Background
To date, scientific literature has not as yet come up with any review showing the diagnostic tests used for functional assessment of the foot and leg.
Methods
A literature review was conducted of electronic databases (MEDLINE, PEDro, DOAJ, BioMed Central, PLOS, and Centre for Reviews and Dissemination at the University of York) up to December 8, 2018. The biomechanical tests, which have adequate supportive literature, were divided into qualitative tests that provide a dichotomy/trichotomy-type answer to clinical diagnostic questions; semiquantitative tests that provide numerical data to clinical diagnostic questions; and quantitative tests that record continuous numerical data (in analogue or digital form).
Results
These tests produce a useful functional evaluation model of the foot and leg for different purposes: evaluation of lower limb deficits or abnormalities in healthy patients and in athletes (in sports or other physical activities); assessment of tissue stress syndromes caused by pathomechanics; evaluation of lower limb deficits or abnormalities in rheumatic disease and diabetic foot patients; and to determine the appropriate functional or semifunctional foot orthotic therapy and therapeutic path used in gait rehabilitation.
Conclusions
Many of these tests have adequate diagnostic reliability and reproducibility and therefore can be considered diagnostic. Few of these are validated, and some have initiated the validation process by determining their sensitivity and specificity. The widespread use of these tools in clinical practice (diagnosis of function) lacks scientific evidence and in-depth analysis of their limitations.
Backround
We compared postoperative outcomes in adolescent patients who did and did not undergo plate-screw fixation of at least one of the lateral, medial, or posterior malleoli in ankle fractures. It was hypothesized that using plate-screw fixation would not negatively affect postoperative outcomes.
Methods
All of the preoperative data and postoperative outcomes for 56 patients with ankle fractures aged 12 to 15 years who underwent surgical treatment between January 1, 2007, and December 31, 2017, were reviewed retrospectively. Patients were grouped into plate-screw fixation (n = 15) and non–plate-screw fixation (n = 41) groups and as high- and low-energy trauma patients.
Results
There were no significant differences in postoperative outcomes between the plate-screw fixation and non–plate-screw fixation groups. The mean American Orthopaedic Foot & Ankle Society score of high-energy trauma patients was significantly lower than that of low-energy trauma patients (P < .001), and the rate of degenerative change in high-energy trauma patients was significantly higher than that in low-energy trauma patients (P = .008). There were no significant differences between high- and low-energy trauma patients with respect to other postoperative outcomes.
Conclusions
If anatomical reduction is performed without damaging the growth plate, postoperative clinical outcomes may be near perfect regardless of screw-plate fixation use. Postoperative outcomes of adolescent ankle fracture after high-energy trauma, independent of Salter-Harris classification and surgical treatment methods, were negative.
Background
Diabetic foot infections (DFIs) are the most common cause of hospitalization for patients with diabetes. Studies have shown diabetic patients have high readmission rates. It is important to identify variables that contribute to readmission. This study aimed to investigate clinical variables associated with 30-day hospital readmission in patients with DFI.
Methods
We conducted a retrospective study of adults admitted to the hospital for DFI between July 1, 2012, and July 1, 2015. We identified patients by International Classification of Diseases, Ninth Revision codes and randomly selected 35% of medical records for review. Patients were excluded if they did not have a DFI by review, were pregnant, or were incarcerated. The primary outcome was 30-day readmission. Data collected included baseline demographics, medical comorbidities, substance abuse, homelessness, tobacco use, and laboratory and surgical pathology data. Univariate and multivariate logistic regression models were used to identify independent predictors.
Results
Of 140 included patients, 106 (76%) were male. Median age was 55 years and length of stay (LOS) was 7 days. In univariate analysis, 31 patients (22%) were readmitted in the 30 days after the index hospitalization. Factors associated with readmission included treatment failure, elevated C-reactive protein level, and hospital LOS (P < .05). In multivariate analyses, LOS and treatment failure were independent predictors of readmission.
Conclusions
The 30-day readmission rate for patients with DFI is high. Treatment failure, C-reactive protein, and LOS are independently associated with readmission. More work is needed to determine reasons for readmission so that appropriate measures can be taken before discharge.
Background
Onychomycosis is estimated to occur in approximately 10% of the global population, with most cases caused by Trichophyton rubrum. Some persistent onychomycosis is caused by mixed infections of T rubrum and one or more co-infecting nondermatophyte molds (NDMs). In onychomycosis, T rubrum strain types may naturally switch and may also be triggered to switch in response to antifungal therapy. T rubrum strain types in mixed infections of onychomycosis have not been characterized.
