bluuebunny/crossref_metadata_2025 huggingface dataset:
A successful technique for the treatment of diabetic neurotrophic ulcers
Authors: Ritz G , Kushner D , Friedman S
Published: April 2014

Over 90% of the diabetic neurotrophic ulcers treated with the felted foam technique at the Cleveland Foot Clinic have completely healed. The average healing time for plantar ulcers has been approximately 8 weeks. After the ulcerations have healed, molded shoes or orthopedic shoes with Plastazote inserts are prescribed. The felted foam technique is simple to perform in an office setting and can be used by both the novice and the experienced practitioner.
Calcaneonavicular bar resection. A retrospective review
Authors: Cohen AH , Laughner TE , Pupp GR
Published: April 2014

The authors present a retrospective study evaluating the results of calcaneonavicular bar resection with interposition of the extensor digitorum brevis in ten patients with painful calcaneonavicular coalition. All operative procedures were supervised by one of the authors to ensure consistency in preoperative evaluation, surgical technique, and postoperative care. Results obtained from questionnaires showed significant improvement of preoperative symptoms with increased activity levels noted in all patients.
1993 William J. Stickel Bronze Award. Imaging of the infected foot. Fact or fancy?
Authors: Cicchinelli LD , Corey SV
Published: April 2014

Advancements in methods of imaging infection have surpassed their worth. Although scientifically substantiated, their clinical pertinence is frequently disappointing. Diabetic infections, postoperative or traumatic sequelae, rheumatologic conditions, and Charcot disease are difficult to differentiate from osseous infection because they all manifest as inflammation. As this country struggles to contain health care costs, a critical investigation regarding the practical benefits of imaging osteomyelitis in the foot is overdue.
Salvaging the ischemic transmetatarsal amputation through distal arterial reconstruction
Authors: Pomposelli FB , Basile P , Campbell DR , LoGerfo FW
Published: April 2014

From 1982 to 1991, 17 patients underwent a lower extremity arterial bypass to salvage an ischemic transmetatarsal amputation at the New England Deaconess Hospital. Eleven patients were male, and 16 had diabetes for an average of 29 years. The mean age was 71 years. Twelve patients presented with an ischemic ulcer, one had rest pain, and four underwent bypass for failure to heal a transmetatarsal amputation. Twelve patients presented with findings of secondary infection. All 17 patients underwent successful lower extremity bypass procedures to a variety of outflow vessels. Thirteen bypasses were to infrapopliteal arteries, including four to the dorsalis pedis artery. There were no perioperative deaths and all patients were discharged with patent grafts and healing limbs. Actuarial graft patency of the 14 vein grafts was 90% at 2 years. Actuarial limb salvage for the entire group was 93% at 2 years. Thirteen of the 14 patients who maintained patent grafts and healed their transmetatarsal amputations were ambulatory at their last known follow-up examination. Ischemic complications of previously created transmetatarsal amputations are uncommon. However, limb salvage attempts by lower extremity arterial bypass have a high likelihood of success. Major amputation in these patients should not be done without having first undergone a comprehensive vascular evaluation.
Cuboid stress fracture. A case report
Authors: Chen JB
Published: April 2014

Because a stress fracture is rare and easily missed on an x-ray, it might go undetected. If a patient presents with an activity related injury to the midfoot and x-rays are negative, a computed tomography scan can be helpful in diagnosing a cuboid stress fracture. Also, computed tomography scans graphically show the fracture location and size, in addition to tracking progressive bone changes during the healing process.
Role of soft tissue structures as an etiology of hallux limitus
Authors: Durrant MN , Siepert KK
Published: April 2014

The authors establish common mechanical criteria for structures that can adversely affect dorsiflexion of the hallux, examine soft tissue anatomical structures around the first metatarsophalangeal joint that meet the established standards, and propose alternative methods of approaching the deformity surgically.
Retrospective study of fifth metatarsal fractures
Authors: Holubec KD , Karlin JM , Scurran BL
Published: April 2014

On the basis of the authors' results in treating avulsion fractures of the tuberosity, immobilization in a short leg weightbearing cast for 4 weeks is the preferred treatment. If still symptomatic at 4 weeks, some patients may require further immobilization for an additional 1 to 3 weeks. Rarely do these patients require surgery. In patients with these types of fractures, no angulation or displacement deformity was seen on x-rays, so open reduction was not warranted. Although the study does not strongly support the view that delayed healing of Jones fractures is associated with weightbearing cast treatment, the authors still tend to recommend treatment with a short leg nonweightbearing plaster cast for 6 weeks. Patients may not tolerate such treatment for this amount of time. To encourage better patient compliance, a minimum of 3 to 4 weeks in a nonweightbearing cast followed by 3 weeks in a weightbearing cast is recommended. Although open reduction was indicated in a few cases, all patients with Jones fractures, aged 20, 22, 24, 24, and 27 years, declined that option. Specifically, one patient had a delayed union of the Jones-type fracture (Fig. 4). In spite of being young and athletic, and thus at high risk for refracture, he decided against open reduction internal fixation and opted for prolonged casting.
Ankle joint dorsiflexion. Establishment of a normal range
Authors: Baggett BD , Young G
Published: April 2014

