bluuebunny/crossref_metadata_2025 huggingface dataset:
Foot Problems in Older Patients
Authors: Helfand Arthur E.
Published: April 2014

This study sought to demonstrate the prevalence of foot conditions in older individuals and their association with chronic risk diseases such as diabetes mellitus, peripheral arterial disease, and arthritis, and to develop care plans to reduce complications from local foot problems and chronic diseases. One thousand individuals older than 65 years who were ambulatory and not institutionalized underwent a standardized and validated podogeriatric examination assessment protocol or index. Overall, 74.6% of all patients had a history of pain, 57.2% were receiving current care for diabetes mellitus, 22.9% indicated current care for peripheral vascular disease, 94.2% had onychodystrophy, 64.2% had one or more foot deformities, 64.0% demonstrated some loss of protective sensation, and 81.7% had one or more symptoms and signs of peripheral arterial insufficiency. These findings demonstrate that foot problems in the older population result from disease, disability, and deformity related to multiple chronic diseases as well as changes associated with repetitive use and trauma. Older people are at a high risk of developing foot-related disease and should receive continuing foot assessment, education, surveillance, and care. (J Am Podiatr Med Assoc 94(3): 293–304, 2004)
Revisional Hallux Abducto Valgus Surgery Using Tricorrectional Bunionectomy
Authors: Selner Allen J. , Selner Marc D. , Cyr Robert P. , Noiwangmuang Wanlop
Published: April 2014

We present a radiographic analysis of 91 failed hallux abducto valgus surgeries. Patients were categorized by type of postoperative complication: hallux varus, hallux limitus, or recurrent hallux abducto valgus deformities. All deformities were radiographically evaluated preoperatively and after correction using tricorrectional bunionectomy. Analysis of the surgical revisions showed improvement in radiographic parameters, including the intermetatarsal angle, hallux abductus angle, proximal articular set angle, and tibial sesamoid position. We conclude that tricorrectional bunionectomy is a versatile procedure that can be used when addressing a residual deformity after failed hallux abducto valgus surgery. (J Am Podiatr Med Assoc 94(4): 341–346, 2004)
Combined Popliteal and Saphenous Nerve Blocks at the Knee
Authors: Donohue Cornelius M. , Goss Larry R. , Metz Samuel , Weingarten Michael S. , Dyal Larry B.
Published: April 2014

Peripheral nerve blocks at the ankle have long been used for foot surgery. However, when local foot and ankle blocks are inappropriate or contraindicated, general and spinal anesthesia are the common alternatives. Both have disadvantages and require added equipment and monitors. Combined popliteal and saphenous nerve blocks at the knee can offer a desirable alternative to general and spinal anesthesia for foot and ankle surgery. In addition, popliteal and saphenous nerve blocks provide anesthesia of the entire lower leg, thus permitting a greater variety of procedures to be performed. This article reviews the anatomical considerations, various block techniques, and surgical applications of this useful approach to lower-leg anesthesia. (J Am Podiatr Med Assoc 94(4): 368–374, 2004)
Complications of Intra-articular Fractures of the Calcaneus
Authors: Walter John H. , Rockett Matthew S. , Goss Larry R.
Published: April 2014

Most complications of calcaneal fractures are due to the combination of the dynamic nature and the mechanism of the injury itself. Complications are usually secondary to three integral parts of this complex fracture pattern: 1) fracture and depression of the subtalar joint, 2) loss of the height of the calcaneal body with varus rotation, and 3) expansion of the lateral wall of the calcaneus. Other complications occur with less frequency. This article describes the complications and sequelae of old, malunited intra-articular calcaneal fractures in relation to the nature and the components of these unique fractures. (J Am Podiatr Med Assoc 94(4): 382–388, 2004)
Can Static Plantar Pressures of Prepubertal Children Be Predicted by Inked Footprints?
Authors: Dowling Annaliese M. , Steele Julie R. , Baur Louise A.
Published: April 2014

A study was conducted to determine whether a pedograph could be used as a field-based screening tool to predict pressures generated on the plantar surfaces of the feet of prepubertal children during single-limb weightbearing stance. Plantar pressures were collected in 51 primary school–aged children using a pressure distribution measurement system. Statistically significant negative correlations were found between footprint angle and both peak force (r = −0.453) and peak area (r = −0.539), and statistically significant positive correlations were found between the Chippaux-Smirak Index and both peak force (ρ= 0.285) and peak area (ρ = 0.559). Although statistically significant, the weak relationships precluded foot structure variables from being used to predict the plantar pressures of children during static weightbearing. It is therefore recommended that an alternative field-based tool that directly measures plantar pressures be used to screen children in the public school system to identify those at risk of excessive plantar pressures. (J Am Podiatr Med Assoc 94(5): 429–433, 2004)
Refraction Effects of Diffraction-Enhanced Radiographic Imaging
Authors: Muehleman Carol , Sumner Dale R. , Zhong Zhong
Published: April 2014

The objective of this study was to demonstrate the ability of a novel radiographic technology—diffraction-enhanced imaging—to detect contrast in bone tissue through absorption, refraction, and scatter rejection. Diffraction-enhanced imaging uses a synchrotron x-ray beam to produce images of high contrast by measuring the object’s refraction and ultra-small angle scattering of x-rays in addition to the attenuation measured by conventional radiography. We present evidence that diffraction-enhanced imaging provides contrast enhancement at the edges of cortical and cancellous bone and a three-dimensional appearance of trabeculae. (J Am Podiatr Med Assoc 94(5): 453–455, 2004)
Adding Stability to the Crescentic Basilar First Metatarsal Osteotomy
Authors: Carpenter Brian , Motley Travis
Published: April 2014

