Orthopaedic Simulation of a Morton's Extension to Test the Effect on Plantar Pressures of Each Metatarsal Head in Patients without Deformity: A Pre-Post-Test Study.

BACKGROUND: the area beneath the metatarsal heads is a common location of foot pain, which is often associated with high plantar pressures. The aim of this study was to determine the effect of the application of a Morton's extension on the pressure in the metatarsal bones of the foot using a pressure platform. METHODS: twenty-five subjects without musculoskeletal pathology were selected for this study, and an experiment was conducted with them as the subjects, before and after application of a Morton's extension. The foot regions were divided into the forefoot (transversely subdivided into six areas corresponding to the first, second, third, fourth, and fifth metatarsal heads, and the hallux), midfoot, and rearfoot, and then the maximum and average pressures exerted at each region were measured before and after placing a Morton's extension. MAIN FINDINGS: we found a pressure reduction, with a p-value less than (p < 0.05), in the head of the second and third metatarsals in statics and dynamics. CONCLUSIONS: we can conclude that the Morton's extension produces a variation in plantar pressures on the lesser metatarsals. The application of a Morton's extension may be beneficial for the management of forefoot pathology. This study will help clinicians consider various tools to treat forefoot disorders. NCT05879094 (ClinicalTrial.gov (accessed on 18 May 2023)).

Effects of Myofascial Induction Therapy on Ankle Range of Motion and Pressure Pain Threshold in Trigger Points of the Gastrocnemius-A Clinical Trial.

BACKGROUND: The myofascial induction technique (MIT) has been shown to increase shoulder range of motion (ROM) in breast cancer survivors and decrease pain pressure threshold over the radial nerve in patients with epicondylalgia. To the authors' best knowledge, no study on trigger points and MIT has been published to date. The effect on ROM of latent trigger points is also unknown. METHODS: A total of 20 twins with one latent trigger point of the gastrocnemius muscle were evaluated pre- and post-MIT in the calf. We measured static footprint variables in a pre-post study. RESULTS: We found differences in PPT (p = 0.001) and no differences in ROM with knee flexed (p = 0.420) or stretched (p = 0.069). CONCLUSIONS: After Calf MIT, latent myofascial trigger points improve PPT but no change in ankle dorsiflexion with knee bent or knee flexed were found in non-restriction healthy subjects.

A Rare Paronychia with Superinfection with Prevotella bivia and Staphylococcus haemolyticus: The Importance of Early Microbiological Diagnosis.

Prevotella bivia is an anaerobic, gram-negative bacillus which naturally thrives in the human vagina, and is usually related to vaginal tract infections. However, this microorganism can also cause infections in other body locations. Infections with Prevotella bivia are frequently severe due to the risk of osteomyelitis and the lack of good protocols for adequate therapeutic management. Staphylococcus haemolyticus infection is one of the most frequent etiological factors of nosocomial infections, which hasthe ability to acquire multiple resistance against antimicrobial agents. We report a rare case of foot and hand paronychia with superinfection of Prevotella bivia and Staphylococcus haemolyticus. We highlight the importance of early microbiological diagnosis, and proper therapeutic management to avoid the risk of complications and the development of bacterial resistance to antibiotics.

Radiographic Analysis on the Distortion of the Anatomy of First Metatarsal Head in Dorsoplantar Projection.

Background: The diagnostic of flat and crest-shaped of first metatarsal heads has been associated as an important risk factor for hallux deformities, such as hallux valgus and hallux rigidus. The rounded form of the first metatarsal head on the dorsoplantar radiograph of the foot has been believed to be associated with the development of hallux valgus. Purpose: The aim of this study was to clarify the effect of tube angulation on the distortion of first metatarsal head shape, and verify the real shape of the metatarsal head in anatomical dissection after an X-ray has been taken. Materials and Methods: In this prospective study at Universidad Complutense de Madrid, from December 2016 to June 2019, 103 feet from embalmed cadavers were included. We performed dorsoplantar radiograph tube angulation from 0° until 30° every 5° on all specimens; then, two observers verified the shape of the first metatarsal head in the radiographs and after its anatomic dissection. Kappa statistics and McNemar Bowker tests were used to assess and test for intra and interobserver agreement of metatarsal shape. Results: We calculated the intraobserver agreement, and the results showed that the first metatarsal head is distorted and crested only when the angle of the X-ray beam is at 20° of inclination (p < 0.001). The interobserver agreement showed good agreement at 0°, 5°, 10°, 20°, and 25° and was excellent at 30° (p < 0.001). Conclusion: All of the studies that we identified in the literature state that there are three types of shapes of the first metatarsal head and relate each type of head to the diagnosis of a foot pathology, such as hallux valgus or hallux rigidus. This study demonstrates that there is only the round-shaped form, and not three types of metatarsal head shape. Therefore, no diagnoses related to the shape of the first metatarsal head can be made.

