bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessment of Plantar Pressure in Hindfoot Relief Shoes of Different Designs
Authors: Hahn Thomas , Carl Hans-Dieter , Jendrissek Andreas , Brem Matthias , Swoboda Bernd , Rummel Philipp , Pauser Johannes
Published: April 2014

Background

Although there are several different concepts of hindfoot relief footwear, there are no studies on the extent of pressure reduction to be achieved by this footwear. Therefore, we sought to evaluate the reduction in plantar pressure to be achieved with two different hindfoot relief shoes.

Methods

Ten healthy volunteers performed three trials at a self-selected speed. Peak pressure values in mass-produced shoes (normal gait) were considered as 100% and were compared with measurements in two differently designed hindfoot relief shoes. Foot portions were defined as heel (0%–15% of total insole length), hindfoot (16%–30%), midfoot (31%–60%), and forefoot (61%–100%).

Results

Heel and hindfoot peak pressures were significantly reduced in both shoes compared with normal gait (P < .05), but the extent of peak pressure reduction under the heel and hindfoot varied significantly between the tested shoes. Midfoot peak pressure was not significantly reduced in tested shoes compared with baseline (P > .05) but differed significantly between the two shoes. Forefoot peak pressure was significantly reduced with one of the tested shoes (to a median 73% baseline; P = .004) but not with the other (median, 88% baseline).

Conclusions

Hindfoot relief shoes leave a considerable amount of peak pressure, predominantly under the hindfoot. The extent of peak pressure reduction for the heel and the hindfoot varies between different hindfoot relief shoes. Depending on the affected foot area, the kind of hindfoot relief shoe should be carefully chosen.
Effect of Orthotic Therapy on Claw Toe Loading
Authors: Claisse Penny J. , Binning Jodi , Potter Julia
Published: April 2014

This study demonstrates the effect of orthotic therapy for toe deformity on toe and metatarsal head pressures using a new analysis method facilitated by an in-shoe pressure-measurement system’s ability to export detailed data. Plantar pressure–time integrals in 11 individuals (22 feet) with claw deformity of the lesser toes were measured with and without toe props. Differences in pressure–time integrals at every individual sensor unit were then calculated for the two conditions, and significance was tested using the paired t-test. Plantar surface charts with contours of equal significant pressure–time integral change showed significant reduction under 17 second toes (77%), 22 third toes (100%), 15 fourth toes (68%), 13 second metatarsal heads (59%), 16 third metatarsal heads (73%), and 16 fourth metatarsal heads (73%). All 22 feet showed increases under the prop in the area of the third toe sulcus. This innovative approach to plantar pressure analysis could improve access to data that show significant pressure–time integral changes and, therefore, could advance the clinical application of plantar pressure measurement. (J Am Podiatr Med Assoc 94(3): 246–254, 2004)
Forefoot Plantar Pressures in Rheumatoid Arthritis
Authors: Otter Simon J. , Bowen Catherine Jane , Young Adam K.
Published: April 2014

We sought to investigate the magnitude and duration of peak forefoot plantar pressures in rheumatoid arthritis. The spatial and temporal characteristics of forefoot plantar pressures were measured in 25 patients with a positive diagnosis of rheumatoid arthritis of 5 to 10 years’ duration (mean, 8 years) and a comparison group using a platform-based pressure-measurement system. There were no significant differences between groups in the magnitude of peak plantar pressure in the forefoot region. Significant differences were, however, noted for temporal aspects of foot-pressure measurement. The duration of loading over sensors detecting peak plantar pressure was significantly longer in the rheumatoid arthritis group. In addition, the rheumatoid arthritis group demonstrated significantly greater force–time integrals. Significant increases in the temporal parameters of plantar pressure distribution, rather than those of amplitude, may be characteristic of the rheumatoid foot. (J Am Podiatr Med Assoc 94(3): 255–260, 2004)
Sagittal Plane Compensations for Artificially Induced Limitation of the First Metatarsophalangeal Joint
Authors: Hall Christine , Nester Christopher J.
Published: April 2014

This study was undertaken to establish whether reduced dorsiflexion at the first metatarsophalangeal joint affects sagittal plane kinematics at the ankle, knee, and hip. Twenty individuals with symptom-free metatarsophalangeal joints were studied as they walked with and without an insole designed to restrict first metatarsophalangeal joint dorsiflexion. Sagittal plane kinematics at the ankle, knee, and hip were compared in the two conditions. When walking with the insole, the ankle was more dorsiflexed during late midstance and less plantarflexed during propulsion, the knee was more flexed during midstance, and the hip was less extended during late midstance. This evidence of a link between the first metatarsophalangeal joint and the kinematics of the proximal joints demonstrates the potential for the clinical entities of hallux rigidus and hallux limitus to influence gait and justifies more detailed study of this relationship. (J Am Podiatr Med Assoc 94(3): 269–274, 2004)
Analgesic Efficacy of Preoperative Parecoxib Sodium in an Orthopedic Pain Model
Authors: Desjardins Paul J. , Traylor Louise , Hubbard Richard C.
Published: April 2014

