Journal of the American Podiatric Medical Association

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Our APMA

by Phillip E. Ward

J. Am. Podiatr. Med. Assoc. 2015, 105(5), 468; https://doi.org/10.7547/8750-7315-105.5.468 - 1 Sep 2015

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Evidence-Based Approach to Advanced Wound Care Products

by Jeffrey M. Robbins and Jeremiah Dillon

J. Am. Podiatr. Med. Assoc. 2015, 105(5), 456-467; https://doi.org/10.7547/14-089 - 1 Sep 2015

Cited by 7 | Viewed by 64

Abstract

There is increasing pressure from industry to use advanced wound care products and technologies. Many are very expensive but promise to reduce overall costs associated with wound care. Compelling anecdotal evidence is provided that inevitably shows wounds that failed all other treatments but [...] Read more.

There is increasing pressure from industry to use advanced wound care products and technologies. Many are very expensive but promise to reduce overall costs associated with wound care. Compelling anecdotal evidence is provided that inevitably shows wounds that failed all other treatments but responded positively to the subject product. Evidence-based medicine is the standard by which physician-scientists must make their clinical care decisions. In an attempt to provide policy makers with the most current evidence on advanced wound care products, the Department of Veteran Affairs conducted an Evidence-based Synthesis Program review of advanced wound care products. This paper suggests how to take this information and apply it to policy to drive evidence-based care to improve outcomes and fiduciary responsibility. Full article

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Kyrle Disease. A Rare Dermatologic Condition Associated with the Diabetic Foot

by Myron Bodman, Duane Ehredt Jr, Robert Barker, Amity Kirkland and Priyanka Mude

J. Am. Podiatr. Med. Assoc. 2015, 105(5), 451-455; https://doi.org/10.7547/14-009 - 1 Sep 2015

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We report two cases of biopsy-confirmed Kyrle disease. Kyrle disease is one of the perforating dermatoses associated with diabetic patients undergoing renal dialysis. In this report, we describe the clinical and histopathologic features, the differential diagnoses, and successful treatment of this unusual disorder. [...] Read more.

We report two cases of biopsy-confirmed Kyrle disease. Kyrle disease is one of the perforating dermatoses associated with diabetic patients undergoing renal dialysis. In this report, we describe the clinical and histopathologic features, the differential diagnoses, and successful treatment of this unusual disorder. Full article

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True Pathologic Abnormality versus Artifact. Foot Position and Magic Angle Artifact in the Peroneal Tendons with 3T Imaging

by Deena Blair Horn, Steven Meyers and William Astor

J. Am. Podiatr. Med. Assoc. 2015, 105(5), 443-450; https://doi.org/10.7547/14-068 - 1 Sep 2015

Cited by 5 | Viewed by 79

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Magnetic resonance imaging is a commonly ordered examination by many foot and ankle surgeons for ankle pain and suspected peroneal tendon pathologic abnormalities. Magic angle artifact is one of the complexities associated with this imaging modality. Magic angle refers to the increased signal [...] Read more.

Magnetic resonance imaging is a commonly ordered examination by many foot and ankle surgeons for ankle pain and suspected peroneal tendon pathologic abnormalities. Magic angle artifact is one of the complexities associated with this imaging modality. Magic angle refers to the increased signal on magnetic resonance images associated with the highly organized collagen fibers in tendons and ligaments when they are orientated at a 55° angle to the main magnetic field. We present several examples from a clinical practice setting using 3T imaging illustrating a substantial reduction in magic angle artifact of the peroneal tendon in the prone plantarflexed position compared with the standard neutral (right angle) position. Full article

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A Novel Case of an Acrochordon Occurring on the Plantar Foot

by Harrison P. Nguyen, Maura J. Holcomb, Bhuvaneswari Krishnan and Rajani Katta

J. Am. Podiatr. Med. Assoc. 2015, 105(5), 440-442; https://doi.org/10.7547/14-083 - 1 Sep 2015

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We report on a 63-year-old male who was found to have an acrochordon on his plantar foot. Although acrochordons constitute a common benign clinical finding, this observation represents, to our knowledge, only the second case reported on the foot and the first occuring [...] Read more.

