Prognostic Value of Diagnostic Sonography in Patients With Plantar Fasciitis.

OBJECTIVES: The primary objective of this study was to determine whether the sonographic appearance of the plantar fascia is predictive of the treatment (ie, pain) response in patients receiving supportive therapy for proximal plantar fasciitis. This study was a secondary analysis of data obtained from a randomized controlled trial of ambulatory adults, which examined the efficacy of 3 different foot supports for plantar fasciitis. METHODS: Participants underwent diagnostic sonographic examinations of their heel at baseline and again at 3 months by a single experienced foot and ankle surgeon. Quantitative (eg, thickness) and qualitative (eg, biconvexity) characteristics of the fascia were recorded according to a standard protocol. Logistic regression models were used to identify predictors of the pain response. RESULTS: Seventy patients completed a baseline evaluation, and 63 patients completed a 3-month follow-up assessment. The pain response was not associated with the type of foot support (P> .05). The only significant indicator of an unfavorable response in the univariate and multivariate analyses was biconvexity of the plantar fascia on sonography at presentation (multivariate odds ratio, 4.76 [95% confidence interval, 1.16-19.5; P= .030). Furthermore, changes in self-reported pain over the 3-month study period were not accompanied by alterations in plantar fascia thickness over this time (r = .056; P = .671). CONCLUSIONS: We conclude that patients who present with biconvexity of the plantar fascia may be less responsive to tier 1 treatment regimens that center around mechanical support of the plantar fascia. Furthermore, follow-up measurements of the fascia in this population should not weigh heavily in decisions such as return to play.

Estimation of Center of Mass Trajectory using Wearable Sensors during Golf Swing.

This study suggests a wearable sensor technology to estimate center of mass (CoM) trajectory during a golf swing. Groups of 3, 4, and 18 participants were recruited, respectively, for the purpose of three validation studies. Study 1 examined the accuracy of the system to estimate a 3D body segment angle compared to a camera-based motion analyzer (Vicon®). Study 2 assessed the accuracy of three simplified CoM trajectory models. Finally, Study 3 assessed the accuracy of the proposed CoM model during multiple golf swings. A relatively high agreement was observed between wearable sensors and the reference (Vicon®) for angle measurement (r > 0.99, random error <1.2° (1.5%) for anterior-posterior; <0.9° (2%) for medial-lateral; and <3.6° (2.5%) for internal-external direction). The two-link model yielded a better agreement with the reference system compared to one-link model (r > 0.93 v. r = 0.52, respectively). On the same note, the proposed two-link model estimated CoM trajectory during golf swing with relatively good accuracy (r > 0.9, A-P random error <1cm (7.7%) and <2cm (10.4%) for M-L). The proposed system appears to accurately quantify the kinematics of CoM trajectory as a surrogate of dynamic postural control during an athlete's movement and its portability, makes it feasible to fit the competitive environment without restricting surface type. Key pointsThis study demonstrates that wearable technology based on inertial sensors are accurate to estimate center of mass trajectory in complex athletic task (e.g., golf swing)This study suggests that two-link model of human body provides optimum tradeoff between accuracy and minimum number of sensor module for estimation of center of mass trajectory in particular during fast movements.Wearable technologies based on inertial sensors are viable option for assessing dynamic postural control in complex task outside of gait laboratory and constraints of cameras, surface, and base of support.

Podiatrist care and outcomes for patients with diabetes and foot ulcer.

