Journal of the American Podiatric Medical Association

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Open AccessArticle

Giving Thanks

by Michael J. King

J. Am. Podiatr. Med. Assoc. 2012, 102(1), 83; https://doi.org/10.7547/1020083 - 1 Jan 2012

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Abstract

‘‘Leaders are good at giving encouragement, and they are never satisfied.’’ [...] Full article

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Open AccessArticle

Pseudarthrosis After Percutaneous Distal Osteotomy in Hallux Valgus Surgery. A Case Report

by Nicolo Martinelli, Francesco Cancilleri, Gianluca Marineo, Andrea Marinozzi, Umile Giuseppe Longo and Vincenzo Denaro

J. Am. Podiatr. Med. Assoc. 2012, 102(1), 78-82; https://doi.org/10.7547/1020078 - 1 Jan 2012

Cited by 3 | Viewed by 56

Abstract

Nonunion of the first metatarsal after hallux valgus surgery is a rare complication that often results in significant pain and disability requiring surgical management. We report the case of a 42-year-old woman who developed a pseudarthrosis of the first metatarsal after percutaneous retrocapital [...] Read more.

Nonunion of the first metatarsal after hallux valgus surgery is a rare complication that often results in significant pain and disability requiring surgical management. We report the case of a 42-year-old woman who developed a pseudarthrosis of the first metatarsal after percutaneous retrocapital distal osteotomy of the first metatarsal for a mild hallux valgus deformity. The operative treatment consisted of debridement of fibrous nonunion with plating followed by application of pulsed electromagnetic fields (PEMF) with an external device. Full article

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Open AccessArticle

Entrapment Involving the Lateral Calcaneal Branch of the Sural Nerve. A Case Study

by Michael Heaslet and Deep Patel

J. Am. Podiatr. Med. Assoc. 2012, 102(1), 75-77; https://doi.org/10.7547/1020075 - 1 Jan 2012

Cited by 5 | Viewed by 73

Abstract

Sural nerve impingement is frequently reported and often arises from localized trauma but much less understood are its mechanical etiologies. This case report describes the effects of local traction on the lateral calcaneal branch of the sural nerve. The association is confirmed anatomically [...] Read more.

Sural nerve impingement is frequently reported and often arises from localized trauma but much less understood are its mechanical etiologies. This case report describes the effects of local traction on the lateral calcaneal branch of the sural nerve. The association is confirmed anatomically and symptoms are alleviated with a heel lift. Full article

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Open AccessArticle

Dislocation of the Fifth Metatarsal Base Following Partial Fourth and Fifth Ray Amputation. A Case Report

by Russell M. Carlson, Nicholas C. Smith, Rodney M. Stuck and Ronald A. Sage

J. Am. Podiatr. Med. Assoc. 2012, 102(1), 71-74; https://doi.org/10.7547/1020071 - 1 Jan 2012

Cited by 3 | Viewed by 71

Abstract

This case report presents a rare postoperative dislocation of the fifth metatarsal base following a healed open partial fourth and fifth ray amputation of a 62-year-old male veteran with poorly controlled diabetes mellitus. The dislocated fifth metatarsal base subsequently created a chronic ulceration [...] Read more.

This case report presents a rare postoperative dislocation of the fifth metatarsal base following a healed open partial fourth and fifth ray amputation of a 62-year-old male veteran with poorly controlled diabetes mellitus. The dislocated fifth metatarsal base subsequently created a chronic ulceration and an inhibition of normal gait. The patient was taken to the operating room where the fifth metatarsal base was resected with transfer of the peroneus brevis tendon to the cuboid to maintain biomechanical stability. (J Am Podiatr Med Assoc 102(1): 71-74, 2012) Full article

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Open AccessArticle

Normal Genetic Variation of the Human Foot: Part 1. The Paradox of Normal Anatomical Alignment in an Evolutionary Epigenetic Context

by Greg Quinn

J. Am. Podiatr. Med. Assoc. 2012, 102(1), 64-70; https://doi.org/10.7547/1020064 - 1 Jan 2012

Cited by 2 | Viewed by 65

Abstract

Molecular genetics is changing our understanding of the developmental translation of genotype to phenotype between and within different phylogenetic groups. Together with a growing understanding of our own evolutionary relationships to common ancestors, the epigenetic processes involved enforce a reexamination of what is [...] Read more.

