Journal of the American Podiatric Medical Association

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Open AccessArticle

New Beginnings

by Joseph M. Caporusso

J. Am. Podiatr. Med. Assoc. 2013, 103(1), 97; https://doi.org/10.7547/1030097 - 1 Jan 2013

Cited by 1 | Viewed by 53

Abstract

Happy New Year! This is an exciting time of year—full of fresh potential and renewed energy [...] Full article

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Open AccessArticle

Measuring Teaching Effectiveness—or Not

by Graham P. Shaw

J. Am. Podiatr. Med. Assoc. 2013, 103(1), 94-96; https://doi.org/10.7547/1030094 - 1 Jan 2013

Cited by 2 | Viewed by 56

Abstract

Faculty in the present-day academic medicine environment are expected to perform multiple functions, notably, the provision of high-quality teaching to the medical professionals of tomorrow. However, evaluating the effectiveness of this teaching is particularly difficult. Student evaluations of teaching, despite their many flaws, [...] Read more.

Faculty in the present-day academic medicine environment are expected to perform multiple functions, notably, the provision of high-quality teaching to the medical professionals of tomorrow. However, evaluating the effectiveness of this teaching is particularly difficult. Student evaluations of teaching, despite their many flaws, are widely used as a convenient tool to measure teaching effectiveness. Administrators continue to routinely use student evaluation of teaching surveys in faculty retention/promotion and merit pay decisions. This practice should be reevaluated since it may have unintended consequences, such as grade inflation and content debasement, and may contribute to faculty leaving the institution and even the profession. A more valid, reliable, and formative protocol for the evaluation of genuine teaching effectiveness needs to be developed as a matter of some urgency. In this review, alternatives to the student evaluation of teaching are explored to better measure true teaching effectiveness. (J Am Podiatr Med Assoc 103(1): 94–96, 2013) Full article

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Open AccessArticle

Podiatric Medicine and Disaster Response. A Survey of the Professional Leadership

by Walter Psoter, David L. Glotzer, Linda S. Baek, Rajiv Karloopia and Douglas E. Morse

J. Am. Podiatr. Med. Assoc. 2013, 103(1), 87-93; https://doi.org/10.7547/1030087 - 1 Jan 2013

Cited by 3 | Viewed by 61

Abstract

Background: We surveyed the podiatric medicine professional and academic leadership concerning podiatric medicine professionals as disaster surge responders. Methods: All US podiatric medical school deans and state society presidents were mailed a self-administered structured questionnaire. The leaders were asked to complete the questionnaire [...] Read more.

Background: We surveyed the podiatric medicine professional and academic leadership concerning podiatric medicine professionals as disaster surge responders. Methods: All US podiatric medical school deans and state society presidents were mailed a self-administered structured questionnaire. The leaders were asked to complete the questionnaire and return it by mail; two repeated mailings were made. Descriptive statistics were produced, and differences between deans and society presidents were tested by the Fisher exact test. Results: The response rate was 100% for the deans and 53% for the society presidents. All of the respondents agreed that podiatric physicians have skills applicable to catastrophe response, are ethically obligated to help, and should receive additional training in catastrophe response. Deans and society presidents agreed with the statements that podiatric physicians should provide basic first aid and place sutures, obtain medical histories, and assist with maintaining infection control. With one exception, all of the society presidents and deans agreed that with additional training, podiatric physicians could interpret radiographs, start intravenous lines, conduct mass casualty triage, manage a point of distribution, prescribe medications, and provide counseling to the worried well. There was variability in responses across the sources for training. Conclusions: These findings suggest that deliberations regarding academic competencies at the podiatric medical school level and continuing education should be conducted by the profession for a surge response role, including prevention, response, mitigation, and recovery activities. After coordination and integration with response agencies, podiatric medicine has a role in strengthening the nation’s catastrophic event surge response. (J Am Podiatr Med Assoc 103(1): 87-93, 2013) Full article

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Open AccessArticle

Mosaicplasty for Osteochondral Lesions of the Talus. A Report of Two Cases

by Chieh Chiang and Man-Kuan Au

J. Am. Podiatr. Med. Assoc. 2013, 103(1), 81-86; https://doi.org/10.7547/1030081 - 1 Jan 2013

Cited by 2 | Viewed by 87

Abstract

Two women (24 and 27 years old) noted pain in the affected ankle of several years’ duration. Radiography and magnetic resonance imaging revealed osteochondral lesions of the talus in both patients. The lesion sites measured 1.3 × 1.0 × 0.4 cm (0.52 cm [...] Read more.

