bluuebunny/crossref_metadata_2025 huggingface dataset:
Arthroscopic Removal of a Subperiosteal Osteoid Osteoma of the Talus
Authors: Gunes Taner , Erdem Mehmet , Sen Cengiz , Bilen Erkal , Yeniel Kursad
Published: April 2014

We report a case of a subperiosteal osteoid osteoma on the talar neck that was removed arthroscopically. Intralesional excision, en bloc resection, and percutaneous ablation techniques have all been used for the treatment of osteoid osteoma. For intra-articular osteoid osteomas, arthroscopy-assisted removal of the tumor has been described in a few case reports. Obtaining a nidus fragment for pathologic evaluation is important during arthroscopic removal of intra-articular osteoid osteomas. Sometimes it is not possible to obtain a specimen for pathologic examination. In the present case, the osteoid osteoma on the talar neck was easily located, the nidus was completely removed, and the tumor was extirpated. (J Am Podiatr Med Assoc 97(3): 238–243, 2007)
Leiomyosarcoma of the Foot
Authors: Engel Erin , Butler Michael , Anain Joseph
Published: April 2014

Leiomyosarcoma is a very rare malignant tumor, with only 28 new cases diagnosed in the United States each year. The prognosis varies, with average 5-year survival of 65%. Although most leiomyosarcomas occur in the lower extremity, there is a paucity in the literature on these sarcomas in the foot. Only 15 cases of leiomyosarcoma in the foot have been reported in the literature since the mid-1930s. We describe a 31-year-old man with a history of an ingrown toenail and nonhealing pyogenic granuloma. His clinical presentation suggested atypical tissue. Biopsy findings confirmed the diagnosis of spindle cell sarcoma, specifically, leiomyosarcoma. The patient was treated with amputation of the affected hallux and adjuvant therapy. The similar presentations of a pyogenic granuloma and a malignant tumor necessitate a thorough differential diagnosis with even common foot ailments. (J Am Podiatr Med Assoc 97(6): 475–479, 2007)
Antiswelling Effect of StepIt—an Active Foot Pump System
Authors: Bergqvist David
Published: April 2014

Background: StepIt is a device for active movement of the foot that simulates normal walking with calf muscle contractions.

Methods: In 40 healthy volunteers with predominantly office work and sitting conditions, StepIt was used regularly for 1 day, and the volume of the calf, approximated to a truncated cone, was measured before and after using StepIt. One leg was used as a control, and after 5 days, the exercise was repeated, with the other leg as the control.

Results: The volume of the leg increased during the day and the increase was significantly smaller in the leg that used StepIt.

Conclusions: By using a device for active foot movement in healthy people, it is possible, in some individuals, to reduce the swelling that occurs during sitting conditions. (J Am Podiatr Med Assoc 99(1): 20–22, 2009)
Podiatric Medicine: A Current Assessment
Authors: Levrio Jay
Published: April 2014

Podiatric medicine had its own evolution in the medical field apart from allopathic and osteopathic medicine. Podiatrists are well-respected members of the health-care team and have earned recognition as physicians within their education, training, and credentialing processes. Unlike allopathic medical doctors and doctors of osteopathic medicine, whose scope of practice is based upon their education, training, and credentialing processes, podiatrists' scopes of practice are determined by state laws (and are often influenced by politics) with variances across the United States. In contrast to a lack of uniformity in the training and credentialing processes of an allopathic medical doctor, podiatrists complete a streamlined educational process that is competency-based and well-aligned from the undergraduate phase (podiatric medical school) to the postgraduate phase (residency) through the credentialing processes (licensure and certification). Podiatric medical students begin to directly engage in the specialty related to the diagnosis and treatment of the lower extremity much earlier in the educational process than an orthopedist, whose foot and ankle exposure is less extensive by comparison. (J Am Podiatr Med Assoc 99(1): 65–72, 2009)
Long Leg Calcaneal Axial and Hindfoot Alignment Radiographic Views for Frontal Plane Assessment
Authors: Mendicino Robert W. , Catanzariti Alan R. , John Shine , Child Brandon , Lamm Bradley M.
Published: April 2014

Reconstructive surgery for hindfoot, ankle, and leg deformities is facilitated by proper radiographic analysis. The long leg calcaneal axial and hindfoot alignment views have been proved to be useful in deformity planning at The Foot and Ankle Institute at The Western Pennsylvania Hospital. These radiographic views can be attained in an office setting or in any hospital radiology department. The details provided herein of this radiographic technique will be useful to physicians, office staff, and radiology technicians to facilitate proper imaging of hindfoot, ankle, and leg deformities. (J Am Podiatr Med Assoc 98(1): 75–78, 2008)
Wound Complications from Surgeries Pertaining to the Achilles Tendon
Authors: Saxena Amol , Maffulli Nicola , Nguyen Aidan , Li Albert
Published: April 2014

Background: A retrospective review of one surgeon’s practice was conducted to assess the prevalence of wound complications associated with acute and chronic rupture repair, peritenolysis, tenodesis, debridement, retrocalcaneal exostectomy/bursectomy, and management of calcific tendinopathy of the Achilles tendon.

Methods: We evaluated the incidence of infection and other wound complications, such as suture reactions, scar revision, hematoma, incisional neuromas, and granuloma formation.

