bluuebunny/crossref_metadata_2025 huggingface dataset:
Ultrasound Assessment of Dorsal Lisfranc Ligament Strain Under Clinically Relevant Loads
Authors: Graves Nathan C. , Rettedal David D. , Marshall Joshua J. , Frush Katherine , Vardaxis Vassilios
Published: April 2014

Background

Pure Lisfranc ligament injuries have a varied clinical presentation, making them difficult to diagnose. This study seeks to understand in vivo strain characteristics of the dorsal Lisfranc ligament under clinically relevant stress loads and foot orientations measured by ultrasound.

Methods

Randomized ultrasound imaging trials were performed on 50 asymptomatic feet of 20-to-32-year-old individuals who were free of lower-extremity abnormalities. The dorsal Lisfranc ligament was ultrasound imaged under low, medium, and high stress while at 0° and 15° abducted foot orientations. Load was applied using a seated calf-raise apparatus, and a single examiner performed all of the tests. Two-way repeated-measures analysis of variance was used to determine any significant load or position main effects or load × position interaction.

Results

Position main effect for dorsal Lisfranc ligament length demonstrated a significant overall increase in ligament length of 0.21 mm (P < .001), which reflects a 4.03% change in ligament length between the rectus and 15° abducted orientations. Furthermore, low and medium loads demonstrated significant length increase with position effect (P = .03 and P < .001, respectively). No significant load main effect or interaction was determined.

Conclusions

Dorsal Lisfranc ligament length undergoes more strain in an abducted foot position at the same load compared with in a rectus foot. We advocate measuring under a medium load if possible and comparing foot positions for the maximum length changes. The participant stress loads and foot positions used are clinically feasible, which makes it possible to perform this ultrasound procedure in the clinical setting.
Topical Treatment of Onychomycosis as a Realistic Option to Systemic Therapy
Authors: Gupta Aditya K.
Published: April 2014

Onychomycosis is a very common disease, especially in podiatric medical practice. It can be associated with significant patient distress, major disability and pain, and is challenging to treat successfully. This is a case study of a 41-year-old man with distal lateral subungual onychomycosis of 5 years' duration. Forty percent of the great toenail was affected and a total of six toenails were involved. Baseline fungal cultures were positive for Trichophyton rubrum. This patient was treated with efinaconazole 10% solution, a new topical antifungal, once daily for 48 weeks. Mycological cure was noted at the first assessment period (12 weeks), and compete cure was seen at follow-up. This case study alerts physicians to a promising new topical treatment for onychomycosis under development, and to the importance of mycological cure as an early indicator of treatment success.
Recognizing the Prevalence of Changing Adult Foot Size
Authors: Connolly John E. , Wrobel James S.
Published: April 2014

Ill-fitting shoes may precipitate up to half of all diabetes-related amputations and are often cited as a leading cause of diabetic foot ulcers (DFU), with those patients being 5 to 10 times more likely to present wearing improperly fitting shoes. Among patients with prior DFU, those who self-select their shoe wear are at a three-fold risk for reulceration at 3 years versus those patients wearing prescribed shoes. Properly designed and fitted shoes should then address much of this problem, but evidence supporting the benefit of therapeutic shoe programs is inconclusive. The current study, performed in a male veteran population, is the first such effort to examine the prevalence and extent of change in foot length affecting individuals following skeletal maturity. Nearly half of all participants in our study experienced a ≥1 shoe size change in foot length during adulthood. We suggest that these often unrecognized changes may explain the broad use of improperly sized shoe wear, and its associated sequelae such as DFU and amputation. Regular clinical assessment of shoe fit in at-risk populations is therefore also strongly recommended as part of a comprehensive amputation prevention program.
Efficacy of Magnetic Resonance Imaging in Diagnosing Osteomyelitis in Diabetic Foot Ulcers
Authors: Fujii Miki , Terashi Hiroto , Tahara Shinya
Published: April 2014

Background

The clinical diagnosis of osteomyelitis is difficult because of neuropathy, vascular disease, and immunodeficiency; also, with no established consensus on the diagnosis of foot osteomyelitis, the reported efficacy of magnetic resonance imaging (MRI) in detecting osteomyelitis and distinguishing it from reactive bone marrow edema is unclear. Herein, we describe a retrospective study on the efficacy of MRI for decision-making accuracy in diagnosing osteomyelitis in diabetic foot ulcers.

Methods

Twelve diabetic patients with infected foot ulcers underwent preoperative MRI between January 1, 2008, and December 31, 2011. The findings were compared with the histopathologic features of 67 parts of 45 resected bones, the cut ends of which were also histopathologically evaluated.

Results

Osteomyelitis was disclosed by MRI and histopathologically confirmed in 30 parts. In contrast, bone marrow edema diagnosed by MRI in 29 parts was confirmed in 23; the other six parts displayed osteomyelitis. Among 17 resected bones, 13 cut ends displayed bone marrow edema and four were normal. All of the wounds healed uneventfully.

