Journal of the American Podiatric Medical Association

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Open AccessArticle

Progressive Pain Response in Idiopathic Clubfoot Children Undergoing Ponseti Casting: A Prospective Evaluation in 34 Feet

by Sitanshu Barik, Anil Agarwal, Ankur Upadhyay and Yogesh Patel

J. Am. Podiatr. Med. Assoc. 2024, 114(3), 23056; https://doi.org/10.7547/23-056 - 1 May 2024

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Abstract

Background: Investigations of pain and physiologic responses response during Ponseti casting are in the preliminary stage. This short-term study aims to quantify pain responses and to note the variations, if any, during subsequent casting sessions. Methods: In this prospective study, the pain parameters [...] Read more.

Background: Investigations of pain and physiologic responses response during Ponseti casting are in the preliminary stage. This short-term study aims to quantify pain responses and to note the variations, if any, during subsequent casting sessions. Methods: In this prospective study, the pain parameters were evaluated in 34 clubfeet. Video recording of each casting session was performed 1 minute before casting, during casting, and after 1 minute of casting. The videos were scored objectively using Neonatal Infant Pain Score (NIPS). Heart rate (HR) and oxygen saturation were recorded by using a pulse oximeter. Results: There was progressive increase in pain response until, at the last casting session, it was recorded as NIPS 4 (interquartile range, 1) (P = .02479). Before, during, and after casting, HR rose significantly in succeeding sessions. The mean HR during the first cast session was 175.5 ± 27.2/min, which increased to a mean of 197.3 ± 18.9/min (P = .000282). For the third parameter (oxygen saturation), no differences were observed between the first and last casting sessions. Conclusions: There was moderate pain response during Ponseti casting sessions as demonstrated by the NIPS. It rose significantly toward the last cast. The clubfoot child showed an exaggerated heart rate in succeeding casting sessions. No variations were noticed for oxygen saturation. (J Am Podiatr Med Assoc 114(3), 2024; doi:10.7547/23-056) Full article

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Open AccessArticle

Angioleiomyoma of the Foot: Clinical and Functional Outcomes of Surgical Treatment in a Case Series

by Edoardo Ipponi, Elena Bechini, Alfio Damiano Ruinato, Silvia De Franco, Antonio D’Arienzo and Lorenzo Andreani

J. Am. Podiatr. Med. Assoc. 2024, 114(3), 23025; https://doi.org/10.7547/23-025 - 1 May 2024

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Abstract

Background: Angioleiomyoma is a benign soft-tissue tumor that arises from the smooth muscle cells in the tunica media of the blood vessels. Although the most common location for these neoplasms is the uterine wall, they can also originate from lower limbs. Altogether, these [...] Read more.

Background: Angioleiomyoma is a benign soft-tissue tumor that arises from the smooth muscle cells in the tunica media of the blood vessels. Although the most common location for these neoplasms is the uterine wall, they can also originate from lower limbs. Altogether, these neoplasms account for 0.2% of all those located in the foot and ankle region. Signs and symptoms of foot angioleiomyoma can be a localized pain, swelling, and functional impairment. To date, only case reports and case series with small populations have been reported in the literature to describe the clinical picture of these neoplasms and the effectiveness of surgical treatment. In this study, we report our results of surgical treatment for angioleiomyomas of the foot. Methods: Thirteen cases suffering from angioleiomyoma of the foot underwent surgical resection in our institution between January of 2017 and January of 2022. For each case, we recorded preoperative and postoperative symptoms, and their preoperative and postoperative functional status according to both Musculoskeletal Tumor Society Score (MSTS) and American Orthopedic Foot and Ankle Society Score (AOFAS). Eventual complications and local recurrence were reported. Results: Each patient had at least mild pain before surgical treatment. The mean preoperative MSTS and AOFAS were 22.1 and 76.8, respectively. The mean tumor size was 17.7mm. Preoperatively, each patient underwent resection with wide margins. None had local recurrences or major complications at their latest follow-up. After surgery, the mean postoperative MSTS and AOFAS increased to 29.5 and 98.8, respectively. Each case had a marked increment of their functionality and a reduction of their pain after surgery. Conclusions: Our results suggest that surgical approach with tumor resection should be considered a safe and reliable treatment for foot angioleiomyomas in light of the extremely low risk of local recurrence and because of the good postoperative pain relief and functional restoration that can be obtained after the treatment. (J Am Podiatr Med Assoc 114(3), 2024; doi:10.7547/23-025) Full article

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Open AccessArticle

Microwave Energy for the Treatment of Painful Intractable Plantar Keratosis: A Retrospective Medical Record Review of Nine Patients

by Ivan R. Bristow and Raphael Lilker

J. Am. Podiatr. Med. Assoc. 2024, 114(3), 23019; https://doi.org/10.7547/23-019 - 1 May 2024

Cited by 2 | Viewed by 107

Abstract

Background: Plantar keratoma are common hyperkeratinized, deep-seated lesions, often located on weightbearing areas of the foot. Such lesions are frequently associated with pain and disability. Intractable plantar keratomata (IPK) are highly recurrent and, in most patients, require regular, palliative treatment visits with a [...] Read more.

