bluuebunny/crossref_metadata_2025 huggingface dataset:
Effective Orthotic Therapy for the Painful Cavus Foot
Authors: Burns Joshua , Crosbie Jack , Ouvrier Robert , Hunt Adrienne
Published: April 2014

Patients with a cavus or high-arched foot frequently experience foot pain, which can lead to significant limitation in function. Custom foot orthoses are widely prescribed to treat cavus foot pain. However, no clear guidelines for their construction exist, and there is limited evidence of their efficacy. In a randomized, single-blind, sham-controlled trial, the effect of custom foot orthoses on foot pain, function, quality of life, and plantar pressure loading in people with a cavus foot type was investigated. One hundred fifty-four participants with chronic musculoskeletal foot pain and bilateral cavus feet were randomly assigned to a treatment group receiving custom foot orthoses (n = 75) or to a control group receiving simple sham insoles (n = 79). At 3 months, 99% of the participants provided follow-up data using the Foot Health Status Questionnaire. Foot pain scores improved more with custom foot orthoses than with the control (difference, 8.3 points; 95% confidence interval [CI], 1.2 to 15.3 points; P = .022). Function scores also improved more with custom foot orthoses than with the control (difference, 9.5 points; 95% CI, 2.9 to 16.1 points; P = .005). Quality-of-life data favored custom foot orthoses, although differences reached statistical significance only for physical functioning (difference, 7.0 points; 95% CI, 1.9 to 12.1 points; P = .008). Plantar pressure improved considerably more with custom foot orthoses than with the control for all regions of the foot (difference, −3.0 N · s/cm2; 95% CI, −3.7 to −2.4 N · s/cm2; P < .001). In conclusion, custom foot orthoses are more effective than a control for the treatment of cavus foot pain and its associated limitation in function. (J Am Podiatr Med Assoc 96(3): 205–211, 2006)
Acquired Constriction Ring Syndrome
Authors: O’Quinn Jonathan C. , Friedman Roger L. , Wilms Kimberly L.
Published: April 2014

Acquired constriction ring syndrome is a clinical condition of infancy characterized by circumferential constriction of a toe or another appendage, such as fingers and genitalia. The foot and ankle specialist should be aware of this condition because vascular obstruction of the affected appendage can rapidly lead to gangrene and autoamputation. Treatment consists of prompt identification and removal of the constricting foreign material. Although this condition is uncommon, it can lead to digital loss. Early treatment yields a good prognosis. A case report is presented of a 9-week-old infant who experienced acquired constriction ring syndrome caused by a strand of hair wrapped around the third and fourth toes that was treated by unwinding the hair under loupe magnification. (J Am Podiatr Med Assoc 96(3): 253–255, 2006)
Changes in Male Foot Shape and Size with Weightbearing
Authors: Houston Vern L. , Luo Gangming , Mason Carl P. , Mussman Martin , Garbarini Maryanne , Beattie Aaron C.
Published: April 2014

Accurate, consistent measurement of foot-ankle geometry is essential for the design and manufacture of well-fitting, functional, comfortable footwear; for the diagnosis of certain biomechanical disorders; and for consistent longitudinal monitoring and assessment of pedorthic treatment outcomes. We sought to formulate a basic set of measures characterizing the principal geometric dimensions of the foot, to investigate how these measures vary with increasing weightbearing, and to explore the implications of weightbearing changes in pedal geometry for orthopedic footwear design and manufacture. The right feet of 40 healthy men aged 22 to 71 years were scanned using the Department of Veterans Affairs Pedorthics Optical Digitizer in neutral alignment, sequentially bearing 0%, 10%, 25%, 50%, and 100% of the subjects’ body weight. With support of the full body weight, the following mean changes in the pedal parameters were observed: heel-to-toe length, 1.5%; ball width, 4.3%; maximum heel width, 4.8%; and instep height, –9.3%. On average, 71% of the changes sustained in the pedal parameters at full weightbearing occurred when, or before, 25% of the body weight was applied. (J Am Podiatr Med Assoc 96(4): 330–343, 2006)
A Previously Unreported Etiology of Trigger Toe
Authors: Ozkan Korhan , Goksan Bora , Ozkan Feyza Unlu , Bilsel Kerem , Bilgic Bilge , Ciftci Feyyaz
Published: April 2014

Trigger toe is a rare entity, with only a few cases reported in the literature. It is usually seen in ballet dancers as a result of compression of the flexor hallucis longus tendon in the tarsal tunnel beneath the medial malleolus. We report a case of trigger toe due to a constricting lesion on the extensor hallucis longus tendon. (J Am Podiatr Med Assoc 96(4): 356–358, 2006)
Poststreptococcal Reactive Arthritis
Authors: Logan Daniel , McKee Patrick J.
Published: April 2014

Acute rheumatic fever is a delayed inflammatory disease that follows streptococcal infection of the throat. Poststreptococcal reactive arthritis is a sterile arthritis associated with antecedent streptococcal infection in patients not fulfilling the Jones criteria for acute rheumatic fever. Poststreptococcal reactive arthritis has been reported to have lower-extremity predominance and, therefore, should be included in the differential diagnosis of patients with lower-extremity arthritis. A review of the literature, distinguishing poststreptococcal reactive arthritis from acute rheumatic fever, and treatment options are discussed here. A case report is also presented. (J Am Podiatr Med Assoc 96(4): 362–366, 2006)
Sagittal Plane Range of Motion of the Pediatric Ankle Joint
Authors: Evans Angela M. , Scutter Sheila D.
Published: April 2014

