Journal of the American Podiatric Medical Association

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Open AccessArticle

Percutaneous Electrochemical Debridement of the Plantaris Tendon. A Novel Option in the Treatment of Midportion Achilles Tendinopathy

by Gabriele Mattiussi and Carlos Moreno

J. Am. Podiatr. Med. Assoc. 2018, 108(5), 437-441; https://doi.org/10.7547/17-078 - 1 Sep 2018

Cited by 4 | Viewed by 50

Abstract

Plantaris tendon disorders are a well-known source of midportion Achilles tendinopathy. Plantaris tendon thickening and fibrous tissue formation between the tendons are the histologic abnormalities that are typically observed. Surgical approaches (scraping of the Achilles medial and ventral paratendinous tissues and excision of [...] Read more.

Plantaris tendon disorders are a well-known source of midportion Achilles tendinopathy. Plantaris tendon thickening and fibrous tissue formation between the tendons are the histologic abnormalities that are typically observed. Surgical approaches (scraping of the Achilles medial and ventral paratendinous tissues and excision of the plantaris tendon) have already shown good clinical outcomes; despite this, the cost-benefit ratio of these interventions may be unfavorable, and their accessibility is limited. Percutaneous needle electrolysis is a minimally invasive ablative technique increasingly being considered for the treatment of tendinopathies and associated conditions. Herein we introduce a novel procedure to treat plantaris tendon–related midportion Achilles tendinopathy. The procedure starts with the ultrasound-guided insertion of an uncoated needle (diameter, 0.30–0.40 mm; length, 30 mm) between the plantaris and Achilles tendons. Subsequently, galvanic current (intensity, 2 mA) is locally transferred, which induces instant nonthermal electrochemical ablation of the intertendinous tissues in close proximity to the needle, finally debriding the plantaris tendon. To further promote its release, the second part of the procedure involves partial tenotomy of the lateral peripheral aspects of the plantaris tendon. Usually, the session does not exceed 30 min. Percutaneous needle electrolysis may be considered as a valid alternative to surgery. The outpatient procedure presented herein is, in fact, safe and quick to perform. In addition, long suspension of working or sporting activities after treatment is not required. Future investigations are needed to ascertain the short- and long-term therapeutic outcomes of plantaris tendon–related midportion Achilles tendinopathy treatment, in particular by comparing them with those obtained with other mini-invasive interventions. Full article

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Open AccessArticle

Combined Osseous Medial Cuneonavicular Coalition and Nonosseous Naviculocuboid Coalition Presenting as First Metatarsophalangeal Joint Pain. A Case Report

by Nina S. Babu and Melinda A. Bowlby

J. Am. Podiatr. Med. Assoc. 2018, 108(5), 434-436; https://doi.org/10.7547/17-017 - 1 Sep 2018

Cited by 2 | Viewed by 58

Abstract

Tarsal coalitions of the lesser tarsus are relatively rare congenital anomalies. A case report of a 54-year-old man with an osseous medial cuneonavicular coalition and a nonosseous naviculocuboid coalition that presented as first metatarsophalangeal joint pain is described. Full article

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Open AccessArticle

Atypical Vascularity Within a Schwannoma. A Case Study

by James A. Wright, Hariklia Bezhani, Rosanna Troia and Fanni Ratzon

J. Am. Podiatr. Med. Assoc. 2018, 108(5), 430-433; https://doi.org/10.7547/16-113 - 1 Sep 2018

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Abstract

We report on the unusual presentation of a schwannoma. Aside from the aberrant dorsolateral anatomical presentation, ultrasonography revealed not only peripheral vascularity but also internal vascularity. Internal vascularity often suggests a malignant process as opposed to a benign one; however, in the presented [...] Read more.

