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At least 127 records · Page 7Linked to original sources
PubMed2005

Foot deformities in rheumatoid arthritis and relevance of foot function index.

The aim of this study were to assess what type of foot deformities are found in rheumatoid arthritis (RA) patients, to detect frequency of deformities, and to evaluate deformities affecting Foot Function Index (FFI) and patient functional capacity. Anteroposterior and lateral weight-bearing radiographs of 156 feet of 78 patients who had RA for > or =2 years and of 76 feet of 38 healthy controls were studied. We measured hallux valgus angle, intermetatarsal angle between first and second (M1/2) and intermetatarsal angle between first and fifth (M1/5) on anteroposterior radiographs, and calcaneal pitch on the lateral radiographs. We examined the feet of all RA patients and healthy controls for hallux rigidus, cock-up deformity, clawing toe, and mallet finger, and measured calcaneal valgus angle. FFI, comprised of pain, disability, and activity limitation subscales, was administered to all RA patients. Their Steinbrocker Functional Class (SFC) and Health Assessment Questionnaire (HAQ) scores were determined. We determined frequency of deformities as 96.2% in RA patients and 97.4% in controls by radiological and physical examination (p>0.05). The frequency of each deformity was markedly increased in RA patients, with the exception of calcaneal valgus deformity. There was significant correlation between SFC and HAQ with FFI and subscales (respectively, r=0.46, p=0.001; r=0.67, p=0.001). For FFI and subscales, HAQ was the most important predictor factor, followed by gender and hallux rigidus. Foot deformities are seen very frequently in RA. These deformities may affect patient functional foot, especially hallux rigidus and calcaneal valgus.

Arthritis, Rheumatoid↗
PubMed1995

Resurfacing the distal part of the foot with a dorsal foot skin island flap pedicled on the plantar vasculature.

The dorsal foot skin island flap pedicled on the plantar vasculature as a reconstructive entity is described. Two successful cases of resurfacing of the distal end of the foot with a dorsal foot island flap pedicled on the proximal communicating vessels and the distal communicating vessels, respectively, are reported, and this type of reconstructive procedure is proposed as an addition to existing procedures for reconstructing the distal end of the foot.

Adult↗
PubMed1993

Role of experimental socks in the care of the high-risk diabetic foot. A multicenter patient evaluation study. American Group for the Study of Experimental Hosiery in the Diabetic Foot.

OBJECTIVE: To assess the acceptability of specially designed socks to provide satisfactory pressure relief in the insensitive, high-risk, diabetic foot. We have conducted a longitudinal multicenter patient evaluation study to assess the acceptability of such hosiery in neuropathic diabetic patients. RESEARCH DESIGN AND METHODS: A group of 86 neuropathic diabetic patients (69 males, 14 with type I diabetes) with a mean age of 63 yr (range 34-85 yr), and a diabetes duration of 16 yr (range 1-45 yr) participated in the study. Peripheral vascular disease was present in 28 (33%) patients, previous foot ulceration in 39 (44%) patients, and active ulceration was present in 11 (13%) patients. All patients were provided with three pairs of specially designed socks and 80 patients with extra-depth shoes. Evaluation and foot examination were performed at 3 and 6 mo. RESULTS: Socks were worn for a mean of 6 days/wk (range 1-7 days/wk). Patient satisfaction evaluated at both visits was good or very good in 85%, average in 12%, and poor in 3% of patients. Ten ulcers healed during this period, and seven new ulcers occurred. Intention to continue wearing the socks, most or all of the time, was expressed by 84% of patients. CONCLUSIONS: We conclude that the experimental socks have a high level of patient satisfaction when worn with suitable shoes, and may be an acceptable and inexpensive addition to existing methods of protecting the high-risk insensitive diabetic foot.

Adult↗
PubMedDate not supplied

Cooling the foot to prevent diabetic foot wounds: a proof-of-concept trial.

The etiology of neuropathic diabetic foot wounds can be summarized by the following formula: pressure x cycles of repetitive stress = ulceration. The final pathway to ulceration consists of an inflammatory response, leading to tissue breakdown. Mitigation of this response might reduce the risk of ulceration. This proof-of-concept trial evaluates whether simple cooling of the foot can safely reduce the time to thermal equilibrium after activity. After a 15-min brisk walk, the six nondiabetic volunteers enrolled were randomly assigned to receive either air cooling or a 10-min 55 degrees F cool water bath followed by air cooling. The process was then repeated with the intervention reversed, allowing subjects to serve as their own controls. There was a rise in mean +/- SD skin temperature after 15 min of activity versus preactivity levels (87.8 degrees +/- 3.9 degrees versus 79 degrees +/- 2.2 degrees F; P = .0001). Water cooling immediately brought the foot to a point cooler than preactivity levels for all subjects, whereas air cooling required an average of nearly 17 min to do so. Ten minutes of cooling required a mean +/- SD of 26.2 +/- 5.9 min to warm to preactivity levels. No adverse effects resulted from the intervention. We conclude that cooling the foot may be a safe and effective method of reducing inflammation and may serve as a prophylactic or interventional tool to reduce skin breakdown risk.

