Necrotizing fasciitis in a patient with type 2 diabetes mellitus.

Necrotizing fasciitis is a soft-tissue infection characterized by extensive necrosis of subcutaneous fat, neurovascular structures, and fascia. In general, fascial necrosis precedes muscle and skin involvement, hence its namesake. Initially, this uncommon and rapidly progressive disease process can present as a form of cellulitis or superficial abscess.

The value of radiographic parameters in the surgical treatment of hallux rigidus.

The purpose of this study was to determine if metatarsal protrusion or the length of the first and second rays were associated with the incidence of hallux rigidus. For this retrospective study, anteroposterior radiographs from 51 patients diagnosed with hallux rigidus and 51 patients without evidence of hallux rigidus were selected for review as a control group. Radiographs were randomly assigned to one of two raters who determined the metatarsal protrusion distance, first metatarsal length, second metatarsal length, length of the proximal phalanx of the hallux, length of the proximal phalanx of the second toe, and overall hallux length.

Neurogenic heel pain.

This article establishes a standard approach for the evaluation of patients with heel pain. With this approach, it should become easier for the physician to distinguish between neurogenic and inflammatory heel pain and to devise a more direct plan for definitive treatment.

Peroneal tendon pathology.

Peroneal tendon pathology is a common entity but is infrequently reported in the literature. The lesion may be due to partial tears, complete ruptures, subluxation, tenosynovitis, a fractured os peroneum, or damage to the peroneal retinacula. Chronic lateral ankle instability and excessive subtalar and ankle varus rotation may cause damage to the peroneal tendons and their associated structures.

Plantar fibromatosis.

Plantar fibromatosis is defined as a benign fibrous disorder involving the plantar aponeurosis. Although its incidence is well described on the hands, it is less commonly seen on the feet, and its etiology is unknown. A differential diagnosis for the heel pain along the medial arch could be a benign thickening of the plantar fascia associated with plantar fibromatosis.

Soft tissue reconstruction of the foot with a reverse flow sural artery neurofasciocutaneous flap.

Distally-based sural artery flaps are used to cover soft tissue defects of the lower leg, ankle, and heel. These flaps are vascularized by septocutaneous perforators of the peroneal artery that anastomose with the perineural and perivenous arterial networks of the sural nerve and the lesser saphenous vein, respectively. A retrospective study of seven patients with a distally-based neurofasciocutaneous sural artery flap for ankle or heel defects that had failed conservative treatment was conducted from 1999 to 2003.

The efficacy of prophylactic intravenous antibiotics in elective foot and ankle surgery.

A retrospective chart review of 555 patients who received elective foot and ankle surgeries between 1995 and 2001 at 1 outpatient podiatric hospital clinic was performed to evaluate the efficacy of preoperative intravenous antibiotic use. Only those patients who were having elective foot or ankle surgery for the first time, were being followed up at the hospital's outpatient clinic, and had a nontraumatic cause for their surgery were included in this study. A wound was considered infected when purulent material from the wound sites was noted and an organism(s) was cultured.

Soft tissue reconstruction of the diabetic foot.

Treatment of wounds in the diabetic foot presents a set of difficult problems that requires "out of the box" thinking. The traditional approach of off-loading these wounds is often expensive, time-consuming, and in some cases seemingly never ending. The literature speaks loudly for a change in the philosophy of treating chronic wounds.

External fixation in the management of Charcot neuroarthropathy.

Charcot neuroarthropathy is a complex sequela of neuropathies associated with diabetes mellitus, syringomyelia, alcoholism, and other disorders. The treatment of deformities associated with Charcot neuroarthropathy is evolving from a passive approach to one in which an earlier recognition of the emergence of the event permits an avoidance of deformity. As the understanding of the etiology and natural history of Charcot neuroarthropathy deepens, it has become apparent that many of the deformities that do develop may be reconstructed expeditiously by the surgeon with a thorough understanding of the diabetic foot and experience in the use of external fixation.

Diabetic foot infections and antibiotic therapy.

Diabetic foot infections are associated with high morbidity and mortality rates as well as significant financial impact on the health care system. Improved patient outcomes and intelligent use of resources should determine the selection of diagnostic procedures and the therapeutic modalities used. Diabetic patients who develop lower extremity infections require a multidisciplinary approach in the management of their infections and other disorders.

Diabetes mellitus and pharmacological therapy.

Diabetes mellitus can be a devastating lifelong disease if not treated appropriately. The physician and the patient should be aware of both extremes involved with DM: hyperglycemia and hypoglycemia. Patient education and preventive care are perhaps more important in this disease than many others.

Digital artery flaps for closure of soft tissue defects of the forefoot.

Reconstruction of recalcitrant soft tissue defects in the weightbearing surface of the forefoot can be achieved by using a neurovascular island flap. Island flaps, based on a pedicle from either the proper digital artery or the common digital artery, were used to provide supple and durable coverage. A retrospective analysis was performed on 12 patients who underwent a total of 15 digital artery flaps.