Measurement of ankle dorsiflexion is a routine part of the podiatric examination of children, yet the reliability of this measure is largely unknown in healthy individuals. This study assessed the intrarater and interrater reliability of the first and second resistance levels of sagittal ankle range of motion in 4- to 6-year-old children. The results show that measures of ankle dorsiflexion in children are highly variable among examiners, and, in general, gastrocnemius range of motion is more reliable than soleal range of motion. (J Am Podiatr Med Assoc 96(5): 418–422, 2006)
Effects of Hallux Limitus on Plantar Foot Pressure and Foot Kinematics During Walking
Authors: Van Gheluwe Bart , Dananberg Howard J. , Hagman Friso , Vanstaen Kerstin
Published: April 2014

The effects of hallux limitus on plantar foot pressure and foot kinematics have received limited attention in the literature. Therefore, a study was conducted to assess the effects of limited first metatarsophalangeal joint mobility on plantar foot pressure. It was equally important to identify detection criteria based on plantar pressures and metatarsophalangeal joint kinematics, enabling differentiation between subjects affected by hallux limitus and people with normal hallux function. To further our understanding of the relation between midtarsal collapse and hallux limitus, kinematic variables relating to midtarsal pronation were also included in the study. Two populations of 19 subjects each, one with hallux limitus and the other free of functional abnormalities, were asked to walk at their preferred speed while plantar foot pressures were recorded along with three-dimensional foot kinematics. The presence of hallux limitus, structural or functional, caused peak plantar pressure under the hallux to build up significantly more and at a faster rate than under the first metatarsal head. Additional discriminators for hallux limitus were peak dorsiflexion of the first metatarsophalangeal joint, time to this peak value, peak pressure ratios of the first metatarsal head and the more lateral metatarsal heads, and time to maximal pressure under the fourth and fifth metatarsal heads. Finally, in approximately 20% of the subjects, with and without hallux limitus, midtarsal pronation occurred after heel lift, validating the claim that retrograde midtarsal pronation does occur. (J Am Podiatr Med Assoc 96(5): 428–436, 2006)
Elephantiasis Nostras Verrucosa
Authors: Yoho Robert M. , Budny Adam M. , Pea Anisa S.
Published: April 2014

Swelling of the leg is a frequent finding in podiatric medicine. Unless the patient draws notice to the condition or the physician is diligent in asking questions and examining the extremity, the condition may be viewed as minor and given little attention. Swelling of the leg can be a clinical sign of certain systemic diseases, lymphatic and venous disorders, or other miscellaneous causes. Dermatologic consequences linked to many of these causes of swelling are well documented. What is not as well chronicled is a dramatic skin alteration associated with chronic lymphedema. This article provides an overview and a case presentation of the unusual and debilitating skin condition related to chronic lymphedema of the lower extremity known as elephantiasis nostras verrucosa. (J Am Podiatr Med Assoc 96(5): 442–444, 2006)
Epidermal Inclusion Cyst in the Foot of a Vietnam Veteran
Authors: Hall Jeffrey P. , Sheffey Robert J. , Chagares William E. , Yong Raymond M.
Published: April 2014

Epidermal inclusion cysts are soft-tissue lesions that result from traumatic implantation of epidermal cells into the dermis. A case report is presented involving a large recurrent plantar inclusion cyst secondary to trauma sustained in the Vietnam War. The patient reported that the initiating trauma was the result of stepping on a punji stake in Vietnam. Punji stakes, sharpened spikes typically made of bamboo and dipped in poison or excrement, were used by the Vietnamese soldiers to wound enemy soldiers. Careful excision of the lesion is imperative to prevent recurrence. (J Am Podiatr Med Assoc 96(5): 445–447, 2006)
Use of Plantar Contact Area to Predict Medial Longitudinal Arch Height During Walking
Authors: McPoil Thomas G. , Cornwall Mark W.
Published: April 2014

A study was conducted to determine whether plantar surface contact area measures calculated from footprints collected during walking can be used to predict the height of the medial longitudinal arch. Thirty healthy women participated in the study. Arch height was determined by the distance from the navicular tuberosity to the floor and by the “bony” arch index. Dynamic plantar surface contact area was recorded using a pressure platform as the subjects walked across a 12-m walkway. The arch index and the total plantar surface contact area were determined from the pressure sensor data. The results indicated that plantar surface contact area could be used to estimate only approximately 27% of the height of the medial longitudinal arch as determined by navicular tuberosity height and the bony arch index. These findings demonstrate the inability of the clinician to predict the vertical height of the medial longitudinal arch on the basis of the amount of foot plantar surface area in contact with the ground during walking. (J Am Podiatr Med Assoc 96(6): 489-494, 2006)
Arthroplasty of the Interphalangeal Joint of the Great Toe Using Costal Osteochondral Grafting
Authors: Motomura Hisashi , Nose Kensuke , Fujiwara Masao , Ozawa Toshiyuki , Harada Teruichi , Muraoka Michinari
Published: April 2014

