Journal of the American Podiatric Medical Association最新文献

Cuboid injuries, including fractures, are rare and infrequently occur in isolation. Often, cuboid injuries can be treated nonoperatively. However, when surgery is indicated, appropriate management is necessary for maintaining the associated biomechanics of the midfoot. Current procedures for surgical management of the cuboid include open reduction and internal fixation, application of external fixation, or primary arthrodesis of the calcaneocuboid joint. Secondary procedures for symptomatic or poor outcomes of nonoperative and operative cuboid injuries consist of corrective osteotomy, bone resection, and interpositional arthroplasty. We present a novel surgical technique using a patient-specific three-dimensional-printed total cuboid replacement. This is an alternative treatment for post-traumatic arthritis of the cuboid along with a shortened lateral column. A single case example is given as well as details and discussion of the surgical technique.

Background: Foot pain is a common presentation, and management is generally geared toward pressure offloading. Although several pressure offloading devices exist on the market, the search for the optimal device is ongoing.

Methods: We recently developed PopSole, an inexpensive, simple, balanced offloading insole focused on reducing targeted foot pain. We conducted a prospective validation study of patients with foot pain lasting longer than 6 months to assess the durability and efficacy of the device with follow-up scheduled at 2 weeks, 4 weeks, 2 months, and 3 months. Patient-reported outcomes were collected using multiple validated surveys. Fifteen patients were enrolled in this study.

Results: At 4 weeks, pain, function, and quality of life across all surveys showed statistically significant improvement. For the 6 patients with long-term outcomes (3 months), patients reported improvement in their pain, function, and quality of life across all surveys, which were significant in the Mayo survey (P = .018), the Manchester Foot Pain and Disability Index (P = .014), the American Orthopaedic Foot and Ankle Society ankle-hindfoot scale (P = .032), the Foot and Ankle Ability Measure activities of daily living (P = .009), and the Pittsburgh foot survey (P = .01); the Foot and Ankle Ability Measure sports approached statistical significance (P = .058).

Conclusions: The PopSole is a durable and effective device to relieve foot pain, improve function, and improve quality of life for up to 3 months of use.

Background: In professional athletes, Achilles tendon ruptures are devastating injuries, often resulting in season loss or decreased return to sports level. We aimed to perform a comprehensive video analysis to describe the mechanisms of Achilles tendon rupture as well as body posture in professional athletes. We hypothesized that Achilles tendon ruptures in professional athletes develop with a specific injury mechanism and that body posture at the time of injury varies by sport.

Methods: Of 114 identified Achilles tendon ruptures that occurred in professional athletes between 1970 and 2020, 42 with adequate video data were analyzed for injury mechanism, body posture, and player and sport characteristics by three independent reviewers.

Results: Mean ± SD age of the 42 athletes (41 men and 1 woman) was 28.4 ± 4.26 years. Eighteen athletes played basketball (42.9%), 14 football (33.3%), five soccer (11.9%), three baseball (7.1%), and two rugby (4.8%). Thirty-five patients (83.3%) had noncontact injuries. The most frequent months of injury were January (16.7%) and October (14.3%). During Achilles tendon rupture, the ankle was in dorsiflexion, the body was bent forward, the knee and hip were in extension, and the foot was in a neutral position. Most injuries occurred during take-off/acceleration (40.5%) or stop and turn (38.5%) maneuvers.

Conclusions: In professional athletes, the Achilles tendon most often ruptures during take-off/acceleration. The most common position during rupture is the trunk in flexion, the knee and hip in extension, and the ankle in dorsiflexion. This information can guide professional athletes in terms of physical therapy techniques, including neuromuscular training, proprioception, and balance training specific to preventing Achilles tendon rupture.

Background: Improvements in muscle oxygenation and exercise posture can significantly impact muscle contraction. The aim of this study was to compare the effects of combined breathing and exercise posture (sitting or standing) on the muscle activity of the foot and ankle during short foot exercises (SFE) in individuals with pes planus.

Methods: The study included 15 subjects aged 21.53 ± 1.06 years, diagnosed with pes planus. Short foot exercises were performed with and without breathing exercises (BE) in sitting and standing positions. Surface electromyography was used to measure the activity of the tibialis anterior (TA), peroneus longus (PL), and abductor hallucis longus (ABDH) muscles during four different SFE. Four-way repeated analyses of variance were used to assess the addition of BE to SFE and muscle activities of the foot and ankle.

Results: Muscle activity in the TA, PL, and ABDH was significantly higher in the SFE with BE than without BE in the standing position than in the sitting position. The SFE performed with BE when standing significantly increased the ABDH and ankle muscle activity compared to without BE.

