Journal of the American Podiatric Medical Association

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Open AccessArticle

Midfoot Plantar Fascia Tear Mimicking Plantar Fibroma

by Michael S. Nirenberg

J. Am. Podiatr. Med. Assoc. 2019, 109(1), 87-90; https://doi.org/10.7547/17-021 - 1 Jan 2019

Cited by 1 | Viewed by 218

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To the Editor [...] Full article

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Open AccessArticle

Technique and Tips for Multiplanar Correction of Plantar Plate Repairs in Lesser Metatarsophalangeal Joints

by Brant L. McCartan, Christopher A. Juels and Jonathan A. Shih

J. Am. Podiatr. Med. Assoc. 2019, 109(1), 80-86; https://doi.org/10.7547/17-086 - 1 Jan 2019

Cited by 1 | Viewed by 154

Abstract

Plantar plate repairs are challenging procedures because of the small anatomy of the plantar plate. This can make them daunting, time-consuming procedures to perform. Advances in technology, such as interference screws and small suture passers, have created improved technique possibilities to decrease difficulty, [...] Read more.

Plantar plate repairs are challenging procedures because of the small anatomy of the plantar plate. This can make them daunting, time-consuming procedures to perform. Advances in technology, such as interference screws and small suture passers, have created improved technique possibilities to decrease difficulty, correct multiple planes of deformity, create stronger constructs, and improve patient results. The plantar plate repair technique presented in this article includes a dorsal approach with a metatarsal osteotomy, a knotless repair that provides a strong construct to allow patients to protectively bear weight immediately, and can reduce operative time by presenting tips to quickly navigate the procedure. The presented technique allows for detailed correction of all three planes of deformity, maximizing patient results. (J Am Podiatr Med Assoc 109(1): 80-86, 2019) Full article

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Open AccessArticle

Threatening Fracture of Intraosseous Lipoma Treated by Internal Fixation: Case Report and Review of the Literature

by Igor Frangež, Tea Nizič-Kos and Matej Cimerman

J. Am. Podiatr. Med. Assoc. 2019, 109(1), 75-79; https://doi.org/10.7547/17-077 - 1 Jan 2019

Cited by 4 | Viewed by 250

Abstract

Intraosseous lipomas are rare benign bone neoplasms with an incidence of less than 0.1%; origin in the calcaneus has been reported in only a few patients. First-line treatment remains conservative, but several surgical techniques have also been described. We describe a 44-year-old woman [...] Read more.

Intraosseous lipomas are rare benign bone neoplasms with an incidence of less than 0.1%; origin in the calcaneus has been reported in only a few patients. First-line treatment remains conservative, but several surgical techniques have also been described. We describe a 44-year-old woman with increasing pain in her left heel for a year and a half, who noticed swelling on the lateral side of the calcaneus. The patient underwent radiography, magnetic resonance imaging, and computed tomography of her left foot, which was suspicious for an intraosseous lipoma with a threatening calcaneal fracture. We performed a surgical procedure, curettage of the tumor, spongioplastics (by autologous bone transplant and ?-tricalcium phosphate), and internal stabilization with a calcaneal plate considering the goal of immediate postoperative weightbearing. Histologic examination confirmed an intraosseous lipoma of the calcaneus. The patient's pain was relieved immediately after surgery. Internal stabilization of the calcaneus allowed the patient to immediately fully weightbear and to return to usual daily activities. Although a benign bone tumor, intraosseous lipoma can cause many complications, such as persistent pain, decreased function, or even pathologic fracture as a result of calcaneal bone weakening. Choosing an appropriate treatment is still controversial. Conservative treatment is the first option, but for patients with severe problems and threatening fracture, surgery is necessary. Internal fixation for stabilization enables immediate postoperative weightbearing and shortens recovery time. Full article

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Use of Cadaveric Graft in Reconstruction of Peroneus Brevis Rupture and Lateral Ankle Instability: A Case Report

by Cory P. Clement, Ronald Guberman, Edward Lee and Lady P. DeJesus

J. Am. Podiatr. Med. Assoc. 2019, 109(1), 70-74; https://doi.org/10.7547/17-113 - 1 Jan 2019

Cited by 5 | Viewed by 206

Abstract

This case study presents a novel technique of end-to-end implantation of cadaver graft for the repair of a complete transversely torn peroneus brevis tendon and partially torn peroneus longus tendon in a 58-year-old woman with chronic lateral ankle instability and associated lateral collateral [...] Read more.

