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At least 145 records · Page 8Linked to original sources
PubMed1975

Foot vascular resistance index: a noninvasive method to assess foot vasomotor tone.

A new objective hemodynamic technique has been evaluated to assess foot vasomotor tone pre- and postoperatively in patients undergoing lumbar sympathectomy alone or as an adjunct to vascular reconstructive surgery. A foot vascular resistance index at rest (FVRIR) and after reactive hyperemia (FVRIHT) was determined with a noninvasive plethysmographic method. The ankle-to-toe systolic pressure gradient and foot blood flow were measured with strain gauge plethysmorgraphy and were combined in a ratio to provide an index of vascular resistance. The indices were measured in patients without vascular disease who were used as controls and in patients undergoing lumbar sympathectomy alone or in conjunction with aortic reconstructions. Patients who underwent reconstructive procedures alone had a mean FVRIR which approximated the control value. In contrast, those patients who, in addition, had a lumbar sympathectomy had a significant reduction in the mean postoperative FVRIR which equalled the mean preoperative FVRIHT. Three of five patients undergoing lumbar sympathectomy alone had excellent preoperative hyperemic responses and benefited from the operation, whereas two patients with poor hyperemia had no benefit and had subsequent amputations. Our studies suggest that this technique is of value in the pre- and postoperative assessment of foot vasomotor tone and also may be useful in the preoperative prediction of response to lumbar sympathectomy.

Adult↗
PubMed1999

[Osteotomies of the mid- and back-foot in recurrent club foot].

There are no clear guidelines on the treatment of relapsed clubfoot, which is a relatively frequent and difficult problem in paediatric orthopaedics. Numerous operative interventions are mentioned in the literature as suitable for correction of a residual deformity of the food. There are numerous soft tissue procedures (release operations, tendon extensions, tendon transfers and redressement by means of a fixateur externe) and osseous interventions (osteotomies, arthrodeses) that can be carried out in isolation or in combination. In the present article two types of osteotomy are described that make it possible to correct the most frequent forms of relapsed clubfoot: combined closing wedge cuboid and opening wedge cuneiform osteotomy for correction of adductus and supination of the forefoot and the calcaneal osteotomy after Dwyer for correction of varus position of the calcaneal part of the foot. The combined osteotomy in the midfoot involves shortening of the lateral ray with simultaneous lengthening of the medial ray, with the wedge out of the cuboid bone inserted into the medial cuneiform bone, which leads mainly to correction of the adductus, but does also make it possible to achieve partial correction of the supination with an osteotomy right through the cuneiform bone. In the case of rigid foot deformities it is advisable to carry out preliminary stretching by means of a fixateur externe, while in the case of a bean-shaped foot a combination of osteotomy and medial and lateral release is recommended. Results of a follow-up study of our own patients treated with this operation have shown that no revision operations were necessary in any of the patients with idiopathic clubfoot. Other types of osteotomy described in the literature as suitable for correction of residual forefoot adductus and supination are also mentioned in this paper. Thecalcaneal osteotomy after Dwyer, for which a lateral approach is always used, generally leads to satisfactory correction of varus position of the calcaneal part of the foot. It the calcaneus is found to have a short posterior part this osteotomy is modified so that instead of taking the form of a wedge osteotomy with lateral closing it is followed by a lateral displacement. In this way it is possible to prevent making the already short posterior calcaneus even shorter. Both the combined midfoot osteotomy and the calcaneal osteotomy after Dwyer can be performed alone or in combination with each other or with different operative interventions.

Bone Malalignment↗
PubMed1995

Development of a connectionist expert system to identify foot problems based on under-foot pressure patterns.

