Journal of the American Podiatric Medical Association

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Open AccessCommunication

Partnerships Between Podiatrists and Vascular Surgeons in Building Effective Wound Care Centers

by Venita Chandra, Natalia O. Glebova, Nichol L. Salvo and Timothy Wu

J. Am. Podiatr. Med. Assoc. 2017, 107(5), 471-474; https://doi.org/10.7547/17-144 - 1 Sep 2017

Cited by 3 | Viewed by 51

This practice memo, a collaborative effort between the Young Physicians' Program of the American Podiatric Medical Association (APMA) and the Young Surgeons Committee of the Society for Vascular Surgery (SVS), is intended to aid podiatrists and vascular surgeons in the early years of [...] Read more.

This practice memo, a collaborative effort between the Young Physicians' Program of the American Podiatric Medical Association (APMA) and the Young Surgeons Committee of the Society for Vascular Surgery (SVS), is intended to aid podiatrists and vascular surgeons in the early years of their respective careers, especially those involved in the care of patients with chronic wounds. During these formative years, learning how to successfully establish an inter-professional partnership is crucial in order to provide the best possible care to this important patient population. Full article

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Open AccessCommunication

Motor-Evoked Potentials of the Abductor Hallucis Muscle and Their Relationship with Foot Arch Functional Anatomy

by Tyrone Mayorga, Erato Giokas, Anaida Abagyan, Dhaval Patel, Yasmin Sarraf, Michael Paula, Eileen Chusid, Anthony D'Antoni and Fortunato Battaglia

J. Am. Podiatr. Med. Assoc. 2017, 107(5), 467-470; https://doi.org/10.7547/16-049 - 1 Sep 2017

Cited by 4 | Viewed by 68

Abstract

Background: The present study aimed to investigate the correlation between abductor hallucis (AH) muscle motor evoked potential (MEP) amplitude and foot arch anatomy. Methods: Twelve healthy individuals underwent foot arch measurement using a digital photographic technique and measurements of cortical excitability using transcranial [...] Read more.

Background: The present study aimed to investigate the correlation between abductor hallucis (AH) muscle motor evoked potential (MEP) amplitude and foot arch anatomy. Methods: Twelve healthy individuals underwent foot arch measurement using a digital photographic technique and measurements of cortical excitability using transcranial magnetic stimulation applied on the cortical representation area of the right AH muscle. Truncated foot length and dorsal height were then measured and used to create the arch height index (AHI). Resting motor threshold, MEP amplitude (using a stimulation intensity of 110% resting motor threshold), and cortical silent period duration were also measured. Results: Mean ± SE values were as follows: truncated foot length, 16.72 ± 0.3 cm; dorsal height, 5.62 ± 0.13 cm; AHI, 0.34 ± 0.01; resting motor threshold, 81.6% ± 2.12%; MEP amplitude, 0.71 ± 0.1 mV; and cortical silent period duration, 108.05 ± 0.45 msec. A significant correlation was found between MEP amplitude and AHI (Spearman's rho: P < .01). Conclusions: These results indicate that AH muscle functional neuroanatomy measurements are reliable and might be used by clinicians and therapists to investigate foot arch physiology and monitor the efficacy of treatments and rehabilitative protocols. Full article

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Open AccessArticle

Human Immunodeficiency Virus–Negative–Associated Lymphangioma-like Kaposi’s Sarcoma with Variable Clinical Presentations. A Case Report

by Georgios Kotzias, Modupe Agunbiade, Leon Isaac and Morteza Khaladj

J. Am. Podiatr. Med. Assoc. 2017, 107(5), 461-466; https://doi.org/10.7547/15-079 - 1 Sep 2017

Cited by 3 | Viewed by 49

Abstract

Lymphangioma-like Kaposi's sarcoma (LLKS) is a rare histologic variant of KS. Kaposi's sarcoma is also known as human herpesvirus type 8. The clinical presentation of the LLKS lesion is highly unusual and similar to that of classic KS but with multinodular vascular tumors [...] Read more.

