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1.
Arch Orthop Trauma Surg ; 144(5): 1955-1967, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38554203

RESUMO

INTRODUCTION: Progressive collapsing foot deformity (PCFD), formally known as "adult-acquired flatfoot deformity" (AAFFD), is a complex foot deformity consisting of multiple components. If surgery is required, joint-preserving procedures, such as a medial displacement calcaneal osteotomy (MDCO), are frequently performed. The aim of this systematic review is to provide a summary of the evidence on the impact of MDCO on foot biomechanics. MATERIALS AND METHODS: A systematic literature search across two major sources (PubMed and Scopus) without time limitation was performed according to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) criteria. Only original research studies reporting on biomechanical changes following a MDCO were included. Exclusion criteria consisted of review articles, case studies, and studies not written in English. 27 studies were included and the methodologic quality graded according to the QUACS scale and the modified Coleman score. RESULTS: The 27 included studies consisted of 18 cadaveric, 7 studies based on biomechanical models, and 2 clinical studies. The impact of MDCO on the following five major parameters were assessed: plantar fascia (n = 6), medial longitudinal arch (n = 9), hind- and midfoot joint pressures (n = 10), Achilles tendon (n = 5), and gait pattern parameters (n = 3). The quality of the studies was moderate to good with a pooled mean QUACS score of 65% (range 46-92%) for in-vitro and a pooled mean Coleman score of 58 (range 56-65) points for clinical studies. CONCLUSION: A thorough knowledge of how MDCO impacts foot function is key in properly understanding the postoperative effects of this commonly performed procedure. According to the evidence, MDCO impacts the function of the plantar fascia and Achilles tendon, the integrity of the medial longitudinal arch, hind- and midfoot joint pressures, and consequently specific gait pattern parameters.


Assuntos
Calcâneo , Pé Chato , Osteotomia , Humanos , Fenômenos Biomecânicos , Calcâneo/cirurgia , Pé Chato/cirurgia , Pé Chato/fisiopatologia , Pé/cirurgia , Pé/fisiopatologia , Pé/fisiologia , Deformidades Adquiridas do Pé/cirurgia , Deformidades Adquiridas do Pé/fisiopatologia , Deformidades Adquiridas do Pé/etiologia , Marcha/fisiologia , Osteotomia/métodos
2.
Diabet Med ; 38(4): e14438, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33084095

RESUMO

AIMS: To investigate people with Charcot midfoot deformity with regard to plantar pressure, footwear adherence and plantar foot ulcer recurrence. METHODS: Twenty people with diabetes, Charcot midfoot deformity, plantar foot ulcer history and custom-made footwear were assessed with regard to barefoot and in-shoe plantar pressures during walking, footwear adherence (% of daily steps over 7-day period) and plantar foot ulcer recurrence over 18 months. In a cohort design, they were compared to 118 people without Charcot foot (non-Charcot foot group) with custom-made footwear and similar ulcer risk factors. RESULTS: Median (interquartile range) barefoot midfoot peak pressures were significantly higher in the Charcot foot group than in the non-Charcot foot group [756 (260-1267) vs 146 (100-208) kPa; P<0.001]. In-shoe midfoot peak pressures were not significantly higher in the Charcot foot group [median (interquartile range) 152 (104-201) vs 119 (94-160) kPa] and significantly lower for all other foot regions. Participants in the Charcot foot group were significantly more adherent, especially at home, than participants in the non-Charcot foot group [median (interquartile range) 94.4 (85.4-95.0)% vs. 64.3 (25.4-85.7)%; P=0.001]. Ulcers recurred in 40% of the Charcot foot group and in 47% of the non-Charcot foot group (P=0.63); midfoot ulcers recurred significantly more in the Charcot foot group (4/8) than in the non-Charcot foot group (1/55; P=0.001). CONCLUSIONS: Effective offloading and very high footwear adherence were found in people with diabetes and Charcot midfoot deformity. While this may help protect against plantar foot ulcer recurrence, a large proportion of such people still experience ulcer recurrence. Further improvements in adherence and custom-made footwear design may be required to improve clinical outcome.


Assuntos
Pé Diabético , Deformidades Adquiridas do Pé , Equipamentos Ortopédicos , Cooperação do Paciente/estatística & dados numéricos , Sapatos , Idoso , Estudos de Coortes , Pé Diabético/epidemiologia , Pé Diabético/patologia , Pé Diabético/fisiopatologia , Pé Diabético/terapia , Feminino , Pé/patologia , Pé/fisiopatologia , Deformidades Adquiridas do Pé/epidemiologia , Deformidades Adquiridas do Pé/patologia , Deformidades Adquiridas do Pé/fisiopatologia , Deformidades Adquiridas do Pé/terapia , Transtornos Neurológicos da Marcha/epidemiologia , Transtornos Neurológicos da Marcha/patologia , Transtornos Neurológicos da Marcha/fisiopatologia , Transtornos Neurológicos da Marcha/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Equipamentos Ortopédicos/estatística & dados numéricos , Pressão , Recidiva , Caminhada/fisiologia
3.
J Peripher Nerv Syst ; 25(3): 297-302, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32662923

