bluuebunny/crossref_metadata_2025 huggingface dataset:
Use of soft heat-molded orthoses in sports. A clinical analysis
Authors: Weik DA , Martin WJ
Published: April 2014

Podiatrists have had considerable success with the use of orthoses in the treatment of athletic injuries and faulty biomechanics. In-office fabrication of soft orthoses out of heat-moldable plastics provides an alternative to the more rigid, prescription device. Easily constructed in 15 to 30 min, the soft heat-molded orthoses have shown favorable results when used clinically with injured athletes. Although the need for more comprehensive studies exists, podiatrists should consider the use of soft heat-molded orthoses with their athletic patients and possibly in combination with the more permanent, rigid orthoses.
Calcaneal donor bone grafts
Authors: Mahan KT
Published: April 2014

Autogenous bone grafting is an important part of many foot and ankle surgical procedures. Although alternative bone graft materials such as allogeneic bone are available, autogenous bone continues to be the material of choice for many procedures. The calcaneus provides a source of small amounts of autogenous corticocancellous or cancellous bone. The author describes the surgical technique for procurement of calcaneal bone grafts. Twenty-five cases are reviewed. The morbidity associated with procuring calcaneal bone grafts is favorably compared with that associated with procuring bone from other donor sites.
MRI evaluation of Orthosorb pin insertion for surgical treatment of hallux abducto valgus
Authors: Bashara ME , Brunetti VA
Published: April 2014

This preliminary study considers the advantage of magnetic resonance imaging over plain film radiography in assessing pin resorption and bone marrow regeneration over a 6-month period. The Orthosorb pin was used to fixate an Austin osteotomy in a patient and was followed with serial magnetic resonance imaging at scheduled intervals. This study expands on the preceding study in this issue of the Journal, which was carried out in the rat model.
Medial fracture dislocation of hallucal interphalangeal joint. A case report
Authors: Sutera AB , Kost K , Luzzi A , Picciotti J
Published: April 2014

A case of medical fracture dislocation of the hallucal interphalangeal joint is presented. The patient did not recall the specific mechanism that caused this injury. However, this type of injury would have to entail a substantial lateral-to-medial force at the distal phalanx. The authors' review of the literature did not reveal a similar case involving a medial dislocation of the distal phalanx. This transverse plane pathology was treated with closed reduction because of a lack of sesamoid or volar plant involvement in the joint.
Osteopetrosis. A case report
Authors: Wolf EW , Fernandez L
Published: April 2014

Osteopetrosis congenita is invariably a fatal disease that is diagnosed within the first decade of the child's life. Although some steps have been taken to overcome this disease by bone marrow transplantation, further research is needed to determine the long-term effectiveness of this treatment. Osteopetrosis tarda is often detected as an incidental finding. Many cases are asymptomatic, yet many patients do suffer from general bone pain, infections, and repeated incidents of pathologic fractures. Such cases may present within the bones of the foot. Treatment is directed at addressing the pathology that may have resulted from the disease state. Osteopetrosis tarda, although rare, can affect the foot. Steps toward treatment of the primary disease entity are still being taken; however, recognition and treatment of the pathology is the primary goal in the adequate treatment of these patients.
1994 William J. Stickel Bronze Award. Amino acids, dipeptides, and leg skeletal muscle wound healing in diabetes
Authors: Pitkow HS , Brekke M , Harte G , Labbad ZG , Bitar MS
Published: April 2014

The authors determined the effects of active amino acids and dipeptides as anabolic agents on surgically induced wound healing in lower extremity skeletal muscles in diabetic and normal rats. In order to induce diabetes, adult male Sprague-Dawley rats (200 g; 10 to 12 animals per group) were injected with streptozotocin (65 mg/kg) 30 days before the onset of the experiment. Their blood sugars were checked at this time. Each group of rats was injected with either one stimulatory amino acid or dipeptide (150 mg/kg body weight) subcutaneously in saline for 7 days and their anabolic effects (RNA, DNA, protein, and collagen contents) on lower extremity skeletal muscle wound healing determined in both diabetic and normal control groups. It is hoped that a treatment regimen will be developed using synergistic anabolic agents locally to decrease the lower extremity muscle healing time. This will enable the diabetic patient to become mobile sooner after surgery.
Effects of surgical technique on bone. A preliminary study
Authors: Johnson JD , Jones HK , Feigelson DP , Gerbert J , Pedroja A
Published: April 2014

The authors compared the use of the power saw with bone-cutting forceps for excision of bone. A total of 44 digits were studied in 12 patients. The study was performed on patients requiring bilateral digital arthroplasties of the proximal and distal interphalangeal joints. The authors examined the differences in healing: pain, inflammation, and fibrosis. Digits on which the power cuts were made showed a slight advantage with regard to inflammation and pain, until 1 week after surgery. By week 12, neither technique demonstrated superiority. Overall results demonstrated no significant digit (p > 0.2) or treatment effect (p = 0.11). The authors believe that the study showed that the technique used for bone excision may have little effect on inflammation and healing in the long-term management of a surgical patient.
Effect of hosiery on skin temperature in spastic quadriplegia. A preliminary study
Authors: Ufer C , Cryer A , Stevenson M
Published: April 2014

