Feet In Group Research Articles

TREATMENT OF PAEDIATRIC ARTHROGRYPOTIC CLUBFOOT: 20 YEARS OF CLINICAL EXPERIENCE

BackgroundTreatment of arthrogrypotic clubfoot (AC) presents a challenging problem. Over time many different methods have been proposed, with variable rates of success, recurrence and other complications. In this study we describe our 20-year experience in treatment of AC.Materials and methodsBetween 1996 and 2016, 165 AC in 90 children (51 males and 39 females) were treated in our department. Their mean age was 7.6 years (3 months-16 years). Ponseti casting and Achilles tendon release (PCATR) was performed on 38 children (68 feet) and soft tissue release and casting (STRC) on 35 children (67 feet). The remaining 17 children (30 feet) underwent wide soft tissue release and correction using the Ilizarov method (STRIL). The results of each subgroup were graded according to clinical (pain, foot appearance, residual deformities, walking and standing status and shoe modifications) and radiological (anteroposterior and lateral talocalcanear angles, the angle between longitudinal axes of talus and the first metatarsal and the position of talus in the lateral view) criteria.ResultsThe average follow up was 6.4 (2–10) years. Results were excellent (plantigrade, painless, properly loaded feet, without deformities, adapted to common shoes) in 56 PCATR group feet, 59 STRC group feet and 23 STRIL group feet. Good results (required orthopaedic shoes) were obtained in 10 PCATR group feet, 6 STRC group feet and 7 STRIL group feet. Fair results (residual temporary pain and/or mild deformity) presented 2 PCATR group feet and 1 STRC group foot, while bad results (reoccurrence of clubfoot) were found in 1 STRC group foot.ConclusionsOn the basis of our 20-year clinical experience we believe that pediatric AC can be successfully treated with PCATR in the age of less than 1 year old (y.o), with STRC between 1–5 y.o. and with STRIL in children over the age of 5 y.o.

The Evaluation of Muller Weiss Diseased and Normal Feet on a Three-Dimensional Foot Model

Category: Hindfoot; Midfoot/Forefoot Introduction/Purpose: The deformities associated with Müller Weis Disease (MWD) have not been well understood which inevitably impacts clinical and surgical decision making. Despite most previous studies characterizing MWD as a paradoxical flatfoot deformity, ie, a flat arch and a varus heel, some studies have treated MWD as a flatfoot deformity by performing a medializing calcaneus osteotomy, and others as an arthritic disorder treated with hind foot arthrodesis but without correcting the deformity. This study used an automatic 3D segmentation program to create an average 3D foot model for both normal controls and a large group of MWD feet, to demonstrate the deformity pattern, and to provide surgeons with a foundation for detailed alignment evaluation and surgical planning. Methods: Weight bearing Scans of 55 health feet without deformities, trauma and surgical histories, and 69 MWD feet were included in this study. The Bonelogic program (Disior, Paragon 28,) was used to automatically segment the bones and 3D information of each foot in the same group was pooled to create an average foot model for both the controls and the MWD feet. Videos were created using all feet in both groups to demonstrate the deformity patterns ranging from normal feet transitioning to MWD feet. Since current axial and angular metrics for alignment evaluation using traditional 2D imaging cannot be extrapolated to 3D this study was kept as a descriptive paper, and no traditional metrics were analyzed and reported. Results: Compared to the average normal foot, the MWD foot model demonstrated the following features: narrowing on the lateral pole and dorsal side of the navicular, lateral rotation and slight dorsal lifting of the talar head and medial rotation of the navicular, a varus heel with more opening in the sinus tarsi, proximal shift of the calcaneal tuberosity, a flat medial arch with subsidence at the talonavicular joint, decreased adduction of the forefoot, medial translation of the cuboid at the calcaneocuboid articulation, and a shortened 1st metatarsal. All of the above changes were consistently demonstrated in video one (a comparison between the two foot models), and video two (a comparison of the peritalar joint alignment between the two groups). Conclusion: The foot models were built up with pixels, with each pixel carrying its own 3D information in space allowing exploration of real 3D alignment evaluation tools. The MWD foot model clearly demonstrated and validated the deformity patterns originally described by Maceira, and subsequently by other authors using both radiographs and WBCT scans. This model facilitates evaluation of alignment from the hindfoot to the forefoot, as well as advanced 3D analysis to assess the morphology of the bones and joints and can be the foundation for surgical planning and predication of outcomes.

