Tibialis Anterior Rupture: A missed diagnosis
Podiatry Internet Journal
ORIGINAL ARTICLE: Closed rupture of the anterior tibial tendon is uncommon. Only a few cases have been reported in the literature. We discuss both conservative and surgical treatment of anterior tibial ruptures. Primary repair is indicated in younger, active individuals while older individuals can be treated conservatively by casting in cases of incomplete rupture. It appears that early diagnosis and treatment will provide the best clinical results.
Oedema of the metatarsal heads II-IV and forefoot pain as an unusual manifestation of Lyme disease: a case report
J. of Med. Case Reports
ORIGINAL ARTICLE: We report the case of a healthy 36 year old man who suffered from foot pain lasting for weeks, without having a specific medical history relating to it. The clinical evaluation was interpreted as a transfer metatarsalgia caused by a splayfoot. The radiographs revealed no pathology except the splayfoot deformity. Due to persistent pain and swelling of the entire forefoot, after two weeks of conventional treatment, magnet resonance images (MRI) and a blood sample were taken. The laboratory investigation showed raised levels of white blood cell count and C-reactive protein. The MRI showed up oedema in the metatarsal heads II-IV, as well as soft tissue swelling of the forefoot without any signs of decomposition. Because of this atypical inflammation of the forefoot a laboratory investigation to check for rheumatology disease was done and revealed borrelia burgdorferi infection. On the basis of these findings, antibiotic treatment was started and maintained over three weeks. The symptoms disappeared after 2 weeks, and the patient was able to resume his sports activities.
Balance problems after unilateral lateral ankle sprains
JRRD
ORIGINAL ARTICLE: We examined balance problems in athletes with acute lateral ankle sprains by recruiting 30 male athletes with right dominant side and traumatic ankle sprain through simple nonprobability sampling. We measured their sway index and limits of stability with the Biodex Balance System under different conditions. Our results showed that balance ability in patients with acute lateral ankle sprain was significantly weaker when their eyes were closed rather than open. We also found that after lateral ankle sprain, balance problems occur and are a result of proprioceptive deficits, especially the unconscious (reflexive) aspect of proprioception as opposed to the conscious (voluntary) aspect. This factor probably plays an important role in recurrence of ankle sprain. Improvement in the conscious aspect can occur in the first month of treatment, but the unconscious aspect experiences a delay in healing of 3 to 6 months. Therefore, an effective rehabilitation program for managing proprioceptive deficits should be followed.
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Melioidotic septic arthritis: a case report and literature review
Journal of Microbiology, Immunology and Infection
ORIGINAL ARTICLE: Burkholderia pseudomallei, the causative agent of melioidosis, is endemic in southeast Asia and northern Australia. In recent years, the incidence of melioidosis has increased worldwide. Septic arthritis is a rare but well- recognized manifestation of melioidosis. Patients with underlying medical conditions, such as diabetes mellitus, renal impairment, cirrhosis, and malignancy are at greater risk. The presentations of melioidotic septic arthritis often mimic other disease processes and patients may not always be clinically septic. We present a case of septic arthritis due to B. pseudomallei in a 66-year-old male with diabetes mellitus presenting with a history of fever and ankle swelling. Follow-up ankle X-ray showed soft tissue swelling. Synovial fluid and blood samples grew B. pseudomallei. The patient improved gradually after parenteral administration of ceftazidime (2 g 8-hourly) and cotrimoxazole (1440 mg 8-hourly). He was discharged on oral cotrimoxazole (1440 mg 12- hourly), doxycycline (100 mg 12-hourly), and chloramphenicol (500 mg 6-hourly) for 6 months. This case highlights the possible occurrence of melioidotic septic arthritis, and the importance of prompt initiation of appropriate antimicrobials to achieve good outcomes.
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APMA News Release
APMA
1. Foot temperature may indicate patients’ risk for foot ulcers
Study Discussed at the American Podiatric Medical Association’s 95th Annual Scientific Meeting
Bethesda, Md. – Diabetes foot complications, such as foot ulcers, are the leading cause of nontraumatic lower-limb amputations in the United States. But what if a thermometer inside a shoe could detect ulcers before they start? A study released at this week’s American Podiatric Medical Association’s (APMA) 95th Annual Scientific Meeting in Philadelphia could help to significantly reduce the risk of ulcers for people with diabetes. The study, funded by the U.S. Department of Veterans Affairs, suggests that a thermometer used to detect change in temperature in feet of a person with diabetes could indicate if conditions are ripe for foot ulcers.