Two women (24 and 27 years old) noted pain in the affected ankle of several years’ duration. Radiography and magnetic resonance imaging revealed osteochondral lesions of the talus in both patients. The lesion sites measured 1.3 × 1.0 × 0.4 cm (0.52 cm³) and 2.0 × 1.9 × 0.5 cm (1.9 cm³). Each patient received a medial malleolar osteotomy with mosaicplasty. Donor plugs were obtained from the ipsilateral knee in both patients. Surgery was performed successfully in both patients without complications. At 2-year follow-up, both patients had recovered good ankle function, with no donor site morbidity. American Orthopedic Foot and Ankle Society ankle/hindfoot scores improved in the affected ankles from 16 to 84 in case 1 and from 43 to 87 in case 2. Mosaicplasty is effective in treating stage III or IV osteochondral lesions of the talus and results in good-to-excellent recovery of function. (J Am Podiatr Med Assoc 103(1): 81–86, 2013) Full article

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Aggressive Early Reconstruction in Open Foot Trauma. A Case Report

by Bryan A. Sagray

J. Am. Podiatr. Med. Assoc. 2013, 103(1), 76-80; https://doi.org/10.7547/1030076 - 1 Jan 2013

Cited by 1 | Viewed by 68

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Open fracture-dislocation of the lower extremity poses a serious risk, has a high incidence of complications, and necessitates prompt surgical intervention. Patients need to be evaluated on presentation to the emergency department for neurovascular injury, soft-tissue insult, stability of the fracture, concomitant injuries, [...] Read more.

Open fracture-dislocation of the lower extremity poses a serious risk, has a high incidence of complications, and necessitates prompt surgical intervention. Patients need to be evaluated on presentation to the emergency department for neurovascular injury, soft-tissue insult, stability of the fracture, concomitant injuries, and overall medical/nutritional status. Implementation of a specific treatment protocol will decrease time to operative management and increase the overall success rate. Success after treatment of lower-extremity trauma should be defined as a noninfected, functional limb with optimal tissue preservation allowing ambulation. We present a case of open fracture-dislocation of the first ray treated with prompt debridement, skeletal stabilization, and immediate soft-tissue reconstruction. (J Am Podiatr Med Assoc 103(1): 76–80, 2013) Full article

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Open AccessArticle

Closed Total Dislocation of Talus Without Any Accompanying Fractures

by Sarper Gursu, Vedat Sahin, Bilal Demir and Timur Yildirim

J. Am. Podiatr. Med. Assoc. 2013, 103(1), 73-75; https://doi.org/10.7547/1030073 - 1 Jan 2013

Cited by 7 | Viewed by 65

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Total talar dislocation, ie, disruption of the talus from the calcaneus, navicula, and tibia, is a rare and severe injury. We present a case of closed peritalar dislocation without any accompanying fractures and, thus, discuss the conflicts encountered in this rare injury. A [...] Read more.

Total talar dislocation, ie, disruption of the talus from the calcaneus, navicula, and tibia, is a rare and severe injury. We present a case of closed peritalar dislocation without any accompanying fractures and, thus, discuss the conflicts encountered in this rare injury. A 25-year-old male patient presented with severe pain, swelling, and deformity in his right ankle within 30 minutes of a fall from a height. There were no wounds around the ankle. Radiographs revealed that the talus was disrupted from the calcaneus, navicula, and tibia moving in the anterolateral direction. No accompanying fractures were seen in the talus or in surrounding bones. After an unsuccessful closed reduction attempt, a further decision was open reduction. It was seen that the interposed joint capsula was preventing reduction. After reduction, stability of the ankle was checked and found to be satisfactory, so no fixation material was used. It has been 2 years since the first injury, and the patient is functioning well, with no pain. The ankle has the same range of motion as the unaffected side. No sign of an avascular necrosis or sclerosis is seen on the final radiographs. Closed total dislocation of the talus without any accompanying fractures is a rare entity. The injury is open to various important complications, such as avascular necrosis, infection in patients with open wounds, and arthritic changes. To achieve a good outcome, early reduction of the dislocation has key importance. (J Am Podiatr Med Assoc 103(1): 73–75, 2013) Full article