Various values have been proposed as the required amount of ankle joint dorsiflexion, but a normal range has not been established. The authors establish a normal range based on direct measurements and compare the standard nonweightbearing method of measuring ankle joint dorsiflexion with a weightbearing method. The normal range for ankle joint dorsiflexion was established as 0 degrees to 16.5 degrees nonweightbearing and 7.1 degrees to 34.7 degrees weightbearing. A statistically significant (p < 0.01) difference exists between the two measuring systems. In addition, the study shows poor correlation between the two measurements. This lack of correlation brings into question the clinical relevance of the standard nonweightbearing measurement.
Research and practice in medical education
Authors: Stritter FT , Becker M
Published: April 2014

Education should be practiced with attention to principles derived from both the research in medical education and the practical experience of health professions instructors. The authors summarize both the major questions addressed by researchers in medical education during recent years and some of the answers. This paper is divided into four major categories of questions that correspond to the areas of an instructor's responsibility: 1) curricular trends, 2) instruction, 3) evaluation of learners, and 4) evaluation of teaching. It focuses largely on the undergraduate medical curriculum, although many of the conclusions could be applied to graduate education as well.
Residency education
Authors: Bashook PG
Published: April 2014

Residency education has an interesting history in the US that speaks clearly about some of the cherished beliefs still perpetuated in today's residency training programs. The history also provides a foundation for considering how the current knowledge of adult education theory and practice can be incorporated into residency education programs. The author presents a brief overview of the history of residency education in the US followed by a recommendation for applying a conception of adult learning to residency education.
Talonavicular coalition. Objective gait analysis
Authors: Pontious J , Hillstrom HJ , Monahan T , Connelly S
Published: April 2014

Talonavicular coalitions, a rarely reported fusion between the talus and navicular, are often an incidental radiographic finding that may be asymptomatic or associated with peroneal spasm. The authors present a review of literature and case report based on clinical evaluation and instrumented gait analysis. Specifically, a patient presenting with a bilateral talonavicular coalition was objectively evaluated with kinetic, kinematic, muscle dynamometry, and pedobarographic testing to understand the biomechanical limitations related to this pathology. An excessive passive component of ankle torque, a high first metatarsophangeal joint plantar pressure, and a diminished time in the midstance portion of stance phase were measured and compared to those of healthy individuals.
Efficacy of disinfectants against fungi isolated from skin and nail infections
Authors: Terleckyj B , Axler DA
Published: April 2014

Commercial disinfectants classified as fungicides may not be effective against commonly encountered fungi within reasonable periods. Cell suspensions of clinical fungal isolates were exposed to use-dilutions of various disinfectants. Quaternary ammonium compounds, iodophors, and phenolics were not fungicidal against all test fungi within 60 min of exposure. Trichophyton mentagrophytes, Epidermophyton floccosum, and Aspergillus fumigatus were among the more resistant fungi. Disinfectants that possess low-level activity should not be used for disinfection of medical instruments that come in contact with the patient. The only reliable and safe measure is to use high-level disinfectants such as the glutaraldehydes, which are fungicidal in 15 to 30 min.
Reducing two-dimensional rearfoot motion variability during walking
Authors: Cornwall MW , McPoil TG
Published: April 2014

Although three-dimensional movement analysis is the preferred method of assessing rearfoot motion during gait, the high cost of equipment and the time required to use it often make it unreasonable or impractical in a clinical setting. The authors discuss a method of minimizing the variability of rearfoot motion measurements during walking, using two-dimensional analysis when three-dimensional is not available to the clinician.
Gait style as an etiology to chronic postural pain. Part I. Functional hallux limitus
Authors: Dananberg HJ
Published: April 2014

A common, but locally asymptomatic and therefore rarely recognized functional inability of the first metatarsophalangeal joint to dorsiflex strictly during gait is described. Normal motion is present in this joint during nonweight-bearing examination; therefore this is referred to as functional hallux limitus. Since this joint forms the pivot about which the entire body advances during each step, this disturbance in function, when repeated thousands of times on a daily basis, can alter foot and postural biomechanics. It can cause and perpetuate many chronic postural ailments, including lower back pain. When functional hallux limitus is specifically addressed in an orthotic treatment plan, 77% of long-term chronic postural pain patients exhibit 50% to 100% improvement in their overall condition, in spite of failing previous therapy on their specific site of pain and never exhibiting any foot symptomatology.
Epidermal culture and grafting. A brief review
Authors: Muehleman C , Wise RD
Published: April 2014

In summary, technological advances in culturing epidermis for the purpose of grafting allow this approach in the treatment of cutaneous wounds. Certainly, full- and split-thickness autografts offer immediate availability and permanent wound coverage, but they also involve a large, painful donor site. Cultured epidermal autografts can provide permanent wound coverage, but the delay required for cultivation of confluent sheets of keratinocytes makes them somewhat less desirable. Both allografts and cultured allografts, on the other hand, are available for immediate use, but the possibility of infectious disease transmission may be a concern. In any case, all types of skin grafts function as biological dressings that promote the proliferation of the host's epidermis and, thus, facilitate the ability of the patient's skin to repair itself.
Comparison of cotton and acrylic socks using a generic cushion sole design for runners
Authors: Herring KM , Richie DH
Published: April 2014