Molecular genetics is changing our understanding of the developmental translation of genotype to phenotype between and within different phylogenetic groups. Together with a growing understanding of our own evolutionary relationships to common ancestors, the epigenetic processes involved enforce a reexamination of what is regarded as a normal foot structure. A revised populationist approach is proposed and supported by paleoanthropologic evidence that reflects a picture of emerging suitability for bipedalism that is driven by natural genetic divergence. (J Am Podiatr Med Assoc 102(1): 64-70, 2012) Full article

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Comparative Analysis of Moral Distress and Values of the Work Organization Between American and Spanish Podiatric Physicians

by Marta Elena Losa Iglesias, Ricardo Becerro de Bengoa Vallejo, Paloma Salvadores Fuentes and Michael J. Trepal

J. Am. Podiatr. Med. Assoc. 2012, 102(1), 57-63; https://doi.org/10.7547/1020057 - 1 Jan 2012

Cited by 9 | Viewed by 50

Abstract

Background: Moral distress is a stress symptom arising from situations that involve ethical dimensions where the health-care provider believes that he or she is unable to preserve all interests and values at stake. The aims of this study were to evaluate the impact [...] Read more.

Background: Moral distress is a stress symptom arising from situations that involve ethical dimensions where the health-care provider believes that he or she is unable to preserve all interests and values at stake. The aims of this study were to evaluate the impact of, and identify possible differences in, moral distress in podiatric physicians in the United States and Spain and to determine the ethical principles most closely related to moral distress. Methods: A 2008 e-mail survey of 93 US podiatric physicians and 93 Spanish podiatric physicians (N=186) presented statements about different ethical dilemmas, values, and goals in the workplace. Results: Although moral distress is strongly present across the sample for all of the questions, the US sample shows higher levels of any kind of moral distress concerning questions about patients’ treatment and economic constraints, overload of paperwork, and acting against one’s conscience. In the US sample, 91.4% of physicians agreed mostly or completely with the statement that they often had to compromise their own values to cope with the demands of the workplace; 89.25% of US podiatric physicians indicated that their own professional values were congruent with the values of the organization; and a similar percentage (77.5%) reported a strong identification with the goals and framework of their work organization. The Spanish sample had similar results. Conclusions: The results underline the significance of moral distress for both samples, mainly related to time constraints and organizational aspects concerning patients and lack of resources. (J Am Podiatr Med Assoc 102(1): 57-63, 2012) Full article

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Open AccessArticle

Podiatric Health Needs of Homeless Populations as a Public Health Concern

by Bright Chen, Analiza Mitchell and David Tran

J. Am. Podiatr. Med. Assoc. 2012, 102(1), 54-56; https://doi.org/10.7547/1020054 - 1 Jan 2012

Cited by 5 | Viewed by 45

Abstract

Background: Foot and ankle health among the homeless is an important public health concern. There are limited studies done thus far on foot and ankle conditions and the podiatric medical needs of homeless populations. A literature review was undertaken to evaluate any studies [...] Read more.

Background: Foot and ankle health among the homeless is an important public health concern. There are limited studies done thus far on foot and ankle conditions and the podiatric medical needs of homeless populations. A literature review was undertaken to evaluate any studies published about the lower-extremity health needs among the homeless. Methods: We did a literature search through PubMed, the US National Library of Medicine’s database of biomedical citations and abstracts for relevant publications from 1988 through 2008. We also searched the references cited in the articles found for any studies relevant to podiatric needs for homeless populations. Results: We found three relevant articles that addressed the needs of podiatric care for the homeless. The articles highlighted the community health importance of foot care for homeless populations, especially in helping prevent potentially limb-threatening pathologies. Conclusions: The small number of studies published so far all emphasize the major public health need for podiatric care among homeless populations. More studies are needed to help address this important public health concern. (J Am Podiatr Med Assoc 102(1): 54-56, 2012) Full article

