Journal of the American Podiatric Medical Association

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 (registering DOI) - 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, 385 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 (registering DOI) - 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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8 pages, 3785 KB

Open AccessArticle

Quantitative Assessment of the Correlation Between ‘COVID Toes’ Search Volume and COVID-19 Case Incidence and Mortality Dynamics: A Longitudinal Data-Driven Approach

by Anna E. Kotula, Rahul A. Pithadia, Ashley Wysong, Mark R. Wakefield and Yujiang Fang

J. Am. Podiatr. Med. Assoc. 2026, 116(3), 38; https://doi.org/10.3390/japma116030038 (registering DOI) - 17 Jun 2026

Abstract

COVID-19, caused by the SARS-CoV-2 virus, has become a global public health crisis with diverse clinical manifestations affecting multiple organ systems, including the integumentary system. One notable cutaneous manifestation, referred to as “COVID toes,” involves the development of pernio-like chilblains, characterized by red-to-violet [...] Read more.

COVID-19, caused by the SARS-CoV-2 virus, has become a global public health crisis with diverse clinical manifestations affecting multiple organ systems, including the integumentary system. One notable cutaneous manifestation, referred to as “COVID toes,” involves the development of pernio-like chilblains, characterized by red-to-violet macules, plaques, or nodules, primarily on toes and fingers. This characteristic clinical feature gained significant attention due to its apparent association with COVID-19, especially during the early stages of the pandemic when individuals with mild or asymptomatic cases exhibited these symptoms. Concurrently, digital platforms such as Google Trends have emerged as tools for tracking public interest in health-related topics, offering insights into real-time patterns of disease awareness. Previous research has demonstrated that Google Trends data may correlate with the incidence of infectious diseases, suggesting that search interest can be a proxy for disease outbreaks. In this study, we sought to explore the potential relationship between public interest in COVID toes, as reflected in Google Trends, and the incidence and mortality rates of COVID-19. Specifically, we examined whether peaks in search interest for “COVID toes” corresponded with surges in COVID-19 cases and deaths. By analyzing trends in search data, we aimed to assess the utility of digital platforms as an epidemiological tool for monitoring disease progression and public awareness. Our findings provide insights into the potential role of digital search data in forecasting outbreaks and highlight the interplay between public perception and the clinical burden of COVID-19, emphasizing the importance of real-time data in public health surveillance and response. Full article

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4 pages, 159 KB

Open AccessOpinion

Reconsidering Nerve Decompression Surgery in Diabetes Foot Complications

by D. Scott Nickerson

J. Am. Podiatr. Med. Assoc. 2026, 116(3), 37; https://doi.org/10.3390/japma116030037 (registering DOI) - 17 Jun 2026

Abstract

In 1988, plastic surgeon Lee Dellon in Annals of Plastic Surgery hypothesized that there was “A Cause for Optimism in Diabetic Neuropathy”. He noted that entrapment neuropathy is common in diabetic peripheral neuropathy (DPN) and explained that multiple sites of local nerve entrapment [...] Read more.

In 1988, plastic surgeon Lee Dellon in Annals of Plastic Surgery hypothesized that there was “A Cause for Optimism in Diabetic Neuropathy”. He noted that entrapment neuropathy is common in diabetic peripheral neuropathy (DPN) and explained that multiple sites of local nerve entrapment can also produce the classically described clinical picture of progressive and irreversible ‘length dependent axonopathy’. This observation has justified for him the use of nerve decompression (ND) surgery for beneficial treatment of DPN pain, diabetic foot ulcer (DFU), ulcer recurrences and their subsequent complications. Subsequent observational and controlled reports have consistently demonstrated post-operative benefit for these problems, but ND has not yet been widely adopted. The lack of an etiologic explanation of the physiology changes which would allow surgery to modify the metabolic disturbances of diabetes has likely been involved in such hesitance. Recent explanations that glycolysis is altered in diabetes through intensified polyol metabolism which produces swollen nerves, local peripheral entrapments and compression neuropathy now provide plausible associations of hyperglycemia with epidermal hypoxia and nutrition deficit. Recognition that nerve enlargements can create secondary fibro-osseous compressions explains the well-known association of diabetes and compression syndromes. Peripheral nerve entrapments damage small c-fibers and produce sympathetic autonomic as well as sensorimotor dysfunction. This explains the diminished skin microcirculation, epidermal hypoxia and nutrition deficit seen in diabetes, DPN, DFU and Charcot neuroarthropathy. Laboratory and clinical evidence has demonstrated that ND in diabetes rejuvenates at least two sympathetically commanded skin microcirculation processes and explains how surgery is producing beneficial results. This article recapitulates the literature which clarifies the processes by which ND surgery can modify painful DPN, DFU occurrence, ulcer healing, DFU recurrence risk, amputations after DFU healing, and bilateral pain relief after unilateral surgery. Full article

13 pages, 1730 KB

Open AccessArticle

Quantification of the Mechanical Response of the Plantar Fascia to Changes in Rearfoot Position

by Mark Price, Thomas Mychost, Roozbeh Naemi and Nachiappan Chockalingam

J. Am. Podiatr. Med. Assoc. 2026, 116(3), 36; https://doi.org/10.3390/japma116030036 - 3 Jun 2026

Abstract

Background: Changes in the rearfoot calcaneal position affect the foot “arch structure” during the stance phase of gait and hence influence reactions in the plantar fascia thickness and stiffness during weight bearing. However, previous research has focused on the non-weight-bearing assessment of [...] Read more.

