Journal of the American Podiatric Medical Association

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In Appreciation

by Warren S. Joseph

J. Am. Podiatr. Med. Assoc. 2008, 98(6), 497; https://doi.org/10.7547/0980497 - 1 Nov 2008

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Medical literature is dependent on peer review. It is this system that ensures that published papers are of the highest quality [...] Full article

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Board Certification and Parity

by Ross E. Taubman

J. Am. Podiatr. Med. Assoc. 2008, 98(6), 495-496; https://doi.org/10.7547/0980495 - 1 Nov 2008

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The APMA Vision 2015 Plan is the blueprint for gaining universal acceptance of podiatrists as physicians within our education, training, and experience [...] Full article

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AMERICAN PODIATRIC MEDICAL ASSOCIATION OFFICIAL NOTICE. TO COMPONENT SOCIETIES AND AFFILIATED ORGANIZATIONS APMA MEETINGS HOUSE OF DELEGATES • 2009 ANNUAL SCIENTIFIC MEETING

by Ross E. Taubman and Glenn B. Gastwirth

J. Am. Podiatr. Med. Assoc. 2008, 98(6), 494; https://doi.org/10.7547/0980494 - 1 Nov 2008

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In compliance with Article 9.10.1 of the Bylaws, you are hereby notified that the Regular Meeting of the House of Delegates of the American Podiatric Med ical Association (APMA) will be held at the time and place indicated in this announcement for the [...] Read more.

In compliance with Article 9.10.1 of the Bylaws, you are hereby notified that the Regular Meeting of the House of Delegates of the American Podiatric Med ical Association (APMA) will be held at the time and place indicated in this announcement for the pur pose of receiving reports of officers and commit tees, for the annual election of officers, for action upon regularly offered amendments to the Bylaws and Administrative Procedures, and for such other bus iness as may be presented [...] Full article

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Mortality Rates and Diabetic Foot Ulcers. Is it Time to Communicate Mortality Risk to Patients with Diabetic Foot Ulceration?

by Jeffrey M. Robbins, Gerald Strauss, David Aron, Jodi Long, Jennifer Kuba and Yelena Kaplan

J. Am. Podiatr. Med. Assoc. 2008, 98(6), 489-493; https://doi.org/10.7547/0980489 - 1 Nov 2008

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Abstract

Five-year mortality rates after new-onset diabetic ulceration have been reported between 43% and 55% and up to 74% for patients with lower-extremity amputation. These rates are higher than those for several types of cancer including prostate, breast, colon, and Hodgkin’s disease. These alarmingly [...] Read more.

Five-year mortality rates after new-onset diabetic ulceration have been reported between 43% and 55% and up to 74% for patients with lower-extremity amputation. These rates are higher than those for several types of cancer including prostate, breast, colon, and Hodgkin’s disease. These alarmingly high 5-year mortality rates should be addressed more aggressively by patients and providers alike. Cardiovascular diseases represent the major causal factor, and early preventive interventions to improve life expectancy in this most vulnerable patient cohort are essential. New-onset diabetic foot ulcers should be considered a marker for significantly increased mortality and should be aggressively managed locally, systemically, and psychologically. Full article

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Penicillin and Cephalosporin Drug Allergies. A Paradigm Shift

by Robert G. Smith

J. Am. Podiatr. Med. Assoc. 2008, 98(6), 479-488; https://doi.org/10.7547/0980479 - 1 Nov 2008

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Medication hypersensitivity is a constant variable that podiatric physicians face during their professional day. To avoid potential patient harm, an understanding of penicillin and cephalosporin hypersensitivities as it pertains to podiatric medicine needs to be achieved. To accomplish this, a narrative describing the [...] Read more.

