Journal of the American Podiatric Medical Association

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Open AccessArticle

by Alan Banks

J. Am. Podiatr. Med. Assoc. 2025, 115(4), 25133; https://doi.org/10.7547/25-133 - 1 Jul 2025

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E. Dalton McGlamry was born in 1931, to a poor family in the town of Moultrie, in southwestern Georgia [...] Full article

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Open AccessArticle

Foot Care for Muslim Patients. A Narrative Review of Clinical Guidelines for Religious Competence

by Mohammad Junayed Khan, Naveed Shah, Rafay Qureshi, Jacob Nasser and Rifat Zaman

J. Am. Podiatr. Med. Assoc. 2025, 115(4), 24208; https://doi.org/10.7547/24-208 - 1 Jul 2025

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Abstract

Islam is the fastest growing religion in the United States and the world, and the number of Muslim patients who foot and ankle specialists will encounter is expected to increase as a result. Therefore, it is important to understand the Muslim patients’ emphasis [...] Read more.

Islam is the fastest growing religion in the United States and the world, and the number of Muslim patients who foot and ankle specialists will encounter is expected to increase as a result. Therefore, it is important to understand the Muslim patients’ emphasis on modesty to ensure comfort during the patient encounter. The provider should understand the permissibility of animal-derived products, especially as it relates to lower-extremity wound care and surgical products. Specific rituals that are pillars of Islam, such as prayer, fasting in Ramadan, and Hajj pilgrimage, all have direct relationships with foot health that providers should be cognizant of. Ritual purification or ablution before prayer is associated with fungal infections, and specific prayer positions may aggravate foot pain. Providers must understand that it is not enough to only treat fungal infections that affect Muslim patients, but they also need to understand the unique circumstances of Muslim worshipers that increase their risk of fungal infections and recurrence. Consequently, educational and preventative measures for managing tinea pedis in the Muslim population are critical. Muslims fast from sunrise to sunset during the month of Ramadan and pray during the night for an extended time, which has potential effects on the lower extremity. Hajj is the major pilgrimage that Muslims are required to complete once in a lifetime, and there are smaller, optional, pilgrimages that Muslims perform as well. There is a high risk of foot, ankle, and leg complications during these pilgrimages, and therefore it is paramount that providers understand the risk factors for lower-extremity complications during Hajj. Although Muslim patients participate in many rituals that have the potential to affect their foot health and overall well-being, the provider should understand that concessions exist for all situations, and the well-being of the patient supersedes any ritualistic obligation. Full article

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Open AccessArticle

The Future of Applications to Podiatric Medical School in the United States—2024

by Martin Yorath

J. Am. Podiatr. Med. Assoc. 2025, 115(4), 24170; https://doi.org/10.7547/24-170 - 1 Jul 2025

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Abstract

Background: The number of applications to podiatric medical schools in the United States continues to fall. There are many reasons for this decline, and this article attempts an impartial look at some of the forces at play in potentially affecting students’ decisions to [...] Read more.

Background: The number of applications to podiatric medical schools in the United States continues to fall. There are many reasons for this decline, and this article attempts an impartial look at some of the forces at play in potentially affecting students’ decisions to apply to podiatric medical school in the first place. Methods: I reviewed the existing literature on the current state of the podiatric medical profession in the United States, with attention to enrollment rates in podiatric medical schools during the past decade. Results: There are limited definitive data, and those displayed herein come from the American Association of Colleges of Podiatric Medicine and other organizations. The data suggest a steady decline in applicants to US podiatric medical schools during the past decade. Conclusions: The reasons for this decline are multifactorial and include problems extrinsic to the profession, such as a declining US birth rate, as well as problems within the profession, most of which are now easily discoverable through Internet searches and research. The issue of lack of plenary licensure, the inconsistent salary data, and in-fighting among the various boards that exist within the profession seem to be major factors that may be perceived as negative influences in choosing a career in podiatric medicine. Full article

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Salvage Surgery with Iliac Wing Autograft Following Total Calcanectomy for Calcaneal Chondrosarcoma. A Case Report

by Mustafa Alper Incesoy, Amrah Farhadov, Gokcen Gundogdu Unverengil and Volkan Gurkan

J. Am. Podiatr. Med. Assoc. 2025, 115(4), 24129; https://doi.org/10.7547/24-129 - 1 Jul 2025

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Abstract

Primary malignancies originating in the calcaneus are rare, constituting fewer than 1% of skeletal tumors. Traditional approaches like amputation, though effective, result in significant morbidity. This study presents a case of a 32-year-old male with calcaneal chondrosarcoma, managed with total calcanectomy and subsequent [...] Read more.

