Journal of the American Podiatric Medical Association

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Open AccessArticle

SCAI/ACR/APMA/SCVS/SIR/SVM/SVS/VESS Position Statement on Competencies for Endovascular Specialists Providing CLTI Care

by Beau M. Hawkins, Jun Li, Luke R. Wilkins, Teresa L. Carman, Amy B. Reed, David G. Armstrong, Philip Goodney, Christopher J. White, Aaron Fischman, Marc L. Schermerhorn, Dmitriy N. Feldman, Sahil A. Parikh and Mehdi H. Shishehbor

J. Am. Podiatr. Med. Assoc. 2022, 112(3), 22096; https://doi.org/10.7547/22-096 - 1 May 2022

Cited by 1 | Viewed by 64

Abstract

Chronic limb-threatening ischemia (CLTI) is the advanced stage of peripheral artery disease (PAD) characterized by rest pain or tissue loss [...] Full article

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Open AccessEditorial

Suicide Prevention in Podiatry

by Rachel Albright and Dyane Tower

J. Am. Podiatr. Med. Assoc. 2022, 112(3), 21194; https://doi.org/10.7547/21-194 - 1 May 2022

Cited by 2 | Viewed by 63

Abstract

As society works to break down the social stigmas surrounding mental health conditions, suicide rates continue to rise [...] Full article

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Open AccessArticle

Foot Loading Analysis of Intra-articular Tibia Pilon Fracture

by Anil Agar, Adem Şahin, Seyit Ali Guclu, Deniz Gülabi and Cemil Erturk

J. Am. Podiatr. Med. Assoc. 2022, 112(3), 21107; https://doi.org/10.7547/21-107 - 1 May 2022

Cited by 5 | Viewed by 57

Abstract

Background: Although pilon fractures are rare, they are important for orthopedic surgeons because of the difficulty of their treatment and their adverse effects on gait function. The aim of this was study to evaluate the relationship between the reduction quality of the fracture, [...] Read more.

Background: Although pilon fractures are rare, they are important for orthopedic surgeons because of the difficulty of their treatment and their adverse effects on gait function. The aim of this was study to evaluate the relationship between the reduction quality of the fracture, functional results, ankle arthrosis, and plantar pressure distribution in patients with tibia pilon fractures. Methods: In this study, a total of 62 patients treated for an intraarticular pilon fracture in our clinic between January of 2015 and January of 2019 were evaluated retrospectively. Postoperative reduction qualities of the patients were evaluated with the Ovadia-Beals criteria; ankle functional scores were evaluated with the Teeny-Wiss score; and ankle arthrosis was evaluated with the Takakura classification. At the last patient follow-up, foot loading analysis was performed, and the results were evaluated for their relation with postoperative reduction quality, ankle function, and ankle arthrosis. Results: There were 62 patients (50 men and 12 women). The average age was 43.3 years (range, 19–78 years). The mean follow-up was 34.3 months (range, 24–58 months). The mean Ovadia-Beals score was 12.35 ± 4.6 on the postoperative plain radiographs of the patients; the mean Teeny-Wiss score at the last follow-up was 76.82 ± 17.69; and the mean Takakura score was 1.47 ± 1.35. Based on the pedobarographic measurements, 47.58% of the patients put weight on the anterior portion and 52.42% on the posterior portion of the foot in the anteroposterior plane. In the mediolateral plane, 42.15% loaded on the medial portion of the ankle and 57.85% loaded on the lateral portion of the foot. Conclusions: Intra-articular tibia pilon fractures can be demonstrated by lateralization of the walking axis and changes in gait patterns and can be associated with clinical outcome. (J Am Podiatr Med Assoc 112(3), 2022) Full article

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Open AccessArticle

Making the Case for Suicide Risk Screening in Outpatient Podiatry Patients: An Opportunity for Injury Prevention

by Adam K. Spector, Annabelle M. Mournet, Deborah J. Snyder, Emmanuella Eastman, Maryland Pao and Lisa M. Horowitz

J. Am. Podiatr. Med. Assoc. 2022, 112(3), 21062; https://doi.org/10.7547/21-062 - 1 May 2022

Cited by 6 | Viewed by 62

Abstract

Background: Despite prevention efforts, suicide rates continue to rise, prompting the need for novel evidence-based approaches to suicide prevention. Patients presenting with foot and ankle disorders in a podiatric medical and surgical practice may represent a population at risk for suicide, given risk [...] Read more.

