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Background: Walking is a complex process that is highly automated and efficient. This knowledge is essential for the study of pathological gait. The amputation of lower limbs involves new biomechanical load and gait patterns, and injuries due to overload or disuse may occur. The objective of this study is to assess muscle activation as part of the gait in unilateral transtibial amputee patients with prosthesis, at different speeds and with different plantar supports. Method: Included in the sample were 25 people with amputation and 25 control participants. Muscle activation was evaluated in both groups by means of surface electromyography (EMG) under normal and altered conditions. Results: Control participants did not show statistically significant differences (p ˃ 0.05) between their muscle groups, irrespective of support and speed. However, people with amputation did show differences in muscle activity in the quadriceps, all of which occurred at the highest speeds, irrespective of support. In the analysis between groups, significant differences (p &lt, 0.05) were obtained between the leg of the amputee patient and the leg of the control participant, all of them in the quadriceps, and at speeds 3 and 4, regardless of the insole used. Conclusions: Participants with unilateral transtibial amputation carry out more quadriceps muscle activity during gait compared to the control group.

Amputation represents a drastic impact on the patient’s body and perception. This cross-sectional study aims to analyse the aesthetic concern represented by body image, self-esteem and quality of life in patients with unilateral transtibial amputations of lower limbs compared to control group. People living with amputations present lower average levels than controls in all subscales of the SF-36 (Short Form 36 Health Survey) quality of life questionnaire, and in both the physical component summary and the mental component summary, although the difference is not statistically significant in the latter. These patients present a significantly lower mean score (p = 0.002) in the MBSRQ (Body-Self Relations Questionnaire) body image questionnaire: 2.64 ± 0.49 opposed to 3.16 ± 0.55 in controls. People living with amputations had a lower mean score on the Rosenberg Self-Esteem scale than controls (34.44 ± 4.61 v 36.04 ± 3.63). The results also show that amputation has a significant influence on the BI (Body image) of patients with unilateral transtibial amputations. SE (Self-Esteem) seems to be an aspect that is not significantly affected by lower limb amputation, although these patients scored a lower mean on the RSE scale compared to the control group. We consider it is highly relevant to assess QoL (Quality of life), BI and SE in patients after a lower limb amputation process.

We present the case of a patient with a glomus tumor that was atypical because of its large size and histologic characteristics. It was located in the dorsal-distal zone of the fifth ray of the left foot and was associated with a neuroma under the fifth metatarsal head. Although the pain (of a neurologic type) was attributed to the neuroma, the unknown nature and evolution of the dorsal lesion (glomus tumor) made surgical treatment necessary. Surgery, together with compensating treatment of the functional alterations of the patient's feet (pronation of the subastragalar joint, supination of the forefoot, and fifth metatarsal overload syndrome), resolved the case.

The purpose of this study was to evaluate the effectiveness of the new Double-V osteotomy of the first metatarsophalangeal joint (1stMPJ) in patients with hallux limitus (HL). A study of 66 patients was performed, 33 patients were treated Cheilectomy and 33 were treated Double-V. All patients underwent an assessment of the passive mobility of the 1stMPJ before the procedure, reevaluated 12 months later evaluating dorsiflexion, plantarflexion, and patients status using both the American Orthopaedic Foot and Ankle Society (AOFAS) for Hallux Metatarsophalangeal–Interphalangeal Scale. In comparing the improvement achieved regarding the increase of mobility obtained with surgical treatment, the feet operated with procedure Double-V gained significant degrees of movement increased in all analyzed parameters (P

Background Squamous cell carcinoma (SCC) in the ungual apparatus is a rare neoplasia. Although it is the most prevalent malignant tumour in this region, its diagnosis is often delayed because it is likened to benign or infectious processes. Objectives Present a case of SCC with subungual location in a toe, and carry out a review of the literature in relation to the most important aspects of subungual SCC in toes. Methods We describe the case of a white woman aged 72, with SCC located in the pulp and in the distal area of the nail bed of the third toe, associated with subungual exostosis. The literature on SCC in the subungual area of toes, in all its forms under clinical or histopathological presentation, is reviewed by means of a search involving Medline, PubMed, and Google Academic, from January 1994 to December 2011. Results Only 36 cases of subungual SCC in toes were reported in the 18 years that were reviewed. The average age of cases reviewed was 58.92, and the male-to-female ratio was 2 : 1. The most affected toe is the hallux, in 69.4% of cases. In 50% of cases, aetiology is unknown or indeterminate; in 22.3% of cases, aetiology is metastatic; and in 19.5% of cases, it is associated with human papillomavirus (HPV). In 58.2% of cases, partial or total resection of the distal phalanx was carried out, of the entire toe, or of the osseous ray of the foot. Conclusions Chronic tissue irritation caused by microtrauma associated with subungual exostosis is the most probable aetiology of the case presented.

