Sample records for characterizing multisegment foot

  1. Characterizing multisegment foot kinematics during gait in diabetic foot patients

    Directory of Open Access Journals (Sweden)

    Denti Paolo


    Full Text Available Abstract Background The prevalence of diabetes mellitus has reached epidemic proportions, this condition may result in multiple and chronic invalidating long term complications. Among these, the diabetic foot, is determined by the simultaneous presence of both peripheral neuropathy and vasculopathy that alter the biomechanics of the foot with the formation of callosity and ulcerations. To diagnose and treat the diabetic foot is crucial to understand the foot complex kinematics. Most of gait analysis protocols represent the entire foot as a rigid body connected to the shank. Nevertheless the existing multisegment models cannot completely decipher the impairments associated with the diabetic foot. Methods A four segment foot and ankle model for assessing the kinematics of the diabetic foot was developed. Ten normal subjects and 10 diabetics gait patterns were collected and major sources of variability were tested. Repeatability analysis was performed both on a normal and on a diabetic subject. Direct skin marker placement was chosen in correspondence of 13 anatomical landmarks and an optoelectronic system was used to collect the data. Results Joint rotation normative bands (mean plus/minus one standard deviation were generated using the data of the control group. Three representative strides per subject were selected. The repeatability analysis on normal and pathological subjects results have been compared with literature and found comparable. Normal and pathological gait have been compared and showed major statistically significant differences in the forefoot and midfoot dorsi-plantarflexion. Conclusion Even though various biomechanical models have been developed so far to study the properties and behaviour of the foot, the present study focuses on developing a methodology for the functional assessment of the foot-ankle complex and for the definition of a functional model of the diabetic neuropathic foot. It is, of course, important to evaluate

  2. A wearable system for multi-segment foot kinetics measurement. (United States)

    Rouhani, H; Favre, J; Crevoisier, X; Aminian, K


    This study aims to design a wearable system for kinetics measurement of multi-segment foot joints in long-distance walking and to investigate its suitability for clinical evaluations. The wearable system consisted of inertial sensors (3D gyroscopes and 3D accelerometers) on toes, forefoot, hindfoot, and shank, and a plantar pressure insole. After calibration in a laboratory, 10 healthy elderly subjects and 12 patients with ankle osteoarthritis walked 50m twice wearing this system. Using inverse dynamics, 3D forces, moments, and power were calculated in the joint sections among toes, forefoot, hindfoot, and shank. Compared to those we previously estimated for a one-segment foot model, the sagittal and transverse moments and power in the ankle joint, as measured via multi-segment foot model, showed a normalized RMS difference of less than 11%, 14%, and 13%, respectively, for healthy subjects, and 13%, 15%, and 14%, for patients. Similar to our previous study, the coronal moments were not analyzed. Maxima-minima values of anterior-posterior and vertical force, sagittal moment, and power in shank-hindfoot and hindfoot-forefoot joints were significantly different between patients and healthy subjects. Except for power, the inter-subject repeatability of these parameters was CMC>0.90 for healthy subjects and CMC>0.70 for patients. Repeatability of these parameters was lower for the forefoot-toes joint. The proposed measurement system estimated multi-segment foot joints kinetics with acceptable repeatability but showed difference, compared to those previously estimated for the one-segment foot model. These parameters also could distinguish patients from healthy subjects. Thus, this system is suggested for outcome evaluations of foot treatments.

  3. Analysis of a kinetic multi-segment foot model. Part I: Model repeatability and kinematic validity. (United States)

    Bruening, Dustin A; Cooney, Kevin M; Buczek, Frank L


    Kinematic multi-segment foot models are still evolving, but have seen increased use in clinical and research settings. The addition of kinetics may increase knowledge of foot and ankle function as well as influence multi-segment foot model evolution; however, previous kinetic models are too complex for clinical use. In this study we present a three-segment kinetic foot model and thorough evaluation of model performance during normal gait. In this first of two companion papers, model reference frames and joint centers are analyzed for repeatability, joint translations are measured, segment rigidity characterized, and sample joint angles presented. Within-tester and between-tester repeatability were first assessed using 10 healthy pediatric participants, while kinematic parameters were subsequently measured on 17 additional healthy pediatric participants. Repeatability errors were generally low for all sagittal plane measures as well as transverse plane Hindfoot and Forefoot segments (mediansegment rigidity analysis suggested rigid body behavior for the Shank and Hindfoot, with the Forefoot violating the rigid body assumptions in terminal stance/pre-swing. Joint excursions were consistent with previously published studies.

  4. Classification of midfoot break using multi-segment foot kinematics and pedobarography. (United States)

    Maurer, Jessica D; Ward, Valerie; Mayson, Tanja A; Davies, Karen R; Alvarez, Christine M; Beauchamp, Richard D; Black, Alec H


    Midfoot break (MFB) is a foot deformity that can occur when ankle dorsiflexion is restricted due to muscle spasticity or contractures, causing abnormal increased motion through the midfoot. MFB has been previously described in terms of forefoot (FF) and hindfoot (HF) motion in the sagittal plane. The purpose of this study was to further classify MFB by describing FF and HF motion in the coronal and transverse planes along with plantar pressures, with the goal of optimizing treatment of this deformity. Three-dimensional foot kinematics were assessed using a multi-segment foot model in children with MFB (n=30) and children with no foot or gait abnormalities (n=30). The MFB group was subdivided into three categories: (1) Pronated MFB, (2) Supinated MFB and (3) Flat Foot MFB. Unique patterns of plantar pressures and foot kinematics were identified for each MFB group. The Pronated MFB group had increased medial midfoot pressures, increased forefoot pronation, and increased external forefoot rotation (forefoot abductus). The Supinated MFB group had increased lateral midfoot pressures, increased forefoot supination, and increased internal forefoot rotation (forefoot adductus). In the Flat Foot MFB group, midfoot pressures were increased and distributed uniformly between the medial and lateral sides, forefoot pronation was increased, and internal forefoot rotation was present. By combining this new information with previously reported methods of measuring sagittal plane kinematics of MFB, it is now possible to characterize midfoot break in terms of severity and foot-floor contact pattern.

  5. Repeatability in the assessment of multi-segment foot kinematics. (United States)

    Deschamps, Kevin; Staes, Filip; Bruyninckx, Herman; Busschots, Ellen; Jaspers, Ellen; Atre, Ameya; Desloovere, Kaat


    A recently published systematic review on 3D multi-segment foot models has illustrated the lack of repeatability studies providing evidence for appropriate clinical decision making. The aim of the current study was to assess the repeatability of the recently published model developed by Leardini et al. [10]. Foot kinematics of six healthy adults were analyzed through a repeated-measures design including two therapists with different levels of experience and four test sessions. For the majority of the parameters moderate or good repeatability was observed for the within-day and between-day sessions. A trend towards consistently higher within- and between-day variability was observed for the junior compared to the senior clinician. The mean inter-session variability of the relative 3D rotations ranged between 0.9-4.2° and 1.6-5.0° for respectively the senior and junior clinician whereas for the absolute angles this variability increased to respectively 2.0-6.2° and 2.6-7.8°. Mean inter-therapist standard deviations ranged between 2.2° and 6.5° for the relative 3D rotations and between 2.8° and 7.6° for the absolute 3D rotations. The ratio of inter-therapist to inter-trial errors ranged between 1.8 and 5.5 for the relative 3D rotations and between 2.4 and 9.7 for the absolute 3D rotations. Absolute angle representation of the planar angles was found to be more difficult. Observations from the current study indicate that an adequate normative database can be installed in gait laboratories, however, it should be stressed that experience of therapists is important and gait laboratories should therefore be encouraged to put effort in training their clinicians.

  6. Foot segment kinematics during normal walking using a multisegment model of the foot and ankle complex. (United States)

    Jenkyn, Thomas R; Anas, Kiersten; Nichol, Alexander


    Gait analysis using optical tracking equipment has been demonstrated to be a clinically useful tool for measuring three-dimensional kinematics and kinetics of the human body. However, in current practice, the foot is treated as a single rigid segment that articulates with the lower leg, meaning the motions of the joints of the foot cannot be measured. A multisegment kinematic model of the foot was developed for use in a gait analysis laboratory. The foot was divided into hindfoot, talus, midfoot, and medial and lateral forefoot segments. Six functional joints were defined: Ankle and subtalar joints, frontal and transverse plane motions of the hindfoot relative to midfoot, supination-pronation twist of the forefoot relative to midfoot, and medial longitudinal arch height-to-length ratio. Twelve asymptomatic subjects were tested during barefoot walking with a six-camera optical stereometric system and passive markers organized in triads. Repeatability of reported motions was tested using coefficients of multiple correlation. Ankle and subtalar joint motions and twisting of the forefoot were most repeatable. Hindfoot motions were least repeatable both within subjects and between subjects. Hindfoot and forefoot pronations in the frontal place were found to coincide with dropping of the medial longitudinal arch between early to midstance, followed by supination and rising of the arch in late stance and swing phase. This multisegment foot model overcomes a major shortcoming in current gait analysis practice-the inability to measure motion within the foot. Such measurements are crucial if gait analysis is to remain relevant in orthopaedic and rehabilitative treatment of the foot and ankle.

  7. A comparison of multi-segment foot kinematics during level overground and treadmill walking. (United States)

    Tulchin, Kirsten; Orendurff, Michael; Karol, Lori


    Previous work comparing treadmill and overground walking has focused on lower extremity motion and kinetics, with few identified differences. However, a comparison of multi-segment foot kinematics between these conditions has not been previously reported. Sagittal ankle motion using a single rigid body foot model and three-dimensional hindfoot and forefoot kinematics were compared during barefoot, level, overground walking at a self-selected speed and treadmill walking at a similar speed for 20 healthy adults. Slight differences were seen in ankle plantarflexion and hindfoot plantarflexion during first rocker, as well as peak forefoot eversion and abduction, however all changes were less than 3 degrees , and most were within the day-to-day repeatability. These results indicate that foot mechanics as determined using a multi-segment foot model were similar between overground and treadmill walking at similar speeds in healthy adults. Treadmill protocols may provide a controlled method to analyze a patient's ability to adapt to walking at different speeds and surface slopes, which are encountered often during ambulation of daily living.

  8. A kinematic description of dynamic midfoot break in children using a multi-segment foot model. (United States)

    Maurer, Jessica D; Ward, Valerie; Mayson, Tanja A; Davies, Karen R; Alvarez, Christine M; Beauchamp, Richard D; Black, Alec H


    Midfoot break (MFB) is a foot deformity that occurs most commonly in children with cerebral palsy (CP), but may also affect children with other developmental disorders. Dynamic MFB develops because the muscles that cross the ankle joint are hypertonic, resulting in a breakdown and dysfunction of the bones within the foot. In turn, this creates excessive motion at the midfoot. With the resulting inefficient lever arm, the foot is then unable to push off the ground effectively, resulting in an inadequate and painful gait pattern. Currently, there is no standard quantitative method for detecting early stages of MFB, which would allow early intervention before further breakdown occurs. The first step in developing an objective tool for early MFB diagnosis is to examine the difference in dynamic function between a foot with MFB and a typical foot. Therefore, the main purpose of this study was to compare the differences in foot motion between children with MFB and children with typical feet (Controls) using a multi-segment kinematic foot model. We found that children with MFB had a significant decrease in peak ankle dorsiflexion compared to Controls (1.3 ± 6.4° versus 8.6 ± 3.4°) and a significant increase in peak midfoot dorsiflexion compared to Controls (15.2 ± 4.9° versus 6.4 ± 1.9°). This study may help clinicians track the progression of MFB and help standardize treatment recommendations for children with this type of foot deformity.

  9. The effects of orthotic intervention on multisegment foot kinematics and plantar fascia strain in recreational runners. (United States)

    Sinclair, Jonathan; Isherwood, Josh; Taylor, Paul J


    Chronic injuries are a common complaint in recreational runners. Foot orthoses have been shown to be effective for the treatment of running injuries but their mechanical effects are still not well understood. This study aims to examine the influence of orthotic intervention on multisegment foot kinematics and plantar fascia strain during running. Fifteen male participants ran at 4.0 m · s(-1) with and without orthotics. Multisegment foot kinematics and plantar fascia strain were obtained during the stance phase and contrasted using paired t tests. Relative coronal plane range of motion of the midfoot relative to the rearfoot was significantly reduced with orthotics (1.0°) compared to without (2.2°). Similarly, relative transverse plane range of motion was significantly lower with orthotics (1.1°) compared to without (1.8°). Plantar fascia strain did not differ significantly between orthotic (7.1) and nonorthotic (7.1) conditions. This study shows that although orthotics did not serve to reduce plantar fascia strain, they are able to mediate reductions in coronal and transverse plane rotations of the midfoot.

  10. Measurement of multi-segment foot joint angles during gait using a wearable system. (United States)

    Rouhani, Hossein; Favre, Julien; Crevoisier, Xavier; Aminian, Kamiar


    Usually the measurement of multi-segment foot and ankle complex kinematics is done with stationary motion capture devices which are limited to use in a gait laboratory. This study aimed to propose and validate a wearable system to measure the foot and ankle complex joint angles during gait in daily conditions, and then to investigate its suitability for clinical evaluations. The foot and ankle complex consisted of four segments (shank, hindfoot, forefoot, and toes), with an inertial measurement unit (3D gyroscopes and 3D accelerometers) attached to each segment. The angles between the four segments were calculated in the sagittal, coronal, and transverse planes using a new algorithm combining strap-down integration and detection of low-acceleration instants. To validate the joint angles measured by the wearable system, three subjects walked on a treadmill for five minutes at three different speeds. A camera-based stationary system that used a cluster of markers on each segment was used as a reference. To test the suitability of the system for clinical evaluation, the joint angle ranges were compared between a group of 10 healthy subjects and a group of 12 patients with ankle osteoarthritis, during two 50-m walking trials where the wearable system was attached to each subject. On average, over all joints and walking speeds, the RMS differences and correlation coefficients between the angular curves obtained using the wearable system and the stationary system were 1 deg and 0.93, respectively. Moreover, this system was able to detect significant alteration of foot and ankle function between the group of patients with ankle osteoarthritis and the group of healthy subjects. In conclusion, this wearable system was accurate and suitable for clinical evaluation when used to measure the multi-segment foot and ankle complex kinematics during long-distance walks in daily life conditions.

  11. Reliability and minimal detectable difference in multisegment foot kinematics during shod walking and running. (United States)

    Milner, Clare E; Brindle, Richard A


    There has been increased interest recently in measuring kinematics within the foot during gait. While several multisegment foot models have appeared in the literature, the Oxford foot model has been used frequently for both walking and running. Several studies have reported the reliability for the Oxford foot model, but most studies to date have reported reliability for barefoot walking. The purpose of this study was to determine between-day (intra-rater) and within-session (inter-trial) reliability of the modified Oxford foot model during shod walking and running and calculate minimum detectable difference for common variables of interest. Healthy adult male runners participated. Participants ran and walked in the gait laboratory for five trials of each. Three-dimensional gait analysis was conducted and foot and ankle joint angle time series data were calculated. Participants returned for a second gait analysis at least 5 days later. Intraclass correlation coefficients and minimum detectable difference were determined for walking and for running, to indicate both within-session and between-day reliability. Overall, relative variables were more reliable than absolute variables, and within-session reliability was greater than between-day reliability. Between-day intraclass correlation coefficients were comparable to those reported previously for adults walking barefoot. It is an extension in the use of the Oxford foot model to incorporate wearing a shoe while maintaining marker placement directly on the skin for each segment. These reliability data for walking and running will aid in the determination of meaningful differences in studies which use this model during shod gait.

  12. A comparison between joint coordinate system and attitude vector for multi-segment foot kinematics. (United States)

    Rouhani, H; Favre, J; Crevoisier, X; Jolles, B M; Aminian, K


    The joint angles of multi-segment foot models have been primarily described using two mathematical methods: the joint coordinate system and the attitude vector. This study aimed to determine whether the angles obtained through these two descriptors are comparable, and whether these descriptors have similar sensitivity to experimental errors. Six subjects walked eight times on an instrumented walkway while the joint angles among shank, hindfoot, medial forefoot, and lateral forefoot were measured. The angles obtained using both descriptors and their sensitivity to experimental errors were compared. There was no overall significant difference between the ranges of motion obtained using both descriptors. However, median differences of more than 6° were noticed for the medial-lateral forefoot joint. For all joints and rotation planes, both descriptors provided highly similar angle patterns (median correlation coefficient: R>0.90), except for the medial-lateral forefoot angle in the transverse plane (median R=0.77). The joint coordinate system was significantly more sensitive to anatomical landmarks misplacement errors. However, the absolute differences of sensitivity were small relative to the joints ranges of motion. In conclusion, the angles obtained using these two descriptors were not identical, but were similar for at least the shank-hindfoot and hindfoot-medial forefoot joints. Therefore, the angle comparison across descriptors is possible for these two joints. Comparison should be done more carefully for the medial-lateral forefoot joint. Moreover, despite different sensitivities to experimental errors, the effects of the experimental errors on the angles were small for both descriptors suggesting that both descriptors can be considered for multi-segment foot models.

  13. Multi-segment foot kinematics after total ankle replacement and ankle arthrodesis during relatively long-distance gait. (United States)

    Rouhani, H; Favre, J; Aminian, K; Crevoisier, X


    This study aimed to investigate the influence of ankle osteoarthritis (AOA) treatments, i.e., ankle arthrodesis (AA) and total ankle replacement (TAR), on the kinematics of multi-segment foot and ankle complex during relatively long-distance gait. Forty-five subjects in four groups (AOA, AA, TAR, and control) were equipped with a wearable system consisting of inertial sensors installed on the tibia, calcaneus, and medial metatarsals. The subjects walked 50-m twice while the system measured the kinematic parameters of their multi-segment foot: the range of motion of joints between tibia, calcaneus, and medial metatarsals in three anatomical planes, and the peaks of angular velocity of these segments in the sagittal plane. These parameters were then compared among the four groups. It was observed that the range of motion and peak of angular velocities generally improved after TAR and were similar to the control subjects. However, unlike AOA and TAR, AA imposed impairments in the range of motion in the coronal plane for both the tibia-calcaneus and tibia-metatarsals joints. In general, the kinematic parameters showed significant correlation with established clinical scales (FFI and AOFAS), which shows their convergent validity. Based on the kinematic parameters of multi-segment foot during 50-m gait, this study showed significant improvements in foot mobility after TAR, but several significant impairments remained after AA.

  14. Multi-segmented Magnetic Nanowires Fabrication and Characterization

    KAUST Repository

    Moreno Garcia, Julian


    In this work, nickel-gold multi-segmented magnetic nanowires were grown by electrodeposition in anodized alumina templates. The templates were fabricated by a two step anodization process of aluminum disks in an aqueous solution of oxalic acid. In this process, ordered pores grew in an alumina oxide layer at the exposed aluminum area. Each disk was electropolished before the anodization process and the features at its surface were characterized to assess the effect on the pore ordering. Nickel Watts and gold cyanide electrolyte baths were prepared to electrodeposit pure nickel and gold in the templates. Both solutions response to a range of externally applied voltages was characterized and a threshold voltage above which deposition occurs is reported. Single nanowires were isolated by chemically dissolving the template and dispersed in ethanol. Devices were fabricated with these isolated nanowires in which gold contacts were deposited to measure the resistance. A current pulse setup was implemented in a magnetoresistance system allowing to send current pulses with amplitude as low as 2nA and 50μs width. Magneto resistance measurement were carried out on the single nanowires devices and the effect of current pulses was studied. It was found that distinct resistance states can be achieved by applying a determined current pulse at a constant applied field and that the initial state can be recovered by removing excess charge from the nanowire. Finally, the effect of annealing the nanowires in an air atmosphere at 150°C for 24 hours is studied showing that the nickel sections oxidize and the gold sections remain unchanged.

  15. A multi-segment foot model based on anatomically registered technical coordinate systems: method repeatability in pediatric feet. (United States)

    Saraswat, Prabhav; MacWilliams, Bruce A; Davis, Roy B


    Several multi-segment foot models to measure the motion of intrinsic joints of the foot have been reported. Use of these models in clinical decision making is limited due to lack of rigorous validation including inter-clinician, and inter-lab variability measures. A model with thoroughly quantified variability may significantly improve the confidence in the results of such foot models. This study proposes a new clinical foot model with the underlying strategy of using separate anatomic and technical marker configurations and coordinate systems. Anatomical landmark and coordinate system identification is determined during a static subject calibration. Technical markers are located at optimal sites for dynamic motion tracking. The model is comprised of the tibia and three foot segments (hindfoot, forefoot and hallux) and inter-segmental joint angles are computed in three planes. Data collection was carried out on pediatric subjects at two sites (Site 1: n=10 subjects by two clinicians and Site 2: five subjects by one clinician). A plaster mold method was used to quantify static intra-clinician and inter-clinician marker placement variability by allowing direct comparisons of marker data between sessions for each subject. Intra-clinician and inter-clinician joint angle variability were less than 4°. For dynamic walking kinematics, intra-clinician, inter-clinician and inter-laboratory variability were less than 6° for the ankle and forefoot, but slightly higher for the hallux. Inter-trial variability accounted for 2-4° of the total dynamic variability. Results indicate the proposed foot model reduces the effects of marker placement variability on computed foot kinematics during walking compared to similar measures in previous models.

  16. In-shoe multi-segment foot kinematics of children during the propulsive phase of walking and running. (United States)

    Wegener, Caleb; Greene, Andrew; Burns, Joshua; Hunt, Adrienne E; Vanwanseele, Benedicte; Smith, Richard M


    Certain styles of children's shoes reduce 1st metatarsophalangeal joint (MTPJ) and midfoot motion during propulsion of walking. However, no studies have investigated if the splinting effect of shoes on children's 1st MTPJ and midfoot motion occurs during running. This study investigated the effect of sports shoes on multi-segment foot kinematics of children during propulsion of walking and running. Twenty children walked and ran at a self-selected velocity while barefoot and shod in a random order. Reflective markers were used to quantify sagittal plane motion of the 1st MTPJ and three-dimensional motion of the midfoot and ankle. Gait velocity increased during shod walking and running and was considered a covariate in the statistical analysis. Shoes reduced 1st MTPJ motion during propulsion of walking from 36.0° to 10.7° and during running from 31.5° to 12.6°. Midfoot sagittal plane motion during propulsion reduced from 22.5° to 6.2° during walking and from 27.4° to 9.6° during running. Sagittal plane ankle motion during propulsion increased during shod running from 26.7° to 34.1°. During propulsion of walking and running, children's sports shoes have a splinting effect on 1st MTPJ and midfoot motion which is partially compensated by an increase in ankle plantarflexion during running.

  17. Measured and estimated ground reaction forces for multi-segment foot models. (United States)

    Bruening, Dustin A; Cooney, Kevin M; Buczek, Frank L; Richards, James G


    Accurate measurement of ground reaction forces under discrete areas of the foot is important in the development of more advanced foot models, which can improve our understanding of foot and ankle function. To overcome current equipment limitations, a few investigators have proposed combining a pressure mat with a single force platform and using a proportionality assumption to estimate subarea shear forces and free moments. In this study, two adjacent force platforms were used to evaluate the accuracy of the proportionality assumption on a three segment foot model during normal gait. Seventeen right feet were tested using a targeted walking approach, isolating two separate joints: transverse tarsal and metatarsophalangeal. Root mean square (RMS) errors in shear forces up to 6% body weight (BW) were found using the proportionality assumption, with the highest errors (peak absolute errors up to 12% BW) occurring between the forefoot and toes in terminal stance. The hallux exerted a small braking force in opposition to the propulsive force of the forefoot, which was unaccounted for by the proportionality assumption. While the assumption may be suitable for specific applications (e.g. gait analysis models), it is important to understand that some information on foot function can be lost. The results help highlight possible limitations of the assumption. Measured ensemble average subarea shear forces during normal gait are also presented for the first time.

  18. One year follow-up after operative ankle fractures: a prospective gait analysis study with a multi-segment foot model. (United States)

    Wang, Ruoli; Thur, Charlotte K; Gutierrez-Farewik, Elena M; Wretenberg, Per; Broström, Eva


    Ankle fractures are one of the most common lower limb traumas. Several studies reported short- and long-term post-operative results, mainly determined by radiographic and subjective functional evaluations. Three-dimensional gait analysis with a multi-segment foot model was used in the current study to quantify the inter-segment foot motions in 18 patients 1 year after surgically treated ankle fractures. Data were compared to that from gender- and age-matched healthy controls. The correlations between Olerud/Molander ankle score and kinematics were also evaluated. Patients with ankle fractures showed less plantarflexion and smaller range of motion in the injured talocrural joint, which were believed to be a sign of residual joint stiffness after surgery and immobilization. Moreover, the forefoot segment had smaller sagittal and transverse ranges of motion, less plantarflexion and the hallux segment had less dorsiflexion and smaller sagittal range of motion. The deviations found in the forefoot segment may contribute to the compensation mechanisms of the injured ankle joint. Findings of our study show that gait analysis with a multi-segment foot model provides a quantitative and objective way to perform the dynamic assessment of post-operative ankle fractures, and makes it possible to better understand not only how the injured joint is affected, but also the surrounding joints.

  19. A comparison of subtalar joint motion during anticipated medial cutting turns and level walking using a multi-segment foot model. (United States)

    Jenkyn, T R; Shultz, R; Giffin, J R; Birmingham, T B


    The weight-bearing in-vivo kinematics and kinetics of the talocrural joint, subtalar joint and joints of the foot were quantified using optical motion analysis. Twelve healthy subjects were studied during level walking and anticipated medial turns at self-selected pace. A multi-segment model of the foot using skin-mounted marker triads tracked four foot segments: the hindfoot, midfoot, lateral and medial forefoot. The lower leg and thigh were also tracked. Motion between each of the segments could occur in three degrees of rotational freedom, but only six inter-segmental motions were reported in this study: (1) talocrural dorsi-plantar-flexion, (2) subtalar inversion-eversion, (3) frontal plane hindfoot motion, (4) transverse plane hindfoot motion, (5) forefoot supination-pronation twisting and (6) the height-to-length ratio of the medial longitudinal arch. The motion at the subtalar joint during stance phase of walking (eversion then inversion) was reversed during a turning task (inversion then eversion). The external subtalar joint moment was also changed from a moderate eversion moment during walking to a larger inversion moment during the turn. The kinematics of the talocrural joint and the joints of the foot were similar between these two tasks. During a medial turn, the subtalar joint may act to maintain the motions in the foot and talocrural joint that occur during level walking. This is occurring despite the conspicuously different trajectory of the centre of mass of the body. This may allow the foot complex to maintain its function of energy absorption followed by energy return during stance phase that is best suited to level walking.

  20. Generation of subject-specific, dynamic, multisegment ankle and foot models to improve orthotic design: a feasibility study

    Directory of Open Access Journals (Sweden)

    Oosterwaal Michiel


    Full Text Available Abstract Background Currently, custom foot and ankle orthosis prescription and design tend to be based on traditional techniques, which can result in devices which vary greatly between clinicians and repeat prescription. The use of computational models of the foot may give further insight in the biomechanical effects of these devices and allow a more standardised approach to be taken to their design, however due to the complexity of the foot the models must be highly detailed and dynamic. Methods/Design Functional and anatomical datasets will be collected in a multicentre study from 10 healthy participants and 15 patients requiring orthotic devices. The patient group will include individuals with metarsalgia, flexible flat foot and drop foot. Each participant will undergo a clinical foot function assessment, 3D surface scans of the foot under different loading conditions, and detailed gait analysis including kinematic, kinetic, muscle activity and plantar pressure measurements in both barefoot and shod conditions. Following this each participant will undergo computed tomography (CT imaging of their foot and ankle under a range of loads and positions while plantar pressures are recorded. A further subgroup of participants will undergo magnetic resonance imaging (MRI of the foot and ankle. Imaging data will be segmented to derive the geometry of the bones and the orientation of the joint axes. Insertion points of muscles and ligaments will be determined from the MRI and CT-scans and soft tissue material properties computed from the loaded CT data in combination with the plantar pressure measurements. Gait analysis data will be used to drive the models and in combination with the 3D surface scans for scaling purposes. Predicted plantar pressures and muscle activation patterns predicted from the models will be compared to determine the validity of the models. Discussion This protocol will lead to the generation of unique datasets which will be used

  1. Growth and Characterization of Multisegment Chalcogenide Alloy Nanostructures for Photonic Applications in a Wide Spectral Range (United States)

    Turkdogan, Sunay

    In this dissertation, I described my research on the growth and characterization of various nanostructures, such as nanowires, nanobelts and nanosheets, of different semiconductors in a Chemical Vapor Deposition (CVD) system. In the first part of my research, I selected chalcogenides (such as CdS and CdSe) for a comprehensive study in growing two-segment axial nanowires and radial nanobelts/sheets using the ternary CdSxSe1-x alloys. I demonstrated simultaneous red (from CdSe-rich) and green (from CdS-rich) light emission from a single monolithic heterostructure with a maximum wavelength separation of 160 nm. I also demonstrated the first simultaneous two-color lasing from a single nanosheet heterostructure with a wavelength separation of 91 nm under sufficiently strong pumping power. In the second part, I considered several combinations of source materials with different growth methods in order to extend the spectral coverage of previously demonstrated structures towards shorter wavelengths to achieve full-color emissions. I achieved this with the growth of multisegment heterostructure nanosheets (MSHNs), using ZnS and CdSe chalcogenides, via our novel growth method. By utilizing this method, I demonstrated the first growth of ZnCdSSe MSHNs with an overall lattice mismatch of 6.6%, emitting red, green and blue light simultaneously, in a single furnace run using a simple CVD system. The key to this growth method is the dual ion exchange process which converts nanosheets rich in CdSe to nanosheets rich in ZnS, demonstrated for the first time in this work. Tri-chromatic white light emission with different correlated color temperature values was achieved under different growth conditions. We demonstrated multicolor (191 nm total wavelength separation) laser from a single monolithic semiconductor nanostructure for the first time. Due to the difficulties associated with growing semiconductor materials of differing composition on a given substrate using traditional planar

  2. Frontal plane multi-segment foot kinematics in high- and low-arched females during dynamic loading tasks. (United States)

    Powell, Douglas W; Long, Benjamin; Milner, Clare E; Zhang, Songning


    The functions of the medial longitudinal arch have been the focus of much research in recent years. Several studies have shown kinematic differences between high- and low-arched runners. No literature currently compares the inter-segmental foot motion of high- and low-arched recreational athletes. The purpose of this study was to examine inter-segmental foot motion in the frontal plane during dynamic loading activities in high- and low-arched female athletes. Inter-segmental foot motions were examined in 10 high- and 10 low-arched female recreational athletes. Subjects performed five barefooted trials in each of the following randomized movements: walking, running, downward stepping and landing. Three-dimensional kinematic data were recorded. High-arched athletes had smaller peak ankle eversion angles in walking, running and downward stepping than low-arched athletes. At the rear-midfoot joint high-arched athletes reached peak eversion later in walking and downward stepping than the low-arched athletes. The high-arched athletes had smaller peak mid-forefoot eversion angles in walking, running and downward stepping than the low-arched athletes. The current findings show that differences in foot kinematics between the high- and low-arched athletes were in position and not range of motion within the foot.

  3. A method to investigate the effect of shoe-hole size on surface marker movement when describing in-shoe joint kinematics using a multi-segment foot model. (United States)

    Bishop, Chris; Arnold, John B; Fraysse, Francois; Thewlis, Dominic


    To investigate in-shoe foot kinematics, holes are often cut in the shoe upper to allow markers to be placed on the skin surface. However, there is currently a lack of understanding as to what is an appropriate size. This study aimed to demonstrate a method to assess whether different diameter holes were large enough to allow free motion of marker wands mounted on the skin surface during walking using a multi-segment foot model. Eighteen participants underwent an analysis of foot kinematics whilst walking barefoot and wearing shoes with different size holes (15 mm, 20mm and 25 mm). The analysis was conducted in two parts; firstly the trajectory of the individual skin-mounted markers were analysed in a 2D ellipse to investigate total displacement of each marker during stance. Secondly, a geometrical analysis was conducted to assess cluster deformation of the hindfoot and midfoot-forefoot segments. Where movement of the markers in the 15 and 20mm conditions were restricted, the marker movement in the 25 mm condition did not exceed the radius at any anatomical location. Despite significant differences in the isotropy index of the medial and lateral calcaneus markers between the 25 mm and barefoot conditions, the differences were due to the effect of footwear on the foot and not a result of the marker wands hitting the shoe upper. In conclusion, the method proposed and results can be used to increase confidence in the representativeness of joint kinematics with respect to in-shoe multi-segment foot motion during walking.

  4. Ankle and midfoot kinetics during normal gait: a multi-segment approach. (United States)

    Dixon, Philippe C; Böhm, Harald; Döderlein, Leonhard


    Multi-segment foot models are increasingly being used to evaluate intra and inter-segment foot kinematics such as the motion between the hindfoot/tibia (ankle) and the forefoot/hindfoot (midfoot) during walking. However, kinetic analysis have been mainly restricted to one-segment foot models and could be improved by considering a multi-segment approach. Therefore, the aims of this study were to (1) implement a kinetic analysis of the ankle and theoretical midfoot joints using the existing Oxford Foot Model (OFM) through a standard inverse dynamics approach using only marker, force plate and anthropometric data and (2) to compare OFM ankle joint kinetics to those output by the one-segment foot plugin-gait model (PIG). 10 healthy adolescents fitted with both the OFM and PIG markers performed barefoot comfortable speed walking trials over an instrumented walkway. The maximum ankle power generation was significantly reduced by approximately 40% through OFM calculations compared to PIG estimates (psegment foot models overestimate ankle power, and may also overestimate the contribution of the triceps surae. A multi-segment approach may help quantify the important contribution of the midfoot ligaments and musculature to power generation. We therefore recommend the use of multi-segment foot models to estimate ankle and midfoot kinetics, especially when surgical decision-making is based on the results of three-dimensional gait analysis.

  5. Characterization of diabetic foot patients attended in an army hospital in Recife


    Isabel Cristina Ramos Vieira Santos; Juliana Magalhães Bernardino


    This research aims to characterize a profi le of diabetic foot patients attended in an army hospital in Recife, in the year 2005. It is a quantitative study, carried out by surveying all diabetic patients attended in the clinic of the mentioned hospital. The variables of interest used in the form were the following: age, sex, origin, functional situation and co-morbidities. The results found a prevalence of 3. 4% of diabetic foot patients. It was noticed a higher frequency in the age group of...

  6. Passive legged, multi-segmented, robotic vehicle.

    Energy Technology Data Exchange (ETDEWEB)

    Hayward, David R.


    The Passive-legged, Multi-segmented, Robotic Vehicle concept is a simple legged vehicle that is modular and scaleable, and can be sized to fit through confined areas that are slightly larger than the size of the vehicle. A specific goal of this project was to be able to fit through the opening in the fabric of a chain link fence. This terrain agile robotic platform will be composed of multiple segments that are each equipped with appendages (legs) that resemble oars extending from a boat. Motion is achieved by pushing with these legs that can also flex to fold next to the body when passing through a constricted area. Each segment is attached to another segment using an actuated joint. This joint represents the only actuation required for mobility. The major feature of this type of mobility is that the terrain agility advantage of legs can be attained without the complexity of the multiple-actuation normally required for the many joints of an active leg. The minimum number of segments is two, but some concepts require three or more segments. This report discusses several concepts for achieving this type of mobility, their design, and the results obtained for each.

  7. Design and characterization of a biologically inspired quasi-passive prosthetic ankle-foot. (United States)

    Mooney, Luke M; Lai, Cara H; Rouse, Elliott J


    By design, commonly worn energy storage and release (ESR) prosthetic feet cannot provide biologically realistic ankle joint torque and angle profiles during walking. Additionally, their anthropomorphic, cantilever architecture causes their mechanical stiffness to decrease throughout the stance phase of walking, opposing the known trend of the biological ankle. In this study, the design of a quasi-passive pneumatic ankle-foot prosthesis is detailed that is able to replicate the biological ankle's torque and angle profiles during walking. The prosthetic ankle is comprised of a pneumatic piston, bending spring and solenoid valve. The mechanical properties of the pneumatic ankle prosthesis are characterized using a materials testing machine and the properties are compared to those from a common, passive ESR prosthetic foot. The characterization spanned a range of ankle equilibrium pressures and testing locations beneath the foot, analogous to the location of center of pressure within the stance phase of walking. The pneumatic ankle prosthesis was shown to provide biologically appropriate trends and magnitudes of torque, angle and stiffness behavior, when compared to the passive ESR prosthetic foot. Future work will focus on the development of a control system for the quasi-passive device and clinical testing of the pneumatic ankle to demonstrate efficacy.

  8. Foot kinematics and kinetics during adolescent gait. (United States)

    MacWilliams, Bruce A; Cowley, Matthew; Nicholson, Diane E


    Gait analysis models typically analyze the ankle joint complex and treat the foot as a rigid segment. Such models are inadequate for clinical decision making for patients with foot impairments. While previous multisegment foot models have been presented, no comprehensive kinematic and kinetic databases for normal gait exist. This study provides normative foot joint angles, moments and powers during adolescent gait. Eighteen subjects were evaluated using 19 retroreflective markers, six cameras, a pressure platform and a force plate. A nine-segment model determined 3D angles, 3D moments, and powers in eight joints or joint complexes. A complete sets of sagittal, coronal and frontal plane results are presented. Results indicate that single link models of the foot significantly overestimate ankle joint powers during gait. Understanding normal joint kinematics and kinetics during gait will provide a baseline for documenting impairments in patients with foot disorders.

  9. The role of foot morphology on foot function in diabetic subjects with or without neuropathy. (United States)

    Guiotto, Annamaria; Sawacha, Zimi; Guarneri, Gabriella; Cristoferi, Giuseppe; Avogaro, Angelo; Cobelli, Claudio


    The aim of this study was to investigate the role of foot morphology, related with respect to diabetes and peripheral neuropathy in altering foot kinematics and plantar pressure during gait. Healthy and diabetic subjects with or without neuropathy with different foot types were analyzed. Three dimensional multisegment foot kinematics and plantar pressures were assessed on 120 feet: 40 feet (24 cavus, 20 with valgus heel and 11 with hallux valgus) in the control group, 80 feet in the diabetic (25 cavus 13 with valgus heel and 13 with hallux valgus) and the neuropathic groups (28 cavus, 24 with valgus heel and 18 with hallux valgus). Subjects were classified according to their foot morphology allowing further comparisons among the subgroups with the same foot morphology. When comparing neuropathic subjects with cavus foot, valgus heel with controls with the same foot morphology, important differences were noticed: increased dorsiflexion and peak plantar pressure on the forefoot (Pfoot morphology in altering both kinematics and plantar pressure in diabetic subjects, diabetes appeared to further contribute in altering foot biomechanics. Surprisingly, all the diabetic subjects with normal foot arch or with valgus hallux were no more likely to display significant differences in biomechanics parameters than controls. This data could be considered a valuable support for future research on diabetic foot function, and in planning preventive interventions.

  10. Molecular Characterization of Foot-and-Mouth Disease Viruses Collected in Tanzania Between 1967 and 2009. (United States)

    Kasanga, C J; Wadsworth, J; Mpelumbe-Ngeleja, C A R; Sallu, R; Kivaria, F; Wambura, P N; Yongolo, M G S; Rweyemamu, M M; Knowles, N J; King, D P


    This paper describes the molecular characterization of foot-and-mouth disease viruses (FMDV) recovered from outbreaks in Tanzania that occurred between 1967 and 2009. A total of 44 FMDV isolates, containing representatives of serotypes O, A, SAT 1 and SAT 2 from 13 regions of Tanzania, were selected from the FAO World Reference Laboratory for FMD (WRLFMD) virus collection. VP1 nucleotide sequences were determined for RT-PCR amplicons, and phylogenetic reconstructions were determined by maximum likelihood and neighbour-joining methods. These analyses showed that Tanzanian type O viruses fell into the EAST AFRICA 2 (EA-2) topotype, type A viruses fell into the AFRICA topotype (genotype I), type SAT 1 viruses into topotype I and type SAT 2 viruses into topotype IV. Taken together, these findings reveal that serotypes O, A, SAT 1 and SAT 2 that caused FMD outbreaks in Tanzania were genetically related to lineages and topotypes occurring in the East African region. The close genetic relationship of viruses in Tanzania to those from other countries suggests that animal movements can contribute to virus dispersal in sub-Saharan Africa. This is the first molecular description of viruses circulating in Tanzania and highlights the need for further sampling of representative viruses from the region so as to elucidate the complex epidemiology of FMD in Tanzania and sub-Saharan Africa.

  11. Development of an artificial multifunctional foot: A project review (United States)

    Almeida, João; Ferreira, Maria José; Lobarinhas, Pedro; Silva, Luís F.; Leite, Abílio; Araújo, Alfredo; Sousa, Fernando


    The main purpose of this project is the development of a multifunctional artificial foot, capable of duplicate a human foot in a laboratory environment, in order to evaluate and simulate footwear's performance under certain conditions. This foot is used as a laboratory prototype and is multisegmented, in order that each section is controlled independently in terms of heat generation and sweating rate, therefore it is possible to simulate more accurately the real behaviour of a human foot. The device produces thermal insulation values that will help to design footwear with better ability in terms of thermal comfort, replacing human volunteers in thermal comfort perception tests, which are very subjective. The prototype was already tested, and preliminary results indicated that thermal insulation values are within the range of expected values produced by other foot thermal manikins and by human volunteers' tests. This fact suggests that this lab prototype can be used infuture thermal comfort evaluations.

  12. Vibration and wave propagation characteristics of multisegmented elastic beams (United States)

    Nayfeh, Adnan H.; Hawwa, Muhammad A.


    Closed form analytical solutions are derived for the vibration and wave propagation of multisegmented elastic beams. Each segment is modeled as a Timoshenko beam with possible inclusion of material viscosity, elastic foundation and axial forces. Solutions are obtained by using transfer matrix methods. According to these methods formal solutions are first constructed which relate the deflection, slope, moment and shear force of one end of the individual segment to those of the other. By satisfying appropriate continuity conditions at segment junctions, a global 4x4 matrix results which relates the deflection, slope, moment and shear force of one end of the beam to those of the other. If any boundary conditions are subsequently invoked on the ends of the beam one gets the appropriate characteristic equation for the natural frequencies. Furthermore, by invoking appropriate periodicity conditions the dispersion relation for a periodic system is obtained. A variety of numerical examples are included.

  13. Integrated kinematics-kinetics-plantar pressure data analysis: a useful tool for characterizing diabetic foot biomechanics. (United States)

    Sawacha, Zimi; Guarneri, Gabriella; Cristoferi, Giuseppe; Guiotto, Annamaria; Avogaro, Angelo; Cobelli, Claudio


    The fundamental cause of lower-extremity complications in diabetes is chronic hyperglycemia leading to diabetic foot ulcer pathology. While the relationship between abnormal plantar pressure distribution and plantar ulcers has been widely investigated, little is known about the role of shear stress. Moreover, the mutual relationship among plantar pressure, shear stress, and abnormal kinematics in the etiology of diabetic foot has not been established. This lack of knowledge is determined by the lack of commercially available instruments which allow such a complex analysis. This study aims to develop a method for the simultaneous assessment of kinematics, kinetics, and plantar pressure on foot subareas of diabetic subjects by means of combining three commercial systems. Data were collected during gait on 24 patients (12 controls and 12 diabetic neuropathics) with a motion capture system synchronized with two force plates and two baropodometric systems. A four segment three-dimensional foot kinematics model was adopted for the subsegment angles estimation together with a three segment model for the plantar sub-area definition during gait. The neuropathic group exhibited significantly excessive plantar pressure, ground reaction forces on each direction, and a reduced loading surface on the midfoot subsegment (pfoot ulcerations, and help planning prevention programs.

  14. Characterization of Legionella pneumophila Isolated from Environmental Water and Ashiyu Foot Spa

    Directory of Open Access Journals (Sweden)

    Masato Tachibana


    Full Text Available Hot springs are the most common infectious source of Legionella pneumophila in Japan. However, little is known about the association between L. pneumophila and environmental waters other than hot springs. In this study, water samples from 22 environmental water sites were surveyed; of the 22 samples, five were L. pneumophila positive (23%. L. pneumophila was mainly isolated from ashiyu foot spas, a type of hot spring for the feet (3/8, 38%. These isolates had genetic loci or genes that encoded the virulence factors of L. pneumophila. Moreover, these isolates showed higher intracellular growth and stronger cytotoxicity compared with the reference strain. These results suggest that ashiyu foot spa can be the original source for L. pneumophila infection.

  15. Overview of post Cohen-Boyer methods for single segment cloning and for multisegment DNA assembly. (United States)

    Sands, Bryan; Brent, Roger


    In 1973, Cohen and coworkers published a foundational paper describing the cloning of DNA fragments into plasmid vectors. In it, they used DNA segments made by digestion with restriction enzymes and joined these in vitro with DNA ligase. These methods established working recombinant DNA technology and enabled the immediate start of the biotechnology industry. Since then, "classical" recombinant DNA technology using restriction enzymes and DNA ligase has matured. At the same time, researchers have developed numerous ways to generate large, complex, multisegment DNA constructions that offer advantages over classical techniques. Here, we provide an overview of "post-Cohen-Boyer" techniques used for cloning single segments into vectors (T/A, Topo cloning, Gateway and Recombineering) and for multisegment DNA assembly (Biobricks, Golden Gate, Gibson, Yeast homologous recombination in vivo, and Ligase Cycling Reaction). We compare and contrast these methods and also discuss issues that researchers should consider before choosing a particular multisegment DNA assembly method.

  16. Foot posture is associated with kinematics of the foot during gait: A comparison of normal, planus and cavus feet. (United States)

    Buldt, Andrew K; Levinger, Pazit; Murley, George S; Menz, Hylton B; Nester, Christopher J; Landorf, Karl B


    Variations in foot posture are associated with the development of some lower limb injuries. However, the mechanisms underlying this relationship are unclear. The objective of this study was to compare foot kinematics between normal, pes cavus and pes planus foot posture groups using a multi-segment foot model. Ninety-seven healthy adults, aged 18-47 were classified as either normal (n=37), pes cavus (n=30) or pes planus (n=30) based on normative data for the Foot Posture Index, Arch Index and normalised navicular height. A five segment foot model was used to measure tri-planar motion of the rearfoot, midfoot, medial forefoot, lateral forefoot and hallux during barefoot walking at a self-selected speed. Angle at heel contact, peak angle, time to peak angle and range of motion was measured for each segment. One way ANOVAs with post-hoc analyses of mean differences were used to compare foot posture groups. The pes cavus group demonstrated a distinctive pattern of motion compared to the normal and pes planus foot posture groups. Effect sizes of significant mean differences were large and comparable to similar studies. Three key differences in overall foot function were observed between the groups: (i) altered frontal and transverse plane angles of the rearfoot in the pes cavus foot; (ii) Less midfoot motion in the pes cavus foot during initial contact and midstance; and (iii) reduced midfoot frontal plane ROM in the pes planus foot during pre-swing. These findings indicate that foot posture does influence motion of the foot.

  17. Nonlinear dynamical analysis of an aeroelastic system with multi-segmented moment in the pitch degree-of-freedom (United States)

    Vasconcellos, Rui; Abdelkefi, Abdessattar


    The effects of a multi-segmented nonlinearity in the pitch degree of freedom on the behavior of a two-degree of freedom aeroelastic system are investigated. The aeroelastic system is free to plunge and pitch and is supported by linear translational and nonlinear torsional springs and is subjected to an incoming flow. The unsteady representation based on the Duhamel formulation is used to model the aerodynamic loads. Using modern method of nonlinear dynamics, a nonlinear characterization is performed to identify the system's response when increasing the wind speed. It is demonstrated that four sudden transitions take place with a change in the system's response. It is shown that, in the first transition, the system's response changes from simply periodic (only main oscillating frequency) to two periods (having the main oscillating frequency and its superharmonic of order 2). In the second transition, the response of the system changes from two periods (having the main oscillating frequency and its superharmonic of order 2) to a period-1. The results also show that the third transition is accompanied by a change in the system's response from simply periodic to two periods (having the main oscillating frequency and its superharmonic of order 3). After this transition, chaotic responses take place and then the fourth transition is accompanied by a sudden change in the system's response from chaotic to two periods (having the main oscillating frequency and its superharmonic of order 3). The results show that these transitions are caused by the tangential contact between the trajectory and the multi-segmented nonlinearity boundaries and with a zero-pitch speed incidence. This observation is associated with the definition of grazing bifurcation.

  18. Foot Health (United States)

    ... straight across and not too short Your foot health can be a clue to your overall health. For example, joint stiffness could mean arthritis. Tingling ... foot checks are an important part of your health care. If you have foot problems, be sure ...

  19. Development of the multi-segment lumbar spine for humanoid robots

    Directory of Open Access Journals (Sweden)

    Penčić Marko M.


    Full Text Available The paper presents development of multi-segment lumbar structure based on the human spine. The research is performed within the project based on development of socially acceptable robot named "SARA". Two approaches for spine realization of humanoids exist: multi-joint viscoelastic structures (5-10 joints that have variable flexibility and structures that consist of one joint - torso/waist joint, which has low elasticity and high stiffness. We propose multi-joint flexible structure with stiff, low backlash and self-locking mechanisms that require small actuators. Based on kinematic-dynamic requirements dynamical model of robot is formed. Dynamical simulation is performed for several postures of the robot and driving torques of lumbar structure are determined. During development of the lumbar structure 16 variant solutions are considered. Developed lumbar structure consists of three equal segments, it has 6 DOFs (2 DOFs per segment and allows movements of lateral flexion ±30° and torsion ±45°, as well as the combination of these two movements. In development phase the movements of flexion/extension are excluded, for the bending of the body forward to an angle of 45° is achieved by rotation in the hip joints. Proposed solution of the lumbar structure is characterized by self-locking of mechanisms (if for any reason actuators stop working, lumbar structure retains current posture, low backlash (high positioning accuracy and repeatability of movements, compactness, high carrying capacity and small dimensions. [Projekat Ministarstva nauke Republike Srbije, br. III44008 and by Provincial secretariat for science and technological development under contract 114-451-2116/2011

  20. Preparation and characterization of resistant starch III from elephant foot yam (Amorphophallus paeonifolius) starch. (United States)

    Reddy, Chagam Koteswara; Haripriya, Sundaramoorthy; Noor Mohamed, A; Suriya, M


    The purpose of this study was to assess the properties of resistant starch (RS) III prepared from elephant foot yam starch using pullulanase enzyme. Native and gelatinized starches were subjected to enzymatic hydrolysis (pullulanase, 40 U/g per 10h), autoclaved (121°C/30 min), stored under refrigeration (4°C/24h) and then lyophilized. After preparation of resistant starch III, the morphological, physical, chemical and functional properties were assessed. The enzymatic and retrogradation process increased the yield of resistant starch III from starch with a concomitant increase increase in its water absorption capacity and water solubility index. A decrease in swelling power was observed due to the hydrolysis and thermal process. Te reduced pasting properties and hardness of resistant starch III were associated with the disintegration of starch granules due to the thermal process. The viscosity was found to be inversely proportional to the RS content in the sample. The thermal properties of RS increased due to retrogradation and recrystallization (P<0.05).

  1. Construction and characterization of 3A-epitope-tagged foot-and-mouth disease virus. (United States)

    Ma, Xueqing; Li, Pinghua; Sun, Pu; Bai, Xingwen; Bao, Huifang; Lu, Zengjun; Fu, Yuanfang; Cao, Yimei; Li, Dong; Chen, Yingli; Qiao, Zilin; Liu, Zaixin


    Nonstructural protein 3A of foot-and-mouth disease virus (FMDV) is a partially conserved protein of 153 amino acids (aa) in most FMDVs examined to date. Specific deletion in the FMDV 3A protein has been associated with the inability of FMDV to grow in primary bovine cells and cause disease in cattle. However, the aa residues playing key roles in these processes are poorly understood. In this study, we constructed epitope-tagged FMDVs containing an 8 aa FLAG epitope, a 9 aa haemagglutinin (HA) epitope, and a 10 aa c-Myc epitope to substitute residues 94-101, 93-101, and 93-102 of 3A protein, respectively, using a recently developed O/SEA/Mya-98 FMDV infectious cDNA clone. Immunofluorescence assay (IFA), Western blot and sequence analysis showed that the epitope-tagged viruses stably maintained and expressed the foreign epitopes even after 10 serial passages in BHK-21 cells. The epitope-tagged viruses displayed growth properties and plaque phenotypes similar to those of the parental virus in BHK-21 cells. However, the epitope-tagged viruses exhibited lower growth rates and smaller plaque size phenotypes than those of the parental virus in primary fetal bovine kidney (FBK) cells, but similar growth properties and plaque phenotypes to those of the recombinant viruses harboring 93-102 deletion in 3A. These results demonstrate that the decreased ability of FMDV to replicate in primary bovine cells was not associated with the length of 3A, and the genetic determinant thought to play key role in decreased ability to replicate in primary bovine cells could be reduced from 93-102 residues to 8 aa residues at positions 94-101 in 3A protein.

  2. Verification and Validation of Multisegmented Mooring Capabilities in FAST v8: Preprint

    Energy Technology Data Exchange (ETDEWEB)

    Andersen, Morten T.; Wendt, Fabian; Robertson, Amy; Jonkman, Jason; Hall, Matthew


    The quasi-static and dynamic mooring modules of the open-source aero-hydro-servo-elastic wind turbine simulation software, FAST v8, have previously been verified and validated, but only for mooring arrangements consisting of single lines connecting each fairlead and anchor. This paper extends the previous verification and validation efforts to focus on the multisegmented mooring capability of the FAST v8 modules: MAP++, MoorDyn, and the OrcaFlex interface. The OC3-Hywind spar buoy system tested by the DeepCwind consortium at the MARIN ocean basin, which includes a multisegmented bridle layout of the mooring system, was used for the verification and validation activities.

  3. Verification and Validation of Multisegmented Mooring Capabilities in FAST v8

    Energy Technology Data Exchange (ETDEWEB)

    Andersen, Morten T.; Wendt, Fabian F.; Robertson, Amy N.; Jonkman, Jason M.; Hall, Matthew


    The quasi-static and dynamic mooring modules of the open-source aero-hydro-servo-elastic wind turbine simulation software, FAST v8, have previously been verified and validated, but only for mooring arrangements consisting of single lines connecting each fairlead and anchor. This paper extends the previous verification and validation efforts to focus on the multisegmented mooring capability of the FAST v8 modules: MAP++, MoorDyn, and the OrcaFlex interface. The OC3-Hywind spar buoy system tested by the DeepCwind consortium at the MARIN ocean basin, which includes a multisegmented bridle layout of the mooring system, was used for the verification and validation activities.

  4. Co/Au multisegmented nanowires: a 3D array of magnetostatically coupled nanopillars (United States)

    Bran, C.; Ivanov, Yu P.; Kosel, J.; Chubykalo-Fesenko, O.; Vazquez, M.


    Arrays of multisegmented Co/Au nanowires with designed segment lengths and diameters have been prepared by electrodeposition into aluminum oxide templates. The high quality of the Co/Au interface and the crystallographic structure of Co segments have determined by high-resolution transmission electron microscopy. Magnetic hysteresis loop measurements show larger coercivity and squareness of multisegmented nanowires as compared to single segment Co nanowires. The complementary micromagnetic simulations are in good agreement with the experimental results, confirming that the magnetic behavior is defined mainly by magnetostatic coupling between different segments. The proposed structure constitutes an innovative route towards a 3D array of synchronized magnetic nano-oscillators with large potential in nanoelectronics.

  5. Computer-assisted multi-segment gradient optimization in ion chromatography. (United States)

    Tyteca, Eva; Park, Soo Hyun; Shellie, Robert A; Haddad, Paul R; Desmet, Gert


    This study reports simulation and optimization of ion chromatography separations using multi-segment gradient elution. First, an analytical expression for the gradient retention factor under these complex elution profiles was derived. This allows a rapid retention time prediction calculations under different gradient conditions, during computer-assisted method development. Next, these analytical expressions were implemented in an in-house written Matlab(®) routine that searches for the optimal (multi-segment) gradient conditions, either via a four-segment grid search or via the recently proposed one-segment-per-component search, in which the slope is adjusted after the elution of each individual component. Evaluation of the retention time simulation and optimization approaches was performed on a mixture of 18 inorganic anions and different subsets with varying number of compounds. The two considered multi-segment gradient optimization searches resulted in similar proposed gradient profiles, and corresponding chromatograms. Moreover, the resultant chromatograms were clearly superior to the chromatograms obtained from the best simple linear gradient profiles, found via a fine grid search. The proposed approach is useful for automated method development in ion chromatography in which complex elution profiles are often used to increase the separation power.

  6. Characterization of foot-and-mouth disease virus gene products with antisera against bacterially synthesized fusion proteins

    Energy Technology Data Exchange (ETDEWEB)

    Strebel, K.; Beck, E.; Strohmaier, K.; Schaller, H.


    Defined segments of the cloned foot-and-mouth disease virus genome corresponding to all parts of the coding region were expressed in Escherichia coli as fusions to the N-terminal part of the MS2-polymerase gene under the control of the inducible lambdaPL promoter. All constructs yielded large amounts of proteins, which were purified and used to raise sequence-specific antisera in rabbits. These antisera were used to identify the corresponding viral gene products in /sup 35/S-labeled extracts from foot-and-mouth disease virus-infected BHK cells. This allowed us to locate unequivocally all mature foot-and-mouth disease virus gene products in the nucleotide sequence, to identify precursor-product relationships, and to detect several foot-and mouth disease virus gene products not previously identified in vivo or in vitro.

  7. Foot-and-mouth disease

    DEFF Research Database (Denmark)

    Belsham, Graham; Charleston, Bryan; Jackson, Terry;


    Foot-and-mouth disease is an economically important, highly contagious, disease of cloven-hoofed animals characterized by the appearance of vesicles (blisters) on the feet and in and around the mouth. The causative agent, foot-and-mouth disease virus, was the first mammalian virus to be discovered...

  8. Athlete's Foot (United States)

    ... area. Your doctor also may take a small scraping of the skin on your foot. This sample ... Privacy Policy & Terms of Use Visit the Nemours Web site. Note: All information on TeensHealth® is for ...

  9. A multisegment computer simulation of normal human gait. (United States)

    Gilchrist, L A; Winter, D A


    The goal of this project was to develop a computer simulation of normal human walking that would use as driving moments resultant joint moments from a gait analysis. The system description, initial conditions and driving moments were taken from an inverse dynamics analysis of a normal walking trial. A nine-segment three-dimensional (3-D) model, including a two-part foot, was used. Torsional, linear springs and dampers were used at the hip joints to keep the trunk vertical and at the knee and ankle joints to prevent nonphysiological motion. Dampers at other joints were required to ensure a smooth and realistic motion. The simulated human successfully completed one step (550 ms), including both single and double support phases. The model proved to be sensitive to changes in the spring stiffness values of the trunk controllers. Similar sensitivity was found with the springs used to prevent hyperextension of the knee at heel contact and of the metatarsal-phalangeal joint at push-off. In general, there was much less sensitivity to the damping coefficients. This simulation improves on previous efforts because it incorporates some features necessary in simulations designed to answer clinical science questions. Other control algorithms are required, however, to ensure that the model can be realistically adapted to different subjects.

  10. A novel theoretical framework for the dynamic stability analysis, movement control, and trajectory generation in a multisegment biomechanical model. (United States)

    Iqbal, Kamran; Roy, Anindo


    We consider a simplified characterization of the postural control system that embraces two broad components: one representing the musculoskeletal dynamics in the sagittal plane and the other representing proprioceptive feedback and the central nervous system (CNS). Specifically, a planar four-segment neuromusculoskeletal model consisting of the ankle, knee, and hip degrees-of-freedom (DOFs) is described in this paper. The model includes important physiological constructs such as Hill-type muscle model, active and passive muscle stiffnesses, force feedback from the Golgi tendon organ, muscle length and rate feedback from the muscle spindle, and transmission latencies in the neural pathways. A proportional-integral-derivative (PID) controller for each individual DOF is assumed to represent the CNS analog in the modeling paradigm. Our main hypothesis states that all stabilizing PID controllers for such multisegment biomechanical models can be parametrized and analytically synthesized. Our analytical and simulation results show that the proposed representation adequately shapes a postural control that (a) possesses good disturbance rejection and trajectory tracking, (b) is robust against feedback latencies and torque perturbations, and (c) is flexible to embrace changes in the musculoskeletal parameters. We additionally present detailed sensitivity analysis to show that control under conditions of limited or no proprioceptive feedback results in (a) significant reduction in the stability margins, (b) substantial decrease in the available stabilizing parameter set, and (c) oscillatory movement trajectories. Overall, these results suggest that anatomical arrangement, active muscle stiffness, force feedback, and physiological latencies play a major role in shaping motor control processes in humans.

  11. Characterization of a chimeric foot-and-mouth disease virus bearing bovine rhinitis B virus leader proteinase (United States)

    Our recent study has shown that bovine rhinovirus type 2 (BRV2), a new member of the Aphthovirus genus, shares many motifs and sequence similarities with foot-and-mouth disease virus (FMDV). Despite low sequence conservation (36percent amino acid identity) and N- and C-terminus folding differences,...

  12. Assembly and characterization of foot-and-mouth disease virus empty capsid particles expressed within mammalian cells

    DEFF Research Database (Denmark)

    Gullberg, Maria; Muszynski, Bartosz; Organtini, Lindsey J.;


    The foot-and-mouth disease virus (FMDV) structural protein precursor, P1-2A, is cleaved by the virus-encoded 3C protease (3Cpro) into the capsid proteins VP0, VP1 and VP3 (and 2A). In some systems, it is difficult to produce large amounts of these processed capsid proteins since 3Cpro can be toxic...

  13. Cavus Foot Surgery (United States)

    ... All Site Content AOFAS / FootCareMD / Treatments Cavus Foot Surgery Page Content What is a cavus foot? A ... problems. What are the goals of cavus foot surgery? The main goal of surgery is to reduce ...

  14. Verification and Validation of Multisegmented Mooring Capabilities in FAST v8

    DEFF Research Database (Denmark)

    Andersen, Morten Thøtt; Wendt, Fabian F.; Robertson, Amy N.


    The quasi-static and dynamic mooring modules of the open-source aero-hydro-servo-elastic wind turbine simulation software, FAST v8, have previously been verified and validated, but only for mooring arrangements consisting of single lines connecting each fairlead and anchor. This paper extends...... of the mooring system, was used for the verification and validation activities. This paper focuses on free-decay tests because the influence of the multisegmented moorings is most important for yaw motion, which is not excited by waves. All of the listed modules are able to represent the platform motion observed...

  15. Club foot

    DEFF Research Database (Denmark)

    Engell, V; Damborg, F; Andersen, M;


    The aetiology of congenital club foot is unclear. Although studies on populations, families and twins suggest a genetic component, the mode of inheritance does not comply with distinctive patterns. The Odense-based Danish Twin Registry contains data on all 73,000 twin pairs born in Denmark over t...

