Journal of the American Podiatric Medical Association

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Open AccessArticle

Acceptance Address, APMA House of Delegates, Washington, DC, March 16, 2014

by Frank Spinosa

J. Am. Podiatr. Med. Assoc. 2014, 104(3), 316-319; https://doi.org/10.7547/0003-0538-104.3.316 - 1 May 2014

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Abstract

Good afternoon delegates, guests, friends! [...] Full article

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Open AccessBook Review

Forensic Podiatry: Principles and Methods

by Michael S. Nirenberg

J. Am. Podiatr. Med. Assoc. 2014, 104(3), 313-314; https://doi.org/10.7547/0003-0538-104.3.313 - 1 May 2014

Cited by 1 | Viewed by 71

Abstract

The highest honor bestowed by the criminalistics section of the American Academy of Forensic Sciences is the Paul L. Kirk Award [...] Full article

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Open AccessArticle

Letter to the Editor

by Matthew L. Brown and Judith F. Baumhauer

J. Am. Podiatr. Med. Assoc. 2014, 104(3), 311-312; https://doi.org/10.7547/0003-0538-104.3.311 - 1 May 2014

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Abstract

To The Editor: [...] Full article

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Open AccessArticle

Doctors of Podiatric Medicine—On a Pathway to Becoming Fully Licensed Physicians and Surgeons?

by Leonard A. Levy

J. Am. Podiatr. Med. Assoc. 2014, 104(3), 305-310; https://doi.org/10.7547/0003-0538-104.3.305 - 1 May 2014

Cited by 4 | Viewed by 68

Abstract

Since the 1970s, the profession of podiatric medicine has undergone major changes in the dimensions of its practice as well as its education and training. Herein, I describe how podiatric medicine has evolved to become a profession of independent practitioners who now provide [...] Read more.

Since the 1970s, the profession of podiatric medicine has undergone major changes in the dimensions of its practice as well as its education and training. Herein, I describe how podiatric medicine has evolved to become a profession of independent practitioners who now provide patients with comprehensive medical and surgical care affecting the foot and ankle in community practice, academic health centers, and hospital operating rooms. Preparation for the profession virtually mirrors the education and training of the MD and DO, including a 4-year postbaccalaureate curriculum with a preclinical curriculum that matches that of Liaison Committee on Medical Education–accredited medical schools and most of the clinical curriculum of undergraduate medical education. Completion of the degree of doctor of podiatric medicine prepares graduates to enter hospital-based graduate medical education programs, now 3 years in duration. A description is provided of the current podiatric medical practitioner now prepared at a level that is virtually equal to that of medical and surgical specialists who hold an unrestricted medical license. Full article

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Open AccessArticle

Subungual Schwannoma with Clinical, Sonographic, and Histologic Correlation

by Rosamary Soto, Maria Jose Aldunce, Ximena Wortsman and Ivo Sazunic

J. Am. Podiatr. Med. Assoc. 2014, 104(3), 302-304; https://doi.org/10.7547/0003-0538-104.3.302 - 1 May 2014

Cited by 16 | Viewed by 58

Abstract

We show an unusual presentation of a schwannoma that was located in the ungual bed of the left great toe. The clinical, color Doppler ultrasound imaging, and histologic findings are shown to illustrate the case. This type of neurogenic tumor and the ultrasound [...] Read more.

We show an unusual presentation of a schwannoma that was located in the ungual bed of the left great toe. The clinical, color Doppler ultrasound imaging, and histologic findings are shown to illustrate the case. This type of neurogenic tumor and the ultrasound presurgical imaging support should be considered when dealing with subungual tumors of the foot. Full article

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Open AccessArticle

Acute Rupture of the Tibialis Posterior Tendon without Fracture

by Nicolò Martinelli, Carlo Bonifacini, Alberto Bianchi, Laura Moneghini, Gennaro Scotto and Elena Sartorelli

J. Am. Podiatr. Med. Assoc. 2014, 104(3), 298-301; https://doi.org/10.7547/0003-0538-104.3.298 - 1 May 2014

Cited by 10 | Viewed by 55

Abstract

The acute rupture of the tibialis posterior (TP) tendon, compared to an acute rupture of the Achilles tendon, is a quite uncommon disease to be diagnosed in the emergency department setting. In most cases symptoms related to a TP dysfunction, like weakness, pain [...] Read more.

