bluuebunny/crossref_metadata_2025 huggingface dataset:
Rationale and design of the Oxycodone Users Registry: A prospective, multicenter registry of patients with nonmalignant pain
Authors: Kim, PhD Myoung , Chow, PharmD, MPH Wing , Benson, MS Carmela
Published: March 2014

Objective: This article describes the rationale and design of the Oxycodone Users Registry (OUR) study and lessons learned during study development and data collection.Design: The OUR study used a prospective registry design.Setting: Sixty-five academic and private medical practices across the United States, including both specialists and primary care settings.Participants: A total of 814 patients with 1) injury or trauma of the head, neck, back, chest, or extremities; 2) fibromyalgia; 3) arthritis; 4) neuropathic pain; 5) other back or neck pain; or 6) postoperative pain following outpatient orthopedic surgery.Interventions: Patients received immediate-release oxycodone either as monotherapy or as combination therapy, starting within 3 days following the baseline visit and continuing as needed for at least 5 days.Main outcome measures: Patient demographics and disease information were recorded at baseline. Follow-up assessments at days 3, 7, 14, 21, and 28 included pain intensity, pain relief, opioid-related symptoms, a sleep scale, the Brief Pain Inventory-Short Form, and the Work Limitations Questionnaire-Short Form. Adverse events, medical resource utilization, and changes to the oxycodone prescription were recorded during the study. At the end of study treatment, patients rated global treatment satisfaction, how bothersome side effects were, and the most important factor that would discourage them from future oxycodone therapy.Results: This report describes the study design, rationale, and lessons learned.Conclusions: Understanding the rationale, design, and lessons learned from the conduct of the OUR study provides insight that can used in future registry studies.Keywords: oxycodone, opioid, registry, design, rationaleDOI:10.5055/jom.2013.0160
Opioid prescribing knowledge and practices: Provider survey following promulgation of guidelines–Utah, 2011
Authors: Porucznik, PhD, MSPH Christina A. , Johnson, MPH Erin M. , Rolfs, MD, MPH Robert T. , Sauer, PhD Brian C.
Published: March 2014

Objective: The Utah Department of Health published the Utah Clinical Guidelines on Prescribing Opioids for Treatment of Pain in 2010. The objective was to evaluate the impact of the Guidelines on provider behaviors such as documentation and use of screening tools.Setting: Web-based questionnaire about opioid prescribing knowledge and practices distributed among 85 providers of a university-based, primary care community clinic system in the summer of 2011.Main outcome measures: Provider-reported knowledge about and comfort prescribing opioids and use of tools for managing opioid patients. Results: Forty-seven providers who prescribe opioids on an outpatient basis completed the questionnaire after an initial e-mail invitation and two reminders (55 percent response rate). Providers most often used simple rating scales that can be included easily in the notes of the electronic medical record (EMR) to assess pain. When treating patients with chronic pain, 26 percent of respondents reported that they did not use any tool for patient assessment prior to treatment. Providers desire more training in opioid prescribing and feel that they lack referral resources for patients with chronic, noncancer pain. Prescription monitoring program use was common with 77 percent of providers reporting that they would access the system before prescribing opioids for a new patient.Conclusions: System-level changes such as inclusion of screening tools into EMRs will be needed to improve compliance with the Guidelines. Providers find treatment of chronic pain to be challenging and something for which they desire additional training and referral support.Keywords: guidelines, opioid prescribing, primary care, chronic painDOI:10.5055/jom.2013.0162
The Spectrum of Cervical Glandular Neoplasia and Issues in Differential Diagnosis
Authors: Loureiro Joana , Oliva Esther
Published: March 2014

Context.—Premalignant and malignant glandular lesions of the cervix are known to often cause diagnostic problems with a variety of benign (more common) as well as other malignant mimics, the latter setting often being represented by secondary involvement by endometrioid endometrial carcinoma especially in small samplings.

Objective.—To highlight key histologic features and immunohistochemical markers that may be helpful in the distinction of in situ endocervical carcinoma from benign glandular proliferations, and those that separate different subtypes of invasive endocervical carcinoma, as well as invasive carcinoma from other carcinomas secondarily involving the cervix and nonneoplastic proliferations of the cervix.

Conclusions.—Clinical and morphologic features as well as immunohistochemistry results should be used in conjunction in the differential diagnosis of glandular proliferations of the cervix, as correct interpretation has major clinical consequences for the patient in most instances (especially benign versus malignant). Immunohistochemical markers should be used as part of a panel of antibodies, as exceptions may occur to the usual pattern of staining, and if used singly, they may mislead the pathologist to establish a wrong diagnosis.
Fluorescence Immunophenotyping and Interphase Cytogenetics (FICTION) Detects BCL6 Abnormalities, Including Gene Amplification, in Most Cases of Nodular Lymphocyte-Predominant Hodgkin Lymphoma
Authors: Bakhirev Alexei G. , Vasef Mohammad A. , Zhang Qian-Yun , Reichard Kaaren K. , Czuchlewski David R.
Published: March 2014

Context.— BCL6 translocations are a frequent finding in B-cell lymphomas of diverse subtypes, including some cases of nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL). However, reliable analysis of BCL6 rearrangements using fluorescence in situ hybridization is difficult in NLPHL because of the relative paucity of neoplastic cells. Combined immunofluorescence microscopy and fluorescence in situ hybridization, or fluorescence immunophenotyping and interphase cytogenetics as a tool for the investigation of neoplasms (FICTION), permits targeted analysis of neoplastic cells.

