Revista Espanola de Podologia最新文献

The longitudinal arch of the human foot is a complex mechanical structure that must be compliant on uneven surfaces and also have sufficient stiffness to allow the foot to be an efficient propulsive organ during walking and running gait. To serve these functions, the longitudinal arch has a unique four-layer load-sharing system consisting of the plantar fascia, plantar intrinsic muscles, plantar arch extrinsic muscles and plantar ligaments. These four layers of tension load-bearing elements, working together with the osseous elements which serve as the framework of the longitudinal arch, work synergistically to increase longitudinal arch stiffness during weightbearing activities. The passive tension load-bearing elements of this load-sharing system, the plantar fascia and plantar ligaments, are not under direct central nervous system control and thus serve to stiffen the longitudinal arch with an automatic stiffening mechanism that is based on Achilles tendon tension and plantar forefoot loading. The active tension load-bearing elements, the plantar intrinsic and plantar extrinsic muscles, are under direct central nervous system control and serve to increase or decrease the stiffness of the medial and lateral longitudinal arches depending on the type and intensity of the prevailing weightbearing activity of the individual. Together, the elements of the longitudinal arch load-sharing system ensure that proper weightbearing function of the longitudinal arch, and the foot and lower extremity, can still occur even when a failure of one of these tension load-bearing elements occurs due to injury.

Introduction

Deformity and foot pain are almost omnipresent (90%) in rheumatoid arthritis (RA), due to the interaction between inflammation and abnormal biomechanical. Non-pharmacological interventions (insoles, footwear) have an important role but it is still a careless area. Clinical practice guidelines (CPG) have recommendations for patient care, reducing variability in clinical practice. There are several general CPG to treat patients with RA, but not for foot pathology. The aim of this work is to develop CPG meeting the demand of non-pharmacological treatment of foot pathology in patients with RA.

Method

Review of the scientific literature to identify all CPG of RA and foot, between 1975-2016. The instrument used to evaluate the CPG was the AGREE II.

Results

In relation to the overall quality, the best CPG is NICE CPG (score 6/7) and GUIPCAR and Brazilian Society of Rheumatology Consensus for the treatment of rheumatoid arthritis CPG have the lowest score. In relation to the recommendations of the foot, not all CPG have them (Brazilian Society of Rheumatology Consensus for the treatment of rheumatoid arthritis CPG no) and those with more are the HAS and Guidelines for the management of the foot health problems associated with rheumatoid arthritis CPG.

Conclusion

In general, the best CPG in AR is NICE CPG. There are also three other recommended GPC: RACGP, SIGN and non-drug treatment (excluding surgery) in rheumatoid arthritis GPC.

Introduction

There is no clear consensus regarding the best surgical treatment options in patients with hallux rigidus. The present study compares the effectiveness of 2 commonly used techniques in advanced cases of hallux rigidus: Keller artrhoplasty and hemi-implant artrhoplasty.

Patients and methods

All cases of hallux rigidus that underwent surgical treatment with either Keller or hemiimplant artrhoplasties during the year 2004 were analyzed. AOFAS scale and several angles in A/P x-rays were used for comparison at the preoperative moment and at 6 months, 1 year, 3 years and 5 years postoperatively.

Results

A total of 54 feet were included in the study (27 in each group of treatment). No differences were observed between groups in the AOFAS scale in all the postoperative moments analyzed. Significant differences were observed in the AOFAS score and in the complications of the techniques in each separate group by age factor.

Discussion

The results of the techniques of podiatric surgery of Keller and hemi-implant arthroplasty seems to be dependent on the age of the patient and progress time. Keller artrhoplasty have offered better results in patients older that 55, independently of the sex, but transfer metatarsalgia at 3 and 5 years is a common postoperative finding. The hemi-implant procedure seems to be more beneficial in patients less that 55.

