Background
Patients with limited English proficiency (LEP) encounter many health disparities and inequalities due to the lack of effective communication. The lack of effective communication places patients with LEP at higher risk for noncompliance with the treatment plan. Pain is one of the main common health issues, and patients with LEP have difficulties reporting their pain and adhering to the plan of care due to the lack of effective communication.
Methods
We measured the effectiveness of using a professional interpreter during office visits for Farsi-speaking patients with LEP to improve pain management and adherence with follow-up visits. In this single-sample quasi-experimental study, 16 Farsi-speaking participants with LEP who visited a podiatric medical office for foot pain rated their pain level at the initial visit and after the intervention during the first follow-up visit. Participants were provided with a professional Farsi-speaking interpreter during the visit.
Results
Overall, patients reported lower mean ± SD levels of pain during the follow-up visit (4.19 ± 2.29) than at the initial visit (6.56 ± 2.03). Of all of the participants, 75% attended the follow-up appointment, demonstrating that most of the participants adhered to the plan of care.
Conclusions
The use of a professional interpreter during an office visit for patients with LEP was associated with improved pain management outcomes and increased adherence to the treatment plan.
Background
Joint hypermobility is a connective tissue disorder that increases joint range of motion. Plantar pressure and foot loading patterns may change with joint hypermobility. We aimed to analyze static plantar pressure in young females with and without joint hypermobility.
Methods
Joint laxity in 27 young females was assessed cross sectionally using the Beighton and Horan Joint Mobility Index. Participants were divided into the hypermobility (score, 4–9) and no hypermobility (score, 0–3) groups according to their scores. Static plantar pressure and forces were recorded using a pedobarographic mat system.
Results
Higher peak pressures (P = .01) and peak pressure gradients (P = .025) were observed in the nondominant foot in the hypermobility group. According to the comparison of dominant and nondominant feet in each group, the hypermobility group showed significantly higher peak pressures (P = .046), peak pressure gradients (P = .041), and total force values (P = .028) in the nondominant foot.
Conclusions
The plantar pressure and loading patterns vary in young females with joint hypermobility. Evaluation of plantar loading as an injury prevention tool in individuals with joint hypermobility syndrome can be suggested.
Background
The skin on human feet presents unique environments for the proliferation of potentially pathogenic commensals. This study examined microflora changes on healthy intact skin under a semiocclusive dressing on the medial longitudinal arch of the foot to determine changes in growth, distribution, and frequency of microflora under the dressing.
Methods
Nine human participants wore a low-adherent, absorbent, semiocclusive dressing on the medial longitudinal arch of the left foot for 2 weeks. An identical location on the right foot was swabbed and used as a control. Each foot was swabbed at baseline, week 1, and week 2. The swabs were cultured for 48 hours. Visual identification, Gram staining, DNase test agar, and a latex slide agglutination test were used to identify genera and species.
Results
Microflora growth was categorized as scant (0–10 colony-forming units [CFU]), light (11–50 CFU), moderate (51–100 CFU), or heavy (>100 CFU). Scant and light growth decreased and moderate and heavy growth increased under the dressing compared with the control. Seven different genera of bacteria were identified. Coagulase-negative Staphylococcus spp appeared most frequently, followed by
Conclusions
Changes in microflora distribution, frequency, and growth were found under the dressing, supporting historical studies. Microflora changes were identified as an increase in bioburden and reduction in diversity. The application of similar methods, using more sophisticated identification and analysis techniques and a variety of dressings, could lead to a better understanding of bacterial and fungal growth under dressings, informing better dressing selection to assist the healing process of wounds and prevent infection.
Background
The purpose of the present study was to retrospectively compare the outcomes of patients who underwent arthroscopic thermal capsular shrinkage with those who underwent both arthroscopic thermal capsular shrinkage and arthroscopic osteochondral lesion (OCL) treatment with microfractures. Our hypothesis was that the simultaneous treatment does not negatively affect the outcome of the combined surgical procedure by influencing the postoperative rehabilitation protocol and does not significantly differ from capsular shrinkage alone in terms of subjective and objective outcomes.
