Journal of the American Podiatric Medical Association

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The Story of Our Success

by Kathleen M. Stone

J. Am. Podiatr. Med. Assoc. 2011, 101(1), 91; https://doi.org/10.7547/1010091 - 1 Jan 2011

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‘‘Of all the things I’ve done, the most vital is coordinating those who work with me and aiming their efforts at a certain goal.’’–Walt Disney [...] Full article

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Motivational Interviewing by Podiatric Physicians

by Robert A. Gabbay, Shailja Kaul, Jan Ulbrecht, Neil M. Scheffler and David G. Armstrong

J. Am. Podiatr. Med. Assoc. 2011, 101(1), 78-84; https://doi.org/10.7547/1010078 - 1 Jan 2011

Cited by 34 | Viewed by 43

Abstract

Foot ulceration and lower-extremity amputation are devastating end-stage complications of diabetes. Despite agreement that diabetic foot self-care is a key factor in prevention of ulcers and amputation, there has only been limited success in influencing these behaviors among patients with diabetes. While most [...] Read more.

Foot ulceration and lower-extremity amputation are devastating end-stage complications of diabetes. Despite agreement that diabetic foot self-care is a key factor in prevention of ulcers and amputation, there has only been limited success in influencing these behaviors among patients with diabetes. While most efforts have focused on increasing patient knowledge, knowledge and behavior are poorly correlated. Knowledge is necessary but rarely sufficient for behavior change. A key determinant to adherence to self-care behavior is clinician counseling style. Podiatrists are the ideal providers to engage in a brief behavioral intervention with a patient. Motivational interviewing is a well-accepted, evidence-based teachable approach that enhances self-efficacy and increases intrinsic motivation for change and adherence to treatment. This article summarizes some key strategies that can be employed by podiatrists to improve foot self-care. (J Am Podiatr Med Assoc 101(1): 78-84, 2011). Full article

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Extra-Abdominal Desmoid Fibromatosis in the Foot

by Alan A. MacGill, Vincent R. Milione and Laura G. Sullivan

J. Am. Podiatr. Med. Assoc. 2011, 101(1), 70-74; https://doi.org/10.7547/1010070 - 1 Jan 2011

Cited by 5 | Viewed by 52

Abstract

Extra-abdominal desmoid tumors account for 0.03% of all neoplasms and rarely present in the foot. They are benign but locally aggressive, and wide local surgical excision is the treatment of choice owing to the high rate of recurrence in the lower extremities. Invasiveness [...] Read more.

Extra-abdominal desmoid tumors account for 0.03% of all neoplasms and rarely present in the foot. They are benign but locally aggressive, and wide local surgical excision is the treatment of choice owing to the high rate of recurrence in the lower extremities. Invasiveness into the surrounding soft-tissue structures often makes wide excision difficult without compromise of function. We describe a 34-year-old woman with a large, pedal, extra-abdominal desmoid fibroma treated by wide local surgical excision with minimal complications postoperatively and no clinical evidence of recurrence at 28 months. (J Am Podiatr Med Assoc 101(1): 70-74, 2011). Full article

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Open AccessArticle

Clinical Assessment of Ankle Joint Dorsiflexion

by Alfred Gatt and Nachiappan Chockalingam

J. Am. Podiatr. Med. Assoc. 2011, 101(1), 59-69; https://doi.org/10.7547/1010059 - 1 Jan 2011

Cited by 52 | Viewed by 86

Abstract

Ankle dorsiflexion measurement is important for clinical and research use. With so much evidence on the unreliability of goniometric measurements, a systematic review was performed to investigate various alternative techniques for measuring ankle dorsiflexion in the nonneurologic patient. All of the major databases [...] Read more.