Apoyo diagnóstico con ecografía en papilomas plantares: caso clínico / Diagnostic support with ecography in plant papillomas: clinical case

Las verrugas cutáneas son tumores intraepidérmicos benignos de la piel con una variedad de manifestaciones incluyendo verrugas comunes (verrucae vulgaris), verrugas palmar y plantar (verrugas palmares y plantares), verrugas en mosaico, verrugas planas (verrugas planas) generalmente diagnosticado por su apariencia clínica aunque el diagnóstico definitivo depende del examen histopatológico. La ecografía puede definir su extensión, ubicaciones exactas y patrones de flujo sanguíneo siendo extremadamente útil en casos difíciles, especialmente cuando los síntomas como el dolor persisten en el tiempo. También puede dar relevancia información prequirúrgica y, finalmente, puede proporcionar ideas importantes sobre las condiciones asociadas del pie

Cutaneous warts are benign intraepidermal skin tumors with a variety of manifestations including common warts (verrucae vulgaris), palmar and plantar warts (palmar and plantar warts), mosaic warts, flat warts (flat warts) generally diagnosed by their clinical appearance although the definitive diagnosis depends on the histopathological examination.Ultrasound can define its extent, exact locations and blood flow patterns being extremely useful in difficult cases, especially when symptoms such as pain persist over time. It can also give pre-surgical information relevance and can finally provide important insights into associated conditions of the foot

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

Rotura en tendón de Aquiles: manejo postquirúrgico para acelerar el regreso a la actividad deportiva / Achilles Tendon rupture: Post-surgical management to accelerate the return to sport activity

La ruptura de tendón de Aquiles es una interrupción de tendón, se trata de una lesión comúnmente presente en la comunidad deportiva. Existen varios factores de riesgo, baja vascularización, infiltración de corticoides, fluoroquinolona, degeneración del tendón o recidivas. Tenemos dos vías de tratamiento conservador y quirúrgico. Encontramos menor proporción Re-interrupciones del tendón en tratamientos quirúrgicos. Los programas de tratamiento funcional han documentado resultados satisfactorios para la recuperación temprana de la lesión a través de ensayos controlados aleatorios y metaanálisis. Se comienza a evaluar el uso del Plasma Rico en Plaquetas (PRP) como tratamiento para lesiones de tejido musculo esquelético como la RTA en técnicas quirúrgicas abiertas. Esta revisión tiene como objetivo valorar la recuperación a través de técnicas funcionales e infiltraciones de PRP para la recuperación temprana del RTA. Las autoras declaran no tener intereses económicos

The rupture of the Achilles tendon is a disruption of the tendon, it is an injury present in the sports community. There are several risk factors, low vascularization, corticoid infiltration, fluoroquinolone, tendon degeneration or recurrence. We have two routes of conservative and surgical treatment. We found a lower proportion of tendon reinterruptions in surgical treatments. The functional treatment programs have documented satisfactory results for the early recovery of the lesion through randomized controlled trials and meta-analyzes. The use of Platelet Rich Plasma (PRP) as a treatment for musculoskeletal tissue injuries such as RTA in open surgical techniques is being evaluated. The purpose of this review is to assess the recovery through functional techniques and infiltrations of PRP for the early recovery of the RTA