Background: Changes in the rearfoot calcaneal position affect the foot “arch structure” during the stance phase of gait and hence influence reactions in the plantar fascia thickness and stiffness during weight bearing. However, previous research has focused on the non-weight-bearing assessment of plantar fascia thickness (PFT) and stiffness (PFS) and has not linked these measurements to rearfoot position. Methods: This study aims to investigate if a change in the weight-bearing rearfoot position influences the PFT and PFS. A linear actuator-driven 3D-printed platform was utilised to reliably move the rearfoot through a range of frontal (F (4,12) = 19,585.8, p = 0.00) and sagittal plane angles (F (2,6) = 11,751.32, p = 0.00) whilst weight bearing. An ultrasound probe capable of shear wave elastography was incorporated into the platform for the closed-chain weight-bearing assessment of the PF. The PFT and PFS were collected for 13 (26 feet) participants (11 male, two female; age 35.62 ± 15.04; BMI: 30.31± 6.22 Kg/m²) from a convenience sample who met the inclusion criteria. Results: The data were subject to appropriate statistical, collective and cluster analysis. Individual participant data analysis showed a strong nonlinear correlation between PFT and PFS in the relaxed calcaneal position. The rearfoot sagittal plane cluster demonstrated an auxetic property in 54.3% of the group, where both the PFT and PFS increased. The frontal plane cluster demonstrated an auxetic property in 76% of the group, where the PFT increased as the PFS increased. Conclusions: The results suggest that the PF does have a specific response to changes in the rearfoot position for individuals, which, in some, can show an auxetic property. Full article

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13 pages, 1530 KB

Open AccessArticle

Quantifying the Phoenix Sign: A Double-Blind Pilot Study on Lidocaine and Papaverine-Induced Vascular and Motor Changes After Common Peroneal Nerve Block in Diabetic Neuropathy

by Stephen L. Barrett, Andrew Rader, Sequioa DuCasse, Artinder Nagra, Karen Anderson, Miquel Dalmau Pastor, Dwayne S. Yamasaki and Scott Nickerson

J. Am. Podiatr. Med. Assoc. 2026, 116(3), 35; https://doi.org/10.3390/japma116030035 - 22 May 2026

Abstract

Background: Focal entrapment of the Common Peroneal (Fibular) nerve (CPN) is the most frequent lower-extremity nerve entrapment yet it can be difficult to diagnose clinically. The Phoenix Sign—an increase in extensor hallucis longus (EHL) motor strength following lidocaine injection—may assist diagnosis. Additional observed [...] Read more.

Background: Focal entrapment of the Common Peroneal (Fibular) nerve (CPN) is the most frequent lower-extremity nerve entrapment yet it can be difficult to diagnose clinically. The Phoenix Sign—an increase in extensor hallucis longus (EHL) motor strength following lidocaine injection—may assist diagnosis. Additional observed effects include improved arterial perfusion and Doppler waveforms. Methods: In this double-blinded, randomized small pilot study, only four patients (N = 4) with diabetic peripheral neuropathy underwent bilateral peripheral nerve blocks with lidocaine or papaverine. The first leg to be tested was randomized; the contralateral leg received a different agent that was randomized initially. Pre- and post-block assessments included motor strength, Doppler velocity of dorsalis pedis and posterior tibial arteries, and near-infrared spectroscopy for microvascular perfusion. Results: All patients demonstrated increased EHL motor strength after injection with either agent. Doppler waveforms of the dorsalis pedis artery improved: lidocaine produced a 151.7% increase in blood flow velocity (p = 0.03), whereas papaverine produced a 16.8% increase (p = 0.19). Posterior tibial artery flow increased by 37.4% with lidocaine (p = 0.06) and 13.9% with papaverine (p = 0.33), but neither was statistically significant. No changes in oxygen saturation, oxyhemoglobin, deoxyhemoglobin, or total hemoglobin were observed using near-infrared spectroscopy. The consistency of motor responses across subjects supports the validity of the Phoenix Sign as a diagnostic tool. Conclusions: Peripheral nerve blocks with lidocaine or papaverine improved motor strength and macrovascular function in patients with diabetic peripheral neuropathy, though microvascular changes were not detected. These preliminary findings are consistent with the Phoenix Sign phenomenon and support further study as a potential clinical indicator. While these preliminary findings indicate support as a diagnostic tool, they are preliminary and hypothesis-generating for evaluating the Phoenix Sign as a potential clinical indicator of CPN entrapment and highlight the need for larger studies to evaluate vascular responses. Trial Registration: NCT06919289 (retrospectively registered 8 April 2025). Full article

