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BACKGROUND Abnormal foot morphology in children and adolescents is a possible risk factor for lower extremity pain. Foot posture index-6 (FPI-6) is a valid and reliable tool to assess foot morphology. However, the normative data on the age distribution for FPI-6 in Asian children and adolescents are still minimal. Further, the correlation of FPI-6 with lower extremity pain is poorly understood. We aimed to investigate the normative distribution for FPI-6 and the relationship between FPI-6 scores and knee and heel pain in Japanese children. METHODS We included 2569 Japanese children, aged 9-15 years, at a single school from 2016 to 2018. We summarized the age distribution of children and their mean bilateral FPI-6 scores. Additionally, we assessed the tenderness at the apophysis or tendon insertions at the knee and heel. We performed a cross-sectional analysis to investigate the correlations between FPI-6 scores and sex, age, and knee and heel pain for the data obtained each year. RESULTS The mean FPI-6 score was 3.1 ± 2.4, 3.4 ± 2.0, and 3.2 ± 1.9 for the left foot and 3.0 ± 2.4, 3.2 ± 1.9, and 3.1 ± 1.9 for the right foot in 2016, 2017, and 2018, respectively. Boys tended to have higher scores than girls, and the FPI-6 score of the left foot was significantly higher than that of the right foot (p

We present the case of a healthy 2-year-old child, with irrelevant personal and family history, that was taken to the emergency department for a papulovesicular rash that has developed and evolved over 5 days. It started on the foot, subsequently reaching to the hands, face and remaining integument

Background: Os peroneum and os vesalianum are sesamoid bones that could be found within fibularis longus and brevis tendons, respectively. They are rarely a cause of lateral foot pain and are often identified as incidental radiographic findings. However, in the context of trauma, these sesamoids may be radiographically misinterpreted as fractures . This study aimed to evaluate the prevalence and normal morphological variants of os peroneum and os vesalianum. Materials and methods: Standard oblique lateral and/or anteroposterior radiographic views of 624 feet of adolescent and adult patients were retrospectively reviewed to determine the prevalence and anatomical variations of the os peroneum and os vesalianum.in relation to age and gender using plain radiography. Results: Os peroneum was found in 22% and os vesalianum. was found in 1.6%. Age was found to significantly correlate with the presence of os peroneum with the highest prevalence (30%) detected in the elderly group. Among 137 feet with os peroneum, 54.0% were between 4 and 8 mm, 67.2%% were close to the tubercle of cuboid, 32.8% were located at the level of calcaneocuboid joint, 81.8% were solitary, and 18.2% were bi/multipartite. Among 10 feet with os vesalianum., Type I was identified in 40% and Type II in 60%. Conclusions: Different anatomical variants of the lateral sesamoid bones of the foot have been described in this study. A thorough knowledge of normal anatomical variants is essential for proper diagnosis and management and can enhance our diagnostic skills in detecting these sesamoids.

During walking, the foot is in direct contact with the insole of the footwear, and it affects the biomechanics of the whole human body. The aim of this study was to compare the plantar pressure dis...

Foot ulceration in diabetes mellitus is common. Foot problems remain the commonest cause of hospital admission amongst patients with diabetes in Western countries. The lifetime risk of a patient with diabetes developing an ulcer is 25%, and up to 85% of all lower limb amputations in diabetes are preceded by foot ulcers. As many as 50% of older patients with type 2 diabetes have risk factors for foot problems and regular screening by careful clinical examination is essential; those found to be at risk should attend more regular follow-up together with education in foot self-care. The key to management of diabetic neuropathic foot ulceration is aggressive debridement with removal of callus and dead tissue, followed by application of some form of cast to offload the ulcer area. Most ulcers will heal if pressure is removed from the ulcer site, if the arterial circulation is sufficient and if infection is managed and treated aggressively. Any patient with a warm swollen foot without ulceration should be presumed to have acute Charcot neuroarthropathy (CN) until proven otherwise. The optimal approach to reducing ulceration requires regular screening, patient education and a team approach to management, both in the community and in hospital.

This retrospective case series aimed to identify whether trans-articular screws, dorsal bridging plates or if a 4-corner compression plate offers better functional outcome after B2 Lis Franc injuries. Thirty-eight patients underwent surgical fixation for these injuries over five years in a Level 1 Trauma Centre. Patients were treated in 1 of 3 treatment arms: trans-articular screw, dorsal bridge plate, or 4-corner compression plate fixation. The primary outcome measures were the Manchester Oxford Foot and Ankle Questionnaire and the Euroqol- 5DL score and surgical results included postoperative complications and further surgery. Injury type, energy of mechanism, open versus closed status were not significantly different within any fixation group. We achieved 94.7% (n=36) good anatomical reduction. Finding significant improvement between plate fixation (both types) versus trans-articular screw groups treatment functional outcomes. A clinically crucial improvement in Manchester Oxford Foot & Ankle Questionnaire scores, and improved Euroqol- 5DL outcomes between 4-corner compression plate and trans-articular screw group. Overall, there was no significant difference in metalware failure, metalware removal and soft tissue complications. This study concludes that functional outcomes after Lis Franc fractures are not just dependant on the quality of anatomical reduction but are affected by fixation type. Further studies are required to provide qualitative analysis and assessment of dorsal bridge plate fixation versus 4-corner compression plate. Significantly, we have seen the 4-corner compression plate group reached the minimum clinically meaningful difference in the Manchester Oxford Foot and Ankle Questionnaire when compared to trans-articular screw fixation. Level of Clinical Evidence: 4

