Case Report of a Diabetic Foot Infection Caused by Staphylococcus pseudintermedius, a Zoonotic Pathogen of Canine Origin.

Staphylococcus pseudintermedius is an emerging zoonotic pathogen that is very similar to human Staphylococcus pathogens, particularly multidrug-resistant Staphylococcus aureus. Recent reports have indicated that S pseudintermedius is easily transmitted between pets (mainly dogs) and owners because of these similarities. Although this pathogen has been associated with diabetic foot infections, it has not yet been described in the podiatric medical literature. In this case report, we present a diabetic foot infection in a 61-year-old man that was refractory to multiple rounds of antibiotic drug therapy. Deep wound cultures eventually grew S pseudintermedius, which was the first known case of this pathogen reported in our hospital system.

Open Evaluation of the Peroneal Tendons Should Be Considered in Patients With Chronic Lateral Ankle Instability Undergoing Ankle Arthroscopy With Lateral Ankle Stabilization.

Peroneal tendon pathology is commonly associated with chronic lateral ankle instability. Foot and ankle surgeons often rely on preoperative magnetic resonance imaging (MRI) for identification of related pathology and surgical planning in these patients. The purpose of this study was to assess the ability of preoperative MRI to accurately detect peroneal tendon pathology in patients with chronic lateral ankle instability. Consecutive surgical cases involving arthroscopic evaluation and management of lateral ankle instability sequelae were evaluated retrospectively. Preoperative MRI were compared to intraoperative findings in order to determine the sensitivity, specificity, positive and negative predictive values. Eighty-two patients met inclusion criteria, 58 females and 24 males. The average age at the time of surgery was 46 years (range 13-75). Peroneal tendon pathology was identified intraoperatively in 76 (92.7%) patients and on MRI in 40 (48.8%) patients. The most commonly identified pathologies were tenosynovitis, tendinopathy and longitudinal split/tear, with the peroneus brevis tendon being most commonly involved. MRI was 38.7% specific, 50.0% sensitive, had a positive predictive value of 92.5%, and a negative predictive value of 7.1%. While MRI is a helpful study for evaluation of co-pathologies and surgical planning in patients with lateral ankle instability, procedural selection should not be solely based on MRI results, and the peroneal tendons should be evaluated intraoperatively in patients undergoing arthroscopic procedures for lateral ankle instability.

Control of lower extremity edema in patients with diabetes: Double blind randomized controlled trial assessing the efficacy of mild compression diabetic socks.

AIMS: Persons with diabetes frequently present with lower extremity (LE) edema; however, compression therapy is generally avoided for fear of compromising arterial circulation in a population with a high prevalence of peripheral arterial disease. This double blind randomized controlled trial (RCT) assessed whether diabetic socks with mild compression could reduce LE edema in patients with diabetes without negatively impacting vascularity. METHODS: Eighty subjects with LE edema and diabetes were randomized to receive either mild-compression knee high diabetic socks (18-25mmHg) or non-compression knee high diabetic socks. Subjects were instructed to wear the socks during all waking hours. Follow-up visits occurred weekly for four consecutive weeks. Edema was quantified through midfoot, ankle, and calf circumferences and cutaneous fluid measurements. Vascular status was tracked via ankle brachial index (ABI), toe brachial index (TBI), and skin perfusion pressure (SPP). RESULTS: Seventy-seven subjects (39 controls and 38 mild-compression subjects) successfully completed the study. No statistical differences between the two groups in terms of age, body mass index, gender, and ethnicity. Repeated measures analysis of variance and Sidak corrections for multiple comparisons were used for data analyses. Subjects randomized to mild-compression diabetic socks demonstrated significant decreases in calf and ankle circumferences at the end of treatment as compared to baseline. LE circulation did not diminish throughout the study with no significant decreases in ABI, TBI or SPP for either group. CONCLUSIONS: Results of this RCT suggest that mild compression diabetic socks may be effectively and safely used in patients with diabetes and LE edema.