bluuebunny/crossref_metadata_2025 huggingface dataset:
Navicular Stress Reactions in Runners
Authors: Yoho Robert M. , Wells Shevonne K.
Published: April 2014

Navicular stress injuries in athletes can be devastating. Clinical findings are frequently nonspecific until significant progression of the abnormality has occurred. The use of diagnostic imaging techniques early in the discovery period increases the likelihood of establishing an immediate diagnosis and avoids frank fracture of the navicular bone. Delayed diagnosis of navicular stress injuries in athletes can cause dire consequences. The physician must be aware of the injury in establishing a high index of clinical suspicion. The timing and sequencing of diagnostic imaging studies is essential in establishing a diagnosis to manage the patient and minimize time away from competition. This case study examines the history and management of an elite high school track athlete who sustained a navicular stress injury. The timing and use of diagnostic imaging studies is reviewed. (J Am Podiatr Med Assoc 101(5): 447–451, 2011)
Lengthening of the Midfoot in a Case of Lower-extremity Hemimelia
Authors: Kraus Tanja , Zwick Ernst B. , Svehlik Martin , Linhart Wolfgang E.
Published: April 2014

Hemimelia of the lower limb belongs to the group of congenital deficiency disorders. The clinical spectrum ranges from minimal shortening of the long bones to severe deficiencies of the extremities. Several etiologies, such as X-rays or drugs, have been implicated to be responsible for hemimelia. In the present report the clinical course and the long-term follow-up of a patient with transverse terminal hemimelia of the left foot at the level of the basis of the metatarsals is described. Due to frequent episodes of pain, development of pressure sores, and an increasing psychological burden, operative intervention consisting of a lengthening procedure using an Ilizarov fixator was indicated. Long-term outcome was good; the patient is now able to painlessly wear conventional shoes and displays a normal gait pattern. (J Am Podiatr Med Assoc 101(5): 456–461, 2011)
Hallux interphalangeal joint sesamoidectomy using minimal incision technique
Authors: Valinsky MS , Hettinger DF , Mortvedt JK
Published: April 2014

There has been little emphasis placed on the excision of accessory bones of the foot. The authors present a review of the literature and a description of a surgical procedure for excision of the hallux interphalangeal joint sesamoid using minimal incision technique. A detailed analysis of the anatomy involved is also presented. A variety of other procedures for excision of this accessory bone are reviewed.
Incidence of sacroiliac joint malalignment in leg length discrepancies
Authors: Schuit D , McPoil TG , Mulesa P
Published: April 2014

The purpose of this study was to ascertain the incidence of leg length discrepancies in a sample of asymptomatic female college students, and then to determine the incidence of sacroiliac joint malalignment within that same sample. Structural leg length, functional leg length, and sacroiliac position were determined for each subject. The results indicate a high incidence of leg length discrepancies within the sample, and also a fairly high incidence of asymptomatic sacroiliac joint malalignment when leg length discrepancies are present.
Surgical approach for enlarged peroneal tubercles
Authors: Berenter JS , Goldman FD
Published: April 2014

The peroneal tubercle is an anatomic landmark consistently found on the lateral aspect of the calcaneus. Its enlargement can be either congenital or acquired. In the past, surgical treatment of enlarged tubercles has consisted of simple excision of the tubercle. The authors have presented a technique to preserve the gliding facet that is often found on the inferior surface of the tubercle.
Silver sulfadiazine and hydrocortisone cream 1% in the management of phenol matricectomy
Authors: Altman MI , Suleskey C , Delisle R , DeVelasco M
Published: April 2014

The phenol matricectomy is one of the most common procedures performed in the podiatrist's office. Since a chemical burn is produced, correct care of the wound is essential. The authors studied the use of silver sulfadiazine, hydrocortisone cream, and a mixture of the two, on wounds resulting from phenol matricectomy procedures. The study shows that when silver sulfadiazine and hydrocortisone are used in combination, some of the usual sequelae seen with phenol matricectomies are markedly reduced and wound healing progresses at a more rapid rate with less complications.
Epidermal inclusion cysts as a complication of nail surgery
Authors: Wadhams PS , McDonald JF , Jenkin WM
Published: April 2014

The authors presented a study of 93 patients who underwent a total of 183 nail matricectomies. The study was undertaken to establish the incidence of postoperative epidermal inclusion cysts, which was 5.5%.
Podiatric resident education at the James A. Haley Veterans Hospital
Authors: Black JR
Published: April 2014

The Department of Veterans Affairs is the single largest source of podiatric resident education. The author describes the James A. Haley Veterans Hospital and discusses the development of the podiatric residency training program. A detailed description of all aspects of the training program is presented.
Vitamin B deficiency neuropathy. Case reports
Authors: Skelton WP , Skelton NK
Published: April 2014

Poor nutrition is common throughout the third world. The US also has examples among recent Asian and Latin American immigrants, alcoholics, the homeless, and former prisoners of war. All of these groups are susceptible to long-term pathologic damage, depending on the degree of malnutrition which they experience. The peripheral nervous system is quite vulnerable to impairment and damage from vitamin B loss.
Stingray injuries of the foot. Two case reports
Authors: Burk MP , Richter PA
Published: April 2014

