Search Results
Background: Soft-tissue movement has challenged the use of noninvasive skin-based markers that are assumed to be rigidly attached to the underlying bony landmarks. We assessed soft-tissue movement in multiple foot segments by calculating the relative changes in the intermarker distances of the hindfoot, midfoot, and forefoot segments during the early, middle, and late stances of walking compared with the intermarker distances measured while participants remained still during standing.
Methods: Seven healthy young adults with no previous lower-limb injury were tested while walking barefoot at a comfortable pace. Skin-based markers were placed on three foot regions (hindfoot-calcaneus, midfoot-navicular, and forefoot–first to fifth metatarsals). A motion system sampled at 120 Hz was used to capture the foot markers during the stance phase of walking.
Results: Soft-tissue movement was found in the forefoot region characterized by shortened distances, specifically during early (breaking) stance and late (propulsion) stance. In the hindfoot region, soft-tissue movement was characterized by shortened and elongated distances during the early and late stance periods, respectively. All of the foot regions showed the least intermarker distance changes during midstance.
Conclusions: The dynamics of soft-tissue movement in multiple foot segments were characterized by the greatest changes in the intermarker distances in the forefoot and hindfoot during the early and late stance phases and the least changes in the foot segments during midstance. The results provide a feasible and accessible measurement for assessing soft-tissue movement in the foot when skin-based motion markers are used. (J Am Podiatr Med Assoc 101(1): 25–34, 2011)
Background:
Metatarsal pads are frequently prescribed for patients with metatarsalgia to reduce pain under the distal metatarsal heads. Several studies showed reduced pain and reduced plantar pressure just distal to the metatarsal pad. However, only part of the pain reduction could be explained by the decrease in plantar pressure under the forefoot. Therefore, an alternative hypothesis is proposed that pain relief is related to a widening of the foot and the creation of extra space between the metatarsal heads. This study focused on the effect of a metatarsal pad on the geometry of the forefoot by studying forefoot width and the height of the second metatarsal head.
Methods:
Using a motion analysis system, 16 primary metatarsalgia feet and 12 control feet were measured when walking with and without a metatarsal pad.
Results:
A significant mean increase of 0.60 mm in forefoot width during the stance phase was found when a metatarsal pad was worn. During midstance, the mean increase in forefoot width was 0.74 mm. In addition, walking with a metatarsal pad revealed an increase in the height of the second metatarsal head (mean, 0.62 mm). No differences were found between patients and controls.
Conclusions:
The combination of increased forefoot width and the height of the second metatarsal head produced by the metatarsal pad results in an increase in space between the metatarsal heads. This extra space could play a role in pain reduction produced by a metatarsal pad. (J Am Podiatr Med Assoc 102(1): 18–24, 2012)
Efinaconazole Topical Solution, 10%
Efficacy in Patients with Onychomycosis and Coexisting Tinea Pedis
Background
We sought to evaluate the efficacy of efinaconazole topical solution, 10%, in patients with onychomycosis and coexisting tinea pedis.
Methods
We analyzed 1,655 patients, aged 18 to 70 years, randomized (3:1) to receive efinaconazole topical solution, 10%, or vehicle from two identical multicenter, double-blind, vehicle-controlled 48-week studies evaluating safety and efficacy. The primary end point was complete cure rate (0% clinical involvement of the target toenail and negative potassium hydroxide examination and fungal culture findings) at week 52. Three groups were compared: patients with onychomycosis and coexisting interdigital tinea pedis on-study (treated or left untreated) and those with no coexisting tinea pedis.
Results
Treatment with efinaconazole topical solution, 10%, was significantly more effective than vehicle use irrespective of the coexistence of tinea pedis or its treatment. Overall, 352 patients with onychomycosis (21.3%) had coexisting interdigital tinea pedis, with 215 of these patients (61.1%) receiving investigator-approved topical antifungal agents for their tinea pedis in addition to their randomized onychomycosis treatment. At week 52, efinaconazole complete cure rates of 29.4% were reported in patients with onychomycosis when coexisting tinea pedis was treated compared with 16.1% when coexisting tinea pedis was not treated. Both cure rates were significant compared with vehicle (P = .003 and .045, respectively), and in the latter subgroup, no patients treated with vehicle achieved a complete cure.
Conclusions
Treatment of coexisting tinea pedis in patients with onychomycosis enhances the efficacy of once-daily topical treatment with efinaconazole topical solution, 10%.
Another Cystic Lesion in the Calcaneus
Benign Fibrous Histiocytoma of Bone
Benign fibrous histiocytoma is a rare benign primary skeletal tumor that occurs frequently in the long bones and the pelvis. The calcaneus is an unusual location for benign fibrous histiocytoma. We did not identify any case of benign fibrous histiocytoma involving the calcaneus in the relevant literature. We describe a 22-year-old male patient with benign fibrous histiocytoma involving the calcaneus treated with curettage and bone grafting. At the final follow-up visit, 1 year after surgery, the patient was free of pain and walking unaided. We discuss the differential diagnosis of cystic lesions of the calcaneus. (J Am Podiatr Med Assoc 103(2): 141–144, 2013)
This article describes a patient with plantar fascial pain who presented to the office of one of the authors. Physical examination and the patient’s description of the history of symptoms revealed classic signs and symptoms of plantar fasciitis. The patient was treated with numerous conservative modalities, including ultrasound, nonsteroidal anti-inflammatory medications, trigger-point injections, over-the-counter orthoses, and stretching exercises. When the pain was not relieved by these conservative measures, magnetic resonance imaging of the area was performed. Visualization of the insertional area of the plantar fascia revealed a mass inferior to, as well as infiltrated into, the plantar fascia. Surgical excision of the lesion resulted in complete elimination of the patient’s pain. (J Am Podiatr Med Assoc 91(2): 89-92, 2001)
New drugs and tissue replacements are currently being approved and integrated into treatment regimens for chronic wounds. This article focuses on a standardized procedure for the use of specific growth factor, a recombinant human platelet-derived growth factor (rhPDGF-BB) manufactured for topical administration. The recommendations made in this article may not reflect product recommendations made by the manufacturer of the drug. Clinicians must be able to support any off-label indication for use of a product. (J Am Podiatr Med Assoc 92(1): 7-11, 2002)
Background:
Ingrown nail is a common health problem that significantly affects daily life due to its painful nature. The purpose of this study was to reveal the clinical and sociodemographic characteristics of ingrown nails.
