Assessment of the severity of curly toe

BackgroundCurly/underlapping toe involves flexion, adduction, and varus deformity of the interphalangeal joints. There are no previous reports showing the relationship between physical examination and X-ray findings among patients with curly toe deformity.MethodsWe investigated the clinical findings of 116 consecutive patients associated with 239 underlapping toes. We compared the age and affected toes between patients whose deformities were pointed out at a pediatric medical examination (group 1) and those referred for medical treatment (group 2). The degree of curly toe deformity was graded by a physical examination and X-ray.ResultsThe average age at presentation was 2.7 years. The affected toes were significantly different between groups 1 and 2 (p < .001). The morbidity of each toe differed significantly in group 2 (p < .005) but not in group 1. The correlation between the appearance grading and classification by X-ray was very strong using Spearman's rank correlation coefficient. The severity of curly toe was divided into mild in 104 toes, moderate in 105 toes, and severe in 17 toes. The methods of conservative treatment were observation only in 15 cases, manipulations in 30 cases, taping in 67 cases, and a brace in 9 cases. Surgery was performed in 8% of cases.ConclusionCurly toe deformity of the third or fourth toes tend to be referred for medical treatment because of the abnormality. Our grading system using a physical examination and classification by X-ray was useful for assessing the severity of curly toe.     

38例糖尿病足的观察与护理

目的 探讨糖尿病足溃疡的有效护理方法。方法 将38例发生糖尿病足溃疡的患者随机分2组,分别给予不同的换药方法,观察其疗效。结果 局部加用胰岛素组的疗效显著。结论 有效的护理方法是治疗糖尿病足溃疡的关键。     

一效膏治疗糖尿病足临床研究

目的:研究一效膏治疗糖尿病足患者溃疡创面的临床疗效。方法:应用随机数字表法将108例糖尿病足溃疡患者随机分为治疗组54例和对照组54例。两组患者给予基础治疗后,治疗组予一效膏外用治疗,对照组予康复新液外用治疗。观察两组患者治疗前后足部症状评分(包括创面缩小率、肉芽组织填充率、坏死组织附着率、创面渗出、疼痛)、创面组织血管内皮生长因子(VEGF)、血小板衍生生长因子(PDGF)水平变化,比较两组临床疗效及安全性。结果:治疗后,治疗组创面缩小率评分、肉芽组织填充率评分、坏死组织附着率评分、疼痛程度足部症状评分均低于对照组,差异有统计学意义(均P<0.05)。治疗后,治疗组创面组织VEGF、PDGF水平均高于对照组,差异有统计学意义(均P<0.05)。治疗组临床总有效率94.44%,高于对照组的77.78%,组间差异有统计学意义(P<0.05)。治疗期间,两组患者均未发生严重不良反应。结论:一效膏外用治疗糖尿病足溃疡,可明显改善足部症状评分,以及局部VEGF、PDGF水平,临床疗效较好。     

Peer reviewing in foot and ankle surgery: is there a limit to scientific altruism?

IntroductionComplex foot and ankle trauma surgery is a super-specialization of orthopedic trauma surgery. This topic is gaining in interest, both clinically and in research. The peer review process is the cornerstone of the current scientific model of evaluation of research papers. The burden of peer review activity in foot and ankle trauma surgery is currently unknown.Material and methodA comprehensive Microsoft Outlook® analysis of over seven years’ worth of review invites from one surgical Foot & Ankle specialist working at a Level-1 trauma center was evaluated. The topic of each paper was recorded. Whether or not the journal was specifically foot ankle, orthopedic, general medicine or predatory of origin was noted. In addition, it was recorded if the journal was indexed in Pubmed, Medline, or Scopus. The topic of the paper was scored as being foot and ankle related, and more specifically foot and ankle trauma related. Review of revisions were scored as invites as well.ResultsFrom January 2013 to December 2019 a total of 467 review invites were received. The number of peer review invitations rose from 14 in 2013 to 127 in 2019. The percentage of foot and ankle specific journals was 27.4%. The number of requests from non-indexed (predatory) journals rose from 3.7% in 2014 to 36.2% in 2019, with a decrease in article topics related to the authors subspecialty. The annual absolute number of performed reviews stayed approximately the same throughout the study period (34 on average in the last 5 years).ConclusionThe number of review requests in foot and ankle surgery has increased about 5-fold over the 5 year period evaluated. There is a need for more reviewers to spread the burden. Therefore, foot and ankle specialists who are prepared to publish, should also be prepared to provide peer reviews to maintain a high level of quality in foot and ankle research.     

Gait changes in persons with diabetes: Early risk marker for diabetic foot ulcer

Background Increasing prevalence of diabetic foot ulcer (DFU) and subsequent foot amputation in persons with type 2 diabetic neuropathy is a well known fact. The present study was aimed to identify the initial risk marker for DFU.Methods Dynamic plantar pressure analysis was done for persons with type 2 diabetes mellitus (T2DM) without neuropathy (D), patients with diabetic neuropathy (DN) with normal foot profile and healthy persons with normal foot profile (C).Results The data showed a significant difference in dynamic peak plantar pressure between C and DN (P = 0.035) and no significant difference between D and DN (P = 0.997). The dynamic segmental peak plantar pressure results showed significant difference only in the medial heel region (P = 0.009) among the three groups.Conclusions Gait variations and restrictions in subtalar and first metatarsophalangeal joint are found in persons with diabetic neuropathy even before the onset of foot deformity.