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Abstract
Background: Fat pad atrophy is the loss of subcutaneous tissue in the plantar foot, inhibiting the cushioning function. Patients experience severe pain upon ambulation from high-pressure forces. Soft tissue augmentation or fat pad restoration is performed to improve the thickness and cushioning ability of the subcutaneous layer. A first-of-its-kind, allograft adipose matrix (AAM), which has been reported to support native fat pad restoration, was evaluated to address fat pad atrophy and the cushioning ability in the plantar foot.
Method: An IRB approved retrospective study review and analysis on 16 patients (21 feet) treated with AAM in the plantar foot was conducted. Adverse events and a patient subjective evaluation of percentage improvement were reported, sometimes supported by imaging.
Results: The average volume of AAM injected was 2.2±0.7cc (1.5-2.6cc range) with a follow-up time of 3-20 months, in patients aged 68.6±8.9 years. Overall minimal adverse events were observed and the percentage improvement, as per patient feedback, was 72.9±23.0% (100% corresponds to fully satisfied). The quality of skin improved with reduced presence of callus and patients resumed their daily activities.
Conclusion: AAM can support endogenous fat pad restoration by supplementing fat thickness and its natural cushioning ability. The early clinical observations in this retrospective study review demonstrated that patients could resume daily activities after treatment.
Abstract
Background: An abnormal hallux interphalangeal angle may be an important risk factor for the recurrence of ingrown toenails.
Methods: In this study, sixty pediatric patients who underwent surgery for an ingrown toenail were evaluated retrospectively in terms of recurrence. The patients were divided into two groups. Group 1 included 30 patients (22 male, 8 female) with hallux valgus interphalangeal deformity. Group 2 included 30 patients (20 male, 10 female) without toe deformity.
Results: The mean age was 12.8±1.42 years and 12.5±1.45 years for patients in Group 1 and in Group 2 respectively. There was no statistically significant difference between the patient and control group in terms of age and gender (p>0.05). The mean follow-up time was 40 months. We observed recurrence in six patients (20%) in Group 1 and in 2 patients (6.6%) in Group 2.
Conclusion: We concluded that the recurrence of an ingrown toenail may be associated with increased hallux interphalangeal angle in pediatric patients. Factors related to the hallux interphalangeal angle abnormality, which increases the risk of ingrown toenails, also increase the recurrence rate in these patients. Therefore, it is surmised that hallux valgus interphalangeal deformity should be evaluated before surgery, and patients and their families should be informed about the risk of increased recurrence.
Abstract
Background: The human foot has three arches. The medial longitudinal arch is the longest, the highest, and the most important. The development of a normal foot arch is greatly affected by genetic inheritance, differences in the environment, socioeconomic development, body weight, sex, ethnicity, and culture. The purpose of this study was to compare the arch type between shoe-wearing and barefooted individuals.
Methods: A cross-sectional study was conducted. The data obtained were checked for clarity and consistency before analysis. The analysis was done using descriptive statistics and chi-square. p-values less than 0.05 were considered to be statistically significant.
Result: From a total of 446 subjects, 217 (48.7%) were males, 131 (29.6%) were urban residents and 226 (50.6 %) were shoe wearers. From the total sample, 46.2%, 42.8%, and 11% are high, normal, and flat-arched individuals, respectively. Of the shoe wearers, 6.7% have a flat arch while 4.3% of the barefooted subjects are flat-arched. Of the total flat-arched subjects, 8.3% are males and 2.7% are females. Of the urban residents, 17.5% have a flat foot and 8.3% of rural residents were flat arched. Among the shoe wearers, 8.8% use closed-toe shoes, and 4.4% that wear sandals are flat-arched.
Conclusion: The result indicates sex, type of shoes, wearing shoes, and being barefooted affected the development of the foot arch.
Abstract
Background: Plantar fasciitis (PF) is predominantly treated conservatively through some modalities such as extracorporeal shock wave therapy (ESWT) and low-level laser therapy (LLLT), yet the short effect of these modalities on pain and function is still ambiguous. This study aims to compare the short-term effectiveness of ESWT and LLLT on pain and function in patients with PF.
Methods: Participants (n=47) were randomly assigned into 2 groups as ESWT (n=27) and LLLT (n=20). ESWT (once a week) and LLLT (three times a week) were administered to the participants for 3 weeks. Foot function index (FFI) including pain, disability, and activity limitation subscales was administered at baseline and post-treatment. A reduction of one point in total scores was considered as a minimum clinically important difference. Repeated measures of ANOVA were used to analyze the changes in outcomes and compare the groups.
Results: There were significant main effects of time, and significant interaction effects between group and time on pain (P<0.001), disability (P<0.001), and activity limitation (P<0.05). The main effect of the group was not significant for all subscales (P=0.811, P=0.481, P=0.865, respectively). The LLLT group showed a significant decline in pain (P<0.001), disability (P<0.001), and activity limitation (P<0.001) while there was no change in the ESWT group over time (P=0.319, P=0.711, P=1.0 respectively). Consistently, 95% of participants in the LLLT had CID in the pain subscale whereas 48% of the ESWT group had.
