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Dancers frequently perform jumps in the context of a prolonged, continuous dance piece. The purpose of this study is to explore the lower-extremity energetics in healthy dancers performing repetitive dance jumps (sautés) before and after typical dance-specific choreography. Lower-extremity kinetic data were collected from 14 healthy female dancers during a series of sautés performed before and after 3 minutes of dance. Percent contributions of the lower-extremity joints to the whole-limb mechanical energy expenditure during ground contact were calculated. The jumps performed at the beginning were compared with the jumps at the end of the dance choreography. Dancers maintained the jump rate and consistent whole-limb mechanical energy expenditure between the jump series. As expected, for both jump series, the sautés had greater relative energetic contribution from the ankle and knee as compared with lesser contribution from the hip and toe. However, we observed lesser contribution from the knee and greater contribution from the hip after a 3-minute dance. After performing typical dance choreography, the dancers demonstrated a distal to proximal redistribution of individual joints' contribution to whole-limb mechanical energy expenditure. [ABSTRACT FROM AUTHOR]

This paper introduces the foot-slip turning motion by combining a slider-like mechanism with the double-support parallel spring-loaded inverted pendulum model, in which the musculoskeletal robot uses the model to simplify the slip-turning motion with its compliant structure and utilizes the foot muscle to improve its postural stability. The slip-turning motion, characterized by slight movements for swift turning via foot slippage, is advantageous for musculoskeletal robots due to their limited range of movement. The challenge lies in the reduced support area during the motion, which impacts stability. In our previous study, the robot 'PneuTurn-T' successfully executed said motion, whereas the details of the turning mechanism were lacking. This study investigated the utilization of leg compliance in the motion and its static postural stability in the landing stance. Experimental results exhibited a leg compression rate derived from the collected data in the early phase of the motion and validated intrinsic toe joint stabilization with foot muscle for passive postural control. The ground reaction force proves the capability to maintain the posture for 130% longer in the foot with plantar intrinsic muscle. Despite structural challenges, this approach shows promise for musculoskeletal robots, highlighting their ability to handle a turning task with simple control. [ABSTRACT FROM AUTHOR]

We used finite element analysis to study the mechanical stress distribution of a new intramedullary implant used for proximal interphalangeal joint (PIPJ) arthrodesis (PIPJA) to surgically correct the claw‐hammer toe deformity that affects 20% of the population. After geometric reconstruction of the foot skeleton from claw toe images of a 36–year‐old male patient, two implants were positioned, in the virtual model, one neutral implant (NI) and another one 10° angled (10°AI) within the PIPJ of the second through fourth HT during the toe‐off phase of gait and results were compared to those derived for the non‐surgical foot (NSF). A PIPJA was performed on the second toe using a NI reduced tensile stress at the proximal phalanx (PP) (45.83 MPa) compared to the NSF (59.44 MPa; p < 0.001). When using the 10°AI, the tensile stress was much higher at PP and middle phalanges (MP) of the same toe, measuring 147.58 and 160.58 MPa, respectively, versus 59.44 and 74.95 MPa at corresponding joints in the NSF (all p < 0.001). Similar results were found for compressive stresses. The NI reduced compressive stress at the second PP (−65.12 MPa) compared to the NSF (−113.23 MPa) and the 10°AI (−142 MPa) (all p < 0.001). The von Mises stresses within the implant were also significantly lower when using NI versus 10°AI (p < 0.001). Therefore, we do not recommend performing a PIPJA using the 10°AI due to the increase in stress concentration primarily at the second PP and MP, which could promote implant breakage. [ABSTRACT FROM AUTHOR]

Pain associated with Parkinson disease is mostly episodic, nociceptive, nocturnal, and localized in the feet where it manifests as cramps. In our prospective cross-sectional study, we comprehensively characterized Parkinson disease (PD)–related pain in monocentrically recruited patients with PD using standardized tools of pain assessment and categorization. One hundred fifty patients were systematically interviewed and filled in questionnaires for pain, depression, motor, and nonmotor symptoms. Patients with PD-related pain (PD pain), patients without PD-related pain (no PD pain), and patients without pain (no pain) were compared. Pain was present in 108/150 (72%) patients with PD, and 90/150 (60%) patients were classified as having PD-related pain. Most of the patients with PD (67/90, 74%) reported nociceptive pain, which was episodic (64/90, 71%), primarily nocturnal (56/90, 62%), and manifested as cramps (32/90, 36%). Parkinson disease–related pain was most frequently located in the feet (51/90, 57%), mainly at the toe joints (22/51, 43%). 38/90 (42%) patients with PD-related pain received analgesic medication with nonsteroidal anti-inflammatory drugs being the most frequently used (31/42, 82%) and opioids most effective (70% pain reduction of individual maximum pain intensities, range 22%-100%, confidence interval 50%-90%). All patients received oral PD treatment; however, levodopa equivalent dose showed no correlation with mean pain intensities (Spearman ρ = 0.027, P > 0.05). Our data provide a comprehensive analysis of PD-related pain, giving evidence for mainly non-neuropathic podalgia, which bears the potential to rethink assessment and analgesic treatment of pain in PD in clinical practice. [ABSTRACT FROM AUTHOR]

Background: Interphalangeal coalition is characterized by fusion of interphalangeal joint between the middle and distal phalanges. Interphalangeal coalition fractures often result in delayed union or nonunion. The purpose of this study was to evaluate the results of focused extracorporeal shock wave therapy (ESWT) for painful delayed union or nonunion of fractures of the interphalangeal coalition. Methods: The study group consisted of 9 patients (9 feet) diagnosed with painful delayed union or nonunion due to persistent pain and no tendency toward bony union for at least 3 months after the interphalangeal coalition fracture on plain radiographs between 2021 and 2023 were included. The mean age was 51.3 years (23-64). Focused ESWT was performed in all patients. The mean time from the date of injury to the start of ESWT was 16.1 weeks (12-15). ESWT was performed every 2 weeks, with each session consisting of 3000 impulses (0.15-0.25 mJ/mm2). Plain radiographs were used to confirm bone union, and visual analog scale (VAS) scores were used for pain assessment. Results: Complete bony union was documented in all 9 patients. The application of focused ESWT was performed a mean of 2.7 times (2-4), and the mean duration from the initiation of treatment to the confirmation of bony union was 7.4 weeks (3.6-12.7). In all cases, the symptoms of swelling and pain were alleviated. The VAS scores exhibited significant improvement, with the mean VAS score decreasing from 3.8 (2-6) before ESWT to 0 after the achievement of union (P <.001). Conclusion: In this small cohort, all patients with painful delayed union or nonunion of fractures at the interphalangeal coalitions achieved complete bony fusion after focused ESWT. Moreover, bony union was observed within 2 months of ESWT initiation. These findings suggest that focused ESWT may be a valuable treatment option for painful delayed union or nonunion of interphalangeal coalition fractures. Level of Evidence: Level IV, case series. [ABSTRACT FROM AUTHOR]

