Appearance Of Foot Research Articles

A nomogram-based diabetic sensorimotor polyneuropathy severity prediction using Michigan neuropathy screening instrumentations

BackgroundDiabetic Sensorimotor polyneuropathy (DSPN) is one of the major indelible complications in diabetic patients. Michigan neuropathy screening instrumentation (MNSI) is one of the most common screening techniques used for DSPN, however, it does not provide any direct severity grading system. MethodFor designing and modeling the DSPN severity grading systems for MNSI, 19 years of data from Epidemiology of Diabetes Interventions and Complications (EDIC) clinical trials were used. Different Machine learning-based feature ranking techniques were investigated to identify the important MNSI features associated with DSPN diagnosis. A multivariable logistic regression-based nomogram was generated and validated for DSPN severity grading using the best performing top-ranked MNSI features. ResultsTop-10 ranked features from MNSI features: Appearance of Feet (R), Ankle Reflexes (R), Vibration perception (L), Vibration perception (R), Appearance of Feet (L), 10-gm filament (L), Ankle Reflexes (L), 10-gm filament (R), Bed Cover Touch, and Ulceration (R) were identified as important features for identifying DSPN by Multi-Tree Extreme Gradient Boost model. The nomogram-based prediction model exhibited an accuracy of 97.95% and 98.84% for the EDIC test set and an independent test set, respectively. A DSPN severity score technique was generated for MNSI from the DSPN severity prediction model. DSPN patients were stratified into four severity levels: absent, mild, moderate, and severe using the cut-off values of 17.6, 19.1, 20.5 for the DSPN probability less than 50%, 75%–90%, and above 90%, respectively. ConclusionsThe findings of this work provide a machine learning-based MNSI severity grading system which has the potential to be used as a secondary decision support system by health professionals in clinical applications and large clinical trials to identify high-risk DSPN patients.

Anatomy of the Dorsum of the Foot and Its Relevance for Nonsurgical Cosmetic Procedures.

Operative procedures to enhance the aesthetic appearance of the feet are associated with risks. Minimally invasive procedures to volumize the dorsum of the foot are to this point not described. The present study investigates the safety and efficacy of such procedures in a retrospective clinical, anatomical, and ultrasound-based study. A total of 106 feet from 53 female patients (mean age, 64.1 ± 8.3 years) were investigated retrospectively after the injection of a commercially available calcium hydroxylapatite product using a single-entry proximal-to-distal fanning injection technique. Anatomical dissections in 20 fresh, nonembalmed feet from 10 human body donors (mean age, 83.1 ± 8.8 years) were dissected, and 20 feet from 10 healthy volunteers (mean age, 26.5 ± 6.2 years) were examined by ultrasound imaging to help guide conclusions. Aesthetic outcome after 3 months was graded by the patients as 4, connoting good improvement (range, 3 to 5). No allergic reactions or other types of adverse events were documented. The layered anatomy of the dorsum of the foot was confirmed by anatomical dissections and ultrasound imaging as follows: skin, dorsal superficial fatty layer, dorsal superficial fascia, dorsal intermediate fatty layer, superficial lamina of the dorsal deep fascia, dorsal deep fatty layer, and deep lamina of the dorsal deep fascia. Minimally invasive injections of soft-tissue filler in the dorsum of the foot can provide an alternate solution to enhance the aesthetic appearance of feet. The present study provides support for the safety and efficacy of volumizing procedures using a 22-gauge, 50-mm, blunt-tip cannula. Therapeutic, IV.

