bluuebunny/crossref_metadata_2025 huggingface dataset:
Rehabilitation management of the lower extremity in HIV disease
Authors: McReynolds MA
Published: April 2014

The sequelae of human immunodeficiency virus (HIV) disease include a host of devastating conditions involving the lower extremity. These include rheumatologic dysfunction, Kaposi's sarcoma, peripheral neuropathies, and skin ulcers. Pain, weakness, and loss of range of motion caused by these conditions can lead to changes in gait pattern, loss of mobility and function, and limited quality of life. The role of the rehabilitation specialist in the care and treatment of HIV disease as it affects the lower extremity, and the treatment strategies, precautions, and suggestions will be discussed.
Antiseptics and disinfectants. Current issues
Authors: Terleckyj B , Elsinger EC , Axler DA
Published: April 2014

The authors address current issues regarding use of antiseptics and disinfectants with particular emphasis on the problems associated with claims made by manufacturers of various chemical agents. Other issues include the efficacy and limitations of commercial products, selecting the most appropriate formulation for proper disinfection, especially with instruments that come in contact with the patient, and preventing or minimizing iatrogenic infections in clinical practices. The authors stress that low-level and some intermediate-level disinfectants are unreliable because of their narrow safety margin and that chemical agents with a high level of activity should be used by all practitioners because of multi-drug resistant microorganisms and acquired immune deficiency syndrome (AIDS).
New method for reconstruction in lateral ankle instability
Authors: Bauer GR
Published: April 2014

Ankle instability is a frequent sequel following inversion sprain mechanisms of injury and has been estimated as occurring in approximately 20% of patients, regardless of the type of initial treatment. Mismanagement and undertreatment of this common injury contribute to the development of chronic instability symptoms with resultant tendencies toward reinjury. Loss of anatomical integrity of the injured ligamentous structures, proprioceptive deficits, or superimposed varus structural aberrations may all contribute to the chronicity of this condition. Surgical reconstruction of the insufficient ligaments can be accomplished through a variety of methods to restore stability. The more popular procedures currently being performed will be critiqued, and a new variant will be suggested that reduplicates the injured collateral ligaments more anatomically and reduces the technical complications inherent to operative procedures of this nature.
Variations in foot volume before and after exercise
Authors: Chalk PJ , McPoil T , Cornwall MW
Published: April 2014

Foot volume measurements were taken on 12 feet of nine female intercollegiate volleyball players (mean age of 20 years) before and after a 2-hr rigorous practice session. No significant difference was found between foot volume before and after exercise. A slight reduction in the foot volume after exercise was noted in comparison with the foot volume before exercise. These findings suggest that fitting footwear with extra space in front of the longest toe to accommodate changes in foot length associated with foot volume increases following exercise is not necessary. However, providing extra space in front of the longest toe during shoe fitting should still be considered in order to accommodate anterior sliding of the foot during athletic activities.
Surgical referrals as evidence of a de facto podiatric medical specialization
Authors: Grimm JW , Chumbler NR
Published: April 2014

The authors present evidence on the patterns and correlates of surgical referrals to podiatric physicians that suggests a surgical specialty now exists in podiatric medicine. The primary factors on which surgical specialization appears to be based are residency training, hospital medical staff membership, and increased hospital podiatric practice activity. Surgically specialized podiatric physicians tend to be younger, but such specialization is not related to either the gender or race of podiatric physicians.
Magnetic resonance imagery of a calcaneal lipoma
Authors: Richardson AA , Erdmann BB , Beier-Hanratty S , Lautz D , Jacobs PM , Julsrud ME , Ringstrom JB
Published: April 2014

An intraosseous lipoma of the calcaneus has been present and stable in this patient for at least 16 years; the only change has been an increase in the central calcification of the tumor. Because of the apparent stability of the lesion and the patient's complete lack of symptoms, no surgical intervention has been attempted. A baseline magnetic resonance image of the tumor was obtained to confirm the diagnosis and to aid in ruling out malignant degeneration of the tumor. The magnetic resonance image appearance of the calcaneal lipoma; increased signal intensity on T1-weighted images, with areas of decreased signal intensity centrally within the lesion; and corresponding increased signal intensity on the T2-weighted images and Short Tau Inversion Recovery suppression, are consistent with the descriptions from various texts on magnetic resonance imaging of the foot and ankle.
Cerebral gigantism (Sotos' syndrome). A rare cause of delayed walking and awkward gait
Authors: Sobel E
Published: April 2014

A case history of an 8-year-old girl with cerebral gigantism (Sotos' syndrome) has been presented. Throughout her life, this child has demonstrated all of the common features of Sotos' syndrome including large size at birth, excessive growth during childhood, dysmorphic craniofacial features, delay in motor and speech development, generalized clumsiness, and awkward gait. Family history was contributory with delays in early language development and the possibility that the child's father had Sotos' syndrome. When evaluating a pediatric patient for pes planus, delayed walking, and gait problems, the practitioner should consider the entire clinical profile and unusual etiologies.
Effect of exercise on bone mineral metabolism in diabetes
Authors: Burke JP , Fenton MR , Saadat M
Published: April 2014

