oot 21

Aa

d

T

Pt

ICJ

waaii

aodgrf

6puoo34

Mplf

d

E

D(

a

reu(TauTDfTdct

Abstracts / The F

Conclusions: Pain with a neuropathic component is common.lthough treatments are effective, patients may benefit from moreggressive management.

oi:10.1016/j.foot.2011.01.005

hird Place

revalence of MRSA in diabetic foot infections in a communityeaching hospital

jaz Zia (DPM), Vietahn Vu (DPM), Michael Hester (BS), Pramilheriyath (MD), Jeffery Marks (DPM), Allan B. Grossman (DPM),

ohn Goldman (MD), Daniel Fischman (MD)

Goal/purpose: One out of every five Americans will be diagnosedith diabetes mellitus, and suffer such complications as foot ulcer-

tion and infection. Furthermore, a diabetic foot infection has beenssociated with a fifteen-year decrement in life expectancy. Wenvestigated MRSA prevalence rates, of diabetic lower extremitynfections at a community teaching hospital.

Methods: After institutional review board approval was granted,retrospective chart review was conducted of a random samplingf patients who were admitted to our hospital with a primaryiagnosis of a diabetic-related lower extremity infection. Demo-raphical and bacterial isolate information was collected fromecords and microbiologic reports. Statistical analysis was per-ormed using Minitab 16.0.

Results: Our sample consisted of 50 patients. The mean age was7.24 years. 44.90% used tobacco products. 83.67% had a history oferipheral vascular disease and 82% had experienced a prior footlcer. 42.86% had undergone previous foot surgery. Gram-positiverganisms were found in 98% of cultured wounds; gram-negativerganisms in 64%, and 62% had both types. MRSA was isolated from0% of the patients. In our institution, the 2009 MRSA rate was8.15% (p-value = 0.085).

Conclusion: Our findings are consistent with our institution’sRSA prevalence. Furthermore, previous studies looking at the

revalence of MRSA in diabetic foot ulcers have also reported simi-ar rates. Thus, efforts to curb the spread of this pathogen have thusar not been successful.

oi:10.1016/j.foot.2011.01.006

rythromelagia: A rarely seen diagnosis of the foot and ankle

aniel G. Hodson (DPM), Lacey Clawson (DPM), Donald M. LynchDPM)

Goal/purpose: To create awareness of an often misunderstoodnd misdiagnosed condition of the foot and ankle.

Methods: A case report and literature review.Results: We describe a 50-year old female with symptoms of

ubor, calor, dolor (specifically burning pain), and tumor of bilat-ral ankles. The patient’s laboratory results were normal (includingric acid level) with the exception of elevated platelet countthrombocytosis), and elevated erythrocyte sedimentation rate.he procedures during the patient’s hospital stay included: CTngiogram of the lower extremities, MRI of the right foot, Dopplerltrasound of the lower extremities, and a three-phase bone scan.hese studies were negative for vascular occlusion, osteomyelitis,VT and reflex sympathetic dystrophy, respectively. The patient

ailed to respond to anti-inflammatory and antibiotic treatments.he diagnosis of erythromelagia was made by rheumatology. Weiscuss the difficulty surrounding diagnosis and treatment of thisondition. A review of the etiology and classification of the condi-ion are also discussed.

(2011) 52–54 53

Conclusions: Erythromelagia is a condition that is difficult todiagnose. There are no diagnostic tests for the condition. Diagno-sis is based on history, physical examination during a symptomaticepisode, and the exclusion of other probable causes for the syn-drome. Early recognition of the signs and symptoms as well as earlytreatment offer patients the best hope of remission and improvedquality of life.

doi:10.1016/j.foot.2011.01.007

Efficacy of a novel supinating wedge for stretching the Achillestendon

Emily Haak (BA), Summer Watkins (RN, MSN, CPNP-AC), FaridAmirouche (PhD), Prasad Gourineni (MD)

Purpose: Achilles tendon tightness leads to multiple footpathologies. Typical treatments include stretching the foot on a flatsurface, but some argue foot supination while dorsiflexing directsmore force to the talocrural joint, resulting in a better stretch.Through a retrospective review, we sought to determine if use of anovel-supinating wedge during stretching resulted in significantlyimproved ankle dorsiflexion after three weeks.

Methods: Thirteen patients diagnosed with Achilles tightnesshad ankle dorsiflexion measurements taken at an initial visit, andthree weeks later after stretching daily with the supinating wedge.Descriptive statistics were used to classify sample characteristics,and ANOVA was used to determine statistical significance.

