Journal of the American Podiatric Medical Association

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Open AccessArticle

Effects of Subtalar Joint Mobilization with Movement on Muscle Strength, Balance, Functional Performance, and Gait Parameters in Patients with Chronic Stroke: A Single-Blind Randomized Controlled Study

by Buket Büyükturan, Senem Şaş, Caner Kararti, İsmail Özsoy, Aida Habibzadeh and Öznur Büyükturan

J. Am. Podiatr. Med. Assoc. 2022, 112(1), 20275; https://doi.org/10.7547/20-275 - 1 Jan 2022

Cited by 2 | Viewed by 188

Abstract

Background: Losses in muscle strength, balance, and gait are common in patients with chronic stroke (CS). Ankle joint movements play a key role in this population to maintain a sufficient level of functional activity. The aim of this study was to investigate the [...] Read more.

Background: Losses in muscle strength, balance, and gait are common in patients with chronic stroke (CS). Ankle joint movements play a key role in this population to maintain a sufficient level of functional activity. The aim of this study was to investigate the effects of the subtalar joint (STJ) mobilization with movement (MWM) technique on muscle strength, balance, functional performance, and gait speed (GS) in patients with CS. Methods: Twenty-eight patients with CS were randomly divided into the control group (n = 14) and the STJ MWM group (n = 14). A 30-min neurodevelopmental treatment program and talocrural joint MWM were applied to both groups. Also, STJ MWM was applied to the STJ MWM group. The patients were treated 3 days a week for 4 weeks. Ankle dorsiflexion and plantarflexion muscle strength, Berg Balance Scale, Timed Up and Go test, and GS were evaluated before and after treatment. Results: Berg Balance Scale and Timed Up and Go test scores, dorsiflexion and plantarflexion muscle strength, and GS improved in both groups after the treatment sessions (P < .05), but the improvements were greater in the STJ MWM group compared with the control group (P < .05). Conclusions: According to these results, STJ MWM together with neurodevelopmental treatment and talocrural joint MWM can increase ankle muscle strength, balance, functional performance, and GS on the affected leg in patients with CS. (J Am Podiatr Med Assoc 112(1), 2022). Full article

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Open AccessArticle

Morphometric Study of the Navicular Bone in a Nigerian Population: A Direct Measurement Study

by Ogugua A. Egwu, Emmanuel Anayochukwu Esom, Elizabeth Finbarrs-Bello and Substance Ekechukwu

J. Am. Podiatr. Med. Assoc. 2022, 112(1), 20254; https://doi.org/10.7547/20-254 - 1 Jan 2022

Cited by 1 | Viewed by 119

Abstract

Background: The human foot, containing approximately 26 bones, is highly developed for movement, balance, and weightbearing. It is modified into medial longitudinal, lateral longitudinal, and transverse arches which, in addition to the above functions, play a role in protecting the plantar tissues and [...] Read more.

Background: The human foot, containing approximately 26 bones, is highly developed for movement, balance, and weightbearing. It is modified into medial longitudinal, lateral longitudinal, and transverse arches which, in addition to the above functions, play a role in protecting the plantar tissues and neurovascular structures. Morphometry of the navicular bone, one of the bones of the foot that plays an important role in the medial longitudinal arch, was investigated in this study. Methods: One hundred fifty adult dry navicular bones were used. Navicular breadth, height, maximum thickness, maximum talar facet height and breadth, maximum cuneiform facet height and breadth, and maximum navicular tuberosity projection height were measured using digital Vernier callipers. The anatomical features were used to determine the side. Bones with features that suggested previous fractures or any previous disease were excluded from this study. Ethical approval was obtained from the Research Ethics Committee of the Department of Anatomy, Ebonyi State University, Abakaliki, Nigeria. Results: The navicular bone showed great variations in its left and right sides, with the values of the dimensions on the left being higher than the right. Conclusions: An understanding of these variations will be helpful to medical scientists, osteologists, and orthopedic surgeons during surgical interventions on navicular bone fracture and accessory navicular syndrome. (J Am Podiatr Med Assoc 112(1), 2022). Full article

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Open AccessArticle

Efficacy of Lasers for the Management of Dermatophyte Toenail Onychomycosis

by Aditya K. Gupta, Maanasa Venkataraman and Emma M. Quinlan

J. Am. Podiatr. Med. Assoc. 2022, 112(1), 20236; https://doi.org/10.7547/20-236 - 1 Jan 2022

Cited by 7 | Viewed by 2078

Abstract

Background: Onychomycosis is a chronic fungal nail infection caused predominantly by dermatophytes, and less commonly by nondermatophyte molds and Candida species. Onychomycosis treatment includes oral and topical antifungals, the efficacy of which is evaluated through randomized, double-blind, controlled trials for US Food and [...] Read more.

