bluuebunny/crossref_metadata_2025 huggingface dataset:
Pigmented Villonodular Synovitis of the Ankle
Authors: Hao Da-Peng , Zhang Jian-Zhong , Xu Wen-Jian , Wang Zhen-Chang , Wang Xue-Na
Published: April 2014

Background:

Pigmented villonodular synovitis (PVNS) of the ankle is a rare benign proliferative growth of the synovium. Studies of the radiologic characteristics of ankle PVNS are sparse.

Methods:

To characterize the radiologic features of ankle PVNS, five patients with histologically proven ankle PVNS were retrospectively studied. The features of their radiographs, computed tomographic scans, and magnetic resonance images were reviewed, with emphasis on the morphological features, extension, margin, bone involvement, signal intensity, and degree of magnetic resonance enhancement.

Results:

All five lesions were diffuse, affecting the ankle and distal tibiofibular joint; three lesions also involved the subtalar joint. Radiography demonstrated extrinsic bone erosions with marginal sclerosis of the involved joints in all of the patients, but computed tomography identified this much better than did radiography. Magnetic resonance imaging revealed multiple lobulated soft-tissue masses in all of the cases. These soft-tissue masses surrounded the flexor hallux longus tendon and were hypointense on T1-weighted images, with a heterogeneous signal in two cases and homogenous hypointensity in three cases on fat-suppressed T2-weighted images. In one patient who underwent gadolinium-enhanced imaging, the masses showed intense enhancement.

Conclusions:

Magnetic resonance imaging is the best way to reveal ankle PVNS. Magnetic resonance imaging findings of predominant hypointensity on all pulse sequences and standard radiography findings of bone erosion with marginal sclerosis are characteristic. (J Am Podiatr Med Assoc 101(3): 252–258, 2011)
An Unusual Cause of a Cystic Lesion with an Osteochondral Defect in the Talus
Authors: Atay Evren Fehmi , Güven Melih , Çakar Murat , Başsorgun Cumhur Ibrahim , Akman Budak , Bes Cemal
Published: April 2014

An intraosseous lipoma is a rare benign bone lesion that proliferates from mature lipocytes. It occurs most frequently in the lower limb, particularly in the calcaneus. The talus is an unusual location for this rare lesion. A review of the literature produced only two reports with talar intraosseous lipomas under the name of intraosseous lipomatosis, which described multiple lipomas in different areas. We describe a 38-year-old male patient who had an isolated intraosseous lipoma with an osteochondral defect in the talus and was treated with autologous osteochondral graft transplantation by medial malleolar osteotomy. He could walk with full weightbearing without any assistance at the end of 12 months. Intraosseous lipoma localized in the talus may be confused radiologically with other bone lesions, especially with unicameral bone cyst, if it is associated with an osteochondral defect. Autologous osteochondral graft transplantation is a successful treatment method for talar intraosseous lipoma. (J Am Podiatr Med Assoc 101(3): 269–274, 2011)
Invasive Cutaneous Squamous Cell Carcinoma Presenting as a Nonhealing Radiation Wound
Authors: Longobardi Stephen J. , Sullivan Brian , Mansour E. Hani
Published: April 2014

Cutaneous squamous cell carcinoma is the second most common form of skin cancer and accounts for 20% of cutaneous malignancies. We report the case of a patient who presented with a complaint of nonhealing wounds following radiation therapy for the treatment of noninvasive squamous cell carcinoma of both lower extremities. Initial biopsies of the wounds were benign. However, a second biopsy performed approximately 2 months later was found to be positive for invasive squamous cell carcinoma. This case uniquely exemplifies that all nonhealing wounds should be viewed with a critical eye for possible malignancy even in the presence of previous negative biopsy. This is especially true for radiation wounds that may be prone to malignant transformation or recurrence. (J Am Podiatr Med Assoc 101(4): 360–362, 2011)
Development of a Novel Rating System to Assess Lower-limb Comfort
Authors: Kinchington Michael , Ball Kevin , Naughton Geraldine
Published: April 2014

Background:

Comfort evaluation techniques are commonplace in medicine. However, measures of lower-limb comfort are infrequently used in the sporting environment. The purpose of this study was to develop an instrument for measuring lower-limb comfort, which will extend previous work in the field of injury awareness.

Methods:

A lower-limb comfort index (LLCI) was developed for use in the environment of elite sport. Forty professional footballers participated in development of the index. The study had three components. A critical appraisal of the literature established the need for an LLCI. The second phase involved 20 professional footballers establishing and testing the components of the comfort index as an instrument for measuring comfort.

Results:

Nonparametric statistics (the McNemar test) in phase 2 indicated that the LLCI demonstrated good responsiveness to suitability (P = .019) and ease of use (P < .01). After a high level of agreement for responses, the third stage required 20 players to pilot test the reliability of the LLCI in a controlled environment. Repeated measures of difference between two periods for sum comfort (intraclass correlation coefficient = 0.99) and individual anatomical segments (κ = 0.72–1) provided confidence that the comfort index was reliable.

