Plantar Region Research Articles

Plantar Pressure Distribution during Standing in Female Patients with Hip Osteoarthritis Who Underwent Total Hip Arthroplasty

Introduction: Assessment of plantar pressure indicates the manner in which the plantar region contacts the ground as the first point in a leg-linked kinetic chain, and receives force from the ground. However, few studies have examined the changes in plantar pressure distribution in patients who underwent Total Hip Arthroplasty (THA) before and after THA, or compared plantar pressure distribution between THA patients and healthy adults. Objective: Plantar pressure distribution in patients with end-stage hip osteoarthritis who undergo THA may be adjusted to that in healthy adults by correcting leg length discrepancy. Herein, our objective was to find out if the plantar pressure distribution during standing differs before and after THA, and between healthy adults and THA patients. Design: Case control study. Setting: Single orthopedic clinic in Japan. Participants: THA patients (n=58; THA group) and healthy adults (n=53; control group). Interventions: Not applicable. Main outcome measure(s): The maximum plantar pressure under each foot measured during standing for 20 s was assessed for location, symmetry, and leg length discrepancy. Results: The distribution plantar pressure in the THA group differed preand postoperatively. The maximum plantar pressure region was the heel in approximately 80% of the patients three months after THA; it was not different in THA patients three months postoperatively and in healthy adults. Patients with asymmetrical maximum plantar pressure regions were those whose postoperative maximum plantar pressure region in the affected leg was the forefoot and those whose maximum plantar pressure region in the affected leg shifted to the heel. The leg length discrepancies decreased significantly after THA. Conclusions: The plantar pressure distribution during standing in female patients adjusted to that in healthy adults after THA. Patients with asymmetrical distribution of maximum plantar pressure may benefit from balance assessment and physical therapy.

A study of the dermatoglyphic pattern in diabetic subjects in Kalaburagi district

Dermatoglyphics is the scientific study of epidermal ridges and their configurations on the palmar region of hand and fingers and plantar region of foot and toes. Diabetes mellitus is a metabolic disorder characterized by hyperglycemia resulting from defect in insulin secretion, action or both. Dermatoglyphic patterns are genetically determined and can be used as supportive for diagnosis of various hereditary disorders including T2DM. This study was carried out to compare palmar dermatoglyphic pattern in T2DM and control group and compare with previous studies. A hospital based case control study was conducted 100 cases of T2DM are taken from Basaweshwar hospital Gulbarga, and another 100 persons are included as control group. The palms and fingers are smeared with ink to bring out the dermatoglyphiic patterns which were subsequently studied.There was increased number of whorls and decreased number of ulnar loops in both T2DM patients compared with normal individuals. Total finger ridge count and Absolute finger ridge count is increased in both T2DM patients and there is also increased atd angle. The knowledge of dermatoglyphics in patients with T2DM and essential hypertension can be utilized to find out genetic correlation. The existence of such relation might be important for the screening programme for prevention of T2DM.

ESTABLISHING THE NORMAL GAIT OF CHINESE YOUTH BASED ON THE PLANTAR PRESSURE TEST: AN EXPERIMENTAL STUDY

Objective: This study will measure the geometric and pressure centerlines of the foot’s plantar region in healthy Chinese youth to construct a gait norm. Methods: In the present experiment, 203 healthy college students and postgraduates (90 males and 113 females) were recruited as subjects. Their average age was [Formula: see text] years old, average height was [Formula: see text][Formula: see text]cm, and average weight was [Formula: see text][Formula: see text]kg. A double-blind method was used in this experiment. The plantar pressure and gait parameters of time and space among subjects were tested using a gait and balance function-training evaluation system. Data were collected using five pressure-sensor plates, based on the distribution in the geometric and pressure centers of the foot’s plantar area, according to the calculation formula of biomechanics. Results: From 20 selected subjects, the experiment gathered a total of 197 data points from the plantar pressure during walking. The results defined the foot’s centerline of maximum pressure while walking and showed that the pressure and geometric centerlines tended to converge and overlap in normal youth, irrespective of gender. In addition, differences were found between the foot’s centerline of pressure and the geometric and pressure centerlines of the plantar. Conclusion: This study showed that the plantar’s pressure and geometric centerlines can be used as a reference to assess normal gait in Chinese youth.