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Heparin-induced Thrombocytopenia in the Setting of Perioperative Bridging for Podiatric Surgery. A Case Report

by Robert G. Frykberg, Scott Gordon, Edward Tierney and Arthur Tallis

J. Am. Podiatr. Med. Assoc. 2013, 103(1), 67-72; https://doi.org/10.7547/1030067 - 1 Jan 2013

Cited by 1 | Viewed by 64

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Heparin is an anticoagulant commonly used to treat and prevent deep venous thrombosis. Heparin-induced thrombocytopenia and possible thrombosis are serious complications associated with its use. This can occasionally complicate treatment of patients undergoing podiatric surgery. Heparin-induced thrombocytopenia is often not immediately recognized and [...] Read more.

Heparin is an anticoagulant commonly used to treat and prevent deep venous thrombosis. Heparin-induced thrombocytopenia and possible thrombosis are serious complications associated with its use. This can occasionally complicate treatment of patients undergoing podiatric surgery. Heparin-induced thrombocytopenia is often not immediately recognized and is underreported in podiatric medicine literature. The goal of this case report is to highlight the multiple risk factors associated with the development of heparin-induced thrombocytopenia and to aid with early recognition, understanding of pathogenesis, and treatment options. (J Am Podiatr Med Assoc 103(1): 67–72, 2013) Full article

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Open AccessArticle

Perceived Value of the Clinical Dual-degree Program to DPM/MHA Alumni

by Kyle Pearson and Carla Stebbins

J. Am. Podiatr. Med. Assoc. 2013, 103(1), 56-66; https://doi.org/10.7547/1030056 - 1 Jan 2013

Cited by 1 | Viewed by 57

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Background: This article provides an analysis of the perceived value to doctor of podiatric medicine/master of health-care administration (DPM/MHA) alumni of the clinical dual-degree program at Des Moines University, Des Moines, Iowa, and a review of the literature on physician leaders. Methods: An [...] Read more.

Background: This article provides an analysis of the perceived value to doctor of podiatric medicine/master of health-care administration (DPM/MHA) alumni of the clinical dual-degree program at Des Moines University, Des Moines, Iowa, and a review of the literature on physician leaders. Methods: An in-depth review of the current literature and an evaluation of survey results from 21 of 33 alumni of the DPM/MHA dual-degree program at Des Moines University was completed. Results: There was an overwhelming positive response from alumni toward the DPM/ MHA dual-degree program. It was also found that there is a need for physician leaders who obtain knowledge and understanding of the business aspects of medicine in the current health-care industry. Conclusions: These survey results provide justification that the DPM/MHA dual-degree program at Des Moines University is fulfilling its goal of providing an educational background in the administrative and clinical aspects of medicine that prepares students for the complex and ever-changing health-care industry. The dual-degree program is a great opportunity for the podiatric medicine profession and podiatric medical schools to increase their collaboration with MHA programs to offer dual-degree programs to help fill the void and prepare future physician leaders. (J Am Podiatr Med Assoc 103(1): 56-66, 2013) Full article

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Open AccessArticle

Customized Foot Insoles Have a Positive Effect on Pain, Function, and Quality of Life in Patients with Medial Knee Osteoarthritis

by Søren Thorgaard Skou, Lea Hojgaard and Ole H. Simonsen

J. Am. Podiatr. Med. Assoc. 2013, 103(1), 50-55; https://doi.org/10.7547/1030050 - 1 Jan 2013

Cited by 16 | Viewed by 83

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Background: Knee osteoarthritis (KOA) is a prevalent degenerative disease in older adults. Treatment strategies, including insoles, focus on reducing pain and physical disability. In medial KOA, insoles have been studied extensively with conflicting results, possibly due to heterogeneity in outcome measures and the [...] Read more.

