Medicaid Coverage for Routine Foot Care.

Background: Despite national and international guidelines supporting podiatric services as a means of prevention for lower-extremity complications, especially in at-risk individuals, current coverage for these services under the US Medicaid program is not universal. The vast differences between state Medicaid programs regarding reimbursable foot care services is confusing and potentially serves as a barrier for the most vulnerable populations to receive preventative services. This article provides a brief discussion of "routine" podiatric services from a clinical perspective and provides a review of state Medicaid programs including optional services (eg, podiatric coverage).

Updates in Tendinopathy Treatment Options.

Tendinopathy is a common but disabling condition. The term describes a complex, multifaceted pathology of the tendon characterized by pain, decreased function, and reduced exercise tolerance. Tendinopathy accounts for up to 30% of general practice musculoskeletal consultations.

The effect of torsional shoe flexibility on gait and stability in children learning to walk.

Purpose: To examine the effects of different torsional flexibilities of shoes on gait and stability in children who are newly walking.

Methods: Twenty-five children walking 5 months or less were evaluated barefoot and in 4 shoes with different torsional flexibilities (UltraFlex, MidFlex, LowFlex, and Stiff). Gait pattern was assessed using GaitMatII.

Human papilloma virus type 69 identified in a clinically aggressive plantar verruca from an HIV-positive patient.

Background: Verrucae are caused by infection of epidermal keratinocytes by human papilloma virus (HPV). Although there are currently more than 100 known types of HPV, certain lesions are consistently caused by infection with one or a few types. Recent studies have identified the presence of unusual HPV types in anogenital and cervical condylomata (warts) of patients infected with human immunodeficiency virus (HIV).

Ketocazole as an adjunct to finasteride in the treatment of androgenetic alopecia in men.

Dihydrotestosterone (DHT) binding to androgen receptors (AR) in hair follicles is commonly accepted as the first step leading to the miniaturizing of follicles associated with androgenetic alopecia (AGA). Testosterone is converted to DHT by the enzyme 5alpha-reductase. Finasateride a 5alpha-reducase inhibitor blocks the production of DHT and is currently used to treat AGA.

Peripheral vascular considerations.

Arterial pathology of the lower extremity is common in the elderly. It has been the author's experience that most arterial pathology affecting the foot is caused by peripheral arterial occlusive disease, emboli, or infection. One of the most important factors determining whether healing will take place is the adequacy of the arterial blood supply.

Irradiation as adjunctive treatment of diffuse pigmented villonodular synovitis of the foot and ankle prior to tumor surgical excision.

In this manuscript, the author undertakes a brief description of the diffuse form of pigmented villonodular synovitis and provides a recommendation of pre-surgical tumor irradiation as adjunctive treatment for reduction of recurrence and better preservation of function of the lower extremity.

Effect of the low-Dye strap on pronation-sensitive mechanical attributes of the foot.

The low-Dye strap is used routinely to temporarily control pronation of the foot and, thereby, to diagnose and treat pronatory sequelae. However, the exact biomechanical effects of this strapping technique on the foot are not well documented. The main purpose of this study was to establish the specific mechanical effects of the low-Dye strap on the pronatory foot.

Botanicals and dietary supplements in diabetic peripheral neuropathy.

Background: Many persons use botanicals and dietary supplements for chronic conditions that do not respond to traditional Western medications. Tricyclic antidepressants, a common treatment option for diabetic neuropathy, can have many side effects and are a poor choice in certain populations (eg, the elderly). As such, patients might turn to botanicals and dietary supplements, not realizing that these products are not well regulated.

Plantar fasciitis: a new experimental approach to treatment.

Plantar fasciitis has been and remains one of the most common pathologic conditions of the lower extremity. Patients diagnosed with plantar fasciitis are treated conservatively with various degrees of success. This article presents a review of the literature pertaining to treatment of plantar fasciitis as well as introduces a modified experimental footplate, which potentially may improve the outcome and shorten the time of therapeutic regimen.

Reduction of peak pressure on the forefoot with a rigid rocker-bottom postoperative shoe.

An ideal postoperative shoe should be comfortable to wear and protect the foot during recovery from surgery or injury. Protection is assumed to be related to peak pressure and force-time integral under the foot. This study compared a commonly used postoperative shoe with a new postoperative shoe that incorporates a rigid sole with an 11 degrees rocker bottom.

What future direction should podiatric biomechanics take?

With researchers from many scientific and medical disciplines currently devoting countless hours trying to solve the mechanical mysteries of the foot, it is important that the proper direction for research be established. The author of this article believes that one of the most important directions in podiatric biomechanics will focus on the development of accurate models of the human foot and lower extremity. Accurate models will be useful because they provide relatively accurate predictions of the magnitudes of loading forces that occur in the structural component of the human foot and lower extremity during weight-bearing activities.

Subtalar joint axis location and rotational equilibrium theory of foot function.

