Journal of the American Podiatric Medical Association最新文献

Background: In patients with rheumatoid arthritis (RA), the pathologic progression of lower-limb biomechanics is established. Although specific aspects of RA gait patterns have been studied and described, we are aware of no studies of gait pattern compensations across the entire disease course. This study aimed to describe a model that could predict the evolution of lower-limb pathomechanics in patients with RA.

Methods: A literature review was conducted of electronic databases (MEDLINE, PEDro, Trip Database, DOAJ, BioMed Central, PLoS Clinical Trials, ScienceDirect, CRD York University, AHRQ, NICE, and Cochrane Library) to October 3, 2023.

Results: A theory was developed that all people with RA induce or augment gait evolution syndromes following the same biomechanical course. Specifically, we postulate rheumatoid equinus syndrome, rheumatoid abnormal pronation syndrome, and rheumatoid shuffle syndrome, which have never been described before.

Conclusions: A new model of the evolution of gait compensation in RA is proposed. An important challenge of RA is that it increases the risk of ulcerative lesions, falls, pain, fractures, and health-care costs. The proposed model can be used to reduce morbidity in this patient group by helping explain and reduce the pain, deformity, and ankylosis of foot RA.

Background: Falls in the geriatric population lead to increased risk of injury and health-care costs. Orthotics are commonly prescribed because of this risk or after injury. This study aimed to evaluate center of pressure (COP) sway and velocity, functional testing, and participant preferences in different braces.

Methods: In this laboratory-based crossover study, four conditions were evaluated: the participant's own shoe, own shoe plus TayCo brace, own shoe plus Moore balance brace, and walking boot. A total of 18 ambulatory adults over the age of 65 completed three bilateral stance balance trials in which COP excursion and velocity were measured on a Bertec instrumented force plate followed by a Timed Up and Go test for each condition. Participants rated each condition for overall perceived stability and comfort on a visual analog scale, ranking them from 1 to 4.

Results: There was significantly less anteroposterior COP excursion (P = .001; effect size [ES] = 1.03) in the TayCo brace versus the walking boot, and there was significantly less mediolateral COP excursion (P = .02; ES = 0.60) in the TayCo brace versus the Moore brace. There was significantly less overall COP velocity (P = .02; ES = 0.94) in the TayCo brace versus the Moore brace or walking boot. There were no significant differences (P > .05) between the rest of the conditions. Timed Up and Go times were found to be significantly higher (P < .05) for the walking boot compared with the other bracing conditions. There were no significant differences (P > .05) between the other orthotic conditions. The walking boot was perceived to be significantly (P < .05) less stable than the other conditions. Participants' shoes were perceived to be significantly (P = .03; ES = 1.44) more comfortable than the TayCo brace, but the TayCo brace was perceived to be significantly more comfortable (P < .01) than the Moore balance brace (ES = 0.74) and walking boot (ES = 2.37).

Conclusions: The TayCo brace demonstrated decreased COP excursion compared with other conditions and performed similarly to the participants' own shoes. Further study should investigate the effects of this brace for clinical implementation.

Background: Infrapopliteal arterial calcifications (IPACs) are commonly seen on radiographs. No studies have examined the association between IPACs on radiographs and coronary artery calcium scores among the general population.

Methods: This retrospective cohort study examined patients who had both a heart scan for calcium scoring and foot, ankle, heel, or tibia/fibula plain film radiographs within a year of each other. Two radiologists and three foot and ankle specialists reviewed radiographs independently followed by a consensus review. Agatston scores and demographics were recorded via chart review. Univariate and regression analyses were performed to compare rates of abnormal and severe cardiac scans among patients with and without IPACs.

Results: Blind concordance was achieved among five reviewers for 211 of 283 radiographs (74.5%); each reviewer scored higher than 89% compared with the consensus results. Thirty-four of 283 patients were found to have IPACs and were more likely to have a nonzero heart scan score compared with those without IPACs (91% [31 of 34] versus 55% [136 of 249]; odds ratio, 8.6; 95% confidence interval, 2.6-28.8; P < .0001). Sixty-two percent (21 of 34) of patients with IPACs had category 3 or 4 heart scores, whereas only 21% (52 of 249) of those without IPACs had category 3 or 4 heart scores (P < .0001). IPACs remained significantly associated with category 3 or 4 heart scores (odds ratio, 4.4; 95% confidence interval, 2.0-9.7; P = .0003) even after controlling for age and diabetes with logistic regression modeling. Only four of 34 patients (11.7%) had IPACs reported on their original radiology report.

