Journal of the American Podiatric Medical Association

50 KB

Open AccessArticle

The 2021 Podiatric Residency Candidate and Program Virtual Interview Experience During COVID-19 with Multispecialty Reflections and Recommendations for a Successful Virtual Match: A 2024 Update

by Andrew J. Meyr, Danae L. Lowell, Susan K. Claffey, Moraith G. North and Charles Lombardi

J. Am. Podiatr. Med. Assoc. 2024, 114(6), 24095; https://doi.org/10.7547/24-095 - 1 Nov 2024

Viewed by 44

Abstract

This objective of this communication is to provide an update from the Council of Teaching Hospitals (COTH) and the American Association of Colleges of Podiatric Medicine (AACPM) with respect to the profession’s residency interview process, otherwise known as the Centralized Residency Interview Process [...] Read more.

This objective of this communication is to provide an update from the Council of Teaching Hospitals (COTH) and the American Association of Colleges of Podiatric Medicine (AACPM) with respect to the profession’s residency interview process, otherwise known as the Centralized Residency Interview Process (CRIP). During the 2022–2023 academic year, CRIP returned to an in-person format following a period of virtual interviews during the COVID-19 pandemic. Survey data since this change indicate that a large majority of residency program directors and student applicants prefer an in-person format to the residency interview process. This communication serves as an organizational update with respect to the residency interview process aimed at the profession, residency programs directors, and student applicants. Full article

266 KB

Open AccessCase Report

Acute Achille Tendon Rupture After Treatment of Levofloxacin for Helicobacter pylori Eradication: A Case Report

by Aysun Şeker and Nurdan Şentürk Durmuş

J. Am. Podiatr. Med. Assoc. 2024, 114(6), 24033; https://doi.org/10.7547/24-033 - 1 Nov 2024

Cited by 1 | Viewed by 149

Abstract

This case report aims to demonstrate a rare occurrence of tendon rupture attributable to levofloxacin use in Helicobacter pylori eradication. On the seventh day of treatment, the patient experienced severe foot pain and difficulty in walking, leading to a diagnosis of Achilles tendon [...] Read more.

This case report aims to demonstrate a rare occurrence of tendon rupture attributable to levofloxacin use in Helicobacter pylori eradication. On the seventh day of treatment, the patient experienced severe foot pain and difficulty in walking, leading to a diagnosis of Achilles tendon rupture confirmed through magnetic resonance imaging. Levofloxacin-induced tendinopathy and/or rupture are rare complications that are often linked to age and sex. Health-care providers should exercise caution when prescribing fluoroquinolones, especially to at-risk patients, and should inform them about potential side effects. Full article

► Show Figures

Figure 1

453 KB

Open AccessArticle

Arthroscopically Assisted Reduction and Fixation of Acute Tillaux, Pilon, Bosworth, Talar, and Calcaneal Fractures: A Systematic Review

by Konstantinos Giatroudakis, Efthymios Iliopoulos, Georgios Drosos, Konstantinos Tilkeridis and Athanasios Ververidis

J. Am. Podiatr. Med. Assoc. 2024, 114(6), 23200; https://doi.org/10.7547/23-200 - 1 Nov 2024

Viewed by 70

Abstract

Increased use of arthroscopically assisted techniques for the treatment of ankle fractures has been reported. Despite their rapid development, there is only one systematic review regarding arthroscopically assisted treatment of ankle fractures, in which, however, only malleolar fracture studies are included. Various other [...] Read more.

Increased use of arthroscopically assisted techniques for the treatment of ankle fractures has been reported. Despite their rapid development, there is only one systematic review regarding arthroscopically assisted treatment of ankle fractures, in which, however, only malleolar fracture studies are included. Various other types of ankle fractures have also been treated with arthroscopically assisted procedures. The purpose of this review was to identify and evaluate the existing literature about arthroscopically assisted surgical management of other types of foot and ankle fractures, such as Tillaux, pilon, Bosworth, talar, and calcaneal fractures. A systematic review was conducted until December 2022 using the Arksey and O'Malley framework and reported according to the PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews). Three databases—PubMed, Elsevier Scopus, and Cochrane Library—were searched for relevant studies. The chosen studies were divided into groups according to the fracture type. Of the 424 initially identified studies, 36 were finally included in the review: 22 case reports or case series and 14 original retrospective cohort studies. Participant demographic characteristics; methods of arthroscopically assisted reduction and fixation; and clinical, radiologic, and patient-reported outcomes were extracted. Arthroscopically assisted techniques for the treatment of Tillaux, pilon, Bosworth, talar, and calcaneal fractures are effective procedures and have already shown satisfactory and promising clinical and radiologic outcomes. There are some limitations in their use though, especially in some specific fracture patterns. Long-term effects and possible superiority of arthroscopically assisted techniques over classic reduction and fixation must be further studied. Full article

