Feet In Elevation Research Articles

Blood pressure response to clonidine in children with short stature is correlated with postural characteristics: a retrospective cross-sectional study

BackgroundClonidine stimulation test has been widely used in the diagnosis of growth hormone deficiency in children with short stature with a high level of reliability. However, it may cause hypotension, which usually appears as headache, dizziness, bradycardia, and even syncope. It is well known that elevating the beds to make patients’ feet above their cardiac level might relieve this discomfort. However, the real efficiency of this method remains to be proved while the best angle for the elevated bed is still unclear.MethodsA total of 1200 children with short stature were enrolled in this retrospective cross-sectional study. Age, gender, weight, and basic systolic and diastolic blood pressure were collected. Blood pressure at 1, 2, 3, and 4 h after stimulation tests were recorded. The participants were divided into 3 groups based on the angles of the elevated foot of their beds named 0°, 20°, and 40° groups.ResultsAt one hour after the commencement of the tests, participants lying on the elevated beds showed a higher mean increase on the change of pulse pressure. The difference in the angles of the elevated beds did not show statistical significance compared with those who did not elevate their beds (0.13 vs. 2.83, P = 0.001; 0.13 vs. 2.18, P = 0.005; 2.83 vs. 2.18, P = 0.369). When it came to 4 h after the tests began, participants whose beds were elevated at an angle around 20° had a significantly higher mean increase in the change of pulse pressure values compared with those whose beds were elevated at an angle around 40° (1.46 vs. -0.05, P = 0.042).ConclusionElevating the foot of the beds of the patients who are undergoing clonidine stimulation tests at an angle of 20°might be a good choice to alleviate the hypotension caused by the tests.

Effects of Lunar Phases on Foot Temperature, Oxidative Stress, and Inflammation in Type 2 Diabetic Subjects.

It has been observed that the lunar phases alter the fasting plasma glucose (FPG) level in type-2 diabetic (T2DM) subjects. Diabetic peripheral neuropathy (DPN) was also reported to be associated with elevated foot temperature (FT), oxidative stress, and inflammation in T2DM subjects. The purpose of the present study was to evaluate the changes in FT, oxidative stress, and inflammation levels and assess the relationship of FT with oxidative stress, antioxidant enzyme activity, and inflammatory markers in T2DM subjects at different lunar phases. The plasma glucose, glycated hemoglobin, and dorsal and plantar surface temperatures of the feet by infrared dermal thermometer were measured in 88 randomly selected T2DM subjects at different lunar phases. The levels of oxidative stress and inflammation were assessed by measuring malondialdehyde (MDA), glucose 6-phosphate dehydrogenase (G6PDH), and tumor necrosis factoralpha (TNF-α). The FTs, MDA, and TNF-α were significantly increased, and G6PDH activity was significantly decreased in the new moon (NM) and full moon (FM) than in the third quarter (TQ) and first quarter (FQ) for both sexes. The FTs, MDA, and TNF-α levels were significantly positively correlated, whereas G6PDH activity was significantly negatively correlated with FPG at NM and FM in both sexes. The MFT was significantly positively correlated with MDA and TNF-α and significantly negatively correlated with G6PDH at NM and FM in T2DM subjects. The lunar phases showed a prominent influence on the FT, oxidative stress, and inflammatory status in T2DM subjects, which might be due to the existence of biological rhythm interaction with lunar electromagnetic radiations.

Flood risk assessment for residences at the neighborhood scale by owner/occupant type and first-floor height.

Evaluating flood risk is an essential component of understanding and increasing community resilience. A robust approach for quantifying flood risk in terms of average annual loss (AAL) in dollars across multiple homes is needed to provide valuable information for stakeholder decision-making. This research develops a computational framework to evaluate AAL at the neighborhood level by owner/occupant type (i.e., homeowner, landlord, and tenant) for increasing first-floor height (FFH). The AAL values were calculated here by numerically integrating loss-exceedance probability distributions to represent economic annual flood risk to the building, contents, and use. A simple case study for a census block in Jefferson Parish, Louisiana, revealed that homeowners bear a mean AAL of $4,390 at the 100-year flood elevation (E 100), compared with $2,960, and $1,590 for landlords and tenants, respectively, because the homeowner incurs losses to building, contents, and use, rather than only two of the three, as for the landlord and tenant. The results of this case study showed that increasing FFH reduces AAL proportionately for each owner/occupant type, and that two feet of additional elevation above E 100 may provide the most economically advantageous benefit. The modeled results suggested that Hazus Multi-Hazard (Hazus-MH) output underestimates the AAL by 11% for building and 15% for contents. Application of this technique while partitioning the owner/occupant types will improve planning for improved resilience and assessment of impacts attributable to the costly flood hazard.

