Effectiveness of a Multidisciplinary Limb Preservation Program in Reducing Regional Hospitalization Rates for Patients With Diabetes-Related Foot Complications.

OBJECTIVE: This study evaluated the toe and flow model (TFM), a limb preservation program led by podiatric surgeons in Alberta, Canada, for its impact on hospitalization rates and length of stay (LOS) in patients with diabetic foot complication (DFC). Diabetes, a leading cause of non-traumatic lower extremity amputations (LEAs) in Canada, often results in diabetic foot ulcers (DFUs), a major cause of infection, amputation, and hospitalization. TFM has reportedly reduced amputation rates by 39% to 56%. METHODS: The study analyzed Alberta's health database from 2007 to 2017, focusing on diabetes patients aged 20 and above. It included patients with various DFCs and compared outcomes in regions using TFM and standard of care (SOC). The study also examined data from two major cities, one with TFM and the other without, including rural referrals to Calgary and Edmonton. The data were normalized for the diabetic population and analyzed using a standard Student's t-test. RESULTS: TFM regions showed significantly lower hospitalization rates (p = 1.22E-12) than SOC regions. Over 11 years, TFM maintained lower average and median LOS by 0.13 and 0.26 days, respectively. TFM access reduced hospitalization risk by up to 30%, and patients in TFM regions had a 21% shorter LOS compared to SOC regions. CONCLUSION: Despite similar demographics and healthcare systems, the TFM region benefited from a dedicated multidisciplinary program and comprehensive limb preservation services. The study shows that TFM effectively reduces hospitalizations and LOS for DFCs, with significantly better outcomes in the TFM region than in SOC regions.

Sectioning the plantar fascia. Effect on first metatarsophalangeal joint motion.

A study on the effect of sectioning the plantar fascia on the range of motion at the first metatarsophalangeal joint is presented. Dorsiflexion and plantarflexion range-of-motion data from 18 patients who had no first metatarsophalangeal joint pathology and had undergone an in-step plantar fasciotomy for recalcitrant plantar fasciitis were analyzed. The average increase in dorsiflexion of the first metatarsophalangeal joint after plantar fascia release was 9.8 degrees, which represented a statistically significant increase using a paired t-test. Thus release of the plantar fascia can be considered a potential adjunct to hallux limitus surgery.

Scientific analysis of phenol nail surgery.

Chemical matrixectomy using phenol is one of the most common surgical procedures for the permanent removal of toenails. The concentration of phenol solution and duration of its application have varied widely and have not been subjected to scientific study. The authors studied the histologic effects of phenol on the nail matrix and determined the optimal concentration of phenol and time the phenol solution needs to be in contact with the nail bed.