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2015-2016 PMR Vol 24 the Final Copy 2.Pages New York College of Podiatric Medicine Podiatric Medical Review Volume 24 2015-2016 Case Report: Gangrenous Toes due to Heparin- Bone Marrow Edema Syndrome of the Talus: A Case Induced Thrombocytopenia Report and Literature Review Mika Hirano, BS, and Sharon Barlizo, DPM 4 Joseph Waterhouse, BS, and Glenn Weiss, DPM 96 Herpes Zoster as a Rare Cause of Foot Drop: A A Review of Current Case Reports Involving Sports- Literature Review of Case Reports Related Tarsometatarsal (TMT) Joint Complex Sara Stachura, BS, BA, Adenike Sonaike, BS, Pathologies Lauren Kuenzi, BS 11 Alexandra Black, BA, Rosario Saccomanno, BS, Jered M. Stowers, BS, BA 102 The Role of the Windlass Mechanism in the Pathogenesis of Plantar Fasciitis A Comparison of Non-Surgical and Surgical Djavlon Khakimov, BS, Raymond Morales, BS, 20 Treatment Options in Diabetic Foot Calcaneal Sang Hyub Kim, BA, Diltaj Singh, BS Osteomyelitis: A Literature Review Tyrone Mayorga, BA, Yasmin Sarraf, BS, A Literature Review on the Contributing Factors of Dhaval Patel, BS 115 Second Metatarsal Stress Fractures in Ballet Dancers Pooja Shah, BA, Maya Robinson, BS, 28 The Efficacy of Maggot Debridement Therapy on Suganthi Kandasamy, BA, MPH Diabetic Foot Ulcers and Its Further Applications Gabrielle Lee, BA, Paulina Piekarska, BS, A Systematic Review of Plantar Calcaneonavicular Michael Sayad, BS 126 Ligament Reconstruction Techniques And Its Role In Maintaining The Medial Longitudinal Arch Current Surgical Management of Charcot Neuroarthropathy: A Systematic Qualitative Review Gireesh Reddy, BS, Ammar Al Rubaiay, BA, 36 Abigail B. Dunklee, BS, Alisha Poonja, BS, Ibn Ansari, BS Edwin Zhu, BA, Kenny Luong, BA, Sam Mark, BS 143 The Apert Foot: Anatomy and Management Effects of Adjuvants on Onset and Duration of Local James H. Chung, BS, and Hye Jin Yoo, BS 44 Anesthetics Used In Regional Nerve Block Amara Abid, BS, MSC, Alina Kogan, BS, A Systematic Review of Mesenchymal and Amniotic Nader Ghobrial, BS, MSC 153 Stem Cell Therapy of Achilles Tendinopathies Sirisha V. Pokala, BS, Sahar R. Zadeh, BS, 53 A Literature Review of Malignancies Masquerading as Diabetic Ulcers McKenna Green, BS, Traci Bologna-Jill, BA, A Comparative Review of Minimally Invasive Surgical Vrunda Dalal, BA, MBS, Disha Shah, BA Treatment Options for Intra-articular Calcaneal 162 Fractures A Qualitative Review of Surgical Interventions in the Danielle Dubois, BS, Mark Rotenstein, BS, 61 Treatment of Jones Fractures: Comparison of Nicholas Salerno, BS Intramedullary Screw Fixation and External Fixation Kevin Yee, BA, Brittany Hervey, BS, The Effects of Foot Orthoses on Achilles Sang Hyub Kim, BA 170 Tendinopathy in Runners: A Systematic Review 75 Maria C. Cifone, BS, and Hye Jin Yoo, BS The Advantages of Dermoscopy in the diagnosis of Acral Melanoma from Other Podiatric Lesions: A Low-Level Laser Therapy in Patients with Diabetic Literature Review Peripheral Neuropathy: A Systematic Literature HyunJi Boo, BS, Suganthi Khandasamy, BA, MPH, Review Dhagash Patel, BA, BS, Mansi Patel, BA Sahar Zadeh, BS, Daniel J. Stevens, MLS(ASCP)CM 87 180 STUDENT JOURNAL OF THE NEW YORK PMRCOLLEGE OF PODIATRIC MEDICINE Editors-in-Chief Aaron P. Bradley, BS Danielle E. Boyle, BS Senior Editor Sam Mark, BS Editors Djavlon Khakimov, BS Sang Hyub Kim, BA Student Peer Reviewers Faculty Reviewers Mustafa Ahmed, BS Sharon Barlizo, DPM Shadi Aouad, BS Loretta Cacace, DPM, MPH HyunJi Boo, B.Sc. Johanna Godoy, DPM James H. Chung, BS Khurram Khan, DPM McKenna Green, BS Kristina Karlic, DPM Brittany Hervey, BS Danielle McNeil, DPM Rahman Majid, BS Barbara Resseque, DPM Tyrone Mayorga, BA Susan Rice, DPM Raymond Morales, BS Michael Rossidis, DPM Mansi Patel, BA Michael Rothstein, NP Diltaj Singh, BS Thomas Vitale, DPM Sara Stachura, BS, BA Russell Volpe, DPM Jered Stowers, BS, BA Adrian Wright, DPM Faculty Advisor Communications Director Anthony Iorio, DPM Ellen Lubell, Editor !2 Podiatric Medical Review • Volume 24 A Note from the Editors We are delighted to present the twenty-fourth volume of the Podiatric Medical Review (PMR). The efforts from previous Editors-in-Chief Dr. Adrian Wright and Dr. Michael Rossidis have considerably raised the stature and quality of the PMR over the past four years. Since its hiatus four years ago, the journal has grown immensely and has adapted to the evolving field. Our editorial board has expanded to adjust for the record volume of manuscript submissions this year. This year we also implemented an Executive Board mentorship program to cultivate peer editing skills in addition to continuing the monthly research workshops we offer to all students on campus. Additionally, we would like to extend our gratitude to the senior editor, editors, and peer reviewers for their countless efforts and sacrifices. This year's journal would not have been possible without their hard work and dedication. The peer reviewers are all strongly dedicated to advancing practices to reflect the evolving research and techniques of podiatric medicine. Though the PMR has continued to evolve year after year, the