Journal of the American Podiatric Medical Association

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Open AccessArticle

The March Against Onychomycosis: A Systematic Review of the Sanitization Methods for Shoes, Socks, and Textiles

by Aditya K. Gupta, Aaron J. Simkovich and Deanna C. Hall

J. Am. Podiatr. Med. Assoc. 2022, 112(4), 21223; https://doi.org/10.7547/21-223 - 1 Jul 2022

Cited by 5 | Viewed by 512

Drug-based treatment of superficial fungal infections, such as onychomycosis, is not the only defense. Sanitization of footwear such as shoes, socks/stockings, and other textiles is integral to the prevention of recurrence and reduction of spread for superficial fungal mycoses. The goal of this [...] Read more.

Drug-based treatment of superficial fungal infections, such as onychomycosis, is not the only defense. Sanitization of footwear such as shoes, socks/stockings, and other textiles is integral to the prevention of recurrence and reduction of spread for superficial fungal mycoses. The goal of this review was to examine the available methods of sanitization for footwear and textiles against superficial fungal infections. A systematic literature search of various sanitization devices and methods that could be applied to footwear and textiles using PubMed, Scopus, and MEDLINE was performed. Fifty-four studies were found relevant to the different methodologies, devices, and techniques of sanitization as they pertain to superficial fungal infections of the feet. These included topics of basic sanitization, antifungal and antimicrobial materials, sanitization chemicals and powder, laundering, ultraviolet, ozone, nonthermal plasma, microwave radiation, essential oils, and natural plant extracts. In the management of onychomycosis, it is necessary to think beyond treatment of the nail, as infections enter through the skin. Those prone to onychomycosis should examine their environment, including surfaces, shoes, and socks, and ensure that proper sanitization is implemented. (J Am Podiatr Med Assoc 112(4), 2022) Full article

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Open AccessArticle

Patient-Reported Outcomes of Minimally Invasive Distal Linear Metatarsal Osteotomy for Hallux Valgus

by Hiroyuki Seki, Yasunori Suda, Kenichiro Takeshima, Masaki Nagashima and Ken Ishii

J. Am. Podiatr. Med. Assoc. 2022, 112(4), 21186; https://doi.org/10.7547/21-186 - 1 Jul 2022

Cited by 4 | Viewed by 86

Abstract

Background: Modified Bösch osteotomy, or distal linear metatarsal osteotomy (DLMO), is one of the minimally invasive correctional operations for hallux valgus deformity. Although the clinical and radiographic results of DLMO have been previously shown, the relationship between clinical outcomes using a validated patient-reported [...] Read more.

Background: Modified Bösch osteotomy, or distal linear metatarsal osteotomy (DLMO), is one of the minimally invasive correctional operations for hallux valgus deformity. Although the clinical and radiographic results of DLMO have been previously shown, the relationship between clinical outcomes using a validated patient-reported outcome measure and radiographic corrections have yet to be evaluated. Methods: A total of 70 patients (97 feet) treated at our hospital were included in the study. The Self-Administered Foot Evaluation Questionnaire (SAFE-Q) and radiographic data were evaluated at a minimum 1-year follow-up. Results: Scores of all five SAFE-Q subscales showed a statistically significant improvement: pain and pain-related (from 63.3 to 86.6), physical functioning and daily living (from 81.3 to 92.7), social functioning (from 79.5 to 94.4), shoe-related (from 43.1 to 72.3), and general health and well-being (from 67.7 to 92.1). The mean hallux valgus angle improved from 39.1° to 9.3°, and the mean intermetatarsal angle improved from 16.6° to 7.0°. Recurrence and hallux varus at the final follow-up occurred in nine feet (9.3%) and 15 feet (15.5%), respectively. Four of the five SAFE-Q subscale scores improved significantly even in patients with hallux varus. Conclusions: Distal linear metatarsal osteotomy improves foot-related quality of life in patients with hallux valgus deformity despite of the high rate of postoperative radiographic complication, especially hallux varus. Patients might be willing to tolerate mild hallux varus after DLMO, as indicated by patient-centered clinical results. (J Am Podiatr Med Assoc 112 (4), 2022) Full article

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Open AccessArticle

Searching for a New Parameter in the Healing of Tibia Pilon Fractures: Fracture Area Measurement

by Batuhan Gencer, Özgür Doğan, Volkan Igdir, Ahmet Çulcu, Emrah Caliskan and Ali Biçimoğlu

J. Am. Podiatr. Med. Assoc. 2022, 112(4), 21137; https://doi.org/10.7547/21-137 - 1 Jul 2022

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Abstract

Background: Tibia pilon fractures are associated with high complication rates, decreased quality of life, and low patient satisfaction. Although many factors such as reduction quality and soft-tissue coverage have been identified, researchers continue to investigate the factors that affect healing in tibia pilon [...] Read more.

