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1.
Clin Imaging ; 61: 90-94, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32000118

RESUMO

The spectrum of myoepithelial tumors usually occur in the salivary glands, and occasionally in the skin, breast, upper aero-digestive tract, and soft tissues. The myoepithelial tumors have no sex predominance and usually present within a wide range of age of distribution around the third and fifth decades. We describe a 12 year old male patient with primary malignant myoepithelial tumor in the foot plantar soft tissues. Including this tumor with unusual location, and age of presentation is essential in the differential diagnosis for soft tissue tumors in the pediatric population.


Assuntos
Mioepitelioma/diagnóstico por imagem , Neoplasias de Tecidos Moles/diagnóstico por imagem , Biomarcadores Tumorais , Criança , Diagnóstico Diferencial , Humanos , Masculino , Mioepitelioma/patologia , Placa Plantar/diagnóstico por imagem , Sarcoma/diagnóstico , Neoplasias de Tecidos Moles/patologia
2.
J Foot Ankle Surg ; 59(1): 112-116, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31882133

RESUMO

Turf toe is hyperextension injury of the plantar plate at the first metatarsophalangeal joint. Etiologies have often included sports/activities with excessive forefoot axial loading and/or violent pivotal movements. The purpose of the systematic review was to systematically review and present an overview for the current evidence-based treatment options of turf toe. Both authors systematically reviewed the PubMed and EMBASE databases from inception to April 2016 based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The level of evidence and quality of evidence were assessed by using the Level of Evidence for Primary Research Question of the Journal of Bone and Joint Surgery, and the quality of evidence was assessed with use of the Newcastle-Ottawa scale. Data were collected and categorized into: case reports and case series. Eight studies (16 turf toes) met the aforementioned criteria and were included. Five case reports and 3 case series reported various treatment options for turf toe. Specifically, 3 studies reported solely conservative treatment (n = 5), 1 study reported solely surgical treatment (n = 1), and 4 studies involved patients in conservative and/or surgical treatments (n = 10). All studies were of level of clinical evidence 4 and quality of clinical evidence score 2 (poor quality). Conservative treatment included closed reduction and immobilization, and surgical treatment included plantar plate tenodesis. Restricted dorsiflexion was the most common complication reported. Turf toe is an underreported injury with no evidence-based treatment guideline to date. Future studies of higher level and quality of evidence with a specific classification system (Jahss or Anderson) consistently reported are warranted for the development of an optimal guideline to determine the most appropriate treatment for each specific severity in injury.


Assuntos
Traumatismos em Atletas/terapia , Traumatismos do Pé/terapia , Placa Plantar/lesões , Traumatismos em Atletas/cirurgia , Traumatismos do Pé/cirurgia , Antepé Humano/lesões , Antepé Humano/cirurgia , Humanos , Articulação Metatarsofalângica/lesões , Articulação Metatarsofalângica/cirurgia , Placa Plantar/cirurgia , Suporte de Carga
3.
Foot Ankle Clin ; 24(4): 627-640, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31653367

RESUMO

Advancements in lesser metatarsophalangeal (MTP) instability have involved the use of minimally invasive surgery techniques, synthetic augmentation of existing transfers, and use of arthroscopy for both diagnosing and addressing MTP disorder. Advances in imaging modalities, particularly MRI, have aided in diagnosing subtle instability. Clinical outcomes seem to be similar to traditional approaches as the indications and applicability continue to evolve.


Assuntos
Instabilidade Articular/cirurgia , Articulação Metatarsofalângica/cirurgia , Artroscopia , Humanos , Instabilidade Articular/classificação , Instabilidade Articular/diagnóstico por imagem , Articulação Metatarsofalângica/diagnóstico por imagem , Procedimentos Cirúrgicos Minimamente Invasivos , Osteotomia/métodos , Placa Plantar/diagnóstico por imagem , Placa Plantar/cirurgia
4.
BMC Musculoskelet Disord ; 20(1): 239, 2019 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-31113484