RESUMO

Structural foot deformities consequent to Charcot Marie Tooth (CMT) can be treated by functional surgery (FS). This study aims to evaluate both long-term walking ability and patients' satisfaction in CMT subjects who underwent FS during their lifetime. We conducted a retrospective observational study. Age, sex, CMT type, comprehensive surgical history, current walking ability assessed by the Walking Handicap Scale (WHS) and patients' global impression of change (pGIC) were retrieved from a custom database managed at our institution. WHS and pGIC were assessed between mid-2018 and mid-2019. Data from 79 patients were screened and 63 were included, 35W-28M, mean age 42 (15), with demyelinating (75%), axonal (20%), and other types (5%) of CMT, who underwent FS between 1967 and 2018. FS evolved significantly over the years from bone-related procedures (e.g., arthrodesis) to both bone and soft tissues-related procedures. The re-intervention rate decreased from 70% before 2000 to 32% in the last decade. Complications arose in five cases. FS was mainly performed on adults (73%). WHS was ≥ 5 in three-quarters of the sample (range 1-6) and was significantly affected by age groups in patients with demyelinating CMT (n=47, p<0.01, non-parametric ANOVA). Nearly 80% of patients were satisfied with FS (pGIC ≥ 4). In conclusion, CMT subjects who underwent FS surgery maintained a high gait efficiency in the long-term period, with middle to high levels of satisfaction in the majority of the cases. This confirms the validity of FS in the management of acquired foot deformities in CMT patients.


Assuntos
Doença de Charcot-Marie-Tooth/fisiopatologia , Doença de Charcot-Marie-Tooth/cirurgia , Deformidades Adquiridas do Pé/cirurgia , Extremidade Inferior/cirurgia , Procedimentos Ortopédicos , Avaliação de Resultados em Cuidados de Saúde , Satisfação do Paciente , Caminhada/fisiologia , Adolescente , Adulto , Idoso , Doença de Charcot-Marie-Tooth/complicações , Feminino , Deformidades Adquiridas do Pé/etiologia , Deformidades Adquiridas do Pé/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Ortopédicos/normas , Estudos Retrospectivos , Adulto Jovem
4.
J Athl Train ; 55(7): 699-706, 2020 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-32511713

RESUMO

CONTEXT: After a lower extremity injury, patients often return to sport (RTS) when the injured limb's performance on unilateral hopping tests is similar to that of the uninjured limb. However, the exact target symmetry value patients must reach before the RTS is unclear. OBJECTIVE: To identify variables that predict limb symmetry index (LSI) values on 6 unilateral hopping tests in healthy, physically active adults. DESIGN: Cross-sectional study. SETTING: Research laboratory. PATIENTS OR OTHER PARTICIPANTS: In total, 275 healthy, physically active adults, consisting of recreational athletes (n = 198), National Collegiate Athletic Association Division I student-athletes (n = 56), and Army Reserve Officer Training Corps cadets (n = 21), volunteered to participate (143 men, 132 women, age = 20.16 ± 2.19 years, height = 172.66 ± 10.22 cm, weight = 72.64 ± 14.29 kg). INTERVENTION(S): Each participant completed 3 speed (6-m crossover-hop, side-hop, figure-8 hop) and 3 distance (triple-crossover-hop, lateral-hop, medial-hop) functional performance tests on both limbs. MAIN OUTCOME MEASURE(S): Mean performance of the dominant and nondominant limbs and LSI values. Two multiple regression models were used to find variables that might help to predict a participant's LSI for each functional performance test. RESULTS: The models helped to predict limb symmetry for 10 of the 12 multiple regressions. Unilateral limb performance was the best predictor of LSI values, as it was statistically significant in 11 of the 12 regression models. Sex and body mass index were significant predictor variables for the side hop and figure-8 hop, respectively. CONCLUSIONS: We found significant predictor variables that clinicians can use in the absence of baseline testing to determine patient-specific LSI values. Individualizing RTS decisions in this way may help to minimize subjectivity in the decision-making process and ensure a safe and timely return to competition.


Assuntos
Traumatismos em Atletas , Teste de Esforço/métodos , Deformidades Adquiridas do Pé , Traumatismos da Perna , Volta ao Esporte , Adulto , Traumatismos em Atletas/complicações , Traumatismos em Atletas/reabilitação , Estudos Transversais , Tomada de Decisões , Feminino , Deformidades Adquiridas do Pé/diagnóstico , Deformidades Adquiridas do Pé/etiologia , Deformidades Adquiridas do Pé/fisiopatologia , Humanos , Traumatismos da Perna/complicações , Traumatismos da Perna/psicologia , Traumatismos da Perna/reabilitação , Masculino , Desempenho Físico Funcional , Volta ao Esporte/fisiologia , Volta ao Esporte/psicologia
5.
Jt Dis Relat Surg ; 31(2): 372-376, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32584739

RESUMO

The varus ankle deformity can lead to osteoarthritis; therefore, numerous supramalleolar tibia osteotomy techniques are described to correct this deformity. Many of these techniques are more suitable for uniplanar ankle deformity. Particularly, if there are multiplane ankle deformities, the use of the six-axis deformity correction system may be successful in solving the problems which may occur during the correction. In this article, we report two cases of three plane deformities of ankle joint due to trauma sequelae, which were treated with supramalleolar osteotomy using a hexapod fixator which is called the Smart Correction Frame®.


