bluuebunny/crossref_metadata_2025 huggingface dataset:
Vascular decompression. The critical element in forefoot crush injury
Authors: Corey SV , Cicchinelli LD , Pitts TE
Published: April 2014

The authors present an overview of post-traumatic foot compartment syndrome with an emphasis on the importance of relieving vascular compromise immediately. The incisional approach selected should not only effectively decompress the foot, but also allow for repair of concomitant osseous and soft tissue injury as well. Vascular considerations may dictate the course of simultaneous fracture management.
Bilateral osteochondritis dissecans of the first metatarsophalangeal joint
Authors: Camasta CA , Pitts TE , Corey SV
Published: April 2014

The authors present a review of the literature concerning the pathogenesis, diagnosis, and treatment of osteochondral defects of the lower extremity. A case of bilateral osteochondritis dissecans of the first metatarsophalangeal joint in a 43-year-old female is presented, including surgical treatment with 1- and 3-year follow-up examinations. The correlation between articular damage to the first metatarsal head and concomitant hallux limitus and hallux rigidus is discussed. The authors also propose that osteochondritis dissecans lesions almost always occur on the convex surface of a joint because of a convergence of impaction forces.
Podiatric medical students' views toward geriatrics and elderly patients. A preliminary study
Authors: Chumbler NR , Robbins JM
Published: April 2014

This study examines podiatric medical students' perceptions toward podiatric medicine, their impressions of their geriatric training, and their attitudes toward treating elderly patients. A questionnaire was distributed to a random sample of 240 podiatric medical students at the Ohio College of Podiatric Medicine. The survey response rate was 57.1%. In general, the podiatric medical students were satisfied with their geriatric training; however, they believed that more geriatric training is needed. Podiatric medical students who entered podiatric medicine for intrinsic reasons, who visited their grandparents frequently, and who had close relationships with them while growing up, had favorable impressions toward geriatric patients. Furthermore, those who have had good geriatric instruction are more likely to have favorable impressions of geriatric patients.
Foot care data from two recent nationwide surveys. A comparative analysis
Authors: Greenberg L
Published: April 2014

On the issues of incidence and prevalence: Specific Foot Problems. At the national level, ie, all respondents combined, the agreement between the NHIS and BrimmComm findings is remarkably close. Much of the difference, if not all, is believed explainable by the approximately 5% shortfall in the reported rate of problems associated with individuals who failed or refused to report their income. Where there are major differences between the NHIS and BrimmComm findings, they occur chiefly when the data are disaggregated by sex, age, or income. Technically speaking, the differences are in most cases statistically insignificant because of the generally small sample sizes associated with individual population segments in the BrimmComm survey. Injuries. Although the differences here are somewhat greater than they are for other foot problems, this may be the result of the greater emphasis being placed in the BrimmComm survey (as opposed to the NHIS) on the reporting of injuries. On the issue of utilization: Basic Treatment Patterns. Nothing in the BrimmComm data refutes the observation that podiatrists remain the provider of choice for toenail problems, corns and calluses, and bunions, and are a strong second to MDs for the treatment of foot infections. Overall Number of Visits. The BrimmComm data would indicate a total of 41.4 million visits involving patients 18 years and older in a period of 12 months. Following technical adjustments described in the text (including augmentation to include patients 17 years of age or younger), the total number of visits to podiatrists in 1990 involving civilian noninstitutionalized patients is believed to be in the vicinity of 50 million.(ABSTRACT TRUNCATED AT 250 WORDS)
Primary bone tumors of the talus
Authors: Dhillon MS , Singh B , Singh DP , Prabhu V , Nagi ON
Published: April 2014

A review of 12 cases of bony tumors involving the talus is presented. Giant cell tumor was the most common tumor. Malignant tumors should be treated by surgical ablation followed by chemotherapy. There are good results after excision or curettage and bone grafting in the treatment of benign neoplasms. Giant cell tumors, if diagnosed early, can be treated by curettage and bone grafting, but if there is talar collapse, a talectomy can be performed.
Nutrition and wound healing
Authors: Mazzotta MY
Published: April 2014

Proper nutrition in presurgical patients can enhance wound healing and potentially decrease the cost of postsurgical medical care. Therefore, to combat increasing health care costs, it is important that the health care professional have a solid understanding of the role of essential nutrients in the healing process. The author reviews the role of the following in wound healing: protein, vitamin A, zinc, vitamin C, vitamin E, and iron.
Unilobed and bilobed skin flaps. Detailed surgical technique for plantar lesions
Authors: Bouch√© RT , Christensen JC , Hale DS
Published: April 2014

The authors provide a detailed description of effective surgical techniques for painful plantar skin lesions of the foot that are not amenable to simple excisional procedures. Modified unilobed and bilobed skin flaps are described, emphasizing step-by-step design and procedure performance. These advanced techniques offer numerous advantages over other excisional and flap methods, such as being reproducible and yielding predictable results.
1995 William J. Stickel Bronze Award. Prevalence of mixed infections in the diabetic pedal wound. A retrospective review of 112 infections
Authors: Armstrong DG , Liswood PJ , Todd WF
Published: April 2014