A longitudinal single-blind study was conducted to test the friction blister prevention properties of synthetic acrylic socks in a generic construction. This study serves as a comparison with the authors' previous work comparing acrylic and cotton socks in a patented padded construction. Twenty-seven long-distance runners provided data regarding dampness, temperature, friction blister incidence, severity, and size. Two different socks were tested; each was identical in every aspect of construction except the fiber content. One test sock was composed of 100% synthetic acrylic fibers, and the other was composed of 100% natural cotton fibers. These results were unsuccessful at demonstrating any superiority of cotton or acrylic fibers when knitting produced a generic "cushion sole" sock. The superiority of acrylic fibers has thus far been demonstrated only when sock knitting provides adequate anatomical padding [corrected].
Popliteus tendinitis
Authors: Olson WR , Rechkemmer L
Published: April 2014

Popliteus tendinitis is a relatively infrequent and often misdiagnosed injury of the posterior aspect of the knee. The clinical significance of this injury is particularly relevant to the serious runner and triathlete, as the symptoms resulting from this injury can be disabling.
Contact characteristics of the ankle joint. Part 1. The normal joint
Authors: Driscoll HL , Christensen JC , Tencer AF
Published: April 2014

The contact characteristics of ankle joints in 18 fresh cadaver specimens were studied by using pressure-sensitive film to provide baseline information for subsequent studies of various pathologic ankle conditions. Specimens, consisting of the distal half of the tibia and fibula and the intact ankle and foot, were mounted in a materials testing system on a loading frame that allowed positioning in neutral, and 20 degrees of plantarflexion and dorsiflexion. An 800 N load (1 body weight) was axially applied to the specimens through the tibia with 10% of the total load distributed through the fibula. Transducers made of pressure-sensitive film were used to make a contact print and were scanned along with calibration strips to form a digital image. The image was analyzed quantitatively to determine total contact area, mean contact pressure, ratio of contact to plafond areas, and high pressure zone centroid location as a function of sagittal plane foot position in the normal ankle joint. The results demonstrated significant changes in ankle joint contact characteristics with different foot positions.
Comparison of three methods for obtaining plantar pressures in nonpathologic subjects
Authors: Meyers-Rice B , Sugars L , McPoil T , Cornwall MW
Published: April 2014

The purpose of this study was to determine if pressure data, collected after taking one step or two steps, were similar to values obtained by using the traditional midgait method. Ten healthy subjects, with a mean age of 27 years, walked across a sensor platform sampling at 70 Hz. Each subject was randomly assigned to take one step, two steps, or multiple steps (midgait method) across the sensor platform. The results of the study indicate that the two-step method, in comparison with the one-step method, provides pressure data more representative of the midgait method, and different values for pressure and force will be obtained, depending on the method of pressure data collection selected by the clinician.
1994 William J. Stickel Gold Award. Contact characteristics of the ankle joint. Part 2. The effects of talar dome cartilage defects
Authors: Christensen JC , Driscoll HL , Tencer AF
Published: April 2014

Variations in ankle joint contact characteristics caused by articular defects of the talar dome were investigated in 14 fresh-frozen cadaver specimens using pressure-sensitive film. Intact ankle and foot specimens were mounted in a materials tester on a loading frame which allowed positioning in neutral, and 20 degrees of dorsiflexion and plantarflexion. Joint contact prints were recorded while an 800 N load was axially applied through the leg. Specimens were randomly placed into two lesion groups: either anterolateral or posteromedial. During testing, each specimen had four concentrically placed lesions on the talar dome, graduated in size. Following removal, the film transducers were digitized along with pressure calibration prints. The images were analyzed quantitatively to determine contact areas, mean contact pressures, ratio of to contact plafond areas, and high pressure centroid position as a function of lesion size and location. The results demonstrated significant changes in contact characteristics for larger lesions (> or = 7.5 x 15 mm) (P < 0.05). These findings suggest that determining the size of a lesion may assist in predicting the long-term outcome of ankles with cartilage defects.
Aloe vera, hydrocortisone, and sterol influence on wound tensile strength and anti-inflammation
Authors: Davis RH , DiDonato JJ , Johnson RW , Stewart CB
Published: April 2014

Aloe vera at doses of 100 and 300 mg/kg daily for 4 days blocked the wound healing suppression of hydrocortisone acetate up to 100% using the wound tensile strength assay. This response was because of the growth factors present in A. vera masking the wound healing inhibitors such as sterols and certain amino acids. The sterols showed good anti-inflammatory activity (-36%) in reducing the croton oil-induced ear swelling. This activity displayed a dose-response relationship.
Acrometastases. Initial presentation as diffuse ankle pain
Authors: Leonheart EE , DiStazio J
Published: April 2014

