Search Results
Background:
The midsole is an essential assembly of footwear for retaining the shape of the shoe, delivering support to the foot, and serving as a cushioning and stability device for walking. To improve leg muscle balance and muscle co-contraction, we propose a new midsole design for high heels with different hardness levels at the forefoot region.
Methods:
Five healthy women participated in the study, with a mean ± SD age of 21.80 ± 4.09 years, and duration of high-heeled shoe wear of 5.20 ± 4.09 years. Two midsole conditions, control and multiple-hardness midsole (MHM), with heel heights of 2 (flat), 5, and 8 cm were used. The main outcome measures were to examine the acute effects of MHM by electromyography on muscle activity balance and co-contraction at varying heel heights during shuttle walk.
Results:
Use of the MHM significantly reduced the muscle activity ratio between the medial and lateral gastrocnemius muscles (P = .043) during push-off to heel strike with a heel height of 5 cm (−22.74%) and heel strike to midstance with a heel height of 8 cm (−22.26%). The increased co-contraction indices of the tibialis anterior–peroneus longus muscles (14.35% with an 8-cm heel height) and tibialis anterior–soleus muscles (15.18% with a 5-cm heel height) are significant (P = .043), with a large effect size (d = 0.8).
Conclusions:
These results deliver important implications in advancing the engineering of MHM design without changing the in-shoe volume to enhance leg muscle balance and co-contraction during walking.
Subtotal Pedal Amputations
Biomechanical and Intraoperative Considerations
Proper treatment for the compromised diabetic foot often requires surgical correction and subtotal pedal amputation. This article discusses various levels of amputation of the human foot, including digital, ray, transmetatarsal, midfoot, and Syme amputations. Surgical techniques and biomechanical considerations are presented in order to assist the surgeon in planning for the most functional outcome of the patient. A review of the literature and the experiences of the authors are presented. (J Am Podiatr Med Assoc 91(1): 6-12, 2001)
Background:
We compared the long-term clinical and ultrasonographic effects of radial extracorporeal shockwave therapy (rESWT) versus ultrasound-guided corticosteroid injection treatment in patients with plantar fasciitis unresponsive to conservative therapy.
Methods:
Seventy-two patients with unilateral plantar fasciitis were randomized to receive either rESWT (three times once per week) (n = 36) or corticosteroid treatment (a single 1-mL dose of betamethasone sodium plus 0.5 mL of prilocaine under ultrasound guidance by injection into the plantar fascia) (n = 36). The primary outcome measures were visual analog scale (VAS) and Foot Function Index (FFI) scores. Secondary outcome measures included the heel tenderness index (HTI) score and plantar fascia thickness (PFT) as obtained by ultrasound examination. All of the assessments were performed at baseline and 1, 3, and 6 months after treatment.
Results:
Significant improvements were observed in the rESWT group in VAS, HTI, and FFI scores and PFT at the end of treatment and were maintained during follow-up. Posttreatment improvements in VAS, HTI, and FFI scores and PFT were also seen in the corticosteroid group but were not maintained for VAS and FFI scores after the completion of therapy and were lost at 1 and 6 months, respectively. No serious treatment-related complications occurred.
Conclusions:
Both rESWT and corticosteroid injection therapy are effective modalities for treatment of chronic plantar fasciitis. However, rESWT seems to be superior to corticosteroid injection therapy due to its longer duration of action.
Pediatric Subtalar Joint Synovial Chondromatosis
Report of a Case and an Up-to-date Review
Synovial chondromatosis is a rare, usually benign disorder affecting the population predominantly in the third and fourth decades of life and mainly involving the large weightbearing joints of the lower limb—the knees and the hip. In this report, we highlight an unusual pediatric clinical presentation of synovial osteochondromatosis involving the subtalar joint and discuss its surgical management; we also provide a comprehensive up-to-date literature review of the disorder. This patient was successfully treated with en masse surgical excision. He has been doing well, with complete pain relief and improved range of motion at 1-year follow-up. An exceptional involvement of the subtalar joint and an unusual presentation in the pediatric age group makes this case unique.
In-Shoe Plantar Pressure Profiles in Amateur Basketball Players
Implications for Footwear Recommendations and Orthosis Use
Background:
Biomechanical analysis of foot loading characteristics may provide insights into the injury mechanisms and guide orthotic prescription for basketball players. This study aimed to quantify in-shoe plantar pressure profiles in amateur players when executing typical basketball movements.
Methods:
Twenty male university basketball players performed four basketball-specific movement tasks—running, maximal forward sprinting, maximal 45° cutting, and layup—in a pair of standardized basketball shoes fitted with an in-shoe plantar pressure measurement system. Peak pressure (PP) and pressure-time integral (PTI) data were extracted from ten plantar regions. One-way repeated-measures analysis of variance was performed across the tasks, with significance set at P < .05.
