Journal of the American Podiatric Medical Association最新文献

Islam is the fastest growing religion in the United States and the world, and the number of Muslim patients who foot and ankle specialists will encounter is expected to increase as a result. Therefore, it is important to understand the Muslim patients' emphasis on modesty to ensure comfort during the patient encounter. The provider should understand the permissibility of animal-derived products, especially as it relates to lower-extremity wound care and surgical products. Specific rituals that are pillars of Islam, such as prayer, fasting in Ramadan, and Hajj pilgrimage, all have direct relationships with foot health that providers should be cognizant of. Ritual purification or ablution before prayer is associated with fungal infections, and specific prayer positions may aggravate foot pain. Providers must understand that it is not enough to only treat fungal infections that affect Muslim patients, but they also need to understand the unique circumstances of Muslim worshipers that increase their risk of fungal infections and recurrence. Consequently, educational and preventative measures for managing tinea pedis in the Muslim population are critical. Muslims fast from sunrise to sunset during the month of Ramadan and pray during the night for an extended time, which has potential effects on the lower extremity. Hajj is the major pilgrimage that Muslims are required to complete once in a lifetime, and there are smaller, optional, pilgrimages that Muslims perform as well. There is a high risk of foot, ankle, and leg complications during these pilgrimages, and therefore it is paramount that providers understand the risk factors for lower-extremity complications during Hajj. Although Muslim patients participate in many rituals that have the potential to affect their foot health and overall well-being, the provider should understand that concessions exist for all situations, and the well-being of the patient supersedes any ritualistic obligation.

Background: The anterior approach to the ankle addresses many pathologies. The orthoplastic anteromedial incisional approach to the ankle courses between the anterior tibial and posterior tibial angiosomes. There are various modalities that can be used in evaluating the integrity of these angiosomes before surgical intervention.

Methods: A retrospective review of 23 patients using the anteromedial ankle approach in either total talus replacement or total ankle replacement was performed from January 1, 2016, through August 31, 2021. Surgical intervention occurred from January 29, 2016, through January 10, 2019, and follow-up was through August 2021.

Results: Patients were evaluated based on medical history, postoperative week of suture or staple removal, incision complications, and time at which full weightbearing began. Smoking history was also documented. Eighteen patients healed uneventfully, and some of these patients had a smoking history, a history of type 2 diabetes mellitus, or both.

Conclusion: A preoperative evaluation of vascular supply is necessary to determine the healing potential of this approach. Atraumatic handling of the soft-tissue envelope is imperative to aid in wound healing and optimize the postoperative course. The orthoplastic anteromedial ankle incisional approach is a possible alternative option for an anterior ankle incision if adequate vascular status is determined to be present before surgical intervention.

Background: Ankle arthritis is a debilitating condition that negatively impacts a patient's quality of life. The total ankle arthroplasty procedure continues to gain traction as a viable treatment option for end-stage ankle arthritis that has failed conservative treatment. Although newer total ankle models have shown improvement in complications and survivorship, intraoperative and postoperative medial malleolus fractures continue to be a concern.

Methods: We created two novel radiographic measurements of the bone bridge between the total ankle prosthesis and the tibial cortex. Using 72 patients, we analyzed the correlation between the bone bridge and intraoperative and postoperative fractures.

Results: We found patients with no fractures had a larger transverse and short bone bridge (12.67 ± 2.93 and 11.24 ± 2.7 mm, respectively) compared with patients who experienced an intraoperative or postoperative medial malleolus fracture. Although patients who received a prophylactic screw had a bone bridge that was over 4 mm smaller compared with the group with no fractures, it was successful in preventing further fractures.

Conclusions: We recommend that the surgeon consider placement of a prophylactic screw in patients with a transverse bone bridge of 12 mm or short bone bridge of 10 mm.

Background: Abnormal foot anthropometry and posture of patients with Duchenne muscular dystrophy (DMD) can be considered as possible risk factors for performance and ambulation. We aimed to examine the effects of foot posture and anthropometric characteristics, which deteriorated from the early period, on the ambulation and performance of patients with DMD.

Methods: The foot arch height, metatarsal width, subtalar pronation angle, and ankle limitation degree were evaluated to determine the foot anthropometric characteristics of the patients. The Foot Posture Index-6 was used to evaluate foot posture. Performance of the patients was determined by the 6-minute walk test (6MWT), the 10-meter walk test, and the ascend/descend four standard steps test, and ambulation was determined by the North Star Ambulatory Assessment (NSAA). Spearman correlation coefficient was calculated to assess the relationship between foot anthropometric characteristics and posture and performance and ambulation.

Results: The sample consisted of 48 patients with DMD aged 5.5 to 12 years. Foot Posture Index-6 scores for both the right and left feet were associated with all the parameters except descending four steps. Left foot arch height was associated with 6MWT and NSAA, and left metatarsal width was associated with 6MWT. Ankle limitation degree of the right foot was associated with 6MWT, ascending/descending four steps, and NSAA and of the left foot was associated with NSAA (P < .05). There was no relationship between other parameters.

Conclusions: These findings suggest that postural disorders in the foot and ankle may contribute to the decrease in performance and ambulation in patients with DMD.

Hammertoe deformities are common pathologies treated in podiatry clinics and are most often associated with tendon imbalances. In this case study, we present the case of a 41-year-old patient with soft-tissue chondroma being the cause of a rigid deformity. We describe the surgical technique used to remove and treat the hammertoe.