We examined whether outcomes of care (amputation and hospitalisation) among patients with diabetes and foot ulcer differ between those who received pre-ulcer care from podiatrists and those who did not. Adult patients with diabetes and a diagnosis of a diabetic foot ulcer were found in the MarketScan Databases, 2005-2008. Multivariate Cox proportional hazard models estimated the hazard of amputation and hospitalisation. Logistic regression estimated the likelihood of these events. Propensity score weighting and regression adjustment were used to adjust for potentially different characteristics of patients who did and did not receive podiatric care. The sample included 27 545 patients aged greater than 65+ years (Medicare-eligible patients with employer-sponsored supplemental insurance) and 20 208 patients aged lesser than 65 years (non Medicare-eligible commercially insured patients). Care by podiatrists in the year prior to a diabetic foot ulcer was associated with a lower hazard of lower extremity amputation, major amputation and hospitalisations in both non Medicare-eligible commercially insured and Medicare-eligible patient populations. Systematic differences between patients with diabetes and foot ulcer, receiving and not receiving care from podiatrists were also observed; specifically, patients with diabetes receiving care from podiatrists tend to be older and sicker.

A novel plantar stimulation technology for improving protective sensation and postural control in patients with diabetic peripheral neuropathy: a double-blinded, randomized study.

BACKGROUND: Many diabetes-related peripheral neuropathy (DPN) patients also experience postural instability. OBJECTIVE: This study examined the effect of electrical stimulation therapy on DPN patients' postural control as well as recovery of plantar sensation. METHODS: 54 patients with mild to moderate DPN were enrolled into this study evaluating treatment of DPN with electrical stimulation provided via aqueous solution. The subjects were randomized into either sham or active stimulation. Treatments were administered 5 times per week for 6 weeks. Changes in neuropathy severity were assessed via Semmes-Weinstein monofilament tests and vibration perception threshold (VPT) tests. The potential benefit in postural control was assessed in a subsample of 13 subjects by measuring the area of center of mass (COM) sway. RESULTS: The active group saw a significant (p < 0.05) improvement in VPT at treatment week 6 in comparison to the sham group. The difference did not remain significant at follow-up visits. There were no significant differences between groups for the Semmes-Weinstein monofilament test. However, time was a significant main effect, with both groups improving over the course of the study. The area of COM sway was significantly reduced on average by 36% at treatment week 2 compared to the baseline. Although at treatment week 6 an additional 7% reduction in COM sway was observed compared to treatment week 2, the improvement from treatment week 2 to treatment week 6 was not significant (p > 0.6). Interestingly, no significant difference was observed in the sham group during the study (p > 0.7). CONCLUSION: This randomized pilot study provides preliminary data on the potential of electrical stimulation via aqueous solution to improve protective sensation and postural stability in DPN patients.

Golfing skill level postural control differences: a brief report.

Golfers have better balance than their age-matched counterparts; however, it is uncertain if this persists during the swing as a function of skill level. The purpose of the study was to investigate dynamic postural control (center of mass (COM) motion) measured during different phases of the swing in golfers of varying proficiency. Eighteen healthy golfers were grouped by handicap: novice (no handicap, n = 7), intermediate (handicap 15-19, n = 7), and advanced (handicap 9-14, n = 4). Indoor testing was performed hitting 3 tee shots using a common driver. A five-camera (60 Hz) motion analysis system (9 markers) was used to extract kinematics data. There were no significant group differences in gender, age, or BMI. Advanced players had lower COM displacement with respect to address at the time of maximum arm speed (p = 0. 001) compared to intermediate (57%, p = 0.014) and novice (73%, p = 0.023). These changes persisted after COM distance and time normalization. Advanced golfers had improved COM linearity during the downswing (p < 0.001) compared to intermediate (30%, p = 0.029) and novice (51%, p < 0.001). Advanced players had decreased COM displacement at the time of maximum arm speed and a more linear COM path during the early downswing. Further study should focus on these changes during ball launch conditions. Key pointsStudies suggest that static and dynamic balance is important in golf. However, none have investigated dynamic postural control during the golf swing in golfers of varying proficiency.Our findings suggest advanced players demonstrated improved postural control at the point of maximum arm speed when compared to less skilled players. Furthermore, center of mass acceleration in advanced players is closer to impact than less-skilled players.We observed an increased center of mass linearity of trajectory during the early downswing for advanced players over novice players. We theorized this strategy may help advanced golfers to improve the economy of COM motion during golf swing and improve the performance of the shot.

