bluuebunny/crossref_metadata_2025 huggingface dataset:
Podiatric Involvement in Multidisciplinary Falls-Prevention Clinics in Australia
Authors: Menz Hylton B. , Hill Keith D.
Published: April 2014

Background: Falls in older people are a major public health problem, and there is increasing evidence that foot problems and inappropriate footwear increase the risk of falls. Several multidisciplinary prevention clinics have been established to address the problem of falls; however, the role of podiatry in these clinics has not been clearly defined. The aims of this study were to determine the level of podiatric involvement in multidisciplinary falls clinics in Australia and to describe the assessments undertaken and interventions provided by podiatrists in these settings.

Methods: A database of falls clinics was developed through consultation with departments of health in each state and territory. Clinic managers were contacted and surveyed as to whether the clinic incorporated podiatry services. If so, the podiatrists were contacted and asked to complete a brief questionnaire regarding their level of involvement and the assessment procedures and interventions offered.

Results: Of the 36 clinics contacted, 25 completed the survey. Only four of these clinics reported direct podiatric involvement. Despite the limited involvement of podiatry in these clinics, all of the clinic managers stated that they considered podiatry to have an important role to play in falls prevention. Podiatry service provision in falls clinics varied considerably in relation to eligibility criteria, assessments undertaken, and interventions provided.

Conclusions: Despite the recognition that foot problems and inappropriate footwear are risk factors for falls, podiatry currently has a relatively minor and poorly defined role in multidisciplinary falls-prevention clinics in Australia. (J Am Podiatr Med Assoc 97(5): 377–384, 2007)
Second-Toe Length and Forefoot Disorders in Ballet and Folk Dancers
Authors: Oztekin Haluk H. , Boya Hakan , Nalcakan Mesut , Ozcan Ozal
Published: April 2014

Background: Although there is no ideal foot type for classical dancers, second-toe length seems to be a factor in the etiology of foot disorders in ballet dancers.

Methods: We investigated the relationship between second-toe length and foot disorders in 30 ballet dance students and 25 folk dance students. Second-toe length in relation to the hallux (longer or equal/shorter), hallux deformities, first metatarsophalangeal joint inflammation, number of callosities, and daily pain scores were recorded in both groups and compared.

Results: There was no statistically significant difference in toe length between the two groups (P > .05). Ballet dancers with equal-length or shorter second toes had lower pain scores, less first metatarsophalangeal joint inflammation, and fewer callosities in their feet compared with dancers with longer second toes.

Conclusions: Second-toe length seems to be a factor in the development of forefoot disorders in classical ballet dancers but not folk dancers. Dancers who have equal-length or shorter second toes in relation to the hallux may have fewer forefoot disorders as dance professionals. (J Am Podiatr Med Assoc 97(5): 385–388, 2007)
Intraosseous Ganglion of the Talus Treated with the Talonavicular Joint Approach Without Exposing the Ankle Joint
Authors: Cebesoy Oguz
Published: April 2014

Intraosseous ganglion, which is generally seen in metaphyseal-epiphyseal regions of long bones, is not a rare disorder. It is extremely rare in the talus, however. Differential diagnosis of a cystic talar lesion should include enchondroma, chondroblastoma, giant cell tumor, and unicameral bone cyst. This article presents a case of intraosseous ganglion of the talus in a 38-year-old woman treated with a new surgical approach and technique. The patient had mild ankle pain at the arc of motion in her right ankle that increased with activity. Radiographs and magnetic resonance images showed a cystic lesion in the medial side of the talar dome. It was treated by curettage and autocorticocancellous bone grafting through an opening in the talonavicular joint without disturbing the intact talar dome cartilage. One month after the operation, the patient had an excellent clinical outcome. This approach and technique can be used to treat other lesions of the talus that do not involve the joint space. (J Am Podiatr Med Assoc 97(5): 424–427, 2007)
Low Bone Mass and Fractures on Foot Radiographs: Missed Opportunities to Evaluate for Osteoporosis
Authors: Newton Marisha T. , Archer Juanita A. , Scruggs Michangelo , Geter Kirk , Al-Dabagh Hiba , Lloyd Errol , Nwokike Maria
Published: April 2014

Background: Osteoporosis is often unrecognized, even in the presence of radiologic evidence of vertebral or nonvertebral fragility fractures.

Methods: Ninety patients aged 50 years and older with radiographs of the foot taken at Howard University Hospital between 2003 and 2005 were randomly selected. In phase 1, standard radiograph reports were reviewed for evidence of osteopenia, fractures, or both. In phase 2, risk factors for osteoporosis and dual energy x-ray absorptiometry scans were obtained.

Results: In phase 1, radiologists reported all of the fractures for all 90 participants; however, osteopenia was reported in only 54.7% of these. In phase 2, for 50% of the participants with radiographic evidence of osteopenia, fractures, or both, there was no evidence that the clinicians evaluated risk factors for low bone mass or requested a dual energy x-ray absorptiometry scan. Of participants who had radiographic evidence of osteopenia, osteoporosis, or both, 83.3% met the criteria for dual energy x-ray absorptiometry scans.