Predictive neuromuscular simulations are a powerful tool for studying the biomechanics of human walking, and deriving design criteria for technical devices like prostheses or biorobots. Good agreement between simulation and human data is essential for transferability to the real world. The human foot is often modeled with a single rigid element, but knowledge of how the foot model affects gait prediction is limited. Standardized procedures for selecting appropriate foot models are lacking. We performed 2D predictive neuromuscular simulations with six different foot models of increasing complexity to answer two questions: What is the effect of a mobile arch, a toe joint, and the coupling of toe and arch motion through the plantar fascia on gait prediction? and How much of the foot's anatomy do we need to model to predict sagittal plane walking kinematics and kinetics in good agreement with human data? We found that the foot model had a significant impact on ankle kinematics during terminal stance, push-off, and toe and arch kinematics. When focusing only on hip and knee kinematics, rigid foot models are sufficient. We hope our findings will help guide the community in modeling the human foot according to specific research goals and improve neuromuscular simulation accuracy. [ABSTRACT FROM AUTHOR]

Hallux valgus is a common condition where the subluxation of the first metatarsophalangeal joint and lateral deviation of the hallux at the interphalangeal joint creates difficulty with footwear fit. Footwear and foot orthoses are commonly prescribed nonsurgical treatments for hallux valgus. Do extra-width footwear and foot orthoses influence peak pressure at the medial aspect of the metatarsophalangeal and interphalangeal joints in women with hallux valgus? Community-dwelling women with symptomatic hallux valgus underwent gait testing when wearing their own shoes and when wearing extra-width footwear fitted with three-quarter length, arch-contouring prefabricated foot orthoses. Peak pressure (kPa) on the medial aspect of the metatarsophalangeal and medial interphalangeal joints and on the plantar surface of the foot (hallux, lesser toes, metatarsophalangeal joint 1, metatarsophalangeal joints 2–5, midfoot and heel) were measured using the novel pedar®-X system with the pedar® pad and pedar® insole, respectively (Novel, GmbH, Munich, Germany). Paired samples t -tests were used to calculate the differences between the two conditions, and the magnitude of observed differences was calculated using Cohen's d. We tested 28 participants (aged 44–80 years, mean 60.7, standard deviation 10.7). Compared to their own footwear, wearing the intervention footwear and orthoses was associated with a statistically significant decrease in pressure on the medial aspect of the metatarsophalangeal joint (58.3 ± 32.8 versus 42.6 ± 32.8, p =0.026, d =0.49), increased pressure under the midfoot (70.7 ± 25.7 versus 78.7 ± 23.6, p =0.029, d =0.33) and decreased pressure underneath the heel (137.3 ± 39.0 versus 121.3 ± 34.8, p =0.019, d =0.45). The intervention footwear and orthoses significantly decreased peak pressure on the medial aspect of the first metatarsophalangeal joint but had no significant effect on the interphalangeal joint. Further studies are required to determine whether these changes are associated with improvements in symptoms associated with hallux valgus. • We investigated peak medial and plantar pressure in women with hallux valgus. • The intervention decreased medial pressure at the first metarsophalangeal joint. • The intervention increased midfoot and decreased heel plantar pressure. • Women with hallux valgus may benefit from extra-width footwear and orthoses. [ABSTRACT FROM AUTHOR]

Background The flexor hallucis longus (FHL) muscle is crucial in fine motor control of the great toe but the muscle is often sacrificed in free fibula flap (FFF) reconstruction. The aim of this study was to compare great toe movement between complete and partial FHL resection during FFF harvest to see if FHL can be left behind (without undergoing fibrosis) in situ when bulk is not required at the recipient site. Methods A prospective, cross-sectional, observational study was performed including patients undergoing FFF harvest over a 2-year period. Movement of great toe interphalangeal joint was recorded of operated and unoperated legs in patients undergoing partial and complete FHL harvest and data analyzed. Results There was a statistically significant (p < 0.05) difference between the two groups of patients. Conclusion FHL can be safely left in situ in patients not requiring bulk at the recipient site as blood supply, nerve supply, and muscle function are not compromised in partial FHL harvest. Further image-based and dye-based studies are warranted. [ABSTRACT FROM AUTHOR]

This report presents a unique case of checkrein deformities in both halluces following isolated intramuscular sarcoidosis, a rare occurrence given the infrequent musculoskeletal involvement in sarcoidosis. Typically resulting from flexor hallucis longus tendon entrapment by scar tissue post-trauma, the checkrein deformity reported in this paper presented with unusual metatarsophalangeal joint flexion and interphalangeal joint extension during ankle dorsiflexion. A 49-year-old woman with a history of intramuscular sarcoidosis presented with a great toe deformity and discomfort while wearing shoes, leading to a diagnosis of dynamic deformity, possibly attributed to tendon tethering by sarcoidosis. Surgical treatments, including abductor hallucis muscle intratendinous tenotomy, flexor hallucis longus Z-plasty lengthening, Weil osteotomy, and Kirschner wire fixation, significantly improved the functional scores and patient discomfort. This report underscores the importance of recognizing dynamic deformities and the potential for rare diseases, such as sarcoidosis, to cause such conditions, highlighting the need for careful diagnosis and tailored surgical intervention for atypical checkrein deformities. [ABSTRACT FROM AUTHOR]

Walking on sloped surfaces is challenging for many lower limb prosthesis users, in part due to the limited ankle range of motion provided by typical prosthetic ankle-foot devices. Adding a toe joint could potentially benefit users by providing an additional degree of flexibility to adapt to sloped surfaces, but this remains untested. The objective of this study was to characterize the effect of a prosthesis with an articulating toe joint on the preferences and gait biomechanics of individuals with unilateral below-knee limb loss walking on slopes. Nine active prosthesis users walked on an instrumented treadmill at a +5° incline and -5° decline while wearing an experimental foot prosthesis in two configurations: a Flexible toe joint and a Locked-out toe joint. Three participants preferred the Flexible toe joint over the Locked-out toe joint for incline and decline walking. Eight of nine participants went on to participate in a biomechanical data collection. The Flexible toe joint decreased prosthesis Push-off work by 2 Joules during both incline (p = 0.008; g = -0.63) and decline (p = 0.008; g = -0.65) walking. During incline walking, prosthetic limb knee flexion at toe-off was 3° greater in the Flexible configuration compared to the Locked (p = 0.008; g = 0.42). Overall, these results indicate that adding a toe joint to a passive foot prosthesis has relatively small effects on joint kinematics and kinetics during sloped walking. This study is part of a larger body of work that also assessed the impact of a prosthetic toe joint for level and uneven terrain walking and stair ascent/descent. Collectively, toe joints do not appear to substantially or consistently alter lower limb mechanics for active unilateral below-knee prosthesis users. Our findings also demonstrate that user preference for passive prosthetic technology may be both subject-specific and task-specific. Future work could investigate the inter-individual preferences and potential benefits of a prosthetic toe joint for lower-mobility individuals. [ABSTRACT FROM AUTHOR]

