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1.
Acta Orthop Belg ; 89(3): 507-514, 2023 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-37935236

RESUMO

Fusion of the first metatarsophalangeal joint (MTPJ) is a commonly performed surgical procedure. Although the effect of first MTPJ fusion on reduction of Intermetatarsal angle (IMA) is well described, contributing factors remain unclear. The aim of this study was to identity predictive parameters for IMA reduction. Fifty-one patients (68 feet) who underwent a first MTPJ fusion and had an IMA greater than fourteen degrees were assessed retrospectively. The average age was 68 (31.4-79.3) years. Sixteen demographic and radiographic variables were evaluated using a multivariate regression analysis for association with change in IMA after surgery. The mean preoperative IMA was 16.11 (range, 14.0-22.5) degrees with a mean reduction of 4.95 (range, 0-17) degrees after surgery. Multivariate regression analysis revealed three significant independent predictors of the change in IMA. Increased preoperative IMA (ß = .663, CI = .419, .908, P <.001), increased preoperative translation at base of MT1 (ß = .490, CI = 0.005, .974, P = 0.039), and less postoperative translation in the fusion (ß= -0.693, CI= -1.054, -.331, P= 0.002) significantly increased the amount of IMA reduction. Pre-operative IMA and translation at the base of the first metatarsal were positive predictors for correction of IMA after first MTPJ fusion. Translation at the level of the MTP I fusion was a negative predictor for the amount of IMA correction. Based on these findings, we recommend minimizing the lateral translation of the proximal phalanx relative to the metatarsal head to optimize IMA correction after MTPJ fusion.


Assuntos
Hallux Valgus , Ossos do Metatarso , Articulação Metatarsofalângica , Humanos , Idoso , Hallux Valgus/cirurgia , Estudos Retrospectivos , Articulação Metatarsofalângica/diagnóstico por imagem , Articulação Metatarsofalângica/cirurgia , Ossos do Metatarso/diagnóstico por imagem , Ossos do Metatarso/cirurgia , Artrodese/métodos , Resultado do Tratamento
2.
Knee Surg Sports Traumatol Arthrosc ; 26(7): 2095-2102, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28439639

RESUMO

PURPOSE: The purpose of this study is to propose recommendations for the treatment of patients with chronic lateral ankle instability (CAI) based on expert opinions. METHODS: A questionnaire was sent to 32 orthopaedic surgeons with clinical and scientific experience in the treatment of CAI. The questions were related to preoperative imaging, indications and timing of surgery, technical choices, and the influence of patient-related aspects. RESULTS: Thirty of the 32 invited surgeons (94%) responded. Consensus was found on several aspects of treatment. Preoperative MRI was routinely recommended. Surgery was considered in patients with functional ankle instability after 3-6 months of non-surgical treatment. Ligament repair is still the treatment of choice in patients with mechanical instability; however, in patients with generalized laxity or poor ligament quality, lateral ligament reconstruction (with grafting) of both the ATFL and CFL should be considered. CONCLUSIONS: Most surgeons request an MRI during the preoperative planning. There is a trend towards earlier surgical treatment (after failure of non-surgical treatment) in patients with mechanical ligament laxity (compared with functional instability) and in high-level athletes. This study proposes an assessment and a treatment algorithm that may be used as a recommendation in the treatment of patients with CAI. LEVEL OF EVIDENCE: V.


Assuntos
Traumatismos do Tornozelo/cirurgia , Articulação do Tornozelo/cirurgia , Prova Pericial/normas , Instabilidade Articular/cirurgia , Ligamentos Laterais do Tornozelo/cirurgia , Adulto , Traumatismos do Tornozelo/diagnóstico por imagem , Articulação do Tornozelo/diagnóstico por imagem , Doença Crônica , Comorbidade , Consenso , Feminino , Pesquisas sobre Atenção à Saúde , Humanos , Instabilidade Articular/diagnóstico por imagem , Ligamentos Laterais do Tornozelo/diagnóstico por imagem , Ligamentos Laterais do Tornozelo/lesões , Ligamentos/diagnóstico por imagem , Ligamentos/cirurgia , Imageamento por Ressonância Magnética , Masculino , Cuidados Pré-Operatórios , Procedimentos de Cirurgia Plástica/métodos , Adulto Jovem
3.
Acta Chir Belg ; 118(3): 188-191, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28454504

