bluuebunny/crossref_metadata_2025 huggingface dataset:
Diagnosis of Trichophyton rubrum from Onychomycotic Nail Samples Using Polymerase Chain Reaction and Calcofluor White Microscopy
Authors: Gupta Aditya K. , Zaman Muhammad , Singh Jagpal
Published: April 2014

Background: A high rate of false-negative dermatophyte detection is observed when the most common laboratory methods are used. These methods include microscopic observation of potassium hydroxide–digested nail clippings and culture methods using agar-based media supplemented with cycloheximide, chloramphenicol, and gentamicin to isolate dermatophytes. Microscopic detection methods that use calcofluor white staining or periodic acid–Schiff staining may also be substituted for and have previously been reported to be more sensitive than potassium hydroxide–digested nail clippings.

Methods:
Trichophyton rubrum infections were detected directly from nails in a double-round polymerase chain reaction assay that uses actin gene–based primers. This method was compared with detection of fungal hyphae by using calcofluor white fluorescence microscopy of nail samples collected from 83 patients with onychomycosis who were undergoing antifungal drug therapy.

Results: Twenty-six of 83 samples (31.3%) were found to be positive by calcofluor white fluorescence microscopy, and 21 of 83 samples (25.3%) yielded positive results for T rubrum when actin gene–based primers in a double-round polymerase chain reaction assay were used. When calcofluor white fluorescence microscopy and polymerase chain reaction assay were used, the combined detection was 46.9% compared with 31.3% when calcofluor microscopy and culture of nail samples on Sabouraud’s dextrose agar supplemented with cycloheximide, chloramphenicol, and gentamicin were used.

Conclusions: These results suggest that the use of a direct DNA protocol is an alternative method for detecting Trichophyton infections. When this protocol is used, the presence of T rubrum DNA is directly detected. However, the viability of the dermatophyte is not addressed, and further methods need to be developed for the detection of viable T rubrum directly from nail samples. (J Am Podiatr Med Assoc 98(3): 224–228, 2008)
Physical Evaluation of Insole Materials Used to Treat the Diabetic Foot
Authors: Faulí Angel Camp , Andrés Cristina Llobell , Rosas Norberto Porta , Fernández Maria José , Parreño Enrique Montiel , Barceló César Orgilés
Published: April 2014

Background: The selection of materials for the production of multilayer insoles for diabetic feet is a difficult task owing to the lack of technical information about these materials. Therefore, objective criteria were established for the selection of these materials.

Methods: Mechanical- and comfort-related tests for the mechanical characterization of different materials and their combinations were considered. These tests were conducted according to standardized test methods for polymeric cellular materials.

Results: Criteria for the use of cellular materials were obtained. The properties of accommodation, cushioning, and filling materials were established and the most adequate polymer nature for each of the three applications was identified. Variables that affect the properties of these material combinations were studied.

Conclusions: These test results will allow podiatrists to select insoles in a more objective way, thus achieving a more successful treatment for diabetic foot-related injuries. (J Am Podiatr Med Assoc 98(3): 229–238, 2008)
Pedal Presentation of Metastatic Invasive Squamous Cell Carcinoma of the Bladder
Authors: Dux Katherine E. , Sage Ronald A. , Gocke Sean P.
Published: April 2014

Squamous cell carcinoma is a malignant tumor of the squamous epithelium and can occur in many different organs. We present a case of a 61-year-old veteran with metastatic squamous cell carcinoma of the bladder with distal metastasis to the middle phalanx of the fourth toe, which is a rare occurrence in the literature. (J Am Podiatr Med Assoc 99(3): 251–253, 2009)
Granular Cell Tumor of the Posterior Tibial Nerve as a Rare Cause of Heel Pain
Authors: Dogramaci Yunus , Kalaci Aydiner , Sevinc Teoman Toni , Hakverdi Sibel , Canda Serefettin , Yanat Ahmet Nedim
Published: April 2014

Granular cell tumor of peripheral nerves is extremely rare. We present the case of a patient with a well-capsulated intraneural granular cell tumor involving the posterior tibial nerve, who presented with chronic heel pain mimicking plantar fasciitis. Magnetic resonance imaging revealed a well-defined intraneural soft-tissue mass within the substance of the posterior tibial nerve. Histopathologic examination showed a granular cell tumor, which is extremley rare in the peripheral nerves. Heel pain is one of the common conditions handled by physicians, podiatrists, and orthopedic surgeons. Posterior tibial nerve lesions at the leg should be kept in mind in the differential diagnosis of patients with persistent heel and foot pain. Magnetic resonance imaging is a useful method in the anatomical evaluation of focal intraneural lesions. (J Am Podiatr Med Assoc 99(3): 254–257, 2009)
Evidence-Based Podiatric Medicine
Authors: Hawke Fiona , Burns Joshua , Landorf Karl B.
Published: April 2014

