Injuries Of Foot Research Articles

Clinical case of squamous cell carcinoma arising in non-healing wound of foot in patient with diabetes mellitus

Clinical case of squamous cell carcinoma arising in non-healing wound of foot in patient with diabetes mellitus

Management of neglected Lisfranc Injury of foot -a tertiary referral centre experience

In vitro predatory activity of 157 native isolates of Arthrobotrys oligospora from China on larvae of trichostrongylides (Trichostrongylus colubriformis and Haemonchus contortus) in feces of sheep were assessed. The results showed that 135 of tested isolates of A. oligospora reduced the development of trichostrongylide larvae in feces by 90–99.99%, 11 isolates by 80–89.46% and 11 isolates by 14.58–78.82%. To understand their capacity of passing through gastrointestinal tract of sheep, 50 native isolates of A. oligospora were selected and assessed in sheep. Among these isolates, 16 isolates significantly reduced the number of larvae developing in the feces (P < 0.05); their percentage reduction of L3 ranged from 42.87% to 99.51% and the isolates tested were harvested in 5 g sub-samples of from sheep in each treatment group, indicating that these isolates had the capacity of preying larvae of trichostrongylides after the passage through gastrointestinal tract of sheep. The remaining isolates of A. oligospora were not able to survive after passage through gastrointestinal tract of sheep. In the following, the 16 isolates that presented more or less viability after sheep gastrointestinal passage were selected and assessed in goats. The results showed that the 11 isolates out of them could be able to pass through the digestive tract of goats without loss of ability of preying larvae of trichostrongylides in feces and their efficacies ranged from 53.88% to 94.28%, and that the isolates tested were harvested in 5 g sub-samples of feces from goats in each treatment group. In the current study, these isolates which demonstrated outstanding properties in vitro and could survive in the passage through the alimentary tract of sheep and goat should be potential candidates as a possible feed additive.

Negative pressure wound therapy in the management of mine blast injuries of lower limbs: Lessons learnt at a tertiary care center

BackgroundMine blast injuries of foot are devastating injuries that result in composite tissue loss or amputations. Negative pressure wound therapy has helped in the management of such combat-related wounds. The aim of this study was to report experiences gained in managing such injuries at a tertiary care center. Methods17 combatants who sustained mine blast injuries were included in this study. Severity of foot injury was assessed as per Foot and Ankle Severity Score. After wound debridement, negative pressure wound therapy was started and foot defect was appropriately reconstructed. Following wound healing, the foot was assessed for Foot and Ankle Severity Score in terms of impairment. The patients were then suitably rehabilitated by shoe modifications, orthosis, or custom-made prosthesis. ResultsMean age of soldiers who sustained mine blast injuries was 30.2 years. The mean Foot and Ankle Severity Score was 3.76. Temporary wound closure was achieved using negative pressure wound therapy and it prevented local and systemic infection. The defect could be reconstructed appropriately using split skin graft, regional fasciocutaneous flap, or microvascular free flap. Mean time to definitive reconstructive procedure was 16.5 days. Mean Foot and Ankle Severity Score in terms of impairment was 4.11. All soldiers could be rehabilitated and were returned to their respective units and were able to perform sedentary duties assigned to them. ConclusionThe negative pressure wound therapy was helpful in preventing proximal amputations due to mine blast injury and was helpful in satisfactory reconstruction of foot defects.

