bluuebunny/crossref_metadata_2025 huggingface dataset:
Contralateral Peak Plantar Pressures with a Postoperative Boot
Authors: Mieras Jamie N. , Singleton Tanya J. , Barrett Stephen L.
Published: April 2014

Background: Frequent use of walking boots in podiatric medicine often elicits patient complaints and sequelae from the imposed limb-length discrepancy. This study was designed primarily to determine whether peak plantar pressures are decreased in the contralateral foot when a moderately worn athletic shoe is worn opposite a high-calf walking boot and, if so, secondarily to determine whether a specialized surgical shoe worn on the contralateral foot can also effectively reduce this pressure. The pressure reductions were then compared to determine whether significantly greater plantar pressure reduction was provided by either the athletic shoe or the surgical shoe.

Methods: Participants without a foot abnormality walked on a treadmill in four footwear combinations: barefoot bilaterally, high-calf rocker-bottom sole (HCRB) walking boot/ barefoot, HCRB walking boot/athletic shoe, and HCRB walking boot/modified walking boot shoe. Measurements were taken with the participants wearing socks. Peak plantar calcaneal pressures were collected.

Results: Peak plantar pressures under the calcaneus opposite the HCRB walking boot were significantly reduced from barefoot pressures when either an athletic shoe or the modified walking boot shoe was worn. However, no significant difference was seen when comparing the reduction by the athletic shoe with that by the modified walking boot.

Conclusions: Wearing an athletic shoe on the foot opposite an HCRB walking boot reduces calcaneal pressures; however, wearing a modified device with structural properties of an HCRB walking boot sole is no better than an athletic shoe at reducing peak calcaneal pressures. (J Am Podiatr Med Assoc 101(2): 127–132, 2011)
Sever’s Disease
Authors: Scharfbillig Rolf W. , Jones Sara , Scutter Sheila
Published: April 2014

Background: Sever’s disease, also known as calcaneal apophysitis, is thought to be an inflammation of the apophysis of the heel, which is open in childhood. This condition has been commented on and looked at in a retrospective manner but has not been examined systematically. We assembled the most commonly cited theoretical causative models identified from the literature and tested them to determine whether any were risk factors.

Methods: Children with Sever’s disease were compared with a similarly aged nonsymptomatic population to determine whether identifiable risk factors exist for the onset of Sever’s disease. Areas raised in the literature and, hence, compared were biomechanical foot malalignment, as measured by Root et al–type foot measurements and the Foot Posture Index; ankle joint dorsiflexion, measured with a modified apparatus; body mass index; and total activity and types of sport played.

Results: Statistically significant but small odds ratios were found in forefoot to rearfoot determination and left ankle joint dorsiflexion.

Conclusions: This study suggests that there is no evidence to support that weight and activity levels are risk factors for Sever’s disease. The statistically significant but clinically negligible odds ratio (0.93) on the left side for decreased ankle joint dorsiflexion and statistically significant and clinically stronger odds ratio bilaterally for forefoot to rearfoot malalignment suggest that biomechanical malalignment is an area for further investigation. (J Am Podiatr Med Assoc 101(2): 133–145, 2011)
Surgical Treatment of Pressure Ulcers of the Heel in Skilled Nursing Facilities
Authors: Han Paul Y. , Ezquerro Ruben
Published: April 2014

Background: Chronic nonhealing pressure ulcers of the heel in nursing homes are frequent occurrences among bedridden patients with lower-extremity contractures of varying degrees of severity. Conservative local wound care for these patients can be time consuming, ineffective, costly, and may only delay an eventual major leg amputation. This study evaluates the efficacy of limb salvage surgical procedures, partial calcanectomy, total calcanectomy, and excision of the entire calcaneus and talus, for heel ulcers.

Methods: We performed a retrospective review of 57 nursing home residents who had chronic infected nonhealing pressure ulcers of the heel that we had treated over 12 years. Forty-three patients underwent partial calcanectomy, nine underwent total calcanectomy, and five underwent excision of the entire calcaneus and talus. Average postoperative follow-up was 15 months. Also included in this study are representative surgical cases.

Results: Forty-three patients completed follow-up. Complete healing occurred in 25 patients (58%). Failure to resolve the heel ulcer owing to persistent infection, or recurrence was seen in 18 patients (42%) who eventually had a below-the-knee or above-the-knee amputation. All of the patients with heel pressure ulcers were found to have lower-extremity contractures.

Conclusions: In the nonambulatory contracted patient with a heel ulcer, partial or total calcanectomy or excision of the entire calcaneus and talus offer a viable alternative not only for resolution of infection but also for prevention of limb loss. An aggressive plan must also be instituted to address the lower-extremity contractures in order to prevent recurrence. (J Am Podiatr Med Assoc 101(2): 167–175, 2011)
Management in the Wound-care Center Outpatient Setting of a Diabetic Patient with Forefoot Osteomyelitis Using Cerament Bone Void Filler Impregnated with Vancomycin
Authors: Karr Jeffrey C.
Published: April 2014

