Journal of the American Podiatric Medical Association

725 KB

Open AccessArticle

A Technical Review of Foot Temperature Measurement Systems

by Josef Grech, Stephen Mizzi and Owen Falzon

J. Am. Podiatr. Med. Assoc. 2022, 112(2), 21065; https://doi.org/10.7547/21-065 - 1 Mar 2022

Cited by 6 | Viewed by 247

People suffering from diabetes are at risk of developing foot ulcerations which, if left untreated, could also lead to amputation. Monitoring of the foot temperature can help in the prevention of these foot complications, and various studies have shown that elevated temperatures may [...] Read more.

People suffering from diabetes are at risk of developing foot ulcerations which, if left untreated, could also lead to amputation. Monitoring of the foot temperature can help in the prevention of these foot complications, and various studies have shown that elevated temperatures may be indicative of ulceration. Over the years, there have been various devices that were designed for foot temperature monitoring, for both clinical and home use. The technologies used included infrared thermometry, liquid crystal thermography, infrared thermography, and a vast range of analogue and digital temperature sensors incorporated into different measurement platforms. All these systems are able to collect thermal data from the foot, with some being able to acquire data only when the foot is stationary and others being able to acquire data from the foot in motion, which can give more in-depth insight into any emerging problems. The aim of this review is to evaluate the available literature related to the technologies used in these systems, outlining the benefits of each and what further developments may be required to make the foot temperature analysis more effective. Full article

► Show Figures

Figure 1

555 KB

Open AccessArticle

Total Dystrophic Onychomycosis Successfully Treated with Efinaconazole Topical Solution in Times of Coronavirus Disease of 2019: A Case Study

by Matthew G. Garoufalis

J. Am. Podiatr. Med. Assoc. 2022, 112(2), 21050; https://doi.org/10.7547/21-050 - 1 Mar 2022

Viewed by 661

Abstract

Toenail onychomycosis is a common condition that is equally challenging for podiatrists and patients. This case study documents a 26-year-old woman with bilateral total dystrophic onychomycosis of at least 5 years’ duration. She had previously failed to respond to treatment with ciclopirox nail [...] Read more.

Toenail onychomycosis is a common condition that is equally challenging for podiatrists and patients. This case study documents a 26-year-old woman with bilateral total dystrophic onychomycosis of at least 5 years’ duration. She had previously failed to respond to treatment with ciclopirox nail lacquer 8% and, despite hiding her condition with nail polish, was suffering from embarrassment, distress, and low self-esteem. At initial consultation, 100% of both great toenails was affected. After discussion of all treatment options, the patient opted for topical efinaconazole 10% solution, once daily for 48 weeks. Significant improvement was noted at the first (4-week) assessment period. This improvement was maintained through each subsequent virtual consultation, and complete cure was seen at a 30-week follow-up visit. To the author’s knowledge, this is the first published report on the use of efinaconazole in total dystrophic onychomycosis. It suggests that the product may be effective in patients with even the most severe and treatment-recalcitrant disease, who are unwilling or unable to tolerate systemic antifungal therapy. (J Am Podiatr Med Assoc 112(2), 2022). Full article

► Show Figures

Figure 1

330 KB

Open AccessArticle

Avoiding the Deep Plantar Arterial Arch in Transmetatarsal Amputations: A Cadaver Study

by James H. Whelan, Caroline R. Kiser, John P. Lazoritz and Vassilios Vardaxis

J. Am. Podiatr. Med. Assoc. 2022, 112(2), 20298; https://doi.org/10.7547/20-298 - 1 Mar 2022

Cited by 1 | Viewed by 132

Abstract

Background: The deep plantar arterial arch (DPAA) is formed by an anastomosis between the deep plantar artery and the lateral plantar artery. The potential risk of injury to the DPAA is concerning when performing transmetatarsal amputations, and care must be taken to preserve [...] Read more.

Background: The deep plantar arterial arch (DPAA) is formed by an anastomosis between the deep plantar artery and the lateral plantar artery. The potential risk of injury to the DPAA is concerning when performing transmetatarsal amputations, and care must be taken to preserve the anatomy. We sought to determine the positional anatomy of the DPAA based on anatomical landmarks that could be easily identified and palpated during transmetatarsal amputation. Methods: In an effort to improve our understanding of the positional relationship of the DPAA to the distal metatarsal parabola, dissections were performed on 45 cadaveric feet to measure the location of the DPAA with respect to the distal metatarsal epiphyses. Images of the dissected specimens were digitally acquired and saved for measurement using inhouse– written software. The mean, SD, SEM, and 95% confidence interval were calculated for all of the measurement parameters and are reported on pooled data and by sex. An independent- samples t test was used to assess for sex differences. Interrater reliability of the measurements was estimated using the intraclass correlation coefficient. Results: The origin of the DPAA was located a mean ± SD of 35.6 ± 3.9 mm (95% confidence interval, 34.5–36.8 mm) proximal to the perpendicular line connecting the first and fifth metatarsal heads. The average interrater reliability across all of the measurements was 0.921. Conclusions: This study provides the positional relationship of the DPAA with respect to the distal metatarsal parabola. This method is easily reproducible and may assist the foot and ankle surgeon with surgical planning and approach when performing partial pedal amputation. (J Am Podiatr Med Assoc 112(2), 2022). Full article

► Show Figures

Figure 1

1549 KB

Open AccessArticle

Staged Treatment for Unstable Open Fracture-Dislocation of the Ankle: A Case Report

by Jin Park, Hyo Beom Lee, Gab Lae Kim and Kyu Hyun Yang

J. Am. Podiatr. Med. Assoc. 2022, 112(2), 20255; https://doi.org/10.7547/20-255 - 1 Mar 2022

Cited by 1 | Viewed by 265

Abstract

Unstable fracture-dislocation of the ankle is a common lower-extremity injury. Treatment is challenging when the fracture-dislocation is open and cannot be treated with conventional open reduction and internal fixation (ORIF). Immediate ORIF may not be possible for severe, unstable ankle injuries, such as [...] Read more.

