bluuebunny/crossref_metadata_2025 huggingface dataset:
Foot Pain Impairs Balance and Functional Ability in Community-Dwelling Older People
Authors: Menz Hylton B. , Lord Stephen R.
Published: April 2014

Foot problem assessments were performed on 135 community-dwelling older people in conjunction with clinical tests of balance and functional ability. Eighty-seven percent of the sample had at least one foot problem, and women had a higher prevalence than men of foot pain, hallux valgus, plantar hyperkeratosis, lesser digital deformity, and digital lesions. Postural sway did not differ between older people with and without each of these foot conditions. However, the presence of specific foot conditions impaired performance in a more challenging balance test and in some functional tests. In particular, older people with foot pain performed worse in a leaning balance test, stair ascent and descent, an alternate step-up test, and a timed six-meter walk. Furthermore, multiple regression analyses revealed that foot pain was a significant independent predictor of performance in each of these tests. These results show that the presence of foot problems, particularly foot pain, impairs balance and functional ability. As foot pain is amenable to treatment, podiatric intervention has the potential to improve mobility and independence in older people. (J Am Podiatr Med Assoc 91(5): 222-229, 2001)
A Comparison of Radiographic Foot Measurements Taken in Two Different Positions
Authors: Bryant Jennifer A.
Published: April 2014

The purpose of this study was to ascertain if positioning of the feet for radiographic assessment produces significant variations in measured angles, and if measurements taken from radiographs taken on two separate occasions are reproducible. Weightbearing x-rays were taken of both feet of ten male healthy subjects in two standardized positions: 1) the angle and base of gait and 2) the feet together and straight-ahead positions. The radiographs were repeated 2 weeks later. The results failed to demonstrate significant differences of radiographic measurements between the two specific foot-positioning methods. No significant differences were found between radiographic measurements of normal feet taken on different occasions. A strong correlation of the repeated measures suggests that weightbearing foot radiographs can be reliably reproduced. (J Am Podiatr Med Assoc 91(5): 234-239, 2001)
The Efficacy of Functional Foot Orthoses in the Control of Pain in Ankle Joint Disintegration in Hemophilia
Authors: Slattery Matthew , Tinley Paul
Published: April 2014

Sixteen subjects with hemophilia A of levels 1–5 stage of joint damage were tested over a 6-week period to evaluate the efficacy of functional foot orthoses. The level of ankle bleeds (hemarthrosis) before and after the intervention with functional foot orthoses was determined by evaluating pain, disability, and activity levels. All subjects reported a significant reduction of ankle bleeds coinciding with the intervention of functional foot orthoses. The use of a foot-pain disability measure clearly showed significant reduction in the level of pain experienced by the subjects and in their overall index score. However, the disability and activity index scores showed no significant improvement after the intervention with orthoses. This finding would support the use of functional foot orthoses to treat patients with hemophilia A, as significant reduction in pain levels appears to greatly improve the lives of the patients. (J Am Podiatr Med Assoc 91(5): 240-244, 2001)
Function of the Windlass Mechanism in Excessively Pronated Feet
Authors: Aquino Anna , Payne Craig
Published: April 2014

The foot postures of 39 subjects were evaluated for excessive pronation by means of six static weightbearing and five nonweightbearing measurements, and two types of footprint indexes. Visual evidence of windlass function was recorded by video. Chi-square analysis revealed that excessive pronation does not affect the establishment of the windlass mechanism. The position of the forefoot relative to the rearfoot, subtalar joint axis position, and navicular drift/foot length ratio were significantly associated with dynamic windlass function. These results suggest that selected static measurements may have value in predicting some aspects of dynamic foot function during the propulsive phase of the gait cycle. (J Am Podiatr Med Assoc 91(5): 245-250, 2001)
Outpatient Care and Morbidity Reduction in Diabetic Foot Ulcers Associated with Chronic Pressure Callus
Authors: Sage Ronald A. , Webster Julie Kate , Fisher Susan Gross
Published: April 2014

In a retrospective review of 233 cases of diabetic foot ulceration preceded by minor trauma, 192 ulcerations exhibited focal pressure keratosis as the preceding traumatic event. The frequency of outpatient visits and other foot care interventions were correlated with the occurrence and severity of ulceration. Patients seen more frequently in an outpatient foot clinic had less severe ulcers and were less likely to undergo surgical treatment than those with less frequent visits. (J Am Podiatr Med Assoc 91(6): 275-279, 2001)
Radiographic Analysis of Metatarsus Primus Elevatus
Authors: Christman Robert A. , Flanigan K. Paul , Sorrento Dean L. , Stanich Christopher C.
Published: April 2014

The authors investigated the effect of x-ray tube head angulation and central ray direction on the position of the first metatarsal relative to the second metatarsal in the lateral foot radiographic view. This preliminary study shows that these variables may influence the perception of metatarsus primus elevatus in the weightbearing lateral foot radiograph. (J Am Podiatr Med Assoc 91(6): 294-299, 2001)
Magnetic Resonance Imaging Evaluation of Monostotic Fibrous Dysplasia of the Tibia
Authors: Karr Jeffrey C. , Black James A. , Bernard Joshua M.
Published: April 2014

