Pes planus in patients with posterior tibial tendon insufficiency: asymptomatic versus symptomatic foot.

Bilateral weightbearing anteroposterior and lateral radiographs were analyzed in 43 patients with a clinical diagnosis of posterior tibial tendon insufficiency by two independent observers. The radiographs of each patient's asymptomatic foot was considered to serve as the control for the preexistance of pes planus. The radiographs were assessed for the severity of flatfoot deformity, the degree of talonavicular coverage, the talometatarsal angle, the calcaneometatarsal angle, the cuneiform to ground height and the cuneiform to fifth metatarsal height. Interobserver correlations were assessed. Results indicated that there was a high interobserver correlation for the values measured, making these angles reproducible among observers. Strong correlations were found in the degree of severity of flatfoot deformity between the asymptomatic and symptomatic feet as well as the values used to assess pes planus (i.e., similar radiographic measurements on the opposite side). The data suggest that patients with posterior tibial tendon insufficiency often have a preexisting flatfoot. This substantiates our belief that a preexisting flexible flatfoot, although far from the determining factor, is one of several etiological factors in the development of posterior tibial tendon insufficiency.

Macrodystrophia lipomatosa of the foot: a report of three cases and literature review.

Macrodystrophia lipomatosa is a distinct clinical entity often misdiagnosed as other forms of macrodactyly. The most specific finding is an overabundance of fibrofatty tissue on the plantar aspect of the foot. Three cases, with the diagnoses made from tissue specimens, are presented in this article. The clinical, pathologic, and roentgenographic findings are discussed and a review of the literature is provided.

Clinical evaluation of the Ruiz-Mora procedure: long-term follow-up.

The Ruiz-Mora procedure has been advocated for treatment of congenital overlapping fifth toes, fifth hammertoe, and clavus deformities. This study evaluated the results of the Ruiz-Mora procedure in 12 patients with an average follow-up of more than 4 years. The data indicate the majority of patients are satisfied with the results of the procedure. Unacceptable cosmesis was the primary complaint of all dissatisfied patients. Assessment of preoperative versus postoperative symptoms indicate an improvement in symptoms as well as maintenance of stability and function. The average shortening of the toe was 12.8 mm. This presented no functional problems to the patients. Three patients had transient skin healing problems which resolved with local care. Based on this series, the Ruiz-Mora procedure is effective in dealing with the problem of the cock-up fifth hammertoe and is associated with few complications. Because of patient dissatisfaction with cosmesis, consideration should be given to showing patients postoperative photographs of the procedure before surgery and reserving this procedure for salvage of iatrogenic cock-up deformities, recalcitrant hard corns, and congenital cock-up deformities.

Short-term memory, alertness and performance: a reappraisal of their relationship to body temperature.

Previous studies have led to the beliefs: (1) that short-term memory is best during the night when the body temperature is at its nadir, and (2) that the circadian rhythms of short-term memory and subjective alertness are driven by oscillators independent from each other and from the body temperature cycle. Unfortunately, these conclusions, which would have major implications for understanding the organization of the human circadian timing system, are largely based on field and laboratory studies, which in many cases sampled data infrequently and/or limited data collection to normal waking hours. In order to investigate these points further, we have monitored behavioural variables in two different protocols under controlled laboratory conditions: (1) during a period of 36-60 h of sustained wakefulness; and (2) during forced desynchrony between the body temperature and sleep/wake cycles, allowing testing of non-sleep-deprived subjects at all circadian phases. Contrary to earlier findings, we report here that the circadian rhythm of short-term memory varies in parallel with the circadian rhythms of subjective alertness, calculation performance, and core body temperature under both these experimental conditions. These results challenge the notion that short-term memory is inversely linked to the body temperature cycle and suggest that the human circadian pacemaker, which drives the body temperature cycle, is the primary determinant of endogenous circadian variations in subjective alertness and calculation performance as well as in the immediate recall of meaningful material.