Lymphangioma-like Kaposi's sarcoma (LLKS) is a rare histologic variant of KS. Kaposi's sarcoma is also known as human herpesvirus type 8. The clinical presentation of the LLKS lesion is highly unusual and similar to that of classic KS but with multinodular vascular tumors and lymphedema. We present a 63-year-old native Haitian man with multiple slowly progressive exophytic ulcerated lesions covering more than 60% of his left lower extremity with no systemic involvement. Much confusion surrounded the clinical presentation of these wounds, and we postulated several differential diagnoses. Herein we describe the evaluation, clinical appearance, and progression of LLKS. Due to the rarity of LLKS, treating physicians need to be aware of the clinical presentation and diagnostic criteria of this variant. Despite being incurable, early diagnosis of LLKS can lead to long-term treatment options and a major reduction in symptoms. Full article

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Open AccessArticle

Cutaneous Adenoid Cystic Carcinoma with Perineural Invasion Diagnosed in the Foot. A Case Report

by Modupe Agunbiade, Sanaz Lalehparvar and Morteza Khaladj

J. Am. Podiatr. Med. Assoc. 2017, 107(5), 457-460; https://doi.org/10.7547/16-091 - 1 Sep 2017

Cited by 2 | Viewed by 50

Abstract

Adenoid cystic carcinoma is a rare, slow-growing neoplasm. It is most commonly located in the salivary glands, affects people older than 55 years of age, and has a predilection for women. These lesions may recur locally but have shown low metastatic potential. We [...] Read more.

Adenoid cystic carcinoma is a rare, slow-growing neoplasm. It is most commonly located in the salivary glands, affects people older than 55 years of age, and has a predilection for women. These lesions may recur locally but have shown low metastatic potential. We present the unique case of a 71-year-old female with a nonraised hyperpigmented lesion isolated to the right heel. Confusion surrounded the clinical presentation of this dermatologic lesion, and many physicians postulated several differential diagnoses. The purpose of this case report is to bring further awareness to this rare dermatologic variant of adenoid cystic carcinoma, which has been rarely reported in the literature. Full article

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Open AccessArticle

Behcet’s Disease. A Case Report

by James M. Mahoney and Kelsey Millonig

J. Am. Podiatr. Med. Assoc. 2017, 107(5), 454-456; https://doi.org/10.7547/16-087 - 1 Sep 2017

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Abstract

Behcet's disease is a rare autoimmune systemic vasculitis. It usually presents with a symptom complex involving primarily mucocutaneous lesions, genital lesions, and uveitis. When it involves the lower extremity, venous and arterial disease predominates, and joint involvement occurs in approximately 50% of patients. [...] Read more.

Behcet's disease is a rare autoimmune systemic vasculitis. It usually presents with a symptom complex involving primarily mucocutaneous lesions, genital lesions, and uveitis. When it involves the lower extremity, venous and arterial disease predominates, and joint involvement occurs in approximately 50% of patients. We present a patient with Behcet's disease who was initially referred to us for chronic toenail pathology. Full article

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Open AccessArticle

Atypical Melanocytic Proliferation in a Pediatric Patient with Double Advancement Flap Repair

by Daniel Pollack

J. Am. Podiatr. Med. Assoc. 2017, 107(5), 450-453; https://doi.org/10.7547/16-057 - 1 Sep 2017

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Abstract

This report highlights an unusual case of an atypical melanocytic proliferation in a pediatric patient and the surgical method used to repair the defect. I describe a 10-year-old boy with hallux irregular discoloration that was present from birth and rapidly enlarging. A biopsy [...] Read more.

This report highlights an unusual case of an atypical melanocytic proliferation in a pediatric patient and the surgical method used to repair the defect. I describe a 10-year-old boy with hallux irregular discoloration that was present from birth and rapidly enlarging. A biopsy led to the diagnosis of atypical melanocytic proliferation, which may represent an unusual manifestation of early melanoma in situ. Complete excision of the patch was performed, and the hallux was repaired using a double advancement flap for closure, thus curing the patient. Full article

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Open AccessArticle

Rupture of the Extensor Hallucis Longus Muscle Secondary to Repetitive Overuse in a Taekwondo Athlete. A Case Report

by Dong-Il Chun, Jun-Hyuck Lee and Jaeho Cho

J. Am. Podiatr. Med. Assoc. 2017, 107(5), 446-449; https://doi.org/10.7547/16-012 - 1 Sep 2017

Cited by 2 | Viewed by 72

Abstract

Closed rupture of the extensor hallucis longus (EHL) tendon is rare, with most cases caused by either direct penetrating trauma or predisposing factors such as corticosteroid injection and iatrogenic trauma incidences. Almost all of the previous case reports have reported on rupture of [...] Read more.