► Show Figures

Figure 1

317 KB

Open AccessArticle

Enthesitis of Plantar Fascia Affects Gait in Patients With Ankylosing Spondylitis

by Songul Baglan Yentur, Furkan Bilek, Gulnihal Deniz, Gürkan Akgöl and Süleyman Serdar Koca

J. Am. Podiatr. Med. Assoc. 2024, 114(6), 23159; https://doi.org/10.7547/23-159 - 1 Nov 2024

Viewed by 104

Abstract

Background: Many factors, such as decreased spinal mobility, pain, and dysfunction can affect gait parameters in patients with ankylosing spondylitis. The purpose of this study was to investigate the effects of plantar fascia enthesitis and disease-specific measurements on gait parameters in patients [...] Read more.

Background: Many factors, such as decreased spinal mobility, pain, and dysfunction can affect gait parameters in patients with ankylosing spondylitis. The purpose of this study was to investigate the effects of plantar fascia enthesitis and disease-specific measurements on gait parameters in patients with ankylosing spondylitis. Methods: The Win-Track platform was used to evaluate spatiotemporal parameters in patients with ankylosing spondylitis and in healthy controls. The Bath Ankylosing Spondylitis Metrology Index (BASMI), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), and Bath Ankylosing Spondylitis Function Index (BASFI) were used for disease-related parameters in patients with ankylosing spondylitis, respectively. Tendon thickness in the plantar fascia was measured using ultrasound to evaluate enthesitis. Results: Thirty-one patients with ankylosing spondylitis and 31 healthy participants were included in the study. Cadence and step-cycle duration had a significant relationship with enthesitis for all regions and disease-related measurements. In addition, step length had a significant relationship with enthesitis for the midfoot and metatarsal bones, BASMI, and BASDAI; the left step length had a significant relationship with enthesitis in the calcaneus. The double-support phase had a significant relationship with enthesitis and BASMI. In the regression analysis, a significant relationship was found between BASDAI and step cycle time. A significant correlation was observed between all ultrasonographic parameters and cadence and stride cycle time values. Conclusions: Impaired gait parameters were found in ankylosing spondylitis patients, and we concluded that plantar fascia enthesitis, function, disease activity, and spinal mobility affect gait parameters for these patients. Therefore, therapy for enthesitis, and adding foot rehabilitation to the routine program should be considered for patients with ankylosing spondylitis. Full article

► Show Figures

2353 KB

Open AccessArticle

Primary Antiphospholipid Syndrome Causing Critical Limb Ischemia and Ultimately Amputation in an Otherwise Healthy Young Female

by Katherine Lyons, Ronald Adelman, Vanessa Adelman and Britney Wenig

J. Am. Podiatr. Med. Assoc. 2024, 114(6), 23096; https://doi.org/10.7547/23-096 - 1 Nov 2024

Viewed by 103

Abstract

This case report describes an otherwise healthy 43-year-old female who presented with severe pain, foot drop, and critical limb ischemia to her left foot caused by thrombosis of a peripheral artery secondary to antiphospholipid syndrome. Antiphospholipid syndrome is an autoimmune disease that frequently [...] Read more.

This case report describes an otherwise healthy 43-year-old female who presented with severe pain, foot drop, and critical limb ischemia to her left foot caused by thrombosis of a peripheral artery secondary to antiphospholipid syndrome. Antiphospholipid syndrome is an autoimmune disease that frequently manifests as recurrent arterial and/or venous thrombotic events, ischemic strokes, and miscarriages. Antiphospholipid syndrome affecting primarily the arteries is less common as compared to venous thrombosis. Our patient underwent several vascular surgical interventions and anticoagulant treatment; despite this, she ultimately underwent a below-the-knee amputation due to worsening ischemia. The purpose of the current case report is to emphasize that antiphospholipid syndrome should be kept on the differential for arterial ischemic events such as critical limb ischemia without another known cause and should be managed with an interprofessional team approach. Full article

