Plantar Region Research Articles

Sequential Therapy of Common and Plantar Warts with Salicylic Acid after Cryotherapy Versus Cryotherapy Alone: A CaseControl Study in 42 Subjects

Background: Common wart (CW; Verruca vulgaris) is a benign cutaneous virus infection caused by human papilloma virus commonly located in the palmar and plantar regions. Warts, especially located at pressure points, could be painful, but in general they are asymptomatic. Treatment is not always necessary but when multiple lesions, pain, immunosuppression and discomfort are present therapeutic intervention could be mandatory. Chemical or physical destructions are commonly used for the treatment of CW. Cryotherapy with liquid nitrogen is a common clinician-administered treatment. The most relevant drawbacks of this procedure are the pain associated with treatment, the need of several sessions and the recurrence of new lesion. Salicylic acid (SA) applied under tape occlusion is a convenient, effective, and safe therapy of CW, even if no effective as cryotherapy. So far, there are few data regarding the efficacy and safety of the sequential treatment of CW with cryotherapy followed by a 10-day treatment course with SA. Study Design: We evaluated in a case-control study the clinical efficacy of cryotherapy alone and cryotherapy with SA in adult immunocompetent subjects with common or plantar warts.

Effects of contoured insoles with different materials on plantar pressure offloading in diabetic elderly during gait

To investigate the effect of contoured insoles constructed of different insole materials, including Nora Lunalastik EVA, Nora Lunalight A fresh, Pe-Lite, and PORON Medical 4708 with Langer Biomechanics longitudinal PPT arch pads on offloading plantar pressure on the foot of the elderly with Type 1 or 2 diabetes during gait. Twenty-two elderly with Type 1 or 2 diabetes participated in the study. Their plantar pressure was measured by using an insole measurement system, while the participants walked 10 m in their bare feet or used each experimental insole in random order. The plantar surface was divided into four specific regions including the toes, forefoot, midfoot, and rearfoot. The mean peak pressure (MPP) and pressure–time integral (PTI) of ten steps with or without wearing one of the four insoles were analyzed on the dominant foot and the four specific plantar regions. After completion of the activities, the participants scored each insole from 1 (the least comfortable) to 10 (the most comfortable). The analysis of variance (ANOVA) factor of the insoles had significant effects on the MPP (P < 0.001) and PTI (P = 0.004) in the dominant foot during gait. Pairwise comparison results showed that the MPP and PTI in the dominant foot were significantly lower (P < 0.001) with PORON Medical 4708 than barefoot, Nora Lunalight A fresh, and Pe-Lite. Additionally, the insole materials had a significant effect for the forefoot (P < 0.001) and rearfoot (P < 0.001) in terms of the MPP and PTI compared with the barefoot condition during gait. Regardless of the plantar region, the MPP and PTI values were the lowest when PORON Medical 4708 was used as the insole material among four insole materials. Meanwhile, a significantly lower MPP and PTI can be found in the forefoot and rearfoot with the use of the four experimental insoles when compared with barefoot. The soft insole materials (i.e., PORON medical 4708 and Nora Lunalastik EVA) had a better performance than the rigid insole materials (i.e., Nora Lunalight A fresh, and Pe-Lite) on plantar pressure offloading for diabetic elderly.

Vascular photobiomodulation increases muscle fiber diameter and improves the gait during compensatory hypertrophy of plantar muscle in rats.

The local photobiomodulation (LPBM) has demonstrated positive effects during compensatory hypertrophy (CH) in skeletal muscle as a response to an overload. The aim was to compare the effects of the transcutaneous vascular photobiomodulation (VPBM) and the LPBM on muscle fiber size, gait functionality, and on mechanical sensitivity during the CH model in rats. VPBM was administered over the rat's main tail vein and LPBM was applied over the plantar muscle region. VPBM induced an increase in muscle fiber diameter and cross-sectional area (CSA) after 7 days. At 14 days, an increase in the fiber diameter was found in both irradiated groups. The VPBM and LPBM promoted the reestablishment of normal gait evaluated by the sciatic functional index after 14 days. No changes were found in the mechanical (nociceptive) sensitivity in VPBM and LPBM groups in comparison to the CH group but there was an increase in the nociceptive sensitivity in the CH groups in comparison to the control after 7 and 14 days. In conclusion, both PBM, vascular and local, were able to improve the muscle size and gait during the CH process with more pronounced effects when irradiation was performed systemically (VPBM).