Although many reports have been published on the usefulness of costal cartilage grafting in the reconstruction of interphalangeal joints of fingers, there are only a few published reports on the reconstruction of interphalangeal joints of toes. We describe a 21-year-old woman with a tissue defect of the dorsum pedis and a partial defect of the interphalangeal joint of the great toe caused by a motor-vehicle accident. We attempted arthroplasty using a free latissimus dorsi myocutaneous flap and a costal osteochondral graft. The grafted rib and cartilage survived, allowing the patient to resume functional ambulation for day-to-day activities. Arthroplasty using costal osteochondral grafts seems to be an effective means of reconstructing the interphalangeal joints of toes. (J Am Podiatr Med Assoc 96(6): 508–512, 2006)
Effects of Foot Orthoses on Patients with Chronic Ankle Instability
Authors: Richie Douglas H.
Published: April 2014

Chronic instability of the ankle can be the result of mechanical and functional deficits. An acute ankle sprain can cause mechanical and functional instability, which may or may not respond to standard rehabilitation programs. Chronic instability results when there is persistent joint laxity of the ankle or when one or more components of neuromuscular control of the ankle are compromised. A loss of balance or postural control seems to be the most consistent finding among athletes with chronic instability of the ankle. Recent research in patients with acute and chronic ankle instability has revealed positive effects of foot orthoses on postural control. This article reviews the current research relevant to the use of foot orthoses in patients with chronic ankle instability and clarifies the suggested benefits and the shortcomings of these investigations. (J Am Podiatr Med Assoc 97(1): 19–30, 2007)
Achilles Tendon Sports Injuries
Authors: Werd Matthew B.
Published: April 2014

Achilles tendon injuries are among the three most frequent sports-related injuries of the foot and ankle. Proper function of the Achilles tendon is critical to performance in sports. A thorough knowledge of the anatomy and biomechanical function of this tendon is essential to the effective treatment of these injuries. Distinguishing among the various pathologies of the Achilles tendon is an important first step toward successful treatment and return of the athlete to sports activity. The term Achilles tendinitis is a nonspecific diagnosis that does not accurately describe an actual injury. This review is intended to provide the sports medicine physician with a means of classifying Achilles tendon injuries and, thus, arriving at an accurate diagnosis and treatment plan. (J Am Podiatr Med Assoc 97(1): 37–48, 2007)
Magnetic Resonance Imaging in the Evaluation of Sports Injuries of the Foot and Ankle
Authors: Riley Geoffrey M.
Published: April 2014

Magnetic resonance imaging is playing an increasingly important role in evaluation of the injured athlete’s foot and ankle. Magnetic resonance imaging allows accurate detection of bony abnormalities, such as stress fractures, and soft-tissue abnormalities, including ligament tears, tendon tears, and tendinopathy. The interpreter of magnetic resonance images should systematically review the images, noting normal structures and accounting for changes in soft-tissue and bony signal. (J Am Podiatr Med Assoc 97(1): 59–67, 2007)
Current Approaches to the Management of Plantar Heel Pain Syndrome, Including the Role of Injectable Corticosteroids
Authors: Pribut Stephen M.
Published: April 2014

Plantar heel pain syndrome, which has a multifactorial and widely disputed etiology, affects more than 2 million people annually. A survey was conducted of members of the American Academy of Podiatric Sports Medicine about their strategies for managing plantar heel pain syndrome, especially the role of injectable corticosteroids. The respondents tended to be experienced (10–24 years in practice) podiatric physicians with a concentration in sports medicine. They reported that for early-stage plantar heel pain syndrome they generally recommend avoidance of wearing flat shoes and walking barefoot (92%), use of over-the-counter arch supports and heel cushions (90%), regular stretching of the calf muscles (88%), strapping of the foot (75%), cryotherapy applied directly to the affected part of the foot (67%), and nonsteroidal anti-inflammatory drug therapy (60%). When these measures fail to relieve heel pain, most of the responding podiatric physicians recommend using custom orthotic devices (60%) and corticosteroid injections (60%) as intermediate therapy. Surgical plantar fasciotomy (88%), cast immobilization (77%), and extracorporeal shockwave therapy (69%) are generally recommended as late-stage therapy for resistant cases. A staged approach seems to yield the best results in treatment of this common condition. (J Am Podiatr Med Assoc 97(1): 68–74, 2007)
Return-to-Activity Levels in 96 Athletes with Stress Fractures of the Foot, Ankle, and Leg
Authors: Heaslet Michael W. , Kanda-Mehtani Sneh L.
Published: April 2014

Stress fractures of the foot and ankle are common in the athletic population. Because this population is especially eager to return to activity, such fractures can be challenging to treat. If the biomechanical faults are not addressed or gradual return to activity is not monitored appropriately, fractures occasionally recur. A retrospective analysis was conducted of 96 athletes who presented to a podiatric sports medicine practice over the course of 10 years with stress fractures confirmed by radiograph or bone scan. The most common type of fracture sustained by this population was tibial stress fracture, followed by second metatarsal fracture. Marathon training was the most common pre-injury activity overall, although fitness walking was the most common activity among those with metatarsal fractures. This study relates the most common types of stress fractures of the foot, ankle, and leg to certain athletic activities and correlates duration of symptoms before presentation with return-to-activity time. (J Am Podiatr Med Assoc 97(1): 81–84, 2007)
Prediction of Dynamic Foot Posture During Running Using the Longitudinal Arch Angle
Authors: McPoil Thomas G. , Cornwall Mark W.
Published: April 2014

Background: A study was conducted to determine whether the longitudinal arch angle can be used to predict dynamic foot posture during running.

