Showing papers in "Journal of the American Podiatric Medical Association in 1994"
TL;DR: Aloe vera improves wound healing and inhibits inflammation, and mannose-6-phosphate is the major sugar in the Aloe gel, the authors examined the possibility of its being an active growth substance.
Abstract: Aloe vera improves wound healing and inhibits inflammation. Since mannose-6-phosphate is the major sugar in the Aloe gel, the authors examined the possibility of its being an active growth substance. Mice receiving 300 mg/kg of mannose-6-phosphate had improved wound healing over saline controls. This dose also had anti-inflammatory activity. The function of mannose-6-phosphate in A. vera is discussed.
276Â citations
TL;DR: The results of the study indicate that the two-step method provides pressure data more representative of the midgait method, and different values for pressure and force will be obtained, depending on the method of pressure data collection selected by the clinician.
Abstract: The purpose of this study was to determine if pressure data, collected after taking one step or two steps, were similar to values obtained by using the traditional midgait method. Ten healthy subjects, with a mean age of 27 years, walked across a sensor platform sampling at 70 Hz. Each subject was randomly assigned to take one step, two steps, or multiple steps (midgait method) across the sensor platform. The results of the study indicate that the two-step method, in comparison with the one-step method, provides pressure data more representative of the midgait method, and different values for pressure and force will be obtained, depending on the method of pressure data collection selected by the clinician.
123Â citations
TL;DR: Three specific goals for prevention of amputation are identified: identification of at risk individuals needing prevention and the specific factors placing them at risk; protection of the foot against the adverse effects of external forces (pressure, friction, and shear); and reduction of the incidence of diabetic foot ulcers through educational programs.
Abstract: Fifteen percent of individuals with diabetes will likely develop foot ulcers in their lifetime, and approximately 15% to 20% of these ulcers are estimated to result in lower extremity amputation. Techniques to prevent lower extremity amputation range from the simple but often neglected foot inspection to complicated vascular and reconstructive foot surgery. Appropriate management can prevent and heal diabetic foot ulcers, thereby greatly decreasing the amputation rate and medical care costs. Prevention is the key to treatment. The author discusses general guidelines for foot screening and identifies three specific goals for prevention of amputation: 1) identification of at risk individuals needing prevention and the specific factors placing them at risk; 2) protection of the foot against the adverse effects of external forces (pressure, friction, and shear); and 3) reduction of the incidence of diabetic foot ulcers through educational programs.
72Â citations
TL;DR: Aloe vera at doses of 100 and 300 mg/kg daily for 4 days blocked the wound healing suppression of hydrocortisone acetate up to 100% using the wound tensile strength assay.
Abstract: Aloe vera at doses of 100 and 300 mg/kg daily for 4 days blocked the wound healing suppression of hydrocortisone acetate up to 100% using the wound tensile strength assay. This response was because of the growth factors present in A. vera masking the wound healing inhibitors such as sterols and certain amino acids. The sterols showed good anti-inflammatory activity (-36%) in reducing the croton oil-induced ear swelling. This activity displayed a dose-response relationship.
71Â citations
TL;DR: The FDA is taking steps to encourage health professionals to report adverse events that might be associated with medications or devices to the Food and Drug Administration (FDA) or to the manufacturer as mentioned in this paper.
Abstract: UNFORTUNATELY, many health professionals do not think to report adverse events that might be associated with medications or devices to the Food and Drug Administration (FDA) or to the manufacturer. That needs to change, and the FDA is taking steps to encourage that to happen. Reports from health professionals of adverse events or product quality problems are essential to ensure the safety of drugs, biologicals, medical devices, and other products regulated by the FDA once they are introduced into the US market. Even the large, well-designed clinical trials that are conducted to gain pre-market approval cannot uncover every problem that can come to light once a product is widely used. A new drug application, for example, typically includes safety data on several hundred to several thousand patients. If an adverse event occurs in perhaps one in 5000 or even one in 1000 users, it could be missed in clinical trials
62Â citations
TL;DR: Hip joint movements are identified as being the most significant contributors to prediction of rearfoot angles produced during walking.
