Left Leg Research Articles

Lisfranc Injury: A Case Report and Literature Review

Lisfranc injuries are relatively rare, accounting for only 0.2% of all injuries, and few case reports have been published on this topic. In this report, we present a case of a Lisfranc injury in a healthy 30-year-old male who fell down a staircase, landing on his left foot. The diagnosis was made using X-rays and computed tomography (CT). The X-rays showed dislocation of the tarsometatarsal joint with lateral displacement of the M4, M3, M2, and M1 metatarsals. The CT scan revealed a fracture-dislocation of the second metatarsal, with detachment of intra- and extra-articular bone fragments associated with a fracture of the medial cuneiform bone. Surgical management, in the form of open reduction and internal fixation, was performed. The patient followed an expected postoperative course and was doing well, without pain or limitation of activities, at his 3-month postoperative visit. Additionally, we provide a brief review of similar published cases and an overview of Lisfranc injuries.

Focal muscle vibration and action observation: a combined approach for muscle strengthening.

Muscle strength is essential for autonomy in daily activities and performance in sports activities. Yet, conventional strength training is challenging during recovery from pathological conditions. This study investigates a novel combined intervention employing Focal Muscle Vibration (FMV) and Action Observation (AO) to enhance muscle strength. Twenty-seven healthy volunteers (18 females and 9 males, aged 22 to 42 years) were enrolled for an intervention-control study comparing 2 groups: the intervention group received AO treatment with FMV on the right leg, and the control group underwent only FMV on the right leg. This design allowed the comparison of four conditions: FMV+AO (intervention group, right leg), AO alone (intervention group, left leg), FMV alone (control group, right leg), and no-treatment NT (control group, left leg). The treatment, conducted five times a week (Mon-Fri) for two weeks, involved a 20-minute session of FMV on the right quadriceps, coupled, for the intervention group, with the observation of a gym training video. The assessments of Maximum Voluntary Contraction (MVC), and fatigue coefficient (FC) expressed at knee extension bilaterally were measured at the beginning (T0), after the first week (T1), at the end of treatment (T2), and one-week post-intervention for the follow-up (T3). The FMV+AO group demonstrated a significant improvement in MVC over time, reaching statistical significance at T2 and maintaining the gain at T3. In contrast, all the other conditions demonstrated milder MVC increases without statistical significance. FC did not differ significantly in any condition. The combination of FMV and AO optimized muscle strengthening, offering insights for targeted treatments in various settings.

Restoring a natural skeleton of a premature infant from the early twentieth century

Traditional anatomical preparations as they are often found in university collections are both historical treasure and moral responsibility of the hosting institutions. These remains not only represent the tradition and history of anatomical science and education, but above all are the remains of human beings and thus should be treated with dignity. While the discussion on public display of historical human remains is ongoing, the responsibility to keep them in an optimal state of preservation is not in question. However, most time-honored anatomical collections do or did not have the financial and/or technical capacity to keep these high standards, underlining the need for exchange of technical know-how between anatomical institutes and the support of restoration/conservation professionals. Here, we present a state-of-the-art conservation and restoration of a fetal natural skeleton from the early twentieth century along with the professional documentation of restoration-measures. Therefore, we used modern photo- and video documentation, including photogrammetry, as well as UV- and x-ray-examinations to record historical and new restoration procedures. We carried out measures to reconstitute the structural stability of the skeleton. Moreover, we replaced lost parts of the left foot skeleton, and critically discuss the legitimacy of body part replacement in historical specimens. We are convinced, that similar cases of insufficiently preserved specimens can be found in most anatomical collections. Therefore, this article is not only intended to document the state-of-the-art conservation and restoration of a natural skeleton, but also serve as an inspiration for similar campaigns in other institutions in the future.

Preventing and Treating Diabetic Foot Infections

Diabetic foot infections (DFIs) represent a significant complication of diabetes mellitus, contributing to morbidity, prolonged hospital stays, and increased healthcare costs. This paper explores the epidemiology, pathophysiology, and clinical presentation of DFIs, while emphasizing strategies for prevention and treatment. Comprehensive care, including glycemic control, patient education, proper footwear, regular foot examinations, and early intervention, is critical. Treatment options span from conservative measures like antibiotics to surgical interventions. Emerging therapies and the role of multidisciplinary teams in managing DFIs are also discussed.

