Foot Loading Analysis of Intraarticular Tibia Pilon Fracture

BACKGROUND: Although pilon fractures are rare, they are important for orthopedic surgeons because of the difficulty of treatment and adverse effects on gait function. The aim of the study to evaluate the relationship between the reduction quality of the fracture, functional results, ankle arthrosis and plantar pressure distribution in patients with tibia pilon fractures. METHODS: In this study, a total of 62 patients treated for an intraarticular pilon fracture in our clinic between January 2015 and January 2019 were evaluated retrospectively. Postoperative reduction qualities of the patients were evaluated with the Ovadia-Beals criteria, ankle functional scores with the Teeny-Wiss score, and ankle arthrosis with the Takakura classification. In the last follow-up of the patients, foot loading analysis was performed and the results of the patients were evaluated for their relation with postoperative reduction quality, ankle functions and ankle arthrosis. RESULTS: There were 62 patients (50 men and 12 women). The average age was 43.3 years (range 19-78). The mean follow-up was 34.3 months (range 24 - 58). The mean Ovadia-Beals score was 12.35 {plus minus} 4.6 in the postoperative plain radiographs of the patients; the mean Teeny-Wiss score in the last follow-up was 76.82 {plus minus} 17.69, and the Takakura score was 1.47 {plus minus} 1.35. Based on the pedobarographic measurements, 47.58% of the patients put weight on the anterior and 52.42% on the posterior of the foot in the anteroposterior plane. In the mediolateral plane, 42.15% loaded on the medial of the ankle and 57.85% loaded on the lateral of the foot. CONCLUSION: Intra-articular tibia pilon fractures can be demonstrated by lateralization of the walking axis and changes in gait patterns and can be associated with clinical outcome.

The Musculoskeletal Applications of Extracorporeal Shockwave Therapy for Foot and Ankle Disorders: A Systematic Review and Meta-Analysis

BACKGROUND: Extracorporeal Shockwave Therapy (ESWT) was first introduced into clinical practice in 1982 and has proved to be a beneficial adjuvant in the non-invasive treatment of numerous orthopaedic pathologies. However, clinical evidence reporting the use of ESWT in treating musculoskeletal disorders of the foot and ankle remain limited and a general consensus on its efficacy has not been achieved. Therefore, we reviewed the available literature and analysed any reported evidence in order to determine the benefits of ESWT in this cohort. METHODS: PubMed, EMBASE and Cochrane Library databases were systematically reviewed for any clinical studies that reported the treatment of foot and ankle disorders with ESWT. RESULTS: A total of 24 clinical studies, including 12 randomised control trials and 12 case series, were identified and included into this study. Analysis of the reported evidence indicate that ESWT can be beneficial in the symptomatic management of plantar fasciitis, calcaneal spur, Achilles tendinopathy and Morton's neuroma. However, differences in ESWT protocols used limit the generalizability of these findings and prevented an optimum treatment protocol from being determined. CONCLUSIONS: Evidence from the articles analysed in this review suggest a beneficial healing effect of ESWT in treating musculoskeletal disorders affecting the foot and ankle, with minimal side effects being reported. Thus, ESWT can be used safely in combination with other treatment modalities in order to achieve the best patient outcomes. Future studies should attempt to optimize the treatment protocols of ESWT to confirm these findings.

Effect of a topical gel based on Adelmidrol + Trans-traumatic acid in the treatment of diabetic foot ulcers: an open-label study

BACKGROUND:Diabetic foot ulceration is a severe complication of diabetes characterized by chronic inflammation and impaired wound healing. This study aims to evaluate the effect of a medical device gel based on Adelmidrol + Trans traumatic acid in the healing process of diabetic foot ulcers. METHODS: Thirty-seven diabetic patients with foot ulcers of mild/moderate grade were treated with the gel applied daily for 4 weeks on the affected area. The following parameters were evaluated at baseline and weekly: a) wound area, measured drawing a map of the ulcer then calculated with Photoshop6 tools, b) clinical appearance of the ulcer, assessed recording the presence/absence of dry/wet necrosis, infection, fibrin, neoepithelium, exudate, redness, granulation tissue. RESULTS: Topical treatment led to progressive healing of diabetic foot ulcers with a significant reduction of the wound area and an improvement in the clinical appearance of the ulcers. No adverse events treatment-related were observed. CONCLUSIONS: The results of this open-label study show the potential benefits of Adelmidrol + Trans traumatic acid topical administration to promote re-epithelialization of diabetic foot ulcers. Further studies need to confirm the observed results.

