Journal of the American Podiatric Medical Association

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Open AccessArticle

The Why Behind the Establishment of Western University College of Podiatric Medicine

by Lawrence B. Harkless and V. Kathleen Satterfield

J. Am. Podiatr. Med. Assoc. 2018, 108(6), 568-571; https://doi.org/10.7547/8750-7315-108.6.568 - 1 Nov 2018

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Podiatry was starting to get the attention of the medical world by the 1970s, enough so that the president of the American Orthopedic Foot and Ankle Society used the occasion of his inauguration to address the profession [...] Full article

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Open AccessArticle

Temple University School of Podiatric Medicine

by Kieran T. Mahan

J. Am. Podiatr. Med. Assoc. 2018, 108(6), 564-567; https://doi.org/10.7547/8750-7315-108.6.564 - 1 Nov 2018

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The journey that is the Temple University School of Podiatric Medicine (TUSPM) began as the Temple University School of Chiropody in 1915 [...] Full article

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Open AccessArticle

Interprofessionalism. A Cornerstone of Innovation and Medical Education at Scholl College of Podiatric Medicine

by Robert Joseph, Richmond Robinson, Adam Fleischer, Leland Jaffe, Alison Joseph, Isabel Baker, Jacqueline Truong, Aksone Nouvong, Nancy L. Parsley and John H. Becker

J. Am. Podiatr. Med. Assoc. 2018, 108(6), 560-563; https://doi.org/10.7547/8750-7315-108.6.560 - 1 Nov 2018

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In 1912, the Illinois College of Chiropody and Orthopedics was founded, and is today known as the Dr. William M. Scholl College of Podiatric Medicine. It has been an integral part of Rosalind Franklin University of Medicine and Science in North Chicago, Illinois [...] Read more.

In 1912, the Illinois College of Chiropody and Orthopedics was founded, and is today known as the Dr. William M. Scholl College of Podiatric Medicine. It has been an integral part of Rosalind Franklin University of Medicine and Science in North Chicago, Illinois since 2001. Through the ensuing decades, Scholl College alumni have been instrumental in moving the profession forward. (J Am Podiatr Med Assoc 108(6): 560- 563, 2018) Full article

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Open AccessArticle

New York College of Podiatric Medicine. 107 Years of Innovation

by Eileen Daly Chusid, Robert A. Eckles, Mark H. Swartz, Michael J. Trepal and Ellen Lubell

J. Am. Podiatr. Med. Assoc. 2018, 108(6), 558-559; https://doi.org/10.7547/8750-7315-108.6.558 - 1 Nov 2018

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The 107-year history of the New York College of Podiatric Medicine (NYCPM) has been marked by continuous progress and innovation in the field of podiatric medical education [...] Full article

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Open AccessArticle

Affiliation Between a Public University and a Private College of Podiatric Medicine. A Novel Partnership

by Marie Mantini Blazer, Rocco A. Petrozzi and Donna M. Perzeski

J. Am. Podiatr. Med. Assoc. 2018, 108(6), 554-557; https://doi.org/10.7547/8750-7315-108.6.554 - 1 Nov 2018

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College History [...] Full article

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Open AccessArticle

The DMU Way

by James Mahoney and Robert “Tim” Yoho

J. Am. Podiatr. Med. Assoc. 2018, 108(6), 550-553; https://doi.org/10.7547/8750-7315-108.6.550 - 1 Nov 2018

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History of Des Moines University [...] Full article

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Necessity Is the Mother of Invention. The Story of a Simulated Inpatient Medicine Rotation

by William J. Stiers, Irma Walker-Adamé and Eric D. Stamps

J. Am. Podiatr. Med. Assoc. 2018, 108(6), 547-549; https://doi.org/10.7547/8750-7315-108.6.547 - 1 Nov 2018

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What do you do when a podiatric medicine–friendly teaching hospital abruptly terminates a required monthlong inpatient medicine rotation? You can try to negotiate a new rotation at another facility, but that's difficult in the San Francisco Bay Area with three local medical schools [...] Read more.

