Foot Deformities In Patients Research Articles

Planovalgus Foot Deformity in Patients Undergoing Total Hip Arthroplasty Is Associated With Increased Risk of Falls, Implant-Related Complications, and Revisions: A Case-Control Analysis

BackgroundPes planus occurs due to the loss of the longitudinal arch of the foot, resulting in altered gait mechanics. This may lead to increased complications following total hip arthroplasty (THA). Thus, the aim of this study was to assess the effects that pes planus has on rates of falls, implant complications, fall-related injuries, and times to revision among THA patients. MethodsA retrospective review of a private insurance claims database was conducted from 2010 to 2021. Patients who had a diagnosis of congenital or acquired pes planus and cases of THA were identified. Patients undergoing THA with a diagnosis of pes planus were matched to control patients 1:5 based on age, sex, and comorbidity profiles. Logistic regression was utilized to assess for differences in complication rates. ResultsA total of 3,622 pes planus patients were matched to 18,094 control patients. The pes planus group had significantly higher rates of falls than the control group (6.93 versus 2.97%, OR [odds ratio]: 2.43; CI [confidence interval]: 2.09 to 2.84; P < .001). Pes planus patients also had significantly greater odds of dislocation (OR: 1.89; CI: 1.58 to 2.27; P < .001), mechanical loosening (OR: 2.43; CI: 2.09 to 2.84; P = .019), and periprosthetic fracture (OR: 2.43; CI: 2.09 to 2.84; P < .001). The pes planus group had significantly greater rates of proximal humerus fractures (P = .008), but no difference was seen in distal radius fractures (P = .102). The time to revision was significantly shorter in the pes planus group (190 versus 554 days, P < .001). ConclusionsPes planus in patients undergoing THA is associated with increased risk of complications and faster time to revision. These findings may allow orthopaedic surgeons to identify those patients at risk and allow for more educated patient counseling and operative planning.

Surgical Treatment of Post-Amputation Foot Deformations in Diabetic Neuropathy

Relevance The number of amputations performed on patients with diabetic foot syndrome is increasing all over the world. Almost half of these operations are the so-called “minor amputations” carried out within the foot. The high recurrence rate of neuropathic ulcers, impaired biomechanics, and a decrease in the quality of life of patients after these surgeries encourage the study of this problem and the search for possible treatment options due to the capabilities of surgical treatment for post-amputation foot deformities.Aim of study To evaluate the nature of surgical interventions for post-amputation foot deformities in patients with diabetic neuropathy.Material and methods The literature search was carried out in the databases of medical publications PubMed, CyberLeninka, Google Scholar, Scopus, Medline, eLIBRARY among articles in English and Russian. The search was performed using the following terms: transmetatarsal resection, diabetic foot syndrome, transmetatarsal amputation, minor amputation.Results Surgical treatment methods for deformities after amputation of part of the forefoot are widely presented in the world literature and are more studied. The possibilities of correcting foot deformities that occurred after amputation of the entire anterior section (from transmetatarsal amputation to the level of the Chopart`s joint) are less covered, this direction and methods have been studied to a lesser extent.Conclusions Surgical methods for the correction of post-amputation foot deformities have firmly entered the wide international practice. Their effectiveness is confirmed by studies with a high level of evidence. Nevertheless, a wider, academic research of the problem of orthopedic status in patients with this pathology and the corresponding methods of surgical treatment is required.

Evaluation of Foot Deformities in Patients With Ingrown Nails.

Ingrown nail is a condition caused by the perforation of the periungual soft tissues on nail folds by the sides of nail plaque, causing inflammation and severe pain. Recently, the role of foot anatomical disorders in ingrown nail development has been emphasized. The main objective of this study aimed to determine whether foot deformities played significant roles in ingrown nail development with objective radiological parameters. The study included 64 patients diagnosed with clinical ingrown nail and 71 patients as controls without any ingrown nail history. In both groups, we evaluated the bilateral foot radiographs of patients with ingrown nails for hallux valgus angle (HVA), interphalangeal angle (IPA), and intermetatarsal angle (IMA) associated with hallux valgus, and the calcaneal pitch angle (CPA), talohorizontal angle (THA), and talometatarsal angle (TMA) related to pes planus. No significant difference was found in terms of hallux valgus radiological measurements of HVA, IPA and IMA as well as pes planus radiological measurements of CPA and TMA values, when compared to controls. THA was statistically significantly higher in the control group (P = 0.025). There was a moderate strength positive relationship between ingrown nail stage and measured TMA for pes planus diagnosis (rho = 0.326; P = 0.04), yet there are no significant correlations between ingrown nail stage and other angles. Therefore, we do not recommend foot anatomy correction in the prevention and treatment of ingrown nails, unless there is an accompanying foot deformity; however, pes planus is a foot deformity that can accompany patients with severely ingrown nails.

