The effectiveness of "Dijital Steps" web based telerehabilitation system for patient with hindfoot pain: A randomised controlled trial.

OBJECTIVE: The aim of the study was to evaluate and compare effective therapeutic options for hindfoot pain, develop and investigate the effectiveness of tele-rehabilitation systems, and ensure patients perform their exercises and preventive measures regularly and accurately, while monitoring results. METHODS: Hindfoot pain (HP) patients (N = 77 with 120 feet) were admitted to this study and divided into two pathologies; Plantar Fasciitis and Achilles Tendinopathy. Patients in each pathology were randomized into three different rehabilitation programs-web-based telerehabilitation (PF-T & AT-T), -hands-on healing techniques combined with exercise (PF-C & AT-C)-unsupervised home exercise (PF-H & AT-H) program. Disability, activity restrictions, first-step pain, dorsiflexion-plantar flexion range of motion and kinesiophobia scores were recorded. The outcomes of the study groups were collected pre-post intervention (8thweek). Telerehabilitation system was developed via user-driven innovation and tested before using formally. RESULTS: Each group had significant improvements in pain, disability, functional status and kinesiophobia (p < 0.001). In terms of functional status, PF-C had a statistically significant difference from others (p < 0.001). There was no difference between the groups for the pain scores in both pathologies. (p > 0.001). However, web-based telerehabilitation (PF-T & AT-T) were found to be more effective on kinesiophobia compared to the other groups (p < 0.001). CONCLUSIONS: The presented web-based telerehabilitation system for management of hindfoot pain is an effective way and might be preferred instead of unsupervised home exercise specially for kinesiophobia. Additionally, Foot and ankle stretching and strengthening exercises protocols, myofascial releasing and mulligan concept manual therapy are effective modalities in terms of ROM, VISA-A, FAAM, FFI, TSK and VAS scores for hindfoot pain. The results indicated that three promised different rehabilitation protocols could be an effective strategy for HP.

Extracorporeal Shockwave Therapy Versus Graston Instrument-Assisted Soft-Tissue Mobilization in Chronic Plantar Heel Pain: A Randomized Controlled Trial.

BACKGROUND: Although there are studies showing that extracorporeal shockwave therapy (ESWT) and instrument-assisted soft-tissue mobilization methods are effective in chronic plantar heel pain (CPHP) treatment, there is a need for studies comparing these techniques. We compared the effectiveness of ESWT versus instrument-assisted soft-tissue mobilization using Graston Technique (GT) instruments in addition to stretching exercises (SEs) in CPHP. METHODS: Sixty-nine patients were randomly assigned to three groups: ESWT+SEs (group 1), GT+SEs (group 2), and SEs only (control group) (ratio, 1:1:1). The SEs, twice daily for 8 weeks, were standard for all. Group 1 received low-intensity ESWT; in group 2, GT was the selected method. Visual analog scales (for initial step and activity pain), the Foot Function Index (FFI), the 12-item Short-Form Health Survey (SF-12), and the Tampa Scale for Kinesiophobia were used pretreatment, posttreatment, and at 8-week and 6-month follow-up. RESULTS: Visual analog scale and FFI scores improved posttreatment and during follow-up in all groups (P < .001). Although effect sizes were greater in groups 1 and 2 than in the control group in initial step pain posttreatment and at 8-week follow-up, group 2 had the highest effect size at 6 months. Mean SF-12 scores in groups 1 and 2 improved on the posttreatment assessment. Furthermore, group 2 showed significant improvements in FFI scores compared with the other groups at 6-month follow-up (F = 6.33; P = .003). CONCLUSIONS: Although ESWT+SEs and GT+SEs seem to have similar effects on initial step pain posttreatment and at 8-week follow-up, GT+SEs was found most effective for improving functional status at 6 months in the management of CPHP.

Outpatient vs Home Management Protocol Results for Plantar Fasciitis.

