Histopathology of persistent long COVID toe: A case report.

During the 2020 coronavirus (SARS-CoV-2) pandemic, several cutaneous lesions were identified, including pseudo-chilblain, vesicular, urticarial, maculopapular, and livedo/necrosis. A 59-year-old obese man with probable COVID-19 developed painful cyanosis with histopathologic capillary thrombosis of toes, and the cyanosis persisted for nearly 22 months. Shortly after initial exposure to family members with documented SARS-CoV-2, he developed upper respiratory symptoms, yet his anti-SARS-CoV-2 antibody and nasal swab RT-PCR tests were repeatedly negative. Two family members were hospitalized and one of them succumbed with documented SARS-CoV-2 pneumonia within 10 days of exposure. Biopsy specimen of the distal toe 16 weeks after initial exposure showed papillary dermal capillary thrombosis with endothelial swelling, telangiectasia, and peri-eccrine lymphocytic infiltrates resembling pernio. Overall, this is the first case of biopsy specimen of "long COVID toe" following presumed SARS-CoV-2 exposure, with a demonstration of thrombotic vasculopathy, toe cyanosis, and pernio-like pathology.

A simple test to assist with the diagnosis of common fibular nerve entrapment and predict outcomes of surgical decompression.

BACKGROUND: Common fibular (peroneal) nerve (CFN) entrapment is the most frequent nerve entrapment in the lower extremity. It can cause pain, sensory abnormalities, and reduced ability to dorsiflex the foot or a drop foot. A simple test to assist with diagnosis of CFN entrapment is described as an adjunctive clinical tool for the diagnosis of CFN entrapment and also as a predictor of successful surgical decompression of a CFN entrapment. METHODS: The test, a lidocaine injection into the peroneus longus muscle at the site of a common fibular nerve entrapment, was studied retrospectively in 21 patients who presented with a clinical suspicion of CFN entrapment. Patients ages ranged from 17 to 71 (mean 48.5). RESULTS: The lidocaine injection test (LIT) was positive in 19 patients, and of these, 17 underwent surgical decompression and subsequently experienced improved ability to dorsiflex their foot and reduced sensory abnormalities. CONCLUSION: The LIT is a simple, safe adjunctive test to help diagnose and also predict a successful outcome of surgical decompression of a CFN entrapment. The proposed mechanism of action of the LIT could lead to new, non-surgical treatments for CFN entrapment.

Two-dimensional metric comparison between dynamic bare and sock-clad footprints for its forensic implications - A pilot study.

Footprints may be present at crime scenes as physical evidence. This pilot study compares two-dimensional measurements of bare and sock-clad footprints to determine if significant differences or similarities exist. Dynamic footprints were collected from 30 males and 20 females between the ages of 20 and 61 years old (mean of 28.2 years) using the Identicator Inkless Shoe Print Model LE 25P system. A midgait protocol was employed for obtaining footprints. The fifth and sixth footprint of gait were collected for the right and left foot, respectively, in both sock-clad and barefoot trials. The footprint measurements between sock-clad and bare footprints were compared. The results did not indicate any significant difference (p > .05) between bare and sock-clad foot length measurements for right or left feet. Significant differences were seen for the width measurements between bare and sock-clad footprints. These findings have forensic implications, particularly in criminal cases where it is unclear if a footprint impression is from a sock-clad foot or a bare foot. This study shows that such a determination is generally not necessary when utilizing two-dimensional measurements for length comparison between a bare and sock-clad footprint. However, if width measurements are being evaluated, the distinction between bare and sock-clad footprints should be considered.

Forensic measurement comparison of foot insole impressions.