High-Output Heart Failure Secondary to Post-Traumatic Arteriovenous Fistula

Introduction: Arteriovenous fistulas are abnormal connections between the arterial and venous systems that bypass normal anatomical capillary beds. Any device, implement, or projectile that passes through an artery and vein has the potential to lead to one, thereby preventing normal blood flow through the capillary bed. Late complications of untreated arteriovenous fistulas include proximal arterial dilation, venous congestion, congestive heart failure, and distal ischemia. Objective: Describe the clinical manifestations, diagnostic, therapeutic, prognostic complexities and complications present in post-traumatic arteriovenous fistula and its association with heart failure. Material and methods: Retrospective study presentation of a clinical case. Results: The case of a 55-year-old female patient is presented, with a 2-year history of ischemic heart disease and a gunshot wound 20 years ago. Who was admitted for bypass and coronary angiography + cardiac angiography in whom no etiology of his dilated ischemic heart disease was found until Doppler ultrasound and tomography angiography was performed due to recurrence of pain in the lower limbs and changes in skin color, which revealed presence of arteriovenous fistula. The same one that was resolved with distal ligation of the popliteal vein + exclusion of aneurysm. Conclusions: Risk factors for the development of this pathology are difficult to establish. Therefore, the shotgun trauma to the left leg 20 years ago, in addition to her obesity and female sex, led to the formation of an arteriovenous fistula that would gradually produce high-grade heart failure. Endovascular AVF repair is a treatment alternative for those patients considered high risk from anesthesia, those who have a hostile groin due to excessive scar tissue, or who cannot tolerate the consequences of bleeding that can occur with surgical control. of the FAV.

In-Vivo MRI in Rodents: A Protocol for Optimal Animal Positioning.

Magnetic resonance imaging (MRI) is a potentially powerful novel peripheral nerve diagnosis technique. To determine its validity, in-vivo preclinical studies are necessary. However, when using a rodent model, positioning rats and achieving high-resolution images can be challenging. We present a short report that outlines an optimal protocol for positioning rats for in-vivo MRI acquisition. Female Sprague-Dawley rats with sciatic nerve injury were induced into anesthesia using 4% isoflurane in oxygen and maintained at 1.5%. Rats were placed into a plexiglass cradle in a right lateral recumbent position, and a surface coil was placed over the left leg. Respiration rate and body temperature were monitored throughout the scan. Our protocol was successful as rats were able to undergo MRI scanning safely and efficiently. There were no adverse reactions, and clear images of the left sciatic nerve were obtained. Animal positioning took 30 minutes, and 5 different acquisitions were obtained in 2 hours. The total time from anesthesia induction to recovery was under 3 hours. Given the increasing interest in MRI diagnostic techniques, we hope this report aids other researchers studying peripheral nerve injury imaging in rat models.

Botulinum toxin as an effective treatment for persistent twitching in first toe: a detailed case study.

Continuous fasciculation that occurs without weakness is referred to as benign fasciculation. Although generally considered non-threatening, cases that persist can significantly impact an individual's quality of life. This study presents a case of a male patient in his 30s experiencing unyielding twitching localized to the sole of his left foot for 2 years. His medical history was devoid of any notable neuromuscular diseases. Results from electromyography testing were also normal for all parameters. Attempts with pharmacological intervention did not yield any improvement of his condition. Although a nerve block targeting the left tibial nerve managed to reduce the severity of the twitching, it failed to decrease its frequency or provide a lasting solution. In search of a more effective treatment, botulinum toxin was administered via ultrasound guidance into the flexor hallucis and digitorum longus muscles. This approach resulted in a marked reduction in both the frequency and severity of the twitching, enabling the patient to resume his daily activities and achieve restful sleep without experiencing any adverse effects. Through this case, the efficacy of botulinum toxin injections as a treatment for intractable twitching is underscored, offering valuable insights into potential therapeutic strategies for similar clinical presentations.

