Biomechanical Evaluation of Hemiarthroplasty in the First Proximal Phalanx. A Finite Element Study

ABSTRACT Hallux rigidus produces a decrease in the dorsiflexion of the first metatarsophalangeal joint and is usually associated with the appearance of osteophytes. Hemiarthroplasty in the first proximal phalanx is a recommended surgical procedure in patients with advanced grade of hallux rigidus. Finite element analysis allows us to understand the biomechanical behavior of the foot. The objective of this work is to evaluate the biomechanical effects of an hemi implant placed in first proximal phalanx. Two models of finite elements are going to be compared, one free of pathologies and the other with a hemiarthroplasty in the first ray of the foot. We detected after inserting the prosthesis in the model that passive windlass mechanism is lost, and the lesser toes become overloaded, which leads to a loss of efficiency in gait as well as being able to cause postsurgical medical complications.

[The experience of caring for people with eating disorders: a qualitative study of nurses' perspectives].

BACKGROUND: Eating disorders (ED) are an increasingly prevalent problem with serious consequences for different spheres of life. This study aims to analyze nurses' perspectives and experiences of the care provided to people diagnosed with an ED. METHODS: Hermeneutical phenomenological qualitative study. Nineteen nurses from Alcalá de Henares (Madrid) collab-orated in the research sharing their experience through interviews and stories, which were recorded, transcribed and analyzed thematically. RESULTS: Three issues were obtained: a fight between the heart and mind, conscious reflection: the body says what the head keeps silent and learning how to care holistically. Nurses experience a struggle with their feelings of transference / countertransference when caring for patients. They set out to combine skills acquired from their experience with new research, without losing sight of the individual and the factors involved (family, society and work), which are key to understand the patient's experience and recovery. CONCLUSIONS: Nurses need more specialization, ongoing training, coordination and teamwork with other professionals to provide people with holistic care. Gender perspectives should be taken into account to enable care to be adapted to the needs of men and women. This study takes an in-depth look at the care relationship between nurse and patient, to obtain a hitherto unknown perspective of care, which makes it possible to expand knowledge and individualize the care provided.

La experiencia de cuidar a personas con trastornos alimentarios: un estudio cualitativo desde la perspectiva del profesional de enfermería / The experience of caring for people with eating disorders: a qualitative study of nurses' perspectives

FUNDAMENTO: Los trastornos de la conducta alimentaria (TCA), cada vez más prevalentes, tienen graves consecuencias sobre las diferentes esferas de la vida. El objetivo es analizar la visión y experiencia de profesionales de Enfermería sobre los cuidados prestados a personas diagnosticadas de un TCA. MÉTODO: Estudio cualitativo fenomenológico hermenéutico. Diecinueve enfermeras de Alcalá de Henares (Madrid) colaboraron en la investigación aportando su experiencia a través de entrevistas y relatos que fueron grabados, transcritos y analizados temáticamente. RESULTADOS: Se obtuvieron tres temas: una lucha entre cabeza y corazón, una reflexión consciente: el cuerpo dice lo que la cabeza calla, y aprender a cuidar de manera holística. El profesional experimenta una lucha con sus sentimientos de transferencia / contratransferencia a la hora de cuidar a los pacientes, trata de combinar los conocimientos fruto de la experiencia con las nuevas investigaciones, y considera la individualidad de la persona y todos los elementos implicados (familia, sociedad u ocupación) que resultan claves para el entendimiento de la vivencia del paciente y su recuperación. CONCLUSIONES: Es necesaria la especialización de las enfermeras, la formación continuada, la coordinación y el trabajo en equipo con otros profesionales para cuidar de manera holística a la persona. La perspectiva de género debe tenerse en cuenta para adaptar los cuidados a las necesidades de hombres y mujeres. Este estudio profundiza en la relación de cuidados entre enfermera y paciente, obteniendo una perspectiva desconocida de cuidados que posibilita ampliar el conocimiento e individualizar los cuidados prestados

