Persistent Foot Research Articles

PH- and Matrix Metalloproteinase-Responsive Multifunctional Bilayer Microneedles Platform for Treatment of Tinea Pedis.

Persistent foot odor and itchiness are common symptoms of tinea pedis, significantly disrupting the daily life of those affected. The cuticular barrier at the site of the tinea pedis is thickened, which impedes the effective penetration of antifungal agents. Additionally, fungi can migrate from the skin surface to deeper tissues, posing challenges in the current clinical treatment for tinea pedis. To effectively treat tinea pedis, we developed a platform of bilayer gelatin methacrylate (GelMA) microneedles (MNs) loaded with salicylic acid (SA) and FK13-a1 (SA/FK13-a1@GelMA MNs). SA/FK13-a1@GelMA MNs exhibit pH- and matrix metalloproteinase (MMP)-responsive properties for efficient drug delivery. The MNs are designed to deliver salicylic acid (SA) deep into the stratum corneum, softening the cuticle and creating microchannels. This process enables the antibacterial peptide FK13-a1 to penetrate through the stratum corneum barrier, facilitating intradermal diffusion and exerting antifungal and anti-inflammatory effects. In severe cases of tinea pedis, heightened local pH levels and MMP activity further accelerate drug release. Our research demonstrates that SA/FK13-a1@GelMA MNs are highly effective against Trichophyton mentagrophytes, Trichophyton rubrum, and Candida albicans. They also reduced stratum corneum thickness, fungal burden, and inflammation in a guinea pig model of tinea pedis induced by T. mentagrophytes. Furthermore, it was discovered that SA/FK13-a1@GelMA MNs exhibit excellent biocompatibility. These findings suggest that SA/FK13-a1@GelMA MNs have significant potential for the clinical treatment of tinea pedis as well as other fungal skin disorders.

Intra Articular Calcaneal Fracture with Subtaler Joint Depression: Minimally Invasive Sinus Tarsi Approach for Open Reduction and Internal Fixation

Background Numerous studies have demonstrated that fractures of the calcaneum, which account for a significant fraction of major tarsal bone fractures, are linked to severe and protracted impairment. This study aimed to evaluate minimally invasive sinus tarsi approach (STA) for open reduction and internal fixation of calcaneal fracture with joint depression to clarify and identify it benefits and drawbacks. Methods This prospective cohort research was performed on all adult cases with a displaced intra articular calcaneus fracture who were admitted to our institution. Patients aged of 14 to 60 years with unilateral, isolated, uncomplicated fractures were included. Results Our study conducted on 31patients with 34 fractures with a mean age of 34 years (type II 47% and type III 53%). The mean duration of follow-up was 20.45 months, the mean American orthopaedic foot and ankle society was 91.38% and the mean Maryland foot score was 94.79%. Pain and discomfort" were reported by 14 patients in regards to their foot. Seven individuals were found to have soreness at the locations of the posterior screws. The remaining 7 cases were identified as having complex regional pain syndrome, which is characterised by persistent foot pain, particularly when bearing weight. Sural nerve dystrophy was the only patient's complaint. One patient exhibited slight toe clawing. Conclusion The STA is a minimally invasive intervention utilised in the treatment of calcaneal fractures. It enables anatomic reduction of articular surfaces and allows for a clear view of the fracture.

Foot drop after gastrocsoleus lengthening for equinus deformity in children with cerebral palsy