Objective.—To better define the spectrum of BCL6 abnormalities in NLPHL using FICTION analysis.

Design.—We performed an optimized FICTION analysis of 24 lymph nodes, including 11 NLPHL, 5 follicular hyperplasia with prominent progressive transformation of germinal centers, and 8 follicular hyperplasia without progressive transformation of germinal centers.

Results.— BCL6 rearrangement was identified in 5 of 11 cases of NLPHL (46%). In addition, BCL6 gene amplification, with large clusters of BCL6 signals in the absence of chromosome 3 aneuploidy, was detected in 3 of 11 cases of NLPHL (27%). One NLPHL showed extra copies of BCL6 present in conjunction with multiple copies of chromosome 3. Altogether, we detected BCL6 abnormalities in 9 of 11 cases of NLPHL (82%). None of the progressive transformation of germinal centers or follicular hyperplasia cases showed BCL6 abnormalities by FICTION.

Conclusions.—To our knowledge, this is the first report of BCL6 gene amplification in NLPHL. Our optimized protocol for FICTION permits detection of cytogenetic abnormalities in most NLPHL cases and may represent a useful ancillary diagnostic technique.
Biopsies of Facial Dermatoses Made Simple
Authors: Al-Mohammedi Faisal , Crawford Richard I. , Martinka Magdalena
Published: March 2014

Context.—Biopsy of the face is rarely done for inflammatory skin diseases, unless the entire process is confined to the face.

Objective.—We hypothesized that facial dermatitis has a differential diagnosis that is more limited than the differential diagnosis of inflammatory skin diseases that affect other parts of the body. To our knowledge, the classification of inflammatory skin diseases occurring on the face has never been conducted before in the English literature.

Design.—The most-recent 100 facial biopsies of inflammatory skin conditions were retrieved from our files, and the cases were categorized into the main inflammatory skin patterns.

Results.—Forty-seven cases (47%) were categorized as interface dermatitis, 2 cases (2%) as psoriasiform dermatitis, 11 cases (11%) as spongiotic dermatitis, 16 cases (16%) as diffuse and nodular dermatitis, 8 cases (8%) as perivascular dermatitis, 14 cases (14%) as folliculitis and perifolliculitis, 1 case (1%) as panniculitis, and 1 case (1%) as fibrosing dermatitis. The number of diagnostic entities represented within each of these patterns was small.

Conclusions.—We believe that facial dermatitis should have its own more-circumscribed differential diagnosis. From a practical viewpoint, many of the inflammatory skin diseases that affect other parts of the body should be excluded from the differential diagnosis after the tissue is determined to be from a facial skin biopsy, and others should not be considered unless the biopsy is from the face.
Blastic Plasmacytoid Dendritic Cell Neoplasm: A Clinicopathologic Review
Authors: Shi Yang , Wang Endi
Published: March 2014

Blastic plasmacytoid dendritic cell neoplasm is a rare entity grouped with the acute myeloid leukemia–related precursor neoplasms in the 2008 World Health Organization classification. It was previously postulated to originate from natural killer cells, T cells, or monocytes but is now believed to arise from the plasmacytoid dendritic cell. The pathogenesis of blastic plasmacytoid dendritic cell neoplasm is not well understood, although the neoplasm demonstrates frequent deletion of tumor suppressor genes, including RB1, CDKN1B, CDKN2A, and TP53. Blastic plasmacytoid dendritic cell neoplasm is a clinically aggressive tumor that often initially presents as cutaneous lesions and subsequently progresses to bone marrow involvement and leukemic dissemination. It is characterized by enhanced expression of CD56, CD4, and CD123, which can be detected by flow cytometry/immunohistochemistry. The differential diagnoses include myeloid sarcoma/acute myeloid leukemia, T-cell lymphoblastic leukemia/lymphoma, NK-cell lymphoma/leukemia, and some mature T-cell lymphomas/leukemias. Patients usually respond to initial chemotherapy but often relapse. Stem cell transplant may improve survival.
Use of the ADAMTS13 Activity Assay Improved the Accuracy and Efficiency of the Diagnosis and Treatment of Suspected Acquired Thrombotic Thrombocytopenic Purpura
Authors: Barrows Brad D. , Teruya Jun
Published: March 2014

Context.—Acquired thrombotic thrombocytopenic purpura (A-TTP) is a rare but significant disease requiring rapid diagnosis and treatment. The diagnosis is often difficult because of variability in the presence of specific clinical criteria. The primary etiology of A-TTP involves inhibitors directed against ADAMTS13 (a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13). Literature has shown that the ADAMTS13 activity assay is sensitive and specific for identifying cases of A-TTP, and application of this test as an on-site screening method has not been fully explored.

Objective.—Our objective is to determine if the ADAMTS13 activity assay can be used as a successful, on-site diagnostic modality to rapidly identify cases of A-TTP and prevent unnecessary use of prophylactic therapeutic plasma exchange.

Design.—A retrospective analysis was performed including 152 patients with clinically suspected A-TTP, screened using the ADAMTS13 activity assay. Results were correlated with potential therapeutic plasma exchange treatment for all cases highly suspicious for A-TTP and evaluated for unnecessary patient morbidity and financial cost.