Crescentic basilar osteotomies for metatarsus primus varus and hallux valgus allow for substantial correction of the first intermetatarsal angle and the hallux valgus angle. Crescentic osteotomies have two well-documented pitfalls: sagittal plane instability and difficulty in fixation. We describe the addition of a plantar shelf to crescentic basilar osteotomy that allows for easier fixation and less risk of elevation of the first metatarsal postoperatively. This plantar shelf is made in the metaphyseal portion of the first metatarsal, which provides the benefit of better bone healing. In 20 patients, we found an average reduction in the intermetatarsal angle of 9.3° and an average reduction in the hallux valgus angle of 21.8°. Eight weeks postoperatively, only one patient showed elevation of the first metatarsal. (J Am Podiatr Med Assoc 94(5): 502–504, 2004)
Effectiveness of Different Types of Foot Orthoses for the Treatment of Plantar Fasciitis
Authors: Landorf Karl B. , Keenan Anne-Maree , Herbert Robert D.
Published: April 2014

Clinicians often use foot orthoses to manage the symptoms of plantar fasciitis. Although there has been considerable research evaluating the effectiveness of orthoses for this condition, there is still a lack of scientific evidence that is of suitable quality to fully inform clinical practice. Randomized controlled trials are recognized as the “gold standard” when evaluating the effectiveness of treatments. We discuss why randomized controlled trials are so important, the features of a well-conducted randomized controlled trial, and some of the problems that arise when trial design is not sound. We then evaluate the available evidence for the use of foot orthoses, with particular focus on published randomized controlled trials. From the evidence to date, it seems that foot orthoses do have a role in the management of plantar fasciitis and that prefabricated orthoses are a worthwhile initial management strategy. At this time, however, it is not possible to recommend either prefabricated or customized orthoses as being better, and it cannot be inferred that customized orthoses are more effective over time and therefore have a cost advantage. Additional good-quality randomized controlled trials are needed to answer these questions. (J Am Podiatr Med Assoc 94(6): 542–549, 2004)
Pes Cavus
Authors: Statler Trenton K. , Tullis Brandon L.
Published: April 2014

Pes cavus is a complex deformity with various components. The etiology is multifaceted, which can result in changes to the rearfoot, forefoot, or both areas. Proper patient evaluation is crucial to understanding the deformity and its management. Various soft-tissue and osseous procedures may be used in the reconstruction of the symptomatic cavus foot deformity. This article discusses the clinical and radiographic findings of pes cavus, as well as the various etiologies of this challenging foot deformity and the surgical principles of its correction. (J Am Podiatr Med Assoc 95(1): 42–52, 2005)
Double Calcaneal Osteotomy
Authors: Catanzariti Alan R. , Mendicino Robert W. , King Glenda L. , Neerings Brian
Published: April 2014

Posterior calcaneal displacement and anterior calcaneal distraction osteotomies have been recommended for surgical management of flexible flatfoot deformity. We combined these procedures for surgical management of adolescent flatfoot and late stage II posterior tibial tendon dysfunction in the adult. Lateral column distraction has been shown to reduce rearfoot valgus and forefoot abduction by stabilizing the midtarsal joint. Posterior calcaneal displacement osteotomy, which results in medial translation of the tuberosity, converts the posterior muscle group from an everter to an inverter. A supinatory moment, therefore, is created about the subtalar joint axis, which results in supination during the midstance phase of gait. These procedures may be considered when calcaneal valgus, forefoot abduction, and midtarsal joint instability are clinically significant. We also include rearfoot alignment radiographs, long leg calcaneal axial radiographs, and malleolar valgus indices to further evaluate alignment of the foot, ankle, and leg. Ideal realignment is achieved when the heel is vertical in resting calcaneal stance position, the forefoot is parallel to the rearfoot in the frontal plane, and the medial column is stabilized, with elimination of forefoot abduction. (J Am Podiatr Med Assoc 95(1): 53–59, 2005)
Technical Considerations in Tarsometatarsal Joint Arthrodesis
Authors: Catanzariti Alan R. , Mendicino Robert W.
Published: April 2014

Tarsometatarsal arthrodesis is indicated for degenerative joint disease after trauma. Deformity is often associated with post-traumatic arthropathy. Outcomes after surgical management are directly related to realignment. This article reviews the indications, preoperative evaluation, technical execution, and postoperative management of tarsometatarsal arthrodesis. Special emphasis is placed on realignment and restoration of normal foot architecture. (J Am Podiatr Med Assoc 95(1): 85–90, 2005)
Arthroscopy-Assisted Retrograde Drilling of Osteochondral Lesions of the Talar Dome
Authors: Nelson Scott C. , Haycock Darryl M.
Published: April 2014

Traumatic ankle conditions can lead to long-term sequelae if a pathologic process is misdiagnosed. The clinical presentation of an osteochondral lesion of the talar dome requires the clinician to have a high index of suspicion, and advanced imaging is often necessary to make the final diagnosis. Treatment should be initiated once the lesion is appropriately staged by radiologic or magnetic resonance imaging. We discuss the use of arthroscopy-assisted retrograde drilling of the medial talar dome that spares the articular cartilage within the talotibial articulation. (J Am Podiatr Med Assoc 95(1): 91–96, 2005)
Cooling the Foot to Prevent Diabetic Foot Wounds
Authors: Armstrong David G. , Sangalang Melinda B. , Jolley David , Maben Frank , Kimbriel Heather R. , Nixon Brent P. , Cohen I. Kelman
Published: April 2014