► Show Figures

Figure 1

793 KB

Open AccessReview

Supernumerary Muscles in the Leg and Foot: A Review of Their Types, Frequency, and Clinical Implications

by Anushka S. Ramnani, Jessica T. Landeros, Mathew Wedel, Rebecca Moellmer, Stephen Wan and David W. Shofler

J. Am. Podiatr. Med. Assoc. 2024, 114(6), 23042; https://doi.org/10.7547/23-042 - 1 Nov 2024

Cited by 1 | Viewed by 125

Abstract

Variations of the ankle anatomy are infrequent and exist as supernumerary muscles and tendons. Often understudied and overlooked, their presence can cause many complications of the lower extremity. These muscles, although often asymptomatic, can cause great pain and complications such as tenosynovitis, tarsal [...] Read more.

Variations of the ankle anatomy are infrequent and exist as supernumerary muscles and tendons. Often understudied and overlooked, their presence can cause many complications of the lower extremity. These muscles, although often asymptomatic, can cause great pain and complications such as tenosynovitis, tarsal tunnel syndrome, lateral ankle instability, and ankle pain when they impinge on the normal anatomy of the patient. The goals of this study were to examine the prevalence of common variants such as the peroneus quartus, peroneus digiti quinti, accessory soleus, flexor accessorius digitorum longus, peroneocalcaneus internus, and tibiocalcaneus internus and to understand the morphological and clinical significance of these accessory muscles and their interactions with surrounding muscles. A literature review of anatomically and clinically based articles was conducted to evaluate the supernumerary muscles. Phrases such as accessory muscles were used to refine the search. Supernumerary muscles have an incidence of 3% to 62%, depending on the muscular compartment and the specific muscle. Although conservative treatments such as orthoses and nonsteroidal anti-inflammatory drugs may help alleviate some pain, surgical treatment yields higher success rates. Identification of supernumerary muscles is mainly by magnetic resonance imaging, but they can be detected by other methods, such as ultrasound. Due to the wide implications of these supernumerary muscles, this study attempted to create a reference guide for physicians to use in aiding their diagnoses and therapeutic plans. Although supernumerary muscles are typically asymptomatic, knowledge of these muscles is beneficial for clinicians in aiding their treatment plans. Full article

► Show Figures

Figure 1

1230 KB

Open AccessArticle

The Role of Serum HMGB-1 Level in Differentiating the Soft-Tissue Infection From Diabetic Foot Osteomyelitis

by Ibrahim Halil Rizvanoglu, Ümit Cinkir, Vuslat Bosnak, Nuri Orhan, Necla Benlier and Füsun Kokcu

J. Am. Podiatr. Med. Assoc. 2024, 114(6), 22209; https://doi.org/10.7547/22-209 - 1 Nov 2024

Viewed by 45

Abstract

Background: The incidence of diabetic foot infections is increasing due to the rising number of persons with diabetes and the prolonged life expectancy. It is vital to differentiate soft-tissue infection (STI) from diabetic foot osteomyelitis (DFO), as treatment modalities and durations vary [...] Read more.

Background: The incidence of diabetic foot infections is increasing due to the rising number of persons with diabetes and the prolonged life expectancy. It is vital to differentiate soft-tissue infection (STI) from diabetic foot osteomyelitis (DFO), as treatment modalities and durations vary widely, but this can be challenging. We aimed to assess the blood concentration levels of the high mobility group box 1 protein (HMGB-1) in STI and DFO compared to healthy subjects, and to investigate whether this protein could contribute to differentiating STI from DFO. Methods: Data from patients with suspected soft-tissue infection or diabetic foot osteomyelitis and healthy volunteers were prospectively recorded. Mean C-reactive protein, erythrocyte sedimentation rate, white blood cell, andHMGB-1 values in the groupswere analyzed. Cut-off values of HMGB-1 between the three groups were also determined. A three-phase bone scintigraphy was accepted as the diagnosticmethod for differentiating STI andDFO. Results: Atotal of 92 volunteers,were included in the study.Group 1 comprised 28 healthy individuals who composed the control group.Group 2 comprised the 35 patients diagnosed with STI, and Group 3 comprised 29 patients diagnosedwithDFO. TheHMGB-1was significantly higher inDFO. The sensitivity, specificity, and accuracy of HMGB-1 in differentiating between STI and DFO was 55%, 94%, and 77%, respectively. Conclusions: We concluded that measurement of the serum HMGB-1 level could be an adjunctive test in the differential diagnosis of diabetic foot infections. Full article