Therapeutic ultrasound ameliorates hyperalgesia and edema on CFA-induced persistent inflammatory response in mice

BackgroundThe present study investigated the effects of pulsed and continuous ultrasound (USP and USC) in edema and hyperalgesia after chronic inflammatory process induced by Complete Freund's Adjuvant-CFA and analyzing the relationship of the application frequency of ultrasound, in pro- and anti-inflammatory cytokine production. MethodsForty-five animals were divided into 9 groups; all animals from groups 2 to 9 were subjected to a persistent inflammation model induced by CFA in mice. We report the effects and the underlying action mechanisms of USP and USC in the animals which were irradiated two, three or five times a week on the left hind paw. The analyses performed in this study were: evaluation of hind paw edema through the plethysmometer, evaluation of thermal hyperalgesia through withdrawal test using a water container at 44.5°C (± 0.5°C), and the plantar region of the left paw which was removed for analysis of cytokines. ResultsOur results showed that USP and USC consistently reduced paw edema, and pulsed ultrasound showed a higher significant effect than the continuous mode. Moreover, groups with irradiation frequency of five times a week presented an inhibition of the edema, and groups with frequency of three or two times a week reduced mainly hyperalgesia, in comparison with the control group. The beneficial effects of the US then seem to be associated with upregulation of anti- and pro-inflammatory mediators, such as IL-10 and IL-6, respectively. ConclusionThis study provided evidence that ultrasound constitutes an important non-pharmacological intervention for the management of inflammatory and pain states.

Diosmin and Trolox Have Anti-Arthritic, Anti-Inflammatory and Antioxidant Potencies in Complete Freund's Adjuvant-Induced Arthritic Male Wistar Rats: Roles of NF-κB, iNOS, Nrf2 and MMPs.

Rheumatoid arthritis (RA) is a chronic, progressive, autoimmune disease caused by a malfunction of the immune system. The aim of this study was to examine the anti-arthritic effects and suggest the mechanisms of actions of diosmin and trolox in male Wistar rats. Complete Freund’s adjuvant (CFA) was used to establish RA in the animals by subcutaneous injection of 100 µL CFA/rat into plantar region of right hind leg in two consecutive days. Diosmin and/or trolox were administered orally at a dosage of 20 mg/kg/day to CFA-induced arthritic rats for 2 weeks. The normal and arthritic control groups were orally given the same equivalent volume of a vehicle (1% carboxymethyl cellulose) in which treatment agents were dissolved. At the end of the experiment, blood samples were collected from the jugular vein for the detection of the total leukocyte count (TLC) and differential leukocyte count (DLC) in blood and the detection of rheumatoid factor (RF), anti-citrullinated protein antibodies (ACPA), tumor necrosis factor-α (TNF-α), interleukin-13 (IL-13), and interleukin-17 (IL-17) levels by enzyme-linked immunosorbent assay (ELISA), as well as markers of oxidative stress and the antioxidant defense system in serum. The right hind ankle regions of three rats from each group were dissected out and fixed in 10% neutral-buffered formalin for histological examination and the other three were kept at −30 °C for Western blot analysis of nuclear factor-kappa B (NF-κB) protein 50 (NF-κB p50), NF-κB p65, inducible nitric oxide synthase (iNOS), nuclear factor erythroid-2-related factor 2 (Nrf2), and matrix metalloproteinase (MMP)-1 (MMP-1), MMP-3, and MMP-9. The CFA injection was deleterious to the ankle joint’s histological architecture, manifesting as infiltration of inflammatory cells into the articular cartilage, hyperplasia of the synovium, and erosion of the cartilage. All these effects were ameliorated by diosmin and/or trolox, with the combined dose being the most effective. The two compounds significantly lowered the elevated serum levels of RF, ACPA, TNF-α, and IL-17, as well as other pro-inflammatory mediators, such as NF-κB p50, NF-κB p65, iNOS, MMP-1, MMP-3 and MMP-9. They also increased the levels of the anti-inflammatory cytokine, IL-13, and the cytoprotective transcription factor Nrf2. The compounds stimulated higher activities of antioxidants, such as glutathione, glutathione-S-transferase, catalase, and superoxide dismutase, and reduced lipid peroxidation in the serum of arthritic rats. In conclusion, diosmin, trolox, and their combination, which was the most potent, exerted anti-arthritic, anti-inflammatory and antioxidant effects by suppressing NF-κB signaling, inhibiting matrix metalloproteinases, and activating Nrf2.