Primary malignancies originating in the calcaneus are rare, constituting fewer than 1% of skeletal tumors. Traditional approaches like amputation, though effective, result in significant morbidity. This study presents a case of a 32-year-old male with calcaneal chondrosarcoma, managed with total calcanectomy and subsequent limb salvage through iliac wing autograft reconstruction. The decision for reconstruction considered tumor characteristics, patient factors, and feasibility of reconstruction methods. Successful recovery and functional outcomes were achieved without evidence of recurrence during the 67-month follow-up. The use of autogenous iliac bone graft demonstrated its suitability for structural reconstruction, emphasizing limb-sparing options in calcaneal chondrosarcomas. Full article

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Immediate Effects of Wearing Compression and Textured Materials on Plantar Tactile Sensitivity, Balance, and Mobility in Community-Dwelling Older Adults

by Sevim Beyza Olmez, Tugce Coban and Selda Basar

J. Am. Podiatr. Med. Assoc. 2025, 115(4), 24096; https://doi.org/10.7547/24-096 - 1 Jul 2025

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Abstract

Background: Evidence suggests that lower-limb stimulation strategies are designed to enhance somatosensory feedback by stimulating the plantar receptors. However, previous studies have focused on only a single sensory stimulation strategy in older adults. Combining two stimulation strategies might produce better results by boosting [...] Read more.

Background: Evidence suggests that lower-limb stimulation strategies are designed to enhance somatosensory feedback by stimulating the plantar receptors. However, previous studies have focused on only a single sensory stimulation strategy in older adults. Combining two stimulation strategies might produce better results by boosting the sensorimotor signals in older adults. Therefore, the aim of this study was twofold: first, to investigate the effects of the combined use of compression stockings and textured insoles on plantar touch sensitivity, balance, and mobility and to compare these results with each intervention applied separately and with a control intervention; second, to examine whether there was an improvement in plantar touch sensitivity compared with baseline. Methods: This study assessed plantar tactile sensitivity, balance, and mobility in 24 communitydwelling older adults (mean age, 72.4 ± 6.3 years) under four interventions: 1) compression sockswith textured insoles, 2) compression sockswith smooth insoles, 3) smooth socks with textured insoles, and 4) smooth socks with smooth insoles (control), all in the standard shoe. The Friedman test or repeatedmeasures analysis of variance was used to compare results. Results: Each intervention had similar plantar tactile sensitivity, balance, and mobility parameters (P > 0.05). However, it was determined that only wearing compression socks caused an improvement in plantar tactile sensitivity compared with baseline (P < 0.05). Conclusions: Compression socks could be beneficial in increasing somatosensory feedback in older adults, as compression socks increase plantar tactile sensitivity more than textured insoles. Full article

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Fibrolipomatous Hamartoma Involving the Tibial Nerve. A Case Report

by Ryan G. Chiu, Jasmina Solankee, Faraaz Azam, Carson Gundlach, Srivats Srinivasan, Haibi Cai and Russell Payne

J. Am. Podiatr. Med. Assoc. 2025, 115(4), 24078; https://doi.org/10.7547/24-078 - 1 Jul 2025

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Abstract

Fibrolipomatous hamartomas (FLHs) are rare pathologies almost exclusively involving the median nerve. Rarer is extra-median involvement of FLH, especially in nerves outside of the upper extremity. In this case report, we detail the case of a 48-year-old male with FLH involving his right [...] Read more.

Fibrolipomatous hamartomas (FLHs) are rare pathologies almost exclusively involving the median nerve. Rarer is extra-median involvement of FLH, especially in nerves outside of the upper extremity. In this case report, we detail the case of a 48-year-old male with FLH involving his right tibial nerve—the first in reported literature in this nerve distribution to our knowledge— and perform a review of the existing case reports on extra-median FLH within the English-based literature. Full article

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Toe Walking Tool. Translation and Cross-Cultural Adaptation in a Greek Pediatric Population

by Eleni Skarmoutsou, Theofani Bania, Eleni Potamiti, Dimitra Tsouni, Panagiota Panagaki, Athina Koulosousa, Efstratia Kalamvoki and Evdokia Billis

J. Am. Podiatr. Med. Assoc. 2025, 115(4), 24068; https://doi.org/10.7547/24-068 - 1 Jul 2025

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Abstract

Background: The Toe Walking Tool is used to highlight the need for further investigation of toe-walking children by a more qualified expert. Such a tool is not yet available within Greek clinical settings. Therefore, the aim of this study was to translate and [...] Read more.

Background: The Toe Walking Tool is used to highlight the need for further investigation of toe-walking children by a more qualified expert. Such a tool is not yet available within Greek clinical settings. Therefore, the aim of this study was to translate and cross-culturally adapt into Greek the Toe Walking Tool. Methods: The Toe Walking Tool was translated into Greek according to international guidelines by five pediatric physiotherapists, all fluent in the English language. Fifteen children with toe-walking due to pathologic reasons or idiopathic toe-walking were video-recorded performing the tasks and tests of the tool. Parents answered the questions regarding the children’s medical history. Seven pediatric physiotherapists evaluated the 15 children using the video recordings and the parents’ answers to complete the tool. Data were analyzed with Fleiss k , percentage agreement, and x² tests. Face and content validity was determined by a group of experts. Results: The Greek version of the Toe Walking Tool proved to be clinically applicable and user-friendly. The tool was also found to have substantial intrarater reliability, with a Fleiss k index of 0.73. The percentage agreement between the seven raters was high to very high, ranging from 86% to 100%, and no statistical differences were found between the raters (P < .1). Conclusions: The Greek version of the Toe Walking Tool demonstrated adequate evidence of interrater reliability and can be used to refer, if required, toe-walking children for further investigation. (J Am Podiatr Med Assoc 115(4), 2025; doi:10.7547/24-068) Full article

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Optimal Guidewire Starting Position for Medial Column Intramedullary Fixation. A Cadaver Study

by Dominick Casciato, Ross Groeschl and Robert Mendicino

J. Am. Podiatr. Med. Assoc. 2025, 115(4), 24059; https://doi.org/10.7547/24-059 - 1 Jul 2025

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Abstract

Background: Insertion of medial column intramedullary fixation during Charcot reconstruction relies on proper guidewire placement in preparation for reaming to optimize endosteal purchase. Although fluoroscopy and jigs assist with wire placement, no anatomical relationship between the center of the intramedullary canal and metatarsal [...] Read more.