Mt. Rainier Sanctification

Mt. Rainier Sanctification

Effects of multi-obstacle contexts on obstacle negotiation strategies in healthy older adults under dual-task conditions

BackgroundPerformance of obstacle crossing is an attentionally demanding task due to the need for motor planning and gait regulation, particularly among older adults. Despite extensive studies on age-associated changes in obstacle negotiation strategies, relatively little is known about adaptive mechanisms in the elderly regarding multiple obstacle crossings with different execution demands. Research questionFor better understanding of avoidance strategies employed by the elderly, the current study investigated adaptive mechanisms related to planning and implementation of more complex multi-obstacle contexts. Do older adults use a more conservative strategy such as prolonged step duration or elevated foot height when crossing obstacles with increased task demands of obstacle negotiation? MethodsEleven healthy older and 11 young adults participated in the experiment. We examined how the presence and physical property of the second obstacle influenced the planning and adjustments for obstacle avoidance performance. Spatiotemporal characteristics of the stepping movement were analyzed using a 3D motion capture system. ResultsOlder adults showed a longer stance time before crossing the first obstacle than young adults when the task complexity increased. These stepping characteristics were more evident in the dual-task condition. However, their foot clearance and crossing speed were not influenced by the level of task complexity. SignificanceThese findings suggest that healthy elderly participants may have difficulty in developing the motor plan rather than implementing the stepping strategies under more complex obstacle constraints. A general cognitive decline with advancing age or adaptation of compensatory adjustment to enhance postural stability may underlie such altered obstacle negotiation behaviors in older adults.

The Thermo-Pressure Concept: A New Model in Diabetic Foot Risk Stratification

Elevated foot pressure and high temperatures have been proposed as predictive factors for diabetic foot ulceration; however, on their own, their predictive value is still questionable. This pilot study hypothesized that combining these two measurements in a thermo-pressure model could result in a more reliable risk assessment tool for providing risk categorization aimed to determine whether there is a correlation between foot plantar pressure and temperature in patients living with diabetes mellitus (DM) when compared with healthy individuals following a 15 min walk. Foot pressure and thermographic images were taken from 48 participants who were categorised into four groups following clinical evaluation into healthy individuals (Group A), living with DM with no complications (Group B), DM with peripheral arterial disease (Group C) and DM patients with neuropathy (Group D). This study demonstrated a positive correlation between pressure and temperature; as pressure increases, so does temperature. This was more pronounced in the groups with DM when compared to the healthy group. More research is warranted to further develop this innovative thermo-pressure model, which could hopefully be more sensitive in categorizing and identifying patients living with DM who are at risk of developing foot ulceration to initiate prompt care.

Mechanical Energy Expenditure at Lumbar Spine and Lower Extremity Joints During the Single-Leg Squat Is Affected by the Nonstance Foot Position.