Background: Tibia pilon fractures are associated with high complication rates, decreased quality of life, and low patient satisfaction. Although many factors such as reduction quality and soft-tissue coverage have been identified, researchers continue to investigate the factors that affect healing in tibia pilon fractures. Our objective was to investigate the effect of initial fracture crack width and displacement degree on clinical functional results in tibia pilon fractures. Methods: In this retrospective cohort study, 40 patients with Arbeitsgemeinschaft für Osteosynthesefragen and Orthopaedic Trauma Association type 43B and 43C tibia pilon fractures and operated on through the extensile anteromedial approach were analyzed. The demographic data of the patients, injury mechanisms, fracture type, reduction quality, clinical results, and postoperative complications were recorded. To evaluate the objective quantity of initial fracture crack width and displacement, a new parameter was defined: “fracture area.” All measurements were conducted using a feature from the picture archiving and communication system on anteroposterior and lateral radiographs taken separately in standard fashion. Results: With an average follow-up period of 29.2 months (range, 24–40 months), 34 patients (85%) had excellent or good results, whereas only two patients (5%) had poor clinical results. Age, injury mechanism, and reduction quality have a significant relationship with Maryland Foot Score (P < .001, P < .037, and P < .001, respectively). Preoperative fracture area, measured on both the anteroposterior and the lateral views, are significantly related to both Ovadia-Beals Score and Maryland Foot Score (P < .001 for each). Conclusions: Preoperative fracture area measurement has a major effect on healing of tibia pilon fractures. Increased initial fracture area is correlated with poor clinical functional results. High-energy injuries, older age, and poor reduction quality are also related to worse clinical outcomes. (J Am Podiatr Med Assoc 112(4), 2022) Full article

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Open AccessArticle

Letter to the Editor

by Mingjin Zhong and Huangyu Xie

J. Am. Podiatr. Med. Assoc. 2022, 112(4), 21104; https://doi.org/10.7547/21-104 - 1 Jul 2022

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Abstract

To the Editor: We had the opportunity to read, with great interest, the article entitled “Does the Association of Microfractures for the Treatment of Osteochondral Lesions of the Talus Affect the Outcome Following Arthroscopic Treatment for Chronic Ankle Instability?” by Legnani et al. [...] Read more.

To the Editor: We had the opportunity to read, with great interest, the article entitled “Does the Association of Microfractures for the Treatment of Osteochondral Lesions of the Talus Affect the Outcome Following Arthroscopic Treatment for Chronic Ankle Instability?” by Legnani et al. [...] Full article

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Open AccessArticle

Heel Spur and Radiotherapy: Case Report and Systematic Literature Review

by Antonio Piras, Luca Boldrini, Calogero Rinaldi, Antonella Sanfratello, Andrea D’Aviero, Angelo Toscano, Tommaso Angileri, Massimiliano Spada and Antonino Daidone

J. Am. Podiatr. Med. Assoc. 2022, 112(4), 21090; https://doi.org/10.7547/21-090 - 1 Jul 2022

Cited by 1 | Viewed by 98

Abstract

Heel spur is a chronic inflammatory condition causing pain and other typical symptoms. Therapeutic recommendations include the use of several drug or orthotic/physical therapies, performed alone or in combination. Surgery is usually reserved for refractory conditions. Radiotherapy has been shown to ensure good [...] Read more.

