Journal of the American Podiatric Medical Association

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by Michael J. King

J. Am. Podiatr. Med. Assoc. 2011, 101(6), 538; https://doi.org/10.7547/1010538 - 1 Nov 2011

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As I write this message, I’ve just returned from a phenomenally successful Annual Scientific Meeting in Boston [...] Full article

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Foot Salvage After Loss of the First and Second Metatarsal Rays with a Free Fibular Osteocutaneous Flap

by Christopher J. Salgado, Chih-Hung Lin, David A. Fuller, Alissa N. Duncan, Liliana Camison and Samir Mardini

J. Am. Podiatr. Med. Assoc. 2011, 101(6), 531-536; https://doi.org/10.7547/1010531 - 1 Nov 2011

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Abstract

Severely comminuted fractures of the metatarsal bones with significant bone and softtissue loss have commonly subjected patients to proximal amputation procedures. We describe two patients who experienced high-energy traumatic injuries to their limbs that resulted in significant destruction of their first and second [...] Read more.

Severely comminuted fractures of the metatarsal bones with significant bone and softtissue loss have commonly subjected patients to proximal amputation procedures. We describe two patients who experienced high-energy traumatic injuries to their limbs that resulted in significant destruction of their first and second metatarsal bones with overlying soft-tissue trauma not amenable to local coverage. In both cases, a vascularized free fibular osteocutaneous flap was used to reconstruct the metatarsal bone defect and traumatized soft tissues so that a proximal amputation was avoided. At an average of 14 months of follow-up, both patients had recovered well and regained independent ambulation, with one patient being able to play soccer. We show that the free fibular osteoseptocutaneous flap is useful in reconstructing significant metatarsal bone defects and in avoiding amputations in this patient population. The skin component of the flap may be used to fill soft-tissue losses, and the fibula bone may be osteotomized so that more than one ray may be reconstructed. (J Am Podiatr Med Assoc 101(6): 531- 536, 2011) Full article

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The Medial Oblique Shell Inclination Technique. A Method to Increase Subtalar Supination Moments in Foot Orthoses

by Paul Harradine, Simon Collins, Chris Webb and Lawrence Bevan

J. Am. Podiatr. Med. Assoc. 2011, 101(6), 523-530; https://doi.org/10.7547/1010523 - 1 Nov 2011

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Abstract

A medially deviated axis has been cited as an etiologic factor in increasing pronatory moments across the subtalar joint axis. Orthoses are often used to reduce these pronatory moments, aiming to off-load related injured structures. By aligning the posting or incline of an [...] Read more.

A medially deviated axis has been cited as an etiologic factor in increasing pronatory moments across the subtalar joint axis. Orthoses are often used to reduce these pronatory moments, aiming to off-load related injured structures. By aligning the posting or incline of an orthosis shell medial to the axis and parallel to it, the amount of moments applied will be theoretically greater than if prescribed at a less-than-optimal angle. We first published the medial oblique shell inclination as a method to increase supinatory moments to a medially deviated subtalar joint axis in 2008. This paper summarizes the theoretical reasons for use and introduces original methods of construction. (J Am Podiatr Med Assoc 101(6): 523-530, 2011) Full article

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Surgical Treatment of Diaphyseal Stress Fractures of the Fifth Metatarsal in Competitive Athletes. Long-Term Follow-Up and Computerized Pedobarographic Analysis

by Marko Pecina, Ivan Bojanic, Tomislav Smoljanovic, Alan Ivkovic, Maja Mirkovic and Miroslav Jelic

J. Am. Podiatr. Med. Assoc. 2011, 101(6), 517-522; https://doi.org/10.7547/1010517 - 1 Nov 2011

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Abstract

Background: Proximal diaphyseal stress fractures of the fifth metatarsal are common in athletes. Conservative treatment has been shown to result in high rates of delayed union, nonunion, and refracture, so internal fixation has become the treatment of choice in competitive athletes. Methods: Twenty [...] Read more.

