1998 William J. Stickel Gold Award. The effects of extrinsic muscle forces on the forefoot-to-rearfoot loading relationship in vitro. Tibia and Achilles tendon

The effects of muscular activity on the distribution of forces under the foot, as well as within the foot, are of great importance for determining the mechanisms of foot pathologies. Limited data exist concerning muscle forces during the gait cycle and the effects of muscle forces conveyed to the ground-reactive forces of the foot. The authors developed a cadaveric loading system to determine the effects of force applied to the Achilles tendon on the forefoot-to-rearfoot loading relationship in eight cadaveric specimens. The study indicated that, during axial loading of the tibia, force was inherently transferred from the rearfoot to the forefoot. However, the observed forefoot-to-rearfoot loading relationship did not match the predicted loading relationship from a rigid-body diagram, as would be observed in a class I lever. The results indicated that, as the force was increased on the Achilles tendon, the change in loads on the forefoot and rearfoot was not linear. Specimens with calcaneal inclination angles greater than 20 degrees demonstrated a more linear increase as compared with those with inclination angles less than 20 degrees.

1998 William J. Stickel Silver Award. Mechanically assisted, delayed primary closure of diabetic foot wounds

The authors evaluated the time to healing and prevalence of complications in patients undergoing mechanically assisted, delayed primary closure of diabetic foot wounds compared with a similar population who received standard wound care. A total of 55 patients were enrolled for study, with 25 in the experimental group and 30 in the control group. Patients in the experimental (stretch) group underwent mechanically assisted primary closure of their wounds using a skin-stretching device. There was no difference between the stretch and control groups with regard to any descriptive characteristics, including wound chronicity. Although the wounds were over three times as large on average in the stretch group (P < .001), the stretch group reached full epithelialization approximately 40% sooner than the control group (26.4 +/- 16.0 versus 42.5 +/- 19.9 days; P < .002). Eighty-eight percent of patients in the stretch group experienced wound dehiscence, at a mean time of 1.8 +/- 0.6 weeks following mechanically assisted closure. However, patients who experienced dehiscence in the stretch group healed significantly faster than patients in the control group (27.4 +/- 16.7 versus 42.5 +/- 19.9 days; P < .007). The results of this study suggest that mechanically assisted closure of diabetic foot wounds may result in reduced healing time compared with healing by secondary intention.

The past, present, and future of podiatric biomechanics

The author places the history and development of podiatric biomechanics, as well as current thinking about its underpinnings and future, in the context of a theoretical framework drawn from the philosophy and sociology of science. This analysis sets the stage for an exploration of the possible future directions in which podiatric biomechanics could develop.

1997 William J. Stickel Silver Award. The anti-inflammatory action of locally injected ketorolac

Locally injected steroids are used to treat inflammatory conditions, in spite of the complications associated with their use. Ketorolac tromethamine, an injectable nonsteroidal anti-inflammatory drug, has not previously been evaluated for treatment of musculoskeletal inflammatory conditions via local administration. Eighty Achilles tendons of rabbits were traumatized in a controlled fashion. At the time of trauma, a single dose of ketorolac (1, 3, or 5 mg/kg) or normal saline was administered peritendinously. Three days later, the tendons were harvested and examined histologically to evaluate the degree of inflammation present in the tissue. No statistically significant difference was found between the experimental and control groups. The authors conclude that locally injected ketorolac does not prevent the onset of an inflammatory process.

1997 William J. Stickel Gold Award. Morphological and biochemical properties of metatarsophalangeal joint cartilage

Although there is sparse information concerning the properties of foot-joint cartilages, knowledge of the morphology and biochemistry of these cartilages is important in the study of changes that occur in the development of osteoarthritis. Normal first and fifth metatarsophalangeal joints were chosen for comparison because of the difference between these two joints in the prevalence of osteoarthritis, particularly with advancing age. The authors' study shows that there is no age-related decrease in articular-cartilage thickness; however, there is an age-related decrease in the chondrocyte density in the superficial zone in both joints. There is, however, a difference between the two joints in the level of expression of matrix-degrading enzymes. This difference may indicate differences in specific chondrocyte activity that precedes or accompanies the development of osteoarthritis or other degenerative morphological changes.