Post-treatment leukocytosis predicts an unfavorable clinical response in patients with moderate to severe diabetic foot infections.

Our aim was to determine whether post-treatment laboratory values could help to predict the clinical response in patients with advanced diabetic foot infections. One hundred and three consecutive patients hospitalized for moderate or severe diabetic foot infections at a large, university-affiliated hospital were identified and their records retrospectively reviewed. Definitive therapy during each patient's hospital course was defined as any foot surgery when additional major surgery was not anticipated or when a course of deep soft tissue and/or bone culture-specific antibiotics had been initiated. The clinical response was assessed at 90 days after the start of definitive therapy. A poor response was recognized as persistent infection at the initial or a contiguous site or when unplanned revision surgery or amputation was subsequently required. The peripheral white blood cell count, neutrophil count, erythrocyte sedimentation rate, and C-reactive protein levels measured shortly after initiating definitive therapy (i.e., post-treatment) were examined for their association with the clinical response using logistic regression models. A total of 38 patients with the complete compliment of laboratory and clinical follow-up aged 59.7 ± 12.3 years with a diabetes duration of 13.3 ± 9.1 years were included. Leukocytosis, defined as a white blood cell count >11,000 cells/µL, observed an average of 3 ± 1.4 days after treatment, was the single most important marker for predicting a poor clinical response, and the only significant study variable in both univariate and multivariate analyses (multivariate odds ratio 9.7, 95% confidence interval 1.0 to 92, p = .048). We conclude that leukocytosis observed shortly after initiating definitive therapy is predictive of an unfavorable clinical response by 90 days.

Creating a diabetes foot reminder-based registry using the electronic medical record.

OBJECTIVE: We created a new diabetes foot examination clinical reminder to directly populate a foot risk registry and examined its accuracy versus administrative data. METHODS: A pre- and post-test design assessed accuracy of coding foot risk and clinician acceptability. The intervention hospital's reminder was replaced with a dialogue tick box containing the International Diabetic Foot Classification System to populate risk using health factors. RESULTS: There were no hospital agreement differences for each foot condition except diabetes and peripheral neuropathy, demonstrating higher agreement at the intervention hospital. There were no differences in service agreement adherence or consulting rates although both demonstrated significantly lower consulting rates at study end. The intervention hospital had a significantly lower patient cancellation rate (1% v. 5%, P=0.01) and better coding for grade 3 patients. The new reminder demonstrated high acceptability. CONCLUSIONS: The registry system resulted in improved discrimination of the highest foot risk. Further testing is recommended.

Describing Normative Foot Temperatures in Patients With Diabetes-Related Peripheral Neuropathy.

BACKGROUND: Prior research shows increased foot temperatures are predictive of diabetes-related foot complications. Our aim was to describe normative skin foot temperatures for individuals with diabetic peripheral neuropathy to better inform new technologies. We also explored for potential risk factors which correlate with changes in foot temperatures. METHODS: We conducted a retrospective chart review of adult patients >18 years of age with diabetes mellitus and clinically diagnosed diabetic peripheral neuropathy with pedal digital thermometry performed between 2009 and 2018. A total of 58 patients met these criteria. Univariate modeling was based on covariates that may affect foot temperature including age, peripheral arterial disease, toe pressure, seasonality of measurement, smoking pack-years, caffeine use, insulin use, and calcium channel blocker use. RESULTS: In patients with diabetic peripheral neuropathy, mean toe temperatures of 27.67°C (6.300°C), forefoot of 28.58°C (5.36°C), midfoot of 29.21°C (3.81°C), and rearfoot of 29.88°C(3.83°C) were demonstrated. A modest negative correlation between seasonality and toe and metatarsal temperatures (r = -0.38, P < .05; r = -0.43 P < .01, respectively) was demonstrated. Midfoot temperatures were modestly and positively correlated to the presence of small fiber symptoms (r = 0.33, P = .03). Positive modest correlation with rearfoot temperatures and amount of pack-year history (r = 0.30, P = .03) was seen. CONCLUSION: Normative foot temperatures in neuropathic patients were found to be inversely associated with seasonality at the toe and metatarsal level. Smoking and pack-year history demonstrate modest correlation previously unseen in temperature analyses and warrant further exploration. Normative temperatures in neuropathic patients can better inform new technologies for the prevention of diabetic foot ulcer and Charcot neuroarthropathy.

