Forefoot Research Articles

Exploring biomechanical variations in ankle joint injuries among Latin dancers with different stance patterns: utilizing OpenSim musculoskeletal models.

Background: Dancers represent the primary demographic affected by ankle joint injuries. In certain movements, some Latin dancers prefer landing on the Forefoot (FT), while others prefer landing on the Entire foot (ET). Different stance patterns can have varying impacts on dancers' risk of ankle joint injuries. The purpose of this study is to investigate the differences in lower limb biomechanics between Forefoot (FT) dancers and Entire foot (ET) dancers. Method: A group of 21 FT dancers (mean age 23.50 (S.D. 1.12) years) was compared to a group of 21ET dancers (mean age 23.33 (S.D. 0.94) years), performing the kicking movements of the Jive in response to the corresponding music. We import data collected from Vicon and force plates into OpenSim to establish musculoskeletal models for computing kinematics, dynamics, muscle forces, and muscle co-activation. Result: In the sagittal plane: ankle angle (0%-100%, p < 0.001), In the coronal plane: ankle angle (0%-9.83%, p = 0.001) (44.34%-79.52%, p = 0.003), (88.56%-100%, p = 0.037), ankle velocity (3.73%-11.65%, p = 0.017) (94.72-100%, p = 0.031); SPM analysis revealed that FT dancers exhibited significantly smaller muscle force than ET dancers around the ankle joint during the stance phase. Furthermore, FT dancers displayed reduced co-activation compared to ET dancers around the ankle joint during the descending phase, while demonstrating higher co-activation around the knee joint than ET dancers. Conclusion: This study biomechanically demonstrates that in various stance patterns within Latin dance, a reduction in lower limb stance area leads to weakened muscle strength and reduced co-activation around the ankle joint, and results in increased ankle inversion angles and velocities, thereby heightening the risk of ankle sprains. Nevertheless, the increased co-activation around the knee joint in FT dancers may be a compensatory response for reducing the lower limb stance area in order to maintain stability.

Sauropods

This article begins as many others on sauropods before it: "Sauropod dinosaurs were the largest animals to ever walk the Earth, by far". The largest sauropods were easily four times heavier than the largest land mammals (and the largest other dinosaur species, for that matter). The iconic body plan of sauropods is dominated by their very long neck, in some species exceeding 14 meters in length, provided with a relatively small head (Figure 1). The neck was mostly held horizontally or at a low angle. The massive but relatively short trunk was supported by four columnar legs, much like in an elephant. The bones in the fore foot of sauropods are oriented vertically, and some late forms even lost their finger bones, walking on their metacarpals (middle bones of the hand). The hind leg, which bore most of the weight, has a half-upright foot. The femur (thigh bone) was the largest bone in the skeleton, like in most other true land vertebrates (amniotes). The long neck was counterbalanced by the long tail, the base of which also functioned as the anchoring region of the giant muscles that pulled back the hind leg during walking.

Effect of Different Ankle-Foot Immobility on Lateral Gait Stability in the Stance Phase.

Background This study aimed to investigate the effect of limited foot and ankle mobility on the lateral stability of gait through the observation of the mediolateral margin of stability and related kinematic parameters. Methods Thirty young, healthy participants walked at a fixed gait velocity on a level surface. Participants achieved different degrees of restricted mobility by wearing soft-soled shoes (S), an ankle-foot orthosis with unrestricted dorsiflexion-plantarflexion activity only (A), and an ankle-foot orthosis with unrestricted dorsiflexion-plantarflexion and adjustable horizontal rotation of the foot (OU/OR). Furthermore, the spatiotemporal parameters, mediolateral margin of stability, center of pressure, angle of the fore and hind foot relative to the tibia, and correlation coefficients of the factors were analyzed. Regression analysis was also performed. Results At right heel strike, group A had a significantly lower mediolateral margin of stability than group S and group OU. Meanwhile, forefoot adduction (0.2 < |r| <0.4) and plantarflexion (0.2 < |r| <0.4), as well as hindfoot internal rotation (0.2 < |r| <0.6) and inversion (0.2 < |r| <0.4), correlated negatively with lateral stability. Regression analysis revealed forefoot dorsiflexion and supination were the main independent variables for group A. At right heel off, groups OU and OR had a significantly lower mediolateral margin of stability than those in groups A and S. Forefoot adduction (0.2 < |r| <0.4) and dorsiflexion (0.4 < |r| <0.6) were correlated with lateral stability, as were hindfoot dorsiflexion (0.2 < |r| <0.4) and inversion (0.2 < |r| <0.4). Regression analysis revealed forefoot abduction and plantarflexion were the main independent variables for groups OU and OR. Conclusions The present study verified from gait data that forefoot dorsiflexion and supination at the initial contact of the stance phase were relevant factors for the differences in lateral gait stability, whereas abduction and plantar flexion of the forefoot at the terminal stance phase were the main influencing factors of lateral gait stability.