Adult↗
PubMed1988

Foot and foot-related injuries in the young athlete.

This article discusses the more common pediatric problems of the foot associated with microtrauma. In the author's experience, most pediatric foot problems in sports are related to the biomechanics of the foot and lower extremity and most of their treatment is directed toward improving the immediate problem at hand and either at the same time or at a future time improving the biomechanics associated with the problem. It is the author's opinion that much of the macrotrauma is alos related to the biomechanical parameters of the foot type and lower leg function, indirectly or directly contributing to the mechanism of injury. This article elaborates on these mechanisms.

Adolescent↗
PubMed2006

[Three-dimensional analysis of the foot following implantation of a HINTEGRA ankle prosthesis: evaluation with the Heidelberg foot model].

Detailed foot kinematics after total ankle replacement has not yet been investigated. In this study 11 patients with unilateral Hintegra ankle prosthesis were analysed with the Heidelberg Foot Model. This model measures the kinematics of the fore-, mid- and hindfoot in three clinical planes. Moreover, the kinetics of the hip, knee and ankle was captured. A diminished ROM was found in all foot segments investigated. The timing of the kinematics between sound and involved side appeared similar. A limitation in the hindfoot mobility, as experienced after ankle arthrodesis, was not observed. However, a careful hindfoot alignment is essential for optimal foot function, and previous malalignments should be corrected. Concerning the kinetics, the replaced ankle showed a decreased power generation compensated by an increase in power in the ipsilateral knee. For a more detailed evaluation, further studies are required which include pre- and postoperative data and also take into account different types of prostheses.

Aged↗
PubMed2003

Use of foot-to-foot bioelectrical impedance analysis in children.

The aim of this study was to compare two methods of measuring body composition in children aged 6-10 years: with a traditional bioelectrical impedance analyser and a foot-to-foot impedance device. In 117 subjects (55 girls, 62 boys), bioelectrical impedance was measured using a Xitron 4000 device and a foot-to-foot impedance instrument (Rowenta); body fat mass and fat-free mass were then calculated and comparisons between means were performed using appropriate statistical tests.

Body Composition↗
PubMed1993

Comprehensive analysis of dynamic elastic response feet: Seattle Ankle/Lite Foot versus SACH foot.

This study evaluated biomechanical and metabolic performance differences between two prosthetic foot designs in light of their mechanical properties. Ten unilateral below-knee amputee subjects, at least 1 year after amputation, capable of walking and running, were studied. Differences in heel and forefoot compliance explained differences in gait events and alignment. Increased efficiency of pushoff in the Seattle Ankle/Lite Foot exists as evidenced by the decrease loading on the opposite limb during double support and a less shortened step length on the sound side compared to the SACH foot. The natural frequency of oscillation for the prosthetic feet was determined to be too high to provide energy storage and release synchronized with kinematic requirements because neither metabolic cost savings nor differences in metabolic efficiency were found. Comfortable walking speed and the nadir of metabolic rate and efficiency are not different. Via accelerometer measurement, it was found that the more compliant and lossy SACH foot heel was less likely to transmit high frequency vibration.

Adult↗
PubMed1986

Miniature load cells for the measurement of foot-ground reaction forces and centre of foot pressure during gait.

A knowledge of the function of the foot is essential for an understanding of the mechanics of gait. In particular it is necessary to measure the forces, and their directions, between the foot and the ground. Miniature shoe borne load cells were used to measure the centre of foot pressure of a normal subject, a below knee amputee and a polio patient. An analysis of the resulting force patterns has been found useful as a measure of a subject's functional mobility. This paper describes a system which has been developed to measure and analyse the distribution of the forces acting on the foot of a polio patient, an amputee and group of normal subjects.

Adult↗
PubMed2006

Effects of ankle-foot orthoses on ankle and foot kinematics in patients with subtalar osteoarthritis.