La couverture des pertes de substance de l'hallux est indispensable pour la préservation de la fonction locomotrice. Elle est accessible à des solutions locales, à privilégier pour les défects de petite taille. Nous présenterons le cas d'un patient traité par lambeau de cross-toe pour une exposition de l'articulation interphalangienne proximale de l'hallux après fracture ouverte. Le résultat fonctionnel de ce lambeau fiable et simple était très satisfaisant, avec une cicatrisation et une reprise de la marche rapides. Reconstruction of hallux soft-tissue defects is essential for the locomotor function. Some regional flaps are available and have to be preferred in case of small defect. Here, we present the case of a patient treated by a cross-toe flap in order to cover an exposed hallux proximal interphalangeal joint, after an open fracture. The functional outcome of this reliable and easy flap was very satisfying, with quick wound healing and resumption walk. [ABSTRACT FROM AUTHOR]

Flap-based reconstruction techniques have shown promise in preventing scar contractures and enhancing healing in fold areas by providing vascularized and thick tissue. We report a septic rupture of the superficial femoral artery treated with an arterial allograft and covered with a contralateral pedicled Deep Inferior Epigastric Artery Perforator (DIEP) flap. The patient presented favorable outcomes, including optimal healing at 8 months, with no functional limitation. A literature review also discusses alternative pedicled perforator flaps. These modern techniques present several advantages, including reliability, and can be of great interest in complex vascular surgery cases. [ABSTRACT FROM AUTHOR]

This article discusses a case of delayed diagnosis of cervical myelopathy in an adult with Weaver syndrome. Weaver syndrome is a rare genetic condition characterized by bony overgrowth and intellectual impairment. The patient in this case had progressive lower limb spasticity and a history of corrective surgeries for clubfoot and hip dysplasia. Despite a hospital admission and medical workup, the cause of her loss of ambulatory ability was not identified until she was seen by a physiatrist who ordered electrodiagnostic testing and an MRI. The MRI revealed spinal cord compression and myelomalacia, leading to surgery and stabilization of her symptoms. The article highlights the importance of maintaining a high level of suspicion for cervical myelopathy in patients with Weaver syndrome and the need to address cognitive biases that may affect diagnostic and therapeutic decision-making. [Extracted from the article]

Kaposi's sarcoma caused by Kaposi's sarcoma-associated virus, is a rare malignancy in the general population with unique features. However, clinical presentation on the feet can mimic a diabetic foot ulcer. Here we describe the case of a 63-year-old male with type 2 diabetes, who presented with a lesion on the left 4th toe. Left foot radiograph in lateral and dorsoplantar views were normal. Full skin examination identified lesions with a similar morphology on the forearms. A HIV antigen/antibody test was negative, histology showed CD31 positive spindle cells and the presence of Kaposi's sarcoma-associated virus confirming the diagnosis of Kaposi's sarcoma. Kaposi's sarcoma-associated virus' lytic cycle can be triggered by the immunosuppressive state caused by tissue's chronic exposure to a hyperglycaemic environment. A thorough general examination to identify lesions elsewhere in the body can help to identify the systemic nature of the disease. Pedal lesions in patients with diabetes with an atypical presentation that are refractory to standard treatment should prompt early histological examination. Early diagnosis and intervention can improve the chances of remission. [ABSTRACT FROM AUTHOR]

This paper presents the design and testing of an arched foot with several biomimetic features, including five individual MTP (toe) joints, four individual midfoot joints, and plantar fascia. The creation of a triple-arched foot represents a step further in bio-inspired design compared to other published designs. The arched structure creates flexibility that is similar to human feet with a vertical deflection of up to 12 mm. The individual toe joints enable abduction–adduction in the forefoot and therefore a natural pronation motion. Adult female bone data was obtained and converted into a CAD model to accurately identify the location of bones, joints, and arches. An analytical model is presented that gives the relationship between the vertical stiffness and horizontal stiffness of the longitudinal arches and therefore allows the optimization of stiffness elements. Experimental tests have demonstrated a vertical arch stiffness of 76 N/mm which is similar to adult human feet. The range of movement of the foot is similar to human feet with the following values: dorsi-plantarflexion (28°/37°), inversion-eversion (30°/15°), and abduction–adduction (30°/39°). Tests have also demonstrated a three-point contact with the ground that is similar to human feet. [ABSTRACT FROM AUTHOR]

The aim of this study was to present and evaluate methods of measuring toe joint angels using joint-surface based and inertial axes approaches. Nine scans of one frozen human cadaveric foot were obtained using weight-bearing CT. Two observers independently segmented bones in the forefoot and measured metatarsalphalangeal joint (MTPJ) angles, proximal and distal interphalangeal joint (PIPJ and DIPJ) angles and interphalangeal angles of the hallux (IPJ) using 1) inertial axes, representing the long anatomical axes, of the bones and 2) axes determined using centroids of articular joint surfaces. The standard deviations (SD) of the IPJ/PIPJ and DIPJ angles were lower using joint-surface based axes (between 1.5˚ and 4.1˚) than when the inertial axes method was used (between 3.3˚ and 16.4˚), for MTPJ the SD's were similar for both methods (between 0.5˚ and 2.6˚). For the IPJ/PIPJ and DIPJ angles, the width of the 95% CI and the range were also lower using the joint-surface axes method (95% CI: 2.0˚–4.1˚ vs 3.2˚–16.3˚; range: 3.1˚–7.4˚ vs 3.8˚–35.8˚). Intra-class correlation coefficients (ICC) representing inter- and intra-rater reliability were good to excellent regarding the MTPJ and IPJ/PIPJ angles in both techniques (between 0.85 and 0.99). For DIPJ angles, ICC's were good for the inertial axes method (0.78 and 0.79) and moderate for the joint-surface axes method (0.60 and 0.70). The joint-surface axes method enables reliable and reproducible measurements of MTPJ, IPJ/PIPJ and DIPJ angles. For PIPJ and DIPJ angles this method is preferable over the use of inertial axes. [ABSTRACT FROM AUTHOR]