Medication hypersensitivity is a constant variable that podiatric physicians face during their professional day. To avoid potential patient harm, an understanding of penicillin and cephalosporin hypersensitivities as it pertains to podiatric medicine needs to be achieved. To accomplish this, a narrative describing the signs, symptoms, and immunologic mechanisms for the basis of penicillin and cephalosporin drug hypersensitivities is presented. Second, specific medical literature serving as clinical-based evidence to support the prescribing of cephalosporins in patients with documented penicillin allergy is presented. Finally, a review of the medical and legal literature describing health-care provider liability regarding subsequent drug hypersensitivity is presented. The information contained in this review allows for the evolving paradigm that permits the prescribing of selective cephalosporins to patients with a history of penicillin allergy as long as the allergic symptoms were not serious or life-threatening. Full article

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What’s Your Diagnosis?

by Harvey Lemont

J. Am. Podiatr. Med. Assoc. 2008, 98(6), 477-478; https://doi.org/10.7547/0980477 - 1 Nov 2008

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A 28-year-old female presents with a painful keratinous lesion overlying the dorsal aspect of the extensor hallucis tendon (Fig 1) [...] Full article

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Talar Anchor Placement for Modified Brostrom Lateral Ankle Stabilization Procedure

by Arush K. Angirasa and Michael J. Barrett

J. Am. Podiatr. Med. Assoc. 2008, 98(6), 473-476; https://doi.org/10.7547/0980473 - 1 Nov 2008

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The modified Brostrom procedure has been a proven procedure with excellent utility in the treatment of lateral ankle instability within limitation. Multiple variations of the original technique have been described in the literature to date. Included in these variations are differences in anchor [...] Read more.

The modified Brostrom procedure has been a proven procedure with excellent utility in the treatment of lateral ankle instability within limitation. Multiple variations of the original technique have been described in the literature to date. Included in these variations are differences in anchor placement, suture technique, or both. In this research study, we propose placing a bone screw anchor into the lateral shoulder of the talus rather than the typical placement at the lateral malleolus for anatomic reconstruction of the lateral ankle ligaments. Full article

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Acute Traumatic Open Posterolateral Dislocation of the Ankle Without Tearing of the Tibiofibular Syndesmosis Ligaments. A Case Report

by Bahtiyar Demiralp, Mahmut Komurcu, Cagatay Ozturk, Kutay Ozturan, Ersin Tasatan and Kaan Erler

J. Am. Podiatr. Med. Assoc. 2008, 98(6), 469-472; https://doi.org/10.7547/0980469 - 1 Nov 2008

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Pure open dislocation of the ankle, or dislocation not accompanied by rupture of the tibiofibular syndesmosis ligaments or fractures of the malleoli or of the posterior border of the tibia, is an extremely rare injury. A 62-year-old man injured his right ankle in [...] Read more.

Pure open dislocation of the ankle, or dislocation not accompanied by rupture of the tibiofibular syndesmosis ligaments or fractures of the malleoli or of the posterior border of the tibia, is an extremely rare injury. A 62-year-old man injured his right ankle in a motor vehicle accident. Besides posterolateral ankle dislocation, there was a 7-cm transverse skin cut on the medial malleolus, and the distal end of the tibia was exposed. After reduction, we made a 2- to 2.5-cm longitudinal incision on the lateral malleolus; the distal fibular fracture was exposed. Two Kirschner wires were placed intramedullary in a retrograde manner, and the fracture was stabilized. The deltoid ligament and the medial capsule were repaired. The tibiofibular syndesmosis ligaments were intact. At the end of postoperative year 1, right ankle joint range of motion had a limit of approximately 5° in dorsiflexion, 10° in plantarflexion, 5° in inversion, and 0° in eversion. The joint appeared normal on radiographs, with no signs of osteoarthritis or calcification. The best result can be obtained with early reduction, debridement, medial capsule and deltoid ligament restoration, and early rehabilitation. Clinical and radiographic features at long-term follow-up also confirm good mobility of the ankle without degenerative change or mechanical instability. Full article

