Journal of the American Podiatric Medical Association

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Open AccessArticle

by Lloyd S. Smith

J. Am. Podiatr. Med. Assoc. 2004, 94(6), 611-612; https://doi.org/10.7547/0940611 - 1 Nov 2004

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Being an APMA president presents a unique opportunity to advance our profession, but the tenure is short, and every day brings renewed demands for consistency and determination [...] Full article

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Fractures of the Foot and Ankle

by Stephen J. Miller

J. Am. Podiatr. Med. Assoc. 2004, 94(6), 608; https://doi.org/10.7547/0940608 - 1 Nov 2004

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Edited by George Gumann, DPM. 427 pages, illustrated. Elsevier Saunders, Philadelphia, 2004 [...] Full article

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American Podiatric Medical Association Missing Time Survey, 2004

by Allan H. Fisher

J. Am. Podiatr. Med. Assoc. 2004, 94(6), 604-607; https://doi.org/10.7547/0940604 - 1 Nov 2004

Cited by 2 | Viewed by 42

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A 2004 survey of US adults found that 19% had experienced foot problems at work at some time. As a result, 38% reported lost productivity and 28% missed time at work. Younger, less educated male workers were more likely to suffer from foot [...] Read more.

A 2004 survey of US adults found that 19% had experienced foot problems at work at some time. As a result, 38% reported lost productivity and 28% missed time at work. Younger, less educated male workers were more likely to suffer from foot problems. The percentage of the total population surveyed who missed time at work owing to foot problems was 5.4% in 2004. In a previous survey conducted in 2000, the corresponding percentage was 6.6%. (J Am Podiatr Med Assoc 94(6): 604–607, 2004) Full article

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Open AccessArticle

Transfer of the Peroneus Brevis Tendon After Resection of the Fifth Metatarsal Base

by Jodi Schoenhaus, Richard M. Jay and Harold Schoenhaus

J. Am. Podiatr. Med. Assoc. 2004, 94(6), 594-603; https://doi.org/10.7547/0940594 - 1 Nov 2004

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Abstract

After resection of bone or amputation, postoperative stump breakdown occurs frequently. Furthermore, the altered mechanics with ambulation are difficult to control with bracing and orthoses alone. During the past 10 years, the peroneus brevis tendon has been transferred to various locations in the [...] Read more.

After resection of bone or amputation, postoperative stump breakdown occurs frequently. Furthermore, the altered mechanics with ambulation are difficult to control with bracing and orthoses alone. During the past 10 years, the peroneus brevis tendon has been transferred to various locations in the foot after resection of the fifth metatarsal base in an effort to provide continued balance between the supinatory and pronatory forces needed for a steady gait. In patients who have had a peroneus brevis tendon transfer, the rate of postoperative ulceration and the need for further bony resection is minimal. Analysis of the biomechanical influences and effects of different anatomical placements of the transferred tendon reveals the importance of transfer of the peroneus brevis tendon. (J Am Podiatr Med Assoc 94(6): 594–603, 2004) Full article

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Open AccessArticle

Treatment of Freiberg’s Infraction with the Titanium Hemi-implant

by Alan T. Shih, Richard E. Quint, David G. Armstrong and Brent P. Nixon

J. Am. Podiatr. Med. Assoc. 2004, 94(6), 590-593; https://doi.org/10.7547/0940590 - 1 Nov 2004

Cited by 19 | Viewed by 56

Abstract

Freiberg’s infraction is a relatively rare disease for which there is currently no consensus regarding surgical management. We present a case study describing a surgical procedure that uses a novel metatarsophalangeal hemi-implant. This procedure does not alter the metatarsal parabola, and it allows [...] Read more.

Freiberg’s infraction is a relatively rare disease for which there is currently no consensus regarding surgical management. We present a case study describing a surgical procedure that uses a novel metatarsophalangeal hemi-implant. This procedure does not alter the metatarsal parabola, and it allows for other surgical procedures to be performed in the future. (J Am Podiatr Med Assoc 94(6): 590–593, 2004) Full article

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Open AccessArticle

Accessory Soleus Muscle

by Tuba Karagülle Kendi, Aziz Erakar, Olcay Oktay, H. Yusuf Yildiz and Yener Saglik

J. Am. Podiatr. Med. Assoc. 2004, 94(6), 587-589; https://doi.org/10.7547/0940587 - 1 Nov 2004

Cited by 18 | Viewed by 51

Abstract

Accessory soleus muscle is an uncommon anatomical variant that may present as a soft-tissue mass in the posteromedial region of the ankle. It is congenital in origin but usually presents in the second or third decade of life. Although it is a rare [...] Read more.

