Plantar Pad Research Articles

Enhanced wet grip with North American river otter paws.

The semi-aquatic North American river otter (Lontra canadensis) has the unique challenge of navigating slippery algae-coated rocks. Unlike other river otter species, each rear paw of the North American river otter has a series of soft, circular, and keratinized plantar pads similar to the felt pads on the boots of fly fishermen. Surrounding these soft pads is a textured epidermal layer. In this combined experimental and numerical study, we investigate the influence of the plantar pads and surrounding skin on the otter's grip. We filmed an otter walking and performed materials testingand histology on preserved otter paws. We present experiments and numerical modeling of how the otter paw may help evacuate water when contacting the river bed. We hope this study will draw interest into natural amphibious grip mechanisms for use in sports and the military.

The impact of cholesteryl ester transfer protein on the progression of cutaneous leishmaniasis.

Pathogenesis of cutaneous leishmaniases involves parasite growth, persistent inflammation, and likely participation of lipoproteins (LP). The cholesteryl ester transfer protein (CETP), involved in LP remodeling, has been shown to participate in the inflammatory response and the evolution of infectious conditions. We evaluated the impact of the presence of CETP on infection by Leishmania (L.) amazonensis in an experimental model of cutaneous leishmaniasis using C57BL6/J mice transgenic for human CETP (CETP), having as control their littermates that do not express the protein, wild-type (WT) mice. The progression of the lesion after infection in the footpad was monitored for 12 weeks. Two groups of animals were formed to collect the plantar pad in the 4th and 12th week post-infection. The lesion increased from the 3rd week onwards, in both groups, with a gradual decrease from the 10th week onwards in the CETP group compared to the WT group, showing a reduction in parasitism and an improvement in the healing process, a reduction in CD68+ cells, and an increase in CD163+ and CD206, characterizing a population of M2 macrophages. A reduction in ARG1+ cells and an increase in INOS+ cells were observed. During infection, the LP profile showed an increase in triglycerides in the VLDL fraction in the CETP group at 12 weeks. Gene expression revealed a decrease in the CD36 receptor in the CETP group at 12 weeks, correlating with healing and parasite reduction. In vitro, macrophages derived from bone marrow cells from CETP mice showed lower parasite load at 48 h and, a reduction in arginase activity at 4 h accompanied by increased NO production at 4 and 24 h compared to WT macrophages, corroborating the in vivo findings. The data indicate that the presence of CETP plays an important role in resolving Leishmania (L.) amazonensis infection, reducing parasitism, and modulating the inflammatory response in controlling infection and tissue repair.

Comparative morphology of the paw pad of the main arboreal Xenarthras from Amazon.

Paw pads are specializations of the integument and important shock absorbers of the locomotor system, as well as pressure, pain, temperature, storage and excretion sensors. Aiming to describe the paw pad morphology of the main arboreal xenarthras species in the Amazon, 16 animals were studied, Bradypus variegatus (6), Choloepus didactylus (5), Tamandua tetradactyla (3) and Cyclopes didactylus (2) that after death were donated to the Animal Morphological Research Laboratory (LaPMA / Ufra). The corpses were thawed and fixed with 10% aqueous formalin solution. The paw pads were measured, photographed and removed by skin incision dorsally to them. Fragments were used for routine histological processing, using two staining techniques: Hematoxylin-Eosin (HE) and Gomori's Trichrome, in sections of 6 to 8µm. Choloepus didactylus, Tamandua tetradactyla and Cyclopes didactylus have digital paw pads, one in each digit, and one palm, as well as a plantar, whose shapes and colours are distinct from each other. Bradypus variegatus, however, has only one palmar and one plantar pad. Histologically, they have keratinized stratified squamous epithelium, supported by a large amount of collagen fibres and fibroblast cords in the dermis and hypodermis. Groups of eccrine sweat glands were observed in the reticular dermis of C.didactylus, B.variegatus, T.tetradactyla and only in the hypodermis of Cyclopes didactylus.