Reverse V-shaped osteotomy for ankylosing rocker-bottom foot deformity in patients with rheumatoid arthritis: A report of three cases.

This study evaluated a reverse V-shaped osteotomy for ankylosing rocker-bottom foot deformity in patients with rheumatoid arthritis. Three feet were presented in this study: rheumatoid rocker-bottom deformities with painful and/or infectious bony prominence towards the bottom of the foot, treated with a reverse V-shaped osteotomy in the mid-hindfoot. In all three cases, significant correction was achieved with restoration of the medial longitudinal arch, and improvement in clinical scores was confirmed. Reverse V-shaped osteotomy has the potential to be a useful and definitive procedure for ankylosing rocker-bottom deformity in patients with rheumatoid arthritis.

Increase in lateral contact force in the tibiotalar joint during walking in flatfoot patients with reduced stiffness of the spring ligament

Foot deformities in patients with flexible flatfeet, such as the flattened medial arch and hindfoot valgus, affect the force distribution around the tibiotalar joint during walking and increase the risk of secondary injuries. In this study, we developed a multi-segment foot model that could calculate the dynamics around the tibiotalar joint and investigated the difference in the kinetics between normal feet and feet with flatfoot. Ten participants with normal feet and ten with flexible flatfoot were enrolled in the study. The body kinematics, ground reaction force, and foot pressure of the participants were recorded during walking. A five-segment foot model was developed to calculate contact forces in the tibiotalar joint. A flatfoot model was developed by modifying the stiffness of the spring ligaments of a normal foot model. Ground reaction force was applied to the plantar surface of the foot models. The foot models were attached to a full-body musculoskeletal model to conduct inverse dynamic simulations of walking. Participants with flatfoot had significantly greater lateral contact force (1.19 BW vs. 0.80 BW) and more posteriorly located center of pressure (33.7 % vs. 46.6 %) in the tibiotalar joint than those with normal feet (p < 0.05). The average and peak posterior tibialis muscle forces were significantly larger in participants with flatfoot than in those with normal feet (3.06 BW vs. 2.22 BW; 4.52 BW vs. 3.33 BW). The altered mechanics may influence the risk of arthritis.

Assessment of foot deformities in patients with type 2 diabetes mellitus

Background: Affection of lower extremity in diabetic patients leads to development of several foot deformities. The knowledge so far about the particulars of foot deformity in diabetic population is limited. The current study aimed to assess prevalence of foot deformities in known diabetics and to compare it with non-diabetic population. It also aimed to know its association with various risk factors. Methods: Foot was evaluated for presence of deformity in 80 patients with type 2 diabetes mellitus and was compared with the control group of 80 non-diabetic individuals. Type of deformity was noted and its prevalence was compared between the two groups. Statistical analysis was done to see the association of foot deformity with various risk factors. Results: Prevalence of foot deformity was more in diabetics as compared to normal population (p&lt;0.004). Forefoot was involved in majority of cases (84.93%) and nail deformities were most commonly seen (38.35%). Deformities were less common in patients who were aware of diabetic foot care measures (p&lt;0.004) and were more common in presence of diabetic neuropathy, vasculopathy and uncontrolled glycaemic index. Conclusions: All patients with diabetes should be screened for presence of neuropathy as this is the most common factor for development of a foot deformity and hence a foot ulcer. Other helpful screening measures include assessment for peripheral vascular disease and monitoring of glycaemic index (HbA1c). Patients should be educated about the diabetic foot care measures to avoid potential complications.

Developmental Foot Deformities in Patients with Connective Tissue Disorders

Foot deformities make up a large percentage of all orthopaedic complaints in patients with Down syndrome, Marfan syndrome, Ehlers-Danlos syndrome, Larsen syndrome, and osteogenesis imperfecta. Some common causes of foot deformities in these conditions include increased ligament laxity, hypotonia, and hypermobility of the joints. Treatment options for syndromic foot deformities include the use of foot orthoses, physical therapy, bracing, and various surgical procedures. There is limited evidence supporting the use of surgical intervention to correct foot deformities associated with Down syndrome, Marfan syndrome, Ehlers-Danlos syndrome, Larsen syndrome, and osteogenesis imperfecta. Therefore, further research is needed to determine the short-term and long-term outcomes of these procedures.