We report on the unusual presentation of a schwannoma. Aside from the aberrant dorsolateral anatomical presentation, ultrasonography revealed not only peripheral vascularity but also internal vascularity. Internal vascularity often suggests a malignant process as opposed to a benign one; however, in the presented case, the diagnosis of a benign lesion was confirmed with S100 immunohistochemical staining. In this study, we review the literature on this pathology and present an uncommon presentation of a benign nerve tumor. Full article

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Open AccessArticle

Use of GBT013, a Collagen-Based Dressing, for the Healing of Diabetic Foot Ulcers. A Case Series

by Isabelle J. Dumont, Marc Lepeut, Coralie Segalen, Yannis Guillemin and Jean Noel Gouze

J. Am. Podiatr. Med. Assoc. 2018, 108(5), 419-429; https://doi.org/10.7547/16-102 - 1 Sep 2018

Cited by 2 | Viewed by 55

Abstract

The number of people with diabetes is expected to reach 592 million in the year 2035. Diabetic foot lesions are responsible for more hospitalizations than any other complication of diabetes. The aims of this study were to examine for the first time a [...] Read more.

The number of people with diabetes is expected to reach 592 million in the year 2035. Diabetic foot lesions are responsible for more hospitalizations than any other complication of diabetes. The aims of this study were to examine for the first time a new biocompatible and biodegradable tridimensional collagen-based matrix, GBT013, in humans for diabetic foot ulcer wound healing and to evaluate its ease of use to better define a protocol for a future clinical trial. Seven adult patients with a diabetic foot ulcer of grade 1A to 3D (University of Texas Diabetic Wound Classification) were treated using GBT013, a new collagen-based advance dressing and were monitored in two specialized foot care units for a maximum of 9 weeks. Five of seven wounds achieved complete healing in 4 to 7 weeks. Nonhealed ulcers showed a significant reduction of the wound surface (>44%). GBT013 was well tolerated and displayed positive wound healing outcomes as a new treatment strategy of chronic foot ulcers in diabetic patients. Full article

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Open AccessArticle

The Treatment of Complex Motorcycle Spoke Injuries in Children. A Report of Four Cases and Literature Review

by Jiasharete Jielile, Pengfei Li, Wulan Bahetiya, Aynaz Badelhan, Bayixiati Qianman, Ayidaer Jialihasi, Nuerai Shawutali, Jianati Wuerliebieke, Adili Aizezi, Naertai Yeerboo, Elihaer Makemutibieke, Amuding Aisaiding, Tuolihawu Hazehan, Tulede Shatewalede and Zhumatai Awuyyesihan

J. Am. Podiatr. Med. Assoc. 2018, 108(5), 409-418; https://doi.org/10.7547/16-066 - 1 Sep 2018

Cited by 3 | Viewed by 57

Abstract

Motorcycle spoke injuries involving the soft tissue, Achilles tendon, and calcaneal defects are rare in children. Currently, calcaneal defects are very challenging to treat. Multiple methods have been used in clinical practice; however, an effective treatment has yet to be established, especially when [...] Read more.

Motorcycle spoke injuries involving the soft tissue, Achilles tendon, and calcaneal defects are rare in children. Currently, calcaneal defects are very challenging to treat. Multiple methods have been used in clinical practice; however, an effective treatment has yet to be established, especially when Achilles tendon and soft-tissue defects are also present. It is important to address this condition, because the calcaneus plays a key role in standing and gait. Unsatisfactory treatment of calcaneal defects may significantly decrease patients’ quality of life (eg, by limiting mobility). In this article, we report the effective treatment of calcaneal defects in four children using distraction osteogenesis with an external fixator framework designed by the authors. From May 2014 to May 2015, four children (age range, 6–11 years) with defects of the Achilles tendon, soft tissue, and calcaneus resulting from a motorcycle accident were treated at our hospital. The Achilles tendon and soft-tissue defects were treated with second-stage reconstruction. In the third-stage surgery, osteotomy of the residual calcaneus was performed. A customized external fixator was used to lengthen the calcaneus at a rate of 1.5 mm/day in the posterior direction and reposition it by 40° in the inferior direction. In all four children, the calcaneus was lengthened by 5 cm. Distraction osteogenesis through external fixation is effective for restoring the length, width, and height of the calcaneus in children. Full article

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Open AccessArticle

Fulminant Septicemia from Aeromonas hydrophilia in a Nonmobile Diabetic Patient. A Case Report

by Sara E. Lewis, Devin W. Collins and Adam M. Bressler

J. Am. Podiatr. Med. Assoc. 2018, 108(5), 405-408; https://doi.org/10.7547/17-103 - 1 Sep 2018

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Abstract

We report an unusual case of Aeromonas hydrophilia septicemia in a nonmobile diabetic patient secondary to contaminated well water used for bathing with a portal of entry through chronic forefoot and heel ulcers. To date, there are no documented cases similar to this [...] Read more.

