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NewYork,NewYork

PrakashKrishnan,MD,FACC

DirectorofEndovascularServices CardiacCatheterizationLaboratory AssistantDirectorofMountSinaiHeartNetwork MountSinaiHeart AssistantProfessorofMedicine MountSinaiSchoolofMedicine NewYork,NewYork

RekhaKumar,MD

AssistantProfessorofMedicine AttendingEndocrinologist ComprehensiveWeightControlCenter WeillCornellMedicalCollege NewYork,NewYork

MarkLebwohl,MD

ProfessorandChairman DepartmentofDermatology MountSinaiSchoolofMedicine NewYork,NewYork

LeonardA.Levy,DPM,MPH

AssociateDeanforResearchandInnovation Director,InstituteforDisasterandEmergencyPreparedness ProfessorofFamilyMedicine/PublicHealth/BiomedicalInformatics NovaSoutheasternUniversityCollegeofOsteopathicMedicine FortLauderdale,Florida

StevenK.Magid,MD

Professor,ClinicalMedicine WeillCornellMedicalCollege AttendingPhysician HospitalforSpecialSurgery NewYork-PresbyterianHospital NewYork,NewYork

BellaMehta,MD

RheumatologyFellow HospitalforSpecialSurgery NewYork,NewYork

https://t.me/medicina_free

CarolineMiranda,MD

Resident DepartmentofNeurology NewYork-Presbyterian/WeillCornellMedicalCenter NewYork,NewYork

JeffreyY.F.Ngeow,MD

AssociateAttendingAnesthesiologist HospitalforSpecialSurgery ClinicalAssociateProfessorofAnesthesiology WeillCornellMedicalCollege NewYork,NewYork

HelenePavlov,MD,FACR

ProfessorofRadiology ProfessorofRadiologyinOrthopaedicSurgery WeillCornellMedicalCollege AttendingRadiologist NewYork,NewYork

MaryAnnPicone,MD

MedicalDirector MultipleSclerosisComprehensiveCareCenteratHolyNameHospital Teaneck,NewJersey

RockC.J.Positano,BA

NewYorkCollegeofPodiatricMedicine JoeDiMaggioSportsMedicineFootandAnkleCenter HospitalforSpecialSurgery NewYork,NewYork

RockG.Positano,DPM,MSc,MPH

Director Non-surgicalFootandAnkleService JoeDiMaggioSportsMedicineFootandAnkleCenter SportsMedicineService HospitalforSpecialSurgery NewYork,NewYork

NewYork-PresbyterianHospital/WeillMedicalCollegeofCornellUniversity DepartmentofMedicine DepartmentofCardiothoracicSurgery NewYork,NewYork

https://t.me/medicina_free

ProfessorandChairman DepartmentofAcademicOrthopedicScience NewYorkCollegeofPodiatricMedicine NewYork,NewYork

BhaskarPurushottam,MD

Fellow Endovascular&StructuralInterventionalCardiology MountSinaiMedicalCenter NewYork,NewYork

AlyssaG.Rehm,MD

Resident DepartmentofNeurology NewYork-PresbyterianHospital NewYork,NewYork

SatinderS.RekhiJr.,MD

RadiologyFellow DepartmentofRadiology HospitalforSpecialSurgery Fellow DepartmentofRadiology WeillCornellMedicalCollege NewYork,NewYork

AndrewJ.Rosenbaum,MD

Fellow FootandAnkleService DepartmentofOrthopaedicSurgery HospitalforSpecialSurgery NewYork,NewYork

YecheskelSchneider,MD

ClinicalandResearchFellow DivisionofGastroenterologyandHepatology NewYork-Presbyterian/WeillCornellMedicalCenter NewYork,NewYork

BrianShaffer

AssociateProfessor DepartmentofObstetrics&Gynecology-MaternalFetalMedicine OregonHealth&ScienceUniversity

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Portland,Oregon

RahulSharma,MD,MBA,CPE,FACEP

ExecutiveViceChief AssociateProfessorofClinicalMedicine DivisionofEmergencyMedicine WeillCornellMedicalCollege NewYork,NewYork

AlpanaShukla,MD,MRCP(UK)

AssistantProfessorofResearchinMedicine ComprehensiveWeightControlCenter DivisionofEndocrinology,Diabetes,&Metabolism WeillCornellMedicalCollege NewYork,NewYork

CarolynM.Sofka,MD,FACR

AssociateProfessorofRadiology DepartmentofRadiology WeillCornellMedicalCollege AssociateAttendingRadiologist DepartmentofRadiology HospitalforSpecialSurgery NewYork,NewYork

