Transfer of plantar pressure from the medial to the central forefoot in patients with hallux valgus.

BACKGROUND: The aim of the study was to evaluate changes in plantar pressure distribution in feet affected by hallux valgus compared with their contralateral non-affected feet and with the feet of healthy control subjects. METHODS: Thirty-six patients with unilateral hallux valgus who were indicated for surgery and 30 healthy subjects were assessed on a pedobarographic instrumented treadmill for step length and width, mean stance phase, and plantar foot pressure distribution. Plantar pressure distribution was divided into eight regions. RESULTS: Significantly higher plantar pressures were observed in hallux valgus feet under the second and third metatarsal heads (p = .033) and the fourth and fifth toes (p < .001) than in the healthy control feet. Although decreased pressures were measured under the hallux in affected feet (197 [82-467] kPa) in contrast to the contralateral side (221 [89-514] kPa), this difference failed to reach statistical significance (p = .055). The gait parameters step width, step length, and single-limb support did not show any differences between hallux valgus and control feet. CONCLUSION: Although the literature on changes in plantar pressures in hallux valgus remains divided, our findings on transferring load from the painful medial to the central and lateral forefoot region are consistent with the development of transfer metatarsalgia in patients with hallux valgus.

Typical Imaging Patterns in COVID-19 Infections of the Lung on Plain Chest Radiographs to Aid Early Triage.

PURPOSE: To evaluate imaging patterns of a COVID-19 infection of the lungs on chest radiographs and their value in discriminating this infection from other viral pneumonias. MATERIALS AND METHODS: All 321 patients who presented with respiratory impairment suspicious for COVID-19 infection between February 3 and May 8, 2020 and who received a chest radiograph were included in this analysis. Imaging findings were classified as typical for COVID-19 (bilateral, peripheral opacifications/consolidations), non-typical (findings consistent with lobar pneumonia), indeterminate (all other distribution patterns of opacifications/consolidations), or none (no opacifications/consolidations). The sensitivity, specificity, as well as positive and negative predictive value for the diagnostic value of the category "typical" were determined. Chi² test was used to compare the pattern distribution between the different types of pneumonia. RESULTS: Imaging patterns defined as typical for COVID-19 infections were documented in 35/111 (31.5 %) patients with confirmed COVID-19 infection but only in 4/210 (2 %) patients with any other kind of pneumonia, resulting in a sensitivity of 31.5 %, a specificity of 98.1 %, and a positive and negative predictive value of 89.7 % or 73 %, respectively. The sensitivity could be increased to 45.9 % when defining also unilateral, peripheral opacifications/consolidations with no relevant pathology contralaterally as consistent with a COVID-19 infection, while the specificity decreases slightly to 93.3 %. The pattern distribution between COVID-19 patients and those with other types of pneumonia differed significantly (p < 0.0001). CONCLUSION: Although the moderate sensitivity does not allow the meaningful use of chest radiographs as part of primary screening, the specific pattern of findings in a relevant proportion of those affected should be communicated quickly as additional information and trigger appropriate protective measures. KEY POINTS: · COVID-19 infections show specific X-ray image patterns in 1/3 of patients.. · Bilateral, peripheral opacities and/or consolidations are typical imaging patterns.. · Unilateral, peripheral opacities and/or consolidations should also raise suspicion of COVID-19 infection.. CITATION FORMAT: · Kasper J, Decker J, Wiesenreiter K et al. Typical Imaging Patterns in COVID-19 Infections of the Lung on Plain Chest Radiographs to Aid Early Triage. Fortschr Röntgenstr 2021; 193: 1189 - 1196.