Journal of the American Podiatric Medical Association

12 pages, 12453 KB

Open AccessArticle

Correlation Analysis Between Hip Internal Rotation Range and Plantar Pressure During Standing And Walking

by Ziyang Yang, Chen Yan, Xiaocong Yan, Chanchan Ge, Desheng Jiang, Niyuan Hu, Zhenghao Xue and Ying Qin

J. Am. Podiatr. Med. Assoc. 2026, 116(4), 24144; https://doi.org/10.7547/24-144 - 14 Aug 2026

Cited by 2

Abstract

Context: Different studies on football players with fifth metatarsal stress fractures have found that hip internal rotation (HIR)range of motion is significantly reduced, while lateral forefoot pressure is significantly increased; therefore, the purpose of this study was to determine whether HIR range [...] Read more.

Context: Different studies on football players with fifth metatarsal stress fractures have found that hip internal rotation (HIR)range of motion is significantly reduced, while lateral forefoot pressure is significantly increased; therefore, the purpose of this study was to determine whether HIR range of motion is related to lateral plantar pressure. Methods: The study included 120 college students (60 males and 60 females). HIR was measured using a smartphone inclinometer app in the prone position and a compass app in the supine position. Plantar pressure was assessed using the Gaitview AFA-50 system during standing and walking. Correlation analysis was performed using SPSS 27.0. Results: Among all subjects, HIR activity in the prone position was significantly negatively correlated with standing second through fourth metatarsophalangeal joints(MTPJ2-4), fifth metatarsophalangeal joint (MTPJ5), and midfoot (FM)pressures and significantly positively correlated with standing first toe (T1)pressure. During walking, there is a significant negative correlation between HIR in the prone position and MTPJ2-4, MTPJ5, FM, and lateral heel (LH). Similarly, in the supine position, HIR is significantly negatively correlated with MTPJ2-4, MTPJ5, FM, medial heel (MH), and LH. Conclusion: There is a significant negative correlation between HIR and lateral plantar pressure, indicating that reduced HIR is associated with increased lateral plantar pressure. Improving HIR through targeted rehabilitation may reduce lateral plantar pressure, offering new approaches for non-surgical treatment of little toe capsulitis and reducing the risk of fifth metatarsal stress fractures. Full article

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10 pages, 1067 KB

Open AccessArticle

Novel Approach to Plantar Fasciitis Treatment: Pulsed Electromagnetic Field Therapy

by Christopher Bromley, Caitlyn McManus and Daniel McManus

J. Am. Podiatr. Med. Assoc. 2026, 116(4), 1-10; https://doi.org/10.7547/24-136 - 13 Aug 2026

Cited by 2

Abstract

n/a Full article

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10 pages, 1107 KB

Open AccessArticle

Optimizing Ankle Fracture Outcomes with Short-Term Postoperative Immobilization

by Zaigang Dong, Wenze Liu, Kai Lei, Xiaole Xue, Biao Ning and Xuebin Zhang

J. Am. Podiatr. Med. Assoc. 2026, 116(4), 1-15; https://doi.org/10.7547/24-128 - 13 Aug 2026

Abstract

n/a Full article

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6 pages, 139 KB

Open AccessEditorial

N95 Usage During the COVID-19 Pandemic

by Nicole M. DeLauro, Nader Ghobrial and Dong Yu

J. Am. Podiatr. Med. Assoc. 2026, 116(4), 1-6; https://doi.org/10.7547/20-101 - 13 Aug 2026

Cited by 1

Abstract

n/a Full article

7 pages, 783 KB

Open AccessCase Report

Angioleiomyoma of the Hindfoot: A Rare Cause of Chronic Heel Pain

by Alec Wroblewski, Hayden Bush, Devon Niewohner, Jung Wha Kim-Shapiro and John Bonvillian

J. Am. Podiatr. Med. Assoc. 2026, 116(4), 53; https://doi.org/10.3390/japma116040053 - 4 Aug 2026

Abstract

Angioleiomyoma is a benign soft tissue tumor originating from the smooth muscle of vascular structures. Though relatively uncommon, it frequently occurs in the lower extremities and is often misdiagnosed due to its nonspecific clinical presentation. We report the case of a 54-year-old female [...] Read more.