Acrometastases are rare and often misdiagnosed or overlooked. When it involves the feet, it generally attacks the larger bones containing the higher amounts of red marrow. The patient may or may not have a known history of cancer, which makes diagnosis much more difficult. The symptomatology is generally vague and can mimic other conditions, such as osteomyelitis, gouty rheumatoid arthritis, Reiter's syndrome, Paget's disease, osteochondral lesions, and ligamentous sprains. Therefore, the physician must consider metastatic disease in the differential diagnosis. Once the diagnosis is made, the prognosis is poor and treatment is limited to pain relief and maintaining function.
The Kalish osteotomy. A review and retrospective analysis of 265 cases
Authors: Kalish SR , Spector JE
Published: April 2014

One hundred seventy-two patients (265 feet) were reviewed following correction of hallux abducto valgus surgery, using the Kalish modification of the Austin bunionectomy. Fifty-three cases were followed up on an average of 2.5 years from 1986 through 1992. The statistical results support the use of this osteotomy with rigid internal fixation for the reduction of the intermetatarsal angle, hallux abductus angle, and tibial sesamoid position. Patients are weightbearing immediately and are usually back in soft shoes or sneakers 2 weeks after surgery. Surgical techniques and complications of this procedure are discussed to help surgeons use this procedure in correcting hallux abducto valgus deformities.
Diabetes mellitus. Prevention of amputation
Authors: Sanders LJ
Published: April 2014

Fifteen percent of individuals with diabetes will likely develop foot ulcers in their lifetime, and approximately 15% to 20% of these ulcers are estimated to result in lower extremity amputation. Techniques to prevent lower extremity amputation range from the simple but often neglected foot inspection to complicated vascular and reconstructive foot surgery. Appropriate management can prevent and heal diabetic foot ulcers, thereby greatly decreasing the amputation rate and medical care costs. Prevention is the key to treatment. The author discusses general guidelines for foot screening and identifies three specific goals for prevention of amputation: 1) identification of at risk individuals needing prevention and the specific factors placing them at risk; 2) protection of the foot against the adverse effects of external forces (pressure, friction, and shear); and 3) reduction of the incidence of diabetic foot ulcers through educational programs.
Traineeship in diabetes and the older patient. A public health experience
Authors: Helfand AE
Published: April 2014

The author describes an effort that demonstrates a successful partnership between a professional education program in podiatric medicine, the Pennsylvania State Health Department, and the Professional Diabetes Academy, which served as the catalyst for health promotion, prevention, and education. Similar programs through adaptations geared to local resources could be developed as a demonstration of direct secondary prevention of the complications of diabetes in the older population and have the potential to help meet national goals to significantly reduce amputations.
Tricorrectional bunionectomy for correction of high intermetatarsal angles
Authors: Selner AJ , Ginex SL , Selner MD
Published: April 2014

The authors propose the use of the tricorrectional bunionectomy as a viable procedure for correction of high intermetatarsal angles. The tricorrectional bunionectomy was performed on 39 patients (51 feet). All patients had intermetatarsal angles of 16 degrees or greater. The average follow-up period was 12.8 months. The authors believe this procedure is an excellent alternative to more disabling base osteotomies.
Therapeutic footwear for patients with diabetes
Authors: White J
Published: April 2014

The proper prescription and utilization of therapeutic footwear is crucial to successful prevention of diabetic foot complications. The author reviews shoe alternatives' characteristics and proper fit. The concept of foot risk categories is explained and appropriate shoe selections are discussed.
Use of Z-skin plasty in scar revisions and skin contractures of the lower extremity
Authors: Crawford ME , Dockery GL
Published: April 2014

A discussion of the design and use of the Z-skin plasty to revise scars and lengthen skin contractures of the lower extremities is presented. One of the most commonly used rotational flaps to alter scar direction or relieve tension on the existing scar or skin, the Z-plasty can also be the most difficult to perform and carries a high risk of flap loss if inaccurately planned or poorly placed. Several variations of the standard procedure and examples of common usage are presented.
1995 William J. Stickel Silver Award. Structural analysis of absorbable pin and screw fixation in first metatarsal osteotomies
Authors: Higgins KR , Lavery LA , Ashry HR , Athanasiou KA
Published: April 2014

The structural characteristics of 4.0-mm stainless steel screws compared with 4.0-mm poly-L-lactic acid absorbable screws and 2.0-mm stainless steel Steinmann pins compared with 2.0-mm poly-L-lactic acid absorbable pins in oblique closing base wedge osteotomies of the first metatarsal were evaluated. The authors performed oblique closing base wedge using an osteotomy guide in six matched pairs of fresh frozen first metatarsal bones. Fixation was achieved with either a 4.0-mm stainless steel screw or poly-L-lactic acid absorbable screw. An additional five pairs of matched specimens were used to compare 2.0-mm stainless steel and poly-L-lactic acid absorbable pins with the same approach. Specimens were loaded to failure with the Bionix Material Testing System at a constant rate of 0.166 mm/sec. A Student's t-test for paired samples was used with a 95% confidence interval to measure differences in ultimate load, ultimate displacement, and structural stiffness. There was not a significant difference in any of the parameters evaluated in the 4.0-mm poly-L-lactic acid absorbable versus stainless steel screw comparison (P > 0.05). Stainless steel 2.0-mm pins had significantly greater structural stiffness (P = 0.032) and less ultimate displacement (P = 0.021) than their poly-L-lactic acid absorbable counterparts. There was not a significant difference in ultimate load in poly-L-lactic acid absorbable and stainless steel pins (P = 0.59).
Computer-assisted measurement in diabetic patients with and without foot ulceration
Authors: Tassler PL , Dellon AL , Scheffler NM
Published: April 2014

