bluuebunny/crossref_metadata_2025 huggingface dataset:
1998 William J. Stickel Silver Award. Mechanically assisted, delayed primary closure of diabetic foot wounds
Authors: Armstrong DG , Lavery LA
Published: April 2014

The authors evaluated the time to healing and prevalence of complications in patients undergoing mechanically assisted, delayed primary closure of diabetic foot wounds compared with a similar population who received standard wound care. A total of 55 patients were enrolled for study, with 25 in the experimental group and 30 in the control group. Patients in the experimental (stretch) group underwent mechanically assisted primary closure of their wounds using a skin-stretching device. There was no difference between the stretch and control groups with regard to any descriptive characteristics, including wound chronicity. Although the wounds were over three times as large on average in the stretch group (P < .001), the stretch group reached full epithelialization approximately 40% sooner than the control group (26.4 +/- 16.0 versus 42.5 +/- 19.9 days; P < .002). Eighty-eight percent of patients in the stretch group experienced wound dehiscence, at a mean time of 1.8 +/- 0.6 weeks following mechanically assisted closure. However, patients who experienced dehiscence in the stretch group healed significantly faster than patients in the control group (27.4 +/- 16.7 versus 42.5 +/- 19.9 days; P < .007). The results of this study suggest that mechanically assisted closure of diabetic foot wounds may result in reduced healing time compared with healing by secondary intention.
Poroid hidradenoma. A case presentation
Authors: Whitmore RM , Anderson CJ , Piper T
Published: April 2014

Poroid hidradenoma is a benign soft-tissue neoplasm with eccrine differentiation. It is the newest addition to a group of neoplasms known as poromas. Although it becomes malignant in less than 1% of cases, its histologic characteristics may resemble those of malignant neoplasms; thus it is easily misdiagnosed. Twenty-one percent of poroid hidradenomas occur in the extremities. The histologic and clinical features of this tumor are presented here, along with a case report.
Charcot's joint following Keller arthroplasty. A case report
Authors: Darst MT , Weaver TD , Zangwill B
Published: April 2014

Neuropathic osteoarthropathy, i.e., Charcot's joint, has not previously been reported as a sequela of elective foot surgery. The authors present a challenging case of a patient with long-standing diabetes mellitus and peripheral neuropathy who developed neuropathic osteoarthropathy after a Keller arthroplasty for a recalcitrant hallux ulcer. The radiographic findings, diagnostic tests, and histopathology are discussed. Finally, the authors offer suggestions for surgeons contemplating a Keller arthroplasty for patients with peripheral neuropathy.
Pediatric peroneal spastic flatfoot in the absence of coalition. A suggested protocol
Authors: Lowy LJ
Published: April 2014

While most pediatric patients with peroneal spastic flatfoot demonstrate tarsal coalitions, not all do. The absence of coalition may present a diagnostic challenge and make appropriate treatment difficult. Past and present etiologic theories, diagnostic modalities, and treatments are outlined in this article. The common peroneal nerve block is of great value in the diagnosis and treatment of peroneal spastic flatfoot with or without coalition. With adjunctive treatments, increased motion and decreased symptomatology are often obtained. A protocol, applied to five cases described herein, is suggested.
Congenital talonavicular coalition. Review of the literature, case report, and orthotic management
Authors: David DR , Clark NE , Bier JA
Published: April 2014

Talonavicular coalition is a rare entity and is often discovered as a secondary radiographic finding. Today, orthoses are as varied as the patients for whom they are prescribed; however, in cases of symptomatic talonavicular fusion, the use of a shallow U-shaped dispersion within the high medial flange of an orthosis can prove beneficial to the pediatric patient. This article encourages podiatric physicians to return to utilizing basic diagnostic tools (gait analysis, biomechanical examination, and radiographs) to detect and treat talonavicular coalition, a significant but rare anomaly of the foot.
Pediatric resources on the Internet
Authors: Leifer Z
Published: April 2014

This article introduces the podiatric physician interested in pediatrics to the resources available on the Internet. It surveys search engines, gateway sites on the World Wide Web leading to a wealth of pediatric information and services, and features such as electronic mail, news-groups, and Gopher sites. Examples illustrate how such resources can be helpful to the practicing podiatrist.
Foot problems associated with older patients. A focused podogeriatric study
Authors: Helfand AE , Cooke HL , Walinsky MD , Demp PH
Published: April 2014

The authors report on a 3-year prospective program that included foot-health education and an initial assessment of foot problems in an older population. The program represents a cooperative effort by the Philadelphia Corporation for Aging and the Pennsylvania College of Podiatric Medicine to enhance the quality of life of older citizens. The results show that foot problems are prevalent among older patients. The program also refined a protocol that can be applied in other settings.
Contrasts in clinical presentation and genetic transmission of myotonic dystrophy
Authors: Reifer H , Sobel E
Published: April 2014