Ankle dorsiflexion measurement is important for clinical and research use. With so much evidence on the unreliability of goniometric measurements, a systematic review was performed to investigate various alternative techniques for measuring ankle dorsiflexion in the nonneurologic patient. All of the major databases were queried electronically to identify studies that used any method of ankle dorsiflexion measurement in the nonneurologic subject. Keywords included ankle dorsiflexion NOT cerebral palsy NOT stroke, the latter to exclude neurologic conditions. In 755 studies that used some form of ankle joint dorsiflexion measurement, ten different techniques were identified that included various apparatuses designed specifically for this purpose. Reliability testing of these techniques involved test-retest trials with small student populations as subjects, which returned high intraclass correlation coefficient scores. However, their methodological quality would have benefitted from the use of an actual patient population and comparison with a reference standard. When validating ankle dorsiflexion measurement techniques, actual patient populations should be used, otherwise papers would score poorly on methodological quality assessment. Standardizing patient position, foot posture, amount of moment applied, and reference landmarks will ensure that various trial results can be compared directly. (J Am Podiatr Med Assoc 101(1): 59-69, 2011). Full article

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Autologous Skin Fibroblast and Keratinocyte Grafts in the Treatment of Chronic Foot Ulcers in Aging Type 2 Diabetic Patients

by Matteo Monami, Maria Vivarelli, Carla Maria Desideri, Giulio Ippolito, Niccolò Marchionni and Edoardo Mannucci

J. Am. Podiatr. Med. Assoc. 2011, 101(1), 55-58; https://doi.org/10.7547/1010055 - 1 Jan 2011

Cited by 14 | Viewed by 56

Abstract

Background: We assessed the tolerability and efficacy of autologous skin cell grafts in older type 2 diabetic patients with chronic foot ulcers. Methods: Treatment with Hyalograft 3D and Laserskin Autograft was proposed to a consecutive series of type 2 diabetic patients older than [...] Read more.

Background: We assessed the tolerability and efficacy of autologous skin cell grafts in older type 2 diabetic patients with chronic foot ulcers. Methods: Treatment with Hyalograft 3D and Laserskin Autograft was proposed to a consecutive series of type 2 diabetic patients older than 65 years affected by longstanding (.6 months) foot ulcers with an area greater than 15 cm2. Ulcer healing rates and measurements of ulcer area were determined monthly for 12 months. Results: Seven patients with 12 ulcers, nine of which received the described treatment, were enrolled. During 12-month follow-up, all of the ulcers healed except one. In the remaining eight ulcers, the median healing time was 21 weeks (interquartile range, 4–29 weeks). Conclusions: Autologous skin cell grafts are feasible, well tolerated, and apparently effective in the treatment of diabetic ulcers of the lower limbs in advanced age. Age did not seem to moderate healing times. (J Am Podiatr Med Assoc 101(1): 55-58, 2011). Full article

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Prevalence of Toenail Onychomycosis in Patients with Type 2 Diabetes Mellitus and Evaluation of Risk Factors

by Aynur Gulcan, Erim Gulcan, Sukru Oksuz, Idris Sahin and Demet Kaya

J. Am. Podiatr. Med. Assoc. 2011, 101(1), 49-54; https://doi.org/10.7547/1010049 - 1 Jan 2011

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Abstract

Background: We sought to determine the frequency of toenail onychomycosis in diabetic patients, to identify the causative agents, and to evaluate the epidemiologic risk factors. Methods: Data regarding patients’ diabetic characteristics were recorded by the attending internal medicine clinician. Clinical examinations of patients’ [...] Read more.

Background: We sought to determine the frequency of toenail onychomycosis in diabetic patients, to identify the causative agents, and to evaluate the epidemiologic risk factors. Methods: Data regarding patients’ diabetic characteristics were recorded by the attending internal medicine clinician. Clinical examinations of patients’ toenails were performed by a dermatologist, and specimens were collected from the nails to establish the onycomycotic abnormality. All of the specimens were analyzed by direct microscopy and culture. Results: Of 321 patients with type 2 diabetes mellitus, clinical onychomycosis was diagnosed in 162; 41 of those diagnoses were confirmed mycologically. Of the isolated fungi, 23 were yeasts and 18 were dermatophytes. Significant correlations were found between the frequency of onychomycosis and retinopathy, neuropathy, obesity, family history, and duration of diabetes. However, no correlation was found with sex, age, educational level, occupation, area of residence, levels of hemoglobin A1c and fasting blood glucose, and nephropathy. The most frequently isolated agents from clinical specimens were yeasts. Conclusions: Long-term control of glycemia to prevent chronic complications and obesity and to promote education about the importance of foot and nail care should be essential components in preventing onychomycosis and its potential complications, such as secondary foot lesions, in patients with diabetes mellitus. (J Am Podiatr Med Assoc 101(1): 49-54, 2011). Full article