Background: Despite prevention efforts, suicide rates continue to rise, prompting the need for novel evidence-based approaches to suicide prevention. Patients presenting with foot and ankle disorders in a podiatric medical and surgical practice may represent a population at risk for suicide, given risk factors of chronic pain and debilitating injury. Screening has the potential to identify people at risk that may otherwise go unrecognized. This quality improvement project aimed to determine the feasibility of implementing suicide risk screening in an outpatient podiatry clinic and ambulatory surgical center. Methods: A suicide risk screening quality improvement project was implemented in an outpatient podiatry clinic and ambulatory surgical center in collaboration with a National Institute of Mental Health suicide prevention research team. Following training for all staff, patients aged 18 years and older were screened for suicide risk with the Ask Suicide- Screening Questions as standard of care. Clinic staff were surveyed about their opinions of screening. Results: Ninety-four percent of patients (442 of 470) agreed to be screened for suicide risk and nine patients (nine of 442 [2%]) were screened as nonacute positive; zero patients were screened as acute risk. The majority of clinic staff reported that they found screening acceptable, felt comfortable working with patients who have suicidal thoughts, and thought screening for suicide risk was clinically useful. Conclusions: Suicide risk screening was successfully implemented in an outpatient podiatry clinic. Screening with the Ask Suicide-Screening Questions instrument provided valuable information that would not have been ascertained otherwise, positively impacting clinical decision- making and leading to improved overall care for podiatry patients. (J Am Podiatr Med Assoc 112(3), 2022) Full article

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Open AccessArticle

Letter to the Editor

by Russell G. Volpe

J. Am. Podiatr. Med. Assoc. 2022, 112(3), 21052; https://doi.org/10.7547/21-052 - 1 May 2022

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Abstract

To the Editor: The article published in this issue, “Pediatric Flat Feet: A 2020 Guide for Clinicians to Identify the Boomerangs,” by Angela M. Evans, PhD, raises many issues about how best to approach the flexible flat foot in the child [...] Full article

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Open AccessArticle

Avascular Necrosis of the Type II Accessory Navicular Bone: A Rare Case Report

by Aysu Başak Özbalcı, Furkan Erdoğan and Huseyin Sina Coskun

J. Am. Podiatr. Med. Assoc. 2022, 112(3), 21040; https://doi.org/10.7547/21-040 - 1 May 2022

Cited by 3 | Viewed by 80

Abstract

The accessory navicular bone (ANB) is one of the most common accessory ossicles of the foot. Fewer than 1% of ANBs are symptomatic, and most of the symptomatic ANBs are type II ANBs. Avascular necrosis of the type II ANB is an uncommon [...] Read more.

The accessory navicular bone (ANB) is one of the most common accessory ossicles of the foot. Fewer than 1% of ANBs are symptomatic, and most of the symptomatic ANBs are type II ANBs. Avascular necrosis of the type II ANB is an uncommon cause of symptomatic accessory navicular syndrome and also a rarely reported condition in the podiatric medical literature. This rare disorder must be distinguished from other painful conditions of the ANB and should be considered in differential diagnoses. We present a case of avascular necrosis of the type II ANB with sclerosis on radiographs and magnetic resonance images in a 46-year-old woman. (J Am Podiatr Med Assoc 112(3), 2022) Full article

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Open AccessArticle

Osteoid Osteoma of the Talus Misdiagnosed with Juvenile Idiopathic Arthritis: A Case Report

by Maria Francesca Gicchino, Pierluigi Marzuillo, Emanuele Miraglia del Giudice and Alma Nunzia Olivieri

J. Am. Podiatr. Med. Assoc. 2022, 112(3), 21002; https://doi.org/10.7547/21-002 - 1 May 2022

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Abstract

Osteoid osteoma is a primary benign bone tumor that consists of a central area (nidus), surrounded by sclerotic bone. The most relevant symptom is pain that increases during the night and improves after salicylates or nonsteroidal anti-inflammatory drug administration. Osteoid osteoma is frequently [...] Read more.

