Journal of the American Podiatric Medical Association

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Open AccessArticle

Thank You

by David M. Schofield

J. Am. Podiatr. Med. Assoc. 2007, 97(2), 174; https://doi.org/10.7547/0970174 - 1 Mar 2007

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Abstract

Well, gang, here it is, my last opportunity to write to you as president of APMA [...] Full article

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Open AccessArticle

Lower-Extremity Overuse Injury and Use of Foot Orthotic Devices in Women’s Basketball

by Jonathan J. Scarlet

J. Am. Podiatr. Med. Assoc. 2007, 97(2), 172; https://doi.org/10.7547/0970172 - 1 Mar 2007

Viewed by 532

Abstract

To the Editor: The rovers Spirit and Opportunity, recently sent to the surface of Mars, have provided space scientists with enormous amounts of data about that planet [...] Full article

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Open AccessArticle

Equinus Deformity as a Factor in Forefoot Nerve Entrapment

by Hugo R. Perez

J. Am. Podiatr. Med. Assoc. 2007, 97(2), 171; https://doi.org/10.7547/0970171 - 1 Mar 2007

Cited by 5 | Viewed by 538

Abstract

To the Editor: I am writing about the case study by Stephen L. Barrett and Jason Jarvis entitled “Equinus Deformity as a Factor in Forefoot Nerve Entrapment: Treatment with Endoscopic Gastrocnemius Recession” that appeared in the September/October 2005 issue of the Journal [...] [...] Read more.

To the Editor: I am writing about the case study by Stephen L. Barrett and Jason Jarvis entitled “Equinus Deformity as a Factor in Forefoot Nerve Entrapment: Treatment with Endoscopic Gastrocnemius Recession” that appeared in the September/October 2005 issue of the Journal [...] Full article

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Open AccessCommunication

Statistical and Clinical Interpretation of Research Results

by Garry T. Allison

J. Am. Podiatr. Med. Assoc. 2007, 97(2), 165-170; https://doi.org/10.7547/0970165 - 1 Mar 2007

Cited by 2 | Viewed by 550

Abstract

There is a well-known phenomenon of publication bias toward manuscripts that report statistically significant differences. The clinical implications of these statistically significant differences are not always clear because the magnitude of the changes may be clinically meaningless. This article relates the critical P [...] Read more.

There is a well-known phenomenon of publication bias toward manuscripts that report statistically significant differences. The clinical implications of these statistically significant differences are not always clear because the magnitude of the changes may be clinically meaningless. This article relates the critical P value threshold to the magnitude of the actual observed change and provides a rationale for reporting confidence intervals in clinical studies. Strategies for improving statistical power and reducing the magnitude of the confidence interval range for clinical trials are also described. (J Am Podiatr Med Assoc 97(2): 165–170, 2007) Full article

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Open AccessArticle

Posterior Bone Block for Footdrop. A Report of Two Cases

by Onder Kilicoglu and I. Remzi Tozun

J. Am. Podiatr. Med. Assoc. 2007, 97(2), 160-164; https://doi.org/10.7547/0970160 - 1 Mar 2007

Cited by 4 | Viewed by 538

Abstract

A posterior bone-block operation is one of the few treatment options in cases of paralytic footdrop. A case with a flail ankle and no bony deformity is ideal for this approach. Two cases of acquired flail ankle with equinus deformity were treated using [...] Read more.

A posterior bone-block operation is one of the few treatment options in cases of paralytic footdrop. A case with a flail ankle and no bony deformity is ideal for this approach. Two cases of acquired flail ankle with equinus deformity were treated using a new modification of the bone-block technique that does not interfere with subtalar joint motion. A bone block harvested from the iliac crest was fixed at the posterior talus after partial resection of the posterior tubercle. The graft was in contact with the posterior malleolus of the tibia. Satisfactory correction was achieved, and both patients could walk without the use of external splints. (J Am Podiatr Med Assoc 97(2): 160–164, 2007) Full article

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Open AccessArticle

Chondrosarcoma of the Distal Phalanx of the Great Toe

by Masahito Hatori, Mika Watanabe and Shoichi Kokubun

J. Am. Podiatr. Med. Assoc. 2007, 97(2), 156-159; https://doi.org/10.7547/0970156 - 1 Mar 2007

Cited by 4 | Viewed by 588

Abstract

Enchondromas are the most common benign cartilaginous bone tumors of the toe. In contrast, chondrosarcomas are very uncommon in the foot. We report an unusual case of a chondrosarcoma arising in the great toe. The patient was a 62-year-old woman whose chief complaint [...] Read more.