Assuntos
Articulação do Tornozelo , Fixadores Externos , Deformidades Adquiridas do Pé , Osteoartrite/prevenção & controle , Osteotomia , Adolescente , Adulto , Traumatismos do Tornozelo/complicações , Articulação do Tornozelo/diagnóstico por imagem , Articulação do Tornozelo/patologia , Articulação do Tornozelo/cirurgia , Desenho Assistido por Computador , Feminino , Deformidades Adquiridas do Pé/complicações , Deformidades Adquiridas do Pé/fisiopatologia , Deformidades Adquiridas do Pé/cirurgia , Humanos , Masculino , Osteoartrite/etiologia , Osteotomia/instrumentação , Osteotomia/métodos , Radiografia/métodos , Recuperação de Função Fisiológica , Resultado do Tratamento
7.
An. bras. dermatol ; 95(1): 52-56, Jan.-Feb. 2020. tab
Artigo em Inglês | LILACS | ID: biblio-1088713

RESUMO

Abstract Background and objectives: Leprosy remains a leading cause of peripheral neuropathy and disability in the world. Primary objective of the study was to determine the incidence of deformities present at a time of diagnosis and new deformities that patients develop over follow up period. Material and methods: An open, retrospective cohort study was performed at a tertiary medical center in western India. Recruitment phase of the study was of 2 years (2009-2010) followed by observation/follow up phase of 7 years till 31st December 2017. New patients with leprosy and released from treatment cases who presented with deformity as defined by WHO disability grade (1998) and subsequently developing new deformities during the follow up period of up to 7 years were included in the study. Results: The study included 200 leprosy patients. Of the total 254 deformities, 168 (66.14%) deformities were noticed at the moment of diagnosis, 20 (7.87%) deformities occurred during the follow up phase. Of all patients, 21.25% had Grade 1 deformity and 6.31% had Grade 2 or more severe deformity. Deformities of hand were most common in 44.48%, followed by feet 39.76%, and face 15.74% respectively. Limitation of study: Mode of inclusion of patient was self-reporting during follow up phase so there is possible under reporting of the disabilities. Conclusion: New deformities continue to develop in certain forms of leprosy even after release from treatment. Long-term & regular follow up of patients who have been released from treatment is required.


Assuntos
Humanos , Masculino , Feminino , Avaliação da Deficiência , Hanseníase/fisiopatologia , Hanseníase/patologia , Nervos Periféricos/fisiopatologia , Fatores de Tempo , Índice de Gravidade de Doença , Deformidades Adquiridas do Pé/fisiopatologia , Deformidades Adquiridas do Pé/patologia , Deformidades Adquiridas da Mão/fisiopatologia , Deformidades Adquiridas da Mão/patologia , Prontuários Médicos , Estudos Transversais , Estudos Retrospectivos , Seguimentos , Progressão da Doença , Face/anormalidades , Índia
8.
An Bras Dermatol ; 95(1): 52-56, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31952993

RESUMO

BACKGROUND AND OBJECTIVES: Leprosy remains a leading cause of peripheral neuropathy and disability in the world. Primary objective of the study was to determine the incidence of deformities present at a time of diagnosis and new deformities that patients develop over follow up period. MATERIAL AND METHODS: An open, retrospective cohort study was performed at a tertiary medical center in western India. Recruitment phase of the study was of 2 years (2009-2010) followed by observation/follow up phase of 7 years till 31st December 2017. New patients with leprosy and released from treatment cases who presented with deformity as defined by WHO disability grade (1998) and subsequently developing new deformities during the follow up period of up to 7 years were included in the study. RESULTS: The study included 200 leprosy patients. Of the total 254 deformities, 168 (66.14%) deformities were noticed at the moment of diagnosis, 20 (7.87%) deformities occurred during the follow up phase. Of all patients, 21.25% had Grade 1 deformity and 6.31% had Grade 2 or more severe deformity. Deformities of hand were most common in 44.48%, followed by feet 39.76%, and face 15.74% respectively. LIMITATION OF STUDY: Mode of inclusion of patient was self-reporting during follow up phase so there is possible under reporting of the disabilities. CONCLUSION: New deformities continue to develop in certain forms of leprosy even after release from treatment. Long-term & regular follow up of patients who have been released from treatment is required.