Hirsch, SM, Chapman, CJ, Frost, DM, and Beach, TAC. Mechanical energy expenditure at lumbar spine and lower extremity joints during the single-leg squat is affected by the nonstance foot position. J Strength Cond Res 36(9): 2417-2426, 2022-Previous research has shown that discrete kinematic and kinetic quantities during bodyweight single-leg squat (SLS) movements are affected by elevated foot positioning and sex of the performer, but generalizations are limited by the high-dimensional data structure reported. Using a 3D inverse dynamical linked-segment model, we quantified mechanical energy expenditure (MEE) at each joint in the kinetic chain, the total MEE (sum of MEE across aforesaid joints), and the relative contribution of each joint to total MEE during SLSs performed with elevated foot positioned beside stance leg (SLS-Side), and in-front of (SLS-Front) and behind (SLS-Back) the body. Total MEE differed between SLS variations ( p = 0.002), with the least amount observed in the SLS-Back (effect size [ES] = 0.066-0.069). Approximately 50% of total MEE was contributed by the knee joint in each SLS variation, whereas MEE at the ankle, hip, and lumbar spine (in absolute and relative terms) varied complexly as a function of the elevated foot position. Total MEE ( p = 0.0192, ES = 0.852) and the absolute MEE at the knee and spine was greater in men across the SLS variations performed ( p = 0.025-0.036, ES = 0.715-0.766), but only the lumbar spine contribution to total MEE was larger in men across all SLS variations ( p = 0.045, ES = 0.607). Otherwise, there were no other sex-specific responses observed. Biomechanically, SLS movements are generally "knee-dominant," but changing elevated foot position effectively redistributes MEE among other joints in the linkage. Consistent with the previous conclusions reached based on discrete kinematic and kinetic data, not all SLSs are equal.

Quelle est la méthode radiographique la plus fiable pour évaluer l’arche plantaire médiale ? Application sur une population d’adolescents souffrant d’une scoliose idiopathique

BackgroundThe foot arch is known to be altered in subjects with postural malalignment. Foot arch morphology can be studied simultaneously with body's balance by measuring foot radiographic parameters on full-body biplanar x-rays. There is no consensus on which is the most reliable method to use to draw the foot axes. The aim was to determine the most reliable methods to draw the main foot axes and apply these findings in order to study the difference of foot parameters between adolescent idiopathic scoliosis (AIS) and control subjects. Hypotheses1) distant and clear anatomical landmarks are needed to draw the foot axes accurately; 2) foot longitudinal arch parameters differ between AIS and controls. MethodsIn total, 90 AIS patients and 36 controls have undergone full body biplanar X-rays from which 3D spino-pelvic and postural parameters were collected for each patient. Six radiological foot angles were evaluated on the 2D lateral radiographs: calcaneal pitch (CPA), talar declination (TDA), first metatarsal declination (FMDA), talo-calcaneal (TCA), calcaneal first metatarsal (CFMA) and Meary. Angles were calculated based on three major axes of the foot: talar, calcaneal, and first metatarsal. Two to three methods were used to draw each axis and the reliability of each method was assessed (3 operators, 2-times each). Then, differences of the foot parameters between AIS and controls, and determinants of these differences among 3D spino-pelvic and postural parameters were evaluated. ResultsThe most reliable methods for drawing the three axes of the foot were those using distant and clear anatomical landmarks on talus, calcaneum and first metatarsal and used for the subsequent analysis. The AIS group showed a significantly lower TDA (22° vs. 24°, p=0.014) and CFMA (141° vs. 144°, p=0.045), and higher FMDA (18° vs. 15°, p=0.008) and Meary's angle (−5° vs. −9°, p=0.005) when compared to controls. Differences were found to be determined mainly by the center of auditory meatus sagittal plumbline. DiscussionThis is the first study to evaluate the most reliable method to draw foot axes on the lateral radiograph of biplanar X-rays in order to assess radiological foot arch parameters. AIS patients were shown to have more elevated foot arch compared to controls.

High Altitude Pulmonary Edema.