Background: Knee osteoarthritis (KOA) is a prevalent degenerative disease in older adults. Treatment strategies, including insoles, focus on reducing pain and physical disability. In medial KOA, insoles have been studied extensively with conflicting results, possibly due to heterogeneity in outcome measures and the intervention. We sought to investigate the effect of custom-made laterally wedged insoles on pain, function, and quality of life in patients with medial KOA. Methods: Fifty-one consecutive patients with medial KOA were prescribed custommade insoles with arch support and a 5.08 to 8.78 lateral wedge. At follow-up, 42 of the 51 participants (22 men; mean age, 63 years; mean Kellgren-Lawrence, 3.4) participated. Retrospectively, participants were asked to rate the pain intensity in their affected knee before and after the intervention measured on a visual analog scale after 30 min of physical activity (primary outcome), at rest, at night, and after 50 m of walking. Additionally, they completed the Oxford Knee Score and the EQ-5D. The paired-samples t test was applied in the statistics. Results: The visual analog scale score after 30 min of physical activity was significantly reduced after the intervention (mean, 3.3 cm; 95% confidence interval, 2.1–4.5 cm; P , .001). The same significant changes were found in all of the secondary outcomes. Conclusions: There was a significant reduction in pain and improvements in function and quality of life with custom-made laterally wedged insoles with arch support in older adults with mild-to-severe medial KOA. The customization of laterally wedged insoles may be essential for the effect in medial KOA. (J Am Podiatr Med Assoc 103(1): 50-55, 2013) Full article

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Open AccessArticle

Effects of Anthropometric Factors on Nerve Conduction. An Electrophysiologic Study of Feet

by Nilgun Cinar, Sevki Sahin, Mustafa Sahin, Tugba Okluoglu and Sibel Karsidag

J. Am. Podiatr. Med. Assoc. 2013, 103(1), 43-49; https://doi.org/10.7547/1030043 - 1 Jan 2013

Cited by 9 | Viewed by 54

Abstract

Background: Previous studies have shown that age, sex, and body mass index (BMI) affect the amplitude of sensory nerve action potentials (SNAPs), but the total effects of multiple factors and the most prominently affected nerves have not been elucidated. We systematically investigated the [...] Read more.

Background: Previous studies have shown that age, sex, and body mass index (BMI) affect the amplitude of sensory nerve action potentials (SNAPs), but the total effects of multiple factors and the most prominently affected nerves have not been elucidated. We systematically investigated the effects of these factors on motor and sensory nerves of the feet. Methods: The amplitude, latency, and conduction velocity of compound muscle action potential (CMAP), SNAP, and mixed nerve action potential (MNAP) of the posterior tibial, calcaneal, distal posterior tibial, medial and lateral plantar, and sural nerves were measured in 30 healthy individuals (60 feet). The effects of age, sex, height, and BMI on each nerve were estimated by correlation and linear regression analyses. Results: The amplitude of posterior tibial CMAP and distal posterior tibial MNAP decreased with BMI. The amplitude of medial plantar MNAP and sural SNAP decreased with height. The conduction velocity of calcaneal SNAP and distal posterior tibial and lateral plantar MNAP decreased with height and BMI. The conduction velocity of medial plantar MNAP decreased only with height. The latency of posterior tibial CMAP increased with age and height. The latency of lateral plantar CMAP and calcaneal SNAP increased with height. The latency of lateral plantar MNAP increased with BMI. Conclusions: The effects of age, sex, height, and BMI in foot nerve conduction studies are not identical. Height and BMI were shown to strongly affect motor, sensory, and mixed nerve conduction. Further investigations are needed. (J Am Podiatr Med Assoc 103(1): 43-49, 2013) Full article

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Open AccessArticle

Effect of a Forefoot Off-loading Postoperative Shoe on Muscle Activity, Posture, and Static Balance

by Joanne S. Paton, Katherine Thomason, Karl Trimble, James E. Metcalfe and Jonathan Marsden

J. Am. Podiatr. Med. Assoc. 2013, 103(1), 36-42; https://doi.org/10.7547/1030036 - 1 Jan 2013

Cited by 11 | Viewed by 69

Abstract

Background: We investigated whether a forefoot off-loading postoperative shoe (FOPS) alters standing posture, ankle muscle activity, and static postural sway and whether any effects are altered by wearing a shoe raise on the contralateral side. Methods: Posture, ankle muscle activity, and postural sway [...] Read more.