The authors present a case report documenting the evaluation of monostotic fibrous dysplasia by magnetic resonance imaging. This type of evaluation demonstrates specificity for this disease process when combined with other imaging studies, laboratory findings, and clinical presentation. This technique is extremely useful in the identification of a no-touch lesion, allowing avoidance of an unnecessary bone biopsy. (J Am Podiatr Med Assoc 91(6): 306-310, 2001)
Symmetry of Plantar Pressures and Vertical Forces in Healthy Subjects During Walking
Authors: VanZant R. Scott , McPoil Thomas G. , Cornwall Mark W.
Published: April 2014

The purpose of this study was to determine the degree of symmetry for in-shoe plantar pressure and vertical force patterns between the left and right feet of healthy subjects during walking. Thirty subjects with a mean age of 29.6 years participated in the study. Each subject walked a distance of 8 m three times while in-shoe plantar pressure and vertical force data were collected. A total of 12 steps were analyzed for both feet, and maximum vertical force, peak pressure, and pressure-time integrals were calculated for four plantar regions of the foot. No differences in the three variables were noted between male and female subjects. Plantar pressure and vertical force patterns were found to be symmetrical between the left and right feet, except for two of the four plantar regions studied. Only the forefoot and rearfoot regions were found to show significant differences between the left and right feet for plantar pressure and vertical force, respectively. The degree of asymmetry for these two plantar regions in the same foot, however, was minimal. (J Am Podiatr Med Assoc 91(7): 337-342, 2001)
Podiatric Medical Applications of Posterior Night Stretch Splinting
Authors: Evans Angela
Published: April 2014

Podiatric physicians encounter many conditions, especially in sports medicine, that involve pain in the vicinity of the rearfoot or lower leg. These conditions are often associated with ankle equinus and may affect either child or adult sports participants. A review of the literature and clinical experience identify posterior night stretch splinting as an effective adjunct in the treatment of persistent symptomatic plantar fasciitis, negating the need for corticosteroid injections, further protracted pain, or surgery. This article reviews clinical cases in which night stretch splinting was used for a variety of diagnoses. Further research is needed into its efficacy for conditions other than plantar fasciitis. (J Am Podiatr Med Assoc 91(7): 356-360, 2001)
Syndrome of Painful Legs and Moving Toes
Authors: Yoon Joonhyun , Crabtree Christopher , Botek Georgeanne
Published: April 2014

Painful legs and moving toes syndrome is characterized by spontaneous causalgic pain in the lower extremities associated with peculiar involuntary movements of the lower extremities, especially the toes and feet. The pain is diffuse, intractable, aching, and deep. The movements consist of persistent writhing movements in the digits that cannot be limited voluntarily. The syndrome has been observed after a variety of abnormalities affecting the posterior nerve roots, the spinal ganglia, and the peripheral nerves. This article reviews commonly reported findings and current concepts in the etiology and management of this condition. (J Am Podiatr Med Assoc 91(7): 361-364, 2001)
Partial Calcanectomy in the Treatment of Chronic Heel Ulceration
Authors: Lehmann Sean , Murphy R. Dan , Hodor Lawrence
Published: April 2014

Chronic decubitus ulceration of the heels is a common condition encountered by podiatric physicians, especially in diabetic patients. Very often these ulcerations can progress to osteomyelitis of the calcaneus. Many times, this in turn leads to a below-the-knee amputation. A partial calcanectomy is a viable alternative to below-the-knee amputation. A more functional limb both mechanically and cosmetically is achieved, and the morbidity and mortality associated with the calcanectomy is less than with a below-the-knee amputation. A brief overview of the history and outcomes associated with this procedure is outlined and a case utilizing a partial calcanectomy is presented. (J Am Podiatr Med Assoc 91(7): 369-372, 2001)
The Role of Matrix Metalloproteinases in Wound Healing
Authors: Armstrong David G. , Jude Edward B.
Published: April 2014

The structure, classification, function, and regulation of matrix metalloproteinases in normal and abnormal wound healing is discussed. Results from key studies suggest that neutrophil-derived matrix metalloproteinase 8 (MMP-8) is the predominant collagenase present in normal healing wounds, and that overexpression and activation of this collagenase may be involved in the pathogenesis of nonhealing chronic leg ulcers. Excessive collagenolytic activity in these chronic wounds is possible because of the reduced levels of tissue inhibitor metalloproteinase 1 (TIMP-1). However, until recently, there have been no studies evaluating levels of matrix metalloproteinase or tissue inhibitors of metalloproteinase activity in chronic diabetic foot wounds. Improving basic knowledge and pharmaceutical intervention in this area ultimately may help clinicians identify and proactively intervene in an effort to prevent normal wounds from becoming chronic. This may prevent the high prevalence of morbidity associated with this significant health problem. (J Am Podiatr Med Assoc 92(1): 12-18, 2002)
Wound Treatment with Human Skin Equivalent
Authors: De Sumit K. , Reis Ernane D. , Kerstein Morris D.
Published: April 2014

Skin grafting provides an effective means of closing chronic wounds. Autografts and allografts are used most often in skin grafting, but Apligraf, a tissue-engineered bilayered human skin equivalent, provides another safe and effective grafting option for treating diabetic, venous, and pressure ulcers. This skin equivalent has an epidermis and dermis similar to human skin, largely due to its derivation from neonatal foreskin. Apligraf is also easily accessible and has shown little immunoreactivity. (J Am Podiatr Med Assoc 92(1): 19-23, 2002)
Use of Clinical Laboratory Parameters to Evaluate Wound Healing Potential in Diabetes Mellitus
Authors: Abu-Rumman Patricia L. , Armstrong David G. , Nixon Brent P.
Published: April 2014