BACKGROUND: Eating disorders (ED) are an increasingly prevalent problem with serious consequences for different spheres of life. This study aims to analyze nurses' perspectives and experiences of the care provided to people diagnosed with an ED. METHODS: Hermeneutical phenomenological qualitative study. Nineteen nurses from Alcalá de Henares (Madrid) collaborated in the research sharing their experience through interviews and stories, which were recorded, transcribed and analyzed thematically. RESULTS: Three issues were obtained: a fight between the heart and mind, conscious reflection: the body says what the head keeps silent and learning how to care holistically. Nurses experience a struggle with their feelings of transference / countertransference when caring for patients. They set out to combine skills acquired from their experience with new research, without losing sight of the individual and the factors involved (family, society and work), which are key to understand the patient's experience and recovery. CONCLUSIONS: Nurses need more specialization, ongoing training, coordination and teamwork with other professionals to provide people with holistic care. Gender perspectives should be taken into account to enable care to be adapted to the needs of men and women. This study takes an in-depth look at the care relationship between nurse and patient, to obtain a hitherto unknown perspective of care, which makes it possible to expand knowledge and individualize the care provided

Impact of the mechanical hyperkeratotic lesions and its association with quality of life: An observational case-control study.

BACKGROUND: Mechanical hyperkeratotic lesions (MHL) are common condition amongst population of all ages. Such problems may be associated with pain, reduction in mobility, changes of gait and risk of falls and is believed to affect the quality of life (QoL), general health and optimal foot health. OBJECTIVE: The main aim of this study was to describe and compare both foot and general health-related QoL in two groups of participants: (i) with MHL and (ii) healthy controls. METHOD: A total sample of 150 patients, mean age 49.50 ± 36.50 years, was recruited from an outpatient clinic. Demographic data, medical history and clinical characteristics of overall health were determined, and the obtained values were compared by the Foot Health Status Questionnaire (FHSQ). RESULTS: The FHSQ scores of the sample with MHL showed lower scores than control subjects in sections one and two for footwear, general and foot health, foot pain, foot function and physical activity (P < 0.01), but not for social capacity and vigour (P > 0.01). CONCLUSIONS: People with MHL showed a decrease in QoL, based on FHSQ scores, regardless of gender.

Skin temperature in youth soccer players with functional equinus and non-equinus condition after running.

OBJECTIVES: To check how a thermal IR camera can check skin temperature in gastrocnemius-soleus equinus condition and non-gastrocnemius-soleus condition in youth soccer players and thus detect association between the extensibility of the triceps surae (with gastrocnemius-soleus equinus and non-gastrocnemius-soleus equinus) and the muscle temperature pattern. DESIGN: A cross-sectional study secondary level of care. METHODS: Sample from an elite soccer academy in Madrid (Spain) 35 healthy male subjects (youth soccer players) age 12.82 ± 1.07 years, height 158.68 ± 10.79 cm, weight 49.19 ± 9.45 kg, body mass index 19.41 ± 2.25. The exclusion criteria were the presence of musculoskeletal and joint injuries, pelvic pain, ankle sprains, low back pain and use of drugs in the previous week, and scoliosis. RESULTS: Temperature value for gastrocnemius muscles and Achilles tendon were assessed in 35 youth soccer players from an academia before and after training in both 12 gastrocnemius-soleus equinus and 23 non-gastrocnemius-soleus equinus soccer players conditions. State absolute for gastrocnemius soleus condition obtained a 0.34 value (0.19-0.5); we found a significant increase in temperature among these conditions for the gastrocnemius (P = 0.028) and the Achilles tendon (P = 0.007) (confidence interval 95%). The temperature of gastrocnemius-soleus equinus for gastrocnemius and Achilles tendon was increased more than non-gastrocnemius-soleus equinus in youth soccer players. CONCLUSIONS: IR imaging captured temperature is associated with muscle pattern activation for lower limb. Based on our findings, we propose that infrared thermography evaluation of the gastrocnemius and Achilles tendon is suitable to differ gastrocnemius-soleus equinus and non-gastrocnemius-soleus equinus conditions in youth soccer players.

Impact on quality of life related to foot health in a sample of menopausal women: a case-control observational study.

OBJECTIVE: To describe and compare the impact of foot health and health in general on quality of life in a sample of menopausal women and non-menopausal women with normalized reference values. METHODS: A total of 146 participants with a mean age of 50.51 ± 3.977 years came to a health center where self-reported data were registered. Participants were divided into menopausal and non-menopausal groups. Scores obtained were compared by the Foot Health Status Questionnaire (FHSQ), which assesses four foot health domains: pain, function, general health and footwear. RESULTS: The menopausal women showed a lower quality of life related to health in general and to foot health specifically. Differences between the two groups were evaluated by means of a t-test for independent samples, showing statistical significance in foot pain, general foot health and social capacity (p < 0.05). CONCLUSIONS: Menopausal women had a lower quality of life related to foot health, which appears to be associated with menopause.

