Treatment Of Foot Research Articles

Techniques for 3D foot bone orientation angles in weight-bearing from cone-beam computed tomography

BackgroundFor the diagnosis and treatment of foot and ankle disorders, objective quantification of the absolute and relative orientation angles is necessary. The present work aims at assessing novel techniques for 3D measures of foot bone angles from current Cone-Beam technology. MethodsA normal foot was scanned via weight-bearing CT and 3D-model of each bone was obtained. Principal Component Analysis, landmark-based and mid-diaphyseal axes were exploited to obtain bone anatomical references. Absolute and relative angles between calcaneus and first metatarsal bone were calculated both in 3D and in a simulated sagittal projections. The effects of malpositioning were also investigated via rotations of the entire foot model. ResultsLarge angle variations were found between the different definitions. For the 3D relative orientation, variations larger than 10 degrees were found. Foot malposition in axial rotation or in varus/valgus can result in errors larger than 5 and 3 degrees, respectively. ConclusionsNew measures of foot bone orientation are possible in 3D and in weight-bearing, removing operator variability and the effects of foot positioning.

Mechanisms of action and clinical effectiveness of ultratonotherapy in the complex treatment of foot onychomycosis

A long course of onychomycosis, severe hyperkeratosis, slow growth of the nails of the feet, somatic burden, as well as an increase in the resistance of pathogens often lead to a decrease in the effectiveness of traditional antimycotics, dictating the need to create new methods of therapy. A promising direction of treatment is the use of alternating current of supratonal frequency of high voltage and low power - ultratonotherapy (UT) in combination with antifungal drugs. The article presents data on the mechanisms of action and clinical effectiveness of this method in the complex treatment of foot onychomycosis. To study the mechanisms of action and evaluate the clinical effectiveness of UT in the complex treatment of foot onychomycosis. The antifungal effect of UT was studied in the colonies of Trichophyton rubrum and Candida albicans. The distribution of ozone released during the procedure on the affected nail plate was evaluated in vitro using a qualitative chemical reaction and photodermatoscopy. The state of tissue blood flow in the periungual tissues under the influence of UT was studied in vivo by means of ultrasound dopplerographic scanning (USDGS). The clinical effectiveness of the method was evaluated according to the results of complex treatment of patients with foot onychomycosis in comparison with traditional methods of therapy. UT has both fungicidal and fungistatic effects. With a qualitative reaction to ozone, coloring of the surface and small structures of the nail plate was noted. According to the USDGS, after the use of UT, a significant increase in blood supply to the periungual tissues was recorded. The combined use of alternating current of a high voltage ultrasonic frequency with antifungal drugs in patients with foot onychomycosis contributes to the rapid growth of the nail and shorten the duration of mycological cure. UT has an antifungal effect and improves microcirculation in the area of the nail bed. In the complex treatment of patients with foot onychomycosis, the method accelerates clinical and mycological cure, stimulates nail growth, which reduces the rate of systemic and local antifungal therapy.

Financial Impact of Magnetic Resonance Imaging in the Surgical Treatment of Foot and Ankle Osteomyelitis

Magnetic resonance imaging (MRI) is generally considered the most sensitive imaging for diagnosis of osteomyelitis; however, it is associated with significant cost and is at times ordered as initial screening imaging when a less resource-intensive test would suffice. The purpose of this retrospective cohort study was to examine the differences between patients with osteomyelitis of the foot and ankle, and their subsequent treatment course, who underwent MRI compared with those who did not. Financial impact of MRI as it relates to clinical decision-making was also calculated. Patients treated for a diagnosis of osteomyelitis of the foot and ankle from 2009 to 2015 were retrospectively identified. Demographics, imaging modalities, and operative procedures for each patient were collected. An “impact MRI” was defined as one that led to a subsequent operative procedure within the same admission. The impact cost of an MRI was estimated using the equation: (average MRI cost) × (total MRIs/impact MRIs). A total of 144 patients underwent 220 MRIs, and 399 patients did not have MRIs. The operative rate between the 2 groups was similar (70.8% versus 70.4%, p = .93). Multiple linear regression showed that MRI was not a significant predictor of operation (p = .50). However, we found a significant correlation between MRI use and operative intervention for patients with increased comorbidities. From 2011 to 2015, there was a significant increase in impact cost, while controlling for average MRI cost ($8172 to $15,292, p ≤ .05). Over the study period, the impact cost of an MRI significantly increased from 1.8 to 5.0 times the average cost.