  16. Mycetoma foot

    Directory of Open Access Journals (Sweden)

    Somnath Gooptu


    Full Text Available Mycetoma is an uncommon chronic granulomatous infective disease of the skin, dermis and subcutaneous tissues predominantly seen in tropical countries. A patient presented to our hospital with the swelling of the left foot with a healed sinus and a painful nodule. He gave a history of sinuses in the left foot from which there was discharge of yellow granules. Culture of the ultrasound guided fine needle aspiration cytology of the nodule revealed growths of Nocardia species. The patient was treated with a multi-drug therapy along with debridement of the painful nodule. He experienced symptomatic relief and a regression of the swelling within the three months of follow-up so far. Due to the relatively slow progression of the disease, patients are diagnosed at a late stage. Hence, emphasis should be placed on health education and the importance of wearing footwear.

  17. Differences in foot kinematics between young and older adults during walking. (United States)

    Arnold, John B; Mackintosh, Shylie; Jones, Sara; Thewlis, Dominic


    Our understanding of age-related changes to foot function during walking has mainly been based on plantar pressure measurements, with little information on differences in foot kinematics between young and older adults. The purpose of this study was to investigate the differences in foot kinematics between young and older adults during walking using a multi-segment foot model. Joint kinematics of the foot and ankle for 20 young (mean age 23.2 years, standard deviation (SD) 3.0) and 20 older adults (mean age 73.2 years, SD 5.1) were quantified during walking with a 12 camera Vicon motion analysis system using a five segment kinematic model. Differences in kinematics were compared between older adults and young adults (preferred and slow walking speeds) using Student's t-tests or if indicated, Mann-Whitney U tests. Effect sizes (Cohen's d) for the differences were also computed. The older adults had a less plantarflexed calcaneus at toe-off (-9.6° vs. -16.1°, d = 1.0, p = Walking speed did not influence these differences, as they remained present when groups walked at comparable speeds. The findings of this study indicate that independent of walking speed, older adults exhibit significant differences in foot kinematics compared to younger adults, characterised by less propulsion and reduced mobility of multiple foot segments.

  18. Molecular characterization of serotype Asia-1 foot-and-mouth disease viruses in Pakistan and Afghanistan; emergence of a new genetic Group and evidence for a novel recombinant virus

    DEFF Research Database (Denmark)

    Jamal, Syed Muhammad; Ferrari, Giancarlo; Ahmed, Safia;


    Foot-and-mouth disease (FMD) is endemic in Pakistan and Afghanistan. The FMD virus serotypes O, A and Asia-1 are responsible for the outbreaks in these countries. Diverse strains of FMDV, even within the same serotype, co-circulate. Characterization of the viruses in circulation can facilitate...... appropriate vaccine selection and tracing of outbreaks.The present study characterized foot-and-mouth disease serotype Asia-1 viruses circulating in Pakistan and Afghanistan during the period 1998–2009. Phylogenetic analysis of FMDV type Asia-1 revealed that three different genetic Groups of serotype Asia-1...

  19. The influence of footwear on foot motion during walking and running. (United States)

    Morio, Cédric; Lake, Mark J; Gueguen, Nils; Rao, Guillaume; Baly, Laurent


    There are evidences to suggest that wearing footwear constrains the natural barefoot motion during locomotion. Unlike prior studies that deduced foot motions from shoe sole displacement parameters, the aim of this study was to examine the effect of footwear motion on forefoot to rearfoot relative motion during walking and running. The use of a multi-segment foot model allowed accurate both shoe sole and foot motions (barefoot and shod) to be quantified. Two pairs of identical sandals with different midsole hardness were used. Ten healthy male subjects walked and ran in each of the shod condition. The results showed that for barefoot locomotion there was more eversion of the forefoot and it occurred faster than for shod locomotion. In this later condition, the range of eversion was reduced by 20% and the rate of eversion in late stance by 60% in comparison to the barefoot condition. The sole constrained both the torsional (eversion/inversion) and adduction range of motion of the foot. Interestingly, during the push-off phase of barefoot locomotion the rate and direction of forefoot torsion varied between individuals. However, most subjects displayed a forefoot inversion direction of motion while shod. Therefore, this experiment showed that the shoes not only restricted the natural motion of the barefoot but also appeared to impose a specific foot motion pattern on individuals during the push-off phase. These findings have implications for the matching of footwear design characteristics to individual natural foot function.

  20. The prevention of diabetic foot ulceration: how biomechanical research informs clinical practice

    Directory of Open Access Journals (Sweden)

    Frank E. DiLiberto

    Full Text Available ABSTRACT Background Implementation of interprofessional clinical guidelines for the prevention of neuropathic diabetic foot ulceration has demonstrated positive effects regarding ulceration and amputation rates. Current foot care recommendations are primarily based on research regarding the prevention of ulcer recurrence and focused on reducing the magnitude of plantar stress (pressure overload. Yet, foot ulceration remains to be a prevalent and debilitating consequence of Diabetes Mellitus. There is limited evidence targeting the prevention of first-time ulceration, and there is a need to consider additional factors of plantar stress to supplement current guidelines. Objectives The first purpose of this article is to discuss the biomechanical theory underpinning diabetic foot ulcerations and illustrate how plantar tissue underloading may precede overloading and breakdown. The second purpose of this commentary is to discuss how advances in biomechanical foot modeling can inform clinical practice in the prevention of first-time ulceration. Discussion Research demonstrates that progressive weight-bearing activity programs to address the frequency of plantar stress and avoid underloading do not increase ulceration risk. Multi-segment foot modeling studies indicate that dynamic foot function of the midfoot and forefoot is compromised in people with diabetes. Emerging research demonstrates that implementation of foot-specific exercises may positively influence dynamic foot function and improve plantar stress in people with diabetes. Conclusion Continued work is needed to determine how to best design and integrate activity recommendations and foot-specific exercise programs into the current interprofessional paradigm for the prevention of first-time ulceration in people with Diabetes Mellitus.

  1. The Effects of Various Running Inclines on Three-Segment Foot Mechanics and Plantar Fascia Strain

    Directory of Open Access Journals (Sweden)

    Sinclair Jonathan


    Full Text Available Purpose. There has yet to be a combined analysis of three-dimensional multi-segment foot kinematics and plantar fascia strain in running gait at various degrees of inclination. The aim of the current study was therefore to investigate the above during treadmill running at different inclines (0°, 5°, 10° and 15°. Methods. Twelve male participants ran at 4.0 m · s-1 in the four different inclinations. Three-dimensional kinematics of the foot segments and plantar fascia strain were quantified for each incline and contrasted using one-way repeated measures ANOVA. Results and conclusions. The results showed that plantar fascia strain increased significantly as a function of running incline. Given the projected association between plantar fascia strain and the aetiology of injury, inclined running may be associated with a greater incidence of injury to the plantar fascia.

  2. Design and experimental gait analysis of a multi-segment in-pipe robot inspired by earthworm's peristaltic locomotion (United States)

    Fang, Hongbin; Wang, Chenghao; Li, Suyi; Xu, Jian; Wang, K. W.


    This paper reports the experimental progress towards developing a multi-segment in-pipe robot inspired by earthworm's body structure and locomotion mechanism. To mimic the alternating contraction and elongation of a single earthworm's segment, a robust, servomotor based actuation mechanism is developed. In each robot segment, servomotor-driven cords and spring steel belts are utilized to imitate the earthworm's longitudinal and circular muscles, respectively. It is shown that the designed segment can contract and relax just like an earthworm's body segment. The axial and radial deformation of a single segment is measured experimentally, which agrees with the theoretical predictions. Then a multisegment earthworm-like robot is fabricated by assembling eight identical segments in series. The locomotion performance of this robot prototype is then extensively tested in order to investigate the correlation between gait design and dynamic locomotion characteristics. Based on the principle of retrograde peristalsis wave, a gait generator is developed for the multi-segment earthworm-like robot, following which gaits of the robot can be constructed. Employing the generated gaits, the 8-segment earthworm-like robot can successfully perform both horizontal locomotion and vertical climb in pipes. By changing gait parameters, i.e., with different gaits, locomotion characteristics including average speed and anchor slippage can be significantly tailored. The proposed actuation method and prototype of the multi-segment in-pipe robot as well as the gait generator provide a bionic realization of earthworm's locomotion with promising potentials in various applications such as pipeline inspection and cleaning.

  3. Multisegment one-step RT-PCR fluorescent labeling of influenza A virus genome for use in diagnostic microarray applications

    Energy Technology Data Exchange (ETDEWEB)

    Vasin, A V; Plotnikova, M A; Klotchenko, S A; Elpaeva, E A; Komissarov, A B; Egorov, V V; Kiselev, O I [Research Institute of Influenza of the Ministry of Health and Social Development of the Russian Federation, 15/17 Prof. Popova St., St. Petersburg (Russian Federation); Sandybaev, N T; Chervyakova, O V; Strochkov, V M; Taylakova, E T; Koshemetov, J K; Mamadaliev, S M, E-mail: [Research Institute for Biological Safety Problems of the RK NBC/SC ME and S RK, Gvardeiskiy (Kazakhstan)


    Microarray technology is one of the most challenging methods of influenza A virus subtyping, which is based on the antigenic properties of viral surface glycoproteins - hemagglutinin and neuraminidase. On the example of biochip for detection of influenza A/H5N1 virus we showed the possibility of using multisegment RTPCR method for amplification of fluorescently labeled cDNA of all possible influenza A virus subtypes with a single pair of primers in influenza diagnostic microarrays.

  4. Multi-joint foot kinetics during walking in people with Diabetes Mellitus and peripheral neuropathy. (United States)

    DiLiberto, Frank E; Tome, Josh; Baumhauer, Judith F; Quinn, Jill R; Houck, Jeff; Nawoczenski, Deborah A


    Neuropathic tissue changes can alter muscle function and are a primary reason for foot pathologies in people with Diabetes Mellitus and peripheral neuropathy (DMPN). Understanding of foot kinetics in people with DMPN is derived from single-segment foot modeling approaches. This approach, however, does not provide insight into midfoot power and work. Gaining an understanding of midfoot kinetics in people with DMPN prior to deformity or ulceration may help link foot biomechanics to anticipated pathologies in the midfoot and forefoot. The purpose of this study was to evaluate midfoot (MF) and rearfoot (RF) power and work in people with DMPN and a healthy matched control group. Thirty people participated (15 DMPN and 15 Controls). An electro-magnetic tracking system and force plate were used to record multi-segment foot kinematics and ground reaction forces during walking. MF and RF power, work, and negative work ratios were calculated and compared between groups. Findings demonstrated that the DMPN group had greater negative peak power and reduced positive peak power at the MF and RF (all p≤0.05). DMPN group negative work ratios were also greater at the MF and RF [Mean difference MF: 9.9%; p=0.24 and RF: 18.8%; pstudy is recommended to determine how both MF and RF kinetics influence the development of deformity and ulceration in people with DMPN.

  5. The Charcot foot in diabetes. (United States)

    Rogers, Lee C; Frykberg, Robert G; Armstrong, David G; Boulton, Andrew J M; Edmonds, Michael; Van, Georges Ha; Hartemann, Agnes; Game, Frances; Jeffcoate, William; Jirkovska, Alexandra; Jude, Edward; Morbach, Stephan; Morrison, William B; Pinzur, Michael; Pitocco, Dario; Sanders, Lee; Wukich, Dane K; Uccioli, Luigi


    The diabetic Charcot foot syndrome is a serious and potentially limb-threatening lower-extremity complication of diabetes. First described in 1883, this enigmatic condition continues to challenge even the most experienced practitioners. Now considered an inflammatory syndrome, the diabetic Charcot foot is characterized by varying degrees of bone and joint disorganization secondary to underlying neuropathy, trauma, and perturbations of bone metabolism. An international task force of experts was convened by the American Diabetes Association and the American Podiatric Medical Association in January 2011 to summarize available evidence on the pathophysiology, natural history, presentations, and treatment recommendations for this entity.

  6. Modelling soft tissue for kinematic analysis of multi-segment human body models. (United States)

    Benham, M P; Wright, D K; Bibb, R


    Traditionally biomechanical models represent the musculoskeletal system by a series of rigid links connected by rigidly defined rotational joints. More recently though the mechanics of joints and the action of soft tissues has come under closer scrutiny: biomechanical models might now include a full range of physiological structures. However, soft tissue representation, within multi-segment human body models, presents significant problems; not least in computational speed. We present a method for representing soft tissue physiology which provides for soft tissue wrapping around multiple bony objects; while showing forces at the insertion points, as well as normal reactions due to contact between the soft and bony tissues. These soft tissue representations may therefore be used to constrain the joint, as ligaments would, or to generate motion, like a muscle, so that joints may be modelled which more accurately simulate musculoskeletal motion in all degrees of freedom--rotational and translational. This method produces soft tissues that do not need to be tied to a certain path or route between the bony structures, but may move with the motion of the model; demonstrating a more realistic analysis of soft tissue activity in the musculoskeletal system. The combination of solid geometry models of the skeletal structure, and these novel soft tissue representations, may also provide a useful approach to synthesised human motion.

  7. High-throughput templated multisegment synthesis of gold nanowires and nanorods. (United States)

    Burdick, Jared; Alonas, Eric; Huang, Huang-Chiao; Rege, Kaushal; Wang, Joseph


    A cost-effective, high-throughput method for generating gold nanowires and/or nanorods based on a multisegment template electrodeposition approach is described. Using this method, multiple nanowires/nanorods can be generated from a single pore of alumina template membranes by alternately depositing segments of desirable (e.g., gold) and non-desirable metals (e.g., silver), followed by dissolution of the template and the non-desirable metal. Critical cost analysis indicates substantial savings in material requirements, processing times, and processing costs compared to the commonly used single-segment method. In addition to solid gold nanowires/nanorods, high yields of porous gold nanowires/nanorods are obtained by depositing alternate segments of gold-silver alloy and silver from the same gold-silver plating solution followed by selective dissolution of the silver from both segments. It is anticipated that this high-throughput method for synthesizing solid and porous gold nanowires and nanorods will accelerate their use in sensing, electronic, and biomedical applications.

  8. Quantitative magnetometry analysis and structural characterization of multisegmented cobalt–nickel nanowires

    Energy Technology Data Exchange (ETDEWEB)

    Cantu-Valle, Jesus [Department of Physics and Astronomy, University of Texas at San Antonio, One UTSA Circle, San Antonio, TX 78249 (United States); Díaz Barriga-Castro, Enrique [Centro de Investigación de Ciencias Físico Matemáticas/Facultad de Ciencias Físico Matemáticas, Universidad Autónoma de Nuevo León, Pedro de Alba s/n, San Nicolás de Los Garza, Nuevo León 66450 (Mexico); Vega, Víctor; García, Javier [Departamento de Física, Universidad de Oviedo, Calvo Sotelo s/n, Oviedo 33007 (Spain); Mendoza-Reséndez, Raquel [Facultad de Ingeniería Mecánica y Eléctrica. Universidad Autónoma de Nuevo León, Pedro de Alba s/n, San Nicolás de Los Garza, Nuevo León 66450 (Mexico); Luna, Carlos [Centro de Investigación de Ciencias Físico Matemáticas/Facultad de Ciencias Físico Matemáticas, Universidad Autónoma de Nuevo León, Pedro de Alba s/n, San Nicolás de Los Garza, Nuevo León 66450 (Mexico); Manuel Prida, Víctor [Departamento de Física, Universidad de Oviedo, Calvo Sotelo s/n, Oviedo 33007 (Spain); and others


    Understanding and measuring the magnetic properties of an individual nanowire and their relationship with crystalline structure and geometry are of scientific and technological great interest. In this work, we report the localized study of the magnetic flux distribution and the undisturbed magnetization of a single ferromagnetic nanowire that poses a bar-code like structure using off-axis electron holography (EH) under Lorentz conditions. The nanowires were grown by template-assisted electrodeposition, using AAO templates. Electron holography allows the visualization of the magnetic flux distribution within and surroundings as well as its quantification. The magnetic analysis performed at individual nanowires was correlated with the chemical composition and crystalline orientation of the nanowires. - Highlights: • The structure-magnetic property relationship of CoNi nanowires is determined. • Off axis electron holography for the magnetic nanowires is used for the analysis. • The magnetization is quantitatively obtained from the retrieved phase images. • These results lead to a better comprehension of the magneto-crystalline phenomena.

  9. Adult Foot Health (United States)

    ... foot will usually respond to treatment with anti-fungal powders and lotions along with good foot hygiene. ... strikes thousands of Americans. This special type of arthritis can be diagnosed only by medical examination and ...

  10. Prevention of foot blisters. (United States)

    Knapik, Joseph J


    Foot blisters are the most common medical problem faced by Soldiers during foot march operations and, if untreated, they can lead to infection. Foot blisters are caused by boots rubbing on the foot (frictional forces), which separates skin layers and allows fluid to seep in. Blisters can be prevented by wearing properly sized boots, conditioning feet through regular road marching, wearing socks that reduce reduce friction and moisture, and possibly applying antiperspirants to the feet.

  11. Center of mass control and multi-segment coordination in children during quiet stance. (United States)

    Wu, Jianhua; McKay, Sandra; Angulo-Barroso, Rosa


    This study aimed to apply an uncontrolled manifold (UCM) approach to investigate how children utilize the variability of multiple body segment movement to facilitate the center of mass (COM) control during quiet stance. Three groups of participants were included in this study: younger children (YC, mean age 6.3 years), older children (OC, mean age 10.3 years), and young adults (YA, mean age 20.5 years). Participants stood on a force platform with their hands on the iliac crests for 40 s in each trial. Two visual conditions were examined including eyes-open and eyes-closed and three trials were collected for each condition. Results showed that all three groups partitioned more variability of multi-segment movement into the UCM subspace (maintaining the mean COM position) than into the ORT subspace (a subspace orthogonal to the UCM subspace, causing the deviation of the COM from its mean position) in both eyes-open and eyes-closed conditions. Furthermore, both the YC and OC groups partitioned a significantly higher percentage of variability into the UCM subspace than the YA group regardless of visual condition. In addition, results of conventional COM variables indicated that only the YC group produced significantly faster sway velocity and greater standard deviation than the YA group. All the results together suggest that children at 6-10 years of age use a similar variability-partitioning strategy (a greater V(UCM) and a smaller V(ORT)) like young adults in quiet stance to facilitate the COM control, but it takes more than 10 years for children to refine this strategy and achieve an adult-like variability-partitioning capability (i.e., UCM ratio). It also suggests that postural development may include two phases in which children learn to regulate the position and movement of multiple body segments and the COM first and gain an adult-like variability-partitioning capability later.

  12. Molecular characterization of SAT-2 foot-and-mouth disease virus isolates obtained from cattle during a four-month period in 2001 in Limpopo Province, South Africa. (United States)

    Phologane, B S; Dwarka, R M; Haydon, D T; Gerber, L J; Vosloo, W


    Foot-and-mouth disease (FMD) is an acute, highly contagious viral infection of domestic and wild cloven-hoofed animals. The virus is a single-stranded RNA virus that has a high rate of nucleotide mutation and amino acid substitution. In southern Africa the South African Territories (SAT) 1-3 serotypes of FMD virus are maintained by large numbers of African buffaloes (Syncerus caffer), which provide a potential source of infection for domestic livestock and wild animals. During February 2001, an outbreak of SAT-2 was recorded in cattle in the FMD control zone of South Africa, adjacent to the Kruger National Park (KNP). They had not been vaccinated against the disease since they form the buffer between the vaccination and free zones but in the face of the outbreak, they were vaccinated as part of the control measures to contain the disease. The virus was, however, isolated from some of them on several occasions up to May 2001. These isolates were characterized to determine the rate of genetic change in the main antigenic determinant, the 1 D/2A gene. Nucleotide substitutions at 12 different sites were identified of which five led to amino acid changes. Three of these occurred in known antigenic sites, viz. the GH-loop and C-terminal part of the protein, and two of these have previously been shown to be subject to positive selection. Likelihood models indicated that the ratio of non-synonymous to synonymous changes among the outbreak sequences recovered from cattle was four times higher than among comparable sequences isolated from wildlife, suggesting that the virus may be under greater selective pressure during rapid transmission events.

  13. Characterization of Coxsackievirus A6- and Enterovirus 71-Associated Hand Foot and Mouth Disease in Beijing, China, from 2013 to 2015 (United States)

    Li, Jie; Sun, Ying; Du, Yiwei; Yan, Yuxiang; Huo, Da; Liu, Yuan; Peng, Xiaoxia; Yang, Yang; Liu, Fen; Lin, Changying; Liang, Zhichao; Jia, Lei; Chen, Lijuan; Wang, Quanyi; He, Yan


    Background: Etiology surveillance of Hand Foot and Mouth disease (HFMD) in Beijing showed that Coxsackievirus A6 (CVA6) became the major pathogen of HFMD in 2013 and 2015. In order to understand the epidemiological characteristics and clinical manifestations of CVA6-associated HFMD, a comparison study among CVA6-, EV71- (Enterovirus 71), and CVA16- (Coxsackievirus A16) associated HFMD was performed. Methods: Epidemiological characteristics and clinical manifestations among CVA6-, EV71- and CVA16-associated mild or severe cases were compared from 2013 to 2015. VP1 gene of CVA6 and EV71 from mild cases, severe cases were sequenced, aligned, and compared with strains from 2009 to 2015 in Beijing and strains available in GenBank. Phylogenetic tree was constructed by neighbor-joining method. Results: CVA6 became the predominant causative agent of HFMD and accounted for 35.4 and 36.9% of total positive cases in 2013 and 2015, respectively. From 2013 to 2015, a total of 305 severe cases and 7 fatal cases were reported. CVA6 and EV71 were responsible for 57.5% of the severe cases. Five out six samples from fatal cases were identified as EV71. High fever, onychomadesis, and decrustation were the typical symptoms of CVA6-associated mild HFMD. CVA6-associated severe cases were characterized by high fever with shorter duration and twitch compared with EV71-associated severe cases which were characterized by poor mental condition, abnormal pupil, and vomiting. Poor mental condition, lung wet rales, abnormal pupil, and tachycardia were the most common clinical features of fatal cases. The percentage of lymphocyte in CVA6-associated cases was significantly lower than that of EV71. High percentage of lymphocyte and low percentage of neutrophils were the typical characteristics of fatal cases. VP1 sequences between CVA6- or EV71-associated mild and severe cases were highly homologous. Conclusion: CVA6 became one of the major pathogens of HFMD in 2013 and 2015 in Beijing

  14. Amplification and Characterization of Bull Semen Infected Naturally with Foot-and-mouth Disease Virus Type Asial by RT-PCR

    Institute of Scientific and Technical Information of China (English)

    Jun-jun SHAO; Xiang-tao LIU; Zai-xin LIU; Ji-xing LIU; Hui-yun CHANG; Tong LIN; Guo-zheng CONG; Jun-zheng DU; Jian-hong GUO; Hui-fang BAO; You-jun SHANG; Ya-min YANG


    To investigate the security of semen biologically, 15 bull semen samples were collected (of which 5 exhibited clinical signs of Foot-and-mouth disease) and identified by RT-PCR and virus isolation. The results indicated that the semen of the infected bulls were contaminated by Foot-and-mouth disease virus (FMDV), but FMDV was not detected in semen samples from those bulls not showing clinical signs of Foot-and-mouth disease (FMD). This is the first report of the presence of FMDV in bull semen due to natural infection in China. The analysis of the partial sequence of the VP1 gene showed that the virus strain isolated from semen has 97.9% identity with the virus isolated from vesicular liquid of infected bulls showing typical signs of FMD and belonged to the same gene sub-group.

  15. Development and Characterization of A Multiplexed RT-PCR Species Specific Assay for Bovine and one for Porcine Foot-and-Mouth Disease Virus Rule-Out

    Energy Technology Data Exchange (ETDEWEB)

    Smith, S M; Danganan, L; Tammero, L; Vitalis, B; Lenhoff, R; Naraghi-arani, P; Hindson, B


    Lawrence Livermore National Laboratory (LLNL), in collaboration with the Department of Homeland Security (DHS) and the United States Department of Agriculture (USDA), Animal and Plant Health Inspection Services (APHIS) has developed candidate multiplexed assays that may potentially be used within the National Animal Health Laboratory Network (NAHLN), the National Veterinary Services Laboratory (Ames, Iowa) and the Plum Island Animal Disease Center (PIADC). This effort has the ability to improve our nation's capability to discriminate between foreign animal diseases and those that are endemic using a single assay, thereby increasing our ability to protect food and agricultural resources with a diagnostic test which could enhance the nation's capabilities for early detection of a foreign animal disease. In FY2005 with funding from the DHS, LLNL developed the first version (Version 1.0) of a multiplexed (MUX) nucleic-acid-based RT-PCR assay that included signatures for foot-and-mouth disease virus (FMDV) detection with rule-out tests for two other foreign animal diseases (FADs) of swine, Vesicular Exanthema of Swine (VESV) and Swine Vesicular Disease Virus (SVDV), and four other domestic viral diseases Bovine Viral Diarrhea Virus (BVDV), Bovine Herpes Virus 1 (BHV-1), Bluetongue virus (BTV) and Parapox virus complex (which includes Bovine Papular Stomatitis Virus [BPSV], Orf of sheep, and Pseudocowpox). In FY06, LLNL has developed Bovine and Porcine species-specific panel which included existing signatures from Version 1.0 panel as well as new signatures. The MUX RT-PCR porcine assay for detection of FMDV includes the FADs, VESV and SVD in addition to vesicular stomatitis virus (VSV) and porcine reproductive and respiratory syndrome (PRRS). LLNL has also developed a MUX RT-PCR bovine assay for detection of FMDV with rule out tests for the two bovine FADs malignant catarrhal fever (MCF), rinderpest virus (RPV) and the domestic diseases vesicular stomatitis

  16. Does excessive flatfoot deformity affect function? A comparison between symptomatic and asymptomatic flatfeet using the Oxford Foot Model. (United States)

    Hösl, Matthias; Böhm, Harald; Multerer, Christel; Döderlein, Leonhard


    Treatment of asymptomatic flexible flatfeet is a subject of great controversy. The purpose of this study was to examine foot function during walking in symptomatic (SFF) and asymptomatic (ASFF) flexible flatfeet. Thirty-five paediatric and juvenile patients with idiopathic flexible flatfeet were recruited from an orthopaedic outpatient department (14 SFF and 21 ASFF). Eleven age-matched participants with typically developing feet served as controls (TDF). To study foot function, 3D multi-segment foot kinematics and ankle joint kinetics were captured during barefoot gait analysis. Overall, alterations in foot kinematics in flatfeet were pronounced but differences between SFF and ASFF were not observed. Largest discriminatory effects between flatfeet and TDF were noticed in reduced hindfoot dorsiflexion as well as in increased forefoot supination and abduction. Upon clinical examination, restrictions in passive dorsiflexion in ASFF and SFF were significant. During gait, the hindfoot in flatfeet (both ASFF and SFF) was more everted, but less flexible. In sagittal plane, limited hindfoot dorsiflexion of ASFF and SFF was compensated for by increased forefoot mobility and a hypermobile hallux. Concerning ankle kinetics, SFF lacked positive joint energy for propulsion while ASFF needed to absorb more negative ankle joint energy during loading response. This may risk fatigue and overuse syndrome of anterior shank muscles in ASFF. Hence, despite a lack of symptoms flatfoot deformity in ASFF affected function. Yet, contrary to what was expected, SFF did not show greater deviations in 3D foot kinematics than ASFF. Symptoms may rather depend on tissue wear and subjective pain thresholds.

  17. Multi-detector row computed tomography of the heart: does a multi-segment reconstruction algorithm improve left ventricular volume measurements?

    Energy Technology Data Exchange (ETDEWEB)

    Juergens, Kai Uwe; Maintz, David; Heimes, Britta; Fallenberg, Eva Maria; Heindel, Walter; Fischbach, Roman [University of Muenster, Department of Clinical Radiology, Muenster (Germany); Grude, Matthias [University of Muenster, Department of Cardiology and Angiology, Muenster (Germany); Boese, Jan M. [Siemens Medical Solutions, Forchheim (Germany)


    A multi-segment cardiac image reconstruction algorithm in multi-detector row computed tomography (MDCT) was evaluated regarding temporal resolution and determination of left ventricular (LV) volumes and global LV function. MDCT and cine magnetic resonance (CMR) imaging were performed in 12 patients with known or suspected coronary artery disease. Patients gave informed written consent for the MDCT and the CMR exam. MDCT data were reconstructed using the standard adaptive cardiac volume (ACV) algorithm as well as a multi-segment algorithm utilizing data from three, five and seven rotations. LV end-diastolic (LV-EDV) and end-systolic volumes and ejection fraction (LV-EF) were determined from short-axis image reformations and compared to CMR data. Mean temporal resolution achieved was 192{+-}24 ms using the ACV algorithm and improved significantly utilizing the three, five and seven data segments to 139{+-}12, 113{+-}13 and 96{+-}11 ms (P<0.001 for each). Mean LV-EDV was without significant differences using the ACV algorithm, the multi-segment approach and CMR imaging. Despite improved temporal resolution with multi-segment image reconstruction, end-systolic volumes were less accurately measured (mean differences 3.9{+-}11.8 ml to 8.1{+-}13.9 ml), resulting in a consistent underestimation of LV-EF by 2.3-5.4% in comparison to CMR imaging (Bland-Altman analysis). Multi-segment image reconstruction improves temporal resolution compared to the standard ACV algorithm, but this does not result in a benefit for determination of LV volume and function. (orig.)

  18. Characterization of foot-and-mouth disease viruses from Ugandan cattle outbreaks during 2012-2013: Evidence for circulation of multiple serotypes

    DEFF Research Database (Denmark)

    Namatovu, Alice; Tjørnehøj, Kirsten; Belsham, Graham;


    To investigate the foot-and-mouth disease virus (FMDV) serotypes circulating in Uganda’s cattle population, both serological and virological analyses of samples from outbreaks that occurred during 2012-2013 were performed. Altogether, 79 sera and 60 oropharyngeal fluid (OP)/tissue/oral swab sampl...

  19. Diabetic foot infections. (United States)

    Gemechu, Fassil W; Seemant, Fnu; Curley, Catherine A


    Diabetic foot infection, defined as soft tissue or bone infection below the malleoli, is the most common complication of diabetes mellitus leading to hospitalization and the most frequent cause of nontraumatic lower extremity amputation. Diabetic foot infections are diagnosed clinically based on the presence of at least two classic findings of inflammation or purulence. Infections are classified as mild, moderate, or severe. Most diabetic foot infections are polymicrobial. The most common pathogens are aerobic gram-positive cocci, mainly Staphylococcus species. Osteomyelitis is a serious complication of diabetic foot infection that increases the likelihood of surgical intervention. Treatment is based on the extent and severity of the infection and comorbid conditions. Mild infections are treated with oral antibiotics, wound care, and pressure off-loading in the outpatient setting. Selected patients with moderate infections and all patients with severe infections should be hospitalized, given intravenous antibiotics, and evaluated for possible surgical intervention. Peripheral arterial disease is present in up to 40% of patients with diabetic foot infections, making evaluation of the vascular supply critical. All patients with diabetes should undergo a systematic foot examination at least once a year, and more frequently if risk factors for diabetic foot ulcers exist. Preventive measures include patient education on proper foot care, glycemic and blood pressure control, smoking cessation, use of prescription footwear, intensive care from a podiatrist, and evaluation for surgical interventions as indicated.

  20. Development and Characterization of A Multiplexed RT-PCR Species Specific Assay for Bovine and one for Porcine Foot-and-Mouth Disease Virus Rule-Out

    Energy Technology Data Exchange (ETDEWEB)

    Smith, S M; Danganan, L; Tammero, L; Vitalis, B; Lenhoff, R; Naraghi-arani, P; Hindson, B


    Lawrence Livermore National Laboratory (LLNL), in collaboration with the Department of Homeland Security (DHS) and the United States Department of Agriculture (USDA), Animal and Plant Health Inspection Services (APHIS) has developed candidate multiplexed assays that may potentially be used within the National Animal Health Laboratory Network (NAHLN), the National Veterinary Services Laboratory (Ames, Iowa) and the Plum Island Animal Disease Center (PIADC). This effort has the ability to improve our nation's capability to discriminate between foreign animal diseases and those that are endemic using a single assay, thereby increasing our ability to protect food and agricultural resources with a diagnostic test which could enhance the nation's capabilities for early detection of a foreign animal disease. In FY2005 with funding from the DHS, LLNL developed the first version (Version 1.0) of a multiplexed (MUX) nucleic-acid-based RT-PCR assay that included signatures for foot-and-mouth disease virus (FMDV) detection with rule-out tests for two other foreign animal diseases (FADs) of swine, Vesicular Exanthema of Swine (VESV) and Swine Vesicular Disease Virus (SVDV), and four other domestic viral diseases Bovine Viral Diarrhea Virus (BVDV), Bovine Herpes Virus 1 (BHV-1), Bluetongue virus (BTV) and Parapox virus complex (which includes Bovine Papular Stomatitis Virus [BPSV], Orf of sheep, and Pseudocowpox). In FY06, LLNL has developed Bovine and Porcine species-specific panel which included existing signatures from Version 1.0 panel as well as new signatures. The MUX RT-PCR porcine assay for detection of FMDV includes the FADs, VESV and SVD in addition to vesicular stomatitis virus (VSV) and porcine reproductive and respiratory syndrome (PRRS). LLNL has also developed a MUX RT-PCR bovine assay for detection of FMDV with rule out tests for the two bovine FADs malignant catarrhal fever (MCF), rinderpest virus (RPV) and the domestic diseases vesicular stomatitis

  1. Etiology, pathophysiology and classifications of the diabetic Charcot foot

    Directory of Open Access Journals (Sweden)

    Nikolaos Papanas


    Full Text Available In people with diabetes mellitus, the Charcot foot is a specific manifestation of peripheral neuropathy that may involve autonomic neuropathy with high blood flow to the foot, leading to increased bone resorption. It may also involve peripheral somatic polyneuropathy with loss of protective sensation and high risk of unrecognized acute or chronic minor trauma. In both cases, there is excess local inflammatory response to foot injury, resulting in local osteoporosis. In the Charcot foot, the acute and chronic phases have been described. The former is characterized by local erythema, edema, and marked temperature elevation, while pain is not a prominent symptom. In the latter, signs of inflammation gradually recede and deformities may develop, increasing the risk of foot ulceration. The most common anatomical classification describes five patterns, according to the localization of bone and joint pathology. This review article aims to provide a brief overview of the diabetic Charcot foot in terms of etiology, pathophysiology, and classification.

  2. Etiology, pathophysiology and classifications of the diabetic Charcot foot. (United States)

    Papanas, Nikolaos; Maltezos, Efstratios


    In people with diabetes mellitus, the Charcot foot is a specific manifestation of peripheral neuropathy that may involve autonomic neuropathy with high blood flow to the foot, leading to increased bone resorption. It may also involve peripheral somatic polyneuropathy with loss of protective sensation and high risk of unrecognized acute or chronic minor trauma. In both cases, there is excess local inflammatory response to foot injury, resulting in local osteoporosis. In the Charcot foot, the acute and chronic phases have been described. The former is characterized by local erythema, edema, and marked temperature elevation, while pain is not a prominent symptom. In the latter, signs of inflammation gradually recede and deformities may develop, increasing the risk of foot ulceration. The most common anatomical classification describes five patterns, according to the localization of bone and joint pathology. This review article aims to provide a brief overview of the diabetic Charcot foot in terms of etiology, pathophysiology, and classification.

  3. Dynamic Foot Morphology


    Barisch-Fritz, Bettina


    Background: The foot has to fulfil important and complex functions which are, in most regions of the world, supported by shoes. The interface of feet and footwear has often been considered with respect to comfort and function but also to negative effects of shoes. One main contribution to the improvement of footwear fit is provided by matching the shape of the shoe to the shape of the foot. However, current approaches for implementation only include static information. There is still a lack o...

  4. Comparative characterization of the data of magnetic resonance imaging, X-ray and clinical studies of the hand and foot joints in patients with early psoriatic arthritis

    Directory of Open Access Journals (Sweden)

    Svetlana Olegovna Krasnenko


    Full Text Available The clinical manifestations of psoriatic arthritis (PsA at its early stage may be inadequately informative. In this connection, radiological techniques, such as magnetic resonance imaging (MRI and X-ray study of peripheral joints, in addition to clinical examination are of paramount importance in the diagnosis of early PsA. Objective: To compare the data of clinical examination and various imaging methods (MRI and X-ray of the hand and foot joints in early peripheral PsA. Subjects and methods. The trial included 45 patients (14 men and 31 women; mean age 42.08±13.7 years; median PsA duration 1 year [range 0.55 to 2] with early peripheral PsA without previous therapy with disease-modifying antirheumatic drugs (DMARDs, who met the CASPAR criteria (2006. A standard clinical examination was performed and the activity of peripheral arthritis and the presence of enthesitis and dactylitis were determined in the patients. Not later than 2 days after the clinical examination, a standard X-ray examination of the hands and feet in the direct projection and MRI of the same areas were made. Results. When included into the study, the entire group of patients was found to have a moderate PsA by DAS; its median was 3.12 [2.21 to 3.89]. Cutaneous PsA was noted in 40 patients; 5 persons had a family history of PsA; one female patient had ungual PsA only. In the study group, the clinical signs of enthesitis in the tendon attachments at different sites were revealed in 33 (75.3% patients. Dactylitis was found in 34 (75% patients. The clinical examination showed inflammatory changes in the hand and foot joints in 36 (80% and 38 (84% patients, respectively; while MRT revealed them in 31 (69% and 32 (71% patients. Hand MRI displayed arthritis of the proximal interpha-langeal (PIP, metacarpophalangeal (MCP, and distal interphalangeal (DIP joints in 27 (87%, 21 (68%, and 12 (40% of the 31 patients, respectively. Foot MRI exhibited MCP, PIP, and DIP joint arthritis in

  5. Multi-segment and multi-ply overlapping process of multi coupled activities based on valid information evolution (United States)

    Wang, Zhiliang; Wang, Yunxia; Qiu, Shenghai


    Complex product development will inevitably face the design planning of the multi-coupled activities, and overlapping these activities could potentially reduce product development time, but there is a risk of the additional cost. Although the downstream task information dependence to the upstream task is already considered in the current researches, but the design process overall iteration caused by the information interdependence between activities is hardly discussed; especially the impact on the design process' overall iteration from the valid information accumulation process. Secondly, most studies only focus on the single overlapping process of two activities, rarely take multi-segment and multi-ply overlapping process of multi coupled activities into account; especially the inherent link between product development time and cost which originates from the overlapping process of multi coupled activities. For the purpose of solving the above problems, as to the insufficiency of the accumulated valid information in overlapping process, the function of the valid information evolution (VIE) degree is constructed. Stochastic process theory is used to describe the design information exchange and the valid information accumulation in the overlapping segment, and then the planning models of the single overlapping segment are built. On these bases, by analyzing overlapping processes and overlapping features of multi-coupling activities, multi-segment and multi-ply overlapping planning models are built; by sorting overlapping processes and analyzing the construction of these planning models, two conclusions are obtained: (1) As to multi-segment and multi-ply overlapping of multi coupled activities, the total decrement of the task set development time is the sum of the time decrement caused by basic overlapping segments, and minus the sum of the time increment caused by multiple overlapping segments; (2) the total increment of development cost is the sum of the cost

  6. Construction and characterization of a full-length infectious cDNA clone of foot-and-mouth disease virus strain O/JPN/2010 isolated in Japan in 2010. (United States)

    Nishi, Tatsuya; Onozato, Hiroyuki; Ohashi, Seiichi; Fukai, Katsuhiko; Yamada, Manabu; Morioka, Kazuki; Kanno, Toru


    A full-length infectious cDNA clone of the genome of a foot-and-mouth disease virus isolated from the 2010 epidemic in Japan was constructed and designated pSVL-f02. Transfection of Cos-7 or IBRS-2 cells with this clone allowed the recovery of infectious virus. The recovered virus had the same in vitro characterization as the parental virus with regard to antigenicity in neutralization and indirect immunofluorescence tests, plaque size and one-step growth. Pigs were experimentally infected with the parental virus or the recombinant virus recovered from pSVL-f02 transfected cells. There were no significant differences in clinical signs or antibody responses between the two groups, and virus isolation and viral RNA detection from clinical samples were similar. Virus recovered from transfected cells therefore retained the in vitro characteristics and the in vivo pathogenicity of their parental strain. This cDNA clone should be a valuable tool to analyze determinants of pathogenicity and mechanisms of virus replication, and to develop genetically engineered vaccines against foot-and-mouth disease virus.

  7. Macrodystrophia lipomatosa of foot involving great toe. (United States)

    Gaur, A K; Mhambre, A S; Popalwar, H; Sharma, R


    Macrodystrophia lipomatosa is a rare form of congenital disorder in which there is localized gigantism characterized by progressive overgrowth of all mesenchymal elements with a disproportionate increase in the fibroadipose tissues. The adipose tissue infiltration involves subcutaneous tissue, periosteum, nerves and bone marrow. Most of the cases reported have hand or foot involvement. Patient seeks medical help for improving cosmesis or to get the size of the involved part reduced in order to reduce mechanical problems. We report a case of macrodystrophia lipomatosa involving medial side of foot with significant enlargement of great toe causing concern for cosmesis and inconvenience due to mechanical problems. The X-rays showed increased soft tissue with more of adipose tissue and increased size of involved digits with widening of ends. Since the patient's mother did not want any surgical intervention he was educated about foot care and proper footwear design was suggested.

  8. Foot muscles strengthener

    Directory of Open Access Journals (Sweden)

    Boris T. Glavač


    Full Text Available Previous experience in the correction of flat feet consisted of the use of insoles for shoes and exercises with toys, balls, rollers, inclined planes, etc. A device for strengthening foot muscles is designed for the correction of flat feet in children and, as its name suggests, for strengthening foot muscles in adults. The device is made of wood and metal, with a mechanism and technical solutions, enabling the implementation of specific exercises to activate muscles responsible for the formation of the foot arch. It is suitable for home use with controlled load quantities since it has calibrated springs. The device is patented with the Intellectual Property Office, Republic of Serbia, as a petty patent.

  9. Charcot foot syndrome. (United States)

    Jeffcoate, W J


    Charcot foot syndrome is an uncommon complication of diabetes but is potentially devastating in its consequences. Outcome is made worse by widespread professional ignorance leading to delayed diagnosis, but it is also hampered by lack of understanding of its causes and lack of treatments with proven effectiveness, other than offloading. There remains a desperate need for studies into its causes as well as comparative audit and trials designed to determine the best treatment for this difficult condition. Such work can probably only be effectively carried out through the establishment of multicentre networks. Nevertheless, improved understanding in recent years of the likely role of inflammatory pathways has raised awareness of the multiple ways in which the effects of neuropathy may be manifest in the development of the Charcot foot. This awareness is also leading to the realization that similar processes may conceivably contribute to the refractoriness of other foot diseases in diabetes, including both chronic unhealing ulcers and osteomyelitis.

  10. Molecular characterization of SAT 2 foot-and-mouth disease virus from post-outbreak slaughtered animals: implications for disease control in Uganda. (United States)

    Balinda, S N; Belsham, G J; Masembe, C; Sangula, A K; Siegismund, H R; Muwanika, V B


    In Uganda, limiting the extent of foot-and-mouth disease (FMD) spread during outbreaks involves short-term measures such as ring vaccination and restrictions of the movement of livestock and their products to and from the affected areas. In this study, the presence of FMD virus RNA was investigated in cattle samples 3 months after FMD quarantine measures had been lifted following an outbreak in 2004. Oropharyngeal tissue samples were obtained from 12 cattle slaughtered in a small town abattoir in Kiboga. FMD virus RNA was detected by diagnostic RT-PCR in nine of the 12 tissue samples. Part of the coding region for the capsid protein VP1 was amplified and sequenced. All samples were identified as belonging to the SAT 2 serotype. The implications for FMD control of both virus introduction into Uganda and the presence of carrier animals following outbreaks are discussed.

  11. Molecular characterization of SAT 2 foot-and-mouth disease virus from post-outbreak slaughtered animals: implications for disease control in Uganda

    DEFF Research Database (Denmark)

    Balinda, Sheila N; Belsham, Graham; Masembe, Charles


    . Part of the coding region for the capsid protein VP1 was amplified and sequenced. All samples were identified as belonging to the SAT 2 serotype. The implications for FMD control of both virus introductions into Uganda and the presence of carrier animals following outbreaks are discussed.......In Uganda, limiting the extent of foot-and-mouth disease (FMD) spread during outbreaks involves short term measures such as ring vaccination and restrictions to the movement of livestock and their products to and from the affected areas. In this study, the presence of FMD virus RNA was investigated...... in cattle samples, three months after FMD quarantine measures had been lifted in the area in 2004 following an outbreak. Oropharyngeal tissue samples were obtained from 12 cattle slaughtered in a small town abattoir of Kiboga. FMD virus RNA was detected by diagnostic RT- PCR in 9 of the 12 tissue samples...

  12. [The diabetic foot]. (United States)

    Stirnemann, P; Z'Brun, A; Brunner, D


    Problems of the diabetic foot are frequent. The magnitude of the clinical picture and morbidity mirrors the severity and complexity of the underlying pathobiology. The three pathogenetic mechanism involved are ischemia, neuropathy and infection. Seldom do these mechanisms work in isolation, rather most foot problems result from a complex interplay among all three. The clinical picture of the diabetic foot reaches from the neuropathic deformity with diminished or absent sensation of pain to limited gangrene or superficial ulcer. The polymicrobial infection leads to extensive tissue destruction (plantarphlegmone) with osteomyelitis. The patients often notes no pain and may become aware of the infection only through the presence of drainage or a foul odor. These infections are usually more extensive than would be predicted by clinical signs and symptoms. These lesions must be debrided and drained promptly and completely. This often requires amputations of one or more toes, combined with an incision along the entire course of the infected track on the plantar or dorsal aspect of the foot. Cultures should be taken from the depth of the wound. Initial treatment should be with broad-spectrum antibiotics, with subsequent adjustment based on culture results. The diabetic foot is a clinical problem that can be solved with a high degree of success when the approached by an interdisciplinary team (specialists in infectious and vascular disease, podiatry and diabetology). Arterial reconstruction should be designed to restore maximum perfusion to the foot. The most effective result can be obtained with infra-inguinal vein bypass with distal anastomosis to the most proximal artery with direct continuity to the ischemic territory. The single most important factor in the achievement of the reduction of amputation is the autologous vein bypass. The overall outcome in the diabetic patient in terms of graft patency and limb salvage is equal to that in the nondiabetic.

  13. Performance comparisons and resistance modeling for multi-segment electrode designs of power-oriented lithium-ion batteries

    Energy Technology Data Exchange (ETDEWEB)

    Chen, Y.-S. [Department of Chemical Engineering, National Chung Cheng University, Chia-Yi 621, Taiwan (China); Chang, K.-H. [Department of Chemical Engineering, National Tsing Hua University, Hsin-Chu 30013, Taiwan (China); Department of Chemical Engineering, National Chung Cheng University, Chia-Yi 621, Taiwan (China); Hu, C.-C., E-mail: [Department of Chemical Engineering, National Tsing Hua University, Hsin-Chu 30013, Taiwan (China); Cheng, T.-T. [E-ONE MOLI ENERGY CORP, Southern Taiwan Science Park, No. 10, Dali 2nd Rd., Shanhua, Tainan 74144, Taiwan (China)


    This study investigates the influence of tab position and quantity as well as multi-segment electrodes in cell design for the performance of an 18650 power-oriented lithium-ion cell. The resistances of cells with traditional and center-tab designs are simulated by a simplified model. It shows that tab position significantly influences the cell resistance even when other components in the cell are fixed. The performances of both center-tab and traditional designs are compared by the cell direct-current resistance (DCR), body temperature, and 15 A cycling test to demonstrate the impact of cell design. The multi-tab design also shows better performance than the single-tab design for power cells; however there are diminishing returns for cells with three or more tabs as the additional tabs do not significantly reduce the cell resistance. The two-tab design is concluded to be the best choice for an 18650 power cell considering the process ability and overall high-rate performance. The difference in the waste power between the center-tab and the traditional designs, which is transformed into heat, is the main reason for the poor high-rate cycling performance as expected. Such modeling provides a quick design reference for a power cell with new size to get the most suitable electrode design.

  14. Foot Push-Up Test (United States)

    ... may be inflamed and may have been overworked. Consulting a foot and ankle surgeon for weak and ... or last name. Search Where do you hurt? Interactive Foot Diagram Arch Supports Arch supports are devices ...

  15. What Is a Foot and Ankle Surgeon? (United States)

    ... Foot & Ankle Surgeon? A A A | Print | Share What is a Foot & Ankle Surgeon? Foot and ankle ... of conditions that affect people of every age. What education has a foot and ankle surgeon received? ...

  16. Osteomyelitis in the diabetic foot


    Malhotra, Rishi; Chan, Claire Shu-Yi; Nather, Aziz


    Osteomyelitis (OM) is a common complication of diabetic foot ulcers and/or diabetic foot infections. This review article discusses the clinical presentation, diagnosis, and treatment of OM in the diabetic foot. Clinical features that point to the possibility of OM include the presence of exposed bone in the depth of a diabetic foot ulcer. Medical imaging studies include plain radiographs, magnetic resonance imaging, and bone scintigraphy. A high index of suspicion is also required to make the...

  17. Adult cavovarus foot. (United States)

    Younger, Alastair S E; Hansen, Sigvard T


    Cavovarus foot deformity, which often results from an imbalance of muscle forces, is commonly caused by hereditary motor sensory neuropathies. Other causes are cerebral palsy, cerebral injury (stroke), anterior horn cell disease (spinal root injury), talar neck injury, and residual clubfoot. In cavovarus foot deformity, the relatively strong peroneus longus and tibialis posterior muscles cause a hindfoot varus and forefoot valgus (pronated) position. Hindfoot varus causes overload of the lateral border of the foot, resulting in ankle instability, peroneal tendinitis, and stress fracture. Degenerative arthritic changes can develop in overloaded joints. Gait examination allows appropriate planning of tendon transfers to correct stance and swing-phase deficits. Inspection of the forefoot and hindfoot positions determines the need for soft-tissue release and osteotomy. The Coleman block test is invaluable for assessing the cause of hindfoot varus. Prolonged use of orthoses or supportive footwear can result in muscle imbalance, causing increasing deformity and irreversible damage to tendons and joints. Rebalancing tendons is an early priority to prevent unsalvageable deterioration of the foot. Muscle imbalance can be corrected by tendon transfer, corrective osteotomy, and fusion. Fixed bony deformity can be addressed by fusion and osteotomy.

  18. X-Ray Exam: Foot (United States)

    ... Old Feeding Your 1- to 2-Year-Old X-Ray Exam: Foot KidsHealth > For Parents > X-Ray Exam: Foot A A A What's in ... español Radiografía: pie What It Is A foot X-ray is a safe and painless test that ...

  19. Neuropathy and Diabetic Foot Syndrome. (United States)

    Volmer-Thole, Maren; Lobmann, Ralf


    Diabetic foot ulceration is a serious complication of diabetes mellitus worldwide and the most common cause of hospitalization in diabetic patients. The etiology of diabetic foot ulcerations is complex due to their multifactorial nature; in the pathophysiology of diabetic foot ulceration polyneuropathy is important. Proper adherence to standard treatment strategies and interdisciplinary cooperation can reduce the still high rates of major amputations.

  20. Prevalence and characterization of enterovirus infections among pediatric patients with hand foot mouth disease, herpangina and influenza like illness in Thailand, 2012. (United States)

    Puenpa, Jiratchaya; Mauleekoonphairoj, John; Linsuwanon, Piyada; Suwannakarn, Kamol; Chieochansin, Thaweesak; Korkong, Sumeth; Theamboonlers, Apiradee; Poovorawan, Yong


    Hand, foot, and mouth disease (HFMD) and herpangina are common infectious diseases caused by several genotypes of human enterovirus species A and frequently occurring in young children. This study was aimed at analyzing enteroviruses from patients with these diseases in Thailand in 2012. Detection and genotype determination of enteroviruses were accomplished by reverse transcription-polymerase chain reaction and sequencing of the VP1 region. Enterovirus-positive samples were differentiated into 17 genotypes (coxsackievirus A4 (CAV4), A5, A6, A8, A9, A10, A12, A16, A21, B1, B2, B4, B5, echovirus 7, 16, 25 and Enterovirus 71). The result showed CAV6 (33.5%), followed by CAV16 (9.4%) and EV71 (8.8%) as the most frequent genotypes in HFMD, CAV8 (19.3%) in herpangina and CAV6 (1.5%) in influenza like illness. Enterovirus infections were most prevalent during July with 34.4% in HFMD, 39.8% in herpangina and 1.6% in ILI. The higher enterovirus infection associated with HFMD and herpangina occurred in infants over one year-old. This represents the first report describing the circulation of multiple enteroviruses in Thailand.

  1. Foot motion in children shoes: a comparison of barefoot walking with shod walking in conventional and flexible shoes. (United States)

    Wolf, Sebastian; Simon, Jan; Patikas, Dimitrios; Schuster, Waltraud; Armbrust, Petra; Döderlein, Leonhard


    The increased prevalence for flatfoot and hallux valgus in modern societies may be the consequence of inadequate footwear in childhood. Based on the assumption that barefoot walking represents the best condition for the development of a healthy foot the objective of this study was to monitor the influence of commercial footwear on children's foot motion during walking. Furthermore, an attempt was made to reduce this influence by changing the physical properties of standard footwear. Children's barefoot motion pattern was monitored by a marker-based optical 3D-tracking method using a multi-segment foot model. In the study's first stage, barefoot walking was compared to walking with a commercial product. In the second stage it was compared to both, the pattern with the commercial product and with the shoe modified on the basis of the findings of the first stage of the study. Eighteen children (8.2+/-0.7 years old) with no foot deformity and with the same shoe size were recruited for this study. It was found that tibio-talar ROM increased in the commercial shoe (26.6 degrees ) compared to the barefoot condition (22.5 degrees , p=0.001) whereas the medial arch changes for push-off were diminished since the variation in arch length was reduced from 9.9% (barefoot) to 5.9% (shoe, pstudy shows that slimmer and more flexible children's shoes do not change foot motion as much as conventional shoes and therefore should be recommended not only for children in this age but for healthy children in general.

  2. Characterization of foot-and-mouth disease viruses (FMDVs) from Ugandan cattle outbreaks during 2012-2013: evidence for circulation of multiple serotypes. (United States)

    Namatovu, Alice; Tjørnehøj, Kirsten; Belsham, Graham J; Dhikusooka, Moses T; Wekesa, Sabenzia N; Muwanika, Vincent B; Siegismund, Hans R; Ayebazibwe, Chrisostom


    To investigate the foot-and-mouth disease virus (FMDV) serotypes circulating in Uganda's cattle population, both serological and virological analyses of samples from outbreaks that occurred during 2012-2013 were performed. Altogether, 79 sera and 60 oropharyngeal fluid (OP)/tissue/oral swab samples were collected from herds with reported FMD outbreaks in seven different Ugandan districts. Overall, 61/79 (77%) of the cattle sera were positive for antibodies against FMDV by PrioCHECK FMDV NS ELISA and solid phase blocking ELISA detected titres ≥ 80 for serotypes O, SAT 1, SAT 2 and SAT 3 in 41, 45, 30 and 45 of these 61 seropositive samples, respectively. Virus neutralisation tests detected the highest levels of neutralising antibodies (titres ≥ 45) against serotype O in the herds from Kween and Rakai districts, against SAT 1 in the herd from Nwoya district and against SAT 2 in the herds from Kiruhura, Isingiro and Ntungamo districts. The isolation of a SAT 2 FMDV from Isingiro was consistent with the detection of high levels of neutralising antibodies against SAT 2; sequencing (for the VP1 coding region) indicated that this virus belonged to lineage I within this serotype, like the currently used vaccine strain. From the Wakiso district 11 tissue/swab samples were collected; serotype A FMDV, genotype Africa (G-I), was isolated from the epithelial samples. This study shows that within a period of less than one year, FMD outbreaks in Uganda were caused by four different serotypes namely O, A, SAT 1 and SAT 2. Therefore, to enhance the control of FMD in Uganda, there is need for efficient and timely determination of outbreak virus strains/serotypes and vaccine matching. The value of incorporating serotype A antigen into the imported vaccines along with the current serotype O, SAT 1 and SAT 2 strains should be considered.

  3. The athlete's foot. (United States)

    Resnik, S S; Lewis, L A; Cohen, B H


    In general, painful feet can affect the performance of an athlete in any sport. To prevent skin diseases of the feet, the "Athlete's Foot" should be kept clean and dry with toenails trimmed. Properly fitting athletic shoes should be worn to avoid the formation of blisters. Wearing of sandals in locker and shower rooms, which prevents intimate contact with infecting organisms, can alleviate many of the problems that affect the feet.

  4. Chondroblastoma of the foot. (United States)

    Fink, B R; Temple, H T; Chiricosta, F M; Mizel, M S; Murphey, M D


    A total of 322 cases of chondroblastoma were referred to the Armed Forces Institute of Pathology between 1960 and 1990. Ten additional cases of chondroblastoma were treated at Walter Reed Army Medical Center between 1985 and 1993. Forty-two of these involved the foot, two of which were treated at Walter Reed Army Medical Center. Patients with chondroblastoma of the foot were male in 35 (81%) cases, with a mean age of 25.5 years, which was significantly different from the mean age of 17.3 years in patients with chondroblastoma of the long bones (P Chondroblastoma of the foot is most commonly found in the posterior subchondral areas of the talus and calcaneus as well as in the calcaneal apophysis. Radiographically, the lesion was associated with an articular surface or apophyseal area in all cases and appeared radiolucent, with little to no matrix production. The margins were generally well defined. Cystic features were noted grossly and histologically in 24 (57%) specimens, a feature seen in only 21% of all chondroblastomas overall. Treatment consists of thorough curetting and bone grafting with good oncologic and functional results.

  5. The neuropathic diabetic foot. (United States)

    Rathur, Haris M; Boulton, Andrew J M


    Diabetic foot problems are common throughout the world, and result in major medical, social and economic consequences for the patients, their families, and society. Foot ulcers are likely to be of neuropathic origin and, therefore, are eminently preventable. Individuals with the greatest risk of ulceration can easily be identified by careful clinical examination of their feet: education and frequent follow-up is indicated for these patients. When infection complicates a foot ulcer, the combination can be limb-threatening, or life-threatening. Infection is defined clinically, but wound cultures assist in identification of causative pathogens. Tissue specimens are strongly preferred to wound swabs for wound cultures. Antimicrobial therapy should be guided by culture results, and although such therapy may cure the infection, it does not heal the wound. Alleviation of the mechanical load on ulcers (offloading) should always be a part of treatment. Plantar neuropathic ulcers typically heal in 6 weeks with nonremovable casts, because pressure at the ulcer site is mitigated and compliance is enforced. The success of other approaches to offloading similarly depends on the patient's adherence to the strategy used for pressure relief.

  6. The diabetic foot. (United States)

    Rathur, Haris M; Boulton, Andrew J M


    Diabetic foot problems are common throughout the world, resulting in major medical, social and economic consequences for the patients, their families, and society. Foot ulcers are more likely to be of neuropathic origin, and therefore eminently preventable. People at greatest risk of ulceration can easily be identified by careful clinical examination of the feet: education and frequent follow-up is indicated for these patients. When infection complicates a foot ulcer, the combination can be limb or life-threatening. Infection is defined clinically, but wound cultures assist in identifying the causative pathogens. Tissue specimens are strongly preferred to wound swabs for wound cultures. Antimicrobial therapy should be guided by culture results, and although such therapy may cure the infection, it does not heal the wound. Alleviation of the mechanical load on ulcers (offloading) should always be a part of treatment. Plantar neuropathic ulcers typically heal in 6 weeks with irremovable casting, because pressure at the ulcer site is mitigated and compliance is enforced. The success of other approaches to offloading similarly depends on the patients' adherence to the effectiveness of pressure relief.

  7. Relationship between static foot posture and foot mobility

    Directory of Open Access Journals (Sweden)

    McPoil Thomas G


    Full Text Available Abstract Background It is not uncommon for a person's foot posture and/or mobility to be assessed during a clinical examination. The exact relationship, however, between static posture and mobility is not known. Objective The purpose of this study was to determine the degree of association between static foot posture and mobility. Method The static foot posture and foot mobility of 203 healthy individuals was assessed and then analyzed to determine if low arched or "pronated" feet are more mobile than high arched or "supinated" feet. Results The study demonstrated that those individuals with a lower standing dorsal arch height and/or a wider standing midfoot width had greater mobility in their foot. In addition, those individuals with higher Foot Posture Index (FPI values demonstrated greater mobility and those with lower FPI values demonstrated less mobility. Finally, the amount of foot mobility that an individual has can be predicted reasonably well using either a 3 or 4 variable linear regression model. Conclusions Because of the relationship between static foot posture and mobility, it is recommended that both be assessed as part of a comprehensive evaluation of a individual with foot problems.

  8. Development and Characterization of a Multiplexed RT-PCR Species Specific Assay for Bovine and one for Porcine Foot-and-Mouth Disease Virus Rule-Out Supplemental Materials

    Energy Technology Data Exchange (ETDEWEB)

    Smith, S; Danganan, L; Tammero, L; Lenhoff, R; Naraghi-arani, P; Hindson, B


    viruses which are of two bovine types bovine papular stomatitis virus (BPSV) and psuedocowpox (PCP). This document provides details of signature generation, evaluation, and testing, as well as the specific methods and materials used. A condensed summary of the development, testing and performance of the multiplexed assay panel was presented in a 126 page separate document, entitled 'Development and Characterization of A Multiplexed RT-PCR Species Specific Assay for Bovine and one for Porcine Foot-and-Mouth Disease Virus Rule-Out'. This supplemental document provides additional details of large amount of data collected for signature generation, evaluation, and testing, as well as the specific methods and materials used for all steps in the assay development and utilization processes. In contrast to last years effort, the development of the bovine and porcine panels is pending additional work to complete analytical characterization of FMDV, VESV, VSV, SVD, RPV and MCF. The signature screening process and final panel composition impacts this effort. The unique challenge presented this year was having strict predecessor limitations in completing characterization, where efforts at LLNL must preceed efforts at PIADC, such challenges were alleviated in the 2006 reporting by having characterization data from the interlaboratory comparison and at Plum Island under AgDDAP project. We will present an addendum at a later date with additional data on the characterization of the porcine and bovine multiplex assays when that data is available.

  9. Location of foot arteries using infrared images (United States)

    Villasenor-Mora, Carlos; González-Vega, Arturo; Martín Osmany Falcón, Antonio; Benítez Ferro, Jesús Francisco Guillemo; Córdova Fraga, Teodoro


    In this work are presented the results of localization of foot arteries, in a young group of participants by using infrared thermal images, these are the dorsal, posterior tibial and anterior tibial arteries. No inclusion criteria were considered, that causes that no strong statistical data about the influence of the age in the arterial localization. It was achieved to solve the confusion when veins present a heat distribution similar to the artery and in the position of this. it contributes to enhance the rate of location of arteries. In general it is possible to say that the use of infrared thermal images is a good technique to find the foot arteries and can be applied in its characterization in a future. The procedure proposed is a non-invasive technique, and in certain fashion does not requires specialized personnel to achieve locate the arteries. It is portable, safe, and relatively economical.