Conclusions

In the diagnosis of diabetic foot ulcers, osteomyelitis is often reliably distinguished from reactive bone marrow edema, except in special cases.
Morphofunctional Study of Brachymetatarsia of the Fourth Metatarsal
Authors: Munuera Martínez Pedro V. , Lafuente Sotillos Guillermo , Domínguez Maldonado Gabriel , Salcini Macías José Luis , Martínez Camuña Luis
Published: April 2014

Brachymetatarsia is abnormal anatomical shortness of the metatarsals. We describe a new diagnostic test that enables quantification of the shortening of the fourth metatarsal in brachymetatarsia. The metatarsodigital alterations most frequently related to this deformity are presented. (J Am Podiatr Med Assoc 94(4): 347–352, 2004)
Manipulation of the Ankle as a Method of Treatment for Ankle and Foot Pain
Authors: Dananberg Howard J.
Published: April 2014

This article presents a series of case reports to describe the technique of ankle joint manipulation and its effects on common problems of the foot and ankle. The relationship between motion and pain is described, as are the effects of muscular inhibition on the presence of joint restriction and their association with pain in various joints remote to the ankle joint. (J Am Podiatr Med Assoc 94(4): 395–399, 2004)
Modified Z-Osteotomy of the Hallux
Authors: Shrum Dale G.
Published: April 2014

This article describes a proximal phalangeal osteotomy for the correction of abductus deformity of the hallux. The modification uses a Z-osteotomy, which retains the length of the hallux, corrects the abductus component, and provides excellent rigid internal fixation. This procedure may be used only in mild-to-moderate cases. (J Am Podiatr Med Assoc 94(4): 404–408, 2004)
Reliability and Validity of Clinically Assessing First-Ray Mobility of the Foot
Authors: Cornwall Mark W. , Fishco William D. , McPoil Thomas G. , Lane Camilla Rae , O'Donnell Deborah , Hunt Lea
Published: April 2014

The objective of the present study was to determine the amount of agreement among three clinicians in the clinical assessment of dorsal mobility of the foot’s first ray and the agreement between their assessments and that of a mechanical device designed to quantify first-ray mobility. Sixty feet from 30 individuals evaluated clinically by three health-care professionals were classified as having a hypomobile, normal, or hypermobile first ray. The amount of first-ray dorsal mobility of each participant’s foot was then measured using a device specifically constructed for that purpose. The results of this study show generally poor agreement among the three clinicians on whether a foot should be classified as having hypomobility, hypermobility, or normal mobility of the first ray. The amount of agreement with the quantitative device was poor for two of the clinicians and moderate for the third clinician. (J Am Podiatr Med Assoc 94(5): 470–476, 2004)
Anatomy, Biomechanics, and Surgical Approach to Synovial Folds Within the Joints of the Foot
Authors: Lidtke Roy H. , George Joe
Published: April 2014

The presence of synovial folds in various joints of the foot has been previously documented. The function and clinical significance of these structures within the joint have not been established. Histologically they are considered anatomically different from a meniscus primarily owing to their makeup of loose connective tissue with nerve fibrils and several synovial cell layers. We hypothesize that the function of these folds is similar to that of the menisci: to increase joint congruity and stability. We further hypothesize that these folds will be present in joints of the foot that require greater stability. To demonstrate this, 41 fixated cadaveric feet were sectioned in the sagittal plane and the incidence and locations of the synovial folds were documented. Three fixated cadaveric feet were evaluated using a materials testing machine. The first metatarsophalangeal joint was incised, and the presence of the synovial fold was documented. The joint was then taken through its range of motion with and without the synovial fold while data on the force and displacement were collected. The steps were then repeated for the ankle joint. The results showed statistically stiffer ankle and first metatarsophalangeal joints with the synovial fold present, as determined by the stress-strain curve. On the basis of the presence and location of these synovial folds, we demonstrated arthroscopic surgical approaches to many of the documented joints that contain these folds. Because the folds contain synovial cells and vascular tissue, damage to them can result in considerable pain. In such cases, arthroscopic surgery would be of benefit. Further research may indicate whether they need to be salvaged during joint procedures to facilitate normal joint function or should be removed to reduce postoperative complications. (J Am Podiatr Med Assoc 94(6): 519–527, 2004)
Low-Voltage Direct Current as a Fungicidal Agent for Treating Onychomycosis
Authors: Kalinowski Douglas P. , Edsberg Laura E. , Hewson Robert A. , Johnson Robert H. , Brogan Michael S.
Published: April 2014

Onychomycosis, most commonly caused by two species of dermatophyte fungi—Trichophyton rubrum and Trichophyton mentagrophytes—is primarily treated with regimens of topical and systemic antifungal medications. This study was undertaken to evaluate in vitro the efficacy of low-voltage direct current as an antifungal agent for treating onychomycosis. Agar plate cultures of T rubrum and T mentagrophytes were subjected to low-voltage direct current electrostimulation, and antifungal effects were observed as zones in the agar around the electrodes lacking fungal growth. Zones devoid of fungal growth were observed for T rubrum and T mentagrophytes around anodes and cathodes in a dose-dependent manner in the current range of 500 μA to 3 mA. Low-voltage direct current electrostimulation has great clinical potential for the treatment of onychomycosis and perhaps other superficial maladies of fungal etiology. (J Am Podiatr Med Assoc 94(6): 565–572, 2004)
Reconstruction of the Great Toe Ski-Slope, Sunken-Nail Deformity with a Buried Adipofascial Flap
Authors: Roukis Thomas S. , Landsman Adam S.
Published: April 2014