RESUMO

BACKGROUND: Tendinopathies of the lower extremity (e.g. Achilles, patellar, and plantar heel pain) are common in both general and sporting populations. However, the prevalence and incidence in Danish general practice is unknown. The aim was to determine the prevalence and incidence rate of lower-extremity tendinopathies in a Danish general practice. METHODS: In this registry-based study, we extracted data from the electronic patient files of all patients in a single Danish general practice. The practice included 8836 patients. We searched ICPC-2 codes to identify patients with either of the following lower-extremity tendinopathies: plantar heel pain; Achilles tendinopathy; patellar tendinopathy; greater trochanteric pain syndrome or adductor tendinopathy. We defined an incident and prevalent case as a patient with a consultation because of tendinopathy in 2016 only. A prevalent, but not incident case was a patient with consultations in both 2015 and 2016. Incidence and prevalence were expressed as the number of patients with a tendinopathy per 1000 registered patients. RESULTS: The prevalence and incidence rate were 16.6 and 7.9 per 1000 registered patients, respectively. Plantar heel pain was the most prevalent tendinopathy and accounted for 39% of lower-extremity tendinopathies. Patients with tendinopathies were significantly older than all registered patients (46.0 years (95%CI: 43.3;48.7) versus 38.8 years (95%CI: 38.4;39.3), respectively). CONCLUSIONS: Lower-extremity tendinopathies, especially plantar heel pain, had a high prevalence and incidence rate in a Danish general practice. In a typical general practice with 5000 patients, general practitioners should expect to see more than 80 patients with a lower-extremity tendinopathy every year.


Assuntos
Dor/epidemiologia , Tendinopatia/epidemiologia , Tendão do Calcâneo , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Dinamarca/epidemiologia , Feminino , Medicina Geral/estatística & dados numéricos , Humanos , Incidência , Lactente , Recém-Nascido , Extremidade Inferior , Masculino , Pessoa de Meia-Idade , Dor/etiologia , Ligamento Patelar , Placa Plantar , Prevalência , Sistema de Registros/estatística & dados numéricos , Tendinopatia/complicações , Adulto Jovem
5.
Sensors (Basel) ; 19(9)2019 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-31052554

RESUMO

PURPOSE: The goal of the present study was to assess, by ultrasound imaging (USI), the thickness of the plantar fascia (PF) at the insertion of the calcaneus, mid and forefoot fascial locations, and the calcaneal fat pad (CFP) in patients with Achilles tendinopathy (AT). METHODS: An observational case-control study. A total sample of 143 individuals from 18 to 55 years was evaluated by USI in the study. The sample was divided into two groups: A group composed of the chronic non-insertional AT (n = 71) and B group comprised by healthy subjects (n = 72). The PF thicknesses at insertion on the calcaneus, midfoot, rearfoot and CFP were evaluated by USI. RESULTS: the CFP and PF at the calcaneus thickness showed statistically significant differences (P < 0.01) with a decrease for the tendinopathy group with respect to the control group. For the PF midfoot and forefoot thickness, no significant differences (P > 0.05) were observed between groups. CONCLUSION: The thickness of the PF at the insertion and the CPF is reduced in patients with AT measured by USI.


Assuntos
Tendão do Calcâneo/diagnóstico por imagem , Placa Plantar/diagnóstico por imagem , Tendinopatia/diagnóstico , Ultrassonografia , Tendão do Calcâneo/fisiopatologia , Adolescente , Adulto , Fáscia/diagnóstico por imagem , Fáscia/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Placa Plantar/patologia , Tendinopatia/diagnóstico por imagem , Tendinopatia/fisiopatologia , Adulto Jovem
6.
J Am Podiatr Med Assoc ; 109(1): 80-86, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30964313

RESUMO

Plantar plate repairs are challenging procedures because of the small anatomy of the plantar plate. This can make them daunting, time-consuming procedures to perform. Advances in technology, such as interference screws and small suture passers, have created improved technique possibilities to decrease difficulty, correct multiple planes of deformity, create stronger constructs, and improve patient results. The plantar plate repair technique presented in this article includes a dorsal approach with a metatarsal osteotomy, a knotless repair that provides a strong construct to allow patients to protectively bear weight immediately, and can reduce operative time by presenting tips to quickly navigate the procedure. The presented technique allows for detailed correction of all three planes of deformity, maximizing patient results.


