Journal of the American Podiatric Medical Association最新文献

Objectives: Flat feet is a very common deformity in children. Often, radiologic evaluation for children with flat feet is made. Although the measurement reliability of some angles in flat feet has been evaluated in the literature, none of them have been performed in the age range of 3-7 years, when the deformity is most common. Our aim is to evaluate the interobserver and intraobserver reliability of the 7 angles that are used for assessing flat feet.

Methods: Radiologic angles were measured by four independent observers (two specialists and two residents) in two separate sessions on the foot radiographs of 50 children aged 3-7 years with clinically diagnosed flat feet in the appropriate position and intra-class correlation coefficient was evaluated. Thus, interobserver and intraobserver reliability was measured.

Results: High reliability values were found in the AP talus - 1st metatarsal (APT1MT) angle and calcaneus inclination (CI) angle, while the reliability was moderate in the other angles. Intra-observer reliability values tended to be higher than interobserver values, which is consistent with other studies.

Conclusions: It is useful to keep in mind that the measurement reliability is moderate except for APT1MT and CI when angles are measured in this specific age group. No positive effect of experience on measurement reliability was found in our study.

Level of evidence: 3, Case control Study.

Neuropathic ulcerations are a common complication in patients with diabetes mellitus. Failure to manage diabetic foot ulcers can lead to devastating consequences in this patient population. There are a variety of approaches that the clinician and surgeon alike can take to prevent morbidity and mortality in patients with diabetic foot ulcers. Likewise, providers are constantly searching for new ways to help improve patient outcomes. We present an innovative technique in the management of cleft wound defects that are common in central ray foot amputations. The case involves a 66-year-old, type 2 diabetic male presenting to the emergency department with an infected diabetic foot ulcer to the central metatarsal heads. Our technique of combining external fixation with advanced wound care products offered this patient a stable, plantigrade, and ulcer-free foot at 1-year follow-up.

Background: The purpose of this study was to evaluate the efficacy and significance of using an independently designed triangular calcaneal distractor in percutaneous poking reduction and internal fixation for treating Sanders type II and III calcaneal fractures.

Methods: Forty patients with unilateral closed calcaneal fractures treated at our hospital from May 2021 to May 2022 were selected and randomly divided into a treatment group (20 cases treated with a triangular distractor and closed poking reduction) and a control group (20 cases treated with closed reduction and internal fixation). Standardized postoperative treatment was administered to both groups. The surgical duration, number of fluoroscopic exposures, and postoperative calcaneal height and Böhler's angle at 3 days and 3 months were recorded.

Results: In the treatment group, the Böhler angle and the calcaneal height was measured at 3 days and 3months after the operation. There were no statistically significant differences in the calcaneal height or the Böhler angle between the two groups (P > .05). There were also no statistically significant differences in the calcaneal height or the Böhler angle within each group at different time points (P > .05). The treatment group had a shorter surgical duration and only two to three fluoroscopic exposures compared with the control group. The differences between the groups were statistically significant (P < .05).

Conclusions: For Sanders type II and III calcaneal fractures, the triangular distractor enables more precise traction reduction and screw placement during poking reduction treatment, helping to shorten the surgical duration and reduce the number of required intraoperative fluoroscopic exposures (lowering the radiation exposure for surgeons and patients).

Background: Diabetic foot ulcers are a leading cause of major limb amputations in diabetic patients. Timely intervention through early diagnosis of vascular insufficiency and aggressive ulcer management may mitigate these risks. This study evaluated the relationship between early and delayed referral pattern and major amputation and the impact of the coronavirus disease (COVID) 2019 pandemic on associated rates.

Methods: This retrospective cohort study analyzed records from type 2 diabetic patients over 30 years old with lower-extremity ulcers treated at Western Michigan Health clinics between June 1, 2018, and December 31, 2021. The study period was divided into pre-COVID (59 patients) and intra-COVID (92 patients) phases. Patients were followed until diabetic foot ulcer resolution, death, amputation, or loss to follow-up. Early referral was defined as within 4 weeks after ulcer diagnosis. Referral rates to specialists and the use of noninvasive studies such as the ankle-brachial index were examined.

Results: Overall, 151 patients met the inclusion criteria. A total of 11 underwent major amputations, with a trend toward increased rates during the intra-COVID period. There was no significant difference in major amputation rates between early and delayed referrals. Although many of the major amputations had early referrals, this was likely due to late presentation. The study highlighted significant underutilization of noninvasive imaging, with only 37% of patients undergoing ankle-brachial index testing. Wound documentation inconsistencies and variability undermined the reliability of findings and patient treatment. No protocol was identified in ulcer management.

Conclusions: Delayed referrals did not significantly affect major amputation rates, suggesting that factors other than referral timing may influence outcomes. The COVID-19 pandemic led to an increase in amputation rates, possibly owing to pandemic-related lapses in care. Underutilization of noninvasive vascular studies and lack of consistent treatment protocols represent missed opportunities for early intervention. Enhanced provider training, protocol-driven care, and consistent use of noninvasive vascular studies may help prevent major amputations.

