Cerebral Infarction Presenting with Unilateral Isolated Foot Drop

Weakness of the dorsiflexor muscles of the ankle or toe, referred to as foot drop, is a relatively common presentation. In most cases, foot drop is caused by a lower motor neuron disease such as peroneal peripheral neuropathy, L4-5 radiculopathic sciatic neuropathy, or polyneuropathy. Although upper motor neuron lesions can present as foot drop, the incidence is very rare. Here, we report an extremely rare case in which foot drop was the only presenting symptom of cerebral infarction.     

SPECT/CT骨显像与MRI对足踝部病变诊断价值的比较

目的通过对足踝部不同类型病变的分析及与MRI对比,探讨SPECT/CT对足踝部病变的诊断价值。资料与方法回顾性分析76例因足踝部疼痛且患足未行手术治疗、行足踝部SPECT/CT与MRI检查的患者,以检查后手术结果为“金标准”,分别计算SPECT/CT与MRI对足踝部骨病变、关节病变、软组织病变的敏感度、特异度等,比较SPECT/CT与MRI对足踝部病变的诊断价值。结果SPECT/CT与MRI对足踝部病变的总体诊断敏感度、特异度分别为76%、61%和81%、56%,差异无统计学异意义(均P>0.05)。SPECT/CT对足踝部骨病变的敏感度(95%)高于MRI(80%,P<0.005),对足踝部软组织病变的特异度(84%)明显高于MRI(42%,P<0.001)。SPECT/CT和MRI联合诊断足踝部病变的总体敏感度、特异度为98%、57%,其敏感度高于单独使用SPECT/CT或MRI(均P<0.05)。结论SPECT/CT与MRI比较,对足踝部病变的总体诊断价值相当,而对足踝部骨病变的敏感度较高,对软组织病变的特异度较高,两者联合可提高诊断价值。     

Changes in plantar pressure and spatiotemporal parameters during gait in older adults after two different training programs

BackgroundImproving gait is in exercise programs for older adults (OAs) but little is known about how different gait-training approaches affect spatiotemporal parameters and plantar pressure distributions in OAs. High plantar pressures are linked to tissue injury risk, ulceration, and pain in OAs, but no studies have yet compared how they affect podobarometric variables.Research questionThe effect of changing plantar pressure on absolute and mean maximum pressure, the pressure-time integral, stride time, stance time, and gait speed in OAs following either a multicomponent training program (EG) or interval-walking training (WG).MethodsComfortable gait speed, strength (seat-to-stand test), and plantar pressure (Pedar-X mobile in-shoe system), were evaluated in 23 OAs (EG: n = 12, 7 female, 71.58 ± 4.56 years; WG: n = 11, 6 female, 69.64 ± 3.56 years), by dividing the plantar area into 9 regions.ResultsAfter 14 weeks, the maximum pressure in medial and central metatarsus areas in the dominant leg were reduced in the EG (p = 0.01 & p = 0.04, respectively), but increased in the non-dominant leg lateral heel in the WG (p = 0.03). The mean maximum pressure also increased in the WG in medial heel in the dominant leg (p = 0.02) and lateral heel in the non-dominant leg (p = 0.03). The overall pressure-time integral reduced in the whole plantar area in both legs in both groups. WG reduced stride time (dominant: p = 0.01; non-dominant: p = 0.01) and stance time (dominant: p < 0.005; non-dominant: p < 0.005). Gait speed did not change in any group. As expected, lower limb strength improved after both exercise programs (EG: p = 0.02; WG: p = 0.01).SignificanceAlthough these training interventions were short, they indicate the importance of exercise types. Our results suggest that OAs might benefit from periodized training, especially when multicomponent programs are introduced prior to the walking goals. Future, larger studies should explore situations in which special populations with specific foot problems might benefit from these interventions.     