What do you do when a podiatric medicine–friendly teaching hospital abruptly terminates a required monthlong inpatient medicine rotation? You can try to negotiate a new rotation at another facility, but that's difficult in the San Francisco Bay Area with three local medical schools vying for similar positions. Instead, you need to think creatively. (J Am Podiatr Med Assoc 108(6): 547-549, 2018) Full article

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Open AccessArticle

The History of Barry University School of Podiatric Medicine

by Albert Armstrong

J. Am. Podiatr. Med. Assoc. 2018, 108(6), 546; https://doi.org/10.7547/8750-7315-108.6.546 - 1 Nov 2018

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The idea for a school of podiatric medicine at Barry University originated with Sister John Karen Frei, the dean of natural and health sciences [...] Full article

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Open AccessArticle

It’s Not Your Father’s Podiatry School. Advances in Podiatric Medical Education

by Jeffrey C. Page and Denise Freeman

J. Am. Podiatr. Med. Assoc. 2018, 108(6), 538-545; https://doi.org/10.7547/8750-7315-108.6.538 - 1 Nov 2018

Cited by 1 | Viewed by 43

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This paper discusses the innovative changes in podiatric medical education found in today's schools and colleges of podiatric medicine, including changes in philosophy, resources and technology, curriculum, delivery methods, the role of faculty, and assessment tools, and the changing expectations of the students [...] Read more.

This paper discusses the innovative changes in podiatric medical education found in today's schools and colleges of podiatric medicine, including changes in philosophy, resources and technology, curriculum, delivery methods, the role of faculty, and assessment tools, and the changing expectations of the students themselves. There is an emphasis on the shift from a teacher-centered approach to professional education to a student-centered approach. Technological advances have had a tremendous impact on the educational process and have opened doors to many new forms of educational delivery that better meet the needs of today's students. We believe that the podiatric medical education of today is the equivalent of allopathic and osteopathic education in quality and depth. The future holds the promise of many more exciting changes to come. (J Am Podiatr Med Assoc 108(6): 538-545, 2018) Full article

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Open AccessArticle

The American Association of Colleges of Podiatric Medicine. 50 Years of Professional, Political, and Public Health Influence

by Jeffrey M. Robbins, Arthur E. Helfand and Leonard Levy

J. Am. Podiatr. Med. Assoc. 2018, 108(6), 535-537; https://doi.org/10.7547/8750-7315-108.6.535 - 1 Nov 2018

Cited by 1 | Viewed by 53

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As we celebrate the 50th anniversary of the American Association of Colleges of Podiatric Medicine (AACPM), it is appropriate to recognize the contributions that this organization has made to the professional growth, the political influence, and the promotion of podiatric public health [...] [...] Read more.

As we celebrate the 50th anniversary of the American Association of Colleges of Podiatric Medicine (AACPM), it is appropriate to recognize the contributions that this organization has made to the professional growth, the political influence, and the promotion of podiatric public health [...] Full article

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Open AccessArticle

Efficacy of Ultrasound-Guided Pulsed Radiofrequency for Recalcitrant Metatarsalgia. A Case Report

by Tsung-Yen Ho, Ming-Jen Ke, Liang-Cheng Chen and Yung-Tsan Wu

J. Am. Podiatr. Med. Assoc. 2018, 108(6), 532-534; https://doi.org/10.7547/17-147 - 1 Nov 2018

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Metatarsalgia is characterized by pain in the forefoot, which is associated with increased stress over the metatarsal head region. Despite the availability of a variety of conservative or surgical treatments for this condition, a few cases have demonstrated relapse or poor response to [...] Read more.

Metatarsalgia is characterized by pain in the forefoot, which is associated with increased stress over the metatarsal head region. Despite the availability of a variety of conservative or surgical treatments for this condition, a few cases have demonstrated relapse or poor response to treatment. Pulsed radiofrequency (PRF) can provide pain relief in patients with diverse chronic conditions without causing neural injury. Recently, studies have shown that ultrasound-guided PRF may be beneficial for adhesive capsulitis, carpal tunnel syndrome, tarsal tunnel syndrome, and recalcitrant plantar fasciitis. Here, we describe a successful case of significant pain relief achieved by using ultrasound-guided PRF targeting the posterior tibial nerve (PTN) at the ankle of a 67-year-old woman with recalcitrant metatarsalgia. Ten minutes after ultrasound-guided PRF was applied at the PTN, the patient reported decreased pain (from 8 to 3 on a visual analogue scale) and did not exhibit any particular side effects. Three months after PRF application, the patient's visual analogue scale score remained more than 50% below the baseline, and she did not need additional conservative treatment during the follow-up period. To the best of our knowledge, we present the first case report using ultrasound-guided PRF at the PTN for treatment of recalcitrant metatarsalgia. We hypothesize that ultrasound-guided PRF at the PTN may be a potentially novel approach for treating recalcitrant metatarsalgia. (J Am Podiatr Med Assoc 108(6): 532-534, 2018) Full article