Aesthetic reconstruction for syndactyly using the “gradation skin graft” from the plantar instep area

In syndactyly, the donor site of the skin graft should have the characteristics of both the dorsal and the plantar or palmar skin because the skin defects after the dividing procedure are at the lateral sides of the digits. The plantar instep region has a color and texture border between the dorsal and plantar skin as a gradational boundary belt. We performed "gradation skin grafting" including the belt for syndactyly. We retrospectively analyzed 110 skin graft sites in 56 patients, aged ≤ 2 years, with syndactyly of the hand or foot. The follow-up durations were ≥ 6 months. The skin graft sites were divided into the gradation skin graft (G[+]) and the traditional skin graft (G[-]) groups. They were examined for matching of the skin graft with the circumferential skin, the causes of mismatching, the closing method of the donor site, and the complications. Regarding skin graft matching, the excellent rate of achievement was greater in the G(+) than in the G(-) group (P < 0.01). The causes of mismatching were misalignment of the gradational boundary belt in the G(+) group and postoperative pigmentation in the G(-) group. All the donor sites were closed directly without complications. The gradation skin graft for syndactyly was cosmetically superior to the traditional one from the submalleolar area. The design's hazard is that the gradational boundary belt of the skin graft should match the alignment with the gradational boundary belt around the skin defect of the digits.

Evaluation of Small Fiber Peripheral Neuropathy With Infrared Thermographic Camera in Prediabetes

Introduction: The typical microvascular complications of diabetes may ocasionaly occur in patients with prediabetes (PD). Diabetic peripheral neuropathy (DPN) is associated with poor glycemic control as well as with the metabolic syndrome components independently of HbA1c levels. Small fiber DPN is one of the most chalenging diagnosis due to the usualy normal physical examination as well as electrophysiological nerve evaluation. The thermographic camera has emerged as a novel tool for the detection of small nerve fiber dysfunction. The aim of the present study was to evaluate thermography of the plantar foot in individuals with PD. Methods: This was a cross-sectional study with a sample of 51 patients aged 27 to 71 years. Patients were divided into the following three groups: control (n = 18), diabetic (n = 17), and prediabetic (n = 16). The diagnosis of PD was made according to ADA standards. Thermographic analysis of the plantar region was performed using a FLIR C2 camera. Results: Overall, 510 foot regions were analyzed. There were significant diferences in plantar temperatures between prediabetes vs controls as follows: hallux (L: 25.24 ± 2.02 vs 23.6 ± 1.79 ºC; p=0.009/ R: 25.44 ± 2.05 vs 23.89 ± 1.73 ºC; p=0.01); fifth metatarsal (L: 26.31 ± 1.72 vs 24.88 ± 1.38 °C; p=0.006 /R: 26.12 ± 1.60 vs 24.74 ± 1.41 °C; p= 0.006); and calcaneus (L: 26.46 ± 1.71 vs 24.93 ± 1.41 °C; p=0.005 / R: 26.58 ± 1.85 vs 25.07 ± 1.18 °C; p=0.004). There were no similar results for temperatures in individuals with diabetes comparing with prediabetes: hallux (L:25.24 ± 2.02 vs 25.76 ± 2.30 °C; p=0.24 /R: 25.44 ± 2.05 vs 25.64 ± 1.92 °C; p=0.38); fifth metatarsal (L: 26.31 ± 1.72 vs 26.03 ± 1.27 °C; p=0.3 / R: 26.12 ± 1.60 vs 26.21 ± 1.57 °C; p=0.43); and calcaneus (L26.46 ± 1.71 vs 26.82 ± 1.41 °C; p=0.23 / R: 26.58 ± 1.85 vs 26.99 ± 1.42 °C; p=0.24). Conclusion: We found siginificant abnormalities in temperature of various sites of the plantar region in PD feets suggesting that small fiber damage may occur before the onset of type 2 diabetes.

Altered microvascular reactivity assessed by near-infrared spectroscopy after hepato-pancreato-biliary surgery.

