Journal of the American Podiatric Medical Association

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A Shout for Women DPMs, and a Cheer for Equality

by Kathleen M. Stone

J. Am. Podiatr. Med. Assoc. 2010, 100(4), 314; https://doi.org/10.7547/1000314 - 1 Jul 2010

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This month, I would like to take the opportunity to showcase some of our women podiatric physicians and recognize their outstanding contributions to our field [...] Full article

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Letter to the Editor

by Ronald Renzi

J. Am. Podiatr. Med. Assoc. 2010, 100(4), 313; https://doi.org/10.7547/1000313 - 1 Jul 2010

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Abstract

Organized Programs to Prevent Lower- Extremity Amputations [...] Full article

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Letter to the Editor

by Michael Turlik

J. Am. Podiatr. Med. Assoc. 2010, 100(4), 312; https://doi.org/10.7547/1000312 - 1 Jul 2010

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Abstract

Use of Low-Frequency Electrical Stimulation for the Treatment of Plantar Fasciitis [...] Full article

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The Role of Interdisciplinary Team Approach in the Management of the Diabetic Foot. A Joint Statement from the Society for Vascular Surgery and the American Podiatric Medical Association

by Bauer E. Sumpio, David G. Armstrong, Lawrence A. Lavery and George Andros

J. Am. Podiatr. Med. Assoc. 2010, 100(4), 309-311; https://doi.org/10.7547/1000309 - 1 Jul 2010

Cited by 27 | Viewed by 69

Abstract

The Society for Vascular Surgery (SVS) and the American Podiatric Medical Association (APMA) recognize the beneficial impact of a multidisciplinary team approach on the care of patients with critical limb ischemia, especially in the diabetic population. As a first step in identifying clinical [...] Read more.

The Society for Vascular Surgery (SVS) and the American Podiatric Medical Association (APMA) recognize the beneficial impact of a multidisciplinary team approach on the care of patients with critical limb ischemia, especially in the diabetic population. As a first step in identifying clinical issues and questions important to both memberships, and to work together to find solutions that will benefit the shared patient, the two organizations appointed a representative group to write a joint statement on the importance of multidisciplinary team approach to the care of the diabetic foot. Full article

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Subungual Squamous Cell Carcinoma After Organ Transplantation

by Wenjay Sung, Hakeem Sam and Frederic W. B. Deleyiannis

J. Am. Podiatr. Med. Assoc. 2010, 100(4), 304-308; https://doi.org/10.7547/1000304 - 1 Jul 2010

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Abstract

It is accepted that immunosuppressant therapy after organ transplantation is associated with an increase risk of neoplasm. Subungual squamous cell carcinoma of the toe is a rare condition and has not previously been reported, to our knowledge, in patients undergoing immunosuppressant therapy. The [...] Read more.

It is accepted that immunosuppressant therapy after organ transplantation is associated with an increase risk of neoplasm. Subungual squamous cell carcinoma of the toe is a rare condition and has not previously been reported, to our knowledge, in patients undergoing immunosuppressant therapy. The objective of this case study is to report the clinical and histopathologic findings and the multidisciplinary treatment approach for a case of subungual squamous cell carcinoma of the toe in an organ transplant recipient undergoing immunosuppressant drug therapy. Full article

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Trimethoprim-Sulfamethoxazole–Induced Stevens-Johnson Syndrome. A Case Report

by Michael R. Langlois, Francis Derk, Ronald Belczyk and Thomas Zgonis

J. Am. Podiatr. Med. Assoc. 2010, 100(4), 299-303; https://doi.org/10.7547/1000299 - 1 Jul 2010

Cited by 10 | Viewed by 84

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Stevens-Johnson syndrome and toxic epidermal necrolysis are rare; however, when they occur, they usually present with severe reactions in response to medications and other stimuli. These reactions are characterized by mucocutaneous lesions, which ultimately lead to epidermal death and sloughing. We present a [...] Read more.