Stingrays, found predominantly in warm coastal waters, are responsible for at least 1,500 human injuries in this country each year. These occur most often in the lower extremity. The authors discuss the symptoms and treatment of stingray injuries and present two case reports.
Diabetic neuroarthropathy of the foot and ankle
Authors: Scartozzi G , Kanat IO
Published: April 2014

A review of medical literature reveals that there is inconsistency in the reported incidence of Charcot joint disease or neuroarthropathy in the diabetic foot. There is also controversy as to which articulations are most commonly afflicted. Radiographs of 21 patients with bilateral diabetic neuroarthropathy were reviewed to determine the distribution of joint disease in the foot and ankle. Many patients had multiple sites of joint involvement. The results of this study show that the incidence of metatarsophalangeal joint involvement has been greatly underestimated.
Correction of hallux varus via split tendon transfer
Authors: Katz JB
Published: April 2014

The split tendon transfer is introduced as an additional procedure for the correction of hallux varus. More clinical and statistical evaluations are required to fully appreciate its potential benefits.
Long-term evaluation of partial and total surgical and phenol matrixectomies
Authors: Kuwada GT
Published: April 2014

Surgical matrixectomies and phenol alcohol matrixectomies have been effective in eliminating certain nail conditions. The complication rate is at an acceptable level; however, there is a need for comparison to other techniques, such as negative galvanism, trephine, osteotripsy, and laser ablation. Of the 353 patients in this study, two were known diabetics who were seen preoperatively by a vascular surgeon for vascular studies and by their internist. Both consultants agreed that the patients would heal. Both patients healed without complications. The author described the use of a modified Frost partial matrixectomy and modified Fowler total matrixectomy in this review. The phenol alcohol technique had a total complication rate of 9.6%, as did the partial matrixectomy. The total matrixectomy had an overall complication rate of 10.9%.
Juvenile hallux valgus with compensated metatarsus adductus. Case report
Authors: Mahan KT , Jacko J
Published: April 2014

The authors describe a case report of a patient with compensated metatarsus adductus and juvenile hallux valgus bilaterally. Treatment included closing base wedge abductory osteotomies of metatarsals one through five, modified McBride bunionectomy, Evans calcaneal osteotomy, and a percutaneous tendo Achillis lengthening. The patient maintained excellent correction on the right foot after 6 years. Hallux valgus recurred on the left foot after 2 years. The authors attribute this recurrence to a significant internal femoral torsion on the left leg. The significance of superstructural deformities on juvenile hallux valgus is discussed.
Magnetic resonance imaging of the foot and ankle in the pediatric patient
Authors: Bresnahan PJ , Fung J
Published: April 2014

Magnetic resonance is a relatively new imaging technique. Its applications are rapidly evolving. The authors discuss new applications for its use in the foot and ankle of the pediatric patient.
Diagnosis of a computer-simulated podiatric patient
Authors: Conway FJ , Boc SF , Dacus JB
Published: April 2014

The authors discuss the use of computers in medicine. A patient presenting with a condition requiring surgery is represented by a data file in a computer program. The user obtains data from the file by selecting items from a menu. Data are presented on the screen in pop-up windows. By examining the data and making judgments, the user may determine the pathology and make first a provisional and then a definitive diagnosis.
Recent concepts in understanding a child's pain
Authors: Mahan KT , Strelecky DC
Published: April 2014

The management of pain in children is a complex process that has significant differences from adult pain management. The authors describe the myth of children's lack of pain and how that myth has resulted in frequent undermedication of children's pain. The authors describe the physical and psychological aspects of pain. Assessment techniques for more accurately determining pain in children are also described. The authors conclude with a description of pharmacologic aspects of pediatric pain management.
Clinical aspects of bursae and tendon sheaths of the foot
Authors: Hernandez PA , Hernandez WA , Hernandez A
Published: April 2014

The evaluation and treatment of bursitis in the foot is a complex problem for the clinician. There is no one standard approach or set treatment for the patient who presents with pain suspected of being secondary to bursal involvement, primarily because there are myriad conditions and anatomical sites involved. Compounding this problem is the wide variation in the presence of these structures from patient to patient. Therefore, each distinct pathologic situation must be examined, diagnosed, and treated, based on its individual anatomical and etiologic factors. In the interest of completeness, the special anatomy of bursae and their specific pathologic conditions are reviewed.
Deep fascia of the foot. Anatomical and clinical considerations
Authors: Mitchell IR , Meyer C , Krueger WA
Published: April 2014

The deep fascia of the foot lies beneath the subcutaneous tissue and surrounds the intrinsic foot muscles. Depending on its location, the composition of the deep fascia varies. In some areas it is thin, while in other areas it is greatly thickened to form retinacula and the plantar aponeurosis. Selected clinical considerations that relate to the deep fascia of the foot are described. These include the following: plantar fasciitis, infection, compartment syndrome, calcaneal fracture, and neuroma.
Bone graft reconstruction of a flail digit
Authors: Mahan KT
Published: April 2014