Assuntos
Articulação Metatarsofalângica/cirurgia , Placa Plantar/cirurgia , Fios Ortopédicos , Humanos , Ossos do Metatarso/cirurgia , Osteotomia , Placa Plantar/lesões , Podiatria/métodos , Técnicas de Sutura
7.
Foot Ankle Int ; 40(6): 634-640, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30841752

RESUMO

BACKGROUND: The plantar fascia attaches to the tuberosity of the calcaneus, which produces a distinct plantar medial avulsion (PMA) fracture fragment in certain calcaneal fractures. We hypothesized that tongue-type fractures, as described by the Essex-Lopresti classification, were more likely to be associated with this PMA fracture than joint depression fractures. METHODS: A retrospective chart review was performed at 2 distinct Level I trauma centers to identify patients sustaining calcaneal fractures. Radiographs were then reviewed to determine the Essex-Lopresti classification, OTA classification, and presence of a PMA fracture. RESULTS: The review yielded 271 total patients with 121 (44.6%) tongue-type (TT), 110 (40.6%) joint depression (JD), and 40 (14.8%) fractures not classifiable by the Essex-Lopresti classification. In the TT group, 73.6% of the patients had the PMA fracture whereas only 8.2% of JD and 15.0% of nonclassifiable fractures demonstrated a PMA fragment ( P < .001). CONCLUSION: Plantar medial avulsion fractures occurred in 38.4% of the calcaneal fractures reviewed with a significantly greater proportion occurring in TT (73.6%) as opposed to JD (8.2%). Given the plantar fascia attachment to the PMA fragment, there may be clinical significance to identifying this fracture and changing treatment management; however, this requires further investigation. LEVEL OF EVIDENCE: Level III, comparative study.


Assuntos
Calcâneo/lesões , Fratura Avulsão/diagnóstico por imagem , Fraturas Ósseas/diagnóstico por imagem , Fraturas Intra-Articulares/diagnóstico , Placa Plantar/fisiopatologia , Adulto , Idoso , Calcâneo/diagnóstico por imagem , Estudos de Coortes , Feminino , Seguimentos , Fixação Interna de Fraturas/métodos , Consolidação da Fratura/fisiologia , Fratura Avulsão/cirurgia , Fraturas Ósseas/fisiopatologia , Fraturas Ósseas/cirurgia , Humanos , Fraturas Intra-Articulares/cirurgia , Masculino , Pessoa de Meia-Idade , Radiografia/métodos , Estudos Retrospectivos , Medição de Risco
8.
J Foot Ankle Surg ; 58(3): 555-561, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30902492

RESUMO

Disruption of the plantar plate is a common cause of forefoot pain, metatarsalgia, and metatarsophalangeal joint malalignment. Although surgical repair of the plantar plate has improved, there has been no consensus on the clinical superiority of any single technique, or combination of techniques, described in the literature to date. In this publication, we report a case of plantar plate injury treated with an innovative new technique with 20-month follow-up.


Assuntos
Procedimentos Ortopédicos/métodos , Placa Plantar/lesões , Placa Plantar/cirurgia , Técnicas de Sutura , Idoso , Feminino , Humanos
9.
Acta Orthop Traumatol Turc ; 53(2): 145-149, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30638781

