Tag Archives: Editorial: The Foot & Ankle Journal

Editorial: The Peer Review Process

How the Foot & Ankle Journal edits incoming manuscripts 

Al Kline, DPM

The definition of a true peer-reviewed journal is one that regularly screens manuscripts by individuals who are experts in their own fields. [1] It can also be scrutinized by reviewers who are not part of the editorial staff, such as in funded studies. [1,2] In our journal, the members of the editorial staff are the peer reviewers.

Each editor has a particular area of expertise. Most, if not all of our editors, have years of experience in research and manuscript editing. All members of our editorial staff have written a number of journal articles. Some members also sit on other editorial boards for other journals. These include the sectional editorial staff of The Journal of Foot & Ankle Surgery and the advisory editorial staff of the Journal of the American Podiatric Medical Association.

We do not see this as a conflict of interest, but rather a shared effort to improve the quality of manuscript submissions and a joint effort to help stimulate case reports and studies in our field of expertise.

The function of our peer review process is to aid and 1) improve the quality of manuscript content, 2) encourage authors to meet the highest quality standards of the manuscript, 3) provide a readable manuscript without grammatical or typographical errors and 4) provide ideas to stimulate further research and study.

When our journal receives a manuscript, it is rarely rejected. But not all manuscripts are accepted at the initial submission. Sometimes, many revisions take place that include edits to the content and to the body of the manuscript. We try not to entirely re-write a manuscript, but rather, provide information on how to improve the body of work and its presentation.

Manuscripts submitted to The Foot & Ankle Journal are submitted by electronic media. This is usually done by simple electronic mail or e-mail. Our information for authors section of the site illustrates this process. In short, e-mail manuscripts should include the title and body of the work. High quality resolution photos should be sent separately from the manuscript. Captioning can be included in the original manuscript.

The initial manuscript including photos and captions are reviewed by the chief publisher. This is called a preliminary edit. In the preliminary editing process, content and presentation of a case report or study is determined. Also, a brief initial edit of grammatical and spelling errors is performed.

Once the preliminary edit is complete, the manuscript is sent to two of our editors on the editorial board. This is called the initial edit. In the initial editing process, the entire body of work is reviewed including photo presentation, captions, content and referencing.

When the initial editing is complete, the entire manuscript is then reviewed by the Publisher and sent to the entire editorial board for final review. In the final review, the entire board looks over content issues, content presentation, photo presentation and captioning. A final grammatical and spelling review is also completed. When the final review is complete, the manuscript is formatted and uploaded by the copy editor or publisher for open access publication to our website, www.faoj.org.

The publisher is ultimately responsible for the quality and selection of manuscripts chosen and accepted by the journal. This decision is based on review and suggestions from the other editors on the board.

To preserve the integrity of the peer review process, submitting authors will not know the initial reviewer and in some cases, our review board is not aware of who reviewed the manuscript in the initial edit. This is called a masked review. [1]

In a masked or even double-masked review, the editors don’t know who edited the work before they receive the manuscript. This is strictly enforced by the publisher to ensure a non-biased edit of the manuscript.

One advantage to open access publishing in peer review is the ability to form dynamic peer review and suggestions. When a manuscript is uploaded to The Foot & Ankle Journal, at the end of the article in the HTML format, there is an area for open discussion and suggestions (i.e. leave a reply). This will also improve overall understanding and quality of a published case report.

The most common complaint of the peer review process is that it is time intensive. Many authors complain that some journals take months or even years to edit a manuscript. This can discourage and frustrate the author or authors of a well written manuscript. Many times, content editing will mean re-writing the manuscript, sometimes many times over.

The introduction of this journal as the ‘first open access journal for foot and ankle medicine and surgery’ has all but eliminated this frustration. Through electronic media and open access publication, our journal is able to edit a manuscript in a relatively short period of time. Average editing takes roughly two weeks. Our journal content includes mostly case report and study information. This also greatly aids in our ability to publish in a short period of time.

The entire process from submission to online publishing may take less than four weeks. We are able to publish some articles within one to two weeks of submission. This mostly depends on the content and length of the manuscript.

Our peer review process is designed to improve the process of online publishing and make the process less frustrating for authors. We assume that all manuscripts submitted are without fraud, plagiarism and bias.

Peer review has been the accepted process of review and manuscript submission in the modern scientific community. Many articles presented to scientific journals before the twentieth century were not peer-reviewed except for medical peer reviews. [1] The peer review journal is an excellent indicator to the quality, content and presentation of the respective journal.

