Journal of the American Podiatric Medical Association最新文献

Background: The severity of foot disability in children with cerebral palsy (CP) should be examined with both objective and subjective assessment tools. This cross-sectional study investigated the effect of foot-ankle function on physical performance in CP with spastic equinus deformity.

Methods: A cross-sectional prospective study was performed on 61 children with CP. Participants were evaluated by the Gross Motor Function Classification System (GMFCS), Oxford Ankle Foot Questionnaire for Children (OxAFQ-C), Timed Up and Go Test (TUG), single-leg stance test (SLST), 3-Meter Backward Walk Test (3MBWT), and Functional Reach Test.

Results: The mean ± SD age of the children with CP (28 girls and 33 boys) included in the study was 11.3 ± 4.4 years. Individuals with higher foot-ankle function had better TUG, 3MBWT, and SLST performances (P < .005). The OxAFQ-C physical scale was moderately correlated with TUG (r = -0.474) and SLST (right extremity-eyes open) (r = 0.386) (P < .01). In addition, there was a low significant correlation between 3MBWT, SLST (right extremity-eyes closed), SLST (left extremity-eyes open), and SLST (left extremity-eyes closed) with the OxAFQ-C physical scale (P < .05). The OxAFQ-C school and play scale had a moderate-to-weak correlation coefficient (r = 0.257-0.439) with all of the physical performance tests (P < .05). In addition, there were moderate and low correlations of the OxAFQ-C emotional scale with TUG (r = -0.495) and 3MBWT (r = -0.298).

Conclusions: These results show that foot-ankle performance influenced physical performance in time-based physical tasks but not in better performance-based physical conditions. It was concluded that foot-ankle condition was most strongly associated with sit-to-stand and walking performance.

Background: This pilot study aimed to evaluate the presence and use of Instagram among podiatric medicine residency programs and its effect on the 2023 match process.

Methods: Council on Podiatric Medical Education-approved residency programs in the tri-state area of New York, New Jersey, and Connecticut were evaluated for the presence of an Instagram account and metrics including number of posts, number of followers, use of highlights, use of reels, and date of last post (to determine account activity). Programs were also analyzed for regional or national ranking (as per the U.S. News & World Report) and total number of adult hospital beds (a proxy for facility size, staff support, and resources). Programs were then evaluated to determine whether they entered Match Phase II (MPII), otherwise known as "the scramble."

Results: Podiatric medicine residency programs with an Instagram account had a lower likelihood of entering MPII (P = .006). Individual Instagram metrics did not correlate with whether a program entered MPII. Regionally or nationally ranked programs tended to have an Instagram account. There was no correlation between total number of adult hospital beds and whether a podiatric medicine residency program has an Instagram account.

Conclusions: This pilot study suggests that podiatric medicine residency programs without an Instagram account should consider establishing one, and those with an account should keep their page current, as Instagram may be an impactful resource for prospective applicants in the match process. Instagram presence of podiatric medicine residency programs in the United States has not been studied to date, making this study the first of its kind.

Background: A widespread effect of aging is imbalance and risk of falling with inappropriate footwear, which currently does not have an effective solution for older adults at home. We investigated the effect of nonslip socks on maintaining balance and preventing falls in aging women at home.

Methods: This study was a parallel controlled trial with 42 older adults from Farzanegan Daily Caring Foundation of south Iran-Shiraz. The sample size was divided into six equal groups: two control groups and four intervention groups. The intervention groups used four models of nonslip socks, and the control groups consisted of older people with bare feet and sandals. Balance was measured using the Timed Up and Go test and the nine-item Berg Balance Scale, and fear of falling with the Falls Efficacy Scale International in two phases before and after the intervention.

Results: NOVA nonslip socks reduced fear of falling by 19% (ω2 = 0.1903) and had the highest percentage of effectiveness (Cohen's d = 2.11, Glass's δ = 2.54, and Cohen's U3 = 84.8%; P < .05). Coco nonslip socks had a 22.5% increase in Berg Balance Scale score (ω2 = 0.2257) and the highest effect percentage (Cohen's d = 2.04, Glass's δ = 1.72, and Cohen's U3 = 100%; P < .05). ANIPA nonslip socks had a 2.8% increase in back and forth balance (ω2 = 0.0288) and the highest percentage of effectiveness (Cohen's d = 2.00, Glass's δ = 2.18, and Cohen's U3 = 99.5%; P < .05). But nonslip socks could not have an acceptable effect on the number of falls (ω2 = -0.0003; P > .05).

