Journal of the American Podiatric Medical Association

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Acceptance Address APMA House of Delegates Washington, DC. March 21, 2010. “One Vision, One Voice”

by Kathleen M. Stone

J. Am. Podiatr. Med. Assoc. 2010, 100(3), 232-234; https://doi.org/10.7547/1000232 - 1 May 2010

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I am both humbled and excited to stand before you today and accept this most auspicious position as your President of the American Podiatric Medical Association [...] Full article

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Open AccessArticle

Letter to the Editor. Poor Sitting Posture and Metatarsus Adductus Deformity

by Cylie Williams and Alicia James

J. Am. Podiatr. Med. Assoc. 2010, 100(3), 231; https://doi.org/10.7547/1000231 - 1 May 2010

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To the Editor [...] Full article

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Functional Hallux Limitus or Rigidus Caused by a Tenodesis Effect at the Retrotalar Pulley. Description of the Functional Stretch Test and the Simple Hoover Cord Maneuver That Releases This Tenodesis

by Jacques Vallotton, Santiago Echeverri and Vinciane Dobbelaere-Nicolas

J. Am. Podiatr. Med. Assoc. 2010, 100(3), 220-229; https://doi.org/10.7547/1000220 - 1 May 2010

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Abstract

Functional hallux limitus is a loss of metatarsophalangeal joint extension during the second half of the single-support phase, when the weightbearing foot is in maximal dorsiflexion. Functionally, it constitutes a sagittal plane blockade during gait. As a result, the mechanical support and stability [...] Read more.

Functional hallux limitus is a loss of metatarsophalangeal joint extension during the second half of the single-support phase, when the weightbearing foot is in maximal dorsiflexion. Functionally, it constitutes a sagittal plane blockade during gait. As a result, the mechanical support and stability mechanisms of the foot are disrupted, with important consequences during gait. Functional hallux limitus is a frequent, though relatively unknown condition that clinicians may overlook when examining patients with complaints that are not limited to their feet, for they can also present other symptoms such as hip, knee and lower-back pain. The purpose of this article is to present a critical review of the literature on functional hallux limitus and to explain a previously described and simple diagnostic test (flexor hallucis longus stretch test) and a physiotherapeutic manipulation (the Hoover cord maneuver) that recovers the dorsiflexion of the hallux releasing the tenodesis effect at the retrotalar pulley, which according to our clinical experience is the main cause of functional hallux limitus. The latter, to the best of our knowledge, has never been described before. Full article

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Synovial Sarcoma of the Foot. A Case Report

by Roger Racz, Ronald Belczyk, Ronald P. Williams, Martin P. Fernandez and Thomas Zgonis

J. Am. Podiatr. Med. Assoc. 2010, 100(3), 216-219; https://doi.org/10.7547/1000216 - 1 May 2010

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Abstract

We report a case of a 40-year-old woman with synovial sarcoma who presented with neural symptoms in the medial aspect of the right foot and ankle. The radiographic appearance of the foot and ankle was unremarkable, but magnetic resonance imaging showed a relatively [...] Read more.

We report a case of a 40-year-old woman with synovial sarcoma who presented with neural symptoms in the medial aspect of the right foot and ankle. The radiographic appearance of the foot and ankle was unremarkable, but magnetic resonance imaging showed a relatively well-defined enhancing lesion in the plantar soft tissues extending from the master knot of Henry to the posterior tibialis tendon. After orthopedic oncologic evaluation and workup, the patient was ultimately treated with a transtibial amputation, and no evidence of recurrence or metastatic disease was seen at 6-month follow-up. Full article

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Open AccessArticle

Painful Os Intermetatarseum

by Kevin M. Smith and Matt B. Welch

J. Am. Podiatr. Med. Assoc. 2010, 100(3), 213-215; https://doi.org/10.7547/1000213 - 1 May 2010

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Abstract

Accessory ossicles are usually benign radiographic findings. However, they may become clinically significant if they fracture or cause soft-tissue irritation. An os intermetatarseum is an uncommon ossicle found between the bases of the first and second metatarsals. This article reviews some of the [...] Read more.

