Background: Specific kinematic and kinetic outcomes have been used to detect biomechanical change while wearing foot orthoses; however, few studies demonstrate consistent effects. We sought to observe changes in walking economy in patients with musculoskeletal pain across 10 weeks while wearing custom-made foot orthoses and prefabricated shoe inserts.
Methods: In this crossover randomized controlled trial, 40 participants wore custom-made orthoses and prefabricated inserts for 4 weeks each, consecutively. The path length ratio was used to quantify walking economy by comparing the undulating path of a point in the pelvis with its direct path averaged across multiple strides.
Results: For the prefab-custom group (n = 27), significant decreases in path length ratio (improved economy of gait) were noted at the initial introduction of prefabricated inserts (P = .02) and custom orthoses (P = .02) but maintained a trend toward improved economy only while wearing custom orthoses (P = .08). For the custom-prefab group (n = 13), there was worsening of the path length ratio that was significant after removing the custom-made orthoses for 4 weeks (P = .01).
Conclusion: For patients with lower-extremity musculoskeletal pain, immediate improvements in economy of gait can be expected with both interventions. It seems, however, that only the custom-made orthoses maintain economy of gait for 4 weeks. Patients who begin wearing custom-made orthoses and then wear prefabricated insoles can expect a decrease in economy of gait. (J Am Podiatr Med Assoc 98(6): 429–435, 2008)
As of 2016, Medicaid accounted for nearly 20% of state general fund budgets. Optional Medicaid services like podiatry are often subject to cost-cutting measures in periods of economic downturn, as was the case in the wake of the 2007 financial crisis. Although the cuts were intended as a cost-saving measure, research indicates they had the opposite effect. The restriction and limitation of these services during the Great Recession resulted in both poorer health outcomes for beneficiaries, and poorer financial outcomes for state Medicaid programs. With states citing record levels of unemployment as of April 2020 and projecting significant declines in annual revenue in 2021, the economic conditions resulting from the COVID-19 pandemic are likely to rival those of the Great Recession. Given the historical precedent for restricting or eliminating optional Medicaid services as a cost-saving measure, it is likely that podiatric services will once again come under scrutiny. Previous efforts by state-level podiatric societies have proven successful in lobbying for the reinstatement of coverage under Medicaid by conveying evidence of the negative outcomes associated with elimination to stakeholders. The specialty must once again engage policymakers by drawing on evidence gleaned and lessons learned from past cuts of optional Medicaid services to avert counterproductive coverage restrictions intended to mitigate the financial impact of the COVID-19 pandemic.
This article presents a new nail block technique that constitutes an alternative local block for procedures involving the hallux nail and nail fold. It has significant advantages in terms of simplicity, effectiveness, safety, and economy over the traditional hallux block in selected procedures. (J Am Podiatr Med Assoc 95(6): 589–592, 2005)
The health care academic delivery system is dramatically changing in today's economy. In order to survive, the delivery system must decrease its costs and increase productivity. Integration of academic affiliates and community health care facilities has produced a more efficient health care system and improved medical education. The formation and methodology of the mutual benefits and responsibilities between a health care system and a college of podiatric medicine are examined in detail. Developing unique sharing partnerships can mutually improve medical student experiences, reduce financial burdens, combine joint research projects, and ultimately improve patient care.
Understanding the dynamic function of the rearfoot is necessary for recognizing and treating several types of mechanical foot dysfunction. Although the motion of the rearfoot is often measured during treadmill locomotion, the effect of different types of treadmills on the motion of the foot is unclear. In this study, the kinematics of the right subtalar joint in 24 volunteers walking at three speeds on two motorized treadmills were examined. The two treadmills (a wide width and a soft surface versus a narrow width and a hard surface) were selected to maximize motion differences. Maximal change in angular position (positive: supination; negative: pronation) about each volunteer’s subtalar joint axis was estimated during three gait phases: weight acceptance, midstance, and push-off. A factorial, repeated-measures analysis of variance determined that the treadmill design had a significant effect on subtalar joint position (F = 5.423; P = .029), albeit with moderate power (0.61). Descriptively, collapsed over all speeds, the subject’s feet on the narrow/hard compared with the wide/soft treadmill showed more pronation (0.44°), less pronation (0.46°), and more supination (1.44°) during weight acceptance, midstance, and push-off, respectively. We conclude that treadmill design can affect an individual’s rearfoot kinematics. (J Am Podiatr Med Assoc 95(5): 475–480, 2005)
In 2002, the American Podiatric Medical Association initiated a “walking city competition.” The objective of the study was to identify the best cities for walking in the United States. (J Am Podiatr Med Assoc 93(2): 161-163, 2003)