Anatomical and dynamic rotational alignment in spastic unilateral cerebral palsy

BackgroundEven in mild unilateral cerebral palsy increased internal hip rotation can be noted on physical- and gait examination. The influence of spasticity on femoral growth in the transverse plane is not clear. These deviations and asymmetry in movement pattern may negatively affect efficiency of gait and cause psychological concerns about appearance.Research questionIs increased internal hip rotation on the involved side in mild unilateral CP common and is there compensatory external pelvic rotation to keep foot progression symmetrical?MethodsThis prospective study included 45 individuals with unilateral cerebral palsy, mean age 17.7 (13.0−24.0) years. All were Gross Motor Function Classification Level I. Physical examination, three-dimensional gait analysis and magnetic resonance imaging for assessment of rotational alignment was performed.ResultsOn physical examination internal hip rotation was mean 50.6 (SD 10.4) degrees on the involved side and 44.3 (SD 10.3) on the non-involved side, p = 0.001.In gait analysis calculating the whole gait cycle, internal hip rotation was mean 2.3 (6.2) degrees on the involved side, and on the non-involved side external 1.8 (7.6) degrees, p = 0.004.Increased external pelvic rotation was noted on the involved side, mean 2.0 (4.3) degrees with corresponding internal rotation on the non-involved side, mean 3.6 (4.4), p = 0.001. There was no difference in foot progression, p = 0.067, with mean 5.1 (8.6) and 3.9 (6.4) external respectively.Magnetic resonance imaging revealed femoral torsion on the involved side mean 17.3 (11.3) degrees compared to 11.4 (10.8) on the non-involved side, p = 0.001.SignificanceTransverse plane asymmetry in the femur was noted in mild unilateral cerebral palsy. Increased anatomical and dynamic internal rotation was compensated for by external pelvic rotation. Rotational malalignment may contribute to gait deviations in this mild group and should be part of the overall assessment.     

Podiatrist care and outcomes for patients with diabetes and foot ulcer

We examined whether outcomes of care (amputation and hospitalisation) among patients with diabetes and foot ulcer differ between those who received pre‐ulcer care from podiatrists and those who did not. Adult patients with diabetes and a diagnosis of a diabetic foot ulcer were found in the MarketScan Databases, 2005–2008. Multivariate Cox proportional hazard models estimated the hazard of amputation and hospitalisation. Logistic regression estimated the likelihood of these events. Propensity score weighting and regression adjustment were used to adjust for potentially different characteristics of patients who did and did not receive podiatric care. The sample included 27 545 patients aged greater than 65+ years (Medicare‐eligible patients with employer‐sponsored supplemental insurance) and 20 208 patients aged lesser than 65 years (non Medicare‐eligible commercially insured patients). Care by podiatrists in the year prior to a diabetic foot ulcer was associated with a lower hazard of lower extremity amputation, major amputation and hospitalisations in both non Medicare‐eligible commercially insured and Medicare‐eligible patient populations. Systematic differences between patients with diabetes and foot ulcer, receiving and not receiving care from podiatrists were also observed; specifically, patients with diabetes receiving care from podiatrists tend to be older and sicker.     

Midfoot and forefoot osteoarthritis

BackgroundFoot osteoarthritis (OA) is linked with chronic foot pain and functional impairment.ObjectiveTo review the current knowledge on midfoot and forefoot OA.MethodsPubMed, CINAHL, PEDro, and the ISI Web of Science databases (1950–2013) were searched for keywords: foot OA, midfoot OA, forefoot OA and metatarsal OA. The search was limited to reports in human subjects and English language. Published cohort, cross-sectional studies and clinical trials relating to epidemiology, clinical features, functional impairment, risk factors and treatment were included.ResultsWe found heterogeneity in the design, radiographic views and grading systems used among studies. Most of the literature focused on radiographic OA, being the prevalence between 0.1% and 61%, depending on gender, age and joint evaluated. The age and female gender were the main associated factors, whereas structural (bone length) and mechanical factors (hypermobility, altered tarso-metatarsal stress, etc.) seemed to be related. Various treatments are widely used, i.e. physical therapy, orthotics, steroid injection, analgesics and arthrodesis. However, scarce research supports their efficacy.ConclusionMost of the current knowledge comes from observational and small case–control studies. Future population-based studies as well as controlled studies are essential to understand the risk factors and to evaluate the effectiveness of treatment options.     

Repeatability and reproducibility of the Tekscan HR-Walkway system in healthy children

This study investigated the repeatability and reproducibility of the HR Walkway system with regards to peak pressure values (PP) and pressure time integral (PTI) in healthy children, ranging between 5 and 18 years of age. Subjects recruited took part in two non-invasive clinical assessments, at baseline and 1 week later. Gait analysis was carried out using the PP box approach, and plantar foot recording was divided into 10 anatomical areas. The PP and PTI was investigated for the left, right and both feet accounted together. Interclass Correlation Coefficient (ICC) test was adopted for statistical analysis. Overall, 30 healthy patients were recruited and 60 appointments were completed, 53.3% (n = 16) were female and 46.7% (n = 14) were male. Mean age was 13.3 years (SD = 4.5), with an age-range of 5–18.6 years old. Results indicated that for all variables tested the repeatability data were ‘good’ ICC for 73.8% (n = 121) and ‘moderate’ ICC for 26.2% (n = 43). For all variables tested, the reproducibility data showed that ‘good’ ICC for 70.7% (n = 58) and ‘moderate’ ICC for 29.3% (n = 24). In conclusion, the HR Walkway system is able to provide repeatable and reproducible data.