Al Kline DPM
Publisher/Editor, The Foot & Ankle Journal


1. Wikepedia, Peer Review, [online].
2. WAME Policy Statements: Definition of a Peer-Reviewed Journal, [online].

© The Foot & Ankle Journal, 2008

Editorial: Elements of a Case Report

Al Kline DPM

Case reports are a vital link to providing unique medical information, procedures or just simply sharing an important medical finding with one’s colleagues. Many times, case reports stimulate further interest in taking that next step and doing more involved research on a topic. As a physician and surgeon, there are frequent occasions when we encounter a unique condition, pathology report or surgical condition that entices our interest. Medicine and surgery should not be ‘routine’ and ‘boring’, but rather a daily stimulation. In this digital age, it is important to carry a digital camera and capture these events as they unfold. Once these events are captured, a case report is a great way to share this information with one’s colleagues. Uniqueness is not a prerequisite to writing a case report, but rather, any information that one finds useful or important can be presented.In order to write a good case report or study, some fundamental essentials are required. Journals differ in their respective formats when publishing case reports, but some fundamentals remain constant. A case report is described as a single report that includes an abstract, introduction, case presentation, discussion and conclusion. [1] Often, the discussion and conclusion can be combined into one narrative. Case studies are writings that include a few case reports with similarities. [1]

Before we begin discussing the elements of a case report, there are a few things to consider and discuss. When the author sets upon the task of writing a case report, one should consider the important points of a presentation. This includes finding a rare case or new surgical technique, doing a thorough literature search and collecting information related to the case. [2]

Getting consent from the patient to use pictures and information in a case report is important and required for most journals. One can get pre-printed consent forms directly off the internet or produce your own document. A simple document containing information about the case, release of photographs and slides and release of medical information is usually adequate. Have the patient sign this document and keep the contact information handy for future reference. One can also add in the document that the patient’s name and personal information will not be included in the published report.

Once these conditions are set in place, one can begin the task of collecting information, writing and summarizing the case report. The entire process is concluded after submitting the case report to a journal, editing/revising the work and publishing the final draft.

Case reports should be concise and short and present ‘quality over quantity.’ The case report is not a literary dissertation and should not include every review reference from the literature. Along with the elements of the case report, it should include high definition photographs, preferably in color to help present and supplement the case. Drawings and illustrations are also acceptable. Photos, tables and graphs should help to illustrate the case presentation. A common mistake is to repeat the captioned figure text that is already in the main body of the manuscript. Use the main body text to reference photos, tables and graphs and use the figure caption to summarize the information already described in the text. Do not repeat information verbatim in your main text that is already in a table.

Do not simply narrate an operative report of the surgical case. The case report is not a lesson in operative dictation. Proper terminology is important in describing the surgical technique as it reflects in the case report. Include information that helped improve the technique and report any complications one may have found during the surgical procedure. Reporting unexpected conditions or complications is just as important as reporting and supporting the expected outcomes.

Now, let’s discuss the elements of a case report.


The abstract is not a formal component of the case report, but serves to introduce and summarize the written work. It should be concise and include the main ‘points’ of the case report. The importance of the abstract should not be under estimated. It is the first few lines the audience will read and will serve to entice the reader to continue reading the case report or study.


The introduction of a case report should provide the reader with a general overview of the case or condition presented. Introductions vary from one journal to another. Some journals recommend a historical perspective of the case, disease or procedure that includes referenced material. [3] Other journals recommend a description of the case to be reported, and a statement about the uniqueness or unusual nature of the condition or treatment being described. [4] Some simply recommend a one sentence description of the case. [2] Whatever method one chooses, there are a few questions the author should ask. Is the rationale for reporting this case adequately explained and is the rationale sustained by references? [1] Has the condition or technique been described before? A good introduction will drive the point home: What is the single most important point in making this case? What am I trying to communicate with my audience? A common mistake in the introduction is to begin the discussion of the case before the entity or point of your case is made. The introduction is also used to introduce background information on a product, surgical entity, pathology or condition.

Case Report

The purpose of the case description is to allow the reader to understand the case and all its pertinent findings. The case report should including all elements describing the case. This includes the patient’s age, gender, initial presentation and chief complaint, symptoms, medical history, social history, medications and notable physical findings. It should also include conservative treatments, treatments that worked and didn’t work, laboratory data, supportive radiographic information, pathology and histology reports. It can conclude with the differential diagnosis, final diagnosis, treatment and outcomes. If there is an unusual laboratory finding, include the normal values. To keep things brief, only report the positive findings. If the patient has a normal medical history, this may be mentioned without going into the normal results of the examination.

In this section, digital photographs, drawings, graphs and tables in the form of figures can be used to describe the case report. In surgical cases, pictures including before, during and after surgery are encouraged. Pictures showing long-term outcomes are also helpful.

Do not use patient initials in your text. Refer to the person in the case report as “the patient” or “Patient X” rather than “this case”. A case refers to an instance in disease, a patient is a person. [1] Keep the information in the case report interesting, educational and pertinent.


The purpose of this section is to explain anything that wasn’t clear in the introduction and discuss the findings and interpretations. The discussion brings together the introduction and case presentation and introduces the “discovery” about the case report that makes it unique. This is the place to include a brief literary review of the findings. One can describe what others have written about this condition or technique.