Accessory ossicles are usually benign radiographic findings. However, they may become clinically significant if they fracture or cause soft-tissue irritation. An os intermetatarseum is an uncommon ossicle found between the bases of the first and second metatarsals. This article reviews some of the theories relating to the development of this uncommon ossicle and describes its role as a possible etiology of metatarsus primus varus. Full article

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Tarsal Tunnel Syndrome Associated with a Pulsating Artery. Effectiveness of High-Resolution Ultrasound in Diagnosing Tarsal Tunnel Syndrome

by Eunkuk Kim 1 and Martin K. Childers

J. Am. Podiatr. Med. Assoc. 2010, 100(3), 209-212; https://doi.org/10.7547/1000209 - 1 May 2010

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Abstract

We describe a patient with tarsal tunnel syndrome in whom ultrasound imaging revealed compression of the posterior tibial nerve by a pulsating artery. High-resolution ultrasound showed a round pulsating hypoechoic lesion in contact with the posterior tibial nerve. Ultrasound-guided injection of 0.5% lidocaine [...] Read more.

We describe a patient with tarsal tunnel syndrome in whom ultrasound imaging revealed compression of the posterior tibial nerve by a pulsating artery. High-resolution ultrasound showed a round pulsating hypoechoic lesion in contact with the posterior tibial nerve. Ultrasound-guided injection of 0.5% lidocaine temporarily resolved the paresthesia. These findings suggest an arterial etiology of tarsal tunnel syndrome. Full article

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Hallux Valgus Correction in a Patient with Metatarsus Adductus with Multiple Distal Oblique Osteotomies

by Nicolò Martinelli, Andrea Marinozzi, Francesco Cancilleri and Vincenzo Denaro

J. Am. Podiatr. Med. Assoc. 2010, 100(3), 204-208; https://doi.org/10.7547/1000204 - 1 May 2010

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Abstract

Metatarsus adductus is a structural foot deformity that is rarely associated with hallux valgus deformity. Surgical treatment is challenging, and multiple osteotomies are often required to correct both deformities. However, surgical impact must be considered, especially in elderly patients. We present a clinical [...] Read more.

Metatarsus adductus is a structural foot deformity that is rarely associated with hallux valgus deformity. Surgical treatment is challenging, and multiple osteotomies are often required to correct both deformities. However, surgical impact must be considered, especially in elderly patients. We present a clinical case of a 76-year-old woman affected by hallux valgus and metatarsus adductus deformity. Multiple distal oblique osteotomies were performed on the first, second, and third metatarsals, coupled with Z-lengthening of the extensor digitorum longus tendons. Full article

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Static Ankle Joint Equinus. Toward a Standard Definition and Diagnosis

by James Charles, Sheila D. Scutter and Jonathan Buckley

J. Am. Podiatr. Med. Assoc. 2010, 100(3), 195-203; https://doi.org/10.7547/1000195 - 1 May 2010

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Equinus is characterized by reduced dorsiflexion of the ankle joint, but there is a lack of consensus regarding criteria for definition and diagnosis. This review examines the literature relating to the definition, assessment, diagnosis, prevalence, and complications of equinus. Articles on equinus and [...] Read more.

Equinus is characterized by reduced dorsiflexion of the ankle joint, but there is a lack of consensus regarding criteria for definition and diagnosis. This review examines the literature relating to the definition, assessment, diagnosis, prevalence, and complications of equinus. Articles on equinus and assessment of ankle joint range of motion were identified by searching the EMBASE, Medline, PubMed, EBSCOhost, Cinahl, and Cochrane databases and by examining the reference lists of the articles found. There is inconsistency regarding the magnitude of reduction in dorsiflexion required to constitute a diagnosis of equinus and no standard method for assessment; hence, the prevalence of equinus is unknown. Goniometric assessment of ankle joint range of motion was shown to be unreliable, whereas purpose-built tools demonstrated good reliability. Reduced dorsiflexion is associated with alterations in gait, increased forefoot pressure, and ankle injury, the magnitude of reduction in range of motion required to predispose to foot or lower-limb abnormalities is not known. In the absence of definitive data, we propose a two-stage definition of equinus: the first stage would reflect dorsiflexion of less than 10° with minor compensation and a minor increase in forefoot pressure, and the second stage would reflect dorsiflexion of less than 5° with major compensation and a major increase in forefoot pressure. This proposed definition of equinus will assist with standardizing the diagnosis and will provide a basis for future studies of the prevalence, causes, and complications of this condition. Full article