This retrospective study reviewed the culture results of 112 admissions to a multidisciplinary diabetic foot care team with a primary diagnosis of infected diabetic pedal ulceration. An average of 1.5 +/- 0.9 species per patient (P < 0.0001) were isolated. Eighty-nine percent of wounds cultured grew two or fewer organisms. Anaerobic species were isolated in only 5% of all cultures. Of these isolates, the distinction between anaerobic colonization and true anaerobic infection is made. Results suggest that aggressive early hospitalization, coupled with aggressive intraoperative debridement, may yield less microbiologically complex infections that may be controlled with less expensive narrow spectrum antibiotic therapy. Diagnosis of the infected pedal ulceration of a patient with diabetes is a clinical one. If this diagnosis is combined with appropriate surgical intervention, microbiologic correlation, and antimicrobial therapy, the result may be a less complex hospital course and improved outcome.
Incurvated nail. Does the phalanx determine nail plate shape?
Authors: Parrinello JF , Japour CJ , Dykyj D
Published: April 2014

This study examines the relationship between the shape of the nail plate of the hallux and the base of its distal phalanx. Twenty-three cadaver specimens were examined anatomically for nine variables. These variables represented the following: height and width of the distal phalanx base; height and width of the proximal aspect of the nail plate; distal shape of the nail plate; ratio of the nail plate height and width and structural index of the nail plate. Statistics for the variables are presented using correlation coefficients between nail structural index and bone structural index. The study shows a high and significant correlation between the shape of the proximal aspect of the nail plate and that of the phalangeal base.
Candida albicans, the opportunist. A cellular and molecular perspective
Authors: Dupont PF
Published: April 2014

Candida albicans causes the majority of opportunistic fungal infections. The yeast's commensualistic relationship with humans enables it, when environmental conditions are favorable, to multiply and replace much of the normal flora. Virulence factors of C. albicans, enabling the organism to adhere to and penetrate host tissues, involve specific molecular interactions between the cells of the fungus and the host. Localized disease, such as oral candidiasis, onychomycosis, and vaginitis, results. These infections are usually limited to surfaces of the host, and can be quickly and successfully controlled by the use of one of the available antifungal agents. Candida albicans infections typically become systemic and life threatening when the host is immunocompromised. Depending on the immune defect in the host, one of the spectrum of Candida diseases can develop. If successful treatment of these patients is to be achieved, modulation of the immune deficit, as well as the use of an appropriate antifungal drug, must become a routine part of therapeutic interventions.
Tuberculosis of the foot. A diagnostic challenge
Authors: Sobel E , Levitz S
Published: April 2014

Two cases of tuberculosis of the foot are described. The diagnosis for each was delayed and unexpected. The clinical features of osteoarticular tuberculosis are reviewed along with practical guidelines for diagnosis.
Tips for testifying
Authors: Hoover AL
Published: April 2014

The author offers practical suggestions for the witness to help improve effectiveness without compromising truthfulness when testifying in depositions and trial. The guidelines are designed to reduce the podiatrist's apprehension when venturing into the legal arena and to serve as resource material.
Motion of the first metatarsophalangeal joint. Reliability and validity of four measurement techniques
Authors: Hopson MM , McPoil TG , Cornwall MW
Published: April 2014

The purpose of this study was to first determine the intra-rater reliability of four different static measurement procedures used to assess first metatarsophalangeal joint extension range of motion and, second, determine which of the four static procedures provided a valid measure of the amount of first metatarsophalangeal joint extension required for normal walking. Twenty healthy adult subjects between the ages of 21 and 43 years participated in the study. Four static techniques were evaluated and dynamic first metatarsophalangeal joint extension was also determined from video recordings during walking. The results indicate that 1) all static measurement techniques were reliable; 2) the degree of first metatarsophalangeal joint extension obtained for each of the four static measurement techniques exceeded the amount of first metatarsophalangeal joint extension required for walking; 3) although each of the static measurement techniques was reliable, they should not be considered interchangeable; and 4) approximately 65 degrees of first metatarsophalangeal joint extension are required for normal walking.
Superficial white onychomycosis
Authors: Bodman MA , Brlan MR
Published: April 2014

A study on the incidence and causative organisms of pedal superficial white onychomycosis within several patient populations is presented. Early recognition, debridement, and topical antifungal therapy for several weeks with attention to biomechanical factors should resolve the infection and prevent progression to a more destructive form of onychomycosis.
Comparison of rearfoot motion in overground versus treadmill walking
Authors: Lemke K , Cornwall MW , McPoil TG , Schuit D
Published: April 2014

The purpose of this study was to determine whether walking on a treadmill is a valid simulator of overground walking with respect to rearfoot motion. The tibial, calcaneal, and rearfoot motions of 10 subjects (2 males, 8 females) were videotaped while they walked on a treadmill and overground. The results of a series of t-tests showed that there was no statistically significant difference between the two conditions on any of the variables measured.
Chromoblastomycosis. A fungal infection primarily observed in the lower extremity
Authors: Burks JB , Wakabongo M , McGinnis MR
Published: April 2014