This case study presents a novel technique of end-to-end implantation of cadaver graft for the repair of a complete transversely torn peroneus brevis tendon and partially torn peroneus longus tendon in a 58-year-old woman with chronic lateral ankle instability and associated lateral collateral tears. She had a history of multiple ankle sprains and had previously undergone a failed peroneus brevis tendon retubularization procedure. The use of cadaver graft is well documented in the literature for tendon repairs but not well documented in end-to-end repair of the peroneal tendons. A review of the literature revealed only one 2013 study reporting on the benefits and clinical outcomes of cadaver allograft use in peroneal reconstruction. Full article

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Open AccessArticle

Narrative Reasoning in Practice: A Case Study in Podiatry

by Emily T. Bishop

J. Am. Podiatr. Med. Assoc. 2019, 109(1), 64-69; https://doi.org/10.7547/17-099 - 1 Jan 2019

Cited by 1 | Viewed by 138

Abstract

Background: Clinical reasoning and decision making within health care are as important as ever in a world where evidence-based health care and patient outcomes are highly valued. It is increasingly recognized that decisions are not made in isolation, and are influenced by many [...] Read more.

Background: Clinical reasoning and decision making within health care are as important as ever in a world where evidence-based health care and patient outcomes are highly valued. It is increasingly recognized that decisions are not made in isolation, and are influenced by many factors, both intrinsic and extrinsic. Expert and novice practitioners share reasoning techniques, and there are many interpretations of reasoning paradigms within the field of health care. Methods: A reflective diary was kept for 3 months linking personal reflections on a particular clinical decision with theoretical learning on clinical reasoning. Several decision-making paradigms were looked at in relation to the decision, with a deeper focus on narrative reasoning. Narrative reasoning resonated particularly with the author's previous experience studying literature. Results: The clinical decision was usefully analyzed using a narrative reasoning strategy. The decision made by the author was perhaps contrary to the evidence, and yet had a positive outcome. The positive outcome of the decision was looked at within the context of evidence-based practice and ethical practice. Conclusions: Narrative reasoning comes from within the interpretive research model and puts the patient's experience at the heart of decision making. Narrative reasoning can be a valuable way of combining diagnostic, management, and ethical aspects of care. Further research—particularly in podiatry, where research is lacking—could identify helpful reasoning strategies for care of patients with long-term chronic conditions or complex conditions. (J Am Podiatr Med Assoc 109(1): 64-69, 2019) Full article

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Fungal Diversity and Onychomycosis: An Analysis of 8,816 Toenail Samples Using Quantitative PCR and Next- Generation Sequencing

by Annette Joyce, Aditya K. Gupta, Lars Koenig, Randall Wolcott and Jessie Carviel

J. Am. Podiatr. Med. Assoc. 2019, 109(1), 57-63; https://doi.org/10.7547/17-070 - 1 Jan 2019

Cited by 26 | Viewed by 216

Abstract

Background: Onychomycosis is a fungal infection of the nail that is often recalcitrant to treatment and prone to relapse. Traditional potassium hydroxide and culture diagnosis is costly and time-consuming. Therefore, molecular methods were investigated to demonstrate effectiveness in diagnosis and to quantify the [...] Read more.

