Confecção de bota ortopédica com molde de gesso

Apresenta as funções e a finalidade do calçado ortopédico, prescrito para pacientes com pés anestésicos ou com deformidades. Detalha os materiais e técnicas para confecção de bota ortopédica com molde de gesso. Finaliza com orientações sobre o uso correto da bota pelo paciente

Long-term effects on body functions, activity and participation of hemiplegic patients in equino varus foot deformity surgical correction followed by immediate rehabilitation. A prospective observational study.

Background: Functional surgery is an effective approach in the treatment of the rigid equinovarus foot deformity (EVFD). This must be associated with early rehabilitation treatments (ERTs) to prevent muscle rearrangements due to immobilization. Objectives: To assess the effects of EVFD surgical correction in adult stroke patients, when assessed according to the ICF domains. Methods: Variables from 24 adult chronic stroke survivors with EVFD surgical correction followed by ERT, age 55 ± 13 years, affected side 12L/12R, time from lesion 5 ± 4 years were analyzed. Body function domain: pain (NPRS), walking speed, clinical global impression of change (cGIC). Activity domain: Rivermead Mobility Index (RMI), FAC, and 6 min walking test (6MWT). Participation domain: Walking Handicap Scale (WHS). Patients were assessed before (T0), one (T1), three (T2) and twelve (T3) months after surgery by a single assessor. Results: All variables but the 6MWT significantly improved (Wilcoxon test, p < .05) at T1 or T2 and this remained until the 12-months mark. Since T1, all patients reached and maintained a supervised independent walking (FAC≥3) and all those wearing an AFO stopped using it. The median cGCI was "much improved" at T1, with a "further minimal improvement" at T3. This was not associated with the improvement measured by both FAC, and WHS (Chi-square test, p = .20 and p = .36, respectively). Conclusions: Functional surgery combined with ERT is effective in improving the patients' condition according to all ICF domains. Both subjective and objective assessments have to be used when assessing these patients.

"Come and live with my feet and you'll understand" - a qualitative study exploring the experiences of retail footwear in women with rheumatoid arthritis.

BACKGROUND: Foot pain and deformity are common in people with rheumatoid arthritis (RA). Previous research has identified that women with RA seek retail footwear to alleviate their foot problems. The specific footwear features that women with RA require, and what would help them to find shoes that meet these requirements, are unknown. This study aimed to determine the factors that influence the choice of appropriate retail footwear by women with RA. METHOD: An overarching qualitative approach was taken, using reflexive thematic analysis of conversational style interviews. The interviews explored experiences and use of retail footwear in 20 women with RA. The interviews were digitally recorded transcribed verbatim and analysed using a reflexive thematic framework. RESULTS: Women with RA sought retail footwear which had adequate cushioning, width, a flexible sole, lightweight, were made from breathable materials and were easy to put on and take off. However, this choice was driven by the need for comfort, cost and usability, with aesthetics being less of a priority. Despite having opinions on what criteria they felt that they needed, these women did not feel empowered to make good choices about purchasing retail footwear for symptomatic relief. Furthermore, they did not receive the necessary support from podiatrists and shoe shop staff. CONCLUSION: Women with RA have clear ideas about what features a retail shoe should have to achieve comfort. There is a constant compromise between achieving comfort and their feelings about their appearance and how they feel others perceive them. Women with RA describe negative experiences with shoe shop assistants and podiatrists leading to poor footwear choices. Both retail staff and podiatrists need increased understanding about the particular problems that women with RA experience.

Experience of finding footwear and factors contributing to footwear choice in people with gout: a mixed methods study using a web-based survey.

