Cold hypersensitivity in the hands and feet is associated with erectile dysfunction in young Taiwanese men.

Cold hypersensitivity in the hands and feet (CHHF) is a protective or predisposing factor for many diseases; however, the relationship between CHHF and erectile dysfunction (ED) remains unclear. We aimed to investigate associations between CHHF and ED among young men of Southeast Asian origin. In this cross-sectional study, sexually active Taiwanese men aged 20-40 years were enrolled via an online questionnaire comprising general demographic information, comorbidities, subjective thermal sensations of their hands and feet in the past 6 months, and their erectile function using the International Index of Erectile Function-5 (IIEF-5). Participants who reported cold sensation of hands and feet were classified to have CHHF; those with IIEF-5 score ≤ 21 were considered to have ED. Total 54.2% and 27.9% of participants had ED and CHHF, respectively. Men with CHHF were significantly younger, had lower body mass index and IIEF-5 scores (p < 0.001), and a lower prevalence of diabetes mellitus (p = 0.033) along with higher prevalence of ED, psychiatric disorders, and insomnia (p < 0.001). After adjusting for predisposing factors of ED, CHHF (odds ratio 1.410, 95% confidence interval 1.159-1.714; p = 0.001) remained an independent predictor of ED. Thus, CHHF is independently associated with ED, affecting more than a quarter of young Taiwanese men. Autonomic dysregulation and subclinical endothelial dysfunction may be common pathophysiologies of CHHF and ED.

Prevalence of impaired foot function in baseball players with and without disabled throwing shoulder/elbow: a case-control study.

Prevalence of impaired foot function among baseball players with and without a disabled throwing shoulder/elbow was investigated. The study included 138 male players. Players who had previously complained of shoulder/elbow pain during throwing motion were defined as the players with a history, and those who experienced shoulder/elbow pain during the examination were defined as having the injury. Foot function was evaluated by foot "rock paper scissors" movements and floating toes. Their prevalence was assessed and the relationships between players with and without the injuries were statistically analyzed. The prevalence of players with a history and injury was 27% and 7%, respectively. The prevalence of impaired foot function on the non-throwing side among players with injury was significantly higher than those without (60% vs. 28%, P < 0.001) and higher tendency on the throwing side than those without (60% vs. 32%). Regarding floating toes, players with a relevant history showed a significantly higher prevalence on the throwing side than those without (49% vs 28%, P < 0.001) and higher tendency on the non-throwing side than those without (49% vs 32%). Players with disabled throwing shoulder/elbow have a significantly higher prevalence of impaired foot function and floating toes than players without it.

The Stress of Measuring Plantar Tissue Stress in People with Diabetes-Related Foot Ulcers: Biomechanical and Feasibility Findings from Two Prospective Cohort Studies.

Reducing high mechanical stress is imperative to heal diabetes-related foot ulcers. We explored the association of cumulative plantar tissue stress (CPTS) and plantar foot ulcer healing, and the feasibility of measuring CPTS, in two prospective cohort studies (Australia (AU) and The Netherlands (NL)). Both studies used multiple sensors to measure factors to determine CPTS: plantar pressures, weight-bearing activities, and adherence to offloading treatments, with thermal stress response also measured to estimate shear stress in the AU-study. The primary outcome was ulcer healing at 12 weeks. Twenty-five participants were recruited: 13 in the AU-study and 12 in the NL-study. CPTS data were complete for five participants (38%) at baseline and one (8%) during follow-up in the AU-study, and one (8%) at baseline and zero (0%) during follow-up in the NL-study. Reasons for low completion at baseline were technical issues (AU-study: 31%, NL-study: 50%), non-adherent participants (15% and 8%) or combinations (15% and 33%); and at follow-up refusal of participants (62% and 25%). These underpowered findings showed that CPTS was non-significantly lower in people who healed compared with non-healed people (457 [117; 727], 679 [312; 1327] MPa·s/day). Current feasibility of CPTS seems low, given technical challenges and non-adherence, which may reflect the burden of treating diabetes-related foot ulcers.

Multi-segment foot kinematics during gait in children with spastic cerebral palsy.