We report an unusual case of Aeromonas hydrophilia septicemia in a nonmobile diabetic patient secondary to contaminated well water used for bathing with a portal of entry through chronic forefoot and heel ulcers. To date, there are no documented cases similar to this patient’s presentation. Aeromonas hydrophilia is commonly distributed among aquatic environments and tends to be found during warmer months. It is a rare cause of disease but can be life threatening and deadly, as in our case, in immunocompromised individuals. As podiatric physicians, we must remain diligent and have a high index of suspicion to identify patients at risk for this rare but serious infection and administer treatment aggressively to limit morbidity and mortality. Full article

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Open AccessArticle

Talonavicular Dislocation—What Lies Beneath? A Short Review and Report of Three Distinctive Cases

by Ioannis Konstantinidis, Panagiotis D. Symeonidis, Dimitrios Polyzos, Petros Antonarakos, Panagiotis Givissis and Christos Dimitriou

J. Am. Podiatr. Med. Assoc. 2018, 108(5), 397-404; https://doi.org/10.7547/16-170 - 1 Sep 2018

Cited by 3 | Viewed by 67

Abstract

Background: The talonavicular joint is a rare site of dislocation. Its etiology varies and can be the result of either acute trauma or a chronic degenerative process that most commonly occurs in patients with rheumatoid arthritis or Charcot arthropathy. Our aim is to [...] Read more.

Background: The talonavicular joint is a rare site of dislocation. Its etiology varies and can be the result of either acute trauma or a chronic degenerative process that most commonly occurs in patients with rheumatoid arthritis or Charcot arthropathy. Our aim is to highlight the relationship between the underlying pathology of talonavicular dislocations and the final outcome in the case of operative management. Methods: We present three cases of talonavicular dislocation with the dislocation itself as the only common denominator, and a completely different etiology, natural history, treatment, and prognosis among them. Results: There was one case of a traumatic talocalcaneonavicular dislocation in a healthy individual, one case in a rheumatoid arthritis patient, and one case in a patient with diabetes mellitus. All patients were treated surgically. The outcomes were excellent, fair, and poor, respectively. Conclusions: Among many factors that influence prognosis, it is equally critical to evaluate the overall background in which the dislocation occurs so as to apply the suitable treatment. The surgeon not only needs to treat the local incident but also appreciate the general medical condition to provide the best final outcome to the patient. Full article

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Open AccessArticle

Effect of Different Insole Materials on Kinetic and Kinematic Variables of the Walking Gait in Healthy People

by Ramadan Özmanevra, Salih Angin, İzge H. Günal and Ata Elvan

J. Am. Podiatr. Med. Assoc. 2018, 108(5), 390-396; https://doi.org/10.7547/16-175 - 1 Sep 2018

Cited by 9 | Viewed by 61

Abstract

Background: There is a lack of data that could address the effects of off-the-shelf insoles on gait variables in healthy people. Methods: Thirty-three healthy volunteers ranging in age from 18 to 35 years were included to this study. Kinematic and kinetic data were [...] Read more.

Background: There is a lack of data that could address the effects of off-the-shelf insoles on gait variables in healthy people. Methods: Thirty-three healthy volunteers ranging in age from 18 to 35 years were included to this study. Kinematic and kinetic data were obtained in barefoot, shoe-only, steel insole, silicone insole, and polyurethane insole conditions using an optoelectronic three-dimensional motion analysis system. A repeated measures analysis of variance test was used to identify statistically significant differences between insole conditions. The alpha level was set at P < .05 Results: Maximum knee flexion was higher in the steel insole condition (P < .0001) compared with the silicone insole (P = .001) and shoe-only conditions (P = .032). Reduced maximum knee flexion was recorded in the polyurethane insole condition compared with the shoe-only condition (P = .031). Maximum knee flexion measured in the steel insole condition was higher compared to the barefoot condition (P = .020). Higher maximum ankle dorsiflexion was observed in the barefoot condition, and there were significant differences between the polyurethane insole (P < .0001), silicone insole (P = .001), steel insole (P = .002), and shoe conditions (P = .004). Least and highest maximum ankle plantarflexion were detected in the steel insole and silicone insole conditions, respectively. Maximum ankle plantarflexion in the barefoot and steel insole conditions (P = .014) and the barefoot and polyurethane insole conditions (P = .035) were significant. There was no significant difference between conditions for ground reaction force or joint moments. Conclusions: Insoles made by different materials affect maximum knee flexion, maximum ankle dorsiflexion, and maximum ankle plantarflexion. This may be helpful during the decision-making process when selecting the insole material for any pathological conditions that require insole prescription.
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Open AccessArticle