Pododermatite plasmocitária felina: relato de caso

Feline Plasmacytic Pododermatitis is an uncommon dermatological disorder that affects one or multiple paw pads and leads to swelling, ulceration, hemorrhage, scaling, erythema, and striation. Its etiopathogenesis is poorly understood, however, an immune-mediated basis is strongly suggested. A two-year-old neutered, mixed breed, male cat was referred to the Veterinary Clinic of the Federal University of Santa Catarina (UFSC), Curitibanos Campus, with a brief clinical history of progressive lesions on palmar and plantar pads for one month. On physical examination, the patient had enlarged popliteal and inguinal lymph nodes, and paw pads with thin, swollen, hyperemic, erythematous, and purple color skin with multiple white striations. Histopathological diagnosis confirmed plasmacytic pododermatitis, and glucocorticoid therapy with prednisolone was prescribed. In the present report, the patient's clinical follow-up was compromised, as the tutor did not perform the prescribed treatment and did not return with the animal for further evaluations.

Morphological peculiarities in the integument of enigmatic anomalurid gliders (Anomaluridae, Rodentia).

Scaly-tailed squirrels, the most poorly known group of gliding mammals, hold the record for variety of remarkable integument peculiarities. One of the most striking of these features is the scales on the tail, which apparently allow them to reduce energy costs when positioning themselves on a tree trunk. No less interesting is a peculiar spur that supports the flying membrane: the unciform element ('spur'). Despite the peculiarity of such elements, their nature has not yet been studied. Using anatomical, histological methods and scanning electron microscopy we studied the structure of the skin and its derivatives in five of the six species from both genera of extant gliding scaly-tailed squirrels (Anomaluridae, Rodentia): Idiurus macrotis, Idiurus zenkeri, Anomalurus beecrofti, Anomalurus pusillus and Anomalurus derbianus. In addition to the common mammalian skin structures, such as hair, vibrissae, sebaceous glands, meibomian glands of eyelids and eccrine sweat glands of the palmar and plantar pads, these animals have unique species-specific skin derivatives (the tail scaly organ and its specific glands, vibrissae of the withers, patagium and its hair brush) that play a significant role in their adaptation to gliding and to their environment in general. The structure of the elbow spur is also described and hypotheses on its evolutionary origin from the tendon of the triceps muscle are presented.

Dietary fatty acid content and thickness of plantar pads in gilts

The objective of this study was to test a diet enriched in the most abundant components of foot fat pads (oleic and palmitic acid) to increase its thickness in gilts. We evaluated the effects of two oleic and palmitic acid dietary concentrations (control and test) and three treatment durations (35, 45, and 65 d) on 116 gilts (Landrace × Large White), all 180-d-old and slaughtered at the end of the study. Both test and control diets contained 5.9% total fat. The control diet contained 0.9% oleic acid and 0.6% palmitic acid; the test diet contained 1.9% and 1.2%, respectively. Body weight (BW), backfat (BF), lateral, and medial plantar pad thickness from the left rear leg were measured. No significant differences were detected for BW or BF between the test and control groups. The lateral pad was always thicker than the medial one (P < 0.001). No significant difference for plantar pad thickness was detected for the 35 d treatment. For the other treatments, thickness increased with respect to the control group (P < 0.01); the percentage of increase ranged from 20.8% (lateral side, 45 d treatment) to 37.8% (lateral side, 65 d treatment). Its effects on foot health must still be demonstrated.

Forefoot disorders and conservative treatment.