Heel spur is a chronic inflammatory condition causing pain and other typical symptoms. Therapeutic recommendations include the use of several drug or orthotic/physical therapies, performed alone or in combination. Surgery is usually reserved for refractory conditions. Radiotherapy has been shown to ensure good clinical outcomes in this clinical setting. A systematic review was performed to describe the feasibility and effectiveness of radiotherapy in the treatment of heel spur, evaluating its role in alleviating pain and consequently ensuring a better quality of life. A case report of 45-year-old patient treated for refractary right hindfoot pain was reported. A single fraction of 6 Gy RT was delivered with symptomatic complete response at 2 months observed. A systematic database search was conducted according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta‐Analyses) guidelines. The systematic review included studies describing heel spur treatment and providing complete information about radiotherapy. Fifteen articles published between 1996 and 2020 were reviewed. Study characteristic analysis resulted in seven prospective randomized studies and eight retrospective studies. Radiotherapy of painful heel spur seems to be safe and effective, with high response rates even at low doses and with an overall favorable toxicity profile. Predictive parameters and modern tailored treatment should be investigated with further studies. (J Am Podiatr Med Assoc 112(4), 2022) Full article

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Open AccessArticle

An Unusual Pediatric Manifestation of the Herpes Simplex Virus

by Nicholas Salerno and John J. Doolan

J. Am. Podiatr. Med. Assoc. 2022, 112(4), 21085; https://doi.org/10.7547/21-085 - 1 Jul 2022

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Abstract

Herpetic whitlow is a viral infection of the fingers or toes caused by the herpes simplex virus. Herpes simplex virus is a common pathogen that causes infections in any cutaneous or mucocutaneous surface, most commonly gingivostomatitis or genital herpes. However, infection of the [...] Read more.

Herpetic whitlow is a viral infection of the fingers or toes caused by the herpes simplex virus. Herpes simplex virus is a common pathogen that causes infections in any cutaneous or mucocutaneous surface, most commonly gingivostomatitis or genital herpes. However, infection of the digits is also infrequently reported. Herpetic whitlow occurs when the virus infects the distal phalanx of the fingers or toes by means of direct inoculation, causing pain, swelling, erythema, and vesicle formation. The proper diagnosis is important because the condition can mimic various other podiatric abnormalities such as paronychia, bacterial cellulitis, or even embolic disease. Improper diagnosis often leads to unnecessary work-up, antibiotic therapy, or even surgical intervention. This case will help illuminate the clinical presentation of herpetic whitlow in an atypical location, and the patient’s subsequent treatment. We present an atypical case of right hallux herpetic whitlow with delayed diagnosis and associated cellulitis. The patient was admitted after seeing multiple providers for a progressive right hallux infection that presented as a mixture of vesicular lesions and apparent cellulitis. His history was positive for biting his fingernails and toenails, and the lesions were noted to be honeycomb-like, with minimal drainage. The lesions were then deroofed and viral cultures were obtained, which were positive for herpes simplex virus type 1, thus confirming a diagnosis of herpetic whitlow. Although he remained afebrile with negative wound cultures during admission, a secondary bacterial infection could not be excluded because of his nail avulsion and surrounding cellulitis. He was discharged on oral antibiotics, antivirals, and wound care recommendations. Herpetic whitlow should be included in the differential diagnosis of pedal digital lesions that appear as vesicular or cellulitic in the pediatric population. (J Am Podiatr Med Assoc 112(4), 2022) Full article

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Open AccessArticle

New Distinct Component Patterns for Plantar Pressure Variables by Using Principal Component Analysis

by Basar Ozturk and Yusuf Celik

J. Am. Podiatr. Med. Assoc. 2022, 112(4), 21048; https://doi.org/10.7547/21-048 - 1 Jul 2022

Cited by 2 | Viewed by 76

Abstract

Background: It is important to determine the plantar pressure distribution of schoolchildren by applying static and dynamic foot analyses using a pedobarography device. However, it is difficult to obtain clear interpretations from results that can be explained by a large number of plantar [...] Read more.

Background: It is important to determine the plantar pressure distribution of schoolchildren by applying static and dynamic foot analyses using a pedobarography device. However, it is difficult to obtain clear interpretations from results that can be explained by a large number of plantar pressure variables. The aim of this study was to use principal component analysis (PCA) to predict the main components for reducing the size of big data sets, provide a practical overview, and minimize information loss on the subject of plantar pressure assessment in youths. Methods: In total, 112 schoolchildren were included in the study (mean ± SD: age, 10.58 ± 1.27 years; body mass index, 18.86 ± 4.33). During the research, a pedobarography device was used to obtain plantar pressure data. Each foot was divided into six anatomical regions and evaluated. Global and regional plantar pressure distributions, load and surface areas, pressure-time integrals, weight ratios, and geometric foot properties were calculated. Results: The PCA yielded ten principal components that together account for 81.88% of the variation in the data set and represent new and distinct patterns. Thus, 137 variables affecting the subject were reduced to ten components. Conclusions: The numerous variables that affect static and dynamic plantar pressure distributions can be reduced to ten components by PCA, making the research results more concise and understandable. (J Am Podiatr Med Assoc 112(4), 2022) Full article

