M S Pinzur

..Orthopedic or podiatric consultations are warranted for those "at risk" or with foot ulcers...

..This study was done to determine the association between morbid obesity and foot ulcer or infection in patients with diabetes...

..In patients with open wounds and exposed bone and/or chronic osteomyelitis, it is controversial whether resolution of the bony infection should be achieved before attempting surgical correction of the acquired deformity...

..The significant rate of surgical and medical-associated morbidity accompanying this form of treatment has led surgeons to look for improved methods of surgical stabilization, including the use of the circular ring external fixation...

..Many patients are morbidly obese, immunocompromised, and have complex wounds with underlying bony infection or poor bone quality, making operative correction and internal fixation problematic...

..This method, however, often is time-consuming and has a poor result. This study was done to determine the success rate of total contact casting in a small group of patients and to establish a benchmark time period for treatment...

..Specialty assistance may be required from a vascular surgeon, orthopaedic surgeon, podiatrist, endocrinologist/diabetologist, infectious disease consultant, radiologist, and pedorthist...

..Because of the severe osteopenia often associated with Charcot arthropathy of the ankle, an area of stress concentration leading to stress fracture at the proximal aspect of the nail has been identified...

..It helps avoid extensive surgical dissection in a poor host and eliminates the need for bone that is mechanically capable of holding internal fixation devices during the bony and soft tissue healing period...

..A treatment algorithm is presented...

..Experience with these simple applications allows surgeons to expand their spectrum of proficiency and provides alternatives for solving complex clinical problems...

..The creation of a bone bridge between the residual tibia and fibula is a controversial surgical technique used in the performance of transtibial amputation...

..This article discusses patient selection, surgical technique, and rehabilitation of an underused rehabilitation amputation level...

..These technological advances can be overused, imparting substantial potential risks to the patients. The goal of this article is to provide a modern outcomes-oriented approach to the question of limb salvage versus amputation...

..The mainstay of current treatment is optimal glucose and hemoglobin A(1C) control. Drug therapy has limited potential for controlling the associated pain. Alternative methods of treatment have thus far demonstrated limited success...

..In a university health system orthopaedic foot and ankle clinic with a special interest in diabetic foot disorders, a moderate approach evolved for management of this difficult patient population...

..Surgeons have avoided this level because of the perceived high risk for wound failure, wound infection, or migration of the heel pad, which makes prosthesis use difficult...

....

..1 (range, 4-16) weeks. This preliminary experience with a commercially available pneumatic immediate postoperative prosthetic limb system supports its role in the early rehabilitation of lower extremity amputees...

..There is increasing evidence that cytokines identified in platelet rich concentrate and bone marrow aspirate may show equivalence to autologous bone graft in supporting arthrodesis...

..Current residency training guidelines are vague and do not require specific experience or proficiency in this discipline...

..The results suggest that prosthetic malalignment in persons with trans-tibial amputation leads to increased loading of the contralateral limb...

....

..Although the literature contains uniform recommendations for immobilization and non-weightbearing as treatment for the initial phases of Charcot arthropathy, the results of this benchmarking study reveal that currenl treatment is varied...

....

..Weight-bearing ambulation need not be avoided during healing...

....

..3. Early surgical stabilization versus accommodation when deformity first develops. 4. Late reconstruction versus accommodation or amputation in the deformed late stages...

..Prescription footwear accommodates deformity, while decreasing pressure and shear forces applied to skin overlying bone prominences...

..Due to the risk of fracture at the proximal tip of a standard short intramedullary nail, it is recommended to use a nail that extends to the proximal tibial metaphysis...

..The negative effect did not seem to cause cognitive impairment or clinical depression in either focus group...

..It is planned to use this standardized experimental model to compare objectively patterns of midstance loading in patients with injury or disease that is capable of altering normal walking...

....

..By dissecting out the components of mechanical loading and unloading of the foot during walking, we wished to determine if there was a "key" factor associated with either favorable or unfavorable subjective clinical outcomes...

..It leads to frequent disability or premature retirement from the workforce. Pain and emotional illness do not appear to be a major component of the impact of the disease on health-related quality of life...

..Pain was not a significant component of their disability. The results of this study confirm the hypothesis that foot ulcers in patients with diabetes have a negative impact on quality of life in affected individuals...

..Further studies need to be done with larger groups of patients to refine the tool and to begin the validation process. The instrument developed could be used for comparing treatment strategies for Charcot arthropathy...

..With the evolution of end-bearing amputation levels, there is resurgent interest in the bone bridging technique of Johann Ertl and interest in a new pneumatic immediate postoperative prosthetic limb fitting system...

..Internal fixation devices were removed from 5 feet. Thirty (88.2%) of the 34 patients rated their result as excellent or good; the other 4 (11.8%) rated their result as poor...

..This information needs to be constantly reinforced, as retention drops with time...

..Foot-specific patient education and continued periodic monitoring may reduce the morbidity and associated expense of treating the complications of this disorder and may improve the quality of life in this complex patient population...

..Furthermore, the leaflet was translated into 19 other languages for diabetic patients in the United States and around the world with limited English language comprehension...

....

....

..Patients with "fair" radiographic reduction, or presence of arthritis or both at followup, are likely to have a negative effect on their quality of life...

..The purpose of this study was to histologically examine surgical specimens with Charcot arthropathy for cell type and immunoreactivity of known cytokine mediators of bone resorption...

..There is a severe negative impact on mobility and functional capacity when the disease process begins to affect their feet...