Metatarsal Pad Research Articles

The effectiveness of shoe modifications and foot orthoses in conservative treatment of lesser toe deformities: a review of literature.

Forefoot disorders are prevalent in the general population, with an incidence between 2 and 20%. Among them, lesser toe deformities (hammer, claw, and mallet toes) are frequent disorders, and their conservative management is often not adequately considered but usually attempted before surgical indication. Among conservative treatments, shoe modifications and the application of orthoses may, in most cases, alleviate symptoms. From a careful analysis of the available literature, it emerged that treatment approaches should be individualized, and patient education has to be a central aspect of therapy. Proper footwear includes rocker and cushioned soles shoes, a wide toe box, proper length, and a lowered heel, eventually combined with the placement of a felt pad. Narrowed shoes must be avoided, limiting the impaction of the distal phalanx and toenail into the ground. A custom-made silicone orthosis applied at the second digit metatarsophalangeal (MTP) joint in a hammer or claw toe seems to reduce mean peak plantar pressure in the rigid stage of deformity but not the flexible one. A metatarsal pad placed 6.5mm proximal to the second metatarsal head was demonstrated to diminish peak pressures by 33%, and a 12.5-mm insole further reduced peak metatarsal head pressures by 23% compared with a 2.5-mm insole. The best comfort of orthoses seems to be given by treating metatarsalgia resulting from deformities such as MTP joint instability, mallet, and claw toe. Little orthotic relevance is given to deformities such as hammer toes. Although the most significant obstacle appears to be the psychological aspect of patients, who must accept the placement of compensatory orthoses, some studies show that all these management appear to be often beneficial for the treatment of these disorders. However, none of them are permanent solutions to the deformity and they can be treatment of choice just in advanced stages, in elderly and low functional demand patients.

Effect of Foot Orthoses and Footwear in People with Rheumatoid Arthritis: An Updated Systematic Review.

Rheumatoid arthritis is a chronic, systemic, inflammatory disease of an autoimmune nature that causes pain and disability in affected patients. Foot pain has become a challenge due to its negative impact on physical function. The objective of this updated systematic review is to describe the effect of foot orthoses and/or footwear in patients with rheumatoid arthritis and foot problems. Scopus, PubMed, CINALH, WOS, and Dialnet were searched for all articles published from January 2013 to September 2024. Inclusion criteria included randomised clinical trials and crossover trials (level of evidence I), published within the last 10 years, involving adults with a diagnosis of rheumatoid arthritis, with no restrictions on gender, race, or ethnicity. All studies that addressed the use of foot orthoses and/or shoe therapy in any type of comparison between these interventions were considered relevant. Review Manager was used to carry out the bias analysis of the selected studies. The reporting was based on the new PRISMA guidelines. A total of 9 relevant articles were selected from an initial sample of 438. These articles analyse and compare the effectiveness of various types of foot orthoses in reducing pain, functional limitation, and disability, as well as improving balance and kinetic and kinematic parameters affected by rheumatoid arthritis. Foot orthoses reduce pain and disability in rheumatoid arthritis, improving balance and kinematic parameters. However, no significant improvements in the patients' functionality and walking ability have been demonstrated. Customised ones with good arch control, heel reinforcement, and metatarsal pad are more effective. No results on the impact of footwear on patients with rheumatoid arthritis have been found in the last 10 years. This systematic review was registered in PROSPERO (CRD42023405645).

EFFECT OF SUBSTRATE AND WALKING SURFACES ON CENTRAL METATARSAL FOOT PAD WEIGHT LOADING IN MAGELLANIC PENGUINS (SPHENISCUS MAGELLANICUS) WITH AND WITHOUT PODODERMATITIS: AN EX VIVO STUDY.