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Methicillin-Resistant Staphylococcus aureus Endocarditis from a Diabetic Foot Ulcer. Understanding and Mitigating the Risk

by Andrew J. Hale, Emily Vicks, Mary T. LaSalvia, John M. Giurini and Adolf W. Karchmer

J. Am. Podiatr. Med. Assoc. 2018, 108(6), 528-531; https://doi.org/10.7547/17-139 - 1 Nov 2018

Cited by 8 | Viewed by 58

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Diabetic foot infections are a common cause of morbidity and mortality in the United States, and successful treatment often requires an aggressive and prolonged approach. Recent work has elucidated the importance of appropriate therapy for a given severity of diabetic foot infection, and [...] Read more.

Diabetic foot infections are a common cause of morbidity and mortality in the United States, and successful treatment often requires an aggressive and prolonged approach. Recent work has elucidated the importance of appropriate therapy for a given severity of diabetic foot infection, and highlighted the ongoing risk such patients have for subsequent invasive life-threatening infection should diabetic foot ulcers fail to heal. The authors describe the case of a man with diabetes who had prolonged, delayed healing of a diabetic foot ulcer. The ulcer subsequently became infected by methicillin-resistant Staphylococcus aureus (MRSA). The infection was treated conservatively with oral therapy and minimal debridement. Several months later, he experienced MRSA bloodstream infection and complicating endocarditis. The case highlights the ongoing risk faced by patients when diabetic foot ulcers do not heal promptly, and emphasizes the need for aggressive therapy to promote rapid healing and eradication of MRSA. (J Am Podiatr Med Assoc 108(6): 528-531, 2018) Full article

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Open AccessArticle

Which Emerges First: Bone Marrow Edema or Nidus in Osteoid Osteoma?

by Esat Uygur, Oguz Poyanlı and Onder Kılıçoğlu

J. Am. Podiatr. Med. Assoc. 2018, 108(6), 523-527; https://doi.org/10.7547/17-135 - 1 Nov 2018

Cited by 2 | Viewed by 73

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This case report describes a well-documented birth and evolution of an osteoid osteoma at the talus. Although initial radiologic images indicate mild bone marrow edema at first (without nidus), subsequent magnetic resonance imaging and computed tomographic images reveal pathognomonic nidus at the talus. [...] Read more.

This case report describes a well-documented birth and evolution of an osteoid osteoma at the talus. Although initial radiologic images indicate mild bone marrow edema at first (without nidus), subsequent magnetic resonance imaging and computed tomographic images reveal pathognomonic nidus at the talus. During the evolution of the lesion, typical night pain was coincident with the occurrence of the nidus, as seen on magnetic resonance imaging. This may be interpreted that nidus formation may be related to the night pain. In this report, the first finding was bone marrow edema. Although our classic knowledge was that the edema follows the lesion, this report makes a difference. The relationship between bone marrow edema and osteoid osteoma has not been questioned in the literature before. We speculate that this report brings to mind, the question of which comes first? A bone marrow edema or nidus? Another question is: Does osteoid osteoma always start with such a dust cloud in the bone as we presented herein? (J Am Podiatr Med Assoc 108(6): 523-527, 2018) Full article

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Open AccessArticle

Immigration Brings New Pathology with No Standardized Treatment Protocol. Madura Foot Case Studies Phialemonium and Phaeoacremonium

by Tara L. Harrington, Denten Eldredge and Erica K. Benson

J. Am. Podiatr. Med. Assoc. 2018, 108(6), 517-522; https://doi.org/10.7547/17-058 - 1 Nov 2018

Cited by 4 | Viewed by 66

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Madura foot is an uncommon invasive soft-tissue infection that foot and ankle specialists encounter. We present two rare cases of Phialemonium and Phaeoacremonium fungi infections of the foot diagnosed in northern California to inform physicians on the presentation and current treatment options for [...] Read more.

