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Sample records for charcot foot reconstruction

  1. Charcot foot syndrome.

    Science.gov (United States)

    Jeffcoate, W J

    2015-06-01

    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.

  2. Imaging of Charcot foot

    International Nuclear Information System (INIS)

    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.)

  3. An overview of the Charcot foot pathophysiology

    OpenAIRE

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

    2013-01-01

    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 ...

  4. Imaging of Charcot foot; Bildgebung des Charcot-Fusses

    Energy Technology Data Exchange (ETDEWEB)

    Erlemann, Rainer; Schmitz, Annette [Helios Klinikum Duisburg, Helios St. Johannes Klinik, Duisburg (Germany). Inst. fuer Radiologie

    2014-03-15

    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.)

  5. The Charcot foot: pathophysiology, diagnosis and classification.

    Science.gov (United States)

    Trieb, K

    2016-09-01

    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.

  6. Combined Internal and External Fixation for Diabetic Charcot Reconstruction: A Retrospective Case Series.

    Science.gov (United States)

    Hegewald, Kenneth W; Wilder, Megan L; Chappell, Todd M; Hutchinson, Byron L

    2016-01-01

    Diabetic Charcot neuroarthropathy is a complex, limb-threatening disease process with major lifestyle-altering repercussions for patients. When Charcot neuroarthropathy leads to unstable deformity, ulceration, and potential infection despite conservative therapies, foot and ankle surgeons often consider reconstructive limb salvage procedures to restore function. The purpose of the present study was to evaluate the clinical and radiographic outcomes of diabetic Charcot reconstruction using combined internal and external fixation. A total of 22 patients were reviewed; 16 (72.73%) midfoot and 6 (27.27%) tibiotalocalcaneal arthrodesis procedures were consecutively performed from March 2009 to May 2013. All surgical procedures were performed in nonacute phases of the Charcot process in patients with diagnosed diabetes mellitus and documented peripheral neuropathy. Patients were excluded from the study if they were not diabetic despite having undergone Charcot reconstruction, regardless of the fixation method, or if they did not complete radiographic imaging. During a mean follow-up period of 58.60 ± 42.37 (range 16 to 164) weeks, limb salvage was achieved in 20 patients (90.91%), and 2 (9.09%) required below-the-knee amputation at a mean of 42 ± 14.14 weeks. Wound dehiscence occurred in 8 (36.36%), pin tract infection in 10 (45.45%), and superficial wound infection in 9 (40.91%) and peaked in bimodal fashion at 4 and 8 weeks postoperatively. Radiographic analysis of the pre- versus postoperative alignment showed statistically significant changes in the lateral talo-first metatarsal angle (p = .02) and lateral talar declination angle (p = .01). The limb salvage rates with diabetic Charcot reconstruction are improving in part because of the continued development of increasingly superior modalities for both internal and external fixation.

  7. Charcot Neuropathic Arthropathy of the Foot: A Literature Review and Single-Center Experience

    Science.gov (United States)

    Shaikh, Haroun Hassan

    2016-01-01

    Charcot neuropathic osteoarthropathy of the foot is a relatively common complication of diabetic neuropathy. Incorrect diagnosis and improper treatment often result in the extremity having to be amputated. This paper summarises the current view on the etiology, diagnostics, and treatment of diabetic Charcot neuropathic osteoarthropathy, with particular focus on preserving the extremity through surgical intervention from our own experiences. PMID:27656656

  8. Minimally Invasive Early Operative Treatment of Progressive Foot and Ankle Deformity Associated With Charcot-Marie-Tooth Disease.

    Science.gov (United States)

    Boffeli, Troy J; Tabatt, Jessica A

    2015-01-01

    Charcot-Marie-Tooth disease is a neuromuscular disorder that commonly results in a predictable pattern of progressive bilateral lower extremity weakness, numbness, contracture, and deformity, including drop foot, loss of ankle eversion strength, dislocated hammertoes, and severe cavus foot deformity. Late stage reconstructive surgery will be often necessary if the deformity becomes unbraceable or when neuropathic ulcers have developed. Reconstructive surgery for Charcot-Marie-Tooth deformity is generally extensive and sometimes staged. Traditional reconstructive surgery involves a combination of procedures, including tendon lengthening or transfer, osteotomy, and arthrodesis. The described technique highlights our early surgical approach, which involves limited intervention before the deformity becomes rigid, severe, or disabling. We present 2 cases to contrast our early minimally invasive technique with traditional late stage reconstruction. Charcot-Marie-Tooth disease affects different muscles at various stages of disease progression. As 1 muscle becomes weak, the antagonist will overpower it and cause progressive deformity. The focus of the early minimally invasive approach is to decrease the forces that cause progressive deformity yet maintain function, where possible. Our goal has been to maintain a functional and braceable foot and ankle, with the hope of avoiding or limiting the extent of future major reconstructive surgery. The presented cases highlight the patient selection criteria, the ideal timing of early surgical intervention, the procedure selection criteria, and operative pearls. The early minimally invasive approach includes plantar fasciotomy, Achilles tendon lengthening, transfer of the peroneus longus to the fifth metatarsal, Hibbs and Jones tendon transfer, and hammertoe repair of digits 1 to 5.

  9. Pressure pain perception in the diabetic Charcot foot: facts and hypotheses

    Directory of Open Access Journals (Sweden)

    Ernst A. Chantelau

    2013-05-01

    Full Text Available Background:Reduced traumatic and posttraumatic (nociceptive pain is a key feature of diabetic neuropathy. Underlying condition is a gradual degeneration of endings of pain nerves (A-delta fibers and C-fibers, which operate as receivers of noxious stimuli (nociceptors. Hence, the absence of A-delta fiber mediated sharp pain (“first” pain, and of C-fiber mediated dull pain (“second” pain. However, patients with diabetic neuropathy and acute Charcot foot often experience deep dull aching in the Charcot foot while walking on it. Aim: To create a unifying hypothesis on the kind of pain in an acute Charcot foot. Result: Absence of punctuate (pinprick pain perception at the sole of a Charcot foot, as was shown recently, likely corresponds to vanished intraepidermal A-delta fiber endings. C-fiber nociceptors are reduced, according to histopathology studies. Both types of fibers contribute to posttraumatic hyperalgesia at the skin level, as studies show. Their deficiencies likely impact on posttraumatic hyperalgesia at the skin level and, probably, also at the skeletal level. Conclusion: It is hypothesised that deep dull aching in an acute diabetic Charcot foot may represent faulty posttraumatic hyperalgesia involving cutaneous and skeletal tissues.

  10. Routine MRI findings of the asymptomatic foot in diabetic patients with unilateral Charcot foot

    Directory of Open Access Journals (Sweden)

    Poll Ludger W

    2010-04-01

    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.

  11. Sudeck's disease stage 1, or diabetic Charcot's foot stage 0? Case report and assessment of the diagnostic value of MRI

    Directory of Open Access Journals (Sweden)

    Poll Ludger W

    2010-10-01

    Full Text Available Abstract Background The diagnosis of Sudeck's syndrome stage 1 (nowadays termed complex regional pain syndrome I, abbreviated CRPS I is based on clinical features, namely swelling and pain in a limb. Plain X-ray may be normal. In the absence of pain sensitivity, e.g. in diabetic neuropathy, CRPS I of the foot can be mistaken for Charcot's foot stage 0 (so-called neuro-osteoarthropathy. Case presentation The case of a type-1 diabetic woman is reported, in whom CRPS I following a calcaneal fracture was mistaken for Charcot's osteoarthropathy (because of bone marrow edema displayed by conventional MR imaging. In addition, a review is presented on 6 consecutive cases with CRPS I of the foot, and on 20 cases with Charcot's foot stage 0, with particular emphasis on MR imaging findings. The number of bones per foot affected with marrow edema was similar in either condition, with a tendency towards a more patchy, diffuse distribution of bone marrow edema in CRPS I. Bone marrow edema apparently regressed more promptly in response to treatment in Charcot's foot stage 0. Conclusion Differentiation of CRPS I from Charcot's foot stage 0 remains a diagnostic dilemma in patients with pain insensitivity. Conventional MRI may be helpful, when repeated for monitoring the treatment response.

  12. Is the Eichenholtz classification still valid for the diabetic Charcot foot?

    Science.gov (United States)

    Chantelau, Ernst Adolf; Grützner, Gotthard

    2014-01-01

    In his 1966 monograph "Charcot joints", Sidney N. Eichenholtz (1909-2000) described "three well defined stages … in the course and development of a Charcot joint", based on plain X-rays of 68 patients. Since then, medical imaging has advanced very much: computed tomography and magnetic resonance imaging (MRI) scans exceed plain X-ray by far in detecting foot fractures and other injuries. The earliest, nondeforming, X-ray-negative inflammatory stage of the acute Charcot joint of the diabetic foot can be visualised only by use of MRI. This stage, which Eichenholtz evidently failed to recognise, will heal without significant arthropathy, if treated in time. By contrast, the stages considered by Eichenholtz inevitably result in major arthropathy and foot deformity. Hence, superseding the Eichenholtz classification is overdue. We propose an MRI-based classification comprising two severity grades (0 and 1, according to absence/presence of cortical fractures) and two stages (active/inactive, according to presence/absence of skeletal inflammation).

  13. Criteria of immobilization duration of the affected foot in diabetic Charcot neuro-osteoarthropathy

    Directory of Open Access Journals (Sweden)

    Anastasia Gennadyevna Demina

    2014-10-01

    Full Text Available Long-term offloading is the key factor in the treatment of the acute stage of Charcot foot. The indication for remobilization and transition of the affected foot to weight-bearing activities is believed to be based on two factors: the absence of the clinical signs of inflammation and results of the objective diagnostic tests. At the present time, consensus about appropriate methods sufficient for initiating weight-bearing activities after immobilization is absent. This paper discusses current data on clinical and laboratory tests and methods and describes their advantages and disadvantages.

  14. A literature-based guide to the conservative and surgical management of the acute Charcot foot and ankle

    Directory of Open Access Journals (Sweden)

    Valerie L. Schade

    2015-03-01

    Full Text Available Acute Charcot neuroarthropathy of the foot and ankle presents with the insidious onset of a unilateral acutely edematous, erythematous, and warm lower extremity. The acute stages are typically defined as Eichenholtz Stage 1, or Stage 0, which was first described by Shibata et al. in 1990. The ultimate goal of treatment is maintenance of a stable, plantigrade foot which can be easily shod, minimizing the risk of callus, ulceration, infection, and amputation. The gold standard of treatment is non-weight-bearing immobilization in a total contact cast. Surgical intervention remains controversial. A review of the literature was performed to provide an evidenced-based approach to the conservative and surgical management of acute Charcot neuroarthropathy of the foot and ankle.

  15. Bone mineral density in diabetes mellitus patients with and without a Charcot foot

    DEFF Research Database (Denmark)

    Christensen, Tomas M; Bülow, Jens; Simonsen, Lene;

    2010-01-01

    To measure bone mineral density in patients with diabetes mellitus and the complication Charcot osteoarthropathy (CA).......To measure bone mineral density in patients with diabetes mellitus and the complication Charcot osteoarthropathy (CA)....

  16. Microsurgical Reconstruction of Plantar Ulcers of the Insensate Foot.

    Science.gov (United States)

    Kadam, Dinesh

    2016-06-01

    Background Plantar, neuropathic, or trophic ulcers are often found in patients with decreased sensation in the foot. These ulcers can be complicated by infection, deformity, and increased patient morbidity. Excision results in wider defects and local tissues are often insufficient for reconstruction Methods Total 26 free flaps were used in 25 patients to reconstruct plantar ulcers between years 2007 and 2013. The etiology included diabetic neuropathy (n = 13), leprosy (n = 3), spinal/peripheral nerve injury (n = 7), spina bifida (n = 1), and peripheral neuropathy (n = 1). The duration of the ulcer ranged from 1 to 18 years. Fifteen patients had associated systemic comorbidities and six had previous attempts. Free flaps used in reconstruction were the anterolateral thigh flap (n = 18), radial artery forearm flap (n = 4), and the gracilis muscle flap (n = 4). Recipient vessels were the posterior tibial artery (end to side) in 19 and the dorsalis pedis artery in 7. Results The average age at presentation was 44.6 years with mean duration of ulcer of 5.8 years predominantly located over weight-bearing areas. Mean size of ulcer was 59.45 cm(2) and mean follow-up period was 48 months. All flaps survived except a partial loss. Average time to resume ambulation was 6 weeks. Three patients had recurrence with mean follow-up of 48 months. Secondary flap reduction and bony resection was done in four. Conclusion Microvascular reconstruction of the sole has advantages of vascularity, adequate tissue, and leaving rest of the foot undisturbed for offloading. Three significant local conditions influencing selection and transfer of the flap include (1) distally located forefoot ulcers, (2) extensive subcutaneous fibrosis secondary to frequent inflammation, and (3) Charcot arthropathy. In our series, the anterolateral thigh flap is our first choice for reconstruction of these defects.

  17. Innovations in diabetic foot reconstruction using supermicrosurgery.

    Science.gov (United States)

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

    2016-01-01

    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.

  18. A dynamic 3D foot reconstruction system.

    Science.gov (United States)

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

    2011-01-01

    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.

  19. Role of dynamic MRI in the follow-up of acute Charcot foot in patients with diabetes mellitus

    International Nuclear Information System (INIS)

    To evaluate the usefulness of magnetic resonance imaging (MRI) in assessing the level of activity of acute Charcot foot, monitoring treatment response and predicting healing time. Forty diabetic patients with acute Charcot foot were prospectively enrolled. Patients underwent limb immobilization and were followed every 3 months by clinical examination (skin temperature and circumferences) and MRI. MR protocol included T1-weighted and fast spin echo inversion recovery (FSE-IR) sequences, and a dynamic study (fast spoiled gradient echo), after gadolinium administration (0.1 ml/kg). The contrast medium uptake rate at D-MRI and the signal intensity (SI) ratio on the FSE-IR sequence were measured. At baseline, mean contrast medium uptake rate was 136±49.7% and the mean SI ratio was 5±3. A high intra- and inter-observer agreement was found for the contrast medium uptake rate, whereas a low agreement was observed for the SI ratio. At 3 months' follow-up, reduction of the contrast medium uptake rate was observed in all patients with improved clinical findings (n = 34), whereas the SI ratio was reduced in 15/34 (44.1%) patients. Mean healing time was significantly related to the baseline contrast medium uptake rate (P=0.005); it was 5.3 ± 2.7 months in patients with contrast medium uptake rate ≤100%, compared with 9.1 ± 2.5 months in the remaining patients (P=0.0003). Contrast medium uptake rate obtained at D-MRI represents a reproducible parameter that is reliable for predicting and monitoring treatment outcome in acute Charcot foot. (orig.)

  20. Role of dynamic MRI in the follow-up of acute Charcot foot in patients with diabetes mellitus

    Energy Technology Data Exchange (ETDEWEB)

    Zampa, Virna; Bargellini, Irene; Turini, Francesca; Ortori, Simona; Bartolozzi, Carlo [University of Pisa, Department of Diagnostic and Interventional Radiology, Pisa (Italy); Rizzo, Loredana; Piaggesi, Alberto [University of Pisa, Department of Endocrinology and Metabolism, Diabetic Foot Section, Pisa (Italy)

    2011-08-15

    To evaluate the usefulness of magnetic resonance imaging (MRI) in assessing the level of activity of acute Charcot foot, monitoring treatment response and predicting healing time. Forty diabetic patients with acute Charcot foot were prospectively enrolled. Patients underwent limb immobilization and were followed every 3 months by clinical examination (skin temperature and circumferences) and MRI. MR protocol included T1-weighted and fast spin echo inversion recovery (FSE-IR) sequences, and a dynamic study (fast spoiled gradient echo), after gadolinium administration (0.1 ml/kg). The contrast medium uptake rate at D-MRI and the signal intensity (SI) ratio on the FSE-IR sequence were measured. At baseline, mean contrast medium uptake rate was 136{+-}49.7% and the mean SI ratio was 5{+-}3. A high intra- and inter-observer agreement was found for the contrast medium uptake rate, whereas a low agreement was observed for the SI ratio. At 3 months' follow-up, reduction of the contrast medium uptake rate was observed in all patients with improved clinical findings (n = 34), whereas the SI ratio was reduced in 15/34 (44.1%) patients. Mean healing time was significantly related to the baseline contrast medium uptake rate (P=0.005); it was 5.3 {+-} 2.7 months in patients with contrast medium uptake rate {<=}100%, compared with 9.1 {+-} 2.5 months in the remaining patients (P=0.0003). Contrast medium uptake rate obtained at D-MRI represents a reproducible parameter that is reliable for predicting and monitoring treatment outcome in acute Charcot foot. (orig.)

  1. [Charcot's arthropathy

    DEFF Research Database (Denmark)

    Christensen, T.M.; Yderstraede, K.; Ejskjaer, N.;

    2008-01-01

    Charcot's arthropathy is a rare complication to diabetes with peripheral neuropathy. The diagnosis is based on a red, oedematous foot with 2 degrees C difference in skin temperature between the affected foot compared to the unaffected foot. The condition is characterised by fractures, dislocation...... of joints and deformity. The treatment is off-loading. When the off-loading treatment is completed, the patient should gradually adjust to wearing bespoken shoes. Lifelong control of the feet and shoes is necessary Udgivelsesdato: 2008/8/11...

  2. Surgical reconstruction in diabetic foot syndrome

    Directory of Open Access Journals (Sweden)

    Umid Shoyusupov

    2011-04-01

    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.

  3. Den diabetiske Charcots fod

    DEFF Research Database (Denmark)

    Christensen, Tomas Møller; Yderstraede, Knud; Ejskjaer, Niels;

    2008-01-01

    Charcot's arthropathy is a rare complication to diabetes with peripheral neuropathy. The diagnosis is based on a red, oedematous foot with 2 degrees C difference in skin temperature between the affected foot compared to the unaffected foot. The condition is characterised by fractures, dislocation...

  4. Surgical treatment of cavus foot in Charcot-Marie-tooth disease: a review of twenty-four cases: AAOS exhibit selection.

    Science.gov (United States)

    Faldini, Cesare; Traina, Francesco; Nanni, Matteo; Mazzotti, Antonio; Calamelli, Carlotta; Fabbri, Daniele; Pungetti, Camilla; Giannini, Sandro

    2015-03-18

    Charcot-Marie-Tooth disease is the single most common diagnosis associated with cavus foot. The imbalance involving intrinsic and extrinsic muscles has been suggested as the main pathogenetic cause of cavus foot in this disease. The goal of surgical treatment is to correct the deformity to obtain a plantigrade foot. In the presence of a flexible deformity and the absence of degenerative arthritis, preserving as much as possible of the overall range of motion of the foot and ankle is advisable. Twenty-four cavus feet in twelve patients with Charcot-Marie-Tooth disease were included in the study. Clinical evaluation was summarized with the Maryland Foot Score. Radiographic evaluation assessed calcaneal pitch, Meary angle, Hibb angle, and absence of degenerative joint changes. Only patients who had a flexible deformity, with varus of the heel reducible in the Coleman-Andreasi test, and did not have degenerative joint arthritis were included in this study. Surgical treatment consisted in plantar fasciotomy, midtarsal osteotomy, extensor hallucis longus tendon transfer to the first metatarsal (Jones procedure), and dorsiflexion osteotomy of the first metatarsal. Mean follow-up was six years (range, two to thirteen years). The mean Maryland Foot Score was 72 preoperatively and 86 postoperatively. The postoperative result was rated as excellent in twelve feet (50%), good in ten (42%), and fair in two (8%). Mean calcaneal pitch was 34° preoperatively and 24° at the time of the latest follow-up, the mean Hibb angle was 121° preoperatively and 136° postoperatively, and the mean Meary angle was 25° preoperatively and 2° postoperatively. Plantar fasciotomy, midtarsal osteotomy, the Jones procedure, and dorsiflexion osteotomy of the first metatarsal yielded adequate correction of flexible cavus feet in patients with Charcot-Marie-Tooth disease in the absence of fixed hindfoot deformity. The fact that the improvement in the outcome score was only modest may be attributable

  5. Artropatia de charcot do mediopé no paciente diabético: complicação de uma doença epidêmica Mid-foot charcot arthropathy in diabetic patients: complication of an epidemic disease

    Directory of Open Access Journals (Sweden)

    Ricardo Cardenuto Ferreira

    2012-10-01

    patients (110 extremities with Charcot arthropathy of the midfoot. The minimum follow-up period was 12 months. We included 45 patients with Charcot arthropathy affecting the tarsal-metatarsal joints (51%; 20 patients in whom the talonavicular, calcaneocuboid and subtalar joints were affected (23%; and 23 patients in whom both the midfoot and hindfoot were affected (26%, as described by Brodsky and Trepman. We defined the treatment as successful when a functional foot was preserved; and unsuccessful when the foot was amputated. RESULTS: From treating Charcot arthropathy primarily involving the midfoot were satisfactory in the cases of 75 patients (85% treated according to our protocol. For the patients with severe lesions affecting both the midfoot and the hindfoot, a greater number of complex operations (i.e. arthrodesis were needed in order to obtain the same overall rate of satisfactory results. The osteoarticular lesions originating in the midfoot probably extended progressively to the hindfoot because of delayed diagnosis with inadequate early treatment. CONCLUSION: It was possible to preserve a functional extremity in 85% of the patients. Severe lesions involving the midfoot and extending to the hindfoot required a greater number of surgical procedures to treat them.

  6. Den diabetiske Charcots fod

    DEFF Research Database (Denmark)

    Christensen, T.M.; Yderstraede, K.; Ejskjaer, N.;

    2008-01-01

    Charcot's arthropathy is a rare complication to diabetes with peripheral neuropathy. The diagnosis is based on a red, oedematous foot with 2 degrees C difference in skin temperature between the affected foot compared to the unaffected foot. The condition is characterised by fractures, dislocation...... of joints and deformity. The treatment is off-loading. When the off-loading treatment is completed, the patient should gradually adjust to wearing bespoken shoes. Lifelong control of the feet and shoes is necessary Udgivelsesdato: 2008/8/11...

  7. Modification of hand reconstruction with unilateral foot donation

    Institute of Scientific and Technical Information of China (English)

    FAN Cun-yi; LIU Xu-dong; CAI Pei-hua; JIANG Pei-zhu; YU Zhong-jia; ZENG Bing-fang

    2007-01-01

    @@ Multiple toes transplantation is an effective method for restoring the prehension of the hands.1-5 Generally, the thumb, index and middle finger are reconstructed by transferring a free big toe skin-nail flap with the second and third toes from a same foot. The great saphenous vein, superficial veins on the dorsum of the foot, the dorsalis pedis artery, and the first dorsal metatarsal artery are resected to be used as the donor pedicle. The arterial pedicle is freed up to the dorsal digital artery of the big and second toes. Both the second and third toes are supplied by the dorsal digital artery of the second toe on the tibial side. By using unilateral toe donation to reconstruct a digitless hand, we can preserve the normal form and function of the contralateral foot.However, because of the small length of the digital arteries between the big and second toes, the first web space is limited. Here we present our experiences on two cases of hand reconstruction with unilateral three toes transplantation. Good function and motion range of the thumb were achieved in both the patients.

  8. 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

    2012-01-01

    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.

  9. 糖尿病Charcot足患者临床特点及预后%Clinical characteristics and prognosis of diabetes Charcot foot

    Institute of Scientific and Technical Information of China (English)

    王璐宁; 关小宏; 田慧

    2016-01-01

    目的 总结20例糖尿病Charcot足患者临床表现及预后,以提高临床医师对该病的认识.方法 回顾性分析空军总医院2008年6月至2013年6月诊断的20例糖尿病Charcot足患者临床特点及预后情况.结果 20例糖尿病Charcot足均为单足病变,患者平均年龄(55±8)岁,男性占75.0%(15/20);糖尿病病史(12±6)年,患足血供可,足畸形前存在对称性麻木中位时间6年,血糖控制不佳,血脂基本正常.糖尿病慢性并发症中以微血管病变为主,以并发糖尿病肾病、糖尿病自主神经病变为多,分别占65.0% (13/20)、75.0% (15/20).4例行小腿中上1/3截肢术、7例行截趾术、1例行患足第1跖跗单关节内置固定螺丝整形手术;6例换药,创面愈合;1例踝部创面好转出院;1例患足无溃疡,予以配置矫正鞋.随访1~5年,1例死于心肌梗死;1例因心房颤动引发脑梗死卧床;2例因尿毒症开始透析;1例患足原创面再次破溃;1例失访;余患者拄拐或轮椅助行,无糖尿病足溃疡.结论 男性为糖尿病Charcot足相对高发人群;多存在血糖控制不佳;早期患足减压、制动,均利于保护患足和促进足部创面愈合.%Objective To analyze the characteristics and prognosis of 20 patients with diabetes Charcot foot.Methods The clinical characteristics and prognosis of 20 patients with diabetes Charcot foot from June 2008 to June 2013 were retrospectively analyzed.Results All the 20 cases had single foot lesion;the age was (55 ± 8) years old;75.0% (15/20) were male;the mean duration of diabetes was (12 ±6) years;the blood supply of affected food was fine;the median duration of symmetry numbness was 6 years;the glycemic control was poor;the blood lipid was normal.The chronic complications were mostly microvascular disease,especially nephropathy [65.0% (13/20)] and autonomic nerve pathological change [75.0% (15/20)].Four cases underwent amputation of 1/3 of lower leg,7 cases underwent toes amputation

  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

    2008-01-01

    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. Exostectomy for chronic midfoot plantar ulcer in Charcot deformity

    DEFF Research Database (Denmark)

    Laurinaviciene, R.; Kirketerp-Moeller, K.; Holstein, Per Evald

    2008-01-01

    Charcot midfoot ulcers are rare and very difficult to heal, with surgery being an option. This retrospective study assessed healing rates, complications, and the incidence of re-ulceration and other foot ulcer problems following exostectomies Udgivelsesdato: 2008/2...

  12. Three-phase bone scintigraphy for diagnosis of Charcot neuropathic osteoarthropathy in the diabetic foot - does quantitative data improve diagnostic value?

    DEFF Research Database (Denmark)

    Fosbøl, M; Reving, S; Petersen, E H;

    2016-01-01

    AIM: To investigate whether inclusion of quantitative data on blood flow distribution compared with visual qualitative evaluation improve the reliability and diagnostic performance of (99 m) Tc-hydroxymethylene diphosphate three-phase bone scintigraphy (TPBS) in patients suspected for charcot neu...

  13. Dysfunction in the hip joints in children with Charcot-Marie-Tooth syndrome (literature review

    Directory of Open Access Journals (Sweden)

    Иван Юрьевич Поздникин

    2015-09-01

    Full Text Available A review of the literature on the treatment of children with dysfunction in the hip joints in motor-sensory neuropathy Charcot-Marie-Tooth is presented. Peculiarities of disease diagnosis and the approach used in the treatment of patients are described. The Charcot-Marie-Tooth syndrome is a hereditary neuromuscular disease characterized by progressive atrophy of the distal muscle group of the lower limbs. According to international authors, the incidence of hip joint dysfunction in this condition is at least 10%, ranking second only to foot deformities. In the Russian literature, the problem has not been adequately interpreted. Early diagnosis of dysfunction in the hip joints during Charcot-Marie-Tooth syndrome is complicated by the child's age and is characterized by progression. Conflicting clinical signs and trivial symptoms of the disease also confuse diagnosis, until it becomes clearer in adolescence or the second or third decade of life. Surgical reconstructive operations on the hip joint often occur too late, and they are accompanied by a greater frequency of neurological complications. Practitioner awareness coupled with an early diagnosis of hip subluxation and decentration and complex orthopedic and neurological examinations of children with the disease of Charcot-Marie-Tooth should result in more favorable outcomes.

