Background: Ideal suture technique and type in tendon repair are remain unclear. This biomechanical study aimed to assess the biomechanical characteristics of three techniques, modified Kessler (mKE), modified Krackow (mKR), and modified tension Bunnell (mtBU), in sheep Achilles’ tendon tear repair using three suture types, polypropylene, polyester, and ultra-high molecular weight polyethylene (UHMWPE) sutures, which are also compared.
Methods: Sixty-three Achilles’ tendons harvested from sheep were transversely hacked as a replacement for rupture in a standardized measure and repaired using mKE, mKR, and mtBU techniques with No. 2 polypropylene, polyester, and UHMWPE sutures. Biomechanical parameters, such as Young’s modulus, ultimate strength, and strength to the 5-mm gap were recorded for statistical analysis.
Results: The mtBU technique with UHMWPE use resulted in increased ultimate strength, strenght to 5-mm gap, Young’s modulus, and quantity of specimens with low clinical failure modes compared to other techniques with other suture materials. Furthermore, mtBU has the lowest thickness at the repair side of the tendons. This approach showed tendon failure during maximal traction testing, whereas the mKE and mKR had polyethylene and polyester suture failures.
Conclusions: The UHMWPE suture was significantly superior to the other sutures in each suture techniques in terms of strength and durability. The mtBU technique using UHMWPE suture showed better biomechanical results, implying that this repair might be more appropriate to obtain early mobilization after tendon ruptures.
Background: Clinical thermography is a relatively novel technique in wide use in different medical fields because of its versatility and ease of application. It inflicts no pain and it entails no contact with the pediatric patient, which assuages anxiety and fear in subjects when undergoing diagnostic exploration. The use of infrared clinical thermography being suggested here is to establish normality patterns, which have not been described in the relevant literature. These patterns may be extrapolated to pathological study by means of future research lines.
Methods: An observational, cross-sectional study (descriptive in nature) has been carried out, with a sample population of 328 children divided into two age groups; 6-7 and 13-16 years old, all of them schooled in the province of Cáceres (Spain). The variables analyzed here are: age, sex, and temperature. A FLIR E60bx® thermographic camera has been used to study foot temperature.
Results: Results show that the temperature varies among the different study areas established for the foot, although they remain constant bilaterally. In addition, the highest temperature is found to be located in the area of the first toe (29.8ºC), and the lowest at the heel (28.8ºC).
Conclusions: It can be concluded that both feet have the same thermal behavior, despite the variation in temperature among the different areas that were established in the foot for the purposes of this study.
Background: The COVID-19 pandemic impacted all facets of health care in the United States, including the disruption of professional training for podiatry residents and students. In March 2020, the Association of American Medical Colleges (AAMC) recommended pausing then modifying all clinical rotations. The podiatric community followed suit. In-person restrictions, cancellations of clerkships, limited clinical experiences, virtual didactic programs and reduced surgical cases for students and residency programs occurred for many months during the ongoing pandemic. These adaptations impacted the ability of podiatric students to complete clinical rotations and clerkships, which are pivotal to their academic curriculum and residency program application and selection.
Methods: A survey was conducted by the Council of Teaching Hospitals (COTH) and sent out by the American Association of Colleges of Podiatric Medicine (AACPM). The 2021 post-interview surveys were sent out to all participants in the 2021 CASPR application and match cycle, both programs and candidates.
Results: The COTH presents results and comments from the 2021 virtual interview experience and residency match. Data and anecdotal comments from the 2021 post-interview survey conducted by COTH, sent out by AACPM, are presented here.
Conclusions: Results from the surveys of program directors and candidates show a preference by both groups for in-person interviews despite the personal time demands and increased costs associated with travel.
A 30-year-old man working as a waiter presented with a progressively enlarging and symptomatic soft-tissue mass on the plantar medial aspect of his left foot. The mass was painful and disrupting ambulation, despite footwear modifications. He ultimately underwent excision of what was a determined to be a fibrolipoma, returning to his regular shoes and all activities. Plantar neoplasms, even when benign, can grow to sizes that can result in significant disability. If left untreated, particularly in individuals engaged in occupations requiring frequent standing or walking, excision of the mass will often require a more aggressive operative approach.
Background: Transmetatarsal amputation (TMA) is a viable option to avoid major amputation and limb loss in patients with forefoot sepsis, infection, or tissue loss. However, TMAs are associated with a significant incidence of dehiscence, readmission, and reoperation rates ranging from 26% to 63%. To encourage tissue healing, neovascularization, and durable closure, a nonwoven, resorbable, synthetic hybrid-scale fiber matrix whose architecture is similar to native human extracellular matrix was used in an augmented closure technique. We comparatively evaluated clinical outcomes and complication rates in TMA procedures with and without augmented closure.