Temporal differences in the myoelectric activity of lower limb muscles during rearfoot and forefoot running: A statistical parametric mapping approach

The aim of this study was to apply statistical parametric mapping (SPM) to compare temporal changes in EMG amplitude between rearfoot (RF) and forefoot (FF) running techniques. Eleven recreational runners ran on a treadmill at a self-selected speed, once using a RF strike pattern and once using a FF strike pattern (randomized order). The myoelectric activity of five lower limb muscles [rectus femoris (RFe), biceps femoris (BF), tibialis anterior (TA), medial and lateral gastrocnemius (MG and LG)] was evaluated, using bipolar electromyography (EMG). EMG data from the RF and FF running techniques was then processed and posteriorly compared with SPM, dividing the analysis of the running cycle into stance and swing phases. The MG and LG muscles showed higher activation during FF running at the beginning of the stance phase and at the end of the swing phase. During the end of the swing phase the TA muscle’s EMG amplitude was higher, when the RF running technique was used. A higher level of co-activation between the gastrocnemius and TA muscles was observed at the end of the swing phase during RF running. The myoelectric behaviour of the RFe and BF muscles was similar during both running techniques. These findings highlight the importance of SPM for the accurate assessment of differences in muscle activity during running and strongly suggest that these two running techniques predominately reflect adjustments of the leg and not the thigh muscles.

Preliminary biometric characteristics of Border Collies and their dependence on sport activity

&lt;b&gt;Biometric measurements were taken on 40 dogs of both sexes, 20 females and 20 males of Border Collies. Half of the population of each sex, i.e. 10 animals (active dogs), were either currently participating in dog frisbee competitions or had recently finished their sporting careers due to age. The other half (part) of the examined Border Collies, i.e. 10 females and 10 males, were animals that were not active in sports (non-active dogs). Most of the dogs came from Polish kennels but there were also Border Collies from other countries. The following measurements were taken: trunk length, height at withers, chest girth, fore limb (metacarpal) girth, thigh length, shank length, foot length and body weight. The collected results were processed statistically and indexes of trunk length, massiveness, eurysomia and boniness were calculated. It was found that Border Collie are characterized by some biometric traits (indexes) similar to Polish hunting dogs and Polish hounds and some of their indexes are also similar to the domestic breeds of Polish sheepdogs and Polish charts. Conducted biometric analysis showed only few, i.e. concerning height at withers of females and body weight of males statistically significant differences between examined groups of Border Collies. Consequently, there was no positive verification of the research hypothesis, which assumed that the value of traits and biometric indicators of Border Collie is different in jumping dogs in connection with their participation in various disciplines of dog competition. However, it can be assumed that for the needs of the developing sports cynology, there will be a need to select dogs with predispositions for athletic performance, and a useful tool to achieve this goal will be the analysis of biometric traits of dogs. The results of measurements collected in this study and the indices calculated on their basis also extend the biometric database of Border Collie dogs.

