Catapult splint: a foot dorsiflexion assist splint.

BACKGROUND: Loss of dorsiflexion is a common problem in cases where an external fixator or Ilizarov assembly is applied. It results in functional impairment of the foot by affecting the swing phase of gait cycle. We devised a simple dynamic dorsiflexion assist splint for prevention, correction of equinus/cavus deformity and maintenance of normal dorsiflexion of foot. METHODS: This prospective study used a rubber splint styled in the shape of a catapult, made of discarded car rubber tubes attached to the frame of fixator in 50 patients. RESULTS: In 17 patients there was varying amount of loss of dorsiflexion at the time of application of splint while in 22 patients it was applied soon after the application of the fixator. In the rest of patients it was applied for cavus deformity. Out of 17 patients 10 had complete recovery of dorsiflexion. 22 patients in whom it was applied at the outset had normal range of movement at ankle. Correction was achieved in all 6 cases of cavus deformity and prevented its occurrence in the rest of 5 cases. CONCLUSION: Catapult splint is a low cost foot dorsiflexion assist splint.

Vulnerability of the foot's morphological structure to deformities caused by foot loading paradigm in school-aged children: a cross-sectional study.

The study aimed to assess the association between the key predictive foot structure variables and its loading paradigm in 625 school-aged children. Clinical appraisal relied primarily on having the plantar parts of their feet comprehensively assessed with Podoscan 2D Foot CAD, and a dynamometer platform, the research tools of choice widely acknowledged for their overall accuracy and reliability, with a view to determining the distribution of respective foot loads, as well as addressing both balance and gait issues. The Clarke's angle, Wejsflog index, length and width of the feet, regardless of gender, proved the key predictive variables for the foot-loading paradigm. Notably the Clarke's angle, construed the most sensitive variable in assessing flat-footedness, offered an extra added value in overall investigative effort. The actual design of the study protocol effectively complements a standard clinical assessment procedure, whereas by comprehensively addressing those variables, it is also believed to aid clinicians in gaining an extra, hands-on, diagnostic potential, so that any teenagers exposed to the highest risk of developing foot deformities could effectively be identified through pertinent screening tests, and consequently offered a task-oriented, therapeutic management, specifically aimed at preventing potential postural complaints in later life.

Randomized trial of botulinum toxin to prevent pes cavus progression in pediatric Charcot-Marie-Tooth disease type 1A.

Pes cavus in Charcot-Marie-Tooth disease type 1A (CMT1A) is thought to be due to muscle imbalance of the lower leg. Botulinum toxin type A (BoNT-A) can modify foot deformity in other conditions of muscle imbalance. We tested the safety and effectiveness of BoNT-A on pes cavus progression in pediatric CMT1A. A 24-month, randomized, single-blind trial of BoNT-A was undertaken in 10 affected children (20 legs), aged 3-14 years. The treated leg received intramuscular BoNT-A injections at 6-month intervals in the tibialis posterior and peroneus longus. The control leg received no injections. Primary outcome was radiographic alignment at 24 months. Secondary outcomes were foot posture, ankle flexibility, and strength, assessed every 6 months. Radiographically, BoNT-A produced a small non-significant reduction in cavus progression. There was no effect of BoNT-A on secondary outcomes. There were no serious adverse events. At 24 months, the intramuscular BoNT-A injections proved safe and well-tolerated but did not affect the progression of pes cavus in CMT1A.

Recurrence and prevention of diabetic foot ulcers after total contact casting.

BACKGROUND: Total contact casting (TCC) has become established as standard treatment for Wagner grades 1 and 2 diabetic foot ulcers. However, the recurrence rate after TCC is unacceptably high, and a clear concept to prevent recurrences is still lacking. The purpose of this study was to evaluate recurrences and the effectiveness of preventive measures in a group of diabetic patients treated with TCC. METHODS: From January of 1999, to June of 2004, 28 patients (20 men and 8 women; average age 63 years) with 34 ulcers were treated using TCC. Thereafter, orthopaedic shoes were provided and patients were followed regularly. Recurrences were treated first by TCC, and operative correction was carried out in patients with an underlying foot deformity. Mean followup was 2.8 (1 to 5) years. RESULTS: Primary TCC treatment lasted 4 (1 to 17) months. Complete healing was achieved in 85% of ulcers; 57% of patients had a total of 26 recurrences, and 18 new ulcers were found in a different area or on the other foot. Sixteen recurrences were treated successfully by TCC, but the rate of new recurrences during followup was 50%. Eight recurrences were treated by operative correction of foot deformities. Most patients stayed ulcer-free thereafter. An unloading shoe was applied twice. No amputations were required. CONCLUSIONS: The first TCC showed an effective healing rate of 85%. The high recurrence rate of 57% in the presence of optimal instruction, shoes, and followup suggests that these measures are not sufficient. However, because patients who had operative corrections stayed ulcer-free thereafter, it is suggested that foot deformities should be operatively corrected immediately after primary healing rather than waiting until further recurrences occur.