Theory of Biomechanical Evolution of the Rheumatoid Foot: A Narrative Review.

BACKGROUND: In patients with rheumatoid arthritis (RA), the pathological progression of lower limb biomechanics is established. Although specific aspects of RA gait patterns have been studied and described, we are aware of no studies of gait pattern compensations over the entire disease course. This study aimed to describe a model that could predict the evolution of lower limb pathomechanics in patients with RA. METHODS: A literature review was conducted of electronic databases (MEDLINE, PEDro, Trip Database, DOAJ, BioMed Central, PLOS clinical trial, ScienceDirect, and CRD York University, AHRQ, NICE, Cochrane Library) to October 3, 2023. RESULTS: A theory was developed that all people with RA induce or augment gait evolution syndromes following the same biomechanical course. Specifically, we postulate the "rheumatoid equinus syndrome," the "rheumatoid abnormal pronation syndrome" and the "rheumatoid shuffle syndrome," which have never been described before. CONCLUSIONS: A new model of the evolution of gait compensation in RA is proposed. An important challenge of RA is that it increases the risk of ulcerative lesions, falls, pain, fractures, and healthcare costs. The proposed model can be used to reduce morbidity in this patient group by helping to explain and reduce the pain, deformity, and ankylosis of foot RA.

Good Short- and Mid-term Outcome After Cross-Linked Hyaluronic Acid Infiltration for Hallux Rigidus: A Case Report.

We report a first case of hallux rigidus successfully treated in an elderly patient by intra-articular infiltration of cross-linked hyaluronic acid (HA) 21 mg/mL with mannitol (Desirial Plus) and review the previous literature on the different compositions of HA infiltrative treatment applied to hallux rigidus. A 77-year-old female patient with moderate unilateral pain of 6 months of evolution and stiffness of the movement of the first metatarsophalangeal joint of the left foot, corresponding to grade 2 of the classification proposed by Coughlin and Shurnas. The objective of the study was to perform a pilot test to (a) evaluate the correct technique of intra-articular infiltration as well as (b) the use of a commercial cross-linked HA 21 mg/mL with mannitol, to a voluntary patient diagnosed with hallux rigidus. A single cross-linked HA infiltration is applied to the first metatarsophalangeal joint with an administered amount of 1 mL. The loaded dorsiflexion, the unloaded dorsiflexion, and the unloaded plantarflexion angles of the first metatarsophalangeal joint improved from 15°, 20°, and 10°, respectively, before injection to 45°, 52°, and 22°, respectively, at 14 days after injection. Moreover, these improvements maintained until the final follow-up (400 days). The intensity of pain, according to the visual analog scale, improved from 7 of 10 before the injection, passing through 4 of 10 at 14 days after the injection, to 1 of 10 at 60 days after the injection. Cross-linked HA 21 mg/mL with mannitol improves symptomatology, joint mobility of the first metatarsophalangeal joint, and quality of life in the patient with stiff hallux submitted to the pilot test. These effects have been maintained for more than 14 months.

Efficacy of the Treatment of Plantar Warts Using 1064 nm Laser and Cooling.

Cutaneous plantar warts may be treated using several optional methods, with the use of laser surgery having increased in the last few years. This work examined the efficacy of laser treatment combined with simple cooling to reduce pain. The cure rate was approximately 84%. There were no significant differences in the efficacy of treatment for different viral genotypes. The laser parameters were 500 msec pulses, 30 W of power, and a fluence of 212 J/cm2 delivered in up to four sessions. Successful treatment was achieved after an average of 3.6 sessions.

Fibro-osseous Pseudotumor of the Distal Phalanx.

Fibro-osseous pseudotumor of the digit is an unusual benign tumor that appears on the extremities. A 45-year-old, human immunodeficiency virus-positive man presented with a painful lesion on the tip of the fourth toe of his right foot. The tumor was completely excised without any connection to the underlying bone being observed, although the phalanx had to be extirpated. Histopathology confirmed the diagnosis of fibro-osseous pseudotumor. At the follow-up visit, 12 months later, no abnormalities were found.

Evaluation of the Complementary Health Provision of the Podiatric Foot Care Program for Diabetic Patients in Catalonia (Spain).

The Catalan diabetic foot health program was established in 2009 in order to prevent complications caused by type 2 diabetes. This study aims to describe its application from 2009 to 2018. The objective was to describe diabetic foot care provision in the National Health System of Catalonia between 2009 and 2018, including the number of patients and professionals involved, the causes behind patients' visits, and the most demanded codes for diagnosis and treatment filled by the podiatrist in each consultation during 2018-2020. This description was addressed through an analysis of the database provided by the Association of Podiatrists to evaluate the implementation of the program. The results for the diabetic foot health program in Catalonia showed a growth in demand from 2009 (1726) to 2018 (213,095) in terms of visits and from 2009 (1541) to 2018 (104,629) in terms of patients. The number of registered podiatrists from 2009 to 2018 increased from 165 to 470. The most commonly used diagnosis codes were (a) without sensory alterations in control and treatment of grade 1 lesions; (b) grade 0 without neuropathic, vascular, structural, or biomechanical alteration; (c) no sensory structural alterations in the foot; (d) keratopathies. The treatments most commonly used were (a) conservative (chiropody), (b) without ortho-podiatric treatment, and (c) plantar supports. The conclusions show that the health program is in great demand amongst the population. Similarly, the coding system has made it possible to identify the diagnosis and treatment of such demand.

Human papillomaviruses genotyping in plantar warts.

Plantar warts are caused by human papillomaviruses (HPVs) and have been associated with several HPV genotypes. However, there are few studies focused exclusively on plantar warts. In this work, we aim to identify the HPV genotypes of plantar warts and explore their relation to demographic and clinical characteristics of patients. A total of 72 patients diagnosed with plantar warts were recruited at the Laser unit at Podiatric Hospital, University of Barcelona, Spain. Inner hyperkeratosis laminar sections of warts were collected and DNA of samples were extracted. Amplification of a conserved region of the HPV L1 gene was performed with the SK-Polymerase chain reaction method. DNA amplicons were sequenced and HPV types identified. The most prevalent genotypes detected among the 105 analyzed plantar warts were HPV-57 (37.1%), HPV-27 (23.8%), HPV-1a (20.9%), HPV-2 (15.2%), and HPV-65 (2.8%). The majority of patients (78%) presented one single plantar wart, whereas multiple warts were detected in 22.2% of patients. One patient with multiple warts presented HPV types from two different genera, suggesting the spread of warts by self-inoculation as well as by de novo infection. No significant differences between the number of warts in toes, midfoot and heel were found. The most prevalent HPV types detected in all areas belonged to the alpha genus. This work provides new insight on plantar warts and their associated HPV genotypes, and evidences the usefulness and reliability of both the sample collection procedure and the PCR method used for HPV detection and typing. J. Med. Virol. 89:902-907, 2017. © 2016 Wiley Periodicals, Inc.