Plantar pressure distribution profile of type 2 diabetes mellitus with diabetic foot syndrome: A hospital-based observational study

INTRODUCTION: The prevalence of diabetic foot syndrome is increasing in the Indian population. It is a triad of neurological, vascular, and biomechanical changes due to long term diabetes mellitus (DM). Altered plantar pressure distribution is a risk factor for developing diabetic foot ulcers. The purpose of this study is to evaluate the altered plantar pressure distribution in diabetic peripheral neuropathy individuals with peripheral vascular disease in comparison with diabetic peripheral neuropathy and non-diabetic neuropathy. Therefore, the objective of the study is to evaluate the plantar pressure distribution and parameters in type 2 DM (T2DM) with diabetic foot syndrome.METHODS: In this study, 60 participants with T2DM were recruited in either one of the three groups: 20 Diabetic non-neuropathy (DNN), 20 Diabetic peripheral neuropathy (DPN), and 20 Diabetic peripheral neuropathy with the peripheral arterial disease (DNPAD). Then we compared the plantar pressure parameters like maximum plantar pressure, pressure-time integral, fore foot-hind foot ratio, and total contact area were measured using a WinTrack plantar pressure system.RESULTS: The diabetic peripheral neuropathy with peripheral vascular disease group shown a significant difference in all the plantar pressure parameters measured in comparison with the diabetic peripheral neuropathy group. There was increased Maximum plantar pressure, pressure-time integral and forefoot hindfoot ratio, and reduced total contact area of the foot (p &lt; 0.05).CONCLUSION: For patients, with combined peripheral neuropathy and peripheral vascular disease have increased plantar pressure distribution, are at higher risks of developing neuro-ischemic foot, which further leads to diabetic foot ulcers.

English

Introduction: Surface electromyography has been a technique used to describe muscle activity during running. However, there is little literature that analyses the behaviour of muscle coactivation in runners, describing the effect between two techniques associated with the initial contact, such as the use of rearfoot (RF) and forefoot (FF). Material and method: The purpose of this study was to compare muscle coactivation levels developed in the lower limb during two running techniques, FF vs RF. Fourteen amateur runners were evaluated (eight men, six women; age= 23.21 ± 3.58 years, mass= 63.89 ± 8.13 kg, height= 1.68 ± 0.08m). Surface electromyography was used to measure muscle activity during both running techniques evaluated on a treadmill, considering the muscle pairs: Rectus femoris- Biceps femoris (RFe-BF), Lateral Gastrocnemius–Tibialis Anterior (LG-TA), and Medial Gastrocnemius - Tibialis Anterior (MG-TA). These were calculated in three windows considering ten running cycles (0-5%, 80-100%, and 0-100%). To compare FF vs RF t-student test for paired data was used. Results: It was observed significant differences in the MG-TA pair (FF= 18.42 ± 11.84% vs RF = 39.05 ± 13.28%, p = 0.0018 during 0-5%, and RFe-BF pair (FF = 42.38 ± 18.11% vs RF = 28.37 ± 17.2%, p = 0.0331) during 80-100% of the race. Conclusion: Our findings show that the behaviour of muscle coactivation is different between FF vs RF techniques if we analyze little windows in the running cycle. This could be associated with an increase in the joint stability between these short intervals, represented in the initial and final regions of the running cycle.

Diabetic foot and its complications: A cross sectional study in rural medical college

Objectives of the study: To understand the pathology of diabetic foot and relative distribution of this condition according to age, sex, among diabetic patients. To study the benefit and outcome of the different treatment modalities for diabetic foot. To reduce the risk of lower limb complications in people with diabetes by strict diabetic control, through debridement, meticulous dressing, and appropriate antibiotic therapy. To identify and educate those at high risk to prevent foot lesions developing and early detection of problems and the need for rapid help.Methods: This study was conducted comprising of 100 patients of diabetic foot in the department of general surgery at Trichy SRM Medical College and Hospital, Trichy during the period of Jan 2020 to Jun 2021.Results: Commonest presenting lesion was ulcers (44%), followed by gangrene (24%) and cellulitis (20%). Commonest site of the lesion was dorsum of the foot (32%), followed by fore foot (28%), and toes (22%). Trivial trauma is the initiating factor in more than half of the cases. More than half of the patients 82% had infection. Most common microorganism grown from culture was Staphylococcus aureus (30%), 28(28%) patients were treated with wound debridement, 18(18%) patients underwent major amputation. Prognosis was good in 72(72%) patients. 2(2%) patient died due to septicemia.Conclusion: Diabetic patients at risk for foot lesions must be educated about risk factors. The multidisciplinary team approach to diabetic foot disorders has been demonstrated as the optimal method to achieve favorable rates of limb salvage in the high-risk diabetic patient. Infection in a diabetic foot is potentially limb-threatening and always requires urgent diagnostic and therapeutic attentions.

