Journal of the American Podiatric Medical Association最新文献

Surgical reconstruction of the foot and ankle following degenerative changes secondary to Charcot neuroarthropathy poses a challenge due to both soft-tissue and osseous deformity. As a limb salvage procedure, this article aims to address such deformity with the goal of returning to a braceable limb without subsequent ulceration and infection. As this disease process affects both bone and soft tissue, surgical reconstruction should be directed to address osseous and ligamentous deformities that may contribute to postoperative failure. We present an algorithm to eliminate deforming forces, identify and stabilize at-risk and damaged anatomy, and stabilize the ankle joint to reduce the risk of postoperative progression to Charcot collapse of the ankle joint in individuals with midfoot Charcot neuroarthropathy. In conjunction with a multidisciplinary infection, perfusion, and bone metabolism assessment, this algorithm serves as comprehensive tool to evaluate and reconstruct midfoot Charcot collapse.

Background: Diabetes mellitus is a very common medical condition with many macrovascular and microvascular complications. Neuropathy and peripheral vascular disease with external trauma are the main factors of foot ulcers in a diabetic patient. We aimed to investigate the aesthetic, weight, and functional satisfaction of prosthesis use depending on the level of amputation.

Methods: Forty-four patients were included in the study. The patients were divided into two groups after surgery according to level of amputation: below-the-knee (group 1) and above-the-knee (group 2) amputations. Those who had to be operated on again due to wound and stump problems and those who could not use prostheses due to being bedridden were excluded from the study.

Results: The mean ± SD age for group 1 was 66.8 ± 9.25 years and for group 2 was 71.25 ± 9.78 years. The mean ± SD Trinity Amputation and Prosthesis Experience Scales (TAPES) scores for groups 1 and 2, respectively, were as follows: aesthetic satisfaction, 7.43 ± 0.51 and 7.64 ± 0.56 (P = .234); weight satisfaction, 1.69 ± 0.48 and 1.57 ± 0.51 (P = .459); and functional satisfaction, 10.75 ± 0.78 and 6.75 ± 0.80 (P < .001).

Conclusions: No difference was found in the aesthetic and weight satisfaction of patients who had below- or above-the-knee amputation due to diabetic foot and used permanent prostheses.

Background: Many arch structure classification methods exist, but arch structure may be influenced by factors such as age and physical activity. It is unknown if previous arch structure classifications from adult populations are appropriate for adolescents. The purpose of our study was to compare arch structure classifications between adolescent-specific and previously published classification systems.

Methods: We enrolled 141 uninjured adolescents who participated in long-distance running activities. We measured arch height index (AHI) for both feet in seated and standing positions and classified arch structure as cavus, rectus, or planus. We calculated kappa and percent agreement to compare arch structure classification for our participants with previously published classifications. We performed one-sample t tests to compare mean AHI values from our participants with previously published values. We performed Pearson correlation and percent agreement for arch structure classification for AHI measured in seated and standing for our participants.

Results: We observed no to weak and unacceptable agreement (κ = -0.008 to 0.702; P < .001 to .77; 29-72%) for seated and standing AHI between our classification and most prior classifications. Our seated and standing mean AHI values differed from most prior studies (P < .001 to .99; d = 0.00-1.52). We observed a very large positive correlation (r = 0.90; P < .001) with moderate and acceptable classification agreement (κ = 0.641; P < .001; 83%) between mean AHI values measured in seated and standing positions.

Conclusions: Arch structure classification varied based on classification system and showed poor agreement between most previously reported classification systems. Mean AHI values were significantly different for adolescent runners in our study compared with most previously reported mean values. Researchers and clinicians may classify arch structure in a seated or standing position if position-specific criteria are applied. Special care should be taken before extrapolating classification systems originating from populations with different characteristics, such as age, sport participation, and health status.

Background: Chemical matrixectomy (CM) is a common procedure to correct painful and ingrown toenails. At our institution, CMs are often performed with either sodium hydroxide (NaOH) or phenol as the chemical agent for germinal nail matrix destruction. The primary aim of this study was to evaluate the recurrence and reoperation rates for this procedure using different chemical agents.

Methods: The medical records of 192 patients during a 2-year period were reviewed. All of the CMs were performed in a standard fashion by three podiatric physicians.

Results: Among phenol partial nail avulsions, 46 nail border removals were performed. Among NaOH partial nail avulsions, 258 nail borders were treated. Mean follow-up was 93 days (median, 17 days). Among partial nail avulsions, the mean reoperation rate per border for CM with phenol was 6.5%. In comparison, the reoperation rate for CM with NaOH was 7.8% (P = .89), indicating that there is no statistically significant difference in reoperation rates between these two chemicals. The mean recurrence of painful nail edge rate per border for CM with phenol was 10.9%. In contrast, with NaOH this rate was 8.1% (P = .58), indicating that there was no statistically significant difference in the rate of development of recurrent painful nail borders between the two procedures.

Conclusions: This retrospective medical record review demonstrated little difference between these chemicals in their reoperation and recurrence rates.

Background: The number of applications to podiatric medical schools in the United States continues to fall. There are many reasons for this decline, and this article attempts an impartial look at some of the forces at play in potentially affecting students' decisions to apply to podiatric medical school in the first place.