Conclusions: SFE with BE may represent a new strengthening program for ABDH and PL foot muscles in rehabilitation programs for individuals with pes planus.

Background: Diabetes foot infection is a very important public health problem that causes serious health problems, mortality, and high health expenditures, and is one of the most important complications of diabetes mellitus. There are concerns that approaches such as limited personal visits to doctors, avoidance of hospitals, and restrictions on nonemergency surgical procedures during the coronavirus disease of 2019 pandemic pose a threat to those with diabetic foot problems, including diabetic foot ulcers (DFUs), ischemia, and infection, resulting in increased limb loss and mortality.

Methods: This multicenter, retrospective, cross-sectional study was conducted in 14 tertiary care hospitals from various regions of Turkey. A total of 1,394 patient records were evaluated, 794 of which were between January 1, 2019, and January 30, 2020 (prepandemic [Pre-P]), and 605 of which were between February 1, 2020, and February 28, 2021 (pandemic period [PP]).

Results: During the PP, diabetic foot patient follow-up decreased by 23.8%. In addition, the number of hospitalizations attributable to DFU has decreased significantly during the PP (P = .035). There was no difference between the groups regarding patient demographics, medical history, DFU severity, biochemical and radiologic findings, or comorbidities, but the mean duration of diabetes mellitus years was longer in patients in the Pre-P than in those in the PP (15.1 years versus 13.7 years). There was no difference between the two groups in terms of major complications such as limb loss and mortality, but infection recurrence was higher in the PP than in the Pre-P (12.9% versus 11.4%; P < .05). The prevalence of nonfermentative gram-negative bacteria as causative agents in DFU infections increased during the PP. In particular, the prevalence of carbapenem-resistant Pseudomonas spp. increased statistically during the PP.

Conclusions: The rapid adaptation to the pandemic with the measures and changes developed by the multidisciplinary diabetic foot care committees may be the reasons why there was no increase in complications because of DFU during the pandemic in Turkey.

Background: Nail excisions are indicated for onychocryptosis and nail spicules. They are technically demanding and require a refined skill set. We aimed to characterize practice patterns of US providers performing nail excisions.

Methods: We conducted a retrospective analysis of Medicare provider use and payment data, part D, for all claims of partial or complete nail/nail matrix excision with/without nail plate removal/destruction (current procedural terminology code 11750). High performers were defined as providers performing annual nail excisions 2 standard deviations above the mean. We analyzed demographic risk factors for nail excision high performers, including practice location, years of experience, household median income, practice type, and provider gender. Statistical analysis was conducted in SAS v9.4, with values of P < .05 considered statistically significant.

Results: Providers (n = 32,279) and high performers (n = 942) performed mean 34.7 and 173 nail excisions annually. Unsurprisingly, podiatrists constituted 99.7% of all nail excision performers. Providers in the South versus Midwest and Northeast were more often nail excision high performers (odds ratio [OR], 1.95; P < .0001, and OR, 1.46; P < .0001). Solo versus group practitioners were more likely, respectively, to be nail excision high performers (OR, 2.15; P < .0001). With linear regression analysis, for every 10-year increase in years of provider experience, there was an increase of 1.2 nail excisions annually per provider (P < .0001). For every $100,000 increase in household median income of practice location, there was a decrease of 9.9 nail excisions annually per provider.

Conclusions: Southern podiatrists, podiatrists with more years of experience, solo practitioners, and those practicing in regions with lower household median incomes were more likely to perform higher numbers of nail excisions. Identifying performance trends among podiatrists can help podiatrists understand how their performance of nail excisions compares to other podiatrists across the country.

Background: Surgical treatment for Freiberg disease (also known as avascular necrosis of the metatarsal head) has not been completely defined. This retrospective study evaluated short-term outcomes after arthroscopic treatment of Freiberg disease.

Methods: From 2015 to 2019, 13 patients (15 feet) diagnosed as having Freiberg disease were enrolled for arthroscopic surgery. Feet were divided based on the Smillie classification system (two with stage I, eight with stage II, three with stage III, one with stage IV, and one with stage V). Arthroscopic interventions, including synovectomy, debridement, chondroplasty, microfracture, and loose body removal, were performed without considering the Smillie classification stage. Radiologic outcomes were evaluated by radiography (preoperatively and 3, 6, and 12 months postoperatively) and magnetic resonance imaging (preoperatively and 12 months postoperatively). Clinical outcomes were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) lesser metatarsophalangeal (MTP)-interphalangeal score and the visual analog scale (VAS) score. The MTP joint range of motion was measured using a goniometer preoperatively and postoperatively.