The extirpation of Meckel's diverticulum (MD) via conventional or laparoscopic surgery is the definitive treatment. However, certain circumstances may modify or alter this situation and require the application of exceptional measures. We report a case under our observation who previously had an exploratory abdominal laparotomy for a suspected MD; however, the findings were negative. At that time, the diagnosis was established based on low-level gastrointestinal bleeding and isotopic tests that confirmed the existence of the diverticulum. Given the findings of gamma-graphic exploration and the previous negative surgical exploration, a decision was made to remove the lesion by laparoscopic radioguided surgery. The patient underwent bilateral laparoscopic radioguided surgery using a gamma radiation detection probe. The exploration of the abdominal cavity noted the existence of the diverticulum about 60 to 70 cm from the ileocecal valve. In this way, it was possible to proceed with the resection of the bowel loop and perform an intracorporeal anastomosis termino lateral. The postoperative course was uneventful, and the patient was discharged on the fifth postoperative day. We believe that the combination of radioguided surgery and single photon emission computed tomography/computed tomography could be useful for treating lesions in locations that are surgically difficult because of the characteristics of the lesion itself or the peculiarities of an individual patient.

Intravascular myopericytoma (IVMP), regarded as a variant of myopericytoma, is a rare tumor. Very few cases have been described, none in the foot. The first case of IVMP located in the heel of the foot is described in this article. A literature review is reported of all cases of IVMP published in the English literature. A 48-year-old man possessed an IVMP on the heel of the right foot. The physical examination and histopathological and ultrasound studies are described. The literature review yielded 5 cases of IVMP, 2 of which were in the thigh and 1 each in the oral mucosa, the periorbital region, and the leg. The possibility that these lesions may be malignant suggests that the histopathological study of vascular tumors should include immunohistochemical tests.

Background Having reviewed the studies on the biphalangeal fifth toe, we have observed a great disparity of data depending on the research center. We have investigated the frequency of biphalangeal toes and also its handedness. We have also analyzed the relationship of pathological deviations of fifth toe with this feature and with the fifth metatarsal. Methods We performed a descriptive prospective study, which analyzed 2494 feet (1247 people) with bilateral dorsoplantar radiographs. We studied the number of phalanges of the fifth toe, the deviations in the sagittal and transverse plane, and the state of the fifth metatarsal phalangeal joint. Results After analyzing the data we found the presence of biphalangeal fifth toe in 46.3% of the feet, presenting this feature bilaterally in 97.4% of them. A statistically significant higher percentage of pathological toes was found in people with triphalangeal fifth toe (pathological in 29.91%) than in the biphalangeal toes (pathological in 15.60%). We found that these differences are accentuated in the alterations of the fifth toe in the sagittal plane. Conclusions It is almost 4 times more likely to suffer a fifth hammer toe if the fifth toe is triphalangeal (OR = 3.98 to p =0.000). Alterations in the coronal plane of the fifth toe are associated with tailor’s bunion (p =0.000). We did not find any significant differences regarding the need for surgery of the fifth toe of the biphalangeal (39.1%) versus triphalangeal toes (60.9%). Clinical relevance: There may be an association between pathologic deviations and bigger mobility of the triphalangeal fifth toes. However, biphalangeal fifth toes show bigger rigidity leading to smaller accommodation inside the shoe, which may lead to less painful feet and decreased proportion of surgery.

The laparoscopic adrenalectomy is considered as the procedure of choice for the treatment of adrenal hyperplasia and tumor lesions. However, some special situations may limit the use of this method due to the difficulty to locate the gland and perform the lesion excision. We analyze 2 patients of a left adrenal tumor, explaining how they have overcome the difficulties in both situations. The first case was a patient with a history of intra-Abdominal surgery and the other patient suffered from severe obesity. We performed with the use of the gamma probe, and the 2 cases, was of great help to access and glandular localization. The help of gamma probe test was achieved in the surgical bed, that removal was complete. The use of the portable gamma probe facilitated the access to the left adrenal gland as well as conducting the glandular excision without delay, despite the difficulties due to the intra abdominal surgery caused by the previous surgery, and in the case of severe obesity.