Influence of foot orthoses on plantar pressures,foot pain and walking ability of rheumatoid arthritis patients–a randomised controlled study

Purpose. To compare the effectiveness of functional foot orthoses and unshaped (flat) orthotic material on plantar pressure redistribution, forefoot pain reduction and walking ability in rheumatoid arthritis (RA) patients.

Methods. Forty patients with RA were randomised to receive unshaped material (UM) (n = 20) or functional foot orthoses (n = 20). Plantar pressure measurement was performed with an F-scan system. Foot pain was assessed by the pain subscale of the Foot Function Index. Walking ability was assessed by the 6-min walking test. Investigations were performed at baseline, 1 week after the patient received shoes with orthoses and 6 months later.

Results. Plantar pressures were significantly higher at painful than at non-painful foot areas. No differences in plantar pressure redistribution were found between the groups. Notable reduction of pain and improvement of activity (walking ability) was observed in both groups. Foot pain has moderate impact on the walking ability of RA patients.

Conclusions. The study showed no clear advantage of functional foot orthoses over UM.     

Ein Fall von Makrogenitosomia praecox und Nebennierentumor bei einem 3 jährigen Mädchen

Ohne ZusammenfassungBilder und Priparate demonstriert in der Gesellschaft für innere Medizin und Kinderheilkunde am 1. Juli 1920.Mit 3 Textabbildungen.     

The incidence of idiopathic inflammatory myopathies in the adult Slovenian population

Clinical Rheumatology - Idiopathic Inflammatory myopathies (IIM) are rare disorders. The aim of our study was to determine the incidence of IIM in a well-defined Slovenian region. This...     

MicroRNA expression in the affected skin of adult patients with IgA vasculitis

Clinical Rheumatology - IgA vasculitis (IgAV) represents a common systemic vasculitis in pediatric and adult population. Our current knowledge of disease pathogenesis is still very limited, without...     

Arm movement improves performance in clinical balance and mobility tests

Previous studies have suggested that arm movements can contribute to preventing the loss of balance or falls, and that aging affects the functions of arm movements. Clinical balance and mobility tests may be able to detect such aging effects. As the first step to approaching this question, the purpose of this pilot study was to investigate the effects of arm movements on the performance of clinical balance and mobility tests. Ten participants were evaluated in four clinical tests: (1) Maximal Step Length Test (MST), (2) Step Test (ST), (3) Timed Up and Go Test (TUG), and (4) Walk along an Elliptical Line (WEL). Each test was performed with free and limited arm movement and the outcomes were compared. Statistical analysis indicated a significant improvement in test performance when arms were used freely for three out of four tests (MST, ST and TUG), with inconclusive results on WEL. This pilot study showed improved performance on the clinical balance and mobility tests, suggesting that the contribution of arm movements is sufficiently large to be detected. This implies a feasibility for novel usage of clinical balance and mobility tests, i.e., to test the effectiveness of arm usage in balance and mobility.     

A retrospective analysis of the definitive management of open talus fractures at a major trauma centre,comparing ORIF to FUSION: cohort study and audit of BOAST 4 guidelines

Purpose

Open talus fractures are notoriously difficult to manage, and they are commonly associated with a high level of complications including non-union, avascular necrosis and infection. Currently, the management of such injuries is based upon BOAST 4 guidelines although there is no suggested definitive management, and thus, definitive management is based upon surgeon preference. The key principles of open talus fracture management which do not vary between surgeons are early debridement, orthoplastic wound care, anatomic reduction and definitive fixation whenever possible. However, there is much debate over whether the talus should be preserved or removed after open talus fracture/dislocation and proceeded to tibiocalcaneal fusion.

Methods

A review of electronic hospital records for open talus fractures from 2014 to 2021 returned fourteen patients with fifteen open talus fractures. Seven cases were initially managed with ORIF, and five cases were definitively managed with FUSION, while the others were managed with alternative methods. We collected patient’s age, gender, surgical complications, surgical risk factors and post-treatment functional ability and pain and compliance with BOAST guidelines. The average follow-up of the cohort was 4 years and one month. EQ-5D-5L and FAAM-ADL/Sports score was used as a patient reported outcome measure. Data were analysed using the software PRISM.

Results

Comparison between FUSION and ORIF groups showed no statistically significant difference in EQ-5D-5L score (P = 0.13), FAAM-ADL (P = 0.20), FAAM-Sport (P = 0.34), infection rate (P = 0.55), surgical times (P = 0.91) and time to weight bearing (P = 0.39), despite a higher proportion of polytrauma and Hawkins III and IV fractures in the FUSION group.

Conclusion

FUSION is typically used as second line to ORIF or failed ORIF. However, there is a lack of studies that directly compared outcome in open talus fracture patients definitively managed with FUSION or ORIF. Our results demonstrate for the first time that FUSION may not be inferior to ORIF in terms of patient functional outcome, infection rate and quality of life, in the management of patients with open talus fracture patients. Of note, as open talus fractures have increased risks of complications such as osteonecrosis and non-union, FUSION should be considered as a viable option to mitigate these potential complications in these patients.

     

Rethinking childhood ependymoma: a retrospective,multi-center analysis reveals poor long-term overall survival

Journal of Neuro-Oncology - Ependymoma is the third most common brain tumor in children, but there is a paucity of large studies with more than 10 years of follow-up examining the long-term...