Fracturas de estrés en atletas / No disponible

La fractura por estrés se trata de una solución de continuidad parcial o completa de un hueso como resultado de cargas excesivas o repetidas, a una determinada intensidad máxima, resultando en una mayor reabsorción frente a una insuficiente formación de tejido óseo. La distribución de las fracturas de estrés más comunes es en tibia, huesos del tarso y metatarsianos y varios son los factores de riesgo para producirse dicha lesión como los factores extrínsecos relacionados con equipamiento deportivo y acondicionamiento físico y Los factores intrínsecos como son la edad, el sexo, la etnicidad, la densidad ósea y a nivel metabólico. Este articulo tiene como objetivo realizar una revisión sistemática sobre los huesos de miembros inferiores más sensibles de producir dicha lesión, la distribución de la edad de los pacientes atletas, el sexo, los factores de riesgo de tipo intrínseco como extrínsecos, el tratamiento a aplicar y las recomendaciones que debemos comunicar como profesionales sanitarios para la prevención de la lesión en el entrenamiento

Stress fracture is a solution of partial or complete continuity as a result of excessive or repeated loads, an acute and severe tide, resulting in a greater resorption compared to a weak tissue formation. The distribution of the most common stress fractures in the tibia, the tarsal bones and the metatarsals and several are the risk factors for the production of the injury such as extrinsic factors related to sports equipment and physical conditioning and factors intrinsic factors such as age, sex, race, bone density and metabolic level. This article aims to perform a systematic review on the bones of the smallest, most sensitive members of the lesion, the distribution of patients' age, sex, intrinsic and extrinsic risk factors, the treatment to be applied the recommendations that should be communicated as health services for the prevention of injury in training

Hallux rígidus: Artroplastia o Artrodesis. ¿Qué técnica ofrece mejores resultados? / Hallux rigidus: Arthroplasty or arthrodesis. What technique produces better results?

El Hallux Rígidus (HR) afecta a la primera articulación metatarsofalángica (AMTF) entre el 35% y el 60% de la población mayor de 65 años y existen múltiples vías de tratamiento. En función del estadio radiológico en el que se encuentre la deformidad, se determina el procedimiento a realizar; en los estadios iniciales se realiza las técnicas de queilectomia y osteotomías correctoras mientras que en las clasificaciones más avanzadas, el cirujano escoge entre las técnicas consideradas destructivas como la artrodesis y la artroplastia. Este trabajo de fin de grado tiene como objetivo centrarse en las técnicas destructivas en 1 AMTF, para aclarar cuál de los procedimientos genera mejores resultados según una serie de parámetros; los resultados de la escala American Orthopaedic Foot and Ankle Society-Hallux Metatarsophalangeal Interphalangeal scale (AOFAS), rango de movimiento (ROM) de la 1ºAMTF, clasificación radiológica. En cuanto a la técnica de artroplastias por implante, este artículo nos ofrece información sobre el material y diseño qué genera mejores resultados relacionándolo con las características del paciente como la edad, la presencia de patologías inflamatorias articulares, la viabilidad y la durabilidad del implante. La conclusión obtenida en esta revisión es que los valores obtenidos en la artrodesis según AOFAS disminuyen debido a la pérdida de movilidad, pero ambas técnicas presentan valores similares de efectividad y concluye con la decisión de que la técnica a utilizar se determina teniendo en cuenta varios factores y características del paciente (AU)

Hallux rígidus (HR) affects the first metatarsophalangeal joint (MTPJ) between 35% and 60% of the population over 65 years and there are multiple ways of treatment. Depending on the radiological stage where you find the deformity determines the procedure to be performed; in the early stages cheilectomy techniques and corrective osteotomy is performed while the more advanced ratings, the surgeon chooses destructive techniques considered as arthrodesis and arthroplasty. This final of degree project aims to focus on 1 MTPJ destructive techniques to clarify which of the procedures generates better results by a number of parameters; outcomes of the American Orthopaedic Foot scale and Ankle Society Hallux metatarsophalangeal Interphalangeal-scale (AOFAS), range of motion (ROM) of the 1ºAMTF, radiological classification. As for the implant arthroplasty technique, this article offers information on material and design that generates better relating to patient characteristics such as age, inflammatory joint diseases, viability and durability of the implant results. The conclusion from this review is that the values obtained in the arthrodesis according AOFAS decrease due to loss of mobility, but both techniques have similar values of effectiveness and concludes with the decision that the technique used is determined taking into account various factors and patient characteristics (AU)