The Effect of Customized and Silicon Insoles on Mid- and Hindfoot in Adult Flexible Pes Planovalgus.

Background: Flexible flat foot or pes planovalgus is a common foot deformity, and silicone and customized insole are commonly used as a non-operative treatment modality of flexible planovalgus. However, there are inadequate data and limited evidence available regarding the immediate effects of their use in midfoot and hindfoot of adults. The aim of this study is to quantify and compare the radiological parameters immediately on weightbearing with silicon and customized insoles and without them to assess the effect on midfoot and hindfoot of the flexible planovalgus in adults. Methods: A total number of 11 (8 females and 3 males) subjects with flexible pes planovalgus deformity without any other foot deformity were included in the study. Each patient was assessed three times in a random sequence without and with use of either silicon insoles or customized insole. The radiographic parameters without insole, with silicon insole, and with customized insole conditions were calculated using online available computer software Kinovea. Results: One-way ANOVA analysis was performed between groups (without insole, with silicone insole and with customized insole). The hindfoot parameters depicted that calcaneal inclination angle (CIA) was significant increased (P = 0.000) and talar declination angle (TDA) was significantly decreased (P = 0.003) only with the use of customized insole compared to without insole. The midfoot parameters depicted that the first metatarsal angle (FMA) and talonavicular coverage angle (TCA) were significantly lower with customized insole (P = 0.00) as compared to other two groups and significantly lower with silicone insole (P = 0.00) as compared to without insole group. Conclusion: The results imply that the compressibility of the insole material affects the forefoot and hindfoot biomechanics differently. This study concludes that silicone insole affects only the midfoot which bears 45% of bodyweight and customized insole affects both midfoot and more importantly the hindfoot which bears 55% of bodyweight.

Acquired limb deficiencies. 1. Acquired limb deficiencies in children and young adults.

UNLABELLED: This self-directed learning module highlights prosthetic treatment considerations and challenges in children and young adults. It is part of the chapter on acquired limb deficiencies in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article specifically focuses on prosthetic considerations for a child experiencing a mutilating traumatic amputation, examines the rationale for limb salvage versus surgical amputation for malignant bone tumors, discusses the unique management options available for patients undergoing hip disarticulation due to a tumor, and highlights the complications associated with amputations resulting from trauma and malignancies. OVERALL ARTICLE OBJECTIVE: To summarize prosthetic treatment considerations and challenges in children and young adults.

Acquired limb deficiencies. 2. Perioperative management.

UNLABELLED: This self-directed learning module highlights recent advances in the evaluation and management of complications arising from diabetes and peripheral vascular disease leading to amputation. It is part of the chapter on acquired limb deficiencies in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article includes discussion of comorbid conditions that may have an impact on the prosthetic rehabilitation of a transtibial amputee. It also offers essential information regarding perioperative management of an upper extremity amputee. OVERALL ARTICLE OBJECTIVE: To review recent advances in the evaluation and management of complications arising from diabetes and peripheral vascular disease leading to amputation.

Daily functioning of patients with an amputated lower extremity.

The National Center for Health statistics estimates more than 300,000 individuals with major lower extremity amputation currently are living in the United States. Current healthcare climate mandates effective rehabilitation be provided in the most effective manner. An interdisciplinary amputee team approach to rehabilitation with active participation of the patient should be implemented early in the preamputation period to facilitate short hospital stays and earlier return to productivity with associated cost savings. This paper discusses preoperative assessment and education, postoperative intervention, and indications for inpatient rehabilitation. Gait training with prosthesis in simple and complex environments, assistive devices needed for effective functioning at home, and prosthetic modification for participation in recreational activities are reviewed along with issues related to vocational rehabilitation.

Neuromuscular problems in the burn patient: cause and prevention.

Neuromuscular complications of the burn patient that occur during hospitalization frequently are overlooked. Eighty-eight patients with signs of weakness or complaints of easy fatigability were examined clinically and electrodiagnostically. The most frequently diagnosed neuromuscular abnormality in this study was generalized peripheral neuropathy. Other specific neuromuscular problems, in order of frequency of occurrence, were found to involve the deltoid muscle, peroneal nerve, ulnar nerve, median nerve, and brachial plexus. These lesions are found to be commonly due to (1) poor positioning, both in bed and in the operating room, and (2) heavy bulky dressings over superficial nerves. Thus, it is concluded that many of these injuries offer a significant potential for prevention through attention to physiologic positioning and meticulous patient care.