Dorsum Of Foot Research Articles

Hybrid Regenerative Therapy for Successful Reconstruction of an Infected Traumatized Diabetic Foot Wound.

Diabetic foot ulcers are a significant complication of diabetes, affecting millions globally, and require appropriate antibiotics, surgical debridement, wound care, and metabolic optimization for management. This article presents an innovative hybrid regenerative therapy for reconstructing an infected, traumatized foot wound of a 62-year-old man with diabetes mellitus who presented with a week-old injury after a car accident. At presentation, he had a 14 × 10 cm dorsal foot wound with skin necrosis, pus discharge, and bony instability owing to partial fractures and joint dislocations. Antibiotics were administered to treat multidrug-resistant bacteria and followed by surgical debridement and the application of a portable Velnext negative pressure wound therapy device. Once the wound condition stabilized, hybrid regenerative therapy was performed weekly. Six milliliters platelet-rich plasma and 6 mL platelet-poor plasma were prepared from 27 mL of venous blood mixed with 3 mL sodium citrate and injected into the tendons, soft-tissues, and muscles. Next, the exposed bones and tendons were covered with platelet-rich fibrin and semi-occlusive membranes, and a Velnext negative pressure wound therapy device was applied over them. The wound improved progressively during the subsequent 6 weeks and was finally covered with a split-skin graft. The patient had a successful 18-month postoperative period until now with stable grafts, anatomical restoration, and excellent foot functionality. Thus, hybrid regenerative therapy, encompassing several prevalent methods for healing wounds, has excellent benefits for treating complex diabetic foot ulcers.

A Suspected Case of Imported Yaws in New York

Introduction: Yaws is an endemic non-venereal treponematoses, which is caused by Treponema pallidum, subspecies pertenue and is spread from person-to-person through direct skin contact with an infected lesion. Yaws causes a chronic skin infection that is characterized by papillomas and ulcers and if left untreated can be disfiguring and debilitating. Cases typically occur in warm, humid, tropical climates and cases are commonly seen in children under 15 years old. However, due to migration, cases can be seen outside of its endemic region.
 Case Description: We present a case of a 39-year-old African American male who presented with painless bilateral ulcers on his dorsal feet that began as blisters approximately 1-2 weeks prior to presentation at our clinic. Our patient had recent travel history to Jamaica and reported potential sources of trauma to his feet by walking barefoot on the beach and roofing in sandals prior to onset. These findings led to the clinical diagnosis of Yaws. A regimen of azithromycin and basic wound care led to significant improvement.
 Discussion: Non-venereal endemic treponematoses, such as Yaws, are typically not seen outside of their endemic region. However, due to migration and the ease of travel non-venereal endemic treponematoses can be found elsewhere and it is important for healthcare workers to keep these diseases on their differential, especially in a patient with travel history. After making the diagnosis of Yaws, proper treatment and basic wound care can result in rapid significant improvement and prevent the progression of Yaws lesions to the subsequent stage.

Interacting effects of AFO stiffness, neutral angle and footplate stiffness on gait in case of plantarflexor weakness: A predictive simulation study

To maximize effects of dorsal leaf ankle foot orthoses (AFOs) on gait in people with bilateral plantarflexor weakness, the AFO properties should be matched to the individual. However, how AFO properties interact regarding their effect on gait function is unknown. We studied the interaction of AFO bending stiffness with neutral angle and footplate stiffness on the effect of bending stiffness on walking energy cost, gait kinematics and kinetics in people with plantarflexor weakness by employing predictive simulations.Our simulation framework consisted of a planar 11 degrees of freedom model, containing 11 muscles activated by a reflex-based neuromuscular controller. The controller was optimized by a comprehensive cost function, predominantly minimizing walking energy cost. The AFO bending and footplate stiffness were modelled as torsional springs around the ankle and metatarsal joint. The neutral angle of the AFO was defined as the angle in the sagittal plane at which the moment of the ankle torsional spring was zero. Simulations without AFO and with AFO for 9 bending stiffnesses (0–14 Nm/degree), 3 neutral angles (0–3-6 degrees dorsiflexion) and 3 footplate stiffnesses (0–0.5–2.0 Nm/degree) were performed.When changing neutral angle towards dorsiflexion, a higher AFO bending stiffness minimized energy cost of walking and normalized joint kinematics and kinetics. Footplate stiffness mainly affected MTP joint kinematics and kinetics, while no systematic and only marginal effects on energy cost were found.In conclusion, the interaction of the AFO bending stiffness and neutral angle in bilateral plantarflexor weakness, suggests that these should both be considered together when matching AFO properties to the individual patient.