Due to the exponential increase in the quantity and quality of podiatric medicine–related research during the past decade, podiatric physicians are inundated with an insurmountable volume of research relevant to clinical practice. Systematic reviews can refine this literature by using explicit, rigorous, and reproducible methods to identify, critically appraise, and synthesize the best evidence from all clinical trials to answer clearly defined clinical questions. The Cochrane Collaboration is an international not-for-profit organization created to improve the user-friendliness and accessibility of medical literature mainly through preparing and maintaining systematic reviews of health-care interventions. The Cochrane Library currently contains more than 50 podiatric medicine–relevant systematic reviews summarizing and synthesizing evidence from many hundreds of randomized controlled trials evaluating interventions for foot problems. Although more than 60 countries worldwide have open online access to The Cochrane Library, in the United States, only the state of Wyoming has free access to full-text reviews. In an era demanding an evidence-based approach for every clinical intervention, high-quality systematic reviews streamline podiatric medical literature by reducing the time, cost, and training necessary to establish a solid evidence base for practice. (J Am Podiatr Med Assoc 99(3): 260–266, 2009)
Plantar Pressures During Shod Gait in Diabetic Neuropathic Patients with and without a History of Plantar Ulceration
Authors: Sacco Isabel C. N. , Bacarin Tatiana Almeida , Canettieri Maíra Grizzo , Hennig Ewald M.
Published: April 2014

Background: Diabetic neuropathy leads to progressive loss of sensation, lower-limb distal muscle atrophy, autonomic impairment, and gait alterations that overload feet. This overload has been associated with plantar ulcers even with consistent daily use of shoes. We sought to investigate and compare the influence of diabetic neuropathy and plantar ulcers in the clinical history of diabetic neuropathic patients on plantar sensitivity, symptoms, and plantar pressure distribution during gait while patients wore their everyday shoes.

Methods: Patients were categorized into three groups: a control group (CG; n = 15), diabetic patients with a history of neuropathic ulceration (DUG; n = 8), and diabetic patients without a history of ulceration (DG; n = 10). Plantar pressure variables were measured by Pedar System shoe insoles in five plantar regions during gait while patients wore their own shoes.

Results: No statistical difference between neuropathic patients with and without a history of plantar ulcers was found in relation to symptoms, tactile sensitivity, and duration of diabetes. Diabetic patients without ulceration presented the lowest pressure–time integral under the heel (72.1 ± 16.1 kPa × sec; P = .0456). Diabetic patients with a history of ulceration presented a higher pressure–time integral at the midfoot compared to patients in the control group (59.6 ± 23.6 kPa × sec × 45.8 ± 10.4 kPa × sec; P = .099), and at the lateral forefoot compared to diabetic patients without ulceration (70.9 ± 17.7 kPa sec × 113.2 ± 61.1 kPa × sec, P = .0193). Diabetic patients with ulceration also presented the lowest weight load under the hallux (0.06 ± 0.02%, P = .0042).

Conclusions: Although presenting a larger midfoot area, diabetic neuropathic patients presented greater pressure–time integrals and relative loads over this region. Diabetic patients with ulceration presented an altered dynamic plantar pressure pattern characterized by overload even when wearing daily shoes. Overload associated with a clinical history of plantar ulcers indicates future appearance of plantar ulcers. (J Am Podiatr Med Assoc 99(4): 285–294, 2009)
Effect of Running Shoe Type on the Distribution and Magnitude of Plantar Pressures in Individuals with Low- or High-Arched Feet
Authors: Molloy Joseph M. , Christie Douglas S. , Teyhen Deydre S. , Yeykal Nancy S. , Tragord Bradley S. , Neal Matthew S. , Nelson Eric S. , McPoil Thomas
Published: April 2014

Background: Research addressing the effect of running shoe type on the low- or high-arched foot during gait is limited. We sought 1) to analyze mean plantar pressure and mean contact area differences between low- and high-arched feet across three test conditions, 2) to determine which regions of the foot (rearfoot, midfoot, and forefoot) contributed to potential differences in mean plantar pressure and mean contact area, and 3) to determine the association between the static arch height index and the dynamic modified arch index.

Methods: Plantar pressure distributions for 75 participants (40 low arched and 35 high arched) were analyzed across three conditions (nonshod, motion control running shoes, and cushioning running shoes) during treadmill walking.

Results: In the motion control and cushioning shoe conditions, mean plantar contact area increased in the midfoot (28% for low arched and 68% for high arched), whereas mean plantar pressure decreased by approximately 30% relative to the nonshod condition. There was moderate to good negative correlation between the arch height index and the modified arch index.

Conclusions: Cushioning and motion control running shoes tend to increase midfoot mean plantar contact area while decreasing mean plantar pressure across the low- or high-arched foot. (J Am Podiatr Med Assoc 99(4): 330–338, 2009)
The Short-term Effectiveness of Full-Contact Custom-made Foot Orthoses and Prefabricated Shoe Inserts on Lower-Extremity Musculoskeletal Pain
Authors: Trotter Leslie C. , Pierrynowski Michael Raymond
Published: April 2014

Background: Foot orthoses are commonly dispensed for musculoskeletal complaints of the foot and lower limb. Few randomized clinical trials evaluate the clinical effectiveness of foot orthoses.

Methods: In this randomized clinical trial with a crossover design, 42 participants wore custom orthoses and prefabricated inserts in their regular footwear for 4 weeks each, consecutively. Twenty-seven participants received prefabricated inserts first and 13 received custom orthoses first. A numeric pain rating scale (possible score, 0–10) was used to measure participant pain.

Results: Statistically and clinically important decreases in pain were reported after 3 weeks by participants wearing custom orthoses first (−1.39 pain units, t12 = 2.70, P = .02). Participants who wore prefabricated inserts first reported no statistically significant change in pain. When the alternative intervention was introduced, participants now wearing prefabricated inserts had greater pain after 1 and 2 weeks (1.1 pain units, t12 = 3.09, P = .01 and 0.9 pain units, t12 = 2.65, P = .02, respectively). Participants now wearing custom orthoses did not demonstrate significantly lower pain at any week compared with the second baseline but did have significantly lower pain scores compared with their initial baseline scores (−0.81 pain units, t12 = 2.31, P = .03).

