Foot Problems in Older Adults Presenting to a Falls and Balance Clinic.

INTRODUCTION: Foot problems, including musculoskeletal problems, peripheral neuropathy, peripheral arterial disease and dermatologic pathology are common in older adults and are associated with an increased risk of falling. Multicomponent podiatry interventions have been shown to reduce the incidence of falls. This paper aimed to identify older adults requiring podiatry input in a Falls and Balance clinic; to describe the model of foot health care they receive; to explore cross-sectional associations between foot problems and function and ultimately demonstrate the role of podiatry input in the multidisciplinary management of falls risk. METHODS: Cohort study of patients attending a Falls and Balance Clinic for Comprehensive Geriatric Assessment. Demographic information was collected and functional independence, mobility, foot problems, and footwear were assessed in the clinic. RESULTS: One-hundred and two patients were included; median age 79.3 (73-84.3) years, 68.6% female, 93.1% residing independently, 62.7% used a gait aid. Podiatry referrals were made in 80.4% of cases, with muscle weakness being the most common problem identified (90.2%); 74.8% were found to be wearing inappropriate footwear. Most patients received footwear education and half were prescribed foot and ankle strengthening exercises. Hallux and lesser toe weakness were associated with lower Short Physical Performance Battery scores (p < 0.001). CONCLUSION: The majority of older adults in the Falls and Balance Clinic required podiatry input, with foot weakness and inappropriate footwear being common reasons for referral. Those with weakness of the hallux and lesser toes had poorer balance and mobility, which is known to be associated with greater falls risk. This highlights the need for podiatry assessment and interventions as part of the multidisciplinary approach to the management of falls risk in older adults.

From second webspace syndrome to second cross over toe: Clinical and radiological findings following Weil osteotomy with no soft tissue procedure.

BACKGROUND: The second webspace syndrome (SWS) refers to the progressive divergence between 2nd and 3rd toes associated with pain at the second intermetatarsal space that can be confused with Morton's neuroma and treated as such without considering the underlying deformity. There is yet no consensus regarding the best treatment, from isolated soft tissue or bony procedures or a combination of both. The objective of this study was to describe the clinical characteristics of the disease, as well as to evaluate the radiological outcomes of patients with SWS treated with open Weil's osteotomy or distal metatarsal minimal invasive osteotomy (DMMO) of the second metatarsal, with main emphasis on medialization of the head in the anteroposterior plane in either procedure. METHODS: A retrospective study of all patients with SWS treated with Weil's medializing osteotomy (open and percutaneous) associated or not with other forefoot procedures, treated between 2012 and 2019, was performed. Radiological variables such as metatarsal-phalangeal angle (MTPA), percentage of metatarsal uncoverage of M2 with respect to its phalanx, intermetatarsal angle (M1, M2 and M3), length of second metatarsal and intermetatarsal distance M2 - M3 were measured and compared before and after surgery. RESULTS: Twenty-six patients were included, with a mean follow-up of 26 months. All patients presented divergence between the 2nd and 3rd toes, 75 % associated pain at the level of the second intermetatarsal space and two patients presented neuropathic symptoms. After surgery (nineteen open and seven DMMO), all patients rated their results as good or excellent, and the two patients with neuropathic symptoms had improvement in their symptoms. Regarding the radiological results, the percentage of subluxation of the second MTP decreased in a large percentage of the operated patients (from 43.3 % to 3.9 %) with statistical significance as well as the length of M2, IM angle between M1 - M2, IM distance between M2-M3 and the percentage of uncoverage of the second MTP (p < 0.001). CONCLUSION: Medial translation associated with open Weil osteotomy or DMMO seems to correct the muscle-ligament imbalance of the second metatarsophalangeal joint and restore normal radiographic measurements, especially in the coronal and sagittal plane, without the need for soft tissue procedures, as well as the resolution of associated neuropathic symptoms in some patients. LEVEL OF EVIDENCE: Level IV, retrospective case series.