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Osteochondral Lesions of the Talus. Comparison of Three-Dimensional Fat-Suppressed Fast Spoiled Gradient-Echo Magnetic Resonance Imaging and Conventional Magnetic Resonance Imaging

by Da-Peng Hao, Jian-Zhong Zhang, Zhen-Chang Wang, Wen-Jian Xu, Ji-Hua Liu and Ben-Tao Yang

J. Am. Podiatr. Med. Assoc. 2010, 100(3), 189-194; https://doi.org/10.7547/1000189 - 1 May 2010

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Abstract

Background: Conventional magnetic resonance imaging (MRI) has been demonstrated to be a valuable tool in diagnosing osteochondral lesions of the talus. No previous study, to our knowledge, has evaluated the diagnostic ability of fat-suppressed fast spoiled gradient-echo (FSPGR) MRI in osteochondral lesions of [...] Read more.

Background: Conventional magnetic resonance imaging (MRI) has been demonstrated to be a valuable tool in diagnosing osteochondral lesions of the talus. No previous study, to our knowledge, has evaluated the diagnostic ability of fat-suppressed fast spoiled gradient-echo (FSPGR) MRI in osteochondral lesions of the talus. We sought to compare three-dimensional fat-suppressed FSPGR MRI with conventional MRI in diagnosing osteochondral lesions of the talus. Methods: Thirty-two consecutive patients with clinically suspected cartilage lesions undergoing three-dimensional fat-suppressed FSPGR MRI and conventional MRI were assessed. Sensitivity, specificity, and accuracy of diagnosis were determined using arthroscopic findings as the standard of reference for the different imaging techniques. The location of the lesion on the talar dome was recorded on a nine-zone anatomical grid on MRIs. Results: Arthroscopy revealed 21 patients with hyaline cartilage defects and 11 with normal ankle joints. The sensitivity, specificity, and accuracy of the two methods for detecting articular cartilage defect were 62%, 100%, and 75%, respectively, for conventional MRI and 91%, 100%, and 94% for three-dimensional fat-suppressed FSPGR MRI. Sensitivity and accuracy were significantly higher for FSPGR imaging than for conventional MRI (P < .05), but there was no difference in specificity between these two methods. According to the nine-zone anatomical grid, the area most frequently involved was the middle of the medial talar dome (16 lesions, 76%). Conclusions: T1-weighted three-dimensional fat-suppressed FSPGR MRI is more sensitive than is conventional MRI in detecting defects of articular cartilage covering osteochondral lesions of the talus. (J Am Podiatr Med Assoc 100(3): 189-194, 2010) Full article

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Strength of Braided Polyblend Polyethylene Sutures versus Braided Polyester Sutures in Achilles Tendon Repair. A Cadaveric Study

by Keith D. Cook, Greg Clark, Eric Lui, Gaurav Vajaria and George F. Wallace

J. Am. Podiatr. Med. Assoc. 2010, 100(3), 185-188; https://doi.org/10.7547/1000185 - 1 May 2010

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Background: Various techniques may be used to repair Achilles tendon ruptures; however, we contend that using the strongest suture with the least amount of suture material is ideal. Methods: To compare the strength of 2-0 FiberLoop (Arthrex Inc, Naples, Florida) and #2 Ethibond [...] Read more.

Background: Various techniques may be used to repair Achilles tendon ruptures; however, we contend that using the strongest suture with the least amount of suture material is ideal. Methods: To compare the strength of 2-0 FiberLoop (Arthrex Inc, Naples, Florida) and #2 Ethibond (Ethicon Inc, Somerville, New Jersey) suture materials in Achilles tendon repairs, 12 Achilles tendons were harvested from cadavers aged 18 to 62 years (median age, 42 years). The tendons were transected and repaired using a modified Krackow suture technique. All of the right limbs were repaired with 2-0 FiberLoop, and the contralateral side was repaired with #2 Ethibond. The specimens were mounted to a materials testing system, and the repairs were pulled to failure in an anatomical direction. Results: The mean ± SD yield loads of 2-0 FiberLoop and #2 Ethibond were 233 ± 48 N and 134 ± 34 N, respectively (P = .002). The mean ± SD ultimate load of 2-0 FiberLoop was 282 ± 58 N, and that of #2 Ethibond was 135 ± 33 N (P < .001). The cross-sectional area of one pass of 2-0 FiberLoop was calculated to be 0.21 mm², and one pass of #2 Ethibond was 0.28 mm². Conclusions: The smaller-caliber 2-0 FiberLoop was significantly stronger than #2 Ethibond. This study suggests that there is no advantage to using the traditional larger suture material for Achilles tendon repairs; however, further clinical testing is needed to determine the optimal repair technique. (J Am Podiatr Med Assoc 100(3): 185-188, 2010) Full article

