Journal of the American Podiatric Medical Association最新文献

Background: The objective of this study was to explore the relationship between plantar fascia (PF) thickness and various factors, including pain, function, and anthropometric parameters, in women diagnosed with plantar fasciopathy.

Methods: A total of 37 female patients were randomly selected for this investigation. Using ultrasound, the thickness of the PF was meticulously measured. Subsequently, the correlation between PF thickness and several factors, such as pain intensity, functional impairment, height, age, weight, PF biconvexity, duration of disease, recurrence of plantar fasciopathy, and daily activity level, was analyzed.

Results: The findings of this study unveiled a significant positive correlation between PF thickness and several parameters. Specifically, there was a notable correlation with pain intensity in which increased thickness corresponded to heightened pain levels. Additionally, PF thickness exhibited positive associations with height, age, and weight, indicating that these anthropometric factors may influence PF thickness. Moreover, the biconvexity of the PF, disease duration, and recurrence of plantar fasciopathy showed correlations with PF thickness, suggesting potential implications for disease progression and management. Furthermore, the study identified a relationship between PF thickness and daily activity level, underscoring the impact of physical exertion on PF health. Notably, the presence of hyperemia in the PF, as determined by power Doppler ultrasound, also showed a correlation with PF thickness, highlighting potential vascular implications in plantar fasciopathy.

Conclusions: This study provides valuable insights into the multifaceted relationship between PF thickness and various clinical parameters in women with plantar fasciopathy. Understanding these correlations may aid in the development of more targeted and effective management strategies for this debilitating condition.

Background: Investigating the kinematics of copers, who are individuals with no recurrent ankle sprains, is necessary to prevent the development of chronic ankle instability (CAI). Because the "giving way" of the ankle joint (episodes of excessive inversion of the rearfoot that do not result in an acute lateral ankle sprain) usually occurs during walking, investigating the intrafoot coordination during walking is necessary. This study aimed to identify intrafoot coordination and its variability in copers while walking.

Methods: The study included 12 copers, 13 patients with CAI, and ten control patients. The participants were required to walk on a treadmill at a fixed speed of 1.3 m/sec. Using the modified vector coding technique, the coupling angle between the intrafoot joints, representing interjoint coordination, was calculated and categorized into four coordination patterns. The coupling angle standard deviation represented the coordination variability during the stance phase.

Results: The coordination between the rearfoot and midfoot in the frontal plane showed a significantly lower proportion of antiphase with proximal dominance in the coper group than in the CAI and control groups during midstance (P < .05). Regarding coordination between the midfoot and forefoot in the sagittal plane, the coper group also showed a significantly lower proportion of in-phase coordination with distal dominance than the CAI group during midstance (P < .05). For coordination between the midfoot and forefoot in the frontal plane, the coper group also showed a significantly lower proportion of antiphase with distal dominance than the CAI group during late stance (P < .05).The coordination variability between the sagittal midfoot and forefoot in the coper group was significantly lower than that in the CAI group and similar to that in the control group during midstance (P < .05).

Conclusions: These differences may explain why copers do not experience ankle sprain recurrence.

Background: Diabetic foot ulcers (DFUs) often lead to lower-limb amputation (LLA), and comorbid foot infections increase this risk. The chronological timeline from ulceration to amputation has not been well studied, especially when accounting for foot infections. This study aims to analyze the timing between diagnosis of DFU, subsequent foot infection, and LLA.

Methods: Records of 3,156 patients with DFU treated at a single institution from 1996 to 2023 were used via the TriNetX research platform. Patients were stratified by whether they received a diagnosis of concomitant foot infection during or after DFU diagnosis (DFU+i) or not (DFU-i). Infection after ulceration was used as a time-varying covariate, and the two groups were analyzed for differences in time to LLA, rates of LLA, and patient characteristics (age at ulceration, sex, race, ethnicity, and amputation or infection before the first identified ulcer).

Results: A diagnosis of comorbid foot infection was given to 51.1% of patients either during or after DFU diagnosis, and 8.7% of patients required an amputation. Patients with a history of pre-DFU foot infections were more likely to develop a post-DFU infection (72.2% versus 32.7%; P < .001). Patients with pre-DFU amputations were also more likely to develop a post-DFU infection (67.6% versus 48.7%; P = .028). The amputation rate reached 50% in the DFU+i group by 4,857 days. The DFU-i group never exceeded an amputation rate of 6% by almost 10,000 days. When accounting for patient characteristics, post-DFU infections were 12 times more likely (P < .001) than noninfected ulcers to require amputation.

Conclusions: Patients who developed a subsequent foot infection during or after DFU diagnosis were likelier to require an amputation and had these earlier than those without infection. Great care is required to ensure that patients with DFUs minimize risk of infection and amputation.