Madura foot is an uncommon invasive soft-tissue infection that foot and ankle specialists encounter. We present two rare cases of Phialemonium and Phaeoacremonium fungi infections of the foot diagnosed in northern California to inform physicians on the presentation and current treatment options for this unique pathology. The two cases presented outline the clinical presentations, diagnostic data, and surgical and antimicrobial interventions. There is a concentration on the antimicrobial options depending on which of the over 20 species is encountered. The pertinent literature and supporting data are reviewed to create an outline for discussion of treatment protocols when faced with these emerging opportunistic infections. (J Am Podiatr Med Assoc 108(6): 517-522, 2018) Full article

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Open AccessArticle

Podiatric Adverse Events and Foot Care in Cancer Patients and Survivors. Awareness, Education, and Literature Review

by Mario E. Lacouture, David J. Kopsky, Raphael Lilker, Fiona Damstra, Mecheline H.M. van der Linden, Azael Freites-Martinez and Mischa P.M. Nagel

J. Am. Podiatr. Med. Assoc. 2018, 108(6), 508-516; https://doi.org/10.7547/17-010 - 1 Nov 2018

Cited by 4 | Viewed by 115

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Cancer is one of the leading causes of mortality and morbidity worldwide. Recent improved therapies have resulted in more patients surviving cancer and living longer. Despite these advances, the majority of patients will develop adverse events from anticancer therapies. Foot alterations, including nail [...] Read more.

Cancer is one of the leading causes of mortality and morbidity worldwide. Recent improved therapies have resulted in more patients surviving cancer and living longer. Despite these advances, the majority of patients will develop adverse events from anticancer therapies. Foot alterations, including nail toxicities, hand-foot syndrome, edema, xerosis, hyperkeratosis, and neuropathy, are frequent among cancer patients. These untoward conditions may negatively impact quality of life, and in some cases may result in the interruption or discontinuation of cancer treatments. Appropriate prevention, diagnosis, and management of podiatric adverse events are essential to maintain foot function and health-related quality of life, both of which are critical for the care of cancer patients and survivors. This article shows results related to complaint and impact on quality of life of the Oncology Foot Care program and reviews publications specific to podiatric adverse events related to cancer treatments. Full article

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Open AccessArticle

The Perception of the Scope of Practice of Podiatric Medicine in a Large Teaching Hospital Demonstrated by Internal Medicine Residents and Patients

by Christopher Seat, Andrea Seat and Jeffery Alexander

J. Am. Podiatr. Med. Assoc. 2018, 108(6), 503-507; https://doi.org/10.7547/17-128 - 1 Nov 2018

Cited by 2 | Viewed by 60

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Background: The scope of podiatric practice has changed significantly in the past couple of decades. Despite the increased quality of training, many people outside of podiatry may not realize what our scope of practice entails. Methods: We conducted a survey consisting of 10 [...] Read more.

Background: The scope of podiatric practice has changed significantly in the past couple of decades. Despite the increased quality of training, many people outside of podiatry may not realize what our scope of practice entails. Methods: We conducted a survey consisting of 10 items and asked internal medicine residents at Rush University Medical Center and patients whether they would feel comfortable consulting podiatrists, or being treated for each issue. Results: The results for residents are as follows: 1) toenail fungus, 35% yes and 65% no; 2) diabetic wound care, 87.5% yes and 12.5% no; 3) bunion surgery, 90% yes and 10% no; 4) ankle fracture surgery, 25% yes and 75% no; 5) calcaneal fracture surgery, 50% yes and 50% no; 6) tarsal tunnel nerve surgery, 62.5% yes and 37.5% no; 7) lower extremity arterial bypass, 5% yes and 95% no; 8) below-knee amputation, 5% yes and 95% no; 9) transmetatarsal amputation, 67.5% yes and 32.5% no; and 10) venous stasis wound care, 65% yes and 35% no. The results for patients are as follows: 1) toenail fungus, 72.5% yes and 27.5% no; 2) diabetic wound care, 70% yes and 30% no; 3) bunion surgery, 62.5% yes and 37.5% no; 4) ankle fracture surgery, 57.5% yes and 42.5% no; 5) calcaneal fracture surgery, 55% yes and 45% no; 6) tarsal tunnel nerve surgery, 50% yes and 50% no; 7) lower extremity arterial bypass, 32.5% yes and 67.5% no; 8) below-knee amputation, 27.5% yes and 72.5% no; 9) transmetatarsal amputation, 52.5% yes and 47.5% no; and 10) venous stasis wound care, 32.5% yes and 67.5% no. Conclusions: Internal medicine residents and patients do not have an accurate perception of the scope of podiatric medicine. This proves that, as a profession, we need to raise awareness about what the podiatric scope of medicine actually entails. Full article

