bluuebunny/crossref_metadata_2025 huggingface dataset:
Low-Molecular-Weight Heparins
Authors: Smith Robert G.
Published: April 2014

Deep venous thrombosis is a common but underdiagnosed medical condition. The epidemiologic features, economic impact, morbidity, and mortality of venous thromboembolism make it imperative that the podiatric physician be familiar with its pathogenesis as well as its pharmacologic treatment. Medical literature rooted in clinical evidence has demonstrated that low-molecular-weight heparins are safe and effective for the prevention and treatment of venous thromboembolism. The primary purpose of this article is to review the pharmacologic characteristics of low-molecular-weight heparins. Dosing recommendations for low-molecular-weight heparins as they apply to the prevention of deep venous thrombosis are presented. Finally, a dosing criteria chart is presented to assist the podiatric physician in prescribing and evaluating low-molecular-weight heparins as a therapeutic class. (J Am Podiatr Med Assoc 95(4): 383–389, 2005)
Congenital Malalignment of the Great Toenails in a Pair of Monozygotic Twins
Authors: Özdemir Esin , Bostanci Seher , Akyol Aynur , Ekmekci Pelin , Gürgey Erbak
Published: April 2014

Congenital malalignment of the great toenails is the lateral deviation of the long axis of nail growth relative to the distal phalanx. The nails grow slowly, with thickening, curving, and transverse ridging. We describe a pair of 3-year-old monozygotic female twins with congenital malalignment of the great toenails complicated by ingrowing and paronychia. Although there are a few cases without any family history, congenital malalignment is believed to be inherited through an autosomal-dominant gene of variable expression. This report provides further evidence of the heritability of the disease. (J Am Podiatr Med Assoc 95(4): 398–400, 2005)
Endoscopic Gastrocnemius Recession for the Treatment of Gastrocnemius Equinus
Authors: DiDomenico Lawrence A. , Adams Heiko B. , Garchar David
Published: April 2014

A prospective analysis was conducted of the amount of correction obtained and number of complications resulting from 31 endoscopic gastrocnemius recessions in 28 patients. The average amount of increase in ankle dorsiflexion was 18°. Few complications were encountered, with mild “soreness” and distal “bruising” being reported by four patients. The only other complaint was “weakness.” The endoscopic gastrocnemius recession is a minimally invasive technique with a low rate of complications that offers a comparable amount of correction to that of traditional open procedures in the treatment of gastrocnemius equinus. (J Am Podiatr Med Assoc 95(4): 410–413, 2005)
Surgical Decompression in Lower-Extremity Diabetic Peripheral Neuropathy
Authors: Rader Andrew J.
Published: April 2014

Peripheral neuropathy can be a devastating complication of diabetes mellitus. This article describes surgical decompression as a means of restoring sensation and relieving painful neuropathy symptoms. A prospective study was performed involving patients diagnosed as having type 1 or type 2 diabetes with lower-extremity peripheral neuropathy. The neuropathy diagnosis was confirmed using quantitative sensory testing. Visual analog scales were used for subjective assessment before and after surgery. Treatment consisted of external and as-needed internal neurolysis of the common peroneal, deep peroneal, tibial, medial plantar, lateral plantar, and calcaneal nerves. Subjective pain perception and objective sensibility were significantly improved in most patients who underwent the described decompression. Surgical decompression of multiple peripheral nerves in the lower extremities is a valid and effective method of providing symptomatic relief of neuropathy pain and restoring sensation. (J Am Podiatr Med Assoc 95(5): 446–450, 2005)
Equinus Deformity as a Factor in Forefoot Nerve Entrapment
Authors: Barrett Stephen L. , Jarvis Jason
Published: April 2014

Forefoot nerve entrapments are common, and they are usually mistakenly categorized under the misnomer of “Morton’s neuroma.” Although the complete etiology of these forefoot entrapments is still not known, exogenous mechanical factors must be considered when patients present with clinical signs of forefoot nerve entrapment. It has been well established that equinus deformity can increase plantar forefoot pressures. This article provides a brief overview of equinus deformity as it relates to forefoot pathology, specifically, its mechanical contribution to forefoot nerve entrapment, and the use of endoscopic gastrocnemius recession for the treatment of forefoot nerve entrapment. (J Am Podiatr Med Assoc 95(5): 464–468, 2005)
Effectiveness of Extracorporeal Shockwave Treatment in 353 Patients with Chronic Plantar Fasciitis
Authors: Norris Donald M. , Eickmeier Kimberly M. , Werber Bruce R.
Published: April 2014

A 16-question post-treatment survey was sent to 874 patients after extracorporeal shockwave treatment for chronic plantar fasciitis. Of the 377 surveys returned, 353 were used for analysis. These patients were treated by 169 physicians in 19 states using either electrohydraulic or electromagnetic extracorporeal shockwave equipment. Seventy-six percent of the patients underwent treatment after having had continued pain for a year or longer. Seventy percent of patients who rated their pretreatment pain level as severe (score ≥ 8 on a scale from 1 to 10) experienced sharp declines in pain, with a sharp decline considered to be a difference in pain level before and after treatment of 3 or more. In addition, 66% of patients who rated their pretreatment immobility as severe (score ≥ 8 on a scale from 1 to 10) experienced sharp declines in immobility. Of the patients who underwent extracorporeal shockwave treatment, 69% indicated that they would recommend this procedure to someone in a similar situation. If extracorporeal shockwave treatment were not available, 62% of patients indicated that they would have undergone open or invasive surgery, and 41% indicated that they would have continued with additional physician office visits. (J Am Podiatr Med Assoc 95(6): 517–524, 2005)
Effectiveness of Low-Dye Taping for the Short-term Management of Plantar Fasciitis
Authors: Landorf Karl B. , Radford Joel A. , Keenan Anne-Maree , Redmond Anthony C.
Published: April 2014