Normalization of Microbiome after Diabetic Foot Ulcer Treatment

Category:DiabetesIntroduction/Purpose:Diabetic ulcers carry with it extensive morbidity. The microbiome of diabetic foot infections have previously been shown to be polymicrobial. We hypothesized that ulcer treatment would normalize the foot microbiome.Methods:Microbiome profiles of the fore, mid and hind diabetic foot. Diabetic foot (with ulcer) were taken pre and post treatment with a combination of surgical debridement, local and systemic antibiotics. 10 subjects were studied. Microbiome graphs and images pre and post treatment of feet are shown.Results:The microbiome profile of the diabetic foot almost completely normalized to that of normal flora. Before treatment, the foot microbiome was associated with polymicrobial pathogenic bacteria mostly away from the ulcer. The ulcer itself only contained minimal species, albeit pathogenic bacteria. The differences in profiles between the pre and post treatment were significantly different p < 0.01.Conclusion:Chicken or egg, the foot microbiome almost completely reverts to normal flora with simple ulcer debridement and local/systemic antibiotics. Our data point possibly suggest ulcers could be prevented by reducing pathogenic microbiome load (chlorhexidine washes) or microbiome transplants. We next move to controls as a proof of concept.

Patient Knowledge of Provider Training Background and Preferences for Treatment of Foot and Ankle Conditions

Category:Professional, Patient CareIntroduction/Purpose:Differences exist in the training backgrounds of medical providers who treat foot and ankle disorders. Considerable overlap and similarities also exist between podiatric and orthopaedic surgeons, though patients may be unaware of the differences. It is not known to what extent professional training influences how patients seek care. The purpose of this study is to understand patients’ knowledge of the differences in professional training background between podiatry and orthopedic surgery and to determine which factors are important to patients when selecting a provider.Methods:Patient survey data was gathered from Froedtert Memorial Lutheran Hospital and the Mayo Clinic. A 27-question survey was administered to new patients who were referred to the foot and ankle service in an orthopedic department at both institutions. Survey questions included data on patient demographics, patient opinion, and knowledge of differences between podiatry, orthopedics, and other foot and ankle providers. Patients were grouped by provider preference. Univariate and multivariate regressions were used to characterize the study population and determine provider preference. Significance was determined through t-tests, Fisher’s Exact test, and chi-square tests.Results:Of the 169 patients who completed the entire survey, 99 chose “orthopedic surgeon” as their provider of preference for any foot or ankle injury. Between the groups, there was no significant difference in age, healthcare affiliation, previous podiatric visits, level of education, and perceived knowledge about the differences between the two specialties (Table 1). For patients who listed podiatry as their preference, they were less likely to expect their doctor to have completed residency (76.2% vs. 90.7-94.9%, p=0.03). Patients preferred an orthopedic surgeon over a podiatrist for ankle (63.3% vs. 9.5%, p<0.001) and knee injuries (82.8% vs. 5.8%, p<0.001), while they preferred a podiatrist for toe pain (42.6% vs. 27.8%, p<0.001). 76.3% of patients thought orthopaedic surgeons and podiatrist undergo the same professional training.Conclusion:Foot and ankle patients have poor understanding of the different medical and surgical training backgrounds between a podiatrist and orthopedic surgeon. The majority of patients believe podiatrist and orthopaedic surgeons have the same professional training. However, patients also believed orthopaedic surgeons have a longer training period, though it was still underestimated by three years. Patients preferred care for podiatrist with conditions affecting the toes and orthopaedic surgeons for all other conditions.