Toe-walking is one of the most common gait deviations (due to soleus and/or gastrocnemius muscle contractures), compromising the first (heel rocker) and second (ankle rocker) of the foot during walking. The aim of this study is to evaluate the effect of emulated artificially gastrocnemius and soleus contractures on the first and second rocker during walking. An exoskeleton was built to emulate contractures of the bilateral gastrocnemius and soleus muscles. Ten healthy participants were recruited to walk under the following conditions: without emulated contractures or with bilateral emulated contractures at 0°,10°, 20° and 30° of plantarflexion of the soleus or gastrocnemius in order to create an artificial restriction of dorsiflexion ankle movement. A linear regression from the ankle plantar-dorsiflexion angle pattern was performed on 0–5 % of the gait cycle (first rocker) and on 12–31 % of the gait cycle (second rocker) to compute the slope of the curve. The proportion of participants with the presence of the first and second rocker was then computed. A Statistical Parametric Mapping (SPM) analysis assessed the kinematic variations among different degrees of emulated contractures. The first and second rockers are completely absent from 10° of plantarflexion emulated contracture. The data indicate there was a non-linear shift of the gait pattern of the ankle kinematics and an important shift toward plantarflexion values with the loss of the rockers. This study suggests that toe-walking in the experimental simulation situation is not necessarily due to a high emulated contracture level and can occur with a small emulated contracture by an adaptation choice. This study may improve interpretation of clinical gait analysis and shows that the link between the level of gastrocnemius/soleus emulated contracture and progression of toe-walking (increased plantarflexion during gait) is not linear. • An exoskeleton artificially emulated contractures during walking at the ankle level. • Gastrocnemius and soleus were limited to 0°, −10°, −20° and −30° dorsiflexion. • First and second rocker during walking were analysed. • These findings could contribute to a better understanding of certain hypotheses that may aid in CGA interpretation. [ABSTRACT FROM AUTHOR]

H syndrome is a rare autosomal recessive genetic disorder characterized by the following clinical features: cutaneous hyperpigmentation, hypertrichosis, hepatosplenomegaly, heart anomalies, hearing loss, hypogonadism, short stature, hallux valgus, hyperglycemia, fixed flexion contractures of the toe joints, and the proximal interphalangeal joints. In rare cases, autoinflammatory and lymphoproliferative manifestations have also been reported. This disorder is due to loss-of-function mutations in SLC29A3 gene, which encode the equilibrative nucleoside transporter ENT3. This deficiency leads to abnormal function and proliferation of histiocytes. H syndrome is part of the R-group of histiocytosis. We report two different cases, one was diagnosed in adulthood and the other in childhood. The first case reported is a 37-year-old woman suffering from H syndrome with an autoinflammatory systemic disease that begins in adulthood (fever and diffuse organ's infiltration) and with cutaneous, articular, auditory, and endocrinological manifestations since childhood. The second case reported is a 2-year-old girl with autoinflammatory, endocrine, and cutaneous symptoms (fever, lymphadenopathy, organomegaly, growth delay, and cutaneous hyperpigmentation). Homozygous mutations in SLC29A3 confirmed the diagnosis of H syndrome in both cases. Each patient was treated with Tocilizumab with a significant improvement for lymphoproliferative, autoinflammatory, and cutaneous manifestations. Both cases were reported to show the multiple characteristics of this rare syndrome, which can be diagnosed either in childhood or in adulthood. In addition, an overview of the literature suggested Tocilizumab efficiency. [ABSTRACT FROM AUTHOR]

Background Many people with a longer second toe or lesser toes experience symptoms such as corns, hammertoe, and numerous others, especially when wearing open-toe shoes. Proximal interphalangeal joint arthrodesis using intraosseous loop wiring performed through a hidden side incision is a useful method to shorten the lesser toes aesthetically. Methods Aesthetic toe-shortening procedures were performed in 30 patients. All patients were evaluated by a physical examination and X-rays, and they underwent proximal interphalangeal joint arthrodesis using intraosseous loop wiring through a medial incision. Demographic characteristics, including foot morphology, were analyzed. The number of resected toes and resection amounts of each toe were measured. Patients’ satisfaction was determined through a questionnaire administered at each follow-up. Results In total, 91 toe-shortening procedures were performed in 30 patients who were followed up for an average of 24 months (range, 6–48 months). Sixteen patients had Greek-type feet (53.3%) and 14 had square-type feet (46.7%). Twelve patients had hammer toe deformity (40.0%) and 13 had corns (43.3%). The average length of the resected second and third toes was 9.66±2.79 mm (range, 5–15 mm) and 7.78±2.51 mm (range, 5–12 mm), respectively. The vast majority of patients were satisfied with the final results. No significant complications such as nonunion occurred. Only one case of mild angulation of the second toe was noted. Conclusions Aesthetic toe-shortening using the procedure described here can prevent the development of lessor toe deformities and provide permanent, aesthetically pleasing results with a short recovery time.

Owing to their complex structural design and control system, musculoskeletal robots struggle to execute complicated tasks such as turning with their limited range of motion. This study investigates the utilization of passive toe joints in the foot slip-turning motion of a musculoskeletal robot to turn on its toes with minimum movements to reach the desired angle while increasing the turning angle and its range of mobility. The different conditions of plantar intrinsic muscles (PIM) were also studied in the experiment to investigate the effect of actively controlling the stiffness of toe joints. The results show that the usage of toe joints reduced frictional torque and improved rotational angle. Meanwhile, the results of the toe-lifting angle show that the usage of PIM could contribute to preventing over-dorsiflexion of toes and possibly improving postural stability. Lastly, the results of ground reaction force show that the foot with different stiffness can affect the curve pattern. These findings contribute to the implementations of biological features and utilize them in bipedal robots to simplify their motions, and improve adaptability, regardless of their complex structure.