The author presents a case report with a 1-year follow-up period demonstrating successful bone graft stabilization of an iatrogenic flail second toe. The author discusses the techniques for calcaneal autogenous bone grafting for reconstruction of the iatrogenic shortened toe combined with ancillary procedures to improve the digital length pattern. After 18 months, this staged approach to stabilization of the digit and realignment of the digital length pattern appears to be successful.
Synovial osteochondromatosis. A brief review
Authors: Valmassy R , Ferguson H
Published: April 2014

An unusual clinical finding is presented with a brief review of the literature. Synovial osteochondromatosis is typically a benign process involving metaplasia of the synovial intima and the formation of cartilaginous nodules that may eventually become ossified. Synovial osteochondromatosis should always be considered as a differential diagnosis whenever a patient presents with pain, swelling, and loss of function at or around a joint. Chondrosarcoma has been misdiagnosed, leading to radical and unnecessary amputation, because synovial osteochondromatosis has not been considered. Alternatively, synovial osteochondromatosis may degenerate to or be associated with a malignant process. When radiographs or more sophisticated investigative procedures, such as magnetic resonance imaging, fail to provide a conclusive answer, histologic findings provide the definitive diagnosis.
Repair of distal tendo Achillis rupture with the use of the Mitek Anchor System
Authors: Hanna JR , Russell RD , Giacopelli JA
Published: April 2014

Surgical repair of an acute, distal, tendo Achillis rupture in a 59-year-old diabetic male is described in which the Mitek Anchor System was used. The injury described is a distal tear of the insertion of the tendon into the calcaneus without avulsion fracture of the calcaneus. Sixteen months of postoperative follow-up care, including casting for equinus deformity, progressive weightbearing, range of motion exercises, and physical therapy, have been free of complications. The authors include a brief overview of historical and current reparative techniques for comparison. The authors conclude that the use of the Mitek Anchor System affords the surgeon a simple and effective method for the repair of acute, distal, tendo Achillis rupture when other methods cannot be used because of the location of the rupture.
Tendo Achillis procedures for chronic ulcerations in diabetic patients with transmetatarsal amputations
Authors: Barry DC , Sabacinski KA , Habershaw GM , Giurini JM , Chrzan JS
Published: April 2014

Recurrent ulceration following transmetatarsal amputation commonly results from hypertrophic bone formation or equinus deformity. In the current study, 31 diabetic patients underwent 33 Achilles tendon procedures for recurrent ulcerations at the distal stump of their transmetatarsal amputation. Primary healing was achieved in 21 procedures (64%) and secondary healing in 9 procedures (27%) for an overall healing rate of 91%. Two procedures failed to resolve the original ulceration (6%). The average follow-up examination was 27 months. The authors conclude that Achilles tendon procedures are an effective means of managing ulcerations in transmetatarsal amputation feet exhibiting an equinus deformity.
Anatomical basis for congenital deformities of the lower extremities. Part III. The foot and ankle
Authors: McCarthy DJ , Sperandio CP
Published: April 2014

The human foot has been characterized as a miracle of engineering and mechanical efficiency. It is a complex organ, both physiologically and structurally. The authors present a study of the foot and ankle with emphasis on the anatomy of midterm fetuses as revealed by cryomicrotomy.
Intraosseous lipoma of the os calcis
Authors: Rhodes RD , Page JC
Published: April 2014

The authors present three cases of a rare calcaneal tumor, intraosseous lipoma. The differentiation of intraosseous lipoma from other benign tumors is discussed. The diagnosis and treatment are reviewed.
Brachymetatarsia. Axial lengthening by using the callus distraction technique
Authors: Boike AM , Gerber MR , Snyder AJ
Published: April 2014

The authors present a modified approach to the ilizarov callus distraction technique for bone lengthening on a patient with brachymetatarsia. This approach has certain advantages and disadvantages that will be discussed along with historical methods of treating brachymetatarsia. The actual case history, surgical technique, and perioperative care of the patient are described in detail.
Epiphysiodesis in juvenile hallux abducto valgus. A preliminary retrospective study
Authors: Seiberg M , Green R , Green D
Published: April 2014

Juvenile hallux abducto valgus manifested prior to physeal plate closure was treated by lateral epiphyseal stapling and modified McBride bunionectomy in nine children (15 feet) from 1984 to 1992. The prevalent preoperative symptoms were significantly reduced postoperatively. The intermetatarsal angle decreased an average of 6.6 degrees (initial decrease was 2.7 degrees with an additional 3.9 degrees occurring over time). The hallux abducto valgus angle decreased an average of 19.6 degrees (initial decrease was 10.7 degrees with an additional 8.9 degrees occurring over time).
Comparison of piroxicam and naproxen in osteoarthritis of the foot
Authors: Jennings MB
Published: April 2014