  10. PCA-based 3D Shape Reconstruction of Human Foot Using Multiple Viewpoint Cameras

    Institute of Scientific and Technical Information of China (English)

    Edmée Amstutz; Tomoaki Teshima; Makoto Kimura; Masaaki Mochimaru; Hideo Saito


    This paper describes a multiple camera-based method to reconstruct the 3D shape of a human foot. From a foot database,an initial 3D model of the foot represented by a cloud of points is built. The shape parameters, which can characterize more than 92% of a foot, are defined by using the principal component analysis method. Then, using "active shape models", the initial 3D model is adapted to the real foot captured in multiple images by applying some constraints (edge points' distance and color variance). We insist here on the experiment part where we demonstrate the efficiency of the proposed method on a plastic foot model, and also on real human feet with various shapes. We propose and compare different ways of texturing the foot which is needed for reconstruction. We present an experiment performed on the plastic foot model and on human feet and propose two different ways to improve the final 3D shape's accuracy according to the previous experiments' results. The first improvement proposed is the densification of the cloud of points used to represent the initial model and the foot database. The second improvement concerns the projected patterns used to texture the foot. We conclude by showing the obtained results for a human foot with the average computed shape error being only 1.06mm.

  11. Current concepts of Charcot foot in diabetic patients. (United States)

    La Fontaine, Javier; Lavery, Lawrence; Jude, Edward


    The Charcot foot is an uncommon complication of neuropathy in diabetes. It is a disabling and devastating condition. The etiology of the Charcot foot is unknown, but it is characterized by acute inflammation with collapse of the foot and/or the ankle. Although the cause of this potentially debilitating condition is not known, it is generally accepted that the components of neuropathy that lead to foot complications must exist. When it is not detected early, a severe deformity will result in a secondary ulceration, infection, and amputation. Immobilization in the early stages is the key for success, but severe deformity may still develop. When severe deformity is present, bracing may be attempted but often patients will need surgical intervention. Good success has been shown with internal and external fixation. In patients with concomitant osteomyelitis, severe deformity, and/or soft tissue infection, a high amputation may be the best treatment of choice.

  12. A dynamic model of the windlass mechanism of the foot: evidence for early stance phase preloading of the plantar aponeurosis. (United States)

    Caravaggi, Paolo; Pataky, Todd; Goulermas, John Y; Savage, Russel; Crompton, Robin


    In the present study we have estimated the temporal elongation of the plantar aponeurosis (PA) during normal walking using a subject-specific multi-segment rigid-body model of the foot. As previous studies have suggested that muscular forces at the ankle can pre-load the PA prior to heel-strike, the main purpose of the current study was to test, through modelling, whether there is any tension present in the PA during early stance phase. Reflective markers were attached to bony landmarks to track the kinematics of the calcaneus, metatarsus and toes during barefoot walking. Ultrasonography measurements were performed on three subjects to determine both the location of the origin of the PA on the plantar aspect of the calcaneus, and the radii of the metatarsal heads. Starting with the foot in a neutral, unloaded position, inverse kinematics allowed calculation of the tension in the five slips of the PA during the whole duration of the stance phase. The results show that the PA experienced tension significantly above rest during early stance phase in all subjects (P<0.01), thus providing support for the PA-preloading hypothesis. The amount of preloading and the maximum elongation of the slips of the PA decreased from medial to lateral. The mean maximum tension exerted by the PA was 1.5 BW (body weight) over the three subjects.

  13. Malignant Melanoma of the Foot (United States)

    ... page. Please enable Javascript in your browser. Malignant Melanoma of the Foot What Is Malignant Melanoma? Melanoma is a cancer that begins in the ... people of all age groups, even the young. Melanoma in the Foot Melanoma that occurs in the ...

  14. Sesamoid Injuries in the Foot (United States)

    ... the shoe may be prescribed for long-term treatment of sesamoiditis to balance the pressure placed on the ball of the foot. When Is Surgery Needed? When sesamoid injuries fail to respond to nonsurgical treatment, surgery may be required. The foot and ankle ...

  15. Comparison of in vivo segmental foot motion during walking and step descent in patients with midfoot arthritis and matched asymptomatic control subjects. (United States)

    Rao, Smita; Baumhauer, Judith F; Tome, Josh; Nawoczenski, Deborah A


    The purpose of this study was to compare in vivo segmental foot motion during walking and step descent in patients with midfoot arthritis and asymptomatic control subjects. Segmental foot motion during walking and step descent was assessed using a multi-segment foot model in 30 patients with midfoot arthritis and 20 age, gender and BMI matched controls. Peak and total range of motion (ROM), referenced to subtalar neutral, were examined for each of the following dependent variables: 1st metatarso-phalangeal (MTP1) dorsiflexion, 1st metatarsal (MT1) plantarflexion, ankle dorsiflexion, calcaneal eversion and forefoot abduction. The results showed that, compared to level walking, step descent required greater MTP1 dorsiflexion (pwalking. Patients with midfoot arthritis responded differently to the step task compared to control subjects in terms of MT1 and calcaneus eversion excursion. During walking, patients with midfoot arthritis showed significantly less MT1 plantarflexion excursion compared to control subjects (p=0.03). However, during step descent, both groups showed similar MT1 plantarflexion excursion. During walking, patients with midfoot arthritis showed similar calcaneus eversion excursion compared to control subjects. However, during step descent, patients with midfoot arthritis showed significantly greater calcaneus eversion excursion compared to control subjects (p=0.03). Independently or in combination, these motions may contribute to articular stress and consequently to symptoms in patients with midfoot arthritis.

  16. The Effect of Taping on Foot Structure, Functional Foot Stability and Running Gait Patterns of the Foot

    Institute of Scientific and Technical Information of China (English)

    Malia Ho; Tsai Djun; John Cher Chay Tan


    Running related foot injuries are associated with excessive foot movements due to malaligned foot structure and poor functional foot stability. Clinicians tape the foot to alleviate pain and prevent further injuries, whilst allowing the athlete to continue training. However, the effect of taping is not conclusive. The purpose of this study is to investigate if taping effectively improves foot structure, functional foot stability and reduces excessive foot movements during running. Twenty-two subjects had their foot structure identified as: fiat foot stable, fiat foot unstable and normal arched unstable according to the FPI (foot posture index) and the Modified Romberg's Test with the BESS (balance error scoring system) criteria. The subjects ran on an instrumented treadmill barefooted with their feet taped and untaped. Running kinetic and kinematic data were collected and analysed using a paired t-test and 3x2 ANOVA. Taping improved foot structure but not functional foot stability. During running, taping significantly reduced rearfoot eversion. Taping increased the loading rate in the fiat foot and normal arched unstable groups but reduced the loading rate for the flat foot stable group. Implication on the appropriate use of foot taping was discussed.

  17. Complications of the diabetic foot. (United States)

    Kim, Paul J; Steinberg, John S


    The diabetic foot is at high risk for complications because of its role in ambulation. Peripheral neuropathy and peripheral vascular disease can lead to chronic foot ulcers, which are at high risk for infection, in part attributable to areas of high pressure caused by lack of tolerance of the soft tissue and bone and joint deformity. If left untreated, infection and ischemia lead to tissue death, culminating in amputation. Treatment strategies include antibiosis, topical therapies, offloading, debridement, and surgery. A multidisciplinary team approach is necessary in the prevention and treatment of complications of the diabetic foot.

  18. Challenges for Serology-Based Characterization of Foot-and-Mouth Disease Outbreaks in Endemic Areas; Identification of Two Separate Lineages of Serotype O FMDV in Uganda in 2011. (United States)

    Namatovu, A; Belsham, G J; Ayebazibwe, C; Dhikusooka, M T; Wekesa, S N; Siegismund, H R; Muwanika, V B; Tjørnehøj, K


    Control of foot-and-mouth disease (FMD) in Uganda by ring vaccination largely depends on costly trivalent vaccines, and use of monovalent vaccines could improve the cost effectiveness. This, however, requires application of highly specific diagnostic tests. This study investigated outbreaks of FMD in seven Ugandan districts, during 2011, using the PrioCHECK® FMDV NS ELISA, solid-phase blocking ELISAs (SPBEs) and virus neutralization tests (VNTs), together with virological analyses for characterization of the responsible viruses. Two hundred and eighteen (218) cattle and 23 goat sera as well as 82 oropharyngeal fluid/epithelial tissue samples were collected. Some 50% of the cattle and 17% of the goat sera were positive by the PrioCHECK® FMDV NS ELISA, while SPBEs identified titres ≥80 for antibodies against serotype O FMD virus (FMDV) in 51% of the anti-NSP positive cattle sera. However, 35% of the anti-NSP positive cattle sera had SPBE titres ≥80 against multiple serotypes, primarily against serotypes O, SAT 1 and SAT 3. Comparison of SPBEs and VNTs for the detection of antibodies against serotypes O, SAT 1 and SAT 3 in 72 NSP positive cattle sera showed comparable results against serotype O (P = 0.181), while VNTs detected significantly fewer samples positive for antibodies against SAT 1 and SAT 3 than the SPBEs (P < 0.001). Detection of antibodies against serotype O was consistent with the isolation of serotype O FMDVs from 13 samples. Four of these viruses were sequenced and belonged to two distinct lineages within the East Africa-2 (EA-2) topotype, each differing from the currently used vaccine strain (EA-1 topotype). The relationships of these lineages to other serotype O viruses in the Eastern Africa region are discussed. To enhance the control of FMD in Uganda, there is need to improve the specificity of the SAT-SPBEs, perform vaccine matching and implement improved regional FMD control.

  19. Analysis of foot structural damage in rheumatoid arthritis: clinical evaluation by validated measures and serological correlations

    Directory of Open Access Journals (Sweden)

    E. Bartoloni Bocci


    Full Text Available Objective: To examine foot involvement in rheumatoid arthritis (RA and to characterize structural alterations in patients with anti-cyclic citrullinated peptide (CCP antibody-positive and -negative disease. Methods: Seventy-eight patients with RA with foot pain were consecutively enrolled. The Manchester Hallux Valgus (MHV rating scale was used to evaluate the hallux valgus deformity degree. The Foot Posture Index (FPI6, a novel, foot-specific outcome measure, was adopted in order to quantify variation in the position of the foot. The findings were correlated with disease duration and presence or absence of anti-CCP antibodies. Results: About 84.6% patients had different degrees of hallux valgus and 65.4% subjects had a pronated foot. These two foot alterations were prevalently found in patients with long-standing disease and circulating anti-CCP antibodies. On the contrary, RA patients without anti-CCP and early disease essentially displayed a supinated foot without relevant hallux valgus deformity. Conclusion: Our findings allowed to identify different anatomic foot alterations in RA patients according to disease duration and negative prognostic factors such as anti-CCP antibodies. Our findings support the role of an accurate analysis of foot structural damage and may suggest the usefulness of a correct plantar orthosis prescription also in early phases of the disease.

  20. Hand, Foot, and Mouth Disease

    Centers for Disease Control (CDC) Podcasts


    Hand, foot, and mouth disease is a contagious illness that mainly affects children under five. In this podcast, Dr. Eileen Schneider talks about the symptoms of hand, foot, and mouth disease, how it spreads, and ways to help protect yourself and your children from getting infected with the virus.  Created: 8/8/2013 by National Center for Immunization and Respiratory Diseases (NCIRD).   Date Released: 8/8/2013.

  1. Imaging the diabetic foot

    Energy Technology Data Exchange (ETDEWEB)

    Gold, R.H. [Dept. of Radiological Sciences, UCLA School of Medicine, Los Angeles, CA (United States); Tong, D.T.F. [Dept. of Radiological Sciences, UCLA School of Medicine, Los Angeles, CA (United States); Crim, J.R. [Durham Radiology Associates, Durham, NC (United States); Seeger, L.L. [Dept. of Radiological Sciences, UCLA School of Medicine, Los Angeles, CA (United States)


    Early and accurate diagnosis of infection or neuropathy of the diabetic foot is the key to successful management. Angiopathy leads to ischemia which, in combination with peripheral neuropathy, predisposes to pedal skin ulceration, the precursor of osteomyelitis. Chronic hyperglycemia promotes production of glycosylated end products which accumulate on endothelial proteins, causing ischemia of the vasa nervorum. When combined with axonal degeneration of the sensory nerves, the result is hypertrophic neuroarthropathy. Should the sympathetic nerve fibers also be damaged, the resultant loss of vasoconstrictive impulses leads to hyperemia and atrophic neuroarthropathy. Plain radiography, although less sensitive than radionuclide, magnetic resonance (MR), and computed tomographic examinations, should be the initial procedure for imaging suspected osteomyelitis in the diabetic patient. If the radiographs are normal but the clinical suspicion of osteomyelitis is strong, a three-phase {sup 99m}Tc-MDP scan or MR imaging is recommended. An equivocal {sup 99m}Tc-MDP scan should be followed by MR imaging. To exclude osteomyelitis at a site of neuroarthropathy, a {sup 111}In white blood cell scan is preferable. To obtain a specimen of bone for bacteriological studies, percutaneous core biopsy is the procedure of choice, with the entrance of the needle well beyond the edge of the subjacent ulcer. (orig.)

  2. Bacteriology of diabetic foot lesions. (United States)

    Yoga, R; Khairul, A; Sunita, K; Suresh, C


    Infection plays a pivotal role in enhancing a diabetic foot at risk toward amputation. Effective antibiotic therapy against the offending pathogens is an important component of treatment of diabetic foot infections. Recognition of the pathogen is always difficult as the representative deep tissue sample for culture is surrounded by ulcer surface harbouring colonies of organisms frequently labelled as skin commensals. The emergent of resistant strains represents a compounding problem standing against efforts to prevent amputation. This study was undertaken to identify the pathogens associated with diabetic foot infection in terms of their frequency and sensitivity against certain commonly used antibiotics. Forty-four consecutive patients with open diabetic foot infections had wound swab taken for culture and sensitivity testing. Cultures positive were observed in 89% of the cases with Staphylococcus aureus, Klebsiella pneumoniae, Pseudomonas aeroginosa encountered in 20%, 14% and 14% of cases respectively. Mixed growths were isolated in 6% of cultures. All Staphylcoccus aureus isolates were resistant to Penicillin but 80% were sensitive to Erythromycin and Co-trimoxazole. Klebsiella pneumoniae isolates were sensitive to Methicillin and Gentamycin in 80% and 60% of cases respectively, and resistant to Ampicillin and Ceftazidime in 83% and 50% respectively. All Pseudomonas aeroginosa isolates were sensitive to Amikacin and Ciprofloxacin but 50% were resistant to Gentamycin. There was no single antibiotic possessing good coverage for all common organisms isolated from diabetic foot lesions. Staphylococcus aureus remains the predominant cause of diabetic foot infections followed by Klebsiela pneumonia and Pseudomonas aeroginosa. Most infections are monomicrobial. The emergence of multiresistant organisms is a worrying feature in diabetic foot infections.

  3. Do you know this syndrome? Hand-foot syndrome* (United States)

    Braghiroli, Cintia Santos; Ieiri, Rodrigo; Ocanha, Juliana Polizel; Paschoalini, Rafael Bispo; Miot, Hélio Amante


    Hand-foot syndrome is a common cutaneous adverse effect associated with certain systemic chemotherapy drugs. It is characterized by erythema, edema, and burning sensation, especially over palmoplantar surfaces. We report the case of an elderly patient undergoing chemotherapy after a breast cancer surgery who developed symptoms two months after the start of the regimen. There are no studies that explore specific therapies. Suggestive therapy include reducing agent dosage, increasing the interval between cycles, or even stopping chemotherapy. Emollients, analgesics, and cold packs are described as effective. After alopecia and mucositis, hand-foot syndrome is the most common adverse dermatologic reaction to chemotherapeutic agents. PMID:28225974

  4. Challenges for Serology-Based Characterization of Foot-and-Mouth Disease Outbreaks in Endemic Areas; Identification of Two Separate Lineages of Serotype O FMDV in Uganda in 2011

    DEFF Research Database (Denmark)

    Namatovu, A.; Belsham, Graham; Ayebazibwe, C.;


    Control of foot-and-mouth disease (FMD) in Uganda by ring vaccination largely depends on costly trivalent vaccines, and use of monovalent vaccines could improve the cost effectiveness. This, however, requires application of highly specific diagnostic tests. This study investigated outbreaks of FM...

  5. Electric foot shock stress adaptation: Does it exist or not? (United States)

    Bali, Anjana; Jaggi, Amteshwar Singh


    Stress adaptation is a protective phenomenon against repeated stress exposure and is characterized by a decreased responsiveness to a repeated stress stimulus. The adaptation is associated with a complex cascade of events, including the changes in behavior, neurotransmitter and gene expression levels. The non-adaptation or maladaptation to stress may underlie the affective disorders, such as anxiety, depression and post-traumatic stress disorder (PTSD). Electric foot shock is a complex stressor, which includes both physical and emotional components. Unlike immobilization, restraint and cold immersion stress, the phenomenon of stress adaptation is not very well defined in response to electric foot shock. A number of preclinical studies have reported the development of adaptation to electric foot shock stress. However, evidence also reveals the non-adaptive behavior in response to foot shocks. The distinct adaptive/non-adaptive responses may be possibly influenced by the type, intensity, and duration of the stress. The present review discusses the existence or non-existence of adaptation to electric foot shock stress along with possible mechanism.

  6. Foot Comfort for the Fashionable (United States)


    Modellista Footwear's new shoe line uses Tempur(TM) material, which conforms to each wearer's unique foot shape to absorb shock and cushion the foot. The foam's properties allow the shoe to change with the wearer's foot as it shrinks and swells throughout the day. Scientists at NASA's Ames Research Center originally developed temper foam in the early 1970s to relieve the intense pressure of G-forces experienced by astronauts during rocket launches. Tempur-Pedic, Inc., further developed the foam and granted Modellista a license to use it in footwear. The Modellista collection is the first shoe design and construction to be certified by the Space Awareness Alliance. The shoes, with designs ranging from traditional clog shapes to sling backs and open-toe sandals, are currently available nationwide at select specialty shoe stores and through catalogs. Tempur(TM) is a registered trademark of Tempur-Pedic, Inc.

  7. [Operative treatment of diabetic foot]. (United States)

    Hintermann, B


    The majority of diabetic foot ulcers are the results of repetitive pressure that exceeds the threshold of soft-tissue tolerance, leading to mechanical destruction of the tissue. Progression of plantar ulcers can rapidly lead to osteomyelitis that may result in loss of the foot through amputation. In order to prevent such a disaster, surgical treatment should be taken into consideration when conservative treatment remains without success. The goal of surgical treatment of an infected ulcer is debridement of the soft-tissue and removal of the underlying pressure by careful bone resection or correction of a deformity by arthrodesis. Various authors have recently reported successful surgical reconstruction of neuroarthropathic foot deformity and instability. Apparently arthrodesis is a viable alternative to amputation for patients with unstable deformity or recurrent ulceration. Proper preoperative evaluation is mandatory. The indications are not well defined yet.

  8. Design and Analysis of New Prosthetic Foot.

    Directory of Open Access Journals (Sweden)

    Kadhim K.Al-Kinani,MSc


    Full Text Available There is a variety of artificial foot designs variable for use with prosthetic legs . Most of the design can be divided into two classes, articulated and non-articulated feet. one common non-articulated foot is the SACH . The solid ankle cushion heel foot referred to as the SACH foot has a rigid keelOne key or the key factor in designing a new prosthesis is in the analysis of a patients response This view is the most important because if the foot does not provide functional , practical or cosmetically acceptable characteristics the patient will not feel comfortable with the prosthesis , therefore design and manufacturing a new foot is essential, this foot made from polyethylene, its different shape and characteristics The characteristics deemed important by patients in achieving natural gait motion include:Dorsiflexion Energy return Fatigue test In this study, including all these characteristics test, design fatigue foot tester according to ISO 10328 and design new foot .Also, the testometric crosshead was modified to find dorsiflexion angle and energy return .The fatigue criteria for polymer was proposed, in mathematical solution. Finally , the characteristics of SACH foot was compared with new foot by mathematical solution and used visual basic program and experimental method by different tests. From these test that the new foot is better than SACH foot for all test .

  9. Diabetic foot ulcers: practical treatment recommendations. (United States)

    Edmonds, Michael


    When treating diabetic foot ulcers it is important to be aware of the natural history of the diabetic foot, which can be divided into five stages: stage 1, a normal foot; stage 2, a high risk foot; stage 3, an ulcerated foot; stage 4, an infected foot; and stage 5, a necrotic foot. This covers the entire spectrum of foot disease but emphasises the development of the foot ulcer as a pivotal event in stage 3, which demands urgent and aggressive management. Diabetic foot care in all stages needs multidisciplinary management to control mechanical, wound, microbiological, vascular, metabolic and educational aspects. Achieving good metabolic control of blood glucose, lipids and blood pressure is important in each stage, as is education to teach proper foot care appropriate for each stage. Ideally, it is important to prevent the development of ulcers in stages 1 and 2. In stage 1, the normal foot, it is important to encourage the use of suitable footwear, and to educate the patient to promote healthy foot care and footwear habits. In stage 2, the foot has developed one or more of the following risk factors for ulceration: neuropathy, ischaemia, deformity, swelling and callus. The majority of deformities can be accommodated in special footwear and as callus is an important precursor of ulceration it should be treated aggressively, especially in the neuropathic foot. In stage 3, ulcers can be divided into two distinct entities: those in the neuropathic foot and those in the neuroischaemic foot. In the neuropathic foot, ulcers commonly develop on the plantar surface of the foot and the toes, and are associated with neglected callus and high plantar pressures. In the neuroischaemic foot, ulcers are commonly seen around the edges of the foot, including the apices of the toes and back of the heel, and are associated with trauma or wearing unsuitable shoes. Ulcers in stage 3 need relief of pressure (mechanical control), sharp debridement and dressings (wound control), and

  10. Cosmetic Foot Surgery: Fashion's Pandora's Box (United States)

    ... A A A | Print | Share Cosmetic Foot Surgery: Fashion’s Pandora’s Box? Foot and ankle surgeons warn against ... a "face lift" and fit them into high-fashion shoes. But physician members of the American College ...

  11. American Orthopaedic Foot and Ankle Society (United States)

    ... education site of the American Orthopaedic Foot & Ankle Society. Patients Visit the official patient education site of the American Orthopaedic Foot & Ankle Society. Patients Visit the official patient education site of ...

  12. Diabetic Foot - Multiple Languages: MedlinePlus (United States)

    ... Are Here: Home → Multiple Languages → All Health Topics → Diabetic Foot URL of this page: ... V W XYZ List of All Topics All Diabetic Foot - Multiple Languages To use the sharing features on ...

  13. An overview of the Charcot foot pathophysiology


    Öğüt, Tahir; Kaynak, Gökhan; Birsel, Olgar; Güven, Mehmet Fatih


    Charcot arthropathy of the foot is a rare but devastating complication of diabetes that remains to be a challenging issue for the foot and ankle surgeons. Charcot foot fails to be an obvious diagnostic option that comes to mind, even in a pathognomonic clinical appearance. The rarity of the disorder, more common pathologies that mimic the condition, and the self-limiting prognosis deviate the clinician from the right diagnosis. The clinical challenges in the diagnosis of Charcot foot require ...

  14. Foot Health Facts for Athletes (United States)

    ... as basketball, can lead to tears and even ruptures of the Achilles tendon. These conditions should be followed by a foot and ankle surgeon. Heel pain —This condition is most often caused by plantar fasciitis, although other things, such as stress fractures or ...

  15. 24 CFR 3285.312 - Footings. (United States)


    ... MODEL MANUFACTURED HOME INSTALLATION STANDARDS Foundations § 3285.312 Footings. (a) Materials approved... density. A footing must support every pier. Footings are to be either: (1) Concrete. (i) Four inch nominal... requirements when frame blocking only is used. 2. In addition to blocking required by § 3285.311, see Table...


    Directory of Open Access Journals (Sweden)

    P. Rajagopal


    Full Text Available BACKGROUND AND OBJECTIVES Infections of all types are more common in patients with diabetes, on the basis of outcome of retrospective study in Canada. Many types of infections are very common in diabetic than non-diabetic patients. Foot is the most common site. Diabetic foot infections range from mild infections to limb threatening conditions. Most require emergency medical attention. Diabetic foot infection is a global burden and projected to increase from 246 million people to over 380 million people by the year 2025. Many people with diabetes develop complications that seriously affect their quality and length of life. Lower limb complications are common, particularly foot ulcers and gangrene. Development of these complications is attributed to individual risk factors, poverty, racial and ethnic differences, and quality of local and national health care systems. The wide variations noted suggest that best practices in low incidence areas could easily be adapted in high incidence areas to reduce the burden of complications. Almost every infection begins in a wound, often as neuropathic ulceration or a traumatic break in the skin. Infections that begin as a small problem may progress to involve soft tissue, bones and joints. Because of these morbidity and occasional mortality by these foot infections several authoritative groups have recently developed guidelines for assessing and treating diabetic foot. METHODOLOGY 100 Diabetic patients with foot ulcers were admitted and wounds were classified using wagner’s classification. Pus was sent for culture and sensitivity and treated accordingly. RESULTS In our study the most common organism cultured from the wound with diabetes mellitus was staphylococcus. The most sensitive drug for these organisms was found to be chloramphenicol on most occasions. CONCLUSION The rationale of pus culture and sensitivity is not only to definitively treat the diabetic wound after the culture sensitivity report is

  17. Clinical examination and foot pressure analysis of diabetic foot: Prospective analytical study in Indian diabetic patients.

    Directory of Open Access Journals (Sweden)

    Harshanand Popalwar


    Conclusion: Meticulous clinical examination can easily identify diabetic neuropathy and related pathological complications of diabetic foot. This shall help for early diagnosis and prevention of diabetic foot complications. Foot pressure analysis can be useful tool to screen patients of diabetic foot for abnormal high pressure point areas and can predict future risk of ulceration due to high foot pressure. This study states findings in Indian diabetic patients. [Natl J Med Res 2016; 6(1.000: 17-22

  18. Reliability and normative values of the foot line test: a technique to assess foot posture

    DEFF Research Database (Denmark)

    Brushøj, C; Larsen, Klaus; Nielsen, MB;


    STUDY DESIGN: Test-retest reliability. OBJECTIVE: To examine the reliability and report normative values of a novel test, the foot line test (FLT), to describe foot morphology. BACKGROUND: Numerous foot examinations are performed each day, but most existing examination techniques have considerable......). There was no significant association between foot size and FLT values. CONCLUSION: The FLT is a reproducible technique to assess foot posture....

  19. Multi-segment trunk models used to investigate the crunch factor in golf and their relationship with selected swing and launch parameters. (United States)

    Joyce, Christopher; Chivers, Paola; Sato, Kimitake; Burnett, Angus


    The use of multi-segment trunk models to investigate the crunch factor in golf may be warranted. The first aim of the study was to investigate the relationship between the trunk and lower trunk for crunch factor-related variables (trunk lateral bending and trunk axial rotation velocity). The second aim was to determine the level of association between crunch factor-related variables with swing (clubhead velocity) and launch (launch angle). Thirty-five high-level amateur male golfers (Mean ± SD: age = 23.8 ± 2.1 years, registered golfing handicap = 5 ± 1.9) without low back pain had kinematic data collected from their golf swing using a 10-camera motion analysis system operating at 500 Hz. Clubhead velocity and launch angle were collected using a validated real-time launch monitor. A positive relationship was found between the trunk and lower trunk for axial rotation velocity (r(35) = .47, P < .01). Cross-correlation analysis revealed a strong coupling relationship for the crunch factor (R(2) = 0.98) between the trunk and lower trunk. Using generalised linear model analysis, it was evident that faster clubhead velocities and lower launch angles of the golf ball were related to reduced lateral bending of the lower trunk.

  20. Wearable Multi-Frequency and Multi-Segment Bioelectrical Impedance Spectroscopy for Unobtrusively Tracking Body Fluid Shifts during Physical Activity in Real-Field Applications: A Preliminary Study

    Directory of Open Access Journals (Sweden)

    Federica Villa


    Full Text Available Bioelectrical Impedance Spectroscopy (BIS allows assessing the composition of body districts noninvasively and quickly, potentially providing important physiological/clinical information. However, neither portable commercial instruments nor more advanced wearable prototypes simultaneously satisfy the demanding needs of unobtrusively tracking body fluid shifts in different segments simultaneously, over a broad frequency range, for long periods and with high measurements rate. These needs are often required to evaluate exercise tests in sports or rehabilitation medicine, or to assess gravitational stresses in aerospace medicine. Therefore, the aim of this work is to present a new wearable prototype for monitoring multi-segment and multi-frequency BIS unobtrusively over long periods. Our prototype guarantees low weight, small size and low power consumption. An analog board with current-injecting and voltage-sensing electrodes across three body segments interfaces a digital board that generates square-wave current stimuli and computes impedance at 10 frequencies from 1 to 796 kHz. To evaluate the information derivable from our device, we monitored the BIS of three body segments in a volunteer before, during and after physical exercise and postural shift. We show that it can describe the dynamics of exercise-induced changes and the effect of a sit-to-stand maneuver in active and inactive muscular districts separately and simultaneously.

  1. Adding Stiffness to the Foot Modulates Soleus Force-Velocity Behaviour during Human Walking (United States)

    Takahashi, Kota Z.; Gross, Michael T.; van Werkhoven, Herman; Piazza, Stephen J.; Sawicki, Gregory S.


    Previous studies of human locomotion indicate that foot and ankle structures can interact in complex ways. The structure of the foot defines the input and output lever arms that influences the force-generating capacity of the ankle plantar flexors during push-off. At the same time, deformation of the foot may dissipate some of the mechanical energy generated by the plantar flexors during push-off. We investigated this foot-ankle interplay during walking by adding stiffness to the foot through shoes and insoles, and characterized the resulting changes in in vivo soleus muscle-tendon mechanics using ultrasonography. Added stiffness decreased energy dissipation at the foot (p muscle lever arms) (p muscle behaviour, leading to greater peak force (p shortening speed (p < 0.001). Despite this shift in force-velocity behaviour, the whole-body metabolic cost during walking increased with added foot stiffness (p < 0.001). This increased metabolic cost is likely due to the added force demand on the plantar flexors, as walking on a more rigid foot/shoe surface compromises the plantar flexors’ mechanical advantage.

  2. Weigh-in-motion scale with foot alignment features

    Energy Technology Data Exchange (ETDEWEB)

    Abercrombie, Robert Knox; Richardson, Gregory David; Scudiere, Matthew Bligh


    A pad is disclosed for use in a weighing system for weighing a load. The pad includes a weighing platform, load cells, and foot members. Improvements to the pad reduce or substantially eliminate rotation of one or more of the corner foot members. A flexible foot strap disposed between the corner foot members reduces rotation of the respective foot members about vertical axes through the corner foot members and couples the corner foot members such that rotation of one corner foot member results in substantially the same amount of rotation of the other corner foot member. In a strapless variant one or more fasteners prevents substantially all rotation of a foot member. In a diagonal variant, a foot strap extends between a corner foot member and the weighing platform to reduce rotation of the foot member about a vertical axis through the corner foot member.

  3. Foot Plantar Pressure Measurement System: A Review

    Directory of Open Access Journals (Sweden)

    Yufridin Wahab


    Full Text Available Foot plantar pressure is the pressure field that acts between the foot and the support surface during everyday locomotor activities. Information derived from such pressure measures is important in gait and posture research for diagnosing lower limb problems, footwear design, sport biomechanics, injury prevention and other applications. This paper reviews foot plantar sensors characteristics as reported in the literature in addition to foot plantar pressure measurement systems applied to a variety of research problems. Strengths and limitations of current systems are discussed and a wireless foot plantar pressure system is proposed suitable for measuring high pressure distributions under the foot with high accuracy and reliability. The novel system is based on highly linear pressure sensors with no hysteresis.

  4. Narrative review: Diabetic foot and infrared thermography (United States)

    Hernandez-Contreras, D.; Peregrina-Barreto, H.; Rangel-Magdaleno, J.; Gonzalez-Bernal, J.


    Diabetic foot is one of the major complications experienced by diabetic patients. An early identification and appropriate treatment of diabetic foot problems can prevent devastating consequences such as limb amputation. Several studies have demonstrated that temperature variations in the plantar region can be related to diabetic foot problems. Infrared thermography has been successfully used to detect complication related to diabetic foot, mainly because it is presented as a rapid, non-contact and non-invasive technique to visualize the temperature distribution of the feet. In this review, an overview of studies that relate foot temperature with diabetic foot problems through infrared thermography is presented. Through this research, it can be appreciated the potential of infrared thermography and the benefits that this technique present in this application. This paper also presents the different methods for thermogram analysis and the advantages and disadvantages of each one, being the asymmetric analysis the method most used so far.

  5. Diabetic foot ulcer: assessment and management. (United States)

    Saraogi, Ravi Kant


    Diabetic foot ulcer is a rising health problem with rising prevalence of diabetes. It is the most important cause of non-traumatic foot amputations. Diabetic foot ulcers are primarily due to neuropathy and/or ischaemia, and are frequently complicated by infection. Up to 85% of all diabetic foot related problems are preventable through a combination of good foot care and appropriate education for patients and healthcare providers. The holistic care of diabetic foot ulcer patients requires a multidisciplinary team approach. Apart from blood sugar control, treatment of ulcer involves debridement, offloading, appropriate dressings, vascular maintenance and infection control. Use of adjunctive treatments such as various growth factors, skin replacement dressings and vacuum assisted closure will accelerate healing in selected cases.

  6. 3D finite element model of the diabetic neuropathic foot: a gait analysis driven approach. (United States)

    Guiotto, Annamaria; Sawacha, Zimi; Guarneri, Gabriella; Avogaro, Angelo; Cobelli, Claudio


    Diabetic foot is an invalidating complication of diabetes that can lead to foot ulcers. Three-dimensional (3D) finite element analysis (FEA) allows characterizing the loads developed in the different anatomical structures of the foot in dynamic conditions. The aim of this study was to develop a subject specific 3D foot FE model (FEM) of a diabetic neuropathic (DNS) and a healthy (HS) subject, whose subject specificity can be found in term of foot geometry and boundary conditions. Kinematics, kinetics and plantar pressure (PP) data were extracted from the gait analysis trials of the two subjects with this purpose. The FEM were developed segmenting bones, cartilage and skin from MRI and drawing a horizontal plate as ground support. Materials properties were adopted from previous literature. FE simulations were run with the kinematics and kinetics data of four different phases of the stance phase of gait (heel strike, loading response, midstance and push off). FEMs were then driven by group gait data of 10 neuropathic and 10 healthy subjects. Model validation focused on agreement between FEM-simulated and experimental PP. The peak values and the total distribution of the pressures were compared for this purpose. Results showed that the models were less robust when driven from group data and underestimated the PP in each foot subarea. In particular in the case of the neuropathic subject's model the mean errors between experimental and simulated data were around the 20% of the peak values. This knowledge is crucial in understanding the aetiology of diabetic foot.

  7. Prevention and treatment of diabetic foot ulcers. (United States)

    Lim, Jonathan Zhang Ming; Ng, Natasha Su Lynn; Thomas, Cecil


    The rising prevalence of diabetes estimated at 3.6 million people in the UK represents a major public health and socioeconomic burden to our National Health Service. Diabetes and its associated complications are of a growing concern. Diabetes-related foot complications have been identified as the single most common cause of morbidity among diabetic patients. The complicating factor of underlying peripheral vascular disease renders the majority of diabetic foot ulcers asymptomatic until latter evidence of non-healing ulcers become evident. Therefore, preventative strategies including annual diabetic foot screening and diabetic foot care interventions facilitated through a multidisciplinary team have been implemented to enable early identification of diabetic patients at high risk of diabetic foot complications. The National Diabetes Foot Care Audit reported significant variability and deficiencies of care throughout England and Wales, with emphasis on change in the structure of healthcare provision and commissioning, improvement of patient education and availability of healthcare access, and emphasis on preventative strategies to reduce morbidities and mortality of this debilitating disease. This review article aims to summarise major risk factors contributing to the development of diabetic foot ulcers. It also considers the key evidence-based strategies towards preventing diabetic foot ulcer. We discuss tools used in risk stratification and classifications of foot ulcer.

  8. Priorities in offloading the diabetic foot. (United States)

    Bus, Sicco A


    Biomechanical factors play an important role in diabetic foot disease. Reducing high foot pressures (i.e. offloading) is one of the main goals in healing and preventing foot ulceration. Evidence-based guidelines show the strong association between the efficacy to offload the foot and clinical outcome. However, several aspects related to offloading are underexposed. First, in the management of foot complications, offloading is mostly studied as a single entity, whereas it should be analysed in a broader perspective of contributing factors to better predict clinical outcome. This includes assessment of patient behavioural factors such as type and intensity of daily physical activity and adherence to prescribed treatment. Second, a large gap exists between evidence-based recommendations and clinical practice in the use of offloading for ulcer treatment, and this gap needs to be bridged. Possible ways to achieve this are discussed in this article. Third, our knowledge about the efficacy and role of offloading in treating complicated and non-plantar neuropathic foot ulcers needs to be expanded because these ulcers currently dominate presentation in multidisciplinary foot practice. Finally, foot ulcer prevention is underexposed when compared with ulcer treatment. Prevention requires a larger focus, in particular regarding the efficacy of therapeutic footwear and its relative role in comparison with other preventative strategies. These priorities need the attention of clinicians, scientists and professional societies to improve our understanding of offloading and to improve clinical outcome in the management of the diabetic foot.

  9. The madura foot: looking deep. (United States)

    Venkatswami, Sandhya; Sankarasubramanian, Anandan; Subramanyam, Shobana


    "Mycetoma" means a fungal tumor. Mycetoma is a chronic, granulomatous, subcutaneous tissue infection caused by both bacteria (actinomycetoma) and fungi (eumycetoma). This chronic infection was termed Madura foot and eventually mycetoma, owing to its etiology. Inoculation commonly follows minor trauma, predominantly to the foot and hence is seen more among the barefoot-walking populations, common among adult males aged 20 to 50 years. The hallmark triad of the disease includes tumefaction, fistulization of the abscess, and extrusion of colored grains. The color of these extruded grains in the active phase of the disease offers a clue to diagnosis. Radiology, ultrasonology, cytology, histology, immunodiagnosis, and culture are tools used in diagnosis. Recently, DNA sequencing has also been used successfully. Though both infections manifest with similar clinical findings, Actinomycetoma has a rapid course and can lead to amputation or death secondary to systemic spread. However, actinomycetomas are more responsive to antibiotics, whereas eumycetomas require surgical excision in addition to antifungals. Complications include secondary bacterial infections that can progress to full-blown bacteremia or septicemia, resulting in death. With extremely disfiguring sequelae, following the breakdown of the nodules and formation of discharging sinuses, it poses a therapeutic challenge.

  10. Classification of diabetic foot ulcers. (United States)

    Game, Frances


    It is known that the relative importance of factors involved in the development of diabetic foot problems can vary in both their presence and severity between patients and lesions. This may be one of the reasons why outcomes seem to vary centre to centre and why some treatments may seem more effective in some people than others. There is a need therefore to classify and describe lesions of the foot in patients with diabetes in a manner that is agreed across all communities but is simple to use in clinical practice. No single system is currently in widespread use, although a number have been published. Not all are well validated outside the system from which they were derived, and it has not always been made clear the clinical purposes to which such classifications should be put to use, whether that be for research, clinical description in routine clinical care or audit. Here the currently published classification systems, their validation in clinical practice, whether they were designed for research, audit or clinical care, and the strengths and weaknesses of each are explored.

  11. Diabetic Foot and Risk: How to Prevent Losing Your Leg (United States)

    ... Site Content AOFAS / FootCareMD / Conditions / Diabetic Foot The Diabetic Foot and Risk: How to Prevent Losing Your ... Page Content Don't deny you are a diabetic Anyone who has ever had an elevated blood ...

  12. Robust Foot Clearance Estimation Based on the Integration of Foot-Mounted IMU Acceleration Data. (United States)

    Benoussaad, Mourad; Sijobert, Benoît; Mombaur, Katja; Coste, Christine Azevedo


    This paper introduces a method for the robust estimation of foot clearance during walking, using a single inertial measurement unit (IMU) placed on the subject's foot. The proposed solution is based on double integration and drift cancellation of foot acceleration signals. The method is insensitive to misalignment of IMU axes with respect to foot axes. Details are provided regarding calibration and signal processing procedures. Experimental validation was performed on 10 healthy subjects under three walking conditions: normal, fast and with obstacles. Foot clearance estimation results were compared to measurements from an optical motion capture system. The mean error between them is significantly less than 15 % under the various walking conditions.

  13. [The "diabetic foot" syndrome. An overview]. (United States)

    Chantelau, E


    Amputation has been used most frequently to treat the diabetic foot syndrome, occlusive microangiopathy being suspected as the underlying cause. This paradigm is obsolete: most diabetic foot lesions are due to traumatic painless (neuropathic) infections. Evidence is presented for alternative treatment strategies to effectively reduce exorbitant amputation rates in diabetic patients.

  14. Louisiana farm discussion: 8 foot row spacing (United States)

    This year several tests in growers’ fields were used to compare traditional 6-foot row spacing to 8-foot row spacing. Cane is double-drilled in the wider row spacing. The wider row spacing would accommodate John Deere 3522 harvester. Field data indicate the sugarcane yields are very comparable in 8-...

  15. An overview of the Charcot foot pathophysiology. (United States)

    Kaynak, Gökhan; Birsel, Olgar; Güven, Mehmet Fatih; Oğüt, Tahir


    Charcot arthropathy of the foot is a rare but devastating complication of diabetes that remains to be a challenging issue for the foot and ankle surgeons. Charcot foot fails to be an obvious diagnostic option that comes to mind, even in a pathognomonic clinical appearance. The rarity of the disorder, more common pathologies that mimic the condition, and the self-limiting prognosis deviate the clinician from the right diagnosis. The clinical challenges in the diagnosis of Charcot foot require in-depth investigations of its enigmatic nature to establish useful guidelines. Yet, this goal seems to be beyond reach, without a holistic view of the immense literature concerning the pathophysiology of the disorder. The primary objective of this article is to put together and review the recent advancements about the etiology and intrinsic mechanisms of diabetic Charcot foot.

  16. An overview of the Charcot foot pathophysiology

    Directory of Open Access Journals (Sweden)

    Gökhan Kaynak


    Full Text Available Charcot arthropathy of the foot is a rare but devastating complication of diabetes that remains to be a challenging issue for the foot and ankle surgeons. Charcot foot fails to be an obvious diagnostic option that comes to mind, even in a pathognomonic clinical appearance. The rarity of the disorder, more common pathologies that mimic the condition, and the self-limiting prognosis deviate the clinician from the right diagnosis. The clinical challenges in the diagnosis of Charcot foot require in-depth investigations of its enigmatic nature to establish useful guidelines. Yet, this goal seems to be beyond reach, without a holistic view of the immense literature concerning the pathophysiology of the disorder. The primary objective of this article is to put together and review the recent advancements about the etiology and intrinsic mechanisms of diabetic Charcot foot.

  17. Foot roll-over evaluation based on 3D dynamic foot scan. (United States)

    Samson, William; Van Hamme, Angèle; Sanchez, Stéphane; Chèze, Laurence; Van Sint Jan, Serge; Feipel, Véronique


    Foot roll-over is commonly analyzed to evaluate gait pathologies. The current study utilized a dynamic foot scanner (DFS) to analyze foot roll-over. The right feet of ten healthy subjects were assessed during gait trials with a DFS system integrated into a walkway. A foot sole picture was computed by vertically projecting points from the 3D foot shape which were lower than a threshold height of 15 mm. A 'height' value of these projected points was determined; corresponding to the initial vertical coordinates prior to projection. Similar to pedobarographic analysis, the foot sole picture was segmented into anatomical regions of interest (ROIs) to process mean height (average of height data by ROI) and projected surface (area of the projected foot sole by ROI). Results showed that these variables evolved differently to plantar pressure data previously reported in the literature, mainly due to the specificity of each physical quantity (millimeters vs Pascals). Compared to plantar pressure data arising from surface contact by the foot, the current method takes into account the whole plantar aspect of the foot, including the parts that do not make contact with the support surface. The current approach using height data could contribute to a better understanding of specific aspects of foot motion during walking, such as plantar arch height and the windlass mechanism. Results of this study show the underlying method is reliable. Further investigation is required to validate the DFS measurements within a clinical context, prior to implementation into clinical practice.

  18. Surgical treatment of the Charcot foot. (United States)

    Pinzur, Michael S


    With the increased number of diabetics worldwide and the increased incidence of morbid obesity in more prosperous cultures, there has become an increased awareness of Charcot arthropathy of the foot and ankle. Outcome studies would suggest that patients with deformity associated with Charcot Foot arthropathy have impaired health related quality of life. This awareness has led reconstructive-minded foot and ankle surgeons to develop surgical strategies to treat these acquired deformities. This article outlines the current clinical approach to this disabling medical condition.

  19. 5-foot Vertical Wind Tunnel (United States)


    The researcher is sitting above the exit cone of the 5-foot Vertical Wind Tunnel and is examining the new 6-component spinning balance. This balance was developed between 1930 and 1933. It was an important advance in the technology of rotating or rolling balances. As M.J. Bamber and C.H. Zimmerman wrote in NACA TR 456: 'Data upon the aerodynamic characteristics of a spinning airplane may be obtained in several ways; namely, flight tests with full-scale airplanes, flight tests with balanced models, strip-method analysis of wind-tunnel force and moment tests, and wind-tunnel tests of rotating models.' Further, they note: 'Rolling-balance data have been of limited value because it has not been possible to measure all six force and moment components or to reproduce a true spinning condition. The spinning balance used in this investigation is a 6-component rotating balance from which it is possible to obtain wind-tunnel data for any of a wide range of possible spinning conditions.' Bamber and Zimmerman described the balance as follows: 'The spinning balance consists of a balance head that supports the model and contains the force-measuring units, a horizontal turntable supported by streamline struts in the center of the jet and, outside the tunnel, a direct-current driving motor, a liquid tachometer, an air compressor, a mercury manometer, a pair of indicating lamps, and the necessary controls. The balance head is mounted on the turntable and it may be set to give any radius of spin between 0 and 8 inches.' In an earlier report, NACA TR 387, Carl Wenzinger and Thomas Harris supply this description of the tunnel: 'The vertical open-throat wind tunnel of the National Advisory Committee for Aeronautics ... was built mainly for studying the spinning characteristics of airplane models, but may be used as well for the usual types of wind-tunnel tests. A special spinning balance is being developed to measure the desired forces and moments with the model simulating the actual

  20. Age-related differences in women's foot shape

    NARCIS (Netherlands)

    Ansuategui Echeita, Jone; Hijmans, Juha M.; Smits, Sharon; Van der Woude, Lucas H. V.; Postema, Klaas


    Purpose: Describe age-related differences in women's foot shape using a wide range of measurements and ages. Study design: Cross-sectional, observational study. Main outcome measurements: Six foot-shape measurements of each foot: foot lengths, ball widths, ball circumferences, low instep circumferen

  1. Effect of forward/backward standing posture on foot shape

    NARCIS (Netherlands)

    Daanen, H.A.M.; Tan, T.K.; Punte, P.A.J.


    Foot length and breadth are generally used to determine the correct shoe size. An important question is whether foot length and foot breadth are dependent upon body posture. Therefore, the effect of leaning forward/backward on foot length and breadth is investigated in this study. Seven subjects par

  2. Clinical and functional correlates of foot pain in diabetic patients.

    NARCIS (Netherlands)

    Rijken, P.M.; Dekker, J.; Rauwerda, J.A.; Dekker, E.; Lankhorst, G.J.; Bakker, K.; Dooren, J.


    Purpose: patients with diabetes mellitus frequently suffer from foot pain. This pain seems to be a neglected area in studies on the diabetic foot. The purpose of this study was to identify clinical variables associated with foot pain in diabetic patients. In addition, the relationships between foot

  3. Flavonoids from the bird's foot trefoil seeds (Lotus corniculatus L.

    Directory of Open Access Journals (Sweden)

    Piotr M. Górski


    Full Text Available In the seeds of bird's foot trefoil (Lotus corniculatus L. the presence of quercetin- and kaempferol heterosides was found. Eight crystalline compounds and one chromatographically homogeneous fraction were obtained from the flavonoid mixture using column chromatography on polyamide and cellulose. By means of TL-chromatography, elemental analysis and UV-spectrometry seven of the isolated compounds were identified to be quercetin, quercetin 3-arabopyranoside (guajaverin, quercetin 3-galactoside, quercetin 3-rhamnoside, kaempferol 3,7-diglucoside, kaempferol 3,7-dirhamnoside kaempferol 3-glucosyl-7-rhamnoside and two remaining ones were only partly characterized a snearer indefinite kaempferol heterosides.

  4. Glossary of Foot and Ankle Terms (United States)

    ... long bones of the fingers or toes. Plantar fascia - Plantar fascia is a thin layer of tough tissue supporting ... foot. Plantar fasciitis - An inflammation of the plantar fascia. Symptoms are usually pain at the bottom of ...

  5. On-the-Job Foot Health (United States)

    ... and direct flame PROTECTION: overshoes or boots of fire-resistant materials with wooden soles HAZARD: high voltage ... in the workplace. Only one out of four victims of job- related foot injury wear any type ...

  6. The diabetic foot in 2015: an overview. (United States)

    Markakis, K; Bowling, F L; Boulton, A J M


    In 2015, it can be said that the diabetic foot is no longer the Cinderella of diabetic complications. Thirty years ago there was little evidence-based research taking place on the diabetic foot, and there were no international meetings addressing this topic. Since then, the biennial Malvern Diabetic Foot meetings started in 1986, the American Diabetes Association founded their Foot Council in 1987, and the European Association for the Study of Diabetes established a Foot Study Group in 1998. The first International Symposium on the Diabetic Foot in The Netherlands was convened in 1991, and this was soon followed by the establishment of the International Working Group on the Diabetic Foot that has produced useful guidelines in several areas of investigation and the management of diabetic foot problems. There has been an exponential rise in publications on diabetic foot problems in high impact factor journals, and a comprehensive evidence-base now exists for many areas of treatment. Despite the extensive evidence available, it, unfortunately, remains difficult to demonstrate that most types of education are efficient in reducing the incidence of foot ulcers. However, there is evidence that education as part of a multi-disciplinary approach to diabetic foot ulceration plays a pivotal role in incidence reduction. With respect to treatment, strong evidence exists that offloading is the best modality for healing plantar neuropathic foot ulcers, and there is also evidence from two randomized controlled trials to support the use of negative-pressure wound therapy in complex post-surgical diabetic foot wounds. Hyperbaric oxygen therapy exhibits the same evidence level and strength of recommendation. International guidelines exist on the management of infection in the diabetic foot. Many randomized trials have been performed, and these have shown that the agents studied generally produced comparable results, with the exception of one study in which tigecycline was shown to

  7. Intramedullary foot fixation for midfoot Charcot neuroarthropathy. (United States)

    Lamm, Bradley M; Siddiqui, Noman A; Nair, Ajitha K; LaPorta, Guido


    Midfoot Charcot collapse commonly occurs through the tarsometatarsal and/or midtarsal joints, which creates the characteristic "rocker bottom" deformity. Intramedullary metatarsal fixation spanning the tarsus into the talus and/or calcaneus is a recently developed method for addressing unstable midfoot Charcot deformity. The intramedullary foot fixation technique has various advantages when addressing midfoot Charcot deformity in the neuropathic patient. These advantages include anatomical realignment, minimally invasive fixation technique, formal multiple joint fusion, adjacent joint fixation beyond the level of Charcot collapse, rigid interosseus fixation, and preservation of foot length. The goals of the intramedullary foot fixation procedure are to create a stable, plantigrade, and ulcer-free foot, which allows the patient to ambulate with custom-molded orthotics and shoes.

  8. American College of Foot and Ankle Surgeons (United States)

    ... Practice Management Education Opportunities Practice Management e-Learning e-Learning CME Transcripts Corporate Relations Faculty Application Research & Publications Journal of Foot and Ankle Surgery ACFAS Update Read ...

  9. Growth factors for treating diabetic foot ulcers

    DEFF Research Database (Denmark)

    Martí-Carvajal, Arturo J; Gluud, Christian; Nicola, Susana


    BACKGROUND: Foot ulcers are a major complication of diabetes mellitus, often leading to amputation. Growth factors derived from blood platelets, endothelium, or macrophages could potentially be an important treatment for these wounds but they may also confer risks. OBJECTIVES: To assess...... the benefits and harms of growth factors for foot ulcers in patients with type 1 or type 2 diabetes mellitus. SEARCH METHODS: In March 2015 we searched the Cochrane Wounds Group Specialised Register, The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), Ovid MEDLINE, Ovid MEDLINE...... (minimum of one toe), complete healing of the foot ulcer, and time to complete healing of the diabetic foot ulcer as the primary outcomes. DATA COLLECTION AND ANALYSIS: Independently, we selected randomised clinical trials, assessed risk of bias, and extracted data in duplicate. We estimated risk ratios...

  10. [Diabetic, neuropathic, arteriopathic foot and dressing choice]. (United States)

    Lowe, S; Kayoumi, M


    The definition for the diabetic foot is infection, ulceration or destruction of deep tissues of the foot associated with neuropathy or peripheral vascular disease in the lower extremity of people with diabetes. Non-diabetic patients may suffer the same risks when neuropathy and arteriopathy are present. Knowing that 85% of amputations are preceded by foot ulcers, prevention is primordial. At the onset of an ulcer, immediate treatment must be undertaken and preferably by an interdisciplinary team. Delayed healing and increased risk of infection are often due to an associated vascular disease. While the array of dressings is expansive there is no «gold standard» treatment or «miracle dressing» described for foot ulcers. The management consists of wound analysis, debridement, woundcare and especially offloading.

  11. Diabetic foot ulcer management: the podiatrist's perspective. (United States)

    Turns, Martin


    Diabetic foot complications result from two broad pathologies-neuropathic and neuro-ischaemic feet. It is important for diabetic patients to have at least a yearly review of foot ulcer risk factors, and they should have a corresponding risk classification agreed based on this assessment. Diabetic foot ulcer assessment should include a wound classification tool, which can give an indication of wounds at greater risk of non-healing or amputation. The treatment of diabetic foot ulcers should be part of a comprehensive care plan that should also include treatment of infection, frequent debridement (if deemed appropriate by a skilled specialist clinician), biomechanical offloading, blood glucose control and treatment of comorbidities. Clinicians should base dressing selection on the wound's location, size and depth, amount of exudate, presence of infection or necrosis and the condition of the surrounding tissue.

  12. A dynamic 3D foot reconstruction system. (United States)

    Thabet, Ali K; Trucco, Emanuele; Salvi, Joaquim; Wang, Weijie; Abboud, Rami J


    Foot problems are varied and range from simple disorders through to complex diseases and joint deformities. Wherever possible, the use of insoles, or orthoses, is preferred over surgery. Current insole design techniques are based on static measurements of the foot, despite the fact that orthoses are prevalently used in dynamic conditions while walking or running. This paper presents the design and implementation of a structured-light prototype system providing dense three dimensional (3D) measurements of the foot in motion, and its use to show that foot measurements in dynamic conditions differ significantly from their static counterparts. The input to the system is a video sequence of a foot during a single step; the output is a 3D reconstruction of the plantar surface of the foot for each frame of the input. Engineering and clinical tests were carried out for the validation of the system. The accuracy of the system was found to be 0.34 mm with planar test objects. In tests with real feet, the system proved repeatable, with reconstruction differences between trials one week apart averaging 2.44 mm (static case) and 2.81 mm (dynamic case). Furthermore, a study was performed to compare the effective length of the foot between static and dynamic reconstructions using the 4D system. Results showed an average increase of 9 mm for the dynamic case. This increase is substantial for orthotics design, cannot be captured by a static system, and its subject-specific measurement is crucial for the design of effective foot orthoses.

  13. The landmine foot: its description and management. (United States)

    Jacobs, L G


    The injuries of 54 patients involved in landmine explosions are described. In 72 per cent the injuries affected the mid- and hindfoot. Of these injuries, 67 per cent were open fractures involving the calcaneus. The injury resulted in the 'landmine foot', an entity not previously described. Its clinical features and orthotic management are described. The prognosis of 'landmine foot' was generally favourable in this Third World setting, with adequate rehabilitation provided by a customized surgical boot.

  14. Charcot foot and ankle with osteomyelitis


    Donegan, Ryan; Sumpio, Bauer; Peter A. Blume


    This paper presents a review of the current literature discussing topics of Charcot osteoarthropathy, osteomyelitis, diagnosing osteomyelitis, antibiotic management of osteomyelitis, and treatment strategies for management of Charcot osteoarthropathy with concurrent osteomyelitis.Keywords: Charcot foot; osteomyelitis; diabetes mellitus; infection; neuropathy(Published: 1 October 2013)Citation: Diabetic Foot & Ankle 2013, 4: 21361 -

  15. Postoperative infection in the foot and ankle.

    LENUS (Irish Health Repository)

    Chan, Victoria O


    Our discussion highlights the commonly performed surgical procedures in the foot and ankle and reviews the various imaging modalities available for the detection of infection with graphic examples to better enable radiologists to approach the radiological evaluation of postoperative infection in the foot and ankle. Discrimination between infectious and noninfectious inflammation remains a diagnostic challenge usually needing a combination of clinical assessment, laboratory investigations, and imaging studies to increase diagnostic accuracy.

  16. The management of the infected diabetic foot. (United States)

    Caravaggi, Carlo; Sganzaroli, Adriana; Galenda, Paolo; Bassetti, Matteo; Ferraresi, Roberto; Gabrielli, Livio


    Diabetes is a chronic disease with a worldwide increasing trend. Foot complications, closely related to neuropathy and obstructive peripheral vascular disease, are responsible for more than 1 million of leg amputations every year. Foot infection can dramatically increase the risk of amputation. Although many ulcer classification systems have been proposed to stratify the severity of the infectious process, the definition of a specific therapeutic approach still remains an unsolved problem. A Diabetic Foot Triage and an Integrated Surgical Protocol are proposed to identify a diagnostic flowchart and a step-by-step surgical protocol that can be applied in the treatment of diabetic foot infection. Considering the rapid climbing of multidrug resistant strains it is very important to rationalize the use of antibiotics utilizing them only for the treatment of true infected ulcers. PAD is widely considered the most important factor conditioning the outcome of a diabetic foot ulcer. Currently no randomized control trials are reported in the international literature directly comparing open versus endovascular revascularisation in diabetic patients with CLI. Insufficient data are available to demonstrate whether open bypass surgery or endovascular interventions are more effective in these patients. A decisional flow chart in choosing the best revascularization strategy in diabetic patients with CLI is proposed. Goals and technical aspects of emergency and elective surgical procedures in diabetic foot are analysed to evaluate critical aspects and to suggest proper surgical choices.

  17. The Charcot foot: pathophysiology, diagnosis and classification. (United States)

    Trieb, K


    Neuropathic changes in the foot are common with a prevalence of approximately 1%. The diagnosis of neuropathic arthropathy is often delayed in diabetic patients with harmful consequences including amputation. The appropriate diagnosis and treatment can avoid an extensive programme of treatment with significant morbidity for the patient, high costs and delayed surgery. The pathogenesis of a Charcot foot involves repetitive micro-trauma in a foot with impaired sensation and neurovascular changes caused by pathological innervation of the blood vessels. In most cases, changes are due to a combination of both pathophysiological factors. The Charcot foot is triggered by a combination of mechanical, vascular and biological factors which can lead to late diagnosis and incorrect treatment and eventually to destruction of the foot. This review aims to raise awareness of the diagnosis of the Charcot foot (diabetic neuropathic osteoarthropathy and the differential diagnosis, erysipelas, peripheral arterial occlusive disease) and describe the ways in which the diagnosis may be made. The clinical diagnostic pathways based on different classifications are presented. Cite this article: Bone Joint J 2016;98-B:1155-9.

  18. Outcomes of a Nurse-Managed Diabetes Foot Clinic (United States)


    Managed Diabetes Foot Clinic 5b. GRANT NUMBER HU0001-04-1-TS10 5c. PROGRAM ELEMENT NUMBER N/A 6. AUTHOR(S) 5d. PROJECT NUMBER N04-017...measured outcomes of a nurse-managed diabetes foot clinic on foot wound rates, health care costs, and changes in health status in adults with...assignment by risk. All received diabetic - foot self-care education and foot assessment. Controls were seen very three months. Treatment participants

  19. The cost of living in the membrane: a case study of hydrophobic mismatch for the multi-segment protein LeuT. (United States)

    Mondal, Sayan; Khelashvili, George; Shi, Lei; Weinstein, Harel


    K288A mutant. The involvement of hydrophobic mismatch is somewhat different in the functionally distinct conformations (outward-open, occluded, inward-open) of LeuT, and the differences are shown to connect to structural elements (e.g., TM1a) known to play key roles in transport. This finding suggests a mechanistic hypothesis for the enhanced transport activity observed for the K288A mutant, suggesting that the unfavorable hydrophobic-hydrophilic interactions hinder the motion of TM1a in the functionally relevant conformational transition to the inward-open state. Various extents of such unfavorable interactions, involving exposure to the lipid environment of adjacent hydrophobic and polar residues, are common in multi-segment transmembrane proteins, and must be considered to affect functionally relevant conformational transitions.

  20. Movement of the human foot in 100 pain free individuals aged 18–45: implications for understanding normal foot function


    Nester, Christopher J; Jarvis, Hannah L; Jones, Richard K; Bowden, Peter D; Liu, Anmin


    Background Understanding motion in the normal healthy foot is a prerequisite for understanding the effects of pathology and thereafter setting targets for interventions. Quality foot kinematic data from healthy feet will also assist the development of high quality and research based clinical models of foot biomechanics. To address gaps in the current literature we aimed to describe 3D foot kinematics using a 5 segment foot model in a population of 100 pain free individuals. Methods Kinematics...

  1. SAT Type Foot-and-Mouth Disease (FMD) Chimeric Vaccine Elicits Protection in Pigs (United States)

    The recent development of infectious cDNA clone technology for foot-and-mouth disease (FMD), Southern African Territories (SAT) viruses has provided a valuable tool for genetic and biological characterization of field and laboratory strains. Recombinant chimeric viruses, containing the capsid-coding...

  2. Foot lengthening and shortening during gait: a parameter to investigate foot function?

    NARCIS (Netherlands)

    Stolwijk, N.M.; Koenraadt, K.L.M.; Louwerens, J.W.; Grim, D.; Duysens, J.E.J.; Keijsers, N.L.W.


    INTRODUCTION: Based on the windlass mechanism theory of Hicks, the medial longitudinal arch (MLA) flattens during weight bearing. Simultaneously, foot lengthening is expected. However, changes in foot length during gait and the influence of walking speed has not been investigated yet. METHODS: The f

  3. The forgotten foot - an assessment of foot and ankle radiograph pathology in final year medical students.

    LENUS (Irish Health Repository)

    Groarke, P J


    It has been shown that doctors in Emergency Departments (EDs) have inconsistent knowledge of musculoskeletal anatomy. This is most likely due to a deficiency in focused musculoskeletal modules at undergraduate level in medical school. The aims of this study were to evaluate the knowledge of final year medical students on foot anatomy and common foot and ankle pathology as seen on radiographs.