Clinicians caring for chronic wounds can easily overlook nutritional status. Patients with diabetes are at high risk for primary and secondary malnutrition. Although profiles exist defining the extent of the deficiency, the process of wound healing and the interactions of the macronutrients and micronutrients necessary to accomplish it must first be understood. In elderly patients with diabetes, additional factors such as liver and renal function, the interdependence of the immune system, and protein synthesis, also must be considered. This article provides a practical format to assist clinicians in better evaluating this often difficult-to-assess area of care. (J Am Podiatr Med Assoc 92(1): 38-47, 2002)
Offloading Properties of a Rocker Insole
Authors: Frykberg Robert G. , Bailey LaWanda F. , Matz Amanda , Panthel Lisa A. , Ruesch Gina
Published: April 2014

Multiple offloading modalities are currently used in the management of diabetic plantar foot ulcerations. A relatively new device, the Rocker Insole, was tested for its ability to relieve plantar forefoot pressures when inserted into a surgical boot as compared to a patient’s customary footwear and the surgical boot alone. The Rocker Insole significantly reduced forefoot pressures by 48% when worn inside the surgical boot. Mean peak pressures unexpectedly increased 12% when the surgical boot was worn alone. This preliminary investigation suggests that when worn in conjunction with a surgical boot, the Rocker Insole can effectively offload plantar forefoot pressures and may be useful in the management of plantar metatarsal ulcerations. (J Am Podiatr Med Assoc 92(1): 48-53, 2002)
Long-term Follow-up of the Green-Watermann Osteotomy for Hallux Limitus
Authors: Dickerson Jason B. , Green Richard , Green Donald R.
Published: April 2014

The authors undertook a retrospective analysis of the long-term efficacy of the Green-Watermann procedure for the treatment of painful hallux limitus or rigidus. Questionnaires were sent to 80 consecutive patients who had such procedures performed between 1990 and 1999. Medical records and radiographs were reviewed for the 32 patients who completed the questionnaires, representing 40 Green-Watermann procedures. Twenty-four patients were able to return for clinical evaluation. The average length of follow-up was 4 years (range, 1 to 10 years). The questionnaires addressed pain before and after surgery, function after surgery, complications, and overall impression and satisfaction. Nearly all of the patients (30 of 32; 94%) reported that surgery had significantly relieved their hallux joint pain, and a slightly smaller proportion (28 of 32; 88%) felt that their chief complaints were at least 70% improved. Clinical evaluation revealed adequate range of motion at the first metatarsophalangeal joint. It is concluded that the Green-Watermann procedure is an effective treatment approach for hallux limitus and rigidus, resulting in a significant reduction in pain, an increase in function, and a high degree of patient satisfaction. (J Am Podiatr Med Assoc 92(10): 543-554, 2002)
Integrating Research Into the Clinic
Authors: Keenan Anne-Maree , Redmond Anthony C.
Published: April 2014

This paper is the first in a series of three aimed at introducing clinicians to current concepts in research, and outlining how they may be able to apply these concepts to their own clinical practice. It has become evident in recent years that while many practitioners may not want to become actively involved in the research process, simply keeping abreast of the burgeoning publication base will create new demands on their time, and will often require the acquisition of new skills.

This series introduces the philosophies of integrating what sometimes may appear to be abstract research into the realities of the clinical environment. It will provide practitioners with an accessible summary of the tools required in order to understand the research process. For some, it is hoped this series may provide some impetus for the contemplative practitioner to become a more active participant in the research process. This first paper addresses how the evidence based practice (EBP) revolution can be used to empower the individual practitioner and how good quality evidence can improve the overall clinical decision making process. It also suggests key strategies by which the clinician may try to enhance their clinical decision making process and make research evidence more applicable to their day to day clinical practice. (J Am Podiatr Med Assoc 92(2): 115-122, 2002)
Symptomatic Reversal of Peripheral Neuropathy in Patients with Diabetes
Authors: Kochman Alan B. , Carnegie Dale H. , Burke Thomas J.
Published: April 2014

Forty-nine consecutive subjects with established diabetic peripheral neuropathy were treated with monochromatic near-infrared photo energy (MIRE) to determine if there was an improvement of sensation. Loss of protective sensation characterized by Semmes-Weinstein monofilament values of 4.56 and above was present in 100% of subjects (range, 4.56 to 6.45), and 42 subjects (86%) had Semmes-Weinstein values of 5.07 or higher. The ability to discriminate between hot and cold sensation was absent (54%) or impaired (46%) in both groups prior to the initiation of MIRE treatment. On the basis of Semmes-Weinstein monofilament values, 48 subjects (98%) exhibited improved sensation after 6 treatments, and all subjects had improved sensation after 12 treatments. Therefore, MIRE may be a safe, drug-free, noninvasive treatment for the consistent and predictable improvement of sensation in diabetic patients with peripheral neuropathy of the feet. (J Am Podiatr Med Assoc 92(3): 125-130, 2002)
The Mozena Classification System and Treatment Algorithm for Ingrown Hallux Nails
Authors: Mozena John D.
Published: April 2014