Methods: Seventeen healthy, experienced runners participated in the study. The static longitudinal arch angle was determined from a digital image of the medial aspect of each subject’s feet obtained in relaxed standing posture. For the dynamic phase, subjects were asked to walk across a 12-m walkway and then to run across a 25-m runway while the medial aspect of each foot was videotaped. The longitudinal arch angle was digitized from the video images at midstance in walking and at midsupport while running for five trials per extremity.

Results: The longitudinal arch angle obtained in relaxed standing posture was highly predictive of dynamic foot posture at midstance in walking (r2 = 0.854) and at midsupport while running (r2 = 0.846).

Conclusions: The static measurement of longitudinal arch angle is highly predictive of dynamic foot posture during walking and running. The longitudinal arch angle measured in relaxed standing posture significantly contributed to explaining more than 85% of the variance associated with the longitudinal arch angle position at midstance during walking and at midsupport while running. These results seem to validate use of the longitudinal arch angle as part of the foot and ankle physical examination. (J Am Podiatr Med Assoc 97(2): 102–107, 2007)
Use of Quantitative Ultrasound Scans of the Calcaneus to Diagnose Osteoporosis in Patients with Rheumatoid Arthritis
Authors: Cryer Jacqueline R. , Otter Simon J. , Bowen Catherine J.
Published: April 2014

Background: Patients with rheumatoid arthritis are recognized as being at risk for osteoporosis as a result of the disease process as well as the medication used to treat it. This study was conducted to consider the use of calcaneal scanning with quantitative ultrasound—contact ultrasound bone analysis (CUBA)—to diagnose osteoporosis in patients with rheumatoid arthritis.

Methods: Forty-six patients (11 men and 35 women) with established rheumatoid arthritis underwent dual-energy x-ray absorptiometry (DEXA) of the nondominant wrist and CUBA of the nondominant heel. Sensitivity, specificity, and positive and negative predictive values were used to determine the correlation between osteoporosis as diagnosed by the CUBA heel scan compared with the DEXA wrist scan given that DEXA is widely seen as the gold standard for the diagnosis of osteoporosis.

Results: The CUBA heel scan revealed a sensitivity of 90% and a specificity of 44% for a diagnosis of osteoporosis compared with DEXA. The positive predictive value of the CUBA scan was 31%, and the negative predictive value was 94%. Therefore, if normal bone density is found using CUBA, there is 94% certainty this is correct. However, if osteoporosis is diagnosed using CUBA, there is only 31% certainty this is correct. In such instances a secondary scan using a different method (eg, DEXA) would be required. Future work should consider the effect of minor alterations to the equipment or scanning protocol, because this may improve diagnosis.

Conclusions: The CUBA unit could be used as a primary screening device. Given the cost and accessibility issues associated with DEXA, quantitative ultrasound may have a role in screening for osteoporosis in the primary-care setting to determine the most appropriate routes of referral for patients requiring further investigations. (J Am Podiatr Med Assoc 97(2): 108–114, 2007)
Posterior Bone Block for Footdrop
Authors: Kilicoglu Onder , Tozun I. Remzi
Published: April 2014

A posterior bone-block operation is one of the few treatment options in cases of paralytic footdrop. A case with a flail ankle and no bony deformity is ideal for this approach. Two cases of acquired flail ankle with equinus deformity were treated using a new modification of the bone-block technique that does not interfere with subtalar joint motion. A bone block harvested from the iliac crest was fixed at the posterior talus after partial resection of the posterior tubercle. The graft was in contact with the posterior malleolus of the tibia. Satisfactory correction was achieved, and both patients could walk without the use of external splints. (J Am Podiatr Med Assoc 97(2): 160–164, 2007)
Complications Associated with Distraction Osteogenesis for the Correction of Brachymetatarsia
Authors: Wilusz Peter M. , Van Phi , Pupp Guy R.
Published: April 2014

Background: Congenital brachymetatarsia is often treated with callus distraction. This technique is associated with a variety of complications. We investigated complications encountered in treatment of brachymetatarsia in four female patients and reviewed adjunctive procedures performed to treat these complications.

Methods: We reviewed five distraction osteogenesis procedures performed in four female patients with congenital shortening of the fourth metatarsal over a 3-year period. Serial radiographs were obtained weekly until bone consolidation was achieved, at which time the external fixator was removed. Follow-up ranged from 5 to 10 months.

Results: Three patients (four metatarsals) were satisfied with the cosmetic and functional outcomes of their procedure. One patient was dissatisfied with the cosmetic result owing to a short digit from a short proximal phalanx but was completely functional and resumed all of her normal activities. Complications associated with callus distraction were decreased range of motion and stiffness at the metatarsophalangeal joint, flexion deformity of the digit, angulation of the metatarsal, prolonged distraction time due to pain, fracture of the bone callus, pin-site infection, and an undesirable cosmetic appearance due to a short proximal phalanx. Adjunctive procedures were needed in some of these cases and yielded good results.