Computer-assisted measurement of sensibility was done at four anatomical sites of the foot of patients with diabetes with (19) and without (40) foot ulceration. Cutaneous pressure threshold measurements of patients with diabetes were compared with measurements on 30 patients without diabetes who had nonulcerated feet. Both groups had mean one-point static and moving touch, and two-point discrimination thresholds significantly different from the general population. Computer-assisted sensibility testing demonstrated significantly higher pressure thresholds for one-point static and moving touch and two-point discrimination in the ulcerated compared with the nonulcerated foot of patients with diabetes. This measurement technique is valid for documenting diminished sensation in the foot.
Henoch-Sch√∂nlein purpura. Case report and review of the literature
Authors: Smalls G , Alaie M , Anzilotti M , Lebwohl M
Published: April 2014

The similarity in the skin manifestations in Henoch-Sch√∂nlein purpura as compared with systemic lupus erythematosus and rheumatoid arthritis complicates diagnosis. Therefore, analysis of hematologic studies, tissue histology, and immunofluorescence should be thoroughly reviewed.
Contralateral limb during total contact casting. A dynamic pressure and thermometric analysis
Authors: Armstrong DG , Liswood PJ , Todd WF
Published: April 2014

The authors draw attention to the importance of evaluation of the contralateral limb when treating unilateral sequelae secondary to distal symmetrical polyneuropathy. Plantar pressure measurements of the contralateral limb during total contact casting are reviewed. The results of thermometric evaluation before and after initiation of repetitive stress were reviewed. The results suggest that the patient walking in a total contact cast may experience a reduced focal pressure on the contralateral limb when compared with uncasted walking and three-point walking with crutches. Dermal thermometry may be a highly sensitive tool in evaluating even mild increases in repetitive stress. To explain this decrease in contralateral stress, the authors examine the features inherent to the total contact cast and propose the concept of proprioceptive stability.
Calcific leiomyoma. A unique case report
Authors: Davis JL , Russell RD , Giacopelli JA
Published: April 2014

Leiomyomas are benign soft tissue tumors originating in smooth muscle. They present clinically as a soft tissue mass causing a well localized, paroxysmal pain. Treatment of choice for such lesions is total excision. Recurrence or malignant transformation of these tumors is rare. Calcific leiomyomas, as diagnosed in this study, have seldom been reported in the foot. When treating lesions involving atopic calcification, it is important to maintain a high level of understanding of the various etiologies, both metabolic and nonmetabolic, which may lead to calcium deposition in the soft tissues.
Performing a workers' compensation medicolegal evaluation
Authors: Karhu LA
Published: April 2014

The purpose of this article is to familiarize the reader with the elements and parameters of a worker's compensation medicolegal evaluation. Physicians play a critical role in the determination of whether an alleged injury warrants compensation and vocational training. The author provides information that will assist the physician who is called on to make such a judgment.
Fracture of the fifth digit. An atypical presentation
Authors: Venegas L , Rainieri JJ , Rzonca EC
Published: April 2014

Digital fractures are a common injury in the forefoot. Most fractures, however, do not present relatively free of pain. When they present without pain or with few symptoms, they may be overlooked or misdiagnosed. The following is a case presentation of a patient who presented to Franklin Delano Roosevelt Hospital after trauma to the right fifth toe. The case was atypical in that the patient was asymptomatic despite the recent injury. Rapid conservative intervention by the patient at home, coupled with sensory neuropathy secondary to diabetes, can alter the clinical presentation as witnessed in this case. An appropriate history and physical examination combined with radiographs were essential to an otherwise ordinary clinical presentation.
Bullosis diabeticorum
Authors: Pirotta SS , Johnson JD , Young G , Bezzant J
Published: April 2014

The authors present a case of bullous dermatosis in a diabetic patient. The lesions were drained and deroofed, and at 1-year follow-up, the patient related no problems. Proper diagnosis and treatment of these lesions will avoid infection and ulceration.
Total contact casting
Authors: Baker RE
Published: April 2014

The treatment of diabetic foot ulcerations has been a difficult task for podiatrists. Numerous methods and materials have been used in an attempt to alleviate this frustrating and complex treatment dilemma. However, there is one treatment method that has been used successfully for decades on plantar ulcerations of the neuropathic foot. Total contact casting has been an easily applicable and effective treatment modality for neuropathic ulcerations of the diabetic foot.
Maggot debridement therapy. An alternative treatment for nonhealing ulcers
Authors: Stoddard SR , Sherman RA , Mason BE , Pelsang DJ , Sherman RM
Published: April 2014

The authors illustrated a chronic bilateral plantar foot ulcer of several years' duration that was resistant to all forms of conventional therapy, yet was resolved after 13 1/2 weeks of maggot therapy. The contralateral foot ulcer showed no improvement during the same period, despite continual inpatient conventional dressing changes. At a time when medical cost containment is a critical issue, maggot therapy may resurge as a viable alternative in treating nonhealing wounds.
Conservative podiatric medicine and disability in elderly people
Authors: Crawford VL , Ashford RL , McPeake B , Stout RW
Published: April 2014

