Journal of the American Podiatric Medical Association

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Open AccessArticle

Finding the Future, Being a Mentor, and Parity

by Ross E. Taubman

J. Am. Podiatr. Med. Assoc. 2008, 98(5), 427-428; https://doi.org/10.7547/0980427 - 1 Sep 2008

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Our profession is poised for an explosion. The recently completed Workforce Study on Podiatric Medicine by the State University of New York at Albany provides challenges to our profession over the next three decades [...] Full article

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Open AccessArticle

Letter to the Editor

by Leonard A. Levy

J. Am. Podiatr. Med. Assoc. 2008, 98(5), 426; https://doi.org/10.7547/0980426 - 1 Sep 2008

Cited by 1 | Viewed by 38

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To the Editor: The President’s Message from Christian A. Robertozzi, DPM, on “Public Health and Podiatry,” published in the March/April 2008 issue of JAPMA, had a most important theme, emphasizing the nation’s health [...] Full article

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Open AccessArticle

Wound Closure Technique for Lateral Extensile Approach to Intra-Articular Calcaneal Fractures

by Shane Hollawell

J. Am. Podiatr. Med. Assoc. 2008, 98(5), 422-425; https://doi.org/10.7547/0980422 - 1 Sep 2008

Cited by 9 | Viewed by 37

Abstract

Multiple wound closure techniques have been described for a lateral extensile calcaneal incision in the literature. In this article, a technique is presented that involves a subcutilar closure over a closed drain system, which has proven to be effective in minimizing sural nerve [...] Read more.

Multiple wound closure techniques have been described for a lateral extensile calcaneal incision in the literature. In this article, a technique is presented that involves a subcutilar closure over a closed drain system, which has proven to be effective in minimizing sural nerve injury and wound dehiscence in open reduction internal fixation of 20 calcaneal fractures. (J Am Podiatr Med Assoc 98(5): 422–425, 2008) Full article

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Open AccessArticle

Gauze Application of Phenol for Matrixectomy

by Ricardo Becerro de Bengoa Vallejo, Marta Elena Losa Iglesias, Ruben Sanchez Gomez and Kevin T. Jules

J. Am. Podiatr. Med. Assoc. 2008, 98(5), 418-421; https://doi.org/10.7547/0980418 - 1 Sep 2008

Cited by 15 | Viewed by 38

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Phenol matrixectomy is commonly used to treat onychocryptosis. The podiatric medical community has been progressively improving the technique of phenol application to avoid cases of burns. We describe a modification that uses gauze to provide a safe way for the phenol to be [...] Read more.

Phenol matrixectomy is commonly used to treat onychocryptosis. The podiatric medical community has been progressively improving the technique of phenol application to avoid cases of burns. We describe a modification that uses gauze to provide a safe way for the phenol to be applied and prevents skin lesions due to phenol burns. (J Am Podiatr Med Assoc 98(5): 418–421, 2008) Full article

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Mini-Open Technique for the Achilles Tenotomy in Correction of Idiopathic Clubfoot. A Report of 25 Cases

by Ali Dogan, Ali Murat Kalender, Ebubekir Seramet, Mustafa Uslu and Ahmet Sebik

J. Am. Podiatr. Med. Assoc. 2008, 98(5), 414-417; https://doi.org/10.7547/0980414 - 1 Sep 2008

Cited by 21 | Viewed by 42

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Achilles tenotomy is performed for the residual equinus deformity in the Ponseti method of clubfoot treatment. In the present article, we describe a mini-open Achilles tenotomy technique to prevent complications that could occur during tenotomy. This technique was performed on 15 patients (25 [...] Read more.