The authors attempt to assess the relationship between exercise, diabetes, and bone metabolism. An animal model system was developed to study the relationship. Animals given streptozotocin to induce a type I diabetic state show elevated plasma glucose and triglyceride levels and a decrease in body weight. Analysis of femurs revealed alterations in copper, phosphorus, and zinc levels in animals with diabetes compared with controls. Mineral analysis of femurs from diabetic animals placed on an exercise regimen revealed values closer to control levels.
New method of studying joint kinematics from three-dimensional reconstructions of MRI data
Authors: Hirsch BE , Udupa JK , Samarasekera S
Published: April 2014

A new method of measuring the kinematic parameters of joints has been developed. This article describes the procedure, using tarsal joints as examples. The method uses the technique of computerized three-dimensional reconstruction from magnetic resonance images, taken at regular intervals throughout a foot's range of motion. From these reconstructions, various kinematic information, such as orientation of instantaneous axes, amounts of rotation, amounts and direction of translation, and bony contact areas, is derived. The method is noninvasive and can be applied to individual subjects or patients.
Local anesthetics. Is there an advantage to mixing solutions?
Authors: Ribotsky BM , Berkowitz KD , Montague JR
Published: April 2014

The advantages to using a 50/50 mixture of lidocaine and bupivacaine with respect to onset and duration of local anesthesia instead of using the solutions independently were evaluated. In a double-blind randomized experiment, 12 subjects, each volunteering both feet, were studied. One foot was injected with 1 ml of one of the following three solutions: 1% plain lidocaine, 0.25% plain bupivacaine (Marcaine), or a 50/50 mixture of 1% lidocaine and 0.25% bupivacaine; and in the other foot, a 1-ml injection of normal saline as a blinded control. A 5.07 (10 g) Semmes-Weinstein monofilament wire was used for testing for sensory blockade, and the onset and duration of anesthesia was recorded for each subject. It was determined that there was no significant difference in the mean onset times for the three solutions, and no significant difference between the durations of anesthesia of plain lidocaine and the 50/50 mixture. Additionally, it was determined that bupivacaine had a prolonged duration of anesthesia compared with the other two solutions. The results of this preliminary study suggest that there is no clinical advantage, with respect to onset and duration of local blockade, to using a 50/50 mixture of plain lidocaine and plain bupivacaine in place of their independent use.
Osteoarthropathy versus osteomyelitis: does magnetic resonance imaging help?
Authors: Naftulin KA , Stone PA , McGarry JJ
Published: April 2014

Osteomyelitis and osteoarthropathy may appear clinically and radiographically similar. Many retrospective and some prospective studies have shown that magnetic resonance imaging provides valuable information about the pathologic basis of disease, specifically in the differentiation of osteomyelitis from osteoarthropathy. Although culture and biopsy of bone are the definitive diagnostic procedure, this may not always be possible. Magnetic resonance imaging can be used as an adjunct to help plan treatment protocols.
Magnetic resonance imaging of the foot. Rheumatologic disorders mimicking osteomyelitis
Authors: Jelinek J , Pearl AB , Kominsky SJ , Schultz PM
Published: April 2014

The authors highlight the importance of close clinical and radiologic correlation in patients with either known rheumatologic conditions or with increased risk factors for rheumatoid arthritides. Some rheumatoid conditions may mimic osteomyelitis.
Kaposi's sarcoma versus bacillary angiomatosis
Authors: Caldwell BD , Kushner D , Young B
Published: April 2014

Persons with acquired immune deficiency syndrome (AIDS) are subject to a host of pathologic entities secondary to a depressed immune system. Kaposi's sarcoma frequently presents in this immunocompromised population and, therefore, diagnosis seems clinically straightforward. However, because of the prevalence of a strikingly similar infectious disease known as bacillary angiomatosis, skin biopsy of one or more lesions is crucial.
"Stand down for the homeless". Podiatric screening of a homeless population in Cleveland
Authors: Robbins JM , Roth LS , Villanueva MC
Published: April 2014

Health care for the homeless is a major public health concern. With the rise in antibiotic-resistant tuberculosis, the increase of human immunodeficiency virus (HIV) diseases, and other health risks, the medical community has begun to recognize the urgency of taking a proactive role in providing care for this population. Lower extremity pathology can result in limb-threatening and, in some cases, life-threatening sequelae for homeless populations. This patient group has limited access to regular hygiene, appropriate shoes, and podiatric medical care. Participation in the "Stand Down for the Homeless" projects provided an opportunity to evaluate the podiatric needs of a homeless population and to project a response to those needs. The authors define and compare this homeless population with the national homeless population, compare the podiatric needs of this homeless populations versus the general population, and respond to those needs.
Rewards of entering podiatric medicine and attitudes toward older adults
Authors: Chumbler NR , Robbins JM , Poplawski ME
Published: April 2014