Clinical experience of free superficial temporal fascia flap/anterolateral femoral fascial flap combined with skin grafting in repairing deep tissue defects of special parts of extremities

The deep tissue defects of extremities are prone to cause the exposure of tendons, blood vessels, nerves, and bones, which are commonly repaired with free flaps in clinical practice. However, for special parts such as fingers, toes, posterior ankles, anterior tibias, and dorsum of feet, the appearances are usually bulky after being repaired with free flaps and need lipectomy operations, which bring great physiological, psychological, and economic burden to patients. As the fascia flap is soft and thin with reliable blood supply and strong anti-infection ability, the free fascia flap combined with skin grafting offers some advantages in repairing the above-mentioned wounds. However, its clinical application is severely limited due to the complexity of surgical operation and the difficulty in observing blood supply after operation. In recent years, our team has carried out a lot of work and accumulated rich experience in repairing deep tissue defects of special parts of extremities with free superficial temporal fascia flap/anterolateral femoral fascial flap combined with skin grafting. From the clinical perspective, this paper mainly introduces the anatomy and harvesting method of free superficial temporal fascia flap/anterolateral femoral fascial flap, as well as the advantages, difficulties, and precautions of clinical application, for reference of peers.

Percutaneous deep venous arterialization with balloon angioplasty salvaged a life‐threatening critical limb in a hemodialysis patient after repeated pedal angioplasty failed: A case report

AbstractChronic limb‐threatening ischemia (CLTI) with severe below‐the‐ankle (BTA) lesions is often difficult to revascularize with endovascular treatment (EVT) and surgical treatment. We present a case of successful limb salvage using percutaneous deep venous arterialization (pDVA) in a patient with CLTI whose BTA lesion reconstruction failed. A 57‐year‐old man with diabetes mellitus and end‐stage renal failure on maintenance hemodialysis was referred to our hospital because of gangrene in the second and third toes of his left foot. EVT was repeated for the anterior tibial artery, posterior tibial artery (PTA), dorsal foot artery, and plantar artery lesions; however, revascularization below the ankle was unsuccessful. As the infection had spread to the sole of the foot, below‐the‐knee amputation was indicated, but the patient refused. Therefore, we performed pDVA on the left PTA simultaneously with a Lisfranc amputation. An arteriovenous fistula was created at the ankle joint using a Venous Arterialization Simplified Technique and a guidewire was inserted into the plantar vein. Balloon dilatation from PTA to the plantar vein was performed to complete the pDVA. Although repeated EVT was required to maintain blood flow in the pDVA, skin grafting was performed 3 months after the pDVA, the wound completely healed, and he was discharged 6 months after the DVA. The pDVA can be an option for limb salvage in patients with no‐option CLTI who are confronted by imminent amputation.

Foot Melanoma Localized to Subungual Toe Location Portends Poorer Prognosis

Our group previously reported that melanoma of the foot is associated with advanced disease on diagnosis and decreased survival. Lesions localized to the toe appeared to have the worst outcomes. In this study, we both expanded our study to include a 10-year population of patient with invasive melanoma of the foot and ankle and investigated additional factors associated with prognosis. Between January 2007 and December 2016, 211 patients underwent biopsy diagnosis and surgery for invasive melanoma in the BLANK health care system. Demographic, pathologic, staging, and localization characteristics were studied for overall survival. Lesions were localized to dorsal foot, plantar foot, toe (nonsubungual), and toe (subungual) locations. Multivariable analysis found Breslow depth, ulceration, lymph node involvement, and subungual toe location to be associated with poorer survival. Overall survival rate for foot melanoma was 70.6%. Overall survival for nonsubungual toe melanoma was 60.7%, compared to 53.1% for subungual toe melanoma. Of the subungual melanomas, 37.5% of presented as deep lesions with a Breslow depth >4.0 mm. Subungual melanoma was statistically significant for and found to be an independent prognostic factor associated with poorer survival and advanced disease. Based on the results of this study, there should be a low threshold to biopsy suspicious lesions of the toe and foot with particular attention to be dedicated to subungual lesions.