Abstract: Twenty nonsymptomatic subjects were assessed while walking at a photoelectronically monitored place (2 +/- 0.1 m.s-1) using high speed cinematography (200 Hz) to record the rearfoot motion in the frontal plane, and electrogoniometry (100 Hz) to measure joint kinematics in the lower extremity. The foot type of the subjects was determined statically by using a podiascope and digitization techniques. The results demonstrated that no foot type variables contributed significantly to the variance in either rearfoot angle at foot strike or maximum rearfoot angle (p > 0.05). Regression equations were developed using kinematic variables: rearfoot angle at foot strike = 3.81 + (0.06*time to hip internal rotation) - (0.46*tibia internal rotation) + (0.14*plantarflexion); (R = 0.87, SE = 1.23 degrees); maximum rearfoot angle = 4.02 + (0.52*hip internal rotation) - (0.11*time to hip internal rotation); (R = 0.66, SE = 2.07 degrees). This study identifies hip joint movements as being the most significant contributors t...
53Â citations
TL;DR: The author reviews the role of the following in wound healing: protein, vitamin A, zinc, vitamin C, vitamin E, and iron.
Abstract: Proper nutrition in presurgical patients can enhance wound healing and potentially decrease the cost of postsurgical medical care. Therefore, to combat increasing health care costs, it is important that the health care professional have a solid understanding of the role of essential nutrients in the healing process. The author reviews the role of the following in wound healing: protein, vitamin A, zinc, vitamin C, vitamin E, and iron.
50Â citations
TL;DR: The contact characteristics of ankle joints in 18 fresh cadaver specimens were studied by using pressure-sensitive film to provide baseline information for subsequent studies of various pathologic ankle conditions and demonstrated significant changes in ankle joint contact characteristics with different foot positions.
Abstract: The contact characteristics of ankle joints in 18 fresh cadaver specimens were studied by using pressure-sensitive film to provide baseline information for subsequent studies of various pathologic ankle conditions. Specimens, consisting of the distal half of the tibia and fibula and the intact ankle and foot, were mounted in a materials testing system on a loading frame that allowed positioning in neutral, and 20 degrees of plantarflexion and dorsiflexion. An 800 N load (1 body weight) was axially applied to the specimens through the tibia with 10% of the total load distributed through the fibula. Transducers made of pressure-sensitive film were used to make a contact print and were scanned along with calibration strips to form a digital image. The image was analyzed quantitatively to determine total contact area, mean contact pressure, ratio of contact to plafond areas, and high pressure zone centroid location as a function of sagittal plane foot position in the normal ankle joint. The results demonstrated significant changes in ankle joint contact characteristics with different foot positions.
45Â citations
TL;DR: Three quarters of a group of 65 patients with adolescent hallux abducto valgus were found to have an abnormally high metatarsus adductus angle, and patients who had a closing base wedge osteotomy had higher preoperative radiographic angles.
Abstract: The authors review 63 surgical cases of adolescent hallux abducto valgus in 54 patients from the Foot and Ankle Institute of the Pennsylvania College of Podiatric Medicine over a 7-year period. Twenty-five closing base wedge and capital osteotomies were evaluated for radiographic changes. Three quarters of a group of 65 patients with adolescent hallux abducto valgus were found to have an abnormally high metatarsus adductus angle. Patients who had a closing base wedge osteotomy had higher preoperative radiographic angles for the intermetatarsal, metatarsus adductus, hallux abductus, and proximal articular set angles as well as the tibial sesamoid position. Those patients had 4.49 degrees more intermetatarsal angle correction than the patients who had a capital osteotomy. Implications for evaluation and treatment are discussed.
45Â citations
TL;DR: It is suggested that determining the size of a lesion may assist in predicting the long-term outcome of ankles with cartilage defects as a function of lesion size and location.
Abstract: Variations in ankle joint contact characteristics caused by articular defects of the talar dome were investigated in 14 fresh-frozen cadaver specimens using pressure-sensitive film. Intact ankle and foot specimens were mounted in a materials tester on a loading frame which allowed positioning in neutral, and 20 degrees of dorsiflexion and plantarflexion. Joint contact prints were recorded while an 800 N load was axially applied through the leg. Specimens were randomly placed into two lesion groups: either anterolateral or posteromedial. During testing, each specimen had four concentrically placed lesions on the talar dome, graduated in size. Following removal, the film transducers were digitized along with pressure calibration prints. The images were analyzed quantitatively to determine contact areas, mean contact pressures, ratio of to contact plafond areas, and high pressure centroid position as a function of lesion size and location. The results demonstrated significant changes in contact characteristics for larger lesions (> or = 7.5 x 15 mm) (P < 0.05). These findings suggest that determining the size of a lesion may assist in predicting the long-term outcome of ankles with cartilage defects.