Forefoot disorders are often seen in clinical practice. Forefoot deformity and pain can deteriorate gait function and decrease quality of life. This review presents common forefoot disorders and conservative treatment using an insole or orthosis. Metatarsalgia is a painful foot condition affecting the metatarsal (MT) region of the foot. A MT pad, MT bar, or forefoot cushion can be used to alleviate MT pain. Hallux valgus is a deformity characterized by medial deviation of the first MT and lateral deviation of the hallux. A toe spreader, valgus splint, and bunion shield are commonly applied to patients with hallux valgus. Hallux limitus and hallux rigidus refer to painful limitations of dorsiflexion of the first metatarsophalangeal joint. A kinetic wedge foot orthosis or rocker sole can help relieve symptoms from hallux limitus or rigidus. Hammer, claw, and mallet toes are sagittal plane deformities of the lesser toes. Toe sleeve or padding can be applied over high-pressure areas in the proximal or distal interphalangeal joints or under the MT heads. An MT off-loading insole can also be used to alleviate symptoms following lesser toe deformities. Morton’s neuroma is a benign neuroma of an intermetatarsal plantar nerve that leads to a painful condition affecting the MT area. The MT bar, the plantar pad, or a more cushioned insole would be useful. In addition, patients with any of the above various forefoot disorders should avoid tight-fitting or high-heeled shoes. Applying an insole or orthosis and wearing proper shoes can be beneficial for managing forefoot disorders.

"Keep your feet on the ground": Simulated range of motion and hind foot posture of the Middle Jurassic sauropod Rhoetosaurus brownei and its implications for sauropod biology.

The biomechanics of the sauropod dinosaur pes is poorly understood, particularly among the earliest members of the group. To date, reasonably complete and articulated pedes in Early Middle Jurassic sauropods are rare, limited to a handful of taxa. Of these, Rhoetosaurus brownei, from eastern Australia, is currently the only one from the Gondwanan Middle Jurassic that preserves an articulated pes. Using Rhoetosaurus brownei as a case exemplar, we assessed its paleobiomechanical capabilities and pedal posture. Physical and virtual manipulations of the pedal elements were undertaken to evaluate the range of motion between the pedal joints, under both bone-to-bone and cartilaginous scenarios. Using the results as constraints, virtual reconstructions of all possible pedal postures were generated. We show that Rhoetosaurus brownei was capable of significant digital mobility at the osteological metatarsophalangeal and distal interphalangeal joints. We assume these movements would have been restricted by soft tissue in life but that their presence would have helped in the support of the animal. Further insights based on anatomy and theoretical mechanical constraints restricted the skeletal postures to a range encompassing digitigrade to subunguligrade stances. The approach was extended to additional sauropodomorph pedes, and some validation was provided via the bone data of an African elephant pes. Based on the resulting pedal configurations, the in-life plantar surface of the sauropod pes is inferred to extend caudally from the digits, with a soft tissue pad supporting the elevated metatarsus. The plantar pad is inferred to play a role in the reduction of biomechanical stresses, and to aid in support and locomotion. A pedal pad may have been a key biomechanical innovation in early sauropods, ultimately resulting in a functionally plantigrade pes, which may have arisen during the Early to Middle Jurassic. Further mechanical studies are ultimately required to permit validation of this long-standing hypothesis.

Afferent stimulation inhibits abnormal cutaneous reflex activity in patients with spinal cord injury spasticity syndrome.

Tibialis Anterior (TA) cutaneous reflex (CR) activity evoked following cutaneous stimulation of the plantar (Pl) surface (Pl-TA CR) has demonstrated hyperreflexia and damage of inhibitory mechanisms in subjects with spinal cord injury (SCI) and spasticity. To modulate Pl-TA CR and Soleus H-reflex activity with transcutaneous electrical nerve stimulation (TENS) and vibratory stimulation of the plantar pad during rest and controlled isometric plantarflexion. Non-injured subjects (n = 11) and individuals with incomplete SCI with (n = 14) and without spasticity (n = 14) were recruited. The effect of TENS and vibratory stimuli on Pl-TA CR and soleus H-reflex activity were assessed during rest and controlled ramp-and-hold plantarflexion. Vibration failed to inhibit H-reflex activity during rest or plantarflexoin following SCI compared to healthy subjects. In contrast, vibration-induced inhibition of Pl-TA CR was specifically detected in SCI spastic subjects during both rest and the hold phase of plantarflexion. TENS inhibited Pl-TA CR activity in the SCI spasticity group only during hold plantarflexion. Plantar vibratory stimuli inhibited the pl-TA CR, but not the H reflex, during rest and controlled movement in SCI spastic subjects. Assessment of Pl-TA CR modulation should contribute to the development of modality-specific sensory stimuli programmes for the neurorehabilitation of SCI spasticity.