RESUMO

Painful tarsal tunnel syndrome is a compression neuropathy with a variety of possible sources. As it presents a challenging differential diagnostic problem, it is often under-diagnosed. Among the intrinsic and extrinsic factors, varicose veins are the main source in case of a venous etiology. We report a case of a 39-year old male patient who presented with complaints of paresthesia and excessive pain of the right foot, especially the medial side. Further work up by ultrasonography, magnetic resonance imaging and electromyography revealed an extensive congenital venous malformation of the right lower limb with subsequent compression of the tibial nerve in the tarsal tunnel. We did not treat the source, but the cause by open tarsal tunnel release. Excellent result with immediate full relieve of the patients complaints was achieved.


Assuntos
Descompressão Cirúrgica/métodos , Síndrome do Túnel do Tarso/diagnóstico por imagem , Síndrome do Túnel do Tarso/cirurgia , Malformações Vasculares/diagnóstico por imagem , Adulto , Eletromiografia/métodos , Humanos , Angiografia por Ressonância Magnética/métodos , Masculino , Prognóstico , Doenças Raras , Recuperação de Função Fisiológica/fisiologia , Medição de Risco , Índice de Gravidade de Doença , Resultado do Tratamento , Ultrassonografia Doppler/métodos , Malformações Vasculares/cirurgia
4.
Haemophilia ; 23(4): e250-e258, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28306191

RESUMO

BACKGROUND: Although regular factor replacement can reduce the incidence of joint bleeds and slow down the development of haemophilic arthropathy, the ankle joint remains particularly vulnerable even in children with haemophilia on primary or secondary prophylaxis and is now the primary joint affected. The heterogeneity in the pathoaetiology of haemophilic ankle arthropathy means that the functional consequences of early stage of ankle arthropathy are difficult to define as early morphological and structural changes can be observed in clinically asymptomatic ankles. In this context, understanding biomechanics of the normal and arthritic foot is complex and difficult to quantify unless considering the foot as multiple functional segments using more sophisticated assessment tools such as multisegment foot models. However, this understanding can undoubtedly aid in the analysis of an underlying clinical problem and provide a strategic basis for a more optimal management. AIMS: The purpose of this narrative review was firstly to revise information on the anatomy and biomechanics of the foot and ankle. Finally, related biomechanical markers of human motor performance, which are potentially implicated in the development of haemophilic ankle arthropathy, will be discussed based on published literature and expert opinion. MATERIALS AND METHODS: Searches in published literature were limited to the year 2000 onwards. RESULTS: Although the ankle (tibiotalar joint) is the most commonly affected joint, associated subtalar joint (SJT) involvement is often seen. This would therefore imply that an alternative phraseology might be better. DISCUSSION AND CONCLUSION: In this context, the authors propose the use of 'haemophilic tarsal pan-arthropathy' (HTPA) which encompasses both tibiotalar and subtalar joints.


Assuntos
Articulação do Tornozelo/fisiopatologia , Hemartrose/complicações , Hemartrose/fisiopatologia , Hemofilia A/complicações , Fenômenos Mecânicos , Articulação Talocalcânea/fisiopatologia , Fenômenos Biomecânicos , Humanos
5.
J Sports Med Phys Fitness ; 55(3): 191-204, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25735228

RESUMO

The non-invasive nature of pedobarographic measurements is particularly attractive to researchers for analyzing and characterizing the impact of specific pathological foot conditions. However, adequate clinical use of pedobarographic technology requires a profound technical and methodological knowledge. Several papers summarized the technical capacities of pedobarographic technology. Moreover, methodological expertise has grown considerably during the last two decades. Therefore, two crucial decisions have to be made before pathomechanical modelling or functional interpretation of foot and lower limb disorders can be pursued. The first is the selection of the specific method to analyse the dynamic plantar footprint, and the second is the choice of parameters to quantify the results. In the first part of this paper, we review the different methods used to analyse the dynamic plantar footprint and discuss their conceptual backgrounds. We also aim to illustrate the clinical relevance of each method and elaborate on the future perspectives. In the second part, we review quantification methods of pedobarographic measurements. The latter is of primary relevance to clinicians and investigators with a special interest in foot and lower limb biomechanics.


