Background:
Ingrown nail is a common health problem that significantly affects daily life due to its painful nature. The purpose of this study was to reveal the clinical and sociodemographic characteristics of ingrown nails.
Methods:
The clinical and sociodemographic characteristics of patients older than 18 years presenting with ingrown nail were investigated.
Results:
Two hundred six patients aged 18 to 77 years (mean age, 39 years; female to male ratio, 1.45) were included in the study. A total of 729 lesions were evaluated (718 ingrown nails were on the feet and 11 were on the fingers). A family history of ingrown nail was present in 7.6% of the participants. Of the 206 patients, 26.7% were treated with surgical methods for ingrown nails previously and experienced recurrence. Ingrown toenails were in the hallux in 81.3% of patients, and 52% were on the lateral margin. Incorrect nail-cutting habits (73.5%), poorly fitting shoes (46.2%), excessive angulation of the nail plate (35.8%), obesity (34.1%), trauma to the feet (24.3%), pregnancy (23.8% of women), hyperhidrosis (16.8%), and lateral deviation of the nail plate (9.9%) were closely associated with ingrown nails.
Conclusions:
This study revealed the clinical and sociodemographic characteristics of ingrown nails. The study data will be useful in preventing the development of ingrown nail and recurrences after treatment by identifying and then eliminating conditions establishing a predisposition to it.
Background:
Cole osteotomy is performed in patients having a cavus deformity with the apex of the deformity in the midfoot. Correction of the deformity at this midfoot level improves foot and ankle stability by creating a plantigrade foot. We retrospectively reviewed the clinical and radiographic results of six feet (five patients) that underwent Cole midfoot osteotomy (2011–2015).
Methods:
The patients had different etiologies (spastic cerebral palsy, burn sequelae, spina bifida, and Charcot-Marie-Tooth disease). Dorsal and slightly laterally based transverse wedge osteotomy through the navicular bone medially and the cuboid bone laterally was performed. Patients were under routine clinical follow-up. We evaluated clinical and radiographic results.
Results:
Mean clinical follow-up was 15.7 months (range, 6–36 months). The mean preoperative and postoperative talo–first metatarsal angles on lateral radiographs were 29.9° and 8.7°, respectively (P < .05) and on anteroposterior radiographs were 30.3° and 8.6° (P < .05). The mean preoperative talocalcaneal angle on anteroposterior radiographs increased from 19.2° to 29.8° postoperatively (P < .05). The mean postoperative calcaneal pitch angle change was 10.8° on the lateral radiograph (P < .05). At final follow-up, all five patients were independently active, had plantigrade feet, and were able to wear conventional shoes. The mean American Orthopaedic Foot and Ankle Society questionnaire score was 38.8 preoperatively and 79.5 postoperatively (P < .05). Only one patient did not have full bony union. Achilles tightness was seen in one patient.
Conclusions:
Cole midfoot osteotomy is a laboring procedure to correct adult pes cavus deformity with the apex in midfoot, although having some complication risks.
Background:
Precision in minimal-incision surgery allows surgeons to achieve accurate osteotomies and patients to avoid risks. Herein, a surgical guide for the foot is designed and validated in vitro using resin foot models for hallux abducto valgus surgery.
Methods:
Three individuals with different experience levels (an undergraduate student, a master's student, and an experienced podiatric physician) performed an Akin osteotomy, a Reverdin osteotomy, and a basal osteotomy of the first metatarsal.
Results:
The average measurements of each osteotomy and the angle of the basal osteotomy do not reveal significant differences among the three surgeons. A shorter deviation from the planned measurements has been observed in variables corresponding to the Akin osteotomy (the maximum deviation in the measurement of the distance from the proximal medial end of the Akin osteotomy to the first metatarsophalangeal joint interline was 1.67 mm, and the maximum deviation from the proximal lateral end of the Akin osteotomy to the first metatarsophalangeal joint interline was 1.00 mm). As for the Reverdin osteotomies, the maximum deviations in the measurement of the distance from the proximal medial end of the osteotomy to the first metatarsophalangeal joint interline were 3.60 and 3.53 mm in the expert and undergraduate surgeons, respectively. All of the osteotomies were precise among the groups, reducing the learning curve to the maximum.
Conclusions:
The three-dimensional–printed prototype has been proven effective in guiding surgeons to perform different types of osteotomies. Minimal deviations from the predefined osteotomies were found among the three surgeons.
Background:
The purpose of this study was to determine feasibility of further investigation of treatment with instrument-assisted soft-tissue mobilization (IASTM), using the Graston technique, compared with conservative care for treatment of chronic plantar heel pain (CPHP).