  14. Foot Modeling and Smart Plantar Pressure Reconstruction from Three Sensors

    Science.gov (United States)

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

    2014-01-01

    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

  15. Progress of surgical treatment for foot and ankle deformities due to the Charcot-Marie-Tooth disease%Charcot-Marie-Tooth病足踝畸形与外科治疗进展

    Institute of Scientific and Technical Information of China (English)

    梁喜斌; 秦泗河

    2014-01-01

    Charcot-Marie-Tooth病(CMT)是一种进行性、神经性肌萎缩综合征,是周围神经系统最常见的遗传性疾病,易引起下肢足踝畸形,尤以高弓内翻足多见.由于CMT病涉及多学科,临床表现多样,临床医生对此病的治疗熟悉甚少,使此类患者就医时出现较大困惑.本文参考近年文献,归纳认为对于CMT引起的足踝畸形的外科治疗,应根据患者年龄、畸形类别与程度、肌力失衡的范围及程度、患者对矫形治疗的期望值等因素确定手术指征、制定矫形方案.

  16. Perforator-based chimaeric thoracodorsal flap for foot reconstruction.

    Science.gov (United States)

    Rausky, Jonathan; Binder, Jean-Philippe; Mazouz-Dorval, Sarra; Hamou, Cynthia; Revol, Marc

    2013-12-01

    The reconstruction of severe defects of the ankle and foot is a challenge. The ideal solution should combine a thin skin flap on the dorsum to allow shoe fitting and a muscle flap with a split-thickness skin graft on the weight-bearing area. Perforator-based thoracodorsal chimaeric flaps allow us to achieve these two goals with minimal donor-site morbidity. We present a reconstruction of an extended circumferential defect of the ankle with an exposed heel using a chimaeric thoracodorsal perforator flap with a serratus muscle flap. The skin flap was transferred on the dorsal foot, whereas the serratus anterior muscle was transferred on the exposed heel. Postoperative recovery was uneventful and the patient began full weight bearing after 3 months. Twelve months after reconstruction, natural shape and walking function were successfully achieved.

  17. Posterior tibial nerve as a tendon transfer for drop foot reconstruction: a devastating complication.

    Science.gov (United States)

    Armangil, Mehmet; Basat, H Çağdaş; Bilgin, S Sinan

    2015-01-01

    Iatrogenic peripheral nerve injuries can result from numerous medical procedures, particularly transection, stretching, compression, injections, heat, radiation, and the use of anticoagulant agents. Late diagnosis may lead to atrophy of the motor endplate and result in poor outcomes. We report a case in which the posterior tibial nerve was accidentally sectioned as the posterior tibial tendon for transfer to the anterior tibial tendon in the reconstruction of drop foot. This iatrogenic complication ultimately required foot amputation. Physicians must be aware of the anatomy of the posterior tibial nerve in order to avoid such complications. PMID:25803264

  18. Charcot's hysteria renaissant.

    OpenAIRE

    Critchley, E M; Cantor, H E

    1984-01-01

    The authenticity of Charcot's original descriptions of hysteria has been questioned in the popular media. None the less, it is still possible to encounter florid forms of hysteria in culturally deprived communities, and to answer Charcot's present day critics we present a selection of patients from Kentucky's Appalachian countries with hysterial neurological disease. Their case histories are contrasted with those Charcot himself described and thereby form a modern commentary on such condition...

  19. Reconstruction of bilateral tibial aplasia and split hand-foot syndrome in a father and daughter

    Directory of Open Access Journals (Sweden)

    Ali Al Kaissi

    2014-01-01

    Full Text Available Background: Tibial aplasia is of heterogeneous aetiology, the majority of reports are sporadic. We describe the reconstruction procedures in two subjects - a daughter and father manifested autosomal dominant (AD inheritance of the bilateral tibial aplasia and split hand-foot syndrome. Materials and Methods: Reconstruction of these patients required multiple surgical procedures and orthoprosthesis was mandatory. The main goal of treatment was to achieve walking. Stabilization of the ankle joint by fibular-talar-chondrodesis on both sides, followed by bilateral Brown-procedure at the knee joint level has been applied accordingly. Results: The outcome was with improved function of the deformed limbs and walking was achieved with simultaneous designation of orthotic fitting. Conclusion: This is the first study encompassing the diagnosis and management of a father and daughter with bilateral tibial aplasia associated with variable split hand/foot deformity without foot ablation. Our patients showed the typical AD pattern of inheritance of split-hand/foot and tibial aplasia.

  20. Adipofascial sural artery flap for foot and ankle reconstruction in children: for better aesthetic outcome

    International Nuclear Information System (INIS)

    Wheel spoke injury of the ankle and foot is very common in children and its reconstruction is challenging. Reverse flow sural artery fasciocutaneous flap is versatile for this area but lead to significant donor site morbidity. Free tissue transfer is an option in children which needs a micro-vascular expertise, expensive equipment and long operating time. Method: Fifteen adipofascial flaps were done for foot and ankle coverage from June 2011 to June 2014 at CH and ICH Lahore. The efficacy of adipofascial sural artery flap for the coverage of these defects was evaluated. Results: Fifteen children presented with defects of foot and ankle, 11 (73%) were male and 4 (27%) were female. Their age ranged from 1 - 13 years. All patients had trauma to the foot due to wheel spoke injury. Flaps were used to cover tendoachilles and malleoli. In one patient there was flap tip necrosis with partial graft loss which healed with dressings. Donor site aesthetic outcome was satisfactory in all cases. Mean follow-up was I year. Conclusion: Adipofascial Sural artery flap is quick and safe with wide arc of rotation, minimal donor site morbidity and better aesthetic outcome and it does not sacrifice major extremity vessel. (author)

  1. Use of the semitendinosus tendon for foot and ankle tendon reconstructions,

    Directory of Open Access Journals (Sweden)

    Frederico Lutti Guerra de Aguiar Zink

    2014-10-01

    Full Text Available Objective:To demonstrate the results obtained from foot and ankle tendon reconstructions using the tendon of the semitendinosus muscle. The clinical results, the patient's degree of satisfaction and complications in the graft donor and recipient areas were evaluated.Methods:This was a retrospective study in which the medical files of 38 patients who underwent this surgical procedure between 2006 and 2010 were surveyed. The functional results from this technique, the complications in the donor and recipient areas and the patients' degree of satisfaction were evaluated.Results:Three patients presented complications in the recipient area (skin necrosis; one patient showed complications in the donor area (pain and insensitivity; and all patients had satisfactory functional results, with complete range of motion.Conclusion:The semitendinosus muscle is a good option for treatments for foot and ankle tendon injuries.

  2. Quality-of-life in Charcot-Marie-Tooth disease: the patient's perspective.

    Science.gov (United States)

    Johnson, Nicholas E; Heatwole, Chad R; Dilek, Nuran; Sowden, Janet; Kirk, Callyn A; Shereff, Denise; Shy, Michael E; Herrmann, David N

    2014-11-01

    This study determines the impact of symptoms associated with Charcot-Marie-Tooth disease on quality-of-life. Charcot-Marie-Tooth patients in the Inherited Neuropathies Consortium Rare Diseases Clinical Research Network Contact Registry were surveyed. The survey inquired about 214 symptoms and 20 themes previously identified as important to Charcot-Marie-Tooth patients through patient interviews. Symptom population impact was calculated as the prevalence multiplied by the relative importance of each symptom identified. Prevalence and symptom impact were analyzed by age, symptom duration, gender, Charcot-Marie-Tooth type, and employment status. 407 participants returned the survey, identifying foot and ankle weakness (99.7%) and impaired balance (98.6%) as the most prevalent themes. Foot and ankle weakness and limitations with mobility were the themes with the highest impact. Both symptom prevalence and impact gradually increased with age and symptom duration. Several themes were more prevalent in women with Charcot-Marie-Tooth, including activity limitations, pain, fatigue, hip-thigh weakness, and gastrointestinal issues. All of the themes, except emotional or body image issues, were more prevalent among unemployed individuals. There were minimal differences in symptom prevalence between Charcot-Marie-Tooth types. There are multiple symptoms that impact Charcot-Marie-Tooth quality-of-life in adults. These symptoms have different levels of importance, are readily recognized by patients, and represent critical areas of Charcot-Marie-Tooth health.

  3. Phylodynamic reconstruction of O CATHAY topotype foot-and-mouth disease virus epidemics in the Philippines.

    Science.gov (United States)

    Di Nardo, Antonello; Knowles, Nick J; Wadsworth, Jemma; Haydon, Daniel T; King, Donald P

    2014-01-01

    Reconstructing the evolutionary history, demographic signal and dispersal processes from viral genome sequences contributes to our understanding of the epidemiological dynamics underlying epizootic events. In this study, a Bayesian phylogenetic framework was used to explore the phylodynamics and spatio-temporal dispersion of the O CATHAY topotype of foot-and-mouth disease virus (FMDV) that caused epidemics in the Philippines between 1994 and 2005. Sequences of the FMDV genome encoding the VP1 showed that the O CATHAY FMD epizootic in the Philippines resulted from a single introduction and was characterised by three main transmission hubs in Rizal, Bulacan and Manila Provinces. From a wider regional perspective, phylogenetic reconstruction of all available O CATHAY VP1 nucleotide sequences identified three distinct sub-lineages associated with country-based clusters originating in Hong Kong Special Administrative Region (SAR), the Philippines and Taiwan. The root of this phylogenetic tree was located in Hong Kong SAR, representing the most likely source for the introduction of this lineage into the Philippines and Taiwan. The reconstructed O CATHAY phylodynamics revealed three chronologically distinct evolutionary phases, culminating in a reduction in viral diversity over the final 10 years. The analysis suggests that viruses from the O CATHAY topotype have been continually maintained within swine industries close to Hong Kong SAR, following the extinction of virus lineages from the Philippines and the reduced number of FMD cases in Taiwan.

  4. Reconstruction of multiplanar deformity of the hindfoot and midfoot with internal fixation techniques.

    Science.gov (United States)

    Dreher, Thomas; Hagmann, Sebastién; Wenz, Wolfram

    2009-09-01

    Reconstruction surgery of the midand hindfoot is a demanding challenge for foot surgeons. Satisfactory results depend not only on surgical technique and skills but also on the knowledge of underlying disorders, pathomechanics, and indication criteria. The cavovarus foot, the planovalgus foot, and Charcot's foot are some of the most challenging foot deformities, requiring different surgical strategies for their correction. Most of the osteotomies and fusions in children and adults can be fixed with transcutaneous Kirschner wires, which are inexpensive and easy to use and remove. The use of alternative fixation systems such as cannulated screws, compression screws, or angle-stable locking plates depends on patient age, vascular situation, risk for nonunion, and underlying pathology.

  5. Charcot arthropathy in ultrasound examination - a case report.

    Science.gov (United States)

    Płaza, Mateusz; Nowakowska-Płaza, Anna; Walentowska-Janowicz, Marta; Chojnowski, Marek; Sudoł-Szopińska, Iwona

    2016-06-01

    This article presents a patient with a long history of type 1 diabetes mellitus complicated with neuropathy and Charcot disease. The most common cause of neuropathic osteoarthropathy, called Charcot osteoarthropathy, is poorly controlled diabetes. The clinical picture is characterized by considerable edema, redness and increased skin temperature with relatively slight pain due to injury to nerve fibers responsible for pain sensation. The differential diagnosis should include bacterial or autoimmune arthritis, arthritis associated with gout as well as venous thrombosis and injury. The contribution of a local inflammatory reaction and abnormal bone turnover with excessive osteoclast activity might play a role in the etiopathogenesis of this disease. As a result, osseous and articular destruction progresses rapidly leading to irreversible deformity of the foot. Avoiding weight-bearing and resting the foot in a specially selected plaster cast is the most important part of treatment. Patients with the aforementioned complaints are referred to radiologists for imaging examinations. An ultrasonographer should pay attention to changes typical of Charcot arthropathy, such as: inflammatory and destructive changes in joints of the foot, uneven contour of bones with thickening and periosteal hyperemia as well as soft tissue swelling.

  6. Hand involvement in children with Charcot-Marie-Tooth disease type 1A

    NARCIS (Netherlands)

    Burns, Joshua; Bray, Paula; Cross, Lauren A.; North, Kathryn N.; Ryan, Monique M.; Ouvrier, Robert A.

    2008-01-01

    Charcot-Marie-Tooth disease type 1A (CMT1A), a demyelinating neuropathy characterised by progressive length-dependent muscle weakness and atrophy, is thought to affect the foot and leg first followed some time later by hand weakness and dysfunction. We aimed to characterise hand Strength, function a

  7. Surgical reconstruction of end-stage ankle arthritis and concomitant stage II posterior tibial tendon insufficient flat foot.

    Science.gov (United States)

    Desai, Sarang; Grierson, Randolph; Manoli, Arthur

    2011-01-01

    End-stage degenerative joint disease of the ankle and concomitant ipsilateral Stage II posterior tibial tendon insufficient flat foot is a well known entity. Despite this, treatment options have not been discussed in the orthopaedic literature. A case series consisting of five patients was conducted to determine the efficacy of our treatment proposal. Our surgical treatment included an ankle fusion and concomitant flat foot reconstruction with a medializing calcaneal osteotomy, lengthening calcaneal osteotomy, and flexor digitorum longus transfer. At the final followup visit all patients were content with the results of the procedure, and would have it performed again. Each patient had significant relief of ankle and foot pain, and believed they had improved quality of life and function. Complications included two ankle nonunions treated with revision bone grafting and internal fixation, painful hardware and iliac crest hematoma. We conclude that our method of treatment is a viable option for this complex problem. A long recovery period should be anticipated and patients should be counseled accordingly. PMID:22381416

  8. Incidence and management of ulcers in diabetic Charcot feet.

    Science.gov (United States)

    Larsen, K; Fabrin, J; Holstein, P E

    2001-09-01

    This study followed 115 patients with diabetes--who between them had 140 feet with Charcot's arthropathy--over six to 114 months (median: 48). A total of 43 patients (37%) developed ulcers in 53 feet. Their treatment was multifactorial. An offloading regimen was adopted, with the use of crutches and therapeutic sandals with soft, individually moulded insoles, followed by adjusted or bespoke shoes. Recalcitrant ulcers were treated with surgery in 16 patients (37%). Antibiotics were needed by 21 patients (49%). The incidence of ulceration was 17% per year. The median time interval between the acute component of Charcot's arthropathy and ulcer development was 36 months (range: 0-120 months). In seven patients, the ulcer developed during the acute phase. In 12 patients the ulcers were localised to the rockerbottom deformity in the mid-foot region, but in 31 patients other regions were affected. Dynamic footprint analysis was used to help adjust the offloading shoe/insole on the rockerbottom deformity. Such ulcers took twice as long to heal as other ulcers. Surgical treatment comprised: major amputation (two patients), arthrodesis for unstable ankle (three patients), toe amputations (seven patients), resection of the rockerbottom deformity (one patient) and other revisions (three patients). One patient died with an unhealed ulcer. There is a four-fold risk of ulcers in diabetic Charcot deformity compared with the overall risk of foot ulcers in diabetic feet. Healing was achieved in 40 patients (93%). The surgical intervention rate of 37% in ulcer cases in Charcot feet was low compared with the literature.

  9. Preoperative imaging of charcot neuroarthropathy. Does the additional application of {sup 18}F-FDG-PET make sense?

    Energy Technology Data Exchange (ETDEWEB)

    Hoepfner, S. [Abt. fuer Diagnostische Radiologie, Universitaetsklinikum Giessen und Marburg, Standort Giessen (Germany); Krolak, C. [Inst. fuer Klinische Radiologie, Klinikum der Ludwig-Maximilians-Univ. Muenchen (Germany); Kessler, S. [Chirurgische Klinik und Poliklinik, Klinikum der Ludwig-Maximilians-Univ. Muenchen (Germany); Tiling, R. [Klinik und Poliklinik fuer Nuklearmedizin, Klinikum der Ludwig-Maximilians-Univ. Muenchen (Germany)

    2006-07-01

    With about 4 million diabetics in Germany and presumed inclination over the following years the treatment of diabetic complications like diabetic foot will become an even more important point. The management of Charcot's foot has undergone fundamental change in the last few years. Formerly, treatment was almost exclusively limited to non surgical measures; since the late 1990's, however, current practice has shifted to early, stage-appropriate surgical therapy. The aim of the present prospective study was to investigate the value of positron emission tomography (PET) in the pre-operative work-up of Charcot's foot. PET were compared to magnetic resonance tomography (MRI). Patients, methods: MRI and PET imaging were used as part of the preoperative work-up in 18 patients with Type II diabetes mellitus. The diagnosis of Charcot's foot requiring surgical treatment were made on the basis of clinical and radiologic criteria. Results: of 46 Charcot's lesions confirmed at surgery, 44 and 35 were detected by means of PET and MRI, respectively. PET can be used in the work-up of patients with metal implants where the MRI does not show adequate findings. PET shows the areas of detritus formation exhibit only moderately increased glucose metabolism and at visual interpretation do not usually impress as typical for acute osteomyelitis. Average SUV values stood at 1.2 (range: 0.5-2.9). Conclusions: the differentiation between Charcot's lesions and floride osteomyelitis provides the surgeon with important additional information, which is often unavailable from MRI. Because of this important additional data, PET could be considered preferable to morphologic imaging (CT, projection radiography) in the preoperative work-up of Charcot's foot. (orig.)

  10. Charcot-Marie-Tooth Disease

    Science.gov (United States)

    Charcot-Marie-Tooth disease (CMT) is a group of genetic nerve disorders. It is named after the three doctors who first identified it. ... a nerve biopsy. There is no cure. The disease can be so mild you don't realize ...

  11. The diabetic foot - modern possibilities of vascular reconstruction. Der diabetische Fuss - moderne Moeglichkeiten der Gefaessrekonstruktion

    Energy Technology Data Exchange (ETDEWEB)

    Arlart, I.P. (Katharinenhospital, Stuttgart (Germany). Radiologisches Inst.)

    1992-05-01

    Arterial vascular disease in diabetic patients includes both microangiopathy and macroangiopathy. Macroangiopathy, i.e. stenoses of occlusions of the ilio-femoro-popliteal arteries and crural arteries, can be treated by surgical vascular reconstructions and radiological procedures such as recanalisation via catheter and CT-guided lumbar sympathetic trunk, neurolysis. In this paper the different therapeutic techniques are presented in respect of indications and results particularly in the diabetic patients. (orig.).

  12. [Rehabilitation of Charcot-Marie-Tooth Disease].

    Science.gov (United States)

    Tajima, Fumihiro; Nakamura, Takeshi; Nishimura, Yukihide; Arakawa, Hideki; Kawasaki, Takashi; Ogawa, Takahiro; Nishiyama, Kazunari

    2016-01-01

    Charcot-Marie-Tooth disease (CMT) is one of the most commonly inherited neuromuscular diseases causing progressive muscle weakness; contracture; deformity in the feet, legs, and hands; and impairments of ambulation and handgrip. Reduced physical ability can be attributed not only to the disease but also to physical deconditioning. Previously, most physicians in the field of rehabilitation were anxious about the hypothesis of overwork weakness in CMT, and did not conduct intensive exercise programs for patients with CMT. However, recent studies have reported that progressive resistance strengthening programs for lower extremities are feasible, safe, beneficial, and improve exercise intolerance and undue fatigue in patients with CMT. Although the improvement in exercise tolerance may be partly due to the reversal of deconditioning effect of related sedentary lifestyle, progressive resistance training and physical fitness can improve walking function, activities of daily living, and subjective perception of pain and fatigue in patients with CMT. To increase the daily physical function, some studies described the potential benefits of ankle-foot orthoses (AFOs); however, no control study supported it. So far, the training programs on CMT have been dependent on the exercise programs for able-bodied individuals. To increase the effects of rehabilitation, optimal programs that combine the training protocol and AFO strategies will have to be designed for patients with CMT. PMID:26764300

  13. Amputation versus functional reconstruction in the management of complex hind foot injuries caused by land-mine explosions: a long-term retrospective comparison.

    Science.gov (United States)

    Demiralp, Bahtiyar; Ege, Tolga; Kose, Ozkan; Yurttas, Yuksel; Basbozkurt, Mustafa

    2014-05-01

    The purpose of this study is to compare the long-term clinical outcomes of patients who were treated with either hind foot reconstruction or amputation in complex hind foot injuries accompanied with bone and soft tissue loss due to land-mine explosions. Between 1994 and 2004, all patients with hind foot complex injuries due to land-mine explosion, who were operated in our clinic, were enrolled to the study. All patients were evaluated with Short-Form 36 (SF-36), Foot and Ankle Disability Index (FADI) and Body Image Quality of Life Inventory (BIQLI) after a mean of 15.1 ± 2.2 (range 9-19) years of follow-up. Demographic characteristics, number of operations, necessity of psychiatric treatment and all complications were compared between groups. There were a total of 42 patients [21 in reconstruction group (Gr I) and 21 in amputation group (Gr II)]. The mean age at the time of final follow-up was 38.4 ± 3.04 years in Gr I and 38.2 ± 4.24 years in Gr II (p = 0.732). The mean follow-up duration was 15.7 ± 2.07 years in Gr I and 14.57 ± 2.29 years in Gr II (p = 0.081). The number of operations was significantly higher in Gr I (8.66 ± 10.2 times vs. 4.42 ± 7.7 times, respectively, p = 0.001). The mean FADI score at the final follow-up was 64.3 ± 18.1 in Gr I. In amputation group, more patients needed psychotherapy due to major depression (12 patients vs. 4 patients, p = 0.012). Major complications in Gr I were musculocutaneous flap atrophy in calcaneal region (n = 8 patients), limited ankle motion (n = 11) and painful osteophytes on plantar region (n = 6). In Gr II, stump problems were dominating (pain and tenderness n = 10, ulcer n = 2, allergic skin lesions n = 7, painful neuroma n = 10, bony spur n = 5, paresthesia n = 1, excessive sweating n = 12). At the final visit, although SF-36 scores were similar between groups (p = 0.182), extremity reconstruction group had significantly higher BIQLI scores than the amputation group (p = 0.016). If the dorsalis pedis is

  14. Charcot-Marie-Tooth disease masquerading as acute demyelinating encephalomyelitis-like illness.

    Science.gov (United States)

    Kim, Gun-Ha; Kim, Kyoung Min; Suh, Sang-Il; Ki, Chang-Seok; Eun, Baik-Lin

    2014-07-01

    X-linked Charcot-Marie-Tooth disease (CMTX1) is a clinically heterogeneous hereditary motor and sensory neuropathy with X-linked transmission. Common clinical manifestations of CMTX1 disease, as in other forms of Charcot-Marie-Tooth (CMT) disease, are distal muscle wasting and weakness, hyporeflexia, distal sensory disturbance, and foot deformities. Mutations in the connexin-32 gene (gap junction protein β1 [GJB1]) are responsible for CMTX1 disease. In this report, we describe a patient with CMTX1 disease presenting with recurrent attacks of transient and episodic acute demyelinating encephalomyelitis (ADEM)-like symptoms without previous signs of lower extremity weakness or foot deformities; the patient, as well as his asymptomatic mother, exhibited a novel GJB1 mutation (p.Met1Ile). Differential diagnosis of recurrent and transient ADEM-like illness, if unexplained, should include the possibility of CMTX1 disease.

  15. Charcot-Marie-Tooth disease.

    LENUS (Irish Health Repository)

    Reilly, Mary M

    2011-03-01

    Charcot-Marie-Tooth (CMT) disease is the commonest inherited neuromuscular disorder affecting at least 1 in 2,500. Over the last two decades, there have been rapid advances in understanding the molecular basis for many forms of CMT with more than 30 causative genes now described. This has made obtaining an accurate genetic diagnosis possible but at times challenging for clinicians. This review aims to provide a simple, pragmatic approach to diagnosing CMT from a clinician\\'s perspective.

  16. 1型糖尿病并发夏科足一例报告并文献复习%Type 1 Diabetes Mellitus Complicated With Charcot Foot:A Case Report and Literature Review

    Institute of Scientific and Technical Information of China (English)

    张景义; 孟令宇; 吴雪静; 庞玉娟; 赵沙沙; 许颖; 汤建中

    2015-01-01

    夏科( Charcot)关节病是指由神经性疾病导致患者关节深部感觉丧失、骨质破坏,从而引起关节结构异常和功能紊乱的一类疾病。目前,糖尿病已经成为 Charcot 关节病的主要病因之一,其中以 Charcot 足最为常见。Charcot足起病较为隐匿,呈进行性发展,临床症状不典型,易被漏诊和误诊。本文报道了1例1型糖尿病并发Charcot足患者的临床诊治经过,并对其发病机制、临床特点、分期、诊断及治疗等进行讨论和分析,并结合文献复习,以期能提高临床医生对该类疾病的认识。%Charcot arthropathy is a disease induced by neurologic diseases and causes the loss of feeling and bone destruction in deep joint, which further causes abnormal structure and dysfunction in joints. Currently, diabetes has become one of the main causes of Charcot arthropathy, among which Charcot foot is the most common type. Charcot foot has an insidious onset and shows a progressive development. The clinical manifestations of Charcot foot are untypical, thus missed diagnosis and misdiagnosis always occur. This paper reported the process of diagnosis and treatment of a case of type 1 diabetes complicated with Charcot foot, discussed and analyzed the pathogenesis, clinical features, staging, diagnosis and treatment and made relevant literature review, in order to improve clinical doctors′understanding about the disease.

  17. The use of differential scintigraphy in the clinical diagnosis of osseous and soft tissue changes affecting the diabetic foot

    Energy Technology Data Exchange (ETDEWEB)

    Visser, H.J.; Jacobs, A.M.; Oloff, L.; Drago, J.J.

    Prompt recognition of cellulitis, osteomyelitis, diabetic osteolysis, Charcot neuroarthropathy, septic synovitis, and deep plantar abscesses in the diabetic foot is essential because the therapy is drastically different. Differential diagnosis has been greatly facilitated by recently developed scanning techniques.

  18. The pathogenesis of Charcot osteoarthropathy: the role of the peripheral nervous system

    Directory of Open Access Journals (Sweden)

    Galstyan Gagik Radikovich

    2015-01-01

    Full Text Available Neuroosteoarthropathy is a rare, but devastating complication affecting patients with peripheral neuropathy. It is a progressive, destructive condition that is characterised by progressive bone and joint deterioration of the foot leading to permanent incapacity. Nowadays, diabetes mellitus is by far the most common etiology of CNO (Charcot neuro-osteoarthropathy, especially if it affects the foot or ankle.The cause of the condition is still controversial among experts. In particular, new data have emerged on the central role of RANK/RANKL/OPG in the pathogenesis of this complication, also known as Charcot foot. No pharmacological methods of therapy have proven effective to date. Very little progress has been made in treating this condition since the days of Jean-Martin Charcot. Today, the universally accepted treatment involves completely relieving pressure from the limb using a polymer retaining bandage. The aim of this review is to analyze research into the pathogenesis of CNO and our potential to better understand the nature of this condition.Particular attention is paid to modern concept of neuroosteopathology, according to which neuropathy is crucial to developing acute osseous pathology. Revealing new aspects of CNO pathogenesis can help extend therapeutic resources for treating this patient group.

  19. Critical Limb Ischemia in Association with Charcot Neuroarthropathy: Complex Endovascular Therapy for Limb Salvage

    Energy Technology Data Exchange (ETDEWEB)

    Palena, Luis Mariano, E-mail: marianopalena@hotmail.com [Policlinico Abano Terme, Interventional Radiology Unit (Italy); Brocco, Enrico [Policlinico Abano Terme, Diabetic Foot Department, Foot and Ankle Clinic (Italy); Manzi, Marco [Policlinico Abano Terme, Interventional Radiology Unit (Italy)

    2013-05-09

    Charcot neuroarthropathy is a low-incidence complication of diabetic foot and is associated with ankle and hind foot deformity. Patients who have not developed deep ulcers are managed with offloading and supportive bracing or orthopedic arthrodesis. In patients who have developed ulcers and severe ankle instability and deformity, below-the-knee amputation is often indicated, especially when deformity and cutaneous involvement result in osteomyelitis. Ischemic association has not been described but can be present as a part of peripheral arterial disease in the diabetic population. In this extreme and advanced stage of combined neuroischemic diabetic foot disease, revascularization strategies can support surgical and orthopedic therapy, thus preventing osteomyelitis and leading to limb and foot salvage.