The effect of hosiery on 21 patients with spastic quadriplegia was studied by examining skin temperatures before and after wearing control socks (cotton or cotton/acrylic), compared with the test socks (21% stretch nylon and 80% synthetic hollow-core fiber). The latter are claimed by the manufacturers to provide superior warmth. Other investigations suggest that no material for a given thickness has superior insulation properties. The results of this preliminary study support these investigations, in that no significant difference in skin temperatures was found between the control and test socks when worn by this population.
Soft tissue anchor systems
Authors: Yu GV , Chang T , White JM
Published: April 2014

The concept of soft tissue attachment and reattachment has been addressed over the years through a variety of surgical techniques. This includes tendons and ligaments that have been detached both surgically and traumatically from their osseous origins or insertions. This study is designed to provide the reader with a comprehensive overview of current commercially available devices. Detailed descriptions of the various devices are provided along with a discussion of the advantages and disadvantages of each. Their application and use in reconstructive foot and ankle surgery are also discussed.
Metatarsocuneiform coalition
Authors: Day FN , Naples JJ , White J
Published: April 2014

This was clearly a case of an unusual anomaly. Clinically, this was a case of an osseous coalition of congenital origin. Since the patient eventually became asymptomatic, no further treatment was necessary. Unfortunately, the patient's parents were unavailable to be radiographed to test the hereditary nature of this disorder. The radiographs and fluoroscopy films were sent to a radiologist. The radiology report stated a total and complete coalition (osseous fusion) between the third metatarsal base and the third cuneiform, with no indication of a joint space present in the left foot scan. Since this pathology is more of an incidental finding and caused the patient no discomfort, surgical correction was not necessary. Certainly, more coalitions of this nature may exist without patient knowledge. This case demonstrates another pathology that the podiatric physician may need to address.
Hallux set angle. A new radiographic measurement for hallux valgus
Authors: Boberg JS , Menn JJ , Tamburri SA , Chang TJ
Published: April 2014

The authors introduce a unique and clinically oriented technique for evaluation of hallux abducto valgus deformity and its operative correction. A new concept in the application of the Austin osteotomy is also presented.
Arthrodesis of the first metatarsophalangeal joint. Current recommendations
Authors: Yu GV , Shook JE
Published: April 2014

Fusion of the first metatarsophalangeal joint is a time-honored, effective procedure for multiple conditions. Numerous fixation techniques have been described over the years. The authors provide an extensive overview of specific fixation techniques used throughout the past 6 years. Emphasis is placed on the potential advantages and disadvantages of the individual fixation techniques.
Lapidus arthrodesis. A different perspective
Authors: Chang TJ , Ruch JA
Published: April 2014

Fusion of the first metatarsocuneiform joint may provide correction of positional deformities of the first metatarsal while offering significant structural stability to the medial column. The authors present a modification of the Lapidus procedure that uses well established internal fixation principles.
Podiatric medical considerations in dealing with elder abuse
Authors: Anetzberger G , Robbins JM
Published: April 2014

The geriatric population is expanding at a rapid rate. With greater numbers of elderly patient visits to the podiatric medical office, the likelihood of difficult psychosocial problems increases. Elder abuse is potentially a serious health risk and the need for the podiatric physician to identify and report elder abuse is a professional and, in many cases, a legal responsibility. The authors identify the signs and symptoms of elder abuse and methods to address this difficult and perplexing problem.
Foot types and lower limb injuries in elite netball players
Authors: Hopper D , Bryant A , Elliott B
Published: April 2014

In assessing the foot types and lower limb injuries of elite netball players, the following summary seems warranted. Ninety percent of elite female netball players had symmetrical foot types for both feet and these players had experienced at least one lower limb injury. Only 7.6% players (N = 16) of the 204 players surveyed had never sustained a lower limb injury during their netball careers. Regardless of foot type, the injury history of these elite netball players presented with a total number of 449 injuries that occurred to both ankle joints (36%), one ankle joint (16%), both knee joints (6%), one knee joint (13%), shin soreness (18%), and retropatellar pain problems (11%). On further inspection, 55% of players experienced one to two lower limb injuries throughout their netball careers. Injured players showed that players with the pronating foot types with rearfoot abnormalities (57%) were the most commonly injured and that compensated rearfoot varus foot type presented the most lower limb injuries for all body sites.
Peripheral skeletal tuberculosis of the foot. Etiologic review and case study
Authors: Werd MB , Mason EJ , Landsman AS , Hanft JR , Kashuk KB
Published: April 2014