A survey was conducted of 248 noninstitutionalized people aged 75 years and older, residing in a designated geographical area. The effect of dependency and physical disability on the receipt of conservative podiatric medicine was examined, and, in addition, the prevalence of medical and podiatric conditions was determined.
Bizarre parosteal osteochondromatous proliferation. An unusual bone tumor
Authors: Kissel CG , McQuaid M , Lucas DR , Sundareson AS , Klimecki RS
Published: April 2014

Bizarre parosteal osteochondromatous proliferation of bone is a rare, benign bone tumor. The authors discuss two cases involving the bones of the feet, and review clinical, radiographic, and histopathologic characteristics. Awareness of this lesion is essential as bizarre parosteal osteochondromatous proliferation of bone can be mistaken for a malignancy.
Patient-reported medical outcomes according to physician type and region
Authors: Glenn LL
Published: April 2014

The purpose of the present study was to determine whether patients with common foot disorders have different medical outcomes depending on whether podiatrists, orthopedic surgeons, or other physicians provided their medical care in rural or urban areas. A validated medical effectiveness score was formulated using indirect standardization of risk-adjusted morbidity, based on patient reports from a national random household interview survey of 3,270 subjects. Patients in rural and urban areas did not differ significantly in medical outcomes across provider types, but there was a trend for patients in rural areas to have poorer outcomes. The medical effectiveness score of podiatrists was 3.9 times higher (indicating more beneficial outcomes) than that of orthopedic surgeons or other physicians (p < 0.01). Patients that visited podiatrists for common foot problems reported significantly more beneficial outcomes than those who visited other types of health care providers.
Osteomyelitis caused by Corynebacterium jeikeium
Authors: Boc SF , Martone JD
Published: April 2014

A case study has been presented where C. jeikeium was isolated as the causative bacterium of an osteomyelitis of the fifth metatarsal. Partial amputation, local wound care, frequent and aggressive debridement, and appropriate antibiotics were all used with apparent success. The lack of complete patient follow-up prohibits the authors from declaring the infection cured; however, all signs of infection were absent immediately prior to discharge. The authors believe this to be the first reported case of Corynebacterium species as the bacterial isolate in confirmed osteomyelitis.
Torsion of the tendon of tibialis posterior
Authors: Roukis TS , Hurless JS , Page JC
Published: April 2014

The authors present a previously undescribed torsion located within the tendon of tibialis posterior. The musculotendinous unit of tibialis posterior was isolated from 17 lower extremities of cadavers. A small goniometer was constructed and used to quantify the degree of torsion located within each tibialis posterior tendon. Torsion was present in all 17 cadaver specimens, with a mean of 47.5 degrees and a range from 21 degrees to 62 degrees. The regional anatomy and biomechanical functions of tibialis posterior are discussed, and proposed bases for the embryologic origins and functional significance of the torsion are presented.
Clinical perspective of the treatment of fifth metatarsal fractures
Authors: O'Shea MK , Spak W , Sant'Anna S , Johnson C
Published: April 2014

The authors present a retrospective study of fifth metatarsal fractures. These fractures include Jones fractures, avulsion fractures, spiral and oblique midshaft fractures, and the author-termed "tulip" fracture (impaction fracture of the fifth metatarsal head). These fractures were fixated with the cannulated screw, Kirschner wires, and cerclage loop wires combined with Kirschner wires. A one-way analysis of variance (ANOVA) was performed on the data to test for any significant difference in the fixation type used and the overall healing time. The ANOVA was found to be nonsignificant, F(2,10) = 0.379, p < 0.05. Therefore, it can be concluded that all three types of fixation work equally well. Other analyses were performed on each of the three specific types of fractures to see if there was any difference in fixating the fracture versus no fixation and immobilization. This information was significant for only the Jones fracture, F(1,5)2.23, p < 0.05, meaning that Jones fractures heal in a significantly shorter amount of time when some type of open reduction internal fixation is used. Since there was no difference in healing time between the different types of fixation, the authors advise that the cannulated screw be strongly considered because of its efficiency of insertion. In addition, because of the vascularity, muscle insertions, and motion related to the fifth metatarsal, the authors recommend that most Jones fractures be fixated for a more rapid return to function.
Autogenous calcaneal bone graft repair of a closing base wedge osteotomy nonunion
Authors: Pontious J , Marcoux JT
Published: April 2014

The authors present a case report showing successful autogenous calcaneal bone graft stabilization of a first metatarsal closing base wedge osteotomy nonunion. The authors discuss the complications and clinical sequelae associated with first metatarsal base wedge osteotomy nonunions. The patient's clinical presentation, surgical procedure, and postoperative course are discussed. Comparative preoperative and postoperative objective gait analyses are presented. This approach to first metatarsal nonunion salvage appears to be clinically successful with a 15-month follow-up period.
Functional motion of the medial column joints of the foot during propulsion
Authors: Phillips RD , Law EA , Ward ED
Published: April 2014