Phosphopenic osteomalacia of tumor genesis under mask of ankylosing spondylitis

Aim. To present a clinical case of osteomalacia associated with fibroblast growth factor-23-secreting tumor under the mask of ankylosing spondylitis (AS).Materials and methods. Clinical observation of a 31-year-old patient with long-time diagnosis of AS is presented. Underestimation of back pain cause at the initial stage of diseaseled to an erroneous diagnosis of AS. A thorough assessment of the anamnesis, additional examination using modern imaging methods in combination with laboratory analysis (low blood phosphorus level, hyperphosphaturia, normal value of C-reactive protein, erythrocyte sedimentation rate, negative HLA-B27), made it possible to establish the correct diagnosis of “mesenchymal phosphaturic tumor of the left foot (surgical intervention dated 11.26.2020), secondary hypophosphatemic tumor-induced osteomalacia complicated by multiple bone fractures”, to carry out timely treatment with full recovery.Results. The literature data on epidemiology, pathogenetic mechanisms, clinical manifestations and management approaches of tumor induced phosphopenic osteomalacia are presented. An algorithm for examining patients with suspected of this disease is described, taking into account the expression of somatostatin transmembrane receptors on the surface of a mesenchymal phosphaturic tumor.Conclusion. One of the rarest causes of specific back pain is osteomalacia, which can be caused by various diseases, for example, a tumor secreting FGF23 The complexity of the diagnosis lies in the non-specificity of clinical manifestations – generalized myalgia and myopathy, ossalgia, pathological fractures, etc. Timely diagnosis and radical treatment makes it possible to achieve stable remission with complete leveling of symptoms, therefore surgical excision of the tumor is the “gold” standard of therapy.

Elevation and distraction of the Tibial periosteum in the management of chronic ischemic lower limb diseases.

This study investigates the effectiveness of tibia periosteum distraction (TPD) applied to the tibial periosteum, an innovative approach grounded in Ilizarov's tension-stress theory, for the treatment of ischemic diabetic foot and vasculitic foot conditions. A retrospective analysis was conducted on 33 patients (36 limbs) who underwent TPD between June 2019 and May 2022. The study comprised 21 males (23 limbs) and 12 females (13 limbs), aged 41 to 80 years (mean age: 63.4 years). Diabetic foot accounted for 27 cases, thromboangiitis obliterans for 2 cases, and arterial occlusive disease for 4 cases. The distribution of affected limbs included 15 left feet and 21 right feet. Periosteum traction commenced on the third postoperative day at a rate of approximately 0.75mm/day, adjusted biweekly. The traction device was removed after two weeks. Evaluation included capillary refill and wound healing assessment, along with pre- and postoperative analysis of foot skin temperature, ankle-brachial index (ABI), visual analogue scale (VAS) pain scores, and peripheral blood oxygen saturation. CT angiography (CTA) was utilized to assess vascular conditions in both lower limbs. All 33 patients were successfully followed up for a duration ranging from 4 to 24 weeks (mean: 11.03 weeks). VAS pain scores significantly decreased from preoperative (5.09 ± 1.70, range: 2-8) to postoperative two weeks (2.24 ± 0.90, range: 1-4) (t = 9.44, p < .001). Oxygen saturation levels increased from 83.88% ± 11.82% (range: 58%-97%) preoperatively to 91.36% ± 5.69% (range: 76%-98%) at two weeks postoperatively (t = -4.21, p < .001). Foot skin temperature also showed a significant increase (t = -3.98, p < .001). Capillary refill test at two weeks postoperatively demonstrated notable improvement. CTA revealed evident neovascularization in the operated limbs compared to preoperative conditions. Wound improvement was significant in all 33 patients within two months postoperatively. TPD emerges as a promising technique for chronic ischemic lower limb diseases, demonstrating favorable preliminary outcomes in wound healing promotion and amputation rate reduction. Nevertheless, large-scale randomized controlled trials are essential to further validate its efficacy.