Closed rupture of the extensor hallucis longus (EHL) tendon is rare, with most cases caused by either direct penetrating trauma or predisposing factors such as corticosteroid injection and iatrogenic trauma incidences. Almost all of the previous case reports have reported on rupture of the EHL tendon rather than the EHL muscle. In this report, we highlight an unusual clinical presentation of a rupture of the EHL muscle and discuss its predisposing factors. This patient was a taekwondo athlete with EHL muscle rupture secondary to repetitive overuse without any underlying systemic or local predisposing factors or direct trauma. Fifteen months after successful surgical treatment, he became fully functional again as an elite taekwondo athlete. (J Am Podiatr Med Assoc 107(5): 446-449, 2017) Full article

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Open AccessArticle

A Rare Case of Chondroblastoma with Revision After Graft Rejection. A Case Report

by Brandon Gumbiner, Elizabeth Jacobsen, Mary Stancukas and Ngan Nguyen

J. Am. Podiatr. Med. Assoc. 2017, 107(5), 440-445; https://doi.org/10.7547/15-216 - 1 Sep 2017

Cited by 2 | Viewed by 47

Abstract

We present a rare case of calcaneal chondroblastoma with subsequent surgical revision after graft rejection in a 13-year-old boy. Complications were encountered after the injectable bone graft filler was placed in the calcaneus after curettage. With noted subsequent sinus tract formation, revision surgery [...] Read more.

We present a rare case of calcaneal chondroblastoma with subsequent surgical revision after graft rejection in a 13-year-old boy. Complications were encountered after the injectable bone graft filler was placed in the calcaneus after curettage. With noted subsequent sinus tract formation, revision surgery was performed that involved dissection of the sinus tract, removal of bone void filler, and application of demineralized bone matrix sponge human allograft soaked in vancomycin-impregnated saline. Sixteen weeks after the revision surgical intervention, the patient resumed normal athletic activities without pain or restrictions. One and a half years after the initial surgery, the patient had complete resolution of the calcaneal cyst and was discharged. (J Am Podiatr Med Assoc 107(5): 440-445, 2017) Full article

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Open AccessArticle

Isolated Fracture of the Medial Cuneiform. A Case Report

by Nina S. Babu, Gabriel V. Gambardella and Melinda A. Bowlby

J. Am. Podiatr. Med. Assoc. 2017, 107(5), 436-439; https://doi.org/10.7547/16-013 - 1 Sep 2017

Cited by 3 | Viewed by 62

Abstract

An isolated medial cuneiform fracture is a rarely encountered injury of the foot. We present a case of an isolated medial cuneiform fracture in a patient after sustaining a fall from a 15-foot height. Treatment consisted of primary arthrodesis of the first tarsometatarsal [...] Read more.

An isolated medial cuneiform fracture is a rarely encountered injury of the foot. We present a case of an isolated medial cuneiform fracture in a patient after sustaining a fall from a 15-foot height. Treatment consisted of primary arthrodesis of the first tarsometatarsal joint due to a high degree of comminution and intra-articular pain. When radiographs are inconclusive and the index of suspicion remains high for a lesser tarsus fracture, computed tomography is recommended. In patients with minimal displacement, conservative treatment is usually successful in achieving osseous fusion. When the fracture is displaced, intra-articular, or comminuted, surgical intervention, including open reduction with internal fixation and primary arthrodesis, should be considered. (J Am Podiatr Med Assoc 107(5): 436-439, 2017) Full article

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Open AccessReview

Management of Plantar Keratodermas. Lessons from Pachyonychia Congenita

by Rebecca M. Porter, Albert A. Bravo and Frances J.D. Smith

J. Am. Podiatr. Med. Assoc. 2017, 107(5), 428-435; https://doi.org/10.7547/16-043 - 1 Sep 2017

Cited by 3 | Viewed by 60

Abstract

Plantar keratodermas can arise due to a variety of genetically inherited mutations. The need to distinguish between different plantar keratoderma disorders is becoming increasingly apparent because there is evidence that they do not respond identically to treatment. Diagnosis can be aided by observation [...] Read more.