Little is known about microcirculatory dysfunction following abdominal surgeries. This study aimed to evaluate changes in microvascular reactivity (MVR) before and after major abdominal surgery, assessed by near-infrared spectroscopy in conjunction with a vascular occlusion test. This prospective observational study included 50 adult patients who underwent hepato-pancreato-biliary surgery lasting ≥ 8h. MVR was assessed by tissue oxygen saturation (StO2) changes in the plantar region of the foot during 3min of vascular occlusion and subsequent release under general anesthesia before and after surgery. The primary outcome was alteration in the recovery slope of StO2 (RecStO2) and recovery time (tM) between the preoperative and postoperative values. Postoperative short-term outcome was represented by the Post-operative Morbidity Survey (POMS) score on the morning of postoperative day 2. After surgery, RecStO2 was reduced (0.74% [0.58-1.06]/s vs. 0.89% [0.62-1.41]/s, P = 0.001), and tM was longer (57.0 [42.9-71.0] s vs. 41.3 [35.5-56.5] s, P < 0.001), compared to the preoperative values. Macrohemodynamic variables such as cardiac index, arterial pressure, and stroke volume during postoperative measurement did not differ with or without relative MVR decline. In addition, the POMS score was not associated with postoperative alterations in microcirculatory responsiveness. MVR in the plantar region of the foot was reduced after major hepato-pancreato-biliary surgery regardless of macrocirculatory adequacy. Impaired MVR was not associated with short-term outcomes as long as macrocirculatory indices were well maintained. The impact of relative microcirculatory changes, especially combined with inadequate macrocirculation, on postoperative complications remains to be elucidated.Clinical Trial Registrations UMIN-CTR trial ID: 000033461.

High inter- and intra-observer agreement for measuring tissue oxygenation of the plantar surface of the foot in healthy participants with the Hyperview®: A pilot study.

The Hyperview® is a novel camera that applies hyperspectral imaging to project local concentrations of oxyhaemoglobin (OXY), deoxyhaemoglobin (DEOXY) and O2-saturation (O2-SAT) in a map. In this pilot validation study, we assessed inter - and intra-observer agreement for measuring OXY, DEOXY and O2-SAT in healthy participants. The plantar region of the right foot was assessed with the Hyperview® in 50 healthy participants. Two consecutive pictures were taken by the same observer, followed by two images by a second observer. Measurements were performed without and with standardization (a static device for both the foot and the Hyperview camera). Inter- and intra-observer agreements were expressed as Intraclass Correlation coefficients (ICC) with their 95% confidence interval (CI). A score <0.40 indicates poor agreement, 0.40-0.59 fair, 0.60-0.74 good and 0.75-1.00 excellent agreement. Bland and Altman plots were also generated. Without standardization, the ICC values between the observers for OXY, DEOXY and O2-SAT ranged from 0.70 to 0.83. The intra-observer agreement of both observers ranged from 0.36 to 0.83. With standardization, the ICC values between the observers ranged from 0.80 to 0.82 and intra-observer agreement varied from 0.75 to 0.92. Four Bland and Altman plots were generated of the measurements of OXY by observers 1 and 2. When standardization is used, the Hyperview® camera is a reliable device with excellent intra- and inter-observer agreements for the assessment of OXY, DEOXY and O2-SAT. In future research, the inter- and intra-observer agreements of the camera should be investigated in patients with diabetes and/or peripheral arterial disease.

Subunit Principle: Key Element for Plantar Reconstruction with Free Sensate Flaps

Purpose: Plantar wounds represent a frequent practice of the plastic and reconstructive surgeon. The uniqueness and high complexity of the microarchitecture and biomechanics of the plantar region explain the complex challenge of its reconstruction. With the advances in microsurgery, including the plantar subunit principle, both applied in the restoration of plantar defects through the use of sensorineural free flaps have allowed an optimal reconstruction.Methods: A descriptive, retrospective study was carried out in a period of time established between January 2016 and January 2019, obtaining a total of 18 patients with plantar defects, reconstructed using sensory free flaps. Tissue stability, recovery of protective sensitivity, early ambulation, and correct use of footwear were evaluated.Results: The most frequent etiology was secondary to oncological resections due to melanoma (n = 12, 66.7%), followed by gunshot wounds (n = 4, 22.2%). Subunit 3 was the most frequently involved in 38.9% (n = 7). In the 88.8% of the cases, was used an anterolateral thigh flap (n = 16) and the lateral antebrachial flap in 22.2% (n = 2). The free flap survival rate was 100%. An average of seven points was obtained at 6 months based on the Semmes-Weinstein test. The mean for the return to their daily activities was 2.5 months. The patients of 94.4% (n = 17) recovered ambulation and could footwear. Conclusion: The reconstruction of plantar defects must have a systematic approached, taking the subunit principle as a central point. The treatment of plantar defects with sensorineural free flaps represent an unprecedented option for optimal reconstruction.

