Background: Physical activity is important throughout the lifespan. Racket sports are popular with older adults and offer important social benefits. It is unknown how the physiologic changes attributable to aging affect lower limb loading during multidirectional sports and how this may influence footwear requirements. The purpose of this work was to explore the footwear needs and preferences of older adults in racket sports to inform footwear design and development.
Methods: Semistructured interviews were conducted online with 16 participants (56–92 years of age) who typically play racket sports at least once per week. Thematic analysis was used to group basic themes into organizing themes.
Results: The organizing themes were comfort (general comfort, pain-free, and cushioning), functionality (relating to the structure of the shoe and performance), and choice (mostly around the appearance of the shoe). Comfort was a key priority for the majority of participants, although it was often stressed that the footwear must also be supportive. Support was frequently defined in relation to preventing ankle sprains; however, when asked directly about managing injury risk, avoiding certain shots and appropriate grip were mentioned over support. More than half of participants reported needing a wide-fitting sport shoe, which limited the footwear selection available to them.
Conclusions: This study provides novel insight into the footwear requirements of active older adults, which can inform the development of footwear to facilitate safe and pain-free participation in sport for all.
Background: To evaluate complications and risk factors for nonunion in patients with diabetes after ankle fracture.
Methods: We conducted a retrospective study of 139 patients with diabetes and ankle fractures followed for 1 year. We evaluated the incidence of wounds, infections, nonunions, Charcot’s arthropathy, and amputations. We determined Fracture severity (unimalleolar, bimalleolar, trimalleolar), nonunion, and Charcot’s arthropathy from radiographs. Nonunion was defined as a fracture that did not heal within 6 months of fracture. Analysis of variance was used to compare continuous variables, and χ2 tests to compare dichotomous variables, with α = 0.05. Logistic regression was performed with a binary variable representing nonunions as the dependent variable.
Results: Complications were common: nonunion (24.5%), Charcot’s arthropathy (7.9%), wounds (5.2%), wound site infection (17.3%), and leg amputation (2.2%). Patients with nonunions were more likely to be male (55.9% versus 29.5%; P = .005), have sensory neuropathy (76.5% versus 32.4%; P < .001), have end-stage renal disease (17.6% versus 2.9%; P < .001), and use insulin (73.5% versus 40.1%; P < .001), β-blockers (58.8% versus 39.0%; P = .049), and corticosteroids (26.5% versus 9.5%; P = .02). Among patients with nonunion, there was an increased risk of wounds (odds ratio [OR], 3.3; 95% confidence interval [CI], 1.46–7.73), infection (OR, 2.04; 95% CI, 0.72–5.61), amputation (OR, 7.74; 95% CI, 1.01–100.23), and long-term bracing (OR, 9.51; 95% CI, 3.8–23.8). In the logistic regression analysis, four factors were associated with fracture nonunion: dialysis (OR, 7.7; 95% CI, 1.7–35.2), insulin use (OR, 3.3; 95% CI, 1.5–7.4), corticosteroid use (OR, 4.9; 95% CI, 1.4–18.0), and ankle fracture severity (bimalleolar or trimalleolar fracture) (OR, 2.5; 95% CI, 1.1–5.4).
Conclusions: These results demonstrate risk factors for nonunions: dialysis, insulin use, and fracture severity after ankle fracture in patients with diabetes.
Longitudinal epiphyseal bracket of the first metatarsal, also known as first enclosed metatarsal, is a rare congenital disorder characterized by an abnormal development in the length of the first metatarsal ray because of the asymmetric presence of a longitudinal epiphyseal bracket. This causes interruption in the lengthways development of the affected bone, which becomes squat and short, with a trapezoidal or triangular shape, leading to a hallux varus deformity. First enclosed metatarsal occurs in 2% to 14% of all congenital defects in the hands and feet; with bilateralism in 75% of cases and a greater incidence in male patients. The deformity is classified as a differentiation defect; it is frequently associated with abnormalities such as syndactyly or polydactyly. There are different surgical treatments reported in the literature. Most of them are aimed at the excision of the epiphyseal bracket before complete skeletal maturity and frequently in the first year of life to promote a normal lengthways growth of the bone. In this study, the authors present three cases of bilateral first enclosed metatarsal in which the surgical treatment, aimed at lengthening the first metatarsal ray by using the Penning Minifixator, was instead carried out at the end of growth. This different surgical approach allowed the planning of a surgical operation involving both the skeletal structures and the surrounding soft tissue.
Osteonecrosis is acknowledged as a relatively uncommon disorder caused by various factors, including autoimmune diseases, drug-induced diseases, inherited metabolic disorders, coagulation disorders, and underlying malignancies. To our knowledge, no previous research has investigated osteonecrosis stemming from extracorporeal membrane oxygenation. Herein, we report a rare case of postperipheral venoarterial extracorporeal membrane oxygenation–induced multifocal osteonecrosis in the foot and ankle that demonstrated a low serpiginous peripheral signal on T1-weighted images and a double-line sign on fat-suppressed or T2-weighted magnetic resonance images. Conservative treatment was applied, and the patient was mostly recuperated after 6 months.
Background: Onychomycosis is the most common nail disease seen in clinical practice. Medication safety, severity of disease, comorbidities, concomitant medications, patient age, and cost are all important considerations when treating onychomycosis. Because cost may affect treatment decisions, we sought to analyze Medicaid formulary coverage of onychomycosis antifungals.