Background: Onychomycosis is a chronic fungal nail infection caused predominantly by dermatophytes, and less commonly by nondermatophyte molds and Candida species. Onychomycosis treatment includes oral and topical antifungals, the efficacy of which is evaluated through randomized, double-blind, controlled trials for US Food and Drug Administration approval. The primary efficacy measure is complete cure (complete mycologic and clinical cure). The secondary measures are clinical cure (usually ≤10% involvement of target nail) and mycologic cure (negative microscopy and culture). Some lasers are US Food and Drug Administration approved for the mild temporary increase in clear nail; however, some practitioners attempt to use lasers to treat and cure onychomycosis. Methods: A systematic review of the literature was performed in July of 2020 to evaluate the efficacy rates demonstrated by randomized controlled trials of laser monotherapy for dermatophyte onychomycosis of the great toenail. Results: Randomized controlled trials assessing the efficacy of laser monotherapy for dermatophyte toenail onychomycosis are limited. Many studies measured cure rates by means of nails instead of patients, and performed only microscopy or culture, not both. Only one included study reported mycologic cure rate in patients as negative light microscopy and culture (0%). The combined clinical cure rates in short- and long-pulsed laser studies were 13.0%–16.7% and 25.9%, respectively. There was no study that reported the complete cure rate; however, one did report treatment success (mycologic cure [negative microscopy and culture] and ≤10% clinical involvement) in nails as 16.7%. Conclusions: The effectiveness of lasers as a therapeutic intervention for dermatophyte toenail onychomycosis is limited based on complete, mycologic, and clinical cure rates. However, it may be possible to use different treatment parameters or lasers with a different wavelength to increase the efficacy. Lasers could be a potential management option for older patients and onychomycosis patients with coexisting conditions such as diabetes, liver, and/or kidney diseases for whom systemic antifungal agents are contraindicated or have failed. (J Am Podiatr Med Assoc 112(1), 2022). Full article

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Open AccessArticle

Effect of Diluted Dakin’s Solution Versus Standard Care on Diabetic Foot Ulcer Management: A Randomized Controlled Trial

by Deema Jaber, Nidal Younes, Enam Khalil, Abla Albsoul-Younes, Ayman Mismar, Moayyad Nassar and Amal G. Al-Bakri

J. Am. Podiatr. Med. Assoc. 2022, 112(1), 20213; https://doi.org/10.7547/20-213 - 1 Jan 2022

Cited by 12 | Viewed by 364

Abstract

Background: Diabetic foot ulcers (DFUs) are the main cause of hospitalizations and amputations in diabetic patients. Failure of standard foot care is the most important cause of impaired DFU healing. Dakin’s solution (DS) is a promising broad-spectrum bactericidal antiseptic for management of DFUs. [...] Read more.

Background: Diabetic foot ulcers (DFUs) are the main cause of hospitalizations and amputations in diabetic patients. Failure of standard foot care is the most important cause of impaired DFU healing. Dakin’s solution (DS) is a promising broad-spectrum bactericidal antiseptic for management of DFUs. Studies investigating the efficacy of using DS on the healing process of DFUs are scarce. Accordingly, this is the first evidence-based, randomized, controlled trial conducted to evaluate the effect of using diluted DS compared with the standard care in the management of infected DFUs. Methods: A randomized controlled trial was conducted to assess the efficacy of DS in the management of infected DFUs. Patients were distributed randomly to the control group (DFUs irrigated with normal saline) or the intervention group (DFUs irrigated with 0.1% DS). Patients were followed for at least 24 weeks for healing, reinfection, or amputations. In vitro antimicrobial testing on DS was performed, including determination of its minimum inhibitory concentration, minimum bactericidal concentration, minimum biofilm inhibitory concentration, minimum biofilm eradication concentration, and suspension test. Results: Replacing normal saline irrigation in DFU standard care with 0.1% DS followed by soaking the ulcer with commercial sodium hypochlorite (0.08%) after patient discharge significantly improved ulcer healing (P < .001) and decreased the number of amputations and hospitalizations (P < .001). The endpoint of death from any cause (risk ratio, 0.13; P = .029) and the amputation rate (risk ratio, 0.27; P < .001) were also significantly reduced. The effect on ulcer closure (OR, 11.9; P < .001) was significantly enhanced in comparison with the control group. Moreover, DS irrigation for inpatients significantly decreased bacterial load (P < .001). The highest values for the in-vitro analysis of DS were as follows: minimum inhibitory concentration (MIC), 1.44%; minimum bactericidal concentration (MBC), 1.44%; minimum biofilm inhibitory concentration (MBIC), 2.16%; and minimum biofilm eradication concentration (MBEC), 2.87%. Conclusions: Compared with standard care, diluted DS (0.1%) was more effective in the management of infected DFUs. Dakin’s solution (0.1%) irrigation with debridement followed by standard care is a promising method in the management of infected DFUs. (J Am Podiatr Med Assoc 112(1), 2022). Full article

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Open AccessArticle

Dermoscopy for the Identification of Amelanotic Acral Melanoma

by Jenna E. Koblinski, Hadjh T. Ahrns, M. Joel Morse and Elizabeth V. Seiverling

J. Am. Podiatr. Med. Assoc. 2022, 112(1), 20184; https://doi.org/10.7547/20-184 - 1 Jan 2022

Cited by 3 | Viewed by 285

Abstract

Acral lentiginous melanoma is commonly misdiagnosed, and when detected late it portends a poor prognosis. Acral lentiginous melanoma can be mistaken for verruca, pyogenic granuloma, poroma, an ulcer, or other benign skin conditions. Patients with acral skin growths often present initially to a [...] Read more.

