Functional outcome after the nonsurgical treatment for adolescent spasmodic valgus foot.

BACKGROUND: Adolescent spasmodic valgus foot is usually associated with resistant pain and deformity. It shows controversy regarding its incidence, etiology, and treatment. Our study aimed to evaluate the functional outcome after the nonsurgical treatment for such condition. METHODS: This study included 50 planovalgus feet secondary to peroneal or peroneo-extensor spasm in 33 adolescents with a mean age of 14 ± 2.8 years. The procedure included foot manipulation under general anesthesia, sinus tarsi injection with corticosteroids, and a walking cast in the neutral position. Patients were evaluated functionally (using the American Orthopedic Foot and Ankle Society (AOFAS)) and radiologically before the procedure, after cast removal, and 3, 9, and 18 months later with special attention given for recurrence during the follow-up period with a mean duration of 22.5 ± 3.5 months. RESULTS: Once general anesthesia had been conducted, the deformity was corrected without any manipulation, and full passive inversion could be easily obtained in 26 feet, the deformity was corrected only after manipulation, and full passive inversion had been obtained in 14 feet, while 10 feet remained stiff even after manipulation. The mean AOFAS score was significantly improved ( p < 0.001) from 40.9 ± 3.5 at presentation to 73.56 ± 5.2 at the last follow-up in which 12 feet was painless and freely mobile and 24 feet had partial relapse, while 14 feet had complete relapse. CONCLUSION: The nonsurgical treatment for adolescent spasmodic valgus foot could be a simple and effective treatment. Apart from limited complete recurrence, the overall functional outcome was satisfactory. Level of evidence: type IV case series.

Common Foot Problems: Over-the-Counter Treatments and Home Care.

Most foot disorders do not require podiatry referral or complex interventions. After the clinical diagnosis is made, these conditions can typically be managed with over-the-counter (OTC) and home remedies, with guidance from the primary care physician. Stretching and strengthening exercises, along with the use of heel cups, resolve most plantar fasciitis cases and are at least as effective as nonsteroidal anti-inflammatory drugs or steroid injections. Hallux rigidus is best managed with a hard-soled shoe or rigid insert that relieves pain by restricting motion across the metatarsophalangeal joint. Hallux valgus responds to use of wide toe box shoes, and surgery is not clearly beneficial beyond one year. Plantar warts can be treated effectively at home with OTC salicylic acid and cryotherapy topical agents, which have equal effectiveness to liquid nitrogen. In patients with corns and calluses, OTC topical salicylic acid has short-term benefits, and pads and inserts that more evenly redistribute contact forces have long-term benefits. Inserts are commonly recommended to redistribute forefoot pressure and relieve pain. Several OTC preparations are available for the treatment of tinea pedis, with topical allylamines being the most effective. Although OTC topical treatments have been widely used for onychomycosis, they have poor long-term cure rates compared with prescription oral medications.

Manual and manipulative therapy compared to night splint for symptomatic hallux abducto valgus: an exploratory randomised clinical trial.