Conclusions: Callus distraction is an effective treatment for congenital shortening of the fourth metatarsal, but the procedure is associated with a number of complications. Because most patients proceed with surgery for cosmetic reasons, it is important to present the possible complications and the adjunctive surgical procedures that may be necessary for a desirable outcome. (J Am Podiatr Med Assoc 97(3): 189–194, 2007)
An Uncommon Presentation of Malignant Fibrous Histiocytoma of the Calcaneus
Authors: Demiralp Bahtiyar , Erler Kaan , Ozturan Engin Kutay , Bek Dogan , Ozdemir Taner , Kurt Bulent
Published: April 2014

Malignant fibrous histiocytoma of bone is the osseous counterpart of the tumor in soft tissue. It is a rare primary bone tumor, and there have been conflicting reports on its grades of malignancy. The appendicular skeleton, especially the femur, is the most common site of involvement, whereas the calcaneus is rarely involved. We describe a primary malignant fibrous histiocytoma of the calcaneal bone in a 21-year-old man. The patient underwent neoadjuvant and adjuvant chemotherapy and below-the-knee amputation, and no local recurrence or metastasis was noted after 2 years of follow-up. (J Am Podiatr Med Assoc 97(3): 218–222, 2007)
Negative-Pressure Wound Therapy and Diabetic Foot Amputations
Authors: Frykberg Robert G. , Williams David V.
Published: April 2014

Background: This study was undertaken to assess the benefits of negative-pressure wound therapy (NPWT) versus traditional wound therapies in reducing the incidence of lower-extremity amputations in patients with diabetic foot ulcers.

Methods: Administrative claims data for patients with diabetic foot ulcers from commercial payers (n = 3,524) and Medicare (n = 12,795) were retrospectively analyzed. Patients were divided into NPWT and control/traditional therapy groups on the basis of administrative codes. Risk-adjustment procedures were then performed to match patient risk categories (through total treatment costs) and wound severities (through debridement depth).

Results: The incidence of amputations in the NPWT groups was lower than that in the control groups. For the cost-based risk-adjustment analysis, amputation incidences with NPWT versus traditional therapy were 35% lower in the Medicare sample (10.8% versus 16.6%; P = .0077) and 34% lower in the commercial payer sample (14.1% versus 21.4%; P = .0951). Whereas overall amputation rates increased progressively with increasing wound debridement depth in both control groups, the same increasing trend did not occur in the NPWT groups.

Conclusions: Patients with diabetic foot ulcers in the Medicare sample treated with NPWT had a lower incidence of amputations than those undergoing traditional wound therapy; this finding was evident in wounds of varying depth in both populations studied. (J Am Podiatr Med Assoc 97(5): 351–359, 2007)
Anthropometric Foot Structure of Peripubescent Children with Excessive versus Normal Body Mass
Authors: Morrison Stewart C. , Durward Brian R. , Watt Gordon F. , Donaldson Malcolm D. C.
Published: April 2014

Background: A variety of musculoskeletal problems have been associated with excessive body mass in children, including structural foot problems.

Methods: Two hundred children aged 9 to 12 years were recruited to evaluate the effect of body mass on foot structure. Three reliable anthropometric measures were recorded: foot length, forefoot width, and navicular height.

Results: Following independent sample t test analysis of the data, significant differences were found for the three anthropometric variables when children with normal body mass were compared with those with excessive body mass. The research indicates that foot length and width increase with body mass, whereas navicular height drops.

Conclusions: Excessive body mass affects the discrete anthropometric structure of the peripubescent foot. With the growing concern about childhood obesity, further research is essential to develop a comprehensive understanding of the issues identified and to quantify the findings presented here. (J Am Podiatr Med Assoc 97(5): 366–370, 2007)
Painful Diabetic Peripheral Neuropathy
Authors: Smith Robert G.
Published: April 2014

Painful peripheral neuropathy is a common complication of diabetes mellitus that can affect almost every tissue of the body. In the absence of a curative therapy for this disorder, pharmacologic or nonpharmacologic tools, or a combination of both, can be used to provide relief of symptoms. This article reviews medications currently used to manage painful diabetic neuropathy. The pathogenesis of painful diabetic neuropathy is described as a basis for understanding medication selection. The literature describing the pharmacologic properties of medications used to treat painful diabetic neuropathy is also reviewed. Comparisons of medication dosages, frequencies, and adverse effects are offered to help with selection of the most appropriate agent for each individual patient. (J Am Podiatr Med Assoc 97(5): 394–401, 2007)
Negative-Pressure Wound Therapy and External Fixation for Infection and Hematoma After Hallux Abducto Valgus Surgery
Authors: Ferdinando Edward , Guerin Laura , Jervis Aluko O. , Obidigbo Henrietta
Published: April 2014

Hematoma refers to the collection or extravasation of blood, usually clotted, in a closed tissue space. It is caused by leakage from local vessels damaged by blunt trauma, local injury, or surgical dissection. In the postoperative phase, a hematoma often results in edema, pain, wound dehiscence, infection, and scarring of the surgical wound. We describe a 44-year-old woman who developed severe complications, including hematoma, abscess, failure of internal fixation, and loss of soft-tissue structures, after hallux abducto valgus surgery. Hospitalization was required for infection control, soft-tissue coverage through negative-pressure wound therapy, and first metatarsophalangeal joint stabilization through external fixation. Early recognition of the signs of infection and hematoma can help decrease the incidence of postoperative complications. (J Am Podiatr Med Assoc 97(5): 410–414, 2007)
Modified Youngswick Procedure for Hallux Limitus
Authors: Radovic Philip , Yadav-Shah Ekta , Choe Ki
Published: April 2014