Plantar keratodermas can arise due to a variety of genetically inherited mutations. The need to distinguish between different plantar keratoderma disorders is becoming increasingly apparent because there is evidence that they do not respond identically to treatment. Diagnosis can be aided by observation of other clinical manifestations, such as palmar keratoderma, more widespread hyperkeratosis of the epidermis, hair and nail dystrophies, or erythroderma. However, there are frequent cases of plantar keratoderma that occur in isolation. This review focuses on the rare autosomal dominant keratin disorder pachyonychia congenita, which presents with particularly painful plantar keratoderma for which there is no specific treatment. Typically, patients regularly trim/ pare/file/grind their calluses and file/grind/clip their nails. Topical agents, including keratolytics (eg, salicylic acid, urea) and moisturizers, can provide limited benefit by softening the skin. For some patients, retinoids help to thin calluses but may lead to increased pain. This finding has stimulated a drive for alternative treatment options, from gene therapy to alternative nongenetic methods that focus on novel findings regarding the pathogenesis of pachyonychia congenita and the function of the underlying genes. (J Am Podiatr Med Assoc 107(5): 428-435, 2017) Full article

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Open AccessArticle

Reliability and Correlation of Static and Dynamic Foot Arch Measurement in a Healthy Pediatric Population

by Timo Scholz, Astrid Zech, Karl Wegscheider, Susanne Lezius, Klaus-Michael Braumann, Susanne Sehner and Karsten Hollander

J. Am. Podiatr. Med. Assoc. 2017, 107(5), 419-427; https://doi.org/10.7547/16-133 - 1 Sep 2017

Cited by 19 | Viewed by 66

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Background: Measurement of the medial longitudinal foot arch in children is a controversial topic, as there are many different methods without a definite standard procedure. The purpose of this study was to 1) investigate intraday and interrater reliability regarding dynamic arch index and [...] Read more.

Background: Measurement of the medial longitudinal foot arch in children is a controversial topic, as there are many different methods without a definite standard procedure. The purpose of this study was to 1) investigate intraday and interrater reliability regarding dynamic arch index and static arch height, 2) explore the correlation between both arch indices, and 3) examine the variation of the medial longitudinal arch at two different times of the day. Methods: Eighty-six children (mean 6 SD age, 8.9 6 1.9 years) participated in the study. Dynamic footprint data were captured with a pedobarographic platform. For static arch measurements, a specially constructed caliper was used to assess heel-to-toe length and dorsum height. A mixed model was established to determine reliability and variation. Results: Reliability was found to be excellent for the static arch height index in sitting (intraday, 0.90; interrater, 0.80) and standing positions (0.88 and 0.85) and for the dynamic arch index (both 1.00). There was poor correlation between static and dynamic assessment of the medial longitudinal arch (standing dynamic arch index, r = –0.138; sitting dynamic arch index, r = –0.070). Static measurements were found to be significantly influenced by the time of day (P < .001), whereas the dynamic arch index was unchanged (P = .845). This study revealed some further important findings. The static arch height index is influenced by gender (P = .004), whereas dynamic arch index is influenced by side (p = .011) and body mass index (P < .001). Conclusions: Dynamic and static foot measurements are reliable for medial longitudinal foot arch assessment in children. The variation of static arch measurements during the day has to be kept in mind. For clinical purposes, static and dynamic arch data should be interpreted separately. (J Am Podiatr Med Assoc 107(5): 419-427, 2017) Full article

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Open AccessArticle

Point-of-Care Diagnosis of Onychomycosis by Dermoscopy

by Myron A. Bodman

J. Am. Podiatr. Med. Assoc. 2017, 107(5), 413-418; https://doi.org/10.7547/16-183 - 1 Sep 2017

Cited by 13 | Viewed by 66

Abstract

Background: Onychomycosis is one of the most common diseases of the toenails. The costs of diagnosis and treatment are substantial, and as the population ages, the overall cost burden will continue to escalate. The purpose of this study was to correlate dermoscopic features [...] Read more.