Several nonbiodegradable and biodegradable antibiotic cement delivery systems are available for the delivery of antibiotics for adjunctive therapy in the management of osteomyelitis. A major nonbiodegradable delivery system is polymethylmethacrylate beads. Antibiotics that can be incorporated into this delivery system are limited to the heat-stable antibiotics vancomycin and aminoglycosides, tobramycin being the most popular. Calcium sulfate and hydroxyapatite (Cerament Bone Void Filler) is a unique biocompatible and biodegradable ceramic bone void filler that can successfully deliver heat-stable and heat-unstable antibiotics in musculoskeletal infections. The use of Cerament as antibiotic beads has not been previously reported. An off-label case of diabetic foot osteomyelitis successfully managed with surgical bone resection and vancomycin Cerament antibiotic beads is presented. Subsequent surgery for the bone infection and staged removal of the antibiotic beads was not necessary. (J Am Podiatr Med Assoc 101(3): 259–264, 2011)
Metastatic Renal Cell Carcinoma Presenting as Foot Metastasis
Authors: Choufani Elie , Diligent Jerome , Galois Laurent , Mainard Didier
Published: April 2014

Malignant tumors frequently metastasize to bone centrally in the skeleton. Metastatic disease distal to the knee is unusual. Metastasis to the foot (acrometastasis) is rare (0.01%) and is usually a late manifestation of disseminated disease. The purpose of this article is to present a rare case of metastatic renal cell carcinoma with foot metastasis as the primary manifestation along with another rare localization of metastatic disease distal to the knee, in the contralateral tibial diaphysis. To highlight the delay in diagnosis of such a rare condition to consider it in the diagnosis of a painful foot, we also present a review of the literature. (J Am Podiatr Med Assoc 101(3): 265–268, 2011)
Freiberg’s Disease
Authors: Chun Kyung Ah , Oh Hyung Keun , Wang Kook Hyun , Suh Jin Soo
Published: April 2014

Background:

The extent of necrosis is the main determining factor in the outcome of osteonecrosis. There is no method for measuring the extent of osteonecrosis of the metatarsal head in Freiberg’s disease. The purpose of this study was to determine the reliability and prognostic ability of a new method for measurement of the extent of osteonecrosis in Freiberg’s disease on three-dimensional computed tomography.

Methods:

A retrospective review of 11 cases with symptomatic Freiberg’s disease in ten patients (5 males and 5 females; mean age, 27 years) undergoing computed tomography between July 2005 and September 2007 was performed. Two investigators (K.A.C. and H.K.O.) used a new method to measure the necrotic extent of the metatarsal head: the necrotic angle ratio of necrotic arc angle to normal arc angle of the articular surface on the sagittal reconstruction image of computed tomography. The interobserver reliability was determined for computed tomography measurement. Correlation between the Smillie staging using radiographs and the necrotic angle ratio on computed tomography was also evaluated.

Results:

One patient presented with stage I disease (Smillie staging), one with stage II, two with stage III, five with stage IV, and two with stage V, respectively. The necrotic angle ratio of the metatarsal head was 14% in stage I, 21% in stage II, 34% in stage III, 43% in stage IV, and 53% in stage V. The interobserver reliability for computed tomography measurement was high (Cronbach α=0.96). We found the increase of the necrotic extent in proportion to the Smillie stage. The Smillie staging using radiographs and the necrotic angle ratio on computed tomography were significantly correlated. (P<0.05)

Conclusions:

Three-dimensional computed tomography measurement of the necrotic extent of the metatarsal head is a reliable and useful method in evaluating the staging of Freiberg’s disease and may eventually help to optimize treatment. (J Am Podiatr Med Assoc 101(4): 335–340, 2011)
Stabilization of Joint Forces of the Subtalar Complex via HyProCure Sinus Tarsi Stent
Authors: Graham Michael E. , Parikh Rachit , Goel Vijay , Mhatre Devdatt , Matyas Aaron
Published: April 2014

Background:

The foot is the foundation of the body. The stability of the osseous hindfoot structure is crucial in bipedal locomotion. The subtalar joint is responsible for conversion of the rotatory forces of the lower extremities and dictates the movements of the midtarsal joints and the forefoot. In a hyperpronated foot, excessive abnormal pronation results in partial to full obliteration of the sinus tarsi. The hypothesis is that the HyProCure device will prevent obliteration of the sinus tarsi, thereby stabilizing the subtalar joint complex and eliminating the excessive forces to the proximal and distal musculoskeletal system that occur with every step.

Methods:

Five fresh-frozen human foot cadaver specimens that represented pathologic hindfoot and midfoot instability and partial to full obliteration of the sinus tarsi were axially compressed to 2,000 N and internally rotated by 15° to produce maximum pronation of the subtalar joint using a biaxial materials testing machine. The forces were measured across the posterior and anterior talocalcaneal joint facets before and after placement of the HyProCure stent.

Results:

The subtalar joint stabilized after placement of the HyProCure sinus tarsi stent. The mean ± 1 SD forces in the posterior talocalcaneal joint increased from 795.88 ± 106 N to 1,004.86 ± 72.41 N (P < 0.05, two-tailed paired t test). The mean ± SD forces at the anterior talocalcaneal joint decreased from 520.15 ± 127.18 N to 394.56 ± 73.83 N (P < 0.05), shifting the contact area posteriorly.

