Search Results
Background:
As the facilitator of the standardized patient rotation at the Ohio College of Podiatric Medicine (now Kent State University College of Podiatric Medicine [KSUCPM]) for the past 4 years, I have felt that there is underused time in the program. Therefore, I sought the views of podiatric medical students at KSUCPM who have completed the standardized patient rotation to see how they felt their time in the course was used and whether they felt that the course was useful to them in terms of advancing their podiatric medical education.
Methods:
A survey was administered to 105 third-year podiatric medical students. These students had already completed the standardized patient rotation, which at KSUCPM is in the second year.
Results:
Seventy-seven students completed the survey. Most of these students felt that there was improperly used time in the course, and many recommended ways of improving the course organization.
Conclusions:
The students answered positively that the standardized patient rotation was important in terms of improving interviewing skills and worthwhile for future professional development. The students agreed that there likely was underused time in the course and even suggested ways in which they would make the course run more efficiently. (J Am Podiatr Med Assoc 102(6): 477–484, 2012)
The topic of pain management remains a minor component of the formal education and training of residents and physicians in the United States. Misguided attitudes concerning acute and chronic pain management, in addition to reservations about the legal aspects of pain management, often translate into a “fear of the unknown” when it comes to narcotic prescription. The intentionally limited scope of this review is to promote an understanding of the laws regulating pain management practices in the United States and to provide recommendations for appropriate pain management assessment and documentation based on the Model Policy for the Use of Controlled Substances for the Treatment of Pain established by the Federation of State Medical Boards of the United States. (J Am Podiatr Med Assoc 100(6): 511–517, 2010)
Effect of Excessive Body Weight on Foot Arch Changes in Preschoolers
A 2-Year Follow-up Study
Background
A stable standing posture, and effective and aesthetic gait, depend heavily on correct anatomical construction of the feet, thanks to which they can play their important role. The shape and height of the foot arches are already formed in the preschool and early school years; therefore, abnormalities and disorders in children's feet, and correlations between foot formation and somatic build, are still crucial and interesting issues for orthopedists, pediatricians, physiotherapists, and podiatrists. This study deals with changes in the height of the longitudinal and transverse arches of the foot in 4- to 6-year-old children.
Methods
A total of 102 boys and 105 girls took part in a 24-month study in which their body weight, height, body mass index, and Clarke's and gamma angles were measured. The analysis also focused on correlations among sex, nutritional status, and changes in foot arch height.
Results
It was discovered that sex did not considerably affect Clarke's and gamma angle values. However, it was found that between ages 4 and 6 years, the proportion of overweight and obese boys and girls increased, and the medial longitudinal arch of the foot had a tendency to collapse in those with excessive body weight. The effect of nutritional status on the transverse arch of the foot is rather dubious.
Conclusions
In light of these findings, therapeutic programs for preventing foot deformities in children should also focus on body weight control.
Integrating Research Into the Clinic
What Evidence Based Practice Means to the Practising Podiatrist
This paper is the first in a series of three aimed at introducing clinicians to current concepts in research, and outlining how they may be able to apply these concepts to their own clinical practice. It has become evident in recent years that while many practitioners may not want to become actively involved in the research process, simply keeping abreast of the burgeoning publication base will create new demands on their time, and will often require the acquisition of new skills.
This series introduces the philosophies of integrating what sometimes may appear to be abstract research into the realities of the clinical environment. It will provide practitioners with an accessible summary of the tools required in order to understand the research process. For some, it is hoped this series may provide some impetus for the contemplative practitioner to become a more active participant in the research process. This first paper addresses how the evidence based practice (EBP) revolution can be used to empower the individual practitioner and how good quality evidence can improve the overall clinical decision making process. It also suggests key strategies by which the clinician may try to enhance their clinical decision making process and make research evidence more applicable to their day to day clinical practice. (J Am Podiatr Med Assoc 92(2): 115-122, 2002)
Background:
Anthropometric status can influence gait biomechanics, but there is relatively little published research regarding foot and ankle characteristics in the obese pediatric population. We sought to compare the structural and functional characteristics of the foot and ankle complex in obese and non-obese children.
Methods:
Twenty healthy children (ten obese and ten normal weight) were recruited for a cross-sectional research study. Anthropometric parameters were measured to evaluate active ankle dorsiflexion, arch height (arch height index, arch rigidity index ratio, and arch drop), foot alignment (resting calcaneal stance position and forefoot-rearfoot alignment in unloaded and loaded positions), and foot type (malleolar valgus index). Independent t tests determined significant differences between groups for all assessed parameters. Statistical significance was set at P < .0125.
Results:
Compared with non-obese participants, obese participants had significantly greater arch drop (mean ± SD: 5.10 ± 2.13 mm versus 2.90 ± 1.20 mm; P =.011) and a trend toward lower arch rigidity index ratios (mean ± SD: 0.92 ± 0.03 versus 0.95 ± 0.02; P = .013). In addition, obese participants had significantly less active ankle dorsiflexion at 90° of knee flexion versus non-obese participants (mean ± SD: 19.57 ± 5.17 versus 29.07 ± 3.06; P < .001). No significant differences existed between groups for any other anthropometric measurements.