Role of footwear allergens in juvenile plantar dermatosis

<p class="abstract"><strong>Background:</strong> Juvenile plantar dermatosis (JPD) is characterized by shiny dry fissured dermatitis of the plantar surface of the foot, affecting children aged 3-14years. The most accepted theory is that JPD is a frictional contact dermatitis of the forefoot in which atopics are more prone to develop. Allergic contact dermatitis remains a close differential diagnosis; it can aggravate the predisposing JPD. In this background we carried out a study among children aged fourteen years and below with clinically diagnosed JPD to know the age and sex profile, aggravating factors and clinical features in this part of the country<span lang="EN-IN">.</span></p><p class="abstract"><strong>Methods:</strong> All children aged 14 years and below with JPD attending our outpatient department from November 2006 to November 2007 were included in this study. Using a preset proforma, data regarding age and sex, information on any relation to footwear, past history of allergic disorders in person or family members was collected. All the 40 patients were patch tested using the footwear allergen series in petrolatum base. Patch test unit was removed after 48hours and the results were interpreted using criteria laid down by International Contact Dermatitis Group (ICDRG). The data was analyzed and made an attempt to understand the role of footwear allergy in JPD.</p><p class="abstract"><strong>Results:</strong> 22 girls and 18 boys attended our OPD with JPD between the age group of 4-14 years. 52.5% were using footwear made of plastic; 25%used leather; 12.5% rubber footwear. Patients presented with erythema and glazed appearance of foot along with fissuring. The areas of involvement were distal soles and toes in 70%, distal sole alone in 7.5% and distal sole and dorsum of toes in 22.5% of patients. Personal history of atopy was documented in 15% of patients and family history of atopy was present in 20% of cases. 20% of patients complained of exacerbation with footwear. Of the 40 patients who underwent patch testing, 10% only showed <span lang="EN-IN">positive patch test reaction mainly to potassium dichromate (5%). </span></p><p class="abstract"><strong>Conclusions:</strong> JPD is not an uncommon disease and it predominantly affects school going children. Seasonal variation was associated with aggravation of disease. Specific footwear was identified to cause flare ups in a significant percentage of study population (20%) and this was proven by patch test results in half of them. Though nearly one fifth of the affected had an atopic diathesis in person or family, the present data suggests that JPD is not exclusive to atopics. A large sized study is required to <span lang="EN-IN">evaluate the role of footwear in JPD.</span></p>

Bow legs and knock knees: is it physiological or pathological?

Knock knees and bow legs are commonly seen pediatric orthopedic problem, as the child grows the knee undergoes sequential changes in the axial development from varus to valgus. Differences in appearance of foot and position of foot while the child is walking as noticed by parents most often reflect variations of normal physiological development. As parents are not aware of normal growth and development of lower-extremity, and desire for normal alignment in their children, they are very much concern and motivated to seek medical advice. Many children are referred unnecessary to orthopedician for treatment of physiological genu varum and genu valgus which is unnecessary and may turn out to be sometimes harmful also. Most parents are happy to be reassured that this children deformity is with normal limits and will disappear. For this the physician should be aware of when to consider as physiological and pathological for which he has to take a detailed history of the problem, perform a detailed examination to rule out pathological causes. So, this article helps us to know when to consider physiological and rule out pathological so as to avoid unnecessary interventions for the child.

Interpreting outcome following foot surgery in people with rheumatoid arthritis.

BackgroundFoot surgery is common in RA but the current lack of understanding of how patients interpret outcomes inhibits evaluation of procedures in clinical and research settings. This study aimed to explore which factors are important to people with RA when they evaluate the outcome of foot and ankle surgery.Methods and ResultsSemi structured interviews with 11 RA participants who had mixed experiences of foot surgery were conducted and analysed using thematic analysis. Responses showed that while participants interpreted surgical outcome in respect to a multitude of factors, five major themes emerged: functional ability, participation, appearance of feet and footwear, surgeons’ opinion, and pain. Participants interpreted levels of physical function in light of other aspects of their disease, reflecting on relative change from their preoperative state more than absolute levels of ability. Appearance was important to almost all participants: physical appearance, foot shape, and footwear were closely interlinked, yet participants saw these as distinct concepts and frequently entered into a defensive repertoire, feeling the need to justify that their perception of outcome was not about cosmesis.Surgeons’ post-operative evaluation of the procedure was highly influential and made a lasting impression, irrespective of how the outcome compared to the participants’ initial goals. Whilst pain was important to almost all participants, it had the greatest impact upon them when it interfered with their ability to undertake valued activities.ConclusionsPeople with RA interpret the outcome of foot surgery using multiple interrelated factors, particularly functional ability, appearance and surgeons’ appraisal of the procedure. While pain was often noted, this appeared less important than anticipated. These factors can help clinicians in discussing surgical options in patients.Electronic supplementary materialThe online version of this article (doi:10.1186/s13047-016-0153-6) contains supplementary material, which is available to authorized users.