Pododermatitis is common in penguins kept under human care. Substrate optimization plays an important role in prevention and treatment; however, there is limited information on biomechanical properties of commonly used substrates on penguin feet. The objectives were to test the ability of different substrates to decrease weight loading on the central metatarsal pad of penguin feet in an ex vivo model using feet with and without bumblefoot harvested from two Magellanic penguin (Spheniscus magellanicus) cadavers. Penguin feet were attached to a digital force gauge mounted onto a stand for compression testing at 2.5 and 5 kg. Forces at the central metatarsal pad were measured in triplicate using small force sensors. Tested substrates included five granular surfaces (sand, wet sand, pea gravel, wet pea gravel, and crushed ice), three compliant surfaces (short-leaf Astroturf, long-leaf Astroturf, and neoprene), and three firm surfaces (tile, rubber drainage mat, and 3M Safety-Walk Wet Area Matting). Data were analyzed using linear mixed models. There were multifaceted effects of applied pressures, substrate surfaces, and pododermatitis on central metatarsal measured pressures. In general, doubling compression forces resulted in higher measured pressures in all firm and compliant surfaces but not in granular surfaces. Firm surfaces were associated with higher recorded plantar pressures at 2.5 kg, but different significance groupings emerged at 5 kg with a high-, medium-, and low-pressure cluster of surfaces. Pododermatitis lesions resulted in significant alterations in statistical significance clustering among substrate surfaces and unique substrate behaviors. The results of this study could help in making recommendations pertaining to foot health for penguin exhibits.

Plasma and Tissue Amikacin Concentrations Following Regional Limb Perfusion of Chickens (Gallus gallus domesticus).

Intravenous regional limb perfusion (IVRLP) has been used in the treatment of pododermatitis and distal limb infections, which are significant causes of morbidity in avian species. This intravenous drug administration technique is designed to achieve high drug tissue concentrations while minimizing systemic toxic effects. Amikacin is commonly used for IVRLP in veterinary medicine, but dosing guidelines have not been established for its use in birds. The current study aimed to determine the tissue concentration of amikacin after a single IVRLP administration in healthy, euhydrated leghorn hen chickens (Gallus gallus domesticus). Chickens received a single IVRLP dose of 10 mg/kg amikacin and were euthanatized posttreatment at 1 hour (n = 6), 12 hours (n = 6), and 24 hours (n = 6) to assess tissue and synovial fluid concentrations of amikacin in the injected leg. Mean tissue concentrations were highest 1 hour post-IVRLP (synovial fluid = 153.0 µg/mL, metatarsal pad tissue = 26.05 µg/mL) before declining at the 12- and 24-hour time points. This indicates that administration of amikacin via IVRLP can reach minimum inhibitory concentrations of common bacterial isolates in tissues after a single treatment with 10 mg/kg amikacin. Regional limb perfusion every 24 hours is recommended, although the minimum days of treatment may be case dependent and vary based on response to therapy.

Investigation of the Effectiveness of Plantar Pressure Redistribution of Customized Insole Structure Designed Based on Plantar Structure

Although both fabricated insoles and customized insoles were designed with varied function components, current knowledge approved that customized insoles worked much better. However, how the customized insoles achieved a better performance in term of load re-distribution was still lacking quantitative assessment. The aim was to determine whether the customized insole structure based on a novel customization procedure proposed in this study performs better than the prefabricated insoles in terms of plantar pressure re-distribution efficiency. This study included ten healthy subjects, each wearing four types of insoles accordingly (control insoles; arch support insoles; orthotic insoles; customized insoles), and plantar pressure was collected in a walking state. The custom insoles are made by determining the subject’s plantar surface and key plantar points, then following the customization procedure to finish them. The plantar area was divided into eight zones and then a pressure transfer algorithm was used to gain insight into the plantar pressure. Compared to the control group insoles, the arch support of the customized insoles reduced pressure in the hallux region and transferred pressure from the M4-5 to the MH and LH regions, while the metatarsal pad enhanced the pressure transfer in the mid-foot, and the anterior-posterior height difference of the insole plays a role in pressure transfer. Furthermore, the customized insoles performed close to the professional orthotic insoles. Design strategy with accurate insole’s component location and reasonably plantar surface matching, our customized insole demonstrated advantages such as a better loading redistribution and significant pressure relieving on the forefoot.