Background: We investigated whether a forefoot off-loading postoperative shoe (FOPS) alters standing posture, ankle muscle activity, and static postural sway and whether any effects are altered by wearing a shoe raise on the contralateral side. Methods: Posture, ankle muscle activity, and postural sway were compared in 14 healthy participants wearing either a FOPS or a control shoe with or without a contralateral shoe raise. Participants were tested under different sensory and support surface conditions. Additionally, reductions in peak pressure under the forefoot while walking were assessed with and without a contralateral shoe raise to determine whether the FOPS continued to achieve its primary off-loading function. Results: Compared with the control condition, wearing a FOPS moved the center of pressure posteriorly, increased tibialis anterior muscle activity, and reduced ankle plantarflexor activity. These changes decreased when a contralateral shoe raise was added. No difference in postural sway was found between footwear conditions. Forefoot peak pressure was always reduced when wearing the FOPS. Conclusions: The posterior shift in center of pressure toward and behind the ankle joint axis is believed to result in the increase in tibialis anterior muscle activity that now acts as the primary stabilizer around the ankle. Instability may, therefore, increase in patients with weak tibialis anterior muscles (eg, diabetic neuropathy) who need to wear offloading devices for ulcer management. We suggest that the addition of a contralateral shoe raise fitted with a FOPS may potentially be beneficial in maintaining stability while off-loading the forefoot in this patient group. (J Am Podiatr Med Assoc 103(1): 36-42, 2013) Full article

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Radiologic Morphology of the Calcaneus. A Study of Radiologic Angles in a Pediatric Population

by Pedro Gutierrez, Manuel Navarro and Margarita Ojeda

J. Am. Podiatr. Med. Assoc. 2013, 103(1), 32-35; https://doi.org/10.7547/1030032 - 1 Jan 2013

Cited by 4 | Viewed by 89

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Background: The Fowler-Philip, calcaneal pitch, and total calcaneal angles define the radiologic morphology of the rearfoot. We studied these angles in healthy adolescents. Methods: We studied 141 feet. Patients with inflammatory or traumatic injuries were excluded. The mean participant age was 11.5 years. [...] Read more.

Background: The Fowler-Philip, calcaneal pitch, and total calcaneal angles define the radiologic morphology of the rearfoot. We studied these angles in healthy adolescents. Methods: We studied 141 feet. Patients with inflammatory or traumatic injuries were excluded. The mean participant age was 11.5 years. The Fowler-Philip, calcaneal pitch, and total calcaneal angles were measured on lateral weightbearing radiographs. The statistics included descriptive, sample size (a¼0.05 and b¼0.20), the Student t test, and analysis of variance; P , .05 was considered significant. Results: The samples were 141 and 35 radiographs for the Fowler-Philip and calcaneal pitch angles, respectively. Ninety percent, 25.1%, and 97.4% of the adolescents had normal Fowler-Philip, calcaneal pitch, and total calcaneal angles, respectively. In addition, 9.9%, 74.9%, and 2.6% of the values were outside the reference ranges, respectively. The Fowler-Philip angle decreased and the calcaneal pitch angle increased significantly with age (P ¼.0005). The total calcaneal angle did not change with age (P ¼ .65). Conclusions: The mean angle values in a pediatric population did not differ from those in adults. We found a high percentage of calcaneal pitch angles outside the reference range. Age influenced the Fowler-Philip and calcaneal pitch angles but not the total calcaneal angle. (J Am Podiatr Med Assoc 103(1): 32-35, 2013) Full article

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Histopathologic Characteristics of Bone Infection Complicating Foot Ulcers in Diabetic Patients

by Almudena Cecilia-Matilla, José Luis Lázaro-Martínez, Javier Aragón-Sánchez, Esther García-Morales, Yolanda García-Álvarez and Juan Vicente Beneit-Montesinos

J. Am. Podiatr. Med. Assoc. 2013, 103(1), 24-31; https://doi.org/10.7547/1030024 - 1 Jan 2013

Cited by 44 | Viewed by 59

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Background: A universally accepted histopathologic classification of diabetic foot osteomyelitis does not currently exist. We sought to evaluate the histopathologic characteristics of bone infection found in the feet of diabetic patients and to analyze the clinical variables related to each type of bone [...] Read more.