Normal Values of the Foot Posture Index in a Young Adult Spanish Population

Although the appearance of foot or lower-limb pathologies is etiologically multifactorial, foot postures in pronation or supination have been related to certain diseases such as patellofemoral syndrome and plantar fasciitis. The objective of the present study was to determine the normal values of foot posture in a healthy young adult Spanish sample, and to identify individuals at risk of developing some foot pathology. The Foot Posture Index (FPI) was determined in a sample of 635 (304 men, 331 women) healthy young adults (ages 18-30 years). The FPI raw score was transformed into a logit score, and a new classification was obtained with the mean ± 2 SD to identify the 5% of the sample with potentially pathologic feet. The normal range of the FPI was -1 to +6, and FPI values from +10 to +12 and -6 to -12 could be classified as indicating potentially pathologic feet. The women's logit FPI (0.50 ± 1.4, raw FPI +3) was higher than the men's (0.25 ± 1.6, raw FPI +2), with the difference being significant (P = 0.038). No statistically significant differences were found between body mass index groups (P = 0.141). The normal FPI range goes from just one point of supination to a certain degree of pronation (+6). The identification of 35 individuals with potentially pathologic feet may help in the implementation of a preventive plan to avoid the appearance of foot disorders.

Calcaneocuboid arthrodesis for recurrent clubfeet: What is the outcome at 17-year follow-up?

PurposeCalcaneocuboid arthrodesis was used during revision clubfoot surgery in order to maintain midfoot correction. The purposes of this study were to determine: (1) functional level at 17-year follow-up compared to 5-year follow-up; (2) patients’ current functional level, satisfaction, and pain; and (3) current arthropometric measurements.MethodsTwenty patients (27 clubfeet) with clubfoot relapse underwent revision soft tissue release and calcaneocuboid fusion between 1991 and 1994. They were previously evaluated at a mean follow-up of 5.5 years. Ten out of 20 patients (13 clubfeet), mean age of 24 years, were reevaluated at mean follow-up of 17.5 years. The Hospital for Joint Diseases Functional Rating System (HJD FRS) for clubfoot surgery, Outcome Evaluation in Clubfoot developed by the International Clubfoot Study Group, the Clubfoot Disease-Specific Instrument, American Academy of Orthopaedic Surgeons (AAOS) Foot and Ankle Outcomes Questionnaire, Laaveg and Ponseti’s functional rating system for clubfoot and pain scale were completed by patient and/or surgeon to assess function, patient satisfaction and pain. Foot and ankle radiographs and anthropometric measurements were reviewed. For HJD FRS, scores from original follow-up were compared to current ones.ResultsThe HJD FRS score of all feet was 65.9, demonstrating a significant decline from the original mean score of 77.8 (p = 0.03). Excellent/good HJD FRS scores went from 85 to 38 %. Mean AAOS Foot Ankle Outcomes Questionnaire standardized core and shoe comfort scores were 84.6 and 84.5, respectively. Average foot pain was 1.8 on a scale of 1–10. Patients were very/somewhat satisfied with status of foot in 76 % of feet and appearance of foot in 46 % of feet, based on Clubfoot Disease-Specific Instrument questions.ConclusionsRevision clubfoot surgery with calcaneocuboid fusion in patients 5–8 years of age showed an expected decline in functional outcome measures over a 17-year follow-up period. It still produced comparable results to other studies for a similar population of difficult, revision cases, and should have a place in current surgical treatment techniques.

The Foot in Surrealist Art and Theory

Abstract This article examines the appearance of feet in surrealist art in terms of their thematic contribution to the philosophical aims of the surrealist movement. Georges Bataille’s theory of bassesse as the mechanism to achieve the informe, or the destruction of all categories of thought, is the basis for the reading of the significance of feet within the surrealist project outlined in this article. It discusses the theoretical preoccupations that make feet appropriate subjects for surrealist art and examines how several specific works of surrealist art employ images of feet.

