RESUMEN
BACKGROUND: Flexion deformity of the knee is a common presentation in children with cerebral palsy with hamstring surgery as an option for addressing this. However, concerns with regard to increased pelvic tilt have been raised. The purpose of this study was to compare preoperative and postoperative pelvic tilt after isolated hamstring lengthening versus combined hamstring lengthening and the influence of Gross Motor Function Classification System (GMFCS) levels on pelvic tilt. METHODS: This retrospective study included 46 ambulatory children with cerebral palsy who had had open medial hamstring lengthening (mean age at surgery, 11 y 11 mo; SD, 2 y 11 mo; GMFCS I, 16; GMFCS II 20; GMFCS III 10). Twelve children underwent isolated surgery and 34 children underwent combined surgery. The isolated hamstring procedures could be combined with foot and/or ankle-level surgery, as only the hamstring procedure would affect the pelvic tilt. Combined surgery was defined as hamstring lengthening with other procedures performed at the knee or more proximally. The preoperative and postoperative 3-dimensional gait analysis data were evaluated in this study. RESULTS: Both the isolated and combined hamstring lengthening groups showed no significant change in pelvic tilt ([INCREMENT]1.28, P=0.203; [INCREMENT]1.47, P=0.113, respectively). A significant change in pelvic tilt was seen in children functioning at GMFCS III ([INCREMENT]4.66, P=0.009) but not GMFCS I and II ([INCREMENT]0.37, P=0.718; [INCREMENT]0.48, P=0.697). Significant postoperative decreases in the knee flexion angle at initial contact were seen for both isolated ([INCREMENT]5.72, P=0.010) and combined hamstring lengthening ([INCREMENT]10.95, P<0.001). CONCLUSIONS: Hamstring lengthening, for the majority of patients, did not lead to a clinically significant change in mean pelvic tilt and improved knee flexion angle at initial contact. Children who functioned at GMFCS level III had an increase in anterior pelvic tilt and caution should be exercised in this group. STUDY DESIGN: Level IV evidence-case series.
Asunto(s)
Parálisis Cerebral , Músculos Isquiosurales , Manipulación Ortopédica , Pelvis/fisiopatología , Adolescente , Parálisis Cerebral/complicaciones , Parálisis Cerebral/fisiopatología , Niño , Preescolar , Femenino , Deformidades Adquiridas del Pie/etiología , Deformidades Adquiridas del Pie/prevención & control , Marcha , Trastornos Neurológicos de la Marcha/fisiopatología , Trastornos Neurológicos de la Marcha/terapia , Músculos Isquiosurales/cirugía , Humanos , Articulación de la Rodilla/fisiopatología , Masculino , Manipulación Ortopédica/efectos adversos , Manipulación Ortopédica/métodos , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
BACKGROUND: Fixed knee flexion deformity is common in children with neuromuscular disorders. Anterior guided growth (AGG) of the distal femur can achieve gradual correction in patients who are skeletally immature. Little outcome data are available on this procedure. METHODS: This is a retrospective matched cohort study. Forty-two knees (26 patients) underwent AGG surgery at our institution between 2007 and 2017. All patients underwent instrumented 3-dimensional gait analysis (3DGA). A nonsurgical control group of 49 knees (43 patients) was selected that matched for age, severity of preoperative knee contracture, and 3DGA parameters. Clinical, radiographic, and 3DGA outcomes were assessed and compared. RESULTS: Average preoperative knee flexion deformity in AGG group was 13±8 degrees. Following AGG, deformity improved by 8±7 degrees (P<0.001) as measured radiographically and by 7±7 degrees (P<0.001) as measured on physical examination. Average rate of correction was 0.7±0.6 degrees per month or 8±8 degrees per year. The 3DGA parameters such as minimum stance phase knee flexion and knee flexion at initial contact were also significantly improved following AGG. In contrast, flexion deformity as measured radiographically worsened by 3±3 degrees (P=0.002) in the control group. Twelve knees (29%) had failure of correction. Predictors of failure included older age, lower level of function, and greater severity of preoperative deformity. The age at time of surgery and the anteroposterior position of plate fixation relative to the distal femoral physis were associated with rate of correction. CONCLUSIONS: In children with neuromuscular disorders, AGG of the distal femur is effective in improving degree of fixed knee flexion deformity as well as objective gait parameters. A significant portion of knees experience inadequate correction. Addressing factors associated with correction failure (ie, age and plate placement) may improve the procedure's success. LEVEL OF EVIDENCE: Level III-case control study.
