Influencia de la fase de menstruación y de ovulación en el rango articular de extensión del tobillo y primera articulación metatarsofalángica / Influence of the menstruation and ovulation phase in the extension range of motion of the ankle and first metatarsophalangeal joint

Objetivos: Se trata de un estudio de investigación observacional prospectivo, cuyo objetivo fue valorar si existen diferencias en el rango articular de las articulaciones: tobillo, primera articulación metatarsofalángica del primer dedo durante la fase de ovulación y de menstruación. Pacientes y métodos: Se tomó como muestra a 14 mujeres de 20 a 25 años, que cumplían con los criterios de inclusión. Fueron exploradas en el Área Clínica de Podología de la Universidad de Sevilla por la investigadora del trabajo, reuniendo todos los requisitos de instalaciones y protección de datos para la paciente. Se tomaron dos medidas: durante la ovulación y durante la menstruación. Las propias pacientes informaron de su ciclo menstrual, tras firmar el previo consentimiento informado. Resultados: Tras el análisis estadístico se observó que la flexión dorsal del tobillo, con rodilla extendida y flexionada, y la extensión de la primera metatarsofalángica del primer dedo aumentaron significativamente (p < 0.001 en ambos pies) su rango articular durante la fase de ovulación. Conclusiones: Se han apreciado diferencias en el rango de extensión del tobillo y de la primera articulación metatarsofalángica del primer dedo, siendo mayor el rango en la fase ovulatoria.(AU)

Objective: This is a prospective, observational research study whose objective was to assess whether there are differences in the joint range of the joints: ankle, first metatarsophalangeal of the first toe during the ovulation and menstruation phase. Patients and methods: A sample of 14 women between the ages of 20 and 25, who met the inclusion criteria, were taken as a sample. They were explored in the Podiatry Clinical Area of the University of Seville by the researcher of the work, meeting all the facilities and data protection requirements for the patient. Two measurements were taken, during ovulation and another during menstruation. The patient themselves reported their menstrual cycle after signing the prior informed consent. Results: After the statistical analysis, it was observed that the dorsiflexion of the ankle, with the knee extended and flexed, and the extension of the first metatarsophalangeal of the first toe significantly increased (p < 0,001 in both feet) their joint range during the ovulation phase.Conclusions: Differences have been observed in the range of extensión of the ankle and of the first metatarsophalangeal joint of the first finger, the range being greater in the ovulatory phase.(AU)

La temperatura del pie como factor predictivo de aparición de úlceras en la Diabetes Mellitus / Foot temperature as a predictor of ulcers in Diabetes Mellitus

El Pie Diabético es una de las complicaciones más importantes de la Diabetes Mellitus debido a la posibilidad que existe de sufrir una úlcera plantar que aboque a una amputación. La neuropatía periférica diabética acontece en un 60-70 % de los sujetos con Diabetes Mellitus y se caracteriza por un trastorno de la sensibilidad táctil y dolorosa, la alteración del umbral de vibración y de la percepción térmica para los umbrales de temperatura al calor y al frío. La temperatura de los pies de los sujetos con Diabetes Mellitus sin neuropatía periférica diabética es menor que con presencia de neuropatía periférica diabética. Se produce una correlación entre el aumento de la temperatura y la aparición de lesiones en los pies, debido a que la temperatura aumenta en las zonas de riesgo de ulceración por la propia inflamación y a la a utolisis enzimática de los tejidos, previa a la aparición de una ulceración de la artropatía de Charcot. Resultados: Actualmente se emplean dos tipos de técnicas de medición de la temperatura: termografía y termometría. Las pruebas de termografía se clasifican en placas superpuestas de cristal líquido termosensible e infrarrojos, y las pruebas de termometría se dividen en infrarrojos y los sensores térmicos. La valoración térmica se debe incluir en los protocolos de exploración neurológica de los pies en la Diabetes Mellitus por ser una prueba eficaz, no invasiva y disminuye la tasa de aparición de úlceras. Conclusiones: Se considera que una diferencia de 2,2º C, en el mismo punto de ambos pues de un sujeto, indica la aparición de lesiones propias del Pie Diabético, bien una ulceración si hay lesión, o una artropatía de Charcot. La evidencia científica indica que el control de la temperatura de los pies disminuye la tasa de ulceraciones en la Diabetes Mellitus. Abogamos por la inclusión de la valoración térmica en el protocolo de exploración de los sujetos con Diabetes Mellitus, debido a su efectividad en la prevención de ulceraciones y por su escaso tiempo de cribado