Lower limb flexibility is known to be decreased in those living in mountainous areas, and musculoskeletal growth is often influenced by lifestyle factors. The purpose of this study was to determine the relationship between the means of transportation to school and lower limb musculoskeletal function and low back pain.During routine medical examinations conducted in two cities in a prefecture in 2016, a questionnaire was administered. The parents of 15,259 students who attended elementary school answered questions evaluating the following parameters: (1) anteflexion limit in the standing posture, (2) crouching failure, (3) one leg standing failure, (4) low back pain during lumbar extension, (5) lower limb alignment abnormalities, and (6) flat foot. Students were divided into a walking commuting group (13,569 students) and a vehicle commuting group (1690 students), and findings were compared between the two groups using chi-square tests.In the walking and vehicle commuting groups, anteflexion limit in the standing posture was present in 23.3% and 26.1% of students, respectively (p = 0.013). Crouching failure was present in 4.6% and 7.3% of students (p 0.001); one leg standing failure in 5.3% and 8.5% of students (p 0.001); low back pain in 5.0% and 7.1% of students (p 0.001); positive leg alignment abnormalities in 7.3% and 8.0% of students (p = 0.260); and flat foot in 7.4% and 8.7% of students (p = 0.067), respectively. Significant differences were observed in all four of the failure measures. No significant differences were observed in the two methods evaluating morphological abnormalities.The decreased walking duration and increased sitting duration associated with vehicle commuting had little effect on lower limb morphology but could induce lower limb dysfunction and low-back pain in children. Thus, supplemental walking should be instated for children who commute by car.

Functional dystonia represents a condition where psychological distress is being expressed as involuntary muscle contractions. In the foot and ankle, it most commonly presents as a sudden onset of a painful fixed ankle/hindfoot deformity in a female patient with a history of trivial trauma or surgery. The “fixed deformity” found on clinical examination is usually correctable under general anesthesia. Less commonly, it can present in the toes or may present as paroxysmal muscle movements rather than a fixed deformity. CRPS may occur concurrently with the dystonia. Failure to consider the diagnosis leads to a long delay in appropriate diagnosis, patient distress and unnecessary or even harmful surgery. A better approach to this clinical syndrome is to define it as fixed abnormal posturing that is most commonly psychogenic. Early referral to a movement disorder clinic is recommended. The prognosis is generally poor as less than a quarter of patients report subjective long-term improvement even when managed in a movement disorder clinic. Foot and ankle surgeons should, whenever possible, avoid operating on patients with functional dystonia in order to avoid symptomatic deterioration.

BACKGROUND Syndesmosis measurments and indices have been controversial and showed interindividual variability. The purpose of this study was to analyze, by conventional axial computed tomography images and a simulated load device, the uninjured tibiofibular syndesmosis under axial force and forced foot positions. METHODS A total of 15 healthy patients (30 ankles) were studied using adjustable simulated load device (ASLD). This device allowed to perform bilateral ankle CT scans in two forced foot and ankle positions (30° of plantar flexion, 15° of inversion, 20° of internal rotation and 15° of dorsal flexion, 15° of eversion, 30° of external rotation). Axial load was applied simultaneously in a controlled manner (70% body weight). Measurements on the axial image of computed tomography were: syndesmotic area (SA), fibular rotation (FR), position of the fibula in the sagittal plane (FPS), depth of the incisura (ID) and direct anterior difference (ADD), direct middle difference (MDD) and direct posterior difference (PDD). RESULTS In patients without injury to the tibiofibular syndesmosis, the application of axial load and forced foot and ankle positions showed statistically significant differences on the distal tibiofibular measurements between the stressed and the relaxed position, it also showed interindividual variability : SA (median = 4.12 [IQR = 2.42, 6.63]) (p < 0.001), ADD (0.67 [0.14, 0.67]) (p < 0.001), MDD(0.45, [0.05, 0.9]) (p < 0.001), PDD (0.73 [-0.05, 0.73]) (p < 0.002). However, it did not detect statistically significant differences when the tibiofibular differences between the stressed and the relaxed position in one ankle were compared with the contralateral side: SA (-0.14, SD = 4.33 [95% CI = -2.53, 2.26]), ADD (-0.42, 1.08 [-1.02, 0.18]), MDD (0.29, 0.54 [-0.01, 0.59]), PDD (-0.1, 1.42 [-0.89, 0.68]). Interobserver reliability showed an Intraclass correlation coefficient of 0.990 [95% CI = 0.972, 0.997]. CONCLUSIONS Wide interindividual variability was observed in all syndesmotic measurements, but no statistically significant differences were found when comparing one ankle to the contralateral side. Measuring syndesmosis alignment parameters, may only be of value, if those are compared to the contralateral ankle.

Background This study aimed to assess the clinical and radiographic outcomes of different surgical procedures in atraumatic osteochondrosis dissecans (OCD) of the talus in youth and adolescence. Methods 32 joints in 30 patients (mean age 14.7 ± 2.2 years) were evaluated. Numeric Rating Scale (NRS), Foot and Functional Index (FFI), American Orthopedic Foot and Ankle Society ankle-hindfoot score (AOFAS), Pediatric Outcome Data Collection Instrument (PODCI), and sport participation were recorded. We compared preoperative and follow-up ankle radiographs to identify specific features in the OCD morphology and any signs of joint degeneration. Results After a median follow-up period of 72.5 months the drilling group showed significantly better scores than the combined fixation and reconstruction groups (AOFAS, p = 0.024; PODCI, p = 0.003; NRS, p = 0.027). Signs of joint degeneration were observed in 50% of all ankles, especially in those treated by OCD-fixation and reconstruction. Conclusions Advanced fixation and reconstruction procedures in unstable and non-salvageable atraumatic talar OCD resulted in inferior clinical scores and a higher prevalence of joint degeneration than drilling procedures in stable OCD in young patients.

Foot pathologies in older adults are associated with falls and complications such as amputations and ulcers. We report a case of an older man who presented to the geriatric medicine outpatient clinic. History taking revealed a fall, recent episode of delirium and decline in functional status with the patient reporting he was no longer able to cut his own toenails. Medical history included hypothyroidism, depression and hearing impairment. Physical examination detected very long, thickened toenails with bilateral bony deformities of the foot. Additionally, he had borderline slow gait speed and had difficulty completing a chair stand. Inability to maintain foot care suggested an early insight into a deterioration of overall function and emergence of frailty. An interprofessional team approach to the patient’s care included a medication review, referrals to podiatry, orthotics, physiotherapy and occupational therapy. His toenails were debrided and orthopaedic shoes were prescribed with no further falls.

