bluuebunny/crossref_metadata_2025 huggingface dataset:
Experience with the rotating podiatric residency/podiatric surgical residency-12 model. Twenty-four months of integrated training
Authors: Battey MA
Published: April 2014

The author describes the positive experiences of Cranston General Hospital, Osteopathic in establishing a 24-month program, combining an entry level rotating podiatric residency and a podiatric surgical residency. The program grew from a 12-month surgical program to become a 24-month program, using expanded training opportunities available in Brown University teaching hospitals. An improved quality of care and a greater fund of knowledge for the residents are two results of the 24-month training program. Recommendations and views about developing entry level residency programs are presented.
An alternative approach to the mandatory year of clinical residency training
Authors: Jacobs AM
Published: April 2014

The author takes the position that a mandatory fifth postgraduate year to serve as a uniform period of clinical education for podiatric medical graduates is unnecessary. A need exists to define primary podiatric medicine as the entry level podiatric medical field of practice. The colleges of podiatric medicine are urged to deemphasize podiatric surgery while placing greater emphasis on primary podiatric care. The author believes that the colleges are responsible for preparing primary podiatric medical practitioners. Residency programs should focus on specialty training in podiatric surgery and podiatric orthopedics.
The entry level residency curriculum. Proposal for discussion
Authors: Lenet MD
Published: April 2014

The author discusses the curriculum proposed for the PGY-1 residency program. The author briefly describes the activities resulting from the March 1992 residency forum that have led to a national survey of residency program directors to ascertain opinions about the critical elements of the PGY-1 residency. The elements proposed as part of the PGY-1 curriculum, including specific training experiences for 13 clinical rotations, are presented. Results of the survey will be used as a basis for discussion at a second residency forum to be held in December 1992.
Inhalation of nail dust from onychomycotic toenails. Part I. Characterization of particles. 1984
Authors: Abramson C , Wilton J
Published: April 2014

Nail dust particles were analyzed by scanning electron microscopy for size and topography. The percentage of "fines" that could be inhaled and deposited in the alveoli and bronchioles were determined by quantitative particle size analysis. Distribution representing the largest total mass was graphed between 1 and 2 microns. The authors found that 86% of nail dust would reach the bronchioles and alveoli, and 31% could be expected to deposit in these areas.
Tissue expansion as an alternative to skin grafting for closure of skin deficits
Authors: Johnson GR , Han P , Giacopelli JA
Published: April 2014

Recent advances in the technical aspects of tissue expanders for closure of skin deficits have led to an overall reduction in the high rate of complications typically associated with their usage. The authors provide a review of the recent refinements in the technique of the tissue expansion process. A discussion of current and future applications using this technique in the treatment of various lower extremity pathologies, including clubfoot, is presented. A case report on the use of a subcutaneous tissue expander for the treatment of a failed skin graft of the medial ankle is included.
Epidemiology of podiatric injuries in US Marine recruits undergoing basic training
Authors: Linenger JM , Shwayhat AF
Published: April 2014

The authors determined the incidence of podiatric injuries that occurred during 233,946 recruit days at risk among US Marine Corps recruits undergoing basic training at the Marine Corps Recruit Depot, San Diego, CA, between February 5 and April 25, 1990. Training-related initial injuries to the foot occurred at a rate of 3.0 new injuries per 1,000 recruit days. The highest specific rates of injury occurred with stress fractures to the foot (0.56 per 1,000 recruit days), ankle sprains (0.53 per 1,000 recruit days), and Achilles tendinitis (0.39 per 1,000 recruit days).
College of Podiatric Medicine and Surgery in Des Moines
Authors: Tomczak RL
Published: April 2014

The College of Podiatric Medicine and Surgery was established in 1981 as a fully integrated college of the University of Osteopathic Medicine and Health Sciences, Des Moines, Iowa, becoming the only school in the profession to be part of an academic health science center. Thus, this college provides a unique opportunity for the students and the podiatric medical profession to receive a multidisciplinary education, preparing them for podiatric medical practice as an integral part of total health care.
Independent studies program in the basic sciences. A curricular innovation
Authors: DeLauro TM , Kornhauser SH , Leifer Z , Luster GA
Published: April 2014

The Independent Studies Program was initiated at the New York College of Podiatric Medicine during the early months of 1987, and it has achieved continued success and acceptance from the administration, faculty, and students. The program emphasizes competence as the constant within a relatively time-independent framework. This paper presents, in a longitudinal fashion, the Independent Studies Program as a program model that combines criterion-referencing concepts, mastery-based learning combinations, and self-learning strategies. As a result, students have taken the initiative for diagnosing their learning needs, formulating their learning goals, identifying their human and material resources, and evaluating their learning outcomes.
Challenges and opportunities facing the Ohio College of Podiatric Medicine
Authors: Melillo TV , Hetherington VJ
Published: April 2014

This article presents the problems and challenges facing the Ohio College of Podiatric Medicine in the view of its President and its Chief Academic Officer. It explores the progress made and the challenges facing the Ohio College overall and in the areas of education. It presents an exciting new vision of the style of podiatric medical education, and the methods that are and will be used to assess the quality of the educational program.
The future of podiatric medical education. Cautious optimism
Authors: Bates JE , Donohue DM , Mahan KT , Axler DA , Martin W , Fenton M
Published: April 2014