Low-Dye taping is often used as a short-term treatment for plantar fasciitis. We evaluated the short-term effectiveness of low-Dye taping in relieving pain associated with plantar fasciitis. In this comparative study conducted at a university-based clinic, 65 participants with plantar fasciitis who received low-Dye taping for 3 to 5 days were compared with 40 participants who did not receive taping. Pain before and after treatment was measured using a visual analog pain scale. Analysis of the data was by the intention-to-treat principle, and a linear regression approach to analysis of covariance was used to compare effects. The visual analog pain scale score improved by a mean of 20 mm (from 44 to 24 mm) in the taping group and worsened by a mean of 6 mm (from 51 to 57 mm) in the control group. The analysis of covariance–adjusted difference in therapeutic effect favored the taping group by 31.7 mm (95% confidence interval, 23.6–39.9 mm) and was statistically significant (t = 7.71). In the short term, low-Dye taping significantly reduces the pain associated with plantar fasciitis. These findings are the first quantitative results to demonstrate the significant therapeutic effect of this treatment modality in relieving the symptoms associated with plantar fasciitis. (J Am Podiatr Med Assoc 95(6): 525–530, 2005)
Clinical and Experimental Models of the Midtarsal Joint
Authors: Nester Christopher J. , Findlow Andrew H.
Published: April 2014

Recent debate and literature have provided impetus to the growing body of thought that we should not model the midtarsal joint as having two simultaneous axes of rotation but as having a single instantaneous axis of rotation. Building on this concept, we present new reference terminology and propose that descriptions of midtarsal joint kinetics and kinematics relate to moments and motion in the cardinal body planes as defined by the x-, y-, and z-axes of the local reference system of the calcaneus. This replaces the existing terminology that describes the oblique and longitudinal axes for the midtarsal joint. The purpose of the new terms of reference and terminology is to aid in the communication of ideas and concepts regarding the biomechanics of the midtarsal joint among clinicians and between researchers and clinicians. It will also allow integration of the midtarsal joint into the emerging biomechanical model of the lower limb, promote consistency in discussions of the joint, and ease understanding of the interrelationships between the kinetics and the kinematics of the articulations in the foot and lower limb and their relationship to pathology and clinical practice. (J Am Podiatr Med Assoc 96(1): 24–31, 2006)
NuGen Fx Bioabsorbable Screws
Authors: Ford Timothy C. , Brown Kevin , Mereau Trinity , Seligson David
Published: April 2014

A single prospective group study in adults was performed using a new bioabsorbable screw, the NuGen Fx screw (Linvatec Biomaterials Ltd, Tampere, Finland). This multisite study included five sites and 50 patients (10 patients per site). The goal of this study was to evaluate the efficiency and safety of the NuGen Fx screw system in the fixation of osteotomies, arthrodeses, and fractures in the foot and ankle. We discuss our own results from 12 patients treated at the Kentucky Podiatric Residency Program at Norton Audubon Hospital, Louisville. The number of patients in the study, screw sizes, instrumentation, radiologic evaluation findings, and our overview of this implant are presented. (J Am Podiatr Med Assoc 96(1): 73–77, 2006)
Intralesional Bleomycin Sulfate Injection for the Treatment of Verruca Plantaris
Authors: Salk Robert , Douglas Troy S.
Published: April 2014

Sixty-two patients were treated for single or multiple warts by intralesional injection of bleomycin sulfate (1.5 U/mL) and then were observed for 6 months. The dose varied according to the size of the lesion and ranged from 0.25 to 1.0 mL per injection per lesion, up to a maximum dose of 3 mL. The total cure rate was 87% after one or two injections. Twelve of the 62 patients required a second injection. (J Am Podiatr Med Assoc 96(3): 220–225, 2006)
Do US Veterans Wear Appropriately Sized Shoes?
Authors: Nixon Brent P. , Armstrong David G. , Wendell Christopher , Vazquez Jefferey R. , Rabinovich Zinoviy , Kimbriel Heather R. , Rosales Mark Anthony , Boulton Andrew J. M.
Published: April 2014

Poorly fitting footwear has frequently been cited as an etiologic factor in the pathway to diabetic foot ulceration. However, we are unaware of any reports in the medical literature specifically measuring shoe size versus foot size in this high-risk population. We assessed the prevalence of poorly fitting footwear in individuals with and without diabetic foot ulceration. We evaluated the shoe size of 440 consecutive patients (94.1% male; mean ± SD age, 67.2 ± 12.5 years) presenting to an interdisciplinary teaching clinic. Of this population, 58.4% were diagnosed as having diabetes, and 6.8% had active diabetic foot ulceration. Only 25.5% of the patients were wearing appropriately sized shoes. Individuals with diabetic foot ulceration were 5.1 times more likely to have poorly fitting shoes than those without a wound (93.3% versus 73.2%; odds ratio [OR], 5.1; 95% confidence interval [CI], 1.2–21.9; P = .02). This association was also evident when assessing only the 32.3% of the total population with diabetes and loss of protective sensation (93.3% versus 75.0%; OR, 4.8; 95% CI, 1.1–20.9; P = .04). Poorly fitting shoes seem to be more prevalent in people with diabetic foot wounds than in those without wounds with or without peripheral neuropathy. This implies that appropriate meticulous screening for shoe-foot mismatches may be useful in reducing the risk of lower-extremity ulceration. (J Am Podiatr Med Assoc 96(4): 290–292, 2006)
Relationship Between Static Posture and Rearfoot Motion During Walking in Patellofemoral Pain Syndrome
Authors: Levinger Pazit , Gilleard Wendy
Published: April 2014