New Opportunities of Topic Therapy of Foot Mycosis

The objective: to evaluate the efficacy and safety of combined external use of naftifine hydrochloride 1% and salicylic ointment 3% in the treatment of foot mycosis.Materials and methods. Under observation were 12 patients with mycosis of the feet, incl. 7 (58%) women and 5 (42%) men, aged 37 to 69 years. The disease duration ranged from 1 to 13 years. Naftifine hydrochloride 1% and salicylic ointment 3% were prescribed to all patients for 2 weeks once a day. Evaluation of clinical efficacy was performed on days 3, 7, and 14 of the treatment. To assess the mycological recovery, bacterioscopic examination was performed on the 14th day of therapy, as well as on the 7th and 10th day after its termination.Results. Analysis of the regression of the clinical manifestations of the disease showed a high efficacy of the proposed treatment regimen. Already on day 3 of therapy, a marked decrease in itching, erythema, edema, desquamation and hyperkeratosis was observed in all patients. At the time of termination of therapy (14 days), all patients showed clinical recovery, manifested by a complete regression of rash, inflammatory manifestations in the lesions, the absence of hyperkeratosis and complete epithelialization of cracks. Bacterioscopic examination on the 14th day of therapy, as well as on the 7th and 10th day after its termination, negative results were obtained in 100% of patients, which indicated mycological recovery.Conclusions. The proposed combined method of external use of naftifine hydrochloride 1% and salicylic ointment 3% in the treatment of mycosis of the feet is effective and safe, demonstrates a pronounced therapeutic effect, is well tolerated by patients.

Léčba dermatofytózy kůže nohou volně prodejnými přípravky

Běžným onemocněnim postihujicim nejen dospělou populaci je dermatofytoza kůže nohou (atleticka noha) – tinea pedis. Clanekshrnuje možnosti samolecby volně dostupnými registrovanými připravky. Jsou zde popsana preventivni opatřeni zvysujici efektivitulecby a chranici pacienta před recidivou.

Treatment of Foot and Leg Ulcers Using a Laser

Treatment of Foot and Leg Ulcers Using a Laser

The Interdisciplinary Management of Foot Drop.

Foot drop can be caused by a variety of diseases and injuries. Although it is a common condition, its overall incidence has not been reported to date. Foot drop markedly restricts the everyday activities of persons suffering from it. There is, therefore, a need for an optimized strategy for its diagnosis and treatment that would be standardized across the medical specialties encountering patients with this problem. This article consists of a review on the basis of pertinent publications re- trieved by a search in the Pubmed/MEDLINE and Cochrane databases, as well as a description of the authors' proposed strategy for the diagnosis and treatment of foot drop. Foot drop can be due to a disturbance at any central or peripheral location along the motor neural pathway that terminates in the dorsiflexor muscles of the foot, or at multiple locations in series. Optimal localization of the lesion(s) is a pre- requisite for appropriate treatment and a successful outcome. The most common causes are L5 radiculopathy and peroneal nerve injury. An operation by a neuro- surgeon or spinal surgeon is a reasonable option whenever there is a realistic chance that the nerve will recover. In our opinion, any patient with a subjectively disturbing foot drop and a clinically suspected compressive neuropathy of the peroneal nerve should be informed about the option of surgical decompression of the nerve at the fibular head, which can be performed with little risk. In case of a permanent foot drop, some patients can benefit from muscle-transfer surgery. For spastic foot drop, the option of botulinum toxin injections should be evaluated. The care of patients with foot drop could be optimized by interdisciplin- ary foot-drop clinics involving all of the relevant specialists. The goals of treatment should always be improved mobility in everyday life and the prevention of falls, pain, and abnormal postures.

Clinical applications of allografts in foot and ankle surgery.

The purpose of this review is to systematically analyse current literature on the use of allografts in the surgical treatment of foot and ankle disorders in adult patients. Based on this study, we propose evidence-based recommendations. The database for PubMed was searched for all published articles. No timeframe restrictions were applied. Clinical studies eligible for inclusion met the following criteria: performed on patients over 18years old; subject to surgical treatment of foot and ankle disorders; with report on the outcome of the use of allografts; with a report and assessment of pain and function, or equivalent; minimum follow-up of 1year was required. Two reviewers independently screened and selected studies for full-text analysis from title and abstract. 107 studies were included from 1113 records. Studies were grouped according to surgical indications into ten categories: musculoskeletal tumours (n = 16), chronic ankle instability (n = 15), ankle arthritis (n = 14), osteochondral lesions of the talus (n = 12), Achilles tendon defects (n = 11), other tendon defects (n = 9), fusions (n = 9), fractures (n = 8), hallux rigidus (n = 3) and other indications (n = 10). Most studies displayed evidence level of IV (n = 57) and V (n = 39). There was one level I, one level II and nine level III studies. Most studies reported allografting as a good option (n = 99; 92.5%). Overall complication rate was 17% (n = 202). Fair evidence (Grade B) was found in favour of the use of allografts in lateral ankle ligament reconstruction or treatment of intra-articular calcaneal fracture. Fair evidence (Grade B) was found against the use of allogeneic MSCs in tibiotalar fusions. V.