The leadership of the Pennsylvania College of Podiatric Medicine sets forth the following treatise on the outlook for podiatric medical education into the 21st century. Despite the seemingly impossible challenges facing the profession and its students, it is their opinion that the future is bright and with dedicated effort the profession will become stronger in the years ahead.
Accreditation and the enhancement of the quality of professional education
Authors: Levrio J
Published: April 2014

The postsecondary accreditation process is a unique system that attempts to evaluate and enhance the quality of higher and professional education in the United States. Critics of accreditation see the process as coercive and a deterrent to academic freedom while others call for accreditors to exercise greater authority. The origination of the process was a result of a number of coinciding events involving the development of educational and professional standards and concern over access. The current focus on assessment of educational outcomes has further established the credibility of postsecondary accreditation and its role in protecting the public interest.
Treatment of lower extremity infections in diabetics
Authors: Joseph WS
Published: April 2014

The infected diabetic lower extremity has enjoyed a surge in popularity in the medical literature. There have been numerous papers outlining classification systems for ulcer depth, surgical approaches, and microbiology. Discussions on antibiotic use have usually been directed toward therapy of the "diabetic foot infections" as a group, without regard to differences in severity and location of these infections. These infections can vary from the most superficial of processes to a severe life- and limb-threatening sepsis. The author presents a review of the processes involved in the diabetic lower extremity infection and suggests a classification system for selection of empiric antibiotic therapy based on the severity of the infection.
Ciprofloxacin in the treatment of Mycobacterium fortuitum infection of the peroneal tendons. A case report
Authors: Binning TA , Karlin JM , Klein D , Scurran BL , Cooke RA
Published: April 2014

In the case reported, M. fortuitum was sensitive in vitro to amikacin, erythromycin, tobramycin, and ciprofloxacin. Because the patient did not respond to long-term therapy with amikacin and erythromycin, an experimental antibiotic, ciprofloxacin, was tried. Only after extensive surgical debridement and 2 1/2 months of oral ciprofloxacin therapy was the infection eradicated and wound healing obtained. The authors conclude that a wound that has reopened, but remains indolent, exudes a clear, serous drainage and responds poorly to antibiotics should suggest a possible mycobacterial infection. Combination antibiotic therapy is recommended because of the high rate of relapse and development of resistance to drugs. Extensive surgical debridement of all infected tissue remains the primary treatment. The therapeutic value of ciprofloxacin and other newer antibiotics in the treatment of mycobacterial infection is promising.
Management of complications associated with an excision of a lipoma from the ankle
Authors: McIver W , Price MB
Published: April 2014

This case study demonstrates the following: close proximity of lipoma to underlined skin can compromise circulation; the size of the lipoma and the resulting redundant skin after the incision can lead to fluid development and impede the healing process; and a patient who is noncompliant and stands or walks excessively after the excision of a lipoma can cause buildup of a hematoma, which can compromise the incision site. Lipomas associated with the foot or ankle are rarely symptomatic. When they do cause pain and are surgically treated, possible complications because of their size and location must be considered. Finally, these complications could have been avoided if the redundant skin had been excised and a Penrose drain inserted to eliminate excess fluid buildup. Also, better communication should have been maintained with the patient during the entire postoperative course.
Surgical repair of a talar body nonunion
Authors: Mahan KT , Lamy C
Published: April 2014

Fractures of the talus are significant injuries and are usually intra-articular. The authors discuss the evaluation and management of a patient with a delayed union of a talar body fracture. Assessment of talar vascularity and joint integrity should be performed preoperatively. The role of internal fixation and continuous passive motion is discussed.
Coumadin skin necrosis. Pedal manifestations
Authors: Viegas GV
Published: April 2014

The idiosyncratic dermatologic reaction to coumarin-like agents, most notably, Coumadin (warfarin sodium) has been well described in the world's literature. Although the incidence is reported to be less than 0.1% of patients treated with Coumadin, pedal cases tend to be striking and their treatment seemingly tenuous.
Aneurysmal bone cyst
Authors: Schmidt RG , Kabbani YM , Mayer DP
Published: April 2014

Key findings that aid in the diagnosis of an aneurysmal bone cyst are: 1) typically the patients are young individuals less than 20 years old; 2) an expansile bone lesion is bordered by a thin, low signal intensity rim mass; 3) the lesion is inhomogenously increased in signal on T2-weighted images; and 4) multiple fluid-fluid levels are seen with the mass on T2-weighted magnetic resonance imaging scans.
Correlation between limb length discrepancy and asymmetrical rearfoot position
Authors: Blake RL , Ferguson HJ
Published: April 2014