Results.—The ADAMTS13 activity assay had an overall sensitivity and specificity of 100% and 99%, respectively. The positive predictive value was 91% and the negative predictive value was 100%. In 95% of the studies ordered, A-TTP was ruled out, leading to decreased patient morbidity and $1.7 million of potential treatment costs avoided.

Conclusion.—Implementation of the fluorescence energy transfer–based ADAMTS13 activity assay as a point-of-care laboratory study decreased patient morbidity while also directing more efficient employment of therapeutic plasma exchange in cases of suspected A-TTP.
Determination of HER2/neu Status: A Pilot Study Comparing HER2/neu Dual In Situ Hybridization DNA Probe Cocktail Assay Performed on Cell Blocks to Immunohistochemisty and Fluorescence In Situ Hybridization Performed on Histologic Specimens
Authors: Hartman Adria K. , Gorman Blythe K. , Chakraborty Subhendu , Mody Dina R. , Schwartz Mary R.
Published: March 2014

Context.—Validation of new methodologies for determining human epidermal growth factor receptor 2 gene (HER2/neu) amplification status is crucial for advancing the standard of care and determining treatment for patients with primary and/or metastatic breast carcinoma.

Objective.—To compare results of HER2/neu gene amplification status by 2-color chromogenic in situ hybridization (ISH) on cell block material to HER2/neu status by immunohistochemistry (IHC) and/or fluorescence in situ hybridization (FISH) in the corresponding resection specimen or previous biopsy specimen.

Design.—Formalin, thrombin, and Cellient cell blocks were prepared from cytologic samples obtained from resection specimens from 27 patients with invasive breast carcinoma. In situ hybridization was performed on cell block sections from 18 of the collected cases, on both the Ventana BenchMark ULTRA and the Ventana BenchMark XT, and the HER2/neu gene amplification status was determined. This was then compared to the HER2/neu status by IHC and/or FISH in the resection specimen or previous biopsy specimen.

Results.—Comparison of HER2/neu status by ISH on the quantifiable cell block sections showed 100% correlation with the HER2/neu status determined by IHC or FISH in the corresponding histologic specimens. The results from thrombin and formalin cell blocks were statistically superior to the results from Cellient cell blocks on both Ventana instruments.

Conclusions.—While further validation and study are needed, preliminary results show that the HER2/neu gene amplification status of breast carcinomas can reliably be determined on thrombin and formalin cell block material by using ISH. More consistent staining and better signal integrity was obtained with the Ventana BenchMark ULTRA than the BenchMark XT.
Pathology Training in Informatics: Evolving to Meet a Growing Need
Authors: Sinard John H. , Powell Suzanne Z. , Karcher Donald S.
Published: March 2014

Context.—The mechanics of the practice of medicine in general and of pathology in particular is evolving rapidly with the rise in the use of electronic information systems for managing the care of individual patients, including the ordering and reporting of laboratory tests, maintaining the health of served populations, and documenting the full range of health care activities. Pathologists currently in practice and those in training need to acquire additional skills in informatics to be prepared to maintain a central role in patient care.

Objective.—To summarize the evolving landscape of pathology informatics, with particular attention to the preparation of pathologists for this discipline and to the possible influence of the new subspecialty certification in clinical informatics.

Data Sources.—Most of the information discussed is drawn from the authors' direct experience with informatics, resident and fellow education, and the organizations supporting these activities in pathology.

Conclusions.—The increasing reliance of medical practice on electronic health records and other clinical information systems is creating a greater need for physicians skilled in the use and management of these tools. The establishment of clinical informatics as a formal subspecialty in medicine will likely help secure a role for physicians within information management structures at health care institutions. Pathologists must actively engage in informatics to assure that our specialty is appropriately recognized and represented in this growing discipline.
Measurement of Foot Dorsiflexion
Authors: Scharfbillig Rolf , Scutter Sheila D.
Published: April 2014

The Lidcombe template was introduced in 1991 for the nonweightbearing assessment of ankle joint dorsiflexion, and it has shown excellent reliability in impaired and unimpaired adult populations. We discuss limitations of the original template and test the reliability of a modified apparatus in an adolescent population. Intrarater and interrater reliability were assessed for 14 children (28 limbs) aged 7 to 14 years, returning intraclass correlation coefficient (1,1) results of greater than 0.99 for both aspects of reliability. (J Am Podiatr Med Assoc 94(6): 573–577, 2004)
The Stance Phase of Walking During Late Pregnancy
Authors: Lymbery Janelle K. , Gilleard Wendy
Published: April 2014

The purpose of this study was to investigate temporospatial and ground reaction force variables in the stance phase of walking during late pregnancy. An eight-camera motion-analysis system was used to record 13 pregnant women at 38 weeks’ gestation and again 8 weeks after birth. In late pregnancy, there was a wider step width, and mediolateral ground reaction force tended to be increased in a medial direction. The center of pressure moved more medially initially and less anteriorly at 100% of stance in late pregnancy. The differences suggest that women may adapt their gait to maximize stability in the stance phase of walking and to control mediolateral motion. (J Am Podiatr Med Assoc 95(3): 247–253, 2005)
Osteochondroma of the Talar Neck
Authors: Keser Selçuk , Bayar Ahmet
Published: April 2014