Methods: A retrospective analysis of ten patients who underwent TMA with augmented closure using the synthetic matrix and ten patients who underwent TMA with standard primary closure was conducted.
Results: After TMA, 80% of the patients who underwent augmented closure demonstrated complete wound healing compared with 60% of the control group. Patients undergoing augmented closure demonstrated five instances of wound dehiscence and 20% limb loss compared with eight instances of wound dehiscence and 40% limb loss in the control group. After TMA and augmented closure, patients required eight interventional procedures before complete healing compared with patients undergoing standard closure, who required 13 interventional procedures before complete healing.
Conclusions: Augmented closure of surgical wounds after TMA using a synthetic hybrid-scale fiber matrix provided a unique means of reducing time to healing (18%), wound dehiscence (29%), number of procedures performed (39%), and rate of limb loss (20%). Augmented closure, therefore, offers a means of improving quality of life and reducing risk for patients undergoing TMA, and potentially reducing total cost of care.
Background: Charcot neuroarthropathy (CN) is a devastating complication of some diseases affecting the peripheral nervous system. Initial subjective and objective presentation of the disease can be variable. Common among all presentations seems to be uncontrolled inflammation yielding dislocations and/or fractures. The exact cause remains the subject of much debate.
Methods: Our study retrospectively looks at the function of olfactory function in consecutive patients with CN and compares the findings with a nonaffected population. The University of Pennsylvania Smell Identification Test was used to assess olfaction and document microsomia.
Results: Twenty consecutive patients presenting with CN demonstrated significant (P < .0001) microsomia when compared to an unaffected population with diabetes.
Conclusions: Microsomia is strongly associated with CN. This finding may be correlated to voltage-gated sodium 1.7 channel impairment and appears to be a candidate precursor for the development of CN.
Background: Side-to-side stress imbalance has been suggested as a risk factor for injury in unilateral sports. The leading leg is suggested to be essential in sports rehabilitation for the return of athletes to the playground. The main aim of this study was to evaluate the dynamic pedobarometric and spatiotemporal gait differences between the leading and nonleading feet of male handball players.
Methods: Thirty healthy elite male handball players (mean ± SD: age, 31.7 ± 2.99 years; height, 177.5 ± 6.0 cm; weight, 78.9 ± 6.3 kg; body mass index, 25.0 ± 0.7) participated in this study; all of the participants were backcourt and pivot handball players. The assessments were performed using the Tekscan Walkway pressure sensor to detect and compare the variables of interest between the leading and nonleading feet during normal walking at a self-selected speed.
Results: Maximum force, peak pressure (total and forefoot pressure), foot width, single-limb support time, and step velocity were significantly increased in the leading foot compared with the nonleading foot. In addition, maximum force, foot width, and total peak pressure showed moderate positive significant correlations with body mass index.
Conclusions: The differences in the pedobarometric and spatiotemporal gait parameters may result from the physiologic and mechanical demands that are put on the leading foot of handball players, which need more rehabilitation attention and protection to avoid expected injuries.
This case describes delayed treatment of a medial talonavicular dislocation with a shear fracture of the talar head, a comminuted posterior talar process fracture, and an intra-articular cuboid fracture with subtle medial displacement of the calcaneocuboid joint and the associated treatment. The injury was sustained in a 35-year-old man following a high-energy motor vehicle accident. Three weeks following the injury, delayed treatment was achieved following an attempted closed reduction under general anesthesia followed by open reduction and percutaneous Kirschner wire fixation. After a 12-month follow-up, the patient was able to return to work and regular activities pain-free without complications. Several associated injuries have been described with isolated talonavicular dislocations. This case reviews the technique and care surrounding this injury pattern and its delayed treatment.
Desmoplastic fibroblastomas are benign and uncommon soft-tissue tumors. They are typically slow-growing, painless masses found in adult men. Rapidly growing masses have been previously reported, but are more rare. A 56-year-old man presented with a rapidly growing mass in his left foot, which was diagnosed as a desmoplastic fibroblastoma after pathologic evaluation. Although many case reports have been published in the dermatology literature, it is important to be aware of this benign neoplasm to avoid confusion with other rapidly growing malignant soft-tissue masses reported in the podiatry literature.