Assuntos
Avaliação da Deficiência , Hanseníase/patologia , Hanseníase/fisiopatologia , Estudos Transversais , Progressão da Doença , Face/anormalidades , Feminino , Seguimentos , Deformidades Adquiridas do Pé/patologia , Deformidades Adquiridas do Pé/fisiopatologia , Deformidades Adquiridas da Mão/patologia , Deformidades Adquiridas da Mão/fisiopatologia , Humanos , Índia , Masculino , Prontuários Médicos , Nervos Periféricos/fisiopatologia , Estudos Retrospectivos , Índice de Gravidade de Doença , Fatores de Tempo
9.
J Diabetes Res ; 2019: 7395769, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31380446

RESUMO

The abnormal plantar pressure distribution and value play a key role in the formation of plantar calluses and diabetic foot ulcer. The prevalence of the highest pressure different distribution and its association with various factors among patients with diabetes is not well known. The study purpose was to evaluate the prevalence of different regions for the highest pressure on the sole and its association with selected factors among patients with diabetes. Medical records of nonulcer patients were retrospectively analysed. The relationship between pressure patterns on the sole obtained during a pedobarographic test as a semiquantitative assessment with colourful print analysis and neuropathy, gender, age, and BMI was searched. The most common location of the highest pressure was the central part of the forefoot. No association was found between the different highest pressure regions and age, sensory neuropathy, calluses, and foot deformities. The highest pressure on the lateral part of the foot and midfoot was observed more often in females and in patients with a BMI ≥ 35. The prevalence of the highest pressure on the forefoot was more common in patients with a BMI < 35. Conclusions. The most frequent regions of the highest pressure on the sole in patients with diabetes were the central part of the forefoot (2-3 metatarsal heads) with no simple relationship to the assessed variables other than BMI < 35. Female gender and higher BMI seem to be responsible for shifting the place of the highest pressure to other places of the foot.


Assuntos
Diabetes Mellitus/fisiopatologia , Neuropatias Diabéticas/epidemiologia , Deformidades Adquiridas do Pé/fisiopatologia , Pé/fisiologia , Pressão , Caminhada/fisiologia , Idoso , Calo Ósseo/fisiopatologia , Diabetes Mellitus/epidemiologia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/fisiopatologia , Pé Diabético/complicações , Pé Diabético/epidemiologia , Pé Diabético/fisiopatologia , Neuropatias Diabéticas/fisiopatologia , Feminino , Deformidades Adquiridas do Pé/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Ortopedia/métodos , Estudos Retrospectivos
10.
J Foot Ankle Res ; 12: 8, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30700995

RESUMO

BACKGROUND: Gout frequently affects the foot yet relatively little is known about the effects of gout on foot structure, pain and functional ability. This study aimed to describe the impact of gout in a UK primary care population. METHODS: A cross-sectional study was nested within an observational cohort study of adults aged ≥50 years with foot pain. Participants with gout were identified through their primary care medical records and each matched on age (±2 years) and gender to four participants without gout. Differences in person-level variables (SF-12 Physical Component Score, Manchester Foot Pain and Disability Index and Short Physical Performance Battery) between gout and non-gout participants were determined using regression models. Differences in foot-level variables (pain regions, skin lesions, deformities, foot posture, and non-weightbearing range of motion) were determined using multi-level regression models. All models were adjusted for body mass index. Means and probabilities with 95% confidence intervals were calculated. RESULTS: Twenty-six participants with gout were compared to 102 participants without gout (77% male; mean age 66 years, standard deviation 11). Subtalar joint inversion and eversion and 1st metatarsophalangeal joint (MTPJ) dorsiflexion range of motion were significantly lower in the gout participants compared to the non-gout participants. Gout participants were more likely to have mallet toes and less likely to have claw toes compared to non-gout participants. There were no statistically significant differences in person-level variables, foot posture, ankle dorsiflexion range of motion, hallux valgus, pain regions, or skin lesions. CONCLUSIONS: Non-weightbearing range of motion at the subtalar joint and 1st MTPJ was reduced in people with gout. Patients with gout who present with chronic foot problems should therefore undergo appropriate clinical assessment of foot structure.


Assuntos
Deformidades Adquiridas do Pé/etiologia , Articulações do Pé/patologia , Gota/complicações , Atividades Cotidianas , Idoso , Estudos Transversais , Avaliação da Deficiência , Feminino , Deformidades Adquiridas do Pé/patologia , Deformidades Adquiridas do Pé/fisiopatologia , Articulações do Pé/fisiopatologia , Gota/patologia , Gota/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Dor/etiologia , Dor/patologia , Dor/fisiopatologia , Atenção Primária à Saúde , Amplitude de Movimento Articular/fisiologia
11.
Injury ; 50(3): 796-803, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30685108

