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Editorial: A new decade of the 21st Century

Posted on January 1, 2010 | Comments Off on Editorial: A new decade of the 21st Century

by Sarah A. Curran PhD, Bsc (Hons)1 ,
Chief Editor, The Foot and Ankle Online Journal

The Foot and Ankle Online Journal 3 (1): 5

Published: January, 2010

ISSN 1941-6806
doi: 10.3827/faoj.2009.0301.0005

As we enter a new decade of the 21st century, The Foot and Ankle Online Journal begins its third year. Before we look forward to 2010, we will take a look back on the developments of the journal over the last year. In 2009, The Foot and Ankle Online Journal continued to evolve receiving an increase in submissions and publications compared to 2008. Various topics were published and included diabetic complications, acute trauma, congenital deformities, obesity, malignancy and infectious conditions.

In December 2009, The Foot and Ankle Online Journal welcomed Dr. Buck Willis, PhD as our new ‘Associate Editor in Chief’. Dr. Willis is the clinical research director at Landmark Medical (Austin, Texas, USA) and has extensive research credentials including knowledge of statistics and experimental design. His contribution to the development of the journal will be invaluable.

While many of the 55 manuscripts published in 2009 were case reports, there was an increase in submissions and subsequent publication of original research. (Fig. 1) The editorial team hopes this trend gains momentum and continues into 2010 (see manuscript submission guidance). Submissions based on technical notes, clinical tips, critical appraisals/literature reviews, letters to the editor and book reviews are also encouraged by the editorial board. The journal’s international recognition also continues to develop and while the majority of the publications are from the United States (i.e. North America), 2009 saw submissions from Sweden and Turkey. (Fig. 2)

Figure 1

Figure 2

Technology, information and communication

‘Technology feeds on itself. Technology makes more technology possible’
Alvin Toffler [1]

December 2009 also saw the introduction of The Foot and Ankle Online Journal to Facebook. At the beginning of the month following the release of each journal issue, every published manuscript will have a direct link to our Facebook application. There is a Discussion tab which works very much like a forum. This application has fundamentally been established for authors, editors and the mainstream to communicate about the published manuscripts.

Even if you are an occasional reader of The Foot and Ankle Online Journal we encourage you to take part in the discussions. In addition, the Facebook application provides an alternative method of making the interaction of discussion more social.

If you are a member of Facebook, the link for review is provided below. If you are a member of Facebook, the link for review is provided below.

Objectives for 2010

The Foot and Ankle Online Journal is a peer reviewed journal which aims to advance knowledge and understanding of clinical and surgical aspects of the foot and ankle. The journal will consider manuscripts submitted from any discipline that addresses the foot and ankle. Key goals of The Foot and Ankle Online Journal for 2010 will be to continue to publish clinically and surgically relevant manuscripts. The editorial team will also strive to maintain the integrity of the peer review process and publish manuscripts within 1 – 2 months of original submission. The journal will continue to function as an open access electronic journal with no subscription fee.

Guidelines for submission of manuscripts

Below are revised guidelines for submission of manuscripts to The Foot and Ankle Online Journal.

i) Title

Should represent the content and breadth of the material reported.

ii) Author information

Name, degree, affiliation and address of all contributing authors should be provided. Email address and telephone number is required for the corresponding author.

iii) Abstract

This section provides a summary of key information of the manuscript. For case reports, critical appraisal/literature reviews and technical/clinical tips the abstract is unstructured providing ‘to the point information’ using no more than 150 words. For original research submissions the traditional IMRAD structure is used which provides the following 4 sections: Introduction and aim (why the research was done), Methods (what was done), Results (what was found) and Discussion (the interpretation of the findings – clinical and/or theoretical perspective). No more than 250 words should be used for a structured abstract.

iv) Keywords

Keywords should be presented below the abstract. Up to 5 single words or short phrases may be included and should cover the main aspect of the manuscript. Authors are encouraged to use the terms listed as Medical Subject Headings (MESH) in Index Medicus (Medline) found at http://www.medline.com/

v) Introduction/background/aim

This section should set the scene by providing pertinent information about the problem being presented and/or studied. Gaps within the existing literature, critical analysis and any conflicting evidence should be highlighted. The aim of the manuscript should be clearly stated. If the submission is based on original research a hypothesis/hypotheses or a research question should be provided.

vi) Method (original research)

The selection of participants (including how they were recruited) and setting of where the data was obtained should be described clearly. The design of the study should be stated, and the methods, equipment and materials should be provided in enough detail so they can be reproduced in future work. Full details of any randomization process must be provided (i.e. control versus placebo, selection of treatment).