Osteoid osteoma is a primary benign bone tumor that consists of a central area (nidus), surrounded by sclerotic bone. The most relevant symptom is pain that increases during the night and improves after salicylates or nonsteroidal anti-inflammatory drug administration. Osteoid osteoma is frequently misdiagnosed because it mimics juvenile idiopathic arthritis, bone infection, or malignancy. A 14-year-old girl presented to our department with a history of chronic pain in her left ankle. Juvenile idiopathic arthritis was diagnosed and anti-inflammatory treatment was prescribed. Because of persistence of ankle pain, the patient underwent further examinations, in particular, bone scintigraphy and computed tomography. As a result, osteoid osteoma of the talar neck was diagnosed. The patient underwent surgical treatment and her condition improved. Osteoid osteoma should also be considered in patients with chronic ankle pain to avoid misdiagnosis and start adequate treatment. This condition should be suspected in a patient with chronic bone pain and normal complete blood count and inflammatory parameters. (J Am Podiatr Med Assoc 112(3), 2022) Full article

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Open AccessArticle

Conservative Approach in the Management of Lesser Toe Deformities in Older Adults

by Cynthia Formosa, Charlene Grixti and Alfred Gatt

J. Am. Podiatr. Med. Assoc. 2022, 112(3), 20274; https://doi.org/10.7547/20-274 - 1 May 2022

Cited by 4 | Viewed by 91

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Background: Toe deformities are common foot abnormalities in older adults, contributing to functional disability, loss of balance, falls, and pressure lesions. The aim of this study was to evaluate the effectiveness of the custom-made molded silicone toe prop in distributing apical and metatarsophalangeal [...] Read more.

Background: Toe deformities are common foot abnormalities in older adults, contributing to functional disability, loss of balance, falls, and pressure lesions. The aim of this study was to evaluate the effectiveness of the custom-made molded silicone toe prop in distributing apical and metatarsophalangeal joint peak plantar pressures and force-time integral in toe deformities, including hammertoes and claw toes, and to observe any difference in pressures between flexible and rigid toe deformities. Methods: A prospective quasi-experimental pretest/posttest study was conducted including 20 “healthy” older adults with a hammer or claw toe at the second digit. Ten subjects presented with a flexible toe and 10 subjects presented with a rigid toe. A molded silicone toe prop was devised for each participant. Dynamic plantar pressure measurements were taken/recorded before applying the toe prop and after the toe prop was placed under the toe. Results: Significant differences in mean peak plantar pressure and pressure-time integral were observed at the apex of the second toe in both the flexible and rigid toe deformity when using a molded silicone toe prop. At the metatarsophalangeal joint, pressures were significantly reduced in the rigid toe deformity but not in the flexible toe deformity. Conclusions: Silicone molded toe props were found to be effective in reducing peak pressure and pressure-time integral on the apex of the second digit in participants with both flexible and rigid claw or hammertoe deformity. Lesser toe deformities may be the cause of several foot complications, including pain on walking, corns, difficulty in wearing footwear, possible ulcerations caused by increased pressure at the apices of the toes, and other comorbidities, that could possibly lead to falls in older adults and thus need to be addressed appropriately. (J Am Podiatr Med Assoc 112(3), 2022) Full article

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Open AccessArticle

Dactylolysis Spontanea: Possible Immunohistologic Etiology Discovered in a Rare Presentation of Bilateral Fourth Digits

by Samuel B. Adegboyega, Steven N. Silvestro, Kihyun Kwon, Daniel S. Yaeger, Jessica L. Harris and Joseph Dobtsis

J. Am. Podiatr. Med. Assoc. 2022, 112(3), 20270; https://doi.org/10.7547/20-270 - 1 May 2022

Viewed by 99

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Dactylolysis spontanea is a rare, progressive disease characterized by fibrous soft-tissue constriction around the base of an appendage. It most commonly occurs bilaterally in the fifth toes of male patients and often progresses to spontaneous autoamputation. The broad spectrum of clinical severity, poorly [...] Read more.

Dactylolysis spontanea is a rare, progressive disease characterized by fibrous soft-tissue constriction around the base of an appendage. It most commonly occurs bilaterally in the fifth toes of male patients and often progresses to spontaneous autoamputation. The broad spectrum of clinical severity, poorly characterized natural clinical timeline, and previous lack of specific confirmatory tests make this condition difficult to diagnose and treat in the early stages where it may be amendable to conservative treatment. We present a case report of a 29-year-old woman with dactylolysis spontanea involving bilateral fourth digits. The diagnosis of dactylolysis spontanea was made based on clinical and radiographic correlations and by excluding other similar conditions. Following surgical removal of the digits, exploratory histopathologic analysis demonstrated the novel presence of positive glucose transporter 1 immunohistochemical staining. Although the diagnosis of dactylolysis spontanea has historically been considered a diagnosis of exclusion and is often complicated by the heterogeneous clinical presentations, glucose transporter 1 staining offers clinicians a valuable tool in assisting with the diagnosis of this condition. This may finally elucidate the etiology of this rare condition. (J Am Podiatr Med Assoc 112(3), 2022) Full article