Motion in the ankle, subtalar, midtarsal, and first metatarsophalangeal joints has been well documented. However, motion in the first metatarsocuneiform, the first cuneonavicular, and the first interphalangeal joint has not been addressed. Motion in these joints has not been documented because many believe that little motion occurs at these joints, and because of the difficulty in assessing motion at these joints. Using two-dimensional motion analysis, the authors present sagittal plane ranges of motion occurring in the first metatarsophalangeal joint, the first metatarsocuneiform joint, the medial cuneonavicular joint, and the first interphalangeal joint during the propulsive period of gait. This pilot study indicates that sagittal plane motion between the navicular and calcaneus and between the first metatarsal and first cuneiform are very mild and inconsistent. However, plantarflexion motion between the first cuneiform and the navicular is significant and comprises most of the plantarflexion motion of the first ray during propulsion. Motion in the first interphalangeal joint is slight during the first 80% of the propulsive period but shows slight-to-moderate dorsiflexion during the last 20% of the propulsive period of gait.
Flashlamp pulsed dye laser (585 nm). Treatment of resistant verrucae
Authors: Borovoy MA , Borovoy M , Elson LM , Sage M
Published: April 2014

The treatment of recalcitrant plantar verrucae has represented challenging clinical problems for podiatric physicians. A procedure described by Borovoy et al studying 46 patients initially indicated a success rate of 76.1%. A review of 200 patients who have been treated with refined treatment protocols and modalities is presented, with an overall success rate of 79.9%. The Candella SPTL 1 and 1B have been used in the study. These lasers produce a full 450-microsecond pulse at 585 nm wave length. Hand pieces ranging from 2 mm to 7 mm were used. The energy density (fluence) used ranged from 6 to 9 J/cm2. Discussion will be presented including treatment protocol, modalities, comparisons with other forms of treatment, and overall success rates.
Flexor digitorum accessorius longus muscle
Authors: VanCourt RB , Siesel KJ
Published: April 2014

The flexor digitorum accessorius longus muscle was encountered during routine dissection of the posteromedial region of the left ankle of an 84-year-old female cadaver, by a first year podiatric medical student, in a lower extremity anatomy laboratory session. The purpose of this article is to describe the flexor digitorum accessorius longus muscle as it appeared in the cadaver; to provide background information on the muscle; and provide clinical implications for the podiatric medical practitioner.
Genetics of split hand and split foot. A case study
Authors: Caldwell BD
Published: April 2014

Split hand and split foot is an autosomal dominant disorder that displays several genetic phenomena. These include variable expressivity, reduced penetrance, and segregation distortion. Although not fully understood at the molecular level, all are important in determining transmission of the gene thought to be mapped to the long arm of chromosome 7 (7q21.3-q22.1). These phenomena, therefore, have significant implications for inheritance of split hand and split foot and for proper referral for genetic counseling.
Practical classification for the use of nonsteroidal anti-inflammatory drugs
Authors: Friedman SL
Published: April 2014

The podiatric physician is faced with a multitude of nonsteroidal anti-inflammatory drugs from which to choose. Podiatric physicians are overwhelmed with advertisements in the literature, outlining the safety and efficacy of one or another of these medications. This article will categorize the nonsteroidal anti-inflammatory drugs to aid in their selection.
Rickets. A study with case report
Authors: Osher L , Lembach L , Brooks TS , Failor L
Published: April 2014

Rickets is a pediatric disorder not commonly encountered by physicians in the US. Nevertheless, the podiatric physician should be aware that it persists and may exist in children who initially present with gait disturbances or failure to thrive. By using routine plain film radiography of the child's foot, the podiatric physician can screen one of the child's most rapid sites of secondary osseous growth, ie, the distal tibia. A brief overview of the rachitic and osteomalacic disorders is presented, followed by a discussion centered primarily on the plain film radiologic diagnosis of rickets.
California Liaison Committee for Podiatric Medical Education and Training
Authors: Medio FJ , Stess R , Naylor BL
Published: April 2014

Podiatric medicine faces some significant challenges that threaten its future growth and development. The California Liaison Committee for Podiatric Medical Education and Training exemplifies an innovative approach to meeting these challenges. The California Liaison Committee has established a dialogue among California's college-based and community-based podiatric medical educators, licensing board members, and private practitioners. The work of the California Liaison Committee, unprecedented in the state, effectively facilitates the curriculum transformation process through cooperation and collaboration.
Foreign-body reaction to absorbable fixation devices
Authors: Frederick J , Hulst TJ , Sundareson AS
Published: April 2014

While it is evident that poly-p-dioxanon is less reactive than polyglycolide, recent studies, including the case above, have shown that Orthosorb pins are not exempt from the same type of foreign-body reaction as the Biofix products.
Subtalar joint motion and the relationship to lower extremity overuse injuries
Authors: Tomaro JE , Burdett RG , Chadran AM
Published: April 2014