Effect of 660/850 nm LED on the microcirculation of the foot: neurovascular biphasic reflex.

Phototherapy (LED) can be used to stimulate the healing of chronic ulcers of the lower limb, as it affects healing cells and neurons. In this way, this study has sought to know if the heat stimulus of the 660-/850-nm contact LED is sufficient to trigger the response in the peripheral sympathetic nervous system of normal volunteers. The LED was applied on the right foot of forty-two normal volunteers followed by serial infrared images. After the stimulus, a biphasic hyperthermia curve was observed synchronously in both feet, in the right and left halluxes, while hyperthermia was attributed to the redistribution of postural blood flow in the plantar region, which may indicate independent neurovascular mechanisms. Thus, periodic thermographic analysis can be used in the evolution of the LED treatment.

Ptiríase rubra pilar: relato de um caso raro

OBJECTIVES: Report the case of pityriasis rubra pilaris (PRP) in a male patient at the age of 2 years and 10 months. METHODS: A review of the medical record as well as the literature regarding the present conditions, via PubMed database. RESULTS: Male patient, 2 years and 10 months, referred for the first year of appearance of pruritic erythematodescamative annular plaques in lower limbs with dissemination to the trunk, upper limbs, and face, associated with scaling in the plantar region and nail dystrophy. The biopsy presented stratum corneum parakeratotic with hypergranulosis and moderate acanthosis. The diagnosis of pityriasis rubra pilaris was considered conclusive. Isotretinoin and oral antihistamine were prescribed, having complete improvement. CONCLUSIONS: PRP remains a challenging disease, be it on its pathogeny, diagnosis or treatment. Randomized studies would aid on establishing a standardized treatment for PRP, improving the quality of life of patients suffering from this disease.

An exploration of changes in plantar pressure distributions during walking with standalone and supported lateral wedge insole designs

BackgroundLateral wedge insoles (LWI), standalone or with medial arch support (supported-LWI), have been thoroughly investigated for their effects on modifying gait biomechanics for people with knee osteoarthritis. However, plantar pressure distribution between these insole types has not been investigated and could provide insight towards insole prescription with concomitant foot symptoms taken into consideration.MethodsIn a sample of healthy individuals (n = 40), in-shoe plantar pressure was measured during walking with LWI, with or without medial arch support (variable- and uniform-stiffness designs), and a flat control insole condition. Pressure data from the plantar surface of the foot were divided into seven regions: medial/lateral rearfoot, midfoot, medial/central/lateral forefoot, hallux. Plantar pressure outcomes assessed were the medial-lateral pressure index (MLPI) for the whole foot, and the peak pressure, pressure-time integral (PTI), and contact area in each plantar region. Comfort in each insole condition was rated as a change relative to the flat control insole condition. Repeated-measures analyses of variance were calculated to compare the plantar pressure outcomes between insole conditions.ResultsRegionally, medial rearfoot and forefoot pressure were reduced by all wedged insoles, with the variable-stiffness supported-wedge showing greater reductions than the standalone wedge. Lateral rearfoot and forefoot pressure were reduced by both supported-LWI, but unchanged by the standalone wedge. In the midfoot, the standalone wedge maintained pressure but reduced regional contact area, while both supported-LWI increased midfoot pressure and contact area. All LWI increased the MLPI, indicating a lateral shift in plantar pressure distribution throughout the weightbearing phase of gait. Comfort ratings were not significantly different between insole conditions.ConclusionsRegional differences in plantar pressure may help determine an appropriate lateral wedge insole variation to avoid exacerbation of concomitant foot symptoms by minimizing pressure in symptomatic regions. Lateral shifts in plantar pressure distribution were observed in all laterally wedged conditions, including one supported-LWI that was previously shown to be biomechanically ineffective for modifying knee joint load distribution. Thus, shifts in foot centre of pressure may not be a primary mechanism by which LWI can modify knee joint load distribution for people with knee osteoarthritis.