► Show Figures

Figure 1

456 KB

Open AccessArticle

Comparison of Bicortical Headless Cannulated Screw Fixations, Tension Band Fixations, and Kirschner Wire Fixations of a Jones Fracture: A Biomechanical Study

by Onur Yilmaz, İbrahim Mutlu, Tolgahan Kuru, Ali Bilge, Berna Güngör, Hasan Kizilay, Hacı Olcar, Recai Özkılıç and H. Yener Erken

J. Am. Podiatr. Med. Assoc. 2024, 114(6), 22201; https://doi.org/10.7547/22-201 - 1 Nov 2024

Cited by 1 | Viewed by 60

Abstract

Background: The aim of study was to biomechanically compare the fixation of Jones fracture using headless cannulated screw, tension band, and two Kirschner wires. Methods: A total of 60 fourth-generation, fifth metatarsal synthetic bone models were divided into three groups according [...] Read more.

Background: The aim of study was to biomechanically compare the fixation of Jones fracture using headless cannulated screw, tension band, and two Kirschner wires. Methods: A total of 60 fourth-generation, fifth metatarsal synthetic bone models were divided into three groups according to the fixation techniques. A vertical load, oriented from plantar to dorsal and lateral to medial, was applied to the metatarsal specimen that were potted with molding material. The stiffness and fatigue values were compared between the three fixation groups. Results: In the plantar to dorsal load test, the stiffness values were found to be significantly higher in Group 1 compared to the other groups (P = .034, P = .013). No significant difference was found in the analysis in terms of fatigue values in plantar to dorsal load testing (P = .348, P = .416). No significant difference was found between compression screw and tension band groups in lateral to medial loading test, in terms of stiffness and fatigue values (P = .096, P = .762). However, the stiffness values and fatigue values of these two groups were found to be statistically significantly higher than the Kirschner wire group (P = .003, P = .002, P = .016, P = .023). Conclusions: The result of this study showed that the bicortical fixation of headless compression screw provides a more stable fixation than other fixation methods, especially in plantar to dorsal loading. Full article

► Show Figures

Figure 1

475 KB

Open AccessArticle

A New Nail Brace for the Maintenance of Recurrence-Prone Ingrown Nails and Pincer Nails

by Sheng-Horng Yu, Che-Wei Liu and Yu-Chen Huang

J. Am. Podiatr. Med. Assoc. 2024, 114(6), 22196; https://doi.org/10.7547/22-196 - 1 Nov 2024

Viewed by 96

Abstract

Dear Colleagues, Ingrown toenails and pincer nails can have a huge impact on daily activities and cause extreme discomfort to patients. [...] Full article

► Show Figures

Figure 1

78 KB

Open AccessArticle

Electrophysiologic Evidence of Concomitant Focal Nerve Entrapments in Persons With Rheumatoid Arthritis: A Cross-Sectional Study

by Michael S. Nirenberg, Roberto P. Segura, Alex M. Segura, Lauren L. Schnack, Craig W. Forsthoefel and Carey Dachman

J. Am. Podiatr. Med. Assoc. 2024, 114(6), 22186; https://doi.org/10.7547/22-186 - 1 Nov 2024

Viewed by 68

Abstract

Background: Although an association between peripheral nerve entrapment issues and rheumatoid arthritis (RA) has been found, research has generally focused solely on nerve entrapment in the upper or lower extremity individually rather than on the consideration of nerve entrapment simultaneously in the [...] Read more.