Conclusion: Full-contact custom-made foot orthoses provide symptomatic relief after 3 weeks of use for patients with lower-extremity musculoskeletal pain if they are prescribed as the initial treatment. (J Am Podiatr Med Assoc 98(5): 357–363, 2008)
Dynamic Splinting for Runner’s Toe
Authors: John Mathew M. , Willis F. Buck , Portillo Alberto
Published: April 2014

We present a case report of runner’s hallux limitus and the effect of dynamic splinting in reducing contracture as measured by gait analysis. After 4 months of treatment with dynamic splinting, the patient regained 45° in active range of motion, and the gait analysis showed significant and beneficial changes. (J Am Podiatr Med Assoc 99(4): 367–370, 2009)
A Comparison of Rearfoot Motion Control and Comfort between Custom and Semicustom Foot Orthotic Devices
Authors: Davis Irene S. , Zifchock Rebecca Avrin , DeLeo Alison T.
Published: April 2014

Background: Motion control and comfort are primary objectives in orthotic intervention. Semicustom orthotic devices have been presented as a more cost-effective solution than custom orthotic devices. However, no studies have compared their function or comfort to that of custom orthotic devices.

Methods: Nineteen uninjured runners were fitted for custom and semicustom orthotic devices. Subjects underwent an instrumented gait analysis of running and walking in no-orthotic, custom orthotic, and semicustom orthotic conditions. Subjects completed visual analog scales for the custom and semicustom orthotic conditions. One-way repeated measures analyses of variance were performed on the rearfoot variables of peak eversion, eversion excursion, eversion duration, and eversion velocity. Two-tailed, dependent t tests were used to compare comfort.

Results: Eversion excursion showed significant differences between the conditions: during running, it was reduced in the custom orthotic as compared to the no-orthotic condition; during walking, it was reduced in the semicustom orthotic as compared to both the custom and no-orthotic conditions. The custom orthotic devices were significantly more comfortable (P < .05) than the semicustom devices in the area of the edges only.

Conclusion: The results suggest that, in uninjured individuals, there are few differences in rearfoot motion control and comfort between the custom and semicustom orthotic devices used in this study. (J Am Podiatr Med Assoc 98(5): 394–403, 2008)
Ischemic Contracture of Deep Posterior Compartment of the Leg Following Isolated Ankle Fracture
Authors: Hernández-Cortés Pedro , Pajares-López Miguel , Hernández-Hernández Miguel Angel
Published: April 2014

Compartment syndromes and ischemic contractures after ankle fractures are exceedingly rare. We report a case in which a Weber type-C ankle fracture resulted in an unrecognized compartment syndrome and ischemic contracture of deep posterior compartment of the leg. Six weeks after injury, the patient had an obvious deformity and clawing of the toes. The deformities were corrected by lengthening the flexor hallucis longus and the flexor digitorum longus. Full correction of all clawed toes was evident. A deep posterior compartment syndrome may follow an ankle fracture and should be considered in any patient with unrelenting pain in the immediate postoperative period. (J Am Podiatr Med Assoc 98(5): 404–407, 2008)
Congenital Clubfoot Associated with an Accessory Soleus Muscle
Authors: Karapinar Levent , Kaya Ahmet , Altay Taskin , Ozturk Hasan , Surenkok Fatih
Published: April 2014

A 16-month-old male with previously untreated bilateral clubfeet was admitted to S.B. Izmir Tepecik Education and Research Hospital, Izmir, Turkey. Both feet underwent surgical treatment. During surgery, an accessory soleus muscle was detected on the right side. The accessory soleus muscle had a distinct distal insertion at the superior anteromedial border of the calcaneus and also anterior and medial to the Achilles tendon. He was treated by bilateral complete subtalar release with Cincinnati incision, and the accessory soleus was also cut and the distal part resected. At the final follow-up visit, when the patient was 6 years and 9 months old, both feet had a normal appearance and appeared normal on radiograph and magnetic resonance imaging, with no presence of the accessory soleus muscle or its remnant. In our opinion, awareness of the association between an accessory soleus muscle and clubfoot, and sectioning of this muscle during surgery may improve surgical results. (J Am Podiatr Med Assoc 98(5): 408–413, 2008)
Effect of a Low-Dye Application of Scotchcast Soft Cast on Peak and Mean Plantar Pressures in Subjects with a Navicular Drop Greater than 10 mm
Authors: Walters Julie L. , Lange Belinda S. , Chipchase Lucy S.
Published: April 2014

Background: We investigated whether a low-Dye application of Scotchcast Soft Cast significantly altered plantar pressure distribution during gait in patients with a navicular drop greater than 10 mm.

Methods: An experimental, same-subject, repeated-measures design was used. Thirty-two subjects aged 18 to 35 years were screened with the navicular drop test and were included if a navicular drop greater than 10 mm was established. The Emed-AT-2 platform system was used to measure the plantar pressure distribution under the right foot of each subject using the midgait method of data collection. Each subject performed six barefoot walks and six walks with Soft Cast applied to the right foot. Average peak and mean plantar pressure measurements were recorded for ten discrete areas (masks). The heel and midfoot were each divided into two masks, and the forefoot and toe regions were divided into three masks each. Paired t tests were used to detect differences in peak and mean plantar pressures for each mask.

