Effect of Buerger-Allen exercise on wound healing in patients with diabetic foot ulcers: a randomised controlled trial.

OBJECTIVE: A diabetic foot ulcer (DFU) is a complication of type 2 diabetes that is difficult to treat. Buerger-Allen exercise has shown effectiveness in improving foot circulation and neuropathy in several studies; however, to the best of our knowledge, no randomised controlled study has investigated its effectiveness for DFU healing. Therefore, this study aimed to assess the effects of Buerger-Allen exercise on the healing of DFUs in patients with type 2 diabetes. METHOD: This is a parallel-group randomised controlled trial (RCT). Of 50 patients with neuropathic DFUs, 41 completed the study. They were assigned randomly to a study group (n=21) and a control group (n=20). Patients in the study group received the standard medical treatment and semi-supervised Buerger-Allen exercise for three sessions per week for four weeks, while patients in the control group only received the standard medical treatment. The outcome measures were: ankle-brachial pressure index (ABPI); ulcer size; ulcer depth; SINBAD score; and ulcer risk for poor outcomes (based on the SINBAD score). RESULTS: The study group's mean age was 49.48±6.45 years and the control group's mean age was 49.15±5.85. The study group's ABPI increased significantly compared to the baseline (1.17±0.04 versus 1.11±0.05, respectively; p<0.001) and the control group (1.17±0.04 versus 1.14±0.05, respectively; p=0.04) post-intervention. Ulcer size also reduced significantly in the study group compared to the baseline (2.63±2.0 versus 7.48±5.55cm2, respectively; p<0.001) and the control group (2.63±2.0 versus 6.43±4.45cm2, respectively; p<0.001) post-intervention. Ulcer depth decreased significantly in the study group compared to the baseline (1.71±1.05 versus 4.19±1.74mm, respectively; p<0.001) and the control group (1.71±1.05 versus 2.80±1.57mm, respectively; p=0.01) post-intervention. Furthermore, the SINBAD score in the study group decreased significantly compared to the baseline (1.38±0.86 versus 2.14±1.06, respectively; p<0.001) and the control group (1.38±0.86 versus 2.0±0.79, respectively; p=0.02) post-intervention. Moreover, the ulcer risk for poor outcomes, based on the SINBAD score, reduced significantly only in the study group, compared to the baseline (p=0.041). The control group showed non-significant changes compared to the baseline in all outcome measures (p>0.05). CONCLUSION: From the findings of this RCT, Buerger-Allen exercise, in combination with standard wound care, may help accelerate the healing of neuropathic DFUs in patients with type 2 diabetes, and could be suggested as part of the management plan for such conditions as an easy-to-perform offloading exercise intervention.

Perceptions of foot health services from the perspective of patients with rheumatoid arthritis in Finland.

BACKGROUND: Foot health services for people with rheumatoid arthritis (RA) are an important part of their comprehensive care. However, little is known about the perceptions of people with RA have about foot health services. This study aimed to explore how people with RA perceive foot health services. METHODS: A descriptive cross-sectional survey design was applied. The electronic survey data were collected in April 2023 from people with RA through a national patients' association (N = 2400, response rate 24%, n = 565). The statistical data were analysed using descriptive statistics and textual data with thematic analysis. RESULTS: Most of the respondents (n = 322, 59%) had used foot health services provided by chiropodist or podiatrist. Those who had used services were mostly satisfied but considered patient education about foot health insufficient. One third reported no visits to foot health services at all because of personal and health service system-related factors. CONCLUSIONS: Those people with RA who have access to foot health services value and appreciate the services. However, many people with RA do not use foot health services because they perceive availability of such services limited and thus unequal and hard to access. There is a need to develop foot health services for people with RA so that they are easy to access, correspond to their foot health needs and have seamless care paths at different levels of the health care system.

Comparing the effectiveness of computer-aided design/computer-aided manufacturing (CAD/CAM) of insoles manufactured from foam box cast versus direct scans on patient-reported outcome measures: a protocol for a double-blinded, randomised controlled trial.

