Journal of the American Podiatric Medical Association

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J. Am. Podiatr. Med. Assoc. 2015, 105(6), 581-588; https://doi.org/10.7547/8750-7315-105.6.581 - 1 Nov 2015

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J. Am. Podiatr. Med. Assoc. 2015, 105(6), 569-580; https://doi.org/10.7547/8750-7315-105.6.569 - 1 Nov 2015

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In Appreciation

by Warren S. Joseph

J. Am. Podiatr. Med. Assoc. 2015, 105(6), 567-568; https://doi.org/10.7547/8750-7315-105.6.567 - 1 Nov 2015

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Medical literature is dependent on peer review [...] Full article

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A Plan for the Future

by Phillip E. Ward

J. Am. Podiatr. Med. Assoc. 2015, 105(6), 566; https://doi.org/10.7547/8750-7315-105.6.566 - 1 Nov 2015

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Many members might imagine that at the ripe old age of 103, APMA is your granddaddy’s association — an organization steeped in the traditions of the past and slow to react to change. Nothing could be further from the truth [...] Full article

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Meetings–House of Delegates and 2016 Annual Scientific Meeting, American Podiatric Medical Association

by Phillip E. Ward and James R. Christina

J. Am. Podiatr. Med. Assoc. 2015, 105(6), 564-565; https://doi.org/10.7547/8750-7315-105.6.564 - 1 Nov 2015

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In compliance with Article 8.11.1 of the Bylaws, you are hereby notified that the Regular Meeting of the House of Delegates of the American Podiatric Medical Association (APMA) will be held at the time and place indicated in this announcement for the purpose [...] Read more.

In compliance with Article 8.11.1 of the Bylaws, you are hereby notified that the Regular Meeting of the House of Delegates of the American Podiatric Medical Association (APMA) will be held at the time and place indicated in this announcement for the purpose of receiving reports of officers and committees, for the annual election of officers, for action upon regularly offered amendments to the Bylaws and Administrative Procedures, and for such other business as may be presented [...] Full article

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Open AccessCase Report

Acinetobacter baumannii Hallux Infection Secondary to Partial Amputation in a US Soldier. A Case Report

by Michelle P. Glover, Lindsey A. Beaman and Cristóbal S. Berry-Cabán

J. Am. Podiatr. Med. Assoc. 2015, 105(6), 560-563; https://doi.org/10.7547/14-048.1 - 1 Nov 2015

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Acinetobacter baumannii is a gram-negative, aerobic, nonmotile bacterial species found in soil, water, sewage, and, increasingly, health-care settings [...] Full article

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Extrapleural Solitary Fibrous Tumor of the Foot. A Case Report

by Charles A. Kean, Bridget R. Moore, Ashley M. Nettles and Richard P. Bui

J. Am. Podiatr. Med. Assoc. 2015, 105(6), 557-559; https://doi.org/10.7547/13-126.1 - 1 Nov 2015

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Solitary fibrous tumors are uncommon mesenchymal neoplasms that were initially described as pleural tumors, but in recent years, numerous extrapleural sites have been reported. A solitary fibrous tumor is characterized as a circumscribed, painless mass with a patternless growth pattern, positive CD34 spindle-shaped [...] Read more.

Solitary fibrous tumors are uncommon mesenchymal neoplasms that were initially described as pleural tumors, but in recent years, numerous extrapleural sites have been reported. A solitary fibrous tumor is characterized as a circumscribed, painless mass with a patternless growth pattern, positive CD34 spindle-shaped cells, bcl-2, and dense keloidal collagen with areas of hypercellularity and hypocellularity. This case report describes a 55-year-old male veteran who presented with a rare manifestation of an extrapleural solitary fibrous tumor of the medial right hallux. Microscopic and immunohistochemical findings were consistent with the previously documented characteristics of solitary fibrous tumors. Complete surgical excision of the tumor is the treatment of choice. Full article

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A Rare Presentation of Transformed, CD30þ High-Grade Cutaneous T-Cell Lymphoma of the Hallux. A Case Report

by Brant Lanser McCartan, Bang Tang, Allyson Berglund, John Giurini and German Pihan

J. Am. Podiatr. Med. Assoc. 2015, 105(6), 550-556; https://doi.org/10.7547/13-103.1 - 1 Nov 2015

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Cutaneous T-cell lymphoma is a type of non-Hodgkin's lymphoma, which is a neoplasm affecting the lymphatic system. Mycosis fungoides is the most common subset of cutaneous T-cell lymphoma and is often treated conservatively. This neoplasm is most common in adults older than 60 [...] Read more.

