Journal of the American Podiatric Medical Association

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Open AccessArticle

The Sprint to the Finish

by Phillip E. Ward

J. Am. Podiatr. Med. Assoc. 2016, 106(1), 87; https://doi.org/10.7547/8750-7315-106.1.87 - 1 Jan 2016

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It seems like just yesterday I was writing my very first presidential message to APMA members, and incredibly, here I am writing my last [...] Full article

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Open AccessReview

Azole Resistance in Dermatophytes. Prevalence and Mechanism of Action

by Mahmoud Ghannoum

J. Am. Podiatr. Med. Assoc. 2016, 106(1), 79-86; https://doi.org/10.7547/14-109 - 1 Jan 2016

Cited by 88 | Viewed by 117

Abstract

Azole antifungal agents (eg, fluconazole and itraconazole) have been widely used to treat superficial fungal infections caused by dermatophytes and, unlike the allylamines (such as terbinafine and naftifine), have been associated with resistance development. Although many published manuscripts describe resistance to azoles among [...] Read more.

Azole antifungal agents (eg, fluconazole and itraconazole) have been widely used to treat superficial fungal infections caused by dermatophytes and, unlike the allylamines (such as terbinafine and naftifine), have been associated with resistance development. Although many published manuscripts describe resistance to azoles among yeast and molds, reports describing resistance of dermatophytes are starting to appear. In this review, I discuss the mode of action of azole antifungals and mechanisms underlying their resistance compared with the allylamine class of compounds. Data from published and original studies were compared and summarized, and their clinical implications are discussed. In contrast to the cidal allylamines, static drugs such as azoles permit the occurrence of mutations in enzymes involved in ergosterol biosynthesis, and the ergosterol precursors accumulating as a consequence of azole action are not toxic. Azole antifungals, unlike allylamines, potentiate resistance development in dermatophytes. Full article

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Open AccessCase Report

Eccrine Syringofibroadenoma of the Heel. A Case Report

by Nathalia Doobay and Jason Mallette

J. Am. Podiatr. Med. Assoc. 2016, 106(1), 76-78; https://doi.org/10.7547/14-121 - 1 Jan 2016

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Abstract

Eccrine syringofibroadenoma is a rare, benign tumor of eccrine ductal differentiation, typically presenting in the extremities. Herein we report a case of a 77-year-old man with pain in the lateral midfoot and the presence of an eccrine syringofibroadenoma lesion in the lateral heel. [...] Read more.

Eccrine syringofibroadenoma is a rare, benign tumor of eccrine ductal differentiation, typically presenting in the extremities. Herein we report a case of a 77-year-old man with pain in the lateral midfoot and the presence of an eccrine syringofibroadenoma lesion in the lateral heel. On surgical excision of the lesion, the foot pain promptly resolved, and at the most recent follow-up visit, the patient remained pain free. Full article

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Open AccessArticle

Assessment of a Cultural Competency Program in Podiatric Medical Education

by Kevin M. Smith, Simon Geletta and Travis Langan

J. Am. Podiatr. Med. Assoc. 2016, 106(1), 68-75; https://doi.org/10.7547/14-067 - 1 Jan 2016

Cited by 3 | Viewed by 45

Abstract

Background: Des Moines University College of Podiatric Medicine and Surgery (CPMS) is implementing a cultural competency program for third-year podiatric medical students. This study assessed the effectiveness of the new educational program on cultural competency at CPMS by comparing pretest and posttest scores [...] Read more.

Background: Des Moines University College of Podiatric Medicine and Surgery (CPMS) is implementing a cultural competency program for third-year podiatric medical students. This study assessed the effectiveness of the new educational program on cultural competency at CPMS by comparing pretest and posttest scores of students from the CPMS graduating classes of 2013 and 2014. Methods: Students from the class of 2013 completed a 10-week online course on cultural competency, and the class of 2014 students did not. A pretest and posttest survey was used to assess cultural competency. The questions were categorized to assess either knowledge acquisition or attitudinal change. The 2013 students completed the pretest before the course and a posttest after completing the course. Without taking the course, 2014 students completed the same pretest and posttest separated by 10 weeks. A repeated-measures analysis of variance was used to compare the knowledge acquisition scores and attitudinal change scores. Results: The repeated-measures analysis of variance revealed a significant interaction effect of taking the attitudinal change course (F(1,77) = 15.2; P < .001). The course did not show a significant interaction on knowledge acquisition (F(1,77) = 0.72; P > .05). Conclusions: The analysis showed a statistically significant improvement in attitudinal change scores. The study suggests that there needs to be a greater knowledge acquisition component to the cultural competency course at CPMS. Full article