Accessory soleus muscle is an uncommon anatomical variant that may present as a soft-tissue mass in the posteromedial region of the ankle. It is congenital in origin but usually presents in the second or third decade of life. Although it is a rare entity, accessory soleus muscle should be included in the differential diagnosis of soft-tissue swelling of the ankle. Awareness of the clinical presentation and specific findings of computed tomography, magnetic resonance imaging, and electromyography help with diagnosis without surgical exploration. We describe a 30-year-old patient with accessory soleus muscle. Magnetic resonance imaging features of the case are described, and the literature is briefly reviewed. (J Am Podiatr Med Assoc 94(6): 587–589, 2004) Full article

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Open AccessArticle

Norwegian Scabies in the Immunocompromised Patient

by Greg Grabowski, Alicia Kanhai, Richard Grabowski, Jean Holewinski and Marie L. Williams

J. Am. Podiatr. Med. Assoc. 2004, 94(6), 583-586; https://doi.org/10.7547/0940583 - 1 Nov 2004

Cited by 10 | Viewed by 73

Abstract

Norwegian, or crusted, scabies can be defined as a generalized severe scabies (Sarcoptes scabiei var. hominis) infestation usually affecting the immunocompromised patient that is most commonly seen with the leukemia-lymphoma group of neoplasms. The diagnosis is commonly missed, which can lead to mismanagement. [...] Read more.

Norwegian, or crusted, scabies can be defined as a generalized severe scabies (Sarcoptes scabiei var. hominis) infestation usually affecting the immunocompromised patient that is most commonly seen with the leukemia-lymphoma group of neoplasms. The diagnosis is commonly missed, which can lead to mismanagement. We describe a patient with Norwegian scabies involving the lower extremities. The patient circumstances and treatment, as well as a review of the literature, are presented. The diagnosis of scabies should always be considered in patients with advanced malignancies and associated pruritus. (J Am Podiatr Med Assoc 94(6): 583–586, 2004) Full article

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Reconstruction of the Great Toe Ski-Slope, Sunken-Nail Deformity with a Buried Adipofascial Flap

by Thomas S. Roukis and Adam S. Landsman

J. Am. Podiatr. Med. Assoc. 2004, 94(6), 578-582; https://doi.org/10.7547/0940578 - 1 Nov 2004

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Abstract

Development of a ski-slope deformity following loss of the great toe nail plate is a problematic condition with few conservative or surgical options available. The condition becomes more difficult to treat when the distal, medial, and lateral labial nail folds are hypertrophied, creating [...] Read more.

Development of a ski-slope deformity following loss of the great toe nail plate is a problematic condition with few conservative or surgical options available. The condition becomes more difficult to treat when the distal, medial, and lateral labial nail folds are hypertrophied, creating the appearance of a sunken nail. We present a case of ski-slope, sunken-nail deformity following multiple attempts at chemical nail matrixectomy. The patient’s persistent pain and deformity were managed through 1) nail plate avulsion and complete surgical excision of the germinal nail matrix, 2) remodeling of the distal phalanx, and 3) elevation of an adipofascial flap from the plantar tuft of the great toe, which was brought from plantar to dorsal and interposed between the dorsal aspect of the distal phalanx and the overlying nail bed in buried fashion. The combination of these procedures elevated the nail bed, which restored normal architecture to the great toe and relieved the pain associated with the chronic deformity. This case demonstrates a potential complication of a commonly performed procedure and a salvage technique useful for dealing with the resultant ski-slope, sunken-nail deformity (J Am Podiatr Med Assoc 94(6): 578–582, 2004) Full article

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Measurement of Foot Dorsiflexion

by Rolf Scharfbillig and Sheila D. Scutter

J. Am. Podiatr. Med. Assoc. 2004, 94(6), 573-577; https://doi.org/10.7547/0940573 - 1 Nov 2004

Cited by 21 | Viewed by 52

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The Lidcombe template was introduced in 1991 for the nonweightbearing assessment of ankle joint dorsiflexion, and it has shown excellent reliability in impaired and unimpaired adult populations. We discuss limitations of the original template and test the reliability of a modified apparatus in [...] Read more.

