scholarly journals Treading on tricky ground: reconstructive approaches to Charcot neuropathic arthropathy of the foot

2018 ◽  
Vol 1 (2) ◽  
pp. 112-120
Author(s):  
Daniela–Elena Ion
Keyword(s):  
Soft Tissues ◽  
Life Quality ◽  
Foot Deformities ◽  
Charcot Foot ◽  
Neuropathic Arthropathy ◽  
Multicenter Studies ◽  
Tendon Lengthening ◽  
Key Features ◽  
Metatarsophalangeal Joints ◽  
Reconstructive Techniques

Abstract Introduction and purpose:Charcot neuroarthropathy defines a cluster of progressive lesions affecting the joints and bones, as well as the soft tissues of the foot in the context of diabetes, a pivotal role being attributed to peripheral neuropathy. Loss of sensation and proprioception, subsequent repeated trauma, muscle and autonomic nervous system impairment contribute to the alteration of the foot’s architecture and distribution of pressure, ultimately triggering ulceration and gangrene. The urge to avoid amputation has fueled the development of conservative and reconstructive techniques capable of delaying, if not preventing such negative outcomes. The purpose of this review was to present the most frequently used reconstruction procedures and the challenges arising in adapting them to particular foot morphologies and lesion stages. Methods:Literature search was conducted using PubMed, resulting in around 90 articles, multicenter studies and reviews, 26 of which were considered most relevant in providing the guidelines for orthopedic reconstruction and postoperative care in Charcot foot patients with diabetic neuropathy prevailing over arteriopathy. Results:The tarsometatarsal and metatarsophalangeal joints are most frequently affected. Closed reduction, arthrodesis, and tendon lengthening are key features of an efficient correction, alternatively accompanied by resections and tenotomies. Ulceration and callus debridement may also be necessary, while prolonged casting and immobilization remain obligatory. Conclusions:Most authors agree that stabilizing the deformities, optimizing the pressure on the soft tissues, and promoting the healing of potential lesions are the main purposes of the interventions. Prompt recognition and correction of Charcot foot deformities improve life quality and minimize the prospects of amputation.

scholarly journals A CLINICAL CASE OF REMOVING A RESIDUAL FOREIGN BODY FROM THE LEFT SUPRACLAVICULAR REGION

2017 ◽  
Vol 4 (3) ◽  
pp. 120-122
Author(s):  
V.V. Boyko ◽  
V.V. Makarov ◽  
A.L. Sochnieva ◽  
V.V. Kritsak
Keyword(s):  
Surgical Treatment ◽  
Foreign Body ◽  
Soft Tissue ◽  
Clinical Case ◽  
Foreign Bodies ◽  
Soft Tissues ◽  
Life Quality ◽  
The Other ◽  
Practical Case ◽  
The One

