bluuebunny/crossref_metadata_2025 huggingface dataset:
Austin bunionectomy with 3M Staplizer fixation. An assessment of 20 cases
Authors: DeFronzo DJ , Landsman AR , Landsman AS , Stern SF
Published: April 2014

The authors describe a new approach to Austin bunionectomy fixation using the 3M Staplizer. Twenty cases are examined retrospectively for various postoperative results. The Staplizer technique is compared and contrasted to other modes of fixation that are described in the literature. The authors suggest that internal fixation with the Staplizer provides decreased risk of infection, early ambulation, high patient acceptance, and fewer complications. A detailed description of the technique used to insert the staples is presented, and mechanical analysis of the osteotomy and optimal staple position are discussed.
Current perception threshold in evaluating foot pain. Two case presentations
Authors: Hill RS , Lawrence A
Published: April 2014

Two cases are reported in which patients presented with complaints of foot pain, and a clinical suspicion of radiculopathy was supported by current perception threshold testing. Chiropractic manipulation of the lumbar spine resulted in alleviation of the lower extremity symptoms. Current perception threshold testing is a valuable neurologic testing modality that is noninvasive, nonaversive, and highly reliable for evaluation of sensory nerves where neuropathy is suspected. This technology has been described for evaluation of diabetic neuropathy, uremic screening, and alcohol and chemical toxicity. Additionally, current perception threshold is useful for evaluation of other neuropathies, such as carpal tunnel syndrome and other entrapment neuropathies. The authors encourage further investigation of this modality in the diagnosis and evaluation of peripheral neuropathy and unexplained foot pain secondary to spinal nerve impingement.
Use of thermography for initial detection of early reflex sympathetic dystrophy
Authors: Karstetter KW , Sherman RA
Published: April 2014

Reflex sympathetic dystrophy is one of a complex of overlapping, sympathetically maintained pain syndromes which are usually initiated by a minor injury that resolves quickly but leaves behind a persistent pain that generalizes to much or all of the limb. The pathophysiology of reflex sympathetic dystrophy is reviewed to show that the pain is accompanied by cooling of the limb, beginning with the distal end and gradually progressing throughout. Thermography is shown to be an effective way to monitor near-surface blood flow in the limbs and to be sensitive to changes accompanying painful conditions. The usefulness of this technique for early detection of reflex sympathetic dystrophy is demonstrated and illustrated with several examples.
Neurologic involvement of multiple myeloma. Literature review and case report
Authors: Sidoti SP , Cherpack FJ
Published: April 2014

A case of malignancy and resultant lower extremity neuropathy is presented. Although not a common cause of such neuropathy, a search should be made for underlying malignancy when more common causes have been ruled out. Early diagnosis and treatment may decrease morbidity and mortality.
Postural sway following inversion sprain of the ankle
Authors: Cornwall MW , Murrell P
Published: April 2014

The single-limb sway of 20 individuals with a history of unilateral inversion ankle sprain was compared to that of a control group of 30 individuals without a history of ankle sprain. Using a force platform to obtain center-of-pressure data, the linear distance traveled (mm) and the mean power frequency, (Hz) of postural sway were calculated for each subject. The results of this study showed that postural sway amplitude was significantly greater in the injured group than in the control group. Contrary to previous investigations, this study indicates that individuals with a history of inversion ankle sprain are less stable in single-limb stance compared to a noninjured control group. This decreased stability is evident as much as 2 years following the injury.
Dynamic pressure analysis of the diabetic charcot foot
Authors: Wolfe L , Stess RM , Graf PM
Published: April 2014

Charcot foot is a form of neuropathic osteoarthropathy, occurring in one or more joints of the foot and ankle. It is a destructive process that alters the weightbearing areas of the foot and, in many cases, results in a rocker-bottom deformity. The authors present quantitative results of dynamic pressure analysis of Charcot foot with the EMED SF pressure analysis system and propose ways in which this information may be used in the evaluation and treatment of this deformity.
Nail matrixectomies using radio wave technique
Authors: Hettinger DF , Valinsky MS , Nuccio G , Lim R
Published: April 2014

The authors present a successful method for surgically correcting ingrown toenails by using radio wave technique. A review of the literature is also presented.
Torsional development of the lower extremity. Implications for in-toe and out-toe treatment
Authors: Cohen-Sobel E , Levitz SJ
Published: April 2014

The authors provide a comprehensive review of the nature, origins, and natural history of torsion of the lower extremity. Norms for children and adults are discussed, along with implications for treatment.
Skin and superficial fascia of the foot
Authors: Bressler RS , Bressler CH
Published: April 2014

The authors provide a brief review of the structure of the skin in general and the specializations of the plantar skin and superficial fascia. This review is intended to provide a basis from which the reader can interpret any relevant data in other papers on anatomy and to direct the reader to a variety of more detailed references.
Traumatic osteoarthrosis of the ankle joint secondary to ankle fractures
Authors: Walter JH , Spector A
Published: April 2014

