Journal of the American Podiatric Medical Association
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J Am Podiatr Med Assoc · Jul 2012
Successful limb-sparing treatment strategy for diabetic foot osteomyelitis.
Diabetic foot osteomyelitis is common and causes substantial morbidity, including major amputations, yet the optimal treatment approach is unclear. We evaluated an approach to limb salvage that combines early surgical debridement or limited amputation with antimicrobial therapy. ⋯ In patients with diabetic foot osteomyelitis, surgical debridement or limited amputation plus antimicrobial therapy is effective at achieving clinical cure and limb salvage.
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J Am Podiatr Med Assoc · May 2012
Case ReportsManagement of nonreducible lesser toe interphalangeal dislocation: an unusual injury.
Interphalangeal joint dislocations of the lesser toes are relatively rare in clinical practice. Most nonreducible interphalangeal joint dislocations occur as a result of rupture or interposition of the plantar plate or of the collateral ligament in the joint space, thus hindering a closed reduction and, in most cases, compelling an open reduction. A post-reduction radiologic exploration is then essential to identify such an entity and proceed consequently. In some cases, such as the one introduced herein, a misdiagnosis, along with an inadequate surgical correction may lead to recurrence of the deformity and, ultimately, to a salvage arthrodesis.
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J Am Podiatr Med Assoc · Mar 2012
Case ReportsSurfer's toe: trauma-induced idiopathic acro-osteolysis in the toes of a 46-year-old surfer: a case report.
Acquired acro-osteolysis (AOL) is defined as the resorption of bone from the tufts or shafts of the terminal phalanges. Acquired acro-osteolysis can manifest as a primary osteolysis syndrome and also appears in a number of disease states including rheumatologic disorders, neuropathic diseases, the result of prolonged exposure to polyvinyl chloride, and in rare cases, as a response to repeated mechanical stress. In this report, a 46-year-old surfer was evaluated for AOL as a complication of sports-related repetitive trauma to the right second and third toes. ⋯ Acquired acro-osteolysis in the surfer's toes resulted from increased blood flow initiated to repair microdamage caused by repeated trauma to the distal ends of his second and third right toes due to the habitual dragging of the affected toes across a surfboard. The always initial lytic phase of bone repair was magnified by the increased arterial input to warm the extremities after prolonged exposure to cold. At 6-years' follow-up, the use of a protective bandage while surfing has permitted full regeneration of the affected toes.
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J Am Podiatr Med Assoc · Mar 2012
Complex regional pain syndrome of the pediatric lower extremity: a retrospective review.
Complex regional pain syndrome (CRPS) type 1 is a disorder of the extremities characterized by pain, edema, limited range of motion, integument changes, and vasomotor instability often after an inciting event. In the pediatric population, CRPS may be misdiagnosed, or missed entirely, as CRPS literature for this patient population is lacking. ⋯ Diagnosis of CRPS type 1 should be considered in a preadolescent female complaining of pain out of proportion after an inciting event with a physical examination demonstrating change in skin color, decrease in skin temperature, edema, and painful or diminished range of motion in affected joints. Prompt diagnosis can decrease the time to resolution of symptoms.
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J Am Podiatr Med Assoc · Mar 2012
Clinical efficacy and safety of tapentadol immediate release in the postoperative setting.
The appropriate treatment for postoperative pain remains a common dilemma for podiatric surgeons and patients undergoing surgery of the foot and ankle. The treatment of moderate to severe acute pain typically relies heavily on the use of opioid analgesics, such as hydrocodone and oxycodone, which are often associated with adverse effects, including nausea and vomiting. These adverse effects may have a negative impact on postoperative outcomes and reduce patient compliance with analgesic therapy. ⋯ Tapentadol immediate release has been evaluated in a series of clinical trials in patients with postoperative pain after bunionectomy. The results of these studies demonstrate that tapentadol immediate release is associated with an improved gastrointestinal tolerability profile relative to oxycodone immediate release at doses providing comparable analgesia. Therefore, tapentadol immediate release may offer an improved analgesic option for the relief of postoperative pain after podiatric surgery.