Non-osseous extra-articular anterolateral talocalcaneal coalition: a case report
Journal of Orthopaedic Surgery
ORIGINAL ARTICLE: We report a case of an extra-articular talocalcaneal coalition located anterolateral to the sinus tarsi. As non-osseous coalitions can be difficult to diagnose, physicians should keep this variant in mind in cases of a symptomatic hind foot with apparently equivocal radiological findings.
Preamputation Evaluation Of Limb Perfusion With Laser Doppler Imaging And Transcutaneous Gases
JRRD 
ORIGINAL ARTICLE: We compared preamputation assessments of leg ischemia with laser Doppler imaging (LDI) and transcutaneous partial pressure of oxygen (TcPO2) and carbon dioxide (TcPCO2) in 31 male subjects with peripheral vascular disease (PVD) and severe leg ischemia and 29 age-matched male control subjects. TcPO2 and TcPCO2 were evaluated with Novametrix monitors, and perfusion (flux) of skin topically heated to 44 °C and adjacent nonheated areas were evaluated with a Moor Instruments LDI scanner. LDI was superior to TcPO2 in correctly discriminating between ischemic and nonischemic skin. The results suggest that an LDI ratio below 5 indicates nonviable skin. PVD is quite prevalent among veterans, and results in amputations, disability, and mortality. Availability of methods to quantify responses of skin vasculature will help in the early diagnosis and management of PVD.
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Effectiveness of calf muscle stretching for the short-term treatment of plantar heel pain: a randomised trial
BMC Musculoskeletal Disorders
ORIGINAL ARTICLE: Plantar heel pain is one of the most common musculoskeletal disorders of the foot and ankle. Treatment of the condition is usually conservative, however, the effectiveness of many treatments frequently used in clinical practice, including stretching, has not been established. We performed a participant-blinded randomised trial to assess the effectiveness of calf muscle stretching, a commonly used short-term treatment for plantar heel pain. Ninety-two participants with plantar heel pain were recruited from the general public between April and June 2005. Participants were randomly allocated to an intervention group that were prescribed calf muscle stretches and sham ultrasound (n=46) or a control group who received sham ultrasound alone (n=46). The intervention period was two weeks. No participants were lost to follow-up. Primary outcome measures were first-step pain (measured on a 100 mm Visual Analogue Scale) and the Foot Health Status Questionnaire domains of foot pain, foot function and general foot health. Both treatment groups improved over the two week period of follow- up but there were no statistically significant differences in improvement between groups for any of the measured outcomes. For example, the mean improvement for first-step pain (0-100 mm) was -19.8 mm in the stretching group and -13.2 mm in the control group (adjusted mean difference between groups -7.9 mm; 95% CI -18.3 to 2.6). For foot function (0-100 scale), the stretching group improved 16.2 points and the control group improved 8.3 points (adjusted mean difference between groups 7.3; 95% CI -0.1 to 14.8). Ten participants in the stretching group experienced an adverse event, however, most events were mild to moderate and short-lived. When used for the short-term treatment of plantar heel pain, a two-week stretching program provides no statistically significant benefit in first-step pain, foot pain, foot function or general foot health compared with not stretching. Trial Registration: Australian Clinical Trials Registry, ACTRN012605000068662.
Pyoderma gangrenosum
Orphanet Journal of Rare Diseases
ORIGINAL ARTICLE: Pyoderma gangrenosum (PG) is a primarily sterile inflammatory neutrophilic dermatosis characterized by recurrent cutaneous ulcerations with a mucopurulent or hemorrhagic exudate. The exact prevalence of PG is unknown. The incidence has been estimated to range between 3 and 10 cases per million per year. The incidence peak occurs between the ages of 20 to 50 years, women being more often affected than men. Clinically, the disease starts with sterile pustules that rapidly progress and turn into very painful ulcers of variable depth and size, with undermined bluish or violaceous borders and surrounding erythema. The legs are most commonly affected but other parts of the skin and mucous membranes may also be involved. The clinical course can be mild or malignant, chronic or relapsing with significant morbidity. In many cases PG is associated with an underlying disease, most commonly inflammatory bowel disease, rheumatic or hematological disease, and malignancy. Etiology has not yet been clearly determined. Diagnosis of PG is based on the history of the underlying disease, typical clinical presentation, histopathology, and exclusion of other diseases that would lead to a similar clinical picture. The treatment of PG is a challenge. Randomized, double-blind prospective multicenter trials for PG are not available. The best documented treatments are systemic corticosteroids and ciclosporin A. Combinations of steroids with cytotoxic drugs are used in resistant cases. The combinations of steroids with sulfa drugs or immunosuppressants are used as steroid-sparing modalities. Rapid improvement of PG has been obtained by anti-tumor necrosis alpha therapy used in Crohn’s disease. Skin transplants and the application of bioengineered skin is useful in selected cases, as a complementary therapy to the immunosuppressive treatment. Topical therapy with modern wound dressings is useful to minimize pain and the risk of secondary infections. Despite recent advances in therapy, the prognosis of PG remains unpredictable.