Arch Height Index, Arch Rigidity Index and Arch Stiffness Values in a Symptomatic Population

BACKGROUND: Normative studies on the Arch Height Index (AHI), Arch Rigidity Index (ARI), and arch stiffness have primarily focused on healthy populations, with little consideration of pathology. The purpose of this study was to create a normative sample of the aforementioned measurements in a pathological sample and to identify relationships between arch structure measurements and pathology. METHODS: AHI was obtained bilaterally at 10% and 90% weightbearing conditions using the Arch Height Index Measurement System (AHIMS). ARI and arch stiffness were calculated using AHI measurements. Dependent t-tests compared right and left, dominant and non-dominant, and injured and non-injured limbs. Measurements of the dominant foot were compared between sexes using independent t-tests. Relationships between arch stiffness and age, sex, and AHI were examined using the coefficient of determination (R2). One-way ANOVAs were used to determine differences between arch structure measurements and number of pathologies or BMI. RESULTS: A total of 110 participants reported either one (n=55), two (n=38), or three or more (n=17) pathologies. Plantar fasciitis (n=31) and hallux valgus (n=28) were the most commonly reported primary concerns. AHI, ARI, and arch stiffness did not differ between limbs for any comparisons, nor between sexes. Between subgroups of BMI and number of pathologies, no differences exist in AHI or ARI; however, BMI was found to have an impact on AHI (10%WB) and arch stiffness (p<.05). Arch stiffness showed a weak relationship to AHI, where a higher AHI was associated with a stiffer arch (R2=0.06). CONCLUSIONS: Normative AHI, ARI and arch stiffness values were established in a pathological sample with a large incidence of plantar fasciitis and hallux valgus. Findings suggest relationships between arch stiffness and both BMI and arch height; however, few trends were noted in AHI and ARI. Determining relationships between arch structure and pathology is helpful for both clinicians and researchers.

Total Dystrophic Onychomycosis Successfully Treated with Efinaconazole Topical Solution in Times of COVID: A Case Study

Toenail onychomycosis is a common condition that is equally challenging for podiatrists and patients. This case study documents a 26-year-old woman with bilateral total dystrophic onychomycosis of at least 5 years' duration. She had previously failed to respond to treatment with ciclopirox nail lacquer 8% and despite hiding her condition with nail polish, was suffering from embarrassment, distress and low self-esteem. At initial consult, one hundred percent of both great toenails were affected. After discussion of all treatment options, the patient opted for topical efinaconazole 10% solution, once daily for 48 weeks. Significant improvement was noted at the first (4 week) assessment period. This improvement was maintained through each subsequent virtual consult and complete cure was seen at a 30-week follow-up visit. To the author's knowledge this is the first published report on the use of efinaconazole in total dystrophic onychomycosis. It suggests that the product may be effective in patients with even the most severe and treatment recalcitrant disease, who are unwilling or unable to tolerate systemic antifungal therapy.

Immediate Effect of Kinesiology Tape on Functionality, Static and Dynamic Balance, Exercise Capacity and Posture in Users of High-Heeled Shoes

Background: Using high-heeled shoes in daily life affects the stability of walking, body posture, and functionality. So, the present study was aimed to determine the immediate effect of Kinesio-taping (KT) on functionality, static and dynamic balance, exercise capacity, posture in young women using high-heeled shoes. Methods: Thirty-seven females who were used high-heeled shoes with a mean age of 20.32{plus minus}1.37 years were divided into two groups: control (n:20) and study group(n:17). The study group's both limbs were taped medially, laterally, and dorsally with KT; no application was made to the control group. Balance [Techno Body Postural Line], functionality [vertical jump and functional reach test], exercise capacity [6-min walk test], human body posture [New York Posture Rating Chart] was assessed. Results: Use of high-heeled shoes was 8(7-9) hours/day, 5(3-5) days/week, 3(2-6.5) years in the study group versus 6(6-8) hours/day, 4(2.5-5.75) days/week for 4(2.5-5.75) years in the control group. Statistical significance in functional reach distance (cm) was found within the control (p:0.010) and study groups (p:0.005) but not between the groups (p˃0.05). Stabilometric mono pedal right foot elips area (mm2; p:0.006) and perimeter (mm;p:0.009); left foot elips area (mm2;p:0.016), perimeter (mm;p:0.023) and front/backward standard deviation (p:0.018); dynamic balance area gap percentage (%; p:0.030) were significant within the study group. Posture, vertical jump distance, exercise capacity, stabilometric test results, bipedal closed-eye&opened eye results were similar within and between the groups (p˃0.05). Conclusions: Kinesio-taping has no immediate effect on exercise capacity, vertical jump function, posture, and bipedal static balance but can modulate the functional reach function, static mono pedal leg balance, and dynamic equilibrium. Further studies are recommended to investigate the additive effect of KT with high heels and after 45 minutes, 24 hours and 72 hours.