  20. Charcot Spine and Parkinson’s Disease

    Directory of Open Access Journals (Sweden)

    Philippe Loriaut

    2014-01-01

    Full Text Available Charcot spine is rare condition whose association with Parkinson’s disease (PD has not been reported yet. The authors reported the cases of two patients with PD who developed Charcot spine. Both patients presented with a history of back pain and bilateral radicular leg pain. They had complete clinical and radiological assessment. Lumbar spine was involved in both patients. Clinical features and response to treatment were described. In the first case, circumferential fusion and stabilization were performed on the dislocated vertebral levels. A solid and stable fusion of the spine was obtained with satisfactory clinical outcome. Surgical treatment has been recommended to the other patient. In both cases, no other neurological etiology was found to account for Charcot spine. In conclusion, Charcot spine is associated with several neurological affections but has not previously been reported in association with Parkinson’s disease.

  1. Learning about Charcot-Marie-Tooth Disease

    Science.gov (United States)

    ... and/or hearing loss, and, in some individuals, scoliosis (curvature of the spine). People with CMT disease ... MBBS, Associate Professor, Department of Physical Medicine and Rehabilitation, Loma Linda University Medical Center, about Charcot-Marie- ...

  2. Charcot's son, commander Jean-Baptiste Charcot: from neurology to "Pourquoi Pas?"

    Directory of Open Access Journals (Sweden)

    Hélio A. G. Teive

    2012-04-01

    Full Text Available Charcot name became very famous around the world, firstly because of the work of Professor Jean-Martin Charcot, the founder of Clinical Neurology, and, secondly, because of his son, Jean-Baptiste, the world famous maritime explorer.

  3. Trench Foot or Immersion Foot

    Science.gov (United States)

    ... Tsunamis Volcanoes Wildfires Winter Weather Trench Foot or Immersion Foot DISASTER RECOVERY FACT SHEET Recommend on Facebook ... is trench foot? Trench foot, also known as immersion foot, occurs when the feet are wet for ...

  4. Trench Foot or Immersion Foot

    Science.gov (United States)

    ... Weather Information on Specific Types of Emergencies Trench Foot or Immersion Foot DISASTER RECOVERY FACT SHEET Recommend on Facebook Tweet Share Compartir What is trench foot? Trench foot, also known as immersion foot, occurs ...

  5. Genetics Home Reference: Charcot-Marie-Tooth disease

    Science.gov (United States)

    Skip to main content Your Guide to Understanding Genetic Conditions Enable Javascript for addthis links to activate. ... Conditions Genes Chromosomes & mtDNA Resources Help Me Understand Genetics Home Health Conditions Charcot-Marie-Tooth disease Charcot- ...

  6. Charcot-like joints in calcium pyrophosphate dihydrate deposition disease

    Energy Technology Data Exchange (ETDEWEB)

    Helms, C.A.; Chapman, G.S.; Wild, J.H.

    1981-10-01

    Two cases of Charcot-like joints in patients with pseudogout who were otherwise neurologically intact are presented. The arthropathy of pseudogout should include Charcot-like joints and it is emphasized that an apparent Charcot joint should raise the question of pseudogout.

  7. COMBINATION TREATMENT FOR ANTERIOR FOOT DEFORMITIES VIA RECONSTRUCTIVE AND JOINT-SPARING SURGERY IN PATIENTS WITH RHEUMATOID ARTHRITIS

    Directory of Open Access Journals (Sweden)

    Ya B Khrennikov

    2011-01-01

    Conclusion. The Weil-osteotomy group showed the preservation and partial salvage of osteotomized heads, which promoted the recovery of swinging function of the foot. The new procedures made it possible to prevent recurrent valgus and hammer toe deformities and callus formation in the late postoperative period, to improve quality of life, and to reduce the time of rehabilitation and the length of hospital stay.

  8. Migrating bone shards in dissecting Charcot joints.

    Science.gov (United States)

    Forrester, D M; Magre, G

    1978-06-01

    Extensive periarticular calcification is characteristic of Charcot joints. Fragmentation of the articular margins of bone contributes to the bony detritus, but the majority forms de novo in the joint capsule. Occasionally the calcific debris is seen far removed from the joint. Dissection of a chronically distended joint along muscle planes is most commonly associated with the inflammatory joint disease of rheumatoid arthritis. Its occurrence in Charcot joints is documented by arthrography, which demonstrates continuity of the joint space and the distant calcifications. PMID:418652

  9. Charcot's Neuroarthropathy After Simultaneous Pancreas-Kidney TransplantA Case Report.

    Science.gov (United States)

    Wilson, Michael

    2016-07-01

    Simultaneous pancreas-kidney transplant (SPKT) is an accepted approach and the treatment of choice in patients with type 1 diabetes with accompanying end-stage renal disease. Charcot's neuroarthropathy of the foot (CN) is a fairly common and devastating complication found in patients with long-standing, mostly uncontrolled, diabetes. However, CN has also been identified as a posttransplant consequence of SPKT. Traditional postoperative immunosuppressive therapy, particularly the use of corticosteroids, is acknowledged as an additional risk factor for the development of de novo CN after SPKT. This article describes an unusual case of a patient who presented with full-blown CN deformity after SPKT.

  10. [Foot defect with vascular and neural injury due to freshwater stingray sting: reconstruction with a lesser saphenous vein adipo-fascial flap].

    Science.gov (United States)

    Moutran, M; Mojallal, A; Chekaroua, K; Martin, E; Braye, F

    2009-04-01

    The emergency care to stingrays envenomation permits, in the majority of cases, to limit the damage caused. In the case of delayed medical care, we can meet deep and extensive lesions that need to be thoroughly explored in order to better address their reconstruction. We report the case of a patient injured by freshwater stingray. He presented a necrotic defect of 6 cm in diameter under the right medial malleolus with bone exposure and neurovascular injury. We opted for a therapeutic strategy in two steps. The first step consisted in a large debridement of the necrotic defect, under appropriate antibiotics and negative pressure therapy. Three weeks later, we covered the defect with a distally based lesser saphenous vein veno-fascia-subcutaneous flap, covered with a split-thickness graft. The coverage of the defect was satisfactory. The infection was controlled with antibiotics, which we prolonged for one month. The patient presented, initially, hypoesthesia of the upper lateral foot in relation with a neurapraxis of the sural nerve. The symptoms resolved at two months. The foot edema due to venous stasis also resolved at two months. The donor site healed without complications. The ability to wear normal shoes was preserved. The patient resumed his daily activities promptly.

  11. ALS5/SPG11/KIAA1840 mutations cause autosomal recessive axonal Charcot-Marie-Tooth disease.

    Science.gov (United States)

    Montecchiani, Celeste; Pedace, Lucia; Lo Giudice, Temistocle; Casella, Antonella; Mearini, Marzia; Gaudiello, Fabrizio; Pedroso, José L; Terracciano, Chiara; Caltagirone, Carlo; Massa, Roberto; St George-Hyslop, Peter H; Barsottini, Orlando G P; Kawarai, Toshitaka; Orlacchio, Antonio

    2016-01-01

    Charcot-Marie-Tooth disease is a group of hereditary peripheral neuropathies that share clinical characteristics of progressive distal muscle weakness and atrophy, foot deformities, distal sensory loss, as well as diminished tendon reflexes. Hundreds of causative DNA changes have been found, but much of the genetic basis of the disease is still unexplained. Mutations in the ALS5/SPG11/KIAA1840 gene are a frequent cause of autosomal recessive hereditary spastic paraplegia with thin corpus callosum and peripheral axonal neuropathy, and account for ∼ 40% of autosomal recessive juvenile amyotrophic lateral sclerosis. The overlap of axonal Charcot-Marie-Tooth disease with both diseases, as well as the common autosomal recessive inheritance pattern of thin corpus callosum and axonal Charcot-Marie-Tooth disease in three related patients, prompted us to analyse the ALS5/SPG11/KIAA1840 gene in affected individuals with autosomal recessive axonal Charcot-Marie-Tooth disease. We investigated 28 unrelated families with autosomal recessive axonal Charcot-Marie-Tooth disease defined by clinical, electrophysiological, as well as pathological evaluation. Besides, we screened for all the known genes related to axonal autosomal recessive Charcot-Marie-Tooth disease (CMT2A2/HMSN2A2/MFN2, CMT2B1/LMNA, CMT2B2/MED25, CMT2B5/NEFL, ARCMT2F/dHMN2B/HSPB1, CMT2K/GDAP1, CMT2P/LRSAM1, CMT2R/TRIM2, CMT2S/IGHMBP2, CMT2T/HSJ1, CMTRID/COX6A1, ARAN-NM/HINT and GAN/GAN), for the genes related to autosomal recessive hereditary spastic paraplegia with thin corpus callosum and axonal peripheral neuropathy (SPG7/PGN, SPG15/ZFYVE26, SPG21/ACP33, SPG35/FA2H, SPG46/GBA2, SPG55/C12orf65 and SPG56/CYP2U1), as well as for the causative gene of peripheral neuropathy with or without agenesis of the corpus callosum (SLC12A6). Mitochondrial disorders related to Charcot-Marie-Tooth disease type 2 were also excluded by sequencing POLG and TYMP genes. An additional locus for autosomal recessive Charcot

  12. Facts that every vascular surgeon needs to know about the diabetic foot.

    Science.gov (United States)

    Edmonds, M

    2014-04-01

    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.

  13. The use of a combined bipedicled axial perforator based fasciocutaneous flap for the treatment of a traumatic diabetic foot wound: a case report

    OpenAIRE

    Ignatiadis, Ioannis A.; Georgakopoulos, Georgios D.; Tsiampa, Vassiliki A.; Matei, Ileana R.; Georgescu, Alexandru V.; Polyzois, Vasilios D.

    2011-01-01

    The axial and perforator vascularised fasciocutaneous flaps are reliable and effective treatment methods for covering lower limb post-traumatic, septic, Charcot, and diabetic foot wounds. The authors describe the unique utilisation of a hybrid flap as an axial-perforator flap combination for the treatment of a traumatic diabetic foot wound. Keywords: diabetic foot; trauma; calcaneus; fasciocutaneous flap; plastic surgery(Published: 7 February 2011)Citation: Diabetic Foot & Ankle 2011, 2: ...

  14. Foot Health

    Science.gov (United States)

    ... toenails straight across and not too short Your foot health can be a clue to your overall ... disease, heart disease, or high blood pressure. Good foot care and regular foot checks are an important ...

  15. Foot Drop

    Science.gov (United States)

    ... Awards Enhancing Diversity Find People About NINDS NINDS Foot Drop Information Page Table of Contents (click to ... research is being done? Clinical Trials What is Foot Drop? Foot drop describes the inability to raise ...

  16. The use of a combined bipedicled axial perforator based fasciocutaneous flap for the treatment of a traumatic diabetic foot wound: a case report

    Directory of Open Access Journals (Sweden)

    Ioannis A. Ignatiadis

    2011-02-01

    Full Text Available The axial and perforator vascularised fasciocutaneous flaps are reliable and effective treatment methods for covering lower limb post-traumatic, septic, Charcot, and diabetic foot wounds. The authors describe the unique utilisation of a hybrid flap as an axial-perforator flap combination for the treatment of a traumatic diabetic foot wound.

  17. Charcot-Marie-Tooth disease and intracellular traffic.

    Science.gov (United States)

    Bucci, Cecilia; Bakke, Oddmund; Progida, Cinzia

    2012-12-01

    Mutations of genes whose primary function is the regulation of membrane traffic are increasingly being identified as the underlying causes of various important human disorders. Intriguingly, mutations in ubiquitously expressed membrane traffic genes often lead to cell type- or organ-specific disorders. This is particularly true for neuronal diseases, identifying the nervous system as the most sensitive tissue to alterations of membrane traffic. Charcot-Marie-Tooth (CMT) disease is one of the most common inherited peripheral neuropathies. It is also known as hereditary motor and sensory neuropathy (HMSN), which comprises a group of disorders specifically affecting peripheral nerves. This peripheral neuropathy, highly heterogeneous both clinically and genetically, is characterized by a slowly progressive degeneration of the muscle of the foot, lower leg, hand and forearm, accompanied by sensory loss in the toes, fingers and limbs. More than 30 genes have been identified as targets of mutations that cause CMT neuropathy. A number of these genes encode proteins directly or indirectly involved in the regulation of intracellular traffic. Indeed, the list of genes linked to CMT disease includes genes important for vesicle formation, phosphoinositide metabolism, lysosomal degradation, mitochondrial fission and fusion, and also genes encoding endosomal and cytoskeletal proteins. This review focuses on the link between intracellular transport and CMT disease, highlighting the molecular mechanisms that underlie the different forms of this peripheral neuropathy and discussing the pathophysiological impact of membrane transport genetic defects as well as possible future ways to counteract these defects.

  18. Significance of Charcot Leyden crystals in hepatic aspirates

    Directory of Open Access Journals (Sweden)

    Misra Vatsala

    2009-01-01

    Full Text Available Charcot Leyden crystals are hexagonal bipyramidal structures localised in the primary granules of the cytoplasm of eosinophils and basophils. Their presence, along with eosinophilic infiltrate, is an indirect evidence of parasitic infestation particularly with Toxocara, Capilliriasis, Ascariasis, or Fasciola. We report here two cases where Charcot Leyden crystals with eosinophilic infiltrate were found in the smears prepared from hepatic abscess.

  19. Effect of painless diabetic neuropathy on pressure pain hypersensitivity (hyperalgesia) after acute foot trauma

    OpenAIRE

    Wienemann, Tobias; Chantelau, Ernst A; Koller, Armin

    2014-01-01

    Introduction and objective: Acute injury transiently lowers local mechanical pain thresholds at a limb. To elucidate the impact of painless (diabetic) neuropathy on this post-traumatic hyperalgesia, pressure pain perception thresholds after a skeletal foot trauma were studied in consecutive persons without and with neuropathy (i.e. history of foot ulcer or Charcot arthropathy).Design and methods: A case–control study was done on 25 unselected clinical routine patients with acute unilateral fo...

  20. Reconstruction of a swine SLA-I protein complex and determination of binding nonameric peptides derived from the foot-and-mouth disease virus.

    Science.gov (United States)

    Gao, Feng-Shan; Fang, Qin-Mei; Li, Yun-Gang; Li, Xin-Sheng; Hao, Hui-Fang; Xia, Chun

    2006-10-15

    No experimental system to date is available to identify viral T-cell epitopes in swine. In order to reconstruct the system for identification of short antigenic peptides, the swine SLA-2 gene was linked to the beta(2)m gene via (G4S)3, a linker encoding a 15-amino acid glycine-rich sequence (G4S)3, using splicing overlap extension-PCR (SOE-PCR). The maltose binding protein (MBP)-SLA-2-(G4S)3-beta(2)m fusion protein was expressed and purified in a pMAL-p2X/Escherichia coli TB1 system. The purified MBP-SLA-2-(G4S)3-beta(2)m protein was cleaved by factor Xa protease, and further purified by DEAE-Sepharose chromatography. The conformation of the SLA-2-(G4S)3-beta(2)m protein was determined by circular dichroism (CD) spectrum. In addition, the refolded SLA-2-(G4S)3-beta(2)m protein was used to bind three nonameric peptides derived from the foot-and-mouth disease virus (FMDV) O subtype VP1. The SLA-2-(G4S)3-beta(2)m-associated peptides were detected by mass spectrometry. The molecular weights and amino acid sequences of the peptides were confirmed by primary and secondary spectra, respectively. The results indicate that the SLA-2-(G4S)3-beta(2)m was 41.6kDa, and its alpha-helix, beta-sheet, turn, and random coil by CD estimation were 78 aa, 149 aa, 67 aa, and 93 aa, respectively. SLA-2-(G4S)3-beta(2)m protein was able to bind the nonameric peptides derived from the FMDV VP1 region: 26-34 (RRQHTDVSF) and 157-165 (RTLPTSFNY). The experimental system demonstrated that the reconstructed SLA-2-(G4S)3-beta(2)m protein complex can be used to identify nonameric peptides, including T-cell epitopes in swine.

  1. Athlete's Foot

    Science.gov (United States)

    Athlete's foot is a common infection caused by a fungus. It most often affects the space between the toes. ... skin between your toes. You can get athlete's foot from damp surfaces, such as showers, swimming pools, ...

  2. Foot Problems

    Science.gov (United States)

    ... much higher rates of foot problems. For women, pain in the toes and ball of the foot is much more common than in men, and it gets worse with age. However, pain in the heel tends to decrease as we ...

  3. Pediatric Charcot-Marie-Tooth disease.

    Science.gov (United States)

    Jani-Acsadi, Agnes; Ounpuu, Sylvia; Pierz, Kristan; Acsadi, Gyula

    2015-06-01

    Heritable diseases of the peripheral nerves (Charcot-Marie-Tooth disease [CMT]) affect the motor units and sensory nerves, and they are among the most prevalent genetic conditions in the pediatric patient population. The typical clinical presentation includes distal muscle weakness and atrophy, but the severity and progression are largely variable. Improvements in supportive treatment have led to better preservation of patients' motor functions. More than 80 genes have been associated with CMT. These genetic discoveries, along with the developments of cellular and transgenic disease models, have allowed clinicians to better understand the disease mechanisms, which should lead to more specific treatments.

  4. Foot pain

    OpenAIRE

    Formosa, Aaron

    2005-01-01

    Foot complaints are very common in general practice and their incidence increases with age. Three out of four people complain of foot pain during the course of a lifetime, while approximately 20% of people aged 65 years or older complain of non-traumatic foot problems.

  5. Foot Health

    Science.gov (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 ...

  6. Nonoperative treatment of neuro-osteoarthropathy of the foot: do we need new criteria?

    Science.gov (United States)

    Chantelau, Ernst; Kimmerle, Renate; Poll, Ludger W

    2007-07-01

    The worst manifestation of neuro-osteoarthropathy of the pain-insensitive foot is the Charcot foot with its devastating osteoarticular destructions and irreversible deformities. New diagnostic tools such as MRI have revealed that mechanical injury and overuse is the origin of the condition. Traditionally, only feet with bone and joint damage apparent on plain radiographs (fracture and dislocation injuries) have undergone nonoperative treatment with off-loading and immobilization; however, treating painless, seemingly asymptomatic nonfracture injuries (bone bruise or bone marrow edema) with off-loading and immobilization has proven highly effective in preventing the Charcot foot. Whether pharmaceutical treatment has a role in terms of prevention or healing of osteoarticular destructions remains to be demonstrated.

  7. Jean-Baptiste Charcot, the French Antarctic expedition and scurvy.

    Science.gov (United States)

    Teive, Hélio Afonso Ghizoni; Germiniani, Francisco Manoel Branco; Munhoz, Renato Puppi

    2014-07-01

    During the second expedition to the South Pole, Commander Jean-Baptiste Charcot and some members of the crew of "Pourquoi Pas?" developed symptoms suggestive of scurvy. The clinical picture was totally reversed after dietary changes. PMID:25054991

  8. Jean-Baptiste Charcot, the French Antarctic expedition and scurvy

    OpenAIRE

    Hélio Afonso Ghizoni Teive; Francisco Manoel Branco Germiniani; Renato Puppi Munhoz

    2014-01-01

    During the second expedition to the South Pole, Commander Jean-Baptiste Charcot and some members of the crew of “Pourquoi Pas?” developed symptoms suggestive of scurvy. The clinical picture was totally reversed after dietary changes.

  9. [Treatment for Patients with Charcot-Marie-Tooth Disease: Orthopaedic Aspects].

    Science.gov (United States)

    Watanabe, Kota

    2016-01-01

    The orthopedic manifestations in patients with Charcot-Marie-Tooth disease include deformity and dysfunction of the extremities and spine. Conservative treatment is the first choice. Orthosis and rehabilitation can improve function, and are important for the prevention of joint contractures. Foot problems are most commonly observed and require surgical treatment. Foot deformities include pes cavus, cavovarus, claw toes, or drop foot. Single or combined surgeries selected for soft tissues are plantar release, tendon transfer, or Achilles tendon lengthening, and those for bones are osteotomies and joint fusions. The upper limb initially demonstrates loss of power of the intrinsic hand muscles followed by symmetrical atrophy of the forearm muscle groups. The typical hand deformity is claw hand. Tendon transfer, joint fusion, soft tissue release, or nerve decompression procedures are performed for correction of hand deformities. Acetabular dysplasia in the hip joints is sometimes observed and osteotomy is selected as surgical treatment in such cases. The associated spinal deformity is scoliosis with or without kyphosis. Similar to treatment of idiopathic scoliosis, posterior spinal fusion is performed in patients with progressive spinal deformities. PMID:26764299

  10. The diabetic foot in 2015: an overview.

    Science.gov (United States)

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

    2016-01-01

    be clinically inferior to ertapenem ± vancomycin. Similarly, there are numerous types of wound dressings that might be used in treatment and which have shown efficacy, but no single type (or brand) has shown superiority over others. Peripheral artery disease is another major contributory factor in the development of ulceration, and its presence is a strong predictor of non-healing and amputation. Despite the proliferation of endovascular procedures in addition to open revascularization, many patients continue to suffer from severely impaired perfusion and exhaust all treatment options. Finally, the question of the true aetiopathogenesis of Charcot neuroarthropathy remains enigmatic, although much work is currently being undertaken in this area. In this area, it is most important to remember that a clinically uninfected, warm, insensate foot in a diabetic patient should be considered as a Charcot foot until proven otherwise, and, as such, treated with offloading, preferably in a cast.

  11. Giant cell tumour of tendon sheath with simultaneous two tendon involvement of the foot treated with excision of the tumour and reconstruction of the flexor retinaculum using tibialis posterior tendon in a paediatric patient: A rare case report.

    Science.gov (United States)

    Tiwari, Vivek; Ansari, Tahir; Mittal, Samarth; Sharma, Pankaj; Nalwa, Aasma

    2015-12-01

    Giant cell tumour of tendon sheath is a benign soft tissue tumour arising from the tendon sheath. The involvement of foot and ankle by such tumours is relatively rare. Children are not commonly afflicted by this condition. All such tumours are reported to arise either from a single tendon sheath or one joint. We report a case of giant cell tumour of tendon sheath in a 12-year-old child, arising simultaneously from the tendon sheaths of tibialis posterior and flexor digitorum longus tendons, as well as extending into the ankle joint. It was treated by complete excision of the mass along with the tendon sheaths with reconstruction of the flexor retinaculum. The location of the tumour, age of the patient, diffuse nature of the tumour and novel technique of reconstruction of the flexor retinaculum make this case extremely rare and the first to be reported in literature. PMID:26564735

  12. Management of diabetic neuropathic foot and ankle malunions and nonunions

    Directory of Open Access Journals (Sweden)

    John J. Stapleton

    2011-05-01

    Full Text Available The management of diabetic neuropathic foot and ankle malunions and/or nonunions is often complicated by the presence of broken or loosened hardware, Charcot joints, infection, osteomyelitis, avascular bone necrosis, unstable deformities, bone loss, disuse and pathologic osteopenia, and ulcerations. The author discusses a rational approach to functional limb salvage with various surgical techniques that are aimed at achieving anatomic alignment, long-term osseous stability, and adequate soft tissue coverage. Emphasis is placed on techniques to overcome the inherent challenges that are encountered when surgically managing a diabetic nonunion and/or malunion. Particular attention is directed to the management of deep infection and Charcot neuroarthropathy in the majority of the cases presented.

  13. Freud with Charcot: Freud's discovery and the question of diagnosis.

    Science.gov (United States)

    Lepoutre, Thomas; Villa, François

    2015-04-01

    Although Charcot's seminal role in influencing Freud is widely stated, although Freud's trip to Paris to study with Charcot is well recognized as pivotal in his shift from neurological to psychopathological work, a key fact of the Freudian heuristic remains largely underestimated: namely, that Freud's psychopathological breakthrough, which gave birth to psychoanalysis, cannot be separated from his 'diagnostic preoccupation', which is a crucial and at times the first organizing principle of his earliest writings. The purpose of this article is therefore to reopen the question of diagnosis by following its development along the path leading from Charcot to Freud. The authors demonstrate that Freud's careful attention to diagnostic distinctions follows strictly in the direction of Charcot's 'nosological method'. More importantly, the article intends to identify the precise way in which his ideas operate in Freud's own work, in order to understand how Freud reinvests them to forge his own nosological system. If the authors trace the destiny of Charcot's lessons as they reach Freud's hands, it is the importance granted to mixed neuroses in Freud's psychopathology that allows them to pinpoint the role played by the diagnostic process in the rationality of psychoanalysis.

  14. Botulinum toxin treatment of pes cavovarus in a child suffering from autosomal recessive axonal Charcot-Marie-Tooth neuropathy (AR-CMT2).

    Science.gov (United States)

    Tiffreau, V; Allart, E; Dangleterre, C; Boutry, N; Petit, F; Cuisset, J M; Thevenon, A

    2015-06-01

    In a 12-year old girl suffering from autosomal recessive axonal Charcot-Marie-Tooth (CMT) neuropathy, pes cavovarus was treated with botulinum toxin injection in the tibialis posterior. The patient underwent a clinical evaluation, video analysis of spatiotemporal gait parameters and dynamic foot plantar pressure assessment before treatment and then two weeks, three months and six months thereafter. The video gait analysis revealed a decrease in varus during the swing phase of gait. The dynamic foot plantar pressure decreased by 50% in the excessive pressure at the side of the foot six months after the injection (maximal pressure=42.6N/cm2 before treatment and 18.9 N/cm2 after 6 month). Botulinum toxin injection appears to be an efficacious means of correcting pes cavovarus in CMT disease. A larger-scale clinical trial is now required to evaluate the putative longer-term preventive effect of this treatment on the pes cavus deformity. PMID:24980632

  15. Foot Problems

    Science.gov (United States)

    ... irritation of the arch ligament and tissues, called PLANTAR FASCIITIS. Try to keep weight off your foot until ... bone, but more likely to be due to PLANTAR FASCIITIS. See your doctor. He or she can suggest ...

  16. Foot Surgery

    Science.gov (United States)

    ... in the toe to maintain realignment. Neuroma Surgery: Neuroma surgery involves removing a benign enlargement of a nerve, usually between the metatarsal heads in the ball of the foot. This soft tissue surgery tends to have a ...

  17. Club foot

    DEFF Research Database (Denmark)

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

    2006-01-01

    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 the...... last 130 years. In 2002 all 46 418 twins born between 1931 and 1982 received a 17-page questionnaire, one question of which was 'Were you born with club foot?' A total of 94 twins answered 'Yes', giving an overall self-reported prevalence of congenital club foot of 0.0027 (95% confidence interval (CI.......09 (95% CI 0.01 to 0.32) for DZss and 0.05 (95% CI 0.006 to 0.18) for all dizygotic (DZtot) twins. We have found evidence of a genetic component in congenital club foot, although non-genetic factors must play a predominant role....

  18. [Pathology of Charcot-Marie-Tooth Disease].

    Science.gov (United States)

    Oka, Nobuyuki

    2016-01-01

    Although genetic testing is available, nerve biopsy is useful in selected patients for the diagnosis of Charcot-Marie-Tooth disease (CMT). These are sporadic cases of hereditary neuropathy, or familial cases in which genetic testing is negative. CMT is caused by mutations of various genes. The pathological features of CMT have mostly been investigated using nerve biopsy, which may shed light on the presumed functions of mutated gene products. PMP22 duplication in CMT1A induces numerous large onion bulb lesions (OB). Compared to chronic inflammatory demyelinating polyradiculoneuropathy, the differential features of CMT1A are patchy distribution of OB and non-inflammatory lesions. CMT1B also manifests as OB, but presents abnormal compaction of myelin sheaths caused by uncompacted myelin or excessive myelin folding. CMT2 includes axonal neuropathies and many causative genes have been found. CMT2A (MFN2 mutation) shows abnormal mitochondria with a spherical morphology instead of tubular in the longitudinal direction. CMT4 consists of autosomal recessive forms with demyelinating pathology. Most subtypes have mutations of genes relating to myelin maintenance, and pathologically, they show abnormal folding of the myelin structure.