Utilization of smartphone and tablet camera photographs to predict healing of diabetes-related foot ulcers.

The objective of this study was to build a machine learning model that can predict healing of diabetes-related foot ulcers, using both clinical attributes extracted from electronic health records (EHR) and image features extracted from photographs. The clinical information and photographs were collected at an academic podiatry wound clinic over a three-year period. Both hand-crafted color and texture features and deep learning-based features from the global average pooling layer of ResNet-50 were extracted from the wound photographs. Random Forest (RF) and Support Vector Machine (SVM) models were then trained for prediction. For prediction of eventual wound healing, the models built with hand-crafted imaging features alone outperformed models built with clinical or deep-learning features alone. Models trained with all features performed comparatively against models trained with hand-crafted imaging features. Utilization of smartphone and tablet photographs taken outside of research settings hold promise for predicting prognosis of diabetes-related foot ulcers.

Gait changes with the use of Heelys: a case study.

Heelys shoes are a novel athletic shoe with a concealed wheel. They have been popular among youths since their introduction in 2000. This case study serves as a first look into the biomechanical implications of Heelys shoes on gait. Pressure readings of the forefoot, midfoot, and rearfoot during ambulation in regular athletic-shoe walking, Heelys without the wheel walking, Heelys with the wheel walking, and Heelys skating with the wheel were recorded on a single subject using the Pedar X System. A visual gait analysis was also performed on the subject. The resulting data show increased forefoot and rearfoot pressure while walking with the Heelys with the wheel. The visual gait analysis showed a diminished heel strike and a more rapid forefoot loading. These results demonstrate that Heelys do in fact affect the biomechanics of gait.

Combined clinical and laboratory testing improves diagnostic accuracy for osteomyelitis in the diabetic foot.

UNLABELLED: The purpose of this investigation was to examine the value of using routinely available clinical and laboratory tests in combination to distinguish osteomyelitis from cellulitis in a diabetic population with mild to moderately infected forefoot ulcers. We conducted a case-control study of 54 diabetic patients with 54 locally infected ulcers admitted to a university-affiliated tertiary-care hospital over a 4.5-year period. A total of 30 clinical and laboratory characteristics obtained at admission were tested for their association with pathology-proven osteomyelitis using logistic regression techniques. Ulcer depth greater than 3 mm (univariate odds ratio 10.4, P = .001) and C-reactive protein greater than 3.2 mg/dL (univariate odds ratio 10.8, P < .001) were the most informative individual clinical and laboratory tests for differentiating osteomyelitis from cellulitis. Adding C-reactive protein also significantly improved upon the accuracy of the study's best clinical testing strategy (area under the curve improved from 0.80 to 0.88, P = .040). Strategies that combined ulcer depth with serum inflammatory markers proved most useful in detecting ulcerated patients with concomitant bone infections (sensitivity 100% [95% CI 89.7%-100%] for both ulcer depth greater than 3 mm or C-reactive protein greater than 3.2 mg/dL, and ulcer depth greater than 3 mm or erythrocyte sedimentation rate greater than 60 mm/h). We conclude that considering clinical and laboratory findings together can significantly improve our diagnostic accuracy for osteomyelitis in the diabetic foot. The specific combination of ulcer depth with serum inflammatory markers appears to be a particularly sensitive strategy that may allow for greater detection of early diabetic osteomyelitis. LEVEL OF CLINICAL EVIDENCE: 3.