Cutaneous T-cell lymphoma is a type of non-Hodgkin's lymphoma, which is a neoplasm affecting the lymphatic system. Mycosis fungoides is the most common subset of cutaneous T-cell lymphoma and is often treated conservatively. This neoplasm is most common in adults older than 60 years and does not regularly manifest in the toes. A case is reported of a 70-year-old man seen for a nonhealing hallux ulceration leading to amputation. Histopathologic examination revealed a rare transformed CD30⁺ high-grade cutaneous T-cell lymphoma. The morbidity of lymphomas is highly dependent on type and grade. Pharmaceutical precision therapies exist that target specific molecular defects or abnormally expressed genes, such as high expression of CD30. This article focuses on treatment protocol and emphasizes the importance of early diagnosis, determination of cell type, and proper referral of atypical dermatologic lesions. Full article

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Nonhealing Venous Ulcers and Chronic Venous Outflow Obstruction. A Case Report

by Jonathan Labovitz, Paul Gagne, Keith Penera and Sandra Wainwright

J. Am. Podiatr. Med. Assoc. 2015, 105(6), 541-549; https://doi.org/10.7547/14-075.1 - 1 Nov 2015

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The etiology of chronic venous insufficiency is typically neglected or misunderstood when treating lower-extremity edema and venous ulcerations. Despite the high prevalence of venous compression syndromes, it is rarely considered when treating venous ulcers and unresolved venous disease. We report a case of [...] Read more.

The etiology of chronic venous insufficiency is typically neglected or misunderstood when treating lower-extremity edema and venous ulcerations. Despite the high prevalence of venous compression syndromes, it is rarely considered when treating venous ulcers and unresolved venous disease. We report a case of bilateral iliac vein outflow obstruction that prohibited venous ulcer healing until properly treated. This case highlights the importance of properly identifying and treating venous compression syndromes to enhance ulcer healing and decrease the risk of venous ulcer recurrence. Full article

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Risk Factors and Protective Factors for Lower-Extremity Running Injuries. A Systematic Review

by Gabriel Gijon-Nogueron and Marina Fernandez-Villarejo

J. Am. Podiatr. Med. Assoc. 2015, 105(6), 532-540; https://doi.org/10.7547/14-069.1 - 1 Nov 2015

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A review of the scientific literature was performed 1) to identify studies describing the most common running injuries and their relation to the risk factors that produce them and 2) to search for potential and specific protective factors. Spanish and English biomedical search [...] Read more.

A review of the scientific literature was performed 1) to identify studies describing the most common running injuries and their relation to the risk factors that produce them and 2) to search for potential and specific protective factors. Spanish and English biomedical search engines and databases (MEDLINE/PubMed, Database Enfermería Fisioterapia Podología [ENFISPO], Cochrane Library, and Cumulative Index to Nursing and Allied Health Literature) were queried (February 1 to November 30, 2013). A critical reading and assessment was then performed by the Critical Appraisal Skills Programme Spanish tool. In total, 276 abstracts that contained the selected key words were found. Of those, 25 identified and analyzed articles were included in the results. Injuries result from inadequate interaction between the runner's biomechanics and external factors. This leads to an excessive accumulation of impact peak forces in certain structures that tends to cause overuse injuries. The main reasons are inadequate muscle stabilization and pronation. These vary depending on the runner's foot strike pattern, foot arch morphology, and sex. Specific measures of modification and control through running footwear are proposed. Full article

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Antibiotic Tissue Penetration in Diabetic Foot Infections. A Review of the Microdialysis Literature and Needs for Future Research

by Amanda Ray, Danielle Malin, David P. Nicolau and Dora E. Wiskirchen

J. Am. Podiatr. Med. Assoc. 2015, 105(6), 520-531; https://doi.org/10.7547/14-036.1 - 1 Nov 2015

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Although many antimicrobial agents display good in vitro activity against the pathogens frequently implicated in diabetic foot infections, effective treatment can be complicated by reduced tissue penetration in this population secondary to peripheral arterial disease and emerging antimicrobial resistance, which can result in [...] Read more.