Angioleiomyoma is a benign soft tissue tumor originating from the smooth muscle of vascular structures. Though relatively uncommon, it frequently occurs in the lower extremities and is often misdiagnosed due to its nonspecific clinical presentation. We report the case of a 54-year-old female with chronic posterolateral heel pain initially attributed to insertional Achilles tendinopathy and Haglund’s deformity. After failure of conservative management, MRI revealed a well-circumscribed subcutaneous lesion with signal characteristics concerning for a soft tissue neoplasm. Surgical excision was performed, and histopathologic analysis confirmed a venous-type angioleiomyoma, characterized by thick-walled vascular channels and smooth muscle proliferation without atypia. Immunohistochemistry was positive for SMA, weakly positive for desmin, and ERG-positive in the vascular endothelium. The patient experienced complete symptom resolution postoperatively. Although not exceedingly rare, angioleiomyomas remain underrecognized in clinical practice, particularly in the foot and ankle, resulting in diagnostic delays averaging over five years. MRI demonstrated characteristic features described in recent literature, validating its utility in preoperative assessment. This case reinforces the importance of maintaining a broad differential when evaluating chronic, focal heel pain and supports the use of advanced imaging and histopathologic confirmation in atypical cases. Greater awareness of angioleiomyomas can help reduce diagnostic delays and improve outcomes in patients with chronic, unexplained soft tissue pain in the foot and ankle. Full article

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10 pages, 1002 KB

Open AccessArticle

Mobility of the First Ray in Feet with and Without Hallux Valgus

by Patricia Granados-Gómez, María Reina-Bueno, Mercedes Gómez-Castro and Pedro V. Munuera-Martínez

J. Am. Podiatr. Med. Assoc. 2026, 116(4), 52; https://doi.org/10.3390/japma116040052 - 24 Jul 2026

Abstract

Background: This study aimed to describe the dorsiflexion and plantarflexion motion of the first ray in feet with and without hallux valgus. Methods: Eight hundred feet were examined and classified into normal feet without hallux valgus (n = 227) and feet with [...] Read more.

Background: This study aimed to describe the dorsiflexion and plantarflexion motion of the first ray in feet with and without hallux valgus. Methods: Eight hundred feet were examined and classified into normal feet without hallux valgus (n = 227) and feet with hallux valgus (n = 387). Dorsiflexion and plantarflexion of the first ray were quantified with a handheld ruler. Univariate comparisons of the first ray mobility were made between feet with and without hallux valgus. A two-stage cluster analysis was performed to define the range of dorsiflexion and plantarflexion values in both groups. Odds Ratios were obtained to determine whether dorsiflexion or plantarflexion showed more influence on hallux valgus. Multinomial logistic regression was used to predict the probability of having or not having hallux valgus, given dorsiflexion and plantarflexion of the first ray as independent variables. Results: Dorsiflexion showed statistically significant differences between groups (p = 0.011) but with a small effect size (Rosenthal’s r = 0.10). Plantarflexion showed statistically significant differences between groups (p < 0.001) with a larger effect size (r = 0.71). Range of dorsiflexion was between 6 and 7 mm in both normal and hallux valgus feet. Range of plantarflexion in normal feet was 6–7 mm, and in hallux valgus feet 4–5 mm. Logistic regression showed that plantarflexion of the first ray had higher influence on HV than dorsiflexion. Conclusions: In hallux valgus feet, plantarflexion of the first ray was significantly lower than in normal feet, suggesting that a decreased range of plantarflexion is strongly related to hallux valgus. Full article

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10 pages, 615 KB

Open AccessArticle

Extracorporeal Magnetotransduction Therapy (EMTT) for Midfoot Osteoarthritis: A Prospective Pilot Study of Pain and Functional Outcomes

by Rohan Charles, Alexander Vlasak and Elizabeth Bondi

J. Am. Podiatr. Med. Assoc. 2026, 116(4), 51; https://doi.org/10.3390/japma116040051 - 10 Jul 2026

Abstract

Extracorporeal magnetotransduction therapy (EMTT) is a high-energy electromagnetic modality that delivers field strengths of 80–150 mT, effective transduction power > 60 kT/s, and dual-frequency architecture with pulse repetition near 8 Hz and oscillations of 100–300 kHz. This prospective pilot study evaluated pain and [...] Read more.

