bluuebunny/crossref_metadata_2025 huggingface dataset:
Unusual presentation of calcaneal osteomyelitis. Twenty-five years after inoculation
Authors: Rogoff RS , Tinkle JD , Bartis DG
Published: April 2014

An unusual presentation of calcaneal osteomyelitis is described, where-by the infection remained undiagnosed for 25 years. The 36-year-old patient recently sought medical treatment for a reported ankle sprain, but the pain was recalcitrant to conservative care. Further investigation yielded a history significant for stepping on a chicken bone as a child, which entered the inferior lateral heel. Magnetic resonance imaging revealed what plain radiographs did not: a well demarcated lytic lesion in the body of the calcaneus. Intraoperative findings were consistent with an abscess of chronic osteomyelitis. The treatment included incision and drainage, antibiotic beads, and a tricortical bone graft.
After amputation. Rehabilitation of the diabetic amputee
Authors: Van Ross ER
Published: April 2014

Rehabilitation should address the physical and psychological scars following ablative surgery and help the amputee plan for the future. Collaboration is required between the surgical team, the rehabilitation team, and social services. Issues of particular concern to the amputee with diabetes are discussed.
Factors associated with pedal ulceration in patients with diabetes mellitus
Authors: Day MR , Harkless LB
Published: April 2014

Understanding the factors associated with pedal ulceration in patients with diabetes mellitus will increase the successful management of the high-risk diabetic foot and decrease the occurrence of ulcerative events. The authors review the associative factors that have been shown to be involved with pedal ulceration.
Imaging of digital neuromas
Authors: Baron RL , Galinski AW , Vlahos M
Published: April 2014

In this case presentation, an incision was made on the nonweightbearing surface of the hallux directly over the mass in question, just long enough to allow for the isolation of the entire mass. This permitted easier identification of the mass and enabled dissection of the abnormal tissue and excision of only the tumor with a minimum of tissue trauma. Healing was uneventful and expedient largely because of the reduced tissue handling. Prior to the advent of magnetic resonance imaging, this type of preoperative detailed surgical mapping would not have been possible. Continuing improvements in magnetic resonance imaging hold great and increasing promise.
Treatment of venous ulcers with human skin equivalent
Authors: Altman MI
Published: April 2014

In the author's clinical experience in rating venous ulcers, human skin equivalent has been efficacious, safe, cost-effective, and easy to use. This innovation is likely to become an important therapeutic tool for podiatric physicians who treat venous ulcers. Leg ulcers are a large economic burden to society, both in direct and total costs, including patient time lost from work for labor- and time-intensive therapies. The cost-containing measures of the managed care environment encourage treatment of venous ulcers in an outpatient center. Because human skin equivalent can be applied in such a setting, podiatric physicians will be able to treat venous ulcers routinely without referring patients to more costly settings such as hospitals or surgical centers. Because human skin equivalent is an effective alternative to standard venous ulcer therapies, this agent, which is currently under review by the Food and Drug Administration, should provide a viable treatment that may reduce the total costs associated with venous ulcer care.
Effect of patient position on the consistency of placing the rearfoot at subtalar neutral
Authors: Pierrynowski MR , Smith SB
Published: April 2014

The ability of foot care specialists to place a rearfoot at the subtalar neutral position is important for the care of patients who require foot orthosis prescription, fabrication, and management. Although some clinicians perform this procedure with the patient in the prone position, others prefer a seated or standing approach. This study examined whether patient position and preferred patient position influence the ability of clinicians to place a subject's rearfoot at the subtalar neutral position. The results suggest the following: a clinician's ability to find the subtalar neutral position is better with a seated subject; clinicians do not necessarily perform better assessments on a subject in a position corresponding to their patient position preference; and clinicians who prefer their patients prone generally have more flexible and reproducible observations. In addition, the findings suggest that the nature and relative importance of the tactile and visual cues used by clinicians to place a rearfoot at the subtalar neutral position warrant further exploration.
Long-term follow-up of Keller arthroplasty with irradiated costochondral implants
Authors: Harlan JT , Goldman FD
Published: April 2014

The authors present results of long-term follow-up of seven patients whose degenerative disease of the first metatarsophalangeal joint was treated with irradiated chondral graft implantation arthroplasty. In appropriate candidates, this procedure is a reasonable alternative to Keller arthroplasty alone, arthrodesis, and nonbiologic implant arthroplasty.
Ethical and legal issues in medical writing
Authors: Block BH
Published: April 2014

The medical community invests great confidence in published articles and research. It is incumbent on authors to be aware of the ethical responsibilities inherent in medical writing.
1998 William J. Stickel Bronze Award. Antifungal activity of Melaleuca alternifolia (tea-tree) oil against various pathogenic organisms
Authors: Concha JM , Moore LS , Holloway WJ
Published: April 2014

