Journal of the American Podiatric Medical Association

1615 KB

Open AccessReview

How Effective Are Devices in the Management of Onychomycosis? A Systematic Review

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

J. Am. Podiatr. Med. Assoc. 2023, 113(1), 21240; https://doi.org/10.7547/21-240 - 1 Jan 2023

Cited by 5 | Viewed by 1838

Onychomycosis is the most common nail disorder, with a global prevalence of approximately 5.5%. It is difficult to cure on both short-term and long-term bases. The most common treatments include the use of oral or topical antifungals. Recurrent infections are common, and the [...] Read more.

Onychomycosis is the most common nail disorder, with a global prevalence of approximately 5.5%. It is difficult to cure on both short-term and long-term bases. The most common treatments include the use of oral or topical antifungals. Recurrent infections are common, and the use of systemic oral antifungals raises concerns of hepatotoxicity and drug-drug interactions, particularly in patients with polypharmacy. A number of device-based treatments have been developed for onychomycosis treatment, to either directly treat fungal infection or act as adjuvants to increase the efficacy of topical and oral agents. These device-based treatments have been increasing in popularity over the past several years, and include photodynamic therapy, iontophoresis, plasma, microwaves, ultrasound, nail drilling, and lasers. Some, such as photodynamic therapy, provide more direct treatment, whereas others, such as ultrasound and nail drilling, aid the uptake of traditional antifungals. We conducted a systematic literature search investigating the efficacy of these device-based treatment methods. From an initial result of 841 studies, 26 were deemed relevant to the use of device-based treatments of onychomycosis. This review examines these methods and provides insight into the state of clinical research for each. Many device-based treatments show promising results, but require more research to assess their true impact on onychomycosis. Full article

► Show Figures

Figure 1

391 KB

Open AccessArticle

Sensory Perception of Varied Shoe Masses in Running

by Bahador Keshvari, Steven Alevras and Veit Senner

J. Am. Podiatr. Med. Assoc. 2023, 113(1), 21229; https://doi.org/10.7547/21-229 - 1 Jan 2023

Cited by 2 | Viewed by 141

Abstract

Background: Studies on the sensory perception of mass mostly focus on the hands rather than the feet. The aim of our study is to measure how accurately runners can perceive additional shoe mass in comparison to a control shoe (CS) while running, and [...] Read more.

Background: Studies on the sensory perception of mass mostly focus on the hands rather than the feet. The aim of our study is to measure how accurately runners can perceive additional shoe mass in comparison to a control shoe (CS) while running, and moreover, whether there is a learning effect in the perception of mass. Indoor running shoes were categorized as a CS (283 g) and shoes with four additional masses: shoe 2 (+50 g), shoe 3 (+150 g), shoe 4 (+250 g), and shoe 5 (+315 g). Methods: There were 22 participants in the experiment, which was divided into two sessions. In session 1, participants ran on a treadmill for 2 min with the CS and then put on one set of weighted shoes and ran for another 2 min at a preferred velocity. A binary question was used after the pair test. This process was repeated for all the shoes to compare them with the CS. Results: Based on our statistical analysis (mixed effect logistic regression), the independent variable (ie, mass) did have a significant effect on perceived mass (F_4,193 = 10.66, P < .0001), whereas repeating the task did not show a significant learning effect (F_1,193 = 1.06, P = .30). Conclusions: An increase of 150 g is the just-noticeable difference among other weighted shoes and the Weber fraction is equal to 0.53 (150:283 g). Learning effect did not improve by repeating the task in two sessions in the same day. This study facilitates our understanding about sense of force and enhances multibody simulation in running. Full article

► Show Figures

Figure 1

1054 KB

Open AccessArticle

Surgical Management and Outcomes of Patients with Idiopathic Peroneal Spastic Flatfoot: A Retrospective Case Series

by Vahdet Uçan, Mehmet Demirel, Orkhan Aliyev, Fatih Yıldız and Gökçer Uzer

J. Am. Podiatr. Med. Assoc. 2023, 113(1), 21210; https://doi.org/10.7547/21-210 - 1 Jan 2023

Cited by 5 | Viewed by 158

Abstract

Background: Although tarsal coalition represents the most common cause of peroneal spastic flatfoot, its existence cannot be verified in several cases. In some patients with rigid flatfoot, no cause can be detected after clinical, laboratory, and radiologic examination, and the condition is called [...] Read more.