Chromoblastomycosis is a cutaneous-subcutaneous fungal infection that is being seen more frequently in patients living in the US. The disease normally occurs in patients living in tropical and subtropical regions, but as the number of immigrants into the US increases, podiatrists must be able to recognize the manifestations of chromoblastomycosis. The most common sight involved is the lower extremity where it easily can be confused with other diseases such as tertiary syphilis, phaeohyphomycosis, and cutaneous tuberculosis, among others. Small lesions should be excised, while antifungal drugs, such as itraconazole, should be used when more tissue is involved.
Ankle equinus. Prevalence and linkage to common foot pathology
Authors: Hill RS
Published: April 2014

One hundred seventy-six of 209 consecutive new patients were examined over a 6-week period for the presence or absence of equinus deformity in the course of their workup for their primary complaint. Of the patients examined, 96.5% exhibited restricted ankle dorsiflexion requiring compensation during gait. Foot complaints were categorized into medial, lateral, and rearfoot problems. The high incidence of equinus reflects "acquired deformity" related to factors of lifestyle that leave the posterior muscles at a physiologic disadvantage toward maintaining flexibility. There is a significant relation between compensation for ankle equinus and podiatric pathology. More attention should be directed at the evaluation of ankle range of motion during examination of common foot problems. Gastrosoleal stretching is an important treatment modality that can lead to a higher success rate of conservative treatment. It can decrease the need for foot surgery, and significantly reduce the number of failed or serial surgical procedures.
Electronmicroscopic diagnosis of human papilloma virus in verruca plantaris
Authors: Johnston FE , Meek WD , Henderson DA , McCosh J
Published: April 2014

The purpose of this study was to identify the human papilloma virus in verruca plantaris by transmission electron microscopy and study the cellular effect of human papilloma virus at both the transmission electron microscopy and light histochemistry level. The authors discuss the cellular pathology in relation to early studies and keratin disorders. Features identified by transmission electron microscopy are consistent with characteristics of human papilloma virus-1.
Skin burns from prolonged exposure to wet cement
Authors: Kelsey R , Alvey T
Published: April 2014

A review and typical case history of a patient with skin burns caused by prolonged exposure to wet cement was presented. This case is similar to other reported cases in the length of exposure, prolonged healing time, and typical scar formation. Burns from prolonged exposure to wet cement can result in potentially devastating long-term sequelae. The dermatologic hazards of wet cement are well recognized; however, many patients have suffered cement burns from working in wet cement. Product education and proper protection appear to be the best preventive measures.
Guide to medications used to treat acquired immune deficiency syndrome
Authors: Rooney MD
Published: April 2014

Currently, there is no means to eradicate the human immunodeficiency virus (HIV) from the human body. Thus, drug therapy provides an important mechanism to slow viral replication and its damaging effects on the body. A review of the drugs used in the care of the patient with acquired immune deficiency syndrome (AIDS) is provided, which highlights the significant adverse reactions and interactions associated with their use.
AIDS and the podiatric medical practice
Authors: Tinkle JD
Published: April 2014

The number of patients with HIV (human immunodeficiency virus) and AIDS (acquired immune deficiency syndrome) has increased to the point that every podiatric physician in this country will be treating patients who are HIV positive, knowingly or not. Podiatric physicians continue to be part of the medical team that must bear responsibility for the rapid changes in HIV education. Attention must be focused on educating physicians about all aspects of this disease, especially the primary and secondary diseases of AIDS and new treatments and their side effects. Sterile technique and universal precautions have now taken on new importance.
Guidelines for the prevention of HIV transmission in the podiatric medical practice
Authors: Cope R
Published: April 2014

The incidence of human immunodeficiency virus (HIV) infection in the US has increased over the past decade. This increase has effected concern regarding the risks of HIV infection within the podiatric medical practice. Implementation of an effective infection control program for blood-borne pathogens within the podiatric medical practice can minimize such risks.
Foot type biomechanics. comparison of planus and rectus foot types
Authors: Song J , Hillstrom HJ , Secord D , Levitt J
Published: April 2014

The basic premise central to the diagnosis and treatment of most mechanogenic foot and ankle pathologies is that a given foot will display a characteristic function depending on the biomechanical alignment of the hindfoot and forefoot. However, the effects of foot type on an individual's ability to perform comfortable cadence locomotion have not been scientifically proven. Therefore, this study was conducted on 21 healthy, young subjects (10 subjects with planus foot type and 11 subjects with rectus foot type) to test whether different foot types yield distinguishable foot functions. New methods were developed to quantify biomechanical foot function during posture and comfortable cadence locomotion. The results of the study indicate that individuals with planus and rectus foot types show statistically significant differences in the biomechanical function of the foot.
Clinical applications of three-dimensional magnetic resonance image analysis
Authors: Bauer GR , Hillstrom HJ , Udupa JK , Hirsch BE
Published: April 2014

