Journal of the American Podiatric Medical Association

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Open AccessArticle

Let's Start a Revolution

by R. Daniel Davis

J. Am. Podiatr. Med. Assoc. 2016, 106(5), 379; https://doi.org/10.7547/8750-7315-106.5.379 - 2 Sep 2016

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I’ve just returned from the 2016 Annual Scientific Meeting (The National) in Philadelphia, and I’m still in the revolutionary spirit. The National itself was a revolution in learning, but I’d like to share with you a few more ways APMA is revolutionizing podiatric [...] Read more.

I’ve just returned from the 2016 Annual Scientific Meeting (The National) in Philadelphia, and I’m still in the revolutionary spirit. The National itself was a revolution in learning, but I’d like to share with you a few more ways APMA is revolutionizing podiatric medicine [...] Full article

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Open AccessArticle

A Case Report of an Osteoid Osteoma on the Bearing Surface of the Talus Treated with Arthroscopic Resection Associated with Autologous Iliac Crest Graft

by Hongliang Liu, Lili Sang, Shuchai Xu and Bojian Chen

J. Am. Podiatr. Med. Assoc. 2016, 106(5), 375-378; https://doi.org/10.7547/15-014 - 2 Sep 2016

Cited by 3 | Viewed by 48

Abstract

Osteoid osteomas are most likely to occur in the talar neck and can be classified as cortical, cancellous, or subperiosteal according to the position of the tumor nidus. However, cases located on the bearing surface of the talus are rare. Herein, the patient [...] Read more.

Osteoid osteomas are most likely to occur in the talar neck and can be classified as cortical, cancellous, or subperiosteal according to the position of the tumor nidus. However, cases located on the bearing surface of the talus are rare. Herein, the patient presented with an osteoid osteoma on the bearing surface of the talus and achieved good curative effects with arthroscopic resection associated with autologous iliac crest graft. (J Am Podiatr Med Assoc 106(5): 375-378, 2016). Full article

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Open AccessArticle

Simultaneous Bilateral Fracture

by Ümit Aygün, Yalkçn Çalçk, Barçş Alkan and Cengiz Işçk

J. Am. Podiatr. Med. Assoc. 2016, 106(5), 370-374; https://doi.org/10.7547/15-102 - 2 Sep 2016

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Abstract

In this study, we present the case of a 42-year-old man with a fracture and dislocation of the left talus neck, and a fracture of the right talus neck due to a fall. This kind of fracture can be considered rare, and thus [...] Read more.

In this study, we present the case of a 42-year-old man with a fracture and dislocation of the left talus neck, and a fracture of the right talus neck due to a fall. This kind of fracture can be considered rare, and thus few cases have been reported. Fracture fixation was provided through cannulated screws on either side. Splints were removed after 6 weeks, and passive/active joint movement exercises were started. The patient was able to walk with partial weightbearing at 2 months and with full weightbearing at 3 months. The magnetic resonance imaging scan at 1 year postoperatively revealed the presence of avascular necrosis on the left, whereas it did not exist on the right. Range of motion in both of the ankles was satisfactory. The patient expressed that he was able to perform daily activities without any difficulty and run for 30 minutes without pain. In this case report, in addition to providing a review of the relevant literature on the subject, we set out to show the importance of rigid fixation and early mobilization in these rare injuries. (J Am Podiatr Med Assoc 106(5): 370-374, 2016). Full article

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Open AccessArticle

Acroangiodermatitis

by Anna L. Hronek, Seth N. Clark, Gregg Young, Daniel Kinikini and Jason Wells

J. Am. Podiatr. Med. Assoc. 2016, 106(5), 364-369; https://doi.org/10.7547/14-162 - 2 Sep 2016

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Abstract

Acroangiodermatitis (AAD), also known as pseudo-Kaposi's sarcoma, is an uncommon benign angioproliferative condition most commonly seen in the lower extremities. This condition often presents as discolored patches that progress to painful ulcerations. The list of vascular conditions associated with this diagnosis is vast. [...] Read more.