BACKGROUND: Gout frequently affects the foot, particularly the first metatarsophalangeal joint. People with gout commonly wear ill-fitting footwear that lacks cushioning and support, which may further contribute to foot pain and disability. Footwear with good cushioning and motion control may be an effective non-pharmacological intervention. Currently, there is limited understanding about the footwear experience in people with gout. The aim was to understand footwear characteristics, experience of finding footwear, and factors contributing to footwear choice, in people with gout. METHODS: A web-based survey of people visiting a gout education website. Participants self-reported a diagnosis of gout. The 17-item survey included questions to elicit demographic and clinical characteristics, type of footwear worn, level of difficulty finding appropriate footwear, and factors contributing to choices about footwear. A mixed quantitative and qualitative methodology was used to report survey findings. RESULTS: Survey respondents (n = 83) were predominately White/Caucasian (84%), male (58%), and aged between 46 and 75 years-old (73%). Thirty-nine percent were newly diagnosed (< 12 months), 43% had gout for 1-10 years, and 19% had disease over 10 years. Gout flares in the feet were reported by 77 (93%) respondents, mostly in the big toe joint (73%). Seventy-six (92%) participants completed questions about footwear. Closed-in athletic shoes (88%), sturdy walking shoes (79%), and casual closed-in slip-on shoes (63%) were most frequently worn. Orthopaedic shoes were worn least often (16%). Comfort, fit, support, and ease to put on/take off were the features most often rated as important or very important when choosing footwear. Over half the respondents (64%) reported difficulty in finding footwear. Three categories, encompassing seven subcategories, were identified from the qualitative analysis to describe experiences of footwear. Categories included difficulty finding suitable shoes; impact of shoes on activity; and preferred footwear. CONCLUSIONS: People with gout need comfortable shoes that conform to the foot, have a wide opening, made from pliable materials with adjustable straps. The main barriers related to footwear include difficulty finding shoes that are wide enough, suitable for work and aesthetically pleasing. These findings provide clinicians with important insights into the priorities and needs of people with gout that should be considered when developing footwear interventions.

Footwear choices for painful feet - an observational study exploring footwear and foot problems in women.

BACKGROUND: A high percentage of the population report footwear related foot pain, yet there is limited research on the effect footwear has on the development of this pain. The aim of this study was to establish whether footwear purchased by patients have an association with foot pain and what choices determined a purchase decision. METHODS: Shape and size measurements of the dominant foot and footwear (length and width) were taken from 67 female participants who routinely received podiatric treatment. Participants were also asked to complete a short questionnaire to rate the shoe characteristics, emotions whilst wearing and reasons for the purchase. RESULTS: Results highlighted a high prevalence of structural foot pathology for those over 61 who preferred slip on shoes. This group also wore shoes that were significantly narrower than their feet with width difference correlating to the presence of Hallux Abductovarus (HAV). In addition, results indicate that individual footwear advice is more important than previously thought, as it is clear that choice of footwear worn to podiatry appointments are not always worn on a daily basis. CONCLUSIONS: This study emphasises that the width of the shoe is an important part of fit, highlighting the need for patient specific footwear assessment and education for behaviour changes.

Adult-acquired flatfoot deformity.

Adult-acquired flatfoot deformity (AAFD) is a known and recognized cause of pain and disability. Loss of PTT function is the most important contributor to AAFD, and its estimated prevalence is thought to be over 3%. This review aims to summarize the current literature and encompass recent advances regarding AAFD.

[Arthrodesis of the First Metatarsophalangeal Joint by Locking Plate]. / Artrodéza I. metatarzofalangeálního kloubu úhlove stabilní dlahou.

PURPOSE OF THE STUDY The authors in their paper evaluate a group of patients who underwent arthrodesis of the first metatarsophalangeal joint using a locking plate. MATERIAL AND METHODS In the period 2010-2015, we performed surgery in 51 patients (56 forefeet), of which in 5 cases bilaterally and in 46 cases unilaterally, in 38 women and 13 men. The mean age was 57.8 years, the mean follow-up was 3.1 years. The indications for surgery were hallux rigidus in 23 patients, hallux valgus in 15 patients, hallux varus in 3 patients, and hallux erectus in 2 patients. In 4 patients the surgery was performed for valgus deformity associated with rheumatoid arthritis, 9 patients were indicated for a failure of the prior surgical intervention. In all 56 forefeet, the anatomic, low-profile titanium plate Variable Angle LCP 1st MTP Fusion Plate 2.4/2.7 was used. RESULTS According to Gainor s score the surgical outcomes were assessed as excellent in 46 patients who underwent surgery (90%), good in 4 patients (8%), fair in 1 patient (2%), and poor in 0 patient (0%). In 53 forefeet, the control radiographs showed solid bone union. In 2 patients and 3 forefeet, non-union of the arthrodesis occurred. In 2 forefeet, revision arthrodesis was performed, after which solid bone union followed. Malpositioned union was reported in 5 forefeet, of which in 4 cases into valgosity and in 1 case into dorsiflexion. DISCUSSION Numerous fixation materials can be used for arthrodesis of the first metatarsophalangeal joint. The use of the least stable Kirschner wires (cerclage) is being abandoned and substituted with a more stable fixation by screws, memory staples and locking plates. The achievement of excellent results requires proper positioning of the arthrodesis. Impingement syndrome between the big toe and the second toe can result in painful callosities formation, too large dorsiflexion can lead to a hallux hammertoe, with reduced big toe support function, to metatarsalgia. CONCLUSIONS The arthrodesis is indicated in patients with Grade III and IV hallux rigidus, with severe hallux valgus, hallux varus, and in patients in whom the previous surgeries failed. We tend to prefer stable arthrodesis. Fixation by anatomic LCP plate facilitates early rehabilitation, loading and early return to work and sports activities. Key words: arthrodesis, metatarsophalangeal joint, hallux rigidus, hallux valgus.