The etiology of neuropathic diabetic foot wounds can be summarized by the following formula: pressure × cycles of repetitive stress = ulceration. The final pathway to ulceration consists of an inflammatory response, leading to tissue breakdown. Mitigation of this response might reduce the risk of ulceration. This proof-of-concept trial evaluates whether simple cooling of the foot can safely reduce the time to thermal equilibrium after activity. After a 15-min brisk walk, the six nondiabetic volunteers enrolled were randomly assigned to receive either air cooling or a 10-min 55°F cool water bath followed by air cooling. The process was then repeated with the intervention reversed, allowing subjects to serve as their own controls. There was a rise in mean ± SD skin temperature after 15 min of activity versus preactivity levels (87.8° ± 3.9° versus 79° ± 2.2° F; P = .0001). Water cooling immediately brought the foot to a point cooler than preactivity levels for all subjects, whereas air cooling required an average of nearly 17 min to do so. Ten minutes of cooling required a mean ± SD of 26.2 ± 5.9 min to warm to preactivity levels. No adverse effects resulted from the intervention. We conclude that cooling the foot may be a safe and effective method of reducing inflammation and may serve as a prophylactic or interventional tool to reduce skin breakdown risk. (J Am Podiatr Med Assoc 95(2): 103–107, 2005)
Sinus Tarsi Denervation
Authors: Dellon A. Lee , Barrett Stephen L.
Published: April 2014

Traumatic neuroma of the branches of the deep peroneal nerve that innervate the sinus tarsi can be the source of recalcitrant lateral ankle pain. That these nerves can be the source of the pain can be demonstrated by nerve blocks, and this pain can be surgically treated by resection of the appropriate branch of the deep peroneal nerve. This article documents the clinical results of this approach in 13 patients with sinus tarsi syndrome. At a minimum of 6 months postoperatively, 10 patients (77%) were completely pain-free, wore normal shoes, and had returned to work. Two patients (15%) had a small degree of residual pain but resumed usual activities and wore normal footwear. One patient had some pain relief but could not resume usual activities. We conclude that denervation of the sinus tarsi can relieve recalcitrant pain emanating from the sinus tarsi. This approach may reduce the need for subtalar fusion or evacuation procedures, including arthroereisis, thus avoiding their potential complications. Moreover, sinus tarsi denervation may allow the continued use of an arthroereisis implant in the presence of satisfactory objective findings, despite the subjective presence of postoperative pain. (J Am Podiatr Med Assoc 95(2): 108–113, 2005)
Future of Gait Analysis
Authors: Curran Sarah A. , Dananberg Howard J.
Published: April 2014

Despite the plethora of information on human gait analysis, its continued use as a clinical tool remains uncertain. Analysis of gait dysfunction has become integral to podiatric medical practice, and, like many specialized fields, it is rapidly changing to meet the needs of the future. Practice in the 21st century is predicated on the concept of multidisciplinary working approaches and a growing trend toward evidence-based practice, in which gait analysis could play a prominent role. This article provides a historical synopsis of instrumented gait analysis and its associated subcomponents and discusses the salient issues concerning its future role in podiatric medicine. (J Am Podiatr Med Assoc 95(2): 130–142, 2005)
A Simple Technique for Correcting Footdrop
Authors: Roukis Thomas S. , Landsman Adam S. , Patel Khushroo E. , Sloan Marc , Petricca Dina
Published: April 2014

Surgical correction of the footdrop deformity caused by various neuromuscular diseases is a time-honored technique, with most surgical procedures intended to correct the absence of active dorsiflexion and a concomitant cavovarus foot deformity. We describe suspension tenodesis of the tibialis anterior tendon to the distal tibia to correct the footdrop deformity. This technique is simpler to perform and more secure than transferring the distal attachment of a tendon to a new location in the foot itself or using tendon weaving techniques. In addition, compared with an ankle fusion, our technique allows for a certain amount of shock absorption during gait and is much less invasive, and a future ankle fusion could be performed if needed for full stability and definitive correction of the symptomatic footdrop. Finally, the technique we describe is easily reproducible and seems to remain stable over time. (J Am Podiatr Med Assoc 95(2): 154–156, 2005)
Capsular Interposition for the Keller Bunionectomy with the Use of Soft-Tissue Anchors
Authors: Cook Keith D.
Published: April 2014

The Keller procedure has been used during the past century for the treatment of first metatarsophalangeal joint pathology. Many modifications to the procedure have been made, including interposition of the joint capsule into the first metatarsophalangeal joint space. Capsular interposition is often the most difficult step in performing the Keller bunionectomy. This article describes a new, simplified technique for capsular interposition with the use of a dorsal capsular flap and soft-tissue anchors. (J Am Podiatr Med Assoc 95(2): 180–182, 2005)
Cutaneous Larva Migrans
Authors: O’Quinn Jonathan C. , Dushin Robert
Published: April 2014

Cutaneous larva migrans is a common skin pathology that occurs in people who have recently visited tropical or subtropical climates. Given the ubiquity of this condition, the podiatric physician may encounter cutaneous larva migrans during clinical practice and should be cognizant of the presenting signs and typical patient history given in these cases. We describe the case of a 62-year-old man who presented with a pruritic, erythematous, serpiginous lesion on the dorsum of his left foot after having vacationed in Florida for several weeks. The patient was treated successfully with oral thiabendazole, 500 mg after meals 4 times daily for 5 days. (J Am Podiatr Med Assoc 95(3): 291–294, 2005)
Effect of Tube Angulation on the Measurement of Intermetatarsal Angles
Authors: Weijers René E. , Kessels Alphons G. H. , Walenkamp Geert H. I. M. , van Mameren Henk , Kemerink Gerrit J.
Published: April 2014