Asunto(s)
Contractura , Fémur/diagnóstico por imagen , Deformidades Adquiridas del Pie , Articulación de la Rodilla , Osteogénesis por Distracción/métodos , Adolescente , Factores de Edad , Placas Óseas , Estudios de Casos y Controles , Niño , Estudios de Cohortes , Contractura/etiología , Contractura/prevención & control , Femenino , Deformidades Adquiridas del Pie/etiología , Deformidades Adquiridas del Pie/prevención & control , Deformidades Adquiridas del Pie/cirugía , Marcha , Humanos , Articulación de la Rodilla/diagnóstico por imagen , Articulación de la Rodilla/fisiopatología , Masculino , Enfermedades Neuromusculares/complicaciones , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
A paucity of published data is available describing the methods for the integration of 3-dimensional (3D) printing technology and surgical simulation into orthopedic surgery. The cost of this technology has decreased and the ease of use has increased, making routine use of 3D printed models and surgical simulation for difficult orthopedic problems a realistic option. We report the use of 3D printed models and surgical simulation for preoperative planning and patient education in the case of deformity correction in foot and ankle surgery using open source, free software.
Asunto(s)
Fracturas de Tobillo/cirugía , Simulación por Computador , Deformidades Adquiridas de la Articulación/prevención & control , Impresión Tridimensional , Cirugía Asistida por Computador/métodos , Accidentes de Tránsito , Fracturas de Tobillo/diagnóstico por imagen , Deformidades Adquiridas del Pie/prevención & control , Humanos , Puntaje de Gravedad del Traumatismo , Masculino , Persona de Mediana Edad , Traumatismo Múltiple/diagnóstico por imagen , Traumatismo Múltiple/cirugía , Cuidados Preoperatorios/métodos , Recuperación de la Función , Medición de Riesgo , Resultado del TratamientoRESUMEN
OBJECTIVE: The objective of the present study was (1) to identify predictors of both nonunion and postoperative wound infections (POWI) and (2) to assess the union and complication rate following posttraumatic subtalar arthrodesis (STA). DESIGN: Retrospective comparative cohort study. SETTING: Level 1 trauma center. PATIENTS: All consecutive adult patients with STA following traumatic injuries between 2000 and May 2015. INTERVENTION: STA for posttraumatic deformities. MAIN OUTCOME MEASUREMENTS: Union (described as a combination of radiographic signs of osseous bridging and a clinically fused joint) and POWI as classified by the Centers for Disease and Control. RESULTS: A total number of 93 (96 feet) patients met the inclusion criteria. Union was achieved in 89% of patients. For primary, secondary in situ, and secondary correction arthrodesis, these percentages were 94%, 84,% and 90%, respectively (NS). The union rate significantly increased over time (P = 0.02). In 17 patients (18%), a POWI occurred, of which 2 were classified as superficial and 15 as deep POWIs. The POWI rate did not differ between the groups. Alcohol, nicotine, and drug abuse were not significantly associated with the occurrence of POWIs. Patients with an open fracture or an infection following open reduction internal fixation had a greater risk of a POWI following STA (P = 0.03 and P = 0.04, respectively). CONCLUSIONS: We could not identify predictors for nonunion. In 18% of the patients, an infectious complication following surgery occurred. Patients with an open fracture or an infection after primary surgical treatment (ie, open reduction internal fixation) have a higher chance of POWIs following STA. The union rate following posttraumatic STA is 89%. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Asunto(s)