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Open AccessArticle

Hallux Interphalangeal Joint Range of Motion in Feet with and Without Limited First Metatarsophalangeal Joint Dorsiflexion

by Pedro V. Munuera, Piedad Trujillo and Israel Güiza

J. Am. Podiatr. Med. Assoc. 2012, 102(1), 47-53; https://doi.org/10.7547/1020047 - 1 Jan 2012

Cited by 9 | Viewed by 77

Abstract

Background: This work was designed to assess the degree of correlation between hallux interphalangeal joint and first metatarsophalangeal joint dorsiflexion and to compare the mobility of the hallux interphalangeal joint between participants with and without limited first metatarsophalangeal joint dorsiflexion (hallux limitus). Methods: [...] Read more.

Background: This work was designed to assess the degree of correlation between hallux interphalangeal joint and first metatarsophalangeal joint dorsiflexion and to compare the mobility of the hallux interphalangeal joint between participants with and without limited first metatarsophalangeal joint dorsiflexion (hallux limitus). Methods: Dorsiflexion of the hallux interphalangeal joint was measured in 60 normal feet and in 60 feet with hallux limitus to find correlations with first metatarsophalangeal joint dorsiflexion with the Spearman correlation coefficient and a simple linear regression equation. In addition, movement of the hallux interphalangeal joint was compared between normal and hallux limitus feet with the Mann-Whitney U test. Results: Significant differences were found between the groups in mean ± SD interphalangeal joint dorsiflexion (control group: 1.17° ± 2.50°; hallux limitus group: 10.65° ± 8.24°; P < .001). A significant inverse correlation was found between first metatarsophalangeal joint dorsiflexion and hallux interphalangeal joint dorsiflexion (ρ = 0.766, P < .001), and the regression equation from which predictions could be made is the following: hallux interphalangeal joint dorsiflexion = 27.17 – 0.381 × first metatarsophalangeal joint dorsiflexion. Conclusions: Hallux interphalangeal joint dorsiflexion was greater in feet with hallux limitus than in normal feet. There was a strong inverse correlation between first metatarsophalangeal joint dorsiflexion and hallux interphalangeal joint dorsiflexion. (J Am Podiatr Med Assoc 102(1): 47-53, 2012) Full article

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Open AccessArticle

Transformative Learning. Empathy and Multicultural Awareness in Podiatric Medical Education

by Craig M. Elliott II, Robert J. Toomey III, Brooke A. Goodman and Peter Barbosa

J. Am. Podiatr. Med. Assoc. 2012, 102(1), 39-46; https://doi.org/10.7547/1020039 - 1 Jan 2012

Cited by 9 | Viewed by 58

Abstract

Background: Short-term medical missions are common in medical educational settings and could possibly affect student learning. Little research has been conducted about the potential of these missions on students’ transformative learning, in particular as it relates to empathy and multicultural awareness. Methods: Eight [...] Read more.

Background: Short-term medical missions are common in medical educational settings and could possibly affect student learning. Little research has been conducted about the potential of these missions on students’ transformative learning, in particular as it relates to empathy and multicultural awareness. Methods: Eight podiatric medical students who participated in short-term medical missions in 2008 and 2009 completed an electronic survey to investigate the effect of their experience as it relates to their learning. The empathy and multicultural awareness impact of the mission experience was emphasized. Qualitative questions in the survey were coded, themed, and triangulated with the quantitative responses. Results: Six students (75%) ‘‘strongly agreed’’ that participating in the medical mission was a significant positive experience in their podiatric medical training. Six students felt that their experiences in serving these communities increased their personal awareness of multicultural/diversity needs in general. All of the students agreed that they will become better podiatric physicians because of their experiences in the medical missions. The qualitative data also indicate that the experience had an effect on the students’ views of health care and increased empathy toward their patients. Conclusions: Short-term medical missions could play a significant role in the transformative learning experience in podiatric medical education. This could affect the empathy and multicultural awareness of podiatric medical students. Further and more extensive evaluations of the potential impact of short-term medical missions in podiatric medical education should be explored because it could influence curriculum and global health in the field of podiatric medicine. (J Am Podiatr Med Assoc 102(1): 39- 46, 2012) Full article

