Continuous activity monitoring in persons at high risk for diabetes-related lower-extremity amputation.

This study evaluated the magnitude and location of activity of diabetic patients at high risk for foot amputation. Twenty subjects aged 64.6 +/- 1.8 years with diabetes, neuropathy, deformity, or a history of lower-extremity ulceration or partial foot amputation were dispensed a continuous activity monitor and a log book to record time periods spent in and out of their homes for 1 week. The results indicate that patients took more steps per hour outside their home, but took more steps per day inside their homes. Although 85% of the patients wore their physician-approved shoes most or all of the time while they were outside their homes, only 15% continued to wear them at home. Focusing on protection of the foot during in-home ambulation may be an important factor on which to focus future multidisciplinary efforts to reduce the incidence of ulceration and amputation. The ability to continuously monitor the magnitude, duration, and time of activity ultimately may assist clinicians in dosing activity just as they dose drugs.

Fatal pontine hemorrhage after podiatric surgery. A case report.

The authors present a case of massive fatal pontine hemorrhage as a complication of hypertension in a patient treated for an infected diabetic ulcer. The podiatric physician must be aware of the risks associated with concomitant medical problems such as hypertension and ensure that proper therapeutic measures are taken to avoid the potential for catastrophic complications.

Nonclostridial cellulitis with subcutaneous emphysema.

Nonclostridial cellulitis with concomitant gas formation in the plantar tissues of the foot is seldomly reported in the literature. The event itself, however, may actually be relatively common. A review of the literature and a case study involving a diabetic patient is presented, along with a review of the etiology, diagnosis, and treatment.

Calcifying aponeurotic fibroma.

The calcifying aponeurotic fibroma is a rare, benign neoplasm that often presents in the palms or soles of young male children. Microscopic examination of this tumor demonstrates atypical fibroblasts, foci of calcification, and patches of chondroid differentiation. The neoplasm's highly cellular architecture, locally aggressive growth pattern, and tendency to recur may lead to a misdiagnosis of fibrosarcoma and subsequent amputation. This manuscript presents a review of the literature and a unique case involving the digits of the foot.

The prevalence and nature of podiatric problems in elderly diabetic patients.

To determine if diabetes in the elderly is associated with increased prevalence of podiatric problems, a random sample of diabetic patients (n = 74) was compared to a group of elderly non-diabetic patients (n = 79). The two groups were comparable in age (range 70-90 years), smoking habits, and consumption of alcohol. The mean duration of diabetes was 14.5 +/- 11.7 years (+/- SD), and mean serum fructosamine level was 3.3 +/- 0.66 mmol/L. The number of medical diagnoses and medications used was significantly higher in the diabetic group. Diabetic patients had modestly higher prevalence of neuropathy, vascular disease, kidney disease, and eye complications. The most common podiatric problem in both groups was elongated toenails. The prevalence of podiatric problems such as cellulitis, amputation, tinea pedia, onychomycosis, calluses, bunions, and hammer toe deformity were not increased in diabetic patients. Active foot ulcers were more common in diabetic patients (13/74 vs 5/79, P less than 0.05). It is concluded that diabetes in the elderly, unlike in young patients, increases the risk of foot problems only marginally.

Silent stroke associated with minor podiatric surgery.

Life-threatening intraoperative complications during minor podiatric surgery are rare. This paper presents a case of a "silent stroke," which occurred during total matrixectomies of hallux nails. The podiatric physician must be aware of the risk factors involved in each case and must be prepared to treat any complications that may arise.

Perioperative management of adrenal cortical suppression.

Two questions asked prior to podiatric surgery for patients with a history of steroid therapy are: what are the risks involved with surgery and what specific measures should be taken in perioperative management for these patients? Studies identifying normal adrenal response to surgery in patients with a long-term history of steroid use have been noted. This paper discusses use of the metyrapone test to identify patients with adrenal suppression who may require additional steroid coverage perioperatively and empirical steroid dosing regimens.