Acroangiodermatitis (AAD), also known as pseudo-Kaposi's sarcoma, is an uncommon benign angioproliferative condition most commonly seen in the lower extremities. This condition often presents as discolored patches that progress to painful ulcerations. The list of vascular conditions associated with this diagnosis is vast. Acroangiodermatitis presents similarly to more aggressive conditions such as Kaposi's sarcoma, making histopathologic examination helpful in its diagnosis. We present two cases of AAD in the setting of chronic venous insufficiency. Full article

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Open AccessArticle

Gift-Giving in the Podiatric Medical Student–Patient Relationship

by Daniel López López, Paula Torreiro Pazo, Marta E. Losa Iglesias and Ricardo Becerro de Bengoa Vallejo

J. Am. Podiatr. Med. Assoc. 2016, 106(5), 361-363; https://doi.org/10.7547/14-160 - 2 Sep 2016

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Abstract

We sought to explore the relationship between the podiatric medical student and the patient as it relates to the act of gift-giving as a sign of gratefulness for the services provided. This article presents the clinical case of a man who visited a [...] Read more.

We sought to explore the relationship between the podiatric medical student and the patient as it relates to the act of gift-giving as a sign of gratefulness for the services provided. This article presents the clinical case of a man who visited a podiatric medical student because of pain in his feet and subsequently presented the student with several gifts. Philanthropy, empathy, a positive attitude, treatment instructions, and the time devoted to the patient are some of the reasons why patients offer gifts to podiatric medical students. The relationship between the podiatric medical student and the patient and the act of gift-giving by patients are of ethical concern. (J Am Podiatr Med Assoc 106(5): 361-363, 2016). Full article

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Open AccessArticle

Unicameral Bone Cyst of the Medial Cuneiform

by Faith A. Schick, Joseph N. Daniel and Juliane S. Miller

J. Am. Podiatr. Med. Assoc. 2016, 106(5), 357-360; https://doi.org/10.7547/14-103 - 2 Sep 2016

Cited by 2 | Viewed by 54

Abstract

A unicameral bone cyst is a relatively uncommon, benign bone tumor found in the metaphysis of long bones, such as the humerus and the femur, in skeletally immature persons. In the foot, these benign, fluid-filled cavities are most commonly found within the os [...] Read more.

A unicameral bone cyst is a relatively uncommon, benign bone tumor found in the metaphysis of long bones, such as the humerus and the femur, in skeletally immature persons. In the foot, these benign, fluid-filled cavities are most commonly found within the os calcis. We present a case report of a 10-year-old female with a unicameral bone cyst of the medial cuneiform. (J Am Podiatr Med Assoc 106(5): 357-360, 2016)。 Full article

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Open AccessArticle

Improving Diabetes Knowledge and Self-Care Practices

by Cynthia Formosa and Ryan Muscat

J. Am. Podiatr. Med. Assoc. 2016, 106(5), 352-356; https://doi.org/10.7547/15-071 - 2 Sep 2016

Cited by 23 | Viewed by 48

Abstract

Background: This study sought to identify the nature and extent of diabetes-related knowledge and self-care practices in people living with type 2 diabetes who attend primary-care clinics and to determine whether a correlation between the two exists. Methods: In a nonexperimental prospective study, [...] Read more.

