Journal of the American Podiatric Medical Association最新文献

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: 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.

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.

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.

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.