A 74-year-old farmer presented to the emergency department (ED) with a 5-day history of left leg pain, swelling and redness. He denied trauma or injury. Background medical history included type 2 diabetes mellitus, diabetic neuropathy, right lower limb lymphoedema, recurrent left leg and foot

Background: Structural foot disorders can widely contribute to lower limb musculoskeletal conditions. Some researchers consider them the origin of overuse injuries in lower limbs. Although their effects on electrical activities of intrinsic and extrinsic foot muscles are well-established, their impact on other lower limb muscle groups are yet to be clarified. Objectives: This study aims to identify the activation patterns of lower limb muscle groups in various foot structures. Materials and Methods: In this case control study, 45 asymptomatic male and female subjects with different foot structures (pronated, supinated, and normal) will be selected using non-random sampling. The electrical activities of the gluteus medius, vastus lateralis and medialis, biceps femoris, semitendinosus, and lateral and medial gastrocnemius muscles will be examined during a jump-landing task. Voluntary response index, including magnitude and similarity index, will be subsequently calculated. Discussion: While several studies have evaluated the activation of lower limb muscles in different foot structures, they have solely focused on foot muscles. In contrast, the present study will assess activation patterns of the global lower limb muscles using the voluntary response index.

The relationship between managing patient expectations and postoperative functional outcomes has been studied widely in other areas of orthopedics, but there is a paucity of information in the foot and ankle literature. The primary objective of the study was to identify the most common patient "expectations" from hallux valgus surgery and establish over what time period postsurgery they would meet those goals. A prospective study of 45 consecutive patients was performed at a single center. This included adult patients (18 years old) that underwent a scarf osteotomy for primary hallux valgus correction. Patients were followed up for 6 months and completed pre- and postoperative Manchester-Oxford Foot Questionnaire and Visual Analogue Scale scores. A separate "expectations" questionnaire was designed and completed assessing the patient's preoperative rehabilitation expectations compared to the actual time taken to achieve those goals. These included 5 domains: pain improvement, return to walking unaided, return to normal foot sensation, return to normal footwear, and return to driving. The postoperative functional scores demonstrated statistically significant improvement postsurgery (p.001). It also highlighted the overall time frame over which the above expectations were met. On average, patients achieved satisfactory pain improvements 1.4 weeks earlier than expected (p.001) along with trends toward an earlier return to driving function of patient expectation (p.05). Patients can thus be reliably informed that their pain symptoms are likely to settle within one month of surgery. This should allow patients to prepare for their rehabilitation more informed, thus facilitating earlier weightbearing and return to function.

Patients and clinicians have expressed frustration when learning or teaching intrinsic foot muscle exercises. However, there is limited information on how patients perceive the workload of an exercise. This study evaluates participants’ perceptions of workload while learning intrinsic foot muscle exercises with or without neuromuscular electrical stimulation. Twenty-six individuals completed a 4-week supervised intrinsic foot muscle training program. Thirteen participants utilized neuromuscular electrical stimulation during the initial 2 weeks of training. Participant perceptions of workload, measured by the National Aeronautics and Space Administration Task Load Index, revealed decreasing load over 2 weeks and minimal load at 4 weeks. Inclusion of neuromuscular electrical stimulation did not affect perception of load of skill acquisition.

Background This study investigated the completeness, accuracy, quality and clinical outcomes of the British Orthopaedic Foot and Ankle Society (BOFAS) registry - Ankle Arthrodesis pathway. Methods An observational study using retrospective data derived from the BOFAS registry. Adults aged ≥18 years with a record of undergoing ankle arthrodesis in the UK from 2014 to 31/10/2019 were included. Accuracy of data capture and completeness were explored using means, SD, medians and IQR for continuous variables and frequencies for categorical variables. The pre and post treatment pathway was evaluated by analysing Patient Reported Outcome Measures (PROMs) including MOXF-FQ scores for pain/walking/standing/social interaction; NRS pain; EQ-5D-5L; and EQ-5D-5L-Health VAS at baseline, 6 months, and 12 months. Results Mean age of the study population (n = 186) was 62.3 (±12.9) years and 65% of the study cohort were male. Completeness of data collection was disappointing but variables such as BMI (62.4%) smoking status (82.3%) were reasonably well recorded. PROMs scores were well recorded at baseline but rapidly declined at 6 and 12-months intervals. Reductions in MOXFQ and NRS pain scores by 12 months following surgery were statistically significant (p = 0.001 and p = 0.008), illustrating that most patients demonstrated reductions in pain intensity, improved walking/standing ability, and social interaction. Conclusion These findings illustrate the potential effectiveness of surgery on all outcomes following ankle arthrodesis that merits evaluation in a clinical trial; but also demonstrated the difficulties in obtaining representative data sets. The analyses strongly suggest that with the improvements in data quality greater resources would bring, the BOFAS registry would become a valuable tool.

Background Along with significant case transmission, hospitalizations, and mortality experienced during the global Sars-CoV-2 (COVID-19) pandemic, there existed a disruption in the delivery of health care across multiple specialties. We studied the effect of the pandemic on inpatients with diabetic foot problems in a level-one trauma center in Central Ohio. Methods A retrospective chart review of patients necessitating a consultation by the foot and ankle surgery service were reviewed from the first 8 months of 2020. A total of 270 patients met the inclusion criteria and divided into pre-pandemic (n = 120) and pandemic groups (n = 150). Demographics, medical history, severity of current infection, and medical or surgical management were collected and analyzed. Results The odds of undergoing any level of amputation was 10.8 times higher during the pandemic versus before the pandemic. The risk of major amputations (below-the-knee or higher) likewise increased with an odds ratio of 12.5 among all patients in the foot and ankle service during the pandemic. Of the patients undergoing any amputation, the odds for receiving a major amputation was 3.1 times higher than before the pandemic. Additionally, the severity of infections increased during the pandemic and a larger proportion of the cases were classified as emergent in the pandemic group compared to the pre-pandemic group. Conclusions The effect of the pandemic on the health-care system has had a deleterious effect on people with diabetes-related foot problems resulting in more severe infections, more emergencies, and necessitating more amputations. When an amputation was performed, the likelihood it was a major amputation also increased.Editor's Note: This Original Article accompanies "Diabetes-Related Amputations: A Pandemic within a Pandemic," by Lee C. Rogers, DPM, Robert J. Snyder, DPM, and Warren S. Joseph, DPM, FIDSA, available at https://doi.org/10.7547/20-248.

