scholarly journals Evaluation of a Novel Orthosis for the Non-Operative Management of Hallux Limitus

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0017
Author(s):  
Jonathan Fung ◽  
Sara Stachura ◽  
Alain Sherman ◽  
Robert Eckles ◽  
John Doucette ◽  
...  
Keyword(s):  
Pain Score ◽  
Plantar Pressure ◽  
Ankle Brachial Index ◽  
Operative Management ◽  
Reduced Pressure ◽  
Foot Health ◽  
Hallux Limitus ◽  
Foot Function ◽  
Non Operative Management ◽  
The Impact

Category: Midfoot/Forefoot Introduction/Purpose: Affecting an estimated 1 in 40 adults over the age of 50, hallux limitus is among the leading arthridites of the foot and ankle, with growing incidence reflecting an aging population. Despite its prevalence and disease burden, treatment of the condition remains equivocal. Many patients fail initial conservative measures (e.g., NSAIDs, physical therapy, corticosteroid injections) and may be averse to or ineligible for surgery. For others, there exists controversy surrounding the indications and outcomes of various surgical procedures. As such, there is demand for new means of non-operative management. The present study sought to examine the impact of a novel in-shoe device, the Hallux Limitus Forefoot Orthosis (HLFO), on plantar pressure, foot function, and pain in patients with hallux limitus. Methods: Twenty adult patients with symptomatic hallux limitus were recruited for the study. Diagnosis of hallux limitus was confirmed via physical exam and plain radiography. Patients with diabetes, pre-diabetes, peripheral artery disease (Ankle Brachial Index < 0.70), neuropathy (positive Semmes-Weinstein monofilament test), or lower extremity wounds were excluded. At baseline, participants completed the Foot Function Index (FFI) and reported foot pain on a visual analogue scale (VAS) from 0 to 10. Heat map profiles were also generated using a plantar pressure sensor. The HLFO was then issued to participants, who were instructed to wear it in standard athletic shoes. Participants were contacted by phone after 2 weeks for feedback and to inquire about any adverse events. One participant was lost to follow-up. At 4 weeks, participants returned, and FFI, VAS pain, and plantar pressure measurements were repeated with the HLFO on. Results: Mean FFI decreased significantly from 43.0% (± 18.8%) to 11.0% (± 9.8%) following use of the HLFO, t(18) = 6.78, p <0.001. Eighteen of the 19 (94.7%) participants experienced a decrease in FFI. One participant reported an increase of 5.9%. Mean VAS pain score also decreased significantly from 4.87 (± 2.16) to 1.18 (± 1.84) following use of the device, t(18) = 6.57, p < 0.001. Eighteen of the 19 (94.7%) participants experienced a decrease in pain, with 12 (63.2%) reporting a final pain score of 0, indicating “no pain.” One participant experienced an increase in pain score from 5.0 to 5.5. Plantar pressure profiles with the HLFO on revealed redistribution of weight from the hallux MTP joint to the lesser digits. Conclusion: The HLFO was well tolerated by participants and effectively reduced pressure on the hallux MTP joint. It resulted in significant improvements in foot function and pain for nearly all participants, with the majority reporting complete resolution of their pain. Based on these findings, the HLFO offers an enticing option for patients seeking non-operative treatment for hallux limitus. Future studies could look at the long-term impact of the device on patients’ foot health, quality of life, and decision to pursue surgery.

scholarly journals Long Term Implications in Surgical Re-assisting (L.I.S.A. study) During Covid-19 Outbreak: A Retrospective Observational Study on a Rural Population.