Methods:
Eleven participants with plantar heel pain lasting 6 weeks to 1 year were randomly assigned to one of two groups, with each group receiving up to eight physical therapy visits. Both groups received the same stretching, exercise, and home program, but the experimental group also received IASTM using the Graston technique. Outcome measures of pain and function were recorded at baseline, after final treatment, and 90 days later. Feasibility of a larger study was determined considering recruitment and retention rates, compliance, successful application of the protocol and estimates of the treatment effect.
Results:
Both groups demonstrated improvements in current pain (pain at time of survey), pain with the first step in the morning, and function after final treatment and at 90-day follow up. Medium-to-large effect sizes between groups were noted, and sample size estimates demonstrated a need for at least 42 participants to realize a group difference. A larger-scale study was determined to be feasible with modifications including a larger sample size and higher recruitment rate.
Conclusions:
This pilot study demonstrates that inclusion of IASTM using the Graston technique for CPHP lasting longer than 6 weeks is a feasible intervention warranting further study. Clinically important changes in the IASTM group and moderate-to-large between-group effect sizes suggest that further research is warranted to determine whether these trends are meaningful.
Background:
The quality of national society conferences is often assessed indirectly by analyzing the journal publication rates for the abstracts presented. Studies have reported rates from 67.5% to 76.7% for oral abstracts and 23.2% to 55.8% for poster abstracts presented at national foot and ankle society conferences. However, no study has evaluated the abstract to journal publication rate for the American Podiatric Medical Association's (APMA's) annual conference.
Methods:
All presented abstracts from the 2010 to 2014 conferences were compiled. PubMed and Google Scholar searches were performed, and the number of abstracts presented, publication rate, mean time to publication, and most common journals of publication were determined. These results were then compared with those for the 2010 to 2014 American College of Foot and Ankle Surgeons' conferences.
Results:
Of 380 abstracts presented, 142 (37.4%) achieved publication, most often in the Journal of the American Podiatric Medical Association. The oral abstract publication rate was 45.2% (14 of 31), with a mean time to publication of 24.2 months (range, 0–47 months). The poster publication rate was 36.7% (128 of 349), with a mean time to publication of 16.3 months (range, 0–56 months). Significant differences were identified between the two societies.
Conclusions:
The overall abstract to journal publication rate for the 2010 to 2014 APMA conferences was 37.4%, and, expectedly, oral abstracts achieved publication more often than posters. Moving forward, a concerted effort between competing societies seems necessary to increase research interest, institutional support, and formal mentorship for future generations of foot and ankle specialists.
Background:
Arch height is an important indicator of risk of foot pathology. The current non-invasive gold standard based on footprint information requires extensive pre-processing. Methods used to obtain arch height that are accurate and easier to use are required in routine clinical practice.
Methods:
The proposed arch index diagonals (AId) method for determining the arch index (AI) reduces the complexity of the preprocessing steps. All footprints were first prepared as required by the Cavanagh and Rodgers method for determining the AI and then compared to the proposed diagonals method. Results were classified according to the Cavanagh and Rodgers cut-off values into three groups of low, normal and high AI. ANOVA and Tukey's post hoc tests were applied to identify significant differences between AI groups. Linear modeling was applied to determine the fit of the new AId method compared to the Cavanagh and Rodgers AI.
Results:
One hundred and ninety-six footprints were analyzed. The ANOVA indicated significant differences between the groups for AId (F1,194=94.49, p<0.0001) and the Tukey post hoc tests indicated significant differences between the pair-wise comparisons (p<0.001). Linear modeling indicated that the AId ratio classified more footprints in the high arch group compared to Cavanagh and Rodgers results (R2=32%, p< 0.01). Intra- and inter-rater correspondence was above 90% and confirmed that the AId results provided a better indication of arch height.
Conclusions:
The proposed method simplifies current processing steps to derive the arch height.
Background:
Efforts made to protect the dorsal aspect of the foot are currently unknown. We sought to determine whether beachgoers protect the dorsal aspect of their feet as frequently as other anatomic sites.
Methods:
A convenience sample of Galveston, Texas, beachgoers completed anonymous surveys to assess whether the dorsal foot was at risk for ultraviolet radiation (UV-R) injury. Additional information collected included demographics and general knowledge about skin cancer to determine if these variables were significantly correlated with dorsal foot protection from UV-R injury.