Effects of Customized Biomechanical Footwear on Gait and Balance in Individuals with Polio: A Randomized Controlled Trial

Background Evidence suggests that the factors behind the increased risk of falls among polio survivors are mainly categorized into intrinsic and extrinsic domains. The intrinsic category involves factors like muscle weaknesses, fear of falls and self-reported balance problem. In contrast, extrinsic factors include poor environmental circumstances and ambulatory issues that cause reduced ability to adapt to walking conditions in polio patients. Therefore, the present study aimed to investigate biomechanical footwear’s effects on gait and balance in individuals with polio. Methods A total of 30 participants were randomly divided into two groups of 15 each. The experimental group received customized shoe footwear with features such as medial arch support, metatarsal pad, rear foot control, fibreglass lateral counter, and a rocker sole. The control group did not receive specialized footwear. Results The intervention group showed significant improvements in several gait parameters compared to the control group, including step length (p=0.008), stride length (p=<0.001), step width (p=0.002), cadence (p<0.001) and speed (p=0.0009). The intervention group also showed significant improvements in Berg Balance Scale scores (p=0.07) compared to the control group. Conclusion Biomechanical footwear with medial arch support, metatarsal pad, and rear foot control can improve gait and balance in individuals with polio. Keywords Disability, Gait, Foot Orthosis, Poliovirus.

Do Orthotics with a Metatarsal Pad Decrease Pain and Fear of Falling in Older Adults? A Randomized Control Trial

Aims This randomized control trial compares the effects of orthotics, with and without metatarsal pads, on pain and fear of falling in older adults (NCT04894396). Methods 206 participants over 60 years old received either an Aetrex L2305 Orthotic with metatarsal pads (intervention) or an Aetrex L2300 Orthotic without metatarsal pads (control). Outcome scores were collected at baseline and at six weeks. Results Both the intervention and control groups reported significant improvements in pain in the back, hips, knees, ankles, and feet, measured on a Numerical Rating Scale (p < 0.001). Foot pain and foot function subscales of the Foot Health Status Questionnaire and the Short Falls Efficacy Scale International also significantly improved in both groups (p < 0.001). Between-group differences were not statistically significant for any outcome (p > 0.05). Conclusions Orthotics, with and without metatarsal pads, decrease pain and fear of falling in older adults.

Hammer Toe Correction with Proximal Interphalangeal Joint Arthrodesis.

