bluuebunny/crossref_metadata_2025 huggingface dataset:
A Novel Device for Standardizing Marker Placement at the Calcaneus
Authors: Deschamps Kevin , Roosen Philip , Birch Ivan , Dingenen Bart , Bruyninckx Herman , Desloovere Kaat , Aertbelien Erwin , Staes Filip
Published: April 2014

Background

The determination of anatomical reference frames in the rearfoot during three-dimensional multisegment foot modeling has been hindered by a variety of factors. One of these factors is related to the difficulty in palpating, or the absence of, anatomical landmarks. A novel device (the Calcaneal Marker Device) aimed at standardizing marker placement at the calcaneus was, therefore, developed and evaluated for its reliability.

Methods

Throughout a random repeated-measures design, the repeatability of calcaneal marker placement was evaluated for two techniques: manual placement and placement using the Calcaneal Marker Device. Translational changes after marker placement and the clinical effect on intersegment angle calculation were quantified.

Results

Intraobserver variability was greater in therapist 2 (<5.3 mm) compared with therapist 1 (<2.9 mm). Intraobserver variability was also found to be less than 1.6 mm throughout use of the device. Interobserver variability was found to be significantly higher for the position of markers placed manually (5.8 mm), whereas with the Calcaneal Marker Device, the variability remained lower (<1.3 mm). The effect on the computed intersegment angles followed a similar trend, with variability of 0.4° to 4.0° and 1.0° to 8.7° for CMD and manual placement, respectively.

Conclusions

These findings suggest that variations in marker placement are considerably reduced when the novel Calcaneal Marker Device is used, possibly toward the limits dictated by the fine motor skills of therapists and tissue artifacts.
A Longitudinal Investigation into the Functional and Physical Durability of Insoles Used for the Preventive Management of Neuropathic Diabetic Feet
Authors: Paton Joanne S. , Stenhouse Elizabeth , Bruce Graham , Jones Ray
Published: April 2014

Background

Insoles are commonly used to assist in the prevention of diabetic neuropathic foot ulceration. Insole replacement is often triggered only when foot lesions deteriorate, an indicator that functional performance is comprised and patients are exposed to unnecessary ulcer risk. We investigated the durability of insoles used for ulcer prevention in neuropathic diabetic feet over 12 months.

Methods

Sixty neuropathic individuals with diabetes were provided with insoles and footwear. Insole durability over 12 months was evaluated using an in-shoe pressure measurement device and through repeated measurement of material depth at the first metatarsal head and the heel seat. Analysis of variance was performed to assess change across time (at issue, 6 months, and 12 months).

Results

Analyses were conducted using all available data (n = 43) and compliant data (n = 18). No significant difference was found in the reduction of mean peak pressure tested across time (P < .05). For both sites, significant differences in insole depth were identified between issue and 6 months and between issue and 12 months but not between 6 and 12 months (P < .05). Most insole compression occurred during the initial 6 months.

Conclusions

Visual material compression does not seem to be a reliable indicator of insole usefulness. Frequency of insole replacement is best informed by a functional review of effect determined using an in-shoe pressure measurement system. These results suggest that insoles for diabetic neuropathic patients can be effective in maintaining peak pressure reduction for 12 months regardless of wear frequency.
Nerve Decompression After Diabetic Foot Ulceration May Protect Against Recurrence
Authors: Nickerson D. Scott , Rader Andrew J.
Published: April 2014

Background

Nerve entrapment, common in diabetes, is considered an associated phenomenon without large consequence in the development of diabetes complications such as ulceration, infection, amputation, and early mortality. This prospective analysis, with controls, of the ulcer recurrence rate after operative nerve decompression (ND) offers an objective perspective on the possibility of frequent occult nerve entrapment in the diabetic foot complication cascade.

Methods

A multicenter cohort of 42 patients with diabetic sensorimotor polyneuropathy, failed pharmacologic pain control, palpable pulses, and at least one positive Tinel's nerve percussion sign was treated with unilateral multiple lower-leg external neurolyses for the indication of pain. All of the patients had healed at least one previous ipsilateral plantar diabetic foot ulceration (DFU). This group was retrospectively evaluated a minimum of 12 months after operative ND and again 3 years later. The recurrence risk of ipsilateral DFU in that period was prospectively analyzed and compared with new ulcer occurrence in the contralateral intact, nonoperated control legs.

Results

Operated legs developed two ulcer recurrences (4.8%), and nine contralateral control legs developed ulcers (21.4%), requiring three amputations. Ulcer risk is 1.6% per patient per year in ND legs and 7% in nonoperated control legs (P = .048).

Conclusions

Adding operative ND at lower-leg fibro-osseous tunnels to standard postulcer treatment resulted in a significantly diminished rate of subsequent DFU in neuropathic high-risk feet. This is prospective, objective evidence that ND can provide valuable ongoing protection from DFU recurrence, even years after primary ulcer healing.
Surgical Treatment of Malignant Tumors of the Calcaneus
Authors: Li Jing , Wang Zheng
Published: April 2014

Background

Amputation has been most commonly considered the only option to achieve local tumor control for calcaneal malignancies. Advances in oncologic treatment modalities and wide resection have made limb salvage increasingly possible. We retrospectively reviewed nine patients with calcaneal malignancies treated with different surgical options.