Conclusions: Osteopenia or fracture observed on radiographs of the foot are predictive of low bone mass but are often not evaluated. (J Am Podiatr Med Assoc 99(1): 1–7, 2009)
Reliability of the Modified Foot Posture Index
Authors: Cornwall Mark W. , McPoil Thomas G. , Lebec Michael , Vicenzino Bill , Wilson Jodi
Published: April 2014

Background: The Foot Posture Index (FPI) has been advocated as a simple and convenient tool to assess static foot posture in a clinical setting. Although published studies have indicated that the FPI has good intrarater reliability and moderate interrater reliability, these studies were conducted on a previous version of the tool that used eight criteria to score a patient’s foot posture. The revised tool has only six criteria (FPI-6). The purpose, therefore, of this study was to investigate the intrarater and interrater reliability of the revised version of the FPI.

Methods: Three different raters used the FPI-6 to twice evaluate 92 feet from 46 individuals.

Results: Intrarater reliability was high but interrater reliability was only moderate. In addition, using the raw score generated by the FPI-6 to classify feet into one of five categories did not improve agreement between raters.

Conclusions: The FPI-6 should be used with extreme caution and may actually have limited value, especially from a research perspective. (J Am Podiatr Med Assoc 98(1): 7–13, 2008)
Transfer of the Flexor Digitorum Brevis Tendon
Authors: de Bengoa Vallejo Ricardo Becerro , Tirado Fermín Viejo , Frutos Juan Carlos Prados , Iglesias Marta Elena Losa , Jules Kevin T.
Published: April 2014

Background: Transposition of the flexor digitorum longus tendon has been widely reported for the correction of flexible claw or hammer toe deformities. In contrast, a search of the literature revealed no previous reports of transposition of the flexor digitorum brevis tendon for treatment of these conditions. We performed a cadaver study to determine whether the flexor digitorum brevis tendon is long enough to be transferred to the dorsum of the proximal phalanx of the toe from its lateral or medial aspect.

Methods: Transposition of the flexor digitorum brevis tendon was attempted in 180 toes of cadaver feet: 45 second toes, 45 third toes, 45 fourth toes, and 45 fifth toes.

Results: The flexor digitorum brevis tendon was long enough to be successfully transposed in 100% of the second, third, and fourth toes and in 42 (93.3%) of the fifth toes. In the three remaining fifth toes (6.7%), the flexor digitorum brevis tendon was absent, a known anatomical variation.

Conclusions: Transfer of the flexor digitorum brevis tendon to the dorsum of the proximal phalanx can be performed for correction of claw or hammer toe deformities, especially in the second, third, and fourth toes. The transverse aponeurotic fibers originating from the extensor digitorum longus impede the transfer of the flexor digitorum brevis tendon, and meticulous excision of these fibers is essential to the success of the procedure. (J Am Podiatr Med Assoc 98(1): 27–35, 2008)
Effectiveness and Safety of Using Podikon Digital Silicone Padding in the Primary Prevention of Neuropathic Lesions in the Forefoot of Diabetic Patients
Authors: Scirè Vincenzo , Leporati Elisa , Teobaldi Ilaria , Nobili Laura Ambrosini , Rizzo Loredana , Piaggesi Alberto
Published: April 2014

Background: In diabetic patients with complications from peripheral neuropathy, the hyperpressure areas can rapidly lead to ulcerative lesions in the absence of protective sensation. Partial digital silicone orthoses could provide an innovative and functional therapeutic solution in the management of preulcerative areas of the forefoot in neuropathic diabetic patients. We clinically tested this hypothesis.

Methods: Digital off-loading silicone padding was prepared for 89 neuropathic patients with deformities and localized hyperkeratosis in the forefoot. After 3 months and in basal conditions, the number of areas of hyperkeratosis was evaluated together with the hardness of the skin, the number of active lesions, and any adverse events associated with use of the orthosis. The patients were compared to a control group of 78 randomized patients undergoing standard therapy. In a subgroup of 10 patients, a static and dynamic biomechanical evaluation was also conducted with a computerized podobarometric platform.

Results: Both the number of lesions and the prevalence of hyperkeratosis and skin hardness were significantly lower (P < .01) in the group treated with the silicone orthoses than in the control group. No adverse events were reported during the 3 months of observation. The podobarometric analysis highlighted a significant (P < .001) reduction of peak pressure in the areas undergoing orthotic correction.

Conclusions: Silicone padding is effective and safe in the prevention of lesions in neuropathic patients at high risk of ulceration and significantly reduces the incidence of new lesions in the 3-month follow-up period compared to standard treatment. (J Am Podiatr Med Assoc 99(1): 28–34, 2009)
First Metatarsal Callus Distraction
Authors: Benson J. Christopher , Banks Alan S.
Published: April 2014

We describe the results in seven patients who underwent surgery to lengthen a short first metatarsal via callus distraction. The increased length achieved ranged from 13 to 48 mm, with an average of 20.2 mm. The technique was successful in restoring length and improving symptoms, although several complications were encountered. (J Am Podiatr Med Assoc 98(1): 51–60, 2008)
A Comparison of Different Assessment Techniques for Measuring Foot and Ankle Volume in Healthy Adults
Authors: Friends John , Augustine Elizabeth , Danoff Jerome
Published: April 2014

Background: Foot and ankle volume may be an important measurement for conditions such as lower-extremity trauma or pathologic abnormalities. Water volumetry, often used for this measure, is accurate but not always convenient. We used figure-of-eight tape measurement, prism approximation, foot size measurement (Brannock device), and optoelectric measurement (Perometer) with the standard of water volumetry to compare foot and ankle volumes.