Tea-tree oil (oil of Melaleuca alternifolia) has recently received much attention as a natural remedy for bacterial and fungal infections of the skin and mucosa. As with most naturally occurring agents, claims of effectiveness have been only anecdotal; however, several published studies have recently demonstrated tea-tree oil's antibacterial activity. This study was conducted to determine the activity of tea-tree oil against 58 clinical isolates: Candida albicans (n = 10), Trichophyton rubrum (n = 8), Trichophyton mentagrophytes (n = 9), Trichophyton tonsurans (n = 10), Aspergillus niger (n = 9), Penicillium species (n = 9), Epidermophyton floccosum (n = 2), and Microsporum gypsum (n = 1). Tea-tree oil showed inhibitory activity against all isolates tested except one strain of E floccosum. These in vitro results suggest that tea-tree oil may be useful in the treatment of yeast and fungal mucosal and skin infections.
Polydactyly of the foot. Overview with case presentations
Authors: Kleanthous JK , Kleanthous EM , Hahn PJ
Published: April 2014

The authors offer two unique case presentations of pedal polydactyly as well as a general discussion of this congenital anomaly. This presentation demonstrates how a common condition has very individualized treatment plans that are based on communication between the patient and the podiatric surgeon.
Trauma-induced Kaposi's sarcoma of the hallux. An unusual case
Authors: Berkowitz KD , Bonner AC , Makimaa B , Flash JP , Sasken H , Blaise JF
Published: April 2014

Kaposi's sarcoma is the most common malignant lesion in patients who test seropositive for the human immunodeficiency virus. Although many cases of this tumor have been described in the literature, only a few cases have been related to Koebner's phenomenon following trauma. Biopsy of lesions remains the standard method of diagnosis, but the numerous treatment options available today require treatment to be determined on a case-by-case basis. The authors present an unusual case of trauma-induced, acquired immunodeficiency syndrome-related Kaposi's sarcoma of the hallux with successful treatment through radiotherapy.
Adenocarcinoma of the colon metastasizing to the foot masquerading as osteomyelitis
Authors: Tuteja A , Owings M , Pulliam J , Elzinga L
Published: April 2014

The authors report an unusual case of adenocarcinoma of the colon metastasizing to the foot. The initial diagnosis of osteomyelitis based on clinical, radiographic, and radionuclide uptake findings led to improper prolonged treatment, resulting in a major complication. A diagnostic biopsy of the involved bone is essential in any case in which the clinical diagnosis is uncertain.
Alternative techniques for the clinical assessment of foot pronation
Authors: Menz HB
Published: April 2014

Clinical measurement is a fundamental component of podiatric biomechanics. However, recent research has seriously questioned the reliability and validity of the commonly used approaches to clinical measurement of foot posture. A reevaluation of foot-morphology measurement is therefore warranted. This article discusses alternative clinical techniques of measuring foot type reported in the literature (arch height, footprint indices, the valgus index, and navicular drop) that may prove to be superior to the commonly used podiatric measurement system. On the basis of a critical evaluation of the literature, it would appear that arch height and footprint indices are invalid as means of categorizing foot morphology, while the valgus index and navicular drop offer a number of benefits over traditional frontal-plane measurements. An additional clinical measurement suggested by the author, navicular "drift," is also introduced. The advantages, disadvantages, and clinical application of each of these approaches are discussed in detail.
Secondary hypertrophic osteoarthropathy
Authors: Olivo D , Rosencrantz F , Caputo WJ
Published: April 2014

Whenever hypertrophic osteoarthropathy is diagnosed, it is imperative to search for the underlying pathology. The disorder is usually associated with a primary pulmonary lesion and periostitis and paresthesias of the lower extremities. Recognizing and understanding the primary pathology is essential to the effective treatment of secondary hypertrophic osteoarthropathy.
Progressive subtalar joint dislocation and limb-length inequality. An unusual case
Authors: Resseque B , Volpe RG
Published: April 2014

Subtalar joint dislocation is a rare entity, accounting for only 1% of all traumatic dislocations. The authors report a case of an adolescent with gradual lateral subluxation of an anatomically abnormal subtalar joint with no history of trauma, an extremely rare presentation. The patient also had a congenitally short limb. The patient underwent llizarov leg lengthening along with multiple surgeries of the subtalar joint. The choice of the Ilizarov technique to lengthen the leg and realign the subtalar joint in this case is discussed.
Cutaneous larva migrans infection in the pediatric foot. A review and two case reports
Authors: Mattone-Volpe F
Published: April 2014

Cutaneous larva migrans is the result of infestation of human skin by helminth larvae, which burrow through the epidermis. This route of infestation makes the foot a typical site for origination of this infection. Children, who frequently play barefoot in locations where the most common of the helminth larvae, the dog and cat hookworms, are endemic, are at particular risk for this disorder. This article reviews the differential diagnosis of cutaneous larva migrans and current concepts in management. Two cases of related children who presented to their pediatricians with this condition are reported.
Foot-care awareness. A survey of persons aged 65 years and older
Authors: Munro BJ , Steele JR
Published: April 2014

The authors conducted a mail survey that examined foot problems, rates of utilization of foot-health services, and the perception of foot problems as medical conditions in a sample of people aged 65 years and older who lived independently. Although 71% of the 128 respondents reported suffering from foot problems, only 39% had consulted medical personnel about their feet, and only 26% identified their foot pathologies as medical conditions. More female than male respondents experienced foot problems and had visited medical personnel about their feet. Increased education of older individuals about their foot-care requirements, as well as increased access to podiatric medical services, is recommended.
Review of the Dockery procedure for lateral ankle instability. A seven-year retrospective analysis
Authors: Evans RD , Feller SR , Heath NS
Published: April 2014