Conclusions:

The LLCI showed good trait construct to provide confidence to conduct a future study to investigate interrater consistency in a wider cohort of professional footballers under different conditions, such as match-day and training-week environments. (J Am Podiatr Med Assoc 101(5): 371–384, 2011)
Bilateral Tibial Hallux Sesamoid Agenesis and Fibular Hallux Sesamoid Hypoplasia in a Patient with Bilateral Hallux Valgus
Authors: Marinozzi Andrea , Longo Umile Giuseppe , Cazzato Luigi , Martinelli Nicolò , Maffulli Nicola , Denaro Vincenzo
Published: April 2014

We report the clinical features, radiographic findings, management, and results of a patient with bilateral hallux valgus and associated bilateral tibial hallux sesamoid agenesis and fibular hallux sesamoid hypoplasia. Our patient was managed operatively with good clinical results. Combined tibial sesamoid agenesis and fibular sesamoid hypoplasia do not seem to negatively influence the management of hallux valgus. (J Am Podiatr Med Assoc 101(5): 452–455, 2011)
Mimicry in Older Patients: Tophaceous Pseudogout as a Tumorlike Lesion
Authors: Erhardt Matthias A. , Vetter Sven Y. , Suda Arnold J. , Wentzensen Andreas , Frank Christian B.
Published: April 2014

Pseudogout is frequently seen in painful arthritis of larger joints, especially the knees and shoulders. This case report describes a rare clinical entity of soft-tissue calcium pyrophosphate dihydrate crystal deposition disease surrounding the second metatarsal bone of an 81-year-old man with moderate painful swelling of the right forefoot for 2 years. Diagnostic imaging demonstrated a calcified soft-tissue tumor adjacent to the second metatarsal bone by considering a neoplastic process in the differential diagnosis. Excisional biopsy revealed a chalklike material on the calcified soft tissue that was pathognomonic for chondrocalcinosis or pseudogout. The excisional biopsy findings led to stagnation of the clinical symptoms, and no recurrence of the initial tumor was seen during 12-month follow-up. In the literature, only 28 cases of tophaceous pseudogout tumors in the extremities have been described. In these cases, the lesions were suspected of being chondrosarcomas. For this reason, a correct diagnosis has to be pursued by performing a biopsy to treat the disease correctly. (J Am Podiatr Med Assoc 101(5): 462–465, 2011)
Hallux Limitus and Its Relationship with the Internal Rotational Pattern of the Lower Limb
Authors: Lafuente Guillermo , Munuera Pedro V. , Dominguez Gabriel , Reina Maria , Lafuente Blanca
Published: April 2014

Background:

The aims of this study were to determine whether individuals with mild hallux limitus show a diminished capacity of internal rotation of the lower limb compared with those without hallux limitus and whether individuals with mild hallux limitus show an increased foot progression angle.

Methods:

In 80 study participants (35 with normal feet and 45 with mild hallux limitus), the capacity of internal rotation of the lower limb (internal rotational pattern), hallux dorsiflexion, and the foot progression angle were measured. The values for internal rotational pattern and foot progression angle were compared between the two study groups, and the correlations between these variables were studied.

Results:

The capacity of internal rotation of the lower limb was significantly lesser in patients with mild hallux limitus (P < .0001). There was no significant difference in foot progression angle between the two groups (P = .115). The Spearman correlation coefficient was 0.638 (P < .0001) for the relationship between internal rotational pattern and hallux dorsiflexion.

Conclusions:

Patients with mild hallux limitus had a lesser capacity of internal rotation of the lower extremity than did individuals in the control group. The more limited the internal rotational pattern of the lower limb, the more limited was hallux dorsiflexion. The foot progression angle was similar in both groups. (J Am Podiatr Med Assoc 101(6): 467–474, 2011)
Effects of Nonslip Socks on the Gait Patterns of Older People When Walking on a Slippery Surface
Authors: Hatton Anna L. , Sturnieks Daina L. , Lord Stephen R. , Lo Joanne C.M. , Menz Hylton B. , Menant Jasmine C.
Published: April 2014

Background:

Slips are a common cause of falls, and nonslip socks have been marketed to prevent slips in older people. However, few studies have investigated the biomechanical and clinical effects of walking in nonslip socks. This study aimed to examine gait parameters in older people walking on a slippery surface wearing nonslip socks compared with standard sock and barefoot conditions.

Methods:

Fifteen older people completed five trials of the fast-paced Timed Up and Go test while barefoot and while wearing standard socks and nonslip socks. Kinematic data (step length, heel horizontal velocity at heel strike, and foot-floor angle at heel strike) and clinical data (total Timed Up and Go test time, total number of steps, number of steps in turn, and observed slips, trips, or falls) were collected.

Results:

Performance on the Timed Up and Go test did not differ between the barefoot and nonslip sock conditions; however, participants walked more slowly and took shorter steps when wearing standard socks. Participants rated nonslip socks to feel less slippery than barefoot and standard socks.