The efficacy and safety of preoperative intravenous administration of parecoxib sodium, a novel parenteral prodrug of a cyclooxygenase-2 selective inhibitor, in treating postoperative pain resulting from bunionectomy were evaluated in 50 patients who were part of a larger cohort of orthopedic and podiatric patients. Following bunionectomy, the median time to rescue medication (survival analysis) was 4 hours 18 min (95% confidence interval, 3 hours 4 min to 4 hours 37 min) in the placebo group, 7 hours 5 min (95% confidence interval, 3 hours 20 min to >24 hours) in the 20-mg parecoxib sodium group, and 10 hours 43 min (95% confidence interval, 4 hours 42 min to 14 hours 7 min) in the 40-mg parecoxib sodium group (significant for 40-mg parecoxib sodium versus placebo). Four or more hours after surgery, the mean pain-intensity (categorical) score was significantly lower in both parecoxib sodium groups than in the placebo group. Preoperative administration of parecoxib sodium was well tolerated and significantly reduced postoperative pain in patients who had undergone bunionectomy. (J Am Podiatr Med Assoc 94(3): 305–314, 2004)
Radiography of Soft Tissue of the Foot and Ankle with Diffraction Enhanced Imaging
Authors: Li Jun , Zhong Zhong , Lidtke Roy , Kuettner Klaus E. , Peterfy Charles , Aliyeva Elmira , Muehleman Carol
Published: April 2014

Non-calcified tissues, including tendons, ligaments, adipose tissue and cartilage, are not visible, for any practical purposes, with conventional X-ray imaging. Therefore, any pathological changes in these tissues generally necessitate detection through magnetic resonance imaging or ultrasound technology. Until recently the development of an X-ray imaging technique that could detect both bone and soft tissues seemed unrealistic. However, the introduction of diffraction enhanced X-ray imaging (DEI) which is capable of rendering images with absorption, refraction and scatter rejection qualities has allowed detection of specific soft tissues based on small differences in tissue densities. Here we show for the first time that DEI allows high contrast imaging of soft tissues, including ligaments, tendons and adipose tissue, of the human foot and ankle. (J Am Podiatr Med Assoc 94(3): 315–322, 2004)
A Patient Satisfaction Survey on Prescription Custom-Molded Foot Orthoses
Authors: Walter John H. , Ng Gregory , Stoltz Jennifer J.
Published: April 2014

A survey of patients treated at the Foot and Ankle Institute at the Temple University School of Podiatric Medicine in Philadelphia, Pennsylvania, was conducted regarding their satisfaction with thermoplastic prescription foot orthoses. Two hundred seventy-five completed questionnaires from patients who had had their orthoses for 1 year or more were analyzed. Overall, the majority of respondents indicated that they were satisfied with their devices, obtaining significant (60% to 100%) relief of symptoms. Very few patients indicated total dissatisfaction; only 9% reported 0% relief of their symptoms. The data strongly suggest that custom-molded foot orthoses are an effective and viable treatment modality associated with a high level of patient satisfaction. (J Am Podiatr Med Assoc 94(4): 363–367, 2004)
A Survey of Podiatric Medical Students’ Computer Literacy
Authors: Morewitz Stephen J. , Shaw Graham P. , Clark Joel R. , Mullins Samantha
Published: April 2014

This article reviews the extent of health-care students’ computer literacy and presents the results of a survey of podiatric medical students’ computer literacy. The results of this survey indicate that podiatric medical students are more likely than other health-care students to rate their computer literacy as good or very good. There was no gender difference in this self-reported computer knowledge. The implications for designing and using Web-based instructional materials and technology for podiatric medical students are discussed. (J Am Podiatr Med Assoc 94(4): 375–381, 2004)
Size and Shape Differences Between Male and Female Foot Bones
Authors: Ferrari Jill , Hopkinson David A. , Linney Alf D.
Published: April 2014

This study introduces a new technique to measure bone size and shape. A three-dimensional laser scan was taken of the talus, navicular, medial cuneiform, and first metatarsal from 107 skeletons of known age and sex. The bones were analyzed for differences in bone morphology between the sexes and the ability of each bone to contribute to the adducted position of the first metatarsal. Linear measurements showed that male bones were larger than female bones. Measurements of articular surfaces suggested that female bones had the potential for more movement to occur in the direction of adduction, possibly resulting in the female first metatarsal being more adducted than that in the male skeleton. Such differences may underlie the predisposition of the female foot to develop hallux valgus deformity. (J Am Podiatr Med Assoc 94(5): 434–452, 2004)
Vascular Anomalies (Birthmarks) of the Foot and Ankle
Authors: Konez Orhan
Published: April 2014

Vascular anomalies (birthmarks) commonly involve the feet and ankles. Little is known about these anomalies among practicing physicians. In this article, vascular anomalies are described, and detailed information is presented regarding appropriate diagnostic work-up and treatment strategies. (J Am Podiatr Med Assoc 94(5): 477–482, 2004)
Preventive Foot-Care Practices Among Adults with Diabetes in North Carolina, 1997 to 2001
Authors: White John C. , Bell Ronny A. , Langefeld Carl D. , Jackson Sharon A.
Published: April 2014

Preventive foot-care practices, such as annual foot examinations by a health-care provider, can substantially reduce the risk of lower-extremity amputations. We examined the level of preventive foot-care practices (reported rates of having at least one foot examination by a physician) among patients with diabetes mellitus in North Carolina and determined the factors associated with these practices. Of 1,245 adult respondents to the 1997 to 2001 North Carolina Behavioral Risk Factor Surveillance System, 71.6% reported that they had had their feet examined within the past year, a rate that is much higher than that previously reported by Bell and colleagues in the same population for 1994 to 1995 (61.7%). Foot care was more common among insulin users than nonusers, those having diabetes for 20 years or longer than those having diabetes for less than 10 years, blacks than whites, and those who self-monitored their blood glucose level daily than those who did not. The results of this study indicate that diabetes educational services can be directed at populations at high risk of ignoring the recommended foot-care practices indicated in these analyses, thereby reducing diabetes-related lower-extremity complications. (J Am Podiatr Med Assoc 94(5): 483–491, 2004)
A Comparison of Results from Two Mycology Laboratories for the Diagnosis of Onychomycosis
Authors: Scherer William P. , Scherer Michael D.
Published: April 2014