Arthritis, in one form or another, is one of the most common disorders that affect man. Whether the etiology is systemic, neurologic, or traumatic, the one common finding is the destruction of joint cartilage. Although there have been massive amounts of literature concerning osteoarthritis, little has been written about arthritis of the ankle joint. Current concepts in the pathology, terminology, symptomatology, and treatment of the arthritic ankle are discussed.
Orthotic effect on metatarsophalangeal joint extension. A preliminary study
Authors: Kilmartin TE , Wallace WA , Hill TW
Published: April 2014

The authors evaluated the effect of modified Root orthoses on first metatarsophalangeal joint extension. Motion within the joint was measured dynamically following the insertion of bone markers into the first metatarsal and the hallux. Extension at the joint was greatest when the subjects were barefoot, the mean angle being 62 degrees. Plimsolls restricted extension of the joint to a mean angle of 57 degrees, while orthoses further reduced the angle of metatarsophalangeal joint extension to a mean angle of 55 degrees. The marginal reduction in first metatarsophalangeal joint extension caused by functional orthoses may be of therapeutic value in the early stages of hallux rigidus, when restricting motion at the joint may slow or prevent development of subchondral sclerosis.
TL-61 versus Rohadur orthoses in heel spur syndrome
Authors: Ferguson H , Raskowsky M , Blake RL , Denton JA
Published: April 2014

The authors present the subjective responses of 40 patients with heel spur syndrome or plantar fascitis to orthotic treatment. Twenty patients had Rohadur orthoses and 20 patients had TL-61 orthoses. These data show no difference in the response to or problems created by either TL-61 or Rohadur orthoses. The authors recommend TL-61 as one alternative to Rohadur, now that that latter is unavailable.
Isolation of a stimulatory system in an Aloe extract
Authors: Davis RH , Parker WL , Samson RT , Murdoch DP
Published: April 2014

The authors' previous work on a 50% ethanol extract of Aloe vera was done to evaluate anti-inflammatory activity using the croton oil-induced ear swelling assay. The anti-inflammatory activity was found in the supernatant fraction. The supernatant fraction decreased inflammation, when applied topically, by 29.2%, and the precipitate decreased inflammation by 12.1%. However, in the present work, the precipitate fraction decreased the wound diameter by an average of 47.1% (stimulatory system). Little or no wound healing activity was found in the supernatant. Aloe vera appears to act as a modulatory system toward wounds and inflammation and is a potentially valuable tool for managing lower extremity conditions.
Achilles tendon rupture. A protocol for conservative management
Authors: Blake RL , Ferguson HJ
Published: April 2014

The authors discuss surgical versus conservative management of closed Achilles tendon ruptures. They favor a conservative approach in most cases and present arguments to support this preference. They present a protocol for conservative management of closed Achilles tendon ruptures, which has been developed at the Center for Sports Medicine, Saint Francis Memorial Hospital, San Francisco.
Charcot-Marie-Tooth disease. Podiatric and systemic considerations
Authors: Barry LD , Fluellen J
Published: April 2014

Charcot-Marie-Tooth disease is a hereditary motor and sensory neuropathy with well documented manifestations in the extremities. Recent literature suggests systemic involvement in this neuropathy. The authors present a review of the literature, anesthetic considerations, and practical recommendations for the assessment of involved systems.
Intraosseous lipoma of the calcaneus. A case report
Authors: Boylan JP , Springer KR , Halpern FP
Published: April 2014

The intention of this report is to heighten the practitioner's clinical suspicion of intraosseous lipoma of the calcaneus. The apparent infrequency of this diagnosis may be attributed to the dependence on radiographic evaluation and the use of closed needle biopsy. Thus, to make a proper diagnosis, a computed tomography scan with the rate of attenuation and, ultimately, a large tissue biopsy with attentive gross and microscopic examination are necessary.
The stepped cuboid
Authors: Shoemaker SK , Sinclair GG
Published: April 2014

The authors review a case presentation of a symptomatic cuboid metatarsal joint anomaly and discuss possible treatments, both conservative and surgical. The patient was treated conservatively and had some relief of symptoms.
Clinical determination of the linear equation for the subtalar joint axis
Authors: Phillips RD , Lidtke RH
Published: April 2014

The authors present a methodology to measure the frontal plane angular and linear displacement and the transverse plane angular displacement of subtalar joint movement. This method is combined with a modification of the Kirby method for determining the transverse plane projection of the subtalar joint axis onto the plantar foot. A mathematical model is then used to construct the subtalar joint axis into a three-dimensional linear equation. Data are obtained from an in vivo series of 62 feet that indicates that within acceptable clinical errors of measurement the subtalar joint is a ginglymus type of joint that moves around a single fixed axis. Results also indicate that the subtalar joint axis is more superior and lateral to the neutral foot than any previous studies on cadaver feet have shown. Finally, the authors show that once the subtalar joint axis can be accurately located, the torque on the joint axis produced by ground reactive forces and muscular forces can be computed.
Opioid receptor affinity for agonist-antagonist analgesics
Authors: Jacobs AM , Youngblood F
Published: April 2014