ACT NOW! A practical toolkit for amputation reduction

People living with diabetes are at risk of foot ulcers, leading to amputations. Jayne Robbie, in collaboration with the iDEAL group, discusses how ACT NOW can provide a practical toolkit to reduce amputations in this group Foot problems are often associated with multiple limb-threatening co-morbidities for people with diabetes. It has been suggested that many of these amputations could be avoided if foot ulcers are effectively detected, assessed, referred and rapidly treated in order to optimise healing. All health professionals in both primary and secondary care can have a pivotal role to play to reduce major amputations by 50%. Adopting ACT NOW and using this tool routinely, can reduce the unacceptably high volume of major amputations.

Comparison of the Ground Reaction Force, Center of Mass to Center of Pressure Changes, and Time to Stabilization During a Jump in Young Professional and Semiprofessional Karate Girls

Background and Aims: Since there is a direct relationship between achieving the best athletic performance and minimizing the damage and the potential injuries with people’s ability to perform the technique, this study aimed at comparing the selected biomechanical variables during consecutive jump-landings between professional and semi-professional karate athletes. Methods: In the current study, using a force plate, the ground reaction force, changes of the center of mass to the center of pressure, and stabilization time during jump-landing of nine young members of the female karate national team (professional) and nine selected karate athletes of Mazandaran province (semi-professional), on their both right and left legs separately, were obtained and statistically analyzed. Results: In the information collected from the selected biomechanical variables, the average and standard deviation in the left foot of both groups were higher than in the right foot. There was a significant difference between the ground reaction force and the change of center of mass to the center of pressure (stress) in the internal-external non – professional karate athletes and the left foot of the professional and non-professional. There was a significant difference between the ground reactions force in the posterior-anterior direction between the right and left foot of the professional group and the right and left foot of the non – professional group and the right and left foot of both groups in the change of center of mass to the center of pressure between the right and left foot of these two groups. However, there was no significant difference in the stabilization time. Conclusion: According to the results, the variables of the ground reaction force and changes in the center of mass to the center of pressure, and the time needed to achieve stability for karate athletes can be used as an index to evaluate the level of ability to perform and detect the potential injuries occurrence in professional and semi-professional karate athletes.

Effects of a Longitudinal Peer to Peer Support Group Foot Care Intervention Program in a Prospective Cohort of Patients with Diabetes Mellitus

Aim: To evaluate the clinical success of a first and longitudinal peer-to-peer support group foot care intervention program in a prospective cohort of persons with diabetes in a disadvantaged population.Method: A prospective cohort-based study design was implemented using standard protocols. A knowledge, attitude, and practice (KAP) instrument toward foot care was administered to persons with type 2 diabetes mellitus before and after the intervention program was implemented. The KAP instrument achieved very high overall and component Cronbach alpha reliability.Results: The average age of the patients at the time of the pre-intervention was 57.9 years (SD ± 9.8). Sixty-nine percent are females, 44.5% are natives (I-Taukei) and 55.5% are migrant Indians (Indo-Fijians), and 76.4% completed high school. Univariate analyses reveal a highly statistically significant and clinically meaningful increase in the component KAP scores following the foot care intervention program. Results from multiple regression analyses adjusting for patient demographics and confounders show significant improvements in patients’ KAP toward foot care.Conclusion: The success and efficacy of this foot care intervention program suggests that other countries with limited resources battling diabetes driven foot care hospitalizations and amputations can implement a similar cost-efficient public health education and awareness model as an initial step. This approach can alleviate the stress on healthcare systems during a pandemic.