Background: Proximal diaphyseal stress fractures of the fifth metatarsal are common in athletes. Conservative treatment has been shown to result in high rates of delayed union, nonunion, and refracture, so internal fixation has become the treatment of choice in competitive athletes. Methods: Twenty top-level athletes with diaphyseal stress fractures fixed with intramedullary malleolar screws were evaluated. Functional outcome was assessed by American Orthopaedic Foot and Ankle Society midfoot score. Static and dynamic maximum vertical force and peak plantar pressures were evaluated with a computerized pedobarograph. Results: Mean follow-up from surgery to interview was 10.3 years (range, 3.5–19.0 years). Clinical healing was 95%, and there has been one refracture (5%). The mean time from surgery to return to sport was 9 weeks (range, 5–14 weeks). Twelve athletes (60%) returned to a higher level of training, 7 (35%) to the same level, and 1 (5%) to a lower level compared with the level of training before injury. Average American Orthopaedic Foot and Ankle Society midfoot score was 93.8 (range, 85–100). During the computerized pedobarographic evaluations, 18 patients (90%) presented with varus of the metatarsus and the midfoot and 2 (10%) presented with a normal plantigrade foot. Conclusions: Intramedullary malleolar screws can yield reliable and effective healing of fifth metatarsal stress fractures in athletes. Varus of the metatarsus and the midfoot were predisposing factors for stress fractures in this population of competitive athletes, and all were recommended to wear orthoses until their competitive careers were completed. (J Am Podiatr Med Assoc 101(6): 517-522, 2011) Full article

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In-Shoe Plantar Pressure Distribution in Nonneuropathic Type 2 Diabetic Patients in Singapore

by Jasper W. K. Tong, U. Rajendra Acharya, Kuang C. Chua and Peck H. Tan

J. Am. Podiatr. Med. Assoc. 2011, 101(6), 509-516; https://doi.org/10.7547/1010509 - 1 Nov 2011

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Abstract

Background: We sought to establish the in-shoe plantar pressure distribution during normal level walking in type 2 diabetic patients of Chinese, Indian, and Malay descent without clinical evidence of peripheral neuropathy. Methods: Thirty-five patients with type 2 diabetes mellitus without loss of tactile [...] Read more.

Background: We sought to establish the in-shoe plantar pressure distribution during normal level walking in type 2 diabetic patients of Chinese, Indian, and Malay descent without clinical evidence of peripheral neuropathy. Methods: Thirty-five patients with type 2 diabetes mellitus without loss of tactile sensation and foot deformities and 38 nondiabetic individuals in a control group had inshoe plantar pressures collected. Maximum peak pressure and peak pressure-time integral of each foot were analyzed as separate variables and were masked into 13 areas. Differences in pressure variables were assessed by analysis of covariance, adjusting for relevant covariates at the 95% confidence interval. Results: No signiﬁcant differences were noted in maximum peak pressures after adjusting for sex, race, age, height, and body mass. However, patients with diabetes mellitus had signiﬁcantly higher mean ± SD pressure-time integrals at the right whole foot (309.50 ± 144.17 kPa versus 224.06 ± 141.70 kPa, P < .05) and ﬁrst metatarsal (198.65 ± 138.27 kPa versus 121.54 ± 135.91 kPa, P < .05) masked areas than did those in the control group after adjustment. Conclusions: Patients without clinical observable signs of foot deformity (implying absence of motor neuropathy) and sensory neuropathy had similar in-shoe maximum peak pressures as controls. This finding supported the notion that either component of neuropathy needs to be present before plantar pressures are elevated. Patients with diabetes mellitus demonstrated greater pressure-time integrals, implying that this variable might be the first clinical sign observable even before peripheral neuropathy could be tested. (J Am Podiatr Med Assoc 101(6): 509-516, 2011) Full article

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Anatomical Variations of Peroneal Muscles. A Cadaver Study in an Indian Population and a Review of the Literature

by Prakash, Chinnaswamy Narayanswamy, Deepak Kumar Singh, Thimmiah Rajini, Jayanthi Venkatiah and Gajendra Singh

J. Am. Podiatr. Med. Assoc. 2011, 101(6), 505-508; https://doi.org/10.7547/1010505 - 1 Nov 2011

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Abstract

Background: Persistent lateral ankle pain is a common presentation in clinics. Various studies on anatomical variations of the peroneal compartment muscles, including the peroneus quartus muscle, have been reported in different populations. However, such studies are rarely from India. Hence, the present study [...] Read more.

