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At least 109 records · Page 6Linked to original sources
PubMed1992

Meticulous attention to foot care improves the prognosis in diabetic ulceration of the foot.

Ulceration of the foot is a major cause of morbidity in patients with diabetes, and its treatment has become a significant part of general surgical practice. It is, therefore, important to develop an efficient and effective approach to the care of this complication. We established a clinic dedicated to the care and prevention of foot ulcers in diabetic patients and since its inception in 1985, 343 patients have been seen. We provide regular prophylactic care and education to patients without ulcers, as well as treating those with ulcers. To assess the effectiveness of the clinic, we compared two groups of patients. Group 1 contained those who had ulcers while attending our prophylactic care program. Group 2 comprised those who were referred to us with lesions already present. There were 21 patients in group 1 and 150 in group 2. There were no statistical differences between the two groups with respect to age, sex, type and duration of diabetes, smoking history, prevalence of peripheral neuropathy, peripheral vascular disease, renal impairment and retinopathy. The sites and sizes of lesions were also no different between the groups. In spite of these similarities, however, patients in group 1 had a significantly better prognosis than those in group 2. The over-all number of lesions per patient was lower (1.52 +/- 0.98, compared with 2.06 +/- 1.33, p less than 0.05), the mean time required for lesions to heal was shorter (111.9 +/- 80.5 days compared with 160.5 +/- 151.3 days, p less than 0.05). The major amputation rate was lower and fewer patients required partial foot amputation. Prior to the opening of the clinic, the mean length of inpatient treatment was 30 days. This now has been reduced to 12.9 +/- 12.8 days. We conclude that the improved prognosis for those in group 1 can be attributed to the earlier detection and treatment of both potential and actual foot lesions. These results support the contention that the establishment of a dedicated diabetic foot care clinic and regular patient review can reduce the morbidity associated with diabetic foot ulceration.

Diabetes Complications↗
PubMed1986

Below-knee amputation: a comparison of the effect of the SACH foot and single axis foot on electromyographic patterns during locomotion.

The purpose of this investigation was to measure the effect of two terminal prosthetic components, the SACH foot and the single axis foot, on the locomotion patterns of unilateral below-knee amputees. The ten subjects who participated in the study were evaluated on two occasions, once following prescription of a PTB prosthesis and one terminal device and once following its replacement with the second device. The two devices were allocated alternately at the time of prosthetic prescription to ensure that five of the subjects used the SACH foot initially and five used the single axis foot. The electromyographic activity of the vastus lateralis and medial hamstrings was recorded bilaterally during gait using Beckman surface electrodes. The EMG signals were full wave rectified and low pass filtered to obtain the linear envelope. Pressure sensitive foot-switches were used to correlate the EMG signals with components of the gait cycle. The pattern of quadriceps and hamstring muscle activity of the contralateral limb was similar to that reported for normal individuals and was unaffected by changing the terminal device on the prosthetic limb. The pattern of quadriceps and hamstring activity of the prosthetic limb differed from that of the contralateral limb and was influenced by the change in terminal device. With both devices the muscles were active for a greater percentage of the stance phase when compared to the contralateral limb. With the SACH foot attachment there appeared to be more contraction of the quadriceps and hamstrings during the mid stance phase of gait.

Adult↗
PubMed2002

The role of intrinsic muscle flaps of the foot for bone coverage in foot and ankle defects in diabetic and nondiabetic patients.