Methods: All five techniques were used to measure both the feet and ankles of ten asymptomatic men and women. Reliability was determined by repeating several trials, and validity was determined by comparing all of the techniques with water volumetry (the established standard). Regression equations were found that related each technique to water volumetry.

Results: All of the techniques were reliable (intraclass correlation coefficient[3,1] = 0.96–0.99). The figure-of-eight technique showed the highest agreement with water volumetry (R2 = 0.96), and the prism method, the lowest (R2 = 0.73).

Conclusions: Although any of these techniques should be acceptable for monitoring foot and ankle volume in normal limbs, the figure-of-eight method comes closest to reproducing the results of water volumetry. We believe that this technique would also be best in the presence of foot deformities, but this remains to be studied. (J Am Podiatr Med Assoc 98(2): 85–94, 2008)
Flexor Tendon Sheath as a Source of Pain in Lesser Metatarsal Overload
Authors: Perez Hugo R. , Roberts Joshua
Published: April 2014

Background: Lesser metatarsal overload may lead to pathologic conditions ranging from plantar metatarsophalangeal joint pain to dislocation. The flexor tendon sheath lies directly plantar to the joint. The increased pressure associated with lesser metatarsal overload may lead to synovitis and pain of the flexor tendon sheath.

Methods: Fifteen consecutive patients with lesser metatarsal overload had visual analog scale scores determined at three metatarsophalangeal joint areas to determine the source of pain. The patients underwent seven maneuvers to determine the pain scale score: single-leg heel raise and palpation of the second and third metatarsophalangeal joints on the plantar proximal, plantar distal, and dorsal aspects. The patients were then injected with 0.5 mL of lidocaine, 2%, into the second and third flexor tendon sheaths, and the maneuvers were repeated.

Results: Before the injection, the second metatarsophalangeal joint had a significantly greater visual analog scale score plantar than dorsal (6.9 and 2.6, P ≤ .01). The flexor tendon sheath injection significantly improved all seven pain scale scores.

Conclusions: Patients with lesser metatarsal overload experienced significantly greater visual analog scale pain scores on the plantar than the dorsal aspect of the second metatarsophalangeal joint. The scores significantly improved after diagnostic injection in the flexor tendon sheaths. The flexor tendon sheaths are probably involved in patients with primarily plantar pain. (J Am Podiatr Med Assoc 99(2): 129–134, 2009)
Plantar Epidermoid Inclusion Cyst as a Possible Cause of Intractable Plantar Keratosis Lesions
Authors: Carmona Francisco J. Garcia , Huerta Javier Pascual , Toledo Javier Hernandez
Published: April 2014

Inclusion cysts are benign lesions that appear as a consequence of traumatic inclusion of epidermal cells into the dermis. They can be painful if they appear under pressure areas, especially the metatarsal heads. We report a case of a 36-year-old woman with an intractable plantar keratosis lesion under the third metatarsal head of 3 years’ duration. Ultrasonography revealed the presence of a subcutaneous mass with a growing epidermoid. It was surgically excised, and pathology confirmed the diagnosis of a plantar epidermoid cyst. All symptoms disappeared after the excision of the lesion. This case should alert the clinician about the existence of keratotic lesions in the metatarsal heads commonly diagnosed and treated as intractable plantar keratosis, although they are not directly derived from metatarsal overload. Some of the lesions could be directly derived from skin problems aggravated by pressure from the metatarsal head. This should be taken into consideration when addressing the management of these lesions. (J Am Podiatr Med Assoc 99(2): 148–152, 2009)
Injectable Botulinum Toxin as a Treatment for Plantar Hyperhidrosis
Authors: Vlahovic Tracey C. , Dunn S. Patrick , Blau Jill C. , Gauthier Caroline
Published: April 2014

Hyperhidrosis is defined as excessive and uncontrollable sweating due to overactivity of the eccrine sweat glands. The first line of treatment for plantar hyperhidrosis consists of conservative therapies such as topical solutions (ie, antiperspirant applications and aluminum chloride preparations) and iontophoresis. When the patient has failed these standard treatments, the other available medical options are rather limited and not well tolerated. Botulinum toxin type A (Botox, Allergan Inc, Irvine, California) is a purified neurotoxin complex approved by the US Food and Drug Administration in 2004 for multiple medical conditions, including severe primary axillary hyperhidrosis that failed conservative topical therapies. Few recent clinical studies have suggested that botulinum toxin is effective in the treatment of plantar hyperhidrosis. In this case study, two patients received intradermal injections of botulinum toxin type A into the plantar aspect of both feet. A 3-month follow-up evaluated the efficacy of botulinum toxin type A by subjectively assessing the amount of residual sweating. In these two patients, botulinum toxin type A was an effective and safe treatment for plantar hyperhidrosis. (J Am Podiatr Med Assoc 98(2): 156–159, 2008)
An Enlarging Distal Tibia Osteochondroma in the Adult Patient
Authors: Galasso Olimpio , Mariconda Massimo , Milano Carlo
Published: April 2014

The extensive enlargement of a solitary osteochondroma in a skeletally mature patient is rare and might result from malignant transformation. Excision of such a lesion in the distal and lateral aspect of the tibia is difficult because of the risk of injury to the neurovascular structures and the possible functional consequences with respect to ankle stability. We present a case of an active osteochondroma arising from the posterolateral distal tibia in an adult patient. The tumor was successfully excised by using a transfibular approach with fibular reconstruction. No signs of recurrence were noted 2 years after surgery. (J Am Podiatr Med Assoc 99(2): 157–161, 2009)
Interposition Arthroplasty of the First Metatarsophalangeal Joint With a Fascia Lata Allograft
Authors: Givissis Panagiotis , Symeonidis Panagiotis , Christodoulou Anastasios , Pournaras John
Published: April 2014