  19. ANESTHESIA FOR CHARCOT-MARIE-TOOTH DISEASE: CASE REPORT.

    Science.gov (United States)

    Alzaben, Khalid R; Samarah, Omar Q; Obeidat, Salameh S; Halhouli, Oday; Al Kharabsheh, Murad

    2016-06-01

    Charcot-Marie-Tooth disease comprises a group of disorders characterized by progressive muscle weakness and wasting. Reviewing the anaesthetic literature produced conflicting reports about the best anaesthetic options for patients with CMTD; as they are at increased risk of prolonged response to muscle relaxants, malignant hyperthermia and risks of regional anaesthesia. We present a case of the successful use of total intravenous anaesthesia with dexmedetomidine and propofol combined with caudal block using bupivacaine mixed with dexmedetomidine without any complications, for a 17 year old male patient with Charcot Marie-Tooth disease who underwent a lower limb orthopedic surgery.

  20. The German and Belgian accreditation models for diabetic foot services.

    Science.gov (United States)

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

    2016-01-01

    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).

  1. Charcot-Marie-Tooth disease type 1A

    DEFF Research Database (Denmark)

    Hertz, Jens Michael; Børglum, A D; Brandt, C A;

    1994-01-01

    Charcot-Marie-Tooth disease type 1A (CMT1A) is an autosomal dominant peripheral neuropathy associated with a DNA duplication on chromosome 17p11.2-p12 in the majority of cases. Most of the sporadic cases are due to a de novo duplication. We have screened for this duplication in 11 Danish patients...

  2. Jean-Baptiste Charcot, the French Antarctic expedition and scurvy

    Directory of Open Access Journals (Sweden)

    Hélio Afonso Ghizoni Teive

    2014-07-01

    Full Text Available During the second expedition to the South Pole, Commander Jean-Baptiste Charcot and some members of the crew of “Pourquoi Pas?” developed symptoms suggestive of scurvy. The clinical picture was totally reversed after dietary changes.

  3. Molecular Diagnosis of Charcot-Marie Tooth Disease

    Directory of Open Access Journals (Sweden)

    J. Gordon Millichap

    2002-02-01

    Full Text Available The frequency of mutations in certain genes in 153 unrelated patients with Charcot-Marie-Tooth disease (CMT was determined by DNA sequencing before clinical testing at the Departments of Molecular and Human Genetics and Pediatrics, Baylor College of Medicine, Houston, TX, and other centers.

  4. 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)

    1995-07-01

    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.)

  5. 不同术式拇手指再造术后供足的步态分析%Gait analysis of the donor foot after various thumb/finger reconstruction

    Institute of Scientific and Technical Information of China (English)

    张立山; 潘勇卫; 田光磊; 郭险峰; 童艳

    2009-01-01

    Objective To study the changes of gait and plantar pressure after various thumb/finger recontruction with different techniques. Methods Gait analyses and dynamic plantar pressure measurements bv F-scan system were performed to patients who underwent various thumb/finger reconstrction with different techniques. Results Thiny-eight patiertts who underwent various thumb/finger reconstruction were followed up,with a mean period of 25 months(4 to 182 months),and given gait analysis.In 10 cases the thumbs were reconstructed with the traditional wrap-around flap.Their Theit cycle and sub-phase of double support of the donor foot had the trend of prolonging compared with those of the intact foot.The peak force and peak pressure greatly increased in some donor great toes, but distinctly decreased,even undetectable for some others.The peak pressure under the 3rd and 4th metatarsal head of the donor foot significantly increased,as well as the peak force.The range that the center of force trajectory moved forward diminished signitlcantly.In 18 cases,the thumbs were recontructed with the modified wrap-around flap.The peak force and pressure-time integral of donor toes were both decreased statistically.but the peak, pressure was nearly the same to that of the intact toes.The duration of the gait cycle and its sub-phases,together with the peak force,peak pressure and pressure-time intecral under the 1st to 5th metalamtl heads had no difference between the donor and the intact foot.The center of fonce traieetory was almost the same on both sides.The kinematic and kinetic parameters of the donor foot were all changed to some extent after other reconstructive procedures.Conclusion Each thumb/finger reconstructive technique may cause certain degree of influence to the kinematics and kinetics of the donor foot. The traditional wrap-around technique brings significant changes,while the modified wrap-around technique has minor trouble to the donor foot function.%目的 研究不同术

  6. Foot Disorders, Foot Posture, and Foot Function: The Framingham Foot Study

    OpenAIRE

    Hagedorn, Thomas J; Alyssa B Dufour; RISKOWSKI, JODY L.; Hillstrom, Howard J; Menz, Hylton B.; Casey, Virginia A.; Hannan, Marian T

    2013-01-01

    Introduction: Foot disorders are common among older adults and may lead to outcomes such as falls and functional limitation. However, the associations of foot posture and foot function to specific foot disorders at the population level remain poorly understood. The purpose of this study was to assess the relation between specific foot disorders, foot posture, and foot function. Methods: Participants were from the population-based Framingham Foot Study. Quintiles of the modified arch index and...

  7. Reconstruction of large wounds using a combination of negative pressure wound therapy and punch grafting after excision of acral lentiginous melanoma on the foot.

    Science.gov (United States)

    Seo, Jimyung; Kim, Jihee; Nam, Kyoung Ae; Zheng, Zhenlong; Oh, Byung Ho; Chung, Kee Yang

    2016-01-01

    Melanoma in darker-pigmented individuals often develops in an acral lentiginous fashion on the foot. After surgical removal of a tumor at this site, repair of the wound can be challenging. This is because there is an insufficient local skin pool and lack of mobility of the skin in this area. Moreover, functional aspects such as walking and weight bearing should be considered. We performed a combination treatment of negative pressure wound therapy (NPWT) and punch grafting on 15 patients, after wide excision of acral lentiginous melanomas on the foot, and compared these to 26 patients who underwent either secondary intention healing (SIH, n = 13) or NPWT (n = 13) alone. The punch grafting with NPWT group showed significantly shorter healing times than those of the other two groups. Evaluation of completely healed wounds using the Vancouver Burn Scar Assessment Scale revealed that the punch grafting group had mean values better, or comparable, to the SIH or NPWT group in four of the five scales (except pigmentation). As for complications, only one patient developed a wound infection after punch grafting. Further, by utilizing NPWT for fixation of punch grafts, it was possible to treat all subjects as outpatients after punch grafting. These results show that a combination treatment of NPWT and punch grafting is an excellent therapeutic option for post-wide excision wounds on the feet, with significantly shortened healing times and favorable cosmetic outcomes. PMID:26173565

  8. Diabetic Foot

    Science.gov (United States)

    ... can cause you to lose feeling in your feet. You may not feel a cut, a blister or a sore. Foot injuries such as these can cause ulcers and ... the blood vessels can also mean that your feet do not get enough blood and oxygen. It ...

  9. Socioeconomic profile of diabetic patients with and without foot problems

    Directory of Open Access Journals (Sweden)

    Aziz Nather

    2010-10-01

    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.

  10. Misclassification and linkage of hereditary sensory and autonomic neuropathy type 1 as Charcot-Marie-Tooth disease, Type 2B

    Energy Technology Data Exchange (ETDEWEB)

    Vance, J.M.; Speer, M.C.; Stajich, J.M. [Duke Univ. Medical Center, Durham, NC (United States)

    1996-07-01

    Recently Kwon et al. published in the Journal their work describing linkage of a single large family with an inherited axonal neuropathy to chromosome 3, which they suggest is a second locus for Charcot-Marie-Tooth (CMT) type 2 and subsequently named {open_quotes}CMT2B.{close_quotes} We think that the diagnostic classification of this family as CMT2 is incorrect, since the subjects have a severe sensory neuropathy that fits within the hereditary sensory and autonomic neuropathy (HSAN) type 1 classification of Dyck (1993). Abnormal sensory findings in CMT2 separate it from distal spinal muscular atrophy but are a minor component of clinical symptoms in most CMT patients, as CMT is primarily a motor neuropathy. When Kwon et al. state that {open_quotes}all [patients] had characteristic findings in their physical examinations, including... evidence of foot sores that were slow to heal, or amputated limbs related to the poorly healing foot ulcers,{close_quotes} it suggests that a different diagnosis is more appropriate. In our experience collecting data on >950 individuals in >60 CMT1, CMT2, CMTX and CMT4 families, we have not seen foot ulcers, osteomyelitis, or amputations. Ulcerations leading to osteomyelitis and amputations are usually associated with severe sensory neuropathies. 16 refs., 1 tab.

  11. Quality-of-Life in Charcot Marie Tooth Disease: The Patient's Perspective

    OpenAIRE

    Johnson, Nicholas E.; Heatwole, Chad R; Dilek, Nuran; Sowden, Janet; Kirk, Callyn A; Shereff, Denise; Shy, Michael E; Herrmann, David N.

    2014-01-01

    This study determines the impact of symptoms associated with Charcot-Marie-Tooth disease on quality-of-life. Charcot-Marie-Tooth patients in the Inherited Neuropathies Consortium Rare Diseases Clinical Research Network Contact Registry were surveyed. The survey inquired about 214 symptoms and 20 themes previously identified as important to Charcot-Marie-Tooth patients through patient interviews. Symptom population impact was calculated as the prevalence multiplied by the relative importance o...

  12. Mycetoma foot

    Directory of Open Access Journals (Sweden)

    Somnath Gooptu

    2013-01-01

    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.

  13. Neuropathic arthropathy (Charcot's joint) in dialysis patients

    Energy Technology Data Exchange (ETDEWEB)

    Meneghello, A.; Bertoli, M.

    1984-08-01

    To the author's knowledge, uraemic neuropathy has not been previously reported as a cause of Charcot's joint. In this paper they present three cases in which the association between clinical and radiographic patterns suggest the diagnosis of neuropathic arthropathy. The features of uraemic neuropathy are stressed and the role of secondary hyperparathyroidism in the development of this type of arthropathy is discussed. The extremely severe hyperparathyroidism reported here, may cause tendon and ligament disease, especially at the site of their bone insertion. Uraemic tendon and ligament failures weaken joints and produce further instability, which may be a precipitating factor of uraemic Charcot's joint in patients undergoing chronic haemodialysis. 5 figs.

  14. Vestibular impairment in patients with Charcot-Marie-Tooth disease

    OpenAIRE

    Poretti, A.; Palla, A; Tarnutzer, A A; Petersen, J A; Weber, K P; Straumann, D; Jung, H H

    2013-01-01

    OBJECTIVE: This case-control study aimed to determine whether the imbalance in Charcot-Marie-tooth (CMT) disease is caused only by reduced proprioceptive input or whether the involvement of the vestibular nerve is an additional factor. METHODS: Fifteen patients with CMT disease (aged 48 ± 17 years; 8 women) underwent cervical vestibular-evoked myogenic potentials, which reflect otolith-spinal reflex function, and quantitative horizontal search-coil head-impulse testing, which assesses the hi...

  15. Charcot-Marie-Tooth disease: insights from skin biopsy

    OpenAIRE

    Pisciotta, Chiara

    2015-01-01

    Inherited neuropathies, collectively known as Charcot-Marie-Tooth disease (CMT), are a group of genetically and phenotypically heterogeneous peripheral neuropathies associated with mutations or copy number variations in over 80 distinct genes. The advent of genetic testing has made sural nerve biopsy unnecessary for diagnosing most cases of CMT, particularly because the technique is somewhat invasive. Unfortunately, this has led to an inability to evaluate morphological effects by the various...

  16. Pé cavo adquirido na doença de Charcot-Marie-Tooth Acquired pes cavus in Charcot-Marie-Tooth disease

    Directory of Open Access Journals (Sweden)

    Daniel Augusto Carvalho Maranho

    2009-01-01

    Full Text Available As neuropatias sensitivomotoras hereditárias, principalmente a doença de Charcot-Marie-Tooth, manifestam-se frequentemente com o aparecimento de pé cavovaro, deformidade caracterizada pela acentuação fixa do arco plantar e inversão do retropé. O diagnóstico da doença de base e a cuidadosa avaliação do paciente fornecem os elementos-chave para decisão do tratamento. O cavo pode situar-se no antepé, retropé ou ser o resultado da associação das duas localizações. Deformidades combinadas, principalmente varismo e garras dos artelhos, devem ser bem avaliadas; as características clínicas como grau das alterações, acometimento da força muscular, flexibilidade e idade são fatores importantes para a decisão da conduta. O tratamento conservador do pé cavovaro por meio de fisioterapia, palmilhas e adaptação nos calçados é reservado ao paciente mais jovem ou casos levemente acometidos. Entretanto, há tendência de agravamento das deformidades devido à característica progressiva da doença neurológica de base. Assim, o tratamento cirúrgico pelas técnicas clássicas é indicado precocemente, sendo importante identificar as alterações primárias, diferenciá-las das secundárias e corrigi-las, se possível. As transferências musculares são usadas no sentido de minimizar o desequilíbrio, estruturas retraídas são seccionadas ou alongadas e osteotomias localizadas devem ser preferíveis às artrodeses, que são reservadas para pés rígidos e muito deformados de pacientes adultos.Hereditary motor and sensory neuropathies, especially Charcot-Marie-Tooth disease, are frequently expressed with an acquired cavusvarus foot which is characterized by a fixed increase of the plantar arch and hindfoot inversion. Diagnosis of the underlying condition achieved through careful patient assessment and local evaluations is the keystone for decision-making about the adequate treatment. The cavus may present as an isolated deformity of

  17. Reconstruction of the Transmission History of RNA Virus Outbreaks Using Full Genome Sequences: Foot-and-Mouth Disease Virus in Bulgaria in 2011

    DEFF Research Database (Denmark)

    Valdazo-González, Begoña; Polihronova, Lilyana; Alexandrov, Tsviatko;

    2012-01-01

    Improvements to sequencing protocols and the development of computational phylogenetics have opened up opportunities to study the rapid evolution of RNA viruses in real time. In practical terms, these results can be combined with field data in order to reconstruct spatiotemporal scenarios that de...... as a number of antibody positive wild boar on both sides of the border with Turkish Thrace. This study highlights how FGS analysis can be used as an effective on-the-spot tool to support and help direct epidemiological investigations of field outbreaks....... the origin and transmission history of the FMD outbreaks which occurred during 2011 in Burgas Province, Bulgaria, a country that had been previously FMD-free-without-vaccination since 1996. Nineteen full genome sequences (FGS) of FMD virus (FMDV) were generated and analysed, including eight representative...

  18. Foot amputation - discharge

    Science.gov (United States)

    Amputation - foot - discharge; Trans-metatarsal amputation - discharge ... You have had a foot amputation. You may have had an accident, or your foot may have had an infection or disease and doctors could ...

  19. Common Foot Problems

    Science.gov (United States)

    ... and rashes clinical tools newsletter | contact Share | Common Foot Problems A A A Trauma, infection, skin disease, ... the sole of the front part of the foot and on the toes. Foot infections include warts; ...

  20. Foot sprain - aftercare

    Science.gov (United States)

    Mid-foot sprain ... There are many bones and ligaments in your foot. A ligament is a strong flexible tissue that holds bones together. When the foot lands awkwardly, some ligaments can stretch and tear. ...

  1. Phenotypic spectrum of dynamin 2 mutations in Charcot-Marie-Tooth neuropathy.

    NARCIS (Netherlands)

    Claeys, K.G.; Zuchner, S.; Kennerson, M.; Berciano, J.; Garcia, A.; Verhoeven, K.; Storey, E.; Merory, J.R.; Bienfait, H.M.; Lammens, M.M.Y.; Nelis, E.; Baets, J.; Vriendt, E. De; Berneman, Z.N.; Veuster, I. De; Vance, J.M.; Nicholson, G.; Timmerman, V.; Jonghe, P. de

    2009-01-01

    Dominant intermediate Charcot-Marie-Tooth neuropathy type B is caused by mutations in dynamin 2. We studied the clinical, haematological, electrophysiological and sural nerve biopsy findings in 34 patients belonging to six unrelated dominant intermediate Charcot-Marie-Tooth neuropathy type B familie

  2. Phenotypic spectrum of dynamin 2 mutations in Charcot-Marie-Tooth neuropathy

    NARCIS (Netherlands)

    K.G. Claeys; S. Züchner; M. Kennerson; J. Berciano; A. Garcia; K. Verhoeven; E. Storey; J.R. Merory; H.M.E. Bienfait; M. Lammens; E. Nelis; J. Baets; E. de Vriendt; Z.N. Berneman; I. de Veuster; J.M. Vance; G. Nicholson; V. Timmerman; P. de Jonghe

    2009-01-01

    Dominant intermediate Charcot-Marie-Tooth neuropathy type B is caused by mutations in dynamin 2. We studied the clinical, haematological, electrophysiological and sural nerve biopsy findings in 34 patients belonging to six unrelated dominant intermediate Charcot-Marie-Tooth neuropathy type B familie

  3. [Jean-Martin Charcot (1825-1893): a physician with multiple facets].

    Science.gov (United States)

    Lellouch, Alain

    2013-12-01

    This work is registered in the year (2013) commemorating the 120 years since Jean-Martin Charcot's (1825-1893) death. Presently, the event takes place during 2013, in France, in Paris, at Hôpital de la Salpêtrière where Charcot practiced as medical chief of l'Hospice de la Vieillesse-Femmes, from 1862 until he died in 1893. The aim of the research is to show, from various examples and sources (printed and handwritten: fonds d'archives Charcot de la Salpêtrière) how talented Charcot was as a clinician, pathologist and microscopist, researcher and experimenter, teacher, artist, designer, cartoonist, polyglot and traveller), how varied his medical career was and how innovative his scientific method was. All this permitted Charcot to make an impressive number of medical discoveries in various fields which are today known as geriatrics and rheumatology, internal medicine, cardiology, neurology, psychiatry and paranormal processes. PMID:26035927

  4. [Jean-Martin Charcot (1825-1893): a physician with multiple facets].

    Science.gov (United States)

    Lellouch, Alain

    2013-12-01

    This work is registered in the year (2013) commemorating the 120 years since Jean-Martin Charcot's (1825-1893) death. Presently, the event takes place during 2013, in France, in Paris, at Hôpital de la Salpêtrière where Charcot practiced as medical chief of l'Hospice de la Vieillesse-Femmes, from 1862 until he died in 1893. The aim of the research is to show, from various examples and sources (printed and handwritten: fonds d'archives Charcot de la Salpêtrière) how talented Charcot was as a clinician, pathologist and microscopist, researcher and experimenter, teacher, artist, designer, cartoonist, polyglot and traveller), how varied his medical career was and how innovative his scientific method was. All this permitted Charcot to make an impressive number of medical discoveries in various fields which are today known as geriatrics and rheumatology, internal medicine, cardiology, neurology, psychiatry and paranormal processes.

  5. A Novel Mutation of GDAP1 Associated with Charcot-Marie-Tooth Disease in An Iranian Family

    Directory of Open Access Journals (Sweden)

    Esmaeel MOHAMMADI PARGOO

    2012-06-01

    Full Text Available As a result of higher distributed consanguinity in the Mediterranean region and the Middle East, autosomal-recessive forms of Charcot-Marie-Tooth (ARCMT are more common in these areas. CMT disease caused by mutations in the ganglioside-induced differentiation-associated protein 1 (GDAP1 gene is a severe autosomal recessive neuropathy resulting in either demyelinating CMT4A neuropathy or axonal neuropathy with vocal cord paresis. The patient was an 8-year-old boy with AR inheritance that showed some delayed achievement of motor milestones, including walking, also bilateral foot drop, wasting of distal muscles in the legs, pes cavus and marked weakness of the foot dorsiflexors. He had no hoarseness or vocal cord paralysis. Total genomic DNA was extracted from whole peripheral blood of the patient and his family by using standard procedures. PCR- sequencing method were used to analysis the whole coding regions of the GDAP1 gene. A novel homozygote insertion of T nucleotide in codon 34 was detected (c.100_101insT that probably led to an early stop codon. This mutation may be associated with a common haplotype, suggesting a common ancestor that needs further investigation in the Iranian population.

  6. [The Salpêtrière from Mazarin to Charcot].

    Science.gov (United States)

    Bonduelle, M

    1997-01-01

    The edict of 1656 creating the Hôpital Général for sheltering the incapacitated and beggars assigned women to the Salpêtrière which kept its name of Petit-Arsenal (1636). Mazarin contributed generously to the construction. The completion of the facade (1756) imparted a final shape to the overall plan that had been uncertain for a long time. The Infirmerie générale (1780-1787) made a start toward medicalization, while the loges housed the insane under better conditions. For the Salpêtrière (named in 1837 Hospice de la Vieillesse-Femmes [Hospice for old Women]), it was the era of the alienists, renown for Pinel, his students and successors. In 1862 Charcot undertook the cultivation of its "inexhaustable resources". A laboratory in the avant-garde of microscopy became the basis for the anatomo-clinical method. In ten years Charcot laid the foundations of neurology: multiple sclerosis, locomotor ataxia, physiological anatomy of the cord, amyotrophic lateral sclerosis, etc. After his work on motor localization (1875), hysteria became his prime subject. Between 1877 and 1881, he built a service that became a model: laboratories, related clinical departments, a polyclinic (an putpatient department, a short-term hospital). The creation in 1882 of the clinical chair for diseases of the nervous system crowned the enterprise. The formal lectures on Fridays and the Tuesday clinical conferences attracted an audience from around the world. Charcot and his school made the Salpêtrière synonomous with neurology.

  7. Charcot-Marie-Tooth disease complicating type 2 diabetes.

    LENUS (Irish Health Repository)

    Win, Htet Htet Ne

    2012-02-01

    Although both conditions are relatively common, there are very few descriptions of type 2 diabetes mellitus coexisting with Charcot-Marie-Tooth disease (CMT). This case report and literature review describes a 53-year-old Irish man who presented with type 2 diabetes and significant neuropathy, and who was subsequently diagnosed with CMT type 1A. This case report will also discuss how to differentiate diabetic neuropathy from a progressive hereditary neuropathy and how coexistence aggravates the progression of neuropathy thus necessitating early diagnosis.

  8. Charcot-marie-tooth disease complicating type 2 diabetes.

    LENUS (Irish Health Repository)

    Win, Htet Htet Ne

    2011-07-01

    Although both conditions are relatively common, there are very few descriptions of type 2 diabetes mellitus coexisting with Charcot-Marie-Tooth disease (CMT). This case report and literature review describes a 53-year-old Irish man who presented with type 2 diabetes and significant neuropathy, and who was subsequently diagnosed with CMT type 1A. This case report will also discuss how to differentiate diabetic neuropathy from a progressive hereditary neuropathy and how coexistence aggravates the progression of neuropathy thus necessitating early diagnosis.

  9. Sarcopenia and body composition in diabetic Charcot osteoarthropathy

    DEFF Research Database (Denmark)

    Jansen, Rasmus Bo; Christensen, Tomas Møller; Bülow, Jens;

    2015-01-01

    BACKGROUND: Treatment of Charcot osteoarthropathy (COA) requires restricted walking and offloading for several months, which lead to fat re-distribution and increased sarcopenia. OBJECTIVES/AIM: To investigate whether subjects with COA have an altered body composition compared to controls. METHODS....../total body fat distribution ratios. RESULTS: Sarcopenia frequency was higher in the total population with diabetes overall (9-40%), compared to normal materials. Using two different models for correlating appendicular lean mass to sarcopenia, there were no differences in sarcopenia-rates between the groups...

  10. Balance and muscle power of children with Charcot-Marie-Tooth

    Directory of Open Access Journals (Sweden)

    Tais R. Silva

    2014-08-01

    Full Text Available BACKGROUND: In certain diseases, functional constraints establish a greater relationship with muscle power than muscle strength. However, in hereditary peripheral polyneuropathies, no such relationship was found in the literature. OBJECTIVE: In children with Charcot-Marie-Tooth (CMT, to identify the impact of muscle strength and range of movement on the static/dynamic balance and standing long jump based on quantitative and functional variables. METHOD: The study analyzed 19 participants aged between 6 and 16 years, of both genders and with clinical diagnoses of CMT of different subtypes. Anthropometric data, muscle strength of the lower limbs (hand-held dynamometer, ankle and knee range of movement, balance (Pediatric Balance Scale and standing long jump distance were obtained by standardized procedures. For the statistical analysis, Pearson and Spearman correlation coefficients were used. RESULTS: There was a strong positive correlation between balance and the muscle strength of the right plantar flexors (r=0.61 and dorsiflexors (r=0.59 and a moderate correlation between balance and the muscle strength of inversion (r=0.41 and eversion of the right foot (r=0.44. For the long jump and range of movement, there was a weak positive correlation with right and left plantar flexion (r=0.20 and r=0.12, respectively and left popliteal angle (r=0.25, and a poor negative correlation with left dorsiflexion (r=-0.15. CONCLUSIONS: The data on the patients analyzed suggests that the maintenance of distal muscle strength favors performance during balance tasks, while limitations in the range of movement of the legs seem not to be enough to influence the performance of the horizontal long jump.

  11. Pierre Janet, Sigmund Freud and Charcot's psychological and psychiatric legacy.

    Science.gov (United States)

    Pérez-Rincón, Héctor

    2011-01-01

    A key moment in the history of psychiatry occurred during Charcot's time at La Salpêtriere. Though his studies on hysteria and hypnotism, the founder of neurology inspired the work of two of his alumni: a Viennese Nervenartz and a French philosopher interested in the dissociation of personality. Even though neither of them was originally an alienist, their respective work allowed the field of neurosis--then belonging to internal medicine--to pass to psychiatry. The parallel lives of these frères enemis, both of whom were treated differently by fame, developed inside a very complex cultural and scientific milieu. Therefore, it is necessary to consider them together with other physicians, some of whom are much less well-known nowadays, who one way or another carried Charcot's influence into psychiatry, psychology and psychotherapy. The fates of the Dioscuri have been reversed--the fame and success of Freudian psychoanalysis ran parallel to Janet's oblivion and his long 'purgatory', but now the 'renaissance' of his work coincides with the decline of psychoanalysis as a theoretical explanation for mental pathology.

  12. Charcot-Marie-Tooth disease: genetic and rehabilitation aspects

    Directory of Open Access Journals (Sweden)

    Mariana CEVEI

    2008-05-01

    Full Text Available Charcot-Marie-Tooth hereditary motor and sensory neuropathy refers to a group of disorders characterized by a chronic motor and sensory polyneuropathy. Typical cases have distal muscle weakness and peroneal atrophy often associated with mild to moderate sensory loss, depressed tendon reflexes, and pes cavus. Hereditary neuropathies are categorized by mode of inheritance and chromosomal locus. The diagnosis is based on family history, characteristic findings on physical examination, EMG, nerve conduction velocity testing, and occasionally on nerve biopsy. The disorder shows allelic and non-allelic genetic heterogeneity, thus mutations of different genes leading to the same clinical features. Also, different mutations of the same gene may lead to different phenotypes. Molecular genetic testing is available in clinical laboratories for diagnosis of 7 subtypes of the disease. Genetic counseling and risk assessment depend on the inheritance. We present two cases with Charcot-Marie-Tooth type 1 and type 2 respectively. There is no cure for the disorder, although physical therapy and moderate activity are often recommended to maintain muscle strength and endurance.

  13. Spinal and bulbar muscular atrophy and Charcot-Marie-Tooth type 1A: Co-existence of two rare neuromuscular genetic diseases in the same patient.