Effects of walking speeds and durations on the plantar pressure gradient and pressure gradient angle

BackgroundWalking exercise has been demonstrated to improve health in people with diabetes. However, it is largely unknown the influences of various walking intensities such as walking speeds and durations on dynamic plantar pressure distributions in non-diabetics and diabetics. Traditional methods ignoring time-series changes of plantar pressure patterns may not fully capture the effect of walking intensities on plantar tissues. The purpose of this study was to investigate the effect of various walking intensities on the dynamic plantar pressure distributions. In this study, we introduced the peak pressure gradient (PPG) and its dynamic patterns defined as the pressure gradient angle (PGA) to quantify dynamic changes of plantar pressure distributions during walking at various intensities.MethodsTwelve healthy participants (5 males and 7 females) were recruited in this study. The demographic data were: age, 27.1 ± 5.8 years; height, 1.7 ± 0.1 m; and weight, 63.5 ± 13.5 kg (mean ± standard deviation). An insole plantar pressure measurement system was used to measure plantar pressures during walking at three walking speeds (slow walking 1.8 mph, brisk walking 3.6 mph, and slow running 5.4 mph) for two durations (10 and 20 min). The gradient at a location is defined as the unique vector field in the two-dimensional Cartesian coordinate system with a Euclidean metric. PGA was calculated by quantifying the directional variation of the instantaneous peak gradient vector during stance phase of walking. PPG and PGA were calculated in the plantar regions of the first toe, first metatarsal head, second metatarsal head, and heel at higher risk for foot ulcers. Two-way ANOVA with Fisher’s post-hoc analysis was used to examine the speed and duration factors on PPG and PGA.ResultsThe results showed that the walking speeds significantly affect PPG (P < 0.05) and PGA (P < 0.05), and the walking durations does not. No interaction between the walking duration and speed was observed. PPG in the first toe region after 5.4 mph for either 10 or 20 min was significantly higher than 1.8 mph. Meanwhile, after 3.6 mph for 20 min, PPG in the heel region was significantly higher than 1.8 mph. Results also indicate that PGA in the forefoot region after 3.6 mph for 20 min was significantly narrower than 1.8 mph.ConclusionsOur findings indicate that people may walk at a slow speed at 1.8 mph for reducing PPG and preventing PGA concentrated over a small area compared to brisk walking at 3.6 mph and slow running at 5.4 mph.

Koinfeksi Sifilis Sekunder, &lt;i&gt;Condyloma Acuminata&lt;/i&gt; dan &lt;i&gt;Human Immundeficiency Virus&lt;/i&gt; (HIV) pada Pria Homoseksual

Introduction: Men who have sex with men (MSM) have higher risk of contracting sexually transmitted infections (STIs) such as syphilis, one of chronic and systemic STI. HIV and HPV infection can be risk factors for syphilis infection, while coinfection between syphilis and HIV facilitates the course of the two diseases. Case: A 22-year-old homosexual man complained of red scaly patches on both palms and feet, no itching, hair loss and lumps in the genital area. Examination revealed nonscarring alopecia on occipital region, bilateral patches with multiple erythematous plaques partly confluent hyperpigmentation and an overlying scale on palmar and plantar region, also multiple nodule papules with pale red smooth surface on perineal region. The acetowhite examination at the verrucous lesion was positive. The results of the CD4 examination was 112 cells/µl, VDRL/RPR was reactive 1:256; and TPHA was also reactive &gt;1:5,120. Histopathological examination of the skin showed the features of skin syphilis and condyloma acuminata. Immunohistochemistry test revealed brownish Spirochaeta. The patient was diagnosed with secondary syphilis coinfection, condyloma acuminata, and HIV. Conclusion: We found a case of MSM patient that was coinfected with secondary syphilis, condyloma acuminata, and HIV. HPV and HIV infection are often coexisting because they both increase the risk of sexually transmitted infections.

Benefit of Foot Thermogram Analysis in the Treatment of Diabetic Foot Ulcer: A Systematic Review

