Categories


Contact

Search

Links


Archive


Journal of Foot and Ankle Research

Thursday Nov 26, 2009

Do the effects of laterally wedged insoles decline after one month of wear?

Laterally wedged insoles in knee osteoarthritis: do biomechanical effects decline after one month of wear?

Rana S Hinman  Kelly Bowles and Kim L Bennell

BMC Musculoskeletal Disorders 2009, 10:146doi:10.1186/1471-2474-10-146

Abstract (provisional)

Objective This study aimed to determine whether the effect of laterally wedged insoles on the adduction moment in knee osteoarthritis (OA) declined after one month of wear, and whether higher reported use of insoles was associated with a reduced effect on the adduction moment at one month. Methods Twenty people with medial compartment OA underwent gait analysis in their own shoes wearing i) no insoles and; ii) insoles wedged laterally 5 degrees in random order. Testing occurred at baseline and after one month of use of the insoles. Participants recorded daily use of insoles in a log-book. Outcomes were the first and second peak external knee adduction moment and the adduction angular impulse, compared across conditions and time with repeated measures general linear models. Correlations were obtained between total insole use and change in gait parameters with used insoles at one month, and change scores were compared between high and low users of insoles using general linear models. Results There was a significant main effect for condition, whereby insoles significantly reduced the adduction moment (all p<0.001). However there was no significant main effect for time, nor was an interaction effect evident. No significant associations were observed between total insole use and change in gait parameters with used insoles at one month, nor was there a difference in effectiveness of insoles between high and low users of the insoles at this time. Conclusions Effects of laterally wedged insoles on the adduction moment do not appear to decline after one month of continuous use, suggesting that significant wedge degradation does not occur over the short-term.

 


 

Thursday Nov 19, 2009

JFAR at the SCP Conference, Harrogate November 19-21

Journal of Foot and Ankle Research Editors-in-Chief, Hylton Menz and Mike Potter, will be at the Society of Chiropodists and Podiatrists stand at the Annual Conference in Harrogate, November 19-20. For more details about the conference, click here.

SCP editor, Clare Richards, with JFAR Deputy Editor-in-Chief, Dr Alan Borthwick, and Editor-in-Chief, Mike Potter:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


 

Wednesday Nov 18, 2009

Dynamic splinting home therapy for toe walking

Dynamic splinting home therapy for toe walking: a case report

Pamela Lundequam and F Buck Willis

Cases Journal 2009, 2:188doi:10.1186/1757-1626-2-188

Abstract

Serial casting is frequently prescribed for toe-walking but that does not allow continued physical therapy (PT). This report described a child and family who chose dynamic splinting (DS) with concurrent PT for treatment. The patient presented with right hemiparesis; below average motor skills and a gait pattern of toe contact (without ankle foot orthosis). Four months of PT plus 6 hours/night of DS as home therapy, the patient's passive dorsiflexion increased 14° and she gained the ability to walk in "flat foot" contact without the Ankle Foot Orthosis. This concurrent treatment achieved improved gait pattern and strength training not possible with casting.

 


 

Proximal tibiofibular dislocation associated with fracture of the tibia

Proximal tibiofibular dislocation associated with fracture of the tibia: a case report

Oscar Ares  Xavier Conesa  Roberto Seijas and Lluis Carrera

Cases Journal 2009, 2:196doi:10.1186/1757-1626-2-196

Abstract (provisional)

Introduction

We report a case of proximal tibiofibular dislocation associated with an ipsilateral tibial fracture, a rare association of injuries that can remain undiagnosed. Case Report: A white 23-year-old man experienced a road accident and was diagnosed with proximal tibiofibular dislocation associated with an open fracture of the tibia and injury to the external popliteus sciatic nerve. He was treated urgently with an intramedullary tibial nail and a cancellous screw at the level of the proximal tibiofibular articulation.

Conclusion

In addition to this case and the surgical treatment, a review of the clinical cases described in the literature is provided, assessing the type of injury and the therapeutic options used, which depend mainly on the stage in which the condition is diagnosed.


 

Anomalous superficial peroneal nerve and variant cutaneous innervation of the sural nerve

Anomalous superficial peroneal nerve and variant cutaneous innervation of the sural nerve on the dorsum of the foot: a case report

Somayaji Nagabhooshana, Venkata Ramana Vollala, Vincent Rodrigues and Mohandas Rao

Cases Journal 2009, 2:197doi:10.1186/1757-1626-2-197

Abstract (provisional)

Background

The superficial peroneal nerve is a branch of common peroneal nerve. There are reports about the variant course and distribution of this nerve. The sural nerve arises from the tibial nerve in the popliteal fossa. The variations of the above nerves described here are unique and provide significant information to surgeons dissecting lower limb.

Case presentation

The present case is about some important anatomic variations observed in left lower limb of approximately 55 - year - old male cadaver. The variations were; high division of superficial peroneal nerve into medial and lateral branches, lateral branch descending in the anterior intermuscular septum in a peroneal tunnel before piercing the deep fascia and variant distribution of sural nerve on the dorsum of the foot. The probable clinical significances of the variation are discussed.