The reference posture used in angular motion calculations may play an important role in the relationship found between static posture and rearfoot motion in the frontal plane in a clinical population such as patients with patellofemoral pain syndrome. This study examined the relationship between rearfoot inversion and eversion during the stance phase of walking and the static relaxed standing measurement in women (aged 18 years and older) with patellofemoral pain syndrome and controls and examined the influence of the reference posture used when calculating dynamic motion. Two reference postures were investigated: vertical alignment between the rearfoot and the lower leg and relaxed calcaneal standing. When using the latter reference posture, a significant correlation was found between the static relaxed standing measurement and peak eversion in controls only. When using the vertical alignment reference posture, significant correlation was found only in the patellofemoral pain syndrome group for peak eversion and inversion. The positive relationship found in the patellofemoral pain syndrome group between dynamic angular measures, based on a neutral reference posture, and static relaxed standing indicated that for subjects with patellofemoral pain syndrome, the clinical rearfoot measurement of relaxed standing can be used to explain the pattern of rearfoot motion during walking. (J Am Podiatr Med Assoc 96(4): 323–329, 2006)
Effect of Extrinsic Rearfoot Post Design on the Lateral-to-Medial Position and Velocity of the Center of Pressure
Authors: Paton Joanne S. , Spooner Simon K.
Published: April 2014

Findings from investigations of the effects of external forefoot and rearfoot posts added to foot orthoses have been inconclusive. This study was undertaken to examine the effects of rearfoot post design on the lateral-to-medial position and velocity of the center-of-pressure path. Four identical pairs of neutral-cast polypropylene orthotic shells were constructed; three pairs had a rearfoot post of specified design added. The fourth pair, the control, did not have a post added. Stance period data were broken down into four functional phases, and the statistically significant differences between the experimental conditions were calculated and analyzed. The addition of a rearfoot post to an orthotic shell affects center-of-pressure lateral-to-medial position and velocity. Although the effect of the post designs seemed to provide reasonably predictable changes in center-of-pressure position, the effect on center-of-pressure velocity was variable and inconsistent. The effect of the orthotic post was dependent on design and phase of gait. The addition of a rearfoot post and, specifically, the design of the post can probably be used to alter the center-of-pressure position and velocity. (J Am Podiatr Med Assoc 96(5): 383–392, 2006)
Distribution of the Metatarsophalangeal Sesamoids in Turkish Subjects
Authors: Kiter Esat , Akkaya Semih , Kiliç B. Alper , Demirkan Fahir
Published: April 2014

No statistically significant pattern of metatarsophalangeal sesamoid distribution has been reported in the literature in relation to genetic pool or group, unilaterality or bilaterality, or sesamoid division. A study was undertaken to evaluate the presence and distribution of the metatarsophalangeal sesamoid bones of the foot in Turkish subjects. A total of 602 foot radiographs from 371 patients without forefoot complaints other than those of the hallux were included in the study. Absence or hypoplasia of the first-ray sesamoids was seen on 0.7% of the radiographs, and second-, third-, fourth-, and fifth-ray sesamoids were present on 2.8%, 0.5%, 1.0%, and 15.1% of the radiographs, respectively. Fifth-ray sesamoids were more prevalent in men (odds ratio, 2.71; 95% confidence interval, 1.52–4.84). The frequency of a normal foot profile (two sesamoids in the first ray) was 83.2%. Divisions of the sesamoids were seen on 4.0% of the radiographs at the first ray and on 20.9% at the fifth ray. Distribution and division of sesamoids were predominantly bilateral (κ = 0.91, 0.91, and 0.95 for the first, second, and fifth digits, respectively; P < .001). (J Am Podiatr Med Assoc 96(5): 437–441, 2006)
The Biomechanical Effects of Talectomy on the Foot
Authors: Ozcan Ozal , Karapinar Hasan , Boya Hakan , Uyulgan Bahadir , Gunal Izge
Published: April 2014

The biomechanical effects of talectomy on the foot were investigated in seven fresh below-the-knee amputation specimens using pressure-sensitive films placed on the facets of the calcaneus, footprints, and loading-pattern diagrams in the intact foot and after talectomy with anterior and posterior displacement of the foot. Both talectomy techniques distorted the loads carried by the facets of the calcaneus. In the intact foot, 65.6% of the loads were carried by the posterior facet of the calcaneus and 34.4% by the anterior and middle facets. After talectomy with anterior displacement of the foot, although the loads carried by the anterior and middle facets decreased significantly (P = .018), the increase in the loads carried by the posterior facet was not significant compared with the intact foot (P = .176). Similarly, the loads carried by the posterior facet decreased significantly after talectomy with posterior displacement of the foot (P = .028), but the increases in the loads carried by the anterior and middle facets were not significant (P = .735). Comparing the two types of talectomy, the loads carried by each facet changed significantly (P = .018). Talectomy with posterior displacement of the foot also changed the loading patterns and resulted in significant pronation of the foot. These results suggest that talectomy should be performed only as a salvage procedure and that talectomy with anterior displacement of the foot may be preferred when talectomy is indicated. (J Am Podiatr Med Assoc 96(6): 495–498, 2006)
The Ability to Predict Dynamic Foot Posture from Static Measurements
Authors: Franettovich Melinda M. , McPoil Thomas G. , Russell Trevor , Skardoon Gillian , Vicenzino Bill
Published: April 2014

Background: A study was undertaken to investigate the ability to predict dynamic foot posture from static measurements.