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15 pages, 5728 KB

Open AccessArticle

Clinical Value of Technetium Tc 99m Monomer Methoxy Isobutyl Isonitrile Scintigraphy for the Level of Lower-Limb Amputation in Patients with Diabetic Foot Ulcers

by Mehmet Ekici, Ali Eray Günay, Seyhan Karaçavuş, Hümeyra Gençer and Fırat Ozan

J. Am. Podiatr. Med. Assoc. 2026, 116(3), 34; https://doi.org/10.3390/japma116030034 - 21 May 2026

Abstract

Background: There is a positive relationship between mitochondrial damage in the cell and uptake in technetium Tc 99m monomer methoxy isobutyl isonitrile (^99mTc-MIBI) scintigraphy. Severe mitochondrial dysfunction with cell death occurs in patients with diabetic foot ulcers (DFUs). To decide [...] Read more.

Background: There is a positive relationship between mitochondrial damage in the cell and uptake in technetium Tc 99m monomer methoxy isobutyl isonitrile (^99mTc-MIBI) scintigraphy. Severe mitochondrial dysfunction with cell death occurs in patients with diabetic foot ulcers (DFUs). To decide on the level of amputation, ^99mTc-MIBI scintigraphy should be considered. Methods: Prospectively, 24 patients with DFUs were included in the study. Based on treatment that started with the hospitalization, patients were divided into two groups: those whose DFUs healed and did not need surgical intervention (healed group) and those whose DFUs did not regress despite surgical and medical treatment and who required further surgical intervention (reoperation group). Before surgery, ^99mTc-MIBI scintigraphy was performed. The ^99mTc-MIBI uptake rates of the injured foot relative to the healthy foot were recorded. Deep-tissue culture was taken at surgery. Erythrocyte sedimentation rate, white blood cell count, and C-reactive protein (CRP) and albumin levels were measured. Results: The ^99mTc-MIBI uptake rates of patients with poor prognosis were higher at all times than those of patients who did not require revision surgery. A significant difference was found between these values in the 10 and 30 s rates. The mean ± SD CRP level was 86.04 ± 21.87 mg/dL in the healed group and 144.43 ± 27.54 mg/dL in the reoperation group (p = 0.040). There was a positive correlation between ulcerated foot and healthy foot ^99mTc-MIBI involvement rates at 10 and 30 s and CRP values, and a negative correlation between albumin values. Conclusions: There was a significant relationship between ^99mTc-MIBI involvement rates and poor prognosis and reamputation. The correlation between CRP and albumin levels, which are among the predictive values, and ^99mTc-MIBI uptake confirmed this relationship in DFUs, which are difficult to manage and treat. Full article

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11 pages, 575 KB

Open AccessArticle

Comparison of ChatGPT-5 and DeepSeek V3 for Artificial Intelligence-Assisted Patient Education in Foot and Ankle Disorders

by Bekir Karagoz, Hünkar Cagdas Bayrak and Tolga Keçeci

J. Am. Podiatr. Med. Assoc. 2026, 116(3), 33; https://doi.org/10.3390/japma116030033 - 21 May 2026

Abstract

Background: This study aims to compare the quality, reliability, and readability of information provided by artificial intelligence-based language models, ChatGPT-5 and DeepSeek V3, regarding foot and ankle disorders. Methods: The quality, reliability, and readability of the texts generated by both AI models were [...] Read more.

Background: This study aims to compare the quality, reliability, and readability of information provided by artificial intelligence-based language models, ChatGPT-5 and DeepSeek V3, regarding foot and ankle disorders. Methods: The quality, reliability, and readability of the texts generated by both AI models were analyzed using DISCERN, the Patient Education Materials Assessment Tool for Printable Materials (PEMAT-P), the Global Quality Score (GQS), and the CLEAR scoring system. DISCERN was used to assess information reliability, PEMAT-P to evaluate understandability and actionability, GQS to assess overall quality, and CLEAR to evaluate content quality and accuracy. Standardized questions were asked to both models for 35 different foot and ankle disorders, and the generated texts were evaluated by two independent orthopedic specialists using a blinded method. Readability analysis was performed using word count, the Flesch–Kincaid Grade Level (FKGL; required reading level), and the Flesch Reading Ease (FRE; ease of readability) scoring systems. Results: ChatGPT-5 scored significantly higher than DeepSeek V3 in DISCERN, PEMAT-P, GQS, and CLEAR evaluations (p < 0.05), indicating that ChatGPT-5 provides more reliable, comprehensive, and higher-quality information. DeepSeek V3 demonstrated better readability, producing simpler and more understandable content, as reflected in its lower FKGL score and higher FRE score. Conclusions: While ChatGPT-5 delivers more detailed and reliable health information, DeepSeek V3 offers simpler and more readable texts. Both models have distinct advantages for patient education. Future research should assess the impact of AI-generated health information on patient decision-making and its clinical application potential. Full article