Ten subjects with a known limb length discrepancy were filmed with the two-dimensional Motion Analysis Foot Trak System; eight were filmed running and walking and two were filmed walking only. A control group of ten subjects with no measured limb length discrepancy was filmed in the same manner (eight walking and running and two walking only). The calcaneus-to-vertical angle was recorded for the entire stance gait cycle (heel contact to toe-off). Analysis of the data between the short and long side showed a significant difference in calcaneal position between the two sides at midstance, with the longer side being more everted by 3 degrees or greater than the short side in most cases. There was no significant difference in the calcaneus-to-vertical angle at heel contact between the long and short side. There was no significant difference between the calcaneus-to-vertical angles of the right and left sides of the ten control subjects, either walking or running.
Panmetatarsal head resection. A viable alternative to the transmetatarsal amputation
Authors: Giurini JM , Basile P , Chrzan JS , Habershaw GM , Rosenblum BI
Published: April 2014

While the transmetatarsal amputation has resulted in the salvage of numerous diabetic limbs, it remains an ablative procedure with both short- and long-term complications. The authors reviewed their experience with the panmetatarsal head resection as an alternative to the transmetatarsal amputation. A retrospective review was performed of all patients having undergone this procedure between May 1986 and November 1991. Thirty-seven procedures were performed; of these, 34 were evaluated. The average follow-up period was 20.9 months. Thirty-two feet showed primary healing while one showed delayed healing. One patient had local recurrence of the original ulceration. Primary healing was 94% while overall success was 97%. No patient required amputation of any kind. The authors conclude that the panmetatarsal head resection is a viable alternative to the transmetatarsal amputation in properly selected patients because it avoids many of the structural and biomechanical pitfalls of the transmetatarsal amputation.
Shin muscle activity and sports surfaces. An electromyographic study
Authors: Richie DH , DeVries HA , Endo CK
Published: April 2014

Twelve human subjects were studied to determine the effect of three different floor surfaces on the medial shin musculature during stationary running. Electromyographic equipment, gated by an accelerometer affixed to the subject's shin, was used to separate the impact (eccentric) phase from the propulsive (concentric) phase of each running step. Excessive eccentric muscle activity has been associated with increased muscle damage, and recent investigations have linked medial tibial shin pain with actual structural damage to the muscle-fascial attachments to the posteromedial aspect of the tibia. Therefore, this study tends to verify the previous assumption that running on hard, noncompliant sport surfaces would predispose running and dancing athletes to shin muscle damage and resultant pain.
New nonfusion procedure for talocalcaneal coalitions with a fixed heel valgus
Authors: Yen RG , Giacopelli JA , Granoff DP , Smith SD
Published: April 2014

The authors present a case of bilateral middle facet talocalcaneal coalitions with peroneal spasm producing a fixed valgus heel. They introduce a corrective procedure used at the Fountain Valley Regional Hospital and Medical Center and discuss its application in podiatric surgery. Correction included resection of the synostosis and lateral opening wedge heterogenous bone graft in the calcaneus to redistribute the body's weight on the heel and centralized over the axis of the subtalar joint.
Neurilemoma presenting as a painless mass on the dorsum of the foot
Authors: Jacobson GF , Edwards MC
Published: April 2014

The neurilemoma is a benign neoplasm of Schwann's cells arising from the sheath of a nerve. This neoplasm most commonly originates from the flexor surface of the body. An unusual presentation of a neurilemoma on the extensor surface of the foot was described. The treatment plan was explained, and pathologic characteristics were outlined. Trauma as a possible etiology was also described.
Epiphysiodesis of the first metatarsal with cancellous allograft
Authors: Ribotsky BM , Nazarian S , Scheuller HC
Published: April 2014

The authors describe a technique for an isolated epiphysiodesis of the first metatarsal with a cancellous allograft for the correction of juvenile hallux abducto valgus deformity. The procedure requires no incision. It is a benign, safe, and effective way of correcting the deformity.
Generalized granuloma annulare in a diabetic patient. A case report
Authors: Hiskes BJ
Published: April 2014

Granuloma annulare is a rare skin condition sometimes associated with diabetes mellitus. The natural history including diagnosis and therapy are discussed and a case is presented.
Reflex sympathetic dystrophy syndrome
Authors: Osher LS , Young GJ , Edwards AA , Usewicz P , Lichniak JE
Published: April 2014

Reflex sympathetic dystrophy syndrome is a troublesome, complex disorder that presents with chronic, unexplained aching or burning pain, the intensity of which is incommensurable with the original injury. Six diagnostic criteria have been described by Genant et al: pain and tenderness in the extremities; swelling of soft tissue; diminished motor function; trophic skin changes; vasomotor instability; and patchy osteoporosis. Currently, the most widely accepted etiology is an initial vasomotor reflex spasm occurring after an injury to the extremity, followed by a loss of vascular tone, persistent vasodilation, and rapid bone resorption.
Evaluating instructional scholarship in medicine
Authors: Irby DM
Published: April 2014

Over the past decade, the evaluation of teaching has increased in importance in US medical schools. In this review, research on student ratings, teaching portfolios, and peer review of teaching is presented in the context of instructional scholarship. Five principles for designing a comprehensive system to evaluate teaching are discussed, along with the impact of such systems on teaching improvement and academic promotions.
Continuing medical education. The next steps
Authors: Curry L
Published: April 2014