Conclusions:

Compared with wearing standard socks, wearing nonslip socks improves gait performance and may be beneficial in reducing the risk of slipping in older people. (J Am Podiatr Med Assoc 103(6): 471–479, 2013)
Footwear Interventions
Authors: Hatton Anna L. , Rome Keith , Dixon John , Martin Denis J. , McKeon Patrick O.
Published: April 2014

Footwear interventions, including shoe insoles and foot orthoses, have the capacity to enhance balance control and gait in older people. This review assessed the evidence for the effect of footwear interventions on static and dynamic balance performance and gait in older populations and explored proposed theories for underlying sensorimotor and mechanical mechanisms. We searched the Medline, EMBASE, CINAHL (the Cumulative Index to Nursing and Allied Health Literature), and AMED databases and conducted hand searches. Of 115 relevant articles screened, 14 met the predefined inclusion criteria. Articles were grouped into one of three categories based on balance task (static balance performance during quiet standing, dynamic balance performance during walking, and dynamic balance performance during perturbed standing or functional tasks) and were scored for methodological quality using the Downs and Black Quality Index tool. Footwear interventions seem to alter underlying strategies controlling static and dynamic movement patterns through a combination of sensorimotor and mechanical mechanisms in older people, including those with chronic sensory and musculoskeletal conditions. Evidence shows a consistent trend toward footwear interventions markedly improving lateral stability measures, which are predictors of falls in the elderly. In-depth investigation of neurophysiologic responses to footwear interventions is necessary to help confirm any sensorimotor adaptations. The long-term effects of footwear interventions on balance, gait, and the prevention of falls in older people require further investigation. (J Am Podiatr Med Assoc 103(6): 516–533, 2013)
Effectiveness of Foot and Ankle Exercise Programs on Reducing the Risk of Falling in Older Adults
Authors: Schwenk Michael , Jordan Elise DeHaven , Honarvararaghi Bahareh , Mohler Jane , Armstrong David G. , Najafi Bijan
Published: April 2014

Background:

Foot and ankle (FA) exercise programs might reduce the risk of falling in older adults. We sought to systematically review the current literature on FA exercise programs targeted at reducing the risk of falling in older adults.

Methods:

A systematic literature search was performed in the PubMed database, the Physiotherapy Evidence Database, the Cumulative Index to Nursing and Allied Health Literature, and the Cochrane Central Register of Controlled Trials. Articles were included based on the following criteria: 1) randomized controlled trial, 2) FA exercise program, and 3) use of fall risk–related motor outcomes (strength, balance, flexibility, and functional ability) or use of falls as an outcome. Weighted effect sizes (d) were calculated across studies for estimating the overall effect of FA exercises on the most frequently reported motor outcome parameters.

Results:

Eight publications met the inclusion criteria. Small to moderate overall effects were found for balance (d = 0.46, P < .001) and ankle flexibility (d = 0.29, P = .006). No significant overall effects were found for ankle plantarflexor strength (d = 0.11, P = .223) and walking performance (d = −0.05, P = .404). Controversial results were reported for other functional measures. Effects varied depending on the type of intervention. Only one study reported improved ankle evertor strength and a significant reduction in falls.

Conclusions:

Evidence suggests that FA exercise can improve certain fall risk–related motor outcomes and reduce falls. Limited effects on strength and functional ability might be related to insufficient training intensity and lack of adherence. Further studies that include progressive strength and flexibility training are necessary to validate which FA exercise programs are most effective at preventing falls. (J Am Podiatr Med Assoc 103(6): 534–547, 2013)
Rotational equilibrium across the subtalar joint axis
Authors: Kirby KA
Published: April 2014

A review of the rotational forces, or moments, acting across the subtalar joint axis during relaxed bipedal stance is presented. The concept of rotational equilibrium about the subtalar joint axis is used to explain some of the biomechanical differences between feet that stand in the neutral and maximally pronated subtalar joint positions. In addition, the mechanical basis of treatment of sinus tarsi syndrome with foot orthoses using the concepts of subtalar joint axis moments rotational equilibrium of the subtalar joint is presented.
A modification of digital splinting to prevent neurovascular impairment
Authors: Borrelli AH
Published: April 2014

In summary, a new splint made out of MPC provides stabilization following injury and appears to have the potential for preventing neurovascular impairment. This is convenient for the patient because he or she can remove and apply the digital splint when necessary for bathing.
Lower extremity peripheral vascular disease. Part 1: Scanning electron microscopy
Authors: McCarthy DJ , Abell N , Reed T
Published: April 2014

The surgical loss of the foot or leg is vigorously resisted by podiatrists who are committed to the conservation of limbs at risk because of peripheral vascular disease. Pathologic changes in blood vessels may, however, progress to a point where no other option is available to the patient. This study assesses amputation of the extremities and investigates tissue alterations that can be identified in diseased blood vessels implicated in these circumstances. Gross pathology and scanning electron microscopy are examined in this, the first of a two-part study.
Treatment of Morton's neuroma using percutaneous electrocoagulation
Authors: Finney W , Wiener SN , Catanzariti F
Published: April 2014

A new modality for treating Morton's neuroma was introduced and performed by the authors, using a nerve lesion generator. Seventy-nine lesions were evaluated by obtaining the patients' responses to three questions. By rating their symptoms on a 0-5 scale both before and after the neurectomy, the patients showed a 56% reduction in symptoms. With a gone-improved-same-worse rating, the patients responded with 25%, 46%, 24%, and 5% in each respective category. The overall assessment of the procedure by the patients yielded 68% pleased and 32% not pleased. An average of 4 hr was missed from work following the neurectomy, and only 20% of the patients required mild analgesics.
T-Screw. A new bone fixation device
Authors: Lichty TK , Gronen WW , Johnson JD , Oliver WK
Published: April 2014

