Heel Width Research Articles

Foot Anthropometry Measures in Relation to Treatment in Patients with Rheumatoid Arthritis: A Longitudinal Study.

Approximately 90% of patients with arthritis exhibit forefoot deformities, including deformities within the metatarsophalangeal and proximal interphalangeal joints. Current pharmacological treatment with Disease Modifying Antirheumatic Drugs (DMARDs) consists of two groups: synthetic drugs (sDMARDs) and biological drugs (bDMARDs). The objective of our study was to investigate foot anthropometry changes in RA patients based on the administered treatment over a five-year period Method: A longitudinal analysis was conducted with RA patients who were grouped based on their pharmacological treatment. The pharmacological treatment groups were categorized into (I) methotrexate (MTX), (II) MTX plus biological treatments (including all variables), (III) biological treatment alone, and (IV) a miscellaneous group comprising patients with diverse treatments, including patients for whom various drugs had failed or who had not achieved remission with pharmacological treatment. For the anthropometric measurements, a foot measurement platform validated by McPoil et al. was used. Post hoc analyses with Bonferroni correction were performed to identify pairwise differences between the treatment groups while controlling for Type I errors due to multiple comparisons. Results: In the period from 2018 to 2023, significant changes were observed in several foot measurements. For instance, the MTX group showed a statistically significant increase in left heel width (p = 0.026). The MTX group experienced a slight increase in left foot length, while the Biologics and MTX + Bio groups exhibited more substantial increases in both maximum medial arch height and midfoot width. Conclusions: Different RA treatments can have a significant impact on foot structure over a five-year period, showing notable changes in heel width and overall foot morphology. Combined treatments with MTX and biologics potentially offer better management of RA.

Functional and Radiological Outcome after Internal Fixation of Intra-articular Calcaneal Fractures.

Calcaneal fractures are rare injuries constituting 2% of all fractures. Fractures of calcaneum correspond to nearly 60-75% of the tarsal bone fractures. The calcaneum is the most commonly fractured tarsal bone 90% occur in males between 21 and 45 years of age. The calcaneal fracture may be extra-articular (sparing the subtalar joint) and intra-articular involving the subtalar joint. Intra-articular fractures account for approximately 75% of calcaneal fractures and have been associated with poor functional outcomes. In this study, we aim to assess the functional outcome of internal fixation in displaced intra-articular calcaneal fractures. A prospective interventional study was conducted on patients with only intra-articular calcaneal fractures admitted to Chettinad Hospital and Research Institute, Kelambakkam during the period from May 1, 2022, to February 29, 2024, and a total of 32 patients were considered. The functional outcome was assessed by the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle Hindfoot Scoring System. The average age of the patients in our study was 39 years of which all were male. Fall from height is the most common mode of injury. The right calcaneum is more commonly involved than the left. The mean duration of hospital stay was around 10 days. The fracture classification was based on the sanders and Essex-Lopresti classification of which 17 patients were sanders type 3 and 13 patients were sanders type 2 and 1 patient was sanders type 4. The mean time for radiological union is 12 weeks. The Bohler's angle and Gissane's angle preoperatively 16.16 ± 8.87 and 121.48 ± 7.47 restored to near normal values after fixation 27.77 ± 6.02 and 113.485 ± 44, respectively. Heel height and heel width restored to near normal values of (pre-operative heel height - 24.74 ± 3.71 and heel width - 39.97 ± 4.11 and post-operative heel height - 31.55 ± 3.38 and heel width - 34.0 ± 3.1), respectively. The most common complications were wound-related complications (superficial wound infection - 9.7%, deep wound infection - 3.2%, and wound margin necrosis and wound dehiscence 6.4%) and the most common late complications were complex regional pain syndrome - 9.7% and subfibular lateral impingement with peroneal tendinitis - 6.5%. AOFAS grading of functional outcome had shown good to excellent results in 83.8% (26 patients) of the cases. The mean AOFAS score was 83.39 in our study. The present study shows that open reduction and internal fixation give superior radiographic results as shown by the restoration of Bohler's and Gissane's angle and height and width of the calcaneus to near normal values, indicating anatomical restoration of calcaneal shape. The functional outcome by AOFAS score showed good to excellent results in most of the patients with minimal wound complications.