Anatomic relationship of the proximal nail matrix to the extensor hallucis longus tendon insertion.

BACKGROUND: The purpose of this study was to delineate the relationship of the terminal extensor hallucis longus tendon insertion to the proximal limit of the nail matrix of the great toe. MATERIAL AND METHODS: Fifty fresh-frozen human cadaver great toes with no evidence of trauma (average age, 62.5 years; 29 males and 21 females) were used for this study. Under 25X magnification, the proximal limit of the nail matrix and the terminal bony insertion of the extensor hallucis longus tendons were identified. The distance from the terminal tendon insertion to the nail matrix was ascertained using precision calipers, an optical microscope, and autocad(®) software for windows. Twenty-five great toes were placed in a neutral formalin solution and further analysed by histological longitudinal-sections. The specimens were stained with haematoxylin and eosin and examined microscopically to determine the presence of the extensor hallucis longus tendon along the dorsal aspect of the distal phalanx of each great toe. RESULTS: The main result we found in great toes was that the extensor tendon is between the matrix and the phalanx and extends dorsally to the distal aspect of the distal phalanx in all, 100%, specimens. The nail matrix of the great toe is not attached to the periosteum of the dorsal aspect of the base of the distal phalanx as is the case for fingers, because the extensor hallucis tendon is plantar or directly underneath the nail matrix and the tendon is dorsal to the bone. CONCLUSIONS: We have found that the extensor tendon is between the matrix and the phalanx and extends dorsally to the distal aspect of the distal phalanx. The nail matrix of the great toe is not attached to the periosteum of the dorsal aspect of the base of distal phalanx as is the case in fingers, because the extensor hallucis tendon is plantar or directly underneath the nail matrix and the tendon is dorsal to the bone. Our anatomic study demonstrates that the proximal limit of the matrix and nail bed of the human great toe are dorsal and overlapping the terminal extensor hallucis longus tendon until its distal bony insertion in all specimens.

Mechanical stress redistribution in the calcaneus after autologous bone harvesting.

The calcaneus is a desirable site for harvesting autologous bone for use in foot surgery. However, fracture of the calcaneus is a serious complication associated with bone harvesting from this site. Currently it is unknown how much bone may be safely harvested from the calcaneus without inducing a fracture. The purpose of this study was to investigate the effect of progressive bone removal from the calcaneus onto the mechanical stress redistribution of the foot, and therefore on the increase in fracture risk. Different loads were applied on the talus to evaluate the calcaneus stress distribution at different situations. Because of the potential increase in mechanical stress in the calcaneus, secondary to contraction of the Achilles tendon, we also evaluated the mechanical behavior properties of the foot with increasing traction force in the Achilles tendon. A three-dimensional (3D) finite element (FE) model developed from CT images obtained from a healthy individual was used to compute displacement, tension and compression stresses in six situations, including intact foot, and five depth of the bone block removed, with a maximum depth of 7.5 mm. The results from these simulations indicated that when the maximum load was applied at the Achilles tendon, the tension stress increased from 42.16 MPa in the intact foot to 86.28 MPa with maximum bone harvesting. Furthermore, as the volume of bone extracted from the calcaneus increases, there is a redistribution of stresses that differs significantly from the intact foot. In fact, although the maximum stress was not significantly affected by increasing the volume of bone harvested-except when increasing the Achilles tendon force-, stresses did increase in areas of the calcaneus is vulnerable to injury, leading to an increase in fracture risk.

Renal excretion of phenol from physicians after nail matrix phenolization: an observational prospective study.

BACKGROUND: Animal studies have shown that many signs of acute poisoning result from phenol entry into the systemic circulation by absorption or ingestion. While no evidence of systemic complications in patients who have undergone phenol nail matrixectomies have been reported, the safety of phenol vapour inhalation by physicians performing this treatment has yet to be investigated. OBJECTIVE: The goal of this study was to determine whether the levels of phenol to which physicians are exposed to during a phenol-based matrixectomy procedure are within the limits of safe exposure. METHODS: A continuous prospective study was carried out to measure the urinary phenol concentrations from physicians after performing chemical matrixectomy for ingrown toenails. RESULTS: The highest concentration of urinary phenol was measured at almost 10 mg/L within the first 2 h after exposure, and subsequently decreased approximately 1 mg/L every 2 h for the first 10 h post exposure. The levels dropped to 3 mg/L at 72 h post exposure. CONCLUSIONS: The risk associated with phenol exposure while performing chemical phenol matrixectomy was well below the current safety limits when the physician is exposed to 90% phenol vapour for approximately 20 min. Thus, no further specific safety recommendations are required for physicians performing this procedure.