Transplantation of mesenchymal stem cell sheet to treat acute hind-limb ischemia: A preclinical study

Introduction: Mesenchymal stem cell (MSC) transplantation has been reported as a promising therapy for acute limb ischemia (ALI). However, the treatment efficacy is limited to only certain improvements. Therefore, this study aims to improve the treatment efficacy of MSC transplantation through the use of MSC sheets produced from MSCs' cultured in fibrin scaffold (Fi-MSCs) in ALI models.
 Methods: MSCs were isolated and expanded from human umbilical cord tissue. The fibril scaffold was produced from human umbilical cord blood. Fi-MSCs were prepared by mixing MSCs with fibril according to a published protocol, and the Fi-MSC sheets were implanted directly into ligated and transected sites in the hind limbs of ischemic models (treatment group — group I). The results were compared with that of the control group (group II) in which mice were injected with saline. The treatment efficacy was recorded and evaluated through the following assays: limb morphology, SpO2, blood perfusion, angiogenesis, and histological morphology on days 7, 14, and 28 after treatment.
 Results: The results indicate that the transplantation of Fi-MSC sheets positively affected the acute ischemia hind-limb mouse models. On day 7 post-transplantation, the SpO2 index recorded at feet in group I (treatment) significantly increased from 79.24% + 1.43% to 89.40% + 1.65% (p-value < 0.05), while in group II (control), the SpO2 index slightly increased from 76.52% + 1.63% to 77.00 + 1.15 (p-value > 0.05). Besides, there were 60.00% (auto-recovery), 13.33%, and 26.67% mice at damage grades 0, I, and II, respectively, in the control group compared to 80%, 20%, and 0% mice at damage grades 0, I, and II, respectively. Moreover, in group I, all mice showed improved blood reperfusion, neovascular, and repaired muscle tissue compared to group II.
 Conclusion: Fi-MSC sheet transplantation positively reduced injury and improved blood perfusion ALI in the Swiss mouse model.

Comparative evaluation and analysis of outcomes in non-idiopathic and idiopathic clubfeet with Ponseti method at a tertiary care centre of a developing country

BackgroundIdiopathic clubfoot (congenital talipes equinovarus, CTEV) is being managed worldwide by Ponseti method with high success rates, while for non-idiopathic clubfoot surgical interventions is being widely used with variable results. This study evaluated the effectiveness of Ponseti method in non-idiopathic clubfoot and compared the results with idiopathic clubfoot. MethodsThe paper evaluated the epidemiological incidence and demographic profile of non-idiopathic clubfoot in a tertiary centre of developing country. A total of 108 subjects with 85 having idiopathic (group I;125 feet) and 23 having non-idiopathic variety (group II;34 feet) were managed with Ponseti method and were followed for a mean duration of 38.33 (12–62) and 36.27 months (12–58) in group I and II respectively. The most common associations were meningomyelocele (MMC/spina bifida,5), arthrogryposis multiplex congenita (AMC,4), developmental dysplasia of hip (DDH,3) and Down’s syndrome and amniotic band syndrome (2 each). ResultsPrimary correction was achieved in both the groups in 98% and 87% in group I and II respectively, while recurrences of at least one deformity was observed in 11 (9%) and 12 (40%) feet in group I and II respectively. Favourable outcomes were noticed in 22 (65%) feet in non-idiopathic group and 12 feet (35%) underwent extensive soft tissue release as compared to 3 feet (2.4%) in idiopathic variety. ConclusionDeformities improved significantly in non-idiopathic clubfeet with Ponseti methods although complete correction was not possible. Extensive surgical interventions were reduced in up to 35% feet in non-idiopathic variety and hence, it is recommended as primary treatment for all variety of clubfeet, irrespective of their etiology.

Midfoot Function Before and After Total Ankle Arthroplasty.

