Pedis Research Articles

Effect of damper mass on soil-structure displacement in dynamic response to earthquake vibration with finite element modelling

Earthquake is a natural disaster that always occur inside the region of pacific ring of fire. Many structures such as high-rise buildings, bridges, dams and many more failed and take severe damage due to the impact of the strong vibration of the earthquake. A pile foundation is a type of deep footing which is suitable for high-rise buildings founded on clay soils where its function to prevent potential failures such as bearing capacity and collapse. In addition, the problem of tall buildings is prone to sway and damaged when earthquake strike and such vibrations cause the dynamic behaviour of structure to change significantly in terms of excessive lateral displacements and accelerations. Thus, the effect of damper mass on soil-structure displacement in dynamic response to earthquake vibration was determined. The effectiveness of vibration absorber to the single pile structured in clay soil was modelled and simulated in finite element program PLAXIS 3D version 20 with and without the presence of the damper where the inputs were taken from the Sumatera and Chi – chi earthquakes. The problem was modelled and simulated by drawing a geometry, assigning the soil and pile materials input, loading and boundary conditions, meshing generated and staged construction for calculations of displacement structure output in response to dynamic due to earthquake vibration. The displacement-time with the effect of mass of the vibration with and without absorber are presented. The results show a good performance of damper on the single pile structured on soft soil with different types of earthquakes.

Autopsy findings in a fetus with monosomy 20 mosaicism

Introduction. Mosaic monosomy 20 is a rare chromosomal aberration, without characteristic clinical features. We present a case of a fetus with monosomy 20 mosaicism revealed after prenatal ultrasound detection of anhydramnios and multiple anomalies. Case outline. The second pregnancy of a 33-year-old woman, was terminated at 23rd gestational week, because of the multiple fetal anomalies and anhydramnios, detected by ultrasound. The autopsy of a female fetus revealed multiple congenital anomalies: ventriculomegaly, bilateral choroid plexus cysts, perivascular gliosis in periventricular region of cerebri, hydropericardium, severe cardiomegaly, severe myocardial hypertrophy, hydrothorax, glandular/canalicular stage of fetal lung development, bilateral renal and ureter agenesis (Potter syndrome), bladder aplasia, agenesis of the uterus, fallopian tubes and proximal vagina and valgus deformity of left foot (pes valgus). Fetal growth was adequate for gestational age with no craniofacial dysmorphia or radiographically visible anomalies of the skeleton, without signs of infection. The umbilical cord was too long for gestational age ? 48 cm. Analysis of fetal karyotype from fetal blood sampling revealed monosomy of chromosome 20 in 10% of analyzed cells in metaphase. Conclusion. Revealing the genetic basis of fetal anomalies is at outmost importance not only for further evaluation of pregnancy, but also for proper genetic informing of patients.

Radiological changes in leprosy patients with disabilities and deformities of hands and feet

Background/Aim: Leprosy (Hansen's disease) affects the skin and nerves. Hands and feet are commonly involved in all types of leprosy often leading to deformities. This study explored radiological changes in leprosy patients with hand and foot disabilities/deformities. Methods: Observational retrospective study was the chosen design. Study was conducted on 50 leprosy patients presenting at a tertiary care hospital with hand and foot disabilities during 2020-2022. Leprosy types were clinically diagnosed, confirmed by acid-fast bacilli staining. Bacteriological index (BI) and morphological index (MI) were calculated via Ridley's scale. Histopathological examination of the skin lesions was also conducted. Radiological exams, anteroposterior and lateral X-rays, identified specific/non-specific bone changes. Results: Mean age was 38.8 years, bone changes identified at 40.3 years. Radiological changes were seen in 42.0 % patients (34 % patients had non-specific and 16 % had specific changes). These changes were seen more common and earlier in females as compared to males, the difference however was not significant (p = 0.6). Mean BI (2.8) and MI (32 %) of the patients with bone changes were slightly higher than those without bone changes but the differences were not statistically significant (2.2 and 27 %) (p = 0.2). Common specific changes were periostitis and subarticular erosion while osteopenia and phalangeal resorption were the most common non-specific changes. Conclusion: Non-specific bone changes were more common than specific ones and in females as compared to males. Lepromatous leprosy (LL) was associated with maximum bone changes with varied involvement in other types of leprosy.