  4. Diagnostics and treatment of the diabetic foot. (United States)

    Apelqvist, Jan


    Every 30 s, a lower limb is amputated due to diabetes. Of all amputations in diabetic patients 85% are preceded by a foot ulcer which subsequently deteriorates to a severe infection or gangrene. There is a complexity of factors related to healing of foot ulcers including strategies for treatment of decreased perfusion, oedema, pain, infection, metabolic disturbances, malnutrition, non-weight bearing, wound treatment, foot surgery, and management of intercurrent disease. Patients with diabetic foot ulcer and decreased perfusion do often not have rest pain or claudication and as a consequence non-invasive vascular testing is recommended for early recognition of ulcers in need of revascularisation to achieve healing. A diabetic foot infection is a potentially limb-threatening condition. Infection is diagnosed by the presence or increased rate of signs inflammation. Often these signs are less marked than expected. Imaging studies can diagnose or better define deep, soft tissue purulent collections and are frequently needed to detect pathological findings in bone. The initial antimicrobial treatment as well as duration of treatment is empiric. There is a substantial delay in wound healing in diabetic foot ulcer which has been related to various abnormalities. Several new treatments related to these abnormalities have been explored in wound healing with various successes. An essential part of the strategy to achieve healing is an effective offloading. Many interventions with advanced wound management have failed due to not recognizing the need for effective offloading. A multidisciplinary approach to wounds and foot ulcer has been successfully implemented in different centres with a substantial decrease in amputation rate.

  5. Factors associated with combined hand and foot eczema Associations between foot and hand eczema

    DEFF Research Database (Denmark)

    Agner, T; Aalto-Korte, K; Andersen, K E;


    BACKGROUND: As for hand eczema, the etiology of foot eczema is multifactorial, and not very well understood. The aim of the present study was to identify factors associated with foot eczema in a cohort of hand eczema patients being classified into different subgroups. METHODS: Associations between...... foot and hand eczema was studied in a cross sectional design in a cohort of hand eczema patients. Consecutive patients were recruited from 9 different European Centres during the period October 2011 - September 2012. Data on demographic factors, presence of foot eczema, hand eczema duration...... and severity, and whether the hand eczema was work-related or not were available, as well as patch-test results. RESULTS: Of a total of 427 hand eczema patients identified, information on foot eczema was available in 419 patients who were included in the present study. 125 patients (29.8 %) had concomitant...

  6. Robust Foot Clearance Estimation Based on the Integration of Foot-Mounted IMU Acceleration Data

    Directory of Open Access Journals (Sweden)

    Mourad Benoussaad


    Full Text Available This paper introduces a method for the robust estimation of foot clearance during walking, using a single inertial measurement unit (IMU placed on the subject’s foot. The proposed solution is based on double integration and drift cancellation of foot acceleration signals. The method is insensitive to misalignment of IMU axes with respect to foot axes. Details are provided regarding calibration and signal processing procedures. Experimental validation was performed on 10 healthy subjects under three walking conditions: normal, fast and with obstacles. Foot clearance estimation results were compared to measurements from an optical motion capture system. The mean error between them is significantly less than 15 % under the various walking conditions.

  7. A shift in priority in diabetic foot care and research: 75% of foot ulcers are preventable. (United States)

    Bus, Sicco A; van Netten, Jaap J


    Diabetic foot ulceration poses a heavy burden on the patient and the healthcare system, but prevention thereof receives little attention. For every euro spent on ulcer prevention, ten are spent on ulcer healing, and for every randomized controlled trial conducted on prevention, ten are conducted on healing. In this article, we argue that a shift in priorities is needed. For the prevention of a first foot ulcer, we need more insight into the effect of interventions and practices already applied globally in many settings. This requires systematic recording of interventions and outcomes, and well-designed randomized controlled trials that include analysis of cost-effectiveness. After healing of a foot ulcer, the risk of recurrence is high. For the prevention of a recurrent foot ulcer, home monitoring of foot temperature, pressure-relieving therapeutic footwear, and certain surgical interventions prove to be effective. The median effect size found in a total of 23 studies on these interventions is large, over 60%, and further increases when patients are adherent to treatment. These interventions should be investigated for efficacy as a state-of-the-art integrated foot care approach, where attempts are made to assure treatment adherence. Effect sizes of 75-80% may be expected. If such state-of-the-art integrated foot care is implemented, the majority of problems with foot ulcer recurrence in diabetes can be resolved. It is therefore time to act and to set a new target in diabetic foot care. This target is to reduce foot ulcer incidence with at least 75%.

  8. Nursing care of the aging foot. (United States)

    Mitty, Ethel


    Feet are not necessarily the most attractive part of the body as it ages, and given the choice, most older adults would rather ignore them. In fact, many older adults cannot even see them, reach them, or care for them properly. And when they ache or look misshapen and oddly colored; well, that's just part of growing old, isn't it? The feet are important for weight bearing, balance, and mobility. Over an average life span, the feet are subject to considerable stress and trauma. Age-related changes of the foot predispose the older adult to discomfort if not pain, fungal infection, reduced range of motion, and itchy dry skin. More than three fourths of older adults (i.e., those age over 65 years) complain of foot pain that is associated with a significant foot problem and have evidence of arthritic changes on x-ray. Impaired ambulation can make the difference between independence versus dependency on others, engagement versus isolation. Assisted living is about choices. Being unable to get where one wants to go or do what one wants to do because of foot problems is a barrier to full enjoyment of the opportunities in assisted living communities. This article describes foot problems associated with aging, diabetes, nursing assessment of the feet, and nursing interventions in the service of accessing and optimizing choices for quality of life.

  9. Adult Foot Macrodactyly: A Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Celalettin Sever


    Full Text Available Macrodactyly of the foot is a rare congenital anomaly characterized by an enlargement of the soft tissue and osseous elements. It is difficult to treat this disorder when both the functional and cosmetic problems are addressed simultaneously. In the presented case, we describe an adult male patient with macrodactyly of the great toe, who underwent surgical correction consisting of amputation with debulking of soft tissues. To our knowledge, only a few cases regarding adults with macrodactyly of the foot have been reported in the literature. We advocate early surgical treatment of macrodactyly of the foot to enhance the quality of social life. [Arch Clin Exp Surg 2014; 3(2.000: 123-128

  10. Outpatient assessment and management of the diabetic foot. (United States)

    DiPreta, John A


    Patients with diabetes and peripheral neuropathy are at risk for foot deformities and mechanical imbalance of the lower extremity. Peripheral neuropathy leads to an insensate foot that puts the patient at risk for injury. When combined with deformity due to neuropathic arthropathy, or Charcot foot, the risks of impending ulceration, infection, and amputation are significant to the diabetic patient. Education of proper foot care and shoe wear cannot be overemphasized. For those with significant malalignment or deformity of the foot and ankle, referral should be made immediately to an orthopedic foot and ankle specialist.

  11. Effect of Custom-Molded Foot Orthoses on Foot Pain and Balance in Children With Symptomatic Flexible Flat Feet (United States)

    Lee, Hong-Jae; Lim, Kil-Byung; Yoo, JeeHyun; Yun, Hyun-Ju; Jeong, Tae-Ho


    Objective To evaluate the effect of custom-molded foot orthoses on foot pain and balance in children with symptomatic flexible flat foot 1 month and 3 months after fitting foot orthosis. Method A total of 24 children over 6 years old with flexible flat feet and foot pain for at least 6 months were recruited for this study. Their resting calcaneal stance position and calcaneal pitch angle were measured. Individual custom-molded rigid foot orthoses were prescribed using inverted orthotic technique to control foot overpronation. Pain questionnaire was used to obtain pain sites, degree, and frequency. Balancing ability was determined using computerized posturography. These evaluations were performed prior to custom-molded foot orthoses, 1 month, and 3 months after fitting foot orthoses. Result Of 24 children with symptomatic flexible flat feet recruited for this study, 20 completed the study. Significant (p<0.001) improvements in pain degree and frequency were noted after 1 and 3 months of custom-molded foot orthoses. In addition, significant (p<0.05) improvement in balancing ability was found after 3 months of custom-molded foot orthoses. Conclusion Short-term use of custom-molded foot orthoses significantly improved foot pain and balancing ability in children with symptomatic flexible flat foot. PMID:26798604

  12. Differences in foot self-care and lifestyle between men and women with diabetes mellitus

    Directory of Open Access Journals (Sweden)

    Mariana Angela Rossaneis

    Full Text Available ABSTRACT Objective: to investigate differences with regard to foot self-care and lifestyle between men and women with diabetes mellitus. Method: cross-sectional study conducted in a sample of 1,515 individuals with diabetes mellitus aged 40 years old or older. Poisson regression models were used to identity differences in foot self-care deficit and lifestyle between sexes, adjusting for socioeconomic and clinical characteristics, smoking and alcohol consumption. Results: foot self-care deficit, characterized by not regularly drying between toes; not regularly checking feet; walking barefoot; poor hygiene and inappropriately trimmed nails, was significantly higher among men, though men presented a lower prevalence of feet scaling and use of inappropriate shoes when compared to women. With regard to lifestyle, men presented less healthy habits, such as not adhering to a proper diet and taking laboratory exams to check for lipid profile at the frequency recommended. Conclusion: the nursing team should take into account gender differences concerning foot self-care and lifestyle when implementing educational activities and interventions intended to decrease risk factors for foot ulceration.

  13. [Mycetoma of the foot: a case report]. (United States)

    Iniesta, A; Baptista, C; Guinard, D; Legré, R; Gay, A


    Mycetoma is a chronic inflammatory cutaneous and subcutaneous pathology caused by either a fongic (eumycetoma) or bacterial (actinomycetoma) infection, which lead to a granulomatous tumefaction with multiple sinuses. When localized in the foot this infection is named "Madura foot". This infection is endemic to tropical and subtropical regions and rarely occurs in western countries. A historical case in Europe of a foot mycetoma evolving since 20 years without any treatment is presented. A histopathologic diagnosis of actinomycetoma has been done in 1987. The patient presented a severe Staphylococcus aureus chronic osteitis leading to a trans-tibial amputation. This case allows to present this infection which, even if rarely presented in France, can be meet especially among a migrant's population.

  14. Chinese Herbal Foot Bath plus Acupoint Massage Beneficial to the Improvement of Grade 0 Diabetic Foot

    Institute of Scientific and Technical Information of China (English)

    Lin Xiao-xia; Xu Xu-yuan; Shangguan Bin-bin


    Objective: To observe the clinical effect of foot bath with Tao Hong Si Wu Tang plus massage on acupoints at the sole for grade 0 diabetic foot. Methods: One hundred and sixty eligible cases were randomly divided into an observation group and a control group, 80 cases in each group. The two groups were treated with routine basic medications to control blood sugar. The patients in the observation group were given foot bath withTao Hong Si Wu Tangplus massage on acupoints at the sole, once every day. At the same time, the patients were instructed to understand the knowledge of diabetes, accept the education on foot care and to know the self-management for diabetes. The patients in the control group only accepted the education on foot care and studied the self-management for diabetes. The patients in the two groups were followed up once every week by phone. The local examination was intensified for the patients in their clinical visit every month. The therapeutic effects were assessed after three months of continuous treatment. Results: The total effective rate was 92.5% in the observation group, remarkably higher than 65.0% in the control group. The difference in comparison of the general therapeutic effect was statistically significant (P Conclusion: Foot bath withTao Hong Si Wu Tang plus massage on acupoints at the sole was beneficial to the improvement of clinical symptoms of grade 0 diabetic foot.

  15. Foot and ankle injuries in theatrical dancers. (United States)

    Hardaker, W T; Margello, S; Goldner, J L


    The theatrical dancer is a unique combination of athlete and artist. The physical demands of dance class, rehearsal, and performance can lead to injury, particularly to the foot and ankle. Ankle sprains are the most common acute injury. Chronic injuries predominate and relate primarily to the repeated impact loading of the foot and ankle on the dance floor. Contributing factors include anatomic variation, improper technique, and fatigue. Early and aggressive conservative management is usually successful and surgery is rarely indicated. Orthotics play a limited but potentially useful role in treatment. Following treatment, a structured rehabilitation program is fundamental to the successful return to dance.

  16. Diabetic foot ulcers: Part II. Management. (United States)

    Alavi, Afsaneh; Sibbald, R Gary; Mayer, Dieter; Goodman, Laurie; Botros, Mariam; Armstrong, David G; Woo, Kevin; Boeni, Thomas; Ayello, Elizabeth A; Kirsner, Robert S


    The management of diabetic foot ulcers can be optimized by using an interdisciplinary team approach addressing the correctable risk factors (ie, poor vascular supply, infection control and treatment, and plantar pressure redistribution) along with optimizing local wound care. Dermatologists can initiate diabetic foot care. The first step is recognizing that a loss of skin integrity (ie, a callus, blister, or ulcer) considerably increases the risk of preventable amputations. A holistic approach to wound assessment is required. Early detection and effective management of these ulcers can reduce complications, including preventable amputations and possible mortality.

  17. Diabetic foot ulcers: Part I. Pathophysiology and prevention. (United States)

    Alavi, Afsaneh; Sibbald, R Gary; Mayer, Dieter; Goodman, Laurie; Botros, Mariam; Armstrong, David G; Woo, Kevin; Boeni, Thomas; Ayello, Elizabeth A; Kirsner, Robert S


    Diabetes mellitus is a serious, life-long condition that is the sixth leading cause of death in North America. Dermatologists frequently encounter patients with diabetes mellitus. Up to 25% of patients with diabetes mellitus will develop diabetic foot ulcers. Foot ulcer patients have an increased risk of amputation and increased mortality rate. The high-risk diabetic foot can be identified with a simplified screening, and subsequent foot ulcers can be prevented. Early recognition of the high-risk foot and timely treatment will save legs and improve patients' quality of life. Peripheral arterial disease, neuropathy, deformity, previous amputation, and infection are the main factors contributing to the development of diabetic foot ulcers. Early recognition of the high-risk foot is imperative to decrease the rates of mortality and morbidity. An interprofessional approach (ie, physicians, nurses, and foot care specialists) is often needed to support patients' needs.

  18. Comorbidities associated with Egyptian diabetic foot disease subtypes

    Directory of Open Access Journals (Sweden)

    Mary N. Rizk


    Conclusion Special attention should be paid toward the identification of patients who are at risk of foot ulceration to help prevent foot problems. Comorbid conditions must also be identified early and managed aggressively.

  19. Chemical purification of Gunungpati elephant foot yam flour to improve physical and chemical quality on processed food (United States)

    Paramita, Octavianti; Wahyuningsih, Ansori, Muhammad


    This study was aimed at improving the physicochemical quality of elephant foot yam flour in Gunungpati, Semarang by chemical purification. The utilization of elephant foot yam flour in several processed food was also discussed in this study. The flour purification discussed in this study was expected to become a reference for the manufacturers of elephant foot yam flour and its processed food in Gunungpati. This study modified the elephant foot yam flour using pre - gelatinization method. The physical and chemical quality of each elephant foot yam flour purification sample were assessed using proximate analysis. The likability test was conducted for its processed food. 20 grams of elephant foot yam flour was put into a beaker glass, then 60 ml of water was added. The suspension was then heated at a temperature of 60 ° C and 70 ° C while stirred until it was homogeneous and thickened for 10, 30 and 60 minutes. The flour which had been heated was then cooled at room temperature for 1 hour and then at a temperature of 0 ° C until it was frozen. Furthermore, flour was dried in an oven at a temperature of 60 ° C for 9 hours. The dried flour was sifted with a 80 mesh sieve. Chemical test was conducted after elephant foot yam was pre-gelatinized to determine changes in the quality flour: test levels of protein, fat, crude fiber content, moisture content, ash content and starch content. In addition, color tests and granular test on elephant foot yam flour were also conducted. The pre-gelatinization as chemical treatment on elephant foot yam flour in this study was able to change the functional properties of elephant foot yam flour towards a better processing characterized by a brighter color (L = 70, a = 6 and b = 12), the hydrolysis of polysaccharides flour into shorter chain (flour content decreased to 44%), the expansion of granules in elephant foot yam resulting in a process - ready flour, and better monolayer water content of 9%. The content of protein and fiber

  20. Influence of footings stiffness on punching resistance

    Directory of Open Access Journals (Sweden)

    Ĺudovít Fillo


    Full Text Available The presented paper brings new aspects of punching resistance due to influence of footing stiffness and consequential ground stresses distribution. Diagrams of design load versus effective depth were created coming from new design criteria which depend on the maximum punching resistance defined from shear-bending failure and on the maximum punching resistance defined from crushing of concrete struts.

  1. Pixel classification for automated diabetic foot diagnosis

    NARCIS (Netherlands)

    Kloeze, C.; Klein, A.; Hazenberg, S.; Heijden, van der F.; Baal, van J.G.; Bus, S.A.


    Worldwide, more than 180 million people suffer from diabetes mellitus. Approximately 50% of these patients will develop complications to their feet. Neuropathy, combined with poor blood supply and biomechanical changes results in a high risk for foot ulcers, which is a key problem in the diabetic fo

  2. Malignant melanoma of the foot and ankle. (United States)

    John, K J; Hayes, D W; Green, D R; Dickerson, J


    Malignant melanoma is a serious and devastating skin disease that podiatrists may be called upon to treat. It is pertinent that delays in diagnosis and treatment of malignant melanoma be avoided. Some of the topics discussed in this article are causes, clinical features, classification, and treatment of malignant melanoma, focusing on the foot and ankle.

  3. Do foot pad scores measure Turkey welfare

    NARCIS (Netherlands)

    Hocking, P.M.; Harkness, A.; Veldkamp, Teun; Vinco, L.J.


    The main aim of the project was to assess the painfulness of different levels of foot pad dermatitis (FPD) in turkeys. Three different analgesics (butorphanol, carprofen and meloxicam) were used to assess their effect on behaviour. Video recordings were taken when the birds were treated with either

  4. Complex interventions for preventing diabetic foot ulceration

    NARCIS (Netherlands)

    Hoogeveen, Ruben C; Dorresteijn, Johannes A N; Kriegsman, Didi M W; Valk, Gerlof D.


    BACKGROUND: Ulceration of the feet, which can lead to the amputation of feet and legs, is a major problem for people with diabetes mellitus, and can cause substantial economic burden. Single preventive strategies have not been shown to reduce the incidence of foot ulceration to a significant extent.


    Directory of Open Access Journals (Sweden)

    Vidyullatha Shetty


    Full Text Available BACKGROUND : Stature is the height of the person in the upright posture. It is an important measure of physical identity. Estimation of body height from its segments or dismember parts has important considerations for identifications of living or dead human body or remains recovered from disasters or other similar conditions. OBJECTIVE : Stature is an important indicator for identification. There are numerous means to establish stature and their significance lies in the simplicity of measurement, applicability and accuracy in prediction. Our aim of the study was to review the relationship between foot length and body height. METHODS : The present study reviews various prospective studies which were done to estimate the stature. All the measurements were taken by using standard measuring devices and standard anthropometric techniques. RESULTS : This review shows there is a correlation between stature and foot dimensions it is found to be positive and statistically highly significant. Prediction of stature was found to be most accurate by multiple regression analysis. CONCLUSIONS : Stature and gender estimation can be done by using foot measurements and stud y will help in medico - legal cases in establishing identity of an individual and this would be useful for Anatomists and Anthropologists to calculate stature based on foot length

  6. 33 CFR 142.33 - Foot protection. (United States)


    ... for foot injury to occur shall wear footwear meeting the specifications of ANSI Z41, except when environmental conditions exist that present a hazard greater than that against which the footwear is designed to protect. (b) Each pair of footwear must be marked with the information specified by ANSI Z41 for the...

  7. Osteoarthritis of the Foot and Ankle (United States)

    ... that creates an increased risk of arthritis. Symptoms People with osteoarthritis in the foot or ankle experience, in varying degrees, one or more of the following: Pain and stiffness in the joint Swelling in or near the joint Difficulty walking or bending the joint Some patients with osteoarthritis ...

  8. Diabetic foot complications: diagnosis and management. (United States)

    Giurini, John M; Lyons, Thomas E


    Foot complications in patients with diabetes mellitus are a challenge to the health care industry. A great deal of expenditure is due to the management of diabetic foot complications. This places a great burden on the health care industry. It also places a great burden on those diabetic patients with foot complications and their families. Therefore, their effective management in an efficient manner is crucial to our patients. To deal with these problems, a dedicated, knowledgeable, and experienced multidisciplinary team is key. Intervention at the earliest possible time yields the best outcome. Prevention is the focus for those with no ulcerations. For those with ulcerations, prompt recognition and treatment is key. The importance of classifying ulcerations according to size, depth, presence or absence of infection, and vascular status can not be overstated. Proper offloading is vital for those with neuropathic lesions. Recognition of patients with a component of ischemia and vascular intervention to increase perfusion will aid in wound healing. Of course deep infection requires immediate drainage. All efforts of those in the multidisciplinary team are directed at the restoration and maintenance of an ulcer-free foot which is important in enabling our patients to maintain their ambulatory status.

  9. Assessment of acute foot and ankle sprains. (United States)

    Lynam, Louise


    Acute ankle and foot trauma is a regular emergency presentation and prompt strategic assessment skills are required to enable nurses to categorise and prioritise these injuries appropriately. This article provides background information on the anatomy and physiology of the lower limb to help nurses to identify various grades of ankle sprain as well as injuries that are limb threatening

  10. Foot deformation during walking: differences between static and dynamic 3D foot morphology in developing feet. (United States)

    Barisch-Fritz, Bettina; Schmeltzpfenning, Timo; Plank, Clemens; Grau, Stefan


    The complex functions of feet require a specific composition, which is progressively achieved by developmental processes. This development should take place without being affected by footwear. The aim of this study is to evaluate differences between static and dynamic foot morphology in developing feet. Feet of 2554 participants (6-16 years) were recorded using a new scanner system (DynaScan4D). Each foot was recorded in static half and full weight-bearing and during walking. Several foot measures corresponding to those used in last construction were calculated. The differences were identified by one-way ANOVA and paired Student's t-test. Static and dynamic values of each foot measure must be considered to improve the fit of footwear. In particular, footwear must account for the increase of forefoot width and the decrease of midfoot girth. Furthermore, the toe box should have a more rounded shape. The findings are important for the construction of footwear for developing feet.

  11. The Athletic Foot and Its Import to Performance during Running. (United States)

    Bogdan, Richard

    In this paper, problems and conditions of the foot, including flat feet, achilles tendon problems, heel spur syndrome, digital problems, shin splints, and leg stress fractures, are examined. Ways to examine the athlete's foot and leg are described, including the one-foot test and the off weight-bearing examination. (CJ)

  12. Quick foot placement adjustments during gait: direction matters

    NARCIS (Netherlands)

    Hoogkamer, W.; Potocanac, Z.; Duysens, J.


    To prevent falls, adjustment of foot placement is a frequently used strategy to regulate and restore gait stability. While foot trajectory adjustments have been studied during discrete stepping, online corrections during walking are more common in daily life. Here, we studied quick foot placement ad

  13. Imaging diagnostics of the foot; Bildgebende Diagnostik des Fusses

    Energy Technology Data Exchange (ETDEWEB)

    Szeimies, Ulrike; Staebler, Axel [Radiologie in Muenchen-Harlaching, Muenchen (Germany); Walther, Markus (eds.) [Schoen-Klinik Muenchen-Harlaching, Muenchen (Germany). Zentrum fuer Fuss- und Sprunggelenkchirurgie


    The book on imaging diagnostics of the foot contains the following chapters: (1) Imaging techniques. (2) Clinical diagnostics. (3) Ankle joint and hind foot. (4) Metatarsus. (5) Forefoot. (6) Pathology of plantar soft tissue. (7) Nervous system diseases. (8) Diseases without specific anatomic localization. (9) System diseases including the foot. (10) Tumor like lesions. (11) Normative variants.

  14. Diabetic foot disease: From the evaluation of the “foot at risk” to the novel diabetic ulcer treatment modalities


    Amin, Noha; Doupis, John


    The burden of diabetic foot disease (DFD) is expected to increase in the future. The incidence of DFD is still rising due to the high prevalence of DFD predisposing factors. DFD is multifactorial in nature; however most of the diabetic foot amputations are preceded by foot ulceration. Diabetic peripheral neuropathy (DPN) is a major risk factor for foot ulceration. DPN leads to loss of protective sensation resulting in continuous unconscious traumas. Patient education and detection of high ris...

  15. Normative values for the Foot Posture Index

    Directory of Open Access Journals (Sweden)

    Redmond Anthony C


    Full Text Available Abstract Background The Foot Posture Index (FPI is a validated method for quantifying standing foot posture, and is being used in a variety of clinical settings. There have however, been no normative data available to date for comparison and reference. This study aimed to establish normative FPI reference values. Methods Studies reporting FPI data were identified by searching online databases. Nine authors contributed anonymised versions of their original datasets comprising 1648 individual observations. The datasets included information relating to centre, age, gender, pathology (if relevant, FPI scores and body mass index (BMI where available. FPI total scores were transformed to interval logit scores as per the Rasch model and normal ranges were defined. Comparisons between groups employed t-tests or ANOVA models as appropriate and data were explored descriptively and graphically. Results The main analysis based on a normal healthy population (n = 619 confirmed that a slightly pronated foot posture is the normal position at rest (mean back transformed FPI raw score = +4. A 'U' shaped relationship existed for age, with minors and older adults exhibiting significantly higher FPI scores than the general adult population (F = 51.07, p t = -1.44, p = 0.149. No relationship was found between the FPI and BMI. Systematic differences from the adult normals were confirmed in patients with neurogenic and idiopathic cavus (F = 216.981, p Conclusion A set of population norms for children, adults and older people have been derived from a large sample. Foot posture is related to age and the presence of pathology, but not influenced by gender or BMI. The normative values identified may assist in classifying foot type for the purpose of research and clinical decision making.

  16. Characterization of a type O foot-and-mouth disease virus re-emerging in the year 2011 in free areas of the Southern Cone of South America and cross-protection studies with the vaccine strain in use in the region. (United States)

    Maradei, Eduardo; Malirat, Viviana; Beascoechea, Claudia Perez; Benitez, Elizabeth Oviedo; Pedemonte, Andrea; Seki, Cristina; Novo, Sabrina Galdo; Balette, Cristina I; D'Aloia, Ricardo; La Torre, José L; Mattion, Nora; Toledo, Jorge Rodríguez; Bergmann, Ingrid E


    Molecular, antigenic and vaccine matching studies, including protective response in vivo, were conducted with a foot-and-mouth disease type O virus isolated during the outbreak in September 2011 in San Pedro, Paraguay, country internationally recognized as free with vaccination in 1997. The phylogenetic tree derived from complete VP(1) sequences as well as monoclonal antibody profiling indicated that this isolate was related to viruses responsible for previous emergencies in free areas of the Southern Cone of South America occurring sporadically between the years 2000 and 2006. Marked differences with the vaccine strain O(1)/Campos, including the loss of reactivity with neutralizing MAbs, were recognized. Levels of protective antibodies induced by the vaccine containing the O(1)/Campos strain against the San Pedro virus and the virus responsible for the previous emergency in 2006 in the Southern Cone assessed by in vitro vaccine matching studies pointed to an insufficient protective response 30 days after vaccination (DPV), which was properly attained at 79 DPV or after revaccination. In agreement with the in vitro assessment, the in vivo challenge in the Protection against Podal Generalization test in cattle indicated appropriate protection for the San Pedro strain at 79 DPV or after revaccination. The complementary conclusions that can be derived from vaccine matching tests designed differently to fit the various objectives intended: prophylaxis, emergency vaccination or incorporation of new field strains into antigen banks, is evaluated. This is the first report of the antigenic and immunogenic characterization of the variants responsible for emergencies in the Southern Cone of South America and the putative impact of the changes on the cross protection conferred by the vaccine strain.

  17. The Relationship with Balance, Foot Posture, and Foot Size in School of Physical Education and Sports Students (United States)

    Irez, Gonul Babayigit


    The aim of this study is to investigate the relationship of foot posture and foot size with balance. A hundred and thirteen healthy volunteers were recruited from undergraduate students (Male = 74, Female = 37, age range 18-22). The Foot Posture Index (FPI-6), anthropometric measurements, dynamic balance and static balance measurements were done…

  18. Visual guidance of the human foot during a step


    Reynolds, R. F.; Day, B L


    When the intended foot placement changes during a step, either due to an obstacle appearing in our path or the sudden shift of a target, visual input can rapidly alter foot trajectory. However, previous studies suggest that when intended foot placement does not change, the path of the foot is fixed after it leaves the floor and vision has no further influence. Here we ask whether visual feedback can be used to improve the accuracy of foot placement during a normal, unperturbed step. To invest...

  19. The clinical assessment study of the foot (CASF): study protocol for a prospective observational study of foot pain and foot osteoarthritis in the general population


    Menz Hylton B; D'Cruz Deborah; Marshall Michelle; Thomas Martin J; Myers Helen; Roddy Edward; Belcher John; Muller Sara; Peat George


    Abstract Background Symptomatic osteoarthritis (OA) affects approximately 10% of adults aged over 60 years. The foot joint complex is commonly affected by OA, yet there is relatively little research into OA of the foot, compared with other frequently affected sites such as the knee and hand. Existing epidemiological studies of foot OA have focussed predominantly on the first metatarsophalangeal joint at the expense of other joints. This three-year prospective population-based observational co...

  20. Modelling vaccination strategies against foot-and-mouth disease (United States)

    Keeling, M. J.; Woolhouse, M. E. J.; May, R. M.; Davies, G.; Grenfell, B. T.


    Vaccination has proved a powerful defence against a range of infectious diseases of humans and animals. However, its potential to control major epidemics of foot-and-mouth disease (FMD) in livestock is contentious. Using an individual farm-based model, we consider either national prophylactic vaccination campaigns in advance of an outbreak, or combinations of reactive vaccination and culling strategies during an epidemic. Consistent with standard epidemiological theory, mass prophylactic vaccination could reduce greatly the potential for a major epidemic, while the targeting of high-risk farms increases efficiency. Given sufficient resources and preparation, a combination of reactive vaccination and culling might control ongoing epidemics. We also explore a reactive strategy, `predictive' vaccination, which targets key spatial transmission loci and can reduce markedly the long tail that characterizes many FMD epidemics. These analyses have broader implications for the control of human and livestock infectious diseases in heterogeneous spatial landscapes.

  1. Clinical management of acute diabetic Charcot foot in Denmark

    DEFF Research Database (Denmark)

    Jansen, Rasmus Bo; Svendsen, Ole Lander; Kirketerp-Møller, Klaus


    INTRODUCTION: Charcot foot is a severe complication to diabetes mellitus and treatment involves several different clinical specialities. Our objective was to describe the current awareness, knowledge and treatment practices of Charcot foot among doctors who handle diabetic foot disorders. METHODS......: This study is based on a questionnaire survey sent out to healthcare professionals, primarily doctors, working with diabetic foot ulcers and Charcot feet in the public sector of the Danish healthcare system. RESULTS: The survey obtained a 52% response rate. A temperature difference of > 2 °C between the two...... and treatment practices of acute diabetic Charcot foot at diabetes foot clinics in Denmark. The responders seem to follow the international recommendations and guidelines on management of the acute diabetic Charcot foot, despite a lack of Danish guidelines. FUNDING: none. TRIAL REGISTRATION: not relevant....

  2. A prospective study of risk factors for foot ulceration: The West of Ireland Diabetes Foot Study.

    LENUS (Irish Health Repository)

    Hurley, L


    BackgroundThis is the first study to examine risk factors for diabetic foot ulceration in Irish general practice.AimTo determine the prevalence of established risk factors for foot ulceration in a community-based cohort, and to explore the potential for estimated glomerular filtration rate (eGFR) to act as a novel risk factor.DesignA prospective observational study.MethodsPatients with diabetes attending 12 (of 17) invited general practices were invited for foot screening. Validated clinical tests were carried out at baseline to assess for vascular and sensory impairment and foot deformity. Ulcer incidence was ascertained by patient self-report and medical record. Patients were re-assessed 18 months later. ResultsOf 828 invitees, 563 (68%) attended screening. On examination 23-25% had sensory dysfunction and 18-39% had evidence of vascular impairment. Using the Scottish Intercollegiate Guidelines Network risk stratification system we found the proportion at moderate and high risk of future ulceration to be 25% and 11% respectively. At follow-up 16\\/383 patients (4.2%) developed a new foot ulcer (annual incidence rate of 2.6%). We observed an increasing probability of abnormal vascular and sensory test results (pedal pulse palpation, doppler waveform assessment, 10g monofilament, vibration perception and neuropathy disability score) with declining eGFR levels. We were unable to show an independent association between new ulceration and reduced eGFR [Odds ratio 1.01; p=0.64].ConclusionsOur data show the extent of foot complications in a representative sample of diabetes patients in Ireland. Use of eGFR did not improve identification of patients at risk of foot ulceration.

  3. How To Prevent Foot Ulcers In Diabetic Patients

    Directory of Open Access Journals (Sweden)

    Ghada Morshed


    Full Text Available The prevalence of development of foot ulcers in diabetic patients is 4% to 10%, these ulcers may be infected, cause morbidity and may lead to lower extremity amputation.Objective: Prevention of diabetic foot ulcers in patients known to be diabetics by fasting blood sugar (FBS, HbA1C tests.Material and Methods: The study was done on 120 patients between March 2010 and July 2011 diagnosed as diabetics and they performed simple screening tests for peripheral neuropathy (Semmes-Weinstein monofilament examination (SWME, superficial pain, vibration testing by the on-off method, the timed method. Nerve conduction studies (NCS were used as standard criterion for detection of neuropathy, they also underwent Doppler ultrasound and ankle-brachial pressure index (ABPI measurement to assess the vascularity of their lower limbs. All patients were given proper education to prevent foot ulcers, including optimising glycemic control, cessation of smoking, debridement of calluses, appropriate foot wear and foot care with periodic foot examination.Results: In our study we succeeded in increasing the prevention of foot ulceration in our diabetic patients by 95%, compared to results achieved with the previous measures.Conclusion: Screening tests are effective for all diabetic patients to identify patients at risk of foot ulceration. They may benefit from prophylactic interventions including, optimising glycemic control, cessation of smoking, debridement of calluses, appropriate foot wear and intensive foot care.Also, we take care of patients with low risk of foot ulceration by adequate foot care and periodic foot examination to prevent foot ulceration.

  4. Hand and foot syndrome secondary to capecitabine

    Directory of Open Access Journals (Sweden)

    Hina Shaikh Lal


    Full Text Available A 55-year-old woman on treatment with capecitabine and paclitaxel for breast carcinoma presented with history of a tingling sensation in her hands and feet with a progressive burning sensation. She also noted discomfort, minimal pain and stiffness while holding objects. On examination, there was patchy hyperpigmentation of both the palms and soles, and the dorsa of hands and feet. This was accompanied by a thickening of the skin more over the knuckles and toes. In addition there was a moist desquamation around the toes and over the palmar creases and a bluish discoloration of the lunulae of both thumbnails. She was diagnosed with hand and foot syndrome and started on pyridoxine and emollients. The finding of keratoderma noted in our patient is not seen commonly in hand and foot syndrome.

  5. Innovations in diabetic foot reconstruction using supermicrosurgery. (United States)

    Suh, Hyun Suk; Oh, Tae Suk; Hong, Joon Pio


    The treatment of diabetic foot ulceration is complex with multiple factors involved, and it may often lead to limb amputation. Hence, a multidisciplinary approach is warranted to cover the spectrum of treatment for diabetic foot, but in complex wounds, surgical treatment is inevitable. Surgery may involve the decision to preserve the limb by reconstruction or to amputate it. Reconstruction involves preserving the limb with secure coverage. Local flaps usually are able to provide sufficient coverage for small or moderate sized wound, but for larger wounds, soft tissue coverage involves flaps that are distantly located from the wound. Reconstruction of distant flap usually involves microsurgery, and now, further innovative methods such as supermicrosurgery have further given complex wounds a better chance to be reconstructed and limbs salvaged. This article reviews the microsurgery involved in reconstruction and introduces the new method of supermicrosurgery.

  6. [Subintimal angioplasty and diabetic foot revascularisation]. (United States)

    Pierret, Charles; Tourtier, Jean-Pierre; Bordier, Lise; Blin, Emmanuel; Duverger, Vincent


    Diabetic wounds foot are responsible for 5-10% minor or major amputation in France. In fact, amputation risk of lower limbs is 15-30% higher for diabetic patients. University of Texas classification (UT) is the reference for diabetic foot wound. It distinguish non ischemic and ischemic wound with more amputation. If ischaemia is combined, revascularization may be considered for salvage of the limb. Some revascularization techniques are well known: as surgical by-pass, angioplasty with or without stent, or hybrid procedures with the both. Subintimal angioplasty is a more recent endovascular technique, in assessment for old patients who are believed to be unsuitable candidates for conventional by-pass or angioplasty.

  7. A study of dermatoglyphics in club foot

    Directory of Open Access Journals (Sweden)

    Sadakat Ali


    Results: Frequency of whorls increase in both hands significantly, frequency of arches and ulnar loops decrease significantly, frequency of radial loops increase in right hand and decrease in left hand but difference was not significant. TFRC count was reduced significantly and no significant difference was found in a-t-d angle and a-b ridge count. Conclusion: Dermatoglyphics is a genetically determined reliable marker for detecting the incidence of club foot. Merely by identifying the dermatoglyphics pattern of couples with family history of club foot may be at risk of having their offspring affected, and they can be diagnosed early and preventive measures can be taken. [Int J Res Med Sci 2014; 2(2.000: 557-559

  8. Minor amputations for diabetic foot salvage

    Directory of Open Access Journals (Sweden)

    Salah Y. Habel


    Full Text Available Foot ulceration in diabetic patients is a frequent complication of diabetes mellitus (DM, necessitating hospitalization for control of infection, wound care and glycemic control. These patients are at risk for potential loss of the involved limb as well as for future loss of the contralateral limb. Diabetic foot is the consequence of peripheral neuropathy complicated by infrapopliteal peripheral vascular disease. Most of the patients present with chronic plantar ulceration and with cellulitis or an abscess. In a significant number of patients, it is observed that the frequency of life or limb threatening infection is less with an intact skin cover. Limb salvage employs the use of culture specific antibiotics, sharp debridement or a minor amputation, wound care and/or skin cover as the situation demands.


    Energy Technology Data Exchange (ETDEWEB)

    Ofman, L. [Catholic University of America, Washington, DC 20064 (United States); Knizhnik, K.; Kucera, T. [NASA Goddard Space Flight Center, Code 671, Greenbelt, MD 20771 (United States); Schmieder, B. [LESIA, Observatoire de Paris, PSL Research University, CNRS, Sorbonne Universités, UPMC Univ. Paris 06, Univ. Paris-Diderot, Sorbonne Paris Cit, 5 place Jules Janssen, F-92195 Meudon (France)


    We study nonlinear waves in a prominence foot using a 2.5D MHD model motivated by recent high-resolution observations with Hinode/Solar Optical Telescope in Ca ii emission of a prominence on 2012 October 10 showing highly dynamic small-scale motions in the prominence material. Observations of Hα intensities and of Doppler shifts show similar propagating fluctuations. However, the optically thick nature of the emission lines inhibits a unique quantitative interpretation in terms of density. Nevertheless, we find evidence of nonlinear wave activity in the prominence foot by examining the relative magnitude of the fluctuation intensity (δI/I ∼ δn/n). The waves are evident as significant density fluctuations that vary with height and apparently travel upward from the chromosphere into the prominence material with quasi-periodic fluctuations with a typical period in the range of 5–11 minutes and wavelengths <2000 km. Recent Doppler shift observations show the transverse displacement of the propagating waves. The magnetic field was measured with the THEMIS instrument and was found to be 5–14 G. For the typical prominence density the corresponding fast magnetosonic speed is ∼20 km s{sup −1}, in qualitative agreement with the propagation speed of the detected waves. The 2.5D MHD numerical model is constrained with the typical parameters of the prominence waves seen in observations. Our numerical results reproduce the nonlinear fast magnetosonic waves and provide strong support for the presence of these waves in the prominence foot. We also explore gravitational MHD oscillations of the heavy prominence foot material supported by dipped magnetic field structure.

  10. Off-label prescriptions in diabetic foot


    Luís Jesuíno de Oliveira Andrade; Larissa Santos França; Paulo Roberto Santana de Melo; Marcelo Araújo


    Prescription of a drug outside of the indications for which it was originally approved by regulators is internationally known as "off-label" prescription. We describe off-label treatments for the diabetic foot reported in international scientific literature. This is a qualitative and descriptive bibliographical review based on the results of a search of the Medline international database. The criteria for review were publication between January 1985 and November 2013, and the MeSH (Medical Su...

  11. Nuclear medicine applications for the diabetic foot

    Energy Technology Data Exchange (ETDEWEB)

    Hartshorne, M.F.; Peters, V.


    Although not frequently described in the podiatric literature, nuclear medicine imaging may be of great assistance to the clinical podiatrist. This report reviews in detail the use of modern nuclear medicine approaches to the diagnosis and management of the diabetic foot. Nuclear medicine techniques are helpful in evaluating possible osteomyelitis, in determining appropriate amputation levels, and in predicting response to conservative ulcer management. Specific indications for bone, gallium, and perfusion imaging are described.

  12. Bacteriological study of diabetic foot infections.

    Directory of Open Access Journals (Sweden)

    Khairul Azmi ABD KADIR


    Full Text Available Introduction: Foot infections are one of the major complications of diabetes mellitus and a significant risk factor for lower extremity amputation. Providing effective antimicrobial therapy is an important component in treating these infections. This study assesses the microbial isolates of patients with diabetic foot infections and their antibiotic susceptibility pattern. Materials and Methods: A retrospective study of 75 patients with diabetic foot infections admitted to RIPAS hospital between June 2008 and June 2010 was undertaken. Bacteriological specimens were obtained and processed using standard hospital procedure for microbiological culture and sensitivity testing. Results: Overall, 40 (54% patients had subcutaneous infections, 22 (29% had infected superficial ulcers, seven (9% had infected deep ulcers involving muscle tissues and six (8% had osteomyelitis. A total of 98 pathogens were isolated. Forty percent of the patients had polymicrobial infection, 39 (52% had single organism and 6(8% had no growth. Gram-negative bacteria (67% were more commonly isolated than gram-positive bacteria (30%. The three most frequently found gram-negative organisms were Pseudomonas aeruginosa (19.4%, Klebsiella pneumoniae (15.3%, and Acinetobacter spp. (10.2% and gram-positive organisms were Staphylococcus aureus (10.2%, Streptococcus pyogenes (7.1% and Methicillin resistant Staphylococcus aureus [MRSA] (7.1%. Vancomycin was found to be the most effective against gram-positive bacteria while amikacin was the most effective against gram-negative bacteria based on antibiotic testing. Conclusion: In 40% of diabetic feet infection was polymicrobial. Staphylococcus aureus and Pseudomonas aeruginosa were the most common gram-positive and gram-negative organisms respectively. This study helps us to choose the empirical antibiotics for cases of diabetic foot infections.

  13. Computed tomographic anatomy of the equine foot. (United States)

    Claerhoudt, S; Bergman, E H J; Saunders, J H


    This study describes a detailed computed tomographic reference of the normal equine foot. Ten forefeet of five adult cadavers, without evidence of orthopaedic disease, were used. Computed tomography (CT) was performed on all feet. Two-millimetre thick transverse slices were obtained, and sagittal and dorsal planes were reformatted. The CT images were matched with the corresponding anatomic slices. The phalanges and the distal sesamoid bone showed excellent detail. The extensor and flexor tendons (including their attachments) could be clearly evaluated. The collateral (sesamoidean) ligaments could be readily located, but were difficult to delineate at their proximal attachment. The distal digital annular ligament could only be distinguished from the deep digital flexor tendon proximal to the distal sesamoid bone, and its proximal attachment could be identified, but not its distal insertion. Small ligaments (impar ligament, chondrosesamoidean, chondrocoronal and chondrocompedal ligaments, axial and abaxial palmar ligaments of the proximal inter-phalangeal joint) were seen with difficulty and not at all slices. The joint capsules could not be delineated from the surrounding soft tissue structures. The lateral and medial proprius palmar digital artery and vein could be visualized occasionally on some slices. The ungular cartilages, corium and hoof wall layering were seen. The nerves, the articular and fibrocartilage of the distal sesamoid bone and the chondroungular ligament could not be assessed. Computed tomography of the equine foot can be of great value when results of radiography and ultrasonography are inconclusive. Images obtained in this study may serve as reference for CT of the equine foot.

  14. Improving Hohlraums for High Foot Implosions (United States)

    Hinkel, D. E.; Berzak Hopkins, L. F.; Ma, T.; Ralph, J. E.; Albert, F.; Benedetti, L. R.; Celliers, P. M.; Doeppner, T.; Goyon, C. S.; Izumi, N.; Jarrott, L. C.; Khan, S. F.; Kline, J. L.; Kritcher, A. L.; Kyrala, G. A.; Nagel, S. R.; Pak, A. E.; Patel, P.; Rosen, M. D.; Rygg, J. R.; Schneider, M. B.; Turnbull, D. P.; Yeamans, C. B.; Callahan, D. A.; Hurricane, O. A.


    Analysis of High Foot implosions show that performance has been limited by the radiation drive environment, i.e., the hohlraum. Demonstrated here is that improvements in the radiation environment result in an enhancement in implosion performance. This is accomplished by using a longer, larger case-to-capsule ratio hohlraum at lower gas fill density. At fixed laser energy, High Foot implosions driven with this hohlraum have achieved a 1.4 x increase in stagnation pressure, with an accompanying relative increase in fusion yield of 50%. Low mode asymmetries are still present, however, and are most likely a consequence of poor inner beam propagation through the hohlraum to the wall. Presented here are results from these High Foot implosions, as well as analyses of inner beam propagation, and additional hohlraum improvements that further ameliorate the implosion. This work performed under the auspices of U.S. Department of Energy by Lawrence Livermore National Laboratory under Contract DE-AC52-07NA27344.

  15. Surgical reconstruction in diabetic foot syndrome

    Directory of Open Access Journals (Sweden)

    Umid Shoyusupov


    Full Text Available Considerable morbidity upon spontaneous wound healing (phlegmons, osteomyelitis, and purulent osteoarthritis of metatarsophalangeal joint as well as loss of the diseased foot’s walking ability are among the reasons for transition to plastic surgery in management tactics. The longer foot lesion persists, the higher probability of amputation. Improvement of treatment of both wound and ulcer lesions by means of reconstructive surgery in patients with diabetic foot syndrome was the main aim of the study. Outcomes of treatment of 460 patients managed at the Center for the Scientific and Clinical Study of Endocrinology, within the period from 2001 to 2009 were analyzed. Size, form, depth and localization of a wound, tissue composition of the wound bed as well as circulation in skin flaps caused the choice of specific operation: autodermoplasty by Parin (with the split-thickness skin flap, local tissue plastic operation (with the sliding or inter-advancing skin flaps, flaps from previously amputated toe or Indian flaps, plastic operation with the controlled tissue tension or combined plastic operation. Reconstructive foot wound surgery allows restoring load-bearing function of the extremity much earlier in contrast to spontaneous healing, reducing incidence of post-operative and long-term complications, amputations and re-amputations, decreasing period of treatment.

  16. Diabetic foot infection treatment and care. (United States)

    Cigna, Emanuele; Fino, Pasquale; Onesti, Maria G; Amorosi, Vittoria; Scuderi, Nicolò


    Foot infections in diabetic patients are a common, complex and costly problem. They are potentially adverse with progression to deeper spaces and tissues and are associated with severe complications. The management of diabetic foot infection (DFI) requires a prompt and systematic approach to achieve more successful outcomes and to ultimately avoid amputations. This study reviews a multi-step treatment for DFIs. Between September 2010 and September 2012, a total of about 37 patients were consulted for DFI. The treatment algorithm included four steps, that is, several types of debridement according to the type of wound, the application of negative pressure therapy (NPT), other advanced dressings, a targeted antibiotic therapy local or systemic as the case may, and, if necessary, reconstructive surgery. This treatment protocol showed excellent outcomes, allowing us to avoid amputation in most difficult cases. Only about 8% of patients require amputation. This treatment protocol and a multidisciplinary approach with a specialised team produced excellent results in the treatment of DFI and in the management of diabetic foot in general, allowing us to improve the quality of life of diabetic patients and also to ensure cost savings.

  17. Diabetes Foot Ulcers: A novel Treatment Strategy

    Directory of Open Access Journals (Sweden)

    Golnaz Namazi


    Full Text Available Foot ulcers are common in 12-25 percent of diabetic patients. Preventing, controlling and treating of these kind chronic wounds are of the major clinical challenges.Evidence based documents revealed that DFU (Diabetic Foot ulcer is a chronic wound type originating from disturbed cellular and molecular mechanisms that have to be in its functional form to overcome its problem. In diabetes and some other chronic based diseases, harmonized acting machine causes chronic phases that result in conditions as foot ulceration and related complications seen commonly in diabetes.DFU needs to be transformed into acute phase in order to be healed in a physiological manner. Disturbed mechanisms have to be corrected reversely and to achieve such a goal it is essential to better understanding of disturbing factors responsible for biological abnormalities. Factors associated with DFU are as cellular and molecular recruitment and function impairments and there is need to repair these mechanisms. For this, we believe that the activated Th-1 cells (T helper-1 Cells might have a critical role in regulation of the several effector functions of the cellular and molecular mechanisms essential to the body to act the best. Evidences and our successful results urge us to suggest this regulatory role for effector cells and molecules generated through activation of Th-1 cells as a treatment strategy.

  18. [Microbial community in wound defects of patients with diabetic foot syndrome in practice of family doctor]. (United States)

    Rosul, M B; Patskan', B M; Nemesh, I I


    Microbial content of the wound were analyzed in 49 patients with diabetic foot syndrome before and after ozone treatment. The wound defects was characterized by high level of colonization by microorganisms in associations, prevalence of the staphylococci, was estimated local wound treatment by ozone at 4000 mμ/l has positive effect onto wound healing process. This was manifested by significant decrease in density of the microbial colonization of the wounds and was accompanied by change of degenerative processes onto regeneration.

  19. Horizontal capacity of skirted circular shallow footings on sand

    Directory of Open Access Journals (Sweden)

    Amr Z. El Wakil


    Full Text Available Shallow footings are subjected to lateral forces induced by earthquake movements, wind loads, water wave pressure, lateral earth pressure, and transmitting power cables. In some structures such as water front structure, earth retaining structure and transmitting power structures, the lateral forces acting on the footings may be dominant. There has been little work studying the performance of skirted footings subjected to lateral loads. Twelve loading tests were performed on small scale circular skirted footing to shed some light on the performance of skirted footings when subjected to lateral loads. The effects of skirt length and the relative density of sand on the performance of the footing were investigated through laboratory testing program. Also a comparative experimental study between ultimate horizontal loads attained by skirted and unskirted footings with the same properties was conducted. From the accomplished laboratory tests it was found that the skirts changed the failure mode of circular shallow footings from sliding mechanism into rotational mechanism. Also the skirts attached to footings increased appreciably the ultimate horizontal capacity of shallow footings.

  20. Assessment of foot perfusion in patients with a diabetic foot ulcer. (United States)

    Forsythe, Rachael O; Hinchliffe, Robert J


    Assessment of foot perfusion is a vital step in the management of patients with diabetic foot ulceration, in order to understand the risk of amputation and likelihood of wound healing. Underlying peripheral artery disease is a common finding in patients with foot ulceration and is associated with poor outcomes. Assessment of foot perfusion should therefore focus on identifying the presence of peripheral artery disease and to subsequently estimate the effect this may have on wound healing. Assessment of perfusion can be difficult because of the often complex, diffuse and distal nature of peripheral artery disease in patients with diabetes, as well as poor collateralisation and heavy vascular calcification. Conventional methods of assessing tissue perfusion in the peripheral circulation may be unreliable in patients with diabetes, and it may therefore be difficult to determine the extent to which poor perfusion contributes to foot ulceration. Anatomical data obtained on cross-sectional imaging is important but must be combined with measurements of tissue perfusion (such as transcutaneous oxygen tension) in order to understand the global and regional perfusion deficit present in a patient with diabetic foot ulceration. Ankle-brachial pressure index is routinely used to screen for peripheral artery disease, but its use in patients with diabetes is limited in the presence of neuropathy and medial arterial calcification. Toe pressure index may be more useful because of the relative sparing of pedal arteries from medial calcification but may not always be possible in patients with ulceration. Fluorescence angiography is a non-invasive technique that can provide rapid quantitative information about regional tissue perfusion; capillaroscopy, iontophoresis and hyperspectral imaging may also be useful in assessing physiological perfusion but are not widely available. There may be a future role for specialized perfusion imaging of these patients, including magnetic resonance

  1. Common Mechanisms Underlying the Proconflict Effects of Corticotropin-Releasing Factor, A Benzodiazepine Inverse Agonist and Electric Foot-Shock

    NARCIS (Netherlands)

    Boer, Sietse F. de; Katz, Jonathan L.; Valentino, Rita J.


    The effects of corticotropin-releasing factor (CRF), a benzodiazepine inverse agonist (methyl-6,7-dimethoxy-4-ethyl-β-carboline-3-carboxylate; DMCM) and electric foot-shock on rat conflict behavior were characterized and compared. Rats were trained to lever press under a multiple fixed-ratio schedul

  2. Diabetic foot disease: From the evaluation of the "foot at risk" to the novel diabetic ulcer treatment modalities. (United States)

    Amin, Noha; Doupis, John


    The burden of diabetic foot disease (DFD) is expected to increase in the future. The incidence of DFD is still rising due to the high prevalence of DFD predisposing factors. DFD is multifactorial in nature; however most of the diabetic foot amputations are preceded by foot ulceration. Diabetic peripheral neuropathy (DPN) is a major risk factor for foot ulceration. DPN leads to loss of protective sensation resulting in continuous unconscious traumas. Patient education and detection of high risk foot are essential for the prevention of foot ulceration and amputation. Proper assessment of the diabetic foot ulceration and appropriate management ensure better prognosis. Management is based on revascularization procedures, wound debridement, treatment of infection and ulcer offloading. Management and type of dressing applied are tailored according to the type of wound and the foot condition. The scope of this review paper is to describe the diabetic foot syndrome starting from the evaluation of the foot at risk for ulceration, up to the new treatment modalities.

  3. Diabetic foot disease: From the evaluation of the “foot at risk” to the novel diabetic ulcer treatment modalities (United States)

    Amin, Noha; Doupis, John


    The burden of diabetic foot disease (DFD) is expected to increase in the future. The incidence of DFD is still rising due to the high prevalence of DFD predisposing factors. DFD is multifactorial in nature; however most of the diabetic foot amputations are preceded by foot ulceration. Diabetic peripheral neuropathy (DPN) is a major risk factor for foot ulceration. DPN leads to loss of protective sensation resulting in continuous unconscious traumas. Patient education and detection of high risk foot are essential for the prevention of foot ulceration and amputation. Proper assessment of the diabetic foot ulceration and appropriate management ensure better prognosis. Management is based on revascularization procedures, wound debridement, treatment of infection and ulcer offloading. Management and type of dressing applied are tailored according to the type of wound and the foot condition. The scope of this review paper is to describe the diabetic foot syndrome starting from the evaluation of the foot at risk for ulceration, up to the new treatment modalities. PMID:27076876

  4. Care of Patients with Diabetic Foot Disease in Oman (United States)

    Al-Busaidi, Ibrahim S.; Abdulhadi, Nadia N.; Coppell, Kirsten J.


    Diabetes mellitus is a major public health challenge and causes substantial morbidity and mortality worldwide. Diabetic foot disease is one of the most debilitating and costly complications of diabetes. While simple preventative foot care measures can reduce the risk of lower limb ulcerations and subsequent amputations by up to 85%, they are not always implemented. In Oman, foot care for patients with diabetes is mainly provided in primary and secondary care settings. Among all lower limb amputations performed in public hospitals in Oman between 2002–2013, 47.3% were performed on patients with diabetes. The quality of foot care among patients with diabetes in Oman has not been evaluated and unidentified gaps in care may exist. This article highlights challenges in the provision of adequate foot care to Omani patients with diabetes. It concludes with suggested strategies for an integrated national diabetic foot care programme in Oman. PMID:27606104

  5. Painful Lytic Lesions of the Foot : A Case Report

    Directory of Open Access Journals (Sweden)

    R Vaishya


    Full Text Available The presence of lytic lesions in the bones of foot raises a number of diagnostic possibilities ranging from infection, inflammatory pathology to neoplastic conditions. Although the radiological picture is not pathognomonic of any pathology, clinical history and histopathological examination can help to clinch the diagnosis. We present a case of multiple lytic lesions of the foot and discuss possible differential diagnoses. The patient was diagnosed as a case of madura foot and the lesions responded to surgical debridement and anti-fungal treatment with a good functional outcome. Madura foot is an uncommon, chronic granulomatous fungal or bacterial infection with a predilection in people who walk barefoot. Although known for a specific geographical distribution, madura foot should be kept as a possible diagnosis in patients presenting with lytic lesions of the foot due to population emigration across the world.

  6. Pathogenesis of foot ulcers and the need for offloading. (United States)

    Rathur, H M; Boulton, A J


    Diabetic foot ulceration represents a major medical, social and economic problem all over the world. While more than 5% of diabetic patients have a history of foot ulceration, the cumulative lifetime incidence may be as high as 15%. Ethnic differences exist in both ulcer and amputation incidences. Foot ulceration results from the interaction of several contributory factors, the most important of which is neuropathy. The use of the total-contact cast is demonstrated in the treatment of plantar neuropathic ulcers. Histological evidence suggests that pressure relief results in chronic foot ulcers changing their morphological appearance by displaying some features of an acute wound. Thus, repetitive stresses on the insensate foot appear to play a major role in maintaining ulcer chronicity. It is hoped that research activity in foot disease will ultimately result in fewer ulcers and less amputation in diabetes.

  7. Use of Pressure Offloading Devices in Diabetic Foot Ulcers


    Wu, Stephanie C; Jensen, Jeffrey L.; Weber, Anna K.; Robinson, Daniel E.; David G Armstrong


    OBJECTIVE—Pressure mitigation is crucial for the healing of plantar diabetic foot ulcers. We therefore discuss characteristics and considerations associated with the use of offloading devices. RESEARCH DESIGN AND METHODS—A diabetic foot ulcer management survey was sent to foot clinics in all 50 states and the District of Columbia in 2005. A total of 901 geographically diverse centers responded. The survey recorded information regarding usage frequency and characteristics of assessment and tre...

  8. Initial misdiagnosis of melanoma located on the foot is associated with poorer prognosis. (United States)

    Sondermann, Wiebke; Zimmer, Lisa; Schadendorf, Dirk; Roesch, Alexander; Klode, Joachim; Dissemond, Joachim


    Acral melanoma has been reported to be associated with poorer outcomes than melanoma occurring on other cutaneous sites. It has been suggested that part of this disparity in outcomes may be related to delay in diagnosis. Therefore, we have analyzed the rate of misdiagnoses in patients with melanoma located on the foot and have characterized the influence on the clinical course and survival of the patients. A prospective, computerized melanoma database at the Skin Cancer Center of the University Hospital Essen, Germany was used to identify patients with histologically confirmed melanoma located on the foot between 2002 and July 2013 for subsequent analysis. A cohort of 151 patients diagnosed with primary melanoma located on the foot was identified. One hundred seven patients qualified for subsequent analysis. Forty-two patients were male (39.3%) and 65 (60.7%) were female; the mean age at first diagnosis was 61.6 years (median 66 years). The youngest patient was 19 years, the oldest 88 years old.Of the 107 patients analyzed, 32 (30%) were initially misdiagnosed. Misdiagnoses included chronic wounds, nevi, hematoma, fungal infections, warts, and paronychia. Misdiagnosis caused a median delay in diagnosis of 9 months. The 5-year disease-free survival rate (47.8% vs 72.7%) and the 5-year overall survival rate (63.5% vs 88.4%) were statistically significant lower in the misdiagnosis cohort.The awareness of potentially overlooked melanoma located on the foot has to increase among physicians.To improve early detection and, thus, the prognosis of patients with melanoma located on the foot, taking a biopsy from any suspicious lesion should be taken into consideration as soon as possible.

  9. Facts that every vascular surgeon needs to know about the diabetic foot. (United States)

    Edmonds, M


    This paper describes important aspects of the diabetic foot which the vascular surgeon needs to understand to efficiently manage the diabetic foot. Firstly, it emphasises the three main pathologies which come together in the diabetic foot, namely neuropathy, ischemia and immunopathy, the latter predisposing to infection. As a result of neuropathy, the signs and symptoms of tissue breakdown, infection and ischemia may be minimal. Nevertheless the pathology emanating from such clinical events proceeds rapidly without the body being aware of it and the end stage of tissue death and necrosis is quickly reached. It is important to have a prompt system of evaluation and intervention to prevent the rapid progression to necrosis. Thus, secondly, the paper describes a simple rapid assessment of the diabetic foot, which comprises inspection, palpation and sensory testing and leads on to a modern classification and staging of the diabetic foot. This classifies six subdivisions of the diabetic foot: foot with neuropathic ulceration, Charcot foot, neuroischemic foot, critically ischemic foot, acutely ischemic foot and renal ischemic foot and six stages in the natural history of each of these subdivisions: normal foot, high risk foot, ulcerated foot, infected foot, necrotic foot and unsalvageable foot. Thirdly, it describes modern management of the diabetic foot, emphazising wound care and revascularization within the context of a multidisciplinary care team that provides integrated care focused in a diabetic foot clinic, to which patients with diabetes should have easy and rapid access. Members of the team include podiatrist, nurse, orthotist, physician, radiologist and surgeons.

  10. Benign and malignant tumors of the foot and ankle

    Energy Technology Data Exchange (ETDEWEB)

    Singer, Adam D.; Datir, Abhijit; Langley, Travis [Emory University Hospital, Department of Radiology, Section of Musculoskeletal Imaging, Atlanta, GA (United States); Tresley, Jonathan [University of Wisconsin, Department of Radiology, Madison, WI (United States); Clifford, Paul D.; Jose, Jean; Subhawong, Ty K. [University of Miami, Department of Radiology, Miami, FL (United States)


    Pain and focal masses in the foot and ankle are frequently encountered and often initiate a workup including imaging. It is important to differentiate benign lesions from aggressive benign or malignant lesions. In this review, multiple examples of osseous and soft tissue tumors of the foot and ankle will be presented. Additionally, the compartmental anatomy of the foot and ankle will be discussed in terms of its relevance for percutaneous biopsy planning and eventual surgery. Finally, a general overview of the surgical management of benign, benign aggressive and malignant tumors of the foot and ankle will be discussed. (orig.)

  11. Gait: the role of the ankle and foot in walking. (United States)

    Dubin, Andrew


    Evaluation of gait and its associated deviations from normal requires an in-depth evaluation of the patient and an appreciation for the complexity of the task. Understanding gait starts with an appreciation of the basic determinants of gait. Foot drop is a common gait deviation. Functionally, a foot drop results in a long limb. This will result in alterations of the gait cycle during swing phase. The common compensations for a foot drop include steppage gait, circumduction, and a persistently abducted limb. Noninterventional options for management of common gait deviations secondary to ankle/foot dysfunction present challenges.