Extracorporeal magnetotransduction therapy (EMTT) is a high-energy electromagnetic modality that delivers field strengths of 80–150 mT, effective transduction power > 60 kT/s, and dual-frequency architecture with pulse repetition near 8 Hz and oscillations of 100–300 kHz. This prospective pilot study evaluated pain and functional outcomes in patients with symptomatic midfoot osteoarthritis (OA). Eight patients (13 feet; five bilateral and three unilateral cases) with radiographic Kellgren–Lawrence (KL) grade 3 or 4 midfoot OA received eight EMTT sessions over four weeks. Outcomes were measured at baseline, after the eighth treatment at four weeks, and at 3-month and 6-month follow-up using the 0–10 Visual Analog Scale (VAS) and Foot and Ankle Ability Measure—Activities of Daily Living (FAAM-ADL). VAS demonstrated a significant overall effect of time (F(3,36) = 3.93, p = 0.016), with mean scores decreasing from 4.15 ± 1.63 at baseline to 2.62 ± 1.98 at 3 months and 3.00 ± 2.08 at 6 months. Bonferroni-adjusted baseline-to-follow-up contrasts approached significance at 3 months (p = 0.067) and were not significant at 6 months (p = 0.150). FAAM-ADL improved significantly over time (F(3,30) = 13.76, p < 0.001), increasing from 61.7% ± 9.9% at baseline to 81.8% ± 11.1% at 6 months. No treatment-related adverse events were observed; one participant proceeded to surgery by 6 months and was classified as a treatment failure. These preliminary findings suggest that EMTT is safe and may provide clinically meaningful functional improvement in selected patients with midfoot OA; larger sham-controlled trials are needed. Full article

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12 pages, 638 KB

Open AccessArticle

Proprioception and Balance in Young Adults with Pes Planus

by Fatma Betul Yardimci, Zeynep Yilmaz and Bahar Anaforoglu

J. Am. Podiatr. Med. Assoc. 2026, 116(4), 50; https://doi.org/10.3390/japma116040050 - 8 Jul 2026

Abstract

Background: Pes planus is a common foot deformity that may lead to both structural and functional consequences. This alteration in foot morphology has been associated with changes in neurosensory mechanisms such as proprioception and balance. This study aims to evaluate proprioception and [...] Read more.

Background: Pes planus is a common foot deformity that may lead to both structural and functional consequences. This alteration in foot morphology has been associated with changes in neurosensory mechanisms such as proprioception and balance. This study aims to evaluate proprioception and balance parameters in young adults with pes planus by comparing them with healthy individuals. Methods: This case–control study, which had a quantitative and cross-sectional design, included a total of 90 volunteer university students aged 18–30. The presence of pes planus was assessed using the Navicular Drop Test. Proprioception assessment was performed using a digital goniometer to measure active and passive joint position sense, while balance assessment was performed using the Y Balance Test. Results: The groups were similar in terms of demographic and anthropometric characteristics (p > 0.05). In the proprioception assessment, a significant difference was observed in active joint position sense scores in individuals with pes planus (p = 0.032). In contrast, no significant difference was found between the two groups in terms of passive joint position sense (p = 0.769). According to the Y Balance Test results, no difference was observed in the anterior and posteromedial directions (p = 0.690 and p = 0.806). At the same time, the balance performance of individuals with pes planus was significantly lower in the posterolateral direction (p = 0.045). Conclusions: Young individuals with flexible pes planus showed differences in active joint position sense and balance performance in the posterolateral direction. This situation shows that pes planus may be associated with not only structural but also neurosensory functions. The findings highlight the importance of planning protective interventions early. In the future, there is a need for longitudinal studies conducted with larger and more heterogeneous samples, including rigid type pes planus. Full article

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6 pages, 181 KB

Open AccessCase Report

Daptomycin-Induced Eosinophilic Pneumonia in a Patient Treated for MRSA Foot Infection: A Case Report

by Ogechi Okafor, Julius Rey Angelo R. Agorilla and Lee C. Rogers

J. Am. Podiatr. Med. Assoc. 2026, 116(4), 49; https://doi.org/10.3390/japma116040049 - 8 Jul 2026

Cited by 1

Abstract

Daptomycin is widely used for serious methicillin-resistant Staphylococcus aureus (MRSA) infections, but it can cause eosinophilic pneumonia, an uncommon and potentially severe adverse drug reaction. We report probable daptomycin-induced eosinophilic pneumonia (DIEP) in a 77-year-old woman receiving intravenous daptomycin with rifampin for a [...] Read more.