Myotonic dystrophy, the most common inherited neuromuscular disease, is an autosomal dominant muscular dystrophy characterized by myotonia and distal muscle weakness. It is caused by an increase in the number of cytosine-thymine-guanine (CTG) nucleotide repeats present on the long arm of chromosome 19. Two patients were evaluated, one with classic adult-onset myotonic dystrophy and the other with congenital myotonic dystrophy. Contrasts in the clinical features and genetic transmission of this disease and clinical management are reviewed.
Bilaterally symmetrical epidermal inclusion cysts with foreign-body giant-cell reaction
Authors: Sheff J , Bregman P , Curran T
Published: April 2014

Epidermal inclusion cysts often occur as a result of traumatic implantation of epidermal cells into dermal tissue. The epidermal cells within the dermis can continue to grow and lead to the production of a lipid- and keratin-filled cyst, which can erode into bone and adjacent tissues. The authors present a case of bilaterally symmetrical epidermal inclusion cysts that occurred separately over a 10-year period. A brief review of the literature is also presented.
Improved healing with a collagen-alginate dressing in the chemical matricectomy
Authors: Van Gils CC , Roeder B , Chesler SM , Mason S
Published: April 2014

A prospective clinical trial was conducted to evaluate the efficacy of a collagen-alginate wound dressing in the postoperative management of chemical matricectomies. The study involved 20 patients and 23 separate procedures. The collagen-alginate-dressing treatment group had an average healing time of 24.4 days, compared with 35.8 days for the control group, which received treatment consisting of soaks and daily dressing changes (P < .05). The authors suggest that using a collagen-alginate wound dressing in the postoperative management of chemical matricectomies will shorten healing time, thus reducing infection rates and increasing patient compliance and satisfaction.
Infectious causes of heel pain
Authors: Kosinski M , Lilja E
Published: April 2014

Heel pain is often attributed to a biomechanical etiology or sports-related injury. However, failure to recognize an infectious cause can lead to a delay in proper treatment and result in severe patient disability. This article reviews some of the more common infectious etiologies of heel pain.
Problems and management of the rearfoot in neuromuscular disease. A report of ten cases
Authors: Sobel E , Giorgini RJ
Published: April 2014

Neuromuscular disease commonly affects the rearfoot as equinus, equinovarus, and equinovalgus deformity. Spastic hemiplegia caused by stroke, head injury, and cerebral palsy results in equinovarus deformity of the rearfoot. Spastic diplegia, most frequently caused by cerebral palsy, results in equinovalgus rearfoot deformity. Problems in ambulation, footwear, and bracing, as well as their orthopedic management, in patients with neuromuscular disease are discussed in a case-report format.
Ammonium lactate 12% lotion versus a liposome-based moisturizing lotion for plantar xerosis. A double-blind comparison study
Authors: Uy JJ , Joyce AM , Nelson JP , West B , Montague JR
Published: April 2014

Two emollients, ammonium lactate 12% lotion and a liposome-based moisturizing lotion, were compared in a double-blind test for efficacy in the treatment of plantar xerosis. A total of 43 out of 57 participants (75%) with bilateral plantar xerosis followed instructions completely and applied the lotions (one to each foot) twice daily for 4 weeks. Each participant was evaluated once a week for 6 weeks (the final 2 weeks for evaluation of post-treatment regression) to determine xerotic grade (degree of dryness) and treatment effectiveness. With both lotions, significant improvement began during the second week of treatment and continued into the fourth week. There were no significant differences between the two lotions in the 6-week patterns of either xerotic grade or treatment effectiveness.
Treatment of stingray injury with topical becaplermin gel
Authors: Baldinger PJ
Published: April 2014

Stingray injuries are most commonly characterized by localized pain, ulceration, and edema; however, potentially serious sequelae may result, including tissue necrosis and life-threatening infection. This case report describes a stingray injury that had progressed to ulceration and was treated with topical application of recombinant human platelet-derived growth factor-BB (becaplermin gel 0.01%) and a standardized regimen of wound care.
Antipronation taping and temporary orthoses. Effects on tibial rotation position after exercise
Authors: Hadley A , Griffiths S , Griffiths L , Vicenzino B
Published: April 2014

Abnormal lower-limb biomechanics--in particular, abnormal pronation of the subtalar joint with concomitant increased internal rotation of the tibia--is one of the major causes of overuse injuries of the lower limb. A randomized, controlled, within-subjects research design (N = 14) was used to investigate the effect of a temporary felt orthosis and an antipronation taping technique to control the transverse tibial rotation position immediately after application and after each of two 10-minute periods of exercise. The results showed that the taping technique was superior to both the orthosis and no intervention in controlling tibial rotation position immediately after application and after 10 minutes of exercise. After 20 minutes of exercise, neither the tape nor the orthosis was significantly superior to the control; however, the trends suggested that some residual control was maintained. Future studies are needed to determine the amount of foot pronation control required to relieve symptoms in a symptomatic population in order to determine the clinical effectiveness of these treatment methods.
Imaging of the rearfoot
Authors: Yozsa S , Lehnert B , Resnick D
Published: April 2014

The authors review various pedal conditions affecting the rearfoot, including plantar fasciitis, Achilles tendon pathology, fractures, arthritides, coalitions, and tumors. Various diagnostic imaging modalities such as routine radiography, radionuclide bone scanning, computed tomography, and magnetic resonance imaging are discussed.
An update on repair of Achilles tendon rupture. Acute and delayed
Authors: Kuwada GT
Published: April 2014