Osteoarthritis is the most common joint disease and the second highest ranking cause of disability in the US. Osteoarthritis commonly affects the hands, wrists, spine, knees, and feet. One of the mainstays of treatment for osteoarthritis is the use of nonsteroidal anti-inflammatory drugs. While there have been controlled comparison studies of the various nonsteroidal anti-inflammatory drugs, these have been limited to osteoarthritis of the hands, spine, and hip. This study was a randomized, double-blind, parallel study of 8 weeks' duration comparing piroxicam (Feldene, 20 mg daily) to naproxen (Naprosyn, 1,000 mg daily) in the treatment of osteoarthritis of the foot in 45 patients. Both groups experienced significant pain relief and improvement of mobility.
Cimetidine therapy for plantar warts
Authors: Ronna T , Lebwohl M
Published: April 2014

Although more than 50% of warts resolve spontaneously within 2 years, many, if untreated, have the propensity to spread and cause considerable discomfort. There are several treatments to date; however, most cause some type of tissue damage. Because spontaneous resolution of warts can occur, the role of cimetidine in the treatment of warts remains controversial. Anecdotal reports suggest cimetidine may have a role in the treatment of plantar warts with no side effects or tissue damage. A double blind trial in a large population should be conducted to further verify the effects of treating viral warts with cimetidine.
Verrucous carcinoma with a dorsal sinus tract
Authors: Wallace GF , Peters S
Published: April 2014

A verrucous carcinoma of the right foot was presented. A unique finding, a dorsal sinus tract at the base of the fourth toe, was found on examination, which communicated with the tumor. Other reports of a sinus tract extending to the dorsal surface of the foot could not be found in the literature.
Use of the Ilizarov external fixator in the treatment of lower extremity deformities
Authors: LaBianco GJ , Vito GR , Kalish SR
Published: April 2014

The authors present a brief history of the development of the Ilizarov external fixator, and the classic uses associated with it. A preliminary study of 3 patients using 56 frames is presented. The Ilizarov external fixator is successfully used in these cases in place of traditional fixation.
Integer-driven relational database for clinical outcomes research
Authors: Conway FJ
Published: April 2014

A working database program specifically designed to organize and analyze data for the purpose of generating clinical outcomes reports is presented. Following the author's hypothesis, the database accepts only integer input but can generate reports in textual format. The pilot model database presented here uses only five clinic data items, three outcomes items, and can generate 90 different outcomes reports in the form of charts, graphs, or grids. The program consists of a graphical user interface front end that drives a relational database.
Functional significance of torsion of the tendon of tibialis posterior
Authors: Roukis TS , Hurless JS , Page JC
Published: April 2014

The authors describe the anatomical necessity and functional significance of torsion of the tendon of tibialis posterior. A wooden model of the right lower extremity has been constructed which includes representations of the ankle, subtalar, and oblique midtarsal joints. The model is used to show that the presence of torsion within the tendon of tibialis posterior eliminates the need for any longitudinal slippage between individual tendon fibers during triplane movement of the joints of the lower extremity.
Nailbed injuries with hallucal phalangeal fractures--evaluation and treatment
Authors: Tucker DJ , Jules KT , Raymond F
Published: April 2014

Adequate assessment of crush injuries to the hallux is necessary before appropriate management can be initiated. When distal phalangeal fractures of the hallux are detected by routine radiography and subungual hematomas are present, open fractures of the hallux may be overlooked if the physician does not routinely avulse the nailplate. The authors review current modalities for the detection and evaluation of these injuries and present a protocol for treatment.
Rheumatoid nodules affecting both heels with surgical debulking: a case report*
Authors: Jones RO , Chen JB , Pitcher D , Gebhart-Mueller EY , Mueller PQ
Published: April 2014

The presence of subcutaneous nodules in association with rheumatoid arthritis is well documented. In most cases, these nodules occur in association with severe rheumatoid disease. Treatment should be initiated with conservative measures such as custom-molded shoes, nonweightbearing, and oral antibiotic therapy to control infection. The goals of surgery were to alleviate pain, improve function and cosmesis, remove infected bone, and prevent further infection. The surgical sites are completely healed without complications 2 years postoperatively.
Anesthesia blocks of the lower extremity. Comparing the Biojector with needle and syringe
Authors: Gerbert J , Burns S , Liedtke LA
Published: April 2014

Podiatric surgical procedures frequently involve administration of preoperative local anesthesia, and because of the nature of these blocks, it is believed that needle-free injection could greatly enhance this aspect of clinical practice. The object of the study was to determine if needle-free injections with the Biojector were equivalent to needle and syringe injections for ankle, Mayo, neuroma, hallux, and digital anesthetic blocks. The results indicate that needle-free injection with the Biojector is equal to needle and syringe for some anesthesia blocks. More research in this area is needed to determine if technique with the Biojector has an impact on time of anesthesia onset or on level of discomfort and ecchymosis.
Chondromyxoid fibroma
Authors: Baron RL , Galinski AW , Vlahos M , Heiring M
Published: April 2014

Chondromyxoid fibroma is a rare benign tumor derived from cartilage. The classic site of involvement is usually the metaphyseal ends of the long tubular bones, such as the tibia. The majority of these tumors are seen in the lower extremities during the second and third decades of life. Local recurrence of the tumor in bone is not uncommon, while soft tissue recurrence is less frequent. Most younger patients and those with recurrent tumors tend to have the mucinous type. This case is somewhat classic in nature. The tumor was originally seen in the second decade of life and was of the mucinoid type. Bone grafting was necessary because of the size and location of the tumor.
Microembolization from atheroembolic disease or aneurysm. A case study
Authors: Caldwell BD , Marrochello VS
Published: April 2014