This is done from the moment a patient enters the examining room. A deformed foot may be seen in a deformed shoe when the patient walks into the examining room. Certain examples are as follows: The shoes of a patient with drop foot show scuffed toes due to scrapping the floor in the swing phase. Similarly a patient with a toe-in shows excessive wear over the lateral border of the sole. Inspection is started in the normal manner with the counting of the toes, as in some cases an extra toe may be seen (supernumerary toe or digit). A disproportionately large great toe may be seen which is swollen or as a congenital anomaly.

Background Bovine Digital Dermatitis (BDD) is a prevalent infectious disease, causing painful foot skin lesions and lameness in cattle. We describe herein the bovine foot skin microbiota and its associations with BDD using 16S rRNA gene amplicon and shotgun metagenomic sequencing on samples from 259 dairy cows from three UK dairy farms. Results We show evidence of dysbiosis, and differences in taxonomy and functional profiles in the bovine foot skin microbiome of clinically healthy animals that subsequently develop BDD lesions, compared to those that do not. Our results suggest that taxonomical and functional differences together with alterations in ecological interactions between bacteria in the normal foot skin microbiome may predispose an animal to develop BDD lesions. Using genome-wide association and regional heritability mapping approaches, we provide first evidence for interactions between host genotype and certain members of the foot skin microbiota. We show the existence of significant genetic variation in the relative abundance of Treponema spp. and Peptoclostridium spp. and identify regions in the bovine genome that explain a significant proportion of this variation. Conclusions Collectively this work shows early changes in taxonomic and functional profiles of the bovine foot-skin microbiota in clinically healthy animals which are associated with subsequent development of BDD and could be relevant to prevention of disease. The description of host genetic control of members of the foot skin microbiota, combined with the association of the latter with BDD development offer new insights into a complex relationship that can be exploited in selective breeding programmes.

Nocturnal leg cramps involving the foot and calf muscles are a frequent symptom adversely affecting sleep continuity. Mostly idiopathic, they may be secondary to other disorders, and can be acutely relieved but are often difficult to prevent.

Objectives\ud To identify by systematic review published prevalence estimates of radiographic ankle osteoarthritis (OA) and to subsequently estimate the prevalence of ankle pain and symptomatic, radiographic ankle OA within community-dwelling older adults from North Staffordshire, UK.\ud \ud Methods\ud Electronic databases were searched using terms for ankle, osteoarthritis and radiography. Data regarding population, radiographic methods, definitions and prevalence estimates of ankle OA were extracted from papers meeting predetermined selection criteria. Adults aged ≥50 years and registered with four general practices in North Staffordshire were mailed a health questionnaire. Ankle pain in the previous month was determined using a foot and ankle pain manikin. Respondents reporting pain in or around the foot in the last 12 months were invited to attend a research clinic where weight-bearing, antero-posterior and lateral ankle radiographs were obtained and scored for OA using a standardised atlas. Prevalence estimates for ankle pain and symptomatic, radiographic ankle OA were calculated using multiple imputation and weighted logistic regression, and stratified by age, gender and socioeconomic status.\ud \ud Results\ud Eighteen studies were included in the systematic review. The methods of radiographic classification of ankle OA were poorly reported and showed heterogeneity. No true general population prevalence estimates of radiographic ankle OA were found, estimates in select sporting and medical community-dwelling populations ranged from 0.0–97.1%. 5109 participants responded to the health survey questionnaire (adjusted response 56%). Radiographs were obtained in 557 participants. The prevalence of ankle pain was 11.7% (10.8,12.6) and symptomatic, radiographic ankle OA grade≥2 was 3.4% (2.3, 4.5) (grade≥1: 8.8% (7.9,9.8); grade = 3: 1.9% (1.0,2.7). Prevalence was higher in females, younger adults (50–64 years) and those with routine/manual occupations.\ud \ud Conclusion\ud No general population prevalence estimates of radiographic ankle OA were identified in the published literature. Our prevalence study found that ankle pain was common in community-dwelling older adults, whereas moderate to severe symptomatic, radiographic ankle OA occurred less frequently. Further investigations of the prevalence of ankle OA using more sensitive imaging modalities are warranted.

Ulceration or reulceration is a common complication following partial or total fifth ray amputations. The primary aim of this study was to evaluate the incidence of reulceration following partial fifth ray amputations. This was a multicenter review of 117 consecutive limbs that underwent partial fifth ray amputations at the University of Pittsburgh Medical Center and Wake Forest Baptist Medical Centers. Procedures were performed at various levels along the fifth metatarsal. Incidence of postoperative ulceration was evaluated on the ipsilateral foot. We hypothesized there would be an association between location of resection and development of reulceration. Seventy-one of 117 patients (60.7%) experienced repeat ulceration following a partial fifth ray amputation. Median follow-up time was 19 months. There was no statistical difference based on location of amputation (proximal, middle, distal, isolated base) with regards to reulceration (p = .166), further amputation (p = .271), transmetatarsal amputation (p = .160), or below knee amputation (p = .769). There was statistical significance in the follow up time between study sites (p = .013), fifth ray amputation reoperation rate between study sites (p = .001), and reulceration rates between study sites (p = .017). Partial fifth ray amputations can be a good initial salvage procedure to clear infection and prolong bipedal ambulatory status. The results of the present study put forward that there is not an association between location of amputations of the fifth ray and development of reulceration, transfer lesions or more proximal amputations.

