The association between preoperative length of stay and surgical site infection after lower extremity bypass for chronic limb-threatening ischemia.

Objective: Surgical site infection (SSI) is an important complication of lower extremity bypass (LEB) and the rate of SSI after LEB varies widely in the existing literature, ranging from 4% to 31%. Prolonged length of stay (LOS) has been implicated in the occurrence of SSI across multiple surgical disciplines. The impact of preoperative LOS in patients with chronic limb-threatening ischemia (CLTI) undergoing LEB is unknown.

Effects of statin and antiplatelet therapy noncompliance and intolerance on patient outcomes following vascular surgery.

Objective: Prior studies have evaluated the effects of statin and antiplatelet agent (APA) medications on patients with peripheral arterial disease. Although the benefits of statin and APA use are well-described, there is a paucity of research into the specific outcomes of patients who are not compliant or those who are unable to take the medication owing to intolerance. Here we examine the outcomes of patients intolerant to statin and APA and compare them with patients who are compliant or noncompliant with these therapies.

Reduction in Diabetes-Related Major Amputation Rates After Implementation of a Multidisciplinary Model: An Evaluation in Alberta, Canada.

Background: Diabetes-related lower limb amputations (LLAs) are a major complication that can be reduced by employing multidisciplinary center frameworks such as the Toe and Flow model (TFM). In this study, we investigate the LLAs reduction efficacy of the TFM compared to the standard of care (SOC) in the Canadian health-care system.

Methods: We retrospectively reviewed the anonymized diabetes-related LLA reports (2007-2017) in Calgary and Edmonton metropolitan health zones in Alberta, Canada.

Puncture wounds of the foot.

Puncture wounds often appear benign but can cause significant pedal morbidity. Podiatric physicians who treat such wounds should educate local emergency room, urgent care center, and primary care physicians as to the potential complications associated with puncture wounds. Timely referral, recognition of the potential complications, and appropriate treatment ensure that the wound does not advance beyond a puncture wound.

Foot and ankle imaging in the athlete.

Foot and ankle injuries are among the most common of all sports-related injuries. Many injuries are simplistic from a diagnostic standpoint, whereas others require a high level of suspicion and the use of appropriate diagnostic imaging modalities. Whether a professional athlete or a weekend warrior, all athletes want minimal disruption to their sporting activity and a quick return to competition.

Anterior ankle abutment.

Anterior ankle abutment can be problematic for both athletes and for persons whose occupations require repeated loading of the anterior ankle joint. Nonoperative care is often not satisfactory for the individual who demands painfree activity. Because the presence of anterior osteophytes has been shown to represent the early stages of degenerative disease of the ankle joint, operative intervention may provide the best option to decelerate the arthritic process.

Stress fractures of the foot and ankle.

Stress fractures of the foot and ankle are common injuries that require a high index of suspicion to make the appropriate diagnosis. If required, advanced imaging modalities should be used to establish the diagnosis. When developing a treatment plan for the runner, the sports medicine physician must keep the athlete informed as to the nature of the injury and the necessity of the treatment.

Hypertrophic scars and keloids.

Excessive scarring caused by pathologically overabundant collagen deposition is a problem known by all surgeons. Complications to wound healing, such as hypertrophic scars and keloids, can lead to an aesthetically unacceptable result or even lead to anatomic dysfunction. An overwhelming amount of hypotheses concerning treatment of these problems is available.

Ostectomy for diabetic neuroarthropathy involving the midfoot.

Diabetic neuroarthropathy is a frequent complication of diabetes mellitus that results in instability of the foot, structural deformity, and soft-tissue breakdown secondary to increased plantar pressure. The midfoot is commonly involved in diabetic neuroarthropathy. Collapse of the medial, lateral, or both longitudinal arches may result in increased plantar pressures and subsequent midfoot ulceration.

Off-loading techniques in the treatment of diabetic plantar neuropathic foot ulceration.

In the individual with diabetes mellitus, foot ulceration represents the single most important risk factor in lower-extremity amputation. The goal of treatment is to obtain a healed and closed wound that (1) eliminates a portal of entry for bacterial invasion and development of limb-threatening infection, and (2) allows for tissue loading. This manuscript reviews current off-loading approaches to the treatment of plantar neuropathic foot ulcers, along with advantages and disadvantages of those techniques.

A new fixation technique for metatarsal fractures.

Intramedullary nail fixation is an excellent option for open reduction and internal fixation of metatarsal neck and shaft fractures. In the authors' experience, the reduction of these fractures with Steinmann pin fixation provided excellent stability, required minimal soft-tissue dissection, and allowed for preservation of the periosteal tissue. Minimal disruption to the periosteum protects the osteoprogenitor cells located in the cambium layer.

Puncture wounds of the foot. Evaluation and treatment.

Puncture wounds of the foot are a common injury, often occurring in the warmer months. Various objects have been described as the penetrating source in these wounds; however, nails and glass are the most common cause of pedal puncture wounds. All puncture wounds should be evaluated thoroughly and treated aggressively to reduce the risk of complications.

Evaluation and surgical management of the arthritic midfoot secondary to rheumatic disease.

RA is a common disorder that has significant destructive effects on the midfoot portion of the foot. When these degenerative joint changes occur, any motion at the involved joints causes severe pain and disability, and limits the patient in his or her attempt to perform daily activities. These changes have a significant social and economic impact, and cause unwanted lifestyle changes.

Cigarette smoking and bone healing: implications in foot and ankle surgery.

Despite the known health risks associated with cigarettes, millions of Americans continue to smoke. Much has been reported on the adverse effects of cigarette smoke on wound healing. Recent experimental work and clinical observation have demonstrated the risk of impaired bone healing associated with cigarette smoking.

Ankle arthrodesis following avascular necrosis of the talus in a patient with lupus.

Avascular necrosis of bone is a common manifestation of systemic lupus erythematosus, particularly in those patients receiving corticosteroids. The authors review the pathogenesis and diagnosis of avascular necrosis and describe an ankle arthrodesis in a patient with systemic lupus erythematosus who developed avascular necrosis of the talus.

Considerations of prescription medications for the pregnant podiatric patient.

Prescription medications are thought to cause less than 1% of all congenital abnormalities. However, prescribing a medication to treat the foot disorder of a pregnant patient can be a source of anxiety for the physician. The authors review some of the medications commonly prescribed in podiatric medical practice and evaluate their use and safety during pregnancy.

A retrospective comparison of endoscopic plantar fasciotomy to open plantar fasciotomy with heel spur resection for chronic plantar fasciitis/heel spur syndrome.

The authors review the etiologies and treatments of plantar fasciitis or heel spur syndrome. They offer results of a retrospective study. Comparison of the return to work time after surgery for this condition, examinations of the effects of patient age at the time of surgery, gender, duration of pain prior to surgery, and type of surgical procedure, either endoscopic plantar fasciotomy or open plantar fasciotomy with heel spur resection, is provided.