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Alan Garrett, DPM

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NCBI: db=pubmed; Term=(Garrett A[Author]) AND (John Peter Smith[Affiliation] OR JPS Health Network[Affiliation] OR JPS [Affiliation] NOT Japan Pancreas Society[Affiliation])
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Temperature- and Pressure-Regulating Insoles for Prevention of Diabetic Foot Ulcers.

Mon, 05/11/2020 - 11:35

Temperature- and Pressure-Regulating Insoles for Prevention of Diabetic Foot Ulcers.

J Foot Ankle Surg. 2020 May 06;:

Authors: Yavuz M, Ersen A, Monga A, Lavery LA, Garrett AG, Salem Y, Hirschman GB, Myers R

Abstract
Diabetic foot ulcers (DFUs) pose a major threat to the United States healthcare system as well as patients and their families. High ulcer recurrence rates indicate that existing preventive measures are not effective. A new generation of multimodal preventive devices may reduce ulceration and amputation rates. Because previous research has revealed that tissue maintained at cooler temperatures is more resistant to breaking down, the evaluated technology may prevent foot ulceration. The purpose of this study was to test previously designed Temperature and Pressure Monitoring and Regulating Insoles (TAPMARI) in diabetic neuropathic and healthy subjects. A cooling unit, a mini-water pump, a battery pack, and a microcontroller (or simply thermostat) were placed inside a box attached to the subjects' calf, which provided cooling inside the shoe. The microcontroller was set at 28°C. Eight subjects provided informed consent, 3 of whom had diabetic neuropathy. Subjects used the instrumented shoe on the right foot and the matching control shoe on the left and walked on a treadmill for 5 minutes at self-selected speeds. Baseline and postwalking thermographs were obtained with a thermal camera. At the 2-hour midpoint, subjects again walked on the treadmill for 5 minutes at self-selected speeds. Second baseline and postwalking thermographs were captured. Plantar pressure distributions were also quantified. The TAPMARI successfully regulated foot temperatures at or below the target temperature. The mean baseline temperature of the right (regulated) and left (control) feet were 28.1 ± 1.9°C (mean ± standard deviation) for all subjects. The mean temperatures at the end of the study were 25.9 ± 2.5°C (right) and 31.7 ± 1.6°C (left) in all subjects. In the diabetic neuropathy group, the final mean temperatures were 27.5 ± 2.4°C (right) and 31.6 ± 0.8°C (left), which indicated that the temperature goal was met inside the instrumented shoe. By regulating temperatures, TAPMARI may reduce the metabolic demands in the foot and prevent cell autolysis by eliminating the imbalance between oxygen demand and supply. This study warrants further development and testing of TAPMARI as well as investigating the clinical effectiveness in preventing DFUs.

PMID: 32386918 [PubMed - as supplied by publisher]

A Biomechanical Examination of Prefabricated Total Contact Cast Kits: Relevance to Patients With Diabetic Neuropathy.

Mon, 04/06/2020 - 02:02
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A Biomechanical Examination of Prefabricated Total Contact Cast Kits: Relevance to Patients With Diabetic Neuropathy.

Int J Low Extrem Wounds. 2020 Mar 29;:1534734620914440

Authors: Ersen A, Lavery LA, Monga A, Richardson M, Schwarz B, Quiben MU, Garrett AG, Flyzik M, Wukich DK, Yavuz M

Abstract
The traditional Total Contact Cast (TCC) is considered the gold standard for treating plantar diabetic ulcers. A number of prefabricated TCC kits have been introduced, which offer a user-friendly casting process for health care providers. Our objective was to evaluate pressure reduction and gait characteristics after application of a TCC kit (TCC-EZ) and traditional TCC. Fifteen individuals (9 males, 6 females; median age of 51.5 years [range = 40.5-71.2 years]) completed 30-m walking trials while fitted with TCC-EZ and TCC in a randomized order. A pair of automated wireless photogate sensors captured time to traverse the distance and pedobarographic insoles measured and recorded plantar pressures. Paired t tests were used to compare peak pressure, gait speed, and cast weights across the 2 modalities. Peak pressure and cast weight were significantly lower in the TCC-EZ arm (169.6 ± 41.3 kPa vs 214.9 ± 63.2 kPa, P = .0048; and 1.79 ± 0.17 kg vs 2.11 ± 0.25 kg, P = .0004). Contact area and gait speed were not significantly different between the 2 modalities (140.4 ± 25.8 cm2 vs 126.9 ± 37.8 cm2, P = .0228, Cohen's d = 0.40; and 0.94 ± 0.19 m/s vs 0.83 ± 0.26 m/s, P = .0532, Cohen's d = .48). TCC-EZ was found to provide more favorable pressure distributions compared with TCC. TCC-EZ is also lighter and may be a preferred treatment modality for patients. More research is necessary to reveal the clinical effectiveness of prefabricated total contact kits.