    Science.gov (United States)

    Sagnelli, Anna; Scaioli, Vidmer; Piscosquito, Giuseppe; Salsano, Ettore; Dalla Bella, Eleonora; Gellera, Cinzia; Pareyson, Davide

    2015-10-01

    Spinal and bulbar muscular atrophy is an X-linked neuromuscular disease caused by a trinucleotide CAG repeat expansion in the androgen receptor gene; it is clinically characterized by adult-onset, slowly progressive weakness and atrophy mainly affecting proximal limb and bulbar muscles. Charcot-Marie-Tooth disease type 1A is an autosomal dominant polyneuropathy due to peripheral myelin protein 22 gene duplication and characterized by slowly progressive distal limb muscle weakness, atrophy and sensory loss with foot deformities. Here we report the co-occurrence of both neuromuscular genetic diseases in the same male patient. Difficulties in climbing stairs and jaw weakness were presenting symptoms consistent with SBMA. However, predominant distal weakness and bilateral pes cavus were rather suggestive of a hereditary polyneuropathy. The combination of two diseases, even if extremely rare, should be considered in the presence of atypical symptoms; in the case of genetic diseases this event may have important implications on family members' counseling.

  14. De novo PMP2 mutations in families with type 1 Charcot-Marie-Tooth disease.

    Science.gov (United States)

    Motley, William W; Palaima, Paulius; Yum, Sabrina W; Gonzalez, Michael A; Tao, Feifei; Wanschitz, Julia V; Strickland, Alleene V; Löscher, Wolfgang N; De Vriendt, Els; Koppi, Stefan; Medne, Livija; Janecke, Andreas R; Jordanova, Albena; Zuchner, Stephan; Scherer, Steven S

    2016-06-01

    We performed whole exome sequencing on a patient with Charcot-Marie-Tooth disease type 1 and identified a de novo mutation in PMP2, the gene that encodes the myelin P2 protein. This mutation (p.Ile52Thr) was passed from the proband to his one affected son, and segregates with clinical and electrophysiological evidence of demyelinating neuropathy. We then screened a cohort of 136 European probands with uncharacterized genetic cause of Charcot-Marie-Tooth disease and identified another family with Charcot-Marie-Tooth disease type 1 that has a mutation affecting an adjacent amino acid (p.Thr51Pro), which segregates with disease. Our genetic and clinical findings in these kindred demonstrate that dominant PMP2 mutations cause Charcot-Marie-Tooth disease type 1.

  15. Jean-Baptiste Charcot in Rio de Janeiro: glamorous trip and celebrity in 1908

    Directory of Open Access Journals (Sweden)

    Hélio A. G. Teive

    2015-09-01

    Full Text Available The authors review the visit of Commander Charcot and the crew of his ship, the “Pourquoi Pas?”, to Rio de Janeiro, Brazil, in 1908, where he stayed for eight days, while en-route as part of the second French expedition to the Antarctic. It was a glamorous stay as Commander Charcot was treated as a true star and international celebrity, befitting his position.

  16. Therapeutic options in Charcot-Marie-Tooth diseases.

    Science.gov (United States)

    Mathis, Stéphane; Magy, Laurent; Vallat, Jean-Michel

    2015-04-01

    Charcot-Marie-Tooth (CMT) diseases represent a heterogeneous genetic disorder (more than 80 genes are implicated in these inherited neuropathies), but sharing a similar phenotype. In recent years, advances in molecular genetics and molecular biology, and also the development of various animal models of CMT, have led to a better understanding. Taken together, this knowledge represents a prerequisite for the development of future therapies in CMT, and in peripheral nervous system disorders in general. The efficacy of various substances has been shown in vitro and also in vivo (in animal models); but, no significant positive effect has yet been confirmed in humans. However, some of these trials are still in development, and we may expect positive results in the future. Although CMT is still an incurable disease, symptomatic treatments (physiotherapy, surgery, analgesic, etc.) are crucial to improve the quality of life of CMT patients.

  17. Noncompaction Cardiomyopathy with Charcot-Marie-Tooth Disease

    Directory of Open Access Journals (Sweden)

    Sherif Ali Eltawansy

    2015-01-01

    Full Text Available We report a case of a 53-year-old female presenting with a new-onset heart failure that was contributed secondary to noncompaction cardiomyopathy. The diagnosis was made by echocardiogram and confirmed by cardiac MRI. Noncompaction cardiomyopathy (also known as ventricular hypertrabeculation is a newly discovered disease. It is considered to be congenital (genetic cardiomyopathy. It is usually associated with genetic disorders and that could explain the genetic pathogenesis of the non-compaction cardiomyopathy. Our case had a history of Charcot-Marie-Tooth disease. There is a high incidence of arrhythmia and embolic complications. The treatment usually consists of the medical management, defibrillator placement, and lifelong anticoagulation. Heart transplantation will be the last resort.

  18. Hand weakness in Charcot-Marie-Tooth disease 1X.

    LENUS (Irish Health Repository)

    Arthur-Farraj, P J

    2012-07-01

    There have been suggestions from previous studies that patients with Charcot-Marie-Tooth disease (CMT) have weaker dominant hand muscles. Since all studies to date have included a heterogeneous group of CMT patients we decided to analyse hand strength in 43 patients with CMT1X. We recorded handedness and the MRC scores for the first dorsal interosseous and abductor pollicis brevis muscles, median and ulnar nerve compound motor action potentials and conduction velocities in dominant and non-dominant hands. Twenty-two CMT1X patients (51%) had a weaker dominant hand; none had a stronger dominant hand. Mean MRC scores were significantly higher for first dorsal interosseous and abductor pollicis brevis in non-dominant hands compared to dominant hands. Median nerve compound motor action potentials were significantly reduced in dominant compared to non-dominant hands. We conclude that the dominant hand is weaker than the non-dominant hand in patients with CMT1X.

  19. 18-F flourodeoxy glucose positron emission tomography-computed tomography imaging: A viable alternative to three phase bone scan in evaluating diabetic foot complications?

    International Nuclear Information System (INIS)

    This paper is based on the initial findings from a prospective ongoing study to evaluate the efficacy of flourodeoxy glucose positron emission tomography-computed tomography (FDG-PET CT) in diabetic foot evaluation. The aim was to compare the diagnostic accuracies of three phase bone scan (TPBS) and FDG PET-CT (FDG-PET) in diabetic foot evaluation. Seventy-nine patients with complicated diabetic foot (osteomyelitis/cellulitis, Charcot's neuropathy) were prospectively investigated. TPBS (15 mci methylene di phosphonate [MDP] intravenous [IV]), followed by FDG-PET (5 mci IV) within 5 days were performed in all patients. Based on referral indication, patients grouped into Group I, n = 36, (?osteomyelitis/cellulitis) and Group II, n = 43 (?Charcot's neuropathy). Interpretation was based on intensity, extent, pattern of MDP and FDG uptake (standardized uptake value) along with CT correlation. Findings were compared with final diagnostic outcome based on bone/soft tissue culture in Group I and clinical, radiological or scintigraphic followup in Group II. Results: Group I: For diagnosing osteomyelitis, TP: TN: FP: FN were 14:5:2:2 by FDG PET and 13:02:05:03 by TPBS respectively. Sensitivity, specificity, positive predictive value and negative predictive value (NPV) of FDG-PET were 87.5%, 71%, 87.5% and 71% and 81.25%, 28.5%, 72% and 40% for TPBS, respectively. Group II: charcot's: cellulitis: Normal were 22:14:7 by FDG PET and 32:5:6 by TPBS, respectively. Flourodeoxy glucose PET-CT has a higher specificity and NPV than TPBS in diagnosing pedal osteomyelitis. TPBS, being highly sensitive is more useful than FDG-PET in detecting Charcot's neuropathy

  20. Charcot-Marie-Tooth病的诊治%Progress of the diagnosis and treatment of Charcot-Marie-Tooth disease

    Institute of Scientific and Technical Information of China (English)

    洪道俊; 张玉生

    2014-01-01

    Charcot-Marie-Tooth病(CMT)是最常见的一种遗传性周围神经病,是一组具有显著临床异质性和遗传异质性的疾病,主要表现为肢体远端肌肉进行性无力和萎缩,伴有轻到中度感觉减退,腱反射减弱和足部畸形等.近20年CMT致病基因的不断被克隆,其疾病分型、临床表型和基因表型的关系发生了巨大变化.本文主要阐述CMT的疾病分型演变、基因诊断策略、临床治疗进展.

  1. [Presentation of a flap web space laterodigital in cleft foot].

    Science.gov (United States)

    Szwebel, J; Haddad, R; Mitrofanoff, M

    2012-08-01

    Cleft foot deformity is characterized by the absence of one or more median rays of the foot. This rare polymorphous congenital anomaly occurs more frequently in males, with a frequent autosomal dominant type of transmission. The purpose of surgical treatment is to narrow the width of the foot, but also to improve its global aesthetic look. Toe reparation, and more specifically web space reconstruction, provide the main technical challenges. We present an adaptation to the foot of a laterodigital cutaneous flap published by Barsky in 1964 for commissural reconstruction in cleft hand syndroms. The anatomical structure of fingers and toes commisures being different, this flap seems more adapted to the surgery of the foot. We gathered seven patients' files treated for ectrodactyly of the foot with this technique by the same surgeon from 2005 to 2008. No particular postoperative complications were noted, and the patients all expressed their satisfaction regarding the improvement of the appearance of their foot. We recommend to add the use of this flap in the "tool box" of the surgeon in charge of the management of foot deformities. PMID:20947236

  2. Sesamoid Injuries in the Foot

    Science.gov (United States)

    ... FootNotes Newsletter Current Issue Archive Subscribe Home » Foot & Ankle Conditions » Sesamoid Injuries in the Foot A A A | Print | Share ... or certain activities. Diagnosis In diagnosing a sesamoid injury, the foot and ankle surgeon will examine the foot, focusing on the ...

  3. Prediction of protective sensory loss, neuropathy and foot ulceration in type 2 diabetes

    Science.gov (United States)

    Paisey, R B; Darby, T; George, A M; Waterson, M; Hewson, P; Paisey, C F; Thomson, M P

    2016-01-01

    Objectives To prospectively determine clinical and biochemical characteristics associated with the development of peripheral neuropathy, loss of protective sensation, and foot ulceration in persons with type 2 diabetes mellitus (DM) over 7 years. Research design and methods Graded monofilament (MF) testing, vibration perception threshold, and neuropathy symptom questionnaires were undertaken in 206 participants with type 2 DM without peripheral vascular disease or history of foot ulceration and 71 healthy participants without DM at baseline and after 7 years. 6 monthly glycosylated hemoglobin (HbA1c) levels and annual serum lipid profiles were measured during follow-up of those with DM. Incident foot ulceration was recorded at follow-up. Results Taller stature and higher quartiles of serum triglyceride and HbA1c levels were associated with neuropathy at follow-up (p=0.008). Remission of baseline neuropathy was observed in 7 participants at follow-up. 9 participants with type 2 DM developed foot ulcers by the end of the study, only 1 at low risk. Mean HbA1c levels were higher in those who developed foot ulceration (p<0.0001). 1 participant with neuropathy throughout developed a Charcot foot. Failure to perceive 2 or more 2, 4 and 6 g MF stimuli at baseline predicted loss of protective sensation at follow-up. Conclusions Tall stature and worse metabolic control were associated with progression to neuropathy. Mean HbA1c levels were higher in those who developed foot ulcers. Graded MF testing may enrich recruitment to clinical trials and assignation of high risk for foot ulceration. PMID:27239314

  4. Hand, Foot and Mouth Disease

    Science.gov (United States)

    ... Submit Button Past Emails CDC Features Hand, Foot & Mouth Disease Language: English Español (Spanish) Recommend on Facebook ... sick Is HFMD the Same as Foot-and-Mouth Disease? No. HFMD is often confused with foot- ...

  5. Systematic review of exercise for Charcot-Marie-Tooth disease.

    Science.gov (United States)

    Sman, Amy D; Hackett, Daniel; Fiatarone Singh, Maria; Fornusek, Ché; Menezes, Manoj P; Burns, Joshua

    2015-12-01

    Charcot-Marie-Tooth disease (CMT) is a slowly progressive hereditary degenerative disease and one of the most common neuromuscular disorders. Exercise may be beneficial to maintain strength and function for people with CMT, however, no comprehensive evaluation of the benefits and risks of exercise have been conducted. A systematic review was completed searching numerous electronic databases from earliest records to February 2015. Studies of any design including participants of any age with confirmed diagnosis of CMT that investigated the effects of exercise were eligible for inclusion. Of 13,301 articles identified following removal of duplicates, 11 articles including 9 unique studies met the criteria. Methodological quality of studies was moderate, sample sizes were small, and interventions and outcome measures used varied widely. Although the majority of the studies identified changes in one or more outcome measurements across exercise modalities, the majority were non-significant, possibly due to Type II errors. Significant effects described included improvements in strength, functional activities, and physiological adaptations following exercise. Despite many studies showing changes in strength and function following exercise, findings of this review should be met with caution due to the few studies available and moderate quality of evidence. Well-powered studies, harmonisation of outcome measures, and clearly described interventions across studies would improve the quality and comparability of the evidence base. The optimal exercise modality and intensity for people with CMT as well as the long-term safety of exercise remain unclear.

  6. The shifting paradigm of Charcot-Marie-Tooth disease.

    Science.gov (United States)

    Echaniz-Laguna, A

    2015-01-01

    Molecular studies have created a paradigm shift in our perception of Charcot-Marie-Tooth disease (CMT). Indeed, CMT has evolved from the concept of a rather homogeneous hereditary disease exclusively involving peripheral nerves to the concept of a highly heterogeneous clinical and genetic syndrome mainly - but sometimes not exclusively - involving the peripheral nervous system. The phenotypic spectrum of CMT overlaps with other inherited neuropathies such as distal hereditary motor neuropathy (dHMN), hereditary sensory and autonomic neuropathy (HSAN), spinal muscular atrophy (SMA) subtypes, and the neuropathies of mitochondrial disorders. At a molecular level, mutations in one given gene may alternatively provoke CMT, HSAN, dHMN or SMA variants. Over the last years, there have been dramatic advances in deciphering the molecular basis for many CMT subtypes and more than 900 different mutations in more than 60 causative genes are now described. However, as 75% of CMT causative genes apparently remain unknown and as disease-specific therapies are not available, major advances are yet to come in the field of CMT.

  7. Diabetic foot infections.

    Science.gov (United States)

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

    2013-08-01

    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.

  8. The foot and ankle

    International Nuclear Information System (INIS)

    Imaging of the foot and ankle can be difficult because of the complex anatomy. Familiarity with the bony and ligamentous anatomy is essential for proper evaluation of radiographic findings. Therefore, pertinent anatomy is discussed as it applies to specific injuries. Special views, tomography, arthrography, and other techniques may be indicated for complete evaluation of foot and ankle trauma

  9. A novel mutation in VCP causes Charcot-Marie-Tooth Type 2 disease.

    Science.gov (United States)

    Gonzalez, Michael A; Feely, Shawna M; Speziani, Fiorella; Strickland, Alleene V; Danzi, Matt; Bacon, Chelsea; Lee, Youjin; Chou, Tsui-Fen; Blanton, Susan H; Weihl, Conrad C; Zuchner, Stephan; Shy, Michael E

    2014-11-01

    Mutations in VCP have been reported to account for a spectrum of phenotypes that include inclusion body myopathy with Paget's disease of the bone and frontotemporal dementia, hereditary spastic paraplegia, and 1-2% of familial amyotrophic lateral sclerosis. We identified a novel VCP mutation (p.Glu185Lys) segregating in an autosomal dominant Charcot-Marie-Tooth disease type 2 family. Functional studies showed that the Glu185Lys variant impaired autophagic function leading to the accumulation of immature autophagosomes. VCP mutations should thus be considered for genetically undefined Charcot-Marie-Tooth disease type 2.

  10. Cx32 gene mutation associated with X-linked recessive Charcot-Marie-Tooth disease

    Institute of Scientific and Technical Information of China (English)

    2003-01-01

    The form of Charcot-Marie-Tooth (CMT) neuropathy that maps to Xq13 is X-linked dominant, or X-linked intermediate. Heterozygous females are more mildly affected than hemizygous males. It has been known that this type of CMT is caused by mutations of connexin32 (Cx32) gene. A typical X-linked recessive Charcot-Marie-Tooth Chinese family was analyzed with single strand conformation polymorphism method. A Cx32 gene point mutation, Arg15Gln, in exon 2 was identified in all affected family members, suggesting that this mutation is responsible for the CMT incidence of this family.

  11. Treatment of diabetic foot ulcer: an overview strategies for clinical approach.

    Science.gov (United States)

    Dalla Paola, Luca; Faglia, Ezio

    2006-11-01

    Diabetic foot disease is a major health problem, which concerns 15% of the 200 million patients with diabetes worldwide. Major amputation, above or below the knee, is a feared complication of diabetes. More than 60% of non-traumatic amputations in the western world are performed in the diabetic population. Many patients who undergo an amputation, have a history of ulceration. Major amputations increase morbility and mortality and reduce the patient's quality of life. Treatment of foot complications is one of the main items in the absorption of economic and health resources addressed to the diabetic population. It is clear that effective treatment can bring about a reduction in the number of major amputations. Over recent years, we have seen a significant increase in knowledge about the physiopathological pathways of this complication, together with improvements in diagnostic techniques, but above all a standardized conservative therapeutic approach, which allows limb salvage in a high percentage of cases. This target has been achieved in specialized centers. An important prelude to diabetic foot treatment is the differing diagnosis of neuropathic and neuroischemic foot. This differentiation is essential for effective treatment. Ulceration in neuropathic foot is due to biomechanical stress and high pressure, which involves the plantar surface of toes and metatarsal heads. Treatment of a neuropathic plantar ulcer must correct pathological plantar pressures through weight bearing relief. Surgical treatment of deformities, with or without ulcerations, is effective therapy. A neuropathic ulcer that is not adequately treated can become a chronic ulcer that does not heal. An ulcer that does not heal for many months has a high probability of leading to osteomyelitis, for which treatment with antibiotics is not useful and which usually requires a surgical procedure. Charcot neuroarthropathy is a particular complication of neuropathy which may lead to fragmentation or

  12. Effect of painless diabetic neuropathy on pressure pain hypersensitivity (hyperalgesia after acute foot trauma

    Directory of Open Access Journals (Sweden)

    Tobias Wienemann

    2014-11-01

    Full Text Available Introduction and objective: Acute injury transiently lowers local mechanical pain thresholds at a limb. To elucidate the impact of painless (diabetic neuropathy on this post-traumatic hyperalgesia, pressure pain perception thresholds after a skeletal foot trauma were studied in consecutive persons without and with neuropathy (i.e. history of foot ulcer or Charcot arthropathy. Design and methods: A case–control study was done on 25 unselected clinical routine patients with acute unilateral foot trauma (cases: elective bone surgery; controls: sprain, toe fracture. Cases were 12 patients (11 diabetic subjects with severe painless neuropathy and chronic foot pathology. Controls were 13 non-neuropathic persons. Over 1 week after the trauma, cutaneous pressure pain perception threshold (CPPPT and deep pressure pain perception threshold (DPPPT were measured repeatedly, adjacent to the injury and at the opposite foot (pinprick stimulators, Algometer II®. Results: In the control group, post-traumatic DPPPT (but not CPPPT at the injured foot was reduced by about 15–25%. In the case group, pre- and post-operative CPPPT and DPPPT were supranormal. Although DPPPT fell post-operatively by about 15–20%, it remained always higher than the post-traumatic DPPPT in the control group: over musculus abductor hallucis 615 kPa (kilopascal versus 422 kPa, and over metatarsophalangeal joint 518 kPa versus 375 kPa (medians; case vs. control group; CPPPT did not decrease post-operatively. Conclusion: Physiological nociception and post-traumatic hyperalgesia to pressure are diminished at the foot with severe painless (diabetic neuropathy. A degree of post-traumatic hypersensitivity required to ‘pull away’ from any one, even innocuous, mechanical impact in order to avoid additional damage is, therefore, lacking.

  13. Charcot-Marie-Tooth病研究进展

    Institute of Scientific and Technical Information of China (English)

    郭晓强; 王江雁; 时兰春; 王仁杰

    2006-01-01

    Charcot-Marie-Tooth disease(CMT病)是一种进行性神经性肌萎缩综合征,又称遗传性运动和感觉神经性疾病(HMSN)和腓骨肌萎缩症(PMA),CMT病本身并不会危害患者的生命,但却严重影响患者的身体状况,给他们的日常生活带来不便。CMT病的进展比较缓慢,患者的临床表现主要是控制脚/小腿或手,前臂的感觉信息和肌肉萎缩为特征,伴感觉障碍、脊柱及足畸形、植物神经功能紊乱等症状。CMT病是最普遍的遗传性神经疾病之一,至今仍没有有效的治疗方法。但随着研究的深入,人们逐渐对CMT病有了更为全面的认识,在治疗上也开始出现一些新的选择,从而为这种疾病的症状改善和最终的治愈带来了希望。

  14. Broca and Charcot's research on Jacques Inaudi: the psychological and anthropological study of a mental calculator.

    Science.gov (United States)

    Nicolas, Serge; Guida, Alessandro; Levine, Zachary

    2014-01-01

    In the nineteenth century, French scientific institutions became interested in young "mental calculators," arithmetical prodigies able to quickly and accurately perform complex mental calculations. The first scientists to study mental calculators were phrenologists who sought to prove the existence of a calculating organ in the frontal lobe. Paul Broca introduced one such mental calculator, Jacques Inaudi, to the Anthropological Society of Paris in 1880. Broca attributed extraordinary faculty for mental calculation to memory functioning (the psychological hypothesis) rather than physiological difference (the phrenological hypothesis). In 1892, prominent French Academy of Sciences member Jean-Martin Charcot produced a noteworthy study of Inaudi on the organization's behalf. Charcot observed that Inaudi called upon auditory memory rather than visual memory in his mental calculations, unlike most mental calculators who preceded him. Like Broca, Charcot was skeptical of the phrenological hypothesis, though he noted that Inaudi's skull was markedly plagiocephalic. Interestingly, anthropological examination of Inaudi is consistent with the themes of modern cognitive neuroscience. Thus, Charcot seems to have anticipated present research on the localization of mental calculation and memory for numbers. 1. (1)The Academy of Sciences, founded in 1666 by Louis XIV (1638-1715) with the goal of contributing to the advancement and application of the sciences in France, was one of the earliest European scientific institutions. As a prestigious society, it played an active role in defining scientific and technological research policy as well as drafting and publishing official reports. PMID:24697632

  15. Charcot-Marie-Tooth disease: frequency of genetic subtypes and guidelines for genetic testing.

    LENUS (Irish Health Repository)

    Murphy, Sinead M

    2012-07-01

    Charcot-Marie-Tooth disease (CMT) is a clinically and genetically heterogeneous group of diseases with approximately 45 different causative genes described. The aims of this study were to determine the frequency of different genes in a large cohort of patients with CMT and devise guidelines for genetic testing in practice.

  16. Charcots artropati som årsag til hypoparatyroid hyperkalcæmi

    DEFF Research Database (Denmark)

    Engberg, Susanne; Jensen, Jens-Erik Beck; Kønig, Karen Bay

    2012-01-01

    A 45-year-old woman with type 2 diabetes and multiple diabetic complications was diagnosed with hypoparathyroid hypercalcaemia. The bone scintigraphy showed Charcots arthropathy. Blood tests, computer tomography and mammography did not give any indication of malignancy, vitamin-D intoxication nor...

  17. Piet Mondrian's trees and the evolution in understanding multiple sclerosis, Charcot Prize Lecture 2011

    NARCIS (Netherlands)

    Steinman, L.; Axtell, R.C.; Barbieri, D.; Bhat, R.; Brownell, S.E.; Jong, B.A. de; Dunn, S.E.; Grant, J.L.; Han, M.H.; Ho, P.P.; Kuipers, H.F.; Kurnellas, M.P.; Ousman, S.S.; Rothbard, J.B.

    2013-01-01

    Four questions were posed about multiple sclerosis (MS) at the 2011 Charcot Lecture, Oct. 22, 2011. 1. The Male/Female Disparity: Why are women developing MS so much more frequently than men? 2. Neuronal and Glial Protection: Are there guardian molecules that protect the nervous system in MS? 3. Pre

  18. Auditory processing in patients with Charcot-Marie-Tooth disease type 1A.

    NARCIS (Netherlands)

    Neijenhuis, C.A.M.; Beynon, A.J.; Snik, A.F.M.; Engelen, B.G.M. van; Broek, P. van den

    2003-01-01

    HYPOTHESIS: It is unclear whether Charcot-Marie-Tooth (CMT) disease, type 1A, causes auditory processing disorders. Therefore, auditory processing abilities were investigated in five CMT1A patients with normal hearing. BACKGROUND: Previous studies have failed to separate peripheral from central audi

  19. Nerve Excitability Properties in Charcot-Marie-Tooth Disease Type 1A

    Science.gov (United States)

    Nodera, Hiroyuki; Bostock, Hugh; Kuwabara, Satoshi; Sakamoto, Takashi; Asanuma, Kotaro; Jia-Ying, Sung; Ogawara, Kazue; Hattori, Naoki; Hirayama, Masaaki; Kaji, Ryuji

    2004-01-01

    Charcot-Marie-Tooth disease type 1A (CMT1A) is commonly considered a prototype of a hereditary demyelinating polyneuropathy. Apart from the myelin involvement, there has been little information on axonal membrane properties in this condition. Taking advantage of the uniform nature of the disease process, we undertook the "in vivo" assessment of…

  20. [PREGNANCY AND DELIVERY IN A PATIENT WITH CHARCOT-MARIE-TOOTH DISEASE].

    Science.gov (United States)

    Pehlivanov, B; Matev, M

    2016-01-01

    We report a case of a 34 years old primigravida with Charcot-Marie-Tooth disease (CMTD). The course of pregnancy was uneventful with no deterioration of symptoms due to the disease. Performed amniocentesis showed healthy fetus. Planned cesarean section with spinal anesthesia was performed because of the restricted pelvis. The possible issues of combination pregnancy and CMTD are discussed.

  1. Neuromuscular Hip Dysplasia in Charcot-Marie-Tooth Disease Type 1A

    Science.gov (United States)

    Bamford, Nigel S.; White, Klane K.; Robinett, Stephanie A.; Otto, Randolph K.; Gospe, Sidney M., Jr.

    2009-01-01

    Charcot-Marie-Tooth disease (CMT) is one of the most common inherited neurological disorders, affecting 36 in 100,000 people. CMT type 1A (hereditary motor and sensory neuropathy) is the most frequent form of this disease, affecting 60 to 80% of the CMT population, but its diagnosis may be delayed because of inconsistent clinical signs and…

  2. Sympathetic neuropathy in diabetes mellitus patients does not elicit Charcot osteoarthropathy

    DEFF Research Database (Denmark)

    Christensen, Tomas M; Simonsen, Lene; Holstein, Per E;

    2011-01-01

    AIM: The aim of the study was to determine the degree of neuropathy (autonomic and somatic) in patients with diabetes mellitus with or without Charcot osteoarthropathy (CA). METHODS: Forty-nine patients with diabetes mellitus type 1 or 2 were investigated. The patient population of interest...

  3. Motor axon loss is associated with hand dysfunction in Charcot-Marie-Tooth disease 1a.

    NARCIS (Netherlands)

    Videler, A.J.; Dijk, J.P. van; Beelen, A.; Visser, M. de; Nollet, F.; Schaik, I.N. van

    2008-01-01

    BACKGROUND: Charcot Marie Tooth type 1a (CMT1a) is a primarily demyelinating neuropathy, characterized by slowly progressive muscle weakness, atrophy, and sensory loss, and is most pronounced in both feet and hands. There is increasing evidence that muscle weakness is determined by motor axonal dysf

  4. Diabetes and Foot Problems

    Science.gov (United States)

    ... Disease, and Other Dental Problems Diabetic Eye Disease Diabetes and Foot Problems How can diabetes affect my feet? Too much glucose, also called ... you have any of these signs. How can diabetes change the shape of my feet? Nerve damage ...