Although many antimicrobial agents display good in vitro activity against the pathogens frequently implicated in diabetic foot infections, effective treatment can be complicated by reduced tissue penetration in this population secondary to peripheral arterial disease and emerging antimicrobial resistance, which can result in clinical failure. Improved characterization of antibiotic tissue pharmacokinetics and penetration ratios in diabetic foot infections is needed. Microdialysis offers advantages over the skin blister and tissue homogenate studies historically used to define antibiotic penetration in skin and soft-tissue infections by defining antibiotic penetration into the interstitial fluid over the entire concentration versus time profile. However, only a select number of agents currently recommended for treating diabetic foot infections have been evaluated using these methods, which are described herein. Better characterization of the tissue penetration of antibiotic agents is needed for the development of methods for maximizing the pharmacodynamic profile of these agents to ultimately improve treatment outcomes for patients with diabetic foot infections. Full article

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Anti-inflammatory Effects of Clostridial Collagenase. Results from In Vitro and Clinical Studies

by Richard C. Galperin, Darrell L. Lange, Sarah J. Ramsay, Lei Shi, Kathy A. Weedon, Nancy M. Hudson, Jaime E. Dickerson, D. Innes Cargill and Herbert B. Slade

J. Am. Podiatr. Med. Assoc. 2015, 105(6), 509-519; https://doi.org/10.7547/14-066.1 - 1 Nov 2015

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Background: Digestion of collagen with clostridial collagenase (CC) produces peptides that can induce cellular responses consistent with wound healing in vivo. However, nonhealing human wounds are typically in a state of chronic inflammation. We evaluated the effects of CC on markers of inflammation [...] Read more.

Background: Digestion of collagen with clostridial collagenase (CC) produces peptides that can induce cellular responses consistent with wound healing in vivo. However, nonhealing human wounds are typically in a state of chronic inflammation. We evaluated the effects of CC on markers of inflammation in cell culture and wound fluid from diabetic patients. Methods: Lipopolysaccharide-induced release of tumor necrosis factor-α and interleukin-6 from interferon-γ–activated THP-1 monocytes was measured in the presence or absence of CC or CC collagen digests. In the clinical study, 17 individuals with mildly inflamed diabetic foot ulcers were randomized to receive CC ointment (CCO) or hydrogel. Weekly assessments included wound appearance and measurements. Wound exudate was collected at baseline and at 2 and 4 weeks of treatment. A multiplex assay was used to measure levels of analytes, including those associated with inflammation and with inflammation resolution. Results: Lower levels of tumor necrosis factor-α and interleukin-6 were found in media of cells cultured with CC or CC digests of collagen type I or III than for untreated lipopolysaccharide controls (P < .05). Clinically, CCO and hydrogel resulted in improvement in wound appearance and a decrease in mean wound area. The CCO, but not the hydrogel, was found to increase the level of analytes associated with resolution of inflammation while decreasing those associated with inflammation. There was a general correlation between resolution of inflammation and healing. Conclusions: These results support a hypothesis that debridement with CCO is associated with decreased inflammation and greater progress toward healing. Full article

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A Retrospective Review of Diagnostic Testing for Onychomycosis of the Foot

by Nell Blake, Junjia Zhu, Giselle Hernandez and Paul Joseph Juliano

J. Am. Podiatr. Med. Assoc. 2015, 105(6), 503-508; https://doi.org/10.7547/14-063.1 - 1 Nov 2015

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Background: Onychomycosis is a fungal infection of the nail that can be caused by dermatophytes, yeasts, or nondermatophyte molds. To diagnose onychomycosis, a clinician must use the patient’s history, physical findings, and diagnostic testing, which can include calcofluor white/potassium hydroxide (KOH) mount, fungal [...] Read more.