This simulation was developed to educate emergency medicine residents on the diagnosis and management of high-altitude pulmonary edema (HAPE). This case is also appropriate for senior medical students and advanced practice providers. The principles of crisis resource management, teamwork, and communication are incorporated into the case. High altitude pulmonary edema may present similarly to pneumonia with nonspecific symptoms, including decreased exercise tolerance, cough, dyspnea with exertion, and fever. Symptoms more specific to HAPE include dyspnea at rest, tachypnea, history of rapid ascent to high altitude, a lowlander patient exposed to high-altitude, or a highlander patient on re-entrance to high altitude after lowland stay. Laboratory and imaging workup may include infiltrates on chest x-ray and leukocytosis.1,2 Of the various forms of altitude sickness, HAPE has the highest fatality rate, estimated at 50% in travellers to the Himalayas who are unable to descend.1 Providers should inquire as to the current elevation of their facility, the patient's recent altitude gain, and the rate of ascent. Treatment priorities include oxygen and immediate descent, as well as supplemental treatment with nifedipine and phosphodiesterase (PDE) inhibitors such as sildenafil or tadalafil. At the conclusion of the simulation session, learners will be able to:obtain a thorough history relevant to altitude illnessesdevelop a differential for dyspnea in a patient with environmental exposuresdiscuss prophylaxis and management of HAPEdiscuss appropriate disposition of the patient including descent and subsequent appropriate level of care. This session was conducted using high-fidelity simulation followed by a debriefing session and lecture on the diagnosis and management of HAPE. Debriefing methods may be left to the discretion of participants, but the authors have utilized advocacy-inquiry techniques. This technique includes an observation statement, a statement describing the framework of the observer, and an invitation to review further to explore the participants' frames. An example of this advocacy-inquiry is as follows: "I heard Sam suggest to the team that acetazolamide be given, but then I didn't hear any follow-up discussion. Acetazolamide is often utilized for acute mountain illness prophylaxis or treatment. I wasn't sure if the team did not hear his suggestion or disagreed with the treatment plan. Tell me more." This scenario was designed as a simulation, but it could be adapted as an oral boards case. Our residents were provided with a survey at the completion of the simulation and debriefing to rate different aspects of the simulation, as well as to provide qualitative feedback. Participants expressed positive feedback, with comments focused on appreciating the review of the presentation, diagnosis, and treatment of altitude illness. The emergency medicine residents surveyed currently practice in a low altitude setting and were appreciative to simulate a scenario to which they might otherwise not get exposure during their residency. Our simulation center's feedback form is based on the Center of Medical Simulation's Debriefing Assessment for Simulation in Healthcare (DASH) Student Version Short Form. This session received all 6 or 7 scores (consistently effective/very good or extremely effective/outstanding) other than a 5 for setting the stage, a 4 for maintaining an engaging context for learning, and two 5s for structured debriefing. This was an effective method to review high altitude illness with learners that may otherwise get limited exposure to such clinical cases during residency. Learners had a broad range of differential diagnoses and demonstrated variable levels of knowledge related to the diagnosis and treatment of high-altitude illness. We used visual stimuli and a reminder from our nurse to reinforce for the learners that the case was taking place at a critical access emergency room at 11,000 feet of elevation. Medical simulation, high altitude pulmonary edema, high altitude cerebral edema, altitude sickness, emergency medicine, wilderness medicine.

The Association Between Elevated Foot Skin Temperature and the Incidence of Diabetic Foot Ulcers: A Meta-Analysis

Prior to the appearance of any foot ulcer, there is an increase in the local temperature due to the presence of an underlying inflammatory process. The use of thermometry to identify inflammation could make patients increase preventive measures until the inflammation disappears. We carried out a meta-analysis to determine the effectiveness of the daily measurement of the foot temperature in 6 points to prevent the occurrence of foot ulcers in patients with diabetes. Patients with temperature differences >4°F (2.2°C) between left and right corresponding sites should reduce activity and increase preventive measures until temperature is normalized. We searched the literature in MEDLINE, EMBASE, Cochrane Library, Web of Knowledge, and clinicaltrials.gov. We have only included randomized clinical trials where individuals were assigned to receive enhanced care (temperature measurement and standard care) versus standard care (education, self-care practices, and periodic clinical visits). We found 4 trials comprising 462 patients from the United States and Norway that met our inclusion criteria. The duration of follow-up varied from 4.5 to 15 months. Overall, 18 (7.9%) subjects in the enhanced foot care group and 53 (22.6%) in the standard foot care group developed foot ulcers (pooled risk ratio = 0.37; 95% confidence interval = 0.21-0.66; P = .0008; percentage of heterogeneity [I2], 25%; P = .26). The number needed to treat was 7 (95% confidence interval = 5-11). The results were robust after analysis by subgroups according to the potential risk of bias in the studies and the duration of follow-up.

