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Les actualités dans l'imagerie du pied de la polyarthrite rhumatoïde (PR) concernent essentiellement l'échographie et l'imagerie par résonance magnétique (IRM). En complément des synovites et des ténosynovites déjà largement étudiées, des lésions inflammatoires juxta-articulaires, comme les bursites inter-capito-métatarsiennes (BIM), ont été décrites plus récemment. Devant des arthralgies cliniquement suspectes d'évolution vers une PR, une synovite échographique avec Doppler d'une articulation métatarso-phalangienne (MTP) et une BIM en IRM sont prédictives de la survenue d'une arthrite clinique. En cas d'arthrite indifférenciée, la présence d'une ténosynovite des fléchisseurs ou des extenseurs des orteils sur une IRM des pieds pourrait augmenter le risque d'évolution vers une PR. Dans la PR débutante, les lésions tendineuses inflammatoires (tibial postérieur, fibulaires) semblent plus fréquentes que les synovites articulaires. Aux avant-pieds, la douleur et le gonflement sont associés à la synovite d'une MTP et à la BIM, mais ces « synovites » sont également souvent rencontrées chez les sujets sains, avec une fréquence décroissante de la MTP 1 à la MTP 5. L'inflammation péri-articulaire aux pieds (ténosynovite, BIM) est associée au diagnostic de PR et pourrait être une caractéristique de l'arthrite débutante. Les érosions échographiques et IRM aux avant-pieds ne sont pas spécifiques de la PR, sauf sur la MTP5. Recent advances in foot imaging in rheumatoid arthritis (RA) essentially concern ultrasound and magnetic resonance imaging (MRI). In addition to synovitis and tenosynovitis, which have already been extensively studied, inflammatory juxta-articular lesions such as intermetatarsophalangeal bursitis (IMB) have been more recently described. In patients presenting with clinically suspect arthralgia evolving towards rheumatoid arthritis, Doppler ultrasound synovitis in metatarsophalangeal (MTP) joint and MRI IMB are predictive of the onset of clinical arthritis. In undifferentiated arthritis patients, the presence of flexor or extensor tenosynovitis on foot MRI could increase the risk of progression to RA. In early RA, inflammatory tendon lesions (tibialis posterior, peroneal tenosynovitis) appear to be more common than joint synovitis. In the forefeet, pain and swelling are associated with MTP synovitis and IMB, but these "synovitis" are also often encountered in healthy subjects, with a decreasing frequency from the first to the fifth metatarsophalangeal joint. Peri-articular inflammation in the feet (tenosynovitis, IMB) is associated with the diagnosis of RA and could be a characteristic of early arthritis. Ultrasound and MRI erosions in the forefeet are not specific to RA, except on the MTP5. [ABSTRACT FROM AUTHOR]

We aimed to study ankle and foot injuries profile among amateur soccer players and to identify eventual risk factors. We carried out a cross-sectional study using a simple self-administered questionnaire based on the (UEFA) Injury Study Questionnaire, The (OSICS) system and the F-MARC consensus statement. The study concerned five amateur male soccer teams from the region of Monastir. Fifty replies were received, giving a response rate of 79%. Half of the players suffered from ankle injuries and 8% presented foot injuries. Among ankle/foot injuries, 68% were acute injuries and 48% were direct injuries. The combinations of injuries that worth attention were acute indirect injuries of the lateral compartment of the ankle as they are the most frequent injuries (14%), and the injuries of ankle posterior compartment as they required the longest absence period (12%). Defenders were the most players suffering from acute indirect injuries. Goalkeepers and midfielders were the most players exposed to acute direct injuries. Only 24% of injured players followed physiotherapy for their injuries. More than half of injured players (56%) reported keeping sequelae. We found that players who suffer from other-body-sites injuries were significantly prone to suffer from ankle/foot injuries (P < 0.05). However, those reporting wearing insoles (12% of all players) were significantly at lower risk to suffer from ankle/foot injuries (P < 0.05). We noticed that players using Turf shoes (4% of all players) were at lower risk to suffer from direct injuries (P < 0.05) and that players who wear ankle/foot supports were significantly at lower risk of facing acute injuries (P < 0.05). After performing multivariate analysis, the occurrence of other-body- sites injuries was the only independent factor that significantly influenced ankle and foot injuries. Our results can lead to pragmatic guidance for the prevention of injuries by tailoring a suitable training or rehabilitation programs, prescription of ankle brace and adapted insoles, according the physical demand and position of the player. The prevention should focus on the whole body, since suffering other-body-sites injuries increases the risk of ankle/foot injuries. [ABSTRACT FROM AUTHOR]