Information on ethical approval should be included. This should also be supported by a statement on whether informed consent was obtained. If consent was not obtained, a clear rationale as to why this was included should be provided by the authors. Details of statistical analysis and statistical analysis software package used (i.e. Statistical Package for the Social Sciences [SPSS] and version) to perform the analysis should be provided.

vii) Results

Results should be presented in a clear and logical manner. Information from all participants should be included, unless otherwise stated. The main important findings should be highlighted and only present actual data. Summarise findings using tables and charts, but avoid repeating this information in the main text.

viii) Discussion and conclusion

This section should begin with a restatement of the aim of the study. The main discussion should build on and extend beyond the results, and consideration should be given to methodological issues as and where appropriate. Observations from the study should be related to previous studies (i.e. support or conflicting findings). The contributions of the study should be clearly stated and ideas for further research should be highlighted. The implications (clinical and theoretical) and limitations of the findings should also be discussed. The conclusion should correspond with the main findings of the study with a key message.

ix) Figures and tables

To support the clarity of the main body text, figures such as schematic, photographs, graphs and tables are encouraged. Figures or tables taken from previous published material will require evidence of copyright permission that should accompany the original submission.

x) References

Please use numerical references (i.e. 1 – 3) and list in order of appearance. When sending the manuscript, please format the reference numbers as Superscript (i.e. 1 – 3). For the main text, when an author’s surname is used and 3 or more authors are listed for the article ‘et al’ must be used (i.e. Banks, et al.,) The following are examples for journal, book and internet references:

Examples:
Journal:
Nishi H, Miyamoto S, Minaminura H, Ishikawa T, Katoh Y, Shimizu Y. Pseudoaneurysm of the dorsalis pedis artery causing neurologic deficit. Annals of Vascular Surgery. 18 (4): 487 – 489, 2004.
Book:
Munro BH, Page EB. Statistical Methods for Health Care Research. 2nd ed. J.B. Lippincott Co, Philadelphia, Pennsylvania, 1993.
Internet:
Saglimbeni AJ, Fulmer CJ. Achilles tendon injuries and tendonitis. http://www.emedicine.com/pmr/topic219.htm Accessed date required.

xi) General

Before using abbreviations they should be presented in full (i.e. Intraclass correlation coefficients [ICC]). Garamond style font should be used throughout. The main text and figure/table legends should be in size 12 font whilst the reference section and table contents should be in size 10 font. All subheadings should be in bold. Following the conclusion of the manuscript (prior to the reference section) the authors should acknowledge any assistance (i.e. financial, clerical, academic) provided.

xii) Conflict of interest statement

All authors should declare if there is a conflict of interest associated with the submitted manuscript.

xiii) Additional guidance for case reports

Authors are referred to Scott Malay’s editorial on the value of an interesting case. The full reference is as follows: Malay SD. The value of an interesting case. Journal of Foot and Ankle Surgery. 46 (4): 211 – 212, 2007.

Method of submission

All articles submitted to be considered for publication in The Foot and Ankle Online Journal should be sent to: picomstaff@hotmail.com or faojeditors@gmail.com as an attachment to an email. Please name your article by presenting the author’s first initial and last name (i.e. SCurran). Submissions will be reviewed for their clinical and scientific merit and relevance to the journal. Authors will be informed of the status of their submission via email within a period of approximately 3 weeks. Once accepted articles are uploaded in PDF and HTML format.

Reference

1. Toffler A: http://thinkexist.com/quotation/technology-feeds-on-itself-technology-makes-more/363784.html. Accessed 12/07/2009.