This study examined the relationships between social and demographic characteristics (ie, gender, race, year in school, desired residency choice, and socioeconomic background), motivations for entering the profession of podiatric medicine (extrinsic and intrinsic rewards), and negative attitudes toward treating elderly patients. The study used ordinary least squares multiple regression models to analyze data from a random, national sample of 448 podiatric medical students. In particular, the ordinary least squares models were developed to determine the independent effect of intrinsic and extrinsic rewards on negative attitudes toward treating elderly patients. Consistent with the study hypotheses, after adjusting for social and demographic characteristics, the study found extrinsic rewards to have strong positive relationships with negative attitudes toward treating elderly patients, and intrinsic rewards to have strong negative relationships with negative attitudes toward treating elderly patients. The authors discussed the implications of the findings for podiatric physicians and educators training podiatric medical students.
Podiatric medical education and practice. 1960s to the 21st century
Authors: Levy LA
Published: April 2014

An overview of the development of medical and podiatric medical education in the US is provided. Beginning with the 1910 Flexner Report in medicine and moving to the 1996 Educational Enhancement Project of podiatric medicine, major changes have taken place that have made podiatric medicine a profession quite comparable to medicine. This is most obvious in the education and training process. It is essential that both the content and method of educating the podiatric physician for the 21st century reflect the rapidly evolving health care delivery and financing system.
Role of state licensing boards
Authors: Rathlesberger JH
Published: April 2014

Some leaders of the profession and its educational components have voiced concern about changes under way in California and questioned whether the state board of podiatric medicine is acting appropriately. The author attempts to clarify the role of state licensing boards, developments in California, and the board's alignment with those calling for state licensing agencies to help lead reform of medical education.
Retrospective review of endoscopic plantar fasciotomy--1992 through 1994
Authors: Stone PA , Davies JL
Published: April 2014

Endoscopic plantar fasciotomy is a rewarding procedure for both patient and surgeon. A vast majority of the patients have complete or near-complete resolution of heel pain at 6 months postoperatively. The procedure, however, is not without side effects and complications. This retrospective statistical study describes the postoperative side effects and complications of endoscopic plantar fasciotomy from 1992 to 1994. The procedure has been modified in an attempt to reduce several of the more commonly reported side effects.
Evaluation of magnetic foil and PPT Insoles in the treatment of heel pain
Authors: Caselli MA , Clark N , Lazarus S , Velez Z , Venegas L
Published: April 2014

The effect of a magnetic foil placed in the PPT/Rx Firm Molded Insole on the relief of heel pain was determined using the foot function index. Nineteen patients wore the PPT/Rx Firm Molded Insoles with the magnetic foil for 4 weeks and 15 patients wore the same PPT/Rx Firm Molded Insole with no magnetic foil for the same time. Approximately 60% of patients in both groups reported improvement. There was also no significant difference in the improvement between the magnetic foil group and the PPT/Rx Firm Molded Insole group in their scores on the post-treatment foot function index. These results suggest that the PPT/Rx Firm Molded Insole alone was effective in treating heel pain after only 4 weeks. The magnetic foil offered no advantage over the plain insole.
Impact of onychomycosis on quality of life
Authors: Drake LA
Published: April 2014

The author reviews the current knowledge of the impact of onychomycosis on quality of life. Like other visible disorders of the integumentary system, onychomycosis affects many aspects of life, including physical functioning, interpersonal interactions, and emotional state. After examining the nature of quality of life and the study instruments used to measure it, the author reviews several studies that have examined the relationship between onychomycosis and quality of life. The author concludes that onychomycosis is a significant medical problem that has a great impact on patients' lives and should therefore be treated as definitively as possible.
Safety of oral terbinafine for toenail onychomycosis
Authors: Pollak R , Billstein SA
Published: April 2014

This open-label multicenter study evaluated the safety and efficacy of 12, 18, and 24 weeks of daily treatment with a 250-mg tablet of terbinafine for onychomycosis of the toenails. The safety data for 1,508 patients with a mean age of 50 years are reported here. Percentages below are based on this denominator. All patients received at least 12 weeks of therapy, with a possible addition of 6 or 12 weeks depending on disease extent. Patients were evaluated at baseline and at weeks 6, 12, 24, 30, 36, 48, and 72. Adverse events were reported in 674 (44.7%) patients; the events were considered unrelated to terbinafine in 557 (36.9%) patients and causally related or of uncertain relationship to terbinafine in 117 (7.8%) patients. Most events involved the skin, the gastrointestinal system, or the respiratory system. Statistically similar results were found for the elderly (over 60 years) and diabetic subpopulations. The study results confirm the safety of terbinafine in the population at large and show no differences for either the elderly or diabetic patients, who are at increased risk for onychomycosis and who frequently take concomitant medications with potential for drug interactions.
Multiple hereditary osteochondromatosis. Two cases with ankle and knee deformities
Authors: Glockenberg A , Sobel E , Levitz SJ
Published: April 2014

Two case histories of multiple hereditary osteochondromatosis are presented. Multiple hereditary exostoses are the most common inherited systemic disorder of bone. The presence of ankle deformity in 50% of the cases and the potential for malignant transformation make this an important disease for the clinician to be familiar with.
Soft tissue surgery using radiowave techniques
Authors: Hettinger DF
Published: April 2014