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17 pages, 365 KB

Open AccessArticle

Healthcare Provider Knowledge and Utilization of the Medicare Therapeutic Shoe Benefit

by Carol Szmuilowicz Kurth and Ryan Thomas Crews

J. Am. Podiatr. Med. Assoc. 2026, 116(3), 32; https://doi.org/10.3390/japma116030032 - 20 May 2026

Abstract

The Therapeutic Shoe Benefit (TSB) allows Medicare insurance beneficiaries to reduce their diabetic foot ulcer risk by providing offloading shoes. Anecdotal evidence suggests that the process is cumbersome and that not all providers are aware of this benefit. This study evaluated TSB awareness [...] Read more.

The Therapeutic Shoe Benefit (TSB) allows Medicare insurance beneficiaries to reduce their diabetic foot ulcer risk by providing offloading shoes. Anecdotal evidence suggests that the process is cumbersome and that not all providers are aware of this benefit. This study evaluated TSB awareness across multiple healthcare disciplines and documented barriers to utilization. An online study surveyed healthcare providers practicing in the United States to determine familiarity with TSB and barriers to prescribing therapeutic shoes. The project was IRB-reviewed and received exempt status. The survey was sent to a wide variety of healthcare practitioners including: podiatrists, primary care providers, physical therapists, orthotist/prosthetists, specialty providers, and diabetes educators. This was done through targeted emails from professional organizations, word-of-mouth messaging through private practice groups, and marketing on LinkedIn. The survey was administered via Qualtrics with embedded branching logic used to gather data from the TSB’s three classifications of healthcare specialists: certifying physicians, prescribing practitioners, and suppliers. A total of 580 valid completions of the survey were analyzed. Irrespective of the TSB, podiatric physicians and medical professionals providing direct patient care recommend supportive shoes for patients with diabetes 98.2% (336/342) of the time. When asked about knowledge of the TSB, 522 or 90% of respondents indicated awareness of this Medicare benefit. Knowledge by specialty was hard to differentiate due to low responses by some specialties; however, prescribing podiatrists and prosthetic providers both responded with a familiarity rate above 92%. Common obstacles to providers prescribing shoes were: complexity of documentation (67.8%), challenges communicating with other providers (55.0%), and financial reasons/labor-to-reimbursement ratio (38.4%). TSB has the potential to reduce amputations and wound care costs. However, therapeutic shoes are underutilized with less than 20% of potential beneficiaries accessing this benefit. This research strengthens the argument that streamlining the process may increase access to therapeutic shoes. Full article

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10 pages, 617 KB

Open AccessOpinion

Social Isolation and Limb Preservation: The Case for the Podiatric Connection Model (PCM)

by Arthur Charles Evensen and Jamie Leigh Moore

J. Am. Podiatr. Med. Assoc. 2026, 116(3), 31; https://doi.org/10.3390/japma116030031 - 14 May 2026

Abstract

Loneliness and social isolation are increasingly recognized as major determinants of health, with physiologic and behavioral effects that rival traditional biomedical risk factors. Populations commonly treated in podiatric practice, including older adults, patients with diabetes, rural residents, and veterans, are disproportionately affected by [...] Read more.

Loneliness and social isolation are increasingly recognized as major determinants of health, with physiologic and behavioral effects that rival traditional biomedical risk factors. Populations commonly treated in podiatric practice, including older adults, patients with diabetes, rural residents, and veterans, are disproportionately affected by social isolation, yet its impact on foot and ankle outcomes remains underrecognized. Emerging evidence demonstrates that loneliness alters immune regulation, inflammatory signaling, pain perception, adherence behaviors, and healthcare utilization, all of which directly influence wound healing, postoperative recovery, and limb preservation. This paper introduces the Podiatric Connection Model (PCM), a clinically actionable framework designed to integrate social connection into podiatric care. The PCM provides a structured approach for identifying social risk factors, strengthening therapeutic relationships, engaging caregivers, tailoring follow-up intensity, and monitoring evolving psychosocial needs throughout the course of treatment. By reframing loneliness as a modifiable comorbidity rather than a background social issue, the PCM offers a practical strategy for improving adherence, reducing complications, and strengthening healing trajectories in high-risk foot and ankle populations. Full article

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10 pages, 354 KB

Open AccessArticle

Responsible AI for Personalized Patient Education and Engagement Across Medical Conditions: Leveraging Multi-Agent LLMs, Ambient Technology, and NotebookLM—A Case Study in Diabetes Education and Limb Preservation

by Shayan Mashatian, Shu-Fen Wung, Aaron Ritter, Jessica Fishman, Jeffrey Robbins, Shereen Aziz, Michelle Huo and David G. Armstrong

J. Am. Podiatr. Med. Assoc. 2026, 116(3), 30; https://doi.org/10.3390/japma116030030 - 8 May 2026

Cited by 1

Abstract

Background: Effective communication with patients is vital for improving health outcomes in chronic disease management. In this study, we investigated WoundScribeAI’s Scribe AI, also known as Ambient Technology, and its patient education and engagement app, Pingoo.AI. It employed a multi-agent AI model [...] Read more.