Background: Persistent lateral ankle pain is a common presentation in clinics. Various studies on anatomical variations of the peroneal compartment muscles, including the peroneus quartus muscle, have been reported in different populations. However, such studies are rarely from India. Hence, the present study was undertaken on cadavers in an Indian population. Methods: The lateral compartments of the legs were dissected in 70 specimens to study the presence, origin, and insertion of accessory muscles. Different peroneal tendons were observed for tears and splits. Results: Three of 70 specimens (4.3%) showed prevalence of the peroneus quartus muscle. Twenty specimens (28.6%) had split or tear lesions of the peroneus brevis muscle. Presence of the peroneus quartus muscle in this Indian population was relatively low compared with that in previous reports in English and American populations (6.6%–21.9%). Conclusions: Racial differences, cultural variations, and postural habits, along with different stages of evolution, may be factors contributing to different observations. Split lesions of the peroneus brevis tendon were six to seven times more prevalent than was presence of the peroneus quartus muscle, which implies that split or tear lesions of the peroneus brevis tendon are more frequently involved in the manifestation of persistent retromalleolar pain compared with complications arising out of presence of the peroneus quartus muscle. Hence, accurate knowledge of presence of the peroneus quartus muscle in different populations is important because it can also be used in grafting and reconstruction in foot and ankle surgery. (J Am Podiatr Med Assoc 101(6): 505-508, 2011) Full article

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Quantification of Skin Marker Movement at the Malleoli and Talar Heads

by Ivan Birch and Kevin Deschamps

J. Am. Podiatr. Med. Assoc. 2011, 101(6), 497-504; https://doi.org/10.7547/1010497 - 1 Nov 2011

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Abstract

Background: Quantifying subtalar joint kinematics during locomotion is a major challenge but is critical to understanding foot function. The difficulty of modeling the subtalar joint is demonstrated by the plethora of three-dimensional multisegment foot models lacking specific consideration of the subtalar joint. Scientific [...] Read more.

Background: Quantifying subtalar joint kinematics during locomotion is a major challenge but is critical to understanding foot function. The difficulty of modeling the subtalar joint is demonstrated by the plethora of three-dimensional multisegment foot models lacking specific consideration of the subtalar joint. Scientific attempts to develop an adequate method of quantifying subtalar joint kinematics should include investigation of the movement of skin-mounted markers. This study reports on a single-subject investigation into this topic. Methods: Radiopaque markers were attached to the skin overlying the medial and lateral malleoli and the medial and lateral talar heads of a single subject. Frontal, sagittal, and transverse plane radiographs were taken with the foot in the fully pronated and fully supinated positions. Parallax corrected measurements were taken of the displacement of the markers from the bony landmarks. Measurements were also taken of the effect of these displacements on angular calculations. Results: Skin movement at the four anatomical locations was not uniform, with displacements varying from 0.61 to 22.18 mm. Movement of the malleolar markers was found to be less than that of the talar head markers. The distortion of angular measurements caused by movement of the skin markers relative to the bony landmarks was found to be only 1° in the sagittal and transverse planes and 58 in the frontal plane. Conclusions: For this subject, skin-mounted markers could be used to assess subtalar joint motion. Further studies are necessary to investigate the implications of these findings to the wider population. (J Am Podiatr Med Assoc 101(6): 497-504, 2011) Full article

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An Open-label, Three-Arm Pilot Study of the Safety and Efficacy of Topical Microcyn Rx Wound Care Versus Oral Levofloxacin versus Combined Therapy for Mild Diabetic Foot Infections

by Adam Landsman, Peter A. Blume, Douglas A. Jordan, Jr., Dean Vayser and Andres Gutierrez

J. Am. Podiatr. Med. Assoc. 2011, 101(6), 484-496; https://doi.org/10.7547/1010484 - 1 Nov 2011

Cited by 27 | Viewed by 68

Abstract

Background: This randomized, prospective, multicenter, open-label study was designed to test whether a topical, electrolyzed, superoxidized solution (Microcyn Rx) is a safe and effective treatment for mildly infected diabetic foot ulcers. Methods: Sixty-seven patients with ulcers were randomized into three groups. Patients with [...] Read more.

Background: This randomized, prospective, multicenter, open-label study was designed to test whether a topical, electrolyzed, superoxidized solution (Microcyn Rx) is a safe and effective treatment for mildly infected diabetic foot ulcers. Methods: Sixty-seven patients with ulcers were randomized into three groups. Patients with wounds irrigated with Microcyn Rx alone were compared with patients treated with oral levofloxacin plus normal saline wound irrigation and with patients treated with oral levofloxacin plus Microcyn Rx wound irrigation. Patients were evaluated on day 3, at the end of treatment on day 10 (visit 3), and 14 days after completion of therapy for test of cure (visit 4). Results: In the intention-to-treat sample at visit 3, the clinical success rate was higher in the Microcyn Rx alone group (75.0%) than in the saline plus levofloxacin group (57.1%) or in the Microcyn Rx plus levofloxacin group (64.0%). Results at visit 4 were similar. In the clinically evaluable population, the clinical success rate at visit 3 (end of treatment) for patients treated with Microcyn Rx alone was 77.8% versus 61.1% for the levofloxacin group. The clinical success rate at visit 4 (test of cure) for patients treated with Microcyn Rx alone was 93.3% versus 56.3% for levofloxacin plus saline–treated patients. This study was not statistically powered, but the high clinical success rate (93.3%) and the P value (P = .033) suggest that the difference is meaningfully positive for Microcyn Rx– treated patients. Conclusions: Microcyn Rx is safe and at least as effective as oral levofloxacin for mild diabetic foot infections. (J Am Podiatr Med Assoc 101(6): 484-496, 2011) Full article