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Extracorporeal Shockwave Therapy for the Treatment of Achilles Tendinopathies. A Prospective Study

by Robert Fridman, Jarrett D. Cain, Lowell Weil and Lowell Weil

J. Am. Podiatr. Med. Assoc. 2008, 98(6), 466-468; https://doi.org/10.7547/0980466 - 1 Nov 2008

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Background: Extracorporeal shockwave therapy has been shown to be effective in the treatment of chronic tendon pathology in the elbow, shoulder, and plantar fascia. This prospective study examines the efficacy of extracorporeal shockwave therapy in the treatment of chronic Achilles tendon disorders. Methods: [...] Read more.

Background: Extracorporeal shockwave therapy has been shown to be effective in the treatment of chronic tendon pathology in the elbow, shoulder, and plantar fascia. This prospective study examines the efficacy of extracorporeal shockwave therapy in the treatment of chronic Achilles tendon disorders. Methods: Twenty-three patients (23 feet) were treated with extracorporeal shockwave therapy for Achilles tendinosis, insertional tendonitis, or both. Indications for treatment were a minimum of 6 months of conservative care, and a visual analog pain score > 5. The mean follow-up was 20 months (range, 4–35 months). Results: Ninety-one percent (14 patients) were satisfied or very satisfied (23 patients) with treatment. Eighty-seven percent (20 patients) stated that extracorporeal shockwave therapy improved their condition, 13% (3 patients) said it did not affect the condition, and none stated that it made them worse. Eighty-seven percent (20 patients) stated they would have the procedure again if given the choice. Four months after extracorporeal shockwave therapy, the mean visual analog score for morning pain decreased from 7.0 to 2.3, and activity pain decreased from 8.1 to 3.1. Conclusion: High-power extracorporeal shockwave therapy is safe, noninvasive, and effective, and it has a role in the treatment of chronic Achilles tendinopathy. Full article

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Effect of a Low-Dye Application of Scotchcast Soft Cast on Peak and Mean Plantar Pressures in Subjects with a Navicular Drop Greater than 10 mm

by Julie L. Walters, Belinda S. Lange and Lucy S. Chipchase

J. Am. Podiatr. Med. Assoc. 2008, 98(6), 457-465; https://doi.org/10.7547/0980457 - 1 Nov 2008

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Abstract

Background: We investigated whether a low-Dye application of Scotchcast Soft Cast significantly altered plantar pressure distribution during gait in patients with a navicular drop greater than 10 mm. Methods: An experimental, same-subject, repeated-measures design was used. Thirty-two subjects aged 18 to 35 years [...] Read more.

Background: We investigated whether a low-Dye application of Scotchcast Soft Cast significantly altered plantar pressure distribution during gait in patients with a navicular drop greater than 10 mm. Methods: An experimental, same-subject, repeated-measures design was used. Thirty-two subjects aged 18 to 35 years were screened with the navicular drop test and were included if a navicular drop greater than 10 mm was established. The Emed-AT-2 platform system was used to measure the plantar pressure distribution under the right foot of each subject using the midgait method of data collection. Each subject performed six barefoot walks and six walks with Soft Cast applied to the right foot. Average peak and mean plantar pressure measurements were recorded for ten discrete areas (masks). The heel and midfoot were each divided into two masks, and the forefoot and toe regions were divided into three masks each. Paired t tests were used to detect differences in peak and mean plantar pressures for each mask. Results: Soft Cast significantly affected peak and mean plantar pressures in seven and nine of the ten masks, respectively. No significant change in peak or mean plantar pressure was found beneath the medial midfoot. Conclusion: Plantar pressure may represent dynamic foot and ankle joint motion. With further research, Soft Cast may provide an alternative to current management techniques in controlling foot pronation and reducing symptoms of lower-limb abnormalities. Full article

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Evaluation of Clinical and Radiographic Outcomes of Complete Subtalar Release in Clubfoot Treatment

by Onder Kalenderer, Ali Reisoglu, Ali Turgut and Haluk Agus

J. Am. Podiatr. Med. Assoc. 2008, 98(6), 451-456; https://doi.org/10.7547/0980451 - 1 Nov 2008

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Abstract

Background: We evaluated patients with unilateral clubfoot deformity who were treated by complete subtalar release according to Simons’ criteria and assessed the correlation between clinical and radiographic results. Methods: Eleven patients underwent a complete subtalar release through a Cincinnati incision. Evaluation included a [...] Read more.

