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Infection with the human immunodeficiency virus (HIV) leads to a chronic disarmament of the immune system. The process is progressive, having different manifestations as the status of the immune system slowly deteriorates. Some of the most common manifestations of HIV infection are cutaneous in origin, and they can have infectious, neoplastic, or noninfectious or non-neoplastic etiologies. A brief history of HIV is given, and the most common cutaneous presentations of the virus infection of interest to podiatrists are outlined.
This case study presents a novel technique of end-to-end implantation of cadaver graft for the repair of a complete transversely torn peroneus brevis tendon and partially torn peroneus longus tendon in a 58-year-old woman with chronic lateral ankle instability and associated lateral collateral tears. She had a history of multiple ankle sprains and had previously undergone a failed peroneus brevis tendon retubularization procedure. The use of cadaver graft is well documented in the literature for tendon repairs but not well documented in end-to-end repair of the peroneal tendons. A review of the literature revealed only one 2013 study reporting on the benefits and clinical outcomes of cadaver allograft use in peroneal reconstruction.
Foot Arch Characterization
A Review, a New Metric, and a Comparison
Background: The medial longitudinal arch of the foot is important because it helps protect the foot from injury. Researchers have developed many measures to quantify the characteristics of the arch, and there is ongoing debate about the suitability of these different metrics. This article compares the various measures related to the foot arch, including a new metric, the midfoot dorsal angle, and then investigates the differences in the dimensional measures among various foot types.
Methods: The right feet of 48 healthy individuals (24 men and 24 women) were measured, and various metrics, including the arch height index, the navicular height to arch length ratio, the arch index, the footprint index, the subjective ranking, the modified arch index, the malleolar valgus index, and the midfoot dorsal angle, were determined.
Results: Correlation analyses showed that the arch index obtained from the inked footprint has a moderate to high correlation (Pearson correlation coefficients >0.50) with all measured foot-type metrics except for the malleolar valgus index. There were no differences in participant age, stature, weight, body mass index, foot length, foot width, and midfoot height among high, normal, and low foot arches. However, the high-arched group had significantly shorter arch lengths but larger navicular heights and higher midfoot dorsal angles compared with the low-arched group. There were differences in force distributions and peak pressures as well. The rearfoot had more loading and greater peak pressure whereas the midfoot had less load in the high-arched group compared with the low-arched group.
Conclusions: The midfoot dorsal angle may be an appropriate metric for characterizing the foot arch because it is quick and easy to measure, without the tedious procedures associated with area calculations and dimension measurements. (J Am Podiatr Med Assoc 100(1): 14–24, 2010)
Hyperbaric oxygen therapy (HBOT) is a useful tool for many conditions within the scope of practice of a Doctor of Podiatric Medicine (DPM). More wound-care clinics are adding HBOT as a service line. The increasing prevalence of DPMs operating inside of these wound-care clinics has raised questions about the licensure and privileging of DPMs to supervise HBOT. This document reviews the safety of outpatient HBOT and provides guidelines for hospitals to credential DPMs to supervise treatments.
Background
Hallux valgus is a progressive foot deformity that commonly affects middle-aged women. The aim of this study was to develop a novel method using only top-view photographs to assess hallux valgus severity.
Methods
A top-view digital photograph was taken of each foot of 70 female participants. Two straight lines were drawn along the medial edge of the great toe and forefoot, and the included angle (termed bunion angle) was measured using a free software program. Each foot was also assessed by a clinician using the Manchester scale as no (grade 1), mild (grade 2), moderate (grade 3), or severe (grade 4) deformity.
Results
The mean bunion angles of the 140 feet were 6.7°, 13.5°, and 16.2° for Manchester grades 1, 2, and 3, respectively (no foot was in grade 4). The reliability was excellent for both intrarater (intraclass correlation coefficient [ICC] = 0.93–0.95) and interrater (ICC = 0.90) assessments. Receiver operating characteristic curves determined the optimal bunion angle cutoff value for screening hallux valgus to be 9°, which gives 89.2% sensitivity and 74.2% specificity.
Conclusions
The bunion angle is a reliable, clinician-free method that can potentially be integrated into a smartphone app for easy and inexpensive self-assessment of hallux valgus.