Background: This study sought to identify the nature and extent of diabetes-related knowledge and self-care practices in people living with type 2 diabetes who attend primary-care clinics and to determine whether a correlation between the two exists. Methods: In a nonexperimental prospective study, the Diabetes Knowledge Questionnaire and the Summary of Diabetes Self-care Activities were used to assess knowledge and self-management in 50 patients. Results: The mean diabetes knowledge score was 14.40 out of a total of 24 and the mean self-care activities score was 2.89 out of a total of 7, indicating a deficit in a number of key areas in the management of diabetes. There was no statistically significant correlation between diabetes knowledge score and diabetes self-care activities (r = 0.190, P = 0.187). On analysis of the individual subscales, a significant relationship resulted between diabetes knowledge score and diet (r = 0.324, P = 0.022) but physical activity (r =0.179, P =0.214), blood sugar testing (r =0.231, P =0.107) and footcare (r = 0.189, P = 0.189) gave no significant results. On further analysis, education level was significantly correlated to diabetes knowledge score (r = 0.374, P = 0.007) and self-care activities score (r = 0.317, P = 0.025) while age was significantly correlated to diabetes knowledge score (P = 0.008) and self-care activities score (P ¼ 0.035). Conclusions: Integrating theories of behavior change into educational interventions at the primary-care level may translate to improved care, reduced long-term complications, and better quality of life. (J Am Podiatr Med Assoc 106(5): 352-356, 2016) Full article

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Open AccessArticle

Effect of Vibram FiveFingers Minimalist Shoes on the Abductor Hallucis Muscle

by Nicholas A. Campitelli, Scott A. Spencer, Kaitlyn Bernhard, Kristen Heard and Alan Kidon

J. Am. Podiatr. Med. Assoc. 2016, 106(5), 344-351; https://doi.org/10.7547/14-084 - 2 Sep 2016

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Abstract

Background: This study investigated the effect of Vibram FiveFingers Bikila minimalist shoes on intrinsic foot musculature. We hypothesized that a gradual transition into minimalist shoes will increase the thickness of the abductor hallucis muscle. Methods: Forty-one individuals were divided into four groups: control [...] Read more.

Background: This study investigated the effect of Vibram FiveFingers Bikila minimalist shoes on intrinsic foot musculature. We hypothesized that a gradual transition into minimalist shoes will increase the thickness of the abductor hallucis muscle. Methods: Forty-one individuals were divided into four groups: control (traditional shod) (n ¼9), restricted walking in Vibram FiveFingers (n =11), running in Vibram FiveFingers (n = 10), and unlimited walking in Vibram FiveFingers (n = 11). At baseline, 12 weeks, and 24 weeks, the thickness of the abductor hallucis muscle was determined using ultrasound. Statistical analysis was performed to determine the significance of differences in muscle thickness at the three different time points. Results: The mean thickness of the abductor hallucis muscle at 24 weeks was significantly greater than that at baseline for the restricted walking (P=.005) and running (P <.001) groups. In the unlimited walking group, the mean thickness of the muscle at 12 weeks was significantly greater than that at baseline (P < .05) but not at 24 weeks. There were no significant differences in muscle thickness among the three time points for the control group (P = .432). Conclusions: This study demonstrated that wearing Vibram FiveFinger Bikila footwear over a controlled period of time, an unlimited amount of time, as well as transitioning runners over a 6-month period of time using the 10% philosophy for increasing mileage, significantly increases intrinsic muscle thickness of the abductor hallucis. The abductor hallucis muscle aids in support of the medial longitudinal arch, and an increase in this muscle thickness may help reduce running-related injuries thought to arise from arch weakness. (J Am Podiatr Med Assoc 106(5): 344-351, 2016) Full article

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Open AccessArticle

The Design, Development, and Reliability Testing of a New Innovative Device to Measure Ankle Joint Dorsiflexion

by James Charles

J. Am. Podiatr. Med. Assoc. 2016, 106(5), 338-343; https://doi.org/10.7547/14-051 - 2 Sep 2016

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Abstract

Background: In clinical and research settings, ankle joint dorsiflexion needs to be reliably measured. Dorsiflexion is often measured by goniometry, but the intrarater and interrater reliability of this technique have been reported to be poor. Many devices to measure dorsiflexion have been developed [...] Read more.

