Journal of the American Podiatric Medical Association

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Open AccessArticle

Myopericytoma: The Importance of a Histologic Diagnosis to Exclude a Malignancy in a Possible Underestimated Benign Condition

by Arianna F. Agnoletti, Emanuele Claudio Cozzani, Elena De Col, Nataniele Piol, Francesco Cabiddu and Aurora Parodi

J. Am. Podiatr. Med. Assoc. 2019, 109(3), 264-265; https://doi.org/10.7547/17-173 - 1 May 2019

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Abstract

Currently, myopericytoma is described as a rare entity, but its real incidence may be underestimated [...] Full article

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Open AccessArticle

Distal Fibular Osteochondroma Resulting in Tarsal Tunnel Syndrome: Case Report and Literature Review

by Patrick A. DeHeer and Nicholas Thompson

J. Am. Podiatr. Med. Assoc. 2019, 109(3), 259-263; https://doi.org/10.7547/18-013 - 1 May 2019

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Abstract

Background: Osteochondromas are benign osseous tumors encountered most routinely by physicians responsible for diagnosing musculoskeletal disorders. Often, these osseous lesions are identified following symptoms related to their impingement on adjacent soft tissue or bone. Methods: This article presents a unique case of an [...] Read more.

Background: Osteochondromas are benign osseous tumors encountered most routinely by physicians responsible for diagnosing musculoskeletal disorders. Often, these osseous lesions are identified following symptoms related to their impingement on adjacent soft tissue or bone. Methods: This article presents a unique case of an asymptomatic osteochondroma of the distal fibula in a 29-year-old Caucasian woman that manifested clinically as an impingement on the tibial nerve. Results: After resection of the osteochondroma, the patient's tarsal tunnel syndrome symptoms resolved. Conclusions: This case report demonstrates a never-before-described osteochondroma of the distal fibula traversing posterior to the ankle joint and impinging on the tibial nerve. After resection, the patient's symptoms resolved. Full article

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Open AccessArticle

Angioleiomyoma (Vascular Leiomyoma) Presenting as a Pseudoaneurysm of the Tibialis Posterior Artery

by Michael A. Ciaramella, Rock Cjay Positano, Darren B. Schneider, John J. Doolan, Molly Forlines and Rock G. Positano

J. Am. Podiatr. Med. Assoc. 2019, 109(3), 253-258; https://doi.org/10.7547/17-218 - 1 May 2019

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Abstract

Reported here is the case of a 55-year-old woman presenting to a podiatry clinic with a chief complaint of left heel and ankle pain, who ultimately underwent operative excision of an angioleiomyoma adjacent to the tibialis posterior artery at the level of the [...] Read more.

Reported here is the case of a 55-year-old woman presenting to a podiatry clinic with a chief complaint of left heel and ankle pain, who ultimately underwent operative excision of an angioleiomyoma adjacent to the tibialis posterior artery at the level of the medial malleolus. Accompanying this case are images from three modalities through which the defining characteristics of an angioleiomyoma can be appreciated. This case advocates for the inclusion of angioleiomyoma in the preoperative differential diagnosis of a mass presenting as a pseudoaneurysm in the lower extremity, particularly among women in the fourth to sixth decades of life. Full article

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Open AccessArticle

Traumatic Hallux Varus in Association with Agenesis of the Fibular Sesamoid: A Case Study

by Tracy Lee and Erik Monson

J. Am. Podiatr. Med. Assoc. 2019, 109(3), 246-252; https://doi.org/10.7547/17-138 - 1 May 2019

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Abstract

Hallux varus is most commonly seen iatrogenically following overaggressive lateral release, removal of the fibular sesamoid, or overaggressive removal of the medial eminence. There are several reported cases of traumatic hallux varus, although this is much less common. We present a case of [...] Read more.