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Open AccessArticle

The Impact of Hallux Valgus on Adolescent Ballet Dancer Balance and Health-Related Quality of Life Scores

by Ozcan Kaya, Irem Kurt, Okan Ozkunt and Kerim Sariyilmaz

J. Am. Podiatr. Med. Assoc. 2022, 112(4), 21030; https://doi.org/10.7547/21-030 - 1 Jul 2022

Cited by 4 | Viewed by 79

Abstract

Background: It is well-known that hallux valgus (HV) alters foot biomechanics. In different populations, HV and postural stability has been studied, but HV and the adolescent ballet dancer has not been studied. The aims of this study were to explore the effect of [...] Read more.

Background: It is well-known that hallux valgus (HV) alters foot biomechanics. In different populations, HV and postural stability has been studied, but HV and the adolescent ballet dancer has not been studied. The aims of this study were to explore the effect of HV on adolescent ballet dancers’ balance and to assess the health-related quality of life (HRQOL) of adolescent ballet dancers with HV. Methods: Female ballet dancers aged 8 to 16 years were screened prospectively and divided into two groups: those with HV (group 1) and those without HV (group 2). The HV diagnosis was made clinically. The groups were compared according to balance parameters and HRQOL questionnaires. Results: In group 1 (n = 31) and group 2 (n = 24), the mean age was 11.6 years and 12.2 years, respectively. Mean first metatarsophalangeal angle was 13.4° (range, 10°–15°) in group 2 and 19.8° (range, 16°–25°) in group 1. A statistically significant difference was found according to the nonparametric Mann-Whitney U test results in the comparison of HV angle between groups. According to Spearman rho correlation analysis, it was determined that the increase in HV angle caused deterioration in the flamingo static balance test (r = 0.552; P = .019). No significant relationship was found between HRQOL questionnaires and the presence of HV (P > .05). Conclusions: Adolescent ballet dancers experience static balance impairment due to HV angle increase. Clinical measurement of HV and application of balance parameters made easy without need of set ups to perform evaluation with high numbers of participants in concordance with the literature. (J Am Podiatr Med Assoc 112(4), 2022) Full article

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Open AccessArticle

Primary Cutaneous Cribriform Carcinoma of the Heel: A Rare Case Report

by Koray Başdelioğlu, Ayşe Nur Toksöz Yıldırım, Arda Akkaya, Sıdıka Şeyma Özkanlı, Muhammed Beşir Öztürk and Korhan Özkan

J. Am. Podiatr. Med. Assoc. 2022, 112(4), 21021; https://doi.org/10.7547/21-021 - 1 Jul 2022

Cited by 2 | Viewed by 73

Abstract

Primary cutaneous cribriform carcinoma (PCCC) is an extremely rare carcinoma of the sweat glands. In this case report, we present a 41-year-old man with PCCC in the heel. The patient had heel pain for 10 months, and his complaints had increased in the [...] Read more.

Primary cutaneous cribriform carcinoma (PCCC) is an extremely rare carcinoma of the sweat glands. In this case report, we present a 41-year-old man with PCCC in the heel. The patient had heel pain for 10 months, and his complaints had increased in the past 2 months. Physical examination revealed a firm nonmobile mass at his heel. The PCCC in the heel was excised by wide resection after biopsy, and the defect that occurred after resection was reconstructed with a vascularized free anterolateral thigh flap. There were no complications during or after the surgery. No recurrence or metastasis was encountered during 48 months of follow-up. The patient continues his daily life activities without any problems or pain. In the heel, PCCC can be effectively treated by extensive resection and reconstruction of the defect with a skin graft/vascularized flap. Cribriform carcinomas of visceral organs and primary cutaneous adenoid cystic carcinoma should be included in the differential diagnosis, which should be made carefully, histopathologically, and immunohistochemically. (J Am Podiatr Med Assoc 112(4), 2022) Full article