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Résumé But de l’étude Les pertes de substance distales des membres inférieurs sont encore un défi pour le chirurgien plasticien. Il faut apporter une couverture efficace et fonctionnelle avec un minimum de séquelle pour le site donneur. Le lambeau libre antérolatéral de cuisse présente dans ces domaines de nombreux avantages par rapport aux lambeaux locaux pédiculés et aux lambeaux musculaires libres classiquement utilisés. Nous essayons de définir sa place à travers notre expérience par une étude rétrospective bicentrique. Patients et méthodes Une analyse rétrospective exhaustive des cas de reconstruction des pertes de substance distales des membres inférieurs par lambeau libre antérolatéral de cuisse a été effectuée dans 2 centres de chirurgie réparatrice. Les caractéristiques des pertes de substance et des reconstructions ont été collectées. Le taux de succès et le taux de complications ont été rapportés, ainsi que les résultats esthétiques et fonctionnels à distance. Résultats Quarante et un patients ont été reconstruits entre 2008 et 2013 pour une prise en charge post-traumatique dans 58,5 % des cas. La taille moyenne des pertes de substance était de 191,4 cm 2 , leur localisation était principalement sur le pied et la cheville (61 %) et une exposition osseuse était le plus souvent retrouvée (82,9 %). Le taux de succès était de 92,8 %. Les résultats fonctionnels étaient jugés comme très bons et bons dans 75,5 % des cas et les résultats esthétiques comme très bons et bons pour 63,6 % des cas. Trois patients « perdus de vue » soit 7,3 % et 3 échecs soit 7,3 % n’ont pas pu être évalués sur le résultat final. Conclusion Montrant des résultats fonctionnels au moins similaires aux autres lambeaux, l’antérolatéral de cuisse fait la preuve de sa fiabilité et limite les séquelles au site donneur à une simple cicatrice ou greffe de peau mince. Sa polyvalence permet de s’adapter à la grande majorité des cas de reconstruction des pertes de substance des membres inférieurs. Summary Context Soft tissue defects of lower leg are still a challenge for the plastic surgeon. It should provide an effective and functional coverage with a minimal morbidity on the donor site. Free anterolateral thigh flap present in these areas many advantages over the pedicled local flaps and free muscle flaps used conventionally. We try to define its place through our experience with a bicentric retrospective study. Materials and methods A retrospective analysis of all cases of reconstruction of the lower leg using the free ALT flap was performed in two centers of reconstructive surgery. The characteristics of the defect and reconstructions were collected. The rate of success and complication has been reported as well as long term aesthetic and functional outcomes. Results Forty-one patients were reconstructed between 2008 and 2013 for post-traumatic care in 58.5% of cases. The average size of the defect was 191.4 cm 2 , their location was mainly on the foot and ankle (61%) and bone exposure was most frequently found (82.9%). Success rate was 92.8%. Functional results were judged as very good and good in 75.5% of cases and aesthetic results as very good and good for 63.6% of cases. Three “lost sight” 7.3% and 3 fails (7.3%) patients were not included in the result analysis. Conclusion Showing functional results at least similar to other flaps, ALT flap demonstrated its reliability and its low morbidity on the donor site. Its versatility allows adaptation to the vast majority of defects of the lower leg. [ABSTRACT FROM AUTHOR]

Copyright of Foot Medicine & Surgery / Medecine et Chirurgie du Pied is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Résumé: Près de 40 % de la population adulte consulte pour une douleur au pied et leurs causes sont nombreuses et douleurs variées. Elles sont souvent débilitantes et affectent la vie professionnelle et psychologique des patients. L’examen clinique doit être précis et rigoureux pour émettre les principales hypothèses diagnostiques permettant de choisir l’examen d’imagerie le plus approprié au diagnostic positif. La radiographie reste la pierre angulaire du bilan d’imagerie initial. Le choix entre IRM et TDM dépendra ensuite de la pathologie suspectée. La collaboration clinicien–radiologue est primordiale pour envisager l’examen optimal permettant de progresser dans la démarche diagnostique afin de mettre en place rapidement le traitement adéquat et ainsi soulager le patient. [Copyright &y& Elsevier]

Résumé: Le pied est un ensemble anatomique et biomécanique complexe. La pathologie locale est riche et de nombreuses maladies, qu’elles soient rhumatologiques voire systémiques, métaboliques, neurologiques ou vasculaires trouvent un mode d’expression, dans une symptomatologie podologique. L’examen clinique du pied n’est de fait jamais restreint à la seule extrémité distale des membres inférieurs car non seulement il amène souvent à suspecter une pathologie plus générale, mais il impose toujours une étude stato-dynamique de l’ensemble du squelette. L’examen clinique, toujours guidé par un interrogatoire préalable obligatoire, se divise en quatre phases : l’examen pieds nus en décharge, pieds nus à la mise en charge, debout en position statique et à la marche ainsi que l’examen pieds chaussés. L’examen des chaussures ainsi que d’éventuelles orthèses plantaires déjà prescrites ne sera pas oublié. [Copyright &y& Elsevier]

