The accessory navicular bone (ANB) is one of the most common accessory ossicles of the foot. Fewer than 1% of ANBs are symptomatic, and most of the symptomatic ANBs are type II ANBs. Avascular necrosis of the type II ANB is an uncommon cause of symptomatic accessory navicular syndrome and also a rarely reported condition in the podiatric medical literature. This rare disorder must be distinguished from other painful conditions of the ANB and should be considered in differential diagnoses. We present a case of avascular necrosis of the type II ANB with sclerosis on radiographs and magnetic resonance images in a 46-year-old woman.
Background: Onychomycosis, or fungal nail infection, is the cause of 50% of onychopathies seen by podiatric physicians. This pathology is accompanied by a negative psychosocial component because of its effect on self-image, which is an essential part of social relations. Conventional pharmacologic treatment based on antifungal agents is lengthy and expensive and has a high abandonment rate and a low cure rate. Therefore, a faster and more efficient solution has been sought using laser treatment. However, studies on the efficacy of this physical method are not conclusive due to the lack of uniformity in the method used to apply the laser and an objective method to measure the results. The aim of this study was to measure the efficacy of laser treatment of onychomycosis by microbiological cure and clinical evolution using the Onychomycosis Severity Index.
Methods: A prospective study with a strictly repetitive protocol of Nd:YAG 1,064-nm laser was applied to 50 participants with onychomycosis in the first toe, following the manufacturer's instructions. The efficacy of the treatment on fungal infection was measured by microbiological culture before and after treatment. The clinical evolution of the nail dystrophy was quantitatively evaluated using the Onychomycosis Severity Index.
Results: The efficacy of Nd:YAG 1,064-nm laser in eliminating fungal infection was 30% (15 participants). However, significant improvement in nail appearance (dystrophy) was observed in 100% of patients (P < .001).
Conclusions: Laser treatment has relatively low efficacy in treating fungal infection but results in an objective improvement in the clinical appearance of the nail in 100% of patients.
Background: Perceived acceptability of barefoot use has largely been ignored in the literature despite its importance to long-term implementation and behavior change. This study aimed to compare the acceptability of undertaking weightbearing physical activities in regular running shoes versus barefoot in habitually shod individuals.
Methods: Healthy young men and women were recruited from the Gold Coast. Participants completed six activities (ie, lunges, walking, jogging, sidestep, vertical jump, and hop) in shod and barefoot conditions then answered questions pertaining to level and source of discomfort, ease of performance, and acceptability. Indices of bone quality were measured from their dominant calcaneus by quantitative ultrasound.
Results: Seventeen healthy male (n = 8) and female (n = 9) university students participated in the study (age, 26.59 ± 7.26 years; body mass index, 23.08 ± 3.58 kg/m2). Men were taller, heavier, and had higher broadband ultrasound attenuation than women (P < .05). For “no” discomfort, “very easy” ease of performance, and a “good amount” or “very good amount” of acceptability, the shod condition demonstrated response rates of 87.25%, 55.88%, and 72.55%, respectively. The barefoot condition demonstrated rates of those responses of 62.75%, 39.22%, and 48.03%, respectively, and reported more ball-of-foot, forefoot, heel, and plantar skin locations as sources of discomfort during activity than in the shod condition. The group vertical jump height was higher barefoot than shod (44.88 ± 8.44 cm and 43.25 ± 8.76 cm, respectively; P < .05), but no difference was seen for the hop. Men jumped and hopped higher than women under both footwear conditions (P < .05).
Conclusions: Participants initiating barefoot weightbearing exercise may experience slightly greater discomfort and less ease of performance in the initial transition from the shod condition, but may perform better in vertical jump. Whether those differences in experience persist over the long term will require longitudinal studies.
Background: Toe deformities are common foot abnormalities in older adults, contributing to functional disability, loss of balance, falls, and pressure lesions. The aim of this study was to evaluate the effectiveness of the custom-made molded silicone toe prop in distributing apical and metatarsophalangeal joint peak plantar pressures and force-time integral in toe deformities, including hammertoes and claw toes, and to observe any difference in pressures between flexible and rigid toe deformities.
Methods: A prospective quasi-experimental pretest/posttest study was conducted including 20 “healthy” older adults with a hammer or claw toe at the second digit. Ten subjects presented with a flexible toe and 10 subjects presented with a rigid toe. A molded silicone toe prop was devised for each participant. Dynamic plantar pressure measurements were taken/recorded before applying the toe prop and after the toe prop was placed under the toe.
Results: Significant differences in mean peak plantar pressure and pressure-time integral were observed at the apex of the second toe in both the flexible and rigid toe deformity when using a molded silicone toe prop. At the metatarsophalangeal joint, pressures were significantly reduced in the rigid toe deformity but not in the flexible toe deformity.