OBJECTIVE: To determine whether different foot orthoses have a similar effect on foot kinematics in subjects with subtalar osteoarthritis (OA) when walking on various ground conditions. DESIGN: Within-subject comparison study. SETTING: Biomechanics research laboratory. PARTICIPANTS: Ten subjects with unilateral subtalar OA. INTERVENTIONS: Custom-made ankle foot orthosis (AFO), rigid hindfoot orthosis (HFO-R), and articulated hindfoot orthosis (HFO-A) were used by subjects walking on level, ascending, and descending ramp, and side slope conditions. MAIN OUTCOME MEASURES: The triplanar range of motion of the calcaneus relative to tibia (hindfoot) and metatarsal relative to calcaneus (forefoot) was measured using an 8-camera motion analysis system when subjects with subtalar OA wore different foot orthoses. RESULTS: Braces tended to perform similarly in reducing motion of the forefoot and hindfoot for all ground conditions when compared with unbraced but wearing shoes. The AFO significantly restricted frontal plane hindfoot motion during ramp descent (P<.01) and on a side slope when the arthritic subtalar joint was higher than the unaffected side (P=.02). The HFO-A provided significant frontal plane hindfoot motion restriction during ramp descent (P<.01) and on a side slope when the arthritic subtalar joint was lower than the unaffected side (P=.03). The HFO-R significantly restricted frontal plane hindfoot motion in all ground conditions except ramp ascent (P<.05). CONCLUSIONS: The HFO-R provides significant subtalar joint motion restriction while walking. The HFO-R may be considered an optimal orthosis for patients with subtalar OA pain arising from subtalar motion.

Adult↗
PubMed2005

Disease management for the diabetic foot: effectiveness of a diabetic foot prevention program to reduce amputations and hospitalizations.

OBJECTIVE: To demonstrate the effectiveness of a diabetic foot disease management program in a managed care organization. METHODS: We implemented a lower extremity disease management program consisting of screening and treatment protocols for diabetic members in a managed care organization. Screening consisted of evaluation of neuropathy, peripheral vascular disease, deformities, foot pressures, and history of lower extremity pathology. We stratified patients into low and high-risk groups, and implemented preventive or acute care protocols. Utilization was tracked for 28 months and compared to 12 months of historic data prior to implementation of the disease management program. RESULTS: After we implemented the disease management program, the incidence of amputations decreased 47.4% from 12.89 per 1000 diabetics per year to 6.18 (p<0.05). The number of foot-related hospital admissions decreased 37.8% from 22.86 per 1000 members per year to 14.23 (37.8%). The average inpatient length-of-stay (LOS) was reduced 21.7% from 4.75 to 3.72 days (p<0.05). In addition, there was a 69.8% reduction in the number of skilled nursing facility (SNF) admissions per 1000 members per year (Table 1) and a 38.2% reduction in the average SNF LOS from 8.72 to 6.52 days (p<0.05). CONCLUSION: A population-based screening and treatment program for the diabetic foot can dramatically reduce hospitalizations and clinical outcomes.

Adult↗
PubMed1997

The relationship of static foot structure to dynamic foot function.

Many theories have been advanced concerning the relationship between structure and function in the human foot, yet few of these theories have been subjected to quantitative examination. In this study, foot structure was characterized by 27 measurements taken from standardized lateral and dorsi-plantar weight-bearing plain radiographs of 50 healthy adult subjects. Regional plantar pressure distribution data collected from the same feet were chosen as the functional measures. A stepwise regression analysis was performed to (1) explore what portion of the variance in peak plantar pressure during walking can be explained by the radiographic measurements, and (2) identify structural characteristics of the foot which are significant predictors of peak plantar pressure under the heel and the first metatarsal head (MTH1). Most of the radiographic measurements were highly reliable. However, only 31 and 38% of the variance in peak plantar pressure at the heel and MTH1, respectively, could be explained using multiple regression analyses with the radiographic measurements as independent variables. Among the structural predictors that were identified, soft tissue thickness (e.g. calcaneus or sesamoid heights), and arch-related measurements were the strongest predictors of plantar pressure under both the heel and the first metatarsal head. We conclude that, in normal subjects, only about 35% of the variance in dynamic plantar pressure can be explained by the measurements of foot structure derived from radiographs. This implies that the dynamics of gait are likely to exert the major influences on plantar pressure during walking.

Adult↗
PubMedDate not supplied

Effect of electrical stimulation on foot skin perfusion in persons with or at risk for diabetic foot ulcers.

