bluuebunny/crossref_metadata_2025 huggingface dataset:
Foot Pathology in Patients with Paget’s Disease of Bone
Authors: Williams Anita E. , O’Neill Terence W. , Mercer Sylvia , Toro Brigitte , Nester Christopher J.
Published: April 2014

The characteristic bone deformities associated with advanced Paget’s disease of bone may result in abnormal gait and plantar foot pressures, which contribute to the development of pressure-related skin problems. This study aimed to characterize the foot problems and foot-care needs in this patient group and to investigate the effect of disease distribution on the occurrence of foot pathology. One hundred thirty-four patients with Paget’s disease were assessed clinically, and the Foot Structure Index was completed for each patient. Patients completed self-administered questionnaires concerning foot function (Foot Function Index) and quality of life (12-Item Short Form). The results of this study suggest that foot-health and footwear problems are common in patients with Paget’s disease. Forty percent of the patients required professional foot care in addition to those already receiving it. The site of pagetic involvement did not affect the occurrence of foot pathology. Further research is required on the impact of the extent of any femoral or tibial deformity on foot symptoms and pathology. Biomechanical studies of the forces and motion in the foot related to different degrees of femoral and tibial deformity might also help determine the impact of deformity on foot pathology. (J Am Podiatr Med Assoc 96(3): 226–231, 2006)
A Prospective Analysis of the Treatment of Friction Blisters with 2-Octylcyanoacrylate
Authors: Levy Phillip D. , Hile David C. , Hile Lisa M. , Miller Michael A.
Published: April 2014

Early military investigations of blister treatment using tissue adhesives have shown promise, finding that these agents provide pain relief, prevent infection, and allow continuation of recruit training. A trial was conducted to compare a 2-octylcyanoacrylate treatment with military standard therapy. Patients were recruited during foot evaluation at the end of a 10-km military road march. Seventy-five patients were screened, and 51 were enrolled. Twenty-six patients received 2-octylcyanoacrylate and 25 received standard treatment. A total of 80 blisters were treated (40 in each group). The mean (SD) blister size in the 2-octylcyanoacrylate group was 12.7 (6.2) mm and in the standard group was 12.0 (5.7) mm. There were no statistically significant differences in any of the baseline variables. Baseline and repeated-measures visual analog scale scores demonstrated no statistically significant differences in initial or repeat pain scores. Both groups showed a similar change across time, with a nonsignificant trend toward improvement in the standard therapy group at 10 min (28.5 versus 24.9) and in the 2-octylcyanoacrylate group at 3 days (42.9 versus 50.1). Mean Likert scores were similar, indicating no difference in patient satisfaction. Time to resumption of normal activity was similar, with one patient in each group unable to return to activity at the time of follow-up. There was a trend toward an increased proportion of patients in the 2-octylcyanoacrylate group who were able to return to normal activity within 48 hours, but this did not reach statistical significance. 2-Octylcyanoacrylate was associated with a greater degree of procedural discomfort. No infected blisters were noted in either group. (J Am Podiatr Med Assoc 96(3): 232–237, 2006)
Relative Metatarsal Protrusion in the Adult
Authors: Domínguez Gabriel , Munuera Pedro V. , Lafuente Guillermo
Published: April 2014

We performed a bibliographic review of the systems proposed by various researchers to evaluate physiologic metatarsal protrusion. The system of measurement devised by Hardy and Clapham to evaluate the protrusion between the first and second metatarsals was adapted to study the whole metatarsal parabola. We studied the five metatarsals of 52 normal feet. Mean metatarsal protrusion relative to the second metatarsal was +1.21% for the first metatarsal, −3.84% for the third metatarsal, −9.66% for the fourth metatarsal, and −16.91% for the fifth metatarsal. (J Am Podiatr Med Assoc 96(3): 238–244, 2006)
Current Concepts in Diabetic Microvascular Dysfunction
Authors: La Fontaine Javier , Harkless Lawrence B. , Davis Christian E. , Allen Marque A. , Shireman Paula K.
Published: April 2014

Microvascular dysfunction is an important component of the pathologic processes that occur in diabetic foot disease. The endothelial abnormalities observed in patients with diabetes mellitus are poorly understood, and evidence suggests that endothelial dysfunction could be involved in the pathogenesis of diabetic macroangiopathy and microangiopathy. With the advent of insulin replacement in the early 1900s and increased efforts toward metabolic control of diabetes, long-term complications of this disease have become apparent. These late-term complications are primarily disorders of the vascular system. This article reviews the process of microvascular dysfunction and how it may relate to the pathogenesis of diabetic foot problems. (J Am Podiatr Med Assoc 96(3): 245–252, 2006)
Arthroscopic Management of Talar Dome Lesions Using a Transmalleolar Approach
Authors: Grady John , Hughes David
Published: April 2014

Surgical treatment of posteromedial talar dome lesions is frequently necessary for Berndt and Harty grade IV osteochondral defects and nondisplaced osteochondral fragments resistant to conservative modalities. When operative intervention is indicated, the approach and management can be complicated by the location and extent of the injury. The operative technique we advocate allows direct exposure of the lesion and minimizes damage to healthy articular cartilage and surrounding soft tissue. Use of a drill guide assists the surgeon in precisely placing a transmalleolar portal through the tibia for subchondral drilling of osteochondral defects when the lesions are inaccessible through traditional arthroscopic portals. (J Am Podiatr Med Assoc 96(3): 260–263, 2006)
Wound-Care Resources on the Internet
Authors: Fikar Charles R. , Delinois Brigitte
Published: April 2014