Boyko V.V., Makarov V.V., Sochnieva A.L., Kritsak V.V.Residual foreign bodies in soft tissues are one of the main causes of chronical infection lesions and decrease in life quality. Surgical treatment is the most common way to relieve the patient from a foreign body. Often there is a question whether to remove a foreign body? On the one hand, all foreign bodies that are in the human body must be removed. On the other hand, in the absence of symptoms, the risk of surgery performed for the purpose of removal exceeds the risk associated with finding the foreign body. We would like to describe a practical case of removing a foreign body (Kirschner`s wires) from the left supraclavicular region. The young patient lived with a fragment of Kirschner's wire left after the osteosynthesis of the fractured clavicle for 5 years. Surgery to remove the residual foreign body was successful. On the 7th postoperative day the patient was discharged from the hospital under the supervision of surgeons at the place of residence.Key words: foreign body in soft tissue, Kirschner`s wire, surgical treatment. КЛІНІЧНИЙ ВИПАДОК ВИДАЛЕННЯ ЗАЛИШКОВ СТОРОННЬОГО ТІЛА З ЛІВОЇ НАДКЛЮЧИЧНОЇ ОБЛАСТІБойко В.В., Макаров В.В., Сочнева А.Л.,  Крицак В.В.Залишкові чужорідні тіла м'яких тканин залишаються однією з основних причин виникнення вогнища хронічної інфекції та зниження рівня якості життя. Хірургічне лікування основний спосіб позбавити хворого від наявності чужорідного агента. Часто виникає питання чи видаляти чужорідне тіло. З одного боку, усі сторонні тіла, що знаходяться в тілі людини, підлягають видаленню, з іншого боку при відсутності симптомів ризик операції, проводимої з метою видалення, перевищує ризик, пов'язаний з перебуванням чужорідного тіла. Ми хотіли б поділитися випадком видалення залишкового стороннього тіла (спиці Кіршнера) лівої надключичної ділянки із власної практики. Молода пацієнтка прожила з уламком спиці Кіршнера, залишеної після металлоостеосинтезу поламаної ключиці протягом 5 років. Операція з видалення залишкового стороннього тіла пройшла успішно. На 7 післяопераційну добу пацієнтка була виписана зі стаціонару під спостереження хірурги за місцем проживання.Ключові слова: чужорідне тіло м'яких тканин, спиця Кіршнера, хірургічне лікування. кЛИНИЧЕСКИЙ СЛУЧАЙ УДАЛЕНИЯ ОСТАТКОВ ИНОРОДНОГО ТЕЛА ИЗ ЛЕВОЙ ПОДКЛЮЧИЧНОЙ ОБЛАСТИ Бойко В.В., Макаров В.В., Сочнева А.Л.,  Крицак В.В.Остаточные инородные тела мягких тканей остаются одной из основных причин возникновения очага хронической инфекции и снижения уровня качества жизни. Хирургическое лечение основной способ избавить больного от наличия чужеродного агента. Часто возникает вопрос удалять ли инородное тело? С одной стороны, все инородные тела, находящиеся в теле человека, подлежат удалению, с другой стороны при отсутствии симптомов риск операции, производимой с целью удаления, превышает риск, связанный с нахождением инородного тела. Мы хотели бы поделится случаем удаления остаточного инородного тела (спицы Киршнера) левой надключичной области из собственной практики. Молодая пациентка прожила с обломком спицы Киршнера, оставленной после металлоостеосинтеза поломанной ключицы в течении 5 лет. Операция по удалению остаточного инородного тела прошла успешно. На 7 послеоперационные сутки пациентка была выписана из стационара под наблюдение хирурги по месту жительства.Ключевые слова: инородное тело мягких тканей, спица Киршнера, оперативное лечение.

scholarly journals Diagnostic possibilities of thermal vision study of trophic ulcers

2020 ◽  
Vol 19 (2) ◽  
pp. 38-42
Author(s):  
G. V. Yarovenko
Keyword(s):  
Conservative Treatment ◽  
Chronic Venous Insufficiency ◽  
Infrared Radiation ◽  
Venous Insufficiency ◽  
Soft Tissues ◽  
Scattered Light ◽  
Life Quality ◽  
Lower Extremities ◽  
Imaging Method ◽  
Thermal Imager

Chronic venous insufficiency is often accompanied by trophic changes in soft tissues. The treatment of such patients is long and often, ineffective. Relapse of a trophic ulcer is about 30% and leads to deterioration of life quality and dissatisfaction with conservative and even surgical treatment. Goal. Objectification of changes in the microvasculature and compensatory the possibilities of collateral circulation in the lower extremities with complicated forms of chronic venous insufficiency. Materials and methods. The studies were carried out on the Linsor installation characterizing the biological tissue by the change of scattered light intensity and on the thermal imager making possible to determine the temperature of a point with an accuracy of 0,001 degrees, followed by software image processing. The examination was performed 3-4 times in the dynamics of the treatment process and before the patient discharge, from a standard distance of 1,5 meters. The soft tissues in 23 patients with chronic venous insufficiency of the lower extremities and the presence of open trophic ulcers was studied. There were 21 women, 2 men, the average age was 45,2±3,6 years. The area of the ulcer defect varied from 5,7 cm² to 15,3 cm². Patients with extensive trophic ulcers (circular) were excluded from the examination, because of absence of ulcer defect epithelization during the period of hospitalization and its visualization by the thermographic method. Results. As a result of the study, we obtained a reduced intensity of infrared radiation of the ulcer surface in all patients. To clearly isolate ulcerative defect from the surrounding tissues, we set the temperature range 35,0–37,5 °C and recalculated the resulting area in cm² (conversion factor 22,73). We studied the microcirculatory changes occurring in the trophic ulcer and surrounding tissues, confirming the need to continue conservative treatment after complete ulcer defect epithelization for at least 7 days, and only after that period the normalized level of infrared radiation was detected and subsequently relapsed trophic ulcers did not occur for a long time. Conclusion. Based on the obtained data, we confirmed the thermal imaging method sensitivity is suitable for assess of microcirculation in the trophic ulcer area; the method provides the possibility to apply it for the dynamics of conservative treatment in patients with complicated forms of chronic venous insufficiency.

