Journal of the American Podiatric Medical Association

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Open AccessArticle

Outcome of Minimally Invasive Chevron and Akin Procedure With an Osteotomized Metatarsal Head Translation of More Than Fifty Percent for the Correction of Hallux Valgus

by Michael Michlin, David Segal, Meron Talmor, Ran Atzmon, Dan Perl, Ezequiel Palmanovich and Nissim Ohana

J. Am. Podiatr. Med. Assoc. 2025, 115(1), l23232; https://doi.org/10.7547/l23-232 - 1 Jan 2025

Cited by 1

Abstract

Background: Surgical protocols for hallux valgus (HV) surgery rely on the severity of the deformity, utilizing various techniques for different severity grades. The purpose of this study was to evaluate the association between the extent of the distal fragment translation and patient-reported outcome [...] Read more.

Background: Surgical protocols for hallux valgus (HV) surgery rely on the severity of the deformity, utilizing various techniques for different severity grades. The purpose of this study was to evaluate the association between the extent of the distal fragment translation and patient-reported outcome measures (PROMs) in patients with HV of varying severity grades who had undergone the same surgery, a minimally invasive chevron and Akin (MICA) procedure, with a fragment translation of at least 50%. Methods: We conducted a retrospective study of patients who had undergone a MICA procedure for HV between January 1, 2017, and August 1, 2022, and had had at least 1-year followup. We collected medical and demographic information and conducted radiographic measurements. PROMs (European Foot and Ankle Society questionnaire and satisfaction anchor questions) were the primary outcome measure and were collected via a telephone survey. Results: Of the 140 cases reviewed, 105 (75% [97 patients]) were included: six (5.7%) were defined as mild HV, 66 (62.9%) as moderate HV, and 33 (31.4%) as severe HV. The mean preoperative and postoperative first intermetatarsal angles were 13.67 6 2.94° and 3.1 6 2.34°, respectively. The mean preoperative and postoperative HV angles were 31.41 6 8.56° and 8.21 6 5.02°, respectively. The mean translation was 77.49 6 13.18%. The extent of translation did not correlate with intermetatarsal angle or HV angle (P 5 .45 and .62, respectively). The PROM questionnaires were answered by 73 patients (80 feet [76.19% of total cases]). The mean postoperative European Foot and Ankle Society score was 18.59 6 6.63, and 67 patients (83.8%) declared that they were satisfied with the surgery. PROMs were not associated with preoperative HV severity or translation extent (P . .1). Conclusions: With MICA distal osteotomy and translation of the first metatarsal head by more than 50% (up to 100%), we were able to correct even severe HV deformities that would previously have required proximal osteotomies and obtain significant angle correction with good clinical results Full article

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Open AccessArticle

Altered Foot Progression Angle and Rearfoot Loading in Patellofemoral and Tibiofemoral Osteoarthritis A Comparative Cross-Sectional Study

by Nazli Busra Cigercioglu, Zilan Bazancir-Apaydin, Gul Baltaci and Hande Guney-Deniz

J. Am. Podiatr. Med. Assoc. 2025, 115(1), l23018; https://doi.org/10.7547/l23-018 - 1 Jan 2025

Abstract

Background: The purpose of this study was to investigate the differences in plantar loading distribution and functional levels between patellofemoral osteoarthritis (PFOA) and tibiofemoral osteoarthritis (TFOA) patients, and to compare them with healthy individuals. Methods: Sixty patients with knee osteoarthritis and 30 age-matched, [...] Read more.

Background: The purpose of this study was to investigate the differences in plantar loading distribution and functional levels between patellofemoral osteoarthritis (PFOA) and tibiofemoral osteoarthritis (TFOA) patients, and to compare them with healthy individuals. Methods: Sixty patients with knee osteoarthritis and 30 age-matched, healthy individuals (control group) were included in the study. The patients were divided into two groups, the PFOA group (n 5 31) and the TFOA group (n 5 29), based on the Kellgren Lawrence classification system. The maximum foot pressure of the foot (FPmax), forefoot weight ratio, rearfoot weight ratio, total load on foot, and foot progression angle (FPA) were determined by pedobarographic analysis. Functional level was assessed with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Results: There was a significant difference in FPA (F(2,79) 5 22.322, P < .001) and rearfoot weight ratio (F(2,77) 5 7.694, P 5 .001) among the groups. The FPA in the PFOA group was lower than in the TFOA group (P <. 001). The rearfoot weight ratio was higher in the PFOA group than in the TFOA group (P <. 05). No significant difference was found in FPmax (P 5 .457), forefoot weight ratio (P 5 .183), and total load on the foot (P 5 .226) among the groups. Also, no difference was found in the WOMAC total score and subscales between the PFAO and TFAO groups (P . .05). Conclusions: The results suggest that the FPA and rearfoot loading were altered in patients with PFOA compared to those with TFOA and healthy individuals. Clinicians need to consider the effect of altered foot position and loading on the knee biomechanics in their treatment approach regarding foot orthoses or gait modification in patients with PFOA. Full article

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Open AccessArticle

Predictors of Peripheral Neuropathy Among Persons with Diabetes Mellitus A Multicenter Cross-Sectional Study

by Yakubu Lawal, Rifkatu Mshelia-Reng, Special Odiase Omonua, Kenechukwu Odumodu, Ramatu Shuaibu, Ukamaka Dorothy Itanyi, Amina Ibrahim Abubakar, Hadijat Oluseyi Kolade-Yunusa, Zumnan Songden David, Babajide Ogunlana, Andrew Clarke, Olufemi Adediran, Caleb O. Ehusani, Zulfiqarali Abbas and Felicia Ehusani Anumah

J. Am. Podiatr. Med. Assoc. 2025, 115(1), l22053; https://doi.org/10.7547/l22-053 - 1 Jan 2025

Cited by 2

Abstract

Background: Diabetic peripheral neuropathy (DPN) is a microvascular complication of diabetes mellitus (DM) that causes substantial morbidities, including pain, foot ulcers, lowerlimb amputations, and depression. It is said to affect approximately 50% of adults with DM. Understanding the predictors of DPN will help [...] Read more.

Background: Diabetic peripheral neuropathy (DPN) is a microvascular complication of diabetes mellitus (DM) that causes substantial morbidities, including pain, foot ulcers, lowerlimb amputations, and depression. It is said to affect approximately 50% of adults with DM. Understanding the predictors of DPN will help refocus on early preventive strategies to reduce its numerous morbidities. Methods: A total of 1,040 persons with DM were consecutively enrolled. Relevant medical history, clinical examinations, and laboratory investigations were performed. Multiple logistic regression was used to determine predictors of DPN. Significance was set at P#.05. Results: Significant predictors of DPN included age (odds ratio [OR], 1.99; P 5 .003); female sex (OR, 1.94; P 5 .023); DM duration (OR, 2.01; P 5 .032); history of systemic hypertension (OR, 1.68; P 5 .037); height (OR, 2.02; P 5 .001); generalized obesity (OR, 2.02; P 5 .002); central obesity (OR, 1.12; P 5 .047); poor control of systolic blood pressure (OR, 1.78; P 5 .001), diastolic blood pressure (OR, 1.45; P 5 .006), fasting plasma glucose (OR, 2.43; P 5 .004), 2-hour postprandial glucose (2HrPP) (OR, 2.83; P 5 .001), and glycated hemoglobin (OR, 2.31; P 5 .004); and peripheral artery disease (OR, 1.89; P 5 .002). The negative predictors of DPN include antidiabetics (OR, 2.39; P5.008), antihypertensives (OR, 2.45; P5.009), statins (OR, 2.21; P5.004), and antiplatelets (OR, 2.46; P5.030). Conclusions: Significant predictors of DPN include age, DM duration, female sex, height, history of systemic hypertension, and obesity. Others include poor control of systolic and diastolic blood pressure, fasting plasma glucose, 2HrPP, and glycated hemoglobin levels. Negative predictors include antidiabetics, antihypertensives, statins, and antiplatelets. Full article