The acute rupture of the tibialis posterior (TP) tendon, compared to an acute rupture of the Achilles tendon, is a quite uncommon disease to be diagnosed in the emergency department setting. In most cases symptoms related to a TP dysfunction, like weakness, pain along the course of the tendon, swelling in the region of the medial malleolus, and the partial or complete loss of the medial arch with a flatfoot deformity precede the complete rupture of the tendon. In this case report, we describe an acute rupture of the TP tendon following a pronation-external rotation injury of the ankle with no association of a medial malleolus fracture and with no history of a prior flatfoot deformity or symptoms. Full article

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Open AccessArticle

Malignant Melanoma Presenting as a Nonhealing Heel Ulceration

by Jacqueline Nicole Fussell, David Lee Troutman, Eric Hossler and Shilpa Agarwal

J. Am. Podiatr. Med. Assoc. 2014, 104(3), 295-297; https://doi.org/10.7547/0003-0538-104.3.295 - 1 May 2014

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Abstract

Malignant melanoma is responsible for more than three-fourths of skin cancer deaths in the United States. Melanomas presenting on acral surfaces are frequently misdiagnosed initially, leading to progression of disease and worse prognosis. This case is presented to reinforce the significance of careful [...] Read more.

Malignant melanoma is responsible for more than three-fourths of skin cancer deaths in the United States. Melanomas presenting on acral surfaces are frequently misdiagnosed initially, leading to progression of disease and worse prognosis. This case is presented to reinforce the significance of careful physical examination and early biopsy of atypical ulcerations of the foot. Full article

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Open AccessArticle

Incidental Pedal Manifestation of Primary Bone Lymphoma

by Nicole M. DeLauro, Shital Sharma, Nrupa Shah and Imtiaz Ahmed

J. Am. Podiatr. Med. Assoc. 2014, 104(3), 291-294; https://doi.org/10.7547/0003-0538-104.3.291 - 1 May 2014

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Abstract

Primary lymphoma of bone (PLB) is an uncommon entity and is extremely rare in the foot and ankle. In this case, PLB was identified from the bone specimen after a bunionectomy of the first and fifth metatarsals. The diagnosis was confirmed with pathologic [...] Read more.

Primary lymphoma of bone (PLB) is an uncommon entity and is extremely rare in the foot and ankle. In this case, PLB was identified from the bone specimen after a bunionectomy of the first and fifth metatarsals. The diagnosis was confirmed with pathologic analysis, genetic karyotyping, positron emission and computed tomography scans, and fluorescence in situ hybridization (FISH). We felt that reporting this case was essential due to the rarity of its pedal occurrence and the lack of preoperative signs or symptoms. Full article

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Open AccessArticle

A New Snowboard Injury Caused by “FLOW” Bindings

by Daniel Haverkamp, Daniel Hoornenborg, Mario Maas and Gino Kerkhoffs

J. Am. Podiatr. Med. Assoc. 2014, 104(3), 287-290; https://doi.org/10.7547/0003-0538-104.3.287 - 1 May 2014

Cited by 2 | Viewed by 48

Abstract

We present a case of a snowboard injury that caused a combination of a complete deltoid and anterior talofibular ligament rupture, without bony or syndesmotic injury. Initial surgical repair for both ligaments was performed. We describe the etiology of this injury to demonstrate [...] Read more.