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Open AccessArticle

Retrospective Evaluation of Ingrown Toenails in a Tertiary Reference Center

by Didem Dincer Rota, Efsun Tanacan, Gulhan Aksoy Sarac and Fatma Gulru Erdogan

J. Am. Podiatr. Med. Assoc. 2022, 112(4), 21013; https://doi.org/10.7547/21-013 - 1 Jul 2022

Cited by 3 | Viewed by 66

Abstract

Background: We evaluated the clinical characteristics of ingrown toenails in one of the biggest reference centers in Turkey. Methods: This retrospective cohort study was conducted on patients admitted to Ufuk University Hospital with ingrown toenail between January 1, 2014, and December 31, 2019. [...] Read more.

Background: We evaluated the clinical characteristics of ingrown toenails in one of the biggest reference centers in Turkey. Methods: This retrospective cohort study was conducted on patients admitted to Ufuk University Hospital with ingrown toenail between January 1, 2014, and December 31, 2019. Clinical characterstics and demographic features of all of the participants were evaluated, and then the study population was divided into two groups: group 1 (patients ≤20 years old) and group 2 (patients >20 years old). These groups were compared in terms of clinical findings. Results: Disease duration, body mass index, rate of medications for chronic diseases, and rate of joint diseases were significantly higher in group 2. Rates of hyperhidrosis and sudden weight gain were significantly higher in group 1 (P < .05). Severity of ingrown toenail was significantly different between groups (P = .006). Stage 1 was the most common stage in both groups, and rate of stage 3 was higher in group 1. Onycoshisis and was more common in group 1, and nail thickening was more common in group 2 (P < .05). Nail wire and aluminum chloride were the most common treatment modalities in groups 2 and 1, respectively (P < .05). Periungual edema, presence of pus, hypertrophy, and granulation were more common in group 1 (P < .05). Thin nail plate was more common in group 1, and normal and thick nail nail plates were more common in group 2 (P < .05). Conclusions: Clinical characteristics of ingrown toenail vary between younger and older populations. Thus, an individualized approach is preferred in the management of ingrown toenail for different age groups. (J Am Podiatr Med Assoc 112(4), 2022) Full article

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Open AccessArticle

Tropical Achilles Tendinopathy: Sea Urchin Spine Injury

by Roger A. Sanguino, Jennifer Cheng and James F. Wyss

J. Am. Podiatr. Med. Assoc. 2022, 112(4), 21007; https://doi.org/10.7547/21-007 - 1 Jul 2022

Cited by 1 | Viewed by 59

Abstract

Sea urchin spine injuries have been reported in the hand and foot, but there are no published cases in the Achilles tendon. We report an unusual case of Achilles tendinopathy secondary to sea urchin spine injury. The patient had Achilles tendon pain that [...] Read more.

Sea urchin spine injuries have been reported in the hand and foot, but there are no published cases in the Achilles tendon. We report an unusual case of Achilles tendinopathy secondary to sea urchin spine injury. The patient had Achilles tendon pain that increased over time and was worsened with weightbearing activity. His left ankle plantarflexion was limited by pain. He had received medical care 3 months earlier to remove sea urchin spines after stepping on a long-spined sea urchin. Bedside ultrasound and imaging studies revealed that there were foreign bodies related to sea urchin spines on the surface of the tendon. The patient was given education about proper footwear and activity modification. His symptoms resolved over time, and he avoided surgical intervention. (J Am Podiatr Med Assoc 112(4), 2022) Full article

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Open AccessArticle

Plantar Erythrodysesthesia from Oral Targeted Cancer Treatment: A Case Report

by Colleen S. Schwartz

J. Am. Podiatr. Med. Assoc. 2022, 112(4), 20268; https://doi.org/10.7547/20-268 - 1 Jul 2022

Cited by 1 | Viewed by 54

Abstract

With the rapid development and use of new cancer therapies, cutaneous reactions related to systemic toxicities are becoming common. This case report establishes the importance of the podiatric physician’s role in the care of oncologic patients with plantar erythrodysesthesia taking a tyrosine kinase [...] Read more.