Osteochondroma is the most common benign bone tumor. It rarely affects rearfoot bones, and only a few cases of talar osteochondroma have been reported. We report a case of a solitary osteochondroma of the talus that presented as a painful callus on the anterior portion of the ankle that was refractory to dermatologic treatment. (J Am Podiatr Med Assoc 95(3): 295–297, 2005)
Testing for Loss of Protective Sensation in Patients with Foot Ulceration
Authors: Wood William A. , Wood Michael A. , Werter Scott A. , Menn Joseph J. , Hamilton Scott A. , Jacoby Richard , Dellon A. Lee
Published: April 2014

Current recommendations for the prevention of foot ulceration and amputation include screening at-risk individuals by testing for loss of protective sensation at eight sites using 10-g (5.07) nylon monofilaments. Yet measurement of the cutaneous pressure threshold to differentiate one-point from two-point static touch stimuli may allow identification of these at-risk individuals earlier in the clinical course of diabetic neuropathy. The present study tested this hypothesis using a prospective, cross-sectional, multicenter design that included sensibility testing of 496 patients with diabetic neuropathy, 17 of whom had a history of ulceration or amputation. Considering the cutaneous pressure threshold of the 5.07 Semmes-Weinstein nylon monofilament to be equivalent to the 95 g/mm2 one-point static touch measured using the Pressure-Specified Sensory Device (Sensory Management Services LLC, Baltimore, Maryland), only 3 of these 17 patients with a history of foot ulceration or amputation would have been identified using the Semmes-Weinstein nylon monofilament screening technique. In contrast, using the Pressure-Specified Sensory Device, all 17 patients were identified as having abnormal sensibility, defined as greater than the 99% confidence limit for age, for two-point static touch on the hallux pulp. We conclude that patients at risk for foot ulceration can best be identified by actual measurement of the cutaneous sensibility of the hallux pulp. (J Am Podiatr Med Assoc 95(5): 469–474, 2005)
Reliability of Ankle Goniometric Measurements
Authors: Martin RobRoy L. , McPoil Thomas G.
Published: April 2014

This article reviews the existing range-of-motion measurement literature related to ankle dorsiflexion and plantarflexion to determine whether the reliability of ankle range-of-motion measurements can be defined, how the characteristics of the study population or clinician affect reliability, and the level of responsiveness for these measures. A MEDLINE search was performed through February 2004, and 11 articles met the inclusion criteria established for this review. Ample evidence was found for intrarater reliability for ankle dorsiflexion and plantarflexion range of motion. Although some evidence for interrater reliability of dorsiflexion was found, little evidence for interrater reliability of plantarflexion range of motion was uncovered. On the basis of the current literature, the responsiveness of ankle joint range-of-motion measurements is uncertain and requires further studies using patient populations. (J Am Podiatr Med Assoc 95(6): 564–572, 2005)
Verrucous Hyperplasia
Authors: Rosales Mark Anthony , Martin Billy R. , Armstrong David G. , Nixon Brent P. , Hall H. Ryan
Published: April 2014

Although verrucous hyperplasia may be common in high-risk insensitive feet, the literature contains little discussion on this topic. Treatment of verrucous hyperplasia is aimed primarily at reducing the causative forces. In cases that result from edema, external compression has proved to be adequate. If verrucous hyperplasia on the foot results from frictional forces, then shoe modifications with proper fit, accommodative liners, or fillers in the case of amputation are necessary. In recalcitrant cases, excision of the affected tissue with local soft-tissue or graft coverage has been successful. We describe a 56-year-old man with verrucous hyperplasia. (J Am Podiatr Med Assoc 96(4): 348–350, 2006)
Radiographic Study of the Size of the First Metatarso-Digital Segment in Feet with Incipient Hallux Limitus
Authors: Munuera Pedro V. , Domínguez Gabriel , Castillo Jose M.
Published: April 2014

Background: The aim of this study is to confirm whether the absolute and relative lengths of the first metatarso-digital segment is greater than normal in incipient hallux limitus deformity.

Methods: In a sample of 144 dorsoplantar radiographs under weightbearing conditions (94 of normal feet and 50 of feet with a slightly stiff hallux), measurements were made of the relative first metatarsal protrusion, the length and width of the first metatarsal and of the proximal phalanx of the hallux, the length of the distal phalanx of the hallux, and the total length of the hallux.

Results: There were significant differences between the two types of feet in the relative first metatarsal protrusion, the width of the first metatarsal, the length and width of the proximal phalanx of the hallux, the length of the distal phalanx, and the total length of the hallux.

Conclusion: The size of the first metatarso-digital segment could be implicated in the development of hallux limitus deformity. (J Am Podiatr Med Assoc 97(6): 460–468, 2007)
A Comparison of Vitamin D Levels in Nondiabetic and Diabetic Patient Populations
Authors: Yoho Robert M. , Frerichs Jill , Dodson Nicholas B. , Greenhagen Robert , Geletta Simon
Published: April 2014

Background: This study was designed to compare the vitamin D levels in a cohort of nondiabetic patients to populations of diabetic patients with and without Charcot neuroarthropathy.

Methods: A total of 41 participants (22 male, 19 female) with a mean ± SD age of 59 ± 9.43 years had serum 25-hydroxyvitamin D levels tested. Fifteen participants composed the nondiabetic group; 13, the group with diabetes but without Charcot neuroarthropathy; and 13, the group with both diabetes and Charcot neuroarthropathy.