Continuing medical education has been following essentially the same model for the past seventy years. The past decade has brought such significant change in society's expectations of medical professionals that medical schools, continuing medical education providers, and physicians themselves are being forced to consider alternate models. These pressures for change and possible directions for change are outlined.
Metatarsus proximus and digital divergence. Association with intermetatarsal neuromas
Authors: Grace TS , Sunshein K , Jones R , Harkless L
Published: April 2014

A retrospective radiologic study was performed to determine whether there is an increased finding of metatarsus proximus and digital divergence in patients with a confirmed diagnosis of intermetatarsal neuroma when compared with an asymptomatic group. The study included 48 patients with pathologic confirmation of neuroma and 100 asymptomatic patients. Results of the study revealed no statistical relationship between the radiologic findings of metatarsus proximus and digital divergence and the physical occurrence of neuromas. An unexpected finding was an increased intermetatarsal angle of the affected interspace in the neuroma group.
Fibromyalgia. Part I. Review of the literature
Authors: Harvey CK , Cadena R , Dunlap L
Published: April 2014

Fibromyalgia presents with generalized body pain, multiple tender points, and associated ancillary symptoms, including fatigue and nonrestorative sleep. The abnormal sleep pattern is the most common accepted etiology for this condition. The diagnosis may be made on the basis of a classic presentation of symptoms and clinical findings. The treatment of fibromyalgia includes aerobic exercise and the use of tricyclic antidepressants to modulate the sleep disorder with less than excellent results. In spite of the frustrations in treating this condition successfully, many patients are relieved to be provided with a diagnosis and to obtain sympathetic and supportive care from their physicians.
Polyunsaturated fatty acid supplementation in peripheral neuropathy
Authors: Burke JP , Fenton MR , Young W , Donatiello L
Published: April 2014

This study is an attempt to assess the role of dietary supplementation in the treatment and prevention of diabetic peripheral neuropathy. The authors developed an animal model system to study this problem. Animals given streptozotocin to induce a type I diabetic state showed elevated glucose levels and decreased body weight. Analysis of the sciatic nerve revealed a decrease in nerve conduction velocity and Na(+)-K(+)-ATPase activity. The activity of protein kinase C, another component of the nerve transmission process, was also affected by the diabetic state. The dietary intervention of polyunsaturated fatty acids seemed to revert some of these changes toward normal.
Walking and hiking injuries. A one year follow-up study
Authors: Blake RL , Ferguson HJ
Published: April 2014

Injury patterns associated with walking and hiking activities were examined for all patients presenting to the clinic over a 1-year period. Among the patient group, the authors found that most injuries were unilateral, resulting from overuse, and occurred in the lower extremity, particularly in the foot, ankle, and knee. There are limited studies investigating walking and hiking injury rates in the general population. The results can be applied only to a small specific sample of the population.
Vertical forces and plantar pressures in selected aerobic movements versus walking
Authors: Thompson DL , Hatley MR , McPoil TG , Cornwall MW
Published: April 2014

Ten subjects between the ages of 19 and 29 years walked and performed four aerobic movements over a force and pressure platform. Peak plantar pressure and peak vertical force data were collected three times on the dominant leg as each subject performed all of the five activities. Peak vertical forces acting on the lower extremities for the low impact aerobic movements were significantly less when compared with the high impact movements. As was expected, no differences were found in peak vertical forces between walking and the low impact aerobic movements. Peak plantar pressures for walking were not significantly different when compared with any of the four aerobic movements studied.
Taping of foot and ankle for Korean karate
Authors: Agnew PS
Published: April 2014

In the practice of Korean karate, the foot is often used as a weapon in self defense. Injuries to the foot are common. Analysis of patterns to these injuries and requirements of the sport led to the development of a strapping technique for protecting the foot from the most common injuries.
1994 William J. Stickel Silver Award. Closing base wedge versus Austin bunionectomies for metatarsus primus adductus
Authors: Seiberg M , Felson S , Colson JP , Barth AH , Green RM , Green DR
Published: April 2014

Hallux abducto valgus with concomitant metatarsus primus adductus was treated by either an isolated Austin bunionectomy or by a combination of a modified McBride bunionectomy, along with a closing base wedge osteotomy, on a total of 73 patients (88 feet) from 1983 to 1993. Both subjective and objective similarities and differences were compared between these two groups of patients. Long-term elevation or depression of the first ray was analyzed by using a technique termed sagittal plane displacement. The prevalent preoperative symptoms were significantly reduced postoperatively in both groups of patients. Initial postoperative elevation of the first ray occurred in approximately one third of the cases in both groups. Long-term elevation of the first ray was greater with the base wedge osteotomy and did not change appreciably with the Austin procedure. The sagittal plane displacement method is a helpful tool in analyzing changes in the position of the first ray perioperatively.
Pigmented villonodular synovitis. Pedal manifestations
Authors: Walter JH , Galitz J , Robertson DW
Published: April 2014

