Journal of the American Podiatric Medical Association

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Open AccessArticle

Happy New Year!

by Matthew G. Garoufalis

J. Am. Podiatr. Med. Assoc. 2014, 104(1), 124; https://doi.org/10.7547/0003-0538-104.1.124 - 1 Jan 2014

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n/a Full article

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Open AccessArticle

When a Heel Won’t Heal. An Important Differential to Consider

by Catriona I. Wootton and Sheelagh M. Littlewood

J. Am. Podiatr. Med. Assoc. 2014, 104(1), 123; https://doi.org/10.7547/0003-0538-104.1.123 - 1 Jan 2014

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Open AccessArticle

Recognizing the Prevalence of Changing Adult Foot Size. An Opportunity to Prevent Diabetic Foot Ulcers?

by John E. Connolly and James S. Wrobel

J. Am. Podiatr. Med. Assoc. 2014, 104(1), 118-122; https://doi.org/10.7547/0003-0538-104.1.118 - 1 Jan 2014

Cited by 5 | Viewed by 44

Abstract

Ill-fitting shoes may precipitate up to half of all diabetes-related amputations and are often cited as a leading cause of diabetic foot ulcers (DFU), with those patients being 5 to 10 times more likely to present wearing improperly fitting shoes. Among patients with [...] Read more.

Ill-fitting shoes may precipitate up to half of all diabetes-related amputations and are often cited as a leading cause of diabetic foot ulcers (DFU), with those patients being 5 to 10 times more likely to present wearing improperly fitting shoes. Among patients with prior DFU, those who self-select their shoe wear are at a three-fold risk for reulceration at 3 years versus those patients wearing prescribed shoes. Properly designed and fitted shoes should then address much of this problem, but evidence supporting the benefit of therapeutic shoe programs is inconclusive. The current study, performed in a male veteran population, is the first such effort to examine the prevalence and extent of change in foot length affecting individuals following skeletal maturity. Nearly half of all participants in our study experienced a ≥1 shoe size change in foot length during adulthood. We suggest that these often unrecognized changes may explain the broad use of improperly sized shoe wear, and its associated sequelae such as DFU and amputation. Regular clinical assessment of shoe fit in at-risk populations is therefore also strongly recommended as part of a comprehensive amputation prevention program. Full article

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Open AccessArticle

Topical Treatment of Onychomycosis as a Realistic Option to Systemic Therapy. A Case Report

by Aditya K. Gupta

J. Am. Podiatr. Med. Assoc. 2014, 104(1), 115-117; https://doi.org/10.7547/0003-0538-104.1.115 - 1 Jan 2014

Cited by 1 | Viewed by 83

Abstract

Onychomycosis is a very common disease, especially in podiatric medical practice. It can be associated with significant patient distress, major disability and pain, and is challenging to treat successfully. This is a case study of a 41-year-old man with distal lateral subungual onychomycosis [...] Read more.

Onychomycosis is a very common disease, especially in podiatric medical practice. It can be associated with significant patient distress, major disability and pain, and is challenging to treat successfully. This is a case study of a 41-year-old man with distal lateral subungual onychomycosis of 5 years' duration. Forty percent of the great toenail was affected and a total of six toenails were involved. Baseline fungal cultures were positive for Trichophyton rubrum. This patient was treated with efinaconazole 10% solution, a new topical antifungal, once daily for 48 weeks. Mycological cure was noted at the first assessment period (12 weeks), and compete cure was seen at follow-up. This case study alerts physicians to a promising new topical treatment for onychomycosis under development, and to the importance of mycological cure as an early indicator of treatment success. Full article

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Open AccessArticle

Diagnostic Imaging of the Mueller-Weiss Syndrome. Findings of a Rare Condition of the Foot

by Anthony S. Nguyen, Gino H. Tagoylo and Gregory A. Mote

J. Am. Podiatr. Med. Assoc. 2014, 104(1), 110-114; https://doi.org/10.7547/0003-0538-104.1.110 - 1 Jan 2014

Cited by 11 | Viewed by 55

Abstract

We report three patients with diagnostic imaging findings that are consistent with Mueller-Weiss syndrome. Mueller-Weiss syndrome is a rare condition that involves osteonecrosis of the navicular bone in an adult. The characteristic findings for Mueller-Weiss syndrome include a dorsomedial dislocation along with the [...] Read more.

