[Analysis of plantar pressure patterns among obese population]. / Elhízott populációra jellemzo talpnyomásminták vizsgálata.

INTRODUCTION: Although the role of body weight on foot health and load has been widely documented in research, the effect of the extra load due to body weight on plantar pressure characteristics is not well known. AIM: The aim of this study was to evaluate the impact of obesity on plantar pressure patterns among the working-age population. METHOD: 180 participants were involved. Two groups were evaluated according to body mass index categories regarding eight regions of the plantar area, focusing on the following parameters: contact area, maximum pressure and peak pressure. RESULTS: Compared with non-obese subjects, the peak pressure was the highest on the midfoot (p<0.001) and the forefoot (p<0.001). Regarding the maximum force, significant statistical difference was detected on the toes (p<0.001), with a value lower among the obese group. The contact area on the total foot and the midfoot was lower among the non-obese subjects (p<0.001). CONCLUSIONS: Loading is greatly increasing on the whole plantar area, especially at the midfoot and the forefoot region. Orv. Hetil., 2016, 157(48), 1919-1925.

Calcaneo-stop procedure for paediatric flexible flatfoot.

BACKGROUND: Flexible flatfoot is a frequent deformity found in children. The aim of this study is to evaluate the pedographic outcome of the percutaneous arthroereisis with the use of a screw through the sinus tarsi into the talus. MATERIALS AND METHODS: 43 calcaneo-stop procedures of 25 patients (18 bilateral, seven unilateral) were evaluated. Mean age at surgery was 10 years (7-14, SD 2.2) (SD: standard deviation), mean follow-up time was 9.7 months (3-19, SD 5.5). Patient satisfaction rate was recorded, the Meary's talus-first metatarsal angle was measured with lateral radiograms, and a dynamic pedographic assessment was also performed. RESULTS: Patient satisfaction rate was excellent for 33 feet of 19 children, good for eight feet of five children, and poor for either feet of one child. We did not observe any complications during or following the surgery.The mean rest heel valgus decreased from 13.4° (10°-17°, SD 1.5) to 2.8° (0°-6°, SD 1.7) post op. The Meary's angle improved from 160.2° (148°-177°, SD 6.8) to 175.9° (167°-179°, SD 3.5). By pedographic analysis, the area and the pressure-time integral (load amount, PTI) values increased on the lateral regions of the sole (except for the lesser toes) and decreased on the medial areas (except for the hallux). The relative contact time in the lateral midfoot increased from 63.8% (39.6-78.4%, SD 10.6) to 75.1% (50-86.1%, SD 9.4), and that in the lateral forefoot region from 81.2% (60.4-89.2%, SD 6.6) to 86.8% (78.1-97.1%, SD 4.8). CONCLUSION: The calcaneo-stop procedure is a simple and reliable method for the correction of severe flexible paediatric flatfoot. Our prospective, short-term results following the anterograde screw implantation into the talus correlate well with the results of similar or different arthroereisis methods. Further investigations are required to evaluate the long-term outcome of the screw calcaneo-stop method, including the conditions following implant removal.

Early experience with the Depuy Proxima short stem in total hip arthroplasty.

Bone saving hip athroplasty is a reasonable option for younger active patients, as they are potential candidates for subsequent revision arthroplasty. In this clinical and radiological study we have evaluated our first 41 consecutive cases of total hip arthroplasty including a DePuy Proxima short stem. Harris Hip Scores (HHS) were calculated preoperatively, and 6,12 and 24 months postoperatively. Mean age at surgery was 49 years (range : 35 to 60), mean follow-up was 26 months (range: 13 to 44). Mean Harris Hip scores increased by 39 and 50 points respectively at 6 and 24 months follow-up. No radiological loosening or migration was observed. In carefully selected young patients when resurfacing is contraindicated, use of the Proxima short stem appears as a simple and effective option for THA. However, longer follow-up time is required to analyse the results and to confirm the durability of the observed clinical out-comes.

Fixation of Akin osteotomy for hallux abductus with absorbable suture.

BACKGROUND: The Akin osteotomy is a widely used procedure where various fixation methods are available, predominantly with the use of metallic component (wire, screw, staple etc.). The aim of this study is to demonstrate the results of our modified Akin procedures, where the fixation of the phalangeal osteotomy is achieved by absorbable suture, without metallic component. MATERIALS AND METHODS: Between July 2004 and October 2008, authors performed their first 22 consecutive Akin procedures with the above technique. Mean age of patients was 49 [standard deviation (SD) 17, range 19-69] years. Mean follow-up time was 26 (SD 13, range 8-57) months. RESULTS: Mean correction of the distal articular set angle (DASA) was 9.4 (SD 7.1, range 5-28) degrees. Mean shortening of the proximal phalanx was 1.8 (SD 1.0, range 0.3-4.1) mm. Among the 22 osteotomies, there was no evidence of non-union, delayed union, excessive bone callus, or loss of correction. 100% of the patients would undergo the procedure again, 91% (20/22) were completely satisfied; and 9% (2/22) were satisfied, including the one complication case. CONCLUSION: The method presented in this study for fixation of the akin osteotomy showed results identical to the ones using conventional (metal) fixation techniques concerning radiological (correction of DASA, shortening of the proximal phalanx), and clinical (complication rate, subjective satisfaction rate) findings, without the risk of complication due to hardware irritation.