Although pigmented villonodular synovitis is a benign process, the potential of osseous destruction makes it a difficult case to manage. The treatment of pigmented villonodular synovitis often necessitates multiple surgical procedures with prolonged periods of nonweightbearing. Recalcitrant pain is often a sequela, secondary to nerve impingement.
Dysplasia epiphysealis hemimelica affecting the subtalar joint
Authors: Graviet S , Thomas JL
Published: April 2014

The case presented here is unique because of the location of the lesions and the extent to which the foot was affected. A two-stage procedure was performed because of the degree of bone deformity. The first stage of the procedure was directed at reducing osseous proliferation; the second stage addressed the frontal and transverse plane deformities. One-stage procedures can be used in treating less severe deformities.
Acute dysvascular limb in a young adult. A case study
Authors: Girvan RJ , Stone PA , McGarry JJ
Published: April 2014

Acute dysvascular limb in young adults is a rare entity. Diagnosis is often difficult because symptoms are not recognized as ischemic. The most common causes of this condition are premature atherosclerosis, thromboangiitis obliterans, microemboli, popliteal entrapment syndrome, collagen vascular disease, Takaysu's arteritis, and coagulopathy. A case study is presented to illustrate the disease process. A systematic approach to diagnosis, consisting of history and physical examination, palpation and auscultation of peripheral pulses at rest and following exercise, and noninvasive vascular examination at rest and following exercise, is recommended. Suggestion of an ischemic condition following noninvasive studies should be followed up with an arteriogram. The prognosis is dependent on the underlying etiology of the ischemia, early detection, and appropriate treatment.
Electrodynographic evaluation of the foot during treadmill versus overground locomotion
Authors: Van Gheluwe B , Smekens J , Roosen P
Published: April 2014

Biomechanical foot function as expressed by the duration of successive ground contact phases and by dynamic variables, such as the peak pressure on different parts of the foot, their respective loading rate, and duration, is compared for two walking and running conditions: overground on a 20-m walkway and on a treadmill. Statistical analysis revealed foot pressure characteristics as measured with a Electrodynogram during walking and running to alter significantly when using a treadmill. The differences were more pronounced for walking than for running. During walking, loading of the forefoot tends to last longer (longer propulsion phase) on a treadmill. Loading rate is decreased for the whole foot during either walking or running. Maximum heel pressure is diminished for walking but increased during running on a treadmill. Moderate variations of treadmill velocity were shown to have no significant influence on the measurements.
Plantar fascial release
Authors: White DL
Published: April 2014

The author reviews the literature for the possible etiology and the conservative and surgical treatment alternatives for mechanically induced plantar heel pain. A long-term retrospective study on a plantar fascial release surgery performed on patients with recalcitrant plantar heel pain, all of whom were unresponsive to conservative therapy, is presented.
Monarthric ankle pain. A diagnostic challenge
Authors: Cohen-Sobel E , Levitz SJ , Caselli M , Reilly K , Levita SJ
Published: April 2014

A patient presented with monarthric ankle pain, which took 2 years to diagnose by numerous physicians and imaging and laboratory tests. A review of the differential diagnosis for monarthritic joint pain with guidelines for the work-up of the patient are presented.
Lisfranc's fracture-dislocation. An unusual case presentation
Authors: Spinner S , McDonald TD
Published: April 2014

The authors present a brief review of the literature with an unusual case presentation of Lisfranc's dislocation. The authors review the mechanism of injury, presentation, and treatment alternatives for both acute trauma-related injuries and neuropathic-related injuries to the Lisfranc's joint. The authors discuss the controversy surrounding the preferred treatment of neuropathic-associated injuries and suggest that possibly criteria may be established for fusion versus conservative care of these injuries.
Comparative study of ankle support devices
Authors: Johnson RE , Veale JR , McCarthy GJ
Published: April 2014

The purpose of this study was to compare the ability of four commonly used ankle support devices (Active Ankle, Aircast Sport Stirrup, DonJoy Ankle Ligament Protector and Malleoloc) to restrict active inversion range of motion before and after exercise. The subjects also compared the devices on subjective characteristics, including stability, comfort, and ease of application and removal. Eighteen subjects had both ankles tested for maximum inversion on a specially designed measuring apparatus during three sessions: 1) before application, 2) before exercise with the support device, and 3) after exercise with the support device.
Atypical case of Becker's muscular dystrophy. Early identification and management
Authors: Cohen-Sobel E , Darmochwal V , Caselli M , Najjar S , Lambert C , Cohen-Sobol E [corrected to Cohen-S E ]
Published: April 2014

A case of a child with Becker's muscular dystrophy is presented. Because of the genetic and clinical similarity with the more common Duchenne muscular dystrophy, these two diseases are compared. Since muscular dystrophy often initially presents with toe walking, flat-foot, and waddling gait, podiatrists may be the first physicians to see the child and provide early diagnosis.
Digital dissecting hematoma. A differential diagnosis
Authors: Pontious J , Mahan KT , Graham ME
Published: April 2014

The dissecting hematoma, a little mentioned postoperative complication following digital surgery, occurs when there is damage to the blood vessels intraoperatively. Accurate and immediate diagnosis is essential for providing early and appropriate treatment.
Feet first. A commentary
Authors: Helfand AE
Published: April 2014