Conclusions:

Placement of the HyProCure subtalar stabilization stent in a hyperpronated foot prevents excessive talar subluxation and assists in proper distribution of the axial loads on the subtalar facet joints. (J Am Podiatr Med Assoc 101(5): 390–399, 2011)
Evaluating Intratester Reliability of Manual Masking of Plantar Pressure Measurements Associated with Chronic Gout
Authors: Rome Keith , Survepalli David George , Lobo Maria , Dalbeth Nicola , McQueen Fiona , McNair Peter J.
Published: April 2014

Background:

Plantar pressure measurements are commonly used to evaluate foot function in chronic musculoskeletal conditions. However, manually identifying anatomical landmarks is a source of measurement error and can produce unreliable data. The aim of this study was to evaluate intratester reliability associated with manual masking of plantar pressure measurements in patients with gout.

Methods:

Twenty-five patients with chronic gout (mean disease duration, 22 years) were recruited from rheumatology outpatient clinics. Patients were excluded if they were experiencing an acute gout flare at the time of assessment, had lower-limb amputation, or had diabetes mellitus. Manual masking of peak plantar pressures and pressure-time integrals under ten regions of the foot were undertaken on two occasions on the same day using an in-shoe pressure measurement system. Test-retest reliability was assessed by using intraclass correlation coefficients, SEM, 95% limits of agreement, and minimal detectable change.

Results:

Mean peak pressure intraclass correlation coefficients ranged from 0.92 to 0.97, with SEM of 8% to 14%. The 95% limits of agreement ranged from−150.3 to 133.5 kPa, and the minimal detectable change ranged from 30.8 to 80.6 kPa. For pressure-time integrals, intraclass correlation coefficients were 0.86 to 0.94, and SEM were 5% to 29%, with the greater errors observed under the toes. The 95% limits of agreement ranged from −48.5 to 48.8 kPa/sec, and the minimal detectable change ranged from 6.8 to 21.0 kPa/sec.

Conclusions:

These findings provide clinicians with information confirming the errors associated with manual masking of plantar pressure measurements in patients with gout. (J Am Podiatr Med Assoc 101(5): 424–429, 2011)
Validation of the Talar–Second Metatarsal Angle as a Standard Measurement for Radiographic Evaluation
Authors: Graham Michael E. , Chikka Avanthi , Jones Paul C.
Published: April 2014

Background:

Radiographs provide valuable information for assessing osseous foot deformities and aid in accurate diagnosis. The radiographic angular measurements can be used to establish a relationship between the forefoot and the hindfoot that will present valuable information about normal versus pathologic alignment of the foot. The talar–first metatarsal (T1M) angle is frequently used as one of these angles in this capacity; however, there are limitations to the anteroposterior T1M angle. We present a more consistent, reproducible, and accurate measurement for determining foot abnormalities in the transverse plane using the T2M angle instead of the T1M angle.

Methods:

Seventy feet in 35 participants (12 men and 23 women) were considered for this study. Individuals were selected on the basis of the established inclusion and exclusion criteria. Anteroposterior radiographs were taken in the angle and base of gait, the neutral calcaneal stance position (NCSP), and the resting calcaneal stance position (RCSP). Three observers measured these angles using three different methods.

Results:

The mean ± SD T2M angle was 2.95° ± 7.16° in NCSP and 18.61° ± 7.21° in RCSP. No significant differences were found among the measurements made by the three observers using slightly varying procedures in NCSP and RCSP (P > .05). The intraclass correlation coefficients among the measurements were 0.905 in NCSP and 0.937 in RCSP. Bland-Altman plots showed very good agreement between the measurements made by the three observers.

Conclusions:

The anteroposterior T2M angle gives a consistent and reproducible measurement that provides accurate information about foot alignment. (J Am Podiatr Med Assoc 101(6): 475–483, 2011)
Quantification of Skin Marker Movement at the Malleoli and Talar Heads
Authors: Birch Ivan , Deschamps Kevin
Published: April 2014

Background:

Quantifying subtalar joint kinematics during locomotion is a major challenge but is critical to understanding foot function. The difficulty of modeling the subtalar joint is demonstrated by the plethora of three-dimensional multisegment foot models lacking specific consideration of the subtalar joint. Scientific attempts to develop an adequate method of quantifying subtalar joint kinematics should include investigation of the movement of skin-mounted markers. This study reports on a single-subject investigation into this topic.

Methods:

Radiopaque markers were attached to the skin overlying the medial and lateral malleoli and the medial and lateral talar heads of a single subject. Frontal, sagittal, and transverse plane radiographs were taken with the foot in the fully pronated and fully supinated positions. Parallax corrected measurements were taken of the displacement of the markers from the bony landmarks. Measurements were also taken of the effect of these displacements on angular calculations.

Results:

Skin movement at the four anatomical locations was not uniform, with displacements varying from 0.61 to 22.18 mm. Movement of the malleolar markers was found to be less than that of the talar head markers. The distortion of angular measurements caused by movement of the skin markers relative to the bony landmarks was found to be only 1° in the sagittal and transverse planes and 5° in the frontal plane.