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Open AccessArticle

Local Anesthetic Duration, Not Onset, Linked to MC1R Genotype in Redheads and Brunettes

by Mark Dalman, Marie Mantini Blazer, Rocco Petrozzi, Bria Pallas, Sophia Huynh, Cham Alden, Tulsi Menaria, Junrui Lin, Alex Pixton and Naagashiv Nagajothi

J. Am. Podiatr. Med. Assoc. 2025, 115(1), 24029; https://doi.org/10.7547/24-029 - 1 Jan 2025

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Abstract

Background: Evidence suggests that redheaded individuals react differently to local anesthetics, but there is no defined human genotype associated with local anesthetic response. As red hair has been associated with unique mutations of the melanocortin-1 receptor (MC1R), we tested the hypothesis that local [...] Read more.

Background: Evidence suggests that redheaded individuals react differently to local anesthetics, but there is no defined human genotype associated with local anesthetic response. As red hair has been associated with unique mutations of the melanocortin-1 receptor (MC1R), we tested the hypothesis that local anesthetic onset and duration of action were significantly modified in red haired individuals as related to the single nucleotide polymorphism (SNP) genotype. Methods: Ninety-two participants between the ages of 18 and 65 years were enrolled and assigned to one of four experimental groups: lidocaine-redhead, lidocaine-brunette hair, bupivacaine- redhead, and bupivacaine-brunette hair. Onset and duration of action were quantified in response to sharp sensation. Sputum samples were collected, gDNA was extracted and subjected to the Illumina CoreExome-24 SNP array (Illumina, San Diego, California). Twenty-five MC1R sequence polymorphisms were analyzed. A two-way analysis of variance (ANOVA) test was used to examine treatment and hair color effects, and their interaction on onset and duration time respectively; P # .05 was considered statistically significant. Results: Overall mean onset of action was statistically significant (P 5 .042) when comparing red hair to brunette responses between anesthesia (lidocaine versus bupivacaine: 2.68 6 0.28 minutes versus 3.6060.30 minutes, and 4.4660.49 minutes versus 5.1460.46 minutes, respectively). The redhead mean duration times were statistically shorter (P 5 .007) than brunettes (lidocaine and bupivacaine: 72.5 6 6.3 min versus 97.6 6 12.1 min, and 367.7 6 21.4 minutes versus 455.5 6 30.2 minutes, respectively). There were no statistical interactions between treatment and hair color on either onset or duration (P 5 .761 and P 5 .120, respectively). Interestingly, bupivacaine-injected redhead participants did show a significantly shorter duration (P 5 .004). Of 25 SNPs from MC1R assayed from the Illumina CoreExome-24 array, two missense mutations at loci rs1805007 (R151C) and rs1805008 (R160W) significantly predicted phenotypic responses to local analgesics. A two-way ANOVA indicated that these SNPs were significantly associated with reduced onset and duration time (P 5 .014, P 5 .047, respectively). Additionally, x 2 tests demonstrated a significantly strong correlation between red hair and theseSNPs: R151C(P<.001,Power51.000) andR160W(P5.016, Power50.732). Conclusions: To our knowledge there are no published studies that associate the effect of hair color with local anesthetic function on onset and duration of action via SNP genotyping. The SNP genotyping reaffirmed functional results, and points to the complimentary impact Full article

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Open AccessArticle

Is Pain Inevitable after Tibia Pilon Fractures? A 3-Year Prospective Analysis

by Batuhan Gencer and Özgür Doğan

J. Am. Podiatr. Med. Assoc. 2025, 115(1), 23231; https://doi.org/10.7547/23-231 - 1 Jan 2025

Cited by 3 | Viewed by 249

Abstract

Background: Tibia pilon fractures are associated with a low rate of pain-free return to normal life. Our objective was to ascertain the prevalence of chronic pain in the extensive postoperative follow-up of pilon fractures. Additionally, the factors affecting the existence and intensity of [...] Read more.

Background: Tibia pilon fractures are associated with a low rate of pain-free return to normal life. Our objective was to ascertain the prevalence of chronic pain in the extensive postoperative follow-up of pilon fractures. Additionally, the factors affecting the existence and intensity of pain were investigated. Methods: This prospective cohort study analyzed 85 patients, with a mean follow-up of 32.98 months (range, 24–65), treated with single-staged surgery between 2015 and 2019. The analyzed parameters were as follows: demographic data, injury mechanisms, fracture type, operation type, preferred main incision and implant, whether posterolateral incision and implant are used, whether the patient can be operated on within the first 48 hours after admission, follow-up period, and complications. Patients’ pain occurrence and intensity were questioned using the Stanmore Functional Scale. Results: During the final follow-up, only 18 (21.2%) patients reported that they returned to pain-free normal life. The choice of implant and incision was found to be significantly related to both the occurrence and the severity of pain (P < .05). Furthermore, the severity of pain was also found to be significantly related to fracture type and posterolateral incision (P<.05). Conclusions: When treating pilon fractures, postoperative pain should be considered as a parameter. Dual-plating has been linked to long-term pain after pilon fractures and this should be kept in mind when creating a treatment plan Full article

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Open AccessArticle

A Uniquely Detailed Foot and Ankle Chart for Accurate Recording of Injuries in Dancers

by Megan Maddocks and Demitri Constantinou

J. Am. Podiatr. Med. Assoc. 2025, 115(1), 23221; https://doi.org/10.7547/23-221 - 1 Jan 2025

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Abstract

Background: Foot and ankle injuries are common in dance and well documented in ballet. Commonly used injury surveillance tools do not depict the foot and ankle in much detail and are often considered as a single anatomical structure. The foot and ankle houses [...] Read more.

Background: Foot and ankle injuries are common in dance and well documented in ballet. Commonly used injury surveillance tools do not depict the foot and ankle in much detail and are often considered as a single anatomical structure. The foot and ankle houses some of the body’s most complex anatomy, and because of the incidence of injuries to these areas in dancers, and different management, a more detailed approach should be taken to reflect the complexity of the area for more accurate research and clinical application. This article proposes and demonstrates that the foot and ankle be broken down into more in detail when selected on a body chart. Methods: There is a conventional whole-body chart available in the Research Electronic Data Capture (RedCap) program that allows a selection of the foot and ankle. As part of a study of injuries in dancers, a custom chart was developed within this platform to expand on that selection by including smaller parts from the dorsal, medial, and plantar aspects. Results: All dance research needs to be more detailed regarding injuries to the foot and ankle for better clinical applications. Notable structures of clinical importance for ballroom and Latin American dancers are the first metatarsophalangeal joint, plantar fascia, and Achilles tendon. Such detail was determined using the newly developed chart and would not have been possible using conventional notations. Further, this chart provides a much clearer injury and clinical picture, which may differ in female ballet dancers who are dancing en pointe and other dance styles. Conclusions: Gathering detailed information using this chart will allow for the development of existing injury surveillance platforms and the advancement of foot and ankle injury research in dancers and may be transferable to other sports Full article

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Open AccessArticle

Prevalence of Large Fiber Neuropathy in Nondiabetic Older Adults Seeking Routine Foot Care

by Todd O’Brien

J. Am. Podiatr. Med. Assoc. 2025, 115(1), 23220; https://doi.org/10.7547/23-220 - 1 Jan 2025

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Abstract

Background: Older adults qualifying for routine foot care (RFC) under the Medicare program are often diagnosed with diabetes, peripheral artery disease (PAD), or neuropathy. Specifically, large fiber neuropathy (LFN) has been shown to increase during the aging process, rendering patients more susceptible to [...] Read more.