The first phase of developing a connectionist expert system is described in this study. Dynamic pressure patterns below the foot obtained by the emed f system of 18 subjects were classified into one of the three categories: normals, pes cavus and hallux valgus. As opposed to the traditional approach for the analysis of the pressure patterns by quantifying isolated segments, a neural network based expert system was trained to perform objective classification of the patterns while keeping their integrity. The results of the backpropagation paradigm were unexpectedly good considering the limiting factors which hindered the performance of the neural networks. The successes indicate the potential of artificial intelligence in automated analysis of foot pathologies based on theemed f system. RELEVANCE:--This paper describes the first steps towards a novel automated screening system, which classifies the patient with foot abnormalities into the pathological category he or she belongs to, based on the pressure pattern below the foot. The decision making is objective, and shows a practical example of the use of artificial intelligence.

Journal Article↗
PubMed1980

[Transplantation of the posterior tibial muscle for treatment of Equinus deformity of the foot and club foot (author's transl)].

The transplantation of the posterior tibial muscle to the dorsal aspect of the foot perforating the interosseous membrane, in the presence of intact muscle function is indicated for the treatment of equinus deformity of the foot following trauma, for flaccid and even spastic paralyses as well as for recurrences of club feet. Contractures of the foot ought to be corrected beforehand. Further requirements for getting good results are the insertion of the tendon close to the middle of the dorsum of the foot in order to prevent an overcorrection, eventually physiotherapy and the use of a night splint as well as a regular follow up. The experiences with 8 feet operated on are confronted with the literature stressing certain operative detals. This procedure deserves a wider application with correct indication and evaluation of the transplants.

Adolescent↗
PubMed2002

Evaluation of a foot-to-foot bioelectrical impedance analyser in highly active, moderately active and less active young men.

The Tanita TBF-305 (Tanita Corp., Tokyo, Japan) is a commercially available foot-to-foot bioelectrical impedance analysis (BIA) system. The manufacturer-supplied equations incorporate gender, mass, height, activity category and a measured impedance value to determine % body fat (BF). The purpose of the present study was to determine whether the manufacturer-supplied 'adult' and 'athlete' equations provided an accurate estimate of % BF for a group of young men with varying activity levels. Fifty-seven men (18-35 years old) were categorized into the following groups: (1) highly active (HA) (> or = 10.0 h aerobic activity/week); (2) moderately active (MA) (2.5-10.0 h aerobic activity/week); (3) less active (LA) (<2.5 h aerobic activity/week). The % BF was measured using the BIA 'athlete' and 'adult' modes. After BIA measurements, residual volume was measured and hydrostatic weighing (HW) was performed. The amount of activity performed by each group was significantly different (P<0.001). No significant differences were found between the % BF determined by the 'athlete' mode and HW for HA (P=0.309) and MA (P=0.091). However, a significant difference was found for LA (P=0.001). The % BF determined by the 'adult' mode and HW was not different for LA (P=0.395), but was significantly different for MA (P<0.001) and HA (P<0.001). The choice of activity mode on the foot-to-foot BIA significantly alters prediction of % BF. With careful selection of activity mode, there was no statistical difference between % BF determined by HW and the BIA, but the range of individual error scores was large.

Analysis of Variance↗
PubMed1983

Foot deformity in myotubular myopathy. Pathology of intrinsic foot musculature.

An intrinsic foot muscle biopsy specimen was taken from a patient with myotubular myopathy who underwent surgical correction for orthopedic deformity. Pathologic findings were typical of primary muscle disease. Foot deformity in myotubular myopathy may result from abnormalities of intrinsic foot muscles, as well as those of more proximal musculature.

Biopsy↗
PubMed1991

The Foot Function Index: a measure of foot pain and disability.

A Foot Function Index (FFI) was developed to measure the impact of foot pathology on function in terms of pain, disability and activity restriction. The FFI is a self-administered index consisting of 23 items divided into 3 sub-scales. Both total and sub-scale scores are produced. The FFI was examined for test-retest reliability, internal consistency, and construct and criterion validity. A total of 87 patients with rheumatoid arthritis were used in the study. Test-retest reliability of the FFI total and sub-scale scores ranged from 0.87 to 0.69. Internal consistency ranged from 0.96 to 0.73. With the exception of two items, factor analysis supported the construct validity of the total index and the sub-scales. Strong correlation between the FFI total and sub-scale scores and clinical measures of foot pathology supported the criterion validity of the index. The FFI should prove useful for both clinical and research purposes.