Information regarding the effect of total ankle arthroplasty (TAA) on midfoot function is extremely limited. The purpose of this study was to characterize midfoot region motion and power during walking in people before and after TAA. This was a prospective cohort study of 19 patients with end-stage ankle arthritis who received a TAA and 19 healthy control group participants. A motion capture and force plate system was used to record sagittal and transverse plane first metatarsal and lateral forefoot with respect to hindfoot motion, as well as sagittal plane midfoot region positive and negative peak power during walking. Parametric or nonparametric tests to examine differences and equivalence across time were conducted. Comparisons to examine differences between postoperative TAA group and control group foot function were also performed. Involved-limb midfoot function was not different between the preoperative and 6-month postoperative time point in the TAA group (all P ≥ .17). Equivalence testing revealed similarity in all midfoot function variables across time (all P < .05). Decreased first metatarsal and lateral forefoot motion, as well as positive peak power generation, were noted in the TAA group postoperative involved limb in comparison to the control group (all P ≤ .01). The similarity of midfoot function across time, along with differences in midfoot function in comparison to controls, suggests that TAA does not change midfoot deficits by 6 months postoperation. Level II, prospective cohort study.

Do Plantar Pressure and Loading Patterns Vary with Joint Hypermobility in Young Females?

Joint hypermobility is a connective tissue disorder that increases joint range of motion. Plantar pressure and foot loading patterns may change with joint hypermobility. We aimed to analyze static plantar pressure in young females with and without joint hypermobility. Joint laxity in 27 young females was assessed cross sectionally using the Beighton and Horan Joint Mobility Index. Participants were divided into the hypermobility (score, 4-9) and no hypermobility (score, 0-3) groups according to their scores. Static plantar pressure and forces were recorded using a pedobarographic mat system. Higher peak pressures (P = .01) and peak pressure gradients (P = .025) were observed in the nondominant foot in the hypermobility group. According to the comparison of dominant and nondominant feet in each group, the hypermobility group showed significantly higher peak pressures (P = .046), peak pressure gradients (P = .041), and total force values (P = .028) in the nondominant foot. The plantar pressure and loading patterns vary in young females with joint hypermobility. Evaluation of plantar loading as an injury prevention tool in individuals with joint hypermobility syndrome can be suggested.

Comparison of the outcome of management of congenital idiopathic clubfoot treated by ponseti method with modified technique

Background: Ponseti's technique has become the standard and most effective treatment modality for correction of Congenital Talipes Equinovarus (CTEV) in newborn. With time, little modification has been done in the classic technique.&#x0D; Objective: Our objective in this study was to compare the outcome in the recent years (modified Ponseti technique) with the results of our previous study (classic Ponseti technique).&#x0D; Methods: A total number of 976 patients (1553 feet) of Congenital Talipes Equino Varus were treated from October 2009 to February 2019 in Khulna Medical College Hospital and in private hospitals. In this retrospective study (based on convenient sampling), there were two groups. In group A, a total 621 patients (with a total 1033 feet) were treated from October 2009 to August, 2015. In group B, 355 patients (520 feet) were treated from November 2015 to February 2019.&#x0D; Results: In this study, in group A, approximately 88.6% was in 0-6 months age group. 64.9% was male patients. 3.7% patients had positive family history. In group B, majority of the patients (301, 84.8%) was in 0-6 months age group. 211 patients (59.4%) was male child. In approximately 3.1% (11) patients family history was positive. Approximately in 95.9% (991 out of total 1033) and 96.5% (502 out of total 520) feet respectively in group A and B, tenotomy was required. Dropout rates were 7.6% and 4.1% in respective groups. Minor bleeding was observed in approximately 1.5% (15) and 1.4% (7) feet in respective groups, followed by plaster related complications in approximately 2.2% (23) and 1.0% (5) feet in group A and B. Patients' compliance was found significantly higher in group B in contrast to group A. In group B, it was over 90%, whereas in group A, it was approximately 64.1 %.&#x0D; Conclusion: The ultimate outcome of Ponseti repair is improving by less requirement of total number of plaster, resistant cases and reduction in overall dropout rate by the newer modification.&#x0D; Bang Med J (Khulna) 2019; 52 : 7-11

Compensatory gait deviations in patients with increased outward tibial torsion pre and post tibial derotation osteotomy

