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Navicular Stress Reactions in Runners
A Review of Evaluation and Management of a Competitive Athlete
Navicular stress injuries in athletes can be devastating. Clinical findings are frequently nonspecific until significant progression of the abnormality has occurred. The use of diagnostic imaging techniques early in the discovery period increases the likelihood of establishing an immediate diagnosis and avoids frank fracture of the navicular bone. Delayed diagnosis of navicular stress injuries in athletes can cause dire consequences. The physician must be aware of the injury in establishing a high index of clinical suspicion. The timing and sequencing of diagnostic imaging studies is essential in establishing a diagnosis to manage the patient and minimize time away from competition. This case study examines the history and management of an elite high school track athlete who sustained a navicular stress injury. The timing and use of diagnostic imaging studies is reviewed. (J Am Podiatr Med Assoc 101(5): 447–451, 2011)
Swelling of the leg is a frequent finding in podiatric medicine. Unless the patient draws notice to the condition or the physician is diligent in asking questions and examining the extremity, the condition may be viewed as minor and given little attention. Swelling of the leg can be a clinical sign of certain systemic diseases, lymphatic and venous disorders, or other miscellaneous causes. Dermatologic consequences linked to many of these causes of swelling are well documented. What is not as well chronicled is a dramatic skin alteration associated with chronic lymphedema. This article provides an overview and a case presentation of the unusual and debilitating skin condition related to chronic lymphedema of the lower extremity known as elephantiasis nostras verrucosa. (J Am Podiatr Med Assoc 96(5): 442–444, 2006)
Background: Student self-assessment is viewed as an important tool in medical education. We sought to identify the relationship between student academic performance and third-year clinical performance self-assessment. No such study exists in podiatric medical education.
Methods: Third-year podiatric medical students from the classes of 2012 through 2014 completed a self-assessment of their performance for each of five broad clinical podiatric medical domains (Professionalism, Medicine, Radiology, Surgery, and Biomechanics/Orthopedics). The assessment was completed after students finished the first 12 weeks of their third-year clinical rotations (PRE) and a second time at the conclusion of the third year (POST). The mean self-assessment score for PRE and POST surveys for all combined domains was determined for each student. This mean was compared with the student's 3-year cumulative grade point average (GPA). Students' clinical experiences for the year were essentially identical.
Results: No statistically significant correlation was identified between cumulative GPA and the PRE and POST clinical self-assessments or with the change between PRE and POST assessments based on the Pearson correlation test for each class separately or on the pooled data.
Conclusions: Published studies in allopathic medical education have shown that students with lower GPAs tend to rate their clinical performance higher in initial clinical performance self-assessment. Our results show that student academic performance was not correlated with clinical performance self-assessment. These findings may be due to the explicit description of successful clinical competency completion, the orientation students receive before the start of clinical training, and the continuous feedback received from clinical preceptors.
This study was performed to determine the relationship between undergraduate academic performance and total Medical College Admission Test score and academic performance in the podiatric medical program at Des Moines University. The allopathic and osteopathic medical professions have published educational research examining this relationship. To our knowledge, no such educational research has been published for podiatric medical education.
The undergraduate cumulative and science grade point averages and total Medical College Admission Test scores of four podiatric medical classes (2007–2010, N = 169) were compared with their academic performance in the first 2 years of podiatric medical school using pairwise Pearson product moment correlations and multiple regression analysis.
Significant low to moderate positive correlations were identified between undergraduate cumulative and science grade point averages and student academic performance in years 1 and 2 of podiatric medical school for each of the four classes (except one) and the pooled data. There was no significant correlation between Medical College Admission Test score and academic performance in years 1 and 2 (except one) and the pooled data.
These results identify undergraduate cumulative grade point average as the strongest cognitive admissions variable in predicting academic performance in the podiatric medicine program at Des Moines University, followed by undergraduate science grade point average. These results also suggest limitations of the total Medical College Admission Test score in predicting academic performance. Information from this study can be used in the admissions process and to monitor student progress. (J Am Podiatr Med Assoc 102(6): 446–450, 2012)
Background: Podiatric and osteopathic medical students at Des Moines University take the same basic science medical curriculum. The first course students complete is medical biochemistry. The final common course is the second-year medical pharmacology course. Attrition typically occurs between these academic offerings. We sought to compare admissions data, retention rates, and academic performance between these two groups of medical students for the classes of 2008 to 2011.
