Plantar Region Research Articles

Rare cutaneous verrucous carcinoma in the femoral region: a case report

BackgroundVerrucous carcinoma (VC) is a well-differentiated variant of squamous cell carcinoma (SCC) characterized by slow growth and low metastatic potential. Cutaneous verrucous carcinoma (CVC) or papillomatosis cutis carcinoides is the term used for VC in other locations than the oral, anogenital, and plantar regions. This rare tumor has a contradictory “benign” histology, but markedly aggressive clinical behavior. We present this case as background knowledge to corroborate clinical course, diagnosis, histopathology, and treatment options for this infrequent disease. Case DescriptionWe report a verrucous carcinoma on a 79-year-old man’s left thigh. Clinical examination showed a fungating mass with cauliflower-like appearance measuring 5x3x1 cm. Excisional biopsy revealed exo-endophytic proliferation of well-differentiated squamous epithelium invading the dermis with marked hyperkeratosis, parakeratosis, acanthosis, papillomatosis, pushing margins, and minimal cellular atypia (T2N0M0). It was successfully treated by wide local excision, inguinal lymph node dissection, and adjuvant radiotherapy. Follow-up after 1 year showed good wound healing without any loss of function or recurrence. ConclusionCutaneous verrucous carcinoma is a subtype of a low-grade SCC and is not an SCC with a verrucous presentation. Identification of the clinicopathological features is essential to distinguish CVC from its mimics and to make an early diagnosis. Although slow growth and confusing early-stage appearances can lead to delay in diagnosis or to misdiagnosis, this case has not raised many diagnosis problems regarding the cardinal manifestations of CVC. Regardless of any available therapeutic methods, surgical excision with safety margins is still a priority and CVC requires aggressive treatment.

Histopathologic and Molecular Features of Cutaneous Melanoma in a Moroccan Population.

Background Cutaneous cancer is the most common malignancy type, among which melanomas are considered the most aggressive and lethal. In Morocco, skin melanoma is the 25th most common cancer. To our knowledge, this is the first and largest Moroccan study specifically describing cutaneous melanoma. Materials and methods We obtained data for 100 patients diagnosed with cutaneous melanoma in the Department of Pathology of Hassan II University Hospital, Morocco. Clinical, histopathological, molecular, and follow-up data were recorded from pathology request forms and the patient's medical records. Results The mean age of our patients was 65 years old. Histologically, the most prevalent were the nodular (48%) and acro-lentiginous (38%) melanoma subtypes. A total of 66% of the patients had a Breslow thickness of >4 mm. The presence of ulceration was noted in 46% of cases. The average mitoses was 9/1 mm². A total of 44% of patients had metastatic melanoma at the time of diagnosis. The BRAF V600E mutation was found in six cases, and the C-KIT mutation in five cases. The five-year overall survival and metastasis-free survival were 85% and 15%, respectively. There was a significant correlation between Breslow thickness and Clark's level (p<0.001), histologic subtype (p=0.012), and presence of metastasis (p=0.002). There was a significant difference between the head and neck melanomas and those of the feet, particularly in the histological subtype and the presence of ulceration. BRAF V600E mutation was found in six cases of metastatic melanomas of the head and neck, of which three cases were positive for this mutation, as compared with the 23 cases of acral melanomas, which tested negative for the same mutation. Conclusion The results of our study showed that cutaneous melanomas were characterized by advanced age at diagnosis and late-stage diagnosis with a high Breslow index. The lower limbs were the most affected sites, especially in the plantar region. The acral lentiginous subtype was the most common. The presence of BRAF V600E mutation was associated with a better prognosis.