EVALUATION OF PLANTAR FASCIA THICKNESS ACCORDING TO THE MORPHOMETRIC OF THE FOOT

OBJECTIVE: In our study, it was aimed to examine the relationship among plantar fascia thickness, foot morphometric values, and Achilles tendon thickness. MATERIAL AND METHODS: The study was carried out on young volunteers who did not engage in any active regular sports. In total, morphometric measurements were performed on 64 feet (17 men, 15 women). The thickness of the plantar fascia on the ultrasound image was measured. Foot length, foot width, heel width, and ankle circumference were used as foot morphometric variables. RESULTS: It was determined that the plantar fascia thickness was greater than 4 mm in 14.7% of young healthy male individuals. The plantar fascia thickness was found to be less than 3.6 mm in all young female individuals. In men, plantar fascia thickness was found to be moderately positively correlated with foot length and ankle circumference (p<0.05). However, it was interesting that there was no correlation between plantar fascia thickness and foot width. When all the participants were evaluated together, a moderate positive correlation was found between plantar fascia thickness and foot length, ankle circumference, and Achilles tendon thickness, while a weak correlation was found with foot width and heel diameter (p<0.001). CONCLUSIONS: The addition of foot morphometry and plantar fascia data to the literature, depending on different racial and geographical conditions, allows anatomists and anthropologists to make necessary comparisons. To support the diagnosis of plantar fasciitis, the accepted “plantar fascia thickness greater than 4 mm” should be reviewed and discussed separately for both men and women.

Regional plantar forces and surface geometry variations of a chronic ankle instability population described by statistical shape modelling

BackgroundUnderstanding detailed foot morphology as well as regional plantar forces could provide insight into foot function and provide recommendation for footwear design for chronic ankle instability (CAI) people. Research QuestionThis study presented 3-dimensional statistical shape models of feet from three different populations including CAI, copers and healthy individuals, with regional plantar forces also acquired. MethodsSixty-six males (22 participants per group) were included in this study to capture 3-dimensional foot shapes under a standing condition and regional plantar forces during a cutting maneuver. Principal component analysis was performed to generate a mean foot shape of each group as well as modes of variations. A generalized procrustes analysis was used to achieve rapid registration of mean shapes. Besides, regional plantar forces and contact duration among these three populations were compared. ResultsFor 3-dimensional foot shapes, although no significant differences of the average distance between each mode and mean shape were found among three populations, there were subtle variations in mean shapes. The CAI population presented a more bulging of the lateral malleolus; copers were characterized by the flexion of the lesser toes, a more bulging of the medial foot in the sagittal plane; and healthy individuals showed a greater heel width and a more bulging of the heel in the sagittal plane. In terms of plantar forces, healthy individuals had significantly greater summated plantar forces and greater plantar forces in the lateral heel area during the early contact phase compared to copers and CAI participants. SignificanceOverall, this study suggested that repetitive ankle sprains may lead to the bulging of the lateral malleolus. Further, CAI and copers seem to stabilize the ankle joint by medially shifting the center of pressure compared to healthy individuals under the static and less challenging dynamic conditions.

Foot morphology as a predictor of hallux valgus development in children

An excess of body weight can produce morphological changes in the feet of children. The aim of this study was to assess the morphological differences of the foot in children based on their body mass index and to determine the risk factors for the development of a hallux valgus in childhood and adolescence. One Thousand Six Hundred Seventy-Eight children (5–17 years) were classified as group with obesity, overweight, and normal weight. Lengths, widths, heights and angles of both feet was measured with a 3D scanner. The risk of developing hallux valgus was calculated. Group with overweight and obesity presented longer feet (p = 0.00), wider metatarsals (p = 0.00) and wider heels (p = 0.00). Arch height was lower (p > 0.01) in the group with obesity, and the hallux angle was greater in the group with normal weight (p < 0.05). The relative risk of a lateral hallux deviation increases with age, foot length and heel width (Exp (B) > 1). Children with overweight and obesity had longer and wider feet. The arch height was higher in children with overweight, and lower in children with obesity. Age, foot length, and heel width could be risk factors for the development of hallux valgus, while metatarsal width and arch height could be protective factors. Monitorization of the development and characterization of the foot in childhood as a clinical tool could help professionals to early identify the patients presenting risk factors and prevent future deformities and other biomechanical conditions in adulthood by implementing protecting measures.