Evidence of the efficacy of alcohol lavage in the phenolization treatment of ingrown toenails.

BACKGROUND: For treatment of ingrown toenails, a phenolization is often chosen. Many reports describe an intra-operative irrigation or lavage of the wound with various types of alcohol to neutralize any residual phenol from this treatment. There are conflicting reports in the literature as to whether a true neutralization is required or merely effective removal of excess phenol. OBJECTIVE: The aim of our study was to analyse the suitability and effectiveness of the alcohol lavage step during the treatment of ingrown toenails with a phenolization procedure. METHODS: We performed an in vitro study using human skin and a diffusion cell apparatus to measure the amount of phenol remaining after various lavage washes. The effect of phenol evaporation was also examined. RESULTS: There was no measurable amount of phenol collected after each experiment, suggesting that diffusion of phenol through the skin does not exist. The open compartment test had significantly less phenol recovered compared with the occluded compartment test, indicating phenol evaporation. STUDY LIMITATIONS: None. CONCLUSIONS: An alcohol lavage step after the phenolization procedure can be a suitable and effective means of diluting and removing any excess or residual phenol from the exposed area.

Self-reported musculoskeletal disorders in podiatrists at work.

UNLABELLED: OBJECTOVE: The objective of the study was two-fold: (1) to ascertain the prevalence of musculoskeletal disorders in podiatrists in Spain, and (2) to identify relationships between intensity and duration of pain and socio-demographic variables. METHODS: Epidemiological analysis of Spanish self-employed or salaried podiatrists who had at least 1 year's experience, worked at least 20 hours per week, and had five patients per working day. The survey consisted of (1) identification of musculoskeletal disorders using the Standardized Nordic questionnaire for analysis of musculoskeletal symptoms; (2) assessment of perceived pain using the Borg CR-IO scale; and (3) analysis of specific socio-demographic variables. We used basic descriptive statistics to analyse the socio-demographic characteristics and perceived pain. Chi squared, Student's t-test, and ANOVA were used to determine differences between variables. RESULTS: The sample consisted of 274 women (65.08%) and 147 men (34.92%), for a total of 421 podiatrists. The females were older and reported a higher pain score compared to the males, however neither values showed statistical significance. When combining genders, pain intensity was significantly related to marital status (p = 0.006, IC 95%). The most frequently reported locations for musculoskeletal symptoms during the previous 7 days were the lower back, upper back and neck (33.02%, 21.85% and 21.62% respectively). They were also the most frequently reported locations for the previous 12 months (21.38%, 13.06% and 13.54% respectively). Female podiatrists and younger podiatrists reported more musculoskeletal complaints in the previous 7 days and younger podiatrists during previous 12 months. CONCLUSION: There is a significant prevalence of musculoskeletal complaints in daily podiatry work and the most affected body areas are the lower back, upper back and neck. The most affected demographic classes seem to be the younger age groups, females and married podiatrists.

Total nail ablation for onychodystrophy with optimized gauze-phenol application.

BACKGROUND: Nail disorders are frequent among the geriatric population and unfortunately, repeat avulsion procedures often result in complications. OBJECTIVE: To utilize a phenol-based total matricectomy technique for permanent nail ablation and evaluate its effectiveness. METHODS: We performed total nail ablation on 34 toenails of the hallux (30 patients) with a gauze-phenol application technique and evaluated the degree of pain reported by the patient 12 months postoperatively compared with the preoperative stage. Furthermore, we evaluated the patients' satisfaction with the final cosmetic appearance as well as their satisfaction with the overall procedure. RESULTS: All patients reported 'too much' or 'severe' pain prior to surgery and 94.11% reported 'no pain' 12 months post-surgery. A vast majority of the patients (82.35%) felt pleased with the cosmetic results and all patients reported that they were 'very satisfied' or 'strongly satisfied' with the procedure when interviewed at their 12 month follow-up examination. LIMITATIONS: There were a limited number of participants in this study across an extensive timeframe. CONCLUSION: Phenol-based total nail ablation with specific gauze application is safe, inexpensive and has a high rate of patient satisfaction.