In 1989, the Board of Directors of the Professional Diabetes Academy, Pennsylvania Diabetes Academy endorsed the concept to revise Feet First, published in 1970, and gained the permission of the US Public Health Service to use the initial document as a base. With marked expansion, added color, nonreflective paper, and larger print, Feet First was published in 1991, and introduced to the podiatric profession during the Annual Meeting of the American Podiatric Medical Association in New York. The concept of need expressed by the late Glen W. McDonald, MD, and the late Seward P. Nyman, DPM, to see a melding of public health education and podiatric medicine has brought new meaning to the subject and provided an interdisciplinary approach to foot health education for the diabetic patient.
Absence of the posterior tibial artery. A case report
Authors: Poratt D , Tilley GE
Published: April 2014

In the case presented, the arteriograms showed that the peroneal artery had replaced the absent posterior tibial artery. The peroneal artery coursed medially below the ankle joint to become the plantar arteries of the foot. This has been previously described in the medical literature.
A six-year retrospective analysis of the T-Screw bone fixation device
Authors: Quagliano TJ , Yaeggi BP , Lichty TK , Gronen WW
Published: April 2014

The authors present a retrospective study of the T-Screw bone fixation device and its use for rigid fixation of osteotomies, arthrodesis, and fractures in foot surgery. The following is a discussion of 395 procedures in which the T-Screw was used for fixation. The results of the data confirm that there are specific advantages when using the device.
Enhanced magnetic resonance imaging of the first metatarsal after a bunionectomy
Authors: Chen JB , Youngberg RA , Jones RO
Published: April 2014

Unenhanced magnetic resonance imaging diagnoses osteonecrosis on the basis of loss of fatty marrow and the presence of edema. Enhanced magnetic resonance imaging, however, directly assesses marrow perfusion and allows earlier prediction of osteonecrosis after a bunionectomy.
Chondromyxoid fibroma of a metatarsal and cuneiform
Authors: Goldenhar AS , Neil J , Whittaker S
Published: April 2014

The occurrence of chondromyxoid fibroma in the foot is relatively rare, and it is highly unusual for the lesion to involve the epiphysis. The authors report a case of a highly aggressive tumor occurring in the first metatarsal bone, crossing the epiphysis and invading the medial cuneiform bone. A literature search did not reveal previous cases of chondromyxoid fibroma in this unusual location.
Painful diabetic peripheral neuropathy. A stepwise approach to treatment
Authors: James JS , Page JC
Published: April 2014

The stepwise approach to the treatment of painful diabetic peripheral neuropathy allows the practitioner to use a broad spectrum of therapeutic modalities and physiologic approaches to this complicated clinical problem. The authors review the etiology and clinical presentation of diabetic neuropathy. Available therapeutic alternatives are discussed and an original stepwise algorithm is presented. Pharmacologic profiles of the most commonly used drugs are also described.
Distal skin plasty of the hallux for clubbing deformity after total nail loss
Authors: Bouch√© RT
Published: April 2014

The author provides a comprehensive review of clubbing deformity and its clinical manifestations after total nail procedures of the hallux. Conservative and surgical treatment is presented with a distal skin plasty procedure described in detail.
Plantar incisional approaches. Current perspectives
Authors: Kuwada GT
Published: April 2014

Plantar incisions on the feet have been a controversial subject for many years because of the potential untoward effects of scarring. The author presents a variety of techniques and the rationale for the use of plantar foot incisions, along with discussion on the prevention of complications.
V-Y plasty and its variants
Authors: Nilson RZ , Dockery GL
Published: April 2014

The authors present an overview of the V-Y plasty technique with a discussion of the basic underlying principles and a description of the surgical technique. The variations available and the direct application of this procedure are discussed with reference to the foot and ankle. Consideration is given for design, location, survival, and postoperative care of the V-Y plasty.
Single-lobe rotation flaps
Authors: Dockery GL
Published: April 2014

The basic principles of a single-lobe flap are discussed along with the description of a modified slide-swing rotational flap. This rotation flap is called the Schrudde flap, and it has many applications in the treatment of skin defects of the foot and ankle. This rotation skin flap procedure provides excellent end results with high patient acceptance.
Use of skin grafting in the foot
Authors: Attinger C
Published: April 2014

Skin grafting is a useful adjunct to treating open wounds. It not only provides rapid wound coverage, but also eliminates the pain and the risk of further infection associated with open wounds. A successful skin graft take requires a well vascularized and relatively sterile bed, as well as complete resolution of any surrounding infection. The author reviews the indications and techniques for obtaining a successful skin graft take.
Hypertrophic and keloid scars
Authors: Dockery GL
Published: April 2014

Scar formation is discussed along with definitions of the three most common types of scars: normal, hypertrophic, and keloid. Several current forms of therapy designed to reduce or eliminate scars are presented. The use of silicone gel sheeting is reviewed as a newer solution for the treatment of many types of lower extremity scars.
1995 William J. Stickel Gold Award. High strain rate tissue deformation. A theory on the mechanical etiology of diabetic foot ulcerations
Authors: Landsman AS , Meaney DF , Cargill RS , Macarak EJ , Thibault LE
Published: April 2014