The failure of foot wounds to heal results in 54,000 people with diabetes having to undergo extremity amputations annually. Therefore, treatment is needed to speed healing in people with diabetes in order to reduce the need for amputation. This study tested the effect of high-voltage pulsed current on foot blood flow in human beings who are at risk for diabetic foot ulcers. Neuropathy, vascular disease, Wagner Class, glucose, gender, ethnicity, and age were measured. A sample of 132 subjects was tested using a repeated-measures design. A baseline transcutaneous oxygen level was obtained; stimulation was applied, and transcutaneous oxygen measurements were recorded at 30- and 60- minute time intervals. The grouped foot transcutaneous oxygen levels decreased (F = 5.66, p =. 0039) following electrical stimulation. Analysis of variance (Scheffe, p <.05) showed that initial transcutaneous oxygen was significantly higher than subsequent readings. However, oxygen response was distributed bimodally: 35 (27%) subjects showed increased transcutaneous oxygen (mean 14.8 mm Hg), and 97 (73%) experienced a decreased transcutaneous oxygen reading (mean 12.2 mm Hg). Logistic regression analysis did not explain these differences. Although this treatment appears to increase blood flow in a subset of patients, further study is needed to identify probable mechanisms for this response.

Adult↗
PubMed2001

The development and validation of a multi-dimensional measure of chronic foot pain: the ROwan Foot Pain Assessment Questionnaire (ROFPAQ).

The development and validation of the ROwan Foot Pain Assessment Questionnaire (ROFPAQ) is described. This is the first attempt to develop a multi-dimensional measure of chronic foot pain, and recognizes pain as having sensory, affective and cognitive dimensions. The ROFPAQ was developed from themes that emerged from running focus groups and semi-structured interviews with people with chronic foot pain. Following piloting and selection of appropriate items by both psychometric and semantic means, the scale was found to meet the accepted criteria for validity and reliability. The final scale demonstrates better than standard readability, has a short completion time and a simple scoring method. The scale allows clinicians to determine which dimension(s) of foot pain are the most relevant to the subject, thereby aiding decisions regarding appropriate treatment. Topics for further work on the ROFPAQ are highlighted.

Age Factors↗
PubMed1976

Intermittent claudication of the foot in view of foot muscle blood flow measured by 133Xe clearance technique and arteriographic findings.

In 20 limbs of 10 healthy subjects and 55 limbs of 41 patients with occlusive areterial diseases of the legs, muscle blood flow was measured in the flexor hallucis brevis muscle by 133Xe clearance technique. The clearance curves after the ischemic exercise differenciated limbs with intermittent claudication of the foot from normals and limbs without claudication. An attempt was also made with arteriographic findings in 102 limbs of 84 patients with occlusions of the leg and/or foot arteries only. From results obtained, it is concluded that 133Xe clearance technique applied in the flexor hallucis brevis muscle can be used for diagnosis of foot pain during walking of uncertain origin and intermittent claudication of the foot is caused by severe circulatory insufficiencies of the plantar muscles during walking in the patients with involvements of the posterior tibial and/or plantar arteries.

Adult↗
PubMed1991

Equipment and methods for laboratory testing of ankle-foot prostheses as exemplified by the Jaipur foot.

A load deflection and a cyclic loading apparatus capable of measuring dorsiflexion/plantarflexion, pronation/supination, internal/external rotation, and cyclic dorsiflexion (60 cycles per minute) of ankle-foot prostheses are described. A test protocol was developed to assess the functional parameters of the Jaipur ankle-foot prosthesis before and after prolonged cyclic loading, with the simultaneous aim of evaluating these machines. The results on 26 Jaipur ankle-foot prostheses revealed that: 1) the prosthesis enjoys considerable mobility in three planes, confirming its known versatility; 2) the prosthesis is robust; and, 3) the testing machines deliver reproducible results and are suitable for in-house testing of ankle-foot prostheses.

Amputation, Surgical↗
PubMed1995

Biomechanical treatment of traumatic foot and ankle injuries with the use of foot orthotics.

Physical therapists commonly treat injuries that occur to the foot and ankle complex following trauma. The goals of rehabilitation typically focus on restoring motion and maximizing functional strength and proprioception. It is important to understand the normal biomechanics of the foot and ankle complex as well as the structural and biomechanical changes that occur following ankle fractures, calcaneal fractures, subtalar joint dislocations, and tarsometatarsal joint dislocations. The purpose of this paper is to provide a theoretical basis for the use of various types of foot orthotics in the biomechanical treatment of traumatic foot and ankle injuries.

Ankle Injuries↗
PubMedDate not supplied

Reliability of the foot posture index and traditional measures of foot position.

Repeatable measures are essential for clinicians and researchers alike. Both need baseline measures that are reliable, as intervention effects cannot be accurately identified without consistent measures. The intrarater and interrater reliability of the new Foot Posture Index and current podiatric measures of foot position were assessed using a same-subject, repeated-measures study design across three age groups. The Foot Posture Index total score showed moderate reliability overall, demonstrating better reliability than most other current measures, although navicular height (normalized for foot length) was the single most reliable measure in adults. None of the tested measures exhibited adequate reliability in young children, and, with less-than-desirable reliability being demonstrated, most measures need to be interpreted accordingly when repeated measures are involved.

Adolescent↗