Development of a ski-slope deformity following loss of the great toe nail plate is a problematic condition with few conservative or surgical options available. The condition becomes more difficult to treat when the distal, medial, and lateral labial nail folds are hypertrophied, creating the appearance of a sunken nail. We present a case of ski-slope, sunken-nail deformity following multiple attempts at chemical nail matrixectomy. The patient’s persistent pain and deformity were managed through 1) nail plate avulsion and complete surgical excision of the germinal nail matrix, 2) remodeling of the distal phalanx, and 3) elevation of an adipofascial flap from the plantar tuft of the great toe, which was brought from plantar to dorsal and interposed between the dorsal aspect of the distal phalanx and the overlying nail bed in buried fashion. The combination of these procedures elevated the nail bed, which restored normal architecture to the great toe and relieved the pain associated with the chronic deformity. This case demonstrates a potential complication of a commonly performed procedure and a salvage technique useful for dealing with the resultant ski-slope, sunken-nail deformity (J Am Podiatr Med Assoc 94(6): 578–582, 2004)
Accessory Soleus Muscle
Authors: Kendi Tuba Karagülle , Erakar Aziz , Oktay Olcay , Yildiz H. Yusuf , Saglik Yener
Published: April 2014

Accessory soleus muscle is an uncommon anatomical variant that may present as a soft-tissue mass in the posteromedial region of the ankle. It is congenital in origin but usually presents in the second or third decade of life. Although it is a rare entity, accessory soleus muscle should be included in the differential diagnosis of soft-tissue swelling of the ankle. Awareness of the clinical presentation and specific findings of computed tomography, magnetic resonance imaging, and electromyography help with diagnosis without surgical exploration. We describe a 30-year-old patient with accessory soleus muscle. Magnetic resonance imaging features of the case are described, and the literature is briefly reviewed. (J Am Podiatr Med Assoc 94(6): 587–589, 2004)
Transfer of the Peroneus Brevis Tendon After Resection of the Fifth Metatarsal Base
Authors: Schoenhaus Jodi , Jay Richard M. , Schoenhaus Harold
Published: April 2014

After resection of bone or amputation, postoperative stump breakdown occurs frequently. Furthermore, the altered mechanics with ambulation are difficult to control with bracing and orthoses alone. During the past 10 years, the peroneus brevis tendon has been transferred to various locations in the foot after resection of the fifth metatarsal base in an effort to provide continued balance between the supinatory and pronatory forces needed for a steady gait. In patients who have had a peroneus brevis tendon transfer, the rate of postoperative ulceration and the need for further bony resection is minimal. Analysis of the biomechanical influences and effects of different anatomical placements of the transferred tendon reveals the importance of transfer of the peroneus brevis tendon. (J Am Podiatr Med Assoc 94(6): 594–603, 2004)
Gastrocnemius Soleus Recession
Authors: Lamm Bradley M. , Paley Dror , Herzenberg John E.
Published: April 2014

Multiple surgical procedures have been described for the correction of equinus deformity. We present a review of the anatomy, biomechanics, and clinical assessment of equinus. In addition, we provide a detailed surgical technique for gastrocnemius soleus recession and introduce an anatomical guide for surgical treatment. (J Am Podiatr Med Assoc 95(1): 18–25, 2005)
Use of the Longitudinal Arch Angle to Predict Dynamic Foot Posture in Walking
Authors: McPoil Thomas G. , Cornwall Mark W.
Published: April 2014

To determine whether differences exist in the longitudinal arch angle based on sex or extremity, the longitudinal arch angle was assessed in 21 men and 21 women using a digital image of the medial aspect of each subject’s feet. The image was obtained with the subject in relaxed standing posture and in maximum internal rotation of the lower leg. To determine whether the longitudinal arch angle could be used to predict dynamic foot posture during walking, 50 different subjects were asked to walk across a 6-m walkway while the medial aspect of each foot was videotaped. The longitudinal arch angle was digitized from digital images obtained at midstance for three walking trials. No differences in the longitudinal arch angle were found based on sex or extremity. The longitudinal arch angles obtained in the static positions of relaxed standing posture and maximum internal rotation were highly predictive of dynamic foot posture at midstance during walking. Relaxed standing posture and maximum internal rotation significantly contributed to explaining more than 90% of the variance associated with the longitudinal arch angle position at midstance during walking. These results validate use of the longitudinal arch angle as part of the foot and ankle physical examination. (J Am Podiatr Med Assoc 95(2): 114–120, 2005)
Melorheostosis in a Pediatric Patient
Authors: Schreck Michael A.
Published: April 2014

Melorheostosis is a nonhereditary and uncommon condition that can affect both adults and children. It can appear on radiographs as increased sclerosis on bones of the upper and lower extremities and may mimic other bony conditions such as osteopoikilosis, osteopetrosis, arthrogryposis multiplex congenita, and osteopathia striata. The sclerotic appearance can differ greatly between adults and children. The skin and subcutaneous tissues may be affected by fibrosis, resulting in contractures of joints and limbs that lead to deformities and limb-length discrepancies. This article reviews the literature on melorheostosis and describes a case in a 10-year-old boy. (J Am Podiatr Med Assoc 95(2): 167–170, 2005)
Maggot Therapy in “Lower-Extremity Hospice” Wound Care
Authors: Armstrong David G. , Salas Precious , Short Brian , Martin Billy R. , Kimbriel Heather R. , Nixon Brent P. , Boulton Andrew J. M.
Published: April 2014