Methods: Public state Medicaid formularies were searched for coverage of US Food and Drug Administration–approved onychomycosis medications and off-label oral fluconazole. Total drug cost for a single great toenail was calculated using the National Average Drug Acquisition Cost. Pearson correlation coefficients were calculated to compare coverage and cost, mycologic cure rate, and complete cure rate.
Results: Oral terbinafine and off-label fluconazole were widely covered for onychomycosis treatment. There was poor coverage of oral itraconazole and topical ciclopirox, and there was no coverage of topical efinaconazole and tavaborole without step-edits or prior authorization. There was a significant negative correlation between medication coverage and cost (r = −0.758; P = .040). There was no correlation between medication coverage and mycologic (r = 0.548; P = .339) and complete (r = 0.768; P = .130) cure rates.
Conclusions: There is poor Medicaid coverage of antifungals for the treatment of onychomycosis, with step-edits and prior authorization based on cost rather than treatment safety and efficacy. We recommend involving podiatrists and dermatologists in developing criteria for insurance approval of onychomycosis treatments.
Abstract
Background: The emergence of minimally invasive techniques in foot and ankle surgery has aimed to reduce iatrogenic tissue insult by utilising the smallest possible incision area to achieve maximum correction of pathological structures. The objective of this study was to assess whether adequate hallux valgus correction can be achieved via the minimally invasive chevron akin (MICA) procedure.
Methods: A retrospective analysis was conducted for a single-surgeon case series of 169 MICA procedures between June 2018 and June 2021 in Australia. Radiographic parameters were evaluated independently by two researchers using 1-2 intermetatarsal angle (1-2 IMA) and hallux valgus angle (HVA) as key measures of procedural outcome.
Results: 95% of participant-operations resulted in normal 1-2 IMA and HVA being obtained post-operatively in a cohort that largely consisted of moderate hallux valgus deformities; 1-2 IMA Reduction: 6.38° ± 3.24 (95% CI 5.89 to 6.87) and HVA Reduction: 20.17° ± 7.69 (95% CI 19.01 to 21.33).
Conclusion: The results of this study help to further strengthen support for the use of minimally invasive bunion surgery as a primary treatment approach in mild to moderate hallux valgus.
Background: We evaluated the relationship between the type of accessory navicular bone (ANB) and radiographic parameters of the foot in patients with bilateral ANBs of different types.
Methods: Patients with bilateral ANBs of different types participated in this study between May 2019 and April 2020. Patient data, including age, sex, body mass index (BMI), and presence of symptoms, were obtained. We aimed to compare the radiographic parameters of both feet to evaluate the differences from one another in patients with bilateral ANBs of different types (one side type 1 and one side type 2) because the foot angles may differ in each person. Seven radiographic parameters evaluating hindfoot, midfoot, and forefoot alignment were measured: calcaneal pitch angle, talocalcaneal angle, tibiocalcaneal angle, naviculocuboid overlap, talonavicular coverage angle, and anteroposterior and lateral talo–first metatarsal angles.
Results: Twenty patients (13 women and seven men) with a mean ± SD age of 38.5 ± 12.3 years were included in the study. The patients had a mean ± SD height of 168.1 ± 7.1 cm, weight of 77.2 ± 10.5 kg, and BMI of 27.4 ± 4.3. There were no significant differences between type 1 and type 2 ANBs in any radiographic parameters and no significant correlations between radiographic parameters and age, BMI, or the presence of symptoms.
Conclusions: We found that the type of ANB had no effect on the radiographic measurements of the foot in patients with bilateral ANBs of different types. Age, BMI, and the presence of symptoms also demonstrated no correlations with the radiographic parameters.
The purpose of this article is to familiarize physicians with the risks of prescribing trimethoprim/sulfamethoxazole (TMP/SMX) for patients who have kidney or cardiac pathology, have hyperkalemia, or take other interacting medications. Although TMP/SMX is a drug that is frequently used to treat skin and soft-tissue infections of the leg and foot, particularly if methicillin-resistant Staphylococcus aureus is identified, it is not an innocuous antibiotic. Literature documenting the many adverse effects of TMP/SMX is reviewed. A case history is presented illustrating the association of TMP/SMX with the development of a life-threatening situation. Ways of avoiding these adverse events are discussed, and the use of safer antibiotics is recommended.
Abstract
Background: Studies on the sensory perception of mass mostly focus on the hands rather than the feet. The aim of our study is to measure how accurately runners can perceive additional shoe mass in comparison to a control shoe (CS) while running, and moreover, whether there is a learning effect in the perception of mass. Indoor running shoes were categorized as a CS (283g) and shoes with four additional masses shoe 2 (+50g), shoe 3 (+150), shoe 4 (+250) and shoe 5 (+315).
Methods: Twenty-two participants attended a to the experiment divided into two sessions. In session one, participants ran on a treadmill for two minutes with the CS and then put on one set of weighted shoes and ran for another two minutes at a preferred velocity. A binary question was used after the pair test. This process was repeated for all the shoes to compare them with the CS.
Results: Based on our statistical analysis (mixed effect logistic regression), the independent variable, mass did have a significant effect on perceived mass, F (4,193) = 10.66, P < 0.0001, while repeating the task did not show a significant learning effect (F (1, 193) = 1.06, P = 0.30).
Conclusions: An increase of +150g is the just noticeable difference among other weighted shoes and Weber’s fraction is equal to 0.53 (150g : 283g). Learning effect did not improve by repeating the task in two sessions in the same day. This study facilitates our understanding about sense of force and enhances multibody simulation in running.
