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.
The clinical and sociodemographic characteristics of patients aged 0 to 18 years presenting with ingrown nail were evaluated retrospectively from clinic records.
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.
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.
A prospective study was performed to examine the performance of bone scintigraphy in the earliest stage of soft-tissue foot ulceration with potential risk for progression to osteomyelitis. Twenty-three podiatry clinic patients with new or recurrent foot ulcers but negative plain film radiographs of the foot underwent 24 (one patient was studied twice) multiphase bone scans (flow, blood pool, and 3- and 24-hour delayed images) that were visually scored for severity of increased uptake on a scale of 0 to 3+, with 0 indicating normal and 3+ indicating severe. Twenty-one scans (88%) showed abnormal uptake on at least one phase, with 17 (71%) having increased bone uptake on late images. Ulcer healing without complications occurred in 20 cases (83%), whereas 4 cases had adverse outcomes, 3 requiring surgical resection for failure to heal and 1 having radiographic progression to frank osteomyelitis. All three patients whose bone scans showed severe abnormal uptake had an adverse clinical outcome. (J Am Podiatr Med Assoc 93(2): 91-96, 2003)
Human amniotic membrane is used to prevent peritendinous adhesions after tendon injuries. This study compares the mechanical properties of modified Kessler repairs and modified Kessler repairs strengthened using multiple layers of human amniotic membrane.
Twenty flexor digitorum profundus tendons of sheep forelimbs were sutured by the two-strand modified Kessler technique (group A) and by the two-strand modified Kessler repair reinforced with multiple layers of human amniotic membrane (group B). To assess the mechanical performance of the repairs, tendons were subjected to a linear noncyclic load-to-failure test using a material testing machine. Outcome measures included ultimate forces and the mode of failure.
The mean ± SD value of the failure strength was 34.6 ± 1.64 N for group A and 50.6 ± 5.60 N for group B. The reinforced repair provided a significantly higher ultimate load compared with the nonreinforced group (P < .001). All of the specimens failed due to suture breakage at the repair site.
The results of this study show that the modified Kessler repair can be reinforced effectively with human amniotic membrane.
Many people experience gastrocnemius tightness. Few studies demonstrate the relationship between gastrocnemius tightness and forefoot pathology. This study aimed to define the association between intractable plantar keratosis of the second rocker (IPK2) (also known as well-localized IPK or discrete keratosis) and metatarsalgia.
The Silfverskiöld (ST) and lunge (LT) tests, used for measuring ankle dorsiflexion, were applied to diagnose gastrocnemius tightness. An instrument for measuring accurate performance and the force to be applied (1.7–2.0 kg of force to the ankle dorsiflexion) complemented the ST for clinical diagnosis and to obtain repeatedly reliable results (the authors apply force manually, which is difficult to quantify accurately).
Of 122 patients studied, 74 were used to devise a prediction model from a logistic regression analysis that determines the probability of presenting gastrocnemius tightness in each test (LT and ST) with the following variables: metatarsalgia, IPK2, and maximum static pressure (baropodometry). The IPK2 plays the principal role in predicting this pathology, with the highest Wald values (6.611 for LT and 5.063 for ST). Metatarsalgia induces a somewhat lower change (66.7% LT and 64.3% ST). The maximum pressure of the forefoot is equally significant (P = .043 LT and P = .025 ST), taking α < .05 as the significance level.
The results of this validation report confirm that a model composed of metatarsalgia, IPK2, and maximum pressure in static acts as a predictive method for gastrocnemius tightness.
Background: The objective of this investigation was to evaluate adverse short-term outcomes following partial forefoot amputation with a specific comparison performed based on subject height.
Methods: The American College of Surgeons National Surgical Quality Improvement Program database was analyzed to select those subjects with a 28805 CPT code (amputation, foot; transmetatarsal) that underwent the procedure with “all layers of incision (deep and superficial) fully closed.” This resulted in 11 subjects with a height ≤60 inches, 202 subjects with a height >60 inches and <72 inches, and 55 subjects ≥72 inches.
Results: Results of the primary outcome measures found no significant differences between groups with respect to the development of a superficial surgical site infection (0.0% vs. 6.4% vs. 5.5%; p=0.669), deep incisional infection (9.1% vs. 3.5% vs. 10.9%; p=0.076), or wound disruption (0.0% vs. 5.4% vs. 5.5%; p=0.730). Additionally, no significant differences were observed between groups with respect to unplanned reoperations (9.1% vs. 16.8% vs. 12.7%; p=0.0630) or unplanned hospital readmissions (45.5% vs. 23.3% vs. 20.0%; p=0.190).
Conclusions: The results of this investigation demonstrate no difference in short-term adverse outcomes following the performance of partial forefoot amputation with primary closure based on subject height. Although height has previously been described as a potential risk factor in the development of lower extremity pathogenesis, this finding was not observed in this study from a large US database.