First described by Soule in 1910, arthrodesis of the proximal interphalangeal joint is a common operative method of treatment of hammer toe, or fixed-flexion deformity of the proximal interphalangeal joint of the lesser toes1. The deformity is often caused by imbalance in intrinsic and extrinsic muscle function across the interphalangeal joint and metatarsophalangeal joint2,3, which can be effectively addressed through proximal interphalangeal joint straightening and arthrodesis in conjunction with soft-tissue balancing of the metatarsophalangeal joint. Following longitudinal skin incision over the joint, a transverse extensor tenotomy and capsulotomy reveal the proximal interphalangeal joint and provide appropriate exposure of the head of the proximal phalanx. With the soft tissues protected, the proximal and middle phalanges undergo resection of the articular surfaces to allow osseous apposition. This step can be performed with a rongeur sagittal saw or with osteotomes4,5. The head of the proximal phalanx is resected proximal to the head-neck junction, and the proximal portion of the middle phalanx is removed to expose the subchondral bone. Often, there is a dorsal contracture of the metatarsophalangeal joint that is elevating the toe, which is addressed with use of a longitudinal incision over the metatarsophalangeal joint, a Z-lengthening of the long extensor tendon to the toe, and a subsequent capsulectomy. If there is an angular component to the deformity, the collateral ligaments are released from the metatarsal neck, and the toe can be balanced. If there is residual subluxation of the joint that is incompletely corrected by soft-tissue procedures, a metatarsal osteotomy should be considered. Fixation is then performed with use of a smooth Kirschner wire. The wire is inserted from the middle phalanx out the tip of the toe and subsequently inserted retrograde across the proximal interphalangeal joint, often into the metatarsal head and neck, holding the metatarsophalangeal joint in appropriate position. This step can also be completed with use of novel methods including screws, bioabsorbable pins, or intramedullary implants6-8. Nonoperative treatments for hammer toe deformity are generally pursued prior to surgery and include shoe modifications such as a wide toe-box, soft uppers, and padding of osseous prominences3,9,10. Alternative surgical treatments include proximal interphalangeal arthroplasty, soft-tissue capsulotomy, extensor tendon lengthening, and amputation11. Although nonoperative treatment can alleviate symptoms temporarily, surgical treatment is often necessary for definitive treatment of hammer toe. Soft-tissue procedures such as tendon lengthening can provide a stabilizing benefit, but the degenerative bone changes associated with hammer toe are better addressed with use of resection of the proximal interphalangeal joint3. Arthroplasty allows for some retained motion; however, this motion may lead to deformity and pain over time2. Arthrodesis provides less painful and more reliable fixation as well as equal outcomes compared with other operative techniques. Patient satisfaction rates after this procedure are high, with pain relief in up to 92% of patients and rare complications7-12. Outcomes of this procedure are favorable, with rates of osseous fusion ranging from 83% to 98%2,4,11,13. Patient satisfaction rates range from 83% to 100%4,11. Historically, patients have expressed dissatisfaction with pain and the appearance of exposed hardware, but novel internal fixative devices provide a more natural appearance to the toe without the need for secondary surgical procedures for pin removal8,14. Patients are often able to return to regular activity at 6 weeks postoperatively; however, there may be persistent pain or swelling in the toe. Wide shoes and activity modifications are frequently continued for several more weeks postoperatively, and some patients may benefit from formal physical therapy and at-home rehabilitation. Avoid vascular compromise by ensuring adequate resection of bone at the proximal interphalangeal joint.A longitudinal incision across the joint provides greater exposure but can lead to scar contracture that elevates the toe. One alternative is the use of an elliptically shaped incision over the proximal interphalangeal joint, which can improve cosmesis but does restrict exposure.Excessive osseous resection can lead to a cosmetically undesirable short toe.If using an implant for the arthrodesis, ensure the implant is not too big for the toe. Most implants are too big for fifth-toe arthrodesis.In toes with severe deformity, fixation with a Kirschner wire is often preferred because excessive stretching of the neurovascular bundle can lead to toe compromise and if Kirschner wire is used the pin can easily be removed at bedside.For flexible deformities, a nonoperative approach is recommended, such as stretching exercises, shoe-wear modifications, and metatarsal pads. A tenotomy of the flexor digitorum brevis is a soft-tissue procedure that can be considered if nonoperative treatment is insufficient to correct the deformity. If flexor digitorum brevis tenotomy does not adequately treat proximal interphalangeal joint deformity, a proximal interphalangeal joint arthrodesis should be the next step. MTP = metatarsophalangealPIP = proximal interphalangeal.

Do prefabricated orthotics with and without a metatarsal pad decrease back pain in older adults? Results from a randomized control trial

Do prefabricated orthotics with and without a metatarsal pad decrease back pain in older adults? Results from a randomized control trial

Exploring in-shoe plantar pressure differences at the metatarsal pad position for patients with diabetes and toe deformities: A pilot study