Background: Plantar keratoma are common hyperkeratinized, deep-seated lesions, often located on weightbearing areas of the foot. Such lesions are frequently associated with pain and disability. Intractable plantar keratomata (IPK) are highly recurrent and, in most patients, require regular, palliative treatment visits with a significant impact on patient time, cost, and quality of life. Methods: We undertook a retrospective chart review of 9 patients (with a total of 21 lesions) who underwent a minimum of two treatments using microwave therapy to their IPK. Pain levels were assessed at each of their treatments using a 10-point scale and patients were invited for review for follow-up in the following year. A total of seven patients undertook four treatments and were included in the final analysis. Results: Mean baseline pain scores significantly dropped with each subsequent treatment, equating to a 90.4% mean reduction in pain between the first and fourth visits, with 71.4% of patients reporting a zero-pain rating at their final treatment visit. Conclusions: The use of microwave therapy has been shown to be effective in producing significant and prolonged pain reduction in a cohort of patients with painful IPK. (J Am Podiatr Med Assoc 114(3), 2024; doi:10.7547/23-019) Full article

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Open AccessArticle

Effects of Balance and Strength Training for Ankle Proprioception in People with Chronic Ankle Instability: A Randomized Controlled Study

by Asena Yekdaneh and Çiğdem Yazıcı Mutlu

J. Am. Podiatr. Med. Assoc. 2024, 114(3), 23008; https://doi.org/10.7547/23-008 - 1 May 2024

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Abstract

Background: After an ankle sprain, the ligament and joint capsule are damaged, and as a result, proprioceptive sense is damaged, causing a feeling of giving away in the ankle and resulting in recurrent sprains. Given the relevant studies, it has been seen that [...] Read more.

Background: After an ankle sprain, the ligament and joint capsule are damaged, and as a result, proprioceptive sense is damaged, causing a feeling of giving away in the ankle and resulting in recurrent sprains. Given the relevant studies, it has been seen that people with chronic ankle instability (CAI) commonly have deficits in joint position sense and reinjury risks. Joint position sense plays an important role in ankle control, thereby reducing the risk of injury. Therefore, this study aims to compare the effects of balance and strength training on ankle proprioception in people with CAI [...] Full article

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Open AccessArticle

Does Short Foot Exercise Combined with Breathing Exercise Increase Muscular Activity in Individuals with Pes Planus?

by Tezel Yıldırım Şahan, Çağlar Soylu, Duygu Turker, Emre Serdar Atalay, Pervin Demir and Necmiye Ün Yıldırım

J. Am. Podiatr. Med. Assoc. 2024, 114(3), 22229; https://doi.org/10.7547/22-229 - 1 May 2024

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Abstract

Background: Improvements in muscle oxygenation and exercise posture can significantly impact muscle contraction. The aim of this study was to compare the effects of combined breathing and exercise posture (sitting or standing) on the muscle activity of the foot and ankle during short [...] Read more.

Background: Improvements in muscle oxygenation and exercise posture can significantly impact muscle contraction. The aim of this study was to compare the effects of combined breathing and exercise posture (sitting or standing) on the muscle activity of the foot and ankle during short foot exercises (SFE) in individuals with pes planus. Methods: The study included 15 subjects aged 21.53 ± 1.06 years, diagnosed with pes planus. Short foot exercises were performed with and without breathing exercises (BE) in sitting and standing positions. Surface electromyography was used to measure the activity of the tibialis anterior (TA), peroneus longus (PL), and abductor hallucis longus (ABDH) muscles during four different SFE. Four-way repeated analyses of variance were used to assess the addition of BE to SFE and muscle activities of the foot and ankle. Results: Muscle activity in the TA, PL, and ABDH was significantly higher in the SFE with BE than without BE in the standing position than in the sitting position. The SFE performed with BE when standing significantly increased the ABDH and ankle muscle activity compared to without BE. Conclusions: SFE with BE may represent a new strengthening program for ABDH and PL foot muscles in rehabilitation programs for individuals with pes planus. (J Am Podiatr Med Assoc 114(3), 2024; doi:10.7547/22-229) Full article

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Open AccessArticle

Vasopressor-Induced Peripheral Gangrene Secondary to COVID-19: A Case Report

by Brennen Lee O’Dell, Kanika Kochhar and Alton Johnson

J. Am. Podiatr. Med. Assoc. 2024, 114(3), 22216; https://doi.org/10.7547/22-216 - 1 May 2024

Cited by 2 | Viewed by 67

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Lower-extremity amputations are a major concern for the current state and future of healthcare, with ischemia contributing significantly to this issue. This is an infrequent but serious complication of vasopressor use. Unfortunately, there is little research existing on the topic and even fewer [...] Read more.