Current surgical treatments for Achilles tendon rupture are thoroughly discussed. New repair techniques, such as the use of soft-tissue anchors, are reviewed, as is the use of synthetic mesh to augment the surgical repair. A classification system devised by the author is presented to make it easier to select the appropriate surgical procedure or combination of procedures in delayed rupture repair. Postoperative physical therapy is paramount in the return to preinjury level of activity for these patients.
Effect of podiatric medical care on rates of lower-extremity amputation in a Medicare population
Authors: Sowell RD , Mangel WB , Kilczewski CJ , Normington JM
Published: April 2014

The purpose of this study was to determine whether Medicare patients at risk for lower-extremity amputation due to complications from diabetes, peripheral vascular disease, and/or gangrene who receive the services classified under Level II code M0101 of the Health Care Financing Administration's Common Procedure Coding System (cutting or removal of corns, calluses, and/or trimming of nails, application of skin creams and other hygienic and preventive maintenance care) have lower rates of lower-extremity amputation than those who do not receive such services. Analysis of the data suggests that those at-risk beneficiaries who received these services were nearly four times less likely to experience lower-extremity amputation than those who did not receive such services. The study has both methodologic limitations (the study considers only one variable, receipt or nonreceipt of certain types of podiatric medical care, while other variables may affect rates of lower-extremity amputation) and technological limitations (attempts to link the 2 years of per case Medicare Part B data were unsuccessful, limiting the length of the study to 1 year). Further research on this topic is encouraged.
The effect of hallux valgus correction on chronic plantar ulceration. A case report
Authors: Bryant AR , Singer KP , Tinley P
Published: April 2014

Plantar pressure-measurement technology may provide the clinician with valuable objective information for monitoring the effects of therapeutic intervention on the foot. The use of this technology is described in the preoperative and postoperative assessment of a patient undergoing hallux valgus surgery for the treatment of a chronic neuropathic skin ulcer over the medioplantar aspect of her first metatarsophalangeal joint.
Magnetic resonance imaging evaluation of heel pain
Authors: Karr JC
Published: April 2014

Magnetic resonance imaging is superior to radiographic and scintigraphic examination for pathologic evaluation of the musculoskeletal system. Magnetic resonance imaging demonstrates increased sensitivity and specificity compared with radiographic evaluation, and equal sensitivity and increased specificity compared with scintigraphic examination. Two case studies of magnetic resonance imaging evaluation of heel pain involving a calcaneal stress fracture and a capillary hemangioma are presented.
Clarifying proximal diaphyseal fifth metatarsal fractures. The acute fracture versus the stress fracture
Authors: Landorf KB
Published: April 2014

This article discusses the classification and treatment of proximal diaphyseal fifth metatarsal fractures. There are two types of proximal diaphyseal fracture of the fifth metatarsal: the acute proximal diaphyseal fracture and the proximal diaphyseal stress fracture. Confusion between the two types of fractures is probably due to their similar location and the historical practice of referring to all fractures in this location as Jones fractures. Both fractures are prone to delayed union and require long periods of nonweightbearing immobilization or internal fixation for healing. However, because the mechanism of injury is different for each fracture, the treatment plan may need to be tailored to the particular type of fracture.
Atypical heel pain. Hyperparathyroidism-induced stress fracture of the calcaneus
Authors: Fishco WD , Stiles RG
Published: April 2014

The authors present a case of atypical heel pain masquerading as plantar fasciitis. The patient was subsequently diagnosed with hyperparathyroidism-induced stress fracture of the calcaneus. The clinical entity of hyperparathyroidism and its manifestations in the skeletal system are presented, as well as a review of stress fractures and pertinent imaging studies.
Dermatofibrosarcoma protuberans. A rare case involving the pediatric foot
Authors: Cione JA , Lynn B , Boylan J
Published: April 2014

Dermatofibrosarcoma protuberans is a rare, slow-growing, locally destructive, intermediate-grade malignancy that originates in the dermal layer of the skin. Dermatofibrosarcoma protuberans rarely metastasizes and has a marked tendency to recur following local surgical excision. The lesion is found most commonly on the trunk, on the proximal aspect of both the lower and upper extremities, and in the head and neck region. Dermatofibrosarcoma protuberans occurs most commonly in people between the ages of 20 and 50. This article describes the clinical and pathologic features of this rare, malignant neoplasm and describes a rare case of dermatofibrosarcoma protuberans involving the pediatric foot.
The calcaneal angle in Nigerians. Relationship to sex, age, and side of the body
Authors: Didia BC , Dimkpa JN
Published: April 2014

The authors studied the calcaneal angle in Nigerians and found it to range from 28 degrees to 38 degrees with a mean of 32.83 degrees (SD 2.84 degrees). The calcaneal angle in Nigerians is not significantly related to sex, age, or side of the body (left or right). Proper alignment of the calcaneus is essential for the maintenance of the arches of the foot, for standing erect, and for walking and running. Thus the calcaneal angle must be borne in mind whenever reconstructive surgery is performed.
Retained digital foreign body after a pellet gun injury
Authors: Vincent A , Jenkins DW
Published: April 2014