We report on a 63-year-old male who was found to have an acrochordon on his plantar foot. Although acrochordons constitute a common benign clinical finding, this observation represents, to our knowledge, only the second case reported on the foot and the first occuring on the plantar surface. Full article

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Pediatric Subtalar Joint Synovial Chondromatosis. Report of a Case and an Up-to-date Review

by Balaji Saibaba, Pebam Sudesh, Gokul Govindan and Mahesh Prakash

J. Am. Podiatr. Med. Assoc. 2015, 105(5), 435-439; https://doi.org/10.7547/14-106 - 1 Sep 2015

Cited by 3 | Viewed by 54

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Synovial chondromatosis is a rare, usually benign disorder affecting the population predominantly in the third and fourth decades of life and mainly involving the large weightbearing joints of the lower limb—the knees and the hip. In this report, we highlight an unusual pediatric [...] Read more.

Synovial chondromatosis is a rare, usually benign disorder affecting the population predominantly in the third and fourth decades of life and mainly involving the large weightbearing joints of the lower limb—the knees and the hip. In this report, we highlight an unusual pediatric clinical presentation of synovial osteochondromatosis involving the subtalar joint and discuss its surgical management; we also provide a comprehensive up-to-date literature review of the disorder. This patient was successfully treated with en masse surgical excision. He has been doing well, with complete pain relief and improved range of motion at 1-year follow-up. An exceptional involvement of the subtalar joint and an unusual presentation in the pediatric age group makes this case unique. Full article

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Perceived Stress and Coffee and Energy Drink Consumption Predict Poor Sleep Quality in Podiatric Medical Students. A Cross-sectional Study

by Mohomad Al Sawah, Naeemah Ruffin, Mohammad Rimawi, Carmen Concerto, Eugenio Aguglia, Eileen Chusid, Carmenrita Infortuna and Fortunato Battaglia

J. Am. Podiatr. Med. Assoc. 2015, 105(5), 429-434; https://doi.org/10.7547/14-082 - 1 Sep 2015

Cited by 35 | Viewed by 77

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Background: A cross-sectional survey administered to first- and second-year podiatric medical students aimed to investigate the effect of coffee intake, energy drink consumption, and perceived stress on sleep quality in medical students during their preclinical studies. Methods: Ninety-eight of 183 students contacted (53.6%) [...] Read more.

Background: A cross-sectional survey administered to first- and second-year podiatric medical students aimed to investigate the effect of coffee intake, energy drink consumption, and perceived stress on sleep quality in medical students during their preclinical studies. Methods: Ninety-eight of 183 students contacted (53.6%) completed a questionnaire comprising standard instruments measuring sleep quality (Pittsburgh Sleep Quality Index), daytime sleepiness (Epworth Sleepiness scale), and perceived stress (ten-item Perceived Stress Scale). Furthermore, we investigated coffee and energy drink consumption. Logistic regression was conducted to identify factors associated with poor sleep quality and the relation between sleep quality and academic performance (grade point average). Results: High prevalences of poor sleep quality, excessive daytime sleepiness, and perceived stress were reported. In addition, higher odds of developing poor sleep quality were associated with coffee and energy drink intake, perceived stress, and excessive daytime sleepiness. The total Pittsburgh Sleep Quality Index score was inversely correlated with grade point average. Conclusions: First- and second-year podiatric medical students have poor sleep quality. Further research is needed to identify effective strategies to reduce stress and decrease coffee and energy drink intake to minimize their negative effect on sleep quality and academic performance in podiatric medical students. Full article

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A Mobile Health Service to Manage Diabetic Foot in Homeless Patients

by Marco Matteoli, Claudia Scaringi, Paola Carella, Luca Fruttaldo, Ulrico Angeloni and Massimo Laurenza

J. Am. Podiatr. Med. Assoc. 2015, 105(5), 424-428; https://doi.org/10.7547/13-152 - 1 Sep 2015

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Background: Homeless people live in poverty, with limited access to public health services. They are likely to experience chronic medical conditions, such as diabetes mellitus; however, they do not always receive the necessary services to prevent complications. This study was designed to determine [...] Read more.

