Foot Pain and Disability in Women with Rheumatoid Arthritis, Ehlers-Danlos Syndrome and Systemic Lupus Erythematosus: Relationship with Quality of Life.

The aim of this work was to investigate the relationship foot pain and foot disability have with HRQoL in groups of women with RA, SLE and EDS, in comparison with a control group. A cross-sectional study was carried out with females with one of these conditions and a control group. The SF-12 questionnaire was used to collect data about quality of life. The type of foot was classified according to the footprint and the foot posture index. A total of 156 patients and 47 controls participated in the study (N = 203). Neither pain nor foot posture were different between groups. The physical and mental components of SF-12 were worse in rheumatoid arthritis and Ehlers-Danlos syndrome patients, and the physical component was worse in systemic lupus erythematosus patients, compared to controls. A significant difference was also observed in the mental component between systemic lupus erythematosus and Ehlers-Danlos syndrome patients, the latter having the lowest values among the groups. We can conclude that women with rheumatoid arthritis, Ehlers-Danlos syndrome, systemic lupus erythematosus and foot pain perceive a worse quality of life. There are no significant changes in foot posture. Pain and health-related quality of life are independent of foot posture.

Effect of a Podiatric Health Education Intervention on the Level of Self-care in Patients with Diabetes Mellitus.

OBJECTIVE: To test the effect of a podiatric health education activity on foot self-care and the degree of foot-related disability in a group of people with diabetes mellitus (DM) in the province of Seville. A pretest-posttest quasi-experimental design was used. METHODS: Twenty-nine people with DM participated. The intervention was a podiatric health education activity consisting of a 1-hour informative talk. Foot pain-related disability was measured using the Manchester Foot Pain and Disability Index. The degree of foot self-care was measured with the University of Malaga Foot Self-care questionnaire. RESULTS: One month after the intervention, both parameters had improved significantly. The mean score on the Manchester Foot Pain and Disability Index increased from 59.96 (SD, 8.69) at baseline to 67.39 (SD, 6.99) at 1 month, and the mean score on the University of Malaga Foot Self-care questionnaire improved from 11.65 (SD, 20.07) at baseline to 4.52 (SD, 5.47) after 1 month. CONCLUSIONS: Therapeutic education increases the level of self-care and decreases the degree of foot-related disability in people with DM.

Corrective bandages and daily manipulations for treatment of congenital vertical talus: a thirteen year follow-up.

PURPOSE: To analyze the results of a conservative method for treating congenital vertical talus in children with early start and to know in which cases surgical treatment was needed. METHODS: A retrospective analysis of all children diagnosed with idiopathic vertical talus was carried out during the years 2008-2021. Thirty-two children (46 feet) were finally included. Children were treated with serial manipulations, muscle stimulation, and corrective bandages. Age at the time of initiation of treatment, duration of treatment, and correction or not of the deformity without surgical intervention were recorded as variables of interest. The talocalcaneal angle, TAMBA, and ankle range of motion were measured before treatment, after treatment, and at the end of the follow-up period. Statistics decision tree was used to determine which variable best discriminated whether the patient needed surgery. To complement the tree diagram, a two-step cluster analysis was carried out. RESULTS: After treatment, TAMBA and talocalcaneal angle changed from "vertical" to "oblique" category in 45 and 37 feet, respectively. The pathological dorsal flexion of the ankle changed to normal in 37 feet and ankle plantar flexion was normal in 46 feet. These variables showed significant changes between the three measurement moments. The results of the statistics decision tree and cluster analysis indicate that "No surgery" was associated with an age equal to or lower than one week when treatment was started, and with an ankle plantar flexion range of motion lower than 36°. CONCLUSIONS: The beginning of this conservative treatment in the first week of life and having a plantar flexion of the ankle lower than 36° were related to the success of the treatment without surgery.

Effectiveness of custom-made functional foot orthoses versus flat cushioning insoles on pain in patients with systemic lupus erythematosus.