Daptomycin is widely used for serious methicillin-resistant Staphylococcus aureus (MRSA) infections, but it can cause eosinophilic pneumonia, an uncommon and potentially severe adverse drug reaction. We report probable daptomycin-induced eosinophilic pneumonia (DIEP) in a 77-year-old woman receiving intravenous daptomycin with rifampin for a postoperative MRSA foot infection with concern for orthopedic-device involvement and osteomyelitis. Daptomycin had been initiated 10 days before admission, when she developed acute hypoxemic respiratory failure with bilateral ground-glass and consolidative opacities on chest computed tomography and a negative evaluation for infection. Daptomycin was discontinued on the day of admission, yet respiratory failure progressed, requiring mechanical ventilation. Bronchoalveolar lavage performed after corticosteroid exposure demonstrated eosinophilia (9%), and she improved with systemic corticosteroids and supportive care. Although she did not meet strict FDA “most likely/definite” criteria, the temporal association, compatible imaging, exclusion of alternative etiologies, abnormal lavage eosinophilia, and clinical response following drug withdrawal support “probable” DIEP criteria. Clinicians managing complex foot infections should consider DIEP when new respiratory symptoms and infiltrates develop during daptomycin therapy, even early in the treatment course and even when peripheral eosinophilia is absent or minimal. Full article

9 pages, 4054 KB

Open AccessArticle

Lateral Column Lengthening Effect on Total Subtalar Joint Range of Motion: A Pilot Study

by Patrick DeHeer, Tyler Sten, William Wolfe and Peter Sorensen

J. Am. Podiatr. Med. Assoc. 2026, 116(4), 48; https://doi.org/10.3390/japma116040048 - 7 Jul 2026

Abstract

Lateral column lengthening (LCL) calcaneal osteotomy is a well-established surgical procedure used in flexible flatfoot reconstructive surgery. The effects of LCL on subtalar joint (STJ) range of motion (ROM) have not been thoroughly explored in the literature. Our study aimed to objectively measure [...] Read more.

Lateral column lengthening (LCL) calcaneal osteotomy is a well-established surgical procedure used in flexible flatfoot reconstructive surgery. The effects of LCL on subtalar joint (STJ) range of motion (ROM) have not been thoroughly explored in the literature. Our study aimed to objectively measure the average decrease in the total ROM of the STJ following LCL. A retrospective cohort study was conducted on 15 patients (20 feet) who underwent LCL for various indications. Data for STJ ROM was collected from both the preoperative and postoperative periods. Mean follow-up for the cohort was 12 weeks postoperatively. The mean total preoperative STJ ROM was 39.65 ± 2.52 degrees, while the mean total postoperative STJ ROM was 19.17 ± 2.62 degrees (p < 0.001). This represents a statistically significant reduction of 20.48 degrees (48% decrease) in STJ ROM from preoperative to postoperative measurements. This study provides the first objective measurement of the STJ ROM decrease following LCL calcaneal osteotomy on patients in vivo. The findings highlight the substantial impact of the procedure on the ROM in the STJ. These results have important implications for patient management and should be considered when evaluating the outcomes of LCL procedures. Further research is warranted to explore the functional consequences and long-term effects of the reduced STJ ROM and to develop strategies for optimizing foot function in patients undergoing this procedure. Full article

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10 pages, 727 KB

Open AccessArticle

Comparison of Oral Versus Intravenous Antibiotics for the Treatment of Diabetic Foot Osteomyelitis: A Propensity-Matched, Retrospective Cohort Study

by Colin Tkatch, Steven Bair and Andrew J. Hale

J. Am. Podiatr. Med. Assoc. 2026, 116(4), 47; https://doi.org/10.3390/japma116040047 - 5 Jul 2026

Abstract

Background: Diabetic foot osteomyelitis (DFO) poses significant challenges due to its high morbidity and recurring nature. Current treatments involve prolonged antibiotics and often surgical intervention; however, the optimal route of antibiotic administration is unknown. This study evaluated the effect of route of antibiotic [...] Read more.