This article presents a critical review of the Dockery procedure (autogenous peroneus longus free graft technique) for the treatment of lateral ankle instability. Those patients with gastrocnemius equinus were treated with gastrocnemius recession during surgery. The authors reviewed 33 stabilizations performed over a period of 7 years to analyze the effectiveness of the procedure with and without the addition of the gastrocnemius recession. Assessed were the type and length of conservative therapy, the time to return to regular activity, complications experienced, and the recurrence rate. The results show a reinjury rate of 3%. The complications included infection, prolonged healing, and occasional screw irritation requiring screw removal. In light of the low incidence of reinjury, this technique is a valid procedure for treating lateral ankle instability.
Review of radiographic measurements following Austin bunionectomy
Authors: Bryant AR , Singer KP
Published: April 2014

This study compared preoperative and postoperative results for selected radiographic measurements of 30 patients undergoing the modified Austin bunionectomy procedure for the correction of hallux abducto valgus. Significant reductions in all postoperative radiographic values were demonstrated, including hallux abductus angle, metatarsus primus adductus angle, tibial sesamoid position, and first metatarsal protrusion distance.
The Ogden Anchor
Authors: Knudson WE , Cerniglia MW , Carro A
Published: April 2014

Many procedures performed by podiatric surgeons today require the use of a soft-tissue anchoring device. In recent years, many new anchoring devices have become available for use in the foot and ankle. The authors introduce a new soft-tissue anchoring device that has yet to be described in the podiatric literature and present two cases in which the new anchor was used.
The reliability of three techniques for measuring foot position
Authors: Weiner-Ogilvie S , Rome K
Published: April 2014

The reliability of three commonly used techniques for measuring foot position--valgus index, navicular height, and arch height--was evaluated in a study involving 20 healthy subjects. The results demonstrated significant differences (P < .05) between two observers for all three techniques, although there were no significant differences between two visits for the same observer (P < .05). Secondary analysis demonstrated that navicular height yielded the highest degree of intraobserver and interobserver agreement. The results suggest that there is a wide variation in foot position in the general population, and that measurement error may result from difficulties in defining foot position, techniques used, and instrumentation.
Development and validation of a questionnaire designed to measure foot-health status
Authors: Bennett PJ , Patterson C , Wearing S , Baglioni T
Published: April 2014

The aim of this study was to apply the principles of content, criterion, and construct validation to a new questionnaire specifically designed to measure foot-health status. One hundred eleven subjects completed two different questionnaires designed to measure foot health (the new Foot Health Status Questionnaire and the previously validated Foot Function Index) and underwent a clinical examination in order to provide data for a second-order confirmatory factor analysis. Presented herein is a psychometrically evaluated questionnaire that contains 13 items covering foot pain, foot function, footwear, and general foot health. The tool demonstrates a high degree of content, criterion, and construct validity and test-retest reliability.
Perimortem calcaneal and talar fractures sustained in a military air crash in Vietnam
Authors: Mann RW , Holland TD
Published: April 2014

The authors report on the skeletal elements of a minimum of 37 men who died in 1965 when their C-123 cargo airplane crashed into a mountainside in South Vietnam. Natural environmental processes reduced their bodies to skeletons; these osseous remains were recovered from the crash site nearly 10 years later. Among the remains were the calcanei and tali of at least 37 people. These bones, devoid of soft tissue, provide a rare opportunity to examine and document the pattern of perimortem fractures in multiple individuals who died in the same incident. This case also provides information on a range of variability of skeletal fractures that is unavailable in comparative skeletal collections, and that might be overlooked with radiography or during physical examination.
Clear cell sarcoma in the first metatarsal. An unusual case
Authors: Brekke MK , Northcote K , Temple WE
Published: April 2014

Clear cell sarcoma is an uncommon malignant neoplasm that, on rare occasion, invades osseous structures. The authors present a case of clear cell sarcoma that appears to have an osseous origin and that was discovered on a routine radiograph of the foot.
Enthesitis, arthritis, and heel pain
Authors: Lehman TJ
Published: April 2014

Often, individuals who present with "isolated" heel pain but with normal laboratory findings are dismissed without diagnosis. However, if these patients are carefully questioned and examined, a significant proportion are found to have a spondyloarthropathy. The keys to making this diagnosis are obtaining a thorough medical history and performing a complete physical examination. The classic complaints of back pain and enthesitis in other areas are frequently not reported by patients unless specifically sought, because they are thought to be unrelated to the heel pain.
Evolution of the rearfoot. A model of adaptation with evidence from the fossil record
Authors: Kidd R
Published: April 2014

The evolution of the human foot presents an obfuscation: explanations for its occurrence and the exact nature of mechanisms of change are still not fully understood. This article outlines a model of adaptation from a primitive ape foot and presents this as a hypothesis. Evidence substantiating the hypothesis is then presented, which explains many of the large-scale features distinctive to the human foot. Further evidence is then presented that goes some way toward explaining the sequence of modification with first the lateral side becoming adapted for terrestrial function followed by the medial side. Paradoxically, this was hypothesized by Morton more than half a century ago in his "hypothetical prehuman foot," though it was not accepted favorably at the time.
Total contact casts and removable cast walkers. Mitigation of plantar heel pressure
Authors: Armstrong DG , Stacpoole-Shea S
Published: April 2014