Results: The results of the study showed that the vitamin D levels in both diabetic populations were significantly lower (P < .05) than the nondiabetic population. There was no statistical difference between the group with diabetes but without Charcot foot disease and the group with both diabetes and Charcot neuroarthropathy.

Conclusions: Based on the results of this study, given the importance of vitamin D in bone metabolism and the osseous consequences associated with diabetes, as well as other systems affected by low levels of vitamin D in the diabetic patient, it appears that vitamin D levels should be monitored in diabetic patients. (J Am Podiatr Med Assoc 99(1): 35–41, 2009)
Arthrodesis of Neuropathic Ankle Joint by Ilizarov Fixator in Diabetic Patients
Authors: Karapinar Hasan , Sener Muhittin , Kazimoglu Cemal , Akgun Ulas
Published: April 2014

Background: Fusion of the neuropathic ankle joint is extremely difficult and associated with many complications. The use of the Ilizarov fixator in ankle fusion for patients with neuropathic arthropathy is not clear. We aimed to evaluate the results of the Ilizarov method for ankle arthrodesis in diabetic patients with neuropathic arthropathy.

Methods: We report the results of neuropathic ankle joint arthrodesis performed with the Ilizarov apparatus in 11 patients. The mean age of the patients was 51 years (range, 35–67 years), all patients were diabetic, and they all had a history of ankle trauma unresponsive to conservative treatment. Deformity and instability of the ankle resulting in a nonplantigrade foot was the operative indication.

Results: Solid fusion was obtained in all patients except one, at an average of 16.1 weeks (range, 12–20 weeks). At final follow-up, excellent results were obtained in three patients, good in six, fair in one, and poor in one. No major complication occured.

Conclusions: The Ilizarov fixator may be an alternative and effective means for neuropathic ankle arthrodesis, especially when the usage of internal fixation methods have some limitations. (J Am Podiatr Med Assoc 99(1): 42–48, 2009)
Effect of Foot Morphology on Center-of-Pressure Excursion During Barefoot Walking
Authors: Wong Lilian , Hunt Adrienne , Burns Joshua , Crosbie Jack
Published: April 2014

Background: The path of the center of pressure during walking varies among individuals by deviating to a greater or lesser extent toward the medial or lateral border of the foot. It is unclear whether this variance is systematic and is affected by foot posture. The aim of this study was to explore the relationship between foot morphology and center-of-pressure excursion during barefoot walking.

Methods: Pressure data were collected from 83 participants whose foot type had been classified as supinated, normal, or pronated according to the Foot Posture Index. Three center-of-pressure variables were analyzed: medial excursion area, lateral excursion area, and total excursion area.

Results: Across the spectrum of foot types, we found that the more supinated a participant’s foot posture, the larger the area of lateral center-of-pressure excursion, and, conversely, the more pronated the foot posture, the smaller the area of lateral center-of-pressure excursion. Furthermore, the supinated foot type had a relatively larger center-of-pressure total excursion area, and the pronated foot type had a relatively smaller center-of-pressure total excursion area.

Conclusions: These results indicate the importance of assessing foot posture when measuring center of pressure and may help explain regional differences in pain and injury location among foot types. (J Am Podiatr Med Assoc 98(2): 112–117, 2008)
Extracorporeal Shockwave Therapy for Interdigital Neuroma
Authors: Fridman Robert , Cain Jarrett D. , Weil Lowell
Published: April 2014

Background: We sought to evaluate the safety and effectiveness of extracorporeal shockwave therapy as a therapeutic treatment for destroying Morton’s neuroma.

Methods: Twenty-five patients (25 feet) were included in the study. Indications for participation were more than 8 months of conservative care with a visual analog scale pain score of 4 or greater. The mean overall pain score on a modified visual analog scale was 6.9 preoperatively.

Results: Thirteen patients were randomized to the active group and 12 to the sham group. Two patients in the sham group were lost to follow-up. Post-treatment evaluations were performed at 1, 6, and 12 weeks by a blinded investigator (L.W.). The end point evaluation parameter was the reduction in visual analog scale score. The treatment group showed a significant difference before and after extracorporeal shockwave therapy (P < .0001). The sham group did not have a significant difference after 12 weeks (P = .1218).

Conclusions: Extracorporeal shockwave therapy is a possible alternative to surgical excision for Morton’s neuroma. (J Am Podiatr Med Assoc 99(3): 191–193, 2009)
Impact of Chronic Plantar Heel Pain on Health-Related Quality of Life
Authors: Irving Damien B. , Cook Jill L. , Young Mark A. , Menz Hylton B.
Published: April 2014

Background: Chronic plantar heel pain (CPHP) is common and is thought to have a detrimental impact on health-related quality of life. However, no study has used normative data or a control data set for comparison of scores. Therefore, we describe the impact of CPHP on foot-specific and general health-related quality of life by comparing CPHP subjects with controls.

Methods: Foot Health Status Questionnaire scores were compared in 80 subjects with CPHP and 80 sex- and age-matched controls without CPHP.

Results: The CPHP group demonstrated significantly poorer foot-specific quality of life, as evidenced by lower scores on the foot pain, foot function, footwear, and general foot health domains of the Foot Health Status Questionnaire. The group also demonstrated significantly poorer general health-related quality of life, with lower scores on the physical activity, social capacity, and vigor domains. In multivariate analysis, CPHP remained significantly and independently associated with Foot Health Status Questionnaire scores after adjustment for differences in body mass index. Age, sex, body mass index, and whether symptoms were unilateral or bilateral had no association with the degree of impairment in people with CPHP.