Conclusions: These results show that nonslip socks improved balance and walking more than sandals and bare feet.

During the FIFA 2022 World Cup and the AFC 2023 Asian Cup in Qatar, podiatry was the second most requested service after radiology. Despite the growing role of podiatry in large sports events, there is limited documentation on the preparation and management of such services in a football (soccer) context. This study explores the delivery of podiatry services during the FIFA 2022 World Cup and AFC 2023 Asian Cup. Podiatry services were provided by four experienced podiatrists during FIFA 2022 and three during AFC 2023. Pre-event planning included team education, training, and resource preparation. Services were delivered centrally at the polyclinic, with additional basecamp visits for teams during FIFA 2022. Data on interventions, diagnoses, and consumables were collected and analyzed. During FIFA 2022, 22% of teams used podiatry services, with 48 requests primarily addressing skin and nail issues. In AFC 2023, 25% of teams requested services, with 32 consultations focused on chronic mechanical injuries. Adaptations in service delivery were made based on the scale of each event and regional needs. The findings highlight the importance of tailored podiatry services, multidisciplinary collaboration, and preparation for diverse clinical demands. Recommendations include improving communication, regional customization of services, addressing footwear needs, and providing pre-event training.

Background: The use of plain radiographs as a surveillance mechanism in diabetic foot ulcers (DFUs) is not well understood. This study aimed to investigate the current use of plain radiographs by podiatric physicians in various DFU clinical scenarios.

Methods: A survey was disseminated to American Podiatric Medical Association member podiatric physicians via a digital e-mail publication across a 2-week period in 2018. The Pearson χ2 test was used to detect differences between respondent groups for clinical scenarios in the survey.

Results: The response rate was 4.5% (558 of 12,310). Seventy-seven percent of respondents were in private practice. For a DFU in a new patient, 66.8% of respondents "always" order plain radiographs, whereas for a new DFU in an established patient, only 46.5% of podiatric physicians "always" order plain radiographs. For an established DFU with underlying osteomyelitis, physicians with more than 5 years of practice experience order significantly more plain radiographs than physicians with less than 5 years of practice experience (P < .001). There was no association between practice experience and frequency of ordering plain radiographs for an established DFU without suspicion of osteomyelitis. For an established DFU, magnetic resonance imaging was the most common choice of secondary imaging modality if plain radiographs and clinical findings are equivocal.

Conclusions: Presence of underlying osteomyelitis, practice experience, and patient status (ie, new versus established) impact the decision about how frequently plain radiographs are ordered when considering DFU clinical scenarios. The results of this survey reflect the variation of plain radiograph use in diabetic foot management. Future qualitative studies may further explore factors that influence the decision to use plain radiographs.

Background: This study aimed to provide an overview of the definitions of claw toe and hammertoe deformities as well as the assessment methods used by various specialties to evaluate their presence and severity in both literature and clinical practice.

Methods: A scoping review was conducted using multiple electronic databases to search for articles that contained a definition or assessment method for claw toe or hammertoe deformity. Additionally, orthopedic surgeons, rehabilitation physicians, and podiatrists completed a questionnaire on the definitions and assessment methods they use in clinical practice.

Results: Most reported definitions of hammertoe deformity in the literature involved hyperflexion of the proximal interphalangeal joint (PIPJ). Sixteen different definitions were reported. Clinicians varied in their responses: most definitions comprised hyperextension of the metatarsophalangeal joint and hyperflexion of the PIPJ with a varying position of the distal interphalangeal joint. For claw toe deformity, 11 different definitions were found in the literature, and the most common involved hyperextension of the metatarsophalangeal joint with hyperflexion of the PIPJ and distal interphalangeal joint. This was also the most commonly reported definition among clinicians. Quantitative methods for assessing toe deformity were limited, with evaluation relying primarily on visual assessment.