Methods

The diagnoses included chondrosarcoma in three patients, Ewing's sarcoma in three, osteosarcoma in two, and small round cell sarcoma in one. Four patients were managed by below-the-knee amputation owing to neurovascular invasion. Five patients were managed by limb salvage procedures. Pedicled osteomyocutaneous fibular grafts were used to reconstruct the defects created after total calcanectomy in limb salvage procedures. Clinical and radiographic evaluations were performed, and functional outcomes were assessed using the Musculoskeletal Tumor Society score.

Results

The patients were followed up for a mean of 42.3 months. Wide resection margins were achieved in all of the patients with limb salvage surgery. At the final follow-up, two patients had died of disease. Lung metastasis was found in two patients who were alive with disease. Five patients had no evidence of disease. No local recurrence occurred in this series. All of the fibular flaps survived, and fibula hypertrophies were observed in three patients. Average Musculoskeletal Tumor Society scores were 74.6% and 83.2% in patients with amputation and limb salvage, respectively.

Conclusions

After wide resection of a calcaneal malignancy, biological reconstruction using pedicled osteocutaneous fibular flaps has proved to be a successful limb salvage procedure, offering a satisfactory oncologic and functional outcome alternative to amputation in selected patients.
Antibiotic Stewardship
Authors: Smith Robert G. , Joseph Warren S.
Published: April 2014

The discovery of antibiotic drugs was one of the most significant medical achievements of the 20th century. The improper use of antibiotic drugs to prevent and treat infections has resulted in the emergence of resistance. Antimicrobic stewardship programs are becoming a mainstay in the fight against multidrug-resistant organisms. Individual clinicians should be encouraged to adopt the principles of antibiotic stewardship when treating lower-extremity infections in their scope of practice. First, a review of the available literature outlining the concept and practice of antibiotic stewardship is offered. Second, a discussion describing how to adopt and apply these principles to the individual clinician's practice as it applies to lower-extremity infections is offered. Finally, specific antimicrobial pharmacologic spectra and antibiogram information are offered.
A Theory of Shoe Wear Pattern Influence Incorporating a New Paradigm for the Podiatric Medical Profession
Authors: Vernon Wesley , Parry Anne , Potter Michael
Published: April 2014

Qualitative analysis of shoe wear patterns collected from a questionnaire evaluating podiatric physicians’ experiences in this area suggests that wear patterns could indicate causative function within a known pathologic context. Several different functions are suggested by patterns associated with each of the pathologic entities involved, and analysis of the relationship between patterns and reasons given by respondents for pattern-form variations show the strongest associations to be with functionally termed conditions. A basic model is proposed to present factors important in wear pattern production, suggesting that a new concept of primary walking intention is more influential than foot pathologies in wear pattern formation and that external factors are also influential, with the combined factors being described as the “holistic foot function.” This model may provide a variety of benefits to podiatric medicine; as shoe wear patterns are records of the usual long-term activity of the functioning foot, this paradigm could form a basis for podiatric medical practice. (J Am Podiatr Med Assoc 94(3): 261–268, 2004)
Burnout and Occupational Stress
Authors: Mandy Anne , Tinley Paul
Published: April 2014

Professional and occupational burnout is a recognized syndrome among healthcare professionals, although the point at which burnout begins is unclear. There is a dearth of research investigating burnout and occupational stress in relation to podiatric medicine, although two recent studies have reported high levels of burnout expressed by podiatric medical practitioners. This study was undertaken to compare the levels of burnout in newly qualified practitioners in Australia and the United Kingdom. The results suggest that levels of burnout are higher in these groups than indicated by the published normative medical data. Occupational stress was associated with lack of professional status and with geographic and professional isolation. Within these two themes, there were clear differences between the two groups. (J Am Podiatr Med Assoc 94(3): 282–291, 2004)
Use of a Maggot Motility Index to Evaluate Survival of Therapeutic Larvae
Authors: Rosales Anthony , Vazquez Jefferey R. , Short Brian , Kimbriel Heather R. , Claxton Matthew J. , Nixon Brent P. , Boulton Andrew J. M. , Armstrong David G.
Published: April 2014

Maggot debridement therapy is rapidly increasing in popularity at major diabetic foot and wound care centers worldwide. However, we are unaware of specific guidelines on the short-term storage of larvae. We sought to evaluate differences in maggot motility over time in larvae refrigerated versus those stored at room temperature. We also introduce a simple surrogate method for evaluating maggot vitality that may be useful for in vivo studies if validated in future works. We randomly selected ten larvae from the same shipment at ten different times in 9 days. Larvae were placed on a translucent acetate grid, and their total excursion in 30 sec was measured. This was converted into a Maggot Motility Index. In the refrigerated group, the index remained at or above 40 mm/min for approximately 60 hours from baseline, when there was a significant decrease. This same phenomenon occurred during the first 12 hours in the nonrefrigerated group. There were significant differences in motility between refrigerated and nonrefrigerated larvae immediately after baseline until day 8. Larvae are more practical for repeated clinical use if kept refrigerated between applications. (J Am Podiatr Med Assoc 94(4): 353–355, 2004)
Scanning Electron Microscope Imaging of Onychomycosis
Authors: Scherer William P. , Scherer Michael David
Published: April 2014

