A comparison of vitamin D levels in nondiabetic and diabetic patient populations.

BACKGROUND: This study was designed to compare the vitamin D levels in a cohort of nondiabetic patients to populations of diabetic patients with and without Charcot neuroarthropathy. METHODS: A total of 41 participants (22 male, 19 female) with a mean +/- SD age of 59 +/- 9.43 years had serum 25-hydroxyvitamin D levels tested. Fifteen participants composed the nondiabetic group; 13, the group with diabetes but without Charcot neuroarthropathy; and 13, the group with both diabetes and Charcot neuroarthropathy. RESULTS: The results of the study showed that the vitamin D levels in both diabetic populations were significantly lower (P < .05) than the nondiabetic population. There was no statistical difference between the group with diabetes but without Charcot foot disease and the group with both diabetes and Charcot neuroarthropathy. CONCLUSIONS: Based on the results of this study, given the importance of vitamin D in bone metabolism and the osseous consequences associated with diabetes, as well as other systems affected by low levels of vitamin D in the diabetic patient, it appears that vitamin D levels should be monitored in diabetic patients.

Preemptive analgesia in foot and ankle surgery.

Central neuroplasticity, or changes in CNS processing due to surgical nociception. can amplify postoperative pain. As a result, a hyperalgesic state called wind-up can occur, having debilitating effects on postoperative patients. Preemptive analgesia works to prevent this process and results in a more positive surgical experience. Inhibition of afferent pain pathways by use of local anesthetic blocks, altered perception of pain with opioid use, and inhibition of pain pathways by NMDA receptor antagonists are examples of preemptive analgesia. Using a combination of preemptive modalities and addressing patients' perceptions can aid in interrupting pathologic pain cycles. Positive and modest results have been obtained from animal and human preemptive trials, yet basic pathophysiology demonstrates the validity and importance of preemptive analgesia. Future studies are needed to test effective blockade of afferent input while controlling perception, hyperalgesia, and NMDA receptor activity. The Agency for Health Care Policy and Research now recommends a multifaceted approach to postoperative pain. The goal in pain management is to inhibit destructive pain pathways, maintain intraoperative analgesia, and prevent central sensitization. Preliminary results of multimodal preemptive analgesia trials continue to be promising.

Modified surgical approach for retrocalcaneal exostectomy with early return to weight bearing.

This procedure is a minimally invasive method of excising a retrocalcaneal exostosis and has been performed at the authors' facility for several years with excellent results and no incidence of Achilles tendon compromise. Postoperative recovery and return to weight bearing are accelerated compared with procedures that reflect the Achilles tendon from its insertion.