Journal of the American Podiatric Medical Association

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Open AccessReview

Fungal Lung. The Risk of Fungal Exposure to Nail Care Professionals

by Aditya K. Gupta and Emma M. Quinlan

J. Am. Podiatr. Med. Assoc. 2021, 111(6), 20269; https://doi.org/10.7547/20-269 - 1 Nov 2021

Cited by 2 | Viewed by 278

Foot and nail care specialists spend a great portion of their day using nail drills to reduce nail thickness and smooth foot calluses. This process generates a large amount of dust, some of which is small enough to breathe in and deposit into [...] Read more.

Foot and nail care specialists spend a great portion of their day using nail drills to reduce nail thickness and smooth foot calluses. This process generates a large amount of dust, some of which is small enough to breathe in and deposit into the deepest regions of the respiratory tract, potentially causing health problems. Foot and nail dust often contains fungi, from both fungus-infected and healthy-appearing nails. Although the majority of healthy individuals can tolerate inhaled fungi, the immune systems of older, immunocompromised, and allergy-prone individuals often react using the inflammatory T helper cell type 2 pathway, leading to mucus overproduction, bronchoconstriction, and, in severe cases, lung tissue damage. To protect vulnerable podiatry professionals, wearing a surgical mask, using a water spray suppression system on nail drills, installing air filtration systems, and considering drilling technique can help reduce exposure to nail dust. (J Am Podiatr Med Assoc 111(6): 1-6, 2021). Full article

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Open AccessArticle

The Effects of Different Screw Combinations on the Initial Stability of Ankle Arthrodesis. A Biomechanical Study

by Natiq Valiyev, Mehmet Demirel, Önder Murat Hürmeydan, Emin Sünbüloglu, Ergun Bozdağ and Önder Kılıçoğlu

J. Am. Podiatr. Med. Assoc. 2021, 111(6), 20241; https://doi.org/10.7547/20-241 - 1 Nov 2021

Cited by 4 | Viewed by 66

Abstract

Background: The literature is scanty regarding the biomechanical effects of different thread configurations on the initial stability of ankle arthrodesis. This study aims to compare the initial stability of tibiotalar fusion site in ankle arthrodesis using cannulated screws with different thread designs. [...] Read more.

Background: The literature is scanty regarding the biomechanical effects of different thread configurations on the initial stability of ankle arthrodesis. This study aims to compare the initial stability of tibiotalar fusion site in ankle arthrodesis using cannulated screws with different thread designs. Methods: We biomechanically tested under cyclic loading the effects of different screw combinations on the initial stability of ankle arthrodesis. A total of 28 synthetic ankle models were divided into four groups: two partially threaded cancellous screws (group A), partially and fully threaded cancellous screws (group B), a partially threaded cancellous screw with a headless compression screw (group C), and a fully threaded cancellous screw and a headless compression screw (group D). Biomechanical variables including ultimate failure load, initial stiffness, ultimate stiffness, and failure angulation were analyzed. Results: There were no differences in any of the biomechanical variables among the four groups (P = .41 for ultimate failure load, P = .079 for initial stiffness, P = .084 for ultimate stiffness, and P = .937 for failure angulation). Conclusions: Combinations of different cannulated screws showed similar results in terms of the stability and stiffness of the tibiotalar fusion site. (J Am Podiatr Med Assoc 111(6): 1-11, 2021). Full article

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Open AccessArticle

Acquired Digital Fibrokeratoma of the Toe. A Rare Anatomical Location

by Soumaya Gara, Anissa Zaouak, Ehsen Ben Brahim, Raja Jouini, Samy Fenniche and Houda Hammami

J. Am. Podiatr. Med. Assoc. 2021, 111(6), 20215; https://doi.org/10.7547/20-215 - 1 Nov 2021

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Abstract

Acquired digital fibrokeratoma is a rare and benign fibrous tumor; it is usually asymptomatic, and frequently arises from the fingers. The diagnosis is easily confirmed by pathologic evaluation. However, in some cases, it may be misdiagnosed as other benign conditions, mainly adnexal tumors [...] Read more.