Local muscle flaps, pioneered by Ger in the late 1960s, were extensively used for foot and ankle reconstruction until the late 1970s when, with the evolution of microsurgery, microsurgical free flaps became the reconstructive method of choice. To assess whether the current underuse of local muscle flaps in foot and ankle surgery is justified, the authors identified from the Georgetown Limb Salvage Registry all patients who underwent foot and ankle reconstruction with local muscle flaps and microsurgical free flaps from 1990 through 1998. By protocol, flap coverage was the reconstructive choice for defects with exposed tendons, joints, or bone. Local muscle flaps were selected over free flaps if the defect was small (3 x 6 cm or less) and within reach of the local muscle flap. During the same time frame, the authors performed 45 free flaps (96 percent success rate) in the same areas when the defects were too large or out of reach of local muscle flaps. Thirty-two consecutive patients underwent local muscle flap reconstruction for 19 diabetic wounds and 13 traumatic wounds. All wounds, after debridement, had exposed bone at their base, with osteomyelitis being present in 52 percent of the diabetic wounds and in 70 percent of the nondiabetic wounds. Wounds were located in the hindfoot (47 percent), midfoot (44 percent), and ankle (9 percent). Vascular disease was more prevalent in the diabetic group, in which 42 percent of the affected limbs required revascularization procedures before reconstruction (versus 7 percent in the nondiabetic group). Subsequently, 83 total operations were required to heal the wounds, of which 46 percent were limited to debridement only. Thirty-four pedicled muscle flaps were used: 19 abductor digiti minimi (56 percent), nine abductor hallucis (26 percent), three extensor digitorum brevis (9 percent), two flexor digitorum brevis (6 percent), and one flexor digiti minimi (3 percent). An additional skin graft for complete coverage was required in 18 patients (53 percent). One patient died and one flap developed distal necrosis, for a 96 percent success rate. The complication rate was 26 percent and included patient death, dehiscence, and partial flap or split-thickness skin graft loss. Twenty-nine of the 32 wounds healed. One patient died in the postoperative period; in two others the wounds failed to heal and required below-knee amputations, for an overall limb salvage rate of 91 percent. Diabetes did not significantly affect healing and limb salvage rates. Diabetes, however, did affect healing times (twofold increase), length of stay (2.7 times as long), and long-term survival (63 percent survival in diabetic patients versus 100 percent in the trauma group). Local muscle flaps provide a simpler, less expensive, and successful alternative to microsurgical free flaps for foot and ankle defects that have exposed bone (with or without osteomyelitis), tendon, or joint at their base. Diabetes does not appear to adversely affect the effectiveness of these flaps. Local muscle flaps should remain on the forefront of possible reconstructive options when treating small foot and ankle wounds that have exposed bone, tendon, or joint.

Adult↗
PubMed1994

Maximizing foot salvage by a combined approach to foot ischemia and neuropathic ulceration in patients with diabetes. A 5-year experience.

OBJECTIVE: The combination of peripheral neuropathy and arterial insufficiency in patients with diabetes frequently results in chronic non-healing foot ulcers. These patients often have a protracted course that commonly ends in limb amputation. RESEARCH DESIGN AND METHODS: Since 1987, 39 diabetic patients presented with 42 neuropathic ulcerations beneath the lesser metatarsal heads, complicated by severe arterial insufficiency. A variety of vascular reconstructions were performed to improve circulation to the foot. After successful vascular reconstruction, 14 patients with deep ulcers underwent resection of the involved bone or joint through a plantar elliptical incision with excision of the ulcer and primary closure (33%). Five patients required a simultaneous panmetatarsal head resection (12%). For fifteen superficial ulcers, metatarsal osteotomy through a dorsal approach was performed (36%). Eight patients underwent a fifth metatarsal head resection through a dorsal approach (19%). RESULTS: In follow-up of 2-64 months (mean 21.2 months), 35 extremities with patent bypass grafts achieved and maintained primary healing of their local foot procedure (83%). Two feet required subsequent revision but ultimately healed (5%). Three feet (7%) developed a new plantar ulceration adjacent to the original one. In two extremities, the foot remained healed in spite of thrombosis of their grafts (5%). One patient with a thrombosed graft required a below-knee amputation. One patient died before the foot healed with a patent bypass graft. Overall, 40 of 42 extremities (95%) ultimately healed over the course of the follow-up period. CONCLUSIONS: We conclude that complex neuropathic ulcers in diabetic patients can be successfully treated by an aggressive surgical approach that removes infected bone and ulcers and corrects underlying structural abnormalities provided arterial insufficiency is corrected first.

Aged↗
PubMed1989

[Reconstructive foot surgery following complex trauma of the foot].

Compound post-traumatic foot deformity may follow indirect, direct, or combined trauma. This is demonstrated by a number of case reports. Particularly during adolescence, primary injuries to the soft tissue, with neurovascular injury or compartment syndrome, and post-traumatic skin contractures can cause severe growth deformity at the site of the injury and distal to it. Compression screw arthrodesis, using the 6.5-mm cancellous screw with the triple arthrodesis and the 3.5-mm cortical screw with the Lisfranc arthrodesis, has particular significance. It is stable, it allows functional treatment later, and bone union takes place rapidly. The most important surgical principles in post-traumatic foot surgery are: precise reconstruction of the foot axes, the medial and lateral foot length, and the longitudinal and transverse arches, i.e., restitution of the normal foot anatomy.

Adolescent↗
PubMed2005

Development and validation of a novel rating system for scoring standing foot posture: the Foot Posture Index.