Methods
Seventy-six patients with chronic ankle instability were treated at our department from 2004 to 2012 and reviewed retrospectively. Forty-two patients underwent arthroscopic thermal-assisted capsular shrinkage (group A), and 34 patients underwent combined arthroscopic capsular shrinkage and microfractures for OCL lesions of the talus (group B). All patients underwent a four-step surgical procedure including synovectomy, debridement, capsular shrinkage, and bracing and nonweightbearing for 21 days. In patients with OCL lesions, microfractures of the OCL were associated. Clinical assessment included objective examination, the American Orthopaedic Foot and Ankle Society ankle and hindfoot scoring system, Karlsson-Peterson score, Tegner activity level, and Sefton articular stability scale.
Results
The median follow-up was 6 years (range, 2–9 years). The median postoperative visual analogue scale score, American Orthopaedic Foot and Ankle Society score, and Tegner score were improved from the preoperative level for both groups (P < .001). No significant difference was found between the two groups for the subjective scores and satisfaction rate (P = not significant). Similarly, no significant difference regarding the incidence of range-of-motion restriction was reported between the two groups (P = not significant).
Conclusions
The association of microfractures for the treatment of osteochondral lesions does not affect the outcome following arthroscopic treatment for chronic ankle instability up to 6 years from surgery.
Background
Plantar pressure assessments are useful for understanding the functions of the foot and lower limb and for predicting injury incidence rates. Musculoskeletal fatigue is likely to affect plantar pressure profiles. This study aimed to characterize college elite basketball players' plantar pressure profiles and pain profiles during static standing and walking.
Methods
Fifty-one male elite basketball players and 85 male recreational basketball players participated in this study. An optical plantar pressure measurement system was used to collect the arch index (AI), regional plantar pressure distributions (PPDs), and footprint characteristics during static and dynamic activities. Elite basketball players' pain profiles were examined for evaluating their common musculoskeletal pain areas.
Results
The AI values were in the reference range in recreational basketball players and considerably lower in elite basketball players. Elite basketball players' static PPDs of both feet were mainly exerted on the lateral longitudinal arch and the lateral heel and were relatively lower on the medial longitudinal arch and medial and lateral metatarsal bones. The PPDs mainly transferred to the lateral metatarsal bone and lateral longitudinal arch and decreased at the medial heel during the midstance phase of walking. The footprint characteristics of elite basketball players illustrated the features of calcaneal varus (supinated foot) of high arches and dropped cuboid foot. The lateral ankle joints and anterior cruciate ligaments were the common musculoskeletal pain areas.
Conclusions
Elite basketball players' AI values indicated high arches, and their PPDs tended to parallel the features of the high-arched supinated and dropped cuboid foot. Their pain profiles resonated with the common basketball injuries and reflected the features of Jones fracture and cuboid syndrome. The potential links among high-arched supinated foot, Jones fracture, and cuboid syndrome are worth further study.
Background
Diagnosis of onychomycosis using the periodic acid–Schiff (PAS) test for sensitive identification of hyphae and fungal culture for identification of species has become the mainstay for many clinical practices. With the advent of polymerase chain reaction (PCR) testing, physicians can identify a fungal toenail infection quickly with the added benefit of species identification. We compared PAS testing with multiplex PCR testing from a clinical perspective.
Methods
A total of 209 patients with clinically diagnosed onychomycosis were recruited. A high-resolution picture was taken of the affected hallux nail, and the nail was graded using the Onychomycosis Severity Index. A proximal sample of the affected toenail and subungual debris were obtained and split into two equal samples. One sample was sent for multiplex PCR testing and the other for PAS testing. The results were analyzed and compared.
Results
Six patients were excluded due to insufficient sample size for PCR testing. Of the remaining 203 patients, 109 (53.7%) tested positive with PAS, 77 (37.9%) tested positive with PCR. Forty-one patients tested positive with PAS but negative with PCR, and nine tested positive with PCR but negative with PAS.
Conclusions
Physicians should continue the practice of using PAS biopsy staining for confirmation of a fungal toenail infection before using oral antifungal therapy. Because multiplex PCR allows species identification, some physicians may elect to perform both tests.
Background
Postural stability (PS) problems arise as individuals grow older, and as a result, risk of falling (RoF) increases in older adults. We sought to examine the effects of insoles of various thicknesses on PS and RoF in older adults.