Percutaneous Fifth Metatarsal Osteotomy for Bunionette Deformity Without Fixation or Strapping: A Retrospective Study.

Bunionette deformity (BD) is a painful condition of the fifth metatarsal characterized by an osseous prominence and fifth toe varus deformity. The purpose of this study is to assess the clinical, functional, and radiographic outcomes of percutaneous distal metatarsal metaphyseal osteotomy (DMMO) without fixation or postoperative strapping of the foot. A retrospective case series was performed on 111 patients (132 feet) with symptomatic BD who underwent percutaneous DMMO of the fifth metatarsal from September 2020 to January 2022 by an experienced minimally invasive surgeon. According to the Shimobayashi classification, we treated 1 type I deformity, 37 type II deformities, 52 type III deformities, 42 feet with type IV deformity, and no patient with a type V deformity. Ninety patients (81%) underwent unilateral osteotomy, and 21 (19%) had bilateral osteotomies. Most cases included other procedures including treatment of 114 associated deformities of the same feet: 68 bunions, 12 lesser metatarsal osteotomies (2-3-4 metatarsals), and 34 hammertoes (20 second hammertoes, 10 third hammertoes, 1 fourth hammertoes, 2 fifth hammertoes). Patient-reported clinical outcome measures, including the Foot Function Index (FFI) questionnaire, the visual analog score (VAS), and overall satisfaction were collected. Fourth-to-fifth intermetatarsal angle (IMA) correction, time to bone union, and complication rates were assessed in all patients. Mean follow-up was 24.1 months (range, 14-39 months). Both radiographic parameters and patient-reported outcome measures significantly improved after DMMO procedure. The average fourth-to-fifth IMA improved from 12.2 degrees, preoperatively, to 4.4 degrees, postoperatively (P < .001). Patient outcomes reflect the overall outcomes of the combined surgeries on a per-patient basis. Preoperatively, patients had a mean VAS score of 7.6, which improved to 0.6 at the last follow-up (P < .001). Furthermore, the average FFI significantly decreased from pre- to postoperation from 19.2 to 4.4, respectively (P < .001). Overall, 108 of 111 patients reported being satisfied with the outcomes of the procedure. Average bone union was achieved at 12.6 weeks postoperation, with a minimum of 12 and a maximum of 25 weeks. The complication rate was 1.5%, including 1 case of an asymptomatic cock-up deformity and 1 case of lateral fifth metatarsal shaft bone overhang pain, which resolved with an exostectomy. The results of this study of patients who had minimally invasive surgery from an experienced surgeon suggest that percutaneous DMMO of the fifth metatarsal without internal fixation or postoperative immobilization or strapping can be effective at improving radiographic alignment, pain, function, and overall satisfaction with minimal rates of complication. Level IV, case series.

Foot Bionics Research Based on Reindeer Hoof Attachment Mechanism and Macro/Microstructures.

The attachment performances of mechanical feet are significant in improving the trafficability and mobility of robots on the extreme ground. In the future, frozen-ground robots can be used to replace human soldiers in scouting and deep space exploration. In this study, the influence factors on the attachment function of the bionic feet were analyzed. Soft frozen soil and tight frozen soil close to natural frozen soil were prepared, and the friction between ungula and frozen soil ground was simulated together with the plantar pressures of reindeer under trotting. The major attachment parts were the ungula cusp, outer edges, and ungula capsules, and the stress on the ungula was mainly 4.56-24.72 MPa. According to the microstructures of plantar fur and ungula, the corresponding ratio of the rib width and length was 0.65:1, and the corresponding ratio of the rib width and distance was 3:1. In addition, the scales of the plantar fur were very tightly arranged and had large ripples. Based on typical curves, an ungula capsule-curved surface, and a nonsmooth plantar fur surface, four types of bionic feet and the corresponding ordinary multidamboard foot were designed. On the frozen soil, the bionic foot with ribs and an ungula capsule showed the best attachment performance. Compared with the multidamboard foot, the dynamic coefficient of friction of the bionic foot with ribs and ungula capsules increased by 11.43-31.75%. The attachment mechanism of the bionic feet is as follows: under the action of pressure, the fine patterns of the bionic convex-crown generate friction with the nonsmooth structure of the frozen soil surface, which improves the attachment performance.

