Journal of the American Podiatric Medical Association最新文献

Background: We aimed to determine the relative risk of pedal vessel calcification (PVC) on major adverse foot events (MAFEs) and chronic kidney disease (CKD) stage in patients with diabetes mellitus (DM) and peripheral neuropathy (PN).

Methods: We retrospectively reviewed electronic medical records of 152 patients with diagnoses of DM, PN, and CKD stages one to five who had at least one foot radiograph obtained. PVC was scored (from 0-4) based on foot anatomic location and radiology reported MAFEs, which includes foot fracture, Charcot neuroarthropathy, foot ulcer, osteomyelitis, or minor amputation. Risk ratios (RR) with 95% confidence intervals (95% CI) and Poisson regressions were performed assessing the risk of sustaining MAFEs with number of PVCs and stage of CKD.

Results: The risk of any MAFE increased as PVC score increased (RR = 1.23); the risk of any MAFE increased as CKD stage increased (RR = 1.35); and risk of any PVC increased as CKD stage increased (RR = 1.71).

Conclusions: Pedal vessel calcification on a foot radiograph increases the risk of any MAFE and increases with progressive stage of CKD. Pedal vessel calcification may serve as a gateway to prompt investigation, treatment, or referral for at-risk diabetic neuropathic, nephropathic patients.

Background: Identification of a specific causal mechanism for medial tibial stress syndrome has been elusive, although there is a consensus that it may be caused by traction on the tibial periosteum elicited by soft tissues. The crural fascia (CF) attaches directly to the tibia throughout the length of the leg, encircling it in a grossly cylindrical fashion, and the leg may thus be viewed as a type of fluid-filled cylinder, subject to both longitudinal and hoop stresses. Prior researchers have not considered the possibility that strain on the medial tibia could be produced by the CF during gait and passive stretching, secondary to fluid pressure increases in the fascial compartments of the leg. The purpose of the present research was to verify the existence of measurable hoop strain in the CF of a cadaver donor at the medial tibial border during a heel cord stretch.

Methods: Strain gauges were affixed to the CF of a cadaver donor to measure hoop and longitudinal strain during repeated heel cord stretches applied manually, and with measurements taken from each strain gauge separately.

Results: Passive heel cord stretches produced 182.96 × 10-3 mV/V and 138.00 × 10-3 mV/V hoop strain in the CF, in the distal third and middle third of the leg, respectively. A maximum longitudinal strain in the CF of the superficial posterior compartment of 75.00 × 10-3 mV/V was also produced.

Conclusions: A heel cord stretch applied to a cadaver donor can elicit a measurable hoop strain within the CF attachment to the medial border of the tibia, in a grossly 2-to-1 manner consistent with the ratio of hoop to longitudinal strain seen with gases and liquids in a closed cylinder. Further research is indicated to replicate these results in multiple subjects, with variation in cadaver fixative and experimental set-up.

Background: The use of telemedicine has garnered significant traction amidst the COVID-19 pandemic. The sudden adoption of certain practices in podiatry was not always supported by empirical evidence, resulting in the development of guidelines and metrics that lacked a foundation in rigorous research.

Methods: A modified Delphi composed of three rounds was conducted with 16 stakeholders (service users, foot and ankle health-care providers, and policymakers) from a primary-care setting to develop a podiatric telemedicine framework for a primary-care setting. The first round consisted of focus group discussions, the second round consisted of a questionnaire composed of different statements that emerged from focus group discussions, and the final third round consisted of a questionnaire with statements from the second round that required further reiterations. Statements that achieved an 80% or higher level of agreement were accepted to form part of the podiatric telemedicine framework.

Results: Excellent consensus data was obtained to develop the podiatric telemedicine framework. Although podiatric telemedicine for low-risk patients in a primary-care setting is relatively new, stakeholders highlighted the importance of having podiatric telemedicine guidelines and setting service user and provider expectations clear on what podiatric telemedicine has to offer and its pitfalls.