Background: A universally accepted histopathologic classification of diabetic foot osteomyelitis does not currently exist. We sought to evaluate the histopathologic characteristics of bone infection found in the feet of diabetic patients and to analyze the clinical variables related to each type of bone infection. Methods: We conducted an observational prospective study of 165 diabetic patients with foot ulcers who underwent surgery for bone infection. Samples for microbiological and histopathologic analyses were collected in the operating room under sterile conditions. Results: We found four histopathologic types of osteomyelitis: acute osteomyelitis (n ¼ 46; 27.9%), chronic osteomyelitis (n ¼ 73; 44.2%), chronic acute osteomyelitis (n ¼ 14; 8.5%), and fibrosis (n ¼32; 19.4%). The mean 6 SD time between the initial detection of ulcer and surgery was 15.4 6 23 weeks for acute osteomyelitis, 28.6 6 22.4 weeks for chronic osteomyelitis, 35 6 31.3 weeks for chronic acute osteomyelitis, and 27.5 6 27.3 weeks for the fibrosis stage (analysis of variance: P ¼ .03). Bacteria were isolated and identified in 40 of 46 patients (87.0%) with acute osteomyelitis, 61 of 73 (83.5%) with chronic osteomyelitis, 11 of 14 (78.6%) with chronic acute osteomyelitis, and 25 of 32 (78.1%) with fibrosis. Conclusions: Histopathologic categorization of bone infections in the feet of diabetic patients should include four groups: acute, chronic, chronic acute, and fibrosis. We suggest that new studies should identify cases of fibrosis to allow comparison with the present results. (J Am Podiatr Med Assoc 103(1): 24-31, 2013) Full article

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The Occurrence of Ipsilateral or Contralateral Foot Disorders and Hand Dominance. The Framingham Foot Study

by Uyen-Sa D. T. Nguyen, Alyssa B. Dufour, Rock G. Positano, Joshua S. Dines, Christopher C. Dodson, David G. Gagnon, Howard J. Hillstrom and Marian T. Hannan

J. Am. Podiatr. Med. Assoc. 2013, 103(1), 16-23; https://doi.org/10.7547/1030016 - 1 Jan 2013

Cited by 4 | Viewed by 98

Abstract

Background: To our knowledge, hand dominance and side of foot disorders has not been described in the literature. We sought to evaluate whether hand dominance was associated with ipsilateral foot disorders in community-dwelling older men and women. Methods: Data were from the Framingham [...] Read more.

Background: To our knowledge, hand dominance and side of foot disorders has not been described in the literature. We sought to evaluate whether hand dominance was associated with ipsilateral foot disorders in community-dwelling older men and women. Methods: Data were from the Framingham Foot Study (N ¼ 2,089, examined 2002– 2008). Hand preference for writing was used to classify hand dominance. Foot disorders and side of disorders were based on validated foot examination findings. Generalized linear models with generalized estimating equations were used to estimate odds ratios and 95% confidence intervals, accounting for intraperson variability. Results: Left-handed people were less likely to have foot pain or any foot disorders ipsilateral but were more likely to have hallux valgus ipsilateral to the left hand. Among right-handed people, the following statistically significant increased odds of having an ipsilateral versus contralateral foot disorder were seen: 30% for Morton’s neuroma, 18% for hammer toes, 21% for lesser toe deformity, and a twofold increased odds of any foot disorder; there was a 17% decreased odds for Tailor’s bunion and an 11% decreased odds for pes cavus. Conclusions: For the 2,089 study participants, certain forefoot disorders were shown to be ipsilateral and others were contralateral to the dominant hand. Future studies should examine whether the same biological mechanism that explains ipsilateral hand and foot preference may explain ipsilateral hand dominance and forefoot disorders. (J Am Podiatr Med Assoc 103(1): 16-23, 2013) Full article