Effects of Low-Dye Tape on Arch Height and Its Impact on the Medial Gastrocnemius Electromyographic Activity in Structurally Differentiable Foot Types: A Cross-Sectional Observational Study.

Low-Dye tape (LDT) is a short-term treatment for plantar fasciitis, where external stabilization by means of the tape improves kinetics, kinematics, pain level, and electromyography (EMG). The purpose of this study was to compare the EMG of the medial gastrocnemius (MG) and changes in arch height (AH) based on the type of foot. A total of 30 subjects participated in this study; they walked on a treadmill barefoot and when taped, where the average activity and changes in AH were measured over a 30 s period. The statistical intraclass correlation coefficient (ICC) to test for reliability was calculated, and the Wilcoxon test was determined for measures of EMG and AH. The reliability of the values of EMG was almost perfect. The data show that there was an increase in height in the comparison of the moment pre-baseline walking and post-taped walking on neutral feet (5.61 ± 0.46 vs. 5.77 ± 0.39 cm, p < 0.05), on pronated feet (5.67 ± 0.57 vs. 6.01 ± 0.53 cm, p < 0.001) and on supinated feet (5.97 ± 0.36 vs. 6.28 ± 0.27 cm, p < 0.05). In the MG, EMG activity decreased significantly in the taped condition compared to the baseline condition in neutral subjects (0.0081 ± 0.016 vs. 0.076 ± 0.016 mV, p < 0.05) and in pronated subjects (0.081 ± 0.022 vs. 0.068 ± 0.025 mV, p < 0.05). It was demonstrated that with the use of LDT, there was an improvement in the average activity in the MG in pronated and neutral feet. All foot types improved in arch height with the use of tape.

A new skeletal model for the ankle joint complex

AbstractThe talocrural and the talocalcaneal articulations collectively form the ankle joint complex of the human foot and are the focus of investigation of this work. The talocrural articulation enables plantarflexion and dorsiflexion, while the talocalcaneal articulation allows inversion and eversion of the foot. A comprehensive analysis of the literature suggests that the ankle joint complex is modeled in different manners considering approaches with varying complexity levels, which more or less accurately mimic its intrinsic anatomical features. Several studies assume that the foot articulates with the leg via the talocrural articulation only, which is modeled as a revolute joint. Other studies consider the movements allowed by both articulations and model the ankle joint complex as spherical, revolute, or classical universal joints. Most existing approaches do not consider sufficiently accurate anatomical modeling of this joint complex. Thus, this work presents a new skeletal model for the ankle joint complex of the human foot that considers the actual anatomy and movements of the talocrural and the talocalcaneal articulations. The proposed approach uses a modified universal joint, which incorporates a massless link to mimic the actual function of the talus bone. The developed formulation is compared with a model available in the literature, which uses a classical universal joint. The outcomes show that modeling the ankle joint complex as a modified universal joint allows a more realistic representation of the anatomy of the human foot. The main differences between the two joint models are observed in the mediolateral direction.

The oldest fossil bird-like footprints from the upper Triassic of southern Africa.

Footprint morphology reflects the anatomy of the trackmaker's foot and is direct evidence for the animal's behaviour. Consequently, fossil tracks can be used to infer ancient diversity, ethology, and evolutionary trends. This is particularly useful for deep-time intervals during which the early history of an animal group is reliant upon limited fossil skeletal material. Fossil tracks of early birds and theropods, the co-existing dinosaurian ancestors of birds, co-occur in the rock record since the Early Cretaceous. However, the evolutionary transition from dinosaur to bird and the timing of the birds' origin are still contested. Skeletal remains of the basal-most birds Aurornis, Anchiornis, Archaeopteryx and Xiaotingia are Middle to Late Jurassic, while tracks with tentative bird affinities, attributed to dinosaurs, are known from as early as the Late Triassic. Here, we present numerous, well-provenanced, Late Triassic and Early Jurassic tridactyl tracks from southern Africa, with demonstrable bird-like affinities, predating basal bird body fossils by c. 60 million years.