Although scanning electron microscope technology has been used for more than 60 years in many fields of medical research, no studies have focused on obtaining high-resolution microscopic images of onychomycosis of the toenail caused by Trichophyton rubrum in a geriatric population. To provide new insight into the intricate structure and behavior of chronic toenail onychomycosis, we produced three-dimensional images of onychomycosis obtained from two geriatric patients with confirmed growth of T rubrum. The photomicrographs illustrate the pervasive integration and penetration of the fungus hyphal elements, underscoring the clinical difficulty of obtaining rapid treatment of fungal infections in the distal and lateral subungual space of the human toenail. Although the scanning electron microscope may not be a practical diagnostic tool for most physicians, it remains invaluable for the researcher to obtain insight into the spatial orientation, behavior, and appearance of onychomycosis. (J Am Podiatr Med Assoc 94(4): 356–362, 2004)
Fibromyalgia and Tinel’s Sign in the Foot
Authors: Shookster Linda , Falke Gerald I. , Ducic Ivica , Maloney Christopher T. , Dellon A. Lee
Published: April 2014

In the physical examination of the patient suspected of having tarsal tunnel syndrome, the podiatric physician relies on Tinel’s sign: tapping the posterior tibial nerve in the tarsal tunnel should produce a distally radiating sensation if the nerve is pathologically compressed at this location. The American College of Rheumatology recognizes fibromyalgia as a condition characterized by multiple “tender points” on physical examination. This report compares the locations of the 18 critical diagnostic fibromyalgia points with known sites of anatomical entrapment of peripheral nerves in the lower extremity. We also describe a patient with both fibromyalgia and tarsal tunnel syndrome. Tinel’s sign in the lower extremity is a valid technique for assessing peripheral nerve compression in the patient with fibromyalgia. (J Am Podiatr Med Assoc 94(4): 400–403, 2004)
Plantar Pressure Changes Using a Novel Negative Pressure Wound Therapy Technique
Authors: Armstrong David G. , Kunze Kristin , Martin Billy R. , Kimbriel Heather R. , Nixon Brent P. , Boulton Andrew J. M.
Published: April 2014

This study evaluated changes in pressure imparted to diabetic foot wounds using a novel negative pressure bridging technique coupled with a robust removable cast walker. Ten patients had plantar pressures assessed with and without a bridged negative pressure dressing on the foot. Off-loading was accomplished with a pressure-relief walker. Plantar pressures were recorded using two pressure-measurement systems. The location and value of peak focal pressure (taken from six midgait steps) were recorded at the site of ulceration. Paired analysis revealed a large difference (mean ± SD, 74.6% ± 6.0%) between baseline barefoot pressure and pressure within the pressure-relief walker (mean ± SD, 939.1 ± 195.1 versus 235.7 ± 66.1 kPa). There was a mean ± SD 9.9% ± 5.6% higher pressure in the combination device compared with the pressure-relief walker alone (mean ± SD, 258.0 ± 69.7 versus 235.7 ± 66.1 kPa). This difference was only 2% of the initial barefoot pressure imparted to the wound. A modified negative pressure dressing coupled with a robust removable cast walker may not impart undue additional stress to the plantar aspect of the foot and may allow patients to retain some degree of freedom (and a potentially reduced length of hospital stay) while still allowing for the beneficial effects of negative pressure wound therapy and sufficient off-loading. (J Am Podiatr Med Assoc 94(5): 456–460, 2004)
Early Surgical Repair of Macrodactyly
Authors: Lagoutaris Emmanuel D. , DiDomenico Lawrence A. , Haber Lawrence L.
Published: April 2014

We report a case of macrodactyly of the foot in a 3-year-old girl. The standard treatment for this condition has been ablation. Studies of phalangeal resection, phalangeal amputation, syndactylization, digit shortening, tissue debulking, and osteotomy have shown varying results. In the case reported here, debulking combined with a shortening osteotomy was the treatment of choice. Although the pediatric patient may require additional surgeries because the deformity will continue to grow, early treatment has allowed this child the benefit of a functional, cosmetically appealing foot that can be fitted with normal footwear. (J Am Podiatr Med Assoc 94(5): 499–501, 2004)
The Histologic Host Response to Liquid Silicone Injections for Prevention of Pressure-Related Ulcers of the Foot
Authors: Wallace William Dean , Balkin S. W. , Kaplan Leo , Nelson Scott
Published: April 2014

This study analyzed the histologic effects of and host response to subdermally injected liquid silicone to augment soft-tissue cushioning of the bony prominences of the foot. A total of 148 postmortem and surgical specimens of pedal skin with attached soft tissue were obtained from 49 patients between July 1, 1974, and November 30, 2002. The longest period that silicone was in vivo was 38 years. The specimens were then processed into paraffin blocks and examined for specific findings. The variables considered included distribution of silicone within the tissue, host response, migration to regional lymph nodes, and viability of the host tissue after treatment. The host response to silicone therapy consisted primarily of delicate-to-robust fibrous deposition and histiocytic phagocytosis, with eventual formation of well-formed elliptic fibrous pads. The response in the foot appears different from that in the breast and other areas of the body previously studied. No examples of granulomas, chronic lymphoplasmacytic inflammation, or granulation tissue formation were seen, with only rare foreign-body giant cells present. Silicone injections in fat pads for the treatment of atrophy and loss of viable tissue show a histologically stable and biologically tolerated host response that is effective, with no evidence of any systemic changes. (J Am Podiatr Med Assoc 94(6): 550–557, 2004)
Percutaneous Supramalleolar Osteotomy for Distal Tibial (Near Articular) Ankle Deformities
Authors: Mendicino Robert W. , Catanzariti Alan R. , Reeves Christopher L.
Published: April 2014