    Directory of Open Access Journals (Sweden)



    Full Text Available Squamous cell carcinoma of the foot is rare. This carcinoma of the foot may arise from a precursor lesion or may be secondary. Squamous cell carcinoma of the foot may resemble verrucous carcinoma or there can be distinct verrucous carcinoma of the foot or epithelioma cuniculatum. We reporting a case of 45 years old male patient developed squamous cell carcinoma over marjolins ulcer and develop ilio - inguinal lymphadenopathy after 1 month of malignancy. We have done below knee amputation and ilioinguinal block dissection

  13. Congenital hypertrophy of multiple intrinsic muscles of the foot. (United States)

    Shiraishi, Tomohiro; Park, Susam; Niu, Atushi; Hasegawa, Hiromi


    Congenital hypertrophy of a single intrinsic muscle of the foot is rare, and as far as we know, only six cases have been reported. We describe a case of congenital anomaly that showed hypertrophy of multiple intrinsic muscles of the foot; the affected muscles were all the intrinsic muscles of the foot except the extensor digitorum brevis or extensor hallucis. Other tissues such as adipose tissue, nervous tissue, or osseous tissue showed no abnormalities. To reduce the volume of the foot we removed parts of the enlarged muscles.

  14. Isolation of a substance activating foot formation in hydra

    DEFF Research Database (Denmark)

    Grimmelikhuijzen, C J; Schaller, H C


    We have developed an assay for a substance from hydra that accelerates foot regeneration in the animal. This substance is specific for the foot as evidenced by the following findings: (1) It is present in the animal as a steep gradient descending from foot to head, paralleling the foot-forming po...... be extracted from hydra tissue with methanol and separated from other known morphogens of hydra by gel filtration and ion-exchange chromatography. A substance with similar biological and physicochemical properties can be isolated from sea anemones....

  15. Prospective study of ankle and foot fractures in elderly women

    Directory of Open Access Journals (Sweden)

    Yadagiri Surender Rao


    Full Text Available The epidemiology of ankle fractures in old people is changing as time passes on. The incidence of ankle fractures increases with advancing age. The study conducted was among a rural popula-tion which comprised of 68 women (32 women with ankle fractures & 36 women with foot fractures. Patients studied were in the age group more than 50 years. The study highlights the etiological & risk factors for fractures of ankle & foot. The commonest ankle fracture was the lateral malleolar fracture & the commonest foot fracture was the 5th Metatarsal fracture. Diabetes is a risk factor which increases the occurrence of ankle and foot injuries.

  16. Foot-pad dermatitis in broilers and turkeys


    Berg, Charlotte C.


    Foot-pad dermatitis is a condition characterised by lesions on the ventral foot-pads of poultry. It is a type of contact dermatitis, which in an early stage results in hyperkeratosis, erosions and discoloration of the skin. The erosions can develop into ulcers. In severe cases, the foot-pad lesions may cause pain which together with a deteriorated state of health constitutes a welfare issue. It has also been indicated that broilers with severe foot-pad dermatitis show slower weight gain. The ...

  17. Foot structure and footwear prescription in diabetes mellitus. (United States)

    Bus, Sicco A


    Foot structure abnormalities such as foot deformity and limited joint mobility are common and well established components of the diabetic foot which are associated with increased levels of mechanical stress on the foot and the development of ulcers. Our understanding of foot structure abnormality in diabetes has improved recently, mainly through the findings from in vivo imaging studies. Several examples will be discussed in this review. A limited understanding, however, still exists about several aspects related to the assessment, etiology, and consequences of change in foot structure in diabetes. Knowledge on these matters is needed if we are to better deal with the implications of foot structure change in diabetes. Diabetic patients with neuropathy and foot deformity are commonly prescribed with custom footwear, in particular after ulcer healing. The goal of this footwear is to redistribute and reduce plantar foot pressures, and to prevent ulcer recurrence. However, the available evidence for the effectiveness of custom footwear in secondary ulcer prevention is not yet strong. This may be associated with several factors, including a lack of standardized or systematic approach (a set of guidelines) in footwear prescription and evaluation or with the significant variability that exists across patients in the offloading effect of different footwear interventions, which increases the difficulty of predicting what works for a given patient. Objective evaluation tools such as in-shoe plantar pressure analysis can be helpful in this regard in order to ensure efficacy of an intervention. This provides a more optimal footwear solution that may lower the risk for ulceration.


    Directory of Open Access Journals (Sweden)

    Mohamed Shameem P. M


    Full Text Available INTRODUCTION Diabetic foot ulcers vary in their clinical presentation and nature of severity and therefore create a challenging problem to the treating surgeon regarding the prediction of the clinical course and the end result of the treatment. Clinical studies have shown that there are certain risk factors for the progression of foot ulcers in diabetics and it may therefore be possible to predict the course of an ulcer foot at presentation itself, thus instituting proper therapy without delay. Spoken otherwise clinical scoring may tell that this particular ulcer is having highest chance of amputation, then one may be able to take an early decision for the same and avoid the septic complications, inconvenience to the patient, long hospital stay and cost of treatments. AIM OF THE STUDY Aim of the study is to evaluate the above-mentioned scoring system in predicting the course the diabetic foot ulcers. MATERIALS AND METHODS 50 patients with Diabetic Foot attending the OPD of Department of Surgery of Government Hospital attached to Calicut Medical College are included in the present study. After thorough history taking and clinical examination, six risk factors like Age, pedal vessels, renal function, neuropathy, radiological findings and ulcers were observed in the patients by giving certain scoring points to each of them. The total number of points scored by the patients at the time of admission or OPD treatment was correlated with the final outcome in these patients, whether leading to amputation or conservative management. All the data was analysed using standard statistical methods. OBSERVATIONS AND RESULTS There were 12 females and 38 males with a female to male ratio 1:3.1. All were aged above 30 years. Twenty-four (48% of them were between 30-60 years and twenty six (52% were above 60 years. 10 patients were treated conservatively with risk score range: 10 to 35. Six had single toe loss with risk score: 25 to 35. Six had multiple toe loss

  19. Characterization of scale-free properties of human electrocorticography in awake and slow wave sleep states

    Directory of Open Access Journals (Sweden)

    John M Zempel


    Full Text Available Like many complex dynamic systems, the brain exhibits scale-free dynamics that follow power law scaling. Broadband power spectral density (PSD of brain electrical activity exhibits state-dependent power law scaling with a log frequency exponent that varies across frequency ranges. Widely divergent naturally occurring neural states, awake and slow wave sleep (SWS periods, were used evaluate the nature of changes in scale-free indices. We demonstrate two analytic approaches to characterizing electrocorticographic (ECoG data obtained during Awake and SWS states. A data driven approach was used, characterizing all available frequency ranges. Using an Equal Error State Discriminator (EESD, a single frequency range did not best characterize state across data from all six subjects, though the ability to distinguish awake and SWS states in individual subjects was excellent. Multisegment piecewise linear fits were used to characterize scale-free slopes across the entire frequency range (0.2-200 Hz. These scale-free slopes differed between Awake and SWS states across subjects, particularly at frequencies below 10 Hz and showed little difference at frequencies above 70 Hz. A Multivariate Maximum Likelihood Analysis (MMLA method using the multisegment slope indices successfully categorized ECoG data in most subjects, though individual variation was seen. The ECoG spectrum is not well characterized by a single linear fit across a defined set of frequencies, but is best described by a set of discrete linear fits across the full range of available frequencies. With increasing computational tractability, the use of scale-free slope values to characterize EEG data will have practical value in clinical and research EEG studies.

  20. Metabolic Foot- and Fingerprinting of Lactobacillus paracasei

    DEFF Research Database (Denmark)

    Jäpelt, Kristina Bak

    in the metabolome, and an increased understanding of bile response mechanisms could be obtained by analysis of the response by tools within metabolomics. Therefore, the aim of this PhD thesis was to develop a platform for metabolic foot- and fingerprinting of L. paracasei subsp. paracasei strain (L. casei CRL-431......, it was demonstrated that the subsequent method used to extract intracellular metabolites from the L. paracasei cells altered the metabolic fingerprint. A comparative study was performed to characterise the effect of the genetic alterations in a set of mutants with enhanced bile tolerance from the parental strain of L...

  1. A Pacinian hyperplasia of the foot. (United States)

    Satge, D; Nabhan, J; Nandiegou, Y; Hermann, B; Goburdhun, J; Labrousse, F


    A case of Pacinian hyperplasia of the right great toe is reported. Pacinian hyperplasia is a rare benign and recently recognized painful lesion composed of an excess of well formed or hyperplastic Pacinian corpuscules, normaly involved in sensory innervation. This lesion that is usually observed in the hand, must be distinguished from nerve tumors harboring onion-bulb structure which are not true well formed Pacinian corpuscules and from Morton neuroma. Pacinian hyperplasia is considered a reactive lesion and not a true neoplasm. To our knowledge, this case is the first described in the foot.

  2. [Experience of treatment of diabetic foot syndrome]. (United States)

    Pertsov, V I; Ponomarenko, O V


    In The Clinic of Cathedra of The Catastrophes Medicine, Military Medicine, Anesthesiology and Reanimatology in 2010 - 2013 yrs 53 patients, ageing 23-65 yrs, were treated for diabetic foot syndrome (DFS) of neuropathic and mixed forms. Diagnostic-treatment algorithm was proposed for determination of level and degree of a circulation and neuropathic disorders, introduction of which have promoted optimization of surgical and local treatment, improvement of the complex treatment results in patients, suffering DFS. A new method of treatment application, using combined preparation of hyaluronic acid with the sodium succinic, have permitted to achieve a complete healing of the ulcer defect.

  3. Wheeled foot quadruped robot HITAN-I

    Institute of Scientific and Technical Information of China (English)

    Wang Pengfei; Sun Lining


    In view of the robot running environment, the structure of wheeled foot and quadruped are adopted in this robot system, which combines the priorities of both wheeled robot and legged robot. Based on CAN bus, the two-class robot control system using multiple controllers and drivers is constructed. At the same time, serial inverse kinematics of swaying leg and parallel inverse kinematics of supporting legs are analyzed independently. The forward gait and turning gait are planned and experiment image is given at last.

  4. A kinematic method to detect foot contact during running for all foot strike patterns. (United States)

    Milner, Clare E; Paquette, Max R


    The biomechanics of distance running are studied in relation to both understanding injury mechanisms and improving performance. Kinematic methods must be used to identify the stance phase of running when data are recorded during running on a standard treadmill or outside the laboratory. Recently, a focus on foot strike patterns has emerged in the field. Thus, there is a need for a kinematic method to identify foot contact that is equally effective for both rearfoot and non-rearfoot strike patterns. The purpose of this study was to determine whether a new kinematic method could accurately determine foot contact during running in both rearfoot and non-rearfoot strikers. Overground gait data were collected at on 22 runners, 11 with a rearfoot strike pattern and 11 with a non-rearfoot strike pattern. Data were processed to identify foot contact from: vertical ground reaction force, two previously published kinematic methods, and our new kinematic method. Limits of agreement were used to determine bias and random error of each kinematic method compared to ground reaction force onset. The new method had comparable random error at 200 Hz sampling frequency (5 ms per frame) to the previous methods (7 frames vs 6-9 frames) and produced the same offset for both strike patterns (3 frames), while the existing methods had different offsets for different strike patterns (4 or 7 frames). Study findings support use of this new method, as it can be applied to all running strike patterns without adjusting the frame offset, simplifying data processing.

  5. Natural gaits of the non-pathological flat foot and high-arched foot

    CERN Document Server

    Fan, Yifang; Li, Zhiyu; Lv, Changsheng; Luo, Donglin


    There has been a controversy as to whether or not the non-pathological flat foot and high-arched foot have an effect on human walking activities. The 3D foot scanning system was employed to obtain static footprints from subjects adopting a half-weight-bearing stance. Based upon their footprints, the subjects were divided into two groups: the flat-footed and the high-arched. The plantar pressure measurement system was used to measure and record the subjects' successive natural gaits. Two indices were proposed: distribution of vertical ground reaction force (VGRF) of plantar and the rate of the footprint areas. Using these two indices to compare the natural gaits of the two subject groups, we found that (1) in stance phase, there is a significant difference (p<0.01) in the distributions of VGRF of plantar; (2) in a stride cycle, there is also a significant difference (p<0.01) in the rates of the footprint areas. Our analysis suggests that when walking, the VGRF of the plantar brings greater muscle tension...


    NARCIS (Netherlands)



    The treatment of foot sarcomas is generally a below knee amputation. In selected sarcomas of the forefoot, however, a transtarsal amputation according to Chopart, a calcaneotibial arthrodesis according to Pirogoff, or a supramalleolar amputation according to Syme can be considered the treatment of c

  7. Mechanism and Design Analysis of Articulated Ankle Foot Orthoses for Drop-Foot

    Directory of Open Access Journals (Sweden)

    Morshed Alam


    Full Text Available Robotic technologies are being employed increasingly in the treatment of lower limb disabilities. Individuals suffering from stroke and other neurological disorders often experience inadequate dorsiflexion during swing phase of the gait cycle due to dorsiflexor muscle weakness. This type of pathological gait, mostly known as drop-foot gait, has two major complications, foot-slap during loading response and toe-drag during swing. Ankle foot orthotic (AFO devices are mostly prescribed to resolve these complications. Existing AFOs are designed with or without articulated joint with various motion control elements like springs, dampers, four-bar mechanism, series elastic actuator, and so forth. This paper examines various AFO designs for drop-foot, discusses the mechanism, and identifies limitations and remaining design challenges. Along with two commercially available AFOs some designs possess promising prospective to be used as daily-wear device. However, the design and mechanism of AFO must ensure compactness, light weight, low noise, and high efficiency. These entailments present significant engineering challenges to develop a new design with wide consumer adoption.

  8. 多频多段人体生物电阻抗测量系统%A Bioelectrical Impedance Measurement System Based on Multi-Frequency and Multi-Segment Technology

    Institute of Scientific and Technical Information of China (English)

    高秀娥; 唐佳; 陈波


    Bioelectrical impedance is an important composition of human body, and reflects the physical conditions of human tissues to some extent. Based on this, a multi-frequency and multi-segment bioelectrical impedance measurement system is designed on the principle of eight electrodes. In fact, the system, which consists of MCU system, sinusoidal excitation current source, RMS-to-DC circuit and etc, has achieved the impedance measurement of the extremities as well as the trunk under the frequency ranged from 5 ~ 500 kHz. Experiment results show that the system finally realizes high-accuracy measurements of amplitude and phase of bioelectrical impedance with the result of a relative error of magnitude which is less than 0. 7% and an absolute error of phase which is less than 0.8°.%人体生物电阻抗是人体体成分的重要组成部分,在一定程度上反映了人体组织的生理状况.基于此,设计了一套基于八电极的多频多段人体生物电阻抗测量系统.测量系统由单片机系统、正弦交流激励电流源、有效值检测电路等组成,实现了5 ~ 500 kHz频率范围的左右上下肢及躯干的5段测量.测试结果表明,测量系统实现了人体生物电阻抗的幅值和相位的高精度测量,幅值相对误差小于0.7%,相位绝对误差小于0.8°.

  9. Update on the diabetic foot 2012: the 14th biennial Malvern Diabetic Foot Conference, May 9-11, 2012. (United States)

    Lamont, Peter; Franklyn, Kerryn; Rayman, Gerry; Boulton, Andrew J M


    The 14th biennial Malvern Diabetic Foot Conference was held in May 2012. Physicians, podiatrists, nurses, orthotists, surgeons, radiologists, and other professionals attended to reflect on the diabetic foot. The conference comprised interactive workshops, oral presentations of new research findings, and lectures from leading figures in the world of the diabetic foot. Over the 3 days, topics such as epidemiology, neuropathy, screening, vascular disease, prevention, and management among others were discussed. The conference has been an excellent platform from which to share new and ongoing research and it will without a doubt improve the treatment of the diabetic foot across the world.

  10. Ultrastructure and Glycoconjugate Pattern of the Foot Epithelium of the Abalone Haliotis tuberculata (Linnaeus, 1758 (Gastropoda, Haliotidae

    Directory of Open Access Journals (Sweden)

    I. Bravo Portela


    Full Text Available The foot epithelium of the gastropod Haliotis tuberculata is studied by light and electron microscopy in order to contribute to the understanding of the anatomy and functional morphology of the mollusks integument. Study of the external surface by scanning electron microscopy reveals that the side foot epithelium is characterized by a microvillus border with a very scant presence of small ciliary tufts, but the sole foot epithelium bears a dense field of long cilia. Ultrastructural examination by transmission electron microscopy of the side epithelial cells shows deeply pigmented cells with high electron-dense granular content which are not observed in the epithelial sole cells. Along the pedal epithelium, seven types of secretory cells are present; furthermore, two types of subepithelial glands are located just in the sole foot. The presence and composition of glycoconjugates in the secretory cells and subepithelial glands are analyzed by conventional and lectin histochemistry. Subepithelial glands contain mainly N-glycoproteins rich in fucose and mannose whereas secretory cells present mostly acidic sulphated glycoconjugates such as glycosaminoglycans and mucins, which are rich in galactose, N-acetyl-galactosamine, and N-acetyl-glucosamine. No sialic acid is present in the foot epithelium.

  11. Clinical analysis of the adolescent patients with multi-segments intramedullary spinal cord tumors%多节段髓内肿瘤青少年患者的临床分析

    Institute of Scientific and Technical Information of China (English)

    孙建军; 林国中; 王振宇; 李振东; 谢京城; 陈晓东; 马长城; 刘彬; 张嘉; 于涛


    Objective: To prospectively analyze the clinical features and characteristics of multi-segments intramedullary spinal cord tumors in adolescent patients. Methods: In our study, 25 consecutive adolescent patients with multi-segments intramedullary spinal cord tumors were recruited, who underwent microsurgery for the tumor using a posterior approach and were hospitalized in Peking University Third Hospital within a period of 8 years. The tumor was exposed through dorsal myelotomy. Preoperative and postoperative neurological functions were scored using the improved Japanese orthopaedic association score system ( IJOA) grading system. The functional outcome was defined as postoperative IJOA score minus preoperative IJOA score. All the patients were followed-up until Oct. 30, 2011. Results: There were 15 male and 10 female adolescent patients younger than 25 years. Their mean age was ( 15. 3 ± 6.83) years. The most common initial symptom was sensory disturbance (including pain and/or numbness, 52% , 13/25) , followed by motor disturbance (including limbs weakness and gait deterioration, 24% , 6/25) , pain and motor disturbance ( 12% , 3/25 ), as well as fever, limbs deformities, and sphincter dysfunction, respectively. The preoperative IJOA scores of the patients were (14.4 ±3. 38). The postoperative IJOA scores of the patients were (15.5 ±3.31). The most commonly involved location was the cervicothoracic segments (36% , 9/25) , followed by the conus terminalis (24% , 6/25), the cervical region( 16% , 4/25) , the thoracic region (16% , 4/25) , and the lumbus region (8% , 2/25). The average involved segments were (4.4 ± 1. 38). The most frequent tumors were neurodevelopmental tumors (including lipoma, epidermoid cyst and teratoma) (32%, 8/25), followed by astrocytomas (28%, 7/25), ependymomas (20%, 5/25), hemangioblastomas (12%, 3/25), and glioblastomas and schwannomas, respectively. Conclusion: In adolescent patients with multi-segments intramedullary spinal cord

  12. A pneumatic power harvesting ankle-foot orthosis to prevent foot-drop

    Directory of Open Access Journals (Sweden)

    Chin Robin


    Full Text Available Abstract Background A self-contained, self-controlled, pneumatic power harvesting ankle-foot orthosis (PhAFO to manage foot-drop was developed and tested. Foot-drop is due to a disruption of the motor control pathway and may occur in numerous pathologies such as stroke, spinal cord injury, multiple sclerosis, and cerebral palsy. The objectives for the prototype PhAFO are to provide toe clearance during swing, permit free ankle motion during stance, and harvest the needed power with an underfoot bellow pump pressurized during the stance phase of walking. Methods The PhAFO was constructed from a two-part (tibia and foot carbon composite structure with an articulating ankle joint. Ankle motion control was accomplished through a cam-follower locking mechanism actuated via a pneumatic circuit connected to the bellow pump and embedded in the foam sole. Biomechanical performance of the prototype orthosis was assessed during multiple trials of treadmill walking of an able-bodied control subject (n = 1. Motion capture and pressure measurements were used to investigate the effect of the PhAFO on lower limb joint behavior and the capacity of the bellow pump to repeatedly generate the required pneumatic pressure for toe clearance. Results Toe clearance during swing was successfully achieved during all trials; average clearance 44 ± 5 mm. Free ankle motion was observed during stance and plantarflexion was blocked during swing. In addition, the bellow component repeatedly generated an average of 169 kPa per step of pressure during ten minutes of walking. Conclusion This study demonstrated that fluid power could be harvested with a pneumatic circuit built into an AFO, and used to operate an actuated cam-lock mechanism that controls ankle-foot motion at specific periods of the gait cycle.

  13. Automatic classification of thermal patterns in diabetic foot based on morphological pattern spectrum (United States)

    Hernandez-Contreras, D.; Peregrina-Barreto, H.; Rangel-Magdaleno, J.; Ramirez-Cortes, J.; Renero-Carrillo, F.


    This paper presents a novel approach to characterize and identify patterns of temperature in thermographic images of the human foot plant in support of early diagnosis and follow-up of diabetic patients. Composed feature vectors based on 3D morphological pattern spectrum (pecstrum) and relative position, allow the system to quantitatively characterize and discriminate non-diabetic (control) and diabetic (DM) groups. Non-linear classification using neural networks is used for that purpose. A classification rate of 94.33% in average was obtained with the composed feature extraction process proposed in this paper. Performance evaluation and obtained results are presented.

  14. Functional clinical typology of the foot and kinematic gait parameters

    Directory of Open Access Journals (Sweden)

    Jitka Marenčáková


    Full Text Available Background: The foot plays a key role in a standing posture, walking and running performance. Changes in its structure or function may alter upper segments of kinematic chain which can lead to formation of musculoskeletal disorders. Although functional clinical typology provides a complex view of foot kinesiology there is a lack of knowledge and evidence about influences of different foot types on human gait. Objective: The aim of the study was to analyse differences of kinematic gait parameters of lower extremity joints and pelvis between functional clinical foot types in healthy young men. Methods: Three-dimensional kinematic analysis by the Vicon Motion Capture MX System device in synchronization with 2 Kistler force platforms was used to obtain kinematic data from 18 healthy men (mean age 23.2 ± 1.9 years. The functional clinical foot type was clinically examined and sorted into 3 basic foot type groups - forefoot varus (FFvar, rearfoot varus (RFvar and forefoot valgus (FFvalg. Peak angular values and range of an angular displacement in all of three movement planes were analysed for pelvis, hip, knee and ankle joint. For statistical analysis of kinematic gait parameters differences between foot types Mann Whitney U test at a statistical significance level p < .05 and Cohen's coefficient d for effect size were used. Results: This study showed that functional clinical foot type can affect kinematic parameters of gait in the joints of the lower limb and pelvis. Significant differences were presented in the FFvar in comparison with other two foot type groups with middle and high size of effect. The most alterations were observed in pelvis area and in a sagittal plane of movement. Nevertheless, significant differences between FFvalg and RFvar foot types were not noticed. Conclusions: Functional clinical foot typology provides one of the possible methods to describe foot structure and function. Our results showed that foot type could

  15. The German and Belgian accreditation models for diabetic foot services. (United States)

    Morbach, Stephan; Kersken, Joachim; Lobmann, Ralf; Nobels, Frank; Doggen, Kris; Van Acker, Kristien


    The International Working Group on the Diabetic Foot recommends that auditing should be part of the organization of diabetic foot care, the efforts required for data collection and analysis being balanced by the expected benefits. In Germany legislature demands measures of quality management for in- and out-patient facilities, and, in 2003, the Germany Working Group on the Diabetic Foot defined and developed a certification procedure for diabetic foot centres to be recognized as 'specialized'. This includes a description of management facilities, treatment procedures and outcomes, as well as the organization of mutual auditing visits between the centres. Outcome data is collected at baseline and 6 months on 30 consecutive patients. By 2014 almost 24,000 cases had been collected and analysed. Since 2005 Belgian multidisciplinary diabetic foot clinics could apply for recognition by health authorities. For continued recognition diabetic foot clinics need to treat at least 52 patients with a new foot problem (Wagner 2 or more or active Charcot foot) per annum. Baseline and 6-month outcome data of these patients are included in an audit-feedback initiative. Although originally fully independent of each other, the common goal of these two initiatives is quality improvement of national diabetic foot care, and hence exchanges between systems has commenced. In future, the German and Belgian accreditation models might serve as templates for comparable initiatives in other countries. Just recently the International Working Group on the Diabetic Foot initiated a working group for further discussion of accreditation and auditing models (International Working Group on the Diabetic Foot AB(B)A Working Group).

  16. Nonlinear MHD waves in a Prominence Foot

    CERN Document Server

    Ofman, Leon; Kucera, Therese; Schmieder, Brigitte


    We study nonlinear waves in a prominence foot using 2.5D MHD model motivated by recent high-resolution observations with Hinode/SOT in Ca~II emission of a prominence on October 10, 2012 showing highly dynamic small-scale motions in the prominence material. Observations of H$\\alpha$ intensities and of Doppler shifts show similar propagating fluctuations. However the optically thick nature of the emission lines inhibits unique quantitative interpretation in terms of density. Nevertheless, we find evidence of nonlinear wave activity in the prominence foot by examining the relative magnitude of the fluctuation intensity ($\\delta I/I\\sim \\delta n/n$). The waves are evident as significant density fluctuations that vary with height, and apparently travel upward from the chromosphere into the prominence material with quasi-periodic fluctuations with typical period in the range of 5-11 minutes, and wavelengths $\\sim <$2000 km. Recent Doppler shift observations show the transverse displacement of the propagating wav...

  17. Autonomic neuropathy and diabetic foot ulceration. (United States)

    Edmonds, M E; Nicolaides, K H; Watkins, P J


    Autonomic function was studied in three groups of insulin-dependent diabetic patients. Heart rate changes during deep breathing and on standing were significantly less in 28 patients with a recent history of foot ulceration compared with 40 patients with peripheral neuropathy but without ulceration (p less than 0.001) and 54 patients without neuropathy (p less than 0.001). Sympathetic function was assessed in 36 of these patients from peripheral arterial diastolic flow patterns obtained by Doppler ultrasound measurements and expressed as the pulsatility index (PI). Patients with a history of ulceration (n = 10) showed considerably increased diastolic flow (PI = 4.28 +/- 0.53, mean +/- S.E.M.) compared with 12 neuropathic patients with no history of ulceration (PI = 7.80 +/- 0.68, p less than 0.002) and 14 patients without neuropathy (PI = 9.55 +/- 0.89, p less than 0.002). Severely abnormal autonomic function occurs in association with neuropathic foot ulceration, but patients without ulcers have lesser degrees of autonomic neuropathy, thus a causal relationship has not been established.

  18. Microsurgical management of the diabetic foot. (United States)

    Rainer, Christian; Schwabegger, Anton H; Meirer, Romed; Perkmann, Reinhold; Ninkovic, Marina; Ninkovic, Milomir


    Allthough there has been dramatic progress in limb salvage in recent decades, management of nonhealing wounds in diabetic patients continues to present a dilemma for the reconstructive surgeon. However, the acceptance of free-flap resurfacing of diabetic foot ulcers has increased in recent years. This study reviews 10 microvascular free muscle flaps in nine patients over a mean follow-up period of 44 months. Five patients had evidence of peripheral vascular disease. There was one flap loss, and nine flaps were transferred successfully. No perioperative mortality was encountered. The operations required a long, costly hospitalization (average hospital stay was 40 days). Seven of eight patients whose flaps survived had complications related to the free-flap recipient site. These seven patients underwent 20 secondary surgical procedures due to arterial and venous thrombosis, partial necrosis of the skin grafts, minor local infections, and gangrene or necrosis of the remaining toes. In three patients, progressive ischemic necrosis of the remaining toes, with total survival of the flap, was attributed to a microvascular steal phenomenon. However, all eight patients whose flaps survived subsequently ambulated on their flaps. The study demonstrates that microvascular surgery may result in functional lower-extremity salvage in diabetic patients with foot wounds that are not treatable by local flaps or skin grafts, and are destined for amputation.

  19. Imaging osteomyelitis and the diabetic foot

    Energy Technology Data Exchange (ETDEWEB)

    Becker, W. (Gottingen Univ. (Germany). Dep. of Nuclear Medicine)


    The clinical diagnosis of osteomyelitis and the diabetic foot is in most of the patients not possible without imaging the bone. The clinical problem is to diagnose infection as early, as reliable and as cheap as possible to prevent the possible longstanding and life-threatening complications. For imaging a lot of different radiological and nuclear medicine methods are available. This article focuses on the possible results of conventional plain radiography and tomography, computed tomography and magnetic resonance imaging as radiological and on bone scan, autologous white blood cell scintigraphy with [sup 111]In-oxin or [sup 99m]Tc-HMPAO, antigranulocyte antibodies, [sup 99m]Tc/[sup 111]In-human immunoglobulin,[sup 67] Ga-citrate and [sup 99m]Tc-nanocelloids. Different methods after different answers. Radiological methods give detailed pathological answers, nuclear medicine methods answer questions of specificity such as leukocyte infiltration. If osteomyelitis is suspected, plain radiography should be the first, three phase bone scintigraphy the second and infection specific radiopharmaceuticals the third step of examination. Only in negative images with high clinical suspicion CT or MRI should be the final imaging procedure. In the diabetic foot imaging cascade should also start with plain radiography, followed by three phase bone scintigraphy or MRI. If clinically neuropathy is present specific nuclear medicine imaging should be performed.

  20. Back to School Foot Pain (Flip-Flops) (United States)

    ... increase in ankle injuries among young athletes. Football, soccer and basketball are the sports most likely to lead to sprains, broken... Foot of the Class After wearing flip-flops all summer, students head back to school with painful ... Soccer Season Prime time for foot and ankle injuries. ...

  1. Compartment syndrome of the foot in a child. (United States)

    Sharma, A K; Sharaf, I; Ajay, S


    We report a case of a 12-year-old boy with acute compartment syndrome of the foot following a road-traffic accident. Due to the rarity of the injury, there was a delay in diagnosing the injury. An emergency fasciotomy was performed 19 hours after the injury. The foot healed with a mild extension contracture of the second toe.

  2. Foot posture and patellar tendon pain among adult volleyball players

    NARCIS (Netherlands)

    Groot, R. de; Malliaras, P.; Munteanu, S.; Payne, C.; Morrissey, D.; Maffulli, N.


    OBJECTIVE: We hypothesized that individuals with a normal foot posture would be less likely to experience patellar tendon pain and pathology than those with a pronated or supinated foot. DESIGN: Observational study. SETTING: Field-based study among competing athletes. PARTICIPANTS: Volleyball player

  3. Foot Posture and Patellar Tendon Pain Among Adult Volleyball Players

    NARCIS (Netherlands)

    de Groot, Reinier; Malliaras, Peter; Munteanu, Shannon; Payne, Craig; Morrissey, Dylan; Maffulli, Nicola


    Objective: We hypothesized that individuals with a normal foot posture would be less likely to experience patellar tendon pain and pathology than those with a pronated or supinated foot. Design: Observational study. Setting: Field-based study among competing athletes. Participants: Volleyball player

  4. Veterinary realities: what is foot and mouth disease?

    NARCIS (Netherlands)

    Law, J.; Mol, A.


    Veterinary science draws on different traditions for knowing and acting, and mobilises different kinds of materials and techniques. This article explores these differences and their tensions for the diagnosis of foot and mouth disease in the UK in 2001. It shows that when they talk of foot and mouth

  5. Skin and nail mycoses in patients with diabetic foot. (United States)

    Papini, M; Cicoletti, M; Fabrizi, V; Landucci, P


    Diabetes mellitus affects all socioeconomic and age groups and its incidence is rapidly increasing worldwide. The diabetic foot complication represents one of the most complex and serious complications in these patients. Fungal infections can also contribute to the severity of the diabetic foot. The aim of the present study was to evaluate the prevalence of foot skin and toenail mycosis in a group of 75 patients with diabetic foot complication and in a matched control group. Diabetic patients showed onychomycosis in 53.3% and foot skin mycosis in 46.7% of the cases, with a prevalence of both fungal infections significantly higher than that observed in the control group. At least one type of these fungal infections was present in 69.3% of diabetic subjects with a highly significant difference compared to control group (Pdiabetic foot complication, and that the problem of fungal infections of the foot in diabetic subjects is still highly underestimated. Consequently, there is an important clinical rationale for careful mycological examination of diabetic foot and an adequate treatment tailored for each individual patient according to the fungal species involved.

  6. Functional limitations due to foot involvement in spondyloarthritis (United States)

    Ozaras, Nihal; Havan, Nuri; Poyraz, Emine; Rezvanı, Aylin; Aydın, Teoman


    [Purpose] Spondyloarthritis is a major inflammatory disease followed-up in the rheumatology clinics, foot involvement in spodyloarthritis is common. The functional states of patients with spondyloarthritis are usually evaluated globally. The aim of this study was to assess the foot involvement-related functional limitations in patients with spondyloarthritis. [Subjects and Methods] Patients with ankylosing spondylitis and psoriatic arthritis with foot pain more than 4 weeks who underwent anteroposterior and lateral feet radiography were enrolled into the study. A “clinical findings score” was calculated by assigning 1 point for every finding of swelling, redness, and tenderness. C-reactive protein and erythrocyte sedimentation rate were used as serum markers for disease activity. Foot radiograms were evaluated using the spondyloarthropathy tarsal radiographic index and the foot-related functional state of patients was determined by the Turkish version of the Foot and Ankle Outcome Score. [Results] There were no relationships between Foot and Ankle Outcome Score subscales and clinical findings score, serum markers, or radiologic score. Pain and symptoms subscale scores were result positively correlated with activity of daily living, sport and recreation, and quality of life subscale scores. [Conclusion] Pain and symptoms are the main determinants of foot-related functional limitations in spondyloarthritis. PMID:27512252

  7. Diabetic foot syndrome--dermatological point of view. (United States)

    Troskot, Nina; Duvancić, Tomislav; Kolić, Maja


    Patients with diabetes mellitus often suffer from diabetic foot syndrome, a condition leading to foot ulceration or even amputation of lower extremity. Peripheral neuropathy combined with repetitive trauma to the foot and peripheral vascular disease are the main etiological factors in the development of foot ulcers. Other major contributive factors include the effects of callus, increased plantar pressures, and local infections. Patient education concerning their disease has a central role in the prevention of foot ulcers. Ordinary preventive measures taken by the patient include regular self-inspections, appropriate daily hygiene of the feet, appropriate footwear to reduce plantar pressures, and medical pedicure performed by a pedicurist experienced in diabetic foot patients. The importance of callus in diabetic patients has been shown in several studies by high predictability of subsequent ulcer development in patients with plantar calluses. For removing callus, urea based preparations are considered to be the treatment of choice. In case of local bacterial and fungal diabetic foot infections, systemic antibiotic and systemic antimycotic therapy is indicated, respectively. Wound dressings of various types are the mainstay in the treatment of chronic foot ulcers with avoidance of occlusive dressings in infected ulcers. Since the vast majority of ulcers and amputations can be prevented in diabetic patients, proper diagnosis and multidisciplinary approach are essential.

  8. Easy ways to offload diabetic foot ulcer in rural setup


    Agrawal, Vijay P


    Diabetic wound management has become a foremost problem in recent era. Offloading is one of the cornerstones of gold-standard treatment in diabetic neuropathic foot ulcer. The following article reviews the easily made offloading systems which are ideal to use in rural setup to offload diabetic foot ulcer.

  9. Innovations in plantar pressure and foot temperature measurements in diabetes. (United States)

    Bus, S A


    Plantar pressure and temperature measurements in the diabetic foot primarily contribute to identifying abnormal values that increase risk for foot ulceration, and they are becoming increasingly more integrated in clinical practice and daily life of the patient. While plantar pressure measurements have long been present, only recently evidence shows their importance in ulcer prevention, as a data-driven approach to therapeutic footwear provision. The long-term monitoring of plantar pressures with the option to provide feedback, when alarming pressure levels occur, is a promising development in this area, although more technical and clinical validation is required. Shear is considered important in ulcer aetiology but is technically difficult to measure. Innovative research is underway to assess if foot temperature can act as a useful surrogate for shear. Because the skin heats up before it breaks down, frequent monitoring of foot temperature can identify these warning signals. This approach has shown to be effective in preventing foot ulcers. Innovation in diagnostic methods for foot temperature monitoring and evidence on cost effectiveness will likely facilitate implementation. Finally, monitoring of adherence to offloading treatment using temperature-based sensors has proven to be a feasible and relevant method with a wide range of possible research and patient care applications. These innovations in plantar pressure and temperature measurements illustrate an important transfer in diabetic foot care from subjective to objective evaluation of the high-risk patient. They demonstrate clinical value and a large potential in helping to reduce the patient and economic burden of diabetic foot disease.

  10. Cold-Weather Foot Care Key for Diabetics (United States)

    ... Cold-Weather Foot Care Key for Diabetics It's important to make sure feet stay as ... Services. Recent Health News Related MedlinePlus Health Topics Diabetic Foot About MedlinePlus Site Map FAQs Customer Support Get ...

  11. Nurses’ role in diabetic foot prevention and care; a review

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    Aalaa M


    Full Text Available Abstract Diabetes as one of Non-communicable diseases has allocated a large proportion of cost, time and human resources of health systems. Now, due to changes in lifestyle and industrial process, incidence of diabetes and its complications have been increased. Accordingly diabetic foot considered as a common complication of diabetes. Nurses are health care providers who actively involved in prevention and early detection of diabetes and its complications. The nurses’ role could be in health care, health, community education, health systems management, patient care and improving the quality of life. Diabetes Nurses play their educating role in the field of prevention of diabetic foot, foot care and preventing from foot injury. In care dimension, nurses responsible for early detection of any changes in skin and foot sensation, foot care, dressing and apply novel technology. In the area of rehabilitation, help patient sufferings from diabetic foot ulcer or amputation, to have movement are diabetes nurse’s duties. Consequently, nurses need to attend in special training to use the latest instructions of diabetic foot care in order that provides the effective services to facilitate promote diabetic patients health.

  12. Bearing capacity of Skirt circular footing on sand

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    Amr Z. EL Wakil


    Full Text Available Skirts are used to improve the bearing capacity of shallow footings on sandy soil by constraining the soil beneath and containing the plastic flow of soil. They are used as an alternative to deep foundations in soils with low strength at the surface. As there has been available little work studying the performance of skirted foundation, we are performing eighteen laboratory experiments on circular steel footings of different diameters and different skirt lengths. The aim of these experiments is to shed some lights on the effects of skirts on the bearing capacity of shallow footings. The effects of skirt length and the relative density of sand on the ultimate load attained were investigated. From the accomplished laboratory tests, it was found that skirts improve appreciably the sustainability of shallow footings to applied load as they increase the ultimate load of shallow footings by some up to 6.25 times for the current study conditions and variables. The performance of skirted footing depends upon the relative density of sand and on the skirt length to footing diameter ratio. Skirts are more beneficial in case of footings on loose sand than in case of medium and dense sand.

  13. Software tool for the prosthetic foot modeling and stiffness optimization. (United States)

    Strbac, Matija; Popović, Dejan B


    We present the procedure for the optimization of the stiffness of the prosthetic foot. The procedure allows the selection of the elements of the foot and the materials used for the design. The procedure is based on the optimization where the cost function is the minimization of the difference between the knee joint torques of healthy walking and the walking with the transfemural prosthesis. We present a simulation environment that allows the user to interactively vary the foot geometry and track the changes in the knee torque that arise from these adjustments. The software allows the estimation of the optimal prosthetic foot elasticity and geometry. We show that altering model attributes such as the length of the elastic foot segment or its elasticity leads to significant changes in the estimated knee torque required for a given trajectory.

  14. The Modulation and Control of the Gecko's Foot Movement

    Institute of Scientific and Technical Information of China (English)

    Guo Ce; Dai Zhen-dong; Ji Ai-hong; Wang Wei-ying; Sun Jiu-rong


    The modulation and control of gecko's foot movements were studied electrophysiologically in order to design the motor control system of a gecko-mimic robot. In this study ( 1 ) the anatomy of the peripheral nerves controlling the gecko's foot movements was determined; (2) the relationship between the limb nerves of the gecko and its foot motor patterns was studied; (3) the afferent impulses of the nerves evoked by rubbing the gecko's toes and palm were recorded; (4) copying the natural patterns of movement of the gecko's foot (abduction, adduction, flexion, and revolution) and its limb nerve modulation and control mechanism, the nerves were stimulated under computer control, and the results recorded by CCD.Results suggest that gecko's foot movements can be successfully controlled by artificial electrical signals.

  15. Software Tool for the Prosthetic Foot Modeling and Stiffness Optimization

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    Matija Štrbac


    Full Text Available We present the procedure for the optimization of the stiffness of the prosthetic foot. The procedure allows the selection of the elements of the foot and the materials used for the design. The procedure is based on the optimization where the cost function is the minimization of the difference between the knee joint torques of healthy walking and the walking with the transfemural prosthesis. We present a simulation environment that allows the user to interactively vary the foot geometry and track the changes in the knee torque that arise from these adjustments. The software allows the estimation of the optimal prosthetic foot elasticity and geometry. We show that altering model attributes such as the length of the elastic foot segment or its elasticity leads to significant changes in the estimated knee torque required for a given trajectory.

  16. Replantation of an avulsive amputation of a foot after recovering the foot from the sea. (United States)

    Yüksel, F; Karacaoğlu, E; Ulkür, E; Güler, M M


    A foot avulsion case, with the dismembered body part submerged in sea water for 1 hour, is presented. This report is unique in that it is the first to document the reattachment of a body part that had been submerged in sea water. It was not known how salt-water exposure would affect wound management. Differences in osmolarity and bacterial flora between the sea water and foot tissues have not caused any problems, and the patient has not suffered any vascular or infectious complications after replantation. Neurotization of the plantar surface by the tibial nerve, which was stripped off during amputation and replaced in its original traces, was the most critical part of convalescence. After management of such an interesting case, we conclude that exposure to sea water of the dismembered part should not be a contraindication for replantation surgery.

  17. The diabetic foot; Der diabetische Fuss

    Energy Technology Data Exchange (ETDEWEB)

    Vestring, T. [Inst. fuer Klinische Radiologie, Univ. Muenster (Germany); Fiedler, R. [Klinik und Poliklinik fuer Technische Orthopaedie und Rehabilitation, Univ. Muenster (Germany); Greitemann, B. [Klinik und Poliklinik fuer Technische Orthopaedie und Rehabilitation, Univ. Muenster (Germany); Sciuk, J. [Klinik und Poliklinik fuer Nuklearmedizin, Univ. Muenster (Germany); Peters, P.E. [Inst. fuer Klinische Radiologie, Univ. Muenster (Germany)


    Familiarity with the spectrum of findings in the different imaging modalities appears essential. Radiographically, significant changes include Charcot joints of the tarsus (destructive type) and bone absorption of the forefoot (mutilating type). In diabetic foot problems, magnetic resonance imaging and leukocyte scintigraphy appear to be the most effective tools for detection of osteomyelitis, and a negative study makes osteomyelitis unlikely. However, the findings of both techniques in active, noninfected neuropathic osteoarthropathy may be indistinguishable from those of osteomyelitis. (orig.) [Deutsch] Da der diabetische Fuss zu einer der haeufigsten Komplikationen der Grunderkrankung zaehlt, muss das Befundspektrum bei den verschiedenen bildgebenden Verfahren bekannt sein. Bei der diabetischen Osteoarthropathie werden uebersichtsradiographisch 2 Formen unterschieden: der destruierende Typ, der die Tarsalknochen bevorzugt, und der mutilierende Typ, welcher sich an den Roehrenknochen des Fusses manifestiert. Die Magnetresonanztomographie und die Leukozytenszintigraphie sind zum Nachweis bzw. Ausschluss einer Osteomyelitis am besten geeignet. Aber auch diese Methoden koennen nicht sicher eine nicht infizierte, aktive Osteoarthropathie von einer Osteomyelitis differenzieren. (orig.)

  18. Risk Factors for Foot Amputation in Patients Hospitalized for Diabetic Foot Infection


    Maria Teresa Verrone Quilici; Fernando de Sá Del Fiol; Alexandre Eduardo Franzin Vieira; Maria Inês de Toledo


    The aim of this study was to identify and quantify risk factors for amputation in diabetic patients hospitalized for foot infections. This cross-sectional study comprised 100 patients with diabetic infectious complications in the lower limbs. The variables investigated were related to diabetes, infection, and treatment compliance. Multiple Cox regression analysis was performed to identify the variables independently associated with the outcome of amputation. The most prevalent chronic complic...

  19. Polymicrobial biofilms by diabetic foot clinical isolates. (United States)

    Mottola, Carla; Mendes, João J; Cristino, José Melo; Cavaco-Silva, Patrícia; Tavares, Luís; Oliveira, Manuela


    Diabetes mellitus is a major chronic disease that continues to increase significantly. One of the most important and costly complications of diabetes is foot ulceration that may be colonized by pathogenic and antimicrobial resistant bacteria, which may express several virulence factors that could impair treatment success. These bacterial communities can be organized in polymicrobial biofilms, which may be responsible for diabetic foot ulcer (DFU) chronicity. We evaluated the influence of polymicrobial communities in the ability of DFU isolates to produce biofilm, using a microtiter plate assay and a multiplex fluorescent in situ hybridization, at three time points (24, 48, 72 h), after evaluating biofilm formation by 95 DFU isolates belonging to several bacterial genera (Staphylococcus, Corynebacterium, Enterococcus, Pseudomonas and Acinetobacter). All isolates were biofilm-positive at 24 h, and the amount of biofilm produced increased with incubation time. Pseudomonas presented the higher biofilm production, followed by Corynebacterium, Acinetobacter, Staphylococcus and Enterococcus. Significant differences were found in biofilm formation between the three time points. Polymicrobial communities produced higher biofilm values than individual species. Pseudomonas + Enterococcus, Acinetobacter + Staphylococcus and Corynebacterium + Staphylococcus produced higher biofilm than the ones formed by E. faecalis + Staphylococcus and E. faecalis + Corynebacterium. Synergy between bacteria present in dual or multispecies biofilms has been described, and this work represents the first report on time course of biofilm formation by polymicrobial communities from DFUs including several species. The biological behavior of different bacterial species in polymicrobial biofilms has important clinical implications for the successful treatment of these infections.

  20. Recognizing the prevalence of changing adult foot size: an opportunity to prevent diabetic foot ulcers? (United States)

    Connolly, John E; Wrobel, James S


    Ill-fitting shoes may precipitate up to half of all diabetes-related amputations and are often cited as a leading cause of diabetic foot ulcers (DFU), with those patients being 5 to 10 times more likely to present wearing improperly fitting shoes. Among patients with prior DFU, those who self-select their shoe wear are at a three-fold risk for reulceration at 3 years versus those patients wearing prescribed shoes. Properly designed and fitted shoes should then address much of this problem, but evidence supporting the benefit of therapeutic shoe programs is inconclusive. The current study, performed in a male veteran population, is the first such effort to examine the prevalence and extent of change in foot length affecting individuals following skeletal maturity. Nearly half of all participants in our study experienced a ≥1 shoe size change in foot length during adulthood. We suggest that these often unrecognized changes may explain the broad use of improperly sized shoe wear, and its associated sequelae such as DFU and amputation. Regular clinical assessment of shoe fit in at-risk populations is therefore also strongly recommended as part of a comprehensive amputation prevention program.

  1. Epidemiology of diabetic foot and management of foot problems in India. (United States)

    Viswanathan, Vijay


    Diabetes the global epidemic is rapidly increasing at an alarming rate. Developing countries like India harbor the majority of diabetic people and by the year 2030 AD India will have the largest number of diabetic patients. Diabetic foot is one of the common diabetic complications found in India. Both aerobic and anaerobic pathogens form the etiology for diabetic foot infection. Members of the Enterobacteriaceae family were the most prominent among the aerobes while members of the Genus Peptostreptococcus and Clostridium were most prominent among the anaerobes. Ulcers infected with anaerobic pathogens showed a longer healing time than ulcers infected with aerobic pathogens. Oxidative stress is one of the major markers of inflammatory response and oxidative stress markers such as lipid peroxidation, thiobarbituric acid reactive substance (TBARS), Superoxide Dismutase (SOD), Catalase, G Peroxidase, G-S Peroxidase and plasma total antioxidant play a major role in the nonhealing of diabetic foot ulcers. Growth factors such as platelet-derived growth factor (PDGF), transforming growth factor (VEGF), and epidermal growth factor (EGF) are needed for normal wound repair, while proteases such as matrix metalloproteinase (MMP) and serine proteases found in chronic wounds delay the healing process.

  2. Foot rot and other foot diseases of goat and sheep in the semiarid region of northeastern Brazil

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    Gildeni M.N Aguiar


    Full Text Available This paper reports the occurrence and epidemiology of outbreaks of foot rot and other foot diseases in goats and sheep in the semiarid region of Paraíba, northeastern Brazil. Four farms were inspected for the presence of foot lesion in sheep and goats and for environmental conditions, general hygiene, pastures, and disease control measures. The prevalence of foot lesions was 19.41% (170/876 in sheep and 17.99% (52/289 in goats, ranging between 5.77% and 33.85% in different farms. Foot rot was the most common disease, affecting 12.1% of the animals examined (141/1165, but with significantly higher (p<0.05 prevalence in sheep (13.69% than in goats (7.27%. The frequency of malignant foot rot was also significantly lower (p<0.05 in goats (9.53% than in the sheep (40.83%. On one farm, Dorper sheep showed significantly higher (p<0.05 prevalence of foot rot (17.5% than Santa Inês sheep (6.79%, and the number of digits affected was also higher in the former. Dichelobacter nodosus and Fusobacterium necrophorum were isolated from cases of foot rot. White line disease was found in 3.95% of the animals, sole ulcers in 1.29%, foot abscess in 1.03% and hoof overgrowth in 0.5%. The high rainfall at the time of occurrence, grazing in wetlands, clay soils with poor drainage, presence of numerous stony grounds, closure of the flocks in pens at night, and introduction of affected animals were considered predisposing factors for the occurrence of foot diseases.

  3. Study on the prevalence of Foot and Mouth Disease in Borana and Guji Zones, Southern Ethiopia

    Directory of Open Access Journals (Sweden)

    Ashenafi Feyisa and Fufa Abunna

    Full Text Available A cross sectional study was conducted on Borana plateau and Guji highlands of southern Ethiopia to determine the prevalence of Foot and Mouth Disease (FMD in bovine species. Seroprevalence investigation was performed using 3ABC- ELISA technique. The result indicated that the overall prevalence of Foot and Mouth Disease was 24.6 %(113/460. Significantly higher prevalence was recorded in Borana 53.6 % ( 82/153 compared to Guji 10.1 %( 31/307. From the various risk factors, geographical distribution (÷²=104.26, P<0.05 and age (÷²=6.68, P<0.05 were seen to be significantly associated with the seroprevalence. The result of this study indicated that FMD is highly prevalent in lowland area (Borana than highland (Guji due to contact of different origin cattle in search of feed and water. The presence of higher prevalence of Foot and Mouth Disease in pastoralists\\\\\\\\\\\\\\' cattle of the area warrants further investigation and characterization of the circulating virus serotype to apply effective control and prevention measures. [Vet. World 2011; 4(7.000: 293-296

  4. Malformations of the first ray of the foot in children: diagnosis, clinical picture, treatment

    Directory of Open Access Journals (Sweden)

    Михаил Павлович Конюхов


    Full Text Available Malformations of the first ray of the foot vary widely and are divided into simple and complex. Complex malformations include abnormality of development of the first metatarsal or the main phalanx and refer to atypical adducted foot deformity. They are also characterized by varus location of the first ray of varying severity. The cause of deformation is a damage of longitudinal epiphyseal growth plate area of the first metatarsal - “longitudinal epiphyseal bracket” or the so-called delta phalanx. Over the past five years, we treated 37 patients (53 feet aged from 6 months to 17 years old with developmental disabilities of the first ray of the foot. The spectrum of pathology is very diverse. In the majority of cases surgical treatment was multi-staged. It was revealed that the removal of deformity at the first stage of treatment should be complete, with maximum use of the bone to restore the length and shape of the affected bone. In treating combined deformities the good effect is guaranteed only with the removal of all the elements, including excision of the fibrous bridle along the inner surface of the first ray.

  5. Hereditary Neuropathy with Liability to Pressure Palsy: A Recurrent and Bilateral Foot Drop Case Report

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    Filipa Flor-de-Lima


    Full Text Available Hereditary neuropathy with liability to pressure palsy is characterized by acute, painless, recurrent mononeuropathies secondary to minor trauma or compression. A 16-year-old boy had the first episode of right foot drop after minor motorcycle accident. Electromyography revealed conduction block and slowing velocity conduction of the right deep peroneal nerve at the fibular head. After motor rehabilitation, he fully recovered. Six months later he had the second episode of foot drop in the opposite site after prolonged squatting position. Electromyography revealed sensorimotor polyneuropathy of left peroneal, sural, posterior tibial, and deep peroneal nerves and also of ulnar, radial, and median nerves of both upper limbs. Histological examination revealed sensory nerve demyelination and focal thickenings of myelin fibers. The diagnosis of hereditary neuropathy with liability to pressure palsy was confirmed by PMP22 deletion of chromosome 17p11.2. He started motor rehabilitation and avoidance of stressing factors with progressive recovery. After one-year followup, he was completely asymptomatic. Recurrent bilateral foot drop history, “sausage-like” swellings of myelin in histological examination, and the results of electromyography led the authors to consider the diagnosis despite negative family history. The authors highlight this rare disease in pediatric population and the importance of high index of clinical suspicion for its diagnosis.

  6. Staphylococcus aureus Toxins and Diabetic Foot Ulcers: Role in Pathogenesis and Interest in Diagnosis

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    Catherine Dunyach-Remy


    Full Text Available Infection of foot ulcers is a common, often severe and costly complication in diabetes. Diabetic foot infections (DFI are mainly polymicrobial, and Staphylococcus aureus is the most frequent pathogen isolated. The numerous virulence factors and toxins produced by S. aureus during an infection are well characterized. However, some particular features could be observed in DFI. The aim of this review is to describe the role of S. aureus in DFI and the implication of its toxins in the establishment of the infection. Studies on this issue have helped to distinguish two S. aureus populations in DFI: toxinogenic S. aureus strains (harboring exfoliatin-, EDIN-, PVL- or TSST-encoding genes and non-toxinogenic strains. Toxinogenic strains are often present in infections with a more severe grade and systemic impact, whereas non-toxinogenic strains seem to remain localized in deep structures and bone involving diabetic foot osteomyelitis. Testing the virulence profile of bacteria seems to be a promising way to predict the behavior of S. aureus in the chronic wounds.

  7. Relationships between foot type and dynamic rearfoot frontal plane motion

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    Chuter Vivienne H


    Full Text Available Abstract Background The Foot Posture Index (FPI provides an easily applicable, validated method for quantifying static foot posture. However there is limited evidence relating to the ability of the FPI to predict dynamic foot function. This study aimed to assess the relationship between dynamic rearfoot motion and FPI scores in pronated and normal foot types. Methods 40 participants were recruited with equal numbers of pronated and normal foot types as classified by their FPI score. Three dimensional rearfoot motion was collected for each of the participants. Dynamic maximum rearfoot eversion was correlated with the total FPI score across all participants and within the normal and pronated foot types. Linear correlations were performed between components of the total FPI scores measuring frontal plane rearfoot position and maximum rearfoot eversion. The capacity of the total FPI score to predict maximum frontal plane motion of the rearfoot was investigated using linear regression analysis. Results The correlation between the total FPI score and maximum rearfoot eversion was strongly positive (r = 0.92, p 2 = 0.85, p Conclusions The results of this study suggest the FPI has strong predictive ability for dynamic rearfoot function. This will assist in clinical screening and research by allowing easy classification by functional foot type. Positive correlations between frontal plane rearfoot measurements and maximum rearfoot eversion suggest the FPI may identify dominant planar components of dynamic rearfoot motion and warrants further investigation.

  8. Predictive factors for diabetic foot ulceration: a systematic review. (United States)

    Monteiro-Soares, M; Boyko, E J; Ribeiro, J; Ribeiro, I; Dinis-Ribeiro, M


    Improving ability to predict and prevent diabetic foot ulceration is imperative because of the high personal and financial costs of this complication. We therefore conducted a systematic review in order to identify all studies of factors associated with DFU and assess whether available DFU risk stratification systems incorporate those factors of highest potential value. We performed a search in PubMed for studies published through April 2011 that analysed the association between independent variables and DFU. Articles were selected by two investigators-independently and blind to each other. Divergences were solved by a third investigator. A total of 71 studies were included that evaluated the association between diabetic foot ulceration and more than 100 independent variables. The variables most frequently assessed were age, gender, diabetes duration, BMI, HbA(1c) and neuropathy. Diabetic foot ulceration prevalence varied greatly among studies. The majority of the identified variables were assessed by only two or fewer studies. Diabetic neuropathy, peripheral vascular disease, foot deformity and previous diabetic foot ulceration or lower extremity amputation - which are the most common variables included in risk stratification systems - were consistently associated with diabetic foot ulceration development. Existing diabetic foot ulceration risk stratification systems often include variables shown repeatedly in the literature to be strongly predictive of this outcome. Improvement of these risk classification systems though is impaired because of deficiencies noted, including a great lack of standardization in outcome definition and variable selection and measurement.

  9. Metrological analysis of the human foot: 3D multisensor exploration (United States)

    Muñoz Potosi, A.; Meneses Fonseca, J.; León Téllez, J.


    In the podiatry field, many of the foot dysfunctions are mainly generated due to: Congenital malformations, accidents or misuse of footwear. For the treatment or prevention of foot disorders, the podiatrist diagnoses prosthesis or specific adapted footwear, according to the real dimension of foot. Therefore, it is necessary to acquire 3D information of foot with 360 degrees of observation. As alternative solution, it was developed and implemented an optical system of threedimensional reconstruction based in the principle of laser triangulation. The system is constituted by an illumination unit that project a laser plane into the foot surface, an acquisition unit with 4 CCD cameras placed around of axial foot axis, an axial moving unit that displaces the illumination and acquisition units in the axial axis direction and a processing and exploration unit. The exploration software allows the extraction of distances on three-dimensional image, taking into account the topography of foot. The optical system was tested and their metrological performances were evaluated in experimental conditions. The optical system was developed to acquire 3D information in order to design and make more appropriate footwear.

  10. Foot Morphological Difference between Habitually Shod and Unshod Runners.

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    Yang Shu

    Full Text Available Foot morphology and function has received increasing attention from both biomechanics researchers and footwear manufacturers. In this study, 168 habitually unshod runners (90 males whose age, weight & height were 23±2.4 years, 66±7.1 kg & 1.68±0.13 m and 78 females whose age, weight & height were 22±1.8 years, 55±4.7 kg & 1.6±0.11 m (Indians and 196 shod runners (130 males whose age, weight & height were 24±2.6 years, 66±8.2 kg & 1.72±0.18 m and 66 females whose age, weight & height were 23±1.5 years, 54±5.6 kg & 1.62±0.15 m (Chinese participated in a foot scanning test using the easy-foot-scan (a three-dimensional foot scanning system to obtain 3D foot surface data and 2D footprint imaging. Foot length, foot width, hallux angle and minimal distance from hallux to second toe were calculated to analyze foot morphological differences. This study found that significant differences exist between groups (shod Chinese and unshod Indians for foot length (female p = 0.001, width (female p = 0.001, hallux angle (male and female p = 0.001 and the minimal distance (male and female p = 0.001 from hallux to second toe. This study suggests that significant differences in morphology between different ethnicities could be considered for future investigation of locomotion biomechanics characteristics between ethnicities and inform last shape and design so as to reduce injury risks and poor performance from mal-fit shoes.

  11. Electric foot shock stress: a useful tool in neuropsychiatric studies. (United States)

    Bali, Anjana; Jaggi, Amteshwar Singh


    Electric foot shock is a complex stressor with both physical and emotional components. It has been employed as an important tool to develop diverse animal models in the field of psychopharmacology. The electric foot shock paradigm includes acute or chronic exposures of shocks of varying intensity and duration on an electrified grid floor in an electric foot shock apparatus. Research evidence reveals that foot shocks of varying intensity produce behavioral and neurochemical changes reflecting depression, anxiety, and post-traumatic stress disorder (PTSD) in humans. Animals generally do not habituate to foot shocks in comparison to other stressors, including loud noise, bright light, and hot and cold temperatures. Additionally, it offers an experimental advantage of control over intensity and duration; therefore, by varying its application parameters, different disorder models have been created. Electric foot shock fear conditioning-induced ultrasonic vocalization and fear-potentiated startle have been explored to develop models of anxiety and panic. Similarly, fear conditioning in the form of foot shock exposure followed by situational reminders has been used to develop a model of PTSD. Electric foot shock-induced conflict has been explored to develop operant conflict models (Geller-Seifter and Vogel tests), which in turn are pharmacologically validated to screen potential anti-anxiety agents. Inescapable electric shock-induced 'learned helplessness' mimics the symptomology of depression, and this phenomenon has been employed to develop the model of depression. The present review describes the pharmacologically validated models of anxiety, depression, and PTSD involving electric foot shock as an aversive stimulus.

  12. The clinical assessment study of the foot (CASF: study protocol for a prospective observational study of foot pain and foot osteoarthritis in the general population

    Directory of Open Access Journals (Sweden)

    Menz Hylton B


    Full Text Available Abstract Background Symptomatic osteoarthritis (OA affects approximately 10% of adults aged over 60 years. The foot joint complex is commonly affected by OA, yet there is relatively little research into OA of the foot, compared with other frequently affected sites such as the knee and hand. Existing epidemiological studies of foot OA have focussed predominantly on the first metatarsophalangeal joint at the expense of other joints. This three-year prospective population-based observational cohort study will describe the prevalence of symptomatic radiographic foot OA, relate its occurrence to symptoms, examination findings and life-style-factors, describe the natural history of foot OA, and examine how it presents to, and is diagnosed and managed in primary care. Methods All adults aged 50 years and over registered with four general practices in North Staffordshire, UK, will be invited to participate in a postal Health Survey questionnaire. Respondents to the questionnaire who indicate that they have experienced foot pain in the preceding twelve months will be invited to attend a research clinic for a detailed clinical assessment. This assessment will consist of: clinical interview; physical examination; digital photography of both feet and ankles; plain x-rays of both feet, ankles and hands; ultrasound examination of the plantar fascia; anthropometric measurement; and a further self-complete questionnaire. Follow-up will be undertaken in consenting participants by postal questionnaire at 18 months (clinic attenders only and three years (clinic attenders and survey participants, and also by review of medical records. Discussion This three-year prospective epidemiological study will combine survey data, comprehensive clinical, x-ray and ultrasound assessment, and review of primary care records to identify radiographic phenotypes of foot OA in a population of community-dwelling older adults, and describe their impact on symptoms, function and

  13. Ostectomy and Medial Plantar Artery Flap Reconstruction for Charcot Foot Ulceration Involving the Midfoot. (United States)

    Sato, Tomoya; Ichioka, Shigeru


    Charcot foot is a serious complication of diabetes, characterized by deformity and overlying ulceration. The condition most commonly affects the midfoot. However, little information is available on the use of a medial plantar artery flap to treat diabetic midfoot ulceration. The purpose of the present study was to evaluate the versatility of ostectomy and medial plantar flap reconstruction for midfoot plantar ulceration associated with rocker-bottom deformity secondary to Charcot foot. Four patients underwent ostectomy and medial plantar flap reconstruction. Before flap reconstruction, the devitalized soft tissues and bone were radically resected. After the infection had been controlled, the ulcerated portion was minimally excised, and the bony prominence underlying the ulcer was removed. A medial plantar artery flap was applied to the ulcer. The donor site was covered with a split-thickness skin graft or artificial dermis. In all patients, the ulcers healed and independent ambulation was achieved. However, 1 patient experienced ulcer recurrence, and subsequent infection necessitated a major amputation. Limb salvage is challenging in the setting of deformity and intractable plantar ulceration. The advantages of medial plantar artery flap reconstruction are that tissues with a rich blood supply are used to cover the exposed bone, and the flap can withstand the pressure and shear stress of the patient's body weight. However, a dominant artery in the foot is sacrificed. Therefore, the patency of the dorsalis pedis artery must be confirmed in every patient. The results of the present study have demonstrated that a medial plantar artery can be an effective alternative for diabetic patients with a plantar ulcer secondary to Charcot foot.