Background: We evaluated patients with unilateral clubfoot deformity who were treated by complete subtalar release according to Simons’ criteria and assessed the correlation between clinical and radiographic results. Methods: Eleven patients underwent a complete subtalar release through a Cincinnati incision. Evaluation included a questionnaire and clinical and radiographic examination. Results: Mean follow-up was 12 years 8 months. The radiographic measurement differences in the diagnostic angles between normal feet and clubfeet were not significant. Shortening of the talus and the navicular bone was significant. The talar dome was flattened in seven patients and was flattened, sclerotic, and irregular in one. Flattening of the talar head was detected in eight patients, irregularity in one, and deformity and sclerosis in one. Six patients had deformity in the talonavicular joint. The navicular bone was wedge shaped in nine patients and subluxated dorsally in seven. The talar head was congruent with the navicular bone semilunar in normal feet; this relation was not detected in patients treated for clubfoot. Conclusion: Radiographic changes, such as flattening of the talar, a wedge-shaped navicular bone, dorsal navicular migration, irregularity, and lack of congruence of the talonavicular joint, can be encountered postoperatively in clinically and cosmetically healthy patients. These changes may be caused by the nature of the disease, correcting manipulations or casting, or surgical techniques. Although complete subtalar release is an effective procedure for satisfactory clinical results, maintenance of anatomical configuration, but not normal anatomical development of tarsal bones, can be achieved with this method. Full article

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Application of Cantharidin and Podophyllotoxin for the Treatment of Plantar Warts

by Ricardo Becerro de Bengoa Vallejo, Marta Elena Losa Iglesias, Beatriz Gómez-Martín, Rubén Sánchez Gómez and Antonio Sáez Crespo

J. Am. Podiatr. Med. Assoc. 2008, 98(6), 445-450; https://doi.org/10.7547/0980445 - 1 Nov 2008

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Abstract

Background: A variety of treatment modalities have been described for cutaneous warts. We sought to determine the safety and efficacy of a topical formulation of cantharidin, podophyllotoxin, and salicylic acid in the treatment of plantar warts. This combination treatment is widely used in [...] Read more.

Background: A variety of treatment modalities have been described for cutaneous warts. We sought to determine the safety and efficacy of a topical formulation of cantharidin, podophyllotoxin, and salicylic acid in the treatment of plantar warts. This combination treatment is widely used in Europe and elsewhere but has not been described in the podiatric medical literature. Methods: A retrospective study was conducted of 144 patients with simple or mosaic plantar warts who were treated with a topical, pharmacy-compounded solution of cantharidin, 1%; podophyllotoxin, 5%; and salicylic acid, 30%. All of the patients, aged 8 to 52 years (mean ± SD, 20.9 ± 11.0 years), were treated according to the authorsʼ standard protocol. Of the 144 patients, 92 were being treated for the first time. None of the 52 previously treated patients had received more than one other type of treatment in the past. Results: After 6 months of follow-up, complete eradication of the plantar warts was noted in 138 of the 144 patients (95.8%). Of these patients, 125 (86.8%) required a single application of the solution, and 13 (9.0%) needed two or more applications. No significant adverse effects or complications were observed. Conclusion: A topical solution of cantharidin, podophyllotoxin, and salicylic acid was found to be safe and effective in the treatment of simple and mosaic plantar warts. This formulation is a promising alternative treatment modality for plantar warts. Full article