CALCANEAL FRACTURE, EPIDEMIOLOGY, ANATOMY, MECHANISM OF INJURY, CLASSIFICATION, IMAGING PRESENTATION, CLINICAL PRESENTATION, MANAGEMENT AND COMPLICATIONS

Introduction: Throughout time, calcaneal burst fractures have been referred to as lovers fractures because the injury occurred when a suitor jumped off a lovers balcony to avoid detection. The calcaneus is part of the 7 tarsal bones, calcaneus, talus, cuboid, navicular, first, second and third cuneiform. Calcaneal fractures are infrequent, however, they have a high potential to weaken the limb. Objective: to detail current information related to calcaneal fractures, epidemiology, anatomy, mechanism of injury, clinical evaluation, imaging evaluation, classification, treatment and complications. Methodology: a total of 30 articles were analyzed in this review, including review and original articles, as well as clinical cases, of which 21 bibliographies were used because the other articles were not relevant to this study. The sources of information were PubMed, Google Scholar and Cochrane; the terms used to search for information in Spanish, Portuguese and English were: calcaneal fracture, calcaneus, calcaneal osteosynthesis, foot fractures. Results: The calcaneus is the most commonly fractured tarsal bone, representing 2% of all fractures. Calcaneal fractures are bilateral in 5 to 10%, and are usually related to fractures of the lumbar spine and other fractures of the lower limb caused by high-impact trauma. About 10 % of calcaneal fractures are open. Conclusions: The calcaneus is the most commonly fractured tarsal bone, accounting for 2 % of all fractures. Calcaneal fractures are bilateral in 5 to 10% and are usually related to fractures of the lumbar spine and other fractures of the lower limb caused by high impact trauma. About 10% of calcaneal fractures are open, and neurovascular injuries are infrequent in calcaneal fractures. Calcaneal fractures are more related to high energy impacts that generate axial loading of the bone, however they can occur with any injury to the foot and ankle. The main characteristics of individuals affected with a calcaneal fracture are pain, swelling, widening, deformity, ecchymosis and functional impotence. To make the radiological diagnosis of calcaneal fracture in the first instance it is recommended to request an anteroposterior projection of the foot, lateral projection of the rearfoot, Harris axial projection and an ankle series; if necessary, a computed tomography can be performed. In practice, calcaneal fractures can be classified as intra-articular or thalamic and extra-articular; in addition, classification systems such as Sanders and Essex-Lopresti are used. Treatment is controversial. Even with adequate reduction and management, calcaneal fractures can become extremely disabling injuries, presenting a mutable prognosis with various types of functional limitation and pain. Currently, some factors have been found to be related to better outcomes, however, the literature comparing various methods of surgical versus conservative treatment show that surgical management has increased complication rates, however, it may lead to optimal functional outcomes in some individuals. Generally, the incidence of complications of calcaneal fractures is high and increases the worse the wound. Among the most common are calcaneal osteomyelitis, post-traumatic osteoarthritis, wound dehiscence, increased heel width, loss of subtalar mobility, chronic peroneal tendonitis, and complex regional pain syndrome. KEY WORDS: fracture, calcaneus, osteosynthesis, foot.

Shoe configuration effects on third phalanx and capsule motion of unaffected and laminitic equine hooves in-situ.

Equine shoes provide hoof protection and support weakened or damaged hoof tissues. Two hypotheses were tested in this study: 1) motion of the third phalanx (P3) and hoof wall deformation are greater in laminitic versus unaffected hooves regardless of shoe type; 2) P3 displacement and hoof wall deformation are greatest while unshod (US), less with open-heel (OH), then egg-bar (EB) shoes, and least with heart-bar (HB) shoes for both hoof conditions. Distal forelimbs (8/condition) were subjected to compressive forces (1.0x102-5.5x103 N) while a real-time motion detection system recorded markers on P3 and the hoof wall coronary band, vertical midpoint, and solar margin. Magnitude and direction of P3 displacement and changes in proximal and distal hemi-circumference, quarter and heel height and proximal and distal heel width were quantified. Hoof condition and shoe effects were assessed with 2-way ANOVA (p<0.05). P3 displacement was greater in laminitic hooves when US or with OH, and EB and HB reduced P3 displacement in laminitic hooves. P3 displacement was similar among shoes in unaffected hooves and greatest in laminitic hooves with OH, then US, EB and HB. EB and HB increased P3 displacement from the dorsal wall in unaffected hooves and decreased it in laminitic hooves. OH and EB increased P3 motion from the coronary band in laminitic hooves, and HB decreased P3 motion toward the solar margin in unaffected and laminitic hooves. In laminitic hooves, HB reduced distal hemi-circumference and quarter deformation and increased heel deformation and expansion. Proximal hemi-circumference constriction was inversely related to proximal heel expansion with and without shoes. Overall, shoe configuration alters hoof deformation distinctly between unaffected and laminitic hooves, and HB provided the greatest P3 stability in laminitic hooves. These unique results about P3 motion and hoof deformation in laminitic and unaffected hooves inform shoe selection and design.

