Walking Pain Research Articles

Recurrence from the Spinal Region of the Patient Whose Treatment Was Completed with Liver and Lung Cystic Echinococcosis: A Rare Pediatric Case of Spinal Cystic Echinococcosis

Cystic echinococcosis is a parasitic disease caused by the Echinococcus tapeworm. The disease can often affect organs such as the liver and lungs, muscles, bones, kidneys, brain, and spleen. Spinal cystic echinococcosis has been reported very rarely in the literature. In this report; we present a pediatric case with spinal cystic echinococcosis, who was diagnosed with multiple cystic echinococcosis in the liver and lungs and was admitted with complaints of difficulty in walking and leg pain 1 year after the albendazole treatment, which he had been taking for 3.5 years. If a diagnosis of cystic echinococcosis was made in any organ, recurrences may occur in another organ at some time, even if the treatment is completed.Kistik ekinokokkoz, Echinococcus tenyasının neden olduğu paraziter bir hastalıktır. Hastalık sıklıkla karaciğer ve akciğer olmak üzere kaslar, kemik, böbrek, beyin, dalak gibi organları tutabilir. Spinal kistik ekinokokkoz hastalığı ise literatürde oldukça nadir bildirilmiştir. Bu raporda; karaciğer ve akciğerde multipl kistik ekinokokkoz tanısı ile 3,5 yıl aldığı albendazol tedavisi kesildikten bir yıl sonra yürümede zorlanma, bacak ağrısı şikayetiyle başvurması üzerine spinal kistik ekinokokkoz tanısı alan bir çocuk olgu sunulmuştur. Bu olguda da görüldüğü gibi, herhangi bir organda kistik ekinokokkoz tanısı konuldu ise tedavi tamamlansa da hayatın bir döneminde başka bir organda dahi nükslerin olabileceği unutulmamalıdır.

Symptoms in women with fibromyalgia after performing physical activity: the role of pain catastrophizing and disease impact

IntroductionWalking is an effective treatment for symptoms’ management in patients with fibromyalgia. However, despite its benefits, fibromyalgia patients face a variety of obstacles that result in reduced ability to sustain physical exercise. The main goal of the study was to analyze the role of pain catastrophizing and fibromyalgia impact in the relationship between regular walking behavior and pain and fatigue experienced after a laboratory walking test.MethodThe study has an observational analytical laboratory design. A total of 100 women were contacted by the research team. Seventy-six women diagnosed with fibromyalgia aged 18 years and older (mean age = 55.05, SD = 7.69) participated.ResultsSignificant correlations were found among regular walking behavior, pain catastrophizing, impact of fibromyalgia, pain intensity after walking, and fatigue intensity after walking. The serial multiple mediation analyses confirmed that pain catastrophizing and impact of fibromyalgia mediated the relationship between regular walking behavior and the level of pain (beta B = 0.044, 95% CI = [0.01–0.012]) and fatigue (beta B = 0.028, 95% CI = [0.01–0.08]) after the laboratory walking test. Also, the participants that walked less regularly experienced more pain and fatigue after the 6-Minute Walk Test.ConclusionsConsidering cognitive variables alongside the impact of fibromyalgia will help understand the inhibitors of engaging in physical activity. Therapeutic walking programs must be tailored to patients with fibromyalgia to reduce pain and fatigue related to physical activity and to promote better functioning and quality of life.Key Points• Regular walking behavior was associated with fibromyalgia impact, pain catastrophizing, and less pain and fatigue after physical activity.• When patients catastrophize pain, they usually interpret physical activity as threatening, which generates more pain and fatigue after doing exercise.• Therapeutic programs should be designed to reduce pain catastrophizing and fibromyalgia impact.

Benign Acute Childhood Myositis: Our Experience on Clinical Evaluation.