We report three patients with diagnostic imaging findings that are consistent with Mueller-Weiss syndrome. Mueller-Weiss syndrome is a rare condition that involves osteonecrosis of the navicular bone in an adult. The characteristic findings for Mueller-Weiss syndrome include a dorsomedial dislocation along with the collapse of the lateral navicular bone, resulting in a comma-shaped configuration. Through these three case studies, we aim to familiarize both foot and ankle specialists and radiologists with the diagnostic imaging findings for Mueller-Weiss syndrome. Full article

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Open AccessArticle

Noninvasive Quantification of Subtalar Joint Kinematics. A Pilot Investigation

by Ivan Birch and Kevin Deschamps

J. Am. Podiatr. Med. Assoc. 2014, 104(1), 103-109; https://doi.org/10.7547/0003-0538-104.1.103 - 1 Jan 2014

Cited by 2 | Viewed by 49

Abstract

A noninvasive method of assessing the motion of the subtalar joint was developed for use in clinical and research settings. Anatomical reference frames for the calcaneus and talus were produced using a marker placement model utilizing 14 markers. An asymptomatic individual was tested [...] Read more.

A noninvasive method of assessing the motion of the subtalar joint was developed for use in clinical and research settings. Anatomical reference frames for the calcaneus and talus were produced using a marker placement model utilizing 14 markers. An asymptomatic individual was tested during barefoot walking with a CODA MPX30 system. Intertrial variability and motion patterns, in all three planes, of the calcaneus with respect to the talus were analyzed as part of a validation study. The observed patterns in all three planes were found to have good face validity with published literature as well as good consistency during stance. The findings of this study support the further use of this model in both clinical and research settings, allowing investigation of the motion patterns of a larger cohort than has hitherto been possible. Full article

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An Unusual Case of Hamartomas Fibroliponeurales and Subungual Pain in the Hallux

by Ricardo Becerro de Bengoa Vallejo, Marta Elena Losa Iglesias and José Andres Moya Madolell

J. Am. Podiatr. Med. Assoc. 2014, 104(1), 99-102; https://doi.org/10.7547/0003-0538-104.1.99 - 1 Jan 2014

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Abstract

A hamartoma is a benign, focal malformation resembling a neoplasm in its tissue of origin. This malady has not been reported to be manifested in the nail plate. Here, we describe a rare case of hamartoma under the nail plate of the first [...] Read more.

A hamartoma is a benign, focal malformation resembling a neoplasm in its tissue of origin. This malady has not been reported to be manifested in the nail plate. Here, we describe a rare case of hamartoma under the nail plate of the first toe and its successful excision from a 30-year-old woman. We used palpation, radiologic analyses, excisional surgery, and histopathology to determine the presence of a hamartoma under the nail plate of the first toe. Removal of the mass was successful for the patient, and histopathologic analysis revealed characteristics of hamartoma. The presence of a hamartoma under the nail plate of the first toe is a unique finding that should be made aware to the clinical community. Full article

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Acquired Calcaneus Deformity Secondary to Osteomyelitis of the Distal Tibia

by Davinder Singh, Lovneesh G. Krishna and Jasbir Kaur

J. Am. Podiatr. Med. Assoc. 2014, 104(1), 95-98; https://doi.org/10.7547/0003-0538-104.1.95 - 1 Jan 2014

Cited by 1 | Viewed by 61

Abstract

Osteomyelitis of the distal tibia with involvement of the distal physis can lead to various deformities around the ankle and foot. Calcaneus deformity of the foot is usually secondary to paralytic disorders. A 14-year-old boy presented with calcaneus deformity as a result of [...] Read more.

Osteomyelitis of the distal tibia with involvement of the distal physis can lead to various deformities around the ankle and foot. Calcaneus deformity of the foot is usually secondary to paralytic disorders. A 14-year-old boy presented with calcaneus deformity as a result of osteomyelitis of the distal tibia. Involvement of the distal tibial epiphysis as a result of osteomyelitis of the distal tibia can lead to calcaneus deformity. This deformity has not been reported in the literature. Osteomyelitis of the distal tibia should also be included as a differential diagnosis of calcaneus deformity. Full article

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Open AccessArticle

Limitation of Magnetic Resonance Imaging in Diagnosing Longitudinal Peroneal Tendon Tears

by Daniel Pollack, Greg Khaimov and Ronald Guberman

J. Am. Podiatr. Med. Assoc. 2014, 104(1), 90-94; https://doi.org/10.7547/0003-0538-104.1.90 - 1 Jan 2014

Cited by 3 | Viewed by 53

Abstract

The purpose of this case study was to highlight a potential limitation of magnetic resonance imaging in diagnosing longitudinal tendon tears and to emphasize the importance of clinical examination for peroneal tendinopathy. We describe a 15-year-old female with lateral ankle pain, who was [...] Read more.