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Open AccessArticle

The Use of Rubrics in the Clinical Evaluation of Podiatric Medical Students. Objectification of the Subjective Experience

by Kevin M. Smith, Simon Geletta and Austin McArdle

J. Am. Podiatr. Med. Assoc. 2016, 106(1), 60-67; https://doi.org/10.7547/14-038 - 1 Jan 2016

Cited by 2 | Viewed by 67

Abstract

Background: We assessed the differences in podiatric medical students' clinical professionalism objective scores (CPOSs) by comparing a previous nonrubric evaluation tool with a more recently implemented objective-centered rubric evaluation tool. This type of study has never been performed or reported on in the [...] Read more.

Background: We assessed the differences in podiatric medical students' clinical professionalism objective scores (CPOSs) by comparing a previous nonrubric evaluation tool with a more recently implemented objective-centered rubric evaluation tool. This type of study has never been performed or reported on in the podiatric medical education literature. Methods: We conducted a retrospective analysis of 89 third-year podiatric medical students between academic years 2010-2011 and 2011-2012. A Pearson correlation coefficient analysis was performed to compare CPOSs from the students’ first (CPOS1) and second (CPOS2) rotations. A correlation analysis was performed comparing students’ grade point averages (GPAs) with each of the individual CPOSs to verify the validity of the rubric evaluation tool. Results: The Pearson correlation coefficients for the relationship between 2012 CPOS1 and CPOS2 and GPA were r = 0.233 (P ≤ .093) and r = 0.290 (P < .035) and for the relationship between 2013 CPOS1 and CPOS2 and GPA were r = 0.525 (P = .001) and r = 0.730 (P < .001). Conclusions: These findings suggest that the use of a rubric in the evaluation of podiatric medical students’ CPOSs is correlated with their GPAs, and CPOS2 demonstrated a higher correlation than CPOS1. We believe that implementation of the rubric evaluation tool has increased the accuracy of the evaluation of podiatric medical students with respect to CPOSs. Full article

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Open AccessArticle

Pathologic Disorders of the Foot in Professional Female Flamenco Dancers

by José M. Castillo-López, Pedro V. Munuera-Martínez, Cristina Algaba-Guisado, María Reina-Bueno, Nadia Salti-Pozo and Alfonso Vargas-Macías

J. Am. Podiatr. Med. Assoc. 2016, 106(1), 54-59; https://doi.org/10.7547/14-111 - 1 Jan 2016

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Abstract

Background: The foot is the main element of artistic creation in flamenco dancing. At the professional level, the foot undergoes high musculoskeletal demands, predisposing the development of podiatric pathologic disorders in this group. The principal objective of this study was to determine the [...] Read more.

Background: The foot is the main element of artistic creation in flamenco dancing. At the professional level, the foot undergoes high musculoskeletal demands, predisposing the development of podiatric pathologic disorders in this group. The principal objective of this study was to determine the most common foot lesions in professional female flamenco dancers. Methods: In a cross-sectional observational study of 44 female professional flamenco dancers, the participants completed a short questionnaire about their demographic features, number of hours danced per week, and years of professional activity. Any foot lesions presented by the participant were also recorded. Results: Some type of pathologic foot condition was noted in 75% of the women, with a particularly high prevalence of hallux abducto valgus (61.4%), hypermobility of the first ray (43.2%), claw toe (40.9%), and varus fifth toe (37.5%) compared with the general population. No significant differences in the presence of pathologic disorders of the foot were found according to the time dedicated to dance or the years of professional activity. Conclusions: Female flamenco dancers in this study had a high prevalence of podiatric medical problems: some kind of pathologic abnormality of the foot was present in 75% of the participants. Hallux abducto valgus, claw toe, and hypermobility of the first ray were the most common pathologic disorders observed. Full article