Enchondromas are the most common benign cartilaginous bone tumors of the toe. In contrast, chondrosarcomas are very uncommon in the foot. We report an unusual case of a chondrosarcoma arising in the great toe. The patient was a 62-year-old woman whose chief complaint was swelling of her left great toe. Radiography showed subtle punctate calcification and mild sclerosis and irregularity of the distal phalanx in the great toe. Magnetic resonance imaging showed extraskeletal growth. The distal phalanx was amputated. Histologic examination demonstrated a grade 1 chondrosarcoma. Two years after surgery, the patient was free of recurrence and lung metastasis. (J Am Podiatr Med Assoc 97(2): 156–159, 2007) Full article

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Open AccessArticle

Protein S Deficiency and Lower-Extremity Arterial Thrombosis. Complicating a Common Presentation

by Krista A. Archer, Thomas Lembo and Jonathan A. Haber

J. Am. Podiatr. Med. Assoc. 2007, 97(2), 151-155; https://doi.org/10.7547/0970151 - 1 Mar 2007

Cited by 5 | Viewed by 570

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A 42-year-old woman presented to the emergency department with progressive painful discoloration of the digits of her right foot and symptoms previously diagnosed as neuroma. She was admitted to the hospital for dorsalis pedis arterial occlusion and ischemic foot pain. Despite attempts to [...] Read more.

A 42-year-old woman presented to the emergency department with progressive painful discoloration of the digits of her right foot and symptoms previously diagnosed as neuroma. She was admitted to the hospital for dorsalis pedis arterial occlusion and ischemic foot pain. Despite attempts to restore perfusion to the right leg, ischemia of the right foot persisted and progressed to digital gangrene. The patient subsequently required right transmetatarsal amputation and eventually below-the-knee amputation. After extensive inpatient vascular and hematologic work-up of this otherwise healthy woman, test results revealed that she had protein S deficiency, hepatitis C, and human immunodeficiency virus type 1. In addition to describing this patient’s evaluation and treatment, we review protein S deficiency, including its correlation with human immunodeficiency virus type 1 infection and laboratory diagnosis. This case promotes awareness of protein S deficiency and serves as a reminder to the physician treating patients with vascular compromise and a history of human immunodeficiency virus type 1 to include protein S deficiency in the differential diagnosis. (J Am Podiatr Med Assoc 97(2): 151–155, 2007) Full article

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Open AccessArticle

Neurilemoma of the Posterior Tibial Nerve and Tarsal Tunnel Syndrome

by Sarnarendra Miranpuri, Eric Snook, David Vang, Raymond M. Yong and William E. Chagares

J. Am. Podiatr. Med. Assoc. 2007, 97(2), 148-150; https://doi.org/10.7547/0970148 - 1 Mar 2007

Cited by 8 | Viewed by 573

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Tarsal tunnel syndrome is defined as a compressive neuropathy of the posterior tibial nerve in the tarsal canal. A neurilemoma is an uncommon, benign, encapsulated neoplasm derived from Schwann cells. We present a case of tarsal tunnel syndrome caused by this rare space-occupying [...] Read more.

Tarsal tunnel syndrome is defined as a compressive neuropathy of the posterior tibial nerve in the tarsal canal. A neurilemoma is an uncommon, benign, encapsulated neoplasm derived from Schwann cells. We present a case of tarsal tunnel syndrome caused by this rare space-occupying lesion. (J Am Podiatr Med Assoc 97(2): 148–150, 2007) Full article

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Open AccessArticle

Acute Myelogenous Leukemia as the Cause of a Nonhealing Infection in a 10-Month-Old Infant

by Michael A. Schreck

J. Am. Podiatr. Med. Assoc. 2007, 97(2), 145-147; https://doi.org/10.7547/0970145 - 1 Mar 2007

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The treating podiatric physician should consider underlying malignant disease when evaluating a child with any slowly healing or nonhealing infection involving the lower extremity. This article reports on an infant who was treated for suspected osteomyelitis involving his right fifth toe that did [...] Read more.