Psoriasis is a chronic autoimmune inflammatory disease that affects the skin and joints. Although its most common presentation is under the form of chronic erythematous-scaly plaques, there are different clinical forms that also are affected as well as the skin, nails and joints. We report a case of palmoplantar pustular psoriasis in an adult woman with recurrent itchy lesions on the palm of the hands, in which the computed tomography (CT) identified erosive signs on the sternal manubrium joint, which the presented clinical oriented diagnosis of SAPHO syndrome (synovitis, acne, pustulosis, hyperostosis and osteitis).

Introduction

There is no clear consensus regarding the best surgical treatment options in patients with hallux rigidus. The present study compares the effectiveness of two commonly used techniques in advanced cases of hallux rigidus: Keller arthroplasty and hemi-implant arthroplasty.

Patients and methods

All cases of hallux rigidus that underwent surgical treatment with either Keller or hemi-implant arthroplasties during the year 2004 were analyzed. AOFAS scale and angles in A/P X-rays were used to compare at the preoperative moment and at 6 months, 1, 3 and 5 years postoperatively.

Results

A total of 54 feet were included in the study (27 in each group of treatment). No differences were observed between groups in the AOFAS scale in all the postoperative moments analyzed. Significant differences were observed in the AOFAS score and in the complications of the techniques in each separate group by age factor.

Discussion

The results of the techniques of podiatric surgery of Keller and hemi-implant arthroplasty seem to be dependent on the age of the patient and progress time. Keller arthroplasty has offered better results in patients over 55, independently of the sex, but transfer metatarsalgia at 3 and 5 years is a common postoperative finding. The hemi-implant procedure seems to be more beneficial in patients less that 55.

The longitudinal arch of the human foot is a complex mechanical structure that must be compliant on uneven surfaces and also have sufficient stiffness to allow the foot to be an efficient propulsive organ during walking and running gait. To serve these functions, the longitudinal arch has a unique four-layer load-sharing system consisting of the plantar fascia, plantar intrinsic muscles, plantar arch extrinsic muscles and plantar ligaments. These four layers of tension load-bearing elements, working together with the osseous elements which serve as the framework of the longitudinal arch, work synergistically to increase longitudinal arch stiffness during weightbearing activities. The passive tension load-bearing elements of this load-sharing system, the plantar fascia and plantar ligaments, are not under direct central nervous system control and thus serve to stiffen the longitudinal arch with an automatic stiffening mechanism that is based on Achilles tendon tension and plantar forefoot loading. The active tension load-bearing elements, the plantar intrinsic and plantar extrinsic muscles, are under direct central nervous system control and serve to increase or decrease the stiffness of the medial and lateral longitudinal arches depending on the type and intensity of the prevailing weightbearing activity of the individual. Together, the elements of the longitudinal arch load-sharing system ensure that proper weightbearing function of the longitudinal arch, and the foot and lower extremity, can still occur even when a failure of one of these tension load-bearing elements occurs due to injury.

Introduction

The aim of this study was to determine whether subjects with advanced hallux limitus show a diminished ability of internal rotation of the lower limb and increased foot progression angle compared with normal population. It was also intended to relate rotational and torsional patterns of lower limbs with the foot progression angle, and to compare three different methods of measurement of the foot progression angle.

Patients and methods

Internal and external rotational pattern, internal and external hip rotation and tibial torsion were measured in 30 feet of 15 subjects with advanced hallux limitus and 103 normal feet. The foot progression angle was also obtained using a pressure platform and an inked latex carpet.

Results

The internal rotation of the lower limb was significantly lesser and the foot progression angle was significantly greater in individuals with advanced hallux limitus (p < 0.05). The Pearson correlation coefficient was −0.563 (p < 0.01) for the relationship between the foot progression angle and the internal rotational pattern. The measure of the foot progression angle in the inked latex carpet was significantly greater than in the pressure platform in the left foot (p < 0.05).

Conclusion

Subjects with advanced hallux limitus had a lesser capacity of internal rotation of the lower extremity and greater foot progression angle in comparison with normal population. Internal rotational pattern determines the greater foot progression angle. The foot progression angle values measured with the pressure platform differ from those of the inked latex carpet.