Transperineal pelvic floor ultrasound in male.

The pelvic floor (PF) is a highly complex structure which may be affected by various stimulating factors like decreased PF support. As ultrasound can dynamically observe the position and mobility of anatomical structures, However, there are very few studies on PF ultrasound in males. Twenty-one male patients with normal conditions underwent transperineal pelvic floor ultrasound (TPFU) examination. Ultrasound was performed in a supine lithotomy position. The probe was pressed on the sagittal plane of the perineum and adjusted till the anorectal angle, as well as bladder, were located and the median prostate and pubic symphysis were visible on the sagittal plane. TPFU was carried out to observe the patterns of pelvic floor movement during different phases, measure ultrasound parameters of the PF in men, and assess the potential applications and prospects of the male PF. Two-dimensional male PF ultrasound can detect the bladder, prostate, male urethra, anus, rectum. Resting, Valsalva, and contraction phases of the PF are clearly shown, the pelvic organs in the Valsalva phase shift to the dorsal foot side, and shift to the cephalic ventral side when the levator ani muscle (LAM) contracts. Three-dimensional male PF ultrasound can visually show the shape and structure of the levator ani muscle hiatus. It is a feasible examination tool for detecting PF disorders. However, there are still many fields to explore in the future.

Dermal substitute: a safe and effective way in surgical management of adults post-burn dorsal foot contractures.

Neglected dorsal foοt burns may result in typical fοrefοοt defοrmities characterised by cοntractures leading tο hyperextensiοn οf the tοes and gait disturbance. These defοrmities usually cause a significant impairment in daily activities and difficulty in wearing shοes. This article presents a recοnstructiοn series οf severe fοrefοοt defοrmities by means of dermal regeneratiοn templates (also known as dermal substitutes) and split thickness skin grafts. We retrοspectively reviewed οur institutiοnal burn database from 2010 to 2020 focusing on all those dοrsal fοοt cοntractures treated with the use οf a dermal regeneratiοn template. The patients' demοgraphics, burn injury mechanisms, depth, lοcalizatiοn, surface, treatments and fοllοw-up were described. Twelve patients underwent this prοcedure and the mean affected area was 75 cm2. The mean time between the dermal regeneratiοn template applicatiοn and the split thickness skin graft was 19.6 days. Just fοr one patient, an additiοnal skin grafting prοcedure was required. The mean fοllοw-up was 4.6 years. We did not register specific cοmplicatiοns at bοth the recipient (forefoot) and dοnοr sites (scalp). All patients were able tο wear shοes and walk after the procedure. Nο recurrence οf cοntractures were οbserved. All patients were satisfied with cοsmetic results, and they did not request any additiοnal prοcedure οf cοsmetic imprοvement. The use οf the dermal regeneratiοn template can be cοnsidered as an extremely safe and efficient treatment οf severe post-burn fοrefοοt defοrmities.

Multiple hyperkeratotic papules on the dorsal feet and lower legs.

An 87-year-old Chinese man presented with a 5-year history of multiple scaly, reddish-brown hyperkeratotic papules 1–5 mm in diameter on the dorsal feet and lower legs. Dermoscopic examination under polarized light displayed an erythematous-brownish background and white scales. A biopsy specimen demonstrated hyperkeratosis, focal epidermal atrophy, slight perivascular lymphocytic infiltrate and pigment incontinence in the superficial dermis.

Generalized purpuric lichen nitidus treated successfully with narrowband UVB therapy

AbstractA 66‐year‐old Finnish man suffered from asymptomatic, purpuric skin lesions extending from his ankles and dorsal feet to the trunk and forearms. Based on a skin punch biopsy and the clinical picture, the diagnosis of generalized purpuric lichen nitidus, which is an exceedingly rare form of lichen nitidus, was made. The condition responded well to narrowband UVB phototherapy.