Conclusions:

For this subject, skin-mounted markers could be used to assess subtalar joint motion. Further studies are necessary to investigate the implications of these findings to the wider population. (J Am Podiatr Med Assoc 101(6): 497–504, 2011)
Partial or Total Calcanectomy as an Alternative to Below-the-Knee Amputation for Limb Salvage
Authors: Schade Valerie L.
Published: April 2014

Background:

Below-the-knee amputations are regarded as definitive treatment for calcaneal osteomyelitis. They may be less than desirable in patients with a viable midfoot and forefoot. Partial and total calcanectomies have been reported as an alternative for limb salvage. However, the durability of the residual limb is questionable.

Methods:

A systematic review was undertaken to identify material relating to the potential for limb salvage with partial or total calcanectomy in ambulatory patients with calcaneal osteomyelitis. Studies eligible for inclusion consecutively enrolled ambulatory patients older than 18 years who underwent partial or total calcanectomy without adjunctive free tissue transfer for the treatment of calcaneal osteomyelitis and had a mean follow-up of 12 months or longer.

Results:

Sixteen studies involving 100 patients (76 partial and 28 total calcanectomies) met all of the inclusion criteria. Weighted mean follow-up was 33 months. Minor complications with subsequent healing occurred in less than 24% of patients. Most major complications were related to residual soft-tissue infection and osteomyelitis. Approximately 10% of patients required a major lower-extremity amputation. Major complications and major lower-extremity amputations occurred more frequently after total calcanectomy and in patients with a diagnosis of diabetes. Eighty-five percent of patients maintained or improved their ambulatory status postoperatively. Only 3% of patients decreased their ambulatory status postoperatively, becoming unlimited household ambulators.

Conclusions:

This systematic review provides evidence that partial or total calcanectomy is a viable option for limb salvage in ambulatory patients with calcaneal osteomyelitis. (J Am Podiatr Med Assoc 102(5): 396–405, 2012)
The Role of Podiatry in the Prevention of Falls in Older People
Authors: Najafi Bijan , de Bruin Eling D. , Reeves Neil D. , Armstrong David G. , Menz Hylton B.
Published: April 2014

Given the age-related decline in foot strength and flexibility, and the emerging evidence that foot problems increase the risk of falls, established guidelines for falls prevention recommend that older adults have their feet examined by a podiatrist as a precautionary measure. However, these guidelines do not specify which intervention activities might be performed. Published in this special issue of JAPMA are nine high-quality articles, including seven original studies and two basic science reviews, focusing on the benefit and impact of footwear and foot and ankle interventions in reducing the risk of falling. The selected studies discuss various relevant questions related to podiatric intervention, including adherence to intervention; preference and perception of older adults in selecting footwear; benefit of insoles, footwear, and nonslip socks in preventing falls; fear of falling related to foot problems; benefit of podiatric surgical intervention; and benefit of foot and ankle exercise in preventing falls. (J Am Podiatr Med Assoc 103(6): 452–456, 2013)
Older People’s Perceptions of a Multifaceted Podiatric Medical Intervention to Prevent Falls
Authors: Menz Hylton B. , Spink Martin J. , Landorf Karl B. , Hill Keith D. , Lord Stephen R.
Published: April 2014

Background:

Falls are common in older people and are associated with substantial health-care costs. A recent randomized controlled trial of a multifaceted podiatric medical intervention demonstrated a 36% reduction in the fall rate over 12 months. We evaluated the acceptability of and levels of satisfaction with this intervention in the older people who participated in the trial.

Methods:

Participants allocated to the intervention group (which included a home-based program of foot and ankle exercises, assistance with the purchase of safe footwear when necessary, and provision of prefabricated foot orthoses) completed a structured questionnaire 6 months after they had received the intervention. The questions addressed participants’ perceptions of their balance and foot and ankle strength, the perceived difficulty of the exercise program, and the degree of satisfaction with the footwear and orthoses provided.

Results:

Of 153 participants, 134 (87.6%) attended the 6-month follow-up assessment and completed the questionnaire. Most participants perceived improvements in balance (62.7%) and foot and ankle strength (74.6%) after 6 months of performing the exercises, and 86.6% considered the difficulty level of the exercises to be “about right.” Most participants reported that they were somewhat or very satisfied with the footwear (92.3%) and orthoses (81.6%) provided.

Conclusions:

The multifaceted podiatric medical intervention used in this trial was generally perceived to be beneficial and demonstrated high levels of satisfaction among participants. Further research is now required to evaluate the feasibility of implementing the intervention in a range of clinical practice settings. (J Am Podiatr Med Assoc 103(6): 457–464, 2013)
“Good for Older Ladies, Not Me”
Authors: Davis Annette , Murphy Anna , Haines Terry P.
Published: April 2014

Background:

Footwear selection is important among older adults. Little is known about factors that influence footwear selection among older women. If older women are to wear better footwear that reduces their risk of falls and foot abnormalities, then a better understanding of the factors underlying footwear choice is needed. This study aims to identify factors that drive footwear selection and use among older community-dwelling women with no history of falls.

Methods:

A cross-sectional survey using a structured, open-ended questionnaire was conducted by telephone interview. The participants were 24 women, 60 to 80 years old, with no history of falls or requirement for gait aids. The responses to open-ended questions were coded and quantified under a qualitative description paradigm.