Associations Between Obesity and Pediatric Foot Dimensions

by Stewart C. Morrison, David McCarthy and Ryan Mahaffey

J. Am. Podiatr. Med. Assoc. 2018, 108(5), 383-389; https://doi.org/10.7547/16-172 - 1 Sep 2018

Cited by 6 | Viewed by 117

Abstract

Background: The influence of childhood obesity on shape and structure of the pediatric foot remains poorly understood. The purpose of this work was to determine associations between obesity and pediatric foot dimensions. Methods: A retrospective analysis of pediatric foot dimensions (foot length [FL] [...] Read more.

Background: The influence of childhood obesity on shape and structure of the pediatric foot remains poorly understood. The purpose of this work was to determine associations between obesity and pediatric foot dimensions. Methods: A retrospective analysis of pediatric foot dimensions (foot length [FL] and foot width [FW]) in 3,713 children aged 3 to 18 years was undertaken. Logistic regression was used to determine relationships between FL, FW, and weight category. Results: Compared with obese peers, typical weight (FL, P < .05 [odds ratio (OR)]=.83; FW, P < .05 [OR = .56]) and underweight (FL, P < .05 [OR = .76]; FW, P < .05 [OR = .41]) boys had significantly shorter and narrower feet. Overweight (FL, P = .02 [OR = .88]; FW, P =.02 [OR =.72]), typical weight (FL, P < .05 [OR =.77]; FW, P < .05 [OR = .47]), and underweight (FL, P < .05 [OR = .70]; FW, P < .05 [OR = .33]) girls had significantly shorter and narrower feet. Conclusions: These findings suggest that obesity is an important determinant of pediatric foot dimensions. Given the current prevalence of obesity in children and young people, these findings may have population-wide implications for pediatric foot health. Full article

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Open AccessArticle

Comparative Study Between the Different Techniques of Molding and the Morphology of the Foot in Weightbearing

by María José Manfredi Márquez, Priscila Távara Vidalón, Nuria Lara Hurtado and Javier Ramos-Ortega

J. Am. Podiatr. Med. Assoc. 2018, 108(5), 375-382; https://doi.org/10.7547/17-019 - 1 Sep 2018

Cited by 1 | Viewed by 64

Abstract

Background: Taking a mold of the foot is an important advance for podiatric medicine and an indispensable procedure for the individualization of orthopedic treatments. We sought to determine which method of measuring molds (plaster cast in weightbearing and nonweightbearing and phenolic foam in [...] Read more.

Background: Taking a mold of the foot is an important advance for podiatric medicine and an indispensable procedure for the individualization of orthopedic treatments. We sought to determine which method of measuring molds (plaster cast in weightbearing and nonweightbearing and phenolic foam in weightbearing) reproduces with more reliability the expansion of the foot in weightbearing by comparing the widths of the forefoot and hindfoot in the different methods and in barefoot weightbearing. Methods: In 54 patients, we studied the differences in width between the forefoot and hindfoot in barefoot weightbearing compared with in the different mold obtainment techniques. A descriptive, observational, and transversal study was performed in which foot molds were obtained with the different techniques, without corrective maneuvers, followed by scanning of each as well as barefoot weightbearing. Results: Significant differences among the techniques were shown, with phenolic foam being more similar to barefoot weightbearing in forefoot and hindfoot width. Conclusions: The method that reproduces the expansion of the foot in weightbearing with more reliability is phenolic foam. The forefoot width is superior in barefoot weightbearing versus the three foot casts studied. The hindfoot width is superior in the foot cast with plaster in weightbearing compared with barefoot weightbearing and the other two foot casts. Full article