Unstable fracture-dislocation of the ankle is a common lower-extremity injury. Treatment is challenging when the fracture-dislocation is open and cannot be treated with conventional open reduction and internal fixation (ORIF). Immediate ORIF may not be possible for severe, unstable ankle injuries, such as those with ischemic foot because of a poor blood supply caused by soft-tissue injury, or open fracture-dislocation of the ankle with a deltoid ligament rupture. We describe a staged treatment for unstable open fracture-dislocation of the ankle with a deltoid ligament rupture. The first stage involves temporary vertical transarticular pinning combined with external fixation. The second stage involves delayed definitive plating with autogenous bone graft for the bone defect of the distal fibula. This staged management is useful in select emergency cases of unstable open fracture-dislocations of the ankle combined with deltoid ligament rupture for which conventional ORIF cannot be performed. (J Am Podiatr Med Assoc 112(2), 2022). Full article

► Show Figures

Figure 1

455 KB

Open AccessArticle

Acute-Onset Footdrop Caused by Intraneural Ganglion Cyst of the Common Peroneal Nerve: The Effects of Extraneural Pressure Gradients on Cyst Propagation

by Samantha L. Williams, James T. Clancy and Daniel S. Williamson

J. Am. Podiatr. Med. Assoc. 2022, 112(2), 20252; https://doi.org/10.7547/20-252 - 1 Mar 2022

Cited by 1 | Viewed by 178

Abstract

Ganglion cysts are relatively common entities, but intraneural ganglia within peripheral nerves are rare and poorly understood. We present a case of a 51-year-old man who presented with acute left dropfoot. Initial magnetic resonance imaging (MRI) was misinterpreted as common peroneal neuritis consistent [...] Read more.

Ganglion cysts are relatively common entities, but intraneural ganglia within peripheral nerves are rare and poorly understood. We present a case of a 51-year-old man who presented with acute left dropfoot. Initial magnetic resonance imaging (MRI) was misinterpreted as common peroneal neuritis consistent with a traction injury corroborated by the patient’s history. However, after surgical decompression and external neurolysis were performed, the patient’s symptoms worsened. Repeated MRI revealed an intraneural ganglion cyst of the common peroneal nerve with connection to the superior tibiofibular joint by means of its anterior recurrent branch that was evident retrospectively on preoperative MRI. It is crucial to carefully inspect atypical cases to further recognize and appreciate the dynamic aspect of this disease or “roller-coaster” phenomenon. Intraneural ganglion cysts rely heavily on intraneural and extraneural pressure gradients for propagation, which can be drawn from the expanded work of the unifying articular theory. This report emphasizes the importance of understanding the pathoanatomical and hydraulic factors to appropriately identify and treat intraneural ganglion cysts. Increased recognition of this pathologic entity as a differential diagnosis for acute onset dropfoot is also highlighted. (J Am Podiatr Med Assoc 112(2), 2022). Full article

► Show Figures

Figure 1

539 KB

Open AccessArticle

Ultrasound-Guided Partial Plantar Fascia Release with the Use of a Fine Cutting Device for the Treatment of Persistent Plantar Fasciitis. A Case Series

by Michael-Alexander Malahias, Leonidas Roumeliotis, Evangelos Tyrpenou, Sotirios-Tsambikos Kazas, Ioannis Sourlas and Maria-Kyriaki Kaseta

J. Am. Podiatr. Med. Assoc. 2022, 112(2), 20244; https://doi.org/10.7547/20-244 - 1 Mar 2022

Cited by 3 | Viewed by 232

Abstract

Background: Plantar fasciitis is a common cause of musculoskeletal discomfort. Minimally invasive interventions are preferred as second-line treatments following failure of conservative management. We report on a novel technique of ultrasound-guided percutaneous release of the medial third of the plantar fascia with the [...] Read more.

Background: Plantar fasciitis is a common cause of musculoskeletal discomfort. Minimally invasive interventions are preferred as second-line treatments following failure of conservative management. We report on a novel technique of ultrasound-guided percutaneous release of the medial third of the plantar fascia with the use of a fine cutting device for the treatment of persistent plantar fasciitis. Methods: This is a retrospective case series of all patients treated with the technique between 2013 and 2015. Patients had failed conservative management for a minimum of 6 months. The procedure was performed in an outpatient setting under local anesthesia. Under continuous ultrasound guidance, release of the medial third of the plantar fascia from the calcaneus was performed using an ophthalmic V-Lance knife through a medial stab wound entry point. Results: Fifteen patients (six men and nine women) with an average age of 54.7 years were included. The mean (standard deviation [SD]) visual analogue scale score for pain improved significantly, from 66.0 (SD, 18.8) preoperatively to each consecutive follow-up point: 29.3 (SD, 25.2) at 2 weeks, 30.0 (SD, 27.8) at 4 weeks, and 34.0 (SD, 26.1) at 12 weeks (P < .001). The mild increase in visual analogue scale score between 4 and 12 weeks was statistically significant (P = .018). Average duration of required analgesia was 5.5 days and average time required to return to usual activities was 5.7 days. Two patients suffered with refractory neuropathic pain over the lateral border of the foot without any obvious abnormality. Conclusions: Ultrasound-guided percutaneous release with the use of a fine cutting device could be an alternative option for the treatment of persistent plantar fasciitis. The technique is not without complications, and a mild but statistically significant decline in pain levels from early to short term has been detected. Therefore, the long-term outcomes of this technique need to be investigated before we can advocate its routine use. (J Am Podiatr Med Assoc 112(2), 2022). Full article

► Show Figures

Figure 1

661 KB

Open AccessArticle

Efficacy of a Newly Developed Inward Airflow Safety Cabinet to Prevent the Spread of Infected Nail Dust Particles During Mechanical Nail Reduction in Onychomycosis

by Waranyoo Prasong, Lalita Matthapan, Sumanas Bunyaratavej, Charussri Leeyaphan, Kamonpan Lertrujiwanit and Salisa Supcharoenkul

J. Am. Podiatr. Med. Assoc. 2022, 112(2), 20200; https://doi.org/10.7547/20-200 - 1 Mar 2022

Cited by 2 | Viewed by 124

Abstract

Background: Nail thickening is a poor prognostic factor in onychomycosis. Mechanical reduction by micromotor nail grinding is an alternative treatment for onychomycosis. However, this treatment introduces a large amount of infected nail dust particles into the air and can adversely affect other patients [...] Read more.