Results: A total of 219 surgical cases were available for review (140 males and 70 females; mean ± SD age at the time of surgery, 46.5 ± 12.6 years; age range, 16–75 years). Seven patients experienced a wound infection, three had keloid formation, six had suture granulomas, and six had suture abscesses, for a total complication rate of 10.0%. Six patients had more than one complication; therefore, the percentage of patients with complications was 7.3%. There were no hematomas. Seven patients had additional surgery after their wound complications; some had simple granuloma excision, and one necessitated a flap. Patients with risk factors such as diabetes mellitus, smoking, and rheumatoid arthritis necessitating corticosteroid therapy were more likely to have a wound complication (Fisher exact test, P = .03).

Conclusions: Complications with Achilles tendon surgery may be unavoidable. Suture granulomas may appear in a delayed manner. Absorbable and nonabsorbable sutures can be implicated. (J Am Podiatr Med Assoc 98(2): 95–101, 2008)
A Method for Assessing Off-loading Compliance
Authors: Crews Ryan T. , Armstrong David G. , Boulton Andrew J.M.
Published: April 2014

Background: Off-loading excessive pressure is essential to healing diabetic foot ulcers. However, many patients are not compliant in using prescribed footwear or off-loading devices. We sought to validate a method of objectively measuring off-loading compliance via activity monitors.

Methods: For 4 days, a single subject maintained a written compliance diary concerning use of a removable cast walker. He also wore a hip-mounted activity monitor during all waking hours. An additional activity monitor remained mounted on the cast walker at all times. At the conclusion of the 4 days, the time-stamped hip activity data were independently coded for walker compliance by the compliance diary and by using the time-stamped walker activity data.

Results: An intraclass reliability of 0.93 was found between diary-coded and walker monitor–coded activity.

Conclusions: These results support the use of this dual activity monitor approach for assessing off-loading compliance. An advantage of this approach versus a patient-maintained diary is that the monitors are not susceptible to incorrect patient recall or a patient’s desire to please a caregiver by reporting inflated compliance. Furthermore, these results seem to lend support to existing reports in the literature using similar methods. (J Am Podiatr Med Assoc 99(2): 100–103, 2009)
Treatment of Plantar Fasciitis Using Four Different Local Injection Modalities
Authors: Kalaci Aydiner , Çakici Hüsamettin , Hapa Onur , Yanat Ahmet Nedim , Dogramaci Yunus , Sevinç Teoman Toni
Published: April 2014

Background: To determine the effectiveness of four different local injection modalities in the treatment of plantar fasciitis.

Methods: In a prospective randomized multicenter study of plantar fasciitis, 100 patients were divided into four equal groups and were treated using four different methods of local injection: group A was treated with 2 mL of autologous blood alone; group B, an anesthetic (2 mL of lidocaine) combined with peppering; group C, a corticosteroid (2 mL of triamcinolone) alone; and group D, a corticosteroid (2 mL of triamcinolone) combined with peppering. The outcome was defined by using a 10-cm visual analog scale and modified criteria of the Roles and Maudsley score 3 weeks and 6 months after the injection and compared with the pretreatment condition.

Results: The successful results in all of the groups after injections were higher than those in the pretreatment condition (P = .000). In groups C and D, in which local corticosteroid injections were used, excellent results were obtained, with superior effect in the group in which peppering was used (P < .05).

Conclusions: In the treatment of plantar fasciitis, combined corticosteroid injections and peppering is effective and produces better clinical results. (J Am Podiatr Med Assoc 99(2): 108–113, 2009)
Efficacy of Wedge Resection With Phenolization in the Treatment of Ingrowing Toenails
Authors: Shaikh Faisal M. , Jafri Mansoor , Giri Subhasis K. , Keane Ralph
Published: April 2014

Background: Ingrowing toenail is a common condition treated by general surgeons. Our aim was to analyze the effectiveness of wedge resection with phenolization in the surgical treatment of ingrowing toenails.

Methods: We retrospectively audited 100 patients who underwent wedge resection with phenolization for the treatment of ingrowing toenail between January 2000 and June 2004 by a single surgeon. We reviewed all charts and attempted to contact all patients for a telephone interview to assess patient satisfaction. Outcome measures were: 1) recurrence rate, 2) duration of analgesic use, 3) postoperative complications including wound infection, 4) time to return to normal activities, and 5) satisfaction with the procedure.

Results: A total of 168 wedge resection with phenolization procedures were performed on 100 patients. There was only one recurrence (0.6%). Two patients (2%) had wound infection and were treated with oral antibiotics. The average time for a single wedge resection with phenolization procedure was 7.3 minutes. The mean time to return to normal activities was 2.1 weeks. The patient response rate for the telephone interview was 60%. Most respondents (93.3%) were satisfied with the overall outcome.

Conclusions: Wedge resection with phenolization is a very effective mode of therapy in the surgical treatment of ingrowing toenail, with a very low recurrence rate and minimal postoperative morbidity. Wedge resection with phenolization should be considered as a good alternative technique in the treatment of ingrowing toenail. (J Am Podiatr Med Assoc 98(2): 118–122, 2008)
The Diabetic Person Beyond a Foot Ulcer
Authors: Monami Matteo , Longo Rosella , Desideri Carla Maria , Masotti Giulio , Marchionni Niccolò , Mannucci Edoardo
Published: April 2014

Background: Several studies have shown a significant relationship between depressive symptoms and wound healing, but these studies have not assessed the effects of depressive symptoms on diabetic foot prognosis. We specifically designed our study to assess the role of depressive symptoms in healing and recurrence of diabetic foot ulcers.