Conclusion: Chronic plantar heel pain has a significant negative impact on foot-specific and general health-related quality of life. The degree of negative impact does not seem to be associated with age, sex, or body mass index. (J Am Podiatr Med Assoc 98(4): 283–289, 2008)
Equine Pericardium Collagen Wound Dressing in the Treatment of the Neuropathic Diabetic Foot Wound
Authors: Fleischli John G. , Laughlin Terese J. , Fleischli Jeffery W.
Published: April 2014

Background: Treatment of diabetic foot wounds remains a major health-care issue, with diabetic foot ulcers representing the most common causal pathway to lower-extremity amputation. Although several investigations have examined topical collagen-based dressings, none have specifically looked at equine pericardium. We, therefore, evaluated the effect of the equine pericardium dressing on neuropathic foot wounds.

Methods: Twenty-three consecutive patients with 34 neuropathic foot wounds were evaluated as part of a pilot study. An equine pericardium dressing was applied in a standard manner, and the patients followed a standard postapplication treatment protocol. Changes in wound size were recorded when the equine dressing was removed and 4 and 12 weeks after application. Patients underwent dressing changes every 3 to 4 days until healed or for 12 weeks.

Results: Thirty-two wounds in 22 patients were prospectively available for evaluation. On enrollment, the median wound size was 299 mm2. When the equine material was removed (mean, 2.9 weeks), 30 of the wounds (94%) had improved, with a median size of 115 mm2 and an average reduction in size of 44.3% (P < .0001). At 4 weeks, the average decrease in wound size was 52.3% (P < .0001). At 12 weeks, 15 wounds (47%) had healed.

Conclusions: This first report of equine pericardium used to treat neuropathic foot ulcerations demonstrates that the equine pericardium dressing is a safe and beneficial treatment for neuropathic wounds. (J Am Podiatr Med Assoc 99(4): 301–305, 2009)
Comparison of Male and Female Foot Shape
Authors: Luo Gangming , Houston Vern L. , Mussman Martin , Garbarini Maryanne , Beattie Aaron C. , Thongpop Chaiya
Published: April 2014

Background: Morphological and geometric differences between male and female feet can be the decisive factor of whether well-fitting, functional, and comfortable footwear is available for both men and women.

Methods: Optical scans, plaster wrap casts, and a set of manual measurements from the right feet of 51 female participants, aged 20 to 59 years (32 ± 10.2 years), and 39 male participants, aged 22 to 71 years (47.1 ± 12.1 years), were taken to determine which parameters were the most significant in characterizing pedal geometry and which had the largest difference between male and female feet.

Results: Analysis showed that the heel-to-ball length (ball length) of the male participants’ feet (181.5 mm) was significantly longer, on average, than that of the female participants’ feet (165.0 mm). The width of the male paticipants’ feet at the ball, instep, and heel regions, as well as the ball circumference, normalized by the ball length, were all significantly larger on average, than the female test participants’ feet. However, toe region, instep, and medial and lateral malleoli heights were larger, on average, for the female participants than for the male. The results show that female feet differ in size and shape from male feet and are not algebraically scaled, smaller versions of male feet, as is often assumed.

Conclusions: The study shows that the average male participants’ feet are longer than that of the female participants’ feet, while the female feet are relatively narrower but higher than those of the male participants. (J Am Podiatr Med Assoc 99(5): 383–390, 2009)
Charcot-Marie-Tooth Disease Complicating Type 2 Diabetes
Authors: Win Htet Htet Ne , Davenport Colin , Delaney Siobhan , Kelly Margaret , Smith Diarmuid
Published: April 2014

Although both conditions are relatively common, there are very few descriptions of type 2 diabetes mellitus coexisting with Charcot-Marie-Tooth disease (CMT). This case report and literature review describes a 53-year-old Irish man who presented with type 2 diabetes and significant neuropathy, and who was subsequently diagnosed with CMT type 1A. This case report will also discuss how to differentiate diabetic neuropathy from a progressive hereditary neuropathy and how coexistence aggravates the progression of neuropathy thus necessitating early diagnosis. (J Am Podiatr Med Assoc 101(4): 349–352, 2011)
An Open-label, Three-arm Pilot Study of the Safety and Efficacy of Topical Microcyn Rx Wound Care versus Oral Levofloxacin versus Combined Therapy for Mild Diabetic Foot Infections
Authors: Landsman Adam , Blume Peter A. , Jordan Douglas A. , Vayser Dean , Gutierrez Andres
Published: April 2014

Background:

This randomized, prospective, multicenter, open-label study was designed to test whether a topical, electrolyzed, superoxidized solution (Microcyn Rx) is a safe and effective treatment for mildly infected diabetic foot ulcers.

Methods:

Sixty-seven patients with ulcers were randomized into three groups. Patients with wounds irrigated with Microcyn Rx alone were compared with patients treated with oral levofloxacin plus normal saline wound irrigation and with patients treated with oral levofloxacin plus Microcyn Rx wound irrigation. Patients were evaluated on day 3, at the end of treatment on day 10 (visit 3), and 14 days after completion of therapy for test of cure (visit 4).