Supramalleolar osteotomies are performed to realign the distal tibia and to improve foot and ankle function. This procedure requires a thorough preoperative and intraoperative understanding of limb-deformity parameters and of the center of rotation of angulation method of surgical planning. Radiographic, gait, and clinical analyses along with intraoperative fluoroscopic images are paramount to deformity correction. This article describes the radiographic and clinical analyses and technical considerations in performing a focal dome supramalleolar osteotomy. (J Am Podiatr Med Assoc 95(1): 72–84, 2005)
Management of Hallux Limitus with Distraction of the First Metatarsophalangeal Joint
Authors: Talarico Leonard M. , Vito George R. , Goldstein Larry , Perler Adam D.
Published: April 2014

This article describes a joint-preserving and joint-restoring procedure for the management of hallux limitus and hallux rigidus. The procedure uses a minirail external fixator to obtain distraction with or without arthrotomy of the first metatarsophalangeal joint. This procedure aims to restore joint function through elimination of the pathologic forces involved in hallux limitus and hallux rigidus. Both intrinsic and extrinsic muscular imbalances are reduced. Follow-up of 133 patients treated in this manner since 1997 demonstrates excellent long-term results. (J Am Podiatr Med Assoc 95(2): 121–129, 2005)
A Critical Discussion of the Use of Antiseptics in Acute Traumatic Wounds
Authors: Smith Robert G.
Published: April 2014

Approximately 10 million patients with traumatic wounds are treated in US emergency departments annually. The practice of wound cleansing or antiseptic management has a dichotomous history anchored in tradition and science. The merits of antiseptic fluid irrigation of traumatic wounds have received little scientific study. The purpose of this article is to critically evaluate the potential harm to patient outcome by the use of antiseptics on acute wounds. First, animal and cell culture data that describe the effects of topical antiseptics on wound healing are offered. Second, human case studies are presented to illustrate the potential harm of the indiscriminate use of antiseptics. Finally, data from previously published reviews are presented and evaluated for clinically based evidence to justify the current practice of antiseptic use in acute traumatic wounds. (J Am Podiatr Med Assoc 95(2): 148–153, 2005)
Unusually Large Cellular Schwannoma of the Foot
Authors: Pasternack Warren A. , Winter-Reiken Deborah J.
Published: April 2014

This article presents a case of an unusually large cellular schwannoma of the foot. This uncommon lesion of the lower extremity is described with regard to clinical appearance, radiologic evaluation (including magnetic resonance imaging), histologic characteristics, and intraoperative findings. (J Am Podiatr Med Assoc 95(2): 157–160, 2005)
Metatarsus Primus Elevatus in Hallux Rigidus
Authors: Roukis Thomas S.
Published: April 2014

Two hundred seventy-five lateral weightbearing radiographs of isolated pathology were reviewed and stratified into hallux rigidus (n = 100), hallux valgus (n = 75), plantar fasciitis (n = 50), and Morton’s neuroma (n = 50) groups. The patient population consisted of healthy individuals with no history of foot trauma or surgery. The first to second metatarsal head elevation, Seiberg index, first to second sagittal intermetatarsal angle, first to fifth metatarsal head distance, and hallux equinus angle were measured in each population. Statistically significant differences were found between the hallux valgus, plantar fasciitis, and Morton’s neuroma populations and the hallux rigidus population, which showed greater elevation of the first metatarsal relative to the second for each radiographic measurement technique. In the hallux rigidus population, there was a statistically significant difference between grade II and grades I and III regarding the first to fifth metatarsal head distance (greater in grade II) and the hallux equinus angle (lower in grade II). A review of the literature and comparison with historical controls reveals that metatarsus primus elevatus exists in hallux rigidus and is greater than that found in hallux valgus, plantar fasciitis, and Morton’s neuroma groups. (J Am Podiatr Med Assoc 95(3): 221–228, 2005)
The Bristol Foot Score
Authors: Barnett Sue , Campbell Rona , Harvey Ian
Published: April 2014

We sought to develop a patient-centered foot-health assessment tool by conducting in-depth interviews, focus groups, and surveys of relevant patient groups. A total of 400 hospital- and community-based podiatric patients took part in the development of the Bristol Foot Score, which was refined from a 41-item self-administered questionnaire to one containing 15 items. Podiatric patients easily understood the final questionnaire, and rates of completion were excellent. Overall reliability was high (Cronbach α = .9036), and application of the Bland and Altman technique suggested that the foot score produced stable measurements over time. Statistically significant differences were detected in scores before and after toenail surgery, indicating that the Bristol Foot Score is sensitive to change. A poor level of concordance was found between the Bristol Foot Score and a Chiropody Assessment Criteria Score routinely used by podiatrists to assess the need for podiatric care. The Bristol Foot Score reflects patients’ perceptions of their own foot health, providing a useful additional tool for evaluating the efficacy of interventions and describing foot health within populations. (J Am Podiatr Med Assoc 95(3): 264–272, 2005)
Hallucal Sesamoid Osteonecrosis
Authors: Özkoç Gürkan , Akpinar Sercan , Özalay Metin , Hersekli Murat Ali , Pourbagher Ayşin , Kayaselçuk Fazilet , Tandogan Reha N.
Published: April 2014