The Diabetic Foot is one of the most important complications of Diabetes Mellitus due to the possibility of suffering a plantar ulcer that leads to an amputation. Diabetic peripheral neuropathy occurs in 60-70 % of subjects with Diabetes Mellitus and is characterized by a disturbance of tactile and painful sensitivity, the alteration of the threshold of vibration and thermal perception for temperature thresholds to heat and cold. The temperature of the feet of subjects with Diabetes Mellitus without diabetic peripheral neuropathy is lower than with the presence of diabetic peripheral neuropathy. There is a correlation between the increase in temperature and the appearance of lesions on the feet, because the temperature increases in the areas of risk of ulceration due to the inflammation itself and to the enzymatic autolysis of the tissues, prior to the appearance of a ulceration of Charcot arthropathy. Results: Currently, two types of temperature measurement techniques are used: thermography and thermometry. Thermography tests are classified into thermo sensitive infrared liquid crystal plates, and the thermometry tests are divided into infrared and thermal sensors. The thermal assessment should be included in the neurological examination protocols of the feet in Diabetes Mellitus because it is an effective, non-invasive test and decreases the rate of ulcer appearance. Conclusions: It is considered that a difference of 2.2º C, in the same point of both because of a subject, indicates the appearance of own injuries of the diabetic Foot, either an ulceration if there is an injury, or a Charcot arthropathy. Scientific evidence indicates that controlling the temperature of the feet decreases the rate of ulcerations in Diabetes Mellitus. We advocate the inclusion of thermal assessment in the protocol of exploration of subjects with Diabetes Mellitus, due to its effectiveness in the prevention of ulcerations and its short time of screening

Range of Ankle Dorsiflexion in a Group of Adults with Ligamentous Laxity.

BACKGROUND: Ligamentous or joint laxity is a clinical entity characterized by increased joint mobility beyond the range of motion regarded as normal, and joint mobility is an effective indicator of the degree of laxity. We examined the influence of ligamentous laxity on the range of ankle dorsiflexion with the knee flexed and extended, comparing lax adults with a control (nonlax) group. METHODS: The sample comprised 400 individuals: 200 in the control group (mean ± SD age, 32.49 ± 11.06 years) and 200 in the lax group (mean ± SD age, 29.82 ± 9.40 years). The Beighton criteria were applied to each participant to diagnose laxity or nonlaxity, and sex, age, and angle range of bilateral dorsiflexion with the knee extended and flexed were recorded. RESULTS: The mean ± SD dorsiflexion range with the knee straight was 16.14° ± 5.29° left ankle and 21.21° ± 4.93° right ankle in the lax group and 12.94° ± 4.17° left ankle and 17.08° ± 4.40° right ankle in the control group. The respective values with the knee flexed were 15.84° ± 5.31° and 21.21° ± 4.80° in the lax group and 12.95° ± 3.95 and 17.23° ± 4.25° in the control group. CONCLUSIONS: In this sample, ankle dorsiflexion range in the lax group was 4° bigger than that in the control group in both knee positions.

Structural differences in the lower extremities in children aged 7-9 years, caused by playing football: A cross-sectional study.

BACKGROUND: Physical activity during childhood can be beneficial in the long term. However, this practice can influence the child's physiological development. The aim of this study was to determine whether the practice of soccer, in moderation, could be a risk factor for the inadequate development of the lower limb. METHODS: The study group was composed of 115 children, of whom 59 (mean age 8.03±0.89years) practised soccer 3 times a week and had a positive Physical Activity Questionnaire for Adolescents (PAQ-A) score, while a further 56 (mean age 7.96±0.87years) did not perform any additional physical activity and had a negative PAQ-A score. A foot posture analysis, based on the foot posture index (FPI), the valgus index, the orientation of the subtalar joint (STJ) and the Q angle of the knee, was carried out. RESULTS: For the group of soccer players, the following results were obtained: FPI 4.79±2.38 (R) and 3.95±2.31 (L); valgus index 13.56°±1.66° (R) and 13.42°±1.48° (L); STJ test 79% pronated; Q angle 13.13°±2.06° (R) and 13.18°±1.93° (L). For the non-players, the corresponding values were: FPI 3.62±2.82 (R) and 3.74±2.77 (L); valgus index 12.76°±1.71° (R) and 12.84°±1.72° (L); STJ test 50% pronated; Q angle 13.87°±3.01° (R) and 13.86°±2.94° (L). CONCLUSION: There is a degree of difference between the two groups, but the values do not vary greatly from those considered normal for this age group. Any alterations in this respect can be assumed to be caused at older ages than those analysed.