Anti-Arthritic Effect of the Aqueous Extracts of the Roots and Barks of Gossypium herbaceous in Complete Freund’s Adjuvant Induced Arthritis in Female Wistar Rats

Background: Rheumatoid arthritis (RA) is an autoimmune disease characterized by chronic inflammation of one or more joints resulting to disability. Age (above 50 years) and life style are the main risk factors. In this study, we evaluated the effects of the aqueous extracts of the roots and barks of Gossypium herbaceum (G. herbaceous) in Complete Freund’s Adjuvant (CFA) induced rheumatoid arthritis in female wistar rats.&#x0D; Materials and Methods: In vitro anti-inflammatory tests were conducted through the inhibition of hemolysis and lipid peroxidation. An acute toxicity test of both extracts was done. 25 female Wistar rats were used. RA was induced in 20 rats (4 groups) by injecting CFA into the sub plantar region of the right hind paw of each rat. On day 25 of the experiment, the rats were sacrificed, and the sera were prepared for the evaluation of some inflammatory and biochemical parameters. The paws were dissected and kept for histological analyzes.&#x0D; Results: The extracts revealed anti-inflammatory activities in vitro, with a higher activity observed from the roots. Both extracts restored body weight and significantly reduced edema compared to the negative control group. The histological analyzes of the RA group revealed the presence of white blood cells in the synovial fluid and cartilage destruction as compared to the groups receiving roots’ aqueous extract and methotrexate. Both extracts significantly restored the levels of some inflammatory and biochemical parameters.&#x0D; Conclusion: Anti-inflammatory and biochemical tests showed that the aqueous extracts of the roots and barks of G. herbaceous are potentially effective in the management of RA.

Comparison of the plantar pressure distribution and mechanical alignment in patients with varus knee osteoarthritis following high tibial osteotomy

PurposeThe changes in the lower limb alignment were vitally important after high tibial osteotomy (HTO). Therefore, the purpose of present study was to analyze the characteristics of plantar pressure distribution after HTO, and to investigate the effect of plantar pressure distribution on postoperative limb alignment.MethodsBetween May 2020 and April 2021, varus knee patients undergoing HTO were evaluated in the present study. The peak pressure of plantar regions, medial-lateral pressure ratio (MLPR), foot progression angle (FTA), anteroposterior COP (AP-COP), lateral symmetry of COP (LS-COP), and the radiographic parameters were evaluated preoperatively and at the final follow-up. Compared among the slight valgus (SV), moderate valgus (MV) and large valgus (LV) groups at the final follow-up, the peak pressure of HM, HC and M5 regions, and the MLPR were compared; the Knee Injury and Osteoarthritis Outcome Score4 (KOOS4) including four subscales, and the American of orthopedic foot and ankle society (AOFAS) were evaluated.ResultsThe WBL%, HKA and TPI angle changed significantly after HTO (P < 0.001). The preoperative group exhibited a lower peak pressure in the HM region (P < 0.05) and higher peak pressure in the M5 region (P < 0.05); the pre- and postoperative groups exhibited a lower peak pressure in the HC region (P < 0.05); the rearfoot MLPR was significantly lower and LS-COP was significantly higher in the preoperative group (P = 0.017 in MLPR and 0.031 in LS-COP, respectively). Comparison among the SV, MV and LV groups, the SV group indicated a lower peak pressure in the HM region (P = 0.036), and a lower MLPR in the rearfoot (P = 0.033). The KOOS Sport/Re score in the MV and LV groups increased significantly compared with the SV group (P = 0.042).ConclusionPlantar pressure distribution during the stance phase in patients with varus knee OA following HTO exhibited a more medialized rearfoot plantar pressure distribution pattern than that before surgery. Compared with the small valgus alignment, a moderate to large valgus alignment allows patients to walk with a more even medial and lateral plantar pressure distribution, which is more similar to healthy adults.

Statistical analysis on multi-factors of dynamic plantar pressure to normal subjects

Plantar pressure analysis has been found effective in many fields, such as rehabilitation evaluation, footwear design, nervous system disease analysis, etc. Plantar pressure features may be affected by many factors, such as age, gender, weight, etc., which cannot be ignored in related research and applications. Our research focuses on normal groups, mainly analyzes the differences between different age and gender groups, and considers the influence of height, weight, shoe size, and body mass index (BMI). Measured by a dynamic plantar pressure system, the plantar pressure data of the subjects in walking and standing states are analyzed. Through analysis by statistics and regression methods, we draw the following main conclusions: (1) there are obvious differences between young and old groups in static features, reflecting the impact of age on human balance; (2) the difference between men and women is more in the pressure distribution of the plantar region, especially in the metatarsal region, reflecting the difference in the physiological structure caused by gender; (3) it is also found that height, weight, shoe size and BMI have certain effects.