In forensic podiatry, footprints have been shown to provide a valuable source of discriminatory information. Footprints may be found in various forms, such as bare footprints, sock-clad footprints, or as impressions on insoles within footwear. This study utilized quantitative measures of foot impressions on pairs of insoles from shoes worn by the same person from a population of 31 adults. The measurements were determined by using the Reel method and comprised measurements from the heel to the tips of the toes and width of the ball. The purpose of the study was to assess the margin of error for these measurements to determine whether they were sufficiently accurate for forensic use. A secondary purpose of this study was to determine whether the analyst's experience or lack thereof in forensic podiatry had an impact on the precision of measurement data. The insole foot impressions were assessed by two podiatrists with forensic podiatry experience in footprint analysis, footprint research, and in using the Reel method of footprint measurement, as well as by three students of podiatric medicine without any such experience. A statistical analysis of the data from the study was performed using SPSS v28 (IBM SPSS Statistics for Windows, Version 28.0. Armonk, NY: IBM Corp). The most reliable measurements were of forefoot width, heel to first toe, heel to second toe, and heel to fourth toe. The greatest variation occurred in the measurements of the heel to the third and fifth toes. The measurements of the forensic podiatrist analysts showed less variability than those of the podiatry students, suggesting that measurement precision is related to the experience of the analyst.

Footwear-to-feet examination and analysis: Comparing worn footwear to persons and human remains.

Footwear-to-feet examination and analysis refers to the process of examining and analyzing footwear in regard to criminal matters. This examination and analysis has been done to include or exclude an individual as the wearer of the footwear in question and to help associate or disassociate human remains to footwear. This review of the subject describes its investigative applications, the research that underpins the process, and considers its legal admissibility. The process of footwear-to-feet examination and analysis is scientifically valid and has been widely accepted. As a result, law enforcement and forensic scientists should be aware of the use of this process to assist in criminal investigations.

Injection of the Abductor Hallucis Muscle in the Diagnosis and Treatment of Distal Tarsal Tunnel Syndrome.

BACKGROUND: Tarsal tunnel syndrome (TTS) can be divided into proximal TTS and distal TTS (DTTS). Research on methods to differentiate these two syndromes is sparse. A simple test and treatment is described as an adjunct to assist with diagnosing and providing treatment for DTTS. METHODS: The suggested test and treatment is an injection of lidocaine mixed with dexamethasone administered into the abductor hallucis muscle at the site of entrapment of the distal branches of the tibial nerve. This treatment was studied with a retrospective medical record review in 44 patients with clinical suspicion of DTTS. RESULTS: The lidocaine injection test and treatment (LITT) was positive in 84% of patients. Of patients available for follow-up evaluation (35), 11% of those with a positive LITT test (four) had complete lasting symptom relief. One-quarter of patients with initial complete symptom relief at LITT administration (four of 16) maintained this level of symptom relief at follow-up. Thirty-seven percent of patients evaluated at follow-up (13 of 35) who had a positive response to the LITT experienced partial or complete symptom relief. No association was found between level of symptom relief maintenance and the immediate level of symptom relief (Fisher exact test = 0.751; P = .797). The results showed no difference in the distribution of immediate symptom relief by sex (Fisher exact test = 1.048; P = .653). CONCLUSIONS: The LITT is a simple, safe, invasive method to help diagnose and treat DTTS, and it provides an additional method to assist with differentiating DTTS from proximal TTS. The study also provides additional evidence that DTTS has a myofascial etiology. The proposed mechanism of action of the LITT suggests a new paradigm in diagnosing muscle-related nerve entrapments that may lead to nonsurgical treatments or less invasive surgical interventions for DTTS.

Prevalence of Obesity in High Tarsal Tunnel Syndrome: A Cross-Sectional Study.