Acquired digital fibrokeratoma is a rare and benign fibrous tumor; it is usually asymptomatic, and frequently arises from the fingers. The diagnosis is easily confirmed by pathologic evaluation. However, in some cases, it may be misdiagnosed as other benign conditions, mainly adnexal tumors and common warts, especially when located on the foot and toes. In this article, we report the case of a 45-year-old man who presented to our clinic for an acquired growth over the plantar surface of the second right toe. The tumor had evolved for 1 year and affected the patient's activities and mobility. On examination, the lesion was a dome-shaped, firm tumor with keratotic distal changes and a broad base attached to the overlying skin. Pathologic assessment was consistent with the diagnosis of acquired digital fibrokeratoma, ruling out other causes of abnormal growth. The tumor was completely excised with surgery, with excellent outcomes and no recurrence at follow-up. Although acquired digital fibrokeratoma is a rare condition, mostly located on the distal upper extremities and fingers, it should be considered in the differential diagnosis of plantar soft-tissue tumors. Surgical management remains the mainstay of treatment. (J Am Podiatr Med Assoc 111(6): 1-3, 2021). Full article

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Open AccessArticle

Subungual Exostosis on the Right Hallux. An Illustrative Case Report

by Michael Tritto, Gene Mirkin and Xingpei Hao

J. Am. Podiatr. Med. Assoc. 2021, 111(6), 20209; https://doi.org/10.7547/20-209 - 1 Nov 2021

Cited by 2 | Viewed by 120

Abstract

Subungual exostosis (SE) is a benign, relatively uncommon bony growth underneath the nails of the distal phalanx of toes or fingers, with a majority on the toes. Clinically, it has two subvariants—protruded and nonprotruded growths from nail plates—which are treated differently. In this [...] Read more.

Subungual exostosis (SE) is a benign, relatively uncommon bony growth underneath the nails of the distal phalanx of toes or fingers, with a majority on the toes. Clinically, it has two subvariants—protruded and nonprotruded growths from nail plates—which are treated differently. In this article, we report a case of protruded SE in a teenager with illustrative surgical excision. A 15-year-old boy presented with a painful growth on his right great toe of 6 months' duration. Physical examination revealed a 1-cm-diameter, solid, erythematous, rough, irregular growth penetrating through the skin along the dorsolateral nail bed of the right hallux with deformity of the lateral nail plate. Radiographs showed an elevated mass over the distal phalanx of the right lateral hallux. The mass was surgically excised and histopathologic examination confirmed the diagnosis of SE. The patient had no relapse or recurrence at follow-ups of 6 and 18 months. Subungual exostosis is a relatively uncommon bony growth in the toes. Radiography is favored for the diagnosis. Complete surgical excision is the optimal treatment, with rare recurrence. It needs to be differentiated from other bony lesions, including bizarre parosteal osteochondromatous proliferation, myositis ossificans, fibro-osseous pseudotumor, osteochondroma, and enchondroma. (J Am Podiatr Med Assoc 111(6): 1-5, 2021). Full article

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Open AccessArticle

Primary Aneurysmal Bone Cyst of the Distal Tibia Crossing the Open Physis

by Sumit Arora, Yasim Khan, Vijay Rk, Sumit Sural and Anil Dhal

J. Am. Podiatr. Med. Assoc. 2021, 111(6), 20208; https://doi.org/10.7547/20-208 - 1 Nov 2021

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Abstract

Crossing the barrier of an open physis by primary aneurysmal bone cyst is an exceptional phenomenon. We present a rare case of primary active aneurysmal bone cyst of the distal tibia in a 15-year-old boy in whom the lesion had crossed the open [...] Read more.

Crossing the barrier of an open physis by primary aneurysmal bone cyst is an exceptional phenomenon. We present a rare case of primary active aneurysmal bone cyst of the distal tibia in a 15-year-old boy in whom the lesion had crossed the open lateral distal tibia physis. The diagnosis was confirmed by radiographs, computed tomography, magnetic resonance imaging, and histopathologic findings. The lesion was successfully treated by extended curettage and allograft impaction. The patient was asymptomatic when last seen at 30 months. (J Am Podiatr Med Assoc 111(6): 1-6, 2021). Full article

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Open AccessArticle

Posterior Tibial Tendon Transfer for the Correction of Drop Foot

by James H. Chung, Roland S. Ramdass, Jonathan Dillard and Ryan M. Sherick

J. Am. Podiatr. Med. Assoc. 2021, 111(6), 20205; https://doi.org/10.7547/20-205 - 1 Nov 2021

Cited by 2 | Viewed by 85

Abstract

Background: Drop foot is a crippling condition that often requires surgical intervention to restore functional dorsiflexion. Although transfer of the posterior tibial (PT) tendon has been well described for the treatment of drop foot, there is no consensus on whether tendon transfers [...] Read more.