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Open AccessArticle

Uncovering Eosinophilic Granulomatosis with Polyangiitis in Clinical Practice

by Bonnie J. Nicklas, Patrick A. McEneaney and Joseph D. Rundell

J. Am. Podiatr. Med. Assoc. 2022, 112(3), 20207; https://doi.org/10.7547/20-207 - 1 May 2022

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Eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome) is a small- to medium-vessel vasculitis associated with asthma and eosinophilia. If left untreated, it can lead to systemic complications with a high mortality rate. The authors present a case of eosinophilic granulomatosis with polyangiitis that initially [...] Read more.

Eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome) is a small- to medium-vessel vasculitis associated with asthma and eosinophilia. If left untreated, it can lead to systemic complications with a high mortality rate. The authors present a case of eosinophilic granulomatosis with polyangiitis that initially presented with adult-onset asthma, asymmetric neuropathy to the right lower extremity, and erythematous maculopapular cutaneous lesions to bilateral lower extremities. Through an extensive work-up, the diagnosis of eosinophilic granulomatosis with polyangiitis was made. Steroid therapy was initiated, causing his eosinophil count to return to normal and his presenting symptoms to improve, although his neuropathy and weakness remained. It is our hope that presenting this unusual condition manifesting in the lower extremity can provide guidance to clinicians who might encounter this condition and help them to recognize and treat it before severe chronic complications can manifest. (J Am Podiatr Med Assoc 112(3), 2022) Full article

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Open AccessArticle

Reossification of the Achilles Tendon: A Case Report

by Okan Aslantürk, Muhammed Köroğlu, Mustafa Karakaplan and Zeynep Maraş Özdemir

J. Am. Podiatr. Med. Assoc. 2022, 112(3), 20179; https://doi.org/10.7547/20-179 - 1 May 2022

Cited by 2 | Viewed by 73

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Fracture of an ossified Achilles tendon is a rare clinical entity. Reossification after removal of the bony fragment was reported in only one case previously. In this study, we present a 49-year-old man with a reossified Achilles tendon after the removal of a [...] Read more.

Fracture of an ossified Achilles tendon is a rare clinical entity. Reossification after removal of the bony fragment was reported in only one case previously. In this study, we present a 49-year-old man with a reossified Achilles tendon after the removal of a fractured and ossified Achilles tendon. Treatment of an ossified or fractured Achilles tendon should be selected on a patient-by-patient basis. Surgical treatment can be used when conservative treatment has failed. The possibility of reossification after surgical treatment, especially in patients with risk factors, should be kept in mind, and the patient should be informed about this possibility. (J Am Podiatr Med Assoc 112(3), 2022) Full article

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Open AccessArticle

Rock-Climbing Shoes: A Survey of Attitudes and Practices

by David W. Jenkins, Jeffrey C. Page, Amy Stein, Lance Wissman, Bryn A. Rowe and Fallon E. Rowe

J. Am. Podiatr. Med. Assoc. 2022, 112(3), 20177; https://doi.org/10.7547/20-177 - 1 May 2022

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Abstract

Background: There is a paucity of literature regarding rock climbing footwear. Rock climbers anecdotally voice numerous complaints regarding their current footwear. In an effort to improve existing rock-climbing footwear, implementation of a survey tool assessing the attitudes and practices of rock climbers was [...] Read more.

Background: There is a paucity of literature regarding rock climbing footwear. Rock climbers anecdotally voice numerous complaints regarding their current footwear. In an effort to improve existing rock-climbing footwear, implementation of a survey tool assessing the attitudes and practices of rock climbers was undertaken. Methods: A Web-based survey was developed to assess the demographics, attitudes, and practices of individuals active in rock climbing, with a focus on footwear. Results: Forty-five of the 417 respondents were male and 55% were female. The average years climbing was 7, with a majority of respondents in the 18- to 34-year-old category. The majority climbed 5 to 10 hours/week. Eighty percent identified as intermediate or advanced climbers. Climbing shoes were an average of 0.83 size smaller than the climber’s street shoes. The more elite the climber, the greater the mismatch. Overall satisfaction with current rock-climbing shoes was 88%; however, as the age of climber and number of years of participation increased, the level of satisfaction decreased. The most frequently reported problems with shoes included inconsistent sizing between brands and poor heel fit. The most commonly reported locations of pain were the toes and heel. Conclusions: The authors concluded the following: 1) a surprisingly high satisfaction with current rock-climbing shoes was reported; 2) the difference in size between climbing shoes and street shoes was less than expected; 3) more shoe fitting problems were experienced by those with the most experience in climbing and those who spend the most time climbing; 4) the most common locations for experiencing pain were the toes and the posterior heel or Achilles tendon; 5) higher than expected satisfaction levels with climbing shoes contrasted with the very high number of specific complaints and recommendations for improvement; and 6) because of the increasing popularity of rock climbing, foot care providers should learn about the various types of climbing and the shoe gear needs that result therefrom. (J Am Podiatr Med Assoc 112(3), 2022) Full article