2021 ◽  
Author(s):  
Nicolò Fabbri ◽  
Antonio Pesce ◽  
Lisa Uccellatori ◽  
Salvatore Greco ◽  
Francesco D'Urbano ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Operative Management ◽  
Surgical Interventions ◽  
Male Sex ◽  
Non Operative Management ◽  
The Impact ◽  
Colorectal Resections ◽  
Surgical Operations ◽  
Over Time

Abstract BackgroundThe spread of the COVID-19 is having a worldwide impact on surgicaltreatment. Our aim was to investigate the impact of the pandemic in a rural hospital in a lowdensely populated area.MethodsWe investigated the volume and type of surgical operations during the pandemic(March 2020 - February 2021) versus pre-pandemic period (March 2019 - February 2020) aswell as during the first and second pandemic waves compared to the pre-pandemic period.We compared the volume and timing of emergency appendectomy and cholecystectomyduring the pandemic versus pre-pandemic period, the volume, timing and stages of electivegastric and colorectal resections for cancer during the pandemic versus the pre-pandemicperiod.ResultsIn the prepandemic versus pandemic period, 42 versus 24 appendectomies and 174versus 126 cholecystectomies (urgent and elective) were performed. Patients operated onbefore as opposed to during the pandemic were older (58 vs. 52 years old, p=0.006),including for cholecystectomy (73 vs. 66 years old, p=0.01) and appendectomy (43 vs. 30years old, p = 0.04).The logistic regression analysis with regard to cholecystectomy and appendectomy performedin emergency showed that male sex and age were both associated to gangrenous typehistology, both in pandemic and prepandemic period. Finally, we found a reduction in cancerstage I and IIA in pandemic versus prepandemic period, with no increase in the moreadvanced stages.Conclusionsthe reduction in services imposed by governments during the first months oftotal lock down did not justify the whole decrease in surgical interventions in the year of thepandemic. Data suggest that greater "non-operative management" for cases of appendicitisand acute cholecystitis does not lead to an increase in cases operated over time, nor to anincrease in the "gangrenous" pattern, which seems to depend on age advanced and malepopulation.

scholarly journals Elhízott populációra jellemző talpnyomásminták vizsgálata

2016 ◽  
Vol 157 (48) ◽  
pp. 1919-1925 ◽  
Author(s):  
Eleonóra Leidecker ◽  
Péter Kellermann ◽  
Mónika Galambosné Tiszberger ◽  
Bálint Molics ◽  
Aliz Bohner-Beke ◽  
...  
Keyword(s):  
Body Weight ◽  
Contact Area ◽  
Plantar Pressure ◽  
Peak Pressure ◽  
Maximum Pressure ◽  
Foot Health ◽  
Working Age ◽  
Obese Subjects ◽  
The Impact ◽  
Plantar Area

Introduction: Although the role of body weight on foot health and load has been widely documented in research, the effect of the extra load due to body weight on plantar pressure characteristics is not well known. Aim: The aim of this study was to evaluate the impact of obesity on plantar pressure patterns among the working-age population. Method: 180 participants were involved. Two groups were evaluated according to body mass index categories regarding eight regions of the plantar area, focusing on the following parameters: contact area, maximum pressure and peak pressure. Results: Compared with non-obese subjects, the peak pressure was the highest on the midfoot (p<0.001) and the forefoot (p<0.001). Regarding the maximum force, significant statistical difference was detected on the toes (p<0.001), with a value lower among the obese group. The contact area on the total foot and the midfoot was lower among the non-obese subjects (p<0.001). Conclusions: Loading is greatly increasing on the whole plantar area, especially at the midfoot and the forefoot region. Orv. Hetil., 2016, 157(48), 1919–1925.

scholarly journals Foot Pathology in Patients with Paget’s Disease of Bone

2006 ◽  
Vol 96 (3) ◽  
pp. 226-231 ◽  
Author(s):  
Anita E. Williams ◽  
Terence W. O’Neill ◽  
Sylvia Mercer ◽  
Brigitte Toro ◽  
Christopher J. Nester
Keyword(s):  
Short Form ◽  
Paget’S Disease ◽  
Paget's Disease ◽  
Paget’S Disease Of Bone ◽  
Paget's Disease Of Bone ◽  
Foot Care ◽  
Foot Health ◽  
Abnormal Gait ◽  
Foot Function ◽  
The Impact