We systematically investigated the effect of tube angulation on angular distortion of the anteroposterior radiograph of the foot. Three-dimensional data from the metatarsals originating from computed tomographic scans of ten healthy volunteers were projected onto the supporting surface at various tube angulations to simulate radiography. The distortion of the intermetatarsal angles decreased from 1.2° to 3.5° at 20° tube angulation to 0.4° to 2.7° at 0° tube angulation. The relatively small improvement in angular measurement using 0° instead of 15° tube angulation would not outweigh the adverse effects of changing the standard radiographic technique. Physician awareness of this source of error when planning surgical therapy seems more important. (J Am Podiatr Med Assoc 95(4): 370–375, 2005)
Bone Matrix Therapy for Aneurysmal Bone Cysts
Authors: Carpenter Brian , Motley Travis
Published: April 2014

Aneurysmal bone cysts are unique pathologic entities that cause pain and local osseous destruction. Many surgical treatment modalities have been described. This article reports on the case of a 16-year-old high school athlete with left heel pain due to an aneurysmal bone cyst in the calcaneus. Curettage of the bone cyst was performed, and the void was filled with a commercially available mixture of cancellous bone and demineralized bone matrix. Early return to athletic activity was achieved, with no recurrence noted at 3-year follow-up. (J Am Podiatr Med Assoc 95(4): 394–397, 2005)
Influence of Treadmill Design on Rearfoot Pronation During Gait at Different Speeds
Authors: Sajko Sandy S. , Pierrynowski Michael R.
Published: April 2014

Understanding the dynamic function of the rearfoot is necessary for recognizing and treating several types of mechanical foot dysfunction. Although the motion of the rearfoot is often measured during treadmill locomotion, the effect of different types of treadmills on the motion of the foot is unclear. In this study, the kinematics of the right subtalar joint in 24 volunteers walking at three speeds on two motorized treadmills were examined. The two treadmills (a wide width and a soft surface versus a narrow width and a hard surface) were selected to maximize motion differences. Maximal change in angular position (positive: supination; negative: pronation) about each volunteer’s subtalar joint axis was estimated during three gait phases: weight acceptance, midstance, and push-off. A factorial, repeated-measures analysis of variance determined that the treadmill design had a significant effect on subtalar joint position (F = 5.423; P = .029), albeit with moderate power (0.61). Descriptively, collapsed over all speeds, the subject’s feet on the narrow/hard compared with the wide/soft treadmill showed more pronation (0.44°), less pronation (0.46°), and more supination (1.44°) during weight acceptance, midstance, and push-off, respectively. We conclude that treadmill design can affect an individual’s rearfoot kinematics. (J Am Podiatr Med Assoc 95(5): 475–480, 2005)
Effects of Simulated Genu Valgum and Genu Varum on Ground Reaction Forces and Subtalar Joint Function During Gait
Authors: Van Gheluwe Bart , Kirby Kevin A. , Hagman Friso
Published: April 2014

The mechanical effects of genu valgum and varum deformities on the subtalar joint were investigated. First, a theoretical model of the forces within the foot and lower extremity during relaxed bipedal stance was developed predicting the rotational effect on the subtalar joint due to genu valgum and varum deformities. Second, a kinetic gait study was performed involving 15 subjects who walked with simulated genu valgum and genu varum over a force plate and a plantar pressure mat to determine the changes in the ground reaction force vector within the frontal plane and the changes in the center-of-pressure location on the plantar foot. These results predicted that a genu varum deformity would tend to cause a subtalar pronation moment to increase or a supination moment to decrease during the contact and propulsion phases of walking. With genu valgum, it was determined that during the contact phase a subtalar pronation moment would increase, whereas in the early propulsive phase, a subtalar supination moment would increase or a pronation moment would decrease. However, the current inability to track the spatial position of the subtalar joint axis makes it difficult to determine the absolute direction and magnitudes of the subtalar joint moments. (J Am Podiatr Med Assoc 95(6): 531–541, 2005)
Treatment of Ingrown Toenails Using a New Conservative Method
Authors: Harrer Jörg , Schöffl Volker , Hohenberger Werner , Schneider Ignaz
Published: April 2014

Ingrown toenails cause incapacitation and pain for the patient and lost time from work. Many different conservative and surgical treatment methods have been described. European chiropodists and podologists have long treated ingrown toenails with orthonyxia, which consists of implantation of a small metal brace or plate onto the dorsum of the nail. To determine whether orthonyxia is an acceptable alternative to surgery, we compared the VHO-Osthold brace (VHO-Osthold-Spange GmbH, Deisenhofen, Germany), a new method of orthonyxia, with Emmert’s procedure, a standard surgical method that is virtually identical to the Winograd-type procedure, in a prospective study of 41 patients (21 in the brace group and 20 in the Emmert procedure group). Pain due to treatment was significantly lower in the brace group than in the Emmert procedure group, and patients in the brace group could wear regular shoes again without appreciable pain much earlier than those in the Emmert procedure group. In the brace group, there were four recurrences, and one patient was still receiving treatment at the end of follow-up; in the Emmert procedure group, there were three recurrences. None of the patients in the brace group had to take time off from work, whereas in the Emmert procedure group, working patients were off from work for an average of 14.7 days. Brace treatment proved to be a good conservative alternative to operative procedures. (J Am Podiatr Med Assoc 95(6): 542–549, 2005)
Nitinol Compression Staples for Bone Fixation in Foot Surgery
Authors: Mereau Trinity M. , Ford Timothy C.
Published: April 2014