  14. Perspectives for clinical measures of dynamic foot function-reference data and methodological considerations. (United States)

    Rathleff, M S; Nielsen, R G; Simonsen, O; Olesen, C G; Kersting, U G


    Several studies have investigated if static posture assessments qualify to predict dynamic function of the foot showing diverse outcomes. However, it was suggested that dynamic measures may be better suited to predict foot-related overuse problems. The purpose of this study was to establish the reliability for dynamic measures of longitudinal arch angle (LAA) and navicular height (NH) and to examine to what extent static and dynamic measures thereof are related. Intra-rater reliability of LAA and NH measures was tested on a sample of 17 control subjects. Subsequently, 79 subjects were tested while walking on a treadmill. The ranges and minimum values for LAA and NH during ground contact were identified over 20 consecutive steps. A geometric error model was used to simulate effects of marker placement uncertainty and skin movement artifacts. Results demonstrated the highest reliability for the minimum NH (MinNH), followed by the minimum LAA (MinLAA), the dynamic range of navicular height (DeltaNH) and the range of LAA (DeltaLAA) while all measures were highly reliable. Marker location uncertainty and skin movement artifacts had the smallest effects on measures of NH. The use of an alignment device for marker placement was shown to reduce error ranges for NH measures. Therefore, DeltaNH and MinNH were recommended for functional dynamic foot characterization in the sagittal plane. There is potential for such measures to be a suitable predictor for overuse injuries while being obtainable in clinical settings. Future research needs to include such dynamic but simple foot assessments in large-scale clinical studies.

  15. Ultrasound-guided interventions of the foot and ankle. (United States)

    Yablon, Corrie M


    Ultrasound (US) provides excellent delineation of tendons and ligaments in the foot and ankle and provides real-time visualization of a needle during interventions, yielding greater accuracy and efficacy than the traditional blind approach using anatomical landmarks. For this reason, US is rapidly gaining acceptance as the preferred modality for guiding interventions in the foot and ankle where the anatomy is complex, neurovascular structures should be identified, and precise technique is demanded. In the foot and ankle, US is especially useful to guide tendon sheath, bursal, and Achilles paratenon injections, Morton neuroma injections, plantar fascial injections, and joint aspirations and injections.

  16. Update in diagnosis and treatment of diabetic foot infections. (United States)

    Miller, Andy O; Henry, Michael


    Foot infections are a major cause of morbidity and mortality in diabetics. Evaluation of diabetic foot infections often requires clinical, radiologic, laboratory, and microbiologic assessment. Osteomyelitis has a profound impact on the prognosis and management of these infections, and diagnosis can be difficult; the gold standard remains bone biopsy. Despite a panoply of studies, the optimal management of diabetic foot infections remains poorly understood. Antibiotics, surgery, rehabilitation and/or off-loading, and glycemic control remain the cornerstones of treatment; alternative therapies remain largely unproven.

  17. Clinical characteristics of foot ulceration in people with chronic gout. (United States)

    Rome, Keith; Erikson, Kathryn; Otene, Cynthia; Sahid, Hazra; Sangster, Karyn; Gow, Peter


    Gout is the most common form of inflammatory arthritis and it has an affliction to the foot. Foot involvement in gout has been linked to foot pain, impairment and disability. There has been limited research on the effect of ulceration on foot pain, impairment, disability and health-related quality of life in patients already living with gout. The aim of the study was to describe the wound characteristics and the effect on foot pain, disability and health-related quality of life in patients with foot ulceration associated with gout. Participants were recruited from rheumatology clinics in Auckland, New Zealand. All the current foot ulceration sites and wound characteristics were recorded using the TIME wound assessment tool. The outcome measures included general pain, patient global assessment scale, foot pain, disability and impairment. Participants completed the Cardiff Wound Impact Schedule to assess the effect of ulcers on health-related quality of life. Sensory loss, vibrational thresholds and ankle brachial pressure index were collated to assess for lower limb arterial disease. Six participants were predominantly older men with a long duration of gout, high rates of obesity and co-morbidities such as hypertension, hyperlipidaemia, diabetes and cardiovascular disease. The mean (SD) duration of the foot ulcers was 4 (2) months. The majority of foot ulcers observed were 0·5 cm(2) or smaller superficial thickness with surrounding callus. Partial thickness and full-thickness ulcers were also observed. Two patients presented with ulcers on multiple sites. There was only one case of infection. Gouty tophi were evident in most of the wounds. The dorsal aspect of the third toe was found to ulcerate in most cases. Moderate scores of foot pain, disability, impairment and health-related quality of life were observed. Most participants wore shoes deemed as poor. Foot ulceration in gout is chronic and multiple ulcers can occur with the potential of leading to delayed

  18. Diabetic charcot neuroarthropathy of the foot and ankle with osteomyelitis. (United States)

    Ramanujam, Crystal L; Stapleton, John J; Zgonis, Thomas


    One of the most devastating foot and/or ankle complications in the diabetic population with peripheral neuropathy is the presence of Charcot neuroarthropathy (CN). In recent years, diabetic limb salvage has been attempted more frequently as opposed to major lower extremity amputation for CN of the foot and ankle with ulceration and/or deep infection. Treatment strategies for osteomyelitis in the diabetic population have evolved. This article reviews some of the most common surgical strategies recommended for the diabetic patient with CN of the foot and/or ankle and concomitant osteomyelitis.

  19. Imaging of Soft Tissue Lesions of the Foot and Ankle

    Directory of Open Access Journals (Sweden)

    Seyed Hassan Mostafavi


    Full Text Available Differential diagnosis of soft tissue lesions of the foot may be narrowed with imaging. The cystic nature of ganglia, synovial cysts, and bursitis can be confirmed with MR imaging or sonography. Location and signal characteristics of noncystic lesions may suggest Morton's neuroma, giant cell tumor of the tendon sheath and plantar fibromatosis. Synovial-based lesions of the foot and ankle can be differentiated based on presence or absence of mineralization, lesion density, signal intensity, and the enhancement pattern. Knowledge of the incidence of specific neoplasms of the foot and ankle based on patient age aids in providing a limited differential diagnosis

  20. Co-therapy using lytic bacteriophage and linezolid: effective treatment in eliminating methicillin resistant Staphylococcus aureus (MRSA from diabetic foot infections.

    Directory of Open Access Journals (Sweden)

    Sanjay Chhibber

    Full Text Available BACKGROUND: Staphylococcus aureus remains the predominant pathogen in diabetic foot infections and prevalence of methicillin resistant S.aureus (MRSA strains further complicates the situation. The incidence of MRSA in infected foot ulcers is 15-30% and there is an alarming trend for its increase in many countries. Diabetes acts as an immunosuppressive state decreasing the overall immune functioning of body and to worsen the situation, wounds inflicted with drug resistant strains represent a morbid combination in diabetic patients. Foot infections caused by MRSA are associated with an increased risk of amputations, increased hospital stay, increased expenses and higher infection-related mortality. Hence, newer, safer and effective treatment strategies are required for treating MRSA mediated diabetic foot infections. The present study focuses on the use of lytic bacteriophage in combination with linezolid as an effective treatment strategy against foot infection in diabetic population. METHODOLOGY: Acute hindpaw infection with S.aureus ATCC 43300 was established in alloxan induced diabetic BALB/c mice. Therapeutic efficacy of a well characterized broad host range lytic bacteriophage, MR-10 was evaluated alone as well as in combination with linezolid in resolving the course of hindpaw foot infection in diabetic mice. The process of wound healing was also investigated. RESULTS AND CONCLUSIONS: A single administration of phage exhibited efficacy similar to linezolid in resolving the course of hindpaw infection in diabetic animals. However, combination therapy using both the agents was much more effective in arresting the entire infection process (bacterial load, lesion score, foot myeloperoxidase activity and histopathological analysis. The entire process of tissue healing was also hastened. Use of combined agents has been known to decrease the frequency of emergence of resistant mutants, hence this approach can serve as an effective strategy in

  1. Adaptive control of a variable-impedance ankle-foot orthosis to assist drop-foot gait. (United States)

    Blaya, Joaquin A; Herr, Hugh


    An active ankle-foot orthoses (AAFO) is presented where the impedance of the orthotic joint is modulated throughout the walking cycle to treat drop-foot gait. During controlled plantar flexion, a biomimetic torsional spring control is applied where orthotic joint stiffness is actively adjusted to minimize forefoot collisions with the ground. Throughout late stance, joint impedance is minimized so as not to impede powered plantar flexion movements, and during the swing phase, a torsional spring-damper control lifts the foot to provide toe clearance. To assess the clinical effects of variable-impedance control, kinetic and kinematic gait data were collected on two drop-foot participants wearing the AAFO. For each participant, zero, constant, and variable impedance control strategies were evaluated and the results were compared to the mechanics of three age, weight, and height matched normals. We find that actively adjusting joint impedance reduces the occurrence of slap foot allows greater powered plantar flexion and provides for less kinematic difference during swing when compared to normals. These results indicate that a variable-impedance orthosis may have certain clinical benefits for the treatment of drop-foot gait compared to conventional ankle-foot orthoses having zero or constant stiffness joint behaviors.

  2. Protocol for the Foot in Juvenile Idiopathic Arthritis trial (FiJIA: a randomised controlled trial of an integrated foot care programme for foot problems in JIA

    Directory of Open Access Journals (Sweden)

    Hendry Gordon J


    Full Text Available Abstract Background Foot and ankle problems are a common but relatively neglected manifestation of juvenile idiopathic arthritis. Studies of medical and non-medical interventions have shown that clinical outcome measures can be improved. However existing data has been drawn from small non-randomised clinical studies of single interventions that appear to under-represent the adult population suffering from juvenile idiopathic arthritis. To date, no evidence of combined therapies or integrated care for juvenile idiopathic arthritis patients with foot and ankle problems exists. Methods/design An exploratory phase II non-pharmacological randomised controlled trial where patients including young children, adolescents and adults with juvenile idiopathic arthritis and associated foot/ankle problems will be randomised to receive integrated podiatric care via a new foot care programme, or to receive standard podiatry care. Sixty patients (30 in each arm including children, adolescents and adults diagnosed with juvenile idiopathic arthritis who satisfy the inclusion and exclusion criteria will be recruited from 2 outpatient centres of paediatric and adult rheumatology respectively. Participants will be randomised by process of minimisation using the Minim software package. The primary outcome measure is the foot related impairment measured by the Juvenile Arthritis Disability Index questionnaire's impairment domain at 6 and 12 months, with secondary outcomes including disease activity score, foot deformity score, active/limited foot joint counts, spatio-temporal and plantar-pressure gait parameters, health related quality of life and semi-quantitative ultrasonography score for inflammatory foot lesions. The new foot care programme will comprise rapid assessment and investigation, targeted treatment, with detailed outcome assessment and follow-up at minimum intervals of 3 months. Data will be collected at baseline, 6 months and 12 months from baseline

  3. 38 CFR 4.63 - Loss of use of hand or foot. (United States)


    ... case of the foot, could be accomplished equally well by an amputation stump with prosthesis. (a... foot. 4.63 Section 4.63 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS SCHEDULE... foot. Loss of use of a hand or a foot, for the purpose of special monthly compensation, will be held...

  4. Eumycetoma of the foot caused by Exophiala jeanselmei in a Guinean woman. (United States)

    Desoubeaux, G; Millon, A; Freychet, B; de Muret, A; Garcia-Hermoso, D; Bailly, E; Rosset, P; Chandenier, J; Bernard, L


    Eumycetomas are chronic infectious entities characterized by presence of mycotic grains in (sub-)cutaneous tissues, after accidental inoculation of an exogenous filamentous fungus in the skin. The lesions evolve towards painless pseudotumor of the soft parts. We report the original case of a Guinean woman exhibiting eumycetoma of the right foot. Both laboratory tests identified a dematiaceous fungus, Exophiala jeanselmei, as the responsible infectious agent. A medical treatment with voriconazole alone was sufficient to notice a substantial clinical improvement. This finding is unusual as E. jeanselmei is uncommon in Guinea-Conakry, and as optimal treatment rather associate antifungal azoles and surgical excision.

  5. Foote Brook Macroinvertebrate Biomonitoring-Phase I in Johnson, Vermont (United States)

    Vermont Center for Geographic Information — The Foote Brook Biomonitoring Project, Phase I geospatial dataset consists of data from the biomonitoring of benthic macroinvertebrates at three sites located along...

  6. Foot Modeling and Smart Plantar Pressure Reconstruction from Three Sensors (United States)

    Ghaida, Hussein Abou; Mottet, Serge; Goujon, Jean-Marc


    In order to monitor pressure under feet, this study presents a biomechanical model of the human foot. The main elements of the foot that induce the plantar pressure distribution are described. Then the link between the forces applied at the ankle and the distribution of the plantar pressure is established. Assumptions are made by defining the concepts of a 3D internal foot shape, which can be extracted from the plantar pressure measurements, and a uniform elastic medium, which describes the soft tissues behaviour. In a second part, we show that just 3 discrete pressure sensors per foot are enough to generate real time plantar pressure cartographies in the standing position or during walking. Finally, the generated cartographies are compared with pressure cartographies issued from the F-SCAN system. The results show 0.01 daN (2% of full scale) average error, in the standing position. PMID:25400713

  7. Monotonic Loading of Circular Surface Footings on Clay

    DEFF Research Database (Denmark)

    Ibsen, Lars Bo; Barari, Amin


    Appropriate modeling of offshore foundations under monotonic loading is a significant challenge in geotechnical engineering. This paper reports experimental and numerical analyses, specifically investigating the response of circular surface footings during monotonic loading and elastoplastic beha...

  8. VT Foote Brook Natural Channel Design Restoration 2001-2002 (United States)

    Vermont Center for Geographic Information — (Link to Metadata) The Foote Brook, located in Johnson, Vermont, is known to biologists and anglers as a high quality stream with significant natural reproduction of...

  9. VT Foote Brook Natural Channel Design Restoration 2003 (United States)

    Vermont Center for Geographic Information — (Link to Metadata) The Foote Brook, located in Johnson, Vermont, is known to biologists and anglers as a high quality stream with significant natural reproduction of...

  10. Foote Brook Macroinvertebrate Biomonitoring - Phase 2 in Johnson, Vermont (United States)

    Vermont Center for Geographic Information — In 2000, Foote Brook was identified as a high priority site for restoration after the extensive countywide stream stability study, Stream Stability Assessment of...

  11. Human Behavior Recognition Using Foot Pressure Sensing Shoes (United States)

    Sugimoto, Chika; Ozaki, Kenji; Ezoe, Ryosuke; Hosaka, Hiroshi; Yamato, Hiroyuki

    To recognize human behavior in unlimited environments, sensing shoes for measuring foot pressure distribution were developed. Seven pressure sensors were installed on an insole, and a measurement module was embedded in the shoe. An analysis for discriminating the user's movements from the foot pressure distribution was examined, considering the movements, walking, running, standing, sitting, going upstairs and downstairs, and cycling. These seven actions were discriminated using feature quantities such as the average, standard deviation, maximum, and difference deviation extracted from the data of three sensors by discriminant analysis. The evaluation results showed highly accurate behavior recognition based on foot pressure at some points. In addition, by canonical discriminant analysis, six discriminant functions which classify the seven actions with an accuracy of 100% were derived by using feature quantities extracted from five sensors. The results confirmed that discriminant analysis can be used for automatically recognizing human behaviors based on foot pressure data.

  12. Minimally invasive surgery for diabetic plantar foot ulcerations

    Directory of Open Access Journals (Sweden)

    Caio Nery


    Full Text Available Complications of diabetes mellitus constitute the most common indications for hospitalization and non-traumatic amputations in the USA. The most important risk factors for the development of diabetic foot ulcerations include the presence of peripheral neuropathy, vasculopathy, limited joint mobility, and pre-existing foot deformities. In our study, 500 diabetic patients treated for plantar forefoot ulcerations were enrolled in a prospective study from 2000 to 2008 at the Federal University of São Paulo, Brazil. Fifty-two patients in the study met the criteria and underwent surgical treatment consisting of percutaneous Achilles tendon lengthening to treat plantar forefoot ulcerations. The postoperative follow-up demonstrated prevention of recurrent foot ulcerations in 92% of these diabetic patients that maintained an improved foot function. In conclusion, our study supports that identification and treatment of ankle equinus in the diabetic population may potentially lead to decreased patient morbidity, including reduced risk for both reulceration, and potential lower extremity amputation.

  13. Ultrasound of ankle and foot: overuse and sports injuries. (United States)

    Khoury, Viviane; Guillin, Raphaël; Dhanju, Jag; Cardinal, Etienne


    Sports and overuse injuries of the ankle and foot are commonly encountered in clinical practice. Ultrasound (US) has been established as an excellent diagnostic modality for foot and ankle injuries, providing a rapid noninvasive, economical, and readily available tool that is well tolerated by the patient with acute or chronic pain. The opportunity for dynamic examination is another advantage of US in evaluating ankle and foot pathology, where maneuvers such as muscle contraction and stressing of the joint may be particularly helpful. In many cases, US can be used as a first-line and only imaging modality for diagnosis. This article focuses on ankle disorders related to sports or overuse that affect tendons, including tendinosis, tenosynovitis, paratendinitis, rupture, dislocation, and ligaments that are commonly torn. The sonographic features of certain common foot disorders related to physical activity and overuse are also discussed, including plantar fasciitis, Morton's neuroma, stress fractures, and plantar plate injury.

  14. Diabetic foot ulceration with osteomyelitis: the importance of early detection


    Tranter, Jennifer; McIntosh, Caroline


    This case study explores the\\ud management of a chronic diabetic\\ud foot ulcer complicated by severe\\ud soft tissue infection (cellulitis) and\\ud bony infection (osteomyelitis) in a\\ud patient with type 2 diabetes.


    Directory of Open Access Journals (Sweden)

    Ramesh Kumar


    Full Text Available Lipomas are benign soft tissue tumors that can occur at any age and frequently on the upper back, neck, shoulder and abdomen. We present a case of lipoma over sole of foot which is an uncommon location.

  16. Ascending infection of foot tendons in diabetic patients. (United States)

    Mismar, Ayman; Yousef, Mohammad; Badran, Darwish; Younes, Nidal


    Bone and soft tissue infection in the foot of diabetic patients is a well-described issue in the literature. A sound anatomical knowledge of the foot anatomy and compartments is mandatory to understand the mechanisms of infection spread. We describe four cases of diabetic foot infection complicated by long ascending infection. All did not respond initially to antibiotic treatment and the usual surgical debridement and were cured only after excision of the infected tendons. We highlight a rare but serious complication of the diabetic foot disease not commonly seen by the surgical community. We hope that this report raises the awareness of this condition so that a prompt diagnosis is made and appropriate treatment started, thereby reducing the risk of major lower limb amputations.

  17. Insights into the Capabilities of Tactile-Foot Perception

    Directory of Open Access Journals (Sweden)

    Ramiro Velázquez


    Full Text Available This paper presents a novel wearable interface for the foot: a shoe‐integrated tactile display that enables users to obtain information through the sense of touch via their feet. A 16‐point array of actuators stimulates the sole of the foot by inducing different vibration frequencies. A series of experiments were conducted with 20 sighted and 5 blind voluntary subjects to evaluate the role of tactile perception by the human foot and the tactile sensitivity of the plantar surface. Tests evaluated the perception of simple shapes, patterns and directional instructions. The results showed that some information is discriminable and that tactile‐foot stimulation could be used for a wide number of applications in human‐machine interaction. Furthermore, the results also suggested that the blind perform better in some key tasks and support the feasibility of footwear providing tactile feedback for situational awareness, mobility and the navigation assistance of the blind.

  18. [Prevention, diagnosis and therapy of the diabetic foot]. (United States)

    Hinneburg, Iris


    The diabetic foot belongs to the most dreaded complications of diabetes. If ulcerations are not treated appropriately, amputations might become necessary. But these can be averted by a complex strategy of preventive measures, early diagnosis and sufficient treatment.

  19. Bacteriocin from Bacillus subtilis as a novel drug against diabetic foot ulcer bacterial pathogens

    Institute of Scientific and Technical Information of China (English)

    Baby Joseph; Berlina Dhas; Vimalin Hena; Justin Raj


    Objective:To isolate and identify Bacillus subtilis (B. subtilis) from soil and to characterize and partially purify the bacteriocin. To evaluate the antimicrobial activity against four diabetic foot ulcer bacterial pathogens. Methods:Genotypic identification was done based on Bergey’s manual of systemic bacteriology. Antimicrobial susceptibility test was done by Kirby-Bauer disc diffusion method. Colonies were identified by colony morphology and biochemical characterization and also compared with MTCC 121 strain. Further identification was done by 16S rRNA sequencing. Inhibitory activities of partially purified bacteriocin on all the DFU isolates were done by agar well diffusion method. The strain was identified to produce bacteriocin by stab overlay assay. Bacteriocin was extracted by organic solvent extraction using chloroform, further purified by HPLC and physical, and chemical characterization was performed. Results: The four isolates showed high level of resistance to amoxyclav and sensitivity to ciprofloxacin. HPLC purification revealed that the extracts are bacteriocin. The phylogenetic tree analysis results showed that the isolate was 99%related to B. subtilis BSF01. The results reveled activity to all the four isolates and high level of activity was seen in case of Klebsiella sp. Conclusions:Partially purified bacteriocin was found to have antimicrobial activity against the four diabetic foot ulcer bacterial pathogens, which can thus be applied as a better drug molecule on further studies. The strain B. subtilis are found to be safe for use and these antimicrobial peptides can be used as an antimicrobial in humans to treat DFU bacterial pathogens.

  20. Foot posture in people with medial compartment knee osteoarthritis

    Directory of Open Access Journals (Sweden)

    Feller Julian A


    Full Text Available Abstract Background Foot posture has long been considered to contribute to the development of lower limb musculoskeletal conditions as it may alter the mechanical alignment and dynamic function of the lower limb. This study compared foot posture in people with and without medial compartment knee osteoarthritis (OA using a range of clinical foot measures. The reliability of the foot measures was also assessed. Methods The foot posture of 32 patients with clinically and radiographically-confirmed OA predominantly in the medial compartment of the knee and 28 asymptomatic age-matched healthy controls was investigated using the foot posture index (FPI, vertical navicular height and drop, and the arch index. Independent t tests and effect size (Cohen's d were used to investigate the differences between the groups in the foot posture measurements. Results Significant differences were found between the control and the knee OA groups in relation to the FPI (1.35 ± 1.43 vs. 2.46 ± 2.18, p = 0.02; d = 0.61, medium effect size, navicular drop (0.02 ± 0.01 vs. 0.03 ± 0.01, p = 0.01; d = 1.02, large effect size and the arch index (0.22 ± 0.04 vs. 0.26 ± 0.04, p = 0.04; d = 1.02, large effect size. No significant difference was found for vertical navicular height (0.24 ± 0.03 vs. 0.23 ± 0.03, p = 0.54; d = 0.04, negligible effect size. Conclusion People with medial compartment knee OA exhibit a more pronated foot type compared to controls. It is therefore recommended that the assessment of patients with knee OA in clinical practice should include simple foot measures, and that the potential influence of foot structure and function on the efficacy of foot orthoses in the management of medial compartment knee OA be further investigated.

  1. Ultrasound-guided intervention in the ankle and foot (United States)

    Allen, Gina M; Watura, Roland


    In this comprehensive review, we discuss the main interventions performed in the foot and ankle for Achilles tendinopathy, Morton's neuromas and Plantar fasciitis as well as techniques for intra-articular and peritendinous injections. We present the different imaging techniques and injectable agents that can be used in clinical practice, trying to help the reader decide the most appropriate way of managing the patient with a problem in the ankle and foot. PMID:26537692

  2. Does Foot Massage Relieve Acute Postoperative Pain? A Literature Review

    Directory of Open Access Journals (Sweden)

    Chanif Chanif


    Full Text Available Purpose: This study aimed to examine the current state of knowledge regarding foot massageto determine if foot massage has an effect on relieving acute postoperative pain.Method: The following questions were used to guide this review: How does pain occur?What is the pain management modalities used in relieving acute postoperative pain? Does footmassage relieve acute postoperative pain? A comprehensive systematic search of publishedliterature and journal articles from Science Direct, CINAHL, PubMed, ProQuest and fromrelevant textbooks was conducted. The universal case entry website, Google-scholar was usedas well. The following keywords were used: foot massage, pain management, andpostoperative pain. Eight studies on foot massage and more than thirty related articles werereviewed.Result: Postoperative pain is caused by tissue damage that induces release of chemicalmediators from the surgical wound. The four processes of pain are transduction, transmission,perception and modulation. Pain medication is the goal standard for acute postoperative painrelief. In addition, foot massage is a modality that can be used in relieving acute postoperativepain. Massage stimulates large nerve fibers and dermatome layers which contain tactile andpressure receptors. The receptors subsequently transmit the nerve impulse to the centralnervous system. The gate control system in the dorsal horn is activated through the inhibitoryinterneuron, thus closing the gate. Subsequently, the brain does not receive the pain message.Eight reviewed studies demonstrated that foot massage relieves acute postoperative pain.However, there were some methodological limitations of these studies.Conclusion: It is recommended to examine the effect of foot massage on acute postoperativepain with high homogenous samples using various duration of massage and range of time forpain measurement at different settings.Key words: foot massage, pain management and postoperative pain.

  3. Effect of Foot Massage on Physiological Edema During Pregnancy


    Fatemeh Rahimikian; Azadeh Shadmehr; Abbas Mehran; Mahdieh Kiani


    Introduction: One of the most common and annoying problems during pregnancy is physiological foot edema that may cause activity restrictions during pregnancy for pregnant women. Present study aimed to determine the effect of foot massage on physiological edema during pregnancy. Methods: This study was non-randomized clinical trial and performed in 2012. 120 pregnant women aged 20 to 35 years were non randomly assigned to treatment and control groups. Treatment group, received 20 minutes d...

  4. Identification of Foot Pathologies Based on Plantar Pressure Asymmetry


    Linah Wafai; Aladin Zayegh; John Woulfe; Syed Mahfuzul Aziz; Rezaul Begg


    Foot pathologies can negatively influence foot function, consequently impairing gait during daily activity, and severely impacting an individual’s quality of life. These pathologies are often painful and correspond with high or abnormal plantar pressure, which can result in asymmetry in the pressure distribution between the two feet. There is currently no general consensus on the presence of asymmetry in able-bodied gait, and plantar pressure analysis during gait is in dire need of a standar...

  5. Diabetic foot disease is associated with reduced erythrocyte deformability. (United States)

    Cahn, Avivit; Livshits, Leonid; Srulevich, Ariel; Raz, Itamar; Yedgar, Shaul; Barshtein, Gregory


    The pathogenesis of diabetic foot disease is multifactorial and encompasses microvascular and macrovascular pathologies. Abnormal blood rheology may also play a part in its development. Using a cell flow analyser (CFA), we examined the association between erythrocyte deformability and diabetic foot disease. Erythrocytes from diabetic patients with no known microvascular complications (n = 11) and patients suffering from a diabetic foot ulcer (n = 11) were isolated and their average elongation ratio (ER) as well as the ER distribution curve were measured. Average ER was decreased in the diabetic foot patients compared with the patients with diabetes and no complications (1·64 ± 0·07 versus 1·71 ± 0·1; P = 0·036). A significant rise in the percentage of minimally deformable red blood cells RBCs in diabetic foot patients compared with the patients with no complications was observed (37·89% ± 8·12% versus 30·61% ± 10·17%; P = 0·039) accompanied by a significant decrease in the percentage of highly deformable RBCs (12·47% ± 4·43% versus 17·49% ± 8·17% P = 0·046). Reduced erythrocyte deformability may slow capillary flow in the microvasculature and prolong wound healing in diabetic foot patients. Conversely, it may be the low-grade inflammatory state imposed by diabetic foot disease that reduces erythrocyte deformability. Further study of the rheological changes associated with diabetic foot disease may enhance our understanding of its pathogenesis and aid in the study of novel therapeutic approaches.

  6. Diabetic foot infections: stepwise medical and surgical management. (United States)

    Armstrong, David G; Lipsky, Benjamin A


    Foot complications are common among diabetic patients; foot ulcers are among the more serious consequences. These ulcers frequently become infected, with potentially disastrous progression to deeper spaces and tissues. If not treated promptly and appropriately, diabetic foot infections can become incurable or even lead to septic gangrene, which may require foot amputation. Diagnosing infection in a diabetic foot ulcer is based on clinical signs and symptoms of inflammation. Properly culturing an infected lesion can disclose the pathogens and provide their antibiotic susceptibilities. Specimens for culture should be obtained after wound debridement to avoid contamination and optimise identification of pathogens. Staphylococcus aureus is the most common isolate in these infections; the increasing incidence of methicillin-resistant S. aureus over the past two decades has further complicated antibiotic treatment. While chronic infections are often polymicrobial, many acute infections in patients not previously treated with antibiotics are caused by a single pathogen, usually a gram-positive coccus. We offer a stepwise approach to treating diabetic foot infections. Most patients must first be medically stabilised and any metabolic aberrations should be addressed. Antibiotic therapy is not required for uninfected wounds but should be carefully selected for all infected lesions. Initial therapy is usually empirical but may be modified according to the culture and sensitivity results and the patient's clinical response. Surgical intervention is usually required in cases of retained purulence or advancing infection despite optimal medical therapy. Possible additional indications for surgical procedures include incision and drainage of an abscess, debridement of necrotic material, removal of any foreign bodies, arterial revascularisation and, when needed, amputation. Most foot ulcers occur on the plantar surface of the foot, thus requiring a plantar incision for any drainage

  7. The treatment of diabetic foot infections: focus on ertapenem


    Michael Edmonds


    Michael EdmondsDiabetic Foot Clinic, King’s College Hospital, Denmark Hill, London, UKAbstract: Clinically, 3 distinct stages of diabetic foot infection may be recognized: localized infection, spreading infection and severe infection. Each of these presentations may be complicated by osteomyelitis. Infection can be caused by Gram-positive aerobic, and Gramnegative aerobic and anaerobic bacteria, singly or in combination. The underlying principles are to diagnose infection, culture t...

  8. Neuropathic diabetic foot ulcers – evidence-to-practice

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    Ndip A


    Full Text Available Agbor Ndip1–3, Leonard Ebah3,4, Aloysius Mbako51Department of Diabetes and Medicine, Manchester Royal Infirmary, Central Manchester Foundation Trust, UK; 2Department of Medicine, Royal Bolton Hospital, Bolton, UK; 3Cardiovascular Research Group, School of Biomedicine, University of Manchester, UK; 4Department of Renal Medicine, Manchester Royal Infirmary, Central Manchester Foundation Trust, UK; 5Department of Orthopaedic Surgery, Wrexham Maelor Hospital, Wales, UKAbstract: Foot ulcers and their attendant complications are disquietingly high in people with diabetes, a majority of whom have underlying neuropathy. This review examines the evidence base underpinning the prevention and management of neuropathic diabetic foot ulcers in order to inform best clinical practice. Since it may be impractical to ask patients not to weight-bear at all, relief of pressure through the use of offloading casting devices remains the mainstay for management of neuropathic ulcers, whilst provision of appropriate footwear is essential in ulcer prevention. Simple non-surgical debridement and application of hydrogels are both effective in preparing the wound bed for healthy granulation and therefore enhancing healing. Initial empirical antibiotic therapy for infected ulcers should cover the most common bacterial flora. There is limited evidence supporting the use of adjunctive therapies such as hyperbaric oxygen and cytokines or growth factors. In selected cases, recombinant human platelet-derived growth factor has been shown to enhance healing; however, its widespread use cannot be advised due to the availability of more cost-effective approaches. While patient education may be beneficial, the evidence base remains thin and conflicting. In conclusion, best management of foot ulcers is achieved by what is taken out of the foot (pressure, callus, infection, and slough rather than what is put on the foot (adjuvant treatment.Keywords: diabetic foot ulcers, neuropathic

  9. Construction of Foundation for 15-Foot Spin Tunnel (United States)


    Completed foundation for the outer housing for the 15-Foot Spin Tunnel. Charles Zimmerman was given the assignment to design and build a larger spin tunnel that would supplant the 5-foot Vertical Wind Tunnel. Authorization to build the tunnel using funds from the Federal Public Works Administration (PWA) came in June 1933. Construction started in late winter 1934 and the tunnel was operational in April 1935. The initial construction costs were $64,000.

  10. Stress Fractures of the Foot and Ankle in Athletes


    Mayer, Stephanie W.; Joyner, Patrick W.; Almekinders, Louis C.; Parekh, Selene G.


    Context: Stress fractures of the foot and ankle are a common problem encountered by athletes of all levels and ages. These injuries can be difficult to diagnose and may be initially evaluated by all levels of medical personnel. Clinical suspicion should be raised with certain history and physical examination findings. Evidence Acquisition: Scientific and review articles were searched through PubMed (1930-2012) with search terms including stress fractures and 1 of the following: foot ankle, me...

  11. Soft tissue infections and the diabetic foot. (United States)

    Smith, A J; Daniels, T; Bohnen, J M


    Soft tissue infections are classified as local or spreading. Spreading soft tissue infections are potentially life-threatening conditions, requiring prompt diagnosis and treatment. The information presented is based on a literature review and the authors' clinical experience. Diagnosis of soft tissue infections is aimed at determining the level of infection (skin, fascia, muscle) and whether necrosis is present. The bacteriology of these infections is varied and is of secondary importance. Treatment of skin infections that have no dead tissue is with antibiotics alone. Infections at the fascial or muscle level and those with necrosis at any level require surgical debridement and adjuvant antibiotics. The feet of diabetic patients are prone to plantar forefoot ulcers associated with tissue destruction and infection. The vast majority are caused by mechanical factors. If local immune defenses are adequate, bacterial colonization occurs without infection. Most diabetic foot ulcers will respond to relief of pressure, which may require total contact casting. Antibiotics and debridement are required in infected or deep ulcers, or when the ulcer does not respond to total contact casting.

  12. Radiologic changes of ulcerated foot in leprosy

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    Yoo, Jung Hyun; Ahn, Eun Joo; Chung, Eun Chul; Rhee, Chung Sik [Ewha Woman' s University College of Medicine, Seoul (Korea, Republic of); Choi, Sung Jun [Institute for Leprosy Research, KLCA, Uiwang (Korea, Republic of)


    There are radiologically characteristic bone changes on the foot and tarsus in leprosy. The bone changes are primarily due to Mycobacterium leprae infection and secondarily to the injurious effect, such as trauma, and infection on the denervated tissue. 117 bone changes of 100 leprosy patients with plantar ulcerations from Jan. 1984 to Oct. 1989 in the Korean Leprosy Control Center were analyzed. Male to female ratio was about 2 : 1 and the most prevalent age was 41 to 60 years, and according to Ridley-Jopling's classification. L-type was most common (46%). One hundred and eleven cases (94.9%) showed bone changes, suggesting high incidence of bone changes in patients with plantar ulcers. Specific findings were observed in two cases(1.7%). One hundred and nine cases showed nonspecific bone changes, which were osteomyelitis(23.1%), neurotrophic changes(39.3%), periostitis(5.1%) and arthritis(12.8%). Extensive bone involvement was seen in neurotrophic changes involving forefoot and metatarsal in 22 of 46 cases, and in secondary changes involving metatarsal bone in 23, tarsus in 20 of 49 cases.

  13. Assessment of sensory neuropathy in patients with diabetic foot problems

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    Aziz Nather


    Full Text Available Our aim of this study was to compare the accuracy of three different modalities for testing sensory neuropathy in diabetic patients with and without diabetic foot problems. The three devices used included the pin-prick testing using the Neurotip® (PPT, the Semmes–Weinstein 5.07/10 g monofilament testing (SWMT, and the rapid-current perception threshold (R-CPT measurements using the Neurometer® testing. Our study population consisted of 54 patients (108 feet with diabetic foot problems treated at the National University Hospital in Singapore by our multi-disciplinary diabetic foot care team. Our results showed no difference in sensory neuropathy detected by PPT and 5.07/10 g SWMT in both the pathological and normal foot. In the pathological foot, there was significant increase in sensory neuropathy detected by the Neurometer® device at both the big toe and ankle sites as compared to PPT and 5.07/10 g SWMT. In the normal foot, there was a significant increase in sensory neuropathy detected by the Neurometer® device at the big toe site only as compared to PPT and 5.07/10 g SWMT. Finally, the Neurometer® measurements detected a statistically higher proportion of feet with sensory neuropathy as compared to detection by the PPT or 5.07/10 g SWMT.

  14. Risk factors for major amputation in hospitalised diabetic foot patients. (United States)

    Namgoong, Sik; Jung, Suyoung; Han, Seung-Kyu; Jeong, Seong-Ho; Dhong, Eun-Sang; Kim, Woo-Kyung


    Diabetic foot ulcers are the main cause of non-traumatic lower extremity amputation. The objective of this study was to evaluate the risk factors for major amputation in diabetic foot patients. Eight hundred and sixty diabetic patients were admitted to the diabetic wound centre of the Korea University Guro Hospital for foot ulcers between January 2010 and December 2013. Among them, 837 patients were successfully monitored until complete healing. Ulcers in 809 patients (96·7%) healed without major amputation and those in 28 patients (3·3%) healed with major amputation. Data of 88 potential risk factors including demographics, ulcer condition, vascularity, bioburden, neurology and serology were collected from patients in the two groups and compared. Among the 88 potential risk factors, statistically significant differences between the two groups were observed in 26 risk factors. In the univariate analysis, which was carried out for these 26 risk factors, statistically significant differences were observed in 22 risk factors. In a stepwise multiple logistic analysis, six of the 22 risk factors remained statistically significant. Multivariate-adjusted odds ratios were 11·673 for ulcers penetrating into the bone, 8·683 for dialysis, 6·740 for gastrointestinal (GI) disorders, 6·158 for hind foot ulcers, 0·641 for haemoglobin levels and 1·007 for fasting blood sugar levels. The risk factors for major amputation in diabetic foot patients were bony invasions, dialysis, GI disorders, hind foot locations, low levels of haemoglobin and elevated fasting blood sugar levels.

  15. Socioeconomic profile of diabetic patients with and without foot problems

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    Aziz Nather


    Full Text Available Introduction: To identify the differences in a socioeconomic profile between two cohorts of diabetic patients – one with diabetic foot problems and another without diabetic foot problems. Materials and methods: The cohort with diabetic foot problems (including cellulitis, abscess, osteomyelitis, septic arthritis, gangrene, ulcers, or Charcot joint disease consisted of 122 diabetic patients, while the other cohort without foot problems consisted of 112 diabetic patients. Both were seen at the National University Hospital from January to April 2007. A detailed protocol was designed and the factors studied included patient profile, average monthly household income, education, compliance to diabetic medication, attendance at clinics for diabetic treatment, exercise, smoking, alcohol consumption, gender, and glycosylated haemoglobin (HbA1C level. These were studied for significant differences using univariate and stepwise multivariate logistic regression analysis. Results: With multivariate analysis, Malay ethnicity (p<0.001, education of up to secondary school only (p=0.021, low average monthly household income of less than SGD $2,000 (p=0.030, lack of exercise (at least once a week, p=0.04, and elevated HbA1C level (>7.0%; p=0.015 were found to be significantly higher in the cohort with diabetic foot problems than the cohort without. Conclusions: There are significant differences in the socioeconomic factors between diabetic patients with diabetic foot problems and those without.

  16. Reconstructive foot and ankle surgeries in diabetic patients

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    Ajit Kumar Varma


    Full Text Available Diabetic foot and ankle deformities are secondary to long-standing diabetes and neglected foot care. The concept of surgical correction for these deformities is quite recent. The primary objective of reconstructive foot and ankle surgery is the reduction of increased plantar pressures, reduction of pain and the restoration of function, stability and proper appearance. Foot and ankle deformities can result in significant disability, loss of life style, employment and even the loss of the lower limb. Therefore, restoration of normal, problem free foot function and activities will have a significant impact on peoples′ lives. Reconstructive surgical procedures are complex and during reconstruction, internal and external fixation devices, including pins, compression screws, staples, and wires, may be used for repair and stabilization. The surgeries performed depend on the type and severity of the condition. Surgery can involve any part of the foot and ankle, and may involve tendon, bone, joint, tissue or skin repair. Corrective surgeries can at times be performed on an outpatient basis with minimally invasive techniques. Recovery time depends on the type of condition being treated.

  17. Ultrasound Findings of the Painful Ankle and Foot

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    Suheil Artul


    Full Text Available Objectives: To document the prevalence and spectrum of musculoskeletal ultrasound (MSKUS findings at different parts of the foot. Materials and Methods: All MSKUS studies conducted on the foot during a 2-year period (2012-2013 at the Department of Radiology were reviewed. Demographic parameters including age, gender, and MSKUS findings were documented. Results: Three hundred and sixty-four studies had been conducted in the 2-year period. Ninety-three MSKUS evaluations were done for the ankle, 30 studies for the heel, and 241 for the rest of the foot. The most common MSKUS finding at the ankle was tenosynovitis, mostly in female patients; at the heel it was Achilles tendonitis, also mostly in female patients; and for the rest of the foot it was fluid collection and presence of foreign body, mainly in male patients. The number of different MSKUS abnormalities that were reported was 9 at the ankle, 9 at the heel, and 21 on the rest of the foot. Conclusions: MSKUS has the potential for revealing a huge spectrum of abnormalities. The most common finding was collection/hematoma and foreign bodies at the foot, tenosynovitis at the ankle, and Achilles tendinitis at the heel.

  18. Nociception at the diabetic foot, an uncharted territory. (United States)

    Chantelau, Ernst A


    The diabetic foot is characterised by painless foot ulceration and/or arthropathy; it is a typical complication of painless diabetic neuropathy. Neuropathy depletes the foot skin of intraepidermal nerve fibre endings of the afferent A-delta and C-fibres, which are mostly nociceptors and excitable by noxious stimuli only. However, some of them are cold or warm receptors whose functions in diabetic neuropathy have frequently been reported. Hence, it is well established by quantitative sensory testing that thermal detection thresholds at the foot skin increase during the course of painless diabetic neuropathy. Pain perception (nociception), by contrast, has rarely been studied. Recent pilot studies of pinprick pain at plantar digital skinfolds showed that the perception threshold was always above the upper limit of measurement of 512 mN (equivalent to 51.2 g) at the diabetic foot. However, deep pressure pain perception threshold at musculus abductor hallucis was beyond 1400 kPa (equivalent to 14 kg; limit of measurement) only in every fifth case. These discrepancies of pain perception between forefoot and hindfoot, and between skin and muscle, demand further study. Measuring nociception at the feet in diabetes opens promising clinical perspectives. A critical nociception threshold may be quantified (probably corresponding to a critical number of intraepidermal nerve fibre endings), beyond which the individual risk of a diabetic foot rises appreciably. Staging of diabetic neuropathy according to nociception thresholds at the feet is highly desirable as guidance to an individualised injury prevention strategy.

  19. The treatment of diabetic foot infections: focus on ertapenem

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    Michael Edmonds


    Full Text Available Michael EdmondsDiabetic Foot Clinic, King’s College Hospital, Denmark Hill, London, UKAbstract: Clinically, 3 distinct stages of diabetic foot infection may be recognized: localized infection, spreading infection and severe infection. Each of these presentations may be complicated by osteomyelitis. Infection can be caused by Gram-positive aerobic, and Gramnegative aerobic and anaerobic bacteria, singly or in combination. The underlying principles are to diagnose infection, culture the bacteria responsible and treat aggressively with antibiotic therapy. Localized infections with limited cellulitis can generally be treated with oral antibiotics on an outpatient basis. Spreading infection should be treated with systemic antibiotics. Severe deep infections need urgent admission to hospital for wide-spectrum intravenous antibiotics. Clinical and microbiological response rates have been similar in trials of various antibiotics and no single agent or combination has emerged as most effective. Recently, clinical and microbiological outcomes for patients treated with ertapenem were equivalent to those for patients treated with piperacillin/tazobactam. It is also important to judge the need for debridement and surgery, to assess the arterial supply to the foot and consider revascularization either by angioplasty or bypass if the foot is ischemic. It is also important to achieve metabolic control. Thus infection in the diabetic foot needs full multidisciplinary treatment.Keywords: diabetes, foot, infection, antibiotics, ertapenem

  20. Update on epidemiology and control of Foot and Mouth Disease - A menace to international trade and global animal enterprise

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    P. M. Depa

    Full Text Available Foot and mouth disease (FMD is one of the most economically and socially devastating disease affecting animal agriculture throughout the world. This review describes economic impact of disease outbreaks, an update of recent findings in epidemiology of FMD both at International and national level and control of this disease. The etiological agent (FMD virus is examined in detail at genetic and molecular characterization level and in terms of antigenic diversity. [Vet World 2012; 5(11.000: 694-704

  1. Three cousins with chronic foot ulcers from late-onset hereditary sensory and autonomic neuropathies type 2 (HSAN2). (United States)

    Aghaei, Shahin; Pakmanesh, Kambiz


    The hereditary sensory and autonomic neuropathies (HSAN) are a group of rare disorders characterized by prominent sensory and autonomic neuropathy without motor involvement. We report three male cousins with chronic foot ulcers, all were affected with late-onset HSAN type 2 (HSAN2). In view of the history of consanguinity and male sex, X-linked recessive transmission was likely in our patients. According to the authors' knowledge this is the first report of HSAN2 from Iran.

  2. Inter-rater reliability of the Foot Posture Index (FPI-6 in the assessment of the paediatric foot

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    Ferrari Jill


    Full Text Available Abstract Background Reliability is an integral component of clinical assessment and necessary for establishing baseline data, monitoring treatment outcomes and providing robust research findings. In the podiatric literature traditional measures of foot assessment have been shown to be largely unreliable. The Foot Posture Index (FPI-6 is a clinical tool used in the assessment of foot and to date, there is limited research published which evaluates the reliability of this tool in children and adolescents. Method Thirty participants aged 5 - 16 years were recruited for the research. Two raters independently recorded the FPI-6 score for each participant. Results Almost perfect agreement between the two raters was identified following weighted kappa analysis (Kw = 0.86. Conclusion The FPI-6 is a quick, simple and reliable clinical tool which has demonstrated excellent inter-rater reliability when used in the assessment of the paediatric foot.

  3. [Three-dimensional analysis of the foot following implantation of a HINTEGRA ankle prosthesis: evaluation with the Heidelberg foot model]. (United States)

    Müller, S; Wolf, S; Döderlein, L


    Detailed foot kinematics after total ankle replacement has not yet been investigated. In this study 11 patients with unilateral Hintegra ankle prosthesis were analysed with the Heidelberg Foot Model. This model measures the kinematics of the fore-, mid- and hindfoot in three clinical planes. Moreover, the kinetics of the hip, knee and ankle was captured. A diminished ROM was found in all foot segments investigated. The timing of the kinematics between sound and involved side appeared similar. A limitation in the hindfoot mobility, as experienced after ankle arthrodesis, was not observed. However, a careful hindfoot alignment is essential for optimal foot function, and previous malalignments should be corrected. Concerning the kinetics, the replaced ankle showed a decreased power generation compensated by an increase in power in the ipsilateral knee. For a more detailed evaluation, further studies are required which include pre- and postoperative data and also take into account different types of prostheses.

  4. Transformation of the multidisciplinary diabetic foot clinic into a multidisciplinary diabetic foot day unit: results from a service evaluation. (United States)

    Manu, Chris A; Mustafa, Omar G; Bates, Maureen; Vivian, Gill; Mulholland, Nicola; Elias, David; Huang, Dean Y; Deane, Colin; Cavale, Naveen; Kavarthapu, Venu; Rashid, Hisham; Edmonds, Michael


    The natural history of the diabetic foot is aggressive and complex. To counteract this, we describe the transformation of a Multidisciplinary Diabetic Foot Clinic into a Multidisciplinary Diabetic Foot Day Unit, which delivers an emergency open access system for patients, with a "one-stop," same day service in which investigations are performed, results reviewed and treatment implemented. It also provides joint clinics with vascular, orthopaedic, and plastic surgeons and specialized clinics for casting of complex neuropathic feet and for the administration of intravenous or intramuscular antibiotics on the same day. The aim was to document these increasingly wide-ranging facilities by undertaking a retrospective evaluation over a 6-week period, with analysis of notes, investigations, and an anonymous patient satisfaction survey. The clinic was visited by 597 patients who attended in 1076 appointments, of which 112 (10.4%) were emergency visits; these patients attended the clinic without a booked appointment but via an open access policy, 93 of whom were known to the clinic, but 19 were new self-referred patients to the service. Furthermore, 197 (18%) were seen in a Joint Vascular Diabetic Foot Clinic and 98 (9%) were seen in a Joint Orthopaedic Plastic Diabetic Foot Clinic, 570 (53%) were seen in an Active Ulcer Clinic and 97 (9%) in a Total Contact Casting Clinic. Forty-five percent of patients were prescribed antibiotics, including 188 (76%) as oral and 45(18%) as intravenous antibiotics and 15(6%) as intramuscular injections. Of the 1076 appointments, 150 (14%) patients were in the foot clinic for more than 4 hours. Sixty (10%) patients were reviewed 4 or more times over the 6-week period. Only 22 (2%) were admitted to hospital. Of the 125 survey responders, 98% were satisfied with this service, which has evolved from a Diabetic Foot Clinic into a Multidisciplinary Diabetic Foot Day Unit.

  5. Risk Factors for Foot Amputation in Patients Hospitalized for Diabetic Foot Infection. (United States)

    Quilici, Maria Teresa Verrone; Del Fiol, Fernando de Sá; Vieira, Alexandre Eduardo Franzin; Toledo, Maria Inês


    The aim of this study was to identify and quantify risk factors for amputation in diabetic patients hospitalized for foot infections. This cross-sectional study comprised 100 patients with diabetic infectious complications in the lower limbs. The variables investigated were related to diabetes, infection, and treatment compliance. Multiple Cox regression analysis was performed to identify the variables independently associated with the outcome of amputation. The most prevalent chronic complications were neuropathy and hypertension. Most patients presented with a neuroischemic foot (86%). The Morisky test showed that 72% were not compliant with diabetes treatment. Regarding patient outcome, 61% progressed to amputation, 14% to debridement, and 9% to revascularization. The results showed a 42% higher risk for progression to amputation in patients with previous use of antimicrobials. Also, the amputation risk was 26% higher for those less compliant with diabetes treatment. An increase of one point in the Wagner ulcer classification criteria corresponded to a 65% increase in the risk of amputation. Undergoing conservative, nonsurgical procedures prior to admission provided a 63% reduction in the risk of amputation. Knowledge of these factors is critical to enable multidisciplinary teams to develop treatment plans for these patients so as to prevent the need for amputation.

  6. Routine MRI findings of the asymptomatic foot in diabetic patients with unilateral Charcot foot

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    Poll Ludger W


    Full Text Available Abstract Background Imaging studies of bones in patients with sensory deficits are scarce. Aim To investigate bone MR images of the lower limb in diabetic patients with severe sensory polyneuropathy, and in control subjects without sensory deficits. Methods Routine T1 weighted and T2-fat-suppressed-STIR-sequences without contrast media were performed of the asymptomatic foot in 10 diabetic patients with polyneuropathy and unilateral inactive Charcot foot, and in 10 matched and 10 younger, non-obese unmatched control subjects. Simultaneously, a Gadolinium containing phantom was also assessed for reference. T1 weighted signal intensity (SI was recorded at representative regions of interest at the peritendineal soft tissue, the tibia, the calcaneus, and at the phantom. Any abnormal skeletal morphology was also recorded. Results Mean SI at the soft tissue, the calcaneus, and the tibia, respectively, was 105%, 105% and 84% of that at the phantom in the matched and unmatched control subjects, compared to 102% (soft tissue, 112% (calcaneus and 64% (tibia in the patients; differences of tibia vs. calcaneus or soft tissue were highly significant (p Conclusion MR imaging did not reveal grossly abnormal bone marrow signalling in the limbs with severe sensory polyneuropathy, but occult sequelae of previous traumatic injuries.

  7. The reliability and validity of the Korean version of the foot function index for patients with foot complaints (United States)

    In, Tae-Sung; Jung, Jin-Hwa; Kim, Keunjo; Jung, Kyoung-Sim; Cho, Hwi-Young


    [Purpose] The purpose of this study was to establish the reliability and validity of the Foot Function Index translated into Korean for use in patients with plantar fasciitis and foot/ankle fracture. [Subjects and Methods] Thirty-six subjects with foot complaints, 14 males and 22 females, participated in the study. Reliability was determined by using the intra-class correlation coefficient and Cronbach’s alpha for internal consistency. Validity was examined by correlating Foot Function Index scores with the Short Form-36 and the Visual Analog Scale scores. [Results] Test-retest reliability was 0.90 for the pain subscale, and 0.94 and 0.91 for the disability and activity limitation subscales, respectively. The criterion-related validity was established by comparison with the Korean version of the Short Form-36 and Visual Analog Scale. [Conclusion] The Korean version of the Foot Function Index was shown to be a reliable and valid instrument for assessing foot complaints. PMID:28210038

  8. Infection with foot-and-mouth disease virus (FMDV) induces a natural killer (NK) cell response in cattle that is lacking following vaccination (United States)

    Natural killer (NK) cells play a role in innate antiviral immunity by directly lysing virus-infected cells and producing antiviral cytokines such as interferon gamma (IFNgamma). We developed a system for characterizing the bovine NK response to foot-and-mouth disease virus (FMDV), which causes a dis...

  9. Transcriptomic analysis of persistent infection with foot-and-mouth disease virus in cattle suggests impairment of cell-mediated immunity in the nasopharynx (United States)

    In order to investigate the mechanisms of persistent foot-and-mouth disease virus (FMDV) infection in cattle, transcriptome alterations associated with the FMDV carrier state were characterized using a bovine whole-transcriptome microarray. Eighteen cattle (8 vaccinated with a recombinant FMDV A vac...

  10. Persistent foot-and-mouth disease virus infection in the nasopharynx of cattle: tissue-specific distribution and local cytokine expression (United States)

    Tissues obtained post-mortem from cattle persistently infected with foot-and-mouth disease virus (FMDV) were analyzed to characterize the tissue-specific localization of FMDV and partial transcriptome profiles for selected immunoregulatory cytokines. Analysis of 28 distinct anatomic sites from 21 st...

  11. Tehran Silicon Partial Foot Prosthesis New Method of Making Silicon Partial Foot Prosthesis

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    Alireza Khaghani


    Full Text Available Partial foot amputation includes many surfaces from severing toe to Chopart amputation, and each surface has its own characteristic and creates a particular level of disability, which would require prosthesis to compensate the missing functionality and aesthetics. On the other hand, with regard to materials and style of structure according to the facilities of clinics and the experience of prosthetists a vast scope of prostheses are made for patients, and practically the process of prescription and Production of a prosthesis is an interaction between the patient and the prosthetist ,based on the needs and expectations of the patient and the ability of prosthetist to reach a point of equilibrium which often requires employing the maximum ability of prosthetist in the construction technique. The resulting diversity is the outcome of successful experiences of various prosthetists over the years, and it is natural that when considering the extent of various materials used in the making of prostheses and also the methods of their synthesis and linkage, and also better understanding of the developed biomechanical disorder, we can achieve new designs that would bring better performance and comfort to patients, as well as more aestheticism in appearance. If the amputation is proximal to the metatarsal heads, the individual will lose tolerance for weight bearing of fore foot and will face difficulty in the terminal stance stage for doing the push-off. For Trans-metatarsal and Lisfranc areas which are considered mid foot area, high profile prosthesis have not been well acceptance by patients because a rigid prosthesis continues till near tibia tuberose and more important than that, creates restriction of movement in ankle and subtalar joints, despite having biomechanical advantages in restoring the lever arm for doing the push off .Perimalleolar prostheses which enjoy great variety with regard to design and material used in their structure, mostly are not

  12. Imaging features of foot osteoid osteoma

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    Shukla, Satyen; Clarke, Andrew W.; Saifuddin, Asif [Royal National Orthopaedic Hospital NHS Trust, Department of Radiology, Stanmore, Middlesex (United Kingdom)


    We performed a retrospective review of the imaging of nine patients with a diagnosis of foot osteoid osteoma (OO). Radiographs, computed tomography (CT) and magnetic resonance imaging (MRI) had been performed in all patients. Radiographic features evaluated were the identification of a nidus and cortical thickening. CT features noted were nidus location (affected bone - intramedullary, intracortical, subarticular) and nidus calcification. MRI features noted were the presence of an identifiable nidus, presence and grade of bone oedema and whether a joint effusion was identified. Of the nine patients, three were female and six male, with a mean age of 21 years (range 11-39 years). Classical symptoms of OO (night pain, relief with aspirin) were identified in five of eight (62.5%) cases (in one case, the medical records could not be retrieved). In five patients the lesion was located in the hindfoot (four calcaneus, one talus), while four were in the mid- or forefoot (two metatarsal and two phalangeal). Radiographs were normal in all patients with hindfoot OO. CT identified the nidus in all cases (89%) except one terminal phalanx lesion, while MRI demonstrated a nidus in six of nine cases (67%). The nidus was of predominantly intermediate signal intensity on T1-weighted (T1W) sequences, with intermediate to high signal intensity on T2-weighted (T2W) sequences. High-grade bone marrow oedema, limited to the affected bone and adjacent soft tissue oedema was identified in all cases. In a young patient with chronic hindfoot pain and a normal radiograph, MRI features suggestive of possible OO include extensive bone marrow oedema limited to one bone, with a possible nidus demonstrated in two-thirds of cases. The presence or absence of a nidus should be confirmed with high-resolution CT. (orig.)

  13. Effect of flow material ski boots on foot circulation. (United States)

    Höflin, F; Kempi, V; van der Linden, W; Ringquist, I


    The effect of modern "flow material" ski boots on foot circulation was studied. Pressure inside a flow material ski boot was found to be markedly higher than in a conventional ski boot. In some places the pressure exceeded the diastolic pressure in the foot. 113mIndium chloride, which when injected intravenously is bound to transferrin was used for blood pool scanning. In healthy young volunteers the uptake of radioactivity in the two feet--one with and one without a ski boot--was compared. The activity level of the foot with the ski boot was significantly lower than in the other foot. After corrections were made for absorption by the boot, a significant difference remained. Plethysmographic studies were performed with a mercury strain gauge using a ski boot in which a hole was cut over the big toe. No difference was demonstrated between the blood pressure at the leg just above the boot top and at the big toe. The arterial pulse wave at the big toe was altered; i.e., there was an absence of a dichrotic wave. Intramuscular perfusion was studied with 133xenon. The disappearance curve in a foot with a boot was more shallow than that in a bare foot. Unbuckling resulted in an immediate fall in radioactivity, the disappearance curve then becoming identical to that of the bare foot. The results indicate that when flow material ski boots are to be used by skiers who are not in the habit of unbuckling for short intervals, buckle tension should not be too high.

  14. Foot massage: effectiveness on postoperative pain in breast surgery patients. (United States)

    Ucuzal, Meral; Kanan, Nevin


    The aim of this study was to determine the effect of foot massage on pain after breast surgery, and provide guidance for nurses in nonpharmacologic interventions for pain relief. This was a quasiexperimental study with a total of 70 patients who had undergone breast surgery (35 in the experimental group and 35 in the control group). Patients in the control group received only analgesic treatment, whereas those in the experimental group received foot massage in addition to analgesic treatment. Patients received the first dose of analgesics during surgery. As soon as patients came from the operating room, they were evaluated for pain severity. Patients whose pain severity scored ≥4 according to the Short-Form McGill Pain Questionnaire were accepted into the study. In the experimental group, pain and vital signs (arterial blood pressure, pulse, and respiration) were evaluated before foot massage at the time patients complained about pain (time 0) and then 5, 30, 60, 90, and 120 minutes after foot massage. In the control group, pain and vital signs were also evaluated when the patients complained about pain (time 0) and again at 5, 30, 60, 90, and 120 minutes, in sync with the times when foot massage was completed in the experimental group. A patient information form was used to collect descriptive characteristics data of the patients, and the Short-Form McGill Pain Questionnaire was used to determine pain severity. Data were analyzed for frequencies, mean, standard deviation, chi-square, Student t, Pillai trace, and Bonferroni test. The results of the statistical analyses showed that patients in the experimental group experienced significantly less pain (p ≤ .001). Especially notable, patients in the experimental group showed a decrease in all vital signs 5 minutes after foot massage, but patients in the control group showed increases in vital signs except for heart rate at 5 minutes. The data obtained showed that foot massage in breast surgery patients was

  15. The association between foot-care self efficacy beliefs and actual foot-care behaviour in people with peripheral neuropathy: a cross-sectional study

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    Swerissen Hal


    Full Text Available Abstract Background People with diabetes and peripheral neuropathy often do not implement the foot-care behavioural strategies that are suggested by many health professionals. The concept of self-efficacy has been shown to be an effective predictor of behaviour in many areas of health. This study investigated the relationships between foot-care self-efficacy beliefs, self-reported foot-care behaviour and history of diabetes-related foot pathology in people with diabetes and loss of protective sensation in their feet. Methods Ninety-six participants were included in this cross-sectional study undertaken in a regional city of Australia. All participants had diabetes and clinically diagnosed loss of protective sensation in their feet. The participants completed a self-report pen-paper questionnaire regarding foot-care self efficacy beliefs (the "Foot Care Confidence Scale" and two aspects of actual foot-care behaviour-preventative behaviour and potentially damaging behaviour. Pearson correlation coefficients were then calculated to determine the association between foot-care self-efficacy beliefs and actual reported foot-care behaviour. Multiple analysis of variance was undertaken to compare mean self-efficacy and behaviour subscale scores for those with a history of foot pathology, and those that did not. Results A small positive correlation (r = 0.2, p = 0.05 was found between self-efficacy beliefs and preventative behaviour. There was no association between self-efficacy beliefs and potentially damaging behaviour. There was no difference in self-efficacy beliefs in people that had a history of foot pathology compared to those that did not. Conclusion There is little association between foot-care self-efficacy beliefs and actual foot-care behaviour. The usefulness of measuring foot-care self-efficacy beliefs to assess actual self foot-care behaviour using currently available instruments is limited in people with diabetes and loss of protective

  16. The Influence of an Interdisciplinary Diabetic Foot Team on the Outcome of Patients with Diabetic Foot

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    Omer Coskun


    Full Text Available Aim: Management of diabetic foot infection (DFI is challenging; a multidisciplinary approach has been shown to reduce amputation rates. There is limited information on the effect of having an interdisciplinary diabetic foot team (IDT on patient load and outcomes at infectious disease departments. We aim to investigate the effect of the IDT approach on patient characteristics, the length of hospitalization, and amputation rates in patients hospitalized for DFI at the department of infectious disease. Material and Method: We retrospectively reviewed the files of patients who were hospitalized in the infectious disease department for DFI between January 2005 and October 2014. Patients hospitalized before the establishment of IDT (October 8, 2013 formed Group-1 and those hospitalized after the establishment of IDT formed Group-2. The members of IDT evaluated and treated all of the patients in Group-2. The groups were compared for patient characteristics, clinical findings, length of hospitalization, laboratory results, and outcome. Results: There were 53 patients in Group-1 and 39 patients in Group-2. The patient hospitalization rate increased after IDT (0.5 patients per month vs. 3.25 patients per month. Patients hospitalized after IDT had more advanced stage (Wagner grade 4-5 wounds (26.4% vs. 51.3%; p=0.013. However, the length of hospitalization did not change after IDT (23.4±11.0 vs. 21.0±14.5; p=0.478. Foot ulcers healed without surgical intervention in 13 (24.5% and 11 (28.2% patients in Group-1 and Group-2, respectively (p=0.691. Minor and major amputation rates were 30.2% and 9.4% in Group-1 and 30.8% and 7.7% in Group-2 (p=0.786. Discussion: Despite the fact that patients admitted after the establishment of IDT had more severe wounds, neither the length of hospitalization nor the amputation rate increased. Further studies are needed to evaluate the effectiveness of IDT in the management of DFI.