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Open AccessArticle

A Long-Term Study of the Effect of Subtalar Arthrodesis on the Ankle and Hindfoot Joints

by Chonglin Yang, Xiangyang Xu, Yuan Zhu, Jinhao Liu and Baofu Wei

J. Am. Podiatr. Med. Assoc. 2016, 106(1), 47-53; https://doi.org/10.7547/14-002 - 1 Jan 2016

Cited by 14 | Viewed by 46

Abstract

Background: Subtalar arthrodesis is a common therapy for subtalar joint disorders. In this article, we evaluate the effect of subtalar arthrodesis on the ankle and hindfoot joints [...] Full article

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Open AccessErratum

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J. Am. Podiatr. Med. Assoc. 2016, 106(1), 46; https://doi.org/10.7547/8750-7315-106.1.46 - 1 Jan 2016

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n/a Full article

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Open AccessArticle

Dynamic Flexion Stiffness of Foot Joints During Walking

by Enrique Sanchis-Sales, Joaquin L. Sancho-Bru, Alba Roda-Sales and Javier Pascual-Huerta

J. Am. Podiatr. Med. Assoc. 2016, 106(1), 37-46; https://doi.org/10.7547/14-141 - 1 Jan 2016

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Abstract

Background: Dynamic stiffness can be used for studying foot pathologic abnormalities and for developing prostheses and orthoses. Although previous works have studied the role of ankle joint stiffness during gait, other foot joints have not yet been analyzed. We sought to characterize the [...] Read more.

Background: Dynamic stiffness can be used for studying foot pathologic abnormalities and for developing prostheses and orthoses. Although previous works have studied the role of ankle joint stiffness during gait, other foot joints have not yet been analyzed. We sought to characterize the dynamic stiffness of the ankle, midtarsal, and metatarsophalangeal joints during normal walking. Methods: Kinematics and contact data from four healthy individuals during walking were registered with a three-dimensional motion analysis system and a pressure platform. Stance phases with flexion moment-angle linear relationships were identified, and dynamic stiffnesses were calculated from the slope of their linear regressions. Intraparticipant repeatability was analyzed using analyses of variance, and interparticipant variability was checked through the SD of averaged participant stiffnesses. Results: Flexion moment-angle linear relationships were identified (R² > 0.98) during the early and late midstance phases and the propulsion phase at the ankle (2.76, 5.23, and 3.42 Nm/kg/rad, respectively) and midtarsal (15.88, 3.90, and 4.64 Nm/kg/rad, respectively) joints. At the metatarsophalangeal joint, a linear relationship (R² > 0.96) occurred only during the propulsion phase (0.11 N·m/kg/rad). High dynamic stiffness variability was observed during the late and early midstance phases at the ankle and midtarsal joints, respectively. Conclusions: These results may serve as a basis for future studies aimed at investigating the role of dynamic stiffness identified herein in different foot disorders. The importance of properly controlling the samples in such studies is highlighted. Study of the dynamic stiffnesses identified might be used in the design of prostheses, orthoses, and other assistive devices. Full article

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Open AccessArticle

Assessment and Diagnosis of Posterior Tibial Tendon Dysfunction. Do We Share the Same Opinions and Beliefs?

by Beverley Durrant, Nachiappan Chockalingam and Christopher Morriss-Roberts

J. Am. Podiatr. Med. Assoc. 2016, 106(1), 27-36; https://doi.org/10.7547/14-122 - 1 Jan 2016

Cited by 4 | Viewed by 56

Abstract

Background: Posterior tibial tendon dysfunction is a disabling pathologic flatfoot disorder. Evidence supports the notion that this condition is poorly diagnosed by health-care professionals. In addition, opinion is divided as to the most appropriate assessment and diagnostic techniques used to reflect the progression [...] Read more.