A new technique for interposition arthroplasty of the first metatarsoplalangeal joint is described. It involves minimal resection of the base of the proximal phalanx and the use of a fascia lata allograft. The method is simple, safe, and easily reproducible. In selected cases it can offer restoration of pain-free motion in a nonsalvable joint. (J Am Podiatr Med Assoc 98(2): 160–163, 2008)
Extended Pedal Imaging via Modifications of the Traditional Forefoot Axial Radiographic Study
Authors: Osher Lawrence S. , DeMore Matthew , Atway Said , Thomson Matthew K.
Published: April 2014

Background: The plain film forefoot axial radiographic view is a specialized view in podiatric imaging. In everyday office practice, an axial orthoposer is used, and the study is nonweightbearing. Largely useless for imaging functional pathology, the forefoot axial view’s main use centers around imaging of the plantar metatarsal heads and the hallucal sesamoid complex. To this end, the name “forefoot” is somewhat of a misnomer, and the view is also known as the sesamoid axial study.

Methods: We report on the initial use of oblique sesamoid or “skyline” axial studies for juxtacortical lesions of the sesamoid bones and more proximal dorsolateral tarsal structures, an area traditionally difficult to assess accurately with plain film imaging.

Results: Rather simple, empiric modifications in the forefoot axial technique allowed for 1) “skyline” imaging of exostotic surface lesions involving the dorsal, medial, and lateral midfoot bones, and 2) significant improvement in imaging hallucal sesamoid pathology.

Conclusions: Although the proposed oblique forefoot axial modifications empirically add two additional plain film radiographic studies to a standard forefoot axial study, our initial study suggests that the imaging benefits far outweigh the liabilities. This is especially true when one considers the difficulties encountered when employing standard plain film pedal in an effort to clarify or delineate pathologic processes involving the midfoot bones or metatarsal bases. It is hoped that this study will spawn further use and research of these “novel” views. (J Am Podiatr Med Assoc 98(3): 171–188, 2008)
Bilateral Measurement of Resting Calcaneal Stance Position and Tibial Varum Using Digital Photography and Standardized Positioning Protocols
Authors: Mahar Shannon M. , Livingston Lori A.
Published: April 2014

Background: Excessive calcaneal eversion and tibial varum are thought to predispose individuals to overuse injuries such as patellofemoral pain, yet investigations of this relationship have yielded equivocal results. Differences in the methods used, including stance position, may contribute to the observed differences.

Methods: Forty-six young adults (29 asymptomatic control patients and 17 patients with patellofemoral pain syndrome) participated. Resting calcaneal stance position and tibial varum were measured using a digital photographic-goniometric method while participants adopted three upright, weightbearing stance positions (self-selected, Romberg, and single-limb right or left). Data were collapsed and analyzed by group (asymptomatic, symptomatic) or limb status (uninjured, injured), stance, and limb (right, left).

Results: Mean resting calcaneal stance position and tibial varum values differed significantly among the three stance conditions, whereas differences between groups, limb status, and limb were not observed. Pearson product moment correlations revealed no relationship between measures derived under the differing stance conditions (r = −0.08 to −0.37, P > .05) and only weak to moderate relationships in resting calcaneal stance position and tibial varum measures between the right and left limbs (r = 0.37 to 0.71, P < .01).

Conclusions: If differences in reported values for resting calcaneal stance position and tibial varum in an individual, between groups, or from study to study are to be interpreted as true differences or as products of the measurement method used, a standardized measurement method must be established and methods must be accurately reported. (J Am Podiatr Med Assoc 99(3): 198–205, 2009)
Scientific Assessment of Over-the-Counter Foot Orthoses to Determine Their Effects on Pain, Balance, and Foot Deformities
Authors: Landsman Adam , DeFronzo Donna , Anderson Julie , Roukis Thomas
Published: April 2014

Background: A scientific study was conducted to evaluate the effects of non–custom-molded (over-the-counter) foot orthoses.

Methods: Several parameters were examined, including foot, knee, hip, and back pain; balance; and reduction in flexible deformities, such as hammer toes and hallux valgus. Wherever possible, objective measurements were used, including measurements of shifts in center of pressure to assess balance and changes in bone position examined on radiographs. Forty-one individuals were analyzed using one of two types of prefabricated, noncustom insoles. Insoles were fit by an assistant trained to follow the fitting recommendations of the manufacturer under the direct supervision of a podiatric physician.

Results: Use of these arch supports resulted in a significant reduction in some types of foot pain associated with hallux valgus (P = .04) and pain in the arch area (P = .004), knee (P = .002), and back (P = .007) by week 4. We also measured changes in foot position documented by radiography, although some changes may be attributed to parallax associated with measurement techniques. Improvement in balance was not observed to be significant when the orthoses were worn.

