Not So Uncommon Cause of Foot Pain: Cutaneous Hair Splinter of the Sole

<b><i>Introduction:</i></b> A fragment of hair penetrating the skin has been referred to as cutaneous pili migrans in the literature. The condition is regarded rare and the cause unknown. <b><i>Case Presentation:</i></b> A 55-year-old female experienced painful sensations of the sole. Dermoscopy revealed hair fragments penetrating the skin, and histopathology a hair shaft embedded in the stratum corneum. The hairs were mechanically extracted with immediate relief from the pain. <b><i>Discussion and Conclusion:</i></b> Hair splinters of the sole may be a cause of foot pain related to the skin. The hair splinter is yet another form of hair that has embedded itself in the skin. Patients may believe the hair is growing out of the feet, while the soles are among the specialized skin regions that are hairless. The origin of the hair is exogenous and related to an exposure to freshly cut human or animal hair. Cutaneous embedded hairs can be classified based on the clinical presentation, the location, and association with hair follicles into hair splinters, interdigital pilonidal sinus, migrating hair, or ingrown hair. The condition is an important cause of foot pain and should be considered on clinical examination of the skin of the soles.

Spatiotemporal Parameters And Gait Variability In People With Psoriatic Arthritis (Psa) : A Cross-Sectional Study.

Background: Foot involvement is a major manifestation of psoriatic arthritis (PsA) and could lead to severe levels of foot pain and disability and impaired functional mobility and quality of life. Gait spatiotemporal parameters (STPs) and gait variability, used as a clinical index of gait stability, have been associated with several adverse health outcomes including risk of falling, functional decline, and mortality in a wide range of populations. Previous studies showed some alterations in STPs in people with PsA. However, gait variability and the relationships between STPs, gait variability and self-reported foot pain and disability have never been studied in this populations. Body-worn inertial measurement units (IMUs) are gaining interest in measuring gait parameters in clinical settings.Objectives: To assess STPs and gait variability in people with PsA using IMUs and, to explore their relationship with self-reported foot pain and function and to investigate the feasibility of using IMUs to discriminate patient groups based on gait speed-critical values.Methods: 21 participants with PsA (Age: 53.9 ± 8.9 yrs; median disease duration: 6 yrs) and 21 age and gender-matched healthy participants (Age 54.23 ± 9.3 yrs) were recruited. All the participants performed three 10-meter walk test trials at their comfortable speed. STPs and gait variability were recorded and calculated using six body-worn IMUs and the Mobility Lab software (APDM®). Foot pain and disability were assessed in participants with PsA using the foot function index (FFI).Results: Cadence, gait speed, stride length, and swing phase, were significantly lower, while double support was significantly higher, in the PsA group (p< 0.006). Strong correlations between STPs and the FFI total score were demonstrated (|r|> 0.57, p< 0.006). Gait variability was significantly increased in the PsA group, but it was not correlated with foot pain and function (p< 0.006). Using the IMUs three subgroups of participants with PsA with clinically meaningful differences in self-reported foot pain and disability were discriminated.Conclusion: STPs were significantly altered in participants with PsA which could be associated with self-reported foot pain and disability. Future studies are required to confirm the increased gait variability highlighted in this study and its potential underlying causes. Using IMUs in clinical settings has been useful to objectively assess foot function in people with PsA. Study registration: ClinicalTrials.gov, NCT05075343, Retrospectively registered on 29 September 2021.

The Effects of Custom-made Foot Orthoses on Foot Pain, Foot Function, Gait Function and Freeliving Walking Activities in Psoriatic Arthritis (PsA) Patients: a Pre-experimental Trial