Background: Onychomycosis is a fungal infection of the nail that is often recalcitrant to treatment and prone to relapse. Traditional potassium hydroxide and culture diagnosis is costly and time-consuming. Therefore, molecular methods were investigated to demonstrate effectiveness in diagnosis and to quantify the microbial flora present that may be contributing to disease. Methods: A total of 8,816 clinically suspicious toenail samples were collected by podiatric physicians across the United States from patients aged 0 to 103 years and compared with a control population (N = 20). Next-generation sequencing and quantitative polymerase chain reaction were used to identify and quantify dermatophytes, nondermatophyte molds, and bacteria. Results: Approximately 50% of suspicious toenails contained both fungi and bacteria, with the dermatophyte Trichophyton rubrum contributing the highest relative abundance and presence in 40% of these samples. Of the remaining 50% of samples, 34% had bacterial species present and 16% had neither. Fungi only were present in less than 1% of samples. Nondermatophyte molds contributed to 11.0% of occurrences in funguspositive samples. All of the control samples were negative for fungi, with commensal bacterial species composing most of the flora population. Conclusions: Molecular methods were successful in efficiently quantifying microbial and mycologic presence in the nail. Contributions from dermatophytes were lower than expected, whereas the opposite was true for nondermatophyte molds. The clinical significance of these results is currently unknown. Full article

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Open AccessArticle

The Dynamic Baropodometric Profile of Children with Idiopathic Toe-Walking: A Cross-Sectional Study

by Patricia Martín-Casas, Alfonso Meneses-Monroy, Juan Vicente Beneit-Montesinos, María de Los Ángeles Atín-Arratibel, Gustavo Plaza-Manzano, Daniel Pecos-Martín, Tomás Gallego-Izquierdo and Cylie Williams

J. Am. Podiatr. Med. Assoc. 2019, 109(1), 50-56; https://doi.org/10.7547/17-084 - 1 Jan 2019

Cited by 3 | Viewed by 187

Abstract

Background: Idiopathic toe-walking (ITW) gait may present in children older than 3 years and in the absence of a medical condition known to cause or be associated with toe-walking gait. It is unknown how this gait type changes pressure distribution in the growing [...] Read more.

Background: Idiopathic toe-walking (ITW) gait may present in children older than 3 years and in the absence of a medical condition known to cause or be associated with toe-walking gait. It is unknown how this gait type changes pressure distribution in the growing foot. We sought to determine whether children with ITW gait exhibit different plantar pressures and temporal gait features than typically developing children. Methods: Children aged 3 to 6 years were recruited who had either a typical heel-toe gait pattern or a diagnosis of ITW. The ITW diagnosis was reported by the parent/caregiver and confirmed through history and physical examination. Temporal gait measures, peak pressures, and impulse percentages were measured. A minimum of ten unshod footprints were collected. Data were compared with unpaired t tests. Results: The study included 40 children with typical gait and 56 with ITW gait. The ITW group displayed lower peak pressures at the hallux, midfoot, and hindfoot (P < .05) and higher and lower pressure impulse percentages at the forefoot (P < .001) and hindfoot (P < .001), respectively. The ITW group spent a higher percentage of contact time at all areas of the forefoot and less at the midfoot and rearfoot (P < .05). There were no significant differences in total step duration and foot progression angle between groups (P > .05). Conclusions: There were differences in pressure distributions between groups. Understanding these differences may help us better understand the compensations or potential long-term impact that ITW gait may have on a young child's foot. Podiatric physicians may also consider the use of this equipment in the clinical setting to measure outcomes after treatment for ITW. (J Am Podiatr Med Assoc 109(1): 50-56, 2019) Full article

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Open AccessArticle

Foot Kinetic and Kinematic Profile in Type 2 Diabetes Mellitus with Peripheral Neuropathy: A Hospital-Based Study from South India

by Animesh Hazari, Arun G. Maiya and K.N. Shivashankara

J. Am. Podiatr. Med. Assoc. 2019, 109(1), 36-49; https://doi.org/10.7547/17-059 - 1 Jan 2019

Cited by 13 | Viewed by 119

Abstract

Background: A kinetic change in the foot such as altered plantar pressure is the most common etiological risk factor for foot ulcers in people with diabetes mellitus. Kinematic alterations in joint angle and spatiotemporal parameters of gait have also been frequently observed in [...] Read more.

