Journal of the American Podiatric Medical Association

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Open AccessArticle

Combined Treatment of Diabetic Foot Ulcer with Tarsal Tunnel Release and Perilesional Injections of Peripheral Blood Mononuclear Cells

by Emilio Trignano, Nefer Fallico, Gino Zingone, Corrado Rubino, Fabio Santanelli Di Pompeo and Gian Vittorio Campus

J. Am. Podiatr. Med. Assoc. 2017, 107(2), 171-174; https://doi.org/10.7547/15-098 - 1 Mar 2017

Cited by 1 | Viewed by 57

Abstract

To the Editor: Diabetic foot ulcers are a challenging problem for patients and surgeons because successful healing requires strict medical compliance, intensive local wound care, minimization of contributing factors, and frequent operative debridements and reconstructions [...] Full article

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Open AccessArticle

Communication of Contrast in the Flexor Hallucis Longus Tendon with Other Pedal Tendons at the Master Knot of Henry

by Sayed Ali, Nicole L. Griffin, Whitney Ellis and Andrew J. Meyr

J. Am. Podiatr. Med. Assoc. 2017, 107(2), 166-170; https://doi.org/10.7547/14-148 - 1 Mar 2017

Cited by 6 | Viewed by 48

Abstract

It is important to have a full appreciation of lower-extremity anatomical relationships before undertaking diabetic foot surgery. We sought to evaluate the potential for communication of the flexor hallucis longus (FHL) tendon with other pedal tendons and plantar foot compartments at the master [...] Read more.

It is important to have a full appreciation of lower-extremity anatomical relationships before undertaking diabetic foot surgery. We sought to evaluate the potential for communication of the flexor hallucis longus (FHL) tendon with other pedal tendons and plantar foot compartments at the master knot of Henry and to provide cadaveric images and computed tomographic (CT) scans of such communications. Computed tomography and subsequent anatomical dissection were performed on embalmed cadaveric limbs. Initially, 5 to 10 mL (1:4 dilution) of iohexol and normal saline was injected into the FHL sheath as it coursed between the two hallux sesamoids. Subsequently, CT scans were obtained in the axial plane using a multidetector CT scanner with sagittal and coronal reformatted images. The limbs were then dissected for specific evaluation of the known variable intertendinous connections between the FHL and flexor digitorum longus (FDL) and quadratus plantae (QP) muscles. One cadaver demonstrated retrograde flow of contrast into the four individual tendons of the FDL, with observation of a large intertendinous slip between the FHL and FDL on dissection. Another cadaver demonstrated contrast filling in the QP with an associated intertendinous slip between the FHL and QP on dissection. These results indicate that the master knot of Henry (the location in the plantar aspect of the midfoot where the FHL and FDL tendons decussate, with the FDL passing superficially over the FHL) has at least the potential to serve as one source of communication in diabetic foot infections from the medial plantar compartment and FHL to the central and lateral compartments via the FDL and to the rearfoot via the QP. Full article

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Open AccessArticle

Symptomatic Os Vesalianum. A Case Report and Review of the Literature

by Frank Timo Beil, Rolf D. Burghardt, Andre Strahl, Wolfgang Ruether and Andreas Niemeier

J. Am. Podiatr. Med. Assoc. 2017, 107(2), 162-165; https://doi.org/10.7547/15-160 - 1 Mar 2017

Cited by 10 | Viewed by 67

Abstract

Os vesalianum is a rare accessory bone located proximal to the base of the fifth metatarsal in the peroneus brevis tendon. It is a radiographic diagnosis and mostly an asymptomatic incidental finding with a reported prevalence of 0.1% to 0.9%. Only 11 symptomatic [...] Read more.