The Construction of a Gravity Retaining Wall to Prevent Landslides on the Grogol Kediri Highway

One proof of Kediri's progress is the construction of Doho Kediri International Airport which is expected to improve the economy and tourism in this city. The airport was built with the aim of improving connectivity and suppressing development disparities in southern East Java. The purpose of this study is to plan the construction of an earthquake-resistant which is gravity retaining wall on the Grogol Kediri Highway, Kediri Regency. . Planning is carried out at STA 3.8-4.0. , soil laboratory testing on samples obtained from the studied location. Identification of the soil type, sliding angle, and weight of the soil volume at the site are needed to determine the planning of earthquake-resistant retaining walls. From the soil properties obtained, it can be determined that the land is included in the GC (Clayey Gravel) category With a shear angle of 28° and a weight of 1.463 gr/cm3. These results were used to calculate the dimensions and the stability of the retaining wall using the Coulomb method. The retaining wall should have a peak body width of 1 meter, foundation width of 3.8 meters, foundation thickness of 1 meter, foundation depth of 1.04 meters, foot and heel width of 0.9 meters, height of 6 meters, and bottom body thickness of 2 meters. Based on stability calculations, the retaining wall is safe against overturning, shifting, and subsidence. Therefore, this retaining wall is a viable solution to prevent landslides and mitigate the negative impacts caused by them.

Absolute and relative foot dimensions of males and females school children in Southwest Nigeria aged 10 to 18 years

Absolute and relative foot dimensions are two classifications of anthropometric measures that are of important consideration when designing footwear for males and females. Besides, it can also be of benefit to the clinicians in determining foot types and deformities. A localized, two-stage, stratified, Cross-sectional survey was conducted in 10 secondary schools involving male and female students with a total sample size of 518 (males: n= 235, 45.36% females: n 283, 54.63%) aged 10 to 18 years selected across different ethnic groups in public and private secondary schools in Ikeja, Lagos, Nigeria. The independent t-test conducted on the students population shows that the males’ foot length were statistically significantly longer (left foot: 24.79±1.87cm; right foot: 24.77±1.89cm) than that of their females’ counterpart (left foot: 23.38±1.39cm; right foot: 23.40±1.35cm), (left foot: t (518) =9.8190; right foot: t (518) = 9.6080), p=0.0000). The males’ heel width were statistically significantly wider (left foot: 5.56±0.82cm; right foot: 5.63±0.84cm) than that of the females’ heel width (left foot: 5.29±0.72cm; right foot: 5.29±0.71cm), (left foot: t (518) =3.9520; right foot: t (518) = 4.9894), p=0.0000). Similarly, the ball width of the male students was statistically significantly wider (left foot: 9.23±0.98cm; right foot: 9.31±0.97cm) than that of the female students ball width (left foot: 8.70±0.72cm; right foot: 8.66±0.76cm), (left foot: t (518) =7.1435; right foot: t (518) = 8.5605), p=0.0000). A one-way ANOVA conducted on the children’s foot length, heel width and ball width at different age cohorts showed statistically significant difference between the four age groups. This study concluded that the absolute and relative foot dimensions of male children were larger than their female counterparts from the assessed parameters. The result also revealed statistically significant differences in foot dimensions at different age categories.