Results: With 0◦ of dorsiflexion as the reference point, patientshad an average left ankle dorsiflexion of −22.8◦ and −13.8◦ and anaverage right ankle dorsiflexion of −18.3◦ and −8.9◦ at weeks zeroand three, respectively. The improvement in left ankle dorsiflex-ion represents a statistically significant change, with p = 0.001. Theimprovement on the right, however, was not statistically signifi-cant, with p = 0.081.

Conclusions: A retrospective review of patients with Achillestightening who stretched using a supinating wedge for three weeksrevealed a statistically significant improvement in ankle dorsiflex-ion on the left, but an insignificant improvement on the right. Thissuggests that use of a supinating wedge could potentially be a ben-eficial therapy, but a larger study is needed.

doi:10.1016/j.foot.2011.01.008

Stretch receptor role in tibialis posterior tendon dysfunction,stage I

Dennis Lester (DPM), Paul Kim (DPM)

Goal/Purpose: Tibialis posterior tendon dysfunction (TPTD) isthe most common cause of adult acquired flatfoot deformity. Theexact etiology of TPTD is still unclear. Most literatures suggest acutetraumatic rupture, degenerative chronic change, tendon hypo-vascularity, and biomechanical abnormalities. Our hypothesis isthat the TPTD is impairment of the stretch receptor mechanismof the muscle.

Methods: Literature review of known etiology, current treat-ment options, and stretch receptor relationship with TPTD.

Results: There are many suggested etiologies for TPTD, but thecause is still unknown. A review of the literature has shown manytendon procedures suggested without utilizing osseous correction.The results vary dramatically from study to study, however, most

did not include functional analysis of tibialis tendon during gaitcycle and relation with stretch receptor.

Conclusions: Hypothesis is that over firing stretch receptor willlose its function as a damage regulator, lead to TPTD. This willrequire osseous procedures to correct rather than tendon transfer

5 oot 21

aSbta

d

Hses

I

aop

bdulbp

injections, and biomechanics as taught by Root et al., heel pain

4 Abstracts / The F

lone. To prove this hypothesis, further investigation is required.econd stage research paper will include cadaver studies includingiopsy of the muscle spindle of TPTD to identify the receptor’s func-ional changes, and inter-muscular EMG testing at both standingnd gait cycles of live subjects.

oi:10.1016/j.foot.2011.01.009

eel neuroma: A retrospective study of the first twenty-even cases diagnosed by ultrasound and treated by injectionnhanced by a new PEMF device eliminating the need forurgery

ra D. Shandles (DPM, FACFAOM), Katy L. Reynolds (MD)

Goal: To prove that technology now exists in the exam room toccurately image a heel neuroma, differentiate it from other pathol-gy, while teaching further how to eliminate it without surgery, andrevent its recurrence.

Methods: Twenty-seven cases of heel neuroma were diagnosedy an established focal, palpatory technique, and corroborated by

iagnostic ultrasound using the PICO SonoAce Color 202 portablenit. They were injected every three to four weeks using the estab-

ished injection formula as published in The Foot, 2002, 12, 10–20,ut enhanced afterward by a new PEMF device for 15 min, alsoortable, and manufactured by Ivivi Health Sciences. Once patients

(2011) 52–54

were rendered pain free, all cases were biomechanically evaluatedand casted supine according to Root, and all orthoses finished asRoot functional orthoses by Root lab which corroborating the fore-foot measurements. All patients were followed eight weeks afterdispensing the orthoses and then discharged. All were assayed forup to two-years later. The data were collated and corroborated bya separate clinician, along with the development of all charts.

Results: Of the twenty-seven patients all were adult, twentywere female and seven male. Their mean weight was 213.7 pounds.Their mean age was 53.5 years. Twenty-two were forefoot varusand five forefoot valgus foot-types. Eighteen manifested unilat-eral and nine bilateral heel pain. The unilateral cases required anaverage of 3.8 injections to cure. The bilateral cases required anaverage of 7.6 injections to cure. The average numbers of degreesof deformity of forefoot varus cases were 11.1◦ versus 4.1◦ for fore-foot valgus. Only five of the twenty-seven cases manifested greaterdeformity on the symptomatic side in unilateral pain cases, whilethe remaining cases were lower or equivalent. All were pain freeup to two-years later. None required surgery.

Conclusions: Using proven contemporary technology, touch, safe

due to neuroma can now be accurately diagnosed and safely curedwithout surgery.

doi:10.1016/j.foot.2011.01.010