Comparative anthropometric analysis of shod and unshod feet

The aim of this study was to assess and compare intrinsic forefoot function and pliability of the forefoot in selected cohorts of shoe wearing and barefoot populations. Measurements on the right foot of randomly selected 100 non-shoe wearing (Indians) and 100 shoe wearing (British) groups were carried out. Both groups were matched for age, sex and body mass index, and had not previously suffered foot problems.Using a force gauge, the force of extension and flexion of the great toe, adduction between the first and second toe and abduction at fifth metatarsophalangeal joint was measured. The length and width of the weight bearing and non-weight bearing feet in these groups was compared using a Pliability ratio. Using the Student t-test at 95% confidence interval, there was no statistically significant difference in the intrinsic forefoot muscle function. Multivariate regression analysis showed that after adjustment for other variables like gender and ethnicity, the shod status had a significant influence on the pliability ratio. This study showed that although shoe wearing does not affect the intrinsic forefoot muscle strength, it appeared to result in stiffer forefeet. This difference is more marked in women (p = 0.008) as compared to men (p = 0.0171).Shoe wearing can affect the transmission of forces during locomotion. This can be both in the dynamic and the static settings. Most shoes have an inbuilt medial arch support and toe boxes that are narrower than the true width of forefeet wearing them. This may result in incomplete accommodation of the dynamic correlates of the transverse and longitudinal arches of the foot leading to stiffer feet that may have a negative influence on their functional capability.     

A nonclassified preaxial polydactyly of the foot

Polydactyly of the foot has been classified according to anatomic differences in bony structures, external appearance of involved digits and associated anomalies. A new subtype of the metatarsal type of the medial ray (preaxial) polydactyly of the foot is presented. This includes triplication of the first metatarsal triplication of the tendons and three separate big toes. In addition, associated anomalies were present: short tibia and pes varus.     

Burned foot reconstruction

Reconstruction of the burned foot is vital, as everyday activity and the ability to work are dependent upon proper function of the feet. A classification of foot deformities resulting from burns is presented. Acute care of the burned foot and its relevance to reconstruction is discussed. A review of a decade of experience produced examples of a wide variety of deformities. Techniques of reconstruction for each are discussed and illustrated.     

Study on the foot shape characteristics of the elderly in China

BackgroundWith aging, the feet of the elderly above 60 years old in China present degenerative changes, deformities, and diseases, which significantly affect their daily activities.ObjectivesThe authors aimed to study the morphological characteristics of the feet and identify the foot type according to size (length and width) and defect characteristics of elderly feet in China.MethodsA convenient sample of 1000 subjects above 60 years old was recruited mainly in the regions of Shanghai, Shaanxi, Henan, Hebei, and Sichuan in China. Foot images were collected, and 800 (male 398, female 402) valid questionnaires were recovered. A total of 800 elderly subjects as the test group were invited to measure their foot sizes by means of a Footprint Collector (Tong Yuan Tang Health Management Limited, Qingdao in Shandong province). The foot type of the elderly was compared with that of the general adult Chinese population as the control group using the t-test for independent samples.ResultsHallux valgus (46.9%) and flat foot (50.0%) were the most common foot shape deformities. The most frequent foot diseases were foot scaling (91.2%) and calluses (96.3%). The medial width of the first metatarsal-toe joint of the elderly was significantly higher (elderly female, 44.95 ± 4.86 mm; elderly male, 48.55 ± 4.94 mm) than that of the general adult population (adult female, 40.18 ± 3.43 mm; adult male, 43.22 ± 3.20 mm) (p < 0.01).ConclusionThe foot length of the elderly was not significantly different from that of the general adult Chinese population. The width of the first metatarsal-toe joint in the forefoot of the elderly was significantly higher than that of the general adult Chinese population, which was consistent with the result that a high proportion of elderly subjects presented hallux valgus.     

Practical aspects of foot and ankle arthroscopy

Arthroscopy of the foot and ankle, although sometimes technically challenging, is a useful tool for the foot and ankle surgeon. Burman in 1931 was the first to attempt arthoscopy of the ankle joint and surmised that it was not a suitable joint for arthroscopy because of its narrow intra-articular space. With the development of smaller-diameter arthroscopes and improvements in joint distraction techniques, Watanabe was the first to present a series of 28 ankle arthroscopes in 1972. At present, arthroscopy is used not only to evaluate and treat intra-articular abnormalities but also for endoscopic and tendoscopic procedures.     

