Lower-extremity problems are common in older people; however, the reliability of clinical tools used to assess foot and ankle characteristics has not been rigorously evaluated. This study evaluated the test–retest reliability of a battery of simple clinical tests of foot and ankle characteristics (tactile sensitivity of the first metatarsophalangeal joint, navicular height, foot length and width, hallux valgus severity, an overall foot problem score, ankle flexibility, ankle dorsiflexion strength, and foot pain) in 31 individuals (13 men and 18 women) aged 76 to 87 years recruited from the community. Three examiners performed the tests on two occasions approximately 2 weeks apart. Intraclass correlation coefficients and coefficients of variation were calculated for continuously scored tests, and the kappa statistic (κ) was used to determine the reliability of hallux valgus severity grading. All of the continuously scored tests had acceptable reliability (intraclass correlation coefficients of 0.64 to 0.98; coefficients of variation of 0.6% to 15.0%), as did hallux valgus severity grading (κ = 0.77; absolute percentage agreement, 84%). These simple clinical tests can now be used with confidence in clinical and research settings to provide reliable and functionally important information regarding foot and ankle characteristics in older people. (J Am Podiatr Med Assoc 93(5): 380-387, 2003)
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: Extracorporeal shockwave therapy (ESWT) was first introduced into clinical practice in 1982 and has been a beneficial inclusion to the noninvasive treatment option of numerous orthopaedic pathologies. However, clinical evidence of the use of ESWT for various foot and ankle disorders has been limited with a consensus on its efficacy yet available. Therefore, the purpose of this study is to systematically review the literature, to provide a critical evaluation and meta-analysis for the use of ESWT in foot and ankle disorders.
Methods: The PubMed and Embase databases were systematically reviewed and clinical studies that reported ESWT use for various foot and ankle disorders included.
Results: A total of 24 clinical studies that included 12 randomized controlled trials and 12 case series were identified. Analysis of the evidence has indicated that ESWT can help manage plantar fasciitis, calcaneal spur, Achilles tendinopathy and Morton’s neuroma. Meta-analysis of the change in pre- to post-VAS overall scores for plantar fasciitis significantly favored ESWT compared to placebo/conservative treatment with a MD -3.10 (95% CI, -4.36 to -1.83; I2 = 68%; P < 0.00001).
Conclusions: The current evidence has suggested that ESWT can provide symptomatic benefit to plantar fasciitis treatment, with minimal and unremarkable side effects. Overall, ESWT has been demonstrated to be a safe treatment option with a favorable complication profile. Further well-designed studies of ESWT for the treatment of calcaneal spurs, Achilles tendinopathy and Morton’s neuroma are warranted to more soundly and safely support its current use. Future studies are suggested to investigate the optimization of ESWT treatment protocols.
A recent increase in podiatric medicine fellowships has occurred as the field continues to progress. Research regarding selection criteria from a fellowship director's perspective for potential fellows is lacking. This study aimed to examine objective and subjective selection criteria that directors consider when selecting applicants for the interview and when ranking prospective fellows after the interview.
We electronically surveyed American College of Foot and Ankle Surgeons fellowship directors with preselected criteria for granting applicants an interview and for compiling their ranking list after the interview. A Likert scale from 1 (most important) to 5 (least important) was used to prioritize each criterion, an average rating was calculated, and the results were placed in order of importance.
The most important selection criteria for granting an interview were quality of residency program (1.985), a written personal statement of reasons for attending that fellowship (2.063), and publications/presentations produced as a resident (2.267). The most important criteria in completing the ranking order after the interview were assessment of applicant's personality (1.111), interview performance (1.173), and expressed interest in program (1.563).
Knowledge of the selection criteria that fellowship directors seek in applicants can assist those who desire to further their training. The selection criteria that program directors seek differed between being selected for the interview, which combined both objective and subjective criteria, and when compiling their rankings after the interview, which included only subjective criteria. Results show more emphasis on subjective selection criteria when directors select applicants for an interview and when ranking applicants after the interview.
Background: Ballet dancers are exposed to high rates of foot and ankle injury. Nevertheless, there have been limited efforts to capture their perspectives regarding risk of injury, treatment compliance, and prevention. The purpose of this study was to portray the perspectives of ballet dancers collected through organized focus group discussions.
Methods: Seven focus group sessions were conducted, with 47 ballet dancers participating. The conversation was directed to consider a variety of factors related to injury, both direct and remote. Transcripts from these focus groups were coded into ten major themes: internal pressure, external pressure, ballet milestones, seeking treatment, treatment compliance, targeted treatment, return to dance, nondance activities, physical fatigue, and activity preparation.
Results: It was found that participants returned to dancing prematurely after injury, faced significant internal and external pressure, lacked adherence to suggested treatment, and identified provider communication as lacking.