An investigative study was performed to compare the results from two mycology laboratories for the diagnosis of onychomycosis in a geriatric population and to determine the possible pharmacologic treatments based on the two laboratories’ results. In this study, 85 cases of suspected onychomycosis involving men and women 65 years and older from a nursing home setting in South Florida were used. Samples were taken from the hallux toenail and sent to two different mycology laboratories for fluorescent potassium hydroxide preparation and microscopic examination of a fungal culture. Of the 85 cases studied, the two mycology laboratories reported similar potassium hydroxide preparation results for 58.8% of the patients and similar fungal culture results for genus and species identification for 37.6% of the patients. When the potassium hydroxide preparation and fungal culture results were combined, the two mycology laboratories reported similar results for only 27.1% of the patients. As a result of the two mycology laboratories’ findings, the possible US Food and Drug Administration–approved pharmacologic treatments may differ for 43.5% of the patients studied. The discrepancy between the two independent laboratories leaves physicians to question the reproducibility of fluorescent potassium hydroxide preparation and fungal culture analysis in a geriatric patient population for the diagnosis of onychomycosis. (J Am Podiatr Med Assoc 94(6): 528–534, 2004)
The Effect of 5-Degree Valgus and Varus Rearfoot Wedging on Peak Hallux Dorsiflexion During Gait
Authors: Smith Catherine , Spooner Simon K. , Fletton John Alan
Published: April 2014

The dynamic effects of 5° varus and valgus rearfoot wedging on peak hallux dorsiflexion were investigated in 30 asymptomatic subjects (5 males and 25 females). Statistically significant reductions in peak hallux dorsiflexion were found with rearfoot varus wedging and rearfoot valgus wedging. Furthermore, the reduction in peak hallux dorsiflexion occurring with rearfoot varus wedging was statistically significant compared with that associated with rearfoot valgus wedging. These findings have implications for the orthotic management of a variety of lower-limb pathologies. (J Am Podiatr Med Assoc 94(6): 558–564, 2004)
Norwegian Scabies in the Immunocompromised Patient
Authors: Grabowski Greg , Kanhai Alicia , Grabowski Richard , Holewinski Jean , Williams Marie L.
Published: April 2014

Norwegian, or crusted, scabies can be defined as a generalized severe scabies (Sarcoptes scabiei var. hominis) infestation usually affecting the immunocompromised patient that is most commonly seen with the leukemia-lymphoma group of neoplasms. The diagnosis is commonly missed, which can lead to mismanagement. We describe a patient with Norwegian scabies involving the lower extremities. The patient circumstances and treatment, as well as a review of the literature, are presented. The diagnosis of scabies should always be considered in patients with advanced malignancies and associated pruritus. (J Am Podiatr Med Assoc 94(6): 583–586, 2004)
Realignment Considerations in the Triple Arthrodesis
Authors: Catanzariti Alan R. , Mendicino Robert W. , Whitaker Jeffrey M. , Reeves Christopher L.
Published: April 2014

Triple arthrodesis is indicated for pain, deformity, and instability of the tritarsal complex. Although osseous consolidation is important to outcome, success depends primarily on appropriate realignment. A poorly positioned triple arthrodesis may result in continued pain and disability, gait disturbances, excessive stress in adjacent joints, and footwear problems. We present a protocol for intraoperative realignment of the triple arthrodesis guided by image intensification. This protocol for alignment evaluation was followed in nine patients who underwent triple arthrodesis for a variety of pathologies. (J Am Podiatr Med Assoc 95(1): 13–17, 2005)
Static Rearfoot Alignment
Authors: Lamm Bradley M. , Mendicino Robert W. , Catanzariti Alan R. , Hillstrom Howard J.
Published: April 2014

Foot structure is typically evaluated using static clinical and radiographic measures. To date, the literature is devoid of a correlation between rearfoot frontal plane radiographic parameters and clinical measures of alignment. In a repeated-measures study comparing radiographic and clinical rearfoot alignment in 24 healthy subjects, radiographic angular measurements were made from standard weightbearing anteroposterior, lateral, long leg calcaneal axial, and rearfoot alignment views. Clinical measurements were made using a jig and scanner to assess the malleolar valgus index and a goniometer to evaluate the resting and neutral calcaneal stance positions. There was a significant correlation between frontal plane radiographic angles (long leg calcaneal axial and rearfoot alignment views) (r = 0.814). Similarly, there was a significant correlation between clinical measures (resting calcaneal stance position and malleolar valgus index) (r = 0.714). A multivariate stepwise regression showed that resting calcaneal stance position can be accurately predicted from 3 of the 15 clinical and radiographic measurements collected: malleolar valgus index, rearfoot alignment view, and long leg calcaneal axial view (r = 0.829). In summary, a commonly used clinical measure of static rearfoot alignment, resting calcaneal stance position, was correlated closely with the malleolar valgus index and both frontal plane radiographic parameters. (J Am Podiatr Med Assoc 95(1): 26–33, 2005)
Subtalar Joint Arthrodesis
Authors: Catanzariti Alan R. , Mendicino Robert W. , Saltrick Karl R. , Orsini Roman C. , Dombek Michael F. , Lamm Bradley M.
Published: April 2014