BackgroundGastrocsoleus lengthening (GSL) is the most common surgical procedure to treat equinus deformity in ambulant children with cerebral palsy (CP). Foot drop, where the ankle remains in plantarflexion during swing phase, can persist in some children post-operatively. There is currently limited understanding of which children will demonstrate persistent foot drop after GSL. Research questionWhich children develop persistent foot drop after GSL surgery for equinus? MethodsWe conducted a retrospective cohort study on ambulant children with CP who had GSL surgery for fixed equinus deformity. The aims of the study were: to determine the frequency of persistent foot drop post-operatively and to compare outcome parameters from physical examination and three-dimensional gait analysis for children with hemiplegia or diplegia. ResultsOne hundred and ten children functioning at GMFCS Levels I/II/III of 28/75/7 met the inclusion criteria for this study. There were 71 boys and mean age was 9.1 years at time of GSL surgery. The overall frequency of persistent foot drop was 25%, with a higher frequency of persistent foot drop in children with hemiplegia (42%) than children with diplegia (19%). There were significant improvements in dorsiflexor strength and in selective motor control in children with diplegia but not in children with hemiplegia. Mean (SD) pre-operative mid-swing ankle dorsiflexion for children with hemiplegia was − 14.0° (9.9°) and improved post-operatively to − 1.6° (5.5°). For children with diplegia, the pre-operative mid-swing ankle dorsiflexion was − 12.1° (12.9°) and improved post-operatively to + 4.2° (6.9°). SignificanceFoot drop is present following GSL surgery for fixed equinus deformity in a significant number of children with hemiplegia and to a lesser extent in children with diplegia, which may reflect a difference in the central nervous system lesion between these groups. New management approaches are required for this important and unsolved problem.

Tibial Nerve Block as Treatment of Chronic Foot Pain.

Minimally invasive therapies can alleviate pain and improve walking in individuals with persistent foot and ankle pain. The current study aimed to define the protracted consequences of tibial nerve blocks with steroids for individuals with persistent foot pain and to investigate the link between the thermography of the plantar foot and the beneficial effect of a tibial nerve block with steroids. All patients with chronic foot pain (n = 45) in this cohort underwent a block of the tibial nerve in the Department of Pain Therapy of Pain Clinic De Bilt, Utrecht, Netherlands, within November 2019 to April 2020. The thermographic images of patients were taken before and after injection. Results were retrospectively evaluated after 18 months. In this study, 53% of the patients had pain relief at 7 weeks of follow-up with a unilateral or bilateral block of the tibial nerve. An improvement in walking distance was reported by 22% of the patients. Side effects of the tibial nerve block reported at 7 weeks of follow-up increased pain (5%) and the occurrence of leg cramps (5%) among the treated patients. At 18 months, 45% of the successfully treated feet still had benefits. A difference between the big toe's temperature and the foot's average temperature of less than -0.9°C on thermography before and after the tibial nerve block can predict a beneficial result of therapy. Tibial nerve block provides a safe, minimally invasive treatment option for almost half of the patients with painful feet in this cohort, and when successful, it can last a long term. Thermographic imaging of the plantar foot can predict only to a small extent the beneficial effect of the tibial nerve block with steroids on foot pain. Tibial nerve block should be considered when custom foot orthoses have been inadequate for pain relief or restricted walking distance.

Conservative versus surgical treatment of foot drop in peroneal nerve entrapment: rationale and design of a prospective, multi-centre, randomized parallel-group controlled trial

BackgroundHigh-quality evidence is lacking to support one treatment strategy over another in patients with foot drop due to peroneal nerve entrapment. This leads to strong variation in daily practice.Methods/designThe FOOTDROP (Follow-up and Outcome of Operative Treatment with Decompressive Release Of The Peroneal nerve) trial is a randomized, multi-centre study in which patients with peroneal nerve entrapment and persistent foot drop, despite initial conservative treatment, will be randomized 10 (± 4) weeks after onset between non-invasive treatment and surgical decompression. The primary endpoint is the difference in distance covered during the 6-min walk test between randomization and 9 months later. Time to recovery is the key secondary endpoint. Other secondary outcome measures encompass ankle dorsiflexion strength (MRC score and isometric dynamometry), gait assessment (10-m walk test, functional ambulation categories, Stanmore questionnaire), patient-reported outcome measures (EQ5D-5L), surgical complications, neurological deficits (sensory changes, motor scores for ankle eversion and hallux extension), health economic assessment (WPAI) and electrodiagnostic assessment.DiscussionThe results of this randomized trial may elucidate the role of surgical decompression of the peroneal nerve and aid in clinical decision-making.Trial registrationClinicalTrials.gov NCT04695834. Registered on 4 January 2021.