RESUMO

OBJECTIVE: The aim of study was to analyze the association between Quadriceps Angle (QA) and plantar pressure, navicular height (NH), and calcaneo-tibial angle (CTA). METHODS: A total of 64 volunteers (mean age: 22.25 ± 2.54 (range:19-33)) participated in this cross sectional study. EMED-m (Novel GmbH, Germany) electronic pedobarograph was employed for dynamic plantar pressure measurement using two step protocol. The angle between the vertical axis of calcaneus and the long axis of Achilles tendon for CTA. The height of navicular tubercle from the ground was measured while the subject was standing on both feet for NH. QA was measured while the subject was standing in a relaxed posture where both feet bearing equal weight. RESULTS: There were significant negative correlations between QA and maximum force (MxF) under the 4th. metatarsal head (MH4). The QA was also significantly correlated with MxF and force-time integral (FTI) under the bigtoe (BT). FTI under the 3rd. metatarsal head (MH3), MH4 and 5th. metatarsal head (MH5) were significantly negatively correlated with QA. Pressure-time integral (PTI) under the MH4 and MH5 were found to be significantly negatively correlated with QA. A significant correlation was also found between QA and NH (p < 0.0001), whilst there was no correlation between QA and CTA. Regression analysis showed that NH was appeared as the major contributor for the QA (ß = -0.49, p < 0.001) in the dynamic condition, followed by BT-FTI (ß = 0.37, p < 0.001) and MH5-MxF (ß = -0.21, p < 0.037). CONCLUSION: These findings may imply that the NH which can at least be controlled by appropriate shoe inserts may affect QA. This way, loading pattern of both plantar region and whole lower extremity may be altered. LEVEL OF EVIDENCE: Level III, Diagnostic Study.


Assuntos
Tendão do Calcâneo , Placa Plantar , Pressão , Músculo Quadríceps , Ossos do Tarso , Tendão do Calcâneo/anatomia & histologia , Tendão do Calcâneo/fisiologia , Adulto , Fenômenos Biomecânicos , Estudos Transversais , Feminino , Pé/fisiologia , Voluntários Saudáveis , Humanos , Masculino , Ortopedia/métodos , Placa Plantar/anatomia & histologia , Placa Plantar/fisiologia , Postura , Músculo Quadríceps/anatomia & histologia , Músculo Quadríceps/fisiologia , Análise de Regressão , Rotação , Sapatos , Ossos do Tarso/anatomia & histologia , Ossos do Tarso/fisiologia
10.
Adv Skin Wound Care ; 32(4): 168-175, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30624254

RESUMO

OBJECTIVE: To evaluate the associated diseases, polyneuropathy correlates, and risk covariates of neuropathic plantar ulcers (PUs) and neuropathic arthropathies (NAs). DESIGN: The authors conducted a retrospective, observational study over 3.5 years of 69 patients with neuropathy, NA, or PU seen in a wound clinic who also had a comprehensive neurologic evaluation and neurophysiologic testing. Comparisons were made to a population representative cohort of patients with diabetes mellitus (DM; n = 259). RESULTS: Of the 69 wound clinic patients, 32 had PUs, 14 had NAs, and 23 had both. Of the 61 adequately assessed patients, 37 (61%) had DM, 22 (36%) had no known associated disease, and 2 (3%) had hereditary sensory and autonomic neuropathy. Of the 37 patients with DM, 35 had distal polyneuropathy, and 2 did not. In 22 patients with chronic idiopathic axonal polyneuropathy, 20 had distal polyneuropathy. CONCLUSIONS: Although DM was the disease most commonly associated with PUs and NAs, chronic hyperglycemia may not have been the major underlying risk factor. The major risk covariates are sensation loss from polyneuropathy, old age, obesity, repetitive foot injury, and inadequate foot care or treatment. Physicians and other healthcare providers can help by identifying patients at risk and instituting measures such as adequate foot care to decrease these risks.


Assuntos
Artropatia Neurogênica/epidemiologia , Úlcera do Pé/epidemiologia , Placa Plantar/fisiopatologia , Polineuropatias/epidemiologia , Cicatrização/fisiologia , Distribuição por Idade , Idoso , Artropatia Neurogênica/diagnóstico , Estudos de Coortes , Comorbidade , Progressão da Doença , Feminino , Úlcera do Pé/diagnóstico , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Polineuropatias/diagnóstico , Prognóstico , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Distribuição por Sexo
11.
J Foot Ankle Surg ; 58(2): 260-265, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30658959