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Advances in Limb Salvage Medicine
NACCME
New Treatment Strategies for the Endovascular Approach to Critical Limb Ischemia: ADVANCEMENTS IN LIMB SALVAGE MEDICINE
Complimentary Accredited Live Webcast & RebroadcastWednesday, April 25, 2007: 4pm to 5pm EDT. Rebroadcast is scheduled for Tuesday, May 1, 2007: 7pm to 8pm EDT
This educational activity has been developed for Interventional Cardiologists, Vascular Surgeons, Interventional Radiologists, Podiatric Physicians, Endovascular Allied Professionals, Endocrinologists, Wound Care Specialists, Directors of the Wound Care Clinic, and Primary Care Physicians, Pharmacists, Nurses and Technologists .
Read more and register here . . .
Podiatry Today ENews
Podiatry Today-Volume 5, Issue 12
Essential Insights On Flexor Tendon Transfers
By Babak Baravarian, DPM
Offering pertinent pointers from his experience and a detailed guide to variations of the procedure, this author says flexor tendon transfers can be beneficial in addressing hammertoe correction and other deformities involving the second metatarsophalangeal joint and digit.
Practices Good Reputation Bolsters Referrals
By Brian McCurdy, Senior Editor John McCord, DPM, and his partner Mike Dujela, DPM, have a conservative philosophy in their practice. “If it is not something we would recommend for our wives or mothers, we will not recommend it for our patients,” says Dr. McCord. Dr. McCord says that thinking has helped his practice, the Centralia Medical Center in Centralia, Wash., remain free of malpractice suits for 32 years.
Forum: Taking An Active Role In Medical Staff Leadership
By Larry Crystal, DPM Good morning, Chief . Here comes the Chief and Good morning, Mr. President, are all greetings that I have heard since I was elected into the position of Medical Staff President of a tri-campus rural hospital with 65 active staff and 45 mid-level providers. So how did the only podiatrist on staff come to serve as Chief of Staff?
What You Should Do If You Get A Summons
By Robert L. Goldstucker, JD
Being sued by a patient can result in a range of emotions and confusion regarding the legal process. This attorney helps you navigate the legal process from the time one receives the summons to the deposition and settlement process.
The Foot Blog News this Week
The Foot Blog
Issue 14:
- Texas Court Dismisses Vioxx Lawsuit
- Understanding How Glucocorticoids Work To Stop Skin Irritation
- Probiotics help with antibiotic side effects
- Phase II Trial Of EcoNail For Treatment Of Onychomycosis
- Study doubts benefit of chondroitin for arthritis
- These Israeli Boots Are Made For Treating Peripheral Vascular Disorders
- The DGEMRIC Index As A Predictor Of Cartilage Mechanical Stiffness
- Change of Season Brings Lawn Mower Warning
- Ossur’s Proprio Foot Walks Away With 2007 Medical Design Excellence Award – Ossur’s Bionic Technology Breaks New Ground For Amputeeses
- U.S. panel rejects Merck’s Vioxx successor
Podiatry Related Abstracts this Week
Entrez Pub Med, Wiley Interscience, Ingenta Connect, Blackwell Synergy and more . . .