An updated selection of high-quality Internet resources related to wound and ulcer care is presented. Of potential use to the podiatric medical practitioner, educator, resident, and student, some Web sites that cover hyperbaric medicine, antibiotic use, and wound and ulcer prevention are also included. These Web sites have been evaluated on the basis of their potential to enhance the practice of podiatric medicine, in addition to contributing to the educational process. Readers who require a quick reference source to wound and ulcer care may find this report useful. (J Am Podiatr Med Assoc 96(3): 264–268, 2006)
Application of Center-of-Pressure Data to Indicate Rearfoot Inversion-Eversion in Shod Running
Authors: Dixon Sharon J.
Published: April 2014

Although pressure plates are used to help in the selection of appropriate footwear for runners, evidence relating aspects of pressure data to movement is lacking. A study was conducted to investigate whether center-of-pressure (COP) data obtained for shod running could be used to indicate the amount of rearfoot eversion. It was hypothesized that subjects exhibiting high rearfoot eversion during the initial ground contact phase of running would also show a large lateral-to-medial deviation in the COP. Pressure plate and rearfoot movement data were collected for 33 subjects. The COP was characterized using the lateral-to-medial deviation of the COP during the eversion phase of ground contact. Correlation coefficients were determined for COP deviation versus rearfoot range of motion and versus peak rearfoot eversion (P < .05). In addition, subjects were grouped as high, moderate, or low pronators, and analysis of variance was used to test whether there were significant differences in COP deviation for these three groups (P < .05). The COP deviation was found to have a low correlation with rearfoot range of motion (R = 0.46; P < .05) and with peak rearfoot eversion (R = .54; P < .05). High pronators had significantly higher COP deviation than the medium- and low-pronation groups (P < .05). These findings support the use of COP deviation to detect high pronation. However, caution is advised in using the COP to indicate absolute rearfoot eversion. (J Am Podiatr Med Assoc 96(4): 305–312, 2006)
The Relationship Between Navicular Drop and First Metatarsophalangeal Joint Motion
Authors: Paton Joanne S.
Published: April 2014

This study was conducted to determine whether navicular drop, as a representative measure of foot pronation, was associated with first metatarsal joint motion in 24 healthy subjects aged 21 to 40 years. The magnitude of first metatarsophalangeal joint motion was identified using a custom-built weightbearing goniometer designed to measure maximal hallux dorsiflexion in stance. The weightbearing measure of navicular drop was recorded using an adapted digital caliper. Statistical analysis demonstrated a significant negative correlation (P < .05) between the two variables. Furthermore, simple regression analysis suggested that 33.2% of the variation in maximal hallux dorsiflexion could be explained by different navicular drop values. (J Am Podiatr Med Assoc 96(4): 313–317, 2006)
Foot Schwannomas That Mimic Nerve-Entrapment Syndromes
Authors: Carpintero Pedro , Gascón Emilio , Abad José Antonio , Ruza Manuel
Published: April 2014

Schwannomas of the foot are rare. We describe three cases that mimicked compressive neuropathy, two resembling tarsal tunnel syndrome and a third resembling Morton’s neuroma. All three patients had complete resolution of their pain after resection of the tumor. (J Am Podiatr Med Assoc 96(4): 344–347, 2006)
Technique for Curettage and Grafting of an Intramedullary Tibial Bone Cyst
Authors: Hollawell Shane , Pfeiffer Darelle
Published: April 2014

During examination of an 11-year-old boy who had injured his right ankle, a benign tibial bone tumor was incidentally discovered. The bone tumor was initially treated with conservative care. When the patient returned with pain and an enlarging lesion, surgery was performed to prevent pathologic fracture. This case demonstrates the use of an allograft and synthetic bone graft material with growth factors in the treatment of a benign tibial bone tumor, avoiding the comorbidity and risk factors associated with autogeneic grafting. (J Am Podiatr Med Assoc 96(4): 351–355, 2006)
Atypical Tenosynovial Giant Cell Tumor of the Extensor Hallucis Longus Tendon
Authors: Muramatsu Keiichi , Mine Takatomo , Ichihara Kazuhiko
Published: April 2014

We present a case of atypical giant cell tumor of the tendon sheath originating from the extensor hallucis longus tendon. The tumor contained multiple nodules and overlay the tendon 16 cm. Magnetic resonance imaging was the most useful preoperative investigation and showed the characteristic appearance of giant cell tumor of the tendon sheath, thus allowing local excision to be planned and executed. We discuss how local recurrence of this tumor could be prevented. (J Am Podiatr Med Assoc 96(4): 359–361, 2006)
Evidence-Based Medicine
Authors: Waldman Marvin H.
Published: April 2014

The purpose of this article is to review the history and development of evidence-based medicine, to provide a basic outline of its application to clinical care, and to discuss its pros and cons. This article can be used as a tool in podiatric medicine and surgery to ensure that current best evidence, clinical intuition, and patient preferences inform and guide our medical decision making. (J Am Podiatr Med Assoc 96(4): 374–377, 2006)
A Departmental Outcome Assessment to Evaluate Educational Achievement
Authors: Kilmore Mearl A. , Finnerty Edward P. , Terry Wayne H. , Shen Linjun
Published: April 2014