Infected ingrown toenails raise the question of how much nail should be removed and what amount of nail fold reduction should occur. Often, the ungual labia folds are found to be hypertrophic, forcing the nail to push into the flesh and start a foreign body reaction. A simplified approach to this problem is proposed on the basis of the measurement of 100 normal nail folds and 25 infected nail folds. The results of this study show that the treatment goal should be to achieve an ungual labia fold of less than 3 mm, concluding that there is a correlation between the depth of the ungual labia fold and the severity of the infected ingrown toenail. (J Am Podiatr Med Assoc 92(3): 131-135, 2002)
Clinical and Dynamic Range-of-Motion Techniques in Subjects With and Without Diabetes Mellitus
Authors: Tinley Paul , Taranto Michael
Published: April 2014

Thirty subjects with type 1 diabetes, 30 subjects with type 2 diabetes, and 30 age- and sex-matched controls were evaluated through clinical goniometry and two-dimensional motion analysis systems to determine the dynamic and static range of motion of the knee, ankle, and hallux joints. The purpose of this study was to determine if the knee and ankle joints of patients with diabetes mellitus are affected by limited joint mobility syndrome. The study results support previous medical literature showing significant reduction of range of motion of the hallux in subjects with type 1 diabetes. Significant differences were found between the range of motion of male and female subjects in all lower-limb joints for both subject groups with diabetes compared to the control group, and male subjects in all groups recorded less range of motion than female subjects. (J Am Podiatr Med Assoc 92(3): 136-142, 2002)
Congenital Absence of the Tibial Sesamoid
Authors: Day Fred , Jones P. Clint , Gilbert Christi L.
Published: April 2014

Congenital absence of the tibial sesamoid of the hallux is an infrequent occurrence. The authors present a case of congenital absence of the tibial sesamoid and a review of the literature regarding the clinical significance of this anomaly. (J Am Podiatr Med Assoc 92(3): 153-154, 2002)
‘Horses for Courses’: The Differences Between Quantitative and Qualitative Approaches to Research
Authors: Redmond Anthony C. , Keenan Anne-Maree , Landorf Karl
Published: April 2014

Some clinicians may feel dissociated from, and intimidated by the ever-increasing emphasis on research. However, with an understanding of some of the basic principles and key terms, research can feel less daunting. It is the aim of this article, the second in a series of three focusing on understanding research, to introduce clinicians to the different approaches to research, to improve understanding of what the approaches mean, and to highlight when a particular approach may be appropriate. Furthermore, the article will provide an explanation of some of the common terms used within clinical research. This should aid the clinician in applying good, simple, scientific principles to evaluating clinical research evidence. (J Am Podiatr Med Assoc 92(3): 159-169, 2002)
Sensitivity and Specificity of the Functional Hallux Limitus Test to Predict Foot Function
Authors: Payne Craig , Chuter Vivienne , Miller Kathryn
Published: April 2014

Functional hallux limitus is an underrecognized entity that generally does not produce symptoms but can result in a variety of compensatory mechanisms that can produce symptoms. Clinically, hallux limitus can be determined by assessing the range of motion available at the first metatarsophalangeal joint while the first ray is prevented from plantarflexing. The aim of this study was to determine the sensitivity and specificity of this clinical test to predict abnormal excessive midtarsal joint function during gait. A total of 86 feet were examined for functional hallux limitus and abnormal pronation of the midtarsal joint during late midstance. The test had a sensitivity of 0.72 and a specificity of 0.66, suggesting that clinicians should consider functional hallux limitus when there is late midstance pronation of the midtarsal joint during gait. (J Am Podiatr Med Assoc 92(5): 269-271, 2002)
Understanding Statistics
Authors: Redmond Anthony C. , Keenan Anne-Maree
Published: April 2014

Understanding statistics can be one of the more difficult and daunting tasks facing the clinician attempting to understand and use the research literature. While the fundamental aim of including statistics in literature is to justify the conclusions and to enhance the information presented, all too often, statistics serve only to intimidate and alienate clinicians. There are two sources for this barrier to understanding: poor comprehension of statistics by clinicians, and inappropriate presentation of statistics by researchers. In the third of our papers on evidence-based practice and the clinician, some basic principles of statistics are introduced. Aspects such as the concepts of clinical and statistical significance are discussed, and an outline of the appropriate use of specific statistics is provided. The hope is that this will enable the clinician to better judge the applicability of statistical techniques as applied in the published literature. Some of the newer, more ‘clinician friendly’ statistical approaches are also presented. Finally some of the cheats and shortcuts commonly encountered in the presentation of research are discussed, and the methods for dealing with them are outlined. (J Am Podiatr Med Assoc 92(5): 297-305, 2002)
A Retrospective Analysis of JAPMA Publication Patterns, 1991–2000
Authors: Menz Hylton B.
Published: April 2014

A retrospective analysis of 878 articles published in JAPMA from 1991 to 2000 was conducted to investigate changing patterns of publication activity in podiatric medicine. Most of the articles published in JAPMA were case reports (37%), followed by literature reviews (33%) and original research (30%). The Journal has covered a wide range of topic areas, with the most common being foot surgery (14%). A breakdown of the proportion of original research versus review articles and case reports for each topic area revealed that while orthotic therapy and biomechanics attract considerable attention from researchers, other important specialty areas such as foot surgery, dermatology, pediatrics, and rheumatology continue to be represented primarily by literature reviews and case reports. Two significant trends were observed: a gradual increase in the proportion of original research articles and a steady increase in the number of articles by authors outside the United States. These findings provide valuable insight into patterns of publication in podiatric medicine and raise a number of issues regarding the ongoing development of the profession. (J Am Podiatr Med Assoc 92(5): 308-313, 2002)
Reliability and Accuracy of Biomechanical Measurements of the Lower Extremities
Authors: Van Gheluwe Bart , Kirby Kevin A. , Roosen Philip , Phillips Robert D.
Published: April 2014