Activities of Daily Living↗
PubMed2001

Cross-foot island instep flap: a new use of instep skin flap for management of persistent wounds after complex plantar foot reconstruction.

When presented with an extensive soft-tissue defect involving the sole of the foot, reconstruction with free muscle flaps covered by a split-thickness skin graft is the proposed method of treatment. However, persistent graft breakdown and a chronic wound of the weight-bearing flap is a challenging problem during the late postoperative period, as experienced by the authors in their patients with high-energy-induced lower extremity injuries. The authors used the instep flap as an island cross-foot flap to manage persistent graft breakdown that involved skin-grafted muscle flaps transferred previously to the heel in 3 patients and to treat a chronic wound involving an amputation stump in 1 patient. The vascular pathology of the injured extremities indicated a cross-leg procedure instead of a free flap transfer. Pedicles were wrapped with split-thickness skin grafts and flaps were harvested superficial to the plantar fascia. Pedicles were divided during postoperative week 3, and no complications related to the operation or to immobilization have been encountered during the postoperative follow-up. During the 1-year follow-up, durable coverage, free from development of open wounds, has been achieved, and patients have expressed their satisfaction. In the case of complicated, high-velocity foot injuries, the authors suggest that this procedure be kept in mind as an alternative treatment option because it has some advantages over conventional cross-leg procedures.

Adult↗
PubMed1995

Paradoxical transcutaneous oxygen response to cutaneous warming on the plantar foot surface: a caution for interpretation of plantar foot TcPO2 measurements.

We examined the effect of cutaneous warming on the transcutaneous oxygen measurement (TcPO2) at standard locations below the knee, on the dorsal foot, on the plantar right great toe, and on the plantar surface under the second metatarsal head of 656 diabetic and 16 nondiabetic subjects. All subjects underwent a directed medical history, physical examination, and neurovascular lower extremity evaluation and assessment of autonomic neuropathy. Associations between autonomic neuropathy and TcPO2 were tested using two-way analysis of variance and multiple linear regression. An unexpected, statistically significant fall in TcPO2 occurred with cutaneous warming from 37 degrees C to 44 degrees C on the plantar great toe surface that did not differ by presence of autonomic neuropathy, or the presence of diabetes (mean change: -8.82 mmHG, 95% confidence interval [CI]: -7.70 to -9.93). The TcPO2 measured at the plantar metatarsal head site also fell with cutaneous warming from 37 degrees C to 44 degrees C (mean change: -9.67 mmHG, 95% CI: -7.75 to -11.59). As expected, the TcPO2 increased with cutaneous warming from 37 degrees C to 44 degrees C on the dorsal foot site (mean rise:= 35.61 mmHg, 95% CI: 34.18 to 37.04). The mean TcPO2 at any site did not differ by presence of autonomic neuropathy at either 37 degrees C or 44 degrees C. We conclude that cutaneous warming leads to a paradoxical fall in TcPO2 on the plantar foot surface that does not depend on the presence of autonomic neuropathy or diabetes. Caution in interpretation of ambient versus warmed plantar TcPO2 values is recommended.

Adult↗
PubMed1996

Reducing dynamic foot pressures in high-risk diabetic subjects with foot ulcerations. A comparison of treatments.

