Search Results
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.
Background:
Ingrown nail is a condition frequently seen in children and adolescents, the pain from which can affect their daily living activities and school performances. The purpose of this study was to determine the clinical and sociodemographic characteristics of ingrown nails in children.
Methods:
The clinical and sociodemographic characteristics of patients aged 0 to 18 years presenting with ingrown nail were evaluated retrospectively from clinic records.
Results:
Sixty-two patients aged 3 to 18 years (mean age, 15 years; male to female ratio, 1.06) were enrolled. A total of 175 ingrown nails were evaluated (all of them were in the halluces, 54.3% of them were on the lateral margin). A positive family history of ingrown nail was present in 15.7%. High prevalences of incorrect nail cutting (72.1%), trauma (36.1%), poorly fitting shoes (29%), hyperhidrosis (12.9%), obesity (9.7%), and accompanying nail disorders (9.7%) were determined among the patients.
Conclusions:
This study revealed the clinical and sociodemographic characteristics of ingrown nails in children. These data will be useful in preventing the occurrence of ingrown nail by revealing and then eliminating predisposing factors.
Background: Anterior cruciate ligament injuries are more prevalent in female athletes than in male athletes. Basketball is a high-risk sport for anterior cruciate ligament injury in female athletes. This study was conducted to observe the effect of a foot orthosis on the knee ligament injury rate in female basketball players at one US university.
Methods: One hundred fifty-five players on the women’s basketball team were observed for knee ligament injury from 1992 to 2005. Athletes in the 1992–1993 to 1995–1996 school years (July–June) did not receive a foot orthosis and served as the control group; the treatment group comprised the athletes during the 1996–1997 to 2004–2005 school years (July–June). Athletes in the treatment group received a foot orthosis before participating in basketball. Data analysis included knee ligament injury rates and a comparison of injury rates with an incidence density ratio.
Results: Athletes in the control group had three collateral ligament injuries and three anterior cruciate ligament injuries, for an injury rate of 0.50 for both the anterior cruciate ligament and collateral ligaments. Athletes in the treatment group had four collateral ligament injuries and one anterior cruciate ligament injury, for an injury rate of 0.29 for the collateral ligaments and 0.07 for the anterior cruciate ligament. Athletes in the control group were 1.72 times more likely to sustain a collateral ligament injury and 7.14 times more likely to sustain an anterior cruciate ligament injury than the treatment group.
Conclusions: Foot orthoses may contribute to a decreased knee ligament injury rate in female collegiate basketball players. (J Am Podiatr Med Assoc 98(3): 207–211, 2008)
Biomechanical Comparison of Achilles Tenotomy and Achilloplasty Techniques in Young Rats
An Experimental Study
Background: Tendo Achillis lengthening is performed by means of Z-plasty in the classic treatment of clubfoot. In the Ponseti method for treating clubfoot, Achilles tenotomy is performed percutaneously for residual equine deformity. A randomized study was designed to compare tendon healing after tenotomy versus Z-plasty.
Methods: Thirty-six Sprague-Dawley rats were divided randomly into two groups. On the first day, while the right tendo Achillis of group 1 rats underwent tenotomy, those of group 2 rats underwent Z-plasty. Nine rats from each group were humanely killed on days 21 and 45 postoperatively. The two groups were compared with each other biomechanically and histologically. The Achilles tendons of eight rats in each group were evaluated biomechanically, and the remaining rat in each group underwent histologic evaluation.
Results: Mean ± SD maximum load at rupture of the treated tendons on days 21 and 45 in the tenotomy group was 26.38 ± 7.31 N and 47.16 ± 15.36 N, respectively, and in the Z-plasty group was 27.37 ± 5.20 N and 45.27 ± 9.59 N, respectively. The biomechanical evaluation revealed no significant difference in terms of breaking forces between the two groups. The difference between breaking forces on days 21 and 45 was statistically significant for both groups.
Conclusions: Tendons in the tenotomy group healed as well as those in the Z-plasty group, and Achilles tenotomy in the rat was similar to Z-plasty for Achilles tendon lengthening. Human correlation may or may not exist, but this study suggests that it should be considered and investigated. (J Am Podiatr Med Assoc 99(3): 216–222, 2009)
Background: First metatarsophalangeal joint arthrodesis with isolated dorsal plating without a lag screw and without a compressive mechanism incorporated into the plate is not well studied. Although surface area for bony fusion is increased, there is concern for lower fusion rates and progressive loss of sagittal plane positioning. We present fusion rates and progressive sagittal plane deviation with isolated dorsal plate fixation.
Methods: A retrospective review was performed of 41 patients (43 feet) who underwent first metatarsophalangeal joint arthrodesis with isolated dorsal plate fixation. Patients were excluded if another form of fixation was used, if there was a compressive feature to the dorsal plate, or if a lag screw was used. Preoperative, immediate postoperative, and final postoperative radiographs were reviewed to assess radiographic alignment and fusion about the first metatarsophalangeal joint. Specific attention was placed on hallux dorsiflexion in relation to the first metatarsal. Statistical significance was set at P ≤ .05 a priori.
Results: Patients were followed for an average of 55.7 weeks. Overall union rate was 97.62%. The average time to union was 42.55 days. Reoperation rate was 4.65%, with one patient requiring revisional arthrodesis with a lag screw construct. Hallux abduction and first-second intermetatarsal angle correction reached significance (P < .00001). Hallux dorsiflexion increased by 1.05° between initial postoperative and final postoperative radiographs (P = .542).