Background: Homeless people live in poverty, with limited access to public health services. They are likely to experience chronic medical conditions, such as diabetes mellitus; however, they do not always receive the necessary services to prevent complications. This study was designed to determine the effectiveness of a volunteer health service outreach to reduce disparity in diabetic foot care for homeless people. Methods: The research was conducted on 21 patients with diabetic ulcers of 930 homeless people visited between 2008 and 2013. Each ulcer was treated with regular medication every week for a mean 6 SD of 17.6 6 12 months. The inclusion criteria were 1) homeless with a previous diagnosis of diabetes or a blood glucose level greater than 126 mg/dL at first check and 2) foot ulcer caused by diabetic vasculopathy or neuropathy. The efficacy of the interventions was assessed against the number of successfully cured diabetic feet based on a reduced initial Wagner classification score for each ulcer. Results: Clinical improvement was observed in 18 patients (86%), whose pathologic condition was completely resolved after 3 years and, therefore, no longer needed medication. One patient died of septic shock and kidney failure, and two patients needed amputation owing to clinical worsening of ulcers (Wagner class 4 at the last visit). Conclusions: Most homeless people who have diabetes and diabetic foot encounter many difficulties managing their disease, and a volunteer health-care unit could be a suitable option to bridge these gaps. Full article

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Open AccessArticle

Medical and Economic Impact of a Free Student-Run Podiatric Medical Clinic. A Preliminary Analysis

by Natalie T. Hua, Chia-Ding Shih and David Tran

J. Am. Podiatr. Med. Assoc. 2015, 105(5), 418-423; https://doi.org/10.7547/13-022 - 1 Sep 2015

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Background: Data from the free student-run podiatric medical clinic at Clínica Tepati at the University of California, Davis, were used to analyze medical and economic impacts on health-care delivery and to extrapolate the economic impact to the national level. Clínica Tepati also provides [...] Read more.

Background: Data from the free student-run podiatric medical clinic at Clínica Tepati at the University of California, Davis, were used to analyze medical and economic impacts on health-care delivery and to extrapolate the economic impact to the national level. Clínica Tepati also provides an excellent teaching environment and services to the uninsured Hispanic population in the Greater Sacramento area. Methods: In this analysis, we retrospectively reviewed patient medical records for podiatric medical encounters during 15 clinic days between November 2010 and February 2012. The economic impact was evaluated by matching diagnoses and treatments with Medicare reimbursement rates using International Classification of Diseases codes, Current Procedural Terminology codes, and the prevailing Medicare reimbursement rates. Results: Sixty-three podiatric medical patients made 101 visits during this period. Twenty patients returned to the clinic for at least one follow-up visit or for a new medical concern. Thirty-nine different diagnoses were identified, and treatments were provided for all 101 patient encounters/visits. Treatments were limited to those within the clinic's resources. This analysis estimates that $17,332.13 worth of services were rendered during this period. Conclusions: These results suggest that the free student-run podiatric medical clinic at Clínica Tepati had a significant medical and economic impact on the delivery of health care at the regional level, and when extrapolated, nationally as well. These student-run clinics also play an important role in medical education settings. Full article

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Static Foot Posture and Mobility Associated With Postural Sway in Elderly Women Using a Three-dimensional Foot Scanner

by Mahshid Saghazadeh, Kenji Tsunoda, Yuki Soma and Tomohiro Okura

J. Am. Podiatr. Med. Assoc. 2015, 105(5), 412-417; https://doi.org/10.7547/14-021 - 1 Sep 2015

Cited by 8 | Viewed by 56

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Background: Maintaining balance is a complex phenomenon that is influenced by a range of sensorimotor factors. Foot posture and mobility may also influence balance and postural sway. Recently, three-dimensional foot scanners have been used to assess foot posture. This tool allows many individuals [...] Read more.