Development of intraoperative plantar pressure measuring system considering weight bearing axis.

Surgical reconstructions in three dimensions are needed for treatment of foot and ankle deformities. However, surgical results might be influenced by the skill and experience of doctors which complement the limited information for reconstructions in three dimensions. To solve these, studies were carried out to measure plantar pressure distribution during surgery. Though, it was impossible to accurately measure plantar pressure distribution accurately during operation. Therefore, we proposed an intraoperative plantar pressure measurement (IPPM) device that enables proper navigation in the push direction. For this purpose, first, we investigated how the physiological load axis passes through the human body to identify the pushing direction of the pressure sensor of the device toward the patient's foot. In particular, we hypothesized that the physiological load axis passes through the femoral head center and we evaluated this in a measurement experiment with nine healthy subjects. Second, based on these results, we developed the IPPM device that has two force sensors to identify the pushing direction toward the femoral head center and a conductive ink sensor to measure plantar pressure distribution. Finally, we conducted the experiments with nine healthy subjects and two users. From the first experimental results, the physiological load axis was found to pass through the femoral head center in normal standing posture. From the evaluation experiment, there are no significant differences statistically in plantar pressure distributions between the conditions of using IPPM device and without using it for both a medical student and a surgeon. However, in some cases the plantar pressure distribution can be reproduced similarly to that of the standing posture, and also from the evaluation experiment concerning the relation between CoP position and NCC, the NCC tends to increase when the position of the CoP is closer to that at the standing posture. The IPPM device has possibility to reproduce the plantar pressure distribution during surgery and prevent the recurrence of surgical complications.

Platelet-rich plasma in the foot and ankle.

Platelet-rich plasma has become an increasingly popular treatment option within the orthopedic community to biologically enhance and stimulate difficult-to-heal musculoskeletal tissues. This review evaluates the recent literature on platelet-rich plasma use in the treatment of foot and ankle pathologies. Recent literature has demonstrated platelet-rich plasma to have a possible benefit in the treatment of Achilles pathology, chronic plantar fasciitis, osteochondral lesions of the talus, ankle osteoarthritis, and diabetic foot ulcers. However, given the lack of standardization of platelet-rich plasma preparations and protocols and the predominance of low-quality studies, no definitive treatment indications exist. Platelet-rich plasma is a promising treatment option, but at present, there is only limited clinical evidence supporting its use in foot and ankle applications.

Bipartite Talus: Arthroscopic Resection – Case Report

Background: Bipartite talus is a rare entity. The etiology is uncertain. The definition is a large bone fragment that occupies the posterior portion of the talus and reaches the posterior subtalar joint. Case Report: We report a symptomatic bipartite talus in a female patient, 41 years old, treated with arthroscopic resection. Discussion: Posterior hindfoot arthroscopy has gained more popularity in the treatment of foot and ankle pathologies. Indeed, this is a secure and useful tool for the surgeon. In this report, we described the use of this technique for resection of a large bone fragment (bipartite talus). Conclusions: We present in detail the arthroscopic resection of a bipartite talus. This is an unusual pathology and a differential diagnosis for posterior impingement. We believe that arthroscopic resection of the bone fragment of the bipartite talus is a safe procedure, with less morbidity for the patient, compared with open resections. Level of Evidence: Level V—technique description.

The effect of center of pressure alteration on the ground reaction force during gait: A statistical model