Four cases of osteonecrosis of hallucal sesamoids are reported here. Surgical excision of necrotic sesamoid tissue yielded satisfactory results, with the patients reporting no residual pain. Although it has not been frequently addressed in the literature, avascular necrosis of the sesamoid bones should be considered in the differential diagnosis of persistent forefoot pain. (J Am Podiatr Med Assoc 95(3): 277–280, 2005)
Percutaneous Tendo Achillis Lengthening to Promote Healing of Diabetic Plantar Foot Ulceration
Authors: Willrich Amanda , Angirasa Arush K. , Sage Ronald A.
Published: April 2014

The etiology of ulcerations related to increased plantar pressure in patients with diabetes mellitus is complex but frequently includes a component of gastrocnemius soleus equinus. One viable treatment option is percutaneous tendo Achillis lengthening as a means of increasing dorsiflexory range of motion and decreasing forefoot shear forces. This article presents three case reports illustrating the importance of reducing plantar pressure as a crucial component of treatment of diabetic forefoot ulcerations. (J Am Podiatr Med Assoc 95(3): 281–284, 2005)
Use of Laterally Wedged Custom Foot Orthoses to Reduce Pain Associated with Medial Knee Osteoarthritis
Authors: Rubin Russel , Menz Hylton B.
Published: April 2014

Osteoarthritis of the knee is a common condition that can cause considerable pain and disability. Various forms of lateral wedging may be effective in the treatment of medial compartment osteoarthritis, but it is not known whether incorporating a lateral wedge into a custom-molded foot orthosis will achieve similar results. Therefore, 30 subjects (21 men and 9 women) aged 29 to 77 years (mean ± SD, 58.1 ± 11.6 years) with radiographically confirmed medial compartment knee osteoarthritis were issued custom-molded foot orthoses with a 5° lateral heel wedge. Pain levels were recorded using a 100-mm visual analog pain scale on the date of issue of the orthoses (baseline) and again 3 and 6 weeks later. Mean ± SD pain levels were significantly reduced at 3 weeks (34 ± 22 mm) and 6 weeks (23 ± 22 mm) versus baseline (69 ± 19 mm) (F2 = 39.57). The degree of pain reduction was greater in patients with less severe osteoarthritis. At 6 weeks, all subjects had achieved at least some reduction in pain, and 28 reported that their orthoses were comfortable. This preliminary study indicates that laterally wedged foot orthoses may be beneficial in the treatment of mild-to-moderate osteoarthritis of the medial compartment of the knee. Further investigations using a larger sample, longer follow-up, and a no-treatment control group seem warranted. (J Am Podiatr Med Assoc 95(4): 347–352, 2005)
Efficacy of Fifth Metatarsal Head Resection for Treatment of Chronic Diabetic Foot Ulceration
Authors: Armstrong David G. , Rosales Mark A. , Gashi Agim
Published: April 2014

This study compares the potential benefit of fifth metatarsal head resection versus standard conservative treatment of plantar ulcerations in people with diabetes mellitus. Using a retrospective cohort model, we abstracted data from 40 patients (22 cases and 18 controls) treated for uninfected, nonischemic diabetic foot wounds beneath the fifth metatarsal head. There were no significant differences in sex, age, duration of diabetes mellitus, or degree of glucose control between cases and controls. Patients who underwent a fifth metatarsal head resection healed significantly faster (mean ± SD, 5.8 ± 2.9 versus 8.7 ± 4.3 weeks). Patients were much less likely to reulcerate during the period of evaluation in the surgical group (4.5% versus 27.8%). The results of this study suggest that fifth metatarsal head resection is a potentially effective treatment in patients at high risk of ulceration and reulceration. (J Am Podiatr Med Assoc 95(4): 353–356, 2005)
Plantar Pressure and Radiographic Changes to the Forefoot After the Austin Bunionectomy
Authors: Bryant Alan R. , Tinley Paul , Cole Joan H.
Published: April 2014

We describe the effects of the Austin bunionectomy on plantar pressure distribution and radiographic measurements in the forefoot in 31 subjects (44 feet) with mild-to-moderate hallux valgus deformity and 36 control subjects (36 feet). Plantar pressure measurements before and 24 months after surgery showed peak pressure beneath the hallux reduced to normal values. Peak pressure measurements beneath the first, second, and third metatarsal heads in hallux valgus feet were relatively unchanged after surgery and remained higher than normal values. The operation produced significant decreases in mean preoperative radiographic measurements of hallux abductus, metatarsus primus varus, and first metatarsal protrusion distance in these patients to below-normal values. (J Am Podiatr Med Assoc 95(4): 357–365, 2005)
Three-dimensional Reconstruction of Magnetic Resonance Images of a Displaced Flexor Hallucis Longus Tendon in Hallux Valgus
Authors: Sanders Antal P. , Weijers René E. , Snijders Christiaan J. , Schon Lew C.
Published: April 2014