Background: Older adults qualifying for routine foot care (RFC) under the Medicare program are often diagnosed with diabetes, peripheral artery disease (PAD), or neuropathy. Specifically, large fiber neuropathy (LFN) has been shown to increase during the aging process, rendering patients more susceptible to unperceived trauma because of loss of protective sensation and an increased fall risk because of balance deficits. This study assessed the prevalence of LFN as diagnosed by the timed vibration test (TVT) in the nondiabetic segment of the Medicare population seeking RFC. A comparison wasmade between this group and those patients identified with PAD. Methods: A retrospective electronic medical record review of Medicare patients seeking RFC (Current Procedural Terminology codes 11720, 11721, and 11055) was conducted in a community health center-based podiatry clinic over a 5-year period. The prevalence of LFN as diagnosed by the TVT (International Statistical Classification of Diseases, Tenth Revision code G62.9 and TVT #4 sec at the hallux) and PAD as diagnosed per Medicare class findings for vascular impairment (International Statistical Classification of Diseases, Tenth Revision codes I70.203 and I73.9) was identified in nondiabetic Medicare patients seeking RFC. Results: The prevalence of LFN and PAD within the nondiabetic Medicare population seeking RFC was found to be 21.1%(91 of 431) and 27.6%(119 of 431), respectively. There was a 6.5% difference between the proportions of the LFN and PAD groups, which was significantly different (P 5 .026, confidence interval 5 0.77–12.2%). A total of 10.9% of the population was found to have LFN and PAD concurrently. There was no significant difference between the ages of patients in the LFN and PADgroups (P5.36, standard deviation [SD]51.65), the LFN and LFN/ PADgroups (P5.3,SD51.95), or the PADand LFN/PADgroups (P5.07, SD51.95). Conclusions: LFN and PAD are both present in substantial proportions in nondiabetic Medicare patients seeking RFC. The prevalence of LFN in this at-risk population highlights the importance of accurate diagnosis and implementation of preventative measures designed to mitigate unperceived foot trauma and potential falls. This is especially relevant, as neuropathy in geriatric patients has been associated with earlier mortality. Full article

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Open AccessArticle

Large Osteolipoma of the Posterior Ankle A Rare Tumor in an Unusual Location

by Forrest Rackard, Xuefei Huang, Debajyoti Saha, Ali Akalin, George Watts and Mathew Most

J. Am. Podiatr. Med. Assoc. 2025, 115(1), 23182; https://doi.org/10.7547/23-182 - 1 Jan 2025

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Abstract

Osteolipoma is a rare lipoma variant characterized by mature osseus metaplasia within mature adipose tissue, most commonly found in the head and neck, and seldom reported in the extremities. We present a case of a large osteolipoma of the posterior ankle associated with [...] Read more.

Osteolipoma is a rare lipoma variant characterized by mature osseus metaplasia within mature adipose tissue, most commonly found in the head and neck, and seldom reported in the extremities. We present a case of a large osteolipoma of the posterior ankle associated with antecedent trauma. These tumors are typically slow growing and can be associated with pain and stiffness, depending on tumor size and location. Treatment is surgical excision, and recurrence is not reported. Interdisciplinary care involving radiology, pathology, and the surgical service is necessary for proper diagnosis and treatment of this rare benign neoplasm. Full article

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Open AccessArticle

Computed Tomography Scanographic Analysis of Symptomatic Limb Length Discrepancy

by Alex Fleischman, Michael An and Wendy Young

J. Am. Podiatr. Med. Assoc. 2025, 115(1), 23179; https://doi.org/10.7547/23-179 - 1 Jan 2025

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Abstract

Background: Limb length discrepancy (LLD) is diagnosed when one limb is noted to be longer than the other. Symptomatic LLD is defined as the appearance of symptoms secondary to the compensatory mechanisms of LLD with a measured limb length differential. Several studies have [...] Read more.

Background: Limb length discrepancy (LLD) is diagnosed when one limb is noted to be longer than the other. Symptomatic LLD is defined as the appearance of symptoms secondary to the compensatory mechanisms of LLD with a measured limb length differential. Several studies have been conducted analyzing LLD through plain radiographs, yet there are only a few studies analyzing LLD using computed tomography (CT) scanography. Methods: We conducted a retrospective baseline study of patients between December 2007 and December 2017 in order to reinforce the side dominance and associated measurements of lower-extremity limb lengths through CT scanograms. The average femoral, tibial, and total limb length was calculated for each extremity. Paired sample t tests were conducted between each osseous component and total limb length. Results: Following institutional review board review and exemption, 400 charts that met the inclusion criteria were reviewed. The left limb was significantly longer than the right limb by approximately 0.10 cm (P < .05). The left femur was significantly longer than the right femur by approximately 0.07 cm(P<.05). There was no significant difference in the tibial length (P..05). Conclusions: There was a significant limb length differential in which the left limb was longer than the right limb secondary to increased femoral length. Although our results may seem imperative to our understanding of LLD, it is important to state that all of our differentials were similar, with large SDs, indicating low power of the study. Future research with an increased number of participants is warranted to reinforce the findings Full article

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Open AccessArticle

Does a Relationship Exist Between Plantar Heel Pain and Stress, Anxiety, and Depression A Systematic Review of the Literature

by Joshua Nadimi, Wahid Abdul, Rhys Whelan and Anne-Marie Hutchison

J. Am. Podiatr. Med. Assoc. 2025, 115(1), 23174; https://doi.org/10.7547/23-174 - 1 Jan 2025

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Abstract

Background: Plantar heel pain (PHP) is a debilitating physical condition and may be acute or chronic. The aim of this systematic review of the literature was to examine whether there is an association between patients with PHP and stress, anxiety, and depression. Methods: [...] Read more.

Background: Plantar heel pain (PHP) is a debilitating physical condition and may be acute or chronic. The aim of this systematic review of the literature was to examine whether there is an association between patients with PHP and stress, anxiety, and depression. Methods: A literature search of MEDLINE, Embase, Web of Science Core Collection, PsycInfo, CINAHL, Cochrane Central Register of Controlled Trials, and PEDro was conducted in May 2021. Articles were independently assessed by two reviewers and vetted for eligibility according to set inclusion/exclusion criteria and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework. Methodological quality assessment of eligible articles was undertaken using a Critical Appraisal Skills Programme-based tool. Extracted data included study design, population characteristics, method of diagnosis, and quality of life measures. A descriptive analysis was performed because of the heterogeneous nature of the data. Results: In total, 666 citations were identified from the literature search and eight studies were found to be eligible for the review. A total of 5,883 patients with PHP were identified. Four studies were found to be of medium quality and four studies were found to be of low quality according to the Critical Appraisal Skills Programme scoring tool. An association between PHP and quality of life was demonstrated across a variety of outcome measures and study designs. Conclusions: This study suggests an association between PHP and stress, anxiety, and depression. However, current research in this area is low in both quality and quantity and further robust studies are required to guide management. Full article

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Open AccessArticle

Patient Knowledge and Habits as Predictors of Foot Complications in Diabetes A Cross-Sectional Study

by Khalid M. Edrees, Alanood I. Alqahtani and Mansoor Radwi

J. Am. Podiatr. Med. Assoc. 2025, 115(1), 23069; https://doi.org/10.7547/23-069 - 1 Jan 2025

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Abstract

Background: This cross-sectional study aimed to identify patients’ awareness of predictors of diabetic foot complications (DFCs) based on 1) knowledge of hemoglobin A1c (HbA1c), 2) performance of fasting blood glucose (FBG) at home, and 3) type of footwear used and relationship with DFCs. [...] Read more.