Background: Onychomycosis is one of the most common diseases of the toenails. The costs of diagnosis and treatment are substantial, and as the population ages, the overall cost burden will continue to escalate. The purpose of this study was to correlate dermoscopic features with pathologic diagnosis to support the accuracy of point-of-care diagnosis by dermoscopic examination. Methods: Nail unit pathology reports of 52 patients with abnormal great toenails were compared with the dermoscopic features detected by nail unit dermoscopy. Results: The dermoscopic analysis predicted the laboratory diagnosis in 90.4% of the study patients. The specific dermoscopic findings of short spikes (P < .001), long striae (P < .001), aurora borealis (P < .001), irregular termination (P =.003), dermatophytoma (P = .011), transverse onycholysis (P = .018), and dry scale (P = .04) patterns were all significantly associated with pathology test results consistent with oncyhomycosis. Transverse onycholysis (P = .018) was significantly associated with negative pathology results consistent with the diagnosis of nail dystrophy. Conclusions: Point-of-care examination by dermoscopy positively correlates with histopathologic tests and could be used to diagnose onychomycosis while reducing diagnostic costs. (J Am Podiatr Med Assoc 107(5): 413-418, 2017) Full article

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Open AccessArticle

Physical and Mechanical Therapies for Lower-Limb Problems in Juvenile Idiopathic Arthritis. A Systematic Review with Meta-Analysis

by Antoni Fellas, Andrea Coda and Fiona Hawke

J. Am. Podiatr. Med. Assoc. 2017, 107(5), 399-412; https://doi.org/10.7547/15-213 - 1 Sep 2017

Cited by 11 | Viewed by 57

Abstract

Background: Juvenile idiopathic arthritis (JIA), a chronic, autoimmune, inflammatory joint disease, is the most common arthritis affecting children younger than 16 years. Children with JIA commonly experience lower-limb dysfunction and disability. We systematically reviewed the effectiveness of physical and mechanical therapies for lower-limb [...] Read more.

Background: Juvenile idiopathic arthritis (JIA), a chronic, autoimmune, inflammatory joint disease, is the most common arthritis affecting children younger than 16 years. Children with JIA commonly experience lower-limb dysfunction and disability. We systematically reviewed the effectiveness of physical and mechanical therapies for lower-limb problems in JIA. Methods: Randomized controlled trials of physical and mechanical interventions for lower-limb problems in children with JIA were included. Primary outcome was pain. Secondary outcomes included disability, functional ability, and health-related quality of life. Several databases were searched for eligible studies. Authors of included studies and researchers in the field were contacted to identify additional studies. Results: Two studies evaluating the effectiveness of customized/custom foot orthoses in treating foot and ankle pain in children with JIA (N = 100) were included. One study also evaluated simple cushioned inserts. Meta-analyses for comparisons between custom/customized foot orthoses and a control intervention after 3 months were not significant for the outcomes of pain (mean difference, –8.97; 95% confidence interval [CI], –18.01 to 0.07), child-rated health-related quality of life (mean difference, 4.38; 95% CI, –3.68 to 12.44), and parent-rated health-related quality of life (mean difference, 1.77; 95% CI, –6.35 to 9.90). Meta-analyses were supported by sensitivity analyses. Conclusions: There is a paucity of research evaluating physical and mechanical therapies for lower-limb problems in JIA. No physical therapy has been evaluated in randomized controlled trials, and mechanical therapy evaluation is limited to foot orthoses and shoe inserts for foot and ankle pain. The existing research is hampered by small sample sizes. Until further research is conducted, the effectiveness of mechanical and physical therapies for lower-limb problems in JIA remains unclear. (J Am Podiatr Med Assoc 107(5): 399-412, 2017) Full article

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Open AccessArticle

Radiographic Assessment of Lower-Limb Discrepancy

by Maria Reina-Bueno, Guillermo Lafuente-Sotillos, Jose M. Castillo-Lopez, Estela Gomez-Aguilar and Pedro V. Munuera-Martinez

J. Am. Podiatr. Med. Assoc. 2017, 107(5), 393-398; https://doi.org/10.7547/15-204 - 1 Sep 2017

Cited by 12 | Viewed by 61

Abstract

Background: This study compares different lower-limb length measurements using tests of lower-limb upright full-length radiography and anteroposterior radiography of load-bearing hips. Methods: Forty-seven consecutive individuals aged 17 to 61 years (mean ± SD, 31.47 ± 11.42 years) voluntarily took part in the study; [...] Read more.