With the rapid development and use of new cancer therapies, cutaneous reactions related to systemic toxicities are becoming common. This case report establishes the importance of the podiatric physician’s role in the care of oncologic patients with plantar erythrodysesthesia taking a tyrosine kinase inhibitor. (J Am Podiatr Med Assoc 112(4), 2022) Full article

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Open AccessArticle

Treatment of Posterior Malleolar Fractures in Elderly Individuals with Kirschner Wire Tension Band Fixation

by Bingqi Wang, Maozhong Hu, Dongdong Wan and Kai Sun

J. Am. Podiatr. Med. Assoc. 2022, 112(4), 20250; https://doi.org/10.7547/20-250 - 1 Jul 2022

Cited by 1 | Viewed by 65

Abstract

Background: Generally, posterior malleolar fragments are fixed either with percutaneous anteroposterior screws or through a posterolateral approach using screws and/or a buttress plate. Both surgical methods have some shortcomings, and the use of anteroposterior screws to fix osteoporotic posterior malleolar fractures carries a [...] Read more.

Background: Generally, posterior malleolar fragments are fixed either with percutaneous anteroposterior screws or through a posterolateral approach using screws and/or a buttress plate. Both surgical methods have some shortcomings, and the use of anteroposterior screws to fix osteoporotic posterior malleolar fractures carries a risk of failure. Methods: Nine elderly patients (average age, 67 years) with posterior malleolar fractures were treated with transfibular Kirschner wire tension band fixation. According to the Lauge- Hansen classification, all fractures were of the supination-external rotation type. The operative duration, intraoperative blood loss, and wound healing outcome were recorded. During the follow-up period, clinical outcomes were measured using the American Orthopaedic Foot and Ankle Society ankle-hindfoot score, and the occurrence of complications was observed. Results: The patients were followed up for 12 to 18 months (mean, 15 months). The operative duration ranged from approximately 30 to 95 minutes, with an average of 70 minutes. Anatomical reduction was achieved in nine cases, and there were no complications, such as skin necrosis, wound infection, or skin sensory disturbance. There was one case of delayed wound healing caused by fat liquefaction, which was cured by a dressing change. The functional scores were excellent in four cases, good in four cases, fair in one case, and poor in zero cases. The rate of excellent and good results was 88.89% (eight of nine), with an average of 78.78 points. Conclusion: Kirschner wire tension band fixation through a transfibular approach for the treatment of posterior malleolar fractures does not require a change in patient posture. It facilitates the reduction and internal fixation of the posterior malleolar fragment; furthermore, it is easier to remove internal fixation after fracture healing, which provides a new surgical method for elderly patients with posterior malleolus fracture. Thus, this has potential as a new surgical method for elderly patients with posterior malleolar fractures. (J Am Podiatr Med Assoc 112(3), 2022) Full article

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Open AccessArticle

The Pedal Subcutaneous Phaeohyphomycotic Cyst in an Immunocompetent Adult Man: A Case Report

by Mo Esmaili, Gary W. Procop, Gene Mirkin and Xingpei Hao

J. Am. Podiatr. Med. Assoc. 2022, 112(4), 20249; https://doi.org/10.7547/20-249 - 1 Jul 2022

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Abstract

Phaeohyphomycosis is a spectrum of subcutaneous and systemic infections caused by a variety of dematiaceous fungi. It is an opportunistic disease with an increased incidence in immunocompromised patients. We report a case of a pedal phaeohyphomycotic cyst in an immunocompetent adult male immigrant [...] Read more.

Phaeohyphomycosis is a spectrum of subcutaneous and systemic infections caused by a variety of dematiaceous fungi. It is an opportunistic disease with an increased incidence in immunocompromised patients. We report a case of a pedal phaeohyphomycotic cyst in an immunocompetent adult male immigrant with the goal of highlighting its clinical presentation, diagnosis, and optimal treatment. A 57-year-old male immigrant from Panama presented with a painless, gradually increasing, large cystic lesion in his left foot, first intermetatarsal space, which had been present for many years. The patient was treated with surgical excision without antifungal therapy. Histologic analysis showed multiple granulomas composed of fibrin and necrosis in the centers surrounded by proliferative palisading fibroblasts admixed with heavily infiltrated neutrophils, plasma cells, macrophages, lymphocytes, and eosinophils. Periodic acid-Schiff and Fontana-Masson stains revealed sporadic, scattered dematiaceous fungal hyphae and pseudohyphae among granulomatous tissues. The mass was diagnosed as a phaeohyphomycotic cyst. Polymerase chain reaction–based sequencing failed to identify the fungal species because of the rarity of the fungal elements in the granulomatous tissues. The patient had no recurrence at a follow-up of 2 years. A phaeohyphomycotic cyst is a rare entity that needs to be differentiated from other benign and malignant lesions. Multiple modalities, including clinical evaluation, radiography, histologic analysis, microbiological culture, and nucleic acid sequencing, should be used for the final diagnosis. Surgical excision is an optimal treatment. Antifungal therapy should be considered based on the patient’s clinical manifestation, surgical excision, and immune functional status. (J Am Podiatr Med Assoc 112(4), 2022) Full article