BackgroundFoot problems and lower-limb diseases (e.g., foot ulcers, osteoarthritis, etc.), are presented with a ground reaction force (GRF) that may deviate substantially from the normal. Thus, GRF manipulation is a key parameter when treating symptoms of these diseases. In the current study, we examined the impact of footwear-generated center of pressure (COP) manipulations on the GRF components, and the ability to predict this impact using statistical models. MethodsA foot-worn biomechanical device which allows manual manipulation of the COP location was utilized. Twelve healthy young men underwent gait analysis with the device set to convey seven COP conditions: (1) a neutral condition, (2) lateral and (3) medial offset along the medio-lateral foot axis, (4) anterior and (5) posterior offset along the antero-posterior foot axis, and (6) a dorsi-flexion and (7) plantar-flexion condition. Changes in the magnitude and the early stance-phase impulse of the GRF components across COP conditions were observed. Linear models were used to describe relationships between COP conditions and GRF magnitude and impulse. ResultsWith respect to ANOVA, the vertical and antero-posterior components of the GRF were significantly influenced by the COP configuration throughout the different stages of the stance-phase, whereas the medio-lateral components were not. The models of vertical, antero-posterior and medio-lateral GRF components were statistically significant. SignificanceThe study results are valuable for the development of a method and means for efficient treatment of foot and lower-limb pathologies. The ability to predict and control the GRF components along three orthogonal axes, for a given COP location, provides a strong tool for efficient treatment of foot and lower-limb diseases and may also have relevant implications in sports shoe design. This study is a preliminary investigation for our ultimate goal to develop an effective treatment method by developing an autonomous GRF manipulations device based on closed-loop feedback.

Effects of a 4-Week Intrinsic Foot Muscle Exercise Program on Motor Function: A Preliminary Randomized Control Trial.

Context: Intrinsic foot muscle (IFM) exercises are utilized clinically in the treatment of foot and ankle conditions. However, the effectiveness of training on IFM motor function is unknown. Objective: To study the effects of a 4-week IFM exercise program on motor function, perceived difficulty, and IFM motor activation measured using ultrasound imaging (USI) during 3 IFM exercises. Design: Single-blinded randomized control trial. Setting: Laboratory. Participants: A total of 24 healthy, recreationally active young adults without history of ankle-foot injury who have never performed IFM exercises participated (12 males and 12 females; mean age = 21.5 [4.8]y; body mass index = 23.5 [2.9]kg/m2) Intervention: Following randomization, participants allocated to the intervention group received a 4-week progressive home IFM exercise program performed daily. Participants in the control group did not receive any intervention. Main Outcome Measures: Clinician-assessed motor performance (4-point scale: 0 = does not initiate movement and 3 = performs exercise in standard pattern), participant-perceived difficulty (5-point Likert scale: 1 = very easy and 5 = very difficult), and USI motor activation measures of the abductor hallucis, flexor digitorum brevis, quadratus plantae, and flexor hallucis brevis were assessed during toe-spread-out, hallux-extension, and lesser-toe-extension exercises. Results: The intervention group demonstrated significant improvement in motor performance in the toe-spread-out exercise (pre = 1.9 [0.5], post = 2.6 [0.5], P = .008) and less perceived difficulty in the toe-spread-out (pre = 3.1 [1.3], post = 2.3 [1.2], P = .01), hallux-extension (pre = 3.2 [1.5], post = 2.0 [1.2], P = .005), and lesser-toe-extension (pre = 1.9 [0.7], post = 1.2 [0.4], P = .03) exercises. Both groups demonstrated increased USI motor activation in the abductor hallucis during the toe-spread-out exercise (intervention: pre = 1.07 [0.06], post = 1.11 [0.08] and control: pre = 1.08 [0.06], post = 1.11 [0.06]; P = .05). No other significant main effects or group by time interactions were observed. Conclusion: A 4-week IFM exercise intervention resulted in improved motor performance and decreased perceived difficulty when performing the exercises, but not changes in USI measures of IFM activation compared with a control group.

The results of thermal treatment of foot and calves chronic ulcers in patients with diabetes and vascular diseases