This is also where the interpretation of findings is presented. The author should discuss the positive and negative findings both documented in the literature and something new that may have been discovered. The discussion paragraph is the place to truly explain the case and provide new information that the reader will find useful. Discuss expected and unexpected outcomes. How did this case differ from the norm? How did a particular technique affect the outcome? Were there any lessons gained in the discovery?

The discussion can end with a conclusion that briefly recounts the case report findings. Some journals will have a separate conclusion paragraph that simply restates a summary of the case report.

In summary, the case report is a great way to communicate information with one’s colleagues. A good understanding of these elements will help the author write a readable case report. In this day and age of the internet, publishing also allows one to reach a wider audience and the general public. It is also an asset to the author’s curriculum vitae. Writing a good case report helps contribute to our understanding of selected surgical techniques, complications, interventions and unique conditions that affect the foot and ankle.


1. Iles, R.L. Guidebook to Better Medical Writing, Chapter 10. Case Reports, Letter to the Editor, Book Review, Book Articles and Scientific Posters. [online].
2. Anwar, R. et al. How to write a case report. BMJ. 327:153. 2003. [online].
3. Joseph, W. Guidelines for Authors. JAPMA 97:1, 89-91, 2007.

© The Foot & Ankle Journal

Editorial: Journal Prospectus for 2008: A look at 2007 and beyond

Al Kline DPM

Another year is before us and we are again looking to the future for stimulating case presentations. I am pleased to see the journal move forward and breaking new ground in open-access publication.This year marks a name change for our journal. We are now called The Foot & Ankle Journal instead of the Podiatry Internet Journal. This name change reflects our hope in attracting all foot and ankle specialists desiring open access publication. We are still proud this journal began as the first open access journal for podiatrists.

Some publications would say that a quality journal does not present case reports and will focus more on original works. I couldn’t disagree more. I believe that the case study represents the essence of what we see in our everyday practice and institutions. It also allows us to share information in a unique, open format with our colleagues.
For most case reports to be accepted by a journal, it must represent something unique and extraordinary. This is not always true in the spirit of our journal. We want even the student and resident to experience contribution to their respective field in a case report that they have taken the time to research. They will also have learned something from it that they can share with their respective colleagues. Writing a good case report takes time, energy and considerable research. We, as editors, should not discourage this process by over editing works and resist the urge to completely re-write the work. Our journal has a distinct focus on attempting to help some authors write a quality case presentation by offering helpful insights and tips.

The value of a good case report is reflected in its ability to convey information that is helpful, instructional, and educational in content and presentation. In the July/August 2007 issue of The Journal of Foot & Ankle Surgery, Dr. Scott Malay presents a very valuable editorial on “the value of an interesting case report“. I suggest everyone read his editorial. More importantly, the editorial describes the three fundamental sections of a case report: Introduction, Case Report and Discussion and a well written explanation of each context.

In 2007, we accepted some interesting cases presented to our former journal that, I believe, exemplifies our goals. Cases were submitted and uploaded to our site within 2 weeks of submission. Some cases required more editing than others and valuable ‘tips’ were learned in the process. Although the journal has not reached every doctor and institution, our progress is slowly reaching the masses. Many of our articles are now in the google search engine. Once the original article is uploaded, it is usually available in the google search engine within 2-3 weeks. Of course, the articles are free without subscription or price. The editorial board feels strongly that the information in our journal should be shared and available to anyone who is interested without a price. We also saw a variety of articles in 2007 from countries such as India and New Zealand. This diversity reflects well in our respective professions.

In 2008, the January issue of The Foot & Ankle Journal has three distinct articles from Holland, India and New Zealand. All three articles were submitted in mid December 2007 and uploaded on-line by January 1st, 2008. This year, the journal will continue to actively add features to our website. We have also made some minor changes to the look of the articles to reflect a more readable format. This year also marks our integration of our website with WordPress. WordPress has allowed the articles to integrate into various search engines for world wide access through the internet. It also allows the author to highlight color photos and attach PDF files for color printing right to your home, office or institutional printers.
Another feature that we will pioneer in 2008 will be video clips and surgical video as attachments imbedded in the articles. This will also help to better explain case presentations and techniques. It will also allow the author to discuss a surgical case or technique.

The future looks bright for The Foot & Ankle Journal. We are proud that the journal is the first open-access publication in the area of podiatry and foot and ankle orthopaedics. Once the journal increases its volume of submissions, we will begin the task of securing an ISSN to be listed with PubMed, MedLine and other database internet programs through the National Library of Medicine. We wish everyone a happy and prosperous new year!

Al Kline DPM
Chief Editor, The Foot & Ankle Journal (formerly the Podiatry Internet Journal)

© The Foot & Ankle Journal