Benign acute childhood myositis (BACM) is a transient condition mainly affecting children of school age characterized by muscle pain, typically localized to the calf muscle with symmetrical lower extremity pain and difficulty in walking. Usually, the symptomatology is preceded by a viral infection including influenza, parainfluenza, rotavirus, and mycoplasma. The case series was conducted in four pediatric hospitals in Catania, Italy, over a 12-year observational period. Clinical examination, laboratory data, course, treatment, and complications of the affected children were extracted from electronic medical records of each hospital. For the case series, 50 children diagnosed with BACM were enrolled: the mean age of affected children was 5.35 years, 86% of were males, and in 56% the affections occurred during the winter. In the affected children, the clinical picture was characterized by previous fever and/or symptoms of inflammation of the upper airways, and followed by pain in the lower extremities up to uncoordinated gait. In 17 cases the etiological agent was isolated, including the influenza virus type B as the most frequent and influenza virus type A, Mycoplasma pneumoniae, beta-hemolytic streptococcus, and herpes simplex virus. Children were treated with supportive therapy. In all the children the muscular symptomatology had a good evolution with progressive marked reduction of pain and of the high level of CKemia. Neither clinical recurrences nor sequelae were reported. BACM shows to have in most of the cases a favorable evolution, a spontaneous remission of symptoms, and a good prognosis. However, the disorder generates parental distress for the acute presentation and the striking muscle dysfunction. It is worthy a rapid and early diagnosis to avoid unnecessary diagnostic investigations and a careful follow-up necessary to exclude persistence of symptoms or creatine kinase elevation.

Comparison of Longitudinal Skeletal Thigh Muscle Findings With Magnetic Resonance Imaging in Patients With Peripheral Artery Disease With–Versus–Without Diabetes Mellitus

The aim of this secondary analysis of ELIMIT (The Effect of Lipid Modification on Peripheral Artery Disease after Endovascular Intervention Trial) was to determine longitudinal changes over 24months in skeletal thigh muscle volumes and individual muscle compartments in patients with peripheral artery disease (PAD) with and without diabetes. A total of 48 patients with available magnetic resonance imaging of the distal superficial femoral artery at baseline and 2years were included in this analysis. Muscle volumes and superficial femoral artery wall, lumen, and total vessel volumes were quantified. Intrareader reproducibility of muscle tracings was assessed with the intraclass correlation coefficient using a 2-way model. Baseline characteristics were similar between patients with PAD with and without diabetes, except for smoking history (p=0.049), cholesterol levels (p <0.050), and calf walking pain (p=0.049). Interobserver reproducibility of the muscle volume tracings was excellent for all muscle groups (all intraclass correlation coefficients >0.86, confidence interval 0.69 to 0.94). Total muscle and total leg volumes increased significantly between baseline and 24months among patients with PAD without diabetes (31 ± 6.4cm3 vs 32 ± 7.0cm3, p <0.001; 18 ± 4.4cm3 vs 19 ± 4.8cm3, p=0.045), whereas there was no change in patients with PAD and diabetes. Total muscle volume was inversely associated with age and body mass index in patients with PAD both with and without diabetes (p <0.05). In conclusion, magnetic resonance imaging-quantified thigh muscle volumes are highly reproducible and may be of interest in assessing PAD patients with and without diabetes.

VALGUS INTERTROCHANTERIC OSTEOTOMY USING DYNAMIC HIP SCREW FOR NEGLECTED NON-UNION OF NECK OF FEMUR FRACTURE IN A MIDDLE AGED MALE-A CASE REPORT.

