Journal of the American Podiatric Medical Association

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

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

► Show Figures

Figure 1

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

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

► Show Figures

Figure 1

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 (registering DOI) - 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

► Show Figures

Figure 1

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

► Show Figures

Figure 1

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

► Show Figures

Figure 1

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

► Show Figures

Figure 1

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

► Show Figures

Figure 1

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

► Show Figures

Figure 1

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

► Show Figures

Figure 1

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

► Show Figures

Figure 1

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 - 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

► Show Figures

Figure 1

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 - 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

► Show Figures

Figure 1

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

► Show Figures

Figure 1

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

► Show Figures

Figure 1

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

► Show Figures

Figure 1

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

► Show Figures

Figure 1

Journal Description

Journal of the American Podiatric Medical Association

Latest Articles

Journal Menu

Journal Browser

Highly Accessed Articles

Latest Books

E-Mail Alert

News

Topics

Conferences

Special Issues

Further Information

Guidelines

MDPI Initiatives

Follow MDPI