We present a case of a snowboard injury that caused a combination of a complete deltoid and anterior talofibular ligament rupture, without bony or syndesmotic injury. Initial surgical repair for both ligaments was performed. We describe the etiology of this injury to demonstrate the cause and existence of medial and lateral ankle ligament rupture without osseous and syndesmotic involvement and to create awareness of these types of injuries. Full article

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Open AccessArticle

Perioperative Posterior Heel Pain Caused by Multiple Etiologies Including a Neuroma in Continuity of the Posterior Branch of the Sural Nerve

by Stephen L. Barrett and Nathan L. Larson

J. Am. Podiatr. Med. Assoc. 2014, 104(3), 283-286; https://doi.org/10.7547/0003-0538-104.3.283 - 1 May 2014

Cited by 2 | Viewed by 43

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Posterior heel pain after a prior Haglund's deformity surgical correction can be resultant to multiple etiologies: osseous, tendinous, and neural. In this case report, all three potential etiologies were found to be contributing to the postoperative status of the patient. This case report [...] Read more.

Posterior heel pain after a prior Haglund's deformity surgical correction can be resultant to multiple etiologies: osseous, tendinous, and neural. In this case report, all three potential etiologies were found to be contributing to the postoperative status of the patient. This case report illustrates identification and treatment of a neuroma in continuity of the posterior branch of the sural nerve with preservation of the sural nerve itself via microdissection, which we believe has not been described previously in the literature. Full article

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Open AccessReview

Placebo Cure Rates in the Treatment of Onychomycosis

by Aditya K. Gupta and Maryse Paquet

J. Am. Podiatr. Med. Assoc. 2014, 104(3), 277-282; https://doi.org/10.7547/0003-0538-104.3.277 - 1 May 2014

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Abstract

Placebo cure rates vary among randomized clinical trials for onychomycosis, but the factors influencing these cure rates have not been systematically investigated. The PubMed database and reference sections of relevant publications were searched for randomized controlled trials of dermatophyte toenail onychomycosis that included [...] Read more.

Placebo cure rates vary among randomized clinical trials for onychomycosis, but the factors influencing these cure rates have not been systematically investigated. The PubMed database and reference sections of relevant publications were searched for randomized controlled trials of dermatophyte toenail onychomycosis that included a placebo control and that assessed cure rates. From 21 studies, the pooled mean ± SD placebo cure rates regarding mycological, clinical, and complete cure were 8.7% ± 3.7%, 3.4% ± 2.2%, and 1.2% ± 1.4%, respectively. There was no statistically significant difference between oral and topical treatments. None of the cure rates significantly correlated with any of the participant or study design characteristics analyzed. Placebo cure rates in randomized controlled trials of toenail onychomycosis are relatively low and are independent of the study characteristics. Full article

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Open AccessArticle

“Step Up for Foot Care”

by Bright Chen, Analiza Mitchell and David Tran

J. Am. Podiatr. Med. Assoc. 2014, 104(3), 269-276; https://doi.org/10.7547/0003-0538-104.3.269 - 1 May 2014

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Abstract

Studies have shown that lower-extremity problems in the homeless population have significant public health and economic implications. A combined community service and research project was performed to identify and address the foot and ankle care needs in a sample homeless population in San [...] Read more.

Studies have shown that lower-extremity problems in the homeless population have significant public health and economic implications. A combined community service and research project was performed to identify and address the foot and ankle care needs in a sample homeless population in San Francisco, California. A 37-question survey regarding general demographic characteristics, foot hygiene practices, associated risk factors, and self-reported lower-extremity pathologic conditions was completed by 299 homeless individuals who met the inclusion criteria. The service project included education on proper foot care and the distribution of footwear. The participants demonstrated mostly good efforts regarding foot hygiene but had high-risk factors, including smoking, alcohol use, and extended hours on their feet. More than half of the homeless individuals surveyed experienced foot pain. Approximately one in five had edema and neuropathic symptoms. The most commonly reported foot problems were dermatologic, but these conditions could pose serious sequelae in the setting of risk factors. The community service project was well received by the homeless community. This study demonstrates lack of resources and high-risk factors for lower-extremity complications in the homeless individuals studied. It is important in the realm of public health to keep lower-extremity health in mind because it plays an important role in preventing the spread of infection and lowering the social economic burden. Full article

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Open AccessArticle

Plantar Fasciitis and Its Relationship with Hallux Limitus

by Yolanda Aranda and Pedro V. Munuera

J. Am. Podiatr. Med. Assoc. 2014, 104(3), 263-268; https://doi.org/10.7547/0003-0538-104.3.263 - 1 May 2014

Cited by 17 | Viewed by 105

Abstract

We sought to determine whether patients with plantar fasciitis have limited dorsiflexion in the first metatarsophalangeal joint and which type of foot, pronated or supinated, is most frequently associated with plantar fasciitis. The 100 study participants (34 men and 66 women) were divided [...] Read more.