BACKGROUND: Foot deformities (e.g. planovalgus and cavovarus) are very common in children with spastic cerebral palsy (CP), with the midfoot often being involved. Dynamic foot function can be assessed with 3D gait analysis including a multi-segment foot model. Incorporating a midfoot segment in such a model, allows quantification of separate Chopart and Lisfranc joint kinematics. Yet, midfoot kinematics have not previously been reported in CP. RESEARCH QUESTIONS: What is the difference in multi-segment kinematics including midfoot joints between common foot deformities in CP and typically-developing feet? METHODS: 103 feet of 57 children with spastic CP and related conditions were retrospectively included and compared with 15 typically-developing children. All children underwent clinical gait analysis with the Amsterdam Foot Model marker set. Multi-segment foot kinematics were calculated for three strides per foot and averaged. A k-means cluster analysis was performed to identify foot deformity groups that were present within CP data. The deformity type represented by each cluster was based on the foot posture index. Kinematic output of the clusters was compared to typically-developing data for a static standing trial and for the range of motion and kinematic waveforms during walking, using regular and SPM independent t-tests respectively. RESULTS: A neutral, planovalgus and varus cluster were identified. Neutral feet showed mostly similar kinematics as typically-developing data. Planovalgus feet showed increased ankle valgus and Chopart dorsiflexion, eversion and abduction. Varus feet showed increased ankle varus and Chopart inversion and adduction. SIGNIFICANCE: This study is the first to describe Chopart and Lisfranc joint kinematics in different foot deformities of children with CP. It shows that adding a midfoot segment can provide additional clinical and kinematic information. It highlights joint angles that are more distinctive between deformities, which could be helpful to optimize the use of multi-segment foot kinematics in the clinical decision making process.

Impact of the medial displacement calcaneal osteotomy on foot biomechanics: a systematic literature review.

INTRODUCTION: Progressive collapsing foot deformity (PCFD), formally known as "adult-acquired flatfoot deformity" (AAFFD), is a complex foot deformity consisting of multiple components. If surgery is required, joint-preserving procedures, such as a medial displacement calcaneal osteotomy (MDCO), are frequently performed. The aim of this systematic review is to provide a summary of the evidence on the impact of MDCO on foot biomechanics. MATERIALS AND METHODS: A systematic literature search across two major sources (PubMed and Scopus) without time limitation was performed according to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) criteria. Only original research studies reporting on biomechanical changes following a MDCO were included. Exclusion criteria consisted of review articles, case studies, and studies not written in English. 27 studies were included and the methodologic quality graded according to the QUACS scale and the modified Coleman score. RESULTS: The 27 included studies consisted of 18 cadaveric, 7 studies based on biomechanical models, and 2 clinical studies. The impact of MDCO on the following five major parameters were assessed: plantar fascia (n = 6), medial longitudinal arch (n = 9), hind- and midfoot joint pressures (n = 10), Achilles tendon (n = 5), and gait pattern parameters (n = 3). The quality of the studies was moderate to good with a pooled mean QUACS score of 65% (range 46-92%) for in-vitro and a pooled mean Coleman score of 58 (range 56-65) points for clinical studies. CONCLUSION: A thorough knowledge of how MDCO impacts foot function is key in properly understanding the postoperative effects of this commonly performed procedure. According to the evidence, MDCO impacts the function of the plantar fascia and Achilles tendon, the integrity of the medial longitudinal arch, hind- and midfoot joint pressures, and consequently specific gait pattern parameters.

Validating the usefulness of Sudoscan in ATTRv: a single centre experience.

BACKGROUND: Variant transthyretin amyloidosis (ATTRv) can cause sensorimotor and autonomic neuropathy. Objective quantification of sudomotor function may be essential for early diagnosis and early initiation of treatment. The aim of this study is to evaluate the diagnostic value of the Sudoscan® in ATTRv. METHODS: Electrochemical skin conductance (ESC) was measured in V30M ATTRv patients, asymtomatic V30M carriers and healthy controls. Comparisons between the three groups were made using the Kruskal-Wallis test, and ROC curves were used to estimate the discriminatory power of ESC values between groups. RESULTS: ESC was measured in 52 ATTRv patients, 107 asymptomatic carriers and 40 healthy controls. ESC was significantly lower in ATTRv patients compared to asymptomatic carriers and healthy controls in both feet and hands; median values are as follows: 40 µS, 78 µS and 81 µS, respectively (p < 0.001), and 53 µS, 69 µS and 74 µS, respectively (p < 0.001). ESC in feet < 70.5 µS had a sensitivity of 89.7% and specificity of 84.6% to discriminate asymptomatic carriers from patients with ATTRv. CONCLUSION: The determination of ESC by Sudoscan® is a rapid, noninvasive and easily reproducible technique capable of discriminating patients with ATTRv from asymptomatic carriers and healthy controls with adequate sensitivity and specificity.