Injuries and overloads in combat sports exemplified by Thai boxing and judo

Background: and study aim: Each sports activity, particularly combat sports, involves various injuries and overloads. Injuries are a result of impact of sudden large for ceson tissues, while overloads are caused by small but repetitive forces, which lead to some dysfunction, pain. The aim of this study was to compare injuries and overloads in two combat sports, namely judo and Thai boxing. Material and methods: The study was conducted on 34 judokas (from MaKo Judo Wrocław Sports Club) and 34 Thai boxers (from Puncher Wrocław Sports Club). The group of Thai boxers consisted of 29 men and 5 women, where as the judoka group was comprised of 23 men and 11 women. The average age of participants was 22.6 years. Internship competes patients was 3 years. The training period was similar for Thai boxers and judokas: Thai boxers trained on average for 8.5hper week, while judokas trained for 6.9h per week. Results: The study demonstrated that the most common injuries in Thai boxers occurred in lower limbs, while in judokas– in shoulder joints, knee joints and the spine. Thai boxers most frequently developed overloads in lower limbs, whereas judokas– in shoulder joints and the spine. Conclusions: Thai boxers considerably more frequently sustained injuries of feet, elbow joints and thighs, compared to judokas, who sustained more knee joint injuries. Judokas considerably more frequently suffered from injuries of shoulder joints and the spine compared to Thai boxers. Thai boxers more often developed overloads of lower limbs and elbow joints compared to judokas. On the other hand, judokas considerably more frequently sustained overloads of the spine and shoulder joints compared to Thai boxers.

EFFECT OF THE NEW TECHNOLOGY OF CATTLE HOUSING WATERBEDS ON COMFORT, HEALTH AND MILK PRODUCTION

Abstract A new housing technology double-chamber cow waterbeds should provide the animals with greater comfort improve their health and increase milk production. The study was carried out in the stable for dairy cows and heifers. They were stabled in free-stall housing. Rubber mattresses had been replaced with double-chamber cow waterbeds. The aim of the study was to determine their effect on comfort, health, occurrence of mastitis, count of somatic cells, total milk production. The study confirmed the reduction of number of animals with injuries of feet and incidence of mastitis. The values of somatic cells in milk were constant. Positive effect was shown with fluent increase in milk production. It increased the number of cows and heifers lying in the boxes.

Treatment of open injury of foot and ankle in children

Objective To investigate the clinical characteristics,treatment methods,and clinical outcomes of open injury of foot and ankle in children.Methods From February 2004 to June 2010,35 children with open injury of foot and ankle were treated,including 22 males and 13 females,aged from 3 years to 14 years (average,8.4 years).Twenty-eight cases resulted from traffic accidents; 7 cases occurred from sharp instruments and machine-related crush injuries.Thirty cases were associated with bone fractures,and according to the Gustilo classification of open fractures,five cases were Type Ⅰ injuries,eight cases were Type Ⅱ injuries and 22 cases were Type Ⅲ.Twenty three cases (type Ⅰ,type Ⅱ and type Ⅲ) underwent surgical debridement and/or internal fixation with skin flap grafting.Twelve type Ⅲ cases underwent debridement,temporary Kirschner wire or plaster fixation and VSD in the first stage of treatment.In the second stage of treatment,fracture reduction and internal fixation (with or without bone graft) + skin flap grafting was performed in all 12 cases.Results Thirty patients (85.7％) were followed-up for an average of 38.7months (range,6-89 months).Skin grafting was performed in two Type Ⅱ cases that developed necrosis in parts of the wound.Wound healing time was an average of 8.3 weeks (range,3-15 weeks).One Type Ⅲ case suffered chronic osteomyelitis with the formation of a sinus tract.Two cases suffered from club foot ab normalities 3 years postoperatively.All three patients above mentioned healed after treatment.In 12 type Ⅲpatients with staged treatment,the flap survived,and its color and elasticity were good.Healing time ranged from 3 to 8 weeks (average,6.8 weeks).According to the Maryland standard,17 cases were excellent,9good,3 fair,and 1 bad; the excellent and good rate was 86.7％.Conclusion Traffic accidents are the major causes of open foot and ankle trauma in children.A good surgical outcome can be achieved when patients receive staged treatment that is appropriate to injury severity. Key words: Child; Foot; Ankle; Fractures,open; Soft tissue injuries