Defining and addressing outcome objectives is a crucial process in medical science and education. One outcome objective of the Physiology/ Pharmacology Department at Des Moines University is to prepare students to successfully complete Part I of the national licensure examination. This study assesses the effectiveness of the departmental curriculum in helping the students achieve success on Part I of the licensure examination. Standardized discipline examinations were used as the comprehensive final examination for the physiology and pharmacology courses for the classes of 1997, 1998, and 2002 through 2005. The results were assessed by class year and specific topic area as determined by an item keyword description. Student performance on Part I of the National Podiatric Board examination was assessed for each class. Podiatric medical students’ performance tended to be similar to or slightly lower than that of the national cohort on the discipline examinations. Topic analysis revealed areas of weakness, which were then addressed in the second-year courses. Student performance on Part I was generally acceptable yet showed marked improvement with the curricular interventions and changes. External assessments provide us with an unbiased means to evaluate the strengths and weaknesses of the curriculum through student performance and to make appropriate adjustments to enhance students’ success. (J Am Podiatr Med Assoc 96(5): 448–454, 2006)
Effect of Functional Foot Orthoses on First Metatarsophalangeal Joint Dorsiflexion in Stance and Gait
Authors: Scherer Paul R. , Sanders Jennifer , Eldredge Denten E. , Duffy Susan J. , Lee Ryan Y.
Published: April 2014

Reduction in first metatarsophalangeal joint maximum degree of dorsiflexion with dorsiflexion of the first ray has been proposed to be the predominant cause of hallux abducto valgus and hallux rigidus. We sought to determine whether orthoses made from a cast with the first ray plantarflexed and a 4-mm medial skive could increase the maximum degree of dorsiflexion in patients with functional hallux limitus in stance and gait. Forty-eight feet of 27 subjects were casted for orthoses with the first ray plantarflexed and in the customary neutral rearfoot position with locked midtarsal joint. First metatarsophalangeal joint maximum dorsiflexion was measured with and without orthoses in stance, and subhallux pressure was measured with and without orthoses at heel-off. Changes in mean maximum dorsiflexion in stance and in mean maximum subhallux pressure in gait with orthoses were significant. We investigated the relationship between this increase in dorsiflexion and gender, shoe size, resting calcaneal stance position, and change in resting calcaneal stance position with the use of orthoses. These correlations were not statistically significant. The biomechanical implication of increasing limited first metatarsophalangeal joint dorsiflexion with orthoses is discussed and related to the clinical treatment of deformities, including hallux valgus and hallux rigidus. The use of orthoses to decrease subhallux pressure is also discussed. (J Am Podiatr Med Assoc 96(6): 474–481, 2006)
Efficacy of Concentrated Autologous Platelet-Derived Growth Factors in Chronic Lower-Extremity Wounds
Authors: McAleer Jody Peter , Kaplan Eric , Persich Gianni
Published: April 2014

The efficacy of concentrated autologous platelet-derived growth factors in the healing and closure of chronic lower-extremity wounds was evaluated in 24 patients with 33 lower-extremity wounds treated previously for at least 6 months using traditional methods. Surgical wound debridement was performed to convert chronic ulcers into acute wounds. Concentrated autologous platelet-derived growth factors and thrombin were applied to the wound bases and protected with a nonadhering compression dressing that remained intact for 7 days. Wounds were evaluated and the concentrate was reapplied every 2 weeks. Wound closure and complete epithelialization was achieved in 20 wounds. Seventy-five percent or greater wound closure was obtained in three wounds, 50% to 74% closure in three wounds, and 25% to 49% closure in two wounds. Five wounds displayed no improvement. Mean time to complete closure was 11.15 weeks. The application of concentrated autologous platelet-derived growth factors and thrombin resulted in substantial wound healing and wound-diameter reduction. This technique constitutes a safe and effective treatment option and avoids lengthy treatment periods that increase the potential for infection. (J Am Podiatr Med Assoc 96(6): 482–488, 2006)
Relationship of Functional Leg-Length Discrepancy to Abnormal Pronation
Authors: Rothbart Brian A.
Published: April 2014

The objective of this study was to determine whether a correlation exists between abnormal pronation and functional leg-length discrepancies. Visual assessment and a pelvic thrust maneuver were used to identify the functionally short leg in 56 indigenous Mexicans (20 males and 36 females; mean age, 33 years; mean weight, 59 kg; and mean height, 1.60 m). The Foot Posture Index was used with a modified stance position to identify the more pronated foot. The posterosuperior iliac spines were used to identify the “relative” position of the innominate bones. The raw data obtained from this study were evaluated using the McNemar test for paired proportions. A significant positive correlation was found between abnormal pronation and hip position and between hip position and functional leg-length discrepancy. These results are consistent with a theoretical ascending dysfunctional pelvic model: Abnormal pronation pulls the innominate bones anteriorly (forward); anterior rotation of the innominate bones shifts the acetabula posteriorly and cephalad (backward and upward); and this shift in the acetabula hyperextends the knees and shortens the legs, with the shortest leg corresponding to the most pronated foot. (J Am Podiatr Med Assoc 96(6): 499-507, 2006)
Desyndactylization of the First and Second Toes Using Full-Thickness Autologous Skin Graft from the Ankle
Authors: Giorgini Renato J. , Rostkowski Tomasz , Japour Christopher
Published: April 2014

We present a unique case of congenital bilateral simple syndactyly of the first and second toes that was surgically treated using a full-thickness skin graft harvested from the same foot at the lateral aspect of the ankle. This surgical approach eliminates the potential need to involve another surgical team to harvest a donor graft from above the ankle, saving operating room time, anesthesia time, and overall cost to the patient. Cosmetically, scar formation above the ankle is also eliminated. (J Am Podiatr Med Assoc 96(6): 513–517, 2006)
Virtual Microscopes in Podiatric Medical Education
Authors: Becker John H.
Published: April 2014