Conclusion

Awareness of anatomical variations of superficial peroneal and sural nerves such as those presented here becomes important to avoid injury in real clinical situations.


 

Tuesday Nov 10, 2009

Charcot foot in a patient with Parkinson's disease

A case of Charcot's feet in a patient with Parkinson's disease: a case report

Amresh P Singh and Andew J Kelly

Cases Journal 2009, 2:187doi:10.1186/1757-1626-2-187

Published: 9 November 2009

Abstract (provisional)

Introduction

Parkinson's Disease (PD), amongst its motor symptoms, can cause dystonia of the limbs and trunk. This can lead to subsequent deformities.

Case presentation

We describe a case where Parkinson's Disease has gone on to cause bilateral Charcot feet with rocker-bottom deformity.

Conclusion

There is recognised pattern of foot deformities seen in Parkinson's disease and it is important to realise that patients may go on to develop a Charcot joint. This would warrant early referral to an orthopaedic surgeon so that appropriate management can limit joint damage and deformity.


 

Thursday Oct 29, 2009

The Scientific Basis of Rheumatology: A Decade of Progress

This special collection of reviews - published to mark Arthritis Research & Therapy’s 10th anniversary - provides an in depth overview of the current status of basic and clinical research in rheumatology, and focuses particularly on developments in the past decade, during which there has been an explosion of new information in the field.

All papers are full-text open-access. To browse the list of papers, click here.

 

 


 

Monday Oct 26, 2009

Nonclassical yellow nail syndrome in six-year-old girl

Nonclassical yellow nail syndrome in six-year-old girl: a case report

Filiz Cebeci, Muge Celebi and Nahide Onsun

Cases Journal 2009, 2:165doi:10.1186/1757-1626-2-165

Abstract (provisional)

Introduction

The yellow nail syndrome is usually described as the combination of yellow nails with lymphoedema and often with respiratory manifestations such as pleural effusions, chronic sinusitis and bronchiectasis. The syndrome is most often seen in the middle-aged individuals.

Case presentation

We present a 6-year-old girl with yellow nail syndrome having pansinusitis and bronchiectasis.

Conclusion

The components comprising the classical triad of yellow nail syndrome in children may not necessarily be present altogether. Therefore, yellow nail syndrome should be suspected in children having only typical nail changes.


 

Thursday Oct 22, 2009

Missed diagnosis of ankle pseudoaneurysm following ankle arthroscopy: a case report

Missed diagnosis of ankle pseudoaneurysm following ankle arthroscopy: a case report

Ramavath LAL Ashok , Julie A Cornishm, Muthu Ganapathi and Dean T Williams

Cases Journal 2009, 2:162doi:10.1186/1757-1626-2-162

Abstract (provisional)

Background

Pseudoaneurysm formation is rare complication after arthroscopy with incidence of 0.008%, easy to misdiagnose. Its potential catastrophic sequelae should not be underestimated.

Case presentation

We present a case of missed diagnosis of traumatic anterior tibial artery pseudoaneurysm in a 39 year old female, instead treated as post operative arthroscopy infection. The diagnosis was confirmed with a duplex ultrasound scan and referred to the vascular surgeon with successful out come.

Conclusion

In view of rare presentation this complication it is easily missed. According to one study, incidence of anatomic variations of anterior tibial artery range from 2.4 to 12%. Because of this anatomical variation in course along with other factors, pseudoaneurysm formation at ankle is relatively high. In this report, we discuss the diagnosis, anatomical variations of anterior tibial artery and prevention of this complication following arthroscopy. We believe that surgeons operating in this region should take into account these anatomical variations preoperatively.


 

Tuesday Oct 13, 2009

Why do ineffective treatments seem helpful?

Why do ineffective treatments seem helpful? A brief review

Steve E Hartman

Chiropractic & Osteopathy 2009, 17:10doi:10.1186/1746-1340-17-10

Abstract (provisional)

After any therapy, when symptoms improve, healthcare providers (and patients) are tempted to award credit to treatment. Over time, a particular treatment can seem so undeniably helpful that scientific verification of efficacy is judged an inconvenient waste of time and resources. Unfortunately, practitioners' accumulated, day to day, informal impressions of diagnostic reliability and clinical efficacy are of limited value. To help clarify why even treatments entirely lacking in direct effect can seem helpful, I will explain why real signs and symptoms often improve, independent of treatment. Then, I will detail quirks of human perception, interpretation, and memory that often make symptoms seem improved, when they are not. I conclude that healthcare will grow to full potential only when judgments of clinical efficacy routinely are based in properly scientific, placebo controlled, outcome analysis.


 

Is visual estimation of passive range of motion in the pediatric lower limb reliable?

Is visual estimation of passive range of motion in the pediatric lower limb valid and reliable?

Rami Rachkidi, Ismat Ghanem, Ibrahim Kalouche, Samer El Hage, Fernand Dagher and Khalil Kharrat

BMC Musculoskeletal Disorders 2009, 10:126doi:10.1186/1471-2474-10-126

Abstract (provisional)

Background

Visual estimation (VE) is an essential tool for evaluation of range of motion. Few papers discussed its validity in children orthopedics' practice. The purpose of our study was to assess validity and reliability of VE for passive range of motions (PROMs) of children's lower limbs.