Background: Insertion of medial column intramedullary fixation during Charcot reconstruction relies on proper guidewire placement in preparation for reaming to optimize endosteal purchase. Although fluoroscopy and jigs assist with wire placement, no anatomical relationship between the center of the intramedullary canal and metatarsal head or base has been described, which this cadaver study aimed to identify. Methods: The first metatarsals from ten fresh-frozen cadavers were dissected. The height and width of the first metatarsal head and base as well as length were measured with digital calipers. Each metatarsal was placed in a three-dimensional printed gantry, where radiographs were taken. Image analysis software was used to identify the relationship between the metatarsal head and base and the center of the intramedullary canal. Results: Metatarsals fromsix male and four female cadavers with an age of 68.6 ± 15.14 years were assessed. Metatarsal length was 62.71 ± 5.54 mm. The center point was 51.12 ± 3.51% and 66.8565.09%the height of themetatarsal head and base, respectively, with the inferior cortex as reference.Moreover, the center point was 53.40 ± 6.26%and 52.63 ± 2.90% the width of themetatarsal head and base, respectively, with the lateral cortex as reference. Longer metatarsals correlated withmore superior base starting positions (r = 0.74; P = .02). Conclusions: Guidewire entry should be slightly superior and medial to the center of the first metatarsal head and directed proximally toward the superior third of the metatarsal base. These findings may assist with surgical technique and instrument design. (J Am Podiatr Med Assoc 115(4), 2025; doi:10.7547/24-059) Full article

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Primary Osteochondral Autograft Transfer for the Treatment of Cystic Osteochondral Lesions of the Talus

by Yusuf Onur Kızılay and Murat Kezer

J. Am. Podiatr. Med. Assoc. 2025, 115(4), 24052; https://doi.org/10.7547/24-052 - 1 Jul 2025

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Abstract

Background: The need for intra-articular osteotomy and potential complications at the donor site may lead some surgeons to avoid using the osteochondral autograft transfer method as a primary surgery, instead considering it a revision procedure for osteochondral lesions of the talus. In this [...] Read more.

Background: The need for intra-articular osteotomy and potential complications at the donor site may lead some surgeons to avoid using the osteochondral autograft transfer method as a primary surgery, instead considering it a revision procedure for osteochondral lesions of the talus. In this retrospective study, we hypothesized that the primary application of osteochondral autograft transfer in cystic talar osteochondral lesions would yield good results and intra-articular osteotomy and donor site would not have a negative effect on long-term clinical outcomes. The primary objective of this study was to demonstrate that osteochondral autograft transfer can be safely applied as a primary treatment for cystic talar osteochondral lesions. Methods: In our study, 21 patients underwent primary osteochondral autograft transfer for cystic talar osteochondral lesions. Demographic data of patients, including age, gender, and body mass index, as well as duration of symptoms, etiology of the lesion, location of the lesion, and follow-up duration were recorded from our medical records. The clinical evaluation used the visual analog scale for pain, function, and satisfaction along with the American Orthopaedic Foot & Ankle Society score. In addition, the magnetic resonance observation of cartilage repair tissue scale was used for evaluation of graft healing. Results: The mean follow-up time was 32 months. According to the results of the study, compared with the preoperative status, statistically significant improvement was observed in visual analog scale pain, function, and satisfaction scores as well as in the American College of Foot and Ankle Surgeons score. In addition to these findings, it was observed that there was no negative effect of intra-articular osteotomy and donor site on long-term results. Conclusions: Our study showed that osteochondral autograft transfer can be safely applied as primary surgery in cystic talar osteochondral lesions. (J Am Podiatr Med Assoc 115(4), 2025; doi:10.7547/24-052) Full article

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Adolescent Feet Are Not Small Adult Feet. Arch Height Index Values Are Population-Specific

by Claire McKeone, Micah C. Garcia, Jeffery A. Taylor-Haas, Jason T. Long, Mitchell J. Rauh, Kevin R. Ford, Shelby Peel and David M. Bazett-Jones

J. Am. Podiatr. Med. Assoc. 2025, 115(4), 24045; https://doi.org/10.7547/24-045 - 1 Jul 2025

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Background: Many arch structure classification methods exist, but arch structure may be influenced by factors such as age and physical activity. It is unknown if previous arch structure classifications from adult populations are appropriate for adolescents. The purpose of our study was to [...] Read more.