Background: Posterior tibial tendon dysfunction is a disabling pathologic flatfoot disorder. Evidence supports the notion that this condition is poorly diagnosed by health-care professionals. In addition, opinion is divided as to the most appropriate assessment and diagnostic techniques used to reflect the progression or stage of the condition. Hence, this study intended to explore the views and opinions of health-care professionals who may be involved in its assessment and diagnosis. Methods: A two-phase sequential mixed methods design was used that combined a questionnaire survey and a focus group interview. Results: The questionnaire data were analyzed using the Kendall levels of concordance and the Cohen kappa statistic, and the focus group data were analyzed using thematic analysis, which led to three main themes: resource implications, scope of practice, and awareness of the condition. Conclusions: This study highlights what may have been suspected previously but that has never been investigated in a structured manner. One approach to the assessment and diagnosis of posterior tibial tendon dysfunction is not necessarily the best, and depending on the clinical teams, different guidance may be required to ensure that patients are receiving the most appropriate and best care. Full article

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Open AccessArticle

Cheilectomy as a First-Line Surgical Treatment Option Yields Good Functional Results in Grade III Hallux Rigidus

by Engin Cetinkaya, Merter Yalcinkaya, Sami Sokucu, Abdulkadir Polat, Ufuk Ozkaya and Atilla Sancar Parmaksizoglu

J. Am. Podiatr. Med. Assoc. 2016, 106(1), 22-26; https://doi.org/10.7547/14-098 - 1 Jan 2016

Cited by 8 | Viewed by 48

Abstract

Background: This study aimed to analyze the functional results of cheilectomy in the surgical treatment of grade III hallux rigidus and to evaluate whether cheilectomy is a preferable first-line treatment over other surgical methods. Methods: Of 29 patients with moderate daily physical activity [...] Read more.

Background: This study aimed to analyze the functional results of cheilectomy in the surgical treatment of grade III hallux rigidus and to evaluate whether cheilectomy is a preferable first-line treatment over other surgical methods. Methods: Of 29 patients with moderate daily physical activity who underwent cheilectomy between 2009 and 2012 on being diagnosed as having grade III hallux rigidus according to the Coughlin-Shurnas grading system, 21 patients (14 women and 7 men; mean age, 59.2 years; age range, 52–67 years) (22 feet) with regular follow-up and complete medical records were included in the study. The patients were evaluated in the preoperative and postoperative periods using a visual analog scale for pain and the American Orthopaedic Foot and Ankle Society metatarsophalangeal assessment forms. Results: The preoperative mean American Orthopaedic Foot and Ankle Society score of 53 (range, 29–67) improved to 78 (range, 57–92) postoperatively (Wilcoxon test P ¼ .001). The preoperative mean visual analog scale score of 89 (range, 60–100) improved to 29 (range, 0–70) in the postoperative period (Wilcoxon test P ¼ .001). Conclusions: As a simple and repeatable procedure that allows for further jointsacrificing surgical procedures when required, cheilectomy is a preferable method to be applied as a first-line option for the surgical treatment of grade III hallux rigidus. Full article

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Open AccessArticle

Influence of Children's Foot Type on Their Physical Motor Performance

by Juan Francisco Arévalo-Mora, Maria Reina-Bueno and Pedro V. Munuera

J. Am. Podiatr. Med. Assoc. 2016, 106(1), 15-21; https://doi.org/10.7547/14-086 - 1 Jan 2016

Cited by 8 | Viewed by 77

Abstract

Background: This cross-sectional study aimed to determine whether normal, flat, or high-arched feet corresponded to better performance of certain motor tests in children. Methods: One hundred eighty-seven children (mean 6 SD age, 11.15 6 1.24 years) were recruited and divided into three groups: [...] Read more.

Background: This cross-sectional study aimed to determine whether normal, flat, or high-arched feet corresponded to better performance of certain motor tests in children. Methods: One hundred eighty-seven children (mean 6 SD age, 11.15 6 1.24 years) were recruited and divided into three groups: 96 with normal feet, 54 with high-arched feet, and 37 with low-arched feet. Nine motor trials were selected to assess motor performance: standing long jump, standing triple jump from each foot, standing vertical jump, shuttle run 10 3 5 m, standing-start 20-m sprint, static balance, dynamic balance on a beam of an inverted gym bench, and agility circuit. Results: There were no significant differences in the trial results between groups, although in eight of the nine trials participants in the high-arched group tended to perform better. Boys performed better than girls in all of the trials except those of balance. Conclusions: These results suggest that children with a certain foot type did not achieve better motor performance in the nine trials tested. Full article