Results:

The main themes identified about footwear selection were aesthetics and comfort. Aesthetics was by far the main factor influencing footwear choice. Wearing safe footwear was not identified as a consideration when purchasing footwear.

Conclusions:

This study indicates that older women are driven primarily by aesthetics and comfort in their footwear selection. These footwear drivers have implications for health-care providers when delivering fall and foot health education. (J Am Podiatr Med Assoc 103(6): 465–470, 2013)
A comparative analysis of conservative versus surgical treatment of Morton's neuroma
Authors: Gaynor R , Hake D , Spinner SM , Tomczak RL
Published: April 2014

The authors present a study of the treatment of Morton's neuroma. Sixty patients, involving 65 feet treated, were studied. Conservative treatments were compared to surgical excision of the neuroma. As a result of the findings in this study, the authors recommend surgical excision as the initial treatment of choice.
Use of ciprofloxacin in podiatric medicine
Authors: LeFrock JL
Published: April 2014

Ciprofloxacin is the first of the new class of antibiotics known as fluoroquinolones to be approved for use in skin, skin structure, and bone and joint infections. It has an extremely broad spectrum and is particularly effective against traditionally resistant gram-negative rods. As an oral agent, it is as effective as parenteral drugs against a variety of organisms and diseases. Its spectrum, pharmacokinetics, and podiatric indications are reviewed.
Anatomical study of the sesamoid bones of the first metatarsal
Authors: David RD , Delagoutte JP , Renard MM
Published: April 2014

The authors undertake an anatomical study of the sesamoid apparatus to determine its mechanical functions. The intersesamoid ligament is of particular interest, since its functions are diverse and complex. The sesamoid apparatus appears to coordinate the various forces that converge upon the forefoot into the great toe. The apparatus then seems to form part of a catapult that assists propulsion.
Wound healing. Oral and topical activity of Aloe vera
Authors: Davis RH , Leitner MG , Russo JM , Byrne ME
Published: April 2014

The influence of Aloe vera, orally and topically, on wound healing was studied. Wounds were induced on both sides of the vertebral column of ICR mice using a biopsy punch. For the oral study, experimental animals received A. vera in their drinking water for 2 months, whereas the control animals received only water. In the topical study, experimental animals were given 25% A. vera in Eucerin cream topically. The control animals received cream only. A 62.5% reduction in wound diameter was noted in mice receiving 100 mg/kg/day oral A. vera and a 50.8% reduction was recorded in animals receiving topical 25% A. vera. These data suggest that A. vera is effective by both oral and topical routes of administration.
Renal cell carcinoma and osseous metastases. Case report and literature review
Authors: Goldman FD , Dayton PD , Hanson CJ
Published: April 2014

Renal cell carcinoma is one of the great mimics in medicine. The diagnosis is complicated by clinical presentations involving a multitude of symptoms, often associated with the sites of metastasis. A high percentage of renal cell carcinomas have metastasized at the time of initial presentation, and symptoms associated with this metastasis may actually initiate the diagnosis. Because the site of tumor origin is frequently unknown, a diagnostic strategy for identifying the primary source has been proposed. The prognosis for renal cell carcinoma with metastasis is poor, with fewer than 9% of patients surviving at 5 years. Consequently, treatment is directed primarily at palliation of painful symptoms and stabilization of bony structures. With these goals in mind, treatment modalities run the gamut from radiotherapy, to curettage with polymethyl methacrylate augmentation, to amputation. In the case reported here, renal cell carcinoma was diagnosed in the course of evaluation of a painful lytic lesion of the foot. Treatment alternatives and associated risks and complications were discussed at some length and the patient chose curettage and packing with polymethyl methacrylate in combination with radiotherapy. This approach was successful in palliation of pain and maintenance of walking ability and independence.
Open reduction of Lisfranc's dislocation
Authors: Wojciehoski RF , Krych SM , Harkless LB
Published: April 2014

Cases that are seen early often can be treated by closed reduction. It is believed that the injury in the case presented could have been treated by closed reduction if it had been recognized at the time of occurrence. This would have decreased the patient's long postoperative course. Hardcastle et al found that the postoperative results with the partial incongruity type Lisfranc dislocation were fair. Post-traumatic degenerative joint changes in the midfoot may occur and the patient should receive orthotic therapy.
Brown recluse spider bite. A literature review and case report
Authors: Gutowicz M , Fritz RA , Sonoga AL
Published: April 2014

A review of the literature on brown recluse spider bite is presented, including clinical presentation and treatment. Emphasis is placed on the treatment of local tissue necrosis. A case report of a severe necrotic ulcer secondary to a spider bit is presented. Tissue necrosis following a brown recluse spider bit can be debilitating, and healing may be prolonged for many months. Even with early treatment, prognosis often is poor. Future studies might help establish better treatment regimens.
Osteochondral fracture of the talofibular joint
Authors: Borrelli AH
Published: April 2014