Reconstruction of total degloving injuries of the foot in children

The aim of this study is to introduce experiences of reconstruction of total degloving injuries of the foot in children. Seven children, five male and two female, were treated for total degloving injury of the foot at our medical institution between January 2002 and December 2008. Patients were between 5 years and 9 years of age with a mean age of 7 years. All injuries involved the total foot. In cases 1-3, the foot was covered by intermediate split-thickness skin graft. In cases 4-7, the dorsal aspect of the foot was covered by full-thickness skin graft obtained from the degloving flap in emergency operation and the planta aspect of the foot was covered by posteriortibial artery flap in the second operation. The mean time to wound healing was 29 days to 50 days in cases 1-3 and 21 days to 28 days in cases 4-7. The posteriortibial artery flaps in cases 4-7 all survived. Both the donor and the recipient site healed successfully. All patients were followed for at least 12 months (range, 12-24 months; mean, 17.9 months). All patients showed insensitivity at the recipient sites. No patient complained of cold intolerance in the foot. Cases 1-3 had pain, deformity, and dysfunction to some extent at follow-up. Cases 4-7 did not exhibit pain, deformity, or dysfunction. All toes were amputated in all cases. Patients 1-3 scored fair or poor on the Maryland Foot Score (two fair, one poor), and patients 4-7 scored either good or fair (three good, one fair). This method, the dorsal aspect of the foot covered by full-thickness skin and the planta aspect of the foot covered by posteriortibial artery flap, is a good choice for treatment of total degloving injury of foot in children. At the same time, the early exercise should be emphasized for the functional recovery. Therapeutic study, level IV.

Application of combined saphenous nerve-great saphenous vein flap and cutaneous branches of posterior tibial artery flap in repair of chronic ulcer in foot

Objective To evaluate the efficacy of the combined saphenous nerve-great saphenous vein flap and cutaneous branches of posterior tibial artery flap in repairing refractory wounds. Methods Eighteen cases of pedal chronic ulcers were treated with the combinedsaphenous nervegreat Saphenous vein flap and cutaneous branches of posterior tibial artery flap, in which the wounds were treated with vacuum suction techniques before the operation in 6 cases. Wounds were from 8 cm× 13 cm to 1 cm× 17 cm in zine after debricement, and the designed size of the flaps was from 8 cm× 14 cm to 11 cm× 18 cm. Results After the treatment, 18 cases were evaluated as excellent in 10 cases, and good in 8 cases, in which the primary sealing of the wounds was achieved in 17 cases, but one case presented with focal necrosis of smaal size owing to vein drainage disturbance in a distallypedicled flap, and was healed after flap transplantation. Follow-up for 6 months to 2 years showed that all the patients were satisfied with the results. Conclusions The combined flap has reliable blood supply, skin pedicle of the flap is longer, superior texture and satisfied appearance, and incisive area of the flap is larger. It is particularly useful in repairing refractory wound in foot. Key words: Flap of combined saphenous nerve-great saphenous vein; Cutaneous branches flap of posterior tibial artery flap; Combined flap; Ucer of foot; Vacuum sealing drainage

Free Anterolateral Thigh Flap for Reconstruction of Car Tire Injuries of Children's Feet

Grade IV and V car tire injuries occurring in children cause extensive soft tissue defects with exposure or loss of tendons and bone on the dorsum of the foot. Free tissue transfer is indicated for reconstruction of these defects because of the limited local tissue available. We describe our management of high-grade car tire foot injuries in children with free anterolateral thigh flap (ALT). Five pre-school children with car tire injuries (one grade IV and four grade V) were treated with free ALT flap in the last 4 years. The mean age was 4.8 years. In four patients, immediate flap coverage after initial debridement was performed and delayed reconstruction was used as a secondary procedure in one patient. One of the flaps was re-explored for hematoma evacuation and salvaged. All of the flaps survived completely and there were no donor site complications. None of the flaps required a debulking procedure and custom shoe wear has not been necessary in any of the patients. Minor gait abnormalities were detected in two of the patients. With minimal donor site morbidity, long vascular pedicle allowing anastomosis outside of the trauma zone, we believe free ALT flap provides the ideal soft tissue reconstruction for high grade car tire injuries of foot in children. ALT flap can be further thinned to adapt to the defect, contracts less than muscle flaps and contains a vascularized fascia which can be used for extensor tendon reconstruction.