Methods
T rubrum DNA strains in mixed infections of onychomycosis containing co-infecting NDMs were compared with a baseline North American population through polymerase chain reaction amplification of ribosomal DNA tandemly repetitive subelements (TRSs) 1 and 2. The baseline DNA strain types were determined from 102 clinical isolates of T rubrum. The T rubrum DNA strain types from mixed infections were determined from 63 repeated toenail samples from 15 patients.
Results
Two unique TRS-2 types among the clinical isolates contributed to four unique TRS-1 and TRS-2 strain types. Six TRS-1 and TRS-2 strain types represented 92% of the clinical isolates of T rubrum. Four TRS-1 and TRS-2 strain types accounted for 100% of the T rubrum within mixed infections.
Conclusions
Four unique North American T rubrum strains were identified. In support of a shared ancestry, the T rubrum DNA strain types found in mixed infections with NDMs were among the most abundant types. A population of T rubrum strains in mixed infections of onychomycosis has been characterized, with more than one strain detected in some nails. The presence of a co-infecting NDM in mixed infections may contribute to failed therapy by stabilizing the T rubrum strain type, possibly preventing the antifungal therapy–induced strain type switching observed with infections caused by T rubrum alone.
Background
This study describes the technique for decompression of the intermetatarsal nerve in Morton's neuroma by ultrasound-guided surgical resection of the transverse intermetatarsal ligament. This technique is based on the premise that Morton's neuroma is primarily a nerve entrapment disease. As with other ultrasound-guided procedures, we believe that this technique is less traumatic, allowing earlier return to normal activity, with less patient discomfort than with traditional surgical techniques.
Methods
We performed a pilot study on 20 cadavers to ensure that the technique was safe and effective. No neurovascular damage was observed in any of the specimens. In the second phase, ultrasound-guided release of the transverse intermetatarsal ligament was performed on 56 patients through one small (1- to 2-mm) portal using local anesthesia and outpatient surgery.
Results
Of the 56 participants, 54 showed significant improvement and two did not improve, requiring further surgery (neurectomy). The postoperative wound was very small (1–2 mm). There were no cases of anesthesia of the interdigital space, and there were no infections.
Conclusions
The ultrasound-guided decompression of intermetatarsal nerve technique for Morton's neuroma by releasing the transverse intermetatarsal ligament is a safe, simple method with minimal morbidity, rapid recovery, and potential advantages over other surgical techniques. Surgical complications are minimal, but it is essential to establish a good indication because other biomechanical alterations to the foot can influence the functional outcome.
Background
Different closed kinematic tasks may present different magnitudes of knee abduction, foot pronation, and foot plantar pressure and area. Although there are plenty of studies comparing knee abduction between different tasks, the literature lacks information regarding differences in foot pronation and foot plantar pressure and area. We compared foot angular displacement in the frontal plane and foot plantar pressure and area among five closed kinematic tasks.
Methods
Forefoot and rearfoot angular displacement and foot plantar pressure and area were collected in 30 participants while they performed the following tasks: stair descent, single-leg step down, single-leg squat, single-leg landing, and drop vertical jump. Repeated-measures analyses of variance were used to investigate differences between tasks with α = 0.05.
Results
Single-leg squat and stair descent had increased foot total plantar area compared with single-leg landing (P = .005 versus .027; effect size [ES] = 0.66), drop vertical jump (P = .001 versus P = .001; ES = 0.38), and single-leg step down (P = .01 versus P = .007; ES = 0.43). Single-leg landing and single-leg step down had greater foot total plantar area compared with drop vertical jump (P = .026 versus P = .014; ES = 0.54). There were differences also in rearfoot and midfoot plantar area and pressure and forefoot plantar pressure.
Conclusions
Differences in foot-striking pattern, magnitude of ground reaction force, and task speed might explain these findings. Clinicians should consider these findings to improve decisions about tasks used during rehabilitation of patients with foot conditions.
Background
Health-related quality of life (QOL) is defined as a patient's subjective perception of his or her own health. Insufficient data exist on QOL of patients who undergo a hallux valgus (HV) operation. We used a 36-item short form survey (SF-36) to measure QOL of such patients. Our aim was to evaluate the effect of HV on QOL and to identify QOL determinants.