Background: Diabetic foot osteomyelitis (DFO) poses significant challenges due to its high morbidity and recurring nature. Current treatments involve prolonged antibiotics and often surgical intervention; however, the optimal route of antibiotic administration is unknown. This study evaluated the effect of route of antibiotic administration on treatment failure among patients with diabetic foot osteomyelitis. Methods: The authors conducted a retrospective cohort study among patients with unresected diabetic foot osteomyelitis. A propensity score was used to match the treatment exposure groups. The primary outcome was treatment failure, defined as either (1) treatment with additional antibiotic course or (2) additional surgical debridement/amputation at the original site of infection within 1 year of initial treatment. Secondary outcomes included the impacts of hemoglobin A1c, peripheral arterial disease, obesity, and infection severity on treatment failure. Results: Among 152 patients meeting criteria, 49 matched pairs were analyzed. Treatment failure rates did not significantly differ between oral and intravenous groups (OR 0.98, 95% CI 0.30–3.19, p > 0.9). A time-to-event analysis similarly found no significant outcome disparities between groups (p = 0.3). Conclusions: The study results support the previously published literature that demonstrates comparable treatment outcomes between routes of antibiotic administration when treating diabetic foot osteomyelitis. Full article

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18 pages, 719 KB

Open AccessSystematic Review

Post-Surgical Pyoderma Gangrenosum Following Foot and Ankle Surgery: A Systematic Review

by Biao Zhang, Kayla Obradovic, Rochelle Greenberg and Samuel Adegboyega

J. Am. Podiatr. Med. Assoc. 2026, 116(4), 46; https://doi.org/10.3390/japma116040046 - 1 Jul 2026

Abstract

Post-surgical pyoderma gangrenosum (PSPG) is a challenging diagnosis associated with significant morbidity, often misidentified as postoperative infections, leading to inappropriate management. This systematic review aims to elucidate the characteristics, management strategies, and outcomes of PSPG in the context of foot and ankle surgery [...] Read more.

Post-surgical pyoderma gangrenosum (PSPG) is a challenging diagnosis associated with significant morbidity, often misidentified as postoperative infections, leading to inappropriate management. This systematic review aims to elucidate the characteristics, management strategies, and outcomes of PSPG in the context of foot and ankle surgery to improve diagnostic accuracy and patient care. A systematic literature search was conducted across multiple databases, including PubMed, Scopus, and Embase, for cases of PSPG following foot and ankle surgery published up to January 2023. Data on demographics, clinical presentation, management, and outcomes were extracted and analyzed. Ten cases met the inclusion criteria, predominantly females presenting with rapidly worsening and painful postoperative ulcers. A high rate of negative cultures was observed during the patients’ treatment period. Dermatology consults initially suspected 83.33% of the cases. Notably, 30% of patients underwent amputation of various parts of the lower extremity, all diagnosed more than 35 days after symptom onset, and were female. The mainstream treatment for PSPG involved systemic immunosuppressants, with corticosteroids being the most common, effectively resolving symptoms in the majority of instances. PSPG should be suspected in patients with unexplained, worsening postoperative wounds. Early recognition and appropriate treatment with immunosuppressants are crucial to prevent severe outcomes. Multidisciplinary management involving dermatologists and surgeons is recommended to optimize patient outcomes. Further research is needed to establish robust diagnostic and management protocols for PSPG in the surgical context. Full article

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11 pages, 238 KB

Open AccessArticle

by Mustafa Salış, Boran Yalçın, Bülent Çağlar Bilgin, Ezgi Salış, Alaettin Ünsal and Didem Arslantaş

J. Am. Podiatr. Med. Assoc. 2026, 116(4), 45; https://doi.org/10.3390/japma116040045 - 29 Jun 2026

Abstract

Background: Diabetes mellitus (DM) is a metabolic disease with an increasing global prevalence. It is characterized by chronic and systemic complications. Due to these complications, DM significantly impacts patients’ health-related quality of life (HRQoL). One of the most critical complications of DM [...] Read more.