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A Prospective, Randomized, Double-blinded Study with Crossover to Determine the Efficacy of Radio-frequency Nerve Ablation for the Treatment of Heel Pain

by Adam S. Landsman, Dominic J. Catanese, Steven N. Wiener, Douglas H. Richie and Jason R. Hanft

J. Am. Podiatr. Med. Assoc. 2013, 103(1), 8-15; https://doi.org/10.7547/1030008 - 1 Jan 2013

Cited by 16 | Viewed by 70

Abstract

Background: Previous studies have demonstrated that radio-frequency nerve ablation (RFNA) can be an effective treatment for plantar fasciosis. This study provides additional evidence in support of this treatment, with statistically significant data that demonstrate the success of this technique. Methods: In this multicenter, [...] Read more.

Background: Previous studies have demonstrated that radio-frequency nerve ablation (RFNA) can be an effective treatment for plantar fasciosis. This study provides additional evidence in support of this treatment, with statistically significant data that demonstrate the success of this technique. Methods: In this multicenter, randomized, prospective, double-blinded study with crossover, 17 patients were divided into two groups, with eight initially receiving RFNA treatment and nine initially receiving sham treatment. If no improvement was observed after 4 weeks, a crossover was offered. Results of the treatment were evaluated by the patient and by a blinded physician using a visual analog pain scale to rate first-step pain, average pain, and peak pain in the heel region. Results: We observed a statistically significant improvement in the symptoms of plantar fasciosis in patients actively treated with RFNA and no significant improvement in the sham-treated group. More important, those treated with sham subsequently demonstrated statistically significant improvement after subsequent RFNA treatment. Conclusions: Using a prospective, randomized study with sham treatment and crossover, this study demonstrates the efficacy of RFNA for the treatment of plantar fasciosis. (J Am Podiatr Med Assoc 103(1): 8-15, 2013) Full article

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2012 Infectious Diseases Society of America Clinical Practice Guideline for the Diagnosis and Treatment of Diabetic Foot Infectionsa

by Benjamin A. Lipsky, Anthony R. Berendt, Paul B. Cornia, James C. Pile, Edgar J. G. Peters, David G. Armstrong, H. Gunner Deery, John M. Embil, Warren S. Joseph, Adolf W. Karchmer, Michael S. Pinzur and Eric Senneville

J. Am. Podiatr. Med. Assoc. 2013, 103(1), 2-7; https://doi.org/10.7547/1030002 - 1 Jan 2013

Cited by 114 | Viewed by 95

Abstract

Foot infections are a common and serious problem in persons with diabetes. Diabetic foot infections (DFIs) typically begin in a wound, most often a neuropathic ulceration. While all wounds are colonized with microorganisms, the presence of infection is defined by ≥2 classic findings [...] Read more.

Foot infections are a common and serious problem in persons with diabetes. Diabetic foot infections (DFIs) typically begin in a wound, most often a neuropathic ulceration. While all wounds are colonized with microorganisms, the presence of infection is defined by ≥2 classic findings of inflammation or purulence. Infections are then classified into mild (superficial and limited in size and depth), moderate (deeper or more extensive), or severe (accompanied by systemic signs or metabolic perturbations). This classification system, along with a vascular assessment, helps determine which patients should be hospitalized, which may require special imaging procedures or surgical interventions, and which will require amputation. Most DFIs are polymicrobial, with aerobic gram-positive cocci (GPC), and especially staphylococci, the most common causative organisms. Aerobic gram-negative bacilli are frequently copathogens in infections that are chronic or follow antibiotic treatment, and obligate anaerobes may be copathogens in ischemic or necrotic wounds. Full article

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Diabetic Foot Infection

by Warren S. Joseph

J. Am. Podiatr. Med. Assoc. 2013, 103(1), 1; https://doi.org/10.7547/1030001 - 1 Jan 2013

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Abstract

In 2004, the Diabetic Foot Infection (DFI) Guidelines Committee of the Infectious Diseases Society of America (IDSA) published their first evidencebased guidelines for the diagnosis and treatment of this condition [...] Full article

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J. Am. Podiatr. Med. Assoc., Volume 103, Issue 1 (01 2013) – 17 articles , Pages 1-97

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