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Foot Center of Pressure and Medial Knee Osteoarthritis

by Roy H. Lidtke, Carol Muehleman, Mary Kwasny and Joel A. Block

J. Am. Podiatr. Med. Assoc. 2010, 100(3), 178-184; https://doi.org/10.7547/1000178 - 1 May 2010

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Background: We sought to determine whether symptomatic medial knee osteoarthritis is associated with aberrant loading across the foot during gait. Methods: Twenty-five individuals with medial knee osteoarthritis were compared with 25 controls. Knee radiographs and Western Ontario and McMaster Universities Arthritis Index questionnaires [...] Read more.

Background: We sought to determine whether symptomatic medial knee osteoarthritis is associated with aberrant loading across the foot during gait. Methods: Twenty-five individuals with medial knee osteoarthritis were compared with 25 controls. Knee radiographs and Western Ontario and McMaster Universities Arthritis Index questionnaires were obtained. Participants walked barefoot over pressure sensors, and the center-of-pressure trace was plotted against the axis of the foot, and a center-of-pressure index was calculated. Results: The center-of-pressure indices in the medial knee osteoarthritis group demonstrated high lateral loading compared with the central center-of-pressure pattern in controls (P < .001). There was a correlation between the severity of pain and the center-ofpressure index in patients with medial knee osteoarthritis but no correlation between center of pressure and radiographic severity. Conclusions: The plantar pressure patterns of patients with medial knee osteoarthritis demonstrated greater loading of the lateral aspect of the foot during the contact and midstance phases of gait but not during propulsion compared with those of controls, suggesting that loading patterns in the feet are related to osteoarthritis in the knee. (J Am Podiatr Med Assoc 100(3): 178-184, 2010) Full article

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Treatment of Mild, Moderate, and Severe Onychomycosis Using 870- and 930-nm Light Exposure

by Adam S. Landsman, Alan H. Robbins, Paula F. Angelini, Catherine C. Wu, Jeremy Cook, Mary Oster and Eric S. Bornstein

J. Am. Podiatr. Med. Assoc. 2010, 100(3), 166-177; https://doi.org/10.7547/1000166 - 1 May 2010

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Abstract

Background: The Noveon is a unique dual-wavelength near-infrared diode laser used to treat onychomycosis. The device operates at physiologic temperatures that are thermally safe for human tissue. It uses only 870- and 930-nm near-infrared light, wavelengths that have unique photolethal effects on fungal [...] Read more.

Background: The Noveon is a unique dual-wavelength near-infrared diode laser used to treat onychomycosis. The device operates at physiologic temperatures that are thermally safe for human tissue. It uses only 870- and 930-nm near-infrared light, wavelengths that have unique photolethal effects on fungal pathogens. These wavelengths lack the teratogenic danger presented by ultraviolet light and the photoablation toxic plume associated with pulsed Nd:YAG lasers. Methods: In this randomized controlled study, treatments followed a predefined protocol and laser parameters and occurred on days 1, 14, 42, and 120. Toes were cultured and evaluated, and measurements were taken from standardized photographs obtained periodically during the 180 day follow-up period. Results: We treated mycologically confirmed onychomycosis in 26 eligible toes (ten mild, seven moderate, and nine severe). All of the patients were followed-up for 180 days. An independent expert panel, blinded regarding treatment versus control, found that at 180 days, 85% of the eligible treated toenails were improved by clear nail linear extent (P = .0015); 65% showed at least 3 mm and 26% showed at least 4 mm of clear nail growth. Of the 16 toes with moderate to severe involvement, ten (63%) improved, as shown by clear nail growth of at least 3 mm (P = .0112). Simultaneous negative culture and periodic acid–Schiff was noted in 30% at 180 days. Conclusions: These results indicate a role for this laser in the treatment of onychomycosis, regardless of degree of severity. Ease of delivery and the lack of a need to monitor blood chemistry are attractive attributes. (J Am Podiatr Med Assoc 100(3): 166-177, 2010) Full article