Background: Although an association between peripheral nerve entrapment issues and rheumatoid arthritis (RA) has been found, research has generally focused solely on nerve entrapment in the upper or lower extremity individually rather than on the consideration of nerve entrapment simultaneously in the upper and lower extremities. In addition, most of these studies have used small sample sizes. The aim of this study was to evaluate the incidence of carpal tunnel syndrome (CTS) and tarsal tunnel syndrome (TTS) concurrently in patients with RA using a relatively large sample size. Methods: A cross-sectional study using a nonprobability sampling method retrospectively surveyed the incidence of CTS and TTS in 338 patients with RA who had clinical signs of nerve entrapment and electrodiagnostic test evidence of CTS or TTS. The study comprised a sample of 269 women and 69 men. Results: Electrodiagnostic testing found CTS in 256 patients (75.7%) and TTS in 82 patients (24.3%); CTS was found in 56 men and 200 women, and TTS was seen in 13 men and 69 women. Concurrent CTS and TTS occurred in 50 patients (14.8%; nine men and 41 women). Conclusions: Peripheral nerve entrapment in the form of CTS and TTS was found to have a high incidence in persons with RA. The incidence of CTS and TTS occurring simultaneously in persons with RA was also found to be significant. Full article

729 KB

Open AccessArticle

Tissue Selective Ultrasonic Debridement with Cryopreserved Human Skin Allograft to Heal a Chronic Wound: A Case Report

by Fahad Hussain and Robin C. Lenz

J. Am. Podiatr. Med. Assoc. 2024, 114(6), 22180; https://doi.org/10.7547/22-180 - 1 Nov 2024

Viewed by 64

Abstract

Tissue selective ultrasonic debridement is a new method of debriding chronic wounds that prepares the wound for advanced tissue application. This article presents the case of an 89-year-old woman with a chronic nonhealing wound to her lateral distal leg. The wound had a [...] Read more.

Tissue selective ultrasonic debridement is a new method of debriding chronic wounds that prepares the wound for advanced tissue application. This article presents the case of an 89-year-old woman with a chronic nonhealing wound to her lateral distal leg. The wound had a significant amount of biofilm and fibrous slough. Conservative treatment consisting of debridement and multilayer compression was attempted for 4 weeks. After 4 weeks, the patient was taken to the operating room for tissue selective ultrasonic debridement with placement of cryopreserved human skin allograft. With local wound care and multiple applications of graft, the chronic wound fully epithelialized. This study highlights the use of tissue selective ultrasonic debridement combined with cryopreserved human skin allograft to successfully heal a chronic wound. To our knowledge, this method of operative debridement and application of graft has not been documented in the literature. Full article

► Show Figures

Figure 1

1039 KB

Open AccessArticle

Heel Offloading Posterior Splint for Treatment of Heel Ulcerations

by Fahad Hussain and Robin Lenz

J. Am. Podiatr. Med. Assoc. 2024, 114(6), 22131; https://doi.org/10.7547/22-131 - 1 Nov 2024

Viewed by 65

Abstract

Total contact casting is the gold standard for plantar foot ulcers but has been questioned in heel pressure ulcers. Current offloading of heel ulcers is typically removable offloading boots. We describe using a modified posterior splint to offload heel ulcers in nonweightbearing patients. [...] Read more.

Total contact casting is the gold standard for plantar foot ulcers but has been questioned in heel pressure ulcers. Current offloading of heel ulcers is typically removable offloading boots. We describe using a modified posterior splint to offload heel ulcers in nonweightbearing patients. The posterior splint is readily available and familiar to practitioners, with less of a learning curve than a total contact cast. As part of the dressing, the posterior splint is less likely to be removed and leads to increased compliance. We hypothesize that this can translate to improved healing of pressure ulcers at the heel. Full article

► Show Figures

Figure 1

86 KB

Open AccessArticle

Incidence of Wounds Associated with Posterior Midline Incision for Achilles Tendon Pathology in a Large Cohort at a Tertiary Care Center

by Michael J. Hurst, Hannah J. Hughes, Cody Blazek, Ryan J. Lerch, Patrick R. Burns and Jeffrey Manway

J. Am. Podiatr. Med. Assoc. 2024, 114(6), 22123; https://doi.org/10.7547/22-123 - 1 Nov 2024

Cited by 1 | Viewed by 73

Abstract

Background: We sought to determine the wound complications associated with a straight midline incision overlying the Achilles tendon. Data on sex, age, body mass index (BMI), surgery performed, date of surgery, and wound development were collected. Methods: We retrospectively collected data on 217 [...] Read more.