Cyanosis of the digits may have several etiologies ranging from trauma to connective tissue disease; however, the most common cause of the so-called blue toe syndrome is atheroembolic disease or aneurysm and is frequently misdiagnosed on initial presentation. Pedal pulses are often palpable which may misdirect the physician from a diagnosis of vascular pathology. Furthermore, the proximal source of embolic shower may be far from the sight of symptoms. Noninvasive vascular testing, peripheral angiography, abdominal and popliteal ultrasonography, and echocardiography are all techniques that may be beneficial in discovering the origin of emboli. Atheroembolisms and aneurysms can be limb-threatening or life-threatening and hence early diagnosis is imperative.
Considerations of prescription medications for the pregnant podiatric patient
Authors: Haverstock BD , Chen F , Jacobs AM
Published: April 2014

Prescription medications are thought to cause less than 1% of all congenital abnormalities. However, prescribing a medication to treat the foot disorder of a pregnant patient can be a source of anxiety for the physician. The authors review some of the medications commonly prescribed in podiatric medical practice and evaluate their use and safety during pregnancy.
Partnership between a Veterans Affairs medical center and a podiatric medical college
Authors: Gorecki GA , Albreski DA , Levy LA
Published: April 2014

The health care academic delivery system is dramatically changing in today's economy. In order to survive, the delivery system must decrease its costs and increase productivity. Integration of academic affiliates and community health care facilities has produced a more efficient health care system and improved medical education. The formation and methodology of the mutual benefits and responsibilities between a health care system and a college of podiatric medicine are examined in detail. Developing unique sharing partnerships can mutually improve medical student experiences, reduce financial burdens, combine joint research projects, and ultimately improve patient care.
History of residency selection issues in podiatric medicine
Authors: Dorcey EU , Tinkleman AR
Published: April 2014

Issues related to residency interview and selection processes have concerned the podiatric medical profession for nearly 20 years. This article presents a chronology and summary of efforts undertaken to address these problems, including a discussion of legal ramifications of residency approval requirements related to establishment of a uniform notification date and participation in a resident-matching service.
Pedal manifestations of Milroy's disease
Authors: Mehta SD , Robinson RJ , Bern SA
Published: April 2014

A pedal complication of Milroy's disease has been presented. With a history of multiple debridement procedures as in this case, there is the risk of recurrent infections and the possibility of permanent vascular compromise, particularly with respect to the thin pedal skin on the dorsal aspect. When the toes are recurrently involved with infection, a patient may be best served with a transmetatarsal amputation using a skin flap on the plantar aspect.
Case presentation of calcaneonavicular coalition in monozygotic twins
Authors: Plotkin S
Published: April 2014

A case study of monozygotic twins with bilateral calcaneonavicular coalitions is presented. With the frequency of tarsal coalitions being approximately 1% to 2% and the frequency of monozygotic twins being 0.4%, it is a rare but predictable finding to see monozygotic twins with tarsal coalitions. This sheds additional light on the etiology of tarsal coalition that historically has been believed to be a defect in mesenchymal differentiation with indications of a genetic component. Despite the limited number of subjects used for various studies, tarsal coalitions have been considered to be an autosomal dominant defect with variable penetrance. In fact, inheritance of tarsal coalitions is more complicated than simple mendelian inheritance patterns and is likely to be a single error in a polygenic system. Because of this inheritance pattern, it is important to consider evaluating siblings and close family members of patients diagnosed with a tarsal coalition.
Role of medical education in health care reform
Authors: Caselli MA
Published: April 2014

Health care reform will have great impact on the podiatric physician as the podiatric medical profession continues to integrate into the general medical community. The role of medical education in addressing five major issues that affect health care reform is explored. These issues include specialization, economics, continuous quality improvement, ethics, and fraud.
Dilute lidocaine ankle blocks in the diagnosis of sympathetically maintained pain
Authors: Harvey CK
Published: April 2014

The author has developed a technique of dilute anesthetic ankle block that appears, on the basis of these preliminary observations, to relieve pathologic pain that may be maintained by the sympathetic nervous system. Symptomatic relief following the use of this injection confirms that the patient's problem is not somatic and that further evaluation and treatment of sympathetically maintained pain syndrome may be indicated.
Onychomycosis. Baseline results of an observational study
Authors: Schein JR , Gause D , Stier DM , Lubeck DP , Bates MM , Fisk R
Published: April 2014

The investigators present an analysis of baseline quality-of-life and patient-management approaches from an observational study of 150 patients being treated by podiatric physicians and dermatologists for onychomycosis. The majority (73%) made the initial office visit specifically because of their onychomycosis. Both men and women indicated that they had substantial physical discomfort as well as concerns related to appearance. Women reported significantly more problems than did men as a result of their onychomycosis. Physicians reported that 54% of patients suffered from toenail discomfort, 36% had pain while walking, 40% reported that their condition limited wearing of shoes, and 67% were embarrassed by the condition. The results of this study suggest that the treatment approach of podiatric physicians is more likely to address the palliative concerns of patients with onychomycosis, while the approach of dermatologists is more likely to attempt a definitive cure.
Epidemiology of onychomycosis in special-risk populations
Authors: Levy LA
Published: April 2014