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Plantar Fasciopathy Treated with Dynamic Splinting. A Randomized Controlled Trial

by Larry Sheridan, Angel Lopez, Andres Perez, Mathew M. John, F. Buck Willis and Ramalingam Shanmugam

J. Am. Podiatr. Med. Assoc. 2010, 100(3), 161-165; https://doi.org/10.7547/1000161 - 1 May 2010

Cited by 14 | Viewed by 39

Abstract

Background: Plantar fasciopathy (or plantar fasciitis) is considered to be one of the most common foot abnormalities, affecting up to 2 million Americans each year, and the chief complaint is acute heel pain. Therapeutic protocols for this condition have included stretching exercises, corticosteroid [...] Read more.

Background: Plantar fasciopathy (or plantar fasciitis) is considered to be one of the most common foot abnormalities, affecting up to 2 million Americans each year, and the chief complaint is acute heel pain. Therapeutic protocols for this condition have included stretching exercises, corticosteroid injections, physical therapy, and foot orthoses, but a single modality has not been found to be universally effective. We sought to determine the efficacy of stretching with dynamic splinting for the treatment of plantar fasciitis. Methods: Sixty patients (76 feet) were enrolled in this 12-week study from four different clinics across the United States. Patients were randomly categorized into experimental and control groups. All of the patients received nonsteroidal anti-inflammatory drugs, orthoses, and corticosteroid injections if needed. Thirty experimental patients also received dynamic splinting for nightly wear to obtain a low-load, prolonged-duration stretch with dynamic tension. The dependent variable was change from baseline in Plantar Fasciopathy Pain/Disability Scale score, and the independent variable was group (experimental versus control). Results: Two-sample t tests were calculated, and there was a significant difference in the mean change scores of experimental versus control patients (–33 versus –2 points, P < .0001). Conclusions: Dynamic splinting was effective for reducing the pain of plantar fasciopathy, and this modality should be included in the standard of care for treating plantar fasciopathy. (J Am Podiatr Med Assoc 100(3): 161-165, 2010) Full article

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Diabetic Foot Ulcers Treated with Becaplermin and TheraGauze, a Moisture-Controlling Smart Dressing. A Randomized, Multicenter, Prospective Analysis

by Adam Landsman, Patrick Agnew, Lawrence Parish, Robert Joseph and Robert D. Galiano

J. Am. Podiatr. Med. Assoc. 2010, 100(3), 155-160; https://doi.org/10.7547/1000155 - 1 May 2010

Cited by 44 | Viewed by 48

Abstract

Background: It is hypothesized that moisture regulation specific to the area of contact results in local wound conditions more amenable to healing, which would result in faster and more frequent wound closure. TheraGauze is a new polymer-impregnated dressing designed to regulate moisture to [...] Read more.

Background: It is hypothesized that moisture regulation specific to the area of contact results in local wound conditions more amenable to healing, which would result in faster and more frequent wound closure. TheraGauze is a new polymer-impregnated dressing designed to regulate moisture to a varying degree over the entire surface of a wound. Methods: This prospective, randomized, multicenter study examined outcomes from treatment of diabetic foot ulcers with TheraGauze and TheraGauze in conjunction with becaplermin. We also compared these outcomes with historical data from the literature that used saline-moistened gauze and becaplermin. Results: The rates of wound closure with TheraGauze and TheraGauze + becaplermin were 0.37 and 0.41 cm²/week, respectively (P = .34). The difference between these values was not statistically significant. We also observed high closure rates at 12 weeks (46.2% in both groups) and 20 weeks (61.5% with TheraGauze alone and 69.2% with TheraGauze + becaplermin). These data were also compared with historical data for closure rates (0.18 cm²/week) and percentage of wounds closed using saline-moistened gauze alone and becaplermin with saline-moistened gauze (0.24 cm²/week) from a variety of studies. Conclusions: Wounds in which moisture content was regulated with TheraGauze showed more rapid change in wound area and a higher percentage of wounds achieving closure at 12 and 20 weeks regardless of whether becaplermin was used. (J Am Podiatr Med Assoc 100(3): 155-160, 2010) Full article

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J. Am. Podiatr. Med. Assoc., Volume 100, Issue 3 (05 2010) – 14 articles , Pages 155-234

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