INTRODUCTION: The limitations of clinical methods for appraising foot posture are well documented. A new measure, the Foot Posture Index is proposed, and its development and validation described. METHODS: A four-phase development process was used: (i) to derive a series of candidate measures, (ii) to define an appropriate scoring system, (iii) to evaluate the validity of components and modify the instrument as appropriate, and (iv) to investigate the predictive validity of the finalised instrument relative to static and dynamic kinematic models. Methods included initial concurrent validation using Rose's Valgus Index, determination of inter-item reliability, factor analysis, and benchmarking against three dimensional kinematic models derived from electromagnetic motion tracking of the lower limb. RESULTS: Thirty-six candidate components were reduced to six in the final instrument. The draft version of the instrument predicted 59% of the variance in concurrent Valgus Index scores and demonstrated good inter item reliability (Cronbach's alpha = 0.83). The relevant variables from the motion tracking lower limb model predicted 58-80% of the variance in the six components retained in the final instrument. The finalised instrument predicted 64% of the variance in static standing posture, and 41% of the variance in midstance posture during normal walking. CONCLUSION: The Foot Posture Index has been subjected to thorough evaluation in the course of its development and a final version is proposed comprising six component measures that performed satisfactorily during the validation process. The Foot Posture Index assessment is quick and simple to perform and allows a multiple segment, multiple plane evaluation that offers some advantages over existing clinical measures of foot posture.

Adult↗
PubMed1986

Diabetic foot infections: fate of the contralateral foot.

Following an initial report urging conservative management of severe diabetic foot infections, the authors have managed 45 patients with a minimum 3-year follow-up. By using standard principles for soft-tissue infection, 78 percent of the patients healed minor amputation sites and maintained biped ambulation following the initial foot involvement. Only 22 percent required a major amputation at the time of the initial foot involvement. The 45 patients were followed and 22 (or 49 percent) developed a severe infection involving the contralateral foot within 18 months. Although 15 of the 22 patients developing contralateral infection (or 33 percent of the total series) required some type of amputation on the contralateral foot, the conservative approach allowed 64 percent of the patients with severe infections in both feet to maintain biped ambulation. This included 40 percent of the patients who required amputation of some portion of both feet.

Adult↗
PubMedDate not supplied

Effects of hallux limitus on plantar foot pressure and foot kinematics during walking.

The effects of hallux limitus on plantar foot pressure and foot kinematics have received limited attention in the literature. Therefore, a study was conducted to assess the effects of limited first metatarsophalangeal joint mobility on plantar foot pressure. It was equally important to identify detection criteria based on plantar pressures and metatarsophalangeal joint kinematics, enabling differentiation between subjects affected by hallux limitus and people with normal hallux function. To further our understanding of the relation between midtarsal collapse and hallux limitus, kinematic variables relating to midtarsal pronation were also included in the study. Two populations of 19 subjects each, one with hallux limitus and the other free of functional abnormalities, were asked to walk at their preferred speed while plantar foot pressures were recorded along with three-dimensional foot kinematics. The presence of hallux limitus, structural or functional, caused peak plantar pressure under the hallux to build up significantly more and at a faster rate than under the first metatarsal head. Additional discriminators for hallux limitus were peak dorsiflexion of the first metatarsophalangeal joint, time to this peak value, peak pressure ratios of the first metatarsal head and the more lateral metatarsal heads, and time to maximal pressure under the fourth and fifth metatarsal heads. Finally, in approximately 20% of the subjects, with and without hallux limitus, midtarsal pronation occurred after heel lift, validating the claim that retrograde midtarsal pronation does occur.

Adult↗
PubMed2001

Foot care economics--cost burden to diabetic patients with foot complications: a study from southern India.

OBJECTIVE: To estimate the direct cost burden of diabetic patients with foot complications. METHODS: An illustrative sample of 270 subjects with type two diabetes were seen at the clinic selected for the study. Among them 164 were without any complication (Group I) and 106 patients were with foot complications (Group II). In the latter group 83 (Group IIA) required in-patient (IP) care and 23 (Group IIB) required out-patient (OP) care. Annual expenses on medical care were estimated by a questionnaire method. Validation of the questionnaire data was verifying the amount spent by checking up the bills. RESULT: Group I spent Rs.4373 (US $ 104 Approx.), Group II spent Rs.15450 (US $ 343 Approx.), Group IIA spent Rs.7200 (US $ 171 Approx.) and Group IIB spent Rs.16910 (US $ 403 Approx.) in the study year. In the total sample of 270 subjects 61% were without foot problems, 22% had foot problems requiring OP treatment only (Group IIA), and 78% had foot problems requiring IP treatment (Group IIB). CONCLUSION: Group IIB spent significantly greater percentage of their income than Group IIA, and both groups spent greater percentage of their income than Group I. All differences were statistically significant.

