There is a multitude of neurological diseases which may lead to neuro-orthopaedic problems and subsequently to neurogenic foot deformities. For this reason the diagnostician will be consistently surprised that there is a great multitude of different foot abnormalities and that not only the typical spastic talipes equines dominates. Of particular significance here is that these deformities almost always develop progressively, whereas most diseases persist per se, cerebral palsy being a typical case in point. However, in MMC (myelomeningocele) patients, there is also the danger of a worsening of the basic problem in the case of tethered cord syndrome. Unlike congenital talipes equinovarus, neuro-orthopaedic talipes equinovarus often shows over- or undercorrection postoperatively due to a shift in muscle imbalance. It is important, therefore, that the basis of conservative therapy include regular physiotherapy and orthoses during the day and, if necessary, at night. Botulinum toxin has been established as an additional measure for spasticity; however, this cannot always prevent surgical intervention, but is able to delay this to a better point in the development of the child/patient. The present article describes the diversity of neurological deformities and presents conservative as well as surgical therapeutic approaches.
Miron, Marie-Claude; Grimard, Guy
Foot deformity in infants is the most common congenital musculoskeletal condition. A precise diagnosis can sometimes be impossible to establish clinically. Radiologic imaging plays a major role in the evaluation of musculoskeletal abnormalities. However conventional imaging techniques, such as plain radiographs of the foot, are of very little help in this age group because of the lack of ossification of the tarsal bones. US presents a significant advantage because it permits the visualization of cartilaginous structures. This leads to the detailed assessment of foot deformities in infants. Furthermore, US can also be used as a dynamic imaging modality. Different scanning views are beneficial to evaluate the complete anatomy of the foot; depending on the suspected clinical diagnosis, some planes are more informative to display the pathological features of a specific deformity. We describe the US findings of five of the most common foot deformities referred to our pediatric orthopedic clinic (clubfoot, simple metatarsus adductus, skewfoot, and oblique and vertical talus). For each deformity we propose a specific imaging protocol based on US to provide an accurate diagnosis. US is a complementary tool to the clinical examination for determining the diagnosis and the severity of the deformity and also for monitoring the efficacy of treatment. Radiologists investigating foot deformities in infants should consider using US for the detailed assessment of the foot in this age group.
Vlahovic, Aleksandar M; Pistignjat, Boris S; Vlahovic, Natasa S
Mirror foot is a very rare congenital anomaly, with only a few papers presenting definitive treatment for this entity. There are limited management recommendations. Most cases are treated before walking age. In our case, there were no associated developmental defects of the leg. The child underwent complex rays resection with medial foot reconstruction. After 7.5 years of followup, definitive surgical treatment was performed with satisfactory cosmetic and functional outcome.
Pothrat, Claude; Goislard de Monsabert, Benjamin; Vigouroux, Laurent; Viehweger, Elke; Berton, Eric; Rao, Guillaume
Foot intrinsic motion originates from the combination of numerous joint motions giving this segment a high adaptive ability. Existing foot kinematic models are mostly focused on analyzing small scale foot bone to bone motions which require both complex experimental methodology and complex interpretative work to assess the global foot functionality. This study proposes a method to assess the total foot deformation by calculating a helical angle from the relative motions of the rearfoot and the forefoot. This method required a limited number of retro-reflective markers placed on the foot and was tested for five different movements (walking, forefoot impact running, heel impact running, 90° cutting, and 180° U-turn) and 12 participants. Overtime intraclass correlation coefficients were calculated to quantify the helical angle pattern repeatability for each movement. Our results indicated that the method was suitable to identify the different motions as different amplitudes of helical angle were observed according to the flexibility required in each movement. Moreover, the results showed that the repeatability could be used to identify the mastering of each motion as this repeatability was high for well mastered movements. Together with existing methods, this new protocol could be applied to fully assess foot function in sport or clinical contexts.
Hien, N M
Prevention of habitual or shoe-induced foot and toe deformities in children and treatment of congenital or developing malformations require a change of view towards functional aspects and the use of modern technical possibilities based on our traditional knowledge.Statics, functional anatomy, biomechanics, neuromotor and psychomotor activity, and developmental physiology have to be considered as well as the broad variety of physiological interindividual differences. Modern materials and fabrication techniques make it easier to produce anatomically and functionally correct and appealing shoes, inserts, and orthoses. New means of invasive treatment improve the preconditions for orthotic management. Cultural and cosmetic expectations and the real extent of disability, impairment, and handicap have to be carefully differentiated for the sake of every single child.
Cahn, Avivit; Livshits, Leonid; Srulevich, Ariel; Raz, Itamar; Yedgar, Shaul; Barshtein, Gregory
The pathogenesis of diabetic foot disease is multifactorial and encompasses microvascular and macrovascular pathologies. Abnormal blood rheology may also play a part in its development. Using a cell flow analyser (CFA), we examined the association between erythrocyte deformability and diabetic foot disease. Erythrocytes from diabetic patients with no known microvascular complications (n = 11) and patients suffering from a diabetic foot ulcer (n = 11) were isolated and their average elongation ratio (ER) as well as the ER distribution curve were measured. Average ER was decreased in the diabetic foot patients compared with the patients with diabetes and no complications (1·64 ± 0·07 versus 1·71 ± 0·1; P = 0·036). A significant rise in the percentage of minimally deformable red blood cells RBCs in diabetic foot patients compared with the patients with no complications was observed (37·89% ± 8·12% versus 30·61% ± 10·17%; P = 0·039) accompanied by a significant decrease in the percentage of highly deformable RBCs (12·47% ± 4·43% versus 17·49% ± 8·17% P = 0·046). Reduced erythrocyte deformability may slow capillary flow in the microvasculature and prolong wound healing in diabetic foot patients. Conversely, it may be the low-grade inflammatory state imposed by diabetic foot disease that reduces erythrocyte deformability. Further study of the rheological changes associated with diabetic foot disease may enhance our understanding of its pathogenesis and aid in the study of novel therapeutic approaches.
Choi, In Ho; Kim, Jin Ill; Yoo, Won Joon; Chung, Chin Youb; Cho, Tae-Joon
Melorheostosis often is disabling because of progressive contracture of the joint and soft tissue involved. Operative intervention often is hazardous and patients also have recurrences. A 14-year, 2-month-old boy, who presented with a recurrent equinoplanovalgus deformity of the right foot caused by melorheostosis, was treated successfully using the Ilizarov technique, including distraction osteotomy in the calcaneus. The patient had a painless, plantigrade, and functional foot at age 18 years.
Hains, François; Dzus, Ann K; Cassidy, J David
Neurological impairment secondary to spinal dysraphism most commonly presents as unilateral cavovarus foot in children. The deformity usually develops in the growing child around the age of five or six. The presence of a cavovarus foot of unknown origin in a child should lead to a complete neurological examination, including an assessment of the spine for spinal dysraphism. The early recognition of pathology may prevent severe neurological sequelae. A case of lipomyelomeningocele is presented to illustrate that cord damage in children with spinal dysraphism can present initially as a cavovarus foot. ImagesFigure 1 (a, b and c)Figure 2Figure 3Figure 4
Jang, Gwon Uk; Kweon, Mi Gyoug; Park, Seol; Kim, Ji Young; Park, Ji Won
[Purpose] The aim of this study was to evaluate the structural deformity of the foot joint on the affected side in hemiplegic patients to examine factors that affect this kind of structural deformity. [Subjects and Methods] Thirty-one hemiplegic patients and 32 normal adults participated. The foot posture index (FPI) was used to examine the shape of the foot, the modified Ashworth scale test was used to examine the degree of ankle joint rigidity, the navicular drop test was used to investigate the degree of navicular change, and the resting calcaneal stance position test was used to identify location change of the heel bone. [Results] The FPIs of the paretic side of the hemiplegic patients, the non-paretic side of the hemiplegic patients, and normal participants were −0.25 ± 2.1, 1.74 ± 2.3, and 2.12 ± 3.4 respectively. [Conclusion] Our findings indicated that in stroke-related hemiplegic patients, the more severe the spasticity, the more supinated the foot. Further, the smaller the degree of change in the navicular height of hemiplegic patients is, the more supinated the paretic side foot is. Additionally, a greater change in the location of the calcaneus was associated with greater supination of the overall foot. PMID:25642071
Kirienko, Alexander; Peccati, Andrea; Abdellatif, Ibrahim; Elbatrawy, Yasser; Mostaf, Zayed Mahmoud A; Necci, Valentina
Poliomyelitis is an infectious disease caused by a neurotrophic virus targeting anterior horn cells of lower motor neurons resulting in flaccid paralysis and represents a common condition in developing countries, and even nowadays, most of both treated and untreated cases result in foot deformities. Between 1994 and 2007, 27 patients were treated by classic ring Ilizarov fixator, aiming at producing a stable plantigrade and cosmetically acceptable foot and followed up for meanly 7.17 years. Additional procedures were performed if needed. The mean time in frame was 4.2 months. All the patients were satisfied with their gait, compared to preoperative status. A painless and plantigrade foot was obtained in all patients, and limb-length discrepancy was always corrected where present. No major complications were encountered. In conclusion, the Ilizarov method allows simultaneous progressive correction of all components of severe foot deformities associated with limb-lengthening discrepancy with minimal surgery, reducing risks of cutaneous or neurovascular complications and avoiding important shortening of the foot.
Stebbins, Julie; Harrington, Marian; Thompson, Nicky; Zavatsky, Amy; Theologis, Tim
Cerebral palsy (CP) is a complex syndrome, with multiple interactions between joints and muscles. Abnormalities in movement patterns can be measured using motion capture techniques, however determining which abnormalities are primary, and which are secondary, is a difficult task. Deformity of the foot has anecdotally been reported to produce compensatory abnormalities in more proximal lower limb joints, as well as in the contralateral limb. However, the exact nature of these compensations is unclear. The aim of this paper was to provide clear and objective criteria for identifying compensatory mechanisms in children with spastic hemiplegic CP, in order to improve the prediction of the outcome of foot surgery, and to enhance treatment planning. Twelve children with CP were assessed using conventional gait analysis along with the Oxford Foot Model prior to and following surgery to correct foot deformity. Only those variables not directly influenced by foot surgery were assessed. Any that spontaneously corrected following foot surgery were identified as compensations. Pelvic rotation, internal rotation of the affected hip and external rotation of the non-affected hip tended to spontaneously correct. Increased hip flexion on the affected side, along with reduced hip extension on the non-affected side also appeared to be compensations. It is likely that forefoot supination occurs secondary to deviations of the hindfoot in the coronal plane. Abnormal activity in the tibialis anterior muscle may be consequent to tightness and overactivity of the plantarflexors. On the non-affected side, increased plantarflexion during stance also resolved following surgery to the affected side. Copyright 2010 Elsevier B.V. All rights reserved.
Dreher, T; Wolf, S I; Heitzmann, D; Fremd, C; Klotz, M C; Wenz, W
The foot drop component of cavovarus foot deformity in patients with Charcot-Marie-Tooth disease is commonly treated by tendon transfer to provide substitute foot dorsiflexion or by tenodesis to prevent the foot from dropping. Our goals were to use three-dimensional foot analysis to evaluate the outcome of tibialis posterior tendon transfer to the dorsum of the foot and to investigate whether the transfer works as an active substitution or as a tenodesis. We prospectively studied fourteen patients with Charcot-Marie-Tooth disease and cavovarus foot deformity in whom twenty-three feet were treated with tibialis posterior tendon transfer to correct the foot drop component as part of a foot deformity correction procedure. Five patients underwent unilateral treatment and nine underwent bilateral treatment; only one foot was analyzed in each of the latter patients. Standardized clinical examinations and three-dimensional gait analysis with a special foot model (Heidelberg Foot Measurement Method) were performed before and at a mean of 28.8 months after surgery. The three-dimensional gait analysis revealed significant increases in tibiotalar and foot-tibia dorsiflexion during the swing phase after surgery. These increases were accompanied by a significant reduction in maximum plantar flexion at the stance-swing transition but without a reduction in active range of motion. Passive ankle dorsiflexion measured in knee flexion and extension increased significantly without any relevant decrease in passive plantar flexion. The AOFAS (American Orthopaedic Foot & Ankle Society) score improved significantly. Tibialis posterior tendon transfer was effective at correcting the foot drop component of cavovarus foot deformity in patients with Charcot-Marie-Tooth disease, with the transfer apparently working as an active substitution. Although passive plantar flexion was not limited after surgery, active plantar flexion at push-off was significantly reduced and it is unknown whether
Hastings, Mary K.; Johnson, Jeffrey E.; Strube, Michael J.; Hildebolt, Charles F.; Bohnert, Kathryn L.; Prior, Fred W.; Sinacore, David R.
Background: Charcot neuropathic osteoarthropathy associated foot deformity can result in joint instability, ulceration, and even amputation. The purpose of the present study was to follow patients with and without active Charcot osteoarthropathy for as long as two years to examine the magnitude and timing of foot alignment changes. Methods: We studied fifteen subjects with Charcot osteoarthropathy and nineteen subjects with diabetes mellitus and peripheral neuropathy without Charcot osteoarthropathy for one year; eight of the subjects with osteoarthropathy and five of the subjects with diabetes and peripheral neuropathy were followed for two years. Bilateral weight-bearing radiographs of the foot were made at baseline for all subjects, with repeat radiographs being made at six months for the osteoarthropathy group and at one and two years for both groups. Radiographic measurements included the Meary angle, cuboid height, calcaneal pitch, and hindfoot-forefoot angle. Results: The Meary angle, cuboid height, and calcaneal pitch worsened in feet with Charcot osteoarthropathy over one year as compared with the contralateral, uninvolved feet and feet in patients with diabetes and peripheral neuropathy. Cuboid height continued to worsen over the two-year follow-up in the feet with Charcot osteoarthropathy. These feet also had a greater change in the hindfoot-forefoot angle at one year as compared with the feet in patients with diabetes and peripheral neuropathy and at two years as compared with the contralateral, uninvolved feet. Conclusions: In patients with Charcot neuropathic osteoarthropathy, radiographic alignment measurements demonstrate the presence of foot deformity at the time of the initial clinical presentation and evidence of progressive changes over the first and second years. The six-month data suggest worsening of medial column alignment prior to lateral column worsening. This radiographic evidence of worsening foot alignment over time supports the need
Charles, Y P; Axt, M; Döderlein, L
The operative management of cavovarus foot deformity using soft tissue and bony procedures turns out to be difficult. The present study was undertaken to evaluate an individualised operative treatment and changes in pathologic peak pressure pattern. 38 patients (average age 29.6 years, follow-up 44.6 months) with 59 operated feet were examined pre- and postoperatively. The clinical assessment included a questionnaire, ankle ROM and evidence of callosities. Correction of the longitudinal arch was measured on lateral X-rays using Hibbs', calcaneal pitch and Meary's angles. Plantar peak pressures were analysed in 16 patients (21 feet) using dynamic pedobarography (EMED SF4 system). A good subjective functional and cosmetic result were achieved in 74.6 % of the feet. Walking distance, shoe wear and ankle ROM were improved. The height of longitudinal arch and calcaneal dorsiflexion decreased significantly (p = 0.001). An elevated first ray (overcorrection) was noted in 49.1 % of the cases. Postoperative plantar callosities occurred essentially under the lateral border of the foot but were improved compared to the preoperative situation. Dynamic pedobarography showed a significant postoperative (p = 0.002) decrease of loading under the lateral border, but peak pressures remained relatively high in the midfoot area. An increase of peak pressure under the great toe showed a functional improvement at push off. The individualised operative concept has proved to be successful and leads to satisfaction with early improvement of foot function and shoe wear. Nevertheless it is difficult to restore muscular balance and normal foot posture in progressive neuromuscular disorders. A more selective use of the Jones procedure, an additional peroneus longus to peroneus brevis tendon transfer and a dorsal wedge extension osteotomy should prevent overcorrection of the first ray. To avoid a relapsed hindfoot varus deformity, a stabilising triple arthrodesis including lateral wedge
Kaissi, Ali Al; Klaushofer, Klaus; Grill, Franz
We report on a 3-year-old boy with the full phenotypic features of Freeman Sheldon syndrome (FSS). Severe skew foot deformity has been recognized as additional skeletal abnormality. Parents were first degree cousins, raising the possibility of autosomal recessive pattern of inheritance. To the best of our knowledge this is the first report of severe skew foot deformity in a patient with (FSS). Keywords Freeman-Sheldon syndrome; Skew foot deformity; Metatarsus adductus PMID:22383916
Zambito, A; Dall'oca, C; Polo, A; Bianchini, D; Aldegheri, R
The aim of the study was to investigate the relationship between the clinical evidence of foot deformities in spina bifida occulta and the associated neurophysio-logical damage. The authors studied 47 patients with foot deformities (37 flat foot, 10 pes cavus) and vertebral cleft, variably associated with enuresis, midline cutaneous lesions, and further orthopaedic deformities. An electrophysiological evaluation was performed in an attempt to investigate the peripheral nervous system in greater detail, including conventional motor and sensory nerve conduction, F-wave recording and electromyogram (EMG) testing. The peroneal nerve F wave latency was longer in patients with pes cavus than in those with flat foot (P<0.04). Conversely, the posterior tibial nerve F-wave latency was longer in patients with flat foot than in those with pes cavus (P<0.02). Needle EMG showed large amplitude motor unit potentials during voluntary recruitment in all patients, suggesting a neurogenic origin of these EMG changes. Neurophysiological study makes it possible to distinguish between myogenic and lower motor neuron involvement. The existence of some degree of spinal cord dysraphism may be pathophysiologically associated with foot deformities. Children with foot deformities and clinical evidence of occult spinal dysraphism should have a neuro-physiological assessment in order to obtain an early diagnosis and avoid ineffective foot surgery.
Paecharoen, Siranya; Chadchavalpanichaya, Navaporn
To study the frequency, result, and concomitant factors of the use of custom-made shoes in Foot Clinic, Siriraj Hospital. Studying from patient records and interviewing the patients who had foot deformities without numbness and received custom-made shoes from the Foot Clinic, Siriraj Hospital between January 2009 and December 2011 about the latest custom-made shoes after the first three months of use. Sixty-seven participants were reviewed and included eight males (11.9%) and 59 females (88.1%) with an average age of 57.1 years. The majority had congenital foot deformity (19.4%). Most of them received sandal-type shoes (34.3%) and total contact orthosis (52.2%). The use of custom-made shoes that the participants had to use for more than 3 days/week and for more than or equal to 50% of daily walking and standing duration was 47.8%. Using these shoes reduced foot pain and increased walking stability (p-value = 0.007 and 0.023). Factors associated with the use of custom-made shoes were no previous callus (odds ratio = 25.30, 95% CI 2.20-290.56), decreasing callus after using the shoes (odds ratio = 23.54, 95% CI 1.65-335.23), decreasing foot pain after using the shoes (odds ratio = 5.01, 95% CI 1.20-20.95), and overall satisfaction (odd ratio = 21.47, 95% CI 3.81-121.04). The use of custom-made shoes from the Foot Clinic, Siriraj Hospital was 47.8%. Using the shoes could reduce foot pain and increase walking stability. Factors associated with the use of custom-made shoes were no previous callus, decreasing callus, decreasing foot pain, and overall satisfaction.
Eidelman, Mark; Katzman, Alexander
The Taylor spatial frame is a relatively new external fixator able to correct 6-axis deformities with computer accuracy using a virtual hinge. The Taylor spatial frame has gained tremendous popularity, but its use for the correction of foot deformities is still limited. Various ring configurations and a new foot program have recently become available and allow correction of the most difficult foot deformities. This article reports the results of 13 patients (15 frames) with various foot deformities treated at our institution with 3 different Taylor spatial frame configurations (standard rings construction, miter frame, and butt frame). Treatment goals were achieved in 11 patients, while mild residual deformities persisted in 2 patients. Most complications during treatment consisted of pin tract infections. One patient had premature consolidation, which was treated with additional midtarsal osteotomy; 1 had metatarsophalangeal joint subluxation, which was fixed with tendon lengthening and pining of the joint; and 1 had talar subluxation, which was reduced with residual program correction. Based on our experience, we believe the Taylor spatial frame is a very powerful and accurate surgical modality with a relatively short learning curve for the correction for most difficult foot deformities.
Kelly, Luke A.; Cresswell, Andrew G.; Racinais, Sebastien; Whiteley, Rodney; Lichtwark, Glen
The human foot is characterized by a pronounced longitudinal arch (LA) that compresses and recoils in response to external load during locomotion, allowing for storage and return of elastic energy within the passive structures of the arch and contributing to metabolic energy savings. Here, we examine the potential for active muscular contribution to the biomechanics of arch deformation and recoil. We test the hypotheses that activation of the three largest plantar intrinsic foot muscles, abductor hallucis, flexor digitorum and quadratus plantae is associated with muscle stretch in response to external load on the foot and that activation of these muscles (via electrical stimulation) will generate sufficient force to counter the deformation of LA caused by the external load. We found that recruitment of the intrinsic foot muscles increased with increasing load, beyond specific load thresholds. Interestingly, LA deformation and muscle stretch plateaued towards the maximum load of 150% body weight, when muscle activity was greatest. Electrical stimulation of the plantar intrinsic muscles countered the deformation that occurred owing to the application of external load by reducing the length and increasing the height of the LA. These findings demonstrate that these muscles have the capacity to control foot posture and LA stiffness and may provide a buttressing effect during foot loading. This active arch stiffening mechanism may have important implications for how forces are transmitted during locomotion and postural activities as well as consequences for metabolic energy saving. PMID:24478287
Pinzur, M S
During a 10-year period, 237 patients (129 women, 108 men) with a diagnosis of neuropathic (Charcot) arthropathy of the foot and ankle were treated in a tertiary care university hospital medical center. During this period, 115 of the patients (48.5%) were treated nonoperatively as outpatients with local skin and nail care, accommodative shoe wear, and custom foot orthoses. A total of 120 (50.6%) underwent 143 operations. Surgery included 21 major limb amputations, 29 ankle fusions, 26 hindfoot fusions, 23 exostectomies, and 23 debridements for osteomyelitis. It is widely accepted that patients with diabetes are at risk for developing foot ulcers, which can lead to lower extremity amputation. Within the population of diabetic patients, it is widely accepted that patients with neuropathic (Charcot) arthropathy of the foot and ankle have one of the highest likelihoods of having to undergo lower extremity amputation. The current emphasis in care of the foot of a diabetic patient involves a multidisciplinary team approach combining patient education, skin and nail care, and accommodative shoe wear. As data from prophylactic programs become available, resource allocation and cost of care can be compared with this benchmark baseline. This benchmark analysis can be used by those who are responsible for allocating resources and projecting healthcare costs for this "high utilization"/high risk patient population.
Lamm, Bradley M; Gourdine-Shaw, Monique C; Thabet, Ahmed M; Jindal, Gaurav; Herzenberg, John E; Burghardt, Rolf D
Open midfoot wedge osteotomy correction can cause neurovascular compromise, requires extensive exposure, sacrifices normal joints, and shortens the foot. We used a minimally invasive technique to treat complex foot deformities by combining percutaneous Gigli saw midfoot osteotomy, circular external fixation, and acute, gradual, or gradual with acute manipulation correction. The medical records of 23 patients (26 feet) with complex foot deformities (congenital, 18 feet; neuromuscular, 4 feet; post-traumatic, 3 feet; malunion, 1 foot) who had undergone treatment within an 18-year period (1990 through 2007) were retrospectively reviewed. We also performed the procedure on 10 cadaveric limbs to determine whether anatomic structures were at risk. Correction was achieved in all feet. The mean duration of external fixation treatment was 4.2 (range 3 to 7) months. The mean follow-up duration was 4.7 (range 2 to 18) years. A significant difference was observed in the pre- and postoperative, lateral view, talar-first metatarsal angle (p = .001). Minor complications (4 feet) consisted of bony exostoses. Major complications included recurrent deformity in 3 feet and sural nerve entrapment in 1 foot. Two patients had mild and one moderate foot pain. Three patients had impaired gait function; the remaining patients had functional gait. The mean interval until wearing regular shoes after external fixation removal was 2.3 (range 1 to 4) months. All but 1 of the patients were satisfied with the final results. We observed no cadaveric neurovascular injury. Our results have shown that percutaneous Gigli saw midfoot osteotomy can be performed without neurovascular injury and is capable of successfully correcting complex foot deformities. Copyright © 2014 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.
Barisch-Fritz, Bettina; Schmeltzpfenning, Timo; Plank, Clemens; Grau, Stefan
The complex functions of feet require a specific composition, which is progressively achieved by developmental processes. This development should take place without being affected by footwear. The aim of this study is to evaluate differences between static and dynamic foot morphology in developing feet. Feet of 2554 participants (6-16 years) were recorded using a new scanner system (DynaScan4D). Each foot was recorded in static half and full weight-bearing and during walking. Several foot measures corresponding to those used in last construction were calculated. The differences were identified by one-way ANOVA and paired Student's t-test. Static and dynamic values of each foot measure must be considered to improve the fit of footwear. In particular, footwear must account for the increase of forefoot width and the decrease of midfoot girth. Furthermore, the toe box should have a more rounded shape. The findings are important for the construction of footwear for developing feet.
Gunay, Huseyin; Sozbilen, Murat Celal; Gurbuz, Yusuf; Altinisik, Mahmut; Buyukata, Beyhan
The previously suggested association between the incidence of high-level foot deformity and muscle imbalance is no longer supported, when evaluated independent from motor and sensory loss and level of lesion, by current studies. The purpose of this study was to evaluate the association between level of lesion and foot deformity. Of 545 patients, a total of 136 (272 feet) patients admitted to the spina bifida clinic between 2010 and 2014 were included in this study. Levels of all lesions were evaluated using initial operation data, the motor-sensory exams, and direct radiography. All patients were categorized into four different groups: Thoracic region (group 1), high-level lumbar-L1-2 region (group 2), mild and lower lumbar regions (L3-4-5) (group 3), and Sacral region (group 4). The mean follow-up time was 34.9 months (range 8-176 months). Group 1, group 2, group 3, and group 4 included 24 (17.6%), 14 (10.3%), 19 (14%), and 79 (58.1%) patients with regards to level of lesion, respectively. The incidences of foot deformity were 85.4, 85.7, 81.5, and 50.6% in groups 1, 2, 3, and 4, respectively. Of all patients, 22% (61 feet) had clubfoot, 16% (44 feet) pes cavus, 10% (26 feet) pes valgus, 6% (17 feet) isolated equinus, 6 % (17 feet) pes calcaneus, and 5% (13 feet) metatarsus adductus. Patients without a foot deformity (81% of normal feet) usually had a lesion at the sacral level (p ≤ 0.05). On the other hand, isolated equinus (70%) and clubfoot (49%) deformities were mostly observed in spinal lesions (p > 0.05). The incidence of pes calcaneus, pes valgus, and adductus deformities inclined as the lesion level decreased (p > 0.05). In this study, it was concluded that foot deformities were directly related to the level of lesion. The comparison of higher and lower level lesions revealed that the types of foot deformity differed significantly. The muscle imbalance due to spina bifida was not sufficient to explain the pathology. On the other hand, the
Owsley, D W; Mann, R W
An unusual foot deformity in an archaeological specimen from Oldham County, Texas, is presented. It is hoped that through description and radiographic and photographic examination the readers will be able to offer opinions concerning the frequency or possible etiology of the condition.
Background In spastic cerebral palsy (SCP), a limited range of motion of the foot (ROM), limits gait and other activities. Assessment of this limitation of ROM and knowledge of active mechanisms is of crucial importance for clinical treatment. Methods For a comparison between spastic cerebral palsy (SCP) children and typically developing children (TD), medial gastrocnemius muscle-tendon complex length was assessed using 3-D ultrasound imaging techniques, while exerting externally standardized moments via a hand-held dynamometer. Exemplary X-ray imaging of ankle and foot was used to confirm possible TD-SCP differences in foot deformation. Results SCP and TD did not differ in normalized level of excitation (EMG) of muscles studied. For given moments exerted in SCP, foot plate angles were all more towards plantar flexion than in TD. However, foot plate angle proved to be an invalid estimator of talocrural joint angle, since at equal foot plate angles, GM muscle-tendon complex was shorter in SCP (corresponding to an equivalent of 1 cm). A substantial difference remained even after normalizing for individual differences in tibia length. X-ray imaging of ankle and foot of one SCP child and two typically developed adults, confirmed that in SCP that of total footplate angle changes (0-4 Nm: 15°), the contribution of foot deformation to changes in foot plate angle (8) were as big as the contribution of dorsal flexion at the talocrural joint (7°). In typically developed individuals there were relatively smaller contributions (10 -11%) by foot deformation to changes in foot plate angle, indicating that the contribution of talocrural angle changes was most important. Using a new estimate for position at the talocrural joint (the difference between GM muscle–tendon complex length and tibia length, GM relative length) removed this effect, thus allowing more fair comparison of SCP and TD data. On the basis of analysis of foot plate angle and GM relative length as a function
Liao, Chia-Chi; Qi, Hui-Xin; Reed, Jamie L.; Miller, Daniel J.; Kaas, Jon H.
Limbs may fail to grow properly during fetal development, but the extent to which such growth alters the nervous system has not been extensively explored. Here we describe the organization of the somatosensory system in a 6-year-old monkey (Macaca radiata) born with a deformed left foot in comparison to the results from a normal monkey (Macaca fascicularis). Toes 1, 3, and 5 were missing, but the proximal parts of toes 2 and 4 were present. We used anatomical tracers to characterize the patterns of peripheral input to the spinal cord and brainstem, as well as between thalamus and cortex. We also determined the somatotopic organization of primary somatosensory area 3b of both hemispheres using multiunit electrophysiological recording. Tracers were subcutaneously injected into matching locations of each foot to reveal their representations within the lumbar spinal cord, and the gracile nucleus (GrN) of the brainstem. Tracers injected into the representations of the toes and plantar pads of cortical area 3b labeled neurons in the ventroposterior lateral nucleus (VPL) of the thalamus. Contrary to the orderly arrangement of the foot representation throughout the lemniscal pathway in the normal monkey, the plantar representation of the deformed foot was significantly expanded and intruded into the expected representations of toes in the spinal cord, GrN, VPL, and area 3b. We also observed abnormal representation of the intact foot in the ipsilateral spinal cord and contralateral area 3b. Thus, congenital malformation influences the somatotopic representation of the deformed as well as the intact foot. PMID:25326245
Liao, Chia-Chi; Qi, Hui-Xin; Reed, Jamie L; Miller, Daniel J; Kaas, Jon H
Limbs may fail to grow properly during fetal development, but the extent to which such growth alters the nervous system has not been extensively explored. Here we describe the organization of the somatosensory system in a 6-year-old monkey (Macaca radiata) born with a deformed left foot in comparison to the results from a normal monkey (Macaca fascicularis). Toes 1, 3, and 5 were missing, but the proximal parts of toes 2 and 4 were present. We used anatomical tracers to characterize the patterns of peripheral input to the spinal cord and brainstem, as well as between thalamus and cortex. We also determined the somatotopic organization of primary somatosensory area 3b of both hemispheres using multiunit electrophysiological recording. Tracers were subcutaneously injected into matching locations of each foot to reveal their representations within the lumbar spinal cord, and the gracile nucleus (GrN) of the brainstem. Tracers injected into the representations of the toes and plantar pads of cortical area 3b labeled neurons in the ventroposterior lateral nucleus (VPL) of the thalamus. Contrary to the orderly arrangement of the foot representation throughout the lemniscal pathway in the normal monkey, the plantar representation of the deformed foot was significantly expanded and intruded into the expected representations of toes in the spinal cord, GrN, VPL, and area 3b. We also observed abnormal representation of the intact foot in the ipsilateral spinal cord and contralateral area 3b. Thus, congenital malformation influences the somatotopic representation of the deformed as well as the intact foot.
Boffeli, Troy J; Collier, Rachel C
Intrinsic plus foot deformity has primarily been associated with cerebral palsy and involves spastic contracture of the intrinsic musculature with resultant toe deformities. Digital deformity is caused by a dynamic imbalance between the intrinsic muscles in the foot and extrinsic muscles in the lower leg. Spastic contracture of the toes frequently involves curling under of the lesser digits or contracture of the hallux into valgus or plantarflexion deformity. Patients often present with associated pressure ulcers, deformed toenails, shoe or brace fitting challenges, and pain with ambulation or transfers. Four different patterns of intrinsic plus foot deformity have been observed by the authors that likely relate to the different patterns of muscle involvement. Case examples are provided of the 4 patterns of intrinsic plus foot deformity observed, including global intrinsic plus lesser toe deformity, isolated intrinsic plus lesser toe deformity, intrinsic plus hallux valgus deformity, and intrinsic plus hallux flexus deformity. These case examples are presented to demonstrate each type of deformity and our approach for surgical management according to the contracture pattern. The surgical approach has typically involved tenotomy, capsulotomy, or isolated joint fusion. The main goals of surgical treatment are to relieve pain and reduce pressure points through digital realignment in an effort to decrease the risk of pressure sores and allow more effective bracing to ultimately improve the patient's mobility.
Greenhagen, Robert M; Johnson, Adam R; Bevilacqua, Nicholas J
Contracture of the Achilles-gastrocnemius-soleus complex leading to ankle equinus has been linked to the development of various foot disorders. Decrease in ankle dorsiflexion results in an increase in plantar pressures and in diabetes and neuropathy, increased pressures can lead to ulceration and possibly the formation of Charcot foot. Surgical management of the equinus deformity corrects this abnormality and has the potential to avert the development of Charcot foot or ankle. Gastrocnemius recession, tendo-Achilles lengthening, and Achilles tenotomy have all been offered as surgical solutions to this condition. This article reviews ankle equinus and compares the treatment options available. A video of Hoke's triple hemisection has been included with this article and can be viewed at www.podiatric.theclinics.com.
Westberry, David E; Davids, Jon R; Roush, Thomas F; Pugh, Linda I
quantitative radiographic analysis of the segmental alignment of the involved foot and ankle in children with hemiplegic CP is possible and is more precise and reliable than traditional qualitative techniques. Quantitative techniques can identify a wider range of foot segmental malalignments and should facilitate deformity analysis, preoperative planning, assessment of outcome, and comparison of results between centers.
DiDomenico, Lawrence A; Butto, Danielle N
Subtalar joint arthrodesis is a procedure used in posttraumatic arthritis, osteoarthritis, tarsal coalition management, posterior tibial tendon dysfunction, and inflammatory arthropathies, and can be used in deformity correction. The goals of the procedure are to eliminate pain, improve function, restore stability, and realign the hind foot. The procedure has high patient satisfaction with low complications while preserving motion in adjacent tarsal joints. Joint preparation is important and time should be spent preparing the joint for successful arthrodesis and the fixation construct needs to be done well and effectively to provide a solid Arbeitsgemeinschaft für Osteosynthesefragen (AO) construct for good results. Copyright © 2017 Elsevier Inc. All rights reserved.
Aurell, Y; Johansson, A; Hansson, G; Wallander, H; Jonsson, K
The aim of this study was to establish guidelines for US assessment of the talo-crural, the talo-navicular and the calcaneo-cuboid joints during the first year of life, which could serve as a reference while studying foot deformities. The feet of 54 healthy children were examined at birth and at the age of 4, 7 and 12 months by using three easily defined and reproducible US projections. With a medial projection the relation of the navicular in relation to the medial malleolus and the head of the talus was studied. A lateral projection revealed the calcaneo-cuboid relationship and a dorsal projection the talo-navicular alignment in the sagittal plane. Normal values for measurements of these cartilaginous relationships were established for the different age groups. Intra- and inter-observer reliability was assessed and found to be acceptable ( r=0.53-0.90, Pearson correlation coefficient). With US it is possible to obtain reproducible planes of investigation that give reliable information about the talo-crural, the talo-navicular and the calcaneo-cuboid relationships during the first year of life.
Petre, Marc; Erdemir, Ahmet; Panoskaltsis, Vassilis P.; Spirka, Thomas A.; Cavanagh, Peter R.
Accurate prediction of plantar shear stress and internal stress in the soft tissue layers of the foot using finite element models would provide valuable insight into the mechanical etiology of neuropathic foot ulcers. Accurate prediction of the internal stress distribution using finite element models requires that realistic descriptions of the material properties of the soft tissues are incorporated into the model. Our investigation focused on the creation of a novel three-dimensional (3D) finite element model of the forefoot with multiple soft tissue layers (skin, fat pad, and muscle) and the development of an inverse finite element procedure that would allow for the optimization of the nonlinear elastic coefficients used to define the material properties of the skin muscle and fat pad tissue layers of the forefoot based on a Ogden hyperelastic constitutive model. Optimization was achieved by comparing deformations predicted by finite element models to those measured during an experiment in which magnetic resonance imaging (MRI) images were acquired while the plantar surface forefoot was compressed. The optimization procedure was performed for both a model incorporating all three soft tissue layers and one in which all soft tissue layers were modeled as a single layer. The results indicated that the inclusion of multiple tissue layers affected the deformation and stresses predicted by the model. Sensitivity analysis performed on the optimized coefficients indicated that small changes in the coefficient values (± 10%) can have rather large impacts on the predicted nominal strain (differences up to 14%) in a given tissue layer. PMID:23699713
Petre, Marc; Erdemir, Ahmet; Panoskaltsis, Vassilis P; Spirka, Thomas A; Cavanagh, Peter R
Accurate prediction of plantar shear stress and internal stress in the soft tissue layers of the foot using finite element models would provide valuable insight into the mechanical etiology of neuropathic foot ulcers. Accurate prediction of the internal stress distribution using finite element models requires that realistic descriptions of the material properties of the soft tissues are incorporated into the model. Our investigation focused on the creation of a novel three-dimensional (3D) finite element model of the forefoot with multiple soft tissue layers (skin, fat pad, and muscle) and the development of an inverse finite element procedure that would allow for the optimization of the nonlinear elastic coefficients used to define the material properties of the skin muscle and fat pad tissue layers of the forefoot based on a Ogden hyperelastic constitutive model. Optimization was achieved by comparing deformations predicted by finite element models to those measured during an experiment in which magnetic resonance imaging (MRI) images were acquired while the plantar surface forefoot was compressed. The optimization procedure was performed for both a model incorporating all three soft tissue layers and one in which all soft tissue layers were modeled as a single layer. The results indicated that the inclusion of multiple tissue layers affected the deformation and stresses predicted by the model. Sensitivity analysis performed on the optimized coefficients indicated that small changes in the coefficient values (±10%) can have rather large impacts on the predicted nominal strain (differences up to 14%) in a given tissue layer.
Coşkun, Gürsoy; Talu, Burcu; Bek, Nilgün; Bayramlar, Kezban Yigiter
[Purpose] To investigate the relationship between hallux valgus (HV) deformity and the position of rearfoot joints, and its effects on the quality of life, pain, and related functional status of women with bilateral hallux valgus (HV). [Subjects and Methods] The subjects were 27 right-dominant women. Demographic data, HV angle, weight-bearing and non-weight-bearing subtalar pronation (SP), and navicular height were recorded. Visual Analog Pain Scale, Foot Function Index (FFI), and the American Orthopaedic Foot and Ankle Society (AOFAS) first metatarsophalangeal- interphalangeal (MTP-IP) and AOFAS Mid foot (MF) Scales, and SF-36 were also used. [Results] HV angle, weight-bearing SP, and pain intensity of the left foot were higher. HV angle of left foot was correlated with all sub-scales of FFI, the pain parameter of AOFAS MTP-IP, and pain and total scores of AOFAS-MF Scale. HV angle of the left foot correlated with physical role, pain, and social function sub-domains of SF-36. Right HV angles were correlated with right foot pain and non-weight-bearing SP. [Conclusion] Increasing HV angle and pathomechanical changes in the rear foot are correlated, resulting in increasing pain and thus decreasing functional status as well as decreasing quality of life. Although all the participants were right-dominant, their left foot problems were more prominent. PMID:27134358
De Palma, L; Serra, F; Coletti, V
The authors illustrate the different types of nervous disorders of the foot caused by congenital deformations of the lumbosacral spine. They classify these clinical forms according to the level of the neurological lesions, although emphasizing that more complex neurological damage may cause very atypical deformities that are difficult to classify. Today the treatment of nervous disorders of the foot caused by congenital deformations of the lumbosacral spine seems almost promising when compared to neurological and urological problems which have therapeutic priority. Possible methods of surgical correction, as well as indications that differ according to the age of the patient and the type and extent of the deformity, are discussed. These deformities of the foot evolve very quickly; treatment must be timely or reduction is difficult. Furthermore, their peculiar tendency to relapse necessitates periodic comprehensive follow-up exams and regular maintenance therapy (orthetic and physiatric). Special care must be taken before and during treatment to prevent trophic skin lesions. For this reason, solutions other than casts (external fixation, for example) may be preferable for the maintenance of the correction. The treatment of these deformities, whether conservative or surgical, should aim primarily to achieve adequate plantar support for future aided or autonomous ambulation.
Lazzeri, D; Castello, M F; Grassetti, L; Dashti, T; Zhang, Y X; Persichetti, P
Although Renaissance artists were skilled in representing normal anatomy, a close look at some paintings reveals anatomical variations in the depiction of the feet of human figures. A systematic review has identified 25 paintings by five artists in which the presumptive medico-artistic diagnosis of congenital or acquired foot deformity seems to be varyingly present. The connection between these five painters and what factors have influenced artists' style in the depiction of such deformities is discussed. The possible iconography and medical-historical meaning of such variations, as well as the possibility of artistic licence and real representation that drove the painters to depict these deformities, is explored and debated.
Tang, Ulla Hellstrand; Zügner, Roland; Lisovskaja, Vera; Karlsson, Jon; Hagberg, Kerstin; Tranberg, Roy
Objective Foot deformities, neuropathy, and dysfunction in the lower extremities are known risk factors that increase plantar peak pressure (PP) and, as a result, the risk of developing foot ulcers in patients with diabetes. However, knowledge about the prevalence of these factors is still limited. The aim of the present study was to describe the prevalence of risk factors observed in patients with diabetes without foot ulcers and to explore possible connections between the risk factors and high plantar pressure. Patients and methods Patients diagnosed with type 1 (n=27) or type 2 (n=47) diabetes (mean age 60.0±15.0 years) were included in this cross-sectional study. Assessments included the registration of foot deformities; test of gross function at the hip, knee, and ankle joints; a stratification of the risk of developing foot ulcers according to the Swedish National Diabetes Register; a walking test; and self-reported questionnaires including the SF-36 health survey. In-shoe PP was measured in seven regions of interests on the sole of the foot using F-Scan®. An exploratory analysis of the association of risk factors with PP was performed. Results Neuropathy was present in 28 (38%), and 39 (53%) had callosities in the heel region. Low forefoot arch was present in 57 (77%). Gait-related parameters, such as the ability to walk on the forefoot or heel, were normal in all patients. Eighty percent had normal function at the hip and ankle joints. Gait velocity was 1.2±0.2 m/s. All patients were stratified to risk group 3. Hallux valgus and hallux rigidus were associated with an increase in the PP in the medial forefoot. A higher body mass index (BMI) was found to increase the PP at metatarsal heads 4 and 5. Pes planus was associated with a decrease in PP at metatarsal head 1. Neuropathy did not have a high association with PP. Conclusions This study identified several potential risk factors for the onset of diabetic foot ulcers (DFU). Hallux valgus and hallux
Boffeli, Troy J; Tabatt, Jessica A
Charcot-Marie-Tooth disease is a neuromuscular disorder that commonly results in a predictable pattern of progressive bilateral lower extremity weakness, numbness, contracture, and deformity, including drop foot, loss of ankle eversion strength, dislocated hammertoes, and severe cavus foot deformity. Late stage reconstructive surgery will be often necessary if the deformity becomes unbraceable or when neuropathic ulcers have developed. Reconstructive surgery for Charcot-Marie-Tooth deformity is generally extensive and sometimes staged. Traditional reconstructive surgery involves a combination of procedures, including tendon lengthening or transfer, osteotomy, and arthrodesis. The described technique highlights our early surgical approach, which involves limited intervention before the deformity becomes rigid, severe, or disabling. We present 2 cases to contrast our early minimally invasive technique with traditional late stage reconstruction. Charcot-Marie-Tooth disease affects different muscles at various stages of disease progression. As 1 muscle becomes weak, the antagonist will overpower it and cause progressive deformity. The focus of the early minimally invasive approach is to decrease the forces that cause progressive deformity yet maintain function, where possible. Our goal has been to maintain a functional and braceable foot and ankle, with the hope of avoiding or limiting the extent of future major reconstructive surgery. The presented cases highlight the patient selection criteria, the ideal timing of early surgical intervention, the procedure selection criteria, and operative pearls. The early minimally invasive approach includes plantar fasciotomy, Achilles tendon lengthening, transfer of the peroneus longus to the fifth metatarsal, Hibbs and Jones tendon transfer, and hammertoe repair of digits 1 to 5.
... can lead to severe deformity, disability and even amputation. Because of its seriousness, it is important that ... of Charcot foot, development of ulcers and possibly amputation. In cases with significant deformity, bracing is also ...
Jain, Pragya; Mehtani, Anil; Goel, Meenakshi; Jain, Saurabh; Sood, Alok; Kumar Jain, Anil
Various reported scores for congenital talipes equinovarus are presented with observer variations and lack in objective evidence of severity of deformity. Anteromedial foot bimalleolar angle (FBM), an objective assessment of deformity and correction, was correlated and compared with Pirani scores 0.5-2, 2.5-4, 4.5-6 as grouped I to III for mean and SD in 244 club feet in 137 children. The mean FBM angles of groups I to III were 79.72°, 68.4°, and 53.27°, respectively. The FBM angle gives an objective assessment of the severity of deformity and can be used as objective evidence of improvement/deterioration of deformity.
Liang, Jun; Yang, Yunfeng; Yu, Guangrong; Niu, Wenxin; Wang, Yubin
The majority of foot deformities are related to arch collapse or instability, especially the longitudinal arch. Although the relationship between the plantar fascia and arch height has been previously investigated, the stress distribution remains unclear. The aim of this study was to explore the role of the plantar ligaments in foot arch biomechanics. We constructed a geometrical detailed three-dimensional (3-D) finite element (FE) model of the human foot and ankle from computer tomography images. The model comprised the majority of joints in the foot as well as bone segments, major ligaments, and plantar soft tissue. Release of the plantar fascia and other ligaments was simulated to evaluate the corresponding biomechanical effects on load distribution of the bony and ligamentous structures. These intrinsic ligaments of the foot arch were sectioned to simulate different pathologic situations of injury to the plantar ligaments, and to explore bone segment displacement and stress distribution. The validity of the 3-D FE model was verified by comparing results with experimentally measured data via the displacement and von Mise stress of each bone segment. Plantar fascia release decreased arch height, but did not cause total collapse of the foot arch. The longitudinal foot arch was lost when all the four major plantar ligaments were sectioned simultaneously. Plantar fascia release was compromised by increased strain applied to the plantar ligaments and intensified stress in the midfoot and metatarsal bones. Load redistribution among the centralized metatarsal bones and focal stress relief at the calcaneal insertion were predicted. The 3-D FE model indicated that plantar fascia release may provide relief of focal stress and associated heel pain. However, these operative procedures may pose a risk to arch stability and clinically may produce dorsolateral midfoot pain. The initial strategy for treating plantar fasciitis should be non-operative.
Kusumoto, A; Suzuki, T; Kumakura, C; Ashizawa, K
In order to investigate the shape and size differences in feet caused by daily footwear, a comparative study was conducted on foot morphology in two populations. The data from six measurements in general physique and 18 measurements in the feet and their contours were obtained from 34 Filipino women in Isabela Province and 40 Japanese women in Tokyo. Despite the fact that the Tokyo women had larger physique than the Isabela women, there were no significant differences in foot size between two groups. Both relative size of foot for general physique and intragroup deviation of foot proportion were larger in the Isabela women than those in the Tokyo women. In comparing foot contour, many measurements relating particularly to foot proportion, represented by angles, showed significant differences between the two groups. In gross observation some of the Isabela women showed marked deformity of the grand toe to the lateral side, "like a hallux valgus' without any complaints. In principal-component analysis (PCA), CP1 was interpreted as size factor, CP2 was considered as position of foot axis, CP3 and CP4 were estimated as degree of angle between foot axis and ball axis. Means of individual score by PCA showed a completely inverse pattern between Isabela and Tokyo women. The differences in foot morphology recognized in these two groups were considered from the point of view of differences of daily footwear, which have not changed in the Philippines but have changed dramatically in Japan since World War II. We concluded that the deformity like a hallux valgus, frequently found in previous generations of Japanese who used to wear traditional footwear, geta and zori, must have been a healthy deformity, however, the pathological deformity hallux valgus is observed only in the Isabela women of today.
Chen, Wei; Liu, Xiaoyu; Pu, Fang; Yang, Yang; Wang, Lizhen; Liu, Hong; Fan, Yubo
A novel splint, the assisting ankle-foot orthoses (AFO), was developed to provide adjustable sustained stretching to improve conservative treatment for equinus deformities in children with cerebral palsy (CP). The treatment effect was validated by follow-up visits. This study involved subjects between 2 and 12 years old, including 28 CP children treated with splint-assisted AFO correction, 30 CP children treated with static AFO correction, and 30 normal children with typical development (TD). Quantitative pedobarographic measurements were taken to evaluate the effect of splint-assisted AFO correction. The heel/forefoot ratio was introduced to indicate the degree of the equinus deformity during treatment. The results showed that the heel/forefoot ratios were 1.41 ± 0.26 for the TD children; 0.65 ± 0.41, 1.02 ± 0.44, and 1.24 ± 0.51 for the splint-assisted AFO correction before and after 6-month and 12-month treatments; 0.59 ± 0.37, 0.67 ± 0.44, and 0.66 ± 0.42 for the static AFO correction before and after 6-month and 12-month treatments. This study suggests that correction with the adjustable splint-assisted AFO is an effective treatment for equinus deformity in CP Children.
Giannotti, Erika; Merlo, Andrea; Zerbinati, Paolo; Longhi, Maria; Prati, Paolo; Masiero, Stefano; Mazzoli, Davide
Equinovarus foot deformity (EVFD) compromises several prerequisites of walking and increases the risk of falling. Guidelines on rehabilitation following EVFD surgery are missing in current literature. The aim of this study was to analyze safety and adherence to an early rehabilitation treatment characterized by immediate weight bearing with an ankle-foot orthosis (AFO) in hemiplegic patients after EVFD surgery and to describe gait changes after EVFD surgical correction combined with early rehabilitation treatment. Retrospective observational cohort study. Inpatient rehabilitation clinic. Forty-seven adult patients with hemiplegia consequent to ischemic or haemorrhagic stroke (L/R 20/27, age 56±15 years, time from lesion 6±5 years). A specific rehabilitation protocol with a non-articulated AFO, used to allow for immediate gait training, started one day after EVFD surgery. Gait analysis (GA) data before and one month after surgery were analyzed. The presence of differences in GA space-time parameters, in ankle dorsiflexion (DF) values and peaks at initial contact (DF at IC), during stance (DF at St) and swing (DF at Sw) were assessed by the Wilcoxon Test while the presence of correlations between pre- and post-operative values by Spearman's correlation coefficient. All patients completed the rehabilitation protocol and no clinical complications occurred in the sample. Ankle DF increased one month after surgery at all investigated gait phases (Wilcoxon Test, P<0.0001), becoming neutral at IC. Significant (P<0.05) variations were found for stride length, stride width, anterior step length of the affected side and for the duration of the double support phase of the contralateral side. The postsurgery ankle DF at St was found to be correlated (R=0.81, P<0.0001) with its pre-surgery value, thus being predictable. Weaker significant correlations were found for DF at Sw and DF at IC, where contribution from the dorsiflexor muscles is required in addition to calf muscle
Crevoisier, Xavier; Assal, Mathieu; Stanekova, Katarina
The pathogenesis of hallux valgus deformity is multifactorial. Conservative treatment can alleviate pain but is unable to correct the deformity. Surgical treatment must be adapted to the type and severity of the deformity. Success of surgical treatment ranges from 80% to 95%, and complication rates range from 10% to 30%. Ankle osteoarthrosis most commonly occurs as a consequence of trauma. Ankle arthrodesis and total ankle replacement are the most common surgical treatments of end stage ankle osteoarthrosis. Both types of surgery result in similar clinical improvement at midterm; however, gait analysis has demonstrated the superiority of total ankle replacement over arthrodesis. More recently, conservative surgery (extraarticular alignment osteotomies) around the ankle has gained popularity in treating early- to mid-stage ankle osteoarthrosis. Adult acquired flatfoot deformity is a consequence of posterior tibial tendon dysfunction in 80% of cases. Classification is based upon the function of the tibialis posterior tendon, the reducibility of the deformity, and the condition of the ankle joint. Conservative treatment includes orthotics and eccentric muscle training. Functional surgery is indicated for treatment in the early stages. In case of fixed deformity, corrective and stabilising surgery is performed. Cite this article: Crevoisier X, Assal M, Stanekova K. Hallux valgus, ankle osteoarthrosis and adult acquired flatfoot deformity: a review of three common foot and ankle pathologies and their treatments. EFORT Open Rev 2016;1:58–64. DOI: 10.1302/2058-5241.1.000015. PMID:28461929
Iwanuma, Soichiro; Akagi, Ryota; Hashizume, Satoru; Kanehisa, Hiroaki; Yanai, Toshimasa; Kawakami, Yasuo
The purpose of this study was to clarify how foot deformation affects the relationship between triceps surae muscle-tendon unit (MTU) length and ankle joint angle. For six women and six men a series of sagittal magnetic resonance (MR) images of the right foot were taken, and changes in MTU length (the displacement of the calcaneal tuberosity), foot arch angle, and ankle joint angle were measured. In the passive session, each subject's ankle joint was secured at 10° dorsiflexed position, neutral position (NP), and 10° and 20° plantar flexed positions while MR images were acquired. In the active session, each subject was requested to perform submaximal isometric plantar flexions (30%, 60%, and 80% of voluntary maximum) at NP. The changes in MTU length in each trial were estimated by two different formulae reported previously. The changes of the measured MTU length as a function of ankle joint angles observed in all trials of the active session were significantly (p<0.05) larger than corresponding values in the passive session and by the estimation formulae. In the passive session, MTU length changes were significantly smaller than the estimated values when the ankle was plantar flexed. The foot arch angle increased as the contraction level increased from rest (117 ± 4°) to 80% (125 ± 3°), and decreased as the ankle was positioned further into plantar flexion in the passive session (115 ± 3°). These results indicate that foot deformation profoundly affects the triceps surae MTU length-ankle joint angle relationship during plantar flexion.
Legaspi, J; Li, Y H; Chow, W; Leong, J C
We reviewed 24 feet in 15 patients who had undergone talectomy for recurrent equinovarus deformity; 21 were associated with arthrogryposis multiplex congenita, two with myelomeningocele and one with idiopathic congenital talipes equinovarus. The mean follow-up was 20 years. Good results were achieved in eight feet (33%) in which further surgery was not needed and walking was painless; a fair result was obtained in ten feet (42%) in which further surgery for recurrence of a hindfoot deformity had been necessary but walking was painless; the remaining six feet (25%) were poor, with pain on walking. All patients wore normal shoes and could walk independently, except one who was wheelchair-bound because of other joint problems. Recurrent deformity, the development of tibiocalcaneal arthritis and spontaneous fusion of the tibia to the calcaneum were all seen in these patients.
Kuo, Ken N; Wu, Kuan-Wen; Krzak, Joseph J; Smith, Peter A
Tendon transfers are invaluable in the treatment of severe children's foot deformities. They are often preferable to simple releases, lengthening, or fusion in surgical treatment because they provide an active motor function for deformity correction and, when properly selected, the procedures stabilize the foot against progressive deformity. The authors describe 4 commonly used tendon transfer procedures that are useful in children's foot deformity surgeries.
... Room? What Happens in the Operating Room? Athlete's Foot KidsHealth > For Kids > Athlete's Foot A A A ... a public shower. Why Is It Called Athlete's Foot? Athlete's foot gets its name because athletes often ...
... Surgery? A Week of Healthy Breakfasts Shyness Athlete's Foot KidsHealth > For Teens > Athlete's Foot A A A ... your skin, hair, and nails. What Is Athlete's Foot? The medical name for athlete's foot is tinea ...
Choi, Gene; Jones, David L.; Morris, James; Parham, Martin; Stephens, Jim; Yancey, Gregg
A mechanical design team was formed to design a foot for the lunar utility vehicle SKITTER. The primary design was constrained to be a ski pole design compatible with the existing femur-tibia design legs. The lunar environment had several important effects on the foot design. Three materials were investigated for the SKITTER foot: aluminum alloys, cold worked stainless steel alloys, and titanium alloys. Thin film coatings were investigated as a method of wear reduction for the foot. The performance of the foot is dependent on the action of the legs. The range of motion for the legs was determined to be vertical to 15 degrees above horizontal. An impact analysis was performed for the foot movement, but the results were determined to be inconclusive due to unknown soil parameters. The initial foot design configuration consisted of an annulus attached to the pointed pole. The annulus was designed to prevent excess sinkage. Later designs call for a conical shaped foot with a disk at the point of the tibia attachment. The conical design was analyzed for strength and deflection by two different approaches. A deformable body analysis was performed for the foot under crane load in crane position, and also under actuator load in the vertical position. In both cases, the deflection of the foot was insignificant and the stresses well below the strength of the titanium alloy.