Background: We sought to determine the wound complications associated with a straight midline incision overlying the Achilles tendon. Data on sex, age, body mass index (BMI), surgery performed, date of surgery, and wound development were collected. Methods: We retrospectively collected data on 217 patients with a mean ± SD age of 46.16 ± 13.72 years and follow-up of 9.1 ± 12.42 months. The specific procedures performed with this incision included repair of ruptured Achilles tendon (n = 89), Haglund deformity correction (n = 75), and flexor hallucis longus tendon transfer (n = 63). Wound complication was defined as a delay in wound healing with necrosis of the incisional margins resulting in exposure of superficial or deep layers. Deep infection was defined as the need for intravenous antibiotics. Results: We reported 15 wound complications (6.91%): ten (4.6%) were superficial and five (2.3%) were deep. All five patients with deep wound complications required operative debridement, and four patients required intravenous antibiotics. The infection rate of the midline incisional approach was 1.83%. Superficial wound complications were treated with local care and oral antibiotics, as necessary. There were no significant differences between age (P = .5986; P < .05), BMI (P = .7968; P < .05), smoking history (P = .6356; P < .05), or length of follow-up (P = .8338; P < .05). The overall wound rate of 6.91% is comparable with other literature with larger cohorts. Conclusions: These results will help us better educate surgeons about the risk of wound development with the posterior midline Achilles tendon incision. Full article

68 KB

Open AccessArticle

Shooter’s Abscess: Foot Infections in People Who Inject Drugs

by Amanda L. Killeen, Randi Heming, Peter A. Crisologo, Michael C. Siah and Lawrence A. Lavery

J. Am. Podiatr. Med. Assoc. 2024, 114(6), 22122; https://doi.org/10.7547/22-122 - 1 Nov 2024

Cited by 1 | Viewed by 75

Abstract

Musculoskeletal infections are common among people who inject drugs. Little is known about the prevalence and characteristics of skin and soft-tissue infections in this patient population, especially in the lower extremity. The aim of this study is to describe the clinical characteristics, bacterial [...] Read more.

Musculoskeletal infections are common among people who inject drugs. Little is known about the prevalence and characteristics of skin and soft-tissue infections in this patient population, especially in the lower extremity. The aim of this study is to describe the clinical characteristics, bacterial pathogens, and clinical outcomes in adults with foot infections due to intravenous drug use. Nine patients for whom the podiatric service was consulted for lower-extremity abscess secondary to intravenous drug use were included in this study. Most infections (66.7%) were located on the dorsal foot. Two of the abscesses (22.2%) resulted in amputation, with one toe amputation and one ray amputation. Most infections grew methicillin-resistant Staphylococcus aureus (MRSA) (66.7%). Although our investigation had limitations, we conclude that it is likely people who inject drugs will present with infections due to MRSA and will require surgery to resolve the infection. Full article

793 KB

Open AccessArticle

A Novel Plate for Vertical Shear Fractures of the Medial Malleolus: A Biomechanical Study

by Yunus Emre Bektas, Ramadan Özmanevra, Hakan Cici, Samet Ciklacandir, Nihat Demirhan Demirkiran, Yalcin Isler, Onur Basci and Mehmet Erduran

J. Am. Podiatr. Med. Assoc. 2024, 114(6), 22100; https://doi.org/10.7547/22-100 - 1 Nov 2024

Cited by 2 | Viewed by 64

Abstract

Background: This study aimed to evaluate and compare stiffness and load to failure values of a novel medial malleolus compression plate (MP) and a 3.5-mm one-third tubular plate (TP) in the treatment of vertical shear fractures of the medial malleolus. Methods: Fourteen identical [...] Read more.

Background: This study aimed to evaluate and compare stiffness and load to failure values of a novel medial malleolus compression plate (MP) and a 3.5-mm one-third tubular plate (TP) in the treatment of vertical shear fractures of the medial malleolus. Methods: Fourteen identical synthetic third-generation composite polyurethane bone models of the right distal tibia were randomly separated into two groups. Fracture models were created with a custom-made osteotomy guide to provide the same fracture characteristics in every sample (AO/OTA type 44A2). Fractures were reduced, and a novel MP was applied to bone models in the MP group and a TP was applied in the TP group. All of the samples were evaluated biomechanically, and force/displacement and load to failure values were recorded. Results: The force required to create displacement in the MP group was twice of that in the TP group. There was a significant difference between the two groups in all of the amounts of displacement (P = .006, P 5 .005, P = .007 and P = .015 for 0.5, 1.0, 1.5, and 2.0 mm, respectively). Conclusions: In the treatment of vertical shear fractures of the medial malleolus, the strength of fixation with the novel MP is biomechanically higher than that with the one-third semi-TP. Full article