Artrodesis/efectos adversos , Deformidades Adquiridas del Pie/cirugía , Traumatismos de los Pies/cirugía , Fracturas no Consolidadas/etiología , Articulación Talocalcánea/cirugía , Infección de la Herida Quirúrgica/etiología , Adulto , Anciano , Femenino , Deformidades Adquiridas del Pie/etiología , Deformidades Adquiridas del Pie/prevención & control , Traumatismos de los Pies/complicaciones , Fracturas Abiertas/complicaciones , Fracturas Abiertas/cirugía , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Articulación Talocalcánea/lesiones , Adulto JovenRESUMEN
BACKGROUND: A stable standing posture, and effective and aesthetic gait, depend heavily on correct anatomical construction of the feet, thanks to which they can play their important role. The shape and height of the foot arches are already formed in the preschool and early school years; therefore, abnormalities and disorders in children's feet, and correlations between foot formation and somatic build, are still crucial and interesting issues for orthopedists, pediatricians, physiotherapists, and podiatrists. This study deals with changes in the height of the longitudinal and transverse arches of the foot in 4- to 6-year-old children. METHODS: A total of 102 boys and 105 girls took part in a 24-month study in which their body weight, height, body mass index, and Clarke's and gamma angles were measured. The analysis also focused on correlations among sex, nutritional status, and changes in foot arch height. RESULTS: It was discovered that sex did not considerably affect Clarke's and gamma angle values. However, it was found that between ages 4 and 6 years, the proportion of overweight and obese boys and girls increased, and the medial longitudinal arch of the foot had a tendency to collapse in those with excessive body weight. The effect of nutritional status on the transverse arch of the foot is rather dubious. CONCLUSIONS: In light of these findings, therapeutic programs for preventing foot deformities in children should also focus on body weight control.
Asunto(s)
Peso Corporal , Deformidades Adquiridas del Pie/prevención & control , Pie/anatomía & histología , Sobrepeso/diagnóstico por imagen , Postura/fisiología , Preescolar , Femenino , Estudios de Seguimiento , Deformidades Adquiridas del Pie/etiología , Humanos , Masculino , Sobrepeso/complicaciones , Pronóstico , Estudios Retrospectivos , Factores de TiempoRESUMEN
BACKGROUND: There is a paucity of evidence regarding the design of children's footwear in relation to musculoskeletal structure. OBJECTIVES: The aim was to gain consensus regarding where flexibility and support should be given on a school shoe for the 6- to 10-year-olds. STUDY DESIGN: Delphi Questionnaire. METHODS: Recruitment of 10 Allied Health Professionals yielded a consensus group. Those recruited had dedicated experience in paediatrics and foot health. Rounds of questions were delivered to investigate the basis of the opinions made by the group on the location of support and flexibility in a school shoe for the age range identified. RESULTS: Six themes were generated. Four themes gained 100% consensus regarding footwear allowing normal foot movement, footwear allowing normal forefoot function, footwear providing a stable base and the foot being secure in the shoe. Fleiss' kappa calculations revealed 'poor agreement' for the remaining two themes regarding clinical intervention and the purpose of footwear design in the midfoot in both the upper and sole of the shoe. CONCLUSION: The qualitative data generated through discussion have highlighted areas where more understanding and research are required, particularly in understanding how, in the long term, shoe design can affect the developing foot. CLINICAL RELEVANCE: Children's footwear advice is often delivered from experience and personal belief. This article questions current understanding and opinion from clinical experts in the field of paediatric footwear and highlights that there is a lack of knowledge and confidence into the effects of children's footwear. There is a strong requirement for further empirical research to be completed on children's footwear to allow clinicians to formulate relevant and appropriate footwear advice.