Acral lentiginous melanoma is commonly misdiagnosed, and when detected late it portends a poor prognosis. Acral lentiginous melanoma can be mistaken for verruca, pyogenic granuloma, poroma, an ulcer, or other benign skin conditions. Patients with acral skin growths often present initially to a podiatric physician or their primary care physician. It is at this point when the growth is triaged as benign or potentially malignant. Dermoscopy aids in this decision making. Historically, dermoscopy training has been geared toward dermatologists, but there is increasing recognition of the need for dermoscopy training in primary care and podiatric medicine. Dermoscopy is particularly helpful in pink (amelanotic) growths, which can lack the traditional clinical findings of melanoma. A literature review of acral melanoma and dermoscopy was performed in PubMed. We also describe a case of amelanotic acral melanoma in a 58-year-old with a rapidly enlarging painful mass on her heel. The lesion was initially thought to be a pyogenic granuloma and was treated with debridement (curettage). She was ultimately seen in the dermatology clinic, and the findings under dermoscopy were worrisome for amelanotic melanoma. Biopsy confirmed the diagnosis. The cancer metastasized, and the patient died less than 2 years later. (J Am Podiatr Med Assoc 112(1), 2022). Full article

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Open AccessArticle

Evaluation of Glycologic Point-of-Care Infection Test Kit for Diabetic Foot Ulcers in Relation to Bacterial Presence: A Prospective Cohort Study

by Leon Jonker, Emma Mark, Laura Singleton, Danielle Smith, Stacey Fisher and Doug Gratwohl

J. Am. Podiatr. Med. Assoc. 2022, 112(1), 20183; https://doi.org/10.7547/20-183 - 1 Jan 2022

Cited by 1 | Viewed by 113

Abstract

Background: Point-of-care testing for infection might help podiatric physicians optimize management of diabetic foot ulcers (DFUs). Glycologic’s proprietary GLYWD product has been developed to detect changes in a patient’s immunologic/inflammatory response related to wound infection. We evaluated how bacterial presence in DFUs relates [...] Read more.

Background: Point-of-care testing for infection might help podiatric physicians optimize management of diabetic foot ulcers (DFUs). Glycologic’s proprietary GLYWD product has been developed to detect changes in a patient’s immunologic/inflammatory response related to wound infection. We evaluated how bacterial presence in DFUs relates to GLYWD test outcome. Methods: This was a single-organization, prospective, controlled cohort study of clinical opinion versus GLYWD test result for DFU infection status and the appraisal of bacterial presence in the wounds and semiquantitative microbiology swab at weeks 0, 3, 6, 12, and 18. Spearman correlation, backward elimination linear regression, and principal components analysis were applied to determine which variables, including degree of bacterial load, are associated with a positive clinical opinion or GLYWD result for DFU infection. Results: Forty-eight patients were enrolled, and 142 complete wound appraisals were conducted; a consensus outcome between clinical opinion and GLYWD result was achieved in most (n = 122, 86%). Clinical opinion significantly correlated with a higher bacterial load (Spearman rho = 0.38; P < .01), whereas GLYWD did not (rho = –0.010; P = .91). This observation was corroborated with logistic regression analysis, in which a previous observation of both clinical opinion and GLYWD associating with wound purulence and erythema was also confirmed. Conclusions: Podiatric physicians are guided by hallmark signs of DFU infection, such as erythema and purulence; furthermore, we found that clinical opinion of infection correlates with increased bacterial load. GLYWD test results match clinical opinion in most cases, although the results obtained with this point-of-care method suggest that the degree of bacterial presence might not necessarily mean a higher chance of inducing an immunologic/inflammatory host response to said bacteria. (J Am Podiatr Med Assoc 112 (1), 2022). Full article

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Open AccessArticle

Evaluation of Pressure Pain Sensitivity in the Forefoot of Healthy Individuals

by Ignacio Perez-Gurbindo, Yolanda Fuentes Peñaranda, Ángel Orejana García and Ana Alvarez-Mendez

J. Am. Podiatr. Med. Assoc. 2022, 112(1), 20175; https://doi.org/10.7547/20-175 - 1 Jan 2022

Cited by 1 | Viewed by 154

Abstract

Background: The evaluation of musculoskeletal pain in podiatric medical practice is mainly based on anamnesis and manual examination. However, when manual palpation is performed, the digital pressure necessary to adequately explore the different structures of the foot is unknown. We evaluated the pressure [...] Read more.

Background: The evaluation of musculoskeletal pain in podiatric medical practice is mainly based on anamnesis and manual examination. However, when manual palpation is performed, the digital pressure necessary to adequately explore the different structures of the foot is unknown. We evaluated the pressure pain threshold in forefoot structures to determine the intensity and duration of the stimulus as clinically relevant and representative. Methods: In a transversal analytical study of 15 healthy individuals, 16 forefoot points were explored with a handheld pressure palpometer calibrated to exert maximum pressing force of 1.0 or 2.0 kilogram-force (kgf) applied during 5 or 10 sec. The combinations of the different pressures and intervals were selected randomly. Participants had to self-rate the pressure pain sensitivity of each stimuli on a 100-mm horizontal line (0–100 numeric rating scale), setting the pain threshold to 50 (100 being pain as bad as it could be). Likewise, aftersensation and referred pain patterns were recorded. Results: All participants indicated painful stimuli at some of the 16 forefoot points studied in the experimental protocol when pressure was applied with the 2.0-kgf palpometer; 53.3% showed evidence of pain at any forefoot point when the 1.0-kgf palpometer was used. The odds of evoking a painful sensation are 9.8 times higher when using a 2.0-kgf palpometer versus a 1.0-kgf palpometer. In addition, referred sensations were observed with a significantly higher frequency when applying the 2.0-kgf palpometer. Conclusions: Bone and soft structures show differences in pressure sensitivity, increasing significantly when applying higher pressure force. Soft structures, specifically intermetatarsal spaces, showed the lowest pain pressure thresholds. More research is needed to better understand pressure pain response. Full article