Results:
Distinct plantar pressure distribution patterns were observed among the four movements. Compared with running, significantly higher (P < .05) PP and PTI of up to approximately 55% were found in sprinting and layup, particularly at the forefoot region. Similarly, significantly higher (P < .05) PPs and PTIs, ranging from approximately 23% to 90%, were observed in 45° cutting compared with running at most foot regions.
Conclusions:
Compared with running, sprinting and layup demonstrated higher plantar loading in the forefoot region, and 45° cutting yielded increased plantar loading in most regions of the foot. Understanding the plantar pressure characteristics of different movements may be useful in optimizing footwear designs, orthosis use, or training strategies to minimize regional plantar loading during amateur basketball play.
Twenty nonsymptomatic subjects were assessed while walking at a photoelectronically monitored place (2 +/- 0.1 m.s-1) using high speed cinematography (200 Hz) to record the rearfoot motion in the frontal plane, and electrogoniometry (100 Hz) to measure joint kinematics in the lower extremity. The foot type of the subjects was determined statically by using a podiascope and digitization techniques. The results demonstrated that no foot type variables contributed significantly to the variance in either rearfoot angle at foot strike or maximum rearfoot angle (p > 0.05). Regression equations were developed using kinematic variables: rearfoot angle at foot strike = 3.81 + (0.06*time to hip internal rotation) - (0.46*tibia internal rotation) + (0.14*plantarflexion); (R = 0.87, SE = 1.23 degrees); maximum rearfoot angle = 4.02 + (0.52*hip internal rotation) - (0.11*time to hip internal rotation); (R = 0.66, SE = 2.07 degrees). This study identifies hip joint movements as being the most significant contributors to prediction of rearfoot angles produced during walking.
Charcot’s neuroarthropathy is a relatively common disease in patients with diabetic neuropathy. If unrecognized or left untreated, Charcot’s neuroarthropathy can result in a severely misshapen and unstable foot and ankle. Ulceration, soft-tissue infection, and osteomyelitis frequently ensue, and partial or complete amputation of the foot is not uncommon. A high index of suspicion and proper interpretation of clinical and diagnostic findings are essential to establish a timely and accurate diagnosis and to institute appropriate treatment. The pathogenesis of neuroarthropathy is reviewed and diagnosis and treatment of the stage 0 diabetic Charcot foot are presented. (J Am Podiatr Med Assoc 92(4): 210-220, 2002)
Background:
A patient “handoff,” or the “sign-out” process, is an episode during which the responsibility of a patient transitions from one health-care provider to another. These are important events that affect patient safety, particularly because a significant proportion of adverse events have been associated with a relative lack of physician communication. The objective of this investigation was to survey podiatric surgical residency programs with respect to patient care handoff and sign-out practices.
Methods:
A survey was initially developed and subsequently administered to the chief residents of 40 Council on Podiatric Medical Education–approved podiatric surgical residency programs attempting to elucidate patient care handoff protocols and procedures and on-call practices.
Results:
Although it was most common for patient care handoffs to occur in person (60.0%), programs also reported that handoffs regularly occurred by telephone (52.5%) and with no direct personal communication whatsoever other than the electronic passing of information (50.0%). In fact, 27.5% of programs reported that their most common means of patient care handoff was without direct resident communication and was instead purely electronic. We observed that few residents reported receiving formal education or assessment/feedback (17.5%) regarding their handoff proficiency, and only 5.0% of programs reported that attending physicians regularly took part in the handoff/sign-out process. Although most programs felt that their sign-out practices were safe and effective, 67.5% also believed that their process could be improved.
Conclusions:
These results provide unique information on a potentially underappreciated aspect of podiatric medical education and might point to some common deficiencies regarding the development of interprofessional communication within our profession during residency training.
Onychoheterotopia is an uncommon condition in which nail tissue is found beyond the common nail unit of the digits of the hands and feet, most often on the fifth digit of the hand. It represents an extra and independent nail that can be present either congenitally, or more commonly, acquired following trauma. The exact pathogenesis of the congenital type is undetermined. We report a 25-year-old male with multiple congenital ectopic nails of the toes since birth, which has not been reported before. (J Am Podiatr Med Assoc 103(5): 445–447, 2013)
We describe the results in seven patients who underwent surgery to lengthen a short first metatarsal via callus distraction. The increased length achieved ranged from 13 to 48 mm, with an average of 20.2 mm. The technique was successful in restoring length and improving symptoms, although several complications were encountered. (J Am Podiatr Med Assoc 98(1): 51–60, 2008)