Hallux varus is most commonly seen iatrogenically following overaggressive lateral release, removal of the fibular sesamoid, or overaggressive removal of the medial eminence. There are several reported cases of traumatic hallux varus, although this is much less common. We present a case of traumatic hallux varus in a patient who was later found to have bilateral absence of her fibular sesamoids. We postulated that lack of her fibular sesamoid led to weakness of her lateral capsular ligaments, thereby making her more susceptible to this injury. We performed a repair using a split extensor hallucis longus tendon transfer that was transected proximally, rerouted the tendon under the deep transverse intermetatarsal ligament, and secured it to the first metatarsal with a Bio-Tenodesis (Arthrex, Inc, Naples, Florida) screw. At 22 months postoperatively, she has demonstrated maintenance of correction and has resumed use of normal shoe gear and participation in activities. Our goal was to demonstrate a repair for this condition that successfully maintained correction over time while still allowing for functionality of the first metatarsophalangeal joint. Full article

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Open AccessArticle

Polyarteritis Nodosa Following Vaccination Against Hepatitis B Virus with Lower-Extremity Manifestations: A Case Report

by Daniel R. Wright, Jenni M. Davis, Karl Robstad, Melissa D. Shah, Michael C. Keller and John R.L. Froude

J. Am. Podiatr. Med. Assoc. 2019, 109(3), 241-245; https://doi.org/10.7547/17-121 - 1 May 2019

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Abstract

Polyarteritis nodosa is a progressive, often life-threatening, vasculitis affecting multiple organs, including the skin and peripheral nerves. We report a patient presenting with systemic features of the disease and with characteristic lesions in the feet 3 weeks after vaccination against hepatitis B virus [...] Read more.

Polyarteritis nodosa is a progressive, often life-threatening, vasculitis affecting multiple organs, including the skin and peripheral nerves. We report a patient presenting with systemic features of the disease and with characteristic lesions in the feet 3 weeks after vaccination against hepatitis B virus infection. Full article

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Open AccessArticle

The Solitary Blue Toe: A Unique Presentation of Antiphospholipid Syndrome

by Devin G. Dimond, Jenny K. Lam, Lauren Wurster, Christopher Kiser, Kevin Driscoll and Mark Razzante

J. Am. Podiatr. Med. Assoc. 2019, 109(3), 235-240; https://doi.org/10.7547/17-108 - 1 May 2019

Cited by 7 | Viewed by 59

Abstract

Antiphospholipid syndrome is an autoimmune disease characterized by vascular thrombosis involving both the arterial and venous systems that can lead to tissue ischemia or end-organ damage. Much of the literature describes various symptoms at initial presentation, but isolated tissue ischemia manifesting as a [...] Read more.

Antiphospholipid syndrome is an autoimmune disease characterized by vascular thrombosis involving both the arterial and venous systems that can lead to tissue ischemia or end-organ damage. Much of the literature describes various symptoms at initial presentation, but isolated tissue ischemia manifesting as a solitary blue toe is unusual. We discuss a case of a 23-year-old man who presented to the emergency department with a solitary blue fourth digit with minimal erythema and edema, who was suffering from exquisite pain. Following an extensive workup, the patient was diagnosed with antiphospholipid syndrome with thrombi of the vasculature in their lower extremity. With therapeutic anticoagulation, the patient's symptoms subsided and amputation of the digit was prevented. (J Am Podiatr Med Assoc 109(3): 235-240, 2019) Full article

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Open AccessArticle

The Rare Lateral Cuneocuboid Coalition: A Case Report

by Eric So, Kevin Renner, Amanda Quisno and Daniel Logan

J. Am. Podiatr. Med. Assoc. 2019, 109(3), 231-234; https://doi.org/10.7547/17-018 - 1 May 2019

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Abstract

Tarsal coalitions typically occur at the talocalcaneal or calcaneonavicular joints. Common findings are pain, limited range of motion, and a pes planus deformity. The focus of this case report includes the presentation, imaging, treatment, and outcomes for a 21-year-old woman diagnosed with a [...] Read more.