Background: Drop foot is a crippling condition that often requires surgical intervention to restore functional dorsiflexion. Although transfer of the posterior tibial (PT) tendon has been well described for the treatment of drop foot, there is no consensus on whether tendon transfers affecting the ankle joint sufficiently restore functional status for daily activities. In addition, most studies have focused on drop foot caused by peripheral nerve disorders. The purpose of this study was to evaluate the functional outcomes and patient satisfaction following PT tendon transfer for the correction of drop foot resulting from both peripheral and central neurologic causes. Methods: Patients with drop foot who underwent a PT tendon transfer were followed for a minimum of 1 year and investigated retrospectively. Outcome measures included the American Orthopaedic Foot & Ankle Society ankle and hindfoot scoring system, a patient satisfaction questionnaire, postoperative ankle range of motion, and postoperative ambulatory status. Results: We evaluated 15 feet in 14 patients at a median follow-up of 50 months. The median postoperative American Orthopaedic Foot & Ankle Society ankle and hindfoot score was 85.0. Thirteen patients (92.9%) reported that they would undergo the procedure again. The median postoperative passive ankle dorsiflexion was 5.0°, and the median postoperative passive ankle plantarflexion was 30.0°. Thirteen patients (92.9%) were able to ambulate postoperatively. Ten (71.4%) ambulated without the use of an ankle-foot orthosis (AFO), and three (21.4%) ambulated with the use of an AFO. Overall, orthoses were able to be discontinued in 73.3% of the cases. Conclusions: Our results suggest that the PT tendon transfer is an effective procedure for the treatment of drop foot that can improve the patient's functional status and ability to ambulate. The majority of patients were able to discontinue the use of their AFO postoperatively. Full article

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Open AccessArticle

Effectiveness of Lower-Extremity Electrical Stimulation to Improve Skin Perfusion

by Alejandro Zulbaran-Rojas, Catherine Park, Brian Lepow and Bijan Najafi

J. Am. Podiatr. Med. Assoc. 2021, 111(6), 20172; https://doi.org/10.7547/20-172 - 1 Nov 2021

Cited by 8 | Viewed by 74

Abstract

Background: Although numerous studies suggest the benefit of electrical stimulation (E-Stim) therapy to accelerate wound healing, the underlying mechanism of action is still debated. In this pilot study, we examined the potential effectiveness of lower-extremity E-Stim therapy to improve tissue perfusion in [...] Read more.

Background: Although numerous studies suggest the benefit of electrical stimulation (E-Stim) therapy to accelerate wound healing, the underlying mechanism of action is still debated. In this pilot study, we examined the potential effectiveness of lower-extremity E-Stim therapy to improve tissue perfusion in patients with diabetic foot ulcers. Methods: Thirty-eight patients with diabetic foot ulcers underwent 60 min of active E-Stim therapy on acupuncture points above the level of the ankle joint using a bioelectric stimulation technology platform. Perfusion changes in response to E-Stim were assessed by measuring skin perfusion pressure (SPP) at baseline and during 30 and 60 min of therapy; retention was assessed 10 min after therapy. Tissue oxygen saturation (SatO₂) was measured using a noninvasive near-infrared camera. Results: Skin perfusion pressure increased in response to E-Stim therapy (P = .02), with maximum improvement observed at 60 min (11%; P = .007) compared with baseline; SPP reduced 10 min after therapy but remained higher than baseline (9%; P = .1). Magnitude of improvement at 60 min was negatively correlated with baseline SPP values (r = –0.45; P = .01), suggesting that those with lower perfusion could benefit more from E-Stim therapy. Similar trends were observed for SatO₂, with statistically significant improvement for a subsample (n = 16) with moderate-to-severe peripheral artery disease. Conclusions: This study provides early results on the feasibility and effectiveness of E-Stim therapy to improve skin perfusion and SatO₂. The magnitude of benefit is higher in those with poorer skin perfusion. Also, the effects of E-Stim could be washed out after stopping therapy, and regular daily application might be required for effective benefit in wound healing. (J Am Podiatr Med Assoc 111(6): 1-11, 2021). Full article

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Open AccessCase Report

Eumycetoma, A Neglected Tropical Disease in the United States

by Michael Tritto, Gary W. Procop, Steven T. Billings, Gene Mirkin and Xingpei Hao

J. Am. Podiatr. Med. Assoc. 2021, 111(6), 20150; https://doi.org/10.7547/20-150 - 1 Nov 2021

Cited by 3 | Viewed by 52

Abstract

Eumycetoma, caused by fungi, is a neglected tropical disease. It is endemic in the “mycetoma belt” countries but rare in North America. We report a case of pedal eumycetoma in the state of Maryland. A 51-year-old male immigrant from Guatemala presented with multiple, [...] Read more.