Numerous types of soft tissue surgical procedures can be performed using radiowave techniques. The Ellman International Surgitron is a versatile surgical instrument capable of making incisions, excisions, dessication, and coagulation. It converts electrical current into controlled energy in the radiowave frequency of the electromagnetic spectrum. Surgeons can then choose from three surgical currents based on the results they desire.
Imipenem-cilastatin-induced leukocytoclastic vasculitis
Authors: Reiner MR , Brunetti VA
Published: April 2014

A maculopapular rash has been associated with the administration of imipenem-cilastatin, an antibiotic that was used for treatment of a postoperative infection. This is a first-time association of imipenem with a leukocytoclastic vasculitic reaction. Leukocytoclastic vasculitis has been previously documented with ciprofloxacin, zidovudine, piperazine, and lithium.
Amputation and reamputation of the diabetic foot
Authors: Armstrong DG , Lavery LA , Harkless LB , Van Houtum WH
Published: April 2014

The authors compare the level of foot amputation by age, prevalence of arterial disease as a precipitating factor, gender, and ethnicity in persons with diabetes mellitus. Medical records were abstracted for each hospitalization for a lower extremity amputation from January 1 to December 31, 1993, in six metropolitan statistical areas in south Texas. Amputation level was defined by ICD-9-CM codes and were categorized as foot, leg, and thigh amputations. Foot-level amputations were further subcategorized as hallux or first ray, middle, fifth, multiple digit or ray, and midfoot amputations. Only the highest amputation level for each individual was used in the analysis. Of 1,043 subjects undergoing a lower extremity amputation in south Texas in the year 1993, 477 received their amputation at the level of the foot. African-Americans requiring a foot-level amputation were at significantly higher risk to undergo a midfoot-level amputation than was the rest of the population. Nearly 40% of all subjects undergoing a foot-level amputation had a previous history of amputation. However, nearly 40% of subjects undergoing foot amputations had not been diagnosed either before or during admission with peripheral arterial occlusive disease, suggesting a causal pathway dependent primarily on neuropathy. This implies that better screening of diabetic patients with appropriate risk-directed treatment at the primary care level may significantly impact the large number of preventable diabetes-related lower extremity amputations.
The natural history of acute Charcot's arthropathy in a diabetic foot specialty clinic
Authors: Armstrong DG , Todd WF , Lavery LA , Harkless LB , Bushman TR
Published: April 2014

The aim of this longitudinal study was to report on the clinical characteristics and treatment course of acute Charcot's arthropathy at a tertiary care diabetic foot clinic. Fifty-five diabetic subjects, with a mean age of 58.6 +/- 8.5 years, were studied. All patients were treated with serial total contact casting until quiescence. Following casting and before transfer to prescription footwear, patients were eased into unprotected weightbearing via a removable cast walker. This cohort was followed for their entire treatment course and for a mean 92.6 +/- 33.7 weeks following return to shoes. Pain was the most frequent presenting complaint in these otherwise insensate patients (76%). The mean duration of casting was 18.5 +/- 10.6 weeks. Patients returned to footwear in a mean 28.3 +/- 14.5 weeks. Nine per cent of the population had bilateral arthropathy. These subjects were casted significantly longer than the unilateral group (p < 0.02). Surgery was performed on 25% of patients, with approximately two-thirds of these procedures involving plantar exostectomies and one-third fusions of affected joints. Patients receiving surgery remained casted significantly longer than non-surgical patients (p < 0.05). Additionally, men were casted longer than women (p < 0.008). Acute Charcot's arthropathy requires prompt, uncompromising reduction in weightbearing stress. Our data show that the ambulatory total contact cast is very effective for this. Regardless of the specific treatment method instituted, it is imperative that appropriate and aggressive treatment be undertaken immediately following diagnosis to help prevent progression to a profoundly debilitating, limb-threatening deformity.
Lower extremity macrovascular disease in diabetes
Authors: Arora S , LoGerfo FW
Published: April 2014

Lower extremity macrovascular disease is more common and progresses more rapidly in the presence of diabetes and has a characteristic peritibial distribution with sparing of the foot arteries. The biology of the diabetic foot is compromised, thereby making it more susceptible to injury. Hence, compromises in perfusion have a greater significance, warranting an aggressive approach to revascularization.
Angioleiomyoma of the lower extremity
Authors: Hanft JR , Carbonell JA , Do HQ
Published: April 2014

Angioleiomyomas are benign soft tissue lesions that should be included in the differential diagnosis of any pedal soft tissue mass. There should be an increased index of suspicion for angioleiomyoma, especially when a freely movable subcutaneous mass is encountered in a middle-aged female patient. Treatment of such masses should involve surgical excision to relieve the symptomatology and to obtain tissue for a definitive histologic analysis. If the mass recurs, then the possibility of leiomyosarcoma should be explored.
Possible therapeutic effects of growth hormone on wound healing in the diabetic patient
Authors: Massey KA , Blakeslee C , Pitkow HS
Published: April 2014