Dai, Alper I; Aksoy, Sefika N; Demiryürek, Abdullah T
This retrospective study aimed to compare the therapeutic response, including side effects, for oral baclofen versus oral tizanidine therapy with adjuvant botulinum toxin type A in a group of 64 pediatric patients diagnosed with static encephalopathy and spastic equinus foot deformity. Following botulinum toxin A treatment, clinical improvement led to the gradual reduction of baclofen or tizanidine dosing to one-third of the former dose. Gross Motor Functional Measure and Caregiver Health Questionnaire scores were markedly elevated post-botulinum toxin A treatment, with scores for the tizanidine (Gross Motor Functional Measure: 74.45 ± 3.72; Caregiver Health Questionnaire: 72.43 ± 4.29) group significantly higher than for the baclofen group (Gross Motor Functional Measure: 68.23 ± 2.66; Caregiver Health Questionnaire: 67.53 ± 2.67, P < .001). These findings suggest that the combined use of botulinum toxin A and a low dose of tizanidine in treating children with cerebral palsy appears to be more effective and has fewer side effects versus baclofen with adjuvant botulinum toxin A.
Younes, Nidal A; Ahmad, Azmi T
To review the spectrum of foot problems in patients with diabetes and the underlying etiologic factors. In this review, the term "diabetic foot disease" (DFD) will be used (previously referred to as simply "diabetic foot"). The relevant anatomy of the foot is discussed, the clinical evaluation and severity of DFD are outlined, and the role of both systemic control and local measures in the management of DFD is addressed. DFD is linked with a wide variety of etiologic associations, pathologic forms, and clinical severity. The causes of DFD include such factors as diabetic neuropathy, vascular insufficiency, and the presence of underlying bone deformity. The pathologic forms range from superficial skin lesions, soft tissue infections, joint swellings, and deformities to frank necrosis and gangrene. The clinical severity ranges from mild, self-resolving disease to fulminant, rapidly progressive disease that usually eventuates in amputation. The heterogeneity of patients whose illness is grouped collectively under the diagnosis of DFD has contributed to the persisting confusion and controversy regarding the optimal classification system for diabetes-related foot problems and their appropriate management. Optimal management of DFD involves a multimodality approach directed at regular foot care, blood glucose control, and early recognition of foot problems. Appropriate surgical management, administration of systemic antibiotics, and off-loading techniques are necessary to prevent the progression of DFD.
... Foot Conditions More Americans are developing drug-resistant staph infections, known as MRSA, from common, relatively minor foot ... two types of gangrene are wet (caused by... Staph Infections of the Foot Staphylococcus aureus is a type ...
Pain - foot ... Foot pain may be due to: Aging Being on your feet for long periods of time Being overweight A ... sports activity Trauma The following can cause foot pain: Arthritis and gout . Common in the big toe, ...
Tinea pedis; Fungal infection - feet; Tinea of the foot; Infection - fungal - feet; Ringworm - foot ... Athlete's foot is the most common type of tinea infection. The fungus or yeast thrives in warm, ...
Noonan, K J; Didelot, W P; Lindseth, R E
Foot deformity is present in almost all patients paralyzed by myelomeningocele. This article outlines the pertinent pathoanatomy resulting in differing foot deformities and their effects on normal gait. Treatment of these deformities is discussed, and the most common deformities present for the different levels of paralysis are outlined. Emphasis is placed on surgical and orthotic treatments, which result in functional improvements for the pediatric patient with spina bifida.
Younger, Alastair S E; Hansen, Sigvard T
Cavovarus foot deformity, which often results from an imbalance of muscle forces, is commonly caused by hereditary motor sensory neuropathies. Other causes are cerebral palsy, cerebral injury (stroke), anterior horn cell disease (spinal root injury), talar neck injury, and residual clubfoot. In cavovarus foot deformity, the relatively strong peroneus longus and tibialis posterior muscles cause a hindfoot varus and forefoot valgus (pronated) position. Hindfoot varus causes overload of the lateral border of the foot, resulting in ankle instability, peroneal tendinitis, and stress fracture. Degenerative arthritic changes can develop in overloaded joints. Gait examination allows appropriate planning of tendon transfers to correct stance and swing-phase deficits. Inspection of the forefoot and hindfoot positions determines the need for soft-tissue release and osteotomy. The Coleman block test is invaluable for assessing the cause of hindfoot varus. Prolonged use of orthoses or supportive footwear can result in muscle imbalance, causing increasing deformity and irreversible damage to tendons and joints. Rebalancing tendons is an early priority to prevent unsalvageable deterioration of the foot. Muscle imbalance can be corrected by tendon transfer, corrective osteotomy, and fusion. Fixed bony deformity can be addressed by fusion and osteotomy.
DiPreta, John A
Patients with diabetes and peripheral neuropathy are at risk for foot deformities and mechanical imbalance of the lower extremity. Peripheral neuropathy leads to an insensate foot that puts the patient at risk for injury. When combined with deformity due to neuropathic arthropathy, or Charcot foot, the risks of impending ulceration, infection, and amputation are significant to the diabetic patient. Education of proper foot care and shoe wear cannot be overemphasized. For those with significant malalignment or deformity of the foot and ankle, referral should be made immediately to an orthopedic foot and ankle specialist.
... foot Overview By Mayo Clinic Staff Athlete's foot (tinea pedis) is a fungal infection that usually begins ... closely related to other fungal infections such as ringworm and jock itch. It can be treated with ...
... straight across and not too short Your foot health can be a clue to your overall health. For example, joint stiffness could mean arthritis. Tingling ... foot checks are an important part of your health care. If you have foot problems, be sure ...
Boulton, Andrew J M
Foot ulceration and Charcot neuroarthropathy (CN) are well recognized and documented late sequelae of diabetic peripheral, somatic, and sympathetic autonomic neuropathy. The neuropathic foot, however, does not ulcerate spontaneously: it is a combination of loss of sensation due to neuropathy together with other factors such as foot deformity and external trauma that results in ulceration and indeed CN. The commonest trauma leading to foot ulcers in the neuropathic foot in Western countries is from inappropriate footwear. Much of the management of the insensate foot in diabetes has been learned from leprosy which similarly gives rise to insensitive foot ulceration. No expensive equipment is required to identify the high risk foot and recently developed tests such as the Ipswich Touch Test and the Vibratip have been shown to be useful in identifying the high risk foot. A comprehensive screening program, together with education of high risk patients, should help to reduce the all too high incidence of ulceration in diabetes. More recently another very high risk group has been identified, namely patients on dialysis, who are at extremely high risk of developing foot ulceration; this should be preventable. The most important feature in management of neuropathic foot ulceration is offloading as patients can easily walk on active foot ulcers due to the loss of pain sensation. Infection should be treated aggressively and if there is any evidence of peripheral vascular disease, arteriography and appropriate surgical management is also indicated. CN often presents with a unilateral hot, swollen foot and any patient presenting with these features known to have neuropathy should be treated as a Charcot until this is proven otherwise. Most important in the management of acute CN is offloading, often in a total contact cast.
The majority of diabetic foot ulcers are the results of repetitive pressure that exceeds the threshold of soft-tissue tolerance, leading to mechanical destruction of the tissue. Progression of plantar ulcers can rapidly lead to osteomyelitis that may result in loss of the foot through amputation. In order to prevent such a disaster, surgical treatment should be taken into consideration when conservative treatment remains without success. The goal of surgical treatment of an infected ulcer is debridement of the soft-tissue and removal of the underlying pressure by careful bone resection or correction of a deformity by arthrodesis. Various authors have recently reported successful surgical reconstruction of neuroarthropathic foot deformity and instability. Apparently arthrodesis is a viable alternative to amputation for patients with unstable deformity or recurrent ulceration. Proper preoperative evaluation is mandatory. The indications are not well defined yet.
Foot care prevention programs can reduce the occurrence of foot ulcerations and amputations. The most important factor related to the development of foot ulcer is peripheral neuropathy, associated with loss of pain. Neuropathy can be associated with peripheral vascular disease and foot deformities. Five cornerstones for prevention should be respected, including regular examination of the feet and footwear, identification of high-risk patients, education of the patient and family, appropriate footwear, and treatment of nonulcerative pathology. After examination of the foot using the Semmes-Weinstein monofilament test, each patient can be assigned to one of the four risk categories to guide management. Foot care programs should be provided to high-risk categories of patients. Education plays an important role in prevention. The aim is to increase motivation and skills and enhance compliance with footwear advice. Items may include daily feet inspection and regular washing. Appropriate foot wear should protect against trauma. High-risk patients should participate in a foot care program set up by a multidisciplinary foot care team.
When treating diabetic foot ulcers it is important to be aware of the natural history of the diabetic foot, which can be divided into five stages: stage 1, a normal foot; stage 2, a high risk foot; stage 3, an ulcerated foot; stage 4, an infected foot; and stage 5, a necrotic foot. This covers the entire spectrum of foot disease but emphasises the development of the foot ulcer as a pivotal event in stage 3, which demands urgent and aggressive management. Diabetic foot care in all stages needs multidisciplinary management to control mechanical, wound, microbiological, vascular, metabolic and educational aspects. Achieving good metabolic control of blood glucose, lipids and blood pressure is important in each stage, as is education to teach proper foot care appropriate for each stage. Ideally, it is important to prevent the development of ulcers in stages 1 and 2. In stage 1, the normal foot, it is important to encourage the use of suitable footwear, and to educate the patient to promote healthy foot care and footwear habits. In stage 2, the foot has developed one or more of the following risk factors for ulceration: neuropathy, ischaemia, deformity, swelling and callus. The majority of deformities can be accommodated in special footwear and as callus is an important precursor of ulceration it should be treated aggressively, especially in the neuropathic foot. In stage 3, ulcers can be divided into two distinct entities: those in the neuropathic foot and those in the neuroischaemic foot. In the neuropathic foot, ulcers commonly develop on the plantar surface of the foot and the toes, and are associated with neglected callus and high plantar pressures. In the neuroischaemic foot, ulcers are commonly seen around the edges of the foot, including the apices of the toes and back of the heel, and are associated with trauma or wearing unsuitable shoes. Ulcers in stage 3 need relief of pressure (mechanical control), sharp debridement and dressings (wound control), and
A discussion of the essential deformity in calcaneo-valgus feet develops a theme originally put forward in 1961 on the relapsed club foot (Evans 1961). Whereas in the normal foot the medial and lateral columns are about equal in length, in talipes equino-varus the lateral column is longer and in calcaneo-valgus shorter than the medial column. The suggestion is that in the treatment of both deformities the length of the columns be made equal. A method is described of treating calcaneo-valgus deformity by inserting cortical bone grafts taken from the tibia to elongate the anterior end of the calcaneus.
Williams, Anita E; O'Neill, Terence W; Mercer, Sylvia; Toro, Brigitte; Nester, Christopher J
The characteristic bone deformities associated with advanced Paget's disease of bone may result in abnormal gait and plantar foot pressures, which contribute to the development of pressure-related skin problems. This study aimed to characterize the foot problems and foot-care needs in this patient group and to investigate the effect of disease distribution on the occurrence of foot pathology. One hundred thirty-four patients with Paget's disease were assessed clinically, and the Foot Structure Index was completed for each patient. Patients completed self-administered questionnaires concerning foot function (Foot Function Index) and quality of life (12-Item Short Form). The results of this study suggest that foot-health and footwear problems are common in patients with Paget's disease. Forty percent of the patients required professional foot care in addition to those already receiving it. The site of pagetic involvement did not affect the occurrence of foot pathology. Further research is required on the impact of the extent of any femoral or tibial deformity on foot symptoms and pathology. Biomechanical studies of the forces and motion in the foot related to different degrees of femoral and tibial deformity might also help determine the impact of deformity on foot pathology.
Stirnemann, P; Z'Brun, A; Brunner, D
Problems of the diabetic foot are frequent. The magnitude of the clinical picture and morbidity mirrors the severity and complexity of the underlying pathobiology. The three pathogenetic mechanism involved are ischemia, neuropathy and infection. Seldom do these mechanisms work in isolation, rather most foot problems result from a complex interplay among all three. The clinical picture of the diabetic foot reaches from the neuropathic deformity with diminished or absent sensation of pain to limited gangrene or superficial ulcer. The polymicrobial infection leads to extensive tissue destruction (plantarphlegmone) with osteomyelitis. The patients often notes no pain and may become aware of the infection only through the presence of drainage or a foul odor. These infections are usually more extensive than would be predicted by clinical signs and symptoms. These lesions must be debrided and drained promptly and completely. This often requires amputations of one or more toes, combined with an incision along the entire course of the infected track on the plantar or dorsal aspect of the foot. Cultures should be taken from the depth of the wound. Initial treatment should be with broad-spectrum antibiotics, with subsequent adjustment based on culture results. The diabetic foot is a clinical problem that can be solved with a high degree of success when the approached by an interdisciplinary team (specialists in infectious and vascular disease, podiatry and diabetology). Arterial reconstruction should be designed to restore maximum perfusion to the foot. The most effective result can be obtained with infra-inguinal vein bypass with distal anastomosis to the most proximal artery with direct continuity to the ischemic territory. The single most important factor in the achievement of the reduction of amputation is the autologous vein bypass. The overall outcome in the diabetic patient in terms of graft patency and limb salvage is equal to that in the nondiabetic.
Galli, Manuela; Cimolin, Veronica; Santambrogio, Giorgio Cesare; Crivellini, Marcello; Albertini, Giorgio
Purpose. This case study quantified kinematic and kinetic effects of gastrocnemius lengthening on gait in a Cerebral Palsy child with equinus foot. Methods. A 10-year-old diplegic child with Cerebral Palsy was evaluated with Gait Analysis (GA) before and after gastrocnemius fascia lengthening, investigating the lower limb joints kinematics and kinetics. Results. Kinematics improved at the level of distal joints, which are directly associated to gastrocnemius, and also at the proximal joint (like hip); improvements were found in ankle kinetics, too. Conclusions. This case study highlighted that GA was effective not only to quantify the results of the treatment but also to help preoperative decision making in dealing with CP child. PMID:20339527
... be advised by a podiatrist, depending on your test results or a specific medical condition. Postoperative Care The type of foot surgery performed determines the length and kind of aftercare required ...
... to dyes or adhesives in shoes, eczema, and psoriasis, may mimic athlete's foot. Causes The warmth and ... leave a comment Related Content Warts Sweaty Feet Psoriasis Find a Podiatrist ZIP Code More Options Mile ...
Pinzur, Michael S
With the increased number of diabetics worldwide and the increased incidence of morbid obesity in more prosperous cultures, there has become an increased awareness of Charcot arthropathy of the foot and ankle. Outcome studies would suggest that patients with deformity associated with Charcot Foot arthropathy have impaired health related quality of life. This awareness has led reconstructive-minded foot and ankle surgeons to develop surgical strategies to treat these acquired deformities. This article outlines the current clinical approach to this disabling medical condition. Copyright © 2016 John Wiley & Sons, Ltd.
Jarvis, Hannah L; Nester, Christopher J; Bowden, Peter D; Jones, Richard K
The Root model of normal and abnormal foot function remains the basis for clinical foot orthotic practice globally. Our aim was to investigate the relationship between foot deformities and kinematic compensations that are the foundations of the model. A convenience sample of 140 were screened and 100 symptom free participants aged 18-45 years were invited to participate. The static biomechanical assessment described by the Root model was used to identify five foot deformities. A 6 segment foot model was used to measure foot kinematics during gait. Statistical tests compared foot kinematics between feet with and without foot deformities and correlated the degree of deformity with any compensatory motions. None of the deformities proposed by the Root model were associated with distinct differences in foot kinematics during gait when compared to those without deformities or each other. Static and dynamic parameters were not correlated. Taken as part of a wider body of evidence, the results of this study have profound implications for clinical foot health practice. We believe that the assessment protocol advocated by the Root model is no longer a suitable basis for professional practice. We recommend that clinicians stop using sub-talar neutral position during clinical assessments and stop assessing the non-weight bearing range of ankle dorsiflexion, first ray position and forefoot alignments and movement as a means of defining the associated foot deformities. The results question the relevance of the Root assessments in the prescription of foot orthoses.
Serra, F; Mancini, L; Ghirlanda, G; Ruotolo, V
Diabetic osteoarthropathy is a chronic progressive arthropathy involving the bones and joints being constantly associated to somatic and autonomic peripheral neuropathy. The pathogenesis is related to sensory and motor neuropathy with morphologic foot alterations, relaxation and abnormal position on walking till complete collapse of the foot shown by the depressed longitudinal medial arch. Bone reabsorption due to osteoclasis and increased blood flow until osteomalacia appears, is characteristic of this arthropathy. The clinical features vary according to the location and severity of articular impairment and the stage of identification. The metatarsophalangeal or tarsometatarsal joint may be involved. The typical manifestation of Charcot's foot is plantar ulcer of variable location according to the weight-bearing area. Treatment tends to reduce the abnormal stress predisposing to ulceration with tailored footwear and orthoses.
... All Site Content AOFAS / FootCareMD / Treatments Cavus Foot Surgery Page Content What is a cavus foot? A ... problems. What are the goals of cavus foot surgery? The main goal of surgery is to reduce ...
Lockard, M A
This review article describes shoe inserts and provides information to assist physical therapists to identify patients who may benefit from foot orthoses. The article discusses goals for and types of shoe inserts, in addition to the materials and methods that can be used in fabricating appliances. Clinical considerations for the use of shoe inserts and application to specific patient populations are presented.
... the best ways to exercise and keep fit. Structure of the Foot Each of your feet contains 26 bones, 33 joints, and more than 120 muscles, ligaments, tendons, and nerves. These all work together to support the weight of your body, act as shock ...
... feel a cut, a blister or a sore. Foot injuries such as these can cause ulcers and infections. Serious cases may even lead to amputation. Damage to the blood vessels can also mean that your feet do not get enough blood and oxygen. It ...
Vukašinović, Zoran; Mikić, Nadan
Hallux valgus deformity is a complex chronic progressive disease primarily characterized by a lateral great toe deviation and deformity of the first metatarsophalageal joint. Numerous etiological factors are related with the expression of this disease, and they are divided into two categories: endogenous and exogenous. Complexity of the hallux valgus deformity is reflected with the progression of the disease that gives rise to numerous forefoot deformities. The diagnosis is first of all affirmed by clinical examination and x-ray of the feet in a standing position. Treatment could be either operative or conservative. Conservative treatment has shown to be totally unsuccessful. Before decision making on the type of operative treatment, the patient's complaints, age, profession, clinical and x-ray findings must be taken into consideration. Until now, over two hundred different operative procedures have been described, which clearly supports the observation that there is no single method which could resolve all clinical varieties of this deformity. Therefore, today, when making a choice on the surgical procedure of hallux valgus deformity, the utilization of surgical algorithm is recommended.
Lang-Stevenson, A I; Sharrard, W J; Betts, R P; Duckworth, T
We report a prospective study of the causes and treatment of 26 long-standing neuropathic ulcers of the foot in 21 patients. The most important causal factor, well illustrated by pressure studies, was the presence of a dynamic or static deformity leading to local areas of peak pressure on insensitive skin. All but one of the 26 ulcers had healed after an average of 10 weeks of treatment in a light, skin-tight plaster cast, with the prohibition of weight-bearing. Recurrent ulceration was prevented in all but one foot by early operation to correct the causative deformity; this was performed after the ulcer had healed and before allowing weight-bearing on the limb. Pressure studies after operation confirmed that pressure points had been relieved.
Vaseenon, Tanawat; Wattanarojanaporn, Thongaek; Intharasompan, Piyapong; Theeraamphon, Nipon; Auephanviriyakul, Sansanee; Phisitkul, Phinit
Foot and ankle problems in Thai monks have not been explored. This is an unshod population, and its members have a unique lifestyle living among others in our modern era. Beginning at their ordainment, they follow strict rules about barefoot walking, the amount of daily walking, and their sitting position, practices that theoretically can increase their risk of developing foot and ankle problems. To evaluate the prevalence ofcommon foot and ankle problems in Thai monks. A cross-sectional survey was conducted in combination with foot and ankle examinations of monks living in northern Thailand Foot morphology was examined using a Harris mat footprint. Results of the interviews and the foot and ankle examinations were evaluated. Two hundred and nine monks from 28 temples were included in this study. Common foot and ankle problems found included callosity (70.8%), toe deformities (18.2%), plantar fasciitis (13.4%), metatarsalgia (3.8%), and numbness (2.9%). Callosity and toe deformities were associated with prolonged barefoot walking over extended periods since ordainment (p < 0.05). The callosity was found on the forefoot (47.3%), lateral malleolus (40.7%), and heel (12%). Arch types were considered normal in 66.4% of cases, high in 21.6%, and low in 12%. No association was found between arch type and foot and ankle problems. Callosity and toe deformity were the most common foot and ankle problems found in Thai monks, especially those with prolonged period of barefoot walking and long-term duration ofordainment. The unique pattern of walking and sitting of Thai monks may have contributed to the development of those feet and ankle problems.
Voronov, Michael L; Pinzur, Michael S; Havey, Robert M; Carandang, Gerard; Gil, Joseph A; Hopkinson, William J
Surgeons have questioned whether foot deformity applies abnormal loading on a knee implant. A total of 24 patients with mild knee deformity underwent a static recording of foot loading prior to and at 3 months following knee replacement. Of these patients, 13 had a preoperative varus deformity. The recorded postoperative to preoperative loading in all 6 geographic sites was decreased by an average of 10%. The largest changes were observed in the hallux and lesser toe masks, whereas the postoperative to preoperative foot pressure ratio in the metatarsal head (lateral and medial), heel, and midfoot masks was 0.94. This preliminary investigation reveals a minimal change in geographic foot loading following total knee arthroplasty in patients with mild knee deformity.
Hagedorn, Thomas J.; Dufour, Alyssa B.; Riskowski, Jody L.; Hillstrom, Howard J.; Menz, Hylton B.; Casey, Virginia A.; Hannan, Marian T.
Introduction Foot disorders are common among older adults and may lead to outcomes such as falls and functional limitation. However, the associations of foot posture and foot function to specific foot disorders at the population level remain poorly understood. The purpose of this study was to assess the relation between specific foot disorders, foot posture, and foot function. Methods Participants were from the population-based Framingham Foot Study. Quintiles of the modified arch index and center of pressure excursion index from plantar pressure scans were used to create foot posture and function subgroups. Adjusted odds ratios of having each specific disorder were calculated for foot posture and function subgroups relative to a referent 3 quintiles. Results Pes planus foot posture was associated with increased odds of hammer toes and overlapping toes. Cavus foot posture was not associated with the foot disorders evaluated. Odds of having hallux valgus and overlapping toes were significantly increased in those with pronated foot function, while odds of hallux valgus and hallux rigidus were significantly decreased in those with supinated function. Conclusions Foot posture and foot function were associated with the presence of specific foot disorders. PMID:24040231
Menz, Hylton B.; Dufour, Alyssa B.; Riskowski, Jody L.; Hillstrom, Howard J.; Hannan, Marian T.
Objective To examine the associations of foot posture and foot function to foot pain. Methods Data were collected on 3,378 members of the Framingham Study who completed foot examinations in 2002–2008. Foot pain (generalized and at six locations) was based on the response to the question “On most days, do you have pain, aching or stiffness in either foot?” Foot posture was categorized as normal, planus or cavus using static pressure measurements of the arch index. Foot function was categorized as normal, pronated or supinated using the center of pressure excursion index from dynamic pressure measurements. Sex-specific multivariate logistic regression models were used to examine the effect of foot posture and function on generalized and location-specific foot pain, adjusting for age and weight. Results Planus foot posture was significantly associated with an increased likelihood of arch pain in men (odds ratio [OR] 1.38, 95% confidence interval [CI] 1.01 – 1.90), while cavus foot posture was protective against ball of foot pain (OR 0.74, 95% CI 0.55 – 1.00) and arch pain (OR 0.64, 95% CI 0.48 – 0.85) in women. Pronated foot function was significantly associated with an increased likelihood of generalized foot pain (OR 1.28, 95% CI 1.04 – 1.56) and heel pain (OR 1.54, 95% CI 1.04 – 2.27) in men, while supinated foot function was protective against hindfoot pain in women (OR 0.74, 95% CI 0.55 – 1.00). Conclusion Planus foot posture and pronated foot function are associated with foot symptoms. Interventions that modify abnormal foot posture and function may therefore have a role in the prevention and treatment of foot pain. PMID:23861176
Guo, Jun-Chao; Wang, Li-Zhen; Chen, Wei; Du, Cheng-Fei; Mo, Zhong-Jun; Fan, Yu-Bo
Orthopedic insole was important for partial foot amputation (PFA) to achieve foot balance and avoid foot deformity. The inapposite insole orthosis was thought to be one of the risk factors of reamputation for foot valgus patient, but biomechanical effects of internal tissues on valgus foot had not been clearly addressed. In this study, plantar pressure on heel and metatarsal regions of PFA was measured using F-Scan. The three-dimensional finite element (FE) model of partial foot evaluated different medial wedge angles (MWAs) (0.0°-10.0°) of orthopedic insole on valgus foot. The effect of orthopedic insole on the internal bone stress, the medial ligament tension of ankle, plantar fascia tension, and plantar pressure was investigated. Plantar pressure on medial heel region was about 2.5 times higher than that of lateral region based on the F-Scan measurements. FE-predicted results showed that the tension of medial ankle ligaments was the lowest, and the plantar pressure was redistributed around the heel, the first metatarsal, and the lateral longitudinal arch regions when MWA of orthopedic insole ranged from 7.5° to 8.0°. The plantar fascias maintained about 3.5% of the total load bearing on foot. However, the internal stresses from foot bones increased. The simulation in this study would provide the suggestion of guiding optimal design of orthopedic insole and therapeutic planning to pedorthist.
Morrison, William B; Ledermann, Hans Peter
Diabetes is a common disease with potentially devastating complications affecting the foot and ankle. A combination of vascular disease, peripheral neuropathy, and immunopathy results in a cascade of conditions including ischemia and infarction, tendinopathy, atrophy, edema, deformity, neuropathic osteoarthropathy, callus, ulceration, and infection. MRI is useful for evaluation of these complications, and assists the clinician in medical or surgical planning.
Metelko, Zeljko; Brkljacić Crkvencić, Neva
, lipid disorders (treatment with fenofibrate reduces the incidence of DF amputations (EBM-Ib/A), hypertension, hyperuricemia, neuropathy, and angiopathy (surgical reconstructive bypass) or endovascular (percutaneous transluminar angioplasty). In the low-risk group of PwDM, no particular results can be achieved, in contrast to the high-risk groups of PwDM where patient and professional education has shown significant achievement (EBM-IV/C). In secondary prevention of DF, it is necessary to perform patient and professional education how to avoid most of external influences for DE Patient education should include all topics from primary prevention, danger of neural analgesia (no cooling or warming the foot), careful selection of shoes, daily observation of foot, early detection all foot changes or small wounds, daily hygiene of foot skin, which has to be clean and moist, regular self measurements of skin temperature between the two feet (EBM-Ib/A), prevention of self treatment of foot deformities, changing wrong habits (walking footless), medical consultation for even small foot changes (EBM-Ib/A) and consultation by multidisciplinary team (EBM-IIb/B). Tertiary DF prevention includes ulcer treatment, prevention of amputation and level of amputation. In spite of the primary and secondary prevention measures, DF ulcers develop very often. Because of different etiologic reasons as well as different principles of treatment which are at the same time prevention of the level of amputation, the approach to PwDF has to be multidisciplinary. A high place in the treatment of DF ulcers, especially neuropathic ulcers, have the off-loading principles (EBM-Ib/A), even instead of surgical treatment (EBM-Ib/A). Necrectomy, taking samples for analysis from the deep of ulcer, together with x-ray diagnostics (in particular NMR), the size of the changes can be detected, together with appropriate antibiotic use and indication for major surgical treatment. The patient has to be instructed to the
Nguyen, Uyen-Sa D. T.; Dufour, Alyssa B.; Positano, Rock G.; Dines, Joshua S.; Dodson, Christopher C.; Gagnon, David R.; Hillstrom, Howard J.; Hannan, Marian T.
Background To our knowledge, hand dominance and side of foot disorders has not been described in the literature. The purpose of the current study was to evaluate whether hand dominance was associated with ipsilateral foot disorders among community-dwelling older men and women Methods Data were from the Framingham Foot Study (n=2,089, examined 2002–2008). Hand preference for writing was used to classify hand dominance. Foot disorders and side of disorders were based on a validated foot examination. Generalized linear models with GEE was used to estimate odds ratios (OR) and 95% confidence intervals (CI), accounting for intra-person variability. Results Left-handed people were less likely to have foot pain or any foot disorders ipsilateral, but were more likely to have hallux valgus ipsilateral to the left hand. Among right-handed people, the following statistically significant increased odds of having an ipsilateral foot disorder versus contralateral foot disorder were seen: 30% for Morton’s Neuroma, 18% for hammer toes, 21% for lesser toe deformity, and a 2-fold increased odds of any foot disorder; there was a 17% decreased odds for Tailor’s Bunion, and an 11% decreased odds for pes cavus. Conclusion For the 2089 study participants, certain forefoot disorders were shown to be ipsilateral while other foot disorders were contralateral to the dominant hand. It is possible that the side of the dominant hand was a proxy for biomechanics of the dominant foot that may explain some of the associations with ipsilateral forefoot disorders. PMID:23328848
Morrison, Katherine E; Kaminski, Thomas W
To review the literature that provides information to assist in analyzing the role of the foot in acute and chronic lateral ankle injury. We searched MEDLINE, CINAHL, Institute for Scientific Information's Web of Science, and SPORT Discus from 1965-2005 using the terms lateral, ankle, ligament, injury, risk factors, foot, subtalar joint, talocrural joint, gait analysis, and foot biomechanics. We found substantial information on the incidence and treatment of lateral ankle sprains in sport but very few articles that focused on risk factors associated with these injuries and even less information on the foot as it relates to this condition. Moreover, little information was available regarding the risk factors associated with the development of chronic instability after a lateral ankle sprain. We critically analyzed the foot articulations and the foot's role in the mechanism of injury to assist our clinical synopsis. An in-depth review of the foot complex in relation to lateral ankle sprains strongly suggested its importance when treating and preventing inversion ankle trauma. Throughout the literature, the only static foot measurements that show a significant correlation to this condition are an identified cavovarus deformity, increased foot width, and increased calcaneal eversion range of motion. Authors also provided dynamic measurements of the foot, which produced several significant findings that we discuss. Although our findings offer some insight into the relationship between foot characteristics and lateral ankle injuries, future research is needed to confirm the results of this review and expand this area of investigation.
Chandalia, H B; Singh, D; Kapoor, V; Chandalia, S H; Lamba, P S
We assessed 300 diabetic and 100 age- and sex-matched controls for correlating foot wear practices and foot care knowledge and the presence of foot complications. A structured questionnaire evaluated the knowledge about foot care, type of footwear used, education level, association of tobacco abuse, and any associated symptoms of foot disease. Clinical evaluation was done by inspection of feet for presence of any external deformities, assessment of sensory function (vibration perception threshold, VPT), vascular status (foot pulses and ankle brachial ratio) and presence of any infection.In the diabetes category, 44.7% patients had not received previous foot care education. 0.6% walked barefoot outdoors and 45% walked barefoot indoors. Fourteen (4.7%) patients gave history of foot ulceration in the past and comprised the high risk group; only 2 out of 14 had received foot care education, 6 gave history of tobacco abuse, 8 had symptoms of claudication, 9 had paresthesias, 2 walked barefoot indoors. Average duration of diabetes in the high-risk and low-risk diabetes group was 10.85 +/- 6.53 and 9.83 +/- 7.99 years, respectively. In the high- and low-risk diabetic groups, VPT was 19.57 +/- 11.26 and 15.20 +/- 10.21V (P < 0.02), ankle brachial ratio was 1.05 +/- 0.19 and 1.14 +/- 0.18 (P < 0.05), and the questionnaire scores was 40.8% and 57%, respectively.In the diabetic and the control group, VPT was 15.62 +/- 10.39 and 8.36 +/- 3.61 V (P < 0.01), ankle brachial ratio was 1.14 +/- 0.18 and 1.15 +/- 0.12, and the questionnaire scores were 57% and 40.3%, respectively.In conclusion, poor knowledge of foot care and poor footwear practices were important risk factors for foot problems in diabetes.
Sanchez, Edward; Martin-Carreras, Teresa; Bornstein, Gerald; Wasyliw, Christopher W; Scherer, Kurt F; Bancroft, Laura W
A 40-year-old man presented with a large and painful right foot mass. The patient reported a history of a recurrent right foot mass treated elsewhere with 3 prior surgical excisions. Copyright 2015, SLACK Incorporated.
Vaseenon, Tanawat; Intharasompan, Piyapong; Wattanarojanapom, Thongaek; Theeraamphon, Nipon; Auephanviriyakul, Sansanee; Phisitkul, Phinit
Muay Thai kickboxing is a common sport that uses the foot and ankle in fighting. Muay Thai kickboxing trainees usually receive training in Thailand Foot and ankle problems in this group ofpeople who usually train barefoot remain unexplored To evaluate the prevalence of common foot and ankle problems in Muay Thai kick boxers. The present study is a cross-sectional survey of Muay Thai kick boxers practicing in northern Thailand. Interviews were conducted and foot and ankle examinations were evaluated Foot morphology was examined using a Harris mat footprint. One hundred and twenty-three Muay Thai kickbox ersinnine training gyms were included in this study. Common foot and ankle problems found in the Muay Thai kick boxers were callosity (59%), gastrocnemius contracture (57%), toe deformities (49.3%), wounds (10%) and heel pain (9%). Callosity was most commonly found on the forefoot (77.5%), on the plantar first metatarsal (55.3%) and on the big toe (33.3%). An association was found between a tight heel cord and a history of foot injury with prolonged periods of weekly training. Toe deformities such as hallux rigidus (37.6%) were also associated with prolonged periods of training (p = 0.001). No correlation was found between type of foot arch and foot and ankle problems. Plantar forefoot callosities and wounds as well as toe deformities including tight heel cords are some of the foot and ankle problems commonly found in Muay Thai kick boxers. They are associated with prolonged periods of barefoot training. The unique pattern of training and of the kicks in Muay Thai might be a path mechanism, leading to the development of foot and ankle problems.
... work and the pounding their feet endure from... Foot Injuries in Olympic Athletes and Beyond Foot and ankle ... making them... Athletes Living with Diabetes Face More Foot Injuries Than Athletes Without Foot and ankle injuries are ...
Knapik, Joseph J
Foot blisters are the most common medical problem faced by Soldiers during foot march operations and, if untreated, they can lead to infection. Foot blisters are caused by boots rubbing on the foot (frictional forces), which separates skin layers and allows fluid to seep in. Blisters can be prevented by wearing properly sized boots, conditioning feet through regular road marching, wearing socks that reduce reduce friction and moisture, and possibly applying antiperspirants to the feet.
Papanas, Nikolaos; Maltezos, Efstratios
In people with diabetes mellitus, the Charcot foot is a specific manifestation of peripheral neuropathy that may involve autonomic neuropathy with high blood flow to the foot, leading to increased bone resorption. It may also involve peripheral somatic polyneuropathy with loss of protective sensation and high risk of unrecognized acute or chronic minor trauma. In both cases, there is excess local inflammatory response to foot injury, resulting in local osteoporosis. In the Charcot foot, the acute and chronic phases have been described. The former is characterized by local erythema, edema, and marked temperature elevation, while pain is not a prominent symptom. In the latter, signs of inflammation gradually recede and deformities may develop, increasing the risk of foot ulceration. The most common anatomical classification describes five patterns, according to the localization of bone and joint pathology. This review article aims to provide a brief overview of the diabetic Charcot foot in terms of etiology, pathophysiology, and classification. PMID:23705058
... or weeks after your injury: Rest. Stop any physical activity that causes pain, and keep your foot still when possible. Ice your foot for 20 minutes 2 to 3 times a day. DO NOT apply ice directly to your skin. Keep your foot raised to help keep swelling ...
Uglow, Michael G
The techniques for performing percutaneous osteotomies in treating deformities of the foot in children are presented along with a detailed description of the operative details. The author's use of minimal-access surgery for tibial, os calcis, and midfoot osteotomies is described using a cooled side-cutting burr that has not previously been described for use in the child's foot. The cancellous nature of the bones in the child are easily cut with the burr and the adjacent soft tissues are not damaged. The early experience of the healing times are not impaired and the complications associated with percutaneous scars seem to be negligible. Copyright © 2016 Elsevier Inc. All rights reserved.
Church, C.; Lennon, N.; Alton, R.; Schwartz, J.; Niiler, T.; Henley, J.; Miller, F.
Abstract Purpose Foot deformities are common in children with cerebral palsy (CP), yet the evolution of such deformities is not well documented. We aimed to observe and analyse changes in foot posture during growth in children with CP. Methods We followed 51 children (16 unilateral, 35 bilateral; 37 Gross Motor Function Classification Scale (GMFCS) I/II, 14 III/IV) aged two to 12 years in this level II, IRB-approved prospective longitudinal study. Data after bony foot corrections were excluded. Outcome measures included coronal plane pressure index (CPPI) and pressure impulses from the heel, medial midfoot and medial forefoot. Data were LOESS smoothed and resulting models were compared for significant differences across time using a derived FANOVA method. Results The GMFCS I/II group had more foot valgus than typically developing (TD) children until seven years which normalised thereafter. From two to 12 years, GMFCS III/IV children had more foot valgus than TD children. Heel impulse was significantly reduced in both GMFCS groups compared with TD children, and the III/IV group had less heel contact than the I/II group. Conclusions Due to early variability and the tendency for resolving valgus foot posture in children with CP, conservative management of coronal plane foot deformity is suggested in early childhood, especially for children classified as GMFCS I and II. PMID:28828068
Foot reflexology is defined as massage of zones on the feet which correspond to different parts of the body. A medline-search yielded no literature in the field of foot reflexology. Indications for and results of foot reflexology have been extrapolated from case-descriptions and two pilot studies with small samples. One study (Lafuente et al.) found foot reflexology to be as helpful to patients with headaches as medication (flunarizine), yet foot reflexology was fraught with less side-effects than medication. In a second study (Eichelberger et al.) foot reflexology was used postoperatively on gynecological patients. The intervention group showed a lesser need for medication to enhance bladder tonus than did the control group. The literature describes foot reflexology as enhancing urination, bowel movements and relaxation.
Diabetic foot problems are responsible for nearly 50% of all diabetes-related hospital bed days. Approximately 10-15% of diabetic patients developed foot ulcers at some state in their life and 15% of all load in amputations are performed in patients with diabetes. There is a need to provide extensive education to both primary care physicians and the patients regarding the relationship between glucose control and complications encountered in the foot and ankle. The management of diabetic foot disease is focussed primarily on avoiding amputation of lower extremities and should be carried out through three main strategies; identification of the "at risk" foot, treatment of acutely diseased foot, and prevention of further problems. These are several obstacles in the management of DFI that include poor knowledge and awareness of diabetes and its complications, lack of appropriate podiatry services. These goals are possible only by the establishment of a dedicated team of podiatrist, endocrinologist, vascular surgeon and a pedorthist. The plastic surgeons, orthopaedic surgeons & diabetes teaching nurses/educator dedicated to foot care could be a part of the team. Identifying the patients with diabetes at risk for ulceration requires feet examination, including the vascular & neurological systems, skin conditions, and foot structure. Conservative management of foot problems has dramatically reduced the risk of amputation by simple procedures, such as appropriate foot wear, cleanliness, aggressive surgical debridement, regular wound dressing by simple wet-to-dry saline guage, and ulcer management. Copyright © 2015 Diabetes India. Published by Elsevier Ltd. All rights reserved.
Dos Santos, Alexandre Leme Godoy; Albino, Rômulo Ballarin; Ortiz, Rafael Trevisan; Sakaki, Marcos Hideyo; de Andrade Corsato, Marcos; Fernandes, Tulio Diniz
Diabetes mellitus is a serious disease that affects a large portion of the population. Charcot neuroarthropathy is one of its major complications and can lead to osteoarticular deformities, functional incapacity, ulcers and ankle and foot infections. Realignment of the foot by means of arthrodesis presents a high rate of implant failure due to weight-bearing on an insensitive foot. The aim of this report was to describe successful use of intramedullary osteosynthesis with compression screws to stabilize the deformed foot, in a diabetic patient with neuroarthropathy.
Van Boerum, Drew H; Sangeorzan, Bruce J
When the foot works properly it is an amazing, adaptive, powerful aid during walking, running, jumping, and in locomotion up or down hill and over uneven ground. Dysfunction of the foot can often arise from the foot losing its normal structural support, thus altering is shape. An imbalance in the forces that tend to flatten the arch and those that support the arch can lead to loss of the medial longitudinal arch. An increase in the arch-flattening effects of the triceps surae or an increase in the weight of the body will tend to flatten the arch. Weakness of the muscular, ligamentous, or bony arch supporting structures will lead to collapse of the arch. The main factors that contribute to an acquired flat foot deformity are excessive tension in the triceps surae, obesity, PTT dysfunction, or ligamentous laxity in the spring ligament, plantar fascia, or other supporting plantar ligaments. Too little support for the arch or too much arch flattening effect will lead to collapse of the arch. Acquired flat foot most often arises from a combination of too much force flattening the arch in the face of too little support for the arch. Treatment of the adult acquired flat foot is often difficult. The clinician should remember the biomechanics of the normal arch and respond with a treatment that strengthens the supporting structures of the arch or weakens the arch-flattening effects on the arch. After osteotomies or certain hindfoot fusions, the role of the supporting muscles of the arch, in particular the PTT, play less of a role in supporting the arch. Rebalancing the forces that act on the arch can improve function and lessen the chance for further or subsequent development of deformity.
Bucki, M; Luboz, V; Perrier, A; Champion, E; Diot, B; Vuillerme, N; Payan, Y
Foot pressure ulcers are a common complication of diabetes because of patient's lack of sensitivity due to neuropathy. Deep pressure ulcers appear internally when pressures applied on the foot create high internal strains nearby bony structures. Monitoring tissue strains in persons with diabetes is therefore important for an efficient prevention. We propose to use personalized biomechanical foot models to assess strains within the foot and to determine the risk of ulcer formation. Our workflow generates a foot model adapted to a patient's morphology by deforming an atlas model to conform it to the contours of segmented medical images of the patient's foot. Our biomechanical model is composed of rigid bodies for the bones, joined by ligaments and muscles, and a finite element mesh representing the soft tissues. Using our registration algorithm to conform three datasets, three new patient models were created. After applying a pressure load below these foot models, the Von Mises equivalent strains and "cluster volumes" (i.e. volumes of contiguous elements with strains above a given threshold) were measured within eight functionally meaningful foot regions. The results show the variability of both location and strain values among the three considered patients. This study also confirms that the anatomy of the foot has an influence on the risk of pressure ulcer. Copyright © 2016. Published by Elsevier Ltd.
... foot and ankle surgeons. All Fellows of the College are board certified by the American Board of Foot and Ankle Surgery. Copyright © 2017 American College of Foot and Ankle Surgeons (ACFAS), All Rights ...
Marks, R M
Treatment of the foot and ankle in patients with diabetes often is fraught with complications, frequently multifactorial in nature. Because of the multidisciplinary approach to the patient with diabetes, it is imperative that the patient and all healthcare professionals who are treating the patient recognize the foot at risk, and the clinical hallmarks of Charcot neuroarthropathy. Failure to do so often leads to disastrous results, such as ulceration, destruction of normal foot architecture, and progressive deformity too severe to accommodate a brace, thereby necessitating surgical intervention. The surgical treatment of the foot in a patient with diabetes requires knowledge of the pathophysiology of the neuroarthropathic (Charcot) foot, so that the appropriate timing, extent of surgical intervention, and postoperative treatment in this unique population assures a higher success rate. One also must recognize associated factors that may be present in these patients, such as peripheral vascular compromise and poor nutritional status.
Ramanujam, Crystal L; Zgonis, Thomas
Achilles tendon pathologic conditions are implicated in contributing to the development of many diabetic foot complications including diabetic foot ulceration and Charcot neuroarthropathy. Surgical correction of the diabetic equinus deformity has been studied as an isolated or adjunctive treatment when dealing with difficult-to-close diabetic foot ulcerations or when surgically addressing the diabetic Charcot neuroarthropathy foot or ankle. This article reviews the most common indications, complications, and surgical procedures for equinus correction by either a tendo-Achilles lengthening or gastrocnemius recession for the management of diabetic foot conditions.
... foot and ankle surgeons. All Fellows of the College are board certified by the American Board of Foot and Ankle Surgery. Copyright © 2017 American College of Foot and Ankle Surgeons (ACFAS), All Rights ...
Laminitis is a disease of the suspensory apparatus of the distal phalanx, which can advance to the chronic stage with varying degrees of structural failure. Because the disease may ultimately lead to mechanical failure of the digit, a foot management plan is required to effectively and mechanically treat these cases. Many laminitis cases can be successfully rehabilitated back to athletic soundness, light use, breeding, or pasture soundness, whereas others suffer from permanent instability and never enjoy an acceptable level of comfort. To understand how to minimize damage in the acute laminitic foot or rehabilitate the chronic laminitic foot, the veterinarian should have an understanding of the normal supporting structures of the digit, the biomechanical forces acting on the foot, and the structural failure that results when these otherwise normal forces act on a diseased, damaged foot.
Głebocka, Anna Katarzyna; Zarzycki, Wiesław; Knaś, Małgorzata
A foot is a complicated osteoarticular system. The complex structure and variability predispose it to the formation of foot deformity. The cause deformities of the feet are weakened muscle tissue and ligaments, systemic diseases: obesity, musculoskeletal defects, neurological diseases, rheumatism, diabetes, pregnancy, improper shoes or socks. They interfere with the function of the foot and are reflected in the distribution of support points. The aim of this study was to assess the impact of diabetes on pregnancy and the mechanics of the foot and the risk of developing diabetic foot. The study took part in healthy and diseased women with type 1 diabetes in pregnancy. Evaluation of static foot was performed using podoscope, made up of mirrors, lights and camera. The camera described the distribution of the pressure on the glass plate, which the person being investigated was standing on. It recorded the reflection of feet and transmit them to a computer. Description the results consisted of defining relevant indicators. The evaluation was performed using the dynamic pressure Parotec system, the measuring cylinder placed inside the patient's shoe provided with sensors recording the foot pressure distribution on the ground while standing and walking. The data were stored on a memory card loaded into the computer, where the analysis took place. It has been calculated the average values of pressures exerted on the various zones of the foot. It was found that the increase in body weight resulting from the advancement of women pregnancy increases the load exerted on the foot. Forces are growing in subsequent trimesters of pregnancy reaching a maximum at the end of the third trimester. The longitudinal and transverse arches of the foot are reducing. After the birth, the pressure exerted on each area of the foot decreases, arches of the foot are getting back to starting position. Number of foot deformities is higher in women with type 1 diabetes. It grow the risk of
Abstract Aims Gangrene and amputation are among most feared complications of diabetes mellitus. Early detection of patients at high risk for foot ulceration can prevent foot complications. Regular foot screening (medical history, foot examination and classification into risk groups) was introduced at the out-patient diabetes clinic in Ljubljana in November 1996. We aimed to explore the relationships between the observed variables, check the appropriateness of the risk status classification and of the post-screening decisions. Methods The data of 11.594 patients, obtained in 18 years, were analysed by multiple correspondence analysis (MCA). Most of the observed variables were categorical. Results The majority of the screened population was free of foot complications. We demonstrated an increasing frequency and severity of foot problems with an increasing age, as well as the association between the loss of protective sensation and the history of foot ulceration, foot deformity and callus formation, the history of foot ulcer or amputation and acute foot ulceration. A new finding was that the location of foot deformity points was closer to female than male gender, indicating the possible role of fashionable high-heel footwear. The appropriateness of therapeutic decisions was confirmed: the points representing absent foot pulses and referral to vascular specialist were close together, as well as points representing foot deformity and special footwear prescription or callus formation and referral to pedicurist. Conclusions MCA was applied to the data on foot pathology in the population attending the out-patient diabetes clinic. The method proved to be a useful statistical tool for analysing the data of screening procedures. PMID:28289465
Chen, Ryan C; Gordon, J Eric; Luhmann, Scott J; Schoenecker, Perry L; Dobbs, Matthew B
Recurrent clubfoot deformity after successful initial correction with the use of the Ponseti method continues to be a common problem and is often caused by noncompliance with wear of the traditional foot abduction brace. The purpose of this study was to assess the results of a newly designed dynamic foot abduction orthosis in terms of (1) parental compliance and (2) effectiveness in preventing recurrent clubfoot deformities. Twenty-eight patients (49 clubfeet) who were treated with a dynamic foot abduction orthosis in accordance with the Ponseti method were included in this study. Of the 28 patients, 18 had idiopathic clubfeet (31 clubfeet), 2 had complex idiopathic clubfeet (4 clubfeet), 5 had myelodysplasia (8 clubfeet), and 3 were syndromic (6 clubfeet). The mean duration of follow-up was 29 months (range, 24-36 months). Noncompliance was reported in only 2 (7.1%) of the 28 patients in the new orthosis compared with the authors' previously reported 41% (21/51) noncompliance rate in patients treated with the use of the traditional foot abduction brace. The two patients in this study, in which parents were noncompliant with orthosis wear, developed recurrent deformities. There were 2 patients (7%) who experienced skin blistering in the new orthosis compared with 12 (23.5%) of 51 patients who experienced blistering with the use of traditional abduction brace in the authors' previously reported study. Logistic regression modeling compliance and recurrence revealed that noncompliance with the foot abduction orthosis was most predictive of recurrence of deformity (odds ratio, 27; 95% confidence interval, 2.2-326; P = 0.01). The articulating foot abduction orthosis is well tolerated by patients and parents and results in a higher compliance rate and a lower complication rate than what were observed with the traditional foot abduction orthosis.
Galli, Manuela; Cimolin, Veronica; Pau, Massimiliano; Leban, Bruno; Brunner, Reinald; Albertini, Giorgio
Foot deformity is a major component of impaired functioning in cerebral palsy (CP). While gait and balance issues related to CP have been studied extensively, there is little information to date on foot-ground interaction (i.e. contact area and plantar pressure distribution). This study aimed to characterize quantitatively the foot-ground contact parameters during static upright standing in hemiplegia and diplegia. We studied 64 children with hemiplegia (mean age 8.2 years; SD 2.8 years) and 43 with diplegia (mean age 8.8 years; SD 2.3 years) while standing on both legs statically on a pressure sensitive mat. We calculated pressure data for the whole foot and sub-regions (i.e. rearfoot, midfoot and forefoot) and average contact pressure. The Arch Index (AI) served for classifying the feet as flat, normal or cavus feet. The data were compared with those from a sample of age- and gender-matched participants (control group, 68 children). Most of the feet showed very high AI values, thus indicating a flat foot. This deformity was more common in diplegia (74.4%) than in hemiplegia (54.7%). In both diplegic and hemiplegic children, average plantar pressure was significantly increased in the forefoot and midfoot and decreased in the rearfoot (p<0.001). The present data indicate an increased load on the front parts of the foot, which may be due to plantarflexor overactivity or knee flexion, combined with an increased incidence of low foot arches. As a low foot arch does not necessarily increase forefoot load, this deformity can be regarded as secondary.
Leardini, A; Benedetti, M G; Berti, L; Bettinelli, D; Nativo, R; Giannini, S
This paper proposes a new protocol designed to track a large number of foot segments during the stance phase of gait with the smallest possible number of markers, with particular clinical focus on coronal plane alignment of the rear-foot, transverse and sagittal plane alignment of the metatarsal bones, and changes at the medial longitudinal arch. The shank, calcaneus, mid-foot and metatarsus were assumed to be 3D rigid bodies. The longitudinal axis of the first, second and fifth metatarsal bones and the proximal phalanx of the hallux were also tracked independently. Skin markers were mounted on bony prominences or joint lines, avoiding the course of main tendons. Trajectories of the 14 markers were collected by an eight-camera motion capture system at 100 Hz on a population of 10 young volunteers. Three-dimensional joint rotations and planar angles were calculated according to anatomically based reference frames. The marker set was well visible throughout the stance phase of gait, even in a camera configuration typical of gait analysis of the full body. The time-histories of the joint rotations and planar angles were well repeatable among subjects and consistent with clinical and biomechanical knowledge. Several dynamic measurements were originally taken, such as elevation/drop of the medial longitudinal arch and of three metatarsal bones, rear-foot to fore-foot rotation and transverse plane deformation of the metatarsus. The information obtained from this protocol, consistent with previous clinical knowledge, enhanced our understanding of the dynamics of the human foot during stance.
Kozin, Scott H; Zlotolow, Dan A
Madelung deformity of the wrist is more common in females and is often associated with Leri Weill dyschondrosteosis, a mesomelic form of dwarfism. Patients with Madelung deformity often report wrist deformity resulting from the prominence of the relatively long ulna. The typical Madelung deformity is associated with a Vickers ligament that creates a tether across the volar-ulnar radial physis that restricts growth across this segment. The distal radius deforms in the coronal (increasing radial inclination) and the sagittal (increasing volar tilt) planes. There is lunate subsidence and the proximal carpal row adapts to the deformity by forming an upside-down pyramid shape or triangle. Treatment depends on the age at presentation, degree of deformity, and magnitude of symptoms. Mild asymptomatic deformity warrants a period of nonsurgical management with serial x-ray examinations because the natural history is unpredictable. Many patients never require surgical intervention. Progressive deformity in the young child with considerable growth potential remaining requires release of Vickers ligament and radial physiolysis to prevent ongoing deterioration Concomitant ulnar epiphysiodesis may be necessary. Advanced asymptomatic deformity in older children with an unacceptable-appearing wrist or symptomatic deformity are indications for surgery. A dome osteotomy of the radius allows 3-dimensional correction of the deformity. Positive radiographic and clinical results after dome osteotomy have been reported. Copyright © 2015 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.
Morrison, Katherine E; Kaminski, Thomas W
Objective: To review the literature that provides information to assist in analyzing the role of the foot in acute and chronic lateral ankle injury. Data Sources: We searched MEDLINE, CINAHL, Institute for Scientific Information's Web of Science, and SPORT Discus from 1965–2005 using the terms lateral, ankle, ligament, injury, risk factors, foot, subtalar joint, talocrural joint, gait analysis, and foot biomechanics. Data Synthesis: We found substantial information on the incidence and treatment of lateral ankle sprains in sport but very few articles that focused on risk factors associated with these injuries and even less information on the foot as it relates to this condition. Moreover, little information was available regarding the risk factors associated with the development of chronic instability after a lateral ankle sprain. We critically analyzed the foot articulations and the foot's role in the mechanism of injury to assist our clinical synopsis. Conclusions/Recommendations: An in-depth review of the foot complex in relation to lateral ankle sprains strongly suggested its importance when treating and preventing inversion ankle trauma. Throughout the literature, the only static foot measurements that show a significant correlation to this condition are an identified cavovarus deformity, increased foot width, and increased calcaneal eversion range of motion. Authors also provided dynamic measurements of the foot, which produced several significant findings that we discuss. Although our findings offer some insight into the relationship between foot characteristics and lateral ankle injuries, future research is needed to confirm the results of this review and expand this area of investigation. PMID:17597955
Sabapathy, S. Raja; Periasamy, Madhu
Fifteen percent of people with diabetes develop an ulcer in the course of their lifetime. Eighty-five percent of the major amputations in diabetes mellitus are preceded by an ulcer. Management of ulcers and preventing their recurrence is important for the quality of life of the individual and reducing the cost of care of treatment. The main causative factors of ulceration are neuropathy, vasculopathy and limited joint mobility. Altered bio-mechanics due to the deformities secondary to neuropathy and limited joint mobility leads to focal points of increased pressure, which compromises circulation leading to ulcers. Ulcer management must not only address the healing of ulcers but also should correct the altered bio-mechanics to reduce the focal pressure points and prevent recurrence. An analysis of 700 patients presenting with foot problems to the Diabetic Clinic of Ganga Hospital led to the stratification of these patients into four classes of incremental severity. Class 1 – the foot at risk, Class 2 – superficial ulcers without infection, Class 3 – the crippled foot and Class 4 – the critical foot. Almost 77.5% presented in either Class 3 or 4 with complicated foot ulcers requiring major reconstruction or amputation. Class 1 foot can be managed conservatively with foot care and appropriate foot wear. Class 2 in addition to measures for ulcer healing would need surgery to correct the altered bio-mechanics to prevent the recurrence. The procedures called surgical offloading would depend on the site of the ulcer and would need an in-depth clinical study of the foot. Class 3 would need major reconstructive procedures and Class 4 would need amputation since it may be life-threatening. As clinicians, our main efforts must be focused towards identifying patients in Class 1 and offer advice on foot care and Class 2 where appropriate surgical offloading procedure would help preserve the foot. PMID:28216809
Deis, B. C. (Inventor)
A light weight, economical device to alleviate a plurality of difficulties encountered in walking by a victim suffering from a drop foot condition is discussed. A legband girdles the leg below the knee and above the calf providing an anchor point for the upper end of a ligament having its lower end attached to a toe of a shoe or a toe on the foot. The ligament is of such length that the foot is supported thereby and retained in a normal position during walking.
Ivanenko, Y. P.; Gurfinkel, V. S.
