Journal of the American Podiatric Medical Association最新文献

Background: During the past few years there has been a decrease in the number of applicants to podiatric medical school. It has been suggested that this decrease may be due to unfamiliarity with the profession of podiatric medicine. The goal of this study was to shed light on the misconceptions and lack of awareness of podiatric medicine so that the profession can better bridge the gap in knowledge with a resultant strategy to better increase recruiting efforts. We hypothesized that high school and college students overestimate their awareness of podiatric medicine and that a significant percentage of students have low actual awareness of the profession. It is presumed that this shortfall is greater in high school students.

Methods: An eight-question self-completion survey was created that analyzed self-perceived and actual awareness of the podiatric medicine profession. A total of 318 students (171 high school and 147 college) attending school in Arizona completed the survey to test their actual and perceived knowledge of podiatric medicine.

Results: A total of 294 survey responses met the inclusion criteria and were used in the final evaluation of data. In total, 57.1% of high school students and 47.9% of college students described their knowledge of podiatric medicine as "poor." Each of the five true/false questions were answered incorrectly more than 50% of the time. Overall, there was a statistically significant association between students' perceived knowledge of podiatric medicine (good and higher, fair, or poor) and their actual knowledge.

Conclusions: Evidence supports that many high school and undergraduate students are unaware of the podiatric medicine profession. Furthermore, there are many misconceptions that are believed about the profession that could be causing the recent decline in applicants.

Background: The symptoms of tarsal tunnel syndrome (TTS) have traditionally been considered the result of entrapment of the tibial nerve due to the laciniate ligament or compression of the nerve's distal branches as they course beneath the abductor hallucis (AH) muscle. Recent research shows that TTS may be due to compression of the tibial nerve proximal to these structures, at the level of the high ankle (termed high TTS). This study appears to be among the first to investigate the incidence of compression at either or both of these sites in persons with clinical findings of TTS.

Methods: The medical records of 91 adult patients (56 women and 35 men) who presented to a podiatric medicine practice with clinical findings of TTS and underwent electrodiagnostic (EDX) testing were retrospectively reviewed for the prevalence of nerve compression at the level of the high ankle (ie, high TTS) or the laciniate ligament/AH muscle in the foot.

Results: Of the 91 patients with clinical findings of TTS, EDX testing found that 59 had nerve compression at the laciniate ligament/AH muscle, 69 had nerve compression at the level of the high ankle, 51 had compression in both areas, and 13 did not have any entrapment. Of the 69 patients found to have an entrapment at the high ankle, 41 were women and 28 were men, with the compression occurring bilaterally in 44 of the 69 patients.

Conclusions: In patients presenting with clinical findings of TTS, EDX testing found that compression most often occurred at the level of the high ankle, beneath the fascia of the leg, followed by entrapment at the traditionally recognized site, beneath the laciniate ligament/AH muscle, with a significant number of patients having compression at both sites. A small number of patients had no EDX evidence of nerve compression.

Background: Distal metatarsal chevron osteotomy is widely used in hallux valgus surgery, and many different osteotomy methods have been described in the literature because of its complications, such as nonunion, loss of reduction, and osteolysis. This study aimed to biomechanically compare the newly defined Parmaksızoğlu osteotomy and the distal chevron osteotomy.

Methods: A total of 14 sawbone models were divided into two groups, and Parmaksızoğlu and distal chevron osteotomies were performed with the created incision guides. For biomechanical tests, fatigue testing was performed on the samples with 1,000 cycles of axial loading up to 10 N at a 15° angle. Rigidity, dorsal angulation, and deforming force values were recorded.

Results: In the chevron osteotomy group, the average rigidity value of the 1,000th cycle was measured as 3.69 N/mm, the dorsal angulation value was 1.95°, and the average deforming force value was 20.14 N. In the Parmaksızoğlu osteotomy group, the average rigidity value of the 1,000th cycle was measured as 2.28 N/mm, the dorsal angulation value was 2.12°, and the average deforming force value was 26.72 N.

Conclusions: In this study, Parmaksızoğlu osteotomy and chevron osteotomy were compared in terms of rigidity, dorsal angulation, and deforming force, and no statistically significant superiority of one technique over the other was observed. It has been statistically shown that the Parmaksızoğlu osteotomy, which has demonstrated a lower complication rate and a higher American Orthopaedic Foot & Ankle Society score in previous studies, has biomechanically similar features to the distal chevron osteotomy.