Stevens-Johnson syndrome and toxic epidermal necrolysis are rare; however, when they occur, they usually present with severe reactions in response to medications and other stimuli. These reactions are characterized by mucocutaneous lesions, which ultimately lead to epidermal death and sloughing. We present a unique case report of Stevens-Johnson syndrome and associated toxic epidermal necrolysis in a 61-year-old man after treatment for a peripherally inserted central catheter infection with trimethoprim-sulfamethoxazole. This case report reviews a rare adverse reaction to a commonly prescribed antibiotic drug used in podiatric medical practice for the management of diabetic foot infections. Full article

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Large Subungual Exostosis of the Great Toe. A Case Report

by Serhan Unlu, Ismail Demirkale, Tughan Kalkan, Birol Tunc and Murat Bozkurt

J. Am. Podiatr. Med. Assoc. 2010, 100(4), 296-298; https://doi.org/10.7547/1000296 - 1 Jul 2010

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A subungual exostosis is a benign lesion described as a variant of an osteochondroma. It mostly affects the great toe, and it can be confused with an osteochondroma and a Nora’s lesion. The curative treatment for a subungual exostosis is complete excision, and [...] Read more.

A subungual exostosis is a benign lesion described as a variant of an osteochondroma. It mostly affects the great toe, and it can be confused with an osteochondroma and a Nora’s lesion. The curative treatment for a subungual exostosis is complete excision, and the cartilaginous cap must be totally resected to prevent a possible recurrence. In this article, we present findings regarding a large and painful lesion on the dorsomedial aspect of the great toe of a patient. Full article

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Mini TightRope System for Hallux Abducto Valgus Deformity. A Discussion and Case Report

by Bryan Christopher West

J. Am. Podiatr. Med. Assoc. 2010, 100(4), 291-295; https://doi.org/10.7547/1000291 - 1 Jul 2010

Cited by 14 | Viewed by 47

Abstract

This case report reviews the presentation and treatment of a 68-year-old diabetic woman with severe hallux abducto valgus deformity and progressively worsening pain and joint stiffness. The patient had a history of two distinct episodes of postoperative deep venous thrombosis and was deemed [...] Read more.

This case report reviews the presentation and treatment of a 68-year-old diabetic woman with severe hallux abducto valgus deformity and progressively worsening pain and joint stiffness. The patient had a history of two distinct episodes of postoperative deep venous thrombosis and was deemed inappropriate for cast immobilization. The Arthrex Mini TightRope system was used in an attempt to reduce significantly increased intermetatarsal and hallux abductus angles, with the advantage of immediate postoperative weightbearing. An Integra K2 hemi-joint implant was also used to address the marked osteoarthritis at the first metatarsophalangeal joint. The potential role that this fixation technology may play in forefoot surgery is then discussed, along with its limitations and possible complications. Full article

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Fever—An Update

by John H. Becker and Stephanie C. Wu

J. Am. Podiatr. Med. Assoc. 2010, 100(4), 281-290; https://doi.org/10.7547/1000281 - 1 Jul 2010

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Abstract

Fever is an active yet nonspecific response of the body to infections and other insults that cause immune cells to release cytokines, resulting in a brain prostanoid–mediated rise in body temperature. The causes, types, clinical management, and postoperative consequences of fever are reviewed [...] Read more.

Fever is an active yet nonspecific response of the body to infections and other insults that cause immune cells to release cytokines, resulting in a brain prostanoid–mediated rise in body temperature. The causes, types, clinical management, and postoperative consequences of fever are reviewed in this article. Physicians use fever as a clinical sign for diagnoses and prognoses, but “fevers of unknown origin” continue to be problematic. Fevers that arise 1 or 2 days after surgery are usually due to stress and trauma, but later postoperative fevers often have more serious causes and consequences, such as wound infection. Fever is commonly encountered by podiatric physicians and surgeons, and certain procedures with the lower extremity are more likely to eventuate in fever. Full article

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Admission Characteristics and Academic Performance of Podiatric and Osteopathic Medical Students at Des Moines University

by Robert M. Yoho, Vassilios Vardaxis and Kathryn Comstock

J. Am. Podiatr. Med. Assoc. 2010, 100(4), 276-280; https://doi.org/10.7547/1000276 - 1 Jul 2010

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Abstract

Background: Podiatric and osteopathic medical students at Des Moines University take the same basic science medical curriculum. The first course students complete is medical biochemistry. The final common course is the second-year medical pharmacology course. Attrition typically occurs between these academic offerings. [...] Read more.