Anthropological and biomechanical research suggests that the human foot evolved a unique design for propulsion and support. In theory, the arch and toes must play an important role, however, many postural studies tend to focus on the simple hinge action of the ankle joint. To investigate further the role of foot anatomy and sensorimotor control of posture, we quantified the deformation of the foot arch and studied the effects of local perturbations applied to the toes (TOE) or 1st/2nd metatarsals (MT) while standing. In sitting position, loading and lifting a 10-kg weight on the knee respectively lowered and raised the foot arch between 1 and 1.5 mm. Less than 50% of this change could be accounted for by plantar surface skin compression. During quiet standing, the foot arch probe and shin sway revealed a significant correlation, which shows that as the tibia tilts forward, the foot arch flattens and vice versa. During TOE and MT perturbations (a 2- to 6-mm upward shift of an appropriate part of the foot at 2.5 mm/s), electromyogram (EMG) measures of the tibialis anterior and gastrocnemius revealed notable changes, and the root-mean-square (RMS) variability of shin sway increased significantly, these increments being greater in the MT condition. The slow return of RMS to baseline level (>30 s) suggested that a very small perturbation changes the surface reference frame, which then takes time to reestablish. These findings show that rather than serving as a rigid base of support, the foot is compliant, in an active state, and sensitive to minute deformations. In conclusion, the architecture and physiology of the foot appear to contribute to the task of bipedal postural control with great sensitivity. PMID:22157121
Wright, W G; Ivanenko, Y P; Gurfinkel, V S
Anthropological and biomechanical research suggests that the human foot evolved a unique design for propulsion and support. In theory, the arch and toes must play an important role, however, many postural studies tend to focus on the simple hinge action of the ankle joint. To investigate further the role of foot anatomy and sensorimotor control of posture, we quantified the deformation of the foot arch and studied the effects of local perturbations applied to the toes (TOE) or 1st/2nd metatarsals (MT) while standing. In sitting position, loading and lifting a 10-kg weight on the knee respectively lowered and raised the foot arch between 1 and 1.5 mm. Less than 50% of this change could be accounted for by plantar surface skin compression. During quiet standing, the foot arch probe and shin sway revealed a significant correlation, which shows that as the tibia tilts forward, the foot arch flattens and vice versa. During TOE and MT perturbations (a 2- to 6-mm upward shift of an appropriate part of the foot at 2.5 mm/s), electromyogram (EMG) measures of the tibialis anterior and gastrocnemius revealed notable changes, and the root-mean-square (RMS) variability of shin sway increased significantly, these increments being greater in the MT condition. The slow return of RMS to baseline level (>30 s) suggested that a very small perturbation changes the surface reference frame, which then takes time to reestablish. These findings show that rather than serving as a rigid base of support, the foot is compliant, in an active state, and sensitive to minute deformations. In conclusion, the architecture and physiology of the foot appear to contribute to the task of bipedal postural control with great sensitivity.
Chandalia, H. B.; Singh, D.; Kapoor, V.; Chandalia, S. H.; Lamba, P. S.
We assessed 300 diabetic and 100 age- and sex-matched controls for correlating foot wear practices and foot care knowledge and the presence of foot complications. A structured questionnaire evaluated the knowledge about foot care, type of footwear used, education level, association of tobacco abuse, and any associated symptoms of foot disease. Clinical evaluation was done by inspection of feet for presence of any external deformities, assessment of sensory function (vibration perception threshold, VPT), vascular status (foot pulses and ankle brachial ratio) and presence of any infection. In the diabetes category, 44.7% patients had not received previous foot care education. 0.6% walked barefoot outdoors and 45% walked barefoot indoors. Fourteen (4.7%) patients gave history of foot ulceration in the past and comprised the high risk group; only 2 out of 14 had received foot care education, 6 gave history of tobacco abuse, 8 had symptoms of claudication, 9 had paresthesias, 2 walked barefoot indoors. Average duration of diabetes in the high-risk and low-risk diabetes group was 10.85 ± 6.53 and 9.83 ± 7.99 years, respectively. In the high- and low-risk diabetic groups, VPT was 19.57 ± 11.26 and 15.20 ± 10.21V (P < 0.02), ankle brachial ratio was 1.05 ± 0.19 and 1.14 ± 0.18 (P < 0.05), and the questionnaire scores was 40.8% and 57%, respectively. In the diabetic and the control group, VPT was 15.62 ± 10.39 and 8.36 ± 3.61 V (P < 0.01), ankle brachial ratio was 1.14 ± 0.18 and 1.15 ± 0.12, and the questionnaire scores were 57% and 40.3%, respectively. In conclusion, poor knowledge of foot care and poor footwear practices were important risk factors for foot problems in diabetes. PMID:20165597
The diabetic foot presents a complex interplay of neuropathic, macrovascular, and microvascular disease on an abnormal metabolic background, complicated by an increased susceptibility to mechanical, thermal, and chemical injury and decreased healing ability. The abnormalities of diabetes, once present, are not curable. But most severe foot abnormalities in the diabetic are due to neglect of injury and are mostly preventable. The physician must ensure that the diabetic patient learns the principles of good foot care. If time for teaching is limited, this task must be delegated to a podiatrist or a diabetes nurse educator in a diabetes day centre. It is the physician's responsibility to confirm foot care by personal inspection of the feet of all diabetic patients at every visit. PMID:21234002
... the foot. In: Canale ST, Beaty JH, eds. Campbell's Operative Orthopaedics . 12th ed. Philadelphia, PA: Elsevier Mosby; ... of amputations. In: Canale ST, Beaty JH, eds. Campbell's Operative Orthopaedics . 12th ed. Philadelphia, PA: Elsevier Mosby; ...
... 58. LeCursi N. Sports shoes and orthoses. In: Miller MD, Thompson SR, eds. DeLee and Drez's Orthopaedic ... Ligamentous Injuries of the Foot and Ankle. In: Miller MD, Thompson SR, eds. DeLee and Drez's Orthopaedic ...
The large number of factors that influence the outcome of patients with diabetic foot infections calls for a multidisciplinary management of such patients. Infection is always the consequence of a preexisting foot wound whose chronicity is facilitated by the diabetic peripheral neuropathy, whereas peripheral vascular disease is a factor of poor outcome, especially regarding the risk for leg amputation. Primary and secondary prevention of IPD depends both on the efficacy of wound off-loading. Antibiotic treatment should only be considered for clinically infected foot wounds for which diagnostic criteria have recently been proposed by international consensus. The choice of the antibiotic regimen should take into account the risk for selecting bacterial resistance, and as a consequence, agents with a narrow spectrum of activity should be preferred. Respect of the measures for preventing the spread of bacterial resistance in diabetic foot centers is particularly important.
Blattner, Bunny; And Others
Seventy-six Fort Lauderdale third, fourth, and fifth graders spent an entire day researching, measuring, comparing, and creating fantasies about feet. This article describes "Foot Day" and presents the activity sheets used by the students. (Author/SJL)
Engineer and 12 foot Beacon showing NACA emblem on inflated satelloon . For related information see, Spaceflight Revolution, NASA from Sputnik to Apollo, by James R. Hansen. NASA SP-4308, 1995. p. 173.
... Infographic (English) Low Blood Glucose (Hypoglycemia) Nerve Damage (Diabetic Neuropathies) Diabetic Kidney Disease Diabetes and Foot Problems Diabetic ... time, diabetes may cause nerve damage, also called diabetic neuropathy , that can cause tingling and pain, and can ...
Biehl, C; Eckhard, M; Szalay, G; Heiss, C
The treatment strategy for diabetic foot syndrome must take into account protective sensibility of the foot, open wounds, infection status, and the rules of septic bone surgery. Interventions are classified as elective, prophylactic, curative, or emergency. Amputations in the forefoot and midfoot region are performed as ray amputations (including metatarsal), which can often be carried out as "inner" amputations. Gentle tissue treatment mandatory because of greater risk of revision with re-amputation compared to classical amputation. Good demarcation of infection, acute osteomyelitis, osteolytic lesions, neurotropic ulcer, arterial and venous blood flow to the other toes, gangrene of other toes with metatarsal affection. Arterial occlusive disease, infection of neighboring areas, avoidable amputations, poorly healing ulcers on the lower leg. Primary dorsal approach; minimal incisional distance (5 cm) to minimize skin necrosis risk. Atraumatic preparation, minimize hemostasis to not compromise the borderline perfusion situation. In amputations, plantar skin preparation and longer seams placed as dorsal as possible, either disarticulated and maintain cartilage, or round the cortical metatarsal bone after resection. Diabetes control. Braun splint, mobilization in a shoe with forefoot decompression and hindfoot support, physiotherapy. Antibiotics based on resistance testing. If no complications, dressing change on postoperative day 1. Optimal wound drainage by lowering foot several times a day; drainage removal after 12-24 h. Insoles and footwear optimization. Amputations require continued attention and if necessary treatment to avoid sequelae. Insufficient treatment associated with recurrent ulceration and altered anatomy.
Nather, Aziz; Chionh, Siok Bee; Tay, Patricia L M; Aziz, Zameer; Teng, Janelle W H; Rajeswari, K; Erasmus, Adriaan; Nambiar, Ajay
This study aims to evaluate the results of foot screening performed in a study population of 2137 diabetics (3926 feet) screened from 2006 to 2008 by the National University Hospital (NUH) multi-disciplinary team for diabetic foot problems. A standardised protocol was designed. Foot screening consisted of detailed history taking and clinical examination including assessment for sensory neuropathy by Semmes Weinstein monofilament (SWMF) and neurothesiometer and assessment of vasculopathy by ankle-brachial index (ABI) and total body irradiation (TBI). The foot screening was performed by a trained staff nurse. All patients were classified according to King's College Classification. Majority of the patients were in the fifth (27.9%) and sixth (30.0%) decades of life. Two thousand sixty-four had type II diabetes, and only 73 had type I diabetes. Neuropathy was found in 1307 (33.3%) feet based on 5.07 SWMF. Vasculopathy was recorded in 510 (13.0%) and 546 (13.9%) feet based on ABI <0.8 and TBI <0.7. According to King's Classification, 1069 (50.0%) were Stage 1: Normal and 615 (28.8%) were Stage 2: At-Risk. Foot screening should be performed as early as possible to detect "At-Risk" feet and prevent the development of diabetic foot complications, thereby further reducing the risk of major amputations.
Andrews, Karen L; Houdek, Matthew T; Kiemele, Lester J
Hospital-based studies have shown that mortality rates in individuals with diabetic foot ulcers are about twice those observed in individuals with diabetes without foot ulcers. To assess the etiology and management of chronic diabetic foot ulcers. Literature review. Systematic review of the literature discussing management of diabetic foot ulcers. Since there were only a few randomized controlled trials on this topic, articles were selected to attempt to be comprehensive rather than a formal assessment of study quality. Chronic nonhealing foot ulcers occur in approximately 15% of patients with diabetes. Many factors contribute to impaired diabetic wound healing. Risk factors include peripheral neuropathy, peripheral arterial disease, limited joint mobility, foot deformities, abnormal foot pressures, minor trauma, a history of ulceration or amputation, and impaired visual acuity. With the current treatment for nonhealing diabetic foot ulcers, a significant number of patients require amputation. Diabetic foot ulcers are optimally managed by a multidisciplinary integrated team. Offloading and preventative management are important. Dressings play an adjunctive role. There is a critical need to develop novel treatments to improve healing of diabetic foot ulcers. The goal is to have wounds heal and remain healed. Diabetic neuropathy and peripheral arterial disease are major factors involved in a diabetic foot ulcer. Despite current treatment modalities for nonhealing diabetic foot ulcers, there are a significant number of patients who require amputations. No known therapy will be effective without concomitant management of ischemia, infection, and adequate offloading. © The International Society for Prosthetics and Orthotics 2014.
Salathé, E P; Arangio, G A; Salathé, E P
A mathematical analysis of the deformation of the foot is developed to determine the role that stretch of ligaments and tendons plays in absorbing shock following impact. Our analysis is based on an anatomical biomechanical model that includes each of the bones of the foot. We calculate the time course of the deflection of the joints and the elongation of the ligaments and tendons and determine the ground reaction force acting on the heel. Quasi-linear viscoelastic theory is used for soft tissue constitutive relationships. With biomechanical data selected from the literature, we obtain a vertical force impact peak of 8000 N, occurring at 16 ms following heel strike. This is of higher magnitude and shorter duration than is found experimentally, as is to be expected, since we did not include the heel pad in our model and we assumed that the impact surface was ideally rigid.
Choi, Hwan; Wren, Tishya Anne Leong; Steele, Katherine Muterspaugh
Many individuals with cerebral palsy wear ankle foot orthoses during daily life. Orthoses influence joint motion, but how they impact muscle remains unclear. In particular, the gastrocnemius is commonly stiff in cerebral palsy. Understanding whether orthoses stretch or shorten this muscle during daily life may inform orthosis design and rehabilitation. This study investigated the impact of different ankle foot orthoses on gastrocnemius operating length during walking in children with cerebral palsy. Case series, within subject comparison of gastrocnemius operating length while walking barefoot and with two types of ankle foot orthoses. We performed gait analyses for 11 children with cerebral palsy. Each child was fit with two types of orthoses: a dynamic ankle foot orthosis (Cascade dynamic ankle foot orthosis) and an adjustable dynamic response ankle foot orthosis (Ultraflex ankle foot orthosis). Musculoskeletal modeling was used to quantify gastrocnemius musculotendon operating length and velocity with each orthosis. Walking with ankle foot orthoses could stretch the gastrocnemius more than barefoot walking for some individuals; however, there was significant variability between participants and orthoses. At least one type of orthosis stretched the gastrocnemius during walking for 4/6 and 3/5 of the Gross Motor Functional Classification System Level I and III participants, respectively. AFOs also reduced peak gastrocnemius lengthening velocity compared to barefoot walking for some participants, with greater reductions among the Gross Motor Functional Classification System Level III participants. Changes in gastrocnemius operating length and lengthening velocity were related to changes in ankle and knee kinematics during gait. Ankle foot orthoses impact gastrocnemius operating length during walking and, with proper design, may assist with stretching tight muscles in daily life. Clinical relevance Determining whether ankle foot orthoses stretch tight muscles can
A 15-30% rate of amputation of diabetic feet suggests that efforts have to be directed towards improvement of preventive measure including instruction of patients and relatives concerning foot wear. So called foot rules have been established. If surgery is indicated, an angiological and neurological assessment should be performed preoperatively. An ulcer should undergo debridement, plantar pressure release with a full contact cast and antibiotic therapy, if infected. The goal of treatment of Charcot's disease is prevention of deformity. Usually orthoses are sufficient, in irreducible deformities an arthrodesis should be considered. There is no doubt that the interdisciplinary approach improves the treatment of the diabetic foot.
Alonso-Fernández, Margarita; Mediavilla-Bravo, José Javier; López-Simarro, Flora; Comas-Samper, José Manuel; Carramiñana-Barrera, Francisco; Mancera-Romero, José; de Santiago Nocito, Ana
To ascertain whether patients with type 2 diabetes are screened for diabetic foot, and to analyze the factors related to patients and centers associated to performance of such screening. A multicenter, epidemiological, cross-sectional study was conducted. The clinical records of 443 patients with type 2 diabetes monitored at Primary Care for at least 12 months were reviewed. Demographic and healthcare variables and characteristics of the primary care center were recorded. In the previous year, 51.2% of patients had been trained on foot self-care, 56.4% had undergone foot inspection, 39.5% had been examined with a monofilament, and palpation of peripheral pulses and measurement of the ankle-brachial index were performed in 45.8 and 10.1% of patients, respectively. Diabetic foot screening (inspection, monofilament testing, and palpation of peripheral pulses) was performed in 37% of study patients. Ulcer risk stratification was done in 12.4% of patients. A significant association was found between diabetic foot screening and presence of foot deformities (P<.001), history of neuropathy (P=.005), and history of peripheral artery disease (P<.05). Screening was also associated to some characteristics of the center, such as reception of information about goal achievement (P<.001) and economic incentives for goal attainment (P<.001). Compliance with diabetic foot screening and ulcer risk stratification in patients with type 2 diabetes in Primary Care was poor. Copyright © 2013 SEEN. Published by Elsevier Espana. All rights reserved.
Shirai, Yasuhiro; Wakabayashi, Kenjiro; Wada, Ikuo; Tsuboi, Yoshiaki; Ha, Myongsu; Otsuka, Takanobu
While the foot abduction brace (FAB) plays an important role in the Ponseti method, the true function of the FAB in the treatment of idiopathic clubfoot remains unknown. In our clinical experience, we have noted that many patients with unilateral idiopathic clubfoot developed significant flatfoot in the contralateral foot during brace treatment. The purpose of this study was to investigate the natural history of the contralateral foot development during and after brace wear. We also discuss the effect of the FAB on the contralateral foot.We retrospectively reviewed 21 contralateral feet of 21 patients with unilateral idiopathic clubfoot who were treated using the Ponseti method and were conservatively followed up until the FAB was taken off (6 years of age or older). We evaluated flatfoot indicators of the contralateral foot on standing radiographs during and after brace wear and compared them against the normal reference ranges. We also evaluated the changes in the flatfoot indicators of the contralateral foot during and after brace wear.Although there was a significant difference in the flatfoot indicators between the contralateral foot and normal reference ranges during brace wear, there was no significant difference in the flatfoot indicators after brace wear. While there was no significant improvement in flatfoot indicators of the contralateral foot during brace wear, there was a significant improvement or a trend to improve after brace wear. There was no significant correlation between the contralateral flatfoot and original joint laxity.Significant flatfoot deformity was observed in the contralateral foot during brace wear. The contralateral flatfoot persisted during brace wear and improved to within normal reference ranges after brace wear. Our findings suggest that the FAB may influence the development of the contralateral foot, leading to the flatfoot.
Nork, S E; Coughlin, R R
The foot is a remarkable structure that provides stable support for the body, lessens impact loading during gait, and allows for forward motion that is energy efficient. Because of the enormous loads concentrated at the joints in the foot and ankle with normal activities, frequent injuries occur and present to the primary care provider. Systemic conditions and improper footwear also contribute to the number of foot injuries that require medical attention. This article provides the clinician with the practical tools necessary for a complete examination of the foot and ankle. This article also includes a practical approach to examination and diagnosis of the bunion deformity.
Boffeli, Troy J; Collier, Rachel C
Lower extremity contracture associated with stroke commonly results in a nonreducible, spastic equinovarus deformity of the foot and ankle. Rigid contracture deformity leads to gait instability, pain, bracing difficulties, and ulcerations. The classic surgical approach for stroke-related contracture of the foot and ankle has been combinations of tendon lengthening, tendon transfer, osteotomy, and joint fusion procedures. Recovery after traditional foot and ankle reconstructive surgery requires a period of non-weightbearing that is not typically practical for these patients. Little focus has been given in published studies on minimally invasive soft tissue release of contracture. We present the case of a 61-year-old female with an equinovarus foot contracture deformity secondary to stroke. The patient underwent Achilles tendon lengthening, posterior tibial tendon Z lengthening, and digital flexor tenotomy of each toe with immediate weightbearing in a walking boot, followed by transition to an ankle-foot orthosis. The surgical principles and technique tips are presented to demonstrate our minimally invasive approach to release of foot and ankle contracture secondary to stroke. The main goal of this approach is to improve foot and ankle alignment for ease of bracing, which, in turn, will improve gait, reduce the risk of falls, decrease pain, and avoid the development of pressure sores. Copyright © 2014 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.
Short, Daniel J; Zgonis, Thomas
Numerous techniques have been described for surgical management of the diabetic Charcot foot. External fixation has become a main surgical tool for the reconstructive foot and ankle surgeon when dealing with the ulcerated diabetic Charcot foot. In the presence of an open wound and/or osteomyelitis, staged reconstruction with circular external fixation becomes ideal for salvage of the diabetic lower extremity. Also, circular external fixation can provide simultaneous compression and stabilization, correct the underlying osseous or soft tissue deformities, and surgically offload the diabetic Charcot foot. This article describes a variety of circular external fixation applications for the diabetic Charcot foot.
Claustre, J; Simon, L
Clinical and radiological examination of the foot in 25 cases of ankylosing verteral hyperostosis revealed signs of the disease in 16 cases: eleven patients had painful symptoms (predominantly pain in the heel, 9 cases) and and five had radiological changes in the feet which led to the discovery of the characteristic vertebral involvement. As for other extra-vertebral sites of vertebral hyperostosis, the foot warrants careful examination. The radiological lesions consist of osteophytic proliferations of the calcaneum (sometimes pathognomonic), scattered ossifications in the ligaments of the inferior and posterior aspects of this bone, the neck of the talus, the dorsum of the mid-foot, the internal aspect of the tarsal scaphoid or the external face of the styloid apophysis of the 5th metatarsal, and a bony proliferation enlarging the base of the distal phalanx of the big toe.
ISS011-E-13101 (16 Sept. 2005) --- Astronaut John L. Phillips, Expedition 11 NASA space station science officer and flight engineer, balances on the footplate of a special track attached to the Human Research Facility (HRF) rack in the Destiny laboratory on the International Space Station to perform Foot/Ground Reaction Forces During Spaceflight (FOOT) / Electromyography (EMG) calibration operations. Phillips is wearing the Lower Extremity Monitoring Suit (LEMS), the cycling tights outfitted with 20 sensors, which measures forces on joints and muscle activity.
Langley, Ben; Cramp, Mary; Morrison, Stewart C
Static assessments of the foot are commonly advocated within the running community to classify the foot with a view to recommending the appropriate type of running shoe. The aim of this work was to determine whether selected static foot assessment could predict medial longitudinal arch (MLA) motion during running. Fifteen physically active males (27 ± 5 years, 1.77 ± 0.04 m, 80 ± 10 kg) participated in the study. Foot Posture Index (FPI-6), MLA angle and rearfoot angle were measured in a relaxed standing position. MLA motion was calculated using the position of retro-reflective markers tracked by a VICON motion analysis system, while participants ran barefoot on a treadmill at a self-selected pace (2.8 ± 0.5 m.s(-1)). Bivariate linear regression was used to determine whether the static measures predicted MLA deformation and MLA angles at initial contact, midsupport and toe off. All three foot classification measures were significant predictors of MLA angle at initial contact, midsupport and toe off (p < .05) explaining 41-90 % of the variance. None of the static foot classification measures were significant predictors of MLA deformation during the stance phase of running. Selected static foot measures did not predict dynamic MLA deformation during running. Given that MLA deformation has theoretically been linked to running injuries, the clinical relevance of predicting MLA angle at discrete time points during the stance phase of running is questioned. These findings also question the validity of the selected static foot classification measures when looking to characterise the foot during running. This indicates that alternative means of assessing the foot to inform footwear selection are required.
Arsanjani Shirazi, Azam; Nasiri, Morteza; Yazdanpanah, Leila
Diabetic Foot Syndrome (DFS) is the most costly and devastating complication of diabetes mellitus (DM), which early effective assessment can reduce the severity of complications including ulceration and amputations. This study aimed to review dermatological and musculoskeletal assessment of diabetic foot. In this review article, we searched for articles published between March 1, 1980 and July 28, 2015 in PubMed, Science Direct, Embase, Web of Science, and Scopus, for both English and non-English language articles with the following keywords: "Diabetic foot syndrome", "Ulceration", "Amputation", "Foot assessment", "Skin disorders" and "Musculoskeletal deformities". In dermatological dimension, most studies focused on elucidated changes in skin temperature, color, hardiness and turgor as well as common skin disorders such as Diabetic Dermopathy (DD), Necrobiosis Lipoidica Diabeticorum (NLD) and Diabetic Bullae (DB), which are common in diabetic patients and have high potential for leading to limb-threatening problems such as ulceration and infection. In musculoskeletal dimension, most studies focused on range of motion and muscle strength, gait patterns and as well as foot deformities especially Charcot osteoarthropathy (COA), which is the most destructive musculoskeletal complication of diabetes. DFS as a common condition in DM patients lead to ulceration and lower limb amputation frequently unless a prompt and comprehensive assessment was taken. So that dermatological and musculoskeletal assessments are usually neglected in primary health care, these assessments should be done frequently to reduce the high risk of serious complications. Copyright © 2016 Diabetes India. Published by Elsevier Ltd. All rights reserved.
Lamm, Bradley M; Stasko, Paul A; Gesheff, Martin G; Bhave, Anil
The limb deformity-based principles originate from a standard set of lower extremity radiographic angles and reference points. Objective radiographic measures are the building blocks for surgical planning. Critical preoperative planning and intraoperative and postoperative evaluation of radiographs are essential for proper deformity planning and correction of all foot and ankle cases. A total of 33 angles and reference points were measured on 24 healthy feet. The radiographic measurements were performed on standard weightbearing anteroposterior, lateral, and axial views of the right foot. A total of 4 measurements were made from the axial view, 12 from the lateral view, and 17 from the anteroposterior view. All angles were measured by both senior authors twice, independent of each other. The radiographic angles and measurements presented in the present study demonstrate a comprehensive and useful set of standard angles, measures, and reference points that can be used in clinical and perioperative evaluation of the foot and ankle. The standard radiographic measures presented in the present study provide the foundation for understanding the osseous foot and ankle position in a normal population. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.
Kuryliszyn-Moskal, Anna; Kaniewska, Katarzyna; Dzięcioł-Anikiej, Zofia; Klimiuk, Piotr Adrian
Rheumatic diseases such as osteoarthritis and rheumatoid arthritis constitute the most frequent pathological states leading to the development of foot deformities, which reduce quality of life and cause disability. The aim of the present study was to compare the results of plantoconturographic examinations, obtained by means of a computer podoscope, in osteoarthritis and rheumatoid arthritis patients. Special attention was paid to the differences in the values of each parameter determining the level of foot function. The study was performed in 94 female patients divided into two groups according to the type of disease. There were 54 patients with rheumatoid arthritis and 40 with osteoarthritis. The control group consisted of 34 healthy women. The plantographic assessment of static foot structure was carried out by means of a device for computer-aided foot examination. A fallen transverse arch of the right foot was statistically much more frequent in the rheumatoid arthritis patients than in osteoarthritis patients or the control group (p < 0.005 and p < 0.05, respectively). Significant differences in the values of the Wejsflog index were observed in the case of left foot between rheumatoid arthritis patients and the control group (p < 0.05). Similarly, there were statistically significant differences in the values of the hallux valgus angle (α) for the right foot between rheumatoid arthritis and osteoarthritis patients or control group (in both cases p < 0.05). Rheumatic diseases predispose patients to disturbances of static foot function. The obtained results highlight the importance of diagnosing foot static disturbances in the prevention of destructive changes affecting the functioning of osteoarthritis and rheumatoid arthritis patients.
The frequency and extent of rheumatic forefoot deformities have been greatly reduced since the introduction of disease-modifying antirheumatic drugs (DMARD). The accompanying reduction in arthritic destruction of joints opens up new treatment options whereby priority is given to joint preservation. This is true for the first middle foot ray as well as for the small toe rays. Whereas resection arthroplasty of the metatarsophalangeal joints II-V was previously considered the gold standard treatment, joint-preserving operative procedures (e.g. metatarsal osteotomy and periarticular soft tissue interventions) are now being increasingly more propagated. Resection arthroplasty of the first midfoot ray has major biomechanical disadvantages so that it is not surprising that reconstructive procedures are given priority. In patients with severe arthritic destruction of the first metatarsophalangeal joint, arthrodesis has substantial biomechanical advantages compared to resection arthroplasty. Nevertheless, it has not yet been confirmed that fusion leads to superior clinical results.
in which the maximum force may be applied ’. 2.6. Foot versus Hand Operation of Controls Grether (1946) investigated tracking accuracy with...airplane controls. Technical Note 550, National Advisory Committee for Aeronautics, Washington, D.C. GRETHER , W. P., 1946, A study of several
... Habits for TV, Video Games, and the Internet X-Ray Exam: Foot KidsHealth > For Parents > X-Ray Exam: Foot Print A A A What's in ... You Have Questions What It Is A foot X-ray is a safe and painless test that uses ...
Volmer-Thole, Maren; Lobmann, Ralf
Diabetic foot ulceration is a serious complication of diabetes mellitus worldwide and the most common cause of hospitalization in diabetic patients. The etiology of diabetic foot ulcerations is complex due to their multifactorial nature; in the pathophysiology of diabetic foot ulceration polyneuropathy is important. Proper adherence to standard treatment strategies and interdisciplinary cooperation can reduce the still high rates of major amputations. PMID:27294922
Volmer-Thole, Maren; Lobmann, Ralf
Diabetic foot ulceration is a serious complication of diabetes mellitus worldwide and the most common cause of hospitalization in diabetic patients. The etiology of diabetic foot ulcerations is complex due to their multifactorial nature; in the pathophysiology of diabetic foot ulceration polyneuropathy is important. Proper adherence to standard treatment strategies and interdisciplinary cooperation can reduce the still high rates of major amputations.
... Old Feeding Your 1- to 2-Year-Old X-Ray Exam: Foot KidsHealth > For Parents > X-Ray Exam: Foot A A A What's in this ... español Radiografía: pie What It Is A foot X-ray is a safe and painless test that uses ...
... deformity is often called “pump bump” because the rigid backs of pump-style shoes can create pressure ... when walking. In fact, any shoes with a rigid back, such as ice skates, men’s dress shoes ...
Deformity - contracture ... Contracture can be caused by any of the following: Brain and nervous system disorders, such as cerebral ... Follow your health care provider's instructions for treating contracture at home. Treatments may include: Doing exercises and ...
Bunnell, W P
Spinal deformity is a relatively common disorder, particularly in teenage girls. Early detection is possible by a simple, quick visual inspection that should be a standard part of the routine examination of all preteen and teenage patients. Follow-up observation will reveal those curvatures that are progressive and permit orthotic treatment to prevent further increase in the deformity. Spinal fusion offers correction and stabilization of more severe degrees of scoliosis.
Chantelau, E; Onvlee, G J
Neuropathic osteoarthropathy is characterised by relatively painless swelling together with extensive damage in bones and joints, predominantly in the feet and ankles. The uncontrolled natural course of the condition leads to gross foot deformity, skin pressure ulceration, spreading infections, and sometimes amputation. Jean-Martin Charcot in 1883 described "Charcot foot" named after him in patients with tabes dorsalis insensitivity. Charcot believed that intrinsic bone weakness was the underlying condition, and was caused by neurogenic deficiencies in bone nutrition. His followers believed such dystrophy to be mediated by sympathetic denervation of the bone vasculature (neurotrophic, or neurovascular theory). Attempts to prove this theory were futile. A neurogenic circulatory disorder potentially relevant to bone nutrition could not be identified. Nowadays, Charcot foot is mostly seen in diabetic neuropathy, which has replaced syphilis as a frequent cause of peripheral nerve dysfunction. Recent studies in the diabetic Charcot foot and bone turnover indicate that the neurotrophic theory is a myth. The assumption of bone resorption due to sympathetic denervation proved to be false--sympathetic activity increases osteoclastic activity and thereby bone loss (sympathomimetic bone resorption). Except for the transient, inflammatory stage of the diabetic Charcot foot, there is no evidence of relevant osteoporosis or demineralisation of the foot skeleton in diabetes.
Menz, Hylton B.; Dufour, Alyssa B.; Riskowski, Jody L.; Hillstrom, Howard J.
Objective. Abnormal foot posture and function have been proposed as possible risk factors for low back pain, but this has not been examined in detail. The objective of this study was to explore the associations of foot posture and foot function with low back pain in 1930 members of the Framingham Study (2002–05). Methods. Low back pain, aching or stiffness on most days was documented on a body chart. Foot posture was categorized as normal, planus or cavus using static weight-bearing measurements of the arch index. Foot function was categorized as normal, pronated or supinated using the centre of pressure excursion index derived from dynamic foot pressure measurements. Sex-specific multivariate logistic regression models were used to examine the associations of foot posture, foot function and asymmetry with low back pain, adjusting for confounding variables. Results. Foot posture showed no association with low back pain. However, pronated foot function was associated with low back pain in women [odds ratio (OR) = 1.51, 95% CI 1.1, 2.07, P = 0.011] and this remained significant after adjusting for age, weight, smoking and depressive symptoms (OR = 1.48, 95% CI 1.07, 2.05, P = 0.018). Conclusion. These findings suggest that pronated foot function may contribute to low back symptoms in women. Interventions that modify foot function, such as orthoses, may therefore have a role in the prevention and treatment of low back pain. PMID:24049103
Menz, Hylton B; Dufour, Alyssa B; Riskowski, Jody L; Hillstrom, Howard J; Hannan, Marian T
Abnormal foot posture and function have been proposed as possible risk factors for low back pain, but this has not been examined in detail. The objective of this study was to explore the associations of foot posture and foot function with low back pain in 1930 members of the Framingham Study (2002-05). Low back pain, aching or stiffness on most days was documented on a body chart. Foot posture was categorized as normal, planus or cavus using static weight-bearing measurements of the arch index. Foot function was categorized as normal, pronated or supinated using the centre of pressure excursion index derived from dynamic foot pressure measurements. Sex-specific multivariate logistic regression models were used to examine the associations of foot posture, foot function and asymmetry with low back pain, adjusting for confounding variables. Foot posture showed no association with low back pain. However, pronated foot function was associated with low back pain in women [odds ratio (OR) = 1.51, 95% CI 1.1, 2.07, P = 0.011] and this remained significant after adjusting for age, weight, smoking and depressive symptoms (OR = 1.48, 95% CI 1.07, 2.05, P = 0.018). These findings suggest that pronated foot function may contribute to low back symptoms in women. Interventions that modify foot function, such as orthoses, may therefore have a role in the prevention and treatment of low back pain.
Malhotra, Rishi; Chan, Claire Shu-Yi; Nather, Aziz
Osteomyelitis (OM) is a common complication of diabetic foot ulcers and/or diabetic foot infections. This review article discusses the clinical presentation, diagnosis, and treatment of OM in the diabetic foot. Clinical features that point to the possibility of OM include the presence of exposed bone in the depth of a diabetic foot ulcer. Medical imaging studies include plain radiographs, magnetic resonance imaging, and bone scintigraphy. A high index of suspicion is also required to make the diagnosis of OM in the diabetic foot combined with clinical and radiological studies. PMID:25147627
height, angular orientatior of metatarsal heads, lateral foot contour, plantar arch height, dorsal arch height, breadth of instep, instep girth...with ball length and ball girth, namely the dorsal and plantar arch heights, foot flare, and the angular orientation of the heads of the metatarsals, may...57. RIVARIATE TABE OF BALL OF FOOT CIRCUMFERENCE AND FOOT BREADTH FOR U. S. ARMY WOMEN (1977) FOOT BREADTH Centimeters 7.5 8.0 8.5 9.0 9.5 10.0 10.5
Menz, H B; Lord, S R
Foot problem assessments were performed on 135 community-dwelling older people in conjunction with clinical tests of balance and functional ability. Eighty-seven percent of the sample had at least one foot problem, and women had a higher prevalence than men of foot pain, hallux valgus, plantar hyperkeratosis, lesser digital deformity, and digital lesions. Postural sway did not differ between older people with and without each of these foot conditions. However, the presence of specific foot conditions impaired performance in a more challenging balance test and in some functional tests. In particular, older people with foot pain performed worse in a leaning balance test, stair ascent and descent, an alternate step-up test, and a timed six-meter walk. Furthermore, multiple regression analyses revealed that foot pain was a significant independent predictor of performance in each of these tests. These results show that the presence of foot problems, particularly foot pain, impairs balance and functional ability. As foot pain is amenable to treatment, podiatric intervention has the potential to improve mobility and independence in older people.
Harcourt-Smith, W. E. H.; Throckmorton, Z.; Congdon, K. A.; Zipfel, B.; Deane, A. S.; Drapeau, M. S. M.; Churchill, S. E.; Berger, L. R.; DeSilva, J. M.
Modern humans are characterized by a highly specialized foot that reflects our obligate bipedalism. Our understanding of hominin foot evolution is, although, hindered by a paucity of well-associated remains. Here we describe the foot of Homo naledi from Dinaledi Chamber, South Africa, using 107 pedal elements, including one nearly-complete adult foot. The H. naledi foot is predominantly modern human-like in morphology and inferred function, with an adducted hallux, an elongated tarsus, and derived ankle and calcaneocuboid joints. In combination, these features indicate a foot well adapted for striding bipedalism. However, the H. naledi foot differs from modern humans in having more curved proximal pedal phalanges, and features suggestive of a reduced medial longitudinal arch. Within the context of primitive features found elsewhere in the skeleton, these findings suggest a unique locomotor repertoire for H. naledi, thus providing further evidence of locomotor diversity within both the hominin clade and the genus Homo. PMID:26439101
Harcourt-Smith, W E H; Throckmorton, Z; Congdon, K A; Zipfel, B; Deane, A S; Drapeau, M S M; Churchill, S E; Berger, L R; DeSilva, J M
Modern humans are characterized by a highly specialized foot that reflects our obligate bipedalism. Our understanding of hominin foot evolution is, although, hindered by a paucity of well-associated remains. Here we describe the foot of Homo naledi from Dinaledi Chamber, South Africa, using 107 pedal elements, including one nearly-complete adult foot. The H. naledi foot is predominantly modern human-like in morphology and inferred function, with an adducted hallux, an elongated tarsus, and derived ankle and calcaneocuboid joints. In combination, these features indicate a foot well adapted for striding bipedalism. However, the H. naledi foot differs from modern humans in having more curved proximal pedal phalanges, and features suggestive of a reduced medial longitudinal arch. Within the context of primitive features found elsewhere in the skeleton, these findings suggest a unique locomotor repertoire for H. naledi, thus providing further evidence of locomotor diversity within both the hominin clade and the genus Homo.
Robinson, Christopher; Major, Matthew J; Kuffel, Charles; Hines, Kevin; Cole, Pamela
Clinical management of the patient with neuropathic foot is becoming commonplace in orthotic clinics worldwide. The presentations that can result from neuropathic foot are diverse, requiring clinicians to understand the pathomechanics of ulceration, infection, and Charcot joint arthropathy to provide effective interventions. The purpose of this clinical perspective is to provide a review of the literature regarding clinical concepts associated with orthotic management of neuropathic foot. Literature review and clinical case study. Relevant literature were reviewed and summarized, and a clinical case study synthesizing reviewed concepts was presented. Given the multifactorial nature of the neuropathic foot, treatments must be multifaceted and patient-specific to effectively address the underlying disease processes. While systemic issues such as peripheral arterial disease are treated by physicians, local issues such as foot deformity are managed by orthotists. Orthotic interventions commonly include custom footwear to reduce the risk of ulceration through creation of a protective environment or targeted plantar offloading. Patient and caregiver education to encourage management compliance is equally as important to ensure successful treatment. Patients with neuropathic foot benefit from an interdisciplinary care approach which engages physicians, wound care practitioners, and orthotists to treat and manage systemic and local problems. Addressing this pathology through interdisciplinary care may positively affect the patient's health status while lowering associated healthcare costs through improved treatment efficacy. The commonality of neuropathic foot and associated complications including ulceration, infection, and Charcot joint arthropathy requires that the patient care team have a fundamental understanding of these pathologies and common treatment modalities. We review orthotic treatment modalities to assist clinicians with the management of patients with
Resnik, S S; Lewis, L A; Cohen, B H
In general, painful feet can affect the performance of an athlete in any sport. To prevent skin diseases of the feet, the "Athlete's Foot" should be kept clean and dry with toenails trimmed. Properly fitting athletic shoes should be worn to avoid the formation of blisters. Wearing of sandals in locker and shower rooms, which prevents intimate contact with infecting organisms, can alleviate many of the problems that affect the feet.
For each foot pathology, whatever its nature and aetiology, there is an orthesis, the best mechanical treatment. For toe pathologies due to or worsened by the footwear, we must recommend wearing other shoes and sometimes an orthoplasty which is not covered by health insurance. Sole orthesis are quite effective for most pathologies causing pain when walking, and involving the foot sole or starting in the foot. Realised by an approved splint technician, they are covered by health insurance for a lump sum, but patients are telling us their cost is becoming more and more difficult to bear Mass-produced shoes, therapeutic or not, deserve a special place in the therapeutic arsenal of podiatry. Temporary used shoes improve post-operation situation and some specifically located discharges. More and more shoes are available for longer use, most of them not approved but better looking, and at least as effective as and not costlier than the few models covered by health insurance.They can provide footwear that are not standard and can't be helped by bespoke shoes reserved for precise medical indications.
Rathur, Haris M; Boulton, Andrew J M
Diabetic foot problems are common throughout the world, and result in major medical, social and economic consequences for the patients, their families, and society. Foot ulcers are likely to be of neuropathic origin and, therefore, are eminently preventable. Individuals with the greatest risk of ulceration can easily be identified by careful clinical examination of their feet: education and frequent follow-up is indicated for these patients. When infection complicates a foot ulcer, the combination can be limb-threatening, or life-threatening. Infection is defined clinically, but wound cultures assist in identification of causative pathogens. Tissue specimens are strongly preferred to wound swabs for wound cultures. Antimicrobial therapy should be guided by culture results, and although such therapy may cure the infection, it does not heal the wound. Alleviation of the mechanical load on ulcers (offloading) should always be a part of treatment. Plantar neuropathic ulcers typically heal in 6 weeks with nonremovable casts, because pressure at the ulcer site is mitigated and compliance is enforced. The success of other approaches to offloading similarly depends on the patient's adherence to the strategy used for pressure relief.
Burner, A. W.; Erickson, G. E.; Goodman, W. L.; Fleming, G. A.
This paper describes the video model deformation technique (VMD) used at five NASA facilities and the projection moire interferometry (PMI) technique used at two NASA facilities. Comparisons between the two techniques for model deformation measurements are provided. Facilities at NASA-Ames and NASA-Langley where deformation measurements have been made are presented. Examples of HSR model deformation measurements from the Langley Unitary Wind Tunnel, Langley 16-foot Transonic Wind Tunnel, and the Ames 12-foot Pressure Tunnel are presented. A study to improve and develop new targeting schemes at the National Transonic Facility is also described. The consideration of milled targets for future HSR models is recommended when deformation measurements are expected to be required. Finally, future development work for VMD and PMI is addressed.
Brown, R.D. Jr.
Displaced or deformed rock units and landforms record the past 2 m.y. of faulting, folding, uplift, and subsidence in California. Properly interpreted, such evidence provides a quantitative basis for predicting future earthquake activity and for relating many diverse structures and landforms to the 5 cm/yr of horizontal motion at the boundary between the North American and Pacific plates. Modern techniques of geologic dating and expanded research on earthquake hazards have greatly improved our knowledge of the San Andreas fault system. Much of this new knowledge has been gained since 1965, and that part which concerns crustal deformation during the past 2 m.y. is briefly summarized here.
Background It is not uncommon for a person's foot posture and/or mobility to be assessed during a clinical examination. The exact relationship, however, between static posture and mobility is not known. Objective The purpose of this study was to determine the degree of association between static foot posture and mobility. Method The static foot posture and foot mobility of 203 healthy individuals was assessed and then analyzed to determine if low arched or "pronated" feet are more mobile than high arched or "supinated" feet. Results The study demonstrated that those individuals with a lower standing dorsal arch height and/or a wider standing midfoot width had greater mobility in their foot. In addition, those individuals with higher Foot Posture Index (FPI) values demonstrated greater mobility and those with lower FPI values demonstrated less mobility. Finally, the amount of foot mobility that an individual has can be predicted reasonably well using either a 3 or 4 variable linear regression model. Conclusions Because of the relationship between static foot posture and mobility, it is recommended that both be assessed as part of a comprehensive evaluation of a individual with foot problems. PMID:21244705
Ledford, Cameron K; Nunley, James A; Viens, Nicholas A; Lark, Robert K
Structural bone grafting serves an important and necessary role during pediatric foot reconstruction. Different bone grafts have been used for such reconstructions including corticocancellous autografts, allografts, and synthetic grafts. Bovine xenografts represent a novel option with multiple potential advantages; however, there are limited clinical data on the efficacy and success of such grafts. This retrospective case series was performed to review the anecdotally recognized high failure rate of bovine xenograft transplantation in pediatric foot reconstruction at a tertiary institution. Ten pediatric patients with 13 feet underwent reconstructive procedures involving implantation of bovine xenografts for various foot deformities. The mean age at time of surgery was 14.1 years with an average clinical follow-up of 21.6 months. All patients received lateral column lengthening with additional various other reconstructive procedures performed by 3 separate orthopaedic surgeons in a similar step-wise manner. Clinical outcomes were obtained through a retrospective chart review of standard preoperative and postoperative clinical and radiographic data. Seven of 13 (53.8%) bovine xenografts implanted resulted in clinical symptoms of failure with corresponding radiographic failed graft incorporation. The most common presenting symptom was foot pain with activity and each failure was easily identified on plain radiographs by lucency surrounding the graft sites. All 7 failures required a subsequent revision surgery to remove the bovine graft followed by placement of human iliac crest allograft. After revision surgery, each patient reported subjective improvement in pain and return to daily activity with radiographic evidence of complete incorporation of the graft. Bovine xenografts used as structural grafts in pediatric foot reconstruction resulted in unacceptably high rates of failure and the need for further revision surgery. For this reason, surgeons should be cautioned
Estrada, Raul; Rosenfeld, Warren; Salazar, J. Delfor; Jhaveri, Ramesh
A newborn with the characteristic facies of Freeman-Sheldon syndrome (whistling face syndrome) and unusual hand and foot anomalies is reported. Flexion contractures of fingers were so severe as to prevent their extension. Previously reported patients with similar hand anomalies had only mild to moderate limitation of extension. Over 75 percent of the 29 previous cases of this syndrome had equinovarus deformity. Not only was this deformity absent but the patient had polysyndactyly of the big toe, an anomaly not previously associated with this syndrome. ImagesFigure 1Figure 2Figure 3 PMID:7265275
Joseph, Thomas N; Myerson, Mark S
Talectomy is a procedure that is undertaken rarely in modern orthopedic surgery; however, it has been performed for many years. Talectomy has been used most commonly in pediatric orthopedics with some degree of success in severe clubfoot deformity, arthrogryposis multiplex congenita, myelomeningocele, tuberculosis, and tumors. In adults, talectomy has been used in salvage procedures that involve nonunion of ankle fusions, failed total ankle arthroplasty, inflammatory arthropathy, neuroarthropathy, failed talar prostheses, failed pantalar fusions, adult neglected clubfoot, posttraumatic avascular necrosis talus, and deformities that are due to sciatic nerve palsy and compartment syndrome. This article consider what place talectomy has in modern adult foot and ankle surgery.
Wilson, A; Agass, R; Vaux, S; Sherlock, E; Day, P; Pfau, T; Weller, R
Hoof conformation, foot placement and movement asymmetry are routinely assessed as part of the lameness examination. However, to date, few studies have described these parameters, or the interplay between them, in the general horse population. To assess foot conformation and foot placement in the forelimbs of a group of general purpose horses and investigate the relationships between foot placement, foot conformation and movement asymmetry. Observational cross-sectional study. Forty-three horses were included in the study. Measurements were taken from photographs of each forelimb to assess foot conformation. Video footage was recorded simultaneously from perpendicular cameras at both walk and trot and used to categorise foot placement. Inertial sensor data were used to assess head movement asymmetry in trot. There was a high degree of variation in foot placement between and within horses, but a 'lateral heel' placement was most common in walk and a 'lateral' placement most common in trot. Foot placement was associated with dorsal and palmar hoof angles but there was no relationship between foot placement and the other conformation parameters, nor with movement asymmetry. Moderate negative correlations were found between several of the conformation parameters and movement asymmetry. A relationship exists between foot conformation and movement asymmetry with decreasing hoof width and hoof length related to increasing amount of movement asymmetry. In the population of horses studied here--deemed to be 'well functioning' by their owners/riders--foot placement was found to be independent of movement asymmetry and, to a large extent, independent of foot conformation. © 2014 EVJ Ltd.
... acquired condition. The congenital condition, with depression of the arch, but no evidence of abnormal... compensable or pensionable. In the acquired condition, it is to be remembered that depression of the longitudinal arch, or the degree of depression, is not the essential feature. The attention should be given to...
... acquired condition. The congenital condition, with depression of the arch, but no evidence of abnormal... compensable or pensionable. In the acquired condition, it is to be remembered that depression of the longitudinal arch, or the degree of depression, is not the essential feature. The attention should be given to...
... acquired condition. The congenital condition, with depression of the arch, but no evidence of abnormal... compensable or pensionable. In the acquired condition, it is to be remembered that depression of the longitudinal arch, or the degree of depression, is not the essential feature. The attention should be given to...
Coady, C M; Gow, N; Stanish, W
Most of the common foot problems that bother active middle-aged people are self-limiting and easily treated if detected early. Reviewed here are the causes, symptoms, diagnosis, and treatment of hallux valgus and rigidus, lesser-toe deformities, corns, Morton's neuroma, metatarsal stress fractures, plantar fasciitis, posterior tibialis tenosynovitis and rupture, acquired pes planus, tarsal tunnel syndrome, and foot problems related to rheumatoid arthritis and diabetes. In most cases, conservative treatment will enable patients to return to activity relatively quickly.
Smith, P A; Millar, E A; Sullivan, R C
The Sta-Peg procedure is most effective in the non-rigid foot in which reasonable muscle balance can be attained. Where such balance cannot be attained or where rigid deformity exists, this procedure will not solve the problem and should not be used. The authors want to emphasize that this study pertains to the use of Sta-Peg in the valgus foot caused by cerebral palsy. The procedure is rarely needed in the flexible flatfoot of a normal child.
Lavery, Lawrence A
The objective is to evaluate the effectiveness and safety of surgical off-loading to heal diabetic foot ulcers and prevent ulcer recurrence. Usually, structural foot deformities such as hallux rigidus, hammertoe deformities and equinus of the ankle contribute to abnormal pressure and shear forces and non-healing foot ulcers. Elective surgery to remove the deformity and restore joint mobility has been shown to be safe and effective to improve wound healing of recalcitrant ulcer and to reduce the risk of re-ulceration. Unfortunately, there is very little high-level evidence to help guide patient selection or to compare clinical outcomes. Copyright © 2012 John Wiley & Sons, Ltd.
Hartemann-Heurtier, Agnès; Ha Van, Georges
Diabetic patients are concerned with foot complications when a peripheral neuropathy is present. Screening of predisposed patients may be annually assessed using monofilament testing. Peripheral arterial disease, when associated, increases amputation risk. Ideal treatment requires a multidisciplinary approach with a first-line medical treatment including an optimal off-loading of the diabetic ulcer, ulcer dertersion, glycemic control, and if necessary antibiotic therapy. In case of associated osteomyelitis, a limited surgical resection of the infected bone may be performed. In case of associated arterial disease, a revascularization procedure precede bone resection.
Takahashi, Kota Z.; Gross, Michael T.; van Werkhoven, Herman; Piazza, Stephen J.; Sawicki, Gregory S.
Previous studies of human locomotion indicate that foot and ankle structures can interact in complex ways. The structure of the foot defines the input and output lever arms that influences the force-generating capacity of the ankle plantar flexors during push-off. At the same time, deformation of the foot may dissipate some of the mechanical energy generated by the plantar flexors during push-off. We investigated this foot-ankle interplay during walking by adding stiffness to the foot through shoes and insoles, and characterized the resulting changes in in vivo soleus muscle-tendon mechanics using ultrasonography. Added stiffness decreased energy dissipation at the foot (p < 0.001) and increased the gear ratio (i.e., ratio of ground reaction force and plantar flexor muscle lever arms) (p < 0.001). Added foot stiffness also altered soleus muscle behaviour, leading to greater peak force (p < 0.001) and reduced fascicle shortening speed (p < 0.001). Despite this shift in force-velocity behaviour, the whole-body metabolic cost during walking increased with added foot stiffness (p < 0.001). This increased metabolic cost is likely due to the added force demand on the plantar flexors, as walking on a more rigid foot/shoe surface compromises the plantar flexors’ mechanical advantage. PMID:27417976
Takahashi, Kota Z.; Gross, Michael T.; van Werkhoven, Herman; Piazza, Stephen J.; Sawicki, Gregory S.
Previous studies of human locomotion indicate that foot and ankle structures can interact in complex ways. The structure of the foot defines the input and output lever arms that influences the force-generating capacity of the ankle plantar flexors during push-off. At the same time, deformation of the foot may dissipate some of the mechanical energy generated by the plantar flexors during push-off. We investigated this foot-ankle interplay during walking by adding stiffness to the foot through shoes and insoles, and characterized the resulting changes in in vivo soleus muscle-tendon mechanics using ultrasonography. Added stiffness decreased energy dissipation at the foot (p < 0.001) and increased the gear ratio (i.e., ratio of ground reaction force and plantar flexor muscle lever arms) (p < 0.001). Added foot stiffness also altered soleus muscle behaviour, leading to greater peak force (p < 0.001) and reduced fascicle shortening speed (p < 0.001). Despite this shift in force-velocity behaviour, the whole-body metabolic cost during walking increased with added foot stiffness (p < 0.001). This increased metabolic cost is likely due to the added force demand on the plantar flexors, as walking on a more rigid foot/shoe surface compromises the plantar flexors’ mechanical advantage.
Plantar pressure is a cause of foot ulceration in diabetes. Attempts to determine a pressure threshold have failed. The aim of this study was to determine a pedographic classification to identify patients at risk for a foot ulcer. 210 diabetics and controls categorized into 4 groups with deformities of the forefoot were analyzed. For the pedographic measurement peak pressure, force and their integrals were analyzed using a percentage and an anatomic mask. A multivariant logistic regression analysis was performed. Logistic regression analysis using pedographic variables of a percentage mask revealed a combination of 4 variables (pressure time integral forefoot, peak pressure midfoot, pressure time integral heel, and peak pressure heel) identifying the foot ulcer with a sensitivity of 73% and a specificity of 87%. The analysis using an anatomic mask identified 8 variables (pressure time integral mask 4 (metatarsal 2), force mask 9 (2. toe), force time integral mask 8 (great toe), peak pressure mask 6 (metatarsal 4), pressure time integral mask 6 (metatarsal 4), peak pressure mask 8 (great toe), peak pressure mask 7 (metatarsal 5), and force mask 6 (metatarsal 4)) that characterized a pedal ulcer with a sensitivity of 95% and a specificity of 90%. This screening method identifies diabetics who are at risk for a foot ulcer. Copyright © 2011 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.
Azzam, W.R.; Nasr, A.M.
In this paper, the ultimate load capacities of shell foundations on unreinforced and reinforced sand were determined by laboratory model tests. A series of loading tests were carried out on model shell footing with and without single layer of reinforcement. The tests were done for shell foundation at different shell embedment depth and subgrade density. The results were compared with those for flat foundations without reinforcement. The model test results were verified using finite element analysis using program PLAXIS. The experimental studies indicated that, the ultimate load capacity of shell footing on reinforced subgrade is higher than those on unreinforced cases and the load settlement curves were significantly modified. The shell foundation over reinforced subgrade can be considered a good method to increase the effective depth of the foundation and decrease the resulting settlement. Also the rupture surface of shell reinforced system was significantly deeper than both normal footing and shell footing without reinforcement. The numerical analysis helps in understanding the deformation behavior of the studied systems and identifies the failure surface of reinforced shell footing. PMID:26425361
Boulton, Andrew J M
Diabetic foot ulceration is a common, yet in many cases an eminently preventable, complication that affects 1 in 20 patients with diabetes. Risk factors for ulceration include insensitivity (secondary to somatic neuropathy), high foot pressures, callus formation (a consequence of sympathetic neuropathy and high foot pressures), deformities (such as claw feet, prominent metatarsal heads, etc.), peripheral vascular disease, and most importantly, a past history of ulceration. None of these factors alone causes ulceration; thus, early identification and amelioration of these factors is a primary aim in foot ulcer prevention. A number of therapeutic approaches may help reduce ulcer incidence: these include therapeutic footwear, hosiery, and, potentially, liquid silicone injected under high-pressure areas. In the management of neuropathic ulcers, pressure relief is of the utmost importance, and total contact casting remains the "gold standard" means of achieving such pressure redistribution. The successful management of diabetic foot ulceration depends on a team approach, remembering that ulcers should heal if (1) the arterial circulation is intact, (2) pressure relief is achieved and maintained over the ulcer, and (3) infection is appropriately treated.
Background Intrinsic foot muscle weakness has been implicated in a range of foot deformities and disorders. However, to establish a relationship between intrinsic muscle weakness and foot pathology, an objective measure of intrinsic muscle strength is needed. The aim of this review was to provide an overview of the anatomy and role of intrinsic foot muscles, implications of intrinsic weakness and evaluate the different methods used to measure intrinsic foot muscle strength. Method Literature was sourced from database searches of MEDLINE, PubMed, SCOPUS, Cochrane Library, PEDro and CINAHL up to June 2012. Results There is no widely accepted method of measuring intrinsic foot muscle strength. Methods to estimate toe flexor muscle strength include the paper grip test, plantar pressure, toe dynamometry, and the intrinsic positive test. Hand-held dynamometry has excellent interrater and intrarater reliability and limits toe curling, which is an action hypothesised to activate extrinsic toe flexor muscles. However, it is unclear whether any method can actually isolate intrinsic muscle strength. Also most methods measure only toe flexor strength and other actions such as toe extension and abduction have not been adequately assessed. Indirect methods to investigate intrinsic muscle structure and performance include CT, ultrasonography, MRI, EMG, and muscle biopsy. Indirect methods often discriminate between intrinsic and extrinsic muscles, but lack the ability to measure muscle force. Conclusions There are many challenges to accurately measure intrinsic muscle strength in isolation. Most studies have measured toe flexor strength as a surrogate measure of intrinsic muscle strength. Hand-held dynamometry appears to be a promising method of estimating intrinsic muscle strength. However, the contribution of extrinsic muscles cannot be excluded from toe flexor strength measurement. Future research should clarify the relative contribution of intrinsic and extrinsic muscles
Miller, Roslyn J
Patients with peripheral neuropathy associated with ulceration are the nemesis of the orthopedic foot and ankle surgeon. Diabetic foot syndrome is the leading cause of peripheral neuropathy, and its prevalence continues to increase at an alarming rate. Poor wound healing, nonunion, infection, and risk of amputation contribute to the understandable caution toward this patient group. Significant metalwork is required to hold these technically challenging deformities. Neuropathic Minimally Invasive Surgeries is an addition to the toolbox of management of the diabetic foot. It may potentially reduce the risk associated with large wounds and bony correction in this patient group. Copyright © 2016 Elsevier Inc. All rights reserved.