We sought to determine whether patients with plantar fasciitis have limited dorsiflexion in the first metatarsophalangeal joint and which type of foot, pronated or supinated, is most frequently associated with plantar fasciitis. The 100 study participants (34 men and 66 women) were divided into two groups: patients with plantar fasciitis and controls. The Foot Posture Index and dorsiflexion of the first metatarsophalangeal joint were compared between the two groups, and a correlation analysis was conducted to study their relationship. In the plantar fasciitis group there was a slight limitation of dorsiflexion of the hallux that was not present in the control group (P < .001). Hallux dorsiflexion and the Foot Posture Index were inversely correlated (Spearman correlation coefficient, −0.441; P < .01). Participants with plantar fasciitis presented less hallux dorsiflexion than those in the control group, and their most common foot type was the pronated foot. Full article

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Open AccessArticle

Idiopathic Toe-Walking

by Cylie M. Williams, Paul Tinley and Barry Rawicki

J. Am. Podiatr. Med. Assoc. 2014, 104(3), 253-262; https://doi.org/10.7547/0003-0538-104.3.253 - 1 May 2014

Cited by 17 | Viewed by 90

Abstract

Idiopathic toe-walking (ITW) is a condition commonly seen by podiatric physicians. Because a toe-walking gait style is also caused by or associated with many other medical conditions, podiatric physicians should pay particular attention to ensuring an accurate diagnosis. There are many reported treatment [...] Read more.

Idiopathic toe-walking (ITW) is a condition commonly seen by podiatric physicians. Because a toe-walking gait style is also caused by or associated with many other medical conditions, podiatric physicians should pay particular attention to ensuring an accurate diagnosis. There are many reported treatment options available for ITW. Therefore, a literature review was conducted to determine what treatment options are supported by the evidence as having the best long-term effect on ITW gait. After extraction of relevant articles, 21 manuscripts reporting treatment options for ITW gait were appraised against the levels of evidence. From these articles, there was no single treatment option reported as having a long-term effect on the gait of children with ITW. There was support in the literature for surgical interventions, serial casting, and the use of botulinum toxin type A. There was limited evidence that footwear or orthoses changed the gait pattern. This review updates the knowledge of podiatric physicians, enhances how children who present with this gait style can be managed, and highlights areas for future research. Full article

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The Consistency of Individual-Selected Versus Rater-Determined Angle and Base of Gait

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

J. Am. Podiatr. Med. Assoc. 2014, 104(3), 247-252; https://doi.org/10.7547/0003-0538-104.3.247 - 1 May 2014

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Abstract

Several studies have reported the necessity of using a standardized foot placement to improve reliability when performing standing foot posture measurements. The intent of this study was to determine whether individuals can reliably place their feet in the same standing position after marching [...] Read more.

Several studies have reported the necessity of using a standardized foot placement to improve reliability when performing standing foot posture measurements. The intent of this study was to determine whether individuals can reliably place their feet in the same standing position after marching in place or whether the standing position must be determined by a rater observing the angle and base of gait during walking to ensure the consistency of foot placement. Twenty individuals (12 women and 8 men; mean age, 24.8 years) consented to participate. All of the participants were asked to march in place for 10 sec and then to stop in their preferred angle and base foot placement. Participants then walked over an 8-m walkway so that one of two raters could observe the participant's angle and base while walking. An angle and base of gait tracing was then made for each participant's foot placement. The two raters and all of the participants demonstrated high levels of reliability for foot placement between the two sessions. The results indicate that asking the participant to march in place provides a more consistent angle and base foot placement between two sessions compared with having a rater determine the angle and base of gait foot placement after observing the participant while walking. Based on these findings, we recommend using marching in place to position a patient in his or her angle and base foot placement when the measurement or visual assessment of foot posture must be performed for more than one clinical visit. Full article