OBJECTIVE: To determine the effect of foot orthoses on pain, disability and foot functionality in patients with Systemic Lupus Erythematosus. DESIGN: Randomized clinical trial. SETTING: University Podiatric Clinical Area. SUBJECTS: Patients with systemic lupus erythematosus. INTERVENTIONS: Patients were randomly assigned to either group A, which received custom-made functional foot orthoses, or group B, which received flat cushioning insoles, for three months. MAIN MEASURES: The primary outcome was foot pain, measured by 11-point numeric pain rating scale. Foot functionality and foot-related disability were evaluated using the foot function index, the Manchester foot pain and disability, at the beginning and at days 90. RESULTS: Sixty-six participants (age 47.3 ± 11.9 years) suffering from foot pain, received either the custom-made foot orthoses (N = 33) or the flat cushioning insoles (N = 33). For the analysis of the data, only participants who had finished the follow-up period (90 days) were included. None statistically significant difference between groups were found. In group A, all variables showed statistically significant differences when comparing the initial and final measurements. Pain showed 6.8 ± 1.6 and 4.2 ± 2.9 in group A, at baseline and at 90 days, respectively, group B showed 6.5 ± 1.5 and 4.7 ± 3.0 at baseline and at 90 days, respectively. CONCLUSION: Both groups showed a reduction in foot pain. This study suggests that not only controlling the foot function, but providing cushioning to the foot, may have positive effects to manage foot pain in patients with systemic lupus erythematosus.

Influencia del tratamiento quirúrgico para el hallux abductus valgus en la movilidad del primer radio / Influence of surgical treatment of hallux abducto-valgus on first ray mobility

Objetivo: El objetivo principal de este trabajo es determinar la variación de movilidad pre y postquirúrgica del primer radio. Pacientes y métodos: El diseño corresponde a un estudio prospectivo de series de casos en pacientes sometidos a cirugía de hallux valgus. Se valoró en 13 pies la movilidad del primer radio con el medidor del primer radio, la flexo-extensión de la primera articulación metatarsofalángica, el ángulo de Clarke y el “Arch Index” en pedigrafías, los ángulos hallux valgus e intermetatarsal I-II en radiografías dorsoplantares en carga, y la postura general del pie mediante el “Foot Posture Index” antes y después de ser sometidos a cirugía de hallux valgus. Todo ello con un periodo de seguimiento de 6 meses. Resultados: El rango total de movilidad del primer radio pasó de 11.74 ± 1.88 mm a 6.72 ± 2.20 mm; y el de la primera articulación metatarsofalángica pasó de 79.62° ± 22.33° a 48.69° ± 18.69° tras la cirugía. Los ángulos radiográficos de hallux valgus y ángulo intermetatarsal disminuyeron una media de 19.07° ± 8.20° y 7.23° ± 2.97°, respectivamente. El ángulo de Clarke cambió de 41.31° ± 10.79° a 38.31° ± 11.00°. El “Arch Index” cambió de 0.24 ± 0.06 a 0.25 ± 0.05. Y el “Foot Posture Index” pasó de 6.70 ± 3.33 de media antes de la cirugía a 5.46 ± 3.86 tras la misma. Conclusión: En los participantes incluidos en este estudio se observó una disminución generalizada de todas las variables examinadas tras la cirugía, a excepción de los parámetros valorados en las pedigrafías, que no llegaron a presentar diferencias relevantes.(AU)