Tarsal coalitions typically occur at the talocalcaneal or calcaneonavicular joints. Common findings are pain, limited range of motion, and a pes planus deformity. The focus of this case report includes the presentation, imaging, treatment, and outcomes for a 21-year-old woman diagnosed with a rare lateral cuneocuboid coalition with chronic pain. Clinical and radiographic examinations, typically used to diagnose the common coalition, were unremarkable. Magnetic resonance imaging was diagnostic of the lateral cuneocuboid coalition, which was successfully treated with surgical resection. At 6-year follow-up, she reports resolution of symptoms and has returned to her normal presurgical activity level pain-free. This case is only the third lateral cuneocuboid coalition reported in the literature. The rarity of this coalition and its nonsuspicious clinical presentation make it worthy of acknowledgment. (J Am Podiatr Med Assoc 109(3): 231-234, 2019) Full article

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Open AccessArticle

Publication Rates for Oral and Poster Abstracts from the American Podiatric Medical Association: 2010–2014

by Calvin J. Rushing, Gerald Merritt, Tarak Amin and Steven M. Spinner

J. Am. Podiatr. Med. Assoc. 2019, 109(3), 226-230; https://doi.org/10.7547/18-016 - 1 May 2019

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Abstract

Background: The quality of national society conferences is often assessed indirectly by analyzing the journal publication rates for the abstracts presented. Studies have reported rates from 67.5% to 76.7% for oral abstracts and 23.2% to 55.8% for poster abstracts presented at national foot [...] Read more.

Background: The quality of national society conferences is often assessed indirectly by analyzing the journal publication rates for the abstracts presented. Studies have reported rates from 67.5% to 76.7% for oral abstracts and 23.2% to 55.8% for poster abstracts presented at national foot and ankle society conferences. However, no study has evaluated the abstract to journal publication rate for the American Podiatric Medical Association's (APMA's) annual conference. Methods: All presented abstracts from the 2010 to 2014 conferences were compiled. PubMed and Google Scholar searches were performed, and the number of abstracts presented, publication rate, mean time to publication, and most common journals of publication were determined. These results were then compared with those for the 2010 to 2014 American College of Foot and Ankle Surgeons' conferences. Results: Of 380 abstracts presented, 142 (37.4%) achieved publication, most often in the Journal of the American Podiatric Medical Association. The oral abstract publication rate was 45.2% (14 of 31), with a mean time to publication of 24.2 months (range, 0–47 months). The poster publication rate was 36.7% (128 of 349), with a mean time to publication of 16.3 months (range, 0–56 months). Significant differences were identified between the two societies. Conclusions: The overall abstract to journal publication rate for the 2010 to 2014 APMA conferences was 37.4%, and, expectedly, oral abstracts achieved publication more often than posters. Moving forward, a concerted effort between competing societies seems necessary to increase research interest, institutional support, and formal mentorship for future generations of foot and ankle specialists. (J Am Podiatr Med Assoc 109(3): 226- 230, 2019) Full article

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Open AccessArticle

Understanding Ultraviolet Radiation Dorsal Foot Injury at the Beach

by Timothy Allen, Neil Jackson and Richard Wagner

J. Am. Podiatr. Med. Assoc. 2019, 109(3), 215-225; https://doi.org/10.7547/16-166 - 1 May 2019

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Abstract

Background: Efforts made to protect the dorsal aspect of the foot are currently unknown. We sought to determine whether beachgoers protect the dorsal aspect of their feet as frequently as other anatomic sites. Methods: A convenience sample of Galveston, Texas, beachgoers completed anonymous [...] Read more.