Methods: Arch height and arch height ratio measurements were obtained from videotape images of the medial aspect of the foot during standing, walking, and jogging in 5 male and 13 female asymptomatic subjects.

Results: Arch height and arch height ratio measurements taken in standing explained 66% to 83% of the variance associated with these measurements at midstance during walking and running. Arch height and arch height ratio demonstrated high reliability as static and dynamic measures.

Conclusions: The results of this study support the use of arch height and arch height ratio measurements taken statically in the clinical assessment of the foot and may assist the clinician in estimating foot posture during dynamic activity in patients with lower-limb injuries. (J Am Podiatr Med Assoc 97(2): 115–120, 2007)
Chondrosarcoma of the Distal Phalanx of the Great Toe
Authors: Hatori Masahito , Watanabe Mika , Kokubun Shoichi
Published: April 2014

Enchondromas are the most common benign cartilaginous bone tumors of the toe. In contrast, chondrosarcomas are very uncommon in the foot. We report an unusual case of a chondrosarcoma arising in the great toe. The patient was a 62-year-old woman whose chief complaint was swelling of her left great toe. Radiography showed subtle punctate calcification and mild sclerosis and irregularity of the distal phalanx in the great toe. Magnetic resonance imaging showed extraskeletal growth. The distal phalanx was amputated. Histologic examination demonstrated a grade 1 chondrosarcoma. Two years after surgery, the patient was free of recurrence and lung metastasis. (J Am Podiatr Med Assoc 97(2): 156–159, 2007)
Efficacy of Chemical Neurolysis for the Treatment of Interdigital Nerve Compression of the Foot
Authors: Mozena John D. , Clifford Jared T.
Published: April 2014

Background: Dilute alcohol injection has been described as a nonsurgical treatment option for interdigital nerve compression of the foot, also known as “Morton’s neuroma.” This study reviews the efficacy of the procedure in 49 feet at one treatment center.

Methods: In this historical cohort study, data from 42 patients who had undergone alcohol injection therapy were obtained from clinic records. A total of 49 feet were reviewed.

Results: Symptoms were improved or resolved in 30 (61%) of 49 feet. Nineteen feet (39%) were unimproved, with 12 of those progressing to surgical neurectomy. Feet that received five or more injections were more likely to improve (74%) than those that received fewer than five injections (39%). Three patients reported mild complications associated with dilute alcohol injection, all of which resolved spontaneously within 2 days of the injection.

Conclusions: Dilute alcohol injection is a safe and effective treatment option for patients with Morton’s neuroma who want to avoid a surgical procedure and any associated complications. The procedure may be more successful if the patient receives at least five injections. (J Am Podiatr Med Assoc 97(3): 203–206, 2007)
Giant Cell Tumor of the Talar Neck
Authors: Selek Hakan , Özer Hamza , Turanli Sacit , Erdem Özlem
Published: April 2014

We describe a patient with a giant cell tumor in the talar head and neck of the left foot who was diagnosed as having osteochondritis dissecans and treated with arthroscopic drilling in this same location 3 years earlier. Giant cell tumors can be confused with several conditions, including giant cell reparative granulomas, brown tumors, and aneurysmal bone cysts. Giant cell tumors of bone typically occur in the epiphysis of long bones, including the distal femur and proximal tibia. They are uncommonly found in the small bones of the foot or ankle, and talar involvement is rare. Despite this rarity, the radiographic appearance and clinical signs of talar lesions should be considered in the differential diagnosis of nontraumatic conditions in the foot. (J Am Podiatr Med Assoc 97(3): 225–228, 2007)
Fracture of the Lateral Cuneiform Only
Authors: Shah Kalpesh , Odgaard Anders
Published: April 2014

The three (medial, intermediate, and lateral) cuneiforms and their articulations in the foot are small and relatively well protected from injury. An isolated fracture of the lateral cuneiform is a rare finding. However, isolated injuries may occur as the result of direct trauma. We report a case of an isolated fracture of the lateral cuneiform that was not seen on initial radiographs and only became evident on plain radiographs 4 weeks after the injury. As each of the cuneiform bones articulates with four other bones in the midpart of the foot, persistent displacement of any fracture (subluxation or dislocation) may result in post-traumatic arthritis. We believe that in suspected cases with negative radiographic findings, further imaging (computed tomography or bone scanning) should be requested. Without the use of additional imaging techniques, many fractures may be misdiagnosed as ankle sprains or foot contusions, and patients may be discharged from the hospital. (J Am Podiatr Med Assoc 97(6): 483–485, 2007)
Human Papilloma Virus Type 69 Identified in a Clinically Aggressive Plantar Verruca from an HIV-positive Patient
Authors: Whitaker Jeffrey M. , Palefsky Joel M. , Da Costa Maria , King Christy M. , Johnston James S. , Barbosa Peter
Published: April 2014

Background: Verrucae are caused by infection of epidermal keratinocytes by human papilloma virus (HPV). Although there are currently more than 100 known types of HPV, certain lesions are consistently caused by infection with one or a few types. Recent studies have identified the presence of unusual HPV types in anogenital and cervical condylomata (warts) of patients infected with human immunodeficiency virus (HIV). Although cutaneous verrucae are typically caused by HPV-1, HPV-2, and HPV-4, infection with HIV may predispose an individual to infection with an unusual HPV type.

