The latest medical research on Podiatry
The research magnet gathers the latest research from around the web, based on your specialty area. Below you will find a sample of some of the most recent articles from reputable medical journals about podiatry gathered by our medical AI research bot.
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Risk Factors for Failure of Conservative Management of Insertional Achilles Tendinosis.Foot and Ankle International
While many patients benefit from nonoperative treatment of insertional Achilles tendinopathy (IAT), some elect for surgical debridement and reconstruction. The purpose of this study is to determine the relationship of patient demographic characteristics, comorbidity profiles, and radiological parameters with failure of conservative management of IAT.
A retrospective chart review was performed to identify patients who received either surgical or nonsurgical treatment of IAT at an academic institution from September 2015 to June 2019 (N = 226). Demographic and comorbidity data, and the presence and magnitude of relevant radiological parameters were collected and compared between the surgically (n = 48) and nonsurgically (n = 178) treated groups.
No significant differences could be detected between groups regarding demographic factors or previous procedures. The surgery group was significantly more likely to have evidence of Haglund's deformity on clinical exam (83% vs 69%, P = .005), lower SF-12 physical scores (25.5 vs 35.5, P < .001), higher VAS pain scores (6.3 vs 5.3, P = .033), any mental illness (33% vs 20%, P = .044), and depression (27% vs 12%, P = .012).
Patients who received surgery for IAT were significantly more likely to have evidence of Haglund's deformity on clinical exam, depression, higher VAS pain scores, and lower SF-12 physical scores. Both patients and surgeons should be aware of the higher rates of failure of conservative treatment in these patients.
Retrospective Evaluation of Ingrown Toenail Cases in a Tertiary Reference Center.Am Podiatry Assoc
To evaluate the clinical characteristics of ingrown toenail cases in one of the biggest reference centers.
This retrospective cohort study was conducted on patients admitted to Ufuk University Hospital with ingrown toenail between January 1. 2014 and December 31. 2019. Firstly, clinical charactersitcs and demographic features of all cases were evaluated afterwards the study population was divided into two groups: 1) Group1(Patients who were ≤ 20 years old), 2) Group 2 (Patients who were >20 years old) and these groups were compared in terms of their clinical findings.
Duration of diseases, BMI, rate of medications for chronic diseases and rate of joint diseases were significantly higher in group 2. On the other hand, rates of hyperhidrosis and sudden weight gain were significantly higher in group 1(p<0.05). Severity of ingrown toenail was significantly different between the groups (p=0.006). Stage 1 was the most common stage in both groups and rate of stage 3 was higher in group 1. Onycoshisis and was more common in group 1 while nail thickening was more common in group 2 (p<0.05). Medications were also significantly different between the groups as nail wire and Aluminum chloride were the most common treatment modalities in group 2 and 1, respectively (p<0.05). Periungual edema, presence of pus, hypertrophie and granulation were more common in group 1 (p<0.05). Thin nail plate was more common in group 1 while normal and thick nail nail plate were more common in group2 (p<0.05).
Clinical characteristics of ingrown toe nail vary between younger and older populations. Thus, individualized approach should be preferred in the management of ingrown toe nail for different age groups.
An Innovative Approach to Calcaneal Decubitus Ulcerations Through Calcaneal Decorticalization with Use of Localized Bone Marrow and Negative-Pressure Wound Therapy: A Case Study.Am Podiatry Assoc
Heel decubitus ulcerations are relatively common occurrences that can be limb threatening. There are many options to treat these ulcerations, rangi...
The Use of Patient Simulations to Teach and Assess Clinical Competencies in Colleges of Podiatric Medicine: A Survey of US Podiatric Medical Schools.Am Podiatry Assoc
Human and mechanical simulations are used to teach and assess clinical competencies in medical education. In 2014, the National Board of Podiatric ...
Regional Anesthesia Decreases Inpatient But Not Outpatient Opioid Demand in Ankle and Distal Tibia Fracture Surgery.Foot and Ankle International
Regional anesthesia (RA) is commonly used in ankle and distal tibia fracture surgery. However, the pragmatic effects of this treatment on inpatient and outpatient opioid demand are unclear. The hypothesis was that RA would decrease inpatient opioid consumption and have little effect on outpatient demand in patients undergoing ankle and distal tibia fracture surgery compared with patients not receiving RA.
All patients aged 18 years and older undergoing ankle and distal tibia fracture surgery at a single institution between July 2013 and July 2018 were included in this study (n = 1310). Inpatient opioid consumption (0-72 hours postoperatively) and outpatient opioid prescribing (1 month preoperatively to 90 days postoperatively) were recorded in oxycodone 5-mg equivalents (OEs). Adjusted models were used to evaluate the impact of RA versus no RA on inpatient and outpatient opioid demand.