The purpose of this study was to compare the ability of various modalities to reduce pressure in the plantar heel. Twenty-five patients with grade 1A plantar foot ulcerations were evaluated; a repeat measures design comparing plantar pressure was used to evaluate the total contact cast, the Aircast pneumatic walker, the DH pressure relief walker, and depth-inlay shoes. The total contact cast reduced pressure significantly better than the other modalities; however, its pressure reduction was only 33% less than a baseline sneaker. All other modalities reduced significantly more pressure than the depth-inlay shoe. The DH walker had a significantly lower pressure-time integral than other modalities. These data indicate that, while the total contact cast appears to be effective compared with other modalities, the role that limitation of transverse motion of the fat pad on compression at heel strike has yet to be fully explained.
Os subfibulare. Investigation of an accessory bone
Authors: Champagne IM , Cook DL , Kestner SC , Pontisso JA , Siesel KJ
Published: April 2014

During dissection of a cadaver at the Ohio College of Podiatric Medicine, the authors encountered the os subfibulare. The os subfibulare was encased within the peroneus longus and peroneus brevis tendons and initially appeared as though it may have articulated with the left lateral malleolus distally and posteriorly. The ossicle was not associated with any capsular or ligamentous structures. These findings suggest that the os subfibulare is a true sesamoid bone. A review of the literature is presented and the clinical significance of these findings is discussed.
Teaching clinical biomechanics in the context of uncertainty
Authors: Payne CB , Bird AR
Published: April 2014

Uncertainty in the theories that provide the underpinnings of the clinical practice of podiatric biomechanics creates a dilemma: How should educators prepare students to make clinical decisions in the context of this uncertainty? Students need to be exposed to all approaches and be given the tools to make their own clinical decisions. Critical thinking involves the ability to weigh evidence, examine arguments, and construct rational bases for decisions and beliefs. Perry's model of cognitive development provides educators with one model for fostering critical thinking skills in students to guide them through the uncertainty in clinical biomechanics. This article presents the teaching philosophy that is used to teach undergraduate clinical biomechanics in the Department of Podiatry at La Trobe University, Australia.
Efficacy of a surfactant, allantoin, and benzalkonium chloride solution for onychomycosis. Preliminary results of treatment with periodic debridement
Authors: Wadhams PS , Griffith J , Nikravesh P , Chodosh D
Published: April 2014

A 10-month, hospital-based, open-label clinical study was undertaken of a unique antimicrobial nail solution containing surfactant, allantoin, and benzaikonium chloride to determine its effectiveness, in conjunction with periodic debridement, against pedal onychomycosis. Forty patients with microbial infection of the nails were enrolled in this study, in which a new, objective nail-scoring system was used. At the start of the study, the mean nail score was 8.3, and 79.8% of the nails scored had severe disease (on a scale of 0 to 10, with 10 defined as total nail involvement, accompanied by pain and thickening). By the conclusion of the study, the mean score had decreased to 2.5, 32.6% of the patients' nails were scored 0 or 1, and 90% of the patients subjectively judged their improvement as excellent or good.
Use of a computerized digital camera in podiatric medical practice
Authors: Stacpoole-Shea S , Shea G
Published: April 2014

Multimedia technology was once rarely found outside the realm of commercial production studios or in elaborate computer games. However, with the addition of only a few simple accessories, recent advances have made this technology readily available to the podiatric medical practitioner on a desktop office computer. The role that the application of multimedia technology using a computerized digital camera can play in a podiatric medical practice--including in such areas as record keeping, outcome measurement, patient education, interdisciplinary communications, and practice-management tools--is discussed.
Pyoderma gangrenosum affecting the foot. A case report
Authors: Archer JV , Chabra D , Camarinos NG , Mehl SM
Published: April 2014

The diagnosis of pyoderma gangrenosum is a difficult one to make because of the condition's ability to mimic other ulcerative lesions of the foot and its lack of specific laboratory and pathologic findings. A high index of clinical suspicion can lead to a definitive diagnosis. This article presents a case report and a discussion of the evaluation and management of pyoderma gangrenosum.
Tricorrectional bunionectomy for hallux abducto valgus. A comprehensive outcome study
Authors: Selner AJ , King SA , Samuels DI , Selner MD , Riley J
Published: April 2014

A longitudinal outcome study of the tricorrectional bunionectomy with AO screw fixation for the correction of hallux abducto valgus was undertaken involving 84 consecutive patients (121 feet) with a mean age of 48.4 years who underwent the procedure over a 6-month period. Preoperative and postoperative measurements of forefoot angles were calculated, with the following mean results obtained: intermetatarsal angle of 14.46 degrees corrected to 5.72 degrees, hallux abductus angle of 26.38 degrees corrected to 11.65 degrees, proximal articular set angle of 19.85 degrees corrected to 6.06 degrees, and tibial sesamoid position of 4.75 corrected to 1.87. The average time to return to athletic shoes was 12.63 days. Postoperative complications were minor, with no delayed unions, malunions, hematomas, bone infections, or hallux varus. Long-term follow-up (mean, 21.33 months) using the American Orthopaedic Foot and Ankle Society's objective Hallux Metatarsophalangeal-Interphalangeal Scale revealed an overall mean score of 88.94 points out of a possible 100. An excellent mean result of 95 points out of a possible 100 on the subjective patient rating scale was also reported.
The reappearance of polio. Postpolio syndrome
Authors: Tillett SG , Mozena JD
Published: April 2014