Growth factors are increasingly investigated for their role in wound healing. The authors present evidence from human and animal studies suggesting that growth hormone induces a positive nitrogen balance, enhances connective-tissue synthesis, and increases lean body mass. The physiology of diabetes and wound healing is reviewed in the context of how growth hormone therapy could benefit this patient population.
Extraskeletal chondroma of the foot
Authors: Williams DS , Zichichi S
Published: April 2014

Extraskeletal chondroma is a rare, benign cartilaginous tumor seen most frequently in the soft tissues of the hands and feet. The authors present a case of extraskeletal chondroma in a 52-year-old male patient who had a small mass on the left foot involving the flexor surface of the second toe. Radiographs showed the presence of a soft-tissue mass with scattered calcified foci. Surgical excision revealed a benign, lobulated cartilaginous tumor with prominent areas of calcification. Histologically; the lesion consisted of cartilage cells with centralized zones of cellular pleomorphism and giant-cell proliferation at the tumor margin consistent with extraskeletal chondroma.
Location and indexing of articles written by podiatric physicians
Authors: Parkinson A , Fikar CR
Published: April 2014

This study was undertaken to determine which biomedical journals contain articles written by podiatric physicians and in which indexing sources such articles are likely to appear. A survey was conducted of the 20 most frequently published podiatrist authors from a selected group of podiatric journals during the period from 1990 to 1995. Articles published by these authors during the study period were examined to determine where they had appeared. The MEDLINE database was found to contain the largest number of citations to articles written by these podiatric physicians. Both the Podiatry Index and Embase are also very good sources of citations to podiatric medical literature and should be used to supplement MEDLINE searches.
Ankle-joint salvage following a tibial pilon fracture. A case report
Authors: O'Shea MK , Lewis KA
Published: April 2014

This article presents a case of a tibial pilon fracture following a motor-vehicle accident. It discusses the main classification system and mechanism of injury for such fractures and emphasizes an alternative form of treatment of the usually suggested ankle fusion: an arthrectomy, which allows motion, thereby salvaging the ankle joint.
Tumoral calcinosis-like lesion of the foot. A case report
Authors: Chalmers GW , Brown WR , Stienstra JJ
Published: April 2014

Tumoral calcinosis-like lesions of the foot are a pedal manifestation of end-stage renal disease. Although they are benign, they have the potential to cause significant morbidity because of their invasive nature. Following a brief description of tumoral calcinosis-like lesions, the authors provide an illustrative case presentation including radiographs, magnetic resonance images, surgical photographs, and histopathology.
Rare presentation of hereditary multiple exostoses. A case report
Authors: Farrett WD , Stone PA , McGarry JJ
Published: April 2014

Hereditary multiple exostoses is a relatively uncommon disorder of endochondral bone characterized by the presence of multiple, cartilaginous-capped exostoses arising from the metaphyses. A rare presentation of hereditary multiple exostoses in the calcaneus of a 35-year-old man is reviewed and discussed. A brief review of the literature is provided, as well as a discussion of the patient's family history.
Measurement of tibial torsion
Authors: Lang LM , Volpe RG
Published: April 2014

The anatomic accuracy of noninvasive in vivo measurement of tibial torsion was investigated through a comparison of goniometer measurements with those made on computed tomographic images. Seven normal subjects (2 women and 5 men; 14 legs) who ranged in age from 26 to 73 years were studied. The findings indicated that there was good agreement between measurements made by the two methods on the same limb. However, structural inconsistencies were found that cast doubt on the validity of certain anatomic reference points traditionally used in vivo studies of tibial torsion. In particular, use of the tibial tuberosity as a proximal reference may not give a true measurement of tibial or tibiofibular torsion.
Guidelines for evaluation and management of five common podopediatric conditions
Authors: Connors JF , Wernick E , Lowy LJ , Falcone J , Volpe RG
Published: April 2014

Practice guidelines for five of the most common podopediatric deformities are presented. In establishing these diagnosis and management guidelines, the authors have reviewed an extensive body of literature and considered their experience as clinicians in one of the busiest settings for the evaluation and treatment of disorders of children's feet. No attempt has been made to be encyclopedic; rather, the authors emphasize practical visual descriptors and the rationale for treatment to demonstrate the value of early intervention in moderate-to-severe orthopedic pathology of the foot and leg.
Foot and ankle injuries among martial artists. Results of a survey
Authors: Burks JB , Satterfield K
Published: April 2014

The practice of the martial arts is associated with a variety of lower-extremity injuries. Previous studies of the martial arts have examined injuries to the entire body, while providing only limited information on trauma to the foot and ankle. After a comprehensive review of the literature on martial arts injuries, the authors report the results of a survey on foot and ankle injuries sustained by martial arts practitioners.
Comparison of salicylic acid and urea versus ammonium lactate for the treatment of foot xerosis. A randomized, double-blind, clinical study
Authors: Jennings MB , Alfieri D , Ward K , Lesczczynski C
Published: April 2014