Results: Soft Cast significantly affected peak and mean plantar pressures in seven and nine of the ten masks, respectively. No significant change in peak or mean plantar pressure was found beneath the medial midfoot.

Conclusion: Plantar pressure may represent dynamic foot and ankle joint motion. With further research, Soft Cast may provide an alternative to current management techniques in controlling foot pronation and reducing symptoms of lower-limb abnormalities. (J Am Podiatr Med Assoc 98(6): 457–465, 2008)
Extracorporeal Shockwave Therapy for the Treatment of Achilles Tendinopathies
Authors: Fridman Robert , Cain Jarrett D. , Weil Lowell , Weil Lowell
Published: April 2014

Background: Extracorporeal shockwave therapy has been shown to be effective in the treatment of chronic tendon pathology in the elbow, shoulder, and plantar fascia. This prospective study examines the efficacy of extracorporeal shockwave therapy in the treatment of chronic Achilles tendon disorders.

Methods: Twenty-three patients (23 feet) were treated with extracorporeal shockwave therapy for Achilles tendinosis, insertional tendonitis, or both. Indications for treatment were a minimum of 6 months of conservative care, and a visual analog pain score > 5. The mean follow-up was 20 months (range, 4–35 months).

Results: Ninety-one percent (14 patients) were satisfied or very satisfied (23 patients) with treatment. Eighty-seven percent (20 patients) stated that extracorporeal shockwave therapy improved their condition, 13% (3 patients) said it did not affect the condition, and none stated that it made them worse. Eighty-seven percent (20 patients) stated they would have the procedure again if given the choice. Four months after extracorporeal shockwave therapy, the mean visual analog score for morning pain decreased from 7.0 to 2.3, and activity pain decreased from 8.1 to 3.1.

Conclusion: High-power extracorporeal shockwave therapy is safe, noninvasive, and effective, and it has a role in the treatment of chronic Achilles tendinopathy. (J Am Podiatr Med Assoc 98(6): 466–468, 2008)
Acute Traumatic Open Posterolateral Dislocation of the Ankle Without Tearing of the Tibiofibular Syndesmosis Ligaments
Authors: Demiralp Bahtiyar , Komurcu Mahmut , Ozturk Cagatay , Ozturan Kutay , Tasatan Ersin , Erler Kaan
Published: April 2014

Pure open dislocation of the ankle, or dislocation not accompanied by rupture of the tibiofibular syndesmosis ligaments or fractures of the malleoli or of the posterior border of the tibia, is an extremely rare injury. A 62-year-old man injured his right ankle in a motor vehicle accident. Besides posterolateral ankle dislocation, there was a 7-cm transverse skin cut on the medial malleolus, and the distal end of the tibia was exposed. After reduction, we made a 2- to 2.5-cm longitudinal incision on the lateral malleolus; the distal fibular fracture was exposed. Two Kirschner wires were placed intramedullary in a retrograde manner, and the fracture was stabilized. The deltoid ligament and the medial capsule were repaired. The tibiofibular syndesmosis ligaments were intact. At the end of postoperative year 1, right ankle joint range of motion had a limit of approximately 5° in dorsiflexion, 10° in plantarflexion, 5° in inversion, and 0° in eversion. The joint appeared normal on radiographs, with no signs of osteoarthritis or calcification. The best result can be obtained with early reduction, debridement, medial capsule and deltoid ligament restoration, and early rehabilitation. Clinical and radiographic features at long-term follow-up also confirm good mobility of the ankle without degenerative change or mechanical instability. (J Am Podiatr Med Assoc 98(6): 469–472, 2008)
Penicillin and Cephalosporin Drug Allergies
Authors: Smith Robert G.
Published: April 2014

Medication hypersensitivity is a constant variable that podiatric physicians face during their professional day. To avoid potential patient harm, an understanding of penicillin and cephalosporin hypersensitivities as it pertains to podiatric medicine needs to be achieved. To accomplish this, a narrative describing the signs, symptoms, and immunologic mechanisms for the basis of penicillin and cephalosporin drug hypersensitivities is presented. Second, specific medical literature serving as clinical-based evidence to support the prescribing of cephalosporins in patients with documented penicillin allergy is presented. Finally, a review of the medical and legal literature describing health-care provider liability regarding subsequent drug hypersensitivity is presented. The information contained in this review allows for the evolving paradigm that permits the prescribing of selective cephalosporins to patients with a history of penicillin allergy as long as the allergic symptoms were not serious or life-threatening. (J Am Podiatr Med Assoc 98(6): 479–488, 2008)
An Assessment of Strapping Techniques Commonly Used for Pronated Foot Deformities
Authors: Carter Kate , Chockalingam Nachiappan
Published: April 2014

Background: This study investigated the effects of two low-Dye and two high-Dye strapping techniques that are commonly used to treat pronatory sequelae.

Methods: Plantar pressure distribution in normal adults with a pronated foot type was assessed with a commercially available pressure platform system. Twenty study participants first walked across the platform barefoot and then with each of the four strapping conditions applied. The footprints were averaged and divided into seven areas for analysis.

Results: Paired t tests found significant differences between the barefoot and strapping conditions. Overall, there was a general lateralization of pressures indicating an antipronation effect from all strapping conditions. Low-Dye strap 2, used to limit the degree of calcaneal eversion, produced the most significant changes at the foot pressure areas analyzed.