The treating podiatric physician should consider underlying malignant disease when evaluating a child with any slowly healing or nonhealing infection involving the lower extremity. This article reports on an infant who was treated for suspected osteomyelitis involving his right fifth toe that did not improve with standard surgical, medical, and antibiotic treatments. He was later diagnosed as having acute myelogenous leukemia. (J Am Podiatr Med Assoc 97(2): 145–147, 2007) Full article

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Open AccessReview

Molecular Biology Techniques for Identifying Dermatophytes and Their Possible Use in Diagnosing Onychomycosis in Human Toenail. A Review

by Judith M. Binstock

J. Am. Podiatr. Med. Assoc. 2007, 97(2), 134-144; https://doi.org/10.7547/0970134 - 1 Mar 2007

Cited by 15 | Viewed by 579

Abstract

Traditional methods of diagnosing onychomycosis, such as microscopy, histologic staining, and cultures, may not provide the clinician with documentation before initiating antifungal drug therapy. DNA technology now supplies the tools for increased sensitivity, speed, and accuracy in the diagnostic arena by allowing for [...] Read more.

Traditional methods of diagnosing onychomycosis, such as microscopy, histologic staining, and cultures, may not provide the clinician with documentation before initiating antifungal drug therapy. DNA technology now supplies the tools for increased sensitivity, speed, and accuracy in the diagnostic arena by allowing for the amplification, qualification, and quantitation of DNA. These techniques, already being used to identify many infectious agents, may soon be commonly applied to onychomycosis. This report reviews some of the DNA-based techniques that are currently being used to identify dermatophytes and their possible diagnostic use. (J Am Podiatr Med Assoc 97(2): 134–144, 2007) Full article

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Open AccessArticle

Forefoot Adductus Correction in Clubfoot Deformity with Cuboid-Cuneiform Osteotomy. A Retrospective Analysis

by Daniel K. Lee, Marc Benard, Nicholas Grumbine, Mitchell Pokrassa and Stan Weinstein

J. Am. Podiatr. Med. Assoc. 2007, 97(2), 126-133; https://doi.org/10.7547/0970126 - 1 Mar 2007

Cited by 6 | Viewed by 133

Abstract

Background: Forefoot adduction is the most common residual deformity in the treatment of pediatric clubfoot. Little documentation exists regarding its late occurrence and early detection. A retrospective analysis was conducted to determine the effect of primary posterior medial release for idiopathic clubfoot [...] Read more.

Background: Forefoot adduction is the most common residual deformity in the treatment of pediatric clubfoot. Little documentation exists regarding its late occurrence and early detection. A retrospective analysis was conducted to determine the effect of primary posterior medial release for idiopathic clubfoot that had failed to improve with conservative treatment or had presented after a treatment delay and a subsequent forefoot adduction correction with a cuboid-cuneiform osteotomy. Methods: Radiographic evaluations were conducted of all of the surgical procedures performed at our institution for idiopathic clubfoot during a specified period. Preoperative and postoperative talo–first metatarsal and talocalcaneal angles were measured radiographically. Of 138 patients with clubfoot deformity who met the inclusion criteria, 51 underwent a primary posterior medial release; of these patients, 18 (26 feet) underwent a subsequent cuboid-cuneiform osteotomy. Results: The average preoperative and postoperative talo–first metatarsal anteroposterior angles for patients who underwent primary posterior medial release were 44.6° and 26.8°, respectively. The mean reduction in forefoot adduction was 17.8° (P < .05). After the osteotomy, the average talo–first metatarsal anteroposterior angle was 16°, with an average reduction of 10.8° (P < .05). Mean follow-up was 61.2 months. The average patient age was 3.2 years. Conclusions: Eighteen (35%) of 51 patients who underwent a posterior medial release required a subsequent cuboid-cuneiform osteotomy. The average reduction of 10.8° was statistically significant and has also proved to be clinically significant in the overall correction of the deformity. (J Am Podiatr Med Assoc 97(2): 126-133, 2007). Full article

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Open AccessArticle

The 36-Item Short-Form Health Survey Outcome Evaluation for Multiple Lower-Extremity Nerve Decompressions in Diabetic Peripheral Neuropathy. A Pilot Study

by Scott C. Nelson and Eugene R. Little

J. Am. Podiatr. Med. Assoc. 2007, 97(2), 121-125; https://doi.org/10.7547/0970121 - 1 Mar 2007

Cited by 11 | Viewed by 97

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Background: Diabetic neuropathy can be disabling owing to pain and loss of sensibility. Theoretically, surgical restoration of sensation and relief of pain may prevent these complications and improve quality of life. A study was conducted to perform outcome analysis of patients after [...] Read more.