BACKGROUND: We compared the effectiveness of stretching and strengthening exercises combined with myofascial releasing and mobilization techniques to a stretching and strengthening only home program in plantar fasciitis (PF) management. METHOD: The study included 53 feet of 47 patients with plantar fasciitis (35 women / 12 men; mean age 48.9±11.2 years). Pain, disability, and activity restrictions were assessed by Foot Function Index (FFI), and first step pain was graded by visual analog scale (VAS). Ankle range of motion (ROM), gastrocnemius-soleus flexibility, proprioception, dynamic balance, and foot sensation were also considered. The patients were randomly divided into outpatient clinic treatment (Outpatient, n = 27 feet) and home rehabilitation groups (Home, n = 26 feet). Patient education was routine for all at the beginning of the management programs. In the Outpatient group, the foot-ankle-hip exercise program, myofascial releasing, and joint and soft tissue mobilization techniques were "hands on" at a clinic (twice a week for 8 weeks), whereas the Home group completed their home rehabilitation program on their own (8 weeks' duration with follow-ups every week). RESULTS: VAS, FFI, ROM, balance, proprioception, foot sense, and flexibility improved at the eighth week in both groups according to intragroup comparison (P < .05). When the 2 groups were compared, the results of plantar flexion range, balance, proprioception, foot sensation, flexibility, FFI, and VAS showed significant improvements in the Outpatient vs the Home group (P < .05). Also, the FFI and VAS scores at the sixth month were superior in the Outpatient group (P < .05). CONCLUSION: A combined supervised management protocol had superior clinical results in plantar fasciitis management. LEVEL OF EVIDENCE: Level II, comparative study.

Prevalence estimation and familial tendency of common forefoot deformities in Turkey: A survey of 2662 adults.

OBJECTIVE: This survey was designed to evaluate the prevalence estimations of HV, bunionette, hammertoe as well as their relations to shoe wearing and also familial tendency, in Turkey. MATERIAL AND METHODS: Two thousand six hundred sixty two volunteers (1615 females and 1047 males) with a mean age of 34.15 ± 14.23 (range; 18 to 96) years were asked to answer the predetermined questionnaire between January and June, 2016. Hallux valgus, hammertoe and bunionette images were provided as references and every adult participant without any known forefoot problems or past forefoot surgery history was asked to rate his/her foot and to respond the questions about family history and shoe wearing habits. Responses were statistically analyzed. RESULTS: The prevalence estimations of hallux valgus, bunionette and hammertoe were calculated as 54.3%, 13.8% and 8.9% and positive family history rates were 53.2%, 61.2% and 56.1%, respectively. All three deformities were more common in females than in males (p < 0.001). Nonetheless the older age group reported significantly higher prevalence rates for only HV (p < 0.001). Likewise, among the three deformities, females reported a higher rate of positive family history only in HV compared to men (p < 0.001). Constricting shoe wear was found to affect HV incidence in women (p < 0.001) and bunionette incidence in both sexes (p < 0.01). CONCLUSION: This study concludes that forefoot deformities are common with high familial tendency. Hence it is worthwhile to work on molecular genetics and this may enable the anticipation of forthcoming deformities in order to take early action in prevention, in nearly the half of the population.

The results of Scarf osteotomy combined with distal soft tissue procedure are mostly satisfactory in surgical management of moderate to severe hallux valgus.

BACKGROUND: Intrinsically stable diaphyseal osteotomy gained popularity in recent years for symptomatic hallux valgus deformities. In this study, Scarf osteotomy results, in surgical management of moderate to severe hallux valgus, are presented. METHODS AND PATIENTS: Study group consisted of 40 feet of 32 (28 females, four males) patients surgically managed by Scarf osteotomy between September 2009 and 2011, with a mean age of 52,98 (range, 31-75) years at the time of surgery. Patient satisfaction and VAS were used for subjective evaluation while for objective measures AOFAS score, first metatarsophalangeal joint ROM and radiological measurements (intermetatarsal, hallux valgus and distal metatarsal articular angles) were evaluated. RESULTS: Mean follow-up period was 38 (range, 24-60) months. Sixteen feet (40%) were reported as very satisfied, 19 (47,5%) as satisfied and the remaining five (12,5%) as unsatisfied resulting with a total of 35 (87,5%) satisfaction. The mean preoperative VAS and AOFAS forefoot scores improved from 8,13±0,791 to 2,68±1,228 (p=0,0001) and from 58,25±6,15 to 78,25±8,13 (p=0,0001) on the final follow-up, respectively. The postoperative change of first metatarsophalangeal joint ROM was not statistically significant (p=0,281). On the radiological evaluation; intermetatarsal and hallux valgus angles improved from a mean value of 14,77±1,76 to 8,13±1,52° (p=0,0001) and from 35,28±5,86 to 20,10±5,55° (p=0,0001), respectively. Distal metatarsal articular angle did not show any statistically significant change (p=0,195). CONCLUSION: Scarf osteotomy combined with distal soft tissue procedure is a technically demanding procedure. The osteotomy is intrinsically stable and the correction power is high and the results are mostly satisfactory.