RESUMO

The aim of our study was to compare gait in terms of foot loading and temporal variables after 2 different operative approaches (the extended lateral approach [ELA] and sinus tarsi approach). Twenty-two patients who sustained an intra-articular calcaneal fracture underwent plantar pressure distribution measurements 6 months after surgery. Measurements were performed while patients walked on the pedobarography platform. The values of dynamic variables were significantly lower on the operated limb in the ELA. In the sinus tarsi approach, no differences were observed between the operated and uninjured limbs (UIN) at peak pressure and at maximal vertical force. The values of temporal variables (contact time of the foot and of the heel) between the operated and UIN differed in the ELA. The hypothesis that differences in foot load between operated and UIN will be more significant in the ELA was confirmed. Our results showed that the differences in loading and temporal variables between the operated and the UIN persisted 6 months after surgery in both methods. The operated limb was less loaded, with the tendency to shift the load toward the midfoot and forefoot. After the less invasive sinus tarsi approach, the dynamic and temporal variables on the operated limb were nearly the same as those on the healthy one. The sinus tarsi surgical approach can be recommended for treatment of displaced calcaneal fractures.


Assuntos
Calcâneo/cirurgia , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/cirurgia , Marcha/fisiologia , Fraturas Intra-Articulares/cirurgia , Suporte de Carga/fisiologia , Adulto , Idoso , Fenômenos Biomecânicos , Índice de Massa Corporal , Calcâneo/lesões , Estudos de Coortes , Feminino , Seguimentos , Traumatismos do Pé/diagnóstico por imagem , Traumatismos do Pé/cirurgia , Fratura-Luxação/diagnóstico por imagem , Fratura-Luxação/cirurgia , Fraturas Ósseas/diagnóstico por imagem , Humanos , Escala de Gravidade do Ferimento , Fraturas Intra-Articulares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Placa Plantar , Pressão , Estudos Retrospectivos , Medição de Risco , Estatísticas não Paramétricas , Fatores de Tempo , Resultado do Tratamento , Caminhada/fisiologia
12.
Artigo em Inglês | MEDLINE | ID: mdl-30467272

RESUMO

Background and Aim: Treatment of palmoplantar warts is a challenge for dermatologists. We aimed to study the efficacy and safety of Falknor's needling method in palmoplantar warts. Methods: In an open, nonrandomized study, the index wart of eligible patients was punctured several times with a 26-gauge needle to produce a "beefy" red wound. Patients were followed up to 6 months. Results: Out of 82 patients, complete resolution occurred in 58 (70.7%) and partial response in 5 (6.1%) patients. Nine (10.9%) patients developed secondary infection. Limitations: Small sample size, No comparison group. Conclusion: Falknor's needling method provides a high rate of complete resolution after a single treatment session. It is easy to perform and is cost effective.


Assuntos
Imunoterapia/métodos , Agulhas , Placa Palmar/patologia , Placa Plantar/patologia , Verrugas/diagnóstico , Verrugas/terapia , Adolescente , Adulto , Feminino , Seguimentos , Humanos , Imunoterapia/instrumentação , Masculino , Pessoa de Meia-Idade , Placa Palmar/imunologia , Placa Plantar/imunologia , Estudos Prospectivos , Verrugas/imunologia , Adulto Jovem
13.
J Foot Ankle Surg ; 58(1): 27-33, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30448184

RESUMO

A dorsal drawer exam, also known as a modified Lachman's test, is a common clinical test for plantar plate insufficiency. This disorder presents as a dislocated metatarsophalangeal joint. The aim of this cadaveric case study was to quantify the degree of the plantar plate pathology necessary to correlate with a positive Lachman's test. The second metatarsophalangeal joint was tested on 18 cadaveric lower extremities. Limbs with previous digital surgery or with an obvious digital deformity were excluded from this study. A plantar linear incision over the plantar aspect of the second metatarsophalangeal joint was performed, and the flexor tendons were retracted to expose the plantar plate. After evaluating the plantar plate's integrity and measuring its width, a Lachman's test was then performed under fluoroscopy. The plantar plate was subsequently severed in a serial manner in 2-mm increments. A modified Lachman's test was performed with the different levels of rupture to assess the degree of dislocation. We found that a tear as small as 2 mm, detected in 12 (66.7%) of 18 specimens, produced gross instability in the second metatarsophalangeal joint. We also showed that a simulated plantar plate tear ≥4 mm but <6 mm resulted in joint subluxation (positive modified Lachman's test) with a sensitivity of 90.3%. This study reinforces the finding that a modified Lachman's test is a clinical exam that demonstrates high sensitivity in diagnosing plantar plate insufficiency.