Asunto(s)
Técnica Delphi , Articulaciones del Pie/fisiología , Rango del Movimiento Articular/fisiología , Instituciones Académicas , Zapatos/normas , Encuestas y Cuestionarios , Fenómenos Biomecánicos/fisiología , Niño , Femenino , Deformidades Adquiridas del Pie/prevención & control , Ortesis del Pié , Personal de Salud , Humanos , Masculino , Dolor/prevención & control , Competencia ProfesionalRESUMEN
BACKGROUND: To evaluate the effectiveness of shelf acetabuloplasty in the containment of extruded hips without hinge abduction in early stages of Legg-Calve-Perthes disease, we present a retrospective series of 44 patients (45 hips) treated between August 1999 and February 2010, which included 34 boys and 10 girls with a mean age at diagnosis of 7.4 years (range, 3.9 to 15.3). METHODS: All patients presented with sclerosis or early fragmentation stages. The average time from diagnosis to surgery was 2.1 months (range, 0 to 8.2) and the mean time to heal was 40.4 months (range, 20 to 82.2). The Reimer migration and the deformity indices were measured on initial, preoperative, postoperative, and healed x-rays. The average deformity index at 3 of those 4 timepoints was significantly related to their final Stulberg classification. CE angles increased and Sharp angles decreased significantly as a result of treatment. RESULTS: At the healed stage and consistent with other published series, 84.4% of patients were Stulberg III or less, denying any pain, and with full range of movement, whereas 15.6% were classified as Stulberg IV. CONCLUSIONS: We defend that shelf acetabuloplasty should be performed early in the disease and, uniquely, we propose that the indication for treatment should be guided by the deformity and the Reimer migration indices. LEVEL OF EVIDENCE: IV.
Asunto(s)
Acetabuloplastia , Deformidades Adquiridas del Pie , Enfermedad de Legg-Calve-Perthes , Acetabuloplastia/efectos adversos , Acetabuloplastia/métodos , Adolescente , Niño , Preescolar , Femenino , Cabeza Femoral/diagnóstico por imagen , Estudios de Seguimiento , Deformidades Adquiridas del Pie/diagnóstico , Deformidades Adquiridas del Pie/etiología , Deformidades Adquiridas del Pie/prevención & control , Humanos , Enfermedad de Legg-Calve-Perthes/complicaciones , Enfermedad de Legg-Calve-Perthes/diagnóstico , Enfermedad de Legg-Calve-Perthes/cirugía , Masculino , Gravedad del Paciente , Periodo Posoperatorio , Radiografía , Estudios Retrospectivos , Tiempo de Tratamiento , Resultado del Tratamiento , Reino UnidoRESUMEN
Osteoid osteoma is a benign bone tumour usually found in the lower extremities of children and young adults. This tiny bone tumour causes pain out of all proportion to its size and hinders the daily activities. This Quasi-experimental study conducted in the department of Orthopaedic surgery of BSMMU from January 2008 to December 2009. Twenty one patients were included in the study where purposive sampling technique was used on the basis of inclusion and exclusion criteria and all the ethical conditions were fulfilled. Diagnosis was almost obtained by taking history, clinical examination, and relevant investigations. Clinical variables were age, sex, site, pain, swelling, deformity and outcome variables were painless active life, removal of swelling, prevention of deformity, rate of recurrence. After localization of the tumour with the help of C arm, the nidus was excised in a small block of bone. The outcome is categorized by consensus, as clinically successful, only if the patient was free of pain and was taking no medication. The treatment was considered to have failed if a subsequent procedure had been performed to remove tumour. Among 21 cases, 14(66.7%) were male and 7(33.7%) were female. Maximum number of patients 15(71.4%) was between 10 years to 20 years. Most of the patients (76.2%) affected by osteoid osteoma were young students and most of the patients (95.2%) experienced moderate aching pain, usually aggravating at night which was typically relieved by aspirin or other NSAIDs (71.4%). Lower limbs (76.2%) particularly femur and tibia were commonly affected. Out of 21 patients, 19(90.5%) patients have got immediate pain relief or required no medication. In only 2 patients (9.5%), subsequent procedure has been performed to relief pain. So, successful outcome (in 19 out of 21) was significantly (p<0.001) higher in comparison to failed. Surgical excision of the nidus is a simple and easy procedure and does not require extensive resection of bone. If localization is done properly success rate is high and patients can return to normal daily activities.