Xerosis is defined as dehydration of skin characterized by redness, dry scaling, and fine crackling that may resemble the crackling of porcelain. The present double-blind trial was a randomized paired comparison study evaluating the keratolytic effect of 5% salicylic acid and 10% urea ointment (Kerasal) on one foot and 12% ammonium lactate lotion (Lac-Hydrin) on the other foot in mild-to-moderate xerosis. Seventy patients were initially enrolled in the trial. Fifty-four patients were evaluated after 2 weeks of treatment; of those 54 patients, 39 were evaluated after 4 weeks of treatment. Although there was significant improvement in severity of xerosis after 2 and 4 weeks of treatment, there was no statistically significant difference between treatment groups. Irrespective of the mechanism of action, this study shows that both Kerasal and Lac-Hydrin 12% lotion result in reduction in the severity of xerosis after 4 weeks of therapy.
Effect of shoe color on shoe temperature and potential solar injury to the insensate foot
Authors: DeLuca PA , Goforth WP
Published: April 2014

The authors compared shoes of different colors in terms of the amount by which their temperature increased when subjected to radiant heat. Three trials of temperature measurements were performed for white and black leather walking shoes. A balloon filled with water was placed in the shoe and the surface temperature of the balloon was measured at baseline and after the shoe had been exposed to an infrared heat lamp for 15- and 30-minute periods. The results were significant: The mean increase in temperature after 15 minutes of exposure was between 4.0 degrees F and 8.8 degrees F greater in the black shoe than in the white shoe. After 30 minutes of exposure, the mean increase in temperature was between 7.8 degrees F and 13.6 degrees F greater in the black shoe than in the white shoe. This information can help prevent thermal injury to the insensate foot when shoes are worn in the sun for a prolonged period. Brief case reports of three patients who experienced such thermal injury are presented.
Refsum's disease. A unique case
Authors: Jaffe DF , Crezee KS , Mason S , Leavens-Chiarelli T , Lawrence W
Published: April 2014

Refsum's disease, or heredopathia atactica polyneuritiformis, is a peroxisomal disorder leading to the accumulation of phytanic acid throughout the body. It affects sensory and motor neurons and the skeletal system. Peripheral neuropathy, ataxia, blindness, deafness, and skeletal hyperostosis are significant findings used in the diagnosis of the disease.
Characterization of plantar verrucae among individuals with human immunodeficiency virus
Authors: Meberg R , Kenyon E , Bierman R , Loveland L , Barbosa P
Published: April 2014

Plantar verrucae, caused by human papillomavirus (HPV), are commonly found in patients who have tested positive for the antibodies to human immunodeficiency virus (HIV). A better understanding of the characteristics of plantar verrucae in HIV+ patients in needed. A pilot study was conducted concentrating on three characteristics--the size, the number, and the clinical type--of verrucae present in this population. These parameters were studied in HIV+ and HIV- populations, and they were evaluated in relation to the CD4 levels of HIV+ individuals. The HIV+ individuals presented with plantar verrucae that were larger and more numerous than those found in HIV- individuals. The HIV+ population presented with all three clinical types of plantar verrucae and had significantly more mosaic-type warts than did HIV- individuals. The three characteristics did not correlate with CD4 cell counts, suggesting that the severity and extent of HPV infection do not depend on the level of immunosuppression of the HIV+ patient.
Effect of scalpel debridement on the pain associated with plantar hyperkeratosis
Authors: Redmond A , Allen N , Vernon W
Published: April 2014

Seventy-nine subjects from 14 centers in eight English National Health Service Trusts recorded their levels of preoperative and postoperative pain and perceived change in pain on 100-mm visual analog scales before and after scalpel debridement of painful plantar hyperkeratosis. A significant reduction in pain was reported following treatment, and there were highly significant differences between the preoperative and postoperative scores. There were no age- or sex-related differences in any of the preoperative, postoperative, or perceived-change scores. The objective data support the anecdotal evidence that scalpel debridement of painful plantar hyperkeratosis is immediately effective in the palliative management of such patients.
Subungual malignant melanoma mimicking a squamous cell carcinoma
Authors: Robinette JW , Hahn PJ , Naples JJ
Published: April 2014

When a suspicious lower-extremity lesions is encountered, an appropriate biopsy should be performed. The lesion must then be excised with the proper margins and submitted for pathologic evaluation to ensure complete removal.
The plantar transverse incisional approach for heel spur syndrome. A retrospective study
Authors: Thornton D , Ruelle AL
Published: April 2014

The efficacy of the transverse plantar incisional approach for the treatment of recalcitrant heel spur syndrome or plantar fasciitis was investigated by evaluating cases of this procedure performed by the authors from 1991 to 1998. Patient records were reviewed for conservative treatment rendered prior to surgical intervention as well as for the perioperative course of the patient. All patients were asked to complete questionnaires regarding their heel spur syndrome or plantar fasciitis and their opinion of both the conservative and the surgical treatments received.
Limb salvage with Chopart's amputation and tendon balancing
Authors: Reyzelman AM , Hadi S , Armstrong DG
Published: April 2014