Background: Pilon fractures refer to distal tibial fractures that may involve extra-articular, partial articular, or complete intra-articular components, most commonly caused by high-energy trauma. The choice between early (<72 hours) and delayed (>7 days) surgical fixation significantly impacts clinical outcomes. This study aimed to compare the effects of early vs. delayed plate fixation on fracture healing time, functional outcomes, and complication rates.

Materials and methods: This retrospective study analyzed 80 patients who underwent surgical treatment for pilon fractures between 2018 and 2023. Patients were divided into two groups: Early surgery (<72 hours, n=40) Delayed surgery (>7 days, n=40) Additionally, patients were categorized based on the fixation method: Single plate fixation (n=40) Double plate fixation (n=40) Outcome Measures: Fracture healing time (weeks) - Defined as cortical continuity on radiographs Functional outcomes (AOFAS score) Complication rates (infection, malunion, implant failure) Results: Shorter healing time was observed in the early surgery group (14.2 vs. 16.8 weeks, p<0.05). Better functional outcomes were recorded in the early surgery group (AOFAS score: 82.3±6.5 vs. 78.1±7.2, p<0.05). Lower infection rates were noted in the delayed surgery group (7.5% vs. 12.5%, p<0.05). Double plate fixation provided better mechanical stability but resulted in higher soft tissue complication rates. Single plate fixation preserved soft tissue integrity but had higher malunion and implant failure rates.

Conclusion: Early surgery is associated with shorter healing time and better functional outcomes, but increased soft tissue complications require careful management. Delayed surgery offers a safer approach for soft tissue healing but may prolong functional recovery. While double plate fixation ensures greater stability, it may increase soft tissue morbidity, whereas single plate fixation reduces soft tissue complications but may compromise stability. A personalized surgical approach is recommended for optimal outcomes in pilon fracture management.

Background: The objective is to evaluate the differences in the efficacy of wound care algorithms for diabetic foot ulcers (DFUs) and venous leg ulcers (VLUs) treated by a mobile wound clinic. Most patients requiring home treatment performed worse with the standard of care (SOC) compared to those in traditional outpatient clinics, especially chronic wounds associated with multiple comorbidities.

Methods: A retrospective chart review was conducted on one year's data from patient records of a mobile wound clinic (July 2022 - June 2023) involving patients suffering from DFU and VLU. Patients were divided into a control group receiving SOC with debridement and a group receiving SOC plus placental-based tissue grafts. The wound area and depth were assessed weekly. The SOC plus grafting group was monitored for the duration and number of graft applications per wound. Wounds were also scored for granulation-epithelialization (G+E) and eschar-slough (E+S). Statistical analysis included paired t-tests and ANOVA for multiple comparisons.

Results: In the interventional group, the average reduction in wound area was 39%, compared to a 10% reduction in the SOC with debridement cohort (p < 0.05). The average wound depth decreased by 33% in the interventional group and by 2% in the SOC with debridement cohort (p<0.05). The interventional group improved their positive wound scores by 8% (G+E), while negative wound scores decreased by 55% (E+S) compared to SOC with debridement patients. The mean grafting period was 94 days (±10 days) per patient, with a mean of 15 grafts (±2.6) applied per wound.

Conclusion: Despite severe comorbidities, we observed improved wound healing in a home-based care setting for most DFU and VLU patients who underwent SOC with debridement and grafting compared to SOC with debridement alone. Patients receiving SOC alone showed poorer performance at home compared to those receiving SOC plus grafting, consistently showing improvement over time.

This case report describes a bipartite os trigonum fracture in a 21-year-old female patient following a pedestrian traffic accident. The os trigonum, a rare accessory bone located posterolaterally in the talus, can sometimes lead to painful symptoms. In this case, a fracture of the bipartite os trigonum was identified, along with an anterior talofibular ligament rupture. Radiologic examinations revealed both the bipartite variation of the os trigonum and the associated fracture, with diagnosis confirmed through computed tomography (CT) and magnetic resonance imaging (MRI). Treatment involved a short leg splint and joint range-of-motion exercises, resulting in symptom improvement and functional recovery. This case highlights the importance of recognizing the rare occurrence of os trigonum fractures, particularly the even rarer bipartite variant, and underscores the significance of CT and MRI in a detailed diagnosis.

Background: This study examined the influence of foot posture and balance function in individuals with knee osteoarthritis (KOA) and nonspecific low-back pain (LBP).

Methods: This study included participants aged 40 to 65 years categorized into three groups: nonspecific LBP (n = 44), KOA (n = 43), and healthy controls (n = 45). Demographic data were collected and disability levels were assessed using the Oswestry Disability Index for LBP and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) for KOA. Foot posture was evaluated using the Foot Posture Index 6 (FPI-6) and navicular drop test, whereas balance was quantified using the Y Balance Test.