Many accounts have been written concerning osteochondral fracture of the ankle joint. However, many of these pertain only to the talus. The author discusses an osteochondral fracture of the fibular articulating surface of the ankle joint. The etiology of the osteochondral fracture, previously undescribed, is postulated to arise from a plantarflexed inverted foot that undergoes axial rotation. The talus, therefore, fractures the fibular articulating surface. These fractures may be difficult to diagnose and require special radiographic views, such as computed tomography scans or tomograms, to help differentiate the diagnosis. In some cases, ankle arthrography may be helpful in identifying the fracture.
Gastrocnemius recession in the treatment of nonspastic ankle equinus. A retrospective study
Authors: Downey MS , Banks AS
Published: April 2014

An updated and thorough review of the gastrocnemius equinus deformity and its surgical correction is presented. For the first time, a long-term retrospective study documents the overall improvement in the symptoms and architecture of the lower extremity and foot following gastrocnemius recession. Additionally, numerous associated concerns and the surgical procedure are examined retrospectively.
Homologous and heterogenous bone grafting in podiatric surgery
Authors: McCarthy DJ , Hutchinson BT
Published: April 2014

Homologous and heterogenous bone grafting as it might be used in podiatric surgery is reviewed with emphasis on histologic events observed. New bone proliferation, resorption, revascularization, and remodeling are contrasted with autogenous bone grafts, which are generally thought to be the preferred surgical option.
Forensic methods and the podiatric physician
Authors: Nirenberg MS
Published: April 2014

This is an introductory study of forensic podiatry. To elevate forensic podiatry to the level of forensic odontology and forensic anthropology, the podiatric medical profession must begin educational programs and research. A system for monitoring the activities of podiatrists involved in forensic medicine must be established to ensure that the high degree of integrity to which the profession is committed is maintained. By following these guidelines, the author believes that sometime in the future a podiatrist will be on the staff of every major police department in the country. At that point, the podiatric medical profession will have achieved unsurpassed status, recognition, and prestige.
Anti-inflammatory activity of Aloe vera against a spectrum of irritants
Authors: Davis RH , Leitner MG , Russo JM , Byrne ME
Published: April 2014

The authors have evaluated the spectrum of anti-inflammatory activity of A. vera in a number of models of inflammation in the hind paw of the experimental rat induced by kaolin, carrageenan, albumin, dextran, gelatin, and mustard. Croton oil was used in a topical model of inflammation to determine the oral activity and time-dependent dosing of A. vera. The authors found that A. vera was active in all models of inflammation. Of the various irritants tested, A. vera was especially active against gelatin-induced and kaolin-induced edema and, in contrast, had minimal activity when tested against dextran-induced edema. Oral activity of A. vera was demonstrated to be dependent on the presence of anthraquinones. The various irritant-induced edema models provided a broad spectrum of anti-inflammatory activity for A. vera.
Distal first metatarsal epiphysis. A common pediatric variant
Authors: Mathis SK , Frame BA , Smith CE
Published: April 2014

While most anatomists have referred to a distal epiphyseal growth plate in the first metatarsal as rare or occasional, one definitive study has shown this accessory growth center to be extremely common in children under the age of 12 years. The authors discuss the significance of this phenomenon, and present a literary review, a clinical case report, and a retrospective radiographic study of 217 pediatric feet, confirming the incidence of the distal growth plate.
Pedal varix. Venous abnormality simulating a soft tissue tumor
Authors: Herstik I , Rubin R
Published: April 2014

A case report of a heretofore undocumented entity was presented. A brief literature review of associated lesions was included. The authors suggest that pedal varix may be a more common occurrence than previously documented.
Tibial torsion. Normal values in children
Authors: Valmassy R , Stanton B
Published: April 2014

In-toeing and out-toeing are common foot problems, and frequently are caused by torsional abnormalities of the tibia. Malleolar position, and thus tibial torsion, was measured in 281 children, 1 1/2 to 6 years of age, with a Tractograph, and normal values for the different age groups were determined. The authors discuss the clinical significance of torsional abnormalities of the tibia regarding gait.
Aneurysmal bone cyst of the cuboid
Authors: Kashuk KB , Hanft JR , Schabler JA , Kado KE , Wolosky BD
Published: April 2014

Aneurysmal bone cysts are a rare entity encountered in podiatric medicine. The frequency of aneurysmal bone cysts distal to the ankle joint is low. The authors present a literature review of the etiologies and possible treatments of an aneurysmal bone cyst. An unusual case of an aneurysmal bone cyst in the cuboid is also presented. Only one other documented case of an aneurysmal bone cyst in the cuboid has been reported since 1967.
Post-traumatic osteochondroma of the calcaneus
Authors: Bates DL , Osborne WM
Published: April 2014

Osteochondroma is the most common bone and cartilage tumor. It is usually congenital but may be related to trauma. A case of osteochondroma affecting the calcaneus, an unusual location for this lesion, is presented. Surgical excision appears to be as effective a cure in this location as in others.
Health promotion and podogeriatrics. A conceptual design for preventive services
Authors: Helfand AE
Published: April 2014