Exploring the Relationship Between Clinical Presentation in Hallux Valgus and Response to AbobotulinumtoxinA Treatment

The relationship between pain/disability and angular deviation of the hallux valgus (HV), and the impact of orthotic use, laterality, and pain variability on treatment outcomes remain unclear. This was explored in post hoc analyses of a placebo-controlled trial of abobotulinumtoxinA (aboBoNT-A; Dysport®) for HV-associated pain (NCT03569098). The primary endpoint was not met in this study (change from baseline Numeric Pain Rating Scale [NPRS] score vs placebo at week 8); however, there was a greater reduction from baseline in mean NPRS score at week 12 with aboBoNT-A 500U versus placebo (p=.06). Adults with painful HV without surgery were randomized (1:1:1) to aboBoNT-A 300U, aboBoNT-A 500U, or placebo. NPRS was completed for 7 days before baseline and weeks 4, 8, and 12. Over-the-counter orthoses were permitted. Participants (N=186) had a mean [standard deviation, SD] age of 48.2 [13.1] years, 18% (33/186) used orthotics, and 67% (124/186) had bilateral HV. No associations between baseline pain severity and angular deviation were identified. Participants with high pain variability at baseline (SD > 2) had a poorer response to aboBoNT-A treatment than those with less variability. In conclusion, no relationship between HV-related pain/disability and angular deviation was observed. PLAIN LANGUAGE SUMMARY: A bunion (medical term: hallux valgus) is a common adult foot problem in which the big toe points inward toward the other toes, and this can be painful. How much the big toe points inward (how deformed the foot is) has been linked to the amount of pain the patient experiences. A better understanding of this foot deformity and bunion pain will help doctors and patients to make the right treatment decisions. A study was completed looking at how injections of a type of botulinum toxin (abobotulinumtoxinA) into specific muscles in the foot may help to reduce bunion pain in patients without surgery. This subsequent analysis of the study data looked at the amount of foot deformity in patients, the bunion pain they experienced, and which factors affected how well abobotulinumtoxinA worked to reduce bunion pain. The results of this study showed that the amount of foot deformity was not linked to the level of bunion pain. When deciding the best treatment option to relieve bunion pain, it is important that doctors not only consider how deformed the foot is, but also other important factors such as foot pain levels.

The relationship between the use of orthotics and foot deformity in cerebral palsy

Aim: Foot deformities are seen in more than 50% of children with cerebral palsy (CP). These deformities may cause gait deviations and mobility disorders over time. We aimed to examine the relationship between orthosis use, gait disturbances, and foot deformities in patients with cerebral palsy. Here, we aimed to analyze the relationship between orthosis use and foot deformities. &#x0D; Materials and Methods: The study was designed as cross-sectional, descriptive. One hundred and two patients who were admitted to Physical Medicine and Rehabilitation Health Care Committee were included. All patients were questioned about their age, birth history, maternal education level, orthosis use, surgery, and botulism toxin application. &#x0D; Detailed neurological examination of all participants (including walking analysis and spasticity) was performed by the same experienced physiatrist.&#x0D; &#x0D; Results: A total of 102 patients (41 males/61 females; mean age 10.1 ± 6.8 years) were included in the study. The most common type of CP was spastic tetraparesis (37.3%). Most commonly, crouch gait was observed in 23.5% of the patients. &#x0D; The rate of orthosis use in the lower extremity was 21.6%. The median duration of the use was 60 min/day, and the most frequent orthosis type was knee ankle foot orthosis (6.9%). Foot deformities were found in 84.3% of the patients (29.4%), and the most common foot deformity type was equinovarus. Also, 15.7% of the patients had botulism toxin application, and 9.8% had surgery. Foot deformity was observed less frequently in orthosis users (P= 0.042). Foot deformity was observed in 54.5% (n = 12) of the patients using orthosis. A negative correlation was found between spasticity score and ambulation (P= 0.00).&#x0D; &#x0D; Conclusion: Foot deformities were found high in non daily orthosis use group. With the widespread use of orthosis in children with CP, the development of foot deformities can be prevented.