Prediction of Diabetes Mellitus Progression Using Supervised Machine Learning

Diabetic peripheral neuropathy (DN) is a serious complication of diabetes mellitus (DM) that can lead to foot ulceration and eventual amputation if not treated properly. Therefore, detecting DN early is important. This study presents an approach for diagnosing various stages of the progression of DM in lower extremities using machine learning to classify individuals with prediabetes (PD; n = 19), diabetes without (D; n = 62), and diabetes with peripheral neuropathy (DN; n = 29) based on dynamic pressure distribution collected using pressure-measuring insoles. Dynamic plantar pressure measurements were recorded bilaterally (60 Hz) for several steps during the support phase of walking while participants walked at self-selected speeds over a straight path. Pressure data were grouped and divided into three plantar regions: rearfoot, midfoot, and forefoot. For each region, peak plantar pressure, peak pressure gradient, and pressure–time integral were calculated. A variety of supervised machine learning algorithms were used to assess the performance of models trained using different combinations of pressure and non-pressure features to predict diagnoses. The effects of choosing various subsets of these features on the model’s accuracy were also considered. The best performing models produced accuracies between 94–100%, showing the proposed approach can be used to augment current diagnostic methods.

Ultrasound Morphometry and Mean Echogenicity of Digital Flexor Tendons, Suspensory Ligament, and Accessory Ligament of Digital Deep Flexor Tendon in Gaited Horses.

The objective of this study was to evaluate and compare the sonographic characteristics of the digital flexor tendons and ligaments of the palmar/plantar of the metacarpal and metatarsal regions in gaited horses, as well as to establish normal reference ultrasound values for Mangalarga Marchador (MM) and Campeiro breeds. Transverse sonographic images were obtained of 50 adult and healthy horses from the MM (n = 25) and Campeiro (n = 25) breeds. The images were taken in six metacarpal/metatarsal zones, and the following measurements were taken: transverse area, circumference, dorsopalmar/plantar length, lateromedial length, and mean echogenicity. Differences were observed between breeds in the fore- and hindlimbs, and, even when not significant, the Campeiro breed tended to have higher values for most variables and structures. Variations between zones and between structures in the same zone followed a similar trend in both breeds for all variables. In addition, the dimensions and variations between zones and structures were different between the fore- and hindlimbs, highlighting the need for specific values for the digital flexor tendons and ligaments of the metatarsal plantar region. In conclusion, the digital flexor tendons, suspensory ligaments, and accessory ligaments of the digital deep flexor tendon are influenced by the breed factor in gaited horses, and they are different between the fore- and hindlimbs.

Factors associated with severity and anatomical distribution of diabetic foot ulcer in Uganda: a multicenter cross-sectional study

BackgroundDiabetic foot ulcer (DFU) is a devastating complication of diabetes mellitus (DM) that is associated with increased mortality, morbidity, amputation rate and economic burden. This study aimed at identifying the anatomical distribution and factors associated with severity of DFU in Uganda.MethodologyThis was a multicenter cross-sectional study conducted in seven selected referral hospitals in Uganda. A total of 117 patients with DFU were enrolled in this study between November 2021 and January 2022. Descriptive analysis and modified Poisson regression analysis were performed at 95% confidence interval; factors with p-value < 0.2 at bivariate analysis were considered for multivariate analysis.ResultsThe right foot was affected in 47.9% (n = 56) of patients, 44.4% (n = 52) had the DFU on the plantar region of the foot and 47.9% (n = 56) had an ulcer of > 5 cm in diameter. The majority (50.4%, n = 59) of patients had one ulcer. 59.8% (n = 69) had severe DFU, 61.5% (n = 72) were female and 76.9% had uncontrolled blood sugar. The mean age in years was 57.5 (standard deviation 15.2 years). Primary (p = 0.011) and secondary (p < 0.001) school educational levels, moderate (p = 0.003) and severe visual loss (p = 0.011), 2 ulcers on one foot (p = 0.011), and eating vegetables regularly were protective against developing severe DFU (p = 0.03). Severity of DFU was 3.4 and 2.7 times more prevalent in patients with mild and moderate neuropathies (p < 0.01), respectively. Also, severity was 1.5 and 2.5 higher in patients with DFU of 5–10 cm (p = 0.047) and in those with > 10 cm diameter (p = 0.002), respectively.ConclusionMost DFU were located on the right foot and on the plantar region of the foot. The anatomical location was not associated with DFU severity. Neuropathies and ulcers of > 5 cm diameter were associated with severe DFU but primary and secondary school education level and eating vegetables were protective. Early management of the precipitating factors is important to reduce the burden of DFU.