Conclusions: Although fusion rates and progressive loss of sagittal plane position have been concerns for first metatarsophalangeal joint arthrodesis with an isolated dorsal plate construct, these results suggest this to be a stable construct without loss of positioning over time.
Abstract
Objectives: To examine the effects of foot dominance and body mass on foot plantar pressures in older women of regular, overweight, and obese weights.
Methods: 96 female adults were divided into regular-weight group (68.30 ± 4.19 yr), overweight group (69.88 ± 3.76 yr), and obesity group (68.47 ± 3.67 yr) based on their body mass index scores. Footscan® plantar pressure test system was used to assess the dynamic plantar pressures, and parameters were collected from risk analysis, foot axis analysis, single foot timing analysis, and pressure analysis.
Results: (1) The local risks of lateral forefoot and midfoot, the minimum and maximum subtalar joint angles, the flexibility of subtalar joint, foot flat phase, as well as the average pressures on toes, metatarsals,, midfoot, and lateral heel, with the peak pressures on toe 2–5, metatarsal 2, metatarsal 5, midfoot, and lateral heel had significant within-subject differences. (2) The phases of initial contact and foot flat, the average pressures on toe 2–5, metatarsals, midfoot, and heels, with the peak pressures on metatarsal 1–4, midfoot, and heels exhibited significant between-subjects differences. (3) There was an interaction effect of foot dominance and body mass index on the flexibility of subtalar joint.
Conclusions: The non-dominant foot works better for stability, especially when touching on and off the ground. The dominant foot works better for propulsion but is more susceptible to pain, injury, and falls. For obese older women, the forefoot and midfoot are primarily responsible for maintaining stability, but the lateral midfoot and hindfoot are more prone to pain and discomfort.
Podiatric Medicine and Disaster Response
A Survey of the Professional Leadership
Background:
We surveyed the podiatric medicine professional and academic leadership concerning podiatric medicine professionals as disaster surge responders.
Methods:
All US podiatric medical school deans and state society presidents were mailed a self-administered structured questionnaire. The leaders were asked to complete the questionnaire and return it by mail; two repeated mailings were made. Descriptive statistics were produced, and differences between deans and society presidents were tested by the Fisher exact test.
Results:
The response rate was 100% for the deans and 53% for the society presidents. All of the respondents agreed that podiatric physicians have skills applicable to catastrophe response, are ethically obligated to help, and should receive additional training in catastrophe response. Deans and society presidents agreed with the statements that podiatric physicians should provide basic first aid and place sutures, obtain medical histories, and assist with maintaining infection control. With one exception, all of the society presidents and deans agreed that with additional training, podiatric physicians could interpret radiographs, start intravenous lines, conduct mass casualty triage, manage a point of distribution, prescribe medications, and provide counseling to the worried well. There was variability in responses across the sources for training.
Conclusions:
These findings suggest that deliberations regarding academic competencies at the podiatric medical school level and continuing education should be conducted by the profession for a surge response role, including prevention, response, mitigation, and recovery activities. After coordination and integration with response agencies, podiatric medicine has a role in strengthening the nation’s catastrophic event surge response. (J Am Podiatr Med Assoc 103(1): 87–93, 2013)
“Good for Older Ladies, Not Me”
How Elderly Women Choose Their Shoes
Background:
Footwear selection is important among older adults. Little is known about factors that influence footwear selection among older women. If older women are to wear better footwear that reduces their risk of falls and foot abnormalities, then a better understanding of the factors underlying footwear choice is needed. This study aims to identify factors that drive footwear selection and use among older community-dwelling women with no history of falls.
Methods:
A cross-sectional survey using a structured, open-ended questionnaire was conducted by telephone interview. The participants were 24 women, 60 to 80 years old, with no history of falls or requirement for gait aids. The responses to open-ended questions were coded and quantified under a qualitative description paradigm.
Results:
The main themes identified about footwear selection were aesthetics and comfort. Aesthetics was by far the main factor influencing footwear choice. Wearing safe footwear was not identified as a consideration when purchasing footwear.
Conclusions:
This study indicates that older women are driven primarily by aesthetics and comfort in their footwear selection. These footwear drivers have implications for health-care providers when delivering fall and foot health education. (J Am Podiatr Med Assoc 103(6): 465–470, 2013)
Defining and addressing outcome objectives is a crucial process in medical science and education. One outcome objective of the Physiology/ Pharmacology Department at Des Moines University is to prepare students to successfully complete Part I of the national licensure examination. This study assesses the effectiveness of the departmental curriculum in helping the students achieve success on Part I of the licensure examination. Standardized discipline examinations were used as the comprehensive final examination for the physiology and pharmacology courses for the classes of 1997, 1998, and 2002 through 2005. The results were assessed by class year and specific topic area as determined by an item keyword description. Student performance on Part I of the National Podiatric Board examination was assessed for each class. Podiatric medical students’ performance tended to be similar to or slightly lower than that of the national cohort on the discipline examinations. Topic analysis revealed areas of weakness, which were then addressed in the second-year courses. Student performance on Part I was generally acceptable yet showed marked improvement with the curricular interventions and changes. External assessments provide us with an unbiased means to evaluate the strengths and weaknesses of the curriculum through student performance and to make appropriate adjustments to enhance students’ success. (J Am Podiatr Med Assoc 96(5): 448–454, 2006)