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Open AccessArticle

The Significance of an MBA Degree for a Podiatric Physician—Is It Worth It? A Survey Study

by Abe G. Osbourne, Rachel E. Johnson, Carlyn Hinish and Khatija Ahmed

J. Am. Podiatr. Med. Assoc. 2018, 108(6), 494-502; https://doi.org/10.7547/17-091 - 1 Nov 2018

Cited by 2 | Viewed by 46

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Background: The Kent State University College of Podiatric Medicine is negotiating with the College of Business Administration at Kent State University to establish a dual Doctor of Podiatric Medicine (DPM)/Master of Business Administration (MBA) degree. Of the nine colleges of podiatric medicine in [...] Read more.

Background: The Kent State University College of Podiatric Medicine is negotiating with the College of Business Administration at Kent State University to establish a dual Doctor of Podiatric Medicine (DPM)/Master of Business Administration (MBA) degree. Of the nine colleges of podiatric medicine in the nation, there are two schools that have a joint DPM/MBA program listed in their catalogue, but no joint program was operational at the time this survey was conducted. A telephone survey of the other eight podiatric medical colleges was conducted to obtain that information. This survey was used to assess further data for the exploration of a dual DPM/MBA program at Kent State University College of Podiatric Medicine. Methods: A survey was sent out to 38 individuals who possessed both a DPM and an MBA degree. They responded to questions about why they obtained the business degree, how they are using their business degree, what courses in the MBA program are most relevant, and whether they would recommend that DPM students pursue a dual degree. Results: The majority of respondents indicated that they obtained an MBA degrees to gain a better understanding of the marketplace, to increase their income, and to better manage a podiatric medical practice. The respondents were generally very happy to have obtained their MBA degree and would encourage a dual-degree option. They admitted that a minor or series of courses with a business focus may be helpful to a DPM student who did not opt for an MBA degree. Conclusions: The positive survey results from respondents encourage continued research into a dual-degree DPM/MBA program. During research for a DPM/MBA degree, we feel a DPM with an MBA degree will allow our students to be better prepared for leadership roles within their community and administrative positions and to have a deeper understanding of the business of health care. Full article

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Open AccessArticle

Safety of Deep Sedation in Patients Undergoing Full- Thickness Skin Graft Harvesting and Skin Graft Reconstruction for Limb Salvage. An Outcome Analysis

by Alice M. Kai, Nalini Vadivelu, Feng Dai, Susan Dabu-Bondoc, Hosni Mikhael and Peter A. Blume

J. Am. Podiatr. Med. Assoc. 2018, 108(6), 487-493; https://doi.org/10.7547/17-042 - 1 Nov 2018

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Background: Studies on obtaining donor skin graft using intravenous sedation for patients undergoing major foot surgeries in the same operating room visit have not previously been reported. The objective of this retrospective study is to demonstrate that intravenous sedation in this setting is [...] Read more.

Background: Studies on obtaining donor skin graft using intravenous sedation for patients undergoing major foot surgeries in the same operating room visit have not previously been reported. The objective of this retrospective study is to demonstrate that intravenous sedation in this setting is both adequate and safe in patients undergoing skin graft reconstruction of the lower extremities in which donor skin graft is harvested from the same patient in one operating room visit. Methods: Medical records of 79 patients who underwent skin graft reconstruction of the lower extremities by one surgeon at the Yale New Haven Health System between November 1, 2008, and July 31, 2014, were reviewed. The patients’ demographic characteristics, American Society of Anesthesiologists class, comorbid conditions, intraoperative analgesic administration, estimated blood loss, total operating room time, total postanesthesia care unit time, and postoperative complications within the first 72 hours were reviewed. Results: This study found minimal blood loss and no postoperative complications, defined as any pulmonary or cardiac events, bleeding, admission to the intensive care unit, or requirement for invasive monitoring, in patients who underwent major foot surgery in conjunction with full-thickness skin graft. Conclusions: We propose that given the short duration and peripheral nature of the procedures, patients can safely undergo skin graft donor harvesting and skin graft reconstruction procedures with intravenous sedation regardless of American Society of Anesthesiologists class in one operating room visit. Full article