JessicaR.Spivey,MD

RadiologyResident DepartmentofRadiology NewYork-Presbyterian/WeillCornellMedicalCenter NewYork,NewYork

DexterY.Sun,MD,PhD

ClinicalProfessorofNeurology WeillCornellMedicalCollege NewYork-PresbyterianHospital/WeillCornellMedicine HospitalforSpecialSurgery NewYork,NewYork

MarkH.Swartz,MD

Professor DepartmentofMedicalScience VicePresident,MedicalandProfessionalAffairs NewYorkCollegeofPodiatricMedicine

https://t.me/medicina_free

ProfessorofMedicine SUNYDownstateCollegeofMedicine AdjunctClinicalProfessorofMedicine AlbertEinsteinCollegeofMedicine AdjunctProfessorofMedicine NewYorkMedicalCollege NewYork,NewYork

IshaanSwarup,MD

Resident DepartmentofOrthopaedicSurgery HospitalforSpecialSurgery NewYork,NewYork

MinyiTan,MD

AssistantProfessor DepartmentofAnesthesiology StonyBrookUniversitySchoolofMedicine StonyBrook,NewYork

ArthurTarricone,MPH

MountSinaiHeart MountSinaiMedicalCenter NewYork,NewYork

JasonP.TartaglioneMD

Resident DepartmentofOrthopaedicSurgery AlbanyMedicalCenter Albany,NewYork

MichaelJ.Trepal,DPM,FACFAS

ProfessorofSurgery VicePresidentforAcademicAffairs Dean NewYorkCollegeofPodiatricMedicine NewYork,NewYork

HunterVincent,DO

ResidentPhysician DepartmentofPhysicalMedicineandRehabilitation UniversityofCalifornia,Davis Sacramento,California

https://t.me/medicina_free

RihamM.Wahba,MD

ResearchAssistant JohnsHopkinsUniversitySchoolofMedicine Baltimore,Maryland

CloverYounWest,DO

Resident Neurology MountSinaiBethIsrael NewYork,NewYork

GeoffreyH.Westrich,MD

AssociateProfessor DepartmentofOrthopaedicSurgery HospitalforSpecialSurgery NewYork,NewYork

PeterZ.Yan,MD

ChiefResident ClinicalOperations DepartmentofNeurology WeillCornellMedicalCenter NewYork-PresbyterianHospital NewYork,NewYork

https://t.me/medicina_free

edicinehasneededacutting-edge,authoritativetextbookonhowsystemic diseasecan

manifestin thefoot,ankle,andoverall lower extremity. Itis with greatpleasure, and from thepersonal point ofview of a satisfied consumer,that I writethe foreword forthis fascinatingbook.

Podiatric problems provide vital insights into the health care system as a window to systemicdisease,coveringallthebodysystemssuchasnerves,vascular,skin,endocrine,and musculoskeletal.

Footandanklepainwilloftenbringapersonintothehealthcaresystembecauseofhowit threatenstheir lifestyle.It happens quite oftenthatapodiatricevaluationwill pointtoother pathologiesthatcanthenbeidentifiedandtreatedbytheappropriatespecialist.

Therefore,whileapatientmaypresentwithseeminglyminormaladies,itiscriticalthatthe medical professional has the knowledge and insight to identify those lower extremity pathologies as markers for more systemic disease. From quality-of-life issues to a more seriousexaminationofoverallhealth,theDoctorofPodiatricMedicine(DPM)inconjunction with the Doctor of Medicine (MD) has the opportunity to open a portal to an integrated science–basedhealthcareapproachthatseekstohealthewholebody.

AsDr. Positano andI havediscussed,therehas beenno significantresearchinWestern medicinethat“maps”outthe footandthe many meridiansthat Easternmedicinehasalways recognizedascriticaltowell-being.Forthefirsttime,thereisanauthoritativebook,clearly, compellingly, and eloquently written, that provides a benchmark for the practicing medical professional.

ItisrarethatIrecommendamedicaltextbookasbothsageandilluminating.ButIdoso hereinwithnoreservation.