Methods: We report the detection of a rare HPV type in a clinically aggressive plantar verruca from an HIV-positive patient. The viral DNA from this specimen was analyzed to identify the predominant HPV type. To complete this analysis, HPV DNA was extracted from the formalin-fixed specimen, followed by polymerase chain reaction with consensus HPV primers and digestion with a specific group of restriction endonucleases. The fragments were separated on an agarose gel, and the restriction fragment length polymorphism pattern was compared with known patterns for identification of the specific HPV type.

Results: Identification of HPV-69, an HPV type previously reported to be rare and associated with dysplastic lesions, was confirmed by HPV DNA dot-blot hybridization with specific DNA probes for each known HPV type.

Conclusions: Plantar verrucae in HIV-positive patients may be associated with unusual HPV types and should be analyzed and treated aggressively given the potential for a more distinct clinical manifestation. Additional lesional analysis studies are needed. (J Am Podiatr Med Assoc 99(1): 8–12, 2009)
Medial Plantar Artery Pseudoaneurysm Following Percutaneous Pinning For Lisfranc Fracture-Dislocation
Authors: Baeza Leslie , Farrell Eric D. , Salgado Christopher J.
Published: April 2014

We report a pseudoaneurysm of the medial plantar artery that developed after percutaneous pinning for a Lisfranc fracture-dislocation in a 68-year-old male. Postembolization ultrasound and arteriography demonstrated successful ablation of the pseudoaneurysm following intra-arterial thrombin injection. Postoperative pulse volume recording and photoplethysmograph of the digits revealed excellent perfusion following ablation. (J Am Podiatr Med Assoc 99(1): 58–60, 2009)
Varicosities as an Etiology of Tarsal Tunnel Syndrome and the Significance of Tinel’s Sign
Authors: Pasku Dritan S. , Karampekios Spiros K. , Kontakis George M. , Katonis Pavlos G.
Published: April 2014

Two cases of tarsal tunnel syndrome in two young men with surgical and radiologic details are reported. The role of varicosities as a cause of tarsal tunnel syndrome and the significance of Tinel3s sign are discussed through a large review of the literature. (J Am Podiatr Med Assoc 99(2): 144–147, 2009)
Ultrasound-guided Plantar Fascia Release Technique
Authors: Vohra Praveen K. , Japour Christopher J.
Published: April 2014

Background: Ultrasound-guided plantar fascia release offers the surgeon clear visualization of anatomy at the surgical site. This technique uses small arthroscopic dissecting instruments through a 0.5-cm incision, allowing the surgeon to avoid the larger and more tissue-disruptive incision that is traditionally used for plantar heel spur resection and plantar fascia releases.

Methods: Forty-one patients (46 feet) were selected for the study. The mean patient age was 47 years. Twenty-nine were considered obese with a body mass index greater than 30 kg/m2. Patients were functionally and subjectively evaluated 4 weeks after surgery using the American Orthopedic Foot and Ankle Society Ankle and Hindfoot Rating Scale.

Results: Results from the study show a significant improvement (P = .05 confidence level) 4 weeks postoperatively for the 41 patients (46 feet), compared to their preoperative condition. The mean pretest score was 33.6 (range 10–52); this score improved to 88.0 (range 50–100), 4 weeks postoperatively. There were no postoperative infections or complications.

Conclusions: The ultrasound-guided plantar fascia release technique is a practical surgical procedure for the relief of chronic plantar fascia pain because the surgeon is able to clearly visualize the plantar fascia by ultrasound. In addition, there is minimal disruption to surrounding tissue because small instruments are passed through a small 0.5-cm incision. The traditional open method of heel spur surgery, in contrast, uses a larger skin incision of 3 to 5 cm, followed by larger instruments to dissect to the plantar fascia. (J Am Podiatr Med Assoc 99(3): 183–190, 2009)
Public Perceptions of the Podiatrist and the DPM Degree
Authors: Akers Michael D. , VanDemark-Teplica Jennifer M. , Kiss Alex , Alfieri Donna M. , Jennings Maureen B.
Published: April 2014

Background: The purpose of this study was to ascertain public perception of the terms podiatry and DPM.

Methods: We distributed a survey to 847 people in ten states across the United States. It was hypothesized that most respondents would be less familiar with the DPM degree than the term podiatrist. It was also expected that people would choose MD over DPM for more complex procedures.

Results: The majority of respondents selected a podiatrist and a DPM as a foot specialist, almost one-half selected DPM for foot surgery, but only one-third stated they would have foot surgery done by a DPM if they had a heart problem. In addition, it was hypothesized that respondents would choose the contrived PMD over DPM simply because PMD looks more like MD; this was not shown to be true.