Demographic, morphologic, hormonal and metabolic factors associated with the rate of improvement from equine hyperinsulinaemia-associated laminitis.

BACKGROUND: Although several studies have investigated factors associated with the onset and occurrence of hyperinsulinaemia-associated laminitis (HAL), few have examined the factors associated with the rate of improvement during recovery from an acute bout of the disease. This observational study sought to discover if a range of demographic, morphologic, hormonal and metabolic variables are associated with the improvement rate from HAL in 37 naturally-occurring cases identified by 16 clinics across Germany. Each case was evaluated for laminitis severity on the day of inclusion in the trial (d 0), then after 4, 9, 14, 25 and 42 d. The horses were managed according to best clinical practice including restricting exercise and prescribing a diet of hay-only, for a minimum of 9 d. Blood samples were also collected during each evaluation, except on d 9, and analysed for glucose, insulin, ACTH and leptin. RESULTS: Based on individual clinical laminitis scores plotted against time, most horses improved markedly within 2 weeks, with a 'fast group' (n = 27) having a median (interquartile range) score on a 12-point scale of 0 (0-2) by d 14. However, there was a clear disparity within the total cohort, as ~ 1 in 4 horses demonstrated much slower improvement, with a median score of 5 (4-7) by d 14, or a marked relapse thereafter ('slow group', n = 10). Horses in the slow improvement group were younger (12.5 (8.8-16.3) vs 17 (14-24) yr; P = 0.008), but were not more likely to be heavier, male, very fat, to have presented with a previous history of laminitis or elevated ACTH concentrations, or to be receiving pergolide treatment. Of the hormonal and metabolic parameters measured, glucose and insulin concentrations were within the normal range following transition to the hay-only diet, but were higher in the group that failed to improve quickly, with a small but significant difference being evident on d 4, 14 and 25 for glucose (11 to 16%; P < 0.05), and a larger difference for insulin on d 14 and 25 (51 to 55%; P < 0.05). There was no difference between the groups in ACTH or leptin concentrations throughout the study. The main limitations of this study were the small number of slow-improvement horses and an inability to control or measure certain variables, such as feed quality. CONCLUSIONS: Young age and a modest increase in blood glucose and insulin concentrations are associated with delayed laminitis improvement.

Metabolic profile distinguishes laminitis-susceptible and -resistant ponies before and after feeding a high sugar diet.

BACKGROUND: Insulin dysregulation (ID) is a key risk factor for equine endocrinopathic laminitis, but in many cases ID can only be assessed accurately using dynamic tests. The identification of other biomarkers could provide an alternative or adjunct diagnostic method, to allow early intervention before laminitis develops. The present study characterised the metabolome of ponies with varying degrees of ID using basal and postprandial plasma samples obtained during a previous study, which examined the predictive power of blood insulin levels for the development of laminitis, in ponies fed a high-sugar diet. Samples from 10 pre-laminitic (PL - subsequently developed laminitis) and 10 non-laminitic (NL - did not develop laminitis) ponies were used in a targeted metabolomic assay. Differential concentration and pathway analysis were performed using linear models and global tests. RESULTS: Significant changes in the concentration of six glycerophospholipids (adj. P ≤ 0.024) and a global enrichment of the glucose-alanine cycle (adj. P = 0.048) were found to characterise the response of PL ponies to the high-sugar diet. In contrast, the metabolites showed no significant association with the presence or absence of pituitary pars intermedia dysfunction in all ponies. CONCLUSIONS: The present results suggest that ID and laminitis risk are associated with alterations in the glycerophospholipid and glucose metabolism, which may help understand and explain some molecular processes causing or resulting from these conditions. The prognostic value of the identified biomarkers for laminitis remains to be investigated in further metabolomic trials in horses and ponies.

The effects of social environment on standing behavior and the development of claw horn lesions.