Changes in gait pattern and quality of life of adolescents with flexible flat foot after Calcaneal Lengthening Osteotomy

BackgroundCalcaneal Lengthening Osteotomy is a surgical technique to correct flexible flat foot deformities in patients who did not show any change in their symptoms after conservative treatment. In this study, the effects of CLO on the kinematic and kinetic changes of gait was analyzed and the clinical and quality of life improvements in children treated by CLO for moderate to severe symptomatic flexible flat foot deformities were assessed. MethodsParticipants were seven adolescents (13 feet) with symptomatic FFF who underwent during 2019–2022 and seven (10 feet) healthy children as control group. Three items were evaluated in each foot before and after surgery including: 1. Clinical examination 2.quality of life (using Pediatric Quality of Life Inventory version 4 questionnaire) 3. Gait analysis (Vicon motion systems, Oxford metrics Inc., UK). Also, the kinetic and kinematic analysis between patients and healthy groups were compared. ResultsKinematic results of control was significantly better than FFF group. Ankle range of motion(32.94 ± 13.39 compared to 32.94 ± 13.39,P-Value:0.01),foot progression angle (−9.26 ± 7.67 compared to −16.07 ± 9.00,P-Value:0.01),and internal rotation of ankle was higher in control group compared to FFF. FFF patients demonstrated improvement in kinematic results after CLO surgery. Foot progression angle was improved after surgery (−11.31 ± 6.07 compared to −16.19 ± 7.06, P-value:0.00), maximum plantar flexion decreased after CLO surgery due to achil tendon procedure during CLO surgery. Kinetic results of FFF patients showed significant increase in ankle Power in coronal and transverse plane, Also knee and hip power showed similar results.Quality of life parameters showed significant improve in all parameters (Physical,Social, emotional and school function), Also ADKE and ADKF improved after surgery. ConclusionCLO surgery significantly improved patients' quality of life of patients with symptomatic FFF. Also, kinetic results showed improvement in some parameters of gait results after CLO surgery. Thus, our study suggested CLO surgery as an excellent surgical option for symptomatic FFF.

The posterior/medial dry needling approach of the tibialis posterior muscle is an accurate and safe procedure: a cadaveric study

BackgroundEvidence suggests that tibialis posterior muscle plays an important role in equinovarus foot deformity in patients who had suffered a stroke and it is one of the most frequently injected lower-extremity muscles for the management of spasticity. Our aim was to assess if a needle accurately and safely penetrates the tibialis posterior muscle during the application of dry needling. Methods We conducted a cadaveric descriptive study. Needling insertion of the tibialis posterior was conducted in 11 cryopreserved cadavers with a 70 mm needle. The needle was inserted using two common approaches, at midpoint (posterior/medial approach) and at upper third (anterior approach) of the leg towards the tibialis posterior. The needle was advanced into the tibialis posterior based upon clinician judgement. Cross-sectional anatomical dissections were photographed and analyzed by photometry. Safety was assessed by calculating the distances from the tip and the path of the needle to proximate neurovascular structures.ResultsAccurate needle penetration of the tibialis posterior muscle was observed in all cadavers with both approaches. In general, distances from the needle to the neurovascular bundles were larger with the posterior/medial approach than with the anterior approach, reaching statistically significance for needle tip to nerve (mean difference: 0.6 cm, 95%CI 0.35 to 0.85 cm) and vascular bundle (mean difference: 0.55 cm, 95%CI 0.3 to 0.8 cm) distances (P < 0.001) and needle path to vascular bundle distance (difference: 0.25 cm, 95%CI 0.1 to 0.4 cm, P = 0.045). Age and gender did not influence the main results.ConclusionsThis cadaveric study suggests that needling of the tibialis posterior muscle can be accurately and safely conducted. Safety seems to be larger with the posterior/medial approach when compared with the anterior approach.