Background: This study compares different lower-limb length measurements using tests of lower-limb upright full-length radiography and anteroposterior radiography of load-bearing hips. Methods: Forty-seven consecutive individuals aged 17 to 61 years (mean ± SD, 31.47 ± 11.42 years) voluntarily took part in the study; 23 (48.9%) were women and 24 (51.1%) were men. All individuals presenting a difference of 5 mm or greater between both lower limbs quantified with a tape measure were included. All of the participants signed an informed consent form to take part in the study. Two anteroposterior load-bearing radiographs were taken: one of the hip and an upright full-length radiograph of the lower limbs. Lower-limb–length discrepancy was quantified by taking different reference points. Interobserver and intraobserver reliability was assessed for each radiographic measurement. Any correlation between the different measurements were also verified. Results: Interobserver and intraobserver reliability was high for all of the measurements because the intraclass correlation was greater than 0.75 in all of the cases. There was a strong and positive correlation between the different measurements because when performing bivariate correlations with the Pearson correlation coefficient, positive values close to 1 were found. Conclusions: In this study, the different reference points reported in the upright fulllength radiograph in addition to the hip radiographs are useful for assessing lower-limb– length discrepancy. The results showed that there is a correct correlation between the different measurements. (J Am Podiatr Med Assoc 107(5): 393-398, 2017) Full article

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Open AccessArticle

Hiking with Diabetes. Risks and Benefits

by David W. Jenkins and Alexander Jenks

J. Am. Podiatr. Med. Assoc. 2017, 107(5), 382-392; https://doi.org/10.7547/15-219 - 1 Sep 2017

Cited by 5 | Viewed by 62

Abstract

Background: Exercise is highly beneficial for persons with diabetes. Similar to many other patients, those with diabetes may be reluctant to exercise given a lack of motivation and proper instruction regarding an exercise prescription. In general, medical providers are poorly equipped to develop [...] Read more.

Background: Exercise is highly beneficial for persons with diabetes. Similar to many other patients, those with diabetes may be reluctant to exercise given a lack of motivation and proper instruction regarding an exercise prescription. In general, medical providers are poorly equipped to develop an exercise prescription and furnish motivation. Attempts to find activities that not only provide effective aerobic challenges but also are enjoyable to participate in are fraught with difficulty. Hiking as a potential option for a safe and enjoyable activity is discussed, including the possible downsides. Methods: Multiple publications were reviewed using key words. Results: A review of the literature uncovered limited publications or controlled trials that discussed the use of hiking per se as an activity for the management of diabetes. Newer studies reviewing weightbearing exercise and diabetic polyneuropathy and those discussing the advantages of trekking poles for balance and proprioception are cited in support of the recommendation for hiking as an activity for those with diabetes. Conclusions: Exercise has been shown to substantially benefit individuals with diabetes, but convincing patients with diabetes to exercise is daunting. Hiking, unlike other, more tedious exercise programs, may be an exercise option that persons with diabetes might find enjoyable. Hiking may encourage balance training and reduced ground reaction forces. These benefits may be augmented by trekking poles, which may likewise counter the concerns of the uneven surfaces that present challenges to the hiker with diabetes. (J Am Podiatr Med Assoc 107(5): 382-392, 2017) Full article

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Open AccessArticle

Clinical Utility of Ultrasound Measurements of Plantar Fascia Width and Cross-Sectional Area. A Novel Technique

by Adebisi Bisi-Balogun and Michael Rector

J. Am. Podiatr. Med. Assoc. 2017, 107(5), 375-381; https://doi.org/10.7547/16-042 - 1 Sep 2017

Cited by 11 | Viewed by 51

Abstract

Background: We sought to develop a standardized protocol for ultrasound (US) measurements of plantar fascia (PF) width and cross-sectional area (CSA), which may serve as additional outcome variables during US examinations of both healthy asymptomatic PF and in plantar fasciopathy and determine its [...] Read more.