Background: Although tarsal coalition represents the most common cause of peroneal spastic flatfoot, its existence cannot be verified in several cases. In some patients with rigid flatfoot, no cause can be detected after clinical, laboratory, and radiologic examination, and the condition is called idiopathic peroneal spastic flatfoot (IPSF). This study aimed to present our experience with surgical management and outcomes in patients with IPSF. Methods: Seven patients with IPSF, who were operated on between 2016 and 2019, and followed for at least 12 months were included, whereas those with known causes, such as tarsal coalition or other causes (eg, traumatic) were excluded. All patients were followed up for 3 months with botulinum toxin injection and cast immobilization as a routine protocol, and clinical improvement was not achieved. The Evans procedure and grafting with tricortical iliac crest bone graft in five patients and subtalar arthrodesis in two patients were performed. The American Orthopaedic Foot and Ankle Society ankle-hindfoot scale scores and Foot and Ankle Disability Index scores were obtained preoperatively and postoperatively from all patients. Results: On physical examination, all feet manifested rigid pes planus with varying degrees of hindfoot valgus and limited subtalar motion. Overall, the mean American Orthopaedic Foot and Ankle Society and Foot and Ankle Disability Index scores significantly increased from 42 (range, 20–76) and 45 (range, 19–68) preoperatively (P = .018) to 85 (range, 67– 97) and 84 (range, 67–99) (P = .043) at the final follow-up, respectively. No major intraoperative or postoperative complications were observed in any of the patients. All computed tomographic and magnetic resonance imaging scans revealed no evidence of tarsal coalitions in any of the feet. All radiologic workups failed to demonstrate secondary signs of fibrous or cartilaginous coalitions. Conclusions: Operative treatment seems to be a good option in the treatment of patients with IPSF who do not benefit from conservative treatment. In the future, it is recommended to investigate the ideal treatment options for this group of patients. Full article

► Show Figures

Figure 1

620 KB

Open AccessArticle

Staged Revision Arthrodesis with Interposition of Tricortical Iliac Crest Autograft to Address an Infected Nonunion of the First Metatarsophalangeal Joint: A Case Report

by Rosario Saccomanno and Adam D. Bitterman

J. Am. Podiatr. Med. Assoc. 2023, 113(1), 21149; https://doi.org/10.7547/21-149 - 1 Jan 2023

Viewed by 163

Abstract

A 55-year-old woman with a complicated infected nonunion after first metatarsophalangeal joint arthrodesis is presented. The patient initially underwent cross-screw fixation for the treatment of hallux rigidus that resulted in joint infection and hardware loosening. A staged surgical approach was undertaken by means [...] Read more.

A 55-year-old woman with a complicated infected nonunion after first metatarsophalangeal joint arthrodesis is presented. The patient initially underwent cross-screw fixation for the treatment of hallux rigidus that resulted in joint infection and hardware loosening. A staged surgical approach was undertaken by means of initial hardware removal with implementation of an antibiotic cement spacer followed by revision arthrodesis with interposition of tricortical iliac crest autograft. This case report aims to highlight an accepted surgical approach to address an infected nonunion at the level of the first metatarsophalangeal joint. Full article

► Show Figures

Figure 1

1701 KB

Open AccessArticle

Late-Diagnosed Dislocation of the Proximal Interphalangeal Joint of the Fifth Toe in a 7-Year-Old Boy: A Case Report

by Alper Koksal, Kadir- Abul and Osman Cimen

J. Am. Podiatr. Med. Assoc. 2023, 113(1), 21128; https://doi.org/10.7547/21-128 - 1 Jan 2023

Cited by 1 | Viewed by 130

Abstract

Dislocation of the proximal interphalangeal joint of the fifth toe is an uncommon injury. When it is diagnosed in the acute phase, closed reduction is commonly an adequate treatment option. We describe a rare case of a 7-year-old patient who presented with late-diagnosed [...] Read more.

Dislocation of the proximal interphalangeal joint of the fifth toe is an uncommon injury. When it is diagnosed in the acute phase, closed reduction is commonly an adequate treatment option. We describe a rare case of a 7-year-old patient who presented with late-diagnosed isolated dislocation of the proximal interphalangeal joint of the fifth toe. Although there are a few reported cases of late-diagnosis combined fracture-dislocation of the toes in both adult and pediatric age groups in the literature, belatedly diagnosed dislocation of the fifth toe without accompanying fracture in the pediatric population, to our knowledge, has not yet been reported. This patient achieved good clinical outcomes after treatment via open reduction and internal fixation. Full article

► Show Figures

Figure 1

622 KB

Open AccessArticle

Novel Use of Diaphyseal Fibular Autograft for Revision Arthrodesis in Failed Keller Arthroplasty: A Case Report

by Colton Webber, Zachary Herzwurm, Jahan Threeths and Edward Szabo

J. Am. Podiatr. Med. Assoc. 2023, 113(1), 21116; https://doi.org/10.7547/21-116 - 1 Jan 2023

Viewed by 104

Abstract

This case report describes a unique solution to the complex problem of bone loss and first-ray instability after a failed Keller arthroplasty. The patient was a 65-year-old woman who presented 5 years after undergoing Keller arthroplasty of the left first metatarsophalangeal joint for [...] Read more.

