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- Author or Editor: Ricardo Becerro de Bengoa Vallejo x
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Background
There is a high prevalence of musculoskeletal complaints related to day-to-day work among podiatric physicians. We sought to determine the relationships among musculoskeletal pain, job satisfaction, depression, and anxiety in Spanish podiatric physicians.
Methods
A convenience sample of 421 Spanish podiatric physicians was administered a survey that included questions about sociodemographic variables, musculoskeletal pain, job satisfaction, depression, and anxiety.
Results
On average, respondents were found to have a high level of pain, a moderate level of job satisfaction, and low-to-moderate levels of depression and anxiety. Young single women had the highest levels of pain and anxiety. Analysis with the Student t test indicated significant differences between the sexes for levels of pain (P < .0001) and anxiety (P < .014). Job satisfaction was inversely related to depression and anxiety.
Conclusions
These findings, particularly the increased levels of pain, job dissatisfaction, anxiety, and depression in young single female podiatrists, indicate a need for strategies to reduce the risks posed by the work environment in podiatric medicine, thus minimizing the negative psychological and physical consequences of participating in the profession.
A hamartoma is a benign, focal malformation resembling a neoplasm in its tissue of origin. This malady has not been reported to be manifested in the nail plate. Here, we describe a rare case of hamartoma under the nail plate of the first toe and its successful excision from a 30-year-old woman. We used palpation, radiologic analyses, excisional surgery, and histopathology to determine the presence of a hamartoma under the nail plate of the first toe. Removal of the mass was successful for the patient, and histopathologic analysis revealed characteristics of hamartoma. The presence of a hamartoma under the nail plate of the first toe is a unique finding that should be made aware to the clinical community.
Background:
Abnormal plantar pressures are the hallmark characteristic of several conditions and pathologic abnormalities. Pressure platforms allow for quick and accurate screening of patients and help guide clinical treatment. However, it is essential to evaluate the reliability and repeatability of these devices before making clinical decisions. The purpose of this study was to determine the reliability of the EPS-Platform during static and dynamic activities.
Methods:
Fifty-six healthy individuals stood and walked onto the pressure platform. Five trials were performed during two separate testing sessions to determine intrasession and intersession reliability. Pressure data were obtained and several variables of interest were calculated for intrasession and intersession reliability using intraclass correlation coefficients (ICCs), SEM, percent error, and coefficient of variation.
Results:
Static and dynamic intrasession and intersession reliability produced moderate-to-excellent ICCs, low SEMs, low percent errors, and low coefficients of variation. Static trials had higher ICCs, lower percent errors, and lower coefficients of variation compared with dynamic trials. Intersession reliability also had higher ICCs, lower percent errors, and lower coefficients of variation compared with intrasession reliability.
Conclusions:
This study demonstrates that the EPS-Platform is a reliable device for collecting gait plantar pressures. Static trials produce better reliability, most likely owing to the large inherent variability during dynamic gait. Intersession reliability was higher than intrasession reliability owing to the intersession measures being calculated with an average of five trials. By averaging the trials, the variability of gait is decreased, and this improves the accuracy of the results. These results can be used as the basis for future studies and to determine a priori sample sizes for investigations that use the EPS-Platform. (J Am Podiatr Med Assoc 103(3): 197–203, 2013)
Stress at the Second Metatarsal Bone After Correction of Hammertoe and Claw Toe Deformity
A Finite Element Analysis Using an Anatomical Model
Background:
We used finite element analysis to evaluate three techniques for the correction of hammertoe and claw toe deformities: flexor digitorum longus tendon transfer (FDLT), flexor digitorum brevis tendon transfer (FDBT), and proximal interphalangeal joint arthrodesis (PIPJA).
Methods:
We performed a finite element analysis of FDLT and FDBT compared with PIPJA of the second toe using multislice computed tomography and 93 tomographic images of the foot obtained in a healthy 36-year-old man.