Because the majority of practicing podiatrists' received their professional training when less emphasis was placed on geriatrics, future continuing education activities should be expanded to upgrade a practitioners' understanding of elderly patients and the diagnosis and treatment of their foot problems, particularly among the frail elderly living at home or in nursing homes or other institutional settings. Efforts should also include special emphasis on the current publications in the profession on the subject of aging, including patient care, health care delivery, and other related topics. The podiatric medical profession stands ready, as it has always done, to care for the elderly with dignity and quality. The elderly should not be allowed to waste away because of their inability to help themselves. As we strive to meet these objectives and needs, there is no doubt that they will be met, as long as there is a national recognition of the needs and appropriate changes take place in the total health care delivery system to provide the mechanism for action.
Surgical correction of brachymetatarsia
Authors: Bartolomei FJ
Published: April 2014

Brachymetatarsia describes the condition of an abnormally short metatarsal. Although the condition has been recorded since antiquity, surgical options to correct the deformity have been available for only two decades. Most published procedures involve metaphyseal lengthening with autogenous grafts from different donor sites. The author discusses one such surgical technique. In addition, the author proposes specific criteria for the objective diagnosis of brachymetatarsia.
Pin tract infections. Incidence and management in foot surgery
Authors: Herstik I , Pelletier JP , Kanat IO
Published: April 2014

The development of pin tract reactions and their sequelae is based on a complex series of events. Analysis of pin tract infections directly related to static external wire fixation at Kern Hospital for Special Surgery from 1981 through 1988 showed an incidence of 0.46%; however, the overall incidence is probably higher. A discussion of the pathogenesis and guidelines for prevention, diagnosis, and treatment are presented. The authors suggest that pin tract infections occur because of postoperative skin contamination, rather than intraoperative implantation.
Radiographic anatomy of the first metatarsal
Authors: Christman RA , Ly P
Published: April 2014

Normal radiographic anatomy of the first metatarsal bone is established through cadaver dissection, examination of bone specimens, and radiography. Extra-articular and distal articular anatomical landmarks are identified with wire markers. Dorsoplantar, lateral, lateral oblique, and medial oblique radiographs of 15 osteologic sites are presented, including the articular margins of the first metatarsal head, the borders of the three diaphyseal surfaces, the origins of the metatarsophalangeal collateral and metatarsosesamoid suspensory ligaments, and the insertions of the first cuneiform-metatarsal joint ligaments and the tibialis anterior and peroneus longus tendons. The correlation of gross anatomy and radiographs is described.
Comparison of flurbiprofen and acetaminophen with codeine in postoperative foot pain
Authors: Ottinger ML , Kinney KW , Black JR , Wittenberg M
Published: April 2014

The purpose of this double-blind, randomized, parallel, multiple-dose study was to compare the efficacy and safety of flurbiprofen with acetaminophen with codeine phosphate in the 96-hr postoperative period following foot surgery. Analysis of mean pain intensity and mean pain relief for the patients not requiring rescue medication did not reveal any significant differences between treatment groups. There were also no significant differences between treatment groups with respect to patient and investigator global evaluations of therapy. The incidence of termination of the study because of side effects was higher for the acetaminophen with codeine group.
Local antibiotic treatment of soft tissue and bone infections of the foot
Authors: Stabile DE , Jacobs AM
Published: April 2014

Twenty-seven pedal soft tissue and bone infections in 26 patients were treated with surgical necrectomy of infected tissues and implantation of antibiotic-loaded polymethyl methacrylate bone cement beads on chains. The definitive diagnosis of the infected tissues was obtained by culture and histologic examination in all of the cases. A wide variety of foot infections was successfully treated in this manner. The success rate without recurrence of osteomyelitis or soft tissue infection was 95% in this study at an average of 16 months after surgery.
Development and application of antibiotic-loaded bone cement beads
Authors: Stabile DE , Jacobs AM
Published: April 2014

The authors presented an overview of the development of antibiotic-loaded bone cement beads and their indications for usage, method of application, advantages, disadvantages, and causes of failure. This method of treatment for bone and soft tissue infections of the foot is not a panacea and should be used only in selected cases. The vascular status and the physiologic ability of the patient to heal a peripheral wound or infection are the basis for the success of this method of therapy. European literature makes little mention of adjunctive systemic antibiotic therapy with local antibiotic-loaded bone cement bead use. It is the authors' opinion that clinical judgment should be used to determine the necessity for such therapy.
Vitamin C influence on localized adjuvant arthritis
Authors: Davis RH , Rosenthal KY , Cesario LR , Rouw GR
Published: April 2014

This work attempts to determine the influence of vitamin C on locally induced inflammation and arthritis in rat paws, as measured by rat paw swelling, polymorphonuclear leukocyte infiltration, pain, and surface skin temperature. Daily subcutaneous administration of 150 mg/kg of vitamin C over 20 days reduced arthritic swelling, increased pain tolerance, and decreased polymorphonuclear leukocyte infiltration, with no significant change in surface temperature. Vitamin C may provide podiatrists with a supplemental or alternative treatment for patients with rheumatoid arthritis.
Aerobic dance survey. A study of high-impact versus low-impact injuries
Authors: Janis LR
Published: April 2014

A survey of 275 aerobic dance instructors and participants was performed to determine the overall injury rate for each group, as well as the rate of injury in high-impact versus low-impact aerobics. Injuries occurred in 35% of the combined group. Instructors reported a 53% injury rate. Those who took high-impact classes had a 35% injury rate versus 24% in low-impact classes. The rate of injury was analyzed in terms of age, number of workouts, shoe type, and floor type.
Contamination and infection rate of percutaneous Kirschner wires in foot surgery
Authors: Halpern FP , Trepal MJ , Hodge W
Published: April 2014