  17. Foot ulcers in the diabetic patient, prevention and treatment

    Directory of Open Access Journals (Sweden)

    Stephanie C Wu


    Full Text Available Stephanie C Wu1, Vickie R Driver1, James S Wrobel2, David G Armstrong21Center for Lower Extremity Ambulatory Research,William M. Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine and Science, and National Center of Limb Salvage, Advocate Lutheran General Hospital, Chicago, IL, USA; 2Center for Lower Extremity Ambulatory Research, Dr. William M. Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine, Chicago, IL, USAAbstract: Lower extremity complications in persons with diabetes have become an increasingly significant public health concern in both the developed and developing world. These complications, beginning with neuropathy and subsequent diabetic foot wounds frequently lead to infection and lower extremity amputation even in the absence of critical limb ischemia. In order to diminish the detrimental consequences associated with diabetic foot ulcers, a common-sense-based treatment approach must be implemented. Many of the etiological factors contributing to the formation of diabetic foot ulceration may be identified using simple, inexpensive equipment in a clinical setting. Prevention of diabetic foot ulcers can be accomplished in a primary care setting with a brief history and screening for loss of protective sensation via the Semmes-Weinstein monofilament. Specialist clinics may quantify neuropathy, plantar foot pressure, and assess vascular status with Doppler ultrasound and ankle-brachial blood pressure indices. These measurements, in conjunction with other findings from the history and physical examination, may enable clinicians to stratify patients based on risk and help determine the type of intervention. Other effective clinical interventions may include patient education, optimizing glycemic control, smoking cessation, and diligent foot care. Recent technological advanced combined with better understanding of the wound healing process have resulted in a myriad of advanced

  18. Development and evaluation of prefabricated antipronation foot orthosis

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    Rachel Majumdar, BSc (Hons


    Full Text Available Our aim was to develop and evaluate a new antipronation foot orthosis that addressed problems perceived by clinicians and users with existing foot orthoses. Clinicians and users were engaged to develop a user specification for the orthosis, and orthotic geometry and materials were developed using clinical reasoning. The orthotic material properties were tested and the ability of the orthosis to reduce foot pronation evaluated on 27 individuals. Clinicians expressed concern that current prefabricated orthoses often did not offer sufficient support to the foot because of a combination of the shape and materials used, and users concurred but also highlighted issues of durability and hygiene. The geometry of the new orthosis was, therefore, adjusted to enable individual foot size orthoses to be produced. A material was selected that was harder and more durable than materials used in many prefabricated orthoses. When the new orthosis was being worn, maximum rearfoot eversion was reduced in both walking (mean reduction −3.8 degrees, p < 0.001 and running (mean reduction −2.5 degrees, p < 0.001. Through a structured process, orthotic design decisions were made that addressed the specific concerns of clinicians and users and the new orthosis was proven to reduce rearfoot pronation.

  19. Diabetes foot disease: the Cinderella of Australian diabetes management? (United States)

    Lazzarini, Peter A; Gurr, Joel M; Rogers, Joseph R; Schox, Andrew; Bergin, Shan M


    Diabetes is one of the greatest public health challenges to face Australia. It is already Australia's leading cause of kidney failure, blindness (in those under 60 years) and lower limb amputation, and causes significant cardiovascular disease. Australia's diabetes amputation rate is one of the worst in the developed world, and appears to have significantly increased in the last decade, whereas some other diabetes complication rates appear to have decreased. This paper aims to compare the national burden of disease for the four major diabetes-related complications and the availability of government funding to combat these complications, in order to determine where diabetes foot disease ranks in Australia. Our review of relevant national literature indicates foot disease ranks second overall in burden of disease and last in evidenced-based government funding to combat these diabetes complications. This suggests public funding to address foot disease in Australia is disproportionately low when compared to funding dedicated to other diabetes complications. There is ample evidence that appropriate government funding of evidence-based care improves all diabetes complication outcomes and reduces overall costs. Numerous diverse Australian peak bodies have now recommended similar diabetes foot evidence-based strategies that have reduced diabetes amputation rates and associated costs in other developed nations. It would seem intuitive that "it's time" to fund these evidence-based strategies for diabetes foot disease in Australia as well.

  20. Diabetes foot disease: the Cinderella of Australian diabetes management?

    Directory of Open Access Journals (Sweden)

    Lazzarini Peter A


    Full Text Available Abstract Diabetes is one of the greatest public health challenges to face Australia. It is already Australia’s leading cause of kidney failure, blindness (in those under 60 years and lower limb amputation, and causes significant cardiovascular disease. Australia’s diabetes amputation rate is one of the worst in the developed world, and appears to have significantly increased in the last decade, whereas some other diabetes complication rates appear to have decreased. This paper aims to compare the national burden of disease for the four major diabetes-related complications and the availability of government funding to combat these complications, in order to determine where diabetes foot disease ranks in Australia. Our review of relevant national literature indicates foot disease ranks second overall in burden of disease and last in evidenced-based government funding to combat these diabetes complications. This suggests public funding to address foot disease in Australia is disproportionately low when compared to funding dedicated to other diabetes complications. There is ample evidence that appropriate government funding of evidence-based care improves all diabetes complication outcomes and reduces overall costs. Numerous diverse Australian peak bodies have now recommended similar diabetes foot evidence-based strategies that have reduced diabetes amputation rates and associated costs in other developed nations. It would seem intuitive that “it’s time” to fund these evidence-based strategies for diabetes foot disease in Australia as well.

  1. Ray amputation for the treatment of foot macrodactyly in children. (United States)

    Kim, J; Park, J W; Hong, S W; Jeong, J Y; Gong, H S; Baek, G H


    Macrodactyly of the foot is a rare but disabling condition. We present the results of surgery on 18 feet of 16 patients, who underwent ray amputation and were followed-up for more than two years at a mean of 80 months (25 to 198). We radiologically measured the intermetatarsal width and forefoot area pre-operatively and at six weeks and two years after surgery. We also evaluated the clinical results using the Oxford Ankle Foot Questionnaire for children (OxAFQ-C) and the Questionnaire for Foot Macrodactyly. The intermetatarsal width and forefoot area ratios were significantly decreased after surgery. The mean OxAFQ-C score was 42 (16 to 57) pre-operatively, improving to 47 (5 to 60) at two years post-operatively (p = 0.021). The mean questionnaire for Foot Macrodactyly score two years after surgery was 8 (6 to 10). Ray amputation gave a measurable reduction in foot size with excellent functional results. For patients with metatarsal involvement, a motionless toe, or involvement of multiple digits, ray amputation is a clinically effective option which is acceptable to patients.

  2. Objective assessment of foot strike in Parkinson's disease*. (United States)

    Contin, M; Riva, R; Martinelli, P; Balboni, M; Tonello, C; Albani, F; Baruzzi, A


    We assessed the nature of foot strike and the potential effect of acute levodopa dosing in Parkinsonian patients with mild to severe fluctuations of motor performances in comparison with healthy volunteers. Forty-eight patients were enrolled in the study and compared with 33 age and gender matched controls. Each patient was assessed by a computerized electropodographic system before levodopa dosing and 1 and 2-h after intake of a standard fasting morning dose of levodopa plus benserazide. Twelve foot strikes (six right, six left) were analysed per patient. The controls underwent three repeated examinations at 1-h intervals. Patients' motor response to acute levodopa dosing was evaluated at fixed times by a battery of motor tests. Foot strike dynamics differed between patients and controls: in particular, first ground contact of the foot was significantly shifted from heel to forefoot in patients compared to controls. The forward shift in footprint during walking was more marked on the more affected body side but was unrelated to the severity and duration of Parkinsonism and unresponsive to levodopa dosing. Tapping and walking tests were overall responsive to acute levodopa intake. The system seemed suitable to detect irregular patterns of foot strike even at the early stages of Parkinsonism, when lower limb disorder was not clinically overt, and might be useful in the search for clinical markers of Parkinsonian gait.

  3. Nociception at the diabetic foot, an uncharted territory

    Institute of Scientific and Technical Information of China (English)

    Ernst A Chantelau


    The diabetic foot is characterised by painless footulceration and/or arthropathy; it is a typical complicationof painless diabetic neuropathy. Neuropathy depletesthe foot skin of intraepidermal nerve fibre endings of theafferent A-delta and C-fibres, which are mostly nociceptorsand excitable by noxious stimuli only. However, someof them are cold or warm receptors whose functionsin diabetic neuropathy have frequently been reported.Hence, it is well established by quantitative sensory testingthat thermal detection thresholds at the foot skin increaseduring the course of painless diabetic neuropathy. Painperception (nociception), by contrast, has rarely beenstudied. Recent pilot studies of pinprick pain at plantardigital skinfolds showed that the perception thresholdwas always above the upper limit of measurement of 512mN (equivalent to 51.2 g) at the diabetic foot. However,deep pressure pain perception threshold at musculus abductor hallucis was beyond 1400 kPa (equivalent to 14 kg; limit of measurement) only in every fifth case. These discrepancies of pain perception between forefoot and hindfoot, and between skin and muscle, demand further study. Measuring nociception at the feet in diabetes opens promising clinical perspectives. A critical nociception threshold may be quantified (probably corresponding to a critical number of intraepidermal nerve fibre endings), beyond which the individual risk of a diabetic foot rises appreciably. Staging of diabetic neuropathy according to nociception thresholds at the feet is highly desirable as guidance to an individualised injury prevention strategy.

  4. Smart Diabetic Socks: Embedded device for diabetic foot prevention

    CERN Document Server

    Perrier, Antoine; Luboz, Vincent; Bucki, Marek; Cannard, Francis; Diot, Bruno; Colin, Denis; Rin, Delphine; Bourg, Jean-Philippe; Payan, Yohan


    1) Objectives Most foot ulcers are the consequence of a trauma (repetitive high stress, ill-fitting footwear, or an object inside the shoe) associated to diabetes. They are often followed by amputation and shorten life expectancy. This paper describes the prototype of the Smart Diabetic Socks that has been developed in the context of the French ANR TecSan project. The objective is to prevent pressure foot ulcers for diabetic persons. 2) Material and methods A fully wireless, customizable and washable "smart sock" has been designed. It is made of a textile which fibers are knitted in a way they provide measurements of the pressure exerted under and all around the foot in real-life conditions. This device is coupled with a subject-specific Finite Element foot model that simulates the internal strains within the soft tissues of the foot. 3) Results A number of derived stress indicators can be computed based on that analysis, such as the accumulated stress dose, high internal strains or peak pressures near bony p...

  5. Shod wear and foot alignment in clinical gait analysis. (United States)

    Louey, Melissa Gar Yee; Sangeux, Morgan


    Sagittal plane alignment of the foot presents challenges when the subject wears shoes during gait analysis. Typically, visual alignment is performed by positioning two markers, the heel and toe markers, aligned with the foot within the shoe. Alternatively, software alignment is possible when the sole of the shoe lies parallel to the ground, and the change in the shoe's sole thickness is measured and entered as a parameter. The aim of this technical note was to evaluate the accuracy of visual and software foot alignment during shod gait analysis. We calculated the static standing ankle angles of 8 participants (mean age: 8.7 years, SD: 2.9 years) wearing bilateral solid ankle foot orthoses (BSAFOs) with and without shoes using the visual and software alignment methods. All participants were able to stand with flat feet in both static trials and the ankle angles obtained in BSAFOs without shoes was considered the reference. We showed that the current implementation of software alignment introduces a bias towards more ankle dorsiflexion, mean=3°, SD=3.4°, p=0.006, and proposed an adjusted software alignment method. We found no statistical differences using visual alignment and adjusted software alignment between the shoe and shoeless conditions, p=0.19 for both. Visual alignment or adjusted software alignment are advised to represent foot alignment accurately.

  6. The myofascial compartments of the foot: a cadaver study. (United States)

    Ling, Z X; Kumar, V P


    Compartment syndrome of the foot requires urgent surgical treatment. Currently, there is still no agreement on the number and location of the myofascial compartments of the foot. The aim of this cadaver study was to provide an anatomical basis for surgical decompression in the event of compartment syndrome. We found that there were three tough vertical fascial septae that extended from the hindfoot to the midfoot on the plantar aspect of the foot. These septae separated the posterior half of the foot into three compartments. The medial compartment containing the abductor hallucis was surrounded medially by skin and subcutaneous fat and laterally by the medial septum. The intermediate compartment, containing the flexor digitorum brevis and the quadratus plantae more deeply, was surrounded by the medial septum medially, the intermediate septum laterally and the main plantar aponeurosis on its plantar aspect. The lateral compartment containing the abductor digiti minimi was surrounded medially by the intermediate septum, laterally by the lateral septum and on its plantar aspect by the lateral band of the main plantar aponeurosis. No distinct myofascial compartments exist in the forefoot. Based on our findings, in theory, fasciotomy of the hindfoot compartments through a modified medial incision would be sufficient to decompress the foot.

  7. Nonplantigrade Foot Posture: A Constraint on Dinosaur Body Size.

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    Tai Kubo

    Full Text Available Dinosaurs had functionally digitigrade or sub-unguligrade foot postures. With their immediate ancestors, dinosaurs were the only terrestrial nonplantigrades during the Mesozoic. Extant terrestrial mammals have different optimal body sizes according to their foot posture (plantigrade, digitigrade, and unguligrade, yet the relationship of nonplantigrade foot posture with dinosaur body size has never been investigated, even though the body size of dinosaurs has been studied intensively. According to a large dataset presented in this study, the body sizes of all nonplantigrades (including nonvolant dinosaurs, nonvolant terrestrial birds, extant mammals, and extinct Nearctic mammals are above 500 g, except for macroscelid mammals (i.e., elephant shrew, a few alvarezsauroid dinosaurs, and nondinosaur ornithodirans (i.e., the immediate ancestors of dinosaurs. When nonplantigrade tetrapods evolved from plantigrade ancestors, lineages with nonplantigrade foot posture exhibited a steady increase in body size following Cope's rule. In contrast, contemporaneous plantigrade lineages exhibited no trend in body size evolution and were largely constrained to small body sizes. This evolutionary pattern of body size specific to foot posture occurred repeatedly during both the Mesozoic and the Cenozoic eras. Although disturbed by the end-Cretaceous extinction, species of mid to large body size have predominantly been nonplantigrade animals from the Jurassic until the present; conversely, species with small body size have been exclusively composed of plantigrades in the nonvolant terrestrial tetrapod fauna.

  8. Nonplantigrade Foot Posture: A Constraint on Dinosaur Body Size. (United States)

    Kubo, Tai; Kubo, Mugino O


    Dinosaurs had functionally digitigrade or sub-unguligrade foot postures. With their immediate ancestors, dinosaurs were the only terrestrial nonplantigrades during the Mesozoic. Extant terrestrial mammals have different optimal body sizes according to their foot posture (plantigrade, digitigrade, and unguligrade), yet the relationship of nonplantigrade foot posture with dinosaur body size has never been investigated, even though the body size of dinosaurs has been studied intensively. According to a large dataset presented in this study, the body sizes of all nonplantigrades (including nonvolant dinosaurs, nonvolant terrestrial birds, extant mammals, and extinct Nearctic mammals) are above 500 g, except for macroscelid mammals (i.e., elephant shrew), a few alvarezsauroid dinosaurs, and nondinosaur ornithodirans (i.e., the immediate ancestors of dinosaurs). When nonplantigrade tetrapods evolved from plantigrade ancestors, lineages with nonplantigrade foot posture exhibited a steady increase in body size following Cope's rule. In contrast, contemporaneous plantigrade lineages exhibited no trend in body size evolution and were largely constrained to small body sizes. This evolutionary pattern of body size specific to foot posture occurred repeatedly during both the Mesozoic and the Cenozoic eras. Although disturbed by the end-Cretaceous extinction, species of mid to large body size have predominantly been nonplantigrade animals from the Jurassic until the present; conversely, species with small body size have been exclusively composed of plantigrades in the nonvolant terrestrial tetrapod fauna.

  9. Neuropathic diabetic foot ulcers - evidence-to-practice. (United States)

    Ndip, Agbor; Ebah, Leonard; Mbako, Aloysius


    Foot ulcers and their attendant complications are disquietingly high in people with diabetes, a majority of whom have underlying neuropathy. This review examines the evidence base underpinning the prevention and management of neuropathic diabetic foot ulcers in order to inform best clinical practice. Since it may be impractical to ask patients not to weight-bear at all, relief of pressure through the use of offloading casting devices remains the mainstay for management of neuropathic ulcers, whilst provision of appropriate footwear is essential in ulcer prevention. Simple non-surgical debridement and application of hydrogels are both effective in preparing the wound bed for healthy granulation and therefore enhancing healing. Initial empirical antibiotic therapy for infected ulcers should cover the most common bacterial flora. There is limited evidence supporting the use of adjunctive therapies such as hyperbaric oxygen and cytokines or growth factors. In selected cases, recombinant human platelet-derived growth factor has been shown to enhance healing; however, its widespread use cannot be advised due to the availability of more cost-effective approaches. While patient education may be beneficial, the evidence base remains thin and conflicting. In conclusion, best management of foot ulcers is achieved by what is taken out of the foot (pressure, callus, infection, and slough) rather than what is put on the foot (adjuvant treatment).

  10. Pressure and the diabetic foot: clinical science and offloading techniques. (United States)

    Boulton, Andrew J M


    Diabetic foot ulceration is a common, yet in many cases an eminently preventable, complication that affects 1 in 20 patients with diabetes. Risk factors for ulceration include insensitivity (secondary to somatic neuropathy), high foot pressures, callus formation (a consequence of sympathetic neuropathy and high foot pressures), deformities (such as claw feet, prominent metatarsal heads, etc.), peripheral vascular disease, and most importantly, a past history of ulceration. None of these factors alone causes ulceration; thus, early identification and amelioration of these factors is a primary aim in foot ulcer prevention. A number of therapeutic approaches may help reduce ulcer incidence: these include therapeutic footwear, hosiery, and, potentially, liquid silicone injected under high-pressure areas. In the management of neuropathic ulcers, pressure relief is of the utmost importance, and total contact casting remains the "gold standard" means of achieving such pressure redistribution. The successful management of diabetic foot ulceration depends on a team approach, remembering that ulcers should heal if (1) the arterial circulation is intact, (2) pressure relief is achieved and maintained over the ulcer, and (3) infection is appropriately treated.

  11. MR imaging features of foot involvement in patients with psoriasis

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    Erdem, C. Zuhal [Department of Radiology, Zonguldak Karaelmas University, School of Medicine, Zonguldak (Turkey)], E-mail:; Tekin, Nilgun Solak [Department of Dermatology, Zonguldak Karaelmas University, School of Medicine, Zonguldak (Turkey); Sarikaya, Selda [Department of Physical Therapy and Rehabilitation, Zonguldak Karaelmas University, School of Medicine, Zonguldak (Turkey); Erdem, L. Oktay; Gulec, Sezen [Department of Radiology, Zonguldak Karaelmas University, School of Medicine, Zonguldak (Turkey)


    Objective: To determine alterations of the soft tissues, tendons, cartilage, joint spaces, and bones of the foot using magnetic resonance (MR) imaging in patients with psoriasis. Materials and methods: Clinical and MR examination of the foot was performed in 26 consecutive patients (52 ft) with psoriasis. As a control group, 10 healthy volunteers (20 ft) were also studied. Joint effusion/synovitis, retrocalcaneal bursitis, retroachilles bursitis, Achilles tendonitis, soft-tissue edema, para-articular enthesophytes, bone marrow edema, sinus tarsi syndrome, enthesopathy at the Achilles attachment and at the plantar fascia attachment, plantar fasciitis, tenosynovitis, subchondral cysts, and bone erosions, joint space narrowing, subchondral signal changes, osteolysis, luxation, and sub-luxation were examined. Results: Clinical signs and symptoms (pain and swelling) due to foot involvement were present in none of the patients while frequency of involvement was 92% (24/26) by MR imaging. The most common MR imaging findings were Achilles tendonitis (acute and peritendinitis) (57%), retrocalcaneal bursitis (50%), joint effusion/synovitis (46%), soft-tissue edema (46%), and para-articular enthesophytes (38%). The most commonly involved anatomical region was the hindfoot (73%). Conclusion: Our data showed that the incidence of foot involvement was very high in asymptomatic patients with psoriasis on MR imaging. Further MR studies are needed to confirm these data. We conclude that MR imaging may be of importance especially in early diagnosis and treatment of inflammatory changes in the foot.

  12. Imaging of Charcot foot; Bildgebung des Charcot-Fusses

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    Erlemann, Rainer; Schmitz, Annette [Helios Klinikum Duisburg, Helios St. Johannes Klinik, Duisburg (Germany). Inst. fuer Radiologie


    The onset of a Charcot foot ist a feared complication of a long lasting diabetes mellitus. A peripheral neuropathy and continuous weight bearing of the foot subsequent to repeated traumas depict the conditions. There exist three types of a Charcot foot, an atrophic, a hypertophic and a mixed type. In early stages a differentiation from osteoarthritis is difficult. Subluxation or luxation within the Lisfranc's joint is typical. The joints of the foot could rapidly and extensively be destroyed or may present the morphology of a 'superosteoarthritis'. Often, soft tissue infections or osteomyelitis evolve from ulcers of the skin as entry points. Diagnosis of osteomyelitis necessitate MR imaging as plain radiography offers only low sensitivity for detection of an osteomyelitis. The existence of periosteal reactions is not a proof for osteomyelitis. Bone marrow edema and soft tissue edema also appear in a non infected Charcot foot. The range of soft tissue infections goes from cellulitis over phlegmon to abscesses. The ghost sign is the most suitable diagnostic criterion for osteomyelitis. In addition, the penumbra sign or the existence of a sinus tract between a skin ulcer and the affected bone may be helpful. (orig.)

  13. Increased healing in diabetic toe ulcers in a multidisciplinary foot clinic—An observational cohort study

    DEFF Research Database (Denmark)

    Almdal, Thomas Peter; Nielsen, A.A.; Nielsen, K.E.


    AIM: To study toe ulcer healing in patients with diabetic foot ulcers attending a multidisciplinary foot clinic over a 10 years period. METHODS: The study was retrospective, consecutive and observational during 2001 through 2011. The patients were treated according to the International Consensus...... on the Diabetic Foot. During the period the chiropodist staffing in the foot clinic was doubled; new offloading material and orthopedic foot corrections for recalcitrant ulcers were introduced. Healing was investigated in toe ulcers in Cox regression models. RESULTS: 2634 patients developed foot ulcers, of which...

  14. Thermal analysis of an arc heater electrode with a rotating arc foot (United States)

    Milos, Frank S.; Shepard, Charles E.


    A smoothly rotating arc foot and an arc foot that jumps between multiple sticking points were analyzed using analytic formulations and numerical solution procedures. For each case the temperature distribution for a copper electrode was obtained for the plausible range of operating conditions. It is shown that the smoothly rotating arc foot is an extremely safe mode of operation, whereas the jumping arc foot produces excessively high electrode surface temperatures which are not greatly alleviated by increasing the average rotational frequency of the arc foot. It is suggested to eliminate arc-foot rotation and rely on the distribution of fixed electrodes with stationary arc attachment to avoid electrode failure at high current.

  15. Effect of intensive nursing education on the prevention of diabetic foot ulceration among patients with high-risk diabetic foot: a follow-up analysis. (United States)

    Ren, Meng; Yang, Chuan; Lin, Diao Zhu; Xiao, Hui Sheng; Mai, Li Fang; Guo, Yi Chen; Yan, Li


    The aim of the study was to discuss the effect of intensive nursing education on the prevention of diabetic foot ulceration among patients at high risk for diabetic foot. One hundred eighty-five diabetes patients at high risk for foot diseases were enrolled in this study and provided with intensive nursing education, including individualized education about diabetes mellitus and diabetic foot diseases, instruction in podiatric care (the right way of washing the foot, the care of foot skin, appropriate choice of shoes and socks, intense examinations and records of feet by patients themselves every day, and the assistant management of calluses). Study subjects were followed up for 2 years. Once the foot ulceration developed, the inducing factors of foot ulceration were inquired about, the ulcers were evaluated, and the incidence of foot ulceration was analyzed before and after the intensive nursing education according to self-paired data. Results showed there were highly statistically significant improvements in the intensive treatment group compared with the control group in plasma glucose, blood pressure, and high-density lipoprotein cholesterol levels. More important is that intensive nursing education helps to prevent diabetic foot ulceration and to decrease the rate of amputation among patients at high risk for diabetic foot.

  16. Relationships between the Foot Posture Index and foot kinematics during gait in individuals with and without patellofemoral pain syndrome

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    Crossley Kay M


    Full Text Available Abstract Background Foot posture assessment is commonly undertaken in clinical practice for the evaluation of individuals with patellofemoral pain syndrome (PFPS, particularly when considering prescription of foot orthoses. However, the validity of static assessment to provide insight into dynamic function in individuals with PFPS is unclear. This study was designed to evaluate the extent to which a static foot posture measurement tool (the Foot Posture Index - FPI can provide insight into kinematic variables associated with foot pronation during level walking in individuals with PFPS and asymptomatic controls. Methods Twenty-six individuals (5 males, 21 females with PFPS aged 25.1 ± 4.6 years and 20 control participants (4 males, 16 females aged 23.4 ± 2.3 years were recruited into the study. Each participant underwent clinical evaluation of the FPI and kinematic analysis of the rearfoot and forefoot during walking using a three-dimensional motion analysis system. The association of the FPI score with rearfoot eversion, forefoot dorsiflexion, and forefoot abduction kinematic variables (magnitude, timing of peak and range of motion were evaluated using partial correlation coefficient statistics with gait velocity entered as a covariate. Results A more pronated foot type as measured by the FPI was associated with greater peak forefoot abduction (r = 0.502, p = 0.013 and earlier peak rearfoot eversion relative to the laboratory (r = -0.440, p = 0.031 in the PFPS group, and greater rearfoot eversion range of motion relative to the laboratory (r = 0.614, p = 0.009 in the control group. Conclusion In both individuals with and without PFPS, there was fair to moderate association between the FPI and some parameters of dynamic foot function. Inconsistent findings between the PFPS and control groups indicate that pathology may play a role in the relationship between static foot posture and dynamic function. The fair association between pronated foot

  17. Foot disorders in diabetics. Source of serious morbidity. (United States)

    Shuman, C R


    In the diabetic patient, the foot is particularly vulnerable to disorders resulting from vascular insufficiency, neuropathy, and infection. Without proper treatment, these disorders can lead to serious disability or amputation. Hyperglycemia, smoking, hypertension, and obesity contribute to the development of foot lesions. Early recognition of pedal lesions allows institution of measures (eg, special shoes, fitted inserts) that reduce risks of serious disorders. Patient education regarding foot care also plays an important role in prevention and management of disease. Aggressive treatment of infection and local care of lesions prevent extension of disease to adjacent areas. In cases of established infection or occlusive vascular disease amenable to bypass procedures, surgical intervention is frequently necessary. When amputation is required, rehabilitation professionals can assist the physician in patient education regarding personal care and readjustment.

  18. Management of the diabetic foot ulcer: exercising control. (United States)

    Bentley, Jenny; Foster, Ali


    The incidence of diabetes is increasing and therefore patients with diabetic foot ulcers will become increasingly common in the community. The NHS model of Health and Social Care (Department of Health (DH), 2005) places a high emphasis on self care and disease management, and, as a long-term condition, diabetes mellitus requires efficient and effective management. The supervision and organization of the care of diabetic patients is multi-factorial and for this reason, a multi-disciplinary approach is essential for effective care, without which patients with diabetic foot ulcers are at high risk of complications. Diabetic wounds present differently to other chronic wounds; unless these are adequately assessed and treated, there may be devastating consequences for the patient--the most serious being major amputation and/or death. In the first article, accurate assessment was discussed; in this second article, the management of diabetic foot ulcers is explored.

  19. Minimizing Hexapod Robot Foot Deviations Using Multilayer Perceptron

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    Vytautas Valaitis


    Full Text Available Rough-terrain traversability is one of the most valuable characteristics of walking robots. Even despite their slower speeds and more complex control algorithms, walking robots have far wider usability than wheeled or tracked robots. However, efficient movement over irregular surfaces can only be achieved by eliminating all possible difficulties, which in many cases are caused by a high number of degrees of freedom, feet slippage, frictions and inertias between different robot parts or even badly developed inverse kinematics (IK. In this paper we address the hexapod robot-foot deviation problem. We compare the foot-positioning accuracy of unconfigured inverse kinematics and Multilayer Perceptron-based (MLP methods via theory, computer modelling and experiments on a physical robot. Using MLP-based methods, we were able to significantly decrease deviations while reaching desired positions with the hexapod’s foot. Furthermore, this method is able to compensate for deviations of the robot arising from any possible reason.

  20. Translation-Invariant Representation for Cumulative Foot Pressure Images

    CERN Document Server

    Zheng, Shuai; Tan, Tieniu


    Human can be distinguished by different limb movements and unique ground reaction force. Cumulative foot pressure image is a 2-D cumulative ground reaction force during one gait cycle. Although it contains pressure spatial distribution information and pressure temporal distribution information, it suffers from several problems including different shoes and noise, when putting it into practice as a new biometric for pedestrian identification. In this paper, we propose a hierarchical translation-invariant representation for cumulative foot pressure images, inspired by the success of Convolutional deep belief network for digital classification. Key contribution in our approach is discriminative hierarchical sparse coding scheme which helps to learn useful discriminative high-level visual features. Based on the feature representation of cumulative foot pressure images, we develop a pedestrian recognition system which is invariant to three different shoes and slight local shape change. Experiments are conducted on...

  1. Modelling and measurement of a wireless foot plantar pressure

    Directory of Open Access Journals (Sweden)

    Khwaja Ramizuddin


    Full Text Available Foot plantar pressure is the pressure fields that act between the foot skin and its supporting surface that humans experience during daily activities. Information derived from such pressure is important for diagnosing lower limb problems, footwear design, sport biomechanics performance and injury prevention. This paper presents the design and implementation of a wireless data acquisition (DAQ for foot plantar pressure sensors. The system is intended for an in-shoe wireless pressure measurement system. The objective of this DAQ is to be a system which can be integrated into a shoe with the ability of wireless transmission to an external on body receiver. Such device provides low power consumption, convenient and comfortable testing system simulating a range of normal daily life activities.

  2. Illness Beliefs Predict Mortality in Patients with Diabetic Foot Ulcers (United States)

    Vedhara, Kavita; Dawe, Karen; Miles, Jeremy N. V.; Wetherell, Mark A.; Cullum, Nicky; Dayan, Colin; Drake, Nicola; Price, Patricia; Tarlton, John; Weinman, John; Day, Andrew; Campbell, Rona; Reps, Jenna; Soria, Daniele


    Background Patients’ illness beliefs have been associated with glycaemic control in diabetes and survival in other conditions. Objective We examined whether illness beliefs independently predicted survival in patients with diabetes and foot ulceration. Methods Patients (n = 169) were recruited between 2002 and 2007. Data on illness beliefs were collected at baseline. Data on survival were extracted on 1st November 2011. Number of days survived reflected the number of days from date of recruitment to 1st November 2011. Results Cox regressions examined the predictors of time to death and identified ischemia and identity beliefs (beliefs regarding symptoms associated with foot ulceration) as significant predictors of time to death. Conclusions Our data indicate that illness beliefs have a significant independent effect on survival in patients with diabetes and foot ulceration. These findings suggest that illness beliefs could improve our understanding of mortality risk in this patient group and could also be the basis for future therapeutic interventions to improve survival. PMID:27096609

  3. Hyperbaric oxygen in the treatment of a diabetic foot ulcer.

    LENUS (Irish Health Repository)

    Davenport, Colin


    Although simultaneous pancreas and kidney transplant improves most complications of type 1 diabetes, suppression of the immune system increases the risk for infection. The authors report the case of a patient who, despite receiving a simultaneous pancreas and kidney transplant, subsequently developed neuro-ischemic ulcers of his right foot requiring repeated amputations. He then developed an infected ulcer of his remaining right big toe, with significant implications for his mobility. This ulcer proved resistant to multiple courses of antibiotics and care in a specialist foot clinic but resolved completely following a course of hyperbaric oxygen therapy. The role of hyperbaric oxygen in diabetic foot ulcers is not yet fully established but should be considered in resistant cases with vascular insufficiency and a significant infective component.

  4. Hyperbaric oxygen in the treatment of a diabetic foot ulcer.

    LENUS (Irish Health Repository)

    Davenport, Colin


    Although simultaneous pancreas and kidney transplant improves most complications of type 1 diabetes, suppression of the immune system increases the risk for infection. The authors report the case of a patient who, despite receiving a simultaneous pancreas and kidney transplant, subsequently developed neuro-ischemic ulcers of his right foot requiring repeated amputations. He then developed an infected ulcer of his remaining right big toe, with significant implications for his mobility. This ulcer proved resistant to multiple courses of antibiotics and care in a specialist foot clinic but resolved completely following a course of hyperbaric oxygen therapy. The role of hyperbaric oxygen in diabetic foot ulcers is not yet fully established but should be considered in resistant cases with vascular insufficiency and a significant infective component.

  5. Staphylococcus lugdunensis: A Rare Pathogen for Osteomyelitis of the Foot. (United States)

    Kear, Shelby; Smith, Collin; Mirmiran, Roya; Hofinger, Diedre


    Staphylococcus lugdunensis is an aggressive gram-positive bacteria that can lead to devastating infections in humans. S. lugdunensis has been associated with rare cases of osteomyelitis of the vertebra, prosthetic implants, and endocarditis. Reports of this organism associated with osteomyelitis of the foot or ankle have been infrequent. We present a unique case of acute osteomyelitis of a foot caused by S. lugdunensis after a patient stepped on a thorn. Our case is unique, because the radiographic changes were noted within 4 days, despite normal plain films and magnetic resonance images on the day of admission. This finding suggests the aggressiveness and virulence of S. lugdunensis. In addition, we report the first case of foot osteomyelitis as a result of isolated S. lugdunensis that involved 2 distinct specimens with 2 different antibiotic sensitivity reports.

  6. Posterior Tibial Tendon Dysfunction: An Overlooked Cause of Foot Deformity (United States)

    Bubra, Preet Singh; Keighley, Geffrey; Rateesh, Shruti; Carmody, David


    Posterior tibial tendon dysfunction is the most common cause of adult acquired flatfoot. Degenerative changes in this tendon, lead to pain and weakness and if not identified and treated will progress to deformity of the foot and degenerative changes in the surrounding joints. Patients will complain of medial foot pain, weakness, and a slowly progressive foot deformity. A “too many toes” sign may be present and patients will be unable to perform a single heal raise test. Investigations such X-ray, ultrasound and magnetic resonance imaging will help stage the disease and decide on management. The optimal manage may change based on the progression of deformity and stage of disease. Early identification and prompt initiation of treatment can halt progression of the disease. The purpose of this article is to examine the causes, signs, symptoms, examinations, investigations and treatment options for posterior tibial tendon dysfunction. PMID:25810985

  7. Shoe concerns and foot problems of wearers of safety footwear. (United States)

    Marr, S J; Quine, S


    In Australia workers in many industries are required to wear safety footwear (footwear incorporating a steel toe cap). An investigation of the problems reported by 321 workers (70 per cent male) employed in a broad range of work activities and required to wear safety footwear was conducted in 1990 and 1991. Respondents were interviewed by a professionally trained podiatrist using a structured questionnaire followed by a foot examination. An extremely high percentage (91 per cent) of subjects reported one or more foot problems (which were verified by the podiatrist), and most considered that the safety footwear either caused the problem or adversely affected an existing foot condition. The main shoe concerns reported were excessive heat (65 per cent of all respondents), inflexible soles (52 per cent), weight (48 per cent) and pressure from steel toe cap (47 per cent). Certain gender differences were identified. General recommendations are made.

  8. Quantitative estimation of foot-flat and stance phase of gait using foot-worn inertial sensors. (United States)

    Mariani, Benoit; Rouhani, Hossein; Crevoisier, Xavier; Aminian, Kamiar


    Time periods composing stance phase of gait can be clinically meaningful parameters to reveal differences between normal and pathological gait. This study aimed, first, to describe a novel method for detecting stance and inner-stance temporal events based on foot-worn inertial sensors; second, to extract and validate relevant metrics from those events; and third, to investigate their suitability as clinical outcome for gait evaluations. 42 subjects including healthy subjects and patients before and after surgical treatments for ankle osteoarthritis performed 50-m walking trials while wearing foot-worn inertial sensors and pressure insoles as a reference system. Several hypotheses were evaluated to detect heel-strike, toe-strike, heel-off, and toe-off based on kinematic features. Detected events were compared with the reference system on 3193 gait cycles and showed good accuracy and precision. Absolute and relative stance periods, namely loading response, foot-flat, and push-off were then estimated, validated, and compared statistically between populations. Besides significant differences observed in stance duration, the analysis revealed differing tendencies with notably a shorter foot-flat in healthy subjects. The result indicated which features in inertial sensors' signals should be preferred for detecting precisely and accurately temporal events against a reference standard. The system is suitable for clinical evaluations and provides temporal analysis of gait beyond the common swing/stance decomposition, through a quantitative estimation of inner-stance phases such as foot-flat.

  9. The Influence of a Prefabricated Foot Orthosis on Lower Extremity Mechanics During Running in Individuals With Varying Dynamic Foot Motion. (United States)

    Almonroeder, Thomas G; Benson, Lauren C; O'Connor, Kristian M


    Study Design Controlled laboratory study, cross-sectional. Background Orthotic prescription is often based on the premise that the mechanical effects will be more prominent in individuals with greater calcaneal eversion. Objective To compare the effects of a prefabricated foot orthosis on lower extremity kinematics and kinetics between recreational athletes with high and low calcaneal eversion during running. Methods Thirty-one recreational athletes were included in this study. Three-dimensional kinematic and kinetic data were collected while running with and without a foot orthosis. Participants were grouped based on the degree of calcaneal eversion during the running trials relative to a standing trial (dynamic foot motion). The effects of the orthosis on the frontal and transverse plane angles and moments of the hip and knee were compared between the 10 participants with the greatest and least amount of dynamic foot motion. Results There were no significant interactions (group by orthotic condition) for any of the kinematic or kinetic variables of interest. Conclusion The effects of an orthosis on the mechanics of the hip and knee do not appear to be dependent on an individual's dynamic foot motion. J Orthop Sports Phys Ther 2016;46(9):749-755. Epub 5 Aug 2016. doi:10.2519/jospt.2016.6253.

  10. Progress in detailed modelling of low foot and high foot implosion experiments on the National Ignition Facility (United States)

    Clark, D. S.; Weber, C. R.; Eder, D. C.; Haan, S. W.; Hammel, B. A.; Hinkel, D. E.; Jones, O. S.; Kritcher, A. L.; Marinak, M. M.; Milovich, J. L.; Patel, P. K.; Robey, H. F.; Salmonson, J. D.; Sepke, S. M.


    Several dozen high convergence inertial confinement fusion ignition experiments have now been completed on the National Ignition Facility (NIF). These include both “low foot” experiments from the National Ignition Campaign (NIC) and more recent “high foot” experiments. At the time of the NIC, there were large discrepancies between simulated implosion performance and experimental data. In particular, simulations over predicted neutron yields by up to an order of magnitude, and some experiments showed clear evidence of mixing of ablator material deep into the hot spot that could not be explained at the time. While the agreement between data and simulation improved for high foot implosion experiments, discrepancies nevertheless remain. This paper describes the state of detailed modelling of both low foot and high foot implosions using 1-D, 2-D, and 3-D radiation hydrodynamics simulations with HYDRA. The simulations include a range of effects, in particular, the impact of the plastic membrane used to support the capsule in the hohlraum, as well as low-mode radiation asymmetries tuned to match radiography measurements. The same simulation methodology is applied to low foot NIC implosion experiments and high foot implosions, and shows a qualitatively similar level of agreement for both types of implosions. While comparison with the experimental data remains imperfect, a reasonable level of agreement is emerging and shows a growing understanding of the high-convergence implosions being performed on NIF.

  11. BIONic WalkAide for correcting foot drop. (United States)

    Weber, Douglas J; Stein, Richard B; Chan, K Ming; Loeb, Gerald; Richmond, Frances; Rolf, Robert; James, Kelly; Chong, Su Ling


    The goal of this study was to test the feasibility and efficacy of using microstimulators (BIONs) to correct foot drop, the first human application of BIONs in functional electrical stimulation (FES). A prototype BIONic foot drop stimulator was developed by modifying a WalkAide2 stimulator to control BION stimulation of the ankle dorsiflexor muscles. BION stimulation was compared with surface stimulation of the common peroneal nerve provided by a normal WalkAide2 foot drop stimulator. Compared to surface stimulation, we found that BION stimulation of the deep peroneal nerve produces a more balanced ankle flexion movement without everting the foot. A three-dimensional motion analysis was performed to measure the ankle and foot kinematics with and without stimulation. Without stimulation, the toe on the affected leg drags across the ground. The BIONic WalkAide elevates the foot such that the toe clears the ground by 3 cm, which is equivalent to the toe clearance in the unaffected leg. The physiological cost index (PCI) was used to measure effort during walking. The PCI is high without stimulation (2.29 +/- 0.37; mean +/- S.D.) and greatly reduced with surface (1.29 +/- 0.10) and BION stimulation (1.46 +/- 0.24). Also, walking speed is increased from 9.4 +/- 0.4 m/min without stimulation to 19.6 +/- 2.0 m/min with surface and 17.8 +/- 0.7 m/min with BION stimulation. We conclude that functional electrical stimulation with BIONs is a practical alternative to surface stimulation and provides more selective control of muscle activation.

  12. Risk factors for ulceration and amputation in diabetic foot: study in a cohort of 496 patients. (United States)

    Moura Neto, Arnaldo; Zantut-Wittmann, Denise Engelbrecht; Fernandes, Tulio Diniz; Nery, Marcia; Parisi, Maria Candida Ribeiro


    Treatment strategies for foot at risk and diabetic foot are mainly preventive. Studies describing demographic data, clinical and impacting factors continue to be, however, scarce. Our objective was to determine the epidemiological presentation of diabetic foot and understand whether there were easily assessable variables capable of predicting the development of diabetic foot. This was a retrospective study of 496 patients with established foot at risk or diabetic foot, who were evaluated based on age, gender, type and duration of diabetes, foot at risk classification, and the presence of deformities, ulceration, and amputation. The presence of deformities, ulceration, and amputation was recorded in 45.9, 25.3, and 12.9 % of patients, respectively. As for diabetic foot classification, the great majority of our cohort had diabetic neuropathy (92.9 %). Approximately 30 % had neuro-ischemic disease and only 7.1 % had ischemic disease alone. Sixty-two percent of patients presented neuropathy with no signs of arteriopathy. Foot classification was as a significant predictor for the presence of ulcer (p = 0.009; OR = 3.2; 95 % CI = 1.18-7.3). Only male gender was a significant predictor for ulceration (p diabetic foot (p diabetic foot were male gender and the presence of neuropathy. The combination of neuropathy and peripheral vascular disease adds significantly to the risk for amputation among patients with the diabetic foot syndrome. Men, presenting combined risk factors, should be a group receiving special attention and in the foot clinic, due to their potentially worse evolution.


    Directory of Open Access Journals (Sweden)

    Marwa A. Mohamed


    Full Text Available Background: Premenstrual syndrome is a current condition characterized by troublesome symptoms as tension, irritability, depression, headache, anxiety and loss of self-control, so the aim of this study was to investigate the effect of foot reflexology augmented with relaxation training on premenstrual syndrome in adolescent females. Methods: A sample of 50 volunteers, virgin females diagnosed as premenstrual syndrome was selected from the students of Faculty of Physical Therapy, Cairo University. Their age was ranged between 19 to 23 years with mean value of (21.53±2.27 yrs and BMI was ≤28 Kg/m² with mean value of (24.04±2.41 Kg/m².A detailed medical history was obtained to screen other pathological conditions that may affect the results. Females were randomly assigned into two equal groups. Group (A consisted of 25 subjects who received foot reflexology in addition to relaxation training techniques twice a week for 8 weeks. Group (B consisted of 25 patients, who received relaxation training techniques only twice a week for 8 weeks. Assessment of all subjects in both groups was carried out before and after the treatment program through heart rate, respiratory rate in addition to plasma cortisol level and daily symptoms report chart. Results: Showed a statistical highly significant decrease (p<0.001 in heart rate, respiratory rate, plasma cortisol level as well as daily symptoms report score in group (A while there was a statistical significant decrease (p<0.05 in all variables in group (B. Conclusions: Adding foot reflexology to relaxation training had a great positive effect on premenstrual syndrome in adolescent females than relaxation training only.

  14. Virological investigation of hand, foot, and mouth disease in a tertiary care center in South India

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    Pavithra M Vijayaraghavan


    Full Text Available Context: Hand, foot, and mouth disease (HFMD remains a common problem in India, yet its etiology is largely unknown as diagnosis is based on clinical characteristics. There are very few laboratory-based molecular studies on HFMD outbreaks. Aim: The aim of this study was to characterize HFMD-related isolates by molecular techniques. Settings and Design: Between 2005 and 2008, during two documented HFMD outbreaks, 30 suspected HFMD cases presented at the Outpatient Unit of the Department of Dermatology, Christian Medical College (CMC, Vellore. Seventy-eight clinical specimens (swabs from throat, mouth, rectum, anus, buttocks, tongue, forearm, sole, and foot were received from these patients at the Department of Clinical Virology, CMC, for routine diagnosis of hand, foot, and mouth disease. Materials and Methods: Samples from these patients were cultured in Vero and rhabdomyosarcoma (RD cell lines. Isolates producing enterovirus-like cytopathogenic effect (CPE in cell culture were identified by a nested reverse transcription-based polymerase chain reaction (RT-PCR and sequenced. The nucleotide sequences were analyzed using the BioEdit sequence program. Homology searches were performed using the Basic Local Alignment Search Tool (BLAST algorithm. Statistical Analysis used: The statistical analysis was performed using Epi Info version 6.04b and Microsoft Excel 2002 (Microsoft Office XP. Results: Of the 30 suspected HFMD cases, only 17 (57% were laboratory confirmed and Coxsackievirus A16 (CVA16 was identified as the etiological agent in all these cases. Conclusions: Coxsackievirus A16 (CVA16 was identified as the virus that caused the HFMD outbreaks in Vellore between 2005 and 2008. Early confirmation of HFMD helps to initiate control measures to interrupt virus transmission. In the laboratory, classical diagnostic methods, culture and serological tests are being replaced by molecular techniques. Routine surveillance systems will help understand the

  15. Foot-and-mouth disease: past, present and future

    DEFF Research Database (Denmark)

    Jamal, Syed Muhammad; Belsham, Graham


    ABSTRACT: Foot-and-mouth disease (FMD) is a highly contagious disease of cloven-hoofed animals including cattle, pigs, sheep and many wildlife species. It can cause enormous economic losses when incursions occur into countries which are normally disease free. In addition, it has long-term effects...... within countries where the disease is endemic due to reduced animal productivity and the restrictions on international trade in animal products. The disease is caused by infection with foot-and-mouth disease virus (FMDV), a picornavirus. Seven different serotypes (and numerous variants) of FMDV have been...

  16. The Dynamic Stiffness of Surface Footings for Offshore Wind Turbines

    DEFF Research Database (Denmark)

    Vahdatirad, Mohammadjavad; Andersen, Lars; Clausen, Johan;


    This study concerns the dynamic stiffness of foundations for large offshore wind turbines. Especially, the purpose of the analysis is to quantify the uncertainties related to the first natural frequency of a turbine supported by a surface footing on layered soil. The dynamic properties...... due to sediment transportation. Further, the stiffness and density of the materials within a single layer is subject to uncertainties. This leads to uncertainties of the dynamic stiffness of the foundation and therefore the natural frequencies. The aim of the study is to quantify the level...... of uncertainties and discuss the utilization of reliability-based design of surface footings for wind turbines....

  17. Offloading of the diabetic foot: orthotic and pedorthic strategies. (United States)

    McCartan, Brant L; Rosenblum, Barry I


    The diabetic foot is more susceptible than the non-diabetic foot to collapse. This frequently leads to bony prominences followed by ulceration. Offloading of areas of increased pressure is paramount to ulcer prevention and healing. Several devices and accommodations can aid practitioners in saving patients' extremities and allow them to ambulate. A team approach works best, and patient education is a must. Regular assessment and modifications are required for longevity of each device. In this article, different therapeutic options are detailed. A variety of presentations and situations are discussed and the authors' best tips for avoiding complications are offered.

  18. Three-dimensional measurement of foot arch in preschool children

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    Chang Hsun-Wen


    Full Text Available Abstract Background The prevalence of flexible flatfoot is high among preschool-aged children, but the effects of treatment are inconclusive due to the unclear definitions of normal flatfoot. To date, a universally accepted evaluation method of the foot arch in children has not been completely established. Our aims of this study were to establish a new method to evaluate the foot arch from a three dimensional perspective and to investigate the flexibility of the foot arch among children aged from two to six. Methods A total of 44 children aged from two to six years of age were put into five age groups in this study. The navicular height was measured with one leg standing, and both feet were scanned separately in both sitting and one leg standing positions to compute the foot arch volume. The arch volume index, which represents the ratio of the difference in volume between sitting and one leg standing positions to the volume when sitting was calculated to demonstrate the flexibility of the foot arch. The differences of measured parameters between each aged group were analyzed by one-way ANOVA. Results The arch volumes when sitting and standing were highly correlated with the navicular height. The navicular height ranged from 15.75 to 27 mm, the arch volume when sitting ranged from 6,223 to 11,630 mm3, and the arch volume when standing from 3,111 to 7,848 mm3 from two to six years of age. The arch volume index showed a declining trend as age increased. Conclusion This study is the first to describe the foot arch with volume perspective in preschool-aged children. The foot arch volume was highly correlated with the navicular height. Research results show both navicular height index and arch volume index gradually increase with age from two to six. At the same time the arch also becomes rigid with age from two to six. These results could be applied for clinical evaluation of the foot arch and post-treatment evaluation.

  19. Diabetic foot disease:From the evaluation of the “foot at risk” to the novel diabetic ulcer treatment modalities

    Institute of Scientific and Technical Information of China (English)

    Noha; Amin; John; Doupis


    The burden of diabetic foot disease(DFD) is expected to increase in the future. The incidence of DFD is still rising due to the high prevalence of DFD predisposing factors. DFD is multifactorial in nature; however most of the diabetic foot amputations are preceded by foot ulceration. Diabetic peripheral neuropathy(DPN) is a major risk factor for foot ulceration. DPN leads to loss of protective sensation resulting in continuous unconscious traumas. Patient education and detection of high risk foot are essential for the prevention of foot ulceration and amputation. Proper assessment of the diabetic foot ulceration and appropriate management ensure better prognosis. Management is based on revascularization procedures, wound debridement, treatment of infection and ulcer offloading. Management and type of dressing applied are tailored according to the type of wound and the foot condition. The scope of this review paper is to describe the diabetic foot syndrome starting from the evaluation of the foot at risk for ulceration, up to the new treatment modalities.

  20. Type 2 diabetes–related foot care knowledge and foot self-care practice interventions in the United States: a systematic review of the literature

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    Timethia Bonner


    Full Text Available Introduction: The purpose of this systematic literature review is to review published studies on foot care knowledge and foot care practice interventions as part of diabetic foot care self-management interventions. Methods: Medline, CINAHL, CENTRAL, and Cochrane Central Register of Controlled Trials databases were searched. References from the included studies were reviewed to identify any missing studies that could be included. Only foot care knowledge and foot care practice intervention studies that focused on the person living with type 2 diabetes were included in this review. Author, study design, sample, intervention, and results were extracted. Results: Thirty studies met the inclusion criteria and were classified according to randomized controlled trial (n=9, survey design (n=13, cohort studies (n=4, cross-sectional studies (n=2, qualitative studies (n=2, and case series (n=1. Improving lower extremity complications associated with type 2 diabetes can be done through effective foot care interventions that include foot care knowledge and foot care practices. Conclusion: Preventing these complications, understanding the risk factors, and having the ability to manage complications outside of the clinical encounter is an important part of a diabetes foot self-care management program. Interventions and research studies that aim to reduce lower extremity complications are still lacking. Further research is needed to test foot care interventions across multiple populations and geographic locations.

  1. An exploration of diabetic foot screening procedures data by a multiple correspondence analysis

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    Urbančič Rovan Vilma


    Full Text Available Gangrene and amputation are among most feared complications of diabetes mellitus. Early detection of patients at high risk for foot ulceration can prevent foot complications. Regular foot screening (medical history, foot examination and classification into risk groups was introduced at the out-patient diabetes clinic in Ljubljana in November 1996. We aimed to explore the relationships between the observed variables, check the appropriateness of the risk status classification and of the post-screening decisions.



    Mithun N; Pattanashetty; Reshmina; Sharath Babu; Harikrishna; Sreedhar Reddy; Ramakrishna J


    INTRODUCTION : India is considered as the diabetic capital of the world. Diabetic foot osteomyelitis is considered as one of the severe complications of diabetes mellitus. Diabetic foot osteomyelitis tends to complicate around one third of diabetic foot infections. In v iew of this we conducted a prospective study on the bacteriological analysis of diabetic foot osteomyelitis at a tertiary care center. MATERIALS AND METHODS : A prospective study was perform...

  3. Offloading for the Treatment of the Diabetic Foot - A Systematic Review


    de Oliveira, Ana Lucia M


    Abstract Aim: To compare the strengths and limitations of different offloading devices in the treatment of diabetic foot ulcers. Method: Systematic review. Background: Diabetes is a chronic disease where neuropathy and peripheral vascular disease, associated with foot deformity, trauma and high plantar pressures contribute to the development of foot ulceration. For those with existing ulcers, if the foot is subject to continuous high pressures, tissue damage persists and healing will...

  4. An intelligent telemedicine system for detection of diabetic foot complications

    NARCIS (Netherlands)

    Liu, Chanjuan


    Early identification and timely treatment of diabetic foot complications are essential in preventing their devastating consequences such as lower-extremity amputation and mortality. Frequent and automatic risk assessment by an intelligent telemedicine system may be feasible and cost-effective. As th

  5. Coxsackievirus A6 and hand, foot, and mouth disease, Finland. (United States)

    Osterback, Riikka; Vuorinen, Tytti; Linna, Mervi; Susi, Petri; Hyypiä, Timo; Waris, Matti


    During fall 2008, an outbreak of hand, foot, and mouth disease (HFMD) with onychomadesis (nail shedding) as a common feature occurred in Finland. We identified an unusual enterovirus type, coxsackievirus A6 (CVA6), as the causative agent. CVA6 infections may be emerging as a new and major cause of epidemic HFMD.

  6. Onate's Foot: Remembering and Dismembering in Northern New Mexico (United States)

    Trujillo, Michael L.


    This essay analyzes the historical construction of "Spanish" icons in northern New Mexico and the complex Hispanic and Chicano identities they both evoke and mask. It focuses on the January 1998 vandalism of a statue depicting New Mexico's first Spanish colonial governor, Don Juan de Onate. The removal of the Onate statue's foot references a…

  7. The pathogenesis of Foot-and-Mouth Disease in pigs (United States)

    The greatest segment of foot-and-mouth disease (FMD) clinical research has been dedicated to elucidating pathogenesis and enhancing vaccine protection in cattle with less efforts invested in studies that are specific to pigs. However, accumulated evidence from FMD outbreaks and experimental invest...

  8. Foot-and-mouth disease: Host range and pathogenesis

    DEFF Research Database (Denmark)

    Alexandersen, Søren; Mowat, N.


    In this chapter the host range of foot-and-mouth disease (FMD) under natural and experimental conditions is reviewed. The routes and sites of infection, incubation periods and clinical and pathological findings are described and highlighted in relation to progress in understanding the pathogenesis...

  9. Morton's foot and pyridoxal 5'-phosphate deficiency: genetically linked traits. (United States)

    Nichols, Trent W; Gaiteri, Christopher


    Vitamin B6 is an essential vitamin needed for many chemical reactions in the human body. It exists as several vitamins forms but pyridoxal 5'-phosphate (PLP) is the phosphorylated form needed for transamination, deamination, and decarboxylation. PLP is important in the production of neurotransmitters, acts as a Schiff base and is essential in the metabolism of homocysteine, a toxic amino acid involved in cardiovascular disease, stroke, thrombotic and Alzheimer's disease. This report announces the connection between a deficit of PLP with a genetically linked physical foot form known as the Morton's foot. Morton's foot has been associated with fibromyalgia/myofascial pain syndrome. Another gene mutation methylenetetrahydrofolate reductase (MTHFr) is now being recognized much commonly than previous with chronic fatigue, chronic Lyme diseases and as "the missing link" in other chronic diseases. PLP deficiency also plays a role in impaired glucose tolerance and may play a much bigger role in the obesity, diabetes, fatty liver and metabolic syndrome. Without the Schiff-base of PLP acting as an electron sink, storing electrons and dispensing them in the mitochondria, free radical damage occurs! The recognition that a phenotypical expression (Morton's foot) of a gene resulting in deficiency of an important cofactor enzyme pyridoxal 5'-phosphate will hopefully alert physicians and nutritionist to these phenomena. Supplementation with PLP, L5-MTHF, B12 and trimethylglycine should be used in those patients with hyperhomocysteinemia and/or MTHFR gene mutation.

  10. How Prosody Marks Shifts in Footing in Classroom Discourse (United States)

    Skidmore, David; Murakami, Kyoko


    Prosody refers to features of speech such as intonation, volume and pace. In this paper, we examine teacher-student dialogue in an English lesson at a secondary school in England, using Conversation Analysis notation to mark features of prosody. We also make connections with Goffman's theoretical concept of footing. We show that, within an episode…

  11. Novel approaches to foot-and-mouth disease vaccine development (United States)

    The need for better Foot-and-mouth disease (FMD) vaccines is not new, a report from the Research Commission on FMD, authored by F. Loeffler and P. Frosch in 1897, highlighted the need for developing a vaccine against FMD and qualified this as a devastating disease causing “severe economic damage to ...

  12. [The BMW (biosurgical mechanical wound treatment) in diabetic foot]. (United States)

    Moch, D; Fleischmann, W; Russ, M


    The BMW-concept (Biosurgical-Mechanical-Wound treatment) is a effective supplement of already existing options of wound treatment. Based on the established principles of septic surgery vacuum sealing, instillation vacuum sealing and the application of sterile maggots optimize the treatment of diabetic foot ulcers, reduce time of treatment and offers a high comfort to the patient.


    Directory of Open Access Journals (Sweden)



    Full Text Available Hand – Foot – Mouth disease of coxsackie a virus and Enteroviruses. With symptoms like fever, sore throat, followed by Maculopapular and vesicular lesions around the oral cavity, palms and soles and recently adding to the list is onychomadesis. As a result of nail matrix function arrest, there is transverse ridging (beau’s lines, temporary loss of nail plate.

  14. Contact allergens in shoe leather among patients with foot eczema

    NARCIS (Netherlands)

    van Coevorden, AM; Coenraads, PJ; Pas, HH; van der Valk, PGM


    Some patients with relapsing foot eczema and a shoe leather allergy, who fail to show positive results with standard series and shoe wear screening tray patch testing, do not respond to the use of hypoallergenic shoe leather. We assume that relevant allergens are present in hypoallergenic shoe leath

  15. Carriers of foot-and-mouth disease virus: a review

    NARCIS (Netherlands)

    Moonen, P.; Schrijver, R.


    This review describes current knowledge about persistent foot-and-mouth disease virus (FMDV) infections, the available methods to detect carrier animals, the properties of persisting virus, the immunological mechanisms, and the risk of transmission. In particular, knowledge about the carrier state,

  16. Scenarios for eradicating foot-and-mouth disease

    NARCIS (Netherlands)

    Bos, E.J.; Leeuwen, van M.G.A.; Vlieger, de J.J.


    Research project commissioned by the Ministery of Agriculture, Nature Management and Fisheries. With the help of desk-research and input-output analysis quantitative information is assembled about the differences in cost for agribusiness and tourism of two eradication scenarios for foot-and-mouth di

  17. Patient education for preventing diabetic foot ulceration (Review)

    NARCIS (Netherlands)

    Dorresteijn, J.A.; Kriegsman, D.M.; Assendelft, W.J.J.; Valk, G.D.


    BACKGROUND: Ulceration of the feet, which can result in loss of limbs and even death, is one of the major health problems for people with diabetes mellitus. OBJECTIVES: To assess the effects of patient education on the prevention of foot ulcers in patients with diabetes mellitus. SEARCH METHODS: Eli

  18. Foot Loading Characteristics of Different Graduations of Partial Weight Bearing (United States)

    Gusinde, Johannes; Pauser, Johannes; Swoboda, Bernd; Gelse, Kolja; Carl, Hans-Dieter


    Limited weight bearing of the lower extremity is a commonly applied procedure in orthopaedic rehabilitation after reconstructive forefoot surgery, trauma surgery and joint replacement. The most frequent limitations are given as percentage of body weight (BW) and represent 10 or 50% BW. The extent of foot loading under these graduations of partial…

  19. Foot pressure distribution during walking in young and old adults

    Directory of Open Access Journals (Sweden)

    Lipsitz Lewis A


    Full Text Available Abstract Background Measurement of foot pressure distribution (FPD is clinically useful for evaluation of foot and gait pathologies. The effects of healthy aging on FPD during walking are not well known. This study evaluated FPD during normal walking in healthy young and elderly subjects. Methods We studied 9 young (30 ± 5.2 years, and 6 elderly subjects (68.7 ± 4.8 years. FPD was measured during normal walking speed using shoe insoles with 99 capacitive sensors. Measured parameters included gait phase characteristics, mean and maximum pressure and force, and relative load. Time-series measurements of each variable for all sensors were grouped into 9 anatomical masks. Results Elderly subjects had lower normalized maximum pressure for the medial and lateral calcaneal masks, and for all medial masks combined. In the medial calcaneus mask, the elderly group also had a lower absolute maximum and lower mean and normalized mean pressures and forces, compared to young subjects. Elderly subjects had lower maximum force and normalized maximum force and lower mean force and normalized mean forces in the medial masks as well. Conclusion FPD differences between the young and elderly groups were confined to the calcaneus and hallux regions and to the medial side of the foot. In elderly subjects, weight bearing on the lateral side of the foot during heel touch and toe-off phases may affect stability during walking.