Common Foot and Ankle Disorders in Adults and Children

2015 ◽  
Vol 19 (2) ◽  
pp. 54-65 ◽  
Author(s):  
Ganesan Balasankar ◽  
Luximon Ameersing
Keyword(s):  
Soft Tissues ◽  
Adult Population ◽  
Complex Structure ◽  
Whole Body ◽  
Clinical Aspects ◽  
Foot Deformities ◽  
Foot And Ankle ◽  
Human Foot ◽  
Flat Feet ◽  
Adults And Children

The human foot is a complex structure, which includes bones, joints, muscles, ligaments, soft tissues, nerves and veins. It supports the weight of the whole body and helps one to walk, run, and jump. Ankle and foot biomechanical functions that are interrupted by various pathological deformities lead to pain or other deformities, and result in difficulties during mobility. Foot problems are very common in children and adults. In this article, attempts are made to explore the clinical aspects of the most common foot and ankle deformities and their management by children and adults. Foot deformities may be congenital or acquired, and may involve arthritis conditions, such as rheumatoid arthritis and osteoarthritis. In children, congenital clubfoot, cavus, and flat feet are the most common disorders and can be treated by non-operative means or surgical management. Hallux valgus and rigidus, lesser toe deformities, and arthritis are mostly present with or without pain in the adult population.

scholarly journals One-step Management of Severely Deformed, Long-Neglected Club Feet

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0046
Author(s):  
Michael Strauss ◽  
Isabella van Dalen
Keyword(s):  
Minimally Invasive ◽  
External Fixation ◽  
Soft Tissues ◽  
Operative Management ◽  
Wedge Osteotomy ◽  
Foot Deformities ◽  
Early Management ◽  
Tendon Transfers ◽  
One Stage ◽  
Deforming Forces

Category: Other Introduction/Purpose: Early management of the club foot using the Ponsetti technique has almost eliminated severe residual deformities from this problem. Unfortunately, in remote regions of the world patients may not have been afforded the benefits of this technique. The consequences are severely deformed, long-neglected foot deformities. Interventions to mitigate this problem have included talectomies, osteotomies, tendon transfers, gradual corrections using Ilizarov principles and as a last resort, transtibial amputations. All have undesirable features such as inadequate corrections with residual deformities, need for additional surgeries, intensive post-operative management and/or need for custom orthotics or prostheses. We propose a one-stage, single setting approach to this problem that fully realigns the foot and requires minimum of post-operative management. Methods: During a 2017 humanitarian mission to Vietnam, six patients with severely deformed, long-neglected club feet were managed at a remote orthopaedic rehabilitation facility using our one-stage, single surgery approach. The six-step procedure included: 1) Percutaneous tri-hemisections (Hoke) of the Achilles tendon, 2) Excision of lateral ulcers/bursas, 3) Minimally invasive releases of all constricting soft tissues structures, 4) Closing wedge osteotomy at apex of deformity, 5) Manual reduction to achieve plantigrade foot, and 6) Maintenance of correction with temporary spanning external fixation in five patients and percutaneous Steinmann pins in a four-year old patient. No tendon transfers were done. No tourniquets or perioperative antibiotics were used with these minimally invasive and percutaneous interventions. At six weeks, the external fixation was removed, walking casts were applied with minimal manipulations to optimally position the feet. At 12 weeks the casts were removed, patients allowed to use footwear of their choosing. Results: Follow-ups initially obtained weekly, then monthly through e-mails by a co-author fluent in Vietnamese were supplemented with photographs. Near-plantigrade feet axially aligned with the leg were obtained with all the initial corrections. By 48 hours pain was reported as minimal even though marked tension occurred across intact joint capsules in order to achieve the corrections. One skin, pin tract infection was reported that resolved once the pin was removed. Follow-up information at six months report that the corrections have been maintained with high satisfaction in all patients. Conclusion: Our innovative approach to deformed, neglected club feet is supported by appreciating the biomechanics of the problems. Dynamic deforming forces (tendons and muscles) must be released. Tendon transfers are inadequate to correct contractures. Bony deformities must be osteotomized. Viscoelasticity of ligaments and joint capsules deform with time and need not be released; corrections initially obtained using the fixators become permanent with time. Our experiences support the use of our approach for the patient population with which we dealt and suggest that earlier soft tissue releases of dynamic deforming forces be done in conjunction with the Ponsetti technique.