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Open AccessArticle

Outcome of Local Corticosteroid Injection by Ultrasound- versus Palpation-Guided Technique in Plantar Fasciitis

by Shalini Mishra, Gita Handa, Shivanand Gamanagatti, Sanjay Wadhwa and Upinderpal Singh

J. Am. Podiatr. Med. Assoc. 2022, 112(4), 20136; https://doi.org/10.7547/20-136 - 1 Jul 2022

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Abstract

Background: Plantar fasciitis is a common cause of heel pain. Conservative treatment is often effective, but in many cases, invasive procedures may be required. Local corticosteroid injection is the most frequently used invasive technique and can be given under ultrasound (USG) or palpation [...] Read more.

Background: Plantar fasciitis is a common cause of heel pain. Conservative treatment is often effective, but in many cases, invasive procedures may be required. Local corticosteroid injection is the most frequently used invasive technique and can be given under ultrasound (USG) or palpation guidance. We sought to compare the outcome of local corticosteroid injection by USG and palpation guidance in plantar fasciitis. Methods: This was a prospective randomized study of patients who presented with heel pain between July 2015 and November 2016 and were screened for plantar fasciitis by USG. Patients with confirmed plantar fasciitis were managed conservatively for 4 weeks. The 60 consecutive patients not responding to the conservative treatment were randomized into two groups. Group A (n = 30) received a corticosteroid injection under USG guidance. Group B (n = 30) received a corticosteroid injection under palpation guidance. Patients were followed up at 3 and 6 weeks. We compared the visual analog scale score, plantar fascia thickness, and heel pad thickness in both groups. Results: There was significant pain relief in both groups after 3 and 6 weeks of local corticosteroid injection, with greater relief noted in the USG-guided group. There was a significant decrement in plantar fascia thickness in both groups after 3 and 6 weeks; however, a greater decrement was observed in the USG-guided group. Neither group showed a significant difference in heel pad thickness after 3 and 6 weeks. Conclusions: Ultrasound-guided injection provided better pain relief and a greater reduction in plantar fascia thickness than palpation-guided injection. (J Am Podiatr Med Assoc 112(4), 2022) Full article

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Open AccessArticle

Surgical Treatment of Plantar First Metatarsal Ulcerations in High-Risk Patients: A Case Series

by Nicole K. Cates, Jered M. Stowers, Alissa Mayer and Jacob Wynes

J. Am. Podiatr. Med. Assoc. 2022, 112(4), 20092; https://doi.org/10.7547/20-092 - 1 Jul 2022

Cited by 1 | Viewed by 86

Abstract

Background: Plantar first metatarsal ulcerations pose a difficult challenge to clinicians. Etiologies vary and include first metatarsal declination, cavus foot deformity, equinus contracture, and hallux limitus/rigidus. Our pragmatic, sequential approach to the multiple contributing etiologies of increased plantar pressure sub–first metatarsal can be [...] Read more.