INTRODUCTION: Custom insoles are a routine treatment for many foot pathologies, and the use of computer-aided design and computer-aided manufacturing (CAD/CAM) is well established within clinical practice in the UK. The method of foot shape capture used to produce insoles varies throughout orthotic services. This trial aims to investigate the effectiveness of two common shape-capture techniques on patient-reported outcomes in people who require insoles for a foot or ankle pathology. METHODS AND ANALYSIS: This double-blinded randomised controlled trial will involve two intervention groups recruited from a National Health Service orthotic service. Participants will be randomly assigned to receive a pair of custom CAD/CAM insoles, manufactured either from a direct digital scan or a foam box cast of their feet and asked to wear the insoles for 12 weeks. The primary outcome measure will be the Foot Health Status Questionnaire (FHSQ) pain subdomain, recorded at baseline (immediately after receiving the intervention), 4, 8 and 12 weeks post intervention. Secondary outcome measures will include FHSQ foot function and foot health subdomains recorded at baseline, 4, 8 and 12 weeks. The Orthotic and Prosthetic User Survey Satisfaction with Device will be recorded at 12 weeks. The transit times associated with each arm will be measured as the number of days for each insole to be delivered after foot shape capture. Tertiary outcome measures will include participant recruitment and dropout rates, and intervention adherence measured as the daily usage of the insoles over 12 weeks. The change in FHSQ scores for the subdomains and insole usage will be compared between the groups and time points, and between group differences in time in transit, cost-time analysis and environmental impact will be compared. ETHICS AND DISSEMINATION: Ethical approval was obtained from the Health Research Authority, London Stanmore Research Ethics Committee (22/LO/0579). Study findings will be submitted for publication in peer-reviewed journals, conference presentations and webinars. TRIAL REGISTRATION NUMBER: NCT05444192.

The assessment and management of foot and toe oedema as part of holistic lower limb care.

Toe and foot swelling can manifest as lymphoedema or chronic oedema but can also be a complication of the treatment of these conditions. In this article, the authors discuss the assessment and treatment options for toe and foot swelling, highlighting the importance of prevention in the first instance.

Are enlarged peroneal tubercle and accessory anterolateral talar facet associated with calcaneal spur?

BACKGROUND: As the anatomical variations of the foot, enlarged peroneal tubercle (EPT) and accessory anterolateral talar facet (AALTF) have attracted the attention of foot surgeons in recent years. However, EPT and AALTF have not been examined for a relationship with calcaneus spur (CS) as a common osteophyte. METHODS: The subjects were 369 individuals who died in northeastern Thailand and were preserved as skeletal specimens. The authors examined for the presence of left and right EPT, AALTF, and calcaneus spur (CS). We divided the EPT (+) group with EPT and the EPT (-) group without it and also divided the AALTF (+) group with AALTF and the AALTF (-) group without it. The age at death and the presence of CS were compared statistically between the EPT (+) and EPT (-) groups and between the AATLF (+) and AALTF (-) groups. RESULTS: Out of the total 369 cases, EPT was found in 117 cases (31.7%), AALTF was positive in 91 cases (24.7%), and CS was found in 194 cases (52.3%). In comparison between EPT (+) and EPT (-) groups, CS was significantly higher (p < 0.0001) in the EPT (+) group, but there was no significant difference in age at death. In comparison between AALTF (+) and AALTF (-) groups, there was no significant difference in age at death or CS. CONCLUSION: This study showed a strong relationship between EPT and CS, and the prevalence of EPT and AALTF by age in Thailand was first reported. We believe it helps to know the pathogenesis and biomechanism of EPT and AALTF. TRIAL REGISTRATION: Not applicable.

A Multistage Hemiplegic Lower-Limb Rehabilitation Robot: Design and Gait Trajectory Planning.