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Open AccessArticle

Foot Mobilization and Exercise Program Combined with Toe Separator Improves Outcomes in Women with Moderate Hallux Valgus at 1-Year Follow-up. A Randomized Clinical Trial

by Sahar Ahmed Abdalbary

J. Am. Podiatr. Med. Assoc. 2018, 108(6), 478-486; https://doi.org/10.7547/17-026 - 1 Nov 2018

Cited by 31 | Viewed by 95

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Background: Few studies have documented the outcome of conservative treatment of hallux valgus deformities on pain and muscle strength. We sought to determine the effects of foot mobilization and exercise, combined with a toe separator, on symptomatic moderate hallux valgus in female patients. [...] Read more.

Background: Few studies have documented the outcome of conservative treatment of hallux valgus deformities on pain and muscle strength. We sought to determine the effects of foot mobilization and exercise, combined with a toe separator, on symptomatic moderate hallux valgus in female patients. Methods: As part of the randomized clinical trial, 56 women with moderate hallux valgus were randomly assigned to receive 36 sessions for 3 months or no intervention (waiting list). All patients in the treatment group had been treated with foot joint mobilization, strengthening exercises for hallux plantarflexion and abduction, toe grip strength, stretching for ankle dorsiflexion, plus use of a toe separator. Outcome measures were pain and American Orthopedic Foot and Ankle Society (AOFAS) scores. Objective measurements included ankle range of motion, plantarflexion and abduction strength, toe grip strength, and radiographic angular measurements. Outcome measures were assessed by comparing pretreatment, posttreatment, and 1-year follow-up after the intervention. Mixed-model analyses of variance were used for statistical assessment. Results: Patients who were treated with 3 months of foot mobilization and exercise combined with a toe separator experienced greater improvement in pain, AOFAS scores, ankle range of motion, hallux plantarflexion and abduction strength, toe grip strength, and radiographic angular measurements than those who did not receive an intervention 3 months and 1 year postintervention (P < .001 for all comparisons). Conclusions: These results support the use of a multifaceted conservative intervention to treat moderate hallux valgus, although more research is needed to study which aspects of the intervention were most effective. Full article

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Open AccessArticle

Reevaluating Magnetic Resonance Imaging in Radiographically Suspected Osteomyelitis of the Toe

by Nicholas Ciotola and William D. Spielfogel

J. Am. Podiatr. Med. Assoc. 2018, 108(6), 472-477; https://doi.org/10.7547/16-148 - 1 Nov 2018

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Background: Magnetic resonance imaging (MRI) is both sensitive and specific in the diagnosis of osteomyelitis, and it is an important imaging modality in preoperative planning of resection of infected bone. In many cases, however, the extent of osseous infection is evident on plain [...] Read more.

Background: Magnetic resonance imaging (MRI) is both sensitive and specific in the diagnosis of osteomyelitis, and it is an important imaging modality in preoperative planning of resection of infected bone. In many cases, however, the extent of osseous infection is evident on plain radiographs, and little additional information is gained from the MRI. The goal of this study was to assess the accuracy of radiographs against MRIs in assessing the spread of suspected osteomyelitis from one phalanx to another or to a metatarsal. Methods: A medical record review was performed, and 14 patients with 16 toes confirmed to have osteomyelitis involving one or more phalanges were included in the study. An investigator blinded to the MRI findings interpreted the extent of osseous involvement based solely on the radiographic and clinical presentation. The accuracy of the radiographic interpretation was then calculated against the MRI findings. Results: In 14 of the 16 toes (87.5%), whether osteomyelitis had spread from one bone to another was determined based on the radiographic and clinical presentation. In one toe, the radiograph did not adequately depict osteomyelitis in adjacent infected bone. In one more toe, the radiograph depicted features of osteomyelitis in uninfected bone. Conclusions: In a large percentage of patients, the phalanges affected by osteomyelitis had visible findings on the radiograph, and operative planning could have been based on the radiograph alone. Full article

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Open AccessArticle

Simulation Improves Podiatry Student Skills and Confidence in Conservative Sharp Debridement on Feet. A Pilot Randomized Controlled Trial

by Aspasia Grollo, Ashley Morphet and Nora Shields

J. Am. Podiatr. Med. Assoc. 2018, 108(6), 466-471; https://doi.org/10.7547/16-121 - 1 Nov 2018

Cited by 8 | Viewed by 62

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Background: An essential skill for podiatrists is conservative sharp debridement of foot callus. Poor technique can result in lacerations, infections and possible amputation. This pilot trial explored whether adding simulation training to a traditional podiatry clinical placement improved podiatry student skills and confidence [...] Read more.

