A Rare Paronychia with Superinfection with Prevotella bivia and Staphylococcus haemolyticus: The Importance of Early Microbiological Diagnosis.

Prevotella bivia is an anaerobic, gram-negative bacillus which naturally thrives in the human vagina, and is usually related to vaginal tract infections. However, this microorganism can also cause infections in other body locations. Infections with Prevotella bivia are frequently severe due to the risk of osteomyelitis and the lack of good protocols for adequate therapeutic management. Staphylococcus haemolyticus infection is one of the most frequent etiological factors of nosocomial infections, which hasthe ability to acquire multiple resistance against antimicrobial agents. We report a rare case of foot and hand paronychia with superinfection of Prevotella bivia and Staphylococcus haemolyticus. We highlight the importance of early microbiological diagnosis, and proper therapeutic management to avoid the risk of complications and the development of bacterial resistance to antibiotics.

Range of Ankle Dorsiflexion in a Group of Adults with Ligamentous Laxity.

BACKGROUND: Ligamentous or joint laxity is a clinical entity characterized by increased joint mobility beyond the range of motion regarded as normal, and joint mobility is an effective indicator of the degree of laxity. We examined the influence of ligamentous laxity on the range of ankle dorsiflexion with the knee flexed and extended, comparing lax adults with a control (nonlax) group. METHODS: The sample comprised 400 individuals: 200 in the control group (mean ± SD age, 32.49 ± 11.06 years) and 200 in the lax group (mean ± SD age, 29.82 ± 9.40 years). The Beighton criteria were applied to each participant to diagnose laxity or nonlaxity, and sex, age, and angle range of bilateral dorsiflexion with the knee extended and flexed were recorded. RESULTS: The mean ± SD dorsiflexion range with the knee straight was 16.14° ± 5.29° left ankle and 21.21° ± 4.93° right ankle in the lax group and 12.94° ± 4.17° left ankle and 17.08° ± 4.40° right ankle in the control group. The respective values with the knee flexed were 15.84° ± 5.31° and 21.21° ± 4.80° in the lax group and 12.95° ± 3.95 and 17.23° ± 4.25° in the control group. CONCLUSIONS: In this sample, ankle dorsiflexion range in the lax group was 4° bigger than that in the control group in both knee positions.

Structural differences in the lower extremities in children aged 7-9 years, caused by playing football: A cross-sectional study.

BACKGROUND: Physical activity during childhood can be beneficial in the long term. However, this practice can influence the child's physiological development. The aim of this study was to determine whether the practice of soccer, in moderation, could be a risk factor for the inadequate development of the lower limb. METHODS: The study group was composed of 115 children, of whom 59 (mean age 8.03±0.89years) practised soccer 3 times a week and had a positive Physical Activity Questionnaire for Adolescents (PAQ-A) score, while a further 56 (mean age 7.96±0.87years) did not perform any additional physical activity and had a negative PAQ-A score. A foot posture analysis, based on the foot posture index (FPI), the valgus index, the orientation of the subtalar joint (STJ) and the Q angle of the knee, was carried out. RESULTS: For the group of soccer players, the following results were obtained: FPI 4.79±2.38 (R) and 3.95±2.31 (L); valgus index 13.56°±1.66° (R) and 13.42°±1.48° (L); STJ test 79% pronated; Q angle 13.13°±2.06° (R) and 13.18°±1.93° (L). For the non-players, the corresponding values were: FPI 3.62±2.82 (R) and 3.74±2.77 (L); valgus index 12.76°±1.71° (R) and 12.84°±1.72° (L); STJ test 50% pronated; Q angle 13.87°±3.01° (R) and 13.86°±2.94° (L). CONCLUSION: There is a degree of difference between the two groups, but the values do not vary greatly from those considered normal for this age group. Any alterations in this respect can be assumed to be caused at older ages than those analysed.

Effect by custom-made foot orthoses with added support under the first metatarso-phalangeal joint in hallux limitus patients: Improving on first metatarso-phalangeal joint extension.

BACKGROUND: Hallux limitus is one of the most common disorders affecting foot biomechanics. Custom-made foot orthoses can improve the function of the first metatarso-phalangeal joint. OBJECTIVES: The objective underlying this study was to test whether custom-made foot orthoses increased the range of mobility of metatarso-phalangeal joint in patients with hallux limitus. STUDY DESIGN: Randomized, double-blinded, and clinical trial. METHODS: The study consisted of 20 participants (40 feet) diagnosed with hallux limitus. A control group and an experimental group both wore the same custom-made foot orthoses and, in the experimental group, a support element under the first metatarso-phalangeal joint was added to the orthoses. Two measurements were made with both groups: the relaxed position of the first metatarso-phalangeal joint and the maximum extension of the hallux. These measurements were made before first placing the foot orthoses and 6 months after application of the treatment. RESULTS: In the experimental group, the results showed an improvement of 4.5° in the relaxed position and 22.2° in the maximum extension being statistically significant (p < 0.001) for both measurements. CONCLUSION: Custom-made foot orthoses with added support under the first metatarso-phalangeal joint were proved to be an effective treatment to restore functionality of this joint in hallux limitus patients. CLINICAL RELEVANCE: Limitation of hallux movement in the joints propulsive phase of gait negatively affects the biomechanics of the lower extremity, causing changes in the rest of the joins. The use of foot orthoses designed in this study restores range of motion of the first metatarso-phalangeal joint.

