Foot最新文献

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.

Introduction

Methods

Results

Conclusion

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.

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.

Introduction

Methods

Results

Discussion

Background

Objectives

Key findings

Conclusion

Level of Clinical Evidence

Background

Objective

Design

Method

Results

Conclusions

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.

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.