Eumycetoma, caused by fungi, is a neglected tropical disease. It is endemic in the “mycetoma belt” countries but rare in North America. We report a case of pedal eumycetoma in the state of Maryland. A 51-year-old male immigrant from Guatemala presented with multiple, enlarging nodules on the dorsal surface of his left great toe present for 1 year, and a new one in the left arch area present for 6 months. The nodular lesions were surgically excised in two separate operations. Pathologic evaluation of all nodules revealed eumycetomas characterized by the Splendore-Hoeppli phenomenon, showing an amorphous eosinophilic center filled with numerous fungal hyphae, observed on periodic acid-Schiff–stained slides, with a surrounding cuff of neutrophils. Polymerase chain reaction–based sequencing identified Cladosporium cladosporioides in the tissues. The patient was further treated with oral fluconazole for 2 months. The patient recovered well postoperatively and had no recurrence at 20-month follow-up. In conclusion, even though eumycetoma is regarded as a rare disease in North America, its incidence may be higher than reported because of millions of immigrants from endemic regions in the United States, which highlights the need to raise awareness of this devastating disease in the medical community. Eumycetoma needs to be differentiated from other infectious and noninfectious benign and malignant lesions. Optimal treatment includes surgical excision with antifungal therapy. (J Am Podiatr Med Assoc 111(6): 1-5, 2021). Full article

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Open AccessCase Report

Treatment of Giant Cell Tumor of Soft Tissue Disguised as Giant Cell Tumor of the Bone Involving the Distal and Proximal Phalanges of the Great Toe

by Ronika Sethi, Grace Tsai, Wei-Jei Liao and Lawrence Horl

J. Am. Podiatr. Med. Assoc. 2021, 111(6), 20124; https://doi.org/10.7547/20-124 - 1 Nov 2021

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Abstract

Giant cell tumors are benign tumors that are locally aggressive and rare in the foot. Giant cell tumors involving bone in the foot have an incidence of 1.2% to 2.8%, whereas giant cell tumors of the tendon sheath constitute 3% to 5% of [...] Read more.

Giant cell tumors are benign tumors that are locally aggressive and rare in the foot. Giant cell tumors involving bone in the foot have an incidence of 1.2% to 2.8%, whereas giant cell tumors of the tendon sheath constitute 3% to 5% of all giant cell tumors in the foot and ankle. We present a case of giant cell tumor of the soft tissue disguised as a giant cell tumor of bone in a healthy 29-year-old male patient. Through radiographic and magnetic resonance imaging evaluation, it was determined that this patient had a bone tumor invading the distal and proximal phalanges of his left great toe with the involvement of soft tissue. With the use of the evidence-based medicine and patient expectation, the decision was made to amputate the digit. To much surprise, when the histopathologic results were reviewed, it was determined that the excised lesion was consistent with giant cell tumor of soft tissue that did not involve the bone. Full article

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Open AccessArticle

A Rare Case Presentation. Bilateral Gangrene of Feet Secondary to Systemic Lupus Erythematosus and Raynaud Phenomenon in an Adolescent

by Oluwatosin Ogunlana

J. Am. Podiatr. Med. Assoc. 2021, 111(6), 20114; https://doi.org/10.7547/20-114 - 1 Nov 2021

Cited by 1 | Viewed by 64

Abstract

Systemic lupus erythematosus is an autoimmune disorder that affects several organs and systems in the human body. Digital gangrene is known to be a rare and severe complication of systemic lupus erythematosus that could lead to amputation. We report a case of an [...] Read more.

Systemic lupus erythematosus is an autoimmune disorder that affects several organs and systems in the human body. Digital gangrene is known to be a rare and severe complication of systemic lupus erythematosus that could lead to amputation. We report a case of an adolescent who presented with an autoimmune disorder and multiple comorbidities and developed gangrenous toes. Full article

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Open AccessArticle

Determination of the Effective Site for Percutaneous Achilles Tenotomy in Ponseti Management of African Idiopathic Clubfoot

by Olalekan A. Anipole, Lawrence M. Oginni, Oluwagbemiga O. Ayoola, Olayinka O. Adegbehingbe, Oluwadare Esan and Joseph O. Mejabi

J. Am. Podiatr. Med. Assoc. 2021, 111(6), 20109; https://doi.org/10.7547/20-109 - 1 Nov 2021

Viewed by 53

Abstract

Percutaneous Achilles tenotomy is an essential step in the Ponseti treatment of idiopathic clubfoot, with reported complications such as injury to the surrounding neurovascular structures and incomplete division of the Achilles tendon (AT). Knowledge of AT thickness would guide tenotomy blade insertion depth, [...] Read more.