Conclusions: The data reported in this study suggest that the four strapping techniques offer different levels of control, and this should be considered during the decision-making process and clinical management of pronatory conditions. It was the contention of this study that low-Dye strap 2 was the most effective strapping technique to control foot mechanics associated with a pronated foot type. (J Am Podiatr Med Assoc 99(5): 391–398, 2009)
A Two-Portal Posterior Endoscopic Approach in the Treatment of a Complex Talus Fracture
Authors: Ogut Tahir , Seyahi Aksel , Aydingoz Onder , Bilsel Nafiz
Published: April 2014

The two-portal hindfoot endoscopy is a relatively new technique that is becoming increasingly popular. It gives excellent access to the posterior ankle compartment, the subtalar joint, and extra-articular structures. We report a 24-year-old man with a complex talus fracture involving the posterior part of the talar body and posterolateral process. He was treated endoscopically, with a two-portal posterior approach to the hindfoot. This approach allowed a better visualization and treatment of accompanying pathologies. Combined excision of the posterolateral process and fixation of the fracture was performed with the two-portal hindfoot endoscopy, which has not been previously described to our knowledge. The two-portal posterior endoscopic approach can be an attractive treatment alternative for the posterior part fractures of the talus, which can in turn, be a new indication for this technique. (J Am Podiatr Med Assoc 99(5): 443–446, 2009)
Use of Low-Frequency Electrical Stimulation for the Treatment of Plantar Fasciitis
Authors: Stratton Michael , McPoil Thomas G. , Cornwall Mark W. , Patrick Kyle
Published: April 2014

Background: Recent research has discussed the use of low-frequency electrical stimulation to increase blood flow by eliciting muscular contraction in soft tissues. This randomized clinical trial examined the efficacy of low-frequency electrical stimulation combined with stretching exercises and foot orthoses in individuals diagnosed as having plantar fasciitis for less than 6 months.

Methods: Twenty-six participants aged 18 to 65 years diagnosed as having plantar fasciitis were randomly assigned to two treatment groups: a control group receiving only stretching and orthoses and a treatment group receiving low-frequency electrical stimulation in addition to stretching and orthoses. To assess treatment response, a visual analog scale was used to determine first-step morning pain, and changes in daily activity levels were monitored by using a validated outcome measure. All of the participants were assessed before starting treatment, after 4 weeks of treatment, and 3 months after the conclusion of treatment.

Results: Participants in the control and experimental groups demonstrated pain reduction and improvements in functional activity levels after 4 weeks and 3 months.

Conclusions: Regardless of whether low-frequency electrical stimulation was used as an intervention, the use of plantar fascia–specific stretching and prefabricated foot orthoses provided short-term (3-month) pain relief and improvement in functional activity levels. (J Am Podiatr Med Assoc 99(6): 481–488, 2009)
Plantar Pressures in Children With and Without Sever’s Disease
Authors: Becerro de Bengoa Vallejo Ricardo , Losa Iglesias Marta Elena , Rodríguez Sanz David , Prados Frutos Juan Carlos , Salvadores Fuentes Paloma , Chicharro José López
Published: April 2014

Background: A case-control study was conducted to compare static plantar pressures and distribution of body weight across the two lower limbs, as well as the prevalence of gastrocnemius soleus equinus, in children with and without calcaneal apophysitis (Sever’s disease).

Methods: The participants were 54 boys enrolled in a soccer academy, of which eight were lost to follow-up. Twenty-two boys with unilateral Sever’s disease comprised the Sever’s disease group and 24 healthy boys constituted a control group. Plantar pressure data were collected using pedobarography, and gastrocnemius soleus equinus was assessed.

Results: Peak pressure and percentage of body weight supported were significantly higher in the symptomatic feet of the Sever’s disease group than in the asymptomatic feet of the Sever’s disease group and the control group. Every child in the Sever’s disease group had bilateral gastrocnemius equinus, while nearly all children in the control group had no equinus.

Conclusions: High plantar foot pressures are associated with Sever’s disease, although it is unclear whether they are a predisposing factor or a result of the condition. Gastrocnemius equinus may be a predisposing factor for Sever’s disease. Further research is needed to identify other factors involved in the disease and to better understand the factors that contribute to abnormal distribution of body weight in the lower limbs. (J Am Podiatr Med Assoc 101(1): 17–24, 2011)
Extra-abdominal Desmoid Fibromatosis in the Foot
Authors: MacGill Alan A. , Milione Vincent R. , Sullivan Laura G.
Published: April 2014

Extra-abdominal desmoid tumors account for 0.03% of all neoplasms and rarely present in the foot. They are benign but locally aggressive, and wide local surgical excision is the treatment of choice owing to the high rate of recurrence in the lower extremities. Invasiveness into the surrounding soft-tissue structures often makes wide excision difficult without compromise of function. We describe a 34-year-old woman with a large, pedal, extra-abdominal desmoid fibroma treated by wide local surgical excision with minimal complications postoperatively and no clinical evidence of recurrence at 28 months. (J Am Podiatr Med Assoc 101(1): 70–74, 2011)
Giant Cell Tumor of the Flexor Hallucis Longus Tendon Sheath
Authors: Findling Jeff , LaScola Natalie K. , Groner Thomas W.
Published: April 2014

