Image intensification of x-rays is useful in monitoring surgical procedures and for precise locat... more Image intensification of x-rays is useful in monitoring surgical procedures and for precise location of osseous pathology and foreign bodies. It is a safe technique and requires little irradiation. With the use of a fluoroscopic image intensification system, an improved image is possible with no increase in irradiation.
Journal of the American Podiatric Medical Association, 2012
Background: Moral distress is a stress symptom arising from situations that involve ethical dimen... more Background: Moral distress is a stress symptom arising from situations that involve ethical dimensions where the health-care provider believes that he or she is unable to preserve all interests and values at stake. The aims of this study were to evaluate the impact of, and identify possible differences in, moral distress in podiatric physicians in the United States and Spain and to determine the ethical principles most closely related to moral distress. Methods: A 2008 e-mail survey of 93 US podiatric physicians and 93 Spanish podiatric physicians (N ¼ 186) presented statements about different ethical dilemmas, values, and goals in the workplace. Results: Although moral distress is strongly present across the sample for all of the questions, the US sample shows higher levels of any kind of moral distress concerning questions about patients' treatment and economic constraints, overload of paperwork, and acting against one's conscience. In the US sample, 91.4% of physicians agreed mostly or completely with the statement that they often had to compromise their own values to cope with the demands of the workplace; 89.25% of US podiatric physicians indicated that their own professional values were congruent with the values of the organization; and a similar percentage (77.5%) reported a strong identification with the goals and framework of their work organization. The Spanish sample had similar results. Conclusions: The results underline the significance of moral distress for both samples, mainly related to time constraints and organizational aspects concerning patients and lack of resources.
Clinical trials were conducted at the Foot Clinics of New York, testing the use of the Johnson & ... more Clinical trials were conducted at the Foot Clinics of New York, testing the use of the Johnson & Johnson Orthosorb absorbable pins as an integral absorbable form of fixation of the Austin osteotomy. Two Orthosorb pins were inserted across the osteotomy from dorsal to plantar. Patients were placed in a plaster splint and allowed to walk with weightbearing as tolerated within 2 weeks of the procedure. A protocol was designed to include a 6-month follow-up with regularly scheduled postoperative examinations. These examinations included a review of pain, walking ability, edema, and measurements of dorsiflexion and plantarflexion. No complications have occurred in this patient population. This study has shown that for a selected group of surgical candidates, Orthosorb bioresorbable pins are an effective form of fixation for the Austin osteotomy.
Journal of the American Podiatric Medical Association, 1997
A case of gout in a patient with primary hypothyroidism has been presented. Often missed as a com... more A case of gout in a patient with primary hypothyroidism has been presented. Often missed as a companion of gout, hypothyroidism has a frequency of occurrence with gout that is significant and is probably a precipitating factor in these gouty attacks. The physician should be alert for signs and symptoms of this often occult disease in patients with hyperuricemia and gout.
A retrospective study was performed for Austin (Chevron) and basilar type osteotomies of the firs... more A retrospective study was performed for Austin (Chevron) and basilar type osteotomies of the first metatarsal in patients with preoperative intermetatarsal angles in the range of 13 to 16 degrees. Results indicated better radiographic correction for both groups than in previous studies. When comparing the results for the Chevron and basilar groups, the radiographic results were almost identical, but the Chevron group appeared to have a slightly better subjective result with less complications of metatarsalgia and callus formation and a better range of motion. Comparing intermetatarsal angle correction as a function of the preoperative hallux adductus, no definitive conclusions were made. However, the trend appears to have reduced correction with higher hallux abductus angles.
Numerous studies have shown that bacteremias occur in patients during and immediately after some ... more Numerous studies have shown that bacteremias occur in patients during and immediately after some types of surgeries, placing the patient at risk of serious infection. This study was designed to ascertain whether a bacteremia will exist following routine podiatric surgery. Blood cultures were taken perioperatively from 42 subjects, and were incubated both aerobically and anaerobically, and swabs of the incision were made during the surgery. No bacteremias occurred during this study. This suggests that podiatric surgery, when properly performed, does not present a risk of bacteremia to the patient.
Journal of the American Podiatric Medical Association
A 30-year-old man working as a waiter presented with a progressively enlarging and symptomatic so... more A 30-year-old man working as a waiter presented with a progressively enlarging and symptomatic soft-tissue mass on the plantar medial aspect of his left foot. The mass was painful and disrupting ambulation, despite footwear modifications. He ultimately underwent excision of what was a determined to be a fibrolipoma, returning to his regular shoes and all activities. Plantar neoplasms, even when benign, can grow to sizes that can result in significant disability. If left untreated, particularly in individuals engaged in occupations requiring frequent standing or walking, excision of the mass will often require a more aggressive operative approach.