Footwear characteristics in people with inflammatory arthritis in Singapore.

BACKGROUND: Foot problems are common in people with inflammatory arthritis. Despite suitable footwear having the potential to alleviate pain, improve mobility and maintain independence, previous studies have found many people with inflammatory arthritis wearing poorly fitting and inappropriate footwear. Footwear styles and characteristics have not been reported in a Singapore inflammatory arthritis population. The objective of this study was to identify current footwear styles and characteristics of footwear worn by people with inflammatory arthritis in Singapore. METHODS: One-hundred-and-one participants with inflammatory arthritis were recruited from the rheumatology outpatient clinic of a large public hospital in Singapore. Disease and clinical characteristics were recorded. A patient-reported outcome included current foot pain. An objective footwear assessment of style, age of shoe, fit and construction was conducted. RESULTS: The majority of participants were Chinese women with a mean (SD) age was 52.0 (15.0) years old and a mean (SD) disease duration of 9.3 (0.3) years. We found 50 % of participants (n = 51) reported footwear problems. Sandals (n = 27, 26 %), flip-flops (n = 19, 19 %) and moccasin type (n = 19, 19 %) was the most common footwear choice. Evaluation of footwear characteristics found that there was a lack of motion control features. Only 32 (32 %) participants had correctly fitting footwear with regard to length, width and depth. No participant was wearing therapeutic footwear. CONCLUSION: This study provides the first insight into footwear preferences of people with inflammatory arthritis in Singapore. Use of slip-on and poorly fitting footwear was found to be common in people with inflammatory arthritis. Further research on footwear preferences in Southeast-Asian communities needs to take into account cultural habit and preference, socio-economic status, footwear options and affordability.

Surgical treatment of the Charcot foot.

With the increased number of diabetics worldwide and the increased incidence of morbid obesity in more prosperous cultures, there has become an increased awareness of Charcot arthropathy of the foot and ankle. Outcome studies would suggest that patients with deformity associated with Charcot Foot arthropathy have impaired health related quality of life. This awareness has led reconstructive-minded foot and ankle surgeons to develop surgical strategies to treat these acquired deformities. This article outlines the current clinical approach to this disabling medical condition.

Surgical management of Charcot neuroarthropathy of the ankle and hindfoot in patients with diabetes.

BACKGROUND: Charcot neuroarthropathy (CN) of the ankle and hindfoot (Sanders/Frykberg Type IV) is challenging to treat surgically or nonsurgically. The deformities associated with ankle/hindfoot CN are often multiplanar, resulting in sagittal, frontal and rotational malalignment. In addition, shortening of the limb often occurs from collapse of the distal tibia, talus and calcaneus. These deformities also result in significant alterations in the biomechanics of the foot. For example, a varus ankle/hindfoot results in increased lateral column plantar pressure of the foot, predisposing the patient to lateral foot ulceration. Collapse of the talus, secondary to avascular necrosis or neuropathic fracture, further accentuates these deformities and contributes to a limb-length inequality. SURGICAL MANAGEMENT: The primary indication for surgical reconstruction is a nonbraceable deformity associated with instability. Other indications include impending ulceration, inability to heal an ulcer, recurrent ulcers, presence of osteomyelitis and/or significant pain. Arthrodesis of the ankle and/or hindfoot is the method of choice when surgically correcting CN deformities in this region. The choice of fixation (i.e. internal or external fixation) depends on largely on the presence or absence of active infection and bone quality. CONCLUSION: Surgical reconstruction of ankle and hindfoot CN is associated with a high rate of infectious and noninfectious complications. Despite this high complication rate, surgeons embarking on surgical reconstruction of ankle and hindfoot CN should strive for limb salvage rates approximating 90%. Preoperative measures that can improve outcomes include assessment of vascular status, optimization of glycemic control, correction of vitamin D deficiency and cessation of tobacco use.

[Orthopedic shoes: Still in touch with the times?]. / Orthopädische Schuhversorgung: Noch zeitgemäß?