Background: Insertion of medial column intramedullary fixation during Charcot reconstruction relies on proper guidewire placement in preparation for reaming to optimize endosteal purchase. Although fluoroscopy and jigs assist with wire placement, no anatomical relationship between the center of the intramedullary canal and metatarsal head or base has been described, which this cadaver study aimed to identify.

Methods: The first metatarsals from ten fresh-frozen cadavers were dissected. The height and width of the first metatarsal head and base as well as length were measured with digital calipers. Each metatarsal was placed in a three-dimensional printed gantry, where radiographs were taken. Image analysis software was used to identify the relationship between the metatarsal head and base and the center of the intramedullary canal.

Results: Metatarsals from six male and four female cadavers with an age of 68.6 ± 15.14 years were assessed. Metatarsal length was 62.71 ± 5.54 mm. The center point was 51.12 ± 3.51% and 66.85 ± 5.09% the height of the metatarsal head and base, respectively, with the inferior cortex as reference. Moreover, the center point was 53.40 ± 6.26% and 52.63 ± 2.90% the width of the metatarsal head and base, respectively, with the lateral cortex as reference. Longer metatarsals correlated with more superior base starting positions (r = 0.74; P = .02).

Conclusions: Guidewire entry should be slightly superior and medial to the center of the first metatarsal head and directed proximally toward the superior third of the metatarsal base. These findings may assist with surgical technique and instrument design.

Multifocal motor neuropathy (MMN) is a rare motor neuron condition that typically presents as asymmetric muscular dystrophy to the distal upper extremities. As an autoimmune disorder, it is hypothesized that the presence of anti-ganglioside-monosialic acid 1 (anti-GM1) antibodies results in demyelination of axons, propagating symptoms of MMN. Intravenous immunoglobulin infusions have proven effective in restoring muscle tone and function if administered at early onset of the disease symptoms. Although uncommon, MMN can also affect the distal lower extremities. In this study, we present a female patient with muscle atrophy and general weakness to her right lower extremity prior to developing similar symptoms to her left upper extremity. Due to this very uncommon presentation, the pathology was identified late in the progression of the disease. The delay in treatment resulted in a permanent reduction in muscle tone and function in the right lower extremity. To the best of the authors' knowledge, such a finding has not been reported in the current literature, prompting the need for awareness of a truly uncommon presentation of an already uncommon condition.

Background: Foot infections are a common condition that foot and ankle providers treat. For patients who require an amputation, surgeons must decide what level of amputation to perform based on the extent of infection, soft-tissue viability, and the biomechanics of the foot. Although the literature has shown the high risk of repeated ulceration and amputation after a foot ulcer, there has been little published comparing partial first-ray amputation with hallux amputation.

Methods: The present study looked at reoperation and reamputation rates in 295 patients with either a partial first-ray amputation or a hallux amputation for treatment of infection.

Results: Almost half of both groups required a reoperation: 41.1% and 42.9% in the hallux and partial first-ray amputation groups, respectively. There was a 31.9% distal amputation rate in the hallux amputation group and a 27.9% rate in the partial first-ray amputation group. There was found to be a 10.6% and 16.9% major amputation rate in the hallux amputation and partial first-ray amputation groups, respectively. We found no statistically significant differences between these two groups regarding reoperation rates and distal or major amputations.

Conclusions: Either procedure is appropriate for infections of the first ray, and the level of amputation should be determined based on the extent of the infection and soft-tissue coverage.

We describe an elite youth football player who developed lateral foot pain of previously unknown origin. A thorough patient history and physical examination, as well as an in-depth presentation of radiographic findings on computed tomography and magnetic resonance imaging scans were performed. Through this combination, the puzzle was resolved and a rare peroneus longus tendinopathy due to bony spurs in the cuboid groove was diagnosed. A peroneus longus exploration and release and reduction of the cuboidal bone spurs were performed, and an intensive rehabilitation phase followed. The patient successfully returned to performance and set a career in professional football.

Background: The Toe Walking Tool is used to highlight the need for further investigation of toe-walking children by a more qualified expert. Such a tool is not yet available within Greek clinical settings. Therefore, the aim of this study was to translate and cross-culturally adapt into Greek the Toe Walking Tool.

Methods: The Toe Walking Tool was translated into Greek according to international guidelines by five pediatric physiotherapists, all fluent in the English language. Fifteen children with toe-walking due to pathologic reasons or idiopathic toe-walking were video-recorded performing the tasks and tests of the tool. Parents answered the questions regarding the children's medical history. Seven pediatric physiotherapists evaluated the 15 children using the video recordings and the parents' answers to complete the tool. Data were analyzed with Fleiss κ, percentage agreement, and χ2 tests. Face and content validity was determined by a group of experts.

Results: The Greek version of the Toe Walking Tool proved to be clinically applicable and user-friendly. The tool was also found to have substantial intrarater reliability, with a Fleiss κ index of 0.73. The percentage agreement between the seven raters was high to very high, ranging from 86% to 100%, and no statistical differences were found between the raters (P < .1).

Conclusions: The Greek version of the Toe Walking Tool demonstrated adequate evidence of interrater reliability and can be used to refer, if required, toe-walking children for further investigation.