Methods:
The clinical and sociodemographic characteristics of patients older than 18 years presenting with ingrown nail were investigated.
Results:
Two hundred six patients aged 18 to 77 years (mean age, 39 years; female to male ratio, 1.45) were included in the study. A total of 729 lesions were evaluated (718 ingrown nails were on the feet and 11 were on the fingers). A family history of ingrown nail was present in 7.6% of the participants. Of the 206 patients, 26.7% were treated with surgical methods for ingrown nails previously and experienced recurrence. Ingrown toenails were in the hallux in 81.3% of patients, and 52% were on the lateral margin. Incorrect nail-cutting habits (73.5%), poorly fitting shoes (46.2%), excessive angulation of the nail plate (35.8%), obesity (34.1%), trauma to the feet (24.3%), pregnancy (23.8% of women), hyperhidrosis (16.8%), and lateral deviation of the nail plate (9.9%) were closely associated with ingrown nails.
Conclusions:
This study revealed the clinical and sociodemographic characteristics of ingrown nails. The study data will be useful in preventing the development of ingrown nail and recurrences after treatment by identifying and then eliminating conditions establishing a predisposition to it.
Background:
The present study aimed to investigate the correlation between abductor hallucis (AH) muscle motor evoked potential (MEP) amplitude and foot arch anatomy.
Methods:
Twelve healthy individuals underwent foot arch measurement using a digital photographic technique and measurements of cortical excitability using transcranial magnetic stimulation applied on the cortical representation area of the right AH muscle. Truncated foot length and dorsal height were then measured and used to create the arch height index (AHI). Resting motor threshold, MEP amplitude (using a stimulation intensity of 110% resting motor threshold), and cortical silent period duration were also measured.
Results:
Mean ± SE values were as follows: truncated foot length, 16.72 ± 0.3 cm; dorsal height, 5.62 ± 0.13 cm; AHI, 0.34 ± 0.01; resting motor threshold, 81.6% ± 2.12%; MEP amplitude, 0.71 ± 0.1 mV; and cortical silent period duration, 108.05 ± 0.45 msec. A significant correlation was found between MEP amplitude and AHI (Spearman's rho: P < .01).
Conclusions:
These results indicate that AH muscle functional neuroanatomy measurements are reliable and might be used by clinicians and therapists to investigate foot arch physiology and monitor the efficacy of treatments and rehabilitative protocols.
Osteolysis, caused by active resorption of bone matrix by osteoclasts, can be primary or can develop secondary to a variety of disease processes. An elevated level of inflammatory cytokines in the local milieu and increased blood flow secondary to infection or autonomic neuropathy stimulate the osteoclasts and cause bone loss in the diabetic foot. Charcot's neuroarthropathy and osteomyelitis are well-known foot complications of diabetes, and secondary osteolysis has largely been underappreciated and, hence, underreported. Plain radiographs, an initial component in the evaluation of the diabetic foot, may not successfully differentiate secondary osteolysis from osteomyelitis. We describe a patient with phalangeal osteolysis secondary to soft-tissue infection in whom a correct and timely diagnosis helped avoid unnecessary surgical interventions.
Background:
Arch height is an important indicator of risk of foot pathology. The current non-invasive gold standard based on footprint information requires extensive pre-processing. Methods used to obtain arch height that are accurate and easier to use are required in routine clinical practice.
Methods:
The proposed arch index diagonals (AId) method for determining the arch index (AI) reduces the complexity of the preprocessing steps. All footprints were first prepared as required by the Cavanagh and Rodgers method for determining the AI and then compared to the proposed diagonals method. Results were classified according to the Cavanagh and Rodgers cut-off values into three groups of low, normal and high AI. ANOVA and Tukey's post hoc tests were applied to identify significant differences between AI groups. Linear modeling was applied to determine the fit of the new AId method compared to the Cavanagh and Rodgers AI.
Results:
One hundred and ninety-six footprints were analyzed. The ANOVA indicated significant differences between the groups for AId (F1,194=94.49, p<0.0001) and the Tukey post hoc tests indicated significant differences between the pair-wise comparisons (p<0.001). Linear modeling indicated that the AId ratio classified more footprints in the high arch group compared to Cavanagh and Rodgers results (R2=32%, p< 0.01). Intra- and inter-rater correspondence was above 90% and confirmed that the AId results provided a better indication of arch height.
Conclusions:
The proposed method simplifies current processing steps to derive the arch height.
