The Foot

Editorial Board

2012-03-01

Editorial

Donald L. Lorimer — 2012-03-01

In the twenty-one years that “The Foot” has been published there has only been a small number of editorials included in all 80 plus issues. This was a deliberate policy as the publication was aimed at a readership drawn from a wide range of professional backgrounds and it was considered that it should concentrate on its principal objective of acting as a vehicle for the publication of research and clinical articles concerning the foot and lower limb. This role has continued over the years with only the occasional editorial being included for particular events. At a recent meeting of the Editorial Board it was decided that this policy should be reversed; and in future editorials will be a regular feature with contributions from a variety of sources dealing with issues that impinge on research or good clinical practice. It is appropriate that as the publication “comes of age” this change should take place to allow opinion to be promulgated and debate to take place.

Parental consanguinity and associated factors in congenital talipes equinovarus

T. Sreenivas, A.R. Nataraj — 2012-03-01

Abstract: Background: The cause of congenital talipes equinovarus (CTEV) is multifactorial and, consanguinity could be one of the causative factors in its development. The purpose of this study was, to determine the prevalence of parental consanguinity in CTEV and other factors like associated, congenital anomalies, maternal and fetal factors and also the severity of CTEV in these patients.Methods: The above factors were studied in 54 patients of less than 1 month of age with parental, consanguinity and 91 feet were evaluated for its severity using Dimeglio classification at the time of presentation.Results: Out of 174 children presented to our department with CTEV, 54 (31%) children were born out, of consanguineous marriage. Thirty seven (68.5%) patients had bilateral CTEV. Twenty five (46.3%), patients had associated congenital anomalies and myelomeningocele being the commonest anomaly, associated. Out of 91 feet 61 (67%) were of grade 4 severity.Conclusion: High grade of severity observed in both idiopathic and non idiopathic CTEV suggests the, probable role of consanguinity as an etiological factor in the development of CTEV especially in our, part of the world.

Gender-based differences in the functional deformation of the foot longitudinal arch

Mako Fukano, Toru Fukubayashi — 2012-03-01

Abstract: Background: Gender differences in physical characteristics are associated with differing incidences of sports-related injuries. However, functional differences in the foot arch, which acts as a shock absorber under dynamic conditions, have not been investigated.Objective: This study investigated gender-based differences in the medial and lateral longitudinal arches under static and dynamic conditions.Methods: Eleven males and 8 females participated in this study. Radiographic images of the subjects’ feet were obtained under static conditions, with and without weight bearing. In addition, each subject performed single leg landing from 10cm platform with the knee extended, and cineangiographic images in the sagittal plane were obtained during landing.Results: In the weight bearing position, the medial and lateral arch angles of the females were significantly greater than those of the males, but neither of the angles differed between the males and females without weight bearing. The magnitude of the angular changes of each arch was significantly greater in the females than in the males.Conclusion: These results suggest that females have a greater range of arch motion than males under static and dynamic loading conditions.

The effect of calf muscle stretching exercises on ankle joint dorsiflexion and dynamic foot pressures, force and related temporal parameters

K. Macklin, A. Healy, N. Chockalingam — 2012-03-01

Abstract: Background: Previous research has found that ankle joint equinus can lead to foot pathologies. Calf stretching exercises are a common treatment prescription; however, no dynamic quantitative data on its effectiveness is available.Objective: To investigate the effect of calf muscle stretching on ankle joint dorsiflexion and subsequent changes within dynamic forefoot peak plantar pressures (PPP), force and temporal parameters.Method: Thirteen runners with ankle joint equinus were required to perform calf muscle stretching twice a day (morning and evening) on a Flexeramp. Measurements were collected on day 1, week 4 and week 8. A repeated measures ANOVA with Bonferroni-adjusted post hoc comparisons was used to assess differences across the three data collection sessions.Results: Findings indicated that the calf stretching program increased ankle joint dorsiflexion significantly (from 5° to 16°, p≤0.05). The adaptive kinetics brought about by the increased ankle joint range of motion included significantly increased forefoot PPP and maximum force during stance phase but decreased time between heel contact and heel lift and total stance phase time.Conclusion: The calf stretching programme used in this study was found to increase ankle joint dorsiflexion and hence can be used for first line conservative management of ankle equinus.

Gait characteristics when walking with rounded soft sole shoes

2012-03-01

Abstract: This study aimed to examine the effect of shoes with a rounded soft sole (Stretch Walker: SW) on gait. Fifteen healthy male (mean age: 23.2) walked under three conditions (SW, Flat-bottomed Shoe: FS, Barefoot: BF). Including walking speed, stance time, step length were selected as temporal-spatial parameters. The angle of hip, knee, and ankle joints during particular phases were selected as kinematic parameters.Walking speed, stance time, step length and flexion angle of the ankle joint at initial contact were greater when wearing either shoe than walking BF; cadence was faster walking BF than wearing either shoe; double support time increased (FS>SW>BF); step width was greater (FS>SW>BF); walking angle was greater wearing the SW than wearing the FS and walking BF; and range of motion and maximum flexion angle of the hip and knee joints were greater wearing the FS than walking BF.In conclusion, wearing the SW with a heel-to-toe rocker and soft sole changes the double support time, step width, and walking angle and increases step length and walking speed compared to walking BF.The difference of the range of motion in hip and knee joints was larger between walking BF and wearing the FS than between walking BF and wearing the SW.