The primary aim of this prospective experimental study was to evaluate how the social environment after calving influenced standing behavior in primiparous cows. At calving, primiparous cows were mixed with familiar peers in a low-stocked pen (≤33% stocking density; n = 22) or mixed with unknown older cows at 100% stocking density (n = 20). All study cows were mixed with older cows 3 wk after calving. Time spent standing and perching (standing with only the front feet in the stall) were measured d 1 to 3 after calving using 5-min scan sampling. To evaluate if the low-stocked treatment constituted a low-stress social environment, agonistic interactions at the feed barrier were measured for 90 min following feed delivery for a subsample of cows in both treatments (12 cows/treatment). The daily behavioral time budget, including the 90 min following milking, was examined for this subset of cows. A secondary aim was to assess if the social environment after calving was related to the risk of developing claw horn lesions later in lactation. Sole and white line lesions were recorded at wk 6 and 12 after calving, and cows were categorized as either having or not having at least 1 hemorrhage of severity ≥3 (scale 1 to 5) for each lesion type and assessment. Prolonged standing after regrouping was not observed, and we found no differences in standing time and time spent perching between treatments. Agonistic behaviors directed toward the focal cows occurred less frequently in the low-stocked pen compared with the control. The number and severity of sole and white line lesions increased after calving. At wk 6 postpartum there was a numeric (but not statistically significant) difference between treatments in the proportion of primiparous cows that had white line hemorrhages of severity score ≥3 (low-stress social environment: 20% vs. control: 50%). In conclusion, under the conditions of this study the social environment did not influence standing behavior, but did affect agonistic interactions and may have influenced the risk of claw horn lesions in the weeks following calving. Further studies should evaluate the relationship between the social environment and claw health.

The equine navicular apparatus as a premier enthesis organ: Functional implications.

Navicular syndrome has been traditionally characterized by progressive lameness with chronic degeneration of the navicular bone. Advances in imaging techniques have revealed that its associated soft tissue structures are also affected. This distribution of lesions is explained by conceptualizing the equine navicular apparatus as an enthesis organ that facilitates the dissemination of mechanical stress throughout the tissues of the foot. The navicular apparatus has the same structural adaptations to mechanical stress as the human Achilles tendon complex. These adaptations efficiently dissipate mechanical force away from the tendon's bony attachment site, thereby protecting it from failure. The comparison of these two anatomically distinct structural systems demonstrates their similar adaptations to mechanical forces, and illustrates that important functional insights can be gained from studying anatomic convergences and cross-species comparisons of function. Such a functional conceptualization of the equine navicular apparatus resolves confusion about the diagnosis of navicular syndrome and offers insights for the development of mechanically based therapies. Through comparison with the human Achilles complex, this review (1) re-conceptualizes the equine navicular apparatus as an enthesis organ in which mechanical forces are distributed throughout the structures of the organ; (2) describes the relationship between failure of the navicular enthesis organ and lesions of navicular syndrome; (3) considers the therapeutic implications of navicular enthesis organ degeneration as a form of chronic osteoarthritis; and based upon these implications (4) proposes a focus on whole body posture/motion for the development of prehabilitative and rehabilitative therapies similar to those that have already proven effective in humans.

Foot health-related quality of life in hemophiliacs: A case-control study.

Background: Haemophilia is considered as a chronic genetic disease related with alteration in coagulation mechanism which affects to health related quality of life (HQoL). Purpose: The goal compared marks of HQoL, in haemophiliacs with respect non haemophilic subjects. Methods: A population of 74 subjects, were recruited from association of haemophilic illness separated in haemophilic subjects (n = 37) and no haemophilic (n = 37). For subjects who suffered haemophilia were enlisted from the association of haemophilic illness after a seminar of 45 minutes to them and to their relatives about foot health. Control subjects, were recruited from their relatives who live with the patient. The marks of the Foot Health Status Questionnaire Spanish S_FHSQ sub-scales were recompiled. Results: All S_FHSQ domains as foot pain, foot function, tootwear, general foot health, general health, physical activity and social capacity showed lower scores in the haemophilic than non-haemophilic group (P <0.01) except for vigour (P = 0.173). Regarding the rest sub-scale marks of S_FHSQ, showed no significant difference P <0.01. Conclusion: Subjects with a haemophilia showed significant worse foot QoL in all S_FHSQ domains except vigour domain compared with non-haemophilic subjects.