Conclusions: Although there are gaps in the public knowledge, our study revealed a greater familiarity with podiatry and the DPM degree than originally thought. (J Am Podiatr Med Assoc 99(3): 223–231, 2009)
A Complex Variant of Lisfranc Joint Complex Injury
Authors: Bulut Güven , Yasmin Davud , Heybeli Nurettin , Erken Hüseyin Yener , Yildiz Muzaffer
Published: April 2014

We report an unusual case of a variant of Lisfranc injury, plantar dislocation of the medial cuneiform with plantar fracture-dislocation of the intermediate cuneiform and dorsal fracture-dislocation of the lateral cuneiform, which has never been reported, to our knowledge. The entire pathologic abnormality was treated by open reduction and fixation with Kirschner wires, which were removed 8 weeks postoperatively because of pin-tract infection. Complex regional pain syndrome, which was a problem early in the recovery process, is now in remission, and at the 25-month follow-up examination, the patient was almost symptom free. (J Am Podiatr Med Assoc 99(4): 359–363, 2009)
Metatarsus Adductus Angle in Male and Female Feet
Authors: Domínguez Gabriel , Munuera Pedro V.
Published: April 2014

Background: The literature contains several techniques for calculating metatarsal adductus angle. Most common systems use the fourth metatarsal cuboid joint and the fifth metatarsal cuboid joint. Although both systems are quite different, normal values of metatarsus adductus angle have not been established with each system of measurement.

Methods: Two hundred six radiographic images of feet in dorsoplantar projection were used to measure the metatarsus adductus angle using two different reference points: the joint between the fourth metatarsal and the cuboid and the joint between the fifth metatarsal and the cuboid.

Results: Comparison of the results of the two measurement techniques showed significant differences (P < .05). The values of the metatarsus adductus angle also showed significant differences in men versus women (P < .05). The reliability of the measurements was checked by using an intra- and inter-evaluator test performed by two evaluators.

Conclusion: Data showed the reliability of both systems of measurement, although significant differences in the metatarsal adductus angle mean value were found using these systems of measurement in the same foot. On the other hand, significant differences were found in mean values of metatarsus adductus angle between male and female feet. (J Am Podiatr Med Assoc 98(5): 364–369, 2008)
International Public Health in Third World Country Medical Missions
Authors: Lee Daniel K. , Weinstein Stanley
Published: April 2014

Medical and surgical missions in Third World countries are mentally, physically, and financially demanding; however, there are many foot and ankle surgeons volunteering their time because it provides high levels of personal and emotional satisfaction. After many years in the missionary field, we would like to share a compilation study of our long-term experience and outcomes from our international medical and surgical pediatric mission trips to Latin American countries. We hope to instill in others the same passion for this work by sharing our portion of contribution in this vast world of international public health. (J Am Podiatr Med Assoc 99(4): 371–376, 2009)
The Flat-Footed Child—To Treat or Not to Treat
Authors: Evans Angela Margaret
Published: April 2014

Background: This article addresses the treatment of pediatric flatfoot with foot orthoses and explores the existing knowledge from an evidence-based perspective.

Methods: Studies investigating the use of foot orthoses for pediatric flatfoot were reviewed and ranked on the evidence hierarchy model according to research designs. Clinical guidelines and efficacy rating methods were also reviewed.

Results: Three randomized controlled trials exist, and a systematic review and possible meta-analysis of these studies is in progress. The results of these studies, although not definitive for the use of orthoses for pediatric flatfoot, provide useful direction. Clinical guidelines for the management of flatfoot are a useful supplement for clinical decision making and have been enhanced.

Conclusion: This article presents a pragmatic and evidence-based clinical care pathway for clinicians to use for pediatric flatfoot. It uses a simple “traffic light” framework to identify three subtypes of pediatric flatfoot. The clinician is advised to 1) treat symptomatic pediatric flatfoot, 2) monitor (or with discretion simply treat) asymptomatic nondevelopmental pediatric flatfoot, and 3) identify and advise asymptomatic developmental pediatric flatfoot. (Children with juvenile arthritis should receive customized foot orthoses.) This approach will dispel much of the contention surrounding the use of foot orthoses in children. (J Am Podiatr Med Assoc 98(5): 386–393, 2008)
Wound Closure Technique for Lateral Extensile Approach to Intra-Articular Calcaneal Fractures
Authors: Hollawell Shane
Published: April 2014

Multiple wound closure techniques have been described for a lateral extensile calcaneal incision in the literature. In this article, a technique is presented that involves a subcutilar closure over a closed drain system, which has proven to be effective in minimizing sural nerve injury and wound dehiscence in open reduction internal fixation of 20 calcaneal fractures. (J Am Podiatr Med Assoc 98(5): 422–425, 2008)
Changes in Gait Economy Between Full-Contact Custom-made Foot Orthoses and Prefabricated Inserts in Patients with Musculoskeletal Pain
Authors: Trotter Leslie C. , Pierrynowski Michael Raymond
Published: April 2014

Background: Specific kinematic and kinetic outcomes have been used to detect biomechanical change while wearing foot orthoses; however, few studies demonstrate consistent effects. We sought to observe changes in walking economy in patients with musculoskeletal pain across 10 weeks while wearing custom-made foot orthoses and prefabricated shoe inserts.

Methods: In this crossover randomized controlled trial, 40 participants wore custom-made orthoses and prefabricated inserts for 4 weeks each, consecutively. The path length ratio was used to quantify walking economy by comparing the undulating path of a point in the pelvis with its direct path averaged across multiple strides.