Neck of femur fracture is a common orthopaedic problem. The management of the non union of the neck of femur is challenging because of the biological and the mechanical factors at play. Osteosynthesis is the modality of choice for the people aged 60 years or less while arthroplasty is the treatment offered for the older age group. Numerous techniques have been described for the osteosynthesis of the non union of neck of femur. The main principle of all these methods remains optimization of the biology and mechanics of the fracture to promote fracture union and delay the onset of hip arthritis. Here we describe a case of a young middle aged male who due to ongoing COVID-19 pandemic and the imposed lockdowns was not able to receive proper healthcare. He presented to us with 9 months duration of nonunion of right neck of femur fracture. Radiographs were obtained which revealed a Pauwels type 3 fracture and a Sandhu class 2 nonunion. MRI studies were done to ascertain the viability of the femoral head. After all the investigations, a decision was taken to attempt head salvage using a Valgus intertrochanteric Osteotomy. Careful preoperative assessment and calculations were done to accurately determine the osteotomy wedge, DHS pin insertion angle and the goal Pauwels angle. It was decided to correct the Pauwels angle to 30° to reduce shear forces at the fracture site and achieve compression at the fracture site. After the surgical procedure patient was followed up and the fracture as well the osteotomy site showed the signs of union at 24 weeks post operative. Patient achieved excellent function in his hip. He was able to walk pain and limp free, he could squat, sit crosslegged and perform his day to day activites as well as his ground level activites. His post operative Harris Hip Score was 90.8(excellent) at 24 weeks follow up. We thus conclude that a carefully planned valgus intertrochanteric osteotomy is able to achieve excellent outcomes in young patients with non union of neck of femur.

Effects of an integrated childbirth education program to reduce fear of childbirth, anxiety, and depression, and improve dispositional mindfulness: A single-blind randomised controlled trial

ObjectiveTo evaluate the effects of an integrated childbirth education intervention on reducing childbirth fear, anxiety, and depression, and improving dispositional mindfulness. DesignA two-arm parallel, single-blind randomised controlled trial. SettingA teaching hospital in Northern Taiwan. ParticipantsPregnant women ≥ 20 years of age with a singleton pregnancy (12–24 weeks gestation) and their support partners were recruited. All women included in the study had a score of ≥ 7 points on a fear of childbirth visual analogue scale. InterventionsThe intervention group (n = 53) received an 8-week course in a childbirth education programme, which included (1) childbirth education using simulation-based learning that highlighted coping with labour pain and (2) instruction in mindfulness breathing, body scans, stretching, sitting meditation, and mindfulness walking. Support partners were invited to participate. The control group (n = 53) received the usual standard prenatal care. MeasurementsThe primary outcome of fear of childbirth was assessed using the Wijma Delivery Expectancy/Experience Questionnaire. The secondary outcomes of anxiety, depression, and dispositional mindfulness were assessed with the Edinburgh Postpartum Depression Scale, State-Trait Anxiety Inventory Scale, and the Mindful Attention Awareness Scale, respectively. Repeated data were collected at baseline, 36 weeks gestation, and 1 week postpartum. FindingsNinety-one mothers completed the study, with a mean age of 33.9 years (SD = 4.4), and most were primipara (n = 83). The baseline measurements did not differ between the groups. Compared with the control group, there were significant differences in all measures from baseline for the intervention group: the scores were significantly lower for fear of childbirth (mean difference (MD) =-14.8 ∼ -23.7, p < .01), symptoms of anxiety (MD =-7.4 ∼ -6.4, p < .01), and depression (MD =-3.7 ∼ -3.5, p < .01); the levels of dispositional mindfulness were significantly higher (MD =4.9 ∼ 5.7, p < .01) at 36 weeks gestation, and 1 week postpartum. Conclusion and implications for practiceThe 8-week integrated childbirth education intervention was effective in reducing the fear of childbirth in pregnant women. The mindfulness techniques were easily learnt and applied by the participants. Using these techniques during pregnancy and labour enhanced participants’ mental health and coping. The integrated childbirth education which includes pregnant women and their support partners could be easily taught by midwives in other contexts.

Action Observation and Motor Imagery administered the day before surgery enhance functional recovery in patients after total hip arthroplasty: A randomized controlled trial