Background: This cross-sectional study aimed to identify patients’ awareness of predictors of diabetic foot complications (DFCs) based on 1) knowledge of hemoglobin A1c (HbA1c), 2) performance of fasting blood glucose (FBG) at home, and 3) type of footwear used and relationship with DFCs. Methods: A total of 4,652 diabetic patients were seen between 2006 and 2021 at Dr. Khalid Edrees Specialized Medical Center. A questionnaire was completed by trained nurses at the patients’ initial visit, collecting patients’ knowledge of the HbA1c test, monitoring of FBG at home, and type of footwear used at the time of the visit. History of foot ulcers, current foot ulceration (CU), and history of lower limb amputation (LLA) were obtained. Results: The majority of our cohort were male (60%), and the mean age was 60 years (SD, 17.5 years). Ninety-six percent had type 2 diabetes, and 39% were diagnosed with diabetes for at least 11 years. More than half did not know what HbA1c was, 32% were not doing home FBG, and 62% were using inappropriate footwear. Fifty-two percent had a CU, 35% had a history of foot ulcers, and 13% had an LLA. We found a significant association between CU and knowledge of HbA1c and type of footwear (P < .001). Similarly, LLA was significantly associated with all of the aforementioned variables (P < .001). A history of foot ulcers was significantly associated with knowledge of HbA1c and type of footwear (P 5 .001) but not with home FBG. Conclusions: A high proportion of patients in our cohort had never heard of HbA1c and were using traditional footwear. This highlights the importance of patient education regarding the basics of diabetes and the use of appropriate footwear in preventing DFCs. Full article

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Open AccessArticle

Static and Dynamic Foot Pressure Analysis in Asymptomatic Adults A Cross-Sectional Analysis

by Osama Neyaz, Binayak Patra, Raj Kumar Yadav and Shabeeba Sherin

J. Am. Podiatr. Med. Assoc. 2025, 115(1), 23024; https://doi.org/10.7547/23-024 - 1 Jan 2025

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Abstract

Background: Normative data on plantar pressure distribution are essential for comparing the plantar pressures of healthy people with those of symptomatic individuals. The present study analyzed the foot pressure distribution variations among healthy males and females in static and dynamic conditions. Methods: A [...] Read more.

Background: Normative data on plantar pressure distribution are essential for comparing the plantar pressures of healthy people with those of symptomatic individuals. The present study analyzed the foot pressure distribution variations among healthy males and females in static and dynamic conditions. Methods: A prospective cross-sectional study was conducted in the Department of Physical Medicine and Rehabilitation on individuals aged 18 to 65 years with no known foot pathologies or deformities. Both static and dynamic pedobarographic variables were measured using the BTS P-WALK system. Results: Among 160 participants, the static analysis showed that average hindfoot pressure (right, 59.8 6 21.4; left, 72.1 6 55.4) was significantly higher than average forefoot pressure (right, 29.2613.9; left, 23.4612.7) (P<.001). The average forefoot pressure was significantly higher in males (right, 30.1 6 23.8; left, 23.8 6 21.7) than in females (right, 21.8 6 20.6; left, 16.6 6 15.3) (P 5 .043 and .016, respectively), whereas the average hindfoot pressure was higher in females (right, 63.5 6 25.9; left, 75.3 6 23.9) than in males (right, 56.1 6 19.6; left, 68.8624.2) (P5.043 and .089, respectively). Conclusions: The hindfoot bore more load than the forefoot when standing. Males carried a greater proportion of load over the forefoot than females. When walking, overall, the weightbearing pattern over the hindfoot and forefoot was similar. Full article

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Open AccessArticle

Outcomes and Comparisons of Minimally Invasive Distal Metatarsal and Phalangeal Osteotomies With Traditional Open Osteotomies for Hallux Valgus Deformity

by Adam R. Johnson

J. Am. Podiatr. Med. Assoc. 2025, 115(1), 23013; https://doi.org/10.7547/23-013 - 1 Jan 2025

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Abstract

Background: Ongoing efforts and innovations to improve current bunionectomy procedures have led to a resurgence of minimally invasive surgery. Methods: A retrospective review of 23 patients who underwent aminimally invasive distalmetatarsal and phalangeal osteotomy bunionectomy procedure was undertaken. The procedure was accomplished using [...] Read more.

Background: Ongoing efforts and innovations to improve current bunionectomy procedures have led to a resurgence of minimally invasive surgery. Methods: A retrospective review of 23 patients who underwent aminimally invasive distalmetatarsal and phalangeal osteotomy bunionectomy procedure was undertaken. The procedure was accomplished using stab incisions (less than 5mmin length) for the introduction of cutting routers and fixation devices to avoid disruption of the soft tissues in and around the firstmetatarsophalangeal joint, including avoidance of firstmetatarsophalangeal joint lateral soft tissue release. Results: The results revealed that the procedure led to an average reduction in first intermetatarsal angle of 63% (14.5° preoperatively versus 5.3° postoperatively) and a reduction in hallux abductus angle of 54% (33.8° preoperatively versus 15.5° postoperatively). Tibial sesamoid position was also recorded and reduced by 63% (an average position of 5 preoperatively versus an average position of 2 postoperatively). Conclusions: A review of recent literature demonstrated that these results were comparable to open midshaft and base osteotomies. Full article

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Open AccessArticle

Reoperation and Reamputation Rates After Isolated Sesamoidectomy for Foot Ulcers

by Bryanna D. Vesely, Devon Niewohner and Cody Blazek

J. Am. Podiatr. Med. Assoc. 2025, 115(1), 23001; https://doi.org/10.7547/23-001 - 1 Jan 2025

Cited by 1 | Viewed by 91

Abstract

Background: Foot wounds are a serious medical condition that can progress rapidly. For patients who have failed conservative treatment, surgery to remove infected bone or surgically offload the wound may be necessary. Methods: In our study, we looked at all patients at a [...] Read more.