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Open AccessArticle

Combined Utility of the Semmes-Weinstein Monofilament and the Timed Vibration Test in the Prediction of Diabetic Foot Ulcers

by Todd O’Brien and Joseph Karem

J. Am. Podiatr. Med. Assoc. 2022, 112(1), 20174; https://doi.org/10.7547/20-174 - 1 Jan 2022

Cited by 3 | Viewed by 196

Abstract

Background: Neurologic screening tests are often used to identify and stratify patients at risk for diabetic foot complications such as infections, ulcers, and amputations. Two of the most commonly cited methods are the 5.07 Semmes-Weinstein monofilament (SWM) for loss of protective sensation [...] Read more.

Background: Neurologic screening tests are often used to identify and stratify patients at risk for diabetic foot complications such as infections, ulcers, and amputations. Two of the most commonly cited methods are the 5.07 Semmes-Weinstein monofilament (SWM) for loss of protective sensation and vibratory sensation testing. The aim of this study was to determine whether combined SWM and the timed vibration test (TVT) more effectively predicts diabetic foot ulcer (DFU) development compared with each test alone. Methods: An electronic medical record database search was performed restricted to podiatric medical clinic patients with diabetes and DFU ICD-10 diagnosis codes. Of 200 patients who met the criteria, 24 developed DFUs. A statistical analysis was performed comparing the SWM and TVT at various cutoff times and the combined SWM/TVT in their ability to predict DFUs. Results: Statistical analysis revealed that the TVT cutoff time of less than 4 sec was superior to the other times for prediction of DFUs. The combined SWM/TVT results at less than 4 sec were superior to each test individually: sensitivity, 87.5%; specificity, 84.7%; positive predictive value, 43.8%; and receiver operating characteristics area under the curve, 0.86. Conclusions: The SWM combined with TVT was shown to be superior compared with either test alone in discriminating DFU risk. In addition, the TVT cutoff time of less than 4 sec proved to have greater diagnostic yield than other times, including 0 sec. This unexpected finding might impact providers relying on the absence of vibration sensation via tuning fork testing as an optimal marker of DFU risk. Full article

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Open AccessArticle

Effect of a Topical Gel Based on Adelmidrol + Trans-Traumatic Acid in the Treatment of Diabetic Foot Ulcers: An Open-Label Study

by Ilaria Teobaldi, Vincenzo Stoico, Fabrizia Perrone, Alessandro Mantovani, Patrizia Piccagli, Fiorenza Grandi and Barbara Baldo

J. Am. Podiatr. Med. Assoc. 2022, 112(1), 20143; https://doi.org/10.7547/20-143 - 1 Jan 2022

Cited by 5 | Viewed by 130

Abstract

Background: Diabetic foot ulceration is a severe complication of diabetes characterized by chronic inflammation and impaired wound healing. This study aimed to evaluate the effect of a medical device gel based on adelmidrol + trans-traumatic acid in the healing process of diabetic [...] Read more.

Background: Diabetic foot ulceration is a severe complication of diabetes characterized by chronic inflammation and impaired wound healing. This study aimed to evaluate the effect of a medical device gel based on adelmidrol + trans-traumatic acid in the healing process of diabetic foot ulcers. Methods: Thirty-seven diabetic patients with foot ulcers of mild/moderate grade were treated with the gel daily for 4 weeks on the affected area. The following parameters were evaluated at baseline and weekly: 1) wound area, measured by drawing a map of the ulcer and then calculated with photo editing software tools, and 2) clinical appearance of the ulcer, assessed by recording the presence/absence of dry/wet necrosis, infection, fibrin, neoepithelium, exudate, redness, and granulation tissue. Results: Topical treatment led to progressive healing of diabetic foot ulcers with a significant reduction of the wound area and an improvement in the clinical appearance of the ulcers. No treatment-related adverse events were observed. Conclusions: The results of this open-label study show the potential benefits of adelmidrol ± trans-traumatic acid topical administration to promote reepithelialization of diabetic foot ulcers. Further studies are needed to confirm the observed results. (J Am Podiatr Med Assoc 112(1), 2022). Full article

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Open AccessArticle

In Vitro Antifungal Activity of Plain Socks and Zinc Oxide Nanoparticle–Coated Socks

by Waranyoo Prasong, Lalita Matthapan, Kamonpan Lertrujiwanit, Salisa Supcharoenkul, Punyawee Ongsri, Rungsima Kiratiwongwan, Charussri Leeyaphan and Sumanas Bunyaratavej

J. Am. Podiatr. Med. Assoc. 2022, 112(1), 20134; https://doi.org/10.7547/20-134 - 1 Jan 2022

Cited by 4 | Viewed by 265

Abstract

Background: Fungal foot infection is a common superficial fungal infection and is recognized as an important public health problem. Related to the wearing of occlusive footwear, foot infection is usually caused by dermatophytes and nondermatophyte molds. Previous in vitro studies have demonstrated that [...] Read more.