BACKGROUND: Tarsal tunnel syndrome (TTS) occurs when an individual suffers from tibial nerve compression at the tarsal tunnel. Symptoms of TTS may include pain, burning, or tingling on the bottom of the foot and into the toes. Tarsal tunnel syndrome can be divided into distal and proximal TTS. Furthermore, a high tarsal tunnel syndrome (HTTS) has also been described as a fascial entrapment proximal to the laciniate ligament at the level of the high ankle. Multiple risk factors, including obesity, have been said to be associated with TTS. This study aimed to determine the frequency of obesity in the form of body mass index (BMI) with HTTS. METHODS: A cross-sectional descriptive study using a nonprobability sampling method retrospectively surveyed the BMI of 73 patients whose clinical presentation suggested HTTS or TTS, and in which electrodiagnostic testing found HTTS. The age of the patients ranged from 25 to 90 years (mean, 56.4 years). Thirty-five patients were men and 38 patients were women. RESULTS: Based on BMI, nine patients with HTTS had normal weight (12.9%), 17 patients were overweight (23.3%), and the remaining 47 patients were obese (64.3%). CONCLUSIONS: The frequency of obesity in the form of BMI was 64.3% in patients with HTTS, which is a significantly high correlation.

Ghosting phenomenon in static and dynamic footprints in India and the United States.

Ghosting is the phenomenon that exists when a footprint has a lighter area around the tip of one or more toes or a shadow-like area at the back of the heel. To date, ghosting has been considered primarily a finding of dynamic (walking) footprints, rather than static (standing) footprints. The prevalence of ghosting in static footprints is unknown, and research on its presence in static and dynamic footprints from the same participant is sparse, as are studies on its occurrence in different geographic populations. This study is among the first to evaluate the occurrence of ghosting in the static and dynamic footprints from a particular individual with participants in two geographic populations. A combination of both inkless and ink footprint collection systems were used to obtain a total of 206 bare footprints from 103 adult participants from the United States and India. The data comprised 103 static and 103 dynamic footprints. Ghosting occurred significantly in static footprints, though less frequently than in dynamic footprints. Ghosting in static footprints was seen most often at the first toe, followed by the third and second respectively. This aspect appeared least at the heel. In dynamic footprints, it occurred most at the first toe, followed by the second and fourth toes, and then the third toe and the heel. The prevalence of ghosting in footprints from the United States and India differed in their locations, notably at the first and second toes in the static footprints and at the heel in the dynamic footprints.

Saphenous Nerve Denervation for Chronic Pain After Compartment Syndrome of the Foot.

Denervation has been a recommended treatment option for a range of pathologies, including relief from chronic pain; however, literature discussing complete denervation of the distal saphenous nerve for foot pain has not been found. A case report of surgical decompression for compartment syndrome resulting in chronic, debilitating foot pain that was successfully alleviated by complete saphenous nerve denervation is presented. The predominant area of the patient's pain was on the medial aspect of the foot, where a thickened scar from a decompression fasciotomy was noted. The patient's initial pain score was reported as 10 of 10, with no relief from numerous conservative treatments attempted over an 11-year period. After a diagnostic injection of a local anesthetic to the distal saphenous nerve provided the patient with immediate, temporary relief, complete denervation of the distal saphenous nerve was performed. The patient reported significant pain reduction shortly after the procedure. This case suggests that physicians should be cognizant of the saphenous nerve and its branches, as well as its variable pathways during surgery. In addition, practitioners should be aware of its influence as a progenitor of pain in the foot that may require denervation.

Reliability of a two-dimensional sock-clad footprint linear measurement method.

A two-dimensional linear measurement approach for footprints, herein referred to as the "Reel Method," has been shown to be valid and reliable when used on bare footprints, however, few measurement approaches have been examined on sock-clad footprints. The present investigation examines the validity and reliability of the Reel Method as a two-dimensional linear measurement approach for use on sock-clad footprints. A walking, mid-gait footprint was collected from 30 volunteer participants using the Identicator Inkless Shoe Print Model LE 25P system. The width of the ball of the foot, calcaneal width, and distance from the most posterior aspect of the heel to the most distal aspect of the first toe were each measured and compared between and within three raters. The statistical analysis demonstrated high reliability of the Reel Method among these three raters. The data were found to be normally distributed, and measurements were consistent between and within raters. 95% Intraclass Correlation coefficients, 95% Bland-Altman Limits of Agreement and 95% Standard Error of Measurement determined high statistical agreement between and within raters, demonstrating that the Reel Method is reliable and thus valid for the linear measurement of sock-clad footprints.