A methodology for measuring the kinematic parameters of joints in vivo has been refined using the technique of computerized three-dimensional reconstruction from magnetic resonance images. A research protocol has been developed to establish a classification of normal and pathologic foot function that will have broad clinical application. Development of algorithms for a computer-directed program that can predict resultant kinematics and joint morphometry for a given osteotomy or osseous remodeling procedure will assist the surgeon in preoperative surgical planning.
Study of ten anatomical variants of the foot and ankle
Authors: Chaney DM , Lee MS , Khan MA , Krueger WA , Mandracchia VJ , Yoho RM
Published: April 2014

This study examined the occurrence rate of ten lower extremity anatomical variants occurring over a 6-year period from 1988 to 1994 in a sample range of 166 to 279 cadavers at the University of Osteopathic Medicine and Health Sciences. Literature review of these anomalies shows similar findings for all presented structures with the exception of two. The peroneus quartus muscle was found to be significantly less prevalent than previous studies have indicated. This difference may be attributed to the larger sample size used in this study or differences of interpretation of the definition of the peroneus quartus muscle. Additionally, the flexor digitorum brevis tendon to the fifth digit was found to be absent much more than Sarrafian reports in a total sample size of 926. The importance of these anatomical variants, both in surgery and while using advanced diagnostic imaging such as computed tomography and magnetic resonance imaging, should be realized by the podiatric physician. Awareness of these variants will decrease confusion when considering treatment options.
Alterations in glomerular permeability in streptozotocin-induced diabetic rats
Authors: Boyd RB , Thompson VW , Atkin J
Published: April 2014

The alteration in glomerular basement membrane permeability associated with microangiopathy in streptozotocin-induced diabetic rats was studied by determining the movement across the glomerular basement membrane of anionic ferritin probes injected into rats at different points in the development of the disease. Visualization of the concentration gradient of anionic ferritin and changes in ultrastructure was accomplished by electron microscopic examination of renal tissue prepared from both control and diabetic rats. In all control rats, the anionic ferritin did not leave the glomerular capillary lumen, nor were there any changes in the normal morphology of the glomerular capillary wall. In the diabetic animals, the concentration of anionic ferritin shifted from the capillary lumen in the abluminal direction. Distinct morphologic changes, such as widening of endothelial intercellular junctions, focal detachment of podocyte foot processes, and extensive thickening of the glomerular basement membrane, were noted in the diabetic rat, and these changes appear to correlate with the observed increase in permselectivity of anionic ferritin across the glomerular capillary wall.
Tailor's bunion. Is fixation necessary?
Authors: Pontious J , Brook JW , Hillstrom HJ
Published: April 2014

Tailor's bunion or bunionette are terms that describe a pathologic enlargement occurring laterally on the fifth metatarsophalangeal joint. Regardless of the etiology that precipitates the deformity, the resulting abnormal protrusion of soft tissue or bone can result in pain for the patient. Symptoms can range from mild discomfort to severe, debilitating pain. The patient may present with pain dorsolaterally, laterally, or plantarly. The symptoms are mechanically induced, and are often associated with hyperkeratotic lesions and adventitious bursae. Patients complain most often that they cannot find comfortable shoes. The authors compare the effectiveness of fixated versus nonfixated distal osteotomies of the fifth metatarsal for the correction of tailor's bunion. This study shows that fixation can help control postoperative dorsal displacement of the fifth metatarsal capital fragment (p < 0.0001) and produce less shortening of the metatarsal resulting in fewer complications.
Analysis of risk factors for neuropathic foot ulceration in diabetes mellitus
Authors: Bennett PJ , Stocks AE , Whittam DJ
Published: April 2014

Diabetes mellitus affects about one in 25 Australians. Neuropathic foot ulceration is a frequent complication in persons with diabetes. This study evaluates the importance of different risk factors for the development of this condition. The role of nonenzymatic glycosylation and pressure beneath the sole of the foot in the pathogenesis of neuropathic foot ulcers was investigated. Twenty-seven subjects with diabetes with a recent history of neuropathic foot ulceration were matched by age and sex with a group of 50 control subjects without neuropathy or history of foot ulceration. The degree of nonenzymatic glycosylation was assessed by analyzing the average level of glycosylated hemoglobin in the 3 years prior to the development of the foot ulcer and a goniometer assessment of peripheral joint (hand and ankle) flexibility. Dynamic pressure of the plantar aspect of the foot was recorded using a Musgrave Footprint System pedobarograph during a normal gait cycle. There was no significant difference in age, sex, body mass index, and duration or type of diabetes between the ulcer and control groups. The pressure of the plantar aspect of the foot was significantly elevated (p < 0.01). Ankle joint flexibility was reduced (p < 0.01) in cases with neuropathic foot ulceration compared with the control group. There was a trend toward elevation of glycosylated hemoglobin (HbA1c fraction) or HbA1c in the ulcer group (p = 0.06). The results suggested that nonenzymatic glycosylation occurs at a more significant level in patients with diabetes with a history of neuropathic foot ulceration.
Prevention of lower limb pain in soldiers using shock-absorbing orthotic inserts
Authors: Sherman RA , Karstetter KW , May H , Woerman AL
Published: April 2014