Effect by custom-made foot orthoses with added support under the first metatarso-phalangeal joint in hallux limitus patients: Improving on first metatarso-phalangeal joint extension.

BACKGROUND: Hallux limitus is one of the most common disorders affecting foot biomechanics. Custom-made foot orthoses can improve the function of the first metatarso-phalangeal joint. OBJECTIVES: The objective underlying this study was to test whether custom-made foot orthoses increased the range of mobility of metatarso-phalangeal joint in patients with hallux limitus. STUDY DESIGN: Randomized, double-blinded, and clinical trial. METHODS: The study consisted of 20 participants (40 feet) diagnosed with hallux limitus. A control group and an experimental group both wore the same custom-made foot orthoses and, in the experimental group, a support element under the first metatarso-phalangeal joint was added to the orthoses. Two measurements were made with both groups: the relaxed position of the first metatarso-phalangeal joint and the maximum extension of the hallux. These measurements were made before first placing the foot orthoses and 6 months after application of the treatment. RESULTS: In the experimental group, the results showed an improvement of 4.5° in the relaxed position and 22.2° in the maximum extension being statistically significant (p < 0.001) for both measurements. CONCLUSION: Custom-made foot orthoses with added support under the first metatarso-phalangeal joint were proved to be an effective treatment to restore functionality of this joint in hallux limitus patients. CLINICAL RELEVANCE: Limitation of hallux movement in the joints propulsive phase of gait negatively affects the biomechanics of the lower extremity, causing changes in the rest of the joins. The use of foot orthoses designed in this study restores range of motion of the first metatarso-phalangeal joint.

Clinical signs in the foot that are predictors of ligamentous laxity in the adult population.

OBJECTIVES: This study evaluates the influence of ligamentous laxity on the foot from observation of clinical signs and quantification of certain joint ranges. METHODS: The sample consisted of 400 subjects - 200 in the non-lax control group (ages 32.49 ± 11.06 years) and 200 in the lax group (ages 29.82 ± 9.41 years). The Beighton criteria were applied to each subject to diagnose laxity or non-laxity after noting their gender, age, and 2 joint ranges and 2 clinical signs for both feet. This was an observational analytical study of cases and controls, in which a multivariate binary logistic regression model was applied. RESULTS: Extension of the first metatarsophalangeal joint (MTPJ) ≥95°, extension of the 1st toe's interphalangeal joint (IPJ) ≥14°, and the signs 1st "in the plantar footprint, marked and narrowly confined support under metatarsal heads" and 2nd "in the plantar footprint, continuity of the 1st toe to the 1st metatarsal" presented significant differences between the lax and the non-lax groups. These are usable as parameters with which to detect laxity. The Beighton criteria were confirmed as being the most appropriate for diagnosis. CONCLUSIONS: We propose the use of 2 clinical signs that can be evaluated in plantar footprints ("1st" and "2nd") and 2 exploratory manoeuvres (extension of the first MTPJ ≥95° and extension of the 1st toe's IPJ ≥14°) as factors present in the foot which allow the detection of ligamentous laxity in the adult population, for subsequent confirmation by applying the Beighton criteria.

Foot orthoses custom-made by vacuum forming on the non-load-bearing foot: preliminary results in male children with calcaneal apophysitis (Sever's disease).

BACKGROUND AND AIM: To our knowledge, the technique of molding orthoses to the non-load-bearing foot is still not widely investigated. The aim of this work is, therefore, first, to describe an off-loading custom-made technique and, second, to explain how it can be specifically adapted to treat Sever's disease. TECHNIQUES: A technique of directly molding orthoses to the non-load-bearing foot by vacuum forming an insole to the foot fabricated with a combination of polyvinyl chloride and polyester resins, 30 Shore A hardness and 148 kg/m(3) density polyethylene-ethylene-vinyl-alcohol, and a cushioning heel cup of 22 Shore A polyurethane, using a directly molding orthoses technique to the non-load-bearing foot by vacuum. DISCUSSION: Results show that this new technique could be a good alternative to traditional insoles in the management of Sever's disease pain.