Percutaneous Achilles tenotomy is an essential step in the Ponseti treatment of idiopathic clubfoot, with reported complications such as injury to the surrounding neurovascular structures and incomplete division of the Achilles tendon (AT). Knowledge of AT thickness would guide tenotomy blade insertion depth, obviating these related complications. We embarked on this study to ultrasonographically determine AT thickness at its different levels from the calcaneal insertion in children with idiopathic clubfoot. This prospective comparative study consisted of two groups of children 4 years and younger: a study group of patients with clubfoot requiring tenotomy and a control group. Both groups underwent ultrasonographic evaluation of their AT. The ultrasonographic data collected include AT thickness 1 and 2 cm from the calcaneal insertion of the AT, thickness of the thinnest portion of the tendon, and the distance of this thinnest portion from the calcaneal insertion. Twenty-seven children with idiopathic clubfoot constituted the study group, and 23 children with no musculoskeletal deformity were enrolled in the control group. Mean ± SD AT thicknesses 1 and 2 cm from the calcaneal insertion in the study group were 2.4 ± 0.7 mm and 2.1 ± 0.7 mm, respectively, and in the control group were 2.5 ± 0.7 mm and 2.3 ± 0.7 mm, respectively. The average thickness of the thinnest portion of the AT along its length was 2 mm at 1.8 cm from the calcaneal insertion in both groups. Safe and complete percutaneous tenotomy would most likely be achieved when performed 1.8 cm from the calcaneal insertion, where the corresponding average AT thickness of 2 mm would be a guide to determine the insertion depth of the tenotomy blade. Full article

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Open AccessArticle

Management of Periprosthetic Polyvinyl Alcohol Synthetic Cartilage Implant Infection with Staged First Metatarsophalangeal Joint Arthrodesis. A Case Report

by Korey S. DuBois, John Benner, Spencer Monaco and Michael T Rossidis

J. Am. Podiatr. Med. Assoc. 2021, 111(6), 20105; https://doi.org/10.7547/20-105 - 1 Nov 2021

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Abstract

Surgical management of hallux rigidus using a polyvinyl alcohol synthetic cartilage implant has gained popularity among foot and ankle surgeons. Although uncommon, appropriate diagnosis and management of a periprosthetic implant infection is critical in limiting morbidity. We present a case report and staged [...] Read more.

Surgical management of hallux rigidus using a polyvinyl alcohol synthetic cartilage implant has gained popularity among foot and ankle surgeons. Although uncommon, appropriate diagnosis and management of a periprosthetic implant infection is critical in limiting morbidity. We present a case report and staged technique for converting a first metatarsal synthetic cartilage hemiarthroplasty to arthrodesis in the setting of a periprosthetic joint infection. Full article

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Open AccessArticle

The Beneficial Effects of Erbium:Yttrium-Aluminum-Garnet Laser in an Ulcer Caused by Lower Leg Arteriopathy

by Aysenur Botsali, Ercan Caliskan and Mustafa Tunca

J. Am. Podiatr. Med. Assoc. 2021, 111(6), 20099; https://doi.org/10.7547/20-099 - 1 Nov 2021

Cited by 1 | Viewed by 46

Abstract

Ablative fractional laser is suggested to promote wound healing in diabetic and venous leg ulcers. In this article, we report the treatment outcome of a recalcitrant foot ulceration related to lower leg arteriopathy. A 43-year-old man with typical digital substraction angiographic findings of [...] Read more.

Ablative fractional laser is suggested to promote wound healing in diabetic and venous leg ulcers. In this article, we report the treatment outcome of a recalcitrant foot ulceration related to lower leg arteriopathy. A 43-year-old man with typical digital substraction angiographic findings of arteriopathy was admitted to our department after 30 sessions of hyperbaric oxygen therapy. There was heterotopic tissue within the ulcer consistent with osseous metaplasia and mature bone tissue. This tissue was removed with full-field erbium:yttrium-aluminum-garnet laser, and the remaining parts received fractional erbium:yttrium-aluminum-garnet laser for the induction of wound healing. A decrease in ulcer dimensions was achieved by the second month of laser interventions without recurrence in the first-year control. Full article

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Open AccessArticle

Additional Akin Proximal Phalanx Procedure Has a Limited Effect on the Outcome of Scarf Osteotomy for Hallux Valgus Surgery

by Marcin Milczarek, Krzysztof Nowak, Bartlomiej Tomasik, Julia Milczarek, Przemyslaw Laganowski and Marcin Domzalski

J. Am. Podiatr. Med. Assoc. 2021, 111(6), 20071; https://doi.org/10.7547/20-071 - 1 Nov 2021

Cited by 9 | Viewed by 48

Abstract

One of the most common supplementary techniques for hallux valgus (HV) surgery is proximal phalanx correction proposed by Akin. This study aims to determine the influence of the Akin procedure on the outcome of scarf osteotomy for HV correction. This prospective randomized study [...] Read more.