39Â citations
TL;DR: Long-term elevation of the first ray was greater with the base wedge osteotomy and did not change appreciably with the Austin procedure, while the prevalent preoperative symptoms were significantly reduced postoperatively in both groups of patients.
Abstract: Hallux abducto valgus with concomitant metatarsus primus adductus was treated by either an isolated Austin bunionectomy or by a combination of a modified McBride bunionectomy, along with a closing base wedge osteotomy, on a total of 73 patients (88 feet) from 1983 to 1993. Both subjective and objective similarities and differences were compared between these two groups of patients. Long-term elevation or depression of the first ray was analyzed by using a technique termed sagittal plane displacement. The prevalent preoperative symptoms were significantly reduced postoperatively in both groups of patients. Initial postoperative elevation of the first ray occurred in approximately one third of the cases in both groups. Long-term elevation of the first ray was greater with the base wedge osteotomy and did not change appreciably with the Austin procedure. The sagittal plane displacement method is a helpful tool in analyzing changes in the position of the first ray perioperatively.
TL;DR: Nothing in the BrimmComm data refutes the observation that podiatrists remain the provider of choice for toenail problems, corns and calluses, and bunions, and are a strong second to MDs for the treatment of foot infections.
Abstract: On the issues of incidence and prevalence: Specific Foot Problems. At the national level, ie, all respondents combined, the agreement between the NHIS and BrimmComm findings is remarkably close. Much of the difference, if not all, is believed explainable by the approximately 5% shortfall in the reported rate of problems associated with individuals who failed or refused to report their income. Where there are major differences between the NHIS and BrimmComm findings, they occur chiefly when the data are disaggregated by sex, age, or income. Technically speaking, the differences are in most cases statistically insignificant because of the generally small sample sizes associated with individual population segments in the BrimmComm survey. Injuries. Although the differences here are somewhat greater than they are for other foot problems, this may be the result of the greater emphasis being placed in the BrimmComm survey (as opposed to the NHIS) on the reporting of injuries. On the issue of utilization: Basic Treatment Patterns. Nothing in the BrimmComm data refutes the observation that podiatrists remain the provider of choice for toenail problems, corns and calluses, and bunions, and are a strong second to MDs for the treatment of foot infections. Overall Number of Visits. The BrimmComm data would indicate a total of 41.4 million visits involving patients 18 years and older in a period of 12 months. Following technical adjustments described in the text (including augmentation to include patients 17 years of age or younger), the total number of visits to podiatrists in 1990 involving civilian noninstitutionalized patients is believed to be in the vicinity of 50 million.(ABSTRACT TRUNCATED AT 250 WORDS)
TL;DR: The statistical results support the use of the Kalish modification of the Austin bunionectomy with rigid internal fixation for the reduction of the intermetatarsal angle, hallux abductus angle, and tibial sesamoid position.
Abstract: One hundred seventy-two patients (265 feet) were reviewed following correction of hallux abducto valgus surgery, using the Kalish modification of the Austin bunionectomy. Fifty-three cases were followed up on an average of 2.5 years from 1986 through 1992. The statistical results support the use of this osteotomy with rigid internal fixation for the reduction of the intermetatarsal angle, hallux abductus angle, and tibial sesamoid position. Patients are weightbearing immediately and are usually back in soft shoes or sneakers 2 weeks after surgery. Surgical techniques and complications of this procedure are discussed to help surgeons use this procedure in correcting hallux abducto valgus deformities.
TL;DR: A review of 12 cases of bony tumors involving the talus is presented, finding giant cell tumor was the most common tumor and good results after excision or curettage and bone grafting in the treatment of benign neoplasms.
Abstract: A review of 12 cases of bony tumors involving the talus is presented. Giant cell tumor was the most common tumor. Malignant tumors should be treated by surgical ablation followed by chemotherapy. There are good results after excision or curettage and bone grafting in the treatment of benign neoplasms. Giant cell tumors, if diagnosed early, can be treated by curettage and bone grafting, but if there is talar collapse, a talectomy can be performed.
TL;DR: The authors evaluated the radiographs of 40 patients under 21 years of age who underwent surgery for symptomatic hallux abducto valgus deformity at Northlake Regional Medical Center and found a statistically significant correlation between an increasing metatarsus adductus angle and an increasing hallux abductionus angle.