Usability Testing for a Mobile Application of Plantar Tactile Sensitivity Measurement

The purpose of this study is to develop a new tactile measurement system that can be used for the early detection of a decrease in tactile sensitivity. The tactile stimuli presentation device consisted of a small precision automatic stage. This system could present lateral skin stretch in the direction horizontal to the tactile sensitivity of the plantar skin. In our previous study, the utility of the measurement method was established in healthy participants, and the measurement data of tactile sensitivity was not influenced by posture and plantar region during measurement. In this study, a new mobile application (App) was developed to operate for a tactile stimuli presentation device. The user can control the tactile device by App using a tablet computer (e.g., laptop, phablet, tablet, or smart device) and understand the measurement methodology of tactile sensitivity. This study was conducted to evaluate a new tactile sensitivity measurement application using a tablet computer. We found that this App could be easily used for participants. In conclusion, an App was developed to operate the tactile stimuli presentation device, and this App was simple to use.

Acute effects of a walking activity on plantar pressure in children with obesity

abstract Children with obesity present greater foot loads during walking when compared to eutrophic ones. However, the acute effects of a moderate walking on the distribution of plantar pressure in children with obesity are still incipient in the literature. Our aim was to verify the acute effects of six-minute walk test on plantar pressure in obese and eutrophic children. A pressure platform was used to record plantar pressure during walking for 62 children (37 girls), aged 7-10 years old, before and after the six-minute walk test. Children were divided into an obese group - OB (n = 20), and an eutrophic group - EU (n = 42). Peak plantar pressure (PPP), maximum force (MF), and contact area (CA) were assessed in three trials during walking at a comfortable speed. The analyses were performed in five plantar regions: rearfoot, midfoot, forefoot, hallux, and toes. For the PPP was higher under the midfoot region of the OB group after walking. In the comparison between groups, PPP, MF, and CA were higher for the OB group for most regions. We concluded that, after a moderate walking activity, children with obesity experience an increase in plantar loads, especially under the midfoot, which can bring greater discomfort and risk of injuries.

POTENTIALS OF NUTRITIONAL FOLLOW-UP IN A DIABETIC PATIENT HOSPITALIZED WITH ULCERATION TABLE IN PLANT REGION

Introduction: Approximately 15% of diabetic individuals are affected with foot ulceration, one of the main causes of lower limb amputation. The percentage of diabetic survival after amputation of a lower limb (MI) is 50% three years after the surgical procedure and the mortality rate varies between 39% to 68% after five years. The impact on the quality of life of diabetic people is high, not only economically, the feelings involved contribute to a negative prognosis. Therefore, adequate metabolic and nutritional control, as well as periodic assessment of immunity and comorbidities, should be part of the therapeutic routine of diabetic patients. Experience report: The work in question refers to the nutritional approach performed on a 71-year-old female patient admitted to the hospital with an ulcer in the right plantar region. In anthropometry, the nutritional status indicators indicated eutrophy with nutritional risk. The biochemical evaluation identified anemic condition and sepsis. Physical evaluation showed the presence of edema in the right and left MI. Glycemic and blood pressure levels were monitored daily. A hypercaloric and hyperprotein diet was prescribed, plus protein supplementation with specific immunomodulators for special metabolic situations that prevent energy-protein malnutrition, in addition to the adequacy of vitamins and minerals, in order to avoid nutritional deficiencies arising from the drug-nutrient interaction. Nutritional monitoring lasted 13 days. Ulceration regressed from the entire plantar region, only to the right hallux, which was amputated. Final considerations: There was an improvement in nutritional and biochemical parameters until hospital discharge.