The utility of shock-absorbing boot and sneaker inserts for reducing the occurrence of lower limb pain among male US Army basic trainees was evaluated. Every other training unit was given inserts. The inserts were issued prior to the start of training when combat boots and sneakers were fitted. According to post-training questionnaires and the participants' medical records, the inserts did not have any preventive effect on occurrence of lower limb problems during training. Five hundred seventeen trainees were issued inserts, 397 were followed but not issued inserts, and 218 were not issued but purchased them on their own. Thirty-eight percent of those issued inserts had lower limb pain problems compared with 29% of those not issued inserts and 38% of those who bought their own. There was no statistical difference between these rates of occurrence. Prior to training, there were minor differences between the groups' scores on physical fitness test scores and run times. These differences disappeared during training so that there were no differences among the groups on either training or clinical variables during or after basic training.
Painful os cuboideum secundarium. Cross-sectional imaging findings
Authors: Logan PM , Connell DG , Janzen DL
Published: April 2014

The authors presented the computed tomography and magnetic resonance imaging appearances of a painful os cuboideum secundarium. To the authors' knowledge, this is the first report of the cross-sectional imaging appearance of this condition, and serves to underline the utility of computed tomography and magnetic resonance imaging in the investigation of foot pain.
Pedal manifestations of meningococcal septicemia
Authors: Welchon JG , Armstrong DG , Harkless LB
Published: April 2014

While there have been several reports of upper and lower extremity amputations secondary to meningitis and purpura fulminans in the literature, the incidence is probably rare. Delmas et al studied five pediatric subjects with gangrene caused by meningococcemia, with four requiring amputation. Weiner reported that all 12 patients in his review received a lower extremity amputation, with several requiring upper extremity amputation. Joint contracture, while not as commonly discussed as amputation, is nonetheless an important and perhaps more common finding. Urbaniak et al indicated that of six patients reviewed, three developed significant joint contractures. With the exception of the gangrenous changes discussed, it was joint contracture that was the most limiting factor in progression to full activity and weightbearing in the authors' subject. Prompt, aggressive physical therapy is tantamount to effecting an acceptable long-term outcome.
Longitudinal epiphyseal bracket: associated foot deformities with implications for treatment
Authors: Sobel E , Levitz S , Cohen R , Giorgini R , Jules KT
Published: April 2014

The longitudinal epiphyseal bracket is a rare ossification defect of bones of the hands and feet and results in an abnormal epiphysis that is C-shaped, longitudinally oriented, and vertically extends into the diaphysis. The longitudinal epiphyseal bracket may exist as an isolated deformity, but is commonly associated with digital deformities such as polydactyly, duplicated digits, congenital hallux varus, and clinodactyly. Five case histories of children with the longitudinal epiphyseal bracket in different bones of the foot are described with three distinct clinical presentations. The development of the longitudinal epiphyseal bracket and implications for treatment are considered.
Use of the Cam Walker in treating diabetic ulcers. A case report
Authors: Ritz G , Rowland WD , Rowland JW
Published: April 2014

This case study shows how a Cam Walker when equipped with an arch filler can be another tool the physician may use to help heal diabetic ulcerations. Even after other methods of conservative care have failed, the Cam Walker with an arch filler has been shown to gradually decrease and heal diabetic ulcerations on the plantar aspect of the foot. It accomplishes this by decreasing the pressure on the ulcerative areas and by decreasing the velocity with which the foot strikes the ground.
Mycobacterial skeletal infection of the foot. A case report
Authors: Nicklas BJ , Osher L , Latta DK
Published: April 2014

Peripheral skeletal infections caused by Mycobacterium are widely reported in the literature. Unfamiliarity with this disease, or oversight caused by inexperience may result in failure to thoroughly investigate the presence of this organism. An unusual case of tuberculous osteomyelitis involving the second digit of the foot is presented. The authors emphasize the importance of including cultures of acid-fast bacillus in the work-up of atypical infectious processes of the foot and ankle, and include Mycobacterium in their differential until it is positively ruled out. An in-depth radiologic review is included.
Treatment-based classification system for assessment and care of diabetic feet
Authors: Armstrong DG , Lavery LA , Harkless LB
Published: April 2014

Appropriate care of feet of patients with diabetes requires a clear, descriptive classification system that may be used to direct appropriate therapy and possibly predict outcome. Ideally, this system would be used by all participants in a multidisciplinary limb-salvage team. The authors report on a logical, treatment-oriented system that may improve communication, leading to a less complex, more predictable treatment course and, ultimately, an improved result.
Validating the process of taking lateral foot x-rays
Authors: Perlman PR , Dubois P , Siskind V
Published: April 2014

This study validates the concept that a standard (static) weightbearing lateral x-ray, taken with an orthoposer device, in the patient's angle and base of gait is clinically similar to findings seen during ambulatory (dynamic) gait. Sixty female subjects requiring diagnostic x-rays underwent videofluoroscopy of their walking gait. Using a single-frame, shuttle-advance video recorder, the appropriate fluoroscopic video frame was identified. The calcaneal pitch angle was measured using a digitized program. A high repeatability of the measuring process and high correlation between x-ray and fluoroscopic results suggest the value of taking weightbearing angle and base of gait lateral x-rays.
Changes in the calcaneal pitch during stance phase of gait. A fluoroscopic analysis
Authors: Perlman PR , Siskind V , Jorgensen A , Wearing S , Squires S
Published: April 2014

