Foot最新文献

Diabetic foot complications are serious issues resulting from uncontrolled diabetes, primarily affecting the feet. Common complications include diabetic neuropathy, ulcers, PAD, Charcot foot, and gangrene. Preventive measures include controlling blood glucose levels, regular foot inspections, proper foot care, wearing appropriate footwear, and seeking prompt medical attention. A holistic approach to diabetic foot management is crucial due to the complex interplay of physiological, psychological, and environmental factors. Glycaemic control is essential for mitigating neuropathy and vasculopathy, while cardiovascular risk factors like hypertension and dyslipidemia are crucial for preventing complications. In South Africa, podiatrists play a crucial role in diabetic foot care, offering specialized expertise in the assessment, management, and prevention of foot complications associated with diabetes mellitus. They collaborate closely with other healthcare professionals to ensure comprehensive and coordinated care.Pharmacological management is a crucial aspect of podiatric care in the UK, where podiatrists use various medications to treat foot conditions effectively. In South Africa, podiatrists lack prescribing authority, leading to limited treatment options, dependency on referrals, and disparities in access to care. This fragmented approach can compromise patient outcomes, especially in chronic conditions like diabetes. To improve patient outcomes and promote optimal foot condition management, policy reforms, interdisciplinary collaboration, and professional advocacy efforts are needed.Policy recommendations for expanding podiatrist prescribing privileges include legislative reforms, regulatory framework updates, and professional accreditation. Legislative reforms could involve amending existing healthcare laws or introducing new regulations that recognize podiatrists as authorized prescribers. Regulatory framework updates should involve working with regulatory bodies to establish prescribing standards, prescribing limitations, and mechanisms for ongoing oversight and accountability. Professional accreditation should ensure educational programs for podiatrists incorporate training in pharmacology, pharmacotherapy, and prescribing practices to prepare graduates for the expanded scope of practice.Stakeholders in South Africa can improve diabetes management by advocating for policy reforms, professional recognition, and patient empowerment initiatives. By aligning policy, practice, education, research, and advocacy efforts, stakeholders can create a supportive ecosystem that fosters innovation, collaboration, and continuous improvement in diabetic foot care.

Aim

The purpose of this study was to assess and evaluate the effect of a bespoke Modified UCBL Foot Orthosis (MUFO) using both kinetic parameters (Centre of Pressure (CoP) and the Ground Reaction Force (GRF) pattern) and comfort scores in subjects diagnosed with flat foot.

Method

This study included thirty-four young adults with symptomatic flatfeet. Two Kistler force plates (100 Hz) were used to record the CoP sway and GRF pattern during four conditions; 1) an MUFO and standard-fit shoe; 2) the University of California-Berkley Lab (UCBL) insole and standard-fit shoe; 3) barefoot and 4) standard-fit shoe only. The magnitude of subject comfort with UCBL and MUFO also was measured by a 10 cm Visual Analogue Scale (VAS) during walking.

Results

The MUFO decreased mean lateral displacement in the initial phase and midstance of gait compared to barefoot walking. During the propulsion phase use of the new MUFO produced more lateral excursion with a mean difference of 3 mm) P < 0.001(compared to barefoot walking and standard shoe wear. No significant difference in comfort rate was found between the MUFO and UCBL (P = 0.165).

Conclusion

The MUFO produced effective pronation control and decreased the CoP displacement in all of stance phase.

Introduction

The prone foot posture has a negative effect on postural stability, function, and knee valgus, but to our knowledge, the contribution of the degree of pronation has not been examined.

Methods

39 participants aged 18–40, with Foot Posture Index (FPI) scores between 6–12 and without any pain complaints were included. Participants with 6–9 points were included in the pronation group (PG) (n = 19), and participants with 10–12 points were included in the hyperpronation group (HPG) (n = 20). Static and dynamic postural stability, Foot and Ankle Ability Measure (FAAM), and frontal plane projection angles (FPPA) were measured for all participants.

Results

The initial data of the participants are distributed homogeneously. In the intergroup evaluation only FPI-1 (p = 0.001; p < 0.05), FPI-4 (p = 0.00; p < 0.05), FPI-5 (p = 0.00; p < 0.05) and FPI-T (p = 0.000; p < 0.05) scores were found significantly different.

Conclusion

Pronation and hyperpronation of the subtalar joint did not lead to a difference in postural stability, function, and knee valgus in healthy individuals. It may be more beneficial to focus on the prone posture rather than the degree of pronation.