Achilles tenotomy is performed for the residual equinus deformity in the Ponseti method of clubfoot treatment. In the present article, we describe a mini-open Achilles tenotomy technique to prevent complications that could occur during tenotomy. This technique was performed on 15 patients (25 feet) during a 3-year period in our clinic on patients whose equinus deformities could not have been corrected by manipulations. Clear improvement (mean angle, 30°) was observed in equinus in our patients, and we have not seen any complication in this method. We conclude that direct visualizing of the tendon with mini-open incision may reduce the risk of neurovascular injury, especially for surgeons who are not experienced. (J Am Podiatr Med Assoc 98(5): 414–417, 2008) Full article

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Congenital Clubfoot Associated with an Accessory Soleus Muscle

by Levent Karapinar, Ahmet Kaya, Taskin Altay, Hasan Ozturk and Fatih Surenkok

J. Am. Podiatr. Med. Assoc. 2008, 98(5), 408-413; https://doi.org/10.7547/0980408 - 1 Sep 2008

Cited by 4 | Viewed by 42

Abstract

A 16-month-old male with previously untreated bilateral clubfeet was admitted to S.B. Izmir Tepecik Education and Research Hospital, Izmir, Turkey. Both feet underwent surgical treatment. During surgery, an accessory soleus muscle was detected on the right side. The accessory soleus muscle had a [...] Read more.

A 16-month-old male with previously untreated bilateral clubfeet was admitted to S.B. Izmir Tepecik Education and Research Hospital, Izmir, Turkey. Both feet underwent surgical treatment. During surgery, an accessory soleus muscle was detected on the right side. The accessory soleus muscle had a distinct distal insertion at the superior anteromedial border of the calcaneus and also anterior and medial to the Achilles tendon. He was treated by bilateral complete subtalar release with Cincinnati incision, and the accessory soleus was also cut and the distal part resected. At the final follow-up visit, when the patient was 6 years and 9 months old, both feet had a normal appearance and appeared normal on radiograph and magnetic resonance imaging, with no presence of the accessory soleus muscle or its remnant. In our opinion, awareness of the association between an accessory soleus muscle and clubfoot, and sectioning of this muscle during surgery may improve surgical results. (J Am Podiatr Med Assoc 98(5): 408–413, 2008) Full article

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Open AccessArticle

Ischemic Contracture of Deep Posterior Compartment of the Leg Following Isolated Ankle Fracture

by Pedro Hernández-Cortés, Miguel Pajares-López and Miguel Angel Hernández-Hernández

J. Am. Podiatr. Med. Assoc. 2008, 98(5), 404-407; https://doi.org/10.7547/0980404 - 1 Sep 2008

Cited by 6 | Viewed by 36

Abstract

Compartment syndromes and ischemic contractures after ankle fractures are exceedingly rare. We report a case in which a Weber type-C ankle fracture resulted in an unrecognized compartment syndrome and ischemic contracture of deep posterior compartment of the leg. Six weeks after injury, the [...] Read more.

Compartment syndromes and ischemic contractures after ankle fractures are exceedingly rare. We report a case in which a Weber type-C ankle fracture resulted in an unrecognized compartment syndrome and ischemic contracture of deep posterior compartment of the leg. Six weeks after injury, the patient had an obvious deformity and clawing of the toes. The deformities were corrected by lengthening the flexor hallucis longus and the flexor digitorum longus. Full correction of all clawed toes was evident. A deep posterior compartment syndrome may follow an ankle fracture and should be considered in any patient with unrelenting pain in the immediate postoperative period. (J Am Podiatr Med Assoc 98(5): 404–407, 2008) Full article

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Open AccessArticle

A Comparison of Rearfoot Motion Control and Comfort between Custom and Semicustom Foot Orthotic Devices

by Irene S. Davis, Rebecca Avrin Zifchock and Alison T. DeLeo

J. Am. Podiatr. Med. Assoc. 2008, 98(5), 394-403; https://doi.org/10.7547/0980394 - 1 Sep 2008

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Background: Motion control and comfort are primary objectives in orthotic intervention. Semicustom orthotic devices have been presented as a more cost-effective solution than custom orthotic devices. However, no studies have compared their function or comfort to that of custom orthotic devices. Methods: Nineteen [...] Read more.

