Introduction: Hammertoe deformities are one of the most common foot deformities affecting up to one-third of the general population. There are a multitude of surgical techniques to correct fixed and/or complex hammertoes with proximal interphalangeal joint arthrodesis. Fusion of the joint can be achieved with various devices with today’s focus on percutaneous Kirschner (K-) wire fixation or commercial intramedullary implant (CI) devices. Purpose: The purpose of this study was to determine whether surgical intervention with percutaneous Kirschner wire versus commercial intramedullary implant is more cost effective for proximal interphalangeal joint arthrodesis in hammertoe surgery. A formal cost-effectiveness analysis using a decision analytic tree model was conducted to investigate the healthcare costs and outcomes associated with either K-wire or CI fixation. Outcomes assessed included long-term costs, quality-adjusted life-years (QALYs), and incremental cost per QALY gained. Costs were evaluated from the healthcare system perspective and expressed in US dollars at a 2017 price base. Results: Our results found commercial implants were minimally more effective than K-wires, but carried significant more cost. The total cost for treatment with percutaneous K-wire was $5,041 with an effectiveness of 0.82 QALYs versus commercial implant cost of $6,059 with an effectiveness of 0.83 QALYs. The incremental cost-effectiveness ratio (ICER) of commercial implants was $146,667. Conclusion: With an ICER of greater than $50,000, commercial implants fail to justify their proposed benefits to outweigh the cost of percutaneous K-wires. In conclusion, percutaneous K-wires would be the preferred treatment for arthrodesis of the PIPJ for hammertoes from a healthcare system perspective.

The purpose of this study was to determine whether surgical intervention with open reduction internal fixation (ORIF) or primary arthrodesis (PA) for Lisfranc injuries is more cost effective. We conducted a formal cost-effectiveness analysis using a Markov model and decision tree to explore the healthcare costs and health outcomes associated with a scenario of ORIF versus PA for 45 years post-operatively. Outcomes assessed included long-term costs, quality-adjusted life-years (QALYs), and incremental cost per QALY gained. Costs were evaluated from the healthcare system perspective and expressed in US dollars at a 2017 price base. ORIF was always associated with greater costs compared to PA, and was less effective long term. When calculating the cost required to gain 1 additional QALY, the PA group cost $1429/QALY, while the ORIF group cost $3958/QALY. The group undergoing primary arthrodesis overall spent on average $43,192 less than the ORIF group, and was overall a more effective technique. Strong dominance over ORIF was demonstrated in multiple scenarios and the model’s conclusions were unchanged in the sensitivity analysis even after varying key assumptions. ORIF failed to show functional or financial benefits. We conclude that from a healthcare system’s standpoint, primary arthrodesis would clearly be the preferred treatment strategy for predominantly ligamentous Lisfranc fracture/dislocations.

The presence of a diabetic foot ulcer is an indication of poorly managed diabetes (Pinzur, Freeland, & Juknelis 2005). Complications associated with a diabetic foot ulcer can lead to amputation which are associated with reductions in quality of life (Boulton et al. 2005; Moulik, Mtonga & Gill 2003; Nabuurs-Franssen et al. 2005; Valensi et al. 2005) and an overall increased risk of mortality (Boulton et al. 2005; Boyko et al. 1996; Martins-Mendes et al. 2014). With early intervention and appropriate advanced wound care, ulcer related amputations can be avoided. Previous studies have demonstrated geographic disparities in rates of amputations (Amin et al. 2014; Margolis et al. 2011; Stevens et al. 2014), but little work has addressed whether there are disparities in diabetic ulcer severity at presentations and outcomes. The purpose of this analysis is to examine the sociogeographic correlates of diabetic foot ulcers in a national sample of outpatient wound care data. Specifically, we test whether there are sociogeographic disparities in diabetic foot ulcer severity at the time of ulcer presentation to an outpatient wound care clinic. Further, we examine the association between foot ulcer healing and amputation with geographic characteristics such as median income, racial distribution, and age distribution of the surrounding community. This analysis uses data from 2014-2017 on N=269,098 diabetic foot ulcer patients from a national sample of outpatient wound care clinics and combined with census population data. Wound severity at time of presentation is assessed using ulcer size, ulcer duration, and Wagner grade. Both wound and patient characteristics are described. Preliminary findings indicate that there are significant geographic disparities in ulcer severity at time of first assessment as well as ulcer healing.

Background: The Centers for Disease Control and Prevention estimates that between 60 and 70% of persons with diabetes will develop neuropathy during the course of their disease. In the United States an estimated 29 million people have diabetes mellitus. Foot ulcers and lower extremity infections are major complications leading to amputations diminished productivity and quality of life. The purpose of the study is to examine individual, social, and health systems factors for footcare among diabetic individuals. This is important effective disease management and improved quality of life. Methods: Weighted data for 11,280 diabetic adults from the 2014-2016 National Health Interview survey for 2014, 2015 and 2016 we modeled to determine predictors of specialist foot care. Data analyzed using Stata 15.0 for Windows and alpha of 0.05. Results: The mean age was 55.0 years (SD=20.9) and predominately female (53.5% vs 46.5% male); 71.9% white and 19.4% Black/African American; 52.3% obese. A tenth (11.2%) needed assistance with caring for themselves, while 5% reported having transportation problems within the 12 months before the interview. Overall, 21.44 have access to podiatric care while 11.5% of patients with activity limitations had access to podiatric care(p<0.001). At multivariate level, having insurance ((OR=1.4; 95% CI: 1.07-1.8), regular source of care (OR=4.2; 95% CI: 2.57-6.88), having personal care (OR=1.48; p<0.01), and having activity limitations (OR=0.65; p<0.001) were significantly associated with access to podiatric care. Conclusion: Having a regular source of care, family support, and general mobility facilitate access and use of critical specialist care in diabetics.