The effects of being habitually barefoot on foot mechanics and motor performance in children and adolescents aged 6–18 years: study protocol for a multicenter cross-sectional study (Barefoot LIFE project)

Background

Barefoot locomotion has evoked an increasing scientific interest with a controversial debate about benefits and limitations of barefoot and simulated barefoot walking and running. While most current knowledge comes from cross sectional laboratory studies, the evolutionary perspective suggests the importance of investigating the long-term effects. Observing habitually barefoot populations could fill the current gap of missing high quality longitudinal studies. Therefore, the study described in this design paper aims to investigate the effects of being habitually barefoot on foot mechanics and motor performance of children and adolescents.

Methods

This study has a cross-sectional, binational design and is part of the “Barefoot Locomotion for Individual Foot- and health Enhancement (Barefoot LIFE)” project. Two large cohorts (n_(total)?=?520) of healthy children and adolescents between 6 and 18 years of age will be included respectively in Germany and South Africa. A barefoot questionnaire will be used to determine habitually barefoot individuals. The testing will be school-based and include foot mechanical (static arch height index, dynamic arch index, foot pliability) and motor performance (coordination, speed, leg power) outcomes. Gender, BMI and level of physical activity will be considered for confounding.

Discussion

The strength of this study is the comparison of two large cohorts with different footwear habits to determine long-term effects of being habitually barefoot on foot mechanics and motor performance.

     

Hindi translation,cross-culture adaptation,validation and relaibility of foot and ankle disability index instrument in patients with chronic recurrent lateral ankle sprain—A study protocol

BackgroundAnkle sprains are one of the most common musculoskeletal injuries. English and Italian versions of the Foot and Ankle Disability Index (FADI) questionnaire are available for assessment, but no Hindi version of the FADI questionnaire is yet available for the population who only communicate and understand the Hindi language.AimThis study aims to translate and culturally adapt the Hindi version of the FADI questionnaire and to evaluate its validity.Study designA Cross-Sectional Study.MethodIn accordance with Beaton guidelines, the FADI questionnaire will be translated into Hindi by two translators with medical and non-medical backgrounds, respectively. The recording observer will then take a seat to create a T1–2 version of the translated questionnaire. A Delphi survey with 6–10 experts will be conducted. The pre-final form will be fully tested on 51 patients, and the scale validity will be reported. Finally, the translated questionnaire version will be analyzed by the ethics committee.ResultStatistical analysis will be done using the Scale-level Content Validity Index (S-CVI). An individual item of the questionnaire will be validated and documented in the context of the Item-level Content Validity Index (I-CVI). This will be achieved with the help of the Averaging method (S-CVI/Ave) and the Universal Agreement calculation method (S-CVI/UA). Both absolute and relative reliability will be calculated. For absolute reliability, Bland and Altman agreement will be used. Intra-class correlation coefficient (ICC) and Cronbach's alpha (internal consistency), along with Spearman Rank rho and Pearson product, will be analysed for relative reliability.ConclusionThe study will determine the content validity and reliability of the Hindi version of the FADI questionnaire in patients with a chronic recurrent lateral ankle sprain.     

Computed tomographic study of lumbar (L3–4) epidural depth and its relationship to physical measurements in young adult men

Background and Objectives. This study was performed to devise a method for predicting epidural depth more accurately with a variety of physical measurements not previously studied. Methods. Computed tomography was used to accurately measure the L3–4 epidural depth. The inclusion criteria were restricted to healthy men, 20–25 years of age, in order to rule out the influences of age and sex. Results. Significant correlations with depth from skin to the center of the “triangular” posterior epidural space (Sk-Ep) were found for waist circumference, waist circumference/height ratio, body mass index (BMI), weight/height ratio, weight/neck circumference ratio, and weight. The depth from the supraspinous ligament to the center of the posterior epidural space (Sl-Ep) did not correlate with any physical measurements. However, Sk-Sl, which equals Sk-Ep minus Sl-Ep (ie, the depth from the skin to the supraspinous ligament) correlated with waist circumference/height ratio, waist circumference, BMI, and weight/height ratio. Conclusion. Addition of the physical parameters such as waist circumference/neck circumference ratio or BMI results in a higher predictive value for epidural depth than use of more traditional physical parameters such as weight/height ratio and/or weight only. The value of Sl-Ep is independent of any physical parameters. Thus, the significant correlation between the physical measurements and the epidural depth seems to be due only to obesity-related factors.     