Background: Nail thickening is a poor prognostic factor in onychomycosis. Mechanical reduction by micromotor nail grinding is an alternative treatment for onychomycosis. However, this treatment introduces a large amount of infected nail dust particles into the air and can adversely affect other patients and health-care providers. The innovative recirculating airflow safety cabinet (ASC) was developed to prevent the spread of these generated infected nail dust particles. The aim of this study was to determine the efficacy of the ASC in patients with onychomycosis or traumatic onychodystrophy. Methods: The ASC was used during the nail-grinding process in 50 patients, including 36 onychomycosis patients and 14 traumatic onychodystrophy patients. For each patient, five Sabouraud dextrose agar plates with chloramphenicol were positioned within the working space of the ASC, and the other five plates were positioned near the area of air exit after the carbon filters within the cabinet. A total of 500 plates were incubated at 25°C and evaluated every 7 days. The results of fungal cultures were analyzed. Results: In the traumatic onychodystrophy group, all fungal cultures of nail dust particles from both before and after filtration from the ASC were negative in all 14 patients. In the onychomycosis group, 52 fungal cultures (28.9%) from nail particles within the ASC working area tested positive; however, the results of fungal cultures of nail dust particles after filtration were all negative. Conclusions: The newly developed ASC was found to be effective for preventing the spread of infected nail dust particles generated by micromotor nail grinding to mechanically reduce nail thickness in patients with onychomycosis. Full article

► Show Figures

Figure 1

672 KB

Open AccessArticle

Assessment of Flap Viability for Complex Transmetatarsal Amputation Using Indocyanine Green Fluorescent Angiography: A Case Study

by Clark K. Brackney, Ivo A. Pestana, Hayden L. Hoffler and Cody D. Blazek

J. Am. Podiatr. Med. Assoc. 2022, 112(2), 20198; https://doi.org/10.7547/20-198 - 1 Mar 2022

Cited by 2 | Viewed by 127

Abstract

Despite advancements in the treatment of diabetic patients with “at-risk” limbs, minor and major amputations remain commonplace. The diabetic population is especially prone to surgical complications from lower extremity amputation because of comorbidities such as renal disease, hypertension, hyperlipidemia, microvascular and macrovascular disease, [...] Read more.

Despite advancements in the treatment of diabetic patients with “at-risk” limbs, minor and major amputations remain commonplace. The diabetic population is especially prone to surgical complications from lower extremity amputation because of comorbidities such as renal disease, hypertension, hyperlipidemia, microvascular and macrovascular disease, and peripheral neuropathy. Complication occurrence may result in increases in hospital stay duration, unplanned readmission rate, mortality rate, number of operations, and incidence of infection. Skin flap necrosis and wound healing delay secondary to inadequate perfusion of soft tissues continues to result in significant morbidity, mortality, and cost to individuals and the health-care system. Intraoperative indocyanine green fluorescent angiography for the assessment of tissue perfusion may be used to assess tissue perfusion in this patient population to minimize complications associated with amputations. This technology provides real-time functional assessment of the macrovascular and microvascular systems in addition to arterial and venous flow to and from the flap soft tissues. This case study explores the use of indocyanine green fluorescent angiography for the treatment of a diabetic patient with a large dorsal and plantar soft-tissue deficit and need for transmetatarsal amputation with nontraditional rotational flap coverage. The authors theorize that the use of indocyanine green may decrease postoperative complications and cost to the health-care system through fewer readmissions and fewer procedures. (J Am Podiatr Med Assoc 112(2), 2022). Full article

► Show Figures

Figure 1

329 KB

Open AccessArticle

Effect of Sensory Neuropathy on the Predictive Value of Inflammatory Biomarkers for Osteomyelitis in Diabetic and Nondiabetic Patients with Foot Infections

by Easton Ryan, Junho Ahn, Dane K. Wukich, Javier La Fontaine, Peter A. Crisologo, Matthew Malone, Orhan K. Oz and Lawrence A. Lavery

J. Am. Podiatr. Med. Assoc. 2022, 112(2), 20168; https://doi.org/10.7547/20-168 - 1 Mar 2022

Cited by 7 | Viewed by 106

Abstract

Objective: To investigate the predictive value of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) in persons with and without diabetes with osteomyelitis (OM). Methods: We evaluated 455 patients in a retrospective cohort study of patients admitted to the hospital with diabetic foot [...] Read more.