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Distally Based Adipofascial Sural Flap for Foot and Ankle Reconstruction

by Ali Mojallal, Christo D. Shipkov, Fabienne Braye and Pierre Breton

J. Am. Podiatr. Med. Assoc. 2011, 101(1), 41-48; https://doi.org/10.7547/1010041 - 1 Jan 2011

Cited by 11 | Viewed by 46

Abstract

Background: This retrospective study of a case series analyzed the results from the application of a distally based adipofascial sural flap for nonweightbearing defects of the foot and ankle. Methods: Twenty-eight patients with post-traumatic ankle and foot defects (ten women and 18 men; [...] Read more.

Background: This retrospective study of a case series analyzed the results from the application of a distally based adipofascial sural flap for nonweightbearing defects of the foot and ankle. Methods: Twenty-eight patients with post-traumatic ankle and foot defects (ten women and 18 men; age range, 17–63 years) underwent surgery between November 1, 2003, and November 30, 2008. Distally based adipofascial sural flaps were used in ten open fractures, 14 soft-tissue post-traumatic defects, and four deep burns. Defects were on the dorsal side of the foot (eight cases), the lateral malleolus (four cases), the medial malleolus and inframalleolar region (four cases), the Achilles tendon region (eight cases), and the anterior surface of the ankle (four cases). Surgical procedures were performed by a single surgeon (A.M.). Results: All of the flaps healed uneventfully. There was no partial or total flap loss. All 28 patients walked normally at the time of follow-up. Three delayed healings occurred at the donor site. Conclusions: This is a homogeneous series of lower-limb reconstructions with the distally based adipofascial sural flap, which permits better analysis of the results. This flap has a constant and reliable blood supply. It can be used for the reconstruction of nonweightbearing foot and ankle regions to avoid the bulky volume of the fasciocutaneous flap in this area and to minimize the donor site scar. (J Am Podiatr Med Assoc 101(1): 41-48, 2011). Full article

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Prevalence of Plantar Verrucae in Patients with Human Immunodeficiency Virus Infection During the Post–Highly Active Antiretroviral Therapy Era

by James Johnston, Christy M. King, Sky Shanks, Saieh Khademi, Joseph Nelson, Jenny Yu and Peter Barbosa

J. Am. Podiatr. Med. Assoc. 2011, 101(1), 35-40; https://doi.org/10.7547/1010035 - 1 Jan 2011

Cited by 6 | Viewed by 49

Abstract

Background: Since the implementation of highly active antiretroviral therapy (HAART), the life expectancy of patients with human immunodeficiency virus (HIV) has significantly increased. This is likely to cause changes in podiatric medical manifestations, such as plantar verrucae, in this population. Methods: Attendees at [...] Read more.

Background: Since the implementation of highly active antiretroviral therapy (HAART), the life expectancy of patients with human immunodeficiency virus (HIV) has significantly increased. This is likely to cause changes in podiatric medical manifestations, such as plantar verrucae, in this population. Methods: Attendees at a San Francisco street fair in 2008 provided information about HIV status and the presence of verrucae via a survey. A total of 504 surveys were analyzed and compared with 1995 data, before HAART implementation. We examined if there was a statistically significant change in the increased likelihood of plantar verrucae in HIV-positive patients from 1995 to 2008. Then we examined the likelihood of HIVpositive patients (compared to HIV-negative patients) presenting with plantar verrucae in 2008, by using logistic regression, and controlling for age, sex, and race/ethnicity. Results: Patients with HIV infection were 5.2 times more likely to present with plantar verrucae compared to patients without HIV infection in 2008 (95% confidence interval, 2.5–11.0, P , .0001) and 10.0 times more likely in 1995 (95% confidence interval, 3.4– 29.0, P , .0001). This decrease in likelihood over time was not statistically significantly different (P = .33). Logistic regression analysis controlling for the covariates of age, race, and sex showed that patients with HIV in 2008 were 4.5 times more likely to present with verrucae compared to patients without HIV (95% confidence interval, 2.1–9.9, P = .0002). Conclusions: Patients with HIV infection in 2008 are still significantly more likely to present with plantar verrucae after controlling for age, race, and sex. This increased likelihood has not changed significantly across time. Because HAART has increased the life expectancy of patients with HIV, this group of patients with plantar verrucae will continue to represent a significant population in the practice of podiatric medicine. (J Am Podiatr Med Assoc 101(1): 35-40, 2011). Full article