By using three-dimensional magnetic resonance image reconstruction, lateral displacement of the flexor hallucis longus tendon and sesamoid bones was made clearly visible in a living patient. This finding supports a biomechanical model related to disturbed muscle balance at the first metatarsophalangeal joint, which could play an important role in the pathogenesis of hallux valgus and metatarsus primus varus. (J Am Podiatr Med Assoc 95(4): 401–404, 2005)
American Podiatric Medical Association Best Walking City Competition, 2004
Authors: Fisher Allan H. , Tzamaras George P. , Scherer Julia E. , Haer Amie
Published: April 2014

In 2004, the American Podiatric Medical Association conducted its third annual “Best Walking City Competition.” This study improved on the 2002 and 2003 studies by increasing the number of cities competing for the title of “Best Walking City” and by including a variety of new measures of walking activities to provide a more comprehensive and equitable basis for comparing cities. The top 20 best walking cities in 2004 were identified from among the 200 largest cities across the United States. Lists of top cities were also developed by city population size and geographic region and by three different types of walking activities prevalent in each city. (J Am Podiatr Med Assoc 95(4): 414–420, 2005)
Morphological and Functional Changes in the Diabetic Peripheral Nerve
Authors: Lee Doohi , Dauphinée Damien M.
Published: April 2014

It has been hypothesized that in individuals with diabetes mellitus the peripheral nerve is swollen owing to increased water content related to increased aldose reductase conversion of glucose to sorbitol. It has further been hypothesized that the tibial nerve in the tarsal tunnel is at risk for chronic nerve compression related to this swelling. We used diagnostic ultrasound to evaluate this hypothesis. Cross-sectional areas of the tibial nerve were measured in diabetic patients with neuropathy and compared with previously reported measurements in nondiabetic patients and diabetic patients without neuropathy. We used the Pressure-Specified Sensory Device (Sensory Management Services LLC, Baltimore, Maryland) to document the presence of neuropathy in 24 diabetic patients (48 limbs). Previous studies have found that the cross-sectional area of the tibial nerve in nondiabetic patients and in diabetic patients without neuropathy is not significantly different. We found that the mean cross-sectional area of the tibial nerve in diabetic patients with neuropathy is significantly greater than that in diabetic patients without neuropathy (24.0 versus 12.0 mm2). Our study highlights the value of newer ultrasound imaging techniques in identifying morphological change in the tibial nerve and confirms that the tibial nerve in the tarsal tunnel is swollen, consistent with chronic compression, in diabetic patients with neuropathy. (J Am Podiatr Med Assoc 95(5): 433–437, 2005)
Comparison of Measures of Large-Fiber Nerve Function in Patients with Chronic Nerve Compression and Neuropathy
Authors: Radoiu Horatio , Rosson Gedge D. , Andonian Eugenia , Senatore John , Dellon A. Lee
Published: April 2014

Measurement of large-fiber peripheral nerve function is critical to the assessment of patients with nerve injury, chronic nerve compression, and neuropathy. We evaluated the Semmes-Weinstein nylon monofilament (SWM), vibrometry, and the Pressure-Specified Sensory Device (PSSD) (Sensory Management Services LLC, Baltimore, Maryland) prospectively on the plantar surface of the hallux, bilaterally, in 35 patients with peripheral nerve problems related to nerve compression and neuropathy. Five patients had carpal tunnel syndrome and, therefore, had normal hallux measurements. Normative data for the SWM were obtained for 59 age-stratified people. A moderately strong Pearson product moment correlation was found for large-fiber nerve function between the PSSD and the SWM and between the PSSD and vibrometry. However, when these functions were compared with normative values for each neurosensory testing technique, sensitivity for detecting the presence of a peripheral nerve problem was 100% for the PSSD, 63% for the SWM, and 30% for vibrometry. False-positive test results were obtained for the hallux in 0% of normal feet when the PSSD was used, in 20% when vibrometry was used, and in 30% when the SWM was used as the test instrument. The PSSD was the most sensitive in identifying the presence of a large-fiber peripheral nerve problem in patients with pain or paresthesia in the foot related to the posterior tibial nerve. (J Am Podiatr Med Assoc 95(5): 438–445, 2005)
Surgical Treatment of Peripheral Neuropathy
Authors: Valdivia Juan M. V. , Dellon A. Lee , Weinand Martin E. , Maloney Christopher T.
Published: April 2014

Since 1992 it has been reported that patients with diabetes mellitus recover sensibility and obtain relief of pain from neuropathy symptoms by decompression of lower-extremity peripheral nerves. None of these reports included a series with more than 36 diabetic patients with lower-extremity nerves decompressed, and only recently has a single report appeared of the results of this approach in patients with nondiabetic neuropathy. No previous report has described a change in balance related to restoration of sensibility. A prospective study was conducted of 100 consecutive patients (60 with diabetes and 40 with idiopathic neuropathy) operated on by a single surgeon, other than the originator of this approach, and with the postoperative results reviewed by someone other than these two surgeons. Each patient had neurolysis of the peroneal nerve at the knee and the dorsum of the foot, and the tibial nerve released in the four medial ankle tunnels. After at least 1 year of follow-up, 87% of patients with preoperative numbness reported improved sensation, 92% with preoperative balance problems reported improved balance, and 86% whose pain level was 5 or greater on a visual analog scale from 0 (no pain) to 10 (the most severe pain) before surgery reported an improvement in pain. Decompression of compressed lower-extremity nerves improves sensation and decreases pain, and should be recommended for patients with neuropathy who have failed to improve with traditional medical treatment. (J Am Podiatr Med Assoc 95(5): 451–454, 2005)
A Neglected Case of Macrodystrophia Lipomatosa of the Foot in an Elderly Man
Authors: Tuzuner Tolga , Parlak Ali Haydar , Kavak Ayse , Alper Murat
Published: April 2014