The Mystery of Tomato Flu in India

Introduction: While the globe fights against monkeypox and the coronavirus, a new virus known as "Tomato flu" threatens. This virus's recognized target is children. In May 2022, the virus was found for the first time in Kerala, India. Due to its principal symptom, tomato-shaped blisters all over the body, the ailment was given the term "Tomato Flu." Recent reports described it as type of hand, foot and mouth disease (HFMD). It is easily diagnosed by a history and physical examination. It is an infectious condition, but there are still a lot of unanswered questions. To shed light on this topic, we decided to collect and summarize the information on this novel viral pathogen. Materials and Methods: To accomplish this, we undertook a thorough literature assessment of the Tomato Flu research that has already been done. We analyzed data from various sources such as medical journals, government reports and news articles to gain a better understanding of this emerging disease. In addition, we conducted interviews with healthcare professionals who have treated patients with Tomato Flu to gain insights into their experiences. Results: Survey of literature showed that Tomato Flu is a self-limiting disease. Children under the age of 5 and immunocompromised individuals are more susceptible to this disease. There is no diagnostic test for the disease, differential diagnosis involves typical symptoms and the absence of other known viral agents. There is no treatment, supportive care brings relief. Conclusion: Overall, this review provides a better understanding of Tomato Flu and its potential impact on public health. By shedding light on this emerging virus, we hope to contribute to ongoing efforts to prevent and treat of this infectious disease. Medicine Today 2023 Vol.35(2): 129-133

Automatic anatomical foot and ankle coordinate toolbox.

Accurate analysis of bone position and orientation in foot and ankle studies relies on anatomical coordinate systems (ACS). Reliable ACSs are necessary for many biomechanical and clinical studies, especially those including weightbearing computed tomography and biplane fluoroscopy. Existing ACS approaches suffer from limitations such as manual input, oversimplifications, or non-physiological methods. To address these shortcomings, we introduce the Automatic Anatomical Foot and Ankle Coordinate Toolbox (AAFACT), a MATLAB-based toolbox that automates the calculation of ACSs for the major fourteen foot and ankle bones. In this manuscript, we present the development and evaluation of AAFACT, aiming to provide a standardized coordinate system toolbox for foot and ankle studies. The AAFACT was evaluated using a dataset of fifty-six models from seven pathological groups: asymptomatic, osteoarthritis, pilon fracture, progressive collapsing foot deformity, clubfoot, Charcot Marie Tooth, and cavovarus. Three analyses were conducted to assess the reliability of AAFACT. Firstly, ACSs were compared between automatically and manually segmented bone models to assess consistency. Secondly, ACSs were compared between individual bones and group mean bones to assess within-population precision. Lastly, ACSs were compared between the overall mean bone and group mean bones to assess the overall accuracy of anatomical representation. Statistical analyses, including statistical shape modeling, were performed to evaluate the reliability, accuracy, and precision of AAFACT. The comparison between automatically and manually segmented bone models showed consistency between the calculated ACSs. Additionally, the comparison between individual bones and group mean bones, as well as the comparison between the overall mean bone and group mean bones, revealed accurate and precise ACSs calculations. The AAFACT offers a practical and reliable solution for foot and ankle studies in clinical and engineering settings. It accommodates various foot and ankle pathologies while accounting for bone morphology and orientation. The automated calculation of ACSs eliminates the limitations associated with manual input and non-physiological methods. The evaluation results demonstrate the robustness and consistency of AAFACT, making it a valuable tool for researchers and clinicians. The standardized coordinate system provided by AAFACT enhances comparability between studies and facilitates advancements in foot and ankle research.

Two-Stage Caving Characteristics of Complex Irregular Goaf: A Case Study in China

Different from the goaf formed by normal mining, the goaf formed by the continuous caving of the lower illegal goafs is extremely irregular and unstable, which leads to the difference in the goaf caving characteristics. Taking the complex irregular goaf of the Shirengou Iron Mine in China as the research object, the 3D laser scanning technology is used to detect the goaf shape and analyze the cause of the formation. Then, the caving characteristics of the goaf are analyzed by the methods of the numerical simulation, the monitoring of the crash of the caving rock, and the monitoring of the deformation of the arch foot. The simulation results show that the transverse expansion of the irregular goaf boundary is mainly along the perpendicular to the direction of the ore body strike when the goaf caves upward in the initial stage. Additionally, the monitoring results show that the caving characteristics can be divided into two stages: the paroxysmal caving stage and the periodicity caving stage. The paroxysmal caving characteristics are intense and irregular, while the periodicity caving characteristics have obvious periodicity, which is mainly reflected in the periodic alternation between the mass caving and the temporary stability. The interval period of the goaf mass caving is about 15–30 days and is changed by the progress of filling treatment. The conclusions in this work reveal the particularity of the caving characteristics in the complex irregular goaf and contribute to the improvement of the caving characteristics and the prediction of mass caving.