Conclusions: IPACs were accurately identified on radiographs by several reviewers but are often not mentioned on radiology reports. When present, IPACs are strongly associated with nonzero heart scores and severe heart scores. This finding could influence preventive cardiac care in asymptomatic patients.

Hallux rigidus is a common condition affecting the foot. I was not able to find evidence regarding the management of patients with hallux rigidus with manual physical therapy consisting of hands-on manual therapy techniques and movement-reinforcing exercise. This case report attempts to highlight the management of a patient with hallux rigidus by a physical therapist. The patient was a 60-year-old male baseball player with clinically apparent pain, loss of metatarsophalangeal joint motion, and radiographically visible degenerative changes suggesting a diagnosis of grade II hallux rigidus. Treatment involved joint distraction mobilization of the first metatarsophalangeal joint. Improvements were noted immediately with regard to the patient's ability to run with decreased symptoms. I carefully instructed the patient to perform the manual distraction techniques at home. After four clinical visits, the patient returned to baseball the following spring. Outcomes were maintained 8 years after initial evaluation.

Intraosseous cysts of the calcaneus are rare, are usually asymptomatic, and most commonly affect the general population in the third and fourth decades of life. When conservative treatment fails, surgery may be necessary. However, there is no consensus on the surgical technique for the removal of intraosseous calcaneal cysts. In this case study, we present a symptomatic intraosseous cyst of the calcaneus in a 17-year-old pediatric patient. Treatment was recalcitrant to conservative measures, and a novel surgical technique using a bone window was used to treat the intraosseous lesion. To our knowledge, this is the first study to describe a windowing technique for access to the lesion followed by reimplantation of the window for additional support.

Background: Acute Achilles tendon rupture (AATR), a common injury among middle-aged amateur athletes, poses significant diagnostic and therapeutic challenges. This study evaluated the outcomes of AATR repair based on whether the ruptured tendon was located in the dominant or nondominant extremity.

Methods: A retrospective analysis was conducted on 28 patients (25 males and three females aged 39.64 ± 5.32 years) who underwent surgical repair using the Krackow technique between 2020 and 2022. Functional outcomes were assessed at 2-year follow-up using clinical scores (Achilles tendon total rupture score and visual analog scale score), range of motion, calf circumference, and ultrasonography measurements.

Results: The Achilles tendon total rupture scores for the dominant limb showed superior clinical outcomes (P = .001), but the calf circumference was significantly smaller on the operated side compared with the nonoperated side (P < .001). Operated tendons exhibited increased thickness and length on ultrasonography, with no adverse impact on functional performance. Early mobilization and rehabilitation contributed to a mean time to return to sports of 5.82 months (85.7% success rate). Complications included superficial infection in one patient and delayed wound healing in one patient, both managed with antibiotic therapy and dressings.

Conclusions: The findings highlight the influence of limb dominance on AATR repair outcomes, suggesting enhanced resilience and recovery in the dominant extremity. Surgical repair with appropriate rehabilitation offers a reliable strategy for active individuals, promoting early return to activity while minimizing re-rupture risks.

Background: The podiatric medicine residency match is a multifaceted system that includes prospective residents ranking their preferred residency programs. As social media increases, residency programs have increased their use of social media.

Methods: The present study used an online survey to investigate the perspectives of podiatric medical trainees on social media use in residency programs.

Results: Ninety-six percent of participants reported using social media, with Instagram (86.8%) and Facebook (78.0%) being the most popular platforms. More than half of the respondents (57.4%) stated that a program's social media affected their view of the program. However, 93.5% stated that it did not impact their residency match rank list. Almost three-quarters of respondents reported following residency programs online.

Conclusions: Overall, we found that social media was heavily used by podiatric medical trainees. Social media platforms affected prospective residents' views about a program but did not impact overall externship selection or residency match rank list.

Background: Flap-based and podoplastic limb salvage in the foot and ankle is difficult due to the presence of biomechanical forces that can impact flap healing and complication rates and, in turn, limb salvage rates. For this reason, external fixation is indicated to neutralize forces across the flap interface and allow for optimal flap take and healing. Although external fixation for flap immobilization is the current standard of care, not much is known about how duration and timing may impact complication and salvage rates.