Introduction: Foot thermograms depict vascular distribution among foot regions with a spectrum of thermal values. Infrared thermography (IRT) is used to explore challenges in diagnosing complications that involve temperature differences. Problem Statement: It is crucial to identify underlying diabetic ulcers in the foot plantar regions, which are typically missed in photographic images. Early detection of ulcer onset can reduce healing time and treatment costs; thus, IRT plays a vital role in identifying early-stage ulcers by detecting vascular changes. This systematic review aimed to identify studies of thermography in foot ulcer diagnosis, including analysis techniques, extracted features, and scores among patients. Method: A literature search was conducted in PubMed and Scopus databases to identify relevant articles published within the last 10 years. The main criteria for the search results were articles in English with abstracts, and full articles that examine the relationship between diabetes mellitus (DM), foot ulcer and thermography among DM patients. Results: The search identified 2,215 articles, with only 8 studies meeting the inclusion criteria. Foot thermograms were used to identify foot ulcer regions associated with temperature differences. The studies included parameters such as ankle brachial index (ABI), toe brachial index (TBI), age, sex, duration of diabetes, and type of diabetes for statistical analyses to verify the validity of temperature difference data in asymmetrical analysis. Conclusion: Further interventional studies should be conducted to investigate foot IRT in patients with DM, as a variation in temperature differences may challenge the validity of foot thermograms in foot ulcer grading.

ULTRASTRUCTURAL CHANGES OF MONONUCLEAR MACROPHAGES UNDER THE ACTION OF OZONE THERAPY AND LOCAL APPLICATION OF AUTOLOGOUS PLATELET-RICH PLASMA IN THE TREATMENT OF DIABETIC FOOT SYNDROME

Objective – to study the character of ultra- structural changes in the tissue macrophages under the eff ect to complex of accessory factors promoting reparative process activation in the wound: ozone therapy, local application of autologous platelet-rich-plasma.Materials and methods. The patients were divided into three groups. The 1st group included 23 (32,85%) individuals who were treated by means of ozone therapy. The 2nd group included 23 (32,85%) patients treated by means of local platelet-rich plasma (PRP) therapy. The control group included 24 (34,28%) individuals who received a complex of therapeutic measures according to the generally accepted method. Surgery or all the patients was performed with maximum saving of the vessels in the plantar region, and the local treatment included topical vacuum therapy in the amount of 5-6 procedures. Electronic- microscopic examination used the fragments of tissue from the wound surface preserved in 2,5% glutaraldehyde solution on phosphate buff erі (рН – 7,2-7,4), followed by further processing in 1% anhydride solution. The material was dehydrated in increasing concentration alcohols and placed into araldite. The morphological structures were contrasted with a concentrated solution of uranyl acetate in the process of dehydration, and on the sections – with lead citrate. The sections 40-60 nm thick obtained by means of ultratome УМТП-3 were examined under the electron microscope TESLA БС-500. The specimens for examination were taken in the patients during dressings on the 7, 14 and 21-23 days of treatment. The dynamics of changes in the tissue macrophages was conducted by means of Astaldi principle generalizing percentage evaluation. It is a semi-quantitative method considering distinctive cytological changes determined in the similar amount of the cells examined (tissue macrophages).Results. Stimulation of the macrophage functional activity under the eff ect of ozone with destructive changes found in the cells without necrotizing damage was found to be explained by apoptosis mechanism involved as a positive factor in the regulation of local homeostasis at the completion of infl ammatory (exudative) phase of the wound process. Activation of phagocytic possibilities of the tissue macrophages with local application of autologous platelet-rich plasma occurs without any signs of apoptosis prevailing, and it is indicative of stimulation of their functional activity by antigenic or enzymatic mechanisms stimulating their functional activity.Conclusions. Stimulation of macrophage functional activity under ozone eff ect and availability of destructive changes in the cells without necrotizing damage can be explained by the involving of apoptosis mechanism as a positive factor in the regulation of local homeostasis at the completion of infl ammatory (exudative) phase of the wound process. Activation of phagocytic possibilities of the tissue macrophages with local application of autologous platelet-rich-plasma occurs without any signs of apoptosis prevailing, and it is indicative of stimulation of their functional activity by antigenic or enzymatic mechanisms stimulating their functional activity.Prospects of further studies. The results obtained confi rm and determine further necessity to conduct search innovations in the treatment of diabetic foot syndrome using the factors of physical and biological eff ect directed to the activation of a reparative process in the wound.