This case report describes a unique solution to the complex problem of bone loss and first-ray instability after a failed Keller arthroplasty. The patient was a 65-year-old woman who presented 5 years after undergoing Keller arthroplasty of the left first metatarsophalangeal joint for hallux rigidus with a chief complaint of pain and inability to wear regular shoes. The patient underwent first metatarsophalangeal joint arthrodesis with diaphyseal fibula used as structural autograft. The patient has been followed for 5 years and has full resolution of previous symptoms without complications using this previously undescribed autograft harvest site. Full article

► Show Figures

Figure 1

1122 KB

Open AccessArticle

Eccrine Poroma: A Case Report

by Katherine R. Kloberdanz, Chris M. Olenech and Husain A. Saleh

J. Am. Podiatr. Med. Assoc. 2023, 113(1), 21110; https://doi.org/10.7547/21-110 - 1 Jan 2023

Cited by 1 | Viewed by 549

Abstract

Eccrine poroma is a benign adnexal neoplasm often mistaken for pyogenic granuloma, skin tag, squamous cell carcinoma, and other soft-tissue tumors. We describe a 69-year-old woman with a soft-tissue mass on the lateral aspect of her right hallux that was initially clinically diagnosed [...] Read more.

Eccrine poroma is a benign adnexal neoplasm often mistaken for pyogenic granuloma, skin tag, squamous cell carcinoma, and other soft-tissue tumors. We describe a 69-year-old woman with a soft-tissue mass on the lateral aspect of her right hallux that was initially clinically diagnosed as a pyogenic granuloma. Histologic examination proved that this mass was instead an eccrine poroma, the rare benign sweat gland tumor. This case exemplifies the importance of a broad differential diagnosis, especially regarding soft-tissue masses of the lower extremity. Full article

► Show Figures

Figure 1

796 KB

Open AccessArticle

Synthetic Hybrid-Scale Fiber Matrix for the Treatment of Complex Lower-Extremity Wounds

by Khalid Husain, Ali Malik and Jennifer Kirchens

J. Am. Podiatr. Med. Assoc. 2023, 113(1), 21071; https://doi.org/10.7547/21-071 - 1 Jan 2023

Cited by 2 | Viewed by 145

Abstract

Background: Chronic, nonhealing wounds are a growing health-care problem in the United States, affecting more than 6.5 million patients annually and costing the health-care system over $25 billion. Chronic wounds, including diabetic foot ulcers (DFUs) and venous leg ulcers (VLUs), are often difficult [...] Read more.

Background: Chronic, nonhealing wounds are a growing health-care problem in the United States, affecting more than 6.5 million patients annually and costing the health-care system over $25 billion. Chronic wounds, including diabetic foot ulcers (DFUs) and venous leg ulcers (VLUs), are often difficult to treat, and patients commonly fail to heal even with the most advanced therapies. The present study was designed to evaluate the efficacy and utility of the synthetic hybrid-scale fiber matrix in the treatment of complex chronic nonhealing lower-extremity ulcers refractory to advanced therapies. Methods: A retrospective analysis of 20 patients with a total of 23 wounds (DFUs, n = 18; VLUs, n = 5) who underwent treatment using the synthetic hybrid-scale fiber matrix was conducted. The majority of ulcers (78%) included in this study were refractory to one or multiple previous advanced wound therapies and therefore considered difficult-to-heal ulcers with high failure risk for future therapies. Results: Subjects had a mean wound age of 16 months and presented with 132 secondary comorbidities and 65 failed interventions and therapies. Treatment of VLUs with the synthetic matrix resulted in complete closure of 100% of the wounds over 244 ± 153 days with an average of 10.8 ± 5.5 applications. Treatment of DFUs with the synthetic matrix resulted in complete closure of 94% of the wounds over 122 ± 69 days with 6.7 ± 3.9 applications. Conclusions: Treatment with the synthetic hybrid-scale fiber matrix resulted in the closure of 96% of complex chronic ulcers refractory to existing therapies. The inclusion of the synthetic hybrid-scale fiber matrix in wound care programs provides a critical and needed solution for costly, long-standing refractory wounds. Full article

► Show Figures

Figure 1

309 KB

Open AccessArticle

Osteonecrosis of the Tarsal Navicular: Not Always Spontaneous!

by Hanene Lassoued Ferjani, Hiba Boussaa, Kaouther Maatallah, Wafa Triki, Dorra Ben Nessib, Dhia Kaffel and Wafa Hamdi

J. Am. Podiatr. Med. Assoc. 2023, 113(1), 21070; https://doi.org/10.7547/21-070 - 1 Jan 2023

Cited by 1 | Viewed by 178

Abstract

Background: Mueller-Weiss disease, a rare and complex foot condition, is defined as spontaneous and progressive navicular fragmentation leading to midfoot pain and deformity. However, its exact etiopathogenesis remains unclear. We report a case series of tarsal navicular osteonecrosis to describe the clinical and [...] Read more.

