In 42 limbs of 36 patients with severe pedal disease suffering from chronic limb-threatening ischemia (CLTI) , we performed percutaneous deep venous arterialization (pDVA)by conventional balloon angioplasty as an alternative to the LimFlow system, which has not yet been approved in Japan. Here, we report on the techniques used and outcomes achieved. The procedure involved first passing a wire through to the plantar veins and performing balloon dilation of the occluded tibial artery (usually the posterior tibial artery) up to the ankle joint to perfuse the foot veins with arterial blood. Then, we used the venous arterialization simplified technique to create a tibial arteriovenous fistula at the ankle. The cohort comprised of 94.4% dialysis patients, all of whom had wounds on their feet; 57.1% of the patients had Rutherford category 6. The procedure success rate was 100%, and no serious complications occurred. Except for two limbs that required bailout stents, all limbs were successfully treated by balloon dilation only. Although the one-year cumulative amputation-free survival rate was poor (47.0%) , only four limbs required major amputations, and the wound healing rate at one year was 56.0%. Our method of using only balloon angioplasty appears to be a viable option for pDVA.

 Tinea pedis is a notable foot care concern, especially as an exacerbating factor for diabetic foot conditions. It is categorized into three types: interdigital, vesicular, and keratotic. The keratotic type is characterized by minimal pruritus in the heel lesion. Accurate diagnosis is crucial, as this disorder may be asymptomatic. The gold standard for diagnosing tinea pedis is the potassium hydroxide (KOH) direct microscopic method. However, the method requires experience, especially for the collection of specimens. In the present study, we explored an alternative approach using a cosmetic electric callus remover (hereinafter referred to as ‘Remover’) . Additionally, we assessed the diagnostic utility of a dermatophyte antigen kit (hereinafter referred to as ‘Kit’) , which incorporates a monoclonal antibody to dermatophytes. Our study included 39 participants: 19 individuals with keratotic-type tinea pedis or a primary complaint of heel keratosis, and 20 able-bodied volunteers. We found that both the Kit and the KOH methods yielded well-matched data in terms of sensitivity, specificity, diagnostic accuracy, positive likelihood ratio, and negative likelihood ratio. The combination of the Remover and the Kit may be useful for diagnosing keratotic-type tinea pedis and could serve as an auxiliary tool to improve diagnostic accuracy.

 Toenails in the elderly have a high prevalence of onychomycosis in addition to age-related changes. This is attributed to insufficient awareness and neglect of nail care, both by the elderly themselves and their caregivers. We investigated the relationship among toenail care practices, associated factors, and the incidence of onychomycosis in elderly individuals.

 Chronic limb-threatening ischemia (CLTI) has a poor prognosis and significantly reduces quality of life and activities of daily living. Pain is severe and pain management remains inadequate for many patients despite medical intervention, potentially causing discontinuation of treatment. This study investigated the long-term efficacy of spinal cord stimulation (SCS) as a treatment modality for pain control in CLTI. SCS involves both a trial phase, where a test stimulus is used, and implantation to assess its efficacy. Herein, we report trial phase cases. SCS was performed for pain control in 33 CLTI patients at Kasukabe Chuo General Hospital between January 2015 and August 2022. Pre- and post-SCS assessments included numeric rating scale (NRS) , Oswestry disability index 2.0 (ODI) , and pain catastrophizing scale (PCS). Wilcoxon signed-rank sum test was used for statistical analysis (significance level of p < 0.05) . We found significant reductions in NRS (mean decrease of 5, n=61) , ODI (mean decrease of 12 points, n=14), and PCS (mean decrease of 13 points, n=8). Our findings suggest that SCS is an effective pain management strategy for CLTI.

 Objective: Hand-foot syndrome (HFS), caused by chemotherapy damages the skin on the hands and feet, particularly in areas under external forces. The external forces on the foot relate to foot morphology and footwear size. This study investigated the foot and footwear characteristics associated with severe HFS, to predict severe HFS risk.
 Methods: This cohort study investigated the arch index (AI), footwear size, and HFS severity (classified from G1 to G3 based on CTCAE) in patients with hepatocellular carcinoma treated with chemotherapy. G2 and above were classified severe group (PG), while non-occurrence of HFS and G1 were classified non-severe group (NG).
 Results: The AI was higher in the PG (n=22), 27.1±4.2 compared to 25.2±3.1 in the NG (n=33), although not significantly difference (p=0.07, p=0.11). Hallux valgus prevalence was also higher in the PG (seven patients, 32%)than in the NG (four patients, 12%); however, without statistical significance (p=0.09, p=0.23). Post hoc test showed AI and hallux valgus power were 0.45 and 0.38, respectively.
 Conclusions: Larger studies are necessary to conform definitively the association between severe HFS and foot and footwear characteristics.

We aimed to evaluate the quality of life（QOL）of chronic limb-threatening ischemia（CLTI）patients treated with Rheocarna® and to examine changes in QOL after Rheocarna® treatment. We performed blood purification therapy with Rheocarna® for CLTI in patients with end-stage renal disease（ESRD）.
 The research design was a survey using the Kidney Disease Quality of Life Short Form version 1.3, a self-administered questionnaire that is validated and widely used to measure QOL in patients with ESRD.
 The subjects were 14 patients who received Rheocarna® treatment between June 21, 2021, and May 30, 2023. We found that CLTI patients had lower comprehensive QOL, particularly in terms of bodily pain, compared to representative values. On the other hand, renal disease-specific QOL was better than representative values, except for the “burden of renal disease.”
 After treatment with Rheocarna®, significant improvements were observed in the comprehensive QOL categories of “bodily pain,” “social functioning,” and “vitality”（p<0.05）.
 These findings suggest that the alleviation of pain symptoms by Rheocarna® treatment leads to other QOL improvements in ESRD patients.

 Chronic limb-threatening ischemia salvage requires a multidisciplinary approach, primarily involving revascularization and wound care. In cases involving lower extremity wounds, healing time is required even after revascularization. Restenosis increases the risk of infection from wound deterioration and toe amputation. In addition to daily foot care, regular blood flow assessments, local treatments, and revascularization when needed are necessary to prevent lower extremity amputation and promote wound healing. It is challenging to provide continuous treatment until wound healing at a single hospital; thus, after hospital discharge, collaboration with nearby medical institutions and home nursing stations is important. Our hospital has developed and implemented a “Foot Care Community Medicine Path” to share patient information with local medical institutions and facilities, such as dialysis hospitals and home nursing stations, to promote unified foot care. Herein, we report a case where major amputation was avoided due to use of the collaborative path and unified foot care methods. This approach also enhanced the patient’s self-care skills and allowed for the early detection of lesions. Herein, the effectiveness of the Foot Care Community Medicine Path is reported through an examination of case studies.