The distribution of pressure forces of the foot on the ground during gait in patients with hip osteoarthritis.

BACKGROUND: Hip osteoarthritis is a major civilizational challenge of the ageing population, usually due to the reduced function of gait. In the light of this fact, gait analysis has become an important issue for the doctor, the physiotherapist and the patient, as it serves as a useful tool in diagnosis, recovery, and rehabilitation. Pedobarography is one of the most modern gait analysis methods. OBJECTIVE: The aim of this study is to assess the distribution of pressure forces of the foot on the ground during gait in patients with hip osteoarthritis. METHODS: Dynamic foot tests were performed by means of a two-meter RSscan® International platform, equipped with 16.384 sensors with the scanning frequency level exceeding 500 Hz. Patients were divided into two groups: the research group of N= 60 individuals with hip osteoarthritis, aged 52-84; and the control group of N= 32 individuals without hip osteoarthritis, aged 50-74. Data distribution analysis was performed with the Shapiro-Wilk test, followed by a non-parametric Mann-Whitney U test. RESULTS: The differences between the mean results of maximal peak values of pressure and force in such areas as the big toe, metatarsal I, III, IV, V, lateral and medial heel are significantly lower in the research group than in the control group. Only in the area of metatarsal II, the mean value of pressure is higher in the research group than in the control group. For all metatarsals, the midfoot and medial heel mean results of the contact area are significantly higher in the research group than in the control group. The differences between mean load rate were also tested. The test revealed statistical significance of metatarsal II and III, and the medial heel while metatarsal II displayed a higher mean value in the research group than in the control group. CONCLUSION: The distribution of the pressure forces of the foot can indicate imbalances which cause degenerative changes. Therefore, early detection of changes can help in prevention or delay of hip osteoarthritis in conjunction with proper therapy.

Bloqueo del tobillo con lidocaína y bupivacaina para amputación de los radios del pie. Hospital General del Sur "Dr. Pedro Iturbe" / Ankle block with lidocaine and bupivacaine for foot rays amputation. Hospital General del Sur "Dr. Pedro Iturbe"

El objetivo de este trabajo es determinar la utilidad del bloqueo del tobillo con lidocaína y Bupivacaína para amputación de los radios del pie en pacientes atendidos en el Hospital General del Sur Dr. Pedro Iturbe, Maracaibo, Venezuela, desde mayo 2019 hasta mayo 2021. Se realizó un estudio pre-experimental, prospectivo y longitudinal. Se incluyeron pacientes de ambos sexos, entre 18 a 90 años, con amputaciones traumáticas, pie diabético e insuficiencia vascular periférica. Se incluyeron 50 pacientes, con edad promedio de 50,76 ± 25,0 años, 35(70,0%) de sexo masculino. Con antecedente de diabetes 13(26,0%) pacientes, fumadores 4(8,0%), cardiópatas 4(8,0%), hipertensos/diabéticos 6(12,0%), obesidad 5(10,0%), trauma 6(12,0%), nefrópatas 2(4,0%), drogas 1(2,0%) y sin antecedentes 9(18,0%). Diagnóstico preoperatorio predominante: amputación traumática 19 pacientes (38,0%), El promedio de tiempo de inicio del bloqueo fue 5-15min en 21(42,0%) casos. El bloqueo fue satisfactorio en 46(92,0%) pacientes. La duración del bloqueo en 22(44,0%) pacientes fue prolongada. Según la EVA del dolor en 19(38,0%) casos fue leve. No se evidenciaron complicaciones asociadas al procedimiento en 50(100,0%) pacientes. El bloqueo con lidocaína y bupivacaína es una técnica útil en la amputación de los radios del pie, inmediata, ambulatoria, a bajo costo, de duración prolongada y satisfactoria, de bajo dolor postoperatorio, poco requerimiento de analgésicos y con bajas complicaciones(AU)

