Application of antibiotic bone cement combined with lobulated perforator flap based on descending branch of the lateral circumflex femoral artery in treatment of infected traumatic tissue defects of foot.

OBJECTIVE: To evaluate the clinical effectiveness of antibiotic bone cement combined with the lobulated perforator flap based on the descending branch of the lateral circumflex femoral artery (d-LCFA) in the treatment of infected traumatic tissue defects in the foot, in accordance with the Enhanced Recovery after Surgery (ERAS) concept. METHODS: From December 2019 to November 2022, 10 patients with infected traumatic tissue defects of the foot were treated with antibiotic bone cement combined with the d-LCFA lobulated perforator flap. The cohort comprised 6 males and 4 females, aged 21 to 67 years. Initial infection control was achieved through debridement and coverage with antibiotic bone cement, requiring one debridement in nine cases and two debridements in one case. Following infection control, the tissue defects were reconstructed utilizing the d-LCFA lobulated perforator flap, with the donor site closed primarily. The flap area ranged from 12 cm×6 cm to 31 cm×7 cm. Postoperative follow-up included evaluation of flap survival, donor site healing, and ambulatory function of the foot. RESULTS: The follow-up period ranged from 7 to 24 months, averaging 14 months. Infection control was achieved successfully in all cases. The flaps exhibited excellent survival rates and the donor site healed by first intention. Based on the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scale, pain and function were evaluated as excellent in 3 cases, good in 5 cases, and moderate in 2 cases. CONCLUSION: The application of antibiotic bone cement combined with the d-LCFA lobulated perforator flap is an effective treatment for infected traumatic tissue defects of the foot with the advantages of simplicity, high repeatability, and precise curative effects. The application of the d-LCFA lobulated perforator flap in wound repair causes minimal damage to the donor site, shortens hospital stays, lowers medical expenses, and accelerates patient rehabilitation, aligning with the ERAS concept. Therefore, it is a practice worth promoting in clinical use.

[A systematic approach to plastic surgical foot reconstruction]. / Systematik der plastischen Defektrekonstruktion am Fuß.

BACKGROUND: Soft tissue defects of the foot are very common sequelae after trauma and require an individual reconstructive approach. OBJECTIVE: Recommendations for the treatment of soft tissue injuries to the foot are given. MATERIAL AND METHODS: The criteria of soft tissue reconstruction, postoperative follow-up and complications are first discussed before the therapeutic approach is explained depending on the reconstruction site. Case examples are given for illustration. RESULTS: Decision making for soft tissue reconstruction of the foot is based on the location, the 3­dimensional extent of the defect, the patient requirements and concomitant diseases. Standardized treatment algorithms are usually applied that need to be adapted according to individual patient factors. Randomized and local pedicled flaps can be applied for foot reconstruction; however, these options involve a significant risk of complications. Consequently, free flaps are frequently indicated after appropriate preoperative diagnostics of the perfusion of the foot. Due to the vast variety of donor sites, free flaps allow an individualized reconstruction, which is adapted to local and patient requirements. CONCLUSION: Precise preoperative reconstructive planning and analysis of the vascularization form the foundation for a successful soft tissue reconstruction of the foot. The aims of the individualized approach to soft tissue reconstruction of the foot are stable soft tissue coverage, resistance to weight bearing of the sole of the foot, the ability to wear normal shoes and maintenance of sensibility.

Foot injuries, playing surface and shoe design: Should we be thinking more about injury prevention.

The increasing use of artificial pitches has occurred in a multitude of sports at both professional and amateur levels. Artificial turf has become an extremely attractive option as it is felt to encourage a faster, safer and more entertaining play. However these pitches are not without controversy among sporting professionals and in the media. Foot and ankle injury in sport remains incredibly common and a significant burden on health professionals, but what impact do the new artificial surfaces have on these injuries. This review article aims to establish whether artificial turf has an impact on injury rates in the foot and ankle.

Sponge Rubber Revealed Two Years After Penetrating Injury: A Case Report.

The present report illustrates a very rare case report of a foreign body granuloma of the foot associated with a 2-year period of a retained spongeous rubber foreign body after a penetrating injury. Because it appeared almost 2 years after the injury, the history of trauma was minimized, the foreign body had migrated from the plantar to the dorsal side of the foot, and the radiographic appearance resembled a malignant process, it was difficult to rule out the possibility of a malignant tumor. This case shows the weakness of magnetic resonance imaging in detecting spongeous rubber in the body. Also, a bone osteoblastic reaction to the foreign body has very rarely been noted. To the best of our knowledge, just 5 cases have been previously reported. Provided suspicion exists of previous trauma with an embedded foreign body, the differential diagnosis of a bone neoplasm should consider the possibility of a foreign body reaction. Biopsy proved to be the best diagnostic tool.