Background: Effective communication with patients is vital for improving health outcomes in chronic disease management. In this study, we investigated WoundScribeAI’s Scribe AI, also known as Ambient Technology, and its patient education and engagement app, Pingoo.AI. It employed a multi-agent AI model that leveraged Large Language Models (LLMs) and NotebookLM to enhance patient communication in clinical settings. Methods: The system comprised specialized agents that transcribed healthcare provider–patient conversations through ambient dictation. This transcription generated medical notes that followed the Subjective, Objective, Assessment, and Plan (SOAP) format—a structured document used by healthcare providers to record and communicate information about patient encounters. Simultaneously, comprehensive visit summaries were also created. In the next step, these visit summaries were used to produce conversational and educational content by leveraging NotebookLM, an AI model introduced by Google that can generate podcast-style conversations from provided information. Integrating these agents allows clinicians to deliver engaging, empathetic, and actionable information to patients. Medical experts conducted a two-phase evaluation of the system’s performance based on multiple criteria, with a particular focus on diabetes education and diabetic foot care. The first phase used pre-recorded training videos, while the second phase involved simulated consultations by clinicians using the system. To validate the AI-generated educational content, we used several established frameworks in health communication that closely align with our enhancement goals. Results: The results showed that the AI model generated accurate clinical documentation and met the criteria for accurate SOAP Notes, visit summaries, and engaging educational content for patients. Given that hallucination is a significant concern related to large language models, especially in critical fields like healthcare, we meticulously analyzed the generated outputs to identify any signs of hallucinated information. Three outcomes successfully passed the validation criteria, including accuracy, completeness, comprehensiveness, absence of potential harm, and no hallucination. Additionally, the Conversational Education content was confirmed against established patient education frameworks and met criteria such as the use of metaphors, empathetic tone, and appropriate language, providing additional detail to help manage the condition. Conclusions: By providing specific instructions and prompts to NotebookLM to transform visit summaries into educational conversations, we significantly enhanced the comprehensiveness and engagement of the content for patients. In contrast to a traditional summary of the clinical visit, the podcast-style conversation enriched the content with background information, encouraging language, an empathetic tone, and helpful metaphors. Our analysis confirmed that the system did not exhibit any hallucinations, highlighting the effectiveness of our approach in mitigating this risk. These findings support the use of multi-agent AI models, combined with ambient dictation and tools like NotebookLM, to improve patient communication that surpasses traditional paper-based brochures, which are often impersonal, minimal, and do not always adhere to recommended factors for health literacy. Full article

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9 pages, 661 KB

Open AccessArticle

The Association Between Footwear Choices, Foot Problems, and Lower Extremity Pain Attributes in Individuals Engaged in Prolonged Standing

by Meltem Koç, Elif Kulet, Merve Samur, İkra Akyürek and Kılıçhan Bayar

J. Am. Podiatr. Med. Assoc. 2026, 116(3), 29; https://doi.org/10.3390/japma116030029 - 8 May 2026

Abstract

Background: Prolonged standing can lead to musculoskeletal disorders, especially in the lower extremities, when appropriate footwear is not used. The aim of this study is to investigate the relationship between footwear styles, foot problems, and pain characteristics related to lower extremities in individuals [...] Read more.

Background: Prolonged standing can lead to musculoskeletal disorders, especially in the lower extremities, when appropriate footwear is not used. The aim of this study is to investigate the relationship between footwear styles, foot problems, and pain characteristics related to lower extremities in individuals with prolonged standing. Methods: A descriptive, cross-sectional study design was employed, using a random sample of individuals with prolonged standing (n = 159). Participants were asked questions about their footwear choices. They were asked to mark the lower extremity pain localization on the McGill Pain Map. In addition, foot deformities were evaluated by physical examination. Results: The findings revealed that most females (n = 88) and males (n = 71) preferred flat/sports footwear styles in both summer and winter. There was no significant difference between footwear styles and foot pain duration, intensity, and localization in both genders (p > 0.05). However, a statistically significant difference was observed among males between their summer footwear styles and pain related to lower extremities (low back pain and knee pain), and among females between their summer footwear styles and foot problems (bone deformities, skin pathologies and soft tissue issues) (p < 0.05). Conclusions: The results of this study show that the preferred footwear style was associated with lower extremity pain and foot problems, which emphasized the importance of footwear selection and footwear evaluation in the musculoskeletal evaluation of the lower extremities. Full article

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8 pages, 732 KB

Open AccessArticle

Measuring the Forefoot-to-Rearfoot Relationship in the Sagittal Plane—A Novel Measurement for Evaluating Pseudoequinus in the Lower Extremity

by Joseph C. D’Amico and Samantha Landau

J. Am. Podiatr. Med. Assoc. 2026, 116(3), 28; https://doi.org/10.3390/japma116030028 - 25 Apr 2026

Abstract

Evaluation of the static angle of the forefoot-to-rearfoot relationship in the sagittal plane is essential in determining the degree of pseudoequinus in the lower extremity. The concept of an increased sagittal plane forefoot-to-rearfoot relationship is generally referred to as anterior equinus, which may [...] Read more.