Bone Stress Injuries of the Ankle and Foot
Am J Sports Med
Forefoot Loading During 3 Athletic Tasks
J Am Sports Med
Mycetoma
Clinic Dermatol
Endoscopic resection of the gouty tophi of the first metatarsophalangeal joint
Arch of Ortho Trauma & Surg
Great Toe-to-Thumb Microvascular Transplantation
Clin Plastic Surg
The effect of three levels of foot orthotic wedging on the surface electromyographic activity of selected lower limb muscles during gait.
Clin Biomech
A biomechanical analysis of the effect of lateral column lengthening calcaneal osteotomy on the flat foot
Clin Biomech
Segmental foot mobility in individuals with and without diabetes and neuropathy
Clin Biomech
Surgical Outcome of Drop Foot Caused by Degenerative Lumbar Diseases
Spine
Neuropathies of the foot
Clin Neurophysiol
ORIGINAL ARTICLE: Idiopathic transient osteoporosis is a self limiting, reversible and uncommon condition. There is usually an overlap between various clinical syndromes, which include reflex sympathetic dystrophy, and infectious etiology. We report a case of idiopathic transient osteoporosis involving both feet. The diagnosis was confirmed by proper clinical examination supported by biochemistry, blood investigations and radiographs. A 45 year old man was treated conservatively with bed rest, Non-steroidal anti- inflammatory drugs, protected weight bearing and physiotherapy. This patient made a full clinical and radiographic recovery. 
ORIGINAL ARTICLE: Numerous procedures have been described for the high-end hallux valgus deformity. The authors describe a modification of the proximal opening wedge osteotomy utilizing the Arthrex Low Profile Plate and Screw System. The system allows for stable fixation of the osteotomy without the need of a bone graft to maintain position. Our hope is that this article will generate a renewed interest in this highly effective procedure. 
ORIGINAL ARTICLE: Plantar fascial rupture is rarely presented in the literature. Spontaneous rupture of the plantar fascia is commonly preceded by plantar fasciitis. A 60 year old male presents following an acute injury of his foot while playing softball. He presents with acute pain and ecchymosis to the plantar arch of the foot. Plantar fascial rupture was diagnosed clinically and confirmed on MRI. This case discusses the clinical evaluation, MRI results and treatment of acute, spontaneous rupture of the plantar fascia. We also describe the MRI differences of plantar fasciitis and plantar fascial rupture. 
ORIGINAL ARTICLE: To the practicing clinician, it seems obvious that limb hemodynamics would be the primary determinant of walking distance. However, other determinants, such as skeletal muscle metabolism, may play a role. Accordingly, in the current study, we examined the relationship between measures of limb hemodynamics and walking capacity in patients with peripheral arterial disease (PAD). We measured toe and ankle pressures for calculation of toe-(TBI) and ankle (ABI)-brachial indices; basal and hyperemic calf blood flow (CBF; by plethysmography); and initial (ICT) and absolute (ACT) claudication time using the Skinner-Gardner protocol. As expected, PAD patients had impaired limb hemodynamics with reduced TBI, ABI and a reduction in ABI post-exercise. However, there was no relationship between any of the hemodynamic variables (including ABI, ABI reduction post-exercise, TBI, baseline or maximal CBF) and walking distance as assessed by ICT or ACT. A subset of PAD patients with an ACT >750 s (n =16; ‘long claudicators’) were compared with a subset of PAD patients with an ACT <260 s (n = 16; ‘short claudicators’). The average ACT in the long claudicants was over fivefold greater than the short claudicators. Surprisingly, there were no differences between the two groups in any of the hemo-dynamic variables. There was also no relationship between the initial ABI, TBI, toe pressure, baseline or hyperemic CBF, and the improvement in ACT over the 3-month course of the study. This study found little relationship between hemodynamic variables and functional capacity in PAD. Accordingly, to assess the response to therapeutic interventions, exercise performance and functional status need to be directly measured, and cannot be predicted from hemodynamic measurements. 
ORIGINAL ARTICLE: Osteosarcoma is the third most common cancer in adolescence, occurring less frequently than only lymphomas and brain tumors. It is thought to arise from a primitive mesenchymal bone- forming cell and is characterized by production of osteoid. The most common form of treatment is removal of the lesion. Limb-sparing procedures can often be used to preserve function. Chemotherapy is also required to treat micrometastatic disease, which is present, but not detectable in most patients at diagnosis. We present a chondroblastic osteosarcoma of the lower tibia in a 13 year old boy. Diagnosis was confirmed by MRI and histopathology. Neo-adjuvant chemotherapy, en bloc resection of the tumor with ankle arthrodesis, fibular grafting and post- operative chemotherapy was performed. The patient made a full clinical and symptomatic recovery after 2 years of follow-up. 