The T-Screw was patented in 1984. A 5-year study was begun in 1980, and FDA approval was granted in 1985. Detailed results of this clinical study will be reported in a later paper. The purpose of this paper is to introduce the device. The authors have found that early return to normal function and wearing shoes has been possible when using T-Screws for fixation of podiatric osteotomies. The screw appears to accelerate bone healing and has numerous applications throughout the foot. The authors believe that its ease of application and removal as well as its ability to generate rigid, compressive fixation makes it an excellent alternative to current fixation devices.
Thermographic evaluation of the autonomic effects of nerve blocks in the foot
Authors: Jacobs AM , Esper R , O'Leary R , Duda ZM , Yorzyk W
Published: April 2014

The authors evaluated regional skin temperatures of the foot following the administration of a variety of local anesthetic nerve blocks with either Xylocaine (lidocaine hydrochloride) or Sensorcaine (bupivacaine hydrochloride). The study was carried out on ten randomized parallel groups of five subjects, each group being tested with one drug and one regional nerve block. The results indicated that both Xylocaine and Sensorcaine, when administered as a posterior tibial block, result in a significantly increased blood flow to the foot. Nerve blockade of the remaining nerves of the foot did not significantly increase the sympatholytic effect obtained by posterior tibial nerve block alone.
Modified V-Y capsulorrhaphy in hallux abducto valgus surgery
Authors: Wenig JA , McCarthy DJ
Published: April 2014

The two-stage capsular closure modification of the V-Y capsulorrhaphy in hallux abducto valgus surgery is a technique for restoring the soft tissue anatomical relationships of the first metatarsophalangeal joint in a bunion deformity. The first stage of the V-Y capsulorrhaphy corrects the plantar and lateral deviation of the abductor hallucis tendon. The second stage of the V-Y capsulorrhaphy closure allows for the correction of abductus and valgus rotation of the hallux. Inasmuch as each element of the soft tissue deformity in hallux abducto valgus deformity is corrected individually, greater precision can be applied to each constituent of the hallux abducto valgus deformity.
Processed Aloe vera administered topically inhibits inflammation
Authors: Davis RH , Rosenthal KY , Cesario LR , Rouw GA
Published: April 2014

Aloe vera preparations were evaluated for topical anti-inflammatory activity using the croton oil-induced edema assay. The results show that small amounts of A. vera given topically will inhibit inflammation induced by a moderate amount of irritant. In general, the decolorized Aloe was more effective than the colorized Aloe (with anthraquinone). A 47.1% inhibition of inflammation was obtained by 5% decolorized irradiated Aloe. These results may be used as a baseline to assess the biologic activity of A. vera in the treatment of inflammation by podiatric physicians.
Compartment pressure in the foot. Analysis of normal values and measurement technique
Authors: Dayton P , Goldman FD , Barton E
Published: April 2014

This clinical trial was carried out to verify the validity of the current objective compartment pressure parameters described in the forearm and leg for use in the foot. The authors evaluated the compartment pressures of the central plantar compartment in 25 normal volunteers (94 separate measurements). In addition to determining an average normal foot compartment pressure, two methods of measurement were compared. Results showed no significant difference in normal values through the use of an arterial line monitor technique (5.98 +/- 2.78 mm Hg [SD]) as compared with a Stryker intracompartmental pressure monitor (4.69 +/- 2.62 mm Hg [SD]). It was found that pedal edema caused a statistically significant increase in pressures. The authors propose a standard technique for pedal compartment pressure measurement and discuss diagnosis and management of compartment syndrome in the foot.
Os trigonum. Variation of a common accessory ossicle of the talus
Authors: Mann RW , Owsley DW
Published: April 2014

The authors present a pictorial essay showing the range of variability of separate and attached os trigona in dry-bone specimens. The presence of free os trigona is found to be 1.7% in an early 20th-century skeletal sample, with no findings of the trait in 513 tali of prehistoric native Americans and Eskimos.
Chronic compartment syndrome of the leg
Authors: Bouch√© RT
Published: April 2014

Chronic compartment syndrome is an uncommon but important cause of exercise-induced leg pain. The author provides a comprehensive review of chronic compartment syndrome of the leg. Case reports are presented to stress the clinical importance of chronic compartment syndrome to the podiatric physician.
Burring technique in modern podiatric palliative care
Authors: Master G , Kelly PF , Walinsky MD
Published: April 2014

A review of the literature reveals sparse references regarding the application of burs in the conservative treatment of soft tissues and nails. The most recent publications were in 1946. The authors present an update on the technology and practical application of burs in podiatric medicine, their metallurgy, types, and recommended bur selection for reduction, remodeling, and burnishing of hyperkeratotic tissue and thickened nails.
Research process. Conducting the research project
Authors: Gabel LL
Published: April 2014

Conducting the research study should be a methodical process in which the details of the planning process are executed. This fourth article in a series of six on the research process presents guidelines with supporting recommendations to increase the likelihood that the study indeed will be conducted as planned. The guidelines emphasize the importance of 1) record-keeping systems, 2) detailed work schedules, 3) communications, and 4) monitoring progress.
Effect of desquamation of facial skin during surgery
Authors: Hodge WR , Trepal M , Woolf WH , Piccora R
Published: April 2014