Outcomes and potential mechanism of a protocol to optimize foot orthoses in patients with rheumatoid arthritis.

BACKGROUND: Foot problems are highly prevalent in patients with rheumatoid arthritis. Treatment of foot problems related to rheumatoid arthritis often consists of custom made foot orthoses. One of the assumed working mechanisms of foot orthoses is redistribution of plantar pressure by creating a larger weight bearing area. Overall, the reported treatment effect of foot orthoses on foot pain in rheumatoid arthritis is small to medium. Therefore, we developed a foot orthoses optimization protocol for evaluation and adaptation of foot orthoses by using the feedback of in-shoe plantar pressure measurements. The objectives of the present study were: 1) to evaluate the 3-months outcomes of foot orthoses developed according to the protocol on pain, physical functioning and forefoot plantar pressure in patients with foot problems related to rheumatoid arthritis, and 2) to determine the relationship between change in forefoot plantar pressure and change in pain and physical functioning. METHODS: Forty-five patients with foot problems related to rheumatoid arthritis were included and received foot orthoses developed according to the protocol. Outcome measures were assessed at baseline and after three months of wearing foot orthoses in 38 patients. Change scores and effect sizes (ES) were calculated for pain, physical functioning and plantar pressure. In a subgroup of patients with combined forefoot pain and high plantar pressure, the relationship between change in plantar pressure and change in pain and physical functioning was analyzed. RESULTS: In the total group of 38 patients, statistically significant changes in pain (ES 0.69), physical functioning (ES 0.82) and forefoot plantar pressure (ES 0.35) were found. In the subgroup (n = 23) no statistically significant relationships were found between change in plantar pressure and change in pain or physical functioning. CONCLUSION: Foot orthoses developed according to a protocol for improving the plantar pressure redistribution properties lead to medium to large improvements in pain and physical functioning. The hypothesis that more pressure reduction would lead to better clinical outcomes could not be proven.

Foot Problems in Patients in Acute Care: A Point-Prevalence Survey.

PURPOSE: Determine the prevalence of foot problems in an inpatient population and to describe demographic data, comorbid conditions, and type of footwear worn. DESIGN: Observational point-prevalence cross-sectional design. SUBJECTS AND SETTING: The study setting was a 722-bed licensed hospital in Western Australia. A convenience sampling was used to include adults hospitalized in the study setting during the period of data collection. METHODS: A subset of foot questions, guided by a literature review, and input from foot, wound, diabetes, and psychometric researchers and clinicians, was incorporated into the hospital point-prevalence survey conducted annually for nursing safety and quality. Trained nurses collected data during the 1-day survey. Data were analyzed using descriptive statistics and 2-tailed tests; associations between study variables were analyzed. RESULTS: Two hundred twenty-one patients participated in the survey; a majority (n = 193, 87%) self-reported at least 1 foot problem. More than half (n = 124) reported 3 foot problems and nearly one-third (n = 67) had 5 or more foot problems. Thick nails, damaged nails, and calluses and corns were the most frequently occurring foot problems. Older participants were more likely to have certain foot problems such as calluses and thick nails. Eleven (5%) participants were admitted to the hospital for a foot-related condition. CONCLUSION: The majority of foot problems in our study were found to be minor and not the primary admitting diagnosis. However, even minor foot problems can pose a risk of worsening, especially in high-risk populations such as those with diabetes. Thus, detection is critical in overall patient assessment, and nurses play a critical role in assessment and management of minor foot problems through the delivery of skin and nail care and through collaboration with other professionals who provide specialized foot care.