What is the most reliable radiographic method to evaluate the longitudinal foot arch? Application in subjects with Adolescent Idiopathic Scoliosis

BackgroundThe foot arch is known to be altered in subjects with postural malalignment. Foot arch morphology can be studied simultaneously with body's balance by measuring foot radiographic parameters on full-body biplanar x-rays. There is no consensus on which is the most reliable method to use to draw the foot axes. The aim was to determine the most reliable methods to draw the main foot axes and apply these findings in order to study the difference of foot parameters between AIS and control subjects. Hypotheses(1) distant and clear anatomical landmarks are needed to draw the foot axes accurately; (2) foot longitudinal arch parameters differ between AIS and controls. MethodsNinety AIS patients and 36 controls have undergone full body biplanar X-rays from which 3D spino-pelvic and postural parameters were collected for each patient. Six radiological foot angles were evaluated on the 2D lateral radiographs: calcaneal pitch (CPA), talar declination (TDA), first metatarsal declination (FMDA), talo-calcaneal (TCA), calcaneal first metatarsal (CFMA) and Meary. Angles were calculated based on three major axes of the foot: talar, calcaneal, and first metatarsal. Two to three methods were used to draw each axis and the reliability of each method was assessed (three operators, 2-times each). Then, differences of the foot parameters between AIS and controls, and determinants of these differences among 3D spino-pelvic and postural parameters were evaluated. ResultsThe most reliable methods for drawing the three axes of the foot were those using distant and clear anatomical landmarks on talus, calcaneum and first metatarsal and used for the subsequent analysis. The AIS group showed a significantly lower TDA (22° vs. 24°, p=0.014) and CFMA (141° vs. 144°, p=0.045), and higher FMDA (18° vs. 15°, p=0.008) and Meary's angle (−5° vs. −9°, p=0.005) when compared to controls. Differences were found to be determined mainly by the center of auditory meatus sagittal plumbline. DiscussionThis is the first study to evaluate the most reliable method to draw foot axes on the lateral radiograph of biplanar X-rays in order to assess radiological foot arch parameters. AIS patients were shown to have more elevated foot arch compared to controls.

Year One of AMLO's Mexico

Year One of AMLO's Mexico Humberto Beck (bio), Carlos Bravo Regidor (bio), and Patrick Iber (bio) On a sunny morning last May on the grounds of Los Pinos, the old presidential residence now open to the public, Mexican citizens strolled past a line of cars, trucks, and armored vehicles. They gazed in the windows of a 1951 Volkswagen bug and posed for pictures in front of a Lamborghini Murciélago. The cars, which all belonged to the Mexican government (some were for official use, some had been seized from criminal organizations), were waiting for auction. "There can be no rich government and a poor people," Andrés Manuel López Obrador (AMLO) had repeated on the campaign trail. Now he was president, and this sale symbolized the new order. Proceeds were destined for some of the country's poorest municipalities. Even the government agency responsible for the auction would have a new name: the Instituto para Devolverle al Pueblo lo Robado (the Institute for Returning to the People What Was Stolen). As they waited to be sold, the vehicles picked up the dust and grime of Mexico City, which sits in a pollution-trapping valley at nearly 7,500 feet of elevation. Just the week prior, the city had virtually shut down for several days because of a pollution emergency, in which high temperatures, low rainfall, and ongoing fires added to the usual stew of exhaust and industrial effluent. In the grime on the window of a Corvette Stingray, someone scrawled a homophobic insult directed at the last president, Enrique Peña Nieto. A few days later, the vehicles were gone. The auction raised more than a million dollars in revenue. The sale was designed to demonstrate some of the new president's political ambitions. Few doubt AMLO's determination to transform his country. Even before taking office he had already envisioned his term in historic dimensions, labeling it the "Fourth Transformation" of Mexico, following independence from Spain, the liberal Reforma, and the Mexican Revolution. Though AMLO has never provided a precise definition of the Fourth Transformation, he invokes it to describe a revindication of national pride, a political project of aligning the presidency with the popular will, and the creation of a social movement that could to do away with the old party system, social inequality, and the economic status quo. [End Page 109] Click for larger view View full resolution AMLO boards a commerical flight in February 2019. (Alfredo Estrella/AFP via Getty Images) AMLO has moved quickly to make changes. Old offices and programs have been dismantled and new social policies put in place. Spending considered profligate has been scrapped and budgets redirected. New priorities have taken over the everyday work of government agencies. Elected with an absolute majority, his party, MORENA, is in firm control of Congress. And his popularity has remained reasonably high, even as criticism mounts: his approval rating has fallen from a post-election peak in the mid-eighties to somewhere in the high-sixties. AMLO is the fourth president—and the first from the left—elected since the end, in 2000, of seven decades of single-party control of the presidency by the Partido Revolucionario Institucional (PRI). Approximately one year into his term in office, his approval rating does not differ significantly from those of his more conservative predecessors at the same point. All of those presidencies—of Vicente Fox, Felipe Calderón, and Enrique Peña Nieto—are considered failures. Indeed, their legacy of accumulated fiascos propelled AMLO to the presidency. Expectations have been high. But for his administration to succeed, AMLO will need to make life better for the majority of Mexicans. To do this, he'll need to reduce corruption, improve economic fairness, and provide safety and security. In each of these areas, however, there are reasons to be concerned about AMLO's ability to make significant progress. [End Page 110] ________ In his campaign for the presidency, AMLO took aim at the most emblematic infrastructure project of the previous administration, Mexico City's New International Airport. At the time, about 20 percent of the construction was already complete and 60 percent of the investment under contract. AMLO...