Background: In clinical and research settings, ankle joint dorsiflexion needs to be reliably measured. Dorsiflexion is often measured by goniometry, but the intrarater and interrater reliability of this technique have been reported to be poor. Many devices to measure dorsiflexion have been developed for clinical and research use. An evaluation of 12 current tools showed that none met all of the desirable criteria. The purpose of this study was to design and develop a device that rates highly in all of the criteria and that can be proved to be highly reliable. Methods: While supine on a treatment table, 14 participants had a foot placed in the Charles device and ankle joint dorsiflexion measured and recorded three times with a digital inclinometer. The mean of the three readings was determined to be the ankle joint dorsiflexion. Results: The analysis used was intraclass correlation coefficient (ICC). There was very little difference in ICC single or average measures between left and right feet, so data were pooled (N ¼28). The single-measure ICC was 0.998 (95% confidence interval, 0.996-0.998). The averagemeasure ICC was 0.998 (95% confidence interval, 0.995-0.999). Limits of agreement for the average measure were also very good: -1.308 to 1.658. Conclusions: The Charles device meets all of the desirable criteria and has many innovative features, increasing its appropriateness for clinical and research applications. It has a suitable design for measuring dorsiflexion and high intrarater and interrater reliability. (J Am Podiatr Med Assoc 106(5): 338-343, 2016). Full article

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Open AccessArticle

A Retrospective Case Series of a Dehydrated Amniotic Membrane Allograft for Treatment of Unresolved Diabetic Foot Ulcers

by Barry I. Rosenblum

J. Am. Podiatr. Med. Assoc. 2016, 106(5), 328-337; https://doi.org/10.7547/15-139 - 2 Sep 2016

Cited by 15 | Viewed by 44

Abstract

Background: Foot ulcers are among the most serious complications of diabetes and can lead to amputation. Diabetic foot ulcers (DFUs) often fail to heal with standard wound care, thereby making new treatments necessary. This case series describes the addition of a dehydrated amniotic [...] Read more.

Background: Foot ulcers are among the most serious complications of diabetes and can lead to amputation. Diabetic foot ulcers (DFUs) often fail to heal with standard wound care, thereby making new treatments necessary. This case series describes the addition of a dehydrated amniotic membrane allograft (DAMA) to standard care in unresolved DFUs. Methods: This is a single-center retrospective chart review of eight patients who had one to three applications of DAMA to nine DFUs that had failed to resolve despite offloading, other standard care, and adjuvant therapies. Following initial DAMA placement, wound size (length, width, depth) was measured every 1 to 2 weeks until closure. The principal outcome assessed was mean time to wound closure; other outcomes included mean percent reduction from baseline in wound area and volume at weeks 2 to 8. Results: All wounds were closed a mean of 9.2 weeks after the first DAMA application (range, 3.0–13.5 weeks). Compared with baseline, wound area and volume, respectively, were reduced by a mean of 48% and 60% at week 2 and by 89% and 91% at week 8. Time to closure was shorter among four patients who had three DAMA applications (mean, 8.3 weeks; range, 4.0–11.0 weeks) than among three patients who had only one application (mean, 12.1 weeks; range, 9.5–13.5 weeks). Conclusions: Chronic, unresolved DFUs treated with DAMA rapidly improved and reached closure in an average of 9.2 weeks. These cases suggest that DAMA can facilitate closure of DFUs that have failed to respond to standard treatments. (J Am Podiatr Med Assoc 106(5): 328-337, 2016) Full article

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Open AccessArticle

First Metatarsal Head and Medial Eminence Widths with and Without Hallux Valgus

by Robin C. Lenz, Darshan Nagesh, Hannah K. Park and John Grady

J. Am. Podiatr. Med. Assoc. 2016, 106(5), 323-327; https://doi.org/10.7547/15-038 - 2 Sep 2016

Cited by 6 | Viewed by 75

Abstract

Background: Resection of the medial eminence in hallux valgus surgery is common. True hypertrophy of the medial eminence in hallux valgus is debated. No studies have compared metatarsal head width in patients with hallux valgus and control patients. Methods: We reviewed 43 radiographs [...] Read more.

