A systematic review of lateral wedge orthotics--how useful are they in the management of medial compartment osteoarthritis?

Studies on the use of lateral wedge orthotics in the conservative management of medial compartment osteoarthritis are widely quoted. This approach, however, does not consider the disruption of the interaction between lower limb and foot and ankle function that lateral wedges would produce. This comprehensive, systematic review was therefore undertaken to evaluate all available literature to determine whether evidence exists to support their use. MEDLINE, EMBASE, CINAHL, Allied and Complimentary Medicine, PubMed, EBSCO HOST and PEDro, Abstracts of Reviews of Effects in the National Electronic Library for Health for Cochrane Reviews and manual searching were used to identify studies. was searched for trials in progress. Data extraction was performed by the three authors using a paper data extraction form which was based on the CONSORT statement and Critical Skills Appraisal Programme (CASP) guidelines. Overall, the results of this review suggest that, based on current evidence there are no major or long-term beneficial effects with the use of lateral wedges.

Maternal vitamin D status has no effect on the ontogeny of calcium-binding proteins in the duodenum, kidney and cerebellum of fetal mice.

The effects of vitamin D3 deficiency on the ontogeny of calcium-binding proteins (CaBPs) and the vitamin D receptor in the duodenum, kidney and cerebellum of the mouse were examined. Maternal vitamin D status did not affect the time of appearance of the fetal 28 kDa CaBP (CaBP-D28k) in the cerebellum, kidney and duodenum, and the 9 kDa CaBP (CaBP-D9k) in the intestine and kidney. Vitamin D receptor was undetectable in all fetal tissues, regardless of maternal vitamin D status, at all stages of gestation examined. Thus it appears that maternal vitamin D status does not affect the ontogeny of CaBP-D9k or CaBP-D28k in the mouse fetus. The factors that influence the appearance of calbindins in the fetus are unclear.

Trophoblastic giant cells of the mouse placenta contain calbindin-D9k but not the vitamin D receptor.

The effects of vitamin D deficiency on the ontogeny of calcium-binding proteins (CaBPs) and the vitamin D receptor (VDR) in the placenta and yolk sac of the mouse were examined. Maternal vitamin D status did not affect the time of appearance of CaBP-D9k (9 kDa) in the yolk sac endoderm or trophoblastic giant cells (TGCs) of the placenta. VDRs were undetectable in TGCs and yolk sac endoderm, but were present in the intraplacental yolk sac. Since yolk sac endoderm and TGCs contain CaBP but not VDR, it is unlikely that CaBP synthesis and/or activity in these cells is controlled by vitamin D. The TGCs, therefore, may be involved in vitamin D-independent transplacental transfer of calcium.

The role of foot and ankle assessment of patients with lower limb osteoarthritis.

OBJECTIVES: Physiotherapists do not routinely examine the feet of patients with lower limb osteoarthritis, and there is no widely used tool for measuring foot posture. However, differences in foot posture have been demonstrated between patients with medial compartment osteoarthritis of the knee and osteoarthritis of the hip, and guidelines for managing these patients include interventions such as orthotics which presume foot assessment. This study considers a new clinical tool, the Foot Posture Index (FPI). It examines its utility in a physiotherapy outpatient setting with a cohort of patients with medial compartment osteoarthritis of the knee and osteoarthritis of the hip, and investigates the relationship of FPI scores with the range of dorsiflexion of the ankle. DESIGN: Cross-sectional observational study. SETTING: A specialist orthopaedic hospital. PARTICIPANTS: In total, there were 60 participants: 20 patients with medial compartment osteoarthritis of the knee, 20 patients with osteoarthritis of the hip, and a control group of 20 age-matched healthy volunteers. OUTCOME MEASURES: A single measurement of the FPI and range of dorsiflexion. RESULTS: Significant differences in FPI scores and range of dorsiflexion were seen between groups. On average, patients with osteoarthritis of the hip had more supinated, plantarflexed feet, and patients with medial compartment osteoarthritis of the knee had pronated feet. Healthy controls fell within the normal range. Patients with osteoarthritis of the hip had a median FPI score of -4.5, patients with medial compartment osteoarthritis of the knee had a median FPI score of 7.0, and the healthy controls had a median FPI score of 1.0. The median difference in FPI scores between patients with osteoarthritis of the hip and medial compartment osteoarthritis of the knee was 12 [95% confidence interval (CI) 10 to 13]; between patients with osteoarthritis of the hip and the healthy group was 6 (95% CI 3 to 9); and between patients with medial compartment osteoarthritis of the knee and the healthy group was 5 (95% CI 3 to 8). The median difference in dorsiflexion scores between patients with osteoarthritis of the hip and medial compartment osteoarthritis of the knee was 10 degrees (95% CI 8 to 15); between patients with osteoarthritis of the hip and the healthy group was 10 degrees (95% CI 7 to 15); and between patients with medial compartment osteoarthritis of the knee and the healthy group was 0 degrees (95% CI -3 to 5). Foot posture and range of dorsiflexion were moderately positively correlated (rho 0.57), with pronated feet having a greater range of dorsiflexion. CONCLUSION: The FPI is sufficiently sensitive to measure differences in foot posture of patients with medial compartment osteoarthritis of the knee and osteoarthritis of the hip, and is easy to use. Accurate foot assessment is useful as foot postures may be influenced by specific physiotherapy treatment modalities and orthotic interventions.