Chronic foot and leg ulcers are a serious medical problem requiring long-term treatment, often complicated by amputations and long-term disability. Balneological and physical methods complement the treatment of those patients who have completed optimal vascular and surgical treatment. The most common causes of ulcers are atherosclerosis, diabetes and venous insufficiency. In the thermal treatment we can effectively improve the treatment results using natural gases such as carbon dioxide and ozone, physical methods, kinesitherapy and treatment of diseases causing ulceration. The aim of our research was to evaluate the results of treatment of ulcers in patients with diabetes, atherosclerosis and venous insufficiency in the thermal center conditions. The material is a group of 46 patients with ulcers, in this group there were 18 women, the mean age was 63.5 years ± 9.8. The number of patients with diabetic, atherosclerotic and venous insufficiency type of ulcer was 56.5 and 17.4 had grade II, and another 3/4/5 respectively 23.2 / 14.2%. Treatment in addition to standard surgical care and antibiotic therapy included ozone-therapy, carbodioxide-therapy, kinesitherapy and physical treatments (pulsed magnetic field and laser therapy). The average duration of treatment was 46 days. The results of the treatment were assessed on a four-level scale: I complete recovery, II improvement with chance to full recovery, III minor improvement, and IV lack of the improvement. In addition, patients were evaluated for changes in metabolic control of diabetes, and lipid parameters were also evaluated. Full recovery was achieved in 32.9 improvement in the prognosis of recovery, small improvement in 24,6 of patients. In the subjective evaluation questionnaire, all patients reported improvement - generally reducing pain and swelling. In additional studies, the statistically significant level of total cholesterol, LDL-cholesterol, triglycerides and fibrinogen decreased. Based on the obtained results, we conclude that thermal treatment is a valuable method that improves treatment outcomes in patients with vascular and diabetic ulcers. For the full assessment of the method, it is necessary to plan further randomized trials comparing the thermal treatment to other reference methods of treatment of chronic foot and culves ulcers.

ПРИМЕНЕНИЕ АКТУАЛЬНЫХ РЕФЕРЕНТНЫХ ЛИНИЙ И УГЛОВ В ДИАГНОСТИКЕ И ЛЕЧЕНИИ ПАТОЛОГИИ СТОПЫ И ГОЛЕНОСТОПНОГО СУСТАВА

ПРИМЕНЕНИЕ АКТУАЛЬНЫХ РЕФЕРЕНТНЫХ ЛИНИЙ И УГЛОВ В ДИАГНОСТИКЕ И ЛЕЧЕНИИ ПАТОЛОГИИ СТОПЫ И ГОЛЕНОСТОПНОГО СУСТАВА

Effect of Antibiotic Prophylaxis on Surgical Site Infections Following Removal of Orthopedic Implants Used for Treatment of Foot, Ankle, and Lower Leg Fractures

Following clean (class I, not contaminated) surgical procedures, the rate of surgical site infection (SSI) should be less than approximately 2%. However, an infection rate of 12.2% has been reported following removal of orthopedic implants used for treatment of fractures below the knee. To evaluate the effect of a single dose of preoperative antibiotic prophylaxis on the incidence of SSIs following removal of orthopedic implants used for treatment of fractures below the knee. Multicenter, double-blind, randomized clinical trial including 500 patients aged 18 to 75 years with previous surgical treatment for fractures below the knee who were undergoing removal of orthopedic implants from 19 hospitals (17 teaching and 2 academic) in the Netherlands (November 2014-September 2016), with a follow-up of 6 months (final follow-up, March 28, 2017). Exclusion criteria were an active infection or fistula, antibiotic treatment, reimplantation of osteosynthesis material in the same session, allergy for cephalosporins, known kidney disease, immunosuppressant use, or pregnancy. A single preoperative intravenous dose of 1000 mg of cefazolin (cefazolin group, n = 228) or sodium chloride (0.9%; saline group, n = 242). Primary outcome was SSI within 30 days as measured by the criteria from the US Centers for Disease Control and Prevention. Secondary outcome measures were functional outcome, health-related quality of life, and patient satisfaction. Among 477 randomized patients (mean age, 44 years [SD, 15]; women, 274 [57%]; median time from orthopedic implant placement, 11 months [interquartile range, 7-16]), 470 patients completed the study. Sixty-six patients developed an SSI (14.0%): 30 patients (13.2%) in the cefazolin group vs 36 in the saline group (14.9%) (absolute risk difference, -1.7 [95% CI, -8.0 to 4.6], P = .60). Among patients undergoing surgery for removal of orthopedic implants used for treatment of fractures below the knee, a single preoperative dose of intravenous cefazolin compared with saline did not reduce the risk of surgical site infection within 30 days following implant removal. clinicaltrials.gov Identifier: NCT02225821.