Identification of modifiable factors associated with owner-reported equine laminitis in Britain using a web-based cohort study approach.

BACKGROUND: Equine laminitis is a complex disease that manifests as pain and lameness in the feet, often with debilitating consequences. There is a paucity of data that accounts for the multifactorial nature of laminitis and considers time-varying covariates that may be associated with disease development; particularly those that are modifiable and present potential interventions. A previous case-control study identified a number of novel, modifiable factors associated with laminitis which warranted further investigation and corroboration. The aim of this study was to identify factors associated with equine laminitis in horses/ponies in Great Britain (GB) using a prospective, web-based cohort study design, with particular interest in evaluating modifiable factors previously identified in the case-control study. RESULTS: Self-selected horse/pony owners in GB submitted initial baseline and follow-up health and management questionnaires for 1070 horses/ponies between August 2014 and December 2016. The enrolled horses/ponies contributed 1068 horse-years at risk with a median of 38 days between questionnaire submissions. Owners reported 123 owner-recognised and/or veterinary-diagnosed episodes of active laminitis using a previously-validated laminitis reporting form. Multivariable Cox regression modelling identified 16 risk/protective factors associated with laminitis development. In keeping with the previous case-control study, a prior history of laminitis (particularly non-veterinary-diagnosed episodes), soreness after shoeing/trimming and weight gain were associated with higher rates of laminitis. There is now strong evidence that these risk factors should be used to guide future recommendations in disease prevention. Factors with some prior evidence of association included breed, steroidal anti-inflammatory administration, transport and worming. The modifiable factors amongst these should be the focus of future laminitis studies. The remainder of the identified factors relating to health, turnout and grazing management and feeding are novel, and require further investigation to explore their relationship with laminitis and their applicability as potential interventions. CONCLUSIONS: This study has demonstrated a temporal relationship between a number of horse- and management-level factors and laminitis, identifying potential interventions and important risk groups for which these interventions would be of particular importance. These results serve as a sound evidence-base towards the development of strategic recommendations for the horse/pony-owning population to reduce the rate of laminitis in GB.

Footwear fit in schoolchildren of southern Spain: a population study.

BACKGROUND: Recent studies support the theory that ill-fitting shoes are an important source of pain and may lead to foot malformations in the medium term. Taking as reference the ideal allowance considered in the literature, the purpose of this study was to verify the outdoor footwear fit in a population of schoolchildren of southern Spain. METHODS: Five hundred and five children within the range of 3-12 years of age participated in this study. Using a measuring instrument designed and validated for this purpose, maximum foot length, width and height were obtained from the longest foot. These measurements were compared with the inner length, width and height of the footwear. An adequate toe allowance of 5-15 mm in length and 10 mm in width were estimated. RESULTS: Inner footwear length was shorter than foot length in 33.3% of the schoolchildren. Based on the allowance established, it was observed that the footwear of the schoolchildren was too short and too narrow in 72.5 and 66.7% of the cases, respectively. CONCLUSIONS: Only one third of the participants analysed had well-fitted footwear. The results show that it is necessary to raise awareness among parents and teachers about the importance of replacing, periodically, the footwear of children in primary education. Manufacturers should adapt the lasts considering the use of 90th percentiles instead of mean values obtained from the growth curves of schoolchildren's feet.

Health professional views on the assessment and management of foot problems in people with psoriatic arthritis in Australia and New Zealand: a qualitative investigation.