Histoarchilecture Of Skin In Guinea Pig

The study aimes to described the histological stricture of skin in guinea pig an differention between thick and thin skin of different body regions , utilizing of (10) cutaneous specimens were taking from (6)anatomical regions including most of body which are abdomen , back, nose , ear , palmer pad and plantar pad. As the results revealed that the epidermis was thin in (ear ,abdomen and back) it composed of four secondary layers including from lower to upper: stratum Basale, Stratum Spinosum, Stratum Granulosum, and Stratum Corneum, while it was thick epidermis in nose, plantar pad , the palmer pad ,which characterized by presence of Stratum Lucidum beside the previous four layers. The study revealed a marked variation in the thickness of epidermis of the different skin regions: the thickest epidermis was in plantar pad (43.2) µm, on the contrary, the epidermis of ear region was found to be the thinnest 31.6 µm.it was also observed a direct relation between the whole thickness of the epidermis and the thickness of the Stratum corneum in all of the studied skin regions. Also we notice that the dermis composed of two essential layers. The superficial thin papillary layer which is located directly under the basement membrane and it's formed of loose and relatively cellular connective tissue and it included dermal papillae which is formed because the waves of basement membrane in different degree in anatomical regions and deep thick reticular layer which consists thick collagen fibers bundles that run parallel to the skin surface. The highest thickness of the dermis was observed in the plantar pad (36) µm, while it is reduced in the abdomen skin to (4) µm, the thickness of the other regions ranging between those two extremes .The study also clear the presence of carbohydrates in dermis more than epidermis as well as the epidermis – dermal junction is delicate in thin skin while dens in thick skin.

Craniometrics are not outdated: Interspecific morphological divergence in cryptic arvicoline rodents from Iran

We studied interspecific variability in external, cranial, and dental traits in seven species belonging to two closely related arvicoline (Arvicolinae) subgenera, the social voles (Sumeriomys) and the grey voles (Microtus). These voles were for long regarded as morphologically cryptic and the species complexity was fully appreciated only after chromosomal and molecular markers were utilized. Specimens we examined displayed clear external differences between the subgenera. Social voles had five plantar pads, relatively shorter tail (22–27% of head and body length), lighter dorsal pelage, whitish grey belly, and monochromatic or indistinctly bicolored tail. Grey voles showed six plantar pads, relatively longer tail (33–44%), dark brown back, grey belly, and sharply bicolored tail. Our results retrieved considerable heterogeneity in cranial and dental morphology. Major cranial differences between the subgenera associated with the interorbital region, the braincase and the tympanic bullae. Genetic (Kimura 2-parameter) distances, which presumably provided a priori correct estimate of the true phylogenetic divergences, explained 42% of morphometric distances between species. Below the level of a subgenus the phylogenetic signal was conserved in grey voles but it dissolved in social voles. The molecular and morphological rates of evolution were obviously decoupled in the latter possibly by selective pressures for a particular phenotype. Climatic variables however explained only 11% of interspecific heterogeneity in cranial shape. The most distinct in terms of morphology and the climatic properties of its habitat was Microtus irani which also occupies the very edge of Microtus distribution. High species richness of social and grey voles combined with heterogeneity of environmental conditions makes the Middle East an ideal region for studying diversity of developmental trajectories in voles at the levels of species and populations.

Getting to the root of scales, feather and hair: As deep as odontodes?