Forty patients (12 men and 28 women) treated with isolated subtalar joint arthrodesis were retrospectively reviewed. The average patient age was 50 years (range, 21–76 years). Preoperative diagnoses included posterior tibial tendon dysfunction, post-traumatic arthritis, nontraumatic arthritis, and subtalar joint middle facet coalition. The average follow-up was 15 months (range, 12–74 months). Subjective postoperative questionnaire results were classified as satisfied (n = 32), satisfied but with reservations (n = 4), or dissatisfied (n = 4). Eighty-three percent of the patients (n = 33) stated that they would undergo the procedure again. Minor complications (those that resolved with nonoperative treatment) occurred in 55% of the patients. However, the major complication rate was only 12.5%. This study showed no statistical correlation between the preoperative diagnosis and the postoperative outcome. Our results also suggested that the prevalence of complications is slightly higher than in previous reports. Isolated subtalar joint arthrodesis is an effective treatment for pain and deformity of the rearfoot. (J Am Podiatr Med Assoc 95(1): 34–41, 2005)
Realignment Arthrodesis of the Rearfoot and Ankle
Authors: Mendicino Robert W. , Lamm Bradley M. , Catanzariti Alan R. , Statler Trenton K. , Paley Dror
Published: April 2014

Ankle and tibiotalocalcaneal arthrodeses are performed for the treatment of painful, arthritic, unstable, and deformed rearfoot and ankle joints. Surgical complications are not uncommon (~30%); some can be attributed to poor preoperative planning and inadequate intraoperative position. Several authors have attempted to define the optimal position for ankle arthrodesis without objective multiplanar radiographic analysis and consistent reference points. This investigation explored the effects of ankle and tibiotalocalcaneal realignment arthrodeses on static lower-extremity position in 20 patients. The most common preoperative diagnosis was severe degenerative joint disease following ankle fractures and ankle instability. Seven tibiotalocalcaneal arthrodeses and 13 isolated ankle arthrodeses were performed (mean follow-up, 22 months). Average time to radiographic osseous union of the isolated ankle and tibiotalocalcaneal arthrodeses was 11 and 7 weeks, respectively. Medical complications occurred in 2 patients (10%). There were no statistically significant differences between preoperative and postoperative angular relationships. This study objectively quantifies multiplanar foot-to-leg realignment and defines the optimal clinical and radiographic positions for ankle and tibiotalocalcaneal realignment arthrodeses. (J Am Podiatr Med Assoc 95(1): 60–71, 2005)
Diffuse Pigmented Villonodular Synovitis
Authors: Peng Hai-En , Segler Christopher P. , Stavosky James W. , Dobbs Bruce M.
Published: April 2014

Pigmented villonodular synovitis is nonmalignant and nonmetastasizing, but it is locally destructive and can result in considerable disability through infiltration and involvement of surrounding soft tissues and bone. This article briefly describes the clinical picture of the diffuse form of pigmented villonodular synovitis and reports on two cases involving juxta-articular erosions of the calcaneocuboid joint. Treatment involved substantial curettage of bone and resection of infiltrated intrinsic musculature. (J Am Podiatr Med Assoc 95(2): 161–166, 2005)
Ulceration of Pyoderma Gangrenosum Treated with Negative Pressure Wound Therapy
Authors: Geller Stephen M. , Longton James A.
Published: April 2014

Pyoderma gangrenosum is a skin disease characterized by wounds with blue-to-purple undermined borders surrounding purulent necrotic bases. This article reports on a patient with a circumferential, full-thickness, and partially necrotic lower-extremity ulceration of unknown etiology. Results of laboratory tests and arterial and venous imaging studies were found to be within normal limits. The diagnosis of pyoderma gangrenosum was made on the basis of the histologic appearance of the wound tissue after biopsy as a diagnosis of exclusion. Negative pressure wound therapy was undertaken, which saved the patient’s leg from amputation. Although negative pressure wound therapy has demonstrated efficacy in the treatment of chronic wounds in a variety of circumstances, this is the first documented use of this technique to treat an ulceration secondary to pyoderma gangrenosum. (J Am Podiatr Med Assoc 95(2): 171–174, 2005)
Onychoplasty with Carbon Dioxide Laser Matrixectomy for Treatment of Ingrown Toenails
Authors: Farley-Sakevich Tara , Grady John F. , Zager Emil , Axe Timothy M.
Published: April 2014

Ingrown toenails are one of the most common pathologic conditions encountered in podiatric medical practice. Many methods of treatment for ingrown toenails have been used and studied, including chemical matrixectomies, surgical approaches, and CO2 laser ablation. This study is a retrospective review of a new technique that consists of resection of the involved nail matrix using a No. 15 blade and controlled cauterization using a CO2 laser. The technique was performed on 381 painful ingrown toenails, and all of the patients were followed up postoperatively for an average of 34 months. The results showed minimal pain, a low recurrence rate, rapid return to activity, and good cosmesis. (J Am Podiatr Med Assoc 95(2): 175–179, 2005)
Internet Resources for Podiatric Medical Students
Authors: Fikar Charles R.
Published: April 2014