► Show Figures

Figure 1

685 KB

Open AccessArticle

Comparison of Bicortical versus Unicortical Medial Malleolus Fixation

by Ryan Lerch, Jeffrey Manway and Gele Moloney

J. Am. Podiatr. Med. Assoc. 2024, 114(6), 22098; https://doi.org/10.7547/22-098 - 1 Nov 2024

Cited by 1 | Viewed by 62

Abstract

Background: Ankle fractures continue to increase in incidence and severity in an older, more challenging geriatric population. Medial malleolus fixation with partially threaded cancellous 4.0-mm screws, a common fixation method, has been shown to fail due to pullout strength. Subsequent cadaveric models have [...] Read more.

Background: Ankle fractures continue to increase in incidence and severity in an older, more challenging geriatric population. Medial malleolus fixation with partially threaded cancellous 4.0-mm screws, a common fixation method, has been shown to fail due to pullout strength. Subsequent cadaveric models have shown increased pullout strength with the use of bicortical screws. The literature has also demonstrated fairly good clinical results with the use of bicortical screw fixation in a general population as well as in a complicated patient cohort. Methods: We sought to compare bicortical fully threaded 3.5-mm screw fixation with unicortical partially threaded 4.0-mm fixation in medial malleolus fractures. The aim was to compare postoperative complications such as screw failure/loosening, nonunion, delayed union, painful hardware, time to union, and time to full weightbearing. Results: Of 292 patients retrospectively reviewed, 126 were included following the inclusion and exclusion criteria. The data included 48 patients in the bicortical group and 78 in the unicortical group, with a mean +/- SD combined age of 56.0 +/- 18.0 years. Complications occurred in three patients (6%) in the bicortical screw fixation group and in six (8%) in the unicortical group, which did not reach statistical significance. Conclusions: These results show that medial malleolus fixation has an overall low complication rate of 7% total combined, which is comparable with the current literature. We demonstrated no significant differences in complications, weeks to ambulation, or time to union between bicortical and unicortical fixation. Full article

► Show Figures

Figure 1

239 KB

Open AccessArticle

Prophylactic Irradiation for the Prevention of Heterotopic Ossification After Foot Amputation: A Case Series

by Amber M. Kavanagh, John D. Miller, Kelly McKeon, Jayson N. Atves, John S. Steinberg and Christopher Attinger

J. Am. Podiatr. Med. Assoc. 2024, 114(6), 22055; https://doi.org/10.7547/22-055 - 1 Nov 2024

Viewed by 91

Abstract

Background: The formation of heterotopic ossification (HO) is a common complication after transosseous partial foot amputation. Development of HO in weightbearing and/or superficial areas can lead to increased pressures, which increases the likelihood of wound formation and pain. Current treatment modalities for [...] Read more.

Background: The formation of heterotopic ossification (HO) is a common complication after transosseous partial foot amputation. Development of HO in weightbearing and/or superficial areas can lead to increased pressures, which increases the likelihood of wound formation and pain. Current treatment modalities for HO of the foot include mechanical off-loading and surgical resection; however, prophylactic measures such as nonsteroidal anti-inflammatory drugs, bisphosphonates, and other medical therapies have been attempted previously with mixed efficacy. Radiation therapy is another prophylactic method that may be used for the prevention of HO in patients after transosseous partial foot amputation. Methods: The present case series evaluated ten patients who underwent transosseous partial foot amputation for HO resection immediately followed by single low-dose radiation treatment. All of the patients received radiation between 700 and 800 cGy, with 6 MV photons directed at the area of concern within 48 hours of surgery. Results: Postoperatively, 10% of patients had HO recurrence, 80% remained fully weightbearing, 90% went on to primarily heal their surgical incisions, and 80% had postoperative pain relief; however, 30% went on to below-the-knee amputation due to chronic pain and/or infectious or nonfunctional pathology. Conclusions: Radiation therapy is a relatively available and safe modality for the prevention of HO that may be used prophylactically in cases of high suspicion of or known HO formation of the foot. (J Am Podiatr Med Assoc 114(6), 2024; doi:10.7547/22-055) Full article

► Show Figures

Figure 1

Journal Menu

Journal Browser

J. Am. Podiatr. Med. Assoc., Volume 114, Issue 6 (11 2024) – 17 articles

Further Information

Guidelines

MDPI Initiatives

Follow MDPI