Evaluation of Usability of the Tiger Full Foot 3D Scanner for the Measurements of Basic Foot Dimensions in Clinical Practice

Background: Foot dimension information is important both for footwear design and clinical applications. In recent years, non-contact three-dimensional foot digitizers/scanners became popular as they are non-invasive and are both valid and reliable for the most of measures. Some of them also offer automated calculations of basic foot dimensions. The study aimed to determine test-retest reliability, objectivity, and concurrent validity of the Tiger full foot 3D scanner as well as the relationship between the manual measures of the medial longitudinal arch of the foot and its alternative parameters obtained automatically by the scanner. Methods: Intraclass correlation coefficients and the values of minimal detectable change were used to assess the reliability and objectivity of the scanner. Concurrent validity and the relationship between the arch height measures were determined by the Pearson's correlation coefficient and the limits of agreement between the scanner and the calliper method. Results: Both the relative and absolute agreement between the repeated measurements obtained by the scanner show excellent reliability and objectivity of linear measures and only good to nearly good test-retest reliability and objectivity of the arch height. Correlations between the values obtained by the scanner and the calliper were generally higher in linear measures (rp{greater than or equal to}0.929). The representativeness of state of bony architecture by the soft tissue margin of the medial foot arch demonstrate the lowest correlations among the all measurements (rp{less than or equal to}0.526). Conclusions: The Tiger full foot 3D scanner offers both excellent reliability and objectivity in linear measures, which correspond to those obtained by the calliper method. However, values obtained by the both methods shouldn't be used interchangeably. The arch height measure is less accurate, which could limit its use in some clinical applications. Orthotists and related professions probably appreciate scanner more than other specialists.

Determination of the Optimal Syndesmosis Fixation Angle Using Mortise View of The Ankle Joint

Background: Syndesmosis is an important soft tissue component supporting the ankle stability and commonly injured accompanying with ankle fractures. The accurate reduction and fixation of syndesmosis is essential to obtain better functional results. Therefore, we aimed to find a practical method using the mortise view of ankle to determine the optimal syndesmosis fixation angle intraoperatively. Methods: We randomly selected 200 adults (100 women and 100 men) between 18 - 60 years of age. Three-dimensional anatomical models of tibia and fibula were created using Materialise MIMICS 21. We created a best fit plane on articular surface of medial malleolus and a ninety degrees vertical plane to medial malleolus plane. We determined two splines on cortical borders of tibia and fibula distant from the most superior point of ankle joint in horizontal view. We created two spheres that fit to the predefined splines. The optimal syndesmosis fixation angle was determined measuring the angle between the line connecting the center points of spheres, and the ninety degrees vertical plane to medial malleolus plane. Results: We observed no statistically significant difference between gender groups in terms of optimal syndesmosis fixation angles. The mean age of our study population was 47.1 {plus minus} 10.5. The optimal syndesmosis fixation angle according to mortise view was found as 21 {plus minus} 4.3 degrees. Conclusions: We determined the optimal syndesmosis fixation angle as 21 {plus minus} 4.3 degrees in accordance with the mortise view of ankle. The surgeon could evaluate the whole articular surface of ankle joint with the medial and lateral syndesmotic space in mortise view accurately and at the same position syndesmosis fixation could be performed at 21 {plus minus} 4.3 degrees.

Treatment of Non-Healing Diabetic Foot Wounds with Vaporous Hyperoxia Therapy in Conjunction with Standard Wound Care

Vaporous Hyperoxia Therapy (VHTTM), a patented FDA-510 (k) cleared technology, is an adjunct therapy used in conjunction with standard wound care (SWC). VHT is said to improve the health of wounded tissue by administering a low-frequency, non-contact, non-thermal ionic anti-microbial hydrating mist alternating with concentrated topical oxygen therapy (TOT). VHT was used to treat 36 subjects with chronic diabetic foot ulcers (DFUs) that were previously treated unsuccessfully with SWC. The average age of DFU in the study was 11 months old and the average size was over 3 cm2. Wounds were either Wagner Grade 2 or 3 and most commonly on the plantar surface around the midfoot. Treatment consisted of twice weekly applications of VHT and wound debridement. Subjects were followed to wound closure, 20 weeks, or 40 treatments, whichever came first. The combination of SWC and VHT in the group that met and maintained compliance throughout the study period achieved an 83% DFU closure rate within a 20-week time period. The average time for DFU closure in this study was 9.4 weeks. Historical analysis of SWC shows a 30.9% healing rate of all wounds, not differentiating chronic wounds. Accordingly, SWC/VHT increases chronic diabetic foot ulcer healing rates by 2.85 times compared with SWC alone. The purpose of this study was two-fold: first, to observe the effect of VHT on healing rates and time to healing in previously nonhealing DFUs and second, to compare VHT with SWC, TOT and hyperbaric oxygen therapy (HBOT) and ultrasound therapies.