Analgesic medications are distributed to a variety of receptors within the central nervous system. Activity at these receptors (mu 1, mu, sigma, delta, kappa) results in both the beneficial pain-relieving effects of analgesics as well as undesirable side effects. The mixed agonist-antagonist class of analgesics offers the potential benefit of greater receptor site selectivity while diminishing the incidence of adverse sequelae, such as respiratory depression. Traditionally, it has been suggested that mixed agonist-antagonist medications may be associated with decreased analgesic effectiveness. However, newer agents of this mixed class may result in effective analgesia while diminishing the incidence of side effects.
Epidermal inclusion cysts following minimal incision surgery
Authors: Farrer AK , Forman WM , Boike AM
Published: April 2014

One of the most frequent causes of epidermal inclusion cysts is trauma involving the epidermis with subsequent implantation of epidermal cells into the dermis or subcutis. Minimal incision surgery is capable of achieving this because it is performed by using small incisions and rapidly rotating power instruments. The technique requires that the surgeon master a high degree of dexterity and knowledge of the anatomy without the aid of direct visualization. Van Enoo and Cane suggest the use of fresh, sharp skin blades to protect against invagination of skin edges which could lead to epidermal inclusion cysts. They also state that an improper position or an incision that is too small will cause tension, which can lead to heat buildup with subsequent sloughing and dehiscence. It may also drive some epidermal cells underneath the dermis and foster an epidermal cyst. Other surgeons using small incisions suggest thorough and copious irrigation to flush away debris and to avoid potential foreign body reactions. The periosteum should be reflected away from the point where the drill bit exits the bone to prevent bone chips from being forced subperiosteally and potentially causing a foreign body reaction. By virtue of the technique, minimal incision surgery lends itself to a greater risk of causing epidermal inclusion cysts. Surgeons who use these techniques must be aware of this potential complication.
Perspectives on entry level residency training in podiatric medicine
Authors: Udris E
Published: April 2014

The author presents information related to the structures of medical and podiatric residency training and statistical information regarding entry level residency positions in approved podiatric residency programs. The results of surveys of residency directors (1989 and 1990) and the residency community of interest (1990) conducted by the Council on Podiatric Medical Education are reported. Specific findings from the surveys indicated the desirability of establishing training sequences consisting of rotating podiatric residencies followed by specialty training programs but identified significant difficulties related to implementation.
Plethysmography. A treatise on its evolution, differential methodology and clinical utilization. 1973
Authors: Feldman MH , Buffington ME
Published: April 2014

Plethysmography is the observation and use of volume changes in physiologic entities. The most influential short-term effect is caused by the pulsatile flow of blood. Attempts to convert these pulsatile volume changes into minimum required blood flow per unit of time have been successful clinically. Plethysmography can be accomplished by encapsulating digits, limbs and entire bodies. Volume changes in the member cause volume changes in the fixed chamber which then influences an observational medium. Plethysmography can also be accomplished with a strain gauge, direct application of electricity to flesh, changing opacity effects on tissue, ultrasound (the Doppler effect) or the piezoelectric method. The piezoelectric plethysmograph was successfully tested on 55 patients.
The effects of local anesthetics containing epinephrine on digital blood perfusion. 1978
Authors: Green D , Walter J , Heden R , Menacker L
Published: April 2014

Digital perfusion research was conducted with two local anesthetics, lidocaine and bupivacaine. The studies were performed utilizing both anesthetic agents, plain and with various concentrations of epinephrine. The drugs' effects on blood perfusion over a 24-hr. period were recorded and discussed. The onset and duration of anesthesia were also compared.
Aloe vera and the inflamed synovial pouch model
Authors: Davis RH , Stewart GJ , Bregman PJ
Published: April 2014

Administration of air under the skin produced a pouch wall that closely resembled a synovium in that the inner lining was made up of macrophages and fibroblasts. Administration of 1% carrageenan directly into the 7-day-old air pouch produced an inflammation characterized by an increased number of mast cells in pouch fluid as well as an increase in wall vascularity. A punch biopsy weight of the pouch wall did not reveal an increase in 1% carrageenan-treated animals. However, a 10% Aloe vera treatment of carrageenan-inflamed synovial pouches reduced the vascularity 50% and the number of mast cells in synovial fluid 48%. The pouch wall punch biopsy weight was increased by A. vera, which was verified by histologic examination of the inner synovial lining. Aloe vera stimulated the synovial-like membrane, as evidenced by an increased number of fibroblasts, suggesting that A. vera stimulated fibroblasts for growth and repair of the synovial model. The synovial air pouch can be used to study simultaneously the acute anti-inflammatory and fibroblast stimulating activities of A. vera.
The os trigonum syndrome. A literature review
Authors: Blake RL , Lallas PJ , Ferguson H
Published: April 2014

The os trigonum syndrome, a musculoskeletal ankle disorder causing posterior ankle pain, is an entity that may present as numerous disorders. To accurately diagnose and treat the syndrome, its anatomy, origin, nomenclature, and biomechanics must be thoroughly understood. For this purpose, a review of recent literature is presented.
The medial heel skive technique. Improving pronation control in foot orthoses
Authors: Kirby KA
Published: April 2014