The reliability of biomechanical measurements of the lower extremities, as they are commonly used in podiatric practice, was quantified by means of intraclass correlation coefficients (ICCs). This was done not only to evaluate interrater and intrarater reliability but also to provide an estimate for the accuracy of the measurements. The measurement protocol involved 30 asymptomatic subjects and five raters of varying experience. Each subject was measured twice by the same rater, with the retest immediately following the test. The study demonstrated that the interrater ICCs were quite low (≤0.51), except for the measurements of relaxed calcaneal stance position and forefoot varus (both 0.61 and 0.62 for left and right, respectively). However, the intrarater ICCs were relatively high (>0.8) for most raters and measurement variables. Measurement accuracy was moderate between raters. (J Am Podiatr Med Assoc 92(6): 317-326, 2002)
Diabetic Foot Wound Care Algorithms
Authors: Han Paul , Ezquerro Ruben
Published: April 2014

The purpose of this article is to present reference guidelines to assist clinicians when treating diabetic patients with foot wounds. Diabetic patients with limb-threatening foot ulcers often have multiple coexisting medical conditions that frequently become impediments to the resolution of foot wounds. Each foot wound is unique and its etiology is multifactorial; therefore, each foot wound should be managed differently. The treatment algorithm presented in this article is divided into three categories: Algorithm I describes the treatment of septic foot wounds, which may be considered true podiatric surgical emergencies; Algorithm II describes the treatment of ischemic foot ulcers or gangrene with or without underlying osteomyelitis; and Algorithm III describes the treatment of neuropathic foot ulcers with or without underlying osteomyelitis. (J Am Podiatr Med Assoc 92(6): 336-349, 2002)
Jean-Martin Charcot (1825–1893)
Authors: Sanders Lee J.
Published: April 2014

Jean-Martin Charcot was one of the most celebrated French physicians of the 19th century. A masterful teacher and a captivating lecturer, Charcot created the foundations of neurology as an independent discipline, and transformed the Salpêtrière hospital, in Paris, into one of the world’s greatest teaching centers for clinical neurologic research. His name is attached to the distinct pathologic entity, Charcot’s joint disease, that he so meticulously described. This article reviews the highlights of Charcot’s career and his clinicoanatomic studies of patients with tabetic arthropathies. (J Am Podiatr Med Assoc 92(7): 375-380, 2002)
The Biology, Medical Management, and Podiatric Implications of Menopause
Authors: Friedlander Arthur H. , Jones Lester J.
Published: April 2014

Approximately 36 million women in the United States are in the postmenopausal phase of life, creating unique challenges for the provision of compassionate, comprehensive podiatric medical treatment. Long-term estrogen deprivation arising from menopause in association with age-related factors disproportionately increases the risk of ischemic heart disease, osteoporosis, and concomitant podiatric complications. This article discusses the physiologic basis of menopause, hormone replacement therapy and its effects on osteoporosis, and other podiatric implications of menopause. Podiatric physicians caring for larger numbers of peri- and postmenopausal women must formulate a comprehensive management plan for treating fractures that arise from a combination of estrogen-deprivation osteoporosis and abnormal foot biomechanics. (J Am Podiatr Med Assoc 92(8): 437-443, 2002)
Ultrasonographic Evaluation of Plantar Fascia Bands
Authors: Vohra Praveen K. , Kincaid Brian R. , Japour Christopher J. , Sobel Ellen
Published: April 2014

The authors measured the thickness of the medial, central, and lateral bands of the plantar fascia using ultrasonographic techniques in 109 symptomatic patients with 211 painful heels. Plantar fasciitis was diagnosed by the presence of plantar heel pain and tenderness of the plantar fascia on palpation and was correlated with plantar fascia thickness. All of the symptomatic feet had medial band tenderness, with an average thickness of 5.9 mm, 68% had central band tenderness, with an average thickness of 5.3 mm, and 26% had lateral band tenderness, with an average thickness of 4.4 mm. The average thickness of all symptomatic bands was 5.35 mm, which was significantly greater than that for all asymptomatic bands, which was 2.70 mm. There were also significant differences in the thickness of the three plantar fascia bands in symptomatic patients. A plantar fascia index was established consisting of the ratio of the mean thickness of symptomatic medial, central, and lateral plantar fascia bands to that of asymptomatic bands; for this study, the index value is 1.98 (5.35/2.70 mm). (J Am Podiatr Med Assoc 92(8): 444-449, 2002)
A Prospective Epidemiologic Survey on the Prevalence of Foot Disease in Hong Kong
Authors: Chan Michael Kam Tim , Chong Lai-Yin , _ _
Published: April 2014