Effect of surcharge load location on the behavior of cantilever retaining wall

Abstract In this study, the effect of location of surcharge load on the stability and behavior of the retaining wall under static and dynamic load has been considered. A cantilever retaining wall of 7 m height retained dry sandy soil with 50 kN/m2 surcharge load. Several parameters were taken into account in the numerical analysis, including the horizontal distance (X) from the edge of the wall to the surcharge load expressed as a ratio to the heel width (X/Bh = 0, 0.25, 0.5, 0.75, and 1), as well as the effect of different values of the earthquake's horizontal component (kh = 0.1, 0.2, and 0.3). Lateral earth pressure distribution decreases with increase (X/B h ) in the upper one third of the wall. The effect of surcharge location at the top of the wall disappears at X/B h = 0.25. Under dynamic load, the maximum displacement at the top of the wall is obtained at X/B h = 0.5. It is increased by about 4 times at k h = 0.3. The possibility of sliding increases by about 4.8 times once the k h increases from 0.1 to 0.3. There is a maximum increase in rotation by 2 times at k h = 0.1. In the dynamic case, the differential settlement decreases with increase in X/B h , and increases with the increase in k h .

Analysis of Diabetic Foot Deformation and Plantar Pressure Distribution of Women at Different Walking Speeds.

Official guidelines state that suitable physical activity is recommended for patients with diabetes mellitus. However, since walking at a rapid pace could be associated with increased plantar pressure and potential foot pain, the footwear condition is particularly important for optimal foot protection in order to reduce the risk of tissue injury and ulceration of diabetic patients. This study aims to analyze foot deformation and plantar pressure distribution at three different walking speeds (slow, normal, and fast walking) in dynamic situations. The dynamic foot shape of 19 female diabetic patients at three walking speeds is obtained by using a novel 4D foot scanning system. Their plantar pressure distributions at the three walking speeds are also measured by using the Pedar in-shoe system. The pressure changes in the toes, metatarsal heads, medial and lateral midfoot, and heel areas are systematically investigated. Although a faster walking speed shows slightly larger foot measurements than the two other walking speeds, the difference is insignificant. The foot measurement changes at the forefoot and heel areas, such as the toe angles and heel width, are found to increase more readily than the measurements at the midfoot. The mean peak plantar pressure shows a significant increase at a faster walking speed with the exception of the midfoot, especially at the forefoot and heel areas. However, the pressure time integral decreases for all of the foot regions with an increase in walking speed. Suitable offloading devices are essential for diabetic patients, particularly during brisk walking. Design features such as medial arch support, wide toe box, and suitable insole material for specific area of the foot (such as polyurethane for forefoot area and ethylene-vinyl acetate for heel area) are essential for diabetic insole/footwear to provide optimal fit and offloading. The findings contribute to enhancing the understanding of foot shape deformation and plantar pressure changes during dynamic situations, thus facilitating the design of footwear/insoles with optimal fit, wear comfort, and foot protection for diabetic patients.

Evaluation of Age-related Differences in Foot Anthropometry among Women

Foot morphological changes induced by degenerative processes are commonly found in old people. Such changes in foot anthropometry may adversely affect foot health and footwear comfort, and prolonged use of ill-fitting footwear may even cause foot deformation. This study compares foot anthropometric measurements between young and old women to determine key foot measurements, which can also act as indicators for developing footwear appropriate for the elderly. Using a three-dimensional handheld scanner, 11 foot anthropometric measurements are captured and used to characterize the dimensions and foot shape between young and old women. Eighty-two women between the ages of 20 and 95 years—that is, 41 young women (mean = 24.0; standard deviation = 3.5) and 41 old women (mean = 82.1; standard deviation = 7.2)—were recruited for this study. The results indicate that old women have a significantly longer and wider heel than young women as well as significantly larger ball and instep circumferences after normalization for foot length. Old women also exhibit larger deformity in the degree of hallux valgus and more pronated feet than young women do. A discriminant analysis linear equation has also been established to classify their foot type based on heel length and heel width with reference to their age group.

The interrelationship between three-dimensional foot mobility and bodyweight bearing.

[Purpose] To clarify the three-dimensional nature of foot mobility and its interrelationships within the foot due to bodyweight bearing. [Participants and Methods] Data regarding left foot mobility due to body weight bearing were collected from 31 healthy adults. Foot shape differences while sitting and standing, and their interrelationship were examined. The same examiner reapplied the landmark stickers when misaligned during measurement position changes. [Results] The foot length, heel width, forefoot width, hallux valgus angle, and calcaneus eversion angle were significantly larger in the standing than in sitting position. The digitus minimus varus angle was significantly smaller in the standing than in sitting position. The medial and lateral malleoli, navicular, and dorsum of the foot were displaced medially and inferiorly; the other indices, except for the midfoot, were displaced anteriorly. The interrelationships within the foot showed a positive correlation between the calcaneus eversion angle and the medial displacement of the medial and lateral malleoli, navicular, and dorsum of the foot points. There was a negative correlation between the calcaneus eversion angle and inferior displacement of the medial malleolus, navicular, and dorsum of the foot. [Conclusion] The intra-foot coordination relationship in response to bodyweight bearing was clarified.

