Journal of the American Podiatric Medical Association

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Strategic Planning

by Christian A. Robertozzi

J. Am. Podiatr. Med. Assoc. 2007, 97(5), 436-437; https://doi.org/10.7547/0970436 - 1 Sep 2007

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Foot Health Training Guide for Long-Term Care Personnel

by Jeffrey M. Robbins

J. Am. Podiatr. Med. Assoc. 2007, 97(5), 430; https://doi.org/10.7547/0970430 - 1 Sep 2007

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Abnormal Proximal Fifth Metatarsal and Os Vesalianum Pedis

by Hakan Boya, Haluk H. Oztekin and Ozal Ozcan

J. Am. Podiatr. Med. Assoc. 2007, 97(5), 428-429; https://doi.org/10.7547/0970428 - 1 Sep 2007

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Intraosseous Ganglion of the Talus Treated with the Talonavicular Joint Approach Without Exposing the Ankle Joint

by Oguz Cebesoy

J. Am. Podiatr. Med. Assoc. 2007, 97(5), 424-427; https://doi.org/10.7547/0970424 - 1 Sep 2007

Cited by 14 | Viewed by 71

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Intraosseous ganglion, which is generally seen in metaphyseal-epiphyseal regions of long bones, is not a rare disorder. It is extremely rare in the talus, however. Differential diagnosis of a cystic talar lesion should include enchondroma, chondroblastoma, giant cell tumor, and unicameral bone cyst. [...] Read more.

Intraosseous ganglion, which is generally seen in metaphyseal-epiphyseal regions of long bones, is not a rare disorder. It is extremely rare in the talus, however. Differential diagnosis of a cystic talar lesion should include enchondroma, chondroblastoma, giant cell tumor, and unicameral bone cyst. This article presents a case of intraosseous ganglion of the talus in a 38-year-old woman treated with a new surgical approach and technique. The patient had mild ankle pain at the arc of motion in her right ankle that increased with activity. Radiographs and magnetic resonance images showed a cystic lesion in the medial side of the talar dome. It was treated by curettage and autocorticocancellous bone grafting through an opening in the talonavicular joint without disturbing the intact talar dome cartilage. One month after the operation, the patient had an excellent clinical outcome. This approach and technique can be used to treat other lesions of the talus that do not involve the joint space. Full article

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Modified Youngswick Procedure for Hallux Limitus

by Philip Radovic, Ekta Yadav-Shah and Ki Choe

J. Am. Podiatr. Med. Assoc. 2007, 97(5), 420-423; https://doi.org/10.7547/0970420 - 1 Sep 2007

Cited by 6 | Viewed by 73

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Multiple surgical procedures have been described for the correction of hallux limitus deformity. We describe a new modification of the Youngswick procedure for the surgical treatment of hallux limitus. Other procedures for hallux limitus correction are also discussed. This modified Youngswick procedure will [...] Read more.

Multiple surgical procedures have been described for the correction of hallux limitus deformity. We describe a new modification of the Youngswick procedure for the surgical treatment of hallux limitus. Other procedures for hallux limitus correction are also discussed. This modified Youngswick procedure will provide a new approach to treating hallux limitus secondary to metatarsus primus elevatus when shortening of the first metatarsal is not indicated. Full article

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Clinical and Radiologic Features of Pigmented Villonodular Synovitis of the Foot. Report of Eight Cases

by Pedro Carpintero, Emilio Gascon, Manuel Mesa, Carlos Jimenez and Ubaldo Lopez

J. Am. Podiatr. Med. Assoc. 2007, 97(5), 415-419; https://doi.org/10.7547/0970415 - 1 Sep 2007

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Pigmented villonodular synovitis, a rare proliferative disease of unknown etiology, is rare in the foot (2% of these lesions). A retrospective review was undertaken of the case histories, radiographs, and imaging results of eight patients treated for pigmented villonodular synovitis of the foot. [...] Read more.