Patients with diabetes are often prescribed insoles with metatarsal pads intended to prevent and offload forefoot ulcers. However, to our knowledge, the plantar pressures specifically at the metatarsal pad had not previously been researched. The aim of this study was therefore to explore plantar pressures at the metatarsal pad position by comparing three toe deformity groups, claw toe (CT)/hammer toe (HT) and hallux valgus (HV), with a control group (NONE). In-shoe plantar pressures were measured using F-ScanTM and a polygon region of interest at the metatarsal pad position was created. Mean peak pressure (MPP), pressure-time integral (PTI) and percentage foot-insole contact area at the metatarsal pad position (%CA) were analysed from 24 patients (48 feet) in the metatarsal pad area. No significant difference was found between the groups regarding MPP, PTI or contact area. For MPP, the highest value was found in CT/HT (140kPa ± 61) and the lowest in HV (112kPa ± 33). In PTI, the highest value was for CT/HT (2.0 Ns/cm2 ± 1.0) and the lowest for HV (1.3 Ns/cm2 ± 0.4). The %CA was highest in CT/HT/HV (95%) and lowest in NONE (70%). A new quantitative approach was presented, assessing the metatarsal pad pressure effect on its corresponding plantar area of the foot. Further studies are needed to identify the conditions in which a metatarsal pad affects different foot statuses with regard to plantar pressure.

Orthotic and Prosthetic Options after Diabetic Foot Amputation

Diabetic foot ulcer is a risk factor for amputation. Infection and ischemia in diabetic foot ulcers are common causes of foot amputation. After minimal amputation of the involved lower extremity, precise and cautious application of orthoses and prostheses is very important to recover function of the foot. In this context, several factors including the patient’s general condition, level of amputation, preoperative ability of gait, contracture of adjacent joints, and wound healing potential must be considered. Most orthoses for diabetic foot amputees are used as an off-loading strategy to relieve pressure from the foot and ankle. Total contact cast is the standard treatment for forefoot off-loading. Footwear and insole design orthoses for off-loading in diabetic foot amputees have a low level of evidence and controversial effectiveness. Removable pressure-relieving ankle foot orthoses can be used as an alternative to total contact casts in selective situations. Metatarsal pads can be used effectively to decrease plantar pressure at a low cost. Prostheses after lower extremity amputation must be used with caution for rehabilitation factors due to sustained wound problems and change of stump size.

The Effect of Increasing Tibial Tuberosity Advancement and Quadriceps Muscle Force on Cranial Translation of the Tibia in the Cranial Cruciate Deficient Stifle Joint in Dogs.

BackgroundCranial cruciate ligament (CCL) disease is a well-known pathology that generates both rotational and translational instability of the stifle joint that leads to osteoarthritis in dogs. Tibial tuberosity advancement (TTA) is a common surgical technique used to dynamically neutralize the tibiofemoral shear forces to achieve stifle joint stability. However, significant persistent instability has been documented in clinical cases. The purpose of this study was to evaluate the effect of increasing quadriceps load, increasing tibial tuberosity advancement, and increasing joint flexion angle on the cranial translation of the tibia relative to the femur in the cranial cruciate ligament deficient stifle joint.Methods and ResultsSix cadaveric hind limbs were collected from six healthy mixed breed dogs of medium build and prepared for biomechanical testing. The specimen was placed into a custom-made joint testing machine, and translation of the tibia relative to the femur was measured at stifle angles of 135°, 120°, and 105°. Cranial tibial thrust was generated by applying a vertical load to the metatarsal pad and the quadriceps muscle was simulated with loads of 0, 5, and 10 kg applied to the patella via a system of weights and pulleys. All specimens were tested with the CCL intact and cut, both of which served as controls. The tibial tuberosity was then advanced using both 6 mm and 9 mm cages, and the specimen was tested using the identical technique. Each specimen was loaded to failure by increasing the load applied to the pes until the sudden marked cranial translation of the tibia. Tibial tuberosity advancement with an applied quadriceps load was successful in limiting cranial tibial translation in 54/62 tests. Under similar loading conditions, TTA failed to limit cranial translation in 8 tests. The failures occurred at all angles of flexion examined. In the cases that failed cranial translation could be limited by either increasing the quadriceps load or increasing the amount of tibial tuberosity advancement.ConclusionThis study showed that TTA with an applied quadriceps load is effective at decreasing cranial tibial translation at functional joint angles.