Cedar Breaks National Monument, North View Overlook

Cedar Breaks National Monument straddles the western rim of the Markagunt Plateau, and, at over 10,000 feet (3050 m) in elevation, offers spectacular views westward into the adjacent Great Basin. The heart of the monument consists of a series of overlooks along a beautiful, 4-mile-long (6 km), west-facing amphitheater that is eroded into the plateau’s margin. These overlooks are adorned with a fantastic variety of hoodoos and sculpted fins eroded from alternating resistant and soft, jointed and fractured layers of the Claron Formation. Of these overlooks, the North View Overlook encapsulates the entire geologic story preserved at Cedar Breaks—a history not only of the enigmatic Claron Formation, but also of the demise of its depositional basin and eventual burial by volcanic sediments of the Brian Head Formation.

Transtibial amputee gait with the unity suspension system

Study Design: Experimental study.Objectives: Research is lacking on the Unity suspension system’s effect on gait performance. The purpose of this study was to evaluate the effects of the Unity elevated vacuum system on level walking performance while the vacuum was active (ON) and inactive (OFF).Methods: Twelve unilateral transtibial amputees were fit with the Ossur elevated vacuum suspension system (Unity) and Pro-flex XC foot. After one month accommodation period, 3D motion analysis was performed using the CAREN-Extended system. Temporal-spatial, kinematics, and kinetics were examined during level walking to understand the effect of the elevated vacuum, separate trials were completed with the vacuum active (ON) or inactive (OFF).Results: Significant differences were found between vacuum conditions (ON and OFF) for some temporal-spatial gait parameters, but differences were very small and may not be clinically significant. Differences between vacuum conditions on most kinetic and kinematic gait parameters were also low. However, step length symmetry between intact and prosthetic limbs improved with active elevated vacuum (ON).Conclusions: Elevated vacuum suspension’s effect on level walking gait is small if a well-fitting liner-based socket is provided.Implications for rehabilitationStep length symmetry between intact and prosthetic limbs improved with an active vacuum system.Differences between vacuum conditions on most gait parameters were small during level walking.Subjective feedback showed improved proprioception and comfort with an active vacuum system.

Comparison of Peak Plantar Pressure and Peak Pressure Gradient among Patients with Prediabetes and Diabetes