Arthroscopic-assisted retrograde mosaicplasty for an osteochondral defect of the femoral head without performing surgical hip dislocation.

Osteochondral autograft transplantation (mosaicplasty) for the osteochondral defects of the femoral head is generally performed with safe dislocation of the hip joint. Here, we present a 27-year-old male patient who had a symptomatic osteochondral defect of the femoral head and underwent mosaicplasty applied by hip arthroscopy without surgical hip dislocation. The preoperative radiological evaluation showed a focal osteochondral defect on the weight-bearing surface of the femoral head. With the assistance of hip arthroscopy, the defect area was reconstructed with osteochondral plug, which was taken from the ipsilateral knee, inserted in a retrograde fashion, and positioned with the spherical surface of the femoral head cartilage under fluoroscopic and arthroscopic control. At the final follow-up (26 months postoperatively), he had full range of motion (ROM) without pain and radiographic evaluation showed near complete incorporation of the graft with preservation of the native joint space. Mosaicplasty can be applied in a retrograde fashion with the assistance of hip arthroscopy without using surgical hip dislocation and may be an alternative treatment option for the osteochondral defects of the femoral head in young patients.

Pedobarographic Analysis in Total Knee Arthroplasty.

Pedobarographic gait analysis is a useful tool for the determination of loading distributions and alterations on the lower extremity and their reflection on the foot sole after many orthopaedic surgical applications. To date, there have been no studies evaluating the relationship between component alignment and changes of pedobarographic gait analysis in total knee arthroplasty (TKA). We aimed to investigate the effects of TKA and prosthetic alignment on the distribution of pedobarographic parameters. Quantitative gait patterns of 47 patients were prospectively evaluated by using pedobarography 1 week before surgery and at the seventh month, on average, postoperatively. Component positions were assessed, and all applications were divided into three groups according to tibial component position as varus, neutral, and valgus. Pedobarographic results were compared between pre- and postoperative values for all applications and compared among the groups. Mean postoperative tibiofemoral angle was 5.4 degrees in valgus, and preoperative knee scores were markedly improved postoperatively. The range of tibial component alignment changed between 1 and 4 degrees in the varus and valgus groups. Plantar loading parameters (force and pressure) were significantly decreased in all operated knees, especially in forefoot and midfoot. In varus tibial components, plantar loading values decreased in midfoot and hindfoot. However, in the neutral and valgus groups, similar alterations of plantar loadings were obtained, which included decreasing in forefoot and midfoot with significant increase in hindfoot. Plantar loading distribution changed statistically significantly after TKA despite good clinical and radiographic results. Tibial component alignment was also responsible for plantar loading distribution. Tibial components in varus position create different foot loading characteristics compared with neutral and valgus aligned components. Pedobarographic evaluation in TKA allows clinicians to obtain a proper understanding of abnormal gait caused by component malposition.

Estimation of human daily boron exposure in a boron-rich area.