We reviewed the use of compression staples made of the memory metal alloy nitinol for fixation in foot surgery. A retrospective study was performed of 31 feet in 27 patients who underwent arthrodesis or an osteotomy fixated using compression staples. OSStaples (BME, San Antonio, Texas) were used in 18 feet, and Memodyn staples (Telos Medical, Fallston, Maryland) were used in 13 feet. A total of 48 compression staples were implanted. The following procedures were performed and fixated using compression staples: 15 Akin osteotomies, 2 first metatarsal base epiphysiodeses, 3 first metatarsal–cuneiform fusions, 2 naviculocuneiform fusions, 3 calcaneocuboid fusions, 4 talonavicular fusions, 3 subtalar joint fusions, and 2 Evans osteotomies. In our clinical experience, compression staples provide an adequate source of internal fixation in foot surgery. Good bone apposition and stabilization and compression of the bone surfaces before staple fixation are important when using staple fixation to promote an optimal environment for bone healing. (J Am Podiatr Med Assoc 96(2): 102–106, 2006)
Subungual Osteochondroma
Authors: Tuzuner Tolga , Kavak Ayse , Parlak Ali Haydar , Ustundag Nil
Published: April 2014

Osteochondroma is the most common skeletal neoplasm of all benign bone tumors. However, it rarely occurs subungually. In this location, the lesion may penetrate the skin, causing nail deformity, and can easily be misdiagnosed. We report two cases of subungual osteochondroma of the distal phalanges of the first toes with cutaneous penetration and discuss the clinical, histologic, and radiographic features and the treatment options. (J Am Podiatr Med Assoc 96(2): 154–157, 2006)
Biomechanical Risk Factors Associated with Neuropathic Ulceration of the Hallux in People with Diabetes Mellitus
Authors: Nubé Vanessa L. , Molyneaux Lynda , Yue Dennis K.
Published: April 2014

In this study of people with diabetes mellitus and peripheral neuropathy, it was found that the feet of patients with a history of hallux ulceration were more pronated and less able to complete a single-leg heel rise compared with the feet of patients with a history of ulceration elsewhere on the foot. The range of active first metatarsophalangeal joint dorsiflexion was found to be significantly lower in the affected foot. Ankle dorsiflexion, subtalar joint range of motion, and angle of gait differed from normal values but were similar to those found in other studies involving diabetic subjects and were not important factors in the occurrence of hallux ulceration. These data indicate that a more pronated foot type is associated with hallux ulceration in diabetic feet. Further studies are required to evaluate the efficacy of footwear and orthoses in altering foot posture to manage hallux ulceration. (J Am Podiatr Med Assoc 96(3): 189–197, 2006)
Trephine Arthrodesis of the Foot and Ankle
Authors: Filiatrault Annette D. , Banks Alan S.
Published: April 2014

We conducted a retrospective analysis of trephine arthrodesis in a total of 22 joints in 15 feet to determine the efficacy of this procedure in the foot and ankle. Twelve of the 22 joints that were fused involved the tarsometatarsal articulations, 3 the naviculocuneiform joint, 6 the subtalar joint, and 1 the ankle. A successful fusion rate of 95% (21/22) was achieved. These results lend evidence that the trephine arthrodesis technique can be used with satisfactory results and confidence in the foot and ankle. (J Am Podiatr Med Assoc 96(3): 198–204, 2006)
The Subtalar Joint Axis Locator
Authors: Spooner Simon K. , Kirby Kevin A.
Published: April 2014

A new clinical device, the subtalar joint axis locator, was created to track the three-dimensional location of the subtalar joint axis during weightbearing movements of the foot. The assumption was that if the anterior exit point of the subtalar joint axis is stationary relative to the dorsal aspect of the talar neck, then, by performing radiographs of the feet with the subtalar joint axis locator in place on the foot, the ability of the locator to track rotations and translations of the talar neck and thus the subtalar joint axis in space could be approximated. In this preliminary study of two adults, the subtalar joint axis locator accurately tracked the talar neck position during weightbearing rotational motions of the subtalar joint. The device was also used in a series of subjects to determine its dynamic capabilities. It is possible, then, that the subtalar joint axis locator can reliably track the spatial location of the subtalar joint axis during weightbearing movements of the foot. (J Am Podiatr Med Assoc 96(3): 212–219, 2006)
Talar Dome Fracture Repaired Using Bioabsorbable Fixation
Authors: Zelent Marek E. , Neese David J.
Published: April 2014

We describe a man with an acute osteochondral defect in the lateral talar dome associated with a supination-adduction–type ankle fracture. The osteochondral defect was readily visible on plain film radiographs, and magnetic resonance imaging was ordered to determine the full extent of soft-tissue and articular injury. It was discovered that the patient had a stage IV lesion of the talar dome, with complete inversion of the fragment, and rupture of the anterior talofibular and calcaneofibular lateral ankle ligaments. Furthermore, the patient experienced an oblique fracture of the medial malleolus with comminution. The talar dome lesion was surgically reduced and fixated using bioabsorbable pins. Nine months after surgery, the patient was fully recovered from his injury and had no functional limitations. (J Am Podiatr Med Assoc 96(3): 256–259, 2006)
Effects of Rearfoot-Controlling Orthotic Treatment on Dorsiflexion of the Hallux in Feet with Abnormal Subtalar Pronation
Authors: Munuera Pedro V. , Domínguez Gabriel , Palomo Inmaculada C. , Lafuente Guillermo
Published: April 2014