Background: Diabetes mellitus (DM) is a metabolic disease with an increasing global prevalence. It is characterized by chronic and systemic complications. Due to these complications, DM significantly impacts patients’ health-related quality of life (HRQoL). One of the most critical complications of DM is diabetic foot ulcers (DFUs), which have serious consequences for patients and healthcare systems. Objective: This study aimed to investigate variables potentially associated with HRQoL in patients with DFUs presenting to our wound care unit. Methods: This prospective cross-sectional study was conducted from February to May of 2023 at the Wound Care Unit of the General Surgery Department at Eskişehir City Hospital. A total of 209 patients who agreed to participate were included in the study. Data were collected via a structured questionnaire developed based on the literature, which included the Diabetic Foot Ulcer Scale–Short Form (DFS-SF). We used the Kolmogorov–Smirnov test, univariate analyses (Mann–Whitney U and Kruskal–Wallis tests), and multiple linear regression. Results: In the multivariate analysis, receipt of foot care education (p < 0.001), frequency of hospital applications due to DFU (p = 0.008), and Wagner classification (p = 0.012) were found to be predictors of HRQoL for DFUs (Adjusted R² = 0.206, F = 4.365, p < 0.001). Conclusions: To maintain a high HRQoL among DFU patients, they should immediately apply to specialized Wound Care Units, receive education, especially regarding early diagnosis and treatment, and receive multidisciplinary management for DFU. Full article

17 pages, 545 KB

Open AccessArticle

Association Between Plantar Pressure Distribution and Postural Stability in Patients with Diabetic Foot: A Cross-Sectional Study

by Yağmur Uysal, Yavuz Aslan and Esra Atılgan

J. Am. Podiatr. Med. Assoc. 2026, 116(4), 44; https://doi.org/10.3390/japma116040044 - 29 Jun 2026

Abstract

Plantar load distribution and postural stability are key functional domains in diabetic foot assessment, yet their association in early-stage disease remains poorly characterized. This study aimed to investigate the association between static plantar load distribution and postural stability parameters in 31 patients with [...] Read more.

Plantar load distribution and postural stability are key functional domains in diabetic foot assessment, yet their association in early-stage disease remains poorly characterized. This study aimed to investigate the association between static plantar load distribution and postural stability parameters in 31 patients with early-stage diabetic foot (Meggitt–Wagner grade 0–1). A cross-sectional study was conducted with 31 participants (mean age 58.48 ± 9.53 years; 51.6% with loss of protective sensation). Static plantar load distribution was assessed using the Tekscan Pressure Measurement System (Presto-Scan DB software) and postural stability was assessed using the Nintendo Wii Balance Board^® under bipedal eyes-open, bipedal eyes-closed, and single-leg stance conditions. Spearman correlation analyses with Benjamini–Hochberg false discovery rate (FDR) correction were performed. A rearfoot-dominant loading pattern was observed bilaterally (right: 61.5 ± 8.2%; left: 61.8 ± 7.9%). Mean CoP sway velocity was 4.78 ± 1.98 mm/s (eyes open) and 5.76 ± 1.88 mm/s (eyes closed) in bipedal stance. No statistically significant associations between plantar load distribution and CoP parameters were found after FDR correction (all q > 0.05). Adults with early-stage diabetic foot exhibit a rearfoot-dominant loading pattern and sensory-dependent postural control behavior. The absence of significant cross-domain associations suggests that static plantar load distribution and postural stability represent complementary assessment targets. Future controlled studies with matched healthy comparators are needed to determine clinical significance. Full article

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8 pages, 738 KB

Open AccessArticle

Association Between Minimally Invasive Osteotomy Techniques and Bunion Correction Outcomes

by Daniel Lowe, Jade Henckel, Leon Rosefigura, Chin-I Cheng, Vanessa Adelman and Ronald Adelman

J. Am. Podiatr. Med. Assoc. 2026, 116(4), 43; https://doi.org/10.3390/japma116040043 - 25 Jun 2026

Abstract

Background: Minimally invasive surgery (MIS) for hallux valgus (HAV) correction may benefit from using the medial eminence to enhance lateral capital fragment translation. This study investigates whether osteotomy placement through the medial eminence correlates with improved HAV and forefoot width (FW) correction. A [...] Read more.