Mycobacterium tuberculosis is a disease that is being reported much more frequently in the literature, primarily because of the rapid increase in severely immunocompromised patients, but also because of the development of multiple drug-resistant tuberculosis strains. Extrapulmonary M. tuberculosis is also reportedly on the rise, and may manifest itself at a number of sites in the body, including the peripheral skeleton. It is important to recognize peripheral tuberculosis osteomyelitis early because early treatment can effectively eliminate long-term morbidity. The authors present a review of the diagnosis and treatment of extrapulmonary M. tuberculosis, with special emphasis on peripheral skeletal tuberculous osteomyelitis. A case study involving peripheral skeletal tuberculous osteomyelitis in the foot is presented.
Adjunctive hyperbaric oxygen therapy in the treatment of the diabetic foot
Authors: Cianci P
Published: April 2014

The use of hyperbaric oxygen therapy for the treatment of conditions of local or focal hypoxia is not new. The author discusses the potential benefits of hyperbaric oxygen in the treatment of chronic wounds when used as a part of a multidisciplinary wound care program. Rationale and mechanism of action are discussed along with possible adverse effects. Costs of care and limb salvage rates are considered.
Wound dressings. A comparison of classes and their principles of use
Authors: Choate CS
Published: April 2014

Selection of an appropriate wound dressing, to potentiate healing, demands knowledge about varying classes of dressings. With the growing number of wound dressings available, health care providers must understand both the principles of dressing development as well as the qualities of each individual product. The author compares five classes of wound dressings: hydrocolloids, hydrogels, films, foams, and sodium/calcium alginates. Also, principles of dressing selection and long-term wound management guidelines are presented.
Wound closure and special suture techniques
Authors: Gusman D
Published: April 2014

In this review, the author presents the physiologic events in wound healing. A discussion is provided with emphasis on proper tissue handling and suture techniques. A variety of methods are demonstrated as they are applied to specific clinical situations in foot and ankle surgery. It is the intent of this discussion to add information and techniques that may be used to complement general knowledge in wound and incision repair.
Osteochondroma of the distal tibia. A case study
Authors: Southerland JT
Published: April 2014

Osteochondromas can undergo malignant transformation, and although the incidence is low, it is important to recognize symptoms that might suggest transformation. Complaints of increasing pain or a dramatic increase in the size of the lesion must not be ignored. If the physician is confident that the lesion is benign and chooses not to resect it, the patient should be monitored periodically with serial radiographs in order to identify any potential degenerative changes that might develop. Since osteochondromas are usually associated with the growth plate of a long bone, the potential for progressive growth exists. This growth takes place through the process of enchondral ossification until closure of the physis occurs. After physiologic fusion of the physis, remnants of the cartilaginous cap may remain, possibly explaining the occasional development of peripheral chondrosarcomas later in life.
Peripheral nerve tumors. Large neurofibroma of the foot
Authors: Reed TS , Marty JA
Published: April 2014

A neurofibroma of the foot is an uncommon finding and may be associated with von Recklinghausen's disease. A case of a large, solitary neurofibroma is presented with no apparent systemic involvement on history and physical examination. The surgical approach and perioperative treatment for this lesion is presented, and a review of peripheral nerve tumors and neurofibromatosis. A tumor of this size poses many unforeseen problems: large dead space, wound dehiscence, and infection caused by hematoma formation. Preoperative magnetic resonance imaging to determine position, depth, and involvements of vital structures is invaluable. The lazy S incision allows for greater exposure with less skin tension from retraction, thus reducing the risk of wound dehiscence. Careful dissection prevents cutting or injuring of underlying atrophied tissue. Two years after surgery, the plantar muscle has returned to normal strength and size and only a slight amount of sensory deficit exists. His gait is normal, without limp, and with normal heel-to-toe ambulation. This patient's life-style has returned to normal with no alterations.
Statistical analysis of 307,601 tumors and other lesions of the foot
Authors: Berlin SJ
Published: April 2014

This laboratory study is limited to lesions submitted from office procedures and makes no claims or comparison regarding statistical data from hospitals, where most malignancies are excised. This study is ongoing, and will be updated regularly to observe trends and alert practitioners to changing patterns of incidence.
Blue nevus
Authors: Valentine BC , Day FN , Naples JJ
Published: April 2014

Dermal melanocytes are generally most numerous in the sacral, dorsal hand, and dorsal foot. There is also a slight rise that often occurs toward the axial line of the trunk. The practitioner needs to be aware and take necessary measures to properly diagnose the blue nevus from other forms of pigmented skin lesion. The authors believe that surgical excision with proper pathologic follow-up is the preferred treatment.
Using ulcer surface area and volume to document wound size
Authors: Johnson JD
Published: April 2014

The evaluation of ulcer size is normally limited to measuring length, width, and depth, and comparing those figures to previously obtained values. These comparisons are grossly inaccurate, and a more representative technique can be used by treating the ulceration as a three-dimensional object. The author proposes several mathematical formulae that are easily computed on a hand-held calculator. The formulae use the measurements of length, width, and depth, and translate those dimensions into surface area and volume.
Podiatric malpractice litigation. What to do and what to expect
Authors: Schimenti J , Rohd SB
Published: April 2014