A new method of foot orthosis modification that enhances the pronation controlling ability of foot orthoses is presented. The medial heel skive technique involves selectively removing small amounts of the medial portion of the plantar heel of the positive cast of the foot to create a unique varus wedging effect within the heel cup of the foot orthosis. The resulting increase in supination moment across the subtalar joint axis of the foot clinically produces significantly improved pronation control on pediatric flexible flat feet, posterior tibial dysfunction, and other types of excessively pronated feet.
Giant cell tumor of the intermediate cuneiform. A case report
Authors: Dunn EC , Mauro G , Cohen R
Published: April 2014

Although it has yet to be determined which surgical procedure provides the least chance for recurrence, surgical treatment remains the preferred therapy for giant cell tumors of bone. Few cases of giant cell tumor of the tarsus have been reported in the literature, with less than 10 of these cases occurring in the cuneiforms. When the extent of the tumor is questionable, definitive radiologic techniques should be used to aid in the selection of the most appropriate surgical procedure. Follow-up radiographic examination is critical to ensure that the patient remains tumor free. Yearly chest x-rays are recommended to rule out pulmonary metastasis. Although giant cell tumors represent only 5% to 8% of all benign primary osseous neoplasms of the foot, they have the potential to undergo malignant transformation, increasing the morbidity and mortality to the patient. Giant cell tumors of bone are locally aggressive, often occurring adjacent to articular surfaces, and usually are large when diagnosed. It is essential for the surgeon to plan a treatment that not only minimizes the chance of recurrence, but also attempts to preserve function of the involved part.
CCPM and podiatric medical education. Preparing for the 21st century
Authors: Oloff LM
Published: April 2014

There are many changes on the horizon that will affect how we teach the future practitioners of podiatric medicine. The author describes the processes undertaken to date at the California College of Podiatric Medicine (CCPM), as well as the vision of tomorrow, for podiatric medical education. The educational system that will result from these changes will be more efficient; it will better meet the needs of students; and, it will broaden their base of knowledge, all to improve care given to the patient.
Warfarin sodium. Practitioner beware
Authors: Bernard JM , Black JR , Kokseng CU , Covey DF
Published: April 2014

The use of warfarin sodium in the US has increased dramatically over the last 40 years. Warfarin sodium or Coumadin is the most popular oral anticoagulant used in the US. The podiatric physician frequently encounters patients taking this agent and therefore needs to understand its potential impact. This article will familiarize the reader with the history, pharmacology, clinical applications, side effects, and frequent drug interactions encountered with warfarin sodium.
Effect of rearfoot posts in reducing forefoot forces. A single-subject design
Authors: Cornwall MW , McPoil TG
Published: April 2014

The purpose of this study was to assess the effectiveness of a semirigid foot orthosis with a varus wedge on forefoot vertical forces in a 24-year-old female with a compensated rearfoot varus deformity. The results of this study indicate that the use of total contact semirigid foot orthoses reduces the forefoot force-time integral during walking, whether a rearfoot varus wedge was or was not used. The authors recommend that total contact construction of the foot orthoses be considered when a reduction of the forces acting on the forefoot is the goal of treatment.
Effect of insole material on force and plantar pressures during walking
Authors: McPoil TG , Cornwall MW
Published: April 2014

Twelve subjects between the ages of 24 and 35 years walked barefoot over a pressure platform with the following insole materials placed directly on top of the platform: 1) PPT, 2) Spenco, and 3) Viscolas. Maximum vertical force, vertical force-time integral as well as maximum plantar pressure data were collected for the rearfoot, midfoot, and forefoot regions. The results were not significant for maximum vertical force and vertical force-time integral among the three insole materials when compared to barefoot-only walking. There was, however, a significant reduction in forefoot maximum plantar pressure among the three materials compared to barefoot-only walking. In the rearfoot region, a reduction in maximum plantar pressure was seen only with PPT and Spenco.
Talectomy for diabetic Charcot foot. An alternative to amputation
Authors: Tom RK , Pupp GR
Published: April 2014

A talectomy was performed because of Charcot degeneration during recovery from a hallux amputation. The patient was treated conservatively but Charcot degeneration continued, resulting in ulceration and dorsomedial dislocation of the talar head. The patient was hospitalized, and the talectomy was performed. The patient returned to normal activities.
1993 William J. Stickel Gold Award. Stability of absorbable fixation in basilar first metatarsal osteotomies
Authors: Lavery LA , Higgins KR , Ashry HR , Athanasiou KA
Published: April 2014

The purpose of this study was to compare the structural characteristics of 2.0-mm polyglycolic acid pins and 2.0-mm Steinmann pins in oblique closing base wedge osteotomies of the first metatarsal bone commonly used to correct metatarsus primus varus. Six pairs of fresh frozen cadaveric first metatarsal bones were osteotomized, fixated with either absorbable or stainless steel 2.0-mm pins, cemented in a specimen-holding jig, and tested with the Bionix Material Testing System. There was no significant difference in the mean ultimate force, ultimate displacement, or structural stiffness when comparing 2.0-mm polyglycolic acid pins and Steinmann pins in this model. The structural characteristics of 2.0-mm absorbable pins were the same as stainless steel pins at the time of initial placement in the oblique closing base wedge osteotomy of the first metatarsal.
Spinal morphine anesthesia and urinary retention
Authors: Mahan KT , Wang J
Published: April 2014