Background: Maintaining balance is a complex phenomenon that is influenced by a range of sensorimotor factors. Foot posture and mobility may also influence balance and postural sway. Recently, three-dimensional foot scanners have been used to assess foot posture. This tool allows many individuals to be scanned quickly and easily and helps eliminate patients’ radiation exposure. The objective of this study was to determine whether static foot posture and mobility are independently associated with postural sway in a large community sample of older women using objective measures of balance status and the recently launched technology of three-dimensional foot scanning. Methods: This cross-sectional study included 140 community-dwelling elderly women (mean 6 SD age, 73.9 6 5.1 years) recruited in Kasama City, Japan. The postural sway variables were total path length and area and were measured by force plate. We measured static foot posture, sitting and standing navicular height, and mobility using a three-dimensional foot scanner. Foot mobility was determined as the amount of vertical navicular excursion between the positions of the subtalar joint, from neutral in sitting position to relaxed bilateral standing. Results: After adjusting for potential cofounders, analysis of covariance revealed that sitting navicular height was associated with total path length (P ¼ .038) and area (P ¼ .031). Foot mobility was associated with total path length (P ¼ .018). Conclusions: These findings suggest that sitting navicular height and foot mobility are associated with postural sway in elderly women and might be an important factor in defining balance control in older adults. Full article

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Efinaconazole Topical Solution, 10%. Efficacy in Patients with Onychomycosis and Coexisting Tinea Pedis

by Bryan Markinson and Bryan Caldwell

J. Am. Podiatr. Med. Assoc. 2015, 105(5), 407-411; https://doi.org/10.7547/14-088 - 1 Sep 2015

Cited by 37 | Viewed by 79

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Background: We sought to evaluate the efficacy of efinaconazole topical solution, 10%, in patients with onychomycosis and coexisting tinea pedis. Methods: We analyzed 1,655 patients, aged 18 to 70 years, randomized (3:1) to receive efinaconazole topical solution, 10%, or vehicle from two identical [...] Read more.

Background: We sought to evaluate the efficacy of efinaconazole topical solution, 10%, in patients with onychomycosis and coexisting tinea pedis. Methods: We analyzed 1,655 patients, aged 18 to 70 years, randomized (3:1) to receive efinaconazole topical solution, 10%, or vehicle from two identical multicenter, doubleblind, vehicle-controlled 48-week studies evaluating safety and efficacy. The primary end point was complete cure rate (0% clinical involvement of the target toenail and negative potassium hydroxide examination and fungal culture findings) at week 52. Three groups were compared: patients with onychomycosis and coexisting interdigital tinea pedis on-study (treated or left untreated) and those with no coexisting tinea pedis. Results: Treatment with efinaconazole topical solution, 10%, was significantly more effective than vehicle use irrespective of the coexistence of tinea pedis or its treatment. Overall, 352 patients with onychomycosis (21.3%) had coexisting interdigital tinea pedis, with 215 of these patients (61.1%) receiving investigator-approved topical antifungal agents for their tinea pedis in addition to their randomized onychomycosis treatment. At week 52, efinaconazole complete cure rates of 29.4% were reported in patients with onychomycosis when coexisting tinea pedis was treated compared with 16.1% when coexisting tinea pedis was not treated. Both cure rates were significant compared with vehicle (P ¼ .003 and .045, respectively), and in the latter subgroup, no patients treated with vehicle achieved a complete cure. Conclusions: Treatment of coexisting tinea pedis in patients with onychomycosis enhances the efficacy of once-daily topical treatment with efinaconazole topical solution, 10%. Full article

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Reduction in Size and Number of Plantar Verrucae in Human Immunodeficiency Virus–Infected Individuals After the Implementation of Highly Active Antiretroviral Therapy

by Endri Afesllari, Timothy J. Miller, Michael J. Huchital, Christy M. King, James S. Johnston and Peter Barbosa

J. Am. Podiatr. Med. Assoc. 2015, 105(5), 401-406; https://doi.org/10.7547/14-044 - 1 Sep 2015

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Background: Implementation of highly active antiretroviral therapy (HAART) significantly increased the life expectancy of those living with human immunodeficiency virus (HIV). Except for prevalence, scientific reports regarding clinical manifestations of plantar verrucae in the post-HAART era are lacking. The objective of this study [...] Read more.