The Lidcombe template was introduced in 1991 for the nonweightbearing assessment of ankle joint dorsiflexion, and it has shown excellent reliability in impaired and unimpaired adult populations. We discuss limitations of the original template and test the reliability of a modified apparatus in an adolescent population. Intrarater and interrater reliability were assessed for 14 children (28 limbs) aged 7 to 14 years, returning intraclass correlation coefficient (1,1) results of greater than 0.99 for both aspects of reliability. (J Am Podiatr Med Assoc 94(6): 573–577, 2004) Full article

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Low-Voltage Direct Current as a Fungicidal Agent for Treating Onychomycosis

by Douglas P. Kalinowski, Laura E. Edsberg, Robert A. Hewson, Robert H. Johnson and Michael S. Brogan

J. Am. Podiatr. Med. Assoc. 2004, 94(6), 565-572; https://doi.org/10.7547/0940565 - 1 Nov 2004

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Onychomycosis, most commonly caused by two species of dermatophyte fungi—Trichophyton rubrum and Trichophyton mentagrophytes—is primarily treated with regimens of topical and systemic antifungal medications. This study was undertaken to evaluate in vitro the efficacy of low-voltage direct current as an antifungal agent for [...] Read more.

Onychomycosis, most commonly caused by two species of dermatophyte fungi—Trichophyton rubrum and Trichophyton mentagrophytes—is primarily treated with regimens of topical and systemic antifungal medications. This study was undertaken to evaluate in vitro the efficacy of low-voltage direct current as an antifungal agent for treating onychomycosis. Agar plate cultures of T rubrum and T mentagrophytes were subjected to low-voltage direct current electrostimulation, and antifungal effects were observed as zones in the agar around the electrodes lacking fungal growth. Zones devoid of fungal growth were observed for T rubrum and T mentagrophytes around anodes and cathodes in a dose-dependent manner in the current range of 500 μA to 3 mA. Low-voltage direct current electrostimulation has great clinical potential for the treatment of onychomycosis and perhaps other superficial maladies of fungal etiology. (J Am Podiatr Med Assoc 94(6): 565–572, 2004) Full article

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The Effect of 5-Degree Valgus and Varus Rearfoot Wedging on Peak Hallux Dorsiflexion During Gait

by Catherine Smith, Simon K. Spooner and John Alan Fletton

J. Am. Podiatr. Med. Assoc. 2004, 94(6), 558-564; https://doi.org/10.7547/0940558 - 1 Nov 2004

Cited by 8 | Viewed by 52

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The dynamic effects of 5° varus and valgus rearfoot wedging on peak hallux dorsiflexion were investigated in 30 asymptomatic subjects (5 males and 25 females). Statistically significant reductions in peak hallux dorsiflexion were found with rearfoot varus wedging and rearfoot valgus wedging. Furthermore, [...] Read more.

The dynamic effects of 5° varus and valgus rearfoot wedging on peak hallux dorsiflexion were investigated in 30 asymptomatic subjects (5 males and 25 females). Statistically significant reductions in peak hallux dorsiflexion were found with rearfoot varus wedging and rearfoot valgus wedging. Furthermore, the reduction in peak hallux dorsiflexion occurring with rearfoot varus wedging was statistically significant compared with that associated with rearfoot valgus wedging. These findings have implications for the orthotic management of a variety of lower-limb pathologies. (J Am Podiatr Med Assoc 94(6): 558–564, 2004) Full article

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Open AccessArticle

The Histologic Host Response to Liquid Silicone Injections for Prevention of Pressure-Related Ulcers of the Foot

by William Dean Wallace, S. W. Balkin, Leo Kaplan and Scott Nelson

J. Am. Podiatr. Med. Assoc. 2004, 94(6), 550-557; https://doi.org/10.7547/0940550 - 1 Nov 2004

Cited by 18 | Viewed by 49

Abstract

This study analyzed the histologic effects of and host response to subdermally injected liquid silicone to augment soft-tissue cushioning of the bony prominences of the foot. A total of 148 postmortem and surgical specimens of pedal skin with attached soft tissue were obtained [...] Read more.

