Plantar pressures increase with raising body weight: A standardised approach with paired sample using neutral shoes.

BACKGROUND: Plantar pressure leads to stress on plantar tissue and can be seen as risk factor for metatarsal stress fractures or plantar ulcers and is associated with prolonged and complicated recurrence of existing tissue damages. A clear demarcation of a systematic raise of body load regarding its effect on plantar pressure has not been described. OBJECTIVE: Assessing plantar pressure patterns in different conditions of body weight, comparing data to initial body weight. METHODS: Seventeen healthy volunteers were asked to participate. Peak pressure values were assessed during walking with dynamic pedobarography and analysed from three foot sections. Body weight was loaded up gradually with 10%, 20% and 30% of the individual initial weight by using a weighted vest. RESULTS: We were able to detect a statistically significant increase of plantar pressure for all foot regions in case of loaded body weight of 20% and 30% comparing to initial weight (p< 0.05). The midfoot area displays a significant increase for peak pressure for the preferred foot even for 10% body load. CONCLUSIONS: Peak plantar pressure increases with loaded body weight. The midfoot area seems to be a sensitive area in case of adapting increasing foot load. Considering the clinical relevance, loaded body weight has to be seen as risk factor for increasing plantar pressure patterns and should be considered in recurrence of plantar ulcers or stress fractures.

[Turf toe injury--extension sprain of the first metatarsophalangeal joint]. / Die Turf-Toe-Verletzung--ein Hyperextensionstrauma der Großzehe.

Injuries of the first metatarsophalangeal (1MTP) joint in the performance of sports are normally rare. The term turf toe injury designates a sprain of the first metatarsophalangeal (1MTP) joint. The trauma mechanism describes a hyperextension in contrast to a "sand-toe"-injury which is caused by a hyperflexion. Injuries to the metatarsophalangeal (MTP) joint of the great toe have increased in incidence over the last years following the introduction of synthetic surfaces and the establish use of lighter footwear. Although most common in American football players, similar injuries can also be found in sporting activities like basketball, soccer, gymnastics or dance. The trauma mechanism leads to varying degrees of sprain or disruption of the supporting soft-tissue structures. Furthermore damage to the articular cartilage and adjacent bone can be detected. An assessment of the extent of soft-tissue disruption or even damage of the cartilage is essential in treatment planning. The conservative treatment methods including relative rest, shoe modification, and insoles are in most cases successful. But in case of an advanced stage or failure of conservative treatment, surgical treatment is mostly necessary. The turf toe injury must be diagnosed early and evaluated properly. The injury leads to a loss in sports time and competition and can progress to chronic osteoarthritis of the first metatarsal joint.

[Foot load with different restrictions of knee joint extension]. / Die Bedeutung der Kniestreckfähigkeit für die plantare Druckverteilung.

BACKGROUND: Dynamic pedobarography has been used for various orthopaedic issues. There is to date a lack of studies describing possible factors of influence with regard to lower limb function. MATERIAL AND METHODS: Ten healthy volunteers were asked to perform a total of six trials (12 left and right steps, data from the right foot) wearing the M.4® ACL/CL knee brace (De Royal Industries, Powell, USA) around the right knee. The limitation ranged from full extension (baseline) to an extension lag of 45 degrees. Peak pressure values were obtained from the hindfoot, midfoot, forefoot and toes with the pedar X system (novel Inc., Munich, Germany). Medians were compared with the two-tailed non-parametric Wilcoxon matched-pairs signed rank test; p-values of less than 0.05 were regarded to be statistically significant. RESULTS: Our study design allows the detection of differences in foot load of 20 % baseline with a power of 80 % or more. With this setting we found no statistically significant reduction of foot load up to a 20 degree extension lag of the knee joint. The opposite hindfoot load was significantly increased with 30 degrees extension lag and significantly reduced for the opposite hindfoot with 45 degrees. CONCLUSION: As can be seen from the perspective of foot load, the intact function of adjacent joints seems to compensate an extension lag of the knee joint up to 20 degrees, but hindfoot load changes significantly with 30 degrees or more, which may be clinically relevant for patients at risk of plantar ulcerations.

Serial immunoreactive erythropoietin levels in autologous blood donors.

The variations in plasma erythropoietin (EPO) concentration during preoperative deposit of autologous blood were studied in 12 patients (8 men, 4 women). Four donations were scheduled at weekly intervals. A predonation hemoglobin concentration of 11 g per dL (110 g/L) was required. Hemoglobin concentration decreased from 14.3 +/- 1.1 g per dL (143 +/- 11 g/L) (mean +/- SD) before the first donation to 11.7 +/- 0.7 g per dL (117 +/- 7 g/L) on Day 22 (p less than or equal to 0.0001). Reticulocyte counts increased from a median of 31,800 (range, 4900-95,000) per microL (median, 32 x 10(9)/L [range, 5-95 x 10(9)/L]) to 93,800 (16,800-194,900) per microL (median, 94 x 10(9)/L [range, 17-195 x 10(9)/L]) on Day 28 (p less than or equal to 0.01). Plasma EPO concentration was 17.8 +/- 5.1 mU per mL prior to the first donation and displayed a small and transient peak after each donation. A sustained elevation followed each peak. Although plasma EPO concentration differed significantly from the baseline value after the first donation, only the peak concentrations after the second (35.5 +/- 15.5 mU/mL), third (38.0 +/- 14.5 mU/mL), and fourth (36.1 +/- 11.0 mU/mL) donations exceeded the normal range. The moderate, biphasic increase in plasma EPO concentration and the moderate increase in erythropoiesis suggest two strategies in autologous blood donation that should be investigated with respect to efficiency and safety: 1) more aggressive donation schemes, which reduce donation intervals and/or the minimum hemoglobin concentration and 2) the administration of recombinant human EPO.