Background: Onychomycosis is a fungal infection of the nail that can be caused by dermatophytes, yeasts, or nondermatophyte molds. To diagnose onychomycosis, a clinician must use the patient’s history, physical findings, and diagnostic testing, which can include calcofluor white/potassium hydroxide (KOH) mount, fungal culture (FC), and periodic acid–Schiff (PAS) stain. Some insurance companies require authorization for antifungal medication and request laboratory results to confirm infection. We sought to compare the reliability of KOH, PAS, and FC diagnostic results for confirmation of fungal disease, to determine the sensitivity and specificity of each test, and to investigate the cost of each test. In addition, we statistically observed the relationship between the test results and demographic variables. Methods: Toenail clippings were obtained from 108 patients clinically diagnosed as having onychomycosis. Diagnostic tests were then performed on each sample; the results were obtained from medical records. Results: For PAS, KOH, and FC, 60.2%, 43.5%, and 39.8% of results, respectively, were positive. Agreement for each pair of tests was slightly higher for FC and KOH. Sensitivities for KOH and PAS were 0.64 and 0.79, respectively. Specificity was 0.79 for KOH and 0.54 for PAS. Both PAS and KOH had a higher percentage of positive test results for men than for women. Conclusions: Of the three tests evaluated, PAS gives the most consistent positive results and has the highest sensitivity. Therefore, PAS should be considered as the best test to verify clinically significant onychomycosis. Full article

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Reduction of Dorsal Displacement of the Proximal and Middle Phalanges Using a Neutral or Angled Implant for Joint Arthrodesis to Treat Hammertoe Deformity. A Finite Element Study

by Javier Bayod López, Ricardo Becerro de Bengoa Vallejo, Marta Elena Losa Iglesias, Kevin T. Jules and Manuel Doblaré

J. Am. Podiatr. Med. Assoc. 2015, 105(6), 493-502; https://doi.org/10.7547/14-032.1 - 1 Nov 2015

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Background: We used finite element analysis to study the mechanical displacements at three planes of the second through fourth hammertoes during the push-off phase of gait using a new neutral or 108 angled memory alloy intramedullary implant (FDA K070598) used for proximal interphalangeal [...] Read more.

Background: We used finite element analysis to study the mechanical displacements at three planes of the second through fourth hammertoes during the push-off phase of gait using a new neutral or 108 angled memory alloy intramedullary implant (FDA K070598) used for proximal interphalangeal joint arthrodesis. Methods: After geometric reconstruction of the foot skeleton from computed tomographic images of a 36-year-old man, an intramedullary implant was positioned in the virtual model at the neutral and 108 angled positions at the proximal interphalangeal joints of the second through fourth hammertoes during the push-off phase of gait. The obtained displacement results in three planes were compared with those derived from the nonsurgical foot model using finite element analysis. Results: These results support the successful use of either a neutral or angled implant for proximal interphalangeal joint arthrodesis, with the neutral implant yielding slightly better results. Conclusions: The neutral implant reduced vertical displacement to a greater extent than did the angled implant. We also highlight the potential risk of iatrogenic curly toe when performing a proximal interphalangeal joint arthrodesis using an angled implant specifically at the fourth toe. Full article

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Effect of Obesity Level on the Longitudinal Arch in 7- to 12-Year-Old Rural and Urban Children

by Renata Woźniacka, Aneta Bac and Stanisław Matusik

J. Am. Podiatr. Med. Assoc. 2015, 105(6), 484-492; https://doi.org/10.7547/13-141.1 - 1 Nov 2015

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Background: We sought to evaluate the influence of obesity level on the medial longitudinal arch (MLA) of the foot in 7- to 12-year-old children. Methods: The study group consisted of 925 children (450 girls and 475 boys). All of the children were subjected [...] Read more.

Background: We sought to evaluate the influence of obesity level on the medial longitudinal arch (MLA) of the foot in 7- to 12-year-old children. Methods: The study group consisted of 925 children (450 girls and 475 boys). All of the children were subjected to podoscopic foot examination and measurement of weight, height, three skinfolds, fat weight, and fat-free body weight. Results: The most common type of MLA was high-arched foot, which was observed in the left foot of 523 children (56.5%) and in the right foot in 592 children (64%). In almost all of the age groups, high-arched foot was the most common disorder. High-arched foot was more common in girls than in boys, and boys displayed a higher percentage of flatfoot. Also, sex-related differences were more prominent in urban children. There was a strongly positive correlation between obesity level and MLA in the examined group. Conclusions: These results suggest that the type of foot arch is influenced by parameters such as age, sex, and obesity level. High-arched foot seemed to be the most frequent pathologic abnormality in the examined group, and flatfoot, which was predominant in boys and obese children, diminished with age. High-arched foot was a more common MLA type than flatfoot regardless of obesity level assessed on the basis of body mass index and sum of three skinfolds. Full article