Osteopathic Approach to Proximal Hamstring Tendinopathy-related Sciatic Nerve Entrapment (PHTrSNE): Case Report

Abstract Proximal Hamstring Tendinopathy (PHT) provides a challenging diagnosis for clinicians due to limited evidence-based research. Presenting as chronic pain originating at the ischial tuberosity, PHT can progress to entrap the sciatic nerve, resulting in proximal hamstring tendinopathy-related sciatic nerve entrapment (PHTrSNE). This case expands the understanding of PHT by describing the osteopathic assessment and treatment of a runner with PHTrSNE. A 24-year-old female marathoner presented to the neurology clinic with a unique running gait: a left leg circumduction, or “leg whip,” that presented only when running. She also reported constantly dull hamstring pain, which occasionally elicited a sharp, shooting pain from her lower gluteal muscles to mid-hamstrings. Activities such as prolonged sitting and intense running exacerbated the sharp pain. On examination, the patient displayed ischial tuberosity tenderness and positive tests for hamstring tendinopathy. Evaluation with EMG/NCS showed mild chronic denervation of the left tibialis anterior muscle. A treatment plan for the patient’s PHTrSNE was created based on the principles of the neurological model of osteopathic medicine. Patients presenting with chronic hamstring discomfort accompanied by sharp, shooting pain may benefit from the diagnostic and therapeutic approach outlined in this study.

Effect of a single versus serial platelet-rich plasma injection on the healing of acute patellar tendon defect: an experimental study

BackgroundThere is no consensus on the frequency and timing of platelet-rich plasma (PRP) injection in tendon healing. We aimed to evaluate the effectiveness of single versus multiple PRP injections in the healing of patellar tendon defects in the experimental model, through histological and biomechanical investigation.MethodsForty-four male skeletally mature Dutch rabbits were randomly divided into the five study groups ( A, B,C, D,E). After creating a longitudinal acute patellar tendon defect on both knees (One-third the width of the patella tendon), the right legs of the rabbits were used as the intervention group and the left legs as the control groups. Animals in groups A, B, and C were euthanized on days 7, 14, and 28, respectively, after the first PRP injection. Animals in group D received the second PRP injection on day 10 and was euthanized on day 14. Animals in group D received the second and third PRP injections on days 10 and 20, respectively, and were euthanized on day 28. The outcomes were evaluated histologically (modification of Movin’s Grading) and biomechanically.ResultsThe inflammatory condition was exaggerated in groups D and E. Load at failure was higher in the non-injected side of groups D and E, while there was no significant difference between the right and left legs of the three groups A, B and C. In other word, groups with a single PRP injection were more resistant to the increasing load compared to the groups with multiple PRP injections.ConclusionsPRP improves tendon healing if injected early after injury, while its injection after the initial phase of injury hampers tendon healing. In addition, a single PRP injection seems to be more effective than multiple PRP injection. Therefore, in cases where PRP injection is indicated for tendon repair, such as acute tendon injury, we recommend using a single PRP injection during tendon repair surgery.

An Improved Practical Measuring Technique for Wireless Cellular Signal Path Loss Forecast in the African Terrain

Several studies on cellular signal path loss measurements at various locations under varying geographical and environmental circumstances in Africa have been conducted. Most of the techniques used, if not all, do not give consideration to the peculiar Africans’ road networks and building patterns, valleys, and hills that usually prevent the driving of motor cars within them when taking the signal strength measurements. The article presents an improved technique for wireless cellular signal strength measurement for better path loss prediction. The approach adopted for measurement is the regular grid outdoor foot technique. The technique was tested at various locations in the Ilorin metropolis and proved to be a better method of obtaining signal strength measurements. Although some of the signal strength values coincided with respect to distance when both methods were used, the drive test method overvalued the signal strength for study locations that were not in line of sight with the BTSs. These values range from 2 dBm to 8 dBm. If this technique is adopted, measurements will be taken in all vital locations that may not be accessible by means of a motor car drive test method, and more accurate values of the cellular signal strength will be obtained for better path loss prediction.

Comparative Effects of Neurodynamic Slider and Tensioner Mobilization Techniques on Sympathetic Nervous System Function: A Randomized Controlled Trial.