scholarly journals Evolution and function of the hominin forefoot

2018 ◽  
Vol 115 (35) ◽  
pp. 8746-8751 ◽  
Author(s):  
Peter J. Fernández ◽  
Carrie S. Mongle ◽  
Louise Leakey ◽  
Daniel J. Proctor ◽  
Caley M. Orr ◽  
...  
Keyword(s):  
Soft Tissues ◽  
Common Ancestor ◽  
Bipedal Locomotion ◽  
Last Common Ancestor ◽  
Primary Role ◽  
Anthropoid Primates ◽  
And Function ◽  
Metatarsophalangeal Joints ◽  
Selection Of

The primate foot functions as a grasping organ. As such, its bones, soft tissues, and joints evolved to maximize power and stability in a variety of grasping configurations. Humans are the obvious exception to this primate pattern, with feet that evolved to support the unique biomechanical demands of bipedal locomotion. Of key functional importance to bipedalism is the morphology of the joints at the forefoot, known as the metatarsophalangeal joints (MTPJs), but a comprehensive analysis of hominin MTPJ morphology is currently lacking. Here we present the results of a multivariate shape and Bayesian phylogenetic comparative analyses of metatarsals (MTs) from a broad selection of anthropoid primates (including fossil apes and stem catarrhines) and most of the early hominin pedal fossil record, including the oldest hominin for which good pedal remains exist, Ardipithecus ramidus. Results corroborate the importance of specific bony morphologies such as dorsal MT head expansion and “doming” to the evolution of terrestrial bipedalism in hominins. Further, our evolutionary models reveal that the MT1 of Ar. ramidus shifts away from the reconstructed optimum of our last common ancestor with apes, but not necessarily in the direction of modern humans. However, the lateral rays of Ar. ramidus are transformed in a more human-like direction, suggesting that they were the digits first recruited by hominins into the primary role of terrestrial propulsion. This pattern of evolutionary change is seen consistently throughout the evolution of the foot, highlighting the mosaic nature of pedal evolution and the emergence of a derived, modern hallux relatively late in human evolution.

Dynamic Gait Electromyography Study in Duchenne Muscular Dystrophy (DMD) Patients∗

Foot & Ankle ◽  
1980 ◽  
Vol 1 (2) ◽  
pp. 78-83 ◽  
Author(s):  
Gregory J. Melkonian ◽  
Robert L. Cristofaro ◽  
Jacquelin Perry ◽  
John D. Hsu
Keyword(s):  
Muscular Dystrophy ◽  
Phase Changes ◽  
Foot Deformities ◽  
Posterior Tibial Tendon ◽  
Interosseous Ligament ◽  
Posterior Tibial ◽  
Tendon Lengthening ◽  
Muscle Groups ◽  
Duchenne's Muscular Dystrophy ◽  
Dynamic Gait

Preoperative and postoperative dynamic gait electromyography (EMG) was performed on 15 patients 8 to 13 years of age with Duchenne's muscular dystrophy who underwent Achilles tendon lengthening and posterior tibial tendon transfer anteriorly through the interosseous ligament for correction of equinus and equinovarus foot deformities. The muscles tested preoperatively (anterior tibial, soleus, gastrocnemius, posterior tibial, peroneal longus, and peroneal brevis) showed phase changes. It is believed that patients with weakened leg muscles fire multiple muscle groups out of phase in an attempt to overcome the action of the stronger muscles, thus stabilizing the limb for ambulation. Postoperative EMGs, performed with the patients walking in long leg braces after the deformity had been corrected, showed litte activity in the muscles tested. As the patients became dependent on the brace, the need for the muscles to be active out of phase was eliminated. The transferred posterior tibial muscle appeared to be active both clinically and electromyographically.

scholarly journals Changes in loading distribution in patients with Charcot foot during long-term follow-up

2018 ◽  
Vol 21 (2) ◽  
pp. 99-104
Author(s):  
Anastasia G. Demina ◽  
Vadim B. Bregovskiy ◽  
Irina A. Karpova ◽  
Tatiana L. Tcvetkova
Keyword(s):  
Foot Deformities ◽  
Charcot Foot ◽  
Maximal Increase ◽  
Custom Made ◽  
Long Term Follow Up ◽  
Maximal Peak ◽  
Peak Pressures ◽  
Different Parts

