Journal of the American Podiatric Medical Association最新文献

Background: Charcot neuroarthropathy (CN) of the hindfoot or ankle often results in important deformity, instability, chronical ulceration and infection that, without adequate treatment, could lead to trans-tibial amputation. Several surgical procedures for the reconstruction of hindfoot- and ankle CN deformities have been described in literature. Their main disadvantage is the extensive soft tissue dissection, which could lead to infection, necrosis and implant failure.

Methods: We introduce a novel technique of minimally invasive surgery (MIS) for correction of CN deformities, followed by retrograde intramedullary nailing of the hindfoot for stabilization. This retrospective limited case-series reports the outcome of 5 patients (3 women, 2 men, 5 feet) with unstable hindfoot Charcot deformities and neuropathic ulcers who underwent MIS.

Results: Mean age was 54.5 years ; the median American Society of Anesthesiologists score was 3. Three patients underwent a single-stage procedure and two patients underwent a two-stage treatment. No postoperative infections occurred. Healing of ulcerations was achieved at average of 5 weeks. Hindfoot angle improved from 33.6 to 6.2 degrees (p<.05). At a mean follow-up of 20.6 months, limb preservation was achieved for all patients. There was no failure of correction or fixation. The mean American Orthopedic Foot & Ankle Society (AOFAS) score improved from 45.0 to 79.8 (p<.05). The mean Euroqol EQ-5D-5L score improved from 0.23 to 0.82 (p<.05).

Conclusion: This proof-of-concept shows that MIS of CN hindfoot and ankle deformities can be a safe and efficient procedure, providing short-term healing of neuropathic ulcers and long-term improvement of function and quality of life.

A 17-year-old male presented with a painful subungual mass, which was clinically diagnosed as a subungual exostosis prior to surgical referral. Few reported cases of subungual osteochondroma exist in the literature, and those published describe skin or nail deformities resulting from the lesion. These deformities can easily be misdiagnosed as subungual exostosis by clinical examination alone. The characteristic findings in this case resulted in a diagnosis of subungual osteochondroma, which was successfully resolved following surgical excision. This report highlights the clinical, radiographic, and histopathologic characteristics of subungual osteochondroma, and differentiates it from subungual exostosis. The results report on the success of a 2-year post-surgical audit of patient-related outcomes.

Primary malignancies originating in the calcaneus are rare, constituting fewer than 1% of skeletal tumors. Traditional approaches like amputation, though effective, result in significant morbidity. This study presents a case of a 32-year-old male with calcaneal chondrosarcoma, managed with total calcanectomy and subsequent limb salvage through iliac wing autograft reconstruction. The decision for reconstruction considered tumor characteristics, patient factors, and feasibility of reconstruction methods. Successful recovery and functional outcomes were achieved without evidence of recurrence during the 67-month follow-up. The use of autogenous iliac bone graft demonstrated its suitability for structural reconstruction, emphasizing limb-sparing options in calcaneal chondrosarcomas.

Background: The purpose of this study was to identify radiographic risk factors for loss of correction (LOC) after hallux valgus surgery and to weight their importance for LOC.

Methods: We retrospectively assessed the radiographs of 1,082 consecutive chevron osteotomy cases regarding early LOC from initially postoperative to 6 and 12 weeks postoperative. The influence of preoperative and postoperative radiographic parameters on LOC of the hallux valgus angle (HVA) and the intermetatarsal 1-2 angle (IMA) was evaluated using nonparametric Spearman rank correlations and multiple linear regression analyses.

Results: Mean ± SD LOC from initially postoperative to 6 and 12 weeks postoperative were 1.4° ± 2.7° and 3.4° ± 2.6° for the IMA and 3.5° ± 5.4° and 7.6° ± 5.6° for the HVA, respectively. Significant correlations were found between LOC of the HVA or IMA for preoperative IMA, HVA, distal metatarsal articular angle, proximal to distal phalangeal articular angle (PDPAA), and joint congruity as well as for postoperative IMA, HVA, PDPAA, joint congruity, and sesamoid position. Categorization of outcome-predicting postoperative radiographic factors revealed the following parameters to be important, in descending order: HVA, sesamoid position, IMA, PDPAA, and joint congruity.

Conclusions: Multiple preoperative and postoperative radiographic parameters correlate with early LOC after hallux valgus surgery. Relevancy grading revealed the postoperative HVA and sesamoid position to be the most important parameters, followed by the IMA, PDPAA, and joint congruity. Consequently, total deformity correction, taking all aspects of the hallux valgus deformity into account, seems reasonable.

Background: Chronic degeneration of the plantar fascia at its insertion on the plantar calcaneus, known as plantar fasciitis (PF), is the most common cause of heel pain in adults. The calcaneal fat pad (CFP) is a structure superficial to the plantar fascia and calcaneus, serving a critical purpose in shock absorption at heel strike during gait. To our knowledge, the radiographic relationship between the thickness of the CFP and PF has never been evaluated. The purpose of this study was to determine if there is a relationship between the thickness of the CFP, as measured on weightbearing lateral radiographs, and the incidence of PF.

Methods: This was a comparative retrospective analysis between a study cohort and a control group performed at our facility. The study cohort consisted of patients diagnosed with PF, whereas the control group consisted of patients who had no known history of PF. All patients involved in this study had weightbearing lateral foot radiographs taken and met study inclusion and exclusion criteria. The CFP thickness of the study participants was measured using the ruler tool in the AccuVueCloud radiography software.

Results: The study cohort consisted of ten patients and the average of the radiographic measurements obtained was 0.808 cm, whereas the control group consisted of ten patients and the average of the radiographic measurements obtained was 1.091 cm. A t test was then conducted to determine if there was a significant difference between the means of the two groups, and the results produced a P value of 0.0045.