Conclusions: Using both subjective and objective measures, we found that these over-the-counter foot orthoses were effective in bringing about changes in foot shape and concomitant relief of certain specific painful conditions. This study indicates that there is a scientific basis for attempting to relieve pain with orthoses. (J Am Podiatr Med Assoc 99(3): 206–215, 2009)
Lower-Extremity Sclerotomes
Authors: Meyr Andrew J. , DiPrimio Raymond
Published: April 2014

A sclerotome is an anatomical concept that defines an area of bone supplied by a single spinal nerve. Similar to the familiar dermatomes, sclerotomes provide an element of depth to the sensory innervation of the lower extremity based on the deep fascia as an embryologic boundary. Anatomical knowledge of sclerotomes can be used clinically in the diagnosis and treatment of pain and in the perioperative setting. Specifically, a modified version of the classic Mayo block is presented to highlight an active anatomical approach to peripheral nerve blockade. (J Am Podiatr Med Assoc 99(3): 232–235, 2009)
Distant Metastases to the Hallux in Nasopharyngeal Carcinoma
Authors: Lee Daniel K.
Published: April 2014

Nasopharyngeal carcinoma is a rare tumor originating from the epithelium of the nasopharynx. Distant metastases involve the lungs, skeleton, liver, and occasionally the choroid. I present the case of a 33-year-old man with stage-IV nasopharyngeal carcinoma and an unusual distant metastasis to the hallux, which has not previously been described in the literature. (J Am Podiatr Med Assoc 98(3): 239–241, 2008)
L-Shaped Big Toe
Authors: Cansü Eren
Published: April 2014

A case report of bilateral severe hallux valgus interphalangeus is presented. This is an interesting case because of the possible etiology that could not be found in any other previous publications. (J Am Podiatr Med Assoc 99(3): 244–246, 2009)
Gait Changes with the Use of Heelys
Authors: Norem Nathan , Feuerstein Catherine , Traverso Vincent , Zomaya Nancy , Crews Ryan , Wrobel James S.
Published: April 2014

Heelys shoes are a novel athletic shoe with a concealed wheel. They have been popular among youths since their introduction in 2000. This case study serves as a first look into the biomechanical implications of Heelys shoes on gait. Pressure readings of the forefoot, midfoot, and rearfoot during ambulation in regular athletic-shoe walking, Heelys without the wheel walking, Heelys with the wheel walking, and Heelys skating with the wheel were recorded on a single subject using the Pedar X System. A visual gait analysis was also performed on the subject. The resulting data show increased forefoot and rearfoot pressure while walking with the Heelys with the wheel. The visual gait analysis showed a diminished heel strike and a more rapid forefoot loading. These results demonstrate that Heelys do in fact affect the biomechanics of gait. (J Am Podiatr Med Assoc 99(3): 247–250, 2009)
CLEAR Cleat: A Proof-of-Concept Trial of an Aerobic Activity Facilitator to Reduce Plantar Forefoot Pressures and Their Potential in Those with Foot Ulcers
Authors: Klein Erin E. , Crews Ryan T. , Wu Stephanie C. , Wrobel James S. , Armstrong David G.
Published: April 2014

Background: Exercise has not been studied extensively in persons with active neuropathic diabetic foot wounds, primarily because a device does not exist that allows patients to exercise while sufficiently off-loading pressure at the ulcer site. The purpose of this project was to demonstrate a device that reduces cycling plantar forefoot pressure.

Methods: Ten healthy participants rode a recumbent bicycle under three cycling conditions. While the left foot interaction remained constant with a standard gym shoe and pedal, the right foot was exposed to a control condition with standard gym shoe and pedal, gym shoe and specialized cleat, and gym shoe with an off-loading insole and specialized cleat. Pressure and contact area of the plantar aspect of the feet were recorded for a 10-sec interval once during each minute of each condition’s 7-min trial.

Results: The off-loading insole and specialized cleat condition yielded significantly lower (P < .01) peak pressure, contact area, and pressure–time integral values in the forefoot than the specialized cleat condition with gym shoe, which yielded significantly lower values (P < .01) than the standard gym shoe and pedal.

Conclusion: Modifications to footwear may alter plantar forefoot pressures, contact area, and pressure–time integrals while cycling. The CLEAR Cleat could play a significant role in the facilitation of fitness in patients with (or at high risk for) neuropathic wounds. (J Am Podiatr Med Assoc 98(4): 261–267, 2008)
The Safety and Efficacy of Pain Checker Socks in the Treatment of Mild-to-Moderate Foot Pain
Authors: Jennings Maureen B. , Lesczczynski Christine , Goodwin Susan
Published: April 2014

Background: Heel pain, bunion pain, and other forms of foot pain syndromes are one of the more common reasons a patient visits a podiatrist. Numerous methods are currently available to attempt to achieve pain relief, including pharmaceuticals, magnets, heat, and electrical stimulation. A textile company developed Pain Checker socks (Pain Checker Health Wear, Cresskill, New Jersey), which contains a material that may counter the circuit of pain and oppose the effect, thereby stopping the conduction of pain.

Methods: The purpose of this placebo-controlled, double-blind clinical trial was to evaluate the safety and efficacy of Pain Checker socks in the treatment of mild-to-moderate foot pain. Fifty patients were enrolled, half on active and half on placebo socks. The subjects were evaluated at baseline, 2, 4, and 6 weeks of treatment.

Results: There was no statistically significant difference in disability, pain, or activity scales between treatment groups, although only 5% of the treatment group received no pain relief on visual analog scale during the trial, while 38% of the placebo group received no pain relief.