We sought to assess, in a case-control model, the potential efficacy of maggot debridement therapy in 60 nonambulatory patients (mean ± SD age, 72.2 ± 6.8 years) with neuroischemic diabetic foot wounds (University of Texas grade C or D wounds below the malleoli) and peripheral vascular disease. Twenty-seven of these patients (45%) healed during 6 months of review. There was no significant difference in the proportion of patients healing in the maggot debridement therapy versus control group (57% versus 33%). Of patients who healed, time to healing was significantly shorter in the maggot therapy than in the control group (18.5 ± 4.8 versus 22.4 ± 4.4 weeks). Approximately one in five patients (22%) underwent a high-level (above-the-foot) amputation. Patients in the control group were three times as likely to undergo amputation (33% versus 10%). Although there was no significant difference in infection prevalence in patients undergoing maggot therapy versus controls (80% versus 60%), there were significantly more antibiotic-free days during follow-up in patients who received maggot therapy (126.8 ± 30.3 versus 81.9 ± 42.1 days). Maggot debridement therapy reduces short-term morbidity in nonambulatory patients with diabetic foot wounds. (J Am Podiatr Med Assoc 95(3): 254–257, 2005)
Utility of Histopathologic Analysis in the Evaluation of Onychomycosis
Authors: Weinberg Jeffrey M. , Koestenblatt Evelyn K. , Jennings Maureen B.
Published: April 2014

Onychomycosis is a common problem seen in clinical practice. Given the differential diagnosis of dystrophic nails, it is helpful to obtain a definitive diagnosis of dermatophyte infection before initiation of antifungal therapy. Potassium hydroxide preparation and fungal culture, which are typically used in the diagnosis of these infections, often yield false-negative results. Recent studies have suggested that nail plate biopsy with periodic acid–Schiff stain may be a very sensitive technique for the diagnosis of onychomycosis. In this article, we review the literature on the utility of histopathologic analysis in the evaluation of onychomycosis. Many of these studies indicate that biopsy with periodic acid–Schiff is the most sensitive method for diagnosing onychomycosis. We propose that histopathologic examination is indicated if the results of other methods are negative and clinical suspicion is high; therefore, it is a useful complementary technique in the diagnosis of onychomycosis. (J Am Podiatr Med Assoc 95(3): 258–263, 2005)
Arch Index as a Predictor of Pes Planus
Authors: Igbigbi Patrick S. , Msamati Boniface C. , Shariff Macfenton B.
Published: April 2014

We determined the arch index of able-bodied indigenous Kenyan and Tanzanian individuals free of foot pain by using their dynamic footprints to classify the foot arch type and determine the prevalence of pes planus according to a previously described method. Males had a significantly higher arch index than females in both groups, and the prevalence of pes planus in Kenyans was 432 per 1,000 population, the highest ever documented and twice as high as that in Tanzanians (203 per 1,000 population). The arch index is useful in determining the prevalence of pes planus and possibly predicting pathologic foot conditions, and it may serve as an early warning sign of structural and functional defects of the foot in a given population. (J Am Podiatr Med Assoc 95(3): 273–276, 2005)
Focal Tuberculous Osteomyelitis of the Calcaneus Secondary to Direct Extension from an Infected Retrocalcaneal Bursa
Authors: Abdelwahab Ibrahim Fikry , Klein Michael J. , Hermann George , Abdul-Quader Mohammed
Published: April 2014

We report a case of focal tuberculous involvement of the posterior margin of the calcaneus with preservation of the articular margin. The route of infection was direct extension through tuberculous retrocalcaneal bursitis, a rare and atypical pathogenesis. Magnetic resonance imaging was helpful in ruling out neoplasm and in limiting the diagnosis to an inflammatory infectious process. (J Am Podiatr Med Assoc 95(3): 285–290, 2005)
Accurate Nomenclature for Forefoot Nerve Entrapment
Authors: Larson Ethan E. , Barrett Stephen L. , Battiston Bruno , Maloney Christopher T. , Dellon A. Lee
Published: April 2014

Current medical nomenclature is often based on the early history of the condition, when the true etiology of the disease or condition was not known. Sadly, this incorrect terminology can become inextricably woven into the lexicon of mainstream medicine. More important, when this is the case, the terminology itself can become integrated into current clinical decision making and ultimately into surgical intervention for the condition. “Morton’s neuroma” is perhaps the most striking example of this nomenclature problem in foot and ankle surgery. We aimed to delineate the historical impetus for the terminology still being used today for this condition and to suggest appropriate terminology based on our current understanding of its pathogenesis. We concluded that this symptom complex should be given the diagnosis of nerve compression and be further distinguished by naming the involved nerve, such as compression of the interdigital nerve to the third web space or compression of the third common plantar digital nerve. Although the nomenclature becomes longer, the pathogenesis is correct, and treatment decisions can be made accordingly. (J Am Podiatr Med Assoc 95(3): 298–306, 2005)
Longitudinal Tear of the Tibialis Anterior Tendon
Authors: Hamilton Graham A. , Ford Lawrence A.
Published: April 2014

Diagnosis and treatment of longitudinal tears of the tibialis anterior tendon are not well documented in the surgical literature. Described here is successful primary surgical repair of a longitudinally torn tibialis anterior tendon in a 60-year-old woman. (J Am Podiatr Med Assoc 95(4): 390–393, 2005)
A New Fixation Technique for the Lapidus Bunionectomy
Authors: Wang James C. , Riley Brendan M.
Published: April 2014