Деформации стоп у пациентов с синдромом диабетической стопы (обзор литературы)

The objective was to review the orthopaedic literature on treatments of diabetic foot disease. Material and methods PubMed, CyberLeninka, Google Scholar, Scopus, Medline, eLIBRARY were searched. Studies in English and in Russian that reported foot deformities in the pathogenesis of diabetic foot disease and orthopaedic correction methods in the complex treatment of this late complication of diabetes mellitus were included for review. All study designs were considered. The search was produced using the following terms: diabetes mellitus, foot deformities, diabetic foot syndrome, orthopaedic treatment, osteotomy, metatarsophalangeal arthroplasty, achilles tendon lengthening. Literature sources reporting methods of orthopaedic correction of foot deformities in isolation from the diabetic foot syndrome and literary sources reporting manifestations of the diabetic foot syndrome without description orthopedic methods of treatment (surgery for purulent complications, vascular surgery, hypoglycemic therapy) were excluded from the study. Results The literature review allowed us to evaluate the role of orthopaedic treatment of foot deformities in patients with diabetic foot syndrome to be addressed either conservatively or surgically. The effectiveness of conservative methods has long been reported in studies with higher degree of evidence. Surgical correction of DFS through orthopaedic interventions has not been covered in such detail. Conclusion The literature review focused on the topical issue at the junction of various medical specialties. The results of treatment reported by Russian and foreign authors were analyzed. "Blind spots" in the literature were explored, goals for subsequent research delineated.

Foot Deformity in Patients With Ankylosing Spondylitis: Is It Associated With Functionality and Disease Activity?

Foot involvement affects mobility and functionality in patients with ankylosing spondylitis but it remains unknown if foot deformities in ankylosing spondylitis patients affect functionality, disease activity, and quality of life. The aim of this study was to evaluate in detail the presence of a relationship between radiologically detected foot deformities in ankylosing spondylitis patients and both clinical and electrophysiological findings. The cross-sectional study included 110 patients with ankylosing spondylitis who were diagnosed according to the Assessment in Spondyloarthritis International Society criteria and were followed in our hospital. Demographic and clinical data of all patients were recorded. Bilateral lateral foot x-rays and electrophysiology examinations were evaluated in all subjects. The arch in the dominant foot of the patients was classified in 3 groups as pes cavus, pes planus, or normal. The clinical outcomes, physical examination and electrophysiological findings were compared between the groups, and correlations were examined of the foot deformities with these parameters. Foot deformities were determined at a high rate (74.5%). These deformities affected foot pain, disability and quality of life. Pes cavus deformity was found to be associated with hip pain and enthesopathy. In the electrophysiological studies, the presence of pes planus was found to be associated with the findings of the tibial and sural nerve conduction studies, and the presence of pes cavus with the findings of the peroneal nerve conduction study. In conclusion, foot deformities may have an effect on the quality of life and functionality in ankylosing spondylitis patients.

Evaluation of Bilateral Foot Deformity in Patients with Hemiplegic Type Cerebral Palsy

ÖZET: Amaç: Çalışmamızda hemiplejik tip CP’li hastaların tutulmuş ve sağlam taraftaki ayaklarını feiss çizgisi ile değerlendirerek hastanın bağımsız yürüyor olma durumunda tedavide çoğunlukla ihmal edilen sağlam tarafta oluşabilecek deformitenin derecesini belirlemeyi amaçladık. Gereç ve yöntem: Çalışmaya hemiplejik tip CP tanısı almış 13 kız, 15 erkek hasta dahil edildi. Hastanın ayak deformitesini belirlemek amacıyla feiss çizgisi ile ayak değerlendirmesi yapıldı. Bunun için hastanın malleolus medialis’inin orta noktası ile birinci metatarsophalangeal eklemin orta noktası düz bir çizgi ile birleştirildi. Os navicula’da tuberositas ossis navicularis de işaretlenerek belirlendi ve düz çizgiye olan dik uzaklığı yaklaşık olarak santimetre cinsinden yumuşak mezura ile ölçüldü. Bu ölçümler her iki ayakta tekrarlandı. Bulgular: Çalışmaya katılanların 13’i kız, 15’i erkekti. Hastaların 12’si sağ taraf hemiplejik tip CP iken 16’sı sol taraf hemiplejik tip CP idi. Hastaların 17’si bağımsız olarak yürüyebiliyordu, 11’i ise destekli veya yardımcı cihaz ile yürüyebiliyordu ya da sadece ayakta durabiliyor aktif olarak yürüyemiyordu. Hastaların yaş ortalaması 14,5 iken; %42,9’u 10 yaş altında iken %57,1’i 10 yaş ve üstündeydi. Hastaların yürüme durumu ile ayak ölçümleri kıyaslandığında sol ayak ölçümleri arasında anlamlı farka rastlanmazken, sağ ayaktaki ölçümlerinin ortalaması arasında anlamı fark vardı. Yaş arttıkça sağ ve sol ayak ölçüm değerlerinin de doğrusal olarak arttığı görülmekteydi. Sonuç: Tutulmuş tarafta var olan deformitelerin zamanla kötüleşebileceği, sağlam tarafta da zamanla yeni deformite oluşabileceği kanısına vardık. Özellikle yürüyebilen vakalarda kas zayıflıklarının etkili olmasından dolayı deformitelerin daha hızlı ilerleyebileceği ve tedavi programında bu durumların mutlaka değerlendirilmesi gerektiğini düşünmekteyiz.

