Journal of the American Podiatric Medical Association最新文献

Background: The need for intra-articular osteotomy and potential complications at the donor site may lead some surgeons to avoid using the osteochondral autograft transfer method as a primary surgery, instead considering it a revision procedure for osteochondral lesions of the talus. In this retrospective study, we hypothesized that the primary application of osteochondral autograft transfer in cystic talar osteochondral lesions would yield good results and intra-articular osteotomy and donor site would not have a negative effect on long-term clinical outcomes. The primary objective of this study was to demonstrate that osteochondral autograft transfer can be safely applied as a primary treatment for cystic talar osteochondral lesions.

Methods: In our study, 21 patients underwent primary osteochondral autograft transfer for cystic talar osteochondral lesions. Demographic data of patients, including age, gender, and body mass index, as well as duration of symptoms, etiology of the lesion, location of the lesion, and follow-up duration were recorded from our medical records. The clinical evaluation used the visual analog scale for pain, function, and satisfaction along with the American Orthopaedic Foot & Ankle Society score. In addition, the magnetic resonance observation of cartilage repair tissue scale was used for evaluation of graft healing.

Results: The mean follow-up time was 32 months. According to the results of the study, compared with the preoperative status, statistically significant improvement was observed in visual analog scale pain, function, and satisfaction scores as well as in the American College of Foot and Ankle Surgeons score. In addition to these findings, it was observed that there was no negative effect of intra-articular osteotomy and donor site on long-term results.

Conclusions: Our study showed that osteochondral autograft transfer can be safely applied as primary surgery in cystic talar osteochondral lesions.

Background: Podiatrists are crucial for managing lower limb pathologies, and effective appointment scheduling is vital for allocating adequate consultation time based on patient conditions. While occasional late patient arrivals may not significantly impact services, frequent lateness can disrupt patient flow and quality of care. This study explored the impact of patient lateness on podiatry practices worldwide, where no countries of origin were excluded. This study assessed current strategies to manage patient lateness, evaluated their effectiveness and reported recommendations for improvement.

Methods: An international cross-sectional online survey was conducted between January and March 2024.

Results: The survey, which garnered 201 responses from podiatrists, revealed that over 90% of podiatrists experienced disruptions in their clinic workflow due to late patients. Common reasons for lateness included traffic issues and difficulties with parking. SMS reminders emerged as the most effective tool for reducing tardiness. Over half (59.3%) of podiatrists implemented a 10-minute grace period before rescheduling late appointments, which effectively reduced lateness by 50%. However, some podiatrists refrained from rescheduling to avoid worsening patients' conditions or dealing with complaints. Additionally, many podiatrists reported a lack of managerial support in handling late patients.

Conclusion: The frequency of late arrivals in podiatry is similar to other health professions and negatively impacts clinic workflow and staff morale. Enhanced managerial support is needed to better manage late patients, allowing podiatrists to concentrate on their clinical responsibilities.

Background: Pulsed electromagnetic field (PEMF) therapy is a conservative, noninvasive, nonpharmacological option for treatment of plantar fasciitis that accelerates the body's anti-inflammatory and healing responses.

Methods: In this case series, adult patients presenting with more than 2 weeks of heel pain due to plantar fasciitis were treated with the OrthoCor Active System (OrthoCor Medical Inc, Blaine MN) PEMF device for 12 weeks. Efficacy was measured at 0 (baseline), 4, 8, and 12 weeks of treatment. Ultrasound was used to measure plantar fascia maximal thickness and hypoechoic region width. Function was evaluated using Foot and Ankle Disability Index (FADI) and Patient Specific Functional Scale (PSFS) survey scores.

Results: Repeated measures ANOVA showed a statistically significant improvement in all assessments with PEMF therapy. The mean plantar fascia thickness decreased by 34%, the mean hypoechoic region width decreased by 79%, the mean FADI score improved by 46%, and the mean PSFS score improved by 166%. Compared to historical control data from other studies, PEMF and stretching therapy reduced plantar fascia thickness by 34% compared to 16% for dexamethasone injection and 6% for placebo saline injection; FADI improved by 46% after 12 weeks of PEMF compared to 43% after 1 year of treatment with indomethacin, heat and shoe pads, plantar facia stretching, or calf stretching; and PSFS improved by 166% with PEMF compared to 96% after primal reflex release treatment.