Results:

In the intention-to-treat sample at visit 3, the clinical success rate was higher in the Microcyn Rx alone group (75.0%) than in the saline plus levofloxacin group (57.1%) or in the Microcyn Rx plus levofloxacin group (64.0%). Results at visit 4 were similar. In the clinically evaluable population, the clinical success rate at visit 3 (end of treatment) for patients treated with Microcyn Rx alone was 77.8% versus 61.1% for the levofloxacin group. The clinical success rate at visit 4 (test of cure) for patients treated with Microcyn Rx alone was 93.3% versus 56.3% for levofloxacin plus saline–treated patients. This study was not statistically powered, but the high clinical success rate (93.3%) and the P value (P = .033) suggest that the difference is meaningfully positive for Microcyn Rx–treated patients.

Conclusions:

Microcyn Rx is safe and at least as effective as oral levofloxacin for mild diabetic foot infections. (J Am Podiatr Med Assoc 101(6): 484–496, 2011)
First metatarsophalangeal joint arthrodesis. Treatment for sesamoid fractures
Authors: Stroh KI , Altman MI , Yee DY
Published: April 2014

Fractures of both hallucal sesamoids are not commonly reported in the literature. The authors address various surgical procedure choices and present a case history. In their case, conservative treatment failed; therefore, surgical intervention was elected, and fusion of the first metatarsophalangeal joint was performed.
Dermatitis artefacta. Case reports
Authors: Appelbaum SA , Cole DR , Root SM , Cambas C , Acree JT
Published: April 2014

Patients who seek care for foot problems may present to the podiatrist with concurrent problems, such as anxiety, depression, phobias, personality disorders, and psychoses. These may or may not have any direct relationship to the pathogenesis of the foot problem. The podiatrist may learn of the presence of an emotional problem directly from the patient or from a family member. In many cases, the patient may be unaware or deny the presence of an emotional problem, leaving the podiatric physician in the dark about the patient's mental health state or its implications for the management of the skin problem. In a review of the psychosomatic aspects of dermatology, Koblenzer offered a working classification of the psychodermatoses. This is helpful to the podiatrist in recognizing those dermatologic disease states in which the various aspects of the individual participate in the disease, signs and symptoms of the disease, and the potential psychological value of the disease for the patient. It is also helpful to the podiatrist for recognizing those dermatoses in which psychiatric consultation may be useful so that recognition, treatment, improvement, and perhaps cure may be effected quickly.
Transmetatarsal amputation. A successful approach to limb salvage
Authors: Sanders LJ , Dunlap G
Published: April 2014

To assess the outcome of transmetatarsal amputations of the foot, data were analyzed for all transmetatarsal and midfoot amputations performed at the Lebanon Veterans Health Administration Medical Center for the period 1984 to 1990. During this 6-year period, 42 consecutive transmetatarsal and midfoot amputations were performed on 39 patients. Patient demographics, factors leading to amputation, level of amputation, outcome, function, and long-term complications were analyzed. Overall healing rate was 83.3%, with an average length of hospital stay of 35.7 days (range 3 to 96 days). Average follow-up period was 30.2 months (range 2 to 65 months).
Rotational scarf (Z) osteotomy bunionectomy for correction of high intermetatarsal angles
Authors: Duke HF
Published: April 2014

A modification of the scarf osteotomy bunionectomy is described. The modification involves a change in the movement of the osseous fragments from lateral transposition to lateral rotation of the metatarsal head fragment around a stationary axis at the metatarsal base. Rotation of the distal fragment in this manner allows greater than 50% transposition and, therefore, higher intermetatarsal angle corrections can be obtained as compared to a transpositional scarf osteotomy. The configuration of the scarf osteotomy is more stable to the stress of weightbearing than the closing base wedge osteotomy, and this modification can provide a useful alternative to closing base wedge osteotomy for the correction of severe hallux valgus deformity.
Gait style as an etiology to chronic postural pain. Part II. Postural compensatory process
Authors: Dananberg HJ
Published: April 2014

The body is designed to pull the center of mass over a single pivotal site formed by dorsiflexion of the first metatarsophalangeal joint. If this response dorsiflexion motion is blocked by functional hallux limitus, then the kinetic energy, which is created for this motion, must somehow be dissipated. The process by which this dissipation occurs creates a specific pattern of compensations which, in the past, has been seen as primary motions unrelated to sagittal plane blockade. These compensatory motions are described along with a brief section concerning the methods of treatment.
Pressure distribution beneath the human foot
Authors: Bennett PJ , Duplock LR
Published: April 2014

A descriptive study was undertaken to establish the 95 percentile limits (proposed normal reference range) for pressure beneath the hallux, metatarsal heads, and heel in a group of healthy adult subjects. A new force plate device capable of accurately measuring discrete areas of pressure beneath the human foot with high temporal and spatial resolution was used. The system is capable of accurately measuring plantar foot pressure during dynamic and static foot function. The results of this research are in close agreement with other published studies of plantar foot pressure measurement with comparable systems.
A biomechanical model for the transmetatarsal amputation
Authors: Chrzan JS , Giurini JM , Hurchik JM
Published: April 2014

The transmetatarsal amputation has been performed for over 40 years as a limb salvage procedure, in diabetic patients with nonhealing ulcerations or nonreconstructible ischemia. It is generally believed that the transmetatarsal amputation provides a better walking extremity than a more proximal amputation and is more energy efficient. A review of the literature reveals little regarding the biomechanics of the "short foot." The authors will review the functions of the myofascial structures in both the normal foot and the transmetatarsal amputation and discuss the influence of mechanics on transmetatarsal amputation lesions.
Current concepts in bone healing. Review of the literature
Authors: Greenbaum MA , Kanat IO
Published: April 2014