Calcaneal pitch has been considered to be an indirect measure of subtalar joint function. The aim of this pilot study was to assess changes in the calcaneal pitch angle during dynamic gait. Sixty female subjects underwent videofluoroscopy to obtain 27 usable gait cycle data. A single-frame, shuttle-advance video recorder was used to identify midstance of the gait cycle. The calcaneal pitch angle was measured during three midstance periods. The study confirms findings from video and forceplate analysis and reintroduces videofluoroscopy as a gait research tool.
Review of the effect of fixation on complication rate in the base wedge osteotomy
Authors: Higgins KR , Shebetka KA , Lavery LA
Published: April 2014

The complications of elevation and shortening in the oblique closing base wedge osteotomy of the first metatarsal fixated with either a single AO screw or two 0.062 Kirschner wires were compared. Thirty-three consecutive oblique closing base wedge osteotomies of the first metatarsal bone are evaluated. With the exception of fixation, which is examined as an independent variable, the patients are managed identically with respect to osteotomy technique and postoperative care. The Reese osteotomy guide is used to normalize osteotomy configuration. The authors found no difference in elevation or shortening when comparing an AO screw with 0.062 Kirschner wire fixation. When other variables are controlled, fixation type does not lead to a statistical difference in elevation or shortening.
Podiatric educational enhancement project. A project overview
Authors: Curry L
Published: April 2014

Commitment to steady, adaptive improvement in podiatric medical professionals has taken shape in the Podiatric Educational Enhancement Project. This project involves wide representation from all interests, aspects, and constituencies in the profession to study opportunities and develop consensus on both small and large enhancements possible in the continuum of podiatric medical education. More than 1,300 podiatric physicians have contributed information and expertise, and more will be involved as the project develops during the next 18 months.
Marching band injuries. A one-season survey of the University of Michigan Marching Band
Authors: Mehler AS , Brink DS , Eickmeier KM , Hesse DF , McGuire JW
Published: April 2014

Clinical data were collected on injury occurrence to members of the University of Michigan Marching Band over the course of one season including a bowl game appearance. Band members were asked to fill out forms at the time of injury to gather pertinent information. The majority of the injuries were self-limiting. Included in this study was a total of 179 injuries, of which 153 (85.5%) involved the lower extremities. The authors provided a one-season injury survey of a collegiate marching band and made recommendations that may help to reduce and prevent future band-related injuries.
Effect of persistent toe walking on ankle equinus. Analysis of 60 idiopathic toe walkers
Authors: Sobel E , Caselli MA , Velez Z
Published: April 2014

Sixty idiopathic toe walkers (age range 1 to 15 years) were evaluated to determine the natural history of toe-to-toe gait and the relationship between the range of ankle dorsiflexion and increasing age. The majority of toe walkers had a normal birth weight (average 7.06 pounds), walked on time (average 11.14 months), began toe walking immediately (87%), stood plantigrade (90%), were able to demonstrate a heel-toe gait (88%), and toe walked intermittently (68%). Forty-six percent of all toe walkers were found to have 0 degree or less of passive ankle dorsiflexion. Equinus toe walkers (mean dorsiflexion -5.2 degrees) had significantly less dorsiflexion than the remaining toe walkers (mean dorsiflexion 16.9 degrees; p < 0.01). An average of 12 degrees of dorsiflexion was resent in the 1-to 2-year age group, which gradually diminished to -4 degrees in the 6- to 15-year age group. It appears that there may be a relationship between persistent toe walking and the development of ankle equinus in some children and therefore interventions should be considered to inhibit the toe walking progression.
Reappraisal of the negative impression cast and the subtalar joint neutral position
Authors: Sobel E , Levitz SJ
Published: April 2014

For many years, podiatric physicians have been casting orthotic devices with the foot placed in the subtalar joint neutral position based on work by Root et al. Recent research pertaining to the subtalar joint neutral position during the gait cycle is in disagreement with the theory of Root et al and the inverted subtalar joint neutral casting technique. The current research and a historical perspective of casting techniques will be reviewed to help clarify terminology and to decipher the relationship between the rearfoot position during the gait cycle and casting technique.
Lower extremity injuries at the New York City Marathon
Authors: Caselli MA , Longobardi SJ
Published: April 2014

The purpose of this study was to determine the type and frequency of lower extremity running injuries incurred by athletes participating in the New York City Marathon. A survey was conducted of 265 athletes presenting to medical stations for podiatric care during the 1994 New York City Marathon. The results of the survey indicated that the most common injuries occurring in marathon runners were corns, calluses, blisters, muscle cramps, acute knee and ankle injuries, plantar fasciitis, and metatarsalgia. An inverse relationship was observed between the number of miles trained per week and the number of injuries. These findings are consistent with long-term studies of running injuries.
Comparison of Viscoped and PORON for painful submetatarsal hyperkeratotic lesions
Authors: Caselli MA , Levitz SJ , Clark N , Lazarus S , Velez Z , Venegas L
Published: April 2014