Multiple surgical procedures have been described for the correction of hallux limitus deformity. We describe a new modification of the Youngswick procedure for the surgical treatment of hallux limitus. Other procedures for hallux limitus correction are also discussed. This modified Youngswick procedure will provide a new approach to treating hallux limitus secondary to metatarsus primus elevatus when shortening of the first metatarsal is not indicated. (J Am Podiatr Med Assoc 97(5): 420–423, 2007)
Effect of Cryotherapy Devices in the Postoperative Setting
Authors: Shibuya Naohiro , Schinke Theresa L. , Canales Michael B. , Yu Gerard V.
Published: April 2014

Background: Sophisticated methods of cryotherapy, such as application of a water-circulating device, have recently been popularized to provide a constant or intermittent therapeutic source in the foot and ankle postoperative setting. In this study, the efficacy and safety of three selected cryotherapy devices (Iceman, EBIce, and Ankle Cryo/Cuff) were investigated.

Methods: Each cryotherapy unit, in the coldest setting, was applied over standard surgical dressings in group I, over one layer of Jones compression bandage in group II, and over two layers of Jones compression bandage in group III on four individuals in excellent overall health. The skin temperature was then recorded every 15 min for 180 min in each trial.

Results: In group I, the Iceman was the only device that required discontinuation in one subject, and the EBIce and Cryo/Cuff were tolerated in all of the subjects. However, the temperatures in all of the devices continued to decrease at the end of the trials. In group II, all of the cryotherapy devices controlled temperatures between 20°C (68°F) and 30°C (86°F). In group III, no device significantly lowered the initial surface skin temperature.

Conclusions: We achieved the safe and effective temperature range when the cryotherapy devices were applied over one layer of Jones compression dressing. The cryotherapy devices resulted in less predicable temperature declination when applied over the thinner surgical dressing. When the devices were applied over two layers of Jones compression dressing, surface skin temperature declination was minimal. (J Am Podiatr Med Assoc 97(6): 439–446, 2007)
Effects of Three- or Four-Cortex Syndesmotic Fixation in Ankle Fractures
Authors: Karapinar Hasan , Kalenderer Onder , Karapinar Levent , Altay Taskin , Manisali Metin , Gunal Izge
Published: April 2014

Background: There is no study comparing how Weber type C ankle fractures treated with either three- or four-cortex syndesmotic fixation affects the structure of the syndesmosis.

Methods: In a retrospective study, 46 patients were separated into two groups: 22 patients with three-cortex fixation and 24 patients with four-cortex fixation. All of the patients were evaluated clinically and radiographically at least 1 year after removal of the syndesmosis screws.

Results: There were three types of joint space obliteration: type 1, synostosis on plain radiographs; type 2, an incomplete bony bridge on magnetic resonance imaging with normal plain radiographs; and type 3, fibrous obliteration of the joint space. Although obliteration of the joint space was significant (P < .005) after four-cortex fixation, radiologic results did not affect the clinical outcome.

Conclusion: Four-cortex fixation for diastasis after an ankle fracture should not be a routine procedure. We advocate three-cortex fixation because the clinical results are no different and there is less syndesmotic space obliteration postoperatively. (J Am Podiatr Med Assoc 97(6): 457–459, 2007)
Lateral Plantar Artery Aneurysm
Authors: Agarwal Monica , Harkless Lawrence , Hagino Ryan T. , Toursarkissian Boulos
Published: April 2014

We report a case of a true plantar artery aneurysm in an adult. True aneurysms of the inframalleolar vessels are rare. The limited literature on the subject is reviewed, including differential diagnosis and suggested treatment. (J Am Podiatr Med Assoc 97(6): 480–482, 2007)
Internet Resources for Podiatric Medical Students
Authors: Fikar Charles R. , Nguyen Scott H.
Published: April 2014

In this article, we present a selection of Internet resources covering subject areas found in standard medical education curricula. Basic sciences and clinical resource sites are explored. We also review Web sites that offer useful materials that can be downloaded to handheld devices such as palmtop computers, smartphones, and portable media players. We judged the sites based on their potential to enhance the learning process, provide practice questions or study guides for examinations, or aid in the preparation of manuscripts. Medical students, residents, educators, and practitioners of podiatric medicine and surgery who require a quick reference source to either the basic science foundations of podiatric medicine or the clinical side of basic medicine, may find this paper useful. (J Am Podiatr Med Assoc 97(6): 486–492, 2007)
Static Response of Maximally Pronated and Nonmaximally Pronated Feet to Frontal Plane Wedging of Foot Orthoses
Authors: Pascual Huerta Javier , Ropa Moreno Juan Manuel , Kirby Kevin A.
Published: April 2014

Background: Research on foot orthoses has shown that their effect on the kinematics of the rearfoot is variable, with no consistent patterns of changes being demonstrated. It has also been hypothesized that the mechanical effect of foot orthoses could be subject specific. The purpose of our study was to determine if maximally pronated feet have a different response to frontal plane wedging of foot orthoses than do nonmaximally pronated feet during static stance.

Methods: One hundred six feet of 53 healthy asymptomatic subjects were divided into two groups (maximally pronated and nonmaximally pronated) on the basis of their subtalar joint rotational position during relaxed bipedal stance. Functional foot orthoses were constructed for each subject and the relaxed calcaneal stance position was measured while standing on five separate frontal plane orthosis wedging conditions, 10° valgus, 5° valgus, no wedging, 5° varus, and 10° varus, to assess changes in calcaneal position.