While every jawed vertebrate, or its recent ancestor, possesses teeth, skin appendages are characteristic of the living clades: skin denticles (odontodes) in chondrichthyans, dermal scales in teleosts, ducted multicellular glands in amphibians, epidermal scales in squamates, feathers in birds and hair-gland complexes in mammals, all of them showing a dense periodic patterning. While the odontode origin of teleost scales is generally accepted, the origin of both feather and hair is still debated. They appear long before mammals and birds, at least in the Jurassic in mammaliaforms and in ornithodires (pterosaurs and dinosaurs), and are contemporary to scales of early squamates. Epidermal scales might have appeared several times in evolution, and basal amniotes could not have developed a scaled dry integument, as the function of hair follicle requires its association with glands. In areas such as amnion, cornea or plantar pads, the formation of feather and hair is prevented early in embryogenesis, but can be easily reverted by playing with the Wnt/BMP/Shh pathways, which both imply the plasticity and the default competence of ectoderm. Conserved ectodermal/mesenchymal signalling pathways lead to placode formation, while later the crosstalk differs, as well as the final performing tissue(s): both epidermis and dermis for teeth and odontodes, mostly dermis for teleosts scales and only epidermis for squamate scale, feather and hair. We therefore suggest that tooth, dermal scale, epidermal scale, feather and hair evolved in parallel from a shared placode/dermal cell unit, which was present in a common ancestor, an early vertebrate gnathostome with odontodes, ca. 420million years ago.

The Applicability of Plantar Padding in Reducing Peak Plantar Pressure in the Forefeet of Healthy AdultsImplications for the Foot at Risk.

We investigated the effectiveness and durability of two types of plantar padding, the plantar metatarsal pad and the single wing plantar cover, which are commonly used for reducing forefoot plantar pressures. Mean peak plantar pressure and impulse at the hallux and at the first, second, third, and fourth metatarsophalangeal joints across both feet were recorded using the two-step method in 18 individuals with normal asymptomatic feet. Plantar paddings were retained for 5 days, and their durability and effectiveness were assessed by repeating the foot plantar measurement at baseline and after 3 and 5 days. The single wing plantar cover devised from 5-mm felt adhesive padding was effective and durable in reducing peak plantar pressure and impulse at the first metatarsophalangeal joint (P = .001 and P = .015, respectively); however, it was not found to be effective in reducing peak plantar pressure and impulse at the hallux (P = .782 and P = .845, respectively). The plantar metatarsal pad was not effective in reducing plantar forefoot pressure and impulse at the second, third, and fourth metatarsophalangeal joints (P = .310 and P = .174, respectively). These results imply limited applicability of the single wing plantar cover and the plantar metatarsal pad in reducing hallux pressure and second through fourth metatarsophalangeal joint pressure, respectively. However, the single wing plantar cover remained durable for the 5 days of the trial and was effective in reducing the peak plantar pressure and impulse underneath the first metatarsophalangeal joint.

The spiny rat Proechimys guyannensis (Rodentia: Echimydae) fails to respond to intradermal inoculation with Leishmania (Viannia) braziliensis

Leishmaniasis a disease of worldwide occurrence is caused by protozoa of the Leishmania genus. In Brazil, Leishmania (Viannia) braziliensis is the main parasite responsible for the American cutaneous leishmaniasis. Main hosts of this protozoa are small wild mammals particularly marsupials and rodents. The aim of this study was to evaluate if spiny rat Proechimys guyannensis (Rodentia: Echimydae) has role in the cycle of the American cutaneous leishmaniasis caused by L. (V.) braziliensis. Thus, promastigotes (the flagellate stage) of Leishmania (Viannia) braziliensis were used to inoculate seven spiny rats (Proechimys guyannensis). After inoculated intradermal at the ear pinna, nose and plantar pad, the rats were monitored for 180 days. Tissue samples collected at 90 and 180 days from the rats proved to be negative for the presence of genetic material from the parasite. After euthanasia, the protozoa also failed to growth in culture medium containing tissue samples collected from the rats showing that there was no infection. These results fail to prove that spiny rat has a role in the cycle of the American cutaneous leishmaniasis caused by L. (V.) braziliensis.