Objective To investigate the effects of Action Observation and Motor Imagery administered the day before surgery on functional recovery in patients after total hip arthroplasty. Design Randomised controlled trial. Setting Humanitas Clinical and Research Center, Milan, Italy Participants Eighty inpatients with end-stage hip osteoarthritis undergoing total hip arthroplasty. Interventions All patients followed a standardized postoperative rehabilitation program. Experimental group (AO + MI) performed two 12-minute Action Observation and Motor Imagery sessions on the preoperative day, whereas control group underwent usual care consisting of education without any additional preoperative activity. Outcome measures A blinded physiotherapist assessed participants for functional mobility (Timed Up and Go – TUG) (primary outcome), maximum walking speed (10-Meter Walk Test – 10MWT), pain (Numeric Pain Rating Scale – NPRS) and fear of movement (Tampa Scale of Kinesiophobia – TSK) the day before and at four days after surgery. Results No between-group differences were found at baseline. Although TUG and 10MWT worsened in both groups (p < 0.001), better TUG was found for AO + MI group at four days (mean difference −5.8 s, 95% confidence interval from −11.3 to −0.3 s, p = 0.039). NPRS (p < 0.001) and TSK (p = 0.036 for AO + MI group, p = 0.003 for control group) improved after surgery without between-group differences. Conclusions Patients undergoing Action Observation and Motor Imagery on the day before surgery showed less functional decline than control group in the first days after total hip arthroplasty. This intervention may contribute to a safer discharge with higher functional abilities in patients hospitalized for total hip arthroplasty.

Associations Between Allergies, Walking, Sedentary Time, and Low Back Pain

PurposeTo examine associations between allergies, low back pain (LBP), walking, and sedentary time in a representative sample of adults aged 50 years and older. DesignA cross-sectional, correlational study. MethodsWe used the 2014-2015 Korean National Health and Nutrition Examination Survey. Allergies of interest included allergic rhinitis, asthma, and atopic dermatitis. Adequate walking was defined as walking five or more days per week. Sedentary time was categorized as <7 h vs. ≥7 h. Logistic regression was performed to examine the association between allergies and LBP, controlling for demographics and lifestyle. Subgroup analyses were conducted to investigate the role of walking and sedentary lifestyle in LBP among those with or without allergies. ResultsOf 4,897 respondents, 23.1% reported LBP. After controlling for covariates, individuals with allergies were 1.68 times more likely to have LBP than those without allergies. In the non-allergy group, those with inadequate walking and sedentary lifestyles were nearly twice as likely to report LBP than those with adequate walking and without sedentary lifestyles. However, this trend was not observed in the patients with allergy diagnoses. ConclusionsWe confirmed associations between lifetime allergy diagnosis and LBP. A protective role of physical activity and non-sedentary lifestyle in LBP remained only among those without allergies. Clinical ImplicationsNurses should emphasize the impact of allergies on LBP. The advantages of walking and non-sedentary lifestyles for preventing or relieving chronic conditions should be routinely included in patient education; however, their preventive role in LBP should be underscored for those without allergies.

Reconstruction and Outcome of Foot Defects Following Oncological Resection-Experience from a Cancer Centre in North-East India.

Solid tumours around the foot are rare and include soft tissue sarcomas, skin and bone malignancies. Extended soft tissue defects due to oncological resection result in the loss of shock-absorbing and friction resistant tissue, which leads to altered walking patterns and pain. Replacement of plantar tissue requires soft tissue resistant to weight, pressure and shear stress. The other important desired goal of foot reconstruction is short wound healing time in order to allow adjuvant therapy at stipulated time. This is a retrospective study from March 2016 to October 2019. A total of twenty-one (n = 21) patients were operated for foot malignancies during this period in our institute and the resulting defects were reconstructed using various methods. Different reconstructive surgeries were performed depending on tumour size, location and general health status of patients. The length of hospitalization and the presence of local postoperative complications were assessed. Functional outcomes were measured in terms of MSTS score. Average age of the series is 53.1years. Sixty-six percent of the patients (n = 14) presented with tumour at the weight bearing areas and 33% patients (n = 7) at the non-weight bearing areas of the foot. Fifty-seven percent of patients (n = 12) presented with malignant melanoma of foot, squamous cell carcinoma was seen in 33% (n = 7) patients and 4% patients (n = 1 each) presented as osteosarcoma and malignant peripheral nerve sheath tumour respectively. The mean MSTS score in patients with weight bearing areas (location) is statistically significant (p = 0.031). There is a significant correlation between the surgical complications and follow up MSTS score (p = 0.046) which signifies that flap related complications result in lower MSTS score. The mean MSTS score was 22.71/30. Complications were observed in three cases which included partial flap necrosis, graft loss and foot stiffness. Simple skin grafts to local flaps maybe a viable option in a limited resource setting based on the location of defect. Free tissue transfer is the ideal choice in case of weight bearing areas to achieve acceptable outcomes.