Biomechanics Analysis of the Lower Limbs in 20 Male Sprinters Using the International Society of Biomechanics Six-Degrees-of-Freedom Model and the Conventional Gait Model.

BackgroundThis biomechanics study of the lower limbs aimed to compare the use of the International Society of Biomechanics Six-Degrees-of-Freedom (ISB-6DOF) model and the conventional gait model (CGM), formerly known as the Helen Hayes model, in 20 male sprinters who habitually used the forefoot (FF) or rearfoot (RF) strike modes.Material/MethodsWe used a motion capture system to compare the difference in lower-extremity joint mechanics between sprinters’ forefoot or rearfoot strike mode during unplanned sidestepping (UPSS). Twenty elite sprinters participated in a motion capture test under 2 models. Each of the 10 participants were classified as having a habitual forefoot strike mode or rearfoot strike mode during unplanned sidestepping. Joint mechanics and gait parameters were calculated according to the designed movement.ResultsComparison of the 2 models showed that the knee joint angles were inconsistent (P<0.05), highlighting the difficulty of the Helen Hayes model in anatomical recognition. The results of the 2 models show that during the unplanned sidestepping, the sprinter using the habitual rearfoot strike mode had a greater load through the knee joint (P<0.05). Sprinters who used the habitual forefoot strike mode experienced greater load through their ankle joints (P<0.05).ConclusionsThe findings from this biomechanics study showed that when compared with the ISB-6DoF model, the findings from the CGM were more reproducible for the evaluation of FF and RF strike during unplanned sidestepping.

Analysis of Different Stop-Jumping Strategies on the Biomechanical Changes in the Lower Limbs

The stop-jumping task is one of the most important technical actions in basketball. A previous study showed 70% probability of non-contact ACL injuries during stop-jumping tasks. Therefore, the present study aimed to investigate the differences in lower extremity biomechanical changes between the rear foot as the initial contact area to terminate the jump (SJR) and the fore foot as the initial contact area to also terminate the jump (SJF) during the horizontal landing during a stop-jumping phase. In total, 25 male amateur Ningbo University basketball athletes from China were recruited for this study. The participants were asked to jump vertically by using two different stop-jumping strategies. Kinematic and kinetics data were amassed during a stop-jumping task. Statistical parametric mapping (SPM) analysis was used to find the differences between SJR and SJF. Our results indicated that the change of different ankle range of motion caused significantly different values for knee angle (p &lt; 0.001), velocity (p = 0.003) (p = 0.023) (p &lt; 0.001), moment (p = 0.04) (p &lt; 0.001), (p = 0.036) and power (p = 0.015) (p &lt; 0.001) during the stop-jumping phase and the horizontal landing phase. The same biomechanical parameters of the hip joint were also significantly different for hip angle (p &lt; 0.001), moment (p = 0.012) (p &lt; 0.001) (p &lt; 0.001), and power (p = 0.01) (p &lt; 0.001) (p &lt; 0.001). These findings indicate that altering the primary contact at the ankle angle might effectively reduce the risk of a knee injury.

ARE GADGETS SAVIOURS IN SALVAGING SICK CASES – ULTRASOUND FOR BOTH NERVE BLOCKS AND VASCULAR ACCESS IN A CASE OF SEPTIC SHOCK

Diabetes mellitus and diabetic foot syndrome presents to us with varying degrees of sepsis. We present a 52-year-old male with chronic diabetes with fore foot sepsis in shock. His blood sugar was controlled with insulin and the other parameters were normal. The blood pressure was around 90/50 mm Hg with noradrenaline support of 0.5 mic/kg/min. We secured a right internal jugular venous access with ultrasound (USG). The volume status as assessed by USG of the IVC was satisfactory. We administered popliteal sciatic nerve block along with saphenous nerve block visualizing the nerves with USG. The amputation of forefoot went on for 1 h where the hemodynamics remained stable at 100/70 mmHg. After the surgery was over, the patient was shifted to sick cubicle and in the next 6 h, the inotrope support was weaned off. The control of sugars was continuously monitored and kept under control. Any other form of neuraxial block could have been detrimental to him in the presence of hemodynamic imbalance. Such precise deposition of local anesthetics in the sciatic nerve is very difficult without the use of USG. We conclude that advanced gadgets may bring back hope in salvaging sick patients.