Many podiatric physicians will never be sued during their careers, but if a suit happens, it can be one of the most stressful times in their lives. After contacting the insurance carrier, the podiatric physician must then wait as the case develops through the legal system. The deposition is when the podiatric physician will be asked questions about the case. It is important to remember to carefully answer the questions asked. Once in the trial stage, the appearance and testimony of the podiatric physician will be important in the jury's eyes. If a decision is not in your favor, you may be able to appeal the case to a higher court. Some cases may not go to trial as they could be settled or arbitrated along the way. By listening to your attorney and following the attorney's advice and recommendations, the legal process will be easier to manage and understand.
Problems with procedures
Authors: Schimenti J
Published: April 2014

The author evaluated over 2,000 nationwide claims in 14 years of podiatric malpractice suits. Surgical results are reviewed along with primary areas that generate claims. Suggestions are given on the impending claims and recommendations for abatement.
Fatal pontine hemorrhage after podiatric surgery. A case report
Authors: Kunz KR , Barrus DM , Nixon BP
Published: April 2014

The authors present a case of massive fatal pontine hemorrhage as a complication of hypertension in a patient treated for an infected diabetic ulcer. The podiatric physician must be aware of the risks associated with concomitant medical problems such as hypertension and ensure that proper therapeutic measures are taken to avoid the potential for catastrophic complications.
Scintigraphic detection of sequential symmetrical metatarsal stress fractures
Authors: Patel NH , Jacobson AF , Williams J
Published: April 2014

A patient with complaints of right foot pain and previous normal radiographs had an abnormal three-phase bone scan consistent with a second metatarsal stress fracture. Subsequent radiographs confirmed this diagnosis. Two months later, the patient developed pain in his left foot, and again initial radiographs were noncontributory. A later bone scan revealed a left second metatarsal stress fracture. The results in this case reemphasize the value of bone scintigraphy in patients with foot pain and no bone abnormalities on plain radiographs.
Patient education for diabetic patients. An integral part of quality health care
Authors: Valente LA , Nelson MS
Published: April 2014

The diabetic patient is at high risk for developing long-term medical complications including serious foot problems with potential loss of limb. With today's growing awareness of the importance of curtailing overall health care costs, the importance of comprehensive diabetic patient education programs is academic. It is demonstrated that a multidisciplinary approach to diabetic care management, with foot care assessment encompassing early preventive measures, can serve as a model for other Veterans Affairs Medical Centers to follow. Foot screenings can individualize specific foot problems and provide an understanding of risk factors to prevent complications. Patients with diabetes or peripheral vascular disease and, especially those individuals at risk of foot ulceration, are referred to the appropriate clinic for ongoing management to prevent amputation. Patient education is considered most effective when it is encouraged throughout a diabetic patient's medical care, and it becomes a part of lifestyle habits.
Evolutionary aspects of foot disorders
Authors: Moorhead J , Wobeskya L
Published: April 2014

The modern human foot can be viewed as the basic prehensile grasping foot of humans' arboreal ancestors, modified by the need for a propulsive lever to serve bipedal walking. The structure of the human foot serves its function remarkably well. However, in spite of its evolutionary success, the foot remains susceptible to clinical disorders that can be related to its development from nonhuman ancestors. An understanding of the evolution of the foot offers a different perspective on some common human foot disorders, and can provide a framework for planning the treatment of those disorders.
Osteochondrosis of the tarsal navicular in a female high school distance runner
Authors: Palamarchuk HJ , Aronson SM
Published: April 2014

A case of osteochondrosis of the tarsal navicular in an adult is presented. The patient was not fully compliant with the recommendations of the physicians involved and, as a result, full recovery has not been accomplished. Left untreated or undertreated, Mueller-Weiss syndrome can result in severe permanent osteoarthritis of the midtarsal joint (talonavicular joint). This may result in permanent deformity and disability. Properly treated with rest and supportive therapy, the condition is self-limiting and should heal without any sequela.
Presentation of an intermetatarsal ganglion
Authors: Saeva JT , Kaye MR
Published: April 2014

Ganglia have occurred in almost all areas of the foot, but most often associated with capsular or tendinous structures. They are fluid-filled masses which often present themselves radiographically as increases in soft tissue density. Ganglia exhibit high intensity magnetic resonance imaging and must be clinically and pathologically differentiated from other masses, such as, but not limited to, neuromas, granulomas, and neurilemomas. The authors present a rare occurrence of an intermetatarsal ganglionic cyst associated with the third dorsal interossei muscle, which was large enough to cause bony deformation of the adjacent metatarsals. It is unusual for ganglia to cause alterations in bone unless they are intraosseus in nature. Bone deformation and invasion are usually associated with aggressive tumors.
Articular cartilage. Part II. The osteoarthritic joint
Authors: Muehleman C , Arsenis CH
Published: April 2014

Articular hyaline cartilage, though a metabolically active tissue, has limited capacity for repair. Though the integrity of the cartilage is dependent upon a certain level of force placed upon it, excessive force leads to damage. It is when the breakdown of the cartilage exceeds the capacity of the cartilage for repair that osteoarthritis results. At present, pharmacologic treatment of osteoarthritis is focused toward the control of pain and stiffness. This treatment, however, masks the symptoms of the disease and effectively allows the patient to do further damage to the joint.
Congenital constriction band syndrome
Authors: Woods T , Romansky N
Published: April 2014