A structured review of outcome measures used for the assessment of rehabilitation interventions for spinal cord injury.

OBJECTIVES: To review the measurement properties of outcome measures of function or mobility currently used in the context of spinal cord injury (SCI). METHODS: A keyword search of multiple databases to identify original papers. Papers were reviewed where they had included an evaluation, of people with SCI, of the psychometric properties of an outcome measure, which included functional or mobility domains.Information was extracted concerning item generation, ease and intended method of use and scale properties, in particular: reliability, validity and responsiveness. Conclusions were reached concerning the psychometric properties of each instrument. RESULTS: Eight outcome measures were identified (plus adapted versions). Five had originally been developed specifically for evaluating patients with SCI (chiefly reflecting clinicians' perspectives), the remaining three had not. The psychometric properties of the instruments varied, with some mixed/contradictory evidence likely relating to differing study sample sizes, characteristics and variable quality. Instruments also varied in stated purpose or emphasis. CONCLUSION: In addition to weighing evidence concerning measurement properties, users need to consider the stated purpose and item content of instruments in relation to their specific aims. With regard to the former, while reviewed instruments had some flaws, the Spinal cord Independence Measure (revised version III), Quadriplegia Index of Function (Short-form), Needs Assessment Checklist and SIP68 appeared the best, despite limited evidence of their responsiveness.

Mercury poisoning. A case report and comment on 6 other cases.

The diagnosis of mercury poisoning requires a high index of suspicion. Mercury poisoning in a patient involved in illicit gold extraction is reported and 6 other cases considered. Some of the clinical features and treatment of this condition are discussed.

Ontogeny of calbindin-D28K and calbindin-D9K in the mouse kidney, duodenum, cerebellum and placenta.

The appearance of the calcium-binding proteins (CaBP-D28K and CaBP-D9K) in embryonic mice tissues was determined using a sensitive immunohistochemical assay. CaBP-D28K first appears in myenteric nerve plexuses of the duodenum on day E15, in duodenal villus cells on day E16, in Purkinje cells of the cerebellum on day E19, in cells of the mesonephric duct on day E11 and in the metanephric duct on day E12. CaBP-D9K first appears in enterocytes of the duodenum on day E18, in trophoblastic giant cells (TGC) of the placenta on day E10, and in the metanephric duct on day E15. A differential time of appearance and colocalization of the two CaBPs is demonstrated in the embryonic mouse kidney, suggesting either that vitamin D does not control both CaBPs in the foetus or that the vitamin D control is unequal. The early appearance and location of CaBP-D9K in TGCs may suggest that these cells play an important role in transplacental transfer of calcium.

Cerebrotendinous xanthomatosis. A case report.

Cerebrotendinous xanthomatosis is a rare hereditary disease, which manifests with tendinous xanthomas, cataracts, dementia and nervous system involvement. The first southern African black patient with this disorder is reported and biochemical abnormalities and treatment are briefly discussed.