RESUMO

BACKGROUND: The purpose of this article was to introduce calcaneal lengthening for partial traumatic loss of the calcaneus. Effectiveness with the use of the technique was also assessed. METHODS: From January 2013 to May 2016, calcaneal lengthening was performed in 15 patients who sustained a partial traumatic loss of the tuberosity portion of calcaneus. There were 13 men and 2 women with an average age of 36 years (range, 19-53 years). Combined Achilles tendon rupture was noted in 7 patients, and the tendon was reinserted to the calcaneus before calcaneal lengthening. Calcaneal lengthening was performed using an Ilizarov frame. Clinical outcome was assessed based on the American Orthopedic Foot and Ankle score. RESULTS: The mean loss of calcaneus was 27% (range, 19%-35%). Calcaneal lengthening (mean total time is157 days; range, 111-226 days) included three periods, i.e., latency (mean 7 days; range, 7-9 days), distraction (mean 43 days; range, 32-57 days), and consolidation (mean 108 days; range, 84-162 days). The mean amount of lengthening was 28% (range, 19%-38%). The mean follow-up duration was 25 months (range, 24-27 months). Based on the American Orthopaedic Foot and Ankle, there were 8 excellent, 6 good, and 1 fair result. CONCLUSIONS: For the treatment of partial traumatic loss of the calcaneus, calcaneal lengthening using an Ilizarov frame is a preferable technique to restore the length of calcaneus and foot function.


Assuntos
Alongamento Ósseo/instrumentação , Calcâneo/cirurgia , Deformidades Adquiridas do Pé/cirurgia , Traumatismos do Pé/cirurgia , Fixação Interna de Fraturas/instrumentação , Osteotomia/métodos , Adulto , Alongamento Ósseo/métodos , Calcâneo/diagnóstico por imagem , Calcâneo/fisiopatologia , Feminino , Seguimentos , Deformidades Adquiridas do Pé/diagnóstico por imagem , Deformidades Adquiridas do Pé/fisiopatologia , Traumatismos do Pé/diagnóstico por imagem , Traumatismos do Pé/patologia , Fixação Interna de Fraturas/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
12.
J Foot Ankle Surg ; 58(2): 243-247, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30583836

RESUMO

Lateral hindfoot pain associated with stage 2 to 3 adult-acquired flatfoot is often attributed to subfibular impingement. Preoperative magnetic resonance imaging (MRI) is generally performed to assess the extent of degeneration within the posterior tibial tendon, attenuation of medial soft tissue constraints, and degeneration of hindfoot and/or ankle articulations. The purpose of this study is to determine the incidence of lateral collateral ligament disease/injury associated with stages 2 and 3 adult-acquired flatfoot. The subjects were identified using a searchable computerized hospital database between 2015 and 2017. Stage 2 or 3 adult-acquired flatfoot deformity was confirmed in patients via chart review and MRI analysis. Lateral ankle ligament injury was confirmed using patient MRI results per the hospital radiologist and documented within the patients' chart. Inclusion criteria required that patients be diagnosed with Johnson and Strom stage 2 or 3 flatfoot deformity with documented lateral ankle pain and that preoperative MRI scans be available with the radiologist's report. Patient exclusion criteria included patients <18 years of age, patients with flatfoot deformity caused by previous trauma, tarsal coalition, neuropathic arthritis, patients with previous surgery, or patients with incomplete medical records. In total, 118 patients were identified with these parameters. Of the 118 patients, 74 patients (62.7%) had documented lateral ankle ligament injury on MRI. Of the 77 patients with stage 2 adult-acquired flatfoot, 55 (71.4%) had confirmed lateral ankle ligament injury on MRI. Of the 41 patients with stage 3 adult-acquired flatfoot, 19 (46.3%) had confirmed lateral ankle ligament injury on MRI. This study demonstrates a relatively high incidence of lateral ligament disease associated with adult-acquired flatfoot deformity. These findings might have long-term implications regarding ankle arthritis after surgical management of adult-acquired flatfoot.


Assuntos
Deformidades Adquiridas do Pé/epidemiologia , Ligamentos Laterais do Tornozelo/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Disfunção do Tendão Tibial Posterior/cirurgia , Amplitude de Movimento Articular/fisiologia , Adulto , Idoso , Traumatismos do Tornozelo/complicações , Traumatismos do Tornozelo/diagnóstico por imagem , Estudos de Coortes , Intervalos de Confiança , Bases de Dados Factuais , Feminino , Pé Chato/diagnóstico por imagem , Pé Chato/etiologia , Pé Chato/cirurgia , Deformidades Adquiridas do Pé/etiologia , Deformidades Adquiridas do Pé/fisiopatologia , Humanos , Ligamentos Laterais do Tornozelo/fisiopatologia , Ligamentos Laterais do Tornozelo/cirurgia , Masculino , Pessoa de Meia-Idade , Procedimentos Ortopédicos/métodos , Disfunção do Tendão Tibial Posterior/complicações , Disfunção do Tendão Tibial Posterior/diagnóstico por imagem , Prevalência , Prognóstico , Recuperação de Função Fisiológica/fisiologia , Estudos Retrospectivos , Medição de Risco , Estatísticas não Paramétricas , Resultado do Tratamento
13.
Foot Ankle Clin ; 23(3): 435-449, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30097083

RESUMO

Tarsal coalitions are the result of impaired mesenchymal separation of the tarsal bones. The most common types include calcaneonavicular or talocalcaneal coalitions. Subtalar stiffness results in pathologic kinematics with increased risk of ankle sprains, planovalgus foot deformity, and progressive joint degeneration. Resection of the coalition yields good results. Tissue interposition may reduce the risk of reossification, and concomitant deformity should be addressed in the same surgical setting.