The characteristic bone deformities associated with advanced Paget’s disease of bone may result in abnormal gait and plantar foot pressures, which contribute to the development of pressure-related skin problems. This study aimed to characterize the foot problems and foot-care needs in this patient group and to investigate the effect of disease distribution on the occurrence of foot pathology. One hundred thirty-four patients with Paget’s disease were assessed clinically, and the Foot Structure Index was completed for each patient. Patients completed self-administered questionnaires concerning foot function (Foot Function Index) and quality of life (12-Item Short Form). The results of this study suggest that foot-health and footwear problems are common in patients with Paget’s disease. Forty percent of the patients required professional foot care in addition to those already receiving it. The site of pagetic involvement did not affect the occurrence of foot pathology. Further research is required on the impact of the extent of any femoral or tibial deformity on foot symptoms and pathology. Biomechanical studies of the forces and motion in the foot related to different degrees of femoral and tibial deformity might also help determine the impact of deformity on foot pathology. (J Am Podiatr Med Assoc 96(3): 226–231, 2006)

scholarly journals The management and outcome of paediatric splenic injuries in the Netherlands

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Maike Grootenhaar ◽  
Dominique Lamers ◽  
Karin Kamphuis-van Ulzen ◽  
Ivo de Blaauw ◽  
Edward C. Tan
Keyword(s):  
The Netherlands ◽  
Hospital Stay ◽  
Operative Management ◽  
Trauma Centre ◽  
Management Approach ◽  
Haemodynamic Instability ◽  
Low Grade ◽  
High Grade ◽  
Level 1 ◽  
Non Operative Management

Abstract Background Non-operative management (NOM) is generally accepted as a treatment method of traumatic paediatric splenic rupture. However, considerable variations in management exist. This study analyses local trends in aetiology and management of paediatric splenic injuries and evaluates the implementation of the guidelines proposed by the American Paediatric Surgical Association (APSA) in a level 1 trauma centre. Methods The charts of paediatric patients with blunt splenic injury (BSI) who were admitted or transferred to a level 1 trauma centre between 2003 and 2020 were retrospectively assessed. Information pertaining to demographics, mechanism of injury, injury description, associated injuries, intervention and outcomes were analysed and compared to international literature. Results There were 130 patients with BSI identified (63.1% male), with a mean age of 11.3 ± 4.0 and a mean Injury Severity Score (ISS) of 21.6 ± 13.7. Bicycle accidents were the most common trauma mechanism (23.1%). Sixty-four percent were multi-trauma patients, 25% received blood transfusions, and 31% were haemodynamically unstable. Mean injury grade was 3.0, with 30% of patients having a high-grade injury. In total, 75% of patients underwent NOM with a 100% efficacy rate. Total splenectomy rate was 6.2%. Four patients died due to brain damage. Patients with a high-grade BSI (grades IV–V) had a significantly higher ISS and longer bedrest and more often presented with an active blush on computed tomography (CT) scans than patients with a low-grade BSI (grades I–III). Non-operative management was mainly the choice of treatment in both groups (76.6% and 79.5%, respectively). Haemodynamic instability was a predictor for operative management (OM) (p = 0.001). Predictors for a longer length of stay (LOS) included concomitant injuries, haemodynamic instability and OM (all p < 0.02). Interobserver agreement in the grading of BSI is moderate, with a Cohens Kappa coefficient of 0.493. Conclusion Non-operative management has proven to be a realistic management approach in both low- and high-grade splenic injuries. Consideration for operative management should be based on haemodynamic instability. Compared to the anticipated length of bedrest and hospital stay outlined in the APSA guidelines, the Netherlands can reduce the length of bedrest and hospital stay through their non-operative management. Level of evidence Therapeutic study, level III

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