Copyright of Foot Medicine & Surgery / Medecine et Chirurgie du Pied is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Summary: The distally based sural flap is widely used in foot and ankle skin and soft tissue repairs. It is described as an easy and reliable procedure. But in our experience, the flap necrosis was observed rather frequently. The analysis of this complication was the main goal of this retrospective study. The distally based sural flap has been used 27 times for skin repair at the foot and ankle. Twenty-six cases were post-traumatic. The success rate was 70%. Eight (mostly partial) necrosis occurred, one total necrosis lead to mid-leg amputation. In post-trauma reconstructions, this flap was not found so reliable. The rate of flap necrosis increases with age and comorbidities. No relationship could be established between the necrosis of the flap and its width. Heel and lateral localizations were found more risky. Technical modifications are discussed with a special focus on the two staged procedure. [ABSTRACT FROM AUTHOR]

Summary: Aim of the study: The treatment of chronic osteomyelitis with large skin defects at the foot or the ankle is uneasy. In such cases, free muscular flaps are currently advised but they are less reliable in patients with medical diseases. In such difficult cases we have used the distally based soleus island flap, vascularized with retrograde flow on the posterior tibial artery. The technique and the indications of this flap are discussed. Patients and method: This flap has been used for seven patients with bone infection and skin defects measuring an average of 10×7 cm. The preoperative arteriography had to find the whole three arteries at the leg, with a good distal anastomotic arcade. The soleus muscle was raised with the posterior tibial artery, after it was ligated proximally and dissected up to the tarsal tunnel. Results: All of the seven flaps totally survived, except one that a marginal necrosis treated by excision and iterative dissection of the pedicle for a more distal repositioning. No clinical vascular deficiency was found on the legs. At the last review, all the osteomyelitis were cured. Discussion: The soleus island flap, distally vascularized on the posterior tibial artery, is a reliable flap, useful for the coverage of the distal leg, from the ankle to the very distal foot. Harvesting a major artery at the leg should be weighed against the failure of a free flap in high risk patients. [Copyright &y& Elsevier]

Summary: The authors report a series of twelve patients with loss of substance of the dorsum of the foot or around the ankle who underwent coverage with a free temporal fascia flap. There were no failure of flaps and no vascular complication at the microanstomosis. There were three complications: partial burn of the flap with a lamp, failure of the split thickness skin graft and an area of scar alopecia at the donor site. With one year of follow up, there were no problems of cicatrisation and no patients had difficulty to the use of normal footwear. The different advantages of this flap led us to recommend it for the covering of wound in this area. [Copyright &y& Elsevier]

Abstract: Distal extremity of lower limb sustains the complications of loss of tissue: problem of coverage (cutaneous and tendon necrosis, osteoarticular infection. The whole point of the surgery is to fight against the infection by repeated debridments, against the deformations or their correction by early osteosynthesis (pins and external fixation). The coverage is very important in this treatment: either with Vacuum-Assisted Closure (VAC®) and skin graft or fasciocutaneous flap. In spite of this management, the after-effects are important although the conservative treatment is the determining factor of satisfaction. [Copyright &y& Elsevier]

Abstract: The authors relate a case of cutaneous cover of the ankle and the right foot on a leg with precarious vascularization by the inner flap of the thigh with a serious burnt person the left leg amputated. The flap, which has been autonomized first before being set apart, got a well development and allowed to cover the ankle and the foot. It is a flap which deserve to be used and can count among the cover means of the ankle and the foot and even to constitute an alternative to the use of classical flaps (sural and supramalleolar flaps) in case of vascular risk. [Copyright &y& Elsevier]

The authors report their experience about a 15 cases series of ankle and foot soft tissues defects reconstruction with the extensor digitorum brevis flap which demonstrates its advantages. The flap was elevated in 9 cases on the tibial artery while the 6 others were raised on the distal dorsalis pedis artery with a retrograde flow. Healing was obtained for all cases with a complete resolution of septic problems for the 8 concerned cases. The outcome was uneventful for all but one which presented with a partial skin donor site secondary necrosis. No functional or trophic problems were noticed in other cases. Elevation of the extensor digitorum brevis flap is simple without note-worthy sequelaes. It is a reliable technique either for skin coverage or osteitis cure at level of the ankle. When raised with a retrograde arterial flow, it also appears as a useful alternative for the fore-foot reconstruction, location recognized difficult to treat by local means. [Copyright &y& Elsevier]