The aim of this study was to determine whether the treatment of abnormal subtalar pronation restores functional (as opposed to structural) limited dorsiflexion of the first metatarsophalangeal joint (functional hallux limitus). We studied 16 feet of eight individuals with abnormal subtalar pronation. Orthoses were made for all of the feet, and hallux dorsiflexion was measured during weightbearing. Each patient was unshod without the orthosis, unshod with the orthosis fitted on the same day, and unshod with the orthosis fitted approximately 5 months later. The results suggest that in functional hallux limitus caused by abnormal subtalar pronation, hallux dorsiflexion will gradually be restored by the use of foot orthoses to control the abnormal subtalar pronation. (J Am Podiatr Med Assoc 96(4): 283–289, 2006)
Comparison of Injection Modalities in the Treatment of Plantar Heel Pain
Authors: Kiter Esat , Çelikbaş Ersen , Akkaya Semih , Demirkan Fahir , Kiliç B. Alper
Published: April 2014

In a prospective randomized study of plantar heel pain, 44 patients were treated with injection of 1 mL of 2% prilocaine using the peppering technique, 1 mL of 2% prilocaine combined with 2 mL of autologous blood, or 1 mL of 2% prilocaine mixed with 40 mg of methylprednisolone acetate. At 6-month follow-up, clinical improvement was evaluated by using a 10-cm visual analog scale and the rearfoot score of the American Orthopaedic Foot and Ankle Society. Results were analyzed using sample t-tests within groups and repeated-measures analyses of variance between groups. Mean ± SD visual analog scale scores in the peppering technique, autologous blood injection, and corticosteroid injection groups improved from 6.4 ± 1.1, 7.6 ± 1.3, and 7.28 ± 1.2 to 2.0 ± 2.2 (P < .001), 2.4 ± 1.8 (P < .001), and 2.57 ± 2.9 (P < .001), respectively. Mean ± SD rearfoot scores in the same groups improved from 64.1 ± 15.1, 71.6 ± 1, and 65.7 ± 12.7 to 78.2 ± 12.4 (P = .018), 80.9 ± 13.9 (P = .025), and 80.07 ± 17.5 (P = .030), respectively. There were no statistically significant differences among the groups. Good outcomes have been documented using the peppering technique and autologous blood injection for the treatment of lateral epicondylitis. Although the curative mechanisms of both injection modalities are based on a hypothesis, they seem to be good alternatives to corticosteroid injection for the treatment of plantar heel pain. (J Am Podiatr Med Assoc 96(4): 293–296, 2006)
Synpolydactyly of the Foot in Homozygotes
Authors: Kuru Ilhami , Maralcan Gokhan , Yucel Aylin , Aktepe Fatma , Turkmen Seval , Solak Mustafa
Published: April 2014

In 2002, we reinvestigated a large synpolydactyly kindred first described in 1995. It was found to have expanded with an increase in number of homozygous offspring. These homozygotes had severe hypoplasia, with synpolydactyly of their hands and feet. We present the clinical, genetic, and surgical findings of this deformity and the histologic findings of the removed bones of the heterozygous and homozygous members. There were 125 affected individuals (113 heterozygotes and 12 homozygotes) of 245 members of the past five generations. We identified seven marriages in which both spouses were affected. Twelve offspring from these marriages had homozygote genetic patterns, hypoplastic synpolydactyly of the hands, and a distinctive foot deformity, with a prominent great toe and syndactylized hypoplastic minor toes. From clinical and surgical perspectives, their hand and foot deformities were different from those of their parents. We surgically treated both feet of four individuals with this deformity, which we called “homozygote foot synpolydactyly.” Clinically, the deformity consisted of a supinated prominent great toe, hypoplastic and severely synpolydactylized minor toes, and secondary problems. Radiographically, the bones were underdeveloped, unshaped, and largely fused. Abundant cartilage covering the bones was observed surgically and histologically. Genetically, analysis of HOXD13 identified a 27–base pair duplication with a homozygote pattern. The foot deformity of the homozygotes was so distinctive and complicated that it should be considered a separate foot synpolydactyly type—homozygote foot synpolydactyly. (J Am Podiatr Med Assoc 96(4): 297–304, 2006)
Effect of a Nitroglycerin Patch on Perfusion to the Foot in Healthy Subjects
Authors: Kim Paul Jeong , Ballinger L. Clay , Kushner Donald
Published: April 2014

Nitric oxide is an endogenous gas released by endothelial cells that induces vasodilatation and plays other important roles in the wound-healing process. Nitroglycerin preparations are liberators of nitric oxide. Podiatric physicians have used nitroglycerin paste and patches on patients in an attempt to increase perfusion to the foot. However, the drug’s efficacy seems to be largely anecdotal. A prospective, randomized, placebo-controlled, double-blind study was conducted to investigate the efficacy of a nitroglycerin patch in locally increasing perfusion to the foot. Twenty-two healthy subjects were randomly assigned to either a drug group (nitroglycerin patch, 0.2 mg/h) or a placebo group (adhesive patch without active ingredient). The patch was applied to the plantar arch of the foot. Objective and subjective measures were then used to detect changes in perfusion to the foot after a 2-hour experimental period. The objective measures, cutaneous thermometry and photoplethysmography, found no significant measurable difference in perfusion to the foot between the drug and placebo groups (P > .05). A subjective questionnaire used to assess changes in temperature or sensation detected by the subject yielded similar results. Thus a nitroglycerin patch dose of 0.2 mg/h showed no measurable ability to increase perfusion to the foot. Further research is needed to validate the indications for this therapy. (J Am Podiatr Med Assoc 96(4): 318–322, 2006)
A Review of Opioid Analgesics Frequently Prescribed by Podiatric Physicians
Authors: Smith Robert G.
Published: April 2014