Sherk, H H; Marchinski, L J; Clancy, M; Melchonni, J
Results of talectomies in 19 patients with severe foot deformities secondary to myelomeningocele were evaluated with an average follow-up of 12 years, 7 months. Although an apparently plantigrade foot was usually obtained, talectomy rarely succeeded in distributing weightbearing forces uniformly over the plantar surface. Photoelastic force-plate analysis incorporating three-dimensional contour mapping clearly identified areas of high ground-foot reaction forces (GFRs) and high-pressure gradients. We suggest that such high-pressure areas predispose these patients to neurotrophic ulceration.
A researcher is launching a model into the tunnel airstream of the 15-Foot Spin Tunnel. Charles Zimmerman wrote in NASA TR No. 557: 'After the observations have been made, the model is lowered into a net held in the air stream by one of the operators or into a large bowl-shaped net at the bottom of the test section. When lowered into the large net, the model is retrieved with a long- handled clamp.' (p. 267) 'The models used are generally 1/10 to 1/16 scale. The size of the models is limited by the wing span and the wing loading. The maximum allowable span is about 36 inches; the maximum wing loading is about 1.3 pounds per square foot.' (p. 266) 'Balsa wood is the usual structural material because of its low density. It is necessary to hollow out the after portion of the fuselage and to cut out a large portion of the wood in the wings to permit proper mass distribution. The wing cut-outs are covered with silk tissue paper. The leading and trailing edges and tips of the wings are fitted with strips of spruce, pattern pine, or bamboo inset into the edge of the balsa to prevent disfigurement from accidental blows or from striking the safety netting. Lead is used for ballast.' (p. 266)
Interior view of model in 15-Foot Spin Tunnel. Charles Zimmerman wrote in NASA TR No. 557: 'After the observations have been made, the model is lowered into a net held in the air stream by one of the operators or into a large bowl-shaped net at the bottom of the test section. When lowered into the large net, the model is retrieved with a long-handled clamp.' (p. 267) 'The models mused are generally 1/10 to 1/16 scale. The size of the models is limited by the wing span and the wing loading. The maximum allowable span is about 36 inches; the maximum wing loading is about 1.3 pounds per square foot.' (p. 266) 'Balsa wood is the usual structural material because of its low density. It is necessary to hollow out the after portion of the fuselage and to cut out a large portion of the wood in the wings to permit proper mass distribution. The wing cut-outs are covered with silk tissue paper. The leading and trailing edges and tips of the wings are fitted with strips of spruce, pattern pine, or bamboo inset into the edge of the balsa to prevent disfigurement from accidental blows or from striking the safety netting. Lead is used for ballast.' (p. 266)
Sternick, Marcelo Back; Formentini, Pierina Kaneno Ishida; de Souza, Gustavo Moreira Costa; Teixeira, Eduardo Cembranelli; de Almeida Filho, Ildeu Afonso; da Costa, Sérgio Moreira
Inherited epidermolysis bullosa is a rare disease characterised by mechanical fragility of the skin when under insignificant stress. The main consequences of epidermolysis bullosa, mainly the dystrophic type, despite pseudosyndactyly, are joint contractures and deformities in hands and feet. In this study, we describe our experience treating patients suffering from epidermolysis bullosa, as far as feet deformities are concerned. This is a retrospective analysis of a consecutive series of patients presenting feet deformities related to epidermolysis bullosa. Extension contractures of the toes, equinus and cavus deformities were treated with soft tissues surgery. Thirteen surgical procedures were done in six patients with feet deformities caused by epidermolysis bullosa. Of the feet operated 85.7 % extension contracture of the toes was asymptomatic at follow-up. However, 42.9 % developed hammertoe deformities. There were no recurrence or complications for other deformities. Subjectively, all patients declared themselves very satisfied with the results. Foot deformities must be treated as early as possible, due to progressive disability for walking and pain symptoms. We considered that, despite long term complications, treatment was adequate and we recommend it. Level of Evidence Level IV.
Dayton, Paul; Kauwe, Merrell; Feilmeier, Mindi
Evolution of the terminology applied to the bunion deformity has progressed in parallel with our changing understanding of the deformity itself. Along this path of progression have been multiple terms, sometimes with multiple meanings. Hallux valgus and metatarsus primus varus are 2 of the most common terms for the deformity. Although commonly used, these descriptors can have multiple meanings, and inconsistencies in interpretation can lead to confusion. We propose a more detailed terminology to provide a more accurate description of the entire bunion deformity in 3 planes and for both the hallux and the metatarsal component of the deformity. The term we propose is hallux abducto valgus with metatarsus primus adducto valgus. An accurate understanding of the multiplanar position of the deformed foot is important for planning deformity correction. The descriptors in the terminology proposed will keep in the forefront the aspects of correction required for the first ray and hallux to be returned to an anatomically correct position.
Larson, Kristine M.
Geodetic measurements of crustal deformation provide direct tests of geophysical models which are used to describe the dynamics of the Earth. Although geodetic observations have been made throughout history, only in the last several hundred years have they been sufficiently precise for geophysical studies. In the 19th century, these techniques included leveling and triangulation. Approximately 25 years ago, trilateration measurements were initiated by the USGS (United States Geological Survey) to monitor active faults in the United States. Several years later, NASA (National Aeronautics and Space Administration) begin an effort to measure plate tectonic motions on a global scale, using space geodetic techniques, VLBI (Very Long Baseline Interferometry) and SLR (Satellite Laser Ranging). The period covered by this report to the IUGG, 1991-1994, was a transition period in the field of crustal deformation. Trilateration measurements (previously the backbone of measurements across plate boundaries in the western United States and Alaska) have been abandoned. This system was labor-intensive, involved highly trained crews to carry out the observations, and only measured the length between sites. In addition, NASA drastically cut the budgets for VLBI and SLR during this period. Fixed site VLBI systems are still operational, but mobile VLBI measurements in North America have ceased. SLR measurements continue on a global scale, but the remaining crustal deformation measurements are now being made with the Global Positioning System (GPS). Nonetheless, because of the time scales involved, older geodetic data (including leveling, triangulation, and trilateration) continue to be important for many geophysical studies.
Wang, Yan; Li, Zengyong; Wong, Duo Wai-Chi; Zhang, Ming
Background/Methodology Ankle arthrodesis is one popular surgical treatment for ankle arthritis, chronic instability, and degenerative deformity. However, complications such as foot pain, joint arthritis, and bone fracture may cause patients to suffer other problems. Understanding the internal biomechanics of the foot is critical for assessing the effectiveness of ankle arthrodesis and provides a baseline for the surgical plan. This study aimed to understand the biomechanical effects of ankle arthrodesis on the entire foot and ankle using finite element analyses. A three-dimensional finite element model of the foot and ankle, involving 28 bones, 103 ligaments, the plantar fascia, major muscle groups, and encapsulated soft tissue, was developed and validated. The biomechanical performances of a normal foot and a foot with ankle arthrodesis were compared at three gait instants, first-peak, mid-stance, and second-peak. Principal Findings/Conclusions Changes in plantar pressure distribution, joint contact pressure and forces, von Mises stress on bone and foot deformation were predicted. Compared with those in the normal foot, the peak plantar pressure was increased and the center of pressure moved anteriorly in the foot with ankle arthrodesis. The talonavicular joint and joints of the first to third rays in the hind- and mid-foot bore the majority of the loading and sustained substantially increased loading after ankle arthrodesis. An average contact pressure of 2.14 MPa was predicted at the talonavicular joint after surgery and the maximum variation was shown to be 80% in joints of the first ray. The contact force and pressure of the subtalar joint decreased after surgery, indicating that arthritis at this joint was not necessarily a consequence of ankle arthrodesis but rather a progression of pre-existing degenerative changes. Von Mises stress in the second and third metatarsal bones at the second-peak instant increased to 52 MPa and 34 MPa, respectively, after
Richter, M; Thermann, H; Wippermann, B; Otte, D; Schratt, H E; Tscherne, H
To analyze the mechanism of injury for foot and ankle fractures resulting from automobile accidents to create a basis for developing an improved design for protection. Retrospective. Level I trauma center with accident research unit. Automobile accident reports and medical records of individuals injured in the accidents. Technical indicators (collision type, impulse angle, deltav, and extent of vehicle deformation) and clinical data (injury location and severity [abbreviated injury scale and injury severity score] and long-term outcome). From 1973 to 1996, 15,559 car accidents were analyzed. Two hundred sixty-one front seat occupants sustained fractures of the foot and ankle (ankle, 41 percent; forefoot, 29 percent; midfoot, 20 percent; and hindfoot, 10 percent). Seventy-five percent of the fractures were classified abbreviated injury scale(foot) 2. The incidence, location, and abbreviated injury scale(foot) category of fractures were similar between driver (n = 210) and front seat passenger (n = 51). Fifty percent of the fractures occurred in head-on collisions and 34 percent occurred in accidents with multiple collisions. The deltav ranged in 82 percent of car crashes between fifteen and sixty kilometers per hour. The deltav and extent of foot compartment deformation correlated with the abbreviated injury scale. During our investigation, deltav increased; the injury severity score decreased; and the extent of deformation did not differ significantly. Although overall car passenger safety has improved, the relative incidence of foot and ankle fractures has increased. Comparing drivers and front seat passengers, the foot pedals, steering wheel, or the asymmetric design of the dashboard did not influence injury incidence, mechanism, or severity. Foot fractures are mainly caused by the foot compartment deformation in head-on collisions, and therefore improvements in foot compartments are essential for fracture prevention.
... foot and ankle surgeons. All Fellows of the College are board certified by the American Board of Foot and Ankle Surgery. Copyright © 2017 American College of Foot and Ankle Surgeons (ACFAS), All Rights ...
Background Neuropathic deformities impair foot and ankle joint mobility, often leading to abnormal stresses and impact forces. The purpose of our study was to determine differences in radiographic measures of hind foot alignment and ankle joint and subtalar joint motion in participants with and without neuropathic midfoot deformities and to determine the relationships between radiographic measures of hind foot alignment to ankle and subtalar joint motion in participants with and without neuropathic midfoot deformities. Methods Sixty participants were studied in three groups. Forty participants had diabetes mellitus (DM) and peripheral neuropathy (PN) with 20 participants having neuropathic midfoot deformity due to Charcot neuroarthropathy (CN), while 20 participants did not have deformity. Participants with diabetes and neuropathy with and without deformity were compared to 20 young control participants without DM, PN or deformity. Talar declination and calcaneal inclination angles were assessed on lateral view weight bearing radiograph. Ankle dorsiflexion, plantar flexion and subtalar inversion and eversion were assessed by goniometry. Results Talar declination angle averaged 34±9, 26±4 and 23±3 degrees in participants with deformity, without deformity and young control participants, respectively (p< 0.010). Calcaneal inclination angle averaged 11±10, 18±9 and 21±4 degrees, respectively (p< 0.010). Ankle plantar flexion motion averaged 23±11, 38±10 and 47±7 degrees (p<0.010). The association between talar declination and calcaneal inclination angles with ankle plantar flexion range of motion is strongest in participants with neuropathic midfoot deformity. Participants with talonavicular and calcaneocuboid dislocations result in the most severe restrictions in ankle joint plantar flexion and subtalar joint inversion motions. Conclusions An increasing talar declination angle and decreasing calcaneal inclination angle is associated with decreases in ankle
Sinacore, David R; Gutekunst, David J; Hastings, Mary K; Strube, Michael J; Bohnert, Kathryn L; Prior, Fred W; Johnson, Jeffrey E
Neuropathic deformities impair foot and ankle joint mobility, often leading to abnormal stresses and impact forces. The purpose of our study was to determine differences in radiographic measures of hind foot alignment and ankle joint and subtalar joint motion in participants with and without neuropathic midfoot deformities and to determine the relationships between radiographic measures of hind foot alignment to ankle and subtalar joint motion in participants with and without neuropathic midfoot deformities. Sixty participants were studied in three groups. Forty participants had diabetes mellitus (DM) and peripheral neuropathy (PN) with 20 participants having neuropathic midfoot deformity due to Charcot neuroarthropathy (CN), while 20 participants did not have deformity. Participants with diabetes and neuropathy with and without deformity were compared to 20 young control participants without DM, PN or deformity. Talar declination and calcaneal inclination angles were assessed on lateral view weight bearing radiograph. Ankle dorsiflexion, plantar flexion and subtalar inversion and eversion were assessed by goniometry. Talar declination angle averaged 34±9, 26±4 and 23±3 degrees in participants with deformity, without deformity and young control participants, respectively (p< 0.010). Calcaneal inclination angle averaged 11±10, 18±9 and 21±4 degrees, respectively (p< 0.010). Ankle plantar flexion motion averaged 23±11, 38±10 and 47±7 degrees (p<0.010). The association between talar declination and calcaneal inclination angles with ankle plantar flexion range of motion is strongest in participants with neuropathic midfoot deformity. Participants with talonavicular and calcaneocuboid dislocations result in the most severe restrictions in ankle joint plantar flexion and subtalar joint inversion motions. An increasing talar declination angle and decreasing calcaneal inclination angle is associated with decreases in ankle joint plantar flexion motion in
Gonzalez-Martin, Cristina; Alonso-Tajes, Francisco; Seoane-Pillado, Teresa; Pertega-Diaz, Sonia; Perez-Garcia, Sergio; Seijo-Bestilleiro, Rocio; Balboa-Barreiro, Vanesa
Introduction Flat foot is a common deformity in adults. It is characterized by medial rotation and plantar flexion of the talus, eversion of the calcaneus, collapsed medial arch and abduction of the forefoot. Aim The aim of this study was to determine the prevalence of flat foot and its impact on quality of life, dependence, foot pain, disability and functional limitation among random population of 40-year-old and above. Materials and Methods A cross-sectional study in a random population sample from Cambre (A Coruña-Spain) (n=835) was performed (α =0.05; Precision=±3.4%). The diagnosis of flat foot was stablished by the study of the footprint obtained with a pedograph. Anthropometric variables were studied, Charlson’s Comorbidity Index, function and state of foot (Foot Function Index (FFI), Foot Health Status Questionnaire (FHSQ)), quality of life (SF-36), and dependence for activities of daily living (Barthel and Lawton index). A logistic and linear multiple regression analysis was performed. Results The prevalence of flat foot was 26.62%. Patients with flat foot were significantly older (65.73±11.04 vs 61.03±11.45-year-old), showed a higher comorbidity index (0.92±1.49 vs 0.50±0.98), had a greater BMI (31.45±5.55 vs 28.40±4.17) and greater foot size (25.16±1.66 vs 24.82±1.65). The presence of flat foot diminishes the quality of life, as measured by the FHSQ, and foot function, measured by the FFI. The presence of flat foot does not alter the physical and mental dimension of the SF-36 or the degree of dependence. Conclusion Flat foot was associated with age, Charlson’s Comorbidity Index, BMI and foot size. The SF-36, Barthel and Lawton questionnaires remained unaltered by the presence of flat foot. The FHSQ and FFI questionnaires did prove to be sensitive to the presence of flat foot in a significant manner. PMID:28571173
Küçükdurmaz, Fatih; Ağır, Ismail; Saygı, Baransel; Bezer, Murat
Valgus foot is a common foot deformity in spina bifida. The most popular operation for the valgus deformity has been the Grice talocalcaneal blocking. It has not been studied primarily in children with spina bifida. We report a prospective series, we present the results of hind foot valgus deformity of children with spina bifida, using Grice talocalcaneal arthrodesis with a tricortical iliac bone graft. Between May 2000 and December 2003, 21 patients with bilateral (42 feet) valgus deformity of feet underwent surgery. There were 7 males and 14 females. The mean age of patients was 67.7 months (range 50-108 months). The total number of feet that had nonunion was 11, in 7 of them the grafts were completely reabsorbed and the outcome of all these feet was unsatisfactory. Four feet had partial union of which three had unsatisfactory and one had satisfactory outcome. Sixteen feet had residual valgus deformity at the last followup visit, 10 patients had nonunion, and 6 had inadequate correction. Mean preoperative talocalcaneal and calcaneal pitch angles were 48.5° and 31.9°, respectively, which decreased to 38.5° and 29.1°, respectively, postoperatively. The decrease in talocalcaneal angle and calcaneal pitch was significant between preoperative and postoperative measurements (P<0.05). Grice subtalar arthrodesis technique is still a valuable option for valgus foot in patients with spina bifida. In this study, we found more encouraging results in older patients.
Küçükdurmaz, Fatih; Ağır, İsmail; Saygı, Baransel; Bezer, Murat
Background: Valgus foot is a common foot deformity in spina bifida. The most popular operation for the valgus deformity has been the Grice talocalcaneal blocking. It has not been studied primarily in children with spina bifida. We report a prospective series, we present the results of hind foot valgus deformity of children with spina bifida, using Grice talocalcaneal arthrodesis with a tricortical iliac bone graft. Materials and Methods: Between May 2000 and December 2003, 21 patients with bilateral (42 feet) valgus deformity of feet underwent surgery. There were 7 males and 14 females. The mean age of patients was 67.7 months (range 50–108 months). Results: The total number of feet that had nonunion was 11, in 7 of them the grafts were completely reabsorbed and the outcome of all these feet was unsatisfactory. Four feet had partial union of which three had unsatisfactory and one had satisfactory outcome. Sixteen feet had residual valgus deformity at the last followup visit, 10 patients had nonunion, and 6 had inadequate correction. Mean preoperative talocalcaneal and calcaneal pitch angles were 48.5° and 31.9°, respectively, which decreased to 38.5° and 29.1°, respectively, postoperatively. The decrease in talocalcaneal angle and calcaneal pitch was significant between preoperative and postoperative measurements (P<0.05). Conclusion: Grice subtalar arthrodesis technique is still a valuable option for valgus foot in patients with spina bifida. In this study, we found more encouraging results in older patients. PMID:22719122
Strbova, L; Krahulec, B; Waczulikova, I; Gaspar, L; Ambrozy, E; Bendzala, M; Dukat, A
The aim of our study was to analyse the foot infections in diabetic patients. We analysed foot ulcerations in 124 diabetics who attended outpatient foot clinic, or were hospitalized in the period from 1996 to 2006. Basic neuropathy screening examination was made with cotton wisp, pin-prick, tuning fork, and monofilament. For evaluation of leg ischemia, besides the evaluation of the presence of pedal pulses, the ankle-brachial pressure index was measured. If the infection of foot ulceration was clinically present, bacteriology examinations was performed. In the case of deep wound infection, x-ray examination was made. If bone destruction was present, osteomyelitis was diagnosed by technecium bone scanning and by technecium-labelled leukocyte scan. Deformation and destruction of the bone without infection was appoited as Charcot neuroarthropathy. Foot ulcer infection was found in 58 % diabetic patients, wounds were more often deep (80 %). Infection was not associated with special location of foot ulcer. Two-third of the total infected wounds were associated with leg ischemia and 30.6 % of infected ulcer ended with leg amputation. More foot ulcer infections were found in the diabetics with HbAlc over 8 %. Infection was coupled with diabetic retinopathy (in 63 % patients) (p=0.023), and also with diabetic nephropathy (in 66 % patients) (p=0.012). Bacteriology examination revealed most often Staphylococci (45.8 %), antibiotic therapy was made most often with chinolones. Osteomyelitis was present in 34.7 % of foot ulcer infections. In 14 diabetics (56 %) after antibiotic therapy it was not necessary to perform a leg amputation. HbAlc seems to be a significant predictor of osteomyelitis (p<0.02; OR=1.76). In conclusion, we confirmed that diabetic foot infections, especially on ischemic leg, in diabetics with poor metabolic control and chronic diabetic microvascular complications, are associated with a higher risk of leg amputations. Further, it is possible to cure
Brodie, B S
The limiting factor in health and mobility for many seniors is the state of their feet. The origins of their foot problems can often be traced back to childhood and years of wearing badly fitting or inappropriate footwear. Well-fitting footwear is essential if mobility and independence are to be retained. The chiropodist (or podiatrist) is a health professional specializing in the treatment of conditions of the foot. Some common foot conditions, together with their treatments, are described. Although numbers of chiropodists in Canada are limited, their role is being increasingly recognized in maintaining or restoring mobility, and also their place in the community health team.
Herman, C.M.; Locke, L.N.; Clark, G.M.
The various foot abnormalities that occur in birds, including pox, scaly-leg, bumble-foot, ergotism and freezing are reviewed. In addition, our findings at the Patuxent Wildlife Research Center include pox from dove, mockingbird, cowbird, grackle and several species of sparrows. Scaly-leg has been particularly prevalent on icterids. Bumble foot has been observed in a whistling swan and in a group of captive woodcock. Ergotism is reported from a series of captive Canada geese from North Dakota. Several drug treatments recommended by others are presented.
Sawacha, Zimi; Cristoferi, Giuseppe; Guarneri, Gabriella; Corazza, Stefano; Donà, Giulia; Denti, Paolo; Facchinetti, Andrea; Avogaro, Angelo; Cobelli, Claudio
Background The prevalence of diabetes mellitus has reached epidemic proportions, this condition may result in multiple and chronic invalidating long term complications. Among these, the diabetic foot, is determined by the simultaneous presence of both peripheral neuropathy and vasculopathy that alter the biomechanics of the foot with the formation of callosity and ulcerations. To diagnose and treat the diabetic foot is crucial to understand the foot complex kinematics. Most of gait analysis protocols represent the entire foot as a rigid body connected to the shank. Nevertheless the existing multisegment models cannot completely decipher the impairments associated with the diabetic foot. Methods A four segment foot and ankle model for assessing the kinematics of the diabetic foot was developed. Ten normal subjects and 10 diabetics gait patterns were collected and major sources of variability were tested. Repeatability analysis was performed both on a normal and on a diabetic subject. Direct skin marker placement was chosen in correspondence of 13 anatomical landmarks and an optoelectronic system was used to collect the data. Results Joint rotation normative bands (mean plus/minus one standard deviation) were generated using the data of the control group. Three representative strides per subject were selected. The repeatability analysis on normal and pathological subjects results have been compared with literature and found comparable. Normal and pathological gait have been compared and showed major statistically significant differences in the forefoot and midfoot dorsi-plantarflexion. Conclusion Even though various biomechanical models have been developed so far to study the properties and behaviour of the foot, the present study focuses on developing a methodology for the functional assessment of the foot-ankle complex and for the definition of a functional model of the diabetic neuropathic foot. It is, of course, important to evaluate the major sources of
ISS011-E-09825 (29 June 2005) --- Astronaut John L. Phillips, Expedition 11 NASA Space Station science officer and flight engineer, enters data into a computer while participating in the Foot/Ground Reaction Forces During Spaceflight (FOOT) experiment in the Destiny laboratory of the International Space Station. Phillips wore the specially instrumented Lower Extremity Monitoring Suit (LEMS), cycling tights outfitted with sensors, during the experiment.
ISS011-E-09822 (29 June 2005) --- Astronaut John L. Phillips, Expedition 11 NASA Space Station science officer and flight engineer, uses the Cycle Ergometer with Vibration Isolation System (CEVIS) while participating in the Foot/Ground Reaction Forces During Spaceflight (FOOT) experiment in the Destiny laboratory of the International Space Station. Phillips wore the specially instrumented Lower Extremity Monitoring Suit (LEMS), cycling tights outfitted with sensors, during the experiment.
ISS011-E-09831 (29 June 2005) --- Astronaut John L. Phillips, Expedition 11 NASA Space Station science officer and flight engineer, works at the Canadarm2 controls while participating in the Foot/Ground Reaction Forces During Spaceflight (FOOT) experiment in the Destiny laboratory of the International Space Station. Phillips wore the specially instrumented Lower Extremity Monitoring Suit (LEMS), cycling tights outfitted with sensors, during the experiment.
Arunakul, Marut; Amendola, Annunziato; Gao, Yubo; Goetz, Jessica E.; Femino, John E.; Phisitkul, Phinit
Background The Tripod Index (TI) has been created to allow assessment of complex foot deformities. It utilizes tripod relationship between center of the heel, medial/lateral borders of the forefoot, and compare it to the center of the talar head. This study aimed to verify diagnostic accuracy of the TI in symptomatic flatfoot and cavovarus foot. Methods Weightbearing radiographs including foot AP with a hemispherical marker around the heel, lateral, and hindfoot alignment views were obtained on 91 patients (110 feet) presenting with medial foot and ankle pain and on 89 patients (90 feet) presenting with lateral foot and ankle pain between June 2010 and May 2011. Radiographs were evaluated blindly for the TI, AP talonavicular coverage angle, lateral talo-first metatarsal angle, calcaneal pitch angle, medial cuneiform-fifth metatarsal height, and coronal plane hindfoot alignment. The sensitivity, specificity, likelihood ratios, and predictive values were calculated. Clinically diagnosed flatfoot and cavovarus foot deformity indicated for surgical reconstruction by one of our foot and ankle orthopaedic surgeons was used as the accepted standard for diagnosis. Results In flatfoot, sensitivity of the TI was 100%, comparable with lateral talo-first metatarsal angle (100%), and medial cuneiform-fifth metatarsal height (100%). Specificity of the TI was 93%, comparable with coronal plane hindfoot alignment (98%), but superior to other parameters. Positive likelihood ratio of the TI was 14.29, which was less than coronal plane hindfoot alignment (47.5), but more than other parameters. In cavovarus foot, sensitivity of the TI was 96%, comparable with coronal plane hindfoot alignment (100%), but superior to other parameters. Specificity of the TI was 95%, comparable with lateral talo-first metatarsal angle (94%), but superior to other parameters. Positive likelihood ratio of the TI was 19.2, which was more than other parameters. Conclusion The Tripod Index showed high accuracy
Sinacore, David R; Hastings, Mary K; Bohnert, Kathryn L; Fielder, Faye A; Villareal, Dennis T; Blair, Vilray P; Johnson, Jeffrey E
Objective: Osteolysis and low bone mineral density (BMD) are underappreciated consequences of several chronic diseases that may elevate the risk for fracture. The purpose of this study was to assess tarsal BMD associated with acute inflammation (ie, inflammatory osteolysis) in individuals with chronic diabetes mellitus (DM), peripheral neuropathy (PN), and recent-onset neuropathic (Charcot) arthropathy (NCA) of the foot. Research Design and Methods: This was a case-control study of 32 people (11 men, 21 women) with DM, PN, and NCA of the foot or ankle. The subjects with DM, PN, and NCA were compared with 64 age-, sex-, and race-matched control subjects (24 men, 40 women) without DM, PN or NCA. Within the first 3 weeks of cast immobilization, BMD was estimated in both calcanei using quantitative ultrasonometry. Acute inflammation was confirmed by comparing skin temperature differences between the feet of the subjects with DM, PN, and NCA and the feet of the control subjects. Results: Skin temperature differences averaged 6.7°F (SD=4.0°F) (involved foot minus noninvolved foot) in the feet of the subjects with DM, PN, and NCA compared with 0.0°F (SD=1.3°F) in the feet of the control subjects. Calcaneal BMD averaged 384 mg/cm2 (SD=110) in the involved feet and 467 mg/cm2 (SD=123) in the noninvolved feet of the subjects with DM, PN, and NCA and 545 mg/cm2 (SD=121) in combined right and left feet of the control subjects. Conclusions: Inflammation in individuals with DM, PN, and NCA may contribute to or exacerbate a rapid loss of BMD. Inflammatory osteolysis may be a prominent factor responsible for both the spontaneous onset of neuropathic fracture and the insidious and progressive foot deformity that is the hallmark of the chronic Charcot foot. PMID:18801857
Sinacore, David R; Hastings, Mary K; Bohnert, Kathryn L; Fielder, Faye A; Villareal, Dennis T; Blair, Vilray P; Johnson, Jeffrey E
Osteolysis and low bone mineral density (BMD) are underappreciated consequences of several chronic diseases that may elevate the risk for fracture. The purpose of this study was to assess tarsal BMD associated with acute inflammation (ie, inflammatory osteolysis) in individuals with chronic diabetes mellitus (DM), peripheral neuropathy (PN), and recent-onset neuropathic (Charcot) arthropathy (NCA) of the foot. This was a case-control study of 32 people (11 men, 21 women) with DM, PN, and NCA of the foot or ankle. The subjects with DM, PN, and NCA were compared with 64 age-, sex-, and race-matched control subjects (24 men, 40 women) without DM, PN or NCA. Within the first 3 weeks of cast immobilization, BMD was estimated in both calcanei using quantitative ultrasonometry. Acute inflammation was confirmed by comparing skin temperature differences between the feet of the subjects with DM, PN, and NCA and the feet of the control subjects. Skin temperature differences averaged 6.7 degrees F (SD=4.0 degrees F) (involved foot minus noninvolved foot) in the feet of the subjects with DM, PN, and NCA compared with 0.0 degrees F (SD=1.3 degrees F) in the feet of the control subjects. Calcaneal BMD averaged 384 mg/cm(2) (SD=110) in the involved feet and 467 mg/cm(2) (SD=123) in the noninvolved feet of the subjects with DM, PN, and NCA and 545 mg/cm(2) (SD=121) in combined right and left feet of the control subjects. Inflammation in individuals with DM, PN, and NCA may contribute to or exacerbate a rapid loss of BMD. Inflammatory osteolysis may be a prominent factor responsible for both the spontaneous onset of neuropathic fracture and the insidious and progressive foot deformity that is the hallmark of the chronic Charcot foot.
Control panel below the test section of the 8-Foot High Speed Tunnel (8-Foot HST). Authorized July 17, 1933, construction of the 8-Foot HST was paid for with funds from the Federal Public Works Administration. Manly Hood and Russell Robinson designed the unusual facility which could produce a 500 mph wind stream across an 8-Foot test section. The concrete shell was not part of the original design. Like most projects funded through New Deal programs, the PWA restricted the amount of money which could be spent on materials. The majority of funds were supposed to be expended on labor. Though originally, Hood and Robinson had planned a welded steel pressure vessel around the test section, PWA officials proposed the idea of concrete. This picture shows the test section inside the igloo-like structure with walls of 1-foot thick reinforced concrete. The thick walls were needed 'because of the Bernoulli effect, [which meant that] the text chamber had to withstand powerful, inwardly directed pressure. Operating personnel located inside the igloo were subjected to pressures equivalent to 10,000-foot altitude and had to wear oxygen masks and enter through airlocks. A heat exchanger removed the large quantities of heat generated by the big fan.'
Cohen, Bruce E; Nicholson, Christopher W
The bunionette, or tailor's bunion, is a lateral prominence of the fifth metatarsal head. Most commonly, bunionettes are the result of a widened 4-5 intermetatarsal angle with associated varus of the metatarsophalangeal joint. When symptomatic, these deformities often respond to nonsurgical treatment methods, such as wider shoes and padding techniques. When these methods are unsuccessful, surgical treatment is based on preoperative radiographs and associated lesions, such as hyperkeratoses. In rare situations, a simple lateral eminence resection is appropriate; however, the risk of recurrence or overresection is high with this technique. Patients with a lateral bow to the fifth metatarsal are treated with a distal chevron-type osteotomy. A widened 4-5 intermetatarsal angle often requires a diaphyseal osteotomy for correction.
... MODEL MANUFACTURED HOME INSTALLATION STANDARDS Foundations § 3285.312 Footings. (a) Materials approved... (incorporated by reference, see § 3285.4). (3) ABS footing pads. (i) ABS footing pads are permitted, provided... use in the soil classification at the site. (ii) ABS footing pads must be listed or labeled for...
... MODEL MANUFACTURED HOME INSTALLATION STANDARDS Foundations § 3285.312 Footings. (a) Materials approved... (incorporated by reference, see § 3285.4). (3) ABS footing pads. (i) ABS footing pads are permitted, provided... use in the soil classification at the site. (ii) ABS footing pads must be listed or labeled for...
... 7 Agriculture 10 2012-01-01 2012-01-01 false Board foot. 1217.4 Section 1217.4 Agriculture..., and Industry Information Order Definitions § 1217.4 Board foot. Board foot or BF means a unit of... cubic equivalent. A board foot calculation for softwood lumber 1 inch or more in thickness is based...
... 7 Agriculture 10 2014-01-01 2014-01-01 false Board foot. 1217.4 Section 1217.4 Agriculture..., and Industry Information Order Definitions § 1217.4 Board foot. Board foot or BF means a unit of... cubic equivalent. A board foot calculation for softwood lumber 1 inch or more in thickness is based...
... 7 Agriculture 10 2013-01-01 2013-01-01 false Board foot. 1217.4 Section 1217.4 Agriculture..., and Industry Information Order Definitions § 1217.4 Board foot. Board foot or BF means a unit of... cubic equivalent. A board foot calculation for softwood lumber 1 inch or more in thickness is based...
McKeon, Patrick O; Fourchet, François
The intrinsic muscles of the foot play a critical role in the regulation of absorption and propulsion during dynamic activities. Dysfunction of these may lead to an increased demand on the remaining components within the foot core system to maintain dynamic foot control, leading to a more rapid breakdown of these contributors and those proximal to the foot. Training the intrinsic foot muscles through a systematic progression of isolation via the short foot exercise offers the opportunity to reincorporate their contribution into the foot core system. This article discusses the function of the intrinsic foot muscles, their contributions to dynamic foot control, and a progressive training paradigm.
... Visit a Foot & Ankle Surgeon Preparing for Your Surgery Videos & Tools ... arches are performing their important functions. In bare feet, stand facing a kitchen counter. Place your palms on the counter with ...
... feet - legs; Ankle swelling; Foot swelling; Leg swelling; Edema - peripheral; Peripheral edema ... 51. Trayes KP, Studdiford JS, Pickle S, Tully AS. Edema: Diagnosis and management. Am Fam Phys . 2013;88( ...
... by a condition such as osteoporosis or a stress fracture. You may be at higher risk of a broken foot or ankle if you: Participate in high-impact sports. The stresses, direct blows and twisting injuries ...
Lui, Tun Hing
Congenital vertical talus is an uncommon foot deformity that is characterised by a fixed dorsal dislocation of the navicular on the talar head and neck. Left untreated, a congenital vertical talus causes significant long-term disability. We present a case of neglected vertical talus in a middle-aged woman who was successfully treated with resection of the talar head and tendon transfers.
Wu, Weiguo; Asai, Take; Akatsuka, Takao
The measurement of the characteristic parameters for a moving object with deformation is often an important problem. Here, an approach to analyze the shape change of a ball, when it is kicked in soccer, is proposed by using a simple shape deformation model to evaluate the shape change from the image sequence. Moreover, to determine the parameters of the model which apply to actual ball deformation, the detection of ball is necessary, and the pattern spectrum based on morphological operators is considered. Here, we assume that the deformation surface of the ball is a circular arc, when it is kicked by foot, and the arc is always convex when it is observed from the kicking side. To obtain the parameters of the arc, the preprocessing of the ball image such as local binarization, the region filling and noisy smoothing with morphological operators, is performed from actual image sequence. In order to detect the ball, the pattern spectrum with morphological operators is measured, and then circumscribed circle of the ball is extracted. So, the center and radius of the ball from circumscribed circle and the arc of the deformation surface of the model are obtained. Finally, the characteristic parameters of a moving ball such as the deformation are measured by using the shape deformation model. To demonstrate the effect of this method, we show an application to extract the deformation of the ball in football for the actual sports skill training.
Weinberg, M S; Williams, C J; Calhan, C
262 respondents from an organization for homosexual foot fetishists provide information from a broader sample than clinical cases and allow examination of the effects of sexual preference on fetishism. Data show a wide range of feet/footwear objects to be arousing. Such interests were often associated with particular types of men, yet interests were subject to change over time. Fetishistic arousal rested on both sensual and symbolic aspects of the fetish. Symbolically, it was the theme of "masculinity" that made male feet/footwear arousing, showing parallels to "femininity" evoked by female feet/footwear for male heterosexual fetishists. For many of the respondents, fetishism did not seem to be a substitute for living persons. Respondents had intimate relationships and were able to incorporate their fetish interests into stable relationships and less intimate ones. Considerable involvement in sadomasochistic practices was also found as was involvement in the gay world. Finally, nothing about a fetishistic interest seemed to preclude the development of subcultural forms around the practice.
Kurita, C.H.; /Fermilab
A test model of the flexible foot support was constructed early in the design stages to check its reactions to applied loads. The prototype was made of SS 304 and contained four vertical plates as opposed to the fourteen Inconel 718 plates which comprise the actual structure. Due to the fact that the prototype was built before the design of the support was finalized, the plate dimensions are different from those of the actual proposed design (i.e. model plate thickness is approximately one-half that of the actual plates). See DWG. 3740.210-MC-222376 for assembly details of the test model and DWG. 3740.210-MB-222377 for plate dimensions. This stanchion will be required to not only support the load of the inner vessel of the cryostat and its contents, but it must also allow for the movement of the vessel due to thermal contraction. Assuming that each vertical plate acts as a column, then the following formula from the Manual of Steel Construction (American Institute of Steel Construction, Inc., Eigth edition, 1980) can be applied to determine whether or not such columns undergoing simultaneous axial compression and transverse loading are considered safe for the given loading. The first term is representative of the axially compressive stress, and the second term, the bending stress. If the actual compressive stress is greater than 15% of the allowable compressive stress, then there are additional considerations which must be accounted for in the bending stress term.
DeRosa, Daniel C; Agee, Willie A; Pires, Valerie L; Yim, Duke G; Ngauy, Viseth
Toothpicks are commonly used household items that rarely cause serious injury or infection. Toothpick-related injuries often occur due to ingestion with subsequent trauma/infection at distal sites within the gastrointestinal tract; however, cardiovascular, pleural, and soft tissue infections have been reported. Eikenella corrodens is a gram-negative, facultative anaerobic bacillus found in oral flora associated with bite wound infections. A few case reports describe E. corrodens osteomyelitis from toothpick puncture wounds. We report a case of foot cellulitis and abscess in an elderly diabetic after toothpick puncture injury that was unresponsive to empiric antibiotics. Wound cultures grew E. corrodens and rare Peptostreptococcus species. E. corrodens is resistant to first-generation cephalosporins, macrolides, aminoglycosides, clindamycin, and metronidazole. This case highlights the insidious nature of E. corrodens infections and the need to tailor empiric antibiotics for skin and soft tissue infections based on the mechanism of injury. In addition, this case stresses the importance of protective footwear in diabetics and serves as a cautionary tale regarding the use of seemingly innocuous toothpicks. PMID:26793413
Molines-Barroso, R J; Lázaro-Martínez, J L; Aragón-Sánchez, F J; Álvaro-Afonso, F J; García-Morales, E; García-Álvarez, Y
To stratify the ulceration risk according to the foot morphology in people with diabetes and a history of forefoot neuropathic ulceration. A cross-sectional study was performed on 139 neuropathic individuals with diabetes and previous forefoot ulcers between January 2012 and February 2014. Foot position of the participants was evaluated by using the foot-posture index. A multivariate analysis adjusted for confounding variables was performed with the ulceration risk factors that were found in the univariate analysis. Two hundred and fifty-eight feet were analysed, 104 (40.3%) feet had a history of ulceration on the forefoot and 154 (59.7%) feet had no previous ulceration. Two positive tests of neuropathy (p<0.001; CI[1.961-6.249] OR 3.500), presence of deformities (p=0.043; CI[1.020-3.599] OR 1.916) and foot type (p=0.039) showed an association with ulceration risk in multivariate analyses. Pronated feet showed a higher risk of ulceration than supinated feet (p=0.011; CI[1.253-5.708] OR 2.675), while significant differences between neutral and supinated feet were not found (p=0.221; CI[0.719-2.753] OR 1.476). A pronated foot has a higher risk of ulceration on the forefoot in neuropathic people with deformities and diabetes mellitus. Foot type should be evaluated in people at risk of ulceration. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.
Lee, Daniel K; Mulder, Gerit D
The growing number of lower-extremity abnormalities that are seen in inpatient and outpatient settings has paralleled the increased number of elderly in the population. Foot and ankle deformities, disorders, and arthritis, which are not manifested until late in life, have become more common as more individuals attain longer lifespans. Although conservative therapies are a priority when addressing the geriatric population, surgical options may be overlooked secondary to a misunderstanding of their ability to overcome perioperative management. Advanced minimally invasive surgical procedures for the foot and ankle have decreased the complications associated with foot surgery, making surgical intervention a viable option for many of the elderly. The newer procedures do not, however, minimize strict perioperative management, including pharmacological and nutritional assessment, and cardiopulmonary precautions. Outpatient surgical intervention may effectively address many ongoing problems associated with pain, decreased ambulation, and decreased quality of life. Current techniques in joint reconstruction in the forefoot and midfoot allow weight bearing from the day of surgery. Most hindfoot and ankle surgeries now permit minimal bone resection and incision through arthroscopy, resulting in improved muscle and tendon repair and early weight bearing. The changes in surgical approaches for the geriatric foot have permitted more effective and rapid intervention in problems affecting ambulation and quality of life in our aged population.
Spyrou, L A; Aravas, N
This paper describes a finite element scheme for realistic muscle-driven simulation of human foot movements. The scheme is used to simulate human ankle plantar flexion. A three-dimensional anatomically detailed finite element model of human foot and lower leg is developed and the idea of generating natural foot movement based entirely on the contraction of the plantar flexor muscles is used. The bones, ligaments, articular cartilage, muscles, tendons, as well as the rest soft tissues of human foot and lower leg are included in the model. A realistic three-dimensional continuum constitutive model that describes the biomechanical behaviour of muscles and tendons is used. Both the active and passive properties of muscle tissue are accounted for. The materials for bones and ligaments are considered as homogeneous, isotropic and linearly elastic, whereas the articular cartilage and the rest soft tissues (mainly fat) are defined as hyperelastic materials. The model is used to estimate muscle tissue deformations as well as stresses and strains that develop in the lower leg muscles during plantar flexion of the ankle. Stresses and strains that develop in Achilles tendon during such a movement are also investigated.
Control panel below the test section of the 8-Foot High Speed Tunnel (8-Foot HST). Authorized July 17, 1933, construction of the 8-Foot HST was paid for with funds from the Federal Public Works Administration. Manly Hood and Russell Robinson designed the unusual facility which could produce a 500 mph wind stream across an 8-Foot test section. The concrete shell was not part of the original design. Like most projects funded through New Deal programs, the PWA restricted the amount of money which could be spent on materials. The majority of funds were supposed to be expended on labor. Though originally, Hood and Robinson had planned a welded steel pressure vessel around the test section, PWA officials proposed the idea of concrete. This picture shows the test section inside the igloo-like structure with walls of 1-foot thick reinforced concrete. The thick walls were needed 'because of the Bernoulli effect, [which meant that] the text chamber had to withstand powerful, inwardly directed pressure. Operating personnel located inside the igloo were subjected to pressures equivalent to 10,000-foot altitude and had to wear oxygen masks and enter through airlocks. A heat exchanger removed the large quantities of heat generated by the big fan.'
Pascale, Renato; Vitale, Mario; Esposito, Silvano; Noviello, Silvana
Diabetes is one of the most common non-transmitted disease and currently 346 million people are affected in the world. According to the World Health Organization about 15% of diabetic patients develop a foot ulcer in need of medical care. Infection is a serious complication and in the western world it is the major responsible cause of lower limb amputation. In the 84% of cases amputation is the final step in the treatment of a non-healing foot ulcer. So, it's clear that, in order to reduce amputation rate, it's important to prevent foot ulcer formation and improve the treatment of lesion. In this review we report the most recent international literature as regards epidemiology, etiology, classification, diagnosis, microbiology and treatment of infected diabetic foot ulcers. The purpose of our work is to remark the multifactorial features of this pathology and the role of infectious disease specialist in a multidisciplinary team for the treatment of infected diabetic foot ulcers. The knowledge of microbiology on one hand, and the need of a complex and long term antibiotic therapy on the other, point out the importance of infectious disease specialist to facilitate, if possible, the healing of a infected diabetic foot ulcers.
Lavery, Lawrence A; Wunderlich, Robert P; Tredwell, Jeffrey L
To demonstrate the effectiveness of a diabetic foot disease management program in a managed care organization. We implemented a lower extremity disease management program consisting of screening and treatment protocols for diabetic members in a managed care organization. Screening consisted of evaluation of neuropathy, peripheral vascular disease, deformities, foot pressures, and history of lower extremity pathology. We stratified patients into low and high-risk groups, and implemented preventive or acute care protocols. Utilization was tracked for 28 months and compared to 12 months of historic data prior to implementation of the disease management program. After we implemented the disease management program, the incidence of amputations decreased 47.4% from 12.89 per 1000 diabetics per year to 6.18 (p<0.05). The number of foot-related hospital admissions decreased 37.8% from 22.86 per 1000 members per year to 14.23 (37.8%). The average inpatient length-of-stay (LOS) was reduced 21.7% from 4.75 to 3.72 days (p<0.05). In addition, there was a 69.8% reduction in the number of skilled nursing facility (SNF) admissions per 1000 members per year (Table 1) and a 38.2% reduction in the average SNF LOS from 8.72 to 6.52 days (p<0.05). A population-based screening and treatment program for the diabetic foot can dramatically reduce hospitalizations and clinical outcomes.
Balasankar, Ganesan; Luximon, Ameersing; Al-Jumaily, Adel
Clubfoot, known as congenital talipes equinovarus, is one of the complex paediatric foot deformity with the incidence of 1 in every 1000 live births. It consists of four complex foot abnormalities such as forefoot adductus, midfoot cavus, and hindfoot varus and ankle equinus. There are a number of surgical techniques (soft tissue releases, arthrodesis) used to correct clubfoot. However currently the conservative management (manipulation, serial casting, and braces) of clubfoot is considered as the best choice and it is widely accepted among orthopaedists. Clubfoot treated with surgical techniques might suffer various complications such as soft tissues contractures, neurovascular complications, infections, and shortening of the limbs. Although conservative method is generally considered as an effective method, it is still challenging to cure clubfoot in advance stages. Also, the classification of the initial severity of clubfoot is essential to evaluate the outcome of the treatment. In this review, the aim is to review the different types of conservative method and the assessment of clubfoot severity.
Hazany, Salar; Ly, Nancy; Hazany, David; Bader, Semon; Ostuka, Norman
Chronic pain and gait disturbance are possible complications of subtalar arthroereisis. Despite literature indicating a considerably high rate of such complications, subtalar arthroereisis continues to be commonly performed for children with pes planus. The goals of this study are to identify common presenting features and an approach to the treatment of foot pain after subtalar arthroereisis. This case report includes six feet in which subtalar implants were used to treat flatfoot deformities in children. After failing conservative management for chronic postoperative pain, all patients had their implants removed resulting in relief of pain. The expedited removal of subtalar implants in cases of chronic foot pain after arthroereisis is encouraged. The authors do not recommend the use of subtalar arthroereisis in pes planus given its potential complications and literature review indicating a paucity of cases with improved function and activity level as a result of the procedure.
Yoga, R; Khairul, A; Sunita, K; Suresh, C
Infection plays a pivotal role in enhancing a diabetic foot at risk toward amputation. Effective antibiotic therapy against the offending pathogens is an important component of treatment of diabetic foot infections. Recognition of the pathogen is always difficult as the representative deep tissue sample for culture is surrounded by ulcer surface harbouring colonies of organisms frequently labelled as skin commensals. The emergent of resistant strains represents a compounding problem standing against efforts to prevent amputation. This study was undertaken to identify the pathogens associated with diabetic foot infection in terms of their frequency and sensitivity against certain commonly used antibiotics. Forty-four consecutive patients with open diabetic foot infections had wound swab taken for culture and sensitivity testing. Cultures positive were observed in 89% of the cases with Staphylococcus aureus, Klebsiella pneumoniae, Pseudomonas aeroginosa encountered in 20%, 14% and 14% of cases respectively. Mixed growths were isolated in 6% of cultures. All Staphylcoccus aureus isolates were resistant to Penicillin but 80% were sensitive to Erythromycin and Co-trimoxazole. Klebsiella pneumoniae isolates were sensitive to Methicillin and Gentamycin in 80% and 60% of cases respectively, and resistant to Ampicillin and Ceftazidime in 83% and 50% respectively. All Pseudomonas aeroginosa isolates were sensitive to Amikacin and Ciprofloxacin but 50% were resistant to Gentamycin. There was no single antibiotic possessing good coverage for all common organisms isolated from diabetic foot lesions. Staphylococcus aureus remains the predominant cause of diabetic foot infections followed by Klebsiela pneumonia and Pseudomonas aeroginosa. Most infections are monomicrobial. The emergence of multiresistant organisms is a worrying feature in diabetic foot infections.
The treatment of severe rigid neurogenic clubfoot deformities still remains a challenging problem in modern paediatric orthopaedics. In those cases, in spite of being a palliative procedure, talectomy has been advocated for the correction of the deformity thus providing a stable plantigrade foot which allows pain-free walking with standard footwear. Herein, we present the results after talectomy in two patients (brother and sister) affected by a hereditary motor and sensory neuropathy type I, with rigid severe pes equinovarus deformities. PMID:25610681
Noor, Saba; Zubair, Mohammad; Ahmad, Jamal
As the prevalence of diabetes is increasing globally, secondary complications associated to this endocrinal disorder are also ascending. Diabetic foot ulcers are potentially modifying complications. Disruption of harmony in glucose homeostasis causes hyperglycemic status, results in activation of certain metabolic pathways which in their abnormal state subsequently leads to development of vascular insufficiency, nerve damages headed by ulceration in lower extremity due to plantar pressures and foot deformity. Insult to foot caused by trauma at the affected site goes unnoticeable to patient due to loss of sensation. Among the above mention causes, resistance to infection is also considered as chief modulator of pathophysiological image of diabetic foot lesions. Healing as well as non-healing nature of ulcer relies upon the wound microbial communities and the extent of their pathogenicity. A validated classification system of foot ulcer is primarily necessary for clinicians in management of diabetic foot problems. Another aspect which needs management is proper identification of causative pathogen causing infection. The way of approaches presently employed in the diagnosis for treatment of foot ulcer colonized by different microbes is conventional techniques. Conventional diagnostic methods are widely acceptable since decades. But in recent years newly invented molecular techniques are exploring the use of 16S ribosomal regions specific to prokaryotes in bacterial identification and quantification. Molecular techniques would be a better choice if engaged, in finding the specific species harboring the wound. Copyright © 2015 Diabetes India. Published by Elsevier Ltd. All rights reserved.
Lázaro-Martínez, José Luis; Aragón-Sánchez, Javier; Alvaro-Afonso, Francisco Javier; García-Morales, Esther; García-Álvarez, Yolanda; Molines-Barroso, Raúl Juan
Foot ulcer recurrence is still an unresolved issue. Although several therapies have been described for preventing foot ulcers, the rates of reulcerations are very high. Footwear and insoles have been recommended as effective therapies that prevent the development of new ulcers; however, the majority of studies have analyzed their effects in terms of reducing peak plantar pressure rather than ulcer relapse. Knowledge of biomechanical considerations is low, in general, in the team approach to diabetic foot because heterogeneous professionals having competence in recurrence prevention are involved. Assessment of biomechanical alterations define a foot type position; examining foot structure and recording plantar pressure could help in appropriate insole and footwear prescription and design. Patient education and compliance should be taken into consideration for better therapy success. When patients suffer from rigid deformities or have undergone an amputation, surgical offloading should be considered as an alternative.
Modellista Footwear's new shoe line uses Tempur(TM) material, which conforms to each wearer's unique foot shape to absorb shock and cushion the foot. The foam's properties allow the shoe to change with the wearer's foot as it shrinks and swells throughout the day. Scientists at NASA's Ames Research Center originally developed temper foam in the early 1970s to relieve the intense pressure of G-forces experienced by astronauts during rocket launches. Tempur-Pedic, Inc., further developed the foam and granted Modellista a license to use it in footwear. The Modellista collection is the first shoe design and construction to be certified by the Space Awareness Alliance. The shoes, with designs ranging from traditional clog shapes to sling backs and open-toe sandals, are currently available nationwide at select specialty shoe stores and through catalogs. Tempur(TM) is a registered trademark of Tempur-Pedic, Inc.
Al-Kaabi, Juma M; Al Maskari, Fatma; Cragg, Paul; Afandi, Bachar; Souid, Abdul-Kader
Diabetes is especially common in the United Arab Emirates. Its complications in patients residing in the region have yet to be fully explored. This study reports on foot problems in our diabetic patients, with emphasis on the impact of illiteracy on foot care and complications due to diabetes. Adults were randomly recruited from the Diabetes Center at Tawam-John Hopkins affiliated hospital. A questionnaire addressing foot care and problems was completed for all patients. In addition, an examination was performed by a trained nurse, an endocrinologist, and a podiatrist. Four hundred twenty-two adults with type 2 (93%) or type 1 (7%) diabetes were enrolled; 67% were females. Patients' mean age was 52 ± 13 years and duration of diabetes ≥ 1 year. Illiterate patients were 51% and were less likely to practice foot care (p=0.002), recognize foot risk factors (p=0.004), use proper footwear (p=0.010), and being physically active (p<0.001). In addition, they were more likely to have diabetic complications, such as neuropathy (p=0.027), eye disease (p=0.032), hypertension (p<0.001), obesity (p=0.003), increased body fat percentage (p<0.001), reduced capillary refill time (p=0.002), reduced monofilament (p=0.003), and reduced vibration (p<0.001). Logistic regression analysis revealed literates [OR=2.4, CI=1.1-5.4, p=0.031], female gender [OR=2.7, CI=1.1-6.2, p=0.023], and history of foot ulcer [OR=6.0, CI=2.1-17.2, p=0.001] were predictors of practicing foot care. Illiteracy invoked significant challenges to diabetic attentiveness and imposed increased foot complications. Physicians should realize that illiterate patients are vulnerable and require effective strategies to improve their education about the disease and reduce their diabetic complications. Copyright © 2015 Primary Care Diabetes Europe. Published by Elsevier Ltd. All rights reserved.
Frykberg, Robert G.; Armstrong, David G.; Boulton, Andrew J.M.; Edmonds, Michael; Van, Georges Ha; Hartemann, Agnes; Game, Frances; Jeffcoate, William; Jirkovska, Alexandra; Jude, Edward; Morbach, Stephan; Morrison, William B.; Pinzur, Michael; Pitocco, Dario; Sanders, Lee; Wukich, Dane K.; Uccioli, Luigi
The diabetic Charcot foot syndrome is a serious and potentially limb-threatening lower-extremity complication of diabetes. First described in 1883, this enigmatic condition continues to challenge even the most experienced practitioners. Now considered an inflammatory syndrome, the diabetic Charcot foot is characterized by varying degrees of bone and joint disorganization secondary to underlying neuropathy, trauma, and perturbations of bone metabolism. An international task force of experts was convened by the American Diabetes Association and the American Podiatric Medical Association in January 2011 to summarize available evidence on the pathophysiology, natural history, presentations, and treatment recommendations for this entity. PMID:21868781
Puthoff, R. L.
An impact test was conducted on an 1142 pound 2 foot diameter sphere model. The purpose of this test was to determine the feasibility of containing the fission products of a mobile reactor in an impact. The model simulated the reactor core, energy absorbing gamma shielding, neutron shielding and the containment vessel. It was impacted against an 18,000 pound reinforced concrete block. The model was significantly deformed and the concrete block demolished. No leaks were detected nor cracks observed in the model after impact.
Lang, G; Kehr, P; Séjourne, P; Paternotte, H; Mathevon, H; Pointu, J
After a precise review of the numerous parameters studied classically in AP and lateral films of the feet under load, the authors emphasis 5 measurements which are easy to determine and which they feel to objectively cover all the deformities which may be found in the static flat foot. These are: Talo-calcaneal divergence in AP and lateral views, the angle between the calcaneum and the floor, the lateral cavitation index and, finally, the angle of the axis of the talus and of the 2nd metatarsal in AP. A score of 20 is attributed to each. A score of 0 to 20 is attributed to each of these points, with a possible total, therefore, of 100. A study of 119 cases of flat foot in the child treated surgically over a period of 6 years made it possible to draw the distinction between the severe flat foot requiring operation and with a total of less than 45 points, and flat foot requiring medical orthopaedic treatment only (more than 45), the score for the normal foot being of the order of 90 points. This radiological study also makes it possible to distinguish, amongst flat feet in children, straight flat foot with collapse of the medial arch but no valgus of the forefoot and valgus flat foot where there is pronation of the calcaneum and abduction of the forefoot. This distinction is important since it determines the choice of operation. Thus in a case of valgus flat foot Judet's so-called "horseman" operation is indicated whilst in a flat foot without valgus, transposition of the tibialis anterior is preferable. In many cases, the lesion is mixed and both surgical gestures are required.