The aim of this study was to evaluate the prevalence and extent of lower extremity Mönckeberg's Medial Calcific Sclerosis (MMCS) in patients with and without diabetes in patients admitted to the hospital for foot infections. This study retrospectively reviewed 446 patients admitted to the hospital with a moderate or severe foot infection. We defined diabetes based on ADA criteria and reviewed electronic medical records for demographics, medical history and physical examination data. Anterior–posterior and lateral foot radiographs were examined to identify the presence and extent of vascular calcification. We categorised MMCS based on anatomical location: ankle joint to the navicular‐cuneiform joint, Lis Franc joint to metatarsophalangeal joints and distal to the metatarsophalangeal joints. The prevalence of MMCS was 40.6%. The anatomic extent of MMCS was 19.3% in the toes, 34.3% in the metatarsals and 40.6% in the hindfoot/ankle. Calcification was not common solely in the dorsalis pedis artery (DP) (3.8%) or solely in the posterior tibial artery (PT) (7.0%). Usually, both DP and PT arteries were affected by MMCS (29.8%). The prevalence of MMCS was higher in people with diabetes (in hindfoot and ankle [50.1% vs. 9.9%, p ≤ 0.01]; metatarsals [42.6% vs. 5.9%, p ≤ 0.01]; and toes [23.8% vs. 4.0%, p ≤ 0.01]). People with diabetes were 8.9 (CI: 4.5–17.8) times more likely to have MMCS than those without diabetes. This is a group that often has poor perfusion and needs vascular assessment. The high prevalence of MMCS raises questions about the reliability of the conventional segmental arterial Doppler studies to diagnose PAD. [ABSTRACT FROM AUTHOR]

Purpose: To define transcutaneous medial plantar nerve stimulation (T-MPNS) as a new neuromodulation method and assess the efficacy of T-MPNS on quality of life (QoL) and clinical parameters associated with incontinence in women with idiopathic overactive bladder (OAB). Materials and Methods: Twenty-one women were included in this study. All women received T-MPNS. Two self-adhesive surface electrodes were positioned with the negative electrode near the metatarsal-phalangeal joint of the great toe on the medial aspect of the foot and the positive electrode 2 cm inferior-posterior of the medial malleolus (in front of the medio-malleolar-calcaneal axis). T-MPNS was performed 2 days a week, 30 minutes a day, for a total of 12 sessions for 6 weeks. Women were evaluated for incontinence severity (24-h pad test), 3-day voiding diary, symptom severity (Overactive Bladder Questionnaire [OAB-V8]), QoL (Quality of Life-Incontinence Impact Questionnaire [IIQ-7]), positive response and cure-improvement rates, and treatment satisfaction at baseline and at the 6th week. Results: Statistically significant improvement was found in the severity of incontinence, frequency of voiding, incontinence episodes, nocturia, number of pads, symptom severity, and QoL parameters at the 6th week compared with baseline. Treatment satisfaction, treatment success, and cure or improvement rates were found to be high at the 6th week. Conclusions: T-MPNS was first described in the literature as a new neuromodulation method. We conclude that T-MPNS is effective on both clinical parameters and QoL associated with incontinence in women with idiopathic OAB. Randomized controlled multicenter studies are needed to validate the effectiveness of T-MPNS. [ABSTRACT FROM AUTHOR]

A 77-year-old woman presented with a mucous cyst on the lateral aspect of the interphalangeal joint of the first toe caused by contact pressure with the second toe from hallux valgus. She complained of discomfort and discharge from the left first toe for approximately 4 months. Physical examination showed the second toe pressing strongly against the first toe due to hallux valgus and discharge from the skin on the lateral aspect of the interphalangeal joint of the first toe. Magnetic resonance imaging showed a cystic lesion at the same level. The patient underwent a modified scarf osteotomy of the first metatarsal for hallux valgus to resolve the contact pressure between the toes--considered the cause of the mucous cyst-- and resection of mucous cyst. Forefoot weight bearing was allowed 6 weeks after surgery. As of 1 year after surgery, she has had no recurrence of the cyst. The score on the Japanese Society for Surgery of the Foot hallux metatarsophalangealinterphalangeal scale improved from 59/100 points to 92/100. This outcome suggests that hallux valgus correction should be considered when a mucous cyst is associated with contact pressure due to a hallux valgus deformity. To the best of our knowledge, there are no previous reports of a mucous cyst caused by contact pressure between the first toe and second toe due to hallux valgus. [ABSTRACT FROM AUTHOR]

Introduction: There is a lack of clear indications to carrying out an Akin osteotomy in addition to scarf osteotomy. Recent studies have shown that a proximal distal phalangeal articular angle (PDPAA) of > 8° as an indication to carrying out additional Akin osteotomy correlates with better radiological outcomes with lesser risk of recurrence. Our study aimed to validate carrying out the additional Akin osteotomy at a PDPAA > 8° while looking into functional outcomes which have not been studied. Methods: Patients who underwent scarf and combined scarf and Akin osteotomy in our institutional registry was identified. Patient reported outcome measures were compared between patients who underwent scarf and combined scarf and Akin osteotomy. The Visual Analogue Scale (VAS), American Orthopedic Foot and Ankle Score (AOFAS), Short Form-36 Physical Component Score (PCS) and Mental Component Score (MCS) were measured pre-operatively and across a follow up period of 2 years. Results: A total of 212 cases were identified. At a PDPAA > 8, there was no difference in VAS, AOFAS, PCS and MCS between patients that had isolated scarf osteotomy and those that received combined scarf and Akin osteotomy pre-operatively, and at 6 months. However, at 2 years post-operatively, patients that received scarf and Akin osteotomy had a significantly better AOFAS score as compared to patients with isolated scarf osteotomy (82.3 ± 15.3 vs 88.4 ± 13.0, p = 0.0224). On the contrary, at a PDPAA < 8, patients who underwent combined scarf and Akin osteotomy had a significantly lower VAS score at 6 months (1.16 ± 2.16 vs 0.321 ± 1.09, p = 0.00633) and 2 years (0.698 ± 1.73 vs 0.333 ± 1.46, p = 0.0466). They also had a higher AOFAS score at 6 months (80.7 ± 14.3 vs 85.4 ± 12.5, p = 0.0123) and 2 years (83.0 ± 14.0 vs 90.7 ± 9.9, p < 0.0001). Conclusion: PDPAA > 8° can serve as a valid indication to carrying out additional Akin on top of scarf osteotomy based on functional outcomes. However, further studies should investigate a PDPAA threshold that is lower than 8°, which can potentially allow more patients to receive the additional Akin osteotomy that can bring better functional outcomes. [ABSTRACT FROM AUTHOR]

Practicing complex everyday life walking activities is challenging in paediatric neurorehabilitation, although it would prepare patients more comprehensively for the requirements of daily life. Floor projections allow simulation and training of such situations in therapy. Twenty healthy youths aged 6–18 years stepped over a tree trunk and balanced over kerbstones in a real and projected condition. Spatiotemporal and kinematic parameters of the two conditions were compared by equivalence analysis, using the medians of the differences between the two conditions with their bootstrapped 95% confidence intervals. Velocity, step and stride length, step width, and single support time were generally equivalent between the two conditions. Knee and hip joint angles and toe clearance decreased substantially during the execution phase of the projected tree trunk condition. The largest differences were found at the end of the execution phase in both tasks for the ankle joints. As spatiotemporal parameters were equivalent between the conditions, floor projections seem suitable to train precise foot placement. However, differences in knee and hip joint kinematics and toe clearance revealed that floor projections are not applicable for obstacles with a vertical extension. Therefore, exercises aiming at knee and hip flexion improvement should favourably be trained with real objects. [ABSTRACT FROM AUTHOR]