Lower-extremity amputations are a major concern for the current state and future of healthcare, with ischemia contributing significantly to this issue. This is an infrequent but serious complication of vasopressor use. Unfortunately, there is little research existing on the topic and even fewer guidelines on treatment options. Vasopressors are often used to treat life-threatening hypotension. However, ischemic changes associated with vasopressor use often do not present for several days. It is frequently recommended that patients undergo amputation when the first signs of ischemia occur. This approach, however, does not allow for the full process of demarcation, making it difficult to determine which portions of the lower extremity will remain viable. This is a case study of a 37-year-old man who developed severe complications from COVID-19 and was subsequently admitted. Because of a complicated hospital course, he required the use of vasopressor medication that subsequently led to the development of ischemic changes to his bilateral forefeet and hands. Through a prolonged period of demarcation and the collaboration of multiple specialties, the patient was able to salvage each limb and maintain his functionality (J Am Podiatr Med Assoc 114(3), 2024; doi:10.7547/22-216) Full article

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Open AccessArticle

Two-Point Discrimination in Feet with Ankle Sprains

by Hacı ali Olcar, Ökkeş H. Miniksar, Berna Güngör, Tolgahan Kuru, Enes E. Kapukaya, Davut Aydın and Murat Korkmaz

J. Am. Podiatr. Med. Assoc. 2024, 114(3), 22192; https://doi.org/10.7547/22-192 - 1 May 2024

Cited by 1 | Viewed by 36

Abstract

Background: This study aimed to compare two-point discrimination in feet with ankle sprains and feet without ankle problems, and to determine whether there was a change in the two-point discrimination values in ankle sprains. Methods: A total of 108 people were included in [...] Read more.

Background: This study aimed to compare two-point discrimination in feet with ankle sprains and feet without ankle problems, and to determine whether there was a change in the two-point discrimination values in ankle sprains. Methods: A total of 108 people were included in the study. These subjects were aged between 18 and 40 years and visited the Medical Faculty of Yozgat Bozok University for various reasons in July and September of 2022. These people were divided into two groups: subjects with an ankle sprain and subjects with no ankle problems. Two-point discrimination values measured in millimeters were recorded for both groups using a caliper (esthesiometer) used in six regions of 216 feet. The two-point discrimination threshold values of the feet were compared statistically according to feet with ankle sprains and feet without ankle problems, and in right and left feet. Results: The study determined that the two-point discrimination threshold values measured at the first toe tip, heel, third plantar metatarsal head, medial malleolus, and lateral malleolus in subjects with an ankle sprain was higher than in subjects with no ankle problems. When comparing both feet of the subjects with an ankle sprain, the two-point discrimination threshold value in the heel of the foot with an ankle sprain was higher than in the heel of the foot without ankle problems. Conclusions: The two-point discrimination threshold value was higher in subjects with an ankle sprain than in subjects with no ankle problems. The data suggest that the two-point discrimination threshold may be higher in people with an ankle sprain. Further studies are needed to better understand the two-point discrimination threshold in ankle sprains. (J Am Podiatr Med Assoc 114(3), 2024; doi:10.7547/22-192) Full article

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A Method for Diabetic Wound-Specific Insole Design, Manufacturing, and Biomechanical Validation for Better Recovery

by Ayfer Peker Karatoprak, Levent Aydin, Berrin Cetinarslan Arslan, Zeynep Cantürk and Alev Selek

J. Am. Podiatr. Med. Assoc. 2024, 114(3), 22115; https://doi.org/10.7547/22-115 - 1 May 2024

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Abstract

Background: Muscle disorders may cause a change in plantar pressures by the misalignment on the foot during gait phases. Therefore, corns or calluses develop at the plantar regions, and diabetic foot ulcers follow for severe cases, although it can be prevented and even [...] Read more.

Background: Muscle disorders may cause a change in plantar pressures by the misalignment on the foot during gait phases. Therefore, corns or calluses develop at the plantar regions, and diabetic foot ulcers follow for severe cases, although it can be prevented and even treated by podiatric approaches with patient-specific therapeutic insoles and footwear. Although the importance of a threshold value of 200 kPa in peak plantar pressure reduction has been highlighted as a standard to prevent reulceration in the diabetic foot, it may not be possible to ensure this pressure reduction for each patient. Methods: In this study, three types of ethylene-vinyl acetate have been used to optimize the off-loading performance for predetermined early-stage diabetic foot ulcer scenarios by means of baropodometric plantar pressure analyses and finite element method for each gait phase. Results: The total cost of the manufacturing for this study was reduced to $10.26 and it was performed in 24.6 minutes. In addition, the off-loaded pressure was increased by 2.3 times and the volume of the off-loading geometry was increased 8.12 times based on the foam polymer used. Conclusions: Consequently, improved off-loading was obtained and a standard was proposed for the first time to calculate the off-loading performance before manufacturing of the therapeutic insole model to ensure a better recovery period. (J Am Podiatr Med Assoc 114 (3), 2024; doi:10.7547/22-115) Full article

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Open AccessArticle

Validation and Utility of a Novel Foot Offloading Device: Improving Pain and Function

by Malke Asaad, Beth Gusenoff and Jeffrey A. Gusenoff

J. Am. Podiatr. Med. Assoc. 2024, 114(3), 22091; https://doi.org/10.7547/22-091 (registering DOI) - 1 May 2024

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Abstract

Background: Foot pain is a common presentation, and management is generally geared toward pressure offloading. Although several pressure offloading devices exist on the market, the search for the optimal device is ongoing [...] Full article