Foot manifestations in a patient with COVID-19 and Epstein-Barr virus: A case study.

SARS-CoV-2 (COVID-19) is highly-contagious. It can lead to respiratory distress-and in some cases-death. Recent reports and observations have identified an association between COVID-19 and manifestations in the feet. However, there are very few reports that describe the course of these foot manifestations in any detail. The authors present a case study chronicling the progression of foot issues in a COVID-19 positive patient who also was positive for the Epstein-Barr virus.

The contact area of static and dynamic footprints: Forensic implications.

When found at crime scenes, footprints may be evidentially valuable and can assist with the identity of a perpetrator based on their features and/or measurements. Footprints can be either static (made while standing) or dynamic (made while walking). While extensive research has been performed on the linear measurements obtained from static and dynamic footprints, research on the comparisons between the contact area of static and dynamic footprints in the forensic context are limited. The present study compares the contact area of static and dynamic bare footprints to determine if statistically significant differences exist between the two. Static and dynamic footprints were obtained from a sample of randomly-selected 461 Jatt Sikh adults (230 males and 231 females) of Indian origin between the ages of 19 and 32 years. The footprint contact area was calculated from each footprint (excluding the toes) using a PedoGRID® sheet. No statistically significant differences were observed between the contact area of static and dynamic footprints for each foot among males and females. However, statistically significant differences between both the sexes were found in the footprint contact areas of both footprint types. The right dynamic footprint contact area was found to be the most predictive measurement for classifying and estimating sex from a footprint's contact area. The study has implications in the analysis of footprints recovered from crime scenes.

Two-dimensional metric comparisons between dynamic bare footprints and insole foot impressions-forensic implications.

Footwear may be found at crime scenes as physical evidence. Such footwear often has impression features of the wearer's foot on the insole of the shoe. Scientific research and literature have established that footprints are distinct. This study compares two-dimensional measurements on bare footprints to foot impressions on insoles to determine if significant differences or similarities exist. Dynamic footprints were collected from 51 donors using theIdenticator® Inkless Shoe Print Model LE 25P system. Seven foot length and width measurements were taken based on the Reel linear measurement method. Footprint measurements between bare footprints and foot impressions on the insoles were compared. Only two differences (p > 0.05) were observed between the various bare footprint and insole foot impression measurements on the right and left side for most of the measurements, CALC (p < 0.001) and A1 (p = 0.04). Bare footprint and insole A5 measurements on the left side were also significantly different (p = 0.015). The results of the study have implications in the forensic analysis of foot impression evidence on insoles in footwear in assisting with identifying the wearer of said footwear. Situations may arise in the forensic context when comparing the foot impression on the insole of footwear to a suspect's bare footprint or a footprint from post-mortem remains. This study contributes to the scant literature available on the topic and to understanding the similarities and differences observed in the various linear measurements that may be utilized in the comparison process of footprint impressions on shoe insoles to bare footprints.

The Application of Forensic Podiatry to Clinical Practice.

The practice of the clinical podiatrist traditionally focuses on the diagnosis and treatment of conditions of the foot, ankle, and related structures of the leg. Clinical podiatrists are expected to be mindful of "the principles and applications of scientific enquiry." This includes the evaluation of treatment efficacy and the research process. In contrast, the forensic podiatrist specializes in the analysis of foot-, ankle-, and gait-related evidence in the context of the criminal justice system. Although forensic podiatry is a separate, specialized field, many aspects of this discipline can be useful in the clinical treatment and management of foot and ankle problems. The authors, who are forensic podiatrists, contend that the clinical podiatrist can gain significant insights from the field of forensic podiatry. This article aims to provide clinical podiatrists with an overview of the principles and methods that have been tested and applied by forensic podiatrists in their practice, and suggests that the clinical practice of the nonforensic foot practitioner may benefit from such knowledge.