This article presents a selection of Internet resources covering most of the subject areas found in standard medical education curricula. Basic-sciences sites are emphasized, but clinical resources are also included. Sites were evaluated on the basis of their potential to enhance the learning process, provide practice questions or study guides for examinations, or aid in the preparation of papers. Podiatric medical students, residents, and practitioners who require a quick reference guide to sources covering the basic-science foundations of podiatric medicine or the clinical side of general medicine may find this article useful. (J Am Podiatr Med Assoc 95(2): 211–215, 2005)
Cimetidine as a First-Line Therapy for Pedal Verruca
Authors: Mullen Barry R. , Guiliana John V. , Nesheiwat Fawaz
Published: April 2014

Can cimetidine therapy effectively stimulate the body’s immune response against warts? Several clinicians have anecdotally reported success using cimetidine against warts. Previous double-blind studies comparing cimetidine with placebo therapy have failed to statistically and scientifically corroborate those results. Between 1995 and 2002, 216 patients underwent an isolated course of oral cimetidine therapy for verruca plantaris. Our treatment outcomes closely parallel those obtained by other researchers. Cimetidine may be used as a safe, effective, lone treatment modality for verruca in all age groups. (J Am Podiatr Med Assoc 95(3): 229–234, 2005)
Foot Type and Overuse Injury in Triathletes
Authors: Burns Joshua , Keenan Anne-Maree , Redmond Anthony
Published: April 2014

Abnormal foot morphology has been suggested to contribute to overuse injuries in athletes. This study investigated the relationship between foot type and injury incidence in a large sample of competitive triathletes not wearing foot orthoses during a 6-month retrospective analysis and a 10-week prospective cohort study. Foot alignment was measured using the Foot Posture Index and the Valgus Index, and participants were assigned to supinated, pronated, and normal foot-type groups. Overall, 131 triathletes sustained 155 injuries during the study. Generally, foot type was not a major risk factor for injury; however, there was a fourfold increased risk of overuse injury during the competition season in athletes with a supinated foot type. The results of this study show that triathletes with a supinated foot type are more likely to sustain an overuse injury. (J Am Podiatr Med Assoc 95(3): 235–241, 2005)
Evaluation of Young’s Modulus in Achilles Tendons with Diabetic Neuroarthropathy
Authors: Grant William P. , Foreman Eric J. , Wilson Anne S. , Jacobus Dwayne A. , Kukla Renee M.
Published: April 2014

The Achilles tendon of the patient with Charcot’s foot neuroarthropathy has significantly altered physical properties compared with a normal tendon. Twenty-nine Achilles tendons from patients with Charcot’s foot (n = 20) and non-Charcot’s foot controls (n = 9) were loaded onto a biomechanical testing instrument. The biomechanical properties of the Charcot and control tendons were determined and the tendons were evaluated for differences in ultimate tensile strength and elasticity (Young’s modulus). Biomechanical test data show that there is a significant difference in ultimate tensile strength and elasticity between tendons of patients with Charcot’s foot and those of non-Charcot’s controls. The term diabetic tendo Achillis equinus is introduced as a new finding in diabetic neuroarthropathy. (J Am Podiatr Med Assoc 95(3): 242–246, 2005)
Partial Calcanectomy for the Treatment of Recalcitrant Heel Ulcerations
Authors: Randall David B. , Phillips John , Ianiro Goffredo
Published: April 2014

Pressure ulcers of the heel are a major and growing health-care problem. Although prevention and aggressive local wound care and pressure reduction remain the gold standard for treatment of most heel ulcers, recalcitrant wounds may require surgical intervention. Limb salvage when dealing with heel ulcers remains a challenge. Nine feet (eight patients) that underwent partial calcanectomy for chronic nonhealing heel ulcers were evaluated retrospectively. Complete healing occurred in seven of nine feet. Patients who were ambulatory before surgery remained ambulatory after healing. (J Am Podiatr Med Assoc 95(4): 335–341, 2005)
Effect of Regular Exercise on the Radiographic Progression of Foot Osteoarthritis
Authors: Wilder Frances V. , Barrett John P. , Farina Edward J.
Published: April 2014

Among the elderly, osteoarthritis often causes chronic pain and disability. Although research has addressed the association between exercise and osteoarthritis, few studies have examined the effect of exercise on the radiographic progression of osteoarthritis. We investigated the relationship between ongoing exercise and radiographic progression of foot osteoarthritis. The first metatarsophalangeal and medial cuneiform–first tarsometatarsal joints were assessed. Joint-specific osteoarthritis radiographic progression scores were determined using four assessments: joint space narrowing, osteophytes, sclerosis, and a composite score. This cohort study included a subset of 221 men and women aged 40 to 91 years participating in a community-based osteoarthritis study. Adjusted risk estimates (95% confidence intervals) summarizing the relationship between ongoing exercise and radiographic progression in the first metatarsophalangeal joint ranged from 0.34 (0.11–0.99) for osteophytes to 0.66 (0.23–1.92) for sclerosis; because only eight individuals experienced medial cuneiform–first tarsometatarsal joint progression, these estimates were less stable, ranging from 2.41 (0.49–11.83) for composite to 4.29 (0.11–166.52) for osteophytes. Overall, our findings do not suggest that regular exercise is a risk factor for foot osteoarthritis progression. Future replication studies are warranted to confirm these findings. (J Am Podiatr Med Assoc 95(4): 342–346, 2005)
Treatment of Verruca Plantaris with a Combination of Topical Fluorouracil and Salicylic Acid
Authors: Young Simon , Cohen Greg E.
Published: April 2014