Address Correspondence to: Sarah A. Curran PhD, BSc(Hons)
Email: scurran@uwic.ac.uk

1  Senior Lecturer, Wales Centre for Podiatric Studies, University of Wales Institute, Cardiff, Western Avenue, Cardiff, CF5 2YB, UK.

© The Foot and Ankle Online Journal, 2010

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Letter to the Editor: Prevalence of Equinus in Patients Diagnosed with Plantar Fasciitis

Posted on April 1, 2009 | Comments Off on Letter to the Editor: Prevalence of Equinus in Patients Diagnosed with Plantar Fasciitis

by Robert D. Phillips, DPM1

The Foot and Ankle Online Journal 2 (4): 5

This is an Open Access article distributed under the terms of the Creative Commons Attribution License.  It permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. ©The Foot and Ankle Online Journal (www.faoj.org) 

Accepted: March, 2009
Published: April, 2009

ISSN 1941-6806
doi: 10.3827/faoj.2009.0204.0005

To the editor:

I read with interest the article by Wenzel, et al., on the relationship between equinus and plantar fasciitis. I feel the authors should be commended for the work they have done in trying to better define the pathomechanics of this syndrome that is so wide spread today. In regards to their findings, I would like to make a few observations and comments.

The authors acknowledge that there is a variation in the literature in accepted dorsiflexion values that are necessary for normal gait, and settle on using the most commonly cited value of 10° as the cut-off point. This magical demarcation point often puzzled me until I began writing chapter 3 for the book Principles and Practices of Podiatric Medicine [1] in which I looked at the passive and active moments created around each joint of the lower extremity during gait. In doing some calculations, I found that for a person of average weight and height and foot length, when the ankle joint dorsiflexed 10°, the center of body mass would pass anterior to the metatarsophalangeal joints. This then made it clear that when the center of body mass is posterior to the metatarsophalangeal joints, the weight of the body places a plantarflexion moment around the metatarsophalangeal joints, and when the center of body mass is anterior to the metatarsophalangeal joints, the body weight places a dorsiflexion moment around the metatarsophalangeal joints.

Pronation dysfunction of the midfoot and rearfoot joints could then be explained by the Achilles tendon trying to lift the heel before the center of body mass passed anterior to the metatarsophalangeal joints.

In light of this argument, it makes sense that there are a number of parameters, which if altered, could make it possible for a person to need more or less than 10° of ankle joint dorsiflexion in order to walk with a normal gait. For example, anything that moves the center of body mass upward would decrease the need for 10° of ankle joint dorsiflexion and anything that moves the center of body mass downward would increase the need for 10° of ankle joint dorsiflexion in gait. For example, just holding one’s hands on top of the head when walking moves the center of body mass upward. In comparison, carrying two heavy weights in one’s hands moves the center of body mass downward. A person carrying a heavy load on the head would mean that less than 10° of ankle joint dorsiflexion may be needed and a person carrying a heavy suitcase would mean that more than 10° of ankle joint dorsiflexion. Body morphology also may place the center of body mass naturally higher or lower. A person who has a robust upper body and a slender lower body phenotype would need less than 10° of dorsiflexion, whereas a person who had an extreme amount of edema in the legs, or had a phenotype that concentrated weight well below the waist would need more than 10° of dorsiflexion.

This argument could easily explain the authors’ finding that people with greater BMI, especially females, would be more affected by decreased ankle joint dorsiflexion. Also it would explain why very young children, who have a much shorter leg in proportion to their height need much more than 10° of dorsiflexion.

Other parameters that would move the center of body mass more anterior or more posterior could mean that less or more than 10° of ankle joint dorsiflexion would be needed. If the body weight is distributed more posteriorly, then more than 10° of dorsiflexion will be needed, whereas carrying the center of body mass more anteriorly would decrease the need for 10° of ankle joint dorsiflexion. The length of the foot is also an important parameter. People with shorter feet relative to the body height should need less than 10° of ankle joint dorsiflexion whereas those with longer foot length relative to their body height should need more than 10° of ankle joint dorsiflexion.