Foot ulcerations are one of the most common and dangerous complications associated with chronic diabetes mellitus. Many studies have focused on neuropathy, in conjunction with elevated ground reactive forces, as the principal cause of these ulcerations. The authors discuss the mechanical cause of diabetic ulcerations at the cellular level. It is hypothesized that increased rate of tissue deformation associated with foot slap secondary to progressive motor neuropathy is the actual culprit, and not the magnitude of local pressure applied. The authors present a cellular model that shows that high rates of tissue deformation may result in elevated intracellular calcium concentrations, which may lead to cellular death, while comparable loads gradually applied do not. Furthermore, there is no significant difference in the response observed at 5 psi and 10 psi. Based on these findings, it is hypothesized that techniques such as ankle foot orthoses, which control the velocity of foot strike, may be useful in treating diabetic foot ulcerations.
Brachymetatarsia. Case report and surgical considerations
Authors: Solomon MG , Blacklidge DK
Published: April 2014

The authors present a case of congenital idiopathic brachymetatarsia of the fourth metatarsal. A combination of techniques was used to address the components of the deformity and its correction, which include preoperative soft tissue stretching, Z-skin plasty, Z-tendon lengthening, Z-lengthening metatarsal osteotomy with internal screw fixation, and bone allografting. Conventional autograft harvesting complications and external fixation were avoided. This case demonstrates the correction of a brachymetatarsal using combined and modified techniques.
Perioperative monitoring of potentially toxic drugs
Authors: Stapp MD , Leaderman ES
Published: April 2014

A list of drugs considered to have a narrow therapeutic margin are discussed. These potentially toxic drugs will be reviewed, including recommended therapeutic ranges, when therapeutic levels should be obtained, and additional laboratory studies that may be required for patients on these medications who are preparing to undergo surgery.
Space-occupying lesions as a cause of tarsal tunnel syndrome
Authors: Boc SF , Hatef J
Published: April 2014

In diagnosing the etiology of tarsal tunnel syndrome, the practitioner must be aware of space-occupying lesions as a possibility. These masses, rarely found beneath the laciniate ligament, can occur. Satisfying results have occurred after removal of these lesions. Careful dissection will assure preservation of the nerve and prevent sensory or motor loss.
Analgesic efficacy of topical butamben picrate
Authors: Armstrong DG , Kanat IO
Published: April 2014

Over the past generation, advents in topical antibiotics and oral analgesia have obscured butamen and its family of topical anesthetics. Using a modified version of the McGill University pain questionnaire, this study attempts to establish the efficacy and clinical utility of this overlooked topical anesthetic.
Hook method of retrieving wire for fixation of osteotomies
Authors: Folio L , Keller AS , Ianiro G , DiBacco R
Published: April 2014

A device for easing retrieval of wire from acute angles of holes drilled in base wedge osteotomies, or any other osteotomy requiring wire fixation, is a Folio Ianiro Retriever. The Folio Ianiro Retriever modifies the way the wire is guided while reducing microtrauma to the bone and expediting the procedure. The use of the device is described with a discussion of the surgical procedure.
Effects of continuous passive motion following Austin bunionectomy. A prospective review
Authors: Connor JC , Berk DM , Hotz MW
Published: April 2014

Thirty-nine patients suffering from hallux valgus deformity were randomized into one of two treatment groups following a corrective Austin procedure. One group received physical therapy only (n = 18), and the other group received physical therapy and continuous passive motion (n = 21). Continuous passive motion was initiated immediately after surgery and patients were instructed to use continuous passive motion for 8 hr a day for 24 days. On the 7th, 14th, 21st, 28th, 60th, and 90th days, range of motion, return to conventional shoes, use of oral analgesics, and complication rate were measured. The group using continuous passive motion had greater range of motion at each postoperative visit compared with the group who used physical therapy only (P < 0.05). The group who used physical therapy only took longer to return to conventional shoes and to cease oral medication than the group who used continuous passive motion (P < 0.01). The use of continuous passive motion as an adjunct to physical therapy following an Austin procedure expedites the rehabilitation time and increases the rate of return to functional range of motion.
Prenatal development of the foot and ankle
Authors: Bareither D
Published: April 2014

The general development of the lower limb and the specific development of the foot and ankle are discussed for each horizon in the embryonic and fetal periods of development. Lower limb general development is discussed only to the extent necessary for the understanding of foot and ankle development.
Stiffness of screw fixation and role of cortical hinge in the first metatarsal base osteotomy
Authors: Christensen JC , Gusman DN , Tencer AF
Published: April 2014