This study analyzed the histologic effects of and host response to subdermally injected liquid silicone to augment soft-tissue cushioning of the bony prominences of the foot. A total of 148 postmortem and surgical specimens of pedal skin with attached soft tissue were obtained from 49 patients between July 1, 1974, and November 30, 2002. The longest period that silicone was in vivo was 38 years. The specimens were then processed into paraffin blocks and examined for specific findings. The variables considered included distribution of silicone within the tissue, host response, migration to regional lymph nodes, and viability of the host tissue after treatment. The host response to silicone therapy consisted primarily of delicate-to-robust fibrous deposition and histiocytic phagocytosis, with eventual formation of well-formed elliptic fibrous pads. The response in the foot appears different from that in the breast and other areas of the body previously studied. No examples of granulomas, chronic lymphoplasmacytic inflammation, or granulation tissue formation were seen, with only rare foreign-body giant cells present. Silicone injections in fat pads for the treatment of atrophy and loss of viable tissue show a histologically stable and biologically tolerated host response that is effective, with no evidence of any systemic changes. (J Am Podiatr Med Assoc 94(6): 550–557, 2004) Full article

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Open AccessArticle

Effectiveness of Different Types of Foot Orthoses for the Treatment of Plantar Fasciitis

by Karl B. Landorf, Anne-Maree Keenan and Robert D. Herbert

J. Am. Podiatr. Med. Assoc. 2004, 94(6), 542-549; https://doi.org/10.7547/0940542 - 1 Nov 2004

Cited by 55 | Viewed by 104

Abstract

Clinicians often use foot orthoses to manage the symptoms of plantar fasciitis. Although there has been considerable research evaluating the effectiveness of orthoses for this condition, there is still a lack of scientific evidence that is of suitable quality to fully inform clinical [...] Read more.

Clinicians often use foot orthoses to manage the symptoms of plantar fasciitis. Although there has been considerable research evaluating the effectiveness of orthoses for this condition, there is still a lack of scientific evidence that is of suitable quality to fully inform clinical practice. Randomized controlled trials are recognized as the “gold standard” when evaluating the effectiveness of treatments. We discuss why randomized controlled trials are so important, the features of a well-conducted randomized controlled trial, and some of the problems that arise when trial design is not sound. We then evaluate the available evidence for the use of foot orthoses, with particular focus on published randomized controlled trials. From the evidence to date, it seems that foot orthoses do have a role in the management of plantar fasciitis and that prefabricated orthoses are a worthwhile initial management strategy. At this time, however, it is not possible to recommend either prefabricated or customized orthoses as being better, and it cannot be inferred that customized orthoses are more effective over time and therefore have a cost advantage. Additional good-quality randomized controlled trials are needed to answer these questions. (J Am Podiatr Med Assoc 94(6): 542–549, 2004) Full article

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Associations Between Static and Functional Measures of Joint Function in the Foot and Ankle

by James S. Wrobel, John E. Connolly and Michael L. Beach

J. Am. Podiatr. Med. Assoc. 2004, 94(6), 535-541; https://doi.org/10.7547/0940535 - 1 Nov 2004

Cited by 21 | Viewed by 63

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Clinicians have traditionally assessed range of motion of the first metatarsophalangeal and ankle joints in a static position. It is unclear, however, if these measurements accurately reflect functional sagittal plane limitations of these joints during gait. For 50 patients (100 feet), we assessed [...] Read more.