Assuntos
Coalizão Tarsal , Ossos do Pé/anormalidades , Ossos do Pé/cirurgia , Deformidades Adquiridas do Pé/diagnóstico , Deformidades Adquiridas do Pé/etiologia , Deformidades Adquiridas do Pé/fisiopatologia , Deformidades Adquiridas do Pé/terapia , Humanos , Ossos do Tarso/anormalidades , Ossos do Tarso/cirurgia , Coalizão Tarsal/diagnóstico , Coalizão Tarsal/etiologia , Coalizão Tarsal/fisiopatologia , Coalizão Tarsal/terapia
14.
Rheumatol Int ; 38(11): 2063-2068, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30135972

RESUMO

To evaluate the static and dynamic balances in psoriatic arthritis (PsA) and to investigate their relationship with clinical and functional parameters. Patients diagnosed with PsA and healthy controls were recruited consecutively into the study. The demographic variables such as age, sex, body mass index of the subjects were noted. Radiographic images were examined for the detection of foot deformities. 'Foot and Ankle Outcome Score' (FAOS) was used to assess foot function. The dynamic and static balance of the patients was evaluated by 'Berg Balance Scale' (BBS) and 'Neurocom Balance Master' device. The fatigue (Multidimensional Assessment of Fatigue: MAF), depression (Beck Depression Inventory: BDI) and sleep disorders (Pittsburgh Sleep Quality Index: PSQI) of all patients were evaluated. This study included 50 PsA patients and 50 healthy controls with mean ages of 45.02 (SD 12.81) and 45.12 (SD 10.56), respectively. Demographic data of both groups were similar. Concerning the balance tests, there were significant differences (p < 0.05) between patient and control groups about the all tests of sway velocity (except on foam surface eyes closed test), end sway of tandem walk test, movement time of bilateral step up over test and lift up index of left step up over test. There was no significant correlation between static and dynamic balance parameters with MAF, BDI, PSQI, foot deformities and FAOS. The static and dynamic balance impairments are seen in PsA. As the balance parameters had no significant correlation with functional and clinical data, they are acceptable as independent parameters during the course of the disease.


Assuntos
Artrite Psoriásica/complicações , Deformidades Adquiridas do Pé/etiologia , Pé/fisiopatologia , Equilíbrio Postural , Transtornos de Sensação/etiologia , Adulto , Artrite Psoriásica/diagnóstico , Artrite Psoriásica/fisiopatologia , Fenômenos Biomecânicos , Estudos de Casos e Controles , Progressão da Doença , Feminino , Pé/diagnóstico por imagem , Deformidades Adquiridas do Pé/diagnóstico por imagem , Deformidades Adquiridas do Pé/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Fatores de Risco , Transtornos de Sensação/diagnóstico , Transtornos de Sensação/fisiopatologia
15.
Ann Vasc Surg ; 50: 298.e1-298.e5, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29518508

RESUMO

BACKGROUND: Major pelvic ilio-iliac arteriovenous fistula (AVF) is an exceedingly rare diagnosis with only a few described cases in the literature, most of them related to congenital defects or trauma. In this case report, we aim to present a case of an ilio-iliac AVF with an atypical clinical presentation. METHODS: Relevant medical data were collected from hospital database. RESULTS: The patient is a 77-year-old woman, with a relevant medical history of a temporally remote hysterectomy. She developed an exuberant unilateral right leg edema and was diagnosed with a femoro-iliac deep vein thrombosis (DVT) and started on anticoagulation and daily use of elastic compression stockings. No improvement in leg edema was evident, and she reported painful complaints refractory to medication. She also progressively developed right foot numbness and foot drop. A computed tomography angiography (CTA) was performed to exclude any compressive or paraneoplastic syndrome, with no remarkable findings other than common iliac vein (CIV) occlusion. As the patient's symptoms continued to worsen, a new CTA was performed 5 months later, which revealed an ilio-iliac AVF that was confirmed by angiography. After 2 ineffective attempts to embolize AVF afferents, we chose to completely embolize the arterial component of the AVF with Helix EV3 coils and Onyx glue (Covidien, Irvine, CA, USA). CIV recanalization and deployment of a Venovo stent (Bard Inc, Tempe, AZ, USA) was also performed. The final angiograms showed exclusion of the AVF and rapid venous flow through the stent. There was progressive improvement of edema and pain but little improvement of foot drop. CONCLUSION: AVF etiology and mechanism of neurologic deficits are controversial, with multiple possible explanations. Endovascular treatment modalities are promising a safer and more efficient approach when compared with open surgery. Our experience in this case was encouraging, but long-term results are currently lacking.