One of the most common supplementary techniques for hallux valgus (HV) surgery is proximal phalanx correction proposed by Akin. This study aims to determine the influence of the Akin procedure on the outcome of scarf osteotomy for HV correction. This prospective randomized study on 145 patients diagnosed with moderate to severe HV who underwent a scarf corrective osteotomy was carried out between 2011 and 2016. Patients were divided into two groups based on the additional Akin correction of the proximal phalanx. Postoperative follow-up was 2 years. The patients underwent an examination performed by two orthopedic surgeons twice—at the primary visit (qualification for the surgery and the study) and at the final follow-up. In between, the patients remained under the care of one of the physicians. Data collected included biometric records, radiographs (eg, hallux valgus angle [HVA]), intermetatarsal angle, American Orthopaedic Foot & Ankle Society Hallux Metatarsophalangeal Index, and visual analog scale score for pain and satisfaction. There was a significant difference in comparison of the HVA between the groups at the final follow-up. Other collected parameters were similar (American Orthopaedic Foot & Ankle Society Hallux Metatarsophalangeal Index, level of pain, and satisfaction). The complication rate was also similar between the groups. We observed comparable rates of reconsent to the treatment and foot appearance satisfaction in both groups. Regardless of additional Akin correction, the outcome was comparable. Despite a significant difference in HVA score, pain and satisfaction level were similar. Based on our results, the Akin procedure may not provide substantial benefit as an adjunct to the scarf procedure. Full article

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Open AccessArticle

The Bipartite Medial Cuneiform. A Case Report

by Daniel Pollack, Matthew Diament, Yelizaveta Kotlyarova and Yechiel Gellman

J. Am. Podiatr. Med. Assoc. 2021, 111(6), 20025; https://doi.org/10.7547/20-025 - 1 Nov 2021

Cited by 2 | Viewed by 64

Abstract

This report discusses an unusual case of a 23-year-old woman with a painful bipartite medial cuneiform and severe arthritic and cystic changes at the partition with no history of trauma. Magnetic resonance imaging confirmed a large cyst with subchondral erosions at the dorsal [...] Read more.

This report discusses an unusual case of a 23-year-old woman with a painful bipartite medial cuneiform and severe arthritic and cystic changes at the partition with no history of trauma. Magnetic resonance imaging confirmed a large cyst with subchondral erosions at the dorsal and plantar segments with significant bone marrow edema. Definitive treatment consisted of arthrodesis on the dorsal to plantar segments using one lag screw, demineralized bone matrix grafting, and a bone stimulator. Full article

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Open AccessArticle

Micronized Dehydrated Human Amnion/Chorion Membrane Injection in the Treatment of Chronic Achilles Tendinitis. A Large Retrospective Case Series

by Jay E. Spector, Brandon Hubbs, Kimberly Kot, Niki Istwan and David Mason

J. Am. Podiatr. Med. Assoc. 2021, 111(6), 19170; https://doi.org/10.7547/19-170 - 1 Nov 2021

Cited by 4 | Viewed by 60

Abstract

Human amniotic membrane contains growth factors and cytokines that promote epithelial cell migration and proliferation, stimulate metabolic processes that lead to collagen synthesis, and attract fibroblasts, while also reducing pain and inflammation. Randomized studies have shown effectiveness of micronized dehydrated human amnion/chorion membrane [...] Read more.

Human amniotic membrane contains growth factors and cytokines that promote epithelial cell migration and proliferation, stimulate metabolic processes that lead to collagen synthesis, and attract fibroblasts, while also reducing pain and inflammation. Randomized studies have shown effectiveness of micronized dehydrated human amnion/chorion membrane (mdHACM) allograft injection in treatment of plantar fasciitis. We present our experience and short-term outcomes with using mdHACM injection as a treatment for Achilles tendinopathy. Retrospective case series of patients with Achilles tendinopathy treated with mdHACM by a single physician. Participants had at least two follow-up visits within 45 days of mdHACM injection. Outcomes examined included change in reported level of pain during the 45-day observation period and treatment-associated adverse events. Follow-up data were available for 32 mdHACM-treated patients. At treatment initiation, 97% of patients reported severe (66%) or moderate (31%) pain. At the first follow-up visit (mean ± SD of 8.1 ± 2.7 days postinjection), 27 patients (84%) reported improvement in pain levels, although 37% of patients continued to report severe (6%) or moderate (31%) pain. At the second follow-up visit (mean ± SD of 23.1 ± 6.2 days postinjection), no patients reported severe pain and one reported moderate pain. Within 45 days of mdHACM injection, complete symptom resolution was reported by 66% of treated patients (n = 21), with the remaining 34% (n = 11) reporting symptom improvement but not complete resolution. Two patients reported calf or quadricep pain or tightness after injection. In our experience, mdHACM injection reduced or eliminated pain in all 32 patients with follow-up data. Full article

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Open AccessArticle

Investigation of the Relationships Among Clinical Measures of Foot Posture in Individuals with and Without Pronated Foot

by Muge Kirmizi, Mehmet Alphan Cakiroglu, Yesim Salik Sengul, Ata Elvan, Ibrahim Engin Simsek and Salih Angin

J. Am. Podiatr. Med. Assoc. 2021, 111(6), 19122; https://doi.org/10.7547/19-122 - 1 Nov 2021

Cited by 3 | Viewed by 54

Abstract

Many indirect clinical techniques have been developed to assess foot posture; however, there is relatively little research investigating the relationships among these techniques. We investigated the relationships among the most commonly used clinical measures of foot posture—Foot Posture Index-6 (FPI-6), navicular drop (NDP), [...] Read more.