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Impact of the COVID-19 Pandemic on Diabetic Foot Patients: A Shift in the Infectious Agent Profile Toward Nonfermentative Gram-Negative Bacilli

by Ali Acar, Neşe Saltoğlu, Necla Tülek, Özge Turhan, Elif Nazlı Serin, Derya Yapar, Murat Kendirci, Serkan Sürme, Banu Yıldız Karaca, Fatma Aybala Altay, Rıdvan Tayşi, İrfan Şencan, Esra Tanyel, Heval Can Bilek, Özlem Güler, Birsen Mutlu, Tolga Aksan, Fatma Yılmaz Karadağ, Ayten Kadanalı, Lütfiye Nilsun Altunal, Moumperra Chral Oglu, Seniha Şenbayrak, Serpil Erol, Öznur Ak, Nazire Aladağ, Neşe Demirtürk, Petek Konya, Dilek Bulut, Derya Öztürk Engin, Hasan Murat Aslan and Sibel Doğan Kaya Show full author list Hide full author list

J. Am. Podiatr. Med. Assoc. 2024, 114(3), 22073; https://doi.org/10.7547/22-073 - 1 May 2024

Cited by 1 | Viewed by 76

Abstract

Background: Diabetes foot infection is a very important public health problem that causes serious health problems, mortality, and high health expenditures, and is one of the most important complications of diabetes mellitus. There are concerns that approaches such as limited personal visits to [...] Read more.

Background: Diabetes foot infection is a very important public health problem that causes serious health problems, mortality, and high health expenditures, and is one of the most important complications of diabetes mellitus. There are concerns that approaches such as limited personal visits to doctors, avoidance of hospitals, and restrictions on nonemergency surgical procedures during the coronavirus disease of 2019 pandemic pose a threat to those with diabetic foot problems, including diabetic foot ulcers (DFUs), ischemia, and infection, resulting in increased limb loss and mortality. Full article

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Open AccessArticle

Senior Podiatrists in Solo Practice are High Performers of Nail Excisions

by Gabrielle M. Rivin, Tracey C. Vlahovic, Rachel C. Hill, Alan B. Fleischer and Shari R. Lipner

J. Am. Podiatr. Med. Assoc. 2024, 114(3), 22063; https://doi.org/10.7547/22-063 - 1 May 2024

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Abstract

Background: Nail excisions are indicated for onychocryptosis and nail spicules. They are technically demanding and require a refined skill set. We aimed to characterize practice patterns of US providers performing nail excisions. Methods: We conducted a retrospective analysis of Medicare provider use and [...] Read more.

Background: Nail excisions are indicated for onychocryptosis and nail spicules. They are technically demanding and require a refined skill set. We aimed to characterize practice patterns of US providers performing nail excisions. Methods: We conducted a retrospective analysis of Medicare provider use and payment data, part D, for all claims of partial or complete nail/nail matrix excision with/without nail plate removal/destruction (current procedural terminology code 11750). High performers were defined as providers performing annual nail excisions 2 standard deviations above the mean. We analyzed demographic risk factors for nail excision high performers, including practice location, years of experience, household median income, practice type, and provider gender. Statistical analysis was conducted in SAS v9.4, with values of P < .05 considered statistically significant. Results: Providers (n 5 32,279) and high performers (n 5 942) performed mean 34.7 and 173 nail excisions annually. Unsurprisingly, podiatrists constituted 99.7% of all nail excision performers. Providers in the South versus Midwest and Northeast were more often nail excision high performers (odds ratio [OR], 1.95; P < .0001, and OR, 1.46; P < .0001). Solo versus group practitioners were more likely, respectively, to be nail excision high performers (OR, 2.15; P < .0001). With linear regression analysis, for every 10-year increase in years of provider experience, there was an increase of 1.2 nail excisions annually per provider (P < .0001). For every $100,000 increase in household median income of practice location, there was a decrease of 9.9 nail excisions annually per provider. Conclusions: Southern podiatrists, podiatrists with more years of experience, solo practitioners, and those practicing in regions with lower household median incomes were more likely to perform higher numbers of nail excisions. Identifying performance trends among podiatrists can help podiatrists understand how their performance of nail excisions compares to other podiatrists across the country. (J Am Podiatr Med Assoc 114(3), 2024; doi:10.7547/22-063). Full article

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Open AccessArticle

Primary Arthrodesis with Retrograde Hindfoot Nail for Elderly Patients with Tibia Pilon Fractures and Psychiatric Illness

by Yen-Chun Chiu, Chin-Hsien Wu, Kun-Ling Tsai, I-Ming Jou, Yuan-Kun Tu and Ching-Hou Ma

J. Am. Podiatr. Med. Assoc. 2024, 114(3), 22048; https://doi.org/10.7547/22-048 - 1 May 2024

Cited by 1 | Viewed by 39

Abstract

Background: Management of tibial pilon fracture in elderly patients with psychiatric illness remains challenging for orthopedic doctors because of patients’ poor bone quality and inability for self-care. This study aimed to ascertain the viability and reliability of primary arthrodesis by using retrograde [...] Read more.