Effects of remifentanil on the noxiously stimulated somatosensory evoked potentials recorded at the spinal cord in dogs and cats

This study assessed the somatosensory evoked potentials (SEPs) in dogs and cats to compare the effect of remifentanil on the action potentials evoked by peripheral noxious stimulation in the spinal cord. Five healthy dogs and five healthy cats underwent general anaesthesia induced with propofol and maintained with isoflurane. Each animals received all dosage of a constant-rate infusion of remifentanil at 0 (control), 0.25, 0.5, 1.0 or 2.0 μg/kg/min. The hair of the dorsal foot of a hind limb was clipped and an intraepidermal stimulation electrode that could selectively stimulate the nociceptive Aδ and C fibres was attached. An electrical stimulus was generated by a portable peripheral nerve testing device. The evoked potentials were recorded by two needle electrodes inserted subcutaneously in the dorsal midline between the lumbar vertebra: L3-L4 and L4-L5. Bimodal waveforms were obtained by electrical stimulation in control dogs and cats. The inhibitory effect of remifentanil was evaluated by comparing the changes in the N1P2 and P2N2 amplitudes. The N1P2 amplitude was depressed by remifentanil in a dose-dependent manner in dogs, but it showed no remifentanil-induced changes in cats. While the P2N2 amplitude was also depressed in a dose-dependent manner in dogs, it showed milder remifentanil-induced effects in cats. The N1P2 and P2N2 amplitudes observed herein are assumed to represent the evoked potentials derived from the Aδ and C fibres, respectively. Thus, the inhibitory effect of remifentanil on nociceptive transmission at the spinal cord was much weaker in cats, especially for transmissions possibly derived from Aδ fibres.

Reconstruction of Small-Sized Complex Defect on the Foot Dorsum Without Microsurgery: Intrinsic Adipofascial Flap.

Dorsal foot defects are difficult to cover and often require major flap surgery by microsurgeons, even for defects of limited sizes. Intrinsic adipofascial flaps for small-sized complex defects are simple and do not require microsurgery; thus, a flap specialist is unnecessary. This study aimed to assess our institutional experience with this technique and define its role in dorsal foot reconstruction. Nine patients aged 48 to 86 years with soft tissue defects of the dorsal foot were treated with the intrinsic adipofascial flap by rotating the adjacent adipofascial tissues from May 2019 and January 2021 in our institution. Demographic, clinical, and followup data were evaluated. Primary outcomes include flap viability, flap bulkiness, ability to wear shoes, and donor site morbidity. The mean followup period was 24.5 months (range, 10-30 months) and the mean defect size was 6.4 cm2 (range, 3.0-9.0 cm2). Eight flaps survived providing an adequate contour and durable coverage with a thin flap. Among 8 cases of healed flaps, 6 required secondary skin grafts while the other 2 healed spontaneously without additional operation. One patient (defect size: 3.0 cm × 3.0 cm) with underlying diabetes mellitus and peripheral arterial occlusive disease encountered flap total necrosis. Revisional flap surgery was performed to cover the flap total necrosis. In conclusion, the intrinsic adipofascial flap is a relatively simple and suitable method for complex dorsal foot defect reconstruction because it provides minimal donor site morbidity. However, relatively large defect size and comorbidities, such as underlying diabetes mellitus and vascular occlusive disease could accompany a risk of flap necrosis.

Unusual Site for Fibro-lipoma – A Case Report

Lipomas and Sebaceous cysts are the most common lumps found in the subcutaneous area. Fibro-lipoma a rare benign tumor, is comprises of both fibrous connective tissues and adipose cells. Although it can be anywhere in the human body, where these tissues are present. But they are rare in the lower extremities. The differential diagnosis of lump in the foot may be challenging, especially when access to special imaging tools is limited in some practice. We are reporting a solitary large fibro-lipoma on the dorsal aspect of the foot in a middle-aged male patient. Keywords: Lumps, Fibro-lipoma, Subcutaneous Connective Tissues, Adipose Cells, Dorsal Aspet Foot, How to Cite This: Yousaf A, Abbas S. Unusual Site for Fibro-lipoma – A Case Report. Isra Med J. 2022; 14(3): 127-128. DOI: https://doi.org/10.55282/imj.cr96

Comparison of Antera 3D® and TcPO2 for Evaluation of Blood Flow in Skin.