The authors investigated various factors that affect stiffness of screw fixation in the oblique first metatarsal osteotomy. One screw versus two screw fixation with intact medial cortical hinge, and two screw fixation without hinge were tested on the same metatarsal specimen. Mechanical properties of the fixation patterns were measured on a materials testing apparatus. Each metatarsal was tested at below failure threshold for stiffness within the elastic range of the specimen. Load versus displacement curves and fixation stiffness values were generated for axial loading, valgus torque, and plantar-to-dorsal cantilever bending. Osteotomies with an intact hinge demonstrated superior stiffness in most parameters as compared to osteotomies without a hinge. Two screw fixation with intact hinge showed significantly increased axial stiffness as compared to one screw fixation. There was no statistical difference between one and two screws in cantilever bending and torsional stiffness with an intact hinge. The major stabilizing factor of the first metatarsal base osteotomy is the medial cortical hinge.
"I did so!" But can you prove it? Avoiding claims through documentation
Authors: Callahan LM
Published: April 2014

The author explains the need to document medical records to provide protection in litigation and to enhance medical care. Practical tips to make documentation easier and more efficient are given.
Scope of practice in podiatric sports medicine
Authors: Ragley PA
Published: April 2014

The author discusses the issue of scope of practice in podiatric sports medicine and cases involving this area of practice, as well as the attendant ramifications. By gaining insight into this tissue, it is hoped the importance of practicing within the specific state scope of practice laws will be recognized.
Role of talectomy in the treatment of rigid talipes equinovarus deformities
Authors: Johnson GR , Han P , Giacopelli JA
Published: April 2014

The authors provide a review of the principles of talectomy as a surgical treatment option for severe, rigid, and resistant clubfoot deformities. Such deformities are associated with a high recurrence rate and frequently involve a large number of surgical interventions to attain a satisfactory result. Talectomy has been successfully used as both a primary and salvage procedure to treat such deformities, often eliminating the need for subsequent surgeries. A discussion of the operative technique, indications, advantages, and common complications associated with the procedure is presented. In addition, a case report of talectomy used to treat a severe, bilateral clubfoot deformity in a 4-year-old boy is included.
Shortening Z-osteotomy for the proximal phalanx of the hallux using axial guides
Authors: Hodor L , Hess T
Published: April 2014

The shortening Z-osteotomy of the proximal phalanx of the hallux has been presented as an alternative to the Regnauld enclavement procedure for patients with the appropriate indications. In addition to sharing the same positive characteristics as the Regnauld procedure, the Z-osteotomy has technical and physiologic advantages. The advantages of the Z-osteotomy over the Regnauld include maintenance of the intrinsic attachments at the base of the proximal phalanx, less risk of avascular necrosis, less technical difficulty, and absence of complications associated with an autogenous bone graft. Also, it does not affect the sesamoid apparatus. Research and extended follow-up studies will continue at Lakewood Regional Medical Center. In the last year, one author has completed approximately 13 of these procedures. The postoperative results have been encouraging and successful with one exception. In one case, the increase of the hallux interphalangeal angle was probably caused by excessive tightening of the distal screw compared with the proximal screw.
Chronic elephantiasis. A case report
Authors: Richman B , Young G
Published: April 2014

The authors presented a rare case study of a patient with chronic elephantiasis involving the lower extremities. The patient had contracted lymphatic filariasis while serving in the armed forces during World War II. The patient was followed regularly for local wound care by the Veterans Affairs podiatry department. However, he died from congestive heart failure and pneumonia in May of 1993.
Articular cartilage. Part I. The normal joint
Authors: Muehleman C , Arsenis CH
Published: April 2014

Articular hyaline cartilage is of interest to both the clinician and the basic scientist because of its unique physical and chemical properties which are a consequence of its biochemical composition. Although it is a tissue which is hypocellular, avascular, and also lacks nerves and lymphatics, it is active in synthesis and degradation. Articular cartilage responds to the forces to which it is subjected and, in this way, maintains its integrity as long as those forces do not exceed the tissue's capacity for repair or permanently change the biologic response of the cells.
Nonskid socks
Authors: Agnew PS
Published: April 2014

For children with normal anatomy, nonskid socks may be safe for indoor wear. However, they lack some protection capacity, and are not biomechanically helpful. Little scientific data exist to guide physicians on what children should wear on their feet. Dogma and prejudice may taint the advice physicians give. Perhaps this type of project will spur further investigation.
Use of desmopressin in a patient with von Willebrand's disease undergoing podiatric surgery
Authors: Felts TJ , Scurran BL , Karlin JM
Published: April 2014

This patient required reconstructive surgery for a productive life, free of pain. The use of desmopressin provided effective hemostasis and avoided the transfusion of potentially hazardous blood products.
History and epidemiology of acquired immune deficiency syndrome
Authors: Levy LA
Published: April 2014

Acquired immune deficiency syndrome (AIDS) and human immunodeficiency virus (HIV) were first noticed in the US in 1981 and continue to spread today. Initially a disease associated completely with homosexual males, it is increasing in incidence and prevalence among heterosexual males and females, particularly, but not limited to, injection drug users. This disease is much more prevalent among blacks and Hispanics. Podiatric physicians are at risk of acquiring the disease as a result of their frequent use of injections and surgical intervention, particularly involving bone. In addition, the foot is a potential portal of entry for HIV infection because of contamination by blood on the feet of podiatric surgeons and their assistants during surgery.