Many indirect clinical techniques have been developed to assess foot posture; however, there is relatively little research investigating the relationships among these techniques. We investigated the relationships among the most commonly used clinical measures of foot posture—Foot Posture Index-6 (FPI-6), navicular drop (NDP), navicular drift (NDT), and static and dynamic arch indices (SAI and DAI)—in individuals with normal foot posture and those with pronated foot. Sixty-three individuals with FPI-6 scores of 0 to 12 were included. A digital caliper was used to measure NDP and NDT; SAI and DAI were measured by electronic pedobarography. Assessments were applied on the dominant foot. Pearson correlation coefficients were calculated to determine the relationships among measures. Participants were classified into two groups, pronated foot (n = 33) and normal foot posture (n = 30), based on FPI-6 scores, providing a multisegmental and multiplanar assessment. The independent-samples t test was used to compare groups regarding NDP, NDT, SAI, and DAI. We found a high correlation between NDP and FPI-6 (r = 0.754) and between NDP and NDT (r = 0.778) (all P < .001). A moderate correlation was found between NDT and FPI-6 (r = 0.599) and between DAI and SAI (r = 0.519) (all P < .001). A negligible correlation was found between NDP and DAI (r = 0.268; P = .033). Furthermore, NDP, NDT, and DAI values were higher in individuals with pronated foot compared with those with normal posture (P < .001 for NDP and NDT; P = .022 for DAI), whereas SAI values were not (P = .837). These results suggest that there are moderate-to-strong relationships among FPI-6, NDP, and NDT and between SAI and DAI. The NDP, NDT, and DAI are suitable for the classification of foot posture based on FPI-6 scores. This study can guide clinicians and researchers to associate the foot posture measures with each other. Full article

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Open AccessArticle

Avulsion Fracture of the Base of the First Metatarsal Bone by Peroneus Longus Tendon. A Case Report

by Samir Ilgaroglu Zeynalov, Anar Alakbarov and Selim Ergun

J. Am. Podiatr. Med. Assoc. 2021, 111(6), 18212; https://doi.org/10.7547/18-212 - 1 Nov 2021

Cited by 2 | Viewed by 99

Abstract

Foot and ankle traumas are frequent causes of emergency room referrals. [...] Full article

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Open AccessArticle

The Association Between Foot Structure and Foot Kinematics During Slow Running

by Malia Ho Tsai Djun and John Tan Cher Chay

J. Am. Podiatr. Med. Assoc. 2021, 111(6), 18098; https://doi.org/10.7547/18-098 - 1 Nov 2021

Cited by 2 | Viewed by 47

Abstract

Clinicians routinely assess foot posture as part of their assessment and management of foot pathologies. Flat or high-arched foot postures have been linked to kinematic deviations and increased risk of foot injuries. The Foot Posture Index (FPI) is a valid clinical tool used [...] Read more.

Clinicians routinely assess foot posture as part of their assessment and management of foot pathologies. Flat or high-arched foot postures have been linked to kinematic deviations and increased risk of foot injuries. The Foot Posture Index (FPI) is a valid clinical tool used to classify feet into high-arched, normal-arched, and flat foot groups and predicts foot function during walking well. Walking and running are distinct locomotion styles, and studies have not been performed to correlate FPI to foot function during running. This study aims to investigate the association of FPI scores to foot kinematics during running. The results will further inform clinicians who perform static assessment of feet of individuals who are runners. Sixty-nine participants had their feet assessed using the FPI scoring system. Based on these scores, the feet were categorized as flat foot, normal-arched, and high-arched. Rearfoot eversion and forefoot dorsiflexion (arch flattening) of the foot were analysed during slow running between 1.4 and 2.2 m/sec. The Pearson correlation was used to analyse the FPI scores on an interval scale, with Cohen's d used to report effect size. One-way analysis of variance and a Bonferroni post hoc test was used to analyze data by category. Level of significance was set at P < .05. Thirty-four flat feet, 26 normal-arched feet, and nine high-arched feet were analyzed. The FPI scores correlated significantly with rearfoot eversion (moderate effect size) and forefoot dorsiflexion (low effect size). Rearfoot eversion was greatest in the flat foot, followed by the normal-arched foot and the high-arched foot. Forefoot dorsiflexion was significantly higher in the flat foot compared with the high-arched group. Foot Posture Index scores are positively correlated with rearfoot eversion and forefoot dorsiflexion during running. Clinicians can use this information to aid their foot assessment and management of individuals who are runners. Full article