A person's susceptibility to onychomycosis and the course of the disease once the nails are infected are functions of the interaction of the fungal agent, the host, and environmental factors. The disease is reported to have an overall prevalence of 2% to 13%, but the prevalence is much higher in certain populations, such as older people and those with immunosuppressive conditions. Although onychomycosis may be merely a nuisance and an embarrassment for healthy individuals, some morbidity is seen with all population groups, but especially high-risk patients: diabetics, patients infected with human immunodeficiency virus (HIV), patients with acquired immunodeficiency syndrome (AIDS), and patients with other types of immunosuppression (eg, transplant recipients and patients on long-term corticosteroid therapy). Whether the increased prevalence of onychomycosis in the elderly (up to 30% by age 60) is related to changes in immune function is not known.
Pediatric aneurysmal bone cyst of the distal tibia
Authors: Goss LR , Walter JH
Published: April 2014

A rare, large pediatric aneurysmal bone cyst with pathologic fracture of the distal tibia of a 4-year-old female was presented. Classic radiographic and magnetic resonance imaging findings have been discussed. In a comprehensive review of the literature, aneurysmal bone cysts are an infrequently reported neoplasm of the foot and ankle bones. Lesions are characteristically seen in patients younger than 20 years of age, but rarely younger than 5 years. The benign cyst has a 2:1 female-to male predilection. In long bones, the lesion is typically metaphyseal in nature. Although the pathogenesis is still unknown, there exists the possibility of two types of aneurysmal bone cysts: a primary type without preexisting lesion and a secondary form associated with some other lesion. The diagnosis of aneurysmal bone cyst can be strongly suspected by correlating the radiographic and magnetic resonance imaging findings. For definitive diagnosis, accurate histologic evaluation is imperative to rule out any confusion or possibility with a malignant tumor.
PMMA bead versus parenteral treatment of Staphylococcus aureus osteomyelitis
Authors: Heard GS , Oloff LM , Wolfe DA , Little MD , Prins DD
Published: April 2014

A. rabbit model of Staphylococcus aureus osteomyelitis was used to compare 3 weeks of clindamycin-impregnated polymethylmethacralate (PMMA) bead treatment with 3 weeks of gentamicin-impregnated polymethylmethacralate bead treatment, 4 weeks of parenteral clindamycin treatment, and surgical debridement without any antibiotic treatment. The animals were weighed throughout the course of the experiment and cortical bone and marrow flush specimens were obtained for bacterial culture at the end of therapy. The cortical specimens were bacteria free in 100% (6/6) of the animals receiving parenteral clindamycin, 83% (5/6) of the animals in the clindamycin PMMA group and, none of the animals in the gentamicin PMMA group. The marrow flush specimens were bacteria free in 83% (5/6) of the animals in the parenteral clindamycin group, 67% (4/6) of the animals in the clindamycin PMMA group, and 40% (2/5) of the animals in the gentamicin PMMA group. While these findings are preliminary and further studies with larger numbers of animals are needed, the authors suggest that when PMMA bead therapy is being contemplated, serious consideration should be given to replacing gentamicin with clindamycin in treatment of gram-positive osteomyelitis. Furthermore, incorporation of clindamycin with gentamicin (or tobramycin) should be considered when treating mixed gram-positive and gram-negative osteomyelitis.
Buffered lidocaine decreases the pain of digital anesthesia in the foot
Authors: Friedman HE , Jules KT , Springer K , Jennings M
Published: April 2014

The pain associated with injections for inducing digital anesthesia can be decreased by adding sodium bicarbonate to plain lidocaine. A randomized, double-blind study has demonstrated that 24 out of 30 participants indicated on a visual analogue scale that buffered lidocaine is less painful than plain lidocaine. The pain decreased by 50% or more for almost half of the participants. Practitioners can easily buffer lidocaine in the office by adding a small volume of sodium bicarbonate to plain lidocaine.
Current methods of measuring ulcers. A review
Authors: Houghton E , Kippen C
Published: April 2014

Following a critique of the literature concerning two-dimensional and three-dimensional measurement of ulcers, the authors describe an interrater and intrarater reliability study on linear measurement of an ulcer. Analysis of the results infers that neither method is reliable.
Accessory bone or unusual congenital anomaly
Authors: O'Rourke J , Stone P , Stern M , McGarry J
Published: April 2014

This case study presents a congenital anomaly, diagnosed in a 23-year-old male, not found previously described in the medical literature. It also reviews the current classification systems used to describe congenital anomalies.
Transmission of microbial pathogens by cedar shoe trees
Authors: Woeste S
Published: April 2014