Although polio is often considered a disease of the past, new symptoms are appearing in patients infected with the polio virus many years ago. Many patients who contracted a paralytic form of poliomyelitis 3, 4, or even 7 decades ago are now relieving their childhood symptoms in what is known as postpolio syndrome.
Akin osteotomy with horizontal interosseous wire-loop fixation
Authors: Schlefman BS
Published: April 2014

The author has devised a new type of fixation for the Akin osteotomy. The fixation consists of double-stranded monofilament wire that is threaded through drill holes medially to laterally both proximal and distal to the osteotomy, encompassing four cortices. The fixation is placed prior to the cutting of the osteotomy, resulting in less chance of disruption to the lateral cortical hinge.
A proposed managed-care curriculum for podiatric residencies
Authors: Chinn SD
Published: April 2014

This article describes a curriculum that could be included in podiatric residencies to help residents function successfully in a managed-care environment. Various groups have identified and implemented the competencies necessary to function within such an environment. Podiatric residents, who are well trained in the clinical management of podiatric problems, can succeed in a managed-care environment if residency programs include training objectives and methods to address these competencies. This article describes the managed-care components of two primary-care residency programs and a podiatric program and proposes a managed-care curriculum for podiatric residencies. The author's goal is to educate residency directors and faculty members on possible objectives and methods that can enhance the podiatric resident's educational experience and knowledge of managed care.
Management of heel pain syndrome with acetic acid iontophoresis
Authors: Japour CJ , Vohra R , Vohra PK , Garfunkel L , Chin N
Published: April 2014

This study was undertaken to determine the effectiveness of acetic acid iontophoresis in the treatment of heel pain. Thirty-five patients with chronic heel pain were treated with acetic acid iontophoresis over a 4-year period. Ninety-four percent of patients had complete or substantial relief of heel pain after an average of 5.7 sessions of acetic acid iontophoresis over an average period of 2.8 weeks. Heel pain levels were rated from 0 to 10, with 10 representing the most severe pain. Heel pain prior to iontophoresis treatment received an average rating of 7.5; by the end of therapy, the average rating had decreased to 1.8. At an average follow-up time of 27 months, heel pain levels averaged 0.64, indicating continued reduction in heel pain. Ninety-four percent of participants said that they would recommend acetic acid iontophoresis to someone with similar heel pain.
Reevaluation of the relaxed calcaneal stance position. Reliability and normal values in children and adults
Authors: Sobel E , Levitz SJ , Caselli MA , Tran M , Lepore F , Lilja E , Sinaie M , Wain E
Published: April 2014

Reliability and normal values for the relaxed calcaneal stance position were determined in a nonclinic population of healthy adults and children (88 adults and 124 children) ranging in age from 5 to 36 years. The mean relaxed calcaneal stance position for adults was 6.07 degrees valgus (SD 2.71 degrees) (range, 1 degree varus to 14 degrees valgus). The mean relaxed calcaneal stance position for children was 5.6 degrees valgus (SD 2.9 degrees) (range, 6 degrees varus to 12 degrees valgus). There was no significant difference between the relaxed calcaneal stance positions of adults and children. In children the relaxed calcaneal stance position did not correlate with age, height, or weight and did not decrease with age to the theoretical normal value of 0 degree +/- 2 degrees as postulated by Root et al. The relaxed calcaneal stance position was found to be a reliable measurement; however, the theoretical normal value of 0 degree +/- 2 degrees was not found. The values reported in the present study correspond with the results of other empirical studies; thus the theoretical normal value for the relaxed calcaneal stance position of 0 degree +/- 2 degrees may be invalid.
Pleomorphic hyalinized angiectatic tumor of soft parts
Authors: Brim SP , Allerding TJ , Buck K
Published: April 2014

Pleomorphic hyalinized angiectatic tumor of soft parts is a recently described neoplasm that most commonly affects the lower extremities. It is locally aggressive but has not been known to metastasize. This article presents a case of a softball-sized tumor on the dorsum of the foot that was identified as pleomorphic hyalinized angiectatic tumor of soft parts. Previously, it would have been misdiagnosed and treated as either a neurilemoma or a malignant fibrous histiocytoma.
Arterial embolus of the lower extremity. An atypical presentation
Authors: Hodor L , NG D
Published: April 2014

Acute arterial occlusion may be caused by an embolus, thrombosis, or trauma. Vascular diseases can involve complications not limited to vascular-related areas and may require a multidisciplinary approach to diagnosis and treatment. An overview of acute arterial occlusion is presented, as well as a case study of an atypical presentation of an arterial embolus of the lower extremity.
Phenol and alcohol chemical matrixectomy in diabetic versus nondiabetic patients. A retrospective study
Authors: Felton PM , Weaver TD
Published: April 2014