Background: Many arch structure classification methods exist, but arch structure may be influenced by factors such as age and physical activity. It is unknown if previous arch structure classifications from adult populations are appropriate for adolescents. The purpose of our study was to compare arch structure classifications between adolescent-specific and previously published classification systems. Methods: We enrolled 141 uninjured adolescents who participated in long-distance running activities. We measured arch height index (AHI) for both feet in seated and standing positions and classified arch structure as cavus, rectus, or planus.We calculated kappa and percent agreement to compare arch structure classification for our participants with previously published classifications. We performed one-sample t tests to compare mean AHI values from our participants with previously published values. We performed Pearson correlation and percent agreement for arch structure classification for AHImeasured in seated and standing for our participants. Results: We observed no to weak and unacceptable agreement (k = −0.008 to 0.702; P < .001 to .77; 29–72%) for seated and standing AHI between our classification and most prior classifications. Our seated and standing mean AHI values differed from most prior studies (P < .001 to .99; d = 0.00–1.52). We observed a very large positive correlation (r = 0.90; P < .001) with moderate and acceptable classification agreement (k = 0.641; P < .001; 83%) between mean AHI values measured in seated and standing positions. Conclusions: Arch structure classification varied based on classification system and showed poor agreement between most previously reported classification systems. Mean AHI values were significantly different for adolescent runners in our study compared with most previously reported mean values. Researchers and clinicians may classify arch structure in a seated or standing position if position-specific criteria are applied. Special care should be taken before extrapolating classification systems originating from populations with different characteristics, such as age, sport participation, and health status. (J Am Podiatr Med Assoc 115(4), 2025; doi:10.7547/24-045) Full article

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Open AccessArticle

Total Ankle Arthroplasty Medial Malleolus Fractures and Use of Prophylactic Screw

by Bryanna D. Vesely, Lindsay Lesavage, Matthew A. King and Aaron T. Scott

J. Am. Podiatr. Med. Assoc. 2025, 115(4), 23143; https://doi.org/10.7547/23-143 - 1 Jul 2025

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Abstract

Background: Ankle arthritis is a debilitating condition that negatively impacts a patient’s quality of life. The total ankle arthroplasty procedure continues to gain traction as a viable treatment option for end-stage ankle arthritis that has failed conservative treatment. Although newer total ankle models [...] Read more.

Background: Ankle arthritis is a debilitating condition that negatively impacts a patient’s quality of life. The total ankle arthroplasty procedure continues to gain traction as a viable treatment option for end-stage ankle arthritis that has failed conservative treatment. Although newer total ankle models have shown improvement in complications and survivorship, intraoperative and postoperative medial malleolus fractures continue to be a concern. Methods: We created two novel radiographic measurements of the bone bridge between the total ankle prosthesis and the tibial cortex. Using 72 patients, we analyzed the correlation between the bone bridge and intraoperative and postoperative fractures. Results: We found patients with no fractures had a larger transverse and short bone bridge (12.67 + 2.93 and 11.24 + 2.7 mm, respectively) compared with patients who experienced an intraoperative or postoperative medial malleolus fracture. Although patients who received a prophylactic screw had a bone bridge that was over 4 mm smaller compared with the group with no fractures, it was successful in preventing further fractures. Conclusions: We recommend that the surgeon consider placement of a prophylactic screw in patients with a transverse bone bridge of 12 mm or short bone bridge of 10 mm. (J Am Podiatr Med Assoc 115(4), 2025; doi:10.7547/23-143) Full article

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A Rare Lower-Extremity Presentation of Multifocal Motor Neuropathy (MMN) Prior to Upper-Extremity Involvement. A Case Study

by J. Adrian Wright, Grayson Catherwood, Christian Vanni and Julia Tanaka

J. Am. Podiatr. Med. Assoc. 2025, 115(4), 23139; https://doi.org/10.7547/23-139 - 1 Jul 2025

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Abstract

Multifocal motor neuropathy (MMN) is a rare motor neuron condition that typically presents as asymmetric muscular dystrophy to the distal upper extremities. As an autoimmune disorder, it is hypothesized that the presence of anti-ganglioside-monosialic acid 1 (anti-GM1) antibodies results in demyelination of axons, [...] Read more.

Multifocal motor neuropathy (MMN) is a rare motor neuron condition that typically presents as asymmetric muscular dystrophy to the distal upper extremities. As an autoimmune disorder, it is hypothesized that the presence of anti-ganglioside-monosialic acid 1 (anti-GM1) antibodies results in demyelination of axons, propagating symptoms of MMN. Intravenous immunoglobulin infusions have proven effective in restoring muscle tone and function if administered at early onset of the disease symptoms. Although uncommon, MMN can also affect the distal lower extremities. In this study, we present a female patient with muscle atrophy and general weakness to her right lower extremity prior to developing similar symptoms to her left upper extremity. Due to this very uncommon presentation, the pathology was identified late in the progression of the disease. The delay in treatment resulted in a permanent reduction in muscle tone and function in the right lower extremity. To the best of the authors’ knowledge, such a finding has not been reported in the current literature, prompting the need for awareness of a truly uncommon presentation of an already uncommon condition. Full article

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Open AccessArticle

Machine Learning for Predicting Amputation and Mortality Risk in Diabetic Foot Syndrome Patients

by Ali Yüce

J. Am. Podiatr. Med. Assoc. 2025, 115(4), 23137; https://doi.org/10.7547/23-137 - 1 Jul 2025

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Retrospective Review Evaluating the Relationship Between Radiographic Calcaneal Fat Pad Thickness and Plantar Fasciitis

by Elizabeth Bonarigo, Ashwin Easow, Steven Cohen, Waleed Faruqi and Austin Carbone

J. Am. Podiatr. Med. Assoc. 2025, 115(4), 23126; https://doi.org/10.7547/23-126 - 1 Jul 2025

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Abstract

Background: Chronic degeneration of the plantar fascia at its insertion on the plantar calcaneus, known as plantar fasciitis (PF), is the most common cause of heel pain in adults. The calcaneal fat pad (CFP) is a structure superficial to the plantar fascia and [...] Read more.