A Case of Severe Dysmelia of All Extremities

A group of limb reduction defects is defined by congenital absence of either part of limbs. We report an extremely rare case of symmetrical upper limb peromelia (absence of distal bones) and asymmetrical lower limb phocomelia (absence of long bones and a flipper-like appearance of feet) in a female fetus at the 20th week of pregnancy. No other malformations were identified. The prevalence of peromelia and phocomelia is extremely rare, and these malformations can be associated with some candidate genes (e.g. de novo apparently balanced reciprocal translocation 46,XX,t(2;12)(p25.1;q24.1)).

My feet – visible but ignored…’ ‐ therapeutic footwear or surgery – that is the question

Therapeutic footwear (TFW) is often provided for people with Rheumatoid Arthritis (RA) for reducing foot pain & increasing patient mobility. However patient dissatisfaction & non-compliance means that it may not be the panacea for foot problems that practitioners presume it to be. The purpose of the study was to explore RA patient’s opinions about their foot problems, foot orthoses (FOs) and footwear Method Following ethical approval 22 people participated in focus groups. Thematic data analysis was employed. Results Foot symptoms & the appearance of feet were one of the most worrying aspects of their disease. However, these were ignored by their GPs & consultants. Some participants had experience of being referred for TFW (n=10) but only 2 were wearing it due to appearance. Those wearing FO’s had restricted choices in their own footwear. There was reluctance by their consultants to refer for foot surgery. Most participants would consider surgery in order to be able to function better and wear reasonable shoes Discussion The participant’s feet were extremely visible to them but ignored by practitioners. Unlike any other intervention TFW replaces something that is normally worn & is part of an individual’s body image. Likewise, the use of foot orthoses impacts on the choice of footwear style. The reluctance of consultant rheumatologists to refer for surgery was of concern, particularly as the participants had knowledge that this would be beneficial even before major structural changes occurred in their feet. There is a great need for foot surgery to be a management option earlier in order to improve function and reduce pain. Additionally it is a realistic option so that people with RA are not condemned to a life time of wearing footwear that is unacceptable and restricts choice in clothing, reduces participation in activities, particularly social ones. A large multi centre clinical trial is needed that would compare the results of foot surgery versus therapeutic footwear in terms of the clinical and patient orientated outcomes.

Modified Mitchell osteotomy for hallux valgus.

From 1988 to 1995, 96 patients (161 feet) underwent a modified Mitchell distal metatarsal osteotomy performed for mild-to-moderate hallux valgus. On AP x-rays of the standing foot, the average intermetatarsal angle was corrected from 15 degrees to 9 degrees, and the first metatarsophalangeal angles were corrected from an average of 41 degrees to 15 degrees. Criteria for evaluation of clinical results included relief of pain, appearance of foot, and shoe wear. After an average follow-up of 38 months, the overall satisfaction rate was 92.5%. Complications included 13 pin tract infections, two delayed unions, and two correction losses. The most common late sequela was transfer metatarsalgia of the lesser toes, which occurred in 20 feet (12.4%), leading to some dissatisfaction. The Mitchell osteotomy can be used on cases with less than 20 degrees of intermetatarsal angle, offering a stable construct with easy postoperative care.

Formation and Maturation of the Calcium Release Apparatus in Developing and Adult Avian Myocardium

Muscle fibers release large amounts of calcium from an internal compartment, the sarcoplasmic reticulum (SR), during activation. Two proteins are involved in this process and its control: plasma membrane calcium channels, or dihydropyridine receptors (DHPRs), and SR calcium release channels, or ryanodine receptors (RyRs). The two proteins form part of a structural complex, perhaps unique to muscle cells, which allows an interaction between plasma membrane and SR, resulting in calcium release from the latter. The surface–SR interaction is a step in the coupling between electrical events in the plasma membrane and contraction (excitation–contraction coupling). The structural complexes have been called calcium release units. One key to further understanding the control of calcium homeostasis in muscle is knowledge of how DHPRs and RyRs assemble into calcium release units. We have studied the development of avian myocardium, using immunocytochemistry to locate DHPRs and RyRs and electron microscopy to follow the formation of calcium release units containing feet (RyRs) and large membrane particles (presumably DHPRs). We find that the initial step is a docking of SR vesicles to the plasma membrane, followed by the appearance of feet in the junctional gap between SR and plasma membrane. Feet aggregate in ordered arrays, and the arrays increase in size until they fill the entire junctional gap. Clustering of membrane particles, presumably DHPRs, is apparently coupled to clustering of feet, since the two junction components assemble within patches of membrane of approximately equal size and containing an approximately constant ratio of particles to feet. Thus, despite the fact that no evidence exists for a direct interaction between DHPRs and RyRs in cardiac muscle, some mechanism exists to ensure that the two molecules are clustered in proximity to each other and in the appropriate proportion.