In many medical schools, microscopes are being replaced as teaching tools by computers with software that emulates the use of a light microscope. This article chronicles the adoption of “virtual microscopes” by a podiatric medical school and presents the results of educational research on the effectiveness of this adoption in a histology course. If the trend toward virtual microscopy in education continues, many 21st-century physicians will not be trained to operate a light microscope. The replacement of old technologies by new is discussed. The fundamental question is whether all podiatric physicians should be trained in the use of a particular tool or only those who are likely to use it in their own practice. (J Am Podiatr Med Assoc 96(6): 518–524, 2006)
Biomechanical Evaluation of Dancers and Assessment of Their Risk of Injury
Authors: Schoene Lisa M.
Published: April 2014

Professional dancers have a 90% risk of injury during their career. The lower extremity is involved in approximately 75% of the injuries sustained by dancers. Proper biomechanical evaluation, risk assessment, and prevention-oriented treatment are necessary to minimize future problems and promote a full and lasting recovery when an injury is sustained. This article outlines the in-office evaluation process and discusses backstage care. (J Am Podiatr Med Assoc 97(1): 75–80, 2007)
Tibial Sesamoid Fracture in a Softball Player
Authors: Jones Jeanine L. , Losito James M.
Published: April 2014

A single case of a tibial sesamoid fracture in a softball player is reported here. A review of the literature confirms that this is an unusual and difficult problem to treat in the athletic population given the significant loads placed on the sesamoids during athletic activity. In the case presented, conservative care was not effective, and the athlete underwent surgical excision of the fractured sesamoid. With use of a postoperative orthosis and cleat modification, surgical management was successful and allowed the athlete to return to her athletic endeavors without restrictions in 8 weeks. (J Am Podiatr Med Assoc 97(1): 85–88, 2007)
Forefoot Adductus Correction in Clubfoot Deformity with Cuboid-Cuneiform Osteotomy
Authors: Lee Daniel K. , Benard Marc , Grumbine Nicholas , Pokrassa Mitchell , Weinstein Stan
Published: April 2014

Background: Forefoot adduction is the most common residual deformity in the treatment of pediatric clubfoot. Little documentation exists regarding its late occurrence and early detection. A retrospective analysis was conducted to determine the effect of primary posterior medial release for idiopathic clubfoot that had failed to improve with conservative treatment or had presented after a treatment delay and a subsequent forefoot adduction correction with a cuboid-cuneiform osteotomy.

Methods: Radiographic evaluations were conducted of all of the surgical procedures performed at our institution for idiopathic clubfoot during a specified period. Preoperative and postoperative talo–first metatarsal and talocalcaneal angles were measured radiographically. Of 138 patients with clubfoot deformity who met the inclusion criteria, 51 underwent a primary posterior medial release; of these patients, 18 (26 feet) underwent a subsequent cuboid-cuneiform osteotomy.

Results: The average preoperative and postoperative talo–first metatarsal anteroposterior angles for patients who underwent primary posterior medial release were 44.6° and 26.8°, respectively. The mean reduction in forefoot adduction was 17.8° (P < .05). After the osteotomy, the average talo–first metatarsal anteroposterior angle was 16°, with an average reduction of 10.8° (P < .05). Mean follow-up was 61.2 months. The average patient age was 3.2 years.

Conclusions: Eighteen (35%) of 51 patients who underwent a posterior medial release required a subsequent cuboid-cuneiform osteotomy. The average reduction of 10.8° was statistically significant and has also proved to be clinically significant in the overall correction of the deformity. (J Am Podiatr Med Assoc 97(2): 126–133, 2007)
Molecular Biology Techniques for Identifying Dermatophytes and Their Possible Use in Diagnosing Onychomycosis in Human Toenail
Authors: Binstock Judith M.
Published: April 2014

Traditional methods of diagnosing onychomycosis, such as microscopy, histologic staining, and cultures, may not provide the clinician with documentation before initiating antifungal drug therapy. DNA technology now supplies the tools for increased sensitivity, speed, and accuracy in the diagnostic arena by allowing for the amplification, qualification, and quantitation of DNA. These techniques, already being used to identify many infectious agents, may soon be commonly applied to onychomycosis. This report reviews some of the DNA-based techniques that are currently being used to identify dermatophytes and their possible diagnostic use. (J Am Podiatr Med Assoc 97(2): 134–144, 2007)
Foot Pathology and Inappropriate Footwear as Risk Factors for Falls in a Subacute Aged-Care Hospital
Authors: Jessup Rebecca L.
Published: April 2014

Background: Falls are a major clinical problem in the hospital setting. This study examined the prevalence of foot pathology and footwear type likely to increase the risk of falls in two subacute-care hospital wards serving elderly patients.

Methods: Two wards of a subacute aged-care hospital were selected for study. Patients were assessed for the presence of foot pathology, and their footwear was evaluated for characteristics identified in the literature as placing individuals at increased risk of falls.

Results: Of 44 patients assessed, 98% had foot pathology, and 41% had foot pathology requiring podiatric medical management. Eighty-six percent of inpatients wore footwear that was likely to increase their risk of falls, with 66% wearing slippers or moccasins.

