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- Author or Editor: RA Sherman x
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Reflex sympathetic dystrophy is one of a complex of overlapping, sympathetically maintained pain syndromes which are usually initiated by a minor injury that resolves quickly but leaves behind a persistent pain that generalizes to much or all of the limb. The pathophysiology of reflex sympathetic dystrophy is reviewed to show that the pain is accompanied by cooling of the limb, beginning with the distal end and gradually progressing throughout. Thermography is shown to be an effective way to monitor near-surface blood flow in the limbs and to be sensitive to changes accompanying painful conditions. The usefulness of this technique for early detection of reflex sympathetic dystrophy is demonstrated and illustrated with several examples.
The authors illustrated a chronic bilateral plantar foot ulcer of several years' duration that was resistant to all forms of conventional therapy, yet was resolved after 13 1/2 weeks of maggot therapy. The contralateral foot ulcer showed no improvement during the same period, despite continual inpatient conventional dressing changes. At a time when medical cost containment is a critical issue, maggot therapy may resurge as a viable alternative in treating nonhealing wounds.
The utility of shock-absorbing boot and sneaker inserts for reducing the occurrence of lower limb pain among male US Army basic trainees was evaluated. Every other training unit was given inserts. The inserts were issued prior to the start of training when combat boots and sneakers were fitted. According to post-training questionnaires and the participants' medical records, the inserts did not have any preventive effect on occurrence of lower limb problems during training. Five hundred seventeen trainees were issued inserts, 397 were followed but not issued inserts, and 218 were not issued but purchased them on their own. Thirty-eight percent of those issued inserts had lower limb pain problems compared with 29% of those not issued inserts and 38% of those who bought their own. There was no statistical difference between these rates of occurrence. Prior to training, there were minor differences between the groups' scores on physical fitness test scores and run times. These differences disappeared during training so that there were no differences among the groups on either training or clinical variables during or after basic training.