Did all theropods have chicken-like feet? First evidence of a non-avian dinosaur podotheca

The podotheca is the structure of scales covering the foot in extant birds. It is usually assumed that this structure is present in the whole clade of theropod dinosaurs; however, the knowledge of the origin of the podotheca is based on scarce direct evidence and its point of emergence within Theropoda is ambiguous. Here we discuss the relatively complete and well preserved podotheca of the basal tetanurae Concavenator corcovatus, which allows the description of its structure and its osteological correlation. We describe the skin pattern around the autopod of Concavenator and we compare it with available fossil skin impressions and the skin of extant crocodiles and birds. These scale impressions present a similar pattern to those observed in the autopod of avian theropods, so our results suggest that Concavenator have a bird-like podotheca. On the other hand, there is a current debate about the ichnological–osteological correlation in dinosaurs, derived from the lack of knowledge about the position of the phalanges in relation to the plantar pads of the podotheca. We describe, in Concavenator, an arthral condition of the position of the plantar pads. This condition would be the basal condition in the tetanurans and, thus, the ichnological record could be interpreted with an additional criterion. The autopod of Concavenator provides the first evidence of this type of structure in a non-avian theropod and it sheds light on the origin and distribution of this structure in the theropod large lineage.

Long-term changes in adaptive behavior of rats after inflammatory pain stimulation during neonatal development

This study is devoted to the investigation of the functional activity of the tonic nociceptive system using the formalin test. We also studied the anxiety level indices, proneness to depression-like behavior and spatial learning in adolescent male rats exposed in the neonatal development to repeated pain stimulation induced by peripheral inflammation. The following groups of 25-day-old rats were used being exposed at the age of 7 and 8 days to: (1) pain stimulation by formalin injection with maternal deprivation for 1 h (FD), (2) same formalin-induced pain stimulation without maternal deprivation (FWD), (3) physiological saline injection with maternal deprivation for 1 h (PD), (4) physiological saline injection without maternal deprivation (PWD) and (5) no stimulation (intact rats). Our findings indicate that pain induced in 7–8-day-old rat pups by formalin injection into the hind leg plantar pad manifests itself at adolescence (25 days) in an inflammatory pain response enhancement under the same pain stimulation as in the formalin test, adaptive behavior disorder in the forced swim test, and spatial learning disability. Also of particular importance is our observation that short-term repeated maternal deprivation of the 7–8-day-old rat pups in the absence of inflammatory pain increases the depression-like behavior proneness index. Thus, the repeated inflammatory pain stimulation during the neonatal development brings about significant changes in the studied types of adaptive behavior as well as in spatial learning in adolescent rats.

Congenital foot deformation alters the topographic organization in the primate somatosensory system.

Limbs may fail to grow properly during fetal development, but the extent to which such growth alters the nervous system has not been extensively explored. Here we describe the organization of the somatosensory system in a 6-year-old monkey (Macaca radiata) born with a deformed left foot in comparison to the results from a normal monkey (Macaca fascicularis). Toes 1, 3, and 5 were missing, but the proximal parts of toes 2 and 4 were present. We used anatomical tracers to characterize the patterns of peripheral input to the spinal cord and brainstem, as well as between thalamus and cortex. We also determined the somatotopic organization of primary somatosensory area 3b of both hemispheres using multiunit electrophysiological recording. Tracers were subcutaneously injected into matching locations of each foot to reveal their representations within the lumbar spinal cord, and the gracile nucleus (GrN) of the brainstem. Tracers injected into the representations of the toes and plantar pads of cortical area 3b labeled neurons in the ventroposterior lateral nucleus (VPL) of the thalamus. Contrary to the orderly arrangement of the foot representation throughout the lemniscal pathway in the normal monkey, the plantar representation of the deformed foot was significantly expanded and intruded into the expected representations of toes in the spinal cord, GrN, VPL, and area 3b. We also observed abnormal representation of the intact foot in the ipsilateral spinal cord and contralateral area 3b. Thus, congenital malformation influences the somatotopic representation of the deformed as well as the intact foot.