Biosignals by In-Shoe Plantar Pressure Sensors on Different Hardness Mats during Running: A Cross-Over Study

Although the effects of running on plantar pressures have been detailed on several surfaces with different hardness, there is a lack of studies assessing the mechanical behavior analysis by in-shoe plantar pressure sensors on different hardness mats during running. The aim of the present study was to determine in-shoe maximum forces and peak plantar pressures on mats with different hardness, such as hard, soft and air chamber mats, during running. A cross-over study was carried out including 36 amateur runners from a sport center. The maximum force and peak pressures of the foot plantar region were analyzed on three different mat hardnesses —soft and hard polyurethane foam mats and air chamber mats—by in-shoe instrumented insoles. Running on soft polyurethane foam mats presented reduced maximum forces in the whole plantar region and mainly peak pressures in the anterior part of the foot plantar region, such as the toes and first to fourth metatarsal heads, compared to hard polyurethane foam and air chamber mats. The peak pressure in the fifth metatarsal head was specifically reduced during running on soft compared to hard polyurethane foam mats, and running on these soft mats decreased calcaneus peak pressures compared to running on air chamber mats. Running on air chamber mats increased peak plantar pressures in the first metatarsal head compared to running on hard polyurethane foam mats. The mechanical behavior of mats of different hardness could be used to adjust the degree of impact on plantar pressures to determine the most appropriate materials and hardness for running.

Effect of Offloading Plantar Pressure on Peak Pressure in Ten Plantar Regions and Gait Speed in Men With Diabetes and Active Diabetic Foot Ulcers, and Healthy Men

Background and Aims Diabetes is associated with dysfunction and damage in various organs due to abnormal pressure on ten plantar regions. This study aims to compare the effect of offloading plantar pressure on peak pressure of ten plantar regions and gait speed in men with diabetes and active diabetic foot ulcers, and healthy men. Methods This is a causal-comparative study. Participants were 30 healthy men, 30 diabetic men and 30 men with active diabetic foot ulcers who needed no leg amputation according to their physicians. Sampling was done using random and convenience methods. Diabetic foot ulcers were classified based on the Meggitt-Wagner classification criteria, according to which grade 1 indicates grade 1 indicates a superficial ulcer and was used as a criterion for selecting people with diabetic foot ulcers. Plantar pressure variables were recorded using RSscan software (RSscan International, Belgium; 0.5×0.5×0.02 m, 4363 sensors) at a sampling frequency of 300 Hz and the gait speed was measured using a digital stopwatch. Correct walking considered as the full impact of the foot on the middle of the foot scan machine. Data were analyzed using independent t-test in SPSS software, version 24. Results The peak pressure in the metatarsal 3 (P&lt;0.001), metatarsal 4 (P= 0.020), medial heel (P= 0.004) and lateral heel (P= 0.007) in the diabetic foot ulcer group significantly increased compared to the diabetic group. In addition, the peak pressure in the medial heel (P= 0.013) and lateral heel (P= 0.019) in the diabetic group significantly decreased compared to the healthy group. Conclusion Men with diabetic foot ulcers are more exposed to abnormal peak pressures in different plantar regions, which can cause irreversible clinical injuries. Diabetic men have a lower gait speed than healthy men which can be important in their rehabilitation.

Surgery and Behavioral Testing in the Tibial Neuroma Transposition Model in Rats.