Methods: A consecutive series of 80 type 2 diabetic patients aged 60 years and older with foot ulcers was enrolled in a cohort observational study with a 6-month follow-up. Patients who healed within 6 months of enrollment were included in a 12-month follow-up study for assessment of ulcer recurrence. Depressive symptoms were assessed with the geriatric depression scale.

Results: Healing was associated with a smaller ulcer area, shorter delay between ulcer onset and treatment, lower glycosylated hemoglobin, and higher ankle-brachial index. Both smoking status and Texas and Wagner scores also had a significant impact on healing. Patients who healed had significantly lower scores on the geriatric depression scale, and those with scores = 10 had a significantly higher risk of not healing at 6 months (relative risk, 3.57; 95% confidence interval, 1.05–12.2). Patients with a recurrent ulcer (59.3%) showed significantly higher total cholesterol levels, higher scores on the Greenfield index of disease severity and geriatric depression scale, and a higher prevalence of cerebrovascular disease. Depressive symptoms maintained a significant association with persistence and recurrence of ulcer even after adjustment for confounders.

Conclusions: Depressive symptoms are associated with impaired healing and recurrence of ulcers in elderly type 2 diabetic patients. (J Am Podiatr Med Assoc 98(2): 130–136, 2008)
Psoriatic Onychopachydermoperiostitis (POPP)
Authors: Mahoney James M. , Scott Ryan
Published: April 2014

The following case of a 37-year-old male describes a very rare form of psoriasis known as psoriatic onychopachydermoperiostitis. There have been fewer than 20 cases reported worldwide. (J Am Podiatr Med Assoc 99(2): 140–143, 2009)
Lipoma Arborescens of the Peroneus Longus and Peroneus Brevis Tendon Sheath
Authors: Dogramaci Yunus , Kalaci Aydiner , Sevinç Teoman Toni , Atik Esin , Esen Erdinc , Yanat Ahmet Nedim
Published: April 2014

Lipoma arborescens is an uncommon pseudotumoral synovial lesion usually located in the suprapatellar pouch of the knee. Lipoma arborescens involving the synovial sheaths of the tendons is exceedingly rare. This diagnosis should be considered, particularly in patients with chronic joint effusion. We report a case with lipoma arborescens affecting the synovial sheaths of the peroneal tendons without involvement of the adjacent ankle joint. To our knowledge, this is the second reported case of lipoma arborescens involving tenosynovial sheaths of tendons arround the ankle joint without ankle joint involvment. (J Am Podiatr Med Assoc 99(2): 153–156, 2009)
Treatment of Hallux Valgus with Three-dimensional Modification of Mitchell’s Osteotomy
Authors: Lucijanic Ivica , Bicanic Goran , Sonicki Zdenko , Mirkovic Maja , Pecina Marko
Published: April 2014

Mitchell’s osteotomy gives very good results but there are still some cases where the original method, as well as its modification, cannot address all aspects of deformity. We modified the original Mitchell’s method to address pronation and plantar displacement of the first metatarsal. Modification includes formation of lateral and plantar spur with metatarsal displacement and derotation of distal metatarsal fragment in the frontal and horizontal planes with stable screw fixation. We present midterm results of the first 60 patients compared to the original Mitchell method (30 patients). Differences between the groups postoperatively were in declination angle, postoperative metatarsalgia rate, and first metatarsal pronation angle. The technique described eliminated many of the disadvantages of Mitchell’s method. (J Am Podiatr Med Assoc 99(2): 162–172, 2009)
Vertical Facial Dimensions Linked to Abnormal Foot Motion
Authors: Rothbart Brian A.
Published: April 2014

Background: Twenty-two children from Jiutepec, Mexico, were studied to determine whether a correlation exists among foot motion, the position of the innominates, and vertical facial dimensions (ie, the distances between the outer corners of the eyes [the exocanthions] and the ipsilateral outer margins of the lips).

Methods: Three null hypotheses were constructed and tested using the one-sample t test. Hypothesis A: there is no relationship between abnormal foot pronation and hip position; Hypothesis B: there is no relationship between hip position and vertical facial dimensions; and Hypothesis C: there is no relationship between abnormal foot pronation and vertical facial dimensions.

Results: The three null hypotheses were rejected.

Conclusions: An ascending foot cranial model was theorized to explain the findings generated from this study: 1) due to the action of gravity on the body, abnormal foot pronation (inward, forward, and downward rotation) displaces the innominates anteriorly (forward) and downward, with the more anteriorly rotated innominate corresponding to the more pronated foot; 2) anterior rotation of the innominates draws the temporal bones into anterior (internal) rotation, with the more anteriorly rotated temporal bone being ipsilateral to the more anteriorly rotated innominate bone; 3) the more anteriorly rotated temporal bone is linked to an ipsilateral inferior cant of the sphenoid and superior cant of the maxilla, resulting in a relative loss of vertical facial dimensions; and 4) the relative loss of vertical facial dimensions is on the same side as the more pronated foot. (J Am Podiatr Med Assoc 98(3): 189–196, 2008)
The Relationship Between the Use of Foot Orthoses and Knee Ligament Injury in Female Collegiate Basketball Players
Authors: Jenkins Walter L. , Raedeke Susanne G. , Williams D.S. Blaise
Published: April 2014

Background: Anterior cruciate ligament injuries are more prevalent in female athletes than in male athletes. Basketball is a high-risk sport for anterior cruciate ligament injury in female athletes. This study was conducted to observe the effect of a foot orthosis on the knee ligament injury rate in female basketball players at one US university.