Clinicians caring for feet may be hearing stories of canines masticating the foot/digits on unsuspecting persons with diabetes and neuropathy. For the most part, these reports are anecdotal. Actual publications on this topic are scarce. The following discussion and case reports depict a typical presentation with a sleeping person with diabetic polyneuropathy and infection, which attracts the canine and results in tissue mastication. The workup and care for such clinical presentations appear straightforward and effective; however, the authors highly recommend that providers that care for persons with diabetes who own pets take precautions, especially during sleep.

Background: This study aimed to compare the rates of recurrence, complications, and patient satisfaction among individuals undergoing different variations of the Winograd method (WM) for the treatment of ingrown toenail, including the addition of electrocoagulation (EC) and a novel suture technique.

Methods: A retrospective analysis was conducted of 605 patients who underwent surgery for ingrown toenail using the WM at two institutions. Patients were divided into four groups based on the surgical technique used: group 1 (WM + EC + new suture), group 2 (WM + EC + traditional suture), group 3 (WM + non-EC + traditional suture), and group 4 (WM + non-EC + new suture). Recurrence rates, complications, and patient satisfaction levels were assessed.

Results: Group 1 demonstrated the lowest recurrence rates, whereas group 3 had the highest. Group 1 exhibited the highest satisfaction rate, whereas group 3 had the lowest. Notably, the suture technique appeared to have a greater impact on reducing recurrence rates than EC.

Conclusions: Incorporating germinal matrixectomy with EC and a new suture method with the WM may improve patient satisfaction and reduce recurrence rates in ingrown toenail treatment. The suture technique appears to play a significant role in decreasing recurrence rates compared with EC.

Background: The literature extensively documents various surgical approaches for managing ingrown toenails. Postoperative recurrence following matrixectomy treatments may influence clinicians to favor external bracing as a treatment modality for ingrown toenails. This study provided a comparative analysis of patients diagnosed with ingrown toenails who underwent either the nail fixation procedure or the Winograd technique.

Methods: A retrospective review was conducted of patients who underwent surgery for ingrown toenails between August 2021 and January 2023. Parameters, including age, sex, Heifetz stage, visual analog scale score, time to return to daily activities, satisfaction state, and recurrence rate, were documented.

Results: The study involved 64 patients, with 30 undergoing nail fixation treatment and 34 opting for the Winograd procedure. No statistical differences were observed in age, sex, affected side, satisfaction state, or visual analog scale score between the two groups. However, patients treated with nail fixation showed significant reductions in both the time to return to daily activities and ingrown toenail recurrence rate (P = .035 and P = .029, respectively).

Conclusions: Nail fixator treatment led to lower recurrence rates and a quicker return to daily activities, likely because of its less invasive nature. However, definitive conclusions are hindered by limited studies, necessitating further extensive research in this field.

Background: Diabetes mellitus is becoming one of the most important health problems today due to its increasing incidence and mortality. Many diabetic patients have foot ulcers; 60% of patients with foot ulcers undergo foot amputations. We aimed to show that circulatory disorders, smoking habit, chronic renal diseases, biochemical parameters, and inflammatory markers can cause and affect the course of reamputation.

Methods: Patients were considered for revision surgery if they had at least one of the following with positive acute phase reactants: an aseptically obtained positive wound culture, abscess or purulent drainage from the surgical site, and infection symptoms such as fever, pain, swelling, erythema, or heat. We considered toe amputation as amputation at any level of the phalanx or at the level of the metatarsophalangeal joint. Patients were divided two groups: single (group 1) and multiple (group 2) toe and metatarsal amputations.

Results: We identified 166 patients (57 women and 109 men) for the study: 114 (68.7%) had a single amputation (group 1) and 52 (31.3%) had multiple amputations (group 2). The mean patient age was 58.3 years (range, 36-88 years). The mean ± SD time to reamputation was 10.0 ± 42.0 days in group 1 and 9.1 ± 18.6 days in group 2; there was no difference between groups (P = .890). It was observed that 122 patients (73%) used a prosthesis after amputation.