  5. Make down the pivot point of sural neurofasciocutaneous flap to reconstruct tissue defects of middle or distant foot%低旋转点腓肠神经筋膜皮瓣修复足部中远端组织缺损的临床应用

    Institute of Scientific and Technical Information of China (English)

    许瑾; 王明刚; 李勇; 武朱明; 余勇

    2011-01-01

    Objective To approach the method of reconstruct tissue defects of middle or distant foot by make down the pivot point of sural neurofasciocutaneous flap. Methods We had used lower pivot point sural neurofasciocutaneous flaps in ten patients for reconstruction of tissue defects of distant foot by electrical injuries or traumatisms scince 2006.The size of the flap ranged from 6cm×5cm~12cm×18cm,and the pivot point is at the range of 0~3cm above the lateral malleolus. Results Nine flaps survived completely. In one flap,superficial necrosis about 2cra in distal parts occured and managed successfully by change of dressing and split-thickness skin graft. Conclusion Make down the pivot point flaps can procure enough length to transfer and repair defects at distal end of foot with a safety blood supply. The flap is easily to operated, quick and safe,do not injury major arteries and it expand the application of sural neurofasciocutaneous flap.%目的:探讨应用低旋转点腓肠神经筋膜皮瓣修复足部中远端组织缺损的方法.方法:降低腓肠神经筋膜皮瓣的旋转点至外踝尖0~3cm范围,使皮瓣旋转后可以达到足远端,皮瓣一期转移,共修复10例,皮瓣面积5cm×6cm~12cm×18cm.结果:9例皮瓣全部成活,1例皮瓣远端出现约2cm2左右皮肤坏死,后行换药、植皮修复.结论:降侣腓肠神经筋膜皮瓣的旋转点可用于修复足远端皮肤软组织缺损,解决了足部中远端组织缺损修复这一难题;其血供安全可靠,切取转移简便易行,拓展了该皮瓣的应用范围.

  6. Foot Anthropometry and Morphology Phenomena

    OpenAIRE

    Agić, Ante; NIKOLIĆ, VASILIJE; Mijović, Budimir

    2006-01-01

    Foot structure description is important for many reasons. The foot anthropometric morphology phenomena are analyzed together with hidden biomechanical functionality in order to fully characterize foot structure and function. For younger Croatian population the scatter data of the individual foot variables were interpolated by multivariate statistics. Foot structure descriptors are influenced by many factors, as a style of life, race, climate, and things of the great importance in ...

  7. Mutations in the MORC2 gene cause axonal Charcot-Marie-Tooth disease.

    Science.gov (United States)

    Sevilla, Teresa; Lupo, Vincenzo; Martínez-Rubio, Dolores; Sancho, Paula; Sivera, Rafael; Chumillas, María J; García-Romero, Mar; Pascual-Pascual, Samuel I; Muelas, Nuria; Dopazo, Joaquín; Vílchez, Juan J; Palau, Francesc; Espinós, Carmen

    2016-01-01

    Charcot-Marie-Tooth disease (CMT) is a complex disorder with wide genetic heterogeneity. Here we present a new axonal Charcot-Marie-Tooth disease form, associated with the gene microrchidia family CW-type zinc finger 2 (MORC2). Whole-exome sequencing in a family with autosomal dominant segregation identified the novel MORC2 p.R190W change in four patients. Further mutational screening in our axonal Charcot-Marie-Tooth disease clinical series detected two additional sporadic cases, one patient who also carried the same MORC2 p.R190W mutation and another patient that harboured a MORC2 p.S25L mutation. Genetic and in silico studies strongly supported the pathogenicity of these sequence variants. The phenotype was variable and included patients with congenital or infantile onset, as well as others whose symptoms started in the second decade. The patients with early onset developed a spinal muscular atrophy-like picture, whereas in the later onset cases, the initial symptoms were cramps, distal weakness and sensory impairment. Weakness and atrophy progressed in a random and asymmetric fashion and involved limb girdle muscles, leading to a severe incapacity in adulthood. Sensory loss was always prominent and proportional to disease severity. Electrophysiological studies were consistent with an asymmetric axonal motor and sensory neuropathy, while fasciculations and myokymia were recorded rather frequently by needle electromyography. Sural nerve biopsy revealed pronounced multifocal depletion of myelinated fibres with some regenerative clusters and occasional small onion bulbs. Morc2 is expressed in both axons and Schwann cells of mouse peripheral nerve. Different roles in biological processes have been described for MORC2. As the silencing of Charcot-Marie-Tooth disease genes have been associated with DNA damage response, it is tempting to speculate that a deregulation of this pathway may be linked to the axonal degeneration observed in MORC2 neuropathy, thus adding a

  8. Hyperbaric oxygen therapy in the treatment of diabetic foot ulcers--prudent or problematic: a case report.

    Science.gov (United States)

    Mutluoglu, Mesut; Uzun, Günalp; Yildiz, Senol

    2010-06-01

    Hyperbaric oxygen (HBO) therapy is increasingly used in the management of problem wounds, notably diabetic foot ulcers. However, concerns about unnecessary, inappropriate, and prolonged use of this adjunctive treatment exist. A case report of a 52-year-old patient with diabetes mellitus, Charcot foot, and a nonhealing plantar ulcer who had received HBO treatments only illustrates these concerns. He presented with normal pedal pulses, adequate transcutaneous partial oxygen pressure levels, no offloading footwear, and a heavily contaminated ulcer (Pseudomonas spp.). Following a course of oral antibiotics, appropriate topical wound care, and offloading instructions, the wound healed within 3 months. Advanced wound therapy modalities are only indicated for use in patients when accepted standards of wound care, including identification and correction of underlying disorders and comorbidities, have failed. To prevent misuse/overuse of HBO therapy, stand-alone HBO centers should include a multidisciplinary wound care team.

  9. A neurological bias in the history of hysteria: from the womb to the nervous system and Charcot

    OpenAIRE

    Marleide da Mota Gomes; Eliasz Engelhardt

    2014-01-01

    Hysteria conceptions, from ancient Egypt until the 19th century Parisian hospital based studies, are presented from gynaecological and demonological theories to neurological ones. The hysteria protean behavioral disorders based on nervous origin was proposed at the beginning, mainly in Great Britain, by the “enlightenment nerve doctors”. The following personages are highlighted: Galen, William, Sydenham, Cullen, Briquet, and Charcot with his School. Charcot who had hysteria and hypnotism prob...

  10. Foot Loading Characteristics of Different Graduations of Partial Weight Bearing

    Science.gov (United States)

    Gusinde, Johannes; Pauser, Johannes; Swoboda, Bernd; Gelse, Kolja; Carl, Hans-Dieter

    2011-01-01

    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…

  11. Metrological analysis of the human foot: 3D multisensor exploration

    Science.gov (United States)

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

    2011-08-01

    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.

  12. Foot muscles strengthener

    Directory of Open Access Journals (Sweden)

    Boris T. Glavač

    2012-04-01

    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.

  13. What Is a Foot and Ankle Surgeon?

    Science.gov (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? ...

  14. Hand, Foot, and Mouth Disease (HFMD)

    Science.gov (United States)

    ... with infected people Commonly Confused With Foot-and-Mouth Disease Hand, foot, and mouth disease is often ... and-Mouth Disease . Outbreaks of Hand, Foot, and Mouth Disease Large outbreaks of hand, foot, and mouth ...

  15. CTA findings in the lower extremity arterial disease of diabetic foot and the accuracy of reconstruction modes%糖尿病足下肢动脉CTA表现及重建方式的准确性评估

    Institute of Scientific and Technical Information of China (English)

    徐锐; 张爱莉; 李建龙; 王瑞敏; 赵龙华

    2010-01-01

    Objective To evaluate the application of CTA in the lower extremity arterial disease of diabetic foot, to find the best display mode and evaluate the capability of collateral circulation formation. Methods 45 patients conforming to standard of diabetic foot were chosen as study subjects. Axial imagings, MIP, MPR and VRT techniques were used to evaluate the target vessels. Part of the patients were compared with DSA. Results Some kinds of artery lesions were found in 44 patiends. Collateral circulation was found in 23 patients (59 arterys with occlusion). Compared with DSA, the diagnostic accuracy of CTA was 97.43 % in judging the degree of medium or more server stenosis, and no significant difference was found between the two techniques (χ2 =20.025 ,P = 0.067). Axial imagings had the most similar measure value compared with DSA. MIP, MPR and VRT techniques were insensitive to mild stenosis. MIP could show more minute blood vessels. Severe stenosis could be identified incorrectly as occlusion when VRT technique was used. Conclusion CTA might be the most economic and accurate method to evaluate the lower extremity arterial disease of diabetic foot;The most effective technique to evaluate the arteries was Axial imagings and MIP;The location of the severe artery lesions was the key point in collateral circulation formation.%目的 评估CTA对糖尿病足患者的应用价值,寻找最佳的显示方式,评估患者侧支循环情况.方法 选择符合糖尿病足诊断标准的患者45例行下肢动脉CTA检查.使用薄层横轴位图像、MIP、MPR、VRT评估成像血管状态;部分患者与DSA对照.结果 44例患者发现不同程度的下肢动脉病变;23例(59支)动脉血管闭塞后,周围有侧支循环建立.CTA对病变血管中度及以上狭窄程度的判断与DSA的符合率为97.43%,二者之间无显著差异(x2=20.025,P=0.067);与DSA测量值最接近的是横轴位图像,VRT、MPR及MIP方式对轻度狭窄更不敏感,薄层MIP显示细小

  16. Identification of a novel SBF2 frameshift mutation in charcot-marie-tooth disease type 4B2 using whole-exome sequencing.

    Science.gov (United States)

    Chen, Meiyan; Wu, Jing; Liang, Ning; Tang, Lihui; Chen, Yanhua; Chen, Huishuang; Wei, Wei; Wei, Tianying; Huang, Hui; Yi, Xin; Qi, Ming

    2014-10-01

    Charcot-Marie-Tooth disease type 4B2 with early-onset glaucoma (CMT4B2, OMIM 604563) is a genetically-heterogeneous childhood-onset neuromuscular disorder. Here, we report the case of a 15-year-old male adolescent with lower extremity weakness, gait abnormalities, foot deformities and early-onset glaucoma. Since clinical diagnosis alone was insufficient for providing pathogenetic evidence to indicate that the condition belonged to a consanguineous family, we applied whole-exome sequencing to samples from the patient, his parents and his younger brother, assuming that the patient's condition is transmitted in an autosomal recessive pattern. A frame-shift mutation, c.4571delG (P.Gly1524Glufs∗42), was revealed in the CMT4B2-related gene SBF2 (also known as MTMR13, MIM 607697), and this mutation was found to be homozygous in the proband and heterozygous in his parents and younger brother. Together with the results of clinical diagnosis, this case was diagnosed as CMT4B2. Our finding further demonstrates the use of whole-exome sequencing in the diagnosis and treatment of rare diseases.

  17. Hand-foot-mouth disease

    Science.gov (United States)

    Hand-foot-mouth disease is a common viral infection that most often begins in the throat. ... Hand-foot-mouth disease (HFMD) is most commonly caused by a virus called coxsackievirus A16. Children under age 10 ...

  18. Foot, leg, and ankle swelling

    Science.gov (United States)

    Swelling of the ankles - feet - legs; Ankle swelling; Foot swelling; Leg swelling; Edema - peripheral; Peripheral edema ... Foot, leg, and ankle swelling is common when the person also: Is overweight Has a blood clot ...

  19. Hand-foot-mouth disease

    Science.gov (United States)

    ... medlineplus.gov/ency/article/000965.htm Hand-foot-mouth disease To use the sharing features on this page, please enable JavaScript. Hand-foot-mouth disease is a common viral infection that most ...

  20. Transplantation of the free anterolateral thigh flap combined with iliotibial band for reconstruction of children's soft tissue defects at foot and ankle%股前外侧皮瓣联合髂胫束移植修复小儿足踝部软组织缺损

    Institute of Scientific and Technical Information of China (English)

    胡锐; 任义军; 严立; 李凡; 韩琼; 程文俊; 勘武生

    2014-01-01

    目的 探讨游离股前外侧皮瓣联合髂胫束移植修复小儿足踝部软组织缺损的临床效果. 方法 2008年1月至2013年1月,采用游离股前外侧皮瓣联合髂胫束移植修复小儿足踝部软组织缺损并重建功能共25例.创面缺损部位足跟部12例,足背部8例,内踝3例,外踝2例;所有患者均伴有不同程度骨折或脱位,且合并有跟腱、足背伸肌腱、内外踝侧副韧带等软组织缺损,软组织缺损髂胫束重建长度3 ~ 16 cm;游离股前外侧皮瓣面积8 cm×5 cm~ 18 cm×12 cm.所有病例术后2周皮瓣成活后在支具保护下行早期康复训练.结果 术后随访6 ~ 24个月,平均14个月;皮瓣全部成活,仅2例皮瓣远端小面积坏死,经换药等治疗愈合;创面愈合时间12~24 d,平均15.1d;术后按Thermann量表功能评定,14例为优,9例为良,可2例,优良率92%.结论 游离股前外侧皮瓣联合髂胫束移植修复小儿足踝部软组织缺损并重建功能,是安全有效的策略,其供区损伤小,缩短治疗周期,能减轻患儿痛苦.%Objective To investigate the clinical effect of transplantation of the free anterolateral thigh flap and iliotibial band for the repair of soft tissue defects at foot and ankle and functional reconstruction.Methods From January,2008 to January,2013,25 pediatric patients with soft tissue defects at foot and ankle were transplantation of the free anterolateral thigh flap and iliotibial band.Of the 25 cases,there were 12 cases at heel,8 cases at dorsum of foot,3 cases at medial malleolus and 2 cases at external malleolus.All the cases were accompanied with different degree of fracture or dislocation,and with soft tissue defect such as achilles tendon,extensor tendon of dorsal,collateral ligament of ankle.The length of soft tissue defect which were reconstructed with iliotibial band were 3 cm to 16 cm.The causes of injury:19 cases were crushed by motorcycle or bicycle,4 cases were crushed machines,2 cases were

  1. Gustilo ⅢB、ⅢC型小腿及足踝部开放性骨折的一期修复与重建%One-stage reconstruction of open fractures of leg, ankle and foot of Gustilo types Ⅲ B and Ⅲ C

    Institute of Scientific and Technical Information of China (English)

    陈雪松; 徐永清; 陈建明; 何金顺; 张黎明; 余晓军; 江珉; 吉丽; 李小松

    2014-01-01

    目的 探讨GustiloⅢB、ⅢC型小腿及足踝部开放性骨折一期修复与重建的临床疗效及手术要点.方法 回顾性分析2001年1月至2012年4月收治的160例GustiloⅢB、ⅢC型小腿及足踝部开放性骨折患者,男103例,女57例;平均年龄为36.3岁.骨折部位及Gustilo分型:胫骨干1 13例(ⅢB型91例,ⅢC型22例),胫骨远端4例(ⅢB型3例,ⅢC型1例),足踝部43例(ⅢB型37例,ⅢC型6例).受伤至手术时间为3~37 h,平均12.7h.彻底清创后应用穿支皮瓣、皮神经营养血管皮瓣、传统轴型皮瓣及肌皮瓣、局部皮瓣一期修复关键创面,选择外固定支架(121例)、钢板(20例)、螺钉或克氏针(14例)及髓内钉(5例)确定性固定骨折,同时完成其他必要的肢体结构及功能重建.结果 本组患者平均住院时间为28.0 d(9 ~76 d),关键创面均经初次手术获得修复.除1例GustiloⅢC型胫腓骨骨折患者因主诉伤肢持续性疼痛而截肢外,其余159例保肢成功患者术后获12~ 83个月(平均21.3个月)随访.随访期间均未发生严重或持续的骨感染,骨性愈合时间为6~19个月(平均11.7个月),肢体功能、外形恢复满意.结论 应用标准的修复重建外科技术及骨折固定技术一期修复与重建GustiloⅢB、ⅢC型小腿及足踝部开放性骨折可显著缩短治疗周期,减少并发症;新鲜创面解剖清晰,手术更为灵活;仅修复关键创面可减少供区牺牲,避免外形臃肿.%Objective To explore one-stage reconstruction of open fractures of leg,ankle and foot of Gustilo types Ⅲ B and ⅢC.Methods From January 2001 to April 2012,160 open fractures of leg,ankle and foot of Gustilo types Ⅲ B and Ⅲ C were treated with one-stage reconstruction.They were 103 men and 57 women,with an average age of 36.3 years.There were 113 cases of tibial shaft fracture (type ⅢB in 91 and type ⅢC in 22),4 cases of tibial distal end fracture (ⅢB in 3 and type ⅢC in one),and 43 cases of

  2. De Novo duplication in Charcot-Marie-Tooth Type 1A

    Energy Technology Data Exchange (ETDEWEB)

    Mandich, P.; Bellone, E.; Ajmar, F. [and others

    1996-09-01

    We read with interest the paper on {open_quotes}Prevalence and Origin of De Novo Duplications in Charcot-Marie-Tooth Disease Type 1A: First Report of a De Novo Duplication with a Maternal Origin,{close_quotes}. They reported their experience with 10 sporadic cases of Charcot-Marie-Tooth type 1A (CMT1A) in which it was demonstrated that the disease had arisen as the result of a de novo duplication. They analyzed the de novo-duplication families by using microsatellite markers and identified the parental origin of the duplication in eight cases. In one family the duplication was of maternal origin, whereas in the remaining seven cases it was of paternal origin. The authors concluded that their report was the first evidence of a de novo duplication of maternal origin, suggesting that this is not a phenomenon associated solely with male meiosis. 7 refs.

  3. Imaging diagnostics of the foot

    International Nuclear Information System (INIS)

    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.

  4. X-Ray Exam: Foot

    Science.gov (United States)

    ... Tropical Delight: Melon Smoothie Pregnant? Your Baby's Growth X-Ray Exam: Foot KidsHealth > For Parents > X-Ray Exam: Foot Print A A A Text Size ... español Radiografía: pie What It Is A foot X-ray is a safe and painless test that uses ...

  5. An Algorithm for Genetic Testing of Serbian Patients with Demyelinating Charcot-Marie-Tooth

    OpenAIRE

    Keckarevic Markovic, Milica P.; Dackovic, Jelena; Mladenovic, Jelena; Milic-Rasic, Vedrana; Kecmanovic, Miljana; Keckarevic, Dusan; Romac, Stanka

    2013-01-01

    Charcot-Marie Tooth (CMT) is a clinically and genetically heterogeneous group of diseases with rough genotype–phenotype correlation, so the final diagnosis requires extensive clinical and electrophysiological examination, family data, and gene mutation analysis. Although there is a common pattern of genetic basis of CMT, there could be some population differences that should be taken into account to facilitate analyses. Here we present the algorithm for genetic testing in Serbian patients wit...

  6. SMN gene analysis of the spinal form of Charcot-Marie-Tooth disease.

    OpenAIRE

    Hanash, A.; LeGuern, E.; Birouk, N; Clermont, O; Pouget, J; Bouche, P; Munnich, A; Brice, A; Melki, J

    1997-01-01

    The spinal form of Charcot-Marie-Tooth disease (spinal CMT) is a rare genetic disorder of the peripheral nervous system, the genetic basis of which remains unknown. To test the hypothesis that a defect of survival motor neuron (SMN), the determining gene for spinal muscular atrophy (SMA), would result in spinal CMT, 18 unrelated spinal CMT patients were studied. Nine of them were sporadic cases and the other nine belonged to unrelated autosomal dominant pedigrees. None of the 18 patients show...

  7. Outcome measures for Charcot-Marie-Tooth disease: clinical and neurofunctional assessment in children

    OpenAIRE

    Pagliano, Emanuela; Moroni, Isabella; Baranello, Giovanni; Magro, Anita; Marchi, Alessia; Bulgheroni, Sara; Ferrarin, Maurizio; Pareyson, Davide

    2011-01-01

    Charcot-Marie-Tooth (CMT) disease is the most common inherited neuromuscular disorder, presenting with symptoms often occurring since childhood, and showing a progressive course. At present, there are no valid and reliable measures for evaluation of impairment and disability in the pediatric population. The aim of this study was to determine the usefulness of outcome measures, commonly used in adult patients, in CMT children. We report the results of a comprehensive evaluation of 21 children ...

  8. Refined genetic mapping of X-linked Charcot-Marie-Tooth neuropathy

    Energy Technology Data Exchange (ETDEWEB)

    Fain, P.R.; Barker, D.F.; Chance, P.F. (Univ. of Utah, School of Medicine, Salt Lake City, UT (United States))

    1994-02-01

    Genetic linkage studies were conducted in four multigenerational families with X-linked Charcot-Marie-Tooth disease (CMTX), using 12 highly polymorphic short-tandem-repeat markers for the pericentromeric region of the X Chromosome. Pairwise linkage analysis with individual markers confirmed tight linkage of CMTX to the pericentromeric region in each family. Multipoint analyses strongly support the order DXS337-CMTX-DXS441-(DXS56, PGK1). 38 refs., 2 figs., 1 tab.

  9. Laparoscopic appendectomy in a pediatric patient with type 1 Charcot-Marie-Tooth disease.

    Science.gov (United States)

    Heller, Joshua A; Marn, Richard Y

    2015-12-01

    A pediatric patient with type 1 Charcot-Marie-Tooth disease-a disorder associated with a demyelinating polyneuropathy-presented for laparoscopic appendectomy in the setting of acute appendicitis. Induction and maintenance of anesthesia were successfully managed without the use of any depolarizing or nondepolarizing neuromuscular blocking agents. The patient was successfully extubated at the completion of the procedure without any respiratory or neuromuscular sequelae, with excellent pain control and no postoperative nausea or vomiting.

  10. XVI European Charcot Foundation Lecture: Nutrition and environment, can MS be prevented?

    OpenAIRE

    Simon, Kelly Claire; Munger, Kassandra L; Ascherio, Alberto

    2011-01-01

    Multiple sclerosis is a relatively common debilitating neurologic disease that affects people in early adulthood. While the characteristic pathology of MS has been well described, the etiology of the disease is not well understood, despite decades of research and the identification of strong genetic and environmental candidates for susceptibility. A question central to all diseases, but posed specifically for MS at the XVI European Charcot Foundation Lecture, was ‘Can MS be prevented?’ To add...

  11. Disability and quality of life in Charcot-Marie-Tooth disease type 1

    OpenAIRE

    PFEIFFER, G; Wicklein, E; Ratusinski, T; Schmitt, L; Kunze, K

    2001-01-01

    OBJECTIVES—Charcot-Marie-Tooth disease type I (CMT1) is a hereditary sensorimotor neuropathy causing variable degrees of handicap. The risk for relevant disability in respect to genetic counselling is unknown. An attempt was made to define it.
METHODS—Disability and ambulation of 50 patients with CMT1 were scored by the Hauser ambulation index score and the Rankin scale. Rankin score 2 was subdivided into 2a (independent without relevant slowness) and 2b (independent, ...

  12. Surgical Treatment of Scoliosis in Patients with Charcot-Marie-Tooth Disease

    Institute of Scientific and Technical Information of China (English)

    Farzad Omidi Kashani; Ibrahim Ghayem Hasankhani; Mahdi Banaii

    2009-01-01

    Objective: Apparently, scoliosis occurs in approximately one-third of patients with Charcot-Marie-Tooth disease. Little is known about the response of these curves to treatment. The purpose of this study was to evaluate the results of spinal surgery in these peculiar patients. Methods: We retrospectively evaluated the results of spinal surgery in eight patients who had scoliosis due to clinically and electrophysiologically proven Charcot-Marie-Tooth disease. Radiographs were reviewed. The location and direction of the curve pattern, the age at the time of surgery, type of surgery, number of levels fused, instrumentations used, intra or postoperative complications, and results and need for reoperation were recorded. Results: Eight patients associated with Charcot-Marie-Tooth disease who underwent scoliotic surgery were identified. The average age and curve at the time of surgery were 21.1 years and 56.4° respectively. 62.5% of the curves had left thoracic component and more than one third was associated with thoracic hyperkyphosis. Long posterior spinal fusion was performed most often, with an average of 11.5 spinal segments fused. Instrumentation was used in all posterior fusions. At an average of 39 months (range, 24 to 72 months) postoperatively, the fusion appeared to be solid in all patients. Conclusion: Scoliosis in patients with Charcot-Marie-Tooth disease differs from that in patients with idiopathic scoliosis in regarding to the etiology and the prevalence of thoracic hyperkyphosis, but the surgical management appears to be similar. Spondylodesis does not appear to be associated with a high rate of complications.

  13. Overlapping molecular pathological themes link Charcot-Marie-Tooth neuropathies and hereditary spastic paraplegias.

    Science.gov (United States)

    Timmerman, Vincent; Clowes, Virginia E; Reid, Evan

    2013-08-01

    In this review we focus on Charcot-Marie-Tooth (CMT) neuropathies and hereditary spastic paraplegias (HSPs). Although these diseases differ in whether they primarily affect the peripheral or central nervous system, both are genetically determined, progressive, long axonopathies that affect motor and sensory pathways. This commonality suggests that there might be similarities in the molecular pathology underlying these conditions, and here we compare the molecular genetics and cellular pathology of the two groups.

  14. Foot posture, foot function and low back pain: the Framingham Foot Study

    OpenAIRE

    Menz, Hylton B.; Alyssa B Dufour; RISKOWSKI, JODY L.; Hillstrom, Howard J; Hannan, Marian T

    2013-01-01

    Objective. Abnormal foot posture and function have been proposed as possible risk factors for low back pain, but this has not been examined in detail. The objective of this study was to explore the associations of foot posture and foot function with low back pain in 1930 members of the Framingham Study (2002–05).

  15. Unfavourable results in thumb reconstruction

    Directory of Open Access Journals (Sweden)

    Samir M Kumta

    2013-01-01

    Full Text Available The history of thumb reconstruction parallels the history of hand surgery. The attributes that make the thumb unique, and that the reconstructive surgeon must assess and try to restore when reconstructing a thumb, are: Position, stability, strength, length, motion, sensibility and appearance. Deficiency in any of these attributes can reduce the utility of the reconstructed thumb. A detailed assessment of the patient and his requirements needs to be performed before embarking on a thumb reconstruction. Most unsatisfactory results can be attributed to wrong choice of procedure. Component defects of the thumb are commonly treated by tissue from adjacent fingers, hand or forearm. With refinements in microsurgery, the foot has become a major source of tissue for component replacement in the thumb. Bone lengthening, osteoplastic reconstruction, pollicisation, and toe to hand transfers are the commonest methods of thumb reconstruction. Unfavourable results can be classified as functional and aesthetic. Some are common to all types of procedures. However each type of reconstruction has its own unique set of problems. Meticulous planning and execution is essential to give an aesthetic and functionally useful thumb. Secondary surgeries like tendon transfers, bone grafting, debulking, arthrodesis, may be required to correct deficiencies in the reconstruction. Attention needs to be paid to the donor site as well.

  16. Charcot-Marie-Tooth病的研究与诊断进展%Progress of Research and Diagnosis of Charcot-Marie-Tooth Disease

    Institute of Scientific and Technical Information of China (English)

    朱琳; 胡静

    2011-01-01

    Charcot-Marie-Tooth disease(CMT) is % group of the most common familial peripheral neuropathies with highly genetic and clinical heterogeneity. CMT accounts for aboul 90% of hereditary neuropathies. CMT has similar clinical manifestations. Now there are at least .15 subtypes, which makes great difficulties in diagnosiing the disease. Therefore, this arliclc review;, the effective diagnostic methods of detailing the phenotypes and screening disease-related geres bused on the analysis of the clinical presentations, electrophysiology. Peripheral nerve pathology and causative genes of the subtypes of CMT.%Charcot-Marie-Tooth病,是一组最常见的在遗传和临床上都具有高度异质性的家族性周围神经病,约占全部遗传性神经病的90%.其基本临床表现相似,目前已知的亚型多达35种,为该病的确诊带来极大困难.因此,本文综述该病各亚型的临床、电生理、周围神经病理、致病基因及有效诊断方法.