Methods: One hundred fifty-five players on the women’s basketball team were observed for knee ligament injury from 1992 to 2005. Athletes in the 1992–1993 to 1995–1996 school years (July–June) did not receive a foot orthosis and served as the control group; the treatment group comprised the athletes during the 1996–1997 to 2004–2005 school years (July–June). Athletes in the treatment group received a foot orthosis before participating in basketball. Data analysis included knee ligament injury rates and a comparison of injury rates with an incidence density ratio.

Results: Athletes in the control group had three collateral ligament injuries and three anterior cruciate ligament injuries, for an injury rate of 0.50 for both the anterior cruciate ligament and collateral ligaments. Athletes in the treatment group had four collateral ligament injuries and one anterior cruciate ligament injury, for an injury rate of 0.29 for the collateral ligaments and 0.07 for the anterior cruciate ligament. Athletes in the control group were 1.72 times more likely to sustain a collateral ligament injury and 7.14 times more likely to sustain an anterior cruciate ligament injury than the treatment group.

Conclusions: Foot orthoses may contribute to a decreased knee ligament injury rate in female collegiate basketball players. (J Am Podiatr Med Assoc 98(3): 207–211, 2008)
Sever’s Disease: What Does the Literature Really Tell Us?
Authors: Scharfbillig Rolf W. , Jones Sara , Scutter Sheila D.
Published: April 2014

Background: Sever’s disease is typical of many musculoskeletal conditions where observational annotations have slowly been accepted as fact with the passing of years. Acceptance of these nontested observations means that health professionals seeking information on this condition access very low-level evidence, mainly being respectable opinion or poorly conducted retrospective case series.

Methods: A comprehensive review of the literature was undertaken gathering available articles and book references relating to Sever’s disease. This information was then reviewed to present what is actually known about this condition.

Results: Respectable opinion and poorly conducted retrospective case series make up the majority of evidence on this condition.

Conclusion: The level of evidence for most of what we purport to know about Sever’s disease is at such a level that prospective, well-designed studies are a necessity to allow any confidence in describing this condition and its treatment. (J Am Podiatr Med Assoc 98(3): 212–223, 2008)
Prostate Cancer Metastases to the Leg, Ankle, and Foot
Authors: Lee Daniel K.
Published: April 2014

Metastases to the bones of the lower extremities from prostate carcinomas are rare and are usually associated with diffuse metastatic disease or primary tumors of the abdomen and lungs. I present the case of a patient who presented with lower leg pain and had undiagnosed prostate carcinoma. Unlike previous reports of prostate carcinoma, this rare case includes magnetic resonance imaging, histology, and medical management. This case is unique in its presentation and has not been described previously in the literature. (J Am Podiatr Med Assoc 98(3): 242–245, 2008)
Tuberculosis of the Midtarsal Joints
Authors: Jerome J. Terrence Jose
Published: April 2014

This case report discusses the presentation, diagnosis, and treatment of a 22-year-old man with extrapulmonary tuberculosis of the foot. Extrapulmonary tuberculosis is extremely rare and accounts for less than 10% of osteoarticular tuberculosis. Radiographic and magnetic resonance imaging correlations are introduced. (J Am Podiatr Med Assoc 98(3): 246–249, 2008)
A Review of the Ponseti Method and Development of an Infant Clubfoot Program in Vietnam
Authors: Evans Angela M. , Van Thanh Do
Published: April 2014

Background: The Feet for Walking clubfoot project from Australia formally introduced the Ponseti technique in Vietnam in 2004 and is based at the Da Nang Orthopedic and Rehabilitation Centre in central Vietnam.

Methods: We provide an initial overview of the management of infant clubfoot deformity using the nonsurgical Ponseti method.

Results: Early indicators of the outcome of implementing this clubfoot project are largely positive but also require ongoing review. Further analyses of the use of the Ponseti method (or obstacles preventing the same) following training of personnel is underway.

Conclusions: Recent research has improved and refined the technique that must now be both appreciated and incorporated by clinicians. This technique is used across the world in both developed and developing countries and is universally regarded as the best management method for clubfoot deformities. (J Am Podiatr Med Assoc 99(4): 306–316, 2009)
Third Metatarsal Brown Tumor with Secondary Hyperparathyroidism
Authors: Yazgan Pelin , Ozturk Adil , Orhan Ismahan , Sirmatel Ocal , Baba Fusun
Published: April 2014

Brown tumors represent the terminal stage of the remodeling process during primary or secondary hyperparathyroidism. We report the first case of brown tumor on the third metatarsal associated with secondary hyperparathyroidism caused by vitamin D deficiency. Radiography showed an expansile tissue mass in the third metatarsal bone. The diagnosis was suggested by the clinical history and was confirmed by biochemical, radiologic, and histopathologic determinations. After intravenous therapy with calcidiol, 1g/d, her symptoms were relieved. The brown tumor showed regression and ossification during the 3 months after therapy. (J Am Podiatr Med Assoc 98(4): 314–317, 2008)
Neuropathy in Diabetes
Authors: Rogers Lee C. , Bevilacqua Nicholas J. , Malik Rayaz A. , Armstrong David G.
Published: April 2014