Most lower limb rehabilitation robots are limited to specific training postures to adapt to stroke patients in multiple stages of recovery. In addition, there is a lack of attention to the switching functions of the training side, including left, right, and bilateral, which enables patients with hemiplegia to rehabilitate with a single device. This article presents an exoskeleton robot named the multistage hemiplegic lower-limb rehabilitation robot, which has been designed to do rehabilitation in multiple training postures and training sides. The mechanism consisting of the thigh, calf, and foot is introduced. Additionally, the design of the multi-mode limit of the hip, knee, and ankle joints supports delivering therapy in any posture and training sides to aid patients with hemiplegia in all stages of recovery. The gait trajectory is planned by extracting the gait motion trajectory model collected by the motion capture device. In addition, a control system for the training module based on adaptive iterative learning has been simulated, and its high-precision tracking performance has been verified. The gait trajectory experiment is carried out, and the results verify that the trajectory tracking performance of the robot has good performance.

Genetic interference with HvNotch provides new insights into the role of the Notch-signalling pathway for developmental pattern formation in Hydra.

The Notch-signalling pathway plays an important role in pattern formation in Hydra. Using pharmacological Notch inhibitors (DAPT and SAHM1), it has been demonstrated that HvNotch is required for head regeneration and tentacle patterning in Hydra. HvNotch is also involved in establishing the parent-bud boundary and instructing buds to develop feet and detach from the parent. To further investigate the functions of HvNotch, we successfully constructed NICD (HvNotch intracellular domain)-overexpressing and HvNotch-knockdown transgenic Hydra strains. NICD-overexpressing transgenic Hydra showed a pronounced inhibition on the expression of predicted HvNotch-target genes, suggesting a dominant negative effect of ectopic NICD. This resulted in a "Y-shaped" phenotype, which arises from the parent-bud boundary defect seen in polyps treated with DAPT. Additionally, "multiple heads", "two-headed" and "ectopic tentacles" phenotypes were observed. The HvNotch-knockdown transgenic Hydra with reduced expression of HvNotch exhibited similar, but not identical phenotypes, with the addition of a "two feet" phenotype. Furthermore, we observed regeneration defects in both, overexpression and knockdown strains. We integrated these findings into a mathematical model based on long-range gradients of signalling molecules underlying sharply defined positions of HvNotch-signalling cells at the Hydra tentacle and bud boundaries.

Myoepithelial Carcinoma of Soft Tissue: Report of Two Cases.

CASE: A 40-year-old man was evaluated for a painful mass on his right calf, and a 36-year-old woman presented with a painless mass on her right foot. Final pathology revealed marked nuclear atypia and positivity for S100/SOX10 and AE1/AE3 confirming diagnoses of myoepithelial carcinoma. Both patients underwent surgical resection and are without evidence of local recurrence or metastatic disease at 1-year follow-up. CONCLUSION: Soft-tissue tumors presenting in the extremities warrant careful evaluation and timely histopathologic diagnosis. Myoepithelial carcinomas are rare, aggressive tumors with a propensity for local recurrence and metastasis. Treatment of these tumors should be discussed by a multidisciplinary tumor team.

Validity and reliability of the Foot Care Scale for Older Diabetics in Turkish society.

BACKGROUND: Older patients with diabetes have behaviors and practices in foot care that differ from those of younger patients. There is a need for a tool to assess the foot care of patients with diabetes who are over the age of 65 years. PURPOSE: This study aimed to assess the validity and reliability of the long and short versions of the Foot Care Scale for Older Diabetics (FCS-OD) in Turkish society. METHODS: A total of 172 older patients with diabetes participated in the study. Language validity, content validity, construct validity, Cronbach's alpha coefficient value, item-scale correlations, parallel form reliability, and test-retest correlations were used to assess the Turkish version of FCS-OD. A patient identification form, FCS-OD, Diabetic Foot Care Self-Efficacy Scale, and Foot Self-Care Behavior Scale were used for data collection. RESULTS: Turkish versions of the FCS-OD, both short and long versions, were at acceptable levels regarding their content (content validity index: 0.964, 0.975) and construct (factor loadings > 0.4). Both versions of the scale showed a high level of internal consistency as demonstrated by Cronbach's alpha values (short version, 0.802; long version, 0.905) and item-scale correlations (> 0.3). Both versions of the scale were stable over time and compared to the parallel forms. CONCLUSIONS: Both versions of the scale were found to be valid and reliable for Turkish society with regard to psychometric properties.