Diabetes foot screening: Challenges and future strategies

BackgroundHealthcare options for people with diabetes is still not uniform both within and between countries. This is particularly evident for diabetic foot disease. The number of existing documents/guidelines, together with discrepancies which exist between different organizations or countries can lead to confusion for both practicing health care professionals and new countries or organizations who are in the process of developing local clinical guidelines. This study was aimed at exploring different stakeholder perspectives with a view to develop and introduce culturally competent foot screening guidelines.MethodsA phenomenological study which incorporated non-structured interviews with eleven local stakeholders and experts related to the field were conducted to explore interviewees’ perspectives regarding foot screening guidelines in Malta.FindingsQualitative analysis identified 3 key themes from the data highlighting barriers to the implementation of diabetes foot screening guidelines. These focused on organizational factors, healthcare professional factors and patient factors.ConclusionCurrent procedures related to diabetes foot screening has shortcomings. The findings of this study clearly highlight the need for change in current practices if effective diabetic foot screening is to be offered. Recommendations from this study are relevant to other countries especially those who share same cultures and practices. Making changes today and implementing them in the appropriate manner could make a world of difference in diabetes foot care.     

The influence of shoe sole's varying thickness on lower limb muscle activity

Background

The lateral ligament injury of the ankle is acknowledged to be the most common ankle injury sustained in sport. Increased peroneus longus muscle contraction in the shod population has already been documented. This study aimed to quantify the effect of shoe sole's varying thickness on peroneus longus muscle activity.

Methods

Electromyographic recordings of the peroneus longus muscle activity following unanticipated inversion of the foot from 0° to 20° in a two-footplate tilting platform were collected from 38 healthy participants. The four test conditions were: barefoot, standard shoe, and shoes with 2.5 cm and 5 cm sole adaptation respectively.

Results

Compared to the barefoot condition, there is an increase in the magnitude of muscle contraction on wearing shoes, which further increases with thickening shoe soles. The peroneus longus was responding earlier in the shod conditions when compared to the barefoot, although the results were variable within the three shod conditions.

Conclusion

Footwear with increasing shoe sole thickness evokes a correspondingly stronger protective eversion response from the peroneus longus to counter the increasing moment at the ankle-subtalar joint complex following sudden foot inversion. Hence, fashion footwear with thicker sole is likely to increase the risk of lateral ligament injury of the ankle when such protective response is overwhelmed. Similarly, the clinicians need to be cautious regarding the amount of shoe raise that they could provide for patients with limb length discrepancy without any detrimental untoward side effects.     

Validity and reliability of the Persian version of self-administered foot evaluation questionnaire (SAFE-Q) in people with foot orthopedic problems

IntroductionFoot problems are one of the main causes of seeing a doctor. According to the World Health Organization's definition of health, the healthcare system must consider patients’ quality of life as an important entity. In this regard, many tools have been developed to evaluate patients' opinions about their health status. The purpose of the present study is to evaluate the validity and reliability of the Persian version of the Foot Self-Assessment Questionnaire (SAFE-Q) in patients with foot orthopedic problems.Method215 people aged 17–60 years with orthopedic foot problems were included in this cross-sectional study. The Spearman correlation coefficient of SAFE-Q questionnaires versus Foot Function Index (FFI) questionnaire was evaluated for the convergent validity. Forty-three people randomly completed SAFE-Q again one week later. Intraclass correlation coefficient (ICC) and Cronbach’s alpha was calculated to evaluate the test-retest reliability and internal consistency of the SAFE-Q, respectively.ResultsA strong relationship was found between the SAFE-Q total score and other scales with FFI questionnaire (r = 0.52 to 0.87). ICC test-retest reliability and Cronbach’s alpha were 0.981 and 0.98 for SAFE-Q, respectively.ConclusionThe results indicate that the Persian version of the SAFE-Q questionnaire has acceptable validity and reliability and can be used to assess the health status and quality of life of Persian speakers with orthopedic foot problems.     

A clinical longitudinal evaluation of pre-fabricated, semi-rigid foot orthoses prescribed to improve foot function

BackgroundCustom-made foot orthoses whilst effective can be expensive and time-consuming to manufacture making ready made devices an attractive option. This study, with follow up after 12 months provides longitudinal data not frequently available.ObjectivesLongitudinal evaluation of the efficacy of a slim, ready made, 3/4th length semi-rigid foot orthosis.MethodData was collected from 21 participants at baseline, at 4 weeks and via postal questionnaire after 12 months. Powerstep orthoses (Cuxson-Gerrard &; Co Ltd., Oldbury, UK) were given to participants with the therapeutic aim of resolving or reducing their lower limb symptoms.ResultsParticipants reported an initial marked decrease in foot pain, found the orthoses fitted in footwear readily, had a sense of increased foot stability and a significant improvement in comfort (p < 0.0001). Some increase in pain levels reported after 4-weeks (p = 0.01), was accompanied by an equally significant increase in mobility (p = 0.01) which triangulated closely against diary records. After a mean of 15.1 months, 73% of participants still found the orthoses beneficial.ConclusionParticipants found ready made orthoses enhanced sense of stability and generally reduced symptoms over a period of at least 1 year.     