Background: Fungal foot infection is a common superficial fungal infection and is recognized as an important public health problem. Related to the wearing of occlusive footwear, foot infection is usually caused by dermatophytes and nondermatophyte molds. Previous in vitro studies have demonstrated that zinc oxide nanoparticles (ZnO-NPs) have antimicrobial activity against fungi. This study, therefore, evaluated the ability of socks coated with ZnONPs to inhibit fungal growth in an in vitro model mimicking real-life situations. Methods: Scale from patients with fungal foot infections was equally divided into three groups: control, plain socks, and ZnO-NP socks. The specimens in the control group were routinely fungal cultured, whereas in the plain sock and ZnO-NP sock groups, scale was incubated with plain socks and ZnO-NP socks, respectively, for 24 hours. After incubation, each piece of sock was cultured. The fungal culture results of the three groups were progressively evaluated for 4 weeks. Results: From 31 specimens, the positive fungal culture results of the control, plain sock, and ZnO-NP sock groups were 100%, 64.5%, and 54.8%, respectively. Specimens incubated with plain socks (P = .001) or with ZnO-NP socks (P < .001) had a significant reduction in the number of positive fungal cultures compared with the control. Conclusions: Plain socks and ZnO-NP socks significantly inhibited fungal growth relative to the control. The wearing of either plain socks or ZnO-NP socks can prevent fungal foot infection because these socks act as a barrier to the insoles of shoes. Full article

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Open AccessArticle

Validity and Diagnostic Accuracy of the Clarke’s Angle in Determining Pediatric Flexible Flatfoot Using Radiographic Findings as a Criterion Standard Measure: A Cross-sectional Study

by Fatma Hegazy, Emad Aboelnasr, Amr Abdel-Aziem, Ali Hassan and In-Ju Kim

J. Am. Podiatr. Med. Assoc. 2022, 112(1), 20133; https://doi.org/10.7547/20-133 - 1 Jan 2022

Cited by 1 | Viewed by 292

Abstract

Background: Clinical diagnosis of pediatric flexible flatfoot is still a challenging issue for health-care professionals. Clarke’s angle (CA) is frequently used clinically for assessing foot posture; however, there is still debate about its validity and diagnostic accuracy in evaluation of static foot [...] Read more.

Background: Clinical diagnosis of pediatric flexible flatfoot is still a challenging issue for health-care professionals. Clarke’s angle (CA) is frequently used clinically for assessing foot posture; however, there is still debate about its validity and diagnostic accuracy in evaluation of static foot posture especially in the pediatric population, with some previous studies supporting and others refuting its validity. The present study aimed to investigate the validity and diagnostic accuracy of the CA using radiographic findings as a criterion standard measure to determine flexible flatfoot between ages 6 and 18 years. Methods: A cross-sectional study of 612 participants (1224 feet) with flexible flatfoot aged 6 to 18 years (mean ± SD age, 12.36 ± 3.39 years) was recruited. The clinical measure results were compared with the criterion standard radiographic measures and displayed on the receiver operating characteristic curve, and the area under the curve was computed. Intrarater reliability, sensitivity, specificity, predictive values, and likelihood ratios were calculated for the CA. A Fagan nomogram was used to detect post-test probability. Results: The CA demonstrated higher intrarater reliability (intraclass correlation coefficient = 0.997), sensitivity (98.4%), specificity (98.8), positive predictive value (97.3), negative predictive value (99.3), positive likelihood ratio (84), and negative likelihood ratio (0.02). The area under the curve was 0.98. The positive likelihood ratio yielded a post-test probability of 97%, and the negative likelihood ratio yielded a post-test probability of 0.02. Conclusions: The CAis a valid measure with high diagnostic accuracy in the diagnosis of flexible flatfoot between ages 6 and 18 years. (JAmPodiatr Med Assoc 112(1), 2022). Full article

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Open AccessArticle

The Cotton Osteotomy as an Adjunct Procedure in Hallux Valgus and Hallux Limitus Surgery

by Lt Aaron R. Chambers, Lt Michael D. Gibboney and Kayla Y. Song

J. Am. Podiatr. Med. Assoc. 2022, 112(1), 20115; https://doi.org/10.7547/20-115 - 1 Jan 2022

Cited by 2 | Viewed by 204

Abstract

The Cotton osteotomy, as described in 1936 by Frederic Cotton, consisted of a medial cuneiform opening base wedge osteotomy. This Cotton osteotomy served to restore the “triangle of support” of the foot. In his address to the New England Surgical Society, he described [...] Read more.