Clinical signs in the foot that are predictors of ligamentous laxity in the adult population.

OBJECTIVES: This study evaluates the influence of ligamentous laxity on the foot from observation of clinical signs and quantification of certain joint ranges. METHODS: The sample consisted of 400 subjects - 200 in the non-lax control group (ages 32.49 ± 11.06 years) and 200 in the lax group (ages 29.82 ± 9.41 years). The Beighton criteria were applied to each subject to diagnose laxity or non-laxity after noting their gender, age, and 2 joint ranges and 2 clinical signs for both feet. This was an observational analytical study of cases and controls, in which a multivariate binary logistic regression model was applied. RESULTS: Extension of the first metatarsophalangeal joint (MTPJ) ≥95°, extension of the 1st toe's interphalangeal joint (IPJ) ≥14°, and the signs 1st "in the plantar footprint, marked and narrowly confined support under metatarsal heads" and 2nd "in the plantar footprint, continuity of the 1st toe to the 1st metatarsal" presented significant differences between the lax and the non-lax groups. These are usable as parameters with which to detect laxity. The Beighton criteria were confirmed as being the most appropriate for diagnosis. CONCLUSIONS: We propose the use of 2 clinical signs that can be evaluated in plantar footprints ("1st" and "2nd") and 2 exploratory manoeuvres (extension of the first MTPJ ≥95° and extension of the 1st toe's IPJ ≥14°) as factors present in the foot which allow the detection of ligamentous laxity in the adult population, for subsequent confirmation by applying the Beighton criteria.

Sensitivity and specificity of a new test for thermographic evaluation of the foot in the diagnosis of diabetic peripheral polyneuropathy.

OBJECTIVE: This work determined the sensitivity, specificity, and predictive values of a test evaluating the thermal perception threshold to cold and heat and established a thermal interval with the participant's basal temperature in order to detect diabetic peripheral neuropathy in 172 people with diabetes, 86 with and 86 without diabetic neuropathy. DESIGN: This was a cross-sectional, diagnosis accuracy study. SETTING: This research was performed from January 2010 to February 2012 in Seville, Spain, and Córdoba, Spain. PARTICIPANTS: One hundred seventy-two people with diabetes, 86 with and 86 without diabetic neuropathy, were recruited to participate in the study. MAIN OUTCOME MEASURES: The thermal sensitivity was examined in the participants' feet with an instrument designed to assess thermal discrimination and sensitivity based on the Peltier principle. The skin temperature was recorded, and it was performed the following tests: (1) determining the thermal discrimination threshold, used to identify the lowest noticeable temperature difference, and (2) examining the thermal sensitivity, used to determine the absolute thermal threshold. The receiver operating characteristic curve technique was used to calculate the sensitivity, specificity, and predictive values. MAIN RESULTS: The area under the curve that showed the best sensitivities and specificities bilaterally was for the warm temperatures under the first and fifth metatarsal heads. In these zones, the temperature difference needed to predict whether a patient was neuropathic was 2°C. Sensitivities were greater than 75%, and the positive predictive values in all cases exceeded 60%. CONCLUSIONS: This technique enabled the authors to quantify the degrees of colder or warmer temperature differences that participants with diabetes (with and without neuropathy) needed to be able to detect a difference, with acceptable sensitivity, specificity, and predictive values.

Foot orthoses custom-made by vacuum forming on the non-load-bearing foot: preliminary results in male children with calcaneal apophysitis (Sever's disease).

BACKGROUND AND AIM: To our knowledge, the technique of molding orthoses to the non-load-bearing foot is still not widely investigated. The aim of this work is, therefore, first, to describe an off-loading custom-made technique and, second, to explain how it can be specifically adapted to treat Sever's disease. TECHNIQUES: A technique of directly molding orthoses to the non-load-bearing foot by vacuum forming an insole to the foot fabricated with a combination of polyvinyl chloride and polyester resins, 30 Shore A hardness and 148 kg/m(3) density polyethylene-ethylene-vinyl-alcohol, and a cushioning heel cup of 22 Shore A polyurethane, using a directly molding orthoses technique to the non-load-bearing foot by vacuum. DISCUSSION: Results show that this new technique could be a good alternative to traditional insoles in the management of Sever's disease pain.