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Open AccessArticle

The Subtalar Joint Axis Palpation Technique—Part 1

by Ken K. Van Alsenoy, Joris De Schepper, Derek Santos, Evie E. Vereecke and Kristiaan D'Août

J. Am. Podiatr. Med. Assoc. 2014, 104(3), 238-246; https://doi.org/10.7547/0003-0538-104.3.238 - 1 May 2014

Cited by 3 | Viewed by 70

Abstract

Locating the position of the subtalar joint axis can be a predictive clinical variable in biomechanical analysis and a valuable tool in the design of functional foot orthoses. Before testing Kirby's palpation technique to locate the subtalar joint axis in cadavers, it was [...] Read more.

Locating the position of the subtalar joint axis can be a predictive clinical variable in biomechanical analysis and a valuable tool in the design of functional foot orthoses. Before testing Kirby's palpation technique to locate the subtalar joint axis in cadavers, it was important to develop and test the experimental methods in a mechanical model in which the exact location of the hinge joint can be controlled. Four testers determined the hinge joint location and moved it through its range of motion, capturing the movement of the joint axis using a kinematic model. The joint axis location was determined and validated by comparing the actual hinge joint location on the mechanical model with the location determined by the palpation technique described by Kirby in 1987 and the location determined by the helical joint axis method using three-dimensional kinematic data. The overall angles result in mean slopes and intersections of 87° and 92 mm, 86° and 97 mm, 85° and 92 mm, and 88° and 91 mm for testers 1, 2, 3, and 4, respectively. Testers 1 and 3 were able to determine the location to 1° and 1 mm accuracy, tester 2 to 0° and 4 mm, and tester 4 to 2° and 2 mm compared with the kinematic data. The technique of determining the points of no rotation as described by Kirby could be validated by using a three-dimensional kinematic model to determine the helical axis. Full article

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Using a Polymerase Chain Reaction as a Complementary Test to Improve the Detection of Dermatophyte Fungus in Nails

by María José Iglesias Sánchez, Ana María Pérez Pico, Félix Marcos Tejedor, María Jesús Iglesias Sánchez and Raquel Mayordomo Acevedo

J. Am. Podiatr. Med. Assoc. 2014, 104(3), 233-237; https://doi.org/10.7547/0003-0538-104.3.233 - 1 May 2014

Cited by 13 | Viewed by 70

Abstract

Dermatomycoses are a group of pathologic abnormalities frequently seen in clinical practice, and their prevalence has increased in recent decades. Diagnostic confirmation of mycotic infection in nails is essential because there are several pathologic conditions with similar clinical manifestations. The classical method for [...] Read more.

Dermatomycoses are a group of pathologic abnormalities frequently seen in clinical practice, and their prevalence has increased in recent decades. Diagnostic confirmation of mycotic infection in nails is essential because there are several pathologic conditions with similar clinical manifestations. The classical method for confirming the presence of fungus in nail is microbiological culture and the identification of morphological structures by microscopy. We devised a nested polymerase chain reaction (PCR) that amplifies specific DNA sequences of dermatophyte fungus that is notably faster than the 3 to 4 weeks that the traditional procedure takes. We compared this new technique and the conventional plate culture method in 225 nail samples. The results were subjected to statistical analysis. We found concordance in 78.2% of the samples analyzed by the two methods and increased sensitivity when simultaneously using the two methods to analyze clinical samples. Now we can confirm the presence of dermatophyte fungus in most of the positive samples in just 24 hours, and we have to wait for the result of culture only in negative PCR cases. Although this PCR cannot, at present, substitute for the traditional culture method in the detection of dermatophyte infection of the nails, it can be used as a complementary technique because its main advantage lies in the significant reduction of time used for diagnosis, in addition to higher sensitivity. Full article

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Open AccessArticle

Is Scintigraphy a Guideline Method in Determining Amputation Levels in Diabetic Foot?

by Yakup Barbaros Baykal, Emre Yaman, Halil Burc, Huseyin Yorgancigil, Tolga Atay and Mustafa Yıldız

J. Am. Podiatr. Med. Assoc. 2014, 104(3), 227-232; https://doi.org/10.7547/0003-0538-104.3.227 - 1 May 2014

Cited by 4 | Viewed by 55

Abstract

In this study, we aimed to evaluate the potential use of a 3-phase bone scintigraphy method to determine the level of amputation on treatment cost, morbidity and mortality, reamputation rates, and the duration of hospitalization in diabetic foot. Thirty patients who were admitted [...] Read more.