OBJECTIVE: To compare the effectiveness of total contact casts, commercially available therapeutic shoes, and removable walking casts to reduce mean peak plantar foot pressures at the site of neuropathic ulcerations in diabetic subjects. RESEARCH DESIGN AND METHODS: We compared the reduction in peak plantar pressures at ulcer sites under the great toe (n = 5), first metatarsal (n = 10), and second through fifth metatarsals (n = 10) using six treatments: total contact casts (TCCs), DH Pressure Relief Walkers (DH), Aircast Pneumatic Walkers, Three D Dura-Steppers (3D), CAM Walkers, and P.W. Minor Xtra Depth shoes. A rubber sole canvas oxford was used to establish baseline pressure values. The canvas oxford could be viewed as a worse-case scenario for this patient population. With the EMED Pedar in-shoe pressure measurement system, data for 40 steps were collected for each treatment. We used Tukey's Studentized Range Test for simultaneous multiple comparisons to compare treatments. RESULTS: DH Pressure Relief Walkers reduced plantar pressures significantly better than other commercially available treatments for ulcers under the first metatarsal, second through fifth metatarsals, and great toe (P < 0.05). There was not a significant difference in mean peak plantar pressures between TCCs and DHs at any of the forefoot ulcer sites. CONCLUSIONS: DH Pressure Relief Walkers were as effective as total contact casts to reduce foot pressures at ulcer sites and may be an effective practical addition in the treatment of foot ulcers.

Casts, Surgical↗
PubMed2000

[Skin and osteoarticular bacterial infections of the diabetic foot. Ulcers of the diabetic foot: epidemiology and physiopathology].

EPIDEMIOLOGY: There are more than 2 million diabetics in France. Fifteen percent have suffered at one time or another from a foot ulcer. This condition accounts for 20% of all admissions of diabetic patients and for 50% of corresponding hospitalization stays. Fifteen to 25% of diabetic foot ulcers lead to an amputation, the patients being in the 45-65 year age range. Fifty percent of the amputated patients will have a contralateral amputation within the next 5 years. PATHOPHYSIOLOGY: Diabetic foot ulcers result from damage caused by diabetic neuropathy and micro- or macroangiopathy. Ulceration is favored by usually minimal trauma and secondary infection. The neuropathy causes deformations and sensorial disorders. Repair is hindered by the often precarious vascular supply. Reduced antibacterial defense related to high serum glucose levels and impaired diapedesis favor superinfection. MANAGEMENT: Careful physical examination and appropriate explorations are required for proper care giving the patient the best chances for cure.

Aged↗
PubMed2006

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

OBJECTIVE: To determine if different foot orthoses have a similar effect on foot kinematics in subjects with ankle osteoarthritis (OA) when walking on various ground conditions. DESIGN: Within-subject comparisons study. SETTING: Biomechanics research laboratory. PARTICIPANTS: Thirteen subjects with unilateral ankle OA. INTERVENTIONS: Custom-made ankle-foot orthosis (AFO), rigid hindfoot orthosis (HFO-R), and articulated hindfoot orthosis (HFO-A) were used by subjects when walking on level, ascending and descending ramp, and side-slope conditions. MAIN OUTCOME MEASURES: The range of motion of the hindfoot (calcaneus relative to tibia) and forefoot (metatarsal relative to calcaneus) was measured using an 8-camera motion analysis system. RESULTS: The AFO and HFO-R provided the best sagittal plane hindfoot motion restriction over all ground conditions (P<.001). The HFO-R allowed the greatest sagittal plane forefoot motion when walking over level (P=.01) and side-slope (P<.02) conditions, the greatest frontal plane forefoot motion walking down the ramp (P=.003), and the greatest transverse plane forefoot motion when walking over level (P=.011) and ramp-ascending conditions (P=.005). The HFO-A restricted motion of the unaffected joint and did not effectively restrict hindfoot motion. CONCLUSIONS: The HFO-R not only provides selective restriction to the ankle-hindfoot motion, but also allows sufficient forefoot motion compared with the AFO. We consider the HFO-R to be the best option of all tested orthoses for treating patients with ankle OA pain arising from ankle motion.

Adult↗
PubMed2007

The Foot Posture Index: Rasch analysis of a novel, foot-specific outcome measure.