Background: Correct use of the feet, step techniques, and positions constitute significant factors in the success of a dancer. Moreover, the type of dance has crucial effects on the posture of the foot and ankle. Therefore, the primary aim of our study was to determine whether there was a relationship between dancesport, dance experience (years), shoe-wearing time (hours), and shoe heel height (centimeters) in dance athletes performing Sportive Latin American Ballroom (SLAB) dance. Second, we aimed to compare the foot posture of SLAB dancers and nondancers with similar demographic characteristics.

Methods: Twenty-six professional SLAB dancers and 26 nondancers who had similar demographic characteristics and did not use high-heeled shoes volunteered to take part in this study. Foot posture (using the Foot Posture Index [FPI]), foot pronation (using the navicular drop test [NDT]), tibiocalcaneal angle, hallux valgus angle (HVA) (using a goniometer), and ankle dorsiflexion range of motion (ROM) (using the weightbearing lunge test) were evaluated.

Results: There was a positive moderate correlation between FPI score and shoe-wearing time on the dominant (P = .041; r = 0.40) and nondominant (P = .026; r = 0.43) sides. A positive very good correlation was found between shoe heel height and HVA (P < .001; r = 0.75). A negative good correlation was observed between years of dancing and nondominant ankle dorsiflexion ROM (P = .027; r = -0.43). When dancers and nondancers were compared, a statistically significant difference was found between FPI and NDT scores (P < .001). The FPI and NDT scores, tibiocalcaneal angle, HVA, and ankle dorsiflexion ROM were significantly greater in the dancer group compared with the nondancer group (P < .001) in all measurements of the dominant and nondominant sides.

Conclusions: Revealing the relationship between dance experience and shoe-wearing time and the difference between the foot posture and deformities of athletes who perform SLAB dance and those of nondancers constitutes a pivotal endeavor that will increase awareness and knowledge among dancers and clinicians.

Background: Medial column nails have been introduced into Charcot's neuroarthropathy reconstruction as superconstruct fixation with high fatigue strength and pullout resistance. Similar to intramedullary nailing throughout other long-bone fixation, injury to neurovascular and musculotendinous structures secondary to percutaneous interlocking screw fixation may exist. We sought to identify structures at risk for injury during the interlocking of a medial column nail.

Methods: Medial column nails were inserted into ten cadaveric limbs. The proximal (talar), middle (first metatarsal), and distal (first metatarsal) locations for the interlocking screws were drilled, and a 0.062 Kirschner wire was inserted into respective drillholes to simulate interlocking screws. After dissection, the distances of each Kirschner wire to nearby anatomical structures were measured. Levels of risk were assigned to each soft-tissue structure based on distance to each Kirschner wire: high (0-3.5 mm), intermediate (3.6-7.0 mm), and low (>7.0 mm). A 3.5-mm threshold for each category was used because this represented a multiple of the diameter of the interlocking screws. Mean ± SD and ranges are reported for structures at high and intermediate risk for injury.

Results: Proximally, the deltoid ligament (ten of ten), posterior tibial tendon (eight of ten), and saphenous vein (six of ten) were at high or intermediate risk for injury consistently. At the middle screw, the medial dorsal cutaneous nerve and the medial marginal vein were at high or intermediate risk in ten and eight specimens, respectively. At the distal interlocking screw, the medial dorsal cutaneous nerve was at high risk for injury in all ten specimens.

Conclusions: There is high and intermediate risk to many musculotendinous and neurovascular structures when performing percutaneous interlocking screws in a medial column nail. These findings serve to educate surgeons of the anatomical considerations they must have when performing medial column nailing for reconstruction of Charcot's foot.

Background: Work-related musculoskeletal disorders have become a leading occupational health problem in health-care professionals. This study aims to bring attention to a growing problem by reporting the prevalence, risk factors, and workplace interventions related to work-related musculoskeletal disorders in Singapore podiatric physicians.

Methods: All of the podiatric physicians in Singapore were eligible to participate. A self-administered survey that included questions from the Nordic Musculoskeletal Questionnaire was used to understand their work practice and musculoskeletal symptoms. Data on workplace interventions for prevention were also collected.

Results: A 50% response rate was achieved (n = 50); 72% of respondents attributed their musculoskeletal pain to work, of which 40% had pain affecting activities of daily living and almost half recorded consequent absenteeism. The neck, wrist/hand, and lower back were most frequently affected. For one-third, pain onset occurred early in professional practice. Ergonomic factors were the predominant cause. Women (odds ratio, 6.7; 95% confidence interval, 1.0-42.8) and those with self-reported poor posture during clinical work (odds ratio, 6.7; 95% confidence interval, 1.0-45.1) were possible risk factors. Trends of higher body mass index, long hours of continuous clinical work, and higher mental stress at work were also observed. Only 26% of respondents reported workplace interventions. Work organization and ergonomic interventions were thought to be most effective.