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Open AccessArticle

Comparative Acceptability of Weightbearing Physical Activity in Sporting Footwear Versus Barefoot in Habitually Shod Individuals

by Christian A. Than, Laura A. Seidl and Belinda R. Beck

J. Am. Podiatr. Med. Assoc. 2022, 112(3), 20148; https://doi.org/10.7547/20-148 - 1 May 2022

Cited by 2 | Viewed by 68

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Background: Perceived acceptability of barefoot use has largely been ignored in the literature despite its importance to long-term implementation and behavior change. This study aimed to compare the acceptability of undertaking weightbearing physical activities in regular running shoes versus barefoot in habitually shod [...] Read more.

Background: Perceived acceptability of barefoot use has largely been ignored in the literature despite its importance to long-term implementation and behavior change. This study aimed to compare the acceptability of undertaking weightbearing physical activities in regular running shoes versus barefoot in habitually shod individuals. Methods: Healthy young men and women were recruited from the Gold Coast. Participants completed six activities (ie, lunges, walking, jogging, sidestep, vertical jump, and hop) in shod and barefoot conditions then answered questions pertaining to level and source of discomfort, ease of performance, and acceptability. Indices of bone quality were measured from their dominant calcaneus by quantitative ultrasound. Results: Seventeen healthy male (n = 8) and female (n = 9) university students participated in the study (age, 26.59 ± 7.26 years; body mass index, 23.08 ± 3.58 kg/m²). Men were taller, heavier, and had higher broadband ultrasound attenuation than women (P < .05). For “no” discomfort, “very easy” ease of performance, and a “good amount” or “very good amount” of acceptability, the shod condition demonstrated response rates of 87.25%, 55.88%, and 72.55%, respectively. The barefoot condition demonstrated rates of those responses of 62.75%, 39.22%, and 48.03%, respectively, and reported more ball-of-foot, forefoot, heel, and plantar skin locations as sources of discomfort during activity than in the shod condition. The group vertical jump height was higher barefoot than shod (44.88 ± 8.44 cm and 43.25 ± 8.76 cm, respectively; P < .05), but no difference was seen for the hop. Men jumped and hopped higher than women under both footwear conditions (P < .05). Conclusions: Participants initiating barefoot weightbearing exercise may experience slightly greater discomfort and less ease of performance in the initial transition from the shod condition, but may perform better in vertical jump. Whether those differences in experience persist over the long term will require longitudinal studies. (J Am Podiatr Med Assoc 112(3), 2022) Full article

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Open AccessArticle

Osteochondromas Around the Ankle

by Hikmet Çinka, Huseyin Sina Coskun, Ferhat Say, Nevzat Dabak and Yakup Sancar Baris

J. Am. Podiatr. Med. Assoc. 2022, 112(3), 20111; https://doi.org/10.7547/20-111 - 1 May 2022

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An osteochondroma or exostosis is the most common benign bone tumor, and it is commonly localized in the metaphyses of the long tubular bones. Lesions are rarely localized around the ankle. We present a case series with osteochondroma around the ankle. All of [...] Read more.

An osteochondroma or exostosis is the most common benign bone tumor, and it is commonly localized in the metaphyses of the long tubular bones. Lesions are rarely localized around the ankle. We present a case series with osteochondroma around the ankle. All of the patients presented with a mass around the ankle. In these three cases, the masses were symptomatic, and in one patient it caused a deformity. Osteochondroma was suspected after physical examination and radiologic evaluation. After preoperative work-up, diagnosis, and exhaustion of conservative care, a plan for surgical excision was presented to each patient. Histopathologic evaluations confirmed the diagnosis of osteochondroma. The patients have been discharged without any complications or symptoms during clinical follow-up. (J Am Podiatr Med Assoc 112(3), 2022) Full article

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Open AccessArticle

Pediatric Flat Feet: A 2020 Guide for Clinicians to Identify the Boomerangs

by Angela M. Evans

J. Am. Podiatr. Med. Assoc. 2022, 112(3), 20103; https://doi.org/10.7547/20-103 - 1 May 2022

Cited by 3 | Viewed by 152

Abstract

The pediatric flatfoot has long occupied a place in the medical literature, with concerns about the significance of its appearance. At the end of the first decade of the 21st century, an article in this journal provoked active debate about the pediatric flatfoot [...] Read more.