Assuntos
Fenômenos Biomecânicos/fisiologia , Pé/fisiologia , Processamento de Imagem Assistida por Computador/métodos , Caminhada/fisiologia , Humanos , Pressão
6.
Osteoarthritis Cartilage ; 17(11): 1477-84, 2009 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-19486958

RESUMO

OBJECTIVE: Study the changes in local and generalized biomechanical characteristics of the ankle joint, associated with a well defined cartilage biopsy at the postero-medial rim of the talar dome, to evaluate its safety. METHODS: Ten cadaver ankles were (sub-) physiologically loaded pre- and post-biopsy; in neutral position, 10 degrees of plantar-flexion (PF) and 10 degrees of dorsi-flexion (DF). Fuji film was used as transducer. Qualitatively, the coverage of the biopsy by the tibial plafond, and changes in the shape of the footprint were analyzed. Quantitatively, the pressure profile plot, normalized-tibio-talar contact area and the centroid position of pressure were examined. Results were reported as a mean for all specimens, and as individual values for every single specimen as well. RESULTS: Mean results did not show significant changes, but those of some single specimens did. The majority of those changes were in PF. Some occurred in N, and besides two exceptions none occurred in DF. Two specimens did not show any change. One specimen showed an isolated quantitative change. Seven specimens showed both qualitative and quantitative changes. However, all changes were of low-magnitude and contact stresses did not show any rebound effect. CONCLUSIONS: Although biopsies at the postero-medial rim of the talar dome did not induce on average significant changes in quantitative contact characteristics, few specimens did show some alterations. Currently, the investigated biopsy site seems safe, but long term follow-up studies in patients are needed for confirmation.


Assuntos
Articulação do Tornozelo/patologia , Cartilagem Articular/patologia , Articulação do Tornozelo/anatomia & histologia , Artroscopia , Fenômenos Biomecânicos , Biópsia , Cadáver , Cartilagem Articular/cirurgia , Feminino , Humanos , Masculino , Modelos Anatômicos , Reprodutibilidade dos Testes , Estresse Mecânico
7.
Proc Inst Mech Eng H ; 222(7): 1065-71, 2008 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-19024154

RESUMO

Sealed pressure-sensitive film is frequently used to record contact characteristics in physiological joints. However, the effect on the pressure-recording characteristics of sealing the film when used in these circumstances has never been studied. This study compares the coefficient of variation, the standardized coefficient of variation, the tangent and secant contact stress gradients, and the actual pressures between unsealed and sealed Fuji film, in a simplified physiological joint model with a full-thickness surface defect. Unsealed film and sealed film were loaded through a range of nominal loads and the resulting stains were analysed by use of custom-made macros for the ImageJ image-processing program. The coefficient of variation did not exceed 5.7 per cent (sealed film), and the standardized coefficient of variation did not exceed 1.8 per cent (unsealed and sealed film). Contact stress gradients did not differ significantly. The recorded pressure at the level of surface defects was always about 0.2 MPa higher in the case of sealed film, and therefore predictable. It is concluded that sealing the film will not change the pressure-recording characteristics.


Assuntos
Interpretação de Imagem Assistida por Computador/métodos , Articulações/fisiologia , Manometria/instrumentação , Modelos Biológicos , Fotografação/instrumentação , Humanos , Fotografação/métodos , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Estresse Mecânico , Propriedades de Superfície
8.
Diabetes Res Clin Pract ; 50(2): 87-95, 2000 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-10960718

RESUMO

This prospective observational study was carried out to assess the annual preventive and curative treatment costs for diabetic foot problems. Measures of resource use over the 1-year study period were taken for 151 patients whose lesions covered the entire Wagner classification. Treatment was provided under the current protocols of a multidisciplinary team. The 1993 market prices for health services were used to convert units of health service utilization to expenditures by the social insurance system and the patients. The severity of the foot problems determined the medical cost. Preventive care (47 cases), represented an average cost per case of US$ 880 (1US$ 1993=BEF 30.65). Curative care (120 cases), including diagnostic tests, wound dressings, antibiotic therapy, revascularization and off loading techniques resulted in a mean cost of US$ 5227 per ulcer. Care for the 16 most severe wounds and amputations involved hospitalization and surgery at a mean cost per ulcer of US$ 31716. The most important cost contributers were hospitalizations (72%), drugs (11%) and diagnostic examinations (4%). Preventive treatment for diabetic foot problems can represent a significant saving for the social insurance system as well as for the patients.