The purpose of this case study was to highlight a potential limitation of magnetic resonance imaging in diagnosing longitudinal tendon tears and to emphasize the importance of clinical examination for peroneal tendinopathy. We describe a 15-year-old female with lateral ankle pain, who was negative for peroneal tendon tear on magnetic resonance imaging. Owing to high clinical suspicion of peroneal tendon pathology, we opted to take the patient to the operating room and found a 6.5-cm longitudinal tear and a low-lying muscle belly of the peroneus brevis tendon. A low-lying muscle belly of the peroneal tendon has been shown to be associated with increased tendon tears. Full article

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A Rare Combination of Brachymetatarsia and Congenital Hallux Varus: Case Report and Review of the Literature

by Vanessa Froehlich and Markus Wuenschel

J. Am. Podiatr. Med. Assoc. 2014, 104(1), 85-89; https://doi.org/10.7547/0003-0538-104.1.85 - 1 Jan 2014

Cited by 4 | Viewed by 55

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Hallux varus is defined as a medial deviation of the phalanx at the first metatarsophalangeal joint and can be congenital or acquired. Brachymetatarsia is defined as shortening of the metatarsal bones. A combination of hallux varus and brachymetatarsia is rare. A 15-year-old girl [...] Read more.

Hallux varus is defined as a medial deviation of the phalanx at the first metatarsophalangeal joint and can be congenital or acquired. Brachymetatarsia is defined as shortening of the metatarsal bones. A combination of hallux varus and brachymetatarsia is rare. A 15-year-old girl presented to our outpatient clinic complaining of problems with her feet. A distinctive hallux varus was present bilaterally combined with a brachymetatarsia of the first metatarsals. The patient reported discomfort. She was restricted in her activities and had severe psychological strain owing to the deformity. We decided on surgery. First, a Pennig MiniFixator for callus distraction of the first metatarsal bone was applied. Owing to the increased plantar subluxation of the phalanx during distraction, an extension of the external fixator was administered so that the hallux could be repositioned to a physiologically satisfying position. After sufficient callus formation, the hardware was removed 14 weeks after surgery. Thereafter, the phalanx moved back to the subluxed position. Finally, an arthrodesis of the first metatarsophalangeal joint was performed with a locking plate. Surgery should not be made only for cosmesis and associated psychological aspects; but, discomfort should be the deciding factor. The postoperative clinical and cosmetic results in our case were good, and the patient was quite satisfied. There was no longer any preoperative discomfort and pain. Full article

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Open AccessArticle

Antibiotic Stewardship. The Lower-Extremity Physician’s Prescription for Effectively Treating Infection

by Robert G. Smith and Warren S. Joseph

J. Am. Podiatr. Med. Assoc. 2014, 104(1), 77-84; https://doi.org/10.7547/0003-0538-104.1.77 - 1 Jan 2014

Cited by 2 | Viewed by 57

Abstract

The discovery of antibiotic drugs was one of the most significant medical achievements of the 20th century. The improper use of antibiotic drugs to prevent and treat infections has resulted in the emergence of resistance. Antimicrobic stewardship programs are becoming a mainstay in [...] Read more.

The discovery of antibiotic drugs was one of the most significant medical achievements of the 20th century. The improper use of antibiotic drugs to prevent and treat infections has resulted in the emergence of resistance. Antimicrobic stewardship programs are becoming a mainstay in the fight against multidrug-resistant organisms. Individual clinicians should be encouraged to adopt the principles of antibiotic stewardship when treating lower-extremity infections in their scope of practice. First, a review of the available literature outlining the concept and practice of antibiotic stewardship is offered. Second, a discussion describing how to adopt and apply these principles to the individual clinician's practice as it applies to lower-extremity infections is offered. Finally, specific antimicrobial pharmacologic spectra and antibiogram information are offered. Full article

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Open AccessArticle

Surgical Treatment of Malignant Tumors of the Calcaneus

by Jing Li and Zheng Wang

J. Am. Podiatr. Med. Assoc. 2014, 104(1), 71-76; https://doi.org/10.7547/0003-0538-104.1.71 - 1 Jan 2014

Cited by 21 | Viewed by 54

Abstract

Amputation has been most commonly considered the only option to achieve local tumor control for calcaneal malignancies. Advances in oncologic treatment modalities and wide resection have made limb salvage increasingly possible. We retrospectively reviewed nine patients with calcaneal malignancies treated with different surgical [...] Read more.