Conclusions: LLLT was found to be superior to ESWT as an effective approach in the short-term management of PF.
Abstract
Background: Body awareness is an expression of the extent of sensitivity and attentiveness to internal bodily signals and sensations. The foot has a critical function in providing interoceptive and exteroceptive information. The purposes of this study were to 1) compare body awareness in individuals with and without hallux valgus (HV) deformity, and 2) investigate the relationship between body awareness and HV-related parameters.
Methods: A total of 129 participants completed the assessments. The severity of the HV was evaluated using the Manchester Scale; pain severity was evaluated using the numeric pain rating scale; and the functional status was evaluated using the Manchester-Oxford Foot Questionnaire. The patients were divided into 2 groups according to the Manchester Scale scores as the presence or absence of HV. The body awareness of the individuals with HV was assessed using the Body Awareness Questionnaire.
Results: Included in this study were 69 participants with HV and 60 healthy participants. There was no difference between groups in terms of demographic properties. Two groups were found different only in pain severity (P < 0.01). The correlation analysis showed that there was a low correlation between the body awareness score and pain severity in both feet (right foot r: 0.306, P = 0.011; left foot r: 0.320, P = 0.007) in individuals with HV.
Conclusions: Participants with HV had higher pain severity and the pain severity was associated with the body awareness. The level of body awareness should be assessed and taken into consideration in the management of pain in patients with HV.
Abstract
Background: Distal osteotomy of the first metatarsal is a widely used method for the correction of mild-to-moderate hallux valgus deformities. The objective of this study was to compare the stability of headless compression screws, kirschner wires and absorbable pins in terms of stiffness and maximum load in distal oblique metatarsal osteotomy.
Methods: A total of 30 4th generation first metatarsal synthetic bone models were divided into three groups according to the fixation techniques. The stiffness of the first metatarsal was calculated as the slope of the linear curve that fit with the first linear part of the force displacement curve. The failure strength was recorded as the maximum load. The stiffness and maximum load values in the axillary and transverse configurations were compared between the three fixation groups.
Results: The stiffness was statistically higher in Group K and Group C compared to Group B in both axial and transverse loading. Similarly, the maximum load was significantly higher in both Group K and Group C compared to Group B in both loading conditions. No significant difference was found between Group K and Group C in stability. The higher failure strength was obtained with headless compression screws (113.34±35.88 N) in the axial loading. The lowest failure strength was found in the absorbable pins technique (16.17±7.72 N) in the transverse loading.
Conclusion: No significant difference was found between the Kirschner wires and headless compression screws techniques, although the highest strength was obtained with headless compression screws that are increasingly used in orthopedic practice.
Abstract
Background: Ideal suture technique and type in tendon repair are remain unclear. This biomechanical study aimed to assess the biomechanical characteristics of three techniques, modified Kessler (mKE), modified Krackow (mKR), and modified tension Bunnell (mtBU), in sheep Achilles’ tendon tear repair using three suture types, polypropylene, polyester, and ultra-high molecular weight polyethylene (UHMWPE) sutures, which are also compared.
Methods: Sixty-three Achilles’ tendons harvested from sheep were transversely hacked as a replacement for rupture in a standardized measure and repaired using mKE, mKR, and mtBU techniques with No. 2 polypropylene, polyester, and UHMWPE sutures. Biomechanical parameters, such as Young’s modulus, ultimate strength, and strength to the 5-mm gap were recorded for statistical analysis.
Results: The mtBU technique with UHMWPE use resulted in increased ultimate strength, strenght to 5-mm gap, Young’s modulus, and quantity of specimens with low clinical failure modes compared to other techniques with other suture materials. Furthermore, mtBU has the lowest thickness at the repair side of the tendons. This approach showed tendon failure during maximal traction testing, whereas the mKE and mKR had polyethylene and polyester suture failures.
Conclusions: The UHMWPE suture was significantly superior to the other sutures in each suture techniques in terms of strength and durability. The mtBU technique using UHMWPE suture showed better biomechanical results, implying that this repair might be more appropriate to obtain early mobilization after tendon ruptures.
Abstract
Background: Clinical thermography is a relatively novel technique in wide use in different medical fields because of its versatility and ease of application. It inflicts no pain and it entails no contact with the pediatric patient, which assuages anxiety and fear in subjects when undergoing diagnostic exploration. The use of infrared clinical thermography being suggested here is to establish normality patterns, which have not been described in the relevant literature. These patterns may be extrapolated to pathological study by means of future research lines.
Methods: An observational, cross-sectional study (descriptive in nature) has been carried out, with a sample population of 328 children divided into two age groups; 6-7 and 13-16 years old, all of them schooled in the province of Cáceres (Spain). The variables analyzed here are: age, sex, and temperature. A FLIR E60bx® thermographic camera has been used to study foot temperature.
Results: Results show that the temperature varies among the different study areas established for the foot, although they remain constant bilaterally. In addition, the highest temperature is found to be located in the area of the first toe (29.8ºC), and the lowest at the heel (28.8ºC).
Conclusions: It can be concluded that both feet have the same thermal behavior, despite the variation in temperature among the different areas that were established in the foot for the purposes of this study.