Conclusions: The results of this study can help with efforts to reduce injuries, encourage treatment compliance, and improve injury prevention. Future studies might consider the effectiveness of specific interventional approaches.
Idiopathic toe-walking (ITW) in children has been associated with ankle equinus. Although equinus has been linked to foot deformity in adults, there has been limited investigation of the impact of equinus on structural foot change in children. We used the weightbearing lunge test and the six-item version of the Foot Posture Index (FPI-6) to evaluate the weightbearing foot and ankle measures of children with an ITW gait and to compare these with their age-matched peers.
Sixty 4-to 6-year-old children were grouped into ITW (n = 30) and non–toe-walking (n = 30) cohorts using a validated ITW tool. Ankle range of motion was determined with weightbearing lunge tests. The FPI-6 was calculated during weightbearing stance.
There was a highly significant difference in the weightbearing lunge test measures between the ITW cohort and the non–toe-walking cohort. The FPI-6 comparison was not significant. The straight-leg lunge test had a statistically significant relationship with the FPI-6 in the ITW cohort.
Children with an ITW gait demonstrated reduced flexibility at the ankle joint but similar weightbearing foot posture compared with non–toe-walking children, showing that for children 4 to 8 years old, an ITW gait affects the available ankle dorsiflexion but seems to have a limited effect on weightbearing foot posture as measured by the FPI-6. (J Am Podiatr Med Assoc 103(5): 374–379, 2013)
A review of medical literature reveals that there is inconsistency in the reported incidence of Charcot joint disease or neuroarthropathy in the diabetic foot. There is also controversy as to which articulations are most commonly afflicted. Radiographs of 21 patients with bilateral diabetic neuroarthropathy were reviewed to determine the distribution of joint disease in the foot and ankle. Many patients had multiple sites of joint involvement. The results of this study show that the incidence of metatarsophalangeal joint involvement has been greatly underestimated.
Background: This literature review was undertaken to evaluate the reliability and validity of the orthopedic, neurologic, and vascular examination of the foot and ankle.
Methods: We searched PubMed—the US National Library of Medicine’s database of biomedical citations—and abstracts for relevant publications from 1966 to 2006. We also searched the bibliographies of the retrieved articles. We identified 35 articles to review. For discussion purposes, we used reliability interpretation guidelines proposed by others. For the κ statistic that calculates reliability for dichotomous (eg, yes or no) measures, reliability was defined as moderate (0.4–0.6), substantial (0.6–0.8), and outstanding (> 0.8). For the intraclass correlation coefficient that calculates reliability for continuous (eg, degrees of motion) measures, reliability was defined as good (> 0.75), moderate (0.5–0.75), and poor (< 0.5).
Results: Intraclass correlations, based on the various examinations performed, varied widely. The range was from 0.08 to 0.98, depending on the examination performed. Concurrent and predictive validity ranged from poor to good.
Conclusions: Although hundreds of articles exist describing various methods of lower-extremity assessment, few rigorously assess the measurement properties. This information can be used both by the discerning clinician in the art of clinical examination and by the scientist in the measurement properties of reproducibility and validity. (J Am Podiatr Med Assoc 98(3): 197–206, 2008)
Foot and ankle (FA) exercise programs might reduce the risk of falling in older adults. We sought to systematically review the current literature on FA exercise programs targeted at reducing the risk of falling in older adults.
A systematic literature search was performed in the PubMed database, the Physiotherapy Evidence Database, the Cumulative Index to Nursing and Allied Health Literature, and the Cochrane Central Register of Controlled Trials. Articles were included based on the following criteria: 1) randomized controlled trial, 2) FA exercise program, and 3) use of fall risk–related motor outcomes (strength, balance, flexibility, and functional ability) or use of falls as an outcome. Weighted effect sizes (d) were calculated across studies for estimating the overall effect of FA exercises on the most frequently reported motor outcome parameters.
Eight publications met the inclusion criteria. Small to moderate overall effects were found for balance (d = 0.46, P < .001) and ankle flexibility (d = 0.29, P = .006). No significant overall effects were found for ankle plantarflexor strength (d = 0.11, P = .223) and walking performance (d = −0.05, P = .404). Controversial results were reported for other functional measures. Effects varied depending on the type of intervention. Only one study reported improved ankle evertor strength and a significant reduction in falls.
Evidence suggests that FA exercise can improve certain fall risk–related motor outcomes and reduce falls. Limited effects on strength and functional ability might be related to insufficient training intensity and lack of adherence. Further studies that include progressive strength and flexibility training are necessary to validate which FA exercise programs are most effective at preventing falls. (J Am Podiatr Med Assoc 103(6): 534–547, 2013)