Wu, Liaofang; Hou, Qian; Zhou, Qiuhong; Peng, Fang
Aims: To determine the prevalency of risk factors for diabetic foot complications in diabetic patients free of active ulceration in a hospital setting and to investigate the knowledge of foot care of the patients. Methods: A retrospective study was conducted on a cohort of 296 patients with diabetes hospitalized in a tertiary hospital. A convenience sampling was adopted to recruit subjects during 2012/2013. All completed an interviewer-administered questionnaire and underwent medical assessment including foot examination and assessment of presence of peripheral sensory neuropathy (PSN) and peripheral arterial disease (PVD). The patients were assigned to a foot risk category which was developed by the International Working Group on the Diabetic Foot (IWGDF). Results: 296 inpatients were evaluated. Foot deformity was noticed in 124 patients (42%), hallux valgus was the most prevalent abnormality, found in 65% of patients. Prevalency of neuropathy hypertension, nephropathy and retinopathy were 66.2%, 57.1%, 48.3% and 44.9% respectively. 37 (12.5%) patients had a history of ulceration (n = 33) and/or toe amputation (n = 4). According to the classification system of the IWGDF, 35.1% of patients were considered as having low-risk by the modified IWGDF classification (group 0), and 49% of the study population were at high risk for pedal ulceration (group 2 and 3). There was a clear trend between the increasing severity of the staging and HbA1c, duration of diabetes, prevalence of hypertension, nephropathy and retinopathy and absent of physical activity. The mean knowledge score of foot care was 21.21±3.84. Conclusion: The risk factors for foot ulceration and lack of fool care knowledge was rather common in a hospital-based diabetic population, emphasizing the importance of implementing simple and affordable screening tools and methods to identify high-risk patients and providing foot care education for them. PMID:26064275
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Mithraratne, K; Ho, H; Hunter, P J; Fernandez, J W
A coupled computational model of the foot consisting of a three-dimensional soft tissue continuum and a one-dimensional (1D) transient blood flow network is presented in this article. The primary aim of the model is to investigate the blood flow in major arteries of the pathologic foot where the soft tissue stiffening occurs. It has been reported in the literature that there could be up to about five-fold increase in the mechanical stiffness of the plantar soft tissues in pathologic (e.g. diabetic) feet compared with healthy ones. The increased stiffness results in higher tissue hydrostatic pressure within the plantar area of the foot when loaded. The hydrostatic pressure acts on the external surface of blood vessels and tend to reduce the flow cross-section area and hence the blood supply. The soft tissue continuum model of the foot was modelled as a tricubic Hermite finite element mesh representing all the muscles, skin and fat of the foot and treated as incompressible with transversely isotropic properties. The details of the mechanical model of soft tissue are presented in the companion paper, Part 1. The deformed state of the soft tissue continuum because of the applied ground reaction force at three foot positions (heel-strike, midstance and toe-off) was obtained by solving the Cauchy equations based on the theory of finite elasticity using the Galerkin finite element method. The geometry of the main arterial network in the foot was represented using a 1D Hermite cubic finite element mesh. The flow model consists of 1D Navier-Stokes equations and a nonlinear constitutive equation to describe vessel radius-transmural pressure relation. The latter was defined as the difference between the fluid and soft tissue hydrostatic pressure. Transient flow governing equations were numerically solved using the two-step Lax-Wendroff finite difference method. The geometry of both the soft tissue continuum and arterial network is anatomically-based and was developed using
Racz, Roger S; Ramanujam, Crystal L; Zgonis, Thomas
Puncture wounds are common injuries of the foot. Although most puncture wounds are benign, devastating complications are possible without adequate treatment. These injuries can occur in all age groups and in various circumstances. Early diagnosis and appropriate medical and surgical management is paramount in achieving successful outcomes.
Foot-and-mouth disease (FMD) is a highly contagious viral disease of cloven-hoofed animals. An outbreak of FMD can have a significant economic impact because of the restrictions on international trade of susceptible animals and their products with FMD-free countries. In this chapter we discuss vario...
Gwani, Abdullahi Suleiman; Salihu, Abubakar Tijjani; Garba, Isa Sa'idu; Rufa'i, Adamu Ahmad
Foot length has been shown to be a reliable dimension for estimation of stature. However, phalanges of the foot are very small bones and their length may not be proportional to person's stature. Thus, we hypothesized that foot length measured excluding the phalanges, the truncated foot length, may be more reliable in stature estimation than full foot length. This study, therefore, aimed at comparing the accuracy of the regression equations derived from the truncated foot length and the full foot length. The study recruited a sample of 32 young adults (16 males and 16 females) aged from 20 to 35 years. Lateral radiographs of the right feet were obtained for each subject in a bilateral standing position while maintaining equal weight on both feet. Standing height of the participants was measured with a stadiometer. Truncated foot length and full foot length were measured on the lateral radiographs of the foot. Independent t-test was used to check for mean differences in the dimensions between genders. Linear regression analysis was used to determine the equations for stature estimation. Intra and inter-observer reliability were calculated from four precision estimates: absolute technical error of measurement (aTEM), relative technical error of measurement (rTEM), coefficient of reliability (Rr) and coefficient of variation (Cv). All the dimensions measured were significantly larger in males than females. Linear regression equations were derived for estimation of stature using both the truncated foot length and full foot length. The regression equations derived from truncated foot length have larger correlation coefficient, coefficient of determination, adjusted coefficient of determination as well as smaller standard error of estimation than those derived from full foot length. All the precision estimates showed that the measurement errors are within acceptable limits. This study suggests that even if the full foot length is available, excluding the phalanges may
Hobizal, Kimberlee B; Wukich, Dane K; Manway, Jeffrey
Lesser digital deformities may present a surgical challenge to even the most skilled foot and ankle surgeon. Multiplanar toe deformities, including the crossover toe, are especially difficult to correct with reproducible results. Undercorrection, pain, stiffness, and recurrent deformity are well reported throughout foot and ankle literature. The goal of this article is to describe a method of correcting digital deformity utilizing the extensor digitorum brevis tendon transfer and a biotenodesis screw. The controlled tension established with the extensor tendon provides the necessary stability for multiplanar correction of multiplanar digital deformities. This technical tip article should serve as pilot study for future evaluation of this method of correction. Level IV: Case series. © 2015 The Author(s).
... Getting an X-ray Why Does My Foot Fall Asleep? KidsHealth > For Kids > Why Does My Foot Fall Asleep? Print A A A Jenna had been ... pins and needles." But why would your foot fall asleep? Many people say this is because you' ...
... (PPE) § 1915.156 Foot protection. (a) Use. The employer shall ensure that each affected employee wears protective footwear when working in areas where there is a danger of foot injuries due to falling or rolling... 29 Labor 7 2010-07-01 2010-07-01 false Foot protection. 1915.156 Section 1915.156...
...) MARINE TERMINALS Personal Protection § 1917.94 Foot protection. (a) The employer shall ensure that each affected employee wears protective footwear when working in areas where there is a danger of foot injuries... 29 Labor 7 2010-07-01 2010-07-01 false Foot protection. 1917.94 Section 1917.94 Labor...
...) MARINE TERMINALS Personal Protection § 1917.94 Foot protection. (a) The employer shall ensure that each affected employee wears protective footwear when working in areas where there is a danger of foot injuries... 29 Labor 7 2011-07-01 2011-07-01 false Foot protection. 1917.94 Section 1917.94 Labor...
... areas where there is a danger of foot injuries due to falling or rolling objects, or objects piercing... 29 Labor 5 2011-07-01 2011-07-01 false Foot protection. 1910.136 Section 1910.136 Labor... OCCUPATIONAL SAFETY AND HEALTH STANDARDS Personal Protective Equipment § 1910.136 Foot protection. (a)...
... areas where there is a danger of foot injuries due to falling or rolling objects, or objects piercing... 29 Labor 5 2010-07-01 2010-07-01 false Foot protection. 1910.136 Section 1910.136 Labor... OCCUPATIONAL SAFETY AND HEALTH STANDARDS Personal Protective Equipment § 1910.136 Foot protection. (a)...
... (PPE) § 1915.156 Foot protection. (a) Use. The employer shall ensure that each affected employee wears protective footwear when working in areas where there is a danger of foot injuries due to falling or rolling... 29 Labor 7 2011-07-01 2011-07-01 false Foot protection. 1915.156 Section 1915.156...
... (incorporated by reference, see § 3285.4). (3) ABS footing pads. (i) ABS footing pads are permitted, provided... use in the soil classification at the site. (ii) ABS footing pads must be listed or labeled for the... support and anchoring. (2) Monolithic slab systems. A monolithic slab is permitted above the frost line...
... (incorporated by reference, see § 3285.4). (3) ABS footing pads. (i) ABS footing pads are permitted, provided... use in the soil classification at the site. (ii) ABS footing pads must be listed or labeled for the... support and anchoring. (2) Monolithic slab systems. A monolithic slab is permitted above the frost line...
Cultural practices are continually tested and upgraded to maximize sugarcane yield in Louisiana. Over the past 3 years extensive research went in to comparing the industry standard 6-foot row spacing to a wider, 8 foot row. Each 8 foot row was double drilled with seed canes that were 2-3 feet apart....
... 29 Labor 5 2014-07-01 2014-07-01 false Foot protection. 1910.136 Section 1910.136 Labor... OCCUPATIONAL SAFETY AND HEALTH STANDARDS Personal Protective Equipment § 1910.136 Foot protection. (a) General... areas where there is a danger of foot injuries due to falling or rolling objects, or objects piercing...
... 29 Labor 7 2013-07-01 2013-07-01 false Foot protection. 1917.94 Section 1917.94 Labor Regulations...) MARINE TERMINALS Personal Protection § 1917.94 Foot protection. (a) The employer shall ensure that each affected employee wears protective footwear when working in areas where there is a danger of foot...
... 29 Labor 7 2014-07-01 2014-07-01 false Foot protection. 1915.156 Section 1915.156 Labor... (PPE) § 1915.156 Foot protection. (a) Use. The employer shall ensure that each affected employee wears protective footwear when working in areas where there is a danger of foot injuries due to falling or...
... 33 Navigation and Navigable Waters 2 2014-07-01 2014-07-01 false Foot protection. 142.33 Section... CONTINENTAL SHELF ACTIVITIES WORKPLACE SAFETY AND HEALTH Personal Protective Equipment § 142.33 Foot... for foot injury to occur shall wear footwear meeting the specifications of ANSI Z41, except...
... 29 Labor 7 2014-07-01 2014-07-01 false Foot protection. 1918.104 Section 1918.104 Labor... (CONTINUED) SAFETY AND HEALTH REGULATIONS FOR LONGSHORING Personal Protective Equipment § 1918.104 Foot... in areas where there is a danger of foot injuries due to falling or rolling objects or...
... 29 Labor 7 2012-07-01 2012-07-01 false Foot protection. 1915.156 Section 1915.156 Labor... (PPE) § 1915.156 Foot protection. (a) Use. The employer shall ensure that each affected employee wears protective footwear when working in areas where there is a danger of foot injuries due to falling or...
... 33 Navigation and Navigable Waters 2 2012-07-01 2012-07-01 false Foot protection. 142.33 Section... CONTINENTAL SHELF ACTIVITIES WORKPLACE SAFETY AND HEALTH Personal Protective Equipment § 142.33 Foot... for foot injury to occur shall wear footwear meeting the specifications of ANSI Z41, except...
... 29 Labor 7 2013-07-01 2013-07-01 false Foot protection. 1918.104 Section 1918.104 Labor... (CONTINUED) SAFETY AND HEALTH REGULATIONS FOR LONGSHORING Personal Protective Equipment § 1918.104 Foot... in areas where there is a danger of foot injuries due to falling or rolling objects or...
... 29 Labor 7 2012-07-01 2012-07-01 false Foot protection. 1917.94 Section 1917.94 Labor Regulations...) MARINE TERMINALS Personal Protection § 1917.94 Foot protection. (a) The employer shall ensure that each affected employee wears protective footwear when working in areas where there is a danger of foot...
... Happens in the Operating Room? Why Does My Foot Fall Asleep? KidsHealth > For Kids > Why Does My Foot Fall Asleep? A A A Jenna had been ... while you might have lost feeling in your foot, it might have felt heavy, or you might ...
... 33 Navigation and Navigable Waters 2 2013-07-01 2013-07-01 false Foot protection. 142.33 Section... CONTINENTAL SHELF ACTIVITIES WORKPLACE SAFETY AND HEALTH Personal Protective Equipment § 142.33 Foot... for foot injury to occur shall wear footwear meeting the specifications of ANSI Z41, except...
... 29 Labor 5 2013-07-01 2013-07-01 false Foot protection. 1910.136 Section 1910.136 Labor... OCCUPATIONAL SAFETY AND HEALTH STANDARDS Personal Protective Equipment § 1910.136 Foot protection. (a) General... areas where there is a danger of foot injuries due to falling or rolling objects, or objects...
... 29 Labor 7 2014-07-01 2014-07-01 false Foot protection. 1917.94 Section 1917.94 Labor Regulations...) MARINE TERMINALS Personal Protection § 1917.94 Foot protection. (a) The employer shall ensure that each affected employee wears protective footwear when working in areas where there is a danger of foot...
... 29 Labor 5 2012-07-01 2012-07-01 false Foot protection. 1910.136 Section 1910.136 Labor... OCCUPATIONAL SAFETY AND HEALTH STANDARDS Personal Protective Equipment § 1910.136 Foot protection. (a) General... areas where there is a danger of foot injuries due to falling or rolling objects, or objects...
... 29 Labor 7 2013-07-01 2013-07-01 false Foot protection. 1915.156 Section 1915.156 Labor... (PPE) § 1915.156 Foot protection. (a) Use. The employer shall ensure that each affected employee wears protective footwear when working in areas where there is a danger of foot injuries due to falling or...
... 29 Labor 7 2012-07-01 2012-07-01 false Foot protection. 1918.104 Section 1918.104 Labor... (CONTINUED) SAFETY AND HEALTH REGULATIONS FOR LONGSHORING Personal Protective Equipment § 1918.104 Foot... in areas where there is a danger of foot injuries due to falling or rolling objects or...
Cheuy, Victor A.; Hastings, Mary K.; Commean, Paul K.; Ward, Samuel R.; Mueller, Michael J.
Background Metatarsophalangeal joint deformity is associated with skin breakdown and amputation. The aims of this study were to compare intrinsic foot muscle deterioration ratios (ratio of adipose to muscle volume), and physical performance in subjects with diabetic neuropathy to controls, and determine their associations with 1) metatarsophalangeal joint angle and 2) history of foot ulcer. Methods 23 diabetic, neuropathic subjects [59 (SD 10) years] and 12 age-matched controls [57 (SD 14) years] were studied. Radiographs and MRI were used to measure metatarsophalangeal joint angle and intrinsic foot muscle deterioration through tissue segmentation by image signal intensity. The Foot and Ankle Ability Measure evaluated physical performance. Findings The diabetic, neuropathic group had a higher muscle deterioration ratio [1.6 (SD 1.2) vs. 0.3 (SD 0.2), P < 0.001], and lower Foot and Ankle Ability Measure scores [65.1 (SD 24.4) vs. 98.3 (SD 3.3) %, P < 0.01]. The correlation between muscle deterioration ratio and metatarsophalangeal joint angle was r = −0.51 (P = 0.01) for all diabetic, neuropathic subjects, but increased to r = −0.81 (P < 0.01) when only subjects with muscle deterioration ratios >1.0 were included. Muscle deterioration ratios in individuals with diabetic neuropathy were higher for those with a history of ulcers. Interpretation Individuals with diabetic neuropathy had increased intrinsic foot muscle deterioration, which was associated with second metatarsophalangeal joint angle and history of ulceration. Additional research is required to understand how foot muscle deterioration interacts with other impairments leading to forefoot deformity and skin breakdown. PMID:24176198
DiLiberto, Frank E; Tome, Josh; Baumhauer, Judith F; Quinn, Jill R; Houck, Jeff; Nawoczenski, Deborah A
Neuropathic tissue changes can alter muscle function and are a primary reason for foot pathologies in people with Diabetes Mellitus and peripheral neuropathy (DMPN). Understanding of foot kinetics in people with DMPN is derived from single-segment foot modeling approaches. This approach, however, does not provide insight into midfoot power and work. Gaining an understanding of midfoot kinetics in people with DMPN prior to deformity or ulceration may help link foot biomechanics to anticipated pathologies in the midfoot and forefoot. The purpose of this study was to evaluate midfoot (MF) and rearfoot (RF) power and work in people with DMPN and a healthy matched control group. Thirty people participated (15 DMPN and 15 Controls). An electro-magnetic tracking system and force plate were used to record multi-segment foot kinematics and ground reaction forces during walking. MF and RF power, work, and negative work ratios were calculated and compared between groups. Findings demonstrated that the DMPN group had greater negative peak power and reduced positive peak power at the MF and RF (all p≤0.05). DMPN group negative work ratios were also greater at the MF and RF [Mean difference MF: 9.9%; p=0.24 and RF: 18.8%; p<0.01]. In people with DMPN, the greater proportion of negative work may negatively affect foot structures during forward propulsion, when positive work and foot stability should predominate. Further study is recommended to determine how both MF and RF kinetics influence the development of deformity and ulceration in people with DMPN.
Vuorisalo, S; Venermo, M; Lepäntalo, M
Diabetic foot ulcers are a major health care problem. Complications of foot ulcers are a leading cause of hospitalization and amputation in diabetic patients. Diabetic ulcers result from neuropathy or ischemia. Neuropathy is characterized by loss of protective sensation and biomechanical abnormalities. Lack of protective sensation allows ulceration in areas of high pressure. Autonomic neuropathy causes dryness of the skin by decreased sweating and therefore vulnerability of the skin to break down. Ischemia is caused by peripheral arterial disease, not by microangiopathy. Poor arterial inflow decreases blood supply to ulcer area and is associated with reduced oxygenation, nutrition and ulcer healing. Necrotic tissue is laden with bacteria apt to grow in such an environment, which also impairs general defence mechanisms against infection. Infections often complicate existing ulcers, but are seldom the cause for ulcers. Protective footwear helps to reduce ulceration in diabetic feet at risk. Relieving pressure on the ulcer area is necessary to allow healing. Blood supply needs to be improved by revascularisation whenever compromised. Systemic antibiotics are helpful in treating acute foot infections, but not uninfected ulcers. Osteomyelitis may underlie a diabetic ulcer and is often treated by resection of the infected bone and always by antibiotics, the mode and length of treatment depending on the adequacy of the debridement. The aim of ulcer bed preparation is to convert the molecular and cellular environment of the chronic ulcer to that of an acute healing wound by debridement, irrigating and cleaning. Moist dressings maintain wound environment favorable for healing. All attempts should be done to prevent diabetic foot ulceration and treat existing ulcers by multidisciplinary teams in order to decrease amputations. Indeed, improvement in ulcer healing has been observed with primary healing rates of 65-85% in mixed series. Even when healed, diabetic foot should be
Sahdi, Haniza; Hoong, Chan Wai; Rasit, Ahmad Hata; Arianto, Fredy; Siong, Lau Kiew; Abdullah, Nur Alyana Benjamin
Diplopodia, being a rare congenital disorder, is infrequently discussed in published texts. Most reported cases have accounted the involvement of duplicated preaxial digits with other associated organ system and physical deformities. Here, we present an unusual case of isolated diplopodia involving postaxial toes in a child with no other organ and physical abnormalities. Radiological studies revealed a set of 10-digit-duplicated foot over the lateral aspect of the native foot, complete with phalanges and its corresponding metatarsals as well as tarsals, supplied by an anomalous posterior branch of the popliteal artery. Definitive surgery was performed just before the child was learning to walk.
López, Daniel López; Callejo González, Lucía; Iglesias, Marta Elena Losa; Canosa, Jesús Luis Saleta; Sanz, David Rodríguez; Lobo, Cesar Calvo; de Bengoa Vallejo, Ricardo Becerro
Hallux Valgus (HV) is a highly prevalent forefoot deformity in older people associated with progressive subluxation and osteoarthritis of the first metatarsophalangeal (MTP) joint and it is believed to be associated with varying degrees of HV effect on the quality of life related to foot health. The aim of this study is to compare the impact of varying degrees of HV on foot health in a sample of older people. The sample consisted of 115 participants, mean age 76.7 ± 9.1, who attended an outpatient center where self-report data were recorded. The degree of HV deformity was determined in both feet using the Manchester Scale (MS) from stage 1 (mild) to 4 (very severe). Scores obtained on the Foot Health Status Questionnaire (FHSQ) were compared. This has 13 questions that assess 4 health domains of the feet, namely pain, function, general health and footwear. The stage 4 of HV shown lower scores for the footwear domain (11.23 ± 15.6); general foot health (27.62 ± 19.1); foot pain (44.65 ± 24.5); foot function (53.04 ± 27.2); vigour (42.19 ± 16.8); social capacity (44.46 ± 28.1); and general health (41.15 ± 25.5) compared with stage 1 of HV (P<0.05) and there were no differences of physical activity (62.81 ± 24.6). Often, quality of life decreases in the elderly population based in large part on their foot health. There is a progressive reduction in health in general and foot health with increasing severity of hallux valgus deformity which appears to be associated with the presence of greater degree of HV, regardless of gender. PMID:26816663
Pino, Alejandro E; Temple, H Thomas
Melorheostosis is a rare and poorly understood condition of bone and soft tissue with a wide range of clinical presentations. This condition is typically characterized by cortical hyperostosis and pain in the involved extremity, but can also be associated with soft-tissue masses and limb deformities that may be additional sources of disability for those affected by this disease. Characteristic radiographic findings can aid in establishing an accurate diagnosis and the condition should not be mistaken for more aggressive neoplasms. This chronic condition is typically managed nonoperatively, but more invasive measures may be necessary when nonoperative measures fail. In cases of surgical intervention, physicians and patients should be aware that this disease has a high recurrence rate. Although there are only a few reports of melorheostosis in the foot and ankle, it is important to be aware of the difficulties the condition may cause in this anatomical location. Melorheostosis can be a source of significant morbidity when the foot and ankle are involved, especially when complicated by symptomatic soft-tissue masses. In this article, we report 3 cases of melorheostosis in the foot and ankle with distinct presentations and variations in outcomes.
Background Surgical treatment and clinical management of foot pathology requires accurate, reliable assessment of foot deformities. Foot and ankle deformities are multi-planar and therefore difficult to quantify by standard radiographs. Three-dimensional (3D) imaging modalities have been used to define bone orientations using inertial axes based on bone shape, but these inertial axes can fail to mimic established bone angles used in orthopaedics and clinical biomechanics. To provide improved clinical relevance of 3D bone angles, we developed techniques to define bone axes using landmarks on quantitative computed tomography (QCT) bone surface meshes. We aimed to assess measurement precision of landmark-based, 3D bone-to-bone orientations of hind foot and lesser tarsal bones for expert raters and a template-based automated method. Methods Two raters completed two repetitions each for twenty feet (10 right, 10 left), placing anatomic landmarks on the surfaces of calcaneus, talus, cuboid, and navicular. Landmarks were also recorded using the automated, template-based method. For each method, 3D bone axes were computed from landmark positions, and Cardan sequences produced sagittal, frontal, and transverse plane angles of bone-to-bone orientations. Angular reliability was assessed using intraclass correlation coefficients (ICCs) and the root mean square standard deviation (RMS-SD) for intra-rater and inter-rater precision, and rater versus automated agreement. Results Intra- and inter-rater ICCs were generally high (≥ 0.80), and the ICCs for each rater compared to the automated method were similarly high. RMS-SD intra-rater precision ranged from 1.4 to 3.6° and 2.4 to 6.1°, respectively, for the two raters, which compares favorably to uni-planar radiographic precision. Greatest variability was in Navicular: Talus sagittal plane angle and Cuboid: Calcaneus frontal plane angle. Precision of the automated, atlas-based template method versus the raters was comparable to
Hirao, Makoto; Ebina, Kosuke; Shi, Kenrin; Tomita, Tetsuya; Noguchi, Takaaki; Tsuboi, Hideki; Hashimoto, Jun; Yoshikawa, Hideki
To determine whether preoperative pain intensity in callosities of the lesser toe metatarsopharangeal (MTP) joint was associated with the grade of fore-mid-hindfoot deformities, because rheumatoid arthritis (RA) foot deformity includes the whole part of foot, and curiously differences between cases in the pain intensity of MTP joint callosities are often observed. We evaluated 24 feet that had undergone forefoot surgery [August, 2014 - December, 2015] for painful lesser toe MTP joint deformity (callosities) in RA cases. A preoperative self-administered foot evaluation questionnaire (SAFE-Q) and pressure distribution information for foot function were also investigated. X-rays of the whole lower extremities and foot at weight-bearing were used to check fore-mid-hindfoot deformities. Group M (mild) [n = 9] included patients with the pain visual analog scale (VAS) less than 40 mm, while group S (severe) [n = 15] included patients whose VAS was over 40 mm. Group M showed stronger hindfoot valgus and pronated (abducted) deformity, and group M showed higher pressure on the first MTP joint compared with group S. These observations reconfirm that hindfoot valgus deformity and/or pronated (abducted) foot deformity affects the forefoot loading distribution, subsequently the pain of callosities in lesser toe MTP joints could be decreased.
Dòria, Montserrat; Rosado, Verónica; Pacheco, Linda Roxana; Betriu, Àngels; Valls, Joan; Mauricio, Dídac
Aim. To assess the prevalence of diabetic foot and other associated conditions in patients with diabetes mellitus under renal replacement in the region of Lleida, Spain. Methods. This was an observational, cross-sectional study of 92 dialysis-treated diabetic patients. Besides a podiatric examination, we explored the presence of cardiovascular risk factors, late diabetes complications, including peripheral neuropathy, atherosclerotic disease, and peripheral artery disease. We assessed risk factors for foot ulceration and amputation by logistic regression. Results. Prevalent diabetic foot was found in 17.4% of patients, foot deformities were found in 54.3%, previous ulcer was found in 19.6%, and amputations were found in 16.3%; and 87% of them had some risk of suffering diabetic foot in the future. We observed a high prevalence of patients with peripheral neuropathy and peripheral artery disease (89.1% and 64.2%, resp.). Multivariable analysis identified diabetic retinopathy and advanced atherosclerotic disease (stenosing carotid plaques) as independent risk factors for foot ulceration (p = 0.004 and p = 0.023, resp.) and diabetic retinopathy also as an independent risk factor for lower-limb amputations (p = 0.013). Moreover, there was a temporal association between the initiation of dialysis and the incidence of amputations. Conclusion. Diabetic patients receiving dialysis therapy are at high risk of foot complications and should receive appropriate and intensive foot care. PMID:27190996
Dòria, Montserrat; Rosado, Verónica; Pacheco, Linda Roxana; Hernández, Marta; Betriu, Àngels; Valls, Joan; Franch-Nadal, Josep; Fernández, Elvira; Mauricio, Dídac
Aim. To assess the prevalence of diabetic foot and other associated conditions in patients with diabetes mellitus under renal replacement in the region of Lleida, Spain. Methods. This was an observational, cross-sectional study of 92 dialysis-treated diabetic patients. Besides a podiatric examination, we explored the presence of cardiovascular risk factors, late diabetes complications, including peripheral neuropathy, atherosclerotic disease, and peripheral artery disease. We assessed risk factors for foot ulceration and amputation by logistic regression. Results. Prevalent diabetic foot was found in 17.4% of patients, foot deformities were found in 54.3%, previous ulcer was found in 19.6%, and amputations were found in 16.3%; and 87% of them had some risk of suffering diabetic foot in the future. We observed a high prevalence of patients with peripheral neuropathy and peripheral artery disease (89.1% and 64.2%, resp.). Multivariable analysis identified diabetic retinopathy and advanced atherosclerotic disease (stenosing carotid plaques) as independent risk factors for foot ulceration (p = 0.004 and p = 0.023, resp.) and diabetic retinopathy also as an independent risk factor for lower-limb amputations (p = 0.013). Moreover, there was a temporal association between the initiation of dialysis and the incidence of amputations. Conclusion. Diabetic patients receiving dialysis therapy are at high risk of foot complications and should receive appropriate and intensive foot care.
Lamm, Bradley M; Gottlieb, H David; Paley, Dror
The goals of Charcot deformity correction are to restore osseous alignment, regain pedal stability, and prevent ulceration. Traditional reconstructive surgical approaches involve large, open incisions to remove bone and the use of internal fixation to attempt to fuse dislocated joints. Such operations can result in shortening of the foot and/or incomplete deformity correction, fixation failure, incision healing problems, infection, and the longterm use of casts or braces. We recommend a minimally invasive surgical technique for the treatment of Charcot deformity, which we performed on 11 feet in 8 patients. Osseous realignment was achieved through gradual distraction of the joints with external fixation, after which minimally invasive arthrodesis was performed with rigid internal fixation. Feet were operated on at various stages of Charcot deformity: Eichenholtz stage I (1 foot), Eichenholtz stage II (6 feet), and Eichenholtz stage III (4 feet). When comparing the average change in preoperative and postoperative radiographic angles, the transverse plane talar-first metatarsal angle (P = .02), sagittal plane talar-first metatarsal angle (P = .008), and calcaneal pitch angle (P = .001) were all found to be statistically significant. Complications included 3 operative adjustments of external or internal fixation, 4 broken wires or half-pins, 2 broken rings, and 11 pin tract infections. Most notably, no deep infection, no screw failure, and no recurrent ulcerations occurred and no amputations were necessary during an average follow-up of 22 months. Gradual Charcot foot correction with the Taylor spatial frame plus minimally invasive arthrodesis is an effective treatment.
Mohamed, Khalid M S; Fenelon, Christopher; Galbraith, John G; D'Souza, Lester G
Lateral column lengthening osteotomy is very useful surgical technique in treating stage II of pes planovalgus deformity of the foot. Either autograft from the iliac crest or allograft can be used for this purpose. In our technique we describe a novel method of obtaining bone graft locally from the calcaneus and therefore avoiding complications and morbidity associated with iliac crest graft. Copyright © 2016 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.
Lee, Jeon Hyeong; Lee, Myoung Hee; Lee, Sang Yeol
[Purpose] Walking with the feet turned inward or outward often causes issues for the people with these walking patterns. The purpose of this study was to examine the influence of in-toeing and out-toeing on maximum force and the center of pressure (COP) trajectory length during stair walking. [Subjects and Methods] The subjects were 30 female university students without orthopedic diseases of the foot. The foot angle was divided into three types: in-toeing, normal, and out-toeing. A plantar pressure measurement instrument was used, and the maximum force was obtained by dividing the foot into six regions covering the anterior medial-lateral, middle medial-lateral, and posterior medial-lateral regions. The COP trajectory length was statistically calculated by measuring the medial-lateral, anterior-posterior, and total travel distances. [Results] During stair climbing, the maximum force was significantly different in the anterior lateral region. During stair descending, the maximum force was significantly different in the anterior lateral, middle medial, middle lateral, posterior medial, and posterior lateral regions. The COP trajectory length showed a statistically significant difference in the medio-lateral travel distance. [Conclusion] Walking with abnormal foot angles causes deformed foot structures and can result in musculoskeletal disabilities in the long term. Therefore, therapeutic intervention is required to maintain normal foot angles. PMID:26504329
García-Álvarez, Yolanda; Lázaro-Martínez, José Luis; García-Morales, Esther; Cecilia-Matilla, Almudena; Aragón-Sánchez, Javier; Carabantes-Alarcón, David
To determine the structural and biomechanical characteristics associated with the conditions diabetes mellitus and diabetic neuropathy. Observational study of 788 patients conducted between February 2007 and February 2009, which included subjects with and without diabetes mellitus who had no active ulcer at enrollment. Demographic variables and the general and specific history of diabetes mellitus were recorded. The patient's foot type according to the Foot Posture Index, joint mobility and deformity were recorded. No associations were found between the different foot types (neutral, pronated and supinated) and the structural and demographic variables at a general level, except for the pronated foot that was associated with a higher body mass index, longer suffering from diabetes and the presence of neuropathy [p<0.001, OR (95% CI): 6.017 (4.198-8.624); p<0.001, OR (95% CI): 1.710 (1.266-2.309); p=0.010, OR (95% CI): 0.759 (0.615-0.937), respectively]. The confluence of risk factors such as neuropathy, body mass index, duration of diabetes and limited joint mobility in patients with diabetes mellitus and pronated foot may be a high-risk anthropometric pattern for developing associated complications such as Charcot foot. A prospective analysis of these patients is required to define the risk for developing Charcot neuroarthropathy. Copyright © 2013 Diabetes India. Published by Elsevier Ltd. All rights reserved.
Bouza Prego, Mª de los Ángeles; Requeijo Constenla, Ana; Saleta Canosa, Jesús Luis; Bautista Casasnovas, Adolfo; Tajes, Francisco Alonso
Objective: To determine whether arch height has an effect on the health-related quality of life of schoolchildren. Methods: One hundred and thirteen schoolchildren attended an out-patient centre where self-reported data were recorded, their feet were classified into one of three groups according to their arch index (high, normal or low) and the scores obtained from the Foot Health Status Questionnaire (FHSQ - Spanish version) were compared. Results: The groups with high, low and normal arch recorded lower scores in Section One for the general foot health and footwear domains and higher scores in foot pain and foot function. In Section Two they obtained lower scores in general health and higher scores in physical activity, social capacity and vigour. Conclusions: Comparison of the scores obtained reveals that arch height has a negative impact on quality of life. Given the limited extent of available evidence in respect of the aetiology and treatment of foot diseases and deformities, these findings reveal the need to implement programmes to promote foot health and carry out further research into this commonly occurring disabling condition. PMID:25767305
Choi, Jung-Kyu; Cha, Eun-Jong; Kim, Kyung-Ah; Won, Yonggwan; Kim, Jung-Ja
From a subject group of pes cavus, the purpose of this study was to evaluate the biomechanical characteristics of lower limbs, based on plantar foot pressure and electromyography (EMG) activities, by the effects on two kind of custom-made insoles. Ten individuals among thirty females with a clinical diagnosis of idiopathic pes cavus (mean age (SD): 22.3 (0.08) years) were selected for the study. The plantar foot pressure data and EMG activities of four lower limb muscles were collected, when subjects walked on a treadmill, under three different experimental conditions. The plantar foot pressure data was analyzed, after the bilateral foot was divided into three areas of masks and into four sections of stance phase, to compare plantar foot pressure. The EMG activities were analyzed for integrated EMG (IEMG) value. The results show that plantar foot pressure concentrated in particular parts is decreased by custom-made insoles. In the case of EMG, all the muscle activities decreased significantly. The custom-made insoles dispersed pressure concentrated by the higher medial longitudinal arch and improved the efficient use of muscles. In particular, the extension structure in the forefoot of custom-made insoles was more efficient for pes cavus. Therefore, it could help patients to walk, by offering support to prevent the disease of pes cavus deformity, and to relieve the burden and fatigue in the lower limbs on gait.
López López, Daniel; Bouza Prego, M de Los Ángeles; Requeijo Constenla, Ana; Saleta Canosa, Jesús Luis; Bautista Casasnovas, Adolfo; Tajes, Francisco Alonso
To determine whether arch height has an effect on the health-related quality of life of schoolchildren. One hundred and thirteen schoolchildren attended an out-patient centre where self-reported data were recorded, their feet were classified into one of three groups according to their arch index (high, normal or low) and the scores obtained from the Foot Health Status Questionnaire (FHSQ - Spanish version) were compared. The groups with high, low and normal arch recorded lower scores in Section One for the general foot health and footwear domains and higher scores in foot pain and foot function. In Section Two they obtained lower scores in general health and higher scores in physical activity, social capacity and vigour. Comparison of the scores obtained reveals that arch height has a negative impact on quality of life. Given the limited extent of available evidence in respect of the aetiology and treatment of foot diseases and deformities, these findings reveal the need to implement programmes to promote foot health and carry out further research into this commonly occurring disabling condition.
Hendry, Gordon J.; Rafferty, Danny; Barn, Ruth; Gardner-Medwin, Janet; Turner, Debbie E.; Woodburn, James
Purpose The objective of this study was to compare disease activity, impairments, disability, foot function and gait characteristics between a well described cohort of juvenile idiopathic arthritis (JIA) patients and normal healthy controls using a 7-segment foot model and three-dimensional gait analysis. Methods Fourteen patients with JIA (mean (standard deviation) age of 12.4 years (3.2)) and a history of foot disease and 10 healthy children (mean (standard deviation) age of 12.5 years (3.4)) underwent three-dimensional gait analysis and plantar pressure analysis to measure biomechanical foot function. Localised disease impact and foot-specific disease activity were determined using the juvenile arthritis foot disability index, rear- and forefoot deformity scores, and clinical and musculoskeletal ultrasound examinations respectively. Mean differences between groups with associated 95% confidence intervals were calculated using the t distribution. Results Mild-to-moderate foot impairments and disability but low levels of disease activity were detected in the JIA group. In comparison with healthy subjects, minor trends towards increased midfoot dorsiflexion and reduced lateral forefoot abduction within a 3–5° range were observed in patients with JIA. The magnitude and timing of remaining kinematic, kinetic and plantar pressure distribution variables during the stance phase were similar for both groups. Conclusion In children and adolescents with JIA, foot function as determined by a multi-segment foot model did not differ from that of normal age- and gender-matched subjects despite moderate foot impairments and disability scores. These findings may indicate that tight control of active foot disease may prevent joint destruction and associated structural and functional impairments. PMID:23142184
Zwipp, H; Dahlen, C; Randt, T; Gavlik, J M
Following complex foot injuries (incidence up to 52 %) in the multiply-injured patient the ultimate goal remains the same as for all significant foot injuries: the restoration of a painless, stable and plantigrade foot to avoid corrective procedures with moderate results. In the case of a complex trauma of the foot (5 point-score) - e. g. a crush injury - primary amputation in the multiply-injured patient (PTS 3-4) is indicated. Limb salvage (PTS 1-2) depends on the intraoperative aspect during the second look (within 24-48 hours after injury): the debridement has to be radical, the selection of amputation level should be at the most distal point compatible with tissue viability and wound healing. A free tissue transfer should be done early if necessary. Single lesions presenting with a compartment syndrome need an immediate dorsal fasciotomy, in the case of a multiply-injured patient as soon as possible. Open fractures are reduced following radical debridement and temporarily stabilized with K-wires and/or tibiotarsal transfixation with an external fixateur until the definitive ORIF. Dislocation-fractures of the talus type 3 and 4 according to Hawkins' classification need open reduction and internal fixation by screws (titan). Open fractures of the calcaneus are stabilized temporarily by a medial external fixateur after debridement until the definitive treatment. If there is a compartment syndrome an immediate dermatofasciotomy is essential. Like closed, calcanear fractures in multiply-injured patients dislocation-fractures of the Chopart's joint need immediate open reduction only if it is an open fracture or associated with a compartment syndrome. The incidence of a compartment syndrome in the case of dislocation fractures of the Lisfranc's joint is high and therefore a dorsal dermatofasciotomy without delay is critical. Open reduction and internal fixation are achieved either by 1.8 mm K-wires or 3.5 mm cortical screws. To avoid further soft tissue damage a
Zwipp, H; Dahlen, C; Randt, T; Gavlik, J M
Following complex foot injuries (incidence up to 52%) in the multiply-injured patient the ultimate goal remains the same as for all significant foot injuries: the restoration of a painless, stable and plantigrade foot to avoid corrective procedures with moderate results. In the case of a complex trauma of the foot (5 point-score)--e.g. a crush injury--primary amputation in the multiply-injured patient (PTS 3-4) is indicated. Limb salvage (PTS 1-2) depends on the intraoperative aspect during the second look (within 24-48 hours after injury): the debridement has to be radical, the selection of amputation level should be at the most distal point compatible with tissue viability and wound healing. A free tissue transfer should be done early if necessary. Single lesions presenting with a compartment syndrome need an immediate dorsal fasciotomy, in the case of a multiply-injured patient as soon as possible. Open fractures are reduced following radical debridement and temporarily stabilized with K-wires and/or tibiotarsal transfixation with an external fixateur until the definitive ORIF. Dislocation-fractures of the talus type 3 and 4 according to Hawkins' classification need open reduction and internal fixation by screws (titan). Open fractures of the calcaneus are stabilized temporarily by a medial external fixateur after debridement until the definitive treatment. If there is a compartment syndrome an immediate dermatofasciotomy is essential. Like closed, calcanear fractures in multiply-injured patients dislocation-fractures of the Chopart's joint need immediate open reduction only if it is an open fracture or associated with a compartment syndrome. The incidence of a compartment syndrome in the case of dislocation fractures of the Lisfranc's joint is high and therefore a dorsal dermatofasciotomy without delay is critical. Open reduction and internal fixation are achieved either by 1.8 mm K-wires or 3.5 mm cortical screws. To avoid further soft tissue damage a delayed
Lee, Sang-Sup; Moon, Jiho; Park, Keum-Sung; Bae, Kyu-Woong
The punching shear failure often governs the strength of the footing-to-column connection. The punching shear failure is an undesirable failure mode, since it results in a brittle failure of the footing. In this study, a new method to increase the strength and ductility of the footing was proposed by inserting the punching shear preventers (PSPs) into the footing. The validation and effectiveness of PSP were verified through a series of experimental studies. The nonlinear finite element analysis was then performed to demonstrate the failure mechanism of the footing with PSPs in depth and to investigate the key parameters that affect the behavior of the footing with PSPs. Finally, the design recommendations for the footing with PSPs were suggested.
Bus, Sicco A
In people with diabetes mellitus, foot ulcers are a major problem because they increase the risk of a foot infection and amputation and reduce quality of life. After a foot ulcer has healed, the risk of recurrence is high. Orthopaedic shoes and orthotics are often prescribed to high risk patients and aim to reduce the mechanical pressure on the plantar surface of the foot. Orthopaedic footwear that is modified to reduce pressure is not much more effective in preventing foot ulcer recurrence than orthopaedic footwear that did not undergo such modification, unless the shoes are worn as recommended. In that case, the risk of ulcer recurrence is reduced by 46%. In patients with a history of ulceration, compliance in wearing orthopaedic shoes at home is low, while these patients walk more inside the house than outside the house. Foot pressure measurements should be part of the prescription and evaluation of orthopaedic footwear for patients at high risk for foot ulceration.
Lee, Sang-Sup; Moon, Jiho; Park, Keum-Sung; Bae, Kyu-Woong
The punching shear failure often governs the strength of the footing-to-column connection. The punching shear failure is an undesirable failure mode, since it results in a brittle failure of the footing. In this study, a new method to increase the strength and ductility of the footing was proposed by inserting the punching shear preventers (PSPs) into the footing. The validation and effectiveness of PSP were verified through a series of experimental studies. The nonlinear finite element analysis was then performed to demonstrate the failure mechanism of the footing with PSPs in depth and to investigate the key parameters that affect the behavior of the footing with PSPs. Finally, the design recommendations for the footing with PSPs were suggested. PMID:25401141
Bálint, Géza P; Korda, Judit; Hangody, László; Bálint, Péter V
Foot pain is very common, especially in women, owing to inappropriate footwear. Overuse, repetitive strain and minor, easily forgettable injuries may result in chronic foot and ankle pain. Rheumatoid arthritis, spondyloarthropathies and gout frequently affect the foot, often as a first presentation. Charcot's joints and foot infections are not rare in diabetes. The rheumatologist should be familiar with foot disorders, either localized or as manifestations of generalized disease. History taking, physical examination, identification of the source of pain by intra-articularly given local anaesthetics and imaging methods should be used to reveal the underlying disorder. Correct diagnosis and efficient therapy-including local steroid injections, physiotherapy, orthoses, surgery-are necessary not only for treatment but also for preventing biomechanical chain reactions. This chapter gives an overview of the epidemiology, diagnosis and treatment of foot pain and foot disorders caused by both local and generalized diseases.
Morales-Orcajo, Enrique; Becerro de Bengoa Vallejo, Ricardo; Losa Iglesias, Marta; Bayod, Javier
The aim of this study was to assess the mechanical properties of the main balance tendons of the human foot in vitro reporting mechanical structural properties and mechanical material properties separately. Tendon structural properties are relevant for clinical applications, for example in orthopedic surgery to elect suitable replacements. Tendon material properties are important for engineering applications such as the development of refined constitutive models for computational simulation or in the design of synthetic materials. One hundred uniaxial tensile tests were performed to obtain the mechanical response of the main intrinsic and extrinsic human foot tendons. The specimens were harvested from five frozen cadaver feet including: Extensor and Flexor tendons of all toes, Tibialis Anterior and Posterior tendons and Peroneus Brevis and Longus tendons. Cross-sectional area, load and strain failure, Young's modulus and ultimate tensile stress are reported as a reference of foot tendon mechanical properties. Two different behaviors could be differentiated. Tibialis and Peroneus tendons exhibited higher values of strain failure compared to Flexor and Extensor tendons which had higher Young's modulus and ultimate tensile stress. Stress-strain tendon curves exhibited proportionality between regions. The initial strain, the toe region and the yield point corresponded to the 15, 30 and 70% of the strain failure respectively. Mechanical properties of the lesser-studied human foot tendons are presented under the same test protocol for different engineering and clinical applications. The tendons that work at the inversion/eversion plane are more deformable at the same stress and strain rate than those that work at the flexion/extension plane. Copyright © 2016 Elsevier Ltd. All rights reserved.
Mickle, Karen J; Steele, Julie R
There is evidence to suggest being overweight or obese places adults at greater risk of developing foot complications such as osteoarthritis, tendonitis and plantar fasciitis. However, no research has comprehensively examined the effects of overweight or obesity on the feet of individuals older than 60 years of age. Therefore we investigated whether foot pain, foot structure, and/or foot function is affected by obesity in older adults. Three hundred and twelve Australian men and women, aged over 60 years, completed validated questionnaires to establish the presence of foot pain and health related quality of life. Foot structure (anthropometrics and soft tissue thickness) and foot function (ankle dorsiflexion strength and flexibility, toe flexor strength, plantar pressures and spatiotemporal gait parameters) were also measured. Obese participants (BMI >30) were compared to those who were overweight (BMI=25-30) and not overweight (BMI <25). Obese participants were found to have a significantly higher prevalence of foot pain and scored significantly lower on the SF-36. Obesity was also associated with foot-related functional limitation whereby ankle dorsiflexion strength, hallux and lesser toe strength, stride/step length and walking speed were significantly reduced in obese participants compared to their leaner counterparts. Therefore, disabling foot pain and altered foot structure and foot function are consequences of obesity for older adults, and impact upon their quality of life. Interventions designed to reduce excess fat mass may relieve loading of the foot structures and, in turn, improve foot pain and quality of life for older obese individuals.
Noviello, Silvana; Esposito, Isabella; Pascale, Renato; Esposito, Silvano; Zeppa, Pio
The diagnosis of wound infection is based on clinical signs and local and/or systemic inflammation. Therefore, the examination has a major role in the diagnosis of infected lesions of the foot. Once the clinical diagnosis of infection is made, the next step is to determine the etiology with the aim to undertake a rational and appropriate treatment. The most reliable method for assessing microbiological etiology is the specimen of material from infected lesion to perform a bacterioscopic examination and culture. The microorganisms involved in the etiology of diabetic foot depends on the type of injury and on specific patient features (antibiotic therapy, previous hospitalization). The most frequently detected pathogen is Staphylococcus aureus. Mild infections are mostly caused by Gram positive cocci, with a prevalence of S. aureus. Moderate infections are mostly supported by pyogenic Gram positive cocci, but also Gram-negative bacteria can be involved. In severe infections the etiology is polymicrobial. As regards the involvement of fungi in diabetic foot infections data are few and mostly conflicting.
Clark, T. A.; Thomsen, P.
A study is presented of deformations in antennas with the emphasis on their influence on VLBI measurements. The GIFTS structural analysis program has been used to model the VLBI antenna in Fairbanks (Alaska). The report identifies key deformations and studies the effect of gravity, wind, and temperature. Estimates of expected deformations are given.
van der Vlies, Cornelis H; Ponsen, Kees J; Besselaar, Philip P; Goslings, J Carel
Stress fractures may occur in any bone, but appear most frequently in the metatarsal bones. Consecutive stress fractures of all lesser metatarsals in a short period are rare, and only a few cases have been described in the literature. We report an unusual case of a young man with consecutive stress fractures of four adjacent lesser metatarsal bones. The etiology was in all probability the fixed forefoot varus deformity. This foot deformity may impose increased mechanical loads across the lateral aspect of the foot that, in turn, may result in stress fractures involving the lesser metatarsals. In our patient conservative treatment finally resulted in a satisfactory outcome.
Abercrombie, Robert Knox; Richardson, Gregory David; Scudiere, Matthew Bligh
A pad is disclosed for use in a weighing system for weighing a load. The pad includes a weighing platform, load cells, and foot members. Improvements to the pad reduce or substantially eliminate rotation of one or more of the corner foot members. A flexible foot strap disposed between the corner foot members reduces rotation of the respective foot members about vertical axes through the corner foot members and couples the corner foot members such that rotation of one corner foot member results in substantially the same amount of rotation of the other corner foot member. In a strapless variant one or more fasteners prevents substantially all rotation of a foot member. In a diagonal variant, a foot strap extends between a corner foot member and the weighing platform to reduce rotation of the foot member about a vertical axis through the corner foot member.
Olivier, S S; Papavasiliou, A P; Barbee, T W; Miles, R R; Walton, C C; Cohn, M B; Chang, K
We are developing a new class of deformable optic based on electrostatic actuation of nanolaminate foils. These foils are engineered at the atomic level to provide optimal opto-mechanical properties, including surface quality, strength and stiffness, for a wide range of deformable optics. We are combining these foils, developed at Lawrence Livermore National Laboratory (LLNL), with commercial metal processing techniques to produce prototype deformable optics with aperture sizes up to 10 cm and actuator spacing from 1 mm to 1 cm and with a range of surface deformation designed to be as much as 10 microns. The existing capability for producing nanolaminate foils at LLNL, coupled with the commercial metal processing techniques being used, enable the potential production of these deformable optics with aperture sizes of over 1 m, and much larger deformable optics could potentially be produced by tiling multiple deformable segments. In addition, based on the fabrication processes being used, deformable nanolaminate optics could potentially be produced with areal densities of less than 1 kg per square m for applications in which lightweight deformable optics are desirable, and deformable nanolaminate optics could potentially be fabricated with intrinsically curved surfaces, including aspheric shapes. We will describe the basic principles of these devices, and we will present details of the design, fabrication and characterization of the prototype deformable nanolaminate optics that have been developed to date. We will also discuss the possibilities for future work on scaling these devices to larger sizes and developing both devices with lower areal densities and devices with curved surfaces.
Dyer, P J; Davis, N
The Pirani scoring system, together with the Ponseti method of club foot management, was assessed for its predictive value. The data on 70 idiopathic club feet successfully treated by the Ponseti method and scored by Pirani's system between February 2002 and May 2004 were analysed. There was a significant positive correlation between the initial Pirani score and number of casts required to correct the deformity. A foot scoring 4 or more is likely to require at least four casts, and one scoring less than 4 will require three or fewer. A foot with a hindfoot score of 2.5 or 3 has a 72% chance of requiring a tenotomy. The Pirani scoring system is reliable, quick, and easy to use, and provides a good forecast about the likely treatment for an individual foot but a low score does not exclude the possibility that a tenotomy may be required.
Plantar fascia release is a surgical alternative for patients who suffer chronic heel pain due to plantar fasciitis and are unaffected by conservative treatment. A computational (finite element) model for analysis of the structural behavior of the human foot during standing was utilized to investigate the biomechanical effects of releasing the plantar fascia. The model integrates a system of five planar structures in the directions of the foot rays. It was built according to accurate geometric data of MRI, and includes linear and non-linear elements that represent bony, cartilaginous, ligamentous and fatty tissues. The model was successfully validated by comparing its resultant ground reactions with foot-ground pressure measurements and its predicted displacements with those observed in radiological tests. Simulation of plantar fascia release (partial or total) was accomplished by gradually removing parts of the fascia in the model. The results showed that total fascia release causes extensive arch deformation during standing, which is greater than normal deformation by more than 2.5mm. Tension stresses carried by the long plantar ligaments increased significantly, and may exceed the normal average stress by more than 200%. Since the contribution of the plantar fascia to the foot's load-bearing ability is of major importance, its release must be very carefully considered, and the present model may be used to help surgeons decide upon the desired degree of release.
Herd, F; Ramanathan, A K; Cochrane, L A; Macnicol, M; Abboud, R J
There are no universal criteria for the assessment of clubfoot. The ideal method should assess functional deformity reliably and objectively. Biomechanical techniques have also been suggested but their role remains undefined. This study aimed to assess surgically corrected clubfeet by biomechanical means with the intention to develop certain ratios to aid in objective assessment. Thirteen children (16 feet) with idiopathic clubfoot, who had previously undergone surgery (lateral-posteromedial release), were reviewed. Various clinical measurements were collected and symptoms assessed using a specially designed questionnaire. Biomechanical (foot pressure) parameters were obtained using two systems: Podotrack and Dynamic Pedobarograph. The results showed that foot pressure data were able to demonstrate abnormalities in foot posture and pressure distribution, which could objectively identify clubfoot deformities. In particular, ratios were calculated, which could be used to determine severity and monitor progression. This study suggests that foot pressure analysis should be routinely used in the assessment of clubfoot. The ratios calculated would be of immense help to the clinicians in monitoring the success of treatment and for early prediction of relapse in patients treated for clubfoot.
Hernandez-Contreras, D.; Peregrina-Barreto, H.; Rangel-Magdaleno, J.; Gonzalez-Bernal, J.
Diabetic foot is one of the major complications experienced by diabetic patients. An early identification and appropriate treatment of diabetic foot problems can prevent devastating consequences such as limb amputation. Several studies have demonstrated that temperature variations in the plantar region can be related to diabetic foot problems. Infrared thermography has been successfully used to detect complication related to diabetic foot, mainly because it is presented as a rapid, non-contact and non-invasive technique to visualize the temperature distribution of the feet. In this review, an overview of studies that relate foot temperature with diabetic foot problems through infrared thermography is presented. Through this research, it can be appreciated the potential of infrared thermography and the benefits that this technique present in this application. This paper also presents the different methods for thermogram analysis and the advantages and disadvantages of each one, being the asymmetric analysis the method most used so far.
Lucas, A P; Leal, M J
Hand and Foot anatomic and physiologic characteristics make the infections, located there, acquire specific aspects. Seventy seven in-patients admitted and/or with follow-up at the out-patient clinic of Dona Estefãnia Hospital with Hand (25) and Foot (52) infections, were reviewed during the period between January 1991 and January 1994. We treated, out-patients with paronychia (7 of the hand and 42 of the foot), one patient with hand pulpitis, and one with dorsum hand cellulitis. The remaining 16 with hand infection (64%) and 15 with foot infection (29%) were being treated with splint in the position of rest, elevation of the affected limb and endovenous antibiotic therapy. In all abscess cases, surgical drainage was conducted, 16 the of hand and 22 of the foot. There were no sequels in hand infection. In foot infection there was one osteitis of the first metatarsus and a cutaneous fistula.
Razak, Abdul Hadi Abdul; Zayegh, Aladin; Begg, Rezaul K.; Wahab, Yufridin
Foot plantar pressure is the pressure field that acts between the foot and the support surface during everyday locomotor activities. Information derived from such pressure measures is important in gait and posture research for diagnosing lower limb problems, footwear design, sport biomechanics, injury prevention and other applications. This paper reviews foot plantar sensors characteristics as reported in the literature in addition to foot plantar pressure measurement systems applied to a variety of research problems. Strengths and limitations of current systems are discussed and a wireless foot plantar pressure system is proposed suitable for measuring high pressure distributions under the foot with high accuracy and reliability. The novel system is based on highly linear pressure sensors with no hysteresis. PMID:23012576
Güven, Mehmet Fatih; Karabiber, Atakan; Kaynak, Gökhan; Öğüt, Tahir
Charcot neuroarthropathy (CN) is a severe joint disease in the foot and ankle that can result in fracture, permanent deformity, and limb loss. It is a serious and potentially limb-threatening lower-extremity late complication of diabetes mellitus. The aim of this manuscript was to evaluate modern concepts of chronic CN through a review of the available literature and to integrate a perspective of management from the authors’ extensive experience. PMID:23919114
Four individuals from three generations of a family had the Hand-Foot-Genital (Hand-Foot-Uterus) syndrome. Affected females had urologic abnormalities confirming that the latter are part of the syndrome.
Simpson, Michael R; Howard, Thomas M
Because our understanding of tendinopathy has evolved in recent years, the condition is now considered a degenerative process; this affects the approach to treatment. Initial therapy should always involve relative rest and modification of physical activity, use of rehabilitative exercises, and evaluation of intrinsic and extrinsic causes of injury. The posterior tibial tendon is a dynamic arch stabilizer; injury to this tendon can cause a painful flat-footed deformity with hindfoot valgus and midfoot abduction (characterized by the too many toes sign). Treatment of posterior tibial tendinopathy is determined by its severity and can include immobilization, orthotics, physical therapy, or subspecialty referral. Because peroneal tendinopathy is often misdiagnosed, it can lead to chronic lateral ankle pain and instability and should be suspected in a patient with either of these symptoms. Treatment involves physical therapy and close monitoring for surgical indications. Achilles tendinopathy is often caused by overtraining, use of inappropriate training surfaces, and poor flexibility. It is characterized by pain in the Achilles tendon 4 to 6 cm above the point of insertion into the calcaneus. Evidence from clinical trials shows that eccentric strengthening of the calf muscle can help patients with Achilles tendinopathy. Flexor hallucis longus tendinopathy is most common among ballet dancers. Patients may complain of an insidious onset of pain in the posteromedial aspect of the ankle; treatment involves correcting physical training errors, focusing on body mechanics, and strengthening the body's core. Anterior tibial tendinopathy is rare, but is typically seen in patients older than 45 years. It causes weakness in dorsiflexion of the ankle; treatment involves short-term immobilization and physical therapy.