Cedar shoe trees are used to keep shoes from shrinking and losing their shape. When the same cedar shoe trees are used by different shoe wearers, there is a chance of transmission of disease-causing microorganisms between people. This study was conducted to determine whether or not transmission of disease-causing microorganisms via cedar shoe trees occurs, what kinds of microorganisms can be transmitted, and how many organisms can be transmitted. In this study, both bacteria and bacterial spores were transmitted, while fungi were not; however, only several hundred to several thousand pathogenic bacteria were transmitted between any two shoes.
The risk of tetanus in podiatric medicine
Authors: Pouillon JM , Caldwell BD
Published: April 2014

Although tetanus is a preventable disease, several cases are reported to the Centers for Disease Control and Prevention each year. Many conditions treated by podiatric physicians carry the risk of infection by Clostridium tetani, and it is advisable for podiatrists to update a patient's tetanus immunization status if the patient presents with a tetanus-prone wound.
Podiatric medicine and public health. Concepts and perspectives. Special Commission of the Podiatric Health Section of the American Public Health Association
Authors: Helfand AE
Published: April 2014

Podiatric physicians play an important role in the field of public health. In 1975, the Podiatric Health Section of the American Public Health Association (APHA) formulated an official statement of the roles and responsibilities of podiatrists in the public health field. Entitled Functions and Educational Qualifications of Podiatrists in Public Health, the document was published in the September 1975 issue of the American Journal of Public Health. For more than 2 decades, it remained the primary document defining and delineating the activities of the specialist in podiatric public health. Recently, it was recognized that in this time of rapid change in health-care delivery, a revision of this important statement was needed. A mini-grant from the APHA in 1996-1997 supported the formation of a special commission to update the formal position of the APHA and its Podiatric Health Section with respect to podiatric public health and to provide direction for the future. This article is a shortened version of the report issued by the special commission of the APHA.
Metastatic breast cancer presenting as heel pain
Authors: Groves MJ , Stiles RG
Published: April 2014

The authors present a case of breast cancer metastasizing to the calcaneus that was confirmed by bone biopsy. The patient's complaint of heel pain provided the initial evidence of skeletal metastasis. Metastatic spread of cancer to the hand or foot (acrometastasis) is considered rare. However, the possibility of acrometastasis should be considered in any patient with a history of cancer presenting with skeletal pain, especially if the symptoms do not respond to therapy.
The demography of limb dominance, body-mass index, and metatarsus adductus deformity
Authors: Montague JR , Bovarnick M , Effren SC , Southerland CC
Published: April 2014

To test the null hypothesis that limb dominance (laterality) and side of complaint are not associated in a diverse population, nearly 400 patients (40% male, 60% female) of varying age and body size from three South Florida podiatric medical teaching facilities were surveyed in 1995-1996. Radiographs of feet were available for 15% of the patients, and the metatarsus adductus angle was measured on each x-ray. The typical patient was a women (median age, 49 years) of average body weight and average body-mass index. No statistical association was found between laterality and side of complaint in the broader sample, although a significant association did appear in the subsample of patients with bilateral x-rays. The prevalence of metatarsus adductus deformity (metatarsus adductus angle > 15 degrees) among patients with x-rays was 62%. No sex-specific, age-specific, or body size-specific associations were found between handedness and metatarsus adductus deformity.
Geometric models that classify structural variations of the foot
Authors: Demp PH
Published: April 2014

The author presents a description of three geometric models to serve as a framework for establishing a numerical classification system of unlimited refinement for structural variations of the foot and foot types. Such a classification system may identify different forms (foot types) that may be closely aligned to complex movements of the foot (dynamic foot function). This may help in the diagnosis and treatment of biomechanical disabilities. Clinical evaluations are based on radiographic landmark data from weightbearing radiographs.
Variability of plantar pressure data. A comparison of the two-step and midgait methods
Authors: McPoil TG , Cornwall MW , Dupuis L , Cornwell M
Published: April 2014

The number of trials required to obtain a reliable representation of the plantar pressure pattern is an important factor in the assessment of people with insensate feet or the use of plantar pressure data as a basis for fabrication of foot orthoses. Traditionally, the midgait method has been used for the collection of pressure data, but the large number of walking trials required by this method can increase the risk of injury to the plantar surface of the insensate foot. As a result, the two-step method of plantar pressure data collection has been advocated. The purpose of this investigation was to determine the degree of variability in regional plantar pressure measurements using the midgait and two-step methods of data collection. Plantar pressure data were collected from ten volunteers (five men and five women) between the ages of 20 and 35 years in 20 trials using both data-collection protocols. The results of the study indicate that three to five walking trials are needed to obtain reliable regional peak pressure and pressure-time integral values when the two-step data-collection protocol is used. Although either method can be used for pressure data collection, one method should be used consistently when repeated assessments are required.
Complex regional pain syndrome
Authors: Hernandez W , Raja A , Capuano C
Published: April 2014

Complex regional pain syndrome is a chronic pain syndrome that is often instigated by postoperative or post-traumatic events. The disease process can progress through three stages, the first of which tends to respond best to treatment. A review of the literature is presented, followed by a report of a patient who developed symptoms of complex regional pain syndrome following a water-skiing accident.
Heel pain in children. Diagnosis and treatment
Authors: Kim CW , Shea K , Chambers HG
Published: April 2014