The unpleasant and subjective sensation resulting from a noxious sensory stimulus defines the phenomenon of pain. The podiatric physician is no stranger to the difficulties in achieving optimal pain therapy. Podiatric physicians must develop analgesic regimens to treat patients with acute, chronic, and postoperative pain. Because opioid therapy is the cornerstone of the pharmacologic management of acute and chronic pain, this review focuses on the prescribing of opioid analgesics to treat lower-extremity pain. The pharmacology of frequently prescribed opioids is introduced. Then, criteria for selecting appropriate opioid analgesics as found in the current medical literature are reported. Finally, a review of the literature describing legal and ethical considerations regarding the prescribing of opioid analgesics is presented. (J Am Podiatr Med Assoc 96(4): 367–373, 2006)
Common Peroneal Nerve Compression
Authors: Anselmi Stevan J.
Published: April 2014

Entrapment of the common peroneal nerve at the knee can cause sensory and motor symptoms and functional problems that affect the foot and ankle. This article reviews the signs and symptoms of entrapment of this nerve. It also presents a retrospective assessment of subjective improvement in symptoms and the activity level after decompression of the common peroneal nerve. A consecutive series of 17 patients who underwent neurolysis of the common peroneal nerve, 4 bilaterally, is reported. Eighteen (86%) of the 21 surgical procedures had a good-to-excellent outcome, whereas three outcomes (14%) were not improved. Decompression of the common peroneal nerve offers a chance for improvement of sensory and motor symptoms in carefully selected patients. (J Am Podiatr Med Assoc 96(5): 413–417, 2006)
Comparison of Two Methods of Joint Distraction for Arthrodesis of the Foot
Authors: Segler Christopher P. , Heninger Spencer , Seegmiller David C.
Published: April 2014

A study was conducted to compare the efficacy of two methods of obtaining the joint exposure needed to perform arthrodesis or exploration of various joints of the foot. The investigation was performed by means of simulated arthrodesis in a cadaveric model. On each specimen, a single investigator performed standard incisions and dissection as typically performed for surgical arthrodesis of the first metatarsocuneiform, naviculocuneiform, medial intercuneiform, talonavicular, calcaneocuboid, and subtalar joints. Each joint was exposed and distracted once using the Tarsal Joint Distractor (Orthovation LLC, Sealy, Texas) and once using the Inge Laminar Spreader (K-Medic, Northvale, New Jersey). While a given joint was distracted, a calibrated digital photograph of the exposed joint was taken from an angle best representing the surgeon’s view of the articular space. Digital images were analyzed to calculate the maximum distance between articular surfaces and the total area of articular surfaces exposed while distracted. Thirty-six joints involving six feet were distracted using each device. The mean area of articular exposure was 178.3 mm2 for the Tarsal Joint Distractor and 116.4 mm2 for the Inge Laminar Spreader (P = .0001). The mean distance of distraction was 8.1 mm for the Tarsal Joint Distractor and 6.5 mm for the Inge Laminar Spreader (P = .0001). An average of 53.1% more exposure and 25.2% more distance between distracted surfaces was achieved when using the Tarsal Joint Distractor. The Tarsal Joint Distractor provides significantly better visualization of articular spaces typical of midfoot and rearfoot arthrodesis procedures than the Inge Laminar Spreader. (J Am Podiatr Med Assoc 96(5): 423–427, 2006)
Treatment of Toenail Onychomycosis with Oral Terbinafine Plus Aggressive Debridement
Authors: Jennings Maureen B. , Pollak Richard , Harkless Lawrence B. , Kianifard Farid , Tavakkol Amir
Published: April 2014

This study was conducted to investigate the efficacy of oral terbinafine with and without aggressive debridement for the treatment of toenail onychomycosis. Onychomycosis patients aged 18 to 75 years received 12 weeks of terbinafine, 250 mg/day, alone (n = 255) or with aggressive debridement (n = 249). Both groups showed marked improvement from baseline at all time points. At week 48, complete, mycologic, and clinical cure rates were higher in the terbinafine plus debridement group compared with the terbinafine alone group, although significance was reached only for clinical cure (59.8% versus 51.4%; P = .023). Although approximately 39% of the patients received at least one antidiabetic, antihypertensive, or cholesterol-lowering agent concomitantly, including statins, the incidence of treatment-emergent adverse events was low and the adverse events were generally mild to moderate in severity. No clinically significant changes in liver transaminase levels were observed 6 weeks after treatment or after 12 weeks in those tested. These results support the well-established safety and efficacy of terbinafine for treatment of onychomycosis. (J Am Podiatr Med Assoc 96(6): 465–473, 2006)
Clinical Uses of In-Shoe Pressure Analysis in Podiatric Sports Medicine
Authors: Williams Bruce E. , Yakel James D.
Published: April 2014