Conclusions: The results of this study demonstrate the need for hospital inpatients who are identified as being at high risk for falling, or have a history of falls, to undergo an assessment of their foot pathology and footwear so that appropriate measures can be taken to address these risk factors. (J Am Podiatr Med Assoc 97(3): 213–217, 2007)
Chondromyxoid Fibroma of the Calcaneus
Authors: Ebrahimzadeh Mohamad H. , Dallouei Seyed R. Sharifi
Published: April 2014

Chondromyxoid fibroma is a rare, benign, aggressive bone tumor whose localization in the calcaneus is even rarer. We report a case of chondromyxoid fibroma in the calcaneus of a 10-year-old Iranian boy who was treated with extended curettage. After 3 years of follow-up, the patient had experienced no recurrence. (J Am Podiatr Med Assoc 97(3): 223–224, 2007)
Post-traumatic Myositis Ossificans Circumscripta
Authors: Todd William , Gianfortune Philip J. , Laughner Todd
Published: April 2014

A 66-year-old woman presented with painful gait and a large, firm, nonmobile mass in her right foot. She had undergone four previous surgeries to remove a recurring “calcified hematoma” that resulted from an injury sustained 3 decades previously. An unusually large ossific mass (7.0 × 7.0 × 2.0 cm) consistent with post-traumatic myositis ossificans circumscripta was excised. After 3 years of follow-up, there was no return of the symptoms or the mass. (J Am Podiatr Med Assoc 97(3): 229–233, 2007)
Exercise-Induced Rhabdomyolysis
Authors: Caban Gregorio , Marin Luis , Scavone Frederick
Published: April 2014

Rhabdomyolysis is a debilitating condition that promotes muscle breakdown and eventually leads to renal dysfunction if not properly managed. The initial presentation may involve lower-extremity muscles, making the foot and ankle specialist one of the first specialists to recognize and diagnose this condition. Proper management of renal function is the primary concern; however, the underlying muscle breakdown needs to be addressed and the condition managed to prevent future problems. In this article we discuss treatment of a patient with exercise-induced rhabdomyolysis; a rehabilitation regimen is presented whose purpose is to condition muscles in order to prevent recurrence of exercise-induced muscle destruction after an acute event. (J Am Podiatr Med Assoc 97(3): 234–237, 2007)
Anterior Cruciate Ligament Injury in Female and Male Athletes
Authors: Jenkins Walter L. , Killian Clyde B. , Williams D.S. , Loudon Janice , Raedeke Suzanne G.
Published: April 2014

Background: It has been shown that anterior cruciate ligament (ACL) injuries are more prevalent in female athletes than in male athletes. Soccer and basketball are considered high-risk sports for ACL injury in female athletes. Several studies have reported a relationship between ACL injury and measures of foot structure. This study was conducted to investigate the relationship between foot structure and ACL injury rates in female and male soccer and basketball players.

Methods: One hundred five soccer and basketball players (53 women and 52 men) were recruited and divided into an ACL-normal group (n = 89) and an ACL-injured group (n = 16). Two measures of foot structure (subtalar joint neutral position and navicular drop test values) were recorded for each subject. An independent t test and a paired t test were used to analyze differences in ACL status, foot structure, and sex. A χ2 analysis determined whether the prevalence of ACL injury was independent of sport.

Results: No statistically significant differences were found in the foot structure measures between women and men. Female soccer and basketball players had an ACL injury rate seven times that of male players.

Conclusions: Values derived from subtalar joint neutral position measurement and the navicular drop test were not associated with ACL injury in collegiate female and male soccer and basketball players. (J Am Podiatr Med Assoc 97(5): 371–376, 2007)
A New Onychocryptosis Classification and Treatment Plan
Authors: Martínez-Nova Alfonso , Sánchez-Rodríguez Raquel , Alonso-Peña David
Published: April 2014

Onychocryptosis is a pathologic condition of the nail apparatus in which the toenail damages the nail fold. It is a common condition provoking pain, inflammation, and functional limitation. It principally occurs in the hallux. Onychocryptosis is one of the most frequent complaints regarding the foot and accounts for many clinical consultations. The disorder has been classified in terms of the stages of the pathologic condition. In our practice, we discovered a clinical entity that was not previously classified in the literature. We classify onychocryptosis into stages I, IIa, IIb, III, and the new stage IV. A treatment plan is offered for each stage of this classification, with both general and specific indications given. In onychocryptosis treatment, it is important to select the surgical technique best suited to the patient’s particular clinical situation. (J Am Podiatr Med Assoc 97(5): 389–393, 2007)
Chronic Ischemia Presenting as Muscular Groin Pain
Authors: Diacogiorgis Dimitri
Published: April 2014

A 66-year-old man was admitted to a hospital rehabilitation unit for the management of chronic groin pain. Since the groin pain began, he had been unable to bear weight on his right foot. During a podiatric examination, the patient reported sharp pain at the apex of his right hallux. A full podiatric assessment was undertaken to evaluate his vascular, neurologic, and biomechanical status. The patient’s ankle-brachial index was found to be 0.34 in the right lower limb and 0.68 in the left lower limb. After vascular assessment, the patient was diagnosed as having chronic ischemia of the right leg. He underwent left-to-right femoral-to-femoral bypass graft surgery to salvage the right lower leg and foot. (J Am Podiatr Med Assoc 97(5): 402–404, 2007)
Osteoid Osteoma
Authors: Freschi Scot , Dodson Nicholas B.
Published: April 2014

