Rate of Development of Hallucal Interphalangeal Degenerative Joint Disease After First Metatarsophalangeal Joint Arthrodesis: A Retrospective Radiographic Analysis.

The development of hallux interphalangeal joint (IPJ) arthritis after an arthrodesis of the first metatarsophalangeal joint has been established in the literature. However, the significance has not been well reported. A retrospective, radiographic review of patients who had undergone a first metatarsophalangeal joint arthrodesis was performed. The Coughlin classification for degree of arthritic degeneration, hallux abductus angle, and hallux interphalangeus angle were measured in 107 radiographs of 103 patients preoperatively and postoperatively. Postoperative angles were measured immediately following surgery at approximately 6 weeks, 3 months, 6 months, 12 months, and 24 months. We found that the hallux abductus angle had decreased in the patients postoperatively; however, the hallux abductus interphalangeus angle increased on average after first metatarsophalangeal fusion. The majority of patients started with a Coughlin classification I of the hallux IPJ, which remained unchanged over the postoperative period, with no statistically significant difference in IPJ degeneration in the patients with or without fusion of the first metatarsophalangeal joint. In addition, no patients had a symptomatic hallux IPJ postoperatively within our limited study period. Further prospective studies would be beneficial with longer follow-up times to assess IPJ degeneration following first metatarsophalangeal joint fusions. Levels of Evidence: Level III: Retrospective, comparative study.

What Is the Current Role and Factors for Success of the Journal Club in Podiatric Foot and Ankle Surgery Residency Training Programs?

The journal club (JC) is a traditional part of postgraduate medical education, although little has been written on its current role in podiatric surgical training programs. The goal of the present study was to determine how JCs are conducted and the factors associated with their success. Anonymous electronic surveys were distributed to all podiatric foot and ankle surgical training program directors in the United States with a valid e-mail address. A total of 202 surveys were initially e-mailed to training program directors, with a second and third round sent to those who did not respond. The eventual response rate was 47.5%. The variables associated with success included high faculty attendance, dissemination of articles in advance, and regularly scheduled meetings. Of the residency programs that responded, 39.0% provided some type of handout or supplemental session and 39.8% provided supplemental session or handouts regarding the process of critical review, epidemiology, or biostatistics. A structured review instrument or checklist was used to guide critical appraisal in 21.5% of the JCs, and 11.8% of the programs provided feedback to residents. The JC was perceived by residency directors to be valuable and worthy of maintaining. Residency directors perceived the following factors to be associated with a successful JC: faculty participation, a designated leader, mandatory attendance, dissemination of materials in advance, and regularly scheduled meetings. Areas cited for improvement included implementation of a structured review instrument, delineation of clear goals, and periodic evaluation. We believe these findings could aid residency directors interested in maximizing the educational benefits of their JC.

Intraosseous Epidermal Inclusion Cyst of the Proximal Phalanx of the Fifth Toe and Review of the Literature: A Case Study.

Intraosseous epidermal inclusion cysts (IEpC) are benign bone tumors that often present in the phalanges of the fingers, but rarely are seen in the lower extremity. These tumors often present following surgery, and have a similar clinical and radiographic presentation to osteomyelitis. The lack of defining characteristics makes preoperative diagnosis of these tumors very difficult. It is crucial to differentiate these tumors from malignant lesions with similar presentation. This case study presents our treatment of this osseous tumor and reviews the available literature describing this condition. LEVELS OF EVIDENCE: Level V: Case report.