The objective to determine the usefulness of the ankle block with lidocaine and Bupivacaine for amputation of the foot rays in patients treated at the Hospital General del Sur Dr. Pedro Iturbe during the period May 2019 to May 2021. A pre-experiment, prospective and longitudinal study was made. Patients of both sexes, between 18 and 90 years old, with traumatic amputations, diabetic foot and peripheral vascular Insufficiency were included. A descriptive statistical analysis was applied. Mean age 50,76±25,0 years, 35(70,0%) male patients. Patients history: Diabetes 13(26,0%), smokers 4(8,0%), heart patients 4(8,0%), hypertensive/diabetics 6(12,0%) patients, obesity 5(10,0%), trauma 6(12,0%), kidney disease 2(4,0%), drugs 1(2,0%), no history 9(18,0%). Predominant preoperative diagnosis: traumatic amputation 19(38,0%) patients, Block onset time: medium (5-15min) 21(42,0%) patients. The blockade was satisfactory in 46 patients (92.0%). Block duration in 22(44,0%) patients was prolonged. Pain scale 19(38,0%) patients mild pain. There were no complications associated with the procedure in 50(100,0%) patients. Conclusions: The blockade with lidocaine and bupivacaine is useful in the amputation of the foot rays since it is performed immediately, on an outpatient basis, at low cost, with a long and satisfactory duration, presenting mild postoperative pain, little need for analgesics and they do not represent a risk for the patient since there were no complications related to the technique(AU)

Morfología y función del pie en pacientes con ciática. Un estudio descriptivo transversal / Morphology and function of the foot in patients with sciatica. A cross-sectional study

Objetivos: El objetivo de este trabajo es comparar las características articulares de los pies de pacientes con ciática, con las de los pies de personas sin esta patología. Pacientes y métodos: Se trata de un estudio descriptivo transversal. Se incluyeron 20 pacientes con ciática y 20 pacientes sin esta patología emparejados por edad y sexo. Se cuantificó el dolor del pie mediante la Numeric Pain Rating Scale 11 y se midió la movilidad de las articulaciones del tobillo, subastragalina, antepié, primer radio y primer dedo. Se clasificó el tipo de pie mediante el Foot Posture Index, y se cuantificó la discapacidad relacionada con el dolor del pie mediante el cuestionario Manchester Foot Pain and Disability Index. Se compararon estas variables entre los dos grupos de participantes (con ciática y sin ciática). Resultados: Se observó un menor rango de movimiento de pronación subastragalina, así como mayor dolor en el pie y mayor discapacidad relacionada con el dolor en el pie, en los participantes con ciática en comparación con los del grupo control. La extensión del hallux también fue significativamente menor en los sujetos con ciática, aunque solo en el pie izquierdo. Además, la fuerza muscular en estos pacientes fue menor que en los que no tenían ciática. Los participantes de ambos grupos presentaron valores de flexión dorsal del tobillo por debajo de la normalidad. Conclusiones: Los participantes con ciática presentaron ciertas diferencias articulares y musculares con respecto al grupo control, aunque no se puede establecer una relación causa-efecto debido al diseño del estudio (AU)

Objectives: The objective of this work is to compare the joint characteristics of the feet of patients with sciatica, with those of people without this pathology. Patients and methods: This is a cross-sectional descriptive study. Twenty patients with sciatica and 20 patients without this pathology were included. Foot pain was quantified using the Numeric Pain Rating Scale 11, and mobility of the ankle, subtalar, forefoot, first ray, and hallux joints were measured. Foot type was classified using the Foot Posture Index, and disability related to foot pain was quantified using the Manchester Foot Pain and Disability Index questionnaire. These variables were compared between the two groups (participants with and without sciatica). Results: Less subtalar pronation range of motion, as well as greater foot pain and greater foot pain-related disability, were observed in participants with sciatica compared with those in the control group. Hallux dorsalflexion was also significantly less in subjects with sciatica, although only in the left foot. Muscle strength in these patients was lower than in those without sciatica. Participants in both groups presented values of ankle dorsiflexion below normal.Conclusions: The participants with sciatica presented certain joint and muscle differences with respect to the control group, although a cause-effect relationship cannot be established due to the study design (AU)

Ciprofloxacin-associated Peripheral Neuropathy in a Child: A Case Report and Review of the Literature.