This paper investigated the effect of repair welding on the microstructure, mechanical properties, and high cycle fatigue properties of S355J2 steel T-joints in orthotropic bridge decks. The test results found that the increase in grain size of the coarse, heat-affected zone decreased the hardness of the welded joint by about 30 HV. The tensile strength of the repair-welded joints was reduced by 20 MPa compared to the welded joints. For the high cycle fatigue behavior, the fatigue life of repair-welded joints is lower than that of the welded joints under the same dynamic load. The fracture positions of toe repair-welded joints were all at the weld root, while the fracture positions of the deck repair-welded joints were at the weld toe and weld root, with the same proportion. The fatigue life of toe repair-welded joints is reduced more than that of deck repair-welded joints. The traction structural stress method was used to analyze fatigue data of the welded and repair-welded joints, and the influence of angular misalignment on was considered. The fatigue data with and without AM are all within the ±95% confidence interval of the master S-N curve. [ABSTRACT FROM AUTHOR]

The arch structure of human foot absorbs impact and assists push-off movements during walking. The objective of this study is to introduce arch structures and toe joints into a biped robot, verify the effects, and devise walk control methods by dynamics simulation. We simulated the upright state and start of walking using Choreonoid. The results confirmed that the arch structure improved the impact absorption and stability in the anteroposterior direction. In addition, the arch structure could be expected to smooth the load transfer between the supporting legs during the step change. [ABSTRACT FROM AUTHOR]

In this study, the effect of the speed on the webbed foot locomotion of the mallard was analyzed based on a considerable number of reliable indoor test data. Four adult male mallards were selected for analysis, and the locomotion speed of the mallard was controlled using the treadmill at an accurate and adjustable speed. The locomotion pattern of the webbed foot of the mallard at different speeds was recorded using a high-speed camera. The changes in the position and conformation of the webbed foot during locomotion on a treadmill were tracked and analyzed using Simi-Motion kinematics software. The results indicated that the stride length of the mallard increased, and the stance phase duration was shortened with the increase of the speed, whereas the swing phase duration did not vary significantly. The duty factor decreased with the increase of the mallard speed but not drop below to 0.5, because the mallards flew with their wings, or moved backward relative to the treadmill with the further increase of the speed. Using the energy method to further distinguish gait, and through the percentage of congruity analysis, it was found that between 0.73 and 0.93 m/s, the gait experienced a transition from walking to grounded running, with no significant changes in spatiotemporal parameters. At speeds between 0.93 and 1.6 m/s, mallards adopt a grounded running gait. The instantaneous changes of the tarsometatarso-phalangeal joint (TMTPJ) angle and the intertarsal joint (ITJ) angle at touch-down, mid-stance and lift-off concomitant with the change of the speed were examined with the TMTPJ and ITJ angle as the research objects. Moreover, the continuous changes of the joint angles were examined in a complete stride cycle. The result indicated that the increase of the speed will also make the TMTPJ and ITJ angle change ahead of time in a stride cycle, proving the shortened stance phase duration. The ITJ angle changed much more than the TMTPJ. Thus, the above result reveals that the mallard primarily responds with the increase of the speed by adjusting the ITJ, instead of the TMTPJ. The vertical displacement of the toe joint points and the toe joint angle was studied (a joint angle is between the second toe and the third toe; β joint angle is between the third toe and the fourth toe) with a complete stride cycle as the research object. The distal phalanxes of the second, third and fourth toes first contacted the ground, and the proximal phalanx touched the ground in turn during the early stance phase duration of the mallard, as indicated by the result of this study. However, the toes got off the ground in turn from the proximal phalanxes when the mallard foot got off the ground. With the decrease of the interphalangeal a and β joint angles, the foot web tended to be close and rapidly recovered before the next touch-down. The above result reveals that the webbed foot of the mallard is a coupling system that plays a role in the adjustment of speed. [ABSTRACT FROM AUTHOR]

This study aimed to develop prosthetic foot for the low-income class. Considering that the prosthetic foot was manufactured through 3D printing, we tested whether the material used can be used for such application. Through load-added simulation, a safety factor of at least 6 was measured. The results show that it can be introduced into the prosthetic foot. An ankle multi-axis rotation device, metatarsal head, and toe joint were introduced for comfortable walking of the patient. The muscle power required for walking was simulayed by conducting a load test of the corresponding motion. The prosthetic foot simulated a muscle power of 1263.56 N through the ankle device and 25.7 N·m through the toe joint. Therefore, the actual human body had a value exceeding the muscle power of 1058.90 N and 20.2 N·m, which would help the wearer's walking. [ABSTRACT FROM AUTHOR]

The plantar or dorsal approach has been previously reported for the replantation or revascularization of a completely or incompletely amputated lesser toe. However, no reports exist describing an alternative approach for the replantation or revascularization of an amputated lesser toe, either complete or incomplete. We encountered a rare case of revascularization of an incompletely amputated second toe using a mid‐lateral approach. The purpose of this case report was to describe the mid‐lateral approach, which is novel in its nature for the replantation or revascularization of a completely or incompletely amputated lesser toe. A 43‐year‐old male was involved in a motor vehicle accident and had incomplete crush amputation of a second toe at the base of the nail, along with open dislocation of the distal interphalangeal (DIP) joint in the third toe. We performed artery‐only revascularization of the second toe using a mid‐lateral approach, with the patient in the supine position with his hip in flexion and external rotation. The postoperative course was uneventful, and the second toe was deemed viable. The Japanese Society for Surgery of the Foot (JSSF) standard rating system of the lesser toe was rated 90 and the Self‐Administered Foot Evaluation Questionnaire (SAFE‐Q) scored 100 in all the mentioned categories. The mid‐lateral approach could be an option for the replantation or revascularization of an amputated lesser toe distal to the proximal interphalangeal (PIP) joint. [ABSTRACT FROM AUTHOR]

We report a case of interdigital acral nodular melanoma on the right fourth toe cleft of a 56-year-old Caucasian man that was initially misdiagnosed and mistreated as tinea pedis for over one year. Despite undergoing complete tumor resection and therapeutic lymphadenectomy, as well as adjuvant immunotherapy, the patient died of metastatic disease 18 months after his first visit. This case emphasizes that refractory interdigital dermatophytoses should raise suspicion for the possibility of concomitant malignant neoplasms. Histopathological assessment is indispensable for definite diagnosis of acral interdigital lesions not responding to treatment. [ABSTRACT FROM AUTHOR]