Neuropathic symptoms in patients with diabetes occur commonly and are most often a consequence of the diabetes. Up to 10% of patients with diabetes and neuropathy have an etiology other than diabetes as a cause of their nerve dysfunction. Herein we present a case of vasculitic neuropathy initially misdiagnosed as diabetic neuropathy that led to separate amputations of two toes. This case emphasizes the importance of considering alternative, potentially treatable, causes of peripheral neuropathy in patients with diabetes. (J Am Podiatr Med Assoc 98(4): 322–325, 2008)
Validation of the Basic Foot Screening Checklist
Authors: Bower Virginia M. , Hobbs Michael
Published: April 2014

Background: We sought to evaluate the validity, reliability, and predictive value of the Basic Foot Screening Checklist.

Methods: Five hundred patients with type 2 diabetes mellitus and impaired glucose tolerance were screened by a generalist foot screener and a specialist podiatric physician to determine the sensitivity and specificity of the Basic Foot Screening Checklist. One hundred twelve of the 500 participants had their feet screened by two foot screeners to determine reliability.

Results: The sensitivity of the screening tool was 0.54 (95% confidence interval, 0.50–0.58), and the specificity was 0.77 (95% confidence interval, 0.73–0.81), with a positive predictive value of 0.82 (95% confidence interval, 0.79–0.85). Overall, the reliability of the tool was poor (κ = 0.35; 95% confidence interval, 0.17–0.53).

Conclusions: The validity and reliability of the Basic Foot Screening Checklist was poor despite the finding that generalist foot screeners performed individual tests with good sensitivity and specificity. This inconsistency was likely attributable to the inability of screeners to adequately interpret the test findings and form accurate risk classification outcomes. (J Am Podiatr Med Assoc 99(4): 339–347, 2009)
The Incidence of Tinea Pedis in Diabetic versus Nondiabetic Patients with Interdigital Macerations
Authors: Legge Bradford S. , Grady John F. , Lacey Autum M.
Published: April 2014

Background: We sought to determine the incidence of tinea pedis in patients with otherwise asymptomatic pedal interdigital macerations. Both diabetic and nondiabetic populations were compared. Age and body mass index were also examined for their significance.

Methods: Fungal cultures of skin scrapings from 80 patients (77 male and 3 female; mean age, 65 years) with interdigital macerations were performed; 40 patients had previously been diagnosed with type 2 diabetes and 40 did not have diabetes.

Results: Cultures revealed a 40% prevalence of tinea pedis in the total study population. The prevalence in the nondiabetic group was 37.5% and 42.5% for the diabetic group. This was not a statistically significant difference. Among patients with interdigital macerations that yielded positive fungal cultures, those in the nondiabetic group were 6.3 years older than those in the diabetic group. It was also observed that the nondiabetic patients with interdigital macerations yielding positive fungal cultures were 9.1 years older than patients with negative fungal cultures in the nondiabetic group.

Conclusion: The results of this study provide the practitioner with a guide for treating pedal interdigital macerations. Because the likelihood of a tinea pedis infection is 40%, it seems prudent to treat these macerations with an antifungal agent. In regard to age, the results suggest that as nondiabetic patients age, the likelihood of an otherwise asymptomatic interdigital maceration yielding a positive fungal culture increases, and that diabetic patients may be susceptible to interdigital fungal infections at a younger age than those without diabetes. (J Am Podiatr Med Assoc 98(5): 353–356, 2008)
Gauze Application of Phenol for Matrixectomy
Authors: de Bengoa Vallejo Ricardo Becerro , Iglesias Marta Elena Losa , Gomez Ruben Sanchez , Jules Kevin T.
Published: April 2014

Phenol matrixectomy is commonly used to treat onychocryptosis. The podiatric medical community has been progressively improving the technique of phenol application to avoid cases of burns. We describe a modification that uses gauze to provide a safe way for the phenol to be applied and prevents skin lesions due to phenol burns. (J Am Podiatr Med Assoc 98(5): 418–421, 2008)
Biomechanical Risk Factors in the Development of Medial Tibial Stress Syndrome in Distance Runners
Authors: Tweed Jo L. , Campbell Jackie A. , Avil Steven J.
Published: April 2014

Background: We investigated the relationship between functional and static foot posture and medial tibial stress syndrome in distance runners.

Methods: Twenty-eight runners with a clinical diagnosis of medial tibial stress syndrome and 12 asymptomatic runners were assessed with the Foot Posture Index to measure static overpronation. Range of motion was measured at the talocrural joint, with the knee extended and flexed as was range of motion at the first metatarsophalangeal joint and the angular difference between the neutral and relaxed calcaneal stance positions. Each participant was then videotaped while running on a treadmill shod and unshod. This videotape was analyzed using freeze frame to identify abnormal or mistimed pronation at each phase of gait. The results were analyzed using logistic regression to give the probability that a runner is likely to experience medial tibial stress syndrome, predicted from the static measurements and dynamic observations.

Results: Variables identified as being significant predictors of medial tibial stress syndrome were the difference between the neutral and relaxed calcaneal stance positions, range of motion of the talocrural joint with the knee extended, early heel lift and abductory twist during gait, and apropulsive gait.