Incidence, risk factors for amputation among patients with diabetic foot ulcer in a North Indian tertiary care hospital

Mohammad Zubair, Abida Malik, Jamal Ahmad — 2012-03-01

Abstract: Objective: Aim of this study was to evaluate the incidence and risk factors for amputation among patients with diabetic foot ulcer (DFU).Research design and methods: We performed a prospective study of 162 DFU in patients treated in a multidisciplinary based diabetes and endocrinology centre of Jawaharlal Nehru Medical College of Aligarh Muslim University, Aligarh, India during the period of December 2008–March 2011. Detailed history and physical examination was carried out for every subject. Risk factors for amputation were determined by univariate analysis with 95% of CI.Results: The overall amputation rate was 28.4%. On univariate analysis, male sex [OR 2.8, RR 1.28], hypertension [OR 2.83, RR 1.31], neuropathy [OR 3.01, RR 1.35], nephropathy [OR 2.24, RR 1.26], LDL-C (>100mg/dl) [OR 2.53, RR 1.28], total cholesterol (>150mg/dl) [OR 3.74, RR 1.52],HDLC(<40mg/dl) [OR 1.19, RR 1.18], triglycerides (>200mg/dl) [OR 5.44, RR1.76], previous antibiotic use [OR 9.12, RR 1.92], osteomyelitis [OR 6.97, RR 2.43] and biofilm infection [OR 4.52, RR 1.41] were significant risk factors.Conclusion: The risk factors for amputation were presence of PVD, leukocytosis, neuropathy, nephropathy, hypertension, dyslipidemia, over use of antibiotics, osteomyelitis, biofilm production and higher grade of ulcer.

“Foot length—A functional parameter for assessment of height”

Rohini M. Pawar, Mohan N. Pawar — 2012-03-01

Abstract: The foot print provides a range of dimensions. Every individual has got a peculiar print. Hence, is being used for personal identification. Foot and foot print dimensions are concomitant with the height of an individual. An attempt was made to find out its correlation.Dermatoglyphics footprints of 100 male and 100 female of 19–23 year age were obtained and studied. Foot length (from foot print) and erect height of the individual was measured. Regression equation was utilised for ascertaining its correlation. The value of constants for male and female comes to be 15.690 and 87.906 respectively. The β coefficient for male is 6.342 and 3.165 for female. Regression equation is derived for height estimation of either gender. The statistically significant “t” value is observed in both cases.

Repeatability of WalkinSense® in shoe pressure measurement system: A preliminary study

Aoife Healy, Philip Burgess-Walker, Roozbeh Naemi, Nachiappan Chockalingam — 2012-03-01

Abstract: Plantar pressure measurements are regularly utilised while assessing patients with in-shoe systems allowing for discrete assessment. In the present study a new portable system capable of continuous monitoring of plantar pressure is assessed for its repeatability when compared to another commercially available and widely used system.

Types of foot problems seen by Australian podiatrists

P.J. Bennett — 2012-03-01

Abstract: Background: Understanding frequency of foot problems can assist health care planners with resource deployment to new and emerging services such as paediatric podiatry and focus future research on the most salient foot conditions.Methods: A review of 2187 patient consultations during a three month period was conducted. Patient medical and podiatric history was coded using industry standards. All patients were recruited for convenience from a metropolitan university podiatry clinic.Results: 392 new patients were identified with mean age 40.6 years old (range 1–95), with 65% being female. Arthritic diseases, asthma, hypertension and allergies were the most common medical conditions reported. The frequency of new consultations in younger people (n=102; 27%) exceeded those of the elderly (n=75; 20%). Conversely, the elderly were nearly three times more prevalent in this cohort (n=910; 43%) compared to younger people (n=332; 16%).Conclusion: This study illustrates the diverse nature of pathology seen by podiatrists. Knowledge that skin lesions are highly prevalent is of relevance to health departments, given the aging nature of most populations. Moreover there appears to be a growing trend in the number of young people who present for care, however government funded access to these services are limited.

Case study: Epidermoid cyst following percutaneous Topaz coblation for plantar fasciitis

Kim Ferguson, Allan George Thomson, John Stuart Moir — 2012-03-01

Abstract: An epidermoid cyst is formed when there is proliferation of epidermal cells within an area of the dermis. They may be formed by the traumatic implantation of epidermal cells within the dermis as well as many other mechanisms. We present a case of epidermoid cyst formation following Topaz coblation for plantar fasciitis; a complication we believe is yet to be reported in the literature.

Use of pulsed radio frequency energy in the effective treatment of recalcitrant plantar fasciitis: Six case histories

R. Michel — 2012-03-01

Abstract: Plantar fasciitis (or Heel Pain Syndrome) is a common foot disorder. Whereas most patients with this condition have satisfactory outcomes with conventional treatment, the condition can become recalcitrant. For these patients, the use of Pulsed Radio Frequency Energy (PRFE) appears to be a safe, noninvasive, and effective treatment option. While PRFE has been used to provide pain relief for other clinical conditions, little clinical information is available regarding its effectiveness for the treatment of plantar fasciitis. Reported here are outcomes for six cases of recalcitrant plantar fasciitis (duration 6 months or longer) that were unresponsive to conventional treatment alone, for which complete or near complete pain relief was achieved following adjunctive PRFE therapy.

Tuberculosis of the right distal fibula bone case repot: An unusual T.B. case

Muhammad I. UL Haq, J.R. Buckley — 2012-03-01

Abstract: A 26-year-old Asian female was referred to on-call trauma services with 2 weeks history of swelling and pain of her right ankle. On laboratory evaluation, she only had an elevated CRP. Ankle roentgenogram showed a lytic lesion of the distal fibula bone with soft tissue swelling.Chest roentgenogram was abnormal along with clinical findings. Bacteriological report from right ankle specimen isolated Acid Fast Bacilli. Histological examination of the biopsy tissue showed granuloma and caseating necrosis of tuberculosis.She had incision and radical debridement of abscess and received anti-tuberculous therapy. During her follow-up in clinic, no residual or recurrent disease was established.