Methods
Fifty patients who underwent surgery for HV between 2015 and 2017 were included in the study. The SF-36 questionnaire was applied to the patients before and after surgery. Patients' medical records were examined to identify possible factors affecting QOL such as age, gender, body mass index, duration of symptoms, or smoking.
Results
The mean age of the patients was 55.6 ± 3.8 years, and 42 of the 50 patients were women. The mean duration of disease was 12 ± 3.7 years. The surgery improved QOL scores for general health, emotional well-being, role limitations due to personal or emotional problems, physical functioning and bodily pain. However, the changes in scores for vitality and social functioning were not statistically significant. Lower postoperative QOL scores for emotional well-being and bodily pain were significantly associated with age and duration of the symptoms. Compared to the mean QOL of healthy adult Turkish population, all scores in subdimensions were lower.
Conclusions
This study shows that HV in adults has a negative impact on general health, bodily pain, physical functioning, physical and emotional well-being rather than social well-being and vitality.
Background
Nonoperational treatments for Morton's neuroma remain controversial because it is believed that sclerosing injections do not change nerve fibers on a cellular level. Up to 80% success rates with 4% ethanol sclerosing have been documented, and the remainder required operational removal of the painful nerve. We sought to evaluate the histologic characteristics of Morton's neuromas treated with 4% ethanol sclerosing injection versus corticosteroid injection alone in patients who required removal of the nerve for pain relief.
Methods
A retrospective histologic review was performed of 23 consecutive patients who were treated with either sclerosing injection or nonsclerosing injection and underwent nerve removal between September 1, 2012, and February 28, 2015.
Results
Of 19 patients who met the inclusion criteria, eight received sclerosing injections and 11 received nonsclerosing injections. Intraneural fibrosis was more severe in the nonsclerosing injection group (P = .008).
Conclusion
Histologic changes are seen in Morton's neuroma with the use of 4% ethanol sclerosing injection, contrary to findings from previous studies.
Background
In a prospective randomized study, we compared two different surgical techniques used in plantar fasciitis surgery.
Methods
Forty-eight patients diagnosed as having plantar fasciitis and treated for at least 6 months with no response to conservative modalities were included in this study. The patients were randomly assigned to receive endoscopic plantar fascia release (EPFR) or cryosurgery (CS). Patients were evaluated using the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS-AHS) as a primary outcome measurement at baseline and 3 weeks and 3, 6, and 12 months after surgery. At the final follow-up visit, the Roles-Maudsley score was used to determine patient satisfaction.
Results
Five patients did not complete the 1-year follow-up examination (one in the EPFR group and four in the CS group). Thus, the study group included 43 patients. Although both groups showed significant improvement at the final evaluation, the patients in the EPFR group had significantly better AOFAS-AHS scores at 3 months. The success rate (Roles-Maudsley scores of excellent and good) in the EPFR group at 12 months was 87% and in the CS group was 65%.
Conclusions
Both EPFR and CS were associated with statistically significant improvements at 1-year follow-up. At 3-month follow-up, EPFR was associated with better results and a higher patient satisfaction rate compared with CS.
Background
Despite sufficient evidence to suggest that lower-limb–related factors may contribute to fall risk in older adults, lower-limb and footwear influences on fall risk have not been systematically summarized for readers and clinicians. The purpose of this study was to systematically review and synethesize the literature related to lower-limb, foot, and footwear factors that may increase the risk of falling among community-dwelling older adults.
Methods
We searched PubMed, Embase, PsycINFO, CINAHL, Web of Science, Cochrane Library, and AgeLine. To describe the trajectory toward increasing risk of falls, we examined those articles that linked age-related changes in the lower limb or footwear to prospective falls or linked them to evidenced-based fall risk factors, such as gait and balance impairment.
Results
This systematic review consisted of 81 articles that met the review criteria, and the results reflect a narrative review of the appraised literature for eight pathways of lower-limb–related influences on fall risk in older adults. Six of the eight pathways support a direct link to fall risk. Two other pathways link to the intermediate factors but lack studies that provide evidence of a direct link.
Conclusions
This review provides strong guidance to advance understanding and assist with managing the link between lower-limb factors and falls in older adults. Due to the lack of literature in specific areas, some recommendations were based on observational studies and should be applied with caution until further research can be completed.