Conclusion: Runners with suspected symptoms of medial tibial stress syndrome should be assessed dynamically and statically for abnormal or mistimed pronation. (J Am Podiatr Med Assoc 98(6): 436–444, 2008)
Quality of Life in People with Their First Diabetic Foot Ulcer
Authors: Winkley Kirsty , Stahl Daniel , Chalder Trudie , Edmonds Michael E. , Ismail Khalida
Published: April 2014

Background: People with diabetic foot ulcers report poor quality of life. However, prospective studies that chart quality of life from the onset of diabetic foot ulcers are lacking. We describe change in quality of life in a cohort of people with diabetes and their first foot ulcer during 18 months and its association with adverse outcomes.

Methods: In this prospective cohort study of adults with their first diabetic foot ulcer, the main outcome was change in Medical Outcomes Study 36-Item Short Form Health Survey scores between baseline and 18-month follow-up. We recorded baseline demographics, diabetes characteristics, depression, and diabetic foot outcomes and mortality at 18 months.

Results: In 253 people with diabetes and their first ulcer, there were 40 deaths (15.8%), 36 amputations (15.5%), 99 recurrences (43.2%), and 52 nonhealing ulcers (21.9%). The 36-Item Short Form Health Survey response rate of survivors at 18 months was 78% (n = 157). There was a 5- to 6-point deterioration in mental component summary scores in people who did not heal (adjusted mean difference, −6.54; 95% confidence interval, −12.64 to −0.44) or had recurrent ulcers (adjusted mean difference, −5.30; 95% confidence interval, −9.87 to −0.73) and a nonsignificant reduction in those amputated (adjusted mean difference, −5.00; 95% confidence interval, −11.15 to 1.14).

Conclusions: Quality of life deteriorates in people with diabetes whose first foot ulcer recurs or does not heal within 18 months. (J Am Podiatr Med Assoc 99(5): 406–414, 2009)
Effect of 7-Degree Rearfoot Varus and Valgus Wedging on Rearfoot Kinematics and Kinetics During the Stance Phase of Walking
Authors: Pascual Huerta Javier , Ropa Moreno Juan Manuel , Kirby Kevin A. , García Carmona Francisco Javier , Orejana García Angel Manuel
Published: April 2014

Background: The scientific evidence behind the mechanical function of foot orthoses is still controversial. Research studies that have investigated the kinematic effect of foot orthoses on the lower extremity have shown variable results, with orthoses causing either no significant change or a small significant change in foot kinematics.

Methods: The right limbs of 12 healthy asymptomatic individuals were studied in three walking conditions: barefoot, with a 7° rearfoot varus wedge, and with a 7° rearfoot valgus wedge. Kinematic and kinetic variables measured were the foot progression angle, the peak internal tibial rotation angle, and net ankle inversion moments during the stance phase in the three conditions.

Results: There were statistically significant differences in the foot progression angle between the barefoot and varus wedge conditions and between the varus and valgus wedge conditions. There were no significant changes in peak internal tibial rotation among the three conditions tested. However, rearfoot varus wedges significantly reduced net ankle inversion moments compared with barefoot and rearfoot valgus wedges.

Conclusions: These results support the idea that foot orthoses work by methods other than by changing kinematic parameters. The present study supports the concept that foot orthoses work primarily by altering kinetics, with their effects on kinematics being secondary. (J Am Podiatr Med Assoc 99(5): 415–421, 2009)
Biomechanical Consequences of Total Plantar Fasciotomy
Authors: Tweed Jo L. , Barnes Mike R. , Allen Mike J. , Campbell Jackie A.
Published: April 2014

Background: Plantar fascia release for chronic plantar fasciitis has provided excellent pain relief and rapid return to activities with few reported complications. Cadaveric studies have led to the identification of some potential postoperative problems, most commonly weakness of the medial longitudinal arch and pain in the lateral midfoot.

Methods: An electronic search was conducted of the MEDLINE, ScienceDirect, SportDiscus, EMBASE, CINAHL, Cochrane, and AMED databases. The keywords used to search these databases were plantar fasciotomy and medial longitudinal arch. Articles published between 1976 and 2008 were identified.

Results: Collectively, results of cadaveric studies suggested that plantar fasciotomy leads to loss of integrity of the medial longitudinal arch and that total plantar fasciotomy is more detrimental to foot structure than is partial fasciotomy. In vivo studies, although limited in number, concluded that although clinical outcomes were satisfactory, medial longitudinal arch height decreased and the center of pressure of the weightbearing foot was excessively medially deviated postoperatively.

Conclusions: Plantar fasciotomy, in particular total plantar fasciotomy, may lead to loss of stability of the medial longitudinal arch and abnormalities in gait, in particular an excessively pronated foot. Further in vivo studies on the long-term biomechanical effects of plantar fasciotomy are required. (J Am Podiatr Med Assoc 99(5): 422–430, 2009)
Combined Surgical Therapy and Orthotic Management of Stress and Tuberosity Avulsion Fracture of the Fifth Metatarsal Bone
Authors: Darabos Nikica , Obrovac Karlo , Knez Nikica , Darabos Anela , Hudetz Damir , Elabjer Esmat
Published: April 2014