A prospective epidemiologic survey on the prevalence of foot disease in Hong Kong found foot disease in 64% of patients screened. All of the patients were ethnically Chinese. Of the conditions specified in the questionnaire, fungal foot infection, tinea pedis, and toenail onychomycosis were the most frequently encountered conditions, followed by metatarsal corns, eczema, psoriasis, and pes planus. Vascular disease, osteoarticular pathology, diabetes mellitus, obesity, atopy, and participation in sports were the main factors coexisting with the foot conditions. Of the study population, 17% and 21% reported that their quality of life was affected by pain and discomfort, respectively. These percentages are much lower than those obtained in other studies; it may therefore be inferred that foot complaints are being neglected by the ethnic Chinese population in Hong Kong. (J Am Podiatr Med Assoc 92(8): 450-456, 2002)
Diabetic Limb Salvage
Authors: DeNamur Chad , Pupp Guy
Published: April 2014

In this retrospective review, 19 diabetic patients with significant lower-extremity pathology were assessed to determine the success of limb salvage in cases of varying complexity. The patients were either scheduled or at risk for below-the-knee amputation before intervention. After the limb-salvage procedure, patients were followed for 4 months to 9 years. Eighteen patients went on to have successful procedures, avoiding below-the-knee amputation; one patient had an above-the-knee amputation. The results demonstrate the benefits of an aggressive team approach with limb salvage as a goal. (J Am Podiatr Med Assoc 92(8): 457-462, 2002)
The Effects of Range-of-Motion Therapy on the Plantar Pressures of Patients with Diabetes Mellitus
Authors: Goldsmith Jon R. , Lidtke Roy H. , Shott Susan
Published: April 2014

A randomized controlled study of 19 patients with diabetes mellitus (10 men, 9 women) was undertaken to determine the effects of home exercise therapy on joint mobility and plantar pressures. Of the 19 subjects, 9 subjects performed unsupervised active and passive range-of-motion exercises of the joints in their feet. Each subject was evaluated for joint stiffness and peak plantar pressures at the beginning and conclusion of the study. After only 1 month of therapy, a statistically significant average decrease of 4.2% in peak plantar pressures was noted in the subjects performing the range-of-motion exercises. In the control group, an average increase of 4.4% in peak plantar pressures was noted. Although the joint mobility data revealed no statistically significant differences between the groups, there was a trend for a decrease in joint stiffness in the treatment group. The results of this study demonstrate that an unsupervised range-of-motion exercise program can reduce peak plantar pressures in the diabetic foot. Given that high plantar pressures have been linked to diabetic neuropathic ulceration, it may be possible to reduce the risk of such ulceration with this therapy. (J Am Podiatr Med Assoc 92(9): 483-490, 2002)
Is the Radiographic Appearance of the Hallucal Tarsometatarsal Joint Representative of Its True Anatomical Structure?
Authors: Sanicola Shawn M. , Arnold Thomas B. , Osher Lawrence
Published: April 2014

The medial cuneiforms and first metatarsals were identified in 515 randomly selected specimens at the Hamman-Todd osteology collection in the Cleveland Museum of Natural History in Cleveland, Ohio, and the transverse plane angulation of the hallucal tarsometatarsal joint was determined by direct measurement of the selected bones. Medial cuneiforms were subsequently separated into three categories corresponding to the amount of measured obliquity. The first tarsometatarsal joint was reassembled, and the paired medial cuneiforms and first metatarsals were radiographed at different declination angles in inverted, everted, and rectus positions. Radiographic evaluation revealed discordance between the appearance of atavism and true atavism in the cuneiform. Specifically, it was determined that the position of the hallucal tarsometatarsal joint significantly influenced the appearance of atavism in the cuneiform. It is concluded that the position of the first ray in an anteroposterior radiograph can produce the appearance of an increased obliquity angle of the medial cuneiform, resulting in an inaccurate representation of the hallucal tarsometatarsal joint. (J Am Podiatr Med Assoc 92(9): 491-498, 2002)
Variability of Neutral-Position Casting of the Foot
Authors: Chuter Vivienne , Payne Craig , Miller Kathryn
Published: April 2014

Neutral-position casting of the foot is used for the manufacture of functional foot orthoses, and an accurate cast is widely assumed to be a prerequisite for a good orthotic device. The primary aim of this study was to determine the variability of casting between inexperienced and experienced clinicians and the variability of one experienced clinician taking multiple casts. Ten inexperienced and ten experienced clinicians took a cast of the right foot of a single subject, and a single experienced clinician took ten casts of the same foot. The frontal plane forefoot-to-rearfoot relationship of each cast was determined, and no difference was found in the mean and variances among the three groups. The range of the forefoot-to-rearfoot relationship across all groups was from 10.0° everted to 6.5° inverted, indicating that there is a wide range in neutral-position casting of the foot. As outcome studies have reported the successful outcomes of functional foot orthoses, this wide variability may not necessarily be a problem. (J Am Podiatr Med Assoc 93(1): 1-5, 2003)
Multiple Schwannomas of the Foot
Authors: Mott Richard C. , Dellon A. Lee
Published: April 2014

Determining the appropriate treatment of a benign tumor of a peripheral nerve in the foot and ankle region presents a clinical dilemma, as resection of the tumor will cause loss of nerve function and create the possibility of a painful neuroma. Several surgical solutions to this problem were used in the care of a patient who presented with painful bilateral Morton’s neuromas and was found to have bilateral schwannomas on pathologic examination of the resected nerves. Subsequent evaluation for recurrent bilateral foot pain demonstrated multiple tumors along the tibial nerve in one foot. The patient also became aware of a painful mass on the dorsolateral aspect of one foot. Review of the treatment options for this patient with multiple schwannomas provides a framework for decision making in the care of the patient with benign neural tumors of the foot. (J Am Podiatr Med Assoc 93(1): 51-57, 2003)
The Influence of Geriatrics Education on Knowledge, Attitudes, and Career Aspirations of Podiatric Medical Students
Authors: Menz Hylton B.
Published: April 2014

