Search Results
The Jones Compression Bandage
Review and Clinical Applications
Lower-extremity edema is a common condition that can be caused by many pathophysiologic processes. Control of edema associated with surgery or trauma is important and will help minimize pain and discomfort and prevent wound complications and blisters. Many techniques are used to control edema. The Jones compression dressing is an excellent tool that has been used successfully by the senior author for 18 years. It continues to be a primary treatment technique for the control of edema. (J Am Podiatr Med Assoc 92(4): 221-231, 2002)
Background: The aim of this study is to compare clinical and radiologic outcomes of self-adhesive taping (SAT) or a short- leg cast (SLC) groups with base of fifth metatarsi.
Methods: Functional outcome was assessed by the Visual-Analogue-Scale Foot and Ankle (VAS-FA) at the Emergency and at 2, 4, 6, and 12 weeks. Labour loss, bone union and The American Orthopedic Foot and Ankle Score (AOFAS) at 12 weeks were also assessed.
Results: There was no difference between the SAT group and SLC group in VAS-FA scores at time of injury, 6 and 12 weeks. The SAT group had a significantly higher mean VAS-FA score at the second and fourth weeks of follow-up compared with the SLC group (P = .001 and P = .039, respectively). No correlation was observed between the fracture gap and functional scores for both groups. There was no difference in AOFAS between two groups at 12 weeks. Twenty one patients were unable to work for a mean of 38.2 days during the treatment. 10 patients with the SAT missed 37.5 days and eleven patients with the SLC g missed 40.2 (p: 0.41). The bone union was also achieved for all patients within 12 weeks.
Conclusion: Treatment with SAT in these fractures had satisfactory functional results compared with traditional SLC. Although there were no significant differences in labor loss and use of assistive devices, The VAS-FA score was significantly higher in SAT group than the SLC group at the second and fourth weeks of treatment.
We present a radiographic analysis of 91 failed hallux abducto valgus surgeries. Patients were categorized by type of postoperative complication: hallux varus, hallux limitus, or recurrent hallux abducto valgus deformities. All deformities were radiographically evaluated preoperatively and after correction using tricorrectional bunionectomy. Analysis of the surgical revisions showed improvement in radiographic parameters, including the intermetatarsal angle, hallux abductus angle, proximal articular set angle, and tibial sesamoid position. We conclude that tricorrectional bunionectomy is a versatile procedure that can be used when addressing a residual deformity after failed hallux abducto valgus surgery. (J Am Podiatr Med Assoc 94(4): 341–346, 2004)
Diagnosis and treatment of longitudinal tears of the tibialis anterior tendon are not well documented in the surgical literature. Described here is successful primary surgical repair of a longitudinally torn tibialis anterior tendon in a 60-year-old woman. (J Am Podiatr Med Assoc 95(4): 390–393, 2005)
Background:
Offloading devices for diabetic foot ulcers (DFU) generally restrict exercise. In addition to traditional health benefits, exercise could benefit DFU by increasing blood flow and acting as thermotherapy. This study functionally evaluated a cycling cleat designed for forefoot DFU.
Methods:
Fifteen individuals at risk of developing a DFU used a recumbent stationary bicycle to complete one 5-minute cycling bout with the DFU cleat on their study foot and one 5-minute bout without it. Foot stress was evaluated by plantar pressure insoles during cycling. Laser Doppler perfusion monitored blood flow to the hallux. Infrared photographs measured foot temperature before and after each cycling bout.
Results:
The specialized cleat significantly reduced forefoot plantar pressure (9.9 kPa versus 62.6 kPa, P < .05) and pressure time integral (15.4 versus 76.4 kPa*sec, P < .05). Irrespective of footwear condition, perfusion to the hallux increased (3.97 ± 1.2 versus 6.9 ± 1.4 tissue perfusion units, P < .05) after exercise. Infrared images revealed no changes in foot temperature.
Conclusions:
The specialized cleat allowed participants to exercise with minimal forefoot stress. The observed increase in perfusion suggests that healing might improve if patients with active DFU were to use the cleat. Potential thermotherapy for DFU was not supported by this study. Evaluation of the device among individuals with active DFU is now warranted.
Background: The use of cushioned or shock-absorbing insoles has been suggested as a mechanism to reduce the impact forces associated with running, thereby protecting against overuse injuries. The purpose of this study was to determine whether the use of cushioned insoles reduced impact forces during running in healthy subjects.
Methods: Sixteen recreational runners (9 females and 7 males) ran at a self-selected pace for five trials with and without the use of cushioned insoles. During each trial, ground reaction forces, tibial accelerations, lower-extremity kinematics, and subject-perceived comfort were recorded. All variables were tested with the level of statistical significance set at α = .05.