How to measure children’s feet: 3D foot scanning compared with established 2D manual or digital methods

BackgroundIn infants and young children, a wide heterogeneity of foot shape is typical. Therefore, children, who are additionally influenced by rapid growth and maturation, are a very special cohort for foot measurements and the footwear industry. The importance of foot measurements for footwear fit, design, as well as clinical applications has been sufficiently described. New measurement techniques (3D foot scanning) allow the assessment of the individual foot shape. However, the validity in comparison to conventional methods remains unclear. Therefore, the purpose of this study was to compare 3D foot scanning with two established measurement methods (2D digital scanning/manual foot measurements).MethodsTwo hundred seventy seven children (125 m / 152 f; mean ± SD: 8.0 ± 1.5yrs; 130.2 ± 10.7cm; 28.0 ± 7.3kg) were included into the study. After collection of basic data (sex, age (yrs), body height (cm), body weight (kg)) geometry of the right foot was measured in static condition (stance) with three different measurement systems (fixed order): manual foot measurement, 2D foot scanning (2D desk scanner) and 3D foot scanning (hand-held 3D scanner). Main outcomes were foot length, foot width (projected; anatomical; instep), heel width and anatomical foot ball breadth. Analysis of variances for dependent samples was applied to test for differences between foot measurement methods (Post-hoc analysis: Tukey-Kramer-Test; α=0.05).ResultsSignificant differences were found for all outcome measures comparing the three methods (p<0.0001). The span of foot length differences ranged from 3 to 6mm with 2D scans showing the smallest and 3D scans the largest deviations. Foot width measurements in comparison of 3D and 2D scans showed consistently higher values for 3D measurements with the differences ranging from 1mm to 3mm.ConclusionsThe findings suggests that when comparing foot data, it is important to consider the differences caused by new measurement methods. Differences of about 0.6cm are relevant when measuring foot length, as this is the difference of a complete shoe size (Parisian point). Hence, correction factors may be required to compare the results of different measurements appropriately. The presented results may have relevance in the field of ergonomics (shoe industry) as well as clinical practice.

Effects of supportive and minimalist footwear on standing balance and walking stability in older women

BackgroundFootwear has been shown to influence balance and is an important consideration in relation to the prevention of falls. However, it remains unclear as to what type of footwear is most beneficial for balance in older people: sturdy, supportive footwear, or minimalist footwear to maximise plantar sensory input. The objectives of this study were therefore to compare standing balance and walking stability in older women wearing these two footwear styles, and to investigate participants’ perceptions in relation to comfort, ease of use and fit.MethodsOlder women (n = 20) aged 66 to 82 years (mean 73.4, SD 3.9) performed a series of laboratory tests of standing balance (eyes open and closed on floor and foam rubber mat, near tandem standing) and walking stability (treadmill, level and irregular surface) using a wearable sensor motion analysis system. Participants were tested wearing supportive footwear (incorporating design features to improve balance) and minimalist footwear. Perceptions of the footwear were documented using structured questionnaires.ResultsThere were no statistically significant differences in balance performance between the supportive and minimalist footwear. Participants perceived the supportive footwear to be significantly more attractive to self and others, easier to put on and off but heavier compared to the minimalist footwear. Overall comfort was similar between the footwear conditions, although the supportive footwear was reported to be significantly more comfortable in the heel, arch height, heel cup, heel width and forefoot width regions. Eighteen participants (90%) reported that they felt more stable in the supportive footwear and 17 (85%) reported that they would consider wearing them to reduce their risk of falling.ConclusionBalance performance and walking stability were similar in supportive footwear designed to reduce the risk of falling and minimalist footwear, although participants preferred the supportive footwear in relation to aesthetics, ease of use, comfort and perceived stability. Prospective studies are now required to ascertain the longer-term advantages and disadvantages of these footwear styles on comfort and stability in older people.Trial registrationAustralian New Zealand Clinical Trials Registry. ACTRN12622001257752p, 20/9/2022 (prospectively registered).