Giant cell tumor of tendon sheath is infrequently documented in the foot and even less near the ankle. This case report involves such a tumor of the flexor hallucis longus tendon presenting at the posterior ankle. Diagnosis was aided by magnetic resonance imaging, and treatment consisted of complete surgical excision. Pathologic examination verified the diagnosis of giant cell tumor of tendon sheath, and follow-up magnetic resonance imaging revealed no remnants or recurrence of tumor 1 year after surgery. (J Am Podiatr Med Assoc 101(2): 187–189, 2011)
Human Digit Partially Consumed by a Canine During Sleep in a Patient with Neuropathy and Diabetes
Authors: Rogers Lee C. , Bevilacqua Nicholas J.
Published: April 2014

A traumatic amputation of a digit as a result of canine mastication and ingestion occurred in a 48-year-old woman with type 2 diabetes and peripheral neuropathy. The injury occurred during sleep and was not felt by the patient. The dangers of sleeping with one’s canine for those with neuropathic wounds are presented, and the literature is reviewed. (J Am Podiatr Med Assoc 101(3): 275–276, 2011)
Prevalence of Podiatric Medical Problems in Veterans versus Nonveterans
Authors: Shibuya Naohiro , Jupiter Daniel C. , Ciliberti Louis J. , VanBuren Vincent , La Fontaine Javier
Published: April 2014

Background:

Lower-extremity pathologic abnormalities have been common in military recruits for many years. Many of these conditions can become chronic and persist even after retiring from military service. We hypothesized that certain foot abnormalities are more prevalent in veterans versus nonveterans. The purpose of this study was to evaluate what foot and ankle disorders are associated with veteran status while controlling for other demographic factors.

Methods:

The National Health Interview Survey (Podiatry Supplement) from 1990 was used for this secondary data analysis. The data were divided into veterans and nonveterans, and the prevalence of podiatric medical problems, including callus, flatfoot deformity, bunion deformity, hammer toe deformity, arthritis, and sprain, was evaluated for each group.

Results:

Flatfoot deformity and arthritis were significantly more prevalent in veterans versus nonveterans in the United States. Bunion deformity was significantly more prevalent in male veterans than in male nonveterans. Male veterans were less likely than male nonveterans to have sprains, and female veterans were more likely than their nonveteran counterparts to have sprains.

Conclusions:

These results may help us understand the potential risk factors for podiatric medical problems and may be used for formulating prevention programs. (J Am Podiatr Med Assoc 101(4): 323–330, 2011)
Tungiasis in a Beach Volleyball Player
Authors: Veraldi Stefano , Persico Maria Chiara , Valsecchi Marta
Published: April 2014

Tungiasis is an infestation caused by penetration of the skin by the gravid female of the flea Tunga penetrans Linnaeus 1758 (Insecta, Siphonaptera: Tungidae). Tunga penetrans is currently found in Central and South America, sub-Saharan Africa, and Central Asia. Prevalence is very high in Brazil. We present a case of tungiasis in an Italian beach volleyball player who acquired the infestation in Brazil. (J Am Podiatr Med Assoc 101(4): 353–355, 2011)
The Symptomatic Os Vesalianum as an Uncommon Cause of Lateral Foot Pain
Authors: Wilson Thomas C. , Wilson Richard C. , Ouzounov Kaloian G.
Published: April 2014

The os vesalianum is an uncommon pedal accessory bone located lateral to the fifth metatarsal base. It may occasionally become symptomatic and require surgical excision, as in the case reported here in a 24-year-old woman. Simple excision of the ossicle, while effective in the present case, can be complicated by the attachment of fibers of the peroneus brevis tendon into the ossicle, thus requiring careful tenorraphy and sometimes tenodesis. (J Am Podiatr Med Assoc 101(4): 356–359, 2011)
The Correlation Between Plantar Fascia Thickness and Symptoms of Plantar Fasciitis
Authors: Mahowald Sarah , Legge Bradford S. , Grady John F.
Published: April 2014

Background:

The purpose of this study was to determine whether changes in plantar fascia thickness are a reliable gauge of efficacy of treatment protocols for plantar fasciitis.

Methods:

Thirty-nine feet (30 patients) with plantar fasciitis received an ultrasound examination to measure the thickness of the medial band of the plantar fascia. Each patient assessed his or her pain using the visual analogue scale. Following various treatments, a second ultrasound examination was performed and the thickness of the plantar fascia was again measured and subjective pain level assessed.

Results:

Twenty-nine feet (74.4%) showed a decrease in plantar fascia thickness and a decrease in pain. One foot (2.6%) experienced an increase in fascia thickness and reported an increase in pain. Four feet (10.3%) had an increase in thickness of the plantar fascia and reported no change in pain level. Three feet had minor increases in fascia thickness but reported a decrease in pain (7.7%). One foot (2.6%) had no change in fascia thickness but a decrease in pain and one foot (2.6%) had a decrease in the plantar fascia but no change in pain level. The average reduction in fascia thickness was 0.82 mm ±1.04 mm, correlating with an average improvement in pain of 3.64 ± 2.7 (P < 0.005).

Conclusions:

This study provides evidence that changing thickness of the plantar fascia is a valid objective measurement to assess effectiveness of new or existing treatment protocols. (J Am Podiatr Med Assoc 101(5): 385–389, 2011)
The In Vitro Reliability of the CODA MPX30 as the Basis for a Method of Assessing the In Vivo Motion of the Subtalar Joint
Authors: Birch Ivan , Deschamps Kevin
Published: April 2014

Background:

The considerable variation in subtalar joint structure and function shown by studies indicates the importance of developing a noninvasive in vivo technique for assessing subtalar joint movement. This article reports the in vitro testing of the CODA MPX30, an active infrared marker motion analysis system. This work represents the first stage in the development of a noninvasive in vivo method for measuring subtalar joint motion during walking.