A symptomatic foreign body embedded in the human body can be a frustrating problem for physician and patient alike. A unique case of a retained foreign object resulting from a pellet gun injury has been presented. Although the course of treatment in this case was uncomplicated, it is important to understand the complexities of the human body's response to foreign bodies.
Chondromyxoid fibroma of the fourth metatarsal
Authors: Feit EM , Dobbs BM
Published: April 2014

Chondromyxoid fibroma is a rare benign tumor that is typically found in the metaphyseal ends of long tubular bones, such as the tibia. The authors describe a case of this neoplasm occurring in the foot. Treatment included complete resection with reconstruction using an autogenous fibular bone graft. The surgical technique and the advantages of using a fibular bone graft are discussed.
A conceptual model for a geriatric fellowship in podiatric medicine
Authors: Helfand AE
Published: April 2014

The number of older individuals living in the United States is projected to increase significantly over the next few decades. To help meet the health-care needs of this growing population, podiatric medicine must assure the public of the availability of specially educated teachers and practitioners who can not only provide direct patient care, but also participate in establishing national policies and priorities pertaining to foot health. Fellowship training, the traditional educational model beyond the first professional degree and residency education, is one means of accomplishing this goal. This article proposes a model for a geriatric fellowship in podiatric medicine. Implementation of such fellowship training in geriatrics can help the podiatric medical profession pursue its mission and fulfill its responsibility to the public.
Effectiveness of various materials in reducing plantar shear forces. A pilot study
Authors: Curryer M , Lemaire ED
Published: April 2014

Vertical plantar forces are known to be a major precipitating factor in the development of foot pathology. It is also postulated that shear forces are important in the pathogenesis of foot ulcers in patients with diabetes mellitus. Various materials are used in insoles designed to reduce forces on the foot. While many foam materials have been tested for their ability to dissipate vertical forces, few studies have tested the effect of these materials on shear forces. This study assessed the effectiveness of five different materials in reducing plantar shear forces and compared two new gel materials with three of the more conventional foam materials. Four subjects were tested while walking over a force platform with one of the five materials taped to the surface. Peak force, impulse, and resultant shear force data were analyzed. The gel materials were significantly better than the foam materials at reducing shear forces. Thus the use of gel materials in insoles may be indicated for the reduction of plantar shear forces on the diabetic foot.
The effect of rearfoot eversion on maximal hallux dorsiflexion. A preliminary study
Authors: Harradine PD , Bevan LS
Published: April 2014

Functional hallux limitus has been recently described as an etiologic factor in postural complaints. Eversion of the rearfoot has been theoretically linked to decreased hallux dorsiflexion, although there have been no scientific studies on this subject to date. This study was undertaken to investigate the relationship between rearfoot eversion and hallux dorsiflexion; the results show that hallux dorsiflexion is decreased with rearfoot eversion in a static setting.
Effect of cast and noncast foot orthoses on plantar pressure and force during normal gait
Authors: Redmond A , Lumb PS , Landorf K
Published: April 2014

A variety of plantar pressure and force measures were explored in 22 healthy individuals with excessive pronation. The measures were obtained while the subjects wore a thin-soled athletic shoe alone, a modified Root foot orthosis made from a neutral cast, and a flat noncast insole with a 6 degrees varus rearfoot post. The data obtained from subjects wearing the noncast insole differed only minimally from those obtained while they were wearing the shoe only. In contrast, the modified Root orthosis had a profound effect on foot function. Heel forces and pressures were reduced, and the rearfoot contact area was increased. Measures of force in the midfoot demonstrated substantial increases in load in this region, but the increase in area associated with the contoured device resulted in no increase in midfoot pressure measurements. Forefoot pressures were reduced both medially and laterally with the cast device in place.
Dermatophyte test medium culture versus mycology laboratory analysis for suspected onychomycosis. A study of 100 cases in a geriatric population
Authors: Scherer WP , Kinmon K
Published: April 2014

Onychomycosis is the most frequently encountered condition in podiatric practice in the United States. A variety of modalities are available to confirm the presumptive diagnosis of onychomycosis. This study was conducted to compare the results of in-office dermatophyte test medium cultures with those of mycology laboratory analysis for 100 cases of suspected onychomycosis in a geriatric population. The results demonstrated that 20% of the patients had dermatophyte involvement, 56% had saprophyte involvement, and 19% had yeast involvement. Only 50% of positive dermatophyte test medium cultures correlated with a positive microscopic fungal culture for dermatophytes. Given these results, it is questionable whether in-office dermatophyte test medium cultures should be routinely used in geriatric patients for the diagnosis of onychomycosis. The authors believe mycology laboratory testing with fluorescent potassium hydroxide preparations and microscopic fungal cultures to be superior to in-office dermatophyte test medium cultures for the diagnosis of onychomycosis in geriatric patients.
Primary-Care Interventions for the Population at Risk for Amputation
Authors: Yacyshyn Vincent J. , Andrews Karen L.
Published: April 2014