Objectives: The main aim of this work is to determine the variation of first ray mobility before and after surgery. Patients and methods: The design corresponds to a prospective case series of patients operated of hallux valgus. A total of 13 feet have been included in this study. Measurements of the first ray mobility were obtained using the first ray mobility measurer. Furthermore, we assess the flexo-extension of the first metatarsophalangeal joint. The Clarke’s angle and the Arch Index were evalued on weightbearing footprints. The hallux valgus angle and intermetatarsal I-II angle were made on weightbearing dorsal-plantar projection radiographs. And finally, the general posture of the foot was quantified using the Foot Posture Index. All this with pre and post measurements of hallux valgus surgery and with a follow-up period of 6 months. Results: The total range of motion of the first ray decreased from 11.74 ± 1.88 mm to 6.72 ± 2.20 mm; and the range of motion of the first metatarsophalangeal joint underwent from 79.62° ± 22.33° to 48.69° ± 18.69° after surgery. The hallux valgus angle and intermetatarsal I-II angle decreased by a mean of 19.07° ± 8.20° and 7.23° ± 2.97°, respectively. The Clarke’s angle changed from 41.31° ± 10.79° to 38.31° ± 11.00°. The Arch Index changed from 0.24 ± 0.06 to 0.25 ± 0.05. And the Foot Posture Index went from 6.70 ± 3.33 before surgery to 5.46 ± 3.86 after it. Conclusion: In the participants included in this study, a generalized decrease was observed in all the examined variables after surgery, except for the parameters assessed in the pedigraphs, which did not present relevant differences.(AU)

Morfología y función del pie en pacientes con ciática. Un estudio descriptivo transversal / Morphology and function of the foot in patients with sciatica. A cross-sectional study

Objetivos: El objetivo de este trabajo es comparar las características articulares de los pies de pacientes con ciática, con las de los pies de personas sin esta patología. Pacientes y métodos: Se trata de un estudio descriptivo transversal. Se incluyeron 20 pacientes con ciática y 20 pacientes sin esta patología emparejados por edad y sexo. Se cuantificó el dolor del pie mediante la Numeric Pain Rating Scale 11 y se midió la movilidad de las articulaciones del tobillo, subastragalina, antepié, primer radio y primer dedo. Se clasificó el tipo de pie mediante el Foot Posture Index, y se cuantificó la discapacidad relacionada con el dolor del pie mediante el cuestionario Manchester Foot Pain and Disability Index. Se compararon estas variables entre los dos grupos de participantes (con ciática y sin ciática). Resultados: Se observó un menor rango de movimiento de pronación subastragalina, así como mayor dolor en el pie y mayor discapacidad relacionada con el dolor en el pie, en los participantes con ciática en comparación con los del grupo control. La extensión del hallux también fue significativamente menor en los sujetos con ciática, aunque solo en el pie izquierdo. Además, la fuerza muscular en estos pacientes fue menor que en los que no tenían ciática. Los participantes de ambos grupos presentaron valores de flexión dorsal del tobillo por debajo de la normalidad. Conclusiones: Los participantes con ciática presentaron ciertas diferencias articulares y musculares con respecto al grupo control, aunque no se puede establecer una relación causa-efecto debido al diseño del estudio (AU)

Objectives: The objective of this work is to compare the joint characteristics of the feet of patients with sciatica, with those of people without this pathology. Patients and methods: This is a cross-sectional descriptive study. Twenty patients with sciatica and 20 patients without this pathology were included. Foot pain was quantified using the Numeric Pain Rating Scale 11, and mobility of the ankle, subtalar, forefoot, first ray, and hallux joints were measured. Foot type was classified using the Foot Posture Index, and disability related to foot pain was quantified using the Manchester Foot Pain and Disability Index questionnaire. These variables were compared between the two groups (participants with and without sciatica). Results: Less subtalar pronation range of motion, as well as greater foot pain and greater foot pain-related disability, were observed in participants with sciatica compared with those in the control group. Hallux dorsalflexion was also significantly less in subjects with sciatica, although only in the left foot. Muscle strength in these patients was lower than in those without sciatica. Participants in both groups presented values of ankle dorsiflexion below normal.Conclusions: The participants with sciatica presented certain joint and muscle differences with respect to the control group, although a cause-effect relationship cannot be established due to the study design (AU)

The Modified versus the Conventional Winograd Technique for the Treatment of Onychocryptosis: A Retrospective Study.

