Background: Foot orthoses are commonly dispensed for musculoskeletal complaints of the foot and lower limb. Few randomized clinical trials evaluate the clinical effectiveness of foot orthoses.
Methods: In this randomized clinical trial with a crossover design, 42 participants wore custom orthoses and prefabricated inserts in their regular footwear for 4 weeks each, consecutively. Twenty-seven participants received prefabricated inserts first and 13 received custom orthoses first. A numeric pain rating scale (possible score, 0–10) was used to measure participant pain.
Results: Statistically and clinically important decreases in pain were reported after 3 weeks by participants wearing custom orthoses first (−1.39 pain units, t 12 = 2.70, P = .02). Participants who wore prefabricated inserts first reported no statistically significant change in pain. When the alternative intervention was introduced, participants now wearing prefabricated inserts had greater pain after 1 and 2 weeks (1.1 pain units, t 12 = 3.09, P = .01 and 0.9 pain units, t 12 = 2.65, P = .02, respectively). Participants now wearing custom orthoses did not demonstrate significantly lower pain at any week compared with the second baseline but did have significantly lower pain scores compared with their initial baseline scores (−0.81 pain units, t 12 = 2.31, P = .03).
Conclusion: Full-contact custom-made foot orthoses provide symptomatic relief after 3 weeks of use for patients with lower-extremity musculoskeletal pain if they are prescribed as the initial treatment. (J Am Podiatr Med Assoc 98(5): 357–363, 2008)
Phlegmons are unencapsulated collections of inflammation that track along soft tissues in various parts of the human body. These soft-tissue lesions are uncommon in the lower extremities and can be difficult to identify and treat. This article presents a case of a plantar foot phlegmon in a nondiabetic patient that was recalcitrant to debridement and antibiotics. The patient’s aseptic phlegmon completely resolved with surgical debridement and iodoform packing. This case report demonstrates the role of advanced imaging in the diagnosis of lower-extremity phlegmons and the importance of thorough surgical debridement and packing for successful resolution.
Background: Extracorporeal shockwave therapy has been shown to be effective in the treatment of chronic tendon pathology in the elbow, shoulder, and plantar fascia. This prospective study examines the efficacy of extracorporeal shockwave therapy in the treatment of chronic Achilles tendon disorders.
Methods: Twenty-three patients (23 feet) were treated with extracorporeal shockwave therapy for Achilles tendinosis, insertional tendonitis, or both. Indications for treatment were a minimum of 6 months of conservative care, and a visual analog pain score > 5. The mean follow-up was 20 months (range, 4–35 months).
Results: Ninety-one percent (14 patients) were satisfied or very satisfied (23 patients) with treatment. Eighty-seven percent (20 patients) stated that extracorporeal shockwave therapy improved their condition, 13% (3 patients) said it did not affect the condition, and none stated that it made them worse. Eighty-seven percent (20 patients) stated they would have the procedure again if given the choice. Four months after extracorporeal shockwave therapy, the mean visual analog score for morning pain decreased from 7.0 to 2.3, and activity pain decreased from 8.1 to 3.1.
Conclusion: High-power extracorporeal shockwave therapy is safe, noninvasive, and effective, and it has a role in the treatment of chronic Achilles tendinopathy. (J Am Podiatr Med Assoc 98(6): 466–468, 2008)
The aim of this study was to investigate the relationship between foot deformities by comparing foot radiographs of patients with complaints of foot pain with those of healthy individuals.
The study included 30 patients with pes cavus, 30 patients with pes planus, 30 patients with calcaneal spur, and 30 controls aged 30 to 60 years. All participants underwent measurement of right and left foot length; metatarsophalangeal width; and calcaneal pitch (CA), talohorizontal (TA), talometatarsal (TM), and lateral talocalcaneal (LTC) angles from lateral radiographs.
There were no statistically significant differences between all participants regarding sex, age, weight, and body mass index (P > .05). Among patients with clinically diagnosed pes cavus, the diagnostic rate of CA was 100% in both feet, and 83.3% in the right foot and 96.7% in the left foot according to the TM angle. The diagnostic rates of angular measurements in patients with pes planus were as follows: 20% in the right foot and 30% in the left foot depending on the CA angle, 100% in both feet depending on the TM angle, and 66.7% in the right foot and 46.7% in the left foot depending on the LTC angle. A very strong positive correlation was found between the CA and LTC angles in patients with calcaneal spur and pes planus (P < .001); also, statistically significant positive correlation was found between the CA and TA angles (P < .05). The angular measurements in patients with calcaneal spur were found to be consistent with pes planus with a high rate.