Motion Analysis of a Frontal Plane Adaptable Prosthetic Foot.

ABSTRACT Introduction An objective of designing a prosthetic foot is to achieve the natural adaptability of the foot and ankle on various surfaces and different forms of gait. Frontal plane position of the foot relative to the shank changes with many functional aspects of gait, such as turning, stairs, and walking on uneven ground. Prosthetic foot designs have variable frontal plane adaptability. An investigation foot with a linkage with ±10° of frontal plane motion was developed to improve frontal plane response under various conditions. The purpose of this study was to compare the kinematics of locked and unlocked conditions of a frontal plane adaptable prosthetic foot and the person’s usual foot while walking forward on a level surface, on an unstable rock surface, and sidestep, using a crossover design. These different conditions result in changes in frontal plane motion in the anatomical foot and ankle, and the current study evaluates whether there are similar trends in prosthetic feet. Materials and Methods People were included if they had a unilateral below-knee amputation, intact residual limb skin, were over 16 years old, and were able to walk more than 400 m on level ground without using a walking aid and without an increase in pain. The control group was people without amputations who completed the procedures once. Participants with amputations completed forward walking on level ground, on an unstable rock surface, and sidestep with their usual foot. Then after 2 weeks of accommodation, participants repeated these tests with the investigational foot unlocked and locked. Motion analysis data were collected with a 12-camera optically based system. Primary outcomes were sagittal and frontal plane motions of the foot relative to the shank. In addition, step length, step width, and stride velocity were obtained from the kinematic measures. Paired t-tests were used for statistical inference for individual participant comparisons. Unpaired t-tests were used for comparisons between the controls and people with amputations. Results Twenty-one people with amputations and 10 controls completed the tests. Participants with amputation had 16 different usual feet. There was a wide variation in usual foot motion during forward walking, whereas investigational foot conditions showed less variability. During level walking, control subjects had more frontal plane motion than any of the foot conditions, and the unlocked had more frontal plane motion than the usual foot and locked condition. Walking across an unstable rock surface showed similar trends, with control participants having more sagittal and frontal plane ankle motion compared with any prosthetic foot condition. Also, the unlocked had statistically greater frontal plane motion than the usual foot or locked condition. Sidestep results were also consistent with other gait tests. The control participants’ sagittal plane ankle range of motion was significantly more than the prosthetic sagittal plane motion for all foot conditions, whether the prosthetic side was leading or trailing. There was significantly more frontal plane motion with the unlocked than the usual foot and locked condition when the prosthetic foot was trailing or leading. Discussion and Conclusions Wide variation in usual foot range of motions in the frontal and sagittal planes confirmed the need for additional controls when considering the effect of the linkage alone. The unlocked had increased frontal plane ranges of motion compared with the locked and the majority of usual foot for all gait conditions, including level walking. This finding demonstrated that people with amputations were functionally using the additional range of motion provided by the linkage. However, control subjects used more range of motion in both the sagittal and frontal planes for the unstable rock surface and sidestepping. Increased frontal plane range of motion did not translate into improved stride length and velocity, step width, or center of mass deviations. Clinical Relevance The person-specific functional activities should be considered when choosing a prosthetic foot. A prosthesis with frontal plane motion may be applicable for a person who moves in a sidestep pattern or on uneven ground.

Narcotic Use and Prescribing Trends Among Workers Compensation Patients Undergoing Foot and Ankle Surgery