For several decades, Chopart's amputation has met with some skepticism owing to reports of significant equinus deformity developing soon after the procedure is performed. However, with appropriate tendon balancing, which generally includes anterior tibial tendon transfer and tendo Achillis lengthening, this level of amputation is often more functional than slightly more distal amputations, such as Lisfranc or short transmetatarsal amputations. The authors offer a rationale for this observation, which includes a discussion of the longitudinal and transverse arch concept of the foot. This concept dictates that the shorter the midfoot-level amputation, the more likely the patient is to develop an equinovarus deformity, thus exposing the fifth metatarsal base and cuboid to weightbearing stress and a high risk of ulceration. Chopart's amputation, in eliminating the cuboid, often obviates the potential varus deformity and thus can have a more acceptable long-term result.
Planovalgus foot deformity. Current status
Authors: Staheli LT
Published: April 2014

Flatfoot may be classified as pathologic or physiologic. Pathologic flatfoot is often characterized by stiffness of the foot, causes disability, and requires treatment. Physiologic flatfoot is a normal variation; it causes no disability and tends to improve with time. Physiologic flatfoot is most common in individuals who are loose-jointed, are obese, or usually wore shoes during childhood. Treatment of children with physiologic flatfoot with orthoses or shoe modifications not only is ineffective but is uncomfortable and embarrassing for the child and is associated with lowered self-esteem in adult life.
Chronic low-back pain and its response to custom-made foot orthoses
Authors: Dananberg HJ , Guiliano M
Published: April 2014

A new approach to treating chronic low-back pain with custom-made foot orthoses was investigated. The Quebec Back Pain Disability Scale was used to objectively assess the functional disability of 32 subjects at different times. Subjects in this prospective study experienced more than twice the improvement in alleviation of pain, and for twice as long, compared with subjects in a study using traditional back-pain treatment. The authors believe that the findings of this study may provide a new method by which patients with chronic low-back pain can be evaluated and treated.
Center of pressure and its theoretical relationship to foot pathology
Authors: Fuller EA
Published: April 2014

The measurement of center of pressure has been widely used in the evaluation of foot function. This article will describe center of pressure and indicate how it can be used to calculate moments about the joint axes of the foot. Various uses of center of pressure described in the literature will be examined. A model based on the use of the location of center of pressure relative to the location of the subtalar joint axis will be proposed as a theoretical explanation of selected foot pathologies and their treatment.
Integrating strategies for podiatric public health, clinical services, and education
Authors: Helfand AE
Published: April 2014

Changes in the health-care system will continue to modify the delivery of podiatric medical care and podiatric medical education. Podiatric medicine and its educational programs will need to focus on the management of care, special populations, and disease prevention. Future providers will need to participate as team members and respond to new patterns of care, including the special needs of the older population. This article explores methodologies for professional activities, administration, incentives for change, academic issues, innovation, implementation, outcome measures, and health policy development. Podiatric medicine must be prepared to establish standards, protocols, and guidelines to serve as the benchmark for foot health.
Avascular necrosis of the first metatarsal head. A different perspective
Authors: Banks AS
Published: April 2014

Avascular necrosis of the first metatarsal head has been reported as a potential complication associated with osteotomies at the first metatarsal head for repair of hallux abducto valgus deformity. However, most if not all of the radiographic and clinical findings associated with avascular necrosis at this level may also be explained by other processes. A critical review of avascular necrosis of the first metatarsal head is presented in conjunction with a discussion of alternative etiologies for the radiographic and clinical findings that may be noted following capital osteotomies.
The use of low-dose trazodone in the treatment of painful diabetic neuropathy
Authors: Wilson RC
Published: April 2014

Thirty-one adult diabetic patients with painful distal symmetrical polyneuropathy were treated with low doses of oral trazodone (50 or 100 mg/day). After 2 weeks of therapy, 19 patients (61.3%) experienced symptomatic relief, and 7 (22.6%) experienced complete relief. Although 8 patients (25.8%) discontinued the drug because of side effects, these were relatively minor (dizziness, headache, insomnia). Low-dose trazodone is recommended as an effective treatment option for painful diabetic neuropathy.
Biomechanics of the tarsal mechanism. A key to the function of the normal human foot
Authors: Huson A
Published: April 2014

This article describes the function of the tarsal complex as a constrained mechanism. The relationship between the interdependence of the motions of the tarsal joints and the special nature of tarsal joint function is explained, with emphasis on the midtarsal joint and its presumed two axes of motion.
Ciclopirox 8% nail lacquer in the treatment of onychomycosis of the toenails in the United States
Authors: Gupta AK , Joseph WS
Published: April 2014