Assuntos
Luxações Articulares/complicações , Placa Plantar/lesões , Ruptura/diagnóstico , Adulto , Cadáver , Humanos
14.
J Back Musculoskelet Rehabil ; 32(1): 37-42, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30056409

RESUMO

BACKGROUND: Oscillatory stimulation provides strong sensory stimulation, which can activate muscle spindles, strengthening proprioceptive sense and, therefore, helping to strengthen the muscles involved in posture stability. OBJECTIVE: This study aimed to investigate the difference in average distribution of plantar pressure resulting from changes in the forward head position (FHP) angle caused by controlling muscle activity in the neck and shoulders through Bodyblade. METHODS: The subjects were divided into an experimental group (Bodyblade, n= 15) and a control group (general physiotherapy, n= 15). Eighteen sessions of exercise were implemented. Craniovertebral angle (CVA) and cranial rotation angle (CRA) were measured to evaluate the change of FHP. The Gaitview AFA-50 (Alfoots Co, Korea) was used to measure the plantar pressure distribution. RESULTS: The experimental group showed a larger increase in CVA than the control group (p< 0.05). Only the experimental group showed a significant decrease in CRA (p< 0.05).Both the anterior pressure and posterior pressure showed a significant improvement only in the experimental group (p< 0.05). The experimental group showed a larger increase in anterior/posterior ratio than the control group (p< 0.05). CONCLUSIONS: Bodyblade improves the angle of FHP, thus positively affecting the average ratio of plantar pressure.


Assuntos
Cervicalgia/terapia , Modalidades de Fisioterapia/estatística & dados numéricos , Placa Plantar/fisiologia , Postura/fisiologia , Articulação do Ombro/fisiologia , Adolescente , Adulto , Feminino , Cabeça , Humanos , Masculino , Pescoço , Pressão , Propriocepção , Rotação , Adulto Jovem
15.
J Am Podiatr Med Assoc ; 109(4): 299-304, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29244535

RESUMO

BACKGROUND: Orthotic insole is a popular physiotherapy for flatfoot. However, the effects and whether flexible flatfoot needs orthotic insole treatment are not clear, and how the plantar pressure changes while walking up and down stairs has not been studied. Therefore, this study observed the plantar pressures of different walking conditions to find the answers. METHODS: Fifteen adults with flexible flatfoot and 15 adults with normal foot were examined while walking on a level surface and while walking up and down 10- and 20-cm stairs before treatment. The maximum force and the arch index were acquired with a force plate system. Participants with flexible flatfoot were instructed to wear the orthotic insoles for 3 months, and plantar pressures were measured again after treatment. The repeated measure was performed to analyze the data. RESULTS: The maximum force and the arch index of flatfoot after treatment were significantly decreased under different walking conditions (P < .01). When walking down 10- and 20-cm stairs, the plantar data of normal foot and flatfoot were significantly increased (P < .05). CONCLUSIONS: Orthotic insoles could effectively improve the plantar pressure of flatfoot under different walking conditions. In addition, the arches of normal foot and flatfoot were obviously influenced when walking down stairs. It is, therefore, necessary to wear orthotic insoles for flexible flatfoot to prevent further deformation.