Fluoroquinolones are reported to have peripheral nerve toxic effects that can be severe and permanent in adults. However, limited data exist for children. We describe a case of acute-onset peripheral neuropathy associated with ciprofloxacin in a 13-year-old boy who was characterized by severe dysesthesia and erythema of both hands and feet, but which resolved promptly after ceasing the antibiotic.

Effects of Custom-made Insoles on Plantar Biomechanics and Upper Extremity Muscle Performance.

OBJECTIVE: To investigate the effectiveness of molding custom-made insoles for female patients with foot pain. METHODS: The study included 20 patients whose insoles were prescribed according to biomechanical evaluations and molded by repositioning the subtalar joint in its neutral position using a simple set of tools. Plantar biomechanics were measured under the following conditions: static stand, walking at self-comfortable walking speed (CWS) barefoot, walking in patient owned running shoes, and walking in running shoes plus insoles. Each patient's upper arm isometric muscle strength and subjective feelings before and after the insole intervention were assessed. RESULTS: The molded insoles increased plantar contact area both during static standing and walking at CWS compared to the barefoot condition. The insoles also had more evenly distributed plantar contact area and loading rate, with the changes in the medial arch area being most significant. Moreover, the custom-made insole intervention immediately increased maximum resistance and duration of bilateral upper arms, as well as improved foot comfort, especially at the medial arch area during single leg squat tests. CONCLUSION: Molding custom-made insoles by repositioning the subtalar joint in its neutral position can be accomplished with a simple set of tools, making this method highly applicable for a majority of less developed regions. Insoles molded using this method are effective in immediately improving plantar biomechanics disorders and enhancing isometric upper muscle performance in female patients with foot pain.

A Retrospective Study of the Risk Factors for Postoperative Foot or Ankle Pain in 90 Patients with Varus Osteoarthritis of the Knee who Underwent Total Knee Arthroplasty.

BACKGROUND The reasons for foot and ankle pain following total knee arthroplasty (TKA) for knee varus osteoarthritis are unknown. This retrospective study aimed to investigate the risk factors for postoperative foot and ankle pain in patients with varus osteoarthritis of the knee who underwent TKA. MATERIAL AND METHODS We enrolled 90 patients who underwent TKA for varus knee osteoarthritis. The visual analog scale (VAS) was used to evaluate patients' foot or ankle pain before and after surgery. The correlation between independent variables (eg, age, sex, body mass index [BMI], ankle osteoarthritis, and varus angle) and foot and ankle pain in patients with osteoarthritis of the knee was measured. Moreover, radiological changes were compared between the groups with and without worsened pain. RESULTS No significant difference in VAS was found between patients <60 and ≥60 years of age (P>0.05). Male sex and BMI <30 kg/m² were weakly correlated with preoperative foot or ankle pain. However, patients with varus of ≥6° and preexisting ankle osteoarthritis had a higher incidence of foot or ankle pain before surgery. Moreover, no significant differences in radiological changes were found between the groups with and without worsened foot or ankle pain after surgery (P>0.05). CONCLUSIONS In male patients with osteoarthritis of the knee, a BMI <30 kg/m², varus of <6°, and no preexisting ankle osteoarthritis were protective factors for foot and ankle pain. TKA corrected knee and ankle malalignment. Therefore, postoperative foot and ankle pain was not associated only with TKA surgery.

Effectiveness of an ankle-foot orthosis on walking in patients with stroke: a systematic review and meta-analysis.