Heel pain in children is common, and its evaluation is challenging. Medical history and physical examination may be unrevealing owing to children's limited communication skills. Often, advanced laboratory and imaging studies are required to make an accurate diagnosis. The most common causes of heel pain in children are apophysitis, enthesopathy, and overuse syndromes such as tendinitis. Juvenile rheumatoid arthritis is relatively uncommon. In very active children, occult fractures must also be evaluated. Pain unrelated to activity may indicate tumors, infection, or congenital problems. In general, heel pain in children is treated nonoperatively. For fractures in particular, children are less likely than adults to receive surgical treatment.
Pyoderma gangrenosum involving the foot. A case report
Authors: Kashefsky H , Callahan E , Ruder UC , Grisafi PJ , Dellacorte MP
Published: April 2014

Pyoderma gangrenosum is a rare and destructive inflammatory skin disease. The authors present a report of a patient with a classic case of pyoderma gangrenosum involving the foot. The diagnosis was made on the basis of clinical presentation and progression of the disease after differential diagnoses of common conditions were excluded. A brief overview of the disease process, its treatment, and its correlation with ulcerative colitis is provided.
Ganglions of the foot and ankle. A retrospective analysis of 63 procedures
Authors: Pontious J , Good J , Maxian SH
Published: April 2014

A retrospective study was conducted to evaluate treatment of foot and ankle ganglion cysts seen at the Foot and Ankle Institute at the Pennsylvania College of Podiatric Medicine (now Temple University School of Podiatric Medicine). From 1990 to 1997, 63 patients (63 ganglion cysts) were treated by conservative or surgical means. Statistical analysis of data collected showed a significant relationship between type of treatment received and recurrence of the cyst. Surgical intervention resulted in significantly less recurrence (11%) than conservative treatment (63%). Regardless of whether treatment was conservative or surgical, there was no significant relationship between location of the cyst and recurrence. The type of conservative treatment was not significantly related to recurrence of the cyst. The surgical recurrence rate reported here is comparable to that reported in other studies of foot and ankle ganglion cysts. The number of foot and ankle ganglion cysts evaluated in this study is the largest in the literature.
Use of the ROC anchor in foot and ankle surgery. A retrospective study
Authors: Kuwada GT
Published: April 2014

A retrospective study was conducted on the use of the ROC (Radial Osteo Compression) soft-tissue anchor in foot and ankle surgery. This article describes how the anchor is deployed, problematic aspects of using the anchor, and complications and success rates associated with the anchor in ankle stabilizations, posterior tibial tendon reconstruction, peroneus brevis tendon reconstruction after fracture of the base of the fifth metatarsal, and detachment and reattachment of the Achilles tendon. The ROC anchor consists of the anchor with nonabsorbable suture attached to the shaft, the deployment handle, and drill bits. The anchor and shaft are snapped into the deployment handle and inserted into the drill hole. Compression of the trigger deploys the anchor into the hole. The ROC anchor was found to be reliable, useful, and relatively easy to deploy, with outcomes similar to those of other soft-tissue anchors.
The effect of pregnancy on footprint parameters. A prospective investigation
Authors: Bird AR , Menz HB , Hyde CC
Published: April 2014

Pregnancy produces significant alterations in the posture of the pregnant woman; however, gait changes that occur during pregnancy have not been adequately evaluated in the literature. This prospective investigation of the footprints of 25 pregnant women from early pregnancy to just prior to parturition revealed a significant increase in the base of gait during walking. This change in gait function may be a compensatory mechanism to improve locomotor stability, and may have important implications for foot function and development of lower-extremity pathology in pregnant women.
The increased prevalence of severe necrotizing infections caused by non-group A streptococci
Authors: Reyzelman AM , Lipsky BA , Hadi SA , Harkless LB , Armstrong DG
Published: April 2014

The authors report on 20 patients who were admitted to the University of Texas Health Science Center at San Antonio during a recent 4-month period with foot infections caused predominantly by non-group A streptococci. This number of patients was significantly greater than the number admitted to the same institution with the same diagnosis during the preceding 3 years. All patients had type 2 diabetes mellitus. In each case, a rapidly spreading cellulitis followed trauma to the foot, which necessitated emergent incision and drainage. Five patients required extensive fascial and skin debridement because of soft-tissue destruction, and two patients needed below-the-knee amputation because of uncontrolled infection. These cases suggest that non-group A streptococci, like group A streptococci, can cause serious skin and soft-tissue infections in patients with diabetes that may require aggressive surgical debridement despite appropriate antibiotic therapy.
The windlass mechanism of the foot. A mechanical model to explain pathology
Authors: Fuller EA
Published: April 2014

This article presents a mechanical model that can be used to understand the foot, to help develop methods of treatment of foot pathology, and to provide direction for future research in foot mechanics and pathology. The anatomy and mechanical function of the windlass mechanism of the foot are analyzed using principles of mechanical engineering. The principles of force couples and free-body diagrams are explained and then applied to the foot. The relationship of the windlass mechanism to plantar fasciitis or heel spur syndrome, hallux abducto valgus, and hallux limitus is discussed.