Sudomotor function and sweat gland innervation in galanin knockout mice

The presence of galanin and galanin binding sites in sweat gland has been demonstrated previously. In order to investigate whether galanin can influence sweat gland function, we compared sweating induced in footpads of wild type and galanin knockout mice by cholinergic and thermal stimulation using the silicone impression technique. Pilocarpine injections resulted in a similar number of reactive sweat glands and non-significant difference in the amount of sweat secretion in wild type and galanin knockout mice. However, thermal stimulation led to a significant increase in the number of secreting sweat glands in galanin knockout mice. To further evaluate possible differences in the innervation of sweat glands that could explain differences in their secretory activity, immunohistochemical labeling of cutaneous and sudomotor innervations against protein gene product 9.5, vasoactive intestinal polypeptide and choline acetyltransferase in plantar pads was performed. Immunohistochemical analysis revealed no significant differences in the distribution and intensity of the innervations between wild type mice and galanin knockout mice. Although our results indicate normal cholinergic responses and innervation of the sweat glands in galanin knockout mice, they also demonstrate that galanin plays a role in regulating the sudomotor activity in response to thermal stimulation.

Plantar Heel Reconstruction with a Sensate Plantar Medial Artery Musculocutaneous Pedicled Island Flap after Wide Excision of Melanoma

Reconstruction of soft tissue defects in the plantar heel pad presents a surgical challenge that requires replacing the lost tissue with another tissue having similarly unique physical characteristics. This case report describes a reconstruction of the plantar heel pad after wide excision of a heel melanoma, using a sensate plantar medial artery musculocutaneous pedicled island flap.

Al-Aqeel Sewairi syndrome, MIM#605156, a prototype for personalized medicine for the study and prevention of genetic metabolic disorders in Saudi Arabia

Aims. Middle Eastern cultures are tribal and heavily consanguineous. Marriage between cousins has been part of the culture for millennia, leading to ‘founder’ effect and a large number of autosomal diseases. In Saudi Arabia, like other Middle Eastern countries, first-cousin marriages account for almost 60–70% of all marriages, leading to uniquely common disorders which are either rare by Western standards or completely unknown. Most of these disorders lead to physical and mental handicap; affected children have poor development and reduced mental capacity. Therefore, accurate diagnosis of the exact molecular defect and prevention is the main aim of our management of these children. Material and Methods. Applying personalized genomics for the diagnosis, prevention and treatment of our patients with genetic metabolic disorders in accordance with our Islamic ethical guidelines is our most important strategy in managing our patients. An example of such an application in Saudi Arabia is the previously described novel autosomal recessive osteolysis/arthritis syndrome, multicentric osteolysis nodulosis with arthritis (MONA) (NOA) (Al-Aqeel Syndrome) (MIM#605156), a distinctive autosomal recessive multicentric osteolysis in Saudi Arabian families with distal arthropathy of the metacarpal, metatarsal and interphalangeal joints, with ultimate progression to the proximal joints with decreased range of movements and deformities with ankylosis and generalized osteopenia. In addition, patients have large, painful to touch palmar and plantar pads; they are also found to have hirsutism and mild dysmorphic facial features including proptosis, a narrow nasal bridge, bulbous nose and micrognathia. Results. The syndrome is caused by inactivating mutations in the MMP2 gene, for which we have established prevention and therapeutic strategy. We have also established with other colleagues the exact genetic defect after establishing the accurate diagnosis and the systematic prevention of genetic disorders by pre-implantation genetic diagnosis with a success in over 160 cases in which the result was the birth of normal children, including patients with Al-Aqeel Sewairi syndrome. We are also establishing stem cell therapy for Genetic Metabolic disorders, with Al-Aqeel Sewairi syndrome as the prototype for such promising modality for treatment of mental and physical handicap in children. These strategies must be done in accordance with our ethical and religious background, with priorities given to the rights of patients and families to know and to make their own decisions as dictated by our Islamic ethics. Conclusion. Personalized medicine includes diagnostic and prognostic approaches, and must include personalized preventive and therapeutic strategies in accordance with our Islamic ethical standards.