Clinician-friendly lower extremity physical performance tests in athletes: a systematic review of measurement properties and correlation with injury. Part 2--the tests for the hip, thigh, foot and ankle including the star excursion balance test.

OBJECTIVE: To review the quality of literature and measurement properties of physical performance tests (PPTs) of the lower extremity in athletes. METHODS: Using the PICOS method we established our research question as to whether individual PPTs of the lower extremity have any relationship to injury in competitive athletes ages 12 years to adult (no limit). A search strategy was constructed by combining the terms 'lower extremity' and synonyms for 'performance test' and names of performance tests with variants of the term 'athlete'. After examining the knee in part 1 of this 2 part series, the current report focuses on findings in the rest of the lower extremity. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed and the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) checklist was used to critique the methodological quality of each paper. A second measure was used to analyse the quality of the measurement properties of each test. RESULTS: Thirty-one articles examined the measurement properties of 14 PPTs pertaining to the lower extremity. The terminology used to name and describe the tests and methodology by which the tests were conducted was inconsistent. The star excursion balance test performed in three directions (anterior, posteromedial, and posterolateral) appears to be the only test to be associated with increased injury risk. There is moderate evidence that the one leg hop for distance and the hexagon hop can distinguish between normal and unstable ankles. There is also moderate evidence that the medial hop can distinguish between painful and normal hips in dancers. CONCLUSIONS: Currently, there is relatively limited research-backed information on PPTs of the lower extremity in athletes. We would suggest convening an international consortium comprised of experts in sports to standardise the descriptions and methodologies, and to set forth a research agenda to establish definitively the measurement properties of the most common PPTs.

Ultrasonography of fractures in sports medicine.

High-resolution ultrasound is emerging as an important imaging modality in fracture assessment due to its availability, ease of use and multiplanar capabilities. Its usefulness includes injury assessment for the presence of a fracture when obtaining radiographs is not immediately available, detecting occult fractures not revealed on radiographs, and diagnosing bone stress injury before radiographic changes. Sonographic evaluation of bone, however, has limitations and should always be coupled with radiographs and possibly advanced imaging modalities such as CT and MR when clinically indicated.

The Application of Neoprene Diving Boots in Reduction of Feet Injuries in the Sowing Process Among the Rice Farmers in Thailand.

Foot injuries have been a problem among Thai farmers for a long time. The sowing process is one of the high-risk processes because farmers have to walk in the field to spray rice seed without footwear. Literature review showed that cuts from stepping on sharp material or snail shells were major sources of injury. Traditional footwear such as Ninja shoes or cloth socks have raised the questions regarding their ability in protection from such injuries. This study investigates using Neoprene diving boots to protect from foot injuries during the rice sowing process. The sample from this study were farmers from Sena District, Phra Nakhon Si Ayutthaya Province, Thailand. 29 farmer wearing Neoprene diving boots, 7 farmers wearing traditional Ninja shoes, and 19 farmers wearing cloth socks were asked to work in the sowing process and interviewed about any foot injuries that may have occurred. The statistical test showed there were no significant differences in characteristics among each group of farmers, except for work experience. The results show that there were no foot injuries in farmers wearing Neoprene diving boots, whereas 73% of farmers wearing Ninja shoes, and 14% of farmers wearing cloth socks still had foot injuries. Most injuries were alaceration that were caused by the golden apple snail. The satisfaction survey showed that farmers were satisfied and strongly satisfied with all of the aesthetics, utilization, and functionality factors. This study suggested that the Neoprene diving boots can be recommended for farmers to use as safeguarding against foot injuries in the rice sowing process.

Utilizing biologic assimilation of bovine fetal collagen in staged skin grafting.

Seven patients underwent 2-stage skin grafting with bovine fetal collagen (BFC) as an initial wound cover. Split-thickness skin grafts were successfully placed on the wounds after completion of interval management. BFC proved to be a resilient acellular dermal matrix that could proceed to assimilation and skin grafting under a variety of wound conditions. BFC may prove to be a valuable material, as the role of acellular dermal matrices in skin grafting becomes better defined.

Rhythmic gymnasts' injuries in a pediatric sports medicine clinic in the United States: a 10-year retrospective chart review.