Background: Implementation of highly active antiretroviral therapy (HAART) significantly increased the life expectancy of those living with human immunodeficiency virus (HIV). Except for prevalence, scientific reports regarding clinical manifestations of plantar verrucae in the post-HAART era are lacking. The objective of this study was to compare clinical manifestations of plantar verrucae between HIV-infected and noninfected individuals and then to compare these findings with those observed before the implementation of HAART. Methods: Nineteen patients with plantar verrucae (ten with HIV and nine without HIV) were examined to determine the size, number, and clinical type of verrucae present. The two groups were first compared with each other and then with previously collected data from a similar analysis conducted in 1995, before the implementation of HAART. Statistical significance was determined using the Fisher exact test or the Wilcoxon rank sum test. Results: No significant differences were observed in the size, number, or clinical type of verrucae between HIV-negative and HIV-positive patients. Compared with the 1995 data, there was a significant decrease in the number of verrucae lesions per individual and a nonsignificant decrease in the average size of verrucae in HIV-positive patients. Conclusions: Study results indicate that the implementation of HAART has impacted the clinical manifestations of plantar verrucae in HIV-positive individuals. Further analyses with a larger number of patients are required to confirm and substantiate these findings. Full article

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Candida albicans Immunotherapy for Verrucae Plantaris

by Tracey C. Vlahovic, Samuel Spadone, S. Patrick Dunn, Tara Fussell, Ian Hersh, Tyson Green, Jeff Merrill, Payel Ghosh and Tran Tran

J. Am. Podiatr. Med. Assoc. 2015, 105(5), 395-400; https://doi.org/10.7547/14-062 - 1 Sep 2015

Cited by 9 | Viewed by 86

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Background: Verrucae plantaris is a viral disease caused by human papilloma virus that is commonly seen in the office setting and is often challenging to treat owing to its high recurrence rate and recalcitrant profile. Candida albicans intralesional injections have been hypothesized to [...] Read more.

Background: Verrucae plantaris is a viral disease caused by human papilloma virus that is commonly seen in the office setting and is often challenging to treat owing to its high recurrence rate and recalcitrant profile. Candida albicans intralesional injections have been hypothesized to incite an immunogenic response toward the virus. Methods: We report on the immunotherapeutic effect of intralesional injection of C albicans into plantar verrucae with a retrospective medical record analysis of 80 patients. Using a luer-lock syringe, 0.1 to 0.3 mL of C albicans antigen was injected into either the first known lesion or the largest lesion. Results: The success rate of intralesional C albicans, defined as total clearance of the lesion, was 65%, which may be underestimated because patients lost to follow-up were included in the 35% failure rate. It was also found that female patients with a previous tissue-destructive treatment process were more than four times more likely to respond to C albicans therapy, whereas this effect was less pronounced in the male patient population. Conclusions: These results indicate that a series of intralesional injections of C albicans is an effective and efficient method of treatment for verrucae plantaris. Full article

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Open AccessArticle

Plate Fixation of Proximal Fifth Metatarsal Fracture

by Assaf Kadar, Ran Ankory, Ronen Karpf, Elhanan Luger and Shlomo Elias

J. Am. Podiatr. Med. Assoc. 2015, 105(5), 389-394; https://doi.org/10.7547/14-035 - 1 Sep 2015

Cited by 9 | Viewed by 78

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Background: Intramedullary screw fixation of fractures of the proximal fifth metatarsal bone may not be satisfactory in comminuted fractures or when the lateral metatarsal bowing has to be restored. We report our experience with plate fixation in these circumstances. Methods: Between June 1, [...] Read more.