Objective: To investigate the effect of slider and tensioner neurodynamic techniques (NDTs) on the sympathetic nervous system (SNS) activity, aiming to identify which technique more effectively modulates autonomic responses in asymptomatic individuals. Materials and Methods: In this double-blind controlled trial, a total of 90 healthy participants were randomly allocated into three groups: slider, tensioner, and control. Skin conductance (SC) was continuously monitored throughout the entire 20 min experiment, while body temperature and blood pressure were measured pre- and post-intervention. Results: The SC levels significantly increased in both the slider and tensioner groups compared to the control group during the intervention and end rest period on the left leg (slider vs. control: p < 0.001, d = 1.20; tensioner vs. control: p < 0.001, d = 1.64) and on the right leg (slider vs. control: p < 0.001, d = 1.47; tensioner vs. control: p < 0.001, d = 0.73). There were no significant differences between the two NDTs on the left (p < 0.13, d = 0.89) and right legs (p < 1.00, d = 0.36). The body temperature of the slider group showed a significant increase compared to both the control group (p < 0.001, d = 0.95) and the tensioner group (p < 0.001, d = 1.48). There were no significant differences between the groups in systolic (p = 0.95) or diastolic blood pressure (p = 0.06). There were no side-specific effects on SNS activity between the left and right legs (p < 0.019) during all intervention phases. Conclusions: Significant sympathoexcitatory responses were elicited by both slider and tensioner NDTs in asymptomatic participants, demonstrating their efficacy in modulating the SNS. The differences between the two techniques were not statistically significant; however, the tensioner NDT showed a slightly more pronounced effect, suggesting that the tensioner NDT can be considered superior in terms of overall SNS effect. These findings indicate that both techniques may have the potential to enhance autonomic regulation in clinical practice; however, the tensioner NDT may be more effective. The consistent responses across participants highlight the systemic benefits of NDTs, providing a foundation for further research into their application in symptomatic populations. This study contributes to evidence-based practice by providing baseline data that support the development of theoretical frameworks and aid in clinical decision-making.

The Effect of Dimple Insole Design on the Plantar Temperature and Pressure in People with Diabetes and in Healthy Individuals.

An increase in plantar pressure and skin temperature is commonly associated with an increased risk of diabetic foot ulcers. However, the effect of insoles in reducing plantar temperature has not been commonly studied. The aim was to assess the effect of walking in insoles with different features on plantar temperature. Twenty-six (F/M:18/8) participants-13 with diabetes and 13 healthy, aged 55.67 ± 9.58 years-participated in this study. Skin temperature at seven plantar regions was measured using a thermal camera and reported as the difference between the temperature after walking with an insole for 20 m versus the baseline temperature. The mixed analyses of variance indicated substantial main effects for the Insole Condition, for both the right [Wilks' Lambda = 0.790, F(14, 492) = 4.393, p < 0.01, partial eta squared = 0.111] and left feet [Wilks' Lambda = 0.890, F(14, 492) = 2.103, p < 0.011, partial eta squared = 0.056]. The 2.5 mm-tall dimple insole was shown to be significantly more effective at reducing the temperature in the hallux and third met head regions compared to the 4 mm-tall dimple insole. The insoles showed to be significantly more effective in the diabetes group versus the healthy group, with large effect size for the right [Wilks' Lambda = 0.662, F(14, 492) = 8.037, p < 0.000, Partial eta-squared = 0.186] and left feet [Wilks' Lambda = 0.739, F(14, 492) = 5.727, p < 0.000, Partial eta-squared = 0.140]. This can have important practical implications for designing insoles with a view to decrease foot complications in people with diabetes.

Cauda equina syndrome successfully treated with microdiscectomy and methylprednisolone therapy: A case report

Cauda equina syndrome (CES) caused by lumbar disc herniation is a rare neurosurgical emergency in young adults that requires immediate decompression. A surgical delay over 48 hours may result in irreversible ramifications, underscoring a crucial timeframe for managing this condition. We presented a 26-year-old man with lower limb weakness persisting for one week, accompanied with exacerbating bowel and bladder issues after massage. The patient had a history of low back pain and tingling sensations radiating to the left leg over the past year. His physical examination showed right motor strength of 5/4 and left motor strength of 5/3, with weakened bowel peristalsis, loose anal sphincter and saddle anaesthesia. A spinal MRI revealed protruded discs extending to the intervertebral levels of L4-L5 and L5-S1, implicating herniated discs as the likely cause of CES. He underwent a microdiscectomy with a posterior approach, and intravenous methylprednisolone was administered before the procedure. The next surgery demonstrated enhancements in motor strength, bowel and bladder function, and it also reduced pain. He was discharged with persistent tingling sensations in his both legs. We concluded that CES represents a critical neurosurgical emergency, which is diagnosed through clinical symptoms and neuroimaging. Rapid decompression and intravenous administration of methylprednisolone are associated with better prognosis.