The incidence of fifth metatarsal fracture is somewhat common in sports and can be complicated in nature. Fractures of the fifth metatarsal can occur at a number of locations. Although some of these fractures respond well to conservative treatment, others have been notoriously hard to heal, with high rates of nonunions and other complications. Foot orthotic devices are commonly used as aids in the treatment of foot problems. In our case, we considered the combined effect of the surgical treatment and application of the custom-made foot orthoses. Special attention was taken with adjustments to the orthotic devices along and beneath the affected regions of the foot for adequate pain management and quick recovery to return to normal sports activities. Requirements for computer aided design/computer aided manufacturing orthotic design and manufacturing in this case were specific and considerably different from the usual procedure. (J Am Podiatr Med Assoc 99(6): 529–535, 2009)
Prevalence of Plantar Verrucae in Patients with Human Immunodeficiency Virus Infection During the Post–Highly Active Antiretroviral Therapy Era
Authors: Johnston James , King Christy M. , Shanks Sky , Khademi Saieh , Nelson Joseph , Yu Jenny , Barbosa Peter
Published: April 2014

Background: Since the implementation of highly active antiretroviral therapy (HAART), the life expectancy of patients with human immunodeficiency virus (HIV) has significantly increased. This is likely to cause changes in podiatric medical manifestations, such as plantar verrucae, in this population.

Methods: Attendees at a San Francisco street fair in 2008 provided information about HIV status and the presence of verrucae via a survey. A total of 504 surveys were analyzed and compared with 1995 data, before HAART implementation. We examined if there was a statistically significant change in the increased likelihood of plantar verrucae in HIV-positive patients from 1995 to 2008. Then we examined the likelihood of HIV-positive patients (compared to HIV-negative patients) presenting with plantar verrucae in 2008, by using logistic regression, and controlling for age, sex, and race/ethnicity.

Results: Patients with HIV infection were 5.2 times more likely to present with plantar verrucae compared to patients without HIV infection in 2008 (95% confidence interval, 2.5–11.0, P < .0001) and 10.0 times more likely in 1995 (95% confidence interval, 3.4–29.0, P < .0001). This decrease in likelihood over time was not statistically significantly different (P = .33). Logistic regression analysis controlling for the covariates of age, race, and sex showed that patients with HIV in 2008 were 4.5 times more likely to present with verrucae compared to patients without HIV (95% confidence interval, 2.1–9.9, P = .0002).

Conclusions: Patients with HIV infection in 2008 are still significantly more likely to present with plantar verrucae after controlling for age, race, and sex. This increased likelihood has not changed significantly across time. Because HAART has increased the life expectancy of patients with HIV, this group of patients with plantar verrucae will continue to represent a significant population in the practice of podiatric medicine. (J Am Podiatr Med Assoc 101(1): 35–40, 2011)
Prevalence of Toenail Onychomycosis in Patients with Type 2 Diabetes Mellitus and Evaluation of Risk Factors
Authors: Gulcan Aynur , Gulcan Erim , Oksuz Sukru , Sahin Idris , Kaya Demet
Published: April 2014

Background: We sought to determine the frequency of toenail onychomycosis in diabetic patients, to identify the causative agents, and to evaluate the epidemiologic risk factors.

Methods: Data regarding patients’ diabetic characteristics were recorded by the attending internal medicine clinician. Clinical examinations of patients’ toenails were performed by a dermatologist, and specimens were collected from the nails to establish the onycomycotic abnormality. All of the specimens were analyzed by direct microscopy and culture.

Results: Of 321 patients with type 2 diabetes mellitus, clinical onychomycosis was diagnosed in 162; 41 of those diagnoses were confirmed mycologically. Of the isolated fungi, 23 were yeasts and 18 were dermatophytes. Significant correlations were found between the frequency of onychomycosis and retinopathy, neuropathy, obesity, family history, and duration of diabetes. However, no correlation was found with sex, age, educational level, occupation, area of residence, levels of hemoglobin A1c and fasting blood glucose, and nephropathy. The most frequently isolated agents from clinical specimens were yeasts.

Conclusions: Long-term control of glycemia to prevent chronic complications and obesity and to promote education about the importance of foot and nail care should be essential components in preventing onychomycosis and its potential complications, such as secondary foot lesions, in patients with diabetes mellitus. (J Am Podiatr Med Assoc 101(1): 49–54, 2011)
Motivational Interviewing by Podiatric Physicians
Authors: Gabbay Robert A. , Kaul Shailja , Ulbrecht Jan , Scheffler Neil M. , Armstrong David G.
Published: April 2014

Foot ulceration and lower-extremity amputation are devastating end-stage complications of diabetes. Despite agreement that diabetic foot self-care is a key factor in prevention of ulcers and amputation, there has only been limited success in influencing these behaviors among patients with diabetes. While most efforts have focused on increasing patient knowledge, knowledge and behavior are poorly correlated. Knowledge is necessary but rarely sufficient for behavior change. A key determinant to adherence to self-care behavior is clinician counseling style. Podiatrists are the ideal providers to engage in a brief behavioral intervention with a patient. Motivational interviewing is a well-accepted, evidence-based teachable approach that enhances self-efficacy and increases intrinsic motivation for change and adherence to treatment. This article summarizes some key strategies that can be employed by podiatrists to improve foot self-care. (J Am Podiatr Med Assoc 101(1): 78–84, 2011)
Posterior Tibial Tendon Dysfunction
Authors: Durrant Beverley , Chockalingam Nachiappan , Hashmi Farina
Published: April 2014