Presented here is a preliminary report of 102 patients who underwent first metatarsocuneiform joint arthrodeses performed with external fixation for the correction of hallux valgus. The advantages of using external fixation are the ability to initiate early weightbearing, predictable fusion, and removal of all of the hardware postoperatively. In the 102 patients reported here, the average time to initiation of unassisted full weightbearing was 13.1 days. The average time to fusion was 5.3 weeks, with removal of the external fixator at an average of 5.5 weeks postoperatively. There was no incidence of delayed union or nonunion. There was one case of pin-tract irritation, which resolved with appropriate pin care and a short course of oral antibiotics. External fixation is an effective alternative to traditional internal fixation techniques in metatarsocuneiform joint arthrodesis. (J Am Podiatr Med Assoc 95(4): 405–409, 2005)
Dorsal Foot Pain Due to Compression of the Deep Peroneal Nerve by Exostosis of the Metatarsocuneiform Joint
Authors: Parker Robert G.
Published: April 2014

Podiatric physicians often encounter patients with dorsal foot pain related to either an exostosis or a ganglion arising at the junction of the first metatarsal and the cuneiform. Removal of the exostosis or ganglion is routine but may not relieve the pain. Exostosis surgery can result in worsening of pain owing to injury of the deep peroneal nerve. In this retrospective series, ten patients with dorsal foot pain–related exostosis or ganglion underwent measurement of the cutaneous pressure threshold of the skin of the dorsal first web space to determine whether compression of the deep peroneal nerve was related to their symptoms. The Pressure-Specified Sensory Device (Sensory Management Services LLC, Baltimore, Maryland) was used for this measurement bilaterally, and the results were compared with age-related normative data. Ninety percent of the patients had abnormal sensibility in the first dorsal web space. During surgery, each patient was noted to have a site of compression of the deep peroneal nerve by the extensor hallucis brevis tendon at the metatarsocuneiform exostosis. Patients with compression of the deep peroneal nerve had pain relief in the immediate postoperative period and have remained pain-free for a mean of 14 months (range, 1–22 months). Neurosensory testing can identify pain related to the deep peroneal nerve in patients with a dorsal exostosis or ganglion in this region. (J Am Podiatr Med Assoc 95(5): 455–458, 2005)
A New Concept of Indexing Tibiofibular Torsion
Authors: Tamari Kotaro , Tinley Paul , Briffa Kathryn , Raine Sally
Published: April 2014

A newly developed clinical method of indexing tibial torsion uses the medial surface of the tibia as the proximal reference; however, the selection of a specific landmark on the medial surface has not been justified. Three different surfaces relating to the tibial tuberosity were tested using 24 dry tibial bones to determine which provides the most accurate and reliable landmark for use as the proximal reference. The medial surface of the tibia at the inferior point of the tibial tuberosity was the most reliable proximal reference that yielded the highest level of association between the newly developed clinical method and true tibial torsion (r = 0.77). The new method has the potential to describe the anatomy of the leg and to improve the clinical measurement of tibiofibular torsion. (J Am Podiatr Med Assoc 95(5): 481–485, 2005)
Lesser-Metatarsal Medial Displacement Osteotomy for the Treatment of Digital Transverse Plane Deformities
Authors: Goforth W. Preston , Overbeek Troy D. , Odom Richard D. , Roe Tommy G. , McDonald Douglas K.
Published: April 2014

We sought to evaluate the clinical and radiographic outcomes in patients treated with a medial displacement transverse osteotomy of the second metatarsal to correct transverse hammer toe deformities. Eighteen patients underwent 20 procedures in 3 years. Each patient had a transverse plane deformity of the second metatarsophalangeal joint. Evaluation consisted of clinical examination, radiographic examination, and self-reported pain and function parameters. Mean ± SD follow-up was 2.5 ± 1.0 years. Radiographic joint congruence improved from 20% before surgery to 95% after surgery. Clinical examination revealed a rectus digit in 85% of cases, a transverse plane deviation in 10%, and a residual hammer toe deformity in 5%. At follow-up, the mean ± SD visual analog scale score for pain with activity was 2.2 ± 2.8 and for pain at rest was 0.6 ± 1.4. Ninety-five percent of the patients said that they would undergo the procedure again. Medial displacement osteotomy for transverse plane deformity of the second metatarsophalangeal joint is a reliable procedure, with substantial improvement in joint congruence and self-reported pain. (J Am Podiatr Med Assoc 95(6): 550–555, 2005)
Classic Kaposi’s Sarcoma
Authors: Levi Michael J.
Published: April 2014

Classic Kaposi’s sarcoma is one form of Kaposi’s sarcoma. It is usually first seen in the skin of the lower extremities, where it is frequently misdiagnosed as a bruise. As time progresses, the lesions increase in size, number, and color. Early diagnosis is paramount to decrease metastasis to other organ systems such as the lungs, kidneys, and liver. The podiatric physician must take a detailed history, follow the course of the illness, and be aware that definitive diagnosis is made by a skin biopsy. This article provides a case history of Kaposi’s sarcoma and discusses diagnosis and treatment of this disease. (J Am Podiatr Med Assoc 95(6): 586–588, 2005)
Endoscopic Decompression of Intermetatarsal Nerve Entrapment
Authors: Barrett Stephen L. , Walsh Amy S.
Published: April 2014

Sixty-nine patients who had 96 interspaces decompressed were retrospectively reviewed to assess the efficacy of the endoscopic decompression of the intermetatarsal nerve procedure. Cases were evaluated between October 1, 1993, and December 31, 1999. Of the 69 patients, 14 were men and 55 were women, and their average age was 50.6 years. Of the 96 interspaces released, 39 were second interspaces and 57 were third interspaces. Nine interspaces were lost to follow-up. There were 75 interspaces with excellent or good results (86%) and 12 with poor results (14%). Of the interspaces with poor results, five required further surgery. Those five interspaces, in five patients, were treated with traditional neurectomy. The other patients, accounting for seven interspaces, who classified their result as poor declined any further surgery. Evaluation of these cases was by means of medical chart review only, where the patient’s success or failure was based on the patient’s subjective assessment. None of the patients who underwent decompression developed a true amputation neuroma. (J Am Podiatr Med Assoc 96(1): 19–23, 2006)
Evaluating Costs for Onychomycosis Treatments
Authors: Warshaw Erin M.
Published: April 2014