  17. 小隐静脉-腓肠神经营养血管逆行岛状皮瓣修复儿童足部软组织缺损%Reverse small saphenous vein-sural neurovascular island flap for the reconstruction of soft tissue defect on foot and ankle in children

    Institute of Scientific and Technical Information of China (English)

    许喜生; 胡永才; 陈凯; 马铮铮; 李柏同; 欧才生; 程勇; 周永生; 李志湘

    2009-01-01

    Objective To investigate the clinical application of reversed small saphenons vein-sural neurovascular island flap for reconstruction of soft tissue defect on foot and ankle in children. Methods From July 2006 to June 2008, 8 children with soft tissue defects on foot, heel or ankle were treated with reversed small saphenous vein-sural neurovaacular island flaps. The size of flaps ranged from 6 cm x 5 cm to 9 cm x 7 cm. The upper margin of the flaps reached the upper third of cruris, with 1 case reaching the transverse line of pepliteal fossa. Results All the flaps survived. The patients were followed up for 1 ~ 17 months with good aesthetic and functional results. The growth of the two legs had no difference. The sensation of the flaps improved with no heel ulcer and no dysfunction at the donor site. The upper boundary of flaps can reach the upper third of the crofts even the reansverse line of popliteal fossa. The rotation point of the flaps located at 4-6 cm above the lateral ankle in children. Conclusions The reversed small saphenous vein-sural neurovascular island flap in children has a reliable survival area. The operation is easily performed without any obvious influence on the growth of the operated cruris. It is a good reconstructive method for soft tissue defect in foot and ankle.%目的 探讨小隐静脉-腓肠神经营养血管逆行岛状皮瓣在修复儿童足部软组织缺损中的应用特点.方法 2006年7月至2008年6月,应用小隐静脉一腓肠神经营养血管逆行岛状皮瓣修复儿童足背、足跟及足踝部软组织缺损8例,皮瓣切取范围6 cm×5 cm~9 cm×7 cm,除2例足踝部外,6例修复足背、足跟,皮瓣上界超过小腿中上1/3交界处,其中1例接近胭窝横纹.结果 8例皮瓣全部成活良好.经1-17个月的随访,皮瓣外观满意,感觉功能有部分恢复,足跟处亦未出现溃烂,供区无功能障碍,双小腿发育未见明显差异,外观稍受影响.皮瓣上界可超过小腿中上1/3

  18. About medicine and the arts. Charcot and French literature at the fin-de-siècle.

    Science.gov (United States)

    Koehler, P

    2001-03-01

    The relationship between medicine and the arts, literature in particular, has many aspects. One of the most obvious relations is the use of literature as a source for historical studies. Jean-Martin Charcot and his school often appear in French literature at the end of the 19th century. Several aspects will be highlighted in this study, including (1) the ideas about degenerative diseases in the work of Emile Zola, the main author of the naturalistic movement; (2) decadence and spiritism in two "transitional" novels by Joris Karl Huysmans, who, once supporter of the naturalistic movement, changed his ideas following observations of disease and cure that could not be explained in a scientific way. Charcot's work on hysteria and hypnosis, as well as Brown-Séquard's rejuvenation experiments with testicular extracts played an important role with this respect; (3) Charcot's relationship with the Daudets, in particular his treatment of Alphonse's tabes dorsalis and the ambivalent attitude of his son Léon Daudet towards Charcot; (4) the influence of the lectures at the Salpêtrière on the work of Guy de Maupassant, who attended the lessons in the mid-1880s. The reading of novels and biographies of these authors provides a part of the social context and the cultural atmosphere in Paris at the "fin-de-siècle" when Charcot and his school played an important role in medicine. Moreover, it shows the influence of medicine and science on society as recorded by writers. PMID:11446262

  19. Estimation of foot trajectory during human walking by a wearable inertial measurement unit mounted to the foot.

    Science.gov (United States)

    Kitagawa, Naoki; Ogihara, Naomichi

    2016-03-01

    To establish a supportive technology for reducing the risk of falling in older people, it is essential to clarify gait characteristics in elderly individuals that are possibly linked to the risk of falling during actual daily activities. In this study, we developed a system to monitor human gait in an outdoor environment using an inertial measurement unit consisting of a tri-axial accelerometer and tri-axial gyroscope. Step-by-step foot trajectories were estimated from the sensor unit attached to the dorsum of the foot. Specifically, stride length and foot clearance were calculated by integrating the gravity-compensated translational acceleration over time during the swing phase. Zero vertical velocity and displacement corrections were applied to obtain the final trajectory, assuming the slope of the walking surface is negligible. Short, normal, and long stride-length walking of 10 healthy participants was simultaneously measured using the proposed system and a conventional motion capture system to evaluate the accuracy of the estimated foot trajectory. Mean accuracy and precision were approximately 20 ± 50 mm, for stride length, and 2 ± 7 mm for foot clearance, indicating that the swing phase trajectory of the sensor unit attached to the foot was reconstructed more accurately and precisely using the proposed system than with previously published methods owing to the flat floor assumption. Although some methodological limitations certainly apply, this system will serve as a useful tool to monitor human walking during daily activities. PMID:26979891

  20. Find an Orthopaedic Foot and Ankle MD/DO

    Science.gov (United States)

    ... page. Home Contact Us FootCareMD Currently selected About Us Overview of Foot & Ankle Glossary of Foot & Ankle Terms Adult Foot Health ... Map American Orthopaedic Foot & Ankle Society ® Orthopaedic Foot ... US) Copyright © 2016 All Rights Reserved

  1. The neuropathic diabetic foot.

    Science.gov (United States)

    Rathur, Haris M; Boulton, Andrew J M

    2007-01-01

    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.

  2. The diabetic foot.

    Science.gov (United States)

    Rathur, Haris M; Boulton, Andrew J M

    2007-01-01

    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.

  3. Chondroblastoma of the foot.

    Science.gov (United States)

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

    1997-04-01

    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.

  4. Relationship between static foot posture and foot mobility

    Directory of Open Access Journals (Sweden)

    McPoil Thomas G

    2011-01-01

    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.

  5. Selected items from the Charcot-Marie-Tooth (CMT) Neuropathy Score and secondary clinical outcome measures serve as sensitive clinical markers of disease severity in CMT1A patients.

    Science.gov (United States)

    Mannil, Manoj; Solari, Alessandra; Leha, Andreas; Pelayo-Negro, Ana L; Berciano, José; Schlotter-Weigel, Beate; Walter, Maggie C; Rautenstrauss, Bernd; Schnizer, Tuuli J; Schenone, Angelo; Seeman, Pavel; Kadian, Chandini; Schreiber, Olivia; Angarita, Natalia G; Fabrizi, Gian Maria; Gemignani, Franco; Padua, Luca; Santoro, Lucio; Quattrone, Aldo; Vita, Giuseppe; Calabrese, Daniela; Young, Peter; Laurà, Matilde; Haberlová, Jana; Mazanec, Radim; Paulus, Walter; Beissbarth, Tim; Shy, Michael E; Reilly, Mary M; Pareyson, Davide; Sereda, Michael W

    2014-11-01

    This study evaluates primary and secondary clinical outcome measures in Charcot-Marie-Tooth disease type 1A (CMT1A) with regard to their contribution towards discrimination of disease severity. The nine components of the composite Charcot-Marie-Tooth disease Neuropathy Score and six additional secondary clinical outcome measures were assessed in 479 adult patients with genetically proven CMT1A and 126 healthy controls. Using hierarchical clustering, we identified four significant clusters of patients according to clinical severity. We then tested the impact of each of the CMTNS components and of the secondary clinical parameters with regard to their power to differentiate these four clusters. The CMTNS components ulnar sensory nerve action potential (SNAP), pin sensibility, vibration and strength of arms did not increase the discriminant value of the remaining five CMTNS components (Ulnar compound motor action potential [CMAP], leg motor symptoms, arm motor symptoms, leg strength and sensory symptoms). However, three of the six additional clinical outcome measures - the 10m-timed walking test (T10MW), 9 hole-peg test (9HPT), and foot dorsal flexion dynamometry - further improved discrimination between severely and mildly affected patients. From these findings, we identified three different composite measures as score hypotheses and compared their discriminant power with that of the CMTNS. A composite of eight components CMAP, Motor symptoms legs, Motor symptoms arms, Strength of Legs, Sensory symptoms), displayed the strongest power to discriminate between the clusters. As a conclusion, five items from the CMTNS and three secondary clinical outcome measures improve the clinical assessment of patients with CMT1A significantly and are beneficial for upcoming clinical and therapeutic trials. PMID:25085517

  6. Selected items from the Charcot-Marie-Tooth (CMT) Neuropathy Score and secondary clinical outcome measures serve as sensitive clinical markers of disease severity in CMT1A patients.

    Science.gov (United States)

    Mannil, Manoj; Solari, Alessandra; Leha, Andreas; Pelayo-Negro, Ana L; Berciano, José; Schlotter-Weigel, Beate; Walter, Maggie C; Rautenstrauss, Bernd; Schnizer, Tuuli J; Schenone, Angelo; Seeman, Pavel; Kadian, Chandini; Schreiber, Olivia; Angarita, Natalia G; Fabrizi, Gian Maria; Gemignani, Franco; Padua, Luca; Santoro, Lucio; Quattrone, Aldo; Vita, Giuseppe; Calabrese, Daniela; Young, Peter; Laurà, Matilde; Haberlová, Jana; Mazanec, Radim; Paulus, Walter; Beissbarth, Tim; Shy, Michael E; Reilly, Mary M; Pareyson, Davide; Sereda, Michael W

    2014-11-01

    This study evaluates primary and secondary clinical outcome measures in Charcot-Marie-Tooth disease type 1A (CMT1A) with regard to their contribution towards discrimination of disease severity. The nine components of the composite Charcot-Marie-Tooth disease Neuropathy Score and six additional secondary clinical outcome measures were assessed in 479 adult patients with genetically proven CMT1A and 126 healthy controls. Using hierarchical clustering, we identified four significant clusters of patients according to clinical severity. We then tested the impact of each of the CMTNS components and of the secondary clinical parameters with regard to their power to differentiate these four clusters. The CMTNS components ulnar sensory nerve action potential (SNAP), pin sensibility, vibration and strength of arms did not increase the discriminant value of the remaining five CMTNS components (Ulnar compound motor action potential [CMAP], leg motor symptoms, arm motor symptoms, leg strength and sensory symptoms). However, three of the six additional clinical outcome measures - the 10m-timed walking test (T10MW), 9 hole-peg test (9HPT), and foot dorsal flexion dynamometry - further improved discrimination between severely and mildly affected patients. From these findings, we identified three different composite measures as score hypotheses and compared their discriminant power with that of the CMTNS. A composite of eight components CMAP, Motor symptoms legs, Motor symptoms arms, Strength of Legs, Sensory symptoms), displayed the strongest power to discriminate between the clusters. As a conclusion, five items from the CMTNS and three secondary clinical outcome measures improve the clinical assessment of patients with CMT1A significantly and are beneficial for upcoming clinical and therapeutic trials.

  7. Doença de Charcot-Marie-Tooth: estudos eletromiográficos em 45 pacientes Charcot-Marie-Tooth disease: electromyographic studies in 45 cases

    OpenAIRE

    Marcos R. G. de freitas; Nascimento, Osvaldo J.M.; Maria T. Nevares; Tânia M. Escada

    1995-01-01

    Foi realizada eletroneuromiografia em 45 pacientes com doença de Charcot-Marie-Tooth (CMT). A classificação em tipo I e tipo II da doença de CMT foi feita com base na neurocondução motora do mediano e do ulnar. Assim 11 pacientes eram do tipo I e 34 eram do tipo II. No tipo I não houve relação entre a queda da VCN motora do ulnar e mediano com o quadro clínico da doença. Devido a ausência do potencial de ação sensitivo (PAS) do nervo sural em muitos casos, achamos impossível a classificação d...

  8. A novel transgenic mouse model of Chinese Charcot-Marie-Tooth disease type 2L

    Institute of Scientific and Technical Information of China (English)

    Ruxu Zhang; Qian Pan; Beisha Tang; Fufeng Zhang; Xiaobo Li; Shunxiang Huang; Xiaohong Zi; Ting Liu; Sanmei Liu; Xuning Li; Kun Xia

    2014-01-01

    We previously found that the K141N mutation in heat shock protein B8 (HSPB8) was respon-sible for Charcot-Marie-Tooth disease type 2L in a large Chinese family. The objective of the present study was to generate a transgenic mouse model bearing the K141N mutation in the human HSPB8 gene, and to determine whether this K141NHSPB8 transgenic mouse model would manifest the clinical phenotype of Charcot-Marie-Tooth disease type 2L, and consequently be suitable for use in studies of disease pathogenesis. Transgenic mice overexpressing K141NHSPB8 were generated using K141N mutant HSPB8 cDNA cloned into a pCAGGS plasmid driven by a human cytomegalovirus expression system. PCR and western blot analysis conifrmed integra-tion of the K141NHSPB8 gene and widespread expression in tissues of the transgenic mice. The K141NHSPB8 transgenic mice exhibited decreased muscle strength in the hind limbs and impaired motor coordination, but no obvious sensory disturbance at 6 months of age by behavioral assess-ment. Electrophysiological analysis showed that the compound motor action potential amplitude in the sciatic nerve was signiifcantly decreased, but motor nerve conduction velocity remained normal at 6 months of age. Pathological analysis of the sciatic nerve showed reduced myelinated ifber density, notable axonal edema and vacuolar degeneration in K141NHSPB8 transgenic mice, suggesting axonal involvement in the peripheral nerve damage in these animals. These ifndings indicate that the K141NHSPB8 transgenic mouse successfully models Charcot-Marie-Tooth disease type 2L and can be used to study the pathogenesis of the disease.

  9. The Gdap1 knockout mouse mechanistically links redox control to Charcot-Marie-Tooth disease.

    Science.gov (United States)

    Niemann, Axel; Huber, Nina; Wagner, Konstanze M; Somandin, Christian; Horn, Michael; Lebrun-Julien, Frédéric; Angst, Brigitte; Pereira, Jorge A; Halfter, Hartmut; Welzl, Hans; Feltri, M Laura; Wrabetz, Lawrence; Young, Peter; Wessig, Carsten; Toyka, Klaus V; Suter, Ueli

    2014-03-01

    The ganglioside-induced differentiation-associated protein 1 (GDAP1) is a mitochondrial fission factor and mutations in GDAP1 cause Charcot-Marie-Tooth disease. We found that Gdap1 knockout mice (Gdap1(-/-)), mimicking genetic alterations of patients suffering from severe forms of Charcot-Marie-Tooth disease, develop an age-related, hypomyelinating peripheral neuropathy. Ablation of Gdap1 expression in Schwann cells recapitulates this phenotype. Additionally, intra-axonal mitochondria of peripheral neurons are larger in Gdap1(-/-) mice and mitochondrial transport is impaired in cultured sensory neurons of Gdap1(-/-) mice compared with controls. These changes in mitochondrial morphology and dynamics also influence mitochondrial biogenesis. We demonstrate that mitochondrial DNA biogenesis and content is increased in the peripheral nervous system but not in the central nervous system of Gdap1(-/-) mice compared with control littermates. In search for a molecular mechanism we turned to the paralogue of GDAP1, GDAP1L1, which is mainly expressed in the unaffected central nervous system. GDAP1L1 responds to elevated levels of oxidized glutathione by translocating from the cytosol to mitochondria, where it inserts into the mitochondrial outer membrane. This translocation is necessary to substitute for loss of GDAP1 expression. Accordingly, more GDAP1L1 was associated with mitochondria in the spinal cord of aged Gdap1(-/-) mice compared with controls. Our findings demonstrate that Charcot-Marie-Tooth disease caused by mutations in GDAP1 leads to mild, persistent oxidative stress in the peripheral nervous system, which can be compensated by GDAP1L1 in the unaffected central nervous system. We conclude that members of the GDAP1 family are responsive and protective against stress associated with increased levels of oxidized glutathione.

  10. Malignant melanoma and Charcot-Marie-Tooth disease: A further case

    Energy Technology Data Exchange (ETDEWEB)

    Manoukian, S.; Briscioli, V.; Lalatta, F. [Instituti Clinici di Perfezionamento, Milan (Italy)

    1997-01-20

    In a previous issue of this journal, Greene et al. described 2 patients with Charcot-Marie-Tooth (CMT) disease who later developed cutaneous malignant melanoma. Although the development of the two diseases in the same patient may have occurred by chance, the authors raised the possibility of a shared neural crest defect or a genetic linkage. Among the patients reported by Greene et al., one had a dominant form of CMT. The patient`s mother and brother were similarly affected. A paternal aunt died of melanoma. The second patient had a neuronal type of CMT. His brother showed the same disease, but the parents were not examined. 7 refs.

  11. Sport activity in Charcot-Marie-Tooth disease: A case study of a Paralympic swimmer.

    Science.gov (United States)

    Vita, Giuseppe; La Foresta, Stefania; Russo, Massimo; Vita, Gian Luca; Messina, Sonia; Lunetta, Christian; Mazzeo, Anna

    2016-09-01

    This study reports the positive physical, emotional and psychosocial changes induced by sport activity in a Paralympic swimmer with Charcot-Marie-Tooth (CMT) type 4A. When we compared evaluations before initiating sport activity with those after five years of competitive activity, we found: i) increased proximal muscles strength of upper limbs; ii) augmented ability to propel wheelchair independently; iii) improved quality of life; iv) reduced trait anxiety and striking improvement of depression; v) enhanced self-esteem. Longitudinal studies in large cohorts to evaluate the positive effects of sport activity are needed to support provision of evidence-based advice to patients and families.

  12. Atypical presentation of Charcot-Marie-Tooth disease 1A: A case report.

    Science.gov (United States)

    Kulkarni, Shilpa D; Sayed, Rafat; Garg, Meenal; Patil, Varsha A

    2015-11-01

    Charcot-Marie-Tooth (CMT) 1A is the most common form of CMT disease and is characterized by duplication of Peripheral myelin protein 22 (PMP22) gene. We report a boy with genetically confirmed CMT1A disease having clinical involvement of hypoglossal and glossopharyngeal nerves, as well as asymmetrical and primarily upper limb involvement. These atypical features widen the clinical spectrum of CMT1A, leading to interesting observations about PMP22 gene related disorders and varied clinical expression of similar genetic mutations.

  13. Sport activity in Charcot-Marie-Tooth disease: A case study of a Paralympic swimmer.

    Science.gov (United States)

    Vita, Giuseppe; La Foresta, Stefania; Russo, Massimo; Vita, Gian Luca; Messina, Sonia; Lunetta, Christian; Mazzeo, Anna

    2016-09-01

    This study reports the positive physical, emotional and psychosocial changes induced by sport activity in a Paralympic swimmer with Charcot-Marie-Tooth (CMT) type 4A. When we compared evaluations before initiating sport activity with those after five years of competitive activity, we found: i) increased proximal muscles strength of upper limbs; ii) augmented ability to propel wheelchair independently; iii) improved quality of life; iv) reduced trait anxiety and striking improvement of depression; v) enhanced self-esteem. Longitudinal studies in large cohorts to evaluate the positive effects of sport activity are needed to support provision of evidence-based advice to patients and families. PMID:27460291

  14. Diabetic foot complications and their risk factors from a large retrospective cohort study.

    Directory of Open Access Journals (Sweden)

    Khalid Al-Rubeaan

    Full Text Available Foot complications are considered to be a serious consequence of diabetes mellitus, posing a major medical and economical threat. Identifying the extent of this problem and its risk factors will enable health providers to set up better prevention programs. Saudi National Diabetes Registry (SNDR, being a large database source, would be the best tool to evaluate this problem.This is a cross-sectional study of a cohort of 62,681 patients aged ≥ 25 years from SNDR database, selected for studying foot complications associated with diabetes and related risk factors.The overall prevalence of diabetic foot complications was 3.3% with 95% confidence interval (95% CI of (3.16%-3.44%, whilst the prevalences of foot ulcer, gangrene, and amputations were 2.05% (1.94%-2.16%, 0.19% (0.16%-0.22%, and 1.06% (0.98%-1.14%, respectively. The prevalence of foot complications increased with age and diabetes duration predominantly amongst the male patients. Diabetic foot is more commonly seen among type 2 patients, although it is more prevalent among type 1 diabetic patients. The Univariate analysis showed Charcot joints, peripheral vascular disease (PVD, neuropathy, diabetes duration ≥ 10 years, insulin use, retinopathy, nephropathy, age ≥ 45 years, cerebral vascular disease (CVD, poor glycemic control, coronary artery disease (CAD, male gender, smoking, and hypertension to be significant risk factors with odds ratio and 95% CI at 42.53 (18.16-99.62, 14.47 (8.99-23.31, 12.06 (10.54-13.80, 7.22 (6.10-8.55, 4.69 (4.28-5.14, 4.45 (4.05-4.89, 2.88 (2.43-3.40, 2.81 (2.31-3.43, 2.24 (1.98-2.45, 2.02 (1.84-2.22, 1.54 (1.29-1.83, and 1.51 (1.38-1.65, respectively.Risk factors for diabetic foot complications are highly prevalent; they have put these complications at a higher rate and warrant primary and secondary prevention programs to minimize morbidity and mortality in addition to economic impact of the complications. Other measurements, such as decompression of lower

  15. Foot-and-mouth disease

    DEFF Research Database (Denmark)

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

    2009-01-01

    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...

  16. Foot Push-Up Test

    Science.gov (United States)

    ... If you can easily rise up onto the ball of your foot but experience pain in your arch, your arch may be inflamed ... at any point between the heel and the ball of the foot is often referred to as arch pain. Although this description is nonspecific, most arch pain ...

  17. Relationship between foot type, foot deformity, and ulcer occurrence in the high-risk diabetic foot.

    Science.gov (United States)

    Ledoux, William R; Shofer, Jane B; Smith, Douglas G; Sullivan, Katrina; Hayes, Shane G; Assal, Mathieu; Reiber, Gayle E

    2005-01-01

    We hypothesized an association between foot type, foot deformity, and foot ulceration and conducted an analysis of a well-characterized, high-risk diabetic population of 398 subjects. The average age was 62 years of age and 74% of the study population were males. Foot-type distributions were 19.5% pes cavus (high arch), 51.5% neutrally aligned (normal arch), and 29.0% pes planus (low arch). We quantified the presence of hallux valgus (23.9%), hammer/claw toes (46.7%), and hallux limitus (24.4%). A significant association was found between foot type and hallux valgus (p = 0.003); pes planus feet had the highest prevalence as compared with neutrally aligned feet (odds ratio [OR] = 2.43, p = 0.0006). Foot type was also significantly associated with fixed hammer/claw toes (p = 0.01); pes cavus feet had the highest prevalence as compared with neutrally aligned feet (OR = 3.89, p = 0.001). Foot type was also significantly associated with hallux limitus (p = 0.006) with pes planus feet having the highest prevalence as compared with neutrally aligned feet (OR = 2.19, p = 0.003). However, foot type was not significantly related to any ulcer outcome (p = 0.7). Fixed hammer/claw toes (OR = 3.91, p = 0.003) and hallux limitus (OR = 3.02, p = 0.006) were associated with increased risk of any ulcer occurrence. This study affirms that foot type and foot deformity are related and that foot deformities are associated with ulcer occurrence. PMID:16586192

  18. Age-related changes in motor unit number estimates in adult patients with Charcot-Marie-Tooth type 1A

    NARCIS (Netherlands)

    J.P. van Dijk; C. Verhamme; I.N. van Schaik; H.J. Schelhaas; E. Mans; L.J. Bour; D.F. Stegeman; M.J. Zwarts

    2010-01-01

    Background: Charcot-Marie-Tooth disease type 1A (CMT1A) is known as a demyelinating hereditary neuropathy. Secondary axonal dysfunction is the most important determinant of disease severity. In adult patients, clinical progression may be because of further axonal deterioration as was shown with comp

  19. Age-related changes in motor unit number estimates in adult patients with Charcot-Marie-Tooth type 1A.

    NARCIS (Netherlands)

    Dijk, J.P. van; Verhamme, C.; Schaik, I.N. van; Schelhaas, H.J.; Mans, E.; Bour, L.J.; Stegeman, D.F.; Zwarts, M.J.

    2010-01-01

    BACKGROUND: Charcot-Marie-Tooth disease type 1A (CMT1A) is known as a demyelinating hereditary neuropathy. Secondary axonal dysfunction is the most important determinant of disease severity. In adult patients, clinical progression may be because of further axonal deterioration as was shown with comp

  20. 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

    2015-01-01

    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.

  1. Reliability of the CMT neuropathy score (second version) in Charcot-Marie-Tooth disease.

    LENUS (Irish Health Repository)

    Murphy, Sinéad M

    2011-09-01

    The Charcot-Marie-Tooth neuropathy score (CMTNS) is a reliable and valid composite score comprising symptoms, signs, and neurophysiological tests, which has been used in natural history studies of CMT1A and CMT1X and as an outcome measure in treatment trials of CMT1A. Following an international workshop on outcome measures in Charcot-Marie-Tooth disease (CMT), the CMTNS was modified to attempt to reduce floor and ceiling effects and to standardize patient assessment, aiming to improve its sensitivity for detecting change over time and the effect of an intervention. After agreeing on the modifications made to the CMTNS (CMTNS2), three examiners evaluated 16 patients to determine inter-rater reliability; one examiner evaluated 18 patients twice within 8 weeks to determine intra-rater reliability. Three examiners evaluated 63 patients using the CMTNS and the CMTNS2 to determine how the modifications altered scoring. For inter- and intra-rater reliability, intra-class correlation coefficients (ICCs) were ≥0.96 for the CMT symptom score and the CMT examination score. There were small but significant differences in some of the individual components of the CMTNS compared with the CMTNS2, mainly in the components that had been modified the most. A longitudinal study is in progress to determine whether the CMTNS2 is more sensitive than the CMTNS for detecting change over time.

  2. Assignment of a second Charcot-Marie-Tooth type II locus to chromosome 3q

    Energy Technology Data Exchange (ETDEWEB)

    Kwon, J.M.; Elliott, J.L.; Yee, W.C. [Washington Univ. School of Medicine, St. Louis, MO (United States)] [and others

    1995-10-01

    Charcot-Marie-Tooth disease (CMT) is the most common inherited motor and sensory neuropathy. The neuronal form of this disorder is referred to as Charcot-Marie-Tooth type II disease (CMT2). CMT2 is usually inherited as an autosomal dominant trait with a variable age at onset of symptoms associated with progressive axonal neuropathy. In some families, the locus that predisposes to CMT2 has been demonstrated to map to the distal portion of the short arm of chromosome 1. Other families with CMT2 do not show linkage with 1p markers, suggesting genetic heterogeneity in CMT2. We investigated linkage in a single large kindred with autosomal dominant CMT2. The gene responsible for CMT2 in this kindred (CMT2B) was mapped to the interval between the microsatellite markers D3S1769 and D3S1744 in the 3q13-22 region. Study of additional CMT2 kindreds should serve to further refine the disease gene region and may ultimately lead to the identification of a gene defect that underlies the CMT2 phenotype. 21 refs., 3 figs., 1 tab.