Cost of Illness↗
PubMed2001

The effect of foot orthoses on standing foot posture and gait of young children with Down syndrome.

The purpose of this study was to determine if foot orthoses (FOs) immediately affected gait of children with Down Syndrome (DS) and excessively pronated feet. Subjects were 3--6 years old; 16 with DS and 10 without disabilities. Gait of children with DS wearing sneakers was compared with and without FOs and compared to gait of children without disabilities. Ankle moment, walking speed during stance phase, sneaker prints, center of pressure, and transverse plane foot angles were collected and compared. In standing, heel eversion was reduced when the children wore FOs (p=0.000). During gait the transverse plane foot angle decreased indicating more internal rotation with FOs (p=0.000). Trial-to-trial variability of pronation-supination index (p=0.0001), foot length contact (p=0.0001), transverse plane foot angle (p=0.0003), and walking speed (p=0.0001) all decreased with FO use. Trial-to-trial variability of normalized peak ankle moment (p=0.0001), and of phase of peak ankle moment (p=0.0001) increased when the children wore FOs.

Child↗
PubMedDate not supplied

Caring for the foot mobile: holistic foot and nail management.

Proper foot and nail management is essential to maintaining a good quality of life and remaining independent as we age. Basic and ongoing care of the feet and proper shoe selection are critical not only for preventing diabetic foot problems, but also for helping to lead productive, balanced lives. When our feet hurt, the rest of our body most likely hurts too. Because proper foot and nail care and education are critical for preventing ulceration and amputation, especially in persons with diabetes, this outcome case study presents a holistic approach to the management of foot and nail problems.

Aging↗
PubMed1993

The ratios of area of foot print to area of foot outline and diabetic sole ulcer formation.

The ratio of area of foot print to area of foot outline for each foot was studied in 50 normal and 70 diabetic subjects. The diabetic group was divided into 2 groups: 44 patients without and 26 patients with sole ulcers. The chief aim was to find a ratio that could predict ulcer formation. One hundred feet in the normal subjects had a mean ratio of 0.621 with a range of 0.51-0.72. The 88 non-ulcerated feet in the diabetic patients had a mean ratio of 0.611 with a range of 0.49-0.70. The difference was statistically not significant (p > 0.05). Thirty-two ulcerated feet in the 26 diabetic patients had a mean ratio of 0.580 with a range of 0.47-0.68. The difference between the ulcer and the non-ulcer group was statistically significant (p < 0.01). Twenty non-ulcerated feet in 20 diabetic patients with unilateral involvement had a mean ratio of 0.60 with a range of 0.50-0.69. The difference between the ulcerated and non ulcerated feet in these 20 unilateral involved patients was also statistically significant (p < 0.01). The sole ulcers in our study were distributed mainly beneath the metatarsal heads and calcaneum. Analysis of the foot prints revealed multiple dark print areas. They were at the locations corresponding to the above bony prominences. As these bony prominences were high pressure points, the dark print areas could serve as crude indicators of excessive pressure. The diabetic ulcer group had smaller mean ratio and the reduction of the contact area could contribute to the formation of sole ulcers.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2005

Control of foot differentiation in Hydra: phylogenetic footprinting indicates interaction of head, bud and foot patterning systems.

Homeodomain transcription factor CnNK-2 seems to play a major role in foot formation in Hydra. Recently, we reported in vitro evidence indicating that CnNK-2 has autoregulatory features and regulates expression of the morphogenetic peptide pedibin. We proposed that CnNK-2 and pedibin synergistically orchestrate foot differentiation processes. Here, we further analyzed the regulatory network controlling foot formation in Hydra. By phylogenetic footprinting we compared the CnNK-2 5'-flanking sequence from two closely related species, Hydra vulgaris and Hydra oligactis. Unexpectedly, we detected a highly conserved binding site for HNF-3beta, a vertebrate Forkhead transcription factor, in the CnNK-2 5'-flanking region. The Hydra HNF-3beta homolog budhead is predominantly expressed in the apical region of the body column and early during budding. Budhead is absent from tissue expressing CnNK-2 and thought to be involved in determining tissue for head differentiation. By electrophoretic mobility shift assays we demonstrate an in vitro interaction between recombinant budhead protein and the interspecific conserved HNF-3beta binding motif in the CnNK-2 5'-flanking region. Our results strengthen the view of CnNK-2 as an important regulator during foot patterning processes. Furtheron, they point to budhead as a candidate for a transcriptional regulator of CnNK-2 and to an interaction of foot and head patterning processes in Hydra on the molecular level.