PMID: 32223354 [PubMed - as supplied by publisher]

Ten-Year Follow-Up of Metatarsal Head Resurfacing Implants for Treatment of Hallux Rigidus.

Wed, 01/30/2019 - 07:24
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Ten-Year Follow-Up of Metatarsal Head Resurfacing Implants for Treatment of Hallux Rigidus.

J Foot Ankle Surg. 2017 Sep - Oct;56(5):1052-1057

Authors: Hilario H, Garrett A, Motley T, Suzuki S, Carpenter B

Abstract
Controversy remains regarding the use of arthroplasty versus arthrodesis in the surgical treatment of late-stage hallux rigidus. The purpose of our retrospective study was to report the long-term follow-up results of the metatarsal head resurfacing implant used for hemiarthroplasty. The patient assessments were conducted using the American Orthopaedic Foot and Ankle Society (AOFAS) metatarsophalangeal clinical rating system and a satisfaction questionnaire. A total of 59 consecutive implantations were performed from January 2005 to December 2009 at our institution. Of the 59 patients, 2 had died and 12 were lost to follow-up, for a 76.3% follow-up rate (45 of 59 procedures) at a mean of 117.67 (range 96 to 143) months. The mean overall AOFAS scale score was 90.6 ± 7.6. The AOFAS pain scale score was 37.78 ± 4.71. One implant was removed, and all remaining patients were happy with their outcome and would repeat the procedure on their other foot, if needed. A subset of patients from a previous mid-term study at our institution showed no significant change in the AOFAS scale scores. Of these 32 patients, 30 (93.75%) were available for follow-up examination at a mean of 122.62 (range 96 to 143) months. We were able to obtain long-term results for 32 implants (30 patients), resulting in a 10-year follow-up rate of 93.7%. With the minimal resection required for this implant, salvage arthrodesis remains a viable option if revision is needed. The surgical treatment of late-stage hallux rigidus with metatarsal head resurfacing allows for low-risk and excellent outcomes at long-term follow-up point.

PMID: 28842091 [PubMed - indexed for MEDLINE]

Plantar Shear Stress in Individuals With a History of Diabetic Foot Ulcer: An Emerging Predictive Marker for Foot Ulceration.

Wed, 01/30/2019 - 07:24
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Plantar Shear Stress in Individuals With a History of Diabetic Foot Ulcer: An Emerging Predictive Marker for Foot Ulceration.

Diabetes Care. 2017 02;40(2):e14-e15

Authors: Yavuz M, Ersen A, Hartos J, Schwarz B, Garrett AG, Lavery LA, Wukich DK, Adams LS

PMID: 27899495 [PubMed]

Comparing the Knotless Tension Band and the Traditional Stainless Steel Wire Tension Band Fixation for Medial Malleolus Fractures: A Retrospective Clinical Study.

Wed, 01/30/2019 - 07:24
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Comparing the Knotless Tension Band and the Traditional Stainless Steel Wire Tension Band Fixation for Medial Malleolus Fractures: A Retrospective Clinical Study.

Scientifica (Cairo). 2016;2016:3201678

Authors: Downey MW, Duncan K, Kosmopoulos V, Motley TA, Carpenter BB, Ogunyankin F, Garrett A

Abstract
The traditional stainless steel wire tension band (WTB) has been popularized for small avulsion fractures at the medial malleolus. Despite the tension band principle creating a stable construct, complications continue to arise utilizing the traditional stainless steel WTB with patients experiencing hardware irritation at the tension band site and subsequent hardware removal. Coupled with hardware irritation is fatigue failure with the wire. The goal of this investigation was to retrospectively compare this traditional wire technique to an innovative knotless tension band (KTB) technique in order to decrease costly complications. A total of 107 patients were reviewed with a minimum follow-up of 1 year. Outcome measures include descriptive data, fracture classification, results through economic costs, and fixation results (including hardware status, healing status, pain status, and time to healing). The KTB group had a 13% lower true cost as compared to the WTB group while the fixation results were equivocal for the measured outcomes. Our results demonstrate that the innovative KTB is comparable to the traditional WTB while offering a lower true cost, an irritation free reduction all without the frustration of returning to the operating room for additional hardware removal, which averages approximately to $8,288.