Background

In response to the all-time high of female sports participation, there has been increasing scientific discourse and media interest in women’s sporting injuries in recent years. In gender comparable sports the rate of foot and ankle injury for women is higher than for men. There are intrinsic and extrinsic factors which may explain this difference.

Methods

A systematic literature search was performed according to the PRISMA guidelines of PubMed, Ovid EMBASE and OVID MEDLINE. Relevant key terms were used to narrow the scope of the search prior to screening. Case reports, review articles, paediatric patients, non foot and ankle injuries and combat sports were excluded. We used dual author, two pass screening to arrive at final included studies.

Results

2510 articles were screened after duplicate exclusion. 104 were included in this literature review. We identified lack of reporting gender difference in the literature.We identified that females have higher frequency and severity of injury. We provide an overview of our current understanding of ankle ligament complex injuries, stress fractures, ostochondral lesions of the talus and Achilles tendon rupture. We expand on the evidence of two codes of football, soccer and Australian rules, as a “case study” of how injury patterns differ between genders in the same sport. We identify gender specific characteristics including severity, types of injury, predisposing risk factors, anatomy, endocrinology and biomechanics associated with injuries. Finally, we examine the effect of level of competition on female injury patterns.

Conclusions

There is a lack of scientific reporting of gender differences of foot and ankle injuries. Female athletes suffer foot and ankle injuries at higher rates and with greater severity compared to males. This is an under-reported, yet important area of orthopaedics and sports medicine to understand, and hence reduce the injury burden for female athletes.

Introduction

Plantar fasciopathy is a common foot-related musculoskeletal disorder. It has been hypothesized that this disorder could be linked to a dysfunctional windlass mechanism. However, no study to date has quantified this link to validate or refute this hypothesis. The first metatarsophalangeal joint (1st MPJ) dorsiflexion resistance test is a reliable test to evaluate the force required to initiate the windlass mechanism. Comparing the results of this test in individuals with and without plantar fasciopathy will allow for a better understanding of the relationship between plantar fasciopathy and the windlass mechanism. Thus, this study aimed to compare 1st MPJ dorsiflexion resistance in individuals with plantar fasciopathy and healthy controls. Additionally, this study aimed to explore the correlations between 1st MPJ dorsiflexion resistance and other commonly used foot orthopedic tests, specifically the supination resistance test and the Foot Posture Index.

Material and methods

Twenty participants with plantar fasciopathy and 20 healthy controls were recruited in this case-control study. First MPJ dorsiflexion resistance was quantified and compared between groups and between feet using a repeated measures ANOVA with one within-subject factor with two levels and one between-subject factor with two levels. It was also correlated with supination resistance and the Foot Posture Index.

Results

There were no significant differences in 1st MPJ dorsiflexion resistance between injured and healthy feet as well as control and plantar fasciopathy groups. There was a moderate to strong correlation (r = 0.674 to 0.891) between 1st MPJ dorsiflexion resistance and supination resistance in both groups. There was no significant correlation between 1st MPJ dorsiflexion resistance and the Foot Posture Index.

Conclusions

The lack of alterations in 1st MPJ dorsiflexion resistance among individuals with plantar fasciopathy implies a potential need to reconsider the biomechanical model, proposing that a dysfunctional windlass mechanism is associated with the development of plantar fasciopathy, may need reconsideration.

The aim of the study was to measure and compare plantar pressures, forces and gait parameters in athletes with and without hallux valgus. It was a cross sectional study with the sample Size: 106 [53 for each group (Hallux valgus and without hallux valgus)]. Hallux valgus angle was calculated with digital photographs uploaded on Karasunpo software. Participants only with the moderate and severe hallux valgus angle were selected. For participant having hallux valgus in both the feet, one with the greater angle of hallux valgus was selected. Participants without hallux valgus were the ones whose hallux valgus angle was less than 15 degrees. The participants of both groups were asked to walk on predetermined speed of 4.8 kmph. The device used was Zebris FDM-T (Zebris® Medical GmbH, Germany) for the pedobarographic and gait parameter measurement. On an average, measurement was recorded for 20 steps during the different phases of gait in all subjects and corresponding mean values were calculated. Mean values for all the readings were documented and statistically calculated. Statistical analysis was done using SPSS (v.27.0.1) with unpaired t-test to compare between both the groups. Shapiro-Wilk test was used to check normality of data. Significant p-values for forefoot forces (0.001), forefoot pressures (<0.001) and midfoot pressures (0.002) were found. There is clear evidence of increased foot loading in young adult athletes with hallux valgus on the forefoot and midfoot regions while performing activities.