Denning, Jaime R
Ankle fractures account for 5% and foot fractures account for approximately 8% of fractures in children. Some complications are evident early in the treatment or natural history of foot and ankle fractures. Other complications do not become apparent until weeks, months, or years after the original fracture. The incidence of long-term sequelae like posttraumatic arthritis from childhood foot and ankle fractures is poorly studied because decades or lifelong follow-up has frequently not been accomplished. This article discusses a variety of complications associated with foot and ankle fractures in children or the treatment of these injuries.
Bus, Sicco A
Biomechanical factors play an important role in diabetic foot disease. Reducing high foot pressures (i.e. offloading) is one of the main goals in healing and preventing foot ulceration. Evidence-based guidelines show the strong association between the efficacy to offload the foot and clinical outcome. However, several aspects related to offloading are underexposed. First, in the management of foot complications, offloading is mostly studied as a single entity, whereas it should be analysed in a broader perspective of contributing factors to better predict clinical outcome. This includes assessment of patient behavioural factors such as type and intensity of daily physical activity and adherence to prescribed treatment. Second, a large gap exists between evidence-based recommendations and clinical practice in the use of offloading for ulcer treatment, and this gap needs to be bridged. Possible ways to achieve this are discussed in this article. Third, our knowledge about the efficacy and role of offloading in treating complicated and non-plantar neuropathic foot ulcers needs to be expanded because these ulcers currently dominate presentation in multidisciplinary foot practice. Finally, foot ulcer prevention is underexposed when compared with ulcer treatment. Prevention requires a larger focus, in particular regarding the efficacy of therapeutic footwear and its relative role in comparison with other preventative strategies. These priorities need the attention of clinicians, scientists and professional societies to improve our understanding of offloading and to improve clinical outcome in the management of the diabetic foot.
Lim, Jonathan Zhang Ming; Ng, Natasha Su Lynn; Thomas, Cecil
The rising prevalence of diabetes estimated at 3.6 million people in the UK represents a major public health and socioeconomic burden to our National Health Service. Diabetes and its associated complications are of a growing concern. Diabetes-related foot complications have been identified as the single most common cause of morbidity among diabetic patients. The complicating factor of underlying peripheral vascular disease renders the majority of diabetic foot ulcers asymptomatic until latter evidence of non-healing ulcers become evident. Therefore, preventative strategies including annual diabetic foot screening and diabetic foot care interventions facilitated through a multidisciplinary team have been implemented to enable early identification of diabetic patients at high risk of diabetic foot complications. The National Diabetes Foot Care Audit reported significant variability and deficiencies of care throughout England and Wales, with emphasis on change in the structure of healthcare provision and commissioning, improvement of patient education and availability of healthcare access, and emphasis on preventative strategies to reduce morbidities and mortality of this debilitating disease. This review article aims to summarise major risk factors contributing to the development of diabetic foot ulcers. It also considers the key evidence-based strategies towards preventing diabetic foot ulcer. We discuss tools used in risk stratification and classifications of foot ulcer.
Karimi, Mohammad Taghi; Fereshtehnejad, Niloofar; Pool, Fatemeh
The human foot contains one of the most variable structures of the body, which is the medial longitudinal arch. Decrease in the height of this arch results in a flat foot. Although there is some evidence regarding the influence of flat foot on gait performance of flat-footed individuals, there is no strong evidence to support the theory that being flat-footed has an effect on energy consumption. Therefore, the aim of this study was to find the relationship between flat foot and energy consumption. Two groups of normal and flat-footed participants were recruited in this research project. They were selected from the staff and students of Isfahan University of Medical Sciences. The foot indexes of both groups were obtained using the footprint method with help of Solid worker software. The physiological cost index (PCI) of the participants was measured by the use of a heart rate monitoring system (Polar Electro, Finland). The differences between the PCIs of both groups of participants was determined using a t test. In addition, the influence of using an insole was evaluated using a paired t test. The energy consumption of flat-footed individuals differed significantly from that of normal individuals (the PCIs of normal and flat-footed individuals were 0.357 and 0.368 beats/m, respectively). Using a foot insole improved the performance of the flat-footed individuals during walking. The PCI of flat-footed individuals is more than that of normal participants as a result of misalignment of foot structure. Moreover, using a foot insole improved foot alignment and decreased energy consumption.
Hillstrom, Howard J.; Song, Jinsup; Kraszewski, Andrew P.; Hafer, Jocelyn F.; Mootanah, Rajshree; Dufour, Alyssa B.; PT, Betty (Shingpui) Chow; Deland, Jonathan T.
Background Differences in foot structure are thought to be associated with differences in foot function during movement. Many foot pathologies are of a biomechanical nature and often associated with foot type. Fundamental to the understanding of foot pathomechanics is the question: do different foot types have distinctly different structure and function? Aim To determine if objective measures of foot structure and function differ between planus, rectus and cavus foot types in asymptomatic individuals. Methods Sixty-one asymptomatic healthy adults between 18 and 77 years old, that had the same foot type bilaterally (44 planus feet, 54 rectus feet, and 24 cavus feet), were recruited. Structural and functional measurements were taken using custom equipment, an emed-x plantar pressure measuring device, a GaitMatII gait pattern measurement system, and a goniometer. Generalized Estimation Equation modeling was employed to determine if each dependent variable of foot structure and function was significantly different across foot type while accounting for potential dependencies between sides. Post hoc testing was performed to assess pairwise comparisons. Results Several measures of foot structure (malleolar valgus index and arch height index) were significantly different between foot types. Gait pattern parameters were invariant across foot types. Peak pressure, maximum force, pressure-time-integral, force-time-integral and contact area were significantly different in several medial forefoot and arch locations between foot types. Planus feet exhibited significantly different center of pressure excursion indices compared to rectus and cavus feet. Conclusions Planus, rectus and cavus feet exhibited significantly different measures of foot structure and function. PMID:23107625
Barriere, H; Berger, M; Billaudel, S
Two characteristic cases encountered in young adults led the authors to present the hand foot and mouth syndrome. They report the characteristic distribution and vesicular appearance of the lesions. The course was benign. The viral origin of the disease was more or less easily confirmed by cell culture, inoculation in new born mice and demonstration of antibodies. Usually the virus was a Coxackie A 16. However in one of the authors cases, an Echo 11 was demonstrated. The apparent rareness of the disease may be explained by lack of recognition.
DiDomenico, Lawrence; Baze, Erigena; Gatalyak, Nikolay
Correction of the fifth digit deformity and Tailor's Bunion can be rewarding as well as challenging for a foot and ankle surgeon. Immense care should be taken when performing these reconstructive surgical procedure, especially to avoid and minimize complication rates and mainly to prevent neurovascular damage. Appropriate surgical procedure selection for the fifth digit deformity and Tailor's Bunion is necessary in order to obtain a long term predictable outcome.
Guiotto, Annamaria; Sawacha, Zimi; Guarneri, Gabriella; Cristoferi, Giuseppe; Avogaro, Angelo; Cobelli, Claudio
The aim of this study was to investigate the role of foot morphology, related with respect to diabetes and peripheral neuropathy in altering foot kinematics and plantar pressure during gait. Healthy and diabetic subjects with or without neuropathy with different foot types were analyzed. Three dimensional multisegment foot kinematics and plantar pressures were assessed on 120 feet: 40 feet (24 cavus, 20 with valgus heel and 11 with hallux valgus) in the control group, 80 feet in the diabetic (25 cavus 13 with valgus heel and 13 with hallux valgus) and the neuropathic groups (28 cavus, 24 with valgus heel and 18 with hallux valgus). Subjects were classified according to their foot morphology allowing further comparisons among the subgroups with the same foot morphology. When comparing neuropathic subjects with cavus foot, valgus heel with controls with the same foot morphology, important differences were noticed: increased dorsiflexion and peak plantar pressure on the forefoot (P<0.05), decreased contact surface on the hindfoot (P<0.03). While results indicated the important role of foot morphology in altering both kinematics and plantar pressure in diabetic subjects, diabetes appeared to further contribute in altering foot biomechanics. Surprisingly, all the diabetic subjects with normal foot arch or with valgus hallux were no more likely to display significant differences in biomechanics parameters than controls. This data could be considered a valuable support for future research on diabetic foot function, and in planning preventive interventions.
Park, Ranhee; Park, Chaisoon
In a clinical setting, patients have been observed to complain of discomfort and to discontinue treatment because of chemotherapy-induced peripheral neuropathy (CIPN), but few data exist regarding the quality of life in these patients in Korea. The purpose of this quasi-experimental study was to analyze the effects of foot bathing and massage in patients with CIPN. Subjects included 48 patients with CIPN, who were hospitalized in C University Hospital. The subjects were alternately assigned to 1 of 2 groups according to their registration order. The interventions consisted of 8 treatments of foot bathing or massage over a period of 2 weeks, at 30 minutes per session, every other day. The foot skin temperature increased significantly in the foot bathing group, whereas it decreased significantly in the massage group. Quality of life was significantly increased in the foot bathing group, whereas it was significantly decreased in the massage group. Although foot bathing and foot massage are both supportive care techniques for CIPN patients, foot bathing was more effective than foot massage on skin temperature, grade of neurotoxicity, and quality of life. Additional well-designed studies are recommended, so that the effectiveness of foot bathing and foot massage is confirmed. Foot bathing is more useful as supportive care with respect to nonpharmacologic interventions for alleviating CIPN and promoting the quality of life in cancer patients.
Kimura, Makoto; Mochimaru, Masaaki; Kanade, Takeo
Recently, techniques for measuring and modeling of human body are taking attention, because human models are useful for ergonomic design in manufacturing. We aim to measure accurate shape of human foot that will be useful for the design of shoes. For such purpose, shape measurement of foot in motion is obviously important, because foot shape in the shoe is deformed while walking or running. In this paper, we propose a method to measure anatomical cross-sections of foot while walking. No one had ever measured dynamic shape of anatomical cross-sections, though they are very basic and popular in the field of biomechanics. Our proposed method is based on multi-view stereo method. The target cross-sections are painted in individual colors (red, green, yellow and blue), and the proposed method utilizes the characteristic of target shape in the camera captured images. Several nonlinear conditions are introduced in the process to find the consistent correspondence in all images. Our desired accuracy is less than 1mm error, which is similar to the existing 3D scanners for static foot measurement. In our experiments, the proposed method achieved the desired accuracy.
Liu, Chanjuan; van Netten, Jaap J.; van Baal, Jeff G.; Bus, Sicco A.; van der Heijden, Ferdi
Early identification of diabetic foot complications and their precursors is essential in preventing their devastating consequences, such as foot infection and amputation. Frequent, automatic risk assessment by an intelligent telemedicine system might be feasible and cost effective. Infrared thermography is a promising modality for such a system. The temperature differences between corresponding areas on contralateral feet are the clinically significant parameters. This asymmetric analysis is hindered by (1) foot segmentation errors, especially when the foot temperature and the ambient temperature are comparable, and by (2) different shapes and sizes between contralateral feet due to deformities or minor amputations. To circumvent the first problem, we used a color image and a thermal image acquired synchronously. Foot regions, detected in the color image, were rigidly registered to the thermal image. This resulted in 97.8%±1.1% sensitivity and 98.4%±0.5% specificity over 76 high-risk diabetic patients with manual annotation as a reference. Nonrigid landmark-based registration with B-splines solved the second problem. Corresponding points in the two feet could be found regardless of the shapes and sizes of the feet. With that, the temperature difference of the left and right feet could be obtained.
Liu, Chanjuan; van Netten, Jaap J; van Baal, Jeff G; Bus, Sicco A; van der Heijden, Ferdi
Early identification of diabetic foot complications and their precursors is essential in preventing their devastating consequences, such as foot infection and amputation. Frequent, automatic risk assessment by an intelligent telemedicine system might be feasible and cost effective. Infrared thermography is a promising modality for such a system. The temperature differences between corresponding areas on contralateral feet are the clinically significant parameters. This asymmetric analysis is hindered by (1) foot segmentation errors, especially when the foot temperature and the ambient temperature are comparable, and by (2) different shapes and sizes between contralateral feet due to deformities or minor amputations. To circumvent the first problem, we used a color image and a thermal image acquired synchronously. Foot regions, detected in the color image, were rigidly registered to the thermal image. This resulted in 97.8% ± 1.1% sensitivity and 98.4% ± 0.5% specificity over 76 high-risk diabetic patients with manual annotation as a reference. Nonrigid landmark-based registration with B-splines solved the second problem. Corresponding points in the two feet could be found regardless of the shapes and sizes of the feet. With that, the temperature difference of the left and right feet could be obtained.
Francia, Piergiorgio; Gulisano, Massimo; Anichini, Roberto; Seghieri, Giuseppe
Lower extremity ulcers represent a serious and costly complication of diabetes mellitus. Many factors contribute to the development of diabetic foot. Peripheral neuropathy and peripheral vascular disease are the main causes of foot ulceration and contribute in turn to the growth of additional risk factors such as limited joint mobility, muscular alterations and foot deformities. Moreover, a deficit of balance, posture and biomechanics can be present, in particular in patients at high risk for ulceration. The result of this process may be the development of a vicious cycle which leads to abnormal distribution of the foot's plantar pressures in static and dynamic postural conditions. This review shows that some of these risk factors significantly improve after a few weeks of exercise therapy (ET) intervention. Accordingly it has been suggested that ET can be an important weapon in the prevention of foot ulcer. The aim of ET can relate to one or more alterations typically found in diabetic patients, although greater attention should be paid to the evaluation and possible correction of body balance, rigid posture and biomechanics. Some of the most important limitations of ET are difficult access to therapy, patient compliance and the transitoriness of the results if the training stops. Many proposals have been made to overcome such limitations. In particular, it is important that specialized centers offer the opportunity to participate in ET and during the treatment the team should work to change the patient's lifestyle by improving the execution of appropriate daily physical activity.
Ozkan, Arif; Atmaca, Halil; Mutlu, Ibrahim; Celik, Talip; Uğur, Levent; Kişioğlu, Yasin
Blount's disease, or tibia vara, is the most common cause of pathologic genu varum in children and adolescents. Changes in the loading of knee structures such as tibial articular cartilage, menisci and subcondral bone are well documented in case of genu varum. But the mechanical effects of this condition on foot bones are still questionable. In this study, the authors hypothesized that stress distributions on foot bones might increase in patients with tibia vara when compared with patients who had normal lower extremity mechanical axis. Three-dimensional (3D) finite element analyses of human lower limb were used to investigate and compare the loading on foot bones in normal population and patient with tibia vara. The segmentation software, MIMICS was used to generate the 3D images of the bony structures of normal and varus malalignment lower extremity. Except the spaces between the adjacent surface of the phalanges fused, metatarsals, cuneiforms, cuboid, navicular, talus and calcaneus bones were independently developed to form foot and ankle complex. Also femur, tibia and fibula were modeled utilizing mechanical axis. ANSYS version 14 was used for mechanical tests and maximum equivalent stresses (MES) were examined. As a result of the loading conditions, in varus model MES on talus, calcaneus and cuboid were found higher than in normal model. And stress distributions changed through laterally on middle and fore foot in varus deformity model.
Córdova, Clay; Dumitrescu, Thomas T.; Intriligator, Kenneth
We classify possible supersymmetry-preserving relevant, marginal, and irrelevant deformations of unitary superconformal theories in d ≥ 3 dimensions. Our method only relies on symmetries and unitarity. Hence, the results are model independent and do not require a Lagrangian description. Two unifying themes emerge: first, many theories admit deformations that reside in multiplets together with conserved currents. Such deformations can lead to modifications of the supersymmetry algebra by central and non-central charges. Second, many theories with a sufficient amount of supersymmetry do not admit relevant or marginal deformations, and some admit neither. The classification is complicated by the fact that short superconformal multiplets display a rich variety of sporadic phenomena, including supersymmetric deformations that reside in the middle of a multiplet. We illustrate our results with examples in diverse dimensions. In particular, we explain how the classification of irrelevant supersymmetric deformations can be used to derive known and new constraints on moduli-space effective actions.
Córdova, Clay; Dumitrescu, Thomas T.; Intriligator, Kenneth
Here, we classify possible supersymmetry-preserving relevant, marginal, and irrelevant deformations of unitary superconformal theories in d ≥ 3 dimensions. Our method only relies on symmetries and unitarity. Hence, the results are model independent and do not require a Lagrangian description. Two unifying themes emerge: first, many theories admit deformations that reside in multiplets together with conserved currents. Such deformations can lead to modifications of the supersymmetry algebra by central and noncentral charges. Second, many theories with a sufficient amount of supersymmetry do not admit relevant or marginal deformations, and some admit neither. The classification is complicated by the fact that short superconformal multiplets display a rich variety of sporadic phenomena, including supersymmetric deformations that reside in the middle of a multiplet. We illustrate our results with examples in diverse dimensions. In particular, we explain how the classification of irrelevant supersymmetric deformations can be used to derive known and new constraints on moduli-space effective actions.
Menz, Hylton B.; Dufour, Alyssa B.; Katz, Patricia; Hannan, Marian T.
Background The foot plays an important role in supporting the body when undertaking weight bearing activities. Aging is associated with an increased prevalence of foot pain and a lowering of the arch of the foot, both of which may impair mobility. Objective To examine the associations of foot pain, foot posture and dynamic foot function with self-reported mobility limitations in community-dwelling older adults. Methods Foot examinations were conducted on 1,860 members of the Framingham Study in 2002–2005. Foot posture was categorized as normal, planus or cavus using static pressure measurements, and foot function was categorized as normal, pronated or supinated using dynamic pressure measurements. Participants were asked whether they had foot pain and any difficulty performing a list of nine weight bearing tasks. Multivariate logistic regression and linear regression models were used to examine the associations of foot pain, posture, function and ability to perform these activities. Results After adjusting for age, sex, height and weight, foot pain was significantly associated with difficulty performing all nine weight bearing activities. Compared to those with normal foot posture and function, participants with planus foot posture were more likely to report difficulty remaining balanced (odds ratio [OR] = 1.40, 95% confidence interval [CI] 1.06 to 1.85; p=0.018) and individuals with pronated foot function were more likely to report difficulty walking across a small room (OR = 2.07, 95% CI 1.02 to 4.22; p=0.045). Foot pain and planus foot posture were associated with an overall mobility limitation score combining performances on each measure. Conclusion Foot pain, planus foot posture and pronated foot function are associated with self-reported difficulty undertaking common weight bearing tasks. Interventions to reduce foot pain and improve foot posture and function may therefore have a role in improving mobility in older adults. PMID:26645379
Bishop, David; Moore, Allan; Chandrashekar, Naveen
Traumatic knee injuries in automobile accidents and sports often lead to damage of the peroneal nerve. A lack of control of muscles innervated by the peroneal nerve due to this damage, results in the inability to dorsiflex and evert the foot and to extend the toes. This condition is commonly known as foot drop. Foot drop reduces the stability in the body while walking and running and may also cause injury due to lack of foot clearance during the swing phase of the gait. Traditionally, an ankle foot orthosis (AFO), comprised of a moulded sheet of plastic that conforms around the posterior calf and distally contains all or part of the calcaneous as well as the plantar foot, is used to treat foot drop. The intent of this orthosis is to dorsiflex the foot to provide clearance during the swing phase of walking and running. Traditional AFO results in increased pressures due to a decrease in dorsiflexion range of motion at the ankle and make the orthosis increasingly uncomfortable to wear. Several other existing designs of foot drop AFO suffer from similar inadequacies. To address these issues, a new AFO was developed. The device was successfully used by one person with foot drop without issues for more than one year. This new design conforms to the lower anterior shin and dorsum of the foot using dorsiassist Tamarack ankle joints to allow for greater plantar and dorsiflexion range of motion. While still limiting ankle inversion it does allow for more ankle eversion. This orthosis can be discretely worn inside shoes due to its smaller size, and can be worn for a longer period of time without discomfort.
Venkatswami, Sandhya; Sankarasubramanian, Anandan; Subramanyam, Shobana
"Mycetoma" means a fungal tumor. Mycetoma is a chronic, granulomatous, subcutaneous tissue infection caused by both bacteria (actinomycetoma) and fungi (eumycetoma). This chronic infection was termed Madura foot and eventually mycetoma, owing to its etiology. Inoculation commonly follows minor trauma, predominantly to the foot and hence is seen more among the barefoot-walking populations, common among adult males aged 20 to 50 years. The hallmark triad of the disease includes tumefaction, fistulization of the abscess, and extrusion of colored grains. The color of these extruded grains in the active phase of the disease offers a clue to diagnosis. Radiology, ultrasonology, cytology, histology, immunodiagnosis, and culture are tools used in diagnosis. Recently, DNA sequencing has also been used successfully. Though both infections manifest with similar clinical findings, Actinomycetoma has a rapid course and can lead to amputation or death secondary to systemic spread. However, actinomycetomas are more responsive to antibiotics, whereas eumycetomas require surgical excision in addition to antifungals. Complications include secondary bacterial infections that can progress to full-blown bacteremia or septicemia, resulting in death. With extremely disfiguring sequelae, following the breakdown of the nodules and formation of discharging sinuses, it poses a therapeutic challenge.
It is known that the relative importance of factors involved in the development of diabetic foot problems can vary in both their presence and severity between patients and lesions. This may be one of the reasons why outcomes seem to vary centre to centre and why some treatments may seem more effective in some people than others. There is a need therefore to classify and describe lesions of the foot in patients with diabetes in a manner that is agreed across all communities but is simple to use in clinical practice. No single system is currently in widespread use, although a number have been published. Not all are well validated outside the system from which they were derived, and it has not always been made clear the clinical purposes to which such classifications should be put to use, whether that be for research, clinical description in routine clinical care or audit. Here the currently published classification systems, their validation in clinical practice, whether they were designed for research, audit or clinical care, and the strengths and weaknesses of each are explored.
Totonchi, Ali; Guyuron, Bahman
The alar rim plays an important role in nasal harmony. Alar rim flaws are common following the initial rhinoplasty. Classification of the deformities helps with diagnosis and successful surgical correction. Diagnosis of the deformity requires careful observation of the computerized or life-sized photographs. Techniques for treatment of these deformities can easily be learned with attention to detail. Copyright © 2016 Elsevier Inc. All rights reserved.
Chiang, P.; Gwo-shyn, S.
Taiwan is located at the junction of the Eurasian Plate and the Philippine Sea Plate. It's because arc-continent collision occurs in the western Taiwan, resulting in the orogeny has formed a fold-and-thrust belt, developing a series of thrusts aligned in north-south direction. The thrust faults, locating in the central island, are the oldest and have almost inactive. Westward to the island, the faults become younger, dipping angles are smaller, and motions were stronger. On the west side, the foot of the Taiwan Western Foothill is considered the youngest thrust faults located along west Taiwan. Scholars recognized them as so-called the deformation front, and they also believed that the deformation front is located in between the compressive terrain uplifted area and the extensional subsidence area. Therefore, this front line is on the boundary of two different tectonic zones. This study investigates the trace of the deformation front in Miaoli area. Previous studies suggested that the west side of Miaoli collision zone should be fault-bounded, and is located in the seabed. However, in the geological map, there is no geologic evidence that appears on land and so-called active faults related with this deformation front. In the near coast seafloor, according to the reflection earthquakes data from the Institute of Oceanography of NTU, we can only see the offshore strata have been uplifted, and the data also shows that seabed is only covered by thin layer of sediments. This study indicates that in offshore place within three kilometers, shallow formations show a special layer of slime which was extruded to be corrugated transversely. Accordingly, we believe that this slime layer should be pressurized and filled with muddy water. Such features should be further investigated with other geological and geophysical survey data to check if they belong to the structural product of the deformation front.
Suh, Jin Soo; Seo, Lan
Background The Maasai are the most widely known African ethnic group located in Kenya and northern Tanzania. Most spend their days either barefoot or in their traditional shoes made of car tires. Although they walk long distances of up to sixty kilometers a day, they do not suffer from any foot ailments. Little is known about their foot structure and gait. The goal of this investigation was to characterize various aspects of Maasai foot in standing and walking. Methods Foot length, calf circumference, hindfoot alignment, step length, cadence, and walking velocity were obtained from 1,096 adult Maasai people (545 males and 551 females; mean age, 40.28 ± 14.69 years; age range, 16 to 65 years). All included subjects were from rural areas, where the primary terrain was sandy soil, who spend most of their lifetime barefoot, walking. They all denied any medical history or previous symptoms related to foot problems. A trained clinician scanned all feet for deformities. Static (standing) and dynamic (walking) Harris mat footprints were taken to determine the distribution of forefoot pressure patterns during walking. Results The average foot length was 250.14 ± 18.12 mm (range, 210 to 295 mm) and calf circumference was 32.50 ± 3.22 cm (range, 25 to 41 cm). The mean hindfoot alignment was 6.21° ± 1.55° of valgus. Sixty-four subjects (5.84%) had bilateral flat-shaped feet with a low medial longitudinal arch that exactly matched the broad pattern of their static footprints. Step length, cadence, and walking velocity were 426.45 ± 88.73 cm (range, 200 to 690 cm), 94.35 steps/min (range, 72 to 111 steps/min), and 40.16 ± 8.36 m/min (range, 18.20 to 63.36 m/min), respectively. A total of 83.39% subjects showed unilateral or bilateral deformities of multiple toes regardless of age. The most frequent deformity was clawing (98.79%) of which the highest incidence occurred with the fifth toe (93.23%). Dynamic footprints showed even pressure patterns throughout the forefoot
Benoussaad, Mourad; Sijobert, Benoît; Mombaur, Katja; Coste, Christine Azevedo
This paper introduces a method for the robust estimation of foot clearance during walking, using a single inertial measurement unit (IMU) placed on the subject's foot. The proposed solution is based on double integration and drift cancellation of foot acceleration signals. The method is insensitive to misalignment of IMU axes with respect to foot axes. Details are provided regarding calibration and signal processing procedures. Experimental validation was performed on 10 healthy subjects under three walking conditions: normal, fast and with obstacles. Foot clearance estimation results were compared to measurements from an optical motion capture system. The mean error between them is significantly less than 15 % under the various walking conditions.
... https://medlineplus.gov/news/fullstory_163022.html Cold-Weather Foot Care Key for Diabetics It's important to ... potentially serious foot problems, especially during the cold weather, a foot and ankle specialist warns. "When it ...
13. 64 foot truss - oblique view of the 64 foot pony truss showing its general configuration. The 80 foot pony trusses are similar. - Weidemeyer Bridge, Spanning Thomes Creek at Rawson Road, Corning, Tehama County, CA
This year several tests in growers’ fields were used to compare traditional 6-foot row spacing to 8-foot row spacing. Cane is double-drilled in the wider row spacing. The wider row spacing would accommodate John Deere 3522 harvester. Field data indicate the sugarcane yields are very comparable in 8-...
... protection equipment when potential foot injury may result from impact, falling or flying objects, electrical... 49 Transportation 4 2010-10-01 2010-10-01 false Foot protection. 214.115 Section 214.115..., DEPARTMENT OF TRANSPORTATION RAILROAD WORKPLACE SAFETY Bridge Worker Safety Standards § 214.115...
... in areas where there is a danger of foot injuries due to falling or rolling objects or objects... 29 Labor 7 2011-07-01 2011-07-01 false Foot protection. 1918.104 Section 1918.104 Labor... (CONTINUED) SAFETY AND HEALTH REGULATIONS FOR LONGSHORING Personal Protective Equipment § 1918.104...
... for foot injury to occur shall wear footwear meeting the specifications of ANSI Z41, except when... 33 Navigation and Navigable Waters 2 2010-07-01 2010-07-01 false Foot protection. 142.33 Section... CONTINENTAL SHELF ACTIVITIES WORKPLACE SAFETY AND HEALTH Personal Protective Equipment § 142.33...
... for foot injury to occur shall wear footwear meeting the specifications of ANSI Z41, except when... 33 Navigation and Navigable Waters 2 2011-07-01 2011-07-01 false Foot protection. 142.33 Section... CONTINENTAL SHELF ACTIVITIES WORKPLACE SAFETY AND HEALTH Personal Protective Equipment § 142.33...
... protection equipment when potential foot injury may result from impact, falling or flying objects, electrical... 49 Transportation 4 2011-10-01 2011-10-01 false Foot protection. 214.115 Section 214.115..., DEPARTMENT OF TRANSPORTATION RAILROAD WORKPLACE SAFETY Bridge Worker Safety Standards § 214.115...
... in areas where there is a danger of foot injuries due to falling or rolling objects or objects... 29 Labor 7 2010-07-01 2010-07-01 false Foot protection. 1918.104 Section 1918.104 Labor... (CONTINUED) SAFETY AND HEALTH REGULATIONS FOR LONGSHORING Personal Protective Equipment § 1918.104...
... density. A footing must support every pier. Footings are to be either: (1) Concrete. (i) Four inch nominal precast concrete pads meeting or exceeding ASTM C 90-02a, Standard Specification for Loadbearing Concrete... compressive strength of 1,200 pounds per square inch (psi); or (ii) Six inch minimum poured-in-place...
... impact on feet can increase risk of damage. Stress fractures of the foot are becoming more common in runners, especially first-time marathoners.The growing popularity of... Founded in 1942, the American College of Foot and Ankle Surgeons is a specialty ...
JSC2004-E-35439 (11 August 2004) --- Astronaut Leroy Chiao, Expedition 10 commander and NASA ISS science officer, participates in Foot/Ground Reaction Forces During Spaceflight (FOOT) Integrated nominal operations during Human Research Facility (HRF) training in the International Space Station (ISS) Destiny laboratory mockup/trainer at Johnson Space Centers Space Vehicle Mockup Facility.
Naito, Eiichi; Hirose, Satoshi
How very long-term (over many years) motor skill training shapes internal motor representation remains poorly understood. We provide valuable evidence that the football brain of Neymar da Silva Santos Júnior (the Brasilian footballer) recruits very limited neural resources in the motor-cortical foot regions during foot movements. We scanned his brain activity with a 3-tesla functional magnetic resonance imaging (fMRI) while he rotated his right ankle at 1 Hz. We also scanned brain activity when three other age-controlled professional footballers, two top-athlete swimmers and one amateur footballer performed the identical task. A comparison was made between Neymar's brain activity with that obtained from the others. We found activations in the left medial-wall foot motor regions during the foot movements consistently across all participants. However, the size and intensity of medial-wall activity was smaller in the four professional footballers than in the three other participants, despite no difference in amount of foot movement. Surprisingly, the reduced recruitment of medial-wall foot motor regions became apparent in Neymar. His medial-wall activity was smallest among all participants with absolutely no difference in amount of foot movement. Neymar may efficiently control given foot movements probably by largely conserving motor-cortical neural resources. We discuss this possibility in terms of over-years motor skill training effect, use-dependent plasticity, and efficient motor control.
... 49 Transportation 4 2014-10-01 2014-10-01 false Foot protection. 214.115 Section 214.115..., DEPARTMENT OF TRANSPORTATION RAILROAD WORKPLACE SAFETY Bridge Worker Safety Standards § 214.115 Foot protection. (a) The railroad or railroad contractor shall require railroad bridge workers to wear...
... 49 Transportation 4 2012-10-01 2012-10-01 false Foot protection. 214.115 Section 214.115..., DEPARTMENT OF TRANSPORTATION RAILROAD WORKPLACE SAFETY Bridge Worker Safety Standards § 214.115 Foot protection. (a) The railroad or railroad contractor shall require railroad bridge workers to wear...
... 49 Transportation 4 2013-10-01 2013-10-01 false Foot protection. 214.115 Section 214.115..., DEPARTMENT OF TRANSPORTATION RAILROAD WORKPLACE SAFETY Bridge Worker Safety Standards § 214.115 Foot protection. (a) The railroad or railroad contractor shall require railroad bridge workers to wear...
Smith, Kirk E.; Whiting, Bruce R.; Reiker, Gregory G.; Commean, Paul K.; Sinacore, David R.; Prior, Fred W.
Few studies exist for bone densitometry of the whole foot. A phantom study demonstrated the sources of error and necessary controls for accurate quantitative computed tomography of the foot. A loss in bone mineral density in the small foot bones may be an early indicator of diabetic foot complications. Purpose Volumetric quantitative computed tomography (vQCT) facilitates assessment of pedal bone osteopenia, which in the presence of peripheral neuropathy may well be an early sign of diabetic foot deformity. To date, sources and magnitudes of error in foot vQCT measurements have not been reported. Methods Foot phantoms were scanned using a 64-slice CT scanner. Energy (kVp), table height, phantom size and orientation, location of “bone” inserts, insert material, location of calibration phantom, and reconstruction kernel were systematically varied during scan acquisition. Results Energy (kVp) and distance from the isocenter (table height) resulted in relative attenuation changes from −5% to 22% and −5% to 0%, respectively, and average bone mineral density (BMD) changes from −0.9% to 0.0% and −1.1% to 0.3%, respectively, compared to a baseline 120 kVp scan performed at the isocenter. BMD compared to manufacturer specified values ranged on average from −2.2% to 0.9%. Phantom size and location of bone-equivalent material inserts resulted in relative attenuation changes of −1.2% to 1.4% compared to the medium sized phantom. Conclusion This study demonstrated that variations in kVp and table height can be controlled using a calibration phantom scanned at the same energy and height as a foot phantom; however, error due to soft tissue thickness and location of bones within a foot cannot be controlled using a calibration phantom alone. PMID:22147208
Kaynak, Gökhan; Birsel, Olgar; Güven, Mehmet Fatih; Öğüt, Tahir
Charcot arthropathy of the foot is a rare but devastating complication of diabetes that remains to be a challenging issue for the foot and ankle surgeons. Charcot foot fails to be an obvious diagnostic option that comes to mind, even in a pathognomonic clinical appearance. The rarity of the disorder, more common pathologies that mimic the condition, and the self-limiting prognosis deviate the clinician from the right diagnosis. The clinical challenges in the diagnosis of Charcot foot require in-depth investigations of its enigmatic nature to establish useful guidelines. Yet, this goal seems to be beyond reach, without a holistic view of the immense literature concerning the pathophysiology of the disorder. The primary objective of this article is to put together and review the recent advancements about the etiology and intrinsic mechanisms of diabetic Charcot foot. PMID:23919113
Khan, Zeeshan; Hussain, Shakir; Carter, Simon R
Sarcomas are rare tumours and particularly rarer in the foot and ankle region. The complex anatomy of the foot and ankle makes it unique and hence poses a challenge to the surgeon for limb salvage surgery. Other lesions found in the foot and ankle region are benign bone and soft tissue tumours, metastasis and infection. The purpose of this article is to discuss the relevance of the complex anatomy of the foot and ankle in relation to tumours, clinical features, their general management principles and further discussion about some of the more common bone and soft tissue lesions. Discussion of every single bone and soft tissue lesion in the foot and ankle region is beyond the scope of this article.
Armstrong, D G; Wunderlich, R P; Lavery, L A
At the present time, there are no evidence-based protocols outlining the use of the Sure-Closure Skin Stretching System on diabetic, neuropathic wounds. Ideally, surgical correction of the precipitating deformity and appropriate shoe gear accommodation should be performed con-comitantly with skin stretching (as indicated) to achieve an optimal long-term result. For several years, we have used the Sure-Closure device as an adjunctive treatment for diabetic-foot wound closure, and believe that, ultimately, this device more likely will be used in a clinical setting. In this manner, a patient with an open wound may, under aseptic conditions, be sequestered for a period of 1 to 2 hours during a clinical visit to allow for skin stretching. This procedure may be carried out two or three times weekly until closure is achieved. Mechanically assisted delayed primary closure is a relatively new category of wound closure; however, this device is by no means a panacea. Appropriate patient selection and intraoperative judgment are of critical preoperative and perioperative importance when employing this technique. Currently, we are completing a clinical trial comparing mechanically assisted delayed primary-wound closure to traditional treatment and off-loading in a population of high-risk diabetic patients. We believe that this project will better elucidate the relative indications and contraindications with what may be a very effective tool for the diabetic foot specialist.
McKeon, Patrick O; Hertel, Jay; Bramble, Dennis; Davis, Irene
The foot is a complex structure with many articulations and multiple degrees of freedom that play an important role in static posture and dynamic activities. The evolutionary development of the arch of the foot was coincident with the greater demands placed on the foot as humans began to run. The movement and stability of the arch is controlled by intrinsic and extrinsic muscles. However, the intrinsic muscles are largely ignored by clinicians and researchers. As such, these muscles are seldom addressed in rehabilitation programmes. Interventions for foot-related problems are more often directed at externally supporting the foot rather than training these muscles to function as they are designed. In this paper, we propose a novel paradigm for understanding the function of the foot. We begin with an overview of the evolution of the human foot with a focus on the development of the arch. This is followed by a description of the foot intrinsic muscles and their relationship to the extrinsic muscles. We draw the parallels between the small muscles of the trunk region that make up the lumbopelvic core and the intrinsic foot muscles, introducing the concept of the foot core. We then integrate the concept of the foot core into the assessment and treatment of the foot. Finally, we call for an increased awareness of the importance of the foot core stability to normal foot and lower extremity function. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Alcacer-Pitarch, Begonya; Siddle, Heidi J; Buch, Maya H; Emery, Paul; Hashmi, Farina; Redmond, Anthony C
The vascular and cutaneous alterations evident in systemic sclerosis/scleroderma (SSc) place the foot at risk of ulceration. The UK Podiatry Rheumatic Care Association (PRCA)/Arthritis and Musculoskeletal Alliance standards of care recommend that all people with SSc should receive at least basic information about their foot health, and that those with foot problems should have access to self-management advice and care where needed. The aim of this study was to evaluate foot health services offered in Leeds (UK) for people with SSc, against nationally agreed standards of care. Ninety-one consecutive patients with SSc were selected from either the connective tissue disease outpatient clinic (n = 70) or the specialist rheumatology foot health clinic (n = 21) at Chapel Allerton Hospital, Leeds Teaching Hospitals NHS Trust. All the patients completed a disease-specific audit tool developed by the UK PRCA that evaluates provision of foot health care for patients with SSc. Sixty-one patients (67%) reported having had foot problems at some point in time and 54 (59%) had current foot problems. Of these 54 patients, 17 (32%) had not received any foot care. Only 36 (39%) of the 91 patients had received any foot health information. This audit demonstrates that patients with SSc have a relatively high prevalence of self-reported foot problems. Foot health care and information are inadequate for people with SSc and foot problems, and preventative information is almost non-existent. Improved foot health information will better empower patients to self-manage low risk problems, and help identify high risk problems which require specialist care.
Background There is little indication that foot health services in Australia are meeting modern day recommendations for Rheumatoid Arthritis (RA) patients. The overall objective of this study was to explore the current state of foot health services for patients with RA with an emphasis on identifying barriers to the receipt of appropriate foot care in South-West Sydney, New South Wales, Australia. Methods A mixed (quantitative and qualitative) approach was adopted. Indications for appropriate access to foot care were determined by comparing the foot health, disease and socio-demographic characteristics of patients with unmet foot care demands, foot care users and patients with no demands for foot care. Perceptions of provision of, and access to, foot care were explored by conducting telephone-based interviews using an interpretative phenomenology approach with thematic analysis. Results Twenty-nine participants took part in the cross-sectional quantitative research study design, and 12 participants took part in the interpretative phenomenological approach (qualitative study). Foot care access appeared to be driven predominantly by the presence of rearfoot deformity, which was significantly worse amongst participants in the foot care user group (p = 0.02). Five main themes emerged from the qualitative data: 1) impact of disease-related foot symptoms, 2) footwear difficulties, 3) medical/rheumatology encounters, 4) foot and podiatry care access and experiences, and 5) financial hardship. Conclusions Foot care provision does not appear to be driven by appropriate foot health characteristics such as foot pain or foot-related disability. There may be significant shortfalls in footwear and foot care access and provision in Greater Western Sydney. Several barriers to adequate foot care access and provision were identified and further efforts are required to improve access to and the quality of foot care for people who have RA. Integration of podiatry services within
Waizy, Hazibullah; Olender, Gavin; Mansouri, Farhad; Floerkemeier, Thilo; Stukenborg-Colsman, Christina
Bunionette, or tailor's bunion, is a painful protrusion on the plantar and/or lateral aspect of the fifth metatarsal head. Until recently, there have been very good results reported in literature when minimally invasive therapy is used to treat this deformity. In this study, the authors critically review the outcome of patients operated by the minimal invasive technique. A total of 31 feet were retrospectively reviewed with a mean follow-up of 52 months (range 14-106 months). The results were related to the preoperative severity of the bunionette deformity. The mean intermetatarsal angle IV/V was reduced from 12° to 7.5° postoperatively. The American Orthopaedic Foot and Ankle Society score showed good and excellent values (80-100 points) at follow-up in 16 (12 type I, 4 type III) feet. Fourteen (2 type I, 5 type II, 7 type III) feet were rated as satisfactory (60-80 points) and one (type III) foot with fair (56 points). Nine patients (5 type II and 4 type III) indicated that they would not undergo the operative procedure again. Our results show inclusive evidence that minimal invasive osteotomies have a good clinical outcome in the treatment of high-grade deformities. The best future option is to consider the classification of the deformity before a minimally invasive operation is to take place.
Garay, Mauricio; Goursac, Axel de; Straten, Duco van
We construct a version of the complex Heisenberg algebra based on the idea of endless analytic continuation. The algebra would be large enough to capture quantum effects that escape ordinary formal deformation quantisation. -- Highlights: •We construct resurgent deformation quantisation. •We give integral formulæ. •We compute examples which show that hypergeometric functions appear naturally in quantum computations.
Ungley, C C; Channell, G D; Richards, R L
1. Prolonged exposure of the extremities to cold insufficient to cause tissue freezing produces a well-defined syndrome. 'Immersion foot' is one of the descriptive but inaccurate terms applied to this syndrome. The clinical features, aetiology, pathology, prevention, and treatment of immersion foot are considered in detail. A discussion on pathogenesis is also included. 2. In the natural history of a typical case of immersion foot there are four stages: the period of exposure and the pre-hyperaemic, hyperaemic, and post-hyperaemic stages. 3. During exposure and immediately after rescue the feet are cold, numb, swollen, and pulseless. Intense vasoconstriction sufficient to arrest blood-flow is believed to be the predominant factor during this phase. 4. This is followed by a period of intense hyperaemia, increased swelling, and severe pain. Hyperaemia is due to the release in chilled and ischaemic tissues of relatively stable vasodilator metabolites; pain may be the result of relative anoxia of sensory nerve-endings. 5. Within 7-10 days of rescue the intense hyperaemia and swelling subside and pain diminishes in intensity. A lesser degree of hyperaemia may persist for several weeks. Objective disturbances of sensation and sweating and muscular atrophy and paralysis now become apparent. These findings are correlated with damage to the peripheral nerves. 6. After several weeks the feet become cold-sensitive; when exposed to low temperature they cool abnormally and may remain cold for several hours. Hyperhidrosis frequently accompanies this cold-sensitivity. The factors responsible for these phenomena are incompletely understood; several possible explanations are considered. 7. Severe cases may develop blisters and gangrene. The latter is usually superficial and massive loss of tissue is rare. 8. The hands may be affected but seldom as severely as the feet. The essential features of immersion hand are the same as those of immersion foot. 9. Prognosis depends upon
Ferber, Reed; Hettinga, Blayne A
Over-the-counter foot orthoses are a cost-effective alternative to custom-made devices. However, few studies have compared over-the-counter devices and most biomechanical research involving orthoses has focused on rearfoot biomechanics. To determine changes in multi-segment foot biomechanics during shod walking in three commercially available over-the-counter devices: SOLE, SuperFeet and Powerstep when compared to no orthotic. Repeated measures, cross-sectional study. Retroreflective markers were placed on the right limb of 18 participants representing forefoot, midfoot, rearfoot and shank segments. Three-dimensional kinematics were recorded using an eight-camera motion capture system while participants walked on a treadmill and the order of condition was randomized between four conditions: SOLE, SuperFeet, Powerstep and no orthotic. All over-the-counter devices exhibited significant decreases in plantar fascia strain compared to no orthotic and only Powerstep exhibited significant decreases in peak rearfoot eversion. Medial longitudinal arch deformation was not reduced for any over-the-counter device. Different over-the-counter devices exhibited specific alterations in rearfoot kinematics and all reduced plantar fascia strain by varying amounts. These over-the-counter-specific kinematic changes should be taken into consideration when recommending these devices as a treatment option. Over-the-counter orthoses are a cost-effective alternative to custom-made devices. We demonstrated that three commonly used over-the-counter devices influence foot kinematics and plantar fascia strain differently. Clinicians can use these results to provide more tailored treatment options for their patients. © The International Society for Prosthetics and Orthotics 2015.
Zheng, Xiaofen; Udupa, Jayaram K.; Hirsch, Bruce E.
In this paper, we estimate the deformations induced on soft tissues by the rigid independent movements of hard objects and create an admixture of rigid and elastic adaptive image registration transformations. By automatically segmenting and independently estimating the movement of rigid objects in 3D images, we can maintain rigidity in bones and hard tissues while appropriately deforming soft tissues. We tested our algorithms on 20 pairs of 3D MRI datasets pertaining to a kinematic study of the flexibility of the ankle complex of normal feet as well as ankles affected by abnormalities in foot architecture and ligament injuries. The results show that elastic image registration via rigid object-induced deformation outperforms purely rigid and purely nonrigid approaches.
Segal, L S; Mann, D C; Feiwell, E; Hoffer, M M
As initial surgical management for rigid equinovarus deformities, 16 children with arthrogryposis (30 involved feet) and 16 myelodysplastic children (26 involved feet) underwent primary talectomies or extensive posterior-medial releases (PMR). When compared with primary PMRs in arthrogrypotic children, primary talectomies revealed a greater number of good and fair results, decreased recurrence rates, less procedures per foot, and maintenance of ambulatory status. Recurrent forefoot and cavus deformities were present after primary talectomies. Primary talectomy in arthrogrypotic children was more effective than posterior-medial releases or secondary (salvage) talectomy. Because of the small number of feet involved, the role of primary talectomy in myelomeningocele was not clarified by this study. Radical PMRs in myelodysplastic children resulted in a significant number of hindfoot valgus deformities that required secondary procedures.
Desbois, Guillaume; Schuck, Bernhard; Urai, Janos
Bulk mechanical and transport properties of reference claystones for deep disposal of radioactive waste have been investigated since many years but little is known about microscale deformation mechanisms because accessing the relevant microstructure in these soft, very fine-grained, low permeable and low porous materials remains difficult. Recent development of ion beam polishing methods to prepare high quality damage free surfaces for scanning electron microscope (SEM) is opening new fields of microstructural investigation in claystones towards a better understanding of the deformation behavior transitional between rocks and soils. We present results of Boom Clay deformed in a triaxial cell in a consolidated - undrained test at a confining pressure of 0.375 MPa (i.e. close to natural value), with σ1 perpendicular to the bedding. Experiments stopped at 20 % strain. As a first approximation, the plasticity of the sample can be described by a Mohr-Coulomb type failure envelope with a coefficient of cohesion C = 0.117 MPa and an internal friction angle ϕ = 18.7°. After deformation test, the bulk sample shows a shear zone at an angle of about 35° from the vertical with an offset of about 5 mm. We used the "Lamipeel" method that allows producing a permanent absolutely plane and large size etched micro relief-replica in order to localize and to document the shear zone at the scale of the deformed core. High-resolution imaging of microstructures was mostly done by using the BIB-SEM method on key-regions identified after the "Lamipeel" method. Detailed BIB-SEM investigations of shear zones show the following: the boundaries between the shear zone and the host rock are sharp, clay aggregates and clastic grains are strongly reoriented parallel to the shear direction, and the porosity is significantly reduced in the shear zone and the grain size is smaller in the shear zone than in the host rock but there is no evidence for broken grains. Comparison of microstructures
Sato, Tomoya; Ichioka, Shigeru
Charcot foot is a serious complication of diabetes, characterized by deformity and overlying ulceration. The condition most commonly affects the midfoot. However, little information is available on the use of a medial plantar artery flap to treat diabetic midfoot ulceration. The purpose of the present study was to evaluate the versatility of ostectomy and medial plantar flap reconstruction for midfoot plantar ulceration associated with rocker-bottom deformity secondary to Charcot foot. Four patients underwent ostectomy and medial plantar flap reconstruction. Before flap reconstruction, the devitalized soft tissues and bone were radically resected. After the infection had been controlled, the ulcerated portion was minimally excised, and the bony prominence underlying the ulcer was removed. A medial plantar artery flap was applied to the ulcer. The donor site was covered with a split-thickness skin graft or artificial dermis. In all patients, the ulcers healed and independent ambulation was achieved. However, 1 patient experienced ulcer recurrence, and subsequent infection necessitated a major amputation. Limb salvage is challenging in the setting of deformity and intractable plantar ulceration. The advantages of medial plantar artery flap reconstruction are that tissues with a rich blood supply are used to cover the exposed bone, and the flap can withstand the pressure and shear stress of the patient's body weight. However, a dominant artery in the foot is sacrificed. Therefore, the patency of the dorsalis pedis artery must be confirmed in every patient. The results of the present study have demonstrated that a medial plantar artery can be an effective alternative for diabetic patients with a plantar ulcer secondary to Charcot foot.
Bonnet, Xavier; Pillet, Hélenè; Fodé, Pascale; Lavaste, Francois; Skalli, Wafa
Energy-storing prosthetic feet are designed to store energy during mid-stance motion and to recover it during late-stance motion. Gait analysis is the most commonly used method to characterize prosthetic foot behaviour during walking. In using this method, however, the foot is generally modelled as a rigid body. Therefore, it does not take into account the ability of the foot to deform. However, the way this deformation occurs is a key parameter of various foot properties under gait conditions. The purpose of this study is to combine finite element modelling and gait analysis in order to calculate the strain, stress and energy stored in the foot along the stance phase for self-selected and fast walking speeds. A finite element model, validated using mechanical testing, is used with boundary conditions collected experimentally from the gait analysis of a single transtibial amputee. The stress, strain and energy stored in the foot are assessed throughout the stance phase for two walking speed conditions: a self-selected walking speed (SSWS), and a fast walking speed (FWS). The first maximum in the strain energy occurs during heel loading and reaches 3J for SSWS and 7J for FWS at the end of the first double support phase. The second maximum appears at the end of the single support phase, reaching 15J for SSWS and 18J for FWS. Finite element modelling combined with gait analysis allows the calculation of parameters that are not obtainable using gait analysis alone. This modelling can be used in the process of prosthetic feet design to assess the behaviour of a prosthetic foot under specific gait conditions.
Han, Youngmin; Kim, Kyoung-Tae; Cho, Dae-Chul; Sung, Joo-Kyung
We report the case of 57-year-old woman diagnosed with Charcot-Marie-Tooth (CMT) disease and lumbar disk herniation (LDH). She had left leg weakness and foot numbness, foot deformity (muscle atrophy, high arch, and clawed toes). The lumbar spine MRI showed LDH at L4-5. Additionally, electrophysiology results were consistent with chronic peripheral motor-sensory polyneuropathy (axonopathy). In genetic testing, 17p11.2-p12 duplication/deletions characteristic of CMT disease were observed. We confirmed the patient's diagnosis as CMT disease and used conservative treatment.
NEVILLE, CHRISTOPHER; HOUCK, JEFF
STUDY DESIGN Case report. BACKGROUND No head-to-head comparisons of different orthoses for patients with stage II posterior tibial tendon dysfunction (PTTD) have been performed to date. Additionally, the cost of orthoses varies considerably, thus choosing an effective orthosis that is affordable to the patient is largely a trial-and-error process. CASE DESCRIPTION A 77-year-old woman was seen with complaints of abnormal foot posture (“my foot is out”), minimal medial foot and ankle pain, and a 3-year history of conservatively managed stage II PTTD. The patient was not able to complete 1 single-limb heel rise on the involved side, while she could complete 3 on the uninvolved side. Ankle strength testing revealed a mild to moderate loss of plantar flexor strength (20%–31% deficit on the involved side), combined with a 22% deficit in isometric ankle inversion and forefoot adduction strength. To assist this patient in managing her flatfoot posture and PTTD, 3 orthoses were considered: an off-the-shelf ankle-foot orthosis (AFO), a custom solid AFO, and a custom articulated AFO. The patient’s chief complaint was partly cosmetic (“my foot is out”). As decreasing flatfoot kinematics may unload the tibialis posterior muscle, thus prevent the progression of foot deformity, the primary goal of orthotic intervention was to improve flatfoot kinematics. Given the difficulties in clinical approaches to evaluating flatfoot kinematics, a quantitative gait analysis, using a multisegment foot model, was used. OUTCOMES In the frontal plane, all 3 orthoses were associated with small changes toward hindfoot inversion. In the sagittal plane, between 2.7° and 6.1°, greater forefoot plantar flexion (raising the medial longitudinal arch) occurred. There were no differences among the orthoses on hindfoot inversion and forefoot plantar flexion. In the transverse plane, the off-the-shelf design was associated with forefoot abduction, the custom solid orthosis was associated with
Park, D J; Han, S K; Kim, W K
In managing diabetic foot ulcers, foot elevation has generally been recommended to reduce oedema and prevent other sequential problems. However, foot elevation may decrease tissue oxygenation of the foot more than the dependent position since the dependent position is known to increase blood flow within the arterial system. In addition, diabetic foot ulcers, which have peripheral vascular insufficiency, generally have less oedema than other wounds. Therefore, we argue that foot elevation may not be helpful for healing of vascularly compromised diabetic foot ulcers since adequate tissue oxygenation is an essential factor in diabetic wound healing. The purpose of this study was to evaluate the influence of foot height on tissue oxygenation and to determine the optimal foot position to accelerate wound healing of diabetic foot ulcers. This study included 122 cases (73 males and 47 females; two males had bilateral disease) of diabetic foot ulcer patients aged 40-93 years. Trans-cutaneous partial oxygen tension (TcpO(2)) values of diabetic feet were measured before and after foot elevation (n=21). Elevation was achieved by placing a foot over four cushions. We also measured foot TcpO(2) values before and after lowering the feet (n=122). Feet were lowered to the patient's tibial height, approximately 30-35 cm, beside a bed handrail. Due to the large number of lowering measurements, we divided them into five sub-groups according to initial TcpO(2.) Tissue oxygenation values were compared. Foot-elevation-lowered TcpO(2) values before and after elevation were 32.5+/-22.2 and 23.8+/-23.1 mmHg (p<0.01), respectively. Foot-lowering-augmented TcpO(2) values before and after lowering were 44.6+/-23.8 and 58.0+/-25.9 mmHg (p<0.01), respectively. The lower the initial TcpO(2) level, the more the TcpO(2) level increased. The foot lowering, rather than elevation, significantly augments TcpO(2) and may stimulate healing of diabetic foot ulcers.
Samson, William; Van Hamme, Angèle; Sanchez, Stéphane; Chèze, Laurence; Van Sint Jan, Serge; Feipel, Véronique
Foot roll-over is commonly analyzed to evaluate gait pathologies. The current study utilized a dynamic foot scanner (DFS) to analyze foot roll-over. The right feet of ten healthy subjects were assessed during gait trials with a DFS system integrated into a walkway. A foot sole picture was computed by vertically projecting points from the 3D foot shape which were lower than a threshold height of 15 mm. A 'height' value of these projected points was determined; corresponding to the initial vertical coordinates prior to projection. Similar to pedobarographic analysis, the foot sole picture was segmented into anatomical regions of interest (ROIs) to process mean height (average of height data by ROI) and projected surface (area of the projected foot sole by ROI). Results showed that these variables evolved differently to plantar pressure data previously reported in the literature, mainly due to the specificity of each physical quantity (millimeters vs Pascals). Compared to plantar pressure data arising from surface contact by the foot, the current method takes into account the whole plantar aspect of the foot, including the parts that do not make contact with the support surface. The current approach using height data could contribute to a better understanding of specific aspects of foot motion during walking, such as plantar arch height and the windlass mechanism. Results of this study show the underlying method is reliable. Further investigation is required to validate the DFS measurements within a clinical context, prior to implementation into clinical practice.
Bowering, C. K.
OBJECTIVE: To review underlying causes of diabetic foot ulceration, provide a practical assessment of patients at risk, and outline an evidence-based approach to therapy for diabetic patients with foot ulcers. QUALITY OF EVIDENCE: A MEDLINE search was conducted for the period from 1979 to 1999 for articles relating to diabetic foot ulcers. Most studies found were case series or small controlled trials. MAIN MESSAGE: Foot ulcers in diabetic patients are common and frequently lead to lower limb amputation unless a prompt, rational, multidisciplinary approach to therapy is taken. Factors that affect development and healing of diabetic patients' foot ulcers include the degree of metabolic control, the presence of ischemia or infection, and continuing trauma to feet from excessive plantar pressure or poorly fitting shoes. Appropriate wound care for diabetic patients addresses these issues and provides optimal local ulcer therapy with débridement of necrotic tissue and provision of a moist wound-healing environment. Therapies that have no known therapeutic value, such as foot soaking and topical antiseptics, can actually be harmful and should be avoided. CONCLUSION: Family physicians are often primary medical contacts for patients with diabetes. Patients should be screened regularly for diabetic foot complications, and preventive measures should be initiated for those at risk of ulceration. PMID:11398715
Seo, Dong-Kyo; Lee, Ho Seong; Park, Jungu; Ryu, Chang Hyun; Han, Duck Jong; Seo, Sang Gyo
It is known that successful pancreas transplantation enables patients with diabetes to maintain a normal glucose level without insulin and reduces diabetes-related complications. However, we have little information about the foot-specific morbidity in patients who have undergone successful pancreas transplantation. The purpose of this study was to investigate the prevalence and predisposing factors for foot complications after successful pancreas transplantation. This retrospective study included 218 patients (91 males, 127 females) who had undergone pancreas transplantation for diabetes. The mean age was 40.7 (range, 15-76) years. Diabetes type, transplantation type, body mass index, and diabetes duration before transplantation were confirmed. After pancreas transplantation, the occurrence and duration of foot and ankle complications were assessed. Twenty-two patients (10.1%) had diabetic foot complications. Fifteen patients (6.9%) had diabetic foot ulcer and 7 patients (3.2%) had Charcot arthropathy. Three patients had both diabetic foot ulcer and Charcot arthropathy. Three insufficiency fractures (1.4%) were included. Mean time of complications after transplantation was 18.5 (range, 2-77) months. Creatinine level 1 year after surgery was higher in the complication group rather than the noncomplication group ( P = .02). Complications of the foot and ankle still occurred following pancreas transplantation in patients with diabetes. Level III, comparative study.