Posterior tibial tendon dysfunction is a progressive deformity that can result in the development of a pathologic flatfoot deformity. Numerous publications have studied the effects of clinical interventions at specific stages of progression of posterior tibial tendon dysfunction, but there is still uncertainty regarding the clinical identification of the condition. It is clear that more information regarding the etiology, progression, and risk factors of posterior tibial tendon dysfunction is required. Clear evidence exists that suggests that the quality of life for patients with posterior tibial tendon dysfunction is significantly affected. Furthermore, evidence suggests that early conservative intervention can significantly improve quality of life regarding disability, function, and pain. This would suggest that significant cost burden reductions could be made by improving awareness of the condition, which would improve early diagnosis. Early conservative intervention may help reduce the number of patients requiring surgery. This review focuses on the etiologic factors, epidemiologic features, and pathogenesis of posterior tibial tendon dysfunction. It aims to analyze, discuss, and debate the current understanding of this condition using the available literature. In addition, there is a discussion of the evidence base surrounding disease characteristics associated with the different clinical stages of posterior tibial tendon dysfunction. (J Am Podiatr Med Assoc 101(2): 176–186, 2011)
What Do I Do when Bone Hits the Ground?
Authors: Brownell Benjamin
Published: April 2014

While performing a distal first metatarsal bunion correction, care is always taken to stabilize the capital fragment during relocation and until fixation is completed. The underlying concern is that one false move could cause the capital fragment to end up on the floor. There are articles relating what surgeons have done when this has happened, but there is no evidence-based literature relating to guidelines or policy for decontaminating dropped bone. This case study relates what happened to me after saying, “Can you pick that up for me please?” (J Am Podiatr Med Assoc 101(2): 190–191, 2011)
Central Talar Dome Lesions
Authors: Dobbs Bruce M. , Cazzell Shawn M. , Dini Monara
Published: April 2014

Osteochondral lesions of the talus have been documented, reported, and studied since as early as the 19th century. The evolution of classification systems has allowed surgeons to better manage osseous lesions. Most osteochondral lesions of the talus have been categorized as anterolateral, posteromedial, or central with respect to the talar dome and its articulating surface. The complexity of the aforementioned lesions each present their own set of obstacles and, hence, management. Specifically, surgery on a central talar dome lesion is complicated by poor exposure and limited access, proving to be a challenging operation. Preoperative planning, including exhaustive imaging before any talar dome surgery, is imperative. We present a case study that involves the need for a distal tibial chevron (wedge) talus, with incorporation of a cadaveric allograft to fill the defect. (J Am Podiatr Med Assoc 101(2): 192–195, 2011)
Foot Biomechanics in Patients with Diabetes Mellitus
Authors: Lázaro-Martínez José Luis , Aragón-Sánchez Francisco Javier , Beneit-Montesinos Juan Vicente , González-Jurado Maximo A. , Morales Esther García , Hernández David Martínez
Published: April 2014

Background:

We sought to identify the biomechanical characteristics of the feet of patients with diabetes mellitus and the interrelationship with diabetic neuropathy by determining the range of joint mobility and the presence and locations of calluses and foot deformities.

Methods:

This observational comparative study involved 281 patients with diabetes mellitus who underwent neurologic and vascular examinations. Joint mobility studies were performed, and deformities and hyperkeratosis locations were assessed.

Results:

No substantial differences were found between patients with and without neuropathy in joint mobility range. Neuropathy was seen as a risk factor only in the passive range of motion of the first metatarsophalangeal joint (mean ± SD: 57.2° ± 19.5° versus 50.3° ± 22.5°, P = .008). Mean ± SD ankle joint mobility values were similar in both groups (83.0° ± 5.2° versus 82.8° ± 9.3°, P = .826). Patients without neuropathy had a higher rate of foot deformities such as hallux abductus valgus and hammer toes. There was also a higher presence of calluses in patients without neuropathy (82.8% versus 72.6%; P = .039).

Conclusions:

Diabetic neuropathy was not related to limited joint mobility and the presence of calluses. Patients with neuropathy did not show a higher risk of any of the deformities examined. These findings suggest that the etiology of biomechanical alterations in diabetic people is complex and may involve several anatomically and pathologically predisposing factors. (J Am Podiatr Med Assoc 101(3): 208–214, 2011)
Reducing the Pain of Local 1% Lidocaine Infiltration with a Preceding Bacteriostatic Saline Injection
Authors: Barrett Stephen L. , Maxka Jim , Mieras Jamie N. , Cooper Kimbal E.
Published: April 2014

Background:

Lidocaine injection for local anesthesia is a common podiatric medical procedure. We tested the hypothesis that injection of bacteriostatic saline solution containing 0.9% benzyl alcohol before the lidocaine infiltration can reduce the burning caused by lidocaine injection.

Methods:

This double-blind prospective trial involved 45 participants who each received four injections in two areas of the dorsum of the foot and rated the perceived pain on a visual analog scale. The order of the injections was designed to disguise the control and intervention arms of the study.

Results:

The sensation of the lidocaine injection after the injection of saline was reduced significantly (P = .028). The percentage of lidocaine injections with visual analog scale scores of 0 increased by 36% after preinjection with bacteriostatic saline solution containing 0.9% benzyl alcohol.

Conclusions:

The fact that 40% of the intervention visual analog scale pain scores for lidocaine injections were 0 suggests that a near painless lidocaine injection technique is an achievable goal and that the present technique is a simple and inexpensive method of reducing the pain of lidocaine injections. (J Am Podiatr Med Assoc 101(3): 223–230, 2011)