The purpose of this study was to determine if there was a difference between the subtalar joint ratio (transverse plane component to frontal plane component) in subjects with overuse symptoms in the foot compared with subjects with overuse symptoms in the leg and knee. Superior and posterior photographs were taken with the subtalar joint in pronation and supination while the subjects were in a seated position. The ratio of the transverse plane to frontal plane components of subtalar joint motion was calculated. A significant (p < 0.05) difference in the subtalar joint ratio existed between subjects with foot overuse symptoms and subjects with leg and knee overuse symptoms.
1997 William J. Stickel Gold Award. Morphological and biochemical properties of metatarsophalangeal joint cartilage
Authors: Muehleman C , Chubinskaya S , Cole AA , Noskina Y , Arsenis C , Kuettner KE
Published: April 2014

Although there is sparse information concerning the properties of foot-joint cartilages, knowledge of the morphology and biochemistry of these cartilages is important in the study of changes that occur in the development of osteoarthritis. Normal first and fifth metatarsophalangeal joints were chosen for comparison because of the difference between these two joints in the prevalence of osteoarthritis, particularly with advancing age. The authors' study shows that there is no age-related decrease in articular-cartilage thickness; however, there is an age-related decrease in the chondrocyte density in the superficial zone in both joints. There is, however, a difference between the two joints in the level of expression of matrix-degrading enzymes. This difference may indicate differences in specific chondrocyte activity that precedes or accompanies the development of osteoarthritis or other degenerative morphological changes.
1997 William J. Stickel Silver Award. The anti-inflammatory action of locally injected ketorolac
Authors: Brook JW , Boike A , Zema RL , Weaver M , Postak P
Published: April 2014

Locally injected steroids are used to treat inflammatory conditions, in spite of the complications associated with their use. Ketorolac tromethamine, an injectable nonsteroidal anti-inflammatory drug, has not previously been evaluated for treatment of musculoskeletal inflammatory conditions via local administration. Eighty Achilles tendons of rabbits were traumatized in a controlled fashion. At the time of trauma, a single dose of ketorolac (1, 3, or 5 mg/kg) or normal saline was administered peritendinously. Three days later, the tendons were harvested and examined histologically to evaluate the degree of inflammation present in the tissue. No statistically significant difference was found between the experimental and control groups. The authors conclude that locally injected ketorolac does not prevent the onset of an inflammatory process.
Ankle arthrodesis following avascular necrosis of the talus in a patient with lupus
Authors: Haverstock BD , Barth LD , Jacobs AM
Published: April 2014

Avascular necrosis of bone is a common manifestation of systemic lupus erythematosus, particularly in those patients receiving corticosteroids. The authors review the pathogenesis and diagnosis of avascular necrosis and describe an ankle arthrodesis in a patient with systemic lupus erythematosus who developed avascular necrosis of the talus.
Torsion of the tendon of peroneus brevis
Authors: Nelson ML , Roukis TS , Page JC , Northcote KL
Published: April 2014

The authors present a previously undescribed torsion located within the tendon of peroneus brevis. The musculotendinous unit of peroneus brevis was isolated from 46 lower extremities of cadavers. A goniometer was constructed and utilized to quantify the degree of torsion located within each peroneus brevis tendon. Torsion was present in all 46 cadaver specimens, with a mean of 38.5 degrees and a range of 26 degrees to 56 degrees. The regional anatomy and biomechanical functions of peroneus brevis are discussed, and proposed bases for the embryologic origins and functional significance of the torsion are presented.
Practice management and managed-care issues in onychomycosis
Authors: Goldsmith H
Published: April 2014

The author gives a general overview of recommendations for practice success in a managed-care environment and describes a new practice paradigm for the treatment of onychomycosis. Recommendations are provided for ensuring optimal reimbursement, particularly in the treatment of managed-care and Medicare patients.
Podiatric medical resources on the Internet
Authors: Fikar CR , Tran MQ
Published: April 2014

The authors discuss Internet sites that provide information on podiatric medicine relevant to practitioners and students. Before going online, the podiatric health professional should be aware that the information located at these sites may vary in quality, reliability, and level of sophistication. A brief introduction to the history of the Internet is presented, along with useful sites and general medical resources.
Spinal stenosis. A common cause of podiatric symptoms
Authors: Goldman SM , Funk JD , Christensen VM
Published: April 2014

Spinal stenosis, involving pressure on either the central spinal cord or nerve root exiting the spinal canal, can cause a variety of symptoms in the lower extremities. A classic symptom is that of neurogenic claudication, involving leg pain and weakness brought on by walking. The pain is relieved by sitting or lying down, not by standing and resting as would be seen in arterial insufficiency-induced claudication. Other symptoms of spinal stenosis can involve paresthesia, weakness or cramping in one or both extremities, rest pain, or burning pain, and are commonly misdiagnosed as peripheral neuropathy, especially in patients with diabetes. Symptoms are often chronic, frequently missed, or misdiagnosed in the medical community, and may cause severe disability or reduction in the quality of life. Spinal stenosis is in some patients the unidentified cause of failure of treatment of foot and leg pain. Podiatric physicians, who focus on the patient's lower extremities, are in a unique position to be able to identify spinal stenosis and facilitate appropriate treatment. The authors provide current information regarding symptoms of spinal stenosis, a guide to diagnosis including the anatomical etiologies, and a basic understanding of treatment.