Ankle and foot osteomyelitis: Treatment protocol and clinical results

Introduction

A management protocol for ankle and foot osteomyelitis and the outcome in 84 patients treated in a unit with special interest in musculoskeletal infection, is presented.

Patients and methods

Patients’ mean age was 50.7 ± 16.5 years and mean follow-up 31.5 ± 18.2 months. Systemic antibiotics were administered initially empirically, and later according to cultures. Surgical treatment included surgical debridement and bead-pouch technique, minor amputation (ray or toe), below knee amputation, and joint fusion. “Second-look” procedures were performed after 48-72 h. Vascularised grafts or Ilizarov's technique were used for bone defect reconstruction. Soft tissues were managed according the ‘reconstructive ladder’ concept.

Results

Host-type (Cierny's classification) was A in 25, B in 53 and C in 6 patients. Seventy-six infections were chronic. Causes were: open trauma without fracture (45/84), open fractures (9/84), ORIF of closed fractures (25/84) and elective surgery (5/84). Patients underwent 3.0 ± 1.5 (range 1-10) operative procedures and spent 14.8 ± 12.2 (range 3-60) days in hospital. Two (host-C) patients died. Complications requiring reoperations occurred in 20/84 (2/25 host-A, 16/53 host-B, 2/6 host-C; significant difference between host-A versus host-B and -C patients, p < 0.001). Infection recurrence occurred in 12 (none host-A; significant difference between host-A versus host-B and -C patients, p < 0.001). Multiple organisms were isolated in 39/84. Ankle arthrodesis using external fixation was performed in 9 (fusion rate 8/9). The free vascularised fibula graft was used in 2 and distraction osteogenesis in 8 patients with a mean bone defect of 5.4 cm (range 3-13). Below knee amputations were performed in 5/84 (3/53 host-B, 2/6 host-C) and foot ray amputations in 8/84 (6/53 host-B, 2/6 host-C). Soft tissue coverage required: free muscle flap transfer in 6/84, reverse soleus flap in 1/84, local fasciocutaneous flaps in 7/84, split thickness skin grafts in 5/84, and vacuum assisted closure in 5/84 patients. Eighty-two surviving patients, including amputees, were able to mobilise independently and were satisfied with the result of treatment.

Conclusions

Host-B and -C patients had more complications and infection recurrences and occasionally required amputations. Reconstructive procedures were performed for limb salvage in patients with soft tissue and bone defects and restoration of a functional limb was achieved.     

Current concepts in the surgical management of acute diabetic foot infections

Diabetic foot complications are common, costly, and difficult to treat. Peripheral neuropathy, repetitive trauma, and peripheral vascular disease are common reasons that lead to ulcers, infection, and hospitalization. Individuals with diabetes presenting with foot infection require optimal medical and surgical management to accomplish limb salvage and prevent amputation; aggressive short-term and meticulous long-term care plans are required. Multiple classification systems have been recommended to ease the understanding and the management of these infections. Multi-disciplinary approach is the mainstay for a successful management. Such teams typically include multiple medical, surgical, and nursing specialties across a variety of public and private health care systems. This article is an overview in how to medically and surgically approach the diabetic foot infection with emphasis in soft tissue infection.     

The forgotten foot – An assessment of foot and ankle radiograph pathology in final year medical students

IntroductionIt has been shown that doctors in Emergency Departments (EDs) have inconsistent knowledge of musculoskeletal anatomy. This is most likely due to a deficiency in focused musculoskeletal modules at undergraduate level in medical school. The aims of this study were to evaluate the knowledge of final year medical students on foot anatomy and common foot and ankle pathology as seen on radiographs.MethodsFinal year medical students were asked to complete our short examination on a handout. The handout was anonymous and non-mandatory. There were four images. The first image is the anatomical section and the remaining images are the pathological section.ResultsAll 235 students responded. 57% were females. For the identification of the normal bones of the foot as shown on an X-ray, the average score for the group was 2.69 (out of a maximum of 6) {SD 1.67}7. Only 8.3% achieved a 6/6 or 100% grade i.e. recognising all six bones correctly. A further 8.3% achieved 5/6 (83%). 8.3% failed to correctly identify any bone seen on the X-ray, a corresponding score of 0.DiscussionThis quick test showed normal anatomy of the foot and common pathology. One would expect final year medical students to be familiar with, especially two weeks before their finals in surgery. The curriculum should address the paucity of time spent in educating students in foot and ankle pathology.     