BackgroundTibial torsion describes the rotation between the proximal and distal joint axis along the shaft, which can be, as rotational deformity, pathologically increased or decreased. Some patients might increase hip internal rotation during walking to compensate increased outward tibial torsion. Research questionThe aim of this study was to assess the effect of tibial derotation osteotomy on gait deviations in patients with increased outward tibial torsion. MethodsThirteen patients (13.5 ± 1.4 yrs, 22 limbs) with increased tibial torsion (CT confirmed 49.2 ± 4.8°) were analyzed pre and post tibial derotation osteotomy and compared with 17 typically developing children (TDC, 13.5 ± 2.3 yrs, 32 limbs). Kinematic and kinetic data were recorded. Subgroup analyses were performed whether patients showed compensatory hip internal rotation (Comp) or not (NoComp). Principal component (PC) analysis was used to achieve data transformation. A linear mixed model was used to estimate the main effect of PC-scores of retained PCs explaining 90% of the cumulative variance. ResultsCompensatory hip internal rotation (Comp, present in 45.5% of limbs analyzed) led to a lower external foot progression angle compared to patients without compensatory hip internal rotation (NoComp). In both patient groups foot progression angle was normalized after tibial derotation osteotomy. Post-operative NoComp had normalized frontal plane joint loadings, while Comp showed an increased hip and knee adduction moment. SignificanceFuture studies should investigate if more time is needed for Comp to normalize gait patterns post-operative or if a pre and post-operative gait training might help. Otherwise the increased knee adduction moment might be clinically relevant due to previous studies reporting a possible association with knee osteoarthritis.

Effect of Reflexology on the Constipation Status of Elderly People.

The current literature shows that one of the alternative therapies used to control constipation is reflexology. This study was conducted to assess the effect of reflexology on the constipation status of elderly people. This study was randomized clinical trial conducted from at the private nursing home in the Ankara Province. At the nursing home, 60 eligible elderly people were randomly assigned into experimental (n = 30) and control (n = 30) groups. The experimental group received foot reflexology massage for 1 month three times per week for 30 min. Reflexology was initiated from the patient's right foot. The foot was relaxed primarily by applying effleurage followed by shaking, rotation, and stretching methods. The practice ended by applying solar plexus pressure on both feet. For elderly people in the control group foot surface massage without pressure was applied to simulate the interventions similar to the experimental group. The scale scores before and after reflexology were noted for the experimental group, and those for the control group, which did not receive any reflexology massage, were also determined. After the implementation of reflexology, the rate of emptying bowels on alternate days increased in the experimental group as opposed to that in the control group (P < 0.001). In this study, reflexology was found to improve the quality of life of the elderly and decrease the severity of constipation. Foot reflexology massage was found to be effective in relieving the constipation of elderly people. Therefore, reflexology is recommended as part of nursing care to reduce the constipation status of elderly people.

Efektifitas Perbandingan Buerger Allen Exercise dan Senam Kaki terhadap Nilai ABI pada Penderita DM Tipe II

The purpose of this study was obtained by comparing the effectiveness of Buerger Allen Exercise and foot exercises to the value of Ankle Brachial Index (ABI) in patients with Type II Diabetes Mellitus. This research method is a quantitative method with Quasi Experiment research design pre and post test two groups with 15 respondents in the intervention group (group A) given Buerger Allen Exercise intervention and 15 respondents in the intervention group (group B) given foot exercise intervention. The results showed that there were significant differences in the value of Ankle Brachial Index (ABI) before and after being given Buerger Allen Exercise and foot exercises with p &lt;0.05 with the difference in the average increase in ABI value Buerger Allen Exercise group of 0.0820 while in the group foot exercises the difference in the average increase in ABI value by 0.0726. The conclusion of this study is that Buerger Allen Exercise is more effective than foot exercises in increasing the value of Ankle Brachial Index (ABI). &#x0D; Keywords : Ankle Brachial Index, Buerger Allen Exercise, Foot Exercise, Type II Diabetes Mellitus.