Comparative analysis of static and dynamic bare footprint dimensions in a north Indian population.

Footprints recovered from the scene of a crime may be made while the perpetrator is standing, termed static, or walking, termed dynamic. Numerous studies on the medical and forensic aspects of static and dynamic footprints have been done and determining whether a footprint found at a crime scene is static or dynamic may have important forensic implications. Yet, little research has focused on the similarities or differences between static and dynamic footprints in the forensic context. The present study compared static and dynamic footprint two-dimensional variables to determine if statistically significant differences existed between them and if one can be estimated from the other. Footprints were taken from a sample of randomly selected 461 Jatt Sikh adults; major north Indian population. A total of 230 males and 231 females aged between 19 and 32 years were included in the study. Static and dynamic footprints were obtained from the participants using standard methodology. Seven linear footprint measurements and three footprint indices were calculated from each footprint. The dynamic footprint variables showed higher magnitudes than the static variables, and the differences were statistically significant for the length and width measurements. Furthermore, all measurements on the static and dynamic parameters exhibited statistically significant sexual dimorphism and bilateral differences. An attempt was made to estimate the static footprint dimensions from the dynamic footprint dimensions using the regression models to check the extent of differences between the two to help the investigators in estimating dimensions of one from another.

Two-dimensional linear analysis of dynamic bare footprints: A comparison of measurement techniques.

In forensic intelligence-gathering, footprints have been shown to be valued evidence found at crime scenes. Forensic podiatrists and footprint examiners use a variety of techniques for measuring footprints for comparison of the crime scene evidence with the exemplar footprints. This study examines three different techniques of obtaining two-dimensional linear measurement data of dynamic bare footprints. Dynamic bare footprints were gathered from 50 students from a podiatric medical school using the Identicator® Inkless Shoe Print Model LE 25P system. After obtaining 100 bilateral footprints from the participants, the quantitative measurement data were collected by using three different measurement techniques: (i) a manual technique using a ruler (direct technique); (ii) an Adobe® Photoshop® technique; and (iii) a GIMP (GNU Image Manipulation Program) technique. The seven Reel linear measurement methodology was used for producing measurements using these three techniques. This study showed that all the mean bare footprint measurements on the right and left feet obtained using the direct technique were larger than those obtained using GIMP and Adobe® Photoshop® images. Differences were also observed in measurements produced using GIMP software and Photoshop images. However, the differences observed in the three techniques used for bare footprint measurements were not found to be statistically significant. The study concludes that there are no significant differences between the three measurement techniques when applied to two-dimensional bare footprints using the Reel method. It further concluded that any of these measurement techniques can be used when employing the Reel methodology for footprint analysis without significant difference.

A metric study of insole foot impressions in footwear of identical twins.

Foot impressions are of utmost importance in crime scene investigations. Foot impressions are available in the form of barefoot prints, sock-clad footprints, and as impressions within footwear. Sometimes suspects leave their footwear at the crime scene, and the insole of this footwear may contain the foot impression of the suspect which may be important evidence linking him or her to the crime. The task of identification based on the analysis of footprints can be challenging when the footprints belonging to one of the identical twin is available for examination. The present study is based on the quantitative measures of the foot impressions in the footwear of adult identical twins. The study was conducted on four sets of female monozygotic twins from the United States of America. A total of 17 length and breadth measurements were taken on each foot impression. A combination of Reel Method and Extended Gunn Method was utilized to produce the measurements. The measurements of the foot impressions were compared among the twins on the right and the left side. Differences were found in the various footprint measurements among the twins. The study's sample size was not large enough to apply robust statistical tests, but the study is significant in that it presents the first detailed comparative analysis of a large number of measurements of insole foot impressions of adult twins. The observations derived from the study are likely to assist forensic investigations in cases involving the foot impressions of the twins.