The Cotton osteotomy, as described in 1936 by Frederic Cotton, consisted of a medial cuneiform opening base wedge osteotomy. This Cotton osteotomy served to restore the “triangle of support” of the foot. In his address to the New England Surgical Society, he described this osteotomy as being multipurpose; it can be used for plantarflexion in hallux valgus surgery and has use in hallux rigidus conditions. Since its inception, the procedure has become a popular adjunct to aid in the restoration of the medial column deformity present in pes planus. Recently, there has been renewed interest in the use of the procedure to aid in the correction of deformities involving metatarsus primus elevatus, specifically, hallux valgus and hallux limitus. The advantage of the use of this procedure as opposed to others is that it allows for the preservation and/or restoration of first ray length and the preservation of motion at the medial column. In retrospective review, the authors evaluated seven cases with a 1-year follow-up. In this series of cases, the Cotton osteotomy was performed as an adjunct to common hallux valgus procedures or hallux limitus corrections. Radiographic review was also performed evaluating for initial evidence of radiographic bone-graft healing and patient weightbearing. Although not without its own limitations, the Cotton osteotomy offers several advantages with minimal complications, proving to be a valuable underused resource in the foot and ankle surgeon’s toolkit. (J Am Podiatr Med Assoc 112(1), 2022). Full article

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Open AccessArticle

Qualitative Analysis of Risk Factors and Foot and Ankle Injuries in Ballet Dancers

by Bryanna Vesely, Tyler Rodericks, Sarah Mansager, Charles Zillweger and David Shofler

J. Am. Podiatr. Med. Assoc. 2022, 112(1), 20108; https://doi.org/10.7547/20-108 - 1 Jan 2022

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Abstract

Background: Ballet dancers are exposed to high rates of foot and ankle injury. Nevertheless, there have been limited efforts to capture their perspectives regarding risk of injury, treatment compliance, and prevention. The purpose of this study was to portray the perspectives of [...] Read more.

Background: Ballet dancers are exposed to high rates of foot and ankle injury. Nevertheless, there have been limited efforts to capture their perspectives regarding risk of injury, treatment compliance, and prevention. The purpose of this study was to portray the perspectives of ballet dancers collected through organized focus group discussions. Methods: Seven focus group sessions were conducted, with 47 ballet dancers participating. The conversation was directed to consider a variety of factors related to injury, both direct and remote. Transcripts from these focus groups were coded into ten major themes: internal pressure, external pressure, ballet milestones, seeking treatment, treatment compliance, targeted treatment, return to dance, nondance activities, physical fatigue, and activity preparation. Results: It was found that participants returned to dancing prematurely after injury, faced significant internal and external pressure, lacked adherence to suggested treatment, and identified provider communication as lacking. Conclusions: The results of this study can help with efforts to reduce injuries, encourage treatment compliance, and improve injury prevention. Future studies might consider the effectiveness of specific interventional approaches. Full article

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Open AccessArticle

Evaluation of the Correlation Between Flamenco Dance and Ankle and Foot Posture

by Aurora Castro-Méndez, Desidero Mateos-Martínez, José M. Castillo-López and Alfonso Vargas-Macías

J. Am. Podiatr. Med. Assoc. 2022, 112(1), 20078; https://doi.org/10.7547/20-078 - 1 Jan 2022

Cited by 3 | Viewed by 208

Abstract

Background: The practice of flamenco dance involves great biomechanical demands, comparable with a high-performance sport. The technical movements of the footwork tap, the jumps, and the turns increase the prevalence of injuries and pathologic disorders of the foot and lower limb. Limited [...] Read more.

Background: The practice of flamenco dance involves great biomechanical demands, comparable with a high-performance sport. The technical movements of the footwork tap, the jumps, and the turns increase the prevalence of injuries and pathologic disorders of the foot and lower limb. Limited research has examined adaptation of the foot posture and dorsiflexion of the ankle in flamenco dancing. Therefore, the aim of this study was to evaluate whether the practice of flamenco dancing produces modifications in the ankle’s dorsiflexion range of motion, Foot Posture Index, or pronation. Methods: A cross-sectional observational study with intentional sampling was performed with 26 individuals (52 feet) in two groups: professional female flamenco dancers (n = 13) and nondancers (n = 13). The participants were assessed in a single session for ankle dorsiflexion, foot pronation (navicular drop test), and foot posture (Foot Posture Index). Results: Significant differences were found between the two groups for left foot Foot Posture Index (P = .007) and right foot navicular drop test (P = .006). Conclusions: The results of this study indicate that flamenco dancing can produce modifications in the Foot Posture Index and foot pronation versus nondancers. Further research is required. (J Am Podiatr Med Assoc 112(1), 2022). Full article

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Open AccessArticle

Comparison of Self-adhesive Taping and Short-Leg Casting to Treat Tuberosity Fractures of the Proximal Fifth Metatarsal: A Prospective Study

by Sefa Batıbay, Serkan Bayram, Sedat Duman, Kayahan Karaytuğ and Savas Camur

J. Am. Podiatr. Med. Assoc. 2022, 112(1), 20068; https://doi.org/10.7547/20-068 - 1 Jan 2022

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Abstract

Background: The aim of this study is to compare clinical and radiologic outcomes of self-adhesive taping (SAT) or a short- leg cast (SLC) groups with base of fifth metatarsi. Methods: Functional outcome was assessed by the Visual-Analogue-Scale Foot and Ankle (VAS-FA) [...] Read more.