OBJECTIVE: To investigate the internal construct validity of a clinician-assessed measure of foot position, the Foot Posture Index (FPI), versions FPI-8 and FPI-6. DESIGN: Rasch analysis of baseline FPI scores from studies conducted during the development of the instrument. SETTING: A community-based and a hospital-based study, conducted at 2 institutions. PARTICIPANTS: Measures were obtained from 143 participants (98 men, 45 women; age range, 8-65y). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Rasch analysis was undertaken using RUMM2020 software in order to evaluate the following properties of the FPI: unidimensionality of each item included in the FPI, the differential item functioning (DIF) of each item, and item and person separation indices. RESULTS: In the developmental draft of the instrument, the 8-item FPI-8 showed some misfit to the Rasch model (chi(16)(2) test=27.63, P=.03), indicating lack of unidimensionality. Two items were identified as problematic in the Rasch modeling: Achilles' tendon insertion (Helbing's sign), which showed illogical response ordering and "congruence of the lateral border of the foot," which showed misfit, indicating that this item may be measuring a different construct (chi(2)(2) test=15.35, P<.01). All FPI-8 items showed an absence of DIF, and the person separation index (PSI) was good (PSI=.88). The revised FPI-6, which does not include the 2 problematic items, showed unidimensionality (chi(12)(2) test=11.49, P=.49), indicating a good overall fit to the model, and improvement over the preliminary version. With the removal of the 2 problematic items, there were no disordered thresholds; all items remained DIF free and all individual items displayed a good fit to the model. The person-separation index for the FPI was similar for both the 8-item (FPI-8=.880) and 6-item (FPI-6=.884) versions. CONCLUSIONS: The original FPI-8 showed significant mismatching to the model. The 2 items in the FPI-8 that were identified as problematic in clinical validation studies were also found to be contributing to the lack of fit to the Rasch model. The finalized 6-item instrument showed good metric properties, including good individual item fit and good overall fit to the model, along with a lack of differential item functioning. This analysis provides further evidence for the validity of the FPI-6 as a clinical instrument for use in screening studies and shows that it has the potential to be analyzed using parametric strategies.

Adolescent↗
PubMed2000

Cost and resource utilization for prevention and treatment of foot lesions in a diabetic foot clinic in Belgium.

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.

Anti-Bacterial Agents↗
PubMed2002

Immediate and long-term effects of ankle-foot orthosis on muscle activity during walking: a randomized study of patients with unilateral foot drop.

OBJECTIVES: To determine (1) whether use of an ankle-foot orthosis (AFO) by patients with ankle dorsiflexor paresis leads to decreased muscle activity, immediately or 6 weeks after AFO use, and (2) whether this decrease (if present) differs between healthy and paretic subjects. DESIGN: Cross-sectional and longitudinal randomized case-control study. SETTING: Rehabilitation research center in the Netherlands. PARTICIPANTS: Fourteen healthy persons and 29 patients with foot drop. INTERVENTIONS: Muscle activity was measured by surface electromyography. Electromyographic reproducibility was tested in 14 healthy volunteers walking with and without AFO. Acute changes in muscle activity from AFO use were compared between the 14 healthy persons and the 29 patients with foot drop. Adaptation effects of AFO use after 6 weeks were studied in 29 patients, randomly chosen 16 of whom had started using an AFO at the first measurement. MAIN OUTCOME MEASURES: Amount of change in mean rectified electromyographic activity (delta value) between walking with and without AFO. Follow-up measurements were conducted after 3 and 6 weeks. RESULTS: Correlation coefficients, reflecting within-subject reproducibility, varied between.68 and.96 (mean,.86). In patients and healthy subjects, tibialis anterior muscle activity decreased by 7% and 20% (P = .01, P = .04), respectively, when using an AFO. In patients, this decrease was measured in the overall activity during the gait cycle; in healthy subjects, it was measured in the first 15% of the gait cycle. Overall electromyographic activity did not change during 6 weeks; delta values per muscle did not change during follow-up in the AFO group. CONCLUSION: AFO use immediately reduced muscle activity of the ankle dorsiflexors. However, using an AFO for 6 weeks did not lead to a generally lower electromyographic activity level nor did the amount of activity reduction accumulate in comparison with patients who did not use an AFO. It is, therefore, safe to use an AFO, even with recently paretic patients.