Conclusion: Although there was no difference in pain relief, the Pain Checker socks were found to be safe and scored high in patient satisfaction. The unique fiber content and construction of the socks may have contributed to the placebo analgesia. (J Am Podiatr Med Assoc 98(4): 278–282, 2008)
Pathogens Isolated From Deep Soft Tissue and Bone in Patients With Diabetic Foot Infections
Authors: Ertugrul M. Bulent , Baktiroglu Selcuk , Salman Serpil , Unal Seher , Aksoy Murat , Berberoglu Kezban , Calangu Semra
Published: April 2014

Background: We sought to determine the similarity of pathogens isolated from soft tissue and bone in patients with diabetic foot infections. It is widely believed that soft-tissue cultures are adequate in the determination of causative bacteria in patients with diabetic foot osteomyelitis. The culture results of specimens taken concurrently from soft-tissue and bone infections show that the former does not predict the latter with sufficient reliability. We sought to determine the similarity of pathogens isolated from soft tissue and bone in patients with diabetic foot infections.

Methods: Forty-five patients with diabetic foot infections were enrolled in the study. Patients had to have clinically suspected foot lesions of grade 3 or higher on the Wagner classification system. In patients with clinically suspected osteomyelitis, magnetic resonance imaging, scintigraphy, or histopathologic examination were performed. Bone and deep soft tissue specimens were obtained from all patients by open surgical procedures under aseptic conditions during debridement or amputation. The specimens were compared only with the other specimens taken from the same patients.

Results: The results of bone and soft-tissue cultures were identical in 49% (n = 22) of cases. In 11% (n = 5) of cases there were no common pathogens. In 29% (n = 13) of cases there were more pathogens in the soft-tissue specimens; these microorganisms included microbes isolated from bone cultures. In four patients (9%) with culture-positive soft-tissue specimens, bone culture specimens remained sterile. In one patient (2%) with culture-positive bone specimen, soft-tissue specimen remained sterile.

Conclusion: Culture specimens should be obtained from both the bone and the overlying deep soft tissue in patients with suspected osteomyelitis whose clinical conditions are suitable. The decision to administer antibiotic therapy should depend on these results. (J Am Podiatr Med Assoc 98(4): 290–295, 2008)
A Review of Current Research in Light-Based Technologies for Treatment of Podiatric Infectious Disease States
Authors: Bornstein Eric
Published: April 2014

Recently, there has been a resurgence of interest in potential phototherapy technologies for the local treatment of bacterial and fungal infection. Currently, onychomycosis is the principle disease that is the target of these phototherapies in podiatric medicine. Some of these technologies are currently undergoing in vitro and in vivo trials approved by institutional review boards. The three light-based technologies are ultraviolet light therapy, near infrared photo-inactivation therapy, and photothermal ablative antisepsis. Each of these technologies have markedly dissimilar mechanisms of action. In this review, each technology will be discussed from the perspectives of history, photobiology, individual mechanism of action, safety, and potential clinical efficacy, with data presented from published material. This review is intended to give podiatric physicians detailed information on state-of-the-art infectious disease phototherapy. (J Am Podiatr Med Assoc 99(4): 348–352, 2009)
Computerized Analysis of Plantar Pressure Variation in Flip-Flops, Athletic Shoes, and Bare Feet
Authors: Carl Tanya J. , Barrett Stephen L.
Published: April 2014

Background: High peak plantar pressures predispose to foot problems and may exacerbate existing conditions. For podiatric physicians to make educated recommendations to their patients, it is important and necessary to begin to look at different shoes and how they affect peak plantar pressure.

Methods: To determine how flip-flops change peak plantar pressure while walking, we compared peak plantar pressures in the same test subjects wearing flip-flops, wearing athletic shoes, and in bare feet. Ten women with size 7 feet and a body mass index less than 25 kg/m2 were tested with an in-shoe pressure-measurement system. These data were collected and analyzed by one-way analysis of variance and computer software.

Results: Statistically significant results were obtained for nine of the 18 comparisons. In each of these comparisons, flip-flops always demonstrated higher peak plantar pressures than athletic shoes but lower pressures than bare feet.

Conclusion: Although these data demonstrate that flip-flops have a minor protective role as a shock absorber during the gait cycle compared with pressures measured while barefoot, compared with athletic shoes, they increase peak plantar pressures, placing the foot at greater risk for pathologic abnormalities. (J Am Podiatr Med Assoc 98(5): 374–378, 2008)
Relationship of Body Mass Index, Ankle Dorsiflexion, and Foot Pronation on Plantar Fascia Thickness in Healthy, Asymptomatic Subjects
Authors: Huerta Javier Pascual , García Juan Maria Alarcón , Matamoros Eva Cosin , Matamoros Julia Cosin , Martínez Teresa Díaz
Published: April 2014

Background: We sought to investigate the thickness of plantar fascia, measured by means of ultrasonographic evaluation in healthy, asymptomatic subjects, and its relationship to body mass index, ankle joint dorsiflexion range of motion, and foot pronation in static stance.

Methods: One hundred two feet of 51 healthy volunteers were examined. Sonographic evaluation with a 10-MHz linear array transducer was performed 1 and 2 cm distal to its insertion. Physical examination was also performed to assess body mass index, ankle joint dorsiflexion, and degree of foot pronation in static stance. Both examinations were performed in a blinded manner.