Janisse, Dennis; Janisse, Erick
Conservative pedorthic management of the diabetic foot has been shown to be an effective method to prevent ulcers, amputations, and re-amputations. This article exhibits why and how pedorthics plays such an important role via modalities such as footwear, shoe modifications, custom foot orthoses, and partial foot prostheses. The objective of this article is to demonstrate how pedorthics has been shown to be an integral part of conservative diabetic foot care. The authors' goal was to educate the reader about the different modalities that are available for use. This article is based largely on review of previously published research and scholarly articles, augmented by the more than 60 years of pedorthic and orthotic clinical experience of the authors. Approximately 60 journal articles and book chapters were reviewed by the authors. Articles were located via online resources such as PubMed as well as the authors' own libraries. It was repeatedly noted that pedorthic modalities such as shoes, foot orthoses, and shoe modifications may be utilized in the treatment and prevention of diabetic foot wounds and other complications. Pedorthic devices may be successfully integrated into a comprehensive treatment plan for patients with diabetes and foot ulcers. This information is of special interest to those who treat patients with diabetes. The article demonstrates the efficacy of pedorthic intervention through the compilation and review of relevant previously published data. © The International Society for Prosthetics and Orthotics 2014.
Hanselman, Andrew E; Powell, Brian D; Santrock, Robert D
Advancements in total ankle arthroplasty (TAA) over the past several decades have led to improved patient outcomes and implant survivorship. Despite these innovations, many implant manufacturers still consider a preoperative coronal plane deformity greater than 10° a relative contraindication to TAA. Without proper intraoperative alignment, these implants may experience abnormal wear and hardware failure. Correcting these deformities, often through the use of soft tissue procedures and/or osteotomies, not only increases the difficulty of a case, but also the intraoperative time and radiation exposure. The authors report a case in which a 54-year-old man with a severe right ankle varus deformity of 29° underwent successful TAA using the INBONE II Prophecy total ankle system (Wright Medical Technology, Inc, Memphis, Tennessee) and additional soft tissue reconstruction. Intraoperatively, the patient's coronal deformity was corrected to 1.8°. At 8 months postoperatively, the patient ambulated without restriction and had substantial improvement in validated patient outcome scores, specifically the Academy of Orthopaedic Surgeons Foot and Ankle Module and the Short Form Health Survey-12 This unique report documents the first time that this particular implant, with an exclusive preoperative computed tomography-derived patient-specific guide, has been used effectively for a severe preoperative varus deformity greater than 20° without the need for an osteotomy. Future studies should be directed toward the prospective evaluation of different total ankle implant systems and their outcomes with severe coronal plane deformity, specifically computed tomography-derived patient-specific guided implants.
Chen, Bi; Jia, Chi-yu; Hu, Da-hai; Zhu, Xiong-xiang; Han, Jun-tao; Yao, Qing-jun; Xu, Ming-da
To explore new measures for functional reconstruction of multiple severe deformities as a result of extensive deep burn (total burn surface area > or = 90% TBSA, including deep burn > or = 70%TBSA) in late stage. Twelve severe burn patients with above-mentioned deformities were hospitalized in our ward during 1960--2005, the scars resulted from burns were distributed from head to foot with 173 deformities, including 27 scar ulcers. All patients lacked of self-care ability, among them some could not stand. Due to inadequate skin source, deformities were corrected by skin from matured scars expanded with subcutaneous balloon at late postburn stage. Following our former clinical experience, anatomic investigation and experimental research, we chose the following methods to correct deformities and restore functions: application of split-thickness scar skin after expansion (88 wounds); use of scar skin flap/scar-Achilles tendon flaps (59 wounds); combination of thin split-thickness skin grafts from scar and allogeneic acellular dermal matrix (composite skin, 40 wounds). All grafts survived, the appearance and function were improved obviously without complications. Follow-up 1-40 years, all patients could take care themselves with satisfactory function and appearance, and among them 8 patients returned to work (one had worked for 40 years), 2 patients married and had children. The above-mentioned measures are safe, reliable and effective for functional reconstruction of deformities.
Bae, Young-Hyeon; Ko, Mansoo; Lee, Suk Min
[Purpose] Revised high-heeled shoes were developed to minimize foot deformities by reducing excessive load on the forefoot during walking or standing in adult females, who frequently wear standard high-heeled shoes. Specifically, this study aimed to investigate the effects of revised high-heeled shoes on foot pressure distribution and center of pressure distance during standing in adult females. [Subjects and Methods] Twelve healthy adult females were recruited to participate in this study. Foot pressures were obtained under 3 conditions: barefoot, in revised high-heeled shoes, and in standard 7-cm high-heeled shoes. Foot pressure was measured using the Tekscan HR mat scan system. One-way repeated analysis of variance was used to compare the foot pressure distribution and center of pressure distance under these 3 conditions. [Results] The center of pressure distance between the two lower limbs and the fore-rear distribution of foot pressure were significantly different for the 3 conditions. [Conclusion] Our findings support the premise that wearing revised high-heeled shoes seems to provide enhanced physiologic standing posture compared to wearing standard high-heeled shoes. PMID:26834343
Bae, Young-Hyeon; Ko, Mansoo; Lee, Suk Min
[Purpose] Revised high-heeled shoes were developed to minimize foot deformities by reducing excessive load on the forefoot during walking or standing in adult females, who frequently wear standard high-heeled shoes. Specifically, this study aimed to investigate the effects of revised high-heeled shoes on foot pressure distribution and center of pressure distance during standing in adult females. [Subjects and Methods] Twelve healthy adult females were recruited to participate in this study. Foot pressures were obtained under 3 conditions: barefoot, in revised high-heeled shoes, and in standard 7-cm high-heeled shoes. Foot pressure was measured using the Tekscan HR mat scan system. One-way repeated analysis of variance was used to compare the foot pressure distribution and center of pressure distance under these 3 conditions. [Results] The center of pressure distance between the two lower limbs and the fore-rear distribution of foot pressure were significantly different for the 3 conditions. [Conclusion] Our findings support the premise that wearing revised high-heeled shoes seems to provide enhanced physiologic standing posture compared to wearing standard high-heeled shoes.
Giurato, Laura; Meloni, Marco; Izzo, Valentina; Uccioli, Luigi
Foot infection is a well recognized risk factor for major amputation in diabetic patients. The osteomyelitis is one of the most common expression of diabetic foot infection, being present approximately in present in 10%-15% of moderate and in 50% of severe infectious process. An early and accurate diagnosis is required to ensure a targeted treatment and reduce the risk of major amputation. The aim of this review is to report a complete overview about the management of diabetic foot osteomyelitis. Epidemiology, clinical aspects, diagnosis and treatment are widely described according to scientific reccomendations and our experience. PMID:28465790
The dancer's foot and ankle are subjected to high forces and unusual stresses in training and performance. Injuries are common in dancers, and the foot and ankle are particularly vulnerable. Ankle sprains, ankle impingement syndromes, flexor hallucis longus tendonitis, cuboid subluxation, stress fractures, midfoot injuries, heel pain, and first metatarsophalangeal joint problems including hallux valgus, hallux rigidus, and sesamoid injuries will be reviewed. This article will discuss these common foot and ankle problems in dancers and give typical clinical presentation and diagnostic and treatment recommendations.
Wee, James; Thevendran, Gowreeson
Orthobiologics are biological substances that are used therapeutically for their positive effects on healing skeletal and soft-tissue injuries. The array of orthobiological products currently available to the foot and ankle surgeon is wide, and includes bone allografts, bone substitutes, growth factors, and chondral scaffolds. Nonetheless, despite the surge in interest and usage of orthobiologics, there remains a relative paucity of research addressing their specific applications in foot and ankle surgery. In this review, we attempt to provide an overview of the literature on commonly available allogenic bone grafts and bone substitutes. There is Level II, III and IV evidence addressing allogenic bone grafts in primary arthrodesis and osteotomy procedures in foot and ankle surgery, which compares favourably with autogenic bone grafts in terms of fusion rates and clinical outcomes (often with fewer complications), and supports a Grade B recommendation for its use. Pertaining to bone substitutes, the multiplicity of products, coupled with a lack of large prospective clinical trials, makes firm recommendations difficult. Level II and IV studies of calcium phosphate and calcium sulphate products in displaced intra-articular calcaneal fractures have found favourable results in addressing bone voids, maintaining reduction and promoting union, meriting a Grade B recommendation. Evidence for TCP is limited to level IV studies reporting similarly good outcomes in intra-articular calcaneal fractures, warranting a Grade C recommendation. The use of demineralised bone matrix products in hindfoot and ankle fusions has been described in Level II and III studies, with favourable results in achieving fusion and good clinical outcomes, supporting a Grade B recommendation for these indications. Overall, despite the general lack of high-level evidence in foot and ankle surgery, allogenic bone grafts and bone substitutes continue to hold front-line roles in treating the bone defects
Chatterjee, Protyush; Sahu, M K
Background: Pes cavus is a progressive and ugly deformity of the foot. Although initially the deformity is painless, with time, painful callosities develop under metatarsal heads and arthritis supervenes later in feet. Mild deformities can be treated with corrective shoes, or foot exercises. However, in others, operative treatment is imperative. Soft tissue operations are largely unsatisfactory and temporary. Bony operations give permanent correction. We present our series of 18 patients of pes cavus in the adolescent age group, treated by Japas' V-osteotomy of the tarsus. Materials and Methods: 18 patients of paralytic pes cavus deformity were treated by Japas osteotomy, between March 1995 and 2005, at our institute. The age of the patients ranged from 8.6 to 15 years (mean 11.3); 10 were boys and 8 girls. All cases had unilateral involvement, and all, but one, were post-polio cases. Result: The mean follow-up is 5.4 years. Of the 18 patients, 14 had excellent or good corrections; 4 had poor correction/complications. However, those patients could be salvaged by triple arthordesis or Dwyer's calcaneal osteotomy. Conclusion: Japas' osteotomy is a satisfactory option for correction of pes cavus deformity in adolescents. In patients who have rigid hind foot equinus or varus, however, the results are compromised. PMID:19838351
Jackson, Jennifer N.; Hass, Chris J.; Fregly, Benjamin J.
Computational walking simulations could facilitate the development of improved treatments for clinical conditions affecting walking ability. Since an effective treatment is likely to change a patient's foot-ground contact pattern and timing, such simulations should ideally utilize deformable foot-ground contact models tailored to the patient's foot anatomy and footwear. However, no study has reported a deformable modeling approach that can reproduce all six ground reaction quantities (expressed as three reaction force components, two center of pressure (CoP) coordinates, and a free reaction moment) for an individual subject during walking. This study proposes such an approach for use in predictive optimizations of walking. To minimize complexity, we modeled each foot as two rigid segments—a hindfoot (HF) segment and a forefoot (FF) segment—connected by a pin joint representing the toes flexion–extension axis. Ground reaction forces (GRFs) and moments acting on each segment were generated by a grid of linear springs with nonlinear damping and Coulomb friction spread across the bottom of each segment. The stiffness and damping of each spring and common friction parameter values for all springs were calibrated for both feet simultaneously via a novel three-stage optimization process that used motion capture and ground reaction data collected from a single walking trial. The sequential three-stage process involved matching (1) the vertical force component, (2) all three force components, and finally (3) all six ground reaction quantities. The calibrated model was tested using four additional walking trials excluded from calibration. With only small changes in input kinematics, the calibrated model reproduced all six ground reaction quantities closely (root mean square (RMS) errors less than 13 N for all three forces, 25 mm for anterior–posterior (AP) CoP, 8 mm for medial–lateral (ML) CoP, and 2 N·m for the free moment) for both feet in all walking
Jackson, Jennifer N; Hass, Chris J; Fregly, Benjamin J
Computational walking simulations could facilitate the development of improved treatments for clinical conditions affecting walking ability. Since an effective treatment is likely to change a patient's foot-ground contact pattern and timing, such simulations should ideally utilize deformable foot-ground contact models tailored to the patient's foot anatomy and footwear. However, no study has reported a deformable modeling approach that can reproduce all six ground reaction quantities (expressed as three reaction force components, two center of pressure (CoP) coordinates, and a free reaction moment) for an individual subject during walking. This study proposes such an approach for use in predictive optimizations of walking. To minimize complexity, we modeled each foot as two rigid segments-a hindfoot (HF) segment and a forefoot (FF) segment-connected by a pin joint representing the toes flexion-extension axis. Ground reaction forces (GRFs) and moments acting on each segment were generated by a grid of linear springs with nonlinear damping and Coulomb friction spread across the bottom of each segment. The stiffness and damping of each spring and common friction parameter values for all springs were calibrated for both feet simultaneously via a novel three-stage optimization process that used motion capture and ground reaction data collected from a single walking trial. The sequential three-stage process involved matching (1) the vertical force component, (2) all three force components, and finally (3) all six ground reaction quantities. The calibrated model was tested using four additional walking trials excluded from calibration. With only small changes in input kinematics, the calibrated model reproduced all six ground reaction quantities closely (root mean square (RMS) errors less than 13 N for all three forces, 25 mm for anterior-posterior (AP) CoP, 8 mm for medial-lateral (ML) CoP, and 2 N·m for the free moment) for both feet in all walking trials. The
Jankowicz-Szymanska, A; Pociecha, M; Mikolajczyk, E; Kolpa, M
Childhood obesity is an increasingly common problem. It is associated with poor posture especially with lower limb deformities. The study aimed at assessing the prevalence of overweight and obesity in preschoolers, the analysis also contained the relationship between the nutritional status and the foot arching. One thousand two hundred ninety-four children at the age from 3 to 6 years took part in the study. The height and weight of the children were measured. From these measurements, the BMI and Cole Index values were calculated. The prevalence of overweight and obesity were estimated. The degree of foot arching was measured using a podoscope and categorised according to Clarke's angle (CA). Differences in CA between right and left foot were analysed across all groups according to age and gender. Secondly CA for both feet was compared between girls and boys from all age groups. Thirdly, CA was compared for the same gender but between different age groups. Finally, nutritional status and CA for the right and left foot were correlated. Basic descriptive statistics, the U Mann-Whitney test, a one-way ANOVA and the linear correlation study were used to verify the presence of trend. Twenty percent of boys and 15.7% of girls were found overweight, and 9.8% of both male and female subjects were found obese. The prevalence of overweight increased with age. The longitudinal arch of the foot was higher in girls. It increased with age. The height of the longitudinal arch of the foot was smaller in overweight and obese children. A substantial number of overweight and obese preschoolers took part in the study, in which a significant dependence between excessive body weight and flat feet was found. The preschool education programmes should include pro-health exercises combining aerobic training with exercises developing good body posture habits.
Li, Chen; Hsieh, S Tonia; Goldman, Daniel I
A diversity of animals that run on solid, level, flat, non-slip surfaces appear to bounce on their legs; elastic elements in the limbs can store and return energy during each step. The mechanics and energetics of running in natural terrain, particularly on surfaces that can yield and flow under stress, is less understood. The zebra-tailed lizard (Callisaurus draconoides), a small desert generalist with a large, elongate, tendinous hind foot, runs rapidly across a variety of natural substrates. We use high-speed video to obtain detailed three-dimensional running kinematics on solid and granular surfaces to reveal how leg, foot and substrate mechanics contribute to its high locomotor performance. Running at ~10 body lengths s(-1) (~1 m s(-1)), the center of mass oscillates like a spring-mass system on both substrates, with only 15% reduction in stride length on the granular surface. On the solid surface, a strut-spring model of the hind limb reveals that the hind foot saves ~40% of the mechanical work needed per step, significant for the lizard's small size. On the granular surface, a penetration force model and hypothesized subsurface foot rotation indicates that the hind foot paddles through fluidized granular medium, and that the energy lost per step during irreversible deformation of the substrate does not differ from the reduction in the mechanical energy of the center of mass. The upper hind leg muscles must perform three times as much mechanical work on the granular surface as on the solid surface to compensate for the greater energy lost within the foot and to the substrate.
The researcher is sitting above the exit cone of the 5-foot Vertical Wind Tunnel and is examining the new 6-component spinning balance. This balance was developed between 1930 and 1933. It was an important advance in the technology of rotating or rolling balances. As M.J. Bamber and C.H. Zimmerman wrote in NACA TR 456: 'Data upon the aerodynamic characteristics of a spinning airplane may be obtained in several ways; namely, flight tests with full-scale airplanes, flight tests with balanced models, strip-method analysis of wind-tunnel force and moment tests, and wind-tunnel tests of rotating models.' Further, they note: 'Rolling-balance data have been of limited value because it has not been possible to measure all six force and moment components or to reproduce a true spinning condition. The spinning balance used in this investigation is a 6-component rotating balance from which it is possible to obtain wind-tunnel data for any of a wide range of possible spinning conditions.' Bamber and Zimmerman described the balance as follows: 'The spinning balance consists of a balance head that supports the model and contains the force-measuring units, a horizontal turntable supported by streamline struts in the center of the jet and, outside the tunnel, a direct-current driving motor, a liquid tachometer, an air compressor, a mercury manometer, a pair of indicating lamps, and the necessary controls. The balance head is mounted on the turntable and it may be set to give any radius of spin between 0 and 8 inches.' In an earlier report, NACA TR 387, Carl Wenzinger and Thomas Harris supply this description of the tunnel: 'The vertical open-throat wind tunnel of the National Advisory Committee for Aeronautics ... was built mainly for studying the spinning characteristics of airplane models, but may be used as well for the usual types of wind-tunnel tests. A special spinning balance is being developed to measure the desired forces and moments with the model simulating the actual
Kim, Taeho; Lee, Dong Yeon; Park, Jinah
Clinical management of foot pathology requires accurate and robust measurement of the anatomical angles. In order to measure a 3D angle, recent approaches have adopted a landmark-based local coordinate system to establish bone angles used in orthopedics. These measurement methods mainly assess the relative angle between bones using a representative axis derived from the morphological feature of the bone and therefore, the results can be affected by bone deformities. In this study, we propose a method of deriving a global frame-of-reference to acquire consistent direction of the foot by extracting the undersurface of the foot from the CT image data. The two lowest positions of the foot skin are identified from the surface to define the base plane, and the direction from the hallux to the fourth toe is defined together to construct the global coordinate system. We performed the experiment on 10 volumes of foot CT images of healthy subjects to verify that the proposed method provides reliable measurements. We measured 3D angles for talus-calcaneus and talus-navicular using facing articular surfaces of paired bones. The angle was reported in 3 projection angles based on both coordinate systems defined by proposed global frame-of-reference and by CT image planes (saggital, frontal, and transverse). The result shows that the quantified angle using the proposed method considerably reduced the standard deviation (SD) against the angle using the conventional projection planes, and it was also comparable with the measured angles obtained from local coordinate systems of the bones. Since our method is independent from any individual local shape of a bone, unlike the measurement method using the local coordinate system, it is suitable for inter-subject comparison studies.
Nishimura, M.; Ono, K.; Onodera, S.
The purpose of this study was to make clear the effects of water temperature during foot immersion (foot bath) on heart rate, blood pressure, rectal temperature and autonomic nervous system modulation. The subjects performed foot immersion at 25, 35, 41 and 45 degrees Celsius at random, during different days, but always at the same time. Cardiac autonomic nervous system modulation was estimated with the power spectrum analysis of heart rate variability by using the Fast Fourier Transformation. The two frequency components of HRV was measured by integrate low frequency (LF; 0.04- 0.15 Hz) and high frequency (HF; 0.15- 0.40 Hz). HF was used as an indicator of cardiac vagal modulation and was showed logarithmically (LogHF). LogHF during foot immersion at 35 and 41 degrees Celsius was significantly increased. These data indicate that cardiac vagal activity was affected by water temperature during foot immersion (foot bath).
Ranawat, Anil S.; Gaudiani, Michael A.; Slullitel, Pablo A.; Satalich, James; Rebolledo, Brian J.
Background: Determining an accurate clinical diagnosis for nonarthritic hip pain may be challenging, as symptoms related to femoroacetabular impingement (FAI) or hip instability can be difficult to elucidate with current testing methods. In addition, commonly utilized physical examination maneuvers are static and do not include a dynamic or weightbearing assessment to reproduce activity-related symptoms. Therefore, implementing a dynamic assessment for FAI and hip instability could help to improve diagnostic accuracy for routine clinical examinations of patients with nonarthritic hip pain. Purpose: To assess the efficacy of a novel diagnostic foot progression angle walking (FPAW) test for identifying hip pathology related to FAI or hip instability. Study Design: Prospective cohort study; Level of evidence, 3. Methods: This prospective study included 199 consecutive patients who were evaluated for unilateral hip pain and who underwent FPAW testing along with standard physical examination testing. Demographic data, including age, sex and hip laterality, were collected from each patient. FPAW testing was performed with directed internal and external foot progression angles from their baseline measurements, with a positive test reproducing pain and/or discomfort. Comparisons were then made with flexion adduction internal rotation (FADIR) and flexion abduction external rotation (FABER) tests as the designated diagnostic standard examinations for FAI and hip instability, respectively. Sensitivity and specificity, along with the McNemar chi-square test for group comparison, were used to generate summary statistics. In addition, areas under the combined receiver operating characteristic curves (AUC) of test performance were calculated for both FPAW and the designated standard examination tests (FADIR, FABER). Radiographic imaging was used subsequently to confirm the diagnosis. Results: The average age of the study cohort was 35.4 ± 11.8 years, with 114 patients being
Kang, Steve; Thordarson, David B; Charlton, Timothy P
Haglund's deformity is an enlargement of the posterosuperior prominence of the calcaneus, which is frequently associated with insertional Achilles tendinitis. To our knowledge, no study has been done successfully correlating the characteristics of a Haglund's deformity with insertional Achilles tendinitis. The purpose of our study was to analyze the characteristics of a Haglund's deformity in patients with and without insertional Achilles tendinitis to see if there was a correlation. The study was a retrospective radiographic review of a single surgeon's patients with insertional Achilles tendinitis from 2005 to 2008. Our study population consisted of 44 patients, 48 heels (22 male, 22 female) with insertional Achilles tendinitis, with a mean age of 52 (range, 23 to 79) years. Our control population consisted of 50 patients (25 males, 25 females) and 50 heels without insertional Achilles tendinitis with a mean age of 55.6 (range, 18 to 89) years. We introduced two new measurements of the Haglund's deformity in this study: the Haglund's deformity height and peak angle. A standing lateral foot or ankle radiograph was analyzed for each patient and the following measurements were made: Haglund deformity height and peak angle; Bohler's angle; Fowler-Philip angle; and parallel pitch sign. We also looked for the presence of calcification in the study group and the length and width of the calcification. Unpaired t-test was used to analyze the measurements between the groups. Ten patients' radiographs were re-measured and correlation coefficients were obtained to assess the reliability of the measuring techniques. For the insertional Achilles tendinitis group, the mean Haglund's deformity height was 9.6 (range, 5.3 to 15.3) mm and the mean Haglund's deformity peak angle was 105 (range, 87 to 123) degrees. Calcification was present in 35 of 48 or (73%) of patients with a mean length of 13.3 (range, 3.2 to 41.9) mm and mean width of 4.5 (range, 1.0 to 10.4) mm. In the control
Jiang, Yufeng; Ran, Xingwu; Jia, Lijing; Yang, Chuan; Wang, Penghua; Ma, Jianhua; Chen, Bing; Yu, Yanmei; Feng, Bo; Chen, Lili; Yin, Han; Cheng, Zhifeng; Yan, Zhaoli; Yang, Yuzhi; Liu, Fang; Xu, Zhangrong
To determine incidence and clinically relevant risk factors for diabetic amputation in a large cohort study of diabetic foot ulceration patients in China, we investigated a total of 669 diabetic foot ulceration patients, who were assessed at baseline for demographic information, medical and social history, peripheral neuropathy screening, periphery artery disease screening, assessment of nutritional status and diabetic control, physical examination including foot deformity in 15 Grade III-A hospitals. Of the 669 patients, 435 were male and 201 were female, with the mean age being 64.0 years. Of all patients, 110 had neuropathic ulcers, 122 had ischemic ulcers, 276 had neuroischemic ulcers, and 12 cases were unclassified. Wagner classification showed 61 cases were grade I, 216 cases grade II, 159 cases grade III, 137 cases grade IV, and 7 cases grade V. The overall amputation rate among diabetic foot patients was 19.03%, and major and minor amputation rates were 2.14% and 16.88%, respectively. By univariate analysis, statistically significant differences were found in smoking, rest pain, ulcer history, revascularization history, amputation history, gangrene, infection, Wagner grades, duration of diabetes, and postprandial blood glucose, aldehyde, total protein, globulin, albumin, white blood cell (WBC), hemoglobin, HbA1c, ulcer property, body mass index, as well as creatinine. Binary logistic regression model showed that increased WBC (odds ratio 1.25) and ulcer history (odds ratio 6.8) were associated with increased risks from diabetic foot ulcer to major amputation; increased duration of diabetes (odds ratio 1.004), WBC (odds ratio 1.102), infection (odds ratio 2.323), foot deformity (odds ratio 1.973), revascularization history (odds ratio 2.662), and decreased postprandial blood sugar (odds ratio 0.94) were associated with increased risks from diabetic foot ulcer to minor amputation. It is of great importance to give better management to diabetic patients at
Janisse, Dennis J; Janisse, Erick J
Amputations in patients with diabetes, while often preventable, are unfortunately a far too common outcome. The roles of the certified or licensed pedorthist, certified orthotist, and the certified prosthetist should not be undervalued in the prevention of diabetic foot complications (eg, amputations, revisions, and foot infections secondary to skin ulcerations) and in returning the patient a normal, active, and productive lifestyle in the event of an amputation. This article highlights the roles these specialists play in treating patients with partial foot amputation.
Riskowski, JL; Dufour, AB; Hagedorn, TJ; Hillstrom, Howard; Casey, VA; Hannan, MT
Objective Studies have implicated foot posture and foot function as risk factors for lower extremity pain. Empirical population-based evidence for this assertion is lacking; therefore, the purpose of this study was to evaluate cross-sectional associations of foot posture and foot function to lower extremity joint pain in a population-based study of adults. Methods Participants were members of the Framingham Foot Study. lower extremity joint pain was determined by the response to the NHANES-type question, “On most days do you have pain, aching or stiffness in your [hips, knees, ankles, or feet]?” Modified Arch Index (MAI) classified participants as having planus, rectus (referent) or cavus foot posture. Center of Pressure Excursion Index (CPEI) classified participants as having over-pronated, normal (referent) or over-supinated foot function. Crude and adjusted (age, gender, BMI) logistic regression determined associations of foot posture and function to lower extremity pain. Results Participants with planus structure had higher odds of knee (1.57, 95% CI: 1.24– 1.99) or ankle (1.47, 95% CI: 1.05–2.06) pain, whereas those with a cavus foot structure had increased odds of ankle pain only (7.56, 95% CI: 1.99–28.8) and pain at one lower extremity site (1.37, 95% CI: 1.04–1.80). Associations between foot function and lower extremity joint pain were not statistically significant, except for a reduced risk of hip pain in those with an over-supinated foot function (0.69, 95% CI: 0.51–0.93). Conclusions These findings offer a link between foot posture and lower extremity pain, highlighting the need for longitudinal or intervention studies. PMID:24591410
... of the Smaller Toes How To... Foot Health Foot Injury Footwear News Videos Find a Surgeon Información en ... all ages. They perform reconstructive procedures, treat sports injuries, and manage and treat trauma of the foot and ankle. Orthopaedic foot and ankle surgeons work ...
Yudovich, A. ); Chin, L.Y. ); Morgan, D.R. )
Casing deformation resulting from reservoir compaction occurred in the Ekofisk field operated by Phillips Petroleum Co. Norway and is a serious problem in three of the fields. This study established a relationship between reservoir compaction and casing failure by statistical analyses, finite-element modeling (FEM), and the analyses of deformed casing and logs run through collapsed casings. Ekofisk casing deformation is related primarily to the near well incremental strain, well inclination, and casing diameter. Useful correlations to estimate future probabilities of casing deformation as a function of reservoir variables and well parameters were also obtained. The authors concluded that casing failure induced by reservoir compaction can be minimized through a pressure-maintenance program to reduce strain by drilling with the highest practical angle and by using the largest possible casing in the well.
The Third Rock Deformation Colloquium was held December 4, 1989, at the AGU Fall Meeting in San Francisco. Steve Kirby of the U.S. Geological Survey, Menlo Park, Calif., reported on actions taken by the rock deformation steering committee. Brian Wernicke of Harvard University, Cambridge, Mass., talked on the structural geology of the Great Basin.The steering committee voted for “Committee on Deformation of Earth Materials” as the name for the AGU technical committee on rock deformation, Kirby said. Considerable discussion has occurred in the steering committee over our relationship to the AGU Mineral Physics Committee. Indeed, Kirby will become chairman of that committee in 1990, underlining the overlap of the two groups. It was agreed that we will pursue closer association with Mineral Physics.
Wrist deformities can occur after fracture because of malunion of the fracture or injury to the growth plate leading to imbalance of growth. Prevention of malunion is paramount by early recognition with proper reduction and casting or fixation with casting. If a mal-union occurs, an osteotomy may be necessary if anticipated growth will not correct the deformity. Injury of the growth plate may lead to wrist deformity in two ways: angular growth or growth arrest. Angular growth deformities are corrected most commonly by osteotomy. Growth arrest of the radius or the ulna leads to an ulnar-positive or an ulnar-negative variance at the wrist. If the ulnar variance is symptomatic, treatment is centered on achieving a level joint. Options for joint leveling procedures include epiphysiodesis or physeal stapling of the longer bone, lengthening osteotomy of the shorter bone, or shortening osteotomy of the longer bone.
... the United States. However, in some countries in Asia, outbreaks are large and occur often. Thousands of ... learn more about outbreaks occurring in countries in Asia, visit the World Health Organization . Podcast: Hand, Foot, ...
... surgeons warn against taking part in growing surgery trend. Getting excited over a snazzy pair of Jimmy ... a stand and calling this an ill-advised trend. Cosmetic foot surgery runs the gamut, from injectable ...
Viswanathan, Vijay; Rao, V Narayan
The burden of diabetic foot complications, in terms of both physical and socioeconomical constraints, poses a heavy challenge both to the patient and the physician, especially in developing countries, where the number of people living with diabetes is increasing at an alarming rate compared with the developed world. In developing countries like India, there are specific causes and risk factors that increase the burden of diabetic foot infections (DFIs), for example, sociocultural risk factors such as barefoot walking, using improper footwear, poor knowledge of foot care practices, lack of adequate and timely access to podiatry services, and poor health care resources. Management of DFI in light of these limitations is quite a challenge to health care professionals. Several techniques and strategies are required to address this problem and should be combined with a multidisciplinary team effort to reduce the burgeoning epidemic of diabetic foot disease. This review is intended to address some of the major aspects of management of DFI in India.
... osteoarthritis develops as a result of abnormal foot mechanics, such as flat feet or high arches. A ... prescribed to provide support to improve the foot’s mechanics or cushioning to help minimize pain. Bracing. Bracing, ...
Hobizal, Kimberlee B.; Wukich, Dane K.
The purpose of this manuscript is to provide a current concept review on the diagnosis and management of diabetic foot infections which are among the most serious and frequent complications encountered in patients with diabetes mellitus. A literature review on diabetic foot infections with emphasis on pathophysiology, identifiable risk factors, evaluation including physical examination, laboratory values, treatment strategies and assessing the severity of infection has been performed in detail. Diabetic foot infections are associated with high morbidity and risk factors for failure of treatment and classification systems are also described. Most diabetic foot infections begin with a wound and once an infection occurs, the risk of hospitalization and amputation increases dramatically. Early identification of infection and prompt treatment may optimize the patient's outcome and provide limb salvage. PMID:22577496
... The most likely culprit is inactivity during a flight. Sitting with your feet on the floor for ... soft tissues. To relieve foot swelling during a flight: Wear loosefitting clothing Take a short walk every ...
Kadel, Nancy J
Although dancers develop overuse injuries common in other athletes, they are also susceptible to unique injuries. This article reviews common foot and ankle problems seen in dancers and provides some basic diagnosis and treatment strategies.
Richard, Jean-Louis; Sotto, Albert; Lavigne, Jean-Philippe
Foot ulcers are common in diabetic patients, have a cumulative lifetime incidence rate as high as 25% and frequently become infected. The spread of infection to soft tissue and bone is a major causal factor for lower-limb amputation. For this reason, early diagnosis and appropriate treatment are essential, including treatment which is both local (of the foot) and systemic (metabolic), and this requires coordination by a multidisciplinary team. Optimal treatment also often involves extensive surgical debridement and management of the wound base, effective antibiotic therapy, consideration for revascularization and correction of metabolic abnormalities such as hyperglycemia. This article focuses on diagnosis and management of diabetic foot infections in the light of recently published data in order to help clinicians in identification, assessment and antibiotic therapy of diabetic foot infections. PMID:21537457
Diabetic foot complications result from two broad pathologies-neuropathic and neuro-ischaemic feet. It is important for diabetic patients to have at least a yearly review of foot ulcer risk factors, and they should have a corresponding risk classification agreed based on this assessment. Diabetic foot ulcer assessment should include a wound classification tool, which can give an indication of wounds at greater risk of non-healing or amputation. The treatment of diabetic foot ulcers should be part of a comprehensive care plan that should also include treatment of infection, frequent debridement (if deemed appropriate by a skilled specialist clinician), biomechanical offloading, blood glucose control and treatment of comorbidities. Clinicians should base dressing selection on the wound's location, size and depth, amount of exudate, presence of infection or necrosis and the condition of the surrounding tissue.
Liu, Xue-Cheng; Embrey, David; Tassone, Channing; Zvara, Kim; Brandsma, Brenna; Lyon, Roger; Goodfriend, Karin; Tarima, Sergey; Thometz, John
Orthoses are commonly prescribed to children with cerebral palsy (CP) in order to provide foot correction and to improve ambulatory function. Immediate effects of ankle foot orthosis (AFOs) have been investigated, but long term kinematic effects are lacking clinical evidence. To determine changes in pediatric patients with Cerebral Palsy's 3D ankle and foot segment motion between initial, and follow up visits (18 month average time differences) in both barefoot gait and gait with their ankle foot orthotic (AFO). We will also investigate intra visit changes between barefoot and AFO gait. A prospective cohort study. Children's Hospital of Wisconsin, Department of Orthopaedic Surgery. Medical College of Wisconsin. A total of 23 children with CP, mean age 10.5 years (6.2 to 18.1) were clinically prescribed either a solid ankle foot orthotic (SAFO), hinged ankle foot orthotic (HAFO), or supramalleolar orthotic (SMO). Holes were cut in the study orthoses so that electromagnetic markers could be directly placed on the skin. A 6 foot segment model (6SF) was used. Kinematic and kinetic data was recorded for each patient's initial and follow up visit (18 month follow up average, 15 to 20 months range) RESULTS: For the SAFO group (gait with AFO), a significant decrease in dorsiflexion was found between the initial and third visit (p=.008). Furthermore, the SAFO group (barefoot gait), had an increased eversion at the midfoot for most of the gait cycle (p < .008). Sagittal forefoot ROM is reduced for all three groups between the barefoot and AFO groups. Use of AFOs long term either maintained or improved foot deformities or dysfunction. Copyright © 2017 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.
This text focuses on the recent achievements in the analysis of rock deformation. It gives an analytical presentation of the essential structures in terms of kinetic and dynamic interpretation. The physical properties underlying the interpretation of rock structures are exposed in simple terms. Emphasized in the book are: the role of fluids in rock fracturing; the kinematic analysis of magnetic flow structures; the application of crystalline plasticity to the kinematic and dynamic analysis of the large deformation imprinted in many metamorphic rocks.
Oosterwaal, Michiel; Carbes, Sylvain; Telfer, Scott; Woodburn, James; Tørholm, Søren; Al-Munajjed, Amir A; van Rhijn, Lodewijk; Meijer, Kenneth
Accurately measuring of intrinsic foot kinematics using skin mounted markers is difficult, limited in part by the physical dimensions of the foot. Existing kinematic foot models solve this problem by combining multiple bones into idealized rigid segments. This study presents a novel foot model that allows the motion of the 26 bones to be individually estimated via a combination of partial joint constraints and coupling the motion of separate joints using kinematic rhythms. Segmented CT data from one healthy subject was used to create a template Glasgow-Maastricht foot model (GM-model). Following this, the template was scaled to produce subject-specific models for five additional healthy participants using a surface scan of the foot and ankle. Forty-three skin mounted markers, mainly positioned around the foot and ankle, were used to capture the stance phase of the right foot of the six healthy participants during walking. The GM-model was then applied to calculate the intrinsic foot kinematics. Distinct motion patterns where found for all joints. The variability in outcome depended on the location of the joint, with reasonable results for sagittal plane motions and poor results for transverse plane motions. The results of the GM-model were comparable with existing literature, including bone pin studies, with respect to the range of motion, motion pattern and timing of the motion in the studied joints. This novel model is the most complete kinematic model to date. Further evaluation of the model is warranted.
Arch, Elisa S; Fylstra, Bretta L
The large, late-stance energy generated by the ankle is believed to be critical during gait. However, the distal foot absorbs/dissipates a considerable amount of energy during the same phase. Thus, the energy generated by the combined ankle-foot system is more modest, which raises questions regarding the necessity of such a large ankle power and the interplay between foot and ankle energetics. This study aimed to evaluate our conservation of energy hypothesis, which predicted if distal foot energy absorption/dissipation was reduced, then less energy would be generated at the ankle and thus the same combined ankle-foot energetics would be achieved. Motion analysis data were collected as healthy subjects walked under 2 conditions (Shoes, Footplate). In the Footplate condition, the shoe was replaced with a customized, rigid footplate with a rocker profile. In support of the hypothesis, there was significantly less positive ankle and less negative distal foot work with footplate use, resulting in very similar combined ankle-foot work between conditions. These findings suggest that there is an interplay between the energy generated by the ankle and absorbed by the foot. This interplay should be considered when designing orthotic and prosthetic ankle-foot systems and rehabilitation programs for individuals with weakened ankle muscles.
Ridola, C; Palma, A
The foot is constituted from a series of small bones making a segmented structure with multiple joints, likened to a dome, in contact with the ground in three points: posteriorly the calcanear tuberosity; anteriorly and medially the head of 1st metatarsum, and anteriorly and laterally the head of 5th metatarsum. In fact, each foot presents a semi-arch whose base is represented by the lateral border and the summit by the medial border of the foot. The foot has been likened to a half-dome, so that when the medial borders of the two feet are placed together, a complete dome is formed. In the foot are present two longitudinal arches: the medial consists of the calcaneus, the talus, the navicular, the three cuneiform bones and the first three metatarsal bones. It is more arcuated and elastic then the lateral, that consist of the calcaneus, the cuboid and the 4th and 5th metatarsus. This is flattened and in contact with the ground. We can identify two transverse arches between longitudinal arches, extending from the medial to the lateral borders of the foot: the first is a lancet dome, between midfoot and forefoot, at the tarsometatarsal joint level; it consists of the bases of the metatarsal bones and the cuboid and the three cuneiform bones; the second is at flat dome, in correspondence of forefoot, at the metatarsophalangeal joint level; it consists of the bases of the proximal phalanges of the fingers and the head of five metatarsal bones. Longitudinal and transversal arches are supported from: the shape of stones of the structure (foot bones); the long and short plantar ligaments, larger and stronger than the dorsal ligaments, tie together the lower edges of the bones; a beam (the plantar aponeurosis and the plantar muscles and tendons) connecting the ends of the bridge effectively prevents separation of the pillars and consequent sagging of the arch; the maintenance of the arch depends on multiple support (ligaments, tendons of extrinsic muscles of the foot
López-Gavito, E; Parra-Téllez, P; Vázquez-Escamilla, J
Diabetes mellitus is a major chronic degenerative disease, which currently is taking on alarming proportions in the population of our country. Neuropathic arthropathy is one of the most interesting degenerative joint disorders and increasingly common within the orthopedic pathology. It is defined as a progressive degenerative arthropathy, chronic and affecting one or more peripheral joints, and develops as a result of the lack of sensory perception normal in the innervation of joints. As a result the joints of the feet are subjected to trauma and repetitive injury causing a neurotraumatic effect with progressive damage to the joints of the hindfoot, midfoot and forefoot. Diagnosis includes a proper medical history, careful examination of the affected limb, conventional X-ray, scintigraphy, computed tomography and magnetic resonance imaging in some cases. Conservative treatment includes: drugs, rest of the affected limb, and the use of appliances like total-contact cast, orthotics or special shoes. Surgical treatment depends on the stage of the disease, and may require one or more surgical procedures, in order to achieve a full foot plantar support to prevent ulcers. One of the surgeries performed most often is the fusion of damaged joints. Surgery must be performed only in the coalescence phase of the disease, using internal, or external fixation or both.
Grubman, Marvin J.; Baxt, Barry
Foot-and-mouth disease (FMD) is a highly contagious disease of cloven-hoofed animals. The disease was initially described in the 16th century and was the first animal pathogen identified as a virus. Recent FMD outbreaks in developed countries and their significant economic impact have increased the concern of governments worldwide. This review describes the reemergence of FMD in developed countries that had been disease free for many years and the effect that this has had on disease control strategies. The etiologic agent, FMD virus (FMDV), a member of the Picornaviridae family, is examined in detail at the genetic, structural, and biochemical levels and in terms of its antigenic diversity. The virus replication cycle, including virus-receptor interactions as well as unique aspects of virus translation and shutoff of host macromolecular synthesis, is discussed. This information has been the basis for the development of improved protocols to rapidly identify disease outbreaks, to differentiate vaccinated from infected animals, and to begin to identify and test novel vaccine candidates. Furthermore, this knowledge, coupled with the ability to manipulate FMDV genomes at the molecular level, has provided the framework for examination of disease pathogenesis and the development of a more complete understanding of the virus and host factors involved. PMID:15084510
Zhai, Jun Na; Wang, Jue; Qiu, Yu Sheng
[Purpose] This study observed the plantar pressure between flexible flatfoot and normal foot on different walking conditions to find out if flexible flatfoot needs the treatment and how the plantar pressure change while walking upstairs and downstairs. [Subjects and Methods] Fifteen adults with mild flexible flatfoot, fifteen adults with severe flexible flatfoot and fifteen adults with normal foot were examined while walking on a level surface, walking up and down 10 cm and 20 cm stairs. The max force and the arch index were acquired using the RSscan system. The repeated measures ANOVA was performed to analyze the data. [Results] Compared with normal foot, both max force and arch index of severe flatfoot were significantly increased on different walking conditions. When walking down 10 cm and 20 cm stairs, the plantar data of both normal foot and flatfoot were significantly increased. [Conclusion] The plantar pressure of severe flexible flatfoot were significantly larger than that of normal foot on different walking conditions. In addition, the arches of both normal foot and flatfoot were obviously deformed when walking downstairs. It is therefore necessary to be treated for severe flexible flatfoot to prevent further deformation. PMID:28533601
Zhai, Jun Na; Wang, Jue; Qiu, Yu Sheng
[Purpose] This study observed the plantar pressure between flexible flatfoot and normal foot on different walking conditions to find out if flexible flatfoot needs the treatment and how the plantar pressure change while walking upstairs and downstairs. [Subjects and Methods] Fifteen adults with mild flexible flatfoot, fifteen adults with severe flexible flatfoot and fifteen adults with normal foot were examined while walking on a level surface, walking up and down 10 cm and 20 cm stairs. The max force and the arch index were acquired using the RSscan system. The repeated measures ANOVA was performed to analyze the data. [Results] Compared with normal foot, both max force and arch index of severe flatfoot were significantly increased on different walking conditions. When walking down 10 cm and 20 cm stairs, the plantar data of both normal foot and flatfoot were significantly increased. [Conclusion] The plantar pressure of severe flexible flatfoot were significantly larger than that of normal foot on different walking conditions. In addition, the arches of both normal foot and flatfoot were obviously deformed when walking downstairs. It is therefore necessary to be treated for severe flexible flatfoot to prevent further deformation.
Low, Keynes TA; Peh, Wilfred CG
This pictorial review aims to illustrate the various manifestations of the diabetic foot on magnetic resonance (MR) imaging. The utility of MR imaging and its imaging features in the diagnosis of pedal osteomyelitis are illustrated. There is often difficulty encountered in distinguishing osteomyelitis from neuroarthropathy, both clinically and on imaging. By providing an accurate diagnosis based on imaging, the radiologist plays a significant role in the management of patients with complications of diabetic foot. PMID:25640096
Anakwenze, Oke A; Milby, Andrew H; Gans, Itai; Stern, John J; Levin, L Scott; Wapner, Keith L
Infections of the foot are a common source of morbidity, disability, and potential limb loss. A large proportion of lower extremity infections occurs in the setting of diabetic neuropathy, with or without circulatory compromise, and are potentially preventable with regular surveillance. Adequate diagnosis and treatment of foot infections can be challenging. Successful treatment is dependent on factors such as etiology; vascular, neurologic, and immune status; and the identity of the offending organism.
Maynard, M J; Weiner, L S; Burke, S W
To determine if a significant relationship existed between type of operation and eventual development of pedal skin breakdown in a spina bifida patient population, 72 feet in 36 ambulatory patients with low lumbar or sacral myelomeningocele were followed for an average of 14 years 5 months. Using a clinical classification for foot suppleness and position, we determined that foot rigidity, nonplantigrade position, and performance of surgical arthrodesis were clinical indicators that had a strong statistical relationship with eventual development of neuropathic skin changes.
Antonellini, Marco; Mollema, Pauline Nella
We report for the first time the occurrence of polygonal faults in sandstone, which is compelling given that layer-bound polygonal fault systems have been observed so far only in fine-grained sediments such as clay and chalk. The polygonal faults are shear deformation bands that developed under shallow burial conditions via strain hardening in dm-wide zones. The edges of the polygons are 1-5 m long. The shear deformation bands are organized as conjugate faults along each edge of the polygon and form characteristic horst-like structures. The individual deformation bands have slip magnitudes ranging from a few mm to 1.5 cm; the cumulative average slip magnitude in a zone is up to 10 cm. The deformation bands heaves, in aggregate form, accommodate a small isotropic horizontal extension (strain <0.005). The individual shear deformation bands show abutting T-junctions, veering, curving, and merging where they mechanically interact. Crosscutting relationships are rare. The interactions of the deformation bands are similar to those of mode I opening fractures. The documented fault networks have important implications for evaluating the geometry of km-scale polygonal fault systems in the subsurface, top seal integrity, as well as constraining paleo-tectonic stress regimes.
Córdova, Clay; Dumitrescu, Thomas T.; Intriligator, Kenneth
Here, we classify possible supersymmetry-preserving relevant, marginal, and irrelevant deformations of unitary superconformal theories in d ≥ 3 dimensions. Our method only relies on symmetries and unitarity. Hence, the results are model independent and do not require a Lagrangian description. Two unifying themes emerge: first, many theories admit deformations that reside in multiplets together with conserved currents. Such deformations can lead to modifications of the supersymmetry algebra by central and noncentral charges. Second, many theories with a sufficient amount of supersymmetry do not admit relevant or marginal deformations, and some admit neither. The classification is complicated by the fact thatmore » short superconformal multiplets display a rich variety of sporadic phenomena, including supersymmetric deformations that reside in the middle of a multiplet. We illustrate our results with examples in diverse dimensions. In particular, we explain how the classification of irrelevant supersymmetric deformations can be used to derive known and new constraints on moduli-space effective actions.« less
Bergin, Shan M; Brand, Caroline A; Colman, Peter G; Campbell, Donald A
Community based prevalence for diabetes related foot disease (DRFD) has been poorly quantified in Australian populations. The aim of this study was to develop and validate a survey tool to facilitate collection of community based prevalence data for individuals with DRFD via telephone interview. Agreed components of DRFD were identified through an electronic literature search. Expert feedback and feedback from a population based construction sample were sought on the initial draft. Survey reliability was tested using a cohort recruited through a general practice, a hospital outpatient clinic and an outpatient podiatry clinic. Level of agreement between survey findings and either medical record or clinical assessment was evaluated. The Questionnaire for Diabetes Related Foot Disease (Q-DFD) comprised 12 questions aimed at determining presence of peripheral sensory neuropathy (PN) and peripheral vascular disease (PVD), based on self report of symptoms and/or clinical history, and self report of foot ulceration, amputation and foot deformity. Survey results for 38 from 46 participants demonstrated agreement with either clinical assessment or medical record (kappa 0.65, sensitivity 89.0%, and specificity 77.8%). Correlation for individual survey components was moderate to excellent. Inter and intrarater reliability and test re-test reliability was moderate to high for all survey domains. The development of the Q-DFD provides an opportunity for ongoing collection of prevalence estimates for DRFD across Australia.
Background Community based prevalence for diabetes related foot disease (DRFD) has been poorly quantified in Australian populations. The aim of this study was to develop and validate a survey tool to facilitate collection of community based prevalence data for individuals with DRFD via telephone interview. Methods Agreed components of DRFD were identified through an electronic literature search. Expert feedback and feedback from a population based construction sample were sought on the initial draft. Survey reliability was tested using a cohort recruited through a general practice, a hospital outpatient clinic and an outpatient podiatry clinic. Level of agreement between survey findings and either medical record or clinical assessment was evaluated. Results The Questionnaire for Diabetes Related Foot Disease (Q-DFD) comprised 12 questions aimed at determining presence of peripheral sensory neuropathy (PN) and peripheral vascular disease (PVD), based on self report of symptoms and/or clinical history, and self report of foot ulceration, amputation and foot deformity. Survey results for 38 from 46 participants demonstrated agreement with either clinical assessment or medical record (kappa 0.65, sensitivity 89.0%, and specificity 77.8%). Correlation for individual survey components was moderate to excellent. Inter and intrarater reliability and test re-test reliability was moderate to high for all survey domains. Conclusion The development of the Q-DFD provides an opportunity for ongoing collection of prevalence estimates for DRFD across Australia. PMID:19939276
Wilson, Barbara; Lawrence, JulieAnn
Individuals with chronic kidney disease are at higher risk for foot problems (i.e., ulcers, deformities, amputations) than the general population. Research demonstrates that assessment and active monitoring, teaching, and timely interventions can reduce the number and severity of lower limb amputations in the hemodialysis population. This paper reports on a quality improvement project aimed at implementation of a foot assessment program in a regional satellite hemodialysis setting based on the Registered Nurses' Association of Ontario's (2005) best practice guideline (BPG), The Assessment and Management of Foot Ulcers for People with Diabetes. Elements of the program include a one-time full assessment of risk for all patients transferring to the satellite program followed by monthly foot checks for those deemed high risk (i.e., people with diabetes). Evaluation of the program has been positive from both patients and hemodialysis nursing staff. There has been a greater emphasis on self-management around the care and management of patients and their high-risk feet. At the same time, the program has resulted in prompt identification of problems and timelier referral to the appropriate services in the patient's local community.
Neuropathic changes in the foot are common with a prevalence of approximately 1%. The diagnosis of neuropathic arthropathy is often delayed in diabetic patients with harmful consequences including amputation. The appropriate diagnosis and treatment can avoid an extensive programme of treatment with significant morbidity for the patient, high costs and delayed surgery. The pathogenesis of a Charcot foot involves repetitive micro-trauma in a foot with impaired sensation and neurovascular changes caused by pathological innervation of the blood vessels. In most cases, changes are due to a combination of both pathophysiological factors. The Charcot foot is triggered by a combination of mechanical, vascular and biological factors which can lead to late diagnosis and incorrect treatment and eventually to destruction of the foot. This review aims to raise awareness of the diagnosis of the Charcot foot (diabetic neuropathic osteoarthropathy and the differential diagnosis, erysipelas, peripheral arterial occlusive disease) and describe the ways in which the diagnosis may be made. The clinical diagnostic pathways based on different classifications are presented. Cite this article: Bone Joint J 2016;98-B:1155-9.
Caravaggi, Carlo; Sganzaroli, Adriana; Galenda, Paolo; Bassetti, Matteo; Ferraresi, Roberto; Gabrielli, Livio
Diabetes is a chronic disease with a worldwide increasing trend. Foot complications, closely related to neuropathy and obstructive peripheral vascular disease, are responsible for more than 1 million of leg amputations every year. Foot infection can dramatically increase the risk of amputation. Although many ulcer classification systems have been proposed to stratify the severity of the infectious process, the definition of a specific therapeutic approach still remains an unsolved problem. A Diabetic Foot Triage and an Integrated Surgical Protocol are proposed to identify a diagnostic flowchart and a step-by-step surgical protocol that can be applied in the treatment of diabetic foot infection. Considering the rapid climbing of multidrug resistant strains it is very important to rationalize the use of antibiotics utilizing them only for the treatment of true infected ulcers. PAD is widely considered the most important factor conditioning the outcome of a diabetic foot ulcer. Currently no randomized control trials are reported in the international literature directly comparing open versus endovascular revascularisation in diabetic patients with CLI. Insufficient data are available to demonstrate whether open bypass surgery or endovascular interventions are more effective in these patients. A decisional flow chart in choosing the best revascularization strategy in diabetic patients with CLI is proposed. Goals and technical aspects of emergency and elective surgical procedures in diabetic foot are analysed to evaluate critical aspects and to suggest proper surgical choices.
20. 80 foot pony truss - an upper chord pin connection at a vertical post other than at the end post. Common to the five 80 foot trusses and similar to the 64 foot truss, there are two pairs per 80 foot truss and one pair on the 64 foot truss for a total of 22. - Weidemeyer Bridge, Spanning Thomes Creek at Rawson Road, Corning, Tehama County, CA
Till, J. L.; Rybacki, E.; Morales, L. F. G.
Magnetite is an important iron ore mineral and the most prominent Fe-oxide phase in the Earth's crust. The systematic occurrence of magnetite in zones of intense deformation in oceanic core complexes suggests that it may play a role in strain localization in some silicate rocks. We performed a series of high-temperature deformation experiments on synthetic magnetite aggregates and natural single crystals to characterize the rheological behavior of magnetite. As starting material, we used fine-grained magnetite powder that was hot isostatically pressed at 1100°C for several hours, resulting in polycrystalline material with a mean grain size of around 40 μm and containing 3-5% porosity. Samples were deformed to 15-20% axial strain under constant load (approximating constant stress) conditions in a Paterson-type gas apparatus for triaxial deformation at temperatures between 900 and 1100°C and 300 MPa confining pressure. The aggregates exhibit typical power-law creep behavior. At high stresses, samples deformed by dislocation creep exhibit stress exponents close to 3, revealing a transition to near-Newtonian creep with stress exponents around 1.3 at lower stresses. Natural magnetite single crystals deformed at 1 atm pressure and temperatures between 950°C and 1150 °C also exhibit stress exponents close to 3, but with lower flow stresses and a lower apparent activation energy than the aggregates. Such behavior may result from the different oxygen fugacity buffers used. Crystallographic-preferred orientations in all polycrystalline samples are very weak and corroborate numerical models of CPO development, suggesting that texture development in magnetite may be inherently slow compared with lower symmetry phases. Comparison of our results with experimental deformation data for various silicate minerals suggests that magnetite should be weaker than most silicates during ductile creep in dry igneous rocks.
Craiovan, B; Zeiler, G; Delling, G; Schuh, A
Melorheostosis is a rare bony dysplasia and often recognised just sporadically by chance. We present a case of a 15 year old girl who presented a melorheostosis of the left foot. After birth there was recognized a shortening and deformity of the 2nd toe on the left foot. Furthermore she had an interphalangeal hallux valgus that displaced the 2nd toe increasingly. Thus in the last years there were more and more difficulties to wear normal shoes. Conservative therapy was not successful. We performed a lengthening extending osteotomy of the 2nd toe (a modified Weil osteotomy) and an Akin osteotomy of the interphalangeal hallux valgus. Since the surgical procedure the patient is out of any complaints. We demonstrate the radiologic and histologic findings and discuss the relevant literature and possible etiology.
Rammelt, Stefan; Godoy-Santos, Alexandre Leme; Schneiders, Wolfgang; Fitze, Guido; Zwipp, Hans
Foot and ankle fractures represent 12% of all pediatric fractures. Malleolar fractures are the most frequent injuries of the lower limbs. Hindfoot and midfoot fractures are rare, but inadequate treatment for these fractures may results in compartment syndrome, three-dimensional deformities, avascular necrosis and early post-traumatic arthritis, which have a significant impact on overall foot and ankle function. Therefore, the challenges in treating these injuries in children are to achieve adequate diagnosis and precise treatment, while avoiding complications. The objective of the treatment is to restore normal anatomy and the correct articular relationship between the bones in this region. Moreover, the treatment needs to be planned according to articular involvement, lower-limb alignment, ligament stability and age. This article provides a review on this topic and presents the scientific evidence for appropriate treatment of these lesions.