Spinal anesthetic is a common form of surgical anesthetic used in foot and ankle surgery. Spinal morphine anesthetic is less common, but has the advantage of providing postoperative analgesia for 12 to 24 hr. A number of complications can occur with spinal anesthesia, including urinary retention that may be a source of severe and often prolonged discomfort and pain for the patient. Management of this problem may require repeated bladder catheterization, which may lead to urinary tract infections or impairment of urethrovesicular function. This study reviews the incidence of urinary retention in 80 patients (40 after general anesthesia and 40 after spinal anesthesia) who underwent foot and ankle surgery at Saint Joseph's Hospital, Philadelphia, PA. Twenty-five percent of the patients who had spinal anesthesia experienced urinary retention, while only 7 1/2% of the group who had general anesthesia had this complication. Predisposing factors, treatment regimen, and recommendations for the prevention and management of urinary retention are presented.
Digital clubbing. A case study
Authors: Mantoura A , Cheslik TM , Blake M
Published: April 2014

In this case, it is difficult to assess whether the severity of the clubbed digits is a result of a purely hereditary nature, liver pathology, chronic respiratory ailments, or a combination of the above. The abnormal liver function test may not be related to the digital clubbing. Instead, they may be the result of the alcohol abuse. The case does appear to be hereditary because his siblings and mother all have clubbed digits and there is a higher frequency in blacks. The authors believe that this case affords an opportunity to make the podiatrist aware of the possibilities that should be considered the differential diagnosis when examining a patient with clubbed digits. It is important to fully work up a patient with clubbed digits even if the presentation is that of hereditary clubbing. Severe clubbing may be the result of a mild hereditary form that was worsened by an underlying systemic condition, such as malignancy, toxicosis, endocrinopathy, and neuropathy.
Bilateral syndactyly. A unique case with surgical correction
Authors: Cisco RW , Pitts TE , Cicchinelli LD , Caldarella DJ
Published: April 2014

Cases must be treated on an individual basis, appreciating the complexity of the syndactyly, considering the patient compliance, and understanding the goals of the surgical correction. Extensive discussion with the patient and parents must occur to clarify the goals of the surgery, the expectations, and possible complications. Careful preoperative planning and incision design is paramount in obtaining satisfactory results. Skin grafting may be required, either full-thickness from a variety of donor sites or split-thickness grafting as in one case study reported. Adjunctively, manipulation and stretching of the web space for 2 to 3 months preoperatively may be helpful to achieve more laxity of the soft tissues. The choice of suture material is of particular concern when dealing with a small child. It is usually wise to use an absorbable suture material for skin closure in a small child to prevent undue emotional stress to the child or even further anesthesia upon suture removal. Vascular compromise caused by soft tissue tension in not an infrequent occurrence. As with any surgery that addresses largely cosmetic deformities, there is no substitute for exact prior planning, meticulous technique, and surgeon experience to optimize results.
Solitary periungual angiofibroma. An unusual case report
Authors: Tisa LM , Iurcotta A
Published: April 2014

Solitary periungual angiofibromas can often be challenging in the diagnosis and treatment of such common lesions. Because of the various histologic presentations of fibrous skin tumor, a complete differential diagnosis would include hemangioma, seborrheic keratosis, fibroma, and digital fibrokeratoma. Treatment by total sharp excision can often be accomplished, depending on the morphological appearance of the lesion. An incisional biopsy of a more expansile lesion may be warranted.
A historical look at the transmetatarsal amputation and its changing indications
Authors: Habershaw GM , Gibbons GW , Rosenblum BI
Published: April 2014

In March 1949, McKittrick described the use of the transmetatarsal amputation for the diabetic foot, along with specific indications. Infection, ischemia, and neuropathic ulcerations of the toes and forefoot were all treated with this procedure. In the past 30 years, however, advances in the management of these problems have led to a decrease in the number of transmetatarsal amputations performed at the New England Deaconess Hospital. With these advances, the current approach to the transmetatarsal amputation has changed, leading to significant modifications in the basic indications for this procedure.
Reduction of plantar pressure with the rigid relief orthosis
Authors: Novick A , Stone J , Birke JA , Brasseaux DM , Broussard JB , Hoard AS , Hawkins ES
Published: April 2014

The rigid relief orthosis was developed to protect vulnerable sites on the plantar surface of the insensitive foot against reulceration by providing both a nonyielding relief under the healed lesion site and a total contact fit. Clinically, the rigid relief orthosis has been effective in protecting the foot against the trauma induced by the repetitive mechanical stress of walking. This study used both the Hercules and F-Scan pressure transducer systems to measure pressure at the first metatarsal head in three orthotic treatments. Both measurement systems recorded significant reductions in pressure at the first metatarsal head with the rigid relief orthosis, establishing a quantitative rationale explaining its clinical effectiveness. Significant pressure differences were also recorded at the secondary sites of the heel, midfoot, and third metatarsal head.
Orthotic survey. Preliminary results
Authors: Moraros J , Hodge W
Published: April 2014