A case of mistaken identity: classic Kaposi sarcoma misdiagnosed as a diabetic foot ulcer in an atypical patient.

BACKGROUND: The presentation of Kaposi sarcoma is divided into four known clinical subtypes. In this case report we describe classic Kaposi sarcoma in an African-American heterosexual, diabetic, seronegative human immunodeficiency virus male. Classic Kaposi sarcoma is rare in this patient demographic and can be easily misdiagnosed. CASE PRESENTATION: The patient presented with a lesion between the fourth and fifth digits of his right foot which was initially diagnosed as a diabetic foot ulcer. Despite local wound care, the lesion did not resolve. A shave biopsy was performed and histopathology findings were consistent with classic Kaposi sarcoma. CONCLUSIONS: The patient tolerated local radiotherapy well and had complete resolution of his pedal lesion. There have been emerging associations between diabetes and Kaposi sarcoma. As such, clinicians should have a low threshold when considering the biopsy of suspicious pedal lesions in patients with diabetes. The utilization of appropriate biopsy technique may lead to the diagnosis of classic KS tumors in populations outside of the current four widely accepted clinical subtypes.

Prospective Analysis of Surgical Bone Margins After Partial Foot Amputation in Diabetic Patients Admitted With Moderate to Severe Foot Infections.

BACKGROUND: Osteomyelitis is common in diabetic foot infections and medical management can lead to poor outcomes. Surgical management involves sending histopathologic and microbiologic specimens which guides future intervention. We examined the effect of obtainment of surgical margins in patients undergoing forefoot amputations to identify patient characteristics associated with outcomes. Secondary aims included evaluating interobserver reliability of histopathologic data at both the distal-to and proximal-to surgical bone margin. METHODS: Data were prospectively collected on 72 individuals and was pooled for analysis. Standardized method to retrieve intraoperative bone margins was established. A univariate analysis was performed. Negative outcomes, including major lower extremity amputation, wound dehiscence, reulceration, reamputation, or death were recorded. RESULTS: Viable proximal margins were obtained in 63 out of 72 cases (87.5%). Strong interobserver reliability of histopathology was recorded. Univariate analysis demonstrated preoperative platelets, albumin, probe-to-bone testing, absolute toe pressures, smaller wound surface area were associated with obtaining viable margins. Residual osteomyelitis resulted in readmission 2.6 times more often and more postoperative complications. CONCLUSIONS: Certain patients were significantly different in the viable margin group versus dirty margin group. High interobserver reliability was demonstrated. Obtainment of viable margins resulted in reduced rates of readmission and negative outcomes. LEVELS OF EVIDENCE: Prognostic, Level I: Prospective.

Plantar fasciitis in patients with type 1 and type 2 diabetes: A contemporary cohort study.

OBJECTIVE: Hyperglycemia leads to increase advanced glycation end products (AGEs) in patients with type 1 and type 2 diabetes. Subsequently, formation of AGEs can cause increased plantar fascial thickness (PFT), an imaging feature of plantar fasciitis (PF). This study evaluates the prevalence of PF in a contemporary cohort of type 1 diabetes and type 2 diabetes patients managed according to current standards, compared to patients without diabetes. RESEARCH DESIGN AND METHODS: This is a five-year prevalence study in a large tertiary health system (approximately 535,000 patients/visits/year) with a single electronic medical record (EMR), applying a cohort discovery tool and database screen (Data Direct) with use of ICD-9 and ICD-10 codes. All patients with a PF diagnosis between 01/01/2011 and 01/01/2016 were included and divided into 3 groups: type 1 diabetes (7148 patients), type 2 diabetes (61,632 patients), and no diabetes (653,659 patients). Prevalence rates were calculated, accounting for other risk factors including BMI and gender using Fisher's exact test. RESULTS: The overall prevalence of PF in the entire study population was 0.85%. Prevalence rates were higher in patients with diabetes, particularly with type 2 diabetes (42% and 64% higher compared with patients with type 1 diabetes and no diabetes respectively). Individually, PF rates were 0.92% in type 1 diabetes and 1.31% in type 2 diabetes compared with 0.80% in patients with no diabetes (Type 1 vs. no diabetes p = 0.26; Type 2 vs. no diabetes p ≪ 0.0001; Type 1 vs. Type 2 diabetes p = 0.0054). Females in all groups had higher prevalence of PF than males (p ≪ 0.0001 for all), with those patients with diabetes having higher prevalence rates than those without diabetes. Patients with higher BMI levels (BMI ≥ 30 kg/m2) were also more likely to have PF in all categories except males with type 1 diabetes (p = 0.40). CONCLUSIONS: In this large contemporary population managed in a tertiary health system, prevalence rates of PF were substantially higher in patients with diabetes compared with no diabetes, particularly in type 2 diabetes. Female gender and higher BMI were also associated with higher prevalence of PF in this cohort.