Background: Diabetic neuropathy can be disabling owing to pain and loss of sensibility. Theoretically, surgical restoration of sensation and relief of pain may prevent these complications and improve quality of life. A study was conducted to perform outcome analysis of patients after these surgical procedures using the 36-Item Short-Form Health Survey. Methods: The 36-Item Short-Form Health Survey was used to evaluate patients with diabetic neuropathy after nerve decompression surgery. These results were compared with those reported in the literature related to diabetic patients without neuropathy, patients with low-back pain, and an age-matched normative population. The pilot study group included six patients with diabetic neuropathy, three of whom underwent multiple nerve decompression surgery bilaterally. Mean follow-up was 6 months. Results: Single-tailed t tests demonstrated that postoperative patients were not statistically significantly different from the other groups in the domains of Physical Functioning, Bodily Pain, General Health, Vitality, Social Functioning, and Mental Health; in the domains of Role-Physical and Role-Emotional, a statistically significant difference was found, with the postoperative patients scoring lower. Conclusions: Although this study is limited by the lack of preoperative administration of the 36-Item Short-Form Health Survey and by its small sample size, we conclude that the survey can evaluate the results of surgical decompression of lower-extremity peripheral nerves and should be added to the traditional assessments of recovery of sensibility and the visual analog scale for pain. (J Am Podiatr Med Assoc 97(2): 121-125, 2007). Full article

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Open AccessArticle

The Ability to Predict Dynamic Foot Posture from Static Measurements

by Melinda M. Franettovich, Thomas G. McPoil, Trevor Russell, Gillian Skardoon and Bill Vicenzino

J. Am. Podiatr. Med. Assoc. 2007, 97(2), 115-120; https://doi.org/10.7547/0970115 - 1 Mar 2007

Cited by 33 | Viewed by 164

Abstract

Background: A study was undertaken to investigate the ability to predict dynamic foot posture from static measurements. Methods: Arch height and arch height ratio measurements were obtained from videotape images of the medial aspect of the foot during standing, walking, and [...] Read more.

Background: A study was undertaken to investigate the ability to predict dynamic foot posture from static measurements. Methods: Arch height and arch height ratio measurements were obtained from videotape images of the medial aspect of the foot during standing, walking, and jogging in 5 male and 13 female asymptomatic subjects. Results: Arch height and arch height ratio measurements taken in standing explained 66% to 83% of the variance associated with these measurements at midstance during walking and running. Arch height and arch height ratio demonstrated high reliability as static and dynamic measures. Conclusions: The results of this study support the use of arch height and arch height ratio measurements taken statically in the clinical assessment of the foot and may assist the clinician in estimating foot posture during dynamic activity in patients with lower-limb injuries. (J Am Podiatr Med Assoc 97(2): 115-120, 2007). Full article

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Open AccessArticle

Use of Quantitative Ultrasound Scans of the Calcaneus to Diagnose Osteoporosis in Patients with Rheumatoid Arthritis

by Jacqueline R. Cryer, Simon J. Otter and Catherine J. Bowen

J. Am. Podiatr. Med. Assoc. 2007, 97(2), 108-114; https://doi.org/10.7547/0970108 - 1 Mar 2007

Cited by 8 | Viewed by 104

Abstract

Background: Patients with rheumatoid arthritis are recognized as being at risk for osteoporosis as a result of the disease process as well as the medication used to treat it. This study was conducted to consider the use of calcaneal scanning with quantitative [...] Read more.

Background: Patients with rheumatoid arthritis are recognized as being at risk for osteoporosis as a result of the disease process as well as the medication used to treat it. This study was conducted to consider the use of calcaneal scanning with quantitative ultrasound—contact ultrasound bone analysis (CUBA)—to diagnose osteoporosis in patients with rheumatoid arthritis. Methods: Forty-six patients (11 men and 35 women) with established rheumatoid arthritis underwent dual-energy x-ray absorptiometry (DEXA) of the nondominant wrist and CUBA of the nondominant heel. Sensitivity, specificity, and positive and negative predictive values were used to determine the correlation between osteoporosis as diagnosed by the CUBA heel scan compared with the DEXA wrist scan given that DEXA is widely seen as the gold standard for the diagnosis of osteoporosis. Results: The CUBA heel scan revealed a sensitivity of 90% and a specificity of 44% for a diagnosis of osteoporosis compared with DEXA. The positive predictive value of the CUBA scan was 31%, and the negative predictive value was 94%. Therefore, if normal bone density is found using CUBA, there is 94% certainty this is correct. However, if osteoporosis is diagnosed using CUBA, there is only 31% certainty this is correct. In such instances a secondary scan using a different method (eg, DEXA) would be required. Future work should consider the effect of minor alterations to the equipment or scanning protocol, because this may improve diagnosis. Conclusions: The CUBA unit could be used as a primary screening device. Given the cost and accessibility issues associated with DEXA, quantitative ultrasound may have a role in screening for osteoporosis in the primary-care setting to determine the most appropriate routes of referral for patients requiring further investigations. (J Am Podiatr Med Assoc 97(2): 108-114, 2007). Full article