A nationwide survey of patient satisfaction and effectiveness with prescription foot orthoses was conducted. Five hundred twenty patients were fitted with foot orthoses and evaluated for 14 weeks. The survey was not confined to a single medical condition. The level of patient satisfaction and the final fit of the custom-fitted orthoses were excellent. Effectiveness of the orthoses in the patient population ranged from 62.5% of the cases having the chief complaint completely resolved to 4.7% unresolved. Orthoses reduced or delayed the need for surgery in general and for hallux valgus and hammer toe specifically. Although several conclusions can be drawn on the basis of these survey results, this study highlights the need for a more detailed study and research into the prescription of orthoses to improve clinical practice, patient quality of life, cost effectiveness, and the design and manufacture of orthoses.
Navicular drop as a composite measure of excessive pronation
Authors: Mueller MJ , Host JV , Norton BJ
Published: April 2014

The measure of navicular drop has been used as an indicator of pronation at the foot. It is defined as the distance the navicular tuberosity moves in standing, as the subtalar joint is allowed to move from its neutral position to a relaxed position. The purposes of this study were to test the reliability of a method to measure navicular drop and to assess the relationships among measures of forefoot to rearfoot position, subtalar joint neutral position, and navicular drop. The results support traditional biomechanical theory but indicate that other factors contribute significantly to navicular drop.
Principles of wound healing and growth factor considerations
Authors: Skokan SJ , Davis RH
Published: April 2014

This review examines some of the important principles in wound repair and significant considerations for the use of growth factors. Moisture provides a positive influence on the mechanical and hormonal aspects of wounds. Atraumatic closure of surgical wounds and postoperative care and the types of wound closure are discussed. Cellular proliferation and migration in wounds are central features regarding growth factors.
Flexor digitorum longus tendon transfer
Authors: Burleigh W , Gold GS , Jex RM , Young G
Published: April 2014

A retrospective evaluation consisting of a written survey and physical examination was completed on flexor digitorum longus tendon transfer patients. The tendon transfer is used to alleviate symptoms and address imbalance of extrinsic and intrinsic muscles. The authors present an evaluation of 110 procedures with an average follow-up period of 65.7 months (range 7 to 198 months). A literature review, discussion of a new theory as to the etiology of hammer toes, and criteria for using the procedure are included.
Etiology of symptomatic recurrent interdigital neuromas
Authors: Young G , Lindsey J
Published: April 2014

Morton's neuroma is a common disease entity of the foot that is often treated with surgical resection. A complication of neuroma resection is recurrence of symptoms as a result of the formation of an amputation neuroma. The authors offer an anatomical and biomechanical explanation for the location of symptomatic amputation neuromas. The neuromas are found on the plantar surface proximal to the condyles of the metatarsal and medial to the interspace where the nerve is resected. The theory is based on intraoperative observations during surgery for recurrent neuromas and on cadaver dissections and offers a method based on this theory to reduce the number of recurrences.
Transverse plantar incision for heel spur surgery. Four-year follow-up survey of 35 patients
Authors: Self TC , Kunz RE , Young G
Published: April 2014

A transverse plantar incisional approach was used on 35 patients who underwent heel spur surgery from 1982 through 1990. Ten bilateral procedures were performed on a total of 45 feet. A medial approach was used for five of the bilateral surgeries. The average age of the patient was 47 years, and the average follow-up period was 49 months. Of the 34 plantar approach cases in which complete data were obtained, 94% showed either good or excellent results. The authors illustrate a technique using a transverse plantar incision as an alternative to the medial approach for heel spur surgery.
Foreign bodies in the foot
Authors: Stein RA , Clarke S
Published: April 2014

A symptomatic foreign object lodged in the foot can be a difficult problem. The object's location and shape are the most important factors to identify before removal of the object is attempted. Many different imaging modalities have been used to locate the foreign objects in the foot. The authors briefly reviewed several common imaging modalities. Computed tomography appears to be superior to the other imaging modalities discussed in visualizing and localizing foreign objects in the foot. Magnetic resonance scanning is probably equal to computed tomography but is less readily available and more expensive and is contraindicated with ferrous metal foreign bodies.
Faculty as change agents
Authors: Wergin J
Published: April 2014

Although the technical world in which medicine exists is rapidly and constantly changing, the educational world in which the institution exists is extremely resistant to change. Professional organizations are themselves resistant to change. The author explores these reasons and offers suggestions for the implementation of positive change.
Toward a philosophy of podiatric medical education
Authors: Tomczak RL
Published: April 2014

Philosophy offers us the ability to think logically and critically about any field of knowledge, podiatric medical education included. By proceeding in an orderly manner, the growth of the profession will be ensured as long as the thinkers are willing to be truthful. Ironically, conformity is not a necessity and a diversity of philosophies is actually encouraged.
Chondroid syringoma. A rare occurrence in the hallux
Authors: Wagoner WL , Spencer RB , Ramos RP
Published: April 2014

The gross and histologic characteristics of chondroid syringoma were discussed. A case history of the fourth published occurrence of this rare tumor of the lower extremity was presented. Because of the rare occurrence of this tumor in the lower extremity, chondroid syringoma can easily be misdiagnosed. However, it should be included in the differential diagnosis of any slow-growing solid nodule in the skin. In the case presented, the hallux was saved by the persistence of the podiatrist and pathologist in obtaining second and third opinions on the histologic presentation of this rare tumor.
Lower extremity tennis injuries. Prevalence, etiology, and mechanism
Authors: Feit EM , Berenter R
Published: April 2014