We conducted a meta-analysis to investigate the effectiveness of ankle-foot orthosis (AFO) use in improving gait biomechanical parameters such as walking speed, mobility, and kinematics in patients with stroke with gait disturbance. We searched the MEDLINE (Medical Literature Analysis and Retrieval System Online), CINAHL (Cumulative Index to Nursing and Allied Health Literature), Cochrane, Embase, and Scopus databases and retrieved studies published until June 2021. Experimental and prospective studies were included that evaluated biomechanics or kinematic parameters with or without AFO in patients with stroke. We analyzed gait biomechanical parameters, including walking speed, mobility, balance, and kinematic variables, in studies involving patients with and without AFO use. The criteria of the Cochrane Handbook for Systematic Reviews of Interventions were used to evaluate the methodological quality of the studies, and the level of evidence was evaluated using the Research Pyramid model. Funnel plot analysis and Egger's test were performed to confirm publication bias. A total of 19 studies including 434 participants that reported on the immediate or short-term effectiveness of AFO use were included in the analysis. Significant improvements in walking speed (standardized mean difference [SMD], 0.50; 95% CI 0.34-0.66; P < 0.00001; I2, 0%), cadence (SMD, 0.42; 95% CI 0.22-0.62; P < 0.0001; I2, 0%), step length (SMD, 0.41; 95% CI 0.18-0.63; P = 0.0003; I2, 2%), stride length (SMD, 0.43; 95% CI 0.15-0.71; P = 0.003; I2, 7%), Timed up-and-go test (SMD, - 0.30; 95% CI - 0.54 to - 0.07; P = 0.01; I2, 0%), functional ambulation category (FAC) score (SMD, 1.61; 95% CI 1.19-2.02; P < 0.00001; I2, 0%), ankle sagittal plane angle at initial contact (SMD, 0.66; 95% CI 0.34-0.98; P < 0.0001; I2, 0%), and knee sagittal plane angle at toe-off (SMD, 0.39; 95% CI 0.04-0.73; P = 0.03; I2, 46%) were observed when the patients wore AFOs. Stride time, body sway, and hip sagittal plane angle at toe-off were not significantly improved (p = 0.74, p = 0.07, p = 0.07, respectively). Among these results, the FAC score showed the most significant improvement, and stride time showed the lowest improvement. AFO improves walking speed, cadence, step length, and stride length, particularly in patients with stroke. AFO is considered beneficial in enhancing gait stability and ambulatory ability.

Gait characteristics during crossing over obstacle in patients with glaucoma using insole foot pressure.

BACKGROUND: Glaucoma, is the most common cause of irreversible visual deficits, presents as an injury to the optic nerve and it is mainly associated with elevated intraocular pressure. The main symptom of glaucoma is a reduction of the visual field, which is usually a source of complaint at the advanced stage of disease. Because of visual deficit, gait dysfunctions, including low gait speed and increased bumping into objects, postural sway, and falling are occurred. Many studies have used stopwatch or motion-sensing devices to report on gait function following glaucoma. However, there are few reports on gait dysfunction assessed by examining foot pressure. This study investigated gait ability following glaucoma according to different gait conditions by assessing foot pressure. METHODS: Thirty older adults (15 in the sex- and age-matched normal group and 15 in the glaucoma group) were recruited for this study. All participants were walked under 2 different gait conditions in an F-scan system and the subject' assessments were randomly assigned to rule out the order effect. Conditions included: gait over an obstacle in a straight 6 m path, gait in a straight path without an obstacle in the 6 m path. Gait variables included cadence, gait cycle, stance time, center of force (COF) deviation, and COF excursion. About 10 minutes were taken for gait evaluation. RESULTS: When walking without an obstacle on a 6 m path, there were significant differences between the 2 groups in gait speed, cadence, gait cycle, and stance time (P < .05). There were significant differences when walking with an obstacle on a 6 m path (P < .05). Two-way analysis of variance showed significant effects associated with "glaucoma" not gait condition on all outcomes except for COF deviation and excursion. Also, there was no the interaction effect between "glaucoma" and "gait condition." CONCLUSION: We demonstrated that glaucoma patients selected the gait strategy such as lower gait function in both gait conditions particularly, slower gait speed and cadence and longer gait cycle and stance time, as determined by examining foot pressure. We believe that our results could help to improve the quality of life of patients with glaucoma.

Foot rash and joint pain.