A study was performed at the Foot Clinics of New York during the months of September 1988 through December 1988, in which 54 Kirschner wires from 40 surgical patients were cultured immediately upon removal to investigate if microorganisms were present. The results and potential implications are presented.
Fibroepithelial polyps. An unusual case report
Authors: Menn JJ , Boberg J
Published: April 2014

Fibroepithelial polyps usually present as small, benign dermal growths known as skin tags. The incidence of this lesion in the foot has not been precisely determined. An unusual case and a literature review were presented.
Brachymetatarsia. A new surgical approach
Authors: Martin DE , Kalish SR
Published: April 2014

Although most practitioners are familiar with brachymetatarsia, it is a relatively uncommon clinical entity presenting for surgical correction. Traditional methods of surgical correction have been successful for the most part; however, a number of potentially devastating complications exist with these procedures. The authors present a review of the deformity, including the historical surgical techniques, and introduce a new surgical approach that minimizes the risk of complication.
Objective identification of ankle equinus deformity and resulting contracture
Authors: Hillstrom HJ , Perlberg G , Siegler S , Sanner WH , Hice GA , Downey M , Stienstra J , Acello A , Neary MT , Kugler F
Published: April 2014

A quantitative diagnostic technique is described for identifying contracture at the ankle joint in patients with equinus deformity, hence addressing the shortcoming of the conventional clinical diagnostic procedure. To gain a better understanding of how contracture contributes to equinus deformity, a study was designed that compared the torque about the ankle joint before and after administering a tibial nerve block to equinus patients and to a control group. Functional equinus, manifested by walking and early heel rise, is defined as inadequate dorsiflexion for normal gait. The ability to accurately identify an equinus condition, and contracture as the contributing factor in equinus deformity, has important implications for the type of treatment prescribed and the evaluation of treatment effectiveness.
Compartment syndrome of the dorsal aspect of the foot
Authors: Bartolomei FJ
Published: April 2014

A second case of compartment syndrome affecting the dorsal aspect of the foot has been presented. The syndrome was arrested by fasciotomy. There were no permanent neurologic, vascular, or musculoskeletal sequelae. Although techniques exist to obtain quantitative measurements of intracompartmental pressure, the diagnosis rests heavily on clinical assessment. Practitioners who encounter trauma victims must recognize the symptoms of the condition and be familiar with the procedures necessary to interrupt it.
Cutaneous foot depigmentation following an intra-articular steroid injection
Authors: Lemont H , Hetman J
Published: April 2014

Local skin depigmentation is a potentially troublesome side effect of local steroid injection. Although many authors believe that it is a rare occurrence, this rarity may be a result of the low number of cases that are actually reported. The authors are of the opinion that the practitioner should take the time to explain depigmentation as a possible side effect of local steroid injection to those patients whose skin color places them at cosmetic risk.
Rigid versus soft foot orthoses. A single subject design
Authors: McPoil TG , Cornwall MW
Published: April 2014

The purpose of this study was to compare the effects of rigid and soft foot orthoses on forefoot and rearfoot forces in a 20-year-old female runner with a history of tibial and metatarsal stress fractures. The results of this study indicate that a soft orthosis significantly reduced vertical forces through the foot during both walking and running. The authors recommend that proper fabrication materials be considered for those patients with a history of foot or lower extremity problems caused by reduced shock attenuation.
Biomechanical analysis of running with 25 degrees inverted orthotic devices
Authors: Baitch SP , Blake RL , Fineagan PL , Senatore J
Published: April 2014

The purpose of this study was to evaluate the effectiveness of two different rigid foot orthotic devices in controlling subtalar joint subluxation and pronation. A high-speed video analysis system was used to record, store, and analyze data from seven runners: 1) barefoot, 2) shoes only, 3) shoes and vertical orthoses, and 4) shoes with 25 degrees inverted orthotic devices. The results indicate the need for suitable studies, on a larger population group, to evaluate the effect of a variety of orthotic devices on running biomechanics.
Normal digital pressure changes following the postocclusive reactive hyperemia test
Authors: Hoffman AF , Schmugler BA , Matthews MJ
Published: April 2014

The authors report digital pressure changes in normal subjects following the 5-min postocclusive reactive hyperemia test. This test increases the sensitivity of using toe pressures to assess the adequacy of blood flow.
Research process. Reporting results of the research
Authors: Gabel LL
Published: April 2014

The preparation of a manuscript to report a research project is the final stage of the research process. Recommendations are made in this article related to preparing to write, getting started, guarding against problems and frustrations by making early decisions, and developing each component of the manuscript. This article is the last in a series of six on the research process, in which the collective purpose has been to offer guidance regarding the spectrum of skills required to produce quality research reports.
Outgrowing trends in the lower extremities of children
Authors: Schuster RO , Skliar JD
Published: April 2014

The authors present an overview of the changing biomechanical values in the growing child. They discuss a technique of evaluating total genu varum and genu valgus. A simple tread mat technique is presented.