Background: The aim of this study is to compare clinical and radiologic outcomes of self-adhesive taping (SAT) or a short- leg cast (SLC) groups with base of fifth metatarsi. Methods: Functional outcome was assessed by the Visual-Analogue-Scale Foot and Ankle (VAS-FA) at the Emergency and at 2, 4, 6, and 12 weeks. Labour loss, bone union and The American Orthopedic Foot and Ankle Score (AOFAS) at 12 weeks were also assessed. Results: There was no difference between the SAT group and SLC group in VAS-FA scores at time of injury, 6 and 12 weeks. The SAT group had a significantly higher mean VAS-FA score at the second and fourth weeks of follow-up compared with the SLC group (P = .001 and P = .039, respectively). No correlation was observed between the fracture gap and functional scores for both groups. There was no difference in AOFAS between two groups at 12 weeks. Twenty one patients were unable to work for a mean of 38.2 days during the treatment. 10 patients with the SAT missed 37.5 days and eleven patients with the SLC g missed 40.2 (p: 0.41). The bone union was also achieved for all patients within 12 weeks. Conclusion: Treatment with SAT in these fractures had satisfactory functional results compared with traditional SLC. Although there were no significant differences in labor loss and use of assistive devices, The VAS-FA score was significantly higher in SAT group than the SLC group at the second and fourth weeks of treatment. (J Am Podiatr Med Assoc 112(1), 2022). Full article

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Open AccessArticle

Clinical and Histologic Evaluation of Partial Achilles Tendon Injury Repair with Amniotic Membrane in Rats

by Nurettin Manti, Yilmaz Guvercin, Tolga Mercantepe, Levent Tumkaya and Mehmet Sabri Balik

J. Am. Podiatr. Med. Assoc. 2022, 112(1), 20055; https://doi.org/10.7547/20-055 - 1 Jan 2022

Cited by 7 | Viewed by 164

Abstract

Background: Adhesions after tendinopathy in individuals who perform physical work and those physically active in middle age are a challenging problem for orthopedic surgeons. We evaluated the effects of human-derivated amniotic membrane on tendon healing, adhesions, angiogenesis, and the inflammatory process. Methods [...] Read more.

Background: Adhesions after tendinopathy in individuals who perform physical work and those physically active in middle age are a challenging problem for orthopedic surgeons. We evaluated the effects of human-derivated amniotic membrane on tendon healing, adhesions, angiogenesis, and the inflammatory process. Methods: Thirty-five rats were divided evenly into five groups, and the left lower extremity was used in this study. No interventions were applied to the control group (group 5). In the other groups, Achilles tendons were partially cut to the midline. Then, primary repair (group 1), amniotic membrane treatment with no repair (group 2), primary repair and amniotic membrane treatment (group 3), or secondary healing with no repair (group 4) was performed. Results: Use of amniotic membrane in tendon healing resulted in decreased adhesion formation and positive effects on collagen sequencing and anti-inflammatory effects. In addition, for the vascular endothelial growth factor evaluation there was no difference among the amniotic membrane repair groups, but there was an increase in vascular endothelial growth factor positivity compared with the control group. Conclusions: These data show that amniotic membrane treatment can alter biological behavior and induce surface-dependent angiogenesis and can have angiogenetic effects on ischemia and inflammation. (J Am Podiatr Med Assoc 112(1), 2022). Full article

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Open AccessArticle

A Focus on Amputation Level: Factors Preventing Length Preservation in the National Inpatient Sample

by Kenneth L. Fan, Jenna C. Bekeny, Christopher J. Kennedy, Elizabeth G. Zolper, John S. Steinberg, Christopher E. Attinger, Karen K. Evans and Derek DeLia

J. Am. Podiatr. Med. Assoc. 2022, 112(1), 20028; https://doi.org/10.7547/20-028 - 1 Jan 2022

Cited by 4 | Viewed by 152

Abstract

Background: Diabetic lower-extremity disease is the primary driver of mortality in patients with diabetes. Amputations at the forefoot or ankle preserve limb length, increase function, and, ultimately, reduce deconditioning and mortality compared with higher-level amputations, such as below-the-knee amputations (BKAs). We sought [...] Read more.

Background: Diabetic lower-extremity disease is the primary driver of mortality in patients with diabetes. Amputations at the forefoot or ankle preserve limb length, increase function, and, ultimately, reduce deconditioning and mortality compared with higher-level amputations, such as below-the-knee amputations (BKAs). We sought to identify risk factors associated with amputation level to understand barriers to length-preserving amputations (LPAs). Methods: Diabetic lower-extremity admissions were extracted from the 2012-2014 National Inpatient Survey using ICD-9-CM diagnosis codes. The main outcome was a two-level variable consisting of LPAs (transmetatarsal, Syme, and Chopart) versus BKAs. Logistic regression analysis was used to determine contributions of patient- and hospital-level factors to likelihood of undergoing LPA versus BKA. Results: The study cohort represented 110,355 admissions nationally: 42,375 LPAs and 67,980 BKAs. The population was predominantly white (56.85%), older than 50 years (82.55%), and male (70.38%). On multivariate analysis, living in an urban area (relative risk ratio [RRR] = 1.48; P < .0001) and having vascular intervention in the same hospital stay (RRR = 2.96; P < .0001) were predictive of LPA. Patients from rural locations but treated in urban centers were more likely to receive BKA. Minorities were more likely to present with severe disease, limiting delivery of LPAs. A high Elixhauser comorbidity score was related to BKA receipt. Conclusions: This study identifies delivery biases in amputation level for patients without access to large, urban hospitals. Rural patients seeking care in these centers are more likely to receive higher-level amputations. Further examination is required to determine whether earlier referral to multidisciplinary centers is more effective at reducing BKA rates versus satellite centers in rural localities. (J Am Podiatr Med Assoc 112(1), 2022). Full article