An osteoid osteoma located in the forefoot can be difficult to diagnose, and the diagnosis is frequently delayed. We present a clinical case of a patient with pain, erythema, and swelling of the left forefoot with no history of trauma. Although rarely seen in the metatarsal, osteoid osteoma should be included in the differential diagnosis of foot pain. Findings from radiographs, magnetic resonance images, and a detailed clinical history led to the diagnosis of osteoid osteoma of the left second metatarsal. The lesion was surgically excised using curettage. This process significantly weakened the lateral cortex of the metatarsal shaft. To correct this surgically induced stress riser, an external fixator was applied to provide stability, allow for callus distraction, and allow the patient to walk as early as possible. We review osteoid osteoma, including the classic clinical presentation and treatment associated with this benign bone tumor. (J Am Podiatr Med Assoc 97(5): 405–409, 2007)
Clinical and Radiologic Features of Pigmented Villonodular Synovitis of the Foot
Authors: Carpintero Pedro , Gascon Emilio , Mesa Manuel , Jimenez Carlos , Lopez Ubaldo
Published: April 2014

Pigmented villonodular synovitis, a rare proliferative disease of unknown etiology, is rare in the foot (2% of these lesions). A retrospective review was undertaken of the case histories, radiographs, and imaging results of eight patients treated for pigmented villonodular synovitis of the foot. Pigmented villonodular synovitis was located in the rearfoot in five patients and in the forefoot in the other three. Radiographs in six patients showed bone involvement. Affected bones included the talus, first cuneiform, first and fifth metatarsals, and second phalanx. Treatment was surgical, and only one recurrence was recorded after 24 months. Pigmented villonodular synovitis should be considered in the differential diagnosis of foot tumors. (J Am Podiatr Med Assoc 97(5): 415–419, 2007)
Kinematic and Electromyographic Analysis of the Trunk and Lower Limbs During Walking in Negative-Heeled Shoes
Authors: Li Jing Xian , Hong Youlian
Published: April 2014

Background: We investigate kinematic adaptation and muscle activities in the trunk and lower extremities of healthy subjects during treadmill walking in negative-heeled sports shoes versus normal sports shoes.

Methods: Thirteen healthy female university students participated in the study. We analyzed sagittal-movement kinematics and electromyographic findings from the erector spinae, rectus abdominus, rectus femoris, biceps femoris, tibialis anterior, and lateral gastrocnemius muscles of the dominant side in two shod conditions.

Results: Negative-heeled gait is characterized by faster cadence, shorter stride length, increased maximal extension angles in the trunk and hip, increased flexion angle in the knee, larger dorsiflexion in the stance phase, and a larger range of motion of the ankle joint. Negative-heeled gait resulted in a significantly larger integrated electromyographic value, a longer duration of electromyographic activity, and a higher mean amplitude of electromyographic activity in the tibialis anterior, lateral gastrocnemius, and biceps femoris muscles.

Conclusions: Negative-heeled gait compared with normal gait places a higher physiologic demand on the tibialis anterior, lateral gastrocnemius, and biceps femoris muscles when walking on a level surface. Thus, negative-heeled shoes could be of value if used in an exercise rehabilitation or training program where inclined walking is not available owing to a flat terrain. (J Am Podiatr Med Assoc 97(6): 447–456, 2007)
Foot Health Service Provision by the Australian Department of Veterans’ Affairs
Authors: Frescos Nicoletta , Menz Hylton B.
Published: April 2014

Background: In Australia, the Department of Veterans’ Affairs provides podiatric medical services, including nail surgery and the provision of footwear and orthoses, for war veterans and their dependents. We sought to evaluate whether the provision of these interventions reduces the number of ongoing maintenance treatments.

Methods: We used the database of the Department of Veterans’ Affairs to document the number of major podiatric medical interventions (footwear, foot orthoses, nail surgery, and combinations of these interventions) for 1996–1997. The number of maintenance podiatric medical treatments provided in the 2 years before (1994–1996) and 2 years after (1997–1999) these interventions was then compared with a control group that did not receive any major interventions.

Results: Compared with the number of treatments in the 2 years before the interventions, in the subsequent 2 years there was a significant increase in the mean ± SD number of maintenance treatments after receiving footwear only (10.4 ± 5.8 versus 12.3 ± 5.0), foot orthoses only (9.4 ± 5.3 versus 12.2 ± 4.6), nail surgery only (10.2 ± 5.8 versus 13.2 ± 4.4), and footwear plus foot orthoses (9.3 ± 6.1 versus 13.3 ± 5.5). In the control group, the mean number of treatments in 1994–1996 and 1997–1999 was 10.8 and 11.8, respectively.

Conclusions: Provision of major podiatric medical interventions did not reduce the number of ongoing maintenance treatments received by veterans. However, owing to the inherent limitations of claims data, it is difficult to determine whether this finding is due to the limited efficacy of the interventions or to the policy structure of podiatric medical service provision in the Department of Veterans’ Affairs. (J Am Podiatr Med Assoc 97(6): 469–474, 2007)
Effect of Cushioned Insoles on Impact Forces During Running
Authors: O’Leary Katherine , Vorpahl Kristin Anderson , Heiderscheit Bryan
Published: April 2014

Background: The use of cushioned or shock-absorbing insoles has been suggested as a mechanism to reduce the impact forces associated with running, thereby protecting against overuse injuries. The purpose of this study was to determine whether the use of cushioned insoles reduced impact forces during running in healthy subjects.