BACKGROUND: Deformities of the foot due to rheumatic disease, particularly rheumatoid arthritis, occur in 85-95% of patients during the course of their disease. OBJECTIVE: This study investigates whether treatment with orthopedic shoes still has a place in modern therapies. RESULTS: Foot orthotics and technical orthopedic shoes can play an important role in purely conservative treatment as well as postoperative therapy. CONCLUSION: Due to a lack of knowledge concerning modern orthopedic shoe techniques, this treatment option has slipped out of focus--in part because of its association with the old-fashioned unshapely black orthopedic shoes. Nevertheless, these shoes can contribute significantly to maintenance of patient mobility; a factor of extreme importance to the individuals who already suffer considerably from the disease per se.

Biomechanical Evaluation of Custom Foot Orthoses for Hallux Valgus Deformity.

The purpose of the present study was to compare the hallux valgus deformity pressure parameters seen in standard footwear (no orthosis) versus the pressure observed in the same footwear with the addition of 3 different length orthoses. The forefoot pressure at a hallux valgus deformity was recorded with pressure sensors placed on the plantar, medial, and dorsal surface of the first metatarsal head. The participants performed walking trials without an orthosis and with orthoses of 3 different lengths. The average pressure and maximum pressure of each area was recorded for each orthosis, and comparisons were made across the groups. The plantar pressures were decreased in the full length and 3/4 length orthoses, and the dorsal pressures were increased with the use of the full-length and sulcus-length orthoses. Significant changes in medial pressure were not seen with the addition of any orthosis compared with standard footwear alone. However, a trend toward increased medial pressures was seen with the full- and sulcus-length orthoses, and the 3/4-length orthoses exhibited a trend toward decreased medial pressures. We were unable to demonstrate that the use of a custom foot orthosis significantly decreases the medial pressures on the first metatarsal head in patients with hallux valgus deformity. The 3/4-length orthosis was less likely to negatively affect the dorsal or medial pressures, which were noted to increase with the sulcus- and full-length orthoses. Our data suggest that if a clinician uses this treatment option, a 3/4-length orthosis might be a better choice than a sulcus- or full-length orthosis.

The development, preliminary validation and clinical utility of a shoe model to quantify foot and footwear kinematics in 3-D.

Functional electrical stimulation (FES) applied to the common peroneal nerve is commonly prescribed to correct both equinus and excessive foot inversion in swing and initial contact. This paper presents the development of a simple shoe model, to allow quantification of 3-D shoe (foot and footwear) kinematics in clinical situations when footwear is required, e.g. with FES systems requiring footswitches. To preliminarily validate the shoe model, barefoot 'normal' adult data (n=11) processed using validated 3-D foot models, were reprocessed with the shoe model. Outputs were compared through calculation of waveform similarity and correlation. Clinical utility of the shoe model is demonstrated through the presentation of 3-D shoe kinematics, calculated from a cohort of existing unilateral common peroneal FES users (n=16), both with and without FES. A trend of reduced inversion at mid-swing and initial contact was seen, although this was not found to be statistically significant (p≤0.0125). The shoe model was found to be practical to use in a clinical environment, and has potential to contribute to the evidence base for interventions such as common peroneal FES.

Rasch analysis of Dutch-translated version of the Foot Impact Scale for rheumatoid arthritis.

OBJECTIVE: To translate the foot impact scale for RA (FIS-RA) to the dutch target language and to evaluate its internal construct validity using rasch analysis. METHODS: Forward and backward translations of the original English version of the FIS-RA scale, combined with synthesis techniques and expert committee review, were undertaken to produce a final Dutch version with two subscales for impairment/footwear (FIS-RA(IF)) and activity/participation (FIS-RA(AP)). The pre-final version was field tested in RA patients to investigate face and content validity. FIS-RA questionnaires were completed by 207 Dutch RA patients. Rasch analysis tested the data for overall fit to the model, item and person fit, unidimensionality, differential item function (DIF) by age, gender and disease duration, targeting, reliability and local response dependency. Item deletion and re-analysis were planned, where Rasch model assumptions were violated. RESULTS: The FIS-RA(IF) (P < 0.0001) and FIS-RA(AP) (P < 0.0001) subscales did not fit the overall Rasch model. Misfitting items, DIF by age, gender and disease duration, and local response dependency were observed in both subscales. Item thresholds showed good coverage over both scales although a floor effect was observed for the FIS-RA(AP) subscale. The person separation index was 0.81 and 0.92 for the FIS-RA(IF) and FIS-RA(AP) subscales, respectively. Both subscales were not unidimensional. Item deletion and repeat Rasch analysis produced two subscales that fitted the Rasch model and were unidimensional. CONCLUSION: A Dutch language version of the FIS-RA questionnaire was successfully developed using Rasch analysis. Subscales for impairment/footwear and activity/participation showed good construct validity and were unidimensional.