BACKGROUND: Active foot disease persists in a high proportion of people with psoriatic arthritis despite the availability of pharmacological and non-pharmacological interventions to modify the course of the disease. Limited information exists on the provision of health care for foot disease in psoriatic arthritis. The objective of this study was to explore the views of health professionals on the assessment and management of people with psoriatic arthritis-related foot involvement. METHODS: Convenience sampling was used to recruit health professionals working in rheumatology outpatient clinics in Sydney, Australia and Auckland, New Zealand. Three focus groups were undertaken to explore the views and experiences of health professionals on the assessment and management of foot problems in people with psoriatic arthritis. All interviews were audio-recorded and transcribed verbatim. Qualitative data was analysed using a constant comparative analytic approach to identify themes. RESULTS: A total of seventeen health professionals participated including rheumatologists, podiatrists and a physiotherapist. Key themes derived from the focus groups suggest that health professionals perceived that people with psoriatic arthritis-related foot problems experience suboptimal management from symptom onset, to diagnosis and treatment. Frustration was expressed throughout discussions relating to lack of appropriate training and expertise required for the specialised management of foot problems typically encountered with psoriatic arthritis and poor access for patients to specialist podiatry services. CONCLUSIONS: This study provides new insight into the perspectives of health professionals on the management of foot problems related to psoriatic arthritis. Deficiencies in the diagnosis, assessment and treatment of foot problems were revealed. To meet the foot health needs of people with psoriatic arthritis, reducing diagnostic delay, improving knowledge and awareness about the disease among people with psoriatic arthritis and health professionals, and increasing specialist podiatry service provision may be required.

Estimating the value of infectious or noninfectious foot disorder prevention strategies within dairy farms, as influenced by foot disorder incidence rates and prevention effectiveness.

A farm-level stochastic simulation model was adapted to estimate the value of implementing foot disorder prevention on a dairy farm by calculating the return on investment associated with implementation of foot disorder prevention. Two potential strategies for foot disorder prevention were tested: strategy 1 was prevention focused on reducing infectious foot disorders (i.e., digital dermatitis) in the model, and strategy 2 was prevention focused on reducing noninfectious foot disorders (i.e., sole ulcer and white line disease) in the model. For each strategy, we evaluated the effect of foot disorder incidence on the value of prevention by setting the incidence of foot disorders at 3 levels. For strategy 1, the level of digital dermatitis incidence without prevention in all parities was 20, 40, or 60%, and the incidence level of the noninfectious foot disorders in the model were held constant. For strategy 2, levels of sole ulcer and white line disease incidence without prevention in parity ≥3 cows were 5, 15, or 25%, and the incidence level of the infectious foot disorders included in the model were held constant; the incidence levels of noninfectious foot disorders in younger cows were adjusted to be lower. Overall, 6 scenarios were run, 1 for each prevention strategy × foot disorder incidence rate combination. To evaluate how the effectiveness of each prevention strategy would influence the investment value, the effectiveness of prevention could vary from a prevention risk ratio (RR) of 0.0 (100% reduction in disorder incidence) to 1.0 (0% reduction in disorder incidence). When implementing strategy 1, the return on prevention investment per cow-year (mean ± standard deviation) when prevention effectiveness was low (prevention RR = 0.91 to 1.0) and the digital dermatitis incidence rate was originally 20, 40, or 60% was $0.6 ± 0.4, $1.2 ± 0.9, and $1.8 ± 1.3, respectively. In comparison, the return on prevention investment per cow-year when prevention effectiveness was high (prevention RR = 0.00 to 0.09) and the digital dermatitis incidence rate was originally 20, 40, or 60% was $12.2 ± 3.0, $24.4 ± 6.0, and $36.5 ± 9.0, respectively. When implementing strategy 2, the return on prevention investment per cow-year when prevention effectiveness was low and noninfectious foot disorder incidence rates were originally 5, 15, or 25% in parity ≥3 cows was $0.6 ± 0.4, $1.9 ± 1.1, and $3.2 ± 1.9, respectively. In comparison, the return on prevention investment per cow-year when prevention effectiveness was high and noninfectious foot disorder incidence rates were originally 5, 15, or 25% in parity ≥3 cows was $12.4 ± 1.5, $37.3 ± 4.6, and $62.2 ± 7.6, respectively. The return on investment for foot disorder prevention would depend on the cost of the prevention strategy and the other benefits associated with the selected prevention strategy. This model could be used as a decision support tool to help identify the amount that could be paid to implement a selected prevention strategy.