Assuntos
Pé Chato/terapia , Órtoses do Pé , Caminhada/fisiologia , Adulto , Estudos de Casos e Controles , Pé Chato/fisiopatologia , Pé/fisiologia , Pé/fisiopatologia , Humanos , Placa Plantar/fisiologia , Pressão
16.
Foot Ankle Int ; 40(4): 457-464, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30565497

RESUMO

BACKGROUND:: Lesser toe plantar plate attenuation or disruption is being increasingly implicated in a variety of common clinical conditions. A multitude of surgical techniques and devices have been recently developed to facilitate surgical repair of the plantar plate. However, the microvascular anatomy, and therefore the healing potential in large part, has not been defined. We investigated the microvasculature of the plantar plate by employing a novel technique involving microvascular perfusion and nano-computed tomography (nano-CT) imaging. METHODS:: Twelve human adult cadaveric lower extremities were amputated distal to the knee. The anterior and posterior tibial arteries were perfused with a barium solution. The soft tissues of each foot were then counterstained with phosphomolybdic acid (PMA). The second through fourth toe metatarsophalangeal (MTP) joints of 12 feet were imaged with nano-CT at 14-micron resolution. Images were then reconstructed for analysis of the plantar plate microvasculature and calculation of the vascular density along the length of the plantar plate. RESULTS:: A microvascular network extends from the surrounding soft tissues at the attachments of the plantar plate on both the metatarsal and proximal phalanx. The midsubstance of the plantar plate appears to be relatively hypovascular. Analysis of the vascular density along the length of the plantar plate demonstrated a consistent trend with increased vascular density at approximately the proximal 29% and distal 22% of the plantar plate. CONCLUSION:: There is a vascular network extending from the surrounding soft tissues into the proximal and distal attachments of the plantar plate. CLINICAL RELEVANCE:: The hypovascular midportion of the plantar plate may play an important role in the underlying pathoanatomy and pathophysiology of this area. These findings may have significant clinical implications for the reparative potential of this region and the surgical procedures currently described to accomplish anatomic plantar plate repair.


Assuntos
Articulação Metatarsofalângica/irrigação sanguínea , Articulação Metatarsofalângica/diagnóstico por imagem , Microvasos/diagnóstico por imagem , Placa Plantar/irrigação sanguínea , Placa Plantar/diagnóstico por imagem , Adolescente , Adulto , Idoso , Cadáver , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nanotecnologia , Tomografia Computadorizada por Raios X
17.
BMC Pediatr ; 18(1): 357, 2018 11 19.
Artigo em Inglês | MEDLINE | ID: mdl-30453930

RESUMO

BACKGROUND: This study determined if the body mass index, dynamic plantar-pressures, plantar surface contact-area, velocity of the centre of pressure (COP), gastrocnemius equinus, and gastrocnemius soleus equines are related to calcaneal apophysitis (Sever's disease) in athletic children. METHODS: This case-control study examined 106 boys enrolled in a soccer academy, including 53 with Sever's disease and 53 age-matched healthy controls. The dynamic average and maximum peak plantar-pressures, plantar surface contact-area, and velocity of the COP were evaluated with a digital pressure sensor platform. Goniometry was used to measure the ankle dorsiflexion range of motion and thereby identify gastrocnemius equinus and gastrocnemius soleus equinus. RESULTS: Participants with Sever's condition had significantly higher BMI and peak plantar-pressures (maximum and average) at the heel (Cohen's d > 3 for pressures) than the controls. Those with Sever's disease also had significantly slower velocity of the COP (Cohen's d > 3). Boys with Sever's disease were also 8 times more likely to have bilateral gastrocnemius equinus than disease controls. CONCLUSIONS: High heel plantar pressure and low velocity of COP are related to Sever's condition in boys, although it is not clear whether these factors predispose individuals to the disease or are consequences of the disease. Gastrocnemius ankle equinus could be a predisposing factor for Sever's condition.