The Winograd technique is a common surgical treatment for ingrown toenails. Attempting to improve the results of this technique, two modifications were adopted: the incisional approach and the use of adhesive approximation strips. This study aimed to compare the conventional technique and the modified version based on (i) postoperative complications, (ii) healing time, (iii) recurrence rate, and (iv) overall patient satisfaction. A longitudinal, observational, and retrospective design was used, with a sample of 208 patients divided into the modified Winograd technique (n = 111) and the conventional Winograd technique (n = 97) in three clinics in Portugal, with follow-up periods of more than 15 years and 10 years, respectively. The modifications to the Winograd technique revealed fewer postsurgical complications, in terms of infections (1.8% vs. 20.62%, p < 0.010), recurrence rate (2.7% vs. 5.21%, p > 0.05), shorter recovery time (8.10 ± 0.76 vs. 14.51 ± 3.48 days, p < 0.001), and lower postoperative pain and better satisfaction with the functional and esthetic results, with the patient's overall satisfaction, and with significant differences in relation to the conventional technique (p < 0.001). The modifications performed showed a lower rate of infection, decreased healing time, and better patient satisfaction, suggesting that it may be adopted in clinical practice for the treatment of stages II and III ingrown toenails.

Relationship of Body Mass Index and Footprint Morphology to the Actual Height of the Medial Longitudinal Arch of the Foot.

The medial longitudinal arch height of the foot is linked to individual characteristics such as sex and body mass index, and these characteristics have been shown to be associated with conditions such as flat feet. In this cross-sectional descriptive study, we examined the medial longitudinal arch morphology in an adult population to determine if there are differences related to sex and body mass index, and values were obtained for the foot posture index. Normalized anthropometric measurements and arch indices were calculated from footprints. Groups, defined by sex and body mass index, were compared, and the correlations between body mass index and the variables were determined. In the population studied (266 women and 177 men), significant differences between men and women for the foot posture index and normalized arch measurements were found. Analysis of the variables related to body mass index indicated there were significant differences in arch indices. Significant differences and positive correlations were also found between the arch index and body mass index for the left and right feet among the men and women studied. The results obtained allow us to reflect on and analyze whether the medial longitudinal arch morphology classification methods used in the clinical and research setting are adequate or whether the influence of factors such as body mass index can generate confusion.

Foot Pain and Morphofunctional Foot Disorders in Patients with Rheumatoid Arthritis: A Multicenter Cross-Sectional Study.

Foot problems are highly prevalent in people with rheumatoid arthritis. This study aims to explore the foot morphology, pain and function in rheumatoid arthritis patients and the relation with the time of disease debut. A cross-sectional study was designed. Footprint, the Foot Posture Index, the hallux valgus prevalence, foot pain and function in 66 rheumatoid arthritis patients and the association with time since diagnosis, were recorded. The Foot Function Index, the Manchester Foot Pain and Disability Index, the Visual Analogic Scale, and the Manchester Scale for hallux valgus were administered and analyzed in two groups, with less and more than 10 years of diagnosis of the disease. A high prevalence of pronated (right 36.8% and left 38.6%) and highly pronated (right 15.8% and left 15.8%) feet was observed, as well as an elevated percentage of low arched footprints (right 68.4 and left 66.7%) and hallux valgus (right 59.6% and left 54.4%). Hallux valgus prevalence, toe deformities and Foot Function Index (Functional limitation) factors were significantly associated with the time since RA diagnosed adjusted for the other factors. The adjusted odds ratio of Hallux valgus prevalence was 4.9 (1.2-19.7). In addition, the foot function was diminished, and foot pain was present in most participants. In conclusion, rheumatoid arthritis patients' feet showed altered morphology and function, and with longer rheumatoid arthritis history, metatarsophalangical stability and foot function, but not pain and global foot posture, were likely to deteriorate.

Effectiveness of custom-made foot orthoses in patients with systemic lupus erythaematosus: protocol for a randomised controlled trial.