Background: Management of tibial pilon fracture in elderly patients with psychiatric illness remains challenging for orthopedic doctors because of patients’ poor bone quality and inability for self-care. This study aimed to ascertain the viability and reliability of primary arthrodesis by using retrograde hindfoot nail for these difficult cases. Methods: We retrospectively reviewed eight elderly consecutive patients (age older than 65 years) with tibial pilon fractures and psychiatric illness from January of 2012 to December of 2019 in our institute. Primary tibiotalocalcaneal arthrodesis with retrograde hindfoot nail was used as a definitive procedure. The bone union time, wound complication rate, ankle alignment, necessity for narcotic agents, and ambulation status were evaluated. Results: The average length of follow-up was 22.25 months (range, 15–36 months). Additional bone grafting surgery was performed for one patient because of fusion-site nonunion 6 months postoperatively. Another patient required debridement and removal of posterior calcaneal screw because of implant prominence and local infection. Osseous union with angular deformity less than 10° was achieved in all patients finally. The average bone union time was 6.6 months (range, 4–12 months). In terms of walking ability, six patients were capable of outdoor ambulation (classes 2 and 3). Two patients required oral pain medication at the final visit. Conclusions: The current study involved only a small number of patients, and two of the eight cases encountered undesired complications (one local infection and one bone nonunion); however, we believe that our method may serve as a valuable alternative for the treatment of tibial pilon fractures in elderly patients with psychiatric illness, considering the specificity of this fragile population. Full article

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Open AccessArticle

Short-Term Outcomes of Arthroscopic Treatment of Freiberg Disease

by Jong-Kil Kim, Do-Yeon Kim, Jong-Sung Oh, Dong-Ill Ko and Kwang-Bok Lee

J. Am. Podiatr. Med. Assoc. 2024, 114(3), 22025; https://doi.org/10.7547/22-025 - 1 May 2024

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Abstract

Background: Surgical treatment for Freiberg disease (also known as avascular necrosis of the metatarsal head) has not been completely defined. This retrospective study evaluated short-term outcomes after arthroscopic treatment of Freiberg disease. Methods: From 2015 to 2019, 13 patients (15 feet) [...] Read more.

Background: Surgical treatment for Freiberg disease (also known as avascular necrosis of the metatarsal head) has not been completely defined. This retrospective study evaluated short-term outcomes after arthroscopic treatment of Freiberg disease. Methods: From 2015 to 2019, 13 patients (15 feet) diagnosed as having Freiberg disease were enrolled for arthroscopic surgery. Feet were divided based on the Smillie classification system (two with stage I, eight with stage II, three with stage III, one with stage IV, and one with stage V). Arthroscopic interventions, including synovectomy, debridement, chondroplasty, microfracture, and loose body removal, were performed without considering the Smillie classification stage. Radiologic outcomes were evaluated by radiography (preoperatively and 3, 6, and 12 months postoperatively) and magnetic resonance imaging (preoperatively and 12 months postoperatively). Clinical outcomes were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) lesser metatarsophalangeal (MTP)–interphalangeal score and the visual analog scale (VAS) score. The MTP joint range of motion was measured using a goniometer preoperatively and postoperatively. Results: Radiologic studies showed no evidence of osteonecrosis progression in postoperative 12-month radiographs of any patients. Postoperative 12-month magnetic resonance images showed reduction of bone marrow edema, irregularity of subchondral bone, and cartilage defects in all patients. Significant improvements in AOFAS and VAS scores occurred at all postoperative time points compared with preoperative scores (P = .001). The MTP joint range of motion also showed improvement at last follow-up (P = .001). Conclusions: Arthroscopic surgery for Freiberg disease showed excellent clinical outcomes, MTP joint range of motion, and short-term outcomes regardless of stage (Smillie classification) in radiologic evaluation. Full article

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Open AccessArticle

Partial Ankle Arthroplasty: Talus Resurfacing for Mild-to-Moderate Osteoarthritis and Talus Hemiarthroplasty for Complex Osteochondral Lesions

by Nik Žlak, Matic Kolar, Nedim Mujanović and Matej Drobnič

J. Am. Podiatr. Med. Assoc. 2024, 114(3), 22017; https://doi.org/10.7547/22-017 - 1 May 2024

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Abstract

Background: We present prospective short-term results of a limited patient series treated with two innovative partial ankle arthroplasties: talar dome resurfacing for mild-to-moderate ankle osteoarthritis and talar shoulder hemiarthroplasty for chronic medial osteochondral lesions of the talus. Methods: Eleven patients underwent [...] Read more.