Clinical effect of vacuum sealing drainage in the treatment of complex fracture and dislocation of foot with severe soft tissue injury

Objective: To observe the clinical effect of vacuum sealing drainage (VSD) in the treatment of complex fracture and dislocation of foot with severe soft tissue injury. Methods: From March 2012 to January 2015, a retrospective analysis of 108 cases of the foot closed complex fracture dislocation with severe soft tissue injury in Department of Foot and Ankle, the Second Hospital of Tangshan City, Tangshan.Injury mechanisms included press and crush injury, traffic accident.According to the operation the cases were divided into the VSD group (56 cases) and the control group (52 cases). The injury foot swelling after treated by open reduction and internal fixation or fusion joint fracture and dislocation. VSD technique was used to cover the wound and wound in group VSD. The wound was sutured, the sterile dressing was covered and the dressing was changed regularly in the control group. Results: Preoperative hospitalization time: 16 days in group VSD, 28 days in the control group; the total hospitalization time: 33 days in group VSD, 53 days in the control group; wound healing: 29 cases in VSD group, 12 cases in the control group; prolonged healing after dressing: 16 cases in VSD group, 13 cases in the control group; after skin grafting healing: 9 cases in VSD group, 17 cases in the control group; healed after flap transposition: 2 cases in VSD group and 10 cases in thecontrol group.The difference of the data of the two groups was statistically significant, P<0.05.Maryland foot score: 55-98 (average: 88.8, median: 91.5) points in VSD group, 38-97 (average: 84.85, median: 91) points in control group, compared with median by rank sum test, Z value: -2.755, the difference was statistically significant, P< 0.05.The late recovery effect rating: 39 casesexcellent, good 12 cases, can be 5 cases, no poor in VSD group, excellent 29 cases, good 8 cases, can be 11 cases, poor 4 cases in the the control group, the difference was statistically significant, P<0.05. Conclusion: VSD can shorten the preoperative waiting time and total hospitalization time, improve the wound healing rate directly, reduce the skin grafting and flap transfer replacement rate, reduce the secondary injury, increased fracture risk reduction and internal fixation, reduce joint fusion rate in the treatment of foot closed complex fracture and dislocation with severe soft tissue injury.

Financial Impact of MRI in Treatment of Foot and Ankle Osteomyelitis

Category: Ankle, Diabetes, Hindfoot, Lesser Toes, Midfoot/Forefoot, Infection Introduction/Purpose: Osteomyelitis of the foot and ankle is a common condition with a high economic burden in the United States, particularly in the context of diabetes mellitus. The timely and accurate diagnosis of osteomyelitis is important to initiate treatment and possibly reduce overall healthcare costs. Plain radiographs are the initial study of choice given their widespread availability and low cost. Magnetic resonance imaging (MRI) is generally considered the most sensitive imaging modality for detecting osteomyelitis, however it is associated with significant cost and may not change overall treatment as compared to plain radiographs. The purpose of our retrospective study is to determine whether the use of MRI at our institution changed clinical decision making and calculate the financial impact in patients with foot and ankle osteomyelitis. Methods: We retrospectively identified patients at our tertiary care, academic center treated for a diagnosis of osteomyelitis using ICD-9 codes 730.07, 730.17, and 730.27. Demographic data including age, sex, race and ethnicity and patient comorbidities was collected. The use of plain radiographs, MRI, and any operative procedures up to 2 years after the index encounter for each patient were identified. An impact MRI was defined as an MRI that led to an operative procedure within the same admission encounter. The cost of an impact MRI was estimated using the equation: (average MRI cost)*(total MRIs/impact MRIs). Chi- squared test was used to statistically compare patients that underwent procedures in the MRI group vs. those in non-MRI group. Results: 619 patients undergoing osteomyelitis treatment between January 2009 and September 2015 at our institution were identified, of which 40.4% were female and 59.6% were male. 151 patients had a total of 227 MRIs of the lower extremity performed vs. 468 patients that did not have MRIs performed. Of the MRI cohort, 104/151 patients (68.9%) had subsequent operative procedures, whereas in the non-MRI cohort 299/468 patients (63.9%) had subsequent operative procedures (p = 0.26). Of the 227 MRIs performed, 85 were deemed impactful MRIs and 142 were deemed non-impactful MRIs. Average MRI cost at our institution for the lower extremity with and without contrast was $5069.75. Using our previous definition, the cost of an impact MRI was calculated to be effectively $13,539.21. Conclusion: MRI can be an effective modality in aiding the clinical diagnosis of osteomyelitis, however, it can be an unnecessary cost when not used to guide treatment. In our study, we did not find a significant difference in the operative rate between patients undergoing MRIs vs. those that did not. We also found that the effective cost of an MRI that led to a change in treatment was $13,539, almost 2.7 times higher than the average cost of an MRI at our institution.