Background: Foot ulcers are a serious complication associated with diabetes peripheral neuropathy (DPN). Diabetes foot complications associated with increased ulcer risk include: 1) decreases in plantar soft-tissue thickness, 2) increases in plantar tissue stiffness, and 3) increases in forefoot (FF) to rearfoot (RF) loading. Aim: The purpose of this study was to determine whether patients with DPN demonstrate higher forefoot to rearfoot pressures during barefoot walking compared to diabetes patients without peripheral neuropathy (DWPN) and prediabetes patients without peripheral neuropathy (PWPN). Methods: Eight PWPN, twenty-six DWPN and fourteen DPN patients participated in the study. Barefoot walking trials were performed while wearing Medilogic® pressure-measuring insoles. Peak plantar pressure (PPP) and peak pressure gradient (PPG) were measured on the right foot for the FF and RF regions. FF to RF PPP and PPG ratios were then calculated and normalized to body mass. Walking velocity was used as a co-variate for ANCOVAs. A priori statistical significance was set at α=0.05. Results: No significant interactions were observed for Group*Region for PPP (F(2, 89)=1.454, p=0.239) and PPG (F(2, 89)=0.579, p=0.563). Main effects of region revealed significantly higher FF to RF loading in both PPP (F(1, 89)=6.67, p=0.011) and PPG (F(1, 89)=4.02, p=0.048) measures driven by DWPN and DPN patients. No significant differences were observed between groups for FF to RF PPP (F(2, 44)=2.624, p=0.084) or PPG (F(2, 44)=1.331, p=0.275) ratios. Conclusion: Our findings suggest DWPN and DPN patients demonstrate a pattern of loading related to elevated foot ulcer risk. However, no significant difference was observed between groups for FF to RF PPP and PPG ratios. Inclusion of a more robust sample size will allow better testing of our hypothesis. Disclosure K. Izuora: None. M. Trabia: None. J. DeBerardinis: None. D.E. Lidstone: None. M. Varre: None. A.L. Trotter: None. J.S. Dufek: None.

Abstract: A Prospective Randomized Controlled Trial of Autologous Fat Grafting for Pedal Fat Pad Atrophy

INTRODUCTION: Pedal fat pad atrophy is associated with pain, decreased tissue thickness, and elevated foot pressures. To date, no objective studies have investigated the utility of injecting fat into the forefoot to treat this costly and debilitating form of lipoatrophy. We hypothesize that pedal fat grafting can reduce pain, improve function, increase tissue thickness, and decrease pedal pressures. MATERIALS AND METHODS: A randomized, controlled trial was performed, assessing tissue thickness, pain, and foot pressures after fat grafting to the forefoot. Patients were randomized to receive either fat grafting or conservative management. Ultrasound-assessed tissue thickness, pedobarograph-assessed foot pressures, and the Manchester Foot Pain and Disability Index (MFPDI)1 were obtained at baseline, 6mo, and 12mo visits. 18 patients (4 Male, 14 Female) comprised the treatment group, and 12 patients (4 Male, 8 Female) comprised the control group. RESULTS: Average age was 60 ± 8.7 years for the treatment group and 65.3 ± 8.5 for the control. Mean BMI was 26.8 ± 4.7 and 25.6 ± 6.1 in treatment and control groups respectively. 11 patients received bilateral injections with a mean volume of 4.8 ± 0.8mL and 4.7 ± 0.7mL in the right and left feet respectively. Mean follow-up time was 8.7 ± 6.2 months for the treatment group and 13.8 ± 4.2 months for controls (p=0.001). At 1 year, grafted subjects demonstrated improvements in foot function (p=0.022), pain (p=0.022), and work/leisure activities (p=0.021) with a significant increase in tissue thickness over the metatarsal heads (p<0.04) at 6mo but not at 12mo. However, controls experienced significant decreases in average metatarsal tissue thickness over the first 6mo (p<0.05), and in the thickness over the 3rd metatarsal at 12mo (p=0.036), with most of the worsening occurring between the 6mo and 12mo time point (p=0.023). Foot pressures did not decrease after grafting. However, controls experienced increasing left foot pressure (P=0.011). When comparing the groups at 1 year, controls had significantly greater foot pressures and forces than patients receiving fat grafting (p<0.05). CONCLUSION: Despite decreasing tissue thickness over time, fat grafting for forefoot fat pad atrophy significantly improves pain and disability outcomes and prevents worsening foot forces and pressures. Pedal fat grafting is a safe, minimally invasive approach to treat fat pad atrophy with minimal downtime. Future analysis will reveal whether fat grafting has lasting efficacy. DISCLOSURE/FINANCIAL SUPPORT:Supported by a PSF Pilot Research Grant (awarded to Dr. Jeffrey A Gusenoff). None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript. REFERENCES: 1. Garrow AP, Papageorgiou AC, Silman AJ, Thomas E, Jayson MI, Macfarlane GJ. Development and validation of a questionnaire to assess disabling foot pain. Pain. 2000;85(1–2):107–113. doi:10.1016/S0304-3959(99)00263-8.