Background: We present prospective short-term results of a limited patient series treated with two innovative partial ankle arthroplasties: talar dome resurfacing for mild-to-moderate ankle osteoarthritis and talar shoulder hemiarthroplasty for chronic medial osteochondral lesions of the talus. Methods: Eleven patients underwent talus resurfacing and six patients had talar hemiarthroplasty. The outcome was followed by patient-reported measures and by pursuing serious adverse events or implant failures over a 2-year period. Progression of ankle osteoarthritis, peri-implant bone changes, and implant migration were followed radiographically. Results: Active dorsiflexion increased from 3° to 10° in resurfacing and from 15° to 22° in hemiarthroplasty. Patient-reported ankle function, quality of life, and activity level tended to improve only slightly after resurfacing (cumulative Foot and Ankle Outcome Score, from 41 to 42; Foot and Ankle Ability Measures for daily activities [FAAM-ADL], from 43 to 46; EQ- 5D-3L time trade-off, from 0.38 to 0.39; Tegner activity scale score, from 1.6 to 2.0) but moderately after hemiarthroplasty (cumulative Foot and Ankle Outcome Score, from 58 to 68; FAAM-ADL, from 37 to 71; EQ-5D-3L time trade-off, from 0.53 to 0.72; Tegner activity scale score, from 3.1 to 3.1). No implant-related radiographic changes, implant failures, or implant-related revision surgeries were recorded. Conclusions: Based on a small and heterogeneous prospective case series, both partial ankle implants investigated were safe and stable over 2-year follow-up, without any radiographic osteoarthritis progression of the remaining joint. However, patient-reported ankle function, quality of life, and activity level showed a tendency toward only minor improvement after resurfacing but a moderate increase after hemiarthroplasty. Full article

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Open AccessArticle

Effect of Nail Disorders on Quality of Life Scale Scores: A Prospective, Cross-sectional Study from a Tertiary Referral Center

by Efsun Tanacan and Fatma Gulru Erdogan

J. Am. Podiatr. Med. Assoc. 2024, 114(3), 21208; https://doi.org/10.7547/21-208 - 1 May 2024

Cited by 4 | Viewed by 63

Abstract

Background: To investigate the relationships among nail disorders, various clinical factors, and commonly used quality of life scales. Methods: A prospective cross-sectional study was conducted on 188 patients older than 18 years who applied to the Dermatology and Venereology Department of [...] Read more.

Background: To investigate the relationships among nail disorders, various clinical factors, and commonly used quality of life scales. Methods: A prospective cross-sectional study was conducted on 188 patients older than 18 years who applied to the Dermatology and Venereology Department of Ufuk University Hospital (Ankara, Turkey). The Turkish Quality of Life instrument, the Hospital Anxiety and Depression Scale, and the 36-Item Short-Form Health Survey were used for the analyses. Eight groups were formed based on 1) sex, 2) age (18–45 years, >45 years), 3) duration of nail disease (≤1 year, >1 year), 4) number of affected nails (1, 2, ≥3), 5) type of nail disease (nail thickening, ingrown toenail, pincer nail, and other nail diseases), 6) presence of onychomycosis, 7) fingernail involvement, and 8) pain score (0–5, 6–10), and the quality of life scales were compared between these groups. In addition, correlation analyses were performed between age, number of affected nails, duration of disease, presence of onychomycosis, chronic diseases and medications, and body mass index and the quality of life scale scores. Results: Nail disorders were associated with decreased quality of life in affected individuals. Moreover, age, duration of disease, type of nail disorder, body mass index, comorbid conditions, and pain scores had significant effects on quality of life scale scores. Conclusions: Management of nail disorders is challenging, and generally, a long period is necessary to achieve favorable outcomes. Both physcians and patients should be persistent during the treatment process. In addition, emotional and social support should be provided to patients. Full article

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Open AccessArticle

Dermatofibromas on the Foot and Ankle: A Clinicopathologic Characterization of 31 Cases

by Xingpei Hao, David Freedman, Joon Yim, Michelle Le, Robert Baglio, David Levine, Gina Saffo, Priya Parthasarathy and Gene Mirkin

J. Am. Podiatr. Med. Assoc. 2024, 114(3), 21207; https://doi.org/10.7547/21-207 - 1 May 2024

Cited by 1 | Viewed by 145

Abstract

Background: Dermatofibroma (DF) is a common benign soft-tissue tumor. It occurs anywhere on the body but is commonly seen on the upper and lower extremities. It is frequently found in young to middle-aged adults and predominantly in females. Methods: Thirty-one patients [...] Read more.

Background: Dermatofibroma (DF) is a common benign soft-tissue tumor. It occurs anywhere on the body but is commonly seen on the upper and lower extremities. It is frequently found in young to middle-aged adults and predominantly in females. Methods: Thirty-one patients with DF on the foot and ankle diagnosed and treated during a 6-year period were characterized. Results: The patients (16 males, 15 females) were aged 7 to 75 years (average, 55 years). Clinically, 17 patients noted painful symptoms, and 14 were painless. Grossly, DF manifested as a raised red, pink, tan, or skin-colored soft mass. The tumor size ranged from 0.3 to 1.5 cm (average, 0.67 cm in diameter). Twenty-six DFs (84%) were localized on the dorsal surface of the foot and ankle, and five (16%) were found on the plantar aspect. Eighteen patients were treated by surgical excision of the tumor (>0.5 cm), and 13 patients had observational follow-up after punch biopsy due to the small size (≤0.5 cm) and benign nature of these lesions. Further follow-up found that only one patient (3.2%) had a local recurrence, 37 months after surgical excision, which was completely reexcised. Histologically, DF is characterized by proliferation of spindle fibroblasts and histiocytes, in a vague fascicular pattern, and thickened collagen bundles. Conclusions: Dermatofibroma on the foot and ankle predominantly occurs in patients in their 50s, without a preponderance by sex. It needs to be differentiated from other benign and malignant tumors with histologic analysis and immunostaining with factor XIIIa, CD68, and other biomarkers. Treatment options include either surgical excision or observational follow- up after biopsy, depending on the clinical characteristics and effect on functional activity. Full article