Amputation has been most commonly considered the only option to achieve local tumor control for calcaneal malignancies. Advances in oncologic treatment modalities and wide resection have made limb salvage increasingly possible. We retrospectively reviewed nine patients with calcaneal malignancies treated with different surgical options. The diagnoses included chondrosarcoma in three patients, Ewing's sarcoma in three, osteosarcoma in two, and small round cell sarcoma in one. Four patients were managed by below-the-knee amputation owing to neurovascular invasion. Five patients were managed by limb salvage procedures. Pedicled osteomyocutaneous fibular grafts were used to reconstruct the defects created after total calcanectomy in limb salvage procedures. Clinical and radiographic evaluations were performed, and functional outcomes were assessed using the Musculoskeletal Tumor Society score. The patients were followed up for a mean of 42.3 months. Wide resection margins were achieved in all of the patients with limb salvage surgery. At the final follow-up, two patients had died of disease. Lung metastasis was found in two patients who were alive with disease. Five patients had no evidence of disease. No local recurrence occurred in this series. All of the fibular flaps survived, and fibula hypertrophies were observed in three patients. Average Musculoskeletal Tumor Society scores were 74.6% and 83.2% in patients with amputation and limb salvage, respectively. After wide resection of a calcaneal malignancy, biological reconstruction using pedicled osteocutaneous fibular flaps has proved to be a successful limb salvage procedure, offering a satisfactory oncologic and functional outcome alternative to amputation in selected patients. Full article

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Open AccessArticle

Nerve Decompression After Diabetic Foot Ulceration May Protect Against Recurrence. A 3-Year Controlled, Prospective Analysis

by D. Scott Nickerson and Andrew J. Rader

J. Am. Podiatr. Med. Assoc. 2014, 104(1), 66-70; https://doi.org/10.7547/0003-0538-104.1.66 - 1 Jan 2014

Cited by 29 | Viewed by 53

Abstract

Nerve entrapment, common in diabetes, is considered an associated phenomenon without large consequence in the development of diabetes complications such as ulceration, infection, amputation, and early mortality. This prospective analysis, with controls, of the ulcer recurrence rate after operative nerve decompression (ND) offers [...] Read more.

Nerve entrapment, common in diabetes, is considered an associated phenomenon without large consequence in the development of diabetes complications such as ulceration, infection, amputation, and early mortality. This prospective analysis, with controls, of the ulcer recurrence rate after operative nerve decompression (ND) offers an objective perspective on the possibility of frequent occult nerve entrapment in the diabetic foot complication cascade. A multicenter cohort of 42 patients with diabetic sensorimotor polyneuropathy, failed pharmacologic pain control, palpable pulses, and at least one positive Tinel's nerve percussion sign was treated with unilateral multiple lower-leg external neurolyses for the indication of pain. All of the patients had healed at least one previous ipsilateral plantar diabetic foot ulceration (DFU). This group was retrospectively evaluated a minimum of 12 months after operative ND and again 3 years later. The recurrence risk of ipsilateral DFU in that period was prospectively analyzed and compared with new ulcer occurrence in the contralateral intact, nonoperated control legs. Operated legs developed two ulcer recurrences (4.8%), and nine contralateral control legs developed ulcers (21.4%), requiring three amputations. Ulcer risk is 1.6% per patient per year in ND legs and 7% in nonoperated control legs (P = .048). Adding operative ND at lower-leg fibro-osseous tunnels to standard postulcer treatment resulted in a significantly diminished rate of subsequent DFU in neuropathic high-risk feet. This is prospective, objective evidence that ND can provide valuable ongoing protection from DFU recurrence, even years after primary ulcer healing. Full article

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Open AccessArticle

Effects of High-Heeled Shoes and Asymmetrical Load Carrying on Lower-Extremity Kinematics During Walking in Young Women

by Soul Lee and Jing Xian Li

J. Am. Podiatr. Med. Assoc. 2014, 104(1), 58-65; https://doi.org/10.7547/0003-0538-104.1.58 - 1 Jan 2014

Cited by 13 | Viewed by 53

Abstract

Asymmetrical load carrying and wearing high-heeled shoes are very common. Biomechanics studies on the combined effects of high-heeled shoe wearing and asymmetrical load carrying are lacking. We sought to identify changes in lower-extremity joint kinematics associated with the effect of shoes and asymmetrical [...] Read more.