OBJECTIVES: Rhythmic gymnastics injuries have not been studied thoroughly especially in the United States. Existing research studies are predominantly from Europe or Canada or from more than 15 years ago. The purpose of our study was to provide an updated description of injury patterns among rhythmic gymnasts in the United States. METHODS: A retrospective chart review was conducted of 193 rhythmic gymnastics injuries in 79 females, ages 6-20. Patients were seen between January 2010 and March 2020 in a hospital-based pediatric sports medicine clinic. Gymnast demographics, injury locations, and injury types were collected as available. Descriptive and bivariate statistical analysis was performed using general linear mixed models. RESULTS: Our cohort had a mean age of 14.61 ± 2.61 years. Overuse injuries (76.7%) were more common than acute injuries (23.3%). The most common injury types were strain (20.7%), nonspecific pain (15.5%), and tendinitis/tenosynovitis (10.36%). The most frequently injured body regions were lower extremity (75.1%), followed by trunk/back (19.2%), upper extremity (4.7%), and head/neck (1.0%). The most common injured body parts were foot (24.9%), ankle (15.5%), knee (15.0%), lower back (14.0%), and hip (13.0%). General linear mixed models revealed that older age (p = 0.001) and higher competitive level (p = 0.016) were associated with a greater number of diagnoses. Gymnasts with foot injuries were older than gymnasts with ankle (p = 0.026), hip (p < 0.0001), and knee (p = 0.002) injuries. Gymnasts with higher BMI-for-age percentile were more likely to have acute injuries than overuse (p = 0.035). CONCLUSION: Our data showed that injuries among rhythmic gymnasts were most frequently located in the lower extremities, specifically the foot, followed by trunk/back. Additionally, the most frequent injury types were strains and nonspecific pain, and overuse was the most prevalent mechanism. Gymnasts with foot injuries were older than gymnasts with ankle, hip, and knee injuries. Higher BMI is a predictor of acute injuries.

Clinical evaluation of a PHMB-impregnated biocellulose dressing on paediatric lacerations.

OBJECTIVE: To evaluate the clinical benefits, primarily tolerability and reduction in pain levels, associated with the use of a PHMB-impregnated biosynthetic cellulose dressing (Suprasorb X + PHMB) on paediatric heel lacerations. METHOD: These lacerations were caused when children, who were being transported on their parents' bicycles, got their heels trapped in the wheel spokes. Where these injuries just comprised skin contusion and laceration, treatment had previously comprised cleansing followed by application of conventional dressings and moist wound healing dressings. However, the high incidence of infection necessitated regular dressing changes, which caused parents and children stress and anxiety. This clinical evaluation assessed the benefits of a new treatment protocol, where the PHMB-impregnated biocellulose dressing was applied and left in situ until epithelialisation occurred. A cork splint was used for 3 days to prevent pes equinus and to let the ankle joint rest. Change in wound size (cm²), incidence of local infection, wound bed characteristics and pain levels (measured on a 0-10 paediatric pain scale) were assessed at 3-day intervals during the 14-day treatment period. Satisfaction with the dressing was also evaluated. RESULTS: Twenty children (mean age 5.6 years (± 1.33) were recruited into the study and included in the analysis. The mean baseline wound area was 8.60cm² (± 6.57). The mean time to complete wound closure was 12.95 days (± 7.69) with a mean total of 4.70 visits (± 1.56). The mean VAS pain score was 9.55 (± 0.69), compared with 0.15 (± 0.37) on day 14 (p<0.003). At the second visit (after 3 days) 17 of the 20 children were reported to be free of pain. No cases of local infection were noted. CONCLUSION: The dressing was found to be child and parent friendly. The evaluation also showed that it was well tolerated and achieved good healing outcome. It has now been incorporated into the clinic's treatment protocol for these wounds. CONFLICT OF INTEREST: None. The authors have no relevant financial interest in this article. All authors were involved in the critical revision of the manuscript for important intellectual content.

Effect of a steel toe cap on forefoot injury pattern in a cadaveric model.