A clinical study was performed to evaluate the efficacy of the Viscoped Insole as compared with an 1/8-inch PORON medical materials insole in the treatment of lesser submetatarsal hyperkeratotic callosities. Thirty-five patients, ranging in age from 23 through 61 years (average 42 years) were randomly divided into three groups. All three groups initially had debridement of their submetatarsal callosities. In addition to the debridement, the first group (16 patients) wore a Viscoped Insole for 4 weeks. The patients in the second group wore a PORON insole for 4 weeks. The third group did not receive an insole after their debridement and served as the control. There was a significant improvement in the Viscoped group and the PORON group versus the control group (x2 = 40; p < 0.01) as measured by the foot function index. Insole therapy combined with debridement for submetatarsal hyperkeratoses is more effective than debridement alone.
Traditional approaches to treatment of onychomycosis
Authors: Markinson BC , Monter SI , Cabrera G
Published: April 2014

The authors discuss the traditional approaches to treatment of onychomycosis in podiatric medicine: debridement, traditional oral agents, and topical medication. Although the newer systemic antifungal agents have proven to be both safe and effective, many podiatric physicians believe that for many patients, it is better to treat in a conservative manner.
Possible drug interactions in oral treatment of onychomycosis
Authors: Katz HI
Published: April 2014

A variety of medications may interact with oral antifungal agents used to treat onychomycosis. This article summarizes some possible consequences of concurrent administration of various therapeutic agents with the oral antifungals fluconazole, griseofulvin, itraconazole, ketoconazole, and terbinafine.
Drop foot as a complication of acupuncture injury and intragluteal injection
Authors: Sobel E , Huang EY , Wieting CB
Published: April 2014

Two cases of peroneal nerve palsy resulting in drop foot are reported. One case involves direct injury to the common peroneal nerve by an acupuncture needle. A second case describes sciatic nerve injury caused by an intragluteal injection. Although acupuncture injury at the spinal cord level and the peripheral nerves of the upper extremity has been documented, peroneal nerve palsy resulting from acupuncture therapy has not been previously reported.
Cauda equina syndrome resulting in late sequela of calcaneal gait and neuropathic heel ulcer
Authors: Ward K , Sobel E , Kosinski MA
Published: April 2014

The case of a 27-year-old female, 5 years after a motor vehicle accident that resulted in spinal cord damage, is reviewed. She progressed well after her accident for 4 years, at which time she developed a neuropathic heel ulceration, aggravated by her calcaneal gait and pregnancy weight gain. The rarity of such a case involving neuropathic ulceration and calcaneal gait after partial deficit of cauda equina function prompted this article.
Nonossifying fibroma. Four cases and review of the literature
Authors: Glockenberg A , Sobel E , No√´l JF
Published: April 2014

Nonossifying fibroma is a benign, lytic lesion that occurs in young children and adolescents. Radiographically, the lesion is multilocular and sharply demarcated. It often occurs at the metaphyseal region of long bones of the lower extremity and is usually eccentrically located. Four cases of nonossifying fibroma occurring during the past 7 years are presented with a review of the literature.
Nineteen-year-old female with unilateral ankle pain. What is your diagnosis?
Authors: Sobel E , Kosinski MA , Lehman TJ
Published: April 2014

The case history of a 19-year-old female with left ankle pain of 18 months' duration is presented. The reader is encouraged to make his or her own diagnosis after reviewing the history, laboratory values, and imaging. The final diagnosis with a full explanation and differential diagnosis will follow.
Iatrogenic metatarsus primus elevatus. Etiology, evaluation, and surgical management
Authors: Cicchinelli LD , Camasta CA , McGlamry ED
Published: April 2014

Iatrogenic metatarsus primus elevatus is an infrequent but devastating complication of first ray surgery. The authors address their clinical and radiographic evaluation of metatarsus primus elevatus, and describe a surgical treatment with emphasis on the sagittal plane Z-osteotomy. This osteotomy provides predictable and versatile correction for the treatment of iatrogenic deformities of the first metatarsal. It allows for plantarflexion and lengthening of the first metatarsal while avoiding an interpositional bone graft. The technical aspects of the procedure are thoroughly discussed.
Shortening of the first metatarsal following closing base wedge osteotomy
Authors: Banks AS , Cargill RS , Carter S , Ruch JA
Published: April 2014

Shortening of the first metatarsal has been one of the reported complications noted in association with base osteotomies. Previous studies have used radiographs as a means of assessing metatarsal length, the reliability of which has been subject to question. In this study, the authors have determined the amount of shortening that may be anticipated with a closing base wedge osteotomy of the first metatarsal through an experimental model. A mathematical model was also devised that confirmed these findings. Additional studies were performed to determine what influences other variables may have on this procedure.
Guillain-Barr√© syndrome. Review and presentation of a case with pedal manifestations
Authors: Viegas GV
Published: April 2014