The pediatric flatfoot has long occupied a place in the medical literature, with concerns about the significance of its appearance. At the end of the first decade of the 21st century, an article in this journal provoked active debate about the pediatric flatfoot as part of development, and proposed a considered titration of presenting cases in an effort to justify treatment and appreciated the range and expected change in normal foot posture with growth. A decade later, the availability of normative pediatric foot posture data, and the prospective findings to confirm lessening flat feet with age, encourage a structured and considered approach to this frequent primary care presentation. The pragmatic concept of the “boomerang” is built on the research identifying pediatric flat feet likely to be symptomatic, thus requiring intervention, and filtering from those likely to remain asymptomatic. Differential diagnoses are advisedly considered, and gait remains the hallmark outcome. In this contemporary guide, an eight-step strategy has been developed to improve the approach to community pediatric flatfoot concerns. Furthermore, the three boomerang flat feet factors delineating symptomatic from asymptomatic flat feet, and applicable cutoff levels, are availed for practical reference and use. Given the recognized state of overdiagnosis and resulting unnecessary treatment that pervades the 21st century, it is timely for clear 20/20 vision for the presentation of pediatric flatfoot. (J Am Podiatr Med Assoc 112(3), 2022) Full article

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Open AccessArticle

Relationship Between Recurrent Adductus Deformity of the Forefoot and Achilles Tendon Elongation Following Ponseti Treatment in Children with Idiopathic Clubfoot

by Mehmet Demirel, Fuat Bilgili, Çiğdem Özkara Bilgili, Serkan Bayram, Ömer Naci Ergin and Yener Temelli

J. Am. Podiatr. Med. Assoc. 2022, 112(3), 20048; https://doi.org/10.7547/20-048 - 1 May 2022

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Abstract

Background: Many authors have highlighted the role of muscle strength imbalance around the ankle in the development of recurrent clubfoot following Ponseti treatment. However, this possible underlying mechanism behind recurrence has not been investigated sufficiently to date. This study aimed to explore whether [...] Read more.

Background: Many authors have highlighted the role of muscle strength imbalance around the ankle in the development of recurrent clubfoot following Ponseti treatment. However, this possible underlying mechanism behind recurrence has not been investigated sufficiently to date. This study aimed to explore whether there is a relationship between Achilles tendon elongation and recurrent metatarsus adductus deformity in children with unilateral clubfeet treated by the Ponseti method. Methods: A retrospective chart review was performed on 20 children (14 boys and six girls; mean age, 7 years; age range, 5–9 years) with a recurrent metatarsus adductus deformity treated by the Ponseti method for unilateral idiopathic clubfoot. At the final follow-up, isometric muscle strength was measured using a portable, hand-held dynamometer in reciprocal muscle groups of the ankle. The length of the tendons around the ankle was measured ultrasonographically. Results: The plantarflexion-to-dorsiflexion ratio was lower on the involved side (P = .001). No significant differences in the strength ratio of inversion to eversion were found (P = .4). No difference was observed in lengths of tibialis anterior and posterior tendons (P = .1), but the Achilles tendon was longer on the involved side (P = .001; P < .01). A significant negative correlation was discovered between involved-to-uninvolved Achilles tendon length ratios and involved-to-uninvolved plantarflexion strength ratios (r = –0.524; P = .02). Conclusions: Achilles tendon elongation may be a contributor to the muscle imbalance in clubfeet with relapsed forefoot adduction treated by the Ponseti technique. (J Am Podiatr Med Assoc 112(3), 2022) Full article

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Open AccessArticle

Clinical Improvement of Onychomycosis After Nd:YAG 1,064-nm Laser Treatment

by Felix Marcos-Tejedor, Raquel Mayordomo Acevedo, Ana María Pérez Pico, María C. Santos-Blanco and María J. Iglesias-Sánchez

J. Am. Podiatr. Med. Assoc. 2022, 112(3), 20035; https://doi.org/10.7547/20-035 - 1 May 2022

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Abstract

Background: Onychomycosis, or fungal nail infection, is the cause of 50% of onychopathies seen by podiatric physicians. This pathology is accompanied by a negative psychosocial component because of its effect on self-image, which is an essential part of social relations. Conventional pharmacologic treatment [...] Read more.