Os vesalianum is a rare accessory bone located proximal to the base of the fifth metatarsal in the peroneus brevis tendon. It is a radiographic diagnosis and mostly an asymptomatic incidental finding with a reported prevalence of 0.1% to 0.9%. Only 11 symptomatic cases have been described in the literature. Surgical therapy has been reported with good outcome in adults, whereas recurrence may follow excision during skeletal growth. We report a case of a 19-year-old girl with chronic weightbearing pain proximal to the base of the fifth metatarsal of her left foot. She first experienced exacerbated pain on increased loading when she started professional training as a shop assistant. Because several months of nonsurgical therapy failed, the decision was made to surgically excise the accessory bone from the peroneus brevis tendon via a longitudinal incision and a simple tendon-to-tendon reconstruction. Postoperative treatment consisted of using a walker to avoid weightbearing for 6 weeks, followed by a gradual return to full weightbearing as tolerated. At final follow-up, the patient was fully asymptomatic and was able to return to work. Citing this case, this article discusses differential diagnoses and treatment options for os vesalianum. Full article

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Open AccessArticle

Successful Excision of Cutaneous Horns in the Foot and Application of a Full-Thickness Pinch Skin Graft for Primary Closure

by Sanaz Lalehparvar, Ayesha Mohiuddin and Irene Labib

J. Am. Podiatr. Med. Assoc. 2017, 107(2), 158-161; https://doi.org/10.7547/15-155 - 1 Mar 2017

Cited by 2 | Viewed by 47

Abstract

Cutaneous horns (cornu cutaneum) are chronic, dense, hyperkeratotic cutaneous lesions resembling the horn of an animal. These lesions are associated with a variety of benign, premalignant, and malignant cutaneous diseases. Cutaneous horns are often found on the upper parts of the body, such [...] Read more.

Cutaneous horns (cornu cutaneum) are chronic, dense, hyperkeratotic cutaneous lesions resembling the horn of an animal. These lesions are associated with a variety of benign, premalignant, and malignant cutaneous diseases. Cutaneous horns are often found on the upper parts of the body, such as the face, neck, and shoulders. These lesions rarely occur in areas with no sun exposure, such as the feet. We present the case of a 51-year-old man with two cutaneous horns on the lateral aspect of the third digit of the left foot. Treatment consisted of excision of the lesions and application of a full-thickness skin graft from the ipsilateral sinus tarsi. Full article

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Open AccessArticle

A Case Report of Hereditary Hemorrhagic Telangiectasia Diagnosed in a Podiatric Medical Patient

by Kunal Amin and Douglas Mckay

J. Am. Podiatr. Med. Assoc. 2017, 107(2), 155-157; https://doi.org/10.7547/15-144 - 1 Mar 2017

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Abstract

Hereditary hemorrhagic telangiectasia (HHT), which is also known as Osler-Weber-Rendu syndrome, is a group of related disorders characterized by the development of arteriovenous malformations. These malformations occur in almost all organs but predominantly in the skin, intestines, liver, lungs, and brain. This is [...] Read more.

Hereditary hemorrhagic telangiectasia (HHT), which is also known as Osler-Weber-Rendu syndrome, is a group of related disorders characterized by the development of arteriovenous malformations. These malformations occur in almost all organs but predominantly in the skin, intestines, liver, lungs, and brain. This is a case report of a patient with cutaneous manifestations of HHT in the lower extremities as diagnosed by his podiatric physician. To our knowledge, the literature does not present any case reports in which cutaneous manifestations of the lower extremities followed by a further work-up allowed a diagnosis of HHT. Full article

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Open AccessArticle

Underlying Adenocarcinoma of the Lung Metastasizing to the Proximal Phalanx of the Foot Causing Complex Regional Pain Syndrome. A Case Report

by Sam Bazrafshan, Maria Pacheco and Julio C. Ortiz

J. Am. Podiatr. Med. Assoc. 2017, 107(2), 150-154; https://doi.org/10.7547/15-179 - 1 Mar 2017

Cited by 2 | Viewed by 47

Abstract

We report an unusual case of adenocarcinoma of the lung metastasizing to the proximal phalanx of the third digit in a 56-year-old woman with overlying complex regional pain syndrome. The patient was initially treated for neuroma, fracture, and neuropathic pain with no improvement [...] Read more.