Assuntos
Fístula Arteriovenosa/complicações , Edema/etiologia , Deformidades Adquiridas do Pé/etiologia , Transtornos Neurológicos da Marcha/etiologia , Artéria Ilíaca/anormalidades , Veia Ilíaca/anormalidades , Trombose Venosa/etiologia , Idoso , Fístula Arteriovenosa/diagnóstico por imagem , Fístula Arteriovenosa/fisiopatologia , Fístula Arteriovenosa/terapia , Angiografia por Tomografia Computadorizada , Edema/diagnóstico , Edema/fisiopatologia , Edema/terapia , Embolização Terapêutica/instrumentação , Procedimentos Endovasculares/instrumentação , Feminino , Deformidades Adquiridas do Pé/diagnóstico , Deformidades Adquiridas do Pé/fisiopatologia , Transtornos Neurológicos da Marcha/diagnóstico , Transtornos Neurológicos da Marcha/fisiopatologia , Humanos , Artéria Ilíaca/diagnóstico por imagem , Artéria Ilíaca/fisiopatologia , Veia Ilíaca/diagnóstico por imagem , Veia Ilíaca/fisiopatologia , Flebografia , Fluxo Sanguíneo Regional , Stents , Resultado do Tratamento , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/fisiopatologia , Trombose Venosa/terapia
16.
BMJ Case Rep ; 20182018 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-29386212

RESUMO

A 33-year-old male with poorly controlled chronic tophaceous gout and chronic kidney disease (CKD) with estimated glomerular filtration rate (GFR) of 37 cc/min. His uric acid was 11 mg/dL despite maximal dosing of febuxostat. He had previously failed pegloticase infusions as well. This patient had a reduction in his uric acid level to less than 6 mg/dL following addition of probenecid to his febuxostat regimen. Most guidelines recommend against utilisation of probenecid therapy in patients with GFR <50, but there is no obvious contraindication to its use, provided renal calculi do not develop. Our case illustrates the synergistic effect probenecid can add to maximal xanthine oxidase inhibitor therapy for patients with refractory hyperuricaemia in a patient with CKD stage IIIb. With the approval of a new uricosuric medication, lesinurad, probenecid may remain a suitable alternative for patients with financial limitations to achieve target uric acid levels.


Assuntos
Febuxostat/uso terapêutico , Deformidades Adquiridas do Pé/tratamento farmacológico , Supressores da Gota/uso terapêutico , Gota/tratamento farmacológico , Probenecid/uso terapêutico , Insuficiência Renal Crônica/tratamento farmacológico , Ácido Úrico/metabolismo , Adulto , Doença Crônica , Quimioterapia Combinada , Deformidades Adquiridas do Pé/diagnóstico por imagem , Deformidades Adquiridas do Pé/fisiopatologia , Gota/metabolismo , Gota/fisiopatologia , Humanos , Masculino , Insuficiência Renal Crônica/metabolismo , Insuficiência Renal Crônica/fisiopatologia , Índice de Gravidade de Doença , Resultado do Tratamento
17.
Foot Ankle Surg ; 24(3): 213-218, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29409213

RESUMO

BACKGROUND: The normal hindfoot angle is estimated between 2° and 6° of valgus in the general population. These results are solely based on clinical findings and plain radiographs. The purpose of this study is to assess the hindfoot alignment using weightbear CT. METHODS: Forty-eight patients, mean age of 39.6±13.2 years, with clinical and radiological absence of hindfoot pathology were included. A weightbear CT was obtained and allowed to measure the anatomical tibia axis (TAx) and the hindfoot alignment (HA). The HA was firstly determined using the inferior point of the calcaneus (HAIC). A density measurement of this area was subsequently performed to analyze if this point concurred with an increased ossification, indicating a higher load exposure. Secondly the HA was determined by dividing the calcaneus in the long axial view (HALA) and compared to the (HAIC) to point out any possible differences attributed to the measurement method. Reliability was assessed using an intra class correlation coefficient (ICC). RESULTS: The mean HAIC equaled 0.79° of valgus±3.2 (ICCHA IC=0.73) with a mean TAx of 2.7° varus±2.1 (ICCTA=0.76). The HALA equaled 9.1° of valgus±4.8 (ICCHA LA=0.71) and differed significantly by a P<0.001 from the HAIC, which showed a more neutral alignment. Correlation between both was shown to be good by a Spearman's correlation coefficient of 0.74. The mean density of the inferior calcaneal area equaled 271.3±84.1 and was significantly higher than the regional calcaneal area (P<0.001). CONCLUSIONS: These results show a more neutral alignment of the hindfoot in this group of non-symptomatic feet as opposed to the generally accepted constitutional valgus. This could have repercussion on hindfoot position during fusion or in quantifying the correction of a malalignment. The inferior calcaneus point in this can be used during pre-operative planning of a hindfoot correction as an anatomical landmark due to its shown influence on load transfer.