The aim is to present a single-center case series of patients with symptomatic hyperpronated feet treated with arthroereisis by using a second generation extra-osseous talo-tarsal stabilization device. This case series enrolled 123 feet in 87 patients (20 [6-75] years) treated with arthroereisis, either isolated (76 cases) or combined procedure (47 cases). At their final follow-up, a patient reported questionnaire (overall satisfaction, foot stability and shape, activities of daily living, pain level, and analgesics usage) was distributed. The average postoperative follow-up period was 30 (13-55) months. Nineteen (15%) cases required at least one revision surgery: the implant was manipulated in 5 (4%), while 14 cases (11%) required definitive implant removal. The predominant reason for implant removal was pain (50%), followed by implant migration (27%). The pediatric population with isolated procedure showed lowest revision rate (5%), while adults with combined ankle/hindfoot procedures demonstrated revision rate of 50%. The overall patient satisfaction after arthroereisis was 84%. The patients' perceived improvement in foot stability was 75%, foot shape 85%, and activities of daily living 64%. Eighty-two percent of cases reported no analgesics usage in the last month and mean visual analogue scale (0-10) pain level decreased from 5.5 to 2.2 (p.001). The subgroup analyses of patient-reported questionnaires revealed the best outcome in the pediatric-isolated cases, while adults with combined procedures reported the lowermost outcome. Extra-osseous talo-tarsal stabilization demonstrated a low rate of revisions surgery and a high satisfaction rate as an isolated procedure. Patients with conjoined procedures experienced more revisions and considerably lower satisfaction rates.

Diabetic foot infections (DFI) are an increasingly common cause of hospitalizations. Once hospitalized with DFI, many patients require some level of amputation, often undergoing multiple operations. With increasing importance on patient-centered metrics, self-reported health-related quality of life (HRQOL) tools have been developed. This prospective cohort study aimed assessed the impact of DFI on HRQOL. Two hundred twenty-four patients completed the 29-item Patient-Reported Outcome Measurement Information System (PROMIS) and 12-Item Short Form (SF-12) survey. Secondary outcomes using the Foot and Ankle Ability Measures survey were obtained and included in the analysis. The study group was comprised of hospitalized patients with DFIs (n = 120), and the control group was comprised of patients with diabetes who were evaluated for routine outpatient foot care (n = 104); diabetic foot screening, wound care, onychomycosis, and/or callosities. Using this cohort, a propensity score-matched sample of hospitalized patients with DFI (n = 35) and control group patients (n = 35) was created for comparative analysis. The 2-independent sample t test was used to test for group differences on each of the PROMIS subscale outcomes. Using PROMIS, we found that hospitalized patients with DFI reported significantly worse HRQOL in 6 of 7 subscales (physical function, anxiety, depression, fatigue, social role, pain intensity; p value range: .0001-.02) compared to outpatients with diabetes evaluated for routine foot care. There was no significant difference between the 2 groups on sleep disturbance (p = .22). Patients hospitalized for DFI report lower HRQOL compared to patients with diabetes receiving routine outpatient foot care.

This study aimed to assess how the postoperative medial arch height influenced postoperative patient-reported clinical outcomes after surgery for stage Ⅱ acquired adult flatfoot deformity.A total of 30 feet of 30 patients (7 males, 23 females) who underwent surgery for stage Ⅱ acquired adult flatfoot deformity and could be followed up for at least 2 years were included. The average age at surgery was 60.0 (standard deviation, 13.0) years, and the average follow-up period was 40 (standard deviation, 15.4) months. Among them, 16 patients underwent lateral column lengthening and 14 patients did not. Patient-reported clinical outcomes were evaluated using the Self-Administered Foot Evaluation Questionnaire. Radiographic alignment was evaluated by the talonavicular coverage angle, lateral talo-1st metatarsal angle, medial cuneiform height, medial cuneiform to 5th metatarsal height, and calcaneal pitch. The correlation between postoperative Self-Administered Foot Evaluation Questionnaire and radiographic alignment was assessed with Pearson's correlation analysis.Self-Administered Foot Evaluation Questionnaire and radiographic alignment significantly improved postoperatively in all patients (P 0.0001). In patients with severe deformity who needed lateral column lengthening, lateral talo-1st metatarsal angle was negatively and medial cuneiform to 5th metatarsal height was positively correlated with physical functioning Self-Administered Foot Evaluation Questionnaire subscales (r = -0.56 and 0.55), and medial cuneiform height was positively correlated with physical functioning, social functioning and general health Self-Administered Foot Evaluation Questionnaire subscales (r = 0.70, 0.55 and 0.73, respectively).Postoperative medial arch height could influence physical functioning, social functioning, and general health in patients with severe stage II adult-acquired flatfoot deformity.

The purpose of this study was to investigate the measurement properties of the Short Form 36 (SF-36) to detect real change after forefoot reconstruction surgery. Responsiveness and minimally important change estimates were compared with those from the Manchester-Oxford Foot Questionnaire (MOXFQ) and the American Orthopaedic Foot and Ankle Society (AOFAS) measures. Eighty-three patients awaiting surgery were recruited. Patients completed pre- and 12 months postoperative the SF-36 and the MOXFQ. A surgeon assessed the AOFAS scores. The responsiveness to change was determined using the effect size (ES), the minimal detectable change (MDC) and the minimal clinically important change. Two subscales of the SF-36 demonstrated significant improvement, bodily pain (BP) and mental health. Only the BP domain appeared the most responsive with an ES of 0.73. All domains of the MOXFQ and AOFAS produced much larger effect sizes (ES > 1.5). MDC values for the majority of the SF-36 domains fell within measurement error except for the BP domain. Fewer patients showed significant improvement when compared with the MOXFQ pain domain. In conclusion, the SF-36 measuring tool proved to be neither reliable nor responsive enough to detect real change after forefoot surgery. Though the BP domain appeared to be the most responsive, it failed to detect meaningful change when compared to the MOXFQ-Pain and the Visual Analogue Scale.

Background: Morton neuroma is a common, painful disorder of the foot with multiple treatment options of varying cost and effectiveness. Objective: The aim of this study was to determine the most co...