direction of the PMR still remains committed to serve as a learning platform for podiatric medical students. We are proud of the fact that this journal is run by the student body at the NYCPM campus. Our hope is that the readers not only learn from the topics presented, but also use this platform as a stepping stone to ignite curiosity that encourages the pursuit of new research. With this new research we hope to obtain the ultimate goal of improving care for our patients. Danielle Boyle, BS Aaron Bradley, BS Editor-in-Chief Editor-in-Chief !3 Case Report: Gangrenous Toes due to Heparin- Induced Thrombocytopenia Mika Hirano, BS and Sharon Barlizo, DPM Abstract Introduction Heparin-induced-thrombocytopenia has been proven in literature to cause distal limb gangrene, although it is uncommon. It is a condition in which heparin exposure causes individuals to form IgG antibodies against platelet factor 4 (PF4) and heparin complex. The antibodies bind to platelets and endothelial receptors, resulting in platelet activation and a limb threatening, paradoxical thrombotic state that can manifest as distal limb gangrene. Methods A careful history was taken from the patient when she came into clinic. The patient’s past medical notes were reviewed to get further information of her situation. A thorough literature search was done to review other cases of gangrene from heparin-induced thrombocytopenia. Study Design: Case Report Results A 59 year old female patient presented with a reaction to heparin, which was administered following a stroke she suffered during an aortic dissection repair surgery. Subsequent to the reaction, the patient developed gangrene on the right second and fourth toes. Patient was taken off of heparin immediately and she has been taking Coumadin since her discharge. Her clinic notes indicate that she was positive for heparin-induced-thrombocytopenia and spontaneous platelet aggregation at the onset of gangrene. This patient’s case of gangrene has not yet resolved after five months and continues to get progressively worse. There have been cases in literature in which the gangrene has resolved without complications, has resulted in amputations, and has been fatal. Conclusion It is important for us physicians to recognize and monitor for this disorder as well as identify those individuals at increased risk for heparin-induced-thrombocytopenia in order to reduce the likelihood and severity of associated complications, such as an amputation. Keywords: Heparin-induced thrombocytopenia, gangrene Level of Evidence: 4 !4 NYCPM PMR Vol. 24 INTRODUCTION antibodies against platelet factor 4 (PF4) and heparin complex. Platelet factor 4 is a Heparin is a commonly used intravenous chemokine expressed by megakaryocytes anticoagulant agent worldwide for treatment and is released from platelet α-granules and prophylaxis of thrombosis, emboli, and when platelets become activated.1 Cosmi et stroke. Although severe side effects to this al. has found that only the IgG antibody is d r u g a r e r a r e , h e p a r i n - i n d u c e d - pathological, even though IgM and IgA thrombocytopenia (HIT) is a very dangerous antibodies are also created. The roles of IgM complication characterized by a drop in and IgA antibodies in the development of HIT platelet count and a paradoxical currently remain uncertain. In addition, Nazi hypercoagulable state1. Gangrene at the et al. has found that the IgG antibodies need distal ends of their extremities will occur as a to be present at a certain titer level in order result of the thrombosis. If treatment is not for HIT to occur. When the antibodies bind to initiated promptly, the body will continue to the complex, platelets get activated and form thromboses, despite progressively depleted. This usually occurs about 5-10 decreasing levels of platelets, leading to life- days after initial exposure to heparin, or threatening complications. earlier if there was another previous exposure to heparin less than 30 days ago.2 There are two types of heparin-induced Although the platelet count decreases, it thrombocytopenia described in literature. causes a thrombotic state as the complexes Type 1 HIT occurs due to direct activation of release platelet-derived procoagulant platelets by heparin and usually resolves on microparticles and activates monocytes and its own. However, it is mostly implied that the endothelial cells.1 This is paradoxical term “heparin-induced thrombocytopenia” is because thrombotic state is usually referring to type 2 and the distinction associated with increasing levels of platelets, between type 1 and type 2 are historical.1 however in the case of HIT, the thrombotic Type 2 HIT occurs due to formation of IgG state is caused by the increased levels of complex formed by IgG antibody, PF4, and heparin. As a result, thrombins may form, which subsequently can cause arterial and venous thrombosis and gangrene. In this case report, we present a patient who presented to the podiatry clinic with gangrenous toes as a result of heparin- induced-thrombocytopenia, following an aortic dissection repair surgery.
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