Foot and ankle functions and deformities focus on posterior tibial tendon dysfunction using magnetic resonance imaging in patients with rheumatoid arthritis.

Posterior tibial tendon dysfunction (PTTD) affects the support of the medial longitudinal arch and stability of the hindfoot. The purpose of this study was to assess the relationships of PTTD with foot and ankle functions and foot deformities in patients with rheumatoid arthritis (RA). A total of 129 patients (258 feet) who underwent magnetic plain and contrast-enhanced magnetic resonance imaging were enrolled in this study. Positive magnetic resonance imaging findings were defined as tenosynovitis and incomplete and complete rupture of the posterior tibial tendon. Foot and ankle functions were assessed using the Japanese Society for Surgery of the Foot standard rating system for the RA foot and ankle scale (JSSF-RA) and self-administered foot evaluation questionnaire. Plain radiographs were examined for the hallux valgus angle, first metatarsal and second metatarsal angle, lateral talo-first metatarsal angle, and calcaneal pitch angle. PTTD was associated with motion in the JSSF-RA (p = .024), activities of daily living in JSSF-RA (p = .017), and pain and pain-related factors in the self-administered foot evaluation questionnaire (p = .001). The calcaneal pitch angle was significantly lower in the feet with PTTD than in those without PTTD (median: 16.2° vs. 18.0°; p = .007). The present study shows that PTTD was associated with foot and ankle functions and flatfoot deformity. Thus, a better understanding of PTTD in patients with RA is important for the management of foot and ankle disorders in clinical practice.

Is the Prevalence of Equinus Foot in Cerebral Palsy Overestimated? Results from a Meta-Analysis of 4814 Feet.

Background: Equinus is a common foot deformity in patients with cerebral palsy (CP). However, its prevalence is scarcely reported in the literature. Therefore, we conducted this review to estimate the prevalence of equinus foot in CP. Methods: Eight databases were searched. Our primary outcome was the prevalence of equinus foot in CP patients. Subgroup analysis was conducted based on study design, the laterality of CP, and whether equinus foot was defined or not. Results: The prevalence of equinus foot in CP was 93% (95% CI: 71–99). The prevalence was 99% (95% CI: 55–100), 96% (95% CI: 57–100), and 65% (95% CI: 37–86) in unilateral, both, and bilateral CP, respectively. Based on study design, equinus foot prevalence was 92% (95% CI: 34–100) in case series and 62% (95% CI: 47–74) in cohort studies. Four studies reported definition criteria for equinus foot, with a pooled prevalence rate of equinus foot of 99% (95% CI: 36–100) compared to a rate of 89% (95% CI: 59–98) among studies that lacked a definition criterion. Conclusions: This is the first meta-analysis to address the prevalence of equinus foot in CP patients. Although its prevalence is very high, our findings should be interpreted with caution due to the presence of multiple limitations, such as the lack of standardized definition criteria for equinus foot, the inappropriate study design, the wide confidence interval of equinus foot rate, and the small number of studies investigating it as a primary outcome.

Foot deformities in patients with diabetic mellitus (with and without peripheral neuropathy)

BackgroundDiabetic peripheral neuropathy (DPN) is one of the most common complications in diabetes mellitus. It is the disorder that most commonly affects the feet of people with diabetes. The aim of the present study is to determine the relationship between DPN and the presence of deformities in the foot. Material and methodsA descriptive observational study was conducted of 111 patients diagnosed with Diabetes Mellitus (DM) type 1 or 2. All participants were aged at least 18 years and were previously informed in detail about the aims and procedures of the study. ResultsRegarding the presence of DPN, the only significant relationships were found for the right foot with the deformity of the second toe (claw, hammer or mallet) (p = 0.017, OR 0.29 [0.10–0.83]) and for the left foot with the deformity of the second toe (p = 0.048; OR: 0.37 [0.14–1.01]), third toe (p = 0.012; OR: 0.29 [0.11–0.79]) and the presence of hallux extensus (p = 0.05; OR: 8.27 [1.05–64.98]). ConclusionsA significant number of foot deformities were observed among these patients with DM, regardless of the presence of DPN. These deformities should be carefully evaluated in order to determine the most appropriate treatment at an early stage, which will reduce the risk of ulceration. Although it should be use with caution to be transferrable to the general population with peripheral neuropathy.