Conclusions: Silicone molded toe props were found to be effective in reducing peak pressure and pressure-time integral on the apex of the second digit in participants with both flexible and rigid claw or hammertoe deformity. Lesser toe deformities may be the cause of several foot complications, including pain on walking, corns, difficulty in wearing footwear, possible ulcerations caused by increased pressure at the apices of the toes, and other comorbidities, that could possibly lead to falls in older adults and thus need to be addressed appropriately.
Dactylolysis spontanea is a rare, progressive disease characterized by fibrous soft-tissue constriction around the base of an appendage. It most commonly occurs bilaterally in the fifth toes of male patients and often progresses to spontaneous autoamputation. The broad spectrum of clinical severity, poorly characterized natural clinical timeline, and previous lack of specific confirmatory tests make this condition difficult to diagnose and treat in the early stages where it may be amendable to conservative treatment. We present a case report of a 29-year-old woman with dactylolysis spontanea involving bilateral fourth digits. The diagnosis of dactylolysis spontanea was made based on clinical and radiographic correlations and by excluding other similar conditions. Following surgical removal of the digits, exploratory histopathologic analysis demonstrated the novel presence of positive glucose transporter 1 immunohistochemical staining. Although the diagnosis of dactylolysis spontanea has historically been considered a diagnosis of exclusion and is often complicated by the heterogeneous clinical presentations, glucose transporter 1 staining offers clinicians a valuable tool in assisting with the diagnosis of this condition. This may finally elucidate the etiology of this rare condition.
Desmoplastic fibroblastoma (collagenous fibroma) is a rare benign soft-tissue tumor. Often found in the subcutaneous and muscle tissue, it is slowly enlarging and generally not painful or invasive. The literature often describes the tumor to be found in the upper extremities, neck, and back. Full excision of the tumor is the treatment of choice, and the prognosis is generally favorable; there are no documented cases of recurrence after full excision. We present an atypical case of desmoplastic fibroblastoma found on the dorsum of the foot with a larger tumor present in a substantially younger patient than is typical.
Background: Extracorporeal shockwave therapy (ESWT) was first introduced into clinical practice in 1982 and has been a beneficial inclusion to the noninvasive treatment option of numerous orthopaedic pathologies. However, clinical evidence of the use of ESWT for various foot and ankle disorders has been limited with a consensus on its efficacy yet available. Therefore, the purpose of this study is to systematically review the literature, to provide a critical evaluation and meta-analysis for the use of ESWT in foot and ankle disorders.
Methods: The PubMed and Embase databases were systematically reviewed and clinical studies that reported ESWT use for various foot and ankle disorders included.
Results: A total of 24 clinical studies that included 12 randomized controlled trials and 12 case series were identified. Analysis of the evidence has indicated that ESWT can help manage plantar fasciitis, calcaneal spur, Achilles tendinopathy and Morton’s neuroma. Meta-analysis of the change in pre- to post-VAS overall scores for plantar fasciitis significantly favored ESWT compared to placebo/conservative treatment with a MD -3.10 (95% CI, -4.36 to -1.83; I2 = 68%; P < 0.00001).
Conclusions: The current evidence has suggested that ESWT can provide symptomatic benefit to plantar fasciitis treatment, with minimal and unremarkable side effects. Overall, ESWT has been demonstrated to be a safe treatment option with a favorable complication profile. Further well-designed studies of ESWT for the treatment of calcaneal spurs, Achilles tendinopathy and Morton’s neuroma are warranted to more soundly and safely support its current use. Future studies are suggested to investigate the optimization of ESWT treatment protocols.
Background: Although pilon fractures are rare, they are important for orthopedic surgeons because of the difficulty of their treatment and their adverse effects on gait function. The aim of this was study to evaluate the relationship between the reduction quality of the fracture, functional results, ankle arthrosis, and plantar pressure distribution in patients with tibia pilon fractures.
Methods: In this study, a total of 62 patients treated for an intraarticular pilon fracture in our clinic between January of 2015 and January of 2019 were evaluated retrospectively. Postoperative reduction qualities of the patients were evaluated with the Ovadia-Beals criteria; ankle functional scores were evaluated with the Teeny-Wiss score; and ankle arthrosis was evaluated with the Takakura classification. At the last patient follow-up, foot loading analysis was performed, and the results were evaluated for their relation with postoperative reduction quality, ankle function, and ankle arthrosis.
Results: There were 62 patients (50 men and 12 women). The average age was 43.3 years (range, 19–78 years). The mean follow-up was 34.3 months (range, 24–58 months). The mean Ovadia-Beals score was 12.35 ± 4.6 on the postoperative plain radiographs of the patients; the mean Teeny-Wiss score at the last follow-up was 76.82 ± 17.69; and the mean Takakura score was 1.47 ± 1.35. Based on the pedobarographic measurements, 47.58% of the patients put weight on the anterior portion and 52.42% on the posterior portion of the foot in the anteroposterior plane. In the mediolateral plane, 42.15% loaded on the medial portion of the ankle and 57.85% loaded on the lateral portion of the foot.
Conclusions: Intra-articular tibia pilon fractures can be demonstrated by lateralization of the walking axis and changes in gait patterns and can be associated with clinical outcome.