There are many theories regarding the etiology of this rare syndrome. However, the current thinking is that these bands result from rupture of the amnion that causes permanent constrictions of extremities or amputations in utero. This clinically resembles temporary strangulation of an appendage by hair or thread, and must be distinguished. A historical overview as to the etiology of constriction bands will be presented, as well as case studies.
Direct extension osteomyelitis secondary to chronic onychocryptosis. Three case reports
Authors: Cox HA , Jones RO
Published: April 2014

The podiatric physician should be alert to the possibility of underlying bony infections in cases of chronic or neglected nail infections. X-rays should be taken when drainage has been present for 4 weeks. This will rule out bony changes as well as provide assistance in following the progression, if no improvement is seen, despite treatment.
Bilateral talonavicular and calcaneocuboid joint coalition
Authors: Frost RA , Fagan JP
Published: April 2014

A second case of bilateral talonavicular and calcaneocuboid coalition has been presented with treatment used to date. This unusual coalition was seen in a patient without a known family history of similar condition.
Primary osteoma cutis
Authors: Klein MD
Published: April 2014

This case report was presented because there are few published cases of a solitary lesion of primary osteoma cutis occurring in the foot. It is an unusual cause of heel pain.
Neurologic conditions affecting the lower extremities in HIV infection
Authors: Gilmer WS
Published: April 2014

The vast majority of patients with human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) have symptoms or signs involving the feet and lower extremities. Patients presenting to podiatrists with foot complaints may, in fact, have neurologic complications of HIV originating in any level of the neuraxis, and multiple levels may be involved. These include multiple classes of peripheral neuropathy and myopathy, inflammatory radiculopathy, myelopathy, and central nervous system lesions caused by direct HIV infection or opportunistic infections. Common complaints such as pain, numbness, burning, tingling, weakness, cramps, unsteady gait, and others should be systematically evaluated with both podiatric and neurologic etiologies in mind for early diagnosis and intervention.
Cutaneous manifestations of HIV-1 infection
Authors: Memar O , Cirelli R , Lee P , Tyring SK
Published: April 2014

Infection with the human immunodeficiency virus (HIV) leads to a chronic disarmament of the immune system. The process is progressive, having different manifestations as the status of the immune system slowly deteriorates. Some of the most common manifestations of HIV infection are cutaneous in origin, and they can have infectious, neoplastic, or noninfectious or non-neoplastic etiologies. A brief history of HIV is given, and the most common cutaneous presentations of the virus infection of interest to podiatrists are outlined.
Legal implications of treating patients with HIV
Authors: Katine M
Published: April 2014

The status of a patient with human immunodeficiency virus (HIV) often has significant impact on a physician's willingness and ability to provide quality medical care. A physician may face substantial penalties for refusing to treat a patient with HIV. Even the referral of a patient with HIV to a specialist in the disease may constitute a discriminatory act. The law provides certain guidelines which, if followed, may help keep the physician out of the courtroom.
Nutrition and HIV infection. A continuum of care
Authors: Elbein RC
Published: April 2014

Nutrition is a fundamental intervention in the early and ongoing treatment of human immunodeficiency virus (HIV) disease. Nutrition therapy, in coordination with other medical interventions, can extend and improve the quality and quantity of life in individuals infected with HIV and living with acquired immune deficiency syndrome (AIDS). The author reviews the current literature and practice for nutrition use in the treatment of patients with HIV and AIDS.
Motile Aeromonas as agent of infections of the foot
Authors: Wakabongo M
Published: April 2014

Motile Aeromonas infections of the foot are caused mostly by post-traumatic incidence, occurring mostly during summer months. Serious complications such as osteomyelitis and amputation can result if the infections go untreated or are inadequately treated. The role of each species of motile Aeromonas in pathogenesis and response to antimicrobial agents is not well understood because of taxonomic uncertainty. As a group, motile Aeromonas respond well to aminoglycosides, second-generation and third-generation cephalosporins, quinolones, and some beta-lactam antibiotics.
Role of the plantar fascia in digital stabilization. A case report
Authors: Pontious J , Flanigan KP , Hillstrom HJ
Published: April 2014

The plantar aponeurosis is a ligamentous structure that extends from the calcaneus to the proximal phalanges. Under tension, it functions to support the longitudinal arch, supinate the rearfoot, and stabilize the digits against the ground. The anatomy and biomechanics of the plantar fascia and plantar aponeurosis, particularly their role in digital stabilization, are reviewed. A case is presented showing a patient who developed hammer toes as a postoperative complication after having a portion of the plantar aponeurosis removed.
Closed kinetic chain tarsal mechanics of subtalar joint arthroereisis
Authors: Christensen JC , Campbell N , DiNucci K
Published: April 2014