BACKGROUND: Crush injuries to the foot are a common workplace injury and a significant source of morbidity, disability and lost wages. Many regulatory bodies including the Occupational Safety and Health Administration (OSHA) recommend the use of safety shoes in certain occupations to help protect against these occupational hazards. However there remains controversy and paucity of published data regarding the protection afforded by a steel toe cap in regards to clinical injury pattern. This study looks to investigates the protective influence of a steel toe cap on crush injuries of the forefoot. MATERIALS AND METHODS: Five non-osteoporotic paired cadaver lower extremities were appropriately fitted to a standard work boot. One foot of each pair was fitted into a steel toe capped boot (designated ``ST'' group) while the other foot was fitted into an identical version of the work boot but without the protective steel toe cap (designated ``NST'' group). Each foot was crushed using a custom designed rig with a load of 150 lb dropped from a calibrated height of 3 feet to the forefoot. X-rays were obtained to assess fracture location & comminution and stress fluoroscopy was used to assess for any ligamentous Lisfranc injury. RESULTS: The NST group averaged 8.2 fractured bones per foot while the ST group averaged 3.6 fractured bones per foot (p = 0.001). The NST group demonstrated significantly more metatarsal fractures (3.2 fractures/foot) versus the ST group (one fracture/foot) (p = 0.020). The NST group demonstrated significantly more proximal phalanx fractures (4.2 fractures/foot) compared to the ST group (2.6 fractures/foot) (p = 0.035). Middle and distal phalanx fractures were not significantly different between the two groups. A higher percentage of the bones fractured were deemed comminuted in the NST group (53.6%) versus the ST group (38.8%) although this did not reach statistical significance. CONCLUSION: This study demonstrated that the steel toe affords protective advantages in crush injuries to the foot in limiting the number and severity of metatarsal and proximal phalanx fractures. However the steel toe does not fully protect the forefoot from injury. CLINICAL RELEVANCE: Crush injuries to the foot are a common workplace injury. Strict adherence to workplace safety standards may limit the severity of crush injuries to the foot and additional safety measures such as metatarsal guards should be considered when appropriate.

Escalators, rubber clogs, and severe foot injuries in children.

BACKGROUND: Reports in the media suggest that escalator-related foot injuries are on the rise. Trendy, bright-colored rubber clogs have been implicated in a significant number of these incidents involving children. We review the children who sustained severe foot injuries on escalators, were wearing rubber clogs at the time of injury, and who were admitted to hospital for emergency surgery. METHODS: A list of children who sustained foot injuries on escalators was generated from the hospital database and included for study. From clinical chart review, demographic data, footwear type, and injuries sustained were recorded. Inpatient or outpatient treatment rendered was also recorded for each patient. RESULTS: Between September 2006 and September 2008, we treated 17 children for escalator-related foot injuries. There were 10 boys and 7 girls who were between 2 and 9 years of age (mean: 5.5). Thirteen children (76.5%) from this group were wearing rubber clogs at the time of injury. Nine of these 13 (69.2%) children sustained severe foot injuries that required admission to hospital for emergency surgery and are the focus of this study. One child had an unsalvageable traumatic amputation of the great toe at the level of the interphalangeal joint. Two children sustained crush injuries to the great toe: 1 with severe degloving and the other with an open fracture of the proximal phalanx. One child had an open fracture-dislocation of the second metatarsophalangeal joint with a comminuted fracture of the second metatarsal. Five children sustained multiple deep lacerations in the foot and 2 of them had associated cut tendons that required repair. In the group not wearing rubber clogs, 3 of 4 children had severe foot injuries. In this series, 4 children with rubber clogs and another child with a different footwear sustained minor injuries; they were treated as outpatients. CONCLUSIONS: Escalator-related foot injuries involving rubber clogs can result in severe crushing of the foot and even traumatic amputation. The broad toe-box design may give a false perception of the distance between the foot and the side of the escalator, whereas the 'softness' of these rubber clogs makes them vulnerable to crush by moving escalator steps. This is the first report in the literature describing escalator-related severe foot injuries in children who were wearing rubber clogs. Injuries sustained can be significant and permanent. The potential dangers of escalators and rubber clogs must not be underestimated. LEVEL OF EVIDENCE: Level IV, Case Series.

Nail puncture wound through a rubber-soled shoe: a retrospective study of 96 adult patients.

Nail punctures through rubber-soled shoes expose the foot to the possibility of deep infection and foreign body retention. In this article, we describe characteristics of adult patients who sustained nail puncture wounds through a rubber-soled shoe and were treated at our institution from January 1, 2000, to January 8, 2008. Of the 96 patients, 36 (37.5%) were treated conservatively and 60 (62.5%) were treated surgically in the operating room. Of those treated surgically, 15 (25%) had a foreign body extracted during the operation. The operated group had a longer duration of time from injury to hospital admission than did the nonoperated group (5.0 +/- 6.8 days versus 2.7 +/- 3.8 days, P < .05). Treatment success was observed in 91 (94.8%) of the patients, and the median lag time before admission for the less successfully treated group was longer than that for the successfully treated group (10 days versus 2 days, P < .002); and, the less successfully treated group was more likely to receive antibiotics in the community before hospitalization (100.0% versus 47.2%, P < .06), and was more likely to be diabetic (40.0% versus 9.9%, P < .10). Fever, white blood cell count, and erythrocyte sedimentation rate were not significantly associated with treatment outcome. Success of the treatment did not depend on white blood cell count, erythrocyte sedimentation rate, or fever. Ultrasonography was useful in detecting the presence of a foreign body.