2. Study finds lower-limb injuries plague U.S. soldiers in Iraq
For the First Time Ever, Podiatric Physicians Treat Lower-limb Injuries During War
Bethesda, Md. – A study released in advance of the American Podiatric Medical Association’s(APMA) 95th Annual Meeting in Philadelphia reveals nearly 68 percent of all US soldiers wounded in the Iraq and Afghanistan conflicts are a result of extremity injuries and nearly 22 percent of those injuries involve the foot and/or ankle. To meet the war’s demands of lower- limb injuries, podiatric physicians are on the surgical front lines for the first time ever. No longer relegated to non-critical cases, podiatric physicians have seen their role expanded to match their medical and surgical training.
3. Study finds foot and ankle exams critical to peripheral arterial disease detection
Understanding Common Risk Factors Key to PAD Prevention
Bethesda, Md. – Its no secret the feet can reveal the first signs and symptoms of systemic diseases, such as diabetes and heart disease. Now a new study released this week at the American Podiatric Medical Association’s (APMA) 95th Annual Scientific Meeting in Philadelphia suggests peripheral arterial disease (PAD), which can decrease blood flow to the legs and feet, can also be detected by a simple, non-invasive foot and ankle exam. More than 12 million Americans have the artery clogging disease, which can often lead to, in its early stages, muscle fatigue and pain when walking. If left untreated, the disease can lead to more severe conditions such as possible leg amputation, heart attack, stroke and even death.
Podiatry Today ENews
Podiatry Today-August-September 2007
How To Handle Plantar Fibromas
By By Matt Sabo, DPM
Offering a pertinent review of plantar fibromas that addresses clinical characteristics and histological characteristics to look for in the diagnostic workup, this author also offers salient pointers on treatment options.
Ankle Replacement Patients Ready For Post- Op Sports
By Brian McCurdy, Senior Editor
Patients who undergo ankle replacement participate more in sports following replacement surgery, according to an abstract presented at the American Academy of Orthopedic Surgeons’ annual meeting.
Understanding Common Knee Injuries And Lower Extremity Implications In Runners
By John F. Connors, DPM, and Ana J. Sanz, DPM
To have a successful sports medicine practice, it is crucial to understand not only the foot and ankle but also the knee and hip, and the mechanism of injuries affecting these areas. Having the opportunity to treat and travel with the best runners in the world has forced me to have a stronger understanding of lower extremity biomechanics, the mechanics of running and the injuries associated with running.
Continuing Education: How To Address Failed Peroneal Tendon Surgery
By Neal M. Blitz, DPM, FACFAS
The long-term effects of a failed peroneal tendon surgery may lead to structural foot deformity. Accordingly, this author reviews pre-op considerations and discusses key nuances of peroneal tendon repair options to help facilitate improved outcomes.
When An Adult Patient Presents With Red Spots On The Feet
By G. “Dock” Dockery, DPM, FACFAS
It is late in the summer when a 29-year-old Caucasian female, employed as a medical assistant in your foot and ankle clinic, presents with a two-day history of red spots on her feet. The red spots became small fluid- filled vesicles, which are present mostly on the soles. She says she has broken one of the small vesicles and it expressed a clear fluid.
Congenital Foot Deformities: A Guide To Conservative Care
By Mark A. Caselli, DPM
In regard to congenital foot deformities, there is an array of conservative therapies that may prevent or reduce the scope of surgical treatment. With this in mind, this author offers a closer look at manipulation therapy, serial casting, corrective shoes, orthoses and splints.
The Foot Blog News
The Foot Blog
Issue 22-August/September 2007:
- Helping Third World Amputees – 15 Year Old Da Vinci Award Winner Invents Artificial Leg Shell
- Stress Fracture Risk In Active Adolescent Girls May Be Hereditary
- Fracture And Bone Loss Risk Reduced If Older People Take Calcium Supplementation
- FDA To Set New Standards For Sunscreens
- Painful ulceration on the ankle of an 82-year-old man
- Lower-limb injuries common place in U.S. soldiers in Iraq
- Foot Care Failure-NHS foot care services in England lacking
- Americans Using Painkillers More Than Ever
- Kids and Crocs: Trendy or Risky?