INTRODUCTION: Systemic lupus erythaematosus (SLE) is a chronic autoimmune disease of heterogeneous involvement. The disease may affect feet with a high prevalence of symptoms such as, for example, pain, forefoot and rearfoot deformities, and biomechanics dysfunctions. Custom-made foot orthoses (CMFO) have been previously reported to be effective in patients with other rheumatic diseases. However, as far as the authors know, there exist no studies about their effectiveness in SLE. This study aims at determining the effect of CMFO versus placebo flat cushioning insoles on pain, foot functionality, fatigue and quality of life in patients with SLE. METHODS AND ANALYSIS: A randomised controlled trial would compare the effects of (1) CMFO and group B, which received a placebo, flat cushioning insoles, for 3 months. The main outcome measures are foot pain, foot functionality and foot-related disability. The secondary outcome measures are fatigue and quality of life. ETHICS AND DISSEMINATION: The study has been approved by the Portal de Ética de la Investigación Biomédica de Andalucía ethical committee 1494-N-19. The results will be disseminated regardless of the magnitude or direction of effect. TRIAL REGISTARTION NUMBER: Clinicaltrials.gov identifier NCT04098055.

Fatigue in Children with Pronated Feet After Aerobic Exercises.

BACKGROUND: Sports have a strong influence on current society. Foot posture has been postulated to be a risk factor for overuse injuries; however, the link between foot posture and injuries is unclear. This study aimed to determine whether children with pronated feet become more fatigued after participating in sports tests than those with normal feet. METHODS: One hundred five children aged 10 to 12 years (mean ± SD age, 10.46 ± 0.78 years) participated in the sports tests, which were aerobic-type resistance exercises with six stations at which each child remained for 30 sec. The posture of the foot was evaluated via the Foot Posture Index and the plantar footprint via the arch index and the Clarke angle before and after aerobic-type resistance exercises. Perceived tiredness was evaluated with the Pictorial Children's Effort Rating Table (PCERT) and whether there was pain during or after physical activity. RESULTS: The variables used to measure foot posture and the plantar arch changed more in the pronated feet, suggesting that the feet undergo more pronation after physical exercise. The neutral feet obtained a mean ± SD PCERT score of 5.46 ± 1.89 and the pronated feet a score of 7.60 ± 1.92. CONCLUSIONS: Children with pronated feet showed more fatigue and foot pain during and/or after physical exercise than those with neutral feet. Foot type could be responsible for the lack of enthusiasm of children toward undertaking healthy activities, and this problem might be solved via appropriate orthopedic treatment.

Validity of clinical methods in the detection of leg-length discrepancies.

INTRODUCTION: Lower limb-length discrepancy is highly prevalent in the general population. Numerous methods and measurement instruments for its diagnosis appear in the literature, but there has not been an agreement about their validity. The aim of this work is to determine the validity of the Weber-Barstow manoeuvre (WB) of the pelvic measuring device (PMD) and the block method (BM), in comparison with standing anteroposterior telemetry of the lower limbs in subjects with leg-length discrepancy (LLD). METHODS: 71 subjects took part in the study. First, the WB was carried out in the supine position. the LLD was then quantified standing with the PMD and with the BM. Lastly, standing anteroposterior telemetry of the lower limbs was obtained. This was measured with Autocad 2013, using the highest part of the head of the femur and the most distal edge of the bisection of the femur as points of reference. RESULTS: The Kappa index was calculated to check the agreement between the WB manoeuvre and the telemetry. This was 0.52. The relation of the PMD, BM and telemetry difference variables was calculated. A direct relation between the BM and telemetry was shown, with p > 0.05 (0.48 cm and 0.51 cm, respectively). CONCLUSIONS: The WB manoeuvre got acceptable validity results. The PMD was not valid according to the results obtained in this work. The BM achieved a good validity result for the diagnosis of LLD.

