Search Results
Plantar heel pain is often managed through podiatric and physical therapy interventions. Numerous differential diagnoses may be implicated in patients presenting with plantar heel pain; however, symptoms are often attributed to plantar fasciitis. Abductor hallucis, flexor digitorum brevis, and quadratus plantae share proximal anatomic attachment sites and mechanical function with the plantar fascia. Although these plantar intrinsic muscles each perform isolated digital actions based on fiber orientation and attachment sites, they function collectively to resist depression of the lateral and medial longitudinal arches of the foot. Overuse injury is the primary contributing factor in tendinopathy. The close anatomic proximity and mechanical function of these muscles relative to the plantar fascia suggests potential for proximal plantar intrinsic tendinopathy as a result of repetitive loading during gait and other weightbearing activities. To date, this diagnosis has not been proposed in the scientific literature. Future studies should seek to confirm or refute the existence of proximal plantar intrinsic tendinopathic changes in patients with acute and chronic plantar heel pain through diagnostic imaging studies, analysis of lactate concentration in pathologic versus nonpathologic tendons, and response to specific podiatric and physical therapy interventions germane to tendinopathy of these muscles.
Accurate Nomenclature for Forefoot Nerve Entrapment
A Historical Perspective
Current medical nomenclature is often based on the early history of the condition, when the true etiology of the disease or condition was not known. Sadly, this incorrect terminology can become inextricably woven into the lexicon of mainstream medicine. More important, when this is the case, the terminology itself can become integrated into current clinical decision making and ultimately into surgical intervention for the condition. “Morton’s neuroma” is perhaps the most striking example of this nomenclature problem in foot and ankle surgery. We aimed to delineate the historical impetus for the terminology still being used today for this condition and to suggest appropriate terminology based on our current understanding of its pathogenesis. We concluded that this symptom complex should be given the diagnosis of nerve compression and be further distinguished by naming the involved nerve, such as compression of the interdigital nerve to the third web space or compression of the third common plantar digital nerve. Although the nomenclature becomes longer, the pathogenesis is correct, and treatment decisions can be made accordingly. (J Am Podiatr Med Assoc 95(3): 298–306, 2005)
The etiology of running-related injuries remains unknown; however, an implicit theory underlies much of the conventional research and practice in the prevention of these injuries. This theory posits that the cause of running-related injuries lies in the high-impact forces experienced when the foot contacts the ground and the subsequent abnormal movement of the subtalar joint. The application of this theory is seen in the design of the modern running shoe, with cushioning, support, and motion control. However, a new theory is emerging that suggests that it is the use of these modern running shoes that has caused a maladaptive running style, which contributes to a high incidence of injury among runners. The suggested application of this theory is to cease use of the modern running shoe and transition to barefoot or minimalist running. This new running paradigm, which is at present inadequately defined, is proposed to avoid the adverse biomechanical effects of the modern running shoe. Future research should rigorously define and then test both theories regarding their ability to discover the etiology of running-related injury. Once discovered, the putative cause of running-related injury will then provide an evidence-based rationale for clinical prevention and treatment.
Podiatric Medical Resources on the Internet
A Fifth Update
An updated selection of high-quality Internet resources of potential use to the podiatric medical practitioner, educator, resident, and student is presented. Internet search tools and general Internet reference sources are briefly covered, including methods of locating material residing on the “invisible” Web. General medical and podiatric medical resources are emphasized. These Web sites were judged on the basis of their potential to enhance the practice of podiatric medicine in addition to their contribution to education. Podiatric medical students, educators, residents, and practitioners who require a quick reference guide to the Internet may find this article useful. (J Am Podiatr Med Assoc 96(2): 162–166, 2006)
This article presents a selection of Internet resources covering most of the subject areas found in standard medical education curricula. Basic-sciences sites are emphasized, but clinical resources are also included. Sites were evaluated on the basis of their potential to enhance the learning process, provide practice questions or study guides for examinations, or aid in the preparation of papers. Podiatric medical students, residents, and practitioners who require a quick reference guide to sources covering the basic-science foundations of podiatric medicine or the clinical side of general medicine may find this article useful. (J Am Podiatr Med Assoc 95(2): 211–215, 2005)
Background
Google Trends proves to be a novel tool to ascertain the level of public interest in pathology and treatments. From anticipating nascent epidemics with data-driven prevention campaigns to identifying interest in cosmetic or bariatric surgery, Google Trends provides physicians real-time insight into the latest consumer trends.
Methods
We used Google Trends to identify temporal trends and variation in the search volume index of four groups of keywords that assessed practitioner-nomenclature inquiries, in addition to podiatric-specific searches for pain, traumatic injury, and common podiatric pathology over a 10-year period. The Mann-Kendall trend test was used to determine a trend in the series, and the Wilcoxon signed-rank test was used to determine whether there was a significant difference between summer and winter season inquiries. Significance was set at P ≤ .05.
Results
The terms “podiatrist” and “foot doctor” experienced increasing Search Volume Index (SVI) and seasonal variation, whereas the terms “foot surgeon” and “podiatric surgeon” experienced no such increase. “Foot pain,” “heel pain,” “toe pain,” and “ankle pain” experienced a significant increase in SVI, with “foot pain” maintaining the highest SVI at all times. Similar results were seen with the terms “foot fractures,” “bunion,” “ingrown toenail,” and “heel spur.” These terms all experienced statistically significant increasing trends; moreover, the SVI was significantly higher in the summer than in the winter for each of these terms.
Conclusions
The results of this study show the utility in illustrating seasonal variation in Internet interest of pathologies today's podiatrist commonly encounters. By identifying the popularity and seasonal variation of practitioner- and pathology-specific search inquiries, resources can be allocated to effectively address current public inquiries. With this knowledge, providers can learn what podiatric-specific interests are trending in their local communities and market their practice accordingly throughout the year.
Evidence-Based Podiatric Medicine
Importance of Systematic Reviews in Clinical Practice
Due to the exponential increase in the quantity and quality of podiatric medicine–related research during the past decade, podiatric physicians are inundated with an insurmountable volume of research relevant to clinical practice. Systematic reviews can refine this literature by using explicit, rigorous, and reproducible methods to identify, critically appraise, and synthesize the best evidence from all clinical trials to answer clearly defined clinical questions. The Cochrane Collaboration is an international not-for-profit organization created to improve the user-friendliness and accessibility of medical literature mainly through preparing and maintaining systematic reviews of health-care interventions. The Cochrane Library currently contains more than 50 podiatric medicine–relevant systematic reviews summarizing and synthesizing evidence from many hundreds of randomized controlled trials evaluating interventions for foot problems. Although more than 60 countries worldwide have open online access to The Cochrane Library, in the United States, only the state of Wyoming has free access to full-text reviews. In an era demanding an evidence-based approach for every clinical intervention, high-quality systematic reviews streamline podiatric medical literature by reducing the time, cost, and training necessary to establish a solid evidence base for practice. (J Am Podiatr Med Assoc 99(3): 260–266, 2009)