Bilateral osteochondroses of the accessory ossification centre of the medial malleolus: A rare entity

We are reporting a rare case of a painful accessory ossification center of the bilateral medial malleoli in a 9 years old girl. Patient was not involved in any sport activity. There was no local foot deformity and limb malalignment. The patient was treated conservatively. There was complete clinical and radiographic healing of the medial malleolus eight months after the first presentation. Osteochondrosis of the accessory ossification center of medial malleolus is generally unilateral and bilateral involvement is very rare. There are various differential diagnosis for this pathological condition with similar clinical features and presentation in this age group. We ruled out the uncommon pathological conditions causing chronic pain in the medial malleolus during this period of skeletal growth. We consider this painful condition to be classified as a bilateral osteochondroses of the accessory ossification center of the medial malleolus. Osteochondrosis of the accessory ossification center of the bilateral medial malleolus is a rare entity. Due to rarity of disease and common presentation similar to other disease this is commonly misdiagnosed or missed in clinical practice. Osteochondrosis is characterized by a disturbance of endochondral ossification in skeletally immature patients and should be investigated in children having a history of persistent foot and ankle pain. An increased clinical attention to this painful condition could lead to improved diagnosis and treatment among the paediatric age group.

A Prospective Cohort Study of Closed Foot Injuries in a Tertiary Hospital in Ghana

Objective: Our objectives were to determine the proportion of closed foot injuries and their treatment outcomes at a large trauma hospital in Accra, Ghana.Methods: A structured questionnaire was used to record, for each patient, the type of closed foot injury, the mechanism of injury, any concomitant injuries, the time interval between injury and arrival at the KBTH for treatment as well as the type of treatment instituted.Enrolled patients were followed up for six months, complications resulting from the foot injury or its treatment were recorded for each patient. The function of the foot after healing of the injury was measured using the American Foot and Ankle Society Score.Results: A total of 46 patients presented with closed foot injuries, males accounted for 58.7% and females 41.3%. Road traffic trauma was by far the most predominant cause of injury accounting for 63% of cases. Soft tissue contusions involving the foot had excellent outcomes after treatment; displaced metatarsal shaft fractures treated with open reduction and internal fixation with Kwires had a good outcome; displaced metatarsal shaft fractures treated with cast immobilization had unfavorable outcomes. Non-operative treatment of Lanfranc fracture-dislocation with cast immobilization resulted in severe limitation of climbing stairs, shoe wear, walking on uneven surfaces and inability to return to previous occupation.Conclusions: Displaced intra-articular calcaneal fractures cause significant persistent foot pain after treatment and Lisfranc fracture- islocations have unfavorable outcomes if treated conservatively with cast immobilization alone. Fractures of the foot cause a longterm morbidity with residual foot pain, limitation of foot wear, climbing stairs, walking on uneven surfaces and difficulty integrating into previous occupation. The resulting foot dysfunction is worse if the fracture is not appropriately stabilized.

Complications associated with talectomy in paediatric patients:\xa0a comparative retrospective study of two surgical techniques