Background: Motion control and comfort are primary objectives in orthotic intervention. Semicustom orthotic devices have been presented as a more cost-effective solution than custom orthotic devices. However, no studies have compared their function or comfort to that of custom orthotic devices. Methods: Nineteen uninjured runners were fitted for custom and semicustom orthotic devices. Subjects underwent an instrumented gait analysis of running and walking in noorthotic, custom orthotic, and semicustom orthotic conditions. Subjects completed visual analog scales for the custom and semicustom orthotic conditions. One-way repeated measures analyses of variance were performed on the rearfoot variables of peak eversion, eversion excursion, eversion duration, and eversion velocity. Two-tailed, dependent t tests were used to compare comfort. Results: Eversion excursion showed significant differences between the conditions: during running, it was reduced in the custom orthotic as compared to the no-orthotic condition; during walking, it was reduced in the semicustom orthotic as compared to both the custom and no-orthotic conditions. The custom orthotic devices were significantly more comfortable (P < .05) than the semicustom devices in the area of the edges only. Conclusion: The results suggest that, in uninjured individuals, there are few differences in rearfoot motion control and comfort between the custom and semicustom orthotic devices used in this study. (J Am Podiatr Med Assoc 98(5): 394-403, 2008) Full article

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Open AccessArticle

The Flat-Footed Child—To Treat or Not to Treat. What Is the Clinician to Do?

by Angela Margaret Evans

J. Am. Podiatr. Med. Assoc. 2008, 98(5), 386-393; https://doi.org/10.7547/0980386 - 1 Sep 2008

Cited by 71 | Viewed by 54

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Background: This article addresses the treatment of pediatric flatfoot with foot orthoses and explores the existing knowledge from an evidence-based perspective. Methods: Studies investigating the use of foot orthoses for pediatric flatfoot were reviewed and ranked on the evidence hierarchy model [...] Read more.

Background: This article addresses the treatment of pediatric flatfoot with foot orthoses and explores the existing knowledge from an evidence-based perspective. Methods: Studies investigating the use of foot orthoses for pediatric flatfoot were reviewed and ranked on the evidence hierarchy model according to research designs. Clinical guidelines and efficacy rating methods were also reviewed. Results: Three randomized controlled trials exist, and a systematic review and possible meta-analysis of these studies is in progress. The results of these studies, although not definitive for the use of orthoses for pediatric flatfoot, provide useful direction. Clinical guidelines for the management of flatfoot are a useful supplement for clinical decision making and have been enhanced. Conclusion: This article presents a pragmatic and evidence-based clinical care pathway for clinicians to use for pediatric flatfoot. It uses a simple “traffic light” framework to identify three subtypes of pediatric flatfoot. The clinician is advised to 1) treat symptomatic pediatric flatfoot, 2) monitor (or with discretion simply treat) asymptomatic nondevelopmental pediatric flatfoot, and 3) identify and advise asymptomatic developmental pediatric flatfoot. (Children with juvenile arthritis should receive customized foot orthoses.) This approach will dispel much of the contention surrounding the use of foot orthoses in children. Full article

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Open AccessArticle

Relationship of Body Mass Index, Ankle Dorsiflexion, and Foot Pronation on Plantar Fascia Thickness in Healthy, Asymptomatic Subjects

by Javier Pascual Huerta, Juan Maria Alarcón García, Eva Cosin Matamoros, Julia Cosin Matamoros and Teresa Díaz Martínez

J. Am. Podiatr. Med. Assoc. 2008, 98(5), 379-385; https://doi.org/10.7547/0980379 - 1 Sep 2008

Cited by 34 | Viewed by 43

Abstract

Background: We sought to investigate the thickness of plantar fascia, measured by means of ultrasonographic evaluation in healthy, asymptomatic subjects, and its relationship to body mass index, ankle joint dorsiflexion range of motion, and foot pronation in static stance. Methods: One [...] Read more.