Effect of laterality discrimination on joint position sense and cervical range of motion in patients with chronic neck pain: a randomized single-blind clinical trial

Purpose: The main objective of the present study was to evaluate the effects of laterality discrimination training on neck joint position sense and cervical range of motion (ROM) in patients with chronic non-specific neck pain (NSCNP).Materials and methods: Forty-eight patients with NSCNP were randomly assigned to the neck group (NG) that observed neck images or the foot group (FG) that observed foot images. Response time, response accuracy, cervical ROM, and joint position error (JPE) were the main variables. The secondary outcome measures included psychosocial variables.Results: Differences between groups in the cervical ROM for flexion (p = .043) were obtained, being NG group the one which obtained greater values. NG showed an improvement in right rotation (p = .018) and a decrease in flexion was found in the FG (p = .039). In JPE, differences between groups were obtained in the left rotation (p = .021) and significant changes were found in the NG for flexion, extension, and left rotation movements (p < .05). Moderate associations were found between left and right accuracy regarding to post-intervention flexion and right rotation (r = 0.46, r = 0.41; p < .05) in NG.Conclusion: Improvements in cervical range of motion and joint position sense are obtained after the performance of the laterality discrimination task of images of the neck but not the feet. Visualization of images of the painful region presents moderate correlations with the accuracy and response time in the movements of flexion and right rotation.

Application of three-dimensional printing technology to design individual angle section on Chevron of hallux valgus osteotomy

To explore clinical application of three-dimensional printing technology to design individual angle section on Chevron of hallux valgus osteotomy. From May 2013 to May 2016, 47 patients(66 feet) with mild to moderate hallux valgus treated by Chevron osteotomy according to different preoperative design were divided into computer osteotomy group(group A) and traditional osteotomy group(group B). In group A, there were 25 patients (33 feet), including 4 males(5 feet) and 21 females(28 feet) with an average age of (47.88±6.08) years old, average weight IMA was (13.58±1.15) degree, AOFAS score was 59.00±5.86, and treated individual 3D printing technology to design operation scheme. While in group B, there were 22 patients (33 feet), including 3 males (3 feet) and 19 females (28 feet) with an average age of (48.16±6.16) years old, average weight IMA was(13.51±1.14) degree, AOFAS score was 60.67±5.85, and treated with osteotomy according to surgical experience. Operation time, blood loss, hospital stays, VAS score at 1 week after operation, wound healing and improvement of postoperative weight-bearing intermetatarsal angle(IMA) were compared between two groups, AOFAS score system was used to evaluate ankle function after surgery. There was no significant difference in following-up between group A 12.41±2.32 and group B 11.73±2.76. There was 1 patient in group B were excluded. Others perform good wounds healing on the first stage after operation. There were no significant differences in operation time, blood loss, hospital stays and VAS score at 1 week after operation(P<0.05); IMA in group A was (5.21±0.88)°, (6.42±0.85)° in group B, and had significant differences between two groups (t=5.68, P<0.05). There was obvious meaning in AOFAS score between group A 88.15±5.19 and group B 82.90±5.01(t=4.14, P<0.05). Fourteen feet in group A obtained excellent results and 19 feet good, while 5 feet in group B obtained excellent results and 27 feet good. Compared with traditional osteotomy group, three-dimensional printing technology to design individual angle section on Chevron of hallux valgus osteotomy could better correct IMA, improve postoperative foot function, and it is a kind of individualized and digital method to design operation.

Fat Graft and Bone Wax Interposition Provides Better Functional Outcomes and Lower Reossification Rates Than Extensor Digitorum Brevis After Calcaneonavicular Coalition Resection.