The tibial neuroma transposition (TNT) is a rat model in which allodynia at the neuroma site (tibial nerve) can be independently evaluated from allodynia at the plantar surface of the hind paw innervated by the intact sural nerve. This TNT model is suitable to test therapies for neuroma pain, such as the potential superiority of certain surgical therapies that are already used in the clinic, or to evaluate new drugs and their effect on both pain modalities in the same animal. In this model, a distal lesion (neurotmesis) is made in the tibial nerve, and the proximal nerve end is transposed and fixed subcutaneously and pretibially to enable assessments of the neuroma site with a 15 g Von Frey monofilament. To assess allodynia over the sural nerve, Von Frey monofilaments can be used via the up-down method on the plantar lateral region of the hind paw. After cutting the tibial nerve, mechanical hypersensitivity develops at the neuroma site within 1 week after surgery and persists at least until 12 weeks after surgery. Allodynia at the sural innervated plantar surface develops within 3 weeks after surgery compared to the contralateral limb. At 12 weeks, a neuroma forms on the proximal end of the severed tibial nerve, indicated by dispersion and swirling of axons. For the TNT model surgery, multiple critical (micro)surgical steps need to be followed, and some surgery practice under terminal anesthesia is advised. Compared to other neuropathic pain models, such as the spared nerve injury model, allodynia over the neuroma site can be independently tested from sural nerve hypersensitivity in the TNT model. However, the neuroma site can be tested only in rats, not in mice. The tips and directions provided in this protocol can help research groups working on pain successfully implement the TNT model in their facility.

Perfil termográfico das extremidades inferiores de indivíduos em tratamento de feridas ulcerativas: uma exploração qualitativa das imagens

ABSTRACT Thermography proves to be a new concept in measuring the thermogenesis of biological systems, a valuable method for confirming clinical diagnosis discarding subjective analysis and personal criteria. The result of the thermographic evaluation is the subject of qualitative and quantitative analyses. This study aimed to identify the thermal profile of the lower extremities of individuals diagnosed with cardiovascular and endocrine and metabolic diseases in the treatment of ulcerative wounds. A thermographic evaluation was performed from 19 dorsal, plantar, lateral, and medial extremities. In the qualitative analysis, images with and without a wound were divided according to diagnosis. After the division, a checklist was elaborated for the qualitative evaluation of the images. A total of 100 individuals (49 women and 51 men) participated, 65 with cardiovascular disease and 35 with endocrine and metabolic disease. There was a difference in the thermal pattern between the extremities in both diagnoses. The groups presented similar thermographic characteristics with signs of more radiation in the wounds, predominantly with red and white stains. More regions of interest with lesions on the medial foot, lateral, and medial ankle border were observed in individuals with chronic cardiovascular disease. Those with endocrine and metabolic disease presented more regions with lesions in the plantar (forefoot), dorsal, and medial ankle regions. The profile showed a discrepancy in the thermal pattern in the regions of interest of wounded and without wound extremities according to the diagnoses. Signs of wounds emitting high levels of radiation were similar in both groups, but the physiology of the disease and treatment differed.

Evaluation of ethanolic extract of leaves of Abutilon indicum on carrageenan-induced rat paw edema

Background: Inflammation is described as a localized physical condition whereat part of the body becomes swollen, reddened, hot, and consistently painful, largely as a response to injury or infection. Aim and Objectives: The current study is designed to study the Abutilon indicum for its anti-inflammatory activity in albino rats-induced paw edema by carrageenan. Materials and Methods: Randomly 30 albino rats from both sexes were taken and divided into five groups, six in each. Normal saline 25 mL/kg (control), diclofenac 9 mg/kg (standard), and three different doses of plant extract (EEAI) such as 250, 500, and 1000 mg/kg (3 test groups) were given in respective groups, after 1-h injection of 0.1 mL of 0.2% carrageenan solution into the sub plantar region of the right hind paw. At 0 h, after 1, 2, and 3 h, paw edema volume was measured by mercury displacement method using plethysmograph. The percentage of edema inhibition was measured in all five groups. Results: The percentage of edema inhibition for EEAI 500 mg/kg was 6.20%, 17.8%, and 26.72% after 1st, 2nd and 3rd h respectively and for EEAI 1000 mg/kg was 8.26%, 20.7%, 31.61% after 1st, 2nd, and 3rd h, respectively. Significant edema inhibition was observed after 2nd and 3rd h of drug administration (P &lt; 0.05) in both groups treated with EEAI 500 and 1000 mg/kg. Conclusion: Ethanolic extract of A. indicum had shown dose dependent anti-inflammatory activity.