Pigmented villonodular synovitis, a rare proliferative disease of unknown etiology, is rare in the foot (2% of these lesions). A retrospective review was undertaken of the case histories, radiographs, and imaging results of eight patients treated for pigmented villonodular synovitis of the foot. Pigmented villonodular synovitis was located in the rearfoot in five patients and in the forefoot in the other three. Radiographs in six patients showed bone involvement. Affected bones included the talus, first cuneiform, first and fifth metatarsals, and second phalanx. Treatment was surgical, and only one recurrence was recorded after 24 months. Pigmented villonodular synovitis should be considered in the differential diagnosis of foot tumors. Full article

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Negative-Pressure Wound Therapy and External Fixation for Infection and Hematoma After Hallux Abducto Valgus Surgery

by Edward Ferdinando, Laura Guerin, Aluko O. Jervis and Henrietta Obidigbo

J. Am. Podiatr. Med. Assoc. 2007, 97(5), 410-414; https://doi.org/10.7547/0970410 - 1 Sep 2007

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Hematoma refers to the collection or extravasation of blood, usually clotted, in a closed tissue space. It is caused by leakage from local vessels damaged by blunt trauma, local injury, or surgical dissection. In the postoperative phase, a hematoma often results in edema, [...] Read more.

Hematoma refers to the collection or extravasation of blood, usually clotted, in a closed tissue space. It is caused by leakage from local vessels damaged by blunt trauma, local injury, or surgical dissection. In the postoperative phase, a hematoma often results in edema, pain, wound dehiscence, infection, and scarring of the surgical wound. We describe a 44-year-old woman who developed severe complications, including hematoma, abscess, failure of internal fixation, and loss of soft-tissue structures, after hallux abducto valgus surgery. Hospitalization was required for infection control, soft-tissue coverage through negative-pressure wound therapy, and first metatarsophalangeal joint stabilization through external fixation. Early recognition of the signs of infection and hematoma can help decrease the incidence of postoperative complications. Full article

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Osteoid Osteoma. An Uncommon Cause of Foot Pain

by Scot Freschi and Nicholas B. Dodson

J. Am. Podiatr. Med. Assoc. 2007, 97(5), 405-409; https://doi.org/10.7547/0970405 - 1 Sep 2007

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An osteoid osteoma located in the forefoot can be difficult to diagnose, and the diagnosis is frequently delayed. We present a clinical case of a patient with pain, erythema, and swelling of the left forefoot with no history of trauma. Although rarely seen [...] Read more.

An osteoid osteoma located in the forefoot can be difficult to diagnose, and the diagnosis is frequently delayed. We present a clinical case of a patient with pain, erythema, and swelling of the left forefoot with no history of trauma. Although rarely seen in the metatarsal, osteoid osteoma should be included in the differential diagnosis of foot pain. Findings from radiographs, magnetic resonance images, and a detailed clinical history led to the diagnosis of osteoid osteoma of the left second metatarsal. The lesion was surgically excised using curettage. This process significantly weakened the lateral cortex of the metatarsal shaft. To correct this surgically induced stress riser, an external fixator was applied to provide stability, allow for callus distraction, and allow the patient to walk as early as possible. We review osteoid osteoma, including the classic clinical presentation and treatment associated with this benign bone tumor. Full article

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Chronic Ischemia Presenting as Muscular Groin Pain

by Dimitri Diacogiorgis

J. Am. Podiatr. Med. Assoc. 2007, 97(5), 402-404; https://doi.org/10.7547/0970402 - 1 Sep 2007

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A 66-year-old man was admitted to a hospital rehabilitation unit for the management of chronic groin pain. Since the groin pain began, he had been unable to bear weight on his right foot. During a podiatric examination, the patient reported sharp pain at [...] Read more.

A 66-year-old man was admitted to a hospital rehabilitation unit for the management of chronic groin pain. Since the groin pain began, he had been unable to bear weight on his right foot. During a podiatric examination, the patient reported sharp pain at the apex of his right hallux. A full podiatric assessment was undertaken to evaluate his vascular, neurologic, and biomechanical status. The patient’s ankle-brachial index was found to be 0.34 in the right lower limb and 0.68 in the left lower limb. After vascular assessment, the patient was diagnosed as having chronic ischemia of the right leg. He underwent left-to-right femoral-to-femoral bypass graft surgery to salvage the right lower leg and foot. Full article

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Painful Diabetic Peripheral Neuropathy

by Robert G. Smith

J. Am. Podiatr. Med. Assoc. 2007, 97(5), 394-401; https://doi.org/10.7547/0970394 - 1 Sep 2007

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Painful peripheral neuropathy is a common complication of diabetes mellitus that can affect almost every tissue of the body. In the absence of a curative therapy for this disorder, pharmacologic or nonpharmacologic tools, or a combination of both, can be used to provide [...] Read more.