Background: Podiatric and osteopathic medical students at Des Moines University take the same basic science medical curriculum. The first course students complete is medical biochemistry. The final common course is the second-year medical pharmacology course. Attrition typically occurs between these academic offerings. We sought to compare admissions data, retention rates, and academic performance between these two groups of medical students for the classes of 2008 to 2011. Methods: Average admission scores, performance scores for the biochemistry and medical pharmacology courses, and retention rates for the 2008 to 2011 classes were obtained from the registrar and enrollment offices. One-way analysis of variance was used to compare the scores of the two cohorts. Linear regression was used to identify changes across time. Results: The DO students showed significantly better performance than the DPM students in matriculating overall and science grade point averages, total Medical College Admissions Test scores, retention rates, and the medical biochemistry course (P < .01). There was no difference in the performance of the student groups in the medical pharmacology course. The DPM student scores across the four classes increased for both academic courses, whereas the DO student scores remained at the same level for medical biochemistry, at a rate of 0.74% per year (R² = 0.50), and pharmacology, at a rate of 0.90% per year (R² = 0.49). Conclusions: Admissions data and initial academic performance of osteopathic medical students were higher than those of podiatric medical students. Once attrition occurred in year 1, the difference in academic performance between these groups of students was no longer statistically significant, and students in both medical programs at that time in the curriculum are equally academically qualified. Full article

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The Percutaneous Surgical Approach for Repairing Acute Achilles Tendon Rupture. A Comprehensive Outcome Assessment

by Shay Tenenbaum, Niv Dreiangel, Ayal Segal, Amir Herman, Amnon Israeli and Ahron Chechik

J. Am. Podiatr. Med. Assoc. 2010, 100(4), 270-275; https://doi.org/10.7547/1000270 - 1 Jul 2010

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Abstract

Background: Treatment modalities for acute Achilles tendon rupture can be divided into operative and nonoperative. The main concern with nonoperative treatment is the high incidence of repeated ruptures; operative treatment is associated with risk of infection, sural nerve injury, and wound-healing sequelae. [...] Read more.

Background: Treatment modalities for acute Achilles tendon rupture can be divided into operative and nonoperative. The main concern with nonoperative treatment is the high incidence of repeated ruptures; operative treatment is associated with risk of infection, sural nerve injury, and wound-healing sequelae. We assessed our experience with a percutaneous operative approach for treating acute Achilles tendon rupture. Methods: The outcomes of percutaneous surgery in 29 patients (25 men; age range, 24–58 years) who underwent percutaneous surgery for Achilles tendon rupture between 1997 and 2004 were retrospectively evaluated. Their demographic data, subjective and objective evaluation findings, and isokinetic evaluation results were retrieved, and they were assessed with the modified Boyden score and the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale. Results: All 29 patients demonstrated good functional outcome, with no- to mildlimitations in recreational activities and high patient satisfaction. Mean follow-up was 31.8 months. Changes in ankle range of motion in the operated leg were minimal. Strength and power testing revealed a significant difference at 908/sec for plantarflexion power between the injured and healthy legs but no difference at 308 and 2408/sec or in dorsiflexion. The mean modified Boyden score was 74.3, and the mean Ankle-Hindfoot Scale score was 94.5. Conclusions: Percutaneous surgery for Achilles tendon rupture is easily executed and has excellent functional results and low complication rates. It is an appealing alternative to either nonoperative or open surgery treatments. (J Am Podiatr Med Assoc 100(4): 270-275, 2010) Full article

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Plantar Shear Stress Distribution in Patients with Rheumatoid Arthritis. Relevance to Foot Pain

by Metin Yavuz, Elaine Husni, Georgeanne Botek and Brian L. Davis

J. Am. Podiatr. Med. Assoc. 2010, 100(4), 265-269; https://doi.org/10.7547/1000265 - 1 Jul 2010

Cited by 8 | Viewed by 51

Abstract

Background: Rheumatoid arthritis is an autoimmune disease that causes chronic, progressive joint inflammation; it commonly affects the joints of the feet. Biomechanical alterations and daily pain in the foot are the common outcomes of the disease. Earlier studies focusing on plantar pressure [...] Read more.

Background: Rheumatoid arthritis is an autoimmune disease that causes chronic, progressive joint inflammation; it commonly affects the joints of the feet. Biomechanical alterations and daily pain in the foot are the common outcomes of the disease. Earlier studies focusing on plantar pressure in such patients reported increased vertical loading along with peak pressure-pain associations. However, footwear designed according to the pressure profiles did not relieve symptoms effectively. We examined plantar shear and pressure distribution in patients with rheumatoid arthritis and compared the findings with those of controls, and we investigated a potential relationship between foot pain and local shear stresses. Methods: A custom-built platform was used to collect plantar pressure and shear stress data from nine patients with rheumatoid arthritis and 14 control participants. Seven patients reported the presence of pain under their feet. Pressure-time and shear-time integral values were also calculated. Results: Peak pressure, pressure-time integral, resultant shear-time integral, and mediolateral shear stress magnitudes were higher in the complication group (P < .05). An association between peak shear-time integral and maximum pain locations was observed. Conclusions: Increased mediolateral shear stresses under the rheumatoid foot might be attributable to gait instability in such patients. A correlation between the locations of maximum shear-time integral and pain indicate the clinical significance of plantar shear in patients with rheumatoid arthritis. Full article