Background: A kinetic change in the foot such as altered plantar pressure is the most common etiological risk factor for foot ulcers in people with diabetes mellitus. Kinematic alterations in joint angle and spatiotemporal parameters of gait have also been frequently observed in participants with diabetic peripheral neuropathy (DPN). Diabetic peripheral neuropathy leads to various microvascular and macrovascular complications of the foot in type 2 diabetes mellitus. There is a gap in the literature for biomechanical evaluation and assessment of type 2 diabetes mellitus with DPN in the Indian population. We sought to assess and determine the biomechanical changes, including kinetics and kinematics, of the foot in DPN. Methods: This cross-sectional study was conducted at a diabetic foot clinic in India. Using the purposive sampling method, 120 participants with type 2 diabetes mellitus and DPN were recruited. Participants with active ulceration or amputation were excluded. Results: The mean ± SD age, height, weight, body mass index, and diabetes duration were 57 ± 14 years, 164 ± 11 cm, 61 ± 18 kg, 24 ± 3 kg/m², and 12 ± 7 years, respectively. There were significant changes in the overall biomechanical profile and clinical manifestations of DPN. The regression analysis showed statistical significance for dynamic maximum plantar pressure at the forefoot with age, weight, height, diabetes duration, body mass index, knee and ankle joint angle at toe-off, pinprick sensation, and ankle reflex (R = 0.71, R² = 0.55, F_12,108 = 521.9 kPa; P = .002). Conclusions: People with type 2 diabetes mellitus and DPN have significant changes in their foot kinetic and kinematic parameters. Therefore, they could be at higher risk for foot ulceration, with underlying neuropathy and biomechanically associated problems. Full article

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Anthropometric and Psychomotor Development Factors Linked to Foot Valgus in Children Aged 6 to 9 Years

by Jose Miguel Morales Asencio, Miguel F. Medina-Alcántara, Ana Belen Ortega-Avila, Ana María Jimenez-Cebrian, Joaquin Paez Moguer, Jose Antonio Cervera-Marin and Gabriel Gijon-Nogueron

J. Am. Podiatr. Med. Assoc. 2019, 109(1), 30-35; https://doi.org/10.7547/16-108 - 1 Jan 2019

Cited by 3 | Viewed by 132

Abstract

Background: Planovalgus foot prevalence estimates vary widely (0.6%–77.9%). Among the many factors that may influence planovalgus foot development, much attention has been given to body mass index, especially that of children's feet; factors related to psychomotor development have been less studied. We sought [...] Read more.

Background: Planovalgus foot prevalence estimates vary widely (0.6%–77.9%). Among the many factors that may influence planovalgus foot development, much attention has been given to body mass index, especially that of children's feet; factors related to psychomotor development have been less studied. We sought to determine the presence of planovalgus foot in children and its association with anthropometric parameters and psychomotor development. Methods: A case-control study was conducted in Málaga, Spain, 2012–2013, of 104 schoolchildren (mean ± SD age, 7.55 ± 0.89 years; 45.2% were boys). Age, sex, body mass index, presence of valgus (valgus index, by pedigraphy), and personal history related to psychomotor development of the lower limbs (presence/absence of crawling, age at onset of crawling, age at onset of walking, use of mobility aids) were evaluated. Results: Of the children with obesity, 53.7% had valgus deformity in the left hindfoot (odds ratio [OR], 6.94; 95% confidence interval [CI], 2.72–17.70; P < .0001). In the right foot, the corresponding values were 54.5% (OR, 9.08; 95% CI, 3.38–24.36; P < .0001). Multivariate logistic regression showed an increased risk of left planovalgus foot in boys, in children with overweight or obesity, and in those who began walking later. For the right foot, the same risk factors applied except age at onset of walking. Conclusions: These results corroborate data from previous studies, which report an association between overweight and obesity and the onset of planovalgus foot in children. In addition, we identify a new risk factor: age at onset of walking. (J Am Podiatr Med Assoc 109(1): 30-35, 2019) Full article

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The Reliability of a Smartphone Goniometer Application Compared With a Traditional Goniometer for Measuring Ankle Joint Range of Motion

by Motaz Abdalla Alawna, Bayram H. Unver and Ertugrul O. Yuksel

J. Am. Podiatr. Med. Assoc. 2019, 109(1), 22-29; https://doi.org/10.7547/16-128 - 1 Jan 2019

Cited by 48 | Viewed by 175

Abstract

Background: Evaluation of range of motion (ROM) is integral to assessment of the musculoskeletal system, is required in health fitness and pathologic conditions, and is used as an objective outcome measure. Several methods are described to check ROM, each with advantages and disadvantages. [...] Read more.