Methods: Sixteen recreational runners (9 females and 7 males) ran at a self-selected pace for five trials with and without the use of cushioned insoles. During each trial, ground reaction forces, tibial accelerations, lower-extremity kinematics, and subject-perceived comfort were recorded. All variables were tested with the level of statistical significance set at α = .05.

Results: The use of cushioned insoles resulted in significant reductions in mean vertical ground reaction force peak impact (6.8%) and ground reaction force loading rate (8.3%), as well as peak tibial acceleration (15.8%). Spectral analysis of the tibial acceleration data in the frequency range associated with impact accelerations (12–25 Hz) revealed no change in the predominant frequency or the power of the predominant frequency. The knee flexion angle at initial contact and perceived comfort were similar for the two conditions.

Conclusions: This study demonstrates the effectiveness of one type of cushioned insole in reducing peak impact force and tibial acceleration at initial foot-ground contact during running. The impact reduction observed was independent of knee kinematic adjustments or changes in perceived comfort. Further study is required to determine whether the reduction in loading that accompanied the use of the cushioned insoles can affect the incidence of running-related injuries. (J Am Podiatr Med Assoc 98(1): 36–41, 2008)
Transmissions Within the Tarsal Gearbox
Authors: Wolf Peter , Stacoff Alex , Luechinger Roger , Boesiger Peter , Stuessi Edgar
Published: April 2014

Background: The dependence of the movements of the calcaneus, cuboid, navicular, and talus on each other have been described as the tarsal gearbox. To provide a basis of its modeling, data on transmissions between tarsal joint rotations within this gearbox are required. The feasibility of tibiocalcaneal rotations to predict tarsal joint rotations is of interest because a meaningful relation would allow the use of common motion analysis with skin markers to investigate rearfoot kinematics.

Methods: We performed linear regression analyses between tarsal joint and tibiocalcaneal rotations on the basis of magnetic resonance imaging of tibia and tarsal bone positions during quasi-static foot pronation and supination.

Results: In the frontal plane and transverse planes, linear models were found to predict tarsal joint rotations quite well (r2 = 0.83–0.97 for the frontal plane and r2 = 0.73–0.95 for the transverse plane). For each degree of talocalcaneal rotation, there was 1.8° of talonavicular rotation in the frontal plane and 1.6° in the transverse plane; each degree of talocalcaneal rotation resulted in 0.6° of calcanealcuboid rotation in the frontal plane and 0.7° in the transverse plane; each degree of calcaneocuboid rotation resulted in 3° of talonavicular rotation in the frontal plane and 2.8° in the transverse; each degree of tibiocalcaneal rotation resulted in 0.9° of talocalcaneal rotation in the frontal plane and 0.9° in the transverse plane; and each degree of tibiocalcaneal rotation resulted in 1.6° of talonavicular rotation in the frontal plane and 1.3° in the transverse plane.

Conclusion: The present study provides a basis on which the tarsal gearbox in the frontal and the transverse planes under quasi-static conditions can be modeled. Furthermore, it is concluded that tibiocalcaneal rotations are practical for predicting tarsal joint rotations during quasi-static motions. (J Am Podiatr Med Assoc 98(1): 45–50, 2008)
Iatrogenic Osteochondral Kissing Lesion After Transmalleolar Drilling of the Talar Dome
Authors: D’Hooghe Pieter , Deschamps Kevin , Matricali Giovanni
Published: April 2014

Ankle injuries can lead to early osteoarthrosis when diagnosis is delayed. The clinical presentation of an osteochondral lesion of the talar dome is often difficult to diagnose in the initial setup of an ankle sprain or fracture. Once the lesion is adequately imaged and staged, open or arthroscopic treatment can be initiated. We discuss the arthroscopic treatment of a posteromedial talar dome lesion in this case report. Transmalleolar drilling was performed to treat an osteochondral lesion of the talar dome in a 24-year-old female. Her ankle evolved toward a severe clinical and radiologic condition in which a combined talar and tibial (kissing) lesion was seen during her follow-up. Therefore, we recommend the use of retrograde drilling or arthroscopic microfracture with minimal iatrogenic risk, instead of transmalleolar drilling, as the treatment of choice in these specific osteochondral lesion of the talar dome cases. (J Am Podiatr Med Assoc 99(1): 54–57, 2009)
Elephantiasis Nostras Verrucosa or “Mossy Foot Lesions” in Lymphedema Praecox
Authors: Duckworth Amy L. , Husain Jugnoo , DeHeer Patrick
Published: April 2014

Elephantiasis nostras verrucosa is a rare disorder that results from chronic obstructive lymphedema. It is characterized clinically by deforming, nonpitting edema; malodorous hyperkeratosis with generalized lichenification; cobblestoned papules; and verrucous changes, that often result in extreme enlargement of the involved body part. Although elephantiasis nostras verrucosa is striking in clinical appearance, biopsy reveals only moderately abnormal findings: pseudoepitheliomatous hyperplasia with dilated lymphatic spaces in the dermis, accompanied by chronic inflammation and fibroblast proliferation. The term elephantiasis nostras (nostras means “from our region”) has traditionally been used to differentiate temperate zone disease from the classic disease process, elephantiasis tropica, which is defined by chronic filarial lymphatic obstruction caused by Wuchereria bancrofti, Wuchereria malayi, or Wuchereria pacifica. We present a case report of elephantiasis nostras verrucosa arising as a result of lymphedema praecox. (J Am Podiatr Med Assoc 98(1): 66–69, 2008)
Preclinical Symptoms of the Diabetic Foot
Authors: Bekler Halil I. , Ertav Aytug
Published: April 2014

Background: The diabetic foot is one of the main complications of diabetes mellitus, with a high risk of minor or major amputation. The preclinical foot lesions of patients without foot complaints were compared with healthy controls and analyzed.

