The Podiatric Medical Profession: A Gender Comparison.

The number of women in podiatric medicine and surgery has increased steadily over the past 4 decades; however, there appears to be a large and continued gender gap with respect to representation in academic medicine and other positions of power. National and state level organizational data were obtained from multiple podiatry professional societies to evaluate the rate at which women achieved leadership roles within the podiatric profession over time. A secondary questionnaire was also developed and electronically mailed to 8684 doctors of podiatric medicine to help capture additional leadership information and to provide further insight into the trends observed. The response rate was 26% (2276/8684). Female representation in academia, research/publications, most leadership positions, and board certifications has increased over time, but at a slower rate than the number of women entering the profession. We observed a decreasing trend of females completing fellowships, speaking at national meetings, becoming residency directors, and receiving American College of Foot and Ankle Surgeons- and American Podiatric Medical Association-sponsored grants/awards. Based on the survey results, female podiatric physicians were more likely to be single, have fewer children, spend more time in a clinical setting, be less satisfied with work, and experience higher work stress levels than their male colleagues. Of the female respondents, 73% described experiencing gender discrimination at some point in their career, and 42% reported experiencing sexual harassment, compared with only 6% and 5% of men, respectively. There continues to be a gender gap in leadership roles, which may be explained partially by work/life balance issues, gender discrimination, and other issues.

American College of Foot and Ankle Surgeons Clinical Consensus Statement: Diagnosis and Treatment of Adult Acquired Infracalcaneal Heel Pain.

Adult acquired inferior calcaneal heel pain is a common pathology seen in a foot and ankle practice. A literature review and expert panel discussion of the most common findings and treatment options are presented. Various diagnostic and treatment modalities are available to the practitioner. It is prudent to combine appropriate history and physical examination findings with patient-specific treatment modalities for optimum success. We present the most common diagnostic tools and treatment options, followed by a discussion of the appropriateness of each based on the published data and experience of the expert panel.

Comparing the Knotless Tension Band and the Traditional Stainless Steel Wire Tension Band Fixation for Medial Malleolus Fractures: A Retrospective Clinical Study.

The traditional stainless steel wire tension band (WTB) has been popularized for small avulsion fractures at the medial malleolus. Despite the tension band principle creating a stable construct, complications continue to arise utilizing the traditional stainless steel WTB with patients experiencing hardware irritation at the tension band site and subsequent hardware removal. Coupled with hardware irritation is fatigue failure with the wire. The goal of this investigation was to retrospectively compare this traditional wire technique to an innovative knotless tension band (KTB) technique in order to decrease costly complications. A total of 107 patients were reviewed with a minimum follow-up of 1 year. Outcome measures include descriptive data, fracture classification, results through economic costs, and fixation results (including hardware status, healing status, pain status, and time to healing). The KTB group had a 13% lower true cost as compared to the WTB group while the fixation results were equivocal for the measured outcomes. Our results demonstrate that the innovative KTB is comparable to the traditional WTB while offering a lower true cost, an irritation free reduction all without the frustration of returning to the operating room for additional hardware removal, which averages approximately to $8,288.

Fully Threaded Versus Partially Threaded Screws: Determining Shear in Cancellous Bone Fixation.

Many researchers have studied and compared various forms of intraosseous fixation. No studies have examined the effects of shear through stiffness and failure strength of a fully threaded versus a partially threaded screw. Our hypothesis was that the fully threaded lag screw technique would provide greater shear strength and resistance. Thirty-six synthetic sawbone blocks were used to test screw fixation. In group 1 (n = 9), 2 blocks were fixed together using a fully threaded 4.0-mm stainless steel cancellous bone screw and the lag technique. In group 2 (n = 8), 2 blocks were fixed together using the standard manufacturer-recommended method for inserting 4.0-mm partially threaded stainless steel cancellous bone screws. The constructs were then mechanically tested. Shear was applied by compressing each construct at an axial displacement rate of 0.5 mm/s until failure. The fully threaded screw had a significantly greater (p = .026) initial stiffness (106.4 ± 15.8 N/mm) than the partially threaded screw (80.1 ± 27.5 N/mm). The yield load and displacement for the fully threaded group (429.4 ± 11.7 N and 7.2 ± 0.35 mm) were 64% and 67% greater than those for the partially threaded screw group (261.4 ± 26.1 N and 4.3 ± 1.03 mm), respectively. The results of the present study have demonstrated the importance of a full-thread construct to prevent shear and to decrease strain at the fracture. The confirmation of our hypothesis questions the future need and use of partially threaded screws for cancellous bone fixation.

Treating segmental bone defects: a new technique.

Repair of segmental bone defects is an enormous challenge for foot and ankle surgeons. This report describes the case of an unusual technique for managing segmental bone voids about the ankle, namely the use of a cylindrical titanium cage packed with bone graft, and an intramedullary nail. The technique was successful at bridging a large segmental defect, and biopsy specimens procured from the length of the healed graft confirmed osseous consolidation.

Nonoperative treatment of bimalleolar equivalent ankle fractures: a retrospective review of 51 patients.

The purpose of this retrospective study was to determine the outcome of bimalleolar equivalent ankle fractures in patients who were treated nonoperatively. The charts of 214 patients with isolated Weber B (supination-external rotation pattern) fibula fractures were reviewed. Fifty-one patients met the inclusion criteria and were administered the American Orthopaedic Foot and Ankle Society Ankle and Hindfoot Functional Survey by telephone or personal interview. The average medial clear space was 5.09 mm; the average American Orthopaedic Foot and Ankle Society Ankle and Hindfoot Functional Survey score was 84.22. A medial clear space of 4, 5, 6, and 7 mm resulted in American Orthopaedic Foot and Ankle Society Ankle and Hindfoot Functional Survey scores of 90.22, 89.4, 72.0 and 63.17, respectively. Further analysis showed significant differences in American Orthopaedic Foot and Ankle Society Ankle and Hindfoot Functional Survey scores between the 4 mm medial clear space group and the 6 mm and 7 mm medial clear space groups; the 5 mm medial clear space group and the 6 mm and 7 mm groups. Our results suggest that medial tenderness and ecchymosis alone are not sufficient to meet operative criteria, a higher medial clear space on stress gravity views correlates with a lower American Orthopaedic Foot and Ankle Society Ankle and Hindfoot Functional Survey score, and that there are significant differences in American Orthopaedic Foot and Ankle Society Ankle and Hindfoot Functional Survey scores between groups with medial clear space 4 to 7 mm. ACFAS Level of Clinical Evidence: 2b.