A retrospective investigation was undertaken to determine the prevalence of tennis-related lower extremity injuries in the San Francisco Bay area. A total of 376 participants at various Bay area tennis clubs completed a questionnaire before registering for tournament play. The results obtained from the survey indicate that 91.2% of this population had an injury to the lower extremity. A discussion of the etiology and mechanism of the various lower extremity injuries is presented.
Injury prediction among runners. Preliminary report on limb dominance
Authors: Herring KM
Published: April 2014

A preliminary study examined the independent association of lower extremity limb dominance to running injuries. For the purposes of this study, limb dominance was recognized as an individual's ability to perform a specific skill test with greater accuracy, speed, and agility with one limb rather than the contralateral limb. Three limb dominance tests were used to identify limb dominance. The protocol, application, and scoring system for these screening tests are presented. The screening tests were sensitive and identified limb dominance among elite runners. No significant (P < 0.05%) association between limb dominance and running injuries could be confirmed by this study. These results could be an artifact of a small (N = 26) subject population or the elite nature of the subject population. Further testing and observation with a larger subject population are recommended.
Orthosorb resorption evaluation using MRI and histologic analysis
Authors: Bashara ME , Mourino MR , Trepal MJ , Lambert WC
Published: April 2014

Resorbable bone fixation devices may be used in various surgical procedures for internal fixation in place of traditional metallic devices. Currently, there is no radiographic technique for tracing the postsurgical location and resorption of these devices. This study was undertaken to ascertain whether magnetic resonance imaging is a suitable tool for performing such evaluations. Using an animal model, the authors investigated the correlation over time between the magnetic resonance image of a surgically implanted pin and its histologically verified location and state.
Tibialis posterior tendon associated with hallux abducto valgus. A preliminary study
Authors: Bozant JG , Serletic DR , Phillips RD
Published: April 2014

The etiology of hallux abducto valgus has been the topic of much study. The authors of this study have attempted to investigate an association of anomalous insertions of the tibialis posterior tendon and their relationship to hallux abducto valgus. The authors present evidence that such anomalous insertions are normal, but may contribute to the development of the deformity because of variations in those insertions. A biomechanical model for that contribution is proposed.
Prosthetic management of a Chopart amputation variant
Authors: Cohen-Sobel E , Caselli MA , Rizzuto J
Published: April 2014

The history and prosthetic difficulties of a patient with an unusual Chopart amputation variant have been presented. Although it is possible for the Chopart amputee to walk with just a shoe and filler, this patient does best with a formal prosthesis. The Chopart amputation, which has been surgically stabilized with Achilles tendon lengthening to prevent equinus contractures, can be fitted successfully with a lightweight circumferential plastic or silicone prosthesis or more traditionally with a solid ankle foot orthosis with filler. This partial foot prosthesis is worn with a sturdy shoe with a rocker and solid ankle cushion heel or a well constructed running shoe. The Chopart amputee with equinus contractures must be fitted with a Chopart clamshell prosthesis or solid ankle patellar tendon bearing orthosis with filler and the above shoe prescription. Recent variants of the partial foot prosthesis including the Imler partial foot prosthesis, the Lange silicone prosthesis, and the ankle corset prosthesis were described.
Chronic peroneal tendon subluxation. New surgical technique and retrospective analysis
Authors: Hutchinson BL , Gustafson LS
Published: April 2014

A retrospective review of 20 patients who had undergone a peroneal regrooving surgical technique for chronic subluxing peroneal tendons was conducted. The design of the study was based subjectively on a questionnaire completed by the patients and objectively on a physical examination of all the patients included in the study. The authors present the technique and emphasize the importance of preoperative assessment in predicting the results that should reasonably be expected by the patient, especially in the presence of any peroneal tendon pathology.
Rare case of lichen sclerosus et atrophicus associated with morphea
Authors: Glockenberg A , Cohen-Sobel E , Caselli M , Chico G
Published: April 2014

A rare case of lichen sclerosus et atrophicus coexisting with morphea in the foot was presented. Orthotic therapy was required to alleviate an antalgic gait.
Objective diagnosis of equinus during gait prior to and following a tibial nerve block
Authors: Maurer BT , Hillstrom HJ , Siegler S , Kugler F , Hice G , Malay DS , Downey M , Stienstra J
Published: April 2014

A quantitative evaluation technique has been developed to assist the clinician in the diagnosis and treatment of ankle equinus deformity. Specifically, the work focuses on accomplishing two major goals: 1) to develop a reliable set of quantitative criteria to assess the degree of dysfunction of the ankle joint during locomotion in patients with equinus deformity; and 2) to determine the effect of various treatment modalities on the ambulatory performance of patients with equinus deformity. A statistically significant difference in two key gait parameters has been demonstrated between healthy subjects and those with equinus deformity.
Fractures of the posteromedial process of the talus
Authors: Banks AS , Caldarella D
Published: April 2014