PMID: 27293969 [PubMed]

Peak Plantar Shear and Pressure and Foot Ulcer Locations: A Call to Revisit Ulceration Pathomechanics.

Wed, 01/30/2019 - 07:24
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Peak Plantar Shear and Pressure and Foot Ulcer Locations: A Call to Revisit Ulceration Pathomechanics.

Diabetes Care. 2015 Nov;38(11):e184-5

Authors: Yavuz M, Master H, Garrett A, Lavery LA, Adams LS

PMID: 26370381 [PubMed]

Association Between Plantar Temperatures and Triaxial Stresses in Individuals With Diabetes.

Wed, 01/30/2019 - 07:24
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Association Between Plantar Temperatures and Triaxial Stresses in Individuals With Diabetes.

Diabetes Care. 2015 Nov;38(11):e178-9

Authors: Yavuz M, Brem RW, Glaros AG, Garrett A, Flyzik M, Lavery L, Davis BL, Hilario H, Adams LS

PMID: 26316629 [PubMed]

Surgical treatment of hallux rigidus using a metatarsal head resurfacing implant: mid-term follow-up.

Wed, 01/30/2019 - 07:24
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Surgical treatment of hallux rigidus using a metatarsal head resurfacing implant: mid-term follow-up.

J Foot Ankle Surg. 2010 Jul-Aug;49(4):321-5

Authors: Carpenter B, Smith J, Motley T, Garrett A

Abstract
The treatment of advanced hallux rigidus remains controversial, with many authors discussing arthrodesis versus arthroplasty. The purpose of this study is to report mid-term outcomes after implantation of a motion-preserving metatarsal head-resurfacing prosthetic and to present our technical considerations and modifications to the published technique to further enhance the clinical benefit of the procedure. Thirty-two implantations were performed in 30 patients. Twenty-three patients were women, 9 men. The average age was 62.8 years (range, 39-86 years). Patients were graded at baseline according to Hattrup and Johnson and completed the American Orthopaedic Foot & Ankle Surgery metatarsophalangeal clinical rating system preoperatively and postoperatively and a patient satisfaction question at final follow-up. Seventy-two percent of implantations were grade III hallux rigidus and 28% were grade II. The average follow-up was 27.3 months (range, 12-43 months). The mean change score for the overall American Orthopaedic Foot & Ankle Surgery scale was 236.8% (SD = 146.62, confidence interval [CI] = 186-287.6). A similar result was achieved between grade II (250.9%, SD = 240.3, CI = 93.9-407.9) and grade III (231.3%, SD = 95.83, CI = 195.14-270.46). No implants were revised or removed, and all patients stated that they were happy with their outcome and would repeat the procedure again if needed. In conclusion, metatarsal head resurfacing in combination with joint decompression, soft tissue mobilization, and debridement can achieve excellent results in grade II and III hallux rigidus. Salvage arthrodesis remains an option if future revisions are indicated.

PMID: 20610200 [PubMed - indexed for MEDLINE]

Evaluation of fibula free flap donor site morbidity.

Wed, 01/30/2019 - 07:24
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Evaluation of fibula free flap donor site morbidity.

Am J Otolaryngol. 2006 Jan-Feb;27(1):29-32

Authors: Garrett A, Ducic Y, Athre RS, Motley T, Carpenter B

Abstract
OBJECTIVE: To evaluate foot and ankle function in a series of patients undergoing fibula microvascular free tissue transfer.
STUDY DESIGN: A nonrandomized, nonblinded analysis was performed using the ankle-hindfoot scale as well as radiographic analysis to determine donor site morbidity.
RESULTS: Overall, foot ankle function was deemed to be good in this series of patients. Average ankle-hindfoot score was 84.82 of a possible 100 (range, 55-100). Radiographic analysis of donor and contralateral ankles showed no difference in the syndesmotic space or medial clear space. Only 1 patient had increased talar tilt compared with the contralateral side, although this patient had preservation of stability.
CONCLUSION: Fibula free flap harvest appears to be associated with acceptable donor site morbidity and preservation of good foot and ankle function in most individuals.

PMID: 16360820 [PubMed - indexed for MEDLINE]

Using a hook plate as alternate fixation for fifth metatarsal base fracture.

Wed, 01/30/2019 - 07:24
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Using a hook plate as alternate fixation for fifth metatarsal base fracture.

J Foot Ankle Surg. 2003 Sep-Oct;42(5):315-6

Authors: Carpenter B, Garrett A

PMID: 14566727 [PubMed - indexed for MEDLINE]