Evaluation of the static angle of the forefoot-to-rearfoot relationship in the sagittal plane is essential in determining the degree of pseudoequinus in the lower extremity. The concept of an increased sagittal plane forefoot-to-rearfoot relationship is generally referred to as anterior equinus, which may result in a pseudoequinus syndrome. As its name implies, pseudoequinus is not a true lack of ankle joint dorsiflexion but rather a condition wherein the ankle joint functions as if it were restricted. Currently, the literature lacks specifications on how to obtain this measurement. Qualitative methods exist to identify an increased sagittal plane forefoot-to-rearfoot relationship whereby the clinician observes whether the patient has an anterior equinus or pseudoequinus present. However, no method has been reported that is suitable for structured evaluation determining the degree of pseudoequinus present. Evaluation of this measurement is important in understanding the overall magnitude of equinus influence present and its concomitant effects on the superstructure. This article describes a new method for measuring the static angle for the sagittal plane forefoot-to-rearfoot relationship using an orthopedic evaluation device. The results of this study indicated that this measurement yielded high interrater and intrarater reliabilities. In effect, this is a simple-to-perform analytics assessment that, as part of comprehensive biomechanical examination, will provide the astute clinician with additional insights into the cause and effect of pathomechanical foot and limb function. Full article

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12 pages, 1207 KB

Open AccessCase Report

Structured Multi-Modal Rehabilitation Program for FHL Tendinitis and Os Trigonum Excision: A Case Report

by Başar Öztürk and Beyza Başer Öztürk

J. Am. Podiatr. Med. Assoc. 2026, 116(3), 27; https://doi.org/10.3390/japma116030027 - 24 Apr 2026

Abstract

Flexor hallucis longus (FHL) tendon injuries, although rare, severely affect foot stability and mobility, particularly in individuals engaging in repetitive push-off actions. This case study examines a 27-year-old male who underwent surgical repair for FHL tendon rupture, followed by a structured, multi-modal rehabilitation [...] Read more.

Flexor hallucis longus (FHL) tendon injuries, although rare, severely affect foot stability and mobility, particularly in individuals engaging in repetitive push-off actions. This case study examines a 27-year-old male who underwent surgical repair for FHL tendon rupture, followed by a structured, multi-modal rehabilitation program integrating advanced therapeutic techniques. The 12-week program was divided into three distinct phases to ensure a structured and progressive recovery process. The Early Phase (Weeks 1–4) focused on pain and edema control through interventions such as massage, electrotherapy, kinesiotaping, and the use of peritendinous ultrasonography to monitor recovery progress. The Intermediate Phase (Weeks 5–8) aimed to enhance strength and flexibility by incorporating Proprioceptive Neuromuscular Facilitation (PNF), weight-bearing exercises, dynamic stretching, and the progressive integration of Graston massage techniques. Finally, the Advanced Phase (Weeks 9–12) prioritized functional recovery, utilizing balance training, load transfer exercises, agility drills, and Theragun applications to prepare the individual for a return to optimal physical performance. Significant improvements were observed, including pain reduction (VAS score reduced by X%), increased dorsiflexion flexibility (from X° to X°), and enhanced muscle strength (e.g., tibialis anterior strength increased by X%). Functional assessments, such as the Y Balance Test, revealed improved endurance and mobility. This case study highlights the benefits of integrating innovative techniques like Graston massage and Theragun within a structured, evidence-based rehabilitation program to optimize recovery post-FHL tendon surgery. Full article

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12 pages, 2323 KB

Open AccessArticle

From Pain to Search: Mapping USA and Global Interest in Plantar Fasciitis

by Bülent Alyanak and Fatih Bağcıer

J. Am. Podiatr. Med. Assoc. 2026, 116(3), 26; https://doi.org/10.3390/japma116030026 - 24 Apr 2026

Abstract

Background: Plantar fasciitis is a leading cause of heel pain, affecting approximately 10% of the population. Despite its prevalence, treatments may result in symptom recurrence and chronicity, which can significantly increase patient dissatisfaction. Google Trends provides insights into public interest through search volume [...] Read more.