Conclusion: Pulsed Electromagnetic Field (PEMF) therapy was effective for stimulating healing and improving function for patients with plantar fasciitis, demonstrated by significant improvement in ultrasound measures and functional scores. This study suggests that PEMF therapy is an effective conservative, nonpharmacologic treatment option for plantar fasciitis.

Background: The correlation between vitamin D levels and bone health has been proven. Vitamin D deficiency is linked to poorer outcomes in osseous surgical procedures. The goal of the present study was to retrospectively investigate the nonunion rates of first metatarsophalangeal joint arthrodesis after implementing a vitamin D optimization protocol. Each patient was tested within 2 months prior to surgery and optimized to at least 20 ng/mL.

Methods: A total of 44 operative extremities were included in this study. We analyzed the time to osseous fusion based on varying vitamin D levels.

Results: There was a low nonunion rate of 2.3%. We found no statistically significant difference in time to fusion based on varying levels of vitamin D of at least 20 ng/mL or in patients who used a bone stimulator. We found no increased risk of delayed or nonunion in patients with a history of deficiency.

Conclusions: We recommend optimizing patients with vitamin D deficiency to a level of at least 20 ng/mL prior to a first metatarsophalangeal arthrodesis procedure.

Background: Minimally invasive hallux valgus correction has gained a presence in the foot and ankle community because of its minimalist approach and reproducibility. Minimally invasive techniques have also gained popularity in other facets of foot and ankle surgery, including bunionette correction. The main objective of this study was to evaluate computed tomography (CT)-derived Hounsfield units (HUs) from four quadrants of the fifth metatarsal head evaluating regional bone density.

Methods: A retrospective analysis was conducted of 30 patients without a history of osteoporosis, fracture, or previous surgery who underwent CT examination. The fifth metatarsal head was separated into quadrants in the coronal plane and CT-derived HUs from a 3.5-mm region of interest centered in each quadrant were obtained. Quadrant HU values were compared using an analysis of variance followed by post hoc testing. The threshold for statistical significance was set at P ≤ .05.

Results: The average cohort age was 43 ± 15 years. The sample was composed of 20 females (67%) and ten males (33%). There existed a statistically significant difference among the fifth metatarsal head quadrants (P < .001). The dorsomedial quadrant density was 301.0 ± 76.4 HUs, which post hoc analysis revealed to be greater than the dorsolateral (186 ± 68 HUs; P = .001), plantar medial (241 ± 69 HUs; P = .007), and plantar lateral (214.0 ± 70 HUs; P = .001) quadrants.

Conclusions: During fixation in minimally invasive bunionette deformity correction, the dorsomedial quadrant of the fifth metatarsal head remains the optimal fixation target site according to regional bone density. Adding to the reproducible minimally invasive surgical technique, surgeons should plan the trajectory to capture this dorsomedial quadrant during fixation.

Background: Insertional Achilles tendinopathy is a common condition treated by foot and ankle surgeons. The literature has demonstrated good outcomes following detachment and reattachment of the Achilles with partial calcanectomy. However, postoperative protocols are variable and have not been well established. The purpose of the present study was to retrospectively review early mobilization with the Willits protocol following insertional Achilles tendinopathy surgery.

Methods: A retrospective chart review was conducted of 25 patients (29 feet) who underwent surgical treatment for insertional Achilles tendinopathy with Haglund's deformity by two foot and ankle surgeons. Patients were evaluated using radiographs and clinical exams. Following surgery, Willits protocol was initiated for early mobilization.

Results: Patients had an average decrease in pain postoperatively from 6.14 to 1.53 on a 10-point scale. One patient (3.4%) experienced a postoperative rupture after trauma. Three patients (10.3%) required reoperation: one debridement for postoperative infection, one flexor hallucis longus transfer and V-Y lengthening for Achilles rupture after a fall, and one gastrocnemius recession for calf tightness.

