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  Case Report of Bullous Diabeticorum: A self-limiting condition with potentially devastating consequences

  Taylor Allison and Randy Semma

  Publication Date: 5-4-2023

  Bullous diabeticorum (BD) is a skin manifestation of patients with diabetes mellitus with an incidence of about 0.16% per year (Larsen et al) although the condition is believed to be widely underdiagnosed. The blistering disease favors acral regions of the body including the feet. There are no accepted diagnostic tests, and histopathology results are often inconclusive which makes BD a clinical diagnosis of exclusion. It is often self-limiting and resolves in a few weeks without residual sequelae. However, it may present with a secondary bacterial infection which can put patients at risk for soft tissue infections and osteomyelitis requiring more aggressive treatment.

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  Septic First Metatarsophalangeal Joint Arthrodesis with Alternative Mini-Rail Fixation

  Brenna Barker, Morgan Gascoyne, and Randy Semma

  Publication Date: 5-4-2023

  For non-infection cases, first metatarsal phalangeal joint arthrodesis is a definitive procedure for painful, arthritic joints.

  Standard fixation methods include screws, plates, staples, or a combination of the three.

  For complex septic joint cases, an alternative method of fixation is needed to reduce the risk of infection retention.

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  Cohort Study Using a Survey to Evaluate the Effects of Sleep on Hba1c Levels and Foot Pathology in Patients Seen in the Podiatry Clinic

  Carmen Johnson, Eric Li, Jihan Toma, and Marshall G. Solomon

  Publication Date: 5-4-2023

  We investigate the impacts of sleep issues on patients in the podiatry clinic by comparing HbA1c, sleep, and foot pathology. Diabetic foot pathology of peripheral arterial disease, peripheral neuropathy, lower extremity ulcerations, and a history of lower extremity amputation all increase the patient's risk of future amputation. Once a patient has an amputation of the lower extremity the five-year mortality rates are 40-70%. So, limb salvage not only improves the quality of life, but also increases the life expectancy for patients. Through a survey and chart review, we are investigating possible impacts of sleep issues on diabetic patients seen in the podiatry clinic as it relates to limb salvage.

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  Diabetic Limb Salvage: Chopart Amputation

  Jesse Miller and Randy Semma

  Publication Date: 5-4-2023

  Diabetic limb salvage is the act of saving a limb, even with decreased function after infection.

  It is the difficult choice of the surgeon/patient to decide to proceed with salvage versus amputation proximally.

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  Applications of Minirail External Fixator in Arthrodesis Foot Surgery for the High-Risk Patient Population A Case Series

  Reema Naman and Randy Semma

  Publication Date: 5-4-2023

  Since the inception of external fixation, there have been many modifications to the utilization of the devices, including the size. The minirail external fixator has evolved since the usage for bracymetatarsia into more complex devices. In the podiatric patient population, there are many comorbidities encountered such as diabetes, idiopathic neuropathy, and smoking. In the diabetic neuropathic population the purpose of use of the minirail external fixator was to provide additional stability as a mini-superconstruct as per Sammarco principles. An additional benefit of the fixator is the option of removing the pins if there are any signs of infection. The purpose of this case series is to exhibit the benefit and myriad of uses of the minirail external fixator in high-risk patient population.

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  Failed Medial Column Fusion due to Subtalar Joint Instability

  Travis Rich, Randy Semma, and Michele Bertelle-Semma

  Publication Date: 5-4-2023

  • CNA is a destructive complication affecting the bone and joint structure, most often in diabetics w/ longstanding peripheral neuropathy.
  • High incidence of major amputation associated with Charcot foot

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  Complex Removal of Heterogenous Soft Tissue Mass in Patient with Prior History of Malignancy

  Yumna Siddiqui and Randy Semma

  Publication Date: 5-4-2023

  There is a variety of pathologies seen in the foot and ankle. One of the more challenging pathologies involves the ability to obtain the correct diagnosis and therapeutic treatment for a soft tissue mass of unknown etiology. With both benign and malignant tumors found in the lower extremities, most malignancy presenting in the foot and ankle is primary in nature. However, in patients with history of malignancy elsewhere in the body, a possible secondary metastatic tumor should always be a differential. Therefore, early diagnosis and treatment is of upmost importance. We present a case study of a patient with prior history of uterine cancer, presenting with an enlarging heterogenous soft tissue mass on her ankle.

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  Utilization of Negative Pressure Wound Therapy and Split Thickness Skin Grafts in the Context of Complex Skin Closure Via Secondary Intention: A Protocol Approach

  Jihan Toma, Eric Li, Randy Semma, Michele L. Bertelle-Semma, and Asif Khan

  Publication Date: 5-4-2023

  Patients with complex, chronic foot wounds or ulcerations are at risk for major amputations. In this quality improvement (QI) initiative, we present an implemented protocol for patients with foot ulcerations and attempt to heal them using a combination of wound vac therapy and split thickness skin grafting. These patients have a history of either diabetes and/or neuropathy that makes wound healing more difficult than an otherwise healthy individua

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  Revisional Arthrodesis of Tarsometatarsal (LisFranc) Complex Injury Secondary to Non-Union

  Lei Wilson and Randy Semma

  Publication Date: 5-4-2023

  The tarsometatarsal joint and its components provide structural support for the foot. Notably the Lisfranc ligament is a fundamental stabilizer for the midfoot. Injuries to this component are complex and can be debilitating. These injuries require surgical intervention when significant displacement resulting in instability is involved.

  Following success of several previous repairs of Lisfranc fractures and dislocations, a treatment algorithm has been proposed. This case report demonstrates the success of the algorithm which has allowed the surgeon to perform reduction and repair in a reproducible, step-wise manner with minimal difficulty to ensure successional revisional arthrodesis of a nonunion

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  Filleted Toe Flap for Closure of Neuropathic Wound with Osteomyelitis

  Robert Boguski and Danniyal Shahid

  Publication Date: 5-2022

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  Case Study: Injectable Bone Cement in Treatment of ORIF Calcaneal Fractures

  Michael Flores and Siraj Panchbhaiya

  Publication Date: 5-2022

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  COVID-19 and Incidence of Necrotizing Fasciitis: A Case Study

  Tehreem Sajjad, Carmen Johnson, and Janet Baatile-Ajrouche

  Publication Date: 5-2022

  COVID-19 manifests as a flu-like respiratory infection affecting multiple organ systems. Symptoms range from mild viral illness to severe acute respiratory infection. There is no definitive relationship between COVID-19 and cellulitis, inflammatory myositis, vasculitis, or necrotizing fasciitis. It is interesting to note that angiotensin-converting enzyme 2 (Receptor for SARS-CoV-2) is present on endothelial cells in multiple organs, including dermal blood vessels and arterial smooth muscle cells. There are several theories that have formed to explain the relationship between COVID-19 and a necrotizing fasciitis infection. This study presents one unique case of an unvaccinated COVID+ patient and the necrotizing fasciitis infection that resulted.