Dense pooling layers in fully convolutional network for skin lesion segmentation.

One of the essential tasks in medical image analysis is segmentation and accurate detection of borders. Lesion segmentation in skin images is an essential step in the computerized detection of skin cancer. However, many of the state-of-the-art segmentation methods have deficiencies in their border detection phase. In this paper, a new class of fully convolutional network is proposed, with new dense pooling layers for segmentation of lesion regions in skin images. This network leads to highly accurate segmentation of lesions on skin lesion datasets, which outperforms state-of-the-art algorithms in the skin lesion segmentation.

Reliability and validity of current physical examination techniques of the foot and ankle.

BACKGROUND: This literature review was undertaken to evaluate the reliability and validity of the orthopedic, neurologic, and vascular examination of the foot and ankle. METHODS: We searched PubMed-the US National Library of Medicine's database of biomedical citations-and abstracts for relevant publications from 1966 to 2006. We also searched the bibliographies of the retrieved articles. We identified 35 articles to review. For discussion purposes, we used reliability interpretation guidelines proposed by others. For the kappa statistic that calculates reliability for dichotomous (eg, yes or no) measures, reliability was defined as moderate (0.4-0.6), substantial (0.6-0.8), and outstanding (> 0.8). For the intraclass correlation coefficient that calculates reliability for continuous (eg, degrees of motion) measures, reliability was defined as good (> 0.75), moderate (0.5-0.75), and poor (< 0.5). RESULTS: Intraclass correlations, based on the various examinations performed, varied widely. The range was from 0.08 to 0.98, depending on the examination performed. Concurrent and predictive validity ranged from poor to good. CONCLUSIONS: Although hundreds of articles exist describing various methods of lower-extremity assessment, few rigorously assess the measurement properties. This information can be used both by the discerning clinician in the art of clinical examination and by the scientist in the measurement properties of reproducibility and validity.

CLEAR Cleat: a proof-of-concept trial of an aerobic activity facilitator to reduce plantar forefoot pressures and their potential in those with foot ulcers.

BACKGROUND: Exercise has not been studied extensively in persons with active neuropathic diabetic foot wounds, primarily because a device does not exist that allows patients to exercise while sufficiently off-loading pressure at the ulcer site. The purpose of this project was to demonstrate a device that reduces cycling plantar forefoot pressure. METHODS: Ten healthy participants rode a recumbent bicycle under three cycling conditions. While the left foot interaction remained constant with a standard gym shoe and pedal, the right foot was exposed to a control condition with standard gym shoe and pedal, gym shoe and specialized cleat, and gym shoe with an off-loading insole and specialized cleat. Pressure and contact area of the plantar aspect of the feet were recorded for a 10-sec interval once during each minute of each condition's 7-min trial. RESULTS: The off-loading insole and specialized cleat condition yielded significantly lower (P < .01) peak pressure, contact area, and pressure-time integral values in the forefoot than the specialized cleat condition with gym shoe, which yielded significantly lower values (P < .01) than the standard gym shoe and pedal. CONCLUSION: Modifications to footwear may alter plantar forefoot pressures, contact area, and pressure-time integrals while cycling. The CLEAR Cleat could play a significant role in the facilitation of fitness in patients with (or at high risk for) neuropathic wounds.