Efeito do casqueamento da região da pinça dos cascos torácicos de equinos sadios sobre a morfologia dos cascos, ângulos articulares distais e locomoção por cinematografia

ABSTRACT Seven forelimb hooves from healthy horses were submitted to regular trimming and fourteen days later, submitted to toe trimming. Toe angle and length, lateral and medial heels, frog and sole length and width, distal, proximal, and metacarpal phalangeal interphalangeal angles were measured, as well as locomotion evaluation through cinematographic analysis. The measurements were performed ten, 14, 15, 30 and 45 days after the regular trimming, and at 14 days two measurements, one before and one after the toe trimming, were carried out. For cinematography, the sequence of supports and time spent in each support were taken. The comparison of the means obtained from the individuals regarding the variables, between limbs, limbs for each individual, time - points, moments for each individual and between limbs for each moment, as well as the time spent in each in the supports, was performed using ANOVA. Results lower than those of statistical significance (p&lt;0.05) were submitted to Tukey’s test. The toe trimming promotes changes in toe length, angle, lateral heel angle, medial and lateral heel length, frog length, width, and sole length, and changes the pattern of the trot of horses.

Optimal landmark for chest compression during cardiopulmonary resuscitation derived from a chest computed tomography in arms-down position

Abstract Funding Acknowledgements Type of funding sources: Private hospital(s). Main funding source(s): The Faculty of Medicine, Chiang Mai University Fund Background Recently evidence, compression at the maximal left ventricular diameter on sternum (LVmax) maximises cardiac output, stroke volume and rate of return of spontaneous circulation. However, there is insufficient evidence for the specific landmark on the chest for high-quality chest compression. Although cardiac arrest patients are usually in the arms-down position, previous studies used chest computed tomography (CCT) of the patient with arms-up position. It might alter the left ventricular position. Purpose This study aimed to identify the landmark of LVmax and to propose the new hand placement to optimise the chest compression by using CCT in arms-down position. Methods A retrospective, cross-sectional study conducted at a university-based, tertiary care hospital between September 2016 and November 2020. We included adult patients who underwent CCT in arms-down position. We measured healthcare providers’ hand heel width and the cardiothoracic parameters in CCT to establish a new optimal landmark of chest compression. We defined the sternal notch as a reference point and measured the distance from the sternal notch to LVmax (DLVmax), to the lower half of sternum (DLH), and to the point of maximal force of hand which placed the palmar margin of the reference hand at the xiphisternal junction (lower end of the sternum). Results A total of 39 patients were enrolled to measure the cardiothoracic parameters. There were 22 male (56.4%) and the median age was 67 years. DLVmax was neither different in inspiratory-hold nor expiratory-hold (mean ± standard deviation: 12.1 ± 1.9 cm and 12.9 ± 2.7 cm, p = 0.386). LVmax was located lower than the lower half of the sternum (Figure 1); the median of DLVmax and DLH were 12.6 cm (interquartile range: 10.6, 13.5 cm) and 10.0 cm (9.5, 11.0 cm), respectively (p &amp;lt;0.001). We found that the distance from the sternal notch to the point of maximal force of the left hand which the ulnar border located at the xiphisternal junction (DLU) was not significantly different from DLVmax (Figure 2); the median of DLVmax and DLU were 12.6 cm (10.6, 13.5 cm) and 11.3 cm (10.6, 12.5 cm), respectively (p 0.076). Conclusions The maximal left ventricular diameter on sternum (DLVmax) in the arms-down position was located lower than the lower half of the sternum (lower than the standard guideline recommendation). We propose that the new hand placement for chest compression is placing the left hand down and the hand’s border located at the xiphisternal junction while approach at left side of the patient. Abstract Figure. Abstract Figure.