Background: Mueller-Weiss disease, a rare and complex foot condition, is defined as spontaneous and progressive navicular fragmentation leading to midfoot pain and deformity. However, its exact etiopathogenesis remains unclear. We report a case series of tarsal navicular osteonecrosis to describe the clinical and imaging characteristics and etiologic profile of the disease. Methods: This retrospective study included five women diagnosed as having tarsal navicular osteonecrosis. The following data were extracted from medical records: age, comorbidities, alcohol and tobacco consumption, history of trauma, clinical presentation, imaging modalities performed, treatment protocol, and outcomes. Results: Five women with a mean age of 51.4 years (range, 39–68 years) were enrolled in the study. Mechanical pain and deformity over the dorsum of the midfoot was the main clinical presentation. Rheumatoid arthritis, granulomatosis with polyangiitis, and spondyloarthritis were reported by three patients. Radiographs revealed bilateral distribution in one patient. Three patients underwent computed tomography. It showed a fragmentation of the navicular bone in two cases.Magnetic resonance imaging was performed in one patient showing flattening of the lateral aspect of the navicular bone with signal abnormalities. Talonaviculocuneiform arthrodesis was performed in all of the patients. Conclusions: Mueller-Weiss disease–like changes may occur in patients with an underlying inflammatory disease such as rheumatoid arthritis and spondyloarthritis. Full article

► Show Figures

Figure 1

1451 KB

Open AccessArticle

Periungual Amelanocytic Malignant Melanoma with Osteocartilaginous Differentiation of the Right Hallux: A Case Report

by Enzo Leone, Gene Mirkin and Xingpei Hao

J. Am. Podiatr. Med. Assoc. 2023, 113(1), 21064; https://doi.org/10.7547/21-064 - 1 Jan 2023

Viewed by 128

Abstract

Malignant melanoma with osteocartilaginous differentiation is extremely rare. We report a case of periungual osteocartilaginous melanoma (OCM) on the right hallux. A 59-year-old man presented with a rapidly growing mass with drainage on his right great toe after treatment of ingrown toenail and [...] Read more.

Malignant melanoma with osteocartilaginous differentiation is extremely rare. We report a case of periungual osteocartilaginous melanoma (OCM) on the right hallux. A 59-year-old man presented with a rapidly growing mass with drainage on his right great toe after treatment of ingrown toenail and infection 3 months earlier. Physical examination showed a 2.0×1.5×1.0-cm, malodorous, erythematous, dusky, granuloma-like mass along the fibular border of the right hallux. Pathologic evaluation of the excisional biopsy revealed diffuse epithelioid and chondroblastoma-like melanocytes with atypia and pleomorphism in the dermis with strong SOX10 immunostaining. The lesion was diagnosed as osteocartilaginous melanoma. The patient was referred to a surgical oncologist for further treatment. Osteocartilaginous melanoma is a rare variant of malignant melanoma that needs to be differentiated from chondroblastoma and other lesions. Immunostains for SOX10, H3K36M, and SATB2 are helpful for the differential diagnosis. Full article

► Show Figures

Figure 1

557 KB

Open AccessArticle

Treatment of a Large Nail-Bed Pyogenic Granuloma with Topical Timolol

by Sarah A. Frommer and Kaylee O. Leathers

J. Am. Podiatr. Med. Assoc. 2023, 113(1), 21063; https://doi.org/10.7547/21-063 - 1 Jan 2023

Cited by 1 | Viewed by 931

Abstract

Nail pyogenic granulomas are common benign vascular lesions often occurring after trauma. A variety of treatment modalities exist, including topical therapies and surgical excision, although both have their pros and cons. In this communication, we describe the case of a 7-year-old boy with [...] Read more.