Conclusions: The Willits protocol, although initially created for Achilles tendon ruptures, provides an early mobilization protocol for patients after insertional Achilles tendinopathy procedures. Our study found a low reoperation rate and improved pain level while allowing patients to mobilize earlier than previously reported in the literature.

Background: Flat feet change lower-extremity alignment, and they may change the load distribution on the Achilles tendon during exercise. The purpose of this study was to investigate the immediate effect of cumulative transverse strain via resistive ankle plantarflexion exercise on the Achilles tendon in individuals with flat feet.

Methods: Fourteen individuals with flat feet and 14 age-matched individuals with normal foot posture were enrolled. Achilles tendon thickness was measured by an ultrasonography device with a linear probe at three points: 1, 2, and 3 cm proximal to the superior aspect of the calcaneus. Ultrasonography measurements were performed before and after participants completed 90 repetitions of double-leg calf raise exercises, which included moving the foot from full ankle dorsiflexion to full ankle plantarflexion.

Results: Achilles tendon thickness at all three points measured was thinner in the flat feet group at preexercise and postexercise conditions compared with that of the control group (P < .05). Achilles tendon thickness at all three points decreased after the exercise in both groups (P < .001). The differences in Achilles tendon thickness at all three points measured between preexercise and postexercise conditions were lower in individuals with flat feet than in those of the control group (P < .05).

Conclusions: There was a significant decrease in Achilles tendon thickness after exercise in both groups; however, tendon thickness markedly diminished in individuals with normal foot posture. The findings are thought to result from changes in tendon structure and load distribution on the Achilles tendon.

Calcaneal malunion, one of the late complications of calcaneal fractures, refers to residual bone malalignment often associated with pain and deformity due to inadequate conservative or inadequate/unsuccessful surgical treatment. Complications associated with calcaneal fractures can be treated either arthroscopically or endoscopically. We aimed to analyze a case in which we performed endoscopy-assisted, minimally invasive calcaneal osteotomy after endoscopic flexor hallucis longus tendon release. We investigate the surgical technique used in a patient with flexor hallucis longus compression caused by osteophytes posterior to the subtalar joint following calcaneal malunion, who presented with difficulty wearing shoes associated with loss of calcaneal height.

A rare case of tarsal tunnel syndrome caused by flexor digitorum brevis hypertrophy. The patient presented with medial plantar pain and paresthesia but denies any injury. Magnetic resonance imaging revealed a marked hypertrophy of the flexor digitorum brevis in close proximity to the medial and lateral plantar nerves, with herniation into the porta pedis. Surgical excision of the herniated muscle was performed, along with a tarsal tunnel release. The combined treatment resulted in symptomatic relief.

Background: The aim of this study was to compare the Achilles tendon stiffness of male amateur soccer players and sedentary individuals.

Methods: In this prospective study, ultrasound shear wave elastography findings obtained from the middle part of the bilateral Achilles tendon were evaluated in 31 male amateur soccer players and 31 sedentary men. Measurements were performed using a linear 4- to 10-mHz ultrasound probe. The correlation between Achilles tendon elasticity and training characteristics of soccer players was also tested.

Results: There were no significant differences between soccer players and the control group in terms of age, body weight, height, and body mass index (P > .05). Achilles tendon stiffness was higher in the soccer players compared with the sedentary individuals (P < .001). However, the difference between right and left Achilles tendon stiffness was not statistically significant. In addition, the correlation between Achilles tendon stiffness and training characteristics (years of training, number of training sessions per week, total training hours per week) was not significant (P > .05).

Conclusions: Ultrasound shear wave elastography can be used for evaluation of Achilles tendon stiffness. Compared with sedentary individuals, higher tendon stiffness in amateur soccer players shows that soccer training increases Achilles tendon stiffness. Including specific flexibility training in the training program may contribute to the achievement of maximum force production and the prevention of tendon pathologies.