Farheen Iqbal, B.S., Mohammad Junayed Khan, B.A.
Necrotizing fasciitis in the lower extremity is a lifethreatening soft tissue infection and is one of the few podiatric surgical emergencies. With a nonspecific clinical presentation, this infection can often be misdiagnosed. Diabetes mellitus is the most common predisposing factor. Behavioral risk factors include smoking and intravenous drug use. Necrotizing fasciitis is subdivided into three types based on bacterial etiology: type
I is a polymicrobial form, type II is a Streptococcus form, and type III is a gram negative form. In addition to clinical findings, diagnostic imaging such as ultrasound, computed tomography, and magnetic resonance imaging can assist diagnosis. Antibiotic therapy and surgical debridement are the keys to treatment, with amputation occurring frequently, especially among patients with diabetes mellitus.
Lisa Yoon, B.A., Jose Lingao, B.A.
Chronic ulcerations account for a large proportion of the total cost of wound care in the United States, yet only a small fraction of the population suffers from these wounds. Therefore, it is imperative to research and develop alternative treatment options that are both efficacious and economical. Aurotherapy, the use of gold compounds in wound care, has been gaining traction in nonhuman trials. Gold is proposed to increase healing rates by inhibiting matrix metalloproteinases and TGF-B and by enhancing angiogenesis and collagen synthesis. Trials involving human applications, however, are limited in the medical literature. This paper reviews the research to date investing gold and its
potential application in wound care.
Stephen Kriger, B.A., Shontal Behan B.S., Sara Shirazi, B.A.
Complex regional pain syndrome is a chronic pain disorder, which typically occurs following trauma or surgery. The condition involves the extremities and is
characterized by disabling pain out of proportion, edema, vasomotor instability, and impaired motor function. While research has not been able to agree on a specific
treatment or prevention of the syndrome, prophylactic vitamin C has been described as a promising, effective form of prevention if given directly following traumatic fracture or surgical intervention.
Caroline Ko, B.S., Isaiah Song, B.S.
A double osteotomy of the first metatarsal is a combined procedure of a proximal and distal osteotomy of the first metatarsal. The technique provides a large angular correction for severe cases of hallux abducto valgus while minimizing the rate of recurrence and preserving the first metatarsophalangeal joint articulation. Historically, this procedure has had major complications, including shortening of the first metatarsal, stiffness of the first metatarsophalangeal joint, and avascular necrosis of the first metatarsal head. The traditional double osteotomy of the first metatarsal has evolved
with the goal of minimizing the aforementioned complications. The Peterson approach maintains the length of the metatarsal while preserving the recurrence rate.
The modified Peterson approach incorporates a medial plate and screws and reduces first metatarsophalangeal joint stiffness. Minimally invasive percutaneous approaches
of the procedure have been suggested to lower risk of avascular necrosis. This literature review provides an overview of double osteotomies of the first metatarsal and a discussion of associated outcomes and complications.
Megan Ishibashi, B.S., Toby Ishizuka, B.A.
Osteotomies that require a large incision site and are performed with a high-energy instrument may result in neurovascular injury and postoperative wound complications.
The Gigli saw technique is a minimally invasive alternative to open dissection osteotomies. This technique uses a flexible stainless steel cable with attached
handles in a reciprocating pattern to cut through bone. This review aims to introduce this procedure to the podiatric medical student, so that one can consider this technique as a surgical option in a patient with peripheral vascular disease, soft tissue injury, or osteoporotic bone quality. This article will review several studies and surgical textbooks to explain how to use a Gigli saw in podiatric surgeries and describe the strengths, weaknesses, and future implications of this minimally invasive technique.
Luke McCann, B.S., M.S.
Ankle joint equinus is frequently mentioned as a major deforming force of the lower extremity. However, it is rarely considered as a primary diagnosis of foot and ankle problems, rather, it is viewed as a secondary factor that often receives inadequate attention. Visual inspection of non-weightbearing ankle dorsiflexion, without the use of a goniometer, is frequently how clinicians diagnose equinus. Interventions including
heel lifts, stretching, injections, and splinting are some of the conservative treatment options available. Surgical treatment is a more definitive treatment option, of which there are a variety of procedures available. A thorough understanding of assessment, as well as treatment options for equinus, is critical for the podiatric physician when making decisions managing this condition.
Meghan Teague, B.S., Lewis Kane, B.A. M.S., Shontal Behan, B.S
Angiosome theory was originally described in the context of plastic surgery and is commonly used to guide revascularization interventions in patients with ischemic foot wounds. This approach asserts that the foot and ankle can be divided into territories (angiosomes) that are each supplied by a primary vessel. Restoring arterial supply to an angiosome may therefore enhance wound healing. However, dynamic vascular anatomy, diseased patient populations, and varied wound distributions have made research on angiosomedirected revascularization strategies difficult to interpret. As a result, there is no current consensus regarding the validity of angiosome theory in ischemic wound therapy. Here we provide a brief overview of angiosome theory, the data supporting and refuting it, and potential approaches for future research.