Thyroid Dermopathy Treatment of the Foot in the Setting of Graves Hyperthyroidism.

Graves' hyperthyroidism is one of the most common autoimmune diseases, caused by autoantibodies acting against the thyrotropin receptor. Extra-thyroid manifestations include ophthalmopathy, acropachy, and dermopathy, which accounts for 4% to 13% of clinical presentations. This is a case study of a 55-year-old female who presented with recurrent soft tissue mass formation over the dorsal right foot. The patient underwent a soft tissue mass excisional biopsy and the pathology report revealed a soft tissue mass secondary to thyroid dermopathy. Given her history of soft tissue recurrence and previous diagnosis, the patient underwent both excisional biopsy and radiation treatment with success. After 1 year of follow-up, the patient had completely healed without complication. This case demonstrates a multidisciplinary approach for clinical diagnosis and treatment.

Development of Multiple Epidermal Inclusion Cysts After Radiofrequency Microtenotomy for Plantar Fasciitis: A Case Report.

Epidermal inclusion cysts are slowly developing intradermal lesions which form after the implantation of epidermal tissue into the dermal tissue. Epidermal cysts occur infrequently in the foot, but can occur after traumatic episodes, including surgically induced trauma. Epidermal inclusion cysts have been described as a complication of minimally invasive foot and ankle surgery; however, they have been described infrequently as a complication of radiofrequency microtenotomy. To our knowledge, only one other case study exists discussing the development of a singular epidermal cyst after undergoing radiofrequency microtenotomy. Therefore, the purpose of the present case report was to discuss a case of the development of multiple epidermal inclusion cysts of the plantar heel after radiofrequency microtenotomy for treatment of plantar fasciitis. After undergoing radiofrequency coblation in November 2017, the patient developed multiple plantar heel cysts. She went on to have them surgically removed in February 2018 and again in June 2018. By the time of presentation to our office in October 2018, multiple cysts were still present to her heel despite 2 surgical excisions. Seventeen months after surgical excision in February 2019, the patient remained cyst-free.

Lower Extremity Non-Blanchable Purpura Secondary to Methotrexate Toxicity: A Case Report.

Methotrexate is an antimetabolite drug that works as a folic acid analogue to inhibit DNA synthesis. This drug is commonly used for treating conditions such as psoriasis, rheumatoid arthritis, atopic dermatitis, and collagen disease. Although methotrexate may have common adverse effects such as bone marrow suppression and liver abnormalities, less commonly encountered side effects include lower extremity cutaneous blistering and skin necrosis. To our knowledge, there have been no case reports that have described methotrexate toxicity to the foot and ankle. This case report highlights a case of a 61-year-old patient who initially presented to our hospital with a 2-day history of worsening pain, swelling, and blistering of his feet. The patient's initial diagnosis was secondary to burns; however, with thorough investigation, imaging, and a punch biopsy, the final diagnosis was secondary to methotrexate toxicity. This case emphasizes the importance of a thorough history and physical examination for proper diagnosis and treatment of the adverse effect of methotrexate toxicity.

Descriptive quantitative analysis of hallux abductovalgus transverse plane radiographic parameters.

Although the transverse plane radiographic parameters of the first intermetatarsal angle (IMA), hallux abductus angle (HAA), and the metatarsal-sesamoid position (MSP) form the basis of preoperative procedure selection and postoperative surgical evaluation of the hallux abductovalgus deformity, the so-called normal values of these measurements have not been well established. The objectives of the present study were to (1) evaluate the descriptive statistics of the first IMA, HAA, and MSP from a large patient population and (2) to determine an objective basis for defining "normal" versus "abnormal" measurements. Anteroposterior foot radiographs from 373 consecutive patients without a history of previous foot and ankle surgery and/or trauma were evaluated for the measurements of the first IMA, HAA, and MSP. The results revealed a mean measurement of 9.93°, 17.59°, and position 3.63 for the first IMA, HAA, and MSP, respectively. An advanced descriptive analysis demonstrated data characteristics of both parametric and nonparametric distributions. Furthermore, clear differentiations in deformity progression were appreciated when the variables were graphically depicted against each other. This could represent a quantitative basis for defining "normal" versus "abnormal" values. From the results of the present study, we have concluded that these radiographic parameters can be more conservatively reported and analyzed using nonparametric descriptive and comparative statistics within medical studies and that the combination of a first IMA, HAA, and MSP at or greater than approximately 10°, 18°, and position 4, respectively, appears to be an objective "tipping point" in terms of deformity progression and might represent an upper limit of acceptable in terms of surgical deformity correction.