- Birth Defects to Fingers and Toes: Another reason to quit smoking
Podiatry Related Abstracts
Entrez Pub Med, Wiley Interscience, Ingenta Connect, Blackwell Synergy and more . . .
A woman with a dangling digitJDDG
A model to analyse costs and benefit of intensified diabetic foot care in AustriaJ of Eval in Clin Practice
Cutaneous epithelioid hemangioendotheliomaJ of Cutaneous Pathology
The role of the stretch reflex in the gastrocnemius muscle during human locomotion at various speedsJ of Applied Physio
Foot abduction brace in the ponseti method for idiopathic clubfoot deformity: torsional deformities and complianceJ of Ped Ortho
Evaluation of atrophy of foot muscles in diabetic neuropathy – A comparative study of nerve conduction studies and ultrasonographyClin Neurophysio
Osteochondrom a of the phalanx: A late Roman case.Homo
A new approach to the treatment of congenital vertical talusJ of Childrens Ortho
Accuracy analysis of Iso-C3D versus fluoroscopy-based navigated retrograde drilling of osteochondral lesionsJBJS (Br)
Repair of large full- thickness articular cartilage defects by transplantation of autologous uncultured bone-marrow-derived mononuclear cells J Ortho Research
A Painful Thorn in the Foot: A Case of Eumycetoma. Am Journal of Med Sc.
A painful large ganglion cyst of the ankle treated by the injection of OK-432 Mod Rheumatology
Diagnosis of medial tubercle fractures of the talar posterior process using oblique views. Injury
Elderly unilateral transtibial amputee gait on an inclined walkway: A biomechanical analysis. Gait Posture
Nodule on the Toe-Diagnosis Arch of Dermatology
Stress fracture of the distal phalanx of the great toe in a professional ballet dancer: a case report Am J Sports Med
Arthroscopy and endoscopy of the foot and ankle: indications for new techniques Arthroscopy
Kinematics of heelstrike during walking and carrying: implications for slip resistance testing. Ergonomics, Human Factors, Anthropometrics
© Podiatry Internet Communications (PICOMM)
ORIGINAL ARTICLE: A case report describing os subfibulare is presented. A 16 year old female presents with a painful lump of the lateral malleolus. The os subfibulare formed a painful pseudo-arthrosis and the accessory ossicle was excised. Surgical excision resulted in complete, symptomatic relief. Case presentation includes x-ray and CT findings with discussion of various accessory ossicles and their respective incidence in the lower extremity. 
ORIGINAL ARTICLE: A case report describing pretibial myxedema is presented. A 50 year old African- American female presents with a painful pretibial, multinodular plaque. Additional nodules were present on the foot. Clinical presentation including skin biopsy and treatment is discussed. The pathogenesis of PTM is unknown. Treatment consists of corticosteroids under occlusion and other treatments are being investigated. 
ORIGINAL ARTICLE:: Outcome following management of congenital talipes equinovarus (clubfoot) can be assessed in a number of ways. Bjonness stated simply that “the patient is the final judge of whether he has a good foot”; a purely subjective assessment. Others have employed objective measures. Combining subjective evaluation with a more objective assessment of movement and position of the foot, is likely to give a more comprehensive picture of the final result of clubfoot. The purpose of this study was to compare subjective and objective outcome following management of clubfoot, and evaluate sex differences in outcome. We used a patient-administered subjective assessment of outcome following treatment of clubfoot and compared it with objective anthropometry and range of movement of the ankle to assess and compare subjective and objective outcome in clubfoot. Statistical analysis was performed using Pearson correlation coefficients. Significance was tested using Student’s t-test test. Objective outcome can be assessed using length of the foot, calf circumference and range of movement at the ankle. These are easy to measure, reproducible, and correlate well with subjective outcome. Objective outcome is comparable for boys and girls. However, subjectively, female patients and their parents are less happy with the results of management of clubfoot. We conclude that there is a correlation between the anthropometric measures and the subjective outcome and an objective grading can be designed using foot length, calf muscle bulk and range of movement at the ankle. 