Background: Plantar first metatarsal ulcerations pose a difficult challenge to clinicians. Etiologies vary and include first metatarsal declination, cavus foot deformity, equinus contracture, and hallux limitus/rigidus. Our pragmatic, sequential approach to the multiple contributing etiologies of increased plantar pressure sub–first metatarsal can be addressed through minimal skin incisions. Methods: A retrospective review was performed for patients with surgically treated preulcerations or ulcerations sub–first metatarsal head. All of the patients underwent a dorsiflexory wedge osteotomy, and the need for each additional procedure was independently assessed. Equinus contracture was treated with Achilles tendon lengthening, cavovarus deformity was mitigated with Steindler stripping, and plantarflexed first ray was treated with dorsiflexory wedge osteotomy. Results: Eight patients underwent our pragmatic, sequential approach for increased plantar pressure sub–first metatarsal, four with preoperative ulcerations and four with preoperative hyperkeratotic preulcerative lesions. The preoperative ulcerations were present for an average of 25.43 weeks (range, 6.00–72.86 weeks), with an average size of 0.19 cm³ (median, 0.04 cm³). Procedure breakdown was as follows: eight first metatarsal osteotomies, four Achilles tendon lengthenings, and six Steindler strippings. Postoperatively, all eight patients returned to full ambulation, and the four ulcerations healed at an average of 24 days (range, 15–38 days). New ulceration occurred in one patient, and postoperative infection occurred in one patient. There were no ulceration recurrences, dehiscence of surgical sites, or minor or major amputations. Conclusions: The outcomes in patients surgically treated for increased plantar first metatarsal head pressure were evaluated. This case series demonstrates that our pragmatic, sequential approach yields positive results. In diabetic or high-risk patients, it is our treatment algorithm of choice for increased plantar first metatarsal pressure. (J Am Podiatr Med Assoc 112(4), 2022) Full article

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Open AccessArticle

Tension Band Suture Fixation of Fifth Metatarsal Tuberosity Fracture: A Case Report

by Muhammad Ali Fazal, Ardito Widjono and Mohan Remani

J. Am. Podiatr. Med. Assoc. 2022, 112(4), 20085; https://doi.org/10.7547/20-085 - 1 Jul 2022

Cited by 1 | Viewed by 98

Abstract

Tuberosity fractures of the fifth metatarsal are common. The majority of these fractures are treated nonoperatively with good outcome. Surgery is indicated for nonunions, delayed unions, comminuted fractures, and displaced fractures. The surgical modalities include screw fixation, suture anchor fixation, Kirschner wires, tension [...] Read more.

Tuberosity fractures of the fifth metatarsal are common. The majority of these fractures are treated nonoperatively with good outcome. Surgery is indicated for nonunions, delayed unions, comminuted fractures, and displaced fractures. The surgical modalities include screw fixation, suture anchor fixation, Kirschner wires, tension band wiring, and locking plates. We report a case of a symptomatic nonunion of a displaced fracture of the tuberosity of the fifth metatarsal in a young patient treated with a tension band suture fixation that to our knowledge has not been described before. (J Am Podiatr Med Assoc 112(4), 2022) Full article

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Open AccessArticle

Intraosseous Technique for Correction of Hammertoe Deformity

by Trent Lott, Charles Penvose and Gregory Alvarez

J. Am. Podiatr. Med. Assoc. 2022, 112(4), 20084; https://doi.org/10.7547/20-084 - 1 Jul 2022

Cited by 3 | Viewed by 63

Abstract

Hammertoe deformities are among the most common conditions treated by foot and ankle surgeons. Many different types of proximal interphalangeal joint arthrodesis fixation techniques have been used. These include implant fixation, absorbable fixation, screw fixation, two-pin fixation, and single–Kirschner wire fixation. Each of [...] Read more.

Hammertoe deformities are among the most common conditions treated by foot and ankle surgeons. Many different types of proximal interphalangeal joint arthrodesis fixation techniques have been used. These include implant fixation, absorbable fixation, screw fixation, two-pin fixation, and single–Kirschner wire fixation. Each of these has their own set of associated advantages and disadvantages. One of the most common techniques to address hammertoe deformity is the use of Kirschner wires. Although Kirschner wires have been reliable and produced good outcomes, there are some drawbacks associated with their use. Some disadvantages include wire failure (bending/breaking), infection, and patient anxiety associated with removal. One of the more challenging aspects with using a single Kirschner wire for fixation is stability. Pistoning and rotational instability may occur with single–Kirschner wire use. Both pistoning and lack of rotational control can lead to nonunion, fibrous union, malunion, and ultimately patient dissatisfaction. The suturedesis technique is a surgical option that may be considered when a surgeon attempts to address these disadvantages. The authors believe this technique can adequately bring stability to the frontal plane and eliminate pistoning, which may lead to better fusion rates, better postoperative alignment, and better patient satisfaction. This article outlines the authors’ surgical technique of suturedesis in correcting hammertoe deformity. (J Am Podiatr Med Assoc 112(4), 2022) Full article

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J. Am. Podiatr. Med. Assoc., Volume 112, Issue 4 (07 2022) – 18 articles

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