Pyoderma gangrenosum involving the foot. A case report.

Pyoderma gangrenosum is a rare and destructive inflammatory skin disease. The authors present a report of a patient with a classic case of pyoderma gangrenosum involving the foot. The diagnosis was made on the basis of clinical presentation and progression of the disease after differential diagnoses of common conditions were excluded. A brief overview of the disease process, its treatment, and its correlation with ulcerative colitis is provided.

Lower extremity manifestations of cardiovascular disease. An update.

Cardiovascular disease is one of the leading causes of morbidity and mortality, and its system-wide complications are numerous and complex. Many signs and symptoms of cardiovascular pathology are expressed in the lower extremities. This article addresses new research that relates the lower extremity with cardiovascular disease.

Prevention and care of diabetic foot ulcers.

The foot is frequently overlooked in the management of diabetic patients. Failure to control diabetic foot ulcers at an early stage can lead to life-threatening infection or amputation. Preventive care should emphasize patient education, glycemic control, careful daily foot hygiene and appropriate footwear. Early management of a diabetic foot ulcer should include culture-directed antibiotic therapy when there is evidence of infection, moist dressings and adjustment of footwear or casting to avoid pressure on the wound site. All patients with foot ulcers should be evaluated for evidence of foot ischemia. Surgical intervention to debride infected tissue and bone or to revascularize ischemic tissue can aid in ulcer healing. Serious infection or severe ischemia, unfortunately, often necessitates amputation.

Pathophysiology of diabetic neuropathy.

Angiopathy, immunopathy, and neuropathy are the key components responsible for diabetic foot complications. The authors report on the current theories of metabolic and structural causes of diabetic neuropathy.

Bilateral bipartite medial cuneiform. A case report.

A fracture to the intermediate cuneiform that was not definitively detected on routine radiographs because of the overlap of the cuneiform was presented. Weightbearing x-rays did not provide additional information. The anatomical location of the fracture was identified only after a computed tomography scan was performed. An incidental finding, bilateral bipartite medial cuneiforms, was also observed on the computed tomography scan, which contributed to the overlap on routine radiographs. The anatomy of the bipartite medial cuneiforms seen on computed tomography was similar to that described by Barlow in 1942. Retrospective comparison to the initial radiographs with the computed tomography scan sections did reveal bipartite medial cuneiforms on these films as well. The podiatric physician should keep bipartition in mind when evaluating x-rays for any osseous pathology, especially fractures.

The use of prophylactic antibiotics in clean podiatric surgery.

The presence of a postoperative wound infection after clean podiatric surgery may predispose the patient to a prolonged, often nonambulatory, convalescent period. Although the incidence of postoperative infection after elective podiatric surgery is small, a protocol to govern the use of prophylactic antibiotics has been developed in order to achieve their maximum benefits with a minimum of risk. Indications for chemoprophylaxis have been divided into two groups: specific operative procedures that may warrant antibiotic intervention and patients who present with specific risk factors. Additionally, it has been suggested that single dose prophylaxis is preferable to multiple dose administration.