BackgroundStudies describing the surgical approaches utilized for talectomy and their associated complications are scarce. We aimed to compare the surgical techniques and associated procedures from two groups of patients who underwent talectomy using two approaches. The main purpose of this study was to describe the complications and recurrence rates associated with each technique.MethodsBetween January 2004 and December 2019, 62 talectomies were performed in 48 pediatric patients with different pathologies. All patient data were reviewed retrospectively, and data of 31 patients were included in the study. The patients were divided into two groups based on the surgical technique used, and the baseline characteristics, along with the post-operative findings, and the intervention types in relation to complications were analyzed.ResultsIn the terms of hindfoot varus, midfoot adductus, forefoot supination, and dorsal bunions, the prevalence of these deformities was higher in group (A). Group (B) patients tolerated braces (88.9 %) better than group (A) patients (84.0 %). More adjunct procedures were required in group (A) than group (B) Furthermore, the frequency and types of complications, as well as the need for further surgeries were also higher in group (A). There was a higher rate of recurrence in group A than group B.ConclusionsTalectomy is an effective procedure for the treatment of persistent foot deformities despite associated complications. Surgical details and addressing associated deformities with adjunct surgical interventions should be considered.

Ischemic Monomelic Neuropathy: The Case for Reintroducing a Little-Known Term.

Ischemic monomelic neuropathy (IMN) is a little-known, painful axonal neuropathy, secondary to vascular occlusion or steal phenomenon. It typically occurs after vascular bypass, hemodialysis fistulization, or diabetic microvascular disease in the absence of significant clinical features of ischemia. There is limited literature to assist in the characterization and diagnosis of this condition. We describe three patients with IMN with no surgical or peripheral vascular disease history who exhibited spontaneous, persistent foot pain, edema numbness, and weakness with denervation on needle electromyogram in a distal lower leg peripheral nerve distribution. Occlusive disease was found in all patients on angiogram, requiring vascular bypass surgery.

Significance of CT Scan in Persistent Traumatic Foot Pain

Significance of CT Scan in Persistent Traumatic Foot Pain

The clinical- and cost-effectiveness of functional electrical stimulation and ankle-foot orthoses for foot drop in Multiple Sclerosis: a multicentre randomized trial

Objective: To compare the clinical- and cost-effectiveness of ankle-foot orthoses (AFOs) and functional electrical stimulation (FES) over 12 months in people with Multiple Sclerosis with foot drop. Design: Multicentre, powered, non-blinded, randomized trial. Setting: Seven Multiple Sclerosis outpatient centres across Scotland. Subjects: Eighty-five treatment-naïve people with Multiple Sclerosis with persistent (>three months) foot drop. Interventions: Participants randomized to receive a custom-made, AFO (n = 43) or FES device (n = 42). Outcome measures: Assessed at 0, 3, 6 and 12 months; 5-minute self-selected walk test (primary), Timed 25 Foot Walk, oxygen cost of walking, Multiple Sclerosis Impact Scale-29, Multiple Sclerosis Walking Scale-12, Modified Fatigue Impact Scale, Euroqol five-dimension five-level questionnaire, Activities-specific Balance and Confidence Scale, Psychological Impact of Assistive Devices Score, and equipment and National Health Service staff time costs of interventions. Results: Groups were similar for age (AFO, 51.4 (11.2); FES, 50.4(10.4) years) and baseline walking speed (AFO, 0.62 (0.21); FES 0.73 (0.27) m/s). In all, 38% dropped out by 12 months (AFO, n = 21; FES, n = 11). Both groups walked faster at 12 months with device (P < 0.001; AFO, 0.73 (0.24); FES, 0.79 (0.24) m/s) but no difference between groups. Significantly higher Psychological Impact of Assistive Devices Scores were found for FES for Competence (P = 0.016; AFO, 0.85(1.05); FES, 1.53(1.05)), Adaptability (P = 0.001; AFO, 0.38(0.97); FES 1.53 (0.98)) and Self-Esteem (P = 0.006; AFO, 0.45 (0.67); FES 1 (0.68)). Effects were comparable for other measures. FES may offer value for money alternative to usual care. Conclusion: AFOs and FES have comparable effects on walking performance and patient-reported outcomes; however, high drop-outs introduces uncertainty.