Automated peripheral nerve segmentation for MR-neurography

BackgroundMagnetic resonance neurography (MRN) is increasingly used as a diagnostic tool for peripheral neuropathies. Quantitative measures enhance MRN interpretation but require nerve segmentation which is time-consuming and error-prone and has not become clinical routine. In this study, we applied neural networks for the automated segmentation of peripheral nerves.MethodsA neural segmentation network was trained to segment the sciatic nerve and its proximal branches on the MRN scans of the right and left upper leg of 35 healthy individuals, resulting in 70 training examples, via 5-fold cross-validation (CV). The model performance was evaluated on an independent test set of one-sided MRN scans of 60 healthy individuals.ResultsMean Dice similarity coefficient (DSC) in CV was 0.892 (95% confidence interval [CI]: 0.888–0.897) with a mean Jaccard index (JI) of 0.806 (95% CI: 0.799–0.814) and mean Hausdorff distance (HD) of 2.146 (95% CI: 2.184–2.208). For the independent test set, DSC and JI were lower while HD was higher, with a mean DSC of 0.789 (95% CI: 0.760–0.815), mean JI of 0.672 (95% CI: 0.642–0.699), and mean HD of 2.118 (95% CI: 2.047–2.190).ConclusionThe deep learning-based segmentation model showed a good performance for the task of nerve segmentation. Future work will focus on extending training data and including individuals with peripheral neuropathies in training to enable advanced peripheral nerve disease characterization.Relevance statementThe results will serve as a baseline to build upon while developing an automated quantitative MRN feature analysis framework for application in routine reading of MRN examinations.Key PointsQuantitative measures enhance MRN interpretation, requiring complex and challenging nerve segmentation.We present a deep learning-based segmentation model with good performance.Our results may serve as a baseline for clinical automated quantitative MRN segmentation.Graphical

Examination of Left-Right Differences and Intertrial Variability in Grand Jeté Among Professional Ballet Dancers.

Introduction: Ballet demands diverse physical prowess, requiring dancers to execute movements symmetrically, irrespective of their dominant leg. Ballet often includes jumps, including the basic open-leg leap-the grand jeté-which requires uniform performance regardless of the leg on which the leap is initiated. However, no studies have simultaneously evaluated the effects of dominant leg or movement variation on jump height, leg split angle, jump time, and floor reaction forces during take-off and landing, which are related to the feeling of floating in the grand jeté. This study aimed to determine whether the high-level, stable, and beautiful performance required of professional ballet dancers in the grand jeté is affected by the dominant leg. Methods: Twelve female ballet dancers, all right leg dominant, performed the grand jeté 3 times on each side, distinguishing between dominant (right leg landing) and non-dominant (left leg landing) grand jetés. Utilising 3D movement analysis, we measured jump height, jump time, maximum leg split angle, and maximum vertical ground reaction force (VGRF) during take-off and landing. Mean values and coefficients of variation were calculated for each analysed parameter. Paired sample t-tests were conducted to assess differences between left and right grand jetés, with a significance level set at P < .05. Results: Statistically significant differences were observed in jump height (P = .028) and jump time (P = .001) when comparing the average of three trials for each side. However, no significant differences were found in maximum leg split angle (P = 0.643), maximum VGRF at take-off (P = .200), and maximum VGRF at landing (P = .109). In addition, no significant differences in coefficients of variation were identified for all items. Conclusion: Ballet dancers showed consistent performance on dominant and non-dominant legs but higher and longer jumps for grand jetés landing on the dominant leg, which may have affected overall performance.