Quality of life in healing diabetic wounds: does the end justify the means?

The objective of this investigation was to compare the health-related quality of life (QoL) among persons participating in a randomized clinical trial of pressure-offloading modalities to heal diabetic foot wounds and diabetic neuropathic foot ulcers. In this prospective clinical trial, 63 patients with superficial noninfected, non-ischemic plantar neuropathic diabetic foot ulcers were randomized to 1 of 3 offloading modalities: total contact cast (TCC), a half-shoe, or a removable cast walker (RCW). A Short-Form 36 questionnaire (SF-36) was used to measure health-related QoL of patients before and after the 12-week study period. The overall mean baseline physical and mental summary scores for the entire population studied were 65.2 +/- 6.5 and 60.7 +/- 5.3, respectively. There were statistically significant differences between the pre- and posttreatment responses in 7 of the 8 SF-36 scales, with the nonsignificant trend in all cases signifying improvement in overall QoL. Patients' overall QoL improved regardless of the pressure-offloading device employed, although this trend was erased when the groups were dichotomized based on whether or not they healed during the study period. In conclusion, the results of this study suggest the potential moderating role of closure of a foot ulcer on the effects of the offloading modality on a patient's QoL. Specifically, the results suggest that in diabetic patients with neuropathic foot ulcers, QoL may have less to do with how an index wound is treated than it does with whether or not the wound heals.

Physical management of the Charcot foot.

Charcot arthropathy places individuals at risk of developing diabetic foot ulcers and potentially subsequent limb amputation by means of altering the anatomy of the foot and ankle. Physical trauma is an important component to the etiology of the condition. The physical management of the Charcot foot is concerned with minimizing the stress applied to the affected foot and ankle skeletal structure. The most appropriate device is temporally dependent on the progression of the disease. At the initiation of Charcot arthropathy, care by total contact cast is recommended. As the affected bones begin to heal, use of a removable cast walker may be implemented. When the bones reach a fixed state, appropriate footwear is dictated by the degree of deformity.

Use of chlorhexidine-impregnated patch at pin site to reduce local morbidity: the ChIPPS Pilot Trial.

Pin tract infection is one of the most common complications associated with the use of external fixation. While some studies have identified the potential benefit of chlorhexidine gluconate-impregnated polyurethane dressings to reduce the incidence of catheter-related bloodstream infections, we are unaware of any published studies that evaluate the effectiveness of similar technologies in reducing the risk for external-fixation-related pin tract infections. Therefore, the purpose of this study was to evaluate the effectiveness of chlorhexidine gluconate-impregnated polyurethane dressing in reducing percutaneous-device-related skin colonisation and local infections. In this initial retrospective cohort, data were abstracted for two groups of consecutive patients undergoing surgery involving external fixation at an interdisciplinary foot and ankle surgical unit. All patients received surgical treatment of their foot/ankle pathology along with application of a hybrid external fixator. Twenty patients (45% male, age 54.5 +/- 3.69 years) received chlorhexidine gluconate-impregnated polyurethane dressing and twenty (55% male, age 55.8 +/- 3.22 years) received standard pin care. There was a significantly higher rate of pin tract infection in patients who received standard pin care compared with those who received chlorhexidine gluconate-impregnated polyurethane dressings (25% versus 0%, P = 0.047). There was no significant difference in any of the descriptive study characteristics (age, gender, diabetes and presence of neuropathy). The results of this initial study suggest that chlorhexidine gluconate-impregnated polyurethane dressing may be effective to reduce the incidence of pin tract infections and help decrease morbidity associated with external fixation.