The influence of the length of the first metatarsal on transfer metatarsalgia after Wu's osteotomy.

BACKGROUND: The aim of this study was to evaluate how changes in the length of the first metatarsal, hallux valgus angle (HVA), intermetatarsal 1-2 angle (IMA), plantar angulation and sesamoid position influence the severity of the postoperative 2-5 metatarsalgia and to determine patient satisfaction with the cosmetic outcome after Wu's osteotomy. MATERIALS AND METHODS: A retrospective analysis of the clinical data and radiographs of 87 cases was performed at a mean followup time of 4.2 years after Wu's subcapital cross osteotomies. RESULTS: The mean HVA decreased from 42 to 13 degrees, the mean IMA 1-2 from 22 to 10 degrees. The mean first metatarsal lengthening was 0.3 mm. A negative correlation was found between lengthening of the first metatarsal and metatarsalgia at rays 2 and 3. No such pattern was found between the fourth and fifth metatarsal. No correlation was found between the 2-5 metatarsalgia and the decrease in either the HVA or the IMA 1-2. A positive correlation was detected between the HVA decrease and the patients' satisfaction with their postoperative foot alignment; there was no correlation between the perceived postoperative foot alignment and either the first metatarsal lengthening or the IMA 1-2 decrease. CONCLUSION: Preservation of the length of the first metatarsal during osteotomy seems to prevent the postoperative transfer metatarsalgia on the second and third rays; however, it has no major influence on the satisfaction of the patients with their foot alignment. A greater correction of the HVA angle resulted in a higher level of satisfaction with the foot cosmesis.

The effect of first ray shortening in the development of metatarsalgia in the second through fourth rays after metatarsal osteotomy.

BACKGROUND: The aims of this study were to determine the severity of metatarsalgia of the second through fifth rays after shortening of the first ray for correction of hallux valgus deformity and patient satisfaction of the cosmetic results. METHODS: Two hundred and forty metatarsal osteotomies (Wilson osteotomy as modified by Lindgren and Turan) were evaluated 4.19+/-1.29 years postoperatively. The procedure involved a slightly oblique subcapital osteotomy of the first metatarsal and fixation with one screw. RESULTS: The average decrease in the hallux valgus angle was 26+/-5 degrees, the 1-2 intermetatarsal angle was 8.4+/-4 degrees, and the average shortening of the first metatarsal was 3.8+/-1.8 mm. Positive correlations were found between metatarsalgia of the second through fourth rays and first ray shortening (p<0.001 second ray, p<0.001 third ray, and p<0.001 fourth ray); there was no correlation between the fifth ray and first ray shortening. No correlation was found between a decrease in the hallux valgus angle or 1-2 intermetatarsal angle and metatarsalgia in the second through fifth rays. A positive correlation was detected between postoperative foot alignment and decrease in the hallux valgus (p<0.001) and a negative correlation between postoperative foot alignment and first ray shortening (p<0.01). No correlation was noted between postoperative foot alignment and the 1-2 intermetatarsal angle. CONCLUSION: Excessive shortening of the first metatarsal should be avoided to decrease the occurrence of postoperative transfer metatarsalgia. We found a greater patient satisfaction with foot alignment in patients who had a greater decrease in the hallux valgus angle and less shortening of the first ray.

Sociodrama

Este artigo define o sociodrama como um procedimento vivencial grupal destinado a investigacao social e a resolucao de conflitos inter-grupais. O sociodrama deve ser considerado, por isso mesmo, como um correlato da grupanalise, estruturado e orientado para a acao e para o trabalho com grandes grupos. Depois de uma breve descricao de sua historia, pratica e teoria, descrevem-se tres aplicacoes que focalizam, respectivamente, eventos traumaticos concretos e crises sociais, mudancas politicas e desintegracao social e diversidade social que leva a conflitos e preconceitos inter-grupais. Os varios objetivos do sociodrama (maior homeostase, igualdade e tolerancia na sociedade) podem preparar o terreno para a resolucao de conflitos inter-grupais e para a promocao da paz, numa escala politica mais global.