Pregnant women are often burdened with musculoskeletal symptoms of the lower extremity due to the physical, hormonal, and anatomical changes that occur throughout pregnancy. These symptoms are associated with musculoskeletal dysfunctions, modified gait, joint laxity, muscle imbalance, and increased body mass. This article reviews the literature involving the lower-extremity changes experienced by women during pregnancy and their respective pathophysiologic causes.
To date, there is conflicting evidence that high-end “motion control” running shoes can correct and control rearfoot pronation. Many methods have been used to evaluate the efficacy of motion control footwear in reducing hindfoot pronation during gait, including stop-motion photography, three-dimensional camera kinematic analysis, and three-dimensional bone modeling using computed tomography. Until now, there have been no radiographic studies that examined the effect of motion control running shoes on the static posture of the foot. Murley et al devised a reliable system that correlated noninvasive clinical examinations to radiographic values that correspond to foot pronation. The aim of this prospective investigation was to determine whether motion control running shoes are able to produce a significant difference in pronation through a radiographic study, using the angular relationships as described by Murley et al, in two different shoe conditions as compared to the barefoot condition in female subjects.
This prospective study screened 28 female subjects ranging in age from 22 to 27 years on the basis of arch height index. The 24 subjects with a standing arch height index less than 0.370 were invited to participate in the study. Unilateral weightbearing dorsoplantar and lateral foot radiographs were taken in barefoot, neutral shoe, and motion control shoe conditions. Calcaneal inclination angle, calcaneal–first metatarsal (CFMA) angle, talonavicular coverage angle (TNCA), and talus–second metatarsal angle were measured in each condition by two independent observers using the Opal-Ortho PACS software package and then averaged. Angles were compared to barefoot baseline values using paired t tests.
The motion control running shoe produced average decreases of 2.64% in CFMA, 12.62% in TNCA, 5.3% in talus–second metatarsal angle and an average increase of 1.3% in calcaneal inclination angle. Statistically significant (P > .05) improvements in CFMA were noted in both the motion control (P < .000) and neutral shoe conditions (P < .000) when compared to barefoot, whereas TNCA improved only in the motion control shoe condition as compared to barefoot (P = .003).
This investigation found evidence that the particular models of motion control running shoes studied could correct foot pronation in the transverse and sagittal planes in stance. Motion control running shoes improved CFMA and TNCA from the barefoot condition and were more effective in correcting pronation compared with neutral running shoes in this radiographic study simulating static foot posture in stance.
It is well established and accepted that fungi are a major contributing factor in nail dystrophy. It has also been recognized that bacteria play a crucial role in onycholysis. However, the bacteria and fungi that can be grown on culture media in the laboratory are only a small fraction of the total diversity that exists in nature. Contemporary studies have revealed that fungi and bacteria often form physically and metabolically interdependent consortia that harbor properties and pathogenicity distinct from those of their individual components. Metagenomic DNA “shotgun” sequencing has proved useful in determining microbial etiology in clinical samples, effective for not only bacteria but also fungi, archaea, and viruses.
Thirty-nine consecutive nail and subungual debris samples with suspected onychomycosis were sent for laboratory analysis using three examination techniques: DNA sequencing, polymerase chain reaction analysis, and standard fungal culture. The nail plate and surrounding areas were disinfected with an ethyl alcohol swab before nail sampling. Samples from 16 patients were analyzed for suspected onychomycosis with DNA sequencing, searching a database of 25,000 known pathogens. These results were compared with 15 real-time polymerase chain reaction screening assays and eight fungal cultures sampled with the same methods.
The DNA sequencing detected 32 species of bacteria and 28 species of fungi: 50% were solely bacterial, 6.3% were solely fungal, and 43.7% were mixed communities of bacteria and fungi.
Toenails tested with DNA sequencing demonstrated the presence of both bacteria and fungi in many samples. Further work is required to fully investigate its relevance to nail pathology and treatment.