We report an unusual case of adenocarcinoma of the lung metastasizing to the proximal phalanx of the third digit in a 56-year-old woman with overlying complex regional pain syndrome. The patient was initially treated for neuroma, fracture, and neuropathic pain with no improvement over a 4-month period before presenting to the emergency department for left third digit pain. Radiographic imaging showed substantial osteopenia and mottling; magnetic resonance imaging demonstrated an aggressive lesion to the proximal phalanx. The patient underwent excision of the lesion, revealing metastatic moderately differentiated adenocarcinoma. Full article

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Open AccessArticle

Treatment Algorithm for Chronic Achilles Tendon Lesions. Review of the Literature and Proposal of a New Classification

by Roberto Buda, Francesco Castagnini, Gherardo Pagliazzi and Sandro Giannini

J. Am. Podiatr. Med. Assoc. 2017, 107(2), 144-149; https://doi.org/10.7547/15-099 - 1 Mar 2017

Cited by 11 | Viewed by 65

Abstract

Chronic Achilles tendon lesions (CATLs) ensue from a neglected acute rupture or a degenerated tendon. Surgical treatment is usually required. The current English literature (PubMed) about CATLs was revised, and particular emphasis was given to articles depicting CATL classification. The available treatment algorithms [...] Read more.

Chronic Achilles tendon lesions (CATLs) ensue from a neglected acute rupture or a degenerated tendon. Surgical treatment is usually required. The current English literature (PubMed) about CATLs was revised, and particular emphasis was given to articles depicting CATL classification. The available treatment algorithms are based on defect size. We propose the inclusion of other parameters, such as tendon degeneration, etiology, and time from injury to surgery. Partial lesions affecting less than (I stage) or more than (II stage) half of the tendon should be treated conservatively for healthy tendons, within 12 weeks of injury. In II stage complex cases, an end-to-end anastomosis is required. Complete lesions inferior to 2 cm should be addressed by an end-to-end anastomosis, with a tendon transfer in the case of tendon degeneration. Lesions measuring 2 to 5 cm require a turndown flap and a V-Y tendinous flap in the case of a good-quality tendon; degenerated tendons may require a tendon transfer. Lesions larger than 5 cm should be treated using two tendon transfers and V-Y tendinous flaps. A proper algorithm should be introduced to calibrate the surgical procedures. In addition to tendon defect size, tendon degeneration, etiology of the lesion, and time from injury to surgery are crucial factors that should be considered in the surgical planning. Full article

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Open AccessArticle

Relation Between Nail Consistency and Incidence of Ingrown Toenails in Young Male Runners

by Ana María Pérez Pico, Elisabeth Verjano and Raquel Mayordomo

J. Am. Podiatr. Med. Assoc. 2017, 107(2), 137-143; https://doi.org/10.7547/15-121 - 1 Mar 2017

Cited by 21 | Viewed by 72

Abstract

This study examines the possible influence of factors such as nail shape and consistency, sex, and sports activity on the development of the most common nail disorders in a population of young people. The nail plates of 140 young people (66 females and [...] Read more.

This study examines the possible influence of factors such as nail shape and consistency, sex, and sports activity on the development of the most common nail disorders in a population of young people. The nail plates of 140 young people (66 females and 74 males) were studied. Of these 140 participants, 72 were runners who trained more than 10 hours a week and competed regularly, and 68 did not habitually do any sports activity. Nail shape, consistency, and disorders were examined, taking into account the sex of the participants and their sports activity. A hard nail consistency is more frequent in runners (74.4%) than in people who do no sports activity (25.6%). In contrast, a soft nail consistency is more prevalent in participants who do no sports activity (70%) than in runners (30%). It was also shown that onychocryptosis is related to sex, as females had a higher prevalence of this nail disorder (57.8%, P = .016). However, young male runners showed the highest and most significant percentage of the presence of onychocryptosis (74.1%; P = .002). Sports activity by young male runners whose nails have a hard consistency seems to be directly related to the high incidence of onychocryptosis in this population. Full article