Painful peripheral neuropathy is a common complication of diabetes mellitus that can affect almost every tissue of the body. In the absence of a curative therapy for this disorder, pharmacologic or nonpharmacologic tools, or a combination of both, can be used to provide relief of symptoms. This article reviews medications currently used to manage painful diabetic neuropathy. The pathogenesis of painful diabetic neuropathy is described as a basis for understanding medication selection. The literature describing the pharmacologic properties of medications used to treat painful diabetic neuropathy is also reviewed. Comparisons of medication dosages, frequencies, and adverse effects are offered to help with selection of the most appropriate agent for each individual patient. Full article

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A New Onychocryptosis Classification and Treatment Plan

by Alfonso Martínez-Nova, Raquel Sánchez-Rodríguez and David Alonso-Peña

J. Am. Podiatr. Med. Assoc. 2007, 97(5), 389-393; https://doi.org/10.7547/0970389 - 1 Sep 2007

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Onychocryptosis is a pathologic condition of the nail apparatus in which the toenail damages the nail fold. It is a common condition provoking pain, inflammation, and functional limitation. It principally occurs in the hallux. Onychocryptosis is one of the most frequent complaints regarding [...] Read more.

Onychocryptosis is a pathologic condition of the nail apparatus in which the toenail damages the nail fold. It is a common condition provoking pain, inflammation, and functional limitation. It principally occurs in the hallux. Onychocryptosis is one of the most frequent complaints regarding the foot and accounts for many clinical consultations. The disorder has been classified in terms of the stages of the pathologic condition. In our practice, we discovered a clinical entity that was not previously classified in the literature. We classify onychocryptosis into stages I, IIa, IIb, III, and the new stage IV. A treatment plan is offered for each stage of this classification, with both general and specific indications given. In onychocryptosis treatment, it is important to select the surgical technique best suited to the patient’s particular clinical situation. Full article

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Second-Toe Length and Forefoot Disorders in Ballet and Folk Dancers

by Haluk H. Oztekin, Hakan Boya, Mesut Nalcakan and Ozal Ozcan

J. Am. Podiatr. Med. Assoc. 2007, 97(5), 385-388; https://doi.org/10.7547/0970385 - 1 Sep 2007

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Background: Although there is no ideal foot type for classical dancers, second-toe length seems to be a factor in the etiology of foot disorders in ballet dancers. Methods: We investigated the relationship between second-toe length and foot disorders in 30 ballet dance students [...] Read more.

Background: Although there is no ideal foot type for classical dancers, second-toe length seems to be a factor in the etiology of foot disorders in ballet dancers. Methods: We investigated the relationship between second-toe length and foot disorders in 30 ballet dance students and 25 folk dance students. Second-toe length in relation to the hallux (longer or equal/shorter), hallux deformities, first metatarsophalangeal joint inflammation, number of callosities, and daily pain scores were recorded in both groups and compared. Results: There was no statistically significant difference in toe length between the two groups (P > .05). Ballet dancers with equal-length or shorter second toes had lower pain scores, less first metatarsophalangeal joint inflammation, and fewer callosities in their feet compared with dancers with longer second toes. Conclusions: Second-toe length seems to be a factor in the development of forefoot disorders in classical ballet dancers but not folk dancers. Dancers who have equallength or shorter second toes in relation to the hallux may have fewer forefoot disorders as dance professionals. Full article

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Podiatric Involvement in Multidisciplinary Falls-Prevention Clinics in Australia

by Hylton B. Menz and Keith D. Hill

J. Am. Podiatr. Med. Assoc. 2007, 97(5), 377-384; https://doi.org/10.7547/0970377 - 1 Sep 2007

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Background: Falls in older people are a major public health problem, and there is increasing evidence that foot problems and inappropriate footwear increase the risk of falls. Several multidisciplinary prevention clinics have been established to address the problem of falls; however, the role [...] Read more.