Effect of Acupoint Hot Compress on Postpartum Urinary Retention After Vaginal Delivery

Acupoint hot compress during the early postpartum period may benefit patients after a vaginal delivery, but the evidence of this effect is limited. To assess whether acupoint hot compress involving the abdominal, lumbosacral, and plantar regions could reduce the incidence of postpartum urinary retention, relieve postpartum uterine contraction pain, prevent emotional disorders, and promote lactation. This multicenter randomized clinical trial was conducted at 12 hospitals in China. Pregnant patients were screened for eligibility (n = 13 949) and enrolled after vaginal delivery (n = 1200) between January 17 and August 15, 2021; data collection was completed on August 18, 2021. After vaginal delivery, these participants were randomized 1:1 to either the intervention group or control group. Statistical analysis was based on per-protocol population. Participants in the control group received routine postpartum care. Participants in the intervention group received routine postpartum care plus 3 sessions of a 4-hour acupoint hot compress involving the abdominal, lumbosacral, and plantar regions within 30 minutes, 24 hours, and 48 hours after delivery. The primary outcome was the incidence of postpartum urinary retention, defined as the first urination occurring more than 6.5 hours after delivery and/or use of an indwelling catheter within 72 hours after delivery. The secondary outcomes were postpartum uterine contraction pain intensity (assessed with the visual analog scale [VAS]), depressive symptoms (assessed with the Edinburgh Postnatal Depression Scale), and lactation conditions (including lactation initiation time, breastfeeding milk volume, feeding mood and times, and newborn weight). Of the 1200 participants randomized, 1085 completed the study (537 in the intervention group and 548 in the control group, with a median [IQR] age of 26.0 [24.0-29.0] years). Participants in the intervention group compared with the control group had significantly decreased incidence of postpartum urinary retention (relative risk [RR], 0.58; 95% CI, 0.35-0.98; P = .03); improved postpartum uterine contraction pain when measured at 6.5 hours (median [IQR] VAS score, 1 [1-2] vs 2 [1-2]; P < .001), 28.5 hours (median [IQR] VAS score, 1 [0-1] vs 1 [1-2]; P < .001), 52.5 hours (median [IQR] VAS score, 1 [0-1] vs 1 [0-1]; P < .001), and 76.5 hours (median [IQR] VAS score, 0 [0-1] vs 0 [0-1]; P = .01) after delivery; reduced depressive symptoms (RR, 0.73; 95% CI, 0.54-0.98; P = .01); and increased breastfeeding milk volume measured at 28.5, 52.5, and 76.5 hours after delivery. No adverse events occurred in either of the 2 groups. Results of this trial showed that acupoint hot compress after vaginal delivery decreased postpartum urinary retention, uterine contraction pain, and depressive symptoms and increased breastfeeding milk volume. Acupoint hot compress may be considered as an adjunctive intervention in postnatal care that meets patient self-care needs. Chinese Clinical Trial Registry Identifier: ChiCTR2000038417.

Segmentation of Plantar Foot Thermal Images Using Prior Information.

Diabetic foot (DF) complications are associated with temperature variations. The occurrence of DF ulceration could be reduced by using a contactless thermal camera. The aim of our study is to provide a decision support tool for the prevention of DF ulcers. Thus, the segmentation of the plantar foot in thermal images is a challenging step for a non-constraining acquisition protocol. This paper presents a new segmentation method for plantar foot thermal images. This method is designed to include five pieces of prior information regarding the aforementioned images. First, a new energy term is added to the snake of Kass et al. in order to force its curvature to match that of the prior shape, which has a known form. Second, we defined the initial contour as the downsized prior-shape contour, which is placed inside the plantar foot surface in a vertical orientation. This choice makes the snake avoid strong false boundaries present outside the plantar region when evolving. As a result, the snake produces a smooth contour that rapidly converges to the true boundaries of the foot. The proposed method is compared to two classical prior-shape snake methods, that of Ahmed et al. and that of Chen et al. A database of 50 plantar foot thermal images was processed. The results show that the proposed method outperforms the previous two methods with a root-mean-square error of 5.12 pixels and a dice similarity coefficient of 94%. The segmentation of the plantar foot regions in the thermal images helped us to assess the point-to-point temperature differences between the two feet in order to detect hyperthermia regions. The presence of such regions is the pre-sign of ulcers in the diabetic foot. Furthermore, our method was applied to hyperthermia detection to illustrate the promising potential of thermography in the case of the diabetic foot. Associated with a friendly acquisition protocol, the proposed segmentation method is the first step for a future mobile smartphone-based plantar foot thermal analysis for diabetic foot patients.

Assessment of microcirculatory changes in local tissue oxygenation after revascularization for peripheral arterial disease with the Hyperview®, a portable hyperspectral imaging device.