Methods: I reviewed the existing literature on the current state of the podiatric medical profession in the United States, with attention to enrollment rates in podiatric medical schools during the past decade.

Results: There are limited definitive data, and those displayed herein come from the American Association of Colleges of Podiatric Medicine and other organizations. The data suggest a steady decline in applicants to US podiatric medical schools during the past decade.

Conclusions: The reasons for this decline are multifactorial and include problems extrinsic to the profession, such as a declining US birth rate, as well as problems within the profession, most of which are now easily discoverable through Internet searches and research. The issue of lack of plenary licensure, the inconsistent salary data, and in-fighting among the various boards that exist within the profession seem to be major factors that may be perceived as negative influences in choosing a career in podiatric medicine.

Fibrolipomatous hamartomas (FLHs) are rare pathologies almost exclusively involving the median nerve. Rarer is extra-median involvement of FLH, especially in nerves outside of the upper extremity. In this case report, we detail the case of a 48-year-old male with FLH involving his right tibial nerve-the first in reported literature in this nerve distribution to our knowledge- and perform a review of the existing case reports on extra-median FLH within the English-based literature.

Background: Pes planus is a common postural deformity in young adults characterized by decreased medial longitudinal arch height. Supporting the overstretched plantar fascia, reducing pain by loosening the plantar fascia, and increasing medial longitudinal arch support are the main treatment goals in pes planus. The present study aimed to investigate the immediate effects of kinesiology taping and manual release techniques on lower-extremity performance in young adults with pes planus and to determine whether there is a difference between these two interventions.

Methods: Forty individuals with pes planus were included in the study. The individuals were randomly divided into two groups: kinesiology taping (n = 20) and manual release (n = 20). Functional mobility was assessed with timed up and go test, balance with functional reach test, gait with 10-m walk test, and muscle endurance with heel raise test. The kinesiology taping group was evaluated at baseline and 45 min after the intervention and the manual release group was evaluated at baseline and after the intervention.

Results: Demographic and clinical characteristics of the groups were similar (P > .05). Functional mobility, walking time, and endurance improved significantly in both groups (P < .05), whereas there was no change in balance (P > .05). Improvement in functional mobility was greater in the manual release group than the kinesiology taping group (P < .05).

Conclusions: Kinesiology taping and manual release are both immediately effective for endurance, functional mobility, and gait in young adults with pes planus. These interventions can be included in the rehabilitation program of pes planus treatment for more successful results.

Background: The need for intra-articular osteotomy and potential complications at the donor site may lead some surgeons to avoid using the osteochondral autograft transfer method as a primary surgery, instead considering it a revision procedure for osteochondral lesions of the talus. In this retrospective study, we hypothesized that the primary application of osteochondral autograft transfer in cystic talar osteochondral lesions would yield good results and intra-articular osteotomy and donor site would not have a negative effect on long-term clinical outcomes. The primary objective of this study was to demonstrate that osteochondral autograft transfer can be safely applied as a primary treatment for cystic talar osteochondral lesions.

Methods: In our study, 21 patients underwent primary osteochondral autograft transfer for cystic talar osteochondral lesions. Demographic data of patients, including age, gender, and body mass index, as well as duration of symptoms, etiology of the lesion, location of the lesion, and follow-up duration were recorded from our medical records. The clinical evaluation used the visual analog scale for pain, function, and satisfaction along with the American Orthopaedic Foot & Ankle Society score. In addition, the magnetic resonance observation of cartilage repair tissue scale was used for evaluation of graft healing.

Results: The mean follow-up time was 32 months. According to the results of the study, compared with the preoperative status, statistically significant improvement was observed in visual analog scale pain, function, and satisfaction scores as well as in the American College of Foot and Ankle Surgeons score. In addition to these findings, it was observed that there was no negative effect of intra-articular osteotomy and donor site on long-term results.

Conclusions: Our study showed that osteochondral autograft transfer can be safely applied as primary surgery in cystic talar osteochondral lesions.

Background: Podiatrists are crucial for managing lower limb pathologies, and effective appointment scheduling is vital for allocating adequate consultation time based on patient conditions. While occasional late patient arrivals may not significantly impact services, frequent lateness can disrupt patient flow and quality of care. This study explored the impact of patient lateness on podiatry practices worldwide, where no countries of origin were excluded. This study assessed current strategies to manage patient lateness, evaluated their effectiveness and reported recommendations for improvement.

Methods: An international cross-sectional online survey was conducted between January and March 2024.

Results: The survey, which garnered 201 responses from podiatrists, revealed that over 90% of podiatrists experienced disruptions in their clinic workflow due to late patients. Common reasons for lateness included traffic issues and difficulties with parking. SMS reminders emerged as the most effective tool for reducing tardiness. Over half (59.3%) of podiatrists implemented a 10-minute grace period before rescheduling late appointments, which effectively reduced lateness by 50%. However, some podiatrists refrained from rescheduling to avoid worsening patients' conditions or dealing with complaints. Additionally, many podiatrists reported a lack of managerial support in handling late patients.

Conclusion: The frequency of late arrivals in podiatry is similar to other health professions and negatively impacts clinic workflow and staff morale. Enhanced managerial support is needed to better manage late patients, allowing podiatrists to concentrate on their clinical responsibilities.