Aseptic control of organisms in the operating arena has long been a major goal of surgeons. The purpose of this study was to assess the facial skin flora of operating room personnel and its relationship to contamination adjacent to the surgical site. The authors found that, in spite of all attempts at aseptic control, operating room personnel have numerous organisms on the exposed facial areas, and the same organisms appear on the operating room table adjacent to the surgical site of about one in five patients.
Review of metatarsal osteotomies for the treatment of neuropathic ulcerations
Authors: Tillo TH , Giurini JM , Habershaw GM , Chrzan JS , Rowbotham JL
Published: April 2014

The records of 52 patients who underwent metatarsal osteotomies for the treatment of chronic neuropathic ulcerations between the years 1983 and 1985 were analyzed in a retrospective study. Long-term follow-up information was available for all but three patients. All patients were conservatively managed preoperatively and postoperatively with shoes, accommodative orthoses, and local care. A limb salvage rate of 94%, 46 of 49 patients, was achieved in this study. Although 13 patients developed transfer ulcerations, all but one were managed either with conservative care or a lesser podiatric procedure, and all remain healed to date.
Sinus tarsi syndrome in a patient with talipes equinovarus
Authors: Giorgini RJ , Bernard RL
Published: April 2014

The literature reports that 70% of the cases of sinus tarsi syndrome are post-traumatic, following an inversion sprain, and that 30% result from inflammatory disorders, such as rheumatoid arthritis, ankylosing spondylitis, and gouty arthritis. However, in the case presented, talipes equinovarus deformity and sinus tarsi syndrome coexisted. One of the corrective goals in the management of the talipes equinovarus deformity is the realignment of the articulation between the medial plantarly deviated talar head and the anteromedial segment of the calcaneus. The calcaneus must be rotated from a plantarflexed position into a dorsiflexed position. The posterior tubercle will be moved down and in, with the anterior process moved up and out away from the talar head. By correcting the plantarflexed varus attitude of the calcaneus, it is put in a valgus position that often closes down the sinus tarsi upon weightbearing. This compression may result in pain over the lateral aspect of the midfoot with hindfoot instability, as seen in the case presented. As a result of the abnormal anatomical relationship of the talus and calcaneus, the patient developed severe pain in the sinus tarsi. Based on the medical history and present postoperative results, the authors find a long-term sequela of talipes equinovarus deformity to be sinus tarsi syndrome.
Symptomatic os supra naviculare. A case report
Authors: Miller GA , Black JR
Published: April 2014

Accessory bones are common anomalies in the foot. They often may become symptomatic. The authors present such a case in which the patient was successfully treated by surgical incision of the accessory ossicle.
Os trigonum syndrome
Authors: Wenig JA
Published: April 2014

The os trigonum is a frequently encountered accessory bone of the foot. It is located at the posterior aspect of the talus, and may appear either as a separate ossicle or fused to the talus. The separate ossicle may represent an accessory bone or a fracture of the posterior process (also called the trigonal process) of the talus. The author reviews the mechanism of injury and the diagnosis and treatment. A case report of a fracture of the trigonal process is presented.
Foot deformity of unknown etiology in a prehistoric skeleton from Texas
Authors: Owsley DW , Mann RW
Published: April 2014

An unusual foot deformity in an archaeological specimen from Oldham County, Texas, is presented. It is hoped that through description and radiographic and photographic examination the readers will be able to offer opinions concerning the frequency or possible etiology of the condition.
Physical medicine considerations in managing the older patient
Authors: Bruno J , Helfand AE
Published: April 2014

Foot problems are common in elderly patients, and the relief of foot pain can increase the rehabilitative potential for patients with chronic diseases, impairments, or disabilities. The authors discuss the process of evaluation of older persons, physical modalities that can be used as part of a rehabilitation program, and special considerations for various disorders common to geriatric patients. They also present a detailed description of a technique for the clinical management of peripheral arterial insufficiency.
Intramuscular hemangioma. Case report and literature review
Authors: Nack J , Gustafson L
Published: April 2014

A case was presented in which a 28-year-old male presented with tenderness and stiffness in the posterior muscle group of his right leg. The patient's symptoms had been present intermittently for nearly 23 years. Recently, the pain had progressed to the point of limiting his normal daily activities. Initial conservative therapy, which consisted of Zorprin, heel lifts, and low Dye strapping, failed to alleviate the symptoms. Magnetic resonance imaging was used to identify a mass of an unknown etiology. Following orthopedic and oncologic consultation, surgical excision was advised and performed. Pathologic examination of the mass confirmed that the tumor was an intramuscular hemangioma. Classically, with intramuscular hemangiomas, patients may have soft tissue complaints, such as pain and swelling, present for years. Patients usually defer medical attention until the primary symptom of pain occurs. When a patient complains of a painful soft tissue mass of the leg, and intramuscular hemangioma should be included in the differential diagnosis. The appropriate radiographic studies and consultations should be performed, and surgical excision should be carried out.
Piezogenic pedal papules extending into the arch. Case report and discussion
Authors: Pontious J , Lasday S , Mele R
Published: April 2014