Nail pyogenic granulomas are common benign vascular lesions often occurring after trauma. A variety of treatment modalities exist, including topical therapies and surgical excision, although both have their pros and cons. In this communication, we describe the case of a 7-year-old boy with repeated toe trauma, who developed a large nail bed pyogenic granuloma after undergoing surgical debridement and nail bed repair. He was treated with 3 months of topical 0.5% timolol maleate, resulting in complete resolution of the pyogenic granuloma and minimal nail deformity. Full article

► Show Figures

Figure 1

42 KB

Open AccessArticle

Severe Calcification of Femoral Arteries Causes Tourniquet Failure Accompanied by Massive Bleeding

by Narumi Miyazaki, Akiko Kojima, Yutaka Fukushima and Hirotoshi Kitagawa

J. Am. Podiatr. Med. Assoc. 2023, 113(1), 21059; https://doi.org/10.7547/21-059 - 1 Jan 2023

Cited by 1 | Viewed by 150

Abstract

Tourniquet failure is attributed to inadequate tourniquet pressure, inadequate exsanguination, failure to compress medullary vessels within the bone, and incompressible calcified arteries. We herein report a case of massive bleeding using a properly functioning tourniquet in a patient who had bilateral calcified femoral [...] Read more.

Tourniquet failure is attributed to inadequate tourniquet pressure, inadequate exsanguination, failure to compress medullary vessels within the bone, and incompressible calcified arteries. We herein report a case of massive bleeding using a properly functioning tourniquet in a patient who had bilateral calcified femoral arteries. When incompressible calcified arteries are present, the inflated tourniquet cuff fails to adequately compress the underlying artery, yet acts as an efficient venous tourniquet, which leads to an increase in bleeding. It is therefore critical to preoperatively confirm the effectiveness of the tourniquet in arterial occlusion in patients with severe arterial calcification. Full article

186 KB

Open AccessArticle

Fragile Feet and Trivial Trauma: Communicating the Etiology of Diabetic Foot Ulcers to Patients

by Gustav Jarl, Jaap J. van Netten and Peter A. Lazzarini

J. Am. Podiatr. Med. Assoc. 2023, 113(1), 21027; https://doi.org/10.7547/21-027 - 1 Jan 2023

Cited by 8 | Viewed by 152

Abstract

People at risk for diabetic foot ulcer (DFU) often misunderstand why foot ulcers develop and what self-care strategies may help prevent them. The etiology of DFU is complex and difficult to communicate to patients, which may hinder effective self-care. Thus, we propose a [...] Read more.

People at risk for diabetic foot ulcer (DFU) often misunderstand why foot ulcers develop and what self-care strategies may help prevent them. The etiology of DFU is complex and difficult to communicate to patients, which may hinder effective self-care. Thus, we propose a simplified model of DFU etiology and prevention to aid communication with patients. The Fragile Feet & Trivial Trauma model focuses on two broad sets of risk factors: predisposing and precipitating. Predisposing risk factors (eg, neuropathy, angiopathy, and foot deformity) are usually lifelong and result in “fragile feet.” Precipitating risk factors are usually different forms of everyday trauma (eg, mechanical, thermal, and chemical) and can be summarized as “trivial trauma.” We suggest that the clinician consider discussing this model with their patient in three steps: 1) explain how a patient’s specific predisposing risk factors result in fragile feet for the rest of life, 2) explain how specific risk factors in a patient’s environment can be the trivial trauma that triggers development of a DFU, and 3) discuss and agree on with the patient measures to reduce the fragility of the feet (eg, vascular surgery) and prevent trivial trauma (eg, wear therapeutic footwear). By this, the model supports the communication of two essential messages: that patients may have a lifelong risk of ulceration but that there are health-care interventions and self-care practices that can reduce these risks. The Fragile Feet & Trivial Trauma model is a promising tool for aiding communication of foot ulcer etiology to patients. Future studies should investigate whether using the model results in improved patient understanding and self-care and, in turn, contributes to lower ulceration rates. Full article

► Show Figures

Figure 1

806 KB

Open AccessArticle

Impact of Posterior Malleolus Fixation on Clinical and Functional Results

by Olgun Bingol, Guzelali Ozdemir, Taner Karlidag, Alperen Korucu, Niyazi Erdem Yasar and Alper Deveci

J. Am. Podiatr. Med. Assoc. 2023, 113(1), 21008; https://doi.org/10.7547/21-008 - 1 Jan 2023

Cited by 6 | Viewed by 153

Abstract

Background: Clinical studies have shown that posterior malleolar fractures treated with a posterior buttress plate have improved outcomes compared to anterior-to-posterior screw fixation. The aim of this study was to evaluate the impact of posterior malleolus fixation on clinical and functional results. Methods: [...] Read more.

