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Introduction. Omega-3–rich fish skin grafts have been shown to accelerate wound healing in full-thickness wounds. Objective. The goal of this study was to compare the fish skin graft with standard of care (SOC) using collagen alginate dressing in the management of treatment-resistant diabetic foot ulcers (DFUs), defined as superficial ulcers not involving tendon capsule or bone. Materials and Methods. Patients with DFUs who were first treated with SOC (offloading, appropriate debridement, and moist wound care) for a 2-week screening period were then randomized to either receiving SOC alone or SOC plus fish skin graft applied weekly for up to 12 weeks. The primary endpoint was the percentage of wounds closed at 12 weeks. Results. Forty-nine patients were included in the final analysis. At 12 weeks, 16 of 24 patients' DFUs (67%) in the fish skin arm were completely closed, compared with 8 of 25 patients' DFUs (32%) in the SOC arm (P value = .0152 [N = 49]; significant at P < .047). At 6 weeks, the percentage area reduction was 41.2% in the SOC arm and 72.8% in the fish skin arm. Conclusions. The application of fish skin graft to previously nonresponsive DFUs resulted in significantly more fully healed wounds at 12 weeks than SOC alone. The study findings support the use of fish skin graft for chronic DFUs that do not heal with comprehensive SOC treatment.

Eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome) is a small- to medium-vessel vasculitis associated with asthma and eosinophilia. If left untreated, it can lead to systemic complications with a high mortality rate. The authors present a case of eosinophilic granulomatosis with polyangiitis that initially presented with adult-onset asthma, asymmetric neuropathy to the right lower extremity, and erythematous maculopapular cutaneous lesions to bilateral lower extremities. Through an extensive work-up, the diagnosis of eosinophilic granulomatosis with polyangiitis was made. Steroid therapy was initiated, causing his eosinophil count to return to normal and his presenting symptoms to improve, although his neuropathy and weakness remained. It is our hope that presenting this unusual condition manifesting in the lower extremity can provide guidance to clinicians who might encounter this condition and help them to recognize and treat it before severe chronic complications can manifest.

Cryoglobulinemia is an uncommon blood dyscrasia that can manifest itself in the lower extremity. Due to the insidious nature of this disease, dermatological symptoms and ulcerations can easily be mistaken for more common entities. The authors present an overview of cryoglobulinemia and a case report of a patient with lower extremity manifestations of this disorder. This can provide specific guidance on the steps necessary to accurately establish the diagnosis of cryoglobulinemia or rule it out and pursue other etiologies causing lower extremity ulceration.

The superficial fibular (peroneal) nerve traditionally courses through the anterolateral deep leg and pierces the deep crural fascia at the lower leg to divide into its terminal branches. Entrapment of the superficial fibular nerve is most commonly documented to occur at where it pierces the deep fascia, and numerous etiologies causing entrapment are described. In this case report, we describe an unusual cause of entrapment from a tertiary branch of the superficial fibular nerve taking a circumflex course and wrapping around the secondary branch of the main nerve. This was successfully treated by surgical excision. To the best of our knowledge, this cause of entrapment has not been described in the literature at the time of this publication.

Synovial chondromatosis is a rare condition consisting of metaplasia of the synovial tissue that usually presents in large joints such as the knee and hip. The reported occurrence of synovial chondromatosis in the foot and ankle joints is rare in the literature. In this case report, the successful surgical management of two patients presenting with this condition using open ankle arthrotomy & synovectomy is described. These two cases are presented to provide added depth to the current literature, as well as presenting a review of published literature to further guide clinicians in the management of this rare condition. Level of evidence 4 (case study).

Open reduction with rigid internal fixation is the basic principle for surgical management in foot and ankle trauma. High-risk patients present a surgical dilemma for the foot and ankle surgeon because the possible complications are magnified in this patient population. Percutaneous fixation is a unique alternative for achieving anatomic stabilization without increased physical strain to the patient. The significant advantages of percutaneous fixation include minimizing damage to the vascular supply, maintaining and preserving a stable soft tissue envelope, and decreasing the potential risk for infection. This article provides an overview of percutaneous surgical fixation methods and their role in foot and ankle trauma for the high-risk patient.

Freiberg's disease, a type of avascular necrosis, is an idiopathic osteochondrosis disorder affecting epiphyses of developing bones in children, particularly the second metatarsal with respect to the foot. This disorder can be caused by acute trauma and has been documented that exacerbation of it is present in patients with an elongated second metatarsal, thus, making it more vulnerable to repetitive trauma. Here we present a patient with a chief complaint of a painful mass. Radiographic and repetitive MRI findings were used to diagnose the patient with Freiberg's disease. Following the benefit time of conservative care, surgical core decompression was the surgical course of treatment. Core decompression has been routinely used to prevent structural changes in the metatarsal head and to relieve pain by decreasing the increased intraosseous pressure associated with avascular necrosis and allowing for revascularization of the necrotic area. The use of surgical core decompression with respect to the metatarsal head is relatively new; but has been routinely used for the hip and knee. Whether or not this form of surgical treatment will prevent recurrence is uncertain; further long-term studies are needed.

Necrotizing fasciitis is an aggressive, destructive infection of the soft tissue and fascia and is a life-threatening surgical emergency. A case study is presented of necrotizing fasciitis in the right lower extremity of a 53-year-old male resident of a long-term skilled nursing facility. Limb salvage was achieved through a multidisciplinary approach with early surgical management and aggressive postoperative management. Through 3 surgical procedures, the combined efforts of podiatric surgery, orthopaedic surgery, general/trauma surgery, and infectious disease provided early wound closure and limb salvage. An aggressive multidisciplinary approach to the management of necrotizing fasciitis in the lower extremity is necessary for limb salvage. Use of this multidisciplinary approach will minimize the number of surgical procedures and decrease the potential morbidity and mortality seen in patients with this infection.

Herniation of the abductor hallucis muscle has rarely been reported in the literature. This condition causes localized pain, especially while weight bearing, as a result of a complex cascade of biomechanical events directly related to loss of integrity of the medial wall of the foot. The authors present a case of a flexor retinaculum tear with subsequent herniation of the abductor hallucis muscle. When conservative treatment options failed to provide significant relief, surgical intervention was performed, which revealed ischemic muscle tissue and a partial flexor retinaculum tear. The nonviable muscle was surgically debrided and the fascial defect was repaired with a polypropylene nonabsorbable synthetic surgical mesh. This herniorrhaphy reestablished medial compartment support, thus allowing the patient to return to pain-free ambulation.