Background

Böhler’s angle (BA) is used for identifying calcaneal fractures and evaluating calcaneal collapse after reconstruction. This study investigates whether it is possible to determine BA with the help of Computed Tomography (CT).

Methods

A retrospective study was performed to compare the BA on conventional radiograph (Gold Standard, GS) versus measurements on CT. Two groups were studied: one group consisted of 11 subjects with a diagnosed calcaneal fracture, the other group of 11 subjects with a fracture of the lower extremities but no calcaneal fracture. A lateral Böhler angle (LBA), central Böhler angle (CBA) and a medial Böhler angle (MBA) were defined on CT. Furthermore, BA was reconstructed out of a 3D reconstruction (3DBA).

Results

CBA approached the GS with a mean difference of 3.78° (95 %CI: 2.82–4.75) with no significant difference in variance (p = 1.000). 3DBA approached the GS with a mean difference of 2.14° (95 %CI: 1.57–2.70) with a significant difference in variance (p = 0.014). No relevant correlations were found between LBA/MBA and the GS. ICC between raters was considered as good or excellent for both CBA and 3DBA.

Conclusion

Giving the high accuracy and better capability to visualize the anatomy in the case of severe injury, measuring BA on 3D reconstruction is a suggested alternative to the traditional technique.

Level of evidence

III, Retrospective

Heel pain is a prevalent issue in young athletes, often arising from overuse and increased sporting demands. While Sever's Disease is the predominant cause, various other entities, including stress-related injuries and pathologies like tumors and bone lesions, contribute to this condition. The complex hind foot anatomy, encompassing ossicles, physis, and soft tissues, may lead to heel pain. This study aims to provide physicians with a clinically oriented narrative review of adolescent heel pain, supported by illustrative cases.

Conclusion

This study aims to offer physicians a comprehensive understanding of the concepts surrounding heel pain in adolescents. By presenting clinically relevant information and illustrated cases, it seeks to enhance medical practitioners' ability to diagnose and manage heel pain effectively in this specific demographic

Although the ankle is often involved in low energy trauma, high-energy trauma may occur, being this considered more serious and more common of affecting young and active men. The purpose of the present study was to evaluate and compare the functionality, pain and quality of life of active and inactive adult individuals whose ankle fracture was surgically treated. Seventy-six patients split into two groups (active, n = 58 X inactive, n = 18), of the men (active, n = 38; inactive, n = 9) and women (active, n = 20; inactive, n = 9) gender participated in this prospective study. The IPAQ, MMSE, SF-36, VAS, sociodemographic and clinical questionnaires were applied in person right after surgery. The SF-36 and VAS questionnaires were reapplied 3 months in average after the surgery. Active and inactive patients of both genders show significant differences (p ≤ 0.05) in the functional capacity and physical aspect domains; and the bodily pain domain revealed significant difference in active and inactive men (p ≤ 0.05) between the periods post-surgical and 3 months after surgery (on average). Moderate and significant correlations were found (p ≤ 0.05) between functional capacity, physical aspect and bodily pain domains of the SF-36 and the VAS pain scores for active and inactive patients of both genders in the final follow-up period. Other significant correlations (p < 0.05) for inactive men (physical aspect and bodily pain) and inactive women (functional capacity and bodily pain) are observed (after 3 months of surgery). Three months after surgery (on average), active and inactive men had functional limitations and pain symptoms. These factors seem to have negatively influenced the patient's social involvement, worsening their quality of life. Most active and inactive patients had a positive self-perception of their general health status, emotional aspects and mental health domains. Regarding active women, we observed lower energy and vitality after the same postoperative period.

Charcot neuroarthropathy (CN) of the ankle joint can cause marked bone resorption of the talus resulting in severe deformity and instability. The utilisation of a 3-D printed bespoke titanium porous block that allows the use of an intramedullary calcaneo-tibial nail is an attractive option in such cases that has been reported for use in post-trauma deformities, following tumour resections, in avascular necrosis of talus and for revision of failed total ankle replacements, however has not previously been reported for Charcot ankle reconstructions. We present a novel case and surgical technique illustrating the use of a 3-D printed titanium porous block and hindfoot nail for reconstruction of a deformed and unstable Charcot hindfoot.