Background: Evaluation of range of motion (ROM) is integral to assessment of the musculoskeletal system, is required in health fitness and pathologic conditions, and is used as an objective outcome measure. Several methods are described to check ROM, each with advantages and disadvantages. Hence, this study introduces a new device using a smartphone goniometer to measure ankle joint ROM. Objective: To test the reliability of smartphone goniometry in the ankle joint by comparing it with the universal goniometer (UG) and to assess interrater and intrarater reliability for the smartphone goniometer record (SGR) application. Methods: Fifty-eight healthy volunteers (29 men and 29 women aged 18–30 years) underwent SGR and UG measurement of ankle joint dorsiflexion and plantarflexion. Two examiners measured ankle joint ROM. Descriptive statistics were calculated for descriptive and anthropometric variables, as were intraclass correlation coefficients (ICCs). Results: There were 58 usable data sets. For measuring ankle dorsiflexion ROM, both instruments showed excellent interrater reliability: UG (ICC = 0.87) and SGR (ICC = 0.89). Intrarater reliability was excellent in both instruments in ankle dorsiflexion: UG and SGR (mean ICC = 0.91). For measuring ankle plantarflexion, both instruments showed excellent interrater reliability: UG (ICC = 0.76) and SGR (ICC = 0.82). Intrarater reliability was excellent in both instruments in ankle plantarflexion: UG (mean ICC = 0.85) and SGR (mean ICC = 0.82). Conclusions: Smartphone-based goniometers can be used to assess active ROM of the ankle joint because they can achieve a high degree of intrarater and interrater reliability. (J Am Podiatr Med Assoc 109(1): 22-29, 2019) Full article

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Comparison of Biomechanical Effects of Different Configurations of Kirschner Wires on the Epiphyseal Plate and Stability in a Salter-Harris Type 2 Distal Femoral Fracture Model

by Sermet Inal, Kadir Gok, Arif Gok, Ahmet Murat Pinar and Canan Inal

J. Am. Podiatr. Med. Assoc. 2019, 109(1), 13-21; https://doi.org/10.7547/16-112 - 1 Jan 2019

Cited by 18 | Viewed by 124

Abstract

Background: We sought to investigate the different configurations of Kirschner wires used in distal femur Salter-Harris (SH) type 2 epiphyseal fracture for stabilization after reduction under axial, rotational, and bending forces and to define the biomechanical effects on the epiphyseal plate and the [...] Read more.

Background: We sought to investigate the different configurations of Kirschner wires used in distal femur Salter-Harris (SH) type 2 epiphyseal fracture for stabilization after reduction under axial, rotational, and bending forces and to define the biomechanical effects on the epiphyseal plate and the fracture line and decide which was more advantageous. Methods: The SH type 2 fracture was modeled using design software for four different configurations: cross, cross-parallel, parallel medial, and parallel lateral with two Kirschner wires, and computer-aided numerical analyses of the different configurations after reduction were performed using the finite element method. For each configuration, the mesh process, loading condition (axial, bending, and rotational), boundary conditions, and material models were applied in finite element software, and growth cartilage and von Mises stress values occurring around the Kirschner wire groove were calculated. Results: In growth cartilage, the stresses were highest in the parallel lateral configuration and lowest in the cross configuration. In Kirschner wires, the stresses were highest in the cross configuration and lowest in the cross-parallel and parallel lateral configurations. In the groove between the growth cartilage and the Kirschner wire interface, the stresses were highest in the parallel lateral configuration and lowest in the cross configuration. Conclusions: The results showed that the cross configuration is advantageous in fixation. In addition, in the SH type 2 epiphyseal fracture, we believe that the fixation shape should not be applied in the lateral configuration. (J Am Podiatr Med Assoc 109(1): 13-21, 2019) Full article