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Navicula Drop Test Ad Modum Brody. Does It Show How the Foot Moves Under Dynamic Conditions?

by Michael Skovdal Rathleff, Rasmus Gottschalk Nielsen and Uwe G. Kersting

J. Am. Podiatr. Med. Assoc. 2012, 102(1), 34-38; https://doi.org/10.7547/1020034 - 1 Jan 2012

Cited by 13 | Viewed by 50

Abstract

Background: Understanding foot motion and function during activity is essential for clinicians because different foot types may require different treatment or rehabilitation strategies. Brody introduced the static navicular drop (ND) test, which was meant as a quick clinical test to estimate foot pronation [...] Read more.

Background: Understanding foot motion and function during activity is essential for clinicians because different foot types may require different treatment or rehabilitation strategies. Brody introduced the static navicular drop (ND) test, which was meant as a quick clinical test to estimate foot pronation during dynamic conditions. However, how well static ND predicts dynamic ND during walking has never been investigated. The purpose of this study was to investigate how well static ND corresponds to dynamic measures of ND during treadmill walking. Methods: A custom video analysis system was used to assess dynamic ND during treadmill walking. The ND test ad modum Brody was used to evaluate static ND. Results: Static ND showed a significant correlation with dynamic ND (r = 0.357, r² = 0.127, P < .001). Navicular height at heel strike demonstrated a significant correlation with navicular height at the start position of static ND (r = 0.756, r² = 0.571 P < .001). Minimal navicular height during walking was significantly correlated with the end position of static ND (r = 0.951, r² = 0.904, P < .001). Conclusions: This study of asymptomatic individuals did not confirm that static ND can be used to individually predict dynamic ND during treadmill walking. It was demonstrated that the start position of Brody’s test is not well correlated with navicular height at heel strike, with this being the main reason for the weak relationship between static and dynamic ND measures. (J Am Podiatr Med Assoc 102(1): 34-38, 2012) Full article

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Open AccessArticle

Influence of Turnout on Foot Posture and Its Relationship to Overuse Musculoskeletal Injury in Professional Contemporary Dancers. A Preliminary Investigation

by Sonja N. Cimelli and Sarah A. Curran

J. Am. Podiatr. Med. Assoc. 2012, 102(1), 25-33; https://doi.org/10.7547/1020025 - 1 Jan 2012

Cited by 24 | Viewed by 46

Abstract

Background: The angle of turnout is thought to predispose professional dancers to overuse musculoskeletal injuries of the lower limb; yet, the influence of angle of turnout on foot posture is currently unknown. Methods: Twelve professional contemporary dancers (five women and seven men; mean [...] Read more.

Background: The angle of turnout is thought to predispose professional dancers to overuse musculoskeletal injuries of the lower limb; yet, the influence of angle of turnout on foot posture is currently unknown. Methods: Twelve professional contemporary dancers (five women and seven men; mean age, 26.8 years) were recruited. The angle of gait and angle of turnout were measured using a quasi-static clinical tracing method. Foot posture was assessed in the base of gait and angle of turnout using the Foot Posture Index. Each dancer completed a dance history and injury questionnaire. Results: The results show a tendency toward a pronated foot posture (mean, 98) in the angle of turnout position. A significant relationship was noted between the Foot Posture Index and angle of turnout (ρ = 0.933-0.968, P < .01) and between the number of reported injuries and change in foot posture in the angle of turnout (ρ = 0.789, P < .01) (right foot only). Twenty-eight injuries were reported; male dancers experienced a mean of 2.8 injuries and females a mean of 1.6 injuries. An inverse relationship was noted between age at training initiation and total reported injuries (r = −0.867, P < .01). All of the dancers reported a history of injury to the spine or lower limb, and 9 of the 12 reported an injury within the previous 12 months. Conclusions: Turnout is one of the most fundamental aspects of dance technique. This study suggests a trend toward pronation in angle of turnout and a link to lower-limb musculoskeletal injury. (J Am Podiatr Med Assoc 102(1): 25-33, 2012) Full article

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Open AccessArticle

Effect of a Metatarsal Pad on the Forefoot During Gait

by Koen L. M. Koenraadt, Niki M. Stolwijk, Dorine van Den Wildenberg, Jaak Duysens and Noël L. W. Keijsers

J. Am. Podiatr. Med. Assoc. 2012, 102(1), 18-24; https://doi.org/10.7547/1020018 - 1 Jan 2012

Cited by 21 | Viewed by 85

Abstract

Background: Metatarsal pads are frequently prescribed for patients with metatarsalgia to reduce pain under the distal metatarsal heads. Several studies showed reduced pain and reduced plantar pressure just distal to the metatarsal pad. However, only part of the pain reduction could be [...] Read more.