A new theory of foot function based on the spatial location of the subtalar joint axis in relation to the weightbearing structures of the plantar foot is proposed. The theory relies on the concept of subtalar joint rotational equilibrium to explain how externally generated forces, such as ground reaction force, and internally generated forces, such as ligamentous and tendon tensile forces and joint compression forces, affect the mechanical behavior of the foot and lower extremity. The biomechanical effect of variations among individuals in the spatial location of the subtalar joint axis are explored, along with their clinical consequences, to offer an additional theory of foot function, which may improve on existing podiatric biomechanics theory.

Prophylaxis of climbers for prevention of embolic accidents.

The development of deep venous thrombosis and the ensuing secondary complications of pulmonary embolism, disseminated intravascular coagulation, and stroke may be produced in high altitude climbers as a result of acclimatization to altitude. To prevent these serious disorders, investigation for predisposing risk factors and consideration of anticoagulative therapy should be considered.

Hemophilic arthropathy: considerations in management.

The authors evaluate nonsurgical and surgical approaches to treating patients with hemophilic arthropathy and review the functional and economic limitations imposed on treating these patients. Indications for surgery are discussed and a case study that incorporates both conservative and surgical management options is presented. While the advent of factor replacement therapy has dramatically changed the course of treatment and prognosis for patients with hemophilia, the authors argue that the economic burden of treating these patients is still very high.

Transcutaneous electrostimulation: emerging treatment for diabetic neuropathic pain.

Three independent studies utilizing transcutaneous electrical nerve stimulation to relieve diabetic peripheral neuropathic pain were reviewed. The proprietary equipment, an H-wave machine, administered all electrotherapy. The first two studies assessed the efficacy of electrotherapy alone and electrotherapy with amitriptyline.

Effectiveness of a nonrinse, alcohol-free antiseptic hand wash.

This study evaluated the efficacy of a novel surfactant, allantoin, and benzalkonium chloride hand sanitizer using the US Food and Drug Administration's method for testing antiseptic hand washes that podiatric physicians and other health-care personnel use. The alcohol-free product, HandClens, was compared with an alcohol-based product, Purell. Independent researchers from the California College of Podiatric Medicine conducted the study using 40 volunteer students from the class of 2001.

Plantar verrucae in patients with human immunodeficiency virus. Clinical presentation and treatment response.

Several previous studies have yielded data showing that plantar and other cutaneous verrucae follow a more aggressive course in patients infected with human immunodeficiency virus (HIV) than in uninfected individuals. A pilot study was undertaken to identify trends in a sample population that would support this characterization of plantar verrucae in HIV+ patients and to determine whether there are differences in treatment response between HIV+ and HIV- patients. The results show that the HIV+ patients in the study presented with a significantly greater number and total area of lesions than did the HIV- patients.

Barriers to podiatric care among diabetic patients in the San Francisco Bay area.

This study investigates the provision of general medical and foot care, the barriers to access for foot care, and the awareness of foot risks in an urban diabetic population. A survey composed of 26 questions was mailed to 2375 diabetic patients in the San Francisco Bay area who are members of the American Diabetes Association (ADA). Three hundred ninety-two surveys were returned for a response rate of 16%.

Techniques for obtaining specimens for culture to confirm onychomycosis.

A study was conducted to determine whether fungal culture results in cases of suspected onychomycosis differ depending on the location from which the specimen is obtained. Specimens were taken from the nail plate, subungual debris, and nail bed in 30 patients with clinical evidence of onychomycosis. Cultures from the subungual debris were more likely to be positive for dermatophytes, nondermatophytic molds, and yeasts than were cultures from the deeper nail bed or nail plate.

Elliptical fourier analysis of symphyseal shape in great ape mandibles.

The midsagittal profile of the mandibular symphysis has served as both a taxonomic marker and a phylogenetically salient character in debates over hominoid evolution. Nevertheless, the utility of symphyseal shape as an informative attribute for paleobiological reconstructions is suspect. Quantification of shape variation has proven to be particularly problematic; it has long been recognized that conventional linear measurements (and the indices derived from them), while replicable, summarize aspects of shape very poorly because of the vast amount of contour information that is lost in the process.

Use of small cannulated screws for fixation in foot surgery.

Use of cannulated bone screws, as compared with use of traditional bone screws, has been reported to decrease surgical time, allow for more precise screw placement, and reduce sources of error. Cannulation of the smaller-size screws that are routinely used in foot surgery has not been available until the last few years. This article reports on the use of the small cannulated screws manufactured by Alphatec Manufacturing, Inc (Palm Desert, California).

Chondromyxoid fibroma of the fourth metatarsal.

Chondromyxoid fibroma is a rare benign tumor that is typically found in the metaphyseal ends of long tubular bones, such as the tibia. The authors describe a case of this neoplasm occurring in the foot. Treatment included complete resection with reconstruction using an autogenous fibular bone graft.