There is little knowledge of the functional performance of patients with talocalcaneal coalition because of the marginal quantitative information accessible using current motion-analysis and plantar pressure–measurement techniques. A novel system was developed for comprehensively measuring foot–floor interaction during the stance phase of gait that integrates instrumentation for simultaneously measuring bony segment position, ground reaction force, and plantar pressure with synchronization of spatial and temporal variables. An advanced anatomically based analysis of foot joint rotations was also applied. Tracking of numerous anatomical landmarks allowed accurate selection of three footprint subareas and reliable estimation of relevant local forces and moments. Eight patients (11 feet) with talocalcaneal coalition were analyzed. Major impairment of the rearfoot was found in nonsurgical patients, with an everted attitude, limited plantarflexion, and overloading in all three components of ground reaction force. Surgical patients showed more normal loading patterns in each footprint subarea. This measuring system allowed for accurate inspection of the effects of surgical treatment in the entire foot and at several footprint subareas. Surgical treatment of talocalcaneal coalition seems to be effective in restoring more physiologic subtalar and forefoot motion and loading patterns. (J Am Podiatr Med Assoc 96(2): 107–115, 2006)
Background: Digital deformities represent a common presenting pathology and target for surgical intervention in podiatric medicine and surgery. The objective of this investigation was to compare the radiographic width of the heads of the lesser digit proximal phalanges.
Methods: One hundred and fifty consecutive feet with a diagnosis of digital deformity and performance of weight-bearing radiographs were analyzed. The maximum width of the heads of the lesser digit proximal phalanges were recorded from the radiographs utilizing computerized digital software.
Results: The mean±standard deviation (range) of the head of the second digit proximal phalanx was 9.74±0.87 mm (7.94-11.78), of the head of the third digit proximal phalanx was 9.00±0.91 mm (7.27-10.94), of the head of the fourth digit proximal phalanx was 8.49±1.01 mm (5.57-10.73), and of the head of the fifth digit proximal phalanx was 8.67±0.89 mm (6.50-11.75). The width of the head of the proximal phalanx decreased from the second digit to the third digit (p<0.001), decreased from the third digit to the fourth digit (p<0.001), and then increased from the fourth digit to the fifth digit (p=0.032).
Conclusions: The results of this investigation provide evidence in support of an anatomic and structural contribution to digital deformities. The width of the heads of the lesser digit proximal phalanges decreased from the second to the third to the fourth toes, and then subsequently increased with the fifth proximal phalangeal head.
Background: The objective of this investigation was to evaluate adverse short-term outcomes following open lower extremity bypass surgery in subjects with diabetes mellitus with a specific comparison performed based on subject height.
Methods: The American College of Surgeons National Surgical Quality Improvement Program database was analyzed to select those subjects with CPT codes 35533, 35540, 35556, 35558, 35565, 35566, 35570 and 35571 and with the diagnosis of diabetes mellitus. This resulted in 83 subjects ≤60 inches, 1084 subjects >60 inches and <72 inches, and 211 subjects ≥72 inches.
Results: No differences were observed between groups with respect to the development of a superficial surgical site infection (9.6% vs. vs. 6.4% vs. 5.7%; p=0.458), deep incisional infection (1.2% vs. 1.4% vs. 2.8%; p=0.289), sepsis (2.4% vs. 2.0% vs. 2.8%; p=0.751), unplanned reoperation (19.3% vs. 15.6% vs. 21.8%; p=0.071), nor unplanned hospital readmission (19.3% vs. 14.8% vs. 17.1%; p=0.573). A significant difference was observed between groups with respect to the development of a wound disruption (4.8% vs. 1.3% vs. 4.7%; p=0.001). A multivariate regression analysis was performed of the wound disruption outcome with the age, gender, race, ethnicity, height, weight, current smoker and open wound/wound infection variables. Race (p=0.025) and weight (p=0.003) were found to be independently associated with wound disruption, but height was not (p=0.701).
Conclusions: The results of this investigation demonstrate no significant difference in short-term adverse outcomes following the performance of lower extremity bypass surgery based on patient height.
INTRODUCTION AND OBJECTIVES: Immobilization devices such as surgical shoes and walking boots are commonly prescribed by podiatric physicians in the treatment of a variety of lower extremity pathologies and during the post-operative recovery period, but may have the potential to affect a patientâ€™s ability to maintain a safe level of control over the accelerator and brake pedals while operating an automobile. The objective of this investigation was to assess driving outcomes in a group of healthy participants under variable foot wear conditions.
METHODS: Following IRB approval, the braking performances of participants were evaluated with a computerized driving simulator. We assessed three driving outcomes (mean emergency brake response time, frequency of abnormally delayed braking responses, and frequency of inaccurate brake responses) under three variable footwear conditions (regular shoe gear, surgical shoe, and walking boot).
RESULTS: We found that mean brake response times were abnormally delayed in the walking boot compared to both the regular shoe (0.736 seconds vs. 0.575 seconds, p < 0.001 seconds) and surgical shoe (0.736 seconds vs. 0.611 seconds, p < 0.001). We found that abnormally delayed brake responses occurred more frequently in the surgical shoe (18.5% vs. 2.5%, p < 0.001) and the walking boot (55.5% vs. 2.5%, p < 0.001) compared to the regular shoe. And we found that inaccurate brake responses occurred more frequently in the walking boot compared to both the surgical shoe (18.0% vs. 4.0%, p < 0.001) and the regular shoe (18.0% vs. 2.0%, p < 0.001).
CONCLUSIONS: The results of these investigations provide podiatric physicians with a better understanding of how to assess the risk and how to appropriately advise their patients who have been prescribed lower extremity immobilization devices with respect to the safe operation of an automobile.
The general public has become increasingly concerned about the accomplishments of education. Accrediting bodies are holding institutions of higher education accountable for educational services and are demanding a variety of assessment activities. This article presents the plan for assessment of student achievement at the Kent State University College of Podiatric Medicine. (J Am Podiatr Med Assoc 102(6): 529–534, 2012)