Methods:

The in vitro repeatability of the CODA MPX30 system’s measurements of marker position, simple and intermarker set angles, was tested. Angular orientations of markers representing the position of the talus and the calcaneus were measured using a purpose-designed marker placement model.

Results:

Marker location measurements were shown to vary by less than 1.0 mm in all of the planes. The measurement of a 90° angle was also found to be repeatable in all of the planes, although measurements made in the yz plane were shown to be consistently inaccurate (mean, 92.47°). Estimation of segmental orientation was found to be repeatable. Estimations of marker set orientations were shown to increase in variability after a coordinate transform was performed (maximum SD, 1.14°).

Conclusions:

The CODA MPX30 was shown to produce repeatable estimations of marker position. Levels of variation in segmental orientation estimates were shown to increase subsequent to coordinate transforms. The combination of the CODA MPX30 and an appropriate marker placement model offers the basis of an in vivo measurement strategy of subtalar joint movement, an important development in the understanding of the function of the joint during gait. (J Am Podiatr Med Assoc 101(5): 400–406, 2011)
Interrater and Intrarater Reliability in the Measurement of Ankle Joint Dorsiflexion is Independent of Examiner Experience and Technique Used
Authors: Kim Paul Jeong , Peace Ruth , Mieras Jamie , Thoms Tanya , Freeman Denise , Page Jeffrey
Published: April 2014

Background:

Goniometric measurement is currently being used as a diagnostic and outcomes assessment tool for ankle joint dorsiflexion. Despite its common use, its interrater and intrarater reliability has been questioned.

Methods:

This is a prospective study examining whether the experience of the examiner or the technique used affects the interrater and intrarater reliability for measuring ankle joint dorsiflexion. Fourteen asymptomatic individuals (8 male and 6 female) with a mean age of 28.2 years (range, 23–52) were enrolled into this study. The years of clinical experience of the five examiners averaged 10.4 years (range, 0–26). Four examiners used a modified Root, Weed and Orien method of measuring ankle joint dorsiflexion. The fifth examiner utilized a nonstandardized technique. A standard goniometer was used for bilateral measurements of ankle joint dorsiflexion with the knee extended and flexed. All five examiners repeated each measurement three times during each of the three sessions, with each session spaced at least 1 week apart.

Results:

The interclass correlation coefficient reveals a moderate intrarater and poor interrater reliability in ankle joint dorsiflexion measurements using a standard goniometer. More importantly, further analysis indicates that the use of a standardized technique for measurement of ankle joint dorsiflexion or years of clinical experience does not increase the intrarater or interrater reliability.

Conclusions:

The utility of the goniometric measurement of ankle joint dorsiflexion may be limited. (J Am Podiatr Med Assoc 101(5): 407–414, 2011)
Relationship Between the Size of Bone Marrow Edema of the Talus and Ankle Pain
Authors: Tonbul Murat , Guzelant Aliye Yildirim , Gonen Aysun , Baca Emre , Ozbaydar Mehmet U.
Published: April 2014

Background:

We sought to determine the changes in the size of the edema observed on MRI scans and its relation to the patient’s pain during activity and pain during rest in bone marrow edema.

Methods:

A total of 26 patients were followed up at 3-month intervals for a period of 1 year. During the follow-ups, magnetic resonance imaging scans of the patients’ ankles were obtained; the scores obtained on the American Orthopaedic Foot and Ankle Society functional rating scale and visual analog scale were determined. The changes in these parameters and the correlation between them were examined.

Results:

The size of the edema as observed on magnetic resonance imaging scans decreased, and the pain during activity and rest decreased. Although there is a correlation between the decrease in the edema size observed on magnetic resonance imaging scans and decrease in the pain during activity, there is no correlation between the decrease in the edema size observed on magnetic resonance imaging scans and the decrease in pain during rest.

Conclusions:

Patients can be informed more precisely, that the pain during rest and activity may not decrease after the third and sixth month, respectively. Magnetic resonance imaging may not alter after the ninth month, so it may not be necessary to be performed again. (J Am Podiatr Med Assoc 101(5): 430–436, 2011)
In-shoe Plantar Pressure Distribution in Nonneuropathic Type 2 Diabetic Patients in Singapore
Authors: Tong Jasper W. K. , Acharya U. Rajendra , Chua Kuang C. , Tan Peck H.
Published: April 2014

Background:

We sought to establish the in-shoe plantar pressure distribution during normal level walking in type 2 diabetic patients of Chinese, Indian, and Malay descent without clinical evidence of peripheral neuropathy.

Methods:

Thirty-five patients with type 2 diabetes mellitus without loss of tactile sensation and foot deformities and 38 nondiabetic individuals in a control group had in-shoe plantar pressures collected. Maximum peak pressure and peak pressure-time integral of each foot were analyzed as separate variables and were masked into 13 areas. Differences in pressure variables were assessed by analysis of covariance, adjusting for relevant covariates at the 95% confidence interval.

