MRI assessment of regional differences in phosphorus-31 metabolism and morphological abnormalities of the foot muscles in diabetes.

PURPOSE: To assess differences in the phosphorus-31 (31 P) metabolism and morphology in multiple muscle regions in the forefoot of diabetic patients and normal subjects. MATERIALS AND METHODS: Fifteen diabetic patients and 15 normal subjects were assessed for muscle atrophy by 1 H magnetic resonance imaging (MRI) at 3T to grade the flexor hallucis, adductor hallucis, interosseous regions, and entire foot cross-section. Each region and the entire foot were also quantitatively evaluated for metabolic function using 31 P imaging for spatial mapping of the inorganic phosphate (Pi) to phosphocreatine (PCr) ratio (Pi/PCr). The ratio of viable muscle area to the predefined region areas (31 P/1 H) was calculated. The variability of each method was assessed by its coefficient of variation (CV). RESULTS: Muscle atrophy was significantly more severe in diabetic compared to normal subjects in all regions (P < 0.01). The 31 P/1 H area ratio was significantly larger in the adductor hallucis than in the other two regions (P < 0.05). The Pi/PCr ratio was significantly different between the two groups in the flexor hallucis and interosseous regions (P < 0.05) but not adductor hallucis region. The CV for Pi/PCr ranged from 10.13 to 55.84, while it ranged from 73.40 to 263.90 for qualitative grading. CONCLUSION: Changes in atrophy and metabolism appear to occur unequally between different regions of the forefoot in diabetes. The adductor hallucis region appears more capable of maintaining structural and metabolic integrity than the flexor hallucis or interosseous regions. The CV analysis suggests that the quantitative 31 P methods have less variability than the qualitative grading. J. Magn. Reson. Imaging 2016;44:1132-1142.

Forefoot mobility in ankle and foot orthoses: effect on gait of children with cerebral palsy.

BACKGROUND AND PURPOSE: Typical gait requires flexibility in the ankle and foot. During gait, it is critical that the ankle dorsiflex and the toes extend. The purpose of this report is to demonstrate that when foot orthoses block critical movement undesirable compensations that may interfere with gait can appear. CASE DESCRIPTION: Three children with spastic cerebral palsy demonstrate the effect on gait when the blocks attributable to the orthoses were removed. INTERVENTION: All children received electrical stimulation and used foot orthoses. OUTCOMES: Internal hip rotation and toe walking occurred when orthoses blocked digit extension. A block may be small and unnoticed but can still influence gait and force the child to compensate for the loss of mobility.

La electro acupuntura en el tratamiento del miembro superior espastico de pacientes con accidente cerebrovascular / Electroacupunture as treatment of spasticity of superior limbs in patients with vascular brain stroke

Se realiza un estudio prospectivo con 40 pacientes que presentaban espasticidad del miembro superior secundaria a accidente cerebral vascular, atendidos en los Hospitales C. Q. "Hermanos Ameijeiras" y de Rehabilitacion "Julio Diaz". Se aplico tratamiento de electroacupuntura tres veces por semana durante tres meses (36 sesiones). Se obtuvo resultado satisfactorio en el 70 por ciento de los pacientes, un ano despues de finalizado el tratamiento el 50 por ciento de los pacientes se mantienen con resultados satisfactorios