Background: Falls in older people are a major public health problem, and there is increasing evidence that foot problems and inappropriate footwear increase the risk of falls. Several multidisciplinary prevention clinics have been established to address the problem of falls; however, the role of podiatry in these clinics has not been clearly defined. The aims of this study were to determine the level of podiatric involvement in multidisciplinary falls clinics in Australia and to describe the assessments undertaken and interventions provided by podiatrists in these settings. Methods: A database of falls clinics was developed through consultation with departments of health in each state and territory. Clinic managers were contacted and surveyed as to whether the clinic incorporated podiatry services. If so, the podiatrists were contacted and asked to complete a brief questionnaire regarding their level of involvement and the assessment procedures and interventions offered. Results: Of the 36 clinics contacted, 25 completed the survey. Only four of these clinics reported direct podiatric involvement. Despite the limited involvement of podiatry in these clinics, all of the clinic managers stated that they considered podiatry to have an important role to play in falls prevention. Podiatry service provision in falls clinics varied considerably in relation to eligibility criteria, assessments undertaken, and interventions provided. Conclusions: Despite the recognition that foot problems and inappropriate footwear are risk factors for falls, podiatry currently has a relatively minor and poorly defined role in multidisciplinary falls-prevention clinics in Australia. Full article

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Open AccessErratum

ERRATUM

by Thomas S. Roukis, Dave Graner and Thomas Zgonis

J. Am. Podiatr. Med. Assoc. 2007, 97(5), 376; https://doi.org/10.7547/0970376 - 1 Sep 2007

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Anterior Cruciate Ligament Injury in Female and Male Athletes. The Relationship Between Foot Structure and Injury

by Walter L. Jenkins, Clyde B. Killian, D.S. Williams, Janice Loudon and Suzanne G. Raedeke

J. Am. Podiatr. Med. Assoc. 2007, 97(5), 371-376; https://doi.org/10.7547/0970371 - 1 Sep 2007

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Abstract

Background: It has been shown that anterior cruciate ligament (ACL) injuries are more prevalent in female athletes than in male athletes. Soccer and basketball are considered high-risk sports for ACL injury in female athletes. Several studies have reported a relationship between ACL injury [...] Read more.

Background: It has been shown that anterior cruciate ligament (ACL) injuries are more prevalent in female athletes than in male athletes. Soccer and basketball are considered high-risk sports for ACL injury in female athletes. Several studies have reported a relationship between ACL injury and measures of foot structure. This study was conducted to investigate the relationship between foot structure and ACL injury rates in female and male soccer and basketball players. Methods: One hundred five soccer and basketball players (53 women and 52 men) were recruited and divided into an ACL-normal group (n = 89) and an ACL-injured group (n = 16). Two measures of foot structure (subtalar joint neutral position and navicular drop test values) were recorded for each subject. An independent t test and a paired t test were used to analyze differences in ACL status, foot structure, and sex. A χ2 analysis determined whether the prevalence of ACL injury was independent of sport. Results: No statistically significant differences were found in the foot structure measures between women and men. Female soccer and basketball players had an ACL injury rate seven times that of male players. Conclusions: Values derived from subtalar joint neutral position measurement and the navicular drop test were not associated with ACL injury in collegiate female and male soccer and basketball players. Full article

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Anthropometric Foot Structure of Peripubescent Children with Excessive versus Normal Body Mass. A Cross-sectional Study

by Stewart C. Morrison, Brian R. Durward, Gordon F. Watt and Malcolm D. C. Donaldson

J. Am. Podiatr. Med. Assoc. 2007, 97(5), 366-370; https://doi.org/10.7547/0970366 - 1 Sep 2007

Cited by 36 | Viewed by 55

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Background: A variety of musculoskeletal problems have been associated with excessive body mass in children, including structural foot problems. Methods: Two hundred children aged 9 to 12 years were recruited to evaluate the effect of body mass on foot structure. Three reliable anthropometric [...] Read more.