Orthotic treatment for stage I and II posterior tibial tendon dysfunction (flat foot): A systematic review.

OBJECTIVE: To investigate whether orthotic treatment is effective for the treatment of posterior tibial tendon dysfunction stages I and II (flat foot). DATA SOURCES: Five databases (PubMed, Scopus, PEDro, SPORTDiscus and The Cochrane Library) were searched for potential RCTs from their inception until August 2020. REVIEW METHODS: Only randomised controlled trials (RCT) that included subjects diagnosed with posterior tibial dysfunction in the initial stage and treated with orthotic treatments were selected. The outcomes assessed were whatever symptom related to posterior tibial tendon dysfunction stage I and II. Included RCTs were appraised using the Cochrane collaboration risk of bias tool. RESULTS: Four RCT articles and 186 subjects were included. 75% were at high risk of bias for blinding of participants and personnel. Three different types of conservative treatment were used in the studies: foot/ankle-foot orthoses, footwear and stretching /strengthening exercises. Foot orthoses, together with exercise programmes, seemed to improve the effect of orthotic treatment. Foot orthoses with personalised internal longitudinal arch support were more effective than flat insoles or standard treatments in reducing pain. CONCLUSIONS: The use of orthotic treatment may be effective in reducing pain in the early stages of posterior tibial tendon dysfunction. Further research is needed into individualised orthotic treatment and high-intensity monitored exercise programmes.

Psychosocial Influence of Ehlers-Danlos Syndrome in Daily Life of Patients: A Qualitative Study.

(1) Background: Ehlers-Danlos syndrome is a heterogeneous group of connective tissue disorders causing pain, fatigue, and disabilities; it has several implications for patients who suffer from this disease. The major clinical manifestations of EDS include joint hypermobility, skin hyperextensibility, and generalized connective tissue fragility. This research aims to explore their perceptions and experiences about the phycological and social spheres. (2) Methods: Semistructured interviews were carried out. Participants were encouraged to talk about issues related to their disease by asking open-ended questions in one to one interview. The interview guide included questions to identify the syndrome's influence on the social and psychological life of patients All interviews were audio recorded, fully transcribed, and analyzed using the phenomenological theoretical framework. The method of analysis was the thematic interpreting of perspectives and approaches. (3) Results: 31 individuals were proposed to participate in this study. Five patients refused to participate, so a total of 26 interviews were performed. Six themes ((1) Pain and its consequences on a daily basis; (2) The need to name the problem: the diagnosis; (3) Restructuring leisure and social relationships; (4) Limitations due to economic conditions; (5) Psychological impact of the disease situation; (6) Professional limitations) and four subthemes ((1) The value of partner support; (2) The weather influence on social plans; (3) Physical exercise and illness; (4) Support groups) emerged from the data. (4) Conclusions: This study revealed the impact of the syndrome on the social and daily life of patients, and not only in a physical level, but also in a psychological and social approach. These findings allow healthcare providers to know more about this disease in order to support and give advice to patients about the changes they will have to make.

Prevalence of Preoperative Anxiety and Its Relationship with Postoperative Pain in Foot Nail Surgery: A Cross-Sectional Study.

Preoperative anxiety has been studied in different medical disciplines, but it is unknown in minor surgical procedures such as foot nail surgery. This study aimed to determine the prevalence of preoperative anxiety and postoperative pain in foot nail surgery. The validated Amsterdam preoperative anxiety and information scale (APAIS) was used to evaluate preoperative anxiety and the need for information in 155 patients undergoing foot nail surgery. In addition, a questionnaire was used to collect other variables such as age, sex and educational level. The verbal numeric scale was employed to value the postoperative pain after 24 h. Age and sex influenced (p < 0.05) preoperative anxiety, which had a prevalence of 22.6%. More than 43% of patients needed more information and this was correlated with anxiety (r = 0.629; p < 0.001). There was a significant difference when comparing the total anxiety between the group of participants who had more pain and that who had less pain (p < 0.001). The prevalence of anxiety was high in the participants of this study, being greater in young patients and in women. There was a deficit of information, increasing the level of preoperative anxiety, which in turn was related with greater postoperative pain.