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Foot Temperature in Healthy Individuals. Effects of Ambient Temperature and Age

by Rachel A. Nardin, Patricia M. Fogerson, Rui Nie and Seward B. Rutkove

J. Am. Podiatr. Med. Assoc. 2010, 100(4), 258-264; https://doi.org/10.7547/1000258 - 1 Jul 2010

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Abstract

Background: Patient complaints of excessively warm or cold feet are common in medical practice. Such symptoms can be caused by underlying vascular or neurologic disease, and measurement of foot temperature during daily activity and sleep could provide a deeper understanding of their [...] Read more.

Background: Patient complaints of excessively warm or cold feet are common in medical practice. Such symptoms can be caused by underlying vascular or neurologic disease, and measurement of foot temperature during daily activity and sleep could provide a deeper understanding of their actual thermal basis. Methods: We used a Thermochron iButton to assess surface foot temperature variation and its relationship to ambient temperature during the day with activity and at night during sleep in 39 healthy individuals aged 18 to 65 years in a temperate region of the United States. We simultaneously used actigraphy to record leg movement. Results: We identified a mean ± SD awake temperature of 30.6° ± 2.6°C and asleep temperature of 34.0° ± 1.8°C, with values reaching as low as 15.9°C in the winter and as high as 37.5°C in the summer. Foot temperature was found to be independent of foot movement or sex; however, there was, as expected, a strong association between foot temperature and ambient temperature (r = .59, P < .001). Several measures of foot temperature variation demonstrated a significant or near-significant reduction with increasing age, including the Euclidean distance (r = -.38, P = .02) for awake periods and the variance (r = -.30, P = .06) during sleep. Conclusions: These results provide data on the normal variation of foot temperature in individuals living in a temperate climate and demonstrate the potential use of the Thermochron iButton technology in clinical contexts, including the evaluation of patients with excessively warm or cold feet. Full article

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Comparative Analysis of Human Gait While Wearing Thong-Style Flip-flops versus Sneakers

by Justin F. Shroyer and Wendi H. Weimar

J. Am. Podiatr. Med. Assoc. 2010, 100(4), 251-257; https://doi.org/10.7547/1000251 - 1 Jul 2010

Cited by 31 | Viewed by 81

Abstract

Background: Flip-flops are becoming a common footwear option. Casual observation has indicated that individuals wear flip-flops beyond their structural limit and have a different gait while wearing flip-flops versus shoes. This alteration in gait may cause the anecdotal foot and lower-limb discomfort [...] Read more.

Background: Flip-flops are becoming a common footwear option. Casual observation has indicated that individuals wear flip-flops beyond their structural limit and have a different gait while wearing flip-flops versus shoes. This alteration in gait may cause the anecdotal foot and lower-limb discomfort associated with wearing flip-flops. Methods: To investigate the effect of sneakers versus thong-style flip-flops on gait kinematics and kinetics, 56 individuals (37 women and 19 men) were randomly assigned to a footwear order (flip-flops or sneakers first) and were asked to wear the assigned footwear on the day before and the day of testing. On each testing day, participants were videotaped as they walked at a self-selected pace across a force platform. A 2 (sex) 32 (footwear) repeated-measures analysis of variance (P = .05) was used for statistical analysis. Results: Significant interaction effects of footwear and sex were found for maximal anterior force, attack angle, and ankle angle during the swing phase. Footwear significantly affected stride length, ankle angle at the beginning of double support and during the swing phase, maximal braking impulse, and stance time. Flip-flops resulted in a shorter stride, a larger ankle angle at the beginning of double support and during the swing phase, a smaller braking impulse, and a shorter stance time compared with sneakers. Conclusions: The effects of footwear on gait kinetics and kinematics is extensive, but there is limited research on the effect of thong-style flip-flops on gait. These results suggest that flip-flops have an effect on several kinetic and kinematic variables compared with sneakers. Full article

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A Proof-of-Concept Study for Measuring Gait Speed, Steadiness, and Dynamic Balance Under Various Footwear Conditions Outside of the Gait Laboratory

by James S. Wrobel, Sarah Edgar, Dana Cozzetto, James Maskill, Paul Peterson and Bijan Najafi

J. Am. Podiatr. Med. Assoc. 2010, 100(4), 242-250; https://doi.org/10.7547/1000242 - 1 Jul 2010

Cited by 17 | Viewed by 45

Abstract

Background: This pilot study examined the effect of custom and prefabricated foot orthoses on self-selected walking speed, walking speed variability, and dynamic balance in the mediolateral direction. Methods: The gait of four healthy participants was analyzed with a body-worn sensor system [...] Read more.