Objective: To investigate the predictive value of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) in persons with and without diabetes with osteomyelitis (OM). Methods: We evaluated 455 patients in a retrospective cohort study of patients admitted to the hospital with diabetic foot OM (n = 177), diabetic foot soft-tissue infections (STIs) (n = 176), nondiabetic OM (n = 51), and nondiabetic STIs (n = 51). Infection diagnosis was determined through bone culture, histopathologic examination for OM, and/or imaging (magnetic resonance imaging/single-photon emission computed tomography) for STI. The optimal cutoff values of ESR and CRP in predicting OM were determined by receiver operating characteristic curve analysis. Sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios were determined through contingency tables. Results: In persons without diabetes with STI or OM, the mean ESR and CRP differences were 10.0 mm/h and 2.6 mg/dL, respectively. In contrast, persons with diabetes had higher levels of each: 24.8 mm/h and 6.8 mg/dL, respectively. As a result, ESR and CRP predicted OM better in patients with diabetes. However, when patients were stratified by neuropathy status, ESR remained predictive of OM in diabetic patients with neuropathy (75% sensitivity, 58% specificity) but not in diabetic patients without neuropathy (50% sensitivity, 44% specificity). Also, CRP remained predictive irrespective of neuropathy status. A similar trend was observed in patients without diabetes. Conclusions: Previous studies have reported that ESR and CRP are predictive of OM. However, this study suggests that neuropathy influences the predictive value of inflammatory biomarkers. The underlying mechanisms require further study. Full article

► Show Figures

Figure 1

1097 KB

Open AccessArticle

Plantar Vein Thrombosis in the Medial Branch of the Posterior Tibial Vein: A Case Report

by Reem N. Sheikh, Christopher Nguyen and Michelle Cummins

J. Am. Podiatr. Med. Assoc. 2022, 112(2), 20158; https://doi.org/10.7547/20-158 - 1 Mar 2022

Cited by 2 | Viewed by 169

Abstract

Plantar vein thrombosis (PVT) is an atypical cause of plantar heel pain and is seldom reported in the literature. We present a unique, rare case report of a patient exhibiting plantar heel and medial arch pain caused by thrombosis in the plantar medial [...] Read more.

Plantar vein thrombosis (PVT) is an atypical cause of plantar heel pain and is seldom reported in the literature. We present a unique, rare case report of a patient exhibiting plantar heel and medial arch pain caused by thrombosis in the plantar medial branch of the posterior tibial vein. The diagnosis was made by means of magnetic resonance imaging, showing lobulated hypointensity in the medial plantar vein, consistent with a PVT. In this article, we provide an overview of the clinical signs of PVT, which is most commonly plantar heel pain. Furthermore, we discuss ultrasound and magnetic resonance imaging as diagnostic modalities, and conservative treatment options, including anti-inflammatory medications, anticoagulation therapy, and compression therapy. As with other types of venous thromboembolism, this condition must also be diagnosed without delay to avoid potential complications. (J Am Podiatr Med Assoc 112(2), 2022). Full article

► Show Figures

Figure 1

1100 KB

Open AccessArticle

Efficacy and Reliability of Percutaneous Gigli Saw Osteotomy in Midfoot Surgery: A Cadaver Study

by Muharrem Kanar, Rodi Ertogrul, Yunus Oc, Elif Nedret Keskinöz and Bekir Eray Kilinc

J. Am. Podiatr. Med. Assoc. 2022, 112(2), 20156; https://doi.org/10.7547/20-156 - 1 Mar 2022

Cited by 1 | Viewed by 136

Abstract

Background: Midfoot osteotomy is often used in the surgical treatment of foot deformities. The percutaneous Gigli saw osteotomy (PGSO) technique has many advantages compared with known osteotomy techniques. We aimed to show the efficacy and reliability of the PGSO technique in the midfoot [...] Read more.

Background: Midfoot osteotomy is often used in the surgical treatment of foot deformities. The percutaneous Gigli saw osteotomy (PGSO) technique has many advantages compared with known osteotomy techniques. We aimed to show the efficacy and reliability of the PGSO technique in the midfoot of fresh frozen cadavers without using an image intensifier. Methods: Four mini-incisions were performed on the dorsomedial, dorsolateral, plantar medial, and plantar lateral regions of the midfoot. Subperiosteal tunnels were then opened with a thin bone elevator, and the four incisions were combined with each other. The Gigli saw was tied to suture material and passed through the tunnels. The PGSO was performed in the midfoot of 12 feet of the cadaver specimens without using an image intensifier. Cadaver specimens were dissected, and injured structures were noted. Results: The mean ± SD (range) cadaver age was 81.16 ± 10.38 years (65–93 years) and weight was 60.86 ± 12.39 kg (49.8–81.6 kg). All of the osteotomies were adequate as planned in the cuboid-cuneiform level and all of them were complete osteotomy .Incomplete osteotomy was not observed in any cadaver specimens. In one specimen, a complete injury of the peroneal tendons (peroneus longus and brevis) was detected. In another specimen, an incomplete tibialis anterior tendon injury was detected. There was no iatrogenic neurovascular injury in the specimens. Conclusions: The PGSO technique is recommended for use even by inexperienced surgeons owing to its minimal risk of soft-tissue injury, provision of a complete osteotomy line, and easy application with limited incisions. (J Am Podiatr Med Assoc 112(2), 2022). Full article

► Show Figures

Figure 1

1283 KB

Open AccessArticle

A Novel Technique to Close Large Defects in the Foot Secondary to Infection Using Widely Available and Inexpensive Tools: A Case Report

by Ngan T. Nguyen and Tanzim Khan

J. Am. Podiatr. Med. Assoc. 2022, 112(2), 20123; https://doi.org/10.7547/20-123 - 1 Mar 2022

Viewed by 122

Abstract

One of the challenges after central ray resection is a large soft-tissue defect. Many authors have reported the use of external fixators as a means of narrowing the forefoot. Ours is the first article to report an interesting case using widely available and [...] Read more.