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Soft-Tissue Movement at the Foot During the Stance Phase of Walking

by Shing-Jye Chen, Mukherjee Mukul and Li-Shan Chou

J. Am. Podiatr. Med. Assoc. 2011, 101(1), 25-34; https://doi.org/10.7547/1010025 - 1 Jan 2011

Cited by 5 | Viewed by 42

Abstract

Background: Soft-tissue movement has challenged the use of noninvasive skin-based markers that are assumed to be rigidly attached to the underlying bony landmarks. We assessed soft-tissue movement in multiple foot segments by calculating the relative changes in the intermarker distances of the hindfoot, [...] Read more.

Background: Soft-tissue movement has challenged the use of noninvasive skin-based markers that are assumed to be rigidly attached to the underlying bony landmarks. We assessed soft-tissue movement in multiple foot segments by calculating the relative changes in the intermarker distances of the hindfoot, midfoot, and forefoot segments during the early, middle, and late stances of walking compared with the intermarker distances measured while participants remained still during standing. Methods: Seven healthy young adults with no previous lower-limb injury were tested while walking barefoot at a comfortable pace. Skin-based markers were placed on three foot regions (hindfoot-calcaneus, midfoot-navicular, and forefoot–first to fifth metatarsals). A motion system sampled at 120 Hz was used to capture the foot markers during the stance phase of walking. Results: Soft-tissue movement was found in the forefoot region characterized by shortened distances, specifically during early (breaking) stance and late (propulsion) stance. In the hindfoot region, soft-tissue movement was characterized by shortened and elongated distances during the early and late stance periods, respectively. All of the foot regions showed the least intermarker distance changes during midstance. Conclusions: The dynamics of soft-tissue movement in multiple foot segments were characterized by the greatest changes in the intermarker distances in the forefoot and hindfoot during the early and late stance phases and the least changes in the foot segments during midstance. The results provide a feasible and accessible measurement for assessing soft-tissue movement in the foot when skin-based motion markers are used. (J Am Podiatr Med Assoc 101(1): 25-34, 2011). Full article

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Plantar Pressures in Children With and Without Sever’s Disease

by Ricardo Becerro de Bengoa Vallejo, Marta Elena Losa Iglesias, David Rodríguez Sanz, Juan Carlos Prados Frutos, Paloma Salvadores Fuentes and José López Chicharro

J. Am. Podiatr. Med. Assoc. 2011, 101(1), 17-24; https://doi.org/10.7547/1010017 - 1 Jan 2011

Cited by 30 | Viewed by 65

Abstract

Background: A case-control study was conducted to compare static plantar pressures and distribution of body weight across the two lower limbs, as well as the prevalence of gastrocnemius soleus equinus, in children with and without calcaneal apophysitis (Sever’s disease). Methods: The participants were [...] Read more.

Background: A case-control study was conducted to compare static plantar pressures and distribution of body weight across the two lower limbs, as well as the prevalence of gastrocnemius soleus equinus, in children with and without calcaneal apophysitis (Sever’s disease). Methods: The participants were 54 boys enrolled in a soccer academy, of which eight were lost to follow-up. Twenty-two boys with unilateral Sever’s disease comprised the Sever’s disease group and 24 healthy boys constituted a control group. Plantar pressure data were collected using pedobarography, and gastrocnemius soleus equinus was assessed. Results: Peak pressure and percentage of body weight supported were significantly higher in the symptomatic feet of the Sever’s disease group than in the asymptomatic feet of the Sever’s disease group and the control group. Every child in the Sever’s disease group had bilateral gastrocnemius equinus, while nearly all children in the control group had no equinus. Conclusions: High plantar foot pressures are associated with Sever’s disease, although it is unclear whether they are a predisposing factor or a result of the condition. Gastrocnemius equinus may be a predisposing factor for Sever’s disease. Further research is needed to identify other factors involved in the disease and to better understand the factors that contribute to abnormal distribution of body weight in the lower limbs. (J Am Podiatr Med Assoc 101(1): 17-24, 2011). Full article