Macrodystrophia lipomatosa is a rare disorder characterized by three-dimensional enlargement of one or more fingers or toes with predominantly fibroadipose tissue. Radiographically, it appears as hypertrophy of soft tissues and bones. The pathologic findings are infiltration and hypertrophy of adipose tissue in subcutaneous tissue, nerve sheaths, and periosteum. Macrodystrophia lipomatosa is usually diagnosed during childhood. The case presented here involves the most elderly patient with the condition ever reported, to our knowledge. As such, it may advance current knowledge of macrodystrophia lipomatosa. Special emphasis is given to the unique “bridge” formation seen radiographically in this case. (J Am Podiatr Med Assoc 95(5): 486–490, 2005)
Protein C Deficiency
Authors: Motley Travis A. , Vanlandingham Clint L.
Published: April 2014

We describe the management of a patient who presented to a family-practice clinic with gangrenous digits. After a thorough evaluation, she was found to have protein C deficiency, which produced a hypercoagulable state. Differential diagnosis in the evaluation of the coagulopathic patient with appropriate hematologic tests is briefly discussed. (J Am Podiatr Med Assoc 95(5): 491–493, 2005)
Callus Formation of the Tibial Hallux Sesamoid Mimicking a Bone Tumor
Authors: Kiter Esat , Yagci Baki , Duzcan Ender
Published: April 2014

Sesamoid tumors of the hallux are rare, and their incidence and differential diagnosis have not been well described. We present a case with a bizarre callus formation of the medial sesamoid of the hallux that mimicked a bone tumor. After excision of the mass and related sesamoid, the patient remained asymptomatic during 3 years of follow-up. (J Am Podiatr Med Assoc 95(6): 580–582, 2005)
New Nail Block Technique
Authors: Ouzounov Kaloian G.
Published: April 2014

This article presents a new nail block technique that constitutes an alternative local block for procedures involving the hallux nail and nail fold. It has significant advantages in terms of simplicity, effectiveness, safety, and economy over the traditional hallux block in selected procedures. (J Am Podiatr Med Assoc 95(6): 589–592, 2005)
Casting Methods and Plantar Pressure
Authors: Guldemond Nick A. , Leffers Pieter , Sanders Antal P. , Emmen Hans , Schaper Nicolaas C. , Walenkamp Geert H. I. M.
Published: April 2014

Foot orthoses are widely used to treat various foot problems. A literature search revealed no publications on differences in plantar pressure distribution resulting from casting methods for foot orthoses. Four casting methods were used for construction of orthoses. Two foam box techniques were used: accommodative full weightbearing method (A) and functional semiweightbearing method (B). Also, two suspension plaster casting techniques were used: accommodative casting (C) and functional subtalar joint neutral position (Root) method (D). Their effects on contact area, plantar pressure, and walking convenience were evaluated. All orthoses increased the total contact area (mean, 17.4%) compared with shoes without orthoses. Differences in contact areas between orthoses for total plantar surface were statistically significant. Peak pressures for the total plantar surface were lower with orthoses than without orthoses (mean, 22.8%). Among orthoses, only the difference between orthoses A and B was statistically significant. Differences between orthoses for the forefoot were small and not statistically significant. The gait lines of the shoe without an insole and of the accommodative orthoses are more medially located than those of functional orthoses. Walking convenience in the shoe was better rated than that with orthoses. There were no differences in perception of walking convenience between orthoses A, B, and C. Orthosis D had the lowest convenience rating. The four casting methods resulted in differences between orthoses with respect to contact areas and walking convenience but only slight differences in peak pressures. (J Am Podiatr Med Assoc 96(1): 9–18, 2006)
Synovial Chondromatosis of the Subtalar Joint and Tenosynovial Chondromatosis of the Posterior Ankle
Authors: Van Phi , Wilusz Peter M. , Ungar David S. , Pupp Guy R.
Published: April 2014

Synovial chondromatosis is a rare, generally benign condition characterized by the formation of multiple cartilaginous nodules in the synovium of joints and occasionally on the tendon sheath or bursae. If the nodules are intra-articular, the condition is referred to as synovial chondromatosis; if extra-articular, tenosynovial chondromatosis. This space-occupying lesion can lead to chronic pain and limit the function of involved joints. We report a case of synovial chondromatosis involving the subtalar joint and tenosynovial chondromatosis involving the posterior ankle and review current definitions of this uncommon lower-extremity condition. (J Am Podiatr Med Assoc 96(1): 59–62, 2006)
Necrotizing Fasciitis in a Patient with Type 2 Diabetes Mellitus
Authors: Kanuck David M. , Zgonis Thomas , Jolly Gary Peter
Published: April 2014