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Biomechanical Risk Factors in the Development of Medial Tibial Stress Syndrome in Distance Runners

by Jo L. Tweed, Jackie A. Campbell and Steven J. Avil

J. Am. Podiatr. Med. Assoc. 2008, 98(6), 436-444; https://doi.org/10.7547/0980436 - 1 Nov 2008

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Background: We investigated the relationship between functional and static foot posture and medial tibial stress syndrome in distance runners. Methods: Twenty-eight runners with a clinical diagnosis of medial tibial stress syndrome and 12 asymptomatic runners were assessed with the Foot Posture Index to [...] Read more.

Background: We investigated the relationship between functional and static foot posture and medial tibial stress syndrome in distance runners. Methods: Twenty-eight runners with a clinical diagnosis of medial tibial stress syndrome and 12 asymptomatic runners were assessed with the Foot Posture Index to measure static overpronation. Range of motion was measured at the talocrural joint, with the knee extended and flexed as was range of motion at the first metatarsophalangeal joint and the angular difference between the neutral and relaxed calcaneal stance positions. Each participant was then videotaped while running on a treadmill shod and unshod. This videotape was analyzed using freeze frame to identify abnormal or mistimed pronation at each phase of gait. The results were analyzed using logistic regression to give the probability that a runner is likely to experience medial tibial stress syndrome, predicted from the static measurements and dynamic observations. Results: Variables identified as being significant predictors of medial tibial stress syndrome were the difference between the neutral and relaxed calcaneal stance positions, range of motion of the talocrural joint with the knee extended, early heel lift and abductory twist during gait, and apropulsive gait. Conclusion: Runners with suspected symptoms of medial tibial stress syndrome should be assessed dynamically and statically for abnormal or mistimed pronation. Full article

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Changes in Gait Economy Between Full-Contact Custommade Foot Orthoses and Prefabricated Inserts in Patients with Musculoskeletal Pain. A Randomized Clinical Trial

by Leslie C. Trotter and Michael Raymond Pierrynowski

J. Am. Podiatr. Med. Assoc. 2008, 98(6), 429-435; https://doi.org/10.7547/0980429 - 1 Nov 2008

Cited by 15 | Viewed by 46

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Background: Specific kinematic and kinetic outcomes have been used to detect biomechanical change while wearing foot orthoses; however, few studies demonstrate consistent effects. We sought to observe changes in walking economy in patients with musculoskeletal pain across 10 weeks while wearing custom-made foot [...] Read more.

Background: Specific kinematic and kinetic outcomes have been used to detect biomechanical change while wearing foot orthoses; however, few studies demonstrate consistent effects. We sought to observe changes in walking economy in patients with musculoskeletal pain across 10 weeks while wearing custom-made foot orthoses and prefabricated shoe inserts. Methods: In this crossover randomized controlled trial, 40 participants wore custommade orthoses and prefabricated inserts for 4 weeks each, consecutively. The path length ratio was used to quantify walking economy by comparing the undulating path of a point in the pelvis with its direct path averaged across multiple strides. Results: For the prefab-custom group (n = 27), significant decreases in path length ratio (improved economy of gait) were noted at the initial introduction of prefabricated inserts (P = .02) and custom orthoses (P = .02) but maintained a trend toward improved economy only while wearing custom orthoses (P = .08). For the custom-prefab group (n = 13), there was worsening of the path length ratio that was significant after removing the custom-made orthoses for 4 weeks (P = .01). Conclusion: For patients with lower-extremity musculoskeletal pain, immediate improvements in economy of gait can be expected with both interventions. It seems, however, that only the custom-made orthoses maintain economy of gait for 4 weeks. Patients who begin wearing custom-made orthoses and then wear prefabricated insoles can expect a decrease in economy of gait. Full article

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J. Am. Podiatr. Med. Assoc., Volume 98, Issue 6 (11 2008) – 14 articles , Pages 429-497

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