There is a need for quick skin blood flow tests that can be performed in the wound healing field. Antera 3D® is a compact scanner using multispectral imaging. It can perform quick assessment of skin conditions. The purpose of the present study was to investigate the ability of the Antera 3D® to assess skin blood flow in comparison with transcutaneous partial pressure of oxygen (TcPO2) measurements. This study was conducted on 13 patients with a history of lower extremity ulcers. Measurements of hemoglobin average level (hereafter, Hb score) measured by Antera 3D® and TcPO2 measured by a transcutaneous blood gas monitor were obtained at the same sites on the dorsal foot and lower leg. Differences in Hb score and TcPO2 were analyzed by t-test for each measurement site and for the presence of peripheral arterial disease (PAD). The correlation between TcPO2 and Hb score was analyzed by Pearson's correlation coefficient. Twenty-four limbs were tested. Hb score was higher (P < 0.001) and TcPO2 was lower (P = 0.056) in the dorsal foot compared to the lower leg. In the dorsal foot, Hb score was higher (P = 0.023) and TcPO2 was lower (P = 0.046) in patients with PAD compared to those without PAD. A significant negative correlation (r = -0.68; 95% confidence interval -0.85 to -0.38, P < 0.001) between TcPO2 and Hb score was observed in the dorsal foot. The negative correlation between TcPO2 and Hb score may reflect compensatory peripheral vasodilation due to occlusion or stenosis of central arteries. This study showed that Hb score measured by Antera 3D® may be related to skin blood flow.

Метод лазерной допплеровской флоуметрии в оценке влияния лираглутида на микроциркуляцию у крыс с диет-индуцированным ожирением

The state of the microcirculatory bed in rats with obesity caused by the "cafeteria diet" was studied using laser Doppler flowmetry during therapy with liraglutide. It has been shown that obesity causes a decrease in the perfusion index and normalized amplitudes of endothelial and neurogenic oscillations on the skin of the dorsal foot of experimental animals. Therapy with liraglutide contributed to the reduction of excess body weight and the Lee index, which resulted in the restoration of disturbed microcirculation of the skin of the dorsal foot of rats, as well as the normalization of the functional activity of target organs.

Ayurvedic Management of Vicharchika (Lichen Simplex Chronicus) - A Case Report

ABSTRACT Lichen simplex chronicus (LSC) consists of lichenified scaly plaque due to chronic scratching. The available conventional treatments are various topical antipruritic agents and corticosteroids, which are associated with high rates of treatment failure and complications because trans-epidermal drug absorption is limited. LSC manifests as a significant challenge to a physician due to persistent itching and therapeutic resistance. In Ayurveda, this condition has a close resemblance to Vicharchika. Vicharchika is a type of Kshudra kustha with dominancy of Kapha dosha characterized by redness, itching, pain, cracks, and dryness. In this case report, a 48 year old female reported complaints of multiple black-colored patches on the dorsum surface of bilateral feet with severe itching for 6 years. Local examination revealed lichenified hyperpigmented plaques with erythematous bases and well-defined edges covered by white scales with central excoriation. Plaques were found bilaterally over the dorsum of feet and malleolus. Based on symptoms and signs, the case of LSC was diagnosed. This case was managed effectively with Ayurvedic internal medications such as Arogyavardhini Vati, Kaishore Guggulu, Nishaamlaki Vati, Triphala churna, Khadirarishta, and local application of Brihat Marichyadi oil and Sudha Gandhak. The outcome assessment was based on improvement in the size of skin patches, hyperpigmentation, thickening, and itching. Complete improvement has been observed in symptoms after 4 months of regular treatment. No adverse effect pertaining to the prescribed drug was reported during the study period. Ayurvedic medicines offer a good approach to managing LSC.