Background: Foot wounds are a serious medical condition that can progress rapidly. For patients who have failed conservative treatment, surgery to remove infected bone or surgically offload the wound may be necessary. Methods: In our study, we looked at all patients at a single institution over a 7.5-year time period who underwent isolated sesamoidectomy for osteomyelitis or recurrent wounds. A total of 21 patients with 22 operative extremities and an average 430-day follow-up (21–1,346 days) were included in the study. Results: We found a 36.3% reoperation rate due to persistent wound resistant to conservative treatment or infection, with the most common procedure being a partial first-ray amputation (27.3% of patients). We found that the average time to reoperation after the initial surgery was 152.9 days. Conclusions: To our knowledge, this is the first study to look at reoperation rates after sesamoidectomy surgery for wounds. We conclude that isolated sesamoidectomy is an appropriate procedure for isolated osteomyelitis to the sesamoids or resistant wounds that have failed conservative treatment, with overall low reoperation rates compared with distal foot amputations. Full article

Open AccessArticle

High Tibial Nerve Entrapment A Common Component of Tarsal Tunnel Syndrome

by Roberto P. Segura and Michael S. Nirenberg

J. Am. Podiatr. Med. Assoc. 2025, 115(1), 22227; https://doi.org/10.7547/22-227 - 1 Jan 2025

Cited by 2 | Viewed by 190

Abstract

Background: Tarsal tunnel syndrome (TTS) is the result of compression of the tibial nerve in the area of the medial foot, ankle, or both. Individuals suffering from TTS may experience pain, burning, cramping, or numbness on the sole of the foot and toes. [...] Read more.

Background: Tarsal tunnel syndrome (TTS) is the result of compression of the tibial nerve in the area of the medial foot, ankle, or both. Individuals suffering from TTS may experience pain, burning, cramping, or numbness on the sole of the foot and toes. Tarsal tunnel syndrome is divided into a distal component and a proximal component. The latter is referred to as high TTS (HTTS) in which the tibial nerve is compressed above the location of the laciniate ligament. Research on HTTS is scant, and this study is among the first to evaluate the prevalence of HTTS in individuals with clinical signs and symptoms of TTS. Full article

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Open AccessArticle

Ankle Arthroscopy in Early-Stage Ankle Tuberculosis A Case Report

by Ali Yüce, Mustafa Yerli, Nazım Erkurt and Tahsin Olgun Bayraktar

J. Am. Podiatr. Med. Assoc. 2025, 115(1), 22220; https://doi.org/10.7547/22-220 - 1 Jan 2025

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Abstract

Ankle tuberculosis (TBC) is observed in 8 to 10% of the patients with skeletal TBC and 0.1 to 0.3% with extrapulmonary TBC. The ankle joint is an unusual place for TBC arthritis. Due to the lack of TBC-pathognomonic symptoms in ankle cases, it [...] Read more.

Ankle tuberculosis (TBC) is observed in 8 to 10% of the patients with skeletal TBC and 0.1 to 0.3% with extrapulmonary TBC. The ankle joint is an unusual place for TBC arthritis. Due to the lack of TBC-pathognomonic symptoms in ankle cases, it may imitate other diseases. It caused a delay in diagnosis. The present study aimed to examine a case in which joint debridement was applied, and the early-stage ankle tuberculosis diagnosis was made with an arthroscopic biopsy. Full article

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Open AccessCase Report

Rare Case of Osteomyelitis Caused by Achromobacter xylosoxidans

by Christopher P. Girgis, Tyler L. Coye, Elizabeth Ansert, Amanda L. Killeen and Peter A. Crisologo

J. Am. Podiatr. Med. Assoc. 2025, 115(1), 22213; https://doi.org/10.7547/22-213 - 1 Jan 2025

Cited by 1 | Viewed by 86

Abstract

Achromobacter xylosoxidans is a rare opportunistic aerobe that has rarely been documented in the literature as a causative agent for osteomyelitis. It can present with antibiotic resistance, making treatment without operative management challenging. We present the case of a 51-year-old male with a [...] Read more.

Achromobacter xylosoxidans is a rare opportunistic aerobe that has rarely been documented in the literature as a causative agent for osteomyelitis. It can present with antibiotic resistance, making treatment without operative management challenging. We present the case of a 51-year-old male with a past medical history of uncontrolled type 2 diabetes. The patient presented to a clinic with a grade 2 infection to the right fifth digit, as defined by the International Working Group on the Diabetic Foot, and was subsequently admitted for intravenous antibiotics and operative management. Magnetic resonance imaging revealed abnormal signal of the phalanges of the fifth toe with sparing of the base of the proximal phalanx, consistent with osteomyelitis. An arthroplasty of the digit yielded pathology consistent with acute osteomyelitis and culture of Achromobacter xylosoxidans. Surgical debridement and culture-directed antibiotic therapy resulted in clinical cure. In chronic diabetic foot ulcerations, osteomyelitis should be considered, and Achromobacter xylosoxidans should be acknowledged as a potentially resistant organism. Therefore, it is paramount that a multidisciplinary approach is used when treating this condition. Full article

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Open AccessArticle

Effects of Home-Based Telerehabilitation on Foot Intrinsic Muscle Activity and Thickness in Individuals With Flat Feet: A Preliminary Study

by Dong-Chul Moon and Jun-Seok Kim

J. Am. Podiatr. Med. Assoc. 2025, 115(1), 22178; https://doi.org/10.7547/22-178 - 1 Jan 2025

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Abstract

Background: We evaluated the effects of movement control exercise (MCE) and abductor hallucis (AbH) muscle contraction, performed via home-based telerehabilitation, on foot intrinsic and extrinsic muscle activity, AbH muscle thickness, and balance in individuals with flat feet. Methods: In total, 30 [...] Read more.

Background: We evaluated the effects of movement control exercise (MCE) and abductor hallucis (AbH) muscle contraction, performed via home-based telerehabilitation, on foot intrinsic and extrinsic muscle activity, AbH muscle thickness, and balance in individuals with flat feet. Methods: In total, 30 individuals with flat feet were enrolled in the study. Participants were randomly assigned to home-based telerehabilitation focusing on MCE only or MCE emphasizing short foot motion (SFMCE) for the lower extremities. Exercises were performed over 4 weeks. Data for foot intrinsic and extrinsic muscle activity, AbH muscle thickness, and the Y-balance test were collected before and after the 4-week intervention. Results: Abductor hallucis muscle activity in the SFMCE group was significantly higher after exercise compared with before, and there was also a significant difference between the groups. Furthermore, AbH muscle thickness was significantly greater in the SFMCE group compared with the MCE-only group. The Y-balance test performance improved significantly in the posterolateral direction in the SFMCE group. Conclusions: Home-based telerehabilitation focused on SFMCE can be used to improve foot intrinsic muscle activity, AbH muscle thickness, and functional balance in individuals with flat feet. Full article

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Open AccessCase Report

Novel Bone and Marrow Harvesting Approach Through Posterior Subtalar Screw Tunnel for Revision Talonavicular Joint Arthrodesis

by Andrew S. Au and Peter A. Blume

J. Am. Podiatr. Med. Assoc. 2025, 115(1), 22175; https://doi.org/10.7547/22-175 - 1 Jan 2025

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Abstract

We present a case report of revision talonavicular joint arthrodesis following painful nonunion. Following the removal of the previously united subtalar joint arthrodesis hardware, the posterior screw tunnel was used to access the internal aspect of the calcaneus for bone and marrow harvesting [...] Read more.