Conclusions:
The decreased active ankle dorsiflexion in the obese group can increase foot contact for a longer period of the stance phase of gait. Obese participants also presented with a more flexible foot when bearing weight. (J Am Podiatr Med Assoc 102(1): 5–12, 2012)
Background: This cross-sectional study aimed to determine whether normal, flat, or high-arched feet corresponded to better performance of certain motor tests in children.
Methods: One hundred eighty-seven children (mean ± SD age, 11.15 ± 1.24 years) were recruited and divided into three groups: 96 with normal feet, 54 with high-arched feet, and 37 with low-arched feet. Nine motor trials were selected to assess motor performance: standing long jump, standing triple jump from each foot, standing vertical jump, shuttle run 10 × 5 m, standing-start 20-m sprint, static balance, dynamic balance on a beam of an inverted gym bench, and agility circuit.
Results: There were no significant differences in the trial results between groups, although in eight of the nine trials participants in the high-arched group tended to perform better. Boys performed better than girls in all of the trials except those of balance.
Conclusions: These results suggest that children with a certain foot type did not achieve better motor performance in the nine trials tested.
The pediatric flatfoot has long occupied a place in the medical literature, with concerns about the significance of its appearance. At the end of the first decade of the 21st century, an article in this journal provoked active debate about the pediatric flatfoot as part of development, and proposed a considered titration of presenting cases in an effort to justify treatment and appreciated the range and expected change in normal foot posture with growth. A decade later, the availability of normative pediatric foot posture data, and the prospective findings to confirm lessening flat feet with age, encourage a structured and considered approach to this frequent primary care presentation. The pragmatic concept of the “boomerang” is built on the research identifying pediatric flat feet likely to be symptomatic, thus requiring intervention, and filtering from those likely to remain asymptomatic. Differential diagnoses are advisedly considered, and gait remains the hallmark outcome. In this contemporary guide, an eight-step strategy has been developed to improve the approach to community pediatric flatfoot concerns. Furthermore, the three boomerang flat feet factors delineating symptomatic from asymptomatic flat feet, and applicable cutoff levels, are availed for practical reference and use. Given the recognized state of overdiagnosis and resulting unnecessary treatment that pervades the 21st century, it is timely for clear 20/20 vision for the presentation of pediatric flatfoot.
Background: Despite prevention efforts, suicide rates continue to rise, prompting the need for novel evidence-based approaches to suicide prevention. Patients presenting with foot and ankle disorders in a podiatric medical and surgical practice may represent a population at risk for suicide, given risk factors of chronic pain and debilitating injury. Screening has the potential to identify people at risk that may otherwise go unrecognized. This quality improvement project aimed to determine the feasibility of implementing suicide risk screening in an outpatient podiatry clinic and ambulatory surgical center.
Methods: A suicide risk screening quality improvement project was implemented in an outpatient podiatry clinic and ambulatory surgical center in collaboration with a National Institute of Mental Health suicide prevention research team. Following training for all staff, patients aged 18 years and older were screened for suicide risk with the Ask Suicide-Screening Questions as standard of care. Clinic staff were surveyed about their opinions of screening.
Results: Ninety-four percent of patients (442 of 470) agreed to be screened for suicide risk and nine patients (nine of 442 [2%]) were screened as nonacute positive; zero patients were screened as acute risk. The majority of clinic staff reported that they found screening acceptable, felt comfortable working with patients who have suicidal thoughts, and thought screening for suicide risk was clinically useful.
Conclusions: Suicide risk screening was successfully implemented in an outpatient podiatry clinic. Screening with the Ask Suicide-Screening Questions instrument provided valuable information that would not have been ascertained otherwise, positively impacting clinical decision-making and leading to improved overall care for podiatry patients.
Assessing Plantar Pressure Distribution in Children with Flatfoot Arch
Application of the Clarke Angle
Background
Flatfoot, or pes planus, is one of the most common foot posture problems in children that may lead to lower-extremity pain owing to a potential increase in plantar pressure. First, we compared plantar pressure distribution between children with and without flatfoot. Second, we examined the reliability and accuracy of a simple metric for characterization of foot posture: the Clarke angle. Third, we proposed a mathematical model to predict plantar pressure magnitude under the medial arch using body mass and the Clarke angle.
Methods
Sixty children with flatfoot and 33 aged-matched controls were recruited. Measurements included in-shoe plantar pressure distribution, ground reaction force, Clarke angle, and radiography assessment. The measured Clarke angle was compared with radiographic measurements, and its test-retest reliability was determined. A mathematical model was fitted to predict plantar pressure distribution under the medial arch using easy-to-measure variables (body mass and the Clarke angle).
Results
A high correlation was observed between the Clarke angle and radiography measurements (r > 0.9; P < 10−6). Excellent between- and within-day test-retest reliability for Clarke angle measurement (intraclass correlation coefficient, >0.9) was observed. Results also suggest that pressure magnitude under the medial arch can be estimated using the Clarke angle and body mass (R 2 = 0.95; error, <0.04 N/cm2 [2%]).
Conclusions
This study suggests that the Clarke angle is a practical, reliable, and sensitive metric for quantification of medial arch height in children and could be recommended for research and clinical applications. It can also be used to estimate plantar pressure under the medial arch, which, in turn, may assist in the timely intervention and prognosis of prospective problems associated with flatfoot posture.