A medical record review was conducted to determine the clinical outcome and average time to resolution of verruca plantaris in 20 patients treated with twice-daily applications of either 0.5% or 5.0% topical fluorouracil combined with topical 17% and 40% salicylic acid. Seven patients used 0.5% fluorouracil, and 13 used 5.0% fluorouracil. All of the lesions were sharply debrided at regular 1- or 2-week intervals. All 20 patients achieved full clinical resolution in a mean ± SD of 82.5 ± 56.6 days. Three patients (15%) had recurrent lesions, which subsequently resolved with repeated treatment. Two patients (10%) developed local dermatitis, which resolved with temporary discontinuation of the medication and the addition of a topical corticosteroid. It was observed that the twice-daily application of topical fluorouracil and salicylic acid is a safe and effective treatment for verruca plantaris. (J Am Podiatr Med Assoc 95(4): 366–369, 2005)
Use of High-Resolution Ultrasound in Evaluation of the Forefoot to Differentiate Forefoot Nerve Entrapments
Authors: Kincaid Brian R. , Barrett Stephen L.
Published: April 2014

Forefoot pain can have single or multiple etiologies, and frequently pain is attributed solely to a forefoot nerve entrapment. It is well known that forefoot nerve entrapments, such as Morton’s, can be falsely assumed to be the cause of forefoot pain when in fact other factors, such as plantar plate disturbances, are the true cause. Frequently, the cause of the patient’s forefoot pain starts as a forefoot nerve entrapment, but then, as a result of treatment with a corticosteroid injection, other pathologies manifest, such as plantar plate rupture. The development of high-resolution, high-frequency ultrasound scanners has opened the door to in-depth examination of peripheral nerves as well as small pericapsular and intracapsular joint structures of the foot and ankle. In the hands of an experienced clinician, ultrasound can play an important role in differentiating nerve lesions and entrapment syndromes from nonneurogenic pain generators, such as tendons, ligaments, fasciae, and joint capsules. The focus of this article is the forefoot, where differentiation of neuroma, neuritis, and capsulitis can be difficult. (J Am Podiatr Med Assoc 95(5): 429–432, 2005)
Tarsal Tunnel Surgery for Treatment of Tarsal Ganglion
Authors: Rosson Gedge D. , Spinner Robert J. , Dellon A. Lee
Published: April 2014

Three patients who originally presented with a mass in the tarsal tunnel are described to develop an algorithm for management of the tarsal ganglion. All three patients had complications from ganglion excision, including complete division of the posterior tibial nerve, injury to the posterior tibial artery, and ganglion recurrence. The guiding principles relating to the presence of an extraneural versus an intraneural ganglion are developed. An example of a posterior tibial intraneural ganglion is presented. (J Am Podiatr Med Assoc 95(5): 459–463, 2005)
Osteochondroma of the Talus in a Male Adolescent
Authors: Joshi Deepak , Kumar Narendra , Singh Davindar , Lal Yadu , Singh A. K.
Published: April 2014

Osteochondroma of the talus is rare but must be considered as part of the differential diagnosis of any swelling in this part of the skeleton. This article describes the differential diagnosis and treatment of osteochondroma of the talus in a male adolescent. Careful surgical planning in all cases of benign-appearing lesions of small bones will prevent the recurrence of this lesion and its complications. (J Am Podiatr Med Assoc 95(5): 494–496, 2005)
A Train-the-Trainer Model for Integrating Evidence-Based Medicine Training into Podiatric Medical Education
Authors: Green Michael L.
Published: April 2014

This article presents the development, implementation, and evaluation of a national evidence-based medicine faculty-development program for podiatric medical educators. Ten faculty members representing six accredited colleges of podiatric medicine, one podiatric medical residency program, and a Veterans Affairs podiatry service participated in a 2-day workshop, which included facilitated discussions, minilectures, hands-on exercises, implementation planning, and support after the workshop. Participants’ evidence-based medicine skills were measured by retrospective self-reported ratings before and after the workshop. Participants also reported their implementation of “commitments to change” on follow-up surveys at 3 and 12 months. Participants’ evidence-based medicine practice and teaching skills improved after the intervention. They listed a total of 84 commitments to change, most of which related to the program objectives. By 12 months after the workshop, participants as a group had fully implemented 24 commitments (32%), partially implemented 36 (48%), and failed to implement 15 (20%) of a total of 75 commitments with follow-up data. The most common barriers to change at 12 months were insufficient resources, systems problems, and short patient visit times. A train-the-trainer faculty-development program can improve self-reported evidence-based medicine skills and behaviors and affect curriculum reform at podiatric medical educational institutions. (J Am Podiatr Med Assoc 95(5): 497–504, 2005)
Podiatric Medical Students’ Evaluation of a Computerized Student-Patient Encounter Log System
Authors: Morewitz Stephen J. , Shaw Graham P. , Clark Joel R. , Mullins Samantha
Published: April 2014

The computerized student-patient encounter log system represents a considerable improvement in terms of efficiency and accuracy over traditional paper-based student-patient encounter reporting systems. The computerized log not only facilitates faculty monitoring of students’ assessment and management of health problems at geographically disparate locations but also provides a rich resource of data for enhancing clinical teaching and learning experiences. However, little is known about podiatric medical students’ experiences with Web-based computerized student-patient encounter log systems. The findings reported in this article suggest that the computerized student-patient encounter log was considered to be useful and effective by most of the podiatric medical students surveyed and represents an improvement over traditional paper-based recording systems. (J Am Podiatr Med Assoc 95(6): 556–563, 2005)
Determinants of Disabling Foot Pain in Retirement Village Residents
Authors: Menz Hylton B. , Morris Meg E.
Published: April 2014