Patients without RA had higher rates of high-energy mechanism of injury, additional injuries, open fractures, and additional surgery compared with patients with RA. Adjusted models demonstrated decreased inpatient opioid consumption in patients with RA (12.1 estimated OEs without RA vs 8.8 OEs with RA from 0 to 24 hours postoperatively, P < .001) but no significant difference after that time (9.7 vs 10.4 from 24 to 48 hours postoperatively, and 9.5 vs 8.5 from 48 to 72 hours postoperatively). Estimated cumulative outpatient opioid demand was significantly increased in patients receiving RA at all time points (112.5 OEs without RA vs 137.3 with RA from 1 month preoperatively to 2 weeks, 125.6 vs 155.5 OEs to 6 weeks, and 134.6 vs 163.3 OEs to 90 days, all P values for RA <.001).
In ankle and distal tibia fracture surgery, RA was associated with decreased early inpatient opioid demand but significantly increased outpatient demand after adjusting for baseline patient and treatment characteristics. This study encourages the use of RA to decrease inpatient opioid use, although there was a worrisome increase in outpatient opioid demand.
Level III: Retrospective, therapeutic cohort study.
Anterior Capsule Reconstruction in the Setting of PVNS.Foot and Ankle International
Pigmented villonodular synovitis (PVNS) is a benign proliferative disease affecting tendon sheaths and synovial tissue. Pigmented villonodular synovitis in the foot and ankle has a high rate of recurrence, which can be destructive if incompletely removed. This case series analyzes functional outcomes after PVNS operative resection with an anterior ankle capsular reconstruction, using a novel technique.
Three patients with PVNS underwent surgery between 2010 and 2020. The operative technique involved a posterior, midline approach for PVNS resection of the affected ankle joint, followed by a standard anterior approach for capsular excision. Subsequent anterior capsular reconstruction was performed with a regenerative tissue matrix and a bioresorbable anchoring system. Preoperative and postoperative range of motion for the ankle and subtalar joints, visual analog scale (VAS) for pain, and return to daily activities was assessed along with appropriate radiographs and magnetic resonance imaging (MRI) imaging.
All 3 surgeries had a mean follow-up period of 52.3 (range, 4-123) months and resulted in successful recovery as assessed by the VAS and self-reported activity. Preoperative ankle dorsiflexion and plantarflexion along with subtalar inversion and eversion range of motion were all normal. Postoperative ankle motion and subtalar motion were not statistically different. No complications or recurrence of PVNS was observed.
Further investigation is warranted to better understand the clinical outcomes of this technique designed to successfully eliminate PVNS recurrence.
IV- Retrospective case series.
A Focus on Amputation Level: Factors Preventing Length Preservation in the National Inpatient Sample.Am Podiatry Assoc
Diabetic lower-extremity disease is the primary driver of mortality in patients with diabetes. Amputations at the forefoot or ankle preserve limb length, increase function, and, ultimately, reduce deconditioning and mortality compared with higher-level amputations, such as below-the-knee amputations (BKAs). We sought to identify risk factors associated with amputation level to understand barriers to length-preserving amputations (LPAs).
Diabetic lower-extremity admissions were extracted from the 2012-2014 National Inpatient Survey using ICD-9-CM diagnosis codes. The main outcome was a two-level variable consisting of LPAs (transmetatarsal, Syme, and Chopart) versus BKAs. Logistic regression analysis was used to determine contributions of patient- and hospital-level factors to likelihood of undergoing LPA versus BKA.
The study cohort represented 110,355 admissions nationally: 42,375 LPAs and 67,980 BKAs. The population was predominantly white (56.85%), older than 50 years (82.55%), and male (70.38%). On multivariate analysis, living in an urban area (relative risk ratio [RRR] = 1.48; P < .0001) and having vascular intervention in the same hospital stay (RRR = 2.96; P < .0001) were predictive of LPA. Patients from rural locations but treated in urban centers were more likely to receive BKA. Minorities were more likely to present with severe disease, limiting delivery of LPAs. A high Elixhauser comorbidity score was related to BKA receipt.
This study identifies delivery biases in amputation level for patients without access to large, urban hospitals. Rural patients seeking care in these centers are more likely to receive higher-level amputations. Further examination is required to determine whether earlier referral to multidisciplinary centers is more effective at reducing BKA rates versus satellite centers in rural localities.
Evaluation of the Correlation Between Flamenco Dance and Ankle and Foot Posture.Am Podiatry Assoc
The practice of flamenco dance involves great biomechanical demands, comparable with a high-performance sport. The technical movements of the footwork tap, the jumps, and the turns increase the prevalence of injuries and pathologic disorders of the foot and lower limb. Limited research has examined adaptation of the foot posture and dorsiflexion of the ankle in flamenco dancing. Therefore, the aim of this study was to evaluate whether the practice of flamenco dancing produces modifications in the ankle's dorsiflexion range of motion, Foot Posture Index, or pronation.
A cross-sectional observational study with intentional sampling was performed with 26 individuals (52 feet) in two groups: professional female flamenco dancers (n = 13) and nondancers (n = 13). The participants were assessed in a single session for ankle dorsiflexion, foot pronation (navicular drop test), and foot posture (Foot Posture Index).