Conclusions: Many parameters should be evaluated when assessing toe amputations. The possibility of reamputation carries a high risk. Therefore, infection, serum parameters, renal diseases, peripheral artery diseases, C-reactive protein level, duration of diabetes, hypertension, diabetic neuropathy, hematocrit value, and ankle-arm indices should be considered in patients undergoing amputation due to diabetic foot ulcer. Wound care and antibiotic therapy after primary amputation play an important role in preventing reamputation.

Foot drop has various etiologies, such as neurologic (peripheral nerve injury, neuropathy, lumbar radiculopathy, and cerebral lesions) or muscular (extensor muscle injury and compartment syndrome) causes. Tendon transfers can aid in the restoration of dorsiflexion in the treatment of foot drop. The tibialis posterior tendon is the primary tendon used in these surgeries for transfer. In this present study, the flexor hallucis longus tendon is transferred to the dorsum of the foot because of following knee dislocation that caused a nonfunctioning posterior tibial tendon. At the sixth month postoperative, the active dorsiflexion angle of the foot was increased to 00 and the American Orthopaedic Foot and Ankle Society score 81 points.

Background: It is well documented that limb salvage interventions may induce or exacerbate biomechanical dysfunction in the residual limb. As a result, patients with Charcot's neuroarthropathy (CN) are at theoretical risk for progression of or novel neuroarthropathic breakdown, which has been observed in the midfoot after amputation; however, this has not been investigated in rearfoot interventions such as partial calcanectomy.

Methods: We retrospectively identified eight patients during a 7.25-year period who had a history of CN and partial calcanectomy in the ipsilateral limb. Patients with contralateral involvement were excluded, and included medical records were analyzed and radiographically characterized.

Results: The mean patient age was 73.9 years (range, 59-86 years), and the mean body mass index was 31.4 (range, 22-50). Two patients (25.0%) demonstrated multijoint breakdown. Two feet (25.0%) were characterized as Sanders-Frykberg (SF) II, one (12.5%) as SF III, and three (37.5%) as SF IV/V breakdown. Three patients developed CN a mean of 350.3 days after partial calcanectomy was performed. The mean age and body mass index of patients who experienced post-vertical contour calcanectomy CN was 70.7 years (range, 59-83 years) and 29.0 years (range, 22-35 years), respectively. All instances of postcalcanectomy CN resulted in rearfoot breakdown, with one (33.3%) isolated to the tibiotalar joint and two (66.7%) at the tibiotalar and subtalar joints. A 66.7% limb salvage rate was found in patients who developed postcalcanectomy CN.

Conclusions: We conclude that partial calcanectomy in patients with antecedent CN does not result in clinically significant changes that further threaten the limb but identified three instances where partial calcanectomy destabilized the rearfoot and resulted in rearfoot CN breakdown. Although this knowledge should not discourage the use of calcanectomies, clinicians should be cognitive of complications such as CN breakdown that can further threaten the limb.

Background: Osteomyelitis (OM) is a complex bone disease most often caused by microorganism-based infections; it poses significant challenges for diagnosis and treatment. Previous epidemiologic studies have identified upward temporal trends in the diagnosis of OM. This study examined these trends in diabetic OM and OM-related amputations in Texas, a state with one of the highest rates of diabetes in the United States.

Methods: Retrospective analysis was conducted on Texas diabetic inpatient hospital data from 2006 to 2016. Data were extracted for patients who had diagnostic codes for diabetes and for foot and ankle OM, along with data for OM-related major or minor amputations. Rates were calculated per 1,000 people and standardized using 2019 population estimates.

Results: The prevalence of diabetic OM increased from 2006 to 2016, as did total, major, and minor amputations in patients with OM. Decreases were noted in 2014 to 2016. Age-standardized rates demonstrated the same trends, as did rates across all of the age groups. Osteomyelitis increased most in 45- to 64-year-olds. Amputation rates increased similarly in 45- to 64-year-olds, 65- to 74-year-olds, and those 75 years and older. Poisson regression analysis reinforced these trends, with significant increases in risk ratios for OM and amputation rates in all of the age groups.

Conclusions: This preliminary analysis highlights the increasing prevalence of OM and OM-related amputations in diabetic patients from 2006 to 2016 and for all age groups (18-75 years and older) in Texas. Although increasing diabetes rates may contribute to the observed trends in OM, it does not exclusively explain them. Further research should investigate possible interventions to mitigate the rise in diabetic OM and associated amputations.