Assuntos
Atletas , Índice de Massa Corporal , Doenças do Pé/fisiopatologia , Lâmina de Crescimento , Calcanhar , Suporte de Carga/fisiologia , Adolescente , Calcâneo , Estudos de Casos e Controles , Criança , Humanos , Masculino , Músculo Esquelético/fisiologia , Músculo Esquelético/fisiopatologia , Dor/etiologia , Placa Plantar/fisiologia , Placa Plantar/fisiopatologia , Pressão , Fatores de Risco
18.
Foot Ankle Clin ; 23(4): 703-713, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30414662

RESUMO

Lesser toe plantar plate injuries at the metatarsophalangeal (MTP) joint are a common source of metatarsalgia. The second MTP joint is the most commonly affected digit. The fibrocartilaginous plantar plate is the most important static stabilizer of the MTP joint; high loading with weight bearing can lead to attritional plantar plate injuries. Chronic pain with weight bearing is the common presentation of lesser toe instability. Untreated plantar plate instability can lead to hammer toe and mallet toe deformities. Combined Weil osteotomy and plantar plate repair yields favorable pain relief and angular deformity correction for patients who fail conservative treatment.


Assuntos
Deformidades do Pé/diagnóstico , Deformidades do Pé/etiologia , Articulação Metatarsofalângica/lesões , Placa Plantar/lesões , Deformidades do Pé/cirurgia , Humanos
20.
Mol Pain ; 14: 1744806918807050, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30270727

RESUMO

Background Severe postoperative pain remains a clinical problem that impacts patient's rehabilitation. The present work aims to investigate the role of Toll-like receptor-4 (TLR4) activation in wounded plantar tissue and dorsal root ganglion (DRG) in the genesis of postoperative pain and its underlying mechanisms. Results Postoperative pain was induced by plantar incision in rat hind paw. Plantar incision led to increased expression of TLR4 in ipsilateral lumbar 4-5 (L4/L5) DRGs, which occurred at 2 h and was persistent to the third day after surgery. Similar to the change in TLR4 expression, there was also significant increase in phosphorylated nuclear factor-kappa B p65 (p-p65) in DRGs after surgery. Immunofluorescence staining revealed that the increased expressions of TLR4 and p-p65 not only in neuronal cells but also in satellite glial cells in DRG. Furthermore, the enhanced expressions of TLR4 and p-p65 were also detected in plantar tissues around the incision, which was observed starting at 2 h and lasting until the third day after surgery. Prior intrathecal (i.t.) injections of TAK-242 (a TLR4-specific antagonist) or 4',6-diamidino-2-phenylindole-dihydrochloride (PDTC, a nuclear factor-kappa B activation inhibitor) dose dependently alleviated plantar incision-induced mechanical allodynia and thermal hyperalgesia and inhibited the increased expressions of p-p65, tumor necrosis factor-alpha, and interleukin-1 beta in DRG. Prior subcutaneous (s.c.) plantar injection of TAK-242 or PDTC also ameliorated pain-related hypersensitivity following plantar incision. Moreover, the plantar s.c. injection of TAK-242 or PDTC inhibited the increased expressions of p-p65, tumor necrosis factor-alpha, and interleukin-1 beta not only in local wounded plantar tissue but also dramatically in ipsilateral lumbar 4-5 DRGs. Conclusion TLR4/ nuclear factor-kappa B signaling activation in local injured tissue and DRG contribute to the development of postoperative pain via regulating pro-inflammatory cytokines release. Targeting TLR4/ nuclear factor-kappa B signaling in local tissue at early stage of surgery may be an effective strategy for the treatment of postoperative pain.


Assuntos
Gânglios Espinais/metabolismo , NF-kappa B/metabolismo , Dor Pós-Operatória/patologia , Placa Plantar/metabolismo , Transdução de Sinais/fisiologia , Receptor 4 Toll-Like/metabolismo , Análise de Variância , Animais , Antioxidantes/farmacologia , Citocinas/metabolismo , Modelos Animais de Doenças , Relação Dose-Resposta a Droga , Ativação Enzimática/efeitos dos fármacos , Inibidores Enzimáticos/farmacologia , Proteína Glial Fibrilar Ácida/metabolismo , Lectinas/metabolismo , Masculino , Limiar da Dor/efeitos dos fármacos , Prolina/análogos & derivados , Prolina/farmacologia , Ratos , Ratos Sprague-Dawley , Transdução de Sinais/efeitos dos fármacos , Sulfonamidas/farmacologia , Tiocarbamatos/farmacologia , Receptor 4 Toll-Like/antagonistas & inibidores
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