Assuntos
Deformidades Adquiridas do Pé/diagnóstico , Tomografia Computadorizada por Raios X/métodos , Suporte de Carga/fisiologia , Adulto , Idoso , Feminino , Deformidades Adquiridas do Pé/fisiopatologia , Deformidades Adquiridas do Pé/cirurgia , Humanos , Masculino , Reprodutibilidade dos Testes
18.
Foot (Edinb) ; 34: 78-82, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29414117

RESUMO

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.


Assuntos
Deformidades Adquiridas do Pé/fisiopatologia , Extremidade Inferior/fisiologia , Postura/fisiologia , Futebol/fisiologia , Articulação Talocalcânea/fisiologia , Adolescente , Fatores Etários , Criança , Estudos Transversais , Feminino , Pé/fisiologia , Humanos , Masculino , Exame Físico/métodos , Valores de Referência , Medição de Risco , Estatísticas não Paramétricas
19.
Foot Ankle Int ; 39(5): 591-597, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29366341

RESUMO

BACKGROUND: Cavovarus deformity of the hindfoot is typically caused by neurologic disorders. Multiple osteotomies have been described for the correction of varus deformity but without clinical comparison. In this study, we used 18 identical 3-dimensional (3D) prints of a patient with heel varus to compare the operative correction obtained with Dwyer, oblique, and Z osteotomies. METHODS: A computed tomography (CT) scan of a patient with heel varus was used to create 18 identical 3D prints of the talus, calcaneus, and cuboid. Coordinate frames were added to the talus and calcaneus to evaluate rotation. The prints were then divided into 3 groups of 6 models each. A custom jig precisely and accurately replicated each osteotomy. Following the simulated operations, cut models were CT scanned and compared with 6 uncut models. Measurements were calculated using multiplanar reconstruction image processing. An analysis of variance (ANOVA) was performed on the initial data to determine significant differences among the measured variables. A Tukey Studentized range test was run to compare variables that showed statistically significant differences using the ANOVA. RESULTS: The coronal angle of the Dwyer and oblique osteotomies was significantly less than that of the Z osteotomy ( P < .05). The axial angle, lateral displacement, and calcaneal shortening of the uncut model and Z osteotomy were significantly less than the Dwyer and oblique osteotomies. CONCLUSIONS: Dwyer, oblique, and Z osteotomies did not create either lateral translation or coronal rotation without the addition of a lateralizing slide or rotation of the posterior tuberosity. CLINICAL RELEVANCE: Dwyer and oblique osteotomies would be best suited for mild deformity, yet the amount of calcaneal shortening must be acknowledged. A Z osteotomy is a complex procedure that has the capability of correcting moderate-severe coronal plane rotation but fails to provide lateralization of the pull of the Achilles insertion.


Assuntos
Calcâneo/cirurgia , Deformidades Adquiridas do Pé/cirurgia , Calcanhar/fisiologia , Osteotomia/métodos , Tálus/fisiopatologia , Deformidades Adquiridas do Pé/fisiopatologia , Humanos
20.
Dis Mon ; 64(3): 64-91, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28826743

RESUMO

Ageing process is associated with changes to the aspect, biomechanics, structure and function of the foot, it may be related with a marked presence of foot conditions, pain, disability and other overall health problems that constitute a major public health concern. Also, the prevalence of epidemiologic research found an incidence of foot problems which is even higher as a consequence of increasing life expectation. Several studies have also suggested that such foot disorders currently affect between 71 and 87% of older patients and are a frequent cause of medical and foot care. Thus, these kind problems are extremely common conditions in the general population, especially in the elderly who are associated with poor quality of life, balance impairment, increase the risk of falls, dificulty on putting shoes, fractures, restrict mobility and performance of activities of daily living that turn can produce serious physical, mental and social consequences in the older people. The role of the physician in the assessment, evaluation, and examination of foot problems is very important, yet it is often an overlooked and undervalued component of geriatric health care. The purpose of this article is to review and to provide an overview of the most common foot deformities precipitating factors, clinical presentation, evidence-based diagnostic evaluation, and treatment recommendations with a view to preventing medical conditions or deformities affecting the feet that may alter foot condition and general health amongst the elderly.


Assuntos
Doenças do Pé/fisiopatologia , Dor/psicologia , Qualidade de Vida , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Calosidades/fisiopatologia , Feminino , Deformidades Adquiridas do Pé/fisiopatologia , Doenças do Pé/complicações , Doenças do Pé/psicologia , Avaliação Geriátrica , Humanos , Masculino , Osteoartrite/fisiopatologia , Dor/etiologia , Fatores de Risco
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