Background: An essential skill for podiatrists is conservative sharp debridement of foot callus. Poor technique can result in lacerations, infections and possible amputation. This pilot trial explored whether adding simulation training to a traditional podiatry clinical placement improved podiatry student skills and confidence in conservative sharp debridement, compared with traditional clinical placement alone. Methods: Twenty-nine podiatry students were allocated randomly to either a control group or an intervention group on day 1 of their clinical placement. On day 4, the intervention group (n = 15) received a 2-hour simulation workshop using a medical footcare model, and the control group (n = 14) received a 2-hour workshop on compression therapy. Both groups continued to learn debridement skills as opportunities arose while on clinical placement. The participants’ debridement skills were rated by an assessor blinded to group allocation on day 1 and day 8 of their clinical placement. Participants also rated their confidence in conservative sharp debridement using a questionnaire. Data were analyzed using logistic regression (skills) and analysis of covariance (confidence), with baseline scores as a covariate. Results: At day 8, analysis showed that those in the intervention group were 16 times more likely to be assessed as competent (95% confidence interval, 1.6–167.4) in their debridement skills and reported increased confidence in their skills (mean difference, 3.2 units; 95% confidence interval, 0.5–5.9) compared with those in the control group. Conclusions: This preliminary evidence suggests that incorporating simulation into traditional podiatry clinical placements may improve student skills and confidence with conservative sharp debridement. Full article

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Open AccessArticle

Effectiveness of Two Moisturizers in the Treatment of Foot Xerosis. A Randomized Clinical Trial

by Justin C. Parker, Rolf W. Scharfbillig and Sara Jones

J. Am. Podiatr. Med. Assoc. 2018, 108(6), 458-465; https://doi.org/10.7547/16-119 - 1 Nov 2018

Cited by 2 | Viewed by 77

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Background: Xerosis (dryness) of the foot is commonly encountered in clinical care and can lead to discomfort, pain, and predisposition to infection. Many moisturizing products are available, with little definitive research to recommend any particular formulation. Methods: We compared two commonly prescribed moisturizing [...] Read more.

Background: Xerosis (dryness) of the foot is commonly encountered in clinical care and can lead to discomfort, pain, and predisposition to infection. Many moisturizing products are available, with little definitive research to recommend any particular formulation. Methods: We compared two commonly prescribed moisturizing products from different ends of the price spectrum (sorbolene and 25% urea cream) for their effectiveness in reducing xerosis signs using the Specified Symptom Sum Score. A randomized clinical trial of parallel design was conducted over 28 days (February–May 2015) on 41 participants with simple xerosis. Participants, therapists, assessors, and data entry personnel were blinded to treatment, and allocation was determined via a randomization table. Results: Thirty-four participants completed the study (19 urea and 15 sorbolene), with one reporting minor adverse effects. There were statistically significant improvements in both groups after 28 days. Mean differences between pre and post scores were 3.50 (95% confidence interval [CI], 2.80 to 4.20) for the urea group and 2.90 (95% CI, 2.00 to 3.80) for the sorbolene group. There was a slightly lower mean posttreatment score in the urea group (1.16; 95% CI, 0.67 to 1.64) than in the sorbolene group (1.80; 95% CI, 1.25 to 2.35), but this difference was not significant (P ≤ .09). Effect size of difference was –0.48 (95% CI, –1.16 to 0.22). Conclusions: In this study, there was no difference between using sorbolene or 25% urea cream to treat symptoms of foot xerosis. A recommendation, therefore, cannot be made based on efficacy alone; however, sorbolene treatments are invariably cheaper than urea-based ones. Full article

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Open AccessArticle

Effects of In-Shoe Midsole Cushioning on Leg Muscle Balance and Co-Contraction with Increased Heel Height During Walking

by Kit-Lun Yick, Ka-Lai Yeung, Del P. Wong, Yee-Nee Lam 2 and Sun-Pui Ng

J. Am. Podiatr. Med. Assoc. 2018, 108(6), 449-457; https://doi.org/10.7547/16-020 - 1 Nov 2018

Cited by 4 | Viewed by 64

Abstract

Background: The midsole is an essential assembly of footwear for retaining the shape of the shoe, delivering support to the foot, and serving as a cushioning and stability device for walking. To improve leg muscle balance and muscle co-contraction, we propose a new [...] Read more.