The authors performed a retrospective study of the safety and efficacy of toenail phenol and alcohol chemical matrixectomy in diabetic versus nondiabetic patients. Participating in the study were 66 patients, who underwent 137 nail procedures. The diabetic group consisted of 18 patients who underwent 39 procedures; the nondiabetic group consisted of 48 patients who underwent 98 procedures. The mean (+/- SD) healing time was 44 +/- 25 days for the diabetic group and 43 +/- 24 days for the nondiabetic group. The infection rate was 10.3% (4 of 39 procedures) for the diabetic group and 12.2% (12 of 98 procedures) for the nondiabetic group. In addition to validating this procedure for diabetic patients, this study showed no significant differences in the rate of postoperative complications between the two groups.
Onychocryptosis associated with the treatment of onychomycosis
Authors: Connelley LK , Dinehart SM , McDonald R
Published: April 2014

With the advent of effective oral therapies for onychomycosis, there have been anecdotal reports of an increased incidence of onychocryptosis associated with the use of these new agents. The authors undertook a chart review of 100 consecutive patients treated for onychomycosis in a private medical practice to determine the incidence of onychocryptosis. A total of 37 of these patients (37%) developed paronychia ranging from simple pain to a severe inflammatory response with redness, drainage, and granuloma formation. Of these, 19 patients (19%) required surgical procedures to control onychocryptotic symptoms. Podiatric physicians should be aware that ingrown toenails may be an adverse consequence of effective treatment for onychomycosis.
Foot problems, functional impairment, and falls in older people
Authors: Menz HB , Lord SR
Published: April 2014

Falls in older people are common and may lead to considerable disability. Although a number of risk factors for falling have been identified, the role of foot problems has received relatively little attention in the literature. This article reviews the literature pertaining to the prevalence of foot problems in older people and discusses the relationship of foot problems to functional impairment and falls. In addition, a number of theoretical considerations regarding specific foot conditions and postural instability are outlined.
Dynamic foot orthoses. Principles and application
Authors: Pratt DJ
Published: April 2014

Previous research has identified areas under the foot where stimulation evokes specific tonic reflexes. The term "tonic" is used because these reflex movements occur slowly, as if tonus or tension were accumulating, in contrast to the abrupt phasic response of a tendon jerk. The concept of tonic reactions has now been incorporated into the design of dynamic foot orthoses to help provide improved orthotic treatment with a better functional outcome. This article describes the background of this technique, briefly describes the manufacture of the dynamic orthosis, and outlines some of its uses.
Disseminated coccidioidomycosis masquerading as tendinitis
Authors: Fishco WD , Blocher KS
Published: April 2014

The authors report on a case of disseminated coccidioidomycosis of the medial cuneiform. This is a rare finding, with only a few reports of Coccidioides immitis being cultured from the bones of the foot. A brief overview of coccidioidomycosis, pertinent imaging studies, and histopathologic evaluation are presented.
Freiberg's infraction in a collegiate heptathlete
Authors: Palamarchuk HJ , Oehrlein CR
Published: April 2014

In 1914, Freiberg described a condition of infraction of the second metatarsal head. At the time, he considered direct trauma to be the etiologic agent, but he later disproved this by demonstrating a case without a history of trauma. This article describes a case of Freiberg's infraction in a female collegiate heptathlete and the effects of conservative treatment of her condition with custom-made orthoses.
Mycetoma
Authors: Young BA , Fee MJ , Giacopelli JA , Granoff DP , Kobayashi W
Published: April 2014

Subcutaneous fungal infections are relatively uncommon in the lower extremity. Mycetoma begins as painless papules or nodules that increase in size and progresses to involve the connective tissue. Diagnosis is based on biopsy, with definitive identification of the organism needed for effective treatment. Treatment consists of antifungal medications and surgical debridement. This article provides an overview of this disorder and reports on a case of recurrent mycetoma in a 70-year-old woman.
Effect of physical therapy on limited joint mobility in the diabetic foot. A pilot study
Authors: Dijs HM , Roofthooft JM , Driessens MF , De Bock PG , Jacobs C , Van Acker KL
Published: April 2014

Eleven patients with limited joint mobility and neuropathy were enrolled in a physical therapy program of passive joint mobilization at a rate of two sessions per week. Treatment resulted in a significant improvement in joint mobility after 10 sessions. Further improvement after 20 sessions did not reach the level of statistical significance, although near-normal joint mobility was attained. After completion of therapy, there was a progressive deterioration in joint mobility. No serious adverse effects were noted during treatment. This study provides some evidence that use of physical therapy may result in significant, although temporary, improvement in the mobility of the ankle and foot joints in diabetic patients with limited joint mobility and neuropathy. As limited joint mobility has been associated with the development of abnormally high pressures under the feet, which in turn may contribute to plantar ulceration in the susceptible neuropathic foot, the results indicate that physical therapy may be useful in the prevention of plantar ulceration in diabetic patients with limited joint mobility and neuropathy, although this must be verified by additional research.
Fracture mechanics. A comparison study of torsional stress on bone
Authors: VanCourt RB , Byron SE , Ali SJ , Caldwell BD
Published: April 2014