We present a case report of revision talonavicular joint arthrodesis following painful nonunion. Following the removal of the previously united subtalar joint arthrodesis hardware, the posterior screw tunnel was used to access the internal aspect of the calcaneus for bone and marrow harvesting avoiding a second graft site incision. A suction curettage system was then used to acquire adequate autologous cancellous bone graft and nondiluted bone marrow. The talonavicular joint was then prepared for revision arthrodesis, followed by augmentation with the autologous cancellous bone graft and rigid internal fixation placed across the joint for compression. There were no complications noted at the donor site or the arthrodesis site immediately following surgery or during follow-up. Radiographs obtained 4 months postoperatively demonstrate osseous union at the talonavicular joint and near complete consolidation at the calcaneal donor site. The patient is currently walking pain-free in a walking boot and will be continually followed to allow for long-term outcome measures. Full article

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Open AccessArticle

Biomechanical Comparison of Single- and Double-Twist Tension Band, Cancellous Screw, and Single-Screw Tension Band Models in Medial Malleolus Fractures

by Gurdal Nusran, Onur Yılmaz, İbrahim Mutlu, Tolgahan Kuru and H. Yener Erken

J. Am. Podiatr. Med. Assoc. 2025, 115(1), 22172; https://doi.org/10.7547/22-172 - 1 Jan 2025

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Abstract

Background: Models using a double-twist tension band, two partially threaded cancellous screws, a single-twist tension band, and a single-screw tension band were biomechanically compared for fixation of medial malleolus fractures. Methods: All 72 composite cortical tibial bones used in the study [...] Read more.

Background: Models using a double-twist tension band, two partially threaded cancellous screws, a single-twist tension band, and a single-screw tension band were biomechanically compared for fixation of medial malleolus fractures. Methods: All 72 composite cortical tibial bones used in the study were osteotomy suitable for medial malleolus fracture. They were divided into four groups: double-twist tension band (group 1), two partially threaded cancellous screws (group 2), single-twist tension band (group 3), and single-screw tension band (group 4), with 18 composite tibial bones in each group. Bones in each group were divided into three subgroups and subjected to biomechanical tests by applying force as tension, transverse, and axial loading. Results: In the tension and transverse loading tests, the highest mean stiffness was in groups 1 and 4. Group 4 had statistically significantly higher stiffness values than groups 2 and 3. All of the other groups had statistically significantly higher stiffness values than group 2. A statistically significant difference was found comparing group 4 (with the highest value in the axial loading test) with the other groups. No significant difference was found between groups 1 and 3 in any of the biomechanical tests. Conclusions: Tension band method did not make a difference biomechanically when applied as a double or single twist. Single-screw tension band was found to be the most stable fixation method in tension, transverse, and axial loading tests. We think that the single-screw tension band method is a stable and suitable fixation method and should find more place in current surgical practices. Full article

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Open AccessArticle

A Rare Case of Fifth Metatarsophalangeal Joint Subluxation: A Case Report

by Susanna Basciani, Simone Santini, Gianluca Marineo, Piergianni Di Santo and Andrea Marinozzi

J. Am. Podiatr. Med. Assoc. 2025, 115(1), 22151; https://doi.org/10.7547/22-151 - 1 Jan 2025

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Abstract

Dislocations or subluxations of the metatarsophalangeal joints are rare, and open reduction is necessary in exceptional cases. In this case report, we present the case of a 30-year-old man who had chronic dislocation of the fifth metatarsophalangeal joint after a motorcycle accident. Stiffening [...] Read more.

Dislocations or subluxations of the metatarsophalangeal joints are rare, and open reduction is necessary in exceptional cases. In this case report, we present the case of a 30-year-old man who had chronic dislocation of the fifth metatarsophalangeal joint after a motorcycle accident. Stiffening of the joint capsule prevented closed reduction; therefore, the patient underwent surgery. After performing a Gauthier-type osteotomy, the joint was stabilized by Kirschner wire. The patient had an excellent recovery with no new dislocation episodes. Full article

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Open AccessCase Report

Use of Antibiotic Spacer with Syndesmotic “Fin” for Treatment of Septic Ankle Joint: Two-Stage Approach or Definitive Management?

by Samantha L. Williams, Elizabeth Connolly and John Levin

J. Am. Podiatr. Med. Assoc. 2025, 115(1), 22120; https://doi.org/10.7547/22-120 - 1 Jan 2025

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Abstract

Septic ankle joint following orthopedic surgery is a rare but limb-threatening complication that requires emergent multi-modal management. Traditionally, spacers serve as stage one of a two-stage approach involving deep infections seeding to a joint. However, a paucity of literature exists regarding the outcomes [...] Read more.

Septic ankle joint following orthopedic surgery is a rare but limb-threatening complication that requires emergent multi-modal management. Traditionally, spacers serve as stage one of a two-stage approach involving deep infections seeding to a joint. However, a paucity of literature exists regarding the outcomes and longevity of antibiotic spacers in patients who are poor candidates for a subsequent reoperation. We present a case of an 89-year-old female who sustained an open pilon fracture treated with external fixation, and a subsequent open reduction internal fixation following a fall from a height. The patient developed surgical site dehiscence that progressed to a septic ankle joint, confirmed via single-photon emission computed tomography and a three-phase bone scanning. The patient underwent a debridement with operative wash-out and fashioning of a methylmethacrylate antibiotic spacer containing 1 g of vancomycin and 1.2 g of tobramycin. This was positioned in the ankle joint with an adapted “fin” extending anteriorly and proximally in the tibiofibular syndesmosis, to provide stability to the spacer, and potentially increase its longevity interpositionally. With aggressive local wound care and an oral antibiotic course, the patient proceeded to complete reepithelialization of the sinus tract 6 weeks postoperatively. Serial imaging and computed tomographic scan confirmed a well-seated spacer, without evidence of migration or extrusion, 14 months after surgery. Outcome data regarding cement ankle arthroplasties are extremely limited. Retrospective case series have quantified average retention anywhere from 6 to 62 months with varying techniques. However, in the setting of multiple comorbidities, or other factors making a patient a poor candidate for reoperation, an antibiotic spacer may serve as a definitive treatment for such an infection with satisfactory outcomes. We believe the presented method, with use of a proximal fin articulating in the tibiofibular syndesmosis, not only improves implant retention, but also, maintains a functional, plantigrade ankle joint. Full article

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Open AccessCase Report

Bilateral Distal Tibial Fractures with Preexisting Long-Stem Knee Prostheses Treated with Closed Retrograde Intramedullary Nails: A Case Report

by Ryan Lerch and Jeffrey Manway

J. Am. Podiatr. Med. Assoc. 2025, 115(1), 22099; https://doi.org/10.7547/22-099 - 1 Jan 2025

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Abstract

Recently there has been expanded interest in the management of fractures of the ankle in the elderly. This case presentation demonstrates an alternative treatment choice for bilateral distal tibial fractures in a comorbid patient. This is a novel case of interest because low-energy [...] Read more.

Recently there has been expanded interest in the management of fractures of the ankle in the elderly. This case presentation demonstrates an alternative treatment choice for bilateral distal tibial fractures in a comorbid patient. This is a novel case of interest because low-energy bilateral distal tibial fracture in the elderly and comorbid population is a relatively infrequent occurrence. Several case series have demonstrated the efficacy and safety of closed retrograde nailing of distal tibial fractures. The patient was an 80-year-old woman with a medical history that included hypertension, hyperlipidemia, type 2 diabetes, rheumatoid arthritis, chronic obstructive pulmonary disease, coronary artery disease status post stenting, heart failure with preserved ejection fracture, chronic kidney disease, and a history of a transient ischemic attack. The patient’s case was further complicated by the presence of preexisting long-stem bilateral knee prostheses. The patient had been living independently when she experienced a ground-level fall in which imaging showed bilateral distal tibial fractures. The decision to perform closed bilateral concomitant stabilization via retrograde intramedullary nails was based on the need for early ambulation, stability, and the presence of extensive preexisting tibial prostheses. Ultimately, the patient healed uneventfully, returning to a similar level of independence and ambulation as before her injury. Full article

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Open AccessArticle

The Use of Multilayer Felt Padding in the Treatment of Neuropathic Plantar Foot Ulcerations

by Khanh Phuong Tong, Kayla N. Obradovic, Alyse L. Acciani, Norman Wortzman and Stuart Kigner

J. Am. Podiatr. Med. Assoc. 2025, 115(1), 22088; https://doi.org/10.7547/22-088 - 1 Jan 2025

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Abstract

Background: Neuropathic plantar foot ulcers are difficult to treat due to their location and the repetitive pressures applied during ambulation. Total-contact casts and removable offloading devices are effective in off-loading pressures; however, patient intolerance and adherence are barriers to use. Felt padding [...] Read more.