One of the challenges after central ray resection is a large soft-tissue defect. Many authors have reported the use of external fixators as a means of narrowing the forefoot. Ours is the first article to report an interesting case using widely available and inexpensive tools such as Kirschner and cerclage wires as an external fixation means of narrowing the forefoot after a complete second-ray resection and extensive soft-tissue debridement for a severe diabetic foot ulcer. This simple yet inexpensive technique is easy to perform for any foot and ankle surgeon at any hospital or surgical center. (J Am Podiatr Med Assoc 112(2), 2022). Full article

► Show Figures

Figure 1

352 KB

Open AccessArticle

Metatarsal Protrusion Distance and Its Influence on Recurrent Ulceration Rates After Partial First-Ray Amputations: A Retrospective Study

by Hayden L. Hoffler, Nicholas S. Powers, Joni K. Evans and Cody D. Blazek

J. Am. Podiatr. Med. Assoc. 2022, 112(2), 20104; https://doi.org/10.7547/20-104 - 1 Mar 2022

Cited by 3 | Viewed by 114

Abstract

Background: Recurrent ulceration is a common problem after partial first-ray amputations. Loss of the first metatarsophalangeal joint contributes to altered biomechanics and increased pressure on the foot. This may increase risk of adjacent ulcerations and additional amputations. Preserving first-ray length maintains the metatarsal [...] Read more.

Background: Recurrent ulceration is a common problem after partial first-ray amputations. Loss of the first metatarsophalangeal joint contributes to altered biomechanics and increased pressure on the foot. This may increase risk of adjacent ulcerations and additional amputations. Preserving first-ray length maintains the metatarsal parabola and limits transfer lesions, but few data support this. We aimed to evaluate the incidence of ulceration after partial first-ray amputations and to assess the association between metatarsal protrusion distance and recurrent ulceration. Methods: Thirty-two consecutive patients underwent unilateral partial first-ray amputation at various levels along the first metatarsal, and the metatarsal protrusion distance was measured after surgery. Incidence of ulceration was evaluated on the ipsilateral foot. We hypothesized that patients with a longer first metatarsal were less likely to ulcerate again on the ipsilateral foot. Results: Fourteen patients (43.8%) ulcerated again after partial first-ray amputation. Mean time to ulceration was 104 days. Active smoking status was associated with increased risk of another ulceration (P = .02), and chronic kidney disease was associated with a decreased risk of recurrent ulceration (P = .03). The average metatarsal protrusion distance for patients who ulcerated again after surgery was 36.1 mm versus 25.9 mm for patients who did not (P = .04). Logistic regression analysis of the receiver operating characteristic curve demonstrated an ideal cutoff length for recurrent ulceration of 37 mm (area under the curve = 0.7381). Patients with a protrusion distance greater than 37 mm were nine times as likely to ulcerate again (95% CI, 1.7–47.0). Conclusions: Partial first-ray amputations can be a good initial salvage procedure to clear infection and prolong bipedal ambulatory status. Unfortunately, these patients are prone to recurrent ulceration. Significant loss of first metatarsal length is a poor prognostic indicator for recurrent ulceration. (J Am Podiatr Med Assoc 112(2), 2022). Full article

► Show Figures

Figure 1

84 KB

Open AccessArticle

The Use of Patient Simulations to Teach and Assess Clinical Competencies in Colleges of Podiatric Medicine: A Survey of US Podiatric Medical Schools

by Anthony Errichetti, Robert Eckles, Judith Beto, Gretta A. Gross and Amy E. Lorion

J. Am. Podiatr. Med. Assoc. 2022, 112(2), 20077; https://doi.org/10.7547/20-077 - 1 Mar 2022

Cited by 3 | Viewed by 131

Abstract

Human and mechanical simulations are used to teach and assess clinical competencies in medical education. In 2014, the National Board of Podiatric Medical Examiners implemented the Clinical Skills Patient Encounter, an examination using standardized patients. Similar clinical skills examinations already existed as part [...] Read more.

Human and mechanical simulations are used to teach and assess clinical competencies in medical education. In 2014, the National Board of Podiatric Medical Examiners implemented the Clinical Skills Patient Encounter, an examination using standardized patients. Similar clinical skills examinations already existed as part of medical and osteopathic licensure examinations. The purpose of this study was to assess the use of simulation-based education in the nine colleges of podiatric medicine in the United States to inform podiatric clinical faculty and other stakeholders about current trends within the podiatric education system. In 2019, the Clinical Skills Patient Encounter committee of the National Board of Podiatric Medical Examiners developed a survey and contacted each podiatric school to voluntarily participate. The mailed survey instrument gathered information on patient simulation modalities, years used, clinical content application, simulation program administration, facilities and equipment available, and the role of simulation educators. All nine schools participated anonymously. The survey showed that simulation modalities were used in all of the schools during the first 3 years, although there was considerable variance in their use. (J Am Podiatr Med Assoc 112(2), 2022). Full article

871 KB

Open AccessArticle

An Innovative Approach to Calcaneal Decubitus Ulcerations Through Calcaneal Decorticalization with Use of Localized Bone Marrow and Negative-Pressure Wound Therapy: A Case Study

by Christopher Stucke, Lance Reeves and Darryl Haycock

J. Am. Podiatr. Med. Assoc. 2022, 112(2), 20042; https://doi.org/10.7547/20-042 - 1 Mar 2022

Viewed by 115

Abstract

Heel decubitus ulcerations are relatively common occurrences that can be limb threatening. There are many options to treat these ulcerations, ranging from conservative wound care to serial debridement with flap reconstruction. However, not all patients are good candidates for major reconstructive surgery. In [...] Read more.