Asunto(s)
Neoplasias Óseas , Disección , Dolor Nociceptivo , Osteoma Osteoide , Dolor Postoperatorio , Adolescente , Neoplasias Óseas/complicaciones , Neoplasias Óseas/patología , Neoplasias Óseas/fisiopatología , Neoplasias Óseas/cirugía , Disección/efectos adversos , Disección/métodos , Femenino , Deformidades Adquiridas del Pie/etiología , Deformidades Adquiridas del Pie/prevención & control , Humanos , Huesos de la Pierna/patología , Huesos de la Pierna/cirugía , Masculino , Dolor Nociceptivo/diagnóstico , Dolor Nociceptivo/psicología , Osteoma Osteoide/complicaciones , Osteoma Osteoide/patología , Osteoma Osteoide/fisiopatología , Osteoma Osteoide/cirugía , Dimensión del Dolor/métodos , Dolor Postoperatorio/diagnóstico , Dolor Postoperatorio/fisiopatología , Calidad de Vida , Recuperación de la Función , Resultado del Tratamiento , Adulto JovenRESUMEN
BACKGROUND: Muscle atrophy and asymmetric extremity growth is a common feature of linear scleroderma (LS). Extra-cutaneous features are also common and primary neurologic involvement, with sympathetic dysfunction, may have a pathogenic role in subcutaneous and muscle atrophy. The aim was investigate nerve conduction and muscle involvement by electromyography in pediatric patients with LS. METHODS: We conducted a retrospective review of LS pediatric patients who had regular follow up at a single pediatric center from 1997-2013. We selected participants if they had consistently good follow up and enrolled consecutive patients in the study. We examined LS photos as well as clinical, serological and imaging findings. Electromyograms (EMG) were performed with bilateral symmetric technique, using surface and needle electrodes, comparing the affected side with the contralateral side. Abnormal muscle activity was categorized as a myopathic or neurogenic pattern. RESULTS: Nine LS subjects were selected for EMG, 2 with Parry-Romberg/Hemifacial Atrophy Syndrome, 7 linear scleroderma of an extremity and 2 with mixed forms (linear and morphea). Electromyogram analysis indicated that all but one had asymmetric myopathic pattern in muscles underlying the linear streaks. Motor and sensory nerve conduction was also evaluated in upper and lower limbs and one presented a neurogenic pattern. Masticatory muscle testing showed a myopathic pattern in the atrophic face of 2 cases with head and face involvement. CONCLUSION: In our small series of LS patients, we found a surprising amount of muscle dysfunction by EMG. The muscle involvement may be possibly related to a secondary peripheral nerve involvement due to LS inflammation and fibrosis. Further collaborative studies to confirm these findings are needed.