Calcaneonavicular coalitions are the most common form of tarsal coalitions. The prefered treatment for symptomatic coalitions is surgical resection; however, there are no published studies that directly compare different interposition techniques. The purpose of the present study was to retrospectively compare pain relief, functional outcomes, and complications of children and adolescents who had a resection of a symptomatic calcaneonavicular coalition with interposition of fat graft, bone wax, or extensor digitorum brevis (EDB). In total, 48 patients (56 ft) underwent calcaneonavicular coalition resection-interposition at 3 institutions from July 2008 to July 2015. There were 23 feet in group 1 (fat graft), 18 feet in group 2 (bone wax), and 15 feet in group 3 (EDB). Patient demographic characteristics were similar between all groups for age, sex, coalition type, and symptoms onset. Data concerning clinical and radiographic features, surgical technique, and postoperative complications were obtained from all available medical records. Radiographs were evaluated at last follow-up to determine coalition regrowth. Preoperative and postoperative pain was assessed with the visual analog scale, and function was assessed with use of the American-Orthopaedic-Foot and Ankle Society (AOFAS) score. Pain improved to an average of 0.5 in the first group (range, 0 to 6), 0 in group 2, and 1.7 in group 3 (range, 0 to 5) (P=0.033). The average AOFAS score improved from 59 (range, 33 to 71 points) to 98 points (range, 62 to 100 points) in the fat graft group, from 50 (range, 34 to 62 points) to 98 points (range, 88 to 100 points) in the bone wax group, and from 48 (range, 30 to 60 points) to 75 points (range, 70 to 95 points) in the EDB group (P<0.001). Eight feet had regrowth of the coalition on the postoperative radiographs: 1 in group 1 (4%), 1 in group 2 (6%), and 6 in group 3 (40%) (P=0.004). Five feet from the third group developed progressive symptoms. In our study, autogenous fat graft and bone wax interposition techniques provided better pain relief, gave better functional scores, and avoided more effectively coalition reossification than EDB technique. Further studies are required to evaluate safety of bone wax as an interposition material. Level III-therapeutic.

COMPARISON BETWEEN TWO TYPES OF ABDUCTION ORTHOTICS IN TREATING CONGENITAL CLUBFOOT.

ABSTRACTObjective: The objective of this study was to analyze and compare the effectiveness of two types of abduction orthotics used for the feet, the Denis-Browne type (traditional) and the Dobbs type (dynamic), with regard to maintenance of deformity correction and prevention of recurrence . Method: In this comparative retrospective case study, information was collected from the medical records of children with idiopathic congenital clubfoot (CCF). We evaluated a total of 43 feet in 28 patients, which were divided into two groups. Group 1 was comprised of 16 patients with a total of 24 CCFs treated with the traditional orthotic device. Group 2 consisted of 12 patients with a total of 19 CCFs treated with the dynamic orthotic device. The statistical analysis used the ANOVA test to compare the categorical variables between the groups. A significance level of 5% was adopted (p-value≤0.05) . Results: In Group 1, recurrence was observed in 2 feet (8.33%), and in 1 foot in Group 2 (5.26%). No significant difference in effectiveness was seen between the two types of orthotic devices . Conclusion: Both abduction devices were seen to be effective in maintaining correction of congenital clubfoot deformities. There was no statistical significance between type of orthotic device and recurrence. Level of Evidence III, Retrospective Comparative Study.

Comparison of the static tibia-hindfoot angle and arch height between the Oxford Foot Model (OFM) and a full weight bearing 3D-imaging (PedCAT)

Tibial torsion describes the rotation between the proximal and distal joint axis along the shaft, which can be, as rotational deformity, pathologically increased or decreased. Some patients might increase hip internal rotation during walking to compensate increased outward tibial torsion.The aim of this study was to assess the effect of tibial derotation osteotomy on gait deviations in patients with increased outward tibial torsion.Thirteen patients (13.5 ± 1.4 yrs, 22 limbs) with increased tibial torsion (CT confirmed 49.2 ± 4.8°) were analyzed pre and post tibial derotation osteotomy and compared with 17 typically developing children (TDC, 13.5 ± 2.3 yrs, 32 limbs). Kinematic and kinetic data were recorded. Subgroup analyses were performed whether patients showed compensatory hip internal rotation (Comp) or not (NoComp). Principal component (PC) analysis was used to achieve data transformation. A linear mixed model was used to estimate the main effect of PC-scores of retained PCs explaining 90% of the cumulative variance.Compensatory hip internal rotation (Comp, present in 45.5% of limbs analyzed) led to a lower external foot progression angle compared to patients without compensatory hip internal rotation (NoComp). In both patient groups foot progression angle was normalized after tibial derotation osteotomy. Post-operative NoComp had normalized frontal plane joint loadings, while Comp showed an increased hip and knee adduction moment.Future studies should investigate if more time is needed for Comp to normalize gait patterns post-operative or if a pre and post-operative gait training might help. Otherwise the increased knee adduction moment might be clinically relevant due to previous studies reporting a possible association with knee osteoarthritis.