Background: Minimally invasive surgery (MIS) for hallux valgus (HAV) correction may benefit from using the medial eminence to enhance lateral capital fragment translation. This study investigates whether osteotomy placement through the medial eminence correlates with improved HAV and forefoot width (FW) correction. A retrospective analysis of 20 patients who underwent MIS bunion correction was performed. Pre- and postoperative radiographs were reviewed to assess hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), sesamoid position, osteotomy location, osteotomy angle, capital fragment shift, and forefoot width. Pearson correlation and multivariable linear regression were used to identify associations. Chart review was performed at the one-year mark for complications (recurrence, infection, non-union, hardware failure). Significant correlations were found between DMAA and HVA (r = 0.883, p < 0.001), DMAA and IMA (r = 0.573, p = 0.008), and HVA and capital fragment shift (r = 0.541, p = 0.014). Osteotomy location and angle were not significantly associated with correction. Multivariable analysis showed DMAA was independently associated with HVA correction (β = 0.679, p < 0.001), and both capital fragment shift and metatarsal head angulation were associated with FW narrowing. Additionally, no patients in this cohort experienced complications. Use of the medial eminence in MIS osteotomy was not associated with improved HAV or FW correction. Angular deformity parameters and lateral fragment shift were more predictive of radiographic outcomes. Full article

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14 pages, 61023 KB

Open AccessCase Report

Avoidance of Major Amputation After Deep Vein Arterialization and Advanced Wound Management in a Patient with Diabetes and No Direct Revascularization Options: A Case Report

by Mohammad Hossain, Timothy Cheung, Anahita Dua and Sara Rose-Sauld

J. Am. Podiatr. Med. Assoc. 2026, 116(4), 42; https://doi.org/10.3390/japma116040042 - 24 Jun 2026

Abstract

Chronic limb-threatening ischemia (CLTI) in patients with no conventional targets for revascularization presents a formidable challenge in limb salvage. Deep venous arterialization (DVA) is an emerging endovascular approach that redirects arterial blood flow into the venous system to perfuse the ischemic foot. Despite [...] Read more.

Chronic limb-threatening ischemia (CLTI) in patients with no conventional targets for revascularization presents a formidable challenge in limb salvage. Deep venous arterialization (DVA) is an emerging endovascular approach that redirects arterial blood flow into the venous system to perfuse the ischemic foot. Despite early promising results, appropriate wound management of the ischemic foot following a DVA procedure has been described in the literature, albeit infrequently and with limited standardization. Here, we present a case of an 85-year-old male with multiple comorbidities, including peripheral artery disease and a prior right above-knee amputation (AKA), who underwent a successful left-sided DVA following an open transmetatarsal amputation (TMA) for infection. A staged wound care approach with guillotine amputation, delayed revision and skin grafting ultimately preserved his only remaining limb and allowed for ambulation. This case underscores the potential of DVA as a limb-saving option in complex “no-option” patients when paired with multidisciplinary care and tailored wound management. Full article

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7 pages, 567 KB

Open AccessCase Report

Offloading Adherence for Appearance’s Sake?

by Ryan T. Crews, Nahir Negron-Fernandez, Sai V. Yalla, Adam E. Fleischer, Andrew J. M. Boulton, Neil D. Reeves, Loretta Vileikyte and Noah J. Rosenblatt

J. Am. Podiatr. Med. Assoc. 2026, 116(3), 41; https://doi.org/10.3390/japma116030041 - 18 Jun 2026

Abstract

Introduction: Offloading adherence (OA) is critical for diabetic foot ulcer (DFU) healing. This report investigated whether DFU patients with low overall OA (<20%) limit offloading device usage to days they come to the clinic. Methods: Activity monitors measured OA 24 h/day. [...] Read more.