Direct neurectomy of the motor branches of the tibial nerve in hemiplegic adults: an assessment with a mean follow-up period of 11 years.

INTRODUCTION: Neurectomy of the tibial nerve plays a major role in the relief of disabling spasticity, which is refractory to drug treatment and physiotherapy. Although the immediate postoperative results are generally satisfactory, few evaluations of the procedure's long-term efficacy have been published. OBJECTIVE: To estimate the long-term efficacy of total or partial neurectomy of the motor branches of the tibial nerve (combined with additional orthopaedic surgery in some cases). METHOD: A descriptive, retrospective study of 25 brain-damaged patients having undergone neurectomy at least 4 years ago. RESULTS: The mean post-neurectomy follow-up period was 11 years. Twenty patients became less dependent on the use of walking aids. Of the 18 patients unable to walk barefoot before surgery, 11 could do so after surgery. Of the 12 patients unable to walk on uneven ground before surgery, seven could do so afterwards. The walking distance increased for 20 patients. In 22 cases, the spasticity disappeared immediately after the operation and did not reappear in the long-term. In three other cases, spasticity persisted postoperatively and, in the long-term, affected the soleus (the denervation of which had been incomplete or not performed). Eighty-three percent of the patients were satisfied with the operation's outcome. CONCLUSIONS: The observed maintenance of the benefits of total or partial neurectomy after an average follow-up period of 11 years confirms the value of this procedure. The few mediocre outcomes (observed in cases of partial neurectomy of the soleus) are in agreement with literature reports and emphasize the role of the soleus in this pathology.

Neuromuscular deformity: treatment with external fixation.

A multiplanar foot deformity is defined by the presence of more than one deformity affecting the foot. These deformities may develop in any plane, including the frontal, sagittal, or transverse planes. This article focuses on the treatment of multiplanar neuromuscular foot deformities with external fixation, reviewing the indications, preoperative planning, techniques, and complications.

Cementless total ankle arthroplasty in diabetic neuropathic arthropathy.

BACKGROUND: Neuropathic arthropathy (Charcot joint) is a progressive degenerative disease of a joint that may lead to severe deformity and dysfunction and it is now recognized that diabetes is the leading cause of Charcot joint. When the ankle is involved and conservative treatment fails arthrodesis has commonly been performed, whereas arthroplasty has previously been considered to be contraindicated. A total ankle arthroplasty in Charcot ankle has not been previously reported. CASE REPORT: We report the case of a 45-year old, diabetic woman with unilateral Charcot ankle. CONCLUSIONS: The woman successfully completed a rehabilitation programme and, 2 years after total ankle arthroplasty, achieved independence.

Internal pedal amputations.

Internal pedal amputation consists of resection of the metatarsals, midtarsal bones, or talus with preservation of the toes and soft-tissue envelope. Although used in the past for the treatment of tuberculosis within the pedal skeleton, internal pedal amputations have become almost forgotten, historical procedures. However, following internal pedal amputations of a diabetic patient, the foot undergoes significant contracture that results in a stable, functional, foreshortened residual foot capable of being protected in custom-molded shoe gear with external or in-shoe orthoses. The author presents the surgical approach and postoperative treatment regime for each form of internal pedal amputation, as well as "pearls" for success.

Eliminating toe-fixing pattern can improve standing and gait pattern of children with cerebral palsy in a qualitative way.

Toe-fixing pattern has been observed to be a compensatory strategy for children with cerebral palsy (CP) to gain body stability. It has been shown that application of toe sponges could eliminate the toe fixing, and thus would force the children with CP to use the potential resources of their impaired postural system. The aim of this study was to investigate the immediate regression and treatment effects of toe-sponges application on standing and walking patterns in children with CP. A controlled experimental study was conducted, involving 24 school-aged children with CP who were ambulatory with or without walking aids. Twelve children in the experimental group wore toe sponges for 3 weeks whereas the other 12 children in the control group did not. The results did not show a significant difference indicating immediate regression after application of toe sponges in all children or a treatment effect in the experimental group after wearing the toe sponges for 3 weeks. Qualitative improvement of walking pattern in the experimental group was, however, observed. It was believed that the effect of toe-sponge application on improving the standing and walking patterns in children with CP was masked by the children shifting the compensation from toe flexion to the other body parts. Issues that need to be considered in the further studies were suggested.