A unique presentation of a painful piezogenic papule in the medial longitudinal arch has been presented. This lesion puts pressure on nearby structures, causing pain. Walking without pain is achieved through orthopedic padding. It is essential that these papules be differentiated from similar-appearing lesions of a systemic etiology, so that appropriate treatment can be rendered.
Koenig total great toe implant. Preliminary report
Authors: Koenig RD
Published: April 2014

A new first metatarsophalangeal joint implant arthroplasty is described. The two-component, titanium alloy and polyethylene prosthesis designed for weightbearing is noncemented and press-fit. Sixteen cases involving 18 implants were evaluated over 18 months with evidence that good correction and pain free motion can be obtained.
Epidemic and classic Kaposi's sarcoma of the feet. A comparative study
Authors: Steinfeld AD , Cooper JS
Published: April 2014

The clinical behavior of Kaposi's sarcoma involving the feet is compared for patients with and without AIDS. Although AIDS-related Kaposi's sarcoma is less likely to be confined to the legs than is non-AIDS-related Kaposi's sarcoma, the legs are the most common site of disease in both forms. Kaposi's sarcoma occurring in the AIDS setting is as radiosensitive as that which occurs in the patient without AIDS. Palliative radiotherapy can offer substantial relief for affected patients.
Aloe vera as a biologically active vehicle for hydrocortisone acetate
Authors: Davis RH , Parker WL , Murdoch DP
Published: April 2014

Aloe vera, as a biological vehicle for hydrocortisone 21-acetate, was tested topically and systemically against acute inflammation. Systemically, the combination of A. vera and hydrocortisone produced a maximum 88.1% inhibition of edema. Polymorphonuclear leukocyte infiltration was reduced 91.1%. The topical inhibition of edema peaked at 97%. The possibility that A. vera has significant potential as a biologically active vehicle for steroids is discussed.
Research process. Concluding the research project
Authors: Gabel LL
Published: April 2014

This fifth article in a series of six on the research process provides guidelines for concluding a research project. Attention is directed toward a need for the researcher to be sensitive to the persons who supported the project. The other significant aspect of concluding a research project involves activities associated with analyzing the data, preparing the results, and finalizing the findings.
Lisfranc's fracture-dislocation. A review of the literature and case reports
Authors: Kaplan JD , Karlin JM , Scurran BL , Daly N
Published: April 2014

The authors present an in-depth discussion of Lisfranc's fracture-dislocations, including classifications, mechanisms of injury, radiographic evaluation, and a literature review. Four cases are presented for review. Lisfranc's fracture-dislocation is a rare injury that can lead to prolonged disability if undiagnosed or if there is a delay in treatment.
The podiatric application of continuous passive motion. A preliminary report
Authors: Kaczander BI
Published: April 2014

The application of continuous passive motion to joints immediately after podiatric surgery stimulates the regeneration of articular tissue, eliminates adhesions, prevents joint stiffness, reduces pain, and is well tolerated by patients. The author reviews the development of continuous passive motion in animal and clinical studies and how it may be used after podiatric surgery.
Heel spur syndrome. Pathomechanics and nonsurgical treatment. Biomechanics Graduate Research Group for 1988
Authors: Scherer PR
Published: April 2014

In this study, the authors review the multitude of suspected etiologies of heel spur syndrome, propose a new pathomechanical theory, and apply a treatment plan to 84 patients with 133 painful heels. The study investigates whether there is a common foot type to the syndrome and whether factors such as sex, age, occupation, and weight influence incidence or treatment. A subgroup is established, consisting of subjects who only received mechanical treatment, to determine if a change in foot position can relieve symptoms.
Biomechanical management of children and adolescents with Down syndrome
Authors: Caselli MA , Cohen-Sobel E , Thompson J , Adler J , Gonzalez L
Published: April 2014

The authors describe the podiatric biomechanical management of the child and adolescent with Down syndrome. They also present an overview of the genetics, general characteristics, orthopedic problems, and gait of these patients. They discuss the various approaches to the biomechanical problems associated with the syndrome, and present two case histories that demonstrate common considerations in the treatment of the patient with Down syndrome.
Sesamoidectomy for the treatment of chronic neuropathic ulcerations
Authors: Giurini JM , Chrzan JS , Gibbons GW , Habershaw GM
Published: April 2014

Neuropathic ulcerations in diabetic patients are frequent causes of hospitalizations and morbidity. The plantar aspect of the first metatarsophalangeal joint is a common location for these ulcerations, because of the significant weightbearing forces generated through this joint and the presence of sensory and motor neuropathy. The authors describe 24 cases in which excision of the tibial sesamoid, fibular sesamoid, or both, was performed to resolve these lesions.
Tarsal coalitions. A surgical classification
Authors: Downey MS
Published: April 2014

The surgical alternatives for the treatment of tarsal coalitions include procedures as diverse as arthroplasty and arthrodesis. Traditional classifications of tarsal coalitions are primarily descriptive and afford little information regarding preferred treatment. For this reason, the author introduces the Articular Classification System, which is based on the patient's osseous age, the articular involvement of the coalition, and the associated secondary arthritic changes. This classification system can be used as a framework to discuss recommended surgical procedures and their long-term results.
Arteriovenous shunting in the patient with diabetic neuropathy
Authors: Gittens KA , Giacalone VA , Krych SM , Harkless LB
Published: April 2014