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Open AccessArticle

Toenail Changes in Patients with Diabetes Mellitus with and Without Onychomycosis

by Nélia Cunha, Célia Galhardas, Margarida Apetato and André Lencastre

J. Am. Podiatr. Med. Assoc. 2018, 108(5), 370-374; https://doi.org/10.7547/17-006 - 1 Sep 2018

Cited by 6 | Viewed by 92

Abstract

Background: Diabetes mellitus is a predisposing factor for onychomycosis (OM). A high frequency of nonfungal onychodystrophy (OD) is also alleged, although information on the prevalence of specific nail changes is scant. We evaluated the prevalence and types of nail changes in a cohort [...] Read more.

Background: Diabetes mellitus is a predisposing factor for onychomycosis (OM). A high frequency of nonfungal onychodystrophy (OD) is also alleged, although information on the prevalence of specific nail changes is scant. We evaluated the prevalence and types of nail changes in a cohort of diabetic patients with fungal and nonfungal OD. Methods: During a 6-month period, inpatients with diabetes mellitus were screened for foot and toenail changes. Demographic, social, and clinical data were recorded, as was information concerning foot and toenail care. Fungal infection was confirmed by mycologic examination and by histologic analysis of nail clippings. Results: Of the 82 patients included, 65 (79.3%) had nail changes, and 34 of these 65 patients (52.3%) were diagnosed as having OM. The most frequently observed nail signs were subungual hyperkeratosis, onycholysis, yellow discoloration, and splinter hemorrhages, each seen in more than 25% of the patients. Tinea pedis and superficial pseudoleukonychia were observed more frequently in the OM group (P < .05). Conversely, prominent metatarsal heads and history of nail trauma were more frequent in patients with nonfungal OD (P < .05). Conclusions: Physicians who care for diabetic patients should not ignore nail changes. Fungal and nonfungal OD are common and should be addressed in the global evaluation of the feet to help prevent breaks in the skin barrier and subsequent bacterial infections and ulcers. Full article

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Open AccessArticle

Comparison of Diabetic Foot Care with Other Diabetic Preventive Care Services

by Fayegh Jadali, Hamid Nemati, Piran Jadali and Patrick Jadali

J. Am. Podiatr. Med. Assoc. 2018, 108(5), 362-369; https://doi.org/10.7547/17-081 - 1 Sep 2018

Cited by 1 | Viewed by 51

Abstract

Background: Diabetes is a major chronic disease with high morbidity and mortality. Diabetic preventive care services are essential in the management and outcome of the disease. More than other preventive diabetic care services, preventive care of diabetic retinopathy has been emphasized and recommended [...] Read more.

Background: Diabetes is a major chronic disease with high morbidity and mortality. Diabetic preventive care services are essential in the management and outcome of the disease. More than other preventive diabetic care services, preventive care of diabetic retinopathy has been emphasized and recommended by practitioners and insurance companies. We investigated the status of preventive care in the diabetic population. Methods: Information was collected from 420 outpatients aged 30 to 80 years. The patients were divided into two groups: those with well-controlled blood sugar levels (hemoglobin A_1c [HbA_1c] level ≤7%) and those with uncontrolled blood sugar levels (HbA_1c level >7%). Results: Data analysis indicated that for both groups, 93% of the participants were seen for diabetic eye care at least once and 78% were getting an annual eye examination regularly. In the controlled and uncontrolled blood sugar groups, 26% and 32% of patients, respectively, had ever seen a nephrologist and 38% and 49%, respectively, had ever seen a cardiologist. In the controlled and uncontrolled blood sugar groups, 32% and 38% of patients, respectively, had visited a podiatric physician. For statistical analysis and comparison of results between the two groups, we applied the v2 test and calculated 95% confidence intervals. There were some significant differences regarding the complications of diabetes mellitus and preventive care. Conclusions: There is a need for greater engagement by podiatric physicians and health-care providers to promote regular visits for the diabetic population to podiatric medical clinics.
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Open AccessArticle

The Effect of Toe Flexion Exercises on Grip

by Helen Branthwaite, Gemma Grabtree, Nachiappan Chockalingam and Andrew Greenhalgh

J. Am. Podiatr. Med. Assoc. 2018, 108(5), 355-361; https://doi.org/10.7547/16-167 - 1 Sep 2018

Cited by 5 | Viewed by 67

Abstract

Background: Weakness of the toe flexor muscles has been attributed to the development of toe pathologies, and it responds well in the clinic to toe grip exercises. However, it is unknown whether exercising the toe flexor muscles improves the ability to grip and [...] Read more.