Methods: Average admission scores, performance scores for the biochemistry and medical pharmacology courses, and retention rates for the 2008 to 2011 classes were obtained from the registrar and enrollment offices. One-way analysis of variance was used to compare the scores of the two cohorts. Linear regression was used to identify changes across time.
Results: The DO students showed significantly better performance than the DPM students in matriculating overall and science grade point averages, total Medical College Admissions Test scores, retention rates, and the medical biochemistry course (P < .01). There was no difference in the performance of the student groups in the medical pharmacology course. The DPM student scores across the four classes increased for both academic courses, whereas the DO student scores remained at the same level for medical biochemistry, at a rate of 0.74% per year (R 2 = 0.50), and pharmacology, at a rate of 0.90% per year (R 2 = 0.49).
Conclusions: Admissions data and initial academic performance of osteopathic medical students were higher than those of podiatric medical students. Once attrition occurred in year 1, the difference in academic performance between these groups of students was no longer statistically significant, and students in both medical programs at that time in the curriculum are equally academically qualified. (J Am Podiatr Med Assoc 100(4): 276–280, 2010)
This study was performed to determine whether a relationship exists regarding academic achievement between years 1 and 2 of podiatric medical education at Des Moines University. Furthermore, this study evaluates the relationship between academic performance in the first 2 years and clinical performance in year 3.
The academic records of four classes (2007–2010, N = 164) were examined for grade point averages and clinical performance scores using pairwise Pearson product moment correlations.
Significant high correlations existed in academic performance scores between year 1 and year 2 for individual classes and pooled data. Significant low to moderate correlations were found between academic performance and clinical performance scores for individual classes and pooled data.
These results help define the relationship between student academic and clinical performance for podiatric medicine students at Des Moines University and suggest that nonacademic characteristics may play a pivotal role in clinical abilities. These characteristics need to be further identified and developed in the academic curriculum. There may be attributes identified that also benefit the admissions process. (J Am Podiatr Med Assoc 102(4): 314-318, 2012)
Background: This study was designed to compare the vitamin D levels in a cohort of nondiabetic patients to populations of diabetic patients with and without Charcot neuroarthropathy.
Methods: A total of 41 participants (22 male, 19 female) with a mean ± SD age of 59 ± 9.43 years had serum 25-hydroxyvitamin D levels tested. Fifteen participants composed the nondiabetic group; 13, the group with diabetes but without Charcot neuroarthropathy; and 13, the group with both diabetes and Charcot neuroarthropathy.
Results: The results of the study showed that the vitamin D levels in both diabetic populations were significantly lower (P < .05) than the nondiabetic population. There was no statistical difference between the group with diabetes but without Charcot foot disease and the group with both diabetes and Charcot neuroarthropathy.
Conclusions: Based on the results of this study, given the importance of vitamin D in bone metabolism and the osseous consequences associated with diabetes, as well as other systems affected by low levels of vitamin D in the diabetic patient, it appears that vitamin D levels should be monitored in diabetic patients. (J Am Podiatr Med Assoc 99(1): 35–41, 2009)
This prospective study was performed to compare calcaneal and lumbar bone mineral density (BMD) in individuals with and without diabetes mellitus. We compared bone density with the time from onset of Charcot’s neuroarthropathy (CN) in patients with unilateral, nonoperative, reconstructive-stage CN. The final purpose was to investigate the role that sex, age, and serum vitamin D level may have in osseous recovery.
Thirty-three individuals were divided into three groups: controls and patients with diabetes mellitus with and without CN. Peripheral instantaneous x-ray imaging and dual-energy x-ray absorptiometry were performed.
The calcaneal BMD of patients with diabetes mellitus and CN was lower than that of the control group (P < .01) but was not significantly lower than that of patients with diabetes mellitus alone. There was no statistically significant difference in lumbar T-scores between groups. Women demonstrated lower BMD than did men (P = .02), but patients 60 years and older did not demonstrate significantly lower BMD than did patients younger than 60 years (P = .135). A negative linear relationship was demonstrated between time and BMD in patients with CN.
The results of this study suggest that lumbar BMD does not reflect peripheral BMD in patients with diabetes mellitus and reconstructive-stage CN. This study has clinical implications when reconstructive osseous surgery is planned in patients with CN. (J Am Podiatr Med Assoc 102(3): 213–222, 2012)