Background: Intramedullary screw fixation of fractures of the proximal fifth metatarsal bone may not be satisfactory in comminuted fractures or when the lateral metatarsal bowing has to be restored. We report our experience with plate fixation in these circumstances. Methods: Between June 1, 2009, and January 31, 2013, 13 patients who had comminuted fracture or nonunion of fracture of the proximal fifth metatarsal bone underwent plate fixation. Study patients were followed up for a mean of 500 days (range, 51–1238 days). Their medical records and radiographs were retrospectively reviewed for demographic and operative data and radiologic evidence of fracture healing. At their most recent follow-up, patients were evaluated for pain levels with a visual analog scale, for foot function with the Foot and Ankle Disability Index, and for quality of life with the 12-Item Short-Form Health Survey. Results: Fracture union was evident in 12 patients after a mean of 56.8 days (range, 30– 92 days). There was only one major complication of sural nerve neuroma and reflex sympathetic dystrophy. Four patients required reoperation for plate removal. Plate fixation of proximal fifth metatarsal comminuted fractures is associated with high union rates, relief of pain, and patient satisfaction. However, plate removal for various reasons was required in approximately one-third of the study patients. This high revision rate might be avoided by better selection of patients and meticulous intraoperative identification and preservation of the sural nerve. Conclusions: We recommend reserving plate fixation for proximal fifth metatarsal fractures for cases of laterally bowed fifth metatarsal or comminuted fractures. Full article

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Vancomycin Tissue Pharmacokinetics in Patients with Lower-Limb Infections via In Vivo Microdialysis

by Seth T. Housman, Amira A. Bhalodi, Ashley Shepard, James Nugent and David P. Nicolau

J. Am. Podiatr. Med. Assoc. 2015, 105(5), 381-388; https://doi.org/10.7547/14-033 - 1 Sep 2015

Cited by 14 | Viewed by 75

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Background: Vancomycin is a common treatment option for skin and skin structure infections caused by methicillin-resistant Staphylococcus aureus (MRSA). Given the increasing prevalence of MRSA, vancomycin is widely used as empirical therapy. In patients with lower-limb infections, antimicrobial penetration is often reduced because [...] Read more.

Background: Vancomycin is a common treatment option for skin and skin structure infections caused by methicillin-resistant Staphylococcus aureus (MRSA). Given the increasing prevalence of MRSA, vancomycin is widely used as empirical therapy. In patients with lower-limb infections, antimicrobial penetration is often reduced because of decreased vascular perfusion. In this study, we evaluated the tissue concentrations of vancomycin in hospitalized patients with lower-limb infections. Methods: An in vivo microdialysis catheter was inserted near the margin of the wound and was perfused with lactated Ringer’s solution. Tissue and serum samples were obtained after steady state for one dosing interval. Tissue concentrations were corrected for percentage of in vivo recovery using the retrodialysis technique. Results: Nine patients were enrolled (mean 6 SD: age, 54 6 19 years; weight, 105.6 6 31.5 kg). Patients received a mean of 12.8 mg/kg of vancomycin every 12 hours (n ¼7), every 8 hours (n ¼ 1), or every 24 hours (n ¼ 1). Mean 6 SD steady-state trough vancomycin concentrations in serum and tissue were 11.1 6 3.3 and 6.0 6 2.6 lg/mL. The mean 6 SD 24-hour free drug areas under the curve for serum and wound were 283.7 6 89.4 and 232.8 6 75.7 lg*h/mL, respectively. The mean 6 SD tissue penetration ratio was 0.8 6 0.2. Conclusions: These data suggest that against MRSA with minimum inhibitory concentrations of 1 lg/mL or less, vancomycin achieved blood pharmacodynamic targets required for the likelihood of success. Reduced concentrations may contribute to poor outcomes and the development of resistance. As other literature suggests, alternative agents may be needed when the pathogen of interest has a minimum inhibitory concentration greater than 1 lg/mL. Full article

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J. Am. Podiatr. Med. Assoc., Volume 105, Issue 5 (09 2015) – 15 articles , Pages 381-468

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