Introduction: Foot involvement is a major concern in psoriatic arthritis (PsA) as it can lead to severe levels of foot pain and disability as well as reduced mobility and quality of life. Previous studies have shown moderate efficacy in reducing foot pain and disability in rheumatoid arthritis patients with the use of custom-made foot orthoses (CFO). However, evidence on the efficacy of CFO in PsA patients is lacking.Objectives: Explore the effects of CFO on foot function, foot and lower limb pain, gait function, and freeliving walking activities (FWA) in PsA patients.Methods: A Pre-experimental study including 20 PsA patients (mean age: 54.10 ± 9.06 y and disease duration: 11.53 ± 10.22 y), was conducted. All the participants received and wore CFO for a 7-week period. Foot and lower limb pain and foot function were measured before and after the intervention using the numerical rating scale (NRS) and the foot function index (FFI). Gait function was assessed from gait spatiotemporal parameters (STPs) extracted during a 10-meter walk test with an gait analysis system (Mobility Lab). Freeliving walking activities (step count, freeliving cadence, time spent in different ambulatory physical activities (APA)) were recorded over 7 days using accelerometer data collected from an instrumented sock worn during waking hours.Results: PsA patients reported severe baseline levels of foot pain (54.46 ± 14.58 %) and disability (46.65 ± 16.14%) on the FFI. Statistically and clinically significant improvements with large effect sizes (Cohen’s effect size > 1, p<0.005) in foot pain and foot function were observed after 7 weeks of CFO use. A significant correlation (r=-0.64, p<0.01) between CFO wear time after the adaption period and foot function on the FFI at 7 weeks was observed. However, no significant changes were demonstrated for gait STP nor for free-living walking activities after 7 weeks of CFO use.Conclusion: Results support the clinical and biomechanical plausibility of using CFO with PsA patients to reduce pain and improve foot function. Larger and controlled studies are needed to confirm these findings and a multidisciplinary approach including the prescription of exercise therapy and physiotherapy in combination with CFO could be relevant to improve STP and promote APA in PsA patients.Study registration: ClinicalTrials.gov, NCT05075343, Retrospectively registered on 29 September 2021.

Is adiposity associated with back and lower limb pain? A systematic review

Background Back and lower limb pain have a major impact on physical function and quality of life. While obesity is a modifiable risk factor for musculoskeletal pain, the role of adiposity is less clear. This systematic review aimed to examine the relationship between both adiposity and its distribution and back and lower limb pain. Methods A systematic search of electronic databases was conducted to identify studies that examined the association between anthropometric and/or direct measures of adiposity and site specific musculoskeletal pain. Risk of bias was assessed and a best evidence synthesis was performed. Results A total of 56 studies were identified which examined 4 pain regions, including the lower back (36 studies), hip (two studies), knee (13 studies) and foot (eight studies). 31(55%) studies were assessed as having low to moderate risk of bias. 17(30%) studies were cohort in design. The best evidence synthesis provided evidence of a relationship between central adiposity and low back and knee pain, but not hip or foot pain. There was also evidence of a longitudinal relationship between adiposity and the presence of back, knee and foot pain, as well as incident and increasing foot pain. Conclusions This systematic review provides evidence of an association between both body fat and its central distribution and low back and knee pain, and a longitudinal relationship between adiposity and back, knee and foot pain. These results highlight the potential for targeting adiposity in the development of novel treatments at these sites.

Saphenous Nerve Denervation for Chronic Pain After Compartment Syndrome of the Foot

Denervation has been a recommended treatment option for a range of pathologies, including relief from chronic pain; however, literature discussing complete denervation of the distal saphenous nerve for foot pain has not been found. A case report of surgical decompression for compartment syndrome resulting in chronic, debilitating foot pain that was successfully alleviated by complete saphenous nerve denervation is presented. The predominant area of the patient's pain was on the medial aspect of the foot, where a thickened scar from a decompression fasciotomy was noted. The patient's initial pain score was reported as 10 of 10, with no relief from numerous conservative treatments attempted over an 11-year period. After a diagnostic injection of a local anesthetic to the distal saphenous nerve provided the patient with immediate, temporary relief, complete denervation of the distal saphenous nerve was performed. The patient reported significant pain reduction shortly after the procedure. This case suggests that physicians should be cognizant of the saphenous nerve and its branches, as well as its variable pathways during surgery. In addition, practitioners should be aware of its influence as a progenitor of pain in the foot that may require denervation.