Conclusions: When diagnosing PF, radiographs are typically the first imaging modality used, but prior to our study, they lacked diagnostic practicality. Our study suggests that there is a relationship between CFP thickness and the incidence of PF that can be examined using weightbearing lateral radiographs.

Background: Circular ring external fixation has been found to be successful in the treatment of a wide range of foot and ankle pathologies, particularly in patients with multiple comorbidities and soft-tissue compromise, but the procedures are technically demanding, and complications are common. The primary goal of this study was to identify complications associated with circular ring external fixation, and the secondary aim was to identify any independent risk factors associated with them.

Methods: Institutional review board approval was obtained, and a retrospective review was performed of 99 consecutive patients undergoing 100 foot or ankle procedures involving circular ring external fixation. Patient demographics, duration of fixator use, indications for the procedures, and outcomes were recorded. Clinical characteristics and indications for circular ring external fixation were tested for association with complications.

Results: Sixty-one patients experienced 67 complications. Forty-six complications were minor and 21 were major. Body mass index was the only preoperative variable demonstrating a significant increase in complications (P < .001). Obese patients had 3.2 times the odds of having a complication as nonobese patients (95% confidence interval, 1.4-7.6). Patients with diabetes or Charcot's arthropathy showed an increase in complications.

Conclusions: Complications are common with circular ring external fixation of the foot and ankle, and most are minor fine wire complications. There are many variables that may contribute to complications, but obesity was most predictive in this study.

Background: Evidence suggests that lower-limb stimulation strategies are designed to enhance somatosensory feedback by stimulating the plantar receptors. However, previous studies have focused on only a single sensory stimulation strategy in older adults. Combining two stimulation strategies might produce better results by boosting the sensorimotor signals in older adults. Therefore, the aim of this study was twofold: first, to investigate the effects of the combined use of compression stockings and textured insoles on plantar touch sensitivity, balance, and mobility and to compare these results with each intervention applied separately and with a control intervention; second, to examine whether there was an improvement in plantar touch sensitivity compared with baseline.

Methods: This study assessed plantar tactile sensitivity, balance, and mobility in 24 community-dwelling older adults (mean age, 72.4 ± 6.3 years) under four interventions: 1) compression socks with textured insoles, 2) compression socks with smooth insoles, 3) smooth socks with textured insoles, and 4) smooth socks with smooth insoles (control), all in the standard shoe. The Friedman test or repeated measures analysis of variance was used to compare results.

Results: Each intervention had similar plantar tactile sensitivity, balance, and mobility parameters (P > .05). However, it was determined that only wearing compression socks caused an improvement in plantar tactile sensitivity compared with baseline (P < .05).

Conclusions: Compression socks could be beneficial in increasing somatosensory feedback in older adults, as compression socks increase plantar tactile sensitivity more than textured insoles.

Background: Flatfoot causes the medial shift of ground reaction force during the stance phase of gait, which is associated with various foot disorders. To prevent this shift in flatfoot, it is necessary to understand the characteristics of the loading pattern and what foot joint kinematics influence it. We investigated differences in the center of pressure (COP) position between normal foot and flatfoot, and predictors of COP trajectory during gait.

Methods: Fifty healthy females participated. Based on the normalized navicular height truncated score, 27 and 23 participants were classified as having normal foot and flatfoot, respectively. Multisegmental foot kinematic and kinetic data were recorded during three gait trials. The COP trajectory was computed using a plantar local coordinate system defined from the obtained marker positions. COP positions during each phase of stance were compared between normal foot and flatfoot using independent t tests. Multiple regression analyses were performed to identify the relationship between foot joint motion and COP positions during each phase of stance.

Results: COP positions in flatfoot were displaced medially throughout the stance phase compared with normal foot. Multiple regression analyses revealed that the frontal and transversal plane motions of the calcaneus were main statistically significant predictors of the COP positions during the stance phase. Transversal plane motion of the calcaneus had greater standardized coefficients than in the frontal plane.

Conclusions: To correct the medial shift of the COP position in individuals with flatfoot, it may be important to control not only the eversion but also the adduction motion of the rearfoot throughout the stance phase.

Background: Chemical matrixectomy using acidic phenol or alkaline sodium hydroxide (NaOH) is indicated when prevention of toenail growth is preferred. The literature reports outcomes for phenol and NaOH independently; however, no studies are found to compare recurrence rates. This study evaluates the efficacy of these chemicals in preventing nail growth recurrence while analyzing whether age, sex, and body mass index contribute to regrowth after chemical matrixectomy.

Methods: From July 1, 2019, to July 1, 2021, data were obtained for toenail removal procedures that include Current Procedural Terminology codes 11730, 11750, and 11732 and corresponding International Classification of Diseases, Tenth Revision code S61.309A.

Results: Descriptive statistical analyses were conducted on 138 patients who underwent partial or total chemical matrixectomy. A χ2 test, a Fisher exact test, and an independent two-sample test were used to compare health and demographic characteristics on only patients who underwent a chemical matrixectomy (n = 58), evaluating differences between NaOH and phenol. The mean patient age was 43.2 years. Most patients (72%) did not have a previous revision. Approximately 54% of patients underwent partial nail avulsions without chemical matrixectomies versus 44% who had chemical matrixectomies. No statistically significant differences were found between groups. Comparison of recurrence rates did not demonstrate a statistically significant difference between NaOH and phenol. No association was found between nail growth recurrence and age.

Conclusion: Further investigation into application times, technique, and severity of deformity may provide further insight into factors leading to recurrence.