Background: This pilot study examined the effect of custom and prefabricated foot orthoses on self-selected walking speed, walking speed variability, and dynamic balance in the mediolateral direction. Methods: The gait of four healthy participants was analyzed with a body-worn sensor system across a distance of at least 30 m outside of the gait laboratory. Participants walked at their habitual speed in four conditions: barefoot, regular shoes, prefabricated foot orthoses, and custom foot orthoses. Results: In the custom foot orthoses condition, gait speed was improved on average 13.5% over the barefoot condition and 9.8% over the regular shoe condition. The mediolateral range of motion of center of mass was reduced 55% and 56% compared with the shoes alone and prefabricated foot orthoses conditions, respectively. This may suggest better gait efficiency and lower energy cost with custom foot orthoses. This tendency remained after normalizing center of mass by gait speed, suggesting that irrespective of gait speed, custom foot orthoses improve center of mass motion in the mediolateral direction compared with other footwear conditions. Gait intercycle variability, measured by intercycle coefficient of variation of gait speed, was decreased on average by 25% and 19% compared with the barefoot and shoes-alone conditions, respectively. The decrease in gait unsteadiness after wearing custom foot orthoses may suggest improved proprioception from the increased contact area of custom foot orthoses versus the barefoot condition. Conclusions: These findings may open new avenues for objective assessment of the impact of prescribed footwear on dynamic balance and spatiotemporal parameters of gait and assess gait adaptation after use of custom foot orthoses. Full article

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The Impact of a Podiatric Lead Limb Preservation Team on Disease Outcomes and Risk Prediction in the Diabetic Lower Extremity. A Retrospective Cohort Study

by Vickie R. Driver, Russell A. Goodman, Matteo Fabbi, Michael A. French and Charles A. Andersen

J. Am. Podiatr. Med. Assoc. 2010, 100(4), 235-241; https://doi.org/10.7547/1000235 - 1 Jul 2010

Cited by 38 | Viewed by 41

Abstract

Background: We used a model of lower-extremity ulceration to determine the impact of a podiatric lead limb preservation team on identified relationships among risk factors, predictors of ulceration, amputation, and clinical outcomes of lower-extremity disease in patients with diabetes mellitus. Methods: [...] Read more.

Background: We used a model of lower-extremity ulceration to determine the impact of a podiatric lead limb preservation team on identified relationships among risk factors, predictors of ulceration, amputation, and clinical outcomes of lower-extremity disease in patients with diabetes mellitus. Methods: A total of 485 patients with diabetes mellitus were randomly selected from the diabetic population and included in this retrospective cohort study. Patients were then stratified into two groups: those who received specialty podiatric medical care and those who did not. Data covering a 5-year period were collected using electronic medical records and chart abstraction to capture detailed treatment characteristics, ulcer status, and surgical outcomes. Results: Overall, the frequencies of inpatient and outpatient encounters and the durations of hospital stays were significantly greater with increasing wound depth and in the presence of infection. In addition, the overall ulcer incidence was greater in patients with callus (34.3% versus 10.3%, P< .0001) with and without neuropathy (20.4% and 4.1%, P< .0001). Among patients treated in a specialty multidiscipline podiatric medical setting, the proportion of all amputations that were ‘‘minor’’ was significantly increased (33.7% versus 67.3%, P = .0006), and survival was significantly improved (19.5% versus 7.7%, P< .0001). Conclusions: Early identification of individuals at increased risk for lower-extremity ulceration and subsequent referral for advanced multidiscipline podiatric medical specialty care may decrease rates of ulceration and proximal amputation and improve survival in patients with diabetes mellitus who are at high risk for ulceration and limb loss. Full article

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J. Am. Podiatr. Med. Assoc., Volume 100, Issue 4 (07 2010) – 16 articles , Pages 235-314

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