Results: Relative to the no-wedging condition, there were statistically significant differences (P < .05) in calcaneal position between the maximally pronated and the nonmaximally pronated feet with the 10° valgus and the 10° varus wedging conditions. No significant differences in calcaneal position were found with the 5° varus and the 5° valgus wedging conditions.

Conclusions: Our study shows that the response to foot orthoses is variable between individuals. Maximally pronated subjects do not exhibit the same response to frontal plane wedging of foot orthoses as do nonmaximally pronated with 10° wedging. Intrinsic biomechanical factors such as subtalar joint position may influence the response to foot orthoses. (J Am Podiatr Med Assoc 99(1): 13–19, 2009)
Ability of Foot Care Professionals to Cast Feet Using the Nonweightbearing Plaster and the Gait-Referenced Foam Casting Techniques
Authors: Trotter Leslie C. , Pierrynowski Michael Raymond
Published: April 2014

Background: We examined the ability of foot care professionals to consistently capture the forefoot-to-rearfoot angular relationship of a single-cast foot.

Methods: Eleven Canadian certified pedorthists each cast a single foot twice using the plaster of Paris and foam box techniques. Three independent raters subsequently measured the resultant casts. Statistical analysis of the data provided generalizability coefficient estimates (ρ2) of the intracaster, intercaster, and rater reliabilities.

Results: Intracaster reliabilities were excellent when the plaster and foam box techniques were used (ρ2 = 0.831 and 0.939, respectively). The casters were more intrareliable when foam was used (F = 2.755, P = .003). Intercaster reliabilities were poor for both techniques (ρ2 = 0.410 and 0.425). Although, intrarater reliability was excellent (ρ2 = 0.882), interrater reliability was poor (ρ2 = 0.418).

Conclusion: Although plaster of Paris casting is widely perceived by the foot care community as the gold standard, other casting techniques may prove to be equally reliable. (J Am Podiatr Med Assoc 98(1): 14–18, 2008)
Functional Outcome of Meniscal-Bearing Total Ankle Replacement
Authors: Benedetti Maria Grazia , Leardini Alberto , Romagnoli Matteo , Berti Lisa , Catani Fabio , Giannini Sandro
Published: April 2014

Background: Most clinical studies on total ankle replacement (TAR) report assessments based on traditional clinical scores or radiographic analysis. Only a few studies have used modern instrumentation for quantitative functional analysis during the execution of activities of daily living. The aim of this study was to use gait analysis to compare the functional performance of patients who underwent TAR versus a control population.

Methods: A retrospective analysis was performed of ten consecutive patients who had undergone meniscal-bearing TAR. Clinical and functional assessments were performed at a mean follow-up of 34 months with a modified Mazur scoring system and state-of-the-art gait analysis.

Results: Gait analysis assessment of TAR at medium-term follow-up showed satisfactory results for all patients, with adequate recovery of range of motion. Because the literature reports unsatisfying long-term results, it is important to evaluate these patients over a longer follow-up period.

Conclusions: This study showed that TAR yields satisfactory, but not outstanding, general functional results at nearly 3 years’ follow-up. These gait analysis results highlight the importance of integrating in vivo measurements with the standard clinical assessments of patients who underwent TAR while they perform activities of daily living. These results also emphasize the importance of evaluating the functional outcome of TAR over time. (J Am Podiatr Med Assoc 98(1): 19–26, 2008)
Effect of Coexisting Foot Deformity on Disability in Women with Knee Osteoarthritis
Authors: Guler Hayal , Karazincir Sinem , Turhanoglu Ayse Dicle , Sahin Gunsah , Balci Ali , Ozer Cahit
Published: April 2014

Background: Knee osteoarthritis, a common musculoskeletal disorder, can cause considerable pain and disability. This study investigates the effect of certain foot deformities on the functional status of women with knee osteoarthritis.

Methods: The common foot deformities pes planus and hallux valgus were evaluated in 115 women with knee osteoarthritis and Kellgren-Lawrence grade 2 and 3 osteoarthritis. Anteroposterior and lateral foot-ankle standard radiographs were obtained bilaterally. A lateral talometatarsal angle greater than 4° was defined as pes planus. A hallux valgus angle greater than 21° was defined as hallux valgus. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) was used to objectively assess functional impairment. Knee pain intensity was measured with a visual analog scale.

Results: Fifty-nine patients had bilateral pes planus, hallux valgus, or both. The mean visual analog scale value was higher for the deformity group, but the difference was not statistically significant. There was a significant difference in WOMAC scores between the group with foot deformities versus the group without (P = .000). Visual analog scale scores were positively correlated with WOMAC scores (r = 0.499, P = .000). Also, there was a significant correlation between WOMAC scores and lateral talometatarsal angle (r = 0.266, P = .004) and hallux valgus angle (r = 0.362, P = .000) values.

Conclusions: There is a significant correlation between indicators of pain and disability (visual analog scale and WOMAC scores). Also, the presence of foot deformities increased disability levels in women with knee osteoarthritis. (J Am Podiatr Med Assoc 99(1): 23–27, 2009)
Metatarsal Protrusion Angle
Authors: Domínguez Gabriel , Munuera Pedro V. , Lomas Mercedes
Published: April 2014

Background: We performed an adaptation of the system of evaluation of metatarsal protrusion described by Oller in 1994 to study the metatarsal parabola group.