Background: Onychomycosis, or fungal nail infection, is the cause of 50% of onychopathies seen by podiatric physicians. This pathology is accompanied by a negative psychosocial component because of its effect on self-image, which is an essential part of social relations. Conventional pharmacologic treatment based on antifungal agents is lengthy and expensive and has a high abandonment rate and a low cure rate. Therefore, a faster and more efficient solution has been sought using laser treatment. However, studies on the efficacy of this physical method are not conclusive due to the lack of uniformity in the method used to apply the laser and an objective method to measure the results. The aim of this study was to measure the efficacy of laser treatment of onychomycosis by microbiological cure and clinical evolution using the Onychomycosis Severity Index. Methods: A prospective study with a strictly repetitive protocol of Nd:YAG 1,064-nm laser was applied to 50 participants with onychomycosis in the first toe, following the manufacturer's instructions. The efficacy of the treatment on fungal infection was measured by microbiological culture before and after treatment. The clinical evolution of the nail dystrophy was quantitatively evaluated using the Onychomycosis Severity Index. Results: The efficacy of Nd:YAG 1,064-nm laser in eliminating fungal infection was 30% (15 participants). However, significant improvement in nail appearance (dystrophy) was observed in 100% of patients (P < .001). Conclusions: Laser treatment has relatively low efficacy in treating fungal infection but results in an objective improvement in the clinical appearance of the nail in 100% of patients. (J Am Podiatr Med Assoc 112(3), 2022) Full article

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Open AccessArticle

Desmoplastic Fibroblastoma (Collagenous Fibroma) of the Foot: A Case Report of a Rare Benign Tumor in an Atypical Patient

by Ryan Allen, Charles Parks and Monara Dini

J. Am. Podiatr. Med. Assoc. 2022, 112(3), 19020; https://doi.org/10.7547/19-020 - 1 May 2022

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Abstract

Desmoplastic fibroblastoma (collagenous fibroma) is a rare benign soft-tissue tumor. Often found in the subcutaneous and muscle tissue, it is slowly enlarging and generally not painful or invasive. The literature often describes the tumor to be found in the upper extremities, neck, and [...] Read more.

Desmoplastic fibroblastoma (collagenous fibroma) is a rare benign soft-tissue tumor. Often found in the subcutaneous and muscle tissue, it is slowly enlarging and generally not painful or invasive. The literature often describes the tumor to be found in the upper extremities, neck, and back. Full excision of the tumor is the treatment of choice, and the prognosis is generally favorable; there are no documented cases of recurrence after full excision. We present an atypical case of desmoplastic fibroblastoma found on the dorsum of the foot with a larger tumor present in a substantially younger patient than is typical. (J Am Podiatr Med Assoc 112(3), 2022) Full article

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Open AccessArticle

Methods of Investigation of Functional Disturbances After Burn Injury of the Foot

by Babur M. Shakirov

J. Am. Podiatr. Med. Assoc. 2022, 112(3), 18204; https://doi.org/10.7547/18-204 - 1 May 2022

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Abstract

Background: Foot burns involve a specialized area of function, and although they involve a small total body surface area (3.5%), they can cause a significant degree of morbidity. Methods: This study included 104 patients with burn trauma of the foot treated at the [...] Read more.

Background: Foot burns involve a specialized area of function, and although they involve a small total body surface area (3.5%), they can cause a significant degree of morbidity. Methods: This study included 104 patients with burn trauma of the foot treated at the burn department of Republican Scientific Centre of Urgent Medical Aid and Inter-Regional Burn Center, Samarkand, Uzbekistan. A study of support-motor function of the foot after a burn by means of simultaneous registration of mechanograms of ankle join mobility in various terms made it possible to reveal considerable walking disturbances manifested in short-term support ability of various foot parts compared with normal. Results: Deviations in podagrams were clearly marked during the first weeks after elimination of burn wounds, especially the duration of support ability of the plantar surface in those who experienced burns. Conclusions: The study in separate terms after elimination of burn injury showed that the function of feet begins to regenerate in 3 to 4 months in deep foot burns. (J Am Podiatr Med Assoc 112(3), 2022) Full article

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Open AccessArticle

Extracorporeal Shockwave Therapy for Foot and Ankle Disorders: A Systematic Review and Meta-Analysis

by Tengku Nazim B. Tengku Yusof, Dexter Seow and Khushdeep S. Vig

J. Am. Podiatr. Med. Assoc. 2022, 112(3), 18191; https://doi.org/10.7547/18-191 - 1 May 2022

Cited by 18 | Viewed by 192

Abstract

Background: Extracorporeal shockwave therapy (ESWT) was first introduced into clinical practice in 1982 and has been a beneficial inclusion to the noninvasive treatment option of numerous orthopaedic pathologies. However, clinical evidence of the use of ESWT for various foot and ankle disorders has [...] Read more.

