Dynamic stability in runners with and without plantar fasciitis

BackgroundPlantar fasciitis (PF) is a common overuse injury experienced by runners. PF may decrease the ability of the plantar fascia to create tension and reduce stability of the foot. Stability of the foot is necessary for whole-body dynamic stability during running which consists of cyclical periods of single leg stance. Given that a major risk factor for running-related injury is previous injury, evaluating dynamic stability in runners with PF, runners with resolved PF, and healthy runners may elucidate differences between these individuals and clarify risk for secondary injury in these groups.Research questionIs dynamic stability reduced in runners with PF and runners with resolved PF compared to healthy runners?MethodsThirty runners were recruited for this retrospective comparative study based on mileage and injury status: current PF (PF), resolved PF (RPF), or healthy (CON). Kinematic and kinetic data were collected during running and dynamic stability was determined by time-to-contact (TtC) analysis for early, mid, and late stance to the anterior, posterior, medial, and lateral boundary of the foot. Dynamic stability was compared between groups one-way ANOVAs (α = 0.05) and Tukey post-hoc tests conducted when appropriate. Cohen’s d effect sizes (d) were reported for all TtC comparisons (small = 0.20, medium = 0.50, large = 0.80).ResultsTtC values were shorter in PF compared to the other groups to all boundaries during mid-stance. TtC was significantly greater in PF compared to RPF to the anterior boundary during late stance.SignificanceShorter TtC observed in PF compared to the other groups during midstance may indicate reduced dynamic stability during the most stable portion of running which may lead to increased injury risk.     

Association of quadriceps angle with plantar pressure distribution,navicular height and calcaneo-tibial angle

ObjectiveThe aim of study was to analyze the association between Quadriceps Angle (QA) and plantar pressure, navicular height (NH), and calcaneo-tibial angle (CTA).MethodsA total of 64 volunteers (mean age: 22.25 ± 2.54 (range:19–33)) participated in this cross sectional study. EMED-m (Novel GmbH, Germany) electronic pedobarograph was employed for dynamic plantar pressure measurement using two step protocol. The angle between the vertical axis of calcaneus and the long axis of Achilles tendon for CTA. The height of navicular tubercle from the ground was measured while the subject was standing on both feet for NH. QA was measured while the subject was standing in a relaxed posture where both feet bearing equal weight.ResultsThere were significant negative correlations between QA and maximum force (MxF) under the 4th. metatarsal head (MH4). The QA was also significantly correlated with MxF and force-time integral (FTI) under the bigtoe (BT). FTI under the 3rd. metatarsal head (MH3), MH4 and 5th. metatarsal head (MH5) were significantly negatively correlated with QA. Pressure-time integral (PTI) under the MH4 and MH5 were found to be significantly negatively correlated with QA. A significant correlation was also found between QA and NH (p < 0.0001), whilst there was no correlation between QA and CTA. Regression analysis showed that NH was appeared as the major contributor for the QA (β = −0.49, p < 0.001) in the dynamic condition, followed by BT-FTI (β = 0.37, p < 0.001) and MH5-MxF (β = −0.21, p < 0.037).ConclusionThese findings may imply that the NH which can at least be controlled by appropriate shoe inserts may affect QA. This way, loading pattern of both plantar region and whole lower extremity may be altered.Level of evidenceLevel III, Diagnostic Study.     

Intravenous cidofovir treatment for recalcitrant warts in the setting of a patient with myelodysplastic syndrome

Cidofovir is an acyclic nucleoside phosphonate with broad-spectrum activity against DNA viruses, including human papilloma virus (HPV). However, data on the efficacy of cidofovir in an immunosuppressive setting remain contradictory. We report for the first time on the promotion of the healing of recalcitrant warts in a patient with myelodysplastic syndrome with intravenous cidofovir treatment.     