The weightbearing biomechanics of the tarsus with and without subtalar joint arthroereisis was investigated in 11 fresh frozen cadaver specimens using a three-dimensional (3-D) radiowave tracking system. Specimens, consisting of the distal half of the tibia and fibula and the intact ankle and foot, were mounted on a nonmetallic loading frame test system that allowed positioning of the foot to simulate midstance position of gait. The tibia was axially loaded to 756 N (one bodyweight) with 15% of the total load diverted through the fibula. Receiving transducers were attached to the talus, navicular, calcaneus, and cuboid bones. Tarsal movements were monitored as the specimen was loaded with and without subtalar joint arthroereisis. Three-dimensional data sets of osseous positions and orientations were collected and analyzed. Significant rotational differences were detected with and without subtalar joint arthroereisis for all four tarsal bones (p < or = 0.05). Tarsal translational position changes were small and not statistically significant.
Tarsal tunnel syndrome. A retrospective study
Authors: Mahan KT , Rock JJ , Hillstrom HJ
Published: April 2014

Many etiologies of tarsal tunnel syndrome exist, but it is difficult to determine the specific etiology for a patient. Surgical success rates vary in the literature from 44% to 100%. This retrospective study reviewed 40 patients with 45 data sets. Thirty-five patients (87.5%) in the study were female; 35 patients (87.5%) were caucasian. Thirty-two feet (71.1%) showed improvement following the tarsal tunnel surgery. The Tinel's sign parameter improvement was statistically significant. The differences in the subjective parameters of burning, radiating, and sharp sensations were statistically significant, while the differences in pins and needle sensation were nearly significant. The Takakura index and its constituent parameters were all statistically significant postoperatively with the exception of muscle atrophy, which did not have sufficient data for testing.
Hallux interphalangeal joint sesamoidectomy
Authors: Yu GV , Nagle CJ
Published: April 2014

Painful lesions on the plantar aspect of the interphalangeal joint of the great toe respond well to surgical excision of the accessory bone found lying superior to or within the flexor hallucis longus tendon. Several incisional approaches are available, each with potential advantages and disadvantages. Failure to consider each incisional approach and address concomitant deformities may result in a less than desirable postoperative result.
Ankle joint dorsiflexion measurement studies. A review of the literature
Authors: Rome K
Published: April 2014

A spectrum of techniques exists to measure ankle joint dorsiflexion range of motion. However, information pertaining to the objective assessment of ankle joint dorsiflexion is controversial. Different study designs make comparisons of studies difficult which leads to measurement error. These errors can be related to the examiner, the subject, or the procedure. This author reviews the sources of measurement inaccuracies within the clinical setting and describes effective interventions used to reduce measurement error.
Value of white blood cell count with differential in the acute diabetic foot infection
Authors: Armstrong DG , Perales TA , Murff RT , Edelson GW , Welchon JG
Published: April 2014

The authors reviewed the admission leukocyte indices of 338 consecutive admissions (203 males, 135 females, mean age of 60.2 +/- 12.9 years) with a primary diagnosis of diabetic foot infection in a multicenter retrospective study. The mean white blood cell count on admission for all subjects studied was calculated at 11.9 +/- 5.4 x 103 cells/mm3. Of all white blood cell counts secured for patients admitted with a diabetic foot infection, 56% (189 out of 338) were within normal limits. The average automated polymorphonuclear leukocyte percentage was calculated at 71.4 +/- 11.1% (normal range 40% to 80%). Normal polymorphonuclear leukocyte values were present in 83.7% of subjects. The authors stress that the diagnosis of a diabetic pedal infection is made primarily on the basis of clinical signs and symptoms, and that a normal white cell count and white cell differential should not deter the physician from taking appropriate action to mitigate the propagation of a potentially limb-threatening pedal infection.
Hand-foot-and-mouth disease
Authors: Kushner D , Caldwell BD
Published: April 2014

Hand-foot-and-mouth disease is a highly contagious disease most often seen in children during the summer. It is caused most commonly by the virus coxsackie A16, but other enteroviruses have been implicated. It presents with low grade fever, and a vesicular eruption on the hands, feet, and mouth. More serious manifestations are seen less commonly. Diagnosis is most often clinical and treatment is symptomatic in nature. The infection in a male adult is presented.
Podiatric medical education. A view into the next century
Authors: McNevin AJ , Gill CE , North MG
Published: April 2014

The authors examine the future of podiatric medicine through an analysis of the characteristics of students presently enrolled in the colleges of podiatric medicine and the characteristics of college graduates from 1990 to 1995. Specific attention is also given to a number of critical issues surrounding graduate podiatric medical education. The authors conclude that despite a growing number of challenges awaiting podiatric medical education, the present complement of students and graduates of the colleges of podiatric medicine appear to offer the public reasonable expectations for quality foot care.
Evaluation and treatment of the infected foot in a community teaching hospital
Authors: Todd WF , Armstrong DG , Liswood PJ
Published: April 2014