The care of patients at risk for amputation includes the identification of at-risk patients, appropriate follow-up and treatment, and the anticipation of possible complications. Education and long-term follow-up are vital for management of the patient at risk for amputation. (J Am Podiatr Med Assoc 91(1): 2-5, 2001)
The Effect of Customized Insoles on the Reduction of Postwork Discomfort
Authors: Sobel Ellen , Levitz Steven J. , Caselli Mark A. , Christos Paul J. , Rosenblum Jonathan
Published: April 2014

This study examined the effect of customized insoles in relieving postwork discomfort in healthy individuals whose jobs require long periods of standing and walking. CompuSole insoles were worn by 122 New York City Police Department officers for up to 5 weeks for an average of 7 hours per day. The officers walked an average of 3 miles per day. Before the study, one-fifth of the police officers in this study experienced foot pain or discomfort at the end of their workday; 15% had calluses, corns, or athlete’s foot; 18% had sought treatment for a foot problem in the past; and 20% had worn foot orthoses. There was a significant reduction in tiredness in the feet at the end of the day after wearing the insoles, but no improvement in back or leg discomfort. At the end of the workday, 68% had less foot discomfort and 60% were more comfortable at work when wearing the insoles. (J Am Podiatr Med Assoc 91(10): 515-520, 2001)
Survey of the Effects of Aerobic Dance on the Lower Extremity in Aerobic Instructors
Authors: du Toit Verona , Smith Richard
Published: April 2014

The rate of aerobic dance injuries has been high for two decades. To determine the types of lower-extremity injuries to aerobic instructors, a questionnaire was sent to 18 fitness centers in the Sydney, Australia, metropolitan area requesting information on the number and types of injuries, frequency of activity levels, footwear worn, and treatments sought. The reported rate of injury was 77%. The leg was the most common site of injury, reported by 52.9% of respondents, followed by the foot and ankle (32.8%), and the knee (20%). These figures are comparable to previous studies. Further investigation is warranted into causes and preventive measures, and information on the kinetics and kinematics of the lower extremity may increase understanding of the incidence of lower-extremity injuries to aerobic instructors and participants. (J Am Podiatr Med Assoc 91(10): 528-532, 2001)
The Grading of Hallux Valgus
Authors: Garrow Adam P. , Papageorgiou Ann , Silman Alan J. , Thomas Elaine , Jayson Malcolm I. V. , Macfarlane Gary J.
Published: April 2014

This article describes a new, noninvasive method of assessing the severity of hallux valgus deformity by means of a set of standardized photographs. Six podiatrists were independently asked to grade the level of deformity of 13 subjects (26 feet) on a scale of 1 (no deformity) to 4 (severe deformity). The reliability of the four-point scale for the severity of hallux valgus was investigated by means of kappa-type statistics for more than two raters. The results showed that the grading method had excellent interobserver repeatability with a combined kappa-type statistic of 0.86, making it a suitable instrument for clinical and research purposes. (J Am Podiatr Med Assoc 91(2): 74-78, 2001)
Plantar Verrucae in Patients with Human Immunodeficiency Virus
Authors: Whitaker Jeffrey M. , Gaggero Geoffrey L. , Loveland Lacey , Segura Lolita , Barbosa Peter
Published: April 2014

Several previous studies have yielded data showing that plantar and other cutaneous verrucae follow a more aggressive course in patients infected with human immunodeficiency virus (HIV) than in uninfected individuals. A pilot study was undertaken to identify trends in a sample population that would support this characterization of plantar verrucae in HIV+ patients and to determine whether there are differences in treatment response between HIV+ and HIV− patients. The results show that the HIV+ patients in the study presented with a significantly greater number and total area of lesions than did the HIV− patients. Furthermore, the HIV+ patients experienced a greater frequency of recurrence of their lesions following treatment with surgical curettage. These findings should provide the foundation for other extensive, multicenter studies to further characterize the treatment response of these lesions in HIV+ patients and to develop effective guidelines for their management. (J Am Podiatr Med Assoc 91(2): 79-84, 2001)
Molecular Quantification of Human β-Glucuronidase Levels in a Patient with Vohwinkel’s Syndrome
Authors: Hughes Thomas J. , Hughes Monica L. , Caldwell Bryan D.
Published: April 2014

The skin must undergo the process of keratinization in order to perform its functions. During the process of differentiation, certain genes are activated while others are repressed, leading to changes in structural proteins and enzymes and in the synthesis of various lipids. An error in any of these steps can ultimately impair the process of keratinization. Vohwinkel’s syndrome is the direct result of a defect in keratinization. Patients who have this epidermolytic palmoplantar keratoderma present clinically with hyperkeratosis of the stratum corneum. Hyperkeratosis has been linked to an increase in β-glucuronidase levels. The authors studied the absolute concentration of human β-glucuronidase in a patient with Vohwinkel’s syndrome as determined through a double-antibody sandwich enzyme-linked immunosorbent assay and a Western blot assay of the blood, urine, and skin of the patient. (J Am Podiatr Med Assoc 91(3): 114-120, 2001)
Lateral Intermetatarsal Angle: A Useful Measurement of Metatarsus Primus Elevatus?
Authors: Bryant Alan , Mahoney Belinda , Tinley Paul
Published: April 2014