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Validation of the Talar–Second Metatarsal Angle as a Standard Measurement for Radiographic Evaluation

by Michael E. Graham, Avanthi Chikka and Paul C. Jones

J. Am. Podiatr. Med. Assoc. 2011, 101(6), 475-483; https://doi.org/10.7547/1010475 - 1 Nov 2011

Cited by 10 | Viewed by 55

Abstract

Background: Radiographs provide valuable information for assessing osseous foot deformities and aid in accurate diagnosis. The radiographic angular measurements can be used to establish a relationship between the forefoot and the hindfoot that will present valuable information about normal versus pathologic alignment of [...] Read more.

Background: Radiographs provide valuable information for assessing osseous foot deformities and aid in accurate diagnosis. The radiographic angular measurements can be used to establish a relationship between the forefoot and the hindfoot that will present valuable information about normal versus pathologic alignment of the foot. The talar–first metatarsal (T1M) angle is frequently used as one of these angles in this capacity; however, there are limitations to the anteroposterior T1M angle. We present a more consistent, reproducible, and accurate measurement for determining foot abnormalities in the transverse plane using the T2M angle instead of the T1M angle. Methods: Seventy feet in 35 participants (12 men and 23 women) were considered for this study. Individuals were selected on the basis of the established inclusion and exclusion criteria. Anteroposterior radiographs were taken in the angle and base of gait, the neutral calcaneal stance position (NCSP), and the resting calcaneal stance position (RCSP). Three observers measured these angles using three different methods. Results: The mean ± SD T2M angle was 2.95° ± 7.16° in NCSP and 18.61° ± 7.21° in RCSP. No significant differences were found among the measurements made by the three observers using slightly varying procedures in NCSP and RCSP (P > .05). The intraclass correlation coefficients among the measurements were 0.905 in NCSP and 0.937 in RCSP. Bland-Altman plots showed very good agreement between the measurements made by the three observers. Conclusions: The anteroposterior T2M angle gives a consistent and reproducible measurement that provides accurate information about foot alignment. (J Am Podiatr Med Assoc 101(6): 475-483, 2011) Full article

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Hallux Limitus and Its Relationship with the Internal Rotational Pattern of the Lower Limb

by Guillermo Lafuente, Pedro V. Munuera, Gabriel Dominguez, Maria Reina and Blanca Lafuente

J. Am. Podiatr. Med. Assoc. 2011, 101(6), 467-474; https://doi.org/10.7547/1010467 - 1 Nov 2011

Cited by 7 | Viewed by 54

Abstract

Background: The aims of this study were to determine whether individuals with mild hallux limitus show a diminished capacity of internal rotation of the lower limb compared with those without hallux limitus and whether individuals with mild hallux limitus show an increased foot [...] Read more.

Background: The aims of this study were to determine whether individuals with mild hallux limitus show a diminished capacity of internal rotation of the lower limb compared with those without hallux limitus and whether individuals with mild hallux limitus show an increased foot progression angle. Methods: In 80 study participants (35 with normal feet and 45 with mild hallux limitus), the capacity of internal rotation of the lower limb (internal rotational pattern), hallux dorsiflexion, and the foot progression angle were measured. The values for internal rotational pattern and foot progression angle were compared between the two study groups, and the correlations between these variables were studied. Results: The capacity of internal rotation of the lower limb was significantly lesser in patients with mild hallux limitus (P < .0001). There was no significant difference in foot progression angle between the two groups (P = .115). The Spearman correlation coefficient was 0.638 (P < .0001) for the relationship between internal rotational pattern and hallux dorsiflexion. Conclusions: Patients with mild hallux limitus had a lesser capacity of internal rotation of the lower extremity than did individuals in the control group. The more limited the internal rotational pattern of the lower limb, the more limited was hallux dorsiflexion. The foot progression angle was similar in both groups. (J Am Podiatr Med Assoc 101(6): 467-474, 2011) Full article

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J. Am. Podiatr. Med. Assoc., Volume 101, Issue 6 (11 2011) – 10 articles , Pages 467-556

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