Psychological Factors Predicting Functional Ability and Participation After Hip Fracture.

Positive psychological factors have been related to better outcomes among adults with various health conditions. To predict functional ability and participation in older adults who had experienced a hip fracture on the basis of data at admission to acute (inpatient) rehabilitation. We measured physical factors, as well as positive and negative psychological factors, at three time points. Prospective and cross-sectional cohort study. Data collection occurred during admission, at discharge, and 6 mo after rehabilitation. Inpatient geriatric rehabilitation center and follow-up at home. Seventy-one older adults (M age = 78.58 yr, SD = 6.09) who had sustained a hip fracture because of a fall and who attended acute rehabilitation; 55 completed follow-up assessments 6 mo after discharge from rehabilitation. Participants completed the Adult Hope Scale, Life Orientation Test, Positive Affect Questionnaire, Geriatric Depression Scale (at admission only), hand-grip strength measures, Numeric Pain Rating Scale, and FIM® Motor domain (mFIM) before and after acute rehabilitation and after 6 mo. The Activity Card Sort (ACS) was administered only at follow-up. Outcome measures were the mFIM and ACS. At 6-mo follow-up, functional ability was correlated more with optimism than with age, gender, or hand-grip strength measured at admission. Participation was predicted by age, the hope-agency component, and pain in walking at admission; however, the hope-agency component was only marginally significant. At discharge, functional ability was strongly predicted by age, hand-grip strength, and mFIM scores at admission. Optimism and hope played a role in explaining rehabilitation outcomes at 6-mo follow-up. Occupational therapy evaluation should address positive psychological factors, and intervention should aim to strengthen these factors as powerful aids in older adults' recovery from hip fractures. What This Article Adds: This study reflects the philosophy of occupational therapy, which places great emphasis on the connection between clients' mind-body-spirit and their participation in daily life occupations.

Randomized double blind comparative study on efficacy and safety of oral oxaceprol 200 mg versus oral diclofenac 50 mg in patients with moderate osteoarthritis

Background: Osteoarthritis of knee is the most common form of arthritis globally, approximately 250 million people are suffering from osteoarthritis of the knee alone throughout the world. It is a chronic joint disease leading to cause cartilage degradation that involves synovial Inflammation, Subchondral bone remodelling, and Formation of osteophyte pathologically, which leads to cause pain, joint destruction and difficulty in walking. Aim of the current study was to compare the safety and efficacy of oxaceprol 200 mg versus diclofenac 50 mg in patients with moderate osteoarthritis and to determine cost-effectiveness between these two drugsMethods: this is a randomized controlled study, in our study total of 94 patients were screened, of which 85 patients met inclusion &amp; exclusion criteria. In this, 78 members gave written informed consent, they were randomly assigned by double-blind fashion into two treatment groups (oxaceprol and diclofenac). Results were analyzed by applying paired and unpaired student t-test by using SPSS softwareResults: In our study, both oxaceprol and diclofenac were extremely significant in reducing joint pain and joint stiffness and improving physical activity, but when comparing with one another oxaceprol group showed better results in improving physical activityConclusions: From our study, it is concluded that oxaceprol is equally efficacious as diclofenac in reducing knee pain, joint stiffness but more efficacious than diclofenac in improving physical activity of patients by enhancing bone remodelling.