Effectiveness of the Fixtoe Device® in plantar pressure reduction: a preliminary study

BackgroundMetatarsalgia is a common foot condition. The metatarsophalangeal stabilizing taping technique described by Yu et al. has shown good clinical results as a provisional treatment in propulsive metatarsalgia. 35 The Fixtoe Device®, a novel orthopedic device, intends to simulate stabilizing tape. However, to date, there is no evidence of its effectiveness. The aim of this study was to assess plantar pressure changes using the Fixtoe Device®, in comparison with the traditional method (stabilizing tape) in a young, healthy sample thorough a cross-sectional study.MethodsMaximal pressure (Kpa) and pressure–time integral (Kpa/s) in the second metatarsal head were measured in twenty-four healthy volunteers. Registers were taken in four different conditions: barefoot, traditional stabilizing tape, Fixtoe Device® without metatarsal pad, and Fixtoe Device® with metatarsal pad.ResultsMean second metatarsal head maximal pressure and mean pressure–time integral showed statistical difference among the four analyzed conditions (p < 0.0001 in both cases). The improvement in maximal pressure and pressure–time integral obtained in each intervention also showed significance (p < 0.0001 in both cases). Comparing the improvement of the Fixtoe Device® with and without metatarsal pad with that of tape condition showed a moderate to high and moderate effect size for both peak pressure and pressure–time integral reduction.ConclusionsThe Fixtoe Device® reduces median maximal pressure and median pressure–time integral under the second metatarsal head in healthy young individuals. The Fixtoe Device® shows higher effectiveness than the traditional second metatarsophalangeal joint stabilizing taping technique. To our knowledge, this is the first investigation proving the effectiveness of the recently developed Fixtoe Device® in terms of plantar pressure modification, which leads the way to its use in clinics.

The Management of Metatarsalgia in Rheumatoid Arthritis Using Simple Insoles: An Effective Concurrent Treatment to Drug Therapy.

Metatarsalgia is a common affliction in rheumatoid arthritis (RA), often requiring aggressive pharmacologic treatment that carries associated adverse effects. The aim of this study was to investigate whether simple insoles would have a beneficial effect on forefoot pain, disability, and functional limitation in participants with RA experiencing forefoot pain. A prospective, quasi-experimental, pretest-posttest trial was performed at a rheumatology outpatient clinic. Participants were supplied with a simple insole comprising a valgus pad and a plantar metatarsal pad and covered with a cushioning material. The Foot Function Index (FFI) was self-administered before and 3 months after insole use. Reductions in forefoot pain (from 56.78 to 42.97) and total (from 41.64 to 33.54) FFI scores were noted. Statistical significance for this reduction was achieved following the t test (P = .002 and P = .0085, respectively). However, although reductions in mean disability and activity limitation scores were recorded (from 50 to 44.85 and from 18 to 14.57, respectively), these did not reach significance (P = .151 and P = .092, respectively) Conclusions: Simple insoles have been shown to be effective in reducing total and forefoot pain FFI scores in patients with RA experiencing metatarsalgia. This treatment offers advantages because these devices can be fabricated simply and cheaply, thus initiating the patient on an effective orthosis therapy immediately in the clinic without having to wait for prolonged periods until custom orthotic devices can be supplied.

Cardiogenic arterial thromboembolism resulting in tetraplegia in a cat

AbstractA 4‐year‐old male neutered domestic shorthaired cat was presented for acute onset tetraplegia and respiratory signs. No pulses were palpable in any limb, and nociception was absent–all limbs were cold, and digital, metacarpal and metatarsal pads were cyanotic. Point‐of‐care ultrasound of the heart revealed severe left atrial enlargement, containing several large thrombi. Due to concerns for quality of life, euthanasia was elected. Postmortem findings revealed marked left atrial enlargement with thrombi filling the entire atrium, as well as emboli in both subclavian arteries and the abdominal aorta.

Comparison of the Forefoot Pressure-Relieving Effects of Foot Orthoses.