Heel decubitus ulcerations are relatively common occurrences that can be limb threatening. There are many options to treat these ulcerations, ranging from conservative wound care to serial debridement with flap reconstruction. However, not all patients are good candidates for major reconstructive surgery. In this case, we present a 46-year-old man who failed 3 months of conservative wound care after sustaining a heel decubitus ulcer because of immobilization from a motor vehicle accident. The ulceration was treated with sharp excision of the wound with calcaneal decorticalization and use of negative-pressure wound therapy to use the localized bone marrow within the wound bed. The patient went on to heal within 3 months of operative intervention and remains healed greater than 1 year postoperatively. This technique provided the ability to use localized bone marrow to assist in wound healing without the operative morbidity of a reconstructive procedure. (J Am Podiatr Med Assoc 112(2), 2022). Full article

► Show Figures

104 KB

Open AccessArticle

Evaluation of the Usability of the Tiger Full-Foot Three-Dimensional Scanner for the Measurements of Basic Foot Dimensions in Clinical Practice

by OndřEj Laštovička, Roman Cuberek, Miroslav Janura and Tomáš Klein

J. Am. Podiatr. Med. Assoc. 2022, 112(2), 20019; https://doi.org/10.7547/20-019 - 1 Mar 2022

Cited by 4 | Viewed by 102

Abstract

Background: Foot dimension information is important both for footwear design and clinical applications. In recent years, noncontact three-dimensional (3-D) foot digitizers/scanners have become popular because they are noninvasive and are valid and reliable for most of the measures. Some of them also offer [...] Read more.

Background: Foot dimension information is important both for footwear design and clinical applications. In recent years, noncontact three-dimensional (3-D) foot digitizers/scanners have become popular because they are noninvasive and are valid and reliable for most of the measures. Some of them also offer automated calculations of basic foot dimensions. We aimed to determine test-retest reliability, objectivity, and concurrent validity of the Tiger full-foot 3-D scanner and the relationship between manual measures of the medial longitudinal arch of the foot and alternative parameters obtained automatically by the scanner. Methods: Intraclass correlation coefficients and minimal detectable change values were used to assess the reliability and objectivity of the scanner. Concurrent validity and the relationships between the arch height measures were determined by the Pearson correlation coefficient and the limits of agreement between the scanner and the caliper method. Results: The relative and absolute agreement between the repeated measurements obtained by the scanner show excellent reliability and objectivity of linear measures and only good to nearly good test-retest reliability and objectivity of arch height. Correlations between the values obtained by the scanner and the caliper were generally higher in linear measures (r_p ≥ 0.929). The representativeness of state of bony architecture by the soft-tissue margin of the medial foot arch demonstrates the lowest correlation among the measurements (r_p ≤ 0.526). Conclusions: The Tiger full-foot 3-D scanner offers excellent reliability and objectivity in linear measures, which correspond to those obtained by the caliper method. However, values obtained by both methods should not be used interchangeably. The arch height measure is less accurate, which could limit its use in some clinical applications. Orthotists and related professions probably appreciate the scanner more than other specialists. (J Am Podiatr Med Assoc 112(2), 2022). Full article

762 KB

Open AccessArticle

Degloving Traumatic Lesser Toe Injury Reconstruction with Full-Thickness Skin Graft from Partially Amputated Autologous Toe Donor Site: A Case Report

by Michael I. Gazes, Andrew S. Au, Trusha Jariwala and Steven D. Vyce

J. Am. Podiatr. Med. Assoc. 2022, 112(2), 20014; https://doi.org/10.7547/20-014 - 1 Mar 2022

Cited by 2 | Viewed by 229

Abstract

Complex soft-tissue injuries consist of difficult traumatic injuries caused by high-energy mechanisms such as motor vehicle accidents, lawnmower injuries, and crush injuries from heavy objects. Many times, because of the high-energy trauma, there is significant damage to the soft tissue and underlying bone, [...] Read more.

Complex soft-tissue injuries consist of difficult traumatic injuries caused by high-energy mechanisms such as motor vehicle accidents, lawnmower injuries, and crush injuries from heavy objects. Many times, because of the high-energy trauma, there is significant damage to the soft tissue and underlying bone, leading to a complex situation for healing. In this case report, a 43-year-old woman presented with extensive degloving injury and open fractures of the forefoot resulting from a lawnmower accident. After extensive irrigation and debridement, wound closure was achieved using a full-thickness skin graft (FTSG). Although many case reports have been published about management of these complex soft-tissue injuries, there are no reports on using an autologous FTSG from a neighboring digit undergoing distal amputation for wound coverage. This report discusses the technique of using an autologous FTSG from an amputated specimen to achieve wound coverage with adequate limb salvage principles. (J Am Podiatr Med Assoc 112(2), 2022). Full article

► Show Figures

578 KB

Open AccessArticle

Intraoperative Radiation Exposure to U.S. Podiatric and Medicine Surgery Residents Annually: How Much Are We Really Getting?

by Calvin J. Rushing, Viraj Rathnayake, Tarak Amin, Alyssa Pham, Steven M. Spinner and Izzy Izzy Ramaswamy

J. Am. Podiatr. Med. Assoc. 2022, 112(2), 19177; https://doi.org/10.7547/19-177 - 1 Mar 2022

Viewed by 149

Abstract

As the number and complexity of operative techniques taught at U.S. podiatric medicine and surgical residencies (PMSR) with the added credential in reconstructive rearfoot and ankle (RRA) surgery has continued to increase, so to has the use of intraoperative fluoroscopy. The purpose of [...] Read more.