Background: Extracorporeal shockwave therapy (ESWT) was first introduced into clinical practice in 1982 and has been a beneficial inclusion to the noninvasive treatment option of numerous orthopaedic pathologies. However, clinical evidence of the use of ESWT for various foot and ankle disorders has been limited with a consensus on its efficacy yet available. Therefore, the purpose of this study is to systematically review the literature, to provide a critical evaluation and meta-analysis for the use of ESWT in foot and ankle disorders. Methods: The PubMed and Embase databases were systematically reviewed and clinical studies that reported ESWT use for various foot and ankle disorders included. Results: A total of 24 clinical studies that included 12 randomized controlled trials and 12 case series were identified. Analysis of the evidence has indicated that ESWT can help manage plantar fasciitis, calcaneal spur, Achilles tendinopathy and Morton’s neuroma. Meta-analysis of the change in pre- to post-VAS overall scores for plantar fasciitis significantly favored ESWT compared to placebo/conservative treatment with a MD -3.10 (95% CI, -4.36 to -1.83; I² = 68%; P < 0.00001). Conclusions: The current evidence has suggested that ESWT can provide symptomatic benefit to plantar fasciitis treatment, with minimal and unremarkable side effects. Overall, ESWT has been demonstrated to be a safe treatment option with a favorable complication profile. Further well-designed studies of ESWT for the treatment of calcaneal spurs, Achilles tendinopathy and Morton’s neuroma are warranted to more soundly and safely support its current use. Future studies are suggested to investigate the optimization of ESWT treatment protocols. (J Am Podiatr Med Assoc 112(3), 2022) Full article

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The Management of Metatarsalgia in Rheumatoid Arthritis Using Simple Insoles: An Effective Concurrent Treatment to Drug Therapy

by Danine Bartolo, Anne Marie Galea, Cynthia Formosa and Alfred Gatt

J. Am. Podiatr. Med. Assoc. 2022, 112(3), 18002; https://doi.org/10.7547/18-002 - 1 May 2022

Cited by 3 | Viewed by 115

Abstract

Background: Metatarsalgia is a common affliction in rheumatoid arthritis (RA), often requiring aggressive pharmacologic treatment that carries associated adverse effects. The aim of this study was to investigate whether simple insoles would have a beneficial effect on forefoot pain, disability, and functional limitation [...] Read more.

Background: Metatarsalgia is a common affliction in rheumatoid arthritis (RA), often requiring aggressive pharmacologic treatment that carries associated adverse effects. The aim of this study was to investigate whether simple insoles would have a beneficial effect on forefoot pain, disability, and functional limitation in participants with RA experiencing forefoot pain. Method: A prospective, quasi-experimental, pretest-posttest trial was performed at a rheumatology outpatient clinic. Participants were supplied with a simple insole comprising a valgus pad and a plantar metatarsal pad and covered with a cushioning material. The Foot Function Index (FFI) was self-administered before and 3 months after insole use. Results: Reductions in forefoot pain (from 56.78 to 42.97) and total (from 41.64 to 33.54) FFI scores were noted. Statistical significance for this reduction was achieved following the t test (P = .002 and P = .0085, respectively). However, although reductions in mean disability and activity limitation scores were recorded (from 50 to 44.85 and from 18 to 14.57, respectively), these did not reach significance (P = .151 and P = .092, respectively). Conclusions: Simple insoles have been shown to be effective in reducing total and forefoot pain FFI scores in patients with RA experiencing metatarsalgia. This treatment offers advantages because these devices can be fabricated simply and cheaply, thus initiating the patient on an effective orthosis therapy immediately in the clinic without having to wait for prolonged periods until custom orthotic devices can be supplied. (J Am Podiatr Med Assoc 112(3), 2022) Full article

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J. Am. Podiatr. Med. Assoc., Volume 112, Issue 3 (05 2022) – 21 articles

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