Background: Efforts made to protect the dorsal aspect of the foot are currently unknown. We sought to determine whether beachgoers protect the dorsal aspect of their feet as frequently as other anatomic sites. Methods: A convenience sample of Galveston, Texas, beachgoers completed anonymous surveys to assess whether the dorsal foot was at risk for ultraviolet radiation (UV-R) injury. Additional information collected included demographics and general knowledge about skin cancer to determine if these variables were significantly correlated with dorsal foot protection from UV-R injury. Results: Of 216 respondents, only 103 used a topical UV-R barrier on their dorsal feet, while 183 applied sunscreen to the body and 133 applied sunscreen to the legs. Eighty-seven of 113 nonusers explained, “I did not think about it.” The average number of applications of sunscreen per person to the dorsal feet was less than other anatomical body sites (1.19 body applications, 0.86 leg applications, and 0.58 dorsal feet applications per person; P < .001). 58.0% of females applied sunscreen to the dorsal feet compared with only 36.5% of males (P = .001). Self-identifying Fitzpatrick skin type 5 or 6 individuals did not apply sunscreen to the dorsal foot as regularly as individuals with types 1 to 4 (84.6% versus 47.6%; P = .0001). Conclusions: Current skin cancer epidemiology pairs the feet and the legs together as “lower extremity.” For epidemiologic purposes, however, feet and legs should be considered distinct areas in UV-R research because they may use different photoprotection strategies. (J Am Podiatr Med Assoc 109(3): 215-225, 2019) Full article

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Open AccessArticle

Design of a Three-Dimensional–Printed Surgical Glove for Minimal-Incision Podiatric Surgery

by Javier Ferrer-Torregrosa, Sergio Garcia-Vicente, Nadia Fernández-Ehrling, Javier Torralba-Estellés and Carlos Barrios

J. Am. Podiatr. Med. Assoc. 2019, 109(3), 207-214; https://doi.org/10.7547/17-014 - 1 May 2019

Cited by 3 | Viewed by 41

Abstract

Background: Precision in minimal-incision surgery allows surgeons to achieve accurate osteotomies and patients to avoid risks. Herein, a surgical guide for the foot is designed and validated in vitro using resin foot models for hallux abducto valgus surgery. Methods: Three individuals with different [...] Read more.

Background: Precision in minimal-incision surgery allows surgeons to achieve accurate osteotomies and patients to avoid risks. Herein, a surgical guide for the foot is designed and validated in vitro using resin foot models for hallux abducto valgus surgery. Methods: Three individuals with different experience levels (an undergraduate student, a master's student, and an experienced podiatric physician) performed an Akin osteotomy, a Reverdin osteotomy, and a basal osteotomy of the first metatarsal. Results: The average measurements of each osteotomy and the angle of the basal osteotomy do not reveal significant differences among the three surgeons. A shorter deviation from the planned measurements has been observed in variables corresponding to the Akin osteotomy (the maximum deviation in the measurement of the distance from the proximal medial end of the Akin osteotomy to the first metatarsophalangeal joint interline was 1.67 mm, and the maximum deviation from the proximal lateral end of the Akin osteotomy to the first metatarsophalangeal joint interline was 1.00 mm). As for the Reverdin osteotomies, the maximum deviations in the measurement of the distance from the proximal medial end of the osteotomy to the first metatarsophalangeal joint interline were 3.60 and 3.53 mm in the expert and undergraduate surgeons, respectively. All of the osteotomies were precise among the groups, reducing the learning curve to the maximum. Conclusions: The three-dimensional–printed prototype has been proven effective in guiding surgeons to perform different types of osteotomies. Minimal deviations from the predefined osteotomies were found among the three surgeons. (J Am Podiatr Med Assoc 109(3): 207-214, 2019) Full article

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Open AccessArticle

Clinical and Sociodemographic Characteristics of Patients with Ingrown Nails

by Ibrahim Etem Arica, Seher Bostanci, Pelin Kocyigit and Deniz Aksu Arica

J. Am. Podiatr. Med. Assoc. 2019, 109(3), 201-206; https://doi.org/10.7547/17-023 - 1 May 2019

Cited by 22 | Viewed by 98

Abstract

Background: Ingrown nail is a common health problem that significantly affects daily life due to its painful nature. The purpose of this study was to reveal the clinical and sociodemographic characteristics of ingrown nails. Methods: The clinical and sociodemographic characteristics of patients older [...] Read more.