Asymmetrical load carrying and wearing high-heeled shoes are very common. Biomechanics studies on the combined effects of high-heeled shoe wearing and asymmetrical load carrying are lacking. We sought to identify changes in lower-extremity joint kinematics associated with the effect of shoes and asymmetrical load carrying during walking. Fifteen healthy young women (mean ± SD: age, 24.67 ± 3.54 years; body weight, 54.96 ± 6.67 kg; and height, 162.2 ± 3.91 cm) who habitually wore high-heeled shoes participated in the study. They were asked to walk under nine combined conditions of three heights of shoe heels (0, 3, and 9 cm) and three carried loads (0%, 5%, and 10% of body weight). Temporospatial parameters and maximal joint angles in the sagittal and frontal planes of the hip, knee, and ankle on both limbs were studied. It was found that high-heeled shoe wearing and asymmetrical load carrying altered temporospatial parameters and joint kinematics. With increased heel height and load weight, cadence decreased and stride length increased. The knee flexion angle increased with an increase in heel height, and the load served only to exacerbate the changes. Changes in the hip angle were mostly caused by asymmetrical load carrying, whereas angle changes in the ankle were mostly caused by an increase in heel height. This study demonstrated that when high-heeled shoe wearing and asymmetrical load carrying are combined, changes at each joint are much greater than with high-heeled shoe wearing or load carrying alone. Full article

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Open AccessArticle

A Longitudinal Investigation into the Functional and Physical Durability of Insoles Used for the Preventive Management of Neuropathic Diabetic Feet

by Joanne S. Paton, Elizabeth Stenhouse, Graham Bruce and Ray Jones

J. Am. Podiatr. Med. Assoc. 2014, 104(1), 50-57; https://doi.org/10.7547/0003-0538-104.1.50 - 1 Jan 2014

Cited by 12 | Viewed by 61

Abstract

Insoles are commonly used to assist in the prevention of diabetic neuropathic foot ulceration. Insole replacement is often triggered only when foot lesions deteriorate, an indicator that functional performance is comprised and patients are exposed to unnecessary ulcer risk. We investigated the durability [...] Read more.

Insoles are commonly used to assist in the prevention of diabetic neuropathic foot ulceration. Insole replacement is often triggered only when foot lesions deteriorate, an indicator that functional performance is comprised and patients are exposed to unnecessary ulcer risk. We investigated the durability of insoles used for ulcer prevention in neuropathic diabetic feet over 12 months. Sixty neuropathic individuals with diabetes were provided with insoles and footwear. Insole durability over 12 months was evaluated using an in-shoe pressure measurement device and through repeated measurement of material depth at the first metatarsal head and the heel seat. Analysis of variance was performed to assess change across time (at issue, 6 months, and 12 months). Analyses were conducted using all available data (n = 43) and compliant data (n = 18). No significant difference was found in the reduction of mean peak pressure tested across time (P < .05). For both sites, significant differences in insole depth were identified between issue and 6 months and between issue and 12 months but not between 6 and 12 months (P < .05). Most insole compression occurred during the initial 6 months. Visual material compression does not seem to be a reliable indicator of insole usefulness. Frequency of insole replacement is best informed by a functional review of effect determined using an in-shoe pressure measurement system. These results suggest that insoles for diabetic neuropathic patients can be effective in maintaining peak pressure reduction for 12 months regardless of wear frequency. Full article

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Open AccessArticle

A Novel Device for Standardizing Marker Placement at the Calcaneus

by Kevin Deschamps, Philip Roosen, Ivan Birch, Bart Dingenen, Herman Bruyninckx, Kaat Desloovere, Erwin Aertbelien and Filip Staes

J. Am. Podiatr. Med. Assoc. 2014, 104(1), 43-49; https://doi.org/10.7547/0003-0538-104.1.43 - 1 Jan 2014

Cited by 8 | Viewed by 46

Abstract

The determination of anatomical reference frames in the rearfoot during three-dimensional multisegment foot modeling has been hindered by a variety of factors. One of these factors is related to the difficulty in palpating, or the absence of, anatomical landmarks. A novel device (the [...] Read more.