Assuntos
Pé Diabético/economia , Pé Diabético/terapia , Antibacterianos/uso terapêutico , Bandagens , Bélgica , Custos e Análise de Custo , Pé Diabético/classificação , Humanos , Estudos Prospectivos , Fatores de Tempo , Estados Unidos , Procedimentos Cirúrgicos Vasculares
9.
Acta Chir Belg ; 89(2): 73-6, 1989.
Artigo em Holandês | MEDLINE | ID: mdl-2667275

RESUMO

Thrombocytopenia and heparin. Heparin associated thrombocytopenia (HAT), more specially type 2, is an important complication of anticoagulant treatment in clinical practice. Diagnosis may be difficult and requires special laboratory techniques. Platelet count should be performed every two days. Severe complications may occur in 23% of type 2 HAT patients and is associated with a high mortality. Until now there are no prophylactic measurements for high risk patients.


Assuntos
Heparina/efeitos adversos , Trombocitopenia/induzido quimicamente , Feminino , Heparina/uso terapêutico , Humanos , Pessoa de Meia-Idade , Complicações Pós-Operatórias/prevenção & controle , Fatores de Risco , Trombocitopenia/fisiopatologia , Trombocitopenia/prevenção & controle , Trombose/prevenção & controle
10.
Acta Orthop Belg ; 59(3): 315-6, 1993.
Artigo em Inglês | MEDLINE | ID: mdl-8237350

RESUMO

We report a case of a trigger finger due to an anomalous origin of the fourth lumbrical muscle. Total excision of the involved muscle fibers gave complete relief of symptoms.


Assuntos
Dedos , Músculos/anormalidades , Tenossinovite/etiologia , Adulto , Humanos , Masculino , Tenossinovite/cirurgia
11.
Acta Orthop Belg ; 69(1): 49-58, 2003.
Artigo em Inglês | MEDLINE | ID: mdl-12666291

RESUMO

The first ankle prostheses appeared in 1973 as an alternative to ankle arthrodesis, which was until then the only valid solution for a painful degenerative, rheumatoid or posttraumatic ankle. Several designs followed, all with disappointing results. Low-constraint prostheses are now being used, with literature studies of 5 years follow-up. In this study, the authors have evaluated the results of 26 uncemented, hydroxyapatite-coated STAR prostheses, all implanted between January 1996 and December 1999, with an average follow-up of 15.8 months (range: 1.5 to 48 months). For evaluation, all patients filled out a questionnaire at three different moments in time, and all of them were clinically reviewed by one single observer. The Kofoed ankle score was used for clinical evaluation. All ankle prostheses were also radiographically reviewed, using a radiographic scoring system developed by the authors. Evaluation with the Kofoed ankle score showed 74% favourable results. When patients were asked to rate their satisfaction on a scale between 0 and 100, an average improvement of 50/100 was reached. Pain was the most important indication to surgery and is the only parameter that can be predictably influenced. The effects on motion and walking distance are less predictable. No major complications occurred and there were no revision operations. Should prosthetic failure occur, an arthrodesis can still be performed, as bone resection in the primary procedure has been minimal.


Assuntos
Articulação do Tornozelo/patologia , Articulação do Tornozelo/cirurgia , Prótese Articular , Adulto , Idoso , Artrite Reumatoide/complicações , Artrodese , Artroplastia de Substituição/métodos , Materiais Biocompatíveis , Durapatita , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Falha de Prótese , Amplitude de Movimento Articular , Resultado do Tratamento , Caminhada
12.
Acta Orthop Belg ; 59 Suppl 1: 374-6, 1993.
Artigo em Inglês | MEDLINE | ID: mdl-8116434

RESUMO

A cemented revision of failed total hip arthroplasty is prone to early mechanical failure. Cementless revision seems to be much more promising. We present our 2 year follow-up of 19 cementless revisions using the R.M. isoelastic stem. During follow-up special attention focused on the restoration of bone stock on the femoral side of the arthroplasty. Bone stock deficiencies encountered during the operation were managed with grafts. Other complications to solve during the procedure were encountered frequently. The average follow-up was 58 months. Rating the results following Merle d'Aubigné and Postel showed very good or good result only in half of the cases, one case needed a revision. Nevertheless good restoration of bone stock was observed in nearly all cases. A greater number of patients should be followed for a longer period of time to establish the exact role of this prosthesis design.