Angular changes caused by deterioration of foot biomechanics lead to various deformities. Pes planus ranks first among these. Therefore, we believe that radiographic angular measurements in patients presenting with foot pain in addition to clinical evaluation would be useful in considering associated deformities and planning treatments.
The heel fat pad has a unique structure that is important for its shock-absorbing function. Loss of elasticity and changes in the thickness of the heel pad have been suggested as causes of heel pain. The present study of a population with heel pain shows the relationship between the thickness and elasticity of the heel fat pad and age, sex, obesity, duration of symptoms, subcalcaneal spurs, and noninvasive conservative treatment. Of 182 patients with heel pain who visited an outpatient clinic during a 3-year period, 50 (67 heels) fulfilling specific criteria were treated with a combination of nonsteroidal anti-inflammatory drugs, contrast baths, stretching exercises, and change of footwear habits. Patients were followed up for 1 year. Delayed healing, increased thickness, and decreased elasticity of the heel fat pad were found in patients who were older than 40 years, who had symptoms for longer than 12 months before treatment, and who had a large subcalcaneal spur. An increase in heel fat pad thickness with aging and increased body weight reduce the elasticity of the heel fat pad. In addition, subcalcaneal spurs diminish the elasticity of the heel fat pad and play a role in the formation of heel pain. (J Am Podiatr Med Assoc 94(1): 47-52, 2004)
Current medical nomenclature is often based on the early history of the condition, when the true etiology of the disease or condition was not known. Sadly, this incorrect terminology can become inextricably woven into the lexicon of mainstream medicine. More important, when this is the case, the terminology itself can become integrated into current clinical decision making and ultimately into surgical intervention for the condition. “Morton’s neuroma” is perhaps the most striking example of this nomenclature problem in foot and ankle surgery. We aimed to delineate the historical impetus for the terminology still being used today for this condition and to suggest appropriate terminology based on our current understanding of its pathogenesis. We concluded that this symptom complex should be given the diagnosis of nerve compression and be further distinguished by naming the involved nerve, such as compression of the interdigital nerve to the third web space or compression of the third common plantar digital nerve. Although the nomenclature becomes longer, the pathogenesis is correct, and treatment decisions can be made accordingly. (J Am Podiatr Med Assoc 95(3): 298–306, 2005)
Medial longitudinal arch integrity after prolonged running has yet to be well documented. We sought to quantify changes in medial longitudinal arch kinematics before and after a 45-min run in healthy recreational runners.
Thirty runners performed barefoot seated, standing, and running trials before and after a 45-min shod treadmill run. Navicular displacement, arch lengthening, and the arch height index were used to quantify arch deformation, and the arch rigidity index was used to quantify arch stiffness.
There were no statistically significant differences in mean (95% confidence interval) values for navicular displacement (5.6 mm [4.7–6.4 mm]), arch lengthening (3.2 mm [2.6–3.9 mm]), change in arch height index (0.015 [0.012–0.018]), or arch rigidity index (0.95 [0.94–0.96]) after the 45-min run (all multivariate analyses of variance P ≥ .065).
Because there were no statistically significant changes in arch deformation or rigidity, the structures of a healthy, intact medial longitudinal arch are capable of either adapting to cyclical loading or withstanding a 45-min run without compromise.
Randomized trials must be of high methodological quality to yield credible, actionable findings. The main aim of this project was to evaluate whether there has been an improvement in the methodological quality of randomized trials published in the Journal of the American Podiatric Medical Association (JAPMA).
Randomized trials published in JAPMA during a 15-year period (January 1999 to December 2013) were evaluated. The methodological quality of randomized trials was evaluated using the PEDro scale (scores range from 0 to 10, with 0 being lowest quality). Linear regression was used to assess changes in methodological quality over time.
A total of 1,143 articles were published in JAPMA between January 1999 and December 2013. Of these, 44 articles were reports of randomized trials. Although the number of randomized trials published each year increased, there was only minimal improvement in their methodological quality (mean rate of improvement = 0.01 points per year). The methodological quality of the trials studied was typically moderate, with a mean ± SD PEDro score of 5.1 ± 1.5. Although there were a few high-quality randomized trials published in the journal, most (84.1%) scored between 3 and 6.
Although there has been an increase in the number of randomized trials published in JAPMA, there is substantial opportunity for improvement in the methodological quality of trials published in the journal. Researchers seeking to publish reports of randomized trials should seek to meet current best-practice standards in the conduct and reporting of their trials.