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Open AccessArticle

Foot Complications and Mortality. Results from Translating Research Into Action for Diabetes (TRIAD)

by Laura N. McEwen, Kelly R. Ylitalo, Michael Munson, William H. Herman and James S. Wrobel

J. Am. Podiatr. Med. Assoc. 2016, 106(1), 7-14; https://doi.org/10.7547/14-115 - 1 Jan 2016

Cited by 24 | Viewed by 51

Abstract

Background: We sought to study the impact of foot complications on 10-year mortality independent of other demographic and biological risk factors in a racially and socioeconomically diverse managed-care population with access to high-quality medical care. Methods: We studied 6,992 patients with diabetes in [...] Read more.

Background: We sought to study the impact of foot complications on 10-year mortality independent of other demographic and biological risk factors in a racially and socioeconomically diverse managed-care population with access to high-quality medical care. Methods: We studied 6,992 patients with diabetes in Translating Research Into Action for Diabetes (TRIAD), a prospective observational study of diabetes care in managed care. Foot complications were assessed using administrative claims data. The National Death Index was searched for deaths across 10 years of follow-up (2000-2009). Results: Charcot’s neuro-osteoarthropathy and diabetic foot ulcer with debridement were associated with an increased risk of mortality; however, the associations were not significant in fully adjusted models. Lower-extremity amputation (LEA) was associated with an increased risk of mortality in unadjusted (hazard ratio [HR], 3.21; 95% confidence interval [CI], 2.50–4.12) and fully adjusted (HR, 1.84; 95% CI, 1.28–2.63) models. When we examined the associations between LEA and mortality stratified by sex and race, risk was increased in men (HR, 1.96; 95% CI, 1.25–3.07), Hispanic individuals (HR, 5.17; 95% CI, 1.48–18.01), and white individuals (HR, 2.18; 95% CI, 1.37–3.47). In sensitivity analyses, minor LEA tended to increase the risk of mortality (HR, 1.48; 95% CI, 0.92–2.40), and major LEA was associated with a significantly higher risk of death at 10 years (HR, 1.89; 95% CI, 1.18–3.01). Conclusions: In this managed-care population with access to high-quality medical care, LEA remained a robust independent predictor of mortality. The association was strongest in men and differed by race. Full article

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Open AccessArticle

Evaluating Iatrogenic Complications of the Total-Contact Cast. An 8-Year Retrospective Review at Cleveland Clinic

by Tammy M. Owings, Nicole Nicolosi, Jessica M. Suba and Georgeanne Botek

J. Am. Podiatr. Med. Assoc. 2016, 106(1), 1-6; https://doi.org/10.7547/14-107 - 1 Jan 2016

Cited by 11 | Viewed by 51

Abstract

Background: Total-contact casting is an effective method to treat various pathologic abnormalities in patients with diabetic neuropathy, but its use is frequently associated with iatrogenic complications. Methods: The largest retrospective review to date of iatrogenic complications of totalcontact casts was conducted over an [...] Read more.

Background: Total-contact casting is an effective method to treat various pathologic abnormalities in patients with diabetic neuropathy, but its use is frequently associated with iatrogenic complications. Methods: The largest retrospective review to date of iatrogenic complications of totalcontact casts was conducted over an 8-year period at Cleveland Clinic. Results: In the past 8 years, 23% of patients developed complications, and the most common complication was a new heel ulcer formation. Of these complications, 92.1% resolved, 6.4% were lost to follow-up, and 1.4% resulted in a partial foot amputation. Mean cast duration was 10.3 days for patients who developed a total-contact cast iatrogenic complication. The most common indication for the use of a total-contact cast was a neuropathic foot ulceration. Conclusions: The results of this study support the use of total-contact casting in the insensate patient with diabetes. However, adequate staff training in total-contact cast application is recommended to reduce complications. Full article

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J. Am. Podiatr. Med. Assoc., Volume 106, Issue 1 (01 2016) – 14 articles

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