A survey of podiatric medical students in Australia was undertaken prior to and following the completion of a compulsory geriatrics course to evaluate the effect of geriatrics education on knowledge of aging, attitudes toward older people, perceptions of treatment efficacy, and desire to specialize in geriatrics. Students had a reasonable knowledge of aging and favorable attitudes toward older people prior to undertaking the course, but few wanted to specialize in geriatrics. General knowledge of aging and attitudes toward older people improved after completion of the course, but career aspirations remained unchanged. Students generally considered geriatrics to be a low-profile specialty, and less than half stated that they would be interested in pursuing continuing education in geriatrics. These results provide further evidence that students’ lack of desire to specialize in geriatrics may be primarily due to limited recognition within the profession, rather than unfavorable attitudes toward older people or lack of interest in geriatrics during their undergraduate education. (J Am Podiatr Med Assoc 93(2): 124-130, 2003)
Revisiting Epinephrine in Foot Surgery
Authors: Radovic Philip , Smith Robert G. , Shumway Don
Published: April 2014

Anesthetics containing epinephrine have long been thought unsuitable for use in the foot and, particularly, the digits. However, research suggests that epinephrine use is beneficial in the appropriately selected patient. These benefits include a decreased local anesthetic plasma concentration; an increased duration of anesthesia, with a decreased need for additional narcotic use after surgery; decreased development of hemorrhage and postoperative hematoma, without occlusion of vessels; and a lack of complications (in millions of patients reported on in the literature). A retrospective review of more than 150 patients receiving local anesthetics containing epinephrine revealed no complications in the foot and ankle. (J Am Podiatr Med Assoc 93(2): 157-160, 2003)
Clinical and Biomechanical Risk Factors of Patients Diagnosed with Hallux Valgus
Authors: Kernozek Thomas W. , Elfessi Abdulaziz , Sterriker Steven
Published: April 2014

The purpose of this study was to identify the clinical and plantar loading variables related to hallux valgus. Fifty-one healthy control subjects and 40 subjects with a diagnosis of moderate hallux valgus deformity of similar age and body weight were recruited for this study. Clinical measurements of pain, first metatarsophalangeal joint range of motion, and single-leg resting calcaneal stance position were obtained. Biomechanical measurements were obtained using a capacitive pressure platform. Plantar loading variables were calculated for seven regions of the plantar surface. A univariate analysis followed by a stepwise logistic regression was used to analyze the data. The results indicated that high values for pain, single-leg resting calcaneal stance position, hallux region peak pressure and force–time integral, and central forefoot region force–time integral increased the likelihood of hallux valgus. (J Am Podiatr Med Assoc 93(2): 97-103, 2003)
Charcot-Marie-Tooth Disease and Vincristine
Authors: Orejana-García Ángel M. , Pascual-Huerta Javier , Pérez-Melero Andrés
Published: April 2014

This article reports on a case of sensorimotor neuropathy in a 55-year-old man that developed after vincristine therapy. Subsequent biopsy of the sural nerve and electromyographic studies revealed the presence of Charcot-Marie-Tooth disease. Only 17 patients who developed severe neuropathy with very low accumulated doses of vincristine have been described in the literature. Pain and lateral ankle instability were treated with a functional orthosis. Orthopedic treatment and the biomechanical basis of foot and ankle problems in patients with vincristine therapy–induced Charcot-Marie-Tooth disease are discussed. (J Am Podiatr Med Assoc 93(3): 229-233, 2003)
Plantar Fasciitis
Authors: Lemont Harvey , Ammirati Krista M. , Usen Nsima
Published: April 2014

The authors review histologic findings from 50 cases of heel spur surgery for chronic plantar fasciitis. Findings include myxoid degeneration with fragmentation and degeneration of the plantar fascia and bone marrow vascular ectasia. Histologic findings are presented to support the thesis that “plantar fasciitis” is a degenerative fasciosis without inflammation, not a fasciitis. These findings suggest that treatment regimens such as serial corticosteroid injections into the plantar fascia should be reevaluated in the absence of inflammation and in light of their potential to induce plantar fascial rupture. (J Am Podiatr Med Assoc 93(3): 234-237, 2003)
Tarsal Coalitions
Authors: Saxena Amol , Erickson Sonia
Published: April 2014

This study compares activity levels of patients with tarsal coalitions who did and did not have surgery and quantifies the return-to-activity time after tarsal coalition surgery. Thirty-one patients (mean ± SD age, 22.1 ± 11.6 years) with 39 coalitions (28 talocalcaneal, 1 complete talonavicular, and 10 calcaneonavicular) were included. The mean postoperative review time was 3 years. Fifteen patients (17 feet) who underwent resection had a mean ± SD return-to-activity time of 10.3 ± 5.8 weeks. There was no statistically significant difference in the return-to-activity time between talocalcaneal and calcaneonavicular coalitions. Thirteen patients (21 feet) quit sports; 11 (17 feet) were from the nonsurgical group. Three nonsurgical patients continued playing sports. The Fisher exact test was used to determine whether those forgoing surgery had a decreased ability to achieve desired activity levels. The correlation of surgery and failure to achieve the desired activity level was low (–0.69). Therefore, tarsal coalition excision is not correlated with failure of patients to reach desired activity levels. Patients forgoing surgery could not reach desired activity levels. Surgical excision of tarsal coalitions has a favorable outcome. (J Am Podiatr Med Assoc 93(4): 259-263, 2003)
Surgery for Chronic Achilles Tendinopathy
Authors: Saxena Amol , Cheung Steven
Published: April 2014