Category: Midfoot/Forefoot; Hindfoot Introduction/Purpose: Previous studies have shown that workers compensation patients (WC) have worse outcomes, and higher complications rates after orthopaedic surgery. Despite orthopaedic surgeons being the third highest prescribers of narcotic pain medication in the United States there have been no studies to specifically evaluate narcotic use among the WC population. The purpose of this study was to investigate narcotic use among WC patients who underwent foot or ankle operative procedures compared with a procedure matched control group. Methods: A retrospective review was conducted for WC and non-WC patients ages 18 to 70 years old who underwent foot (CPT 28001-28899) or ankle (CPT 27600-27899) procedures in an orthopaedic surgery practice from October 2017 through January 2020. Data collection included demographics, social, surgical, perioperative follow-up and complications. Outcomes measures were timing and number of narcotic prescriptions, total morphine milligram equivalents (MME), and procedure type. Data analysis was performed with SPSS version 28. Comparisons were conducted with Mann-Whitney U test, chi square test, or Fisher’s exact test. Power analysis determined sample size with a 0.05 alpha level, 0.80 power, and 0.5 effect size. Results: 142 total patients met inclusion criteria, with 71 WC patients and 71 non-WC patients. There were no differences regarding the type of foot or ankle procedure performed (p=0.598). WC patients had double the number of overall narcotic prescriptions (median 2 vs 1; p &lt; 0.001). WC patients were prescribed in total 1,125 oxycodone MME and 871.8 hydrocodone MME (P &lt; 0.001), versus 750 oxycodone MME and 450 hydrocodone MME among the non-WC group (p &lt; .008). There was no difference in the number of tramadol prescriptions (p = 0.571). WC patients experienced more days between the date of last narcotic prescription and both index surgery date (median 27 vs 1, p = 0.001) and initial clinic visit date (median 105 vs 49, p = 0.002). Conclusion: This data demonstrates that WC patients portend worse outcomes and utilize narcotics at twice the rate and for longer periods of time post-operatively than non-WC patients. Increased narcotic use may potentiate narcotic dependence and likely leads to worse outcomes. Treating physicians must be aware of these trends in order to best manage these patients. Physicians may need to have longer discussions with WC patients regarding narcotic use post operatively as well as about outcomes and goals of surgery. Physicians should set early expectations with WC patients and clear limits on the amount of narcotics they are willing to prescribe postoperatively.

Does Different Anatomical Foot/ Ankle Arthritis Affect Functional Disability Differently?

Category: Ankle Arthritis; Ankle Introduction/ Purpose: There is paucity of literature comparing foot and general health status including quality of life between patients presenting with Ankle/ Hindfoot, Midfoot and 1st MTPJ arthritis. The aim of this study is to compare foot specific patient reported disability and quality of life satisfaction scores between patients presenting with arthritis of either the ankle/hindfoot, midfoot or 1st MTPJ. Methods: Patients who presented between 2020 and 2021 with a diagnosis of primary Osteoarthritis (OA) in either the ankle/hindfoot (AHA), midfoot (MA) or first MTPJ (MTPJA) were included in this study. Patients with associated foot problems, bilateral presentations, previous reconstructive surgery, or underlying neurological conditions were excluded. Differences in preoperative Patient Reported Outcome Measures (PROMs) including, MOX-FQ (Domains: Pain, Walking/Standing, Social activities), EQ-5D (UK) and Foot and Ankle outcomes scores (FAOS) (Domains: Pain, symptoms, ADL, sport, Recreation, Quality of Life) were analysed. Results: 94 patients (2020-2021) were included in this study (mean age 58.50). There were 45 patients with AHA, 21 with MA and 28 with MTPJA. The AHA group reported worse pain compared to the MTPJA group (p=0.03), and the MA group (p=0.004). AHA patients had more difficulty with Sports &amp; Recreational Activities (p=0.029). Quality of Life scores was not significantly different between the groups. MTPJA patients had more difficulty with engaging in social activities compared the AHA patients (p=0.049). Conclusion: AHA patients suffer more pain that patients with arthritis in other areas of the foot. They appear to struggle with walking and standing and have difficulty participating in sports and recreational activities. Interestingly, MTPJA patients experience the most difficulty taking part in social activities. Patients with any type of foot or ankle arthritis experience similar difficulties with their mental health and their ability to carry out activities of daily living.

Foot &amp; Ankle

The October 2023 Foot &amp; Ankle Roundup360 looks at: Risk factors for failure of total ankle arthroplasties; Effects of synovial fluid fracture haematoma to tissue-engineered cartilage; Coronal plane deformity in CMT-cavovarus feet using automated 3D measurements; Immediate weightbearing after ankle fracture fixation – is it safe?; Unlocking the mystery of Mueller-Weiss disease; Diabetic foot management: predictors of failure.