Onychomycosis is a common problem. The desired outcome of treatment for patients and clinicians is complete cure (negative culture and negative potassium hydroxide examination results plus a completely normal nail). This cost analysis sought to determine the cost-effectiveness of treatments for onychomycosis using complete cure as a unit of effectiveness. A simplified cost-effectiveness analysis was conducted using complete cure rates from randomized, blinded clinical trials involving at least 50 participants. Trials were identified by searching the literature, manually searching for review articles, and reviewing medication package inserts. For each trial that met the entry criteria, three levels of cost were used to calculate medication cost per complete cure: commercial price, average wholesale price, and Veterans Affairs pharmacy price. In addition, a computerized economic model was used to determine total cost per complete cure, including all medical costs. The most cost-effective treatments were those that involved terbinafine: pulse, continuous, or in combination with other agents. Itraconazole, griseofulvin, and fluconazole were less cost-effective. Ciclopirox nail lacquer was at least three times more expensive than all other agents when evaluating total costs per complete cure. Overall, the lowest cost per complete cure resulted from terbinafine treatment, with most evidence supporting 3 months of continuous therapy. (J Am Podiatr Med Assoc 96(1): 38–52, 2006)
Congenital Absence of the Lateral Sesamoid
Authors: Yildirim Yakup , Saygi Baransel
Published: April 2014

Congenital absence of the lateral sesamoid is an extremely rare condition. We present a case of congenital absence of the lateral sesamoid in which magnetic resonance imaging was performed. The literature is reviewed regarding the clinical significance of this anomaly. (J Am Podiatr Med Assoc 96(1): 78–81, 2006)
Topical and Oral Combination Therapy for Toenail Onychomycosis
Authors: Bristow Ivan R. , Baran Robert
Published: April 2014

Although effective, oral antifungal therapy is still not completely successful. Recent studies have shown that combination therapy with oral and topical agents offers an increased cure rate for patients. We review the main drug combinations that have been tested. Additional measures, such as mechanical intervention, may help improve response rates further. (J Am Podiatr Med Assoc 96(2): 116–119, 2006)
Quantifying the Quasi-static Angle and Base of Gait
Authors: Curran Sarah A. , Upton Dominic , Learmonth Ian D.
Published: April 2014

Although the angle and base of gait are useful parameters commonly measured in podiatric medical practice, a standardized procedure has yet to be defined. Static footprints and clinical tracings of the perimeters of both feet were investigated in 25 asymptomatic subjects (17 women and 8 men). The intrarater reliability of each measurement condition was assessed using intraclass correlation coefficients and ranged from 0.965 to 0.981 for the angle of gait and from 0.979 to 0.986 for the base of gait. Both sets of data were compared using paired t-tests and demonstrated no significant differences (P > .001) for the angle and base of gait. The results suggest that footprint data and a simple clinical tracing of the foot are similar, providing a useful clinical tool for static assessment of the angle and base of gait. (J Am Podiatr Med Assoc 96(2): 125–131, 2006)
Spontaneous Bilateral Ankle and Midfoot Sepsis in a Nonimmunocompromised Patient
Authors: Roukis Thomas S. , Baker Jeffrey R. , Tiernan Breck
Published: April 2014

We describe a 70-year-old nonimmunocompromised woman with spontaneous bilateral ankle and midfoot sepsis and a deep-space abscess of the right lower leg. Salvage of both limbs was achieved by aggressive bilateral soft-tissue and osseous debridement, including a four-compartment fasciotomy of the right lower leg, antibiotic-loaded polymethyl methacrylate bone cement implantation, delayed allogeneic bone grafting of the osseous defects impregnated with autologous platelet-rich plasma bilaterally, and external fixation immobilization, implantable bone growth stimulation, and split-thickness skin graft coverage of the right lower leg, ankle, and foot. Osseous incorporation of the bone grafts bilaterally occurred 8 weeks after surgery. No soft-tissue or osseous complications occurred during the postoperative period or at 18-month follow-up except for arthrofibrosis in the right ankle; there was no evidence of recurrent abscesses, sequestrum, or wound-related problems. A review of the literature regarding bilateral pedal sepsis and the techniques used for limb salvage in this patient are presented in detail. (J Am Podiatr Med Assoc 96(2): 139–147, 2006)
Podiatric Medical Resources on the Internet
Authors: Fikar Charles R.
Published: April 2014

An updated selection of high-quality Internet resources of potential use to the podiatric medical practitioner, educator, resident, and student is presented. Internet search tools and general Internet reference sources are briefly covered, including methods of locating material residing on the “invisible” Web. General medical and podiatric medical resources are emphasized. These Web sites were judged on the basis of their potential to enhance the practice of podiatric medicine in addition to their contribution to education. Podiatric medical students, educators, residents, and practitioners who require a quick reference guide to the Internet may find this article useful. (J Am Podiatr Med Assoc 96(2): 162–166, 2006)
Analgesic Efficacy of Valdecoxib for Acute Postoperative Pain After Bunionectomy
Authors: Pollak Richard , Raymond Gary A. , Jay Richard M. , Hillstrom Howard J. , Mahan Kieran T. , Riff Dennis , Jacobs Ellis L. , Brown Mark T. , Verburg Kenneth M.
Published: April 2014