Bone healing is a process of reconstitution of tissue. With the development of rigid internal fixation, primary bone healing has exhibited certain histologic characteristics not previously seen. The authors discuss the histologic, biochemical, and physiologic processes seen in primary and secondary bone healing following fracture or osteotomy.
Medical management of the diabetic patient during podiatric surgery
Authors: Lewis SB , Biondo CF , Page JC
Published: April 2014

Diabetes mellitus commonly causes complications of the foot that can lead to surgery. The appropriate perioperative management of diabetic patients can reduce the morbidity and mortality associated with diabetic foot surgery and enhance wound healing. The authors review the effects of hyperglycemia, detail preoperative, intraoperative, and postoperative care, and describe anesthetic choices. An algorithm for management of hypoglycemia is offered.
Position of the first ray and motion of the first metatarsophalangeal joint
Authors: Roukis TS , Scherer PR , Anderson CF
Published: April 2014

The authors present a quantitative analysis of the effect that first ray position has on motion of the first metatarsophalangeal joint. A goniometer was constructed to measure the degrees of first metatarsophalangeal joint dorsiflexion with the first ray in three positions: weightbearing resting position, dorsiflexed 4 mm from the weightbearing resting position, and dorsiflexed 8 mm from the weightbearing resting position. First metatarsophalangeal joint dorsiflexion decreased 19% as the first ray was moved from the weightbearing resting position to 4 mm dorsiflexed, 19.3% as the first ray was moved from 4 mm dorsiflexed to 8 mm dorsiflexed, and 34.7% as the first ray was moved from the weightbearing resting position to 8 mm dorsiflexed. The biomechanical significance of decreased first metatarsophalangeal joint dorsiflexion that results from first ray dorsiflexion is discussed, and proposed bases for the pathomechanics of hallux abducto valgus and hallux rigidus deformities are presented.
Proficiency of foot care specialists to place the rearfoot at subtalar neutral
Authors: Pierrynowski MR , Smith SB , Mlynarczyk JH
Published: April 2014

The proficiency of clinicians to place a rearfoot at the subtalar neutral position is important for the treatment of patients with lower extremity dysfunctions, and especially for foot orthosis prescription, fabrication, and management. However, the ability of experienced foot care specialists to perform this task has not been statistically compared with an average capacity. In this study, eight experienced chiropodists and eight untrained physiotherapy students placed six rearfeet at the subtalar neutral position five times. Statistically, the foot care specialists were able to find the subtalar neutral position better than the students (mean 0.00 versus 0.99 degrees, SD 1.84 versus 2.97 degrees, range -5.27 degrees to 4.33 degrees versus -6.25 degrees to 9.27 degrees). This can be interpreted as stating that foot care specialists and untrained students place a rearfoot within +/- 1 degree of the subtalar neutral position 41.3% and 25.0% of the time, respectively. Corresponding values within +/- 2 degrees of the subtalar neutral position are 72.3 degrees and 47.6 degrees, respectively. Alternatively, it can be stated that experienced foot care specialists are within +/- 3.0 degrees of the subtalar neutral position 90% of the time. A corresponding value for the students is +/- 4.9 degrees. These results suggest that although experienced foot care specialists position a rearfoot at the subtalar neutral position better than untrained physiotherapy students, there is room for improvement.
Recurrent intermetatarsal neuroma. A follow-up study
Authors: Banks AS , Vito GR , Giorgini TL
Published: April 2014

Sixteen patients were evaluated following excision of recurrent intermetatarsal neuroma. Each underwent removal of a segment of nerve through an incision on the plantar aspect. The nerve stump was buried in the flexor digitorum brevis muscle. At the time of follow-up examinations, six patients were asymptomatic, seven experienced mild pain after extended activity, one suffered mild consistent pain with activity, and two suffered pain that limited activities.
The past, present, and future of podiatric biomechanics
Authors: Payne CB
Published: April 2014

The author places the history and development of podiatric biomechanics, as well as current thinking about its underpinnings and future, in the context of a theoretical framework drawn from the philosophy and sociology of science. This analysis sets the stage for an exploration of the possible future directions in which podiatric biomechanics could develop.
Bone grafting in foot and ankle surgery. A review of 300 cases
Authors: Mahan KT , Hillstrom HJ
Published: April 2014

Three hundred foot and ankle bone grafts were reviewed in three separate series of 100 consecutive grafts from two institutions. The series represent a period from 1977 to 1990 and demonstrate treatment patterns that varied over time and between institutions in indications, graft material, and perioperative management. Over 42% of the 300 grafts were for calcaneal osteotomies; most were Evans calcaneal osteotomies. Over 72% of the grafts were allogeneic bone-bank bone, which performed well in calcaneal osteotomies and for packing of defects. Upon review of the incidence of bone complications, no significant differences were observed between surgical procedures that used autogenous versus allogeneic grafts. However, four out of six failures of first metatarsal repair were with allogeneic bone. There was a significant difference in complication rates for the major indications for bone-graft surgery. Nonunions and arthrodeses resulted in higher complication rates than expected, whereas calcaneal osteotomies resulted in a lower complication rate than expected.