Methods

Fifty typically developing children (100 lower limbs) were examined. Visual estimations for PROMs of hip (flexion, adduction, abduction, internal and external rotations), knee (flexion and popliteal angle) and ankle (dorsiflexion and plantarflexion) were made by a pediatric orthopaedic surgeon (POS) and a 5th year resident in orthopaedics. A last year medical student did goniometric measurements. Three weeks later, same measurements were performed to assess reliability of visual estimation for each examiner.

Results

Visual estimations of the POS were highly reliable for hip flexion, hip rotations and popliteal angle (rhoc [greater than or equal to] 0.8). Reliability was good for hip abduction, knee flexion, ankle dorsiflexion and plantarflexion (rhoc [greater than or equal to] 0.7) but poor for hip adduction (rhoc =0.5). Reproducibility for all PROMs was verified. Resident's VE showed high reliability (rhoc [greater than or equal to] 0.8) for hip flexion and popliteal angle. Good correlation was found for hip rotations and knee flexion (rhoc [greater than or equal to] 0.7). Poor results were obtained for ankle PROMs (rhoc < 0.6) as well as hip adduction and abduction, the results of which not being reproducible. Influence of experience was clearly demonstrated for PROMs of hip rotations, adduction and abduction as well as ankle plantarflexion.

Conclusions

Accuracy of VE of passive hip flexion and knee PROMs is high regardless of the examiner's experience. Same accuracy can be found for hip rotations and abduction whenever VE is performed by an experienced examiner. Goniometric evaluation is recommended for passive hip adduction and for ankle PROMs.


 

Tuesday Sep 22, 2009

Predicting joint damage in RA with MRI

 

 

Editorial

Predicting joint damage in rheumatoid arthritis using MRI scanning

Fiona M McQueen and Nicola Dalbeth

 

Abstract

Predicting prognosis in the patient with newly diagnosed rheumatoid arthritis is of key importance so that high-cost therapies can be tailored to the needs of the individual. In a recent issue of Arthritis Research and Therapy, the prognostic significance of MRI changes at the forefoot has been studied. While progression to radiographic erosion occurred rarely in this group of patients exposed to potent disease-suppressing therapies, including TNF inhibitors, MRI bone edema, representing osteitis, has been further implicated as a forerunner to bone erosion. Early MRI scans of the forefoot were helpful in defining those with the potential to progress as well as those in a good prognosis category.

 

Sample imaging depicting bone defect on magnetic resonance imaging before radiographic erosion. Images (a-c) were taken 1 year before images (d-f). Image (a) is T1-weighted and has a small defect (arrow). Image (b) is T2-weighted with fat saturation clearly showing synovitis (arrow). Image (c), the radiograph, was read as normal because the cortex was intact. Image (d), T1-weighted, clearly shows absence of bone read as erosion (arrow). Image (e) shows synovitis and bone marrow edema (arrow). Image (f) clearly shows bone erosion (arrow).

Mundwiler et al. Arthritis Research & Therapy 2009 11:R94


 

Friday Sep 04, 2009

Ankle patella? Case report of a large accessory bone in the ankle

 

 

 

Ankle patella: a report of a large accessory bone in the ankle: a case report

Yaghoub Salekzamani, Abolhassan Shakeri-Bavil, Nariman Nezami, Yousef Houshyar

Abstract

Introduction: Sesamoids, which are ovoid bones with variable size and shape in the course of tendons, can be found in different parts of skeletal system.

Case presentation: As a case report we observed a large accessory bone which was located anterior to left ankle joint in a 61 years old woman. Since such accessory bones are found very infrequently, their presence may cause some diagnostic confusion.

Conclusion: Regarding complaints in foot area one has to be familiar with such bones in order to make a correct diagnosis.


 

Wednesday Sep 02, 2009

Closed STJ dislocation: case report

 

 

 

Closed subtalar dislocation with non-displaced fractures of talus and navicular: a case report and review of the literature

Elias Fotiadis, Christos Lyrtzis, Theodoros Svarnas, Miltos Koimtzis, Kiriaki Akritopoulou, Byron Chalidis

Abstract

Closed subtalar dislocations associated with talus and navicular fractures are rare injuries. We report on a case of a 43-year-old builder man with medial subtalar dislocation that was further complicated by minimally displaced talar and navicular fractures. Successful closed reduction under general anesthesia was followed by non-weight bearing and ankle immobilization with a below-knee cast for 6 weeks. At 3 years post-injury, the subtalar joint was stable, the foot and ankle mobility was in normal limits and the patient could still work as a builder. However, he complained for occasionally mild pain due to the development of post-traumatic arthritis in subtalar and ankle joints. Our search in literature revealed that conservative treatment of all the successfully reduced and minimally displaced subtalar fracture-dislocations has given superior results compared to surgical management. However, even in cases with no or slight fracture displacement, avascular necrosis of the talus or arthritis of the surrounding joints can compromise the final functional outcome.