Skin Manifestations associated with COVID-19

Introduction: the recognition of skin manifestations in patients with COVID-19 is very useful since its identification could help to diagnose SARS-COV-2 infection early and contribute to delaying the transmission of the virus.Objective: determine the skin manifestations associated with Covid 19.Methods: a narrative bibliographical review was carried out; For the search for information, Scopus and PubMed databases were used with MESH/DECS descriptors using keywords, taking into account the last five years, in English and Spanish, and with inclusion and exclusion criteria for the articles to be analyzed.Results: in Spain, 58 patients admitted to hospital for suspected COVID-19 infection presented skin lesions such as generalized maculopapular rash (20,7 %), Livedo reticularis (6,9 %), Urticaria (6,9 %) and others non-specific eruptions in 22,4 %.Conclusion: the most frequent lesions are urticarial rash, erythematous/maculopapular/morbilliform confluent rash, papulovesicular rash, chilblain-like acral pattern, livedo reticularis/racemose pattern, vasculitic purpuric pattern, cataloging the most frequent skin lesions to maculopapular rash that affect the trunk. and acral regions, especially toes and plantar region

The pressure time integral: An underused, clinically significant parameter as a determinant of neuropathic ulceration in diabetes

BackgroundThe purpose of this study was to evaluate plantar pressure dynamics in the occurrence of active diabetic neuropathic ulceration (DNU) and any changes in loadings occurring in individuals with a history of diabetic neuropathic ulceration (DHNU). Since current gold standard offloading strategies are not producing desirable healing outcomes and optimum ulcer prevention, this study aimed to better understand the effect of diabetic peripheral neuropathy (DPN) and ulceration on mean peak plantar pressure (MPPP) and pressure-time integral (PTI) changes. Research questionIs there a redistribution of plantar pressure during gait in the presence of active and history of diabetic neuropathic ulceration? MethodsA prospective, cross-sectional study was conducted, in which, eighty adult participants were divided into four groups, namely, the DM, DPN, DNU and DHNU groups. Participants were instructed to walk barefoot over a Tekscan HR Mat™ at self-selected speed. MPPP and PTI data were analysed under five forefoot anatomical landmarks and compared between individuals with and without active neuropathic ulceration. ResultsMinimal MPPP significant changes were observed between ulcerated and non-ulcerated groups, however, PTI values were significantly increased in the ulcerated groups under all plantar ulceration regions. No significant plantar pressure differences were observed between the DNU and DHNU groups. Logistic regression tests demonstrated that as PTIs under the hallux increase, the likelihood of an individual living with DPN developing ulceration increases. SignificanceA significant increase in PTI values in the presence of ulceration highlights the importance of evaluating the duration of loads under forefoot regions during gait rather than just focusing on the magnitude of pressures during ulcer management and prevention. Moreover, results show that PTI values remain high in the presence of a history of neuropathic ulceration, possibly demonstrating the value of PTI as a clinical tool over MPPP in the assessment of the high-risk diabetic foot.

Impact of Sex and Velocity on Plantar Pressure Distribution during Gait: A Cross-Sectional Study Using an Instrumented Pressure-Sensitive Walkway.

In-shoe systems and pressure plates are used to assess plantar pressure during gait, but additional tools are employed to evaluate other gait parameters. The GAITRite® system is a clinical gait evaluation tool. Extensive literature is available for spatiotemporal parameters, but it is scarce for relative plantar pressure data. Therefore, we investigated whether, when controlling for age, the GAITRite® system is able to distinguish the effects of walking velocity on plantar pressure parameters in six plantar regions in a large sample of adults. Participants (83 women and 87 men, aged 18−85 years) walked at three self-selected velocities (slow, preferred, fast) on a 6-m long GAITRite® walkway. Relative peak pressure, pressure-time integral, peak time and contact area were computed for six zones (lateral and medial heel, mid- and forefoot). The impact of age (covariate), sex, side, velocity, pressure zone and their interactions on pressure variables was evaluated. Velocity affected peak pressure, pressure-time integral, peak time and contact area (p < 0.001). With increasing self-selected gait velocity, medial forefoot peak pressure and pressure-time integral increased (p < 0.001), while heel and lateral forefoot regions displayed a nonlinear plantar pressure evolution. These results suggest lower (heel strike) or more equally distributed (push-off) loads at preferred gait velocity.