Results:
The PIPJA showed a significantly higher increase in traction and compressive stresses and strain at the medial aspect of the shaft of the second metatarsal bone compared with FDLT or FDBT (P < .01). Mean ± SD compressive stresses increased to −4.35 ± 7.05 MPa compared with the nonsurgical foot (−3.10 ± 4.90 MPa). It can, therefore, be hypothesized that if PIPJA is used to correct the hammertoe and claw toe deformities, it could also increase traction and compressive stresses and strain in the metatarsals during running and other vigorous activities.
Conclusions:
There is a biomechanical advantage to performing FDLT or FDBT instead of PIPJA to surgically treat a hammertoe or claw toe deformity. In addition, tensile strain at the dorsal aspect of the second metatarsal bone when performing PIPJA increases the risk of metatarsalgia or stress fracture in patients at risk. (J Am Podiatr Med Assoc 103(4): 260–273, 2013)
In-toeing in Children with Type I Osteogenesis Imperfecta
An Observational Descriptive Study
Background: Osteogenesis imperfecta is an autosomal-dominant disorder of the connective tissue. Also known as brittle bone disease, it renders those affected susceptible to fractures after minimal trauma. Therefore, it is important to minimize the risk of falls and subsequent fractures in patients with this disease. In-toeing is a common condition in children that can result from various pathologic entities, including anteversion, internal tibial torsion, and metatarsus adductus. These conditions can result in frequent tripping and other functional problems.
Methods: A descriptive study was undertaken to determine the prevalence of in-toeing gait attributable to tibial or femoral torsion or metatarsus adductus in children with type I osteogenesis imperfecta. The study involved orthopedic and biomechanical examination of 15 children (9 girls and 6 boys) aged 4 to 9 years with confirmed type I osteogenesis imperfecta. Patients who used assistive ambulatory devices, such as canes, crutches, and wheelchairs, were excluded from the study.
Results: Of the 15 children studied, 12 (80%) demonstrated previously undiagnosed in-toeing gait attributable to torsional deformity or metatarsus adductus in all but one child.
Conclusions: Many children with confirmed type I osteogenesis imperfecta have in-toeing gait caused by torsional deformity or metatarsus adductus. Detection and control of in-toeing gait in children with osteogenesis imperfecta is important to prevent fractures resulting from trauma directly related to these conditions. (J Am Podiatr Med Assoc 99(4): 326–329, 2009)
Transposition of the flexor digitorum longus tendon has been widely reported for the correction of flexible claw and hammertoe deformities. The most common technique uses two cutaneous incisions, one plantar and another dorsal. We performed a cadaveric study to determine whether the flexor digitorum longus tendon could be transferred to the dorsum of the proximal phalanx of the toe from its lateral or medial aspect through a unique single longitudinal central dorsal incision. The rationale for this novel approach was to minimize the risk of vascular compromise to the digit associated with the two-incision approach. Transposition of the flexor digitorum longus tendon was attempted in 120 toes of cadaveric feet (60 each second and third digits) through a central longitudinal dorsal incision. The flexor digitorum longus tendon segment was long enough to be successfully transposed between the flexor digitorum brevis hemitendons of the second and third toes in 100% of the cases using the central longitudinal dorsal incision approach, with a resection arthroplasty at the proximal interphalangeal joint. Transfer of the flexor digitorum longus tendon to the dorsum of the proximal phalanx can be performed for the correction of claw and hammertoe deformities in the second and third digits. The meticulous longitudinal incision of the flexor tendon sheath to expose the flexor digitorum brevis tendon and its longitudinal incision are essential to the successful transfer of the flexor digitorum longus tendon between the flexor digitorum brevis hemitendons. (J Am Podiatr Med Assoc 103(5): 430–437, 2013)
Background:
Transposition of the flexor digitorum longus tendon has been widely reported for the correction of flexible claw and hammer toe deformities. Only transposition of the flexor digitorum brevis tendon has been reported in the literature in a cadaveric study that used the dorsal and plantar approach. A search of the literature revealed no reports of transposition of the flexor digitorum brevis tendon for treatment of these conditions through a unique dorsal cutaneous incision. We performed a cadaveric study to determine whether the flexor digitorum brevis tendon is long enough to be transferred to the dorsum of the proximal phalanx of the toe from its lateral or medial aspect through a unique dorsal cutaneous incision.