CONTEXT: Hallux abducto valgus (HAV) is a frequent cause of great toe pain and disability, yet common treatments are only supported by mixed or equivocal research findings. Surgery often only provides modest improvement and post-surgery complications may significantly hamper outcomes, implying the need for trials testing conservative treatment, such as manual and manipulative therapy, particularly in cases where surgery may be contraindicated or premature. The purpose of this exploratory trial was to test an innovative protocol of manual and manipulative therapy (MMT) and compare it to standard care of a night splint(s) for symptomatic mild to moderate HAV, with a view gather insight into the effectiveness of MMT and inform the design of a definitive trial. DESIGN: Parallel-group randomised trial set in an out-patient teaching clinic. PARTICIPANTS: A convenience sample of 75 patients was assessed for eligibility, with 30 participants (15 per group) being consented and randomly allocated to either the control group (standard care with a night splint) or the experimental group (MMT). INTERVENTION: Participants in the control group used a night splint(s) and those in the experimental group (MMT) received a structured protocol of MMT, with the participants in the experimental group receiving 4 treatments over a 2-week period. OUTCOME MEASURES: Visual analogue scale (HAV-related pain), foot function index (HAV-related disability) and hallux dorsiflexion (goniometry). RESULTS: There were no participant dropouts and no data was missing. There were no statistical (p<0.05) or clinically meaningful differences (MCID<20%) between the two groups based on outcome measure scores. However, the outcome measure scores in the control group (night splint) regressed between the 1-week follow-up and 1-month follow-up, while the scores in the experimental group (MMT) were sustained up to the 1-month follow-up. The within-group data analysis produced statistically and clinically significant changes from baseline to the 1-week flow-up across all outcome measures. Post hoc power analysis and sample size calculations suggest that the average between group power of this trial was approximately 60% (ES = 0.33) and that a definitive trial would require a minimum of 102 participants per group (N = 204) to achieve satisfactory power of ≥80%. CONCLUSIONS: The trend in results of this trial suggest that an innovative structured protocol of manual and manipulative therapy (experimental group) is equivalent to standard care of a night splint(s) (control group) for symptomatic mild to moderate HAV in the short term. The protocol of MMT maintains its treatment effect from 1-week to 1-month follow-up without further treatment, while patients receiving standard care seem to regress when not using the night splint. Insights from this study support further testing of MMT for symptomatic mild to moderate HAV, particularly where surgery is premature or where surgical outcomes may be equivocal, and serve to inform the design of a future definitive trial.

Actividad de una unidad ambulatoria de cirugía ortopédia y traumatología en un hospital terciario / Activity of an orthopaedics and traumatology ambulatory surgical unit in a third level hospital

OBJETIVOS: Determinar la distribución y características de los pacientes intervenidos en una Unidad de Cirugía Mayor Ambulatoria de Cirugía Ortopédica y Traumatología en un Hospital de tercer nivel. MATERIAL Y MÉTODOS: Muestra: N= 4451 pacientes. Estudio descriptivo de todos los pacientes intervenidos desde el año 1993 hasta el 2004 a los cuales se les ha hecho un seguimiento entre seis meses y un año. RESULTADOS: El 80% (3565) de los pacientes intervenidos en nuestra unidad fueron mujeres. La media de edad fue de 58´2 años. Las patologías más frecuentes fueron: Hallux valgus 1608 (36%), Dedo en martillo 964 (22%) y SDM túnel carpiano 642 (13%). El 96% de las intervenciones se realizaron bajo anestesia local y sedación. El dolor postoperatorio fue ausente o leve en la mitad de los casos (48´73%). La tasa de complicaciones postoperatorias fue del 2´5%, predominando los problemas de cicatrización (1´12%) y la infección de herida (0´9%). La tasa de ingreso fue del 0´16%. La necesidad de atención por el Servicio de Urgencias fue de 1,9% y la satisfacción subjetiva a los 3 o 6 meses de nuestros pacientes fue de "contentos" o "muy contentos" en el 96´61% de los casos (..) (AU)

OBJETIVES: To determine the distribution and characteristics of patients undergoing ambulatory surgery in Traumatology in a third level hospital. METHODS: A descriptive study of 4451 outpatient surgical procedures, performed between January 1993 and May 2004, was undertaken, with a six months to one year follow-up. RESULTS: 80% (3565) of patients requiring surgical procedures in our Unit were women. Mean age was 58.2 years. The most frequent pathologies were: Hallux valgus 1608 (36%), hammer toe procedures 964 (22%) and Carpal Tunnel Release 642 (13%). 96% of the operations were performed under local anesthesia and sedation. Postoperative pain was non-existent or mild in half of patients (48.73%). Post-operative rate of complications was 2.5%, mainly scartissue problems (1.12%) and infection (0.9%). The unplanned hospital admission rate was 0.16%. The need for emergency care was 1.9% and subjective satisfaction after 3 or 6 months was "good" or "excellent" in 96.61% of the patients (AU)

Clinical evaluation of the effective use of magnetic fields in podology.

The use of magnetic fields in medicine has obtained encouraging results and it has stimulated the research conducted so that the use of this method of treatment may be better and more widespread. A double blind study was conducted to evaluate the effectiveness of the generation of magnetic fields on edema and on pain in patients submitted to surgery for bilateral hallux valgus.