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Open AccessArticle

Correlations Among Foot Arching, Ankle Dorsiflexion Range of Motion, and Obesity Level in Primary School Children

by Agnieszka Jankowicz-Szymanska, Edyta Mikolajczyk and Katarzyna Wodka

J. Am. Podiatr. Med. Assoc. 2017, 107(2), 130-136; https://doi.org/10.7547/15-150 - 1 Mar 2017

Cited by 11 | Viewed by 57

Abstract

This study sought to assess the prevalence of flat feet in primary school children and to find correlations among arch height, ankle dorsiflexion range of motion (ROM), and obesity level. The 400 children aged 10 to 12 years who took part in the [...] Read more.

This study sought to assess the prevalence of flat feet in primary school children and to find correlations among arch height, ankle dorsiflexion range of motion (ROM), and obesity level. The 400 children aged 10 to 12 years who took part in the study had their body height, weight, and fat percentage measured. Based on these measurements, body mass index was calculated and weight status was categorized for all of the participants. The height of the longitudinal arch of the foot was measured on a computerized podoscope and given in Clarke's angles. Dorsiflexion ROM was assessed with the child in the nonweightbearing sitting position with the knees 90° flexed. The arithmetic mean and standard deviation were implemented to analyze the data. Intergroup differences were assessed by Mann-Whitney U, Kruskal-Wallis, and post hoc Tukey tests. Significance was accepted at P = .05. Flat feet were found in 36% of participants; limited ROM was found in both feet in 25% of participants and in one foot in 12%. No significant differences in dorsiflexion ROM in children with high-arched, normal, and flat feet were revealed. Excessive body weight was disclosed in 21% of participants. Overweight and obese children had significantly lower foot arches and notably smaller ankle dorsiflexion ROM than those with normal weight. Ankle dorsiflexion ROM is similar in children with high-arched, normal, and flat feet. However, limited dorsiflexion ROM is more often found in children with excessive weight. Full article

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Open AccessArticle

Influence of Age, Sex, and Anthropometric Determinants on the Foot Posture Index in a Pediatric Population

by Ana María Jimenez-Cebrian, María Francisca Morente-Bernal, Pedro Daniel Román-Bravo, Juan Francisco Saucedo-Badía, Juan Antonio Alonso-Ríos and Alonso Montiel-Luque

J. Am. Podiatr. Med. Assoc. 2017, 107(2), 124-129; https://doi.org/10.7547/14-097 - 1 Mar 2017

Cited by 12 | Viewed by 44

Abstract

The Foot Posture Index (FPI) is a clinical tool for diagnosis that aims to quantify the grade of a foot position as neutral, pronated, or supinated. Its purpose is to develop a simple six-factor method for rating foot posture with an easy and [...] Read more.

The Foot Posture Index (FPI) is a clinical tool for diagnosis that aims to quantify the grade of a foot position as neutral, pronated, or supinated. Its purpose is to develop a simple six-factor method for rating foot posture with an easy and quantitative result. We evaluated possible differences in the FPI by sex and the influences of age, weight, height, foot size, and body mass index (BMI) on foot posture. In 150 asymptomatic children (79 boys and 71 girls) aged 8 to 13 years, we determined weight, height, BMI, and FPI in the bipedal, static, and relaxed position. The FPI was obtained as the sum of the scores (–2, –1, 0, 1, 2) given to each of the six criteria. The mean ± SD FPI value for the total sample was 5.1 ± 2.1 (boys: 5.1 ± 2.2; girls: 5.2 ± 2.0), so there were no significant differences between the sexes (P = .636). Of the 150 feet examined, none had FPI values of very supinated or highly pronated, two were supinated (1.3%), 76 neutral (50.7%), and 72 pronated (48.0%). Of the total FPI values, 7.7% can be explained by anthropometric variables: height, weight, and foot size (r² = 0.077; P < .010). The most frequent foot postures in the sample were neutral and pronated. Neither age nor BMI explained variations in the FPI. Full article