Results: Radiologic studies showed no evidence of osteonecrosis progression in postoperative 12-month radiographs of any patients. Postoperative 12-month magnetic resonance images showed reduction of bone marrow edema, irregularity of subchondral bone, and cartilage defects in all patients. Significant improvements in AOFAS and VAS scores occurred at all postoperative time points compared with preoperative scores (P = .001). The MTP joint range of motion also showed improvement at last follow-up (P = .001).

Conclusions: Arthroscopic surgery for Freiberg disease showed excellent clinical outcomes, MTP joint range of motion, and short-term outcomes regardless of stage (Smillie classification) in radiologic evaluation.

Background: This study aimed to compare two-point discrimination in feet with ankle sprains and feet without ankle problems, and to determine whether there was a change in the two-point discrimination values in ankle sprains.

Methods: A total of 108 people were included in the study. These subjects were aged between 18 and 40 years and visited the Medical Faculty of Yozgat Bozok University for various reasons in July and September of 2022. These people were divided into two groups: subjects with an ankle sprain and subjects with no ankle problems. Two-point discrimination values measured in millimeters were recorded for both groups using a caliper (esthesiometer) used in six regions of 216 feet. The two-point discrimination threshold values of the feet were compared statistically according to feet with ankle sprains and feet without ankle problems, and in right and left feet.

Results: The study determined that the two-point discrimination threshold values measured at the first toe tip, heel, third plantar metatarsal head, medial malleolus, and lateral malleolus in subjects with an ankle sprain was higher than in subjects with no ankle problems. When comparing both feet of the subjects with an ankle sprain, the two-point discrimination threshold value in the heel of the foot with an ankle sprain was higher than in the heel of the foot without ankle problems.

Conclusions: The two-point discrimination threshold value was higher in subjects with an ankle sprain than in subjects with no ankle problems. The data suggest that the two-point discrimination threshold may be higher in people with an ankle sprain. Further studies are needed to better understand the two-point discrimination threshold in ankle sprains.

Background: This cross-sectional retrospective study aimed to present the influence of unilateral and bilateral flatfoot on coronal spinopelvic alignment in asymptomatic young healthy males.

Methods: This study was performed by examining the medical reports of individuals who applied to the National Health Board to work in positions requiring physical fitness between January 1, 2018, and January 1, 2019. Plain radiographs of the feet, pelvis, and spine were analyzed. The calcaneal pitch angle for flatfoot, pelvic obliquity, and the Cobb angle for spinal asymmetry were measured. After all of the analyses were completed, participants were divided into two groups-unilateral or bilateral flatfoot, depending on the calcaneal pitch angle measurements-and compared.

Results: There was no significant difference in age between groups (P = .609). The unilateral flatfoot group showed higher values in terms of body mass index, with a significant difference (P = .01). The curve patterns were identified as single thoracic, lumbar, and double. Post-hoc analyses suggest that young males without spinal asymmetry were more likely to have unilateral flatfoot (P < .008). There were significant differences between groups in pelvic obliquity and Cobb angle (P < .05). The effect size was found to be small to medium for pelvic obliquity and medium to large for Cobb angle.

Conclusions: Young males with bilaterally increased foot pronation demonstrate more increased pelvic obliquity and spinal curvature.

Background: After an ankle sprain, the ligament and joint capsule are damaged, and as a result, proprioceptive sense is damaged, causing a feeling of giving away in the ankle and resulting in recurrent sprains. Given the relevant studies, it has been seen that people with chronic ankle instability (CAI) commonly have deficits in joint position sense and reinjury risks. Joint position sense plays an important role in ankle control, thereby reducing the risk of injury. Therefore, this study aims to compare the effects of balance and strength training on ankle proprioception in people with CAI.

Methods: This single-blind randomized controlled study included 29 volunteer participants (21 women and eight men) aged 18 to 30 years. Participants with a Cumberland ankle instability scale score less than or equal to 24 were randomly divided into two treatment groups: strength training (n = 14) and balance training (n = 15). Y balance test, joint position, and vibration sense were evaluated at the beginning and end of the treatment. "Hop to stabilization" exercises were applied to the balance group and resistive bands exercises to the strength group, which were performed for 6 weeks, 35 minutes per day, two times per week.

Results: There was no significant difference between the two groups in the anterior, posterolateral, and posteromedial directions of the Y balance test (P = .89, P = .50, and P = .34, respectively), but the strength training group showed significant improvement in ankle proprioception (140°) and vibration sense (fifth finger) (P < .001), and the post hoc Cohen's d effect size values were medium (.52) and small (.25), respectively.

Conclusions: The findings of this study show that strengthening and balance exercises have similar effects on dynamic balance, but strengthening exercises are more effective in improving joint position and vibration sense. Given the positive effects of both exercise programs, it is recommended to implement the two interventions separately or together for CAI rehabilitation.