The aim of this study was to evaluate the relative contribution of structural foot characteristics and comorbidities to the presence of disabling foot pain in older people. One hundred seventy-two people (55 men and 117 women) aged 62 to 96 years (mean ± SD, 80.1 ± 6.4 years) who lived in a retirement village underwent tests of foot posture, range of motion, and deformity in addition to completing a medical history questionnaire. Disabling foot pain was determined using the Manchester Foot Pain and Disability Index. Thirty-eight subjects (22%) reported disabling foot pain. Subjects with disabling foot pain had a higher body mass index and were more likely to be female; to report osteoarthritis in the spine, hips, hands or wrists, and feet; and to report pain in the back, hips, and hands or wrists. The only significant difference between the groups regarding structural foot characteristics was that those with disabling foot pain exhibited more severe hallux valgus deformity. The strongest determinants of disabling foot pain revealed by a discriminant function analysis were foot osteoarthritis, pain in the hips, and pain in the hands or wrists. These findings indicate that disabling foot pain in older people is more closely related to pain and osteoarthritis in other body regions than to structural characteristics of the foot, and they suggest that more severe forms of foot pain in older people may be a component of a general chronic pain syndrome or a polyarticular form of osteoarthritis. (J Am Podiatr Med Assoc 95(6): 573–579, 2005)
Os Vesalianum Pedis
Authors: Boya Hakan , Özcan Özal , Tandoğan Reha , Günal İzge , Araç Şükrü
Published: April 2014

Os vesalianum pedis is an accessory bone located proximal to the base of the fifth metatarsal. Its prevalence has been reported to be from 0.1% to 1.0%. This bone is found within the peroneus brevis tendon and is considered to be asymptomatic in the majority of people. We describe a patient with os vesalianum pedis with a distinct mediocuboidal articulation. The radiologic differential diagnosis of the ossicle is discussed. (J Am Podiatr Med Assoc 95(6): 583–585, 2005)
Functional Hallux Limitus and Lesser-Metatarsal Overload
Authors: Clough James G.
Published: April 2014

The implications of functional hallux limitus for lesser-metatarsal overload are discussed. A new method of treating functional hallux limitus is proposed, and three case histories are reviewed showing adequate resolution of symptoms using the proposed method of treatment. A proposed mechanism for the development of functional hallux limitus is discussed, and different methods of identification are illustrated. (J Am Podiatr Med Assoc 95(6): 593–601, 2005)
Power Spectral Analysis of Heart Rate Variability in Patients with Charcot’s Neuroarthropathy
Authors: Jirkovská Alexandra , Boucek Petr , Wu Stephanie , Hosová Jana , Bém Robert , Fejfarova Vladimira , Skibová Jelena
Published: April 2014

Charcot’s or neuropathic osteoarthropathy is one of the most debilitating orthopedic sequelae of diabetes mellitus. Distinguishing Charcot’s neuroarthropathy from clinically similar conditions may be challenging. The neurovascular theory postulates that Charcot’s neuroarthropathy may be secondary to sympathetic denervation of the lower-extremity vasculature. A convenient method for assessing autonomic neuropathy in patients with Charcot’s neuroarthropathy is needed. Short-term power spectral analysis (PSA) of heart rate variability (HRV), a noninvasive and quantitative method for assessing autonomic neuropathy, may be advantageous compared with the traditionally used Ewing’s cardiovascular reflex tests. However, there are limitations to the clinical use of PSA of HRV because of poor standardization. We standardized PSA of HRV and assessed autonomic neuropathy in 17 people with acute Charcot’s neuroarthropathy using PSA of HRV versus Ewing’s tests. More patients with Charcot’s neuroarthropathy were diagnosed as having autonomic neuropathy with PSA of HRV than with Ewing’s tests (94% versus 82%); however, no significant difference between the two methods was found. The results of this study suggest that PSA of HRV requires minimal patient collaboration and time expenditure compared with Ewing’s tests and may be useful in detecting autonomic neuropathy in patients with Charcot’s neuroarthropathy. (J Am Podiatr Med Assoc 96(1): 1–8, 2006)
Effect of Foot Posture and Inverted Foot Orthoses on Hallux Dorsiflexion
Authors: Munteanu Shannon E. , Bassed Adam D.
Published: April 2014

A pronated foot posture is considered to be a factor in limitation of dorsiflexion at the first metatarsophalangeal joint during weightbearing. Customized foot orthoses are widely used to increase dorsiflexion at the first metatarsophalangeal joint in people with pronated feet. However, the effect of foot posture and customized foot orthoses on maximum first metatarsophalangeal joint dorsiflexion has not been widely investigated. This study sought to determine 1) the relationship between foot posture and static maximum first metatarsophalangeal joint dorsiflexion and 2) the effect of customized foot orthoses on static maximum first metatarsophalangeal joint dorsiflexion in people with pronated feet. Foot posture was assessed using the Foot Posture Index. Static maximum first metatarsophalangeal joint dorsiflexion of the right foot was determined using a goniometer while participants stood relaxed with and without Blake-style inverted (30°) foot orthoses positioned under their feet. There was a significant negative correlation between Foot Posture Index and static maximum first metatarsophalangeal joint dorsiflexion (r = −0.587). Inverted (30°) foot orthoses increased the magnitude of static maximum first metatarsophalangeal joint dorsiflexion from 83.4° to 85.3° in participants with an excessively pronated foot posture. However, this difference was not statistically significant. People with pronated feet are more likely to exhibit limitation of dorsiflexion at the first metatarsophalangeal joint during gait, and inverted foot orthoses are unlikely to be effective in increasing dorsiflexion at the first metatarsophalangeal joint in these people. (J Am Podiatr Med Assoc 96(1): 32–37, 2006)
Treatment for Simple Plantar Verrucae
Authors: Jennings Maureen B. , Ricketti James , Guadara John , Nach Wendy , Goodwin Susan
Published: April 2014