Background: Resection of the medial eminence in hallux valgus surgery is common. True hypertrophy of the medial eminence in hallux valgus is debated. No studies have compared metatarsal head width in patients with hallux valgus and control patients. Methods: We reviewed 43 radiographs with hallux valgus and 27 without hallux valgus. We measured medial eminence width, first metatarsal head width, and first metatarsal shaft width in patients with and without radiographic hallux valgus. Results: Medial eminence width was 1.12 mm larger in patients with hallux valgus (P <.0001). Metatarsal head width was 2.81 mm larger in patients with hallux valgus (P< .001). Metatarsal shaft width showed no significant difference (P = .63). Conclusions: Metatarsal head width and medial eminence width are significantly larger on anteroposterior weightbearing radiographs in patients with hallux valgus. However, frontal plane rotation of the first metatarsal likely accounts for this difference. (J Am Podiatr Med Assoc 106(5): 323-327, 2016). Full article

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Surgical Treatment of Lateral Malleolar Fractures Using the Compression Cerclage System

by Eren Cansü, Mehmet B. Unal, Serkan Gurcan and Fatih Parmaksizoglu

J. Am. Podiatr. Med. Assoc. 2016, 106(5), 313-318; https://doi.org/10.7547/14-110 - 2 Sep 2016

Cited by 3 | Viewed by 51

Abstract

Background: Lateral malleolar fractures (Weber type B or OTA 44-B) account for 60% of all ankle fractures. To achieve anatomic restoration, surgical stabilization provides better results than conservative treatment. Various fixation methods are available to treat these fractures; however, the best method is [...] Read more.

Background: Lateral malleolar fractures (Weber type B or OTA 44-B) account for 60% of all ankle fractures. To achieve anatomic restoration, surgical stabilization provides better results than conservative treatment. Various fixation methods are available to treat these fractures; however, the best method is still unknown. Our objectives were to present a new, useful, and efficient surgical technique for stabilizing lateral malleolar fractures and to analyze the outcomes of patients treated with the compression cerclage system. Methods: The surgical technique consists of a Kirschner wire that is passed percutaneously and perpendicular to the fracture line, and a cerclage wire that is passed in a semi-circular fashion over the ends of the Kirschner wire on the lateral side of the bone, leaving loops on each side to allow bilateral compression while twisting both wires. We retrospectively evaluated patients treated with this technique, with or without additional fractures. Follow-up of ,24 months and bilateral ankle fractures were the exclusion criteria. Fractures were examined clinically and radiologically in comparison to the uninjured side and were rated according to the criteria reported by McLennon and Ungersma. Olerud and Molander ankle score was used to evaluate functional outcome. Results: At the final follow-up, 15 out of 21 patients (9 women and 6 men; mean age, 48.2 years [range, 19–78 years]) were evaluated. The mean follow-up was 5.16 years (28–129 months). Five patients had an isolated lateral malleolar fracture; eight had lateral and medial malleolar fractures; and two had trimalleolar fractures. At the final follow-up, 11 patients were rated good functionally and four were fair, and all patients were rated good radiographically according to the criteria by McLennon and Ungersma. Mean Olerud and Molander ankle score was 93.3 (range, 80–100). Conclusions: The compression cerclage system provides good functional and radiological outcomes in patients with lateral malleolus fractures. This method is useful, safe, and efficient with minimum hardware. It can be applied through limited soft-tissue stripping, which is especially important in patients with a high risk for wound complications. (J Am Podiatr Med Assoc 106(5): 313-318, 2016). Full article

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J. Am. Podiatr. Med. Assoc., Volume 106, Issue 5 (09 2016) – 12 articles , Pages 313-379

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