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Open AccessArticle

The Relationship Between Arch Height and Arch Flexibility. A Proposed Arch Flexibility Classification System for the Description of Multidimensional Foot Structure

by Rebecca Avrin Zifchock, Christal Theriot, Howard J. Hillstrom, Jinsup Song and Michael Neary

J. Am. Podiatr. Med. Assoc. 2017, 107(2), 119-123; https://doi.org/10.7547/15-051 - 1 Mar 2017

Cited by 54 | Viewed by 56

Abstract

The correlation between arch structure and injury may be related to the fact that foot structure influences foot function. Foot structure is often defined by arch height, although arch flexibility may be just as important to form a more complete description. We propose [...] Read more.

The correlation between arch structure and injury may be related to the fact that foot structure influences foot function. Foot structure is often defined by arch height, although arch flexibility may be just as important to form a more complete description. We propose an arch flexibility classification system, analogous to arch height classification, and then use the classification system to examine the relationship between arch flexibility and arch height. Arch height index was calculated in 1,124 incoming military cadets, of whom 1,056 had usable data. By measuring arch height during both sitting and standing, a measurement of arch flexibility could also be calculated. These values were used to create five arch flexibility categories: very stiff, stiff, neutral, flexible, and very flexible. The distribution of arch flexibility types among arch height categories was statistically compared. The goodness of fit test showed a disproportionate number of each arch flexibility type in each of the arch height categories (P < .01). The largest proportion of cavus feet was very stiff and the smallest proportion was very flexible. Conversely, the largest proportion of planus feet was very flexible and the smallest proportion was very stiff. The results of this research support the common belief that cavus feet tend to be very stiff and planus feet tend to be very flexible. Full article

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Open AccessArticle

Distance Between the Malleoli and the Ground. A New Clinical Method to Measure Leg-Length Discrepancy

by Estela Gomez Aguilar, Águeda Gómez Domínguez, Carolina Peña-Algaba and José M. Castillo-López

J. Am. Podiatr. Med. Assoc. 2017, 107(2), 112-118; https://doi.org/10.7547/15-013 - 1 Mar 2017

Cited by 6 | Viewed by 61

Abstract

The aim of this work is to introduce a useful method for the clinical diagnosis of leg-length inequality: distance between the malleoli and the ground (DMG). A transversal observational study was performed on 17 patients with leg-length discrepancy. Leg-length inequality was determined with [...] Read more.

The aim of this work is to introduce a useful method for the clinical diagnosis of leg-length inequality: distance between the malleoli and the ground (DMG). A transversal observational study was performed on 17 patients with leg-length discrepancy. Leg-length inequality was determined with different clinical methods: with a tape measure in a supine position from the anterior superior iliac spine (ASIS) to the internal and external malleoli, as the difference between the iliac crests when standing (pelvimeter), and as asymmetry between ASISs (PALpation Meter [PALM]; A&D Medical Products Healthcare, San Jose, California). The Foot Posture Index (FPI) and the navicular drop test were also used. The DMG with Perthes rule (perpendicular to the foot when standing), the distance between the internal malleolus and the ground (DIMG), and the distance between the external malleolus and the ground were designed by the authors. The DIMG is directly related to the traditional ASIS–external malleolus measurement (P = .003), the FPI (P = .010), and the navicular drop test (P < .001). There are statistically significant differences between measurement of leg-length inequality with a tape measure, in supine decubitus, from the ASIS to the internal malleolus, and from the ASIS to the external malleolus. This new method (the DMG) is useful for diagnosing leg-length discrepancy and is related to the ASIS–external malleolus measurement. The DIMG is significantly inversely proportional to the degree of pronation according to the FPI. Conversely, determination of leg-length discrepancy with a tape measure from the ASIS to the malleoli cannot be performed interchangeably at the level of the internal or external malleolus. Full article

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Open AccessArticle

Age Estimation Based on a Radiographic Study of the Growing Foot

by Beatriz Gómez-Martín, Elena Escamilla-Martínez, Lourdes María Fernández-Seguín, Andrés Santiago-Sáez, José Antonio Sánchez-Sánchez and Juan Antonio Díaz-Mancha

J. Am. Podiatr. Med. Assoc. 2017, 107(2), 106-111; https://doi.org/10.7547/15-163 - 1 Mar 2017

Cited by 2 | Viewed by 136

Abstract

We sought to determine a predictive model of data, differentiated by sex, from a radiographic study of the skeleton of the foot as an alternative to the classic study of the hand. The study included 2,476 digital radiographs from 816 participants aged 0 [...] Read more.