Results: The use of cushioned insoles resulted in significant reductions in mean vertical ground reaction force peak impact (6.8%) and ground reaction force loading rate (8.3%), as well as peak tibial acceleration (15.8%). Spectral analysis of the tibial acceleration data in the frequency range associated with impact accelerations (12–25 Hz) revealed no change in the predominant frequency or the power of the predominant frequency. The knee flexion angle at initial contact and perceived comfort were similar for the two conditions.
Conclusions: This study demonstrates the effectiveness of one type of cushioned insole in reducing peak impact force and tibial acceleration at initial foot-ground contact during running. The impact reduction observed was independent of knee kinematic adjustments or changes in perceived comfort. Further study is required to determine whether the reduction in loading that accompanied the use of the cushioned insoles can affect the incidence of running-related injuries. (J Am Podiatr Med Assoc 98(1): 36–41, 2008)
Anterior Cruciate Ligament Injury in Female and Male Athletes
The Relationship Between Foot Structure and Injury
Background: It has been shown that anterior cruciate ligament (ACL) injuries are more prevalent in female athletes than in male athletes. Soccer and basketball are considered high-risk sports for ACL injury in female athletes. Several studies have reported a relationship between ACL injury and measures of foot structure. This study was conducted to investigate the relationship between foot structure and ACL injury rates in female and male soccer and basketball players.
Methods: One hundred five soccer and basketball players (53 women and 52 men) were recruited and divided into an ACL-normal group (n = 89) and an ACL-injured group (n = 16). Two measures of foot structure (subtalar joint neutral position and navicular drop test values) were recorded for each subject. An independent t test and a paired t test were used to analyze differences in ACL status, foot structure, and sex. A χ2 analysis determined whether the prevalence of ACL injury was independent of sport.
Results: No statistically significant differences were found in the foot structure measures between women and men. Female soccer and basketball players had an ACL injury rate seven times that of male players.
Conclusions: Values derived from subtalar joint neutral position measurement and the navicular drop test were not associated with ACL injury in collegiate female and male soccer and basketball players. (J Am Podiatr Med Assoc 97(5): 371–376, 2007)
Background: Tibia pilon fractures are associated with high complication rates, decreased quality of life, and low patient satisfaction. Although many factors such as reduction quality and soft-tissue coverage have been identified, researchers continue to investigate the factors that affect healing in tibia pilon fractures. Our objective was to investigate the effect of initial fracture crack width and displacement degree on clinical functional results in tibia pilon fractures.
Methods: In this retrospective cohort study, 40 patients with Arbeitsgemeinschaft für Osteosynthesefragen and Orthopaedic Trauma Association type 43B and 43C tibia pilon fractures and operated on through the extensile anteromedial approach were analyzed. The demographic data of the patients, injury mechanisms, fracture type, reduction quality, clinical results, and postoperative complications were recorded. To evaluate the objective quantity of initial fracture crack width and displacement, a new parameter was defined: “fracture area.” All measurements were conducted using a feature from the picture archiving and communication system on anteroposterior and lateral radiographs taken separately in standard fashion.
Results: With an average follow-up period of 29.2 months (range, 24–40 months), 34 patients (85%) had excellent or good results, whereas only two patients (5%) had poor clinical results. Age, injury mechanism, and reduction quality have a significant relationship with Maryland Foot Score (P < .001, P < .037, and P < .001, respectively). Preoperative fracture area, measured on both the anteroposterior and the lateral views, are significantly related to both Ovadia-Beals Score and Maryland Foot Score (P < .001 for each).
Conclusions: Preoperative fracture area measurement has a major effect on healing of tibia pilon fractures. Increased initial fracture area is correlated with poor clinical functional results. High-energy injuries, older age, and poor reduction quality are also related to worse clinical outcomes.
Background: The establishment of growth reference values is needed in pediatric practice where pathologic conditions can have a detrimental effect on the growth and development of the pediatric foot. This study aims to use multiple regression to evaluate the effects of multiple predictor variables (height, age, body mass, and gender) on anthropometric characteristics of the peripubescent foot.
Methods: Two hundred children aged 9 to 12 years were recruited, and three anthropometric measurements of the pediatric foot were recorded (foot length, forefoot width, and navicular height).
Results: Multiple regression analysis was conducted, and coefficients for gender, height, and body mass all had significant relationships for the prediction of forefoot width and foot length (P = .05, r = 0.7). The coefficients for gender and body mass were not significant for the prediction of navicular height (P = .05), whereas height was (P = .05).
Conclusions: Normative growth reference values and prognostic regression equations are presented for the peripubescent foot. (J Am Podiatr Med Assoc 99(6): 497–502, 2009)