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Effect of Foot Orthoses Contour on Pain Perception in Individuals with Patellofemoral Pain

by Thomas G. McPoil, Bill Vicenzino and Mark W. Cornwall

J. Am. Podiatr. Med. Assoc. 2011, 101(1), 7-16; https://doi.org/10.7547/1010007 - 1 Jan 2011

Cited by 16 | Viewed by 44

Abstract

Background: Foot orthoses have been described as a possible intervention for individuals with patellofemoral joint pain. No study has attempted to quantify the perceived comfort and support of foot orthoses when used as an intervention for patellofemoral joint pain. Methods: A randomized case-control [...] Read more.

Background: Foot orthoses have been described as a possible intervention for individuals with patellofemoral joint pain. No study has attempted to quantify the perceived comfort and support of foot orthoses when used as an intervention for patellofemoral joint pain. Methods: A randomized case-control trial with crossover between contoured and flat orthoses was conducted on ten individuals with patellofemoral pain and ten healthy participants. All of the participants completed a comfort-support assessment and had inshoe plantar pressure data collected before and after 3 weeks of wear. A 1-week washout period was used to minimize any continued treatment effect between orthotics testing. The patellofemoral pain group also completed a numeric rating scale to assess pain reduction after using each orthosis. Results: All of the participants perceived that greater support was provided by the contoured orthoses in the heel and arch regions. Even with a 30% difference in material hardness between the two orthoses, all of the participants rated cushioning as equivalent. Six individuals in the patellofemoral pain group reported a clinically significant reduction in knee pain as a result of wearing foot orthoses. Conclusions: A key factor in the selection of contoured foot orthoses versus flat inserts is the amount of support that an individual perceives in the arch and heel regions. In addition, clinicians using foot orthoses as an intervention for patellofemoral pain should expect an individualistic, nonsystematic response. (J Am Podiatr Med Assoc 101(1): 7- 16, 2011). Full article

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Acute Phase Reactants Predict the Risk of Amputation in Diabetic Foot Infection

by Baris Akinci, Serkan Yener, Sena Yesil, Nur Yapar, Yasin Kucukyavas and Firat Bayraktar

J. Am. Podiatr. Med. Assoc. 2011, 101(1), 1-6; https://doi.org/10.7547/1010001 - 1 Jan 2011

Cited by 39 | Viewed by 40

Abstract

Background: Prediction of amputation would aid clinicians in the management of diabetic foot infections. We aimed to assess the predictive value of baseline and posttreatment levels of acute phase reactants in the outcome of patients with diabetic foot infections. Methods: We collected data [...] Read more.

Background: Prediction of amputation would aid clinicians in the management of diabetic foot infections. We aimed to assess the predictive value of baseline and posttreatment levels of acute phase reactants in the outcome of patients with diabetic foot infections. Methods: We collected data prospectively during minimum follow-up of 6 months in patients with infected diabetic foot ulcers hospitalized in Dokuz Eylul University Hospital between January 1, 2003, and January 1, 2008. After excluding patients who did not attend the hospital for follow-up visits regularly (n = 36), we analyzed data from 165 foot ulcer episodes. Results: Limb ischemia and osteomyelitis were much more frequent in patients who underwent amputation. Wagner grade, which assesses ulcer depth and the presence of osteomyelitis or gangrene, was higher in patients who needed amputation. Ulcer size was slightly larger in the amputation group. Baseline and post-treatment C-reactive protein levels, erythrocyte sedimentation rates, white blood cell counts, and platelet counts were significantly elevated in patients who underwent amputation. Albumin levels were significantly suppressed in the amputation group. Univariate analysis showed that a 1-SD increase in baseline and post-treatment C-reactive protein levels, erythrocyte sedimentation rates, and white blood cell counts and a 1-SD decrease in post-treatment albumin levels were significantly associated with increased risk of amputation. Post-treatment C-reactive protein level was strongly associated with amputation risk. Conclusions: Circulating levels of acute phase reactants were associated with amputation risk in diabetic foot infections. (J Am Podiatr Med Assoc 101(1): 1-6, 2011) Full article

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J. Am. Podiatr. Med. Assoc., Volume 101, Issue 1 (01 2011) – 12 articles , Pages 1-91

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