The lateral intermetatarsal angle, a measurement of the sagittal plane angular divergence between the dorsal cortices of the first and second metatarsals of lateral weightbearing foot radiographs, was compared in 30 normal and 30 hallux limitus feet. The results suggest that the angle may be measured reliably and that although the measured angles are relatively small, a significant difference exists between the normal and hallux limitus subjects studied. Accordingly, the lateral intermetatarsal angle may prove to be a useful radiographic measurement to assist the podiatric physician in the clinical assessment of hallux limitus. (J Am Podiatr Med Assoc 91(5): 251-254, 2001)
Internet Resources for Podiatric Medical Students
Authors: Fikar Charles R. , Fikar Ronald M.
Published: April 2014

This paper presents a selection of Internet resources covering most of the subject areas found in standard medical education curricula. Basic sciences sites are emphasized, but clinical resources are also included. Reported sites were judged based on their potential to enhance the learning process, provide practice questions or study guides for examinations, or aid in the preparation of papers. In addition to podiatric medical students, residents and practitioners who require a quick reference source to either the basic science foundations of podiatric medicine or the clinical side of podiatric practice may find this paper useful. (J Am Podiatr Med Assoc 91(6): 316-323, 2001)
Lesser Proximal Interphalangeal Joint Arthrodesis
Authors: Lamm Bradley M. , Ribeiro Carla E. , Vlahovic Tracey C. , Fiorilli Anthony , Bauer Gary R. , Hillstrom Howard J.
Published: April 2014

A retrospective study was performed to compare the prevalence of complications in peg-in-hole and end-to-end arthrodesis procedures. The authors reviewed 177 second, third, and fourth proximal interphalangeal joint fusions for the correction of hammer toe deformities in 85 patients from 1988 to 1998 at the Temple University School of Podiatric Medicine. The average age of the patients was 49 years. Sixteen percent (14) of the subjects were male and 84% were (71) female. Upon follow-up, the fourth digit was generally associated with a greater number of complications for the end-to-end and peg-in-hole procedures, with the second digit being the most common site of fusion. The prevalence of complications was evaluated using contingency table analysis and expressed as a percent of total complications (27%, the end-to-end group; 17%, the peg-in-hole group). A subset of complications deemed clinically relevant was also computed. Similarly, the prevalence of clinically relevant complications for the end-to-end (10%) and the peg-in-hole (9%) procedures was not statistically significant. Therefore, this study showed no statistically significant differences in the total or clinically relevant complications between end-to-end and the peg-in-hole arthrodesis procedures. (J Am Podiatr Med Assoc 91(7): 331-336, 2001)
Hemophilic Arthropathy: Considerations in Management
Authors: Chang Thomas J. , Mohamed Shenin , Hambleton Julie
Published: April 2014

The authors evaluate nonsurgical and surgical approaches to treating patients with hemophilic arthropathy and review the functional and economic limitations imposed on treating these patients. Indications for surgery are discussed and a case study that incorporates both conservative and surgical management options is presented. While the advent of factor replacement therapy has dramatically changed the course of treatment and prognosis for patients with hemophilia, the authors argue that the economic burden of treating these patients is still very high. The authors recommend that proper conservative and surgical management options for patients with hemophilia should be based upon a thorough understanding of the disease process. (J Am Podiatr Med Assoc 91(8): 406-414, 2001)
Arthrodesis of the Interphalangeal Joint of the Hallux
Authors: Yu Gerard V. , Vargo Frank E. , Brook Joel W.
Published: April 2014

The authors present a simple and effective technique to achieve arthrodesis of the hallucal interphalangeal joint. Stabilization is achieved by external fixation with crossing Kirschner wires joined together to create a single functional unit, a technique that avoids common problems often associated with Kirschner-wire fixation. The authors propose that this simple technique be considered for patients in whom it has been determined that screw fixation should not be used to obtain fusion of the interphalangeal joint. (J Am Podiatr Med Assoc 91(8): 427-434, 2001)
Subtalar Joint Axis Location and Rotational Equilibrium Theory of Foot Function
Authors: Kirby Kevin A.
Published: April 2014

A new theory of foot function based on the spatial location of the subtalar joint axis in relation to the weightbearing structures of the plantar foot is proposed. The theory relies on the concept of subtalar joint rotational equilibrium to explain how externally generated forces, such as ground reaction force, and internally generated forces, such as ligamentous and tendon tensile forces and joint compression forces, affect the mechanical behavior of the foot and lower extremity. The biomechanical effect of variations among individuals in the spatial location of the subtalar joint axis are explored, along with their clinical consequences, to offer an additional theory of foot function, which may improve on existing podiatric biomechanics theory. (J Am Podiatr Med Assoc 91(9): 465-487, 2001)
Dressing Selection in Chronic Wound Management
Authors: Seaman Susie
Published: April 2014