Background: The midsole is an essential assembly of footwear for retaining the shape of the shoe, delivering support to the foot, and serving as a cushioning and stability device for walking. To improve leg muscle balance and muscle co-contraction, we propose a new midsole design for high heels with different hardness levels at the forefoot region. Methods: Five healthy women participated in the study, with a mean ± SD age of 21.80 ± 4.09 years, and duration of high-heeled shoe wear of 5.20 ± 4.09 years. Two midsole conditions, control and multiple-hardness midsole (MHM), with heel heights of 2 (flat), 5, and 8 cm were used. The main outcome measures were to examine the acute effects of MHM by electromyography on muscle activity balance and co-contraction at varying heel heights during shuttle walk. Results: Use of the MHM significantly reduced the muscle activity ratio between the medial and lateral gastrocnemius muscles (P =.043) during push-off to heel strike with a heel height of 5 cm (−22.74%) and heel strike to midstance with a heel height of 8 cm (−22.26%). The increased co-contraction indices of the tibialis anterior–peroneus longus muscles (14.35% with an 8-cm heel height) and tibialis anterior–soleus muscles (15.18% with a 5-cm heel height) are significant (P = .043), with a large effect size (d = 0.8). Conclusions: These results deliver important implications in advancing the engineering of MHM design without changing the in-shoe volume to enhance leg muscle balance and co-contraction during walking. Full article

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Open AccessArticle

Effect of Surgical Weight Loss on Plantar Fasciitis and Health-Care Use

by Mena Boules, Esam Batayyah, Dvir Froylich, Andrea Zelisko, Colin O'Rourke, Stacy Brethauer, Kevin El-Hayek, Allan Boike, Andrew T. Strong and Matthew Kroh

J. Am. Podiatr. Med. Assoc. 2018, 108(6), 442-448; https://doi.org/10.7547/15-169 - 1 Nov 2018

Cited by 5 | Viewed by 124

Abstract

Background: Plantar fasciitis (PF) is one of the most common causes of heel pain. Obesity is recognized as a major factor in PF development, possibly due to increased mechanical loading of the foot due to excess weight. The benefit of bariatric surgery is [...] Read more.

Background: Plantar fasciitis (PF) is one of the most common causes of heel pain. Obesity is recognized as a major factor in PF development, possibly due to increased mechanical loading of the foot due to excess weight. The benefit of bariatric surgery is documented for other comorbidities but not for PF. Methods: A retrospective medical record review was performed for patients with PF identified from a prospectively maintained database of the Cleveland Clinic Bariatric and Metabolic Institute. Age, sex, surgery, excess weight loss, body mass index (BMI), and health-care use related to PF treatment were abstracted. Comparative analyses were stratified by surgery type. Results: Two hundred twenty-eight of 10,305 patients (2.2%) had a documented diagnosis of PF, of whom 163 underwent bariatric surgery and were included in the analysis. Eighty-five percent of patients were women, mean ± SD age was 52.2 ± 9.9 years, and mean ± SD preintervention BMI was 45 ± 7.7. Postoperatively, mean ± SD BMI and excess weight loss were 34.8 ± 7.8 and 51.0% ± 20.4%, respectively. One hundred forty-six patients (90%) achieved resolution of PF and related symptoms. The mean ± SD number of treatment modalities used for PF per patient preoperatively was 1.9 ± 1.0 (P = .25). After surgery, the mean ± SD number of treatment modalities used per patient was reduced to 0.3 ± 0.1 (P = .01). Conclusions: We present new evidence suggesting that reductions in BMI after bariatric surgery may be associated with decreasing the number of visits for PF and may contribute to symptomatic improvement. Full article

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J. Am. Podiatr. Med. Assoc., Volume 108, Issue 6 (11 2018) – 24 articles , Pages 442-571

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