A 30-Year-Old Man with an Unusually Large Untreated Plantar Fibrolipoma That Disrupted Ambulation and Required Operative Excision.

A 30-year-old man working as a waiter presented with a progressively enlarging and symptomatic soft-tissue mass on the plantar medial aspect of his left foot. The mass was painful and disrupting ambulation, despite footwear modifications. He ultimately underwent excision of what was a determined to be a fibrolipoma, returning to his regular shoes and all activities. Plantar neoplasms, even when benign, can grow to sizes that can result in significant disability. If left untreated, particularly in individuals engaged in occupations requiring frequent standing or walking, excision of the mass will often require a more aggressive operative approach.

Psychometric properties and podiatric medical student perceptions of USMLE-style items in a general anatomy course.

BACKGROUND: In 2010, the New York College of Podiatric Medicine general anatomy course was redesigned to emphasize clinical anatomy. Over a 2-year period, United States Medical Licensing Examination (USMLE)-style items were used in lecture assessments with two cohorts of students (N =200). Items were single-best-answer and extended-matching formats. Psychometric properties of items and assessments were evaluated, and anonymous student post-course surveys were administered. METHODS: Mean grades for each assessment were recorded over time and compared between cohorts using analysis of variance. Correlational analyses were used to investigate the relationship between final course grades and lecture examinations. Post-course survey response rates for the cohorts were 71 of 97 (73%) and 81 of 103 (79%). RESULTS: The USMLE-style items had strong psychometric properties. Point biserial correlations were 0.20 and greater, and the range of students answering the items correctly was 25% to 75%. Examinations were highly reliable, with Kuder-Richardson 20 coefficients of 0.71 to 0.76. Students (>80%) reported that single-best-answer items were easier than extended-matching items. Students (>76%) believed that the items on the quizzes/examinations were similar to those found on USMLE Step 1. Most students (>84%) believed that they would do well on the anatomy section of their boards (American Podiatric Medical Licensing Examination [APMLE] Part I). CONCLUSIONS: Students valued USMLE-style items. These data, coupled with the psychometric data, suggest that USMLE-style items can be successfully incorporated into a basic science course in podiatric medical education. Outcomes from students who recently took the APMLE Part I suggest that incorporation of USMLE-style items into the general anatomy course was a successful measure and prepared them well.

Meta-analysis of flexor tendon transfer for the correction of lesser toe deformities.

BACKGROUND: Transfer of the flexor digitorum longus tendon is one of the surgical techniques described to treat lesser toe deformities. A global analysis of the benefits of this procedure has not been presented in the literature to date. The aim of this meta-analysis was to evaluate the clinical benefit of transfer of the flexor digitorum longus tendon regarding patient satisfaction. METHODS: A reviewer formally trained in meta-analysis abstraction techniques searched several databases to identify relevant published studies. Initially, 203 citations were identified and evaluated for relevance. Abstract screening produced 112 articles to be read in their entirety, of which 17 articles studying 515 procedures with a mean ± SD follow-up of 54.21 ± 20.64 months met all of the inclusion criteria necessary for analysis. RESULTS: Overall crude patient satisfaction after flexor digitorum longus tendon transfer was 86.7% (95% confidence interval, 81.7%-90.5%). A low grade of heterogeneity across studies (Q = 24.458, I(2) =34.583, P = .080) and no influence of the individual studies on overall estimation were found. When adjusting for higher-quality prospective studies, overall patient satisfaction increased to 91.8%, although it did not reach statistical significance. Additional a priori sources of heterogeneity (age, sex, studies with <3 years of follow-up, percentage of patients lost to follow-up, and year of publication) were evaluated by subgroup analysis and meta-regression, but no statistical significance was found. This adjustment also significantly decreased heterogeneity across studies (crude Q = 24.458, high-quality studies Q = 1.504). CONCLUSIONS: Regarding patient satisfaction, this comprehensive analysis provides supportive evidence of the clinical benefit of flexor digitorum longus tendon transfer.

Comparative analysis of moral distress and values of the work organization between American and Spanish podiatric physicians.

BACKGROUND: Moral distress is a stress symptom arising from situations that involve ethical dimensions where the health-care provider believes that he or she is unable to preserve all interests and values at stake. The aims of this study were to evaluate the impact of, and identify possible differences in, moral distress in podiatric physicians in the United States and Spain and to determine the ethical principles most closely related to moral distress. METHODS: A 2008 e-mail survey of 93 US podiatric physicians and 93 Spanish podiatric physicians (N = 186) presented statements about different ethical dilemmas, values, and goals in the workplace. RESULTS: Although moral distress is strongly present across the sample for all of the questions, the US sample shows higher levels of any kind of moral distress concerning questions about patients' treatment and economic constraints, overload of paperwork, and acting against one's conscience. In the US sample, 91.4% of physicians agreed mostly or completely with the statement that they often had to compromise their own values to cope with the demands of the workplace; 89.25% of US podiatric physicians indicated that their own professional values were congruent with the values of the organization; and a similar percentage (77.5%) reported a strong identification with the goals and framework of their work organization. The Spanish sample had similar results. CONCLUSIONS: The results underline the significance of moral distress for both samples, mainly related to time constraints and organizational aspects concerning patients and lack of resources.

Chopart's amputation for resection of clear cell sarcoma of the foot: a case report and review of the literature.

UNLABELLED: Clear cell sarcoma (CCS) is a subset of soft tissue sarcoma that occurs mainly in young Caucasians. Although on initial presentation these growths might not appear to be malignant, CCS has a tendency to disseminate to regional lymph nodes and ultimately develop distant metastasis. We report a case of CCS from our institution, discussing the radiological and pathological findings, surgical treatments, and survival prognoses. To our knowledge, this is the first reported case of using a Chopart's amputation technique in the resection of CCS of the foot. LEVEL OF CLINICAL EVIDENCE: 4.