The tension in the Achilles tendon can also be broken down into two components, the active tension component and the passive tension component. The active tension component is proportional to the contractile force exerted by the muscle fibers, however the passive component is set by a fixed length tension curve for that particular tendon. I attempted many years ago to determine in-vivo the passive length tension curve for the Achilles tendon in individuals, but found that the problem was greater than the then-current capabilities of our equipment. However, I do believe that this may be doable in the future with improvements and refinements in technology. This has been brought to the fore by recent articles (quoted by the authors) showing a correlation between tightness in the Achilles tendon and the force under the forefoot in diabetics. Indeed, in diabetics, glycosylation of the collagen fibers, moves the passive length tension curve to the left, which means that it takes more force against the forefoot to stretch the Achilles to a point of the ankle being 10° dorsiflexed. As a result, procedures that lengthen the Achille Tendon are coming in vogue for decreasing the risk of forefoot ulcerations in diabetics.

The authors did report the results of ankle joint dorsiflexion with the knee extended and knee flexed, and it is inferred in the article that the equinus group included those who had less than 10° of motion with the knee extended, no matter what the range of motion was with the knee flexed. Indeed, it may be critical to divide these into two very different types of equinus conditions. This is because if a person has a marked difference between the ankle joint dorsiflexion with the knee flexed and extended, it could have a marked difference in the percent contribution of the passive tensions to the total tension in the Achilles tendon before the heel comes off the ground. Unfortunately, the literature has not well addressed the situation of isolated gastrocnemius tightness to the distribution of forces in the Achilles tendon, verses when both the gastrocnemius and soleus are tight. Theoretically – because of the rotation of the Achilles tendon, such that the soleus inserts more to the medial side of the os calcis and the gastrocnemius inserts more to the lateral side of the os calcis – if only the gastrocnemius is tight, then as the ankle joint dorsiflexes there would result an overload of stress more in the lateral side of the insertion of the Achilles, which would tend to have more of a pronatory moment around the subtalar joint axis. On the other hand if the ankle joint dorsiflexion changes little between the knee being flexed and being extended, it would have less of an eversion torque on the heel, but a greater dorsiflexion moment around the transverse tarsal joint, dorsiflexing the naviculocuboid complex against the talocalcaneal complex. This type of tight Achilles may show less pronation of the rearfoot, especially if it is an adult acquired tightness, yet have a marked increase in the tension of the plantar fascia as it resists dorsiflexion moments around the midtarsal joint. This argument would reinforce the authors’ finding that those with both gastrocnemius and soleus tightness were more likely to have plantar fasciitis than those only with gastrocnemius equinus, without having as much pes planus effect.

In light of these, plus other variables that I have not addressed, I believe it is important that one not put too much faith in the lack of findings of no statistical relationship between the presence of equinus and the presence of plantar fasciitis.

Certainly, the tables show a trend in that direction, but because of the wide standard deviation, the rejection of the null hypothesis at the 95% confidence level cannot be made. The purpose of this letter is to begin to point how unaddressed variables can markedly affect the determination of whether a patient has an equinus condition, which should raise significant doubts in the reader that the 95% confidence level is appropriate to consider rejecting the null hypothesis. Indeed, I feel that a more appropriate confidence level for this paper would be the 80%, which would be more in line with the methods employed and also take into account some of the variables that I have elucidated. Again, this is not to criticize the authors for the fine work they have done, and I applaud the authors for pointing out the weaknesses in the study. However, I would encourage these authors and others for future work to try to better define the term equinus and to be more precise in applying it when researching the relationship between the function of the Achilles and the various maladies and dysfunctions of the foot.

Disclaimer: The views in this article are exclusively those of the author and do not in any way represent the official views of the U.S. Department of Veterans Affairs nor any agency or branch of the U.S. federal government.

References

1. Phillips, RD “Normal Biomechanics [Chapter 3]”. In Principles and Practices of Podiatric Medicine. Levy LA, Hetherington VJ, Bakotic BW (Eds), 2nd edition. Brooklandville, MD, Data Trace Publishing Co., 2006)

Address correspondence to: Robert D. Phillips, D.P.M.

1  Orlando Veterans Affairs Medical Center, Orlando, FL 32803

© The Foot and Ankle Online Journal, 2009

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