Background: Ingrown nail is a common health problem that significantly affects daily life due to its painful nature. The purpose of this study was to reveal the clinical and sociodemographic characteristics of ingrown nails. Methods: The clinical and sociodemographic characteristics of patients older than 18 years presenting with ingrown nail were investigated. Results: Two hundred six patients aged 18 to 77 years (mean age, 39 years; female to male ratio, 1.45) were included in the study. A total of 729 lesions were evaluated (718 ingrown nails were on the feet and 11 were on the fingers). A family history of ingrown nail was present in 7.6% of the participants. Of the 206 patients, 26.7% were treated with surgical methods for ingrown nails previously and experienced recurrence. Ingrown toenails were in the hallux in 81.3% of patients, and 52% were on the lateral margin. Incorrect nail-cutting habits (73.5%), poorly fitting shoes (46.2%), excessive angulation of the nail plate (35.8%), obesity (34.1%), trauma to the feet (24.3%), pregnancy (23.8% of women), hyperhidrosis (16.8%), and lateral deviation of the nail plate (9.9%) were closely associated with ingrown nails. Conclusions: This study revealed the clinical and sociodemographic characteristics of ingrown nails. The study data will be useful in preventing the development of ingrown nail and recurrences after treatment by identifying and then eliminating conditions establishing a predisposition to it. (J Am Podiatr Med Assoc 109(3): 201-206, 2019) Full article

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Open AccessArticle

Instrument-Assisted Soft-Tissue Mobilization for the Management of Chronic Plantar Heel Pain: A Pilot Study

by Edward R. Jones, Margaret A. Finley, Stacie J. Fruth and Thomas G. McPoil

J. Am. Podiatr. Med. Assoc. 2019, 109(3), 193-200; https://doi.org/10.7547/16-105 - 1 May 2019

Cited by 17 | Viewed by 97

Abstract

Background: The purpose of this study was to determine feasibility of further investigation of treatment with instrument-assisted soft-tissue mobilization (IASTM), using the Graston technique, compared with conservative care for treatment of chronic plantar heel pain (CPHP). Methods: Eleven participants with plantar heel pain [...] Read more.

Background: The purpose of this study was to determine feasibility of further investigation of treatment with instrument-assisted soft-tissue mobilization (IASTM), using the Graston technique, compared with conservative care for treatment of chronic plantar heel pain (CPHP). Methods: Eleven participants with plantar heel pain lasting 6 weeks to 1 year were randomly assigned to one of two groups, with each group receiving up to eight physical therapy visits. Both groups received the same stretching, exercise, and home program, but the experimental group also received IASTM using the Graston technique. Outcome measures of pain and function were recorded at baseline, after final treatment, and 90 days later. Feasibility of a larger study was determined considering recruitment and retention rates, compliance, successful application of the protocol and estimates of the treatment effect. Results: Both groups demonstrated improvements in current pain (pain at time of survey), pain with the first step in the morning, and function after final treatment and at 90-day follow up. Medium-to-large effect sizes between groups were noted, and sample size estimates demonstrated a need for at least 42 participants to realize a group difference. A larger-scale study was determined to be feasible with modifications including a larger sample size and higher recruitment rate. Conclusions: This pilot study demonstrates that inclusion of IASTM using the Graston technique for CPHP lasting longer than 6 weeks is a feasible intervention warranting further study. Clinically important changes in the IASTM group and moderate-to-large between-group effect sizes suggest that further research is warranted to determine whether these trends are meaningful. (J Am Podiatr Med Assoc 109(3): 193-200, 2019) Full article

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Open AccessArticle

Reliability of a New Method to Determine Foot Arch Height for Clinicians

by James A. Charles, Clare Mignot and Herbert F. Jelinek

J. Am. Podiatr. Med. Assoc. 2019, 109(3), 187-192; https://doi.org/10.7547/18-007 - 1 May 2019

Cited by 1 | Viewed by 53

Abstract

Background: Arch height is an important indicator of risk of foot pathology. The current non-invasive gold standard based on footprint information requires extensive pre-processing. Methods used to obtain arch height that are accurate and easier to use are required in routine clinical practice. [...] Read more.