The foot arch plays an important role in propulsion and shock absorption during walking and running; however, the relationship among the foot arch, metatarsal locking theory, and nature of the windlass mechanism (WM) remain unclear.What are the differences in the kinematic relationship between the foot arch, hindfoot, and hallux during walking and running?Relative angles within the foot were measured in 18 healthy men using the Oxford foot model (OFM). Data for barefoot walking at a comfortable speed and rearfoot running at 2.0 m/s were collected. Angles of the forefoot relative to the hindfoot (OFM-arch), hallux relative to the forefoot (Hallux) on the sagittal plane, and hindfoot relative to the shank (Hindfoot) on three anatomical planes were obtained. The medial longitudinal arch (MLA) angle was calculated to verify that OFM-arch can substitute the MLA angle. Each parameter was subjected to cross-correlation analysis and Wilcoxon signed-rank tests to examine the relationship with OFM-arch and compare them during walking and running.OFM-arch was similar to the conventional MLA projection angle in both trials (gait: 0.79, running: 0.96 p 0.01). Synchronization of the OFM-arch and Hallux angles was higher in running than in walking (gait: -0.09, running: -0.75 p 0.01). Hindfoot supination was unrelated to OFM-arch. Hindfoot angle on the transverse plane exhibited a moderate relationship with OFM-arch, indicating different correlations in walking and running (gait: 0.63, running: -0.68 p 0.01).The elevation of the foot arch due to hallux dorsiflexion differed during walking and running; hence, other factors besides WM (such as intrinsic muscles) may affect the foot arch elevation during running. The hindfoot in the frontal plane does not contribute to arch raising and foot stability during running; it features different relationships with OFM-arch during walking and running.

Backgrounds: Clubfoot is a foot disorder frequently seen. Although, there are several studies about the efficiency of physiotherapy in the treatment of clubfoot, physiotherapy programs may be more efficient if the treatment apply step by step similar to the logic of the serial casting progression of the involved foot. Therefore, the aim of this study was to determine the effectiveness of three-phase physiotherapy program in children with clubfoot. Methods: Fifty-seven patients (37 males, 20 females; 7.26 ± 1.27 years) with clubfoot which had Ponseti treatment before were included. The ankle dorsiflexion (DF) and plantar flexion (PF) ranges of motion (ROM), one-leg standing time, sit-to-stand test, The Oxford Ankle Foot Questionnaire (OxAFQ) and treatment satisfaction were evaluated before and after treatment. A three-phase physiotherapy program was applied for 3 months. Results: DF, PF, one-leg standing time, sit-to-stand test, treatment satisfaction and all parameters of OxAFQ except ‘Emotional’ parameter of OxAFQ-Children significantly improved after treatment (p < 0.05). Conclusions: The three-phase physiotherapy program increased the ankle range of motion, improved functional status and treatment satisfaction in children with clubfoot. The three-phase physiotherapy might be a reasonable treatment for clubfoot. Although, there is a need for long-term studies to understand its effects on preventing relapse. © 2021 European Foot and Ankle Society The authors thank to all patients for participating in the study.

Background Aneurysmal bone cyst (ABC) is a benign, locally aggressive tumor that occurs in childhood and early adulthood. It usually affects the metaphysis of long bones but can also occur in the foot. Methods This single-center study is a retrospective review of ten patients with primary ABCs of the foot which underwent an intralesional curettage or a polidocanol instillation. Results After intralesional curettage a local recurrence was observed in 3/5 cases. The instillation of polidocanol showed a significant reduction of the initial cyst volume (p = 0.0267). In the instillation subgroup a primary complete healing was achieved in three cases. Due to a persisting disease two cases were converted to intralesional curettage without local recurrence in the follow-up. Conclusions Percutaneous instillation of polidocanol is a minimally invasive treatment option for ABCs of the foot and especially for small bones. Nevertheless, several sequential instillations and a conversion to intralesional curettage can be necessary.

Objectives The purpose of this study was to explore the experiences of self-management of feet for patients with diabetes from the perspective of the patient, support person and health-care provider. Methods The qualitative method, Interpretive Description, was used to guide data collection and analysis. Semistructured interviews were completed with 11 patients, 4 support persons and 9 health-care providers. Results The overarching theme was that self-management of diabetes and specifically foot health is complex. Six subthemes were identified. Four confirmed what is known in the literature: knowledge of foot self-management, physical ability to provide foot care, footwear and support. The remaining 2 subthemes, readiness to self-manage feet and communicating between patients and health-care providers, offered new insights in relation to self-management of foot health. Conclusions The present findings have major implications for clinical practice, which can be categorized as the 3Rs: rapport, readiness and reinforcement. Rapport with patients and support persons is vital in creating an environment where foot health concerns can be addressed. Readiness to self-manage foot health is an important factor; health-care providers can capitalize on a patient’s level of readiness, regularly tailoring foot education to a patient’s needs. Reinforcement of positive foot health with patients and support persons is an important strategy for all health-care providers.

Блокуючий артрориз стопи гвинтом виконали у 8 пацієнтів (11 стоп) віком від 9 до 12 років. Дане оперативне втручання показане пацієнтам віком понад 14 років при першому ступені плоско-вальгусної деформації стопи за умови наростання недостатності заднього великогомілкового м’яза в динаміці, пацієнтам віком від 10 до 14 років із другим ступенем деформації у поєднанні з операцією на м’яких тканинах, пацієнтам віком від 7 до 14 років із третім ступенем деформації у поєднанні з операцією на м’яких тканинах та пацієнтам віком молодше 7 років із четвертим ступенем деформації при прогресуванні недостатності заднього великогомілкового м’яза та віком від 7 до 10 років — у поєднанні з операцією на м’яких тканинах. Перевагами блокуючого артроризу п’яткової кістки гвинтом є малоінвазивність втручанням та можливість корекції гнучкої плоско-вальгусної деформації стопи в дітей та підлітків у короткий термін із максимальним збереженням функції стопи, а ефективність операції залежить від скелетної зрілості кісток стопи.