Background: Clinical studies have shown that posterior malleolar fractures treated with a posterior buttress plate have improved outcomes compared to anterior-to-posterior screw fixation. The aim of this study was to evaluate the impact of posterior malleolus fixation on clinical and functional results. Methods: The patients with posterior malleolar fractures who were treated between January of 2014 and April of 2018 at our hospital were investigated retrospectively. Fifty-five patients included in the study were divided into three groups according to the fixation preferences of fractures (group I, posterior buttress plate; group II, anterior-to-posterior screw; and group III, nonfixated). The groups consisted of 20, nine, and 26 patients, respectively. These patients were analyzed according to demographic data, fixation preferences of fractures, mechanism of injury, hospitalization length of stay, surgical time, syndesmosis screw use, follow-up time, complications, Haraguchi fracture classification, van Dijk classification, American Orthopaedic Foot and Ankle Society score, and plantar pressure analysis. Results: There were no statistically significant differences between the groups in terms of gender, operation side, injury mechanism, length of stay, anesthesia types, and syndesmotic screw usage. However, when the age, follow-up time, operation time, complications, Haraguchi classification, van Dijk classification, and American Orthopaedic Foot and Ankle Society scores were evaluated, statistically significant differences were observed between the groups. Plantar pressure analysis data showed that group I yielded balanced pressure distribution between both feet compared to the other study groups. Conclusions: The posterior buttress plating of posterior malleolar fractures yielded better clinical and functional outcomes compared to the anterior-to-posterior screw fixation and nonfixated groups. Full article

► Show Figures

321 KB

Open AccessArticle

Effectiveness of Iontophoresis in Treating Plantar Hyperhidrosis

by Cynthia Formosa, Claire Saliba Thorne and Alfred Gatt

J. Am. Podiatr. Med. Assoc. 2023, 113(1), 21003; https://doi.org/10.7547/21-003 - 1 Jan 2023

Cited by 1 | Viewed by 832

Abstract

Background: The purpose of this study was to evaluate the effectiveness of tap water iontophoresis as a treatment for plantar hyperhidrosis. Methods: Thirty participants living with idiopathic plantar hyperhidrosis and consented to undergo treatment using iontophoresis were recruited. The Hyperhidrosis Disease Severity Score [...] Read more.

Background: The purpose of this study was to evaluate the effectiveness of tap water iontophoresis as a treatment for plantar hyperhidrosis. Methods: Thirty participants living with idiopathic plantar hyperhidrosis and consented to undergo treatment using iontophoresis were recruited. The Hyperhidrosis Disease Severity Score was used to evaluate the severity of the condition before and after treatment. Results: Tap water iontophoresis was found to be effective in the treatment of plantar hyperhidrosis in the study group (P = .005). Conclusions: Treatment with iontophoresis led to the reduction of disease severity and improvement of quality of life, and it is a safe, easy-to-use method with minimal side effects. This technique should be considered before the use of systemic or aggressive surgical interventions, which could have potentially more severe side effects. Full article

► Show Figures

1082 KB

Open AccessArticle

Ultraviolet-A Light and Negative-Pressure Wound Therapy to Accelerate Wound Healing and Reduce Bacterial Proliferation

by Kathryn E. Davis, Jessica Bills, Debby Noble, Peter A. Crisologo and Lawrence A. Lavery

J. Am. Podiatr. Med. Assoc. 2023, 113(1), 20251; https://doi.org/10.7547/20-251 - 1 Jan 2023

Cited by 1 | Viewed by 168

Abstract

Background: Ultraviolet (UV)-A therapy is a simple, inexpensive, and effective modality for wound healing, with tremendous potential to improve healing and reduce clinical infections in a number of clinical settings. To date, application of UV-A relies on bulky and hard-to-dose lamps that provide [...] Read more.

Background: Ultraviolet (UV)-A therapy is a simple, inexpensive, and effective modality for wound healing, with tremendous potential to improve healing and reduce clinical infections in a number of clinical settings. To date, application of UV-A relies on bulky and hard-to-dose lamps that provide inconsistent therapy, thus making it difficult to apply therapy that is appropriate for the patient. Methods: This study was designed to test the effectiveness of a novel wound therapy device that combines UV-A with traditional negative-pressure wound therapy (NPWT) to promote wound healing. Furthermore, we tested the ability of fiberoptic UV-A delivery to inhibit bacterial proliferation. Finally, we assayed the level of DNA damage that results from UV-A as compared to established UV-C therapies. Wound healing studies were performed in a porcine model using an articulated therapy arm that allows for continued therapy administration over an extended time course. Negative-pressure wound therapy was administered alone or with UV-A fiberoptic therapy for 2 weeks. Dressings were changed twice a week, at which time wound area was assessed. Results: Data demonstrate that UV-A with NPWT treatment of wounds results in greater healing than NPWT alone. Using the same therapy device, we demonstrate that exposure of Staphylococcus aureus and Pseudomonas aeruginosa to fiberoptic UV-A results in decreased colony area and number of both bacterial strains. Finally, we show that UV-A induces minimal DNA damage in human fibroblasts and no more DNA damage in wound tissue as compare to intact skin. Conclusions: These data demonstrate that UV-A can decrease bacterial proliferation and promote wound healing when coupled with NPWT. Full article