Methods: This study was conducted with 89 diabetic patients from an endocrinology clinic and 35 nondiabetic control patients. The patients were asked about the presence, types, and durations of pedal complaints; acquired and congenital foot deformities; and atrophy. Patient gaits were inspected for any swelling; skin and nail changes were also recorded. Ranges of articular motion, deformities, crepitations, and any painful perceptions were noted.

Results: The differences between groups were significant for sensorial defects, joint changes of the foot, nail abnormalities, and neuropathic changes.

Conclusions: Every patient with an established diagnosis of diabetes can be considered a potential sufferer of diabetic foot for whom medical therapy and foot protection programs are indicated. (J Am Podiatr Med Assoc 99(2): 114–120, 2009)
Length of the Sesamoids and Their Distance From the Metatarsophalangeal Joint Space in Feet With Incipient Hallux Limitus
Authors: Munuera Pedro V. , Domínguez Gabriel , Lafuente Guillermo
Published: April 2014

Background: We designed this study to verify whether the sesamoids of the first metatarsal head are longer than normal in feet with incipient hallux limitus, and whether feet with incipient hallux limitus are in a more proximal than normal sesamoid position.

Methods: In a sample of 183 dorsoplantar radiographs under weightbearing conditions (115 of normal feet and 68 of feet with slightly stiff hallux), measurements were made of the length of both the medial and the lateral sesamoids and of the distance between these bones to the distal edge of the first metatarsal head. These variables were compared between the normal and the hallux limitus feet. The relationship between these variables and the hallux dorsiflexion was also studied.

Results: We found significant differences between the two types of foot in the medial and lateral sesamoid lengths, but no significant difference in the distance between the sesamoids to the distal edge of the first metatarsal. A poor-to-moderate inverse correlation was found between hallux dorsiflexion and medial sesamoid length and between hallux dorsiflexion and lateral sesamoid length.

Conclusions: The length of the sesamoid bones of the first metatarsal head could be implicated in the development of the hallux limitus deformity. (J Am Podiatr Med Assoc 98(2): 123–129, 2008)
Diagnosis and Prevalence of Onychomycosis in Diabetic Neuropathic Patients
Authors: Dumont Isabelle J.
Published: April 2014

Background: An observational study was conducted to assess the prevalence of onychomycosis in clinically suspected diabetic neuropathic patients and to assess the reliability of the diagnosis.

Methods: One hundred successive type 1 and 2 diabetic patients with diabetic neuropathy were followed. Diabetic neuropathy was defined by a vibration perception threshold greater than 25 V and onychomycosis by clinical diagnosis. Samples of the most affected nail were taken. Potassium hydroxide testing and culture were performed. Photographs of the nails were used by two dermatologists for diagnosis.

Results: The mean ± SE age was 62.3 ± 11.4 years for the 20 onychomycotic patients and 60.3 ± 10.4 years for the entire cohort; 14 onychomycotic patients (70%) were male versus 56 in the full cohort (56%) (P < .05). The prevalence of onychomycosis was 20% (culture and potassium hydroxide test positive) and 24% (culture positive). Twenty or 30 patients were positive by the potassium hydroxide test, depending on the investigator. The most frequent pathogen found was Trichophyton rubrum (11 of 20 patients; 55%). The positive predictive values of the dermatologist’s diagnoses were 57.8% and 35.6%, and the negative predictive values were 85.0% and 90.5%. The two expert’s results were significantly different (P < .05).

Conclusions: The diagnosis of onychomycosis is difficult to make. The diagnostic methods commonly used are not satisfactory. If onychomycosis is dangerous for the diabetic foot, a better diagnostic method is needed. (J Am Podiatr Med Assoc 99(2): 135–139, 2009)
Comparison of Orthotic Materials on Foot Pain, Comfort, and Plantar Pressure in the Neuroischemic Diabetic Foot
Authors: Burns Joshua , Begg Lindy , Vicaretti Mauro
Published: April 2014

Foot pain and lower-limb neuroischemia in diabetes mellitus is common and can be debilitating and difficult to treat. We report a comparison of orthotic materials to manage foot pain in a 59-year-old man with type 1 diabetes mellitus, peripheral neuropathy, peripheral arterial disease, and a history of foot ulceration. We investigated a range of in-shoe foot orthoses for comfort and plantar pressure reduction in a cross-sectional study. The most comfortable and most effective pressure-reducing orthoses were subsequently evaluated for pain relief in a single system alternating-treatment design. After 9 weeks, foot pain was completely resolved with customized multidensity foot orthoses. The outcome of this case study suggests that customized multidensity foot orthoses may be a useful intervention to reduce foot pain and maintain function in the neuroischemic diabetic foot. (J Am Podiatr Med Assoc 98(2): 143–148, 2008)
Traumatic Dislocation of the First Metatarsophalangeal Joint with Tibial Sesamoid Fracture
Authors: Maskill Michael , Mendicino Robert , Saltrick Karl , Catanzariti Alan
Published: April 2014

We present a case report about traumatic dislocation of the first metatarsophalangeal joint and patterns of injury. We are unaware of previous reports in the literature describing this unusual variant. (J Am Podiatr Med Assoc 98(2): 149–152, 2008)