Adult↗
PubMed2003

Finite element analysis as a tool for parametric prosthetic foot design and evaluation. Technique development in the solid ankle cushioned heel (SACH) foot.

In this study, we developed an approach for prosthetic foot design incorporating motion analysis, mechanical testing and computer analysis. Using computer modeling and finite element analysis, a three-dimensional (3D), numerical foot model of the solid ankle cushioned heel (SACH) foot was constructed and analyzed based upon loading conditions obtained from the gait analysis of an amputee and validated experimentally using mechanical testing. The model was then used to address effects of viscoelastic heel performance numerically. This is just one example of the type of parametric analysis and design enabled by this approach. More importantly, by incorporating the unique gait characteristics of the amputee, these parametric analyses may lead to prosthetic feet more appropriately representing a particular user's needs, comfort and activity level.

Amputation, Surgical↗
PubMed2006

Evaluation of the validity of the Foot Function Index in measuring outcomes in patients with foot and ankle disorders.

BACKGROUND: There is uncertainty regarding which outcomes tools should be used to report the results of treatment for patients with foot and ankle disorders. This study evaluates the validity of the Foot Function Index (FFI) by examining its level of correlation to the Medical Outcomes Study Short Form-36 (SF-36). The SF-36 is an extensively validated outcomes tool that has been used as a benchmark in examining the validity of several orthopaedic outcomes tools. METHODS: Seventy-three patients were recruited at a tertiary referral foot and ankle practice. Patients completed packets which included informed consent forms, the FFI, and the SF-36 questionnaires. The questionnaires were scored and Pearson correlation coefficients were determined between the three domains of the FFI and the eight SF-36 sub-scales, as well as the two SF-36 summary scales. RESULTS: Sixty-nine patients completed an adequate number of items to be included in the study. The mean age of the patient sample was 46 (range 16 to 82) years and 44 were women (64%). Twenty-one patients (30%) had conditions affecting the forefoot, while 48 patients (70%) had conditions affecting the ankle or hindfoot. All three FFI domains had moderate to high levels of correlation to many of the SF-36 scales. The Disability domain of the FFI had the most consistent level of correlation to the SF-36 with Pearson coefficients in the range of -0.23 to -0.69. The Activity Limitation (r=-0.28 to -0.64) and Pain domains (r=-0.10 to -0.61) also demonstrated moderate levels of correlation to several of the SF-36 scales. CONCLUSIONS: The consistently moderate to high levels of correlation of the FFI to the SF-36 seen in this study support the FFI as a valid measure of health status. This suggests that the FFI is a reasonable method to monitor patient outcomes. Future studies should focus on determining if the FFI improves responsiveness to clinical change when used in combination with generic instruments like the SF-36.

Adolescent↗
PubMed1998

Relationship between foot pressure pattern and foot type.

Foot type and location of area of peak pressure under the metatarsal heads were determined for 54 healthy adults between the ages of 21 and 39 years. Feet were classified as neutral, pronated, or supinated. Each subject walked barefoot over a pedobarograph, and the area of peak pressure was identified as being either medial, central, or lateral under the metatarsal heads. A Fisher's exact test determined that there was a significant relationship between the area of peak pressure and foot type. A post hoc lambda asymmetric test showed that the relationship was very weak. Nearly half (49%) of the feet were classified as neutral, 36% were pronated, and 15% were supinated. Pressure patterns were as follows: 62% central, 26% medial, and 12% lateral. Other factors besides foot type influence the area of peak pressure under the metatarsal heads.

Adult↗