Background: A few studies have investigated the relationship between foot posture measures and plantar pressure parameters, but no study has investigated the correlation of foot posture measures with all primary parameters consisting of contact area (CA), maximum force (MF), and peak pressure (PP). We aimed to determine the relationship of Foot Posture Index-6 (FPI-6) and navicular drop (ND) with plantar pressure parameters during static standing and preferred walking.
Methods: Seventy people were included. ND and FPI-6 were used to assess foot posture. Plantar pressure parameters including CA, MF, and PP were recorded by a pressure-sensitive mat during barefoot standing and barefoot walking at preferred speed. All assessments were repeated three times and averaged. Pearson correlation coefficients below 0.300 were accepted as negligible and higher ones were interpreted.
Results: ND was moderately correlated with dynamic CA under the midfoot and second metatarsal (M2), also FPI-6 was moderately correlated with dynamic CA under the midfoot (0.500<r<0.700). The other interpreted correlations were poor (0.300<r<0.500). Both measures were correlated with dynamic CA under the M2 and M3, dynamic CA and MF under the midfoot, and static CA, MF, and PP under the M1 and hallux (p<0.01). ND was also correlated with dynamic MF under the M1 and dynamic CA under the M4 (p<0.01). Further, ND was correlated with static CA and PP under the M2 also static PP under the M5 (p<0.01). FPI-6 was also correlated with dynamic MF and PP under the hallux (p<0.01).
Conclusions: The correlations between foot posture measures and plantar pressure variables are poor to moderate. The measures may be useful in the clinical assessment of medial forefoot problems related to prolonged standing and midfoot complaints related to high force during walking. Further, FPI-6 may provide valuable data regarding hallux complaints related to the high loads during walking.
Background: Onychomycosis is the most common nail disease seen in clinical practice. Medication safety, severity of disease, co-morbidities, concomitant medications, patient age, and cost are all important considerations when treating onychomycosis. Since cost may affect treatment decisions, we sought to analyze Medicaid formulary coverage of onychomycosis antifungals.
Methods: Public state Medicaid formularies were searched for coverage of FDA approved onychomycosis medications and off-label oral fluconazole. Total drug cost for a single great toenail was calculated using National Average Drug Acquisition Cost. Pearson correlation coefficients were calculated to compare coverage and cost, mycological cure rate, and complete cure rate.
Results: Oral terbinafine and off-label fluconazole were widely covered for onychomycosis treatment. There was poor coverage of oral itraconazole and topical ciclopirox, and no coverage of topical efinaconazole and tavaborole without step-edits or prior authorization. There was a significant negative correlation between medication coverage and cost (r = −0.758, p= 0.040). There was no correlation between medication coverage and mycologic (r = 0.548, p = 0.339) and complete (r = 0.768, p = 0.130) cure rates.
Conclusions: There is poor Medicaid coverage of antifungals for the treatment of onychomycosis, with step-edits and prior authorization based on cost rather than treatment safety and efficacy. We recommend involving podiatrists and dermatologists in developing criteria for insurance approval of onychomycosis treatments.
Background: Sinus tarsi syndrome is characterized by permanent pain on the anterolateral side of the ankle. This pain occurs due to chronic inflammation, characterized by fibrotic tissue remnants and synovitis accumulation after repeated traumatic injuries. Few studies have documented the outcome of injection treatments for sinus tarsi syndrome. We sought to determine the effects of corticosteroid and local anesthetic, platelet-rich plasma, and ozone injection on the sinus tarsi syndrome.
Methods: Sixty patients diagnosed with sinus tarsi syndrome were randomly divided into three groups. Patients in the first group received corticosteroid and local anesthetic, patients in the second group received platelet-rich plasma, and patients in the third group were given ozone injections. Outcome measures were Visual Analog Scale (VAS), American Orthopedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS), Foot Function Index (FFI), and Foot-Ankle Outcome Score (FAOS). Outcome measures were evaluated by comparing pre-intervention and post-injection 1-month, 3-month, and 6-month follow-ups.
Results: At the end of the 1st month, third month, and sixth month after injection, significant improvements were observed in all three groups compared to the baseline (p < .001 for all comparisons). In the 1st and third months, the improvements in AOFAS scores were similar in Groups 1 and 3; those in Group 2 were lower (p = .001 and p = .004, respectively). In the 1st month, the improvements in FAOS scores were similar in Groups 2 and 3; those in Group 1 were higher (p < .001). During the 6-month follow-up period, there was no statistically significant difference in VAS and FFI results between all three groups (p > .05).
Conclusions: Corticosteroid and local anesthetic or platelet-rich plasma or ozone injections could provide clinically significant functional improvement for at least six months in patients with sinus tarsi syndrome.
This case describes delayed treatment of a medial talonavicular dislocation with a shear fracture of the talar head, comminuted posterior talar process fracture, and an intra-articular cuboid fracture with subtle medial displacement of the calcanealcuboid joint and the associated treatment. The injury was sustained in a 35-year-old male 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.