LOCOMOTOR KINETICS OF THE LOWER EXTREMITIES IN HEALTHY INDIVIDUALS AND IDIOPATHIC SCOLIOSIS

Aim: The definition of «muscle contractile reserve» is a prognostic criterion in assessing locomotor capabilities. Material and methods: Groups of adolescents: 1-healthy, 2-idiopathic scoliosis. Research methods: dynamometry, 3D video analysis of gait. Results: In AIS, the relative isometric moment of force is reduced compared to healthy ones: in hip extensors by 36% (p=0.00106), hip flexors by 33% (p=0.0002), hip abductors by 38% (p=0003), leg extensors by 37% (p=3.22E-07), leg flexors by 42% (p=4.15E-06). In healthy adolescents, the muscle reserve at a walking speed of 3.7-4.3 km/h was: in hip extensors and flexors 65-75%, hip adductors 30-40%, hip abductors — 80-90%, leg extensors — 70-80%, leg flexors — 80-90% and dorsal foot flexors — 75-90%. The kinetic values of the plantar flexors exceed the isometric maximum when the foot is placed at an angle of 90° by 30-40%. In AIS the distal muscle groups had no signs of functional damage; proximal muscle groups showed asymmetry (up to 25%) and a decrease in strength in the isometric mode by 33-42%. Muscle reserve at the same speed is reduced for anti-gravity muscles in AIS: in hip extensors by 40% and in leg extensors by 70%. The total joints power did not significantly differ from the control group. Conclusions: In locomotor stereotypes in patients with scoliosis, there was a pattern of adaptive redistribution of the kinetic potential of the contractile function from one joint muscle to another.

APRESENTAÇÃO CLÍNICA AGUDA DE QUISTOS FACETÁRIOS LOMBARES COM CIATALGIA BILATERAL

ABSTRACT Facet joint ganglia are benign cystic lesions located adjacent to a facet joint. The majority is asymptomatic. However, can cause important low-back pain and radiculopathy. Neurogenic deficit, claudication, and cauda equina syndrome have also been reported. The authors report two cases of acute low back pain with bilateral sciatica, dorsal foot dysesthesia, and hallux dorsiflexion/extension deficit, due to the presence of encapsulated cysts adjacent to the facet joints causing a significant reduction of the spinal canal. Urgent surgical decompression was performed in both patients with an uneventful recovery. Symptomatic facet joint ganglia is a highly unusual cause of back pain, although it can present with acute onset of bilateral sciatica and canal stenosis requiring urgent surgical decompression. This paper highlights facet joint synovial as a differential diagnosis of lumbar pain and describes two different surgical approaches with good outcomes. Level of Evidence IV; Case Series.

Acrodermatitis Continua of Hallopeau: A Diagnostic Challenge.

Acrodermatitis Continua of Hallopeau: A Diagnostic Challenge.

Atypical adult onset pityriasis rubra pilaris: a rare chronic form of pityriasis rubra pilaris

&lt;p class="abstract"&gt;Pityriasis rubra pilaris (PRP) are a group of clinically similar papulo squamous dermatoses which present with erythematous, hyperkeratotic perifollicular papules which tend to coalesce to form plaques and may progress to erythroderma. We report a case of 46-year-old female patient who came with chief complaint of itching and burning sensation and scaly patches on extremities since one year. On dermatological examination well demarcated hyperkeratotic scaly plaques with follicular plugging and peripheral rim of erythema were seen over extensor and flexor aspects of elbows, knees, thighs, legs, dorsum of foot and gluteal region. Diffuse palmoplantar keratoderma, diffuse scaling and follicular plugging of the scalp, thickened brownish black nails were seen. On histopathology alternating layers of orthokeratosis and parakeratosis, follicular plugging with perifollicular parakeratosis, acanthosis with broad rete ridge, perivascular lymphocytic infiltration in upper dermis was seen, suggestive of PRP. Patient responded well to oral acitretin 25 mg once daily combined with oral methotrexate 10 mg once weekly along with topical emollients and corticosteroids after 6 weeks of treatment.&lt;/p&gt;