Fractures that result from torsional loading of shafts in mechanical systems of nonbiologic materials generate a fracture line that forms a 45 degrees angle to an axis that is perpendicular to the direction of torsional loading on the shaft. As tension and compression are applied to these isotropic substances, the angle of fracture increases and decreases, respectively. Understanding how these forces, particularly compressive forces, generate elongation of a spiral fracture increases the ability to predict the extent of injury to bone. Fibular and metatarsal fractures are of primary importance to the podiatric physician, but any spiral fracture may be subject to torsional loading. Thus the principles stated here apply to the entire skeletal system. The purpose of this article is to provide a better understanding of the mechanics behind the causes and characteristics of fractures and to explore whether these same factors apply to the fracture mechanics of bone.
Chondrosarcoma of the foot
Authors: Lo EP , Pollak R , Harvey CK
Published: April 2014

Chondrosarcomas have been seen clinically as aggressive tumors, with radiographic and histologic findings consistent with malignancy; however, they may have an insidious clinical course, with relatively benign radiographic and histopathologic findings. Rarely, a chondrosarcoma may present as a primary lesion of the foot. It is important to recognize these lesions as malignancies. The authors provide an overview of these neoplasms and describe a case of a low-grade chondrosarcoma in a 64-year-old woman.
A modified approach to the phenol and alcohol chemical partial matrixectomy
Authors: Kominsky SJ , Daniels MD
Published: April 2014

The phenol and alcohol matrixectomy is a frequently used technique for treating onychocryptosis in healthy patients. This article describes a modification of this common procedure. The modified version provides a quick and easy method of removing an ingrown nail.
Use of electrostimulation in the treatment of diabetic neuroarthropathy
Authors: Grady JF , O'Connor KJ , Axe TM , Zager EJ , Dennis LM , Brenner LA
Published: April 2014

Charcot's joint is a difficult and sometimes frustrating condition to treat, for both the patient and the physician. The authors give a brief overview of Charcot's joint and the treatment options available. They discuss the use of bone stimulators and how electrostimulation may be used to help arrest the progression of Charcot's deformity. To the authors' knowledge, the use of electrostimulation for the treatment of Charcot's joint has been described only once in the literature; three patients were evaluated in that study. In the current study, 11 patients were evaluated, with promising results obtained, thus supporting the findings of the previous study.
Squamous cell carcinoma of the hallux
Authors: Holgado RD , Ward SC , Suryaprasad SG
Published: April 2014

This article reports on a case of malignant degeneration of a hallux nail bed ulcer of 30 years' duration. Histologically, this lesion was determined to be a squamous cell carcinoma, a type of lesion that is also known as Marjolin's ulcer. The diagnosis, histologic findings, and treatment of patients with cutaneous squamous cell carcinoma are discussed.
Outcomes research in podiatric medicine
Authors: Wrobel JS
Published: April 2014

Outcomes research has become a high priority for the podiatric medical profession, according to the results of a recent survey of members of the American Podiatric Medical Association (APMA). The methods of population-based studies using claims data, health-related quality-of-life measures, decision and cost-effectiveness analysis, and quality improvement are discussed and their contributions to the podiatric medical profession highlighted. The integration of this methodology into the podiatric medical literature has been sparse. Future work needs to address the training of future researchers in these methods, the establishment of collaborative arrangements, and the development of uniform clinical and health-related quality-of-life measures.
A case of peroneal neuropathy-induced footdrop. Correlated and compensatory lower-extremity function
Authors: Vlahovic TC , Ribeiro CE , Lamm BM , Denmark JA , Walters RG , Talbert T , Penugonda S , Furmato JA , Brower DJ , McMahon J , Bhimji S , Hillstrom HJ
Published: April 2014

This article reports on the case of a man with peroneal neuropathy-induced footdrop who was seen at the authors' institution 3 years after open reduction and internal fixation of a proximal fibular fracture and a distal, spiral, oblique tibial fracture of the right leg. A comprehensive gait analysis was conducted. A significant footdrop in gait resulted in a "reverse check mark" center-of-pressure pattern, an increased transverse-plane rotation of the foot, and excessive knee and hip flexion in the sagittal plane. These objective findings documented significant dysfunction within the involved lower extremity; in addition, aberrant biomechanics were observed in structures other than the site of initial injury within both limbs.
Klippel-Tr√©naunay syndrome. An unusual presentation of unilateral leg edema
Authors: Morin JR , Lee J , Yong R , Chagares W
Published: April 2014

Klippel-Tr√©naunay syndrome is a rare congenital condition that classically presents as a triad of varicosities, bone or soft-tissue hypertrophy, and cutaneous hemangiomas. The authors describe a case of this disease in an otherwise healthy patient with unilateral leg edema and intermittent bleeding from prominent ankle varicosities. The diagnosis was made on the basis of clinical presentation, diagnostic studies, and a comprehensive literature review. An overview of the pathology, treatment, and prognosis of this disease is provided.
Calcaneal bone mineral density and mechanical strength of the metatarsals
Authors: Lidtke RH , Patel D , Muehleman C
Published: April 2014