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Open AccessArticle

Arch Height Index, Arch Rigidity Index, and Arch Stiffness Values in a Symptomatic Population

by Megan E.R. Balsdon, Michaela Khan, Dillon Richards and Colin E. Dombroski

J. Am. Podiatr. Med. Assoc. 2022, 112(1), 19154; https://doi.org/10.7547/19-154 - 1 Jan 2022

Cited by 8 | Viewed by 202

Abstract

Background: Studies of arch height index (AHI), arch rigidity index (ARI), and arch stiffness have primarily focused on healthy populations. Normative values of the aforementioned measurements in a pathologic sample may be useful in identifying relationships between arch structure and pathology. Methods [...] Read more.

Background: Studies of arch height index (AHI), arch rigidity index (ARI), and arch stiffness have primarily focused on healthy populations. Normative values of the aforementioned measurements in a pathologic sample may be useful in identifying relationships between arch structure and pathology. Methods: AHI was obtained bilaterally at 10% and 90% weightbearing conditions using the AHI measurement system. ARI and arch stiffness were calculated using AHI measurements. Dependent t tests compared right and left, dominant and nondominant, and injured and noninjured limbs. Dominant feet were compared between sexes using independent t tests. Relationships between arch stiffness and subcategories were examined using the coefficient of determination (R²). One-way analyses of variance determined differences between arch structure and number of pathologies or body mass index (BMI). Results: A total of 110 participants reported one (n = 55), two (n = 38), or three or more (n = 17) pathologies. Plantar fasciitis (n = 31) and hallux valgus (n = 28) were the most common. AHI, ARI, and arch stiffness did not differ between limbs or sexes for any comparisons. Between subgroups of BMI and number of pathologies, BMI influenced AHI (10% weightbearing) and arch stiffness (P < .05). Arch stiffness showed a weak relationship to AHI, where a higher AHI was associated with a stiffer arch (R² = 0.06). Conclusions: Normative arch structure values were established in a pathologic sample with a large incidence of plantar fasciitis and hallux valgus. Understanding relationships between arch structure and pathology is helpful for clinicians and researchers. Full article

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Open AccessArticle

Radiotherapy for Plantar Fibromas (Ledderhose Disease)

by John D. Mozena, Eric K. Hansen and Paul Clint Jones

J. Am. Podiatr. Med. Assoc. 2022, 112(1), 19008; https://doi.org/10.7547/19-008 - 1 Jan 2022

Cited by 6 | Viewed by 746

Abstract

Ledderhose disease (plantar fibromas) is histologically related to Dupuytren disease, which has been successfully treated for years with radiotherapy. Many conservative treatments have been advanced for plantar fibromas, including accommodative orthotic devices, which help but do not cure the disease. Surgery is considered [...] Read more.

Ledderhose disease (plantar fibromas) is histologically related to Dupuytren disease, which has been successfully treated for years with radiotherapy. Many conservative treatments have been advanced for plantar fibromas, including accommodative orthotic devices, which help but do not cure the disease. Surgery is considered the mainstay of treatment for this malady, but the failure rate has been as high as 100%, depending on the type of fasciectomy. Radiotherapy is a new, exciting modality that has shown promising results for treating plantar fibromas. Full article

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Open AccessArticle

Knee Pain Reduction Using a Shock-Absorbing Sole

by Arnold S. Ross and Lester J. Jones

J. Am. Podiatr. Med. Assoc. 2022, 112(1), 17224; https://doi.org/10.7547/17-224 - 1 Jan 2022

Viewed by 130

Abstract

Background: The biomechanics of the foot and leg are responsible for shock absorption during human gait. Lack of shock absorption is known to be a key component of knee pain. This study compares a new model of shoe sole with a built-in [...] Read more.

Background: The biomechanics of the foot and leg are responsible for shock absorption during human gait. Lack of shock absorption is known to be a key component of knee pain. This study compares a new model of shoe sole with a built-in modification intended to absorb shock with a traditional sole shoe to examine whether shoe design modifications can help alleviate knee pain. Methods: A double-blind randomized controlled study was performed. Fifty-two adults with overuse symptoms of knee pain, either unilateral or bilateral, were enrolled and randomly assigned to use the intervention sole or the traditional sole shoes. For 5 weeks, participants wore either the shoe with the intervention sole or the shoe with the traditional sole, rating their knee pain on a 10-point visual analog scale at study onset, midway, and study completion. Results: After 5 weeks, participants using the intervention sole shoe reported an average reduction in knee pain of 85%, significantly better than participants using the traditional sole shoe (P < .001), whose average pain scores increased. Positive effects on back and foot pain were also observed in those with the intervention sole shoe compared with the traditional sole shoe. Conclusions: The intervention shock-absorbing sole represents an approach to midsole and outsole construction that can potentially increase shock absorption and decrease knee pain during prolonged standing and walking. (J Am Podiatr Med Assoc 112(1), 2022). Full article

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J. Am. Podiatr. Med. Assoc., Volume 112, Issue 1 (01 2022) – 20 articles

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