Impact of the mechanical hyperkeratotic lesions and its association with quality of life: An observational case-control study.

BACKGROUND: Mechanical hyperkeratotic lesions (MHL) are common condition amongst population of all ages. Such problems may be associated with pain, reduction in mobility, changes of gait and risk of falls and is believed to affect the quality of life (QoL), general health and optimal foot health. OBJECTIVE: The main aim of this study was to describe and compare both foot and general health-related QoL in two groups of participants: (i) with MHL and (ii) healthy controls. METHOD: A total sample of 150 patients, mean age 49.50 ± 36.50 years, was recruited from an outpatient clinic. Demographic data, medical history and clinical characteristics of overall health were determined, and the obtained values were compared by the Foot Health Status Questionnaire (FHSQ). RESULTS: The FHSQ scores of the sample with MHL showed lower scores than control subjects in sections one and two for footwear, general and foot health, foot pain, foot function and physical activity (P < 0.01), but not for social capacity and vigour (P > 0.01). CONCLUSIONS: People with MHL showed a decrease in QoL, based on FHSQ scores, regardless of gender.

Skin temperature in youth soccer players with functional equinus and non-equinus condition after running.

OBJECTIVES: To check how a thermal IR camera can check skin temperature in gastrocnemius-soleus equinus condition and non-gastrocnemius-soleus condition in youth soccer players and thus detect association between the extensibility of the triceps surae (with gastrocnemius-soleus equinus and non-gastrocnemius-soleus equinus) and the muscle temperature pattern. DESIGN: A cross-sectional study secondary level of care. METHODS: Sample from an elite soccer academy in Madrid (Spain) 35 healthy male subjects (youth soccer players) age 12.82 ± 1.07 years, height 158.68 ± 10.79 cm, weight 49.19 ± 9.45 kg, body mass index 19.41 ± 2.25. The exclusion criteria were the presence of musculoskeletal and joint injuries, pelvic pain, ankle sprains, low back pain and use of drugs in the previous week, and scoliosis. RESULTS: Temperature value for gastrocnemius muscles and Achilles tendon were assessed in 35 youth soccer players from an academia before and after training in both 12 gastrocnemius-soleus equinus and 23 non-gastrocnemius-soleus equinus soccer players conditions. State absolute for gastrocnemius soleus condition obtained a 0.34 value (0.19-0.5); we found a significant increase in temperature among these conditions for the gastrocnemius (P = 0.028) and the Achilles tendon (P = 0.007) (confidence interval 95%). The temperature of gastrocnemius-soleus equinus for gastrocnemius and Achilles tendon was increased more than non-gastrocnemius-soleus equinus in youth soccer players. CONCLUSIONS: IR imaging captured temperature is associated with muscle pattern activation for lower limb. Based on our findings, we propose that infrared thermography evaluation of the gastrocnemius and Achilles tendon is suitable to differ gastrocnemius-soleus equinus and non-gastrocnemius-soleus equinus conditions in youth soccer players.

Impact on quality of life related to foot health in a sample of menopausal women: a case-control observational study.

OBJECTIVE: To describe and compare the impact of foot health and health in general on quality of life in a sample of menopausal women and non-menopausal women with normalized reference values. METHODS: A total of 146 participants with a mean age of 50.51 ± 3.977 years came to a health center where self-reported data were registered. Participants were divided into menopausal and non-menopausal groups. Scores obtained were compared by the Foot Health Status Questionnaire (FHSQ), which assesses four foot health domains: pain, function, general health and footwear. RESULTS: The menopausal women showed a lower quality of life related to health in general and to foot health specifically. Differences between the two groups were evaluated by means of a t-test for independent samples, showing statistical significance in foot pain, general foot health and social capacity (p < 0.05). CONCLUSIONS: Menopausal women had a lower quality of life related to foot health, which appears to be associated with menopause.

Anatomic relationship of the proximal nail matrix to the extensor hallucis longus tendon insertion.