Background: We sought to investigate the thickness of plantar fascia, measured by means of ultrasonographic evaluation in healthy, asymptomatic subjects, and its relationship to body mass index, ankle joint dorsiflexion range of motion, and foot pronation in static stance. Methods: One hundred two feet of 51 healthy volunteers were examined. Sonographic evaluation with a 10-MHz linear array transducer was performed 1 and 2 cm distal to its insertion. Physical examination was also performed to assess body mass index, ankle joint dorsiflexion, and degree of foot pronation in static stance. Both examinations were performed in a blinded manner. Results: Body mass index showed moderate correlation with plantar fascia thickness at the 1- and 2-cm locations. Ankle dorsiflexion range of motion showed no correlation at either location. Foot pronation showed an inverse correlation with plantar fascia thickness at the 2-cm location and no correlation at the 1-cm location. Conclusion: Body mass index and foot supination at the subtalar joint are related to increased thickness at the plantar fascia in healthy, asymptomatic subjects. Although the changes in thickness were small compared with those in patients with symptomatic plantar fasciitis, they could play a role in the mechanical properties of plantar fascia and in the development of plantar fasciitis. Full article

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Open AccessArticle

Computerized Analysis of Plantar Pressure Variation in Flip-Flops, Athletic Shoes, and Bare Feet

by Tanya J. Carl and Stephen L. Barrett

J. Am. Podiatr. Med. Assoc. 2008, 98(5), 374-378; https://doi.org/10.7547/0980374 - 1 Sep 2008

Cited by 21 | Viewed by 45

Abstract

Background: High peak plantar pressures predispose to foot problems and may exacerbate existing conditions. For podiatric physicians to make educated recommendations to their patients, it is important and necessary to begin to look at different shoes and how they affect peak plantar [...] Read more.

Background: High peak plantar pressures predispose to foot problems and may exacerbate existing conditions. For podiatric physicians to make educated recommendations to their patients, it is important and necessary to begin to look at different shoes and how they affect peak plantar pressure. Methods: To determine how flip-flops change peak plantar pressure while walking, we compared peak plantar pressures in the same test subjects wearing flip-flops, wearing athletic shoes, and in bare feet. Ten women with size 7 feet and a body mass index less than 25 kg/m² were tested with an in-shoe pressure-measurement system. These data were collected and analyzed by one-way analysis of variance and computer software. Results: Statistically significant results were obtained for nine of the 18 comparisons. In each of these comparisons, flip-flops always demonstrated higher peak plantar pressures than athletic shoes but lower pressures than bare feet. Conclusion: Although these data demonstrate that flip-flops have a minor protective role as a shock absorber during the gait cycle compared with pressures measured while barefoot, compared with athletic shoes, they increase peak plantar pressures, placing the foot at greater risk for pathologic abnormalities. Full article

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Surgical Correlation of Preoperative MRI Findings of Trauma to Tendons and Ligaments of the Foot and Ankle

by Gerald T. Kuwada

J. Am. Podiatr. Med. Assoc. 2008, 98(5), 370-373; https://doi.org/10.7547/0980370 - 1 Sep 2008

Cited by 26 | Viewed by 47

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Background: The purpose of this study was to determine whether magnetic resonance imaging findings are accurate and can be confirmed surgically. Methods: Surgical correlation of preoperative magnetic resonance imaging findings of trauma to tendons and ligaments of the foot and ankle [...] Read more.

Background: The purpose of this study was to determine whether magnetic resonance imaging findings are accurate and can be confirmed surgically. Methods: Surgical correlation of preoperative magnetic resonance imaging findings of trauma to tendons and ligaments of the foot and ankle were retrospectively studied in 28 patients who had undergone surgical repair for tears of the Achilles tendon, posterior tibial tendon, peroneal tendons, collateral ligaments, and other pathology. Results: This study corroborates that magnetic resonance imaging findings are confirmed surgically 83% of the time for tears of tendons and ligaments of the foot and ankle. Larger tendons (Achilles, posterior tibial tendon) have a 94% sensitivity and 6% specificity, respectively. Collateral ligament and high ankle sprains have a 73% sensitivity. There is a lower sensitivity of 57% for peroneus brevis and longus ruptures. Conclusion: This study revealed that peroneal trauma can be an isolated event and in some cases can occur with other traumatic pathology such as collateral ligament tears.
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Open AccessArticle

Metatarsus Adductus Angle in Male and Female Feet. Normal Values With Two Measurement Techniques

by Gabriel Domínguez and Pedro V. Munuera

J. Am. Podiatr. Med. Assoc. 2008, 98(5), 364-369; https://doi.org/10.7547/0980364 - 1 Sep 2008

Cited by 32 | Viewed by 92

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Background: The literature contains several techniques for calculating metatarsal adductus angle. Most common systems use the fourth metatarsal cuboid joint and the fifth metatarsal cuboid joint. Although both systems are quite different, normal values of metatarsus adductus angle have not been established [...] Read more.

