Position of the first ray and motion of the first metatarsophalangeal joint.

The authors present a quantitative analysis of the effect that first ray position has on motion of the first metatarsophalangeal joint. A goniometer was constructed to measure the degrees of first metatarsophalangeal joint dorsiflexion with the first ray in three positions: weightbearing resting position, dorsiflexed 4 mm from the weightbearing resting position, and dorsiflexed 8 mm from the weightbearing resting position. First metatarsophalangeal joint dorsiflexion decreased 19% as the first ray was moved from the weightbearing resting position to 4 mm dorsiflexed, 19.

Podiatric medical education and practice. 1960s to the 21st century.

An overview of the development of medical and podiatric medical education in the US is provided. Beginning with the 1910 Flexner Report in medicine and moving to the 1996 Educational Enhancement Project of podiatric medicine, major changes have taken place that have made podiatric medicine a profession quite comparable to medicine. This is most obvious in the education and training process.

The hallucal interphalangeal sesamoid.

The hallucal interphalangeal sesamoid is considered by some to represent an anatomical rarity that possesses little clinical significance. However, the location of this seemingly innocuous sesamoid bone directly inferior to the hallucal interphalangeal joint of the hallux is associated with the development of several important anatomical, biomechanical, and clinical pathologies. The authors present a review of the literature regarding the location, shape, ontogeny, and surgical management of the hallucal interphalangeal sesamoid.

Stepwise approach to hallux limitus. A surgical perspective.

Successful outcomes in hallux limitus surgery are still difficult to reproduce consistently. An attempt is made to improve these results by presenting a systematic approach to surgical reduction of this deformity by isolating several important steps. Emphasis is placed equally on both the soft-tissue and osseous structures.

Anesthesia blocks of the lower extremity. Comparing the Biojector with needle and syringe.

Podiatric surgical procedures frequently involve administration of preoperative local anesthesia, and because of the nature of these blocks, it is believed that needle-free injection could greatly enhance this aspect of clinical practice. The object of the study was to determine if needle-free injections with the Biojector were equivalent to needle and syringe injections for ankle, Mayo, neuroma, hallux, and digital anesthetic blocks. The results indicate that needle-free injection with the Biojector is equal to needle and syringe for some anesthesia blocks.

Congenital digital deformities.

Congenital digital deformities are often challenging to treat. Several deformities and their treatments are discussed. Familiarity with the deformities is important because early treatment is often necessary for a successful outcome.

Digital implant arthroplasty.

Digital implant arthroplasty offers the foot surgeon an excellent alternative to resection arthroplasty and arthrodesis for the treatment of symptomatic digital deformities. The authors discuss the various types of implants used in the toes. The indications, contraindications, and complications of this procedure are reviewed.

Functional significance of torsion of the tendon of tibialis posterior.

The authors describe the anatomical necessity and functional significance of torsion of the tendon of tibialis posterior. A wooden model of the right lower extremity has been constructed which includes representations of the ankle, subtalar, and oblique midtarsal joints. The model is used to show that the presence of torsion within the tendon of tibialis posterior eliminates the need for any longitudinal slippage between individual tendon fibers during triplane movement of the joints of the lower extremity.

Onychomycosis.

The prevalence and clinical types of onychomycosis and diagnostic methods are reviewed in this article. The need for correct identification of the causative organism is emphasized. The use of oral and topical therapeutic agents is outlined, with specific emphasis on relevant research data and potential side effects of these agents.

Torsion of the human Achilles tendon.

An understanding of torsion in the human Achilles tendon would assist in more efficient percutaneous tendon lengthening procedures. Tendoachilles torsion was measured on 16 human cadaver specimens. Significant torsion was found in all tendons studied.

Torsion of the tendon of tibialis posterior.

The authors present a previously undescribed torsion located within the tendon of tibialis posterior. The musculotendinous unit of tibialis posterior was isolated from 17 lower extremities of cadavers. A small goniometer was constructed and used to quantify the degree of torsion located within each tibialis posterior tendon.

History and epidemiology of acquired immune deficiency syndrome.

Acquired immune deficiency syndrome (AIDS) and human immunodeficiency virus (HIV) were first noticed in the US in 1981 and continue to spread today. Initially a disease associated completely with homosexual males, it is increasing in incidence and prevalence among heterosexual males and females, particularly, but not limited to, injection drug users. This disease is much more prevalent among blacks and Hispanics.

Metallic implants used in foot surgery.

Metallic materials have provided a tremendous advantage in the current treatment of many surgical specialties. Further studies on the long-term effects at both local and distant sites of implantation are essential. As this field continues to expand, the podiatric applications of these new devices will grow exponentially.

Clinical experience with two-component first metatarsal phalangeal joint implants.

The development of the two-component implant systems has generated considerable interest over the past 5 years. It is important to critically document and record the clinical experiences with these devices as they occur. The authors present an objective evaluation of their early findings and comment on possible recommendations for the future.

Biofix fixation techniques and results in foot surgery.

Biofix absorbable rods have been used for internal fixation for 10 years, and one of its most utilized applications has been osteotomies of the first metatarsal. This study evaluates 59 procedures on 49 patients completed over a 3-year period, using the 2.0-mm.

Intermetatarsal neuroma.

Interdigital neuroma, more classically referred to as Morton's neuroma, is considered one of the most common nerve problems affecting the foot. In this article, information regarding intermetatarsal neuroma is presented according to both a historical and clinical perspective. In addition, the author presents his own research on neuromas and describes conservative and surgical approaches in a logical format.

Therapeutic footwear for patients with diabetes.

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.

Wound dressings. A comparison of classes and their principles of use.

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.

Nutrition and wound healing.

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.

Absence of the posterior tibial artery. A case report.

In the case presented, the arteriograms showed that the peroneal artery had replaced the absent posterior tibial artery. The peroneal artery coursed medially below the ankle joint to become the plantar arteries of the foot. This has been previously described in the medical literature.

Distraction systems for ankle arthroscopy.

It is clear that for most of the routine pathology addressed with ankle arthroscopy, including most talar dome transchondral fractures, manual distraction (or none at all) is all that is necessary to successfully complete the procedure. There is little need to add the expense and potential complications associated with some distraction systems. However, some cases involve pathology or surgical techniques that either would be better addressed with distraction or absolutely demand distraction.