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Open AccessArticle

The Injury Mechanism of Achilles Tendon Rupture in Professional Athletes: A Video Analysis Study

by Ali Yüce, Mustafa Yerli and Abdulhamit Misir

J. Am. Podiatr. Med. Assoc. 2024, 114(3), 21196; https://doi.org/10.7547/21-196 - 1 May 2024

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Abstract

Background: In professional athletes, Achilles tendon ruptures are devastating injuries, often resulting in season loss or decreased return to sports level. We aimed to perform a comprehensive video analysis to describe the mechanisms of Achilles tendon rupture as well as body posture [...] Read more.

Background: In professional athletes, Achilles tendon ruptures are devastating injuries, often resulting in season loss or decreased return to sports level. We aimed to perform a comprehensive video analysis to describe the mechanisms of Achilles tendon rupture as well as body posture in professional athletes. We hypothesized that Achilles tendon ruptures in professional athletes develop with a specific injury mechanism and that body posture at the time of injury varies by sport. Methods: Of 114 identified Achilles tendon ruptures that occurred in professional athletes between 1970 and 2020, 42 with adequate video data were analyzed for injury mechanism, body posture, and player and sport characteristics by three independent reviewers. Results: Mean ± SD age of the 42 athletes (41 men and 1 woman) was 28.4 ± 4.26 years. Eighteen athletes played basketball (42.9%), 14 football (33.3%), five soccer (11.9%), three baseball (7.1%), and two rugby (4.8%). Thirty-five patients (83.3%) had noncontact injuries. The most frequent months of injury were January (16.7%) and October (14.3%). During Achilles tendon rupture, the ankle was in dorsiflexion, the body was bent forward, the knee and hip were in extension, and the foot was in a neutral position. Most injuries occurred during take-off/acceleration (40.5%) or stop and turn (38.5%) maneuvers. Conclusions: In professional athletes, the Achilles tendon most often ruptures during takeoff/ acceleration. The most common position during rupture is the trunk in flexion, the knee and hip in extension, and the ankle in dorsiflexion. This information can guide professional athletes in terms of physical therapy techniques, including neuromuscular training, proprioception, and balance training specific to preventing Achilles tendon rupture. Full article

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Open AccessArticle

Arthroscopy-Assisted Closed Reduction and Percutaneous Internal Fixation for Medial Malleolus Fracture

by Zhe Zhao, Guo Fu, Jianquan Liu, Yongsheng Li, Xiaoqiang Chen, Guanghui Wang, Xiangyu Cheng, Jianwen Yin, Jiabei Li, Zhiqin Deng, Manyi Wang and Wencui Li

J. Am. Podiatr. Med. Assoc. 2024, 114(3), 21172; https://doi.org/10.7547/21-172 - 1 May 2024

Cited by 2 | Viewed by 49

Abstract

Background: Arthroscopy-assisted closed reduction and percutaneous internal fixation is a minimally invasive technique for medial malleolus fracture treatment. The purpose of the study was to assess the quality and functional outcomes of this technique. Methods: Seventy-eight patients with combined medial malleolus [...] Read more.

Background: Arthroscopy-assisted closed reduction and percutaneous internal fixation is a minimally invasive technique for medial malleolus fracture treatment. The purpose of the study was to assess the quality and functional outcomes of this technique. Methods: Seventy-eight patients with combined medial malleolus fractures were treated with arthroscopy-assisted closed reduction and percutaneous screw fixation technique. The surgical procedure was described in detail; the clinical efficacy of this method was evaluated in terms of time of operation, postoperative complications, and fracture healing time; and functional outcomes were analyzed. Results: All of the patients were followed up for a minimum of 12 months without complications of the medial malleolus wound, and all of the medial malleolus fractures healed within 6 to 8 weeks. At the last follow-up, the visual analog scale scores ranged from 0 to 3 and the American Orthopaedic Foot and Ankle Society ankle and hindfoot function scores ranged from 75 to 95. Conclusions: Arthroscopy-assisted closed reduction and percutaneous internal fixation makes the treatment of medial malleolus fractures less invasive compared with traditional surgical methods and allows simultaneous exploration and management of the articular surface. Full article

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Open AccessArticle

The Influence of Bilateral and Unilateral Flatfoot on Coronal Spinopelvic Alignment in Asymptomatic Young Healthy Males

by Pinar Kisacik and Erman Ceyhan

J. Am. Podiatr. Med. Assoc. 2024, 114(3), 21165; https://doi.org/10.7547/21-165 - 1 May 2024

Cited by 5 | Viewed by 46

Abstract

Background: This cross-sectional retrospective study aimed to present the influence of unilateral and bilateral flatfoot on coronal spinopelvic alignment in asymptomatic young healthy males. Methods: This study was performed by examining the medical reports of individuals who applied to the National Health [...] Read more.