Results:

No significant differences were noted in maximum peak pressures after adjusting for sex, race, age, height, and body mass. However, patients with diabetes mellitus had significantly higher mean ± SD pressure-time integrals at the right whole foot (309.50 ± 144.17 kPa versus 224.06 ± 141.70 kPa, P < .05) and first metatarsal (198.65 ± 138.27 kPa versus 121.54 ± 135.91 kPa, P < .05) masked areas than did those in the control group after adjustment.

Conclusions:

Patients without clinical observable signs of foot deformity (implying absence of motor neuropathy) and sensory neuropathy had similar in-shoe maximum peak pressures as controls. This finding supported the notion that either component of neuropathy needs to be present before plantar pressures are elevated. Patients with diabetes mellitus demonstrated greater pressure-time integrals, implying that this variable might be the first clinical sign observable even before peripheral neuropathy could be tested. (J Am Podiatr Med Assoc 101(6): 509–516, 2011)
Surgical Treatment of Diaphyseal Stress Fractures of the Fifth Metatarsal in Competitive Athletes
Authors: Pecina Marko , Bojanic Ivan , Smoljanovic Tomislav , Ivkovic Alan , Mirkovic Maja , Jelic Miroslav
Published: April 2014

Background:

Proximal diaphyseal stress fractures of the fifth metatarsal are common in athletes. Conservative treatment has been shown to result in high rates of delayed union, nonunion, and refracture, so internal fixation has become the treatment of choice in competitive athletes.

Methods:

Twenty top-level athletes with diaphyseal stress fractures fixed with intramedullary malleolar screws were evaluated. Functional outcome was assessed by American Orthopaedic Foot and Ankle Society midfoot score. Static and dynamic maximum vertical force and peak plantar pressures were evaluated with a computerized pedobarograph.

Results:

Mean follow-up from surgery to interview was 10.3 years (range, 3.5–19.0 years). Clinical healing was 95%, and there has been one refracture (5%). The mean time from surgery to return to sport was 9 weeks (range, 5–14 weeks). Twelve athletes (60%) returned to a higher level of training, 7 (35%) to the same level, and 1 (5%) to a lower level compared with the level of training before injury. Average American Orthopaedic Foot and Ankle Society midfoot score was 93.8 (range, 85–100). During the computerized pedobarographic evaluations, 18 patients (90%) presented with varus of the metatarsus and the midfoot and 2 (10%) presented with a normal plantigrade foot.

Conclusions:

Intramedullary malleolar screws can yield reliable and effective healing of fifth metatarsal stress fractures in athletes. Varus of the metatarsus and the midfoot were predisposing factors for stress fractures in this population of competitive athletes, and all were recommended to wear orthoses until their competitive careers were completed. (J Am Podiatr Med Assoc 101(6): 517–522, 2011)
The Medial Oblique Shell Inclination Technique
Authors: Harradine Paul , Collins Simon , Webb Chris , Bevan Lawrence
Published: April 2014

A medially deviated axis has been cited as an etiologic factor in increasing pronatory moments across the subtalar joint axis. Orthoses are often used to reduce these pronatory moments, aiming to off-load related injured structures. By aligning the posting or incline of an orthosis shell medial to the axis and parallel to it, the amount of moments applied will be theoretically greater than if prescribed at a less-than-optimal angle. We first published the medial oblique shell inclination as a method to increase supinatory moments to a medially deviated subtalar joint axis in 2008. This paper summarizes the theoretical reasons for use and introduces original methods of construction. (J Am Podiatr Med Assoc 101(6): 523–530, 2011)
Fear of Falling Is Prevalent in Older Adults with Diabetes Mellitus But Is Unrelated to Level of Neuropathy
Authors: Kelly Carolyn , Fleischer Adam , Yalla Sai , Grewal Gurtej S. , Albright Rachel , Berns Dana , Crews Ryan , Najafi Bijan
Published: April 2014

Background:

Patients with diabetic peripheral neuropathy (DPN) demonstrate gait alterations compared with their nonneuropathic counterparts, which may place them at increased risk for falling. However, it is uncertain whether patients with DPN also have a greater fear of falling.

Methods:

A voluntary group of older adults with diabetes was asked to complete a validated fear of falling questionnaire (Falls Efficacy Scale International [FES-I]) and instructed to walk 20 m in their habitual shoes at their habitual speed. Spatiotemporal parameters of gait (eg, stride velocity and gait speed variability) were collected using a validated body-worn sensor technology. Balance during walking was also assessed using sacral motion in the mediolateral and anteroposterior directions. The level of DPN was quantified using vibration perception threshold from the great toe.

Results:

Thirty-four diabetic patients (mean ± SD: age, 67.6 ± 9.2 years; body mass index, 30.9 ± 5.7; hemoglobin A1c, 7.9% ± 2.3%) with varying levels of neuropathy (mean ± SD vibration perception threshold, 34.6 ± 22.9 V) were recruited. Most participants (28 of 34, 82%) demonstrated moderate to high concern about falling based on their FES-I score. Age (r = 0.6), hemoglobin A1c level (r = 0.39), number of steps required to reach steady-state walking (ie, gait initiation) (r = 0.4), and duration of double support (r = 0.44) were each positively correlated with neuropathy severity (P < .05). Participants with a greater fear of falling also walked with slower stride velocities and shorter stride lengths (r = −0.3 for both, P < .05). However, no correlation was observed between level of DPN and the participant’s actual concern about falling.

Conclusions:

Fear of falling is prevalent in older adults with diabetes mellitus but is unrelated to level of neuropathy. (J Am Podiatr Med Assoc 103(6): 480–488, 2013)