Conclusions: The podiatric telemedicine framework developed is recommended to all foot and ankle health-care professionals in a primary-care setting who wish to provide telemedicine consultations. Moreover, it is recommended that a pilot study be carried out to look into the feasibility of this framework being translated and implemented as a guideline related to foot and ankle telemedicine consultations.

Background: Proteus syndrome is a rare disorder characterized by overgrowth of limbs and organs and neurocutaneous findings.

Methods: We examined three Proteus syndrome cases with unilateral foot enlargement, megafoot. The patients had ambulatory and cosmetic difficulties. Debulking surgery was performed.

Results: After the surgeries, patient mobility and functional scores were analyzed and found to be improved; only one patient had recurrence after 5 years. In the literature, there is no consensus about the treatment and the timing of treatment of Proteus syndrome. The literature suggests that early surgery for megafoot leads to better functional results. Debulking surgery and amputation are the two options mentioned. In the present cases, soft-tissue debulking was performed.

Conclusions: In patients with megafoot caused by Proteus syndrome, the functional results were better for those with early debulking surgery compared with those who did not undergo surgery. Patients were able to fit into shoes and walk without difficulty.

Background: The canine olfactory system is used for tasks that greatly aid society, such as detecting explosives, finding lost persons, and detecting many diseases and abnormal blood sugar levels early. However, the reliability of detection of glycemic fluctuations is questionable.

Methods: We reviewed the literature on the capability of canines in detecting significant variations in blood sugar. Traditional studies and anecdotal reports were assessed. Articles and resources that outline the available training and certification process were included.

Results: Publications included studies of canines' ability to detect scents associated with hyperglycemia and hypoglycemia as well as behavioral changes associated with blood sugar abnormalities. Several anecdotal reports denoted excellent canine performance in detection. Perusal of literature and Web-based resources found a range of available training, from formal (with certification) to do-it-yourself home training. Evidence supporting improved mental/physical health in persons using service dogs was robust.

Conclusions: Canines have the capability to detect numerous medical conditions, including dangerous fluctuations in blood sugar in persons with diabetes, especially hypoglycemia. Most studies on the reliability and performance of diabetes alert dogs report potential lifesaving benefits but demonstrate notable variability and inconsistencies, which may be due to lack of required formal training or a certification process. Most owners believe their dogs are highly effective and greatly improve their life and safety. Due to the improving technology seen with continuous glucose monitoring devices, many believe diabetes alert dogs will become obsolete. Aside from an early warning system, diabetes alert dogs can play a significant role in overall quality of life, especially in benefiting physical and mental health.

Background: We aimed to analyze levels of knowledge and behavior regarding diabetic foot care and prevention in persons with diabetes according to the International Working Group on the Diabetic Foot (IWGDF) risk stratification system.

Methods: This descriptive study included 83 persons with diabetes at different risk levels for diabetic foot ulceration (DFU) (IWGDF risk 0-3). The previously validated Patient Interpretation of Neuropathy questionnaire was used to analyze their levels of understanding of foot complications. Participants responded using a 5-point Likert scale.

Results: Patients with IWGDF risk 3 knew that good circulation and absence of polyneuropathy in their feet were related to healthy feet relative to the other groups. In addition, they knew that a DFU is not painful relative to the other groups. High-risk patients knew which physical causes could affect the development of a DFU and that foot self-care and medical control could prevent DFU.

Conclusions: Patients with IWGDF risk 3 knew the natural progression of diabetic foot complications and how to prevent them. Clinicians should focus their efforts on educating patients with diabetes who are at lower risk for DFU.

Background: We evaluated patients who were followed after acutely developing single-sided footdrop and improving with conservative management or spontaneously.