Background: Chronic degeneration of the plantar fascia at its insertion on the plantar calcaneus, known as plantar fasciitis (PF), is the most common cause of heel pain in adults. The calcaneal fat pad (CFP) is a structure superficial to the plantar fascia and calcaneus, serving a critical purpose in shock absorption at heel strike during gait. To our knowledge, the radiographic relationship between the thickness of the CFP and PF has never been evaluated. The purpose of this study was to determine if there is a relationship between the thickness of the CFP, as measured on weightbearing lateral radiographs, and the incidence of PF. Methods: This was a comparative retrospective analysis between a study cohort and a control group performed at our facility. The study cohort consisted of patients diagnosed with PF, whereas the control group consisted of patients who had no known history of PF. All patients involved in this study had weightbearing lateral foot radiographs taken and met study inclusion and exclusion criteria. The CFP thickness of the study participants was measured using the ruler tool in the AccuVueCloud radiography software. Results: The study cohort consisted of ten patients and the average of the radiographic measurements obtained was 0.808 cm, whereas the control group consisted of ten patients and the average of the radiographic measurements obtained was 1.091 cm. A t test was then conducted to determine if there was a significant difference between the means of the two groups, and the results produced a P value of 0.0045. Conclusions: When diagnosing PF, radiographs are typically the first imaging modality used, but prior to our study, they lacked diagnostic practicality. Our study suggests that there is a relationship between CFP thickness and the incidence of PF that can be examined using weightbearing lateral radiographs. (J Am Podiatr Med Assoc 115(4), 2025; doi:10.7547/23-126) Full article

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Investigation of the Immediate Effects of Kinesiology Taping and Manual Release on Lower-Extremity Performance in Young Adults With Pes Planus. A Double-Blind Randomized Controlled Trial

by Tugba Ulusoy and Ertugrul Demirdel

J. Am. Podiatr. Med. Assoc. 2025, 115(4), 23125; https://doi.org/10.7547/23-125 - 1 Jul 2025

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Abstract

Background: Pes planus is a common postural deformity in young adults characterized by decreased medial longitudinal arch height. Supporting the overstretched plantar fascia, reducing pain by loosening the plantar fascia, and increasing medial longitudinal arch support are the main treatment goals in pes [...] Read more.

Background: Pes planus is a common postural deformity in young adults characterized by decreased medial longitudinal arch height. Supporting the overstretched plantar fascia, reducing pain by loosening the plantar fascia, and increasing medial longitudinal arch support are the main treatment goals in pes planus. The present study aimed to investigate the immediate effects of kinesiology taping and manual release techniques on lower-extremity performance in young adults with pes planus and to determine whether there is a difference between these two interventions. Methods: Forty individuals with pes planus were included in the study. The individuals were randomly divided into two groups: kinesiology taping (n = 20) and manual release (n = 20). Functional mobility was assessed with timed up and go test, balance with functional reach test, gait with 10-m walk test, and muscle endurance with heel raise test. The kinesiology taping group was evaluated at baseline and 45 min after the intervention and the manual release group was evaluated at baseline and after the intervention. Results: Demographic and clinical characteristics of the groups were similar (P > .05). Functional mobility, walking time, and endurance improved significantly in both groups (P < .05), whereas there was no change in balance (P > .05). Improvement in functional mobility was greater in the manual release group than the kinesiology taping group (P < .05). Conclusions: Kinesiology taping and manual release are both immediately effective for endurance, functional mobility, and gait in young adults with pes planus. These interventions can be included in the rehabilitation program of pes planus treatment for more successful results. (J Am Podiatr Med Assoc 115(4), 2025; doi:10.7547/23-125) Full article

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A Surgical Decision-Making Algorithm for Reconstruction of Charcot Neuroarthropathy. A Case Series

by Dominick Casciato, Korey DuBois, Roberto Brandao and Jacob Wynes

J. Am. Podiatr. Med. Assoc. 2025, 115(4), 23120; https://doi.org/10.7547/23-120 - 1 Jul 2025

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Abstract

Surgical reconstruction of the foot and ankle following degenerative changes secondary to Charcot neuroarthropathy poses a challenge due to both soft-tissue and osseous deformity. As a limb salvage procedure, this article aims to address such deformity with the goal of returning to a [...] Read more.