Anti-inflammatory activity of methanol and ethyl acetate fractions of Sesbania grandiflora roots in rats

The anti-inflammatory potential of methanol and ethyl acetate fractions of Sesbania grandiflora Linn., roots were evaluated by carrageenan induced rat paw oedema method and cotton pellet induced granuloma in rats. Female Wistar rats were treated orally with methanol (MFSGR) and ethyl acetate (EAFSGR) fractions of Sesbania grandiflora roots (100 and 200 mg/kg) and Diclofenac sodium (15 mg/kg). One-hour post treatment, Carrageenan (0.1 ml of 1 % w/v, s.c.) was administered in the sub plantar region of the left hind limb of rat. Thereafter, paw volume was measured at 0, 30 min, 1, 2, 3 and 4 h. Percentage inhibition (PI) of oedema was calculated. In cotton pellet-induced granuloma model, male Wistar rats were treated with Diclofenac sodium (10 mg/kg, p.o.) and MFSGR and EAFSGR (100 and 200 mg/kg, p.o.) respectively. Thirty-minutes after respective treatment, an autoclaved cotton pellet of 20±1 mg was aseptically implanted subcutaneously. Fraction and standard diclofenac were administered once daily for the next 7 days. On 8th day, excised cotton granuloma was dried and weighed, body weight and organ index were calculated. MFSGR and EAFSGR (100 and 200 mg/kg) exhibited a significant inhibition in paw volume against carrageenan-induced paw oedema. In cotton pellet induced granuloma model, MFSGR and EAFSGR exhibited significant inhibition of cotton dry and wet weight. The present study suggests that the methanol and ethyl acetate fractions of Sesbania grandiflora roots exhibit anti-inflammatory activity. The observed effect could be attributed to the presence of vital phytoconstituents.

Coverage maps demonstrate 3D Chopart joint subluxation in weightbearing CT of progressive collapsing foot deformity

A key element of the peritalar subluxation (PTS) seen in progressive collapsing foot deformity (PCFD) occurs through the transverse tarsal joint complex. However, the normal and pathological relations of these joints are not well understood. The objective of this study to compare Chopart articular coverages between PCFD patients and controls using weight-bearing computed tomography (WBCT). In this retrospective case control study, 20 patients with PCFD and 20 matched controls were evaluated. Distance and coverage mapping techniques were used to evaluate the talonavicular and calcaneocuboid interfaces. Principal axes were used to divide the talar head into 6 regions (medial/central/lateral and plantar/dorsal) and the calcaneocuboid interface into 4 regions. Repeated selections were performed to evaluate reliability of joint interface identification. Surface selections had high reliability with an ICC > 0.99. Talar head coverage decreases in plantarmedial and dorsalmedial (− 79%, p = 0.003 and − 77%, p = 0.00004) regions were seen with corresponding increases in plantarlateral and dorsolateral regions (30%, p = 0.0003 and 21%, p = 0.002) in PCFD. Calcaneocuboid coverage decreased in plantar and medial regions (− 12%, p = 0.006 and − 9%, p = 0.037) and increased in the lateral region (13%, p = 0.002). Significant subluxation occurs across the medial regions of the talar head and the plantar medial regions of the calcaneocuboid joint. Coverage and distance mapping provide a baseline for understanding Chopart joint changes in PCFD under full weightbearing conditions.

Reconceptualizing the Juvenile Bunion.