Clinical foot measurements as a proxy for plantar pressure testing in people with diabetes

BackgroundHigh plantar pressures are associated with increased foot ulcer risk in people with diabetes. Identification of high plantar pressures in people with diabetes is clinically challenging due to time and cost constraints of plantar pressure testing. Factors affecting foot biomechanics, including reduced joint range of motion and foot deformity, are implicated in the development of high plantar pressures and may provide a method to clinically identify those at risk of pressure related complications. The aim of this study was to investigate the contribution of joint range of motion and foot deformity measures on plantar pressures in a community dwelling group with diabetes.MethodsBarefoot (Tekscan HR Mat™) and in-shoe (Novel Pedar-X®) plantar pressure variables, weight bearing ankle dorsiflexion, hallux range of motion, lesser toe deformities and hallux abductus (HAV) scale were assessed in 136 adults with diabetes (52.2% male; mean age 68.4 years). Multivariate multiple linear regression was used to assess the effect of the four biomechanical factors plus neuropathy and body mass index on plantar pressure variables. Non-parametric bootstrapping was employed to determine the difference in plantar pressure variables for participants with two or more foot biomechanical pathologies compared to those with less than two pathologies.ResultsAlmost one third (32%) of the cohort had two or more foot biomechanical pathologies. Participants with two or more foot biomechanical pathologies displayed significant increases in all barefoot plantar pressure regions (except forefoot), compared to those with less than two pathologies. No significant changes were found for the in-shoe plantar pressure variables. The regression model explains between 9.9% (95%CI: 8.4 to 11.4%) and 29.6% (95% CI: 28.2 to 31%), and between 2.5% (1.0 to 4.0%) and 43.8% (95% CI: 42.5–44.9%), of the variance in the barefoot and in-shoe plantar pressure variables respectively.ConclusionsParticipants presenting with two or more factors affecting foot biomechanics displayed higher peak pressures and pressure time integrals in all foot regions compared to those with less than two factors. The tests used in this study could help clinicians detect elevated plantar pressures in people with diabetes and present an opportunity for early preventative interventions.

Pharmacological screening of ethanolic extract of Pithecellobium dulce for antiarthritic activity in Rats

Arthritis is an inflammatory joint disorder in which cartilage of the joint is gradually lost and categorized by swelling of joints, pain, and loss of function. The present study was conducted to explore the antiarthritic activity of ethanolic extract of Pithecellobium dulce against formaldehyde induced at sub plantar region of the left hind paw during days 1 and 3 of the study period. The changes observed in paw diameter during the study period, various biochemical, and haematological parameters were monitored. The Radiographic analysis and histopathology significantly improved after treatment with test extract P. dulce (250 mg/kg, b.w., p.o. ) as compared to the standard treatment with indomethacin (10 mg/kg, b.w., p.o. ).The results of the current investigation concluded that ethanolic extract of P. dulce possesses significant anti-arthritic activity against formaldehyde induced arthritis model, justifying its therapeutic role in arthritic conditions. The observed antiarthritic activity may be due to the presence of phytoconstituents such as alkaloids and flavonoids. P. dulce significantly suppressed the paw oedema in formaldehyde models ( P &lt;0.001). The Histopathological and radiographic studies of joints also showed a protective effect of P. dulce .

Precalcaneal congenital fibrolipomatous hamartoma: a case report

Precalcaneal congenital fibrolipomatous hamartomas are represented by benign, asymptomatic and symmetrical nodules in the precalcaneal region of the heel. They are flesh-colored and mostly painless nodules. Classically, lesions present at birth or can appear in the weeks that follow birth, with no predominance of sex. Here, we present the case of 6-month-old girl with a bilateral symmetrical skin colored nodules localized on the precalacneal plantar region of her two heels.