Results: Body mass index showed moderate correlation with plantar fascia thickness at the 1- and 2-cm locations. Ankle dorsiflexion range of motion showed no correlation at either location. Foot pronation showed an inverse correlation with plantar fascia thickness at the 2-cm location and no correlation at the 1-cm location.

Conclusion: Body mass index and foot supination at the subtalar joint are related to increased thickness at the plantar fascia in healthy, asymptomatic subjects. Although the changes in thickness were small compared with those in patients with symptomatic plantar fasciitis, they could play a role in the mechanical properties of plantar fascia and in the development of plantar fasciitis. (J Am Podiatr Med Assoc 98(5): 379–385, 2008)
Evaluation of Clinical and Radiographic Outcomes of Complete Subtalar Release in Clubfoot Treatment
Authors: Kalenderer Onder , Reisoglu Ali , Turgut Ali , Agus Haluk
Published: April 2014

Background: We evaluated patients with unilateral clubfoot deformity who were treated by complete subtalar release according to Simons’ criteria and assessed the correlation between clinical and radiographic results.

Methods: Eleven patients underwent a complete subtalar release through a Cincinnati incision. Evaluation included a questionnaire and clinical and radiographic examination.

Results: Mean follow-up was 12 years 8 months. The radiographic measurement differences in the diagnostic angles between normal feet and clubfeet were not significant. Shortening of the talus and the navicular bone was significant. The talar dome was flattened in seven patients and was flattened, sclerotic, and irregular in one. Flattening of the talar head was detected in eight patients, irregularity in one, and deformity and sclerosis in one. Six patients had deformity in the talonavicular joint. The navicular bone was wedge shaped in nine patients and subluxated dorsally in seven. The talar head was congruent with the navicular bone semilunar in normal feet; this relation was not detected in patients treated for clubfoot.

Conclusion: Radiographic changes, such as flattening of the talar, a wedge-shaped navicular bone, dorsal navicular migration, irregularity, and lack of congruence of the talonavicular joint, can be encountered postoperatively in clinically and cosmetically healthy patients. These changes may be caused by the nature of the disease, correcting manipulations or casting, or surgical techniques. Although complete subtalar release is an effective procedure for satisfactory clinical results, maintenance of anatomical configuration, but not normal anatomical development of tarsal bones, can be achieved with this method. (J Am Podiatr Med Assoc 98(6): 451–456, 2008)
Distal Tibial Epiphyseal Fracture (Tillaux) and Capsular Interposition
Authors: Poyanli Oguz , Unay Koray , Akan Kaya , Ozkan Korhan , Ugutmen Ender
Published: April 2014

Arthroscopic-assisted reduction is one recommended technique for pediatric distal tibial epiphyseal fractures. A 15-year-old male patient with a triplane distal tibial epiphyseal fracture (Tillaux type) was scheduled for arthroscopic reduction and pinning, which failed to provide adequate fracture reduction. Open surgery was subsequently performed, which revealed a capsular interposition in the fracture line attributable to an anterior capsular tear of the ankle. The possibility of capsular interposition should always be taken into consideration when problems such as those described in this case presentation are encountered in such patients. This is precisely why direct visualization either through arthroscopy or open arthrotomy is sometimes necessary. (J Am Podiatr Med Assoc 99(5): 435–437, 2009)
Unrecognized Anterior Compartment Syndrome Following Ankle Fracture Surgery
Authors: Seyahi Aksel , Uludag Serkan , Akman Senol , Demirhan Mehmet
Published: April 2014

A 35-year-old male sustained a lateral malleolar fracture while playing football. The fracture was treated by open reduction and internal fixation with a tourniquet. The next day, the patient returned with pain and swelling of the ankle and was admitted again to the hospital with a suspected diagnosis of cellulitis. Ten hours later, the patient developed the symptoms of anterior compartment syndrome. Emergency open fasciotomy of the anterior compartment was performed. The retrospective analysis of the patient’s history was suggestive of a predisposition to an exercise-induced compartment syndrome. We think that exertional increase of the compartmental pressure before the injury and the tourniquet used during surgery contributed together to the development of compartment syndrome. Physicians should be vigilant in identifying the features of compartment syndrome when managing patients injured during a sporting activity. (J Am Podiatr Med Assoc 99(5): 438–442, 2009)
Diabetic Foot Infections
Authors: Nielson David L. , Ali Yousry
Published: April 2014

Patients with diabetic neuropathy are subject to ulcerations that may be complicated by infection and gangrene, with subsequent risk of amputation. It is the job of the foot specialist to identify and manage these problems early to avoid the unfortunate complication of amputation regardless of the presenting condition of the patient’s limb. We shed light on the hypothesis that suggests that infection and gangrene in a diabetic patient aggravate the degree of ischemia (microvascular, macrovascular, or both) already present enough to endanger the viability of the surrounding tissues unless urgent drainage with decompression and debridement of the necrotic sloughs is performed, with consequent reduction of tissue pressure and improvement in circulation to the area. We present cases with severe infections leading to gangrene and ischemia, which were improved following surgical management with consequent improvement in tissue viability. In these cases, we demonstrate that immediate treatment of the wound despite the delayed presentation of the patients resulted in limb salvage with much less soft-tissue loss than expected before treatment. (J Am Podiatr Med Assoc 99(5): 454–458, 2009)
Late Rearfoot Eversion and Lower-limb Internal Rotation Caused by Changes in the Interaction between Forefoot and Support Surface
Authors: Souza Thales R. , Pinto Rafael Z. , Trede Renato G. , Kirkwood Renata N. , Pertence Antônio E. , Fonseca Sérgio T.
Published: April 2014

Background: The influence of distal mechanical factors that change the interaction between the forefoot and the support surface on lower-limb kinematics is not well established. This study investigated the effects of the use of lateral wedges under the forefoot on the kinematics of the lower extremity during the stance phase of walking.