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Radiographic Investigation of the Absolute and Relative First Metatarsal Lengths in the Asymptomatic Foot

by John Grady, Kathleen Trotter, Jake Ruff and Sarah Miller

J. Am. Podiatr. Med. Assoc. 2015, 105(6), 478-483; https://doi.org/10.7547/13-099.1 - 1 Nov 2015

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Background: We investigated distortion of measured lengths of the first and second metatarsals between two radiographic views and ultrasound-guided measurements. Methods: In a case series performed between June 29, 2012, and February 6, 2013, two standard anteroposterior and lateral radiographs of each foot [...] Read more.

Background: We investigated distortion of measured lengths of the first and second metatarsals between two radiographic views and ultrasound-guided measurements. Methods: In a case series performed between June 29, 2012, and February 6, 2013, two standard anteroposterior and lateral radiographs of each foot were obtained from 27 asymptomatic participants. Three raters performed blinded radiographic measurements of the first and second metatarsal lengths on each view and compared results. Actual first and second metatarsal lengths were measured using diagnostic ultrasound and were compared with the radiographic measurements. The relative distances between the first and second metatarsals were obtained on the anteroposterior and lateral views and were compared. Results: Absolute first metatarsal length measurements were significantly affected by view (mean difference, 5.3 mm; 95% confidence interval [CI], 4.88–5.78 mm; P , .001), with no significant difference between raters (P ¼ .039). Absolute second metatarsal length measurements were significantly affected by view (mean difference, 2.84 mm; 95% CI, 2.8–3.6 mm) and by rater (P ¼ .024). First and second metatarsal anteroposterior values were 13.9% and 15.3% longer, respectively, than the actual length as measured by ultrasound (P , .001). Relative first metatarsal length was significantly shorter on lateral views (mean difference, 3.85 mm; 95% CI, 2.7–5 mm; P , .001). First metatarsal length was best approximated by the lateral view. Conclusions: This study demonstrates the effect of radiographic distortion on the measurement of metatarsal length. The lateral view is more accurate than the anteroposterior view for measuring the first metatarsal. Owing to variance of relative metatarsal length on the two views, conclusions regarding a relatively short or long first metatarsal compared with the second metatarsal cannot be drawn. Full article

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Plantar Pressure and Gait Symmetry in Individuals with Fractures versus Tendon Injuries to the Hindfoot

by Stephanie R. Albin, Mark W. Cornwall, Thomas G. McPoil, Drew H. Van Boerum and James M. Morgan

J. Am. Podiatr. Med. Assoc. 2015, 105(6), 469-477; https://doi.org/10.7547/14-073.1 - 1 Nov 2015

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Background: The intent of this study was to determine whether differences in function, walking characteristics, and plantar pressures exist in individuals after operative fixation of an intra-articular calcaneal fracture (HFX) compared with individuals with operative repair of an Achilles tendon rupture (ATR). Methods: [...] Read more.

Background: The intent of this study was to determine whether differences in function, walking characteristics, and plantar pressures exist in individuals after operative fixation of an intra-articular calcaneal fracture (HFX) compared with individuals with operative repair of an Achilles tendon rupture (ATR). Methods: Twenty patients (ten with HFXs and ten with ATRs) were recruited approximately 3.5 months after operative intervention. All of the participants completed the Lower Extremity Functional Scale and had their foot posture assessed using the Foot Posture Index. Walking velocity was assessed using a pressure mat system, and plantar pressures were measured using an in-shoe sensor. In addition to between-group comparisons, the involved foot was compared with the uninvolved foot for each participant. Results: There were no differences in age, height, weight, or number of days since surgery between the two groups. The HFX group had lower Lower Extremity Functional Scale scores, slower walking velocities, and different forefoot loading patterns compared with the ATR group. The involved limb of both groups was less pronated. Conclusions: The results indicate that individuals with an HFX spend more time on their involved limb and walk slower than those with an ATR. Plantar pressures in the HFX group were higher in the lateral forefoot and lower in the medial forefoot and in the ATR group were symmetrically lower in the forefoot. Full article

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J. Am. Podiatr. Med. Assoc., Volume 105, Issue 6 (11 2015) – 17 articles , Pages 469-588

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