Toward a philosophy of podiatric medical education.

Philosophy offers us the ability to think logically and critically about any field of knowledge, podiatric medical education included. By proceeding in an orderly manner, the growth of the profession will be ensured as long as the thinkers are willing to be truthful. Ironically, conformity is not a necessity and a diversity of philosophies is actually encouraged.

Primary care podiatric medicine and entry level residency. The new millennium.

The author presents the perspective that the nation's health care initiatives demand that greater attention be given to primary care providers. Inasmuch as the credibility of the podiatric medical profession must function in a health care environment dominated by allopathic and osteopathic physicians, the podiatric primary care initiative must be pursued within the guidelines and definitions for primary care that are present in all of mainstream medicine. The author argues that primary care podiatric medicine must establish itself as a specialty that stands as an equal along side of the other recognized specialties in podiatric medicine.

Acquired fibrokeratoma of the heel.

Acquired fibrokeratomas traditionally have been classified by both appearance and anatomical location. They are benign, solitary lesions that characteristically involve the digits of the hands and feet. The authors present a case with unusual involvement of the plantar surface of the heel.

College of Podiatric Medicine and Surgery in Des Moines.

The College of Podiatric Medicine and Surgery was established in 1981 as a fully integrated college of the University of Osteopathic Medicine and Health Sciences, Des Moines, Iowa, becoming the only school in the profession to be part of an academic health science center. Thus, this college provides a unique opportunity for the students and the podiatric medical profession to receive a multidisciplinary education, preparing them for podiatric medical practice as an integral part of total health care.

Osteonecrosis secondary to internal fixation.

Allergies to metals as a cause of failure of joint prostheses has historically been a controversial issue. Loosening of a prosthesis may be due to trauma, infection of the surrounding area, or a faulty implantation of the device. However, cases of loosening of the device do occur without any history of the above criteria.

Smoking and peripheral vascular disease. Podiatric medical update.

Although there is strong evidence that cigarette smoking is perhaps the major risk factor associated with peripheral occlusive vascular disease, there still appears to be little indication that clinicians in podiatric medicine and patients recognize this. When smoking is combined with other risk factors such as diabetes mellitus, the probability of developing peripheral arterial disease is greatly increased. In addition, smoking appears to accelerate the natural history of the process of atherogenesis and thrombosis.

Near fatal systemic toxicity from local injection of podophyllin for pedal verrucae treatment.

An extremely rare case of systemic podophyllin toxicity from local injection is presented with a review of the literature. There is only one other known similar case reported in the medical literature world wide. Clinical and pathologic findings will be discussed.

Clinical determination of the linear equation for the subtalar joint axis.

The authors present a methodology to measure the frontal plane angular and linear displacement and the transverse plane angular displacement of subtalar joint movement. This method is combined with a modification of the Kirby method for determining the transverse plane projection of the subtalar joint axis onto the plantar foot. A mathematical model is then used to construct the subtalar joint axis into a three-dimensional linear equation.

Deep fascia of the foot. Anatomical and clinical considerations.

The deep fascia of the foot lies beneath the subcutaneous tissue and surrounds the intrinsic foot muscles. Depending on its location, the composition of the deep fascia varies. In some areas it is thin, while in other areas it is greatly thickened to form retinacula and the plantar aponeurosis.

Recombinant alpha-interferon and verruca plantaris. A review of the literature.

The authors review the literature and report the mechanisms of action, chemical properties, pharmacokinetics, adverse effects, and clinical studies of recombinant alpha-interferon. The authors believe that clinical trials should be performed with recombinant alpha-interferon therapy on verruca plantaris to prove or disprove the effectiveness of interferon as a potential treatment modality for these commonly encountered lesions.

Modification of high-heeled shoes to decrease pronation during gait.

One of the reasons that high heels may contribute to the formation of halux valgus is that the wearers pronate during propulsion. This pilot study was performed to determine whether relocation of the heel under the counter of a fashion high-heeled pump could change the degree of pronation of the foot during the gait cycle. The authors report that more foot stability was experienced by the subjects when the center of the heel was offset between 2 and 4 mm medial to the center of the heel counter.

Intramuscular hemangioma. Case report and literature review.

A case was presented in which a 28-year-old male presented with tenderness and stiffness in the posterior muscle group of his right leg. The patient's symptoms had been present intermittently for nearly 23 years. Recently, the pain had progressed to the point of limiting his normal daily activities.

Necessary dorsiflexion of the first metatarsophalangeal joint during gait.

Previous studies of first metatarsophalangeal joint range of motion have resulted in varying values for dorsiflexion of this joint. These values reflect assisted dorsiflexion of the first metatarsophalangeal joint, which has been believed to be the same value that would be obtained during the toe-off phase of gait. These values range from 60 degrees to 90 degrees.

Shock absorption.

Abnormal shock is a major cause of chronic and overuse injuries to all aspects of the lower extremity. The two major causes of abnormal shock are (1) decreased fat pad under the calcaneus and (2) dysfunction of the subtalar joint pronation mechanism during contact. Enough literature now exists to indicate that podiatrists should provide prophylactic therapy for patients that exhibit abnormal shock during contact before symptomatology in the lower extremity or spine exhibits itself.

Use of ceftazidime-impregnated polymethyl methacrylate beads in the treatment of Pseudomonas osteomyelitis.

Antibiotic-impregnated polymethyl methacrylate beads have been used in other countries to treat osteomyelitis. The drug of choice for this has historically been gentamicin. The authors have chosen ceftazidime to treat iatrogenic Pseudomonas aeruginosa osteomyelitis in rabbit femurs.

The conservative treatment of adult flexible flatfoot.

The purpose of this article is to attend to the nonsurgical treatment of adult symptomatic flexible flatfoot and its sequelae. Other articles in this issue thoroughly discuss the etiology, radiographic changes, and nonconservative treatment of the congenital and acquired flatfoot presented in children and adults.

Dorsal bunions: a review.

The authors present a review of the literature on dorsal bunion and describe its classification, etiology, predisposing factors, and different methods of treatment. The deformity is functionally limiting during ambulation and cosmetically undesirable for the patient. It is a progressively disabling deformity that requires surgical management.

Effects of fibrin sealant on the fixation of porous titanium and pyrolytic carbon implants.

The authors investigated the potential role the fibrin sealant system may portray in the fixation of osseous implants. The application of a layer of fibrin did not interfere with the fixation of osseous implants of either pyrolytic carbon or Biolite-coated porous titanium. A greater percentage of tissue ingrowth was observed in the porous titanium implants in the presence of the fibrin sealant system; however, no significant difference in the ultimate interfacial shear stress was observed.

Motion of the first metatarsophalangeal joint.

The analysis of motion of the first metatarsophalangeal joint in this study demonstrates the character of motion about this joint. Four instantaneous centers of rotation were calculated in the first metatarsal head that formed an arc encircling an area of increased stress patterns. The joint motion is made up of rolling, sliding, and compression.

Experience as a factor in the efficacy of the surgical scrub.

The efficacy of the preoperative surgical scrub has been studied extensively throughout the years. However, to the best of the authors' knowledge, this is the first comparative study between surgeons, residents, operating room personnel, and medical students. This paper demonstrates the efficacy of the surgical scrub and the differences between these groups, as well as presents a simple method of monitoring the effectiveness of the surgical scrub in vivo.