Abstract: The authors evaluated the radiographs of 40 patients (72 feet) under 21 years of age who underwent surgery for symptomatic hallux abducto valgus deformity at Northlake Regional Medical Center. Forty-eight of 72 feet had metatarsus adductus angles greater than 15 degrees. A statistically significant correlation was found between an increasing metatarsus adductus angle and an increasing hallux abductus angle.
TL;DR: The author discusses the potential benefits of hyperbaric oxygen in the treatment of chronic wounds when used as a part of a multidisciplinary wound care program.
Abstract: The use of hyperbaric oxygen therapy for the treatment of conditions of local or focal hypoxia is not new. The author discusses the potential benefits of hyperbaric oxygen in the treatment of chronic wounds when used as a part of a multidisciplinary wound care program. Rationale and mechanism of action are discussed along with possible adverse effects. Costs of care and limb salvage rates are considered.
TL;DR: The author describes the surgical technique for procurement of calcaneal bone grafts, a source of small amounts of autogenous corticocancellous or cancellous bone, for foot and ankle surgical procedures.
Abstract: Autogenous bone grafting is an important part of many foot and ankle surgical procedures. Although alternative bone graft materials such as allogeneic bone are available, autogenous bone continues to be the material of choice for many procedures. The calcaneus provides a source of small amounts of autogenous corticocancellous or cancellous bone. The author describes the surgical technique for procurement of calcaneal bone grafts. Twenty-five cases are reviewed. The morbidity associated with procuring calcaneal bone grafts is favorably compared with that associated with procuring bone from other donor sites.
TL;DR: Overuse posterior tibial tendinitis is caused by the increased stress placed on the tendon as it tries to compensate for the increased subtalar joint pronatory movement and velocity during physical activity.
Abstract: Overuse posterior tibial tendinitis is caused by the increased stress placed on the tendon as it tries to compensate for the increased subtalar joint pronatory movement and velocity during physical activity. The stress can cause microtrauma and rupture of some of the fibers of the tendon. This leads to an inflammatory process and the classical clinical signs and symptoms. Therapy is directed at reducing the inflammation, minimizing the fibrosis buildup, re-strengthening the weakened tissue, and controlling the pronatory force. The two case reports illustrate typical clinical signs, symptoms, and treatment for this injury.
TL;DR: The author compares five classes of wound dressings: hydrocolloids, hydrogels, films, foams, and sodium/calcium alginates to demonstrate the differences in the qualities of each product.
Abstract: Selection of an appropriate wound dressing, to potentiate healing, demands knowledge about varying classes of dressings. With the growing number of wound dressings available, health care providers must understand both the principles of dressing development as well as the qualities of each individual product. The author compares five classes of wound dressings: hydrocolloids, hydrogels, films, foams, and sodium/calcium alginates. Also, principles of dressing selection and long-term wound management guidelines are presented.
TL;DR: The authors provide an extensive overview of specific fixation techniques used throughout the past 6 years, with emphasis on the potential advantages and disadvantages of the individual fixation techniques.
Abstract: Fusion of the first metatarsophalangeal joint is a time-honored, effective procedure for multiple conditions. Numerous fixation techniques have been described over the years. The authors provide an extensive overview of specific fixation techniques used throughout the past 6 years. Emphasis is placed on the potential advantages and disadvantages of the individual fixation techniques.
TL;DR: The surgical approach in the patient presented here was chosen because of factors that the authors believe increased the likelihood of a pathologic fracture, such as size and extent of the lesion, history of progressive pain, and activity level of the patient.
Abstract: The authors presented a case report of a patient presenting with heel pain symptoms and physical findings similar to those associated with a heel spur syndrome. With a standard x-ray, the presence of a simple bone cyst was evident. Although mainly reported in tubular bones, steroid injection therapy has been successful and appears to be replacing surgical curettage and packing as the preferred choice of treatment in many cases. As more reports of the successful eradication of simple bone cysts of the calcaneus with steroid injections are reported, greater confidence for using it as a treatment choice for this particular lesion may be gained. The surgical approach in the patient presented here was chosen because of factors that the authors believe increased the likelihood of a pathologic fracture, such as size and extent of the lesion, history of progressive pain, and activity level of the patient. The larger body weight and the resulting stress of the patient more likely to present with a calcaneal cyst may also be factors to consider.
TL;DR: The authors present a modification of the Lapidus procedure that uses well established internal fixation principles and may provide correction of positional deformities of the first metatarsal while offering significant structural stability to the medial column.