More inpatient hospital days are used for the care of diabetic foot infection than for any other diabetic sequela. Both the number of lower extremity amputations and the overall treatment cost of treating diabetic infections may be reduced by using a team approach in the care of the infected diabetic pedal wound. The authors propose an evaluation and treatment protocol of infected pedal ulcerations in an urban, community teaching institution when admitted to an established, multidisciplinary diabetic foot care team. The hospital course of 111 patients admitted with a primary diagnosis of infected pedal ulceration are retrospectively reviewed. Results revealed an average-length hospital stay of 7.4 days with a 96% limb-salvage rate. The authors suggest that in the treatment of the infected pedal wound, a diabetic foot care team with a well developed treatment protocol may yield a consistently favorable outcome and a cost-effective hospital course.
Orthotic variants
Authors: Sobel E , Levitz SJ , Jones LS
Published: April 2014

When patients present with problems for which existing devices are not adequate, research is stimulated. However, new methods and devices must improve on the older versions and should not result in variation that is less effective than the original versions. Variants less effective than the originals will be discussed with illustrative examples. Orthoses, prostheses, and pressure-reduction techniques for the diabetic foot will be considered.
1997 William J. Stickel Bronze Award. Comparison of strategies for reducing pressure at the site of neuropathic ulcers
Authors: Fleischli JG , Lavery LA , Vela SA , Ashry H , Lavery DC
Published: April 2014

Few scientific data are available on the effectiveness of commonly used modalities for reducing pressure at the site of neuropathic ulcers in persons with diabetes mellitus. The authors' aim was to compare the effectiveness of total contact casts, half-shoes, rigid-soled postoperative shoes, accommodative dressings made of felt and polyethylene foam, and removable walking casts in reducing peak plantar foot pressures at the site of neuropathic ulcerations in diabetics. Using an in-shoe pressure-measurement system, data from 32 midgait steps were collected for each treatment. There was a consistent pattern in the devices' effectiveness in reducing foot pressures at ulcer sites under the great toe and ball of the foot. Removable walking casts were as effective as or more effective than total contact casts. Half-shoes were consistently the third most effective modality, followed by accommodative dressings and rigid-soled postoperative shoes.
Mixed cavernous and capillary intraosseous hemangioma of the foot
Authors: Davies JL , Stone PA , McGarry JJ
Published: April 2014

Hemangiomas of bone are rare lesions accounting for approximately 1% of all primary bone tumors. Intraosseous hemangiomas of the foot are especially rare, with only sparse reports in the literature. Presented here is a case study of an erosive bony lesion of the midfoot that was microscopically and histopathologically proven to be a mixed cavernous and capillary hemangioma. Eradication of the lesion during diagnostic biopsy obviated further treatment.
Pathologic and diagnostic considerations in onychomycosis
Authors: Lemont H
Published: April 2014

Understanding the physiology and function of the nail unit and its potential avenues of invasion, and properly identifying invading organisms are two key aspects of using the newer therapies available for the treatment of onychomycosis. This article discusses the most common pathologies of onychomycosis, as classified by the sites of entry of the invading fungi. Susceptibility factors leading to infection are also discussed. Obtaining proper tissue samples, using appropriate tests and culture media, and accurately interpreting test results are all paramount to correct identification of the invading organism and, in turn, to effective prescribing. When fungal-growth results do not support the clinical symptoms, or if a more specific identification of the organism is required, additional diagnostic tests are available and are outlined here.
Oral treatment options for onychomycosis
Authors: Joseph WS
Published: April 2014

The author discusses the new oral antifungal agents for the treatment of onychomycosis. The history, mechanisms of action, efficacies, dosing, safety profiles, and costs of itraconazole, terbinafine, and fluconazole are reviewed. The author emphasizes that use of these effective antifungals represents an important paradigm shift for podiatric physicians away from the palliative therapy of nail debridement to a potentially curative treatment.
Surgical treatment of mycotic toenails
Authors: McInnes BD , Dockery GL
Published: April 2014

The authors present several options for the surgical treatment of painful and dystrophic mycotic toenails. The procedures include total and partial nail avulsion as well as chemical and excisional matrixectomies, both partial and total. Adjunctive treatment with topical and oral antifungal agents is also discussed.
Podiatry Institute ankle fusion technique
Authors: Mahan KT , Yu GV , Kalish SR , Corey SV
Published: April 2014

The authors review the ankle and pantalar fusion literature. The authors performed a retrospective review on 42 ankle and pantalar fusions, emphasizing the role of internal fixation. The Podiatry Institute technique for internal fixation of ankle fusions is described and experience with the technique is reviewed. Complications included delayed union and nonunion at the fusion site or the repaired fibular osteotomy site and tibial fractures at screw stress riser sites. Modifications to reduce these complications are discussed. Experience with internal fixation in ankle and pantalar fusions, both in this study and in current literature, has been positive.
Deep venous thrombosis. The dilemma of diagnosis
Authors: Servatjoo P
Published: April 2014