We sought to determine a predictive model of data, differentiated by sex, from a radiographic study of the skeleton of the foot as an alternative to the classic study of the hand. The study included 2,476 digital radiographs from 816 participants aged 0 to 21 years. The radiographs were from the Radiology Diagnostic Services of the Public Health System of Extremadura (Spain) from 2007 to 2011. The method used for their analysis consisted of assigning a numerical code to each ossification center of each growing bone of the foot and subsequently subjecting the data to a multivariate, decision tree, statistical analysis. The decision tree study identified the bones that have a common age-dependent pattern of growth (as determined by a comparison of means test with P < .01) among individuals of the same sex. The quality of the decision tree predictions was evaluated in terms of the r² coefficient. These values were r² = 0.897 for females and r² = 0.890 for males, thus establishing the predictive goodness of the model of bone data to provide a specific estimate of the individual's age. The foot is a good predictor of an individual's age from birth to complete bone maturity. Full article

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Open AccessArticle

High Prevalence of Achilles Tendon Enthesopathic Changes in Patients with Type 2 Diabetes Without Peripheral Neuropathy

by Francesco Ursini, Franco Arturi, Salvatore D'Angelo, Lewa Amara, Kassandra Nicolosi, Emilio Russo, Saverio Naty, Caterina Bruno, Giovambattista De Sarro, Ignazio Olivieri and Rosa Daniela Grembiale

J. Am. Podiatr. Med. Assoc. 2017, 107(2), 99-105; https://doi.org/10.7547/16-059 - 1 Mar 2017

Cited by 24 | Viewed by 51

Abstract

Metabolic disorders are known to alter the mechanical properties of tendons. We sought to evaluate the prevalence of asymptomatic Achilles tendon enthesopathic changes in patients with type 2 diabetes mellitus (T2DM) without peripheral neuropathy. We recruited 43 patients with T2DM and 40 controls. [...] Read more.

Metabolic disorders are known to alter the mechanical properties of tendons. We sought to evaluate the prevalence of asymptomatic Achilles tendon enthesopathic changes in patients with type 2 diabetes mellitus (T2DM) without peripheral neuropathy. We recruited 43 patients with T2DM and 40 controls. Neuropathy was excluded with the Michigan Neuropathy Scoring Instrument. Bilateral ultrasonography of the Achilles tendon enthesis was performed. Patients with T2DM had a higher prevalence of hypoechogenicity (26.7% versus 2.5%; P = .0001), entheseal thickening (24.4% versus 8.7%; P = .007), and enthesophytes (74.4% versus 57.5%; P = .02). No differences were found in the number of patients with erosions (1.2% versus 0%; P > .99), cortical irregularities (11.6% versus 3.7%; P = .09), bursitis (5.8% versus 3.7%; P = .72), or tears (2.3% versus 1.2%; P > .99). The mean ± SD sum of abnormalities was higher in patients with T2DM (1.5 ± 1.1 versus 0.7 ± 0.6; P < .0001), as was the percentage of bilateral involvement (72.1% versus 45.0%; P = .01). Mean ± SD thickness did not differ between patients and controls (4.4 ± 1.1 mm versus 4.2 ± 0.8 mm; P = .07). According to our data, there is an elevated prevalence of asymptomatic Achilles tendon enthesopathic changes in patients with T2DM independent of peripheral neuropathy. Full article

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J. Am. Podiatr. Med. Assoc., Volume 107, Issue 2 (03 2017) – 14 articles , Pages 99-174

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