► Show Figures

419 KB

Open AccessArticle

Development and Intertester Reliability of a Novel Device to Measure Nonweightbearing Ankle Joint Dorsiflexion Range of Motion

by James A. Charles, Romain Diot, Camilia Houari, Vivienne Chuter, Michel Pillu and Daniel Mcdonough

J. Am. Podiatr. Med. Assoc. 2023, 113(1), 20234; https://doi.org/10.7547/20-234 - 1 Jan 2023

Cited by 1 | Viewed by 124

Abstract

Background: Ankle joint dorsiflexion range of motion is essential to normal gait. Ankle equinus has been implicated in a number of foot and ankle pathologies included Achilles tendonitis, plantar fasciitis, ankle injury, forefoot pain, and foot ulceration. Reliable measurement of ankle joint dorsiflexion [...] Read more.

Background: Ankle joint dorsiflexion range of motion is essential to normal gait. Ankle equinus has been implicated in a number of foot and ankle pathologies included Achilles tendonitis, plantar fasciitis, ankle injury, forefoot pain, and foot ulceration. Reliable measurement of ankle joint dorsiflexion range of motion, both clinically and in a research setting, is important. Methods: The primary aim of this study was to investigate the intertester reliability of an innovative device for measuring ankle joint dorsiflexion range of motion. A total of 31 (n = 31) participants volunteered to take part in this study. A paired t-test was performed to assess for systematic differences between the mean measures of each rater. Intertester reliability was evaluated using the intraclass correlation coefficient (ICC) and their 95% confidence intervals. Results: A paired t-test demonstrated that the mean ankle joint dorsiflexion range of motion did not significantly differ between raters. The ankle joint ROM mean for rater 1 was 4.65 SD (3.71) and rater 2 was 4.67 SD (3.91). Intertester reliability for the use of the Dorsi-Meter was excellent and demonstrated a very narrow range of error. The ICC (95%CI) was 0.991 (0.980 to 0.995) the SEM (in degrees) was 0.07, the MDC95, in degrees was 0.19 and 95% LOA, degrees was –1.49 to 1.46. Conclusions: We found the intertester reliability of the Dorsi-Meter to demonstrate higher levels of intertester reliability compared to previous studies investigating other devices. We reported the MDC values to provide an estimate of the smallest amount of change in the ankle joint dorsiflexion range of motion that must be achieved to reflect a true change, outside the error of the test. The Dorsi-Meter has been established as an appropriate reliable device to measure ankle joint dorsiflexion for clinicians and researchers with very small minimal detectable change and limits of agreement. Full article

► Show Figures

1519 KB

Open AccessArticle

Corticosteroid, Platelet-Rich Plasma, and Ozone Injections for Sinus Tarsi Syndrome

by Serdar Toy, Kutsi Tuncer, Murat Topal and Ali Aydın

J. Am. Podiatr. Med. Assoc. 2023, 113(1), 20221; https://doi.org/10.7547/20-221 - 1 Jan 2023

Cited by 2 | Viewed by 302

Abstract

Background: Sinus tarsi syndrome is characterized by permanent pain on the anterolateral side of the ankle due to chronic inflammation characterized by fibrotic tissue remnants and synovitis accumulation after repeated traumatic injuries. Few studies have documented the outcome of injection treatments for sinus [...] Read more.

Background: Sinus tarsi syndrome is characterized by permanent pain on the anterolateral side of the ankle due to chronic inflammation characterized by fibrotic tissue remnants and synovitis accumulation after repeated traumatic injuries. Few studies have documented the outcome of injection treatments for sinus tarsi syndrome. We sought to determine the effects of corticosteroid and local anesthetic (CLA), platelet-rich plasma (PRP), and ozone injections on sinus tarsi syndrome. Methods: Sixty patients with sinus tarsi syndrome were randomly divided into three treatment groups: CLA, PRP, and ozone injections. Outcome measures were visual analog scale, American Orthopedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS), Foot Function Index, and Foot and Ankle Outcome Score before injection compared with 1, 3, and 6 months after injection. Results: At the end of months 1, 3, and 6 after injection, significant improvements were observed in all three groups compared with baseline (P < .001 for all). At months 1 and 3, improvements in AOFAS scores were similar in the CLA and ozone groups; those in the PRP group were lower (P = .001 and P = .004, respectively). At month 1, improvements in Foot and Ankle Outcome Score were similar in the PRP and ozone groups and higher in the CLA group (P < .001). At 6-month follow-up, there were no significant differences in visual analog scale and Foot Function Index results among the groups (P > .05). Conclusions: Ozone, CLA, or PRP injections could provide clinically significant functional improvement for at least 6 months in patients with sinus tarsi syndrome. Full article