The determination of anatomical reference frames in the rearfoot during three-dimensional multisegment foot modeling has been hindered by a variety of factors. One of these factors is related to the difficulty in palpating, or the absence of, anatomical landmarks. A novel device (the Calcaneal Marker Device) aimed at standardizing marker placement at the calcaneus was, therefore, developed and evaluated for its reliability. Throughout a random repeated-measures design, the repeatability of calcaneal marker placement was evaluated for two techniques: manual placement and placement using the Calcaneal Marker Device. Translational changes after marker placement and the clinical effect on intersegment angle calculation were quantified. Intraobserver variability was greater in therapist 2 (<5.3 mm) compared with therapist 1 (<2.9 mm). Intraobserver variability was also found to be less than 1.6 mm throughout use of the device. Interobserver variability was found to be significantly higher for the position of markers placed manually (5.8 mm), whereas with the Calcaneal Marker Device, the variability remained lower (<1.3 mm). The effect on the computed intersegment angles followed a similar trend, with variability of 0.4° to 4.0° and 1.0° to 8.7° for CMD and manual placement, respectively. These findings suggest that variations in marker placement are considerably reduced when the novel Calcaneal Marker Device is used, possibly toward the limits dictated by the fine motor skills of therapists and tissue artifacts. Full article

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Open AccessArticle

Does Foot Placement Affect the Reliability of Static Foot Posture Measurements?

by Thomas G. McPoil, Drew Carrell, Derrik Ehlers, Holly Kuhlman, Judy Mufti, Mary Pomeroy, Olivia Taylor and Mark W. Cornwall

J. Am. Podiatr. Med. Assoc. 2014, 104(1), 34-42; https://doi.org/10.7547/0003-0538-104.1.34 - 1 Jan 2014

Cited by 5 | Viewed by 68

Abstract

Previous studies have reported conflicting results on whether different foot placements in standing can affect static measurements of foot posture. We sought to determine whether three measurements of static foot posture could be consistently measured in three different foot placements while standing. Twenty [...] Read more.

Previous studies have reported conflicting results on whether different foot placements in standing can affect static measurements of foot posture. We sought to determine whether three measurements of static foot posture could be consistently measured in three different foot placements while standing. Twenty individuals, 12 women and eight men, with a mean age of 24.8 years consented to participate. Two raters assessed the dorsal arch height, midfoot width, and heel width of each foot while the participant stood in the following three foot placements: a standardized placement, a participant-determined placement after marching in place, and a rater-determined foot placement based on observation of the participant's angle of gait and base of support while walking. All three measurements of static foot posture were shown to have high levels of intrarater and interrater reliability. Significant differences in the measurements of dorsal arch height, midfoot width, and heel width were found among all three of the foot placements. There were no differences between the two raters for any of the three measurements of foot posture. Based on these findings, we recommend that clinicians perform measurements of static foot posture using the same standing foot placement between sessions to ensure a high level of measurement consistency. Full article

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Open AccessArticle

Clinical Acceptance, Reasons for Rejection, and Reduction of In-Shoe Peak Pressure with Interdigital Silicone Orthoses

by Ulrich Illgner, Tymo Budny, Marc Hoyer and Hans Henning Wetz

J. Am. Podiatr. Med. Assoc. 2014, 104(1), 30-33; https://doi.org/10.7547/0003-0538-104.1.30 - 1 Jan 2014

Cited by 5 | Viewed by 47

Abstract

For several years, confectioned or customized interdigital silicone orthoses have been used to treat toe malformations; however, long-term clinical and biomechanical studies are missing. The aim of this study was to evaluate the biomechanical effects of these orthoses and their clinical acceptance. In [...] Read more.