Assuntos
Prótese de Quadril , Adulto , Idoso , Idoso de 80 Anos ou mais , Transplante Ósseo , Seguimentos , Humanos , Complicações Intraoperatórias/etiologia , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Desenho de Prótese , Reoperação
13.
Clin Biomech (Bristol, Avon) ; 28(7): 813-9, 2013 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-23829980

RESUMO

BACKGROUND: Reduction in foot mobility has been identified as a key factor of altered foot biomechanics in individuals with diabetes mellitus. This study aimed at comparing in vivo segmental foot kinematics and coupling in patients with diabetes with and without neuropathy to control adults. METHODS: Foot mobility of 13 diabetic patients with neuropathy, 13 diabetic patients without neuropathy and 13 non-diabetic persons was measured using an integrated measurement set-up including a plantar pressure platform and 3D motion analysis system. In this age-, sex- and walking speed matched comparative study; differences in range of motion quantified with the Rizzoli multisegment foot model throughout different phases of the gait cycle were analysed using one-way repeated measures analysis of variance (ANOVA). Coupling was assessed with cross-correlation techniques. FINDINGS: Both cohorts with diabetes showed significantly lower motion values as compared to the control group. Transverse and sagittal plane motion was predominantly affected with often lower range of motion values found in the group with neuropathy compared to the diabetes group without neuropathy. Most significant changes were observed during propulsion (both diabetic groups) and swing phase (predominantly diabetic neuropathic group). A trend of lower cross-correlations between segments was observed in the cohorts with diabetes. INTERPRETATION: Our findings suggest an alteration in segmental kinematics and coupling during walking in diabetic patients with and without neuropathy. Future studies should integrate other biomechanical measurements as it is believed to provide additional insight into neural and mechanical deficits associated to the foot in diabetes.


Assuntos
Diabetes Mellitus/fisiopatologia , Neuropatias Diabéticas/fisiopatologia , Pé/fisiopatologia , Marcha/fisiologia , Análise de Variância , Fenômenos Biomecânicos , Estudos de Coortes , Feminino , Pé/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Limitação da Mobilidade , Pressão , Amplitude de Movimento Articular/fisiologia , Valores de Referência , Caminhada/fisiologia
14.
Gait Posture ; 30(3): 379-82, 2009 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-19647431

RESUMO

Plantar pressure measurement is an important tool in gait analysis. Manual placement of small masks (masking) is increasingly used to calculate plantar pressure characteristics. Little is known concerning the reliability of manual masking. The aim of this study was to determine the reliability of masking on 2D plantar pressure footprints, in a population with forefoot deformity (i.e. hallux valgus). Using a random repeated-measure design, four observers identified the third metatarsal head on a peak-pressure barefoot footprint, using a small mask. Subsequently, the location of all five metatarsal heads was identified, using the same size of masks and the same protocol. The 2D positional variation of the masks and the peak pressure (PP) and pressure time integral (PTI) values of each mask were calculated. For single-masking the lowest inter-observer reliability was found for the distal-proximal direction, causing a clear, adverse impact on the reliability of the pressure characteristics (PP and PTI). In the medial-lateral direction the inter-observer reliability could be scored as high. Intra-observer reliability was better and could be scored as high or good for both directions, with a correlated improved reliability of the pressure characteristics. Reliability of multi-masking showed a similar pattern, but overall values tended to be lower. Therefore, small sized masking in order to define pressure characteristics in the forefoot should be done with care.


Assuntos
Pé/fisiopatologia , Hallux Valgus/fisiopatologia , Manometria/instrumentação , Feminino , Hallux Valgus/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Pressão , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
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