First metatarsal extracapsular osteotomy to treat moderate hallux valgus deformity: the modified Wilson-SERI techinique.

From February 2017 to December 2018, 20 patients (a total of 20 feet) had undergone the proposed modified Wilson-SERI osteotomy technique, for moderate hallux valgus. The mean age of patients was 58,25 years (range 19 to 78). The hallux valgus angle (HVA), the intermetatarsal angle between first and second metatarsal bone (IMA) and the distal metatarsal articular angle (D.M.A.A) were measured. The feet were assessed based on the scoring system used by Broughton and Winson and by the American Orthopedic Foot and Ankle Society (AOFAS) hallux-metatarsophalangeal-interphalangeal scale. All twenty one patients were followed up postoperatively for a minimum of 12 months. No patient was lost at follow-up. The mean HVA angle decreased significantly from 31,1° before surgery (range 22.9°-40°SD 5.0) at 11,2° (range 2.5° to 22.0°SD 5.3) at twelve months follow up. The mean IMA angle decreased significantly from 12,5° (range 8.0°-18.6°SD 3.8) before surgery at 7,4° (range 3.4°-14.0°SD 2.5) at twelve months follow up. The mean DMMA angle decreased significantly from 15.1° (range 5.3° to 20.0°SD 4.4) before surgery at 7,4 °(1.5° - 10.7°SD 2.5) at twelve months follow up. The mean score according to the AOFAS forefoot was increased from 22,1 (range 13-30 SD 5.0) to 88,2 (Range 77-96 SD 5.2) (p<0.0001). No complications, like dislocations, avascular necrosis of the first metatarsal and deep venous thrombosis, were observed in the post-operative period. We consider the Wilson-Seri procedure as a low cost minimal invasive and stable technique that could be a valid alternative to the various metatarsal osteotomies in the treatment of moderate hallux valgus deformity. Short term results at twelve months after surgery are quite satisfactory but further studies are necessary, to better comprehend an overall outcome of such approach in the long run.

The Effect of Foot Functional Training on Gait Ability in Older Adults with Activities of Daily Living Disability: A Randomized Controlled Trial

Background: Physical training can prevent gait ability decline in older adults. However, it is unknown whether foot functional training improves gait ability in older adults with activities of daily living (ADL) disability. Therefore, this study aimed to investigate the effects of foot functional training on gait ability in older adults with ADL disability. Methods: We conducted a single-center randomized controlled study involving 27 older Japanese adults (≥ 75 years) with ADL disability between December, 2017 and March, 2018. Participants were randomly assigned to an intervention group or a control group. The intervention group underwent 60-min foot functional training twice weekly for 4 months, in addition to routine activities that the nursing home typically offered to attendees. Results: Gait speed and speed of sound significantly increased after the 4-month training in the intervention group (gait speed: before vs. after, 0.61 ± 0.22 m/s vs. 0.84 ± 0.26 m/s, p ＜ 0.001; speed of sound: before vs. after, 1536 ± 16 m/s vs. 1550 ± 19 m/s), but not in the control group. The change in the peak pressure of the forefoot at the propulsive phase of gait was significantly higher in the intervention group than in the control group (p = 0.003). Gait speed was significantly correlated with the peak pressures of the forefoot (r = 0.27, p = 0.048) in the propulsive phase. Conclusion: The foot functional training significantly improved gait speed, bone strength, and plantar pressure distribution in older adults with ADL disability.