Athletic injuries of the foot and lower extremity are commonly treated with custom foot orthoses. These devices usually provide immediate relief of the athlete’s pain and dysfunction. Occasionally, however, they do not help, or even increase the patient’s discomfort. We discuss a method of using in-shoe pressure-measurement systems to analyze the athletic patient’s foot and lower-extremity function before and after treatment with custom foot orthoses, with a focus on sagittal plane biomechanics. Case histories are presented of athletes whose gait pathologies were identified and treated successfully using an in-shoe pressure-measurement system. (J Am Podiatr Med Assoc 97(1): 49–58, 2007)
The 36-Item Short-Form Health Survey Outcome Evaluation for Multiple Lower-Extremity Nerve Decompressions in Diabetic Peripheral Neuropathy
Authors: Nelson Scott C. , Little Eugene R.
Published: April 2014

Background: Diabetic neuropathy can be disabling owing to pain and loss of sensibility. Theoretically, surgical restoration of sensation and relief of pain may prevent these complications and improve quality of life. A study was conducted to perform outcome analysis of patients after these surgical procedures using the 36-Item Short-Form Health Survey.

Methods: The 36-Item Short-Form Health Survey was used to evaluate patients with diabetic neuropathy after nerve decompression surgery. These results were compared with those reported in the literature related to diabetic patients without neuropathy, patients with low-back pain, and an age-matched normative population. The pilot study group included six patients with diabetic neuropathy, three of whom underwent multiple nerve decompression surgery bilaterally. Mean follow-up was 6 months.

Results: Single-tailed t tests demonstrated that postoperative patients were not statistically significantly different from the other groups in the domains of Physical Functioning, Bodily Pain, General Health, Vitality, Social Functioning, and Mental Health; in the domains of Role-Physical and Role-Emotional, a statistically significant difference was found, with the postoperative patients scoring lower.

Conclusions: Although this study is limited by the lack of preoperative administration of the 36-Item Short-Form Health Survey and by its small sample size, we conclude that the survey can evaluate the results of surgical decompression of lower-extremity peripheral nerves and should be added to the traditional assessments of recovery of sensibility and the visual analog scale for pain. (J Am Podiatr Med Assoc 97(2): 121–125, 2007)
Neurilemoma of the Posterior Tibial Nerve and Tarsal Tunnel Syndrome
Authors: Miranpuri Sarnarendra , Snook Eric , Vang David , Yong Raymond M. , Chagares William E.
Published: April 2014

Tarsal tunnel syndrome is defined as a compressive neuropathy of the posterior tibial nerve in the tarsal canal. A neurilemoma is an uncommon, benign, encapsulated neoplasm derived from Schwann cells. We present a case of tarsal tunnel syndrome caused by this rare space-occupying lesion. (J Am Podiatr Med Assoc 97(2): 148–150, 2007)
Relationship Between Positive Clinical Outcomes of Foot Orthotic Treatment and Changes in Rearfoot Kinematics
Authors: Zammit Gerard V. , Payne Craig B.
Published: April 2014

Background: Previous two-dimensional kinematic studies that assessed the effect of foot orthoses on rearfoot motion have yielded mixed results regarding whether control of rearfoot motion is related to symptom relief.

Methods: We sought to determine the effect of foot orthoses on rearfoot motion and to correlate these changes with the degree of symptom improvement in 22 individuals with excessive rearfoot pronation (17 women and 5 men; mean ± SD age, 44.3 ± 16.7 years; mean ± SD weight, 74.9 ± 15.9 kg). Two-dimensional motion-analysis software was used to assess frontal plane rearfoot motion with and without foot orthoses. The mean ± SD Foot Posture Index of the left foot was 8.83 ± 3.54 and of the right foot was 9.22 ± 3.64). The pain and function subscales of the Foot Health Status Questionnaire were then used to determine the degree of symptom relief associated with the orthoses at baseline and 4 weeks later.

Results: Orthoses had a small but statistically significant effect on rearfoot motion, although no significant correlations were found between differences in rearfoot motion with and without foot orthoses and the improvements demonstrated in the Foot Health Status Questionnaire subscales of pain and function.

Conclusions: The effect of orthoses on frontal plane rearfoot motion is considered small and probably insufficient to account for the extent of symptom reduction found in this study. Other parameters of orthotic function, such as kinetic and neuromechanical variables, should be further investigated. (J Am Podiatr Med Assoc 97(3): 207–212, 2007)
Essential Features of a Handheld Infrared Thermometer Used to Guide the Treatment of Neuropathic Feet
Authors: Foto James G. , Brasseaux Denise , Birke James A.
Published: April 2014

Background: A study was conducted to compare the accuracy, reliability, and essential features of nine commercially available handheld infrared thermometers used to manage the neuropathic foot.

Methods: The thermometers were compared using two temperature-control sources simulating physiologic conditions found in a foot-care clinic. With each control source independently set, temperature difference ranges of 0°, 2°, 4°, and 6° C were randomly sampled and analyzed for each thermometer by two testers. The order of testing was randomly assigned for testers and instruments.

Results: There were differences in mean temperature change among thermometers (P < .001) and between testers (P = .0247). Differences in mean temperature change among instruments (<0.5°C), although small, could affect interpretation of skin temperature if temperature comparisons are made using two different instruments. The difference in temperature change between testers (0.06°C) was not large enough to affect decisions in clinical practice. Instrument response time, distance-to-spot ratio, sensor diameter, display resolution, emissivity, and cost were compared.

Conclusions: The low-cost, general-use infrared thermometers used in this study showed good accuracy, reliability, and performance and are appropriate for use in a foot-care clinic. (J Am Podiatr Med Assoc 97(5): 360–365, 2007)