Cyanoacrylate Nail Glue and the Pajama Catalyst.

Nail glues are routinely used for the application of false nails and are readily available for unrestricted purchase from highstreet and online retailers. We present the case of a young lady who accidentally spilled her nail glue on to her cotton pajama trouser leg setting off a violent exothermic reaction that resulted in a full-thickness burn injury to her foot. She ultimately went on to require surgical debridement and skin grafting. We intend to remind both healthcare workers and members of the public that while nail glue alone in contact with the skin is relatively harmless, contact together with natural fibers such as cotton clothing produces a dangerous chemical reaction, which is too often underestimated and can lead to serious burn injuries. Our patient and the surgical team agree that more must be done to raise awareness of the risks these products pose, and retailers must ensure consumers are responsibly informed.

Orthobiologics.

Use of orthobiologics in sports medicine and musculoskeletal surgery has gained significant interest. However, many of the commercially available and advertised products are lacking in clinical evidence. Widespread use of products before fully understanding their true indications may result in unknown adverse outcomes and may also lead to increased health care costs. As more products become available, it is important to remain judicial in use and to practice evidence-based medicine. Likewise, it is important to continue advances in research in hopes to improve surgical outcomes. This article reviews clinical evidence behind common orthobiologics in the treatment of foot and ankle pathology.

Capnocytophaga canimorsus: infection, septicaemia, recovery and reconstruction.

A case is presented of a life-threatening septicaemia and associated peripheral necrosing microembolic phenomenon, resulting from a dog lick to an insignificant burn wound. The isolated bacterium was Capnocytophaga canimorsus, a slow-growing Gram-negative bacillus commonly found in dog saliva. Any clinician seeing patients with a history of dog bite/saliva contact and progressive illness should consider this bacterium as a possible offender and take special care to elicit an accurate history, specifically including questions regarding animal contact.

Retained Wooden Foreign Body in the Second Metatarsal.

The foot is considered the second most common location for foreign bodies. The most common foreign bodies include needles, metal, glass, wood, and plastic. Although metallic foreign bodies are readily seen on plain film radiographs, radiolucent bodies such as wood are visualized poorly, if at all. Although plain radiography is known to be ineffective for demonstrating radiolucent foreign bodies, it is often the first imaging modality used. In such cases, complete surgical extraction cannot be guaranteed, and other imaging modalities should be considered. We present a case of a retained toothpick of the second metatarsal in a young male patient who presented with pain in the right foot of a few weeks' duration. Plain radiography showed an oval cyst at the base of the second metatarsal of the right foot. Magnetic resonance imaging revealed a toothpick penetrating the second metatarsal. The patient recalled stepping on a toothpick 8 years previously. Surgical exploration revealed a 2-cm toothpick embedded inside the second metatarsal.

Common Foot and Ankle Injuries: What Not to Miss and How Best to Manage.

Injuries to the foot and ankle are commonly encountered, especially among athletes, and can lead to morbidity if not managed appropriately. Health care professionals must have a firm understanding of injury anatomy, diagnoses, and management. This article provides a review of lateral talus process fractures, os trigonum injuries, Lisfranc injuries, turf toe, navicular stress fractures, and syndesmotic injuries.

Role of EVA viscoelastic properties in the protective performance of a sport shoe: computational studies.

Modern sport shoes are designed to attenuate mechanical stress waves, mainly through deformation of the viscoelastic midsole which is typically made of ethylene vinyl acetate (EVA) foam. Shock absorption is obtained by flow of air through interconnected air cells in the EVA during shoe deformation under body-weight. However, when the shoe is overused and air cells collapse or thickness of the EVA is reduced, shock absorption capacity may be affected, and this may contribute to running injuries. Using lumped system and finite element models, we studied heel pad stresses and strains during heel-strike in running, considering the viscoelastic constitutive behavior of both the heel pad and EVA midsole. In particular, we simulated wear cases of the EVA, manifested in the modeling by reduced foam thickness, increased elastic stiffness, and shorter stress relaxation with respect to new shoe conditions. Simulations showed that heel pad stresses and strains were sensitive to viscous damping of the EVA. Wear of the EVA consistently increased heel pad stresses, and reduced EVA thickness was the most influential factor, e.g., for a 50% reduction in thickness, peak heel pad stress increased by 19%. We conclude that modeling of the heel-shoe interaction should consider the viscoelastic properties of the tissue and shoe components, and the age of the studied shoe.