Methods: The system of measurement was applied to the five metatarsals of 169 normal feet (72 feet of women and 97 feet of men) according to the inclusion criteria established.

Results: The mean ± SD metatarsal protrusion angle with respect to the second ray in women was 87.49° ± 5.48° for metatarsal I, 70.00° ± 5.74° for metatarsal III, 63.47° ± 4.17° for metatarsal IV, and 56.38° ± 3.27° for metatarsal V. In men, the values were 85.30° ± 6.75° for metatarsal I, 68.00° ± 6.72° for metatarsal III, 60.56° ± 4.61° for metatarsal IV, and 54.13° ± 3.75° for metatarsal V. The comparative analysis between women and men showed significant differences (P < .05) for all of the values of metatarsal protrusion.

Conclusions: The comparative analysis between women and men indicates a possible difference between the anthropometric values of these variables in humans, suggesting a possible repercussion on the biomechanical patterns by sex. (J Am Podiatr Med Assoc 99(1): 49–53, 2009)
Bilateral Stress Fractures of the Distal Fibula in a Woman with Osteoporosis
Authors: Kazimoglu Cemal , Karapinar Hasan , Sener Muhittin , Bozkurt Attila
Published: April 2014

Bilateral stress fractures of the fibula are very rare. We present an unusual case report of a 54-year-old osteoporotic woman with bilateral stress fractures involving the distal fibula. After conservative treatment, she made a good recovery with full motion and was free of pain. (J Am Podiatr Med Assoc 99(1): 61–64, 2009)
Synovial Osteochondromatosis Involvement in Post-traumatic Ankle Injury
Authors: Lee Daniel K. , Louk Louis , Bell Bryan L.
Published: April 2014

Ankle involvement by synovial chondromatosis is unusual. It is unknown whether a post-traumatic event to the ankle induces the formation and development of these lesions. Synovial osteochondromatosis associated with post-traumatic ankle events are rare but suggest trauma to the synovial tissues as being causative, although this has never been statistically confirmed owing to the lack of reports and frequency. We report a case of primary synovial osteochondromatosis involving the tibiotalar joint with painful symptoms after a history of ankle injury, including magnetic resonance imaging findings of this unusual condition. (J Am Podiatr Med Assoc 98(1): 70–74, 2008)
An Appraisal of Potential Drug Interactions in Cigarette Smokers and Alcohol Drinkers
Authors: Smith Robert G.
Published: April 2014

Background: Many health-care providers may overlook or be unaware of most drug-to-drug interactions. Recognizing the existence of drug interactions with cigarette smoking and alcohol ingestion can empower a clinician with knowledge to avoid dangerous interactions that may result in hazardous, negative patient outcomes. Cigarette smoking and alcohol use can reduce the efficiency of certain drugs or make drug therapy more unpredictable.

Methods: This review offers the physician information regarding prescription drug interactions with cigarette smoking and alcohol use. First, mechanisms found in the medical literature of potential drug interactions in cigarette smokers and alcohol drinkers are presented. Second, the 100 most frequently prescribed medications in 2006 are reviewed regarding cigarette smoking effects and alcohol effects as cited in the medical literature. Lastly, a table of these 100 medications and any reported effects of cigarette smoking or alcohol consumption on each drug is provided.

Results: The actual number of different medications reviewed was 78. Drug interactions resulting from the effects of cigarette smoking occurred with 33.3% of the drugs (n = 26), and drug interactions resulting from the effects of alcohol consumption occurred with 76.9% of the drugs (n = 60). Finally, resource information regarding smoking cessation and alcohol abuse recovery is summarized so that physicians may empower their patients to avoid potential drug-interaction events.

Conclusions: Cigarette smoke and alcohol may interact with medications through pharmacokinetic or pharmacodynamic mechanisms. Engaging in both of these social activities can reduce the efficiency of certain drugs or can make drug therapy unpredictable. This review offers the health-care provider information regarding potential prescription drug interactions. Empowered with this information, clinicians may assist their patients to maximize pharmacologic outcomes by avoiding these reported harmful interactions. (J Am Podiatr Med Assoc 99(1): 81–88, 2009)
Arch Height Index Measurement System
Authors: Butler Robert J. , Hillstrom Howard , Song Jinsup , Richards Christine J. , Davis Irene S.
Published: April 2014

Background: The purposes of this study were 1) to determine the intrarater and interrater reliability of the arch height index measurement system device, 2) to establish population normative values for the arch height index in recreational runners, and 3) to compare arch height index values between the right and left feet and between genders.

Methods: Eleven subjects were used to establish intrarater and interrater reliability of the arch height index measurement system. This system was then used to measure the arch height index of 100 recreational runners.

Results: Measurements taken with the arch height index measurement system device exhibited high intrarater and interrater reliability. The mean ± SD arch height index of the recreational runners was 0.340 ± 0.030. Men had larger feet than women, but the arch height index between genders was similar.

Conclusions: The arch height index measurement system device is reliable to use between testers while simplifying the measurement procedure for recording the arch height index. The arch height index may be helpful in identifying potential structural factors that predispose individuals to lower-extremity injuries. (J Am Podiatr Med Assoc 98(2): 102–106, 2008)