BACKGROUND: The purpose of this study was to delineate the relationship of the terminal extensor hallucis longus tendon insertion to the proximal limit of the nail matrix of the great toe. MATERIAL AND METHODS: Fifty fresh-frozen human cadaver great toes with no evidence of trauma (average age, 62.5 years; 29 males and 21 females) were used for this study. Under 25X magnification, the proximal limit of the nail matrix and the terminal bony insertion of the extensor hallucis longus tendons were identified. The distance from the terminal tendon insertion to the nail matrix was ascertained using precision calipers, an optical microscope, and autocad(®) software for windows. Twenty-five great toes were placed in a neutral formalin solution and further analysed by histological longitudinal-sections. The specimens were stained with haematoxylin and eosin and examined microscopically to determine the presence of the extensor hallucis longus tendon along the dorsal aspect of the distal phalanx of each great toe. RESULTS: The main result we found in great toes was that the extensor tendon is between the matrix and the phalanx and extends dorsally to the distal aspect of the distal phalanx in all, 100%, specimens. The nail matrix of the great toe is not attached to the periosteum of the dorsal aspect of the base of the distal phalanx as is the case for fingers, because the extensor hallucis tendon is plantar or directly underneath the nail matrix and the tendon is dorsal to the bone. CONCLUSIONS: We have found that the extensor tendon is between the matrix and the phalanx and extends dorsally to the distal aspect of the distal phalanx. The nail matrix of the great toe is not attached to the periosteum of the dorsal aspect of the base of distal phalanx as is the case in fingers, because the extensor hallucis tendon is plantar or directly underneath the nail matrix and the tendon is dorsal to the bone. Our anatomic study demonstrates that the proximal limit of the matrix and nail bed of the human great toe are dorsal and overlapping the terminal extensor hallucis longus tendon until its distal bony insertion in all specimens.

[Validity of clinical register of pressure ulcers]. / La validez de un registro clínico de úlceras por presión.

BACKGROUND: To compare pressure ulcers (PU) found in this prospective observational study with PU recorded in the Electronic Medical Record (EHR). METHOD: We use a prospective observational study to record PU, with daily monitoring by an observer in the medical-surgical units of hospitalization, as well as a clinical record review of PU tracking. Patient monitoring was conducted between December 2008 and March 2009 at Fuenlabrada University hospital. We calculated the absolute and relative frequency of PU in the patients followed, as well as the association among qualitative variables and the validity of the registration in the EHR with regard to the reference standard, the observational study. RESULTS: Among the 1,001 patients followed-up in this study, 42 of them showed PU (4.2% of the total patients), compared to 25 (2.5%) patients who had registered PU in the Electronic Health Record, which means a statistically significant difference (p<0.001). The record of PU presents a Kappa index of 0.548, with a sensitivity of 47.62 % and a specificity of 99.48 %, with regard to the reference standard, the observational study. CONCLUSION: The number of patients with pressure ulcers almost doubled if the observational data collection is done by an expert nurse compared to what was recorded in the EHR.

Mechanical stress redistribution in the calcaneus after autologous bone harvesting.

The calcaneus is a desirable site for harvesting autologous bone for use in foot surgery. However, fracture of the calcaneus is a serious complication associated with bone harvesting from this site. Currently it is unknown how much bone may be safely harvested from the calcaneus without inducing a fracture. The purpose of this study was to investigate the effect of progressive bone removal from the calcaneus onto the mechanical stress redistribution of the foot, and therefore on the increase in fracture risk. Different loads were applied on the talus to evaluate the calcaneus stress distribution at different situations. Because of the potential increase in mechanical stress in the calcaneus, secondary to contraction of the Achilles tendon, we also evaluated the mechanical behavior properties of the foot with increasing traction force in the Achilles tendon. A three-dimensional (3D) finite element (FE) model developed from CT images obtained from a healthy individual was used to compute displacement, tension and compression stresses in six situations, including intact foot, and five depth of the bone block removed, with a maximum depth of 7.5 mm. The results from these simulations indicated that when the maximum load was applied at the Achilles tendon, the tension stress increased from 42.16 MPa in the intact foot to 86.28 MPa with maximum bone harvesting. Furthermore, as the volume of bone extracted from the calcaneus increases, there is a redistribution of stresses that differs significantly from the intact foot. In fact, although the maximum stress was not significantly affected by increasing the volume of bone harvested-except when increasing the Achilles tendon force-, stresses did increase in areas of the calcaneus is vulnerable to injury, leading to an increase in fracture risk.

[Impact of implementation of reminders to reduce adverse effects in patients with peripheral venous catheterizations]. / Impacto de la implantación de recordatorios para disminuir eventos adversos en pacientes con accesos venosos periféricos.