The operative management of the juvenile bunion has not enjoyed the same level of success as its adult counterpart leading to the concern that we do not fully understand what differentiates these 2 deformities. This study aims to (1) characterize the radiographic and pedobarographic features commonly encountered in the juvenile bunion and (2) determine which of these radiographic or pedobarographic parameters correlate with patient-reported outcome (PRO) scores at the time of presentation. An IRB-approved retrospective analysis of prospectively enrolled patients between 10 and 18 years of age with bunion deformities was performed at a single pediatric institution over a 4-year period. Standardized weight-bearing radiographs were used to determine hallux valgus angle (HVA), intermetatarsal angle, sesamoid position (SP), distal metatarsal articular angle (DMAA), and other radiographic parameters. Pedobarographic analysis was used to determine peak pressure, contact area, contact time, and pressure-time integral within 11 plantar regions. Foot-specific PRO measures were administered at the initial presentation. Thirty-two patients (57 feet) met the inclusion criteria of which56/57 feet (98.2%) had an elevated DMAA (average 21.4degrees±8.9 degrees), and 51/57 (89.4%) had a congruent joint. The DMAA correlated positively with the HVA (r=0.734 P <0.001), intermetatarsal angle (r=0.439 P =0.001), and SP (r=0.627 P <0.001). Pedobarographic analysis (available in 15/32 patients) demonstrated that the HVA correlated with increased second metatarsal head peak pressure (r=0.667 P =0.011) and pressure-time integral (r=0.604 P =0.002), which in turn was strongly correlated with worse PROs. Conversely, increased first metatarsal head contact area correlated with improved PROs. Analysis of radiographic measurements demonstrated that HVA and lateralized SP correlated significantly with worse PRO scores. Nearly all juvenile bunions have an elevated DMAA and a congruent joint. There is a clear correlation between the severity of radiographic and pedobarographic deformity and worse PRO scores at the time of presentation. We believe that the presence of elevated DMAA is the defining factor that differentiates the juvenile bunion from the deformity typically seen in adults. III.

Chopart Peritalar Subluxation in Progressive Collapsing Foot Deformity Assessed by Three- Dimensional Coverage Maps

Category: Hindfoot; Midfoot/Forefoot; Other Introduction/Purpose: Progressive collapsing foot deformity (PCFD) is a complex three-dimensional (3D) deformity characterized by peritalar subluxation (PTS) of the hindfoot through the triple joint complex. In this context, adjacent structures adopt different positions, and bone relations change, producing areas of higher or less contact and stress. The objective of this study was to use 3D distance maps (DMs) and coverage maps (CMs) from weightbearing CT (WBCT) images to assess subluxation across the Chopart joint in PCFD patients. We hypothesized that CMs would show decreased coverage indicative of subluxation through regions of the Chopart joint in PCFD patients when compared to controls. Methods: In this IRB-approved, retrospective case-control study, we analyzed WBCT data of 20 consecutive patients with flexible PCFD and 20 controls. Using principle component analysis, coverage area was divided into six regions on the talar head and 4 on the calcaneal-cuboid articular surface. Novel 3D distance mapping (DM) technique was used to objectively characterize joint coverage across the entire Chopart surface on both talus and calcaneus. Distance maps were measured in millimeters and colored to highlight covered areas. Distances less than 4mm were defined to be covered, while areas with distances greater than 4mm uncovered. Joint coverage was defined as percentage of articular area with DMs lower than 4 mm. Coverage Maps (CM) were built highlighting areas of coverage (teal) versus non-coverage (pink). The Foot and Ankle Offset (FAO) was used as a reference semi-automatic three-dimensional measurement. Comparisons were performed with independent t-tests, assuming unequal variances and p-values &lt;.05 considered significant. Results: Changes in coverage percentages of PCFD cases relative to controls are indicated in the attached figure. The superomedial and the inferomedial regions of the talar head were found to have a 75% and 79% decrease in coverage in PCFD cases relative to the controls (ps&lt;0.003). The medial side of the head had an overall increase in coverage (ps&lt;0.002). On the calcaneus, the calcaneal-cuboid joint plantar region was found to have a significant coverage decrease of 12% relative to the controls (p=0.037), while the lateral quadrant observed a 13% increase (p=0.002). DMs evaluation showed no significant differences in the mean distances for either the calcaneocuboid or the talonavicular (ps&gt;0.05). The FAO was found to be correlated with changes in talar and calcaneal coverages (rs=0.90; R2=0.81). Conclusion: Our results support the hypothesis that significant changes occur at the Chopart joint in early flexible PCFD cases. Increased coverage in the lateral region of the talar head and decreased coverage in the medial and plantar regions point to internal rotation of the talus indicating subluxation through the entire joint. This behavior was also translated in the calcaneal- cuboid, where plantar and medial areas had a decrease in coverage. Coverage 3D mapping enabled objective subluxation quantification through the Chopart joint in early-stage PCFD. These findings may assist clinical assessment of normal joint alignment restoration during PCFD corrections.