ORIGINAL ARTICLE: Information on the physical and psychosocial disability of lymphatic filariasis in Sri Lanka is scarce. Therefore this study was carried out to describe the physical disability and psychosocial impact associated with chronic lymphoedema in patients attending filariasis clinics in the Colombo district, Sri Lanka. Four hundred and thirteen patients with lymphoedema of limbs attending filariasis clinics in Werahera and Dehiwala in the Colombo district were enrolled in the study after obtaining informed written consent. Data were collected using a pre-tested, interviewer-administered questionnaire and analyzed using SPSS. The Majority (95%) of patients had lower limbs affected and there was a significant association with difficulty in walking (p=0.023). The swollen limb affected the work of 87 (52 %) of employed patients and 26 persons reported loss of job. Approximately 25 % and 6 % reported having problems interacting with the community and family, respectively and 8.7 % felt that they were rejected by society. The swollen limb was perceived as a major problem by 36.8 % of patients. Of the married persons, 5.7 % and 6.2 % reported sexual and marital problems respectively, due to their swollen limb/s. Of those who had marital problems, 77.3% reported sexual problems as well (p < 0.001). Lymphoedema significantly affects physical, psychological and social functioning in affected individuals. Morbidity control, in addition to control of physical disability, should target the psychosocial consequences. 
ORIGINAL ARTICLE: Aneurysms of the peroneal artery are infrequent and consist mainly of pseudoaneurysms. This report describes an unusual case of peroneal pseudoaneurysm developing after thromoboembolectomy with a Fogarty catheter. It was managed successfully using an endovascular technique consisting of selective catheterization and coil embolization. The coils were placed in the peroneal artery, both proximal and distal to the pseudoaneurysm. We conclude that endovascular technique can be successfully used to treat pseudoaneurysms in difficult settings. 
ORIGINAL ARTICLE: Aseptic loosening of a joint prosthesis is associated with remodeling of bone tissue in the vicinity of the prosthesis. In the present study, we have investigated the effects of synovial fluid (SF) from patients with a loose prosthetic component and periprosthetic osteolysis on osteoclast and osteoblast activities in vitro and made comparisons with the effects of SF from patients with osteoarthritis (OA). Bone resorption was assessed by the release of 45Ca from cultured calvariae. The mRNA expression in calvarial bones of molecules known to be involved in osteoclast and osteoblast differentiation was assessed using semi- quantitative RT-PCR and real-time PCR. SFs from patients with a loose joint prosthesis and from patients with OA, but not SFs from healthy subjects, significantly enhanced 45Ca release, effects associated with increased mRNA expression of calcitonin receptor and tartrate resistant acid phosphatase. The mRNA expression of RANKL and OPG was enhanced by SFs from both patient categories. The mRNA expressions of NFAT2 and OSCAR were enhanced only by SFs from OA patients, whereas the mRNA expressions of DAP12 and FcRg were not affected by any of the two different SFs. Bone resorption induced by SFs was inhibited by addition of OPG. Antibodies neutralizing IL-1 a, IL-1 b, soluble IL- 6 receptor, IL-17 or TNF-a, when added to individual SFs, only occasionally decreased the bone resorbing activity. The mRNA expression of alkaline phosphatase and osteocalcin was increased by SFs from OA patients, whereas only osteocalcin mRNA was increased by SFs from patients with a loose prosthesis. Our findings demonstrate the presence of factor(s) stimulating both osteoclast and osteoblast activities in SFs from patients with a loose joint prosthesis and periprosthetic osteolysis, as well as in SFs from OA patients. SF induced bone resorption was dependent on activation of the RANKL/RANK/OPG pathway. The bone resorbing activity could not be solely attributed to any of the known pro-inflammatory cytokines, well known to stimulate bone resorption, or to RANKL or PGE2 in SFs. The data indicate that SFs from patients with a loose prosthesis, or with OA, stimulate bone resorption, and that SFs from OA patients are more prone to enhance bone formation. 