Applicability of histopathological osteomyelitis evaluation score (HOES) in chronic osteomyelitis of the foot — A feasibility study

BackgroundDiagnosis and classification of chronic osteomyelitis is not based on any objective criteria. None of the available methods for this is completely reliable. Tienmann et al. (2014) has described the so called histopathological osteomyelitis evaluation score (HOES) to overcome this limitation. But this has not been externally validated or tested in cases with foot osteomyelitis.MethodsWe prospectively reviewed the histopathological samples of 30 consecutive patients (30 feet) with foot osteomyelitis managed operatively. There were 19 males and 11 females with an average age of 41.6 (range, 27–63) years. The underlying pathology was spina bifida in 12, Charcot’s arthropathy in eleven and post-traumatic in seven patients. The bones involved were calcaneum, talus and fifth metatarsal. Pathological diagnosis was made based on HOES by a single pathologist blinded to the clinical diagnosis and both were compared. Intra- and inter-observer reliability of HOES was assessed by analysing the scores of each patient assigned independently by four different pathologists (blinded to the clinical diagnoses and to each other) at two different occasions one week apart.ResultsAll samples showed features of long-standing osteomyelitis. When attempting to classify to “acute on chronic”, “chronic” and “quiescent” forms, the pathological diagnosis correlatead with the clinical diagnosis only in 16 cases (53.3 percent). Histological classification to Tienmann’s types as per the scoring system yielded three distinct pathological entities that had common histological features with regard to bone, soft tissue and inflammatory infiltration. HOES exhibited excellent intra- and inter-observer reliability.ConclusionsHOES is well applicable in foot osteomyelitis both for diagnosis and classification by unambiguous and precise scoring system. This makes diagnostic labelling more accurate and repeatable. The clinical relevance of these histopathological types in guiding management and determining prognosis needs to be investigated further.     

How to taper glucocorticoids in inflammatory rheumatic diseases? A narrative review of novel evidence in rheumatoid arthritis,systemic lupus erythematosus,and giant cell arteritis

Glucocorticoids (GCs) remain regularly used drugs in patients with chronic inflammatory rheumatic diseases. As long-term intake at high dosages is associated with harm, it is generally advised that GCs be tapered and stopped. However, most recommendations concerning tapering have been eminence- or consensus-based. In this narrative review, we present novel data from recent studies (SEMIRA, CORTICOLUP, and GiACTA) shedding light from different angles on the effects of tapering GCs in patients with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and giant cell arteritis (GCA). In RA and SLE, our main findings comprise that (a) the majority of RA and SLE patients can successfully taper their GC, but that (b) tapering increases the risk of flare. In GCA, tocilizumab was shown to be a potent GC-sparing agent. Finally, we also present exemplary tapering schemes for RA, SLE, and GCA, although different tapering regimens have not yet been sufficiently compared in randomized trials.     

Relationship between patient-reported outcome measures (PROM) and three measures of foot–ankle alignment in patients with metatarsal head pain: a cross-sectional study

Background

The aim of the present study is to establish the relationship between foot–ankle patient-reported outcome measures (PROM) and three measures of foot–ankle alignment (MoFAA) in patients with metatarsal head pain.

Methods

A cross-sectional study where 206 patients completed three PROMs and a clinician recorded three MoFAA bilaterally (three times each). A reliability analysis of the MoFAA, a correlation analysis (between MoFAA and PROM) and regression analysis (dependent variable: PROM; independent variables: MoFAA) were performed.

Results

Pearson’s coefficient changed in each PROM used, ranging from 0.243 (AAOS-FAM_{ShoeComfortScale}–FVA_Right) to 0.807 (FFI_Index–first MTPJE_right). Regression indices (R²-corrected) ranged between 0.117 (AAOS-FAM_{ShoeComfortScale}) and 0.701 (FFI_Index).

Conclusions

The MoFAA correlated between moderately to strongly with the foot–ankle PROM selected. The level of correlation between MoFAA and PROM was higher when patients with metatarsal head pain were asked about foot health status, pain and function; however, the correlation was poor when the patient was asked about shoe aspects. In addition, the MoFAA variable that achieved the highest correlation value was the first metatarsophalangeal joint extension. The results obtained in this study could be used in future studies to develop tools for assessing and monitoring patients with metatarsal head pain.