A patient with persistent foot swelling after ankle sprain: B-Cell lymphoblastic lymphoma mimicking soft-tissue sarcoma

We describe a case of B-cell lymphoblastic lymphoma with an unusual clinical presentation. A 15-year old male with no significant past medical history presented with persistent foot swelling after an ankle sprain. Imaging revealed a mass in the right foot, which was resected and revealed a diffuse infiltrate of B-lymphoblasts. Peripheral blood and bone marrow examinations revealed no abnormalities. These findings were consistent with B-cell lymphoblastic lymphoma, which is an uncommon disease, accounting for only 2% of lymphomas. This case is a reminder that hematolymphoid malignancies can have presentations that mimic sarcomas with no visible peripheral blood or bone marrow involvement. In addition to describing the clinical and histologic features of this case, we also discuss the challenges that can be encountered when establishing a diagnosis of B lymphoblastic lymphoma

Tendon Transfer for Foot Drop: A Simple Procedure with Effective Outcome Local Experience

Introduction: Patients presented with old neglected common peroneal nerve injuries, failed 2ry repair, compression neuropathies not improved after decompression and closed injuries with no improvement on conservative measures which are still unsolved problems. Poor recovery of this nerve after repair or decompression gives great importance to tendon transfer in these situations. Material and Methods: This study was conducted in Neurosurgery Department of Mansoura University from 2015 to 2018 on twenty-six patients (16 males and 10 females). Their age ranged from 6 - 58 years. All of them presented with persistent foot drop at least for one year after injury with no signs of improvement clinically or in electrophysiological studies. All patients underwent tibialis posterior tendon transfer through the interosseous membrane to the tendons of the leg anterior compartment. All of them were put in a plaster cast for four weeks postoperative. A physiotherapeutic program was applied for all patients as preoperative preparation and postoperative rehabilitation. Results: Twenty-two patients showed satisfactory results, three patients fair improvement and one patient no improvement. Two patients had wound infection and there was no mortality in this study. Conclusion: Tendon transfer is an effective valid solution to be considered in the management of foot drop in these patients.

Active Foot Synovitis in Patients With Rheumatoid Arthritis: Unstable Remission Status, Radiographic Progression, and Worse Functional Outcomes in Patients With Foot Synovitis in Apparent Remission.

To determine whether foot synovitis is associated with adverse radiographic and functional outcomes after 3 years in an inception rheumatoid arthritis (RA) cohort receiving treat-to-target combination disease-modifying antirheumatic drug therapy. Disease activity was assessed in early RA patients (n = 266) using the Disease Activity Score in 28 joints, Clinical Disease Activity Index (CDAI), and Simplified Disease Activity Index (SDAI). Radiographic outcomes were assessed with annual hand and feet radiographs and quality of life with the Short Form 36 (SF-36). The prevalence of remission and foot synovitis was calculated using marginal binomial generalized estimating equations, transition between remission and nonremission states by a multistate Markov model, and changes in radiographic scores by a negative binomial mixed regression log-link model. Population-matched SF-36 data were analyzed by mixed-effects linear regression. Disease activity scores that omit foot joints were modest in their ability to capture foot synovitis. Despite the relative stringency of the SDAI and CDAI for remission, 25-36% of patients in remission had foot synovitis. In patients in remission, foot synovitis predicted transition from remission into relapse by up to 2-fold. The sustainability of remission markedly influenced the progression of erosion scores (P = 0.006). After adjusting for disease activity, foot synovitis was associated with worse SF-36 physical functioning scores (P = 0.025). Disease activity measures that omit foot joints capture foot synovitis poorly. When it is used to define remission, foot synovitis is found in a substantial proportion of patients, which predicts relapse and worse physical function. Foot synovitis influences the sustainability of remission, which in turn markedly influences radiographic progression. Regardless of remission status, persistent foot synovitis should prompt therapy escalation in order to improve long-term outcomes.