The Hyperview® is a hyperspectral camera, which can be used to assess the microcirculation of patients with peripheral arterial disease (PAD) and/or diabetes mellitus (DM). It measures local tissue oxygenation in concentrations of oxyhemoblobin (OXY), deoxyhemoglobin (DEOXY), and O2-saturation (O2-SAT) in arbitrary units. The aim of this validation study is to assess whether the Hyperview® is able to monitor microcirculatory changes after revascularization in patients with PAD. In this prospective observational cohort study, 50 patients with PAD were included who were scheduled for endovascular, hybrid, or open revascularization. The ankle-brachial index (ABI), systolic toe pressure (TP) (in case of DM), and a set of Hyperview® measurements of the plantar region were recorded before and after treatment. Changes in pre- and postoperative measurements were assessed with the paired t-test. Some 38 patients underwent endovascular revascularization and eight patients underwent hybrid or open vascular surgical revascularization. After revascularization, the ABI improved from 0.58 to 0.80 (p < 0.001). OXY increased from 72.6 to 77.8 (p = 0.134). DEOXY decreased from 69.1 to 55.0 (p < 0.001). O2-SAT increased from 51.3 to 58.1 (p < 0.001). TP improved from 50.6 to 61.9mmHg (p = 0.065) but was measured in only 16 patients. The Hyperview® is able to observe changes in the microcirculation after revascularization in terms of DEOXY and O2-SAT. The results of this study are a promising step into the validation of the Hyperview®.

Comparison of Plantar Pressure in Patient with Hallux Valgus and Healthy Control and Effect of Demographic Characteristic on it: A Pixel Based Approach

Abstract: There is no detailed information available about the differences in plantar pressure distribution between hallux valgus and healthy feet. The goal of this study was to evaluate the plantar pressure of the left and right feet in hallux valgus patients against healthy controls. The current research also looks at the impact of demographic factors on plantar pressure distribution. Furthermore, a correlation between the hallux valgus foot and radiographic measures such as the hallux valgus angle and intermetatarsal angle is investigated. There were 50 patients with hallux valgus (HV group) and 55 healthy matched controls (C group) who did not have hallux valgus in the research. Age, height, weight, and body mass index did not differ significantly between the HV and C groups. The CAD WALK open access database is used to obtain dynamic plantar pressure measurements. Using manual masking, the plantar region of the foot was divided into eight sections. When compared to healthy controls, the hallux valgus foot has three abnormal pressure patterns in the left foot and two abnormal plantar pressure patterns in the right foot in various regions. The comparison is done using the region of interest's peak pixel intensity. According to our findings, when the hallux valgus angle increases, plantar pressure characteristics change from the medial to lateral side of the forefoot. Demographic characteristics like age, height, and shoe size were discovered to be important considerations during a plantar pressure study. We may conclude from our findings that manual masking on 2D plantar pressure footprints is quite reliable. Keywords: hallux valgus deformity, hallux valgus angle, intermetatarsal angle, peak plantar pressure, plantar pressure distribution

Evaluating some Essential Oils-Based and Coconut Oil Nanoemulgels for the Management of Rheumatoid Arthritis

Essential oil-based and coconut oil nanoemulgels were formulated, and their anti-arthritic effect was evaluated. Nanoemulsions of lemon, ginger, turmeric, and coconut oil were formed by spontaneous emulsification. Nanoemulgels were obtained using 1 % of carboxymethylcellulose and carbopol. Characterizations included pH, transmittance, viscosity, conductivity, spreadability, and droplet size. Stability studies were performed. Arthritis was induced in Wister rats by injecting 0.1 ml formaldehyde (2 % v/v) into the sub plantar region. Paw volumes and thickness were measured for 28 days. Particles were nanosized with polydispersity indices ranging from 0.21 to 0.75. Formulations had pH of 4.96 to 6.81. Transmittances ranged from 0.02 to 95.6 %. Viscosities ranged from 308.3 to 1807 mPaS. Nanoemulgels were more stable at 25 ± 2 ºC. Anti-arthritic evaluations showed that ginger and lemon nanoemulgels exhibited higher and similar percentage inhibition patterns from days 7 to 28. Only ginger nanoemulgel reached basal paw values on day 28. Analysis of variance showed statistically significant differences (p&lt; 0.05) in results obtained on day 7 between Voltaren® and the lemon, turmeric, and coconut groups, while on day 21, there were also significant differences (p&lt;0.05) between the Voltaren® group and the ginger and coconut groups. Ginger nanoemulgel was most effective in treating rheumatoid arthritis.