Deep foot burns: effects of early excision and grafting

Few on the problem of foot burns can be found in the available scientific literature. It is necessary to mention that often deep foot burns occur in Central Asia since many natives still use the ancient means of heating called ‘Sandal’ during the winter months. Eighty-four patients with severe foot burns were treated in the Burn department of RCSUMA and the Inter-regional Burn Center, Uzbekistan. The patients were subdivided into two groups, depending upon the terms of performing operative intervention. There was no special allocation of patients to groups. Criteria for selection were isolated deep burns of the foot. As for the character of the injury, area of deep burn and the severity of injury, patients of the control and basic groups were not different. The first group included 34 patients on whom early excision was done using skin graft 4–5 days after resuscitation, and the second group consisted of 50 patients who were treated in the traditional way. Methods used on the first group, described in this article, helped to improve the general condition of patients, contributed to the restoration of their foot function, lessened joint deformities and post-burn contracture deformities, shortened their stay in hospital and also reduced expenses.     

Population-based incidence and epidemiology of 5912 foot fractures

BackgroundThe present study aimed to report a full overview of the incidence and epidemiology of foot fractures.MethodPopulation-based epidemiological cohort study including all foot fractures over 5 years. All patient charts and radiology were manually assessed.ResultsA total of 4938 patients sustained 5912 foot fractures during the study period. Patients’ mean age at the time of fracture was 36.1 (21.7 SD) years. The overall incidence of foot fractures was 142.3/100,000/year. The hind foot incidence was 13.7/100,000/year, the mid foot incidence 6.5/100,000/year, and the fore foot incidence 123.9/100,000/year. The most common mode of injury was due to low energy trauma (98.7%).ConclusionThis study shows an overall incidence of foot fractures to be 142.3/100,000/year. The hind foot incidence is 13.7/100,000/year, the mid foot incidence 6.5/100,000/year, and the fore foot incidence 123.9/100,000/year.     

Foot structural factors and ground reaction force in hallux valgus grades

BackgroundLittle attention has been paid to foot structural factors and ground reaction force in hallux valgus. Investigating the structural factors in detail and determining their biomechanical effects can help to better manage hallux valgus.MethodsIn this case-control study, 120 females, 90 hallux valgus and 30 healthy, were recruited. Hallux valgus grades (mild, moderate, severe), first metatarsal mobility, foot pronation, hallux rotation, and pain were assessed by clinical tests. Ground reaction forces were measured in barefoot and shod conditions for both feet and analyzed using mixed within-between MANOVA. The association between structural factors and pain with force was analyzed using Spearman correlation coefficient.ResultsThe frequency of foot structural factors and pain severity were reported in hallux valgus grades. A significant difference was seen in the force values between groups (P<0.001). Bonferroni post hoc test indicated that the mean of the first peak for the severe group was significantly higher than the mild group (P = 0.013) and the mean of second peak for the moderate group was higher than that of the healthy group (P = 0.009). The force values were affected by wearing shoe (P<0.001) but not by foot side (P=0.086). There was a medium, positive correlation between the hallux rotation and force in the moderate group (r = 0.39, P=0.03) and also between the pronation and force in the severe group (r = 0.36, P=0.04).ConclusionFoot structural factors, pain, and force were different in each hallux valgus grads. Similar force in both feet, and increased force by wearing shoe were seen. The relationship between the pronation and hallux rotation with force revealed the importance of these factors from the biomechanical viewpoint.     

A surgical approach for the infected diabetic foot

Summary Three hundred cases of major infection of the foot in diabetic patients are analysed. Based on our experience we have been able to define certain criteria which we have found useful in the management of these cases. It is felt that an aggressive surgical approach with careful surgical technique and the appropriate antibiotics can avert major radical amputation.

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Résumé Analyse de 300 cas d'infection grave du pied chez des sujets diabétiques. En se basant sur notre expérience, il nous a été possible de définir un certain nombre de critères qui nous ont paru utiles pour guider la conduite thérapeutique. Il semble qu'un traitement chirurgical actif, avec une technique minutieuse et une antibiothérapie appropriée permet d'éviter les amputations majeures.