Asunto(s)
Deformidades Adquiridas del Pie/prevención & control , Deformidades Adquiridas de la Mano/prevención & control , Músculo Esquelético , Atrofia Muscular , Esclerodermia Localizada , Preescolar , Estudios Transversales , Diagnóstico Precoz , Intervención Médica Temprana , Electromiografía/métodos , Femenino , Deformidades Adquiridas del Pie/etiología , Deformidades Adquiridas de la Mano/etiología , Humanos , Masculino , Músculo Esquelético/inervación , Músculo Esquelético/patología , Músculo Esquelético/fisiopatología , Atrofia Muscular/diagnóstico , Atrofia Muscular/etiología , Atrofia Muscular/fisiopatología , Conducción Nerviosa/fisiología , Evaluación de Resultado en la Atención de Salud , Estudios Retrospectivos , Esclerodermia Localizada/complicaciones , Esclerodermia Localizada/diagnóstico , Esclerodermia Localizada/fisiopatología , Esclerodermia Localizada/terapiaAsunto(s)
Deformidades Adquiridas del Pie/prevención & control , Huesos Metatarsianos/anomalías , Huesos Metatarsianos/cirugía , Osteogénesis por Distracción/métodos , Clavos Ortopédicos , Fluoroscopía , Humanos , Osteogénesis por Distracción/efectos adversos , Complicaciones Posoperatorias/prevención & controlRESUMEN
BACKGROUND: A floating toe deformity occurs in many patients who undergo Weil osteotomies. It is likely caused by the failure of the windlass mechanism in shortening the metatarsal. For patients who require a proximal interphalangeal (PIP) joint arthroplasty or fusion in addition to a Weil osteotomy, the transfer of the flexor digitorum brevis (FDB) tendon to the PIP joint might restore the windlass mechanism and decrease the incidence of floating toes. METHODS: Fourteen cadaveric foot specimens were examined to determine the effects of changing metatarsal length as well as tensioning the FDB tendon on the angle of the metatarsophalangeal (MTP) joint as a measure of a floating toe. RESULTS: Shortening and lengthening the second metatarsal resulted in a significant change in MTP angle (P = .03 and .02, respectively), though there was no clear relationship found between the amount of change in metatarsal length and the change in MTP angle. Transferring the FDB to a PIP arthroplasty site plantarflexed the MTP joint and corrected floating toes; the change in angle was significant compared with the control and shortening groups (P = .0001 and .002, respectively). CONCLUSION: This study supports the theory that change in length of the metatarsal, possibly via the windlass mechanism, plays a role in the pathophysiology of the floating toe deformity. Tensioning and transferring the FDB tendon into the PIP joint helped prevent the floating toe deformity in this cadaveric model. CLINICAL RELEVANCE: Continued research in this subject will help to refine methods of prevention and correction of the floating toe deformity.
Asunto(s)
Deformidades Adquiridas del Pie/prevención & control , Huesos Metatarsianos/cirugía , Osteotomía/efectos adversos , Osteotomía/métodos , Transferencia Tendinosa , Articulación del Dedo del Pie/cirugía , Artroplastia , Cadáver , Deformidades Adquiridas del Pie/fisiopatología , Humanos , Huesos Metatarsianos/patologíaAsunto(s)
Deformidades Adquiridas del Pie/prevención & control , Dermatosis del Pie/terapia , Queratosis/terapia , Enfermedades de la Uña/terapia , Conducta Cooperativa , Tabla de Aranceles , Deformidades Adquiridas del Pie/economía , Deformidades Adquiridas del Pie/etiología , Dermatosis del Pie/diagnóstico , Dermatosis del Pie/economía , Dermatosis del Pie/etiología , Alemania , Humanos , Comunicación Interdisciplinaria , Queratosis/diagnóstico , Queratosis/economía , Queratosis/etiología , Enfermedades de la Uña/diagnóstico , Enfermedades de la Uña/economía , Enfermedades de la Uña/etiología , Uñas Malformadas/diagnóstico , Uñas Malformadas/economía , Uñas Malformadas/etiología , Uñas Malformadas/terapia , Programas Nacionales de Salud/economía , Podiatría , Mecanismo de Reembolso/economía , ZapatosRESUMEN
The aim of our study was to estimate influence of anatomical malformations in foot (characterised by mesoaxial polydactyly) in 26-year old female patient on clinical condition and biomechanical motion. Clinical, radiological and pedobarographic examinations were used in the patient's analysis. The postural pedobarographics examinations revealed persistent disturbances in underfoot pressure distribution despite pain recovered, which has been achieved by discontinued of wearing tight shoes.