Hypophosphatemia Associated with Tumor-Induced Osteomalacia Caused by A Third Primary Tumor: A Case Report

Tumor-induced osteomalacia (TIO) is a paraneoplastic condition in which a tumor, usually of mesenchymal origin, causes osteomalacia often by producing Fibroblast Growth Factor-23 (FGF-23). FGF-23 induces hypophosphatemia through its phosphaturic action. Case Presentation: A 65-year-old male patient presented with complaints of muscle weakness, difficulty walking and severe bone pain. His medical history included distal gastrectomy for a moderate-risk gastrointestinal stromal tumor (GIST) of 4 cm in diameter, Billroth II antecholic gastroenterostomy and subsequently total thyroidectomy for Stage 1 multicentric micropapillary carcinoma (CA). Widespread lesions detected on bone scintigraphy were considered as bone metastases of GIST. Laboratory investigations revealed the following results: calcium (Ca): 8.3 mg/dL; phosphate (P): 1.5 mg/dL; Parathormone (PTH): 75 pg/mL; 25-OH vit D3: 31 ng/mL; 1-25-(OH)2 vit D3: 36 pg/mL; creatinine: 0.75 mg/dL; alkaline phosphatase (ALP): 109 IU/L, urine phosphate: 2.54 g/day. His hypophosphatemia was considered to be most probably due to TIO induced by bone metastases of GIST. Since it was not possible to remove the metastases, the patient was started on oral phosphate and calcitriol therapy. However, despite an improvement in Ca levels after the initiation of the treatment, P levels persisted around 2 mg/dL. After one year of treatment, an ulcer developed on his right first toe, which was excised and identified as “extraskeletal myxoid chondrosarcoma” on pathological examination. Following excision of the tumor, the patient’s Ca and P values returned to normal range. The development of TIO in the presence of a GIST and thyroid CA is an unusual occurrence. As a matter of fact, the cause of hypophosphatemia was TIO which induced by a third primary tumor in this patient. To the best of our knowledge, TIO due to a third primary tumor is the first and only case in the literature. Another primary tumor focus should be suspected and carefully investigated if the patient already has a primary tumor and that tumor is not among those frequently inducing TIO.

Scurvy in Children: The Silent Masquerader.

In modern society, scurvy is well known in its historical perspective rather than clinical relevance. Scurvy is classically thought to manifest with signs of 'bleeding painful gums' in the undernourished. Little is known regarding its ability to mimic a wide range of rheumatological, orthopaedic, neurological and haematological illnesses. Due to the rarity of its occurrence, there is a poor understanding among present-day clinicians, and so scurvy can easily deceive the uninitiated. We report a school-aged boy with normal neurodevelopment who presented with lower limb pain and difficulty in walking. He was seen by multiple specialist doctors before the clinical diagnosis of scurvy was made by a general paediatrician. Investigations showed that this child had X-ray changes typical of scurvy with low serum ascorbic acid levels. On supplementation with vitamin C, he showed dramatic improvement in symptoms and gradually achieved complete recovery.

Case report on efficacy of instrument assisted soft tissue mobilization in a patient having heel pain

Heel pain is the most common ailment of foot, affecting 10% of population including both younger as well as elder people. It also affects the lifestyle of these patients. Plantar fasciitis is one of such conditions which can cause heel pain. Plantar fasciitis is the result of inflammation of plantar aponeurosis due to its attachment on calcaneal tuberosity. Physiotherapy in form of soft tissue mobilization and stretching can be beneficial to achieve functional goals. The commonest sites for identifying this condition are: 1) Experiencing tenderness and pain in medial tubercle of heel bone 2) painful first step in morning and 3) Pain due to prolonged standing or weight bearing. Instrument Assisted Soft-tissue Mobilization (IASTM) and aggressive manual soft-tissue mobilization (AMSTM) are reported in improving soft-tissue mobility in individuals having plantar fasciitis. A 28-year-old female, diagnosed case of plantar fasciitis complaining of heel pain and difficulty in walking, underwent physiotherapy for 4 weeks, which resulted in reduction in pain intensity and increased foot and ankle’s abilities. This case report suggests that physiotherapy given in the form of IASTM led to improving the functional goals progressively and significantly which is a major aspect leading to a successful recovery. Keywords: Physiotherapy, Instrument assisted soft tissue mobilization, Heel pain, Plantar fasciitis.