Predictors of outcome after total talectomy: a retrospective case series

Background: Talectomy has been used as a salvage procedure to correct severe and rigid foot deformities in patients with underlying neuromuscular conditions. Previous clinical reports have failed to compare outcomes based on the underlying condition. We report predictors of outcomes in patients who were treated with talectomy over 23 yr. Methods: We retrospectively reviewed the patients who underwent total talectomy from 1987 to 2010. Clinical results were graded as “good” and “poor” depending on postoperative pain, degree of equinus, skin findings, and the ability to brace. Postoperative lateral radiographs of the ankle were reviewed to determine tibiocalcaneal angle and retained talus. Statistical analysis was used to evaluate the effect of underlying diagnosis and tibiocalcaneal angle on the clinical outcome. Results: Thirty-eight patients (58 feet) were included in the study. The average length of follow-up was 5.1 yr. Fifty operated feet (86.2%) had a “good” outcome. Average tibiocalcaneal angle was 73.92 degrees in patients with outcomes categorized as good compared to 99.75 degrees in patients with outcomes categorized as poor (P=0.012). Of the feet with myelomeningocele, 96.3% (26 feet) had outcomes categorized as good compared to 75% of feet (9 of 12) with arthrogryposis. The clinical outcome was significantly better in patients with myelomeningocele compared to patients with arthrogryposis (P=0.04). Conclusions: Talectomy can be used as a salvage procedure to achieve a pain-free, plantigrade, and braceable foot in patients with a variety of musculoskeletal disorders. A tibiocalcaneal angle of less than 90 degrees at final follow-up and a diagnosis of myelomeningocele correlated with “good” clinical outcomes, aiding clinicians in preoperative stratification based on underlying diagnosis. Level of Evidence: Level III.

Morpho-structural characteristics of feet in patients with rheumatoid arthritis: A cross sectional study.

Objective: The aim of this study was to evaluate and classify the types and incidences of foot deformities in patients with Rheumatoid Arthritis (RA).Methods: A cross-sectional study with convenience sample was obtained of 220 patients with foot pain and RA classification criteria (approved by the American College of Rheumatology and the European League against Rheumatism in 2010). A series of outcomes were assessed to measure the morphological characteristics of the feet. The Foot Posture Index (FPI), the Manchester Scale of Hallux Valgus and the Nijmegen classification of forefoot disorders were assessed.Results: The most common foot posture according to the FPI assessment are the pronated position in the left foot (32.7% of participants) and the neutral position in the right foot (34.1% of participants). The disease progression causes more developed and serious foot deformities. 1.82% of patients present a severe level of Hallux Valgus before 10 years of disease evolution whereas 4.09% of patients present a severe level of Hallux Valgus after 10 years of disease evolution.Conclusions: The most common foot type in patients with RA is the pronated foot type with deformities in the MTP joints without Hallux Valgus. However, a percentage of patients with RA presents supinated foot type. The evolution of the disease shows some morphological changes in terms of patient's feet. The presence of more developed foot deformities is increased, such us Hallux Valgus or MTP joints deformity (Grade 3 in the Nijmegen classification scale).

Impact of Footwear and Foot Deformities in patients with Parkinson's disease: A Case-Series Study.

Background: Parkinson's disease (PD) is a common and complex neurological problem. Gait abnormalities are frequent in PD patients, and this increases the risk of falls. However, little is known about foot deformities and footwear in this vulnerable population. Here we investigate whether patients with PD use an appropriate shoe size and know if they have foot deformities or alterations.Methodology: A study of a series of observational descriptive cases in a convenience sample (n = 53 patients) diagnosed with Parkinson's disease. One trained investigator evaluated foot and ankle health. The footwear and foot measurements were obtained using a Brannock device.Results: The podiatric examination and footwear examination detected a high presence of podiatric pathologies and inappropriate footwear. This has a negative impact on the quality of life of these patients.Conclusions: This research detected an elevated number of people with foot deformities or alterations. Moreover, a high proportion of participants with PD wear inadequate footwear (in length, width, or both).