A radiographic assessment of lumbar spine posture in four different upright standing positions

BackgroundApproximately 50% of a sample population will develop prolonged standing induced low back pain. The cause of this pain may be due to their lumbar spine posture. The purpose of this study was to investigate differences in lumbar posture between 17 participants categorized as a pain or non-pain developers during level ground standing. A secondary purpose was to evaluate the influence of two standing aids (an elevated surface to act as a foot rest and declined sloped surface) on lumbopelvic posture. MethodsFour sagittal plane radiographs were taken: a normal standing position on level ground, when using an elevated foot rest, using a declined sloped surface, and maximum lumbar spine extension as a reference posture. Lumbosacral lordosis, total lumbar lordosis, and L1/L2 and L5/S1 intervertebral joint angles were measured on each radiograph. FindingsThere was a significant difference between the lumbosacral lordosis angle and L5/S1 angles in upright versus maximum extension; however, this was independent of pain group. The elevated surface was most effective at causing lumbosacral spine flexion. InterpretationPotentially successful postures for eliminating low back pain during prolonged standing mainly influence the lower lumbar lordosis. Future work should assess the influence of hip posture on low back pain development during standing.

Latrine access and utilization among people with limited mobility: A cross sectional study.

BackgroundLatrine access is one of the challenges faced by people with physical disabilities that limit their mobility (PPDs) in their home and working environments. Latrines should be designed, built and located such that they are easily accessible and utilizable by PPDs. Therefore, the aim of this study was to determine latrine access and utilization, and explore the challenges in latrine use among PPDs in Bahir Dar city, northwest Ethiopia.MethodsA cross-sectional study design was conducted from July 15 to August 15, 2014. Data were collected using a structured and pre-tested questionnaire, and focus group discussions. Four hundred nineteen participants were included using a systematic random sampling technique. SPSS version 20 was used for data entry and analysis. Binary logistic regression was used to identify factors associated with latrine utilization. Qualitative data were analyzed using themes.ResultsOf 419 participants, 142 (33.9 %) had access to latrines and 173 (41.3 %) had satisfactory latrine utilization. Family support while using latrine (AOR = 4.7, 95 % CI (2.7, 8.3), latrine accessibility (AOR = 2.1, 95 % CI (1.2, 3.7) and past latrine modification (AOR = 3.1, 95 % CI (1.8, 5.4) were factors associated with latrine utilization. Presence of steps at the latrine entrance, privacy while using latrine, absence of handrails, unavailability of family support, narrower latrine door, distant latrine, unclean floor of the latrine and elevated foot rests were challenges mentioned by PPDs.ConclusionsLatrine access and utilization were low among PPDs. Family members should encourage and support PPDs when they need to use latrine, designing accessible latrines, modifying existing latrines to accommodate PPDs are the areas of interventions to increase latrine accessibility and utilization among PPDs.

Use of an asymmetric ovate footpath to overcome the mechanical constraints imposed by non-impact cross-training devices in high-intensity exercise

In this study, we compare differences between the mid-foot running gait of a typical middle distance runner and the footpath of a non-impact elliptical cross-training device. From this analysis, we propose and implement an asymmetric ovate footpath to overcome the substantial differences in biomechanics imposed by elliptical mechanisms. Similar to running, the asymmetric ovate provides 60% swing and 40% stance phase timing as well as an elevated foot position during initial swing at the commencement of foot recovery. Importantly, this reduction of mid-stance to toe-off timing combined with a large arc in the footpath during initial swing induces a simulated leap (double float) even though the feet remain in contact with the pedals. Preliminary analysis comparing the asymmetric ovate with an elliptical footpath (n = 2 × 3 replicates) suggests that the asymmetric ovate is better suited to high-intensity interval training. Applying a 99% confidence level, maximum heart rates were higher and achieved faster using the asymmetric ovate mechanism. While non-impact cross-training mechanisms are by definition different to running, our investigation suggests that the asymmetric ovate provides a closer analogue to running than the ellipse. Future studies are needed to confirm these findings.

A Torrent of Consequences

A Torrent of Consequences