The authors discuss fractures of the posteromedial process of the talus. The surgical approach for open reduction of these injuries is detailed.
Anti-inflammatory and wound healing activity of a growth substance in Aloe vera
Authors: Davis RH , Donato JJ , Hartman GM , Haas RC
Published: April 2014

Aloe vera improves wound healing and inhibits inflammation. Since mannose-6-phosphate is the major sugar in the Aloe gel, the authors examined the possibility of its being an active growth substance. Mice receiving 300 mg/kg of mannose-6-phosphate had improved wound healing over saline controls. This dose also had anti-inflammatory activity. The function of mannose-6-phosphate in A. vera is discussed.
Simple bone cyst of the calcaneus. A case report and literature review
Authors: Smith SB , Shane HS
Published: April 2014

The authors presented a case report of a patient presenting with heel pain symptoms and physical findings similar to those associated with a heel spur syndrome. With a standard x-ray, the presence of a simple bone cyst was evident. Although mainly reported in tubular bones, steroid injection therapy has been successful and appears to be replacing surgical curettage and packing as the preferred choice of treatment in many cases. As more reports of the successful eradication of simple bone cysts of the calcaneus with steroid injections are reported, greater confidence for using it as a treatment choice for this particular lesion may be gained. The surgical approach in the patient presented here was chosen because of factors that the authors believe increased the likelihood of a pathologic fracture, such as size and extent of the lesion, history of progressive pain, and activity level of the patient. The larger body weight and the resulting stress of the patient more likely to present with a calcaneal cyst may also be factors to consider.
Posterior tibial tendinitis. A literature review with case reports
Authors: Blake RL , Anderson K , Ferguson H
Published: April 2014

Overuse posterior tibial tendinitis is caused by the increased stress placed on the tendon as it tries to compensate for the increased subtalar joint pronatory movement and velocity during physical activity. The stress can cause microtrauma and rupture of some of the fibers of the tendon. This leads to an inflammatory process and the classical clinical signs and symptoms. Therapy is directed at reducing the inflammation, minimizing the fibrosis buildup, re-strengthening the weakened tissue, and controlling the pronatory force. The two case reports illustrate typical clinical signs, symptoms, and treatment for this injury.
Lower extremity static and dynamic relationships with rearfoot motion in gait
Authors: Knutzen KM , Price A
Published: April 2014

Twenty nonsymptomatic subjects were assessed while walking at a photoelectronically monitored place (2 +/- 0.1 m.s-1) using high speed cinematography (200 Hz) to record the rearfoot motion in the frontal plane, and electrogoniometry (100 Hz) to measure joint kinematics in the lower extremity. The foot type of the subjects was determined statically by using a podiascope and digitization techniques. The results demonstrated that no foot type variables contributed significantly to the variance in either rearfoot angle at foot strike or maximum rearfoot angle (p > 0.05). Regression equations were developed using kinematic variables: rearfoot angle at foot strike = 3.81 + (0.06*time to hip internal rotation) - (0.46*tibia internal rotation) + (0.14*plantarflexion); (R = 0.87, SE = 1.23 degrees); maximum rearfoot angle = 4.02 + (0.52*hip internal rotation) - (0.11*time to hip internal rotation); (R = 0.66, SE = 2.07 degrees). This study identifies hip joint movements as being the most significant contributors to prediction of rearfoot angles produced during walking.
Characteristics of adolescent hallux abducto valgus. A retrospective review
Authors: Pontious J , Mahan KT , Carter S
Published: April 2014

The authors review 63 surgical cases of adolescent hallux abducto valgus in 54 patients from the Foot and Ankle Institute of the Pennsylvania College of Podiatric Medicine over a 7-year period. Twenty-five closing base wedge and capital osteotomies were evaluated for radiographic changes. Three quarters of a group of 65 patients with adolescent hallux abducto valgus were found to have an abnormally high metatarsus adductus angle. Patients who had a closing base wedge osteotomy had higher preoperative radiographic angles for the intermetatarsal, metatarsus adductus, hallux abductus, and proximal articular set angles as well as the tibial sesamoid position. Those patients had 4.49 degrees more intermetatarsal angle correction than the patients who had a capital osteotomy. Implications for evaluation and treatment are discussed.
Juvenile hallux abducto valgus association with metatarsus adductus
Authors: Banks AS , Hsu YS , Mariash S , Zirm R
Published: April 2014

The authors evaluated the radiographs of 40 patients (72 feet) under 21 years of age who underwent surgery for symptomatic hallux abducto valgus deformity at Northlake Regional Medical Center. Forty-eight of 72 feet had metatarsus adductus angles greater than 15 degrees. A statistically significant correlation was found between an increasing metatarsus adductus angle and an increasing hallux abductus angle.
Complications of the Kalish bunionectomy
Authors: Downey MS
Published: April 2014

The Kalish osteotomy has become a popular method for the correction of mild-to-moderate hallux abducto valgus deformities associated with metatarsus primus adductus. This paper reviews the common pitfalls associated with this procedure, including failure to observe the indications for the procedure, technical failures when performing the procedure, and the most frequent postoperative complications.