Surgical reconstruction of the foot and ankle following degenerative changes secondary to Charcot neuroarthropathy poses a challenge due to both soft-tissue and osseous deformity. As a limb salvage procedure, this article aims to address such deformity with the goal of returning to a braceable limb without subsequent ulceration and infection. As this disease process affects both bone and soft tissue, surgical reconstruction should be directed to address osseous and ligamentous deformities that may contribute to postoperative failure. We present an algorithm to eliminate deforming forces, identify and stabilize at-risk and damaged anatomy, and stabilize the ankle joint to reduce the risk of postoperative progression to Charcot collapse of the ankle joint in individuals with midfoot Charcot neuroarthropathy. In conjunction with a multidisciplinary infection, perfusion, and bone metabolism assessment, this algorithm serves as comprehensive tool to evaluate and reconstruct midfoot Charcot collapse. Full article

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Open AccessArticle

Comparative Analysis of Rate of Recurrence Using Sodium Hydroxide versus Phenol for Chemical Matrixectomies of Toenails

by Sindhu Srinivas, Jaclyn D. Wessinger, Ellianne Nasser, Sarah Strickland and Idorenyin F. Udoeyo

J. Am. Podiatr. Med. Assoc. 2025, 115(4), 23099; https://doi.org/10.7547/23-099 - 1 Jul 2025

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Abstract

Background: Chemical matrixectomy using acidic phenol or alkaline sodium hydroxide (NaOH) is indicated when prevention of toenail growth is preferred. The literature reports outcomes for phenol and NaOH independently; however, no studies are found to compare recurrence rates. This study evaluates the efficacy [...] Read more.

Background: Chemical matrixectomy using acidic phenol or alkaline sodium hydroxide (NaOH) is indicated when prevention of toenail growth is preferred. The literature reports outcomes for phenol and NaOH independently; however, no studies are found to compare recurrence rates. This study evaluates the efficacy of these chemicals in preventing nail growth recurrence while analyzing whether age, sex, and body mass index contribute to regrowth after chemical matrixectomy. Methods: From July 1, 2019, to July 1, 2021, data were obtained for toenail removal procedures that include Current Procedural Terminology codes 11730, 11750, and 11732 and corresponding International Classification of Diseases, Tenth Revision code S61.309A. Results: Descriptive statistical analyses were conducted on 138 patients who underwent partial or total chemical matrixectomy. A x² test, a Fisher exact test, and an independent two-sample test were used to compare health and demographic characteristics on only patients who underwent a chemical matrixectomy (n = 58), evaluating differences between NaOH and phenol. The mean patient age was 43.2 years. Most patients (72%) did not have a previous revision. Approximately 54% of patients underwent partial nail avulsions without chemical matrixectomies versus 44% who had chemical matrixectomies. No statistically significant differences were found between groups. Comparison of recurrence rates did not demonstrate a statistically significant difference between NaOH and phenol. No association was found between nail growth recurrence and age. Conclusion: Further investigation into application times, technique, and severity of deformity may provide further insight into factors leading to recurrence. (J Am Podiatr Med Assoc 115(4), 2025; doi:10.7547/23-099) Full article

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A Retrospective Review of Soft-Tissue Complications in Total Talus Replacement and Total Ankle Replacement Using the Orthoplastic Anteromedial Approach

by Guido A. LaPorta, Lauren L. Schnack, Maria Begum, Eli A. Yates, Stephanie Oexeman and Edgardo R. Rodriguez-Collazo

J. Am. Podiatr. Med. Assoc. 2025, 115(4), 23090; https://doi.org/10.7547/23-090 - 1 Jul 2025

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Abstract

Background: The anterior approach to the ankle addresses many pathologies. The orthoplastic anteromedial incisional approach to the ankle courses between the anterior tibial and posterior tibial angiosomes. There are various modalities that can be used in evaluating the integrity of these angiosomes before [...] Read more.

Background: The anterior approach to the ankle addresses many pathologies. The orthoplastic anteromedial incisional approach to the ankle courses between the anterior tibial and posterior tibial angiosomes. There are various modalities that can be used in evaluating the integrity of these angiosomes before surgical intervention. Methods: A retrospective review of 23 patients using the anteromedial ankle approach in either total talus replacement or total ankle replacement was performed from January 1, 2016, through August 31, 2021. Surgical intervention occurred from January 29, 2016, through January 10, 2019, and follow-up was through August 2021. Results: Patients were evaluated based on medical history, postoperative week of suture or staple removal, incision complications, and time at which full weightbearing began. Smoking history was also documented. Eighteen patients healed uneventfully, and some of these patients had a smoking history, a history of type 2 diabetes mellitus, or both. Conclusion: A preoperative evaluation of vascular supply is necessary to determine the healing potential of this approach. Atraumatic handling of the soft-tissue envelope is imperative to aid in wound healing and optimize the postoperative course. The orthoplastic anteromedial ankle incisional approach is a possible alternative option for an anterior ankle incision if adequate vascular status is determined to be present before surgical intervention. (J Am Podiatr Med Assoc 115(4), 2025; doi:10.7547/23-090) Full article

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Open AccessArticle

Sodium Hydroxide versus Phenol Chemical Matrixectomy. A Comparative Retrospective Medical Record Review

by Clark K. Brackney, Jennifer A. Kipp, Gregory Russell, Cody D. Blazek, Nicholas S. Powers and Ashleigh W. Medda

J. Am. Podiatr. Med. Assoc. 2025, 115(4), 23081; https://doi.org/10.7547/23-081 - 1 Jul 2025

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Abstract

Background: Chemical matrixectomy (CM) is a common procedure to correct painful and ingrown toenails. At our institution, CMs are often performed with either sodium hydroxide (NaOH) or phenol as the chemical agent for germinal nail matrix destruction. The primary aim of this study [...] Read more.