In this study, we aimed to evaluate the potential use of a 3-phase bone scintigraphy method to determine the level of amputation on treatment cost, morbidity and mortality, reamputation rates, and the duration of hospitalization in diabetic foot. Thirty patients who were admitted to our clinic between September 2008 and July 2009, with diabetic foot were included. All patients were evaluated according to age, gender, diabetes duration, 3-phase bone scintigraphy, Doppler ultrasound, amputation/reamputation levels, and hospitalization periods. Patients underwent 3-phase bone scintigraphy using technetium-99m methylene diphosphonate, and the most distal site of the region displaying perfusion during the perfusion and early blood flow phase was marked as the amputation level. Amputation level was determined by 3-phase bone scintigraphy, Doppler ultrasound, and inspection of the infection-free clear region during surgery. The amputation levels of the patients were as follows: finger in six (20%), ray amputation in five (16.6%), transmetatarsal in one (3.3%), Lisfranc in two (6.6%), Chopart in seven (23.3%), Syme in one (3.3%), below-the-knee in six (20%), above the knee in one (3.3%), knee disarticulation in one (3.3%), and two patients underwent amputation at other centers. After primary amputation, reamputation was performed on seven patients, and one patient was treated with debridement for wound site problems. No mortality was encountered during study. We conclude that 3-phase bone scintigraphy prior to surgery could be a useful method to determine the amputation level in a diabetic foot. We conclude that further, comparative, more comprehensive, long-term, and controlled studies are required. Full article

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High Serum Concentration of Interleukin-18 in Diabetic Patients with Foot Ulcers

by Tevfik Sabuncu, Mehmet Ali Eren, Suzan Tabur, Omer Faruk Dag and Omer Boduroglu

J. Am. Podiatr. Med. Assoc. 2014, 104(3), 222-226; https://doi.org/10.7547/0003-0538-104.3.222 - 1 May 2014

Cited by 11 | Viewed by 62

Abstract

It is well known that interleukin-18 (IL-18) plays a key role in the inflammatory process. However, there are limited data on the role IL-18 plays with diabetic foot ulcers, an acute and complex inflammatory situation. Therefore, we aimed to evaluate serum IL-18 levels [...] Read more.

It is well known that interleukin-18 (IL-18) plays a key role in the inflammatory process. However, there are limited data on the role IL-18 plays with diabetic foot ulcers, an acute and complex inflammatory situation. Therefore, we aimed to evaluate serum IL-18 levels of diabetic patients with foot ulcers. Twenty diabetic patients with acute foot ulcers, 21 diabetic patients without a history of foot ulcers, and 21 healthy volunteers were enrolled in our study. Circulating levels of IL-18, and other biochemical markers are parameters of inflammation and were measured in all three groups. Diabetic patients both with and without foot ulcers had high IL-18 concentrations (P < 0.001 and P = 0.020, respectively) when compared with the nondiabetic volunteers. Those with foot ulcers had higher levels of IL-18 level (P < 0.001), high-sensitivity C-reactive protein (hsCRP) (P = 0.001), and erythrocyte sedimentation rate (ESR) (P < 0.001) than those without foot ulcers. We found that serum IL-18 concentrations were elevated in diabetic patients with acute diabetic foot ulcers. However, these findings do not indicate whether the IL-18 elevation is a cause or a result of the diabetic foot ulceration. Further studies are needed to show the role of IL-18 in the course of these ulcers. Full article

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J. Am. Podiatr. Med. Assoc., Volume 104, Issue 3 (05 2014) – 19 articles , Pages 222-319

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