ASSOCIATIONS BETWEEN BIOMARKERS AND SYMPTOMS IN PATIENTS WITH COMPLAINTS SUSPECTED TO BE EARLY HIP OSTEOARTHRITIS. A CHECK STUDY

Purpose: Frequent and debilitating symptoms of hip osteoarthritis are pain while walking, fatigue and nocturnal pain. The aim of the present study was to assess associations of five biochemical markers of joint tissue turnover and inflammation (hs-CRP, CTX-II, COMP, PINP and OC) with the presence and 2-year progression of pain while walking, fatigue and nocturnal pain. CTX-II and COMP are markers of cartilage and bone metabolism. CRP is a nonspecific marker of inflammation. PINP (aminoterminal propeptide of type I procollagen) and OC (osteocalcin) are bone synthesis markers.

Acquired Rectovaginal Fistula and Faecal Incontinence Following Sexual Assault in a 4-Year-Old Girl

Background: Child Sexual Abuse (CSA) is a crime against children. It is largely under-reported and commonly goes unpunished in our society.&#x0D; Case report: The patient is a 4-year-old girl who presented to our emergency paediatric unit with 14 hours duration of faecal incontinence following sexual assault by her landlord’s son. She also complains of pelvic pain and difficulty in walking. The landlords’s son forced his penis into her anus and inserted his fingers through her vagina.&#x0D; On examination of her anal region, there was anal sphincter tear at six 0’ clock, extending exteriorly to the right measuring 1 cm long and 0.5 cm deep with a rectovaginal fistula. Vaginal examination revealed minor laceration and excoriation on the right lateral wall and floor of the vagina, with mild bleeding. She had a left hymenal tear at the lower aspect and a vagina floor tear. Results of urine microscopy culture and sensitivity (MCS) revealed white blood counts (WBC) 2+, leucocytes 2+, epithelial cells+, Staphylococcus aureus was isolated which was sensityive to amoxiciilin.&#x0D; The child was resuscitated and given antibiotics and analgesics and prophylactic antiretroviral drugs. She had a perineal tear repair by the paediatric surgeon. She was placed on sitz bath and she responded well with good healing and recovery. She was discharged after 2 weeks on admission and came back for follow-up.&#x0D; This report highlights the management of a case of rectovaginal fistula in a child as a result of sexual assault.

Effect of foot orthoses vs sham insoles on first metatarsophalangeal joint osteoarthritis symptoms: a randomized controlled trial

To compare contoured foot orthoses to sham flat insoles for first MTP joint OA walking pain. This was a participant- and assessor-blinded, sham-controlled, multi-centre randomized clinical trial set in community-based private practices. Eighty-eight adults aged ≥45 years with symptomatic radiographic first MTP joint OA were randomized to receive contoured foot orthoses (n=47) or sham flat insoles (n=41), worn at all times when wearing shoes for 12 weeks. Primary outcome was change in first MTP joint walking pain (11-point numerical rating scale (NRS), 0-10) over 12 weeks. Secondary outcomes included additional first MTP joint and foot pain measures, physical function, quality of life and physical activity. Separate linear regression models for primary and secondary outcomes on treatment group were fit, adjusting for the outcome at baseline and podiatrist. Other measures included adverse events. 88 participants were randomized and 87 (99%) completed the 12-week primary outcome. There was no evidence foot orthoses were superior to sham insoles for reducing pain (mean difference-0.3 NRS units (95% CI -1.2 to 0.6), p=0.53). Similarly, foot orthoses were not superior to sham on any secondary outcomes. Sensitivity analyses yielded similar results. Adverse events were generally minor and transient. Contoured foot orthoses are no more effective than flat sham insoles for the clinical management of first MTP joint OA. Given the dearth of evidence on treatments for first MTP joint OA, further research is needed to identify effective management approaches for this common and debilitating condition.