Digital deformities are very common and painful conditions that often progress despite conservati... more Digital deformities are very common and painful conditions that often progress despite conservative treatment and require surgical intervention. Numerous surgical techniques and options of orthopaedic hardware exist that offer the foot and ankle surgeon a myriad of choices to achieve surgical correction and arthrodesis. While the post-operative objectives may be similar, different surgical approaches and the surgeon’s choice of implant can effect healing time, patient satisfaction, fusion times, and overall foot function. This study evaluates two different methods of fixation. A prospective randomized multicenter, central IRB approved, comparative effectiveness trial was conducted to analyze the outcomes of two surgical treatments for correcting digital deformities through arthrodesis of the proximal interphalangeal (PIP) joint. A total of 91 patient were consented (95 toes) and 58 patients (58 toes) met the inclusion – exclusion criteria and were randomized into the trial. In the f...
The authors present a review of the clinical handling of the use of local anesthetics in podiatry... more The authors present a review of the clinical handling of the use of local anesthetics in podiatry, as well as the pharmacology, the factors that determine the clinical action of the anesthetics, the toxicity to the anesthesia, allergy, its prevention and treatment, as well as the techniques of anesthesia infiltration.
For a good surgical treatment of desyndactyly a good presurgical planning must be made to decreas... more For a good surgical treatment of desyndactyly a good presurgical planning must be made to decrease the complications intra and post surgical. It is important to inform to the patient the surgical treatment purpouse and to leave in a background the aesthetic result due to the patient can feel fear and unconformed with the scars.
The authors present a review of the clinical handling of the use of local anesthetics in podiatry... more The authors present a review of the clinical handling of the use of local anesthetics in podiatry, as well as the pharmacology, the factors that determine the clinical action of the anesthetics, the toxicity to the anesthesia, allergy, its prevention and treatment, as well as the techniques of anesthesia infiltration.
Objective: This systematic review sought to determine the effectiveness of mental practice (MP) u... more Objective: This systematic review sought to determine the effectiveness of mental practice (MP) upon the activity limitations of the upper-limb in people after stroke, and when, in whom and how it should be delivered.
Image intensification of x-rays is useful in monitoring surgical procedures and for precise locat... more Image intensification of x-rays is useful in monitoring surgical procedures and for precise location of osseous pathology and foreign bodies. It is a safe technique and requires little irradiation. With the use of a fluoroscopic image intensification system, an improved image is possible with no increase in irradiation.
Journal of the American Podiatric Medical Association, 2012
Background: Moral distress is a stress symptom arising from situations that involve ethical dimen... more Background: Moral distress is a stress symptom arising from situations that involve ethical dimensions where the health-care provider believes that he or she is unable to preserve all interests and values at stake. The aims of this study were to evaluate the impact of, and identify possible differences in, moral distress in podiatric physicians in the United States and Spain and to determine the ethical principles most closely related to moral distress. Methods: A 2008 e-mail survey of 93 US podiatric physicians and 93 Spanish podiatric physicians (N ¼ 186) presented statements about different ethical dilemmas, values, and goals in the workplace. Results: Although moral distress is strongly present across the sample for all of the questions, the US sample shows higher levels of any kind of moral distress concerning questions about patients' treatment and economic constraints, overload of paperwork, and acting against one's conscience. In the US sample, 91.4% of physicians agreed mostly or completely with the statement that they often had to compromise their own values to cope with the demands of the workplace; 89.25% of US podiatric physicians indicated that their own professional values were congruent with the values of the organization; and a similar percentage (77.5%) reported a strong identification with the goals and framework of their work organization. The Spanish sample had similar results. Conclusions: The results underline the significance of moral distress for both samples, mainly related to time constraints and organizational aspects concerning patients and lack of resources.
Clinical trials were conducted at the Foot Clinics of New York, testing the use of the Johnson & ... more Clinical trials were conducted at the Foot Clinics of New York, testing the use of the Johnson & Johnson Orthosorb absorbable pins as an integral absorbable form of fixation of the Austin osteotomy. Two Orthosorb pins were inserted across the osteotomy from dorsal to plantar. Patients were placed in a plaster splint and allowed to walk with weightbearing as tolerated within 2 weeks of the procedure. A protocol was designed to include a 6-month follow-up with regularly scheduled postoperative examinations. These examinations included a review of pain, walking ability, edema, and measurements of dorsiflexion and plantarflexion. No complications have occurred in this patient population. This study has shown that for a selected group of surgical candidates, Orthosorb bioresorbable pins are an effective form of fixation for the Austin osteotomy.