Animals↗
PubMed1998

Antenatal sonographic diagnosis of club foot with particular attention to the implications and outcomes of isolated club foot.

OBJECTIVE: There are no studies to date on the implications and outcomes of antenatally detected isolated club foot. The purpose of this study was to perform a contemporary evaluation of club foot diagnosed in the antenatal period. DESIGN: We performed a retrospective analysis of all ultrasound examinations performed in 1989-96 in the Fetal Diagnosis and Treatment Unit of the University of Iowa Hospitals and Clinics (n = 23,863). SUBJECTS AND METHODS: All cases of club foot (n = 35) were evaluated for the presence of other detectable abnormalities and karyotype results if available. Postnatal follow-up was performed until over 1 year of age. RESULTS: We diagnosed unilateral (n = 18) and bilateral (n = 17) club foot from 17.4 to 37.0 weeks. Defects involving other systems were found in 28 of 35 cases. Of the seven cases considered to be isolated antenatally, three were diagnosed with additional malformations in the neonatal period. CONCLUSION: Most cases of antenatally diagnosed club foot were not isolated. Even when they were thought to be isolated on antenatal ultrasound, over half of them were later found to be associated with additional severe abnormalities that were detectable only in the neonatal period.

Abnormalities, Multiple↗
PubMed1996

Measurement of dynamic pressures at the shoe-foot interface during normal walking with various foot orthoses using the FSCAN system.

Foot orthoses are routinely used in clinical practice to redistribute pressure at the shoe-foot interface, although there is very little scientific evidence to support the efficacy of their use. In this study, the FSCAN sensor (an ultrathin in-shoe transducer) was used to determine the efficacy of pressure redistribution with a Plastizote, Spenco, cork, and a plastic foot orthosis as compared with control (no orthosis). Measurement variations of up to 18% occurred between sensors, and changes in stance time of up to 5% occurred between the orthoses and the control conditions. In spite of these potentially confounding variables, statistically significant differences in peak pressure between the orthotic types and the control condition (range, 9-146%) were noted. We conclude that Plastizote, cork, and plastic foot orthoses can be beneficial in relieving pressure in certain regions of the shoe-foot interface, but that they may do so at the cost of increasing pressure in other areas of the plantar surface.

Adult↗
PubMed1993

Comparison of gait using a Multiflex foot versus a Quantum foot in knee disarticulation amputees.

The subjective responses and gait patterns of unilateral knee disarticulation amputees wearing prostheses fitted first with the Multiflex foot and then with the Quantum foot were studied. Nine amputees were included in the trial. A questionnaire asked the amputees about their preference for one of the feet. Gait analysis was performed measuring temporal parameters and goniometry of hips, knees and ankles in the sagittal and frontal planes. There was a slight preference for the Quantum foot. Preference seemed not to be related to physical characteristics of the amputees nor to gait parameters. There were no differences in gait as far as the temporal factors were concerned. The main differences in the range of motion of the joints were in the frontal plane: the eversion-inversion movement of the ankle and the adduction-abduction movement of the hip. During walking at comfortable speed with the Multiflex foot the ankle and hip range of motion averaged 2.1 and 3.1 degrees respectively, less than during walking with the Quantum foot.

Adult↗
PubMedDate not supplied

Development of the foot in prenatal life in relation to idiopathic club foot.

The development of the human foot from the eighth to the twenty-first intrauterine week was studied in 147 specimens. The results documented a stage of "physiologic club foot" characterized by a medial deviation and plantigrade orientation of talar neck and head during the ninth week. At the same time, the calcaneus assumes a position of varus with the forefoot in adduction. By the eleventh week, the foot assumes a normal position. All findings during the stage of physiologic club foot closely resemble those of the intrinsic type of club foot.

Anthropometry↗
PubMed2003

Accessory ossicles and sesamoid bones of the ankle and foot: imaging findings, clinical significance and differential diagnosis.

Accessory ossicles and sesamoid bones are frequent findings in routine radiographs of the ankle and foot. They are commonly considered fortuitous and unrelated to the patient's complaint; however, they may eventually cause painful syndromes or degenerative changes in response to overuse and trauma. They may also suffer or simulate fractures. Our aim was to review, illustrate and discuss the imaging findings of some of the more frequent accessory ossicles and sesamoid bones of the ankle and foot region, with particular emphasis on those that may be of clinical significance or simulate fractures.

Adult↗