The Validity and Reliability of a New Simple Instrument for the Measurement of First Ray Mobility.

Several methods have been described to quantify the first ray mobility. They all have certain disadvantages (great size, sophistication, or lack of validation). The objective of this work was to study the validity and reliability of a new instrument for the measurement of first ray mobility. Anterior-posterior radiographs were obtained from 25 normal feet and 24 hallux valgus feet, with the first ray in a neutral position, maximally dorsiflexed and maximally plantarflexed. The first ray mobility was radiographicaly measured in both groups, and was also manually examined with the new device. A cluster analysis determined whether normal and hallux valgus feet were correctly classified, and a graphic analysis of Bland-Altman was performed to compare the radiographic and manual measurement techniques. Based on the radiographs, the first ray mobility only showed significant differences in dorsiflexion between both groups (P = 0.015). First ray dorsiflexion, plantarflexion and total range of motion measured with the new device were different between both groups (P = 0.040, P = 0.011 and P = 0.006, respectively). The silhouette measure of the cohesion and separation coefficients from the cluster analysis was greater than 0.50 for the dorsiflexion, plantarflexion and total range of motion obtained from the radiographs and from the new device. The Bland-Altman graph suggested that 96% of the data presented agreement between both measurement methods. These results suggested that the new instrument was valid and reliable.

Custom-Made Foot Orthoses Reduce Pain and Fatigue in Patients with Ehlers-Danlos Syndrome. A Pilot Study.

BACKGROUND: Pain and fatigue are major clinical manifestations in patients with Ehlers-Danlos Syndrome (EDS). The aim of this study is to measure change of the effects of custom-made foot orthotics on some manifestations related to EDS, such as foot pain, foot functionality, fatigue, and quality of life. METHODS: Thirty-six patients with EDS wore foot orthoses for three months. Foot pain, foot-related disability, foot functionality, fatigue, and quality of life were measured using the 11-point Numeric Rating Scale, the Manchester Foot Pain and Disability Index, the Foot Function Index, the Fatigue Severity Score, and the 12-Item Short Form Health Survey questionnaires, respectively, at the beginning and after 3 months. RESULTS: Participants demonstrated significantly improved foot pain (p = 0.002), disability related to foot pain (p < 0.001), foot functionality (p = 0.001), fatigue (p < 0.007), and mental health-related quality of life (p = 0.016). The physical health-related quality of life did not show significant changes. CONCLUSIONS: The use of custom-made foot orthoses help in the management of the symptoms by participants. This study could contribute to the foot specialists being considered as an additional member in multidisciplinary teams that are trying to develop an approach for patients with EDS.

Alteraciones podológicas en el síndrome de Ehlers-Danlos / Podiatry alterations in Ehlers-Danlos syndrome

ANTECEDENTES Y OBJETIVO: En este trabajo se pretende describir el tipo de pie y las alteraciones podológicas más frecuentes, el nivel de dolor, la discapacidad, la fatiga y la alteración de la calidad de vida que presentan los pacientes con síndrome de Ehlers-Danlos (SED). MATERIALES Y MÉTODOS: Treinta y ocho individuos con SED tipo hipermóvil o clásico fueron reclutados. Se registró el porcentaje de dolor en el pie y las deformidades, y se les aplicaron distintos cuestionarios. El tipo de pie se clasificó según la huella y el Foot Posture Index. RESULTADOS: Se registra un alto grado de dolor, discapacidad, intensidad de la fatiga y bajo nivel de calidad de vida en estos pacientes. Según la huella el 20% presentó pies planos, el 47% pies normales y el 33% pies cavos. CONCLUSIONES: Los participantes en este estudio presentaron un alto porcentaje de problemas podológicos, altos niveles de dolor y limitación de la funcionalidad en los pies. La calidad de vida de estos pacientes aparece disminuida. Se han observado tipos de pies según la huella y de deformidades similares a la población general