Background: Neuropathic plantar foot ulcers are difficult to treat due to their location and the repetitive pressures applied during ambulation. Total-contact casts and removable offloading devices are effective in off-loading pressures; however, patient intolerance and adherence are barriers to use. Felt padding can provide off-loading with greater tolerance. We present novel felt padding techniques that provide off-loading with greater adherence and may ultimately lead to greater rates of wound closure. Methods: This retrospective study included patients with neuropathic plantar foot ulcers seen at a single center between August 1, 2016 and July 15, 2020. Felt padding was applied to the plantar foot during clinic visits. Ulcer characteristics, medical history, and treatment options were extracted and evaluated. Statistical analyses were performed with descriptive statistics, two-sample t tests, and Fisher exact tests. Kaplan-Meier method was used to estimate time to reach 50% ulcer surface area reduction. Results: Of 59 included patients with neuropathy and a plantar foot ulcer treated with felt padding, 46 (78.0%) had diabetes mellitus. Mean ± SD surface area was 1.0 ± 1.8 cm2. Mean ± SD and median (interquartile range) healing times were 67.4 ± 76.3 days and 45 (40) days, respectively. The percentage healed by 12 weeks was 78.0%. There was no significant difference in healing times between diabetic and nondiabetic patients (P = .57). Conclusions: Multilayer felt padding is an important adjunctive tool for off-loading and healing of neuropathic plantar foot ulcers. Use of multilayer felt off-loading padding should be considered for patients with suspected low adherence to wearing a removable knee-high or ankle-high off-loading device. Full article

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Open AccessArticle

Comparison of Lipid and Glucose Levels in Individuals with and Without Plantar Fasciitis: A Cross-Sectional Observational Study

by Sayyed-Hadi Sayyed-Hosseinian, Farshid Bagheri, Fatemeh Sistanian, Alireza Mousavian, Mohammad Hosein Ebrahimzadeh, Amir Reza Kachooei and Mahla Daliri

J. Am. Podiatr. Med. Assoc. 2025, 115(1), 22084; https://doi.org/10.7547/22-084 - 1 Jan 2025

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Abstract

Background: Tendon problems and biomechanical alterations are linked to hyperlipidemia. We sought to determine the relationship of plantar fasciitis (PF) with lipid profile parameters and fasting blood sugar (FBS) levels. Methods: In a case-control study, we enrolled 68 patients with a [...] Read more.

Background: Tendon problems and biomechanical alterations are linked to hyperlipidemia. We sought to determine the relationship of plantar fasciitis (PF) with lipid profile parameters and fasting blood sugar (FBS) levels. Methods: In a case-control study, we enrolled 68 patients with a clinical diagnosis of PF in the case group and 136 individuals without PF in the control group. Patients’ height, weight, body mass index (BMI), FBS level, and lipid profile, including low-density lipoprotein (LDL-C), high-density lipoprotein, and total cholesterol levels and triglyceride levels, were compared between the groups. The mean difference of each variable between the patient and control groups was tested using an independent t test. We calculated the odds ratio to quantify the strength of association between PF and elevated lipid profile. Correlation coefficient analyses were used to calculate the correlation of patients’ BMI with lipid profile and FBS levels to evaluate the BMI variable as a confounder. Results: Patients with PF had higher levels of total cholesterol (P = .001), LDL-C (P = .004), and triglycerides (P = .02). Odds ratio calculation showed that patients with serum LDL-C levels greater than 130 mg/dL were 3.3 times more likely to develop PF. We found no association between lipid profile parameters and BMI (as a confounder) in either group. Conclusions: These findings show higher serum LDL-C parameters in patients with PF and may be sufficient to support a further clinical trial using statin treatment for persistent PF with increased LDL-C levels. Full article

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Open AccessArticle

Quality Assessment of YouTube Videos as a Source of Information on Ingrown Toenails

by Erdi Imre

J. Am. Podiatr. Med. Assoc. 2025, 115(1), 22054; https://doi.org/10.7547/22-054 - 1 Jan 2025

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Abstract

Background: YouTube is one of the most widely used Internet sources, and many patients watch YouTube videos for gathering more information, especially about health problems. This study aimed to investigate the informative capabilities of YouTube videos about ingrown toenails. We hypothesize that [...] Read more.

Background: YouTube is one of the most widely used Internet sources, and many patients watch YouTube videos for gathering more information, especially about health problems. This study aimed to investigate the informative capabilities of YouTube videos about ingrown toenails. We hypothesize that most of the shared information is of low quality independent of source and that the attraction effect of videos is unrelated to quality. Methods: The first 50 videos in the English language using the keyword query ingrown toenail in YouTube search were analyzed. Journal of the American Medical Association (JAMA) benchmark criteria were used to assess video reliability, and Global Quality Score (GQS) and toenail specific score (TSS) were used to assess the quality of educational content. Results: The first 50 videos had 71,842,230 views (median, 333,585). Forty-one videos (82%) were from health-care professionals, seven (14%) were educational videos, and two (4%) were personal videos. The median JAMA score was 2, with the highest scores coming from academic sources. When grouped by view count (＞300,000 versus ≤300,000) and like count (＞10,000 versus ≤10,000), there was no significant difference in JAMA and GQS scores. The median GQS and toenail specific score were 3.0 and 5.5, respectively. Video duration was a significant predictor ofGQSas a result of regression analysis (P = 0.002; β =0.425). Conclusions: Illustrated by the high number of views, ingrown toenail is a popular health topic on YouTube. Although popular and with content mostly uploaded by health-care professionals, content quality was found to be poor and videos to be unreliable and insufficient for informing patients because most videos seem to be geared toward entertainment rather than direct patient education. Health-care professionals should be aware of the generally low-quality data available. Full article

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Open AccessArticle

Patient-Reported Outcomes After Congenital Toe Syndactyly Repair with a Plantar Triangular Flap

by Kaylee O’Connor, Sofia Gereta, Sarah A. Frommer and Steven L. Henry

J. Am. Podiatr. Med. Assoc. 2025, 115(1), 22043; https://doi.org/10.7547/22-043 - 1 Jan 2025

Cited by 1 | Viewed by 102

Abstract

Background: Syndactyly of the toes is a common congenital malformation, yet there are few reports of long-term outcomes after toe syndactyly repair and its effect on well-being. In this study, we surveyed patients and parents of patients who underwent toe syndactyly repair [...] Read more.