Standing centre of pressure alters the vibration transmissibility response of the foot.

Vibration-white foot as an occupational disease has underscored the need to better understand the vibration response of the foot. While vibration transmissibility data exist for a natural standing position, it is anticipated that weight distribution will affect the response. The purpose of this study was to determine the effects of changes in centre of pressure (COP) on the foot's biomechanical response. Twenty-one participants were exposed to vertical vibration of 30 mm/s, with a sine sweep from 10-200 Hz. Z-axis (vertical) vibration was measured at 24 locations on the right foot, with the COP shifted forward or toward the heel. A mixed model analysis at each location revealed significant differences (p < .001) in the transmissibility response when the COP was altered to the forefoot and rearfoot. In general, the peak frequency of the average vibration response increased for a region of the foot when the COP was shifted toward that region. Practitioner Summary: Altering the centre of pressure location resulted in changes in the transmission of vibration through the foot. The forward lean position was associated with the greatest amplitude of vibration transmissibility at the toes. This information is relevant for clinicians studying vibration-induced white-foot and engineers designing protective equipment.

A Case of Bilateral Baxter's Neuropathy Secondary to Plantar Fasciitis.

Heel pain is 1 of the most common presentations to the foot surgeon, and its causes are multifactorial. Baxter's neuropathy is caused by an impingement of the inferior calcaneal nerve and has been reported to be responsible for up to 20% of heel pain. The diagnostic imaging features are striking, with inflammation or atrophy of the abductor digiti minimi muscle. Multiple studies have found that the prevalence of this finding is much greater than initially thought. However, it is more unusual to find bilateral and symmetrical features. The possible causes of this condition lie along the course of the inferior calcaneal nerve. Management is focused on treating the underlying condition, with conservative therapy and steroid injection as the mainstay. Refractory cases may require surgical release. We present the case of a 56-year-old female presenting with bilateral foot pain. Imaging reveals symmetrical abductor digiti minimi atrophy associated with bilateral plantar fasciitis. These appearances are well demonstrated on both magnetic resonance imaging and ultrasound.

Specific foot health-related quality-of-life impairment in patients with type II versus type I diabetes.

The aims of this research were to evaluate and compare the effect in a matched sample of patients with type II and type I diabetes scores using a specific quality-of-life (QoL) tool related to overall and foot health (Foot Health Status Questionnaire [FHSQ]). A sample of 62 patients with an age median of 59.00 ± 19.00 y were divided into type I (n = 31) and type II (n = 31) diabetes groups. Socio-demographics data include: (1) age, (2) gender, (3) body mass index, (4) professional activity, (5) study level, and (6) civil status. The FHSQ was used to evaluate foot (pain, function, footwear, and general health section I domains) and overall (general health, social capacity, physical activity, and vigour section II domains) health related to QoL. Differences between groups were assessed by means of a t test or Mann-Whitney U test for independent samples. There were no statistically significant differences (P > 0.05) for any socio-demographic data. Regarding the FHSQ section II of the specific foot health-related QoL, the only statistically significant differences (P = 0.042) were observed for the general foot health showing a QoL impairment (lower median ± interquartile range) in patients diagnosed with type II diabetes (60.00 ± 60.00 points) compared with patients who suffered from type I diabetes (25.00 ± 72.50 points). The other domains did not show any statistically significant differences (P > 0.05). Patients with type II diabetes present a negative impact on the specific foot health-related QoL compared with patients who suffered from type I diabetes.

Involvement of foot in patients with spondyloarthritis: Prevalence and clinical features.