Background: We sought to develop a standardized protocol for ultrasound (US) measurements of plantar fascia (PF) width and cross-sectional area (CSA), which may serve as additional outcome variables during US examinations of both healthy asymptomatic PF and in plantar fasciopathy and determine its interrater and intrarater reliability. Methods: Ten healthy individuals (20 feet) were enrolled. Participants were assessed twice by two raters each to determine intrarater and interrater reliability. For each foot, three transverse scans of the central bundle of the PF were taken at its insertion at the medial calcaneal tubercle, identified in real time on the plantar surface of the foot, using a fine wire technique. Reliability was determined using intraclass correlation coefficients (ICC), standard errors of measurement (SEM), and limits of agreement (LOA) expressed as percentages of the mean. Reliability of PF width and CSA measurements was determined using PF width and CSA measurements from one sonogram measured once and the mean of three measurements from three sonograms each measured once. Results: Ultrasound measurements of PF width and CSA showed a mean of 18.6 < 2.0 mm and 69.20 < 13.6 mm² respectively. Intra-reliability within both raters showed an ICC > 0.84 for width and ICC > 0.92 for CSA as well as a SEM% and LOA% , 10% for both width and CSA. Inter-rater reliability showed an ICC of 0.82 for width and 0.87 for CSA as well as a SEM% and LOA% , 10% for width and a SEM% , 10% and LOA% , 20% for CSA. Relative and absolute reliability within and between raters were higher when using the mean of three sonographs compared to one sonograph. Conclusions: Using this novel technique, PF CSA and width may be determined reliably using measurements from one sonogram or the mean of three sonograms. Measurement of PF CSA and width in addition to already established thickness and echogenicity measurements provides additional information on structural properties of the PF for clinicians and researchers in healthy and pathologic PF. (J Am Podiatr Med Assoc 107(5): 375-381, 2017)
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Open AccessArticle

Surgical Treatment of Zone 1 Fifth Metatarsal Base Fractures Using the Locking Compression Plate Distal Ulna Hook Plate

by Jingjing Zhao, Bin Yu, Ming Xie, Ruokun Huang and Kai Xiao

J. Am. Podiatr. Med. Assoc. 2017, 107(5), 369-374; https://doi.org/10.7547/15-208 - 1 Sep 2017

Cited by 5 | Viewed by 66

Abstract

Background: The distal ulna hook plate was recently introduced for the treatment of fifth metatarsal base fractures, but no special articles have reported the surgical results of the plate fixation of displaced or comminuted fifth metatarsal base fractures in zone 1, which are [...] Read more.

Background: The distal ulna hook plate was recently introduced for the treatment of fifth metatarsal base fractures, but no special articles have reported the surgical results of the plate fixation of displaced or comminuted fifth metatarsal base fractures in zone 1, which are the most common forefoot fractures. Methods: Twenty-one patients with Lawrence classification zone 1 fifth metatarsal base fractures with extra-articular displacement greater than 2 mm (n =13) and intra-articular displacement fractures (n =8) were included in the study. Patients were treated with the distal ulna hook plate. Patients were evaluated clinically and radiographically, and the functional outcomes were graded using the American Orthopaedic Foot and Ankle Society midfoot scoring system. Time to union and return to pre-injury levels of activity were calculated. Results: Mean American Orthopaedic Foot and Ankle Society midfoot scores were 42.25 points (range, 27–55 points) preoperatively and 93.16 points (range, 87–100 points) 1 year postoperatively. Mean time to complete union was 61.9 days (range, 52–85 days). Nineteen patients reported returning to previous activities of daily living at a mean of 79.8 days (range, 59–91 days). Two patients showed radiographic signs of mild degenerative changes and noted mild pain, and one patient experienced hardware irritation. Conclusions: The distal ulna hook plate might be considered an effective surgical method for zone 1 displaced fifth metatarsal base fractures or multifragmentary, osteoporotic fifth metatarsal base fractures. (J Am Podiatr Med Assoc 107(5): 369-374, 2017) Full article

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Open AccessArticle

Split-Thickness Skin Grafts to the Foot and Ankle of Diabetic Patients

by Kyle Sanniec, Tea Nguyen, Suzanne van Asten, Javier La Fontaine and Lawrence A. Lavery

J. Am. Podiatr. Med. Assoc. 2017, 107(5), 365-368; https://doi.org/10.7547/15-200 - 1 Sep 2017

Cited by 18 | Viewed by 48

Abstract

Background: There is an increased prevalence of foot ulceration in patients with diabetes, leading to hospitalization. Early wound closure is necessary to prevent further infections and, ultimately, lower-limb amputations. There is no current evidence stating that an elevated preoperative hemoglobin A_1c (HbA [...] Read more.