Guillan-Barr√© syndrome is an acute, symmetrical polyneuropathy with distinctive features. The early clinical course involves painful paresthesia that is usually followed by proximal motor weakness. Albuminocytologic dissociation in the cerebrospinal fluid is considered diagnostically important. Therapy ranges from supportive measures including physical therapy to surgical intervention for residual deformities. A case with pedal manifestations is presented.
Novel methodology to obtain salient biomechanical characteristics of insole materials
Authors: Lavery LA , Vela SA , Ashry HR , Lanctot DR , Athanasiou KA
Published: April 2014

Viscoelastic inserts are commonly used as artificial shock absorbers to prevent neuropathic foot ulcerations by decreasing pressure on the sole of the foot. Unfortunately, there is little scientific information available to guide physicians in the selection of appropriate insole materials. Therefore, a novel methodology was developed to form a rational platform for biomechanical characterizations of insole material durability, which consisted of in vivo gait analysis and in vitro bioengineering measurements. Results show significant differences in the compressive stiffness of the tested insoles and the rate of change over time in both compressive stiffness and peak pressures measured. Good correlations were found between pressure-time integral and Young's modulus (r2 = 0.93), and total energy applied and Young's modulus (r2 = 0.87).
Screening techniques to identify the diabetic patient at risk of ulceration
Authors: Simeone LR , Veves A
Published: April 2014

Foot problems are common in diabetic patients, with neuropathy and peripheral vascular disease being the main causative factors. Identification of high-risk feet can be accomplished by using basic clinical skills and simple equipment. Limb amputation is the most preventable of the long-term diabetes complications and a multidisciplinary approach can achieve a dramatic reduction of major limb amputations.
Surgical morbidity and the risk of amputation due to infected puncture wounds in diabetic versus nondiabetic adults
Authors: Armstrong DG , Lavery LA , Quebedeaux TL , Walker SC
Published: April 2014

We reviewed the hospital course of 77 diabetic and 69 nondiabetic subjects who had incision, drainage, and exploration of infected puncture wounds of the foot. Diabetics were 5 times more likely to have multiple operations and 46 times more likely to have a lower extremity amputation than nondiabetics. The interval from injury to surgery was significantly longer in diabetics than nondiabetics. Total lymphocyte count and hemoglobin, hematocrit, and albumin values were significantly lower in diabetics than in nondiabetics. Diabetic amputees had higher prevalences of nonpalpable pulses, nephropathy, neuropathy, and osteomyelitia as compared with diabetic nonamputees. The neuropathic diabetic foot is not protected by pain. When combined with other comorbid factors, this may increase morbidity associated with puncture wounds of the foot.
Off-loading neuropathic wounds associated with diabetes using an ankle-foot orthosis
Authors: Landsman AS , Sage R
Published: April 2014

Patients with chronic diabetes have a broad spectrum of associated peripheral neurologic deficits that culminate in an increased susceptibility to ulcer formation. The authors focus on the use of the ankle-foot orthosis as both a treatment and a definitive solution for achieving ulcer closure and for minimizing the chance of ulcer recurrence in the ambulatory patient. An analysis of the pathologic forces encountered, and the solution achieved with the ankle-foot orthosis is presented. In addition, the results from a clinical pilot study in subjects with recalcitrant ulcers secondary to Charcot's neuroarthropathy are presented.
Management of painful diabetic neuropathy. A treatment algorithm
Authors: Page JC , Chen EY
Published: April 2014

Peripheral neuropathy manifests as a painful syndrome in a significant number of individuals suffering from diabetes mellitus. Painful diabetic neuropathy may interfere with sleep, work, and activities of daily living. Patients and practitioners alike often view this challenging disorder as incurable. A broad spectrum of therapeutic alternatives and physiologic approaches to this complex clinical problem are available. Careful assessment and a rational approach based on the nature and location of pain will lead to success. The authors review the etiology, clinical presentation, and diagnosis of diabetic peripheral neuropathy. Available therapeutic alternatives are emphasized and an original treatment algorithm is presented.
Gout and hypothyroidism
Authors: Gregoline PE , Peshoff ML , Trepal MJ
Published: April 2014

A case of gout in a patient with primary hypothyroidism has been presented. Often missed as a companion of gout, hypothyroidism has a frequency of occurrence with gout that is significant and is probably a precipitating factor in these gouty attacks. The physician should be alert for signs and symptoms of this often occult disease in patients with hyperuricemia and gout.
Tricorrectional osteotomy for the correction of late-stage hallux limitus/rigidus
Authors: Selner AJ , Bogdan R , Selner MD , Bunch EK , Mathews RL , Riley J
Published: April 2014

The authors propose the use of the tricorrectional osteotomy for treatment of severe hallux limitus/rigidus as an alternative to joint-destructive procedures. A study of 19 patients with follow-up treatment ranges of 10 months to 6 years postoperatively was performed. Data were collected on preoperative and long-term postoperative x-rays, range of motion assessment, F-scan studies, and subjective patient questionnaires. High patient satisfaction along with increased range of motion, minimal complications, and an early return to activities make this an ideal procedure for grades II, III, and IV hallux limitus/rigidus.