Abstract: Fusion of the first metatarsocuneiform joint may provide correction of positional deformities of the first metatarsal while offering significant structural stability to the medial column. The authors present a modification of the Lapidus procedure that uses well established internal fixation principles.
TL;DR: It is proposed that osteochondritis dissecans lesions almost always occur on the convex surface of a joint because of a convergence of impaction forces.
Abstract: The authors present a review of the literature concerning the pathogenesis, diagnosis, and treatment of osteochondral defects of the lower extremity. A case of bilateral osteochondritis dissecans of the first metatarsophalangeal joint in a 43-year-old female is presented, including surgical treatment with 1- and 3-year follow-up examinations. The correlation between articular damage to the first metatarsal head and concomitant hallux limitus and hallux rigidus is discussed. The authors also propose that osteochondritis dissecans lesions almost always occur on the convex surface of a joint because of a convergence of impaction forces.
TL;DR: The author reviews shoe alternatives' characteristics and proper fit and the concept of foot risk categories is explained and appropriate shoe selections are discussed.
Abstract: The proper prescription and utilization of therapeutic footwear is crucial to successful prevention of diabetic foot complications. The author reviews shoe alternatives' characteristics and proper fit. The concept of foot risk categories is explained and appropriate shoe selections are discussed.
TL;DR: Statistical analysis revealed foot pressure characteristics as measured with a Electrodynogram during walking and running to alter significantly when using a treadmill, more pronounced for walking than for running.
Abstract: Biomechanical foot function as expressed by the duration of successive ground contact phases and by dynamic variables, such as the peak pressure on different parts of the foot, their respective loading rate, and duration, is compared for two walking and running conditions: overground on a 20-m walkway and on a treadmill Statistical analysis revealed foot pressure characteristics as measured with a Electrodynogram during walking and running to alter significantly when using a treadmill The differences were more pronounced for walking than for running During walking, loading of the forefoot tends to last longer (longer propulsion phase) on a treadmill Loading rate is decreased for the whole foot during either walking or running Maximum heel pressure is diminished for walking but increased during running on a treadmill Moderate variations of treadmill velocity were shown to have no significant influence on the measurements
TL;DR: The authors present the technique and emphasize the importance of preoperative assessment in predicting the results that should reasonably be expected by the patient, especially in the presence of any peroneal tendon pathology.
Abstract: A retrospective review of 20 patients who had undergone a peroneal regrooving surgical technique for chronic subluxing peroneal tendons was conducted. The design of the study was based subjectively on a questionnaire completed by the patients and objectively on a physical examination of all the patients included in the study. The authors present the technique and emphasize the importance of preoperative assessment in predicting the results that should reasonably be expected by the patient, especially in the presence of any peroneal tendon pathology.
TL;DR: A review of the diagnosis and treatment of extrapulmonary M. tuberculosis, with special emphasis on peripheral skeletal tuberculous osteomyelitis, is presented.
Abstract: Mycobacterium tuberculosis is a disease that is being reported much more frequently in the literature, primarily because of the rapid increase in severely immunocompromised patients, but also because of the development of multiple drug-resistant tuberculosis strains. Extrapulmonary M. tuberculosis is also reportedly on the rise, and may manifest itself at a number of sites in the body, including the peripheral skeleton. It is important to recognize peripheral tuberculosis osteomyelitis early because early treatment can effectively eliminate long-term morbidity. The authors present a review of the diagnosis and treatment of extrapulmonary M. tuberculosis, with special emphasis on peripheral skeletal tuberculous osteomyelitis. A case study involving peripheral skeletal tuberculous osteomyelitis in the foot is presented.
TL;DR: The authors discuss fractures of the posteromedial process of the talus and the surgical approach for open reduction of these injuries is detailed.
Abstract: The authors discuss fractures of the posteromedial process of the talus. The surgical approach for open reduction of these injuries is detailed.
TL;DR: A long-term retrospective study on a plantar fascial release surgery performed on patients with recalcitrant plantar heel pain, all of whom were unresponsive to conservative therapy, is presented.
Abstract: The author reviews the literature for the possible etiology and the conservative and surgical treatment alternatives for mechanically induced plantar heel pain. A long-term retrospective study on a plantar fascial release surgery performed on patients with recalcitrant plantar heel pain, all of whom were unresponsive to conservative therapy, is presented.