Results: Analysis of the FPI-6 scores on the dominant side revealed significant differences between the LBP and healthy control groups (P = .008) and between the LBP and KOA groups (P = .005). The Manchester-Oxford Foot Questionnaire (MOXFQ) scores also showed significant differences between the KOA and healthy control groups (P = .022) and between the LBP and healthy control groups (P = .038). Overall, significant differences were observed among all groups in both FPI-6 (P = .006) and MOXFQ (P = .033) scores. The results of the multiple linear regression models indicated that MOXFQ scores significantly predicted the Oswestry Disability Index, with an R2 of 0.283 (P = .04), whereas WOMAC and FPI-6 scores were significant predictors of the WOMAC score, with an R2 of 0.078 (P = .04).

Conclusions: This study revealed distinct impairments in foot function and posture in KOA and LBP patients. Foot function was compromised in both groups, with more pronounced foot posture changes in the KOA group, whereas balance remained unaffected. Foot function was linked to disability in LBP and foot posture to disability in KOA. These findings highlight the importance of targeted foot assessment in KOA and LBP rehabilitation.

Hyperhomocysteinemia (HHcy), defined as having over 15 µmol/l of homocysteine in the blood, is a disease that is generally linked to either a metabolic defect or a dietary deficiency. Patients suffering from HHcy are known to have elevated risks of arterial cardiovascular events, neuropsychiatric illness, compromised bone health, and increased risk of vein thrombosis in unusual anatomical locations. We present the case of a 45-year-old woman diagnosed with HHcy, who presented with acute pain on the sole of her right foot. The patient had previously experienced recurrent superficial venous thrombosis in the plantar veins. The patient was referred for an ultrasound, which revealed plantar metatarsal vein thrombosis. With fewer than 50 reported cases of plantar vein thrombosis in the literature, none of which are currently linked to HHcy, this is a very rare form of thromboembolic event. This case underscores the importance of considering thromboembolic events in atypical locations, in patients with HHcy who present with pain, even if these patients lack other major risk factors. Our case contributes to the growing body of literature on venous thrombosis in patients with HHcy and emphasizes the need for heightened clinical awareness in such patients. We further highlight the need to be aware of their propensity to develop thrombosis in unusual anatomical locations.

Background: Vaping and electronic cigarettes (e-cigarettes) have grown in popularity over the last decade with the public health desire to limit traditional smoking and nicotine delivery methods. Tobacco has been documented in the orthopedic literature to have negative effects on bone healing and to contribute to surgical complications. The purpose of this study was to assess the effects of e-cigarette use on postoperative complications.

Methods: Data were collected from patients undergoing surgery by two board-certified foot and ankle surgeons from May 1, 2020, to February 25, 2021. Each participant was called and went through a standardized unvalidated questionnaire. Information was recorded, de-identified, and compiled into a spreadsheet. Patient demographics and medical history were documented. Four groups were compiled: tobacco smokers only (n = 29), vape users only (n = 4), smokers and vapers (n = 7), and nonsmokers and nonvapers (n = 54). Procedures comprised 30 forefoot, 32 hindfoot, and 22 other (multiple locations and soft tissue only).

Results: Medical history of hyperlipidemia was the greatest risk factor for perioperative complications (P = .07). Odds ratios and Wald confidence intervals were calculated between the groups but were insignificant.

Conclusions: We were unable to identify a difference in complication rate between vapers and exclusive tobacco users. The inability to reveal a significant difference is likely attributed to the study's small sample size. More studies are warranted to evaluate the effects of e-cigarette use on foot and ankle surgery.

Background: Deep venous thrombosis (DVT) and pulmonary embolism (PE) are relatively rare after foot and ankle surgery, especially after trauma. Diagnosing DVT is difficult, and even when it is discovered it does not necessarily clinically manifest on, for example, duplex ultrasound. Thus, it is often recommended that prophylaxis use be assessed on a case-by-case basis based on risk profile rather than being uniformly given or not prescribed.

Methods: We searched the National Trauma Data Bank Trauma Quality Programs Participant Use File for patients experiencing foot and ankle trauma from 2013 to 2017. Patients were identified using the International Classification of Diseases, 9th Revision codes. Procedures undergone by patients were classified into five categories: closed reduction with fixation, open reduction with or without fixation, closed reduction without fixation, immobilization or no treatment, and soft-tissue procedures (eg, wound debridement).

Results: Roughly 60% of trauma admissions for foot and ankle injury included use of prophylaxis. Female sex and increased age predisposed a patient to prophylaxis use. Hispanic and self-pay patients were less likely to have prophylaxis prescribed. Those with risk factors such as hypertension or smoking and those with open injuries or rearfoot injuries were also more likely to receive prophylaxis. Approximately half of the foot and ankle trauma patients in this cohort were treated with DVT prophylaxis, including those without additional risk factors for DVT/PE.

Conclusions: Further study is needed to better elucidate whether prophylaxis use is driven by protocol or clinical decision-making. Although it is important to understand the epidemiology of DVT/PE, effectiveness of prophylaxis, and recommendations from associations, understanding community practice patterns can promote discussion with policymakers to create new or alter current institutional protocols that may not be specific to the foot and ankle.