Background: A variety of musculoskeletal problems have been associated with excessive body mass in children, including structural foot problems. Methods: Two hundred children aged 9 to 12 years were recruited to evaluate the effect of body mass on foot structure. Three reliable anthropometric measures were recorded: foot length, forefoot width, and navicular height. Results: Following independent sample t test analysis of the data, significant differences were found for the three anthropometric variables when children with normal body mass were compared with those with excessive body mass. The research indicates that foot length and width increase with body mass, whereas navicular height drops. Conclusions: Excessive body mass affects the discrete anthropometric structure of the peripubescent foot. With the growing concern about childhood obesity, further research is essential to develop a comprehensive understanding of the issues identified and to quantify the findings presented here. Full article

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Essential Features of a Handheld Infrared Thermometer Used to Guide the Treatment of Neuropathic Feet

by James G. Foto, Denise Brasseaux and James A. Birke

J. Am. Podiatr. Med. Assoc. 2007, 97(5), 360-365; https://doi.org/10.7547/0970360 - 1 Sep 2007

Cited by 11 | Viewed by 51

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Background: A study was conducted to compare the accuracy, reliability, and essential features of nine commercially available handheld infrared thermometers used to manage the neuropathic foot. Methods: The thermometers were compared using two temperature-control sources simulating physiologic conditions found in a [...] Read more.

Background: A study was conducted to compare the accuracy, reliability, and essential features of nine commercially available handheld infrared thermometers used to manage the neuropathic foot. Methods: The thermometers were compared using two temperature-control sources simulating physiologic conditions found in a foot-care clinic. With each control source independently set, temperature difference ranges of 0°, 2°, 4°, and 6° C were randomly sampled and analyzed for each thermometer by two testers. The order of testing was randomly assigned for testers and instruments. Results: There were differences in mean temperature change among thermometers (P < .001) and between testers (P = .0247). Differences in mean temperature change among instruments (<0.5°C), although small, could affect interpretation of skin temperature if temperature comparisons are made using two different instruments. The difference in temperature change between testers (0.06°C) was not large enough to affect decisions in clinical practice. Instrument response time, distance-to-spot ratio, sensor diameter, display resolution, emissivity, and cost were compared. Conclusions: The low-cost, general-use infrared thermometers used in this study showed good accuracy, reliability, and performance and are appropriate for use in a foot-care clinic. (J Am Podiatr Med Assoc 97(5): 360-365, 2007) Full article

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Negative-Pressure Wound Therapy and Diabetic Foot Amputations. A Retrospective Study of Payer Claims Data

by Robert G. Frykberg and David V. Williams

J. Am. Podiatr. Med. Assoc. 2007, 97(5), 351-359; https://doi.org/10.7547/0970351 - 1 Sep 2007

Cited by 28 | Viewed by 71

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Background: This study was undertaken to assess the benefits of negative-pressure wound therapy (NPWT) versus traditional wound therapies in reducing the incidence of lower-extremity amputations in patients with diabetic foot ulcers. Methods: Administrative claims data for patients with diabetic foot ulcers [...] Read more.

Background: This study was undertaken to assess the benefits of negative-pressure wound therapy (NPWT) versus traditional wound therapies in reducing the incidence of lower-extremity amputations in patients with diabetic foot ulcers. Methods: Administrative claims data for patients with diabetic foot ulcers from commercial payers (n = 3,524) and Medicare (n = 12,795) were retrospectively analyzed. Patients were divided into NPWT and control/traditional therapy groups on the basis of administrative codes. Risk-adjustment procedures were then performed to match patient risk categories (through total treatment costs) and wound severities (through debridement depth). Results: The incidence of amputations in the NPWT groups was lower than that in the control groups. For the cost-based risk-adjustment analysis, amputation incidences with NPWT versus traditional therapy were 35% lower in the Medicare sample (10.8% versus 16.6%; P = .0077) and 34% lower in the commercial payer sample (14.1% versus 21.4%; P = .0951). Whereas overall amputation rates increased progressively with increasing wound debridement depth in both control groups, the same increasing trend did not occur in the NPWT groups. Conclusions: Patients with diabetic foot ulcers in the Medicare sample treated with NPWT had a lower incidence of amputations than those undergoing traditional wound therapy; this finding was evident in wounds of varying depth in both populations studied. (J Am Podiatr Med Assoc 97(5): 351-359, 2007) Full article

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J. Am. Podiatr. Med. Assoc., Volume 97, Issue 5 (09 2007) – 18 articles , Pages 351-437

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