Clinicians have traditionally assessed range of motion of the first metatarsophalangeal and ankle joints in a static position. It is unclear, however, if these measurements accurately reflect functional sagittal plane limitations of these joints during gait. For 50 patients (100 feet), we assessed available dorsiflexion at the first metatarsophalangeal and ankle joints, as well as the presence of pinch callus. We then compared these findings with 11 functional gait parameters, as measured using a pressure sensor system. After adjusting for age, weight, smoking status, glycosylated hemoglobin, and insensitivity to monofilament, we found that patients with pinch callus demonstrated statistically significant compensatory gait patterns in 7 of 11 measures. Hallux limitus and equinus patients demonstrated six and three statistically significant associations, respectively. Pinch callus seems to be as predictive of functional gait alterations as static first metatarsophalangeal joint and ankle dorsiflexion. (J Am Podiatr Med Assoc 94(6): 535–541, 2004) Full article

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A Comparison of Results from Two Mycology Laboratories for the Diagnosis of Onychomycosis: A Study of 85 Cases in a Geriatric Population

by William P. Scherer and Michael D. Scherer

J. Am. Podiatr. Med. Assoc. 2004, 94(6), 528-534; https://doi.org/10.7547/0940528 - 1 Nov 2004

Cited by 7 | Viewed by 53

Abstract

An investigative study was performed to compare the results from two mycology laboratories for the diagnosis of onychomycosis in a geriatric population and to determine the possible pharmacologic treatments based on the two laboratories’ results. In this study, 85 cases of suspected onychomycosis [...] Read more.

An investigative study was performed to compare the results from two mycology laboratories for the diagnosis of onychomycosis in a geriatric population and to determine the possible pharmacologic treatments based on the two laboratories’ results. In this study, 85 cases of suspected onychomycosis involving men and women 65 years and older from a nursing home setting in South Florida were used. Samples were taken from the hallux toenail and sent to two different mycology laboratories for fluorescent potassium hydroxide preparation and microscopic examination of a fungal culture. Of the 85 cases studied, the two mycology laboratories reported similar potassium hydroxide preparation results for 58.8% of the patients and similar fungal culture results for genus and species identification for 37.6% of the patients. When the potassium hydroxide preparation and fungal culture results were combined, the two mycology laboratories reported similar results for only 27.1% of the patients. As a result of the two mycology laboratories’ findings, the possible US Food and Drug Administration–approved pharmacologic treatments may differ for 43.5% of the patients studied. The discrepancy between the two independent laboratories leaves physicians to question the reproducibility of fluorescent potassium hydroxide preparation and fungal culture analysis in a geriatric patient population for the diagnosis of onychomycosis. (J Am Podiatr Med Assoc 94(6): 528–534, 2004) Full article

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Anatomy, Biomechanics, and Surgical Approach to Synovial Folds Within the Joints of the Foot

by Roy H. Lidtke and Joe George

J. Am. Podiatr. Med. Assoc. 2004, 94(6), 519-527; https://doi.org/10.7547/0940519 - 1 Nov 2004

Cited by 8 | Viewed by 51

Abstract

The presence of synovial folds in various joints of the foot has been previously documented. The function and clinical significance of these structures within the joint have not been established. Histologically they are considered anatomically different from a meniscus primarily owing to their [...] Read more.

The presence of synovial folds in various joints of the foot has been previously documented. The function and clinical significance of these structures within the joint have not been established. Histologically they are considered anatomically different from a meniscus primarily owing to their makeup of loose connective tissue with nerve fibrils and several synovial cell layers. We hypothesize that the function of these folds is similar to that of the menisci: to increase joint congruity and stability. We further hypothesize that these folds will be present in joints of the foot that require greater stability. To demonstrate this, 41 fixated cadaveric feet were sectioned in the sagittal plane and the incidence and locations of the synovial folds were documented. Three fixated cadaveric feet were evaluated using a materials testing machine. The first metatarsophalangeal joint was incised, and the presence of the synovial fold was documented. The joint was then taken through its range of motion with and without the synovial fold while data on the force and displacement were collected. The steps were then repeated for the ankle joint. The results showed statistically stiffer ankle and first metatarsophalangeal joints with the synovial fold present, as determined by the stress-strain curve. On the basis of the presence and location of these synovial folds, we demonstrated arthroscopic surgical approaches to many of the documented joints that contain these folds. Because the folds contain synovial cells and vascular tissue, damage to them can result in considerable pain. In such cases, arthroscopic surgery would be of benefit. Further research may indicate whether they need to be salvaged during joint procedures to facilitate normal joint function or should be removed to reduce postoperative complications. (J Am Podiatr Med Assoc 94(6): 519–527, 2004) Full article

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J. Am. Podiatr. Med. Assoc., Volume 94, Issue 6 (11 2004) – 16 articles , Pages 519-612

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