► Show Figures

559 KB

Open AccessArticle

Conservative versus Surgical Management of Fifth Metatarsal Diaphyseal Fractures: A Retrospective Review

by Marc D. Jones, Rebecca V. Omana-Daniels and Kerry J. Sweet

J. Am. Podiatr. Med. Assoc. 2023, 113(1), 20195; https://doi.org/10.7547/20-195 - 1 Jan 2023

Cited by 2 | Viewed by 459

Abstract

Background: Historically, distal fifth metatarsal diaphyseal fractures have been treated with conservative management, with only limited research evaluating surgical treatment of these fractures. This study was performed to compare surgical versus conservative treatment of distal fifth metatarsal diaphyseal fractures in athletes and nonathletes. [...] Read more.

Background: Historically, distal fifth metatarsal diaphyseal fractures have been treated with conservative management, with only limited research evaluating surgical treatment of these fractures. This study was performed to compare surgical versus conservative treatment of distal fifth metatarsal diaphyseal fractures in athletes and nonathletes. Methods: A retrospective review of 53 patients with surgical or conservative treatment of isolated fifth metatarsal diaphyseal fractures was performed. Data recorded included age, sex, tobacco use, diagnosis of diabetes mellitus, time to clinical union, time to radiographic union, athletic versus nonathletic status, time to return to full activity, surgical fixation method, and complications. Results: Patients treated surgically had a mean clinical union time of 8.2 weeks, radiographic union time of 13.5 weeks, and return to activity time of 12.9 weeks. Patients treated conservatively had a mean clinical union time of 16.3 weeks, radiographic union time of 25.2 weeks, and return to activity time of 20.7 weeks. Delayed unions and nonunions occurred in 27.0% of patients (10 of 37) treated conservatively and in none in the surgical group. Conclusions: Surgical treatment significantly decreased time to radiographic union, clinical union, and return to activity by an average of 8 weeks compared with conservative treatment. We suggest that surgical treatment of distal fifth metatarsal fractures is a viable option that may significantly decrease the patient’s time to clinical union, radiographic union, and return to activity. Full article

► Show Figures

Figure 1

506 KB

Open AccessArticle

High-Risk Patients with Infected Puncture Wounds and Appropriate Tetanus Prophylaxis

by David H. Truong, Matthew Malone, Javier La Fontaine, Dane K. Wukich, Orhan K. Oz and Lawrence A. Lavery

J. Am. Podiatr. Med. Assoc. 2023, 113(1), 20146; https://doi.org/10.7547/20-146 - 1 Jan 2023

Cited by 3 | Viewed by 851

Abstract

Background: We sought to evaluate clinicians’ compliance with national guidelines for tetanus vaccination prophylaxis in patients with high-risk feet. Methods: We retrospectively evaluated 114 consecutive patients between June 1, 2011, and March 31, 2019, who presented to the emergency department with a foot [...] Read more.

Background: We sought to evaluate clinicians’ compliance with national guidelines for tetanus vaccination prophylaxis in patients with high-risk feet. Methods: We retrospectively evaluated 114 consecutive patients between June 1, 2011, and March 31, 2019, who presented to the emergency department with a foot infection resulting from a puncture injury. Eighty-three patients had diabetes mellitus and 31 patients did not have diabetes mellitus. Electronic medical records were used to collect a broad range of study data on patient demographics, medical history, tetanus immunization history and tetanus status on presentation to the emergency department, peripheral arterial disease, sensory neuropathy, laboratory values, and clinical/surgical outcomes. Results: Of the 114 patients who presented to the emergency department with a puncture wound, 53 (46.5%) did not have up-to-date tetanus immunization. Of those patients, 79.2% received a tetanus-containing vaccine booster, 3.8% received intramuscular tetanus immunoglobulin, 3.8% received both a tetanus-containing vaccine booster and tetanus immunoglobulins, and 20.8% received no form of tetanus prophylaxis. Comparing data between patients with and without diabetes mellitus, there were no statistically significant differences in tetanus prophylaxis. Conclusions: Guidelines for tetanus prophylaxis among high-risk podiatric medical patients in this study center are not followed in all patients. Patients with diabetes mellitus are at high risk for exposure to tetanus; therefore, we recommend that physicians take a detailed tetanus immunization history and vaccinate patients if the tetanus history is unclear. Full article

► Show Figures

Figure 1

Journal Menu

Journal Browser

J. Am. Podiatr. Med. Assoc., Volume 113, Issue 1 (01 2023) – 20 articles

Further Information

Guidelines

MDPI Initiatives

Follow MDPI