For several years, confectioned or customized interdigital silicone orthoses have been used to treat toe malformations; however, long-term clinical and biomechanical studies are missing. The aim of this study was to evaluate the biomechanical effects of these orthoses and their clinical acceptance. In 2008, 46 patients (30 women and 16 men; average age, 56.8 years) received interdigital silicone orthoses. All of the patients were included in the biomechanical and clinical study. Compliance and acceptance were measured by the Muenster shoe and foot questionnaire, which includes 13 items on pain, activities of daily living, satisfaction, and activity. Mean follow-up was 18 months. Ten feet (eight patients) were chosen by random and underwent pedobarography. One forefoot sensor and two single sensors were attached between the skin and the orthosis. Measurements were performed in-shoe three times with and without the orthosis without removal of the sensors. Forty-four of the 46 patients (95.7%) were included. At the 18-month investigation, 19 patients no longer used their orthoses, most commonly because of pain and failure of the material. Twenty-two patients regularly used their orthoses (8 h/d on average). In-shoe peak pressure lowered significantly with orthosis use (P < .04). Patients who used the orthoses were mostly satisfied. Interdigital silicone orthoses reduce in-shoe peak pressure. Patient satisfaction was good. The durability of the material has to be optimized, and manufacturing remains difficult. The effect on ulcer reduction must be evaluated in a large prospective study. Full article

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Open AccessArticle

Efficacy of Magnetic Resonance Imaging in Diagnosing Osteomyelitis in Diabetic Foot Ulcers

by Miki Fujii, Hiroto Terashi and Shinya Tahara

J. Am. Podiatr. Med. Assoc. 2014, 104(1), 24-29; https://doi.org/10.7547/0003-0538-104.1.24 - 1 Jan 2014

Cited by 13 | Viewed by 65

Abstract

The clinical diagnosis of osteomyelitis is difficult because of neuropathy, vascular disease, and immunodeficiency; also, with no established consensus on the diagnosis of foot osteomyelitis, the reported efficacy of magnetic resonance imaging (MRI) in detecting osteomyelitis and distinguishing it from reactive bone marrow [...] Read more.

The clinical diagnosis of osteomyelitis is difficult because of neuropathy, vascular disease, and immunodeficiency; also, with no established consensus on the diagnosis of foot osteomyelitis, the reported efficacy of magnetic resonance imaging (MRI) in detecting osteomyelitis and distinguishing it from reactive bone marrow edema is unclear. Herein, we describe a retrospective study on the efficacy of MRI for decision-making accuracy in diagnosing osteomyelitis in diabetic foot ulcers. Twelve diabetic patients with infected foot ulcers underwent preoperative MRI between January 1, 2008, and December 31, 2011. The findings were compared with the histopathologic features of 67 parts of 45 resected bones, the cut ends of which were also histopathologically evaluated. Osteomyelitis was disclosed by MRI and histopathologically confirmed in 30 parts. In contrast, bone marrow edema diagnosed by MRI in 29 parts was confirmed in 23; the other six parts displayed osteomyelitis. Among 17 resected bones, 13 cut ends displayed bone marrow edema and four were normal. All of the wounds healed uneventfully. In the diagnosis of diabetic foot ulcers, osteomyelitis is often reliably distinguished from reactive bone marrow edema, except in special cases. Full article

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Open AccessArticle

Assessment of Plantar Pressure in Hindfoot Relief Shoes of Different Designs

by Thomas Hahn, Hans-Dieter Carl, Andreas Jendrissek, Matthias Brem, Bernd Swoboda, Philipp Rummel and Johannes Pauser

J. Am. Podiatr. Med. Assoc. 2014, 104(1), 19-23; https://doi.org/10.7547/0003-0538-104.1.19 - 1 Jan 2014

Cited by 5 | Viewed by 53

Abstract

Although there are several different concepts of hindfoot relief footwear, there are no studies on the extent of pressure reduction to be achieved by this footwear. Therefore, we sought to evaluate the reduction in plantar pressure to be achieved with two different hindfoot [...] Read more.

Although there are several different concepts of hindfoot relief footwear, there are no studies on the extent of pressure reduction to be achieved by this footwear. Therefore, we sought to evaluate the reduction in plantar pressure to be achieved with two different hindfoot relief shoes. Ten healthy volunteers performed three trials at a self-selected speed. Peak pressure values in mass-produced shoes (normal gait) were considered as 100% and were compared with measurements in two differently designed hindfoot relief shoes. Foot portions were defined as heel (0%–15% of total insole length), hindfoot (16%–30%), midfoot (31%–60%), and forefoot (61%–100%). Heel and hindfoot peak pressures were significantly reduced in both shoes compared with normal gait (P < .05), but the extent of peak pressure reduction under the heel and hindfoot varied significantly between the tested shoes. Midfoot peak pressure was not significantly reduced in tested shoes compared with baseline (P > .05) but differed significantly between the two shoes. Forefoot peak pressure was significantly reduced with one of the tested shoes (to a median 73% baseline; P = .004) but not with the other (median, 88% baseline). Hindfoot relief shoes leave a considerable amount of peak pressure, predominantly under the hindfoot. The extent of peak pressure reduction for the heel and the hindfoot varies between different hindfoot relief shoes. Depending on the affected foot area, the kind of hindfoot relief shoe should be carefully chosen. Full article