Introduction: Studies of vocational ballet students are sparce. In particular, there is a lack of gender comparisons. The aim of the present study, therefore, was to give a musculoskeletal and sociodemographic description of the typical vocational ballet student in gender comparison. Methods: In this study, n = 414 female and n = 192 male students of the John Cranko School (JCS), aged between 5 and 22 years (Mean ± SD: 13.9 ± 3.5), were examined by an experienced orthopedist and dance physician. Results: Males started ballet (5.8/8.2 years, p < 0.001) and training at later age than females (13.5/14.6 years, p < 0.05). There was a high prevalence of low body weight among both sexes; however, particularly among female participants (58.4/16.2%, p < 0.001). Both sexes showed a large external rotation of the hip (f/m: 59/62°, p < 0.001), a large turnout (f/m: 82/86°, p < 0.01), high values for plantarflexion of the ankle joint (f/m: 72/68°, p < 0.001) and dorsiflexion of the metatarsophalangeal joint of the big toe (f/m: 90/87°, p < 0.001). Discussion: Differences in ballet-specific characteristics between genders (f/m) are converging and are smaller than described in the past. The particularly high prevalence of low body weight among students in the vocational training sector, particularly among females, highlights the need for deeper diagnostic investigation. [ABSTRACT FROM AUTHOR]

Proximal interphalangeal (PIP) joint fusion with Kirschner (K) -wire fixation remains a popular strategy for hammertoe correction. This study was performed to evaluate the effect of length of wire fixation on clinical outcomes. A retrospective review of all hammertoe reconstructions by a single surgeon was performed. Wire length was chosen at the surgeon's discretion. Outcomes were assessed with metatarsophalangeal (MTP) congruency, pin complications, and PIP union. 157 toes underwent reconstruction. Seventy had wires that spanned the MTP and 87 that did not. Wire breaks were significantly more common with longer wire fixation (P =.024). MTP incongruency was significantly more common in the MTP group (P =.014). Pin breakage was rare and only occurred in the MTP group. MTP incongruence was significantly more common in the MTP group but may not reflect surgical technique. PIP union was more common with longer wire fixation but is not clinically significant. III [ABSTRACT FROM AUTHOR]

This article, published in the journal Advanced Robotics, focuses on the topic of adaptive motion in animals and machines. It highlights the intelligence of animals and their ability to navigate and thrive in changing environments, supported by a combination of reflexive and cognitive processes. The article discusses how studying these interactions has led to the development of adaptive robotic behaviors, providing insights into animal behavior and natural intelligence. The special issue includes five papers that showcase cutting-edge research in this field, covering topics such as flying robots with flapping wings, quadrupedal locomotion, humanoid robots, musculoskeletal structures, and robotic sensory processing. The authors express their gratitude to the contributors and reviewers for their valuable contributions to the publication. [Extracted from the article]

Patients with hallux valgus are known to alter lower limb joint kinematics during gait. However, little information is available about gait changes following hallux valgus surgery. We aimed to longitudinally investigate lower limb kinematic changes at the mid and terminal stances of gait after hallux valgus surgery. This prospective observational study included 11 female patients (17 feet), who underwent first metatarsal osteotomy. Gait analyses were performed preoperatively and 1- and 2-year postoperatively using a three-dimensional motion capture system. Toe-out angle, ankle, knee, and hip joint angles during gait were calculated from the recorded data. The spatiotemporal parameters and these angles at the mid and terminal stances of gait were statistically compared between preoperative and postoperative periods. All spatiotemporal parameters remained unchanged postoperatively. The toe-out angle was significantly greater at 1- and 2-year postoperatively. The ankle pronation angle, the knee abduction angle, and the hip adduction angle at the mid and terminal stances of gait were smaller postoperatively compared to the preoperative. These angular changes showed a similar trend at 1 and 2 years postoperatively. However, the postoperative changes of the sagittal joint angles were relatively small. Hallux valgus surgery can affect the toe-out angle and the lower limb coronal kinematics at the mid and terminal stances of gait in patients with hallux valgus. However, surgical correction of hallux valgus deformity did not directly improve the gait characteristics in patients with hallux valgus. • Kinematic effects of ankle, knee, and hip joints during gait in bunion surgery. • Preoperative and 1- and 2-year postoperative gait analyses by a motion capture system. • Bunion surgery changes toe-out angle and lower limb coronal kinematics during gait. [ABSTRACT FROM AUTHOR]

The aim of the study was to compare the shape of the feet, the mobility of the metatarsophalangeal and interphalangeal joints and the flexibility of the calf muscles in older women with hallux valgus versus middle-aged women with and without this deformation to identify the presence of features which correlate particularly strongly with hallux valgus, and on which prophylaxis and conservative treatment should focus. The study involved 201 women: 92 aged 60–84 years with hallux valgus of both toes, 78 aged 38–59 with hallux valgus of both toes, and 31 aged 38–57 years with correctly shaped feet. The intensity of pain in the foot, the valgus angle of the big toe and fifth toe, the longitudinal and transverse arches of the foot, the symmetry of foot load with body weight, toe joint mobility and muscle flexibility were analysed. Both groups of women with hallux valgus differed from women with normal feet in the height of the transverse arch, the extent of dorsal extension in the first metatarsophalangeal joint and plantar flexion in the first interphalangeal joint. Older women were additionally characterised by reduced plantar flexion in the metatarsophalangeal joint of the big toe, limited flexibility of the soleus and gastrocnemius muscles as well as less pain in the toe area than in the foot itself. The most characteristic changes which were observed in older women with hallux valgus are a limited range of motion in the MTP and IP joints of the big toe, a reduced transverse arch and increased restriction of calf muscle flexibility. [ABSTRACT FROM AUTHOR]