Although, the safe limits of human daily boron (B) exposure are not absolutely clear, there is a growing interest in B and its effects on human health. The aim of the present study was to estimate daily B exposure in 66 males in Turkey living in a B-rich area using water containing at least 2 mg/l boron, with an average age of 38.55 (se 1.66) years and an average number of years of residence in the B-rich area of 35.89 (se 1.73). Another group of males (n 57), living in the city centres of Balikesir and Ankara, were taken as controls; the average age and number of years of residence for this group were 29.44 (se 1.43) and 10.26 (se 1.83) years, respectively. As it is assumed that the B level in urine reflects daily B exposure, the amount of urinary B of both the study and control groups was analysed by using an inductively coupled plasma optical emission spectrometry (ICP-OES) technique. The average daily B exposure value was calculated as 6.77 (se 0.47) mg in the study group and 1.26 (se 0.1) mg in the controls. The results of this study are expected to contribute to creating a reference value for a safe daily B exposure.

[Phalanx-like osseous structure posterior to the cervical vertebrae: a hitherto unreported location for a rare anomaly]. / Servikal vertebra posteriorunda falanks benzeri ektopik kemik yapi: Nadir bir anomali için bildirilmemis bir yerlesim bölgesi.

Several types of abnormalities of the vertebral column have been reported. Pelvic rib or pelvic digit is a rare congenital anomaly of the spine. A 58-year-old male patient presented with a complaint of a firm mass in the neck. He had no history of trauma and had been aware of the mass for years. Physical examination showed a painless and immobile mass in the neck, measuring 4 x 1 cm. About 10 to 15 degrees of restriction was noted in neck movements, with slight pain. A plain radiograph of the cervical region showed two bony formations resembling a coccygeal segment or a phalanx, posterior to the spinous process of the C6 vertebra. They had well-defined cortices and medullae and pseudo-articulation between each other and with the spinous process. These findings were confirmed by three-dimensional computed tomography and magnetic resonance images. The patient did not accept surgery for the lesions were not associated with a significant discomfort. To our knowledge, such a digit has hitherto not been reported in the cervical region.

External application of hypertonic salt solution for treatment of posttraumatic oedema.

In 20 New Zealand rabbits (two groups of 10 rabbits each), hind limb circumference and anterior compartment pressure were measured following ketamin anaesthesia (time zero). During the same anaesthesia, closed transverse proximal tibial shaft fractures were created in both groups. Twenty-four hours after the fractures, during a second anaesthesia, limb circumference and compartment pressure were measured as before, and fractured limbs were fixed to the rabbits' bodies. At the same time, treatment was started: one group received external application of saturated salt solution and the other group received intermittent ice application. During 48 hours of treatment (from 24 to 72 hours) in the saturated salt solution group, the mean limb circumference decreased from 125.70 +/- 9.93 mm to 115.70 +/- 8.78 mm (p = 0.005) and the mean compartment pressure decreased from 18.30 +/- 1.70 mmHg to 12.40 +/- 1.77 mmHg (p = 0.005). In the control group, the mean limb circumference decreased from 127.85 +/- 7.47 mm to 122.00 +/- 6.83 mm (not significant) and the mean compartment pressure decreased from 19.57 +/- 1.27 mmHg to 17.85 +/- 2.67 mmHg (not significant). In short, differences in compartment pressure and limb circumference before and after treatment were statistically significant in the saturated salt solution group (p = 0.005) but not in the control group.

An extremely uncommon infection: Candida glabrata arthritis after total knee arthroplasty.

Prosthetic arthritis caused by Candida species is extremely rare. Of 30 such cases reported in the English literature, only 3 were due to Candida glabrata. We present herein a fourth case; to the best of our knowledge this is the first example of knee arthroplasty infection caused by C. glabrata.

Comparison of nonsurgical treatment measures for de Quervain's disease of pregnancy and lactation.

de Quervain's disease of pregnancy and lactation is usually self-limited and responds well to nonsurgical treatment. We conducted a randomized prospective study on 19 wrists of 18 patients with de Quervain's disease who were either pregnant or breast-feeding. One group had a cortisone injection into the tendon sheath and the other group used thumb spica splints. All 9 patients with injections had complete pain relief with only one late recurrence. None of the patients with splints had complete pain relief; however, at the end of the lactation period, 8 had spontaneous resolution of symptoms and 1 received a cortisone injection. de Quervain's disease of pregnancy and lactation is self-limited and can be treated successfully with cortisone injection. Splinting does not provide satisfactory pain relief.