The authors present a review of the literature on arteriovenous shunting, which is a relatively new theory. It is described in the patient with diabetes and coexisting neuropathy. The authors present a case report of a patient with arteriovenous shunting and diabetic neuropathic ulcerations.
Diagnosis and treatment of tinea pedis. A review and update
Authors: Page JC , Abramson C , Lee WL , McCarthy DJ , McGinley KJ , Williams D
Published: April 2014

Fungal foot infections are becoming an increasingly common public health problem as the population ages. New studies have shown that some of the traditional therapeutic antifungal agents have multiple actions that enable them to be more efficacious than previously thought, and more efficacious than other agents without multiple actions. In this review article, the pedal infections commonly referred to as tinea pedis, or athlete's foot, are described. The etiologic agents involved in the pathogenesis, the methodologies for proper diagnosis, and the therapeutic agents commercially available for treatment are reviewed.
Characterization of the performance of shoe insert materials
Authors: Lewis G , Tan T , Shiue YS
Published: April 2014

It has been widely reported that shoe inserts are an effective interventional modality either for the relief of discomfort to the feet associated with a variety of orthopedic disorders or conditions or simply for comfort. Results from many types of experimental tests have been used to obtain the shock absorption capacity of shoe insert materials. The authors contend in this study that, while shock absorption is a highly desirable property, it is by no means the only that should be used to characterize these materials. Thus, a new index of performance of these materials is proposed. This index is computed from data, obtained in a simple experimental test, on both the shock absorption and energy return performances of the insert material.
The distal saphenous vein cutdown procedure
Authors: Johnson JD , Page JC
Published: April 2014

Distal saphenous vein cutdown is an excellent method for intravenous access. It allows for a rapid infusion of fluids. Although the saphenous vein cutdown is not commonly performed, the podiatrist should be familiar with this procedure, as it may be necessary during an emergency situation.
Anterior inferior tibiofibular ligament. Variations and relationship to the talus
Authors: Ray RG , Kriz BM
Published: April 2014

The anterior inferior tibiofibular ligament was evaluated in 46 preserved specimens with a mean age of 73.8 years. A classification system was devised to encompass the observed variations in ligamentous structure. Particular emphasis was placed on evaluating the extent of impingement between the inferior border of the ligament and the talus. It was determined that the presence of a separate inferior fascicle is not a prerequisite for impingement. However, a triangular, beveled region located anteriorly on the border between the trochlear and lateral surfaces of the talus was identified in association with anterior inferior tibiofibular ligament impingement.
Fracture-dislocation of the talus in the pediatric patient. An unusual injury
Authors: Stutz JM , Karlin JM , Daly N
Published: April 2014

Subtalar fracture-dislocations in children are unusual, perhaps because of the greater elasticity of bone in children. The authors have presented a case of medial subtalar dislocation in a 13-year-old boy, accompanied by a rare fracture of the entire posterior process of the talus. This particular fracture has not been previously reported in association with a subtalar joint dislocation, nor has it been reported in a child. The patient was treated successfully by closed reduction of both the dislocation and the fractures.
Surgical management of chronic tophaceous gout. A case report
Authors: Ford TC
Published: April 2014

Severe chronic tophaceous gout can be a surgical challenge. A classic case of marked first and fifth metatarsophalangeal joint involvement is presented.
Clinical impact of magnetic resonance imaging in foot osteomyelitis
Authors: Nigro ND , Bartynski WS , Grossman SJ , Kruljac S
Published: April 2014

The impact of magnetic resonance imaging (MRI) on the clinical management of patients with foot inflammation and suspected osteomyelitis was evaluated in 44 patients with 47 foot MRI exams. Twenty-nine patients were diabetic. Bone biopsy or bone culture was obtained in 34 patients, and routine radiographs and bone scan studies were available in most patients for comparison. Magnetic resonance imaging showed reliable identification of bone infection with a sensitivity of 100% and specificity of 95%. Plain radiographs were inaccurate and, as expected, bone scans were highly sensitive (90%) but not specific (33%). The high accuracy of MRI allowed for better identification of patients with osteomyelitis and, therefore, improved targeting of potential operative candidates.
Nail dust aerosols from onychomycotic toenails. Part II. Clinical and serologic aspects. 1984
Authors: Abramson C , Wilton J
Published: April 2014

The podiatric procedure of burring hyperkeratotic fungal infected toenails results in large quantities of nail dust aerosols. An extremely large percentage (31%) of podiatrists who were analyzed for immunoglobulin E (IgE) by antibody radioimmunoassay were found to have abnormally high levels. Incidence of precipitin antibodies to Trichophyton rubrum in sera of those in practice from 0 to 15 years was 23%, and those in practice 16 years or more was 29%. In this study, podiatrists who were chronically exposed to nail dust aerosols after years of practice presented with symptoms of conjunctivitis, rhinitis, asthma, coughing, hypersensitivity, and impaired lung function.
Orthotic therapy in the management of osteoarthritis
Authors: Thompson JA , Jennings MB , Hodge W
Published: April 2014