Ciclopirox 8% nail lacquer has recently become the first topical antifungal agent to be approved by the US Food and Drug Administration for the treatment of onychomycosis. This article reviews the results of the two pivotal clinical trials of this drug that have been performed in the United States as well as those that have been carried out in other countries. The two US studies were both double-blind, vehicle-controlled, parallel-group, multicenter studies designed to determine the efficacy and safety of ciclopirox nail lacquer in the treatment of mild-to-moderate onychomycosis of the toenails caused by dermatophytes. The combined results show a 34% mycologic cure rate, as compared with 10% for the placebo. Data from the ten studies conducted worldwide show a meta-analytic mean (+/- SE) mycologic cure rate of 52.6% +/- 4.2%. As expected for a topical agent, ciclopirox nail lacquer was found to be extremely safe, with mild, transient irritation at the site of application reported as the most common adverse event. Ciclopirox nail lacquer may also have potential for use in combination or adjunctive therapy. Further studies will help to better position this agent for the treatment of this widespread podiatric condition.
The potential benefits of advanced therapeutic modalities in the treatment of diabetic foot wounds
Authors: Hogge J , Krasner D , Nguyen H , Harkless LB , Armstrong DG
Published: April 2014

This article discusses the advantages and disadvantages of primary wound healing as compared with primary amputation in individuals with chronic diabetic foot wounds. The authors review the potential benefits of vascular surgical procedures and advanced dressings, including two of the most promising modalities in modern wound care: growth factors and bioengineered skin. In this era of cost-conscious health-care administration, it is incumbent on the practitioner to consider not only the basic science of wound care, but also the economic aspect of treatment rendered. These various interventions, dressings, growth factor delivery systems, and new modalities could significantly reduce healing time, thereby reducing the risk of infection, hospitalization, and amputation while improving quality of life. If so, they may be truly cost-effective.
The instep plantar fasciotomy for chronic plantar fasciitis. A retrospective review
Authors: Fishco WD , Goecker RM , Schwartz RI
Published: April 2014

A retrospective study was conducted on the use of the instep plantar fasciotomy for the treatment of recalcitrant plantar fasciitis. A total of 83 patients (94 feet) were analyzed. The average postoperative follow-up time was 20.9 months. Surgery was deemed successful 93.6% of the time, and in 95.7% of cases, the patient would recommend the procedure to someone with the same condition. The main complications were scarring (9.6%), medial arch or heel pain (7.5%), cramping in the arch (6.4%), lateral column pain (5.3%), aching or pain across the dorsal midfoot (5.3%), and burning or tingling of the ball of the foot (5.3%).
Wound-care resources on the Internet
Authors: Fikar CR , Corral OL
Published: April 2014

The Internet offers many resources in the area of wound and ulcer care that are of potential interest to podiatric physicians and students. This article provides an overview of World Wide Web sites that contain factual information, management guidelines, and illustrations pertaining to various aspects of wound and ulcer care. Web sites that emphasize preventive care are also reviewed. Because the prudent use of antimicrobial therapy is an important part of wound care, a few sites that offer antibiotic information are described.
Primary closure of infected diabetic foot wounds. A report of closed instillation in 30 cases
Authors: Connolly JE , Wrobel JS , Anderson RF
Published: April 2014

Multiple surgical strategies are available for managing the infected diabetic foot at risk for amputation. The authors present their experience with the closed instillation system in the management of 30 such cases in 29 patients over a 5-year period. Data were collected from the hospital records of neuropathic patients presenting with deep-plantar-space infections or presumed acute osteomyelitis. All 29 patients were male; 57% had marginal or poor vascular supply, and 83% were nutritionally compromised or had proteinuria. At the conclusion of the study, 34% of the patients were dead, reflecting the severity of comorbid conditions found in this population. Despite the marginal healing capacity of these patients, the procedure had a 90% success rate, as defined by expeditious return to prior level of functioning and residential living situation without need for re-operation or higher-level amputation.
Proximal articular set angle. Radiographic versus intraoperative measurement
Authors: Evans RD , Lile LN
Published: April 2014

The authors conducted a study to investigate the variability of measurement of the proximal articular set angle. The proximal articular set angle as measured radiographically was compared with the proximal articular set angle as measured intraoperatively. Three groups of evaluators--attending physicians, residents, and third-year podiatric medical students--measured the proximal articular set angle radiographically. The mean measurement, standard deviation, and difference between the mean radiographic measurement and the intraoperative measurement were determined for each group. The authors concluded that the only accurate proximal articular set angle measurement is the intraoperative measurement.
Computed tomographic imaging of the foot and ankle. Developmental and congenital anomalies
Authors: Lomasney LM , Demos TC , Harris EJ
Published: April 2014

Computed tomography is a primary imaging technique for evaluating congenital and developmental anomalies of the foot and ankle. Other imaging modalities have special capabilities, but computed tomography is a fast, safe, and effective method of assessing the anatomy. To demonstrate this point, the authors present and discuss imaging findings of common anomalies of the foot and ankle.
The Boyd amputation as a treatment for osteomyelitis of the foot
Authors: Grady JF , Winters CL
Published: April 2014

The Boyd amputation is a surgical technique used to treat osteomyelitis of the foot. This amputation is a technically more difficult procedure to perform than the Syme amputation, but it offers certain advantages. The Boyd amputation provides a more solid stump because it preserves the function of the plantar heel pad. Also, because a portion of the calcaneus is left and fused to the tibia, the weightbearing surface is more solid than in the case of a Syme amputation. The authors recommend a Boyd amputation as an alternative to a Syme or a below-the-knee amputation to treat patients with osteomyelitis of the forefoot and midfoot.