Behavioural phenomena related to normal and difficult deliveries in dairy cows.

Behavioural aspects of parturition, as well as the behaviour of cows and calves in the earliest post-partum period were studied in a group of 75 Polish Black and White cows. Distinction was made between unassisted deliveries, deliveries that required a little help (traction by not more than 2 persons) and difficult deliveries, requiring veterinary help. Of the cows 14% gave birth without prior behavioural signs of an approaching delivery, 72% manifested clear signs of preparturient unrest and 70% showed outflow of allantoic fluids before the calf appeared. A large variation was seen in the timing of these preparatory phases. Prolonged unrest, a cessation of labour and no appearance of the calf's feet were the clearest signs that a difficult delivery would follow. After the appearance of the feet, only 48% of the cows were able to expell the fetus within 1 h. Spontaneous expulsion of fetal membranes occurred characteristically within 12 h after parturition. Of the cows whose deliveries were unaided or aided, 86 were in recumbent position during the final phase of expulsion of fetus. The majority (64%) of cows with difficult delivery were standing. Cows separated from their calves lie down earlier after calving than those kept with their newborn. From the latter category those after a difficult delivery spent most time licking their calves, partly in lying position. After a difficult delivery calves started their first attempts to stand later, stood later, and when kept with their mothers, suckled later, than did other calves. The behavioural differences between calves from unaided and partly aided deliveries were small. (Abstract retrieved from CAB Abstracts by CABI’s permission)

Incidence of retained placenta following induction of parturition with corticoids or prostaglandins

Three trials involving 214 cows were conducted to 1) compare the timing of events during normal parturition with parturition induced with a corticoid or a prostaglandin; 2) determine if synchrony could be improved by injection of steroids either concurrently or after injection of a corticoid or a prostaglandin; 3) determine if the incidence of retained placenta could be reduced; and 4) explore methods of treating retained placenta. The timing of events following induction of parturition was compared with that following a normal parturition in 76 heifers. The time from onset of labor to appearance of the placenta, abdominal press, appearance of feet and expulsion of the fetus did not differ between normal and induced parturition. The time from onset of labor to calf standing was increased from 2.3 ± 2.0 hours in normal parturition to 5.8 ± 5.5 hours in cows receiving 10 mg of flumethazone (P<0.05). The interval from onset of labor to calf nursing also tended to be longer (P>0.05<0.01). All control cows expelled fetal membranes by 48 hours after onset of labor, but the proportion expelled by the treatment groups varied from 24 to 76%. None of the treatments used in this study significantly increased placental expulsion over that noted when flumethazone or prostaglandins were used alone. No difference in placental expulsion time was noted in cows douched with nolvasan or injected with 30 cc oxytetracycline. None of the treatments used in the three trials reported in this study improved synchrony of parturition over that noted in the cows receiving only an injection of flumethazone or prostaglandins.

Types and Subtypes of Foot and Mouth Disease Virus Currently Found in South America

The appearance of foot and mouth disease (FMD) in South America in 1871 was linked to the great epizootic which was occurring in Europe at that time. The disease spread slowly until, by the mid-1960's, the whole of South America was affected. At about this time programmes for the control of FMD were developed and a decrease in incidence of disease is currently being observed. Some 21 subtypes of the A, O and C types of virus have so far been identified in South America but of these only five are of epizootiological significance. Virus types O and A are more frequently encountered than type C. The type O virus causes extensive outbreaks approximately every four years. Type A virus results in the regular appearance of limited outbreaks while type C gives rise to sporadic outbreaks. Each of the affected countries in South America has developed a system of continuous epizootiological surveillance by diagnostic laboratories with the aim of identifying field virus strains, establishing the immunological cover provided by vaccines against field strains and selecting appropriate strains for vaccine production.