Проаналізовані результати хірургічного лікування 9 пацієнтів (17 плеснофалангових суглобів) із застосуванням остеотомії за Weil. В усіх випадках було діагностовано метатарзалгію та відсутність плеснової параболи за прямою рентгенограмою. Результати оцінювали за схемою AOFAS та візуальною аналоговою шкалою в строки 6–27 місяців (у середньому 18,4 ± 4,5 місяця). Значимість різниці між середніми оцінена за допомогою двовибіркового t-тесту (α = 0,05). Функція стопи до та після операції становила 50,3 ± 5,7/82,8 ± 2,9 бала (p < 0,001), рівень болю — 6,5 ± 0,4/1,3 ± 0,1 см (p < 0,001). Остеотомія за Weil є ефективною хірургічною операцією, що сприяє суттєвому зменшенню больового синдрому та покращенню функції стопи.

Mathematical processing and analysis of treatment outcomes were performed in 123 patients with ischemic contracture of the hand and in 74 — with ischemic contracture of the foot. The high treatment efficiency was established, especially in patients with ischemic contracture of the foot; the factors that influence the effectiveness of treatment were determined. The reliability of the average parameters and the influence of factors on the effectiveness of treatment were justified by the results of analysis of variance. These data confirm the importance of mathematical processing to evaluate the clinical outcomes.

Актуальність. Гнучка плоска стопа є одним із найчастіших скелетних порушень у дітей та підлітків. Провідними хірургами при корекції плоско-вальгусної деформації стоп застосовується методика підтаранного артроерезу, проте відсутні повідомлення про використання даної методики в пацієнтів дитячого віку з гіпермобільністю суглобів на фоні дисплазії сполучної тканини. Матеріали та методи. В основу роботи покладений аналіз результатів хірургічного лікування 8 пацієнтів (16 стоп) із гнучкою плоско-вальгусною деформацією стоп на тлі дисплазії сполучної тканини віком від 6 до 14 років (чоловічої статі — 7 осіб, жіночої — 1). Діагностика дисплазії сполучної тканини виконувалася за допомогою критерію Брайтона, ступінь гіпермобільності суглобів визначався за шкалою Бейтона. На передньо-задній рентгенограмі визначали таранно-п’ятковий кут, на боковій — таранно-п’ятковий кут, кут інклінації п’яткової кістки та тало-метатарзальний кут до та після хірургічного лікування. Оцінку результатів хірургічного лікування проводили за шкалою AOFAS (Американська асоціація хірургів стопи та гомілково-ступневого суглоба) для заднього відділу стопи. Виконаний статистичний аналіз. Результати. Усі пацієнти скаржилися на болі в стопах після навантаження. Дисплазія сполучної тканини у всіх пацієнтів діагностована та підтверджена великими та малими критеріями Брайтона. Гіпермобільність суглобів діагностована за бальною шкалою Бейтона: у 1 пацієнта констатовано 8 балів, у 5 (48 %) — 7, у 2 (42 %) — 6, що свідчить про наявність тяжкого ступеня гіпермобільності суглобів. На підставі аналізу рентгенометричних показників стопи до та після проведеного хірургічного лікування, а саме виконання артроерезу стоп встановлено статистично вірогідне покращання показників тало-метатарзального кута (р < 1,01 E–10), показника п’яткової інклінації (р < 3,39 E–11) та таранно-п’яткового кута (р < 4,05893E–11) після проведеного хірургічного лікування. Відмінний результат за шкалою AOFAS був відмічений у 2 пацієнтів (25 %), добрий — у 6 (75 %). Висновки. Підтаранний артроерез при лікуванні гнучкої симптоматичної плоско-вальгусної деформації стоп у дітей на тлі дисплазії сполучної тканини дозволяє проводити ефективну її корекцію, досягати стійкого ефекту стосовно больового синдрому та покращувати функцію ходьби.

One such complication is a diabetic foot ulcer that can lead to amputation. Various strategies are taken to reduce the occurrence of injuries in diabetic mellitus patients. One of them is through foot care education packaged by using interesting media. Through the development of smartphone-based applications, it aims to help patients and families perform the right foot care anytime and anywhere. The purpose of this activity is to develop educational media while increasing the knowledge of patients and families about performing foot care. The method used is to develop educational media in the form of applications on smartphones and measure knowledge score before and after education. In addition, during the education of patients and families, they will be followed up 3 times in 1 week. The targets of this program are diabetic patients and families at PKU Muhammadiyah Pontianak Clinic. The results of this activity show that smartphone-based "FoCED" foot care education applications can increase patient and family knowledge.

Purpose To explore the mothers' caring experiences of children with congenital hand or foot abnormalities, and to inform the development of tailored intervention strategies to improve the mothers' well-being. Design and methods A qualitative study design was used. A purposive sample of 23 women whose children had congenital abnormalities of the hand or foot were enrolled. Semi-structured, in-depth interviews were conducted from December 2019 to May 2020. The Colaizzi's phenomenological approach was used for data analysis. Results Data analysis revealed four main themes: (a) dynamic negative affect; (b) low health literacy; (c) mothers' need for support; and (d) the shift in social activity and family role. Eleven subthemes were involved in these themes. Conclusions Women whose children have abnormal hands or feet have complicated care experiences and are under tremendous psychological pressure. Some mothers also encounter financial difficulties. Practice implications This study assessed the psychological impact on mothers of children with congenital hand or foot abnormalities. Our findings illustrate the needs of mothers, and call attention to this specific group. The findings may help inform healthcare and social interventions to facilitate the recovery of the affected children and cater to the needs of these families. Healthcare providers should provide adequate instructions to the parents regarding the provision of home management care following discharge from the hospital.

Introduction/Objective. The aim of this study was to examine the association between flat feet and socio-demographic factors and nutritional status in children aged 7?14 years of the Province of Vojvodina, Serbia. Methods. The research was conducted as a cross-sectional study. The survey instrument was a questionnaire, and anthropometric measurements were done using standardized procedures. To determine the impact of socio-demographic factors and nutritional status as independent variables on the flat feet in schoolchildren as a dependent variable, a multivariate logistic regression model was implemented. A multivariate model was adjusted for age, sex, type of settlement, and material status. Results. This study included 1376 children (685 boys and 691 girls). Significant differences were observed in the frequency of flat feet between normal weight, overweight, and obesity (p = 0.006), where obese children were rated highest in the flat foot category. Overweight children had a 1.76 times higher chance to have flat feet than those with normal weight (OR = 1.76; 95% CI 1.08?2.88), while obese children were 1.88 times more likely to have flat feet than those with normal weight (OR = 1.88; 95% CI 1.14?3.11). Conclusion. The research showed that nutritional status was significantly associated with the presence of flat feet in schoolchildren. The high prevalence of flat feet and obesity in schoolchildren should be accepted as a warning sign, and many public health policies should be undertaken to solve these issues.