Results: For the prefab-custom group (n = 27), significant decreases in path length ratio (improved economy of gait) were noted at the initial introduction of prefabricated inserts (P = .02) and custom orthoses (P = .02) but maintained a trend toward improved economy only while wearing custom orthoses (P = .08). For the custom-prefab group (n = 13), there was worsening of the path length ratio that was significant after removing the custom-made orthoses for 4 weeks (P = .01).

Conclusion: For patients with lower-extremity musculoskeletal pain, immediate improvements in economy of gait can be expected with both interventions. It seems, however, that only the custom-made orthoses maintain economy of gait for 4 weeks. Patients who begin wearing custom-made orthoses and then wear prefabricated insoles can expect a decrease in economy of gait. (J Am Podiatr Med Assoc 98(6): 429–435, 2008)
A New Device for Performing Triplanar Distal Osteotomy for Hallux Valgus
Authors: Marinozzi Andrea , Martinelli Nicolò , Ronconi Paolo , Cancilleri Francesco , Papalia Rocco , Denaro Vincenzo
Published: April 2014

Triplanar distal osteotomy is a safe procedure for mild-to-moderate hallux valgus deformity. It allows shortening and plantar displacement of the first metatarsal while correcting the intermetatarsal angle. However, complications such as dorsiflexion and excessive shortening of the first metatarsal have been associated with distal osteotomy. We describe a new device, designed by one of the authors (P.R.), that enables precise positioning of the Kirschner guide wire for the osteotomy cuts. (J Am Podiatr Med Assoc 99(6): 536-540, 2009)
Patellofemoral Pain Syndrome and Its Association with Hip, Ankle, and Foot Function in 16- to 18-Year-Old High School Students
Authors: Mølgaard Carsten , Rathleff Michael Skovdal , Simonsen Ole
Published: April 2014

Background:

An increased pronated foot posture is believed to contribute to patellofemoral pain syndrome (PFPS), but the relationship between these phenomena is still controversial. The objectives of this study were to investigate the prevalence of PFPS in high school students and to compare passive internal and external hip rotation, passive dorsiflexion, and navicular drop and drift between healthy high school students and students with PFPS.

Methods:

All 16- to 18-year-old students in a Danish high school were invited to join this single-blind case-control study (N = 299). All of the students received a questionnaire regarding knee pain. The main outcome measurements were prevalence of PFPS, navicular drop and drift, passive ankle dorsiflexion, passive hip rotation in the prone position, and activity level. The case group consisted of all students with PFPS. From the same population, a randomly chosen control group was formed.

Results:

The prevalence of knee pain was 25%. Of the 24 students with knee pain, 13 were diagnosed as having PFPS. This corresponds to a PFPS prevalence of 6%. Mean navicular drop and drift were higher in the PFPS group versus the control group (navicular drop: 4.2 mm [95% confidence interval (CI), 3.2–5.3 mm] versus 2.9 mm [95% CI, 2.5–3.3 mm]; and navicular drift: 2.6 mm [95% CI, 1.6–3.7 mm] versus 1.4 mm [95% CI, 0.9–2.0 mm]). Higher passive ankle dorsiflexion was also identified in the PFPS group (22.2° [95% CI, 18°–26°] versus 17.7° [95% CI, 15°–20°]).

Conclusions:

This study demonstrated greater navicular drop, navicular drift, and dorsiflexion in high school students with PFPS compared with healthy students and highlights that foot posture is important to consider as a factor where patients with PFPS diverge from healthy individuals. (J Am Podiatr Med Assoc 101(3): 215–222, 2011)
Barefoot Running Claims and Controversies
Authors: Jenkins David W. , Cauthon David J.
Published: April 2014

Background:

Barefoot running is slowly gaining a dedicated following. Proponents of barefoot running claim many benefits, such as improved performance and reduced injuries, whereas detractors warn of the imminent risks involved.

Methods:

Multiple publications were reviewed using key words.

Results:

A review of the literature uncovered many studies that have looked at the barefoot condition and found notable differences in gait and other parameters. These findings, along with much anecdotal information, can lead one to extrapolate that barefoot runners should have fewer injuries, better performance, or both. Several athletic shoe companies have designed running shoes that attempt to mimic the barefoot condition and, thus, garner the purported benefits of barefoot running.

Conclusions:

Although there is no evidence that either confirms or refutes improved performance and reduced injuries in barefoot runners, many of the claimed disadvantages to barefoot running are not supported by the literature. Nonetheless, it seems that barefoot running may be an acceptable training method for athletes and coaches who understand and can minimize the risks. (J Am Podiatr Med Assoc 101(3): 231–246, 2011)
Variations in Foot Posture and Mobility Between Individuals with Patellofemoral Pain and Those in a Control Group
Authors: McPoil Thomas G. , Warren Meghan , Vicenzino Bill , Cornwall Mark W.
Published: April 2014

Background:

We sought to determine whether foot posture and foot mobility were increased in individuals with patellofemoral pain syndrome compared with individuals in a control group.

Methods:

A nested case-control design was used with two controls matched to each patient by sex and age (±1 year). Participants included 43 individuals with a history of unilateral or bilateral patellofemoral pain syndrome and 86 participants in a control group. Data collected included height, weight, and five different measures of foot height and width in weightbearing and nonweightbearing that have been previously shown to have high levels of reliability.