Conclusions: Work-related musculoskeletal disorders are a significant health problem in podiatric physicians that cause disability and impact work through absenteeism. Occupational health practitioners should raise awareness of work-related risks and engage the profession to identify mitigating strategies.

Background: We examined the effects of foot dominance and body mass on foot plantar pressures in regular-weight, overweight, and obese older women.

Methods: Ninety-six women were divided into the regular-weight group (mean ± SD age, 68.30 ± 4.19 years), overweight group (mean ± SD age, 69.88 ± 3.76 years), and obesity group (mean ± SD age, 68.47 ± 3.67 years) based on their body mass index. The Footscan plantar pressure measurement system was used to assess the dynamic plantar pressures, and parameters were collected from risk analysis, foot axis analysis, single-foot timing analysis, and pressure analysis.

Results: Significant within-subject differences were found for local risks of the lateral forefoot and midfoot, minimum and maximum subtalar joint angles, flexibility of the subtalar joint, foot flat phase, as well as the average pressures on toes, metatarsals, midfoot, and lateral heel, with the peak pressures on toes 2 to 5, second metatarsal, fifth metatarsal, midfoot, and lateral heel. The phases of initial contact and foot flat, the average pressures on toes 2 to 5, metatarsals, midfoot, and heels, with the peak pressures on the first to fourth metatarsals, midfoot, and heels, exhibited significant between-subject differences. There was an interaction effect of foot dominance and body mass index on the flexibility of the subtalar joint.

Conclusions: The nondominant foot works better for stability, especially when touching on and off the ground. The dominant foot works better for propulsion but is more susceptible to pain, injury, and falls. For obese older women, the forefoot and midfoot are primarily responsible for maintaining stability, but the lateral midfoot and hindfoot are more prone to pain and discomfort.

Background: Prolotherapy (proliferative therapy) is a nonsurgical regenerative injection technique that introduces small amounts of hyperosmolar dextrose to the site of painful or degenerated tendons or their insertions. Under ultrasound guidance, a 25-gauge needle is used to fenestrate and inject hyperosmolar dextrose into the injured area of the Achilles tendon. This is found to induce the proliferation of new cells, allowing the regeneration of healthy tissue. The purpose of this study was to evaluate the treatment response to prolotherapy in Achilles tendinitis.

Methods: We reviewed 132 participants with nontraumatic Achilles tendinopathy. Data were collected retrospectively from electronic health records from January 1, 2014, to December 31, 2017. These participants have Achilles tendinopathy from daily activity. We excluded any traumatic cause, history of Achilles tendon rupture, and tendon pathology. Participants were followed for 12 months; those lost to follow-up were excluded. The duration of pathology, number of prolotherapy sessions, and outcome data were recorded. Musculoskeletal radiologists performed the prolotherapy. We received an exemption from the institutional review board of Boston Medical Center for this study.

Results: One hundred thirty-two participants (45 men and 87 women) met the study's criteria, with a mean age of 55 years (range, 21-80 years). Overall, within 12 months, 98 participants (74.2%) experienced symptom resolution. Seventy-one participants (53.8%) experienced symptom improvement with a single treatment. Thirty-four participants (25.8%) still had symptoms after 12 months.

Conclusions: This study demonstrated that prolotherapy yielded excellent results for Achilles tendinitis, particularly for participants without skeletal deformities. No adverse events were reported during the 12-month study. A prospective, comparative, and randomized controlled study with long-term follow-up is needed to determine the efficacy of prolotherapy.

Background: There is a known correlation between coronavirus disease 2019 (COVID-19) infection and the creation of a prothrombotic state. However, there is a paucity of literature assessing the influence of COVID-19 on deep venous thrombosis following surgery. This study evaluated the incidence of and risk factors for deep venous thrombosis among COVID-19-positive patients undergoing foot and ankle surgery.

Methods: A retrospective review was performed at a single institution to extract all patients who had a COVID-19-positive diagnosis and foot or ankle surgery. A total of 472 patients met the inclusion criteria. A total of 321 patients had a COVID-19-positive diagnosis within the established perioperative period and the remaining 151 comprised the no COVID-19 group.

Results: Overall, there were ten cases of deep venous thrombosis in the COVID-19-positive population; this was not significantly increased compared with the no COVID-19 group (3.12% versus 1.99%; P = .463). No demographic or medical history variables, such as previous deep venous thrombosis, history of tobacco use, venous insufficiency, peripheral vascular disease, chronic kidney disease, coronary artery disease, diabetes, or clotting disorders, were found to have a statistically significant influence on the rate of deep venous thrombosis in COVID-19-positive patients following foot and ankle surgery. Furthermore, vaccination status, timing of COVID-19 diagnosis in relation to surgery, trauma, anatomical location of surgery, and use of chemical prophylaxis did not demonstrate any statistical significance.

Conclusions: This study did not find COVID-19 to increase the risk of deep venous thrombosis following foot and ankle surgery, and no specific variables were found to influence this risk. This study stands as a preliminary investigation on deep venous thrombosis rates in COVID-19 patients who have undergone foot and ankle surgery. Larger population studies would be of great benefit in the future.