Two randomized, double-blind, placebo-controlled studies assessed the analgesic efficacy of valdecoxib in patients with moderate-to-severe pain after bunionectomy. Study 1 (N = 374) assessed the efficacy of two regimens of valdecoxib on the day after surgery (valdecoxib, 40 mg, with a 20-mg redose [n = 127]; valdecoxib, 40 mg, with a placebo redose [n = 122]; and placebo/placebo [n = 125]), and study 2 (N = 478) examined the efficacy of two different multiple-dose regimens on postoperative days 2 through 5 (valdecoxib, 20 mg, twice daily [n = 160]; valdecoxib, 20 mg, once daily [n = 159]; and placebo [n = 159]). Valdecoxib provided significant pain relief and reduced the use of opioid rescue medication. This efficacy was accompanied by improved global scores, decreased pain interference with function, and increased patient satisfaction. (J Am Podiatr Med Assoc 96(5): 393–407, 2006)
Lower-Extremity Overuse Injury and Use of Foot Orthotic Devices in Women’s Basketball
Authors: Jenkins Walter L. , Raedeke Susanne G.
Published: April 2014

One hundred thirty-two female basketball players were observed for lower-extremity overuse injury between 1993 and 2004. Athletes studied between 1993 and 1996 did not receive foot orthotic devices and composed the control group. The treatment group comprised athletes studied between 1996 and 2004. Athletes in the treatment group were given a foot orthotic device before participation in basketball. Data analysis included lower-extremity overuse injury rates and the effect of foot orthotic devices on lower-extremity overuse injury rates by means of an incidence density ratio. The control group had a lower-extremity overuse injury rate of 5.37 per 1,000 exposures, and the treatment group had a rate of 6.44 per 1,000 exposures. The incidence density ratio was not significant (P = .44). This study rejects the concept that foot orthotic devices may assist in prevention of lower-extremity overuse injury in female basketball players. (J Am Podiatr Med Assoc 96(5): 408–412, 2006)
Medial Tibial Stress Syndrome (Tibial Fasciitis)
Authors: Bouché Richard T. , Johnson Cherie H.
Published: April 2014

Although medial tibial stress syndrome is one of the most common lower-extremity overuse injuries, its pathomechanics remain controversial. Two popular theories have been proposed to account for this condition: tibial bending and fascial traction. This article evaluates the role of fascial traction in medial tibial stress pathomechanics. We hypothesized that with contraction of the deep leg flexors tension would be imparted to the tibial fascial attachment at the medial tibial crest. We also speculated that circumferential straps would dampen tension directed to the medial tibial crest. The amount of strain present in the tibial fascia adjacent to its distal medial tibial crest insertion during loading of the leg was investigated as a descriptive laboratory pilot study using three fresh cadaver specimens. Strain in the distal tibial fascia was measured using strain gauges placed in the fascia at its medial tibial crest insertion. As tension on the posterior tibial, flexor digitorum longus, and soleus tendons increased, strain in the tibial fascia increased in a consistent linear manner (P < .0001). We conclude that fascial tension may play a role in the pathomechanics of medial tibial stress syndrome. The tenting effect of the posterior tibial, flexor digitorum longus, and soleus tendons caused by muscle contraction exerts a force on the distal tibial fascia that is directed to its tibial crest insertion. Circumferential straps provided no dampening effect on tension directed to the medial tibial crest. (J Am Podiatr Med Assoc 97(1): 31–36, 2007)
Use of Noncontact Low-Frequency Ultrasound in the Treatment of Chronic Foot and Leg Ulcerations
Authors: Kavros Steven J. , Schenck Erik C.
Published: April 2014

Background: A feasibility study was conducted to characterize the effects of noncontact low-frequency ultrasound therapy for chronic, recalcitrant lower-leg and foot ulcerations.

Methods: The study was an open-label, nonrandomized, baseline-controlled clinical case series. Patients were initially treated with the Mayo Clinic standard of care before the addition of or the switch to noncontact low-frequency ultrasound therapy. We analyzed the medical records of 51 patients (median ± SD age, 72 ± 15 years) with one or more of the following conditions: diabetes mellitus, neuropathy, limb ischemia, chronic renal insufficiency, venous disease, and inflammatory connective tissue disease. All of the patients had lower-extremity ulcers, 20% had a history of amputation, and 65% had diabetes. Of all the wounds, 63% had a multifactorial etiology, and 65% had associated transcutaneous oximetry levels below 30 mm Hg.

Results: The mean ± SD treatment time of wounds during the baseline standard of care control period versus the noncontact low-frequency ultrasound therapy period was 9.8 ± 5.5 weeks versus 5.5 ± 2.8 weeks (P < .0001). Initial and end measurements were recorded, and percent volume reduction of the wound was calculated. The mean ± SD percent volume reduction in the baseline standard of care control period versus the noncontact low-frequency ultrasound therapy period was 37.3% ± 18.6% versus 94.9% ± 9.8% (P < .0001).