Demographic description of the presentation and treatment of lower extremity skin and soft tissue infections secondary to skin popping in intravenous drug abusers.

Skin popping refers to the act of subcutaneous injection of intravenous drugs, a practice that often results in the development of cellulitis and the formation of soft tissue abscesses. Although the foot and ankle represent common injection sites, few data have described the presentation and natural history of this pathologic entity. The objective of the present study was to retrospectively assess the descriptive demographic data of a patient cohort admitted for lower extremity skin and soft tissue infection caused by intravenous drug abuse. Fifty skin popping lesions in 49 patients were identified during a 733-day data collection period (August 1, 2010 to August 31, 2012) that had been treated by the in-patient podiatric surgical service for lower extremity infection caused by intravenous drug abuse at an urban, level-one trauma center. With respect to patient race, our hospital has a typical in-patient census of 55% black patients and 25% white patients. The present patient cohort consisted of 12% black patients and 65% white patients. The mean length of stay was 5.71 ± 3.56 days, and 42 patients (85.71%) underwent some form of surgical debridement, with 31 (63.27%) having undergone a formal procedure in the operating room. Six patients (12.24%) left the hospital against medical advice or refused intervention at some definitive point of care, and 36 (73.47%) did not return for scheduled outpatient follow-up visits. Three cases (6%) resulted in minor amputation. The microbiologic culture data and common antibiotic prescriptions used in the diagnosis and treatment, respectively, of these patients have been summarized. We hope these original descriptive data can be used by other physicians treating patients at similar urban practices to improve the care of these sometimes difficult-to-treat patients and better serve this population as a whole.

Bilateral Digital Ischemia Secondary to Heparin-Induced Thrombocytopenia with Subsequent Limb Salvage: A Case Study.

Heparin-induced thrombocytopenia (HIT) is a prothrombotic state caused by the buildup of platelet factor 4 antibodies with decreased platelet count caused by heparin therapeutic or prophylactic therapy. It is important to detect this complication, especially in critically ill patients and cardiac patients. Detection of HIT can be demonstrated by positive antibodies in a HIT panel. Based on clinical and laboratory findings, heparin use should be discontinued with immediate transition to alternative anticoagulation therapies. Thromboembolic events can be an adverse effect of HIT and can cause local tissue necrosis, especially in the lower extremity. This case is a retrospective medical record review of a 52-year-old man who was initially admitted as an outpatient for coronary artery bypass grafting and mitral valve replacement who developed digital gangrene from HIT. This case emphasizes the rare adverse effects of HIT and the need for timely consultation for surgical treatment of limb ischemia/gangrene.

Compression peroneal nerve palsy causing isolated extensor hallucis longus dysfunction.

UNLABELLED: The authors describe a case of compression-induced peroneal nerve palsy with isolated extensor hallucis longus dysfunction that resulted in hallux lag without gross drop foot deformity. LEVEL OF CLINICAL EVIDENCE: 4.

The current state of emergency medical training in US schools of podiatric medicine.

BACKGROUND: There is no information available in the medical literature regarding emergency medical training in the podiatric medicine predoctoral curriculum. This study was undertaken to describe the current state of emergency medical training in US schools of podiatric medicine. METHODS: A Web-based descriptive survey was developed to assess course logistics, the curricular topics covered, and the teaching methods used. All of the US schools of podiatric medicine were surveyed. RESULTS: Completed surveys were returned from all nine schools. All of the institutions incorporate training on the management of medical emergencies into their predoctoral curricula. Four schools (44.4%) reported initiating this training before 2000. All of the schools incorporate a didactic (lecture) component, and eight (88.9%) incorporate a clinical (hands-on) component into their training. CONCLUSIONS: All of the schools of podiatric medicine in the United States incorporate emergency medical training into their predoctoral curriculum. However, despite some similarities across institutions, there seems to be variation regarding curricular topics, didactic teaching, and methods of teaching the material.

Extensor hallucis longus tendon rupture repair using a fascia lata allograft.

The authors present a case of a traumatic extensor hallucis longus tendon rupture sustained 2 days after hallux valgus and hammer toe correction. The ruptured tendon, separated by a 6-cm defect, was repaired using a fascia lata allograft. This case demonstrates a serious complication of a commonly performed procedure and a salvage technique useful for dealing with large tendon defects.

Extensive lipoma of the foot.

Although lipomas are the most common benign soft-tissue tumors found in the body, they are not commonly found in the foot. This case study concerns an unusually large lipoma on the plantar lateral aspect of the foot that was successfully excised without any sign of recurrence.