Background: The literature contains several techniques for calculating metatarsal adductus angle. Most common systems use the fourth metatarsal cuboid joint and the fifth metatarsal cuboid joint. Although both systems are quite different, normal values of metatarsus adductus angle have not been established with each system of measurement. Methods: Two hundred six radiographic images of feet in dorsoplantar projection were used to measure the metatarsus adductus angle using two different reference points: the joint between the fourth metatarsal and the cuboid and the joint between the fifth metatarsal and the cuboid. Results: Comparison of the results of the two measurement techniques showed significant differences (P < .05). The values of the metatarsus adductus angle also showed significant differences in men versus women (P < .05). The reliability of the measurements was checked by using an intra- and inter-evaluator test performed by two evaluators. Conclusion: Data showed the reliability of both systems of measurement, although significant differences in the metatarsal adductus angle mean value were found using these systems of measurement in the same foot. On the other hand, significant differences were found in mean values of metatarsus adductus angle between male and female feet. Full article

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The Short-Term Effectiveness of Full-Contact Custom-Made Foot Orthoses and Prefabricated Shoe Inserts on Lower-Extremity Musculoskeletal Pain. A Randomized Clinical Trial

by Leslie C. Trotter and Michael Raymond Pierrynowski

J. Am. Podiatr. Med. Assoc. 2008, 98(5), 357-363; https://doi.org/10.7547/0980357 - 1 Sep 2008

Cited by 22 | Viewed by 46

Abstract

Background: Foot orthoses are commonly dispensed for musculoskeletal complaints of the foot and lower limb. Few randomized clinical trials evaluate the clinical effectiveness of foot orthoses. Methods: In this randomized clinical trial with a crossover design, 42 participants wore custom orthoses [...] Read more.

Background: Foot orthoses are commonly dispensed for musculoskeletal complaints of the foot and lower limb. Few randomized clinical trials evaluate the clinical effectiveness of foot orthoses. Methods: In this randomized clinical trial with a crossover design, 42 participants wore custom orthoses and prefabricated inserts in their regular footwear for 4 weeks each, consecutively. Twenty-seven participants received prefabricated inserts first and 13 received custom orthoses first. A numeric pain rating scale (possible score, 0–10) was used to measure participant pain. Results: Statistically and clinically important decreases in pain were reported after 3 weeks by participants wearing custom orthoses first (–1.39 pain units, t₁₂ = 2.70, P = .02). Participants who wore prefabricated inserts first reported no statistically significant change in pain. When the alternative intervention was introduced, participants now wearing prefabricated inserts had greater pain after 1 and 2 weeks (1.1 pain units, t₁₂ = 3.09, P = .01 and 0.9 pain units, t₁₂ = 2.65, P = .02, respectively). Participants now wearing custom orthoses did not demonstrate significantly lower pain at any week compared with the second baseline but did have significantly lower pain scores compared with their initial baseline scores (–0.81 pain units, t₁₂ = 2.31, P = .03). Conclusion: Full-contact custom-made foot orthoses provide symptomatic relief after 3 weeks of use for patients with lower-extremity musculoskeletal pain if they are prescribed as the initial treatment. Full article

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The Incidence of Tinea Pedis in Diabetic versus Nondiabetic Patients with Interdigital Macerations. A Prospective Study

by Bradford S. Legge, John F. Grady and Autum M. Lacey

J. Am. Podiatr. Med. Assoc. 2008, 98(5), 353-356; https://doi.org/10.7547/0980353 - 1 Sep 2008

Cited by 23 | Viewed by 85

Abstract

Background: We sought to determine the incidence of tinea pedis in patients with otherwise asymptomatic pedal interdigital macerations. Both diabetic and nondiabetic populations were compared. Age and body mass index were also examined for their significance. Methods: Fungal cultures of skin [...] Read more.