The Variation Between Unilateral and Bilateral Weight Bearing in Hindfoot Alignment Evaluation: Part II: A Prospective In Vivo Kinematic and Plantar Pressure Study

Category: Hindfoot; Midfoot/Forefoot Introduction/Purpose: When AP, lateral, and hindfoot views weight bearing XR's were taken, patients were frequently asked to stand on the foot being examined with the other foot lifted off the floor. However, we have found that alignments of the hind and midfoot during unilateral standing are different from those when bearing weight on both feet. This study compared the kinematics and plantar pressures between unilateral and bilateral standing positions in a group of asymptomatic volunteers. Methods: Ten participants (20 feet) without symptoms, previous trauma and surgical history in both lower limbs were included. Each participant first stood comfortably on both feet, then lifted the non-examined foot off the floor. Each person switched between the above two positions three times. Kinematic data was collected using an eight-camera Optitrack 3D motion capture system to reflect changes in alignments of the ankle, subtalar, and midtarsal joints. Plantar pressure distribution was assessed using a pressure platform. Paired t-tests were used to compare the metrics between the two standing positions, with statistical significance level set at P &lt; 0.05. Results: From bilateral to unilateral weightbearing, 14 out of 21 kinematic angular parameters showed medium to high level of statistical significance (p=0.001-0.046) reflecting differences in the relative positions of the ankle, subtalar, and midtarsal joints in the two weightbearing positions resulting from pronation of the hindfoot and midfoot; the average plantar pressure change underneath the hallux (0.1616N), toes 2-5 (0.0907N), metatarsals 2-4 (0.2481N, 0.3204N, 0.2649N), midfoot (0.1794N), medial and lateral heel (0.259N, 0.246N) all showed statistically significant increase. There was a significantly higher plantar pressure increase on the medial than the lateral side of the feet. This corresponded to both the kinematic changes, and our findings in another study investigating the alignment change between the positions radiographically. Conclusion: The hindfoot and midfoot are more pronated in unilateral weightbearing than in bilateral weightbearing which may mask the severity of the deformity in a flexible cavovarus foot but increase that in a flexible flatfoot. Modification of the traditionally used unilateral weightbearing position in obtaining clinical radiographs should be considered. Bilateral WBCT scans may be a better alternative, taking advantage of allowing both feet to bearing weight naturally without concerning about one foot blocking the other during the radiographic imaging.

The Variation Between Unilateral and Bilateral Weight Bearing in Hindfoot Alignment Evaluation. Part I: A Prospective In Vivo Radiographic Study

Category: Hindfoot; Midfoot/Forefoot Introduction/Purpose: When weight bearing radiographs are taken, the patient is frequently asked to stand on the foot being examined with the other foot lifted off the floor. We have found however that alignments of the hind and midfoot change when bearing weight switches from bilateral to unilateral standing. This study investigated the possible differences in hindfoot alignments between unilateral and bilateral weight bearing using radiographical evaluation. Methods: Eight flexible feet without symptoms symptoms, nor significant trauma &amp; surgical history in their lower limbs were recruited for this study. A portable fluoroscopy machine (Smart C, Turner Imaging, Salt Lake City, USA) was used to take weightbearing lateral views. The patient first stood on both feet with the non-examined foot standing outside of the collimator but bearing weight evenly (Figure 1), and then lifted the non-examined foot off the floor when the lateral XR image was taken for the examined foot. Hindfoot alignment in both positions was reflected by measuring the angle between the long axes of the proximal and distal portions of the Achilles tendon on the skin using the subtalar joint line as the intersection. On lateral XRs, various parameters were measured to reflect the subtalar joint alignment, the position of the calcaneus with inversion and eversion of the hindfoot, and the lateral and medial arch heights. Results: From bearing weight on two feet (bilaterally) to one foot (unilaterally), the Hindfoot Alignment Angle (Achilles) increased (6.23 to 11.21 degrees), the Calcaneal Pitch Angle decreased (22.06 to 19.22 degrees), the Middle vs Posterior Facets Angle decreased (166.46 to 160.74 degrees), and the 5th metatarsal/cuboid height decreased (0.73 to 0.67) all significant changes (p &lt; 0.05). All of these represented a pronation movement in the mid and hindfoot, ie, valgus tilt/eversion of the calcaneus, decreased sinus tarsi opening, and reduced lateral arch height. In this small cohort, these differences were more obvious in the feet that were either slightly flat or cavus shaped (Figure 1, Table 1, and 2) than in feet with a more neutral alignment. Conclusion: The hindfoot and midfoot are more pronated in unilateral weightbearing than in bilateral weightbearing which may mask the severity of the deformity in a flexible cavovarus foot, but increase that in a flexible flatfoot. Modification of the traditionally used unilateral weightbearing position in obtaining clinical radiographs should be considered. Bilateral WBCT scans may be a better alternative, taking advantage of allowing both feet to stand in the most natural position without one foot blocking the other during the radiographic imaging.