FUNCTIONAL OUTCOME OF DISPLACED INTRA-ARTICULAR FRACTURES TREATED WITH CONTOURED LOCKING PLATES AND SCREWS

INTRODUCTION: Calcaneal fractures are the most common tarsal bone fractures. If fractured, they cause signicant morbidity since they occur mostly in young working adults.there is signicant disagreement as to the method of treatment of these fractures. AIM: to determine outcome of displaced intra-articular calcaneal fracture treated by ORIF with plate and screw xation METHOD: a prospective interventional study involving 20 patients with calcaneal fractures treated with orif and plating and outcome measured at intervals of 2 and 6 weeks; and 3 and 6 months with parameters of Bohler ratio, heel width and subtalar movements and functional assessment using Creighton-Nebraska score (CNHF score). RESULT: this study shows that 65% of patients were below 40 years of age. All fractures subsequently went for union. 80% went for excellent to good results.older age and reduced Bohler ratio had poorer prognosis. Subtalar arthritis may lead to arthrodesis of this joint as occurred in 3 of our patients. CONCLUSION: Open reduction and xation with contoured locking plates gives excellent to good results in fractures that are not grossly comminuted. Bohlers ratio is a reliable indicator of prognosis. Sub-talar arthrodesis is not the rst line surgical intervention in fractures of calcaneum. Increasing age is associated with poorer outcome in displaced intra articular calcaneum fractures.

Perception of footwear comfort and its relationship with the foot structure among youngest-old women and men.

BackgroundAdequate footwear comfort and functionality are important regardless of age, but they become particularly important in the youngest-old women and men, mainly due to the fact that this age range is the initial period of old age with changes in shoe preferences. The aim of this study was to assess the perception of footwear comfort and its relationship with the feet structure in youngest-old women and men.MethodsThe cross-sectional study covered community dwellers living on their own aged 65–74 years (50 women; 50 men). The feet characteristics were measured using the CQ-ST podoscope (Electronic System, Ltd, EU), and the perception of footwear comfort was assessed with a visual analogue scale. The assessment took into account gender-specific footwear of a certain brand (Befado Dr orto).ResultsStatistically significant intergender differences were observed in the perception of footwear comfort with respect to the shoe heel width (p = 0.022), the arch height (p = 0.013), the overall comfort (p = 0.049) and the material properties of the footwear (p = 0.017). In women, there were statistically significant positive relationships among the heel angle (γ) and the perception of footwear comfort in terms of heel cushioning (p = 0.021), forefoot cushioning (p = 0.015), arch height (p = 0.029). In men, there was a statistically significant negative relationship of the left foot Clarke’s angle with the heel height (p = 0.043), and a positive relationship between the right foot width and the arch height (p = 0.044).ConclusionsYoungest-old women, compared to men of the same age range, have a higher perception of shoe comfort in terms of the shoe heel width, the arch height, the overall comfort of the footwear and the material properties of the footwear. The appropriate profile and construction of the shoe allows for an increase in the contact surface of the foot with the shoe, hence the improvement in the perception of footwear comfort in people with lowered arch or widened forefoot.

Acute Fixation of Displaced Intra-articular Calcaneus Fractures Is Safe Using the Sinus Tarsi Approach.

To analyze the correlation between surgical timing and outcomes for calcaneus fractures treated using a sinus tarsi approach (STA). Single Level-1 trauma center. Retrospective. Seventy consecutive intra-articular calcaneus fractures (OTA/AO 82C; Sanders II-IV) treated operatively using STA with a minimum of 1-year follow-up. Open management using STA. Surgery timing, wound complications, American Orthopaedic Foot and Ankle Society ankle and hindfoot and Patient-reported Outcomes Measurement System scores. Patients were primarily men (68.6%) averaging 46 years (range, 18-77 years). Nineteen (27%) were obese, 27 (38.6%) were smokers, and 3 (4.3%) were diabetic, and 10 (14.3%) had open fractures. Sanders III fracture patterns were most common (45.7%). Mean time to surgery was 4.9 days (range, 0-23 days). Three patients (4.2%) developed postoperative infections requiring surgical debridement and antibiotics. Forty patients (57%) underwent operative repair within 72 hours of injury, 9 (22.5%) of which had open fractures. Of this group, only one patient developed wound necrosis. Restoration of Bohler angle and angle of Gissane and reductions in calcaneal varus angle and heel width were achieved (all P < 0.001). No differences in Ankle Society ankle and hindfoot or Patient-reported Outcomes Measurement System scores were noted between patients treated within or beyond 72 hours from injury. Intra-articular calcaneus fractures can be treated acutely within 72 hours of injury using STA with minimal wound complications and without compromising short-term functional outcome. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.