Epidermoid Cyst of Sole

An epidermoid cyst is benign cystic tumor coated with squamous epithelium and contains keratin. It generally appear on the body parts which have pilosebaceous follicles, such as head, neck, and body. The manifestation of the disease is a skin-colored, mobile, painless nodule with a punctum in the center. Epidermoid cyst of sole is often similar to clavus, callus, and verruca plantaris. However, epidermoid cyst of sole is rare because the area is without pilosebaceous follicles. The etiopathology is believed due to trauma that causes implantation of epidermal cells into the dermis layer, thus triggering the formation of epidermoid cysts. This case report a girl with an epidermoid cyst of sole that was initially thought as a verruca plantaris and clavus. A 14-year-old girl complained about a bump on her right foot that got bigger during nine months. The lesions surface was slippery, and the patient felt pain when walking. The patient denied any trauma or changing footwear with friends or relatives. Examination in the right lateral plantar pedis region, a nodule was found skin-colored, round, measuring 2x2 cm, and solitary. The patient was planned to undergo excochleation, but since a white cystic mass was found during the operation, it was continued with extirpation surgery. The histopathological examination results showed a stroma with keratin, which was concluded as an epidermoid cyst. In the case of epidermoid cysts with atypical clinical symptoms and unusual lesion locations, histopathological examination is required for a definite diagnosis.

Traceable Features of Static Plantar Pressure Characteristics and Foot Postures in College Students with Hemiplegic Cerebral Palsy.

Patients with cerebral palsy (CP) are characterized by disturbances of mobility with postural and foot deformities. Subsequent development of CP may lead to changes in plantar loading. This study examined the characteristics of foot types and relative loads associated with centers of gravity and foot posture in college students with left and right hemiplegic CP, as well as these differences between unaffected and hemiplegic limbs. A cross-sectional study of 45 hemiplegic college students with mild CP and 62 healthy students was conducted. Static plantar pressure was measured with a JC Mat. CP students exhibited low arches, and their plantar pressure distributions (PPDs) were mainly exerted on the left forefoot, as well as on the right forefoot and rearfoot. The weight shifted to the unaffected foot with dual plantar loading regions (forefoot and rearfoot), rather than the hemiplegic foot with a single region (forefoot). PPDs commonly increased at the medial metatarsals of both feet, and hemiplegic CP students presented the increased PPDs on the medial aspect of the hemiplegic foot accompanied by a rearfoot valgus posture pattern. The findings revealed a traceable feature to a possible connection among the pronated low arches, mild centers of gravity, metatarsal syndrome and rearfoot valgus of the hemiplegic limbs in CP patients.

Surgical Treatment Compared to Conservative Treatment in Remission of Pain and Hyposthesia in Tarsal Tunnel Syndrome – Systematic Review

Abstract Introduction Tarsal tunnel syndrome (TTS) is caused by compression of the posterior tibial nerve. Objective To evaluate the effectiveness of surgical treatments compared to conservative treatments in reducing the symptoms of the syndrome. Methods The PubMed, Lilacs, Cochrane Library, and PEDro databases were used for this review. Results Only 11 articles were selected. Conclusion The most common causes of TTS identified were presence of ganglia, bone prominence causing a talocalcaneal collision, trauma, varicose and idiopathic veins. The main symptom was pain in the medial plantar region and paresthesia that can radiate to the fingers or to the calf. Most patients have a positive Tinel sign upon physical examination. Electrodiagnostic test usually shows the presence of latency in sensory nerve conduction. There is no consensus suggesting that a longer time between diagnosis and surgical treatment leads to worse prognosis. In the group of operated patients, the ones who benefited most from the procedure were those who had a structure such as ganglion, cysts, or varicosities causing compression. The most cited surgical complications were postsurgical wound infection, wound dehiscence, and calcaneus hypoesthesia. Regarding surgical techniques, the release of the posterior tibial nerve via endoscopy had a favorable outcome in relation to the symptoms of pain and hypoesthesia, with no reports of infection of the operative site in the articles identified in this review. We observed a rate of good or excellent pain control of 68% (n = 204) for open surgery (n = 299), 100% (n = 8) for endoscopic surgery (n = 8), and 7% (n = 2) for conservative treatment (n = 28).

Efficacy and Reliability of Percutaneous Gigli Saw Osteotomy in Midfoot Surgery: A Cadaver Study.