Background. The inactive stage of the diabetic Charcot arthropathy foot (CA) is characterised by fixed foot deformities and an absence of inflammation. However, it remains unclear if the shape of the foot and its biomechanics change during long-term follow-up. Aim. To evaluate changes in loading distribution of the affected foot, in patients with inactive CA, during long-term follow-up. Materials and methods. Twenty seven patients with unilateral inactive CA (19 females, 8 males) were studied. Computer pedography (emed AT, novel gmbh) was performed and baseline and the last studies were analysed. Maximal peak pressures (PP) were obtained for the first and the last studies and the percentage of the PP change was calculated for the total follow-up period and for periods: 24 months, 2448 months, 48 months. Results. PP increased: under the hallux 50%; 1st metatarsal30.7%; 2nd toe20%; 2nd toe6%; midfoot9%. PP decreased under 35 toes up to 67%. Significant changes at the first period were found under 35 toes only (62%). The increase in loading under the other parts of the foot appeared at 24 months; however, these changes became significant between 24 and 48 months and peaked after 48 months of follow-up. The maximal increase of PP was noticed under the hallux, the 2nd toe, metatarsals 13 and the midfoot. Conclusions. We revealed the gradual redistribution of PP, under the different parts of the foot, in patients with inactive CA. This redistribution reflects changes in the shape of the affected foot. The loading increased under the hallux, the 2nd toe and the corresponding metatarsals, 3rd metatarsal and midfoot, and decreased under the 35 toes. These changes increased during the follow-up, becoming more pronounced after 4 or more years. Our data may be useful for constructing custom-made footwear for patients with CA.

A New Mesostructural Soft Tissue Testing System With Multiaxial Loading and Local Strain Measurement Capabilities

2004 ◽  
Author(s):  
Todd C. Doehring ◽  
Michael Kahelin ◽  
Ivan Vesely
Keyword(s):  
Feature Tracking ◽  
Soft Tissues ◽  
Local Strain ◽  
Local Deformation ◽  
Fiber Bundles ◽  
Testing System ◽  
Multiaxial Loading ◽  
Computer Controlled ◽  
Key Features ◽  
Measurement Capabilities

A new mesostructural testing system (MSTS) has been developed to measure structural and material properties of soft tissues at an intermediate, or “mesostructural” scale (i.e. ~ .01 to 10 mm). Key features of this new system are biaxial computer controlled loading and synchronized high-resolution microscopic digital imaging. The system uses a marker-less feature tracking algorithm to measure local deformation of mesostructures such as the fiber bundles of the aortic valve. Validation and bioengineering applications are described.

Prevalence of Radiographic Foot Abnormalities in Patients with Diabetes

1997 ◽  
Vol 18 (6) ◽  
pp. 342-346 ◽  
Author(s):  
Douglas G. Smith ◽  
Brett C. Barnes ◽  
Andrew K. Sands ◽  
Edward J. Boyko ◽  
Jessie H. Ahroni
Keyword(s):  
Hallux Valgus ◽  
Arterial Calcification ◽  
Foot Deformities ◽  
Radiographic Evidence ◽  
First Metatarsal ◽  
Joint Dislocations ◽  
Second Metatarsal ◽  
Patients With Diabetes ◽  
Metatarsophalangeal Joints ◽  
Radiographic Changes

Clinicians are increasingly aware that mechanical aspects of foot deformities, such as Charcot changes, clawtoes, bunion deformities, or cavus or planus foot deformities, might have an impact on the occurrence, potential healing, and recurrence of foot ulcers. We report the prevalence of plain radiographic changes and attempt to rate the severity of those deformities in the feet of 456 diabetic veteran medicine clinic enrollees. All 456 radiographs were reviewed by orthopaedic surgeons to specifically identify Charcot changes, presence of arterial calcification, dislocation of the lesser toe metatarsophalangeal joints, hallux interphalangeal joint dislocation, and radiographic evidence of previous surgery. Radiographs of 428 patients were taken while weightbearing, and these were reviewed to quantify hallux valgus angles, intermetatarsal 1–2 angles, fifth metatarsalproximal phalangeal angles, second metatarsal lengths, lateral talocalcaneal and talar-first metatarsal angles, and claw toe deformities. The prevalence of Charcot changes was 1.4% (six subjects), and all had radiographic evidence of midfoot Charcot changes. Other deformities, such as clawtoes, hallux valgus, lesser toe joint dislocations, and alterations in arch height, are more common in veterans with diabetes.

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