Background: Plantar fasciitis is a leading cause of heel pain, affecting approximately 10% of the population. Despite its prevalence, treatments may result in symptom recurrence and chronicity, which can significantly increase patient dissatisfaction. Google Trends provides insights into public interest through search volume analysis. This study examines global and USA trends in plantar fasciitis, focusing on temporal, seasonal, and income-based variations. Methods: Google Trends data for “Plantar Fasciitis” (2004–2024) were analyzed for both global and USA search trends. Monthly and seasonal search volumes were grouped by time and location. Regression and post hoc tests were conducted to identify significant patterns. Comparisons were made between high- and low-income states in the USA. Results: Public interest in plantar fasciitis increased significantly over time, both globally (R² = 0.871, p < 0.001) and in the USA (R² = 0.854, p < 0.001). Interest peaked in summer and declined in winter, with seasonal differences significant worldwide (p < 0.05). Monthly variations were significant only in the USA. No significant difference was found between high- and low-income states (p > 0.05). Conclusions: Interest in plantar fasciitis has grown steadily, reflecting its prevalence and impact. The findings emphasize the need for accessible, high-quality information to address public demand. These insights can guide healthcare professionals and policymakers in developing targeted resources. Full article

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11 pages, 1839 KB

Open AccessArticle

Impact of Chronic Ankle Instability Following Ankle Sprain on Ankle Dorsiflexion, Heel Lift Function, and Quality of Life

by Jia Wang, Haomin Li, Xiantie Zeng and Guijun Xu

J. Am. Podiatr. Med. Assoc. 2026, 116(3), 25; https://doi.org/10.3390/japma116030025 - 24 Apr 2026

Abstract

Background: Chronic ankle instability (CAI) post-sprain leads to persistent functional deficits. This study evaluated CAI’s specific impact on ankle dorsiflexion, heel lift function, stability, broader functional impairments, and quality of life. Methods: A case–control study enrolled 100 CAI patients (post-ankle sprain) [...] Read more.

Background: Chronic ankle instability (CAI) post-sprain leads to persistent functional deficits. This study evaluated CAI’s specific impact on ankle dorsiflexion, heel lift function, stability, broader functional impairments, and quality of life. Methods: A case–control study enrolled 100 CAI patients (post-ankle sprain) and 100 healthy controls. Ankle strength (isokinetic dynamometer), stability (pressure plate), maximum dorsiflexion/plantar flexion ROM (mobility meter), functional limitations (0–10 activity scale), pain (VAS), coordination (Agility T-test, figure-of-eight test), and quality of life (FAOS) were compared. ANOVA and Mann–Whitney U tests were used. Results: Compared to controls, the CAI group showed significantly reduced ankle dorsiflexion strength (114.53 ± 10.47 N vs. 156.34 ± 13.26 N), heel lift strength (78.69 ± 5.44 N vs. 105.45 ± 8.28 N), stability scores (4.73 ± 0.52 vs. 8.65 ± 0.71 points), and ROM (dorsiflexion: 16.49° ± 1.23° vs. 22.35° ± 1.65°; plantar flexion: 27.58° ± 6.51° vs. 43.27° ± 5.45°). CAI patients reported higher activity limitation (6.34 ± 1.25 vs. 2.16 ± 0.55) and pain (5.37 ± 1.02 vs. 0.23 ± 0.01) and prolonged Agility T-test (11.24 ± 1.37 s vs. 7.51 ± 1.16 s) and figure-of-eight (16.35 ± 1.67 s vs. 12.43 ± 1.39 s) times. FAOS subscale scores (symptoms, daily activities, sports, pain) were significantly lower in the CAI group. All p < 0.05. Conclusions: CAI significantly compromises ankle dorsiflexion, heel lift strength, stability, and functional mobility, correlating with increased pain, activity restriction, and diminished quality of life. Rehabilitation should prioritize neuromuscular re-education, strength restoration, and dynamic stability training to improve outcomes. Full article

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14 pages, 259 KB

Open AccessArticle

There Is No Role for Extracorporeal Shock Wave Therapy in Chronic Insertional Achilles Tendinopathy: A Comparative Study with Conservative Treatment

by İbrahim Ulusoy, Mehmet Yılmaz, Mehmet Fırat Tantekin, İsmail Güzel and Aybars Kıvrak

J. Am. Podiatr. Med. Assoc. 2026, 116(3), 24; https://doi.org/10.3390/japma116030024 - 24 Apr 2026

Abstract

Background: Chronic insertional Achilles tendinopathy (CIAT) is a type of tendinopathy resistant to conventional conservative treatments. The efficacy of extracorporeal shock wave therapy (ESWT) remains controversial. This study aims to evaluate the effects of ESWT on pain management and functional improvement in CIAT [...] Read more.