Conclusions: There are a wide variety of definitions and a lack of consensus regarding claw toe and hammertoe deformity in the literature and among various specialty disciplines. Additionally, there are no standardized, validated methods for evaluating the presence and severity of these deformities; observation is primarily used. This hampers effective communication and analysis of toe deformity in clinical practice.

Background: The incidence of surgical site infections (SSIs) is well documented in orthopedic surgery. Benchmarking is necessary for elective foot and ankle surgery due to the limited data on this topic. The economic burden of SSI management is high. Identifying the epidemiology and potential risk factors of SSIs is critical to prevention. The primary aim of this meta-analysis was to perform a comprehensive systematic review of the literature to identify the SSI rate and risk factors for elective foot and ankle surgery.

Methods: A meta-analysis was performed of elective foot and ankle SSI articles between 1999 to 2017. The Centers for Disease Control and Prevention definition of SSIs was used for the metameter. Exclusion criteria included a history of infection, revision, pediatric cases, case studies, and nonelective surgeries.

Results: Seven articles met the selection criteria, which included 7,310 procedures in 6,257 patients. Meta-analysis of the data using a random-effects model demonstrated an SSI rate of 2.5% (0.025), with Q = 39.847.

Conclusions: An established benchmark for infection rates for elective foot and ankle surgery is needed. These results show that SSI rates with elective foot and ankle surgery are comparable with those documented in the literature. Due to a large amount of heterogeneity between studies, there is a need for higher-quality studies examining the infection rate in elective foot and ankle surgery. This is complicated by a multitude of confounding factors affecting the incidence rate of infection.

Damaged connective tissues between the bone and tendons or ligaments are common among adults regardless of activity level. Achilles tendinosis is one of the most common tissue defects and enthesopathies. This case report presents the novel application of Wharton's jelly to supplement tissue defects in the Achilles tendon and its insertion. The patient in this study is a 54-year-old female with slow-onset chronic Achilles tendinosis from chronic enthesopathy at the Achilles tendon insertion with a retrocalcaneal exostosis progressively worsening for 3 years, who failed standard-of-care practices for more than 3 years. Her previous care included rest, one successful inferior calcaneal osteotomy, and one minimally successful retrocalcaneal resection of the contralateral foot, both performed by prior surgeons. The patient received extracorporeal pulsed-activated therapy (EPAT) before applying 2 mL of CryoText, a Wharton's jelly tissue allograft. The patient then received class IV laser therapy treatments. The patient started with a 10/10 visual analog scale (VAS) at the initial visit, and by week 13, the patient rated her pain as 0/10 VAS. The improvement in patient-reported pain and functionality reported in this study after the application of Wharton's Jelly, EPAT, and class IV laser therapy warrants future research studying the safety and efficacy of these patient care modalities together as an alternative intervention for patients with Achilles Tendinosis who have failed other standard-of-care treatments. Future research will help identify additional application sites and solidify application and dosage protocols.

Background: The use of an escape room format for teaching podiatric surgery principles in residency programs offers a unique and engaging approach to surgical education. The escape room format of immersing residents in a simulated environment encourages active participation and problem-solving skills.

Methods: Through carefully designed scenarios, residents are challenged to apply their knowledge of podiatric surgery principles, critical-thinking abilities, and decision-making skills to solve puzzles and overcome obstacles within a time-constrained setting. The collaborative nature of escape rooms promotes teamwork and effective communication among residents, simulating the interprofessional dynamics often encountered in surgical settings. Furthermore, the realistic simulation provided by the escape room format allows residents to practice surgical techniques, enhance their intraoperative skills, and develop a deeper understanding of the intricacies involved in podiatric surgery.

Results: This innovative approach has the potential to enhance resident engagement, knowledge retention, and overall surgical competency, ultimately contributing to the delivery of high-quality patient care in the field of podiatry.

Conclusions: The purpose of our study was to highlight the benefits of combining the escape room format with the use of cadavers for teaching podiatric surgery principles to residents and students in a residency setting.