     

The development and use of an anatomy-based retraining program (MusAARP) to assess and treat focal hand dystonia in musicians–A pilot study

BackgroundMovement dysfunctions are commonly reported in musicians, and in extreme cases may result in a persisting loss of motor control. This condition, whereby motor control of the hand during previously highly trained movements on the instrument is lost, is termed focal hand dystonia. It is widely considered to be a consequence of prolonged repetitive daily practice, often in combination with exposure to a range of other risk factors. Current literature recommends retraining as a promising treatment intervention, although only scant scientific evidence exists on which components should be included in a retraining program, and how these may be best administered.MethodsA progressive muscle activation and movement exercise program was devised by one of the authors applying a series of anatomy-based off-instrument movement tasks. This series of fine motor control exercises, was used to both assess and retrain focal hand dystonia in a population of musicians. The standardized approach aimed to provide a systematic method of retraining musically relevant muscular synergies that could later be applied to the instrument, while still allowing individual modifications. Retraining sessions were mostly run online as a consequence of the coronavirus pandemic, although some early sessions were also able to be undertaken face to face. Both qualitative and quantitative measures were used in this case series to evaluate program efficacy, due to the typical heterogeneity of the focal hand dystonia participants. This included: blinded external neurological evaluation of video footage using the Tubiana grading system, written subjective feedback, exercise progressions, and performance outcomes.ResultsPilot testing of 4 patients indicated the utility of the program over approximately a 12- month time period. All subjects improved, 2 of whom have returned to pre-dystonia performance levels. These patients reported the importance of patience and persistence with daily exercise sessions in their recovery.ConclusionUsing off-instrument playing-relevant exercises to enhance fine motor control and muscle activation can be effective in retraining focal hand dystonia, regardless of additional treatments or level of performance. They should be regularly practiced and progressed in order for effects to be best progressed to instrumental applications. Further research may elucidate whether there are optimal outcomes with single or particular combinations of treatment approaches.     

The clinical outcomes of atlanto-axial arthrodesis in patients with rheumatoid arthritis – Assessment according to the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ)

Purpose

The purpose of this study was to evaluate the clinical outcomes of atlanto-axial arthrodesis in rheumatoid arthritis (RA) patients with cervical myelopathy using the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ).

Editorial Commentary: The Nonoperative Instability Severity Index Score Can,in Part,Help to Predict Failure After Nonoperative Management of Anterior Shoulder Instability: Fix Them All Versus Wait and See?

The optimal management of anterior shoulder instability remains a heated topic of debate, particularly after first-time shoulder dislocation. From expedited rehabilitation to arthroscopic Bankart repair and Latarjet coracoid transfer, the shoulder community has staunchly defended its approach with carefully tailored data describing patient satisfaction, instability recurrence, revision surgery, and timeline to return to play or preinjury activity. However, not all patients require surgical stabilization, and a “wait-and-see” approach can often result in favorable outcome. The Nonoperative Instability Severity Index Score has been proposed as a unique tool to stratify risk for failure among athletes after an anterior shoulder instability event. While not a standalone tool for predicting further shoulder dislocation in a broader athletic population, the Nonoperative Instability Severity Index Score reflects a movement toward personalized medicine, where clinical decision making is executed on the individual level based on unique risk factors and circumstances.     

Evaluation of the new defined EFAS score (European foot and ankle society score) in relation to already established functional scores (FFI,MOXFQ) after cartilage reconstructive therapy (AMIC®) for osteochondral lesion of the talus

BackgroundIn 2011, the European Foot and Ankle Society developed a Score (EFAS Score) to generate a standardized questionnaire for several European languages. The aim of this study is to analyse how the newly defined score correlates with already established function scores.MethodsThis study is a monocentric prospective study. The questionnaires were completed at least 12 months postoperatively at the same time point. All patients had undergone surgery with the Autologous Matrix-Induced Chondrogenesis® procedure for osteochondral lesions of the talus.ResultsA total of 69 patients (33 women, 36 men) participated in the study. The EFAS Score correlates very strongly with the Manchester–Oxford Foot Questionnaire (MOXFQ) and strongly with the Foot Function Index (FFI).ConclusionThis study shows that the EFAS Score correlates significantly with the FFI and the MOXFQ. The EFAS seems to be a more patient-friendly alternative due to fewer questions and response choices.     