Background: Weakness of the toe flexor muscles has been attributed to the development of toe pathologies, and it responds well in the clinic to toe grip exercises. However, it is unknown whether exercising the toe flexor muscles improves the ability to grip and alter function. The aim of this study was to assess the effect of toe flexor exercises on apical plantar pressure, as a measure of grip, while seated and during gait. Methods: Twenty-three individuals with no known toe pathologies were recruited. Static peak pressure, time spent at peak pressure, and pressure-time integral while seated, as well as dynamic forefoot maximal force, contact area, and percentage contact time, were recorded before and after exercise. Toe grip exercises with a therapy ball were completed daily for 6 weeks. Results: Static peak pressure significantly increased after exercise on the apex of the second and third digits, as did the pressure-time integral. Dynamic peak force and contact area did not alter after exercise around the metatarsals and toes, yet percentage contact time significantly increased for each metatarsal after completing daily toe grip exercises. Conclusions: Exercises to improve the grip ability of the toes increased the static peak pressure on the apex of the second and third digits as well as the percentage contact time of the metatarsals during gait. The ability to increase apical peak pressure and contact time after exercises could assist in improving forefoot stability and gait efficiency and in reducing toe pathology progression. Full article

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Retrospective Analysis of Plantar Fascia by Ultrasound Imaging in Patients with Plantar Fasciitis

by Michael Henry Slayton, Richard C. Amodei, Keegan B. Compton and Luke D. Cicchinelli

J. Am. Podiatr. Med. Assoc. 2018, 108(5), 349-354; https://doi.org/10.7547/16-083 - 1 Sep 2018

Cited by 5 | Viewed by 91

Abstract

Background: We compared diagnostic ultrasound images of the plantar fascia with available patient histories for symptomatic patients previously diagnosed as having plantar fasciitis. Plantar fascia thickness and depth, the prevalence of perifascial hypoechoic lesions, and injury timelines in patients were reviewed. Methods: Images [...] Read more.

Background: We compared diagnostic ultrasound images of the plantar fascia with available patient histories for symptomatic patients previously diagnosed as having plantar fasciitis. Plantar fascia thickness and depth, the prevalence of perifascial hypoechoic lesions, and injury timelines in patients were reviewed. Methods: Images and histories for 126 symptomatic patients were collected from a patient database. We documented plantar fascia depth and thickness and the visualization of hypoechoic perifascial lesions. After image analysis, the obtained plantar fascia thickness measurements were compared with various patient attributes for possible relationships, including age, weight, and body mass index. In addition, plantar fascia thickness measurements were separated based on injury timeline as well as symptomatic/asymptomatic foot for patients with unilateral conditions to check for significant differences between subgroups. These were, in turn, compared with a control group of 71 individuals with no heel pain or diagnosis of plantar fasciitis. Results: Overall, mean ± SD symptomatic thickness (n = 148) was 6.53 ± 1.56 mm. Mean ± SD symptomatic depth (n = 136) was 13.36 ± 2.14 mm. For the control group, mean 6 SD thickness was 3.20 ± 0.66 mm and depth was 10.30 ± 2.00 mm. Comparison of thickness based on injury timeline showed two significant differences: acute injuries (≤3 months) are significantly thicker than chronic injuries (>3 months), and only acute symptomatic thicknesses are significantly different from their asymptomatic thickness counterparts. Age, weight, and body mass index did not show significant correlations to thickness. Analysis of ultrasound images showed that 93% of symptomatic feet had hypoechoic lesions. Conclusions: Injury timeline and the presence of hypoechoic lesions may play important roles in patient discomfort, diagnosis, and treatment of plantar fasciitis. Full article

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J. Am. Podiatr. Med. Assoc., Volume 108, Issue 5 (09 2018) – 14 articles , Pages 349-441

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