The primary aim of this study was to determine the predictive value of the bone mineral density of the calcaneus for fracture of the metatarsals. The authors report a strong positive correlation between the bone mineral density of the calcaneus and the four-point bending strength of each of the five metatarsals (r2 = 0.76, 0.64, 0.70, 0.68, and 0.78 for metatarsals 1 through 5, respectively). In addition, the relative strengths of the metatarsals and the correlation with their in vivo loads during gait as previously reported in the literature are discussed.
Ectrodactyly-ectodermal dysplasia-clefting syndrome
Authors: Kelman GJ , Aronoff RC
Published: April 2014

Ectrodactyly-ectodermal dysplasia-clefting syndrome is a rare congenital anomaly that affects tissues of mesodermal and ectodermal origin. Musculoskeletal involvement frequently requires orthopedic intervention. The authors present a review of the literature pertaining to this rare syndrome as well as a case report of a female patient who exhibited the complete clinical triad. A description of the surgical management of her condition is also presented.
Reduction of Peak Pressure on the Forefoot with a Rigid Rocker-Bottom Postoperative Shoe
Authors: Fuller Eric , Schroeder Stephen , Edwards Jenifer
Published: April 2014

An ideal postoperative shoe should be comfortable to wear and protect the foot during recovery from surgery or injury. Protection is assumed to be related to peak pressure and force-time integral under the foot. This study compared a commonly used postoperative shoe with a new postoperative shoe that incorporates a rigid sole with an 11° rocker bottom. The new postoperative shoe significantly reduced peak pressures on the forefoot by 20%. The amount of pressure and force-time integral reduction is compared with other values found in the literature for various shoe modifications. Indications for rocker-bottom shoes are also explored. (J Am Podiatr Med Assoc 91(10): 501-507, 2001)
Terbinafine-Associated Taste Disturbance with Normal Taste Threshold Scores
Authors: Lemont Harvey , Sabo Marc
Published: April 2014

The medical literature reveals numerous reports of transient taste disturbance associated with the use of oral terbinafine. A review of these reports, however, fails to confirm taste disturbances by formal taste testing. In this article, a case of long-standing taste dysfunction in a patient who exhibited normal formal taste thresholds is described. (J Am Podiatr Med Assoc 91(10): 540-541, 2001)
Peg-in-Hole, End-to-End, and V Arthrodesis
Authors: Lamm Bradley M. , Ribeiro Carla E. , Vlahovic Tracey C. , Bauer Gary R. , Hillstrom Howard J.
Published: April 2014

The proximal interphalangeal joint arthrodesis is frequently performed to correct hammer toe deformities. This study was conducted to compare the inherent stability of the three proximal interphalangeal joint arthrodeses—peg-in-hole, end-to-end, and V constructs—in the sagittal plane by means of load-to-failure testing of 30 fresh-frozen cadaveric specimens fixated with a 0.045 Kirschner wire. The peg-in-hole construct was associated with significantly higher peak loads at failure compared with the other two procedures. Furthermore, the peg-in-hole construct had significantly higher stiffness values as compared with the V procedure. This study thus provides evidence that the peg-in-hole procedure is the most biomechanically stable surgical construct for proximal interphalangeal joint fusions under sagittal plane loading. (J Am Podiatr Med Assoc 91(2): 63-67, 2001)
Atypical Presentation of Plantar Fasciitis Secondary to Soft-Tissue Mass Infiltration
Authors: Ng Alan , Beegle Terrance , Rockett Andrea K.
Published: April 2014

This article describes a patient with plantar fascial pain who presented to the office of one of the authors. Physical examination and the patient’s description of the history of symptoms revealed classic signs and symptoms of plantar fasciitis. The patient was treated with numerous conservative modalities, including ultrasound, nonsteroidal anti-inflammatory medications, trigger-point injections, over-the-counter orthoses, and stretching exercises. When the pain was not relieved by these conservative measures, magnetic resonance imaging of the area was performed. Visualization of the insertional area of the plantar fascia revealed a mass inferior to, as well as infiltrated into, the plantar fascia. Surgical excision of the lesion resulted in complete elimination of the patient’s pain. (J Am Podiatr Med Assoc 91(2): 89-92, 2001)
The Reliability of Clinical and Caliper-Based Calcaneal Bisection Measurements
Authors: LaPointe Stephan J. , Peebles Charles , Nakra Aprajita , Hillstrom Howard
Published: April 2014

The measurements of subtalar joint neutral position and hindfoot range of motion have been shown to be unreliable. The first step in making these measurements is to determine the calcaneal bisection. This study examines the reliability of bisecting the calcaneus with digital linear calipers. Five trials on each of six cadavers resulted in a mean absolute angular difference of 0.60° (SD ±1.17°). These results were then compared with results from the typical visual method used clinically. Three raters each performed five trials on six cadavers. Visual bisection was more variable, with a mean absolute error of 3.61° (±3.13°). A mean error of 6° (±1°) is certainly possible when the heel is visually bisected. It was determined that the caliper bisection was a valid technique for bisection of the heel, but that clinical visual bisection was not. (J Am Podiatr Med Assoc 91(3): 121-126, 2001)