The effects of local and systemic interferon beta (Fiblaferon) on supratentorial malignant cerebral glioma — A phase II study

In contrast to the highly promising and, with rates up to 40%, surprisingly high response rates of malignant supratentorial brain gliomas to post-operative adjuvant IFN beta therapy, we were unable to demonstrate any definite anti-proliferative, anti-tumor or immunomodulatory effects of interferon in a phase II study in 13 patients. We used high doses of an IFN beta, Fiblaferon, whose potency was repeatedly confirmed by pharmacokinetic investigations, for local and systemic administration, and the times of administration were those used in the Japanese comparative studies. The side effects observed proved to be related to the amount of IFN beta administered and its duration in our patients as well. In this context, the neurotoxic disturbances require particular attention. These resolved completely after discontinuation of IFN treatment, as do the haematological and liver enzyme disturbances after suspension of medication. We did not observe any improvement in the post-operative quality of life, nor, above all, any improvement in long-term prognosis resulting from a prolonged tumor-free remission period and prolongation of the actual post-operative survival time.     

Spinal tuberculosis (Pott’s disease): its clinical presentation, surgical management, and outcome. A survey study on 694 patients

Tuberculosis (TB) of the spine (Pott’s disease) is both the most common and most dangerous form of TB infection. Delay in establishing diagnosis and management cause spinal cord compression and spinal deformity. This study investigated the data on all cases of Pott’s disease reported in Turkey from 1985 to 1996. A total of 694 cases were included. Out of the patients evaluated, 19% were reported in the first half of the period (1985–1990) and 81% in the second half (1991–1996). Tuberculosis affecting the spine was commonly localized in the thoracic region and involved the vertebral body. The presenting symptoms were leg weakness (69%), gibbus (46%), pain (21%), and palpable mass (10%). Decompressive surgery plus anti-TB chemotherapy remains the best mode of therapy for Pott’s disease. Follow-up information was available in 414 of the 694 patients and there were ten deaths (2%), one occurring intraoperatively and the other nine postoperatively. This meta-analysis demonstrates that in Turkey Pott’s disease remains a serious problem, causing paraplegia. It should be considered when patients present with neurological findings suggesting spinal cord compression and spinal deformity. In the present study, it was concluded that the neurological involvement due to Pott’s disease is relatively benign if urgent decompression is performed at the onset of the disease. Received: 11 March 1999 / Accepted: 4 September 2000     

Do arachidonic acid and its metabolites, secreted by rheumatoid and osteoarthritic synovial tissue, account for the strong inhibition of DNA synthesis in cultured human articular chondrocytes? A novel approach to the mechanism of tissue damage

AIMS: To further characterize factors secreted in vitro by osteoarthritic and rheumatoid arthritis synovial membranes that inhibit DNA synthesis by cultured human articular chondrocytes, and extend these findings to synovial fluid. MATERIAL AND METHODS: Synovial tissue, synovial fluid and articular cartilage were obtained at surgery from two patients suffering rheumatoid arthritis and two other patients suffering from osteoarthritis. Synovial tissue was incubated in DMEM, then condition media and synovial fluids were extracted with methanol. Methanol extracts and extracted residues (hyaluronic acid, proteins) were assayed for their capacity to inhibit DNA synthesis in articular chondrocytes. Methanol extracts were also fractionated by thin layer chromatography on silica-coated plates and recovered fractions similarly tested. RESULTS: All extracts exhibited strong and concentration-dependent inhibition of [3H]-thymidine incorporation. The most potent inhibition was obtained with the extracts from rheumatoid joints and the least potent inhibition was with synovial fluids. The removal of active substances with methanol leaves an inactive residue. Methanol extraction does not alter the mitogenic activity of five exogenous growth factors and two cytokines, thus suggesting that such activity is entirely due to lipids. The bulk of anti-mitotic factors extracted by methanol co-migrate when fractionated by thin layer chromatography on silica-coated plates with arachidonic acid and its lipo-oxygenase metabolites. IN CONCLUSION: Inflamed synovium produces and releases lipids, most probably arachidonic acid metabolites that inhibit cell proliferation thus limiting inflammation and pannus formation in arthritis.