Cubicle design and dairy cow rising and lying down behaviours in free-stalls with insufficient lunge space

Cubicle partitions divide the resting area of free-stalls into individual lying places for cows, thereby facilitating the maintenance of good hygiene and reducing competition by separating animals. The forward lunge space in lying cubicles is often insufficient for a natural head lunge movement during rising. Cubicles with open frame partitions and a flexible neck strap aim to alleviate this welfare issue. The open partition frame facilitates lateral space sharing (using space of neighbouring cubicles for the head lunge movement) and the flexible neck strap is presumably less painful upon collision. In an observational study, we investigated the lying behaviour of free-stall housed dairy cows in this ’permissive’ cubicle type with open frame partitions and a flexible neck strap positioned relatively high above the lying surface compared to ’restrictive’ cubicles with partitions with more bar work in the lateral lunge space and a lower-positioned rigid neck rail. The study was conducted on commercial Swiss dairy farms with exclusively wall-facing lying cubicles of either the permissive (four farms) or restrictive (six farms) type. The forward lunge space on these farms ranged from 55 to 70 cm, which we considered insufficient for adult cows to lunge their heads forward. On each farm, 18–20 lactating dairy cows were selected. In total, 188 animals were used in the statistical analysis. Over 1.5 days, rising and lying down movements were videotaped, and the prevalence of atypical behaviours during these movements was recorded. In addition, we determined the daily lying duration, the lying frequency, and the mean lying bout duration using accelerometers mounted on the left hind leg. The data was analysed in relation to the cubicle type (permissive or restrictive). In the permissive cubicle type, staggered head lunge movements during rising and displays of hesitance before lying down were less prevalent. The lying frequency was higher, and daily lying duration was longer in the permissive cubicle type, although these estimates should be interpreted with caution due to the short data collection period. The results of this study suggest that the permissive cubicle with open partitions and a high-positioned flexible neck strap may improve conditions for dairy cows to rise and lie down. A permissive cubicle design may therefore improve cow welfare in free-stalls with insufficient forward lunge space, where increasing lunge space is not feasible.

Age-related variations in stratum corneum hydration in the foot

ObjectiveThe aims of the study are to identify which region of the foot has lower hydration according to age, measure the variation in the level of stratum corneum hydration of the foot across the a wide age range, and examine hydration differences of the foot according to gender. Study designA descriptive observational study was conducted to assess stratum corneum hydration of the foot among 504 participants recruited between November 2023 and March 2024. Main outcomes measuresStratum corneum hydration assessment was conducted using a Corneometer 825® probe at 10 specific points on the foot. Data on sociodemographic variables, medical history, foot care habits, and hydration-related factors were collected. Statistical analyses were performed using SPSS v. 24.0. ResultsStratum corneum hydration of the foot varied significantly across regions, with higher hydration in the digital zone and lower hydration in the heel. An inverse correlation was found between age and hydration, with younger participants exhibiting higher hydration levels. Women showed higher hydration than men. Differences in hydration were observed between the right and left feet. ConclusionThis study highlights the importance of localized assessment of foot skin dehydration. Aging significantly affects stratum corneum hydration of the foot. Gender differences in hydration suggest the importance of personalized approaches to skin care. Differential hydration between feet underscores the influence of mechanical load.

Designing and additive manufacturing of talus implant for post-traumatic talus avascular necrosis: a case study

New technologies in additive manufacturing and patient-specific CT-based custom implant designs make it possible for previously unimaginable salvage and limb-sparing operations a practical reality. This study presents the design and fabrication of a lattice-structured implant for talus replacement surgery. Our primary case involved a young adult patient who had sustained severe damage to the talus, resulting in avascular necrosis and subsequent bone collapse. This condition caused persistent and debilitating pain, leading the medical team to consider amputation of the left foot at the ankle level as a last resort. Instead, we proposed a Ti6Al4V-based patient-specific implant with lattice structure specifically designed for pan-talar fusion. Finite element simulation is conducted to estimate its performance. To ensure its mechanical integrity, uniaxial compression experiments were conducted. The implant was produced using selective laser melting technology, which allowed for precise and accurate construction of the unique lattice structure. The patient underwent regular monitoring for a period of 24 months. At 2-years follow-up the patient successfully returned to activities without complication. The patient’s functional status was improved, limb shortening was minimized.