The authors reviewed 91 surgical procedures in 87 patients with chronic Achilles tendinopathy. There were 62 males and 25 females (mean age, 44.9 years). The average interval between surgery and review for the group was 4.2 years (range, 1 to 10 years). Twenty patients underwent peritenolysis, with a mean return-to-activity time of 7.7 weeks. Four patients with concomitant bony procedures had significantly longer return-to-activity times than 16 patients who underwent peritenolysis only. The mean return-to-activity time was 13.2 weeks in 15 patients who had Achilles debridement for mucoid degeneration, 14.4 weeks in 32 Achilles tendocalcinosis repair patients, 18.6 weeks in 24 patients who had retrocalcaneal exostectomy procedures, and 34.0 weeks in 5 patients who had chronic Achilles rupture repair. Athletic patients (n = 47) had significantly shorter return-to-activity times than active (n = 38) and sedentary (n = 6) patients. Males returned to activity faster than females. Runners returned to activity faster than other patients. (J Am Podiatr Med Assoc 93(4): 283-291, 2003)
Medial Malleolar Stress Fractures
Authors: Kor Alex , Saltzman Andrew T. , Wempe Patrick D.
Published: April 2014

Medial malleolar stress fractures are relatively uncommon injuries that can be quite debilitating and disabling. This article discusses the symptoms, diagnostic aids, pathomechanics, and management of medial malleolar stress fractures. Using three cases, the authors illustrate nonoperative versus operative treatments in an athlete and the influence of an in-season versus an off-season injury. A percutaneous cannulated screw fixation procedure is described that allowed an athlete to return to competition 24 days after sustaining a displaced medial malleolar stress fracture. (J Am Podiatr Med Assoc 93(4): 292-297, 2003)
Osteochondral Lesions of the Talus
Authors: Roach Richard
Published: April 2014

Knowledge of osteochondral lesions of the talus parallels that of similar lesions affecting the knee in many respects. Morbidity can be significant, and a variety of diagnostic and surgical techniques have been described. Although these lesions are significant for all patients, in athletic individuals they may bring about the end of their sporting careers. Fragment stability remains critical in the management of these injuries. With advances in diagnostic methods and further specialization in arthroscopy, outcomes will continue to improve. (J Am Podiatr Med Assoc 93(4): 307-311, 2003)
Athletic Injuries of the First Metatarsophalangeal Joint
Authors: Kubitz Eugene R.
Published: April 2014

Turf-toe injuries can occur in many athletic endeavors. This article describes the different injuries that occur to the first metatarsophalangeal joint that may be termed “turf toe.” These injuries may result in significant morbidity. Thus proper diagnosis is paramount for instituting appropriate treatment to facilitate an athlete’s prompt return to the playing field. Two case studies are presented to illustrate injuries of the first metatarsophalangeal joint in the athletic population. (J Am Podiatr Med Assoc 93(4): 325-332, 2003)
Syndesmotic Rupture Without Ankle Fracture
Authors: Endean Ty , King Warren , Martin H. Rod
Published: April 2014

Two patients with syndesmotic rupture without fracture are presented to demonstrate that ligamentous injury to the distal syndesmosis can occur as an isolated injury. In both cases diagnosis was delayed owing to a negative radiograph on the day of injury. Comprehensive follow-up is imperative to correctly diagnose this injury pattern. (J Am Podiatr Med Assoc 93(4): 336-339, 2003)
Reliability of Clinical Tests of Foot and Ankle Characteristics in Older People
Authors: Menz Hylton B. , Tiedemann Anne , Kwan Marcella Mun-San , Latt Mark Dominic , Sherrington Catherine , Lord Stephen R.
Published: April 2014

Lower-extremity problems are common in older people; however, the reliability of clinical tools used to assess foot and ankle characteristics has not been rigorously evaluated. This study evaluated the test–retest reliability of a battery of simple clinical tests of foot and ankle characteristics (tactile sensitivity of the first metatarsophalangeal joint, navicular height, foot length and width, hallux valgus severity, an overall foot problem score, ankle flexibility, ankle dorsiflexion strength, and foot pain) in 31 individuals (13 men and 18 women) aged 76 to 87 years recruited from the community. Three examiners performed the tests on two occasions approximately 2 weeks apart. Intraclass correlation coefficients and coefficients of variation were calculated for continuously scored tests, and the kappa statistic (κ) was used to determine the reliability of hallux valgus severity grading. All of the continuously scored tests had acceptable reliability (intraclass correlation coefficients of 0.64 to 0.98; coefficients of variation of 0.6% to 15.0%), as did hallux valgus severity grading (κ = 0.77; absolute percentage agreement, 84%). These simple clinical tests can now be used with confidence in clinical and research settings to provide reliable and functionally important information regarding foot and ankle characteristics in older people. (J Am Podiatr Med Assoc 93(5): 380-387, 2003)