Foot最新文献

Background

Objective

Design

Method

Results

Conclusions

Introduction

Methods

Results

Discussion

This study aimed to evaluate maximum toe flexor strength, foot arch height, intrinsic toe flexor muscle size and foot arch stiffness among individuals with different body sizes, and to compare these variables between sitting and standing positions. Maximum toe flexor strength in sitting and standing, and intrinsic foot muscle thicknesses (flexor hallucis brevis: FHB, flexor digitorum brevis: FDB, abductor hallucis: AH and quadratus plantae: QP), were measured using a toe grip dynamometer and a B-mode ultrasound in healthy young men. FHB was thicker than AH, FDB and QP, AH was thicker than FDB and QP, and no significant difference was found between FDB and QP. Toe flexor strength was correlated with FHB and AH, and foot arch height was correlated with FHB. Toe flexor strength was greater in standing than in sitting. Stepwise multiple regression analysis identified FHB and AH as determinants of toe flexor strength in standing, and the relative muscle strength values per body weight in standing were determined by QP, foot arch index and foot arch stiffness. Overweight individuals had a decreased rate of increase in relative toe flexor strength compared to normal individuals. These results suggest that a large muscle thickness of intrinsic foot muscle a key contributor to toe flexor strength. Moreover, toe flexor muscle in upright standing could have the potential to generate force independently of intrinsic foot muscle size, but obese individuals who chronically put weight on their feet might impair the force amplification mechanism in upright standing.

Objective

To evaluate the accuracy of the Ipswich touch test compared to the 10-g monofilament test for identifying of loss of protective sensation in Thai patients with diabetes mellitus.

Methods

A cross-sectional observational study was conducted on Thai patients with diabetes mellitus who attended routine annual foot check-ups in an outpatient diabetes clinic. The loss of protective sensation was assessed by the Ipswich touch test and compared with the Semmes-Weinstein 10-g monofilament test. Sensitivity, specificity, predictive values and likelihood ratios were calculated to measure the accuracy of the Ipswich touch test against 10-g monofilament as a reference standard. The interrater reliability of the Ipswich touch test was assessed by two raters.

Results

In a study of 283 diabetic patients, 10-g monofilament detected a 25 % prevalence of loss protective sensation. The Ipswich touch test demonstrated a good diagnostic accuracy, with a sensitivity of 70.8 %, specificity of 98.6 %, and an area under the curve of 0.85 when compared to 10-g monofilament. Positive and negative predictive values were 94.4 % and 90.8 % respectively. The positive likelihood ratio was 49.82, and the negative likelihood ratio was 0.30. Interrater reliability, assessed with two raters in a subset of 93 participants, yielded a kappa of 0.88, indicating almost perfect agreement.

Conclusions

The Ipswich Touch Test demonstrated good accuracy and interrater reliability compared to the standard 10-g monofilament, thus establishing its effectiveness as a valuable diagnostic tool for identifying loss of protective sensation among diabetic patients. However, its relatively low sensitivity suggests it should be used with caution as a screening tool.

Aims

Patient reported outcome measures (PROMs) have become the de facto measure of success in orthopaedic publications. It has been established that preoperatively collected patient reported outcomes correlate with post-operative outcome. The aim of our research is to identify which factors predict poor pre-operative scores using the most commonly used PROMs.

Methods

MOXFQ and EQ-5D scores were collected for all patients presenting for elective foot and ankle surgery over a four-year period from June 2018 to February 2022. Multivariate linear regression calculated associations between PROMs and demographics, diagnosis, pre-operative appointments and comorbidities.

Results

1217 patients had PROMs taken, 1102 of these underwent a surgical procedure. Ankle and hindfoot arthritis predicted worse pre-operative scores. Total comorbidity number, depression/anxiety, younger patients, female gender and preoperative appointments with orthotist predicted a worse outcome score.

Conclusion

Underlying patient characteristics can influence pre-operative PROMs in foot and ankle surgery.

The Scarf osteotomy involves inherent risks and technical challenges. The short scarf osteotomy with single screw fixation has emerged as an alternative approach. This study aims to evaluate the patient-reported outcome measures (PROMs), radiological outcomes, and complications associated with the short scarf osteotomy fixed with a single screw for hallux valgus correction. A prospective cohort study was conducted between October 2018 and October 2023 at a single center, encompassing 271 osteotomies. PROMs were collected prospectively preoperatively and at various postoperative intervals. Radiographic data, including hallux valgus angle (HVA) and intermetatarsal angle (IMA), were measured preoperatively and six weeks postoperatively. Complications were also documented. Statistically significant improvements were observed in all PROMs and were sustained up to 24 months postoperatively. The Visual Analog Scale (VAS) pain score demonstrated a significant reduction from 46.97 at baseline to 12.52 at 24 months (p < 0.001). Likewise, the EQ-5D score improved notably from 0.73 preoperatively to 0.81 at 24 months (p = 0.002). Analysis of the Manchester-Oxford Foot Questionnaire (MOXFQ) revealed substantial improvements across its pain, walking/standing, and social interaction domains over the same period, with all changes showing statistical significance (all p < 0.001). Radiographically, the mean HVA improved significantly from 31.33° preoperatively to 13.33° postoperatively (p < 0.001). Similarly, the mean IMA improved significantly from 14.67° to 7.66° (p < 0.001). The most common complication was superficial wound infection, effectively managed with oral antibiotics. The were no cases of avascular necrosis or fracture. In conclusion, the short Scarf osteotomy fixed with a single screw demonstrates favorable outcomes. These findings support its efficacy and safety as a treatment option, with potential advantages over the conventional technique. Further prospective studies are warranted to validate these findings.