BACKGROUND: The main purpose of this paper is to measure the clinical impact of the implementation of a reminder system that would warn of patients who are at risk of presenting an adverse event (AE) related to the peripheral venous catheter. METHOD: On the basis of the registers used for monitoring intravenous catheters, an automated consultation was realized that elaborated a list of the patients admitted, including: date of admission, date of the insertion of the venous access device, and type of device. It was implanted in January 2010 and updated three times a day with the computers of the unit. A quasi-experimental study has measured the cumulative incidence of phlebitis, extravasation and obstructions in the patients registered in 2009 and 2010. The association between qualitative variables was evaluated with the Chi-squared test, and relative risk (RR) and Number Needed to Treat (NNT) were estimated. RESULTS: Nine thousand two hundred and sixty-three patients were registered in the studied units in the year 2009, and 9,220 patients in 2010. The results were the following: Patients with phlebitis 2010/2009: RR: 0.827 (p < 0.001). Patients with extravasations 2010/2009: RR: 0.804 (p < 0.001). Patients with obstructions 2010/2009: RR: 0.954 (p < 0.554). CONCLUSION: With the help of a reminder list (which includes the patients with vascular access and the date), there has been a decrease in the number of phlebitis and extravasations but not in the number of obstructions.

Renal excretion of phenol from physicians after nail matrix phenolization: an observational prospective study.

BACKGROUND: Animal studies have shown that many signs of acute poisoning result from phenol entry into the systemic circulation by absorption or ingestion. While no evidence of systemic complications in patients who have undergone phenol nail matrixectomies have been reported, the safety of phenol vapour inhalation by physicians performing this treatment has yet to be investigated. OBJECTIVE: The goal of this study was to determine whether the levels of phenol to which physicians are exposed to during a phenol-based matrixectomy procedure are within the limits of safe exposure. METHODS: A continuous prospective study was carried out to measure the urinary phenol concentrations from physicians after performing chemical matrixectomy for ingrown toenails. RESULTS: The highest concentration of urinary phenol was measured at almost 10 mg/L within the first 2 h after exposure, and subsequently decreased approximately 1 mg/L every 2 h for the first 10 h post exposure. The levels dropped to 3 mg/L at 72 h post exposure. CONCLUSIONS: The risk associated with phenol exposure while performing chemical phenol matrixectomy was well below the current safety limits when the physician is exposed to 90% phenol vapour for approximately 20 min. Thus, no further specific safety recommendations are required for physicians performing this procedure.

Evidence of the efficacy of alcohol lavage in the phenolization treatment of ingrown toenails.

BACKGROUND: For treatment of ingrown toenails, a phenolization is often chosen. Many reports describe an intra-operative irrigation or lavage of the wound with various types of alcohol to neutralize any residual phenol from this treatment. There are conflicting reports in the literature as to whether a true neutralization is required or merely effective removal of excess phenol. OBJECTIVE: The aim of our study was to analyse the suitability and effectiveness of the alcohol lavage step during the treatment of ingrown toenails with a phenolization procedure. METHODS: We performed an in vitro study using human skin and a diffusion cell apparatus to measure the amount of phenol remaining after various lavage washes. The effect of phenol evaporation was also examined. RESULTS: There was no measurable amount of phenol collected after each experiment, suggesting that diffusion of phenol through the skin does not exist. The open compartment test had significantly less phenol recovered compared with the occluded compartment test, indicating phenol evaporation. STUDY LIMITATIONS: None. CONCLUSIONS: An alcohol lavage step after the phenolization procedure can be a suitable and effective means of diluting and removing any excess or residual phenol from the exposed area.

Total nail ablation for onychodystrophy with optimized gauze-phenol application.

BACKGROUND: Nail disorders are frequent among the geriatric population and unfortunately, repeat avulsion procedures often result in complications. OBJECTIVE: To utilize a phenol-based total matricectomy technique for permanent nail ablation and evaluate its effectiveness. METHODS: We performed total nail ablation on 34 toenails of the hallux (30 patients) with a gauze-phenol application technique and evaluated the degree of pain reported by the patient 12 months postoperatively compared with the preoperative stage. Furthermore, we evaluated the patients' satisfaction with the final cosmetic appearance as well as their satisfaction with the overall procedure. RESULTS: All patients reported 'too much' or 'severe' pain prior to surgery and 94.11% reported 'no pain' 12 months post-surgery. A vast majority of the patients (82.35%) felt pleased with the cosmetic results and all patients reported that they were 'very satisfied' or 'strongly satisfied' with the procedure when interviewed at their 12 month follow-up examination. LIMITATIONS: There were a limited number of participants in this study across an extensive timeframe. CONCLUSION: Phenol-based total nail ablation with specific gauze application is safe, inexpensive and has a high rate of patient satisfaction.