Conclusions: Using noncontact low-frequency ultrasound improved the rate of healing and closure in recalcitrant lower-extremity ulcerations. (J Am Podiatr Med Assoc 97(2): 95–101, 2007)
Acute Myelogenous Leukemia as the Cause of a Nonhealing Infection in a 10-Month-Old Infant
Authors: Schreck Michael A.
Published: April 2014

The treating podiatric physician should consider underlying malignant disease when evaluating a child with any slowly healing or nonhealing infection involving the lower extremity. This article reports on an infant who was treated for suspected osteomyelitis involving his right fifth toe that did not improve with standard surgical, medical, and antibiotic treatments. He was later diagnosed as having acute myelogenous leukemia. (J Am Podiatr Med Assoc 97(2): 145–147, 2007)
Protein S Deficiency and Lower-Extremity Arterial Thrombosis
Authors: Archer Krista A. , Lembo Thomas , Haber Jonathan A.
Published: April 2014

A 42-year-old woman presented to the emergency department with progressive painful discoloration of the digits of her right foot and symptoms previously diagnosed as neuroma. She was admitted to the hospital for dorsalis pedis arterial occlusion and ischemic foot pain. Despite attempts to restore perfusion to the right leg, ischemia of the right foot persisted and progressed to digital gangrene. The patient subsequently required right transmetatarsal amputation and eventually below-the-knee amputation. After extensive inpatient vascular and hematologic work-up of this otherwise healthy woman, test results revealed that she had protein S deficiency, hepatitis C, and human immunodeficiency virus type 1. In addition to describing this patient’s evaluation and treatment, we review protein S deficiency, including its correlation with human immunodeficiency virus type 1 infection and laboratory diagnosis. This case promotes awareness of protein S deficiency and serves as a reminder to the physician treating patients with vascular compromise and a history of human immunodeficiency virus type 1 to include protein S deficiency in the differential diagnosis. (J Am Podiatr Med Assoc 97(2): 151–155, 2007)
Statistical and Clinical Interpretation of Research Results
Authors: Allison Garry T.
Published: April 2014

There is a well-known phenomenon of publication bias toward manuscripts that report statistically significant differences. The clinical implications of these statistically significant differences are not always clear because the magnitude of the changes may be clinically meaningless. This article relates the critical P value threshold to the magnitude of the actual observed change and provides a rationale for reporting confidence intervals in clinical studies. Strategies for improving statistical power and reducing the magnitude of the confidence interval range for clinical trials are also described. (J Am Podiatr Med Assoc 97(2): 165–170, 2007)
Analysis of Dynamic Angle of Gait and Radiographic Features in Subjects with Hallux Abducto Valgus and Hallux Limitus
Authors: Taranto Julie , Taranto Michael J. , Bryant Alan R. , Singer Kevin P.
Published: April 2014

Background: Hallux abducto valgus and hallux limitus are two commonly encountered foot deformities causing altered structure and function of the first metatarsophalangeal joint and subsequent compensatory mechanisms. This study was undertaken to determine the relationships between these two deformities and transverse plane position of the foot, or angle of gait, and several radiographic angular and linear parameters with established reliability.

Methods: A convenience sample of 23 subjects with hallux abducto valgus, 22 subjects with hallux limitus, and 20 control subjects was used. Radiographic parameters were standardized weightbearing views and included lateral stressed dorsiflexion of the first metatarsophalangeal joint, composite, dorsoplantar, and lateral views. Angle of gait was obtained from powdered footprints recorded on paper. Two left and two right footprints identified on each trial were used to calculate angle of gait.

Results: The findings of the study suggest that an association between angle of gait and the presence of hallux abducto valgus or hallux limitus does not exist. Possible explanations may relate to the large variability of normal angle of gait, the need to identify factors extrinsic to the foot capable of affecting transverse plane orientation of the foot, and the addition of information relating to symptoms.

Conclusions: In this study, the presence of hallux abducto valgus or hallux limitus did not correspond to an association with a particular angle of gait. Length and elevation of the first metatarsal were associated in subjects with hallux abducto valgus and hallux limitus. (J Am Podiatr Med Assoc 97(3): 175–188, 2007)
Ciclopirox 8% Nail Lacquer Topical Solution for the Treatment of Onychomycosis in Patients with Diabetes
Authors: Brenner Marc A. , Harkless Lawrence B. , Mendicino Robert W. , Page Jeffrey C.
Published: April 2014

Background: An open-label, noncomparative study was conducted to assess the safety and efficacy of ciclopirox 8% nail lacquer topical solution in patients with type 2 diabetes mellitus.

Methods: Forty-nine diabetic patients with distal subungual onychomycosis were treated once daily for 48 weeks with ciclopirox 8% nail lacquer, a topical nail solution approved for the treatment of patients with mild-to-moderate onychomycosis.

Results: Treatment resulted in clinical improvement in 63.4% of patients. Most patients (85.7%) had a mycologic outcome of improvement or cure, with 54.3% attaining mycologic cure. Consideration of mycologic and clinical outcomes generated a treatment outcome of improvement, success, or cure in 84.4% of patients. Moreover, patients experienced improvement in the diseased area of the nail (63.4%), nail surface (56.1%), nail color (48.8%), and nail thickness (65.9%). Ciclopirox 8% nail lacquer was safe, with treatment-related adverse events limited to infection in one patient, which resolved in 15 days; the patient completed the study. No treatment-related serious adverse events were observed.

Conclusion: Ciclopirox 8% nail lacquer is a safe and effective treatment for distal subungual onychomycosis in patients with type 2 diabetes mellitus receiving insulin or oral hypoglycemic therapy. (J Am Podiatr Med Assoc 97(3): 195–202, 2007)