Necrotizing fasciitis is a soft-tissue infection characterized by extensive necrosis of subcutaneous fat, neurovascular structures, and fascia. In general, fascial necrosis precedes muscle and skin involvement, hence its namesake. Initially, this uncommon and rapidly progressive disease process can present as a form of cellulitis or superficial abscess. However, the high morbidity and mortality rates associated with necrotizing fasciitis suggest a more serious, ominous condition. A delay in diagnosis can result in progressive advancement highlighted by widespread infection, multiple-organ involvement, and, ultimately, death. We present a case of limb salvage in a 52-year-old patient with type 2 diabetes mellitus and progressive fascial necrosis. A detailed review of the literature is presented, and current treatment modalities are described. Aggressive surgical debridement, comprehensive medical management of the sepsis and comorbidities, and timely closure of the resultant wound or wounds are essential for a successful outcome. (J Am Podiatr Med Assoc 96(1): 67–72, 2006)
Frontal Plane Motion of the Rearfoot During a One-Leg Squat in Individuals with Patellofemoral Pain Syndrome
Authors: Levinger Pazit , Gilleard Wendy L. , Sprogis Karl
Published: April 2014

Abnormal motion of the foot has been suggested to be a potential contributor to the medial collapse of the knee seen in individuals with patellofemoral pain syndrome during a one-leg squat. Rearfoot frontal plane range of motion and peak angle were investigated during a one-leg squat in patients with patellofemoral pain syndrome compared with controls. A significant increase in the peak eversion angle was found for the patellofemoral pain syndrome group compared with controls (P = .02). Increased rearfoot eversion may contribute to the knee medial collapse observed in these patients because it may lead to tibial abduction relative to the femur. Nevertheless, further research is required to investigate the causal relationship because it remains unclear whether rearfoot eversion instigates the medial collapse of the knee. (J Am Podiatr Med Assoc 96(2): 96–101, 2006)
Gait Analysis with an Integrated System for Functional Assessment of Talocalcaneal Coalition
Authors: Giacomozzi Claudia , Benedetti Maria Grazia , Leardini Alberto , Macellari Velio , Giannini Sandro
Published: April 2014

There is little knowledge of the functional performance of patients with talocalcaneal coalition because of the marginal quantitative information accessible using current motion-analysis and plantar pressure–measurement techniques. A novel system was developed for comprehensively measuring foot–floor interaction during the stance phase of gait that integrates instrumentation for simultaneously measuring bony segment position, ground reaction force, and plantar pressure with synchronization of spatial and temporal variables. An advanced anatomically based analysis of foot joint rotations was also applied. Tracking of numerous anatomical landmarks allowed accurate selection of three footprint subareas and reliable estimation of relevant local forces and moments. Eight patients (11 feet) with talocalcaneal coalition were analyzed. Major impairment of the rearfoot was found in nonsurgical patients, with an everted attitude, limited plantarflexion, and overloading in all three components of ground reaction force. Surgical patients showed more normal loading patterns in each footprint subarea. This measuring system allowed for accurate inspection of the effects of surgical treatment in the entire foot and at several footprint subareas. Surgical treatment of talocalcaneal coalition seems to be effective in restoring more physiologic subtalar and forefoot motion and loading patterns. (J Am Podiatr Med Assoc 96(2): 107–115, 2006)
Immediate Open Reduction and Internal Fixation in Open Ankle Fractures
Authors: Joshi Deepak , Singh Davindar , Ansari Juned , Lal Yadu
Published: April 2014

In this prospective study, 30 patients (28 men and 2 women) with open ankle fractures were treated with early debridement and immediate stable internal fixation after anatomical reduction to achieve better functional results after early mobilization. The procedure was performed an average of 8 hours (range, 6–15 hours) after injury. According to the classification system of Gustilo and Anderson, 11 fractures (37%) were grade I, 12 (40%) were grade II, 5 (17%) were grade IIIA, and 2 (7%) were grade IIIB. Six complications occurred: four patients had superficial skin necrosis and two had loss of reduction, resulting in residual ankle stiffness. Twenty patients had excellent results, eight had good results, and two had fair results according to the modified criteria of Ketenjian and Shelton. We found that immediate debridement, anatomical reduction, and internal fixation of open ankle fractures leads to better functional results, especially in grade I and grade II injuries. (J Am Podiatr Med Assoc 96(2): 120–124, 2006)
The Physician’s Attire and Its Influence on Patient Confidence
Authors: Budny Adam M. , Rogers Lee C. , Mandracchia Vincent J. , Lascher Steven
Published: April 2014

Although physician appearance has been a topic of discussion in the medical literature for many years, no objective research has been performed on this topic in the field of podiatric medicine. Our primary objective was to examine patient confidence in physicians as it relates to professional clinic attire versus casual or scrub outfits. We also assessed the influence of other variables, such as white coat, name tag, age, and sex, on patient confidence. We surveyed 155 podiatric medical patients from a private practice and a hospital-based clinic. The results indicate that 68% of patients surveyed felt that professional attire inspired the most confidence. Ninety-six percent of all patients either preferred white coats or were indifferent to their presence. We conclude that professionally dressed podiatric physicians may inspire more confidence in a significant percentage of their patients. (J Am Podiatr Med Assoc 96(2): 132–138, 2006)