Background: Chemical matrixectomy (CM) is a common procedure to correct painful and ingrown toenails. At our institution, CMs are often performed with either sodium hydroxide (NaOH) or phenol as the chemical agent for germinal nail matrix destruction. The primary aim of this study was to evaluate the recurrence and reoperation rates for this procedure using different chemical agents. Methods: The medical records of 192 patients during a 2-year period were reviewed. All of the CMs were performed in a standard fashion by three podiatric physicians. Results: Among phenol partial nail avulsions, 46 nail border removals were performed. Among NaOH partial nail avulsions, 258 nail borders were treated. Mean follow-up was 93 days (median, 17 days). Among partial nail avulsions, the mean reoperation rate per border for CM with phenol was 6.5%. In comparison, the reoperation rate for CM with NaOH was 7.8% (P = .89), indicating that there is no statistically significant difference in reoperation rates between these two chemicals. The mean recurrence of painful nail edge rate per border for CM with phenol was 10.9%. In contrast, with NaOH this rate was 8.1% (P = .58), indicating that there was no statistically significant difference in the rate of development of recurrent painful nail borders between the two procedures. Conclusions: This retrospective medical record review demonstrated little difference between these chemicals in their reoperation and recurrence rates. (J Am Podiatr Med Assoc 115(4), 2025; doi:10.7547/23-081) Full article

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Open AccessArticle

Cuboid Cobbles Hinder Elite Youth Football Player

by Jari Dahmen, Sjoerd A.S. Stufkens, Miki Dalmau-Pastor, Mario Maas and Gino M.M.J. Kerkhoffs

J. Am. Podiatr. Med. Assoc. 2025, 115(4), 23080; https://doi.org/10.7547/23-080 - 1 Jul 2025

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Abstract

We describe an elite youth football player who developed lateral foot pain of previously unknown origin. A thorough patient history and physical examination, as well as an in-depth presentation of radiographic findings on computed tomography and magnetic resonance imaging scans were performed. Through [...] Read more.

We describe an elite youth football player who developed lateral foot pain of previously unknown origin. A thorough patient history and physical examination, as well as an in-depth presentation of radiographic findings on computed tomography and magnetic resonance imaging scans were performed. Through this combination, the puzzle was resolved and a rare peroneus longus tendinopathy due to bony spurs in the cuboid groove was diagnosed. A peroneus longus exploration and release and reduction of the cuboidal bone spurs were performed, and an intensive rehabilitation phase followed. The patient successfully returned to performance and set a career in professional football. Full article

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Hammertoe Deformity Caused by a Soft-Tissue Chondroma. A Rare Case Report

by Devon Niewohner, Bryanna D. Vesely, Paula Gangopadhyay, Haiyan Lu and Heath Blankenship

J. Am. Podiatr. Med. Assoc. 2025, 115(4), 23071; https://doi.org/10.7547/23-071 - 1 Jul 2025

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Abstract

Hammertoe deformities are common pathologies treated in podiatry clinics and are most often associated with tendon imbalances. In this case study, we present the case of a 41-year-old patient with soft-tissue chondroma being the cause of a rigid deformity. We describe the surgical [...] Read more.

Hammertoe deformities are common pathologies treated in podiatry clinics and are most often associated with tendon imbalances. In this case study, we present the case of a 41-year-old patient with soft-tissue chondroma being the cause of a rigid deformity. We describe the surgical technique used to remove and treat the hammertoe. Full article

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Open AccessArticle

Relevancy Grading of Outcome-Predicting Factors After Distal Chevron Osteotomy for Hallux Valgus Correction

by Franz Endstrasser, Gerhard Kaufmann, Moritz Wagner, Dietmar Dammerer, Michael Liebensteiner, Hanno Ulmer and Matthias Braito

J. Am. Podiatr. Med. Assoc. 2025, 115(4), 23062; https://doi.org/10.7547/23-062 - 1 Jul 2025

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Abstract

Background: The purpose of this study was to identify radiographic risk factors for loss of correction (LOC) after hallux valgus surgery and to weight their importance for LOC. Full article

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Relationship Between Foot Kinematics and Center of Pressure Trajectory During Gait in Individuals with Flatfoot

by Wataru Kawakami, Yoshitaka Iwamoto, Yasutaka Takeuchi, Ryosuke Takeuchi, Junpei Sekiya, Yosuke Ishii and Makoto Takahashi

J. Am. Podiatr. Med. Assoc. 2025, 115(4), 23050; https://doi.org/10.7547/23-050 - 1 Jul 2025

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Abstract

Background: Flatfoot causes the medial shift of ground reaction force during the stance phase of gait, which is associated with various foot disorders. To prevent this shift in flatfoot, it is necessary to understand the characteristics of the loading pattern and what foot [...] Read more.