Anthropometric Study of Foot Breadth of 5-10 Years Aged Bangladeshi Children.

The present anthropometric study was designed to construct data of 5-10 years aged Bangladeshi children regarding foot breadth and an attempt has been made out to grow interest among the researchers for future study and also to compare the data with the data of the people of other races. This cross-sectional, descriptive and analytic type study was conducted among 5-10 years aged 109 Bangladeshi children (70 male and 39 female) at different areas of Mymensingh district (Fulpur, Muktagacha, Fulbaria, Trisal and Haluaghat), Bangladesh from January 2016 to December 2016. Non-random purposive sampling technique was taken for sample collection. Any kind of foot deformity due to either from congenital or physical injury was excluded to construct standard measurement. Foot breadth was measured using slide caliper. The children were asked to stand with weight distributed equally on both feet. The legs were perpendicular to the feet. The mean foot breadth of right side of 5, 6, 7, 8, 9 and 10 years aged male children were 7.08±.61 cm, 7.11±.30 cm, 7.61±.45 cm, 7.44±.43 cm, 8.12±.38 cm and 8.17±.44 cm respectively and those of female children were 6.55±.64 cm, 7.17±.27 cm, 7.04±.70 cm, 7.62±.54 cm, 7.48±.88 cm and 7.85±.72 cm respectively. The mean foot breadth of left side of 5, 6, 7, 8, 9 and 10 years aged male children were 7.04±.60 cm, 7.03±.30 cm, 7.52±.47 cm, 7.36±.45 cm, 8.03±.38 cm and 8.08±.43 cm respectively and those of female children were 6.46±.63 cm, 7.10±.31 cm, 6.95±.71 cm, 7.54±.52 cm, 7.37±.89 cm and 7.77±.71 cm respectively. Comparison of foot breadth between male and female children was done by Unpaired Students 't' test and the differences of means were statistically non-significant. Data were tabulated and statistically analyzed using Microsoft excel and SPSS software. The results of present study would be useful in anatomy, orthopedics, forensic science, plastic surgery, radiology, podiatry, archeology, anthropology and nutrition science.

Evaluation of Foot Structure in Preschool Children Based on Body Mass.

BACKGROUND The human foot has a complex structure and the ligamentous and muscular apparatus undergoes transformation and adaptation during its ontogenetic development. Excessive body mass may be one of the factors disrupting proper foot formation. This study aimed to assess the foot structure in preschool children in relation to body mass. MATERIAL AND METHODS A total of 105 children aged 6.27±0.60 years were examined. Height, weight, and segmental body composition were determined using the Tanita MC-780 body composition analyzer. The foot structure was assessed using the Kasperczyk method, supplemented with digital analysis using the Podoscan 2D camera. The Weisflog index and gamma angle for feet were calculated. Children were divided into 2 groups: children in Group I did not have foot deformities and those in Group II had foot deformities. RESULTS No correlation was observed between body mass and the occurrence of anomalies in foot structure. A correlation was noted between the Weisflog index for the right foot and height in both groups. The Weisflog index for both feet was correlated with BMI, with higher values obtained for the left foot in both groups. In Group II, a correlation was observed between the gamma angle value for the left foot and the predicted muscle mass for the right lower limb, as well as between the same foot and the predicted muscle mass for the left lower limb. CONCLUSIONS No correlation was observed between high BMI and the occurrence of anomalies in foot structure. A relationship was identified between muscle mass and foot structure.

Ankle and hindfoot motion of healthy adults during running revealed by dynamic biplane radiography: Side-to-side symmetry, sex-specific differences, and comparison with walking.