The concept of moist wound healing has been examined and gradually accepted by wound care clinicians during the last 40 years, and has led to the development of hundreds of dressings that support a moist wound environment. This article discusses the characteristics of an ideal dressing in an effort to assist clinicians in making appropriate dressing choices from common categories, including transparent films, hydrocolloids, foams, absorptive wound fillers, hydrogels, collagens, and gauzes. Reimbursement issues are also discussed. (J Am Podiatr Med Assoc 92(1): 24-33, 2002)
Sectioning the Plantar Fascia
Authors: Harton Francois M. , Weiskopf Steven A. , Goecker Robert M.
Published: April 2014

A study on the effect of sectioning the plantar fascia on the range of motion at the first metatarsophalangeal joint is presented. Dorsiflexion and plantarflexion range-of-motion data from 18 patients who had no first metatarsophalangeal joint pathology and had undergone an in-step plantar fasciotomy for recalcitrant plantar fasciitis were analyzed. The average increase in dorsiflexion of the first metatarsophalangeal joint after plantar fascia release was 9.8°, which represented a statistically significant increase using a paired t-test. Thus release of the plantar fascia can be considered a potential adjunct to hallux limitus surgery. (J Am Podiatr Med Assoc 92(10): 532-536, 2002)
A Retrospective Analysis of 772 Patients with Hallux Limitus
Authors: Grady John F. , Axe Timothy M. , Zager Emil J. , Sheldon Lori A.
Published: April 2014

In this retrospective analysis of 772 patients with symptomatic hallux limitus, 428 patients (55%) were successfully treated with conservative care alone; of these 428 patients, 362 (84%) were treated with orthoses. Corticosteroid injections and a change in shoes allowed 24 patients (6% of conservatively treated patients) and 42 patients (10%), respectively, to have less discomfort and return to previous activity levels. Overall, 47% of the patients in this analysis were successfully treated with orthoses. Surgical procedures were performed on 296 patients (38% of all patients) who did not respond to conservative care. In this analysis, 48 of the patients (6% of all patients) who did not respond to conservative care either refused surgery or were not surgical candidates. These data are intended to provide podiatric physicians with expected outcomes for conservative care of hallux limitus. The etiology, symptoms, conservative management, and surgical treatments of hallux limitus and hallux rigidus are also reviewed. (J Am Podiatr Med Assoc 92(2): 102-108, 2002)
Motion of the Calcaneus, Navicular, and First Metatarsal During the Stance Phase of Walking
Authors: Cornwall Mark W. , McPoil Thomas G.
Published: April 2014

One hundred fifty-three subjects between the ages of 18 and 41 years (mean age, 26.2 years) with no history of congenital or traumatic deformity or foot problems walked along a 6-m walkway while the angular and linear displacement of the tibia, calcaneus, navicular, and first metatarsal was measured by means of an electromagnetic motion analysis system. Three-dimensional movement of the calcaneus relative to the tibia, of the navicular relative to the calcaneus, and of the first metatarsal relative to the navicular during the stance phase of gait was calculated. The results of this study provide information on, and an understanding of, how the calcaneus, navicular, and first metatarsal function during the stance phase of normal human walking. (J Am Podiatr Med Assoc 92(2): 67-76, 2002)
A Comparison of Four Methods of Obtaining a Negative Impression of the Foot
Authors: Laughton Carrie , McClay Davis Irene , Williams Dorsey S.
Published: April 2014

Four methods are currently available for taking a negative impression of the foot for the purpose of fabricating an orthotic device: nonweightbearing plaster casting, partial-weightbearing foam impressions, and partial-weightbearing and nonweightbearing laser scanning. This study compares the reliability and accuracy of these methods. Each impression method was performed three times on each foot of 15 subjects. Measures of rearfoot and forefoot width, forefoot-to-rearfoot relationship, and arch height were obtained from the negative impressions. Additionally, rearfoot and forefoot width and forefoot-to-rearfoot relationship were measured clinically for each subject. This study found that 1) foot measures are significantly influenced by the method used to obtain a negative foot impression; 2) the methods differ in reliability; and 3) plaster casting may be preferable to the other three methods when it is important to capture the forefoot-to-rearfoot relationship, as in fabricating a functional orthosis. (J Am Podiatr Med Assoc 92(5): 261-268, 2002)
Chemical Matrixectomy for Ingrown Toenails
Authors: Espensen Eric H. , Nixon Brent P. , Armstrong David G.
Published: April 2014

Chemical matrixectomy for ingrown toenails is one of the most common surgical procedures performed on the foot. The procedure was first described in 1945 by Otto Boll, who discussed the use of phenol to correct ingrown toenails. In the years that followed, many variations of technique and method have been described. This article reviews the pertinent literature detailing chemical matrixectomies and advocates the use of an evidence basis for care. (J Am Podiatr Med Assoc 92(5): 287-295, 2002)
The Association of Hallux Limitus with the Accessory Navicular
Authors: Evans R. D. Lee , Averett Ryan , Sanders Stephanie
Published: April 2014