Background

Fluoroquinolone antibiotics can increase the risk of tendon rupture. Treatment of these Achilles ruptures can be difficult due to comorbidities.

Methods

A case series of 13 consecutive patients with Achilles ruptures following fluoroquinolone use were identified over a 2 year period through the Achilles Tendon rupture clinic and managed conservatively using functional rehabilitation. Follow-up with the Achilles tendon rupture score (ATRS) was completed at 3 months, 6 months and 12 months.

Results

Improvements were seen in ATRS scores over 12 months.

Conclusions

This case series is the largest published. Improvements were seen in ATRS scores indicating that this cohort can be managed successfully using functional rehabilitation after fluoroquinolone-induced Achilles rupture.

Background

Blood flow restriction exercise (BFRE) has been proposed as a viable method for preserving muscle mass and function after an injury during periods of load restrictions such as after an acute Achilles tendon rupture. However, its effectiveness and safety in patients with an Achilles tendon rupture have yet to be evaluated in a randomized trial.

Objectives

First, to investigate the effectiveness of early initiated BFRE in patients with non-surgically treated acute Achilles tendon rupture. Second, to evaluate whether it is better to apply BFRE in the beginning (1–12 weeks) or later (13–24 weeks) in the rehabilitation period.

Methods

This is an assessor-blinded, randomized, controlled multicenter trial with patients assigned in a 1:1 ratio to two parallel groups, that either receive BFRE in weeks 1–12 followed by usual care in weeks 13–24, or receive usual care in weeks 1–12 followed by BFRE in weeks 13–24. The BFRE program is performed three times weekly on the injured leg at 80 % of the pressure required to fully restrict the arterial blood flow. Post-intervention tests are conducted in week 13, comparing early BFRE with usual care, and in week 25, comparing early BFRE with late BFRE. At the 13-week evaluation, the primary outcome is the Single-Leg Heel-Rise test which assesses the patient’s ability to raise the heel of the injured leg a minimum of 2 cm. At the 25-week evaluation, the primary outcome is the Achilles tendon Total Rupture Score which assesses the patient’s self-reported symptoms and physical ability.

Objective

The optimal treatment and rehabilitation strategy for acute Achilles tendon rupture (ATR) remain a debate. This study aimed to compare the results of the two postoperative regimens after treatment for ATR with modified closed percutaneous repair under local anesthesia.

Methods

In a 4-year study, 72 consecutive patients with acute complete ATR were randomized after percutaneous repair into a functional group (FG), using a modified brace (28 males, three females; mean age 41.9 [29–71] years) and an immobilization group (IG), wearing a rigid plaster (28 males, two females; mean age 42.2 [29–57] years), for a period of 6 weeks. Except for immobilization, they followed the same weight-bearing and rehabilitation protocols. The follow-up period was 3 years. The complication rate, active and passive ankle range of motion, standing heel-rise test, clinical outcome using the American Foot and Ankle Society (AOFAS) hindfoot-ankle score, return to the previous activity level, and subjective assessment were assessed.

Results

There was one rerupture in the IG and two transient sural nerve disturbances in the FG and one in the IG, and one suture extrusion in the IG, with no other complications. The average AOFAS scores were 96.9 ± 4.3 and 96.0 ± 4.9 in the FG and IG, respectively. Patients in the FG reached a final range of motion and muscular strength sooner without limping and were more satisfied with the treatment. No significant differences could be detected between groups according to the results in any of the assessed parameters.

Conclusion

Early dynamic functional bracing in patients with ATR treated with modified closed percutaneous repair under local anesthesia resulted in earlier functional recovery with similar final results in terms of complications and functional outcomes, such as rigid postoperative immobilization with standardized rehabilitation and weight-bearing protocol.

Level of evidence

I, Prospective randomized study

Background

Lateral cord plantar fasciitis (LCPF) causes atraumatic pain at the fifth metatarsal base. This study assesses the outcomes of a conservative treatment (PRP + casting) on LCPF.

Methods

Medical history, clinical diagnosis, and ultrasound imaging were used to determine LPCF. All patients received a leucocyte-poor PRP injection at the proximal part of the fifth metatarsal base, followed by three weeks in a walking cast. Follow-up questionnaires, encompassing NRS, AOFAS, and Foot Functioning Index (FFI), were administered at 6 weeks, 12 weeks, and 2 years post-treatment.

Results

Ten patients were enrolled in the study. Ultrasound findings revealed hyposonant and thickened lateral fascia plantaris at the MT 5 insertion point with normal peronei tendons. There was a notable reduction in pain from pre-treatment (NRS_rest 55.1 ± 29.6, NRS_activity 79.20 ± 15.5) to 6 weeks post-treatment (NRS_rest: 22.4 ± 23.6, p = 0.03; NRS_activity: 38.6 ± 30.3, p = 0.005). FFI indicated an improvement between 12 weeks (25.7 ± 25.7) and 2 years (9.1 ± 8.5) compared to pre-treatment (42.6 ± 16.7).

Conclusion

Ultrasound stands out as the preferred diagnostic method for identifying LCPF. A PRP injection followed by a walking cast proves effective in relieving LCPF symptoms within six weeks with sustained relief up to two years.

Level of evidence

Level IV