Kolossváry, Endre; Bánsághi, Zoltán; Szabó, Gábor Viktor; Járai, Zoltán; Farkas, Katalin
"Diabetic foot" as definition covers a multifactorial clinical condition. According to the recent epidemiological data, the role of lower limb ischemia is getting more influential over other pathological causes, like neuropathy, infections and bone or soft tissue deformity. In diabetes, vascular disease leads to increased risk for leg ulcers and minor or major amputations. The traditional diagnostic tools for recognition of peripheral arterial disease have limited value because of diabetes specific clinical manifestations. Available vascular centers with special expertise and diagnostic tools are the prerequisite for efficient diagnosis supporting timely recognition of peripheral arterial disease. In course of treatment of diabetic foot with ischemic origin, beyond effective medical treatment revascularization (open vascular surgery or endovascular procedures) has paramount importance for prevention of limb loss. Vascular teams of vascular specialists, vascular surgeons and interventional radiologist in dedicated centers in multidisciplinary cooperation with other professions represent public health issue in effective prevention. Orv. Hetil., 2017, 158(6), 203-211.
Faldini, Cesare; Traina, Francesco; Nanni, Matteo; Mazzotti, Antonio; Calamelli, Carlotta; Fabbri, Daniele; Pungetti, Camilla; Giannini, Sandro
Charcot-Marie-Tooth disease is the single most common diagnosis associated with cavus foot. The imbalance involving intrinsic and extrinsic muscles has been suggested as the main pathogenetic cause of cavus foot in this disease. The goal of surgical treatment is to correct the deformity to obtain a plantigrade foot. In the presence of a flexible deformity and the absence of degenerative arthritis, preserving as much as possible of the overall range of motion of the foot and ankle is advisable. Twenty-four cavus feet in twelve patients with Charcot-Marie-Tooth disease were included in the study. Clinical evaluation was summarized with the Maryland Foot Score. Radiographic evaluation assessed calcaneal pitch, Meary angle, Hibb angle, and absence of degenerative joint changes. Only patients who had a flexible deformity, with varus of the heel reducible in the Coleman-Andreasi test, and did not have degenerative joint arthritis were included in this study. Surgical treatment consisted in plantar fasciotomy, midtarsal osteotomy, extensor hallucis longus tendon transfer to the first metatarsal (Jones procedure), and dorsiflexion osteotomy of the first metatarsal. Mean follow-up was six years (range, two to thirteen years). The mean Maryland Foot Score was 72 preoperatively and 86 postoperatively. The postoperative result was rated as excellent in twelve feet (50%), good in ten (42%), and fair in two (8%). Mean calcaneal pitch was 34° preoperatively and 24° at the time of the latest follow-up, the mean Hibb angle was 121° preoperatively and 136° postoperatively, and the mean Meary angle was 25° preoperatively and 2° postoperatively. Plantar fasciotomy, midtarsal osteotomy, the Jones procedure, and dorsiflexion osteotomy of the first metatarsal yielded adequate correction of flexible cavus feet in patients with Charcot-Marie-Tooth disease in the absence of fixed hindfoot deformity. The fact that the improvement in the outcome score was only modest may be attributable
Tuttolomondo, Antonino; Maida, Carlo; Pinto, Antonio
Diabetic foot ulcerations have been extensively reported as vascular complications of diabetes mellitus associated with a high degree of morbidity and mortality. Diabetic foot syndrome (DFS), as defined by the World Health Organization, is an “ulceration of the foot (distally from the ankle and including the ankle) associated with neuropathy and different grades of ischemia and infection”. Pathogenic events able to cause diabetic foot ulcers are multifactorial. Among the commonest causes of this pathogenic pathway it’s possible to consider peripheral neuropathy, foot deformity, abnormal foot pressures, abnormal joint mobility, trauma, peripheral artery disease. Several studies reported how diabetic patients show a higher mortality rate compared to patients without diabetes and in particular these studies under filled how cardiovascular mortality and morbidity is 2-4 times higher among patients affected by type 2 diabetes mellitus. This higher degree of cardiovascular morbidity has been explained as due to the observed higher prevalence of major cardiovascular risk factor, of asymptomatic findings of cardiovascular diseases, and of prevalence and incidence of cardiovascular and cerebrovascular events in diabetic patients with foot complications. In diabetes a fundamental pathogenic pathway of most of vascular complications has been reported as linked to a complex interplay of inflammatory, metabolic and procoagulant variables. These pathogenetic aspects have a direct interplay with an insulin resistance, subsequent obesity, diabetes, hypertension, prothrombotic state and blood lipid disorder. Involvement of inflammatory markers such as IL-6 plasma levels and resistin in diabetic subjects as reported by Tuttolomondo et al confirmed the pathogenetic issue of the a “adipo-vascular” axis that may contribute to cardiovascular risk in patients with type 2 diabetes. This “adipo-vascular axis” in patients with type 2 diabetes has been reported as characterized
Sheykhi-Dolagh, Roghaye; Saeedi, Hassan; Farahmand, Behshid; Kamyab, Mojtaba; Kamali, Mohammad; Gholizadeh, Hossein; Derayatifar, Amir A; Curran, Sarah
Flexible flat foot is described as a reduction in the height of the medial longitudinal arch and may occur from abnormal foot pronation. A foot orthosis is thought to modify and control excessive pronation and improve arch height. To compare the immediate effect of three types of orthoses on foot mobility and the arch height index in subjects with flexible flat feet. A quasi-experimental study. The dorsal arch height, midfoot width, foot mobility and arch height index were assessed in 20 participants with flexible flat feet (mean age = 23.2 ± 3 years) for three different foot orthosis conditions: soft, semi-rigid and rigid University of California Biomechanics Laboratory (UCBL). Maximum midfoot width at 90% with arch mobility in the coronal plane was shown in the semi-rigid orthosis condition. The semi-rigid orthosis resulted in the highest mean foot mobility in 90% of weight bearing, and the rigid orthosis (UCBL) had the lowest mean foot mobility. The soft orthosis resulted in foot mobility between that of the rigid and the semi-rigid orthosis. UCBL orthosis showed the highest arch height index, and the semi-rigid orthosis showed the lowest mean arch height index. Due to its rigid structure and long medial-lateral walls, the UCBL orthosis appears to limit foot mobility. Therefore, it is necessary to make an orthosis that facilitates foot mobility in the normal range of the foot arch. Future studies should address the dynamic mobility of the foot with using various types of foot orthoses. Although there are many studies focussed on flat foot and the use of foot orthoses, the mechanism of action is still unclear. This study explored foot mobility and the influence of foot orthoses and showed that a more rigid foot orthosis should be selected based on foot mobility. © The International Society for Prosthetics and Orthotics 2014.
Sacco, Isabel C N; Bacarin, Tatiana A; Gomes, Aline A; Picon, Andreja P; Cagliari, Mariana F
Background. Foot deformities have been related to diabetic neuropathy progression but their influence on plantar distribution during dynamic tasks is not completely understood. The purpose of the present study was to investigate the influence of metatarsal head prominence and claw toes on regional plantar pressures during gait in patients with diabetic neuropathy. Seventy-one adults participated in this study categorized into three groups: a control group (CG, n = 32), patients with diabetic neuropathy without any foot deformities (DG, n = 20), and patients with diabetic neuropathy with metatarsal head prominence and/or claw toes (DMHG, n = 19). Plantar pressure variables (contact area, peak pressure, and maximum mean pressure) were evaluated during gait on rearfoot, midfoot, and forefoot using capacitive insoles (Pedar-X System, Novel Inc., Munich, Germany). A general linear model was applied to repeatedly measure and analyze variance relationships between groups and areas. DMHG presented larger contact areas at the forefoot and midfoot along with higher peak pressure at the rearfoot compared to the other two groups. The DG showed higher mean pressure at the midfoot compared to the other two groups. The coexistence of diabetic neuropathy and metatarsal head prominence in addition to claw toes resulted in overloading the rearfoot and enhancing the contact area of forefoot and midfoot while walking. This plantar pressure distribution is a result of a different coordination pattern adopted in order to reduce plantar loads at the anterior parts of the foot that were structurally altered. Patients with diabetic neuropathy without any forefoot deformities presented a different plantar pressure distribution than patients with deformities suggesting that both neuropathy and structural foot alterations can influence foot rollover mechanisms.
This paper presents the results of modeling tests of the Effect of Confinement Pressure on footing bearing capacity of two kinds of square and strip footing. Footings bearing capacity depends upon many factors including soil kind, depth, form and kind of loading. Soil behavior is variable regarding the kind of loading and the kind of deformations in that can have great importance in the amount of bearing capacity. The kind of deformations depends on the amount of pressure on soil in the past and present. Therefore, studying the role of stress way, which is subject to the amount of confinement pressure on soil, will have an important role in identifying soil behavior. In this study, primarily the effect of confinement pressure on the cohesion and friction angle is studied. Then the effect of both on the bearing capacity with the Meyerhof and Terzaghi methods is evaluated. By using Plaxis software, changes of shearing resistance parameters of both samples different Confinement pressures are studied and bearing capacity of two kinds of square and strip footing has been computed and compared. This study indicated that the amount of bearing capacity by increasing lateral pressure increased, and this increasing is more in grain soil than cohesion one.
Rasit, Ah; Rasit, Ah; Azani, H; Zabidah, Pa; Merikan, A; Nur Alyana, Ba
The recent trend in management of congenital idiopathic clubfoot tends towards conservative treatment. This study reviews the outcomes of treatment in our practice using the quantitative clubfoot assessment of the deformity (QCAD). Thirty patients (38 cases of clubfoot) with congenital idiopathic clubfoot treated at Sarawak General Hospital were followed-up for a mean of 3.6 years. The quantitative assessment consists of limb anthropometric measurement and the Pirani deformity severity score. There were 15 boys and 15 girls, with a mean age of 4.4 years (range, 13m - 8y). Most patients were of the Malay race (67%), followed by Chinese (23%) and others (10%). Eight patients suffered from bilateral congenital idiopathic clubfoot (33%), 12 were left unilateral (40%) and 10 were right unilateral (27%). Out of the total of 30 patients, 12 were treated conservatively with serial casting and 18 patients were treated surgically after resistance to serial casting at the age of nine months. At follow-up, there were significant differences between the surgical group (2.57 ± 1.45); (0.86 ± 0.36) and conservative group (0.7 ± 0.81); (0.34 ± 0.35) respectively (p < 0.05) regarding the mean difference in mid-leg circumference and foot length discrepancy in patients with unilateral clubfoot. There were no significant difference noted between groups with regards to results of the Pirani score, leg length discrepancy and mean difference of mid-foot circumference. There were significant differences in calf atrophy and foot length discrepancy when comparing surgically treated clubfoot patient compared to conservatively treated patients. Conservative treatment of clubfoot is the preferred method of treatment while surgical treatment may be necessary in more resistant cases. Clubfoot, outcome, treatment, quantitative assessment, deformity.
Jackson, Jennifer N; Hass, Chris J; Fregly, Benjamin J
Patient-specific gait optimizations capable of predicting post-treatment changes in joint motions and loads could improve treatment design for gait-related disorders. To maximize potential clinical utility, such optimizations should utilize full-body three-dimensional patient-specific musculoskeletal models, generate dynamically consistent gait motions that reproduce pretreatment marker measurements closely, and achieve accurate foot motion tracking to permit deformable foot-ground contact modeling. This study enhances an existing residual elimination algorithm (REA) Remy, C. D., and Thelen, D. G., 2009, “Optimal Estimation of Dynamically Consistent Kinematics and Kinetics for Forward Dynamic Simulation of Gait,” ASME J. Biomech. Eng., 131(3), p. 031005) to achieve all three requirements within a single gait optimization framework. We investigated four primary enhancements to the original REA: (1) manual modification of tracked marker weights, (2) automatic modification of tracked joint acceleration curves, (3) automatic modification of algorithm feedback gains, and (4) automatic calibration of model joint and inertial parameter values. We evaluated the enhanced REA using a full-body three-dimensional dynamic skeletal model and movement data collected from a subject who performed four distinct gait patterns: walking, marching, running, and bounding. When all four enhancements were implemented together, the enhanced REA achieved dynamic consistency with lower marker tracking errors for all segments, especially the feet (mean root-mean-square (RMS) errors of 3.1 versus 18.4 mm), compared to the original REA. When the enhancements were implemented separately and in combinations, the most important one was automatic modification of tracked joint acceleration curves, while the least important enhancement was automatic modification of algorithm feedback gains. The enhanced REA provides a framework for future gait optimization studies that seek to predict subject
Besse, J-L; Leemrijse, T; Deleu, P-A
As diabetes takes on pandemic proportions, it is crucial for the orthopedic surgeon to be aware of the issues involved in diabetic foot. Ulceration is related to neuropathy and to arterial disease, a vital prognostic factor for healing; infection plays an aggravating role, increasing the risk of amputation. At-risk feet need to be screened for. Ulcer classification is essential, to set treatment strategy and determine prognosis. Before any treatment is decided on, neuropathy, vascular insufficiency and infection should individually be assessed by clinical examination and appropriate additional work-up. Despite the International Consensus on the Diabetic Foot recommendations, management of diabetic foot in Europe still varies greatly from country to country, very few of which have established reference centers. Management of diabetic foot remains multidisciplinary; but it has been shown that the orthopedic surgeon should play a central role, providing a biomechanical perspective so as to avoid complications recurrence. Strategy notably includes prevention of at-risk foot, revascularization surgery (which should systematically precede orthopedic surgery in case of critical vascular insufficiency), and treatment of ulcers, whether these latter are associated with osteitis or not. Indications for "minor" amputation should be adequate, and meticulously implemented. "Acute foot" is a medical emergency, entailing massive empirically selected I.V. antibiotics to "cool" the lesion. Prophylactic surgery to limit further risks of ulceration is to be indicated with caution and only when clearly justified. France urgently requires accredited specialized multidisciplinary centers to manage severe lesions: deep and infected ulceration, advanced arteriopathy, and Charcot foot arthropathy. Copyright © 2011 Elsevier Masson SAS. All rights reserved.
Benoussaad, Mourad; Sijobert, Benoît; Mombaur, Katja; Azevedo Coste, Christine
This paper introduces a method for the robust estimation of foot clearance during walking, using a single inertial measurement unit (IMU) placed on the subject’s foot. The proposed solution is based on double integration and drift cancellation of foot acceleration signals. The method is insensitive to misalignment of IMU axes with respect to foot axes. Details are provided regarding calibration and signal processing procedures. Experimental validation was performed on 10 healthy subjects under three walking conditions: normal, fast and with obstacles. Foot clearance estimation results were compared to measurements from an optical motion capture system. The mean error between them is significantly less than 15% under the various walking conditions. PMID:26703622
Cohen, S. C.
The manner in which the Earth's surface deforms during the cycle of stress accumulation and release along major faults is investigated. In an investigation of the crustal deformation associated with a thin channel asthenosphere displacements are reduced from those computed for a half space asthenosphere. A previous finding by other workers that displacements are enhanced when flow is confined to a thin channel is based on several invalid approximations. The major predictions of the finite element model are that the near field postseismic displacements and strain rates are less than those for a half space asthenosphere and that the postseismic strain rates at intermediate distances are greater (in magnitude). The finite width of the asthenosphere ceases to have a significant impact on the crustal deformation pattern when its magnitude exceeds about three lithosphere thicknesses.
Cohen, S. C.
The manner in which the Earth's surface deforms during the cycle of stress accumulation and release along major faults is investigated. In an investigation of the crustal deformation associated with a thin channel asthenosphere displacements are reduced from those computed for a half space asthenosphere. A previous finding by other workers that displacements are enhanced when flow is confined to a thin channel is based on several invalid approximations. The major predictions of the finite element model are that the near field postseismic displacements and strain rates are less than those for a half space asthenosphere and that the postseismic strain rates at intermediate distances are greater (in magnitude). The finite width of the asthenosphere ceases to have a significant impact on the crustal deformation pattern when its magnitude exceeds about three lithosphere thicknesses.
Seymour, Brian; Shabane, Parvis; Cypull, Olivia; Cheng, Shengfeng; Feitosa, Klebert
Soap bubbles floating at an air-water experience deformations as a result of surface tension and hydrostatic forces. In this experiment, we investigate the nature of such deformations by taking cross-sectional images of bubbles of different volumes. The results show that as their volume increases, bubbles transition from spherical to hemispherical shape. The deformation of the interface also changes with bubble volume with the capillary rise converging to the capillary length as volume increases. The profile of the top and bottom of the bubble and the capillary rise are completely determined by the volume and pressure differences. James Madison University Department of Physics and Astronomy, 4VA Consortium, Research Corporation for Advancement of Science.
Traister, Eric; Simons, Stephen
Foot maladies are often classified descriptively by general foot locations, i.e., forefoot, midfoot, and rearfoot. However, common vernacular verbiage, implicating a common biomechanical purpose, also applies pathology to the medial or lateral foot column. Although imprecisely defined, lateral column injuries to the foot encompass conditions that affect any of the lateral side of the foot from the calcaneus to the toes. The lateral column of the foot includes the calcaneus, the cuboid, the fourth and fifth metatarsals as well as the calcaneocuboid, cuboido-metatarsal, and intermetatarsal joints. It may be helpful to think in a "lateral column" fashion when evaluating and treating certain lateral foot injuries, load patterns, and biomechanical or anatomical faults. Misdiagnosed injuries in this area of the foot can be a source of great morbidity to the athlete. It is important for the clinician to be aware of common conditions presenting as pain to the lateral side of the foot.
Ferri, Melanie; Scharfenberger, Angela V; Goplen, Gord; Daniels, Timothy R; Pearce, Dawn
The three-dimensional relationships of the bones in the foot in a flatfoot deformity are difficult to assess with standard radiographs. CT scans demonstrate these relationships but are typically made in a nonweightbearing mode. Our objective was to assess the use of a weightbearing CT apparatus to image the feet in patients with severe flexible pes planus deformities and to better define the anatomical changes that occur. A specialized device was designed and constructed to simulate weightbearing to the feet during CT examination. Eighteen normal feet and 30 painful severe and flexible pes planus feet were imaged in both the non weightbearing and weightbearing states, set at 50% of body weight. Several measurements of intertarsal relationships were made of the pes planus and normal feet. Navicular floor to skin distance, forefoot arch angle, and subtalar joint subluxation were measured in the coronal plane in both the weightbearing and nonweightbearing states. T-tests were used to analyze measurements of navicular floor to skin distance and forefoot arch angle. The weightbearing device had a significant effect on foot configuration for both normal and pes planus feet (p = 0.0008) and (p < 0.0001) respectively for both floor to skin distance and forefoot arch angle. There was a significant difference between normal feet and pes planus feet with regard to the forefoot arch angle in the nonweightbearing (p = 0.02) and weightbearing states (p = 0.01). Four of the pes planus patients had evidence of subtalar joint subluxation which was more pronounced in the weightbearing state. There was no significant difference between the navicular floor to skin distance in the normal versus pes planus feet in either the non weightbearing (p = 0.05) or the weightbearing states (p = 0.07). A device was designed and constructed to apply a weightbearing load equal to that of 50% body weight with minimal to no patient discomfort. The resultant effects on foot configuration were
Background. Foot pain is very common in the general population and has been shown to have a detrimental impact on health-related quality of life. This is of particular concern in older people as it may affect activities of daily living and exacerbate problems with balance and gait. The objective of this study is to evaluate the independent relationships between foot pain and mobility limitation in a population of community-dwelling older adults. Methods. Population-based cross-sectional study. Participants (n = 1,544) from the Framingham Foot Study (2002–2008) were assessed for physical performance. Foot pain was documented using the question “On most days, do you have pain, aching, or stiffness in either foot?” Mobility limitation was assessed using the Short Physical Performance Battery, dichotomized using 1–9 as an indicator of mobility limitation and 10–12 as no mobility limitation. Results. Foot pain was reported by 19% of men and 25% of women. After adjusting for age, obesity, smoking status, and depression, foot pain was significantly associated with mobility limitation in both men (odds ratio = 2.00, 95% confidence interval 1.14 – 3.50; p = .016) and women (odds ratio = 1.59, 95% confidence interval 1.03 – 2.46; p = .037). Conclusion. In our study of older adults from the Framingham Foot Study, foot pain was associated with an increased odds of having mobility limitation in both men and women. Clinicians should consider assessment of foot pain in general examinations of older adults who are at risk of mobility limitation. PMID:23704204
Minster, B.; Prescott, W.; Royden, L.
Our goal is to understand the motions of the plates, the deformation along their boundaries and within their interiors, and the processes that control these tectonic phenomena. In the broadest terms, we must strive to understand the relationships of regional and local deformation to flow in the upper mantle and the rheological, thermal and density structure of the lithosphere. The essential data sets which we require to reach our goal consist of maps of current strain rates at the earth's surface and the distribution of integrated deformation through time as recorded in the geologic record. Our success will depend on the effective synthesis of crustal kinematics with a variety of other geological and geophysical data, within a quantitative theoretical framework describing processes in the earth's interior. Only in this way can we relate the snapshot of current motions and earth structure provided by geodetic and geophysical data with long-term processes operating on the time scales relevant to most geological processes. The wide-spread use of space-based techniques, coupled with traditional geological and geophysical data, promises a revolution in our understanding of the kinematics and dynamics of plate motions over a broad range of spatial and temporal scales and in a variety of geologic settings. The space-based techniques that best address problems in plate motion and deformation are precise space-geodetic positioning -- on land and on the seafloor -- and satellite acquisition of detailed altimetric and remote sensing data in oceanic and continental areas. The overall science objectives for the NASA Solid Earth Science plan for the 1990's, are to Understand the motion and deformation of the lithosphere within and across plate boundaries'', and to understand the dynamics of the mantle, the structure and evolution of the lithosphere, and the landforms that result from local and regional deformation. 57 refs., 7 figs., 2 tabs.
Khas, Kanwaljit S; Pandey, Pulak M; Ray, Alok R
Clubfoot describes a range of foot abnormalities usually present at birth, in which the foot of a baby is twisted out of shape or position. In order to develop an effective treatment plan for clubfoot and/or assess the extent to which existing interventions are successful, medical practitioners need to be able to accurately measure the nature and extent of the deformity. This is typically performed using a goniometer. However, this device is only able to measure one dimension at a time. As such, a complete assessment of the condition of a foot can be extremely burdensome and time-consuming. This article describes a new device that can quickly and efficiently take several measurements on feet of various sizes and shapes. The use of this device was verified by measuring the deformities of real clubfeet. A silicone rubber clubfoot model was also used in this study to clearly illustrate the effectiveness with which the proposed device can measure the various deformities of clubfoot. It is envisaged that the use of this device will significantly reduce the time and effort orthopedists require to measure clubfoot deformities and develop and assess treatment plans. © IMechE 2015.
Bartman, Randall K.; Wang, Paul K. C.; Miller, Linda M.; Kenny, Thomas W.; Kaiser, William J.; Hadaegh, Fred Y.; Agronin, Michael L.
Micromachined, closed-loop, electrostatically actuated reflectors (microCLEARs) provide relatively simple and inexpensive alternatives to large, complex, expensive adaptive optics used to control wavefronts of beams of light in astronomy and in experimental laser weapons. Micromachining used to make deformable mirror, supporting structure, and actuation circuitry. Development of microCLEARs may not only overcome some of disadvantages and limitations of older adaptive optics but may also satisfy demands of potential market for small, inexpensive deformable mirrors in electronically controlled film cameras, video cameras, and other commercial optoelectronic instruments.
Papavasiliou, Alexandros P.; Olivier, Scot S.
A deformable mirror formed out of two layers of a nanolaminate foil attached to a stiff substrate is introduced. Deformation is provided by an electrostatic force between two of the layers. The internal stiffness of the structure allows for high-spatial-frequency shapes. The nanolaminate foil of the present invention allows for a high-quality mirror surface. The device achieves high precision in the vertical direction by using foils with accurately controlled thicknesses, but does not require high precision in the lateral dimensions, allowing such mirrors to be fabricated using crude lithography techniques. Such techniques allow structures up to about the meter scale to be fabricated.
Papavasiliou, Alexandros P.; Olivier, Scot S.
A deformable mirror formed out of two layers of a nanolaminate foil attached to a stiff substrate is introduced. Deformation is provided by an electrostatic force between two of the layers. The internal stiffness of the structure allows for high-spatial-frequency shapes. The nanolaminate foil of the present invention allows for a high-quality mirror surface. The device achieves high precision in the vertical direction by using foils with accurately controlled thicknesses, but does not require high precision in the lateral dimensions, allowing such mirrors to be fabricated using crude lithography techniques. Such techniques allow structures up to about the meter scale to be fabricated.
Fennell, John; Goodwin, Charlotte; Burn, Jeremy F.; Leonards, Ute
Everybody would agree that vision guides locomotion; but how does vision influence choice when there are different solutions for possible foot placement? We addressed this question by investigating the impact of perceptual grouping on foot placement in humans. Participants performed a stepping stone task in which pathways consisted of target stones in a spatially regular path of foot falls and visual distractor stones in their proximity. Target and distractor stones differed in shape and colour so that each subset of stones could be easily grouped perceptually. In half of the trials, one target stone swapped shape and colour with a distractor in its close proximity. We show that in these ‘swapped’ conditions, participants chose the perceptually groupable, instead of the spatially regular, stepping location in over 40% of trials, even if the distance between perceptually groupable steps was substantially larger than normal step width/length. This reveals that the existence of a pathway that could be traversed without spatial disruption to periodic stepping is not sufficient to guarantee participants will select it and suggests competition between different types of visual input when choosing foot placement. We propose that a bias in foot placement choice in favour of visual grouping exists as, in nature, sudden changes in visual characteristics of the ground increase the uncertainty for stability. PMID:26587273
Semi-automatic readout equipment installed in the 1950s used for data recording and reduction in the 8-Foot High Speed Tunnel (HST). A 1957 NACA report on wind tunnel facilities at Langley included these comments on the data recording and reduction equipment for the 8-foot HST: 'The data recording and reduction equipment used for handling steady force and pressure information at the Langley 8-foot transonic tunnel is similar to that described for the Langley 16-foot transonic tunnel. Very little dynamic data recording equipment, however, is available.' The description of the 16-foot transonic tunnel equipment is as follows: 'A semiautomatic force data readout system provides tabulated raw data and punch card storage of raw data concurrent with the operation of the wind tunnel. Provision is made for 12 automatic channels of strain gage-data output, and eight channels of four-digit manually operated inputs are available for tabulating and punching constants, configuration codes, and other information necessary for data reduction and identification. The data are then processed on electronic computing machines to obtain the desired coefficients. These coefficients and their proper identification are then machine tabulated to provide a printed record of the results. The punched cards may also be fed into an automatic plotting device for the preparation of plots necessary for data analysis.'
Barnett, S J; Shield, J P; Potter, M J; Baum, J D
OBJECTIVES--Foot pathology is a major source of morbidity in adults with diabetes. The aim of this study was to determine if children with insulin dependent diabetes have an increased incidence of foot pathology compared with non-diabetic children. DESIGN--Questionnaire, clinical examination, and biomechanical assessment. SUBJECTS--67 diabetic children and a comparison group matched for age, sex, and social class. RESULTS--We found significantly more foot pathology in the children with diabetes (52 children) than the comparison group (28 children); with more biomechanical anomalies (58 children with diabetes, 34 comparison group); and a higher incidence of abnormal skin conditions (53 children with diabetes, 27 comparison group). Forty two children with diabetes had received foot health education compared with 27 in the comparison group, but the study revealed ignorance and misconceptions among the diabetic group, and previous contact with a podiatrist was minimal. CONCLUSIONS--The survey suggests that children with diabetes have an increased incidence of foot pathology justifying greater input of podiatric care in the hope of preventing later problems. PMID:7574860
Feet are not necessarily the most attractive part of the body as it ages, and given the choice, most older adults would rather ignore them. In fact, many older adults cannot even see them, reach them, or care for them properly. And when they ache or look misshapen and oddly colored; well, that's just part of growing old, isn't it? The feet are important for weight bearing, balance, and mobility. Over an average life span, the feet are subject to considerable stress and trauma. Age-related changes of the foot predispose the older adult to discomfort if not pain, fungal infection, reduced range of motion, and itchy dry skin. More than three fourths of older adults (i.e., those age over 65 years) complain of foot pain that is associated with a significant foot problem and have evidence of arthritic changes on x-ray. Impaired ambulation can make the difference between independence versus dependency on others, engagement versus isolation. Assisted living is about choices. Being unable to get where one wants to go or do what one wants to do because of foot problems is a barrier to full enjoyment of the opportunities in assisted living communities. This article describes foot problems associated with aging, diabetes, nursing assessment of the feet, and nursing interventions in the service of accessing and optimizing choices for quality of life.
Márquez-Godínez, S A; Zonana-Nacach, A; Anzaldo-Campos, M C; Muñoz-Martínez, J A
To determine the risk of diabetic foot in patients with type II diabetes mellitus (DM) seen in a Family Medicine Unit. The study included type II DM patients with a disease duration ≥ 5 years seen in a Family Medicine Unit, Tijuana, Mexico, during September-December 2011. Neuropathy was assessed with the Diabetic Neuropathy Symptom questionnaire, and pressure sensation using a 10-g Semmes-Weinstein monofilament. A patient had a high risk of diabetic foot if there was sensitivity loss, foot deformities, and non-palpable pedal pulses. We studied 205 patients with an average (± SD) age and DM duration of 59 ± 10 years and 10.7 ± 6.7 years, respectively. Ninety one patients (44%) had a high risk of developing diabetic foot, and it was associated with; an education of less than 6 years (OR 2.3; 95%CI: 1-1-4.1), DM disease duration ≥ 10 years (OR 5.1; 95%CI: 2.8-9.4), female gender (OR 2.0; 95%CI: 1.1-3.6), monthly familiar income <236 euros (OR 2.0; 95%CI: 1.1-3.8), and a glycosylated hemoglobin ≥ 7.0% (OR 2.8; 95%CI: 1.5-5.0). It is necessary that all DM patients seen in a family medicine clinic have a yearly screening for the early detection of diabetic neuropathy, since they have a high risk of diabetic foot. Copyright © 2013 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España. All rights reserved.
Shin, Jaeho; Yue, Neng; Untaroiu, Costin D
A finite element (FE) model of the foot and leg was developed to improve understanding of injury mechanisms of the ankle and subtalar joints during vehicle collisions and to aid in the design of injury countermeasures. The FE model was developed based on the reconstructed geometry of a male volunteer close to the anthropometry of a 50th percentile male and a commercial anatomical database. While the forefoot bones were defined as rigid bodies connected by ligament models, the surrounding bones of the ankle and subtalar joints and the leg bones were modeled as deformable structures. The material and structural properties were selected based on a synthesis of current knowledge of the constitutive models for each tissue. The whole foot and leg model was validated in different loading conditions including forefoot impact, axial rotation, dorsiflexion, and combined loadings. Overall results obtained in the model validation indicated improved biofidelity relative to previous FE models. The developed model was used to investigate the injury tolerance of the ankle joint under brake pedal loading for internally and externally rotated feet. Ligament failures were predicted as the main source of injury in this loading condition. A 12% variation of failure moment was observed in the range of axial foot rotations (±15°). The most vulnerable position was the internally rotated (15°) posture among three different foot positions. Furthermore, the present foot and ankle model will be coupled together with other body region FE models into the state-of-art human FE model to be used in the field of automotive safety.
Foot injury was common as a result of the Bangkok flood of 2011. In the future, this type of injury should be prevented to lessen the burden during a disaster. The study was performed to ascertain what type of footwear is appropriate for volunteer rescue workers during a flood. The study was carried out during the flood in November 2011 at Siriraj Hospital. There were 15 volunteers enrolled in the study. None of the volunteers had any foot deformity or injury before the study. Participants were divided into 3 groups of 5 volunteers: group A, the barefoot group; group B, the high top shoe group; and group C, the beach shoe group. All volunteers worked in the areas close to Siriraj Hospital and were followed up after 5 days of rescue work. Prevalence of foot and ankle injuries, satisfaction regarding work conditions and willingness to use the shoes were subjectively evaluated. Wearing of beach shoes during rescue was satisfactory during the early phase of the flood. The age range of volunteers was 20-28. In the group A, most volunteers were barely satisfied with conducting rescue work in water with bare feet, that bare feet were good for working on a wet surface and were 'just satisfied' to not satisfied that bare feet were good for work on dry surfaces. In group B, most of the volunteers had opinions similar to group A with the exception that they felt better while they were working on dry surfaces. In group C, most volunteers were significantly more satisfied under all three conditions. Foot injury occurred in 2 volunteers from group A. Beach shoes offer adequate foot protection during flood rescue.
Siddle, Heidi J; Firth, Jill; Waxman, Robin; Nelson, E Andrea; Helliwell, Philip S
The aim of this study was to describe the clinical characteristics of foot ulceration in patients with rheumatoid arthritis (RA). Adults with RA and current foot ulceration but without diabetes were recruited. Clinical examination included assessment of RA disease activity, foot deformity, peripheral vascular disease, neuropathy and plantar pressures. Location, wound characteristics and time to healing were recorded for each ulcer. Participants completed the Health Assessment Questionnaire and Leeds Foot Impact Scale. Thirty-two cases with 52 current ulcers were recruited. Thirteen patients (41%) experienced more than one current ulcer: 5 (16%) had bilateral ulceration, 15 (47%) had previous ulceration at a current ulcer site. The majority (n = 33) of open ulcers were located over the dorsal aspect of the interphalangeal joints (n = 12), plantar aspect of the metatarsophalangeal joints (MTPJs) (n = 12) and medial aspect of first MTPJs (n = 9). In ulcerated limbs (n = 37), ankle brachial pressure index (ABPI) was <0.8 in 2 (5%); protective sensation was reduced in 25 (68%) and peak plantar pressures were >6 kg/cm(2) in 6 (16%). Mean ulcer size was 4.84 by 3.29 mm. Most ulcers (n = 42, 81%) were superficial; five (9.6%) were infected. Time to healing was available for 41 ulcers: mean duration was 28 weeks. Three ulcers remained open. In conclusion, foot ulceration in RA is recurrent and multiple ulcers are common. Whilst ulcers are small and shallow, time to achieve healing is slow, posing infection risk. Reduced protective sensation is common in affected patients. The prevalence of arterial disease is low but may be under estimated due to high intolerance of ABPI.
Rojas-Villarraga, Adriana; Bayona, Javier; Zuluaga, Natalia; Mejia, Santiago; Hincapie, Maria-Eugenia; Anaya, Juan-Manuel
Background Alterations in the feet of patients with rheumatoid arthritis (RA) are a cause of disability in this population. The purpose of this research was to evaluate the impact that foot impairment has on the patients' global quality of life (QOL) based on validated scales and its relationship to disease activity. Methods This was a cross-sectional study in which 95 patients with RA were enrolled. A complete physical examination, including a full foot assessment, was done. The Spanish versions of the Health Assessment Questionnaire (HAQ) Disability Index and of the Disease Activity Score (DAS 28) were administered. A logistic regression model was used to analyze data and obtain adjusted odds ratios (AORs). Results Foot deformities were observed in 78 (82%) of the patients; hallux valgus (65%), medial longitudinal arch flattening (42%), claw toe (lesser toes) (39%), dorsiflexion restriction (tibiotalar) (34%), cock-up toe (lesser toes) (25%), and transverse arch flattening (25%) were the most frequent. In the logistic regression analysis (adjusted for age, gender and duration of disease), forefoot movement pain, subtalar movement pain, tibiotalar movement pain and plantarflexion restriction (tibiotalar) were strongly associated with disease activity and disability. The positive squeeze test was significantly associated with disability risk (AOR = 6,3; 95% CI, 1.28–30.96; P = 0,02); hallux valgus, and dorsiflexion restriction (tibiotalar) were associated with disease activity. Conclusion Foot abnormalities are associated with active joint disease and disability in RA. Foot examinations provide complementary information related to the disability as an indirect measurement of quality of life and activity of disease in daily practice. PMID:19527518
Navarro, Luis A; García, Daniel O; Villavicencio, Emilio A; Torres, Miguel A; Nakamura, Orlando K; Huamani, Robinson; Yabar, Leopoldo F
Distribution of Foot Pressure reflects the deformations of body biomechanical design. They are caused by different reasons: degenerative, by trauma, etc., being flat foots a common pathology in Peru with high incidence. However there isn't the properly technology to detect properly this disease because is detected by a non-reliable visual way using pedoscopes. Flat foot is the degree of internal plantar arch lack and is well observed in foot pressure distribution. This distribution can be obtained by optical or electronic systems. The most required, by their accuracy, are the electronic ones but sensor manufacturing process increases its price, meanwhile optics provides an indirect optical solution whose price depends on scanners resolution. Therefore, this paper takes advantage of both systems: a direct pressure value from electronics and no problems calibration from optical systems. In regard of these reasons, prototype will use a webcam and twelve FSR (Force sensing resistor) sensors including estimation techniques, and thus obtain the foot pressure distribution. Accordingly, the present study is looking for providing to the specialist with an efficient tool to generate better diagnostics in Perú.
Botezatu, I; Marinescu, R; Laptoiu, D
Percutaneous techniques are currently more and more used in many surgical procedures on the soft tissues and bones of the foot. Practical advantages include lower complication rates and faster recovery times. Potential disadvantages are related to the need for specific equipment and extensive learning curve. One of the most frequent techniques involves a combination of chevron osteotomy of the first metatarsal with osteotomy of the first phalanx, both internally fixated. Lateral metatarsal misalignment and toe deformities can also be addressed by percutaneous treatment, with lower morbidity rates than open techniques. The most commonly performed percutaneous procedures are described, with their current indications, outcomes, and recent developments. PMID:26361518
Han, Seung Hwan; Cho, Jae Ho; Lee, Yu Sang
Postaxial polydactyly is a relatively rare congenital deformity. We present a unique unusual fourth metatarsal type polydactyly in which the extra bone from the fourth metatarsal bone articulated with the most lateral ray proximal phalanx. We discuss the surgical management of this problem using a bone transfer from the extra metatarsal bone within the midfoot. This is the first reported case of fourth metatarsal-type polydactyly treated by bone transfer of the extra metatarsal bone and internal plate fixation to recover normal articulation. The normal orientation of the metatarsophalangeal joint, alignment, and cosmesis are important determinants when selecting the bone to be excised in cases of lateral ray foot polydactyly.
Chang, Wen-Hui; Hsu, Li-Ling
Foot infections are a common chronic complication and a major reason for hospitalization in patients with diabetes. Performing foot examinations correctly and thoroughly may reduce diabetic foot risks and save patients from amputation and death. To assist professional nurses to learn the procedures and tools involved in foot examination, this study proposes that nurse trainers use creative thinking methods, such as those of Mandala, and mind mapping to conduct divergent thinking and analysis of training content define feasible training strategies. This study also proposes the use of rhymes and graphics such as creative mnemonics to help professional nurses expedite their learning of foot examination and preventive foot care techniques.
Pinzur, Michael S
These two morbidly obese patients with severe Charcot foot arthropathy were treated successfully with percutaneous correction of their deformity followed by a stepwise application of a pre-assembled neutrally aligned multiplane ring external fixator. This technique transfers well to the trauma environment in which alignment can be maintained without further violation within the zone of injury. The application of the fine wire ring external fixation has been used for many years to accomplished leg lengthening and correction of deformity. Historically it has required a great deal of experience to apply to complex frames and implement the required daily adjustments. The patient experience often has been an unpleasant ordeal with a high potential for associated morbidity. This negative exposure has prompted practicing orthopedic surgeons to avoid this technique, feeling that it best be left to those in tertiary care setting who are equipped to handle the morbidity and complications. Taking this technology from the domain of the deformity surgeon to the general orthopedic community will require the suppression of bad memories from residency. Using the device solely as a method of maintaining alignment eliminates many of the dynamic attributes that contributes to pain and morbidity. The bone and soft tissues are not stretched, eliminating much of the pain and decreasing the rate of traction-associated pin tract morbidity. Because there is no dynamic of the treatment, the simplified frame can be pre-assembled and have no adjustable components. The experience derived from this application has the potential of expanding the role of ring external fixation. Where the ring has been used previously as method of both obtaining and maintaining alignment, this application uses a simplified neutral version of a complex device to simply maintain alignment in a high risk patient population. Correction of deformity and achieving alignment/reduction of fractures is well within the
Nesbitt, John A. A.
INTRODUCTION: Of an estimated 1.7 to 2 million Canadians with diabetes, approximately 10% will present each year to their family doctors with plantar ulcers. Nearly 3500 will require major lower extremity amputations. SOURCES OF INFORMATION: Most of the recommendations outlined in this paper are based on level I evidence from excellent bench research and epidemiologic studies. MAIN MESSAGE: Both insulin-dependent and non-insulin-dependent diabetics develop foot infections. These patients are on average 60 years old and have had diabetes for more than 10 years. Physicians who insist on excellent blood sugar control, provide ongoing patient education on diabetic foot care, prescribe appropriate shoes, and practise an aggressive multidisciplinary approach to wound care can reduce the rate of lower extremity amputations by more than 50%. CONCLUSION: Foot problems remain one of the main challenges associated with diabetes, but family physicians can manage them successfully. PMID:15116801
Iniesta, A; Baptista, C; Guinard, D; Legré, R; Gay, A
Mycetoma is a chronic inflammatory cutaneous and subcutaneous pathology caused by either a fongic (eumycetoma) or bacterial (actinomycetoma) infection, which lead to a granulomatous tumefaction with multiple sinuses. When localized in the foot this infection is named "Madura foot". This infection is endemic to tropical and subtropical regions and rarely occurs in western countries. A historical case in Europe of a foot mycetoma evolving since 20 years without any treatment is presented. A histopathologic diagnosis of actinomycetoma has been done in 1987. The patient presented a severe Staphylococcus aureus chronic osteitis leading to a trans-tibial amputation. This case allows to present this infection which, even if rarely presented in France, can be meet especially among a migrant's population. Copyright © 2013. Published by Elsevier Masson SAS.
Joong, Mo Ahn; El-Khoury, Georges Y
Chronic foot pain is a common and often disabling clinical complaint that can interfere with a patient's routine activities. Despite careful and detailed clinical history and physical examination, providing an accurate diagnosis is often difficult because chronic foot pain has a broad spectrum of potential causes. Therefore, imaging studies play a key role in diagnosis and management. Initial assessment is typically done by plain radiography; however, magnetic resonance imaging has superior soft-tissue contrast resolution and multiplanar capability, which makes it important in the early diagnosis of ambiguous or clinically equivocal cases when initial radiographic findings are inconclusive. Computed tomography displays bony detail in stress fractures, as well as in arthritides and tarsal coalition. Bone scanning and ultrasonography also are useful tools for diagnosing specific conditions that produce chronic foot pain.
Di Sante, Domenico; Fratini, Simone; Dobrosavljević, Vladimir; Ciuchi, Sergio
We show that, in the presence of a deformable lattice potential, the nature of the disorder-driven metal-insulator transition is fundamentally changed with respect to the noninteracting (Anderson) scenario. For strong disorder, even a modest electron-phonon interaction is found to dramatically renormalize the random potential, opening a mobility gap at the Fermi energy. This process, which reflects disorder-enhanced polaron formation, is here given a microscopic basis by treating the lattice deformations and Anderson localization effects on the same footing. We identify an intermediate "bad insulator" transport regime which displays resistivity values exceeding the Mott-Ioffe-Regel limit and with a negative temperature coefficient, as often observed in strongly disordered metals. Our calculations reveal that this behavior originates from significant temperature-induced rearrangements of electronic states due to enhanced interaction effects close to the disorder-driven metal-insulator transition.
Papavasiliou, A; Olivier, S; Barbee, T; Walton, C; Cohn, M
This ongoing work concerns the creation of a deformable mirror by the integration of MEMS actuators with Nanolaminate foils through metal compression boning. These mirrors will use the advantages of these disparate technologies to achieve dense actuation of a high-quality, continuous mirror surface. They will enable advanced adaptive optics systems in large terrestrial telescopes. While MEMS actuators provide very dense actuation with high precision they can not provide large forces typically necessary to deform conventional mirror surfaces. Nanolaminate foils can be fabricated with very high surface quality while their extraordinary mechanical properties enable very thin, flexible foils to survive the rigors of fabrication. Precise metal compression bonding allows the attachment of the fragile MEMS actuators to the thin nanolaminate foils without creating distortions at the bond sites. This paper will describe work in four major areas: (1) modeling and design, (2) bonding development, (3) nanolaminate foil development, (4) producing a prototype. A first-principles analytical model was created and used to determine the design parameters. A method of bonding was determined that is both strong, and minimizes the localized deformation or print through. Work has also been done to produce nanolaminate foils that are sufficiently thin, flexible and flat to be deformed by the MEMS actuators. Finally a prototype was produced by bonding thin, flexible nanolaminate foils to commercially available MEMS actuators.
Fawzy, Olfat A; Arafa, Asmaa I; El Wakeel, Mervat A; Abdul Kareem, Shaimaa H
groups compared to the DC group (P < 0.05) with no significant difference between the DN and DU groups (P > 0.05). FFPPP, F/R ratio, FFPPG, and FFPPG/RFPPG correlated significantly with the severity of neuropathy according to MNDS (P < 0.05). These same variables as well as MNDS were also significantly higher in patients with foot deformity compared to those without deformity (P < 0.05). Using the receiver operating characteristic analysis, the optimal cut-point of PPP for ulceration risk, as determined by a balance of sensitivity, specificity, and accuracy was 335 kPa and was found at the forefoot. Multivariate logistical regression analysis for ulceration risk was statistically significant for duration of diabetes (odds ratio [OR] = 0.8), smoking (OR = 9.7), foot deformity (OR = 8.7), MNDS (OR = 1.5), 2-h postprandial plasma glucose (2 h-PPG) (OR = 0.9), glycated hemoglobin (HbA1c) (OR = 2.1), FFPPP (OR = 1.0), and FFPPG (OR = 1.0). CONCLUSION In conclusion, persons with diabetes having neuropathy and/or ulcers have elevated PPP. Risk of ulceration was highly associated with duration of diabetes, smoking, severity of neuropathy, glycemic control, and high PP variables especially the FFPPP, F/R, and FFPPG. We suggest a cut-point of 355 kPa for FFPPP to denote high risk for ulceration that would be more valid when used in conjunction with other contributory risk factors, namely, duration of diabetes, smoking, glycemic load, foot deformity, and severity of neuropathy. PMID:25520564
Ward, Christina M.; Dolan, Lori A.; Bennett, D. Lee; Morcuende, Jose A.; Cooper, Reginald R.
Background: Cavovarus foot deformity is common in patients with Charcot-Marie-Tooth disease. Multiple surgical reconstructive procedures have been described, but few authors have reported long-term results. The purpose of this study was to evaluate the long-term results of an algorithmic approach to reconstruction for the treatment of a cavovarus foot in these patients. Methods: We evaluated twenty-five consecutive patients with Charcot-Marie-Tooth disease and cavovarus foot deformity (forty-one feet) who had undergone, between 1970 and 1994, a reconstruction consisting of dorsiflexion osteotomy of the first metatarsal, transfer of the peroneus longus to the peroneus brevis, plantar fascia release, transfer of the extensor hallucis longus to the neck of the first metatarsal, and in selected cases transfer of the tibialis anterior tendon to the lateral cuneiform. Each patient completed standardized outcome questionnaires (the Short Form-36 [SF-36] and Foot Function Index [FFI]). Radiographs were evaluated to assess alignment and degenerative arthritis, and gait analysis was performed. The mean age at the time of follow-up was 41.5 years, and the mean duration of follow-up was 26.1 years. Results: Correction of the cavus deformity was well maintained, although most patients had some recurrence of hindfoot varus as seen on radiographic examination. The patients had a lower mean SF-36 physical component score than age-matched norms, and the women had a lower mean SF-36 physical component score than the men, although this difference was not significant. Smokers had lower mean SF-36 scores and significantly higher mean FFI pain, disability, and activity limitation subscores (p < 0.0001). Seven patients (eight feet) underwent a total of eleven subsequent foot or ankle operations, but no patient required a triple arthrodesis. Moderate-to-severe osteoarthritis was observed in eleven feet. With the numbers studied, the age at surgery, age at the time of follow-up, and body
MECANO ID develops and produces composite parts using RTM (Resin Transfer Molding) and LRI (Liquid Resin Infusion) processes. In collaboration with THALES ALENIA SPACE and ONERA, this project aims at replacing titanium antenna feet, which interface the Earth deck antenna of a telecommunication satellite to its support panel, with composite feet. The objectives of the presentation are to detail: - The methodology applied to develop the composite antenna foot - The experimental validation of the foot sizing This project was granted by the French state and the region Midi-Pyrénées.
Love, Stanley G.; Morin, Lee M.; McCabe, Mary
Fifty years ago, NASA decided that the cockpit controls in spacecraft should be like the ones in airplanes. But controls based on the stick and rudder may not be best way to manually control a vehicle in space. A different method is based on submersible vehicles controlled with foot pedals. A new pilot can learn the sub's control scheme in minutes and drive it hands-free. We are building a pair of foot pedals for spacecraft control, and will test them in a spacecraft flight simulator.
Morris, J M
The human foot evolved to provide: (1) mechanisms to limit the excursion of the center of mass during ambulation and thereby minimize the expenditure of energy; (2) a base of support of sufficien dimensions for the stability necessary to maintain the upright position without excessive muscular activity; (3) mechanisms for flexibility to absorb the shock of the body weight and for accommodation to uneven terrain; (4) rigidity of the foot when it acts as a lever in the push-off period of stance.
Hardaker, W T; Margello, S; Goldner, J L
The theatrical dancer is a unique combination of athlete and artist. The physical demands of dance class, rehearsal, and performance can lead to injury, particularly to the foot and ankle. Ankle sprains are the most common acute injury. Chronic injuries predominate and relate primarily to the repeated impact loading of the foot and ankle on the dance floor. Contributing factors include anatomic variation, improper technique, and fatigue. Early and aggressive conservative management is usually successful and surgery is rarely indicated. Orthotics play a limited but potentially useful role in treatment. Following treatment, a structured rehabilitation program is fundamental to the successful return to dance.
Alavi, Afsaneh; Sibbald, R Gary; Mayer, Dieter; Goodman, Laurie; Botros, Mariam; Armstrong, David G; Woo, Kevin; Boeni, Thomas; Ayello, Elizabeth A; Kirsner, Robert S
The management of diabetic foot ulcers can be optimized by using an interdisciplinary team approach addressing the correctable risk factors (ie, poor vascular supply, infection control and treatment, and plantar pressure redistribution) along with optimizing local wound care. Dermatologists can initiate diabetic foot care. The first step is recognizing that a loss of skin integrity (ie, a callus, blister, or ulcer) considerably increases the risk of preventable amputations. A holistic approach to wound assessment is required. Early detection and effective management of these ulcers can reduce complications, including preventable amputations and possible mortality. Copyright © 2013 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.
Hsu, Andrew R; Anderson, Robert B
Physicians need to be aware of a variety of foot and ankle injuries that commonly occur in American football, including turf toe, Jones fractures, Lisfranc injuries, syndesmotic and deltoid disruption, and Achilles ruptures. These injuries are often complex and require early individual tailoring of treatment and rehabilitation protocols. Successful management and return to play requires early diagnosis, a thorough work-up, and prompt surgical intervention when warranted with meticulous attention to restoration of normal foot and ankle anatomy. Physicians should have a high suspicion for subtle injuries and variants that can occur via both contact and noncontact mechanisms.
To, Matthew J.; Brothers, Thomas D.; Van Zoost, Colin
Introduction Foot problems are common among homeless persons, but are often overlooked. The objectives of this systematic review are to summarize what is known about foot conditions and associated interventions among homeless persons. Methods A literature search was conducted on MEDLINE (1966–2016), EMBASE (1947–2016), and CINAHL (1982–2016) and complemented by manual searches of reference lists. Articles that described foot conditions in homeless persons or associated interventions were included. Data were independently extracted on: general study characteristics; participants; foot assessment methods; foot conditions and associated interventions; study findings; quality score assessed using the Downs and Black checklist. Results Of 333 articles screened, 17 articles met criteria and were included in the study. Prevalence of any foot problem ranged from 9% to 65% across study populations. Common foot-related concerns were corns and calluses, nail pathologies, and infections. Foot pathologies related to chronic diseases such as diabetes were identified. Compared to housed individuals across studies, homeless individuals were more likely to have foot problems including tinea pedis, foot pain, functional limitations with walking, and improperly-fitting shoes. Discussion Foot conditions were highly prevalent among homeless individuals with up to two thirds reporting a foot health concern, approximately one quarter of individuals visiting a health professional, and one fifth of individuals requiring further follow-up due to the severity of their condition. Homeless individuals often had inadequate foot hygiene practices and improperly-fitting shoes. These findings have service provision and public health implications, highlighting the need for evidence-based interventions to improve foot health in this population. An effective interventional approach could include optimization of foot hygiene and footwear, provision of comprehensive medical treatment, and
To, Matthew J; Brothers, Thomas D; Van Zoost, Colin
Foot problems are common among homeless persons, but are often overlooked. The objectives of this systematic review are to summarize what is known about foot conditions and associated interventions among homeless persons. A literature search was conducted on MEDLINE (1966-2016), EMBASE (1947-2016), and CINAHL (1982-2016) and complemented by manual searches of reference lists. Articles that described foot conditions in homeless persons or associated interventions were included. Data were independently extracted on: general study characteristics; participants; foot assessment methods; foot conditions and associated interventions; study findings; quality score assessed using the Downs and Black checklist. Of 333 articles screened, 17 articles met criteria and were included in the study. Prevalence of any foot problem ranged from 9% to 65% across study populations. Common foot-related concerns were corns and calluses, nail pathologies, and infections. Foot pathologies related to chronic diseases such as diabetes were identified. Compared to housed individuals across studies, homeless individuals were more likely to have foot problems including tinea pedis, foot pain, functional limitations with walking, and improperly-fitting shoes. Foot conditions were highly prevalent among homeless individuals with up to two thirds reporting a foot health concern, approximately one quarter of individuals visiting a health professional, and one fifth of individuals requiring further follow-up due to the severity of their condition. Homeless individuals often had inadequate foot hygiene practices and improperly-fitting shoes. These findings have service provision and public health implications, highlighting the need for evidence-based interventions to improve foot health in this population. An effective interventional approach could include optimization of foot hygiene and footwear, provision of comprehensive medical treatment, and addressing social factors that lead to increased risk
Neil, Janice A
In people with insensate extremities, such as those with diabetes mellitus, daily foot care and inspection can prevent the development of foot ulcers and the subsequent complications that may lead to amputation--one of the biggest threats to adults with diabetes. Preventive behaviors focus on not going barefoot, performing/receiving proper foot care, and wearing properly fitting shoes. This descriptive study of footcare practices involved a convenience sample of 61 adult men and women with type 1 or type 2 diabetes, 24 with existing foot ulcers and 37 without foot ulcers, who resided in a rural area of a southeastern state. The questionnaire was divided into four categories: foot inspection, foot cleaning, nail care, and use of footwear. Out of a possible score of 20, those with foot ulcers scored an average of 13.88 and those without ulcers averaged 13.57. These results reveal that those without foot ulcers have similar foot care practices to those with foot ulcers. This instrument is useful in assessing current foot care practices on a point-in-time basis. Preventive practices must be stressed and reinforced so those without foot ulcers do not develop ulcers.
van Schie, C H M
In general, diabetic foot ulcers result from abnormal mechanical loading of the foot, such as repetitive moderate pressure applied to the plantar aspect of the foot while walking. Diabetic peripheral neuropathy causes changes in foot structure, affecting foot function and subsequently leading to increased plantar foot pressure, which is a predictive risk factor for the development of diabetic foot ulceration. Prevention of diabetic foot ulceration is possible by early identification of the insensitive foot, therefore a foot "at risk," and by protecting the foot from abnormal biomechanical loading. Abnormal foot pressures can be reduced using several different approaches, including callus debridement, prescription of special footwear, injection of liquid silicone, Achilles tendon lengthening, and so forth. Off-loading of the diabetic wound is a key factor in successful wound healing, as it is associated with reduced inflammatory and accelerated repair processes. Pressure relief can be achieved using various off-loading modalities including accommodative dressing, walking splints, ankle-foot orthosis, total contact cast, and removable and irremovable cast walkers.
Meyr, Andrew J; Singh, Salil; Chen, Oliver; Ali, Sayed
This pictorial review focuses on basic procedures performed within the field of podiatric surgery, specifically for the hallux abductovalgus or “bunion” deformity. Our goal is to define objective radiographic parameters that surgeons utilize to initially define deformity, lead to procedure selection and judge post-operative outcomes. We hope that radiologists will employ this information to improve their assessment of post-operative radiographs following reconstructive foot surgeries. First, relevant radiographic measurements are defined and their role in procedure selection explained. Second, the specific surgical procedures of the distal metatarsal, metatarsal shaft, metatarsal base, and phalangeal osteotomies are described in detail. Additional explanations of arthrodesis of the first metatarsal-phalangeal and metatarsal-cuneiform joints are also provided. Finally, specific plain film radiographic findings that judge post-operative outcomes for each procedure are detailed. PMID:26622935
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1. VIEW SHOWING REMAINS OF CAMOUFLAGE COVERING CONCRETE FOOTING FOR A GENERATOR PAD - Fort Cronkhite, Anti-Aircraft Battery No. 1, Concrete Footing-Generator Pad, Wolf Road, Sausalito, Marin County, CA
20. LOCK GATES, 3 FOOT WALKWAY, ADJUSTMENT AT GUDGEON PIN AND QUOIN SHOE. May 1933 - Mississippi River 9-Foot Channel Project, Lock & Dam No. 17, Upper Mississippi River, New Boston, Mercer County, IL