After undergoing a total knee arthroplasty (TKA) procedure, patients are at a high risk of falling because they present with ineffective mobility within a complex environment, especially during obstacle crossing. Toe clearance (TC) is an important factor to quantify the risks of trip-related falls. The study aimed to investigate TC height and toe trajectory and joint kinematic changes occurring in the lower limb following TKA during obstacle crossing at the initial swing phase. Twenty TKA patients, including those in preoperative and postoperative stages (three and six months), performed obstacle-crossing tasks to compare their performance with 20 healthy controls. Participants walked at self-pace along an 8 m walkway with 2.5, 5, and 10 cm obstacles positioned along the center of the path. For each participant, body segment motions were traced using reflective markers and the kinematics of lower extremity, toe clearance, and gait parameters were analyzed using a 3D-motion analysis system. TKA patients had lower TC height and toe trajectory at six months, slower toe elevation than controls when swing toe crossed 5 and 10 cm obstacles (p < 0.05), and decreased hip and knee flexion (p < 0.05). These altered gait patterns with decreased TC height and toe trajectory were identified as tripping factors as the toe trajectory was close to the ground surface. TKA patients had acquired different lower limb kinematics to maintain adequate TC. At long-term follow-up, there was an increasing trend for patients to trip after surgery. Therefore, more focus is needed on the exercise prescription for rehabilitation programs to improve muscle strength and stepping control. [ABSTRACT FROM AUTHOR]

Interphalangeal joints (IPJ) play a key role in hand function for performing activities of daily living and are frequently involved in complicated injuries resulting in significant functional limitations such as secondary arthritis and stiffness being the most challenging. In adult patients with more than 5 mm bone loss of the proximal articular surface who request a functional interphalangeal joint with minimal pain a vascularized joint transfer is a treatment choice. A unicondylar loss more than 5 mm wide in a 22-year-old carpenter is reported and illustrates our experience with a vascularized unicondylar transfer showing the advantages compared to the "classic" total joint transfer or distal interphalangeal (DIP) joint arthrodesis. By using this technique at the 12-month follow-up, we achieved no donor site complications, a good graft alignment, a good joint congruity, complete bone healing and a normal vascular patency with no signs of bone malunion or resorption of the graft. [ABSTRACT FROM AUTHOR]

Background: A new bio-integrative fiber-reinforced implant (OSSIOfiber® Hammertoe Fixation Implant, OSSIO Ltd., Caesarea, Israel) was developed for proximal interphalangeal joint (PIPJ) correction-arthrodesis. The main purpose of this clinical study was to assess implant bio-integration at 1-year follow-up.Methods: Twenty-four patients, previously treated for a Hammertoe deformity using the bio-integrative, fiber-reinforced implant, were enrolled in this follow-up study. One-year follow-up included clinical examination, patient reported outcomes, radiographs, Magnetic Resonance Imaging (MRI) and bio-integration scoring.Results: Proximal interphalangeal joint (PIPJ) radiographic fusion rate was 92% (n = 22). MRI was analyzed for 24 (100%) patients. In 100% of patients (n = 24), the border between implant and surrounding tissue was scored as partially visible. There were no cyst formation or fluid accumulation findings. Mild bone edema was detected in 29% (n = 7) and is attributed to the chronic distribution of forces due to chronic abnormal gait and pasture. None of the edema findings were considered as adverse implant-related finding. The mean bio-integration score was 7.71 ± 0.46.Conclusions: This study demonstrates safe bio-integration of the newly developed fiber-reinforced implant at 1-year follow-up without negative side effects. [ABSTRACT FROM AUTHOR]

In an attempt to generate g.A746G substitution in the BMPR-IB gene, we unexpectedly obtained BMPR-IB homozygous knockout piglets (BMPR IB--/-) and heterogeneous knockout piglets with one copy of the A746G mutation (BMPR-IB-/746G) via CRISPR/Cas9 editing. Polymerase chain reaction (PCR) and sequencing revealed complex genomic rearrangements in the target region. All BMPR-IBdisrupted piglets showed an inability to stand and walk normally. Both BMPR-IB-/- and BMPR-IB-/746G piglets exhibited severe skeletal dysplasia characterized by distorted and truncated forearms (ulna, radius) and disordered carpal, metacarpal, and phalangeal bones in the forelimbs. The piglets displayed more severe deformities in the hindlimbs by visual inspection, including fibular hemimelia, enlarged tarsal bone, and disordered toe joint bones. Limb deformities were more profound in BMPR-IB-/- piglets than in the BMPR-IB-/746G piglets. Proteomic analysis identified 139 differentially expressed proteins (DEPs) in the hindlimb fibula of BMPR -IB-/746G piglets compared to the wild-type (WT) controls. Most DEPs are involved in skeletal or embryonic development and/or the TGF-β pathway and tumor progression. Gene Ontology (GO) and protein domain enrichment analysis suggested alterations in these processes. Of the top 50 DEPs, a large proportion, e.g., C1QA, MYO1H, SRSF1, P3H1, GJA1, TCOF1, RBM10, SPP2, MMP13, and PHAX, were significantly associated with skeletal development. Our study provides novel findings on the role of BMPR-IB in mammalian limb development. [ABSTRACT FROM AUTHOR]

Eccrine angiomatous hamartoma is an uncommon, benign clinical entity constituting a nodular proliferation of eccrine glands and vascular structures localized to the dermis that typically present as unilateral, flesh-colored, erythematous, or violaceous papules on the extremities. These hamartomas may be associated with pain, hyperhidrosis, joint deformity, or functional impairment depending on the severity of the disease process. We present a case of bilaterally symmetric, asymptomatic eccrine angiomatous hamartomas involving all proximal interphalangeal joints of both hands. To date, there are only four prior cases of bilaterally symmetric eccrine angiomatous hamartomas reported in the literature, suggesting that the distribution experienced by our patient may represent a previously undescribed syndrome. [ABSTRACT FROM AUTHOR]

Understanding the relationship between the position of the foot and the lower limb joint angles during normal gait is critical for the identification of the mechanisms involved in pathological gait. In this article, we introduce a novel framework that characterizes this relationship using mutual information in healthy subjects. The nonlinear connection between these variables is quantified using mutual information, and the MINE algorithm is used for precise estimation. Several simulations over Gaussian bivariate random variables reveal that overfitting is a critical factor affecting mutual information estimations by MINE, and we propose a simple methodology to address this issue when using gait signals. Our findings indicate that the statistical dependency between joint angles and toe height is symmetrical between the limbs for healthy subjects. Additionally, our results show that the ipsilateral knee angle holds the most significant amount of information regarding the toe height. In simpler terms, this knee angle serves as the most reliable predictor for toe height, and vice versa. To further enhance our understanding, we have developed a mutual information reference profile that enables the comparison of how the relationship between these biomechanical variables evolves under pathological conditions. The findings have significant implications for gait analysis and may aid in the identification and understanding of gait abnormalities in various contexts, contributing to the advancement of biomechanical research and clinical applications. • Nonlinear relation between biomechanical variables is assessed by mutual information. • Mutual Information Neural Estimation algorithm is used for precise estimation. • The knee angle has the most significant amount of information about toe height. • A mutual information profile was created for healthy subjects. [ABSTRACT FROM AUTHOR]