BACKGROUND AND OBJECTIVE: This paper aims to describe the type of foot and most frequent podiatric alterations, as well as the level of pain, disability, fatigue and alteration of quality of life in patients with Ehlers-Danlos syndrome (EDS). MATERIALS AND METHODS: Thirty-eight individuals with hypermobile or classic EDS participated. The percentage of pain in the foot and deformities was recorded, and several questionnaires were administered. The type of foot was classified according to the footprint and the Foot Posture Index. RESULTS: There was a high degree of pain, disability, intensity of fatigue and low quality of life in these patients. According to the footprint, 20% presented flat feet, 47% normal feet and 33% cavus feet. CONCLUSIONS: The participants in this study had a high percentage of foot problems related to high levels of pain and limited functionality in the feet. The quality of life of these patients appeared diminished. Foot types were observed according to the footprint and deformities similar to those of the general population

Podiatry alterations in Ehlers-Danlos syndrome. / Alteraciones podológicas en el síndrome de Ehlers-Danlos.

BACKGROUND AND OBJECTIVE: This paper aims to describe the type of foot and most frequent podiatric alterations, as well as the level of pain, disability, fatigue and alteration of quality of life in patients with Ehlers-Danlos syndrome (EDS). MATERIALS AND METHODS: Thirty-eight individuals with hypermobile or classic EDS participated. The percentage of pain in the foot and deformities was recorded, and several questionnaires were administered. The type of foot was classified according to the footprint and the Foot Posture Index. RESULTS: There was a high degree of pain, disability, intensity of fatigue and low quality of life in these patients. According to the footprint, 20% presented flat feet, 47% normal feet and 33% cavus feet. CONCLUSIONS: The participants in this study had a high percentage of foot problems related to high levels of pain and limited functionality in the feet. The quality of life of these patients appeared diminished. Foot types were observed according to the footprint and deformities similar to those of the general population.

Immediate and short-term radiological changes after combining static stretching and transcutaneous electrical stimulation in adults with cavus foot: A randomized controlled trial.

BACKGROUND: Cavus foot is a deformity represented by an increased and rigid medial longitudinal arch, and it is often associated with persistent pain and gait disturbances. None of the conservative conventional treatments for cavus foot have shown conclusive evidence of effectiveness, and so further is research needed to understand how to manage this condition better. This study aimed to assess the immediate and short-term radiological changes after combining static stretching and transcutaneous electrical stimulation of the plantar fascia in adults with idiopathic cavus foot. METHODS: A randomized, single-blinded clinical trial was conducted. Sixty-eight participants with idiopathic cavus foot, as determined by an internal Moreau-Costa-Bertani angle (MCBA) less than 125° in a lateral weight-bearing foot radiograph, were equally distributed into a neuromuscular stretching group (NSG) or a control group (no intervention). The NSG underwent a single session, combining transcutaneous electrical nerve stimulation with static stretching of the plantar fascia. Primary measurements of 3 angles were taken using a lateral weight-bearing foot radiograph: the internal MCBA; the calcaneal pitch angle (CPA); and the first metatarsal declination angle (FMDA). Outcomes were collected at baseline, immediately postintervention, and 1 week after intervention. RESULTS: Analysis of variance revealed a significant group effect for all angles (all, P < .05). NSG participants showed a significant increase in the internal MCBA (P = .03), and a significant decrease in the CPA (P = .01) and FMDA (P = .04) from baseline to immediately postintervention. These changes remained statistically significant 1 week after the intervention (all, P < .05). CONCLUSION: The combination of static stretching and transcutaneous electrical stimulation of the plantar fascia, compared with no treatment, achieved immediate and short-term changes in the internal MCBA, the CPA, and the FMDA, which resulted in flattening the medial longitudinal plantar arch in adults with idiopathic cavus foot.