BACKGROUND: The purpose of this study was to evaluate the foot involvement in a group of patients with spondyloarthritis in regard to symptoms, type and frequency of deformities, location and radiological changes. METHODS: We conducted a cross sectional study including 60 patients with spondyloarthritis over a period of six months. Anamnesis, clinical examination, podoscopic examination, biological tests and X-rays of feet were done for each patient. RESULTS: Foot involvement was found in 31 patients (52%). It was symptomatic in 35% of cases and inaugural in 42% of cases. The most frequent site was the hindfoot (22 patients/31). Radiological findings were: erosion (17%), reconstruction (33%), erosion and reconstruction (50%). Forefoot involvement was found in 18/31 patients. Forefoot deformities were found in 9 patients. Two patients had sausage toe and feet skin abnormalities were observed in 12 patients. At podoscopic examination, 23 patients had abnormal footprints. Foot involvement was more frequent in peripheral spondyloarthritis (p=0.008). Patients with foot involvement had an advanced age of disease onset (p=0.05), a shorter disease duration (p=0.038) and more comorbidities (p=0.039). Foot involvement was correlated with C Reactive protein (p=0.043). CONCLUSION: In our study, foot involvement and foot symptoms were seen frequently in spondyloarthritis and it is associated with late onset of the disease and with higher inflammation in blood tests.

Pathogenetic insights from quantification of the cerebriform connective tissue nevus in Proteus syndrome.

BACKGROUND: The plantar cerebriform connective tissue nevus (CCTN) is the most common and problematic cutaneous manifestation of Proteus syndrome. OBJECTIVE: To gain insights into CCTN pathogenesis and natural history. METHODS: The size and location of plantar CCTN was measured on 152 images from 22 individuals with Proteus syndrome by 2 independent, blinded reviewers. Average measures of plantar CCTN were transformed into a linear mixed model to estimate proportionate change in size with age. RESULTS: Median patient age was 6.9 years at study onset. The intraclass correlation coefficient between 2 blinded reviewers was 0.946 for CCTN single measures. The CCTN relative area increased with age in children (n = 18, P < .0001) by 5.6% per year. Confluent papules and nodules extending beyond the boundaries of CCTNs were gradually replaced by typical CCTN over time. The location of CCTN in different individuals overlapped near the ball of the foot. A positive relationship between CCTN growth rate and AKT1 mutant allele frequency was observed (0.62, P = .10, n = 8). LIMITATIONS: This was a retrospective review using photographs. CONCLUSION: CCTN growth is affected by age and extent of the CCTN precursor lesion. Monitoring of CCTN size might prove useful for evaluating drug response in the treatment of Proteus syndrome.

Chiari malformation type 1 presenting as unilateral progressive foot drop: a case report and review of literature.

BACKGROUND: Foot drop is a disabling clinical condition with multiplicity of causes, which requires detailed evaluation to identify the exact aetiology. Here, we report an extremely rare cause of foot drop in a child, which if not recognized early, could lead to multiple complications. CASE PRESENTATION: A 6-year-old girl presented with difficulty in walking and left sided foot droop for1-month duration. On examination she had reduced muscle power in dorsiflexors and plantar flexors and diminished knee and absent ankle jerk in the left side. Sensory loss was noted in L4 and L5 dermatomes on the left side. Superficial abdominal reflex was absent on the left side while preserved in the right. Nerve conduction and electromyography revealed nerve root or spinal cord cause for the foot drop. These results prompted ordering MRI spine and brain which revealed Chiari malformation type-1 with holocord syrinx extending from the cervicomedullary junction to conus medullaris. CONCLUSIONS: This case highlights the importance of considering broad differential diagnosis for foot drop and value of the complete neurological examination including superficial reflexes in arriving at a diagnosis. Prompt diagnosis helped to early neurosurgical referral and intervention which is an important prognostic factor.