Methods:
Transposition of the flexor digitorum brevis tendon was attempted in 156 toes of cadaveric feet (52 each second, third, and fourth toes) through a unique dorsal incision.
Results:
The flexor digitorum brevis tendon was long enough to be successfully transposed in 100% of the second, third, and fourth toes by the dorsal incision approach.
Conclusions:
Transfer of the flexor digitorum brevis tendon to the dorsum of the proximal phalanx can be performed for the correction of claw and hammer toe deformities, especially in the second, third, and fourth toes. The meticulous longitudinal incision of the flexor tendon sheath to expose the flexor digitorum brevis tendon is essential to the success of the procedure. (J Am Podiatr Med Assoc 101(4): 297–306, 2011)
Background:
Transfer of the flexor digitorum longus tendon is one of the surgical techniques described to treat lesser toe deformities. A global analysis of the benefits of this procedure has not been presented in the literature to date. The aim of this meta-analysis was to evaluate the clinical benefit of transfer of the flexor digitorum longus tendon regarding patient satisfaction.
Methods:
A reviewer formally trained in meta-analysis abstraction techniques searched several databases to identify relevant published studies. Initially, 203 citations were identified and evaluated for relevance. Abstract screening produced 112 articles to be read in their entirety, of which 17 articles studying 515 procedures with a mean ± SD follow-up of 54.21 ± 20.64 months met all of the inclusion criteria necessary for analysis.
Results:
Overall crude patient satisfaction after flexor digitorum longus tendon transfer was 86.7% (95% confidence interval, 81.7%–90.5%). A low grade of heterogeneity across studies (Q = 24.458, I2 =34.583, P = .080) and no influence of the individual studies on overall estimation were found. When adjusting for higher-quality prospective studies, overall patient satisfaction increased to 91.8%, although it did not reach statistical significance. Additional a priori sources of heterogeneity (age, sex, studies with <3 years of follow-up, percentage of patients lost to follow-up, and year of publication) were evaluated by subgroup analysis and meta-regression, but no statistical significance was found. This adjustment also significantly decreased heterogeneity across studies (crude Q = 24.458, high-quality studies Q = 1.504).
Conclusions:
Regarding patient satisfaction, this comprehensive analysis provides supportive evidence of the clinical benefit of flexor digitorum longus tendon transfer. (J Am Podiatr Med Assoc 102(5): 359–368, 2012)
Background:
The first metatarsal bone is a viable source for autologous bone grafting in foot and ankle surgery and may serve as another convenient graft site to correct a flail toe deformity. We aimed to determine how progressive bone removal from the first metatarsal affects the mechanical redistribution of the foot and whether this bone removal increases the risk of fracture.
Methods:
A three-dimensional finite element model developed from computed tomographic images obtained from a healthy man were used to evaluate traction stresses on the first metatarsal bone as a function of applied loads on the talus and Achilles tendon at two phases of the gait cycle (and according to the depth of bone removal).
Results:
Simulations indicated that when maximum load was applied to the Achilles tendon, tensile stress increased from 2.049 MPa in the intact foot to 5.941 MPa in the area of maximum bone harvest during the stance phase. Furthermore, as the volume of bone extracted from the first metatarsal increased, there was a redistribution of stress that differed significantly from that of the intact foot.
Conclusions:
Although the maximum stress on the first metatarsal was not significantly affected by increasing the volume of bone harvested, the ankle should be splinted in plantarflexion during the postoperative period to eliminate the stance phase of gait and reduce the risk of metatarsal fracture.