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Open AccessArticle

Prediction of Dynamic Foot Posture During Running Using the Longitudinal Arch Angle

by Thomas G. McPoil and Mark W. Cornwall

J. Am. Podiatr. Med. Assoc. 2007, 97(2), 102-107; https://doi.org/10.7547/0970102 - 1 Mar 2007

Cited by 32 | Viewed by 141

Abstract

Background: A study was conducted to determine whether the longitudinal arch angle can be used to predict dynamic foot posture during running. Methods: Seventeen healthy, experienced runners participated in the study. The static longitudinal arch angle was determined from a digital image of [...] Read more.

Background: A study was conducted to determine whether the longitudinal arch angle can be used to predict dynamic foot posture during running. Methods: Seventeen healthy, experienced runners participated in the study. The static longitudinal arch angle was determined from a digital image of the medial aspect of each subject’s feet obtained in relaxed standing posture. For the dynamic phase, subjects were asked to walk across a 12-m walkway and then to run across a 25-m runway while the medial aspect of each foot was videotaped. The longitudinal arch angle was digitized from the video images at midstance in walking and at midsupport while running for five trials per extremity. Results: The longitudinal arch angle obtained in relaxed standing posture was highly predictive of dynamic foot posture at midstance in walking (r² = 0.854) and at midsupport while running (r² = 0.846). Conclusions: The static measurement of longitudinal arch angle is highly predictive of dynamic foot posture during walking and running. The longitudinal arch angle measured in relaxed standing posture significantly contributed to explaining more than 85% of the variance associated with the longitudinal arch angle position at midstance during walking and at midsupport while running. These results seem to validate use of the longitudinal arch angle as part of the foot and ankle physical examination. (J Am Podiatr Med Assoc 97(2): 102-107, 2007). Full article

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Open AccessArticle

Use of Noncontact Low-Frequency Ultrasound in the Treatment of Chronic Foot and Leg Ulcerations. A 51-Patient Analysis

by Steven J. Kavros and Erik C. Schenck

J. Am. Podiatr. Med. Assoc. 2007, 97(2), 95-101; https://doi.org/10.7547/0970095 - 1 Mar 2007

Cited by 68 | Viewed by 541

Abstract

Background: A feasibility study was conducted to characterize the effects of noncontact low-frequency ultrasound therapy for chronic, recalcitrant lower-leg and foot ulcerations. Methods: The study was an open-label, nonrandomized, baseline-controlled clinical case series. Patients were initially treated with the Mayo Clinic standard of [...] Read more.

Background: A feasibility study was conducted to characterize the effects of noncontact low-frequency ultrasound therapy for chronic, recalcitrant lower-leg and foot ulcerations. Methods: The study was an open-label, nonrandomized, baseline-controlled clinical case series. Patients were initially treated with the Mayo Clinic standard of care before the addition of or the switch to noncontact low-frequency ultrasound therapy. We analyzed the medical records of 51 patients (median ± SD age, 72 ± 15 years) with one or more of the following conditions: diabetes mellitus, neuropathy, limb ischemia, chronic renal insufficiency, venous disease, and inflammatory connective tissue disease. All of the patients had lower-extremity ulcers, 20% had a history of amputation, and 65% had diabetes. Of all the wounds, 63% had a multifactorial etiology, and 65% had associated transcutaneous oximetry levels below 30 mm Hg. Results: The mean ± SD treatment time of wounds during the baseline standard of care control period versus the noncontact low-frequency ultrasound therapy period was 9.8 ± 5.5 weeks versus 5.5 ± 2.8 weeks (P < .0001). Initial and end measurements were recorded, and percent volume reduction of the wound was calculated. The mean ± SD percent volume reduction in the baseline standard of care control period versus the noncontact lowfrequency ultrasound therapy period was 37.3% ± 18.6% versus 94.9% ± 9.8% (P < .0001). Conclusions: Using noncontact low-frequency ultrasound improved the rate of healing and closure in recalcitrant lower-extremity ulcerations. (J Am Podiatr Med Assoc 97(2): 95-101, 2007) Full article

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J. Am. Podiatr. Med. Assoc., Volume 97, Issue 2 (03 2007) – 16 articles , Pages 95-174

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