An untreated infection led to a series of unusual signs and symptoms that included difficulty walking.

Impact of quality of life related to foot problems: a case-control study.

Foot problems are highly prevalent conditions, being a frequent reason for medical and podiatric consultation. The aim of this study was to compare the differences of quality of life (QoL) related to foot health in people with and without the presence of foot problems. A case-control study was carried out in an outpatient centre, where a clinician recorded data related to sociodemographic and clinical characteristics. In addition, self-reported data on foot health-related quality of life were recorded using the Spanish version of the Foot Health Status Questionnaire. The sample consisted of 498 participants (249 cases and 249 controls), with a median age of 30 years and an interquartile range of 23 years. The differences between the groups were statistically significant for gender, age, footwear, general health, foot health, and physical activity. Cases showed lower scores for the domain of footwear, physical activity and vitality compared to controls. Foot pathologies have a negative impact on quality of life related to foot health, and the domains of footwear, general health and physical activity seem to be the factors that are associated with the presence of alterations and foot deformities.

Static foot posture and its relation to clinical variables in ankylosing spondylitis.

AIM: Postural abnormalities of the foot are common in rheumatic diseases. Static foot posture is a poorly studied clinical parameter in ankylosing spondylitis (AS). The aim of the study was to evaluate static foot posture in patients with AS and to determine the potential impact of clinical variables on foot posture. METHOD: Fifty patients with AS and 40 age- and sex-matched healthy controls were enrolled in the study. Disease activity was measured using the Ankylosing Spondylitis Disease Activity Score. Axial mobility was evaluated with the Bath Ankylosing Spondylitis Metrology Index three-point answer scale. Functional status was assessed by the Bath Ankylosing Spondylitis Functional Index and Health Assessment Questionnaire-Disability Index. Enthesitis and foot posture were evaluated by the Maastricht Ankylosing Spondylitis Enthesitis Score (MASES) and Foot Posture Index-6, respectively. RESULTS: Patients with AS revealed significantly higher scores of foot posture index when compared with controls (P = 0.005). Abnormal foot posture (pronated and supinated) was more common in the patient group (P < 0.01). According to the multinomial logistic regression analysis, a higher MASES score was associated with supinated foot posture in AS patients (odds ratio 1.47, 95% confidence interval 1.03-2.09, P = 0.035). In addition, supinated foot posture was associated with enthesitis of the Achilles tendon (P = 0.002). CONCLUSION: Enthesitis is related to deteriorated static foot posture in patients with AS. Enthesitis of the Achilles tendon is closely associated with the supinated foot posture.

Functional dystonia in the foot and ankle.

AIMS: To assess the characteristic clinical features, management, and outcome of patients who present to orthopaedic surgeons with functional dystonia affecting the foot and ankle. METHODS: We carried out a retrospective search of our records from 2000 to 2019 of patients seen in our adult tertiary referral foot and ankle unit with a diagnosis of functional dystonia. RESULTS: A total of 29 patients were seen. A majority were female (n = 25) and the mean age of onset of symptoms was 35.3 years (13 to 71). The mean delay between onset and diagnosis was 7.1 years (0.5 to 25.0). Onset was acute in 25 patients and insidious in four. Of the 29 patients, 26 had a fixed dystonia and three had a spasmodic dystonia. Pain was a major symptom in all patients, with a coexisting diagnosis of chronic regional pain syndrome (CRPS) made in nine patients. Of 20 patients treated with Botox, only one had a good response. None of the 12 patients who underwent a surgical intervention at our unit or elsewhere reported a subjective overall improvement. After a mean follow-up of 3.2 years (1 to 12), four patients had improved, 17 had remained the same, and eight reported a deterioration in their condition. CONCLUSION: Patients with functional dystonia typically presented with a rapid onset of fixed deformity after a minor injury/event and pain out of proportion to the deformity. Referral to a neurologist to rule out neurological pathology is advocated, and further management should be carried out in a movement disorder clinic. Response to treatment (including Botulinum toxin (Botox) injections) is generally poor. Surgery in this group of patients is not recommended and may worsen the condition. The overall prognosis remains poor. Cite this article: Bone Joint J 2021;103-B(6):1127-1132.