Background: Metatarsal pads are frequently prescribed for patients with metatarsalgia to reduce pain under the distal metatarsal heads. Several studies showed reduced pain and reduced plantar pressure just distal to the metatarsal pad. However, only part of the pain reduction could be explained by the decrease in plantar pressure under the forefoot. Therefore, an alternative hypothesis is proposed that pain relief is related to a widening of the foot and the creation of extra space between the metatarsal heads. This study focused on the effect of a metatarsal pad on the geometry of the forefoot by studying forefoot width and the height of the second metatarsal head. Methods: Using a motion analysis system, 16 primary metatarsalgia feet and 12 control feet were measured when walking with and without a metatarsal pad. Results: A significant mean increase of 0.60 mm in forefoot width during the stance phase was found when a metatarsal pad was worn. During midstance, the mean increase in forefoot width was 0.74 mm. In addition, walking with a metatarsal pad revealed an increase in the height of the second metatarsal head (mean, 0.62 mm). No differences were found between patients and controls. Conclusions: The combination of increased forefoot width and the height of the second metatarsal head produced by the metatarsal pad results in an increase in space between the metatarsal heads. This extra space could play a role in pain reduction produced by a metatarsal pad. (J Am Podiatr Med Assoc 102(1): 18-24, 2012) Full article

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Open AccessArticle

Arthrodesis of the First Metatarsophalangeal Joint. Comparison of Three Techniques

by Kalpesh Shah, Angelica Augustine, Robert Carter and Angus McFadyen

J. Am. Podiatr. Med. Assoc. 2012, 102(1), 13-17; https://doi.org/10.7547/1020013 - 1 Jan 2012

Cited by 14 | Viewed by 53

Abstract

Background: There are cadaveric and biomechanical studies comparing different methods of fixation for achieving arthrodesis in hallux rigidus. However, there are no comparative clinical studies. We compared the clinical and radiologic outcomes of first metatarsophalangeal joint fusion using three different techniques: lag [...] Read more.

Background: There are cadaveric and biomechanical studies comparing different methods of fixation for achieving arthrodesis in hallux rigidus. However, there are no comparative clinical studies. We compared the clinical and radiologic outcomes of first metatarsophalangeal joint fusion using three different techniques: lag screw, lag screw and circlage wire, and Memory staples. Methods: This was a retrospective study of 46 patients who underwent first metatarsophalangeal joint fusion. All of the operations were performed by experienced surgeons. Each patient had clinical and radiologic assessments postoperatively. Results: The three groups were matching in terms of demographic features and comorbidity. Intraobserver and interobserver reliability for radiographic metatarsophalangeal joint fusion was excellent. The mean time to clinical and radiologic union in the Memory staples group was earlier (7.6 weeks) than that of the other two techniques (8.0 and 8.1 weeks). The Memory staples group also had the lowest incidence of nonunion (1 of 15 compared with 4 of 15 in the single lag screw fixation group and 3 of 16 in the lag screw and circlage wire fixation group) and no hardware-related problems. Conclusions: Our experience corroborates the advantages of Memory staples as described in the literature, including good approximation of bone fragments, technically easy application with fewer steps than an AO-applied screw, and an adequate source of internal fixation to achieve metatarsophalangeal joint fusion. There is also a suggestion that the time to achieve fusion is shorter. (J Am Podiatr Med Assoc 102(1): 13-17, 2012) Full article

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Open AccessArticle

Consequences of Pediatric Obesity on the Foot and Ankle Complex

by Sarah P. Shultz, Michael R. Sitler, Ryan T. Tierney, Howard J. Hillstrom and Jinsup Song

J. Am. Podiatr. Med. Assoc. 2012, 102(1), 5-12; https://doi.org/10.7547/1020005 - 1 Jan 2012

Cited by 23 | Viewed by 41

Abstract

Background: Anthropometric status can influence gait biomechanics, but there is relatively little published research regarding foot and ankle characteristics in the obese pediatric population. We sought to compare the structural and functional characteristics of the foot and ankle complex in obese and [...] Read more.