The effects of taping and foot exercises on patients with Hallux valgus

Background: Hallux valgus is a complex progressive deformity manifesting with lateral deviation of the greater toe and medial deviation of first metatarsal. To decrease or control the hallux valgus angle, various orthosis pulling the hallux laterally and taping and foot exercises can be important in maintaining the mobility of joints. Aim: To determine the effect of taping and foot exercises in relief of pain, improving walking ability and in the angle of hallux valgus.Materials and Methods: The study included 20 female patients. The subjects were divided into 2 groups, the study and control groups. The study group was treated with taping and foot exercises, and the control group was treated only with foot exercises. A goniometer was used to determine the angle of hallux valgus. Foot pain intensity was assessed by the visual analog scale (VAS), and walking ability was evaluated using the walking ability scale (WAS).Result and Conclusion: At the end of the 4-week treatment period, a significant decrease was found in hallux valgus angle, resting pain, and walking pain in both groups (P< 0.05). Also, walking ability improved at least 1 grade in the study group. When the post-treatment results between the 2 groups were compared, the results. The result showed statistical improvement in hallux valgus angle, walking ability in the study group when compared to the control group. There was no significant difference found between the study and control group for VAS score.

Femoral nerve inguinal approach versus proximal femoral triangle ap proach for continuous regional analgesia in active rehabilitation after total knee arthroplasty: A prospective, randomised study

BackgroundA catheter in femoral nerve block (F-Cath) is an effective regional analgesia technique in total knee arthroplasty (TKA) but results in significant quadriceps weakness. The femoral triangle catheter (FTB-Cath) seems to be an interesting alternative. In this study, we aim to demonstrate that the nerve block administration for analgesic purposes via an FTB-Cath results in less quadriceps weakness than via an F-Cath. MethodsThis study included patients scheduled for TKA performed under general anaesthesia. The patients were randomised to receive either an F-Cath or an FTB-Cath. A unique regimen of 0.2% ropivacaine was administrated for 72 h. The primary endpoint was quadriceps strength assessed clinically on postoperative day (POD) 2 by the Manual Muscle Test (MMT) using a motor grading scores (0–5). The secondary endpoints were quadriceps strength measured by a dynamometer, the Timed Up and Go (TUG) test, the 30-m walk test (30MWT) and pain scores. ResultsForty-four patients were analysed (22 in each group). On POD 2, 77.3% of the patients in the FTB-Cath group had MMT scores ≥ 4 and 13.6% in the F-Cath group (p < 0.001). During the first four POD assessments, quadriceps strength evaluated with a dynamometer was less diminished in the FTB-Cath group (p < 0,001). There was no difference between groups regarding pain scores, TUG test results and 30MWT assessment. ConclusionThe FTB-Cath provided a better preservation of quadriceps strength than the F-Cath in TKA, with a similar pain relief.

Effect of Novel based Postoperative physiotherapy rehabilitation on functional outcome in Malunited supracondylar fracture of femur and proximal tibia fracture following implant removal

Supracondylar femur fractures are common fractures that represent a management challenge. Despite consistent fracture patterns and predictable challenges associated with reduction and stabilization, complications, including malunion, nonunion, and implant failure, can occur in patients who undergo treatment for the management of a supracondylar femur fracture. A 25-year male patient reported complaints of pain and difficulty to perform movements of hip joint and weakness in the right leg. On investigations patient was diagnosed as a supracondylar fracture and proximal 1/3rd shaft of femur fracture. Patient was operated with open reduction and internal fixation with interlocking plating.Patient was referred to physiotherapy OPD following implant removal with the findings of malunited fracture with complaints of intense pain in right leg and difficulty while walking , sitting, climbing stairs and sudden pain while lifting the affected leg . Post-operative Rehabilitation protocol was given into 4 phases, 5 days per week for 8 weeks. The key treatment of Rehabilitation protocol was paraffin wax bath, CPM, patellar mobilization along with scar mobilization, Mainland's Mobilization and Hold relax technique of PNF and strengthening exercises. So it is concluded that Novel based Postoperative physiotherapy rehabilitation was effective in malunited supracondylar fracture of femur and proximal tibia fracture following implant removal for reduction of pain and early regain of range of motion, strength and functional activities. Keywords: Supracondylar Fracture, Malunion, Implant Removal, Proximal Tibia Fracture, Physiotherapy Management.