Recreational sports are more popular, with many athletes involved year-round in multiple sports and on multiple teams. Most athletes do not take proper rest, making them more susceptible to stress-related injuries. There are numerous sports-related injuries in the foot and ankle. These issues can be non-traumatic, due to chronic repetitive stresses, or traumatic. Most of these injuries are managed conservatively, and athletes do well and return to play, while some do better with operative management. This article discusses a few of the sports injuries that are common in the leg, foot, and ankle and the recovery process.

Foot compartment syndrome is an uncommon condition that should be recognized by all orthopedic surgeons. The clinical presentation is often less clear than other limb compartment syndromes and requires high clinical suspicion with a low threshold for direct measurement of compartment pressure. Controversy exists regarding the number of anatomic compartments and the most effective treatment. Both acute surgical intervention and delayed management can result in significant morbidity and long-term sequelae.

A 22 years old undergraduate student was injured three times by a C. medius spider while wearing pants. Right foot and internal lower leg were bitten in three sites, leading to local pain and oedema, besides a total leg paresthesia as immediate symptoms. A series of photographs of the sites were taken since day 0 until resolution in day 10. Two hours after the accident, the victim received intravenous promethazine. Despite cessation of pain and paresthesia after 24 hours, an intense erythema and itching emerged reaching the maximum in day 4, when the victim returned to hospital and received topic dexamethasone and oral dexchlorpheniramine. The regression was complete in day 10. This accident opened room for discussion of empiric drug choice for immediate and subsequent symptoms of unknown envenomations, as good as a reference for further accidents with this common spider. Biological aspects such as venom composition and spider control of delivered venom amount are also discussed.

Background Although Foot and Ankle Outcome Score (FAOS) is a widely used patient-reported outcome measure (PROM) for foot and ankle conditions, research on its longitudinal validity is still needed. Minimal important change (MIC) values for the FAOS were determined using predictive modeling. Methods Overall, 134 patients that underwent operative treatment for foot and ankle conditions were included. An anchor based predictive logistic modeling method was used for estimating the MIC values for the FAOS subscales after surgery. Results Mean score changes in the improved and the unimproved groups were 17.7 and 0.43 points for Pain, 3.9 and −3.3 points for Symptoms, 21.3 and 1.8 points for Activities and daily living (ADL), 8.7 and −2.8 points for Sport, and 12.5 and −3.3 points for quality of life subscale, respectively. MIC was successfully determined to four out of five subgroups as follows: Pain 9.5 (94% CI −6.4 to 24.6); ADL 11.7 (95% CI −19.6 to 46.6); Sport (95% CI −10.4 to 15.4); QoL 5.0 (95% CI −2.6 to 12.9). The Symptoms subgroup presented with low MIC of 0.3 (95% CI −11.7 to 13.4) fitting to the measurement error. Conclusion ADL, Sports, Pain, and QoL subscales of the FAOS presented logical MIC values. The MIC can be further evaluated for specific conditions.

Background The aim of this study was to clarify the anatomical features of the interosseous tarsometatarsal ligaments of foot and to classify their types based on the combinations of their ligamentous components. Methods Fifty feet from 27 adult Korean cadavers were dissected. Results The interosseous tarsometatarsal ligaments were observed in the first, second, and third cuneometatarsal joint spaces. The interosseous tarsometatarsal ligament of the first cuneometatarsal space consistently connected the medial cuneiform and the second metatarsal, and was accompanied by one or two accessory ligaments above (34%) and/or below (6%) the Lisfranc ligament. The interosseous tarsometatarsal ligaments of the second and third cuneometatarsal joint spaces comprised seven and five components, and were classified into five and three types depending on the number and combination of the components, respectively. Conclusions These results are expected to advance the current knowledge on the tarsometatarsal joint and provide helpful information for more accurate and successful diagnosis and treatment of lesions at this joint.

Item does not contain fulltext The European Foot and Ankle Society (EFAS) score is a recently developed foot and ankle patient-reported outcome measure. It has been developed and partly validated in seven languages. This study's aim was to investigate the measurement properties of the Dutch version of the EFAS score. Subscales of the Dutch EFAS score were evaluated in 547 patients with a variety of foot and ankle diagnoses. Floor and ceiling effect, reliability, and construct validity were assessed. The internal consistency of the EFAS score was acceptable (Cronbach's alpha 0.79-0.94). Repeatability was considered poor, with intraclass correlation coefficients between 0.32 and 0.39. Construct validity was inadequate with confirmation of 67% of the hypothesized correlations. In conclusion, the Dutch version of the EFAS score does not have adequate measurement properties for use in patient with patients with varying foot and ankle problems.

A 35-year-old man injured his right foot by slipping down 200 m into a crater on top of Mount Fuji, where some snow still remained. The next day the patient climbed up from the crater with his friend's assistance and began to descend the mountain; he met the Shizuoka police mountain distress rescue team at the 9th station. The Shizuoka police mountain distress rescue team transported the patient on foot to the snowless 7th station. The Shizuoka police aviation unit, flying a helicopter, then collected the patient. They transported the patient to the nearby Fujinomiya fire department station. The eastern Shizuoka physician-staffed helicopter emergency medical service landed there, and the patient was transported to Juntendo Shizuoka Hospital. On arrival, he had stable vital signs, but his right foot showed a dislocated fracture with frostbite. This is the first case report of collaboration between a helicopter emergency medical service and a police helicopter to rescue a victim from Mount Fuji. When managing victims in high-altitude settings, such as Mount Fuji, collaboration between multiple organizations is necessary.