1997 William J. Stickel Bronze Award. Comparison of strategies for reducing pressure at the site of neuropathic ulcers

Few scientific data are available on the effectiveness of commonly used modalities for reducing pressure at the site of neuropathic ulcers in persons with diabetes mellitus. The authors' aim was to compare the effectiveness of total contact casts, half-shoes, rigid-soled postoperative shoes, accommodative dressings made of felt and polyethylene foam, and removable walking casts in reducing peak plantar foot pressures at the site of neuropathic ulcerations in diabetics. Using an in-shoe pressure-measurement system, data from 32 midgait steps were collected for each treatment. There was a consistent pattern in the devices' effectiveness in reducing foot pressures at ulcer sites under the great toe and ball of the foot. Removable walking casts were as effective as or more effective than total contact casts. Half-shoes were consistently the third most effective modality, followed by accommodative dressings and rigid-soled postoperative shoes.

A personal revolution in the development of clubfoot correction

This article presents the author's experience of having worked in London, England, under Denis Browne, whose method of treating equinovarus in the newborn involved manipulation of the baby feet until full correction had been achieved at the very first visit. The feet were then strapped to the sole plates of the Denis Browne splint, which ensured that the baby's normal kicking action maintained mobility at the subtalar joints and also a basic plantigrade posture. When he transferred to India, the author found a large population of children who had been born with talipes equinovarus, but who had never had treatment. He worked at obtaining correction without strong manipulation, using serial plaster casting followed by Denis Browne's splints. His personal reactions to the problems and the merits of the two methods forms the subject of this article.

History of residency selection issues in podiatric medicine

Issues related to residency interview and selection processes have concerned the podiatric medical profession for nearly 20 years. This article presents a chronology and summary of efforts undertaken to address these problems, including a discussion of legal ramifications of residency approval requirements related to establishment of a uniform notification date and participation in a resident-matching service.

The residency in podiatric medicine. A brief historical overview

The author provides a general overview of the development of postgraduate residency training in podiatric medicine since 1956. The evolution of residency standards and requirements of the Council on Podiatric Medical Education are discussed. Integration of specialty organizations in the residency evaluation process also are reviewed. The author notes that the current positive number of entry level residency positions available to graduates of colleges of podiatric medicine may be a dubious facade in view of increasing college enrollments and the potential conversion of rotating podiatric residencies to residencies in primary podiatric medicine. He cautions the profession not to overlook these events as it considers the development of the PGY-1 concept in the restructuring of entry level residency training.

Inhalation of nail dust from onychomycotic toenails. Part I. Characterization of particles. 1984

Nail dust particles were analyzed by scanning electron microscopy for size and topography. The percentage of "fines" that could be inhaled and deposited in the alveoli and bronchioles were determined by quantitative particle size analysis. Distribution representing the largest total mass was graphed between 1 and 2 microns. The authors found that 86% of nail dust would reach the bronchioles and alveoli, and 31% could be expected to deposit in these areas.

Nail dust aerosols from onychomycotic toenails. Part II. Clinical and serologic aspects. 1984

The podiatric procedure of burring hyperkeratotic fungal infected toenails results in large quantities of nail dust aerosols. An extremely large percentage (31%) of podiatrists who were analyzed for immunoglobulin E (IgE) by antibody radioimmunoassay were found to have abnormally high levels. Incidence of precipitin antibodies to Trichophyton rubrum in sera of those in practice from 0 to 15 years was 23%, and those in practice 16 years or more was 29%. In this study, podiatrists who were chronically exposed to nail dust aerosols after years of practice presented with symptoms of conjunctivitis, rhinitis, asthma, coughing, hypersensitivity, and impaired lung function.

[Activities of the podiatric group in the Lublin orthopedic departments under the direction of Professor Stanisław Piatkowski]

The development of podology in the Lublin society as well as the personal achievements of prof. Stanisław Piatkowski have been presented. The originated in the 60-ies activities concerning podology have included scientific research, cooperation with shoe industry institutions, and wide prevention of the foot health in the Lublin region.

Podiatry: a medical care specialty in quest of full professional status and recognition

Podiatry as a medical specialty has received little sociological attention. This omission leaves a sizeable gap in our understanding of the total health care system. Given the functional importance of this speciality and the growing need for the services of podiatrists this report represents an attempt to increase our knowledge in this area. The paper attempts to fill that gap by presenting a discussion of the development of podiatry as a health profession; documenting the educational and political development and attempting to explain the reasons which have inhibited the process of professionalization. Our findings suggest that podiatry as a profession has been unable to attain full autonomy over its anatomical area of expertise and this along with other factors has prevented podiatry from attaining full professional status and recognition.