Midfoot osteotomy is often used in the surgical treatment of foot deformities. The percutaneous Gigli saw osteotomy (PGSO) technique has many advantages compared with known osteotomy techniques. We aimed to show the efficacy and reliability of the PGSO technique in the midfoot of fresh frozen cadavers without using an image intensifier. Four mini-incisions were performed on the dorsomedial, dorsolateral, plantar medial, and plantar lateral regions of the midfoot. Subperiosteal tunnels were then opened with a thin bone elevator, and the four incisions were combined with each other. The Gigli saw was tied to suture material and passed through the tunnels. The PGSO was performed in the midfoot of 12 feet of the cadaver specimens without using an image intensifier. Cadaver specimens were dissected, and injured structures were noted. The mean ± SD (range) cadaver age was 81.16 ± 10.38 years (65-93 years) and weight was 60.86 ± 12.39 kg (49.8-81.6 kg). All of the osteotomies were adequate as planned in the cuboid-cuneiform level and all of them were complete osteotomy .Incomplete osteotomy was not observed in any cadaver specimens. In one specimen, a complete injury of the peroneal tendons (peroneus longus and brevis) was detected. In another specimen, an incomplete tibialis anterior tendon injury was detected. There was no iatrogenic neurovascular injury in the specimens. The PGSO technique is recommended for use even by inexperienced surgeons owing to its minimal risk of soft-tissue injury, provision of a complete osteotomy line, and easy application with limited incisions.

Effect of plantar vibration on static and dynamic balance in stroke patients: a randomised controlled study

ObjectiveTo investigate the effects of local vibration applied to the plantar region of the foot on static and dynamic balance in stroke patients. DesignRandomised, controlled trial. SettingInpatient. ParticipantsThirty patients with stroke were randomised equally to the vibration and control groups. InterventionThe control group underwent conventional physical therapy (CPT) for 4 weeks. The vibration group underwent local vibration therapy at a frequency of 80Hz and CPT for 4 weeks. Outcome measuresThe primary outcome measure was the Overall Stability Index (OSI). The secondary outcome measures were: the Anteroposterior Stability Index, Mediolateral Stability Index, fall risk, Berg Balance Scale, Functional Reach Test (FRT), and Timed Up and Go Test (TUG) to assess balance; the Trunk Impairment Scale to measure trunk function; and the 10-m Walk Test (10MWT) to measure walking speed. ResultsParticipants receiving plantar vibration experienced greater improvements in static and dynamic balance assessments compared with participants in the control group. The mean change in OSI score between baseline and 4 weeks was 0.8 [standard deviation (SD) 0.8] for the vibration group and 0.02 (SD 0.6) for the control group [mean difference 0.4, 95% confidence interval (CI) 0.1 to 0.7]. The median change in fall risk score was 0.7 [interquartile range (IQR) 0.4 to 1.4] for the vibration group and 0.1 (IQR -0.1 to 0.6) for the control group (median difference 0.5, 95% CI 0.2 to 0.7). The median change in TUG time was 4 (IQR 1 to 7) seconds for the vibration group and 4 (IQR 0 to 2) seconds for the control group (median difference 2.5, 95% CI 1.5 to 3.5). ConclusionThese findings suggest that plantar vibration is useful in stroke patients. Plantar vibration can be applied to support CPT. Clinicaltrials.gov registration numberNCT03784768.

Medial plantar artery-based perforator and island flaps: a case series of applications in sole defects.

Soft tissue defects of the plantar foot pose a challenge to the reconstructive surgeon. The plantar region of the foot has a unique skin structure, which helps in its paramount functions of weight-bearing and providing protective sensation. It is best replaced with tissue of its own kind. The medial plantar artery (MPA) flap fulfils all the requirements of an ideal replacement for small-to-medium-sized defects in the mid plantar and heel region. This study describes our experience with MPA-based flaps for small-to-medium-sized defects of the plantar foot. The study was conducted in a tertiary referral hospital between April 2017 and March 2020 on patients who presented with defects on the mid plantar region and heel. MPA perforator (MPAP) flap or island flap were applied. The donor site was covered with split-thickness skin grafts. The study included 21 patients. MPAP flap was applied in nine patients and the island flap was applied in 12 patients. The mean age of the patients was 37.95 years and the mean flap size was 36.6cm2. All flaps survived well. In two patients, venous congestion developed which resolved spontaneously, while three patients had small graft loss which also healed with conservative treatment. All patients regained protective sensation within five months of flap coverage. Based on the MPA, both perforator and island flaps can be raised due to the fairly constant position of the perforators. These flaps have the advantage of robust vascularity with the replacement of identical tissue for weight-bearing functions along with acceptable aesthetic outcomes. Since they also have the added advantage of conferring sensation, they can be used as a primary option in cases of small-to-medium-sized plantar foot defects.