Methods: In 2019 and 2020, ten patients were retrospectively evaluated for unilateral weakness of the lower extremity in the form of absent dorsiflexion at the ankle joint and were given a diagnosis of footdrop without etiologic cause. Patients were followed for 18 months. Patients were evaluated for acute footdrop of the affected extremity with electromyography, lumbar spine magnetic resonance imaging (MRI), knee MRI, peripheral MRI neurography, and noncontrast brain MRI. Each patient was evaluated for a history of COVID-19 infection during the past year. Patients with any identified cause were excluded.

Results: Initial evaluation of muscle strength revealed 0/5 by the Medical Research Council muscle testing scale. In two patients, muscle strength was 3/5 at month 6 and in eight patients it was 4/5. Muscle strength of all of the patients improved to 5/5 at 1 year. Six patients were dispensed an ankle-foot orthosis, and nine patients performed physical therapy. Electromyography identified significant neuropathy at the level of the common peroneal at the fibular head in all of the patients. Compared with peroneal nerve stimulation below and above the fibular head in the lateral popliteal fossa, a 50% reduction in sensory amplitude and motor conduction slowing greater than 10 m/sec were present. Knee MRI revealed no masses, edema, or anatomical variations at the level of the fibular head.

Conclusions: Spontaneous resolution of unilateral acute footdrop without an etiologic cause can occur within 1 year.

Gout is a common inflammatory arthritic condition, commonly affecting the first metatarsophalangeal joint (MPJ) in the foot. As reported in literature, only 6.8% of patients with pedal gout have the interphalangeal joints affected. Surgical treatment of gouty tophi in the foot is at times necessary in addition to diet modification and oral medications. We report on 7 cases of gout affecting interphalangeal joints that necessitated surgical treatment. Six out of 7 of the patients had no complications after surgery, and no reoccurrence, with an average follow-up time of 26 months.

Hallux rigidus is a common condition affecting the foot. There is a paucity of evidence describing the management of patients with hallux rigidus with manual physical therapy consisting of hands-on manual therapy techniques and movement reinforcing exercise. This case highlights the management of a patient with hallux rigidus by a physical therapist. The patient was a 60-year-old male baseball player with pain, loss of metatarsophalangeal joint motion, and radiographically visible degenerative changes suggesting a diagnosis of hallux rigidus. Treatment involved non-thrust joint manual distraction mobilization to the 1st metatarsophalangeal joint. Improvements were noted immediately in the patient's ability to run with decreased symptoms. I carefully instructed the patient to perform the manual distraction techniques at home. After 4 clinical visits, the patient returned to baseball the following spring. Outcomes were maintained 8 years after initial evaluation.

Background: Abnormal foot anthropometry and posture of patients with Duchenne Muscular Dystrophy (DMD) can be considered as possible risk factors for performance and ambulation. It was aimed to examine the effects of foot posture and anthropometric characteristics, which deteriorated from the early period, on ambulation and performance of patients with DMD.

Methods: The foot arch height (FAH), the metatarsal width (MW), subtalar pronation angle, and ankle limitation degree (ALD) were evaluated to determine the foot anthropometric characteristics of the patients. Foot Posture Index-6 (FPI-6) was used to evaluate foot posture. The performance of the patients was determined by the 6-minute walk test (6MWT), the 10-meter walk test (10MWT), and ascend/descend a standard 4-step test, and the ambulation was determined by the North Star Ambulatory Assessment (NSAA). Spearman's correlation coefficient was calculated to assess the relationship between foot anthropometric characteristics and posture, and performance and ambulation.

Results: The sample consisted of 48 patients with DMD aged 5.5 to 12 years. Both of the right and left foot FPI-6 scores were associated with all parameters, except descending 4-step. The left FAH was associated with 6MWT and NSAA, and the left MW was associated with 6MWT. The ALD of right foot was associated with 6MWT, ascending/descending 4 steps, and NSAA, and left ankle limitation was associated with NSAA (p<0.05). There was no relationship between other parameters.

Conclusions: These findings suggest that postural disorders in the foot and ankle may contribute to the decrease in performance and ambulation in patients with DMD.