Analysis of clinical characteristics and related factors of type 2 diabetic patients with different ankle brachial index

Objective To study the clinical characteristics and related factors of type 2 diabetes with different ankle brachial index(ABI). Methods Two hundred and sixty-two patients with type 2 diabetes in Tieying Hospital of Fengtai District of Beijing outpatient and inpatient from January 2012 to April 2015 were selected.General information, blood biochemical parameters and ABI of patients were tested and collected.The patients were classified into three groups according to the different ABI.A group was ABI 1.3 with 31 cases.The clinical characteristics of three groups were analyzed. Results The age of the patients in group B was younger than that in group A and C((62±15) years old vs. (72±10) years old vs. (71±9) years old, P=0.048). The duration of disease in group B was shorter than that in group A and C((6±6) years vs. (10±2) years vs. (11±3) years, P=0.037). The Blood uric acid of patient in group B were lower than those of patient in group A and C((320±111) μmol/L vs. (350±110) μmol/L vs. (338±109) μmol/L, P=0.039). The glycosylated hemoglobin levels of patient in group B were higher than those of patient in group A and C((9.5±1.8)% vs. (7.2±2.3)% vs. (8.8±2.0)%, P=0.041). Compared with group A, the level of UA, HbA1c in group B were more higher(P<0.05). The incidence rate of diabetic foot was 23%(9/40) in group A, 6%(11/191) in group B, 23%(7/31) in group C, and the difference was significant(P=0.042). Compared with group A and C, the the incidence rate of diabetic foot in group B was the lower(P<0.05). Correlation analysis showed that ABI was negatively correlated with age, course of disease, HbA1c(r=-0.65, -0.70, -0.79, -0.61, P<0.05). Conclusion Different ABI of patients with type 2 diabetes have different clinical features.With increasing age, disease duration, glycosylated hemoglobin and blood uric acid level, it is likely to cause patients with abnormal ABI and increase the probability of occurrence of diabetic foot. Key words: Type 2 diabetes mellitus; Diabetic foot; Ankle brachial index; Serum uric acid; Glycosylated hemoglobin

A comparative analysis of the two most common surgical exposures for clubfoot

Background:The surgical release of clubfoot should address all the pathological structures, including a complex soft tissue release of the hind foot and mid foot, possibly one of the most complicated procedures performed in orthopedic surgery. As in any surgical procedure involving multiple anatomic steps, exposure is the key to a successful comprehensive release. This study was conducted with the aim of comparing two of the most widely used surgical exposures in clubfeet.Methods: This was a prospective study of 35 patients having 60 diseased feet, aged between 1 to 3 years. Patients with neglected idiopathic clubfoot who did not respond to initial Ponseti’s casting; and were planned for Posteromedial soft tissue release (PMSTR) surgery were included in this study. Group I (18 patients-30 feet) underwent surgery using the hemi-cincinnati incision and group II (17 patients-30 feet) by turco method of exposure. 2 patients (3 feet) of the turco group were lost to follow-up. Preoperative and postoperative pirani scores were calculated and compared. Other clinical follow-up parameters included pain (were assessed using FLACC behavioral pain assessment scale) and wound complications (necrosis, adhesions and scar hypertrophy). Radiological parameters were also assessed.Results:As per the difference between pre and postoperative (3 months) pirani score, 5 feet had a good result, 22 had satisfactory, and 3 had poor results in group I while in group II, 3 had good, 19 had satisfactory, and 5 had poor results. 2 feet in group I and 10 feet in group II had wound necrosis in the immediate postoperative period. There was no substantial difference in the postoperative angles in both groups.Conclusions:PMSTR is an acceptable surgical method for treating neglected idiopathic clubfeet. The hemi cincinnati incision has lesser number of wound complications and also better deformity correction as evaluated by pirani scores. This study supports the use of hemi cincinnati incision over turco incision in posteromedial soft tissue release for treating idiopathic clubfoot.