Journal of the American Podiatric Medical Association, 1997
A case of gout in a patient with primary hypothyroidism has been presented. Often missed as a com... more A case of gout in a patient with primary hypothyroidism has been presented. Often missed as a companion of gout, hypothyroidism has a frequency of occurrence with gout that is significant and is probably a precipitating factor in these gouty attacks. The physician should be alert for signs and symptoms of this often occult disease in patients with hyperuricemia and gout.
A retrospective study was performed for Austin (Chevron) and basilar type osteotomies of the firs... more A retrospective study was performed for Austin (Chevron) and basilar type osteotomies of the first metatarsal in patients with preoperative intermetatarsal angles in the range of 13 to 16 degrees. Results indicated better radiographic correction for both groups than in previous studies. When comparing the results for the Chevron and basilar groups, the radiographic results were almost identical, but the Chevron group appeared to have a slightly better subjective result with less complications of metatarsalgia and callus formation and a better range of motion. Comparing intermetatarsal angle correction as a function of the preoperative hallux adductus, no definitive conclusions were made. However, the trend appears to have reduced correction with higher hallux abductus angles.
Numerous studies have shown that bacteremias occur in patients during and immediately after some ... more Numerous studies have shown that bacteremias occur in patients during and immediately after some types of surgeries, placing the patient at risk of serious infection. This study was designed to ascertain whether a bacteremia will exist following routine podiatric surgery. Blood cultures were taken perioperatively from 42 subjects, and were incubated both aerobically and anaerobically, and swabs of the incision were made during the surgery. No bacteremias occurred during this study. This suggests that podiatric surgery, when properly performed, does not present a risk of bacteremia to the patient.
Journal of the American Podiatric Medical Association
A 30-year-old man working as a waiter presented with a progressively enlarging and symptomatic so... more A 30-year-old man working as a waiter presented with a progressively enlarging and symptomatic soft-tissue mass on the plantar medial aspect of his left foot. The mass was painful and disrupting ambulation, despite footwear modifications. He ultimately underwent excision of what was a determined to be a fibrolipoma, returning to his regular shoes and all activities. Plantar neoplasms, even when benign, can grow to sizes that can result in significant disability. If left untreated, particularly in individuals engaged in occupations requiring frequent standing or walking, excision of the mass will often require a more aggressive operative approach.
Digital deformities are very common and painful conditions that often progress despite conservati... more Digital deformities are very common and painful conditions that often progress despite conservative treatment and require surgical intervention. Numerous surgical techniques and options of orthopaedic hardware exist that offer the foot and ankle surgeon a myriad of choices to achieve surgical correction and arthrodesis. While the post-operative objectives may be similar, different surgical approaches and the surgeon’s choice of implant can effect healing time, patient satisfaction, fusion times, and overall foot function. This study evaluates two different methods of fixation. A prospective randomized multicenter, central IRB approved, comparative effectiveness trial was conducted to analyze the outcomes of two surgical treatments for correcting digital deformities through arthrodesis of the proximal interphalangeal (PIP) joint. A total of 91 patient were consented (95 toes) and 58 patients (58 toes) met the inclusion – exclusion criteria and were randomized into the trial. In the f...
The authors present a review of the clinical handling of the use of local anesthetics in podiatry... more The authors present a review of the clinical handling of the use of local anesthetics in podiatry, as well as the pharmacology, the factors that determine the clinical action of the anesthetics, the toxicity to the anesthesia, allergy, its prevention and treatment, as well as the techniques of anesthesia infiltration.
For a good surgical treatment of desyndactyly a good presurgical planning must be made to decreas... more For a good surgical treatment of desyndactyly a good presurgical planning must be made to decrease the complications intra and post surgical. It is important to inform to the patient the surgical treatment purpouse and to leave in a background the aesthetic result due to the patient can feel fear and unconformed with the scars.
The authors present a review of the clinical handling of the use of local anesthetics in podiatry... more The authors present a review of the clinical handling of the use of local anesthetics in podiatry, as well as the pharmacology, the factors that determine the clinical action of the anesthetics, the toxicity to the anesthesia, allergy, its prevention and treatment, as well as the techniques of anesthesia infiltration.
Objective: This systematic review sought to determine the effectiveness of mental practice (MP) u... more Objective: This systematic review sought to determine the effectiveness of mental practice (MP) upon the activity limitations of the upper-limb in people after stroke, and when, in whom and how it should be delivered.
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Papers by Michael Trepal