Background: Syndactyly of the toes is a common congenital malformation, yet there are few reports of long-term outcomes after toe syndactyly repair and its effect on well-being. In this study, we surveyed patients and parents of patients who underwent toe syndactyly repair to investigate the functional and psychological outcomes of their surgery. Methods: Wereviewed the medical records of all of the patients who underwent toe syndactyly repair using a plantar flap technique between January 1, 2010, and January 1, 2021. Parents or patients completed a survey assessing their opinion regarding cosmesis, function, and overall satisfaction. Independent observers used a modified Vancouver Scar Scale to evaluate surgical scars. Results: A plantar flap technique was used for 19 syndactylous webs in nine patients. Complications included one instance of mild cellulitis and one instance of web creep requiring revision. Average follow-up time was 5.5 years. Overall, 88% of survey respondents were very or moderately satisfied with the surgical outcome. No patients had unwanted hair growth or a bothersome groin site scar. Average modified Vancouver Scar Scale score was 3.2. There was a perceived improvement in toe range of motion and hygiene after surgery. Patients who underwent first web space release could wear flip-flops. All of the respondents would recommend surgery for another child with toe syndactyly. Conclusions: Toe syndactyly repair can be performed with minimal complications and high parent/patient satisfaction. Survey results indicate that there may be functional and psychological benefits to undergoing toe syndactyly repair. Full article

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Open AccessArticle

Early Staged Surgical Reconstruction for Active Midfoot and Ankle Charcot’s Neuroarthropathy

by Michael J. Hurst, Hannah J. Hughes and Patrick R. Burns

J. Am. Podiatr. Med. Assoc. 2025, 115(1), 22036; https://doi.org/10.7547/22-036 - 1 Jan 2025

Cited by 1 | Viewed by 141

Abstract

Background: Charcot’s neuroarthropathy (CN) is a destructive inflammatory process that affects patients with peripheral neuropathy, most commonly those with uncontrolled diabetes mellitus. The disease progresses through an active hyperemic phase that eventually becomes inactive, and the affected bone consolidates. The period in [...] Read more.

Background: Charcot’s neuroarthropathy (CN) is a destructive inflammatory process that affects patients with peripheral neuropathy, most commonly those with uncontrolled diabetes mellitus. The disease progresses through an active hyperemic phase that eventually becomes inactive, and the affected bone consolidates. The period in which the disease progresses from active to inactive is when instability, deformity, dislocation, and ulceration may occur depending on what deforming forces are stressing the affected pathologic area. There is a paucity of literature to support early primary surgical intervention, either single or staged, for active CN. Methods: The purpose of this case series was to retrospectively review 30 reconstructions in 30 patients who underwent primary surgical intervention for active midfoot and ankle CN. All of the 30 patients underwent staged deformity correction with temporary circular ring external fixation followed by definitive internal fixation. Results: Twenty-seven of the staged reconstructions (90%) at final follow-up resulted in limb salvage with no minor amputations after reconstruction. Mean final follow-up was 24.4 months. Nine of the 30 patients (30%) did not remain ulcer-free; however, 50% of the patients had a preexiting ulceration before surgical intervention, and the cohort exhibited a 40% healing rate of ulcers. Conclusions: We achieved a 90% limb salvage rate in patients with active midfoot and ankle CN with a staged surgical intervention protocol. Surgical intervention in the active stage of CN may be beneficial for patients who have gross instability with ulceration, significant midfoot collapse, and frank dislocation. Full article

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Open AccessArticle

Beliefs About and Use of Forefoot Lateral Wedging in Podiatric Medical Practice: A Survey of Podiatric Physicians in New Zealand

by Aaron Jackson, Kelly Sheerin, Duncan Reid and Matthew R. Carroll

J. Am. Podiatr. Med. Assoc. 2025, 115(1), 22022; https://doi.org/10.7547/22-022 - 1 Jan 2025

Cited by 1 | Viewed by 98

Abstract

Background: Evidence is limited exploring the beliefs and application of forefoot lateral wedges (FLWs) in clinical practice by podiatric physicians. We aimed to understand rationale and beliefs that guide the use of FLWs among podiatrists. Methods: A cross-sectional study of New [...] Read more.

Background: Evidence is limited exploring the beliefs and application of forefoot lateral wedges (FLWs) in clinical practice by podiatric physicians. We aimed to understand rationale and beliefs that guide the use of FLWs among podiatrists. Methods: A cross-sectional study of New Zealand (NZ) podiatrists was conducted between May 31 and July 26, 2021. Data were collected anonymously using a Web-based survey platform. The 30-item survey included questions to elicit participant characteristics, why and when podiatrists used orthosis modifications, what biomechanical assumptions influenced clinical decision-making, and how podiatrists fabricated and placed FLWs. Results: Of 65 survey completers, most were trained in NZ (90.8%), had more than 10 years’ experience (70.8%), and worked with a mixed case load (60.0%); 77.3% prescribed zero to ten foot orthoses per week, with FLWs used in 44% of prescriptions. Peroneal tendon injuries and chronic ankle instability were most likely to be treated with FLWs. The most common belief was that FLWs increase first metatarsophalangeal joint range of motion (86.2%). The FLWs were regularly manufactured from 3-mm (73.8%), medium- density ethyl vinyl acetate (92.9%) and positioned from the calcaneocuboid joint (54.8%) to the sulcus (78.6%). Conclusions: Podiatrists in NZ frequently use FLWs. These were generally manufactured from 3-mm, medium-density ethyl vinyl acetate and positioned from the calcaneocuboid joint to the sulcus. The most common rationales for use were to increase first metatarsophalangeal joint range of motion, shift the center of pressure medially, and balance the foot. A discordance was found between the theories of foot function on which clinicians placed the greatest importance and the biomechanical outcomes they thought were being achieved. Survey data also highlighted inconsistency in the nomenclature used to describe FLW thickness and inclination. Full article

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Open AccessArticle

Surgical Site Infection Rate from Office-Based Foot and Ankle Surgeries: A Retrospective Analysis

by Lucas Adams, Nevin Joseph, Clayton Cassidy, Christina Pratt and Mark Razzante

J. Am. Podiatr. Med. Assoc. 2025, 115(1), 21238; https://doi.org/10.7547/21-238 - 1 Jan 2025

Cited by 1 | Viewed by 129

Abstract

Background: This study aimed to present data about the incidence of postoperative infections after procedures performed in a podiatric medicine private practice office setting. The COVID-19 pandemic placed a burden on the health-care system. Performing procedures in a clinic or office setting [...] Read more.

Background: This study aimed to present data about the incidence of postoperative infections after procedures performed in a podiatric medicine private practice office setting. The COVID-19 pandemic placed a burden on the health-care system. Performing procedures in a clinic or office setting played a role in providing a continued high level of patient care for foot and ankle surgeons. Methods: We conducted a retrospective review of 205 procedures in 121 patients who had undergone elective podiatric medical/orthopedic procedures performed in an office setting from February 1, 2018, through July 31, 2021. No patients were given preoperative antibiotics. The following data were extracted: patient age, sex, history of diabetes mellitus, peripheral neuropathy, development of postoperative infection, severity of infection, follow-up time in weeks, and antibiotic use prophylactically and if used postoperatively. Results: The overall infection rate for this study was 1.95%, all of which were superficial infections. The most common procedure performed was a flexor tenotomy, followed by hardware removal. Removing flexor tenotomy procedures, the incidence of postoperative infection was 3.3%. Conclusions: Performing procedures in an office clinical setting is an effective and safe means to treat patients with similar if not lower infection rates compared with a hospital or surgery center in modern literature. Full article

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J. Am. Podiatr. Med. Assoc., Volume 115, Issue 1 (01 2025) – 30 articles

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