Introduction: Offloading adherence (OA) is critical for diabetic foot ulcer (DFU) healing. This report investigated whether DFU patients with low overall OA (<20%) limit offloading device usage to days they come to the clinic. Methods: Activity monitors measured OA 24 h/day. Daily walking and standing OA were calculated for up to four weeks, and participants self-reported their cumulative adherence. Each day was classified as to whether a DFU-related clinic visit occurred. Results: Four participants from an ongoing RCT were identified with <20% overall adherence, despite self-reporting 65–80% adherence. Most days they did not wear their devices at all, while the majority of wear-days coincided with footcare visits. Conclusions: This report describes a cohort that had low daily OA yet consistently wore their devices to the clinic and self-reported inflated OA. To improve OA and DFU healing, more research is needed to understand this phenomenon and help clinicians ascertain adherence during patient encounters. Full article

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8 pages, 3107 KB

Open AccessArticle

Effect of Insoles on Plantar Fascia Tension During Running in Individuals with Flatfoot

by Misa Morioka, Tomoya Takabayashi, Honoka Nishiguchi, Takanori Kikumoto and Masayoshi Kubo

J. Am. Podiatr. Med. Assoc. 2026, 116(3), 40; https://doi.org/10.3390/japma116030040 - 18 Jun 2026

Abstract

Background: Plantar fasciitis is a common condition likely caused by abnormal foot alignment, such as flatfoot. Insoles are commonly used to treat flatfoot, and systematic reviews have shown that insoles improve pain; however, the underlying mechanism is unclear. This study aimed to [...] Read more.

Background: Plantar fasciitis is a common condition likely caused by abnormal foot alignment, such as flatfoot. Insoles are commonly used to treat flatfoot, and systematic reviews have shown that insoles improve pain; however, the underlying mechanism is unclear. This study aimed to investigate the effects of insoles on plantar fascial tension during running in individuals with flatfoot. Methods: The participants were 14 individuals with flatfoot. The task involved running under two conditions: with and without insoles. Insoles that absorbed the shock and supported the medial longitudinal arch were used. The foot marker trajectories and ground reaction forces were measured during running sessions. The plantar fascia tension was estimated based on the ground reaction force, moment arm of the ground reaction force, and that of plantar fascia. Statistical parametric mapping was used to compare the plantar fascia tension during the stance phase between the two conditions. Results: When running with and without insoles, the peak plantar fascial tension was observed at midstance. Planar fascial tension was significantly lower with insoles over a wider range during the stance phase than that without insoles (p < 0.05). Conclusions: This study provided evidence that insoles can reduce plantar pain while running. This result may be useful for reducing pain in individuals with flatfoot and preventing the onset of plantar fasciitis. Full article

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12 pages, 426 KB

Open AccessReview

Reducing Lower Extremity Amputations via Peer Support Interventions: A Scoping Review

by Sophia A. Sorrentino, Brittany M. Cook, Sanam N. Jhaveri, Mohammad S. Javed, Tze-Woei Tan, David G. Armstrong and Ryan T. Crews

J. Am. Podiatr. Med. Assoc. 2026, 116(3), 39; https://doi.org/10.3390/japma116030039 - 17 Jun 2026

Abstract

Patients with diabetes and/or peripheral artery disease (PAD) are at risk for lower limb amputation and a subsequently higher mortality risk. Peer support interventions have been shown to increase diabetes self-management and glycemic control. This scoping review aims to synthesize the current literature [...] Read more.

Patients with diabetes and/or peripheral artery disease (PAD) are at risk for lower limb amputation and a subsequently higher mortality risk. Peer support interventions have been shown to increase diabetes self-management and glycemic control. This scoping review aims to synthesize the current literature on peer support interventions in reducing lower limb amputations. A PubMed search was conducted in June of 2023, excluding publications prior to 2000, focusing on two themes: (1) peer support and (2) the patient population of interest (i.e., individuals with diabetic foot disease and/or PAD). Studies were included if they addressed the population of interest, involved a peer support intervention to improve lower extremity health, and had outcomes pertaining to the health of the lower extremities or programmatic metrics such as participant satisfaction or program adherence. Out of 1730 publications initially identified, six met the inclusion criteria. These six studies were categorized as group foot care education studies (n = 4) or group cognitive behavioral studies (n = 2). The group foot care education studies showed mixed results, which varied from no effect to significant improvements in foot care, self-management, and complications. There was a trend of improvement in self-management behaviors and physical activity in cognitive behavioral interventions. Despite showing promise in other settings, there have been limited investigations of peer support interventions to improve lower extremity outcomes and avert amputations in persons with diabetes and/or PAD. Further studies are required to conclusively determine the efficacy of peer support interventions to reduce lower extremity amputation rates. Full article

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Journal of the American Podiatric Medical Association

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