EMC - Podologie最新文献

Analysis of the joint fluid is an important step of the rheumatologic diagnosis. Cell count must be performed early after puncture; a cell count over 2000 elements/mm³ establishes a diagnosis of inflammatory rheumatism whereas a mechanical affection is diagnosed when it is less than 1000 elements/mm³. A bacteriological assessment should be carried out in emergency prior to any antibiotherapy. Evidence of bacterium by direct examination or culture indicates an infectious arthritis and allows selecting the adequate antibiotic treatment. Crystal screening is a rapid and inexpensive procedure for the diagnosis of crystal-related arthritis. The assessment must run on a fresh fluid sample, between two strips, using successively a standard microscope and a polarizing microscope. Adding a compensator and a revolving stage helps identifying more reliably monosodium urates, with a negative double refringency, and dehydrated calcium pyrophosphates with a positive double refringency. Other crystals (cholesterol, oxalate, cortisone…) may be identified also. To avoid artefact sources, especially anticoagulant crystals, the fluid sample must be collected on a small amount of sodium or citrate heparinate.

The purpose of this study was to compare joint coupling patterns and variability of the rearfoot and tibia during running in subjects who were treated with two types of orthotic devices to that of controls. Eleven subjects with various lower extremity injuries were treated unsuccessfully with a standard orthotic, and then successfully with an inverted orthotic. Three-dimensional kinematic data were collected while subjects ran without orthoses and then in standard and inverted orthoses. Eleven healthy subjects ran without orthoses for comparison. The rearfoot inversion/eversion and tibial internal/external rotation joint coupling pattern and variability relationship was assessed using a vector coding technique. It was hypothesized that when the treated runners ran without orthotic devices, they would exhibit lower joint coupling angles and lower joint coupling variability compared to the controls. In addition, it was hypothesized that there would be no difference in the coupling angle or coupling variability between the standard and no orthotic conditions of the treated runners. Finally, it was hypothesized that coupling angle would decrease and variability would increase in the inverted versus the standard and non-orthotic conditions. No significant differences in joint coupling pattern or variability were observed between the treated and control subjects. In addition, no significant differences were noted between the orthotic conditions in the treated group. These results suggest that foot orthotic devices do not produce significant changes in rearfoot–tibial coupling. Therefore, the relief experienced with the inverted orthotic is likely due to factors other than alterations in this coupling.

Information derived from footprint data serves as a useful, reliable and objective component to the assessment of patients with musculoskeletal pathology. Common spatial parameters extrapolated from such data include the angle and base of gait. Previous research has described a reliable method for analysing dynamic footprint data. While this data remains fundamental, few studies, if any have documented the comparisons of dynamic and static footprints. The purpose of this study was to ascertain the differences between the angle and base of gait from dynamic and static footprint data. Twenty-five subjects provided three dynamic (mid-gait analysis) and three static footprints. Intra-rater reliability of the measurement technique for both the angle and base of gait was found to be excellent (P >0.001) for each of the two conditions (dynamic and static). Comparisons between the dynamic and static condition revealed no significant differences (P <0.0001) for the angle of gait, whilst significant differences were noted between the static and dynamic condition for the base of gait. Further analysis using linear regression identified that the angle of gait for the left and right foot predicted a 67 and 60% of that of a dynamic situation; a slightly lower prediction of 54% was noted for base of gait. These results suggest that static footprints do demonstrate some prediction of dynamic function when assessing the angle and base of gait in normal subjects.

Three unusual medieval examples of pedal bone infection are presented. All occur in males excavated from the cemetery of St. James' Abbey, Northampton. One case was active at the time of death and exhibits exuberant periosteal reaction. In another, fusion of the bones and obliteration of joint space indicates a chronic infection with evidence of healing. The large sample (n = 278) of skeletons presents with a high frequency of bone pathology, including serious fractures, rare congenital deformities and specific chronic infection. This suggests that the associated infirmary enjoyed a large catchment area and was a popular choice for the sick. Such pedal bone infection has rarely been reported in archaeological material. These cases permit examination of the skeletal response to infection prior to the modern antibiotic era.

The os trigonum syndrome is a rare entity with scant evidence in literature regarding diagnosis and treatment. The current literature concerning the clinical presentation, diagnostic techniques and treatment options are reviewed.

That plantar fasciitis is one of the most common causes of heel pain is beyond dispute. It is also by far the most common sports injury presenting to the office of the sports podiatrist and accounts for approximately 15 % of all foot related complaints. The term plantar fasciitis itself has been responsible for considerable confusion, since the condition usually presents as a combination of clinical entities, rather than the discete diagnosis of plantar fasciitis. For this reason, it may be preferable to consider the condition a syndrome, and alter the nomenclature to plantar heel pain syndrome (PHPS). Despite its wide distribution in the sporting and general communities, there remains widespread debate on its aetiology and dissatisfaction with a lack of reliable treatment outcomes. This paper describes the unique anatomical and biomechanical features of plantar fasciitis which may in part explain its resistance to treatment. The history and physical examination are described along with potential differential diagnoses. Because plantar fasciitis is multi-faceted in nature, treatment may be directed at the wrong focus, resulting in poor outcomes and prognosis. The most common conservative management techniques are described, and a new, reliable method of taping is proposed.