Despite advanced medical technology, deep venous thrombosis continues to be a seriously underdiagnosed common postsurgical complication of the patient, particularly of lower extremity procedures, often requiring postoperative bed rest as in any routine podiatric surgery. Deep venous thrombosis and its complication, pulmonary embolism, are elusive clinical conditions since patients often tend to exhibit neither specific nor reliable signs or symptoms. However, the suspicion of the surgeon, generally based on subtle clinical manifestations, is the most important step in the diagnosis. Diagnosis will never be made unless he or she entertains the possibility. Since prevention of the potentially fatal outcome of pulmonary emboli secondary to deep venous thrombosis and possibly the serious morbidity caused by long-term sequelae in the lower extremity is now possible, the importance of an early, adequate diagnosis is indisputable. Diagnosis on clinical grounds alone is notoriously unreliable and objective tests are necessary to avoid overtreatment or undertreatment.
The acutely infected diabetic foot is not adequately evaluated in an inpatient setting
Authors: Edelson GW , Armstrong DG , Lavery LA , Caicco G
Published: April 2014

OBJECTIVE

To evaluate the standard of evaluation and treatment of the infected diabetic foot ulceration at a 551-bed university teaching institution.

DESIGN

A retrospective review of a 4-year consecutive sample (1991-1994).

POPULATION

Two hundred fifty-five patients who were admitted to a hospital for care of an infected diabetic foot ulceration. Patients were subdivided into the following 4 dichotomous variables: (1) whether the patient underwent a lower-extremity amputation, (2) whether the patient was admitted once or multiple times, (3) whether the patient underwent intraoperative debridement, and (4) whether the patient was admitted to medical or surgical services.

RESULTS

All groups that were evaluated had undergone a less than adequate foot examination. Of the admitted patients, 31.4% did not have their pedal pulses documented; 59.7% of the admitted patients were not evaluated for the presence or absence of protective sensation. Nearly 90% of the wounds were not evaluated for involvement of underlying structures, and foot radiographs were not performed in 32.9% of the patients. There were more blood cultures ordered (62.0%) than wound cultures (51.4%).

CONCLUSION

The results of this study highlight the need for a systematic, detailed lower-extremity examination for every diabetic patient who is admitted to a hospital, particularly those who are admitted with a primary diagnosis that involves a foot complication.
Hyperbaric oxygen therapy and the diabetic foot
Authors: Williams RL
Published: April 2014

Hyperbaric oxygen therapy is an adjunctive wound-healing modality receiving increasing use for problem wounds, particularly diabetic foot wounds. Nevertheless, few clinicians understand the physiologic basis for this modality; how patients are selected, or the expected results. The author reviews the development of hyperbaric oxygen therapy, selection of patients, and clinical studies of this modality for diabetic patients with foot wounds.
Team approach toward lower extremity amputation prevention in diabetes
Authors: Frykberg RG
Published: April 2014

Through a discussion of the etiology and pathology of diabetic foot lesions with particular emphasis on ulceration and osteoarthropathy, the author will develop a plan for treatment and prevention using a multidisciplinary approach to such problems. Underlying risk factors including neuropathy, ischemia, infection, and, especially high pressures must be evaluated and appropriately ameliorated in order to promote resolution and avoidance of recidivism. Accordingly, conservative management with pressure-relieving devices, topical therapies, and prophylactic surgery on structural deformities plays an integral part in the overall podiatric management of the high-risk foot in diabetes mellitus.
Teaching diabetic foot care effectively
Authors: Peter-Riesch B , Assal JP
Published: April 2014

Patient education is a fundamental aspect of the management of foot ulcers in the patient with diabetes mellitus. Preventive measures have to be focused on the individual risk profile of the patient and on the chronology of appearance of symptoms. Teaching issues need to be adapted into the following three stages: A) before: prevention of foot ulceration in the at-risk patient; B) acute: prevention of extension of an existing ulcer; and C) after: prevention of recurrence.
Therapeutic footwear helps protect the diabetic foot
Authors: Mueller MJ
Published: April 2014

There is evidence to indicate that therapeutic footwear can help prevent lower extremity amputation in patients with diabetes. The primary means of preventing amputation is to protect the insensitive foot from unnoticed trauma and excessive plantar pressures that occur during walking. The specific prescription of the shoe will depend on many foot risk criteria, but particularly on the patient's level of sensation, history of ulceration, and the amount of foot deformity. This article describes the type of footwear recommended for each of these increasing levels of foot risk categories.
Chronic exertional compartment syndrome of the foot. A case report
Authors: Mollica MB
Published: April 2014

The author describes a case of chronic exertional compartment syndrome of the foot affecting a 19-year-old male triathlete. Relevant anatomy, subjective symptoms, and clinical examination are discussed. Diagnostic confirmation, as achieved with compartment-pressure testing, is also presented, as is surgical treatment through decompressive fasciotomy of the affected compartment.
Bilateral spontaneous avascular necrosis of the navicular. Case presentation with comparative imaging
Authors: Boc SF , Feldman G
Published: April 2014

It is unusual to find such extensive deformity of the navicular in a bilateral and symmetrical fashion. The apparent lack of significant trauma coupled with the patient's unremarkable medical history led the authors to an exclusionary diagnosis of spontaneous osteonecrosis. While changes are clearly evident on plain film radiography, computed tomography and magnetic resonance imaging provide the clinician with a more detailed picture of the extent of destruction.