Background: Arch height is an important indicator of risk of foot pathology. The current non-invasive gold standard based on footprint information requires extensive pre-processing. Methods used to obtain arch height that are accurate and easier to use are required in routine clinical practice. Methods: The proposed arch index diagonals (AI_d) method for determining the arch index (AI) reduces the complexity of the preprocessing steps. All footprints were first prepared as required by the Cavanagh and Rodgers method for determining the AI and then compared to the proposed diagonals method. Results were classified according to the Cavanagh and Rodgers cut-off values into three groups of low, normal and high AI. ANOVA and Tukey's post hoc tests were applied to identify significant differences between AI groups. Linear modeling was applied to determine the fit of the new AI_d method compared to the Cavanagh and Rodgers AI. Results: One hundred and ninety-six footprints were analyzed. The ANOVA indicated significant differences between the groups for AI_d (F1,194=94.49, p<0.0001) and the Tukey post hoc tests indicated significant differences between the pair-wise comparisons (p<0.001). Linear modeling indicated that the AI_d ratio classified more footprints in the high arch group compared to Cavanagh and Rodgers results (R²=32%, p< 0.01). Intra- and inter-rater correspondence was above 90% and confirmed that the AI_d results provided a better indication of arch height. Conclusions: The proposed method simplifies current processing steps to derive the arch height. (J Am Podiatr Med Assoc 109(3): 187-192, 2019) Full article

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Open AccessArticle

The Cole Midfoot Osteotomy: Clinical and Radiographic Retrospective Review of Five Patients (Six Feet) with Different Etiologies

by Selim Ergun and Yakup Yildirim

J. Am. Podiatr. Med. Assoc. 2019, 109(3), 180-186; https://doi.org/10.7547/17-056 - 1 May 2019

Cited by 14 | Viewed by 72

Abstract

Background: Cole osteotomy is performed in patients having a cavus deformity with the apex of the deformity in the midfoot. Correction of the deformity at this midfoot level improves foot and ankle stability by creating a plantigrade foot. We retrospectively reviewed the clinical [...] Read more.

Background: Cole osteotomy is performed in patients having a cavus deformity with the apex of the deformity in the midfoot. Correction of the deformity at this midfoot level improves foot and ankle stability by creating a plantigrade foot. We retrospectively reviewed the clinical and radiographic results of six feet (five patients) that underwent Cole midfoot osteotomy (2011–2015). Methods: The patients had different etiologies (spastic cerebral palsy, burn sequelae, spina bifida, and Charcot-Marie-Tooth disease). Dorsal and slightly laterally based transverse wedge osteotomy through the navicular bone medially and the cuboid bone laterally was performed. Patients were under routine clinical follow-up. We evaluated clinical and radiographic results. Results: Mean clinical follow-up was 15.7 months (range, 6–36 months). The mean preoperative and postoperative talo–first metatarsal angles on lateral radiographs were 29.9° and 8.7°, respectively (P < .05) and on anteroposterior radiographs were 30.3° and 8.6° (P < .05). The mean preoperative talocalcaneal angle on anteroposterior radiographs increased from 19.2° to 29.8° postoperatively (P < .05). The mean postoperative calcaneal pitch angle change was 10.8° on the lateral radiograph (P < .05). At final follow-up, all five patients were independently active, had plantigrade feet, and were able to wear conventional shoes. The mean American Orthopaedic Foot and Ankle Society questionnaire score was 38.8 preoperatively and 79.5 postoperatively (P < .05). Only one patient did not have full bony union. Achilles tightness was seen in one patient. Conclusions: Cole midfoot osteotomy is a laboring procedure to correct adult pes cavus deformity with the apex in midfoot, although having some complication risks. (J Am Podiatr Med Assoc 109(3): 180-186, 2019) Full article

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J. Am. Podiatr. Med. Assoc., Volume 109, Issue 3 (05 2019) – 14 articles , Pages 180-265

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