Results:

Individuals with patellofemoral pain syndrome were found to be four times more likely (odds ratio, 4.04; 95% confidence interval, 1.45–11.32) to have a larger-than-normal difference between nonweightbearing and weightbearing arch height compared with those in the control group. The mean values for difference in arch height and foot mobility magnitude were also statistically significant between the patient and control groups. Foot posture, as determined using the arch height ratio, was not significant between groups (odds ratio, 0.94; 95% confidence interval, 0.34–2.61).

Conclusions:

Although foot posture may not be different between individuals with patellofemoral pain syndrome and controls, foot mobility assessed using difference in arch height and foot mobility magnitude is different between the two groups. (J Am Podiatr Med Assoc 101(4): 289–296, 2011)
Management of Grade III Open Dislocated Ankle Fractures
Authors: Ye Tianwen , Chen Aimin , Yuan Wen , Gou Sanhuai
Published: April 2014

Background:

Isolated dislocation of the ankle with grade III open fracture has been scarcely reported. These ankle injuries usually involved mortise fractures, complete dislocation of the tibial astragaloid joint, capsuloligamentous structure disruption, and severe soft-tissue damage. There is no well-recognized regimen that would result in desirable outcomes.

Methods:

Sixteen patients with grade III open dislocated ankle fractures were treated immediately with bioabsorbable implants and an external fixator between January 2003 and June 2007. According to the classification system of Gustilo and Anderson, five patients were grade IIIA, seven were grade IIIB, and four were grade IIIC. Surgical interventions included combined internal fixation with bioabsorbable screws/rods and external fixation.

Results:

Patients underwent clinical and radiologic examination at an average of 18.1 months after surgery. Outcomes were excellent in seven patients (three IIIA, three IIIB, and one IIIC), good in four (one IIIA, two IIIB, and one IIIC), fair in three (one IIIA, one IIIB, and one IIIC), and poor in two (one IIIB, and one IIIC). In the two patients with poor outcomes, bone defect and cartilage exfoliating in the distal tibia were found during surgery. Painful osteoarthritis in the ankle was discovered 2 years after surgery. Another case had pin tract infections in the external fixator 3 months after surgery. There was no case of late deep infection.

Conclusions:

It may be a reasonable and desirable option that bioabsorbable implants combined with an external fixator be applied for treatment of severe open dislocated ankle fractures. (J Am Podiatr Med Assoc 101(4): 307–315, 2011)
The Use of Focused Electronic Medical Record Forms to Improve Health-care Outcomes
Authors: Caldwell Bryan D. , Katz Robert D. , Pascarella Eugene M.
Published: April 2014

Background:

We tested the use of specifically designed electronic medical record forms, thereby demonstrating the ability to electronically capture, report, and compare clinical data. To that end, podiatric physicians can determine what constitutes the most effective program or treatment for specific conditions by documenting their treatment outcomes.

Methods:

A prospective case series was initiated to determine the value of using focused electronic medical record forms to track walking programs in the practices of podiatric physicians. Three patients were observed for 48 weeks using focused electronic medical record forms to input data (body mass index, cholesterol level, hemoglobin A1c level, blood pressure, and other vital information). Patients were given pedometers so that they could log their mileage and their podiatric physicians could enter it into the medical record. Information was collected using an electronic medical record system with the ability to link multiple templates together and assign logic to create flexible entry completion requirements. The clinical data generated are captured in a common database, where the data offer future opportunity to compare statistics among a multitude of practices in various demographic regions.

Results:

Focused electronic medical record forms were effectively used to track improvements and overall health benefits in a walking program supervised by podiatric physicians.

Conclusions:

Valuable information can be ascertained with focused electronic medical record forms to help determine treatment effectiveness. This information can later be compared with practices across many different demographics to ascertain the best evidence-based practice. (J Am Podiatr Med Assoc 101(4): 331–334, 2011)
Changes in the Plantar Pressure Distribution During Gait Throughout Gestation
Authors: Ribeiro Ana Paula , Trombini-Souza Francis , de Camargo Neves Sacco Isabel , Ruano Rodrigo , Zugaib Marcelo , João Sílvia Maria Amado
Published: April 2014

Background:

The intention of this investigation was to longitudinally describe and compare the plantar pressure distribution in orthostatic posture and gait throughout pregnancy.

Methods:

A prospective longitudinal observational study was conducted with six pregnant women (mean ± SD age, 32 ± 3 years) with a mean ± SD weight gain of 10.0 ± 1.4 kg. Peak pressure, contact time, contact area, and maximum force in five plantar areas were evaluated using capacitive insoles during gait and orthostatic posture. For 1 year, the plantar pressures of pregnant women were evaluated the last month of each trimester. Comparisons among plantar areas and trimesters were made by analysis of variance.

Results:

For orthostatic posture, no differences in contact time, contact area, peak pressure, and maximum force throughout the trimesters were found. During gait, peak pressure and maximum force of the medial rearfoot were reduced from the first to third and second to third trimesters. Maximum force increased at the medial forefoot from the first to second trimester. Contact area increased at the lateral rearfoot from the second to third trimester and at the midfoot from the first to third trimester. Contact time increased at the midfoot and medial and lateral forefoot from the first to third trimester.

Conclusions:

Pregnant women do not alter plantar pressure during orthostatic posture, but, during gait, the plantar loads were redistributed from the rearfoot (decrease) to the midfoot and forefoot (increase) throughout pregnancy. These adjustments help maintain the dynamic stability of the pregnant woman during locomotion. (J Am Podiatr Med Assoc 101(5): 415–423, 2011)