Foot Pain and Disability in Women with Rheumatoid Arthritis, Ehlers-Danlos Syndrome and Systemic Lupus Erythematosus: Relationship with Quality of Life.

The aim of this work was to investigate the relationship foot pain and foot disability have with HRQoL in groups of women with RA, SLE and EDS, in comparison with a control group. A cross-sectional study was carried out with females with one of these conditions and a control group. The SF-12 questionnaire was used to collect data about quality of life. The type of foot was classified according to the footprint and the foot posture index. A total of 156 patients and 47 controls participated in the study (N = 203). Neither pain nor foot posture were different between groups. The physical and mental components of SF-12 were worse in rheumatoid arthritis and Ehlers-Danlos syndrome patients, and the physical component was worse in systemic lupus erythematosus patients, compared to controls. A significant difference was also observed in the mental component between systemic lupus erythematosus and Ehlers-Danlos syndrome patients, the latter having the lowest values among the groups. We can conclude that women with rheumatoid arthritis, Ehlers-Danlos syndrome, systemic lupus erythematosus and foot pain perceive a worse quality of life. There are no significant changes in foot posture. Pain and health-related quality of life are independent of foot posture.

Morphocultural and molecular characterization of Athelia rolfsii associated with foot rot disease of Gomphrena globosa – A new record from India

Globe amaranth is an important floriculture plant grown for the cut flowers. The outbreak of southern blight disease was observed during 2019 in parts of the southern Karnataka. The disease incidence ranged from 9.54 to 21.13%. Disease symptoms include water-soaked lesions on the lower leaves, followed by quick wilting of the whole plant. The fungal pathogen was isolated on potato dextrose agar medium which produced white cottony mycelium with numerous reddish-brown sclerotia developed after 12 days of inoculation. A total of 12 fungal isolates were obtained from infected samples and their identity was established based on micro-morphological studies. Further, three isolates were used for molecular identification by sequencing the ITS-rDNA and tef-1α gene showed 100% sequence similarity with reference sequences. The associated fungal pathogen was identified as Athelia rolfsii. Further, pathogenicity tests were conducted on healthy plants in-vitro and in green house conditions. Typical foot rot disease symptoms were observed after 8 days of post-inoculation. The pathogen was re-isolated and its identity was confirmed. There are no reports of A. rolfsii on globe amaranth. To the best of our knowledge, this is the first report of A. rolfsii associated with southern blight disease of globe amaranth in India.

Model Test Study on the Response of Two Different Shallow-Foundation Framed Buildings under Tunnel Volume Loss

In order to study the influence of tunnel volume loss on adjacent framed buildings with different shallow foundations, this paper carried out physical model experiments with two common types of footings (isolated and strip footings) under different working conditions based on the digital image correlation (DIC) technique. The main finding of the present paper is that the increase in formation loss rate will aggravate the deformation and damage of the structure, and the strip foundation shows stronger integrity and stability compared with the isolated foundation in this process. With the increase in the eccentricity of the frames with respect to the tunnel, the overall tilt and damage degree of structural elements increases first and then decreases for both foundations, reaching the maximum value with the eccentric distance of one multiple of the tunnel diameter. Interestingly, when the isolated footings are located directly above the tunnel, the damage in the inner panels is the most severe and gradually decreases with eccentricity, changing from a sagging mode to a hogging mode for the frame form. While the strip footings always maintain slight hogging, and the trend of the damage degree of panels is similar to that of elements, with the eccentric distance reaching two times the tunnel diameter, the strip foundation structure tends to be stable, while the isolated one still needs attention for its potential possibility of damage in panels. The research results have reference value for the impact assessment of adjacent shallow-foundation framed buildings in subway tunnel construction.