十二烷氮酮氟尿嘧啶凝胶治疗疣及银屑病150例

443例(男225例,女218例;年龄36±14a)皮肤病患者,其中150例(扁平疣52例、寻常疣55例、银屑病43例)外用含1.8％十二烷氮(艹卓)酮的1％氟尿嘧啶(5-FU)凝胶作为治疗组,148例外用1％5-FU凝胶及145例外用2.5％5-FU霜作为2个对照组。经双盲对照临床试验,结果表明含1.8％十二烷氮(艹卓)酮的1％5-FU凝胶的疗效明显优于2个对照组(P<0.01及P<0.005)。证明氮(艹卓)酮对5-FU确有渗透促进作用。     

A review of the effects of external pressure on skin blood flow

The human foot is a complex mechanical structure consisting of bones, ligaments and joints. They act together to provide a robust system capable of absorbing and dissipating the intermitted pressure that is subjected to its plantar surface during walking to prevent soft tissue breakdown. Current studies suggest that plantar foot pressure may lead to soft tissue breakdown (e.g. neuropathic ulceration) and hence research has so far concentrated on investigating the mechanical effects of plantar foot pressure on the foot’s integrity. This has been possible through the widely available pressure and force platforms as well as in-shoe pressure systems. However, to understand how plantar foot pressure causes soft tissue breakdown it is vital to investigate both the physiological–mechanical interactions between the skin and plantar foot pressure. This review suggests that with the current advances in technology, the physiological response of skin blood flow to mechanical plantar foot pressure should be investigated and correlated further, both during static and dynamic loading, by developing a new system capable of either measuring both variables simultaneously or by synchronising two systems in real time.     

Successful treatment of periungual warts using photodynamic therapy: a pilot study

AIM: The aim of this pilot study was an investigation on photodynamic therapy (PDT) whether it is a good alternative for treating periungual and subungual warts of the hands. STUDY DESIGN: Twenty patients (mean age: 30.5 years) with a total of 40 periungual and subungual warts were treated with PDT. A photosensitizer, 20%delta-aminolevulinic acid was applied on the warts. After a mean incubation time of 4.6 h (SD: 1.2), the warts were irradiated with the VersaLight for 5-30 min (15.2 +/- 4.3 min). RESULTS: After a mean of 4.5 treatments a mean clearance of 100% was achieved in 90% of the patients. One patient (5%) showed a clearance of 50% and another showed no improvement. The subungual or periungual location of the wart had no influence on the number of treatments or end result (P > 0.05). There were two recurrences during the mean follow-up period of 5.9 months (SD: 7.6). Besides mainly pain and hyperpigmentation, most treatments had no side-effects. CONCLUSION: PDT can offer a good alternative for treating periungual warts of the hands. Larger studies are indicated.     

Reconstruction of plantar defects

Plantar defects are a challenge for the plastic surgeon; from 1984–1995 59 operations were performed in 57 patients. The radial forearm flap and the latissimus dorsi (LD) flaps were mainly used depending on the amount of tissue loss. Local flaps such as dorsalis pedis and instep flaps were used for smaller defects. The radial forearm flap is ideal in terms of thickness and stability for the sole but limited in its size. The LD flap is a safe procedure especially for severe injuries and osteitis, but has the disadvantage of being bulky and debulking procedures are frequently performed. For nerve reconstruction deep sensibility seems to be sufficient in order to obtain stable postoperative results. In this report the different operative methods are evaluated. Since 1991, the patients were monitored with static and dynamic foot pressure measurements and gait analysis to assess the postoperative result and prevent pressure ulcers, scar irritation and hyperkeratosis. Preoperative investigations may contribute to an optimal schedule for planning and stabilization of the operative regimen.     

The significance of somatosensory stimulations to the human foot in the control of postural reflexes

 The purpose of this study was to investigate the possible pathways in the somatosensory system that relate to the postural reflexes in the leg muscles during a sudden, toes-up platform rotation. The inputs to the cutaneous mechanoreceptors in the sole of the foot as well as to the joint receptors in the ankle joint were modulated by standing on different supporting surfaces and by immobilizing the ankle joints; and three leg muscle responses (characterized by short latency, medium latency, and long latency) to the platform movement were recorded in 15 healthy young subjects. It was found that: (1) the short latency was not affected by the changes in either plantar pressure or ankle joint movement; (2) the medium latency was regulated by the plantar pressures under the foot, as sensed by the cutaneous mechanoreceptors in the sole of the foot, and by the ankle joint movement, as perceived by the joint receptors in the ankle joint; (3) the long latency was also related to the ankle joint movement, but this relation seems to be modulated by the plantar pressures under the foot; and (4) both medium and long latencies were well correlated with the time derivative of the pressure difference between the forefoot and the rear foot regions (r=0.7), as well as with the static pressure in the antagonist foot region (r>0.6). Received: 12 January 1996 / Accepted: 30 September 1996