Background: Using high-heeled shoes in daily life affects the stability of walking, body posture, and functionality. So, the present study was aimed to determine the immediate effect of Kinesio-taping (KT) on functionality, static and dynamic balance, exercise capacity, posture in young women using high-heeled shoes.
Methods: Thirty-seven females who were used high-heeled shoes with a mean age of 20.32±1.37 years were divided into two groups: control (n:20) and study group(n:17). The study group’s both limbs were taped medially, laterally, and dorsally with KT; no application was made to the control group. Balance [Techno Body Postural Line], functionality [vertical jump and functional reach test], exercise capacity [6-min walk test], human body posture [New York Posture Rating Chart] was assessed.
Results: Use of high-heeled shoes was 8(7-9) hours/day, 5(3-5) days/week, 3(2-6.5) years in the study group versus 6(6-8) hours/day, 4(2.5-5.75) days/week for 4(2.5-5.75) years in the control group. Statistical significance in functional reach distance (cm) was found within the control (p:0.010) and study groups (p:0.005) but not between the groups (p>0.05). Stabilometric mono pedal right foot elips area (mm2; p:0.006) and perimeter (mm;p:0.009); left foot elips area (mm2;p:0.016), perimeter (mm;p:0.023) and front/backward standard deviation (p:0.018); dynamic balance area gap percentage (%; p:0.030) were significant within the study group. Posture, vertical jump distance, exercise capacity, stabilometric test results, bipedal closed-eye&opened eye results were similar within and between the groups (p>0.05).
Conclusions: Kinesio-taping has no immediate effect on exercise capacity, vertical jump function, posture, and bipedal static balance but can modulate the functional reach function, static mono pedal leg balance, and dynamic equilibrium. Further studies are recommended to investigate the additive effect of KT with high heels and after 45 minutes, 24 hours and 72 hours.
Background: Given that excess opioid prescriptions contribute to the United States opioid epidemic and there are few national opioid prescribing guidelines for the management of acute pain, it is pertinent to determine if prescribers can sufficiently assess their own prescribing practice. The purpose of this study was to investigate podiatric surgeons’ ability to evaluate if their own opioid prescribing practice is less than, near, or above that of an “average” prescriber.
Methods: We administered a scenario-based, voluntary, anonymous, online questionnaire via Qualtrics which consisted of five surgery-based scenarios commonly performed by podiatric surgeons. Respondents were asked the quantity of opioids they would prescribe at the time of surgery. Respondents were also asked to rate their prescribing practice compared to the average (median) podiatric surgeons. We compared self-reported behavior to self-reported perception (“I prescribe less than average,” “I prescribed about average,” and “I prescribe more than average”). ANOVA was used for univariate analysis between the three groups. We used linear regression to adjust for confounders. Data restriction was used to account for restrictive state laws.
Results: One hundred fifteen podiatric surgeons completed the survey from in April 2020. Less than half of the time, respondents accurately identified their own category. Consequently, there were no statistically significant differences between podiatric surgeons who reported that they “prescribe less,” “prescribe about average,” and “prescribe more.” Paradoxically, there was a flip in scenario #5, whereas respondents who reported they “prescribe more” actually prescribed the least and respondents who believed that they “prescribe less” actually prescribed the most.
Conclusions: Cognitive bias, in the form of a novel effect, occurs in postoperative opioid prescribing practice; in the absence of procedure-specific guidelines or an objective standard, podiatric surgeons, more often than not, were unaware of how their own opioid prescribing practice measured up to other podiatric surgeons.
Background: The purpose of this retrospective audit was to compare patient based clinical outcomes to amputation healing outcomes twelve months after a minor foot amputation in people with diabetes.
Methods: Hospital admission and community outpatient data were extracted for all minor foot amputations in people with diabetes in 2017 in the Central Coast Local Health District.
Results: A total 85 minor foot amputations involving 74 people were identified. At the twelve-month follow-up 74% (n=56) of the minor foot amputations healed, 63% (n=41) of the participants achieved a good clinical outcome (healed, no more proximal amputations, or death within the 12 month follow up period), and the mortality rate was 18%. Poor clinical outcomes were associated with those aged greater than 60 (RR 5.75, 95% CI: 0.85 to 38.7, p=0.013), those undergoing a further surgical debridement procedure during their hospital stay (RR 2.42, 95% CI: 1.3 to 4.4, p=0.005) and those who did not attend CCLHD Podiatry clinics post-amputation (RR 2.3, 95% CI: 1.2 to 4.1, p=0.010).
Conclusions: To improve patient based clinical outcomes post-minor foot amputation, targeted follow-up in a high-risk foot clinic, and tailored discharge treatment plans for people aged over 60 or those undergoing a debridement procedure may be considered.