Background: Flatfoot causes the medial shift of ground reaction force during the stance phase of gait, which is associated with various foot disorders. To prevent this shift in flatfoot, it is necessary to understand the characteristics of the loading pattern and what foot joint kinematics influence it. We investigated differences in the center of pressure (COP) position between normal foot and flatfoot, and predictors of COP trajectory during gait. Full article

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Open AccessArticle

Reoperation and Reamputation Rates After Hallux Amputations versus Partial First-Ray Amputations

by Bryanna D. Vesely, Jennifer Kipp, Madeline R. Fram, Hayden Hoffler, Gregory Russell, Nicholas S. Powers, Ashleigh W. Medda and Cody D. Blazek

J. Am. Podiatr. Med. Assoc. 2025, 115(4), 23033; https://doi.org/10.7547/23-033 - 1 Jul 2025

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Abstract

Background: Foot infections are a common condition that foot and ankle providers treat. For patients who require an amputation, surgeons must decide what level of amputation to perform based on the extent of infection, soft-tissue viability, and the biomechanics of the foot. Although [...] Read more.

Background: Foot infections are a common condition that foot and ankle providers treat. For patients who require an amputation, surgeons must decide what level of amputation to perform based on the extent of infection, soft-tissue viability, and the biomechanics of the foot. Although the literature has shown the high risk of repeated ulceration and amputation after a foot ulcer, there has been little published comparing partial first-ray amputation with hallux amputation. Full article

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Open AccessArticle

Comparison of Satisfaction with Below- and Above-the-Knee Prostheses in Patients with Amputation Due to Diabetic Foot

by Yavuz Aslan, Suat Batar and Abdul Fettah Buyuk

J. Am. Podiatr. Med. Assoc. 2025, 115(4), 23026; https://doi.org/10.7547/23-026 - 1 Jul 2025

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Abstract

Background: Diabetes mellitus is a very common medical condition with many macrovascular and microvascular complications. Neuropathy and peripheral vascular disease with external trauma are the main factors of foot ulcers in a diabetic patient. We aimed to investigate the aesthetic, weight, and functional [...] Read more.

Background: Diabetes mellitus is a very common medical condition with many macrovascular and microvascular complications. Neuropathy and peripheral vascular disease with external trauma are the main factors of foot ulcers in a diabetic patient. We aimed to investigate the aesthetic, weight, and functional satisfaction of prosthesis use depending on the level of amputation. Full article

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Open AccessArticle

The Impact of Postural and Anthropometric Properties of the Foot and Ankle on the Physical Performance and Ambulation of Patients with Duchenne Muscular Dystrophy

by Güllü Aydın-Yağcıoğlu, Numan Bulut, İpek Alemdaroğlu-Gürbüz and Öznur Tunca

J. Am. Podiatr. Med. Assoc. 2025, 115(4), 23012; https://doi.org/10.7547/23-012 - 1 Jul 2025

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Abstract

Background: Abnormal foot anthropometry and posture of patients with Duchenne muscular dystrophy (DMD) can be considered as possible risk factors for performance and ambulation. We aimed to examine the effects of foot posture and anthropometric characteristics, which deteriorated from the early period, on [...] Read more.

Background: Abnormal foot anthropometry and posture of patients with Duchenne muscular dystrophy (DMD) can be considered as possible risk factors for performance and ambulation. We aimed to examine the effects of foot posture and anthropometric characteristics, which deteriorated from the early period, on the ambulation and performance of patients with DMD. Full article

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Open AccessArticle

Complications of Circular Ring External Fixation of the Foot and Ankle

by Cody D. Blazek, Nicholas S. Powers, Paul R. Leatham and Patrick R. Burns

J. Am. Podiatr. Med. Assoc. 2025, 115(4), 22228; https://doi.org/10.7547/22-228 - 1 Jul 2025

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Abstract

Background: Circular ring external fixation has been found to be successful in the treatment of a wide range of foot and ankle pathologies, particularly in patients with multiple comorbidities and soft-tissue compromise, but the procedures are technically demanding, and complications are common. The [...] Read more.

Background: Circular ring external fixation has been found to be successful in the treatment of a wide range of foot and ankle pathologies, particularly in patients with multiple comorbidities and soft-tissue compromise, but the procedures are technically demanding, and complications are common. The primary goal of this study was to identify complications associated with circular ring external fixation, and the secondary aim was to identify any independent risk factors associated with them. Full article

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A Rare Case of Adolescent Subungual Osteochondroma of the Hallux

by Kerry Clark

J. Am. Podiatr. Med. Assoc. 2025, 115(4), 22117; https://doi.org/10.7547/22-117 - 1 Jul 2025

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Abstract

A 17-year-old male presented with a painful subungual mass, which was clinically diagnosed as a subungual exostosis prior to surgical referral. Few reported cases of subungual osteochondroma exist in the literature, and those published describe skin or nail deformities resulting from the lesion. [...] Read more.

A 17-year-old male presented with a painful subungual mass, which was clinically diagnosed as a subungual exostosis prior to surgical referral. Few reported cases of subungual osteochondroma exist in the literature, and those published describe skin or nail deformities resulting from the lesion. These deformities can easily be misdiagnosed as subungual exostosis by clinical examination alone. The characteristic findings in this case resulted in a diagnosis of subungual osteochondroma, which was successfully resolved following surgical excision. This report highlights the clinical, radiographic, and histopathologic characteristics of subungual osteochondroma, and differentiates it from subungual exostosis. The results report on the success of a 2-year post-surgical audit of patient-related outcomes. Full article

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J. Am. Podiatr. Med. Assoc., Volume 115, Issue 4 (07 2025) – 28 articles

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