PurposeMetatarsal pads are prescribed to decrease forefoot plantar pressure. However, the appropriate metatarsal pad placement location remains a debated issue. We aimed to identify the most effective insole design that reduces forefoot plantar pressure and determine the optimal position for metatarsal pad placement.Materials and MethodsWe recruited 16 healthy adult volunteers, and measured their plantar pressure data during walking while using an in-shoe system. The volunteers were randomly assigned to one of four insole conditions: 1/16-inch insole (i.e., control), 1/4-inch soft plastazote (SP) flat insole, metatarsal pad positioned proximal to the metatarsal head (MTH) on the control insole (P0), and metatarsal pad positioned 10 mm distal from the proximal border of the MTH on the control insole (P10). A masking protocol was created by dividing the forefoot into three subareas, distal to the MTH (dMTH), beneath to the MTH (bMTH), and proximal to the MTH (pMTH). The participants reported their comfort level for each insole using a visual analog scale.ResultsThe SP flat insole and metatarsal pads both had a forefoot plantar pressure-reducing effect and provided insole comfort. Of the three insole designs, the SP flat insole was the most effective. No clear difference existed in efficacy in terms of the location of the metatarsal pad placement.ConclusionConsidering the possibility of discomfort caused by improper metatarsal pad placement, the SP that increases shock absorption may be more clinically useful.

Histological and Morphometric Changes in the Femoral Nerve During Lateral Interbody Fusion of the Lumbar Spine: Experimental Study

Background. Neuropathies of the lumbar plexus trunks, in particular those of the femoral nerve, are the most common complications of lateral interbody fusion of the lumbar spine. Modeling of this surgical intervention in normal animals experimentally makes it possible to assess the degree of its trauma to the nervous structures, and to understand what is the reason for the persistence or aggravation of neurological symptoms iatrogenic injuries or the existing pathology progression. Purpose to study histological and morphometric changes in the femoral nerve in the long-term periods after the lateral interbody fusion modeling of the canine lumbar spine. Study design an experimental prospective continuous uncontrolled study. Materials and Methods. Discectomy via lateral approach was performed in 18 mongrel dogs (aged 2-3 years, mass 13.2-17.6 kg) at the level of L4-5 и L5-6, interbody titanium implants were mounted, the lumbar spine was stabilized with a wire device for external fixation within 30 days. Clinical and neurological evaluation was performed, as well as histological investigation of the femoral nerves from the side of surgical approach. Results. In the early postoperative period a temporary decrease in the femoral nerve function was observed, which was manifested by the disorder of the support function and muscle weakness of the pelvic limbs, decrease in the knee reflex, the foot support shift to the metatarsal pad. Later, until the end of the study (18 months), the general condition of all animals was satisfactory, there were no disorders of the limb support function and motor reflexes. After six months, in the femoral nerve there was 4-fold decrease in the proportion of large fast-conducting myelin fibers D10 m and 3-fold increase in that of the small ones. The mean axon diameter and myelin thickness were 62% and 53% of the norm. After 12-18 months, the dimensional characteristics of myelin fibers were restored. During the entire experiment, 4-6% of myelin fibers were reactively and destructively altered. Conclusions. The modeling of the lateral interbody fusion of the lumbar spine in normal animals experimentally demonstrated the absence of neurological symptoms after 6-18 months, which indicated low invasiveness of the surgical intervention. Nevertheless, the subclinical reactive and destructive changes in the myelin fibers of the femoral nerve revealed 6 months after the surgery indicated the need for preventive anti-neurotic therapy.