Background: Chronic insertional Achilles tendinopathy (CIAT) is a type of tendinopathy resistant to conventional conservative treatments. The efficacy of extracorporeal shock wave therapy (ESWT) remains controversial. This study aims to evaluate the effects of ESWT on pain management and functional improvement in CIAT patients and compare it with physical and medical treatments Methods: In this retrospective study, 372 patients diagnosed with CIAT between 2019 and 2023 were evaluated. The patients were divided into two groups: those who received only physical/medical therapy (Group 1) and those who underwent a combination of ESWT and physical/medical therapy (Group 2). Clinical outcomes were assessed using the American Orthopedic Foot and Ankle Society (AOFAS) score and the Visual Analog Scale (VAS) scores. The severity of the disease was determined through magnetic resonance imaging (MRI). Group comparisons were conducted using the independent samples t-test and Fisher’s exact test, while changes over time were assessed with repeated measures ANOVA. Correlation analyses were evaluated using Pearson and Spearman correlation coefficients. Results: Significant improvement in AOFAS and VAS scores was observed in both groups by the third month (p < 0.01). However, at 6 and 12 months, ESWT did not demonstrate superiority over physical/medical treatment. Correlation analysis showed a positive relationship between baseline AOFAS scores and functional improvement, while higher initial VAS scores correlated with greater post-treatment pain reduction. Cardiovascular risk factors negatively impacted both functional recovery and pain reduction (p < 0.05). Although patient satisfaction was higher in the ESWT group, the difference was not statistically significant. Conclusions: ESWT may provide short-term pain relief and functional improvement in CIAT but does not offer a long-term advantage over physical/medical treatment. The placebo effect may contribute to early positive outcomes. These findings do not support ESWT as a routine treatment for CIAT. Full article

7 pages, 2316 KB

Open AccessCase Report

Osteochondroma of the Sesamoid Bone: A Case Report

by Mustafa Karahan, Damla Unal Zilcioglu and Huseyin Karahan

J. Am. Podiatr. Med. Assoc. 2026, 116(3), 23; https://doi.org/10.3390/japma116030023 - 24 Apr 2026

Abstract

Osteochondromas are the most common benign bone tumors; however, they are rarely found in the foot. To date, only three cases involving the sesamoid bone have been reported in the literature. We report the case of a 14-year-old female who presented with a [...] Read more.

Osteochondromas are the most common benign bone tumors; however, they are rarely found in the foot. To date, only three cases involving the sesamoid bone have been reported in the literature. We report the case of a 14-year-old female who presented with a 1.5-year history of foot pain and impaired gait. Clinical evaluation and imaging—including plain radiography and magnetic resonance imaging—identified a lesion in the medial sesamoid bone. The diagnosis of osteochondroma was confirmed histologically, and the lesion was excised with preservation of the sesamoid bone. Postoperatively, the patient’s pain resolved completely, and her gait returned to normal within two months. We recommend surgical excision of symptomatic osteochondromas of the sesamoid bone to alleviate pain and restore functional gait. Full article

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15 pages, 1261 KB

Open AccessArticle

Outcomes of Lapidus Procedure Without Focused Frontal Plane Rotation of the First Metatarsal

by Alan Banks, Chandler Ligas, Donald Scot Malay and Shayla Robinson

J. Am. Podiatr. Med. Assoc. 2026, 116(3), 22; https://doi.org/10.3390/japma116030022 - 23 Apr 2026

Abstract

Background: We present a retrospective radiographic analysis showcasing the ability to correct hallux valgus using the Lapidus arthrodesis without focused frontal plane rotation of the first metatarsal. Methods: A total of 33 feet in 30 patients who had undergone Lapidus arthrodesis [...] Read more.

Background: We present a retrospective radiographic analysis showcasing the ability to correct hallux valgus using the Lapidus arthrodesis without focused frontal plane rotation of the first metatarsal. Methods: A total of 33 feet in 30 patients who had undergone Lapidus arthrodesis for the treatment of hallux abducto valgus deformity from 1 August 2015 to 31 December 2020 were identified. The median age of the cohort was 55.4 years (range, 33–78 years), 23 were female (76.7%), three (10%) underwent bilateral Lapidus arthrodesis, and the median duration of follow-up was 15.9 months (range, 5–72 months). Results: The median (minimum, maximum) preoperative first intermetatarsal angle was 16° (13°, 28°), and at final follow-up it was 5° (0°, 6°) (p < 0.001). The median (minimum, maximum) preoperative hallux abductus angle was 37° (26°, 51°), and at final follow-up it was 8.5° (0°, 22.5°) (p < 0.001). The median (minimum, maximum) preoperative tibial sesamoid position was 6 (4, 7), and at final follow-up it was 3 (2, 5) (p = 0.001). Conclusions: We found the radiographic first metatarsal lateral round sign to be ambiguous. Qualitative comparison of the results of this investigation with prior studies describing outcomes following Lapidus arthrodesis with focused frontal plane rotation of the first metatarsal suggests that similar outcomes can be achieved without employment of a decisive frontal plane rotation of the first metatarsal. Our findings lead us to believe that correction of substantial hallux abducto valgus deformities can be accomplished using the Lapidus procedure combined with lateral release of the first metatarsophalangeal joint without focused derotation of the first metatarsal. Full article

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Journal of the American Podiatric Medical Association

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