Anti arthritic potentials of Piper betle- A preclinical study

The objective of the recent work was to evaluate the anti-arthritic activity of Piper betle leaves against CFA induced arthritis in rats. Anti-arthritic activity of hydro-alcoholic (1:4) extract of Piper betle leaves was investigated against complete Freund’s adjuvant induced arthritis in rats. Two doses 20A0mg/kg and 400mg/kg of Piper betle leaves extract (oral route) was subjected for the evaluation of anti-arthritic activity against complete Freund’s adjuvant (0.1ml sub plantar region) induced arthritis in rats. Diclofenac (50mg/kg oral) was used as standard in both the models (prophylactic & curative). Physical parameters such as paw volume, paw diameter and body weight were evaluated. Serum parameters such as SGPT, SGOT and ALP, rheumatoid factor were evaluated. In addition histopathological study was also carried out. It was observed in both the models that both the lower dose (200mg/kg) and higher dose (400mg/kg) of Piper betle extract showed dose dependent significant decrease in SGPT, SGOT, and ALP, paw volume, paw diameter and increase in body weight when compared to arthritic control group. All treated animals showed significant decrease in serum rheumatoid factor. In addition anti-arthritic effect was also confirmed by histopathology of synovial joint showed less space narrowing of inter tarsal joints in treated rats. The results obtained were comparable with that of standard. The present study concluded that hydro-alcoholic extract of Piper betle leaves has significant anti-arthritic potential. The exact mechanism for the anti-arthritic activity of hydro-alcoholic extract of Piper betle is still unknown. Hence further studies are needed to isolate, characterize the active principles and to find out the exact mechanism responsible for its anti-arthritic activity. Keywords: Arthritis, Complete Freund’s Adjuvant, Diclofenac, Piper betle, Rheumatoid factor.

Effectiveness of Pressure-Relieving Shoes/Insoles on Lowering the Plantar Pressure of Diabetic Foot: A Meta-Analysis

Since current reports demonstrated a higher prevalence of foot ulcers in diabetic patients who suffer from foot complication, the preventing occurrence of foot ulcers were the primary target in foot care. Clinical consensus introduced a variety of pressure-relieving products to diabetic patients and clinicians prescribed these products to their patients and recommended them used in daily life. However, available data were still controversial and whether these products could effectively reduce plantar pressure or not were uncertain. Thereby, this meta-analysis aimed first to summary all relevant findings in current database and secondly to explore whether pressure-relieving insoles/shoes can really relieve plantar pressure and what’s differences between customized products (shoes/insoles) and standard ones in reducing plantar pressure. We first searched published articles cited from Web of Science, Medline via OVID, CINAHL, SCOPUS, INFORMIT, Cochrane Central and EMBASE via OVID. Then we filtered observational studies reporting experimental effect of pressure-relieving insoles/shoes. Meanwhile, we set up primary outcome as overall mean peak plantar pressure (MPP) and secondary outcomes as MPP at various plantar regions and MPP at insoles/shoes with various structure designs. Our results show that pressure-relieving products (shoes/insoles) did lower the amplitude of pressure concentration; effect of custom-made and pre-fabricated products on pressure-relieving were similar. These findings suggested that no matter pressure-relieving products were custom-made or prefabricated standard one, if they were designed targeting to increase overall plantar contact areas, such as designed based on plantar model, or to provide extra arch supports or plug-in structures to transfer pressure concentration, they were all useful in diabetic foot care to prevent occurrence of ulceration. Overall, it is recommended that diabetic patients shall wear pressure-relieving insoles/shoes while walking.

Management guideline for Werner syndrome 2020. 7. Skin ulcer associated with Werner syndrome: Dermatological treatment.

Skin ulcers in Werner's syndrome often arise from hyperkeratotic lesions and trauma to pressure points such as the plantar region, and are more difficult to treat than wound healing in healthy individuals. Multiple factors contribute to the intractable skin ulcers in Werner's syndrome, including skin thinning, sclerosis, fatty tissue loss, impaired blood flow, calcification, and excessive pressure due to osteoarticular deformity. Treatment includes topical application of a keratolytic agent for keratosis around the ulcer. Treatment of ulcers is the same as for normal ulcers, and if the ulcer is associated with infection and necrotic tissue, surgical debridement with a scalpel or scissors should be performed as much as possible after washing with saline or mildly warm water or with an antibacterial agent. Topical medications that promote softening and debridement of the necrotic tissue are used with careful control of moisture in the wound. Topical agents that promote granulation should be used in wounds where necrotic tissue has been removed without infection. Dressings to maintain a moist environment in the wound may also be useful. If the wound does not improve with conservative treatment, surgical treatment should be considered. Geriatr Gerontol Int 2021; 21: 160-162.