Asunto(s)
Deformidades Adquiridas del Pie/etiología , Deformidades Adquiridas del Pie/prevención & control , Zapatos/efectos adversos , Adulto , Diagnóstico Diferencial , Femenino , Deformidades Adquiridas del Pie/diagnóstico , Humanos , Polidactilia/diagnósticoRESUMEN
Charcot neuro-osteoarthropathy (CNO) is one of the more devastating complications affecting diabetic patients with peripheral and/or autonomic neuropathy. The acute phase of the disease is often misdiagnosed, and can rapidly lead to deformity and amputation. The rapid progression towards foot deformation calls for early detection and intervention. Classical neurotraumatic and neurotrophic theories fail to explain all of the features of the condition, although recent advances that have clarified the mechanisms underlying the pathophysiology may make up for this lack. In particular, new data have emerged on the central role of the RANK/RANK-ligand (RANK-L)/osteoprotegerin (OPG) system in the pathogenesis of osteopenia. Also, it is now recognized that the acute phase of CNO can be triggered by any factor leading to local inflammation of the foot, especially in predisposed patients. As the cornerstone of treatment remains any method that avoids weight-bearing on the foot, the primary importance of the RANK/RANK-L/OPG signalling pathway is that it opens up the field to new treatment strategies for the future.
Asunto(s)
Artropatía Neurógena , Conservadores de la Densidad Ósea/uso terapéutico , Pie Diabético , Deformidades Adquiridas del Pie/prevención & control , Alendronato/uso terapéutico , Artropatía Neurógena/complicaciones , Artropatía Neurógena/diagnóstico , Artropatía Neurógena/metabolismo , Artropatía Neurógena/fisiopatología , Artropatía Neurógena/terapia , Biomarcadores/sangre , Calcitonina/uso terapéutico , Pie Diabético/complicaciones , Pie Diabético/diagnóstico , Pie Diabético/metabolismo , Pie Diabético/fisiopatología , Pie Diabético/terapia , Diagnóstico Diferencial , Difosfonatos/uso terapéutico , Diagnóstico Precoz , Deformidades Adquiridas del Pie/etiología , Traumatismos de los Pies/complicaciones , Humanos , Osteoprotegerina/metabolismo , Pamidronato , Ligando RANK/metabolismo , Ensayos Clínicos Controlados Aleatorios como Asunto , Soporte de PesoRESUMEN
El embarazo desencadena diferentes cambiosanatomo-fisiológicos que producen molestias enlas mujeres. Una de estas molestias, muchas vecesinfravalorada o percibida como poco importante,es la molestia en los pies, que se considera inclusocomo normal en el embarazo. Por ello el presenteestudio pretende recabar información sobre las preferenciasde las usuarias, las sensaciones de conforty la incidencia de molestias asociadas al uso delcalzado durante el embarazo. Así como describirlos síntomas patológicos relacionados con los piesy el calzado durante el embarazo(AU)
Pregnancy produces different anatomo-physiologicalchanges that produce troubles in women.One of these troubles, often underestimated inits importance, is foot pain, which is consideredas a normal consequence of the pregnancy. Thepresent study tries to obtain information about womenpreferences, the sensations of comfort and theincidence of inconveniences associated with the useof the footwear during the pregnancy. Furthermore,it tries to describe the most relevant pathologicalsymptoms relative to the feet and footwear duringthe pregnancy(AU)
Asunto(s)
Humanos , Femenino , Embarazo , Complicaciones del Embarazo/prevención & control , Zapatos/efectos adversos , Podiatría/métodos , Deformidades Adquiridas del Pie/prevención & control , Factores SexualesRESUMEN
Malunion of a first metatarsal osteotomy or fracture can result in dorsal angulation of the distal fragment and shortening of the metatarsal, among other deformities. Dorsal malunion can be caused by improper orientation of the osteotomy, poor intraoperative fixation, or loss of fixation post-operatively due to premature weight bearing or catastrophic failure. There is little in the literature on the rate and incidence of malunion following first metatarsal fractures treated either operatively or nonoperatively. However, treatment options would be similar as for malunion following an osteotomy. The treatment of malunions depends on how symptomatic the patient is, including pain, difficulty with ambulation, and whether they complain of transfer metatarsalgia.