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Open AccessArticle

Ultrasound Assessment of Dorsal Lisfranc Ligament Strain Under Clinically Relevant Loads

by Nathan C. Graves, David D. Rettedal, Joshua J. Marshall, Katherine Frush and Vassilios Vardaxis

J. Am. Podiatr. Med. Assoc. 2014, 104(1), 11-18; https://doi.org/10.7547/0003-0538-104.1.11 - 1 Jan 2014

Cited by 9 | Viewed by 58

Abstract

Pure Lisfranc ligament injuries have a varied clinical presentation, making them difficult to diagnose. This study seeks to understand in vivo strain characteristics of the dorsal Lisfranc ligament under clinically relevant stress loads and foot orientations measured by ultrasound. Randomized ultrasound imaging trials [...] Read more.

Pure Lisfranc ligament injuries have a varied clinical presentation, making them difficult to diagnose. This study seeks to understand in vivo strain characteristics of the dorsal Lisfranc ligament under clinically relevant stress loads and foot orientations measured by ultrasound. Randomized ultrasound imaging trials were performed on 50 asymptomatic feet of 20-to-32-year-old individuals who were free of lower-extremity abnormalities. The dorsal Lisfranc ligament was ultrasound imaged under low, medium, and high stress while at 0° and 15° abducted foot orientations. Load was applied using a seated calf-raise apparatus, and a single examiner performed all of the tests. Two-way repeated-measures analysis of variance was used to determine any significant load or position main effects or load × position interaction. Position main effect for dorsal Lisfranc ligament length demonstrated a significant overall increase in ligament length of 0.21 mm (P < .001), which reflects a 4.03% change in ligament length between the rectus and 15° abducted orientations. Furthermore, low and medium loads demonstrated significant length increase with position effect (P = .03 and P < .001, respectively). No significant load main effect or interaction was determined. Dorsal Lisfranc ligament length undergoes more strain in an abducted foot position at the same load compared with in a rectus foot. We advocate measuring under a medium load if possible and comparing foot positions for the maximum length changes. The participant stress loads and foot positions used are clinically feasible, which makes it possible to perform this ultrasound procedure in the clinical setting. Full article

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Open AccessArticle

The Amputation Prevention Initiative

by Emily A. Cook, Jeremy J. Cook, Magdala Peixoto Labre, Howard Givens and James J. DiResta

J. Am. Podiatr. Med. Assoc. 2014, 104(1), 1-10; https://doi.org/10.7547/0003-0538-104.1.1 - 1 Jan 2014

Cited by 6 | Viewed by 49

Abstract

The Amputation Prevention Initiative is a project conducted jointly by the Massachusetts Public Health Association and the Massachusetts Podiatric Medical Society that seeks to study methods to reduce nontraumatic lower-extremity amputations from diabetes. To determine the rate of diabetes-related lower-extremity amputations in Massachusetts [...] Read more.

The Amputation Prevention Initiative is a project conducted jointly by the Massachusetts Public Health Association and the Massachusetts Podiatric Medical Society that seeks to study methods to reduce nontraumatic lower-extremity amputations from diabetes. To determine the rate of diabetes-related lower-extremity amputations in Massachusetts and identify the groups most at risk, hospital billing and discharge data were analyzed. To examine the components of the diabetic foot examination routinely performed by general practitioners, surveys were conducted in conjunction with physician meetings in Massachusetts (n = 149) and in six other states (n = 490). The average age-adjusted number of diabetes-related lower-extremity amputations in 2004 was 30.8 per 100,000 and 5.3 per 1,000 diabetic patients in MA, with high-risk groups being identified as men and black individuals. Among the general practitioners surveyed in Massachusetts, only 2.01% reported routinely conducting all four key components of the diabetic foot examination, with 28.86% reporting not performing any components. These findings suggest that many general practitioners may be failing to perform the major components of the diabetic foot examination believed to prevent foot ulcers and lower-extremity amputations. Full article

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J. Am. Podiatr. Med. Assoc., Volume 104, Issue 1 (01 2014) – 22 articles , Pages 1-124

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