Randomized comparative study between metatarsal head resection and total contact cast in the treatment of diabetic plantar forefoot ulcer

Objective The present study assessed and compared the efficacy of metatarsal head resection (MHR) compared with total contact cast (TCC) in the treatment of neuropathic diabetic foot ulcers located at the plantar surface of metatarsal heads. Materials and methods Between January 2017 and September 2019, this prospective, randomized, comparative study was performed at Menoufia University −Hospitals. One hundred patients suffering from solitary planter forefoot neuropathic ulceration were assigned into two groups: the first group was treated by MHR and the second group was treated by TCC. Wound healing was the primary outcome while ulcer recurrence and complications were the secondary outcomes of this study. Results Baseline patient characteristics were comparable in both groups. Both intention-to-treat and per-protocol analysis were used to evaluate ulcer healing during the treatment period. Percentage of ulcers healed within 12 weeks was 82 and 58% for MHR and TCC groups, respectively (P Conclusion Being an invasive procedure, MHR offers a safe effective offloading option with higher healing potential and lower recurrence rate compared with TCC as the standard offloading modality.

Mechanotendography in Achillodynia shows reduced oscillation variability of pre-loaded Achilles tendon: a pilot study.

The present study focuses on an innovative approach in measuring the mechanical oscillations of pre-loaded Achilles tendon by using Mechanotendography (MTG) during application of a short yet powerful mechanical pressure impact. This was applied on the forefoot from the plantar side in direction of dorsiflexion, while the subject stood on the ball of the forefoot on one leg. Participants with Achilles tendinopathy (AT; n = 10) were compared to healthy controls (Con; n = 10). Five trials were performed on each side of the body. For evaluation, two intervals after the impulse began (0-100ms; 30-100ms) were cut from the MTG and pressure raw signals. The intrapersonal variability between the five trials in both intervals were evaluated using the arithmetic mean and coefficient of variation of the mean correlation (Spearman rank correlation) and the normalized averaged mean distances, respectively. The AT-group showed a significantly reduced variability in MTG compared to the Con-group (from p = 0.006 to p = 0.028 for different parameters). The 95% confidence intervals (CI) of MTG results were disjoint, whereas the 95% CIs of the pressure signals were similar (p = 0.192 to p = 0.601). We suggest from this work that the variability of mechanical tendon oscillations could be an indicative parameter of an altered Achilles tendon functionality.

Arterial Blood Supply and Angiography of the Fore Foot in One- Humped Camel (Camelus dromederius)

The present study was conducted on eight fresh forelimbs to investigate a detailed anatomical description of the arterial blood supply in adult dromedary camel’s foot. Anatomical and angiographic techniques were used in order to give detailed data about the origin and pattern of distribution of these arteries. Moreover, this data serve other researchers in comparison with different animals. The specimens injected with red colored gum milk latex for anatomical dissection and urograffin injection for angiographic purposes throughout the median artery. The main arterial blood supply of camel’s digit was derived from common palmar digital artery, palmar metacarpal artery, in addition to smaller branches detached from the dorsal metacarpal artery.

Population-based incidence and epidemiology of 5912 foot fractures

BackgroundThe present study aimed to report a full overview of the incidence and epidemiology of foot fractures. MethodPopulation-based epidemiological cohort study including all foot fractures over 5 years. All patient charts and radiology were manually assessed. ResultsA total of 4938 patients sustained 5912 foot fractures during the study period. Patients’ mean age at the time of fracture was 36.1 (21.7 SD) years. The overall incidence of foot fractures was 142.3/100,000/year. The hind foot incidence was 13.7/100,000/year, the mid foot incidence 6.5/100,000/year, and the fore foot incidence 123.9/100,000/year. The most common mode of injury was due to low energy trauma (98.7%). ConclusionThis study shows an overall incidence of foot fractures to be 142.3/100,000/year. The hind foot incidence is 13.7/100,000/year, the mid foot incidence 6.5/100,000/year, and the fore foot incidence 123.9/100,000/year.

