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.
Background: Although there are studies showing that extracorporeal shockwave therapy (ESWT) and instrument-assisted soft-tissue mobilization (IASTM) methods are effective in chronic plantar heel pain (CPHP) treatment, there is a need for studies comparing these techniques. Our goal is to compare the effectiveness of ESWT vs IASTM using Graston Technique® (GT®) instruments in addition to stretching exercises (SEs) in CPHP.
Methods: Sixty-nine patients were randomly assigned to 3 groups as ESWT+SEs (Gr I), GT®+SEs (Gr II) and SEs (CG) (ratio 1:1:1). SEs program twice/day, for 8-week was standard for all. Gr I received low intensity ESWT while in Gr II, GT® was the selected method. Visual analog scale (VAS) (for initial step and activity pain); foot function index (FFI); short form-12 (SF-12), and Tampa Scale were used at pretreatment, posttreatment and follow-ups (8-week and 6-month).
Results: VAS and FFI scores improved in the posttreatment and follow-ups in all (p<.00) While effect sizes in Gr I and Gr II were greater than CG in initial step pain at posttreatment and 8-week-follow-up, Gr II had highest effect size at 6-month-follow-up. The mean SF-12 scores in Gr I and Gr II showed improvement on the posttreatment assessment. Furthermore, Gr II showed significant improvements in FFI scores compared to other groups in 6-month-follow-up (F=6.33, p=.003).
Conclusions: Even though ESWT+SEs and GT®+SEs interventions seem to have similar effects on initial step pain at posttreatment and 8-week-follow-up; GT®+SEs was found most effective for improving functional status at 6-month in the management of CPHP.
Background: The emergence of minimally invasive techniques in foot and ankle surgery has aimed to reduce iatrogenic tissue insult by utilising the smallest possible incision area to achieve maximum correction of pathological structures. The objective of this study was to assess whether adequate hallux valgus correction can be achieved via the minimally invasive chevron akin (MICA) procedure.
Methods: A retrospective analysis was conducted for a single-surgeon case series of 169 MICA procedures between June 2018 and June 2021 in Australia. Radiographic parameters were evaluated independently by two researchers using 1-2 intermetatarsal angle (1-2 IMA) and hallux valgus angle (HVA) as key measures of procedural outcome.
Results: 95% of participant-operations resulted in normal 1-2 IMA and HVA being obtained post-operatively in a cohort that largely consisted of moderate hallux valgus deformities; 1-2 IMA Reduction: 6.38° ± 3.24 (95% CI 5.89 to 6.87) and HVA Reduction: 20.17° ± 7.69 (95% CI 19.01 to 21.33).
Conclusion: The results of this study help to further strengthen support for the use of minimally invasive bunion surgery as a primary treatment approach in mild to moderate hallux valgus.
Background: Studies on the sensory perception of mass mostly focus on the hands rather than the feet. The aim of our study is to measure how accurately runners can perceive additional shoe mass in comparison to a control shoe (CS) while running, and moreover, whether there is a learning effect in the perception of mass. Indoor running shoes were categorized as a CS (283g) and shoes with four additional masses shoe 2 (+50g), shoe 3 (+150), shoe 4 (+250) and shoe 5 (+315).
Methods: Twenty-two participants attended a to the experiment divided into two sessions. In session one, participants ran on a treadmill for two minutes with the CS and then put on one set of weighted shoes and ran for another two minutes at a preferred velocity. A binary question was used after the pair test. This process was repeated for all the shoes to compare them with the CS.
Results: Based on our statistical analysis (mixed effect logistic regression), the independent variable, mass did have a significant effect on perceived mass, F (4,193) = 10.66, P < 0.0001, while repeating the task did not show a significant learning effect (F (1, 193) = 1.06, P = 0.30).
Conclusions: An increase of +150g is the just noticeable difference among other weighted shoes and Weber’s fraction is equal to 0.53 (150g : 283g). Learning effect did not improve by repeating the task in two sessions in the same day. This study facilitates our understanding about sense of force and enhances multibody simulation in running.
Background: Many surgical techniques have been reported for the treatment of ingrown toenails. Occurrences of infection after matricectomy procedures could cause clinicians to prefer using external braces to treat ingrown toenails. This study compares patients with ingrown toenails who underwent the nail fixation technique and the Winograd technique.
Methods: Patients who underwent ingrown toenail surgery were retrospectively reviewed. The patients’ demographic characteristics (age, gender, body mass index [BMI] morphology according to Heifetz classification, surgical technique, visual analog scale (VAS) values, time to return to daily activities (days), complications, and satisfaction levels were all recorded.
Results: Seventy patients were included in the study. Of the patients, 33 underwent nail fixation and 37 underwent the Winograd technique. No significant statistical differences were found in terms of patients’ age, gender, BMI, preoperative clinical features, long-term satisfaction, and ingrown toenail recurrence rates between the two groups, but time to return to daily activities and VAS values were statistically significantly lower in patients treated using nail fixation compared with the Winograd technique.
Conclusion: Nail fixation can be an effective surgical treatment option for an ingrown toenail.
Background: Although tarsal coalition represents the most common cause of peroneal spastic flatfoot, its existence cannot be verified in several cases. In some patients with rigid flatfoot, no cause can be detected after clinical, laboratory, and radiologic examination, and the condition is called idiopathic peroneal spastic flatfoot (IPSF). This study aimed to present our experience with surgical management and outcomes in patients with IPSF.