As the number and complexity of operative techniques taught at U.S. podiatric medicine and surgical residencies (PMSR) with the added credential in reconstructive rearfoot and ankle (RRA) surgery has continued to increase, so to has the use of intraoperative fluoroscopy. The purpose of the present prospective observational pilot study was to quantify and compare the shallow dose equivalent (SDE), deep dose equivalent (DDE), and lens of the eye dose equivalent (LDE) exposures for podiatric medicine and surgery residents at a single PMSR-RRA over 12 consecutive months. Shallow-dose equivalent, DDE, and LDE exposures (in millirems) were measured using Landauer Luxel dosimeters from July of 2018 to July of 2019. Dosimeters were exchanged monthly, and mean monthly/annual SDE, DDE, and LDE exposures were calculated and compared. Overall, residents averaged 19 operative cases per month and 222 per year. More than half (53%) required intraoperative fluoroscopy, for which a mini C-arm was used in most cases. Monthly SDE, DDE, and LDE exposures averaged 7.3, 9.3, and 7.0 mrem, respectively; whereas annual SDE, DDE, and LDE exposures averaged 87.3, 112, and 84 mrem, respectively. No significant monthly (P = 1.0, P = .70, and P = .74) or annual (P = .67, P = .67, and P = .33) differences were identified between residents. The annual SDE, DDE, and LDE for residents at a single PMSR-RRA were well below the recommended dose limits of 50,000 mrem/year (SDE), 5,000 mrem/year (DDE), and 15,000 mrem/year (LDE) set by the National Council on Radiation Protection. However, given that the stochastic effects from low levels of ionizing radiation are cumulative, not well studied long-term, and relate both to the degree and duration of exposure, mini-C arm fluoroscopy, radiation tracking, and use of personal protective equipment provide simple means for residents to reduce any long-term potential for risk. (J Am Podiatr Med Assoc 112(2), 2022). Full article

► Show Figures

90 KB

Open AccessArticle

An Analysis of Guideline Consensus for the Prevention, Diagnosis, and Management of Diabetic Foot Ulcers

by Anthony B. Karabanow, Ina Zaimi, Luis B. Suarez, Mark D. Iafrati and Geneve M. Allison

J. Am. Podiatr. Med. Assoc. 2022, 112(2), 19175; https://doi.org/10.7547/19-175 - 1 Mar 2022

Cited by 4 | Viewed by 155

Abstract

Background: Multiple organizations have issued guidelines to address the prevention, diagnosis, and management of diabetic foot ulcers (DFUs) based on evidence review and expert opinion. We reviewed these guidelines to identify consensus (or lack thereof) on the nature of these recommendations, the strength [...] Read more.

Background: Multiple organizations have issued guidelines to address the prevention, diagnosis, and management of diabetic foot ulcers (DFUs) based on evidence review and expert opinion. We reviewed these guidelines to identify consensus (or lack thereof) on the nature of these recommendations, the strength of the recommendations, and the level of evidence. Methods: Ovid, PubMed, Web of Science, Cochrane Library, and Embase were searched in October 2018 using the MESH term diabetic foot, the key word diabetic foot, and the filters guideline or practice guideline. To minimize recommendations based on older literature, guidelines published before 2012 were excluded. Articles without recommendations characterized by strength of recommendation and level of evidence related specifically to DFU were also excluded. A manual search for societal recommendations yielded no further documents. Recommendations were ultimately extracted from 12 articles. Strength of evidence and strength of recommendation were noted for each guideline recommendation using the Grading of Recommendations Assessment, Development, and Evaluation system or the Centre for Evidence-Based Medicine system. To address disparate grading systems, we mapped the perceived level of evidence and strength of recommendations onto the American Heart Association guideline classification schema. Results: Recommendations found in two or more guidelines were collected into a clinical checklist characterized by strength of evidence and strength of recommendation. Areas for future research were identified among recommendations based on minimal evidence, areas of controversy, or areas of clinical care without recommendations. Conclusions: Through this work we developed a multidisciplinary set of DFU guidelines stratified by strength of recommendation and quality of evidence, created a clinical checklist for busy practitioners, and identified areas for future focused research. This work should be of value to clinicians, guideline-issuing bodies, and researchers. We also formulated a method for the review and integration of guidelines issued by multiple professional bodies. (J Am Podiatr Med Assoc 112(2), 2022). Full article

558 KB

Open AccessArticle

Prevalence of Hypertension and Related Characteristics: Perspectives from an Outpatient Podiatric Medical Clinic

by Steven R. Cooperman, David W. Shofler, Byron Lemon, Jordan Richardson and Airani Sathananthan

J. Am. Podiatr. Med. Assoc. 2022, 112(2), 19159; https://doi.org/10.7547/19-159 - 1 Mar 2022

Cited by 3 | Viewed by 111

Abstract

Background: Hypertension is a highly prevalent condition in the general population, conferring a high risk of significant morbidity and mortality. Associated with the condition are many well-characterized controllable and noncontrollable risk factors. This study aimed to identify the prevalence of hypertension in the [...] Read more.

Background: Hypertension is a highly prevalent condition in the general population, conferring a high risk of significant morbidity and mortality. Associated with the condition are many well-characterized controllable and noncontrollable risk factors. This study aimed to identify the prevalence of hypertension in the outpatient podiatric medical clinic setting and to determine the relevance of hypertension risk factors in this setting. Methods: A survey tool was created to characterize relevant risk factors, and systolic and diastolic blood pressures were recorded. Descriptive statistics were generated after conclusion of enrollment. Analysis was also performed to determine the relationship between individual risk factors and systolic blood pressure. Results: Of the 176 patients, 56 (31.8%) had an incidentally high blood pressure at intake, including 18.5% of patients without a known history of hypertension and 38.5% with a known history of hypertension. Three risk factors were found to be significantly associated with increasing systolic blood pressure: weight (P = .022), stress level (P = .017), and presence of renal artery stenosis (P = .021). There was also a near–statistically significant inverse relationship between systolic blood pressure and amount of time spent exercising (P = .068). Conclusions: Overall, a relatively high prevalence of incidental hypertension was identified, including among patients not previously diagnosed as having hypertension. Consideration of risk factors and awareness of the prevalence of the condition can be useful for practitioners, even as they manage presenting podiatric medical concerns. Future investigations may consider interventional or preventive strategies in the outpatient clinic setting. (J Am Podiatr Med Assoc 112(2), 2022). Full article

► Show Figures

190 KB

Open AccessArticle

A Safety and Effectiveness Evaluation of a Callus Softener Containing Potassium Hydroxide

by Kevin M. Towle, Jordan S. Kozal, David A. Galbraith and Andrew D. Monnot

J. Am. Podiatr. Med. Assoc. 2022, 112(2), 19117; https://doi.org/10.7547/19-117 - 1 Mar 2022

Viewed by 251

Abstract

Background: Limited safety information has been described in the peer-reviewed literature for callus-softening products containing potassium hydroxide. Methods: This pilot human use study evaluated the safety and effectiveness of a commercially available callus softener, containing less than 10% potassium hydroxide by weight. Baseline [...] Read more.