Methods: Sixteen healthy young adults participated in this repeated-measures study. They walked wearing flat sandals and laterally wedged sandals, which were medially inclined only in the forefoot. One wedged sandal had a forefoot lateral wedge of 5° and the other wedged sandal had a forefoot lateral wedge of 10°. Kinematic variables of the lower extremity, theoretically considered clinically relevant for injury development, were measured with a three-dimensional motion analysis system. The variables were evaluated for three subphases of stance: loading response, midstance, and late stance.

Results: The 5° laterally wedged sandal increased rearfoot eversion during midstance and the 10° laterally wedged sandal increased rearfoot eversion during mid- and late stances, in comparison to the use of flat sandals. The 10° laterally wedged sandal produced greater internal rotation of the shank relative to the pelvis and of the hip joint, during the midstance, also compared to the use of flat sandals.

Conclusions: Lateral wedges under the forefoot increase rearfoot eversion during mid-and late stances and may cause proximal kinematic changes throughout the lower-extremity kinetic chain. Distal mechanical factors should be clinically addressed when a patient presents late excessive rearfoot eversion during walking. (J Am Podiatr Med Assoc 99(6): 503–511, 2009)
Fracture-Dislocation of the Second Metatarsophalangeal Joint
Authors: Tadros Ayman M. A.
Published: April 2014

Traumatic second metatarsophalangeal dislocation is extremely rare. This article reports a case of traumatic second metatarsophalangeal dislocation associated with fracture of the second metatarsal shaft. Anatomical reduction is indispensable to preserve the function of the metatarsophalangeal joint and to avoid joint ankylosis and chronic foot pain. The patient was treated with open reduction of the fracture without violating the joint to decrease postoperative stiffness. He was followed-up for 6 months. The patient resumed full activity 3 months after surgery, with his joint attaining full range of movement. He reported no pain or joint stiffness during his last visit. To our knowledge, no similar injury has been reported previously. (J Am Podiatr Med Assoc 99(6): 525–528, 2009)
Acute Phase Reactants Predict the Risk of Amputation in Diabetic Foot Infection
Authors: Akinci Baris , Yener Serkan , Yesil Sena , Yapar Nur , Kucukyavas Yasin , Bayraktar Firat
Published: April 2014

Background: Prediction of amputation would aid clinicians in the management of diabetic foot infections. We aimed to assess the predictive value of baseline and post-treatment levels of acute phase reactants in the outcome of patients with diabetic foot infections.

Methods: We collected data prospectively during minimum follow-up of 6 months in patients with infected diabetic foot ulcers hospitalized in Dokuz Eylul University Hospital between January 1, 2003, and January 1, 2008. After excluding patients who did not attend the hospital for follow-up visits regularly (n = 36), we analyzed data from 165 foot ulcer episodes.

Results: Limb ischemia and osteomyelitis were much more frequent in patients who underwent amputation. Wagner grade, which assesses ulcer depth and the presence of osteomyelitis or gangrene, was higher in patients who needed amputation. Ulcer size was slightly larger in the amputation group. Baseline and post-treatment C-reactive protein levels, erythrocyte sedimentation rates, white blood cell counts, and platelet counts were significantly elevated in patients who underwent amputation. Albumin levels were significantly suppressed in the amputation group. Univariate analysis showed that a 1-SD increase in baseline and post-treatment C-reactive protein levels, erythrocyte sedimentation rates, and white blood cell counts and a 1-SD decrease in post-treatment albumin levels were significantly associated with increased risk of amputation. Post-treatment C-reactive protein level was strongly associated with amputation risk.

Conclusions: Circulating levels of acute phase reactants were associated with amputation risk in diabetic foot infections. (J Am Podiatr Med Assoc 101(1): 1–6, 2011)
Autologous Skin Fibroblast and Keratinocyte Grafts in the Treatment of Chronic Foot Ulcers in Aging Type 2 Diabetic Patients
Authors: Monami Matteo , Vivarelli Maria , Desideri Carla Maria , Ippolito Giulio , Marchionni Niccolò , Mannucci Edoardo
Published: April 2014

Background: We assessed the tolerability and efficacy of autologous skin cell grafts in older type 2 diabetic patients with chronic foot ulcers.

Methods: Treatment with Hyalograft 3D and Laserskin Autograft was proposed to a consecutive series of type 2 diabetic patients older than 65 years affected by long-standing (>6 months) foot ulcers with an area greater than 15 cm2. Ulcer healing rates and measurements of ulcer area were determined monthly for 12 months.

Results: Seven patients with 12 ulcers, nine of which received the described treatment, were enrolled. During 12-month follow-up, all of the ulcers healed except one. In the remaining eight ulcers, the median healing time was 21 weeks (interquartile range, 4–29 weeks).

Conclusions: Autologous skin cell grafts are feasible, well tolerated, and apparently effective in the treatment of diabetic ulcers of the lower limbs in advanced age. Age did not seem to moderate healing times. (J Am Podiatr Med Assoc 101(1): 55–58, 2011)