A Development of Plantar Pressure Sensor for Foot Ulcer Detection in Diabetic Neuropathy Individuals – A Pilot Study

Diabetes mellitus is a metabolic disorder that derived from the body’s inability to attain glucose homeostasis. Further increase in glucose level in the bloodstream, if left untreated, will lead to further metabolic disorder and complication such as amputation of a lower limb that caused by a foot ulcer. Approximately, 60% of diabetic foot ulcer comes from neuropathy. Thus, an early detection of foot ulcer would benefit particularly for diabetes individuals to reduce the risk of amputation. In this research, a plantar pressure sensor system is developed by using the Flexiforce sensor with data acquisition of NI-USB6008 as an interface to gather measurement data. There are four Flexiforce sensors that are placed at the most identified points at the right foot, which are heel, mid foot, fore foot and toe. In this pilot study, the right foot was chosen to be tested with this system. Further analysis was carried out to distinguish between 3 healthy individuals and 3 individuals with diabetes based on gathered plantar pressure value. A correlation study was performed between plantar pressure data and blood glucose data at t = 0 (G 0) to further justify the result before distinguishing the metabolic state of the individual. Although results show no significant different (p<0.05) between these two groups based on 4 measurement points, this research provides a promising finding as some of the pressure reading of diabetes patients are significantly higher than a normal person. Hence, early detection of a foot ulcer is a good indicator that can significantly reduce diabetes-related foot complications through early education and appropriate foot care. This early detection of a foot ulcer also could benefit a better diagnosis and reduce subsequent risk and impact on diabetes-related foot complications.

Prevalence of Forefoot Pain among High Heel Wearing Female Teachers and Students of Different Universities in Faisalabad

Background/objectives: The objective behind this study was to observe the prevalence of forefoot pain among ladies due to regular wearing of high heeled shoes. Previous literature showed a significant association of foot pathologies with high heels, but very few studies have been found to highlight the relationship between high heels and forefoot pain. This study focuses on the said prevalence among female teachers and students of different universities in Faisalabad. Methods: The study design selected was a cross-sectional survey. The sample size was 200 based on a previous study. The study setting was different universities of Faisalabad. A simple random sampling technique was used to collect the sample. The self-generated questionnaire was used as a research tool. Results and conclusion: Results were interpreted using frequency distribution bar charts. Results showed that 77.5% of the study population complaint of forefoot pain due to the regular wearing of high heeled shoes. Others suggested either pain in mid-foot and heel or no pain at all. Keywords: Forefoot pain; High heeled

Repairing soft tissue defect in forefoot by a retrograded lateral tarsal artery perforator flap pedicled with anterior branch

Objective To investigate the surgical method and clinical effect of repairing the forefoot soft tissue defect by the retrograded lateral tarsal artery perforator flap pedicled with the anterior branch. Methods From March, 2015 to October, 2018, 9 patients with soft tissue defects in forefoot were repaired by the retrograded lateral tarsal artery perforator flap pedicled with anterior branch. One patient received an emergency repair and 8 received secondary repair. The wounds were all located in the forefoot. Area of defects were 3.0 cm×2.0 cm-5.0 cm×4.0 cm; flap areas were 3.5 cm×3.0 cm-6.0 cm×4.5 cm. The donor sites of flap were repaired with full thickness skin graft. All patients received postoperative followed-up through the visits of outpatient clinics, WeChat or telephone reviews. Results Eight flaps survived successfully and the wounds healed by first intention; One flap had venous crisis 2 days after surgery and after having removed stitches of the pedicle of flap, only distal skin necrosis occurred. And healed after changing treatment. All the skin graft in donor sites of flaps survived well. All patients were entered 3 to 18 months postoperative follow-up. The shape of flaps had good textures and were not bloated. The sensation of flaps partially recovered. In the last followed-up, 8 flaps were assessed by the American Orthopaedic Foot and Ankle Society (AOFAS) middle foot scoring standard. The results were excellent in 5 cases, good in 2 cases and poor in 1 case, with the good and excellent rate of 87.5%. Conclusion The retrograde lateral tarsal artery perforator flap pedicled with the anterior branch is one of the effective methods to repair the soft tissue defect in forefoot without damaging the main trunk of dorsal pedal artery. It features a reliable blood supply to the flap and a relatively simple surgical procedure. Key words: Lateral tarsal artery perforator flap; Anterior branch; Forefoot; Repair