Background: Limited safety information has been described in the peer-reviewed literature for callus-softening products containing potassium hydroxide. Methods: This pilot human use study evaluated the safety and effectiveness of a commercially available callus softener, containing less than 10% potassium hydroxide by weight. Baseline callused skin was scored (grade 1–4) on each study participant’s feet (n = 10). Participants’ feet were soaked and then a licensed manicurist applied a callus softener product to the right foot, which remained on callused skin for 3 to 5 minutes (no callus softener was applied to the participant’s left foot). Both feet were then wiped with a wet towel, and a foot rasp was used to file the callused skin, beginning on the left foot. Callused skin was scored and participants’ feet were evaluated by a physician immediately after use, 1 day after use, and 1 week after use for the presence or absence of skin irritation, adverse skin reactions, and chemical burns. Results: No adverse events were reported by study participants or the physician for all evaluation time points. Each participant’s highest callus grade score on the treated foot either improved or remained the same following product use (compared to baseline). Mean callus grade scores were 1.75 at baseline, 1.55 immediately after use, 1.25 1 day after use, and 1.50 1 week after use. Conclusions: Results from this pilot study suggest that callus-softening products containing less than 10% potassium hydroxide are likely to be safe and effective products under intended use scenarios of 3- to 5-minute application times, as dictated by product label instructions. (J Am Podiatr Med Assoc 112(2), 2022). Full article

► Show Figures

818 KB

Open AccessArticle

Medullary Screw Fixation and the Pilot Hole Technique for the Correction of Hammertoe Deformity

by Daniel B. Logan, Matthew D. Wilson, Eric So and Cherreen H. Tawancy

J. Am. Podiatr. Med. Assoc. 2022, 112(2), 19002; https://doi.org/10.7547/19-002 - 1 Mar 2022

Viewed by 132

Abstract

Background: Historically, Kirschner wires have been used for fixation of the interphalangeal joints of the toe. They are still the most popular form of fixation, likely due to training patterns, ease of use, and decreased cost. Recently, numerous medullary fixation devices have become [...] Read more.

Background: Historically, Kirschner wires have been used for fixation of the interphalangeal joints of the toe. They are still the most popular form of fixation, likely due to training patterns, ease of use, and decreased cost. Recently, numerous medullary fixation devices have become available, including medullary screws. Methods: After performing various forms of fixation for the correction of toe deformities, the authors have developed a new pilot hole technique for screw fixation advancing on the previously described pilot hole technique for Kirschner wire fixation. Results: The authors have found this method to provide intraoperative confidence that improper hardware placement has not occurred. Conclusions: The pilot hole technique described in this paper is a safe and effective technique that may be employed by surgeons using screw fixation for the treatment of hammertoe deformities. The technique reduces the possibility of surgeon error and helps to ensure that the screw is properly placed within the phalanges when properly employed. (J Am Podiatr Med Assoc 112(2), 2022). Full article

► Show Figures

758 KB

Open AccessArticle

Fungal Nails? DNA Facts Challenge Dystrophic Etiology

by Beth Pearce, Stephanie C. Bishop, Curtis E. Jones and John P. Kennedy

J. Am. Podiatr. Med. Assoc. 2022, 112(2), 18042; https://doi.org/10.7547/18-042 - 1 Mar 2022

Viewed by 381

Abstract

Background: Historically recalcitrant to treatment, infection of the nail unit is a pervasive clinical condition affecting approximately 10% to 20% of the US population; patients present with both cosmetic symptomatology and pain, with subsequent dystrophic morphology. To date, the presumptive infectious etiologies include [...] Read more.

Background: Historically recalcitrant to treatment, infection of the nail unit is a pervasive clinical condition affecting approximately 10% to 20% of the US population; patients present with both cosmetic symptomatology and pain, with subsequent dystrophic morphology. To date, the presumptive infectious etiologies include classically reported fungal dermatophytes, nondermatophyte molds, and yeasts. Until now, the prevalence and potential contribution of bacteria to the clinical course of dystrophic nails had been relatively overlooked, if not dismissed. Previously, diagnosis had largely been made by means of clinical presentation, although microscopic examinations (potassium hydroxide) of nail scrapings to identify fungal agents and, more recently, panel-specific polymerase chain reaction assays have been used to elucidate causative infectious agents. Each of these tools suffers from test-specific limitations. Methods: Molecular-age medicine now includes DNA-based tools to universally assess any microbe or pathogen with a known DNA sequence. This affords clinicians with rapid DNA sequencing technologies at their disposal. These sequencing-based diagnostic tools confer the accuracy of DNA-level certainty, and concurrently obviate cultivation or microbial phenotypical biases. Results: Using DNA sequencing-based diagnostics, the results in this article document the first identification and quantification of significant bacterial, rather than mycotic, pathogens to the clinical manifestation of dystrophic nails. Conclusions: In direct opposition to the prevailing and presumptive mycotic-based causes, the results in this article invoke questions about the very basis for our current standards of care, including effective treatment regimens. (J Am Podiatr Med Assoc 112(2), 2022). Full article

► Show Figures

Figure 1

Journal Menu

Journal Browser

J. Am. Podiatr. Med. Assoc., Volume 112, Issue 2 (03 2022) – 23 articles

Further Information

Guidelines

MDPI Initiatives

Follow MDPI