Methods: Seven patients with an IPSF, who were operated on between 2016 and 2019, and followed for at least 12 months were included, whereas those with known etiologies, such as tarsal coalition or other etiologies (traumatic, etc.) were excluded. All patients were followed up for 3 months with botulinum toxin injection and cast immobilization as a routine protocol, and clinical improvement was not achieved. The Evans procedure and grafting with tricortical iliac crest bone graft in 5 patients and subtalar arthrodesis in 2 patients were performed. The American Orthopaedic Foot and Ankle Society ankle-hindfoot scale scores (AOFAS) and Foot & Ankle Disability Index (FADI) scores were obtained pre- and postoperatively from all patients.
Results: In physical examination, all feet manifested by rigid pes planus with varying degrees of hindfoot valgus and limited subtalar motion. Overall, the mean AOFAS and FADI scores significantly increased from 42 (range = 20-76) and 45 (range, 19-68) preoperatively (p = 0.018) to 85 (range = 67-97) and 84 (range, 67-99) (p = 0.043) at the final follow-up, respectively. No major intra- or post-operative complications were observed in any of the patients. All CT and MRI scans revealed no evidence of tarsal coalitions in any of the feet. All radiological workups failed to demonstrate secondary signs of fibrous or cartilaginous coalitions.
Conclusion: Operative treatment seems to be a good option in the treatment of patients with IPSF who do not benefit from conservative treatment. In the future, it is recommended to investigate the ideal treatment options for this group of patients.
Background: Digital deformities represent a common presenting pathology and target for surgical intervention in podiatric medicine and surgery. The objective of this investigation was to compare the radiographic width of the heads of the lesser digit proximal phalanges.
Methods: One hundred and fifty consecutive feet with a diagnosis of digital deformity and performance of weight-bearing radiographs were analyzed. The maximum width of the heads of the lesser digit proximal phalanges were recorded from the radiographs utilizing computerized digital software.
Results: The mean±standard deviation (range) of the head of the second digit proximal phalanx was 9.74±0.87 mm (7.94-11.78), of the head of the third digit proximal phalanx was 9.00±0.91 mm (7.27-10.94), of the head of the fourth digit proximal phalanx was 8.49±1.01 mm (5.57-10.73), and of the head of the fifth digit proximal phalanx was 8.67±0.89 mm (6.50-11.75). The width of the head of the proximal phalanx decreased from the second digit to the third digit (p<0.001), decreased from the third digit to the fourth digit (p<0.001), and then increased from the fourth digit to the fifth digit (p=0.032).
Conclusions: The results of this investigation provide evidence in support of an anatomic and structural contribution to digital deformities. The width of the heads of the lesser digit proximal phalanges decreased from the second to the third to the fourth toes, and then subsequently increased with the fifth proximal phalangeal head.
Background: The objective of this investigation was to evaluate adverse short-term outcomes following partial forefoot amputation with a specific comparison performed based on subject height.
Methods: The American College of Surgeons National Surgical Quality Improvement Program database was analyzed to select those subjects with a 28805 CPT code (amputation, foot; transmetatarsal) that underwent the procedure with “all layers of incision (deep and superficial) fully closed.” This resulted in 11 subjects with a height ≤60 inches, 202 subjects with a height >60 inches and <72 inches, and 55 subjects ≥72 inches.
Results: Results of the primary outcome measures found no significant differences between groups with respect to the development of a superficial surgical site infection (0.0% vs. 6.4% vs. 5.5%; p=0.669), deep incisional infection (9.1% vs. 3.5% vs. 10.9%; p=0.076), or wound disruption (0.0% vs. 5.4% vs. 5.5%; p=0.730). Additionally, no significant differences were observed between groups with respect to unplanned reoperations (9.1% vs. 16.8% vs. 12.7%; p=0.0630) or unplanned hospital readmissions (45.5% vs. 23.3% vs. 20.0%; p=0.190).
Conclusions: The results of this investigation demonstrate no difference in short-term adverse outcomes following the performance of partial forefoot amputation with primary closure based on subject height. Although height has previously been described as a potential risk factor in the development of lower extremity pathogenesis, this finding was not observed in this study from a large US database.
Background: The objective of this investigation was to evaluate adverse short-term outcomes following open lower extremity bypass surgery in subjects with diabetes mellitus with a specific comparison performed based on subject height.
Methods: The American College of Surgeons National Surgical Quality Improvement Program database was analyzed to select those subjects with CPT codes 35533, 35540, 35556, 35558, 35565, 35566, 35570 and 35571 and with the diagnosis of diabetes mellitus. This resulted in 83 subjects ≤60 inches, 1084 subjects >60 inches and <72 inches, and 211 subjects ≥72 inches.
Results: No differences were observed between groups with respect to the development of a superficial surgical site infection (9.6% vs. vs. 6.4% vs. 5.7%; p=0.458), deep incisional infection (1.2% vs. 1.4% vs. 2.8%; p=0.289), sepsis (2.4% vs. 2.0% vs. 2.8%; p=0.751), unplanned reoperation (19.3% vs. 15.6% vs. 21.8%; p=0.071), nor unplanned hospital readmission (19.3% vs. 14.8% vs. 17.1%; p=0.573). A significant difference was observed between groups with respect to the development of a wound disruption (4.8% vs. 1.3% vs. 4.7%; p=0.001). A multivariate regression analysis was performed of the wound disruption outcome with the age, gender, race, ethnicity, height, weight, current smoker and open wound/wound infection variables. Race (p=0.025) and weight (p=0.003) were found to be independently associated with wound disruption, but height was not (p=0.701).
Conclusions: The results of this investigation demonstrate no significant difference in short-term adverse outcomes following the performance of lower extremity bypass surgery based on patient height.