  20. Integrating palliative care with usual care of diabetic foot wounds. (United States)

    Dunning, Trisha


    Palliative care is a philosophy and a system for deciding care and can be used alone or integrated with usual chronic disease care. Palliative care encompasses end-of-life care. Palliative care aims to enhance quality of life, optimize function and manage symptoms including early in the course of chronic diseases. The purposes of this article are to outline palliative care and discuss how it can be integrated with usual care of diabetic foot wounds. Many people with diabetes who have foot wounds also have other comorbidities and diabetes complications such as cardiovascular and renal disease and depression, which affect medicine and other treatment choices, functional status, surgical risk and quality of life. Two broad of diabetic foot disease exist: those likely to heal but who could still benefit from integrated palliative care such as managing pain and those where healing is unlikely where palliation can be the primary focus. People with diabetes can die suddenly, although the life course is usually long with periods of stable and unstable disease. Many health professionals are reluctant to discuss palliative care or suggest people to document their end-of-life care preferences. If such preferences are not documented, the person might not achieve their desired death or place of death and health professionals and families can be confronted with difficult decisions. Palliative care can be integrated with usual foot care and is associated with improved function, better quality of life and greater patient and family satisfaction.

  1. Effect Of Running Shoes on Foot Impact During Running

    CERN Document Server

    Nassif, Henry


    Running is part of almost every sport, and requires a great amount of stamina, endurance, mental toughness and overall strength. At every step, the foot experiences ground reaction forces necessary to support the motion of the body. With the advancements in shoe technology, running shoes have grown in popularity among runners, as well as non-runners, because they reduce the risk of injuries from the impact felt by the foot. The purpose of this report is to analyze the effect of running shoes on impact forces on the foot. This is achieved through the use of three force pads fixed at different locations on the foot The force measured by each sensor is then used to estimate the vertical ground reaction force, using the sensors' calibrations equations . Based on the ground reaction force, the effective mass corresponding to the momentum change occurring during the transient phase of the impact is estimated. The results show that running at 9 miles per hour without running shoes generates an effective mass of (14....

  2. Soft tissue chondromyxoid fibroma of the foot: sonographic findings. (United States)

    Kim, Hye Rin; Lee, Sang Min; Ha, Doo Hoe; Kang, Haeyoun; Rho, Ji Young


    Chondromyxoid fibroma is a rare benign bone tumor, which represents less than 1% of primary bone tumors. However, chondromyxoid fibroma developing in the soft tissue is extremely rare. We report the sonographic findings in a case of soft tissue chondromyxoid fibroma in the foot confirmed pathologically.

  3. Cost-effectiveness of telemonitoring of diabetic foot ulcer patients

    DEFF Research Database (Denmark)

    Fasterholdt, Iben; Gerstrøm, Marie; Rasmussen, Benjamin Schnack Brandt


    This study compared the cost-effectiveness of telemonitoring with standard monitoring for patients with diabetic foot ulcers. The economic evaluation was nested within a pragmatic randomised controlled trial. A total of 374 patients were randomised to either telemonitoring or standard monitoring...

  4. Infrared thermal imaging for automated detection of diabetic foot complications

    NARCIS (Netherlands)

    Netten, van Jaap J.; Baal, van Jeff G.; Liu, Chanjuan; Heijden, van der Ferdi; Bus, Sicco A.


    Background: Although thermal imaging can be a valuable technology in the prevention and management of diabetic foot disease, it is not yet widely used in clinical practice. Technological advancement in infrared imaging increases its application range. The aim was to explore the first steps in the ap

  5. Computer vision algorithm for diabetic foot injury identification and evaluation

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    Castaneda M, C. L.; Solis S, L. O.; Martinez B, M. R.; Ortiz R, J. M.; Garza V, I.; Martinez F, M.; Castaneda M, R.; Vega C, H. R., E-mail: [Universidad Autonoma de Zacatecas, 98000 Zacatecas, Zac. (Mexico)


    Diabetic foot is one of the most devastating consequences related to diabetes. It is relevant because of its incidence and the elevated percentage of amputations and deaths that the disease implies. Given the fact that the existing tests and laboratories designed to diagnose it are limited and expensive, the most common evaluation is still based on signs and symptoms. This means that the specialist completes a questionnaire based solely on observation and an invasive wound measurement. Using the questionnaire, the physician issues a diagnosis. In the sense, the diagnosis relies only on the criteria and the specialists experience. For some variables such as the lesions area or their location, this dependency is not acceptable. Currently bio-engineering has played a key role on the diagnose of different chronic degenerative diseases. A timely diagnose has proven to be the best tool against diabetic foot. The diabetics foot clinical evaluation, increases the possibility to identify risks and further complications. The main goal of this paper is to present the development of an algorithm based on digital image processing techniques, which enables to optimize the results on the diabetics foot lesion evaluation. Using advanced techniques for object segmentation and adjusting the sensibility parameter, allows the correlation between the algorithms identified wounds and those observed by the physician. Using the developed algorithm it is possible to identify and assess the wounds, their size, and location, in a non-invasive way. (Author)

  6. Can foot anthropometric measurements predict dynamic plantar surface contact area?

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    Collins Natalie


    Full Text Available Abstract Background Previous studies have suggested that increased plantar surface area, associated with pes planus, is a risk factor for the development of lower extremity overuse injuries. The intent of this study was to determine if a single or combination of foot anthropometric measures could be used to predict plantar surface area. Methods Six foot measurements were collected on 155 subjects (97 females, 58 males, mean age 24.5 ± 3.5 years. The measurements as well as one ratio were entered into a stepwise regression analysis to determine the optimal set of measurements associated with total plantar contact area either including or excluding the toe region. The predicted values were used to calculate plantar surface area and were compared to the actual values obtained dynamically using a pressure sensor platform. Results A three variable model was found to describe the relationship between the foot measures/ratio and total plantar contact area (R2 = 0.77, p R2 = 0.76, p Conclusion The results of this study indicate that the clinician can use a combination of simple, reliable, and time efficient foot anthropometric measurements to explain over 75% of the plantar surface contact area, either including or excluding the toe region.

  7. Foot Skin Ischemic Necrosis following Heel Prick in a Newborn

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    Esad Koklu


    Full Text Available There are only a few reports on side effects after heel prick in neonates although heel prick has been performed all over the world for many years. The medicine staff had obtained only a drop of blood by pricking the baby’s heel using a lancet without compressing the heel or foot to measure his blood glucose level 3 hours after birth. However he developed a severe and hemorrhagic skin reaction on his entire left foot, beginning 30 minutes after obtaining the drop of blood by pricking the baby’s heel using a lancet. The lesion, which was treated with topical mupirocin and povidone-iodine solution daily, slowly decreased in size and had almost fully resolved within 3 weeks. He was healthy and 9 months old at the time of writing this paper. We herein report a case of foot skin ischemic necrosis following heel prick in a newborn. To our knowledge this patient is the first case of foot skin ischemic necrosis due to heel prick in newborns.

  8. The early pathogenesis of foot-and-mouth disease (United States)

    Understanding the early pathogenesis of foot-and-mouth disease (FMD) is of critical importance to ongoing and future efforts to decrease the impact of FMD in endemic regions and prevent incursions to disease-free territories. The importance of the early phase of virus-host interaction lies in two ke...

  9. Foot trajectory approximation using the pendulum model of walking. (United States)

    Fang, Juan; Vuckovic, Aleksandra; Galen, Sujay; Conway, Bernard A; Hunt, Kenneth J


    Generating a natural foot trajectory is an important objective in robotic systems for rehabilitation of walking. Human walking has pendular properties, so the pendulum model of walking has been used in bipedal robots which produce rhythmic gait patterns. Whether natural foot trajectories can be produced by the pendulum model needs to be addressed as a first step towards applying the pendulum concept in gait orthosis design. This study investigated circle approximation of the foot trajectories, with focus on the geometry of the pendulum model of walking. Three able-bodied subjects walked overground at various speeds, and foot trajectories relative to the hip were analysed. Four circle approximation approaches were developed, and best-fit circle algorithms were derived to fit the trajectories of the ankle, heel and toe. The study confirmed that the ankle and heel trajectories during stance and the toe trajectory in both the stance and the swing phases during walking at various speeds could be well modelled by a rigid pendulum. All the pendulum models were centred around the hip with pendular lengths approximately equal to the segment distances from the hip. This observation provides a new approach for using the pendulum model of walking in gait orthosis design.

  10. Dorsalis pedis arterialized venous flap for hand and foot reconstruction

    Institute of Scientific and Technical Information of China (English)

    YU Guang; LEI Hong-yu; GUO Shuang; HUANG Jian-hua; YU Hao


    Objective:To report the results of repair of skin defects in the extremities with arterialized venous flap harvested from the lateral aspect of the dorsum of the foot.Methods:Six cases of skin and soft tissue defects over the foot and hands were resurfaced by free arterialized venous flaps,including five patients with skin defects of the hands,and one with defects at the dorsum of the foot.The flaps were harvested from the lateral aspect of the dorsum of the foot with the sizes ranging from 2 cm×5.5 cm to 6 cm×11 cm.Two veins at the proximal margin of the flap were retained,one of which was anastomosed to a recipient bed artery to provide arterial inflow and the other was anastomosed to a recipient bed vein for venous outflow.Results:All flaps demonstrated mild edema and survived completely.Blisters appeared on four flaps.Using this technique,we achieved good functional and cosmetic results in this series.Conclusions:Dorsalis pedis arterialized venous flap with rich vascular communications could enhance peripheral perfusion and decrease congestion of venous flaps,thereby improves reliability and utility for extremity reconstruction.

  11. The Diabetic Foot: The Never-Ending Challenge. (United States)

    Peter-Riesch, Bettina


    Diabetes, a major public health concern, is increasing in prevalence worldwide. A diabetic patient has an up to 25% lifetime risk of developing a foot ulcer condition that predisposes that patient to lower-extremity amputation. The underlying pathology is diabetic peripheral neuropathy and peripheral arterial disease (PAD) associated with deformities of foot anatomy due to motor neuropathy. Trauma, often secondary to ill-fitting shoes, precipitates skin breakdown, whereas PAD determines the prognosis for healing. Whenever optimal offloading is guaranteed, a neuropathic ulcer will heal, whereas an ulceration compromised by even a minor degree of arterial insufficiency has little chance of healing without revascularization. The population presenting with diabetic foot ulcers has shown a clear shift from neuropathic ulcers to neuro-ischaemic ulcers over the last two decades, underscoring the necessity to adapt management strategies to this condition. Cohort studies (the Eurodiale study group) teach us that the underlying problems are an absence of assessment of PAD, underuse of imaging and late referral for revascularization. Regarding reducing amputation rates in diabetes, a highly preventable complication, the situation is far from being under control. Prevention strategies targeting the high-risk population to avoid ulcer recurrence, optimized management by multidisciplinary foot care teams, integrated care with a clear definition of the patient itinerary and anticipated action to ameliorate ischaemia are promising options for the future.

  12. [The benefits of foot reflexology in nursing homes]. (United States)

    Simonnet, Karine


    Massages, following the foot reflexology method, were given to patients in a nursing home suffering from Alzheimer's disease or related disorders. A methodical assessment, on a small sample of patients, showed a significant reduction in neuropsychiatric manifestations, opening up new perspectives for non-medication based therapy for the care of elderly dependent people.

  13. Radiographic evaluation of foot and ankle injuries in the athlete. (United States)

    Rettig, A C; Shelbourne, K D; Beltz, H F; Robertson, D W; Arfken, P


    Injuries of the ankle and foot in athletes are quite common. They range from the extremely simple sprain to the difficult stress fracture, and may result in long-term disability. In all cases, the athlete is best treated after an accurate diagnosis is achieved.

  14. NIF Rugby High Foot Campaign from the design side (United States)

    Leidinger, J.-P.; Callahan, D. A.; Berzak-Hopkins, L. F.; Ralph, J. E.; Amendt, P.; Hinkel, D. E.; Michel, P.; Moody, J. D.; Ross, J. S.; Rygg, J. R.; Celliers, P.; Clouët, J.-F.; Dewald, E. L.; Kaiser, P.; Khan, S.; Kritcher, A. L.; Liberatore, S.; Marion, D.; Masson-Laborde, P.-E.; Milovich, J. L.; Morice, O.; Pak, A. E.; Poujade, O.; Strozzi, D.; Hurricane, O. A.


    The NIF Rugby High Foot campaign results, with 8 shots to date, are compared with the 2D FCI2 design simulations. A special emphasis is placed on the predictive features and on those areas where some work is still required to achieve the best possible modelling of these MJ-class experiments.


    Directory of Open Access Journals (Sweden)

    Amarprakash P. Dwivedi


    Full Text Available In diabetes, slight injury to the glucose laden tissue may cause chronic infection and ulcer formation. About 15% of all diabetic patients develops foot ulcer in their life time. The etiological factors include increased sugar level, diabetic micro angiopathy and peripheral neuropathy.Mainstay of treatment includes antibiotics, debridement, and local wound care and footwear improvisation. In spite of all advances in health sciences, statistics reveals that about 3% patients yet have to undergo lower limb amputation.In Sushrut samhita, we get the most scientific description of wound and its management. Similarly, Sushrut has given the utmost importance to Bloodletting therapy and considered Leech as the most unique and effective method of bloodletting even in infected wounds and abscesses.Aforesaid description led us to try Leech therapy in Diabetic foot ulcer. Patient with Diabetic foot ulcer was advised to continue anti diabetic medicine along with weekly application of Leech around the ulcer which was followed by dressing with Nimb-Haridra oil.This Leech therapy proved very effective and the ulcer healed completely within 30 days.However, further evaluation is required to be done by taking a large sample size to prove its significance in treating Diabetic foot ulcer and avoiding lower limb amputation.

  16. Foot disorders in dairy cattle: impact on cow and dairy farmer

    NARCIS (Netherlands)

    Bruijnis, M.R.N.; Beerda, B.; Hogeveen, H.; Stassen, E.N.


    This paper considers the economic consequences and the welfare impact of foot disorders in dairy cattle and the association between them, taking into account clinical and subclinical foot disorders. In dairy farming with cubicle housing and concrete floors, foot disorders are a major welfare problem

  17. Impact of Diabetes and Peripheral Arterial Occlusive Disease on the Functional Microcirculation at the Plantar Foot

    Directory of Open Access Journals (Sweden)

    Mohammad Kabbani, MD


    Conclusions: Functional microcirculation at the plantar foot differs between healthy subjects and patients suffering from diabetes or PAOD of the same age. Patients with either diabetes or PAOD demonstrate deteriorated cutaneous oxygen saturation with equivalent blood perfusion at the plantar foot. More clinical studies have to be conducted to evaluate therapeutical methods that might ameliorate cutaneous oxygen saturation within diabetic foot disease and PAOD.

  18. Influence of foot-stretcher height on rowing technique and performance. (United States)

    Buckeridge, Erica M; Weinert-Aplin, Robert A; Bull, Anthony M J; McGregor, Alison H


    Strength, technique, and coordination are crucial to rowing performance, but external interventions such as foot-stretcher set-up can fine-tune technique and optimise power output. For the same resultant force, raising the height of foot-stretchers on a rowing ergometer theoretically alters the orientation of the resultant force vector in favour of the horizontal component. This study modified foot-stretcher heights and examined their instantaneous effect on foot forces and rowing technique. Ten male participants rowed at four foot-stretcher heights on an ergometer that measured handle force, stroke length, and vertical and horizontal foot forces. Rowers were instrumented with motion sensors to measure ankle, knee, hip, and lumbar-pelvic kinematics. Key resultant effects of increased foot-stretcher heights included progressive reductions in horizontal foot force, stroke length, and pelvis range of motion. Raising foot-stretcher height did not increase the horizontal component of foot force as previously speculated. The reduced ability to anteriorly rotate the pelvis at the front of the stroke may be a key obstacle in gaining benefits from raised foot-stretcher heights. This study shows that small changes in athlete set-up can influence ergometer rowing technique, and rowers must individually fine-tune their foot-stretcher height to optimise power transfer through the rowing stroke on an ergometer.

  19. Flexible and rigid casting tape as a novel approach to offloading diabetic foot ulcers. (United States)

    Malone, M; Gannass, A Al; Bowling, F


    Offloading diabetic ulceration is a key component to the success in healing ulcers on the plantar aspect of the foot. New advances in offloading techniques allow for differing approaches in sometimes complex diabetic foot pathologies with associated ulceration. This case study looks at the use of flexible and rigid casting technique as part of the treatment in offloading plantar foot ulceration.

  20. Development of Foot Massage Program on Nausea and Vomiting for Cancer Patients: A Literature Review

    Directory of Open Access Journals (Sweden)

    Ni Ketut Guru Prapti


    Full Text Available Objective: This study aims to develop a foot massage program to support care activity in reducing nausea and vomiting for cancer patients undergoing chemotherapy. Two phases, a literature review and the development of a foot massage program were conducted. The literature review was to analyze state of the art massage techniques by reviewing problems, related theories and supporting evidence. Method: Eight published studies in the English language were reviewed. A massage can be performed for different durations, from 10 minutes up to 60 minutes for three to six weeks and can be applied on various body areas. We found that the soft stroke/effleurage seems to be the best method and is most suitable for patients with cancer. It is also evident that foot massaging can be applied as a modality to reduce nausea and vomiting for cancer patients undergoing chemotherapy. Result: We developed a foot massage program specifically for patients with cancer. The foot massage program comprised of three sessions, including 1 education session, 2 preparation session, and 3 foot massage session. In the education session, patients obtain brief information about the definition of a foot massage, the benefits and contraindication of foot massaging. During the preparation phase, foot soaking and warming up are performed. Subsequently, the foot massage is applied and should last for 30 minutes. Further research is recommended to test the effectiveness of the proposed foot massage program for nausea and vomiting in cancer patients across countries including Indonesia. Key Words: Foot massage program, chemotherapy, nausea and vomiting

  1. Shoe adaptation after amputation of the II-V phalangeal bones of the foot

    NARCIS (Netherlands)

    Rommers, G. M.; Diepstraten, H. J. M.; Bakker, E.; Lindeman, E.


    In The Netherlands, about 50% of all amputations of the lower limb are toes and forefoot amputations. Traumata of toes and mid-foot are rare. Preservation of the foot is the primary goal for treatment. Crush injuries of the foot may be associated with prolonged morbidity. This case study presents an

  2. [Role of renal sympathetic nerve and oxidative stress in foot shock-induced hypertension in rats]. (United States)

    Jiang, Ren-Di; Zhang, Zhe; Xu, Jian-Bing; Dong, Tao; Zhang, Guo-Xing


    The present study was aimed to investigate the roles of renal sympathetic nerve and oxidative stress in the development of foot shock-induced hypertension. Ninety rats were divided into 6 groups (the number of each group was 15): control group, foot shock group, denervation of renal sympathetic nerve group, denervation of renal sympathetic nerve + foot shock group, Tempol treatment + foot shock group, denervation of renal sympathetic nerve + Tempol treatment + foot shock group. Rats were received electrical foot shock for 14 days (2-4 mA, 75 V, shocks of 50-100 ms every 30 s, for 4 h each session through an electrified grid floor every day). Renal sympathetic ablation was used to remove bilateral renal sympathetic nerve in rats (rats were allowed to recover for one week before the beginning of the foot shock procedure). The antioxidant Tempol was injected intraperitoneally at 1 h before foot shock. Systolic blood pressure was measured at 1 h after foot shock on day 0, 3, 7, 10 and 14. Contents of thiobarbituric acid reactive substance (TBARS), renin, angiotensin II (AngII) and glutathione peroxidase (GSH-Px) in plasma were measured by ELISA after 14-day foot shock. The results showed that systolic blood pressure of foot shock group was significantly increased (P indirectly activate renin-angiotensin-aldosterone system, so the foot shock-induced high blood pressure may be maintained and hypertension may therefore be produced.

  3. When and how to audit a diabetic foot service. (United States)

    Leese, Graham P; Stang, Duncan


    Quality improvement depends on data collection and audit of clinical services to inform clinical improvements. Various steps in the care of the diabetic foot can be used to audit a service but need defined audit standards. A diabetes foot service should have risk stratification system in place that should compare to the population-based figures of 76% having low-risk feet, 17% moderate risk and 7% being at high risk of ulceration. Resources can then be directed towards those with high-risk feet. Prevalence of foot ulceration needs to be audited. Community-based studies give an audit standard of around 2%, with 2 to 9% having had an ulcer at some stage in the past. Amputation rates should be easier to measure, and the best results are reported to be around 1.5-3 per 1000 people with diabetes. This is a useful benchmark figure, and the rate has been shown to decrease by approximately a third over the last 15 years in some centres. Ulceration rates and ulcer healing rates are the ultimate outcome audit measure as they are always undesirable, whilst occasionally for defined individuals, an amputation can be a good outcome. In addition to clinical outcomes, processes of care can be audited such as provision of clinical services, time from new ulcer to be seen by health care professional, inpatient foot care or use of antibiotics. Measurement of clinical services can be a challenge in the diabetic foot, but it is essential if clinical services and patient outcomes are to be improved.

  4. The status of the light-footed clapper rail (United States)

    Wilbur, S.R.


    Only 12 California marsh areas are presently believed to be inhabited by the Light-footed Clapper Rail, and eight of these appear to support only 5-15 birds apiece. Tentative estimates for the other four are: Anaheim Bay 200, Upper Newport 30-35, Los Penasquitos 30, and Tijuana Estuary 150. These estimates, admittedly very rough, indicate a total Light-footed Rail population on only about 500 birds. Recognizing that rails are secretive and hard to inventory, the actual count could be somewhat higher, but I feel it is most unlikely that the number could be more than 750 birds altogether. Reductions in Light-footed Clapper Rail populations can be attributed almost entirely to loss of habitat. An estimated 26,000 acres of saltmarsh once existed between Santa Barbara and the Mexican border. At present there are approximately 8500 acres, much of which has been degraded by pollution, water diversion, and restriction of tidal flow. Of those areas currently occupied by Clapper Rails, few can be considered to have a very secure future. Of the four major areas only Anaheim Bay appears to be relatively safe from future habitat destruction. Tijuana Estuary, Los Penasquitos Lagoon, and Upper Newport Bay are all threatened by commercial developments that could reduce or destroy local rail populations. I have not visited Baja California, but I believe there is still a substantial population of Clapper Rails in the marshes around San Quintin Bay. Taxonomists do not agree on the subspecific identity of these birds, but some feel they are representatives of the Light-footed race. If so, it is fortunate to have a relatively secure (for now) reservoir of these birds, but whether the Light-footed Clapper Rail survives within the United States may well be decided within the next few years.

  5. Staphylococcus aureus small colony variants in diabetic foot infections

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    Estrella Cervantes-García


    Full Text Available Background: Staphylococcus aureus (S. aureus is one of the major pathogens causing chronic infections. The ability of S. aureus to acquire resistance to a diverse range of antimicrobial compounds results in limited treatment options, particularly in methicillin-resistant S. aureus (MRSA. A mechanism by which S. aureus develops reduced susceptibility to antimicrobials is through the formation of small colony variants (SCVs. Infections by SCVs of S. aureus are an upcoming problem due to difficulties in laboratory diagnosis and resistance to antimicrobial therapy. Methods: A prospective study was performed on 120 patients diagnosed with both type 2 diabetes mellitus and infected diabetic foot ulcers. The study was carried out from July 2012 to December 2013 in Hospital General de Mexico. The samples were cultured in blood agar, mannitol salt agar, and MacConkey agar media, and incubated at 37°C in aerobic conditions. Results: We describe the first known cases of diabetic foot infections caused by MRSA-SCVs in patients diagnosed with type 2 diabetes mellitus and infected diabetic foot ulcers. In all of our cases, the patients had not received any form of gentamicin therapy. Conclusions: The antibiotic therapy commonly used in diabetic patients with infected diabetic foot ulcers fails in the case of MRSA-SCVs because the intracellular location protects S. aureus-SCVs from the host's defenses and also helps them resist antibiotics. The cases studied in this article add to the spectrum of persistent and relapsing infections attributed to MRSA-SCVs and emphasizes that these variants may also play a relevant role in diabetic foot infections.

  6. Staphylococcus aureus small colony variants in diabetic foot infections (United States)

    Cervantes-García, Estrella; García-Gonzalez, Rafael; Reyes-Torres, Angélica; Resendiz-Albor, Aldo Arturo; Salazar-Schettino, Paz María


    Background Staphylococcus aureus (S. aureus) is one of the major pathogens causing chronic infections. The ability of S. aureus to acquire resistance to a diverse range of antimicrobial compounds results in limited treatment options, particularly in methicillin-resistant S. aureus (MRSA). A mechanism by which S. aureus develops reduced susceptibility to antimicrobials is through the formation of small colony variants (SCVs). Infections by SCVs of S. aureus are an upcoming problem due to difficulties in laboratory diagnosis and resistance to antimicrobial therapy. Methods A prospective study was performed on 120 patients diagnosed with both type 2 diabetes mellitus and infected diabetic foot ulcers. The study was carried out from July 2012 to December 2013 in Hospital General de Mexico. The samples were cultured in blood agar, mannitol salt agar, and MacConkey agar media, and incubated at 37°C in aerobic conditions. Results We describe the first known cases of diabetic foot infections caused by MRSA-SCVs in patients diagnosed with type 2 diabetes mellitus and infected diabetic foot ulcers. In all of our cases, the patients had not received any form of gentamicin therapy. Conclusions The antibiotic therapy commonly used in diabetic patients with infected diabetic foot ulcers fails in the case of MRSA-SCVs because the intracellular location protects S. aureus-SCVs from the host's defenses and also helps them resist antibiotics. The cases studied in this article add to the spectrum of persistent and relapsing infections attributed to MRSA-SCVs and emphasizes that these variants may also play a relevant role in diabetic foot infections. PMID:25787018

  7. Development of an Active Ankle Foot Orthosis to Prevent Foot Drop and Toe Drag in Hemiplegic Patients: A Preliminary Study

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    Jungyoon Kim


    Full Text Available We developed an active ankle-foot orthosis (AAFO that controls dorsiflexion/plantarflexion of the ankle joint to prevent foot drop and toe drag during hemiplegic walking. To prevent foot slap after initial contact, the ankle joint must remain active to minimize forefoot collision against the ground. During late stance, the ankle joint must also remain active to provide toe clearance and to aid with push-off. We implemented a series elastic actuator in our AAFO to induce ankle dorsiflexion/plantarflexion. The activator was controlled by signals from force sensing register (FSR sensors that detected gait events. Three dimensional gait analyses were performed for three hemiplegic patients under three different gait conditions: gait without AFO (NAFO, gait with a conventional hinged AFO that did not control the ankle joint (HAFO, and gait with the newly-developed AFO (AAFO. Our results demonstrate that our newly-developed AAFO not only prevents foot drop by inducing plantarflexion during loading response, but also prevents toe drag by facilitating plantarflexion during pre-swing and dorsiflexion during swing phase, leading to improvement in most temporal-spatial parameters. However, only three hemiplegic patients were included in this gait analysis. Studies including more subjects will be required to evaluate the functionality of our newly developed AAFO.


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    Full Text Available BACKGROUND: Multiple parameters are in use for the accurate assessment of the gestational age by ultrasound, but the literature suggests that fetal foot length can be used to estimate gestational age, when other parameters are not available for measurement. Foetal femur/ foot length ratio can help in differentiating the foeti that have dysplastic limb reduction, from those whose limbs are short because of constitutional factors/IUGR. A prospective study was done to measure the fetal foot length for gestational age and to evaluate fetal femur to foot length ratio in pregnant women of 16-37 weeks gestation. MATERIALS & METHOD: One hundred and three normal singleton pregnant women of 16-37 weeks gestation were examined for routine obstetrics ultrasound. In these patients fetal foot length measurements were taken and the gestational age was assessed. In addition, fetal femur length to foot length ratio was calculated in each patient. RESULTS/OBSERVATION: Linear relationship between foot length and gestational age was present with a R2 value of 0.90 (p < than 0.001 and the fetal femur length/foot length ratio was found to be more than or equal to 0.92.The foot length can be a reliable parameter for use in assessment of gestational age and as most skeletal dysplasias spare the feet, the fetal femur length/foot length ratio can be used to detect most skeletal dysplasia. CONCLUSIONS: Foetal foot length is a reliable parameter for assessment of gestational age and femur length/foot length ratio is approximately 1 and a ratio of < 0.92 shall be useful in the detection of most skeletal dysplasia.

  9. [The importance of multidisciplinary foot-care services in the management of diabetic patients with peripheral artery disease and diabetic foot ulcers]. (United States)

    Ran, Xing-Wu; Zhao, Ji-Chun


    Diabetic peripheral artery disease and diabetic foot ulcers are leading causes of hospitalization, for patients with diabetes mellitus, and also are the most important causes of amputation of the lower extremity in those patients, which contribute to the increased mortality and cardiovascular death. The incidence of diabetic peripheral artery disease and diabetic foot ulcers shows increasing trend. Diabetic peripheral artery disease and diabetic foot ulcers can be successfully treated only by the multidisciplinary foot-care services which provide more comprehensive and integrated care as compared to ordinary medical team or single specialist. Multidisciplinary foot-care services are provided by the team consist of: diabetologist, diabetes nurse, vascular surgeon, general surgeon, orthopedist, orthopaedic surgeon, podiatrist and orthotist, interventional radiologist and a radiology coordinator, microbiologist, psychologist, educators, shoemaker and rehabilitation team. Contrary to developed countries, multidisciplinary foot-care team has not been constructed in most centres in China. Diabetic education, appropriate foot care, early detection of risk factors of foot ulcers and early intervention are key components in the overall management of diabetic foot disorders and have assumed important roles in programs focused on amputation prevention. Prompt and aggressive treatments of diabetic peripheral artery disease and diabetic foot ulcers can often prevent an exacerbation of the problem and the potential need for amputation, which include correction of biomechanical abnormalities, infection control, serial debridement of ulcers, peripheral revascularization and wound coverage, etc. It is very important to construct a multidisciplinary diabetic foot care team to more effectively improve the survival and prognosis of patients with diabetic peripheral artery disease and diabetic foot ulcers with comprehensive treatments.

  10. Potential rapid evolution of foot morphology in Italian plethodontid salamanders (Hydromantes strinatii) following the colonization of an artificial cave. (United States)

    Salvidio, S; Crovetto, F; Adams, D C


    How organisms respond to environmental change is a long-standing question in evolutionary biology. Species invading novel habitats provide an opportunity to examine contemporary evolution in action and decipher the pace of evolutionary change over short timescales. Here, we characterized phenotypic evolution in the Italian plethodontid salamander, Hydromantes strinatii, following the recent colonization of an artificial cave by a forest floor population. When compared with a nearby and genetically related population in the natural forest floor and a nearby cave population, the artificial cave population displayed significant differences in overall foot shape, with more interdigital webbing relative to the other populations. Further, this population evolved significantly larger feet, which corresponded more closely to those found in other cave populations than to forest floor populations to which the cave population is closely related. Finally, we quantified the rate of evolution for both foot shape and foot area, and found that both traits displayed large and significant evolutionary rates, at levels corresponding to other classic cases of rapid evolution in vertebrates. Together, these findings reveal that the response to novel environmental pressures can be large and rapid and that the anatomical shifts observed in the artificial cave population of H. strinatii may represent a case of rapid evolution in response to novel environmental pressures.

  11. Mechanics of the foot Part 2: A coupled solid-fluid model to investigate blood transport in the pathologic foot. (United States)

    Mithraratne, K; Ho, H; Hunter, P J; Fernandez, J W


    A coupled computational model of the foot consisting of a three-dimensional soft tissue continuum and a one-dimensional (1D) transient blood flow network is presented in this article. The primary aim of the model is to investigate the blood flow in major arteries of the pathologic foot where the soft tissue stiffening occurs. It has been reported in the literature that there could be up to about five-fold increase in the mechanical stiffness of the plantar soft tissues in pathologic (e.g. diabetic) feet compared with healthy ones. The increased stiffness results in higher tissue hydrostatic pressure within the plantar area of the foot when loaded. The hydrostatic pressure acts on the external surface of blood vessels and tend to reduce the flow cross-section area and hence the blood supply. The soft tissue continuum model of the foot was modelled as a tricubic Hermite finite element mesh representing all the muscles, skin and fat of the foot and treated as incompressible with transversely isotropic properties. The details of the mechanical model of soft tissue are presented in the companion paper, Part 1. The deformed state of the soft tissue continuum because of the applied ground reaction force at three foot positions (heel-strike, midstance and toe-off) was obtained by solving the Cauchy equations based on the theory of finite elasticity using the Galerkin finite element method. The geometry of the main arterial network in the foot was represented using a 1D Hermite cubic finite element mesh. The flow model consists of 1D Navier-Stokes equations and a nonlinear constitutive equation to describe vessel radius-transmural pressure relation. The latter was defined as the difference between the fluid and soft tissue hydrostatic pressure. Transient flow governing equations were numerically solved using the two-step Lax-Wendroff finite difference method. The geometry of both the soft tissue continuum and arterial network is anatomically-based and was developed using

  12. Comparison of foot pain and foot care among rheumatoid arthritis patients taking and not taking anti-TNFα therapy: an epidemiological study. (United States)

    Otter, S J; Lucas, K; Springett, K; Moore, A; Davies, K; Young, A; Walker-Bone, K


    Epidemiological studies report foot pain affects more than 90% of people with rheumatoid arthritis (RA). Most data about foot involvement in RA were collected prior to the availability of novel treatments such as biologics. The objective of this study is to compare the prevalence of foot symptoms, frequency of foot examination, and access to foot care services among RA patients currently treated with anti-TNFα to those not receiving biologics. This study is a cross-sectional epidemiological study: a 28-item self-administered questionnaire was posted to 1,040 people with RA throughout the UK. Overall, 585 (55%) useable replies were received, and 120 (20.5%) respondents were currently taking anti-TNFα medication. Prevalence of current foot pain was 99% among the biologics group compared with 76% not treated with biologics. Stiffness, swelling, and numbness in the feet were all significantly more common in the anti-TNFα group (P foot pain with their rheumatologist, but only 70% were receiving podiatry (compared to 78% not taking anti-TNFα). Subjects reported that their feet were examined significantly less frequently (P Foot complaints are common in this group, and allied health professions could enhance rheumatological care by undertaking foot assessment.

  13. International Foot and Ankle Biomechanics Community (i-FAB: past, present and beyond

    Directory of Open Access Journals (Sweden)

    Rosenbaum Dieter


    Full Text Available Abstract The International Foot and Ankle Biomechanics Community (i-FAB is an international collaborative activity which will have an important impact on the foot and ankle biomechanics community. It was launched on July 2nd 2007 at the foot and ankle session of the International Society of Biomechanics (ISB meeting in Taipei, Taiwan. i-FAB is driven by the desire to improve our understanding of foot and ankle biomechanics as it applies to health, disease, and the design, development and evaluation of foot and ankle surgery, and interventions such as footwear, insoles and surfaces.

  14. Surgical Correction of the Achilles Tendon for Diabetic Foot Ulcerations and Charcot Neuroarthropathy. (United States)

    Ramanujam, Crystal L; Zgonis, Thomas


    Achilles tendon pathologic conditions are implicated in contributing to the development of many diabetic foot complications including diabetic foot ulceration and Charcot neuroarthropathy. Surgical correction of the diabetic equinus deformity has been studied as an isolated or adjunctive treatment when dealing with difficult-to-close diabetic foot ulcerations or when surgically addressing the diabetic Charcot neuroarthropathy foot or ankle. This article reviews the most common indications, complications, and surgical procedures for equinus correction by either a tendo-Achilles lengthening or gastrocnemius recession for the management of diabetic foot conditions.

  15. The Assessment of Social Support and Self-Care Requisites for Preventing Diabetic Foot Ulcer in Diabetic Foot Patients

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    Mohammad Taher


    Full Text Available Background and Objectives: Diabetic foot as one of the most common complications of diabetes is involved in more than %25 of diabetic patients’ lives, and if not treated properly can lead to amputation up to %20. The lack of self-care is the underlying cause of mortality, morbidity and chronic complications of diabetes. Identification and rectifying of diabetic foot care needs of patients can additionally reduce readmission; also, %85 of diabetic foot problems can be prevented. Materials and Methods: In this descriptive study, 130patients with diabetic foot from Shahid Modarres hospital were selected using census method. Data in forms of demographic questionnaire, self-care requisites assessment tool for preventing diabetic foot ulcer, and Social Support Behavior Scale were completed by patients and then were collected. Data were analyzed by SPSS version 16. Results: In this study, a significant relationship was found between self-care and social support (P<0.05. This means that people with better social support reported better self-care than those with weaker social support. A significant relationship in level of education and monthly income with self-care was seen, as well as in level of education, monthly income and marital status with social support (P<0.001. Conclusions: The results showed that social support can be considered as an effective factor in individual self-care behaviors, and with regard to this factor in educational, treatment and care programs of patients, can improve their self-care, in addition to decreasing economic costs, and improve their qualities of lives as well.

  16. Multi-segment transpedicle spinal fixation for thoracolumbar fractures with ankylosing spondylitis:one-year follow-up%多节段椎弓根钉置入治疗强直性脊柱炎合并胸腰椎骨折:1年随访

    Institute of Scientific and Technical Information of China (English)

    武兴国; 黄健; 蒋煜青; 郭伟康; 王军


    背景:对于强直性脊柱炎合并胸腰椎骨折患者,采用传统方法行短节段经椎弓根内固定或前路钉板或钉棒系统固定由于其骨质疏松明显,螺钉抗拔出力较差,治疗后容易出现内固定松动。  目的:探讨多节段经椎弓根内固定治疗强直性脊柱炎合并胸腰椎骨折的效果。  方法:选择2009年1月至2012年12月中山大学附属梅州医院骨科收治的强直性脊柱炎合并胸腰椎骨折患者11例,行后路复位多节段椎弓钉内固定,其中6例采用经伤椎椎弓根固定。  结果与结论:11例患者均获随访,随访时间13-36个月。所有患者影像学显示均骨性愈合,未见内固定松动断裂现象。3例脊髓神经损伤按Frankel分级由C级恢复至E级。JOA评分评估腰背痛改善率为100%。结果显示经后路复位多节段椎弓根钉置入治疗强直性脊柱炎合并胸腰椎骨折,可获得坚强内固定,骨折愈合良好。%BACKGROUND:Because of osteoporosis, short-segment transpedicular fixation or screw-rod system fixation is prone to screw loosening depending on its poor anti-pul-out strength in patients with thoracolumbar fracture with ankylosing spondylitis. OBJECTIVE:To probe the clinic outcomes of multi-segment transpedicle spinal fixation for thoracolumbar fractures with ankylosing spondylitis. METHODS:Eleven patients with ankylosing spondylitis combined with thoracolumbar fracture in the Fourth Department of Orthopedics, Meizhou Hospital, Sun Yat-sen University, China from January 2009 to December 2012 were selected. Al the patients underwent posterior reduction and multi-segment transpedicle spinal fixation, among whom, six cases were subjected to internal fixation through the pedicle of fractured vertebra. RESULTS AND CONCLUSION:Al of the 11 patients were fol owed up for 13 to 36 months. Solid bone healing was achieved in al of the patients, and there were no complications related to the

  17. MR imaging of inflammatory joint diseases of the foot and ankle

    Energy Technology Data Exchange (ETDEWEB)

    Weishaupt, D.; Schweitzer, M.E.; Alam, F.; Karasick, D. [Thomas Jefferson Univ., Philadelphia, PA (United States). Dept. of Radiology; Wapner, K. [Dept. of Orthopedic Surgery, Hahneman Medical College, Philadelphia, PA (United States)


    Pain affecting the foot and ankle is a common complaint frequently attributable to inflammatory joint diseases. Although conventional radiography is regarded as the initial step in the diagnostic investigation, MR imaging may contribute to further evaluation of these patients due to the direct visualization of the inflammatory soft tissue formed in the disease and its effects on bone, cartilage and para-articular structures. The high spatial resolution of MR imaging combined with tissue characterization often allows initial detection of inflammatory joint abnormalities at a stage that precedes radiographic evaluation. The typical MR appearance of certain inflammatory joint disorders may be helpful in narrowing the wide differential diagnosis. Furthermore, MR imaging can be used for an exact assessment of the extent of the disorder as well as its complications. Accurate diagnostic information can guide the clinician in further diagnostic tests and implementation of proper therapeutic treatment. (orig.)

  18. Brachymetatarsia with accessory navicular in right foot: A rare coincidental finding

    Institute of Scientific and Technical Information of China (English)

    Praveen Kumar Pandey; Inder Pawar; Sandeep Kumar Beniwal; Raaghav R.Verma


    A 33 years old female patient presented with posttraumatic pain in the right foot for which radiographs of the right foot was advised.No fracture was detected on radiographs and patient was managed conservatively on medications and posterior splint immobilization.We found coincidentally a short fourth metatarsal and an accessory navicular bone in the right foot radiographs.After 3 weeks of immobilization,she underwent mobilization of the right foot,weight bearing and intensive physiotherapy for 6 weeks.After two months of injury she was still complaining of pain on the plantar aspect of right foot which was diagnosed as metatarsalgia and operated on by excision of the neuroma present in the 3rd web space of the right foot.After surgery she was completely relieved of pain and could do activities well related to the right foot.

  19. Cervical posterior implant fixation for multi-segment cervical spondylotic myelopathy:improves symptoms but diminishes cervical range of motion%颈椎后路植入物固定修复多节段脊髓型颈椎病:可改善症状但降低了颈椎活动度

    Institute of Scientific and Technical Information of China (English)

    赵勇; 褚言琛; 李学森; 马金龙; 邹云雯


    BACKGROUND:Cervical Open-door laminoplasty with unilateral mass screw fixation and laminectomy with bilateral mass screw fixation are both procedures that treat cervical spondylotic myelopathy by expanding the space available for the spinal cord. Effectiveness and safety of two operative methods remain unclear. OBJECTIVE:To investigate the biocompatibility of implant and host between open-door laminoplasty with unilateral mass screw fixation and laminectomy with bilateral mass screw fixation to treat multi-segment cervical spondylotic myelopathy. METHODS: Data of 117 patients with multi-segment cervical spondylotic myelopathy (≥ 3 segments) were retrospectively analyzed. Sixty-five cases underwent open-door laminoplasty with unilateral mass screw fixation (laminoplasty group). Fifty-two cases underwent laminectomy with bilateral mass screw fixation (laminectomy group). Clinical outcomes were evaluated by the Japanese Orthopaedic Association scoring system and by recovery rate. Cervical curvature index and cervical range of motion were assessed by X-ray films in both groups. RESULTS AND CONCLUSION:The average folow-up time was 28 months (range 12-59 months) in both groups. No C5 nerve root palsy occurred in the two groups. Japanese Orthopaedic Association scores were greater during final folow-up than pre-fixation in both groups (P 0.05). Cervical range of motion was lower during final folow-up than pre-fixation in both groups (P 0.05)。两组末次随访颈椎活动度均低于固定前(P <0.01)。结果说明,颈后路单开门椎管成形单侧侧块内固定与全椎板切除双侧侧块内固定在改善神经功能、缓解疼痛、减少并发症上有相似的疗效,但一定程度上降低了颈椎活动度。

  20. An exploration of diabetic foot screening procedures data by a multiple correspondence analysis (United States)

    Rovan, Jože


    Abstract Aims Gangrene and amputation are among most feared complications of diabetes mellitus. Early detection of patients at high risk for foot ulceration can prevent foot complications. Regular foot screening (medical history, foot examination and classification into risk groups) was introduced at the out-patient diabetes clinic in Ljubljana in November 1996. We aimed to explore the relationships between the observed variables, check the appropriateness of the risk status classification and of the post-screening decisions. Methods The data of 11.594 patients, obtained in 18 years, were analysed by multiple correspondence analysis (MCA). Most of the observed variables were categorical. Results The majority of the screened population was free of foot complications. We demonstrated an increasing frequency and severity of foot problems with an increasing age, as well as the association between the loss of protective sensation and the history of foot ulceration, foot deformity and callus formation, the history of foot ulcer or amputation and acute foot ulceration. A new finding was that the location of foot deformity points was closer to female than male gender, indicating the possible role of fashionable high-heel footwear. The appropriateness of therapeutic decisions was confirmed: the points representing absent foot pulses and referral to vascular specialist were close together, as well as points representing foot deformity and special footwear prescription or callus formation and referral to pedicurist. Conclusions MCA was applied to the data on foot pathology in the population attending the out-patient diabetes clinic. The method proved to be a useful statistical tool for analysing the data of screening procedures. PMID:28289465

  1. Kinematic coupling relationships exist between non-adjacent segments of the foot and ankle of healthy subjects

    NARCIS (Netherlands)

    Dubbeldam, R.; Nester, C.; Nene, A.V.; Hermens, H.J.; Buurke, J.H.


    Pathologies of foot and ankle structures affect the kinematics at the site of the impaired structure but also influence kinematics elsewhere in the foot and ankle. An understanding of kinematic coupling relationships in the foot could provide insight into mechanisms that explain differences in foot

  2. Necrotizing Fasciitis and The Diabetic Foot. (United States)

    Iacopi, Elisabetta; Coppelli, Alberto; Goretti, Chiara; Piaggesi, Alberto


    Necrotizing fasciitis (NF) represents a rapidly progressive, life-threatening infection involving skin, soft tissue, and deep fascia. An early diagnosis is crucial to treat NF effectively. The disease is generally due to an external trauma that occurs in predisposed patients: the most important risk factor is represented by diabetes mellitus. NF is classified into 3 different subtypes according to bacterial strains responsible: type 1 associated to polymicrobial infection, type 2 NF, generally associated to Streptococcus species, often associated to Staphylococcus aureus and, eventually, Type 3, due to Gram-negative strains, such as Clostridium difficile or Vibrio. NF is usually characterized by the presence of the classic triad of symptoms: local pain, swelling, and erythema. In daily clinical practice immune-compromised or neuropathic diabetic patients present with atypical symptomatology. This explains the high percentage of misdiagnosed cases in the emergency department and, consequently, the worse outcome presented by these patients. Prompt aggressive surgical debridement and antibiotic systemic therapy are the cornerstone of its treatment. These must be associated with an accurate systemic management, consisting in nutritional support, glycemic compensation, and hemodynamic stabilization. Innovative methods, such as negative pressure therapy, once the acute conditions have resolved, can help fasten the surgical wound closure. Prompt management can improve prognosis of patients affected from NF reducing limb loss and saving lives.

  3. New Research Methods Developed for Studying Diabetic Foot Ulceration (United States)


    Dr. Brian Davis, one of the Cleveland Clinic Foundation's researchers, has been investigating the risk factors related to diabetic foot ulceration, a problem that accounts for 20 percent of all hospital admissions for diabetic patients. He had developed a sensor pad to measure the friction and pressure forces under a person's foot when walking. As part of NASA Lewis Research Center's Space Act Agreement with the Cleveland Clinic Foundation, Dr. Davis requested Lewis' assistance in visualizing the data from the sensor pad. As a result, Lewis' Interactive Data Display System (IDDS) was installed at the Cleveland Clinic. This computer graphics program is normally used to visualize the flow of air through aircraft turbine engines, producing color two- and three-dimensional images.

  4. Rayleigh wave scattering at the foot of a mountain

    Directory of Open Access Journals (Sweden)

    P. S. Deshwal


    Full Text Available A theoretical study of scattering of seismic waves at the foot of a mountain is discussed here. A mountain of an arbitrary shape and of width a (0≤x≤a, z=0 in the surface of an elastic solid medium (z≥0 is hit by a Rayleigh wave. The method of solution is the technique of Wiener and Hopf. The reflected, transmitted and scattered waves are obtained by inversion of Fourier transforms. The scattered waves behave as decaying cylindrical waves at distant points and have a large amplitude near the foot of the mountain. The transmitted wave decreases exponentially as its distance from the other end of the mountain increases.

  5. Optimal Cost-Analysis and Design of Circular Footings

    Directory of Open Access Journals (Sweden)

    Prabir K. Basudhar


    Full Text Available The study pertains to the optimal cost-analysis and design of a circular footing subjected to generalized loadings using sequential unconstrained minimization technique (SUMT in conjunction with Powell’s conjugate direction method for multidimensional search and quadratic interpolation method for one dimensional minimization. The cost of the footing is minimized satisfying all the structural and geotechnical engineering design considerations. As extended penalty function method has been used to convert the constrained problem into an unconstrained one, the developed technique is capable of handling both feasible and infeasible initial design vector. The net saving in cost starting from the best possible manual design ranges from 10 to 20 %. For all practical purposes, the optimum cost is independent of the initial design point. It was observed that for better convergence, the transition parameter  should be chosen at least 100 times the initial penalty parameter kr .

  6. Surgical reconstruction of charcot foot neuroarthropathy, a case based review. (United States)

    Kučera, Tomáš; Šponer, Pavel; Šrot, Jaromír


    Our case-based review focuses on limb salvage through operative management of Charcot neuroarthropathy of the diabetic foot. We describe a case, when a below-knee amputation was considered in a patient with chronic Charcot foot with a rocker-bottom deformity and chronic plantar ulceration. Conservative treatment failed. Targeted antibiotic therapy and operative management (Tendo-Achilles lengthening, resectional arthrodesis of Lisfranc and midtarsal joints, fixation with large-diameter axial screws, and plaster cast) were performed. On the basis of this case, we discuss options and drawbacks of surgical management. Our approach led to healing of the ulcer and correction of the deformity. Two years after surgery, we observed a significant improvement in patient's quality of life. Advanced diagnostic and imaging techniques, a better understanding of the biomechanics and biology of Charcot neuroarthropathy, and suitable osteosynthetic material enables diabetic limb salvage.

  7. Hunting efficiency of Red-footed Falcons in different habitats

    Directory of Open Access Journals (Sweden)

    Palatitz Péter


    Full Text Available We studied hunting success of 13 male Red-footed Falcons by radio-telemetry in the second phase of chick rearing. We coded 484 hunting events, and the success measured in captured prey biomass/minute was exceedingly high in corn fields. This is mainly caused by the fact that the effectiveness of hunting for vertebrate prey was high on the harvested stubble fields. Moreover the observed falcons hunted for insects in these stubble field and alfalfa fields most successfully. In the studied habitat the chick feeding period of Red-footed Falcons coincide with the harvest of cereal fields, and the suddenly created lower vegetation cover increases temporarily the accessibility of prey items.

  8. Foot and Ankle Deformity in Young Acrobatic and Artistic Gymnasts

    Directory of Open Access Journals (Sweden)

    Sobera Anna


    Full Text Available Purpose. The aim of the paper was to determine the occurrence of feet and ankle deformities in trampoline and artistic gymnasts. Methods. Ten acrobatic gymnasts (trampolinists and 10 artistic gymnasts aged 6-14 years were recruited. The calcaneal-tibial (rearfoot angle was determined as the angle of the upper calcaneal tendon and the longitudinal heel axis while Clarke angles were determined by podoscopy. Results. The trampolinists showed significantly greater medial angulation (calcaneal valgus than the group of gymnasts. Right and left foot Clark’s angles in both the trampoline and artistic gymnasts were above 55°. Conclusions. Trampolinists exhibit significantly more pronounced calcaneal valgus than artistic gymnasts. The prevalence of foot and ankle deformities in both populations should be addressed by coaches in the gymnastics training of young children.

  9. Journal of Foot and Ankle Research, one year on

    Directory of Open Access Journals (Sweden)

    Borthwick Alan M


    Full Text Available Abstract Journal of Foot and Ankle Research was launched one year ago, and a number of its key achievements are highlighted in this editorial. Although the journal is underpinned by professional bodies associated with the podiatry professions in the UK and Australasia, its content is aimed at the wider foot and ankle research community. Nevertheless, the journal's achievements over the past year reflect the development of research in the profession of podiatry. From this perspective, the journal may be viewed as contributing to the overall attainment of some of the profession's key goals and strategic aims over the last decade, across the UK and Australasia. The journal has also witnessed policy changes in the last year, and these are discussed - notably, the decision not to accept case reports for publication. We also report on a few of the key metrics, providing readers with a summary of the journal's performance over the last year.

  10. Pneumococcal Meningitis in an Adolescent with Fever and Foot Ache

    Directory of Open Access Journals (Sweden)

    Catarina Dias


    Full Text Available Invasive pneumococcal disease predominantly affects younger children, elderly, and immunocompromised patients. Pneumococcal meningitis is a particularly important form of presentation, considering its high rate of morbimortality. We present the case of a previously healthy 12-year-old adolescent male who was hospitalized due to suspicion of osteoarticular infection in his left foot. A few hours later, he developed meningeal signs, exhibiting slight pleocytosis and Streptococcus pneumoniae isolates in both cerebrospinal fluid and blood. Imaging studies were inconclusive regarding the nature of the foot disorder. We considered the hypothesis of osteomyelitis of the navicular bone as the most likely, for which he completed six weeks of antibiotic therapy. There was a favorable clinical evolution, along with complete absence of osteoarticular or neurological sequelae. The relevance of this clinical case resides in the unusual presentation of invasive pneumococcal disease in this age group, as well as in the rare form of orthopedic involvement.

  11. [Pathophysiological aspects of wound healing in normal and diabetic foot]. (United States)

    Maksimova, N V; Lyundup, A V; Lubimov, R O; Melnichenko, G A; Nikolenko, V N


    The main cause of long-term healing of ulcers in patients with diabetic foot is considered to be direct mechanical damage when walking due to reduced sensitivity to due to neuropathy, hyperglycemia, infection and peripheral artery disease. These factors determine the standard approaches to the treatment of diabeticfoot, which include: offloading, glycemic control, debridement of ulcers, antibiotic therapy and revascularization. Recently, however, disturbances in the healing process of the skin in diabetes recognized an additional factor affecting the timing of healing patients with diabetic foot. Improved understanding and correction of cellular, molecular and biochemical abnormalities in chronic wound in combination with standard of care for affords new ground for solving the problem of ulcer healing in diabetes.

  12. Kinematic correlates of walking cadence in the foot. (United States)

    Caravaggi, Paolo; Leardini, Alberto; Crompton, Robin


    Evidence has frequently been reported of modifications in gait patterns within the lower limb related to the cadence of walking. Most reports have concerned relationships between cadence and kinematic and the kinetic changes occurring in the main joints and muscles of the lower limb as a whole. The aim of the present study was to assess whether significant changes are also measurable in kinematics of the foot segments. An existing 15 marker-set protocol allowed a four-segment foot and shank model to be defined for relative rotations between the segments to be calculated. Stereophotogrammetry was employed to record marker position data from ten subjects walking at three cadences. The slow- and normal cadence datasets showed similar profiles of joint rotation in three anatomical planes, but significant differences were found between these and the fast cadence. At all joints, frame-by-frame statistical analysis revealed increased dorsiflexion from heel-strike to midstance (p walking.

  13. Foot anomalies in Antley-Bixler syndrome: three case reports. (United States)

    Nakamura, Naoyuki; Adachi, Masanori; Machida, Jiro; Okuzumi, Shigeharu


    Multiple joint contractures, including radiohumeral synostosis, are the hallmark of Antley-Bixler syndrome (ABS). The detailed description of the skeletal aberration, however, focused in feet is scarce. We carried out the scrutiny for foot lesion in three ABS patients with POR (nicotinamide adenine dinucleotide phosphate-oxidase-cytochrome P450 oxidoreductase) gene mutations, one of whom had undergone surgical intervention for difficulty in walking. Radiographs in all three patients showed middle cuneiform-second metatarsal synostosis and the fourth brachymetapody, irrespective of the severity of their systemic manifestations. In addition, talocalcaneal synostosis, lateral cuneiform-cuboid synostosis, defects of middle phalanx, and distal phalanx-middle phalanx synostosis were found in at least two patients. In conclusion, we found distinctive constellations of foot abnormalities in the patients of ABS with POR gene mutation, which may be useful in planning the treatment strategy, as well as in the diagnostic process.

  14. Chiropractic manipulation for the foot: Diversified chiropractic techniques. (United States)

    Lawrence, D J


    There has been increasing acceptance and development of manual methods in providing for the needs of patients with musculoskeletal dysfunction. Several professions have helped fuel this growth, including the chiropractic profession. To date, there has been only a small amount of collaboration between chiropractors and physical therapists. This paper provides a base foundation for one small part of general chiropractic practice, i.e. procedures used for manipulating the foot. Information is provided about the specific diagnostic procedures used by the chiropractic profession in assessing the joints and soft tissues of the foot, followed by descriptions of a number of chiropractic manipulative techniques drawn from the form of chiropractic in widest usage, Diversified technique. For each technique, information is provided on indications for use, patient position, therapist position, hand placements and procedure. In addition, a short discussion on the genesis of Diversified technique is provided.

  15. Modeling and stress analyses of a normal foot-ankle and a prosthetic foot-ankle complex. (United States)

    Ozen, Mustafa; Sayman, Onur; Havitcioglu, Hasan


    Total ankle replacement (TAR) is a relatively new concept and is becoming more popular for treatment of ankle arthritis and fractures. Because of the high costs and difficulties of experimental studies, the developments of TAR prostheses are progressing very slowly. For this reason, the medical imaging techniques such as CT, and MR have become more and more useful. The finite element method (FEM) is a widely used technique to estimate the mechanical behaviors of materials and structures in engineering applications. FEM has also been increasingly applied to biomechanical analyses of human bones, tissues and organs, thanks to the development of both the computing capabilities and the medical imaging techniques. 3-D finite element models of the human foot and ankle from reconstruction of MR and CT images have been investigated by some authors. In this study, data of geometries (used in modeling) of a normal and a prosthetic foot and ankle were obtained from a 3D reconstruction of CT images. The segmentation software, MIMICS was used to generate the 3D images of the bony structures, soft tissues and components of prosthesis of normal and prosthetic ankle-foot complex. Except the spaces between the adjacent surface of the phalanges fused, metatarsals, cuneiforms, cuboid, navicular, talus and calcaneus bones, soft tissues and components of prosthesis were independently developed to form foot and ankle complex. SOLIDWORKS program was used to form the boundary surfaces of all model components and then the solid models were obtained from these boundary surfaces. Finite element analyses software, ABAQUS was used to perform the numerical stress analyses of these models for balanced standing position. Plantar pressure and von Mises stress distributions of the normal and prosthetic ankles were compared with each other. There was a peak pressure increase at the 4th metatarsal, first metatarsal and talus bones and a decrease at the intermediate cuneiform and calcaneus bones, in

  16. Synthetic Gecko Foot-hairs from Multiwalled Carbon Nanotubes (United States)

    Dhinojwala, Ali


    The mechanism that allows a gecko lizard to climb any vertical surface and hang from a ceiling with one toe has attracted considerable interest and awe for over two millennia. Recent studies have discovered that the gecko's ability to defy gravity comes from its remarkable feet and toes. Each five-toed foot is covered with microscopic elastic hairs called setae. The ends of these hairs split into spatulas which come in contact with the surface and induce enough intermolecular [van der Waals, (VdW)] forces to hold them in place. Similarly, the same VdW forces act between our two hands when they are held together, but in this case, they do not stick to each other. The reason is that the roughness of our hands prevents them from coming close to each other at separations relevant for VdW forces. On the other hand, based on the gecko's foot anatomy, if our hands were made up of tiny elastic structures that were able to deform or bend at different length scales in accordance with the contact surface and correct for the roughness, then perhaps our hands could also adhere to the surfaces we touch. In my talk, I will present the recent advances we have made in fabricating polymer surfaces with multiwalled carbon nanotube hairs with strong nanometer-level adhesion forces that are 200 times higher than those observed for Gecko foot-hairs. This fabrication process allows the flexibility to create structures that are found in nature on the Gecko's foot and offer excellent potential for applications as dry adhesives for space, microelectronics and MEMS devices. This work was done in collaboration with Betul Yurdumakan, Nachiket Raravikar and Pulickel Ajayan.

  17. Impact of Foot Type on Cost of Lower Extremity Injury (United States)


    contributions to this study. We would like to thank David Boland, Peter Doyle, Timothy Eckard, Jess Feldtmann, Cyrus Kardouni, Drew Williams...would like to thank Impact of Foot Type on Cost of Lower Extremity Injury 25 - 10 STO-MP-HFM-228 Cynthia Childress and David Montplaisir for...9. 21. Hreljac, A., R.N. Marshall, and P.A. Hume , Evaluation of lower extremity overuse injury potential in runners. Med Sci Sports Exerc, 2000. 32


    Directory of Open Access Journals (Sweden)

    Saif Omar


    Full Text Available Mirror foot, a form of polydactyly, is a rare congenital anomaly. In this form of congenital anomaly, there are several additional digits with accessory tarsal bones. It may be associated with fibular dimelia, tibial aplasia and tibial dysplasia. Cause of such anomaly is not known. On experimental basis it appears to involve ectopic SHH (Sonic hedgehog signaling in the limb bud mesenchyme

  19. Hand foot syndrome associated with standard dose cytarabine

    Directory of Open Access Journals (Sweden)

    Atul Sharma


    Full Text Available Hand-foot syndrome, is a side effect of cytotoxic chemotherapy, causes erythema, dysthesias, swelling of palms and soles and sometimes blisters. Rarely, it may ulcerate. The most commonly used drug that frequently causes this reaction is 5-fluorouracil or its prodrug oral capecitabine. High dose cytarabine is known to cause HFS. Here we report a case of HFS caused by standard dose cytarabine.

  20. [Overuse injury syndromes of the calf and foot] ]. (United States)

    Smerdelj, M; Madjarević, M; Oremus, K


    The lower leg, foot and ankle form a functional unit of the locomotor system with an important static and dynamic function. Injury or loss of function of any muscle group of the lower leg and the foot influences normal gait or impedes standing. Increased or frequent loads on the muscle group may lead to pain syndromes known as overuse syndromes or overuse injuries. Athletes and certain professions involving standing or walking for a long time are especially susceptible to increased muscle strains. This article describes and clarifies the causes and the development of the pain syndromes in the lower leg, foot and ankle associated with certain professions or sports. The description of anatomical relationships and functions of individual muscle groups is here to clarify the occurrence of overuse injuries which may involve the muscle itself, the tendon, or the point of their attachment to the bone. The article describes observations and experiences from everyday clinical practice, but it also summarises results described in recent publications. The focus is also put on the therapy, which is usually conservative. Particular mention is given to new non-invasive surgical techniques. The article describes the most common overuse injuries of the lower leg such as shin splints, tibialis posterior syndrome, chronic anterior compartment syndrome, overuse injury of the Achilles tendon, enthesitis of the tendo Achilles, retrocalcanear bursitis and rupture of the Achilles tendon. In the foot area the most frequent overuse syndromes are the plantar fasciitis, tibialis posterior tendinitis, tendinitis of the long flexor of the toe, toe extensor tendinitis, and also anterior and posterior impingement syndromes of the ankle.