Methods: We retrospectively identified and analyzed complication and limb salvage rates in 18 patients who underwent flap-frame immobilization with a multiplanar external fixator during a 4.75-year period.

Results: Patients ranged in age from 40 to 75 years (mean, 55.5 years). Sixteen patients (88.9%) had diabetes mellitus, and all had defects that were a mean of 110.9 cm2 (range, 36-500 cm2) and required the use of a local or free flap. Thirteen defects (72.2%) were in the plantar region, with the remaining five (27.8%) in nonplantar regions. Eleven flaps (61.1%) were fasciocutaneous, and the remaining seven (38.9%) were vascularized muscle flaps. All of the flaps were immobilized with either a three- or four-ring circular external fixator. Overall, a 66.7% limb salvage rate (12 of 18) was observed with mean follow-up of 2.4 years, or 892.6 days (range, 222-1,555 days). Seven minor flap complications (38.9%) required a return to the operating room.

Conclusions: External fixation is an essential tool in flap-based limb salvage. These findings hint that the "Goldilocks zone" of duration is approximately 28 to 35 days. Furthermore, we believe that risk factors such as open amputation, increased defect size, and presence of Charcot's neuroarthropathy impact limb salvage rates regardless of duration and timing of flap-frame immobilization.

Background: Whether a sequela of neuropathy or a result of infectious processes to dysvascular changes, talar degeneration in the Charcot ankle proves difficult to treat. Total resection followed by bone void filler or grafts is costly, with varying levels of success. Although tibiocalcaneal fusion allows stabilization, this approach remains a procedure of last resort before amputation. This series presents outcomes of partial talectomy with tibiotalocalcaneal arthrodesis.

Methods: Nineteen patients with Charcot's neuroarthropathy necessitating a tibiotalocalcaneal fusion were included in this study. Tibiotalocalcaneal arthrodesis was performed using a partial talectomy with a combination of internal with and without external fixation constructs.

Results: Among this cohort of 19 patients followed up for a mean ± SD of 22.0 ± 14.8 months, 21% had osteomyelitis of the talus, and 32% presented with a wound at the time of surgery. Successful primary tibiotalocalcaneal arthrodesis with a partial talectomy was reached in 79% of patients. Of patients necessitating revision, two continued with a tibiotalocalcaneal arthrodesis, and the remaining two reverted to a tibiocalcaneal arthrodesis. No patients experienced a major amputation.

Conclusions: Unstable ankle Charcot's deformity with osseous degeneration poses a serious threat of limb loss without surgical reconstruction. Total talectomy allows complete resection of nonviable bone; however, this irreversible approach removes possibly viable native tissue. Partial talectomy proves an effective option by minimizing osseous resection, allowing primary arthrodesis between autogenous osseous segments. Moreover, in patients with failed partial talectomy, conversion to tibiocalcaneal arthrodesis proved viable. Before total removal of native bone, partial talectomy should be considered.

Background: One of the gold standard treatments for diabetic foot ulcers (DFUs) is the ambulatory total-contact cast (TCC). Although there is a well-known association between immobilization and deep venous thrombosis (DVT), we are unaware of reports in the literature exploring the proportion of patients reporting DVT receiving a TCC.

Methods: A review was performed using the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines in the PubMed, Embase, and Ovid Medline databases. Independent reviewers selected studies and extracted data. Inclusion criteria were publications reporting DVTs in patients who were off-loaded or immobilized with TCCs for the treatment of DFUs. Predefined outcomes of interest included the occurrence of DVTs, TCC duration, treatment protocol, and preexisting comorbidities.

Results: Of 380 reports reviewed across multiple databases, two studies met all of the inclusion and exclusion criteria. The combined studies reported a DVT in 178 episodes of immobilization.

Conclusions: The available literature studying the associations among DVTs, DFUs, and TCCs was surprisingly sparse for a population that would otherwise be considered at high risk for similar events. This may be at least in part because TCCs are changed more often than other traditional immobilization devices, such as a standard fracture cast. Although these data seem to suggest a low background prevalence, we look forward to further works confirming or refuting these findings.