Results:
Of 216 respondents, only 103 used a topical UV-R barrier on their dorsal feet, while 183 applied sunscreen to the body and 133 applied sunscreen to the legs. Eighty-seven of 113 nonusers explained, “I did not think about it.” The average number of applications of sunscreen per person to the dorsal feet was less than other anatomical body sites (1.19 body applications, 0.86 leg applications, and 0.58 dorsal feet applications per person; P < .001). 58.0% of females applied sunscreen to the dorsal feet compared with only 36.5% of males (P = .001). Self-identifying Fitzpatrick skin type 5 or 6 individuals did not apply sunscreen to the dorsal foot as regularly as individuals with types 1 to 4 (84.6% versus 47.6%; P = .0001).
Conclusions:
Current skin cancer epidemiology pairs the feet and the legs together as “lower extremity.” For epidemiologic purposes, however, feet and legs should be considered distinct areas in UV-R research because they may use different photoprotection strategies.
Background:
Accurate representation of the insole geometry is crucial for the development and performance evaluation of foot orthoses designed to redistribute plantar pressure, especially for diabetic patients.
Methods:
Considering the limitations in the type of equipment and space available in clinical practices, this study adopted a simple portable three-dimensional (3-D) desktop scanner to evaluate the 3-D geometry of an orthotic insole and the corresponding deformities after the insole has been worn. The shape of the insole structure along horizontal cross sections is defined with 3-D scanning and image processing. Accompanied by an in-shoe pressure measurement system, plantar pressure distribution in four foot regions (hallux, metatarsal heads, midfoot, and heel) is analyzed and evaluated for insole deformity.
Results:
Insole deformities are quantified across the four foot regions. The hallux region tends to show the greatest changes in shape geometry (17%–50%) compared with the other foot regions after 2 months of insole wear. As a result of insole deformities, plantar peak pressures change considerably (–4.3% to +69.5%) during the course of treatment.
Conclusions:
Changes in shape geometry of the insoles could be objectively quantified with 3-D scanning techniques and image processing. This investigation finds that, in general, the design of orthotic insoles may not be adequate for diabetic individuals with similar foot problems. The drastic changes in the insole shape geometry and cross-sectional areas during orthotic treatment may reduce insole fit and conformity. An inadequate insole design may also affect plantar pressure reduction. The approach proposed herein, therefore, allows for objective quantification of insole shape geometry, which results in effective and optimal orthotic treatment.
Background:
Increasing amounts of diabetes-focused content is being posted to YouTube with little regulation as to the quality of the content. Diabetic education has been shown to reduce the risk of ulceration and amputation. YouTube is a frequently visited site for instructional and demonstrational videos posted by individuals, advertisers, companies, and health-care organizations. We sought to evaluate the usefulness of diabetic foot care video information on YouTube.
Methods:
YouTube was queried using the keyword phrase diabetic foot care. Original videos in English, with audio, less than 10 min long within the first 100 video results were evaluated. Two reviewers classified each video as useful or nonuseful/misleading. A 14-point usefulness criteria checklist was used to further categorize videos as most useful, somewhat useful, or nonuseful/misleading. Video sources were categorized by user type, and additional video metrics were collected.
Results:
Of 87 included videos, 56 (64.4%), were classified as useful and 31 (35.6%) as nonuseful/misleading. A significant difference in the mean length of useful videos vs nonuseful/misleading videos was observed (3.33 versus 1.73 min; P < .0001). There was no significant difference in terms of popularity metrics (likes, views, subscriptions, etc) between useful and nonuseful/misleading videos.
Conclusions:
This study demonstrates that although most diabetic foot care videos on YouTube are useful, many are still nonuseful/misleading. More concerning is the lack of difference in popularity between useful and nonuseful videos. Podiatric physicians should alert patients to possibly misleading information and offer a curated list of videos.
Background:
Plantar fasciitis is one of the most common clinical presentations seen by podiatric clinicians today. With corticosteroid injection being a classic treatment modality and extracorporeal pulse-activated therapy (EPAT) technology improving, the purpose of this study was to retrospectively compare pain and functional outcomes of patients with plantar fasciitis treated with either injection or EPAT.
Methods:
Between November 1, 2014, and April 30, 2016, 60 patients who met the inclusion criteria were treated with either corticosteroid injection or EPAT. Patients were evaluated with both the visual analog scale (VAS) and the American Orthopaedic Foot & Ankle Society Hindfoot Score at each visit.
Results:
The EPAT was found to reduce pain on the VAS by a mean of 1.98 points, whereas corticosteroid injection reduced pain by a mean of 0.94 points. This was a significant reduction in the VAS score for EPAT compared with corticosteroid injection (P = .035).
Conclusions:
Extracorporeal pulse-activated therapy is as effective as corticosteroid injection, if not more so, for the treatment of recalcitrant plantar fasciitis and should be considered earlier in the treatment course of plantar fasciitis.
