A retrospective study of patients with diabetes mellitus after partial foot amputation and hyperbaric oxygen treatment.

A retrospective chart review was conducted of 35 patients (40 feet) who received hyperbaric oxygen (HBO) therapy after partial foot amputation between 1990 and 2000. Preoperative transcutaneous partial pressure of oxygen (tcPO2) levels, the number of hyperbaric treatments, time to final outcome, use of revascularization procedures, and postsurgical outcome were extracted from the charts. Seventy percent (n = 28) had a successful outcome, defined as complete healing and absence of ulceration at the amputation site, and lack of further surgical procedures to heal the amputation site; whereas 30% (n = 12) had a failed outcome, defined as lack of healing or the presence of an ulcer at the site of amputation or the need for further surgery to heal the amputation site. The level of amputation, use of revascularization procedures, time to final outcome, and number of hyperbaric treatments were not significantly different (P > .05) between the 2 postsurgical outcome groups. The mean preoperative tcPO2 levels were greater (P < .01) in the successful (24 +/- mm Hg) than in the failed (11 +/- mm Hg) outcome groups. All patients with a tcPO2 level > 29 mm Hg had a successful outcome. Patients with a successful postsurgical outcome had a mean of 20 HBO treatments and took 44 days to final outcome, while those with a failed postsurgical outcome had 16 HBO treatments and took 216 days to final outcome.

Calcaneal stress fractures.

The majority of plantar heel pain is diagnosed as plantar fasciitis or heel spur syndrome. When historic or physical findings are unusual or when routine treatment proves ineffective, one should consider an atypical cause of heel pain. Stress fractures of the calcaneus are a frequently unrecognized source of heel pain. In some cases they can continue to go unrecognized because the symptoms of calcaneal stress fractures sometimes improves with treatments aimed at plantar fasciitis. Calcaneal stress fractures can occur in any population of adults and even children and are common among active people, such as athletes, sports enthusiasts, and military personnel. It is likely that the number of diagnosed calcaneal stress fractures will rise among practitioners with an increased recognition of their possibility.

Introduction to ultrasonography of ankle tendons.

Medical technology is constantly improving, giving the physician more options to aid in diagnosis and treatment of ailments. Ultrasound (US) technology is one area that has made great improvements. Increased resolution and availability are two reasons why ultrasound is now being used to image the musculoskeletal system. This article discusses ultrasound technology, instrumentation, basic exam of ankle tendons, and some of the recent uses. The objective is to make the physician aware of this modality and possibly add it to their diagnostic armementarian.