Verrucae are small, benign, highly vascular epithelial neoplasms that occur singly or in a multiple presentation. Plantar verrucae are usually caused by infection with human papillomavirus types 1, 2, and 4. A clinical trial was conducted to assess the safety and efficacy of monochloroacetic acid and 10% formaldehyde versus 10% formaldehyde alone in the treatment of simple plantar verrucae. Of 57 patients enrolled in the study, 26 were in the monochloroacetic acid and 10% formaldehyde group and 31 were in the 10% formaldehyde alone group. The overall cure rate for this population was 61.4%. There was no statistically significant difference in the cure rate between treatment groups. (J Am Podiatr Med Assoc 96(1): 53–58, 2006)
Stress Fractures of the Lesser Metatarsals After a Wilson Osteotomy for Correction of Hallux Valgus Deformity
Authors: Kirkos John M. , Kyrkos Margaritis J. , Kapetanos George A.
Published: April 2014

This article describes a patient with lesser-metatarsal stress fractures resulting from an oblique Wilson displacement first metatarsal osteotomy. The shortening of the first metatarsal forces the lesser metatarsals to bear the weight previously borne by the first ray and increases the compression stress on the adjacent metatarsal heads. The proximal displacement of the osteotomy must be minimized in order to limit the risk of stress fracture of the lesser metatarsals. (J Am Podiatr Med Assoc 96(1): 63–66, 2006)
Effect of Diabetes Mellitus on the Material Properties of the Distal Tibia
Authors: Fleischli John G. , Laughlin Terese J. , Athanasiou Kyriacos , Lanctot Dan R. , Lavery Lawrence , Wang Xiaodu , Agrawal C. Mauli
Published: April 2014

This investigation evaluates the effects of diabetes on the mechanical properties of human bone, specifically, the tibia. Seven diabetic and seven nondiabetic human (male) cadaveric distal tibiae were used in this study. The average age of the diabetic cadaveric samples was 51 years (range, 46–61 years), and the average age of the nondiabetic cadaveric samples was 75 years (range, 67–85 years). Three-point bending tests for strength and stiffness were performed on a small sample of each distal tibia. Each specimen was loaded at a constant rate until failure. From the recorded curve of load versus displacement, the ultimate and yield strength of bone and the bending modulus of bone were calculated. The diabetic samples were generally weaker than the older, nondiabetic samples, but no statistically significant differences were found in the elastic modulus (P = .29), yield strength (P = .90), ultimate strength (P = .46), and fracture toughness (P = .78), leading to speculation that diabetes has an effect similar to that of aging on the musculoskeletal system. (J Am Podiatr Med Assoc 96(2): 91–95, 2006)
Recalcitrant Verrucous Lesion
Authors: Kelishadi Shahrooz S. , Wirth Garrett A. , Evans Gregory R. D.
Published: April 2014

A 37-year-old woman originally presented in May 2003 with a nonhealing, painless ulcer on the plantar surface of her right foot that had been slowly increasing in size for the previous 1.5 years. Two weeks before presentation, a biopsy of the lesion, performed at another institution, had indicated a probable verrucous carcinoma. After preoperative workup, the patient underwent resection of the lesion, with clear margins and full-thickness skin grafting. The final pathologic findings were not consistent with verrucous carcinoma. A recurrent lesion was noted during a follow-up visit, and a second biopsy revealed a hyperkeratotic papillomatous verrucous lesion, type unclassified. No viral particles were isolated in the random biopsy samples. This recurrent lesion was refractory to treatment with topical acyclovir. Subsequent treatments consisted of imiquimod and CO2 laser ablation, which succeeded in reducing the lesion. Verrucous lesions can be frustrating, and the diagnosis of epithelioma cuniculatum can be difficult to prove. We report a case highly suggestive of but not definitively diagnosed as epithelioma cuniculatum and summarize the literature on this entity. (J Am Podiatr Med Assoc 96(2): 148–153, 2006)
Bizarre Parosteal Osteochondromatous Proliferation of the Little Toe
Authors: Saygi Baransel , Karadag-Saygi Evrim , Erzik Can , Erkan Murat , Yildirim Yakup
Published: April 2014

A 19-year-old woman presented with pain at the lateral side of the fifth toe of her left foot, which was separated from the adjacent toe. Initial examination suggested dislocation of the fifth metatarsophalangeal joint due to a past fracture. Radiographs showed a mass arising from the proximal phalanx of the little toe, with no medullary and cortical continuity. Excisional biopsy of the mass was performed, and a histologic diagnosis of bizarre parosteal osteochondromatous proliferation of bone (Nora’s lesion) was made. (J Am Podiatr Med Assoc 96(2): 158–161, 2006)