This study aimed to characterize ankle and hindfoot kinematics of healthy men and women during overground running using biplane radiography, and to compare these data to those previously obtained in the same cohort during overground walking. Participants ran across an elevated platform at a self-selected pace while synchronized biplane radiographs of their ankle and hindfoot were acquired. Motion of the tibia, talus, and calcaneus was tracked using a validated volumetric model-based tracking process. Tibiotalar and subtalar 6DOF kinematics were obtained. Absolute side-to-side differences in ROM and kinematics waveforms were calculated. Side-to-side and sex-specific differences were evaluated at 10 % increments of stance phase with mixed model analysis. Pearson correlation coefficients were used to assess the relationship between stance-phase running and walking kinematics. 20 participants comprised the study cohort (10 men, mean age 30.8 ± 6.3 years, mean BMI 24.1 ± 3.1). Average absolute side-to-side differences in running kinematics waveforms were 5.6°/2.0 mm or less at the tibiotalar joint and 5.2°/3.2 mm or less at the subtalar joint. No differences in running kinematics waveforms between sides or between men and women were detected. Correlations were stronger at the tibiotalar joint (42/66 [64 %] of correlations were p < 0.05), than at the tibiotalar joint (38/66 [58 %] of correlations were p < 0.05). These results provide a normative reference for evaluating native ankle and hindfoot kinematics which may be informative in surgical or rehabilitation contexts. Sex-specific differences in ankle kinematics during overground running are likely not clinically or etiologically significant. Associations seen between walking and running kinematics suggest one could be used to predict the other.

Relationship between the strength of the ankle and toe muscles and functional stability in young, healthy adults.

This study investigates the relationship between ankle and toe strength and functional stability in young adults, with a sample comprising sixteen females and fourteen males. The research employed force platform data to determine the center of foot pressure (COP) and calculated the forward functional stability index (FFSI) through foot anthropometric measurements. Strength measurements of toe and ankle muscles, during maximal isometric flexion and extension, were conducted using force transducers. Notable positive correlations were found between toe flexor strength and FFSI (left flexor: r = 0.4, right flexor: r = 0.38, p < 0.05), not influenced by foot anthropometry. Contrarily, no significant correlation was observed between ankle muscle strength and FFSI, despite a positive correlation with the COP range. The moderate correlation coefficients suggest that while toe flexor strength is a contributing factor to functional stability, it does not solely determine functional stability. These findings highlight the critical role of muscle strength in maintaining functional stability, particularly during forward movements and emphasize the utility of FFSI alongside traditional COP measures in balance assessment. It is recommended to employ a multifaceted approach is required in balance training programs.

Morphological and radiographic studies on the Manus region in the Arabian one-humped camel (Camelus dromedaries).

The study aims to analyse the normal anatomical and radiographical features of the Manus of the southern Aswanian-adapted Arabian one-humped camel, providing crucial data for diagnosing and treating various ailments. Our study was applied to 10 cadaver forelimbs of adult male one-humped camels (4-5 years old) for an explanation of the gross anatomy of the bones of the Manus region from under the carpal bones by using traditional techniques, including the gross anatomical, radiographic and x-ray (at the dorsopalmar and lateral planes) of the preparation of Manus bones. Our results showed that the large fused (third and fourth) metacarpal bones, in which the fusion extended along the entire length of the bone except at the distal end, diverged to form separate articulations with cross-ponding digits. As described in all ruminant species, especially the camel, there were two digits, and each digit consisted of three phalanges and two proximal sesamoid bones. Our radiographic x-ray data revealed that the complete radiopaque septum that completely divided the medullary cavity into two separate parts was clear from the dorsopalmar view, while the lateral view showed the proximal sesamoid bones that were placed over each other and located palmar to the head of the large metacarpal bone. In conclusion, our study reveals the adaptations of the Arabian one-humped camel to Egyptian conditions, aiding in the early diagnosis of lameness and digit problems and enabling veterinarians and camel owners to better address these issues, thereby improving the overall health and well-being of these animals.