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Open AccessArticle

Does Immobilization Affect Braking Time?

by Faith A Schick, Homyar Karanjia, Nicholas Taweel, Charles Langman and Paul Sullivan

J. Am. Podiatr. Med. Assoc. 2019, 109(1), 9-12; https://doi.org/10.7547/17-025 - 1 Jan 2019

Cited by 1 | Viewed by 141

Abstract

Background: Despite the importance to patients of driving, no well-established guideline exists to help either the patient or the physician determine when it is safe for the patient to return to driving. Previous studies have recommended 6 weeks postoperatively before patients can return [...] Read more.

Background: Despite the importance to patients of driving, no well-established guideline exists to help either the patient or the physician determine when it is safe for the patient to return to driving. Previous studies have recommended 6 weeks postoperatively before patients can return to driving safely. Several scientific studies have found the nationally recommended safe brake time standard to be 1.25 sec (1,250 msec), looking at brake reaction time (BRT) in all types of patients, surgical and nonsurgical. Methods: This is a prospective study assessing BRT after individuals are placed in various forms of immobilization (controlled action motion [CAM] boot, surgical shoe). The study also tested whether BRT is different when using the left foot to brake, with immobilization of the right foot. Results: All 29 male and 71 female participants in this study (mean age, 35.49 years) were capable of driving and were not currently being treated for any foot or ankle conditions. No differences were found regarding age, sex, and use of assistive devices. The mean BRT while wearing a CAM boot was 713 msec, while using the left foot to brake (CAM boot on the right foot) was 593.86 msec, and while wearing a surgical shoe was 626.32 msec. Conclusions: Although most of the study participants were below the nationally recommended safe brake time standard, it was found that not all of the participants fell within these parameters. Full article

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Fasciotomy and Surgical Tenotomy for Chronic Achilles Insertional Tendinopathy: A Retrospective Study Using Ultrasound-Guided Percutaneous Microresection

by Lewis Freed, Mark B. Ellis, Kate Johnson and Todd B. Haddon

J. Am. Podiatr. Med. Assoc. 2019, 109(1), 1-8; https://doi.org/10.7547/15-168 - 1 Jan 2019

Cited by 15 | Viewed by 47

Abstract

Background: Achilles insertional tendon pathology is a common condition affecting a broad range of patients. When conservative treatments are unsuccessful, the traditional open resection, debridement, and reattachment of the Achilles tendon is a variably reliable procedure with significant risk of morbidity. Fasciotomy and [...] Read more.

Background: Achilles insertional tendon pathology is a common condition affecting a broad range of patients. When conservative treatments are unsuccessful, the traditional open resection, debridement, and reattachment of the Achilles tendon is a variably reliable procedure with significant risk of morbidity. Fasciotomy and surgical tenotomy using ultrasound-guided percutaneous microresection is used on various tendons in the body, but the efficacy has not been examined specifically for the Achilles tendon. Methods: A retrospective review evaluated 26 procedures in 25 patients who underwent Achilles fasciotomy and surgical tenotomy. The Foot Function Index was used to quantify pain, disability, activity limitation, and overall scores. Results: Mean Foot Function Index scores were as follows: pain, 8.53%; disability, 7.91%; activity limitation, 2.50%; and overall, 6.97%. Twenty index procedures were successful, and two patients repeated the procedure successfully for an overall 84.6% success rate in patients with chronic insertional pathology with mean surveillance of 16 months. There were no infections or systemic complications. Conclusions: Ultrasound-guided percutaneous microresection is a safe and minimally invasive percutaneous alternative that can be used before proceeding to a more invasive open procedure. (J Am Podiatr Med Assoc 109(1): 1-8, 2019) Full article

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J. Am. Podiatr. Med. Assoc., Volume 109, Issue 1 (01 2019) – 13 articles

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