The authors evaluate the use of orthoses as a primary therapeutic means in the long-term management of patients with osteoarthritis of the foot and ankle. A comparison of the amount of pain relief experienced by 64 subjects (mean age 63 years) with different treatment regimens for osteoarthritis was made to determine the role orthoses played in helping to reduce or eliminate pain. One hundred percent of the subjects wearing orthoses only for relief of pain had a statistically significant longer period of pain relief than those on nonsteroidal anti-inflammatory drugs. Fifty-five percent of the subjects using orthoses and nonsteroidal anti-inflammatory drug therapy also had a statistically significant longer period of pain relief than those receiving nonsteroidal anti-inflammatory drug therapy only.
Hyperpronation control with a dynamic stabilizing innersole system
Authors: Jay RM , Schoenhaus HD
Published: April 2014

An orthotic device, which prevents hyperpronation of a human foot, has an offset, deep heel seat to cup the calcaneus. It maintains the calcaneus in approximately 5 degrees of varus with high medial and lateral flanges, which prevents lateral transverse drift of the first and fifth metatarsals.
Lateral subtalar dislocation. A literature review and unusual case report
Authors: Sands CL , Daly N , Karlin JM , Scurran BL
Published: April 2014

An unusual case of suspected lateral subtalar joint dislocation was reported. A review of the literature found that medial dislocations were reported four times more frequently than lateral dislocations. Half of the cases of subtalar dislocation reviewed here described associated fractures, the incidence of which was higher in lateral dislocations. In both types of dislocations examined, almost half were reduced nonoperatively. In most cases, long-term results of repair of these injuries were considered favorable.
Effectiveness of absorbable fixation devices in Austin bunionectomies
Authors: Gerbert J
Published: April 2014

Forty-eight Austin bunionectomies were fixated by using an absorbable fixation device. Twenty-three were fixated with a 1.5- or 2.0-mm diameter Biofix rod and twenty-five were fixated with a 1.3-mm diameter Orthosorb pin. To be included in this project, all patients were followed radiographically for a minimum of 3 months. One foot (4%) fixated with Biofix developed a sterile sinus discharge 3 months postoperatively after uneventful wound healing. There were no clinical or radiographic changes seen in the feet in which Orthosorb was used. Also, there were no infections or osteotomy dislocations with either fixation device.
Extrinsic rearfoot posts
Authors: Blake RL , Ferguson H
Published: April 2014

The addition of an extrinsic rearfoot post to an orthotic device allows the podiatric practitioner to modify the function of the device. Specifically, rearfoot posts are used to allow for a more inverted heel position at contact, to provide greater resistance to abnormal frontal plane motion of the calcaneus and to provide for motion for shock absorption. The authors present nine prescription variables that each provide for a specific functional change to be incorporated into the orthotic device.
Action agenda for the 1990s. Reflections on directions for podiatric medical education
Authors: McNevin AJ
Published: April 2014

The author reflects upon his experiences within podiatric medical education and shares his thoughts about the directions podiatric medical education should take before the end of the century. The author envisions a collaborative effort between the practitioners and educators within the profession in areas such as curriculum, research, academic health science centers, accreditation, and other important issues. The author calls for an education system relevant to and tested upon the anvil of patient care.
Current diagnostic and radiographic assessment of tendo Achillis rupture
Authors: Tomassi FJ
Published: April 2014

The literature is replete with current clinical evaluation techniques of tendo Achillis rupture. An overview of the etiologies, diagnosis, radiographic evaluation, and treatment modes, either surgical or conservative, is presented with a brief description of two lesser known techniques: the knee flexion examination and needle test.
Treatment of Morton's neuroma as a nerve compression. The role for neurolysis
Authors: Dellon AL
Published: April 2014

The almost universal surgical approach for the treatment of Morton's metatarsalgia is to resect the neuroma through a dorsal incision. Considering that the mechanism for the metatarsalgia is chronic repetitive compression of the common plantar digital nerve between the metatarsal heads, this report explores the use of neurolysis in five patients with 11 involved nerves. In surgery, the intermetatarsal ligament is divided, intrinsic fibrosis is released, and the epineurium is opened. The mean follow-up period is 33 months. Complete pain relief was achieved in four of the five patients, with the fifth patient, 13 years after a crush injury to the foot, achieving good pain relief. All five patients resumed their usual jobs and athletic activities. One patient wears sneakers instead of regular shoes. The patient with the crush injury wears custom-made shoes.
Bilateral bipartite medial cuneiform. A case report
Authors: Dellacorte MP , Lin PJ , Grisafi PJ
Published: April 2014

A fracture to the intermediate cuneiform that was not definitively detected on routine radiographs because of the overlap of the cuneiform was presented. Weightbearing x-rays did not provide additional information. The anatomical location of the fracture was identified only after a computed tomography scan was performed. An incidental finding, bilateral bipartite medial cuneiforms, was also observed on the computed tomography scan, which contributed to the overlap on routine radiographs. The anatomy of the bipartite medial cuneiforms seen on computed tomography was similar to that described by Barlow in 1942. Retrospective comparison to the initial radiographs with the computed tomography scan sections did reveal bipartite medial cuneiforms on these films as well. The podiatric physician should keep bipartition in mind when evaluating x-rays for any osseous pathology, especially fractures.