Background: Anthropometric status can influence gait biomechanics, but there is relatively little published research regarding foot and ankle characteristics in the obese pediatric population. We sought to compare the structural and functional characteristics of the foot and ankle complex in obese and non-obese children. Methods: Twenty healthy children (ten obese and ten normal weight) were recruited for a cross-sectional research study. Anthropometric parameters were measured to evaluate active ankle dorsiflexion, arch height (arch height index, arch rigidity index ratio, and arch drop), foot alignment (resting calcaneal stance position and forefootrearfoot alignment in unloaded and loaded positions), and foot type (malleolar valgus index). Independent t tests determined significant differences between groups for all assessed parameters. Statistical significance was set at P < .0125. Results: Compared with non-obese participants, obese participants had significantly greater arch drop (mean ± SD: 5.10 ± 2.13 mm versus 2.90 ± 1.20 mm; P = .011) and a trend toward lower arch rigidity index ratios (mean ± SD: 0.92 ± 0.03 versus 0.95 ± 0.02; P = .013). In addition, obese participants had significantly less active ankle dorsiflexion at 908 of knee flexion versus non-obese participants (mean ± SD: 19.57 ± 5.17 versus 29.07 ± 3.06; P < .001). No significant differences existed between groups for any other anthropometric measurements. Conclusions: The decreased active ankle dorsiflexion in the obese group can increase foot contact for a longer period of the stance phase of gait. Obese participants also presented with a more flexible foot when bearing weight. (J Am Podiatr Med Assoc 102(1): 5-12, 2012) Full article

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The Anatomical Location of the Flexor Hallucis Brevis as It Pertains to Implant Arthroplasty

by Matthew DeMore III, Erigena Baze, Anthony LaLama, Patrick Branagan, Michael Bowen and Kiana Trent

J. Am. Podiatr. Med. Assoc. 2012, 102(1), 1-4; https://doi.org/10.7547/1020001 - 1 Jan 2012

Cited by 4 | Viewed by 48

Abstract

Background: Hallux limitus/rigidus is a painful arthritic condition affecting the first metatarsophalangeal joint that can be treated by implant arthroplasty, which, ultimately, may cause loss of the anatomical insertion points of the flexor hallucis brevis muscle. Preparation of the base involves resection [...] Read more.

Background: Hallux limitus/rigidus is a painful arthritic condition affecting the first metatarsophalangeal joint that can be treated by implant arthroplasty, which, ultimately, may cause loss of the anatomical insertion points of the flexor hallucis brevis muscle. Preparation of the base involves resection of bone, thus compromising the insertion of the flexor hallucis brevis muscle. Methods: We dissected 54 fresh-frozen cadaveric specimens and quantitatively measured the distalmost insertion point of the medial and lateral heads of the flexor hallucis brevis muscle. These measurements were performed for both heads. The measurements were performed three times by three separate examiners. In addition, taking into consideration the anatomical construct of the articular surface of the base of the proximal phalanx of the hallux, another measurement was performed to note the concavity using 44 of the specimens. Again, these measurements were performed three times by three separate investigators. Results: The mean length from the base of the proximal phalanx to the distalmost insertion of the medial and lateral heads of the flexor hallucis brevis muscle was found to be 7 mm. Conclusions: This study provides precise anatomical data that can be used by foot and ankle surgeons when considering the use of implant arthroplasty for the treatment of hallux limitus/rigidus and the ability to maintain the insertion point of the flexor hallucis brevis muscle. (J Am Podiatr Med Assoc 102(1): 1-4, 2012) Full article

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J. Am. Podiatr. Med. Assoc., Volume 102, Issue 1 (01 2012) – 15 articles , Pages 1-83

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