Prospective Cohort Validation Study of a Novel Foot Offloading Device

Summary:Pressure offloading is often considered a crucial factor affecting healing after a foot injury. We have devised a novel foot offloading device (PopSole) which allows for immediate customization of the area where there is foot pain and allows for adjustable arch support and metatarsal pad height while maintaining patient stability. We hypothesize that pain and function outcomes will improve significantly after use of the device over a 1-month period. Ten participants with foot pain for longer than 6 months completed five validated outcome questionnaires during three visits (initial screening, at 2 weeks, and at 4 weeks). Devices were deflated in areas of pain specific for each patient. Validated patient reported outcomes measures showed significant improvement in pain and function from baseline to week two (r = 0.644, P < 0.05), (r = 0.43, P < 0.05), and (r = 0.552, P < 0.05), respectively, and the Foot & Ankle Ability Measure (FAAM) showed improved ability in activities of daily living (r = 0.58, P < 0.05) and sports (r = 0.69, P < 0.05). All 10 patients reported pain relief during at least one visit and/or an ability to return to standing-based activities that they previously were unable to do. PopSole rapidly improved pain and function, with sustained relief through 4 weeks. Current studies are in progress to assess long-term durability of the device and potential modifications to be made before future randomized studies to assess pressure and gait assessment, shear forces, and diabetic foot ulcer mitigation.

The effect of pre-fabricated insole on plantar pressure distribution in patients with rheumatoid arthritis

BackgroundFoot deformities result in pain and changes in plantar pressure distribution in rheumatoid arthritis (RA) patients. Medical insoles are commonly prescribed for declining pain and modifying foot pressure distribution in these patients. The purpose of this study was to evaluate the effect of a pre-fabricated insole with metatarsal pad and medial longitudinal arch support on plantar pressure distribution in rheumatoid arthritis patients. MethodsFifteen females with RA participated in this study. All patients received a pair of pre-fabricated insoles that were individually modified using metatarsal pads and medial longitudinal arch supports. Mean peak pressure (kPa), maximum force (N), and contact area (cm2) were calculated for the heel, midfoot, metatarsophalangeal joint, and toe regions using the Pedar-X system immediately and after a month follow-up. FindingsIn the heel and metatarsophalangeal joint regions, maximum pressure and force showed a significant reduction in the follow-up assessment (p < 0.05). The comparison showed a significant increase in maximum pressure and force in the midfoot when participants walked with insole compared to without insole condition (p < 0.001). InterpretationUsing a pre-fabricated insole with an individually modified metatarsal pad and medial longitudinal arch support could alter rheumatoid arthritis patients’ plantar pressures after one month of follow-up. This type of insole is simple and inexpensive and showed a significant effect on decreasing pressures under the metatarsal heads.

Bipedal leaping Jurassic vertebrates in Southern Africa: proposed new ichnotaxon and inferred palaeoenvironment

The Lower Jurassic Clarens Formation (Stormberg Group, Karoo Supergroup, Main Karoo basin) contains relatively common vertebrate trackways impressed into apparently soft to firm, fine sediment beds preserved within the succession. At least three known ichnotaxa are interpreted as leaping bipedal vertebrates. Here we provide a generic description of a proposed new ichnotaxon to add to this small group of the oldest known bipedal hopping vertebrates in Africa and globally. Saltirecarpipes Genus Nova (Type Species tinleyi) (saltus – leap; carpe – seize; pes – foot) has been identified from tracks at Giants Castle in the KwaZulu-Natal Drakensberg. The type specimen in the National Museum Bloemfontein exhibits two adjacent tetradactyl impressions with four digits extended from metatarsal pads, comprising three inner digits grouped closer together and facing forwards, the fourth digit being much longer and curved outwards and slightly backwards. The digits are all strongly curved with claw impressions being preserved in several cases. These were small vertebrates, a leap length of ca. 180 mm being inferred. Being found in association with trace fossils of Equisitales (horse tails) a wet palaeoenvironment of small ponds is postulated. These appear to have been associated with distal fan sheetflood deposits of fine sediment at Giants Castle, which pass laterally into more central-basinal palaeodune deposits which characterise the Clarens Formation across the Main Karoo depository. The new ichnotaxon appears to have been restricted to wet desert marginal settings, feeding immature sediment to the desert basin, and which retreated proximally as aridification of the Clarens palaeoenvironment progressed.