ORIGINAL NETQUIZ ARTICLE: A 55 year-old man presented in our clinic with a warty mass on the dorsum of his foot, which had been growing for the past 5-6 years. It was treated as a wart with many household remedies without any success. The patient had a discolored spot in that area since childhood and the present lesion started there until it grew to the present size. He complained of bleeding from the lesion off and on. On examination there was a 3 x 2 cm dark verrucous lesion on the dorsum of the left foot [Figure - 1]. Upon palpation, the lesion was hard to feel, but was freely movable in all directions. There was a slight swelling in the perilesional area, which was soft to palpation. The patient had no history of trauma, fever or weight loss. He had no systemic signs or symptoms. There were no palpable lymph nodes in the affected area or in the inguinal region. His hemogram, liver and kidney functions, blood sugar, chest X-ray and ultrasonography of the abdomen were normal. An excisional biopsy was done with a 4 mm free margin. What is your diagnosis? 
ORIGINAL ARTICLE: Synovial sarcoma is a rare soft tissue neoplasm commonly found in the lower extremity. It is included in the differential diagnosis of all soft tissue masses of the foot and ankle. It has a particular predilection for the lower extremity. Early diagnosis and staging with definitive treatment provides the highest probability in preventing metastasis and local recurrence. A case of synovial sarcoma masquerading as sesamoiditis is presented. Clinical, MRI and histopathologic findings are presented. 
ORIGINAL ARTICLE: Athlete’s Foot (Tinea pedis) is a form of ringworm associated with highly contagious yeast-fungi colonies, although they look like bacteria. Foot bacteria overgrowth produces a harmless pungent odor, however, uncontrolled proliferation of yeast-fungi produces small vesicles, fissures, scaling, and maceration with eroded areas between the toes and the plantar surface of the foot, resulting in intense itching, blisters, and cracking. Painful microbial foot infection may prevent athletic participation. Keeping the feet clean and dry with the toenails trimmed reduces the incidence of skin disease of the feet. Wearing sandals in locker and shower rooms prevents intimate contact with the infecting organisms and alleviates most foot-sensitive infections. Enclosing feet in socks and shoes generates a moisture-rich environment that stimulates overgrowth of pungent both aerobic bacteria and infectious yeast-fungi. Suppression of microbial growth may be accomplished by exposing the feet to air to enhance evaporation to reduce moistures’ growth-stimulating effect and is often neglected. There is an association between yeast- fungi overgrowths and disabling foot infections. Potent agents virtually exterminate some microbial growth, but the inevitable presence of infection under the nails predicts future infection. Topical antibiotics present a potent approach with the ideal agent being one that removes moisture producing antibacterial-antifungal activity. Severe infection may require costly prescription drugs, salves, and repeated treatment. A 63-y female volunteered to enclose feet in shoes and socks for 48 hours. Aerobic bacteria and yeast- fungi counts were determined by swab sample incubation technique (1) after 48-hours feet enclosure, (2) after washing feet, and (3) after 8-hours socks- shoes exposure to a aromatic oil powder-compound consisting of Arrowroot, baking soda, basil oil, oil, tea tree oil, sage oil, and clove oil. In conclusion, application of this novel compound to the external surfaces of feet completely inhibited both aerobic bacteria and yeast-fungi-mold proliferation for 8-hours in spite of being in an enclosed environment compatible to microbial proliferation. Whether topical application of this compound prevents microbial infections in larger populations is not known. This calls for more research collected from subjects exposed to elements that may increase the risk of microbial-induced foot diseases. 
ORIGINAL ARTICLE: Ankle-foot orthoses (AFOs) are intended to improve toe clearance during swing and ankle position at initial contact (IC) and midstance. Changes that lead to improved ankle-foot kinematics may result in a more biomimetic roll-over shape (ROS). ROS is the effective geometry to which the ankle-foot complex conforms between IC and contralateral IC. An effective ROS during gait may facilitate forward progression. This study investigated the effect of an AFO on ROS in adults with hemiplegia following stroke. Kinematic and force data were recorded from 13 people with hemiplegia and 12 controls. Hemiplegic subjects walked at a self- selected speed with and without an articulated AFO with plantar flexion stop. For the involved limb, the AFO significantly increased the ROS arc length (from 32.6% to 55.7% of foot length [FL]) and arc radius (67.4% to 139.3% of FL) and significantly altered the sagittal plane location of the first center of pressure (COP) point, moving it posterior to the ankle center (- 1.2% to -20% of FL) (p < 0.002 for all comparisons). However, when hemiplegic patients walked with an AFO, their mean arc radius was greater, mean arc length less, and the first COP point further posterior than those of control subjects. 