Prescription footwear for severe injuries of foot and ankle: Effect on regularity and symmetry of the gait assessed by trunk accelerometry

After foot and/or ankle fracture, the restoration of optimal gait symmetry is one of the criteria of recovery. Orthotic insoles and orthopaedic shoes improve gait symmetry and regularity by controlling joint motion and improving alignment. The aim of the present study was to assess the effect of prescription footwear on gait quality by using accelerometers attached to the lower back. Sixteen adult patients with persistent disability after ankle and/or foot fractures performed two 30-s walking trials with and without prescription footwear (insoles and stabilizing shoes). Sixteen control subjects were also tested for comparison. The autocorrelation function was computed from the acceleration signal and the first two dominant periods were assessed (d1 and d2). Two parameters were used: (1) Stride Regularity (SR) which expresses the similarity between strides over time (d2), and (2) Stride Symmetry (SS) a ratio (d1/d2) which expresses the left/right similarity of gait independently of repeatability in the successive movements of each limb. In control subjects, SR and SS were 0.86 ± 0.05 (correlation coefficient) and 81 ± 10%, respectively. In the patient group, the effect of footwear was significant (SR: 0.88 ± 0.06 vs. 0.90 ± 0.05, SS: 38 ± 23% vs. 46 ± 27%). Pain was also significantly reduced (−34%). By using a rapid and low-cost method, we objectively quantified gait quality improvement after footwear intervention, concomitant to pain reduction. Substantial inter-patient variability in the footwear outcome was observed. In conclusion, we believe that trunk accelerometry can be a useful tool in the field of gait rehabilitation.

Langzeitergebnisse in der Behandlung von Fußverletzungen bei polytraumatisierten Patienten

The aim of this study was to evaluate the long-term outcome of multiple injured patients with foot injuries. While severity and frequency of multiple injuries could be decreased in the last years, it was not possible to decrease the severity of injuries of the foot and ankle region. These injuries are often not detected and their severity is underestimated in primarily diagnostics what might lead to complaints in the longterm course. The multiple trauma database of the Department of Traumatology of the University of Vienna includes 386 patients from September 1992 to April 2001. 40 (10.4 %) of these patients suffered a fracture or dislocation of foot or ankle. 33 (82.5 %) multiple injured patients with injuries of foot or ankle could be reexamined between April and September 2002 and the longterm outcome of the foot and ankle region could be evaluated objectively and subjectively. 22 (66.7 %) patients were male, 11 (33.3 %) female. The mean age was 34.5 years. 27 (81.8 %) patients still suffered from complaints related to their injured foot and ankle region. After calculation of the AOFAS these complaints were predominantly located in the ankle-hindfoot region. 22 (66.7 %) patients had to limit their sports activity. In our study period an increasing number and severity of injuries of foot or ankle can be shown. Furthermore multiple injured patients with concomitant injuries of foot or ankle show a lower ISS what suggests that these patients might have a higher survival rate and consecutively enter rehabilitation process.

Tibial fractures associated with crush injuries to the soft tissues of the dorsal foot in children

We retrospectively studied 15 children with tibial fractures associated with crush injuries to the soft tissues of the dorsal foot. The fractures, including six open fractures, were united with no complications within an average of 11.1 weeks. Wound closure to treat crush injuries of the dorsal foot was achieved using split- or full-thickness skin grafts in most patients. The outcomes of these grafts were acceptable, and all skin coverage was successful and remained viable with no breakdown. Extensor tendon injuries of the foot sustained by eight patients could not be sutured or repaired due to the nature of the injuries. However, the functional abilities of those injured tendons that could be sutured to surrounding tissues in a neutral position were acceptable, even though two patients had contracture of the toes that was problematic when wearing shoes. To manage crush skin injuries of the dorsal foot, split- or full-thickness skin grafts appear to provide a simple and convenient treatment strategy. In cases associated with extensor tendon injuries, suturing damaged extensor tendons to surrounding tissues represents another useful strategy with acceptable outcomes.

EMERGENCY DEPARTMENT EVALUATION AND TREATMENT OF ANKLE AND FOOT INJURIES

Ankle and foot injuries are among the most common sports injuries and extremity complaints presenting to the emergency department. Although generally benign, some of these injuries have prolonged morbidity. This article reviews the anatomy of the foot and ankle and examines the approach and therapy for common types of injuries.