Significant differences were found between the two groups for left foot Foot Posture Index (P = .007) and right foot navicular drop test (P = .006).
The results of this study indicate that flamenco dancing can produce modifications in the Foot Posture Index and foot pronation versus nondancers. Further research is required.
Radiotherapy for Plantar Fibromas (Ledderhose Disease).Am Podiatry Assoc
Ledderhose disease (plantar fibromas) is histologically related to Dupuytren disease, which has been successfully treated for years with radiothera...
Comparison of Self-adhesive Taping and Short-Leg Casting to Treat Tuberosity Fractures of the Proximal Fifth Metatarsal: A Prospective Study.Am Podiatry Assoc
The aim of this study is to compare clinical and radiologic outcomes of self-adhesive taping (SAT) or a short- leg cast (SLC) groups with base of fifth metatarsi.
Functional outcome was assessed by the Visual-Analogue-Scale Foot and Ankle (VAS-FA) at the Emergency and at 2, 4, 6, and 12 weeks. Labour loss, bone union and The American Orthopedic Foot and Ankle Score (AOFAS) at 12 weeks were also assessed.
There was no difference between the SAT group and SLC group in VAS-FA scores at time of injury, 6 and 12 weeks. The SAT group had a significantly higher mean VAS-FA score at the second and fourth weeks of follow-up compared with the SLC group (P = .001 and P = .039, respectively). No correlation was observed between the fracture gap and functional scores for both groups. There was no difference in AOFAS between two groups at 12 weeks. Twenty one patients were unable to work for a mean of 38.2 days during the treatment. 10 patients with the SAT missed 37.5 days and eleven patients with the SLC g missed 40.2 (p: 0.41). The bone union was also achieved for all patients within 12 weeks.
Treatment with SAT in these fractures had satisfactory functional results compared with traditional SLC. Although there were no significant differences in labor loss and use of assistive devices, The VAS-FA score was significantly higher in SAT group than the SLC group at the second and fourth weeks of treatment.
Clinical and Histologic Evaluation of Partial Achilles Tendon Injury Repair with Amniotic Membrane in Rats.Am Podiatry Assoc
Adhesions after tendinopathy in individuals who perform physical work and those physically active in middle age are a challenging problem for orthopedic surgeons. We evaluated the effects of human-derivated amniotic membrane on tendon healing, adhesions, angiogenesis, and the inflammatory process.
Thirty-five rats were divided evenly into five groups, and the left lower extremity was used in this study. No interventions were applied to the control group (group 5). In the other groups, Achilles tendons were partially cut to the midline. Then, primary repair (group 1), amniotic membrane treatment with no repair (group 2), primary repair and amniotic membrane treatment (group 3), or secondary healing with no repair (group 4) was performed.
Use of amniotic membrane in tendon healing resulted in decreased adhesion formation and positive effects on collagen sequencing and anti-inflammatory effects. In addition, for the vascular endothelial growth factor evaluation there was no difference among the amniotic membrane repair groups, but there was an increase in vascular endothelial growth factor positivity compared with the control group.
These data show that amniotic membrane treatment can alter biological behavior and induce surface-dependent angiogenesis and can have angiogenetic effects on ischemia and inflammation.
The Impact of Hallux Valgus on Adolescent Ballet Dancer Balance and Health Related Quality of Life Scores.Am Podiatry Assoc
It's well known fact that Hallux valgus (HV) alternates foot biomechanics. In different populations HV and postural stability has been studied but HV and adolescent ballet dancer has not been studied. Aim of the our study is to explore affect of HV on adolescent ballet dancers' balance. Also we wanted to explore health related quality of life of adolescent ballet dancers with HV.
Ballets aged between 8-16 years old has been screened prospectively. The dancers divided into two groups group 1;Ballets with HV and group 2; Ballets without HV. HV diagnosis was made clinically. Two groups were compared according to balance parameters and health related quality of life (HRQOL) questionaires.
Group 1 was formed with 31 participants and group 2 was formed with 24 participants. All participants in both groups were female. Mean age in group 1 was 11.6 (8-16 years old) and 12.2 (8-16 years old) in group 2. Mean first metatarsophalangeal angle was 13.4° (10°-15°) in group 2 and 19.8° (16°-25°) in HV group respectively. A statistically significant difference was found according to the nonparametric Mann Whitney U test results in the comparison of HVA (Hallux Valgus Angle) between groups. According to Spearman Rho correlation analysis, it was determined that the increase in HVA caused deterioration in the static Flamingo test. (r=0.552 p=0.019). No significant relationship was found between HRQoL questionaries and the presence of HV. (p>0,05) Conclusions: Adolescent ballet dancers experience static balance impairment due to HV angle increase. Clinical measurement of HV and application of balance parameters made easy without need of set ups to perform evaluation with high numbers of participants in concordance with literature.