Background: This cross-sectional retrospective study aimed to present the influence of unilateral and bilateral flatfoot on coronal spinopelvic alignment in asymptomatic young healthy males. Methods: This study was performed by examining the medical reports of individuals who applied to the National Health Board to work in positions requiring physical fitness between January 1, 2018, and January 1, 2019. Plain radiographs of the feet, pelvis, and spine were analyzed. The calcaneal pitch angle for flatfoot, pelvic obliquity, and the Cobb angle for spinal asymmetry were measured. After all of the analyses were completed, participants were divided into two groups—unilateral or bilateral flatfoot, depending on the calcaneal pitch angle measurements—and compared. Results: There was no significant difference in age between groups (P = .609). The unilateral flatfoot group showed higher values in terms of body mass index, with a significant difference (P = .01). The curve patterns were identified as single thoracic, lumbar, and double. Post-hoc analyses suggest that young males without spinal asymmetry were more likely to have unilateral flatfoot (P < .008). There were significant differences between groups in pelvic obliquity and Cobb angle (P < .05). The effect size was found to be small to medium for pelvic obliquity and medium to large for Cobb angle. Conclusions: Young males with bilaterally increased foot pronation demonstrate more increased pelvic obliquity and spinal curvature. Full article

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Open AccessArticle

Functional Ankle Reconstruction Technique After Total Calcanectomy

by Metin Uzun and Levent Eralp

J. Am. Podiatr. Med. Assoc. 2024, 114(3), 21102; https://doi.org/10.7547/21-102 - 1 May 2024

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Abstract

Background: Although comminuted fractures, osteomyelitis, large skin ulcers, and malignant tumors are rarely seen in the calcaneus, it is a problematic region to treat because it is not an actual compartment and has insufficient blood supply. Few foot and ankle surgeons would [...] Read more.

Background: Although comminuted fractures, osteomyelitis, large skin ulcers, and malignant tumors are rarely seen in the calcaneus, it is a problematic region to treat because it is not an actual compartment and has insufficient blood supply. Few foot and ankle surgeons would recommend total calcanectomy in various cases of malignant tumors, comminuted fractures, ulcerations of the heel often seen in diabetic patients, and chronic osteomyelitis. After calcanectomy, if functional reconstruction is not performed, the patient will experience loss of function, pain, wound problems, talonavicular dislocations, and additional surgical interventions. In this study, we demonstrate calcanectomy and simultaneous functional reconstruction techniques while discussing the patients’ results. Methods: We retrospectively evaluated three patients who underwent total calcanectomy between January 1, 2001, and December 31, 2020.Two of these procedures were due to osteomyelitis of the calcaneus after trauma, and one was due to a chondroblastic osteosarcoma of the calcaneus. Results: The patients were followed up for an average of 116 months. None of the patients developed problems with their wounds in the postoperative term or during follow-up. Conclusions: Total calcanectomy as a surgical method of limb salvage yields successful results. We believe that these results can be improved with functional reconstruction and rehabilitation with custom-made shoes, and the results do not entail additional morbidity or require additional hindfoot bone reconstruction. Full article

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Open AccessArticle

Three-Dimensional–Printed Patient-Specific Total Cuboid Replacement for Treatment of Post-traumatic Arthritis: A Case Report

by Paul R. Leatham and Peter D. Highlander

J. Am. Podiatr. Med. Assoc. 2024, 114(3), 21055; https://doi.org/10.7547/21-055 - 1 May 2024

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Abstract

Cuboid injuries, including fractures, are rare and infrequently occur in isolation. Often, cuboid injuries can be treated nonoperatively. However, when surgery is indicated, appropriate management is necessary for maintaining the associated biomechanics of the midfoot. Current procedures for surgical management of the cuboid [...] Read more.

Cuboid injuries, including fractures, are rare and infrequently occur in isolation. Often, cuboid injuries can be treated nonoperatively. However, when surgery is indicated, appropriate management is necessary for maintaining the associated biomechanics of the midfoot. Current procedures for surgical management of the cuboid include open reduction and internal fixation, application of external fixation, or primary arthrodesis of the calcaneocuboid joint. Secondary procedures for symptomatic or poor outcomes of nonoperative and operative cuboid injuries consist of corrective osteotomy, bone resection, and interpositional arthroplasty. We present a novel surgical technique using a patient-specific three-dimensional–printed total cuboid replacement. This is an alternative treatment for post-traumatic arthritis of the cuboid along with a shortened lateral column. A single case example is given as well as details and discussion of the surgical technique. Full article

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J. Am. Podiatr. Med. Assoc., Volume 114, Issue 3 (05 2024) – 21 articles

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