Methods
Fifty-six study participants had PS and RoF evaluated statically and dynamically under five different conditions: barefoot, only-shoes, with 5-mm insoles, with 10-mm insoles, and with 15-mm insoles. Standard shoes with identical features were used. To avoid time-dependent problems, these assessments were performed under the same conditions in 3 consecutive weeks. The average of these three values was recorded.
Results
Insoles of different thicknesses significantly affected static PS (overall: P =.003; mediolateral [ML]: P =.021; anteroposterior [AP]: P =.006), static RoF (overall, ML, and AP: P < .001), dynamic RoF (overall: P = .003; ML: P = .042; AP: P = .050), and dynamic PS (overall: P = .034; AP: P = .041) but not dynamic PS ML (P = .071). For static PS overall, dynamic PS AP, static RoF overall and ML, and dynamic RoF overall and ML, the highest PS scores and the lowest RoF were recorded when using 10-mm insoles (P < .05).
Conclusions
The use of insoles of different thicknesses has been shown to be effective on all RoF and PS measurements except dynamic PS ML. The 10-mm-thick insole was a better option for elderly individuals to increase PS and reduce RoF compared. For older adults, 10-mm-thick insoles made of medium-density Plastozote may be recommended to help improve PS and reduce RoF.
Background
We aimed to determine the center of pressure (COP) trajectories and regional pressure differences in natural rearfoot strikers while running barefoot, running with a minimalist shoe, and running with a traditional shoe.
Methods
Twenty-two male natural rearfoot strikers ran at an imposed speed along an instrumented runway in three conditions: barefoot, with a traditional shoe, and with a minimalist shoe. Metrics associated to the COP and regional plantar force distribution, captured with a pressure platform, were compared using one-way repeated-measures analysis of variance.
Results
The forefoot contact phase was found to be significantly shorter in the barefoot running trials compared with the shod conditions (P = .003). The initial contact of the COP was located more anteriorly in the barefoot running trials. The mediolateral position of the COP at initial contact was found to be significantly different in the three conditions, whereas the final mediolateral position of the COP during the forefoot contact phase was found to be more lateral in the barefoot condition compared with both shod conditions (P = .0001). The metrics associated with the regional plantar force distribution supported the clinical reasoning with respect to the COP findings.
Conclusions
The minimalist shoe seems to provide a compromise between barefoot running and running with a traditional shoe.
Background
We sought to highlight the humanistic aspect of hallux valgus.
Methods
We conducted a bibliographic search between 2013 and 2017 of scientific, historic, and humanistic articles, in search of the anthropological dimension of hallux valgus. Museums and works of art by relevant painters were analzyed for the presence of hallux valgus.
Results
We showcase the linguistic origin of the terms related to hallux valgus, the evolution of its incidence depending on the footwear and social habits throughout history, the presence of hallux valgus in the work of great painters, and some other curiosities of this pathology.
Conclusions
The knowledge of the humanistic aspect of pathologies we treat, if not imperative for its proper surgical resolution, can help to improve the understanding of them.
Background
The deep plantar (D-PL) artery originates from the dorsalis pedis artery in the proximal first intermetatarsal space, an area where many procedures are performed to address deformity, traumatic injury, and infection. The potential risk of injury to the D-PL artery is concerning. The D-PL artery provides vascular contribution to the base of the first metatarsal and forms the D-PL arterial arch with the lateral plantar artery.
Methods
In an effort to improve our understanding of the positional relationship of the D-PL artery to the first metatarsal, dissections were performed on 43 embalmed cadaver feet to measure the location of the D-PL artery with respect to the base of the first metatarsal. Digital images of the dissected specimens were acquired and saved for measurement using in-house software. Means, standard deviations, and 95% confidence intervals (CIs) were calculated for all of the measurement parameters.
Results
We found that the origin of the D-PL artery was located at a mean ± SD of 11.5 ± 3.9 mm (95% CI, 4.5–24.7 mm) distal to the first metatarsal base and 18.6% ± 6.5% (95% CI, 8.1%–43.4%) of length in reference to the proximal base. The average interrater reliability across all of the measurements was 0.945.
Conclusions
This study helps clarify the anatomical location of the D-PL artery by providing parameters to aid the surgeon when performing procedures in the proximal first intermetatarsal space. Care must be taken when performing procedures in the region to avoid unintended vascular injury to the D-PL artery.