Background: We sought to determine the incidence of tinea pedis in patients with otherwise asymptomatic pedal interdigital macerations. Both diabetic and nondiabetic populations were compared. Age and body mass index were also examined for their significance. Methods: Fungal cultures of skin scrapings from 80 patients (77 male and 3 female; mean age, 65 years) with interdigital macerations were performed; 40 patients had previously been diagnosed with type 2 diabetes and 40 did not have diabetes. Results: Cultures revealed a 40% prevalence of tinea pedis in the total study population. The prevalence in the nondiabetic group was 37.5% and 42.5% for the diabetic group. This was not a statistically significant difference. Among patients with interdigital macerations that yielded positive fungal cultures, those in the nondiabetic group were 6.3 years older than those in the diabetic group. It was also observed that the nondiabetic patients with interdigital macerations yielding positive fungal cultures were 9.1 years older than patients with negative fungal cultures in the nondiabetic group. Conclusion: The results of this study provide the practitioner with a guide for treating pedal interdigital macerations. Because the likelihood of a tinea pedis infection is 40%, it seems prudent to treat these macerations with an antifungal agent. In regard to age, the results suggest that as nondiabetic patients age, the likelihood of an otherwise asymptomatic interdigital maceration yielding a positive fungal culture increases, and that diabetic patients may be susceptible to interdigital fungal infections at a younger age than those without diabetes. Full article

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Role of Tissue-Type Plasminogen Activator in Salicylic Acid–Induced Sloughing of Human Corn Tissue

by Ghanshyam D. Heda and Lee K. Roberts

J. Am. Podiatr. Med. Assoc. 2008, 98(5), 345-352; https://doi.org/10.7547/0980345 - 1 Sep 2008

Cited by 7 | Viewed by 62

Abstract

Background: Plasminogen activators (PAs) and their regulatory counterparts, PA inhibitors (PAIs), play a role in normal differentiation processes and various pathophysiologic conditions of the epidermis. Normal desquamation of corneocytes from the skinʼs surface may, in part, be regulated by the balanced activities [...] Read more.

Background: Plasminogen activators (PAs) and their regulatory counterparts, PA inhibitors (PAIs), play a role in normal differentiation processes and various pathophysiologic conditions of the epidermis. Normal desquamation of corneocytes from the skinʼs surface may, in part, be regulated by the balanced activities of tissue-type PA (tPA) and PAI-2. Salicylic acid (SA) is commonly used to remove the hyperkeratotic tissue of corns, calluses, and verrucae, and it may disrupt intercellular adhesion structures; however, its exact mechanism of keratolytic action is poorly defined. We sought to determine the effects of SA by comparing the levels of PA and PAI messenger RNA (mRNA) in normal skin, untreated corns, and SAtreated corns. Methods: Untreated and SA-treated human corn tissue samples were obtained from patients electing surgery to repair bony defects that underlay their lesions. Histopathologic examination of corns was performed by staining the tissue sections with hematoxylin and eosin and by light microscopy. Polymerase chain reaction was used to compare mRNA expression of PAs and PAIs in normal skin, untreated corns, and SA-treated corns. Results: We demonstrated lower tPA and higher PAI-2 mRNA levels in corn tissue compared with normal skin. In corn tissue treated with SA, the expression of tPA mRNA increased and of PAI-2 mRNA decreased to the levels found in normal skin. Conclusion: An altered balance in tPA and PAI-2 levels contributes to the induction of hyperkeratotic corn tissue and suggests that the keratolytic action of SA is associated with its ability to stimulate proteinase-meditated desquamation processes. Full article

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J. Am. Podiatr. Med. Assoc., Volume 98, Issue 5 (09 2008) – 16 articles , Pages 345-428

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