Background: There is an increased prevalence of foot ulceration in patients with diabetes, leading to hospitalization. Early wound closure is necessary to prevent further infections and, ultimately, lower-limb amputations. There is no current evidence stating that an elevated preoperative hemoglobin A_1c (HbA_1c) level is a contraindication to skin grafting. The purpose of this review was to determine whether elevated HbA_1c levels are a contraindication to the application of skin grafts in diabetic patients. Methods: A retrospective review was performed of 53 consecutive patientswho underwent splitthickness skin graft application to the lower extremity between January 1, 2012, and December 31, 2015. A uniformsurgical techniquewas used across all of the patients. A comparison of HbA1c levels between failed and healed skin grafts was reviewed. Results: Of 43 surgical sites (41 patients) that met the inclusion criteria, 27 healed with greater than 90% graft take and 16 had a skin graft that failed. There was no statistically significant difference in HbA_1c levels in the group that healed a skin graft compared with the group in which skin graft failed to adhere. Conclusions: Preliminary data suggest that an elevated HbA_1c level is not a contraindication to application of a skin graft. The benefits of early wound closure outweigh the risks of skin graft application in patients with diabetes. (J Am Podiatr Med Assoc 107(5): 365-368, 2017)
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Open AccessArticle

Rate of and Factors Associated with Ambulation After Unilateral Major Lower-Limb Amputation at an Urban US Tertiary-Care Hospital with a Multidisciplinary Limb Salvage Team

by Laura E. Sansosti, Amanda Crowell, Eric T. Choi and Andrew J. Meyr

J. Am. Podiatr. Med. Assoc. 2017, 107(5), 355-364; https://doi.org/10.7547/16-073 - 1 Sep 2017

Cited by 20 | Viewed by 39

Abstract

Background: One relatively universal functional goal after major lower-limb amputation is ambulation in a prosthesis. This retrospective, observational investigation sought to 1) determine what percentage of patients successfully walked in a prosthesis within 1 year after major limb amputation and 2) assess which [...] Read more.

Background: One relatively universal functional goal after major lower-limb amputation is ambulation in a prosthesis. This retrospective, observational investigation sought to 1) determine what percentage of patients successfully walked in a prosthesis within 1 year after major limb amputation and 2) assess which patient factors might be associated with ambulation at an urban US tertiary-care hospital. Methods: A retrospective medical record review was performed to identify consecutive patients undergoing major lower-limb amputation. Results: The overall rate of ambulation in a prosthesis was 29.94% (50.0% of those with unilateral below-the-knee amputation [BKA] and 20.0% of those with unilateral abovethe- knee amputation [AKA]). In 24.81% of patients with unilateral BKA or AKA, a secondary surgical procedure of the amputation site was required. In those with unilateral BKA or AKA, statistically significant factors associated with ambulation included male sex (odds ratio [OR] =2.50) and at least 6 months of outpatient follow-up (OR = 8.10), survival for at least 1 postoperative year (OR = 8.98), ambulatory preamputation (OR = 14.40), returned home after the amputation (OR = 6.12), and healing of the amputation primarily without a secondary surgical procedure (OR =3.62). Those who had a history of dementia (OR =0.00), a history of peripheral arterial disease (OR=0.35), and a preamputation history of ipsilateral limb revascularization (OR=0.14) were less likely to walk. We also observed that patients with a history of outpatient evaluation by a podiatric physician before major amputation were 2.63 times as likely to undergo BKA as opposed to AKA and were 2.90 times as likely to walk after these procedures. Conclusions: These results add to the body of knowledge regarding outcomes after major amputation and could be useful in the education and consent of patients faced with major amputation. (J Am Podiatr Med Assoc 107(5): 355-364, 2017) Full article

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J. Am. Podiatr. Med. Assoc., Volume 107, Issue 5 (09 2017) – 19 articles , Pages 355-474

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