PaulGreengard,PhD

NobelLaureate(2000)PhysiologyorMedicine

VincentAstorProfessor

LaboratoryofMolecularandCellularNeuroscience

TheRockefellerUniversity

NewYork,NewYork

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he foot, ankle,andlowerextremity is often referred to by those health care providers who specialize in these areas as amirror of systemic disease because many systemic

diseases,includingheartdisease,diabetes,skindisease,andneurologicdisease,firstpresent inthisanatomicregionofthebody.Althoughalltoofrequentlyignored,examination ofthe lowerextremitycanreflecta person’sgeneral health, both physical andpsychological, and the overall condition of the body’s functional systems such as cardiovascular, neurologic, dermatologic, musculoskeletal, and endocrinologic. Yet, when patients visit their internists, theyareusuallyinstructedto“Takeoffeverythingbutyourshoesandsocks.”Bynotexamining thefootandankle,thephysiciancanmisstheearlywarningsystemofdiseasethatthelower extremitycanprovide.

The foot is unique because it contains all the systems of the body, including

musculoskeletal,vascular,neurologic,dermatologic,andimmune.

Apainfulfoot,heel,bunion,tendon,knee,hip,orlowerbackwillbringapatientintothe healthcaresystem,becausethepaininterfereswithmobility.Theabilitytodoeverydaytasks, such as exercise, walking,shopping, playing sports, is often limited.Foot,ankle,and lower extremitypathologicconditionsmaynotbelifethreateninginmostcases,buttheydorestrict lifestylebothdirectlyandindirectlyandalsothephysicalandmentalhealth.Thisdisruption inthequalityoflifewillbringthepatientintothehealthcaresystem,whichcanresultinearly identification of many more serious medical problems and can lead to referral to the appropriatemedicalspecialist.Significantlife-threateningpathologiesincludingmalignant

neoplasms, cardiovascular disorders, immunosuppressive syndromes, and progressive neuromuscular disease may initially manifest with subtle lower extremity signs and symptoms.

HealthprofessionalswiththeMD,DPM,DO,DC,DPT,andPAtitles,whospecializein musculoskeletal care, canoften recognizesystemic disease initsinfancy or moreadvanced stages.Clinical medicalstudiescould bederived from thethoroughexaminationofthefoot, ankle, and lower extremity in relation to systemic disease. Internal medicine and musculoskeletal disciplines potentially could meet, explore, and produce a new area of specialization.

Forthesereasons,practitionersofinternalmedicine,orthopedics,andpodiatricmedicine needtomaketheexaminationofthefoot,ankle,andlowerextremityanimportantandintegral partoftheirphysicalexamination.Residents,fellows,medicalstudents,andmusculoskeletal practitioners should be instructed inthethorough examinationof the foot,ankle, andlower

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extremity.Itisapowerfuldiagnostictoolthatistoooftenignored.

RockG.Positano,DPM,MSc,MPH

ChristopherW.DiGiovanni,MD

JeffreyS.Borer,MD

MichaelJ.Trepal,DPM

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Preface

CHAPTER1•PresentationofSystemicDiseaseWhenImagingtheLowerExtremity

HelenePavlov,CarolynM.Sofka,SatinderS.RekhiJr.,andJessicaR.Spivey

CHAPTER2•SeronegativeandSeropositiveRheumatologicDisordersAffectingthe LowerExtremity

StephenJ.Dimartino

CHAPTER3•PedalManifestationsofCardiacDisease

MichaelJ.Trepal,MarkH.Swartz,RockG.Positano,andLorettaCacace

CHAPTER4•InfectiousDisease(BoneandSoftTissue)

MarkKosinski

CHAPTER5•PedalandLowerExtremityManifestationsofDiabetesMellitus

KhurramH.KhanandTaraBlitz-Herbel

CHAPTER6•NeuromuscularDiseaseandPresentationInvolvingtheLowerExtremity

PeterZ.Yan,AlyssaG.Rehm,CarolineMiranda,andDexterY.Sun

CHAPTER7•EdemaintheLowerExtremity:PathophysiologyandDifferentialDiagnosis

JeffreyS.Borer,BrianShaffer,RockC.J.Positano,andLorettaCacace

CHAPTER8•DeepVenousThrombosis,Thromboembolism,Thrombophlebitisinthe LowerExtremity

IshaanSwarup,JohnBoles,andGeoffreyH.Westrich

CHAPTER9•PeripheralArterialDisease

SachinKumarAmruthlalJain,ArthurTarricone,BhaskarPurushottam,andPrakashKrishnan

CHAPTER10•GaitDisorders

JosephC.D’amico

CHAPTER11•TumorsoftheLowerExtremity

HenryDeGroot

CHAPTER12•RegionalPainSyndromesThatPresentintheFoot,Ankle,andLower Extremity

JeffreyY.F.NgeowandMinyiTan

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