Persistent Left Foot pain in a Male Collegiate Soccer Player

Persistent Left Foot pain in a Male Collegiate Soccer Player

Osteoma osteoide de calcáneo: caso clínico y revisión de la literatura

The osteoid osteoma appearance of a foot is unusual. An atypical presentation may delay diagnosis and thus delay treatment. We report a case of a 27-year-old man with an 12-month history of persistent foot pain who underwent percutaneous radiofrequency ablation of an osteoid osteoma involving the calcaneus. The patient related an immediate relief of pain and had no recurrence of symptoms or the lesion at 3-year follow-up.

A systematic review of peroneal nerve palsy and recovery following traumatic knee dislocation.

A common peroneal nerve (CPN) palsy has been reported to complicate knee dislocations in 5-40% of patients. Patients who suffer from a persistent foot drop have significantly worse functional outcomes. Reports on prognostic factors for nerve recovery or treatment-specific functional outcomes remain sparse in the literature. Two independent reviewers completed a search of Medline, Embase, PubMed and the Cochrane Library from 1946 to present. Motor strength was determined using the Medical Research Council (MRC) grading system or an equivalent description. A functional recovery was defined as an MRC ≥3/5. The combined search of Medline, Embase, PubMed and the Cochrane Library identified 1528 abstracts. Thirteen articles met our inclusion/exclusion criteria. This included 214 CPN palsies. Functional recovery (MRC ≥3/5) following complete CPN palsy was 38.4%. Full recovery (MRC=5/5) following partial CPN palsy was 87.3%. Younger age was predictive of neurologic recovery. Recovery following isolated neurologic interventions ranged from 0 to 30%. A vastly different prognosis can be expected for patients who suffer an incomplete versus a complete CPN palsy. The majority of patients with an incomplete palsy will achieve a full motor recovery while <40% of patients with a complete motor palsy will regain the ability to dorsiflex at the ankle. While neurologic interventions show promise for the future, the outcomes in knee dislocation patients remain poor. The most predictable means of reestablishing antigravity dorsiflexion in a persistent CPN palsy is a posterior tibial tendon transfer.

Autonomic dysfunction in clinically isolated syndrome suggestive of multiple sclerosis

ObjectivesThe aim of this study was to determine the extent of autonomic dysfunction in patients with clinically isolated syndrome (CIS) by using a standardized battery of autonomic tests in the form of the Composite Autonomic Scoring Scale (CASS). MethodsThis was a prospective, cross sectional study which included 24 consecutive patients who were diagnosed with CIS and 17 healthy controls. In all participants, heart rate and blood pressure responses to the Valsalva maneuver, heart rate response to deep breathing and blood pressure response to passive tilt were performed. In 16 patients, Quantitative Sudomotor Axon Reflex Test (QSART) and catecholamine measurement was performed. ResultsThe proportion of CIS patients with pathological adrenergic index was statistically significantly higher compared to healthy controls (12 vs 2, p=0.018), while there was no difference in cardiovagal index between groups. Five patients had a sudomotor index of 1 (in 4 there was hypohydrosis <50% and in 1 persistent foot hyperhidrosis). When combining adrenergic, cardiovagal and sudomotor index into CASS, 8 patients (50%) had evidence of autonomic dysfunction, 7 mild and one moderate. ConclusionSympathetic nervous system is frequently affected in CIS patients. SignificanceCASS is able to detect autonomic nervous system dysfunction in CIS patients.

36. What Factors Increase Risk of Onset or Persistent Severe Foot Pain in a Population Study?

productivity loss measures and the correlation between these 5 measures were moderate. The latter probably reflecting differences in concepts, recall periods, and references used in these measures. The moderate association between the global at-work productivity measures and VAS general well-being suggests that the impact of arthritis on work is only partly captured by generic health measures. Disclosure statement: The authors have declared no conflicts of interest.

SP0073 A New Paradigm to Managing the Impact of Inflammatory Foot and Ankle Disease

Foot and ankle involvement is common in inflammatory joint disease. Recent evidence has identified persistent foot disease, pain and walking disability in patients in disease remission state. We propose a...