Hallux limitus is one of the most prevalent, debilitating disorders of the first metatarsophalangeal joint, and it has many proposed etiologies. This article reviews these etiologies, focusing primarily on the pes planus foot. The pes planus foot type is often associated with symptomatic hallux limitus and the accessory navicular. This article discusses this correlation, although a causal relationship has not been proven. The prevalence and classification of the accessory navicular are also discussed. Clinical cases involving symptomatic hallux limitus occurring concomitantly with an accessory navicular are reviewed, including radiographic findings, symptoms, and surgical treatment. (J Am Podiatr Med Assoc 92(6): 359-365, 2002)
From Acute to Chronic
Authors: Nubé Vanessa L. , McGill Margaret , Molyneaux Lynda , Yue Dennis K.
Published: April 2014

The monitoring of Charcot’s arthropathy in patients with diabetes mellitus is twofold: 1) assessment of disease activity as the condition progresses from the acute to the chronic phase, and 2) identification of structural abnormalities and complications that may arise as a result of the disease. The former guides the clinician as to the duration of primary treatment, and the latter provides important information regarding the long-term prognosis and facilitates clinical decision making regarding other treatments including surgery, footwear, and orthoses. The mainstay of assessing disease activity remains thorough and regular assessment of swelling, temperature differences, and bony abnormalities. Radiographic assessment performed at baseline and periodically throughout the course of the disease will show stages of early fracture and fragmentation followed by eventual trabecular bridging, ankylosis of the affected joints, and sclerosis, heralding the chronic phase of the disease. Radiographic assessment also provides visualization of bony deformities and prominences. In addition to these assessments, changes may be further quantified by the use of infrared dermal thermography and quantitative bone scanning techniques. Careful clinical monitoring of patients is essential to optimize treatment for acute Charcot’s arthropathy and improve the long-term outcome for patients presenting with this condition. (J Am Podiatr Med Assoc 92(7): 384-389, 2002)
Use of Subatmospheric (VAC) Therapy to Improve Bioengineered Tissue Grafting in Diabetic Foot Wounds
Authors: Espensen Eric H. , Nixon Brent P. , Lavery Lawrence A. , Armstrong David G.
Published: April 2014

The use of bioengineered tissue and topical subatmospheric pressure therapy have both been widely accepted as adjunctive therapies for the treatment of noninfected, nonischemic diabetic foot wounds. This article describes a temporally overlapping method of care that includes a period of simultaneous application of bioengineered tissue (Apligraf, Novartis Pharmaceuticals Corp, East Hanover, New Jersey) and subatmospheric pressure therapy delivered through the VAC (Vacuum Assisted Closure) system (KCI, Inc, San Antonio, Texas). Future descriptive and analytic works may test the hypothesis that combined therapies used at different and often overlapping periods during the wound-healing cycle may be more effective than a single modality. (J Am Podiatr Med Assoc 92(7): 395-397, 2002)
A New Technique for Charcot’s Foot Reconstruction
Authors: Wang James C. , Le Anthony W. , Tsukuda Raymond K.
Published: April 2014

External fixation was used to reduce or arrest progressive degeneration in 28 patients with Charcot’s foot dislocations. Adjunctive procedures included tendo Achilles lengthening and application of an external bone stimulator. Advantages of using external fixation are that surgeries are usually performed percutaneously and that most patients are weightbearing in 10 to 14 days. There was no incidence of pin tract infection or further foot collapse, with the longest follow-up period being 24 months. The authors propose that use of external fixation with bone stimulation may be an effective alternative method of treating the Charcot foot. (J Am Podiatr Med Assoc 92(8): 429-436, 2002)
Use of the Tissue Stress Model as a Paradigm for Developing an Examination and Management Plan for a Patient with Plantar Fasciitis
Authors: Ross Michael
Published: April 2014

This case report demonstrates the use of the tissue stress model to develop an examination, evaluation, and management plan for a patient with an 8-week history of plantar fasciitis. The patient history focused on determining which tissues were being excessively stressed, and the physical examination was used to apply controlled stresses to these tissues and to determine factors contributing to the patient’s condition. After it was confirmed that the patient’s plantar fascia was under excessive mechanical stress, treatment first focused on reducing pain, inflammation, and stress on the plantar fascia and then on returning the patient to her running program while maintaining symptoms at a diminished level. The patient reported being free of pain 7 weeks after the initial physical therapy examination and at the 11-week telephone follow-up. Although no experimental evidence is given, this report suggests that this patient responded positively to treatment based on the tissue stress model. (J Am Podiatr Med Assoc 92(9): 499-506, 2002)
Knowledge of Aging and Attitudes Toward Older People
Authors: Menz Hylton B. , Stewart Francis A. , Oates Matthew J.
Published: April 2014

Podiatric medical students in Australia were surveyed to evaluate their reasons for entering podiatric medicine, knowledge of aging, attitudes toward older people, perceptions of treatment efficacy, and desire to specialize in geriatrics. Few students plan to specialize in geriatrics upon graduation (4%), with most preferring general practice (25%) or sports medicine (21%). However, knowledge of aging was good, and students had favorable attitudes toward older people and considered treatment of older people to be effective. Few age- or gender-related effects were observed. It is concluded that students’ lack of desire to specialize in geriatrics may be due not to unfavorable perceptions of older people but rather to the low profile and limited development of geriatrics as a specialty area within the podiatric medical profession. (J Am Podiatr Med Assoc 93(1): 11-17, 2003)