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Open AccessArticle

Reliability and Repeatability of the Footwork Plantar Pressure Plate System

by José-Víctor Alfaro-Santafé, Antonio Gómez-Bernal, Alejandro-Jesús Almenar-Arasanz and Javier Alfaro-Santafé

J. Am. Podiatr. Med. Assoc. 2021, 111(6), 18057; https://doi.org/10.7547/18-057 - 1 Nov 2021

Cited by 8 | Viewed by 59

Abstract

Plantar pressure plate instruments are commonly used in clinical practice and biomechanical analysis and are useful to establish a relationship between gait disorders and foot pressure. The aim of this study was to verify the reliability and repeatability of the Footwork pressure plate [...] Read more.

Plantar pressure plate instruments are commonly used in clinical practice and biomechanical analysis and are useful to establish a relationship between gait disorders and foot pressure. The aim of this study was to verify the reliability and repeatability of the Footwork pressure plate system for static and dynamic conditions. Forty healthy adults, without apparent gait pathology, were recruited. For the static condition, participants were asked to stand static on the Footwork pressure plate for 5 sec in natural position (arms on either side of the body, feet shoulder-width apart in a comfortable angle, and looking ahead). For the dynamic condition, subjects were told to step five times with each foot on the plate following the three-step protocol. Both conditions were performed in two testing sessions spaced by 1 week. Intrasession and intersession reliability for both conditions showed substantial to almost perfect intraclass correlation coefficient (ICC) values, and low coefficient of variation, low standard error measure, and low percentage error. Intrasession ICCs were 0.724 to 0.993 for static condition evaluation and 0.639 to 0.986 for dynamic condition evaluation. Intersession reliability ICCs ranged from 0.850 to 0.987 for the static condition and from 0.781 to 0.996 for the dynamic condition. Coefficient of variation values were below 8% in both cases and percentage error calculated from standard error measure were less than 10%. The present work demonstrates that the Footwork plantar pressure plate system is a reliable instrument for collecting plantar pressures in static and dynamic conditions. Reliability data were higher for the static trials, probably because of the individual physiologic fluctuations, which are larger during dynamic gait. Reliability for intersession and average intrasession trials were higher than single-test reliability. The results from the present work can be used as a starting point for future research and to establish a basis for sample sizes for investigations that would use the Footwork platform. Full article

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Open AccessArticle

A Bibliometric Evaluation of Worldwide Research of the Podiatry Field from 1965 to 2017

by Laura Carrasco Cortijo, Jose A. Quesada, Adriana Lopez-Pineda, Domingo Orozco-Beltrán, Vicente F. Gil-Guillen and Concepcion Carratala-Munuera

J. Am. Podiatr. Med. Assoc. 2021, 111(6), 18008; https://doi.org/10.7547/18-008 - 1 Nov 2021

Cited by 2 | Viewed by 64

Abstract

To identify the strengths and weaknesses in a given research area, it is necessary to analyze the published literature. International studies on podiatry research productivity are scarce. This study aimed to analyze scientific productivity in the area of podiatric medicine from 1965 to [...] Read more.

To identify the strengths and weaknesses in a given research area, it is necessary to analyze the published literature. International studies on podiatry research productivity are scarce. This study aimed to analyze scientific productivity in the area of podiatric medicine from 1965 to 2017. This was a retrospective, observational, bibliometric study. The MEDLINE database was used to identify research published between 1965 and 2017. Literature searches were performed in 2010 and 2017 through RefWorks, and research production per year, author, document type, country, institution, journal, and language were calculated. Podiatry's contribution to global scientific production was measured by calculating the ratio of podiatry publications to total production, and Price's law was applied to analyze the temporal evolution. Author productivity index, coauthorship, geographic distribution, and the distribution by institution type and journal (Bradford's law) were analyzed. The MEDLINE search yielded 1,256 publications, representing 4.75 articles per 100,000 publications in global scientific research. The growth rate followed Price's law after linear adjustment. The 2,229 identified authors presented a transience index of 85.73%; 0.38% were highly productive authors. The coauthorship index increased from 1.40 in 1965 to 5.80 in 2017. The most common document type was the journal article, whereas 2.1% were clinical trials. Only one document reported a controlled clinical trial. The United States led scientific production, with 77.15% of the documents; 60.5% of the publications were concentrated in four journals. Podiatry is still an emerging research field, and literature is concentrated in a small number of journals, categorized into different subjects. Full article

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J. Am. Podiatr. Med. Assoc., Volume 111, Issue 6 (11 2021) – 21 articles

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