  3. Targeting the colony stimulating factor 1 receptor alleviates two forms of Charcot-Marie-Tooth disease in mice.

    Science.gov (United States)

    Klein, Dennis; Patzkó, Ágnes; Schreiber, David; van Hauwermeiren, Anemoon; Baier, Michaela; Groh, Janos; West, Brian L; Martini, Rudolf

    2015-11-01

    See Scherer (doi:10.1093/awv279) for a scientific commentary on this article.Charcot-Marie-Tooth type 1 neuropathies are inherited disorders of the peripheral nervous system caused by mutations in Schwann cell-related genes. Typically, no causative cure is presently available. Previous preclinical data of our group highlight the low grade, secondary inflammation common to distinct Charcot-Marie-Tooth type 1 neuropathies as a disease amplifier. In the current study, we have tested one of several available clinical agents targeting macrophages through its inhibition of the colony stimulating factor 1 receptor (CSF1R). We here show that in two distinct mouse models of Charcot-Marie-Tooth type 1 neuropathies, the systemic short- and long-term inhibition of CSF1R by oral administration leads to a robust decline in nerve macrophage numbers by ∼70% and substantial reduction of the typical histopathological and functional alterations. Interestingly, in a model for the dominant X-linked form of Charcot-Marie-Tooth type 1 neuropathy, the second most common form of the inherited neuropathies, macrophage ablation favours maintenance of axonal integrity and axonal resprouting, leading to preserved muscle innervation, increased muscle action potential amplitudes and muscle strengths in the range of wild-type mice. In another model mimicking a mild, demyelination-related Charcot-Marie-Tooth type 1 neuropathy caused by reduced P0 (MPZ) gene dosage, macrophage blockade causes an improved preservation of myelin, increased muscle action potential amplitudes, improved nerve conduction velocities and ameliorated muscle strength. These observations suggest that disease-amplifying macrophages can produce multiple adverse effects in the affected nerves which likely funnel down to common clinical features. Surprisingly, treatment of mouse models mimicking Charcot-Marie-Tooth type 1A neuropathy also caused macrophage blockade, but did not result in neuropathic or clinical improvements

  4. Microsurgical management of the diabetic foot.

    Science.gov (United States)

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

    2003-11-01

    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.

  5. Complications of the diabetic foot.

    Science.gov (United States)

    Kim, Paul J; Steinberg, John S

    2013-12-01

    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.

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

    Directory of Open Access Journals (Sweden)

    Denti Paolo

    2009-10-01

    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

  7. Sports Injuries to the Foot and Ankle

    Science.gov (United States)

    ... FootNotes Newsletter Current Issue Archive Subscribe Home » Foot & Ankle Conditions » Sports Injuries to the Foot and Ankle A A A | ... page. Please enable Javascript in your browser. Sports Injuries to the Foot and Ankle Depending on the sport, your feet and ankles ...

  8. Foot Health Facts for Athletes

    Science.gov (United States)

    ... pain —This condition is most often caused by plantar fasciitis, although other things, such as stress fractures or ... foot structure is the most common cause of plantar fasciitis, it can also result from wearing shoes that ...

  9. Hand, Foot, and Mouth Disease

    Centers for Disease Control (CDC) Podcasts

    2013-08-08

    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.

  10. Synovial sarcoma of the foot.

    Science.gov (United States)

    Bekarev, Mikhail; Elsinger, Elisabeth C; Villanueva-Siles, Esperanza; Borzykowski, Ross M; Geller, David S

    2013-01-01

    We report the case of a 75-year-old male who underwent lung lobectomy for presumed lung cancer. Thereafter, he presented with a painful mass between the third and fourth metatarsal heads in the foot that was assumed to be Morton's neuroma. After extensive oncologic evaluation, the foot mass was diagnosed as a synovial sarcoma. In retrospect, his lung lesion was understood to be metastatic disease. PMID:23632071

  11. Dynamic 3D shape of the plantar surface of the foot using coded structured light: a technical report

    KAUST Repository

    Thabet, Ali Kassem

    2014-01-23

    Background The foot provides a crucial contribution to the balance and stability of the musculoskeletal system, and accurate foot measurements are important in applications such as designing custom insoles/footwear. With better understanding of the dynamic behavior of the foot, dynamic foot reconstruction techniques are surfacing as useful ways to properly measure the shape of the foot. This paper presents a novel design and implementation of a structured-light prototype system providing dense three dimensional (3D) measurements of the foot in motion. 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. Methods Engineering and clinical tests were carried out to test the accuracy and repeatability of the system. Accuracy experiments involved imaging a planar surface from different orientations and elevations and measuring the fitting errors of the data to a plane. Repeatability experiments were done using reconstructions from 27 different subjects, where for each one both right and left feet were reconstructed in static and dynamic conditions over two different days. Results The static accuracy of the system was found to be 0.3 mm with planar test objects. In tests with real feet, the system proved repeatable, with reconstruction differences between trials one week apart averaging 2.4 mm (static case) and 2.8 mm (dynamic case). Conclusion The results obtained in the experiments show positive accuracy and repeatability results when compared to current literature. The design also shows to be superior to the systems available in the literature in several factors. Further studies need to be done to quantify the reliability of the system in clinical environments.

  12. Biomechanical Model of the Diabetic Foot

    OpenAIRE

    Agić, Ante; NIKOLIĆ, VASILIJE; Mijović, Budimir; Reischl, Uwe

    2008-01-01

    In this work, a two dimensional (2D) finite element foot model was established from magnetic resonance imaging (MRI) of a male subject. The model comprises first medial planar cross-section through the foot, representing the foot in standing posture. For specified external load, the stress and strain distribution field under foot structure are determined. The material characterization of foot structure components are stronger related to diabetic phenomena. The new material model f...

  13. Foot complications and mortality: results from Translating Research Into Action for Diabetes (TRIAD)

    Science.gov (United States)

    McEwen, Laura N.; Ylitalo, Kelly R.; Munson, Michael; Herman, William H.; Wrobel, James S.

    2016-01-01

    Background Our objective was to study the impact of foot complications on 10 year mortality independent of other demographic and biological risk factors in a racially and socioeconomically diverse managed care population with access to high-quality medical care. Methods We studied 6,992 patients with diabetes in Translating Research Into Action for Diabetes (TRIAD), a prospective observational study of diabetes care in managed care. Foot complications were assessed using administrative claims data. The National Death Index was searched for deaths over 10 years of followup (2000–2009). Results Charcot neuroosteoarthropathy (CN) and diabetic foot ulcer with debridement (DFU) were associated with an increased risk of mortality; however, the associations were not significant in fully adjusted models. Lower extremity amputation (LEA) was associated with an increased risk of mortality in both unadjusted (HR 3.21, 95% CI 2.50–4.12) and fully adjusted models (HR 1.84, 95% CI 1.28–2.63). When we examined the associations between LEA and mortality stratified by sex and race, risk was increased in men (HR 1.96, 95% CI 1.25–3.07), Hispanics (HR 5.17, 95% CI 1.48–18.01), and Whites (HR 2.18, 95% CI 1.37–3.47). In sensitivity analyses, minor LEA tended to increase the risk of mortality (HR 1.48, 95% CI 0.92–2.40) and major LEA was associated with a significantly higher risk of death at 10 years (HR 1.89, 95% CI 1.18–3.01). Conclusions In this managed care population with access to high-quality medical care, LEA remained a robust independent predictor of mortality. The association was strongest in men and differed by race. PMID:26895355

  14. Penile reconstruction

    Institute of Scientific and Technical Information of China (English)

    Giulio Garaffa; Salvatore Sansalone; David J Ralph

    2013-01-01

    During the most recent years,a variety of new techniques of penile reconstruction have been described in the literature.This paper focuses on the most recent advances in male genital reconstruction after trauma,excision of benign and malignant disease,in gender reassignment surgery and aphallia with emphasis on surgical technique,cosmetic and functional outcome.

  15. 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)

    1995-11-01

    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.)

  16. Flexible Foot Test Assembly

    Energy Technology Data Exchange (ETDEWEB)

    Kurita, C.H.; /Fermilab

    1987-04-27

    A test model of the flexible foot support was constructed early in the design stages to check its reactions to applied loads. The prototype was made of SS 304 and contained four vertical plates as opposed to the fourteen Inconel 718 plates which comprise the actual structure. Due to the fact that the prototype was built before the design of the support was finalized, the plate dimensions are different from those of the actual proposed design (i.e. model plate thickness is approximately one-half that of the actual plates). See DWG. 3740.210-MC-222376 for assembly details of the test model and DWG. 3740.210-MB-222377 for plate dimensions. This stanchion will be required to not only support the load of the inner vessel of the cryostat and its contents, but it must also allow for the movement of the vessel due to thermal contraction. Assuming that each vertical plate acts as a column, then the following formula from the Manual of Steel Construction (American Institute of Steel Construction, Inc., Eigth edition, 1980) can be applied to determine whether or not such columns undergoing simultaneous axial compression and transverse loading are considered safe for the given loading. The first term is representative of the axially compressive stress, and the second term, the bending stress. If the actual compressive stress is greater than 15% of the allowable compressive stress, then there are additional considerations which must be accounted for in the bending stress term.

  17. Overview of diabetic foot; novel treatments in diabetic foot ulcer

    Directory of Open Access Journals (Sweden)

    Larijani

    2008-04-01

    Full Text Available Foot ulcers are one of the main complications in diabetes mellitus, with a 15% life time risk in all diabetic patients. The problem and features are infection, ulceration, or gangrene. Neuropathy, poor circulation, and susceptibility to infection are the three major contributors to the development of diabetic foot; which when present, foot deformities or minor trauma can readily lead to ulceration and infection. Not all diabetic foots are preventable, but appropriate preventive measures can dramatically reduce their occurrences. Awareness of physicians about foot problems in diabetic patients, clinical examination and Para clinical assessment, regular foot examination, patient education, simple hygienic practices and provision of appropriate footwear combined with prompt treatment of minor injuries can decrease ulcer occurrence by 50%. Many different methods have been proposed and their goal is to accelerate the wound healing. These treatments other than standard therapy include local use of epidermal growth factor, vacuum-compression therapy (VCT, hyperbaric oxygen and peripheral Stem cell injection. Since all these treatments have a partial effect in ulcer improvement and amputation rate; so more effective treatments are essential."nA novel drug for treatment of this complication is an herbal extract, ANGIPARSTM, which has been studied in all steps of clinical trial. This new treatment by topical, oral and intravenous routs has had beneficial effects in the treatment of diabetic foot ulcer after one month. Angiogenesis is one of the considered mechanisms of action of this drug. Results of these clinical trials showed that this treatment can be superior to other treatments.

  18. Diagnóstico clínico de la enfermedad Charcot-Marie-Tooth

    Directory of Open Access Journals (Sweden)

    Yuselis Pérez Cid

    2014-08-01

    Full Text Available La enfermedad de Charcot-Marie-Tooth es un trastorno polineuropático genéticamente heterogéneo, en la que se han identificado más de 30 genes responsables; sin embargo, el diagnóstico es posible establecerlo sobre las bases de los estudios clínicos y electrofisiológicos. Constituye un reto en la práctica médica de los países del tercer mundo contar con la realización sistemática de estudios genéticos moleculares de las neuropatías hereditarias, por lo que en este trabajo se enfatiza en los estudios clínico-electrofisiológicos para la clasificación de la CMT

  19. Next-generation sequencing and genetic diagnosis of Charcot-Marie-Tooth disease

    Directory of Open Access Journals (Sweden)

    Ashok Verma

    2014-01-01

    Full Text Available Over 70 different Charcot-Marie-Tooth disease (CMT–associated genes have now been discovered and their number is growing. Conventional genetic testing for all CMT genes is cumbersome, expensive, and impractical in an individual patient. Next-generation sequencing (NGS technology allows cost-effective sequencing of large scale DNA, even entire exome (coding sequences or whole genome and thus, NGS platform can be employed to effectively target a large number or all CMT-related genes for accurate diagnosis. This overview discusses how NGS can be strategically used for genetic diagnosis in patients with CMT or unexplained neuropathy. A comment is made to combine simple clinical and electrophysiological algorithm to assign patients to major CMT subtypes and then employ NGS to screen for all known mutations in the subtype-specific CMT gene panel.

  20. Genetic dysfunction of MT-ATP6 causes axonal Charcot-Marie-Tooth disease.

    LENUS (Irish Health Repository)

    Pitceathly, Robert D S

    2012-09-11

    Charcot-Marie-Tooth (CMT) disease is the most common inherited neuromuscular disorder, affecting 1 in 2,500 individuals. Mitochondrial DNA (mtDNA) mutations are not generally considered within the differential diagnosis of patients with uncomplicated inherited neuropathy, despite the essential requirement of ATP for axonal function. We identified the mtDNA mutation m.9185T>C in MT-ATP6, encoding the ATP6 subunit of the mitochondrial ATP synthase (OXPHOS complex V), at homoplasmic levels in a family with mitochondrial disease in whom a severe motor axonal neuropathy was a striking feature. This led us to hypothesize that mutations in the 2 mtDNA complex V subunit encoding genes, MT-ATP6 and MT-ATP8, might be an unrecognized cause of isolated axonal CMT and distal hereditary motor neuropathy (dHMN).

  1. Piet Mondrian's trees and the evolution in understanding multiple sclerosis, Charcot Prize Lecture 2011.

    Science.gov (United States)

    Steinman, Lawrence; Axtell, Robert C; Barbieri, Donald; Bhat, Roopa; Brownell, Sara E; de Jong, Brigit A; Dunn, Shannon E; Grant, Jacqueline L; Han, May H; Ho, Peggy P; Kuipers, Hedwich F; Kurnellas, Michael P; Ousman, Shalina S; Rothbard, Jonathan B

    2013-01-01

    Four questions were posed about multiple sclerosis (MS) at the 2011 Charcot Lecture, Oct. 22, 2011. 1. The Male/Female Disparity: Why are women developing MS so much more frequently than men? 2. Neuronal and Glial Protection: Are there guardian molecules that protect the nervous system in MS? 3. Predictive Medicine: With all the approved drugs, how can we rationally decide which one to use? 4. The Precise Scalpel vs. the Big Hammer for Therapy: Is antigen-specific therapy for demyelinating disease possible? To emphasize how our views on the pathogenesis and treatment of MS are evolving, and given the location of the talk in Amsterdam, Piet Mondrian's progressive interpretations of trees serve as a heuristic. PMID:23303879

  2. Piet Mondrian's trees and the evolution in understanding multiple sclerosis, Charcot Prize Lecture 2011.

    Science.gov (United States)

    Steinman, Lawrence; Axtell, Robert C; Barbieri, Donald; Bhat, Roopa; Brownell, Sara E; de Jong, Brigit A; Dunn, Shannon E; Grant, Jacqueline L; Han, May H; Ho, Peggy P; Kuipers, Hedwich F; Kurnellas, Michael P; Ousman, Shalina S; Rothbard, Jonathan B

    2013-01-01

    Four questions were posed about multiple sclerosis (MS) at the 2011 Charcot Lecture, Oct. 22, 2011. 1. The Male/Female Disparity: Why are women developing MS so much more frequently than men? 2. Neuronal and Glial Protection: Are there guardian molecules that protect the nervous system in MS? 3. Predictive Medicine: With all the approved drugs, how can we rationally decide which one to use? 4. The Precise Scalpel vs. the Big Hammer for Therapy: Is antigen-specific therapy for demyelinating disease possible? To emphasize how our views on the pathogenesis and treatment of MS are evolving, and given the location of the talk in Amsterdam, Piet Mondrian's progressive interpretations of trees serve as a heuristic.

  3. Jean-Martin Charcot, father of modern neurology: an homage 120 years after his death

    Directory of Open Access Journals (Sweden)

    Marleide da Mota Gomes

    2013-10-01

    Full Text Available Jean-Martin Charcot was a pioneer in a variety of subjects, including nervous system diseases; anatomy; physiology; pathology; and diseases of ageing, joints, and lungs. His medical achievements were mainly based on his anatomopathological proficiency, his observation, and his personal thoroughness that favored the delineation of the nosology of the main neurological diseases, including multiple sclerosis, amyotrophic lateral sclerosis, Parkinson’s disease, peroneal muscular atrophy, and hysteria/epilepsy. The link of this anatomoclinical method with iconographic representations and theatrical lessons, and the rich bibliographical documentations, carried out in a crowded diseased people barn - Salpetrière hospital were the basis of his achievements, which are still discussed 120 years after his death.

  4. Charcot-Marie-Tooth disease and pathways to molecular based therapies.

    Science.gov (United States)

    Harel, T; Lupski, J R

    2014-11-01

    The discovery in 1991 that chromosome 17p12 duplication is associated with Charcot-Marie-Tooth (CMT) disease marked the beginning of an era of molecular insight into this disorder, which encompasses the peripheral motor and sensory neuropathies. A mere two decades later, over 40 subtypes of CMT have been molecularly defined and many have been extensively studied in vitro and in animal models, providing the framework for a more comprehensive understanding of the biological pathways dictating myelination, axonal dynamics, and axon-glia interactions. The advent of next-generation sequencing technologies offers opportunities in both research and clinical settings for gene discovery, further molecular understanding and diagnosis, and calls for modifications of the existing algorithms guiding genetic testing. Although treatment is mainly supportive at this time, advances in this field are anticipated as the molecular basis of CMT is unraveled.

  5. [Therapy for Charcot-Marie-Tooth Disease: From the Standpoint of Neurologists].

    Science.gov (United States)

    Nakagawa, Masanori

    2016-01-01

    To date, there is no approved pharmacologic treatment for any form of Charcot-Marie-Tooth disease (CMT). However, some clinical or preclinical trials for CMT1A have been undertaken, for example Neurotrophin-3, PXT3003, and neuregulin-1. Gene therapy for CMT1X, CMT2F and Giant axonal neuropathy using animal model or culture cells have been reported with some interesting results. Stem cell research for example iPS cells derived from patients with CMT2A or CMT2E, is being conducted to clarify the mechanism of CMT and find therapeutic clues. The development of new surrogate markers for clinical trials is also needed. Additionally, steps should be taken to improve the quality of life of patients with CMT, including pain control and life style enhancement.

  6. Connexin mutations in X-linked Charcot-Marie-Tooth disease

    Energy Technology Data Exchange (ETDEWEB)

    Bergoffen, J. (Univ. of Pennsylvania Medical School, Philadelphia, PA (United States)); Scherer, S.S.; Wang, S.; Scott, M.; Bone, L.J.; Chen, K.; Lensch, M.W.; Fischbeck, K.H. (Univ. of Pennsylvania Medical School, PA (United States)); Paul, D.L. (Harvard Medical School, Boston, MA (United States)); Change, P.F. (Univ. of Pennsylvania Medical School and Neurology Division, Philadelphia, PA (United States))

    1993-12-24

    X-linked Charcot-Marie-Tooth disease (CMTX) is a form of hereditary neuropathy with demyelination. Recently, this disorder was mapped to chromosome Xq13.1. The gene for the gap junction protein connexin32 is located in the same chromosomal segment, which led to its consideration as a candidate gene for CMTX. With the use of Northern (RNA) blot and immunohistochemistry techniques, it was found that connexin32 is normally expressed in myelinated peripheral nerve. Direct sequencing of the connexin32 gene showed seven different mutations in affected persons from eight CMTX families. These findings, a demonstration of inherited defects in a gap junction protein, suggest that connexin32 plays an important role in peripheral nerve.

  7. Anesthetic Management of a Patient With Charcot-Marie-Tooth Disease.

    Science.gov (United States)

    Ohshita, Naohiro; Oka, Saeko; Tsuji, Kaname; Yoshida, Hiroaki; Morita, Shosuke; Momota, Yoshihiro; Tsutsumi, Yasuo M

    2016-01-01

    Charcot-Marie-Tooth disease (CMTD) is a hereditary peripheral neuropathy and is characterized by progressive muscle atrophy and motor-sensory disorders in all 4 limbs. Most reports have indicated that major challenges with general anesthetic administration in CMTD patients are the appropriate use of nondepolarizing muscle relaxants and preparation for malignant hyperthermia in neuromuscular disease. Moderate sedation may be associated with the same complications as those of general anesthesia, as well as dysfunction of the autonomic nervous system, reduced perioperative respiratory function, difficulty in positioning, and sensitivity to intravenous anesthetic agents. We decided to use intravenous sedation in a CMTD patient and administered midazolam initially and propofol continuously, with total doses of 1.5 mg and 300 mg, respectively. Anesthesia was completed in 3 hours and 30 minutes without adverse events. We suggest that dental anesthetic treatment with propofol and midazolam may be effective for patients with CMTD.

  8. A Review of X-linked Charcot-Marie-Tooth Disease.

    Science.gov (United States)

    Wang, Ying; Yin, Fei

    2016-05-01

    X-linked Charcot-Marie-Tooth disease (CMTX) is the second common genetic variant of CMT. CMTX type 1 causes 90% of CMTX. The most important clinical features of CMTX are similar with other types of CMT; however, a few patients get the central nervous system involved with or without white matter lesions; males are more severely and earlier affected than females. In this review, the authors focus on the origin and classification of CMTX, the central nervous system manifestations of CMTX1, the possible mechanism by which GJB1 mutations cause CMT1X, and the emerging therapeutic strategies for CMTX. Moreover, several cases are presented to illustrate the central nervous system manifestations.

  9. Anesthetic Management of a Patient With Charcot-Marie-Tooth Disease.

    Science.gov (United States)

    Ohshita, Naohiro; Oka, Saeko; Tsuji, Kaname; Yoshida, Hiroaki; Morita, Shosuke; Momota, Yoshihiro; Tsutsumi, Yasuo M

    2016-01-01

    Charcot-Marie-Tooth disease (CMTD) is a hereditary peripheral neuropathy and is characterized by progressive muscle atrophy and motor-sensory disorders in all 4 limbs. Most reports have indicated that major challenges with general anesthetic administration in CMTD patients are the appropriate use of nondepolarizing muscle relaxants and preparation for malignant hyperthermia in neuromuscular disease. Moderate sedation may be associated with the same complications as those of general anesthesia, as well as dysfunction of the autonomic nervous system, reduced perioperative respiratory function, difficulty in positioning, and sensitivity to intravenous anesthetic agents. We decided to use intravenous sedation in a CMTD patient and administered midazolam initially and propofol continuously, with total doses of 1.5 mg and 300 mg, respectively. Anesthesia was completed in 3 hours and 30 minutes without adverse events. We suggest that dental anesthetic treatment with propofol and midazolam may be effective for patients with CMTD. PMID:27269665

  10. Unusual manifestations of Charcot-Marie-Tooth disease: A clinical observation

    Directory of Open Access Journals (Sweden)

    Akhila Kumar Panda

    2014-01-01

    Full Text Available Charcot-Marie-Tooth disease (CMT is the most common hereditary neuromuscular disorder. Careful assessment of clinical presentations, mode of inheritance, electrophysiological studies, and genetic analysis form the basis for the diagnosis of CMT. CMT4 is a group of progressive motor and sensory axonal demyelinating neuropathies. It is distinguished from other forms of CMT by autosomal recessive pattern of inheritance, variable clinical manifestations, electrophysiological study, nerve biopsy, and specific genetic studies. Here, we report an interesting case of hereditary neuropathy with recessive inheritance pattern who presented with combined clinical phenotypes of 4B1, 4C, and 4D subtypes. The histopathological study revealed onion bulb appearance suggestive of demyelination and remyelination phenomenon. The overlapping clinical manifestation may create a diagnostic challenge which would be confirmed by specific molecular analysis.

  11. Charcot-Marie-Tooth disease and dilated cardiomyopathy. A rare combination.

    Directory of Open Access Journals (Sweden)

    Rafael Pila Pérez

    2011-07-01

    Full Text Available Se presenta el caso de un paciente de 50 años de edad, con 14 años de evolución de manifestaciones clínicas, destacándose las alteraciones musculoesqueléticas de los cuatro miembros con atrofia de las prominencias tenar e hipotenar y de la musculatura de ambas piernas. Se destacó la presencia de alteraciones sensitivas en miembros inferiores con distribución en calcetín, atrofia, atonía, arreflexia y marcha equina. Desde el punto de vista cardiaco, el paciente presentaba un fibriloaleteo. La radiografía de tórax mostró un aumento marcado del área cardiaca y la ecocardiografía puso de manifiesto una miocardiopatía dilatada. El estudio histopatológico confirmó la presencia de la enfermedad de Charcot-Marie-Tooth asociada a miocardiopatía dilatada. El diagnóstico se basó en las características clínicas, la velocidad de conducción motora, y el estudio histopatológico, que demostró desmielinización con lesiones en “cebolla”, si bien faltaron los estudios genéticos. La enfermedad de Charcot-Marie-Tooth es una enfermedad rara; aproximadamente un 60 % de los pacientes que la padecen, son portadores de una duplicación del cromosoma 17. Por ello, se consideró oportuno transmitir la experiencia de este caso.

  12. Secondary digital nerve repair in the foot with resorbable p(DLLA-epsilon-CL) nerve conduits

    NARCIS (Netherlands)

    Meek, MF; Nicolai, JPA; Robinson, PH

    2006-01-01

    Nerve guides are increasingly being used in peripheral nerve repair. In the last decade, Much preclinical research has been undertaken into a resorbable nerve guide composed of p(DLLA-epsilon-CL). This report describes the results of secondary digital nerve reconstruction in the foot in a patient wi

  13. Minimally invasive soft tissue release of foot and ankle contracture secondary to stroke.

    Science.gov (United States)

    Boffeli, Troy J; Collier, Rachel C

    2014-01-01

    Lower extremity contracture associated with stroke commonly results in a nonreducible, spastic equinovarus deformity of the foot and ankle. Rigid contracture deformity leads to gait instability, pain, bracing difficulties, and ulcerations. The classic surgical approach for stroke-related contracture of the foot and ankle has been combinations of tendon lengthening, tendon transfer, osteotomy, and joint fusion procedures. Recovery after traditional foot and ankle reconstructive surgery requires a period of non-weightbearing that is not typically practical for these patients. Little focus has been given in published studies on minimally invasive soft tissue release of contracture. We present the case of a 61-year-old female with an equinovarus foot contracture deformity secondary to stroke. The patient underwent Achilles tendon lengthening, posterior tibial tendon Z lengthening, and digital flexor tenotomy of each toe with immediate weightbearing in a walking boot, followed by transition to an ankle-foot orthosis. The surgical principles and technique tips are presented to demonstrate our minimally invasive approach to release of foot and ankle contracture secondary to stroke. The main goal of this approach is to improve foot and ankle alignment for ease of bracing, which, in turn, will improve gait, reduce the risk of falls, decrease pain, and avoid the development of pressure sores. PMID:23890795

  14. A neurological bias in the history of hysteria: from the womb to the nervous system and Charcot

    Directory of Open Access Journals (Sweden)

    Marleide da Mota Gomes

    2014-12-01

    Full Text Available Hysteria conceptions, from ancient Egypt until the 19th century Parisian hospital based studies, are presented from gynaecological and demonological theories to neurological ones. The hysteria protean behavioral disorders based on nervous origin was proposed at the beginning, mainly in Great Britain, by the “enlightenment nerve doctors”. The following personages are highlighted: Galen, William, Sydenham, Cullen, Briquet, and Charcot with his School. Charcot who had hysteria and hypnotism probably as his most important long term work, developed his conceptions, initially, based on the same methodology he applied to studies of other neurological disorder. Some of his associates followed him in his hysteria theories, mainly Paul Richer and Gilles de La Tourette who produced, with the master's support, expressive books on Salpêtrière School view on hysteria.

  15. Recommendations to enable drug development for inherited neuropathies: Charcot-Marie-Tooth and Giant Axonal Neuropathy [v1; ref status: indexed, http://f1000r.es/33n

    Directory of Open Access Journals (Sweden)

    Lori Sames

    2014-04-01

    Full Text Available Approximately 1 in 2500 Americans suffer from Charcot-Marie-Tooth (CMT disease. The underlying disease mechanisms are unique in most forms of CMT, with many point mutations on various genes causing a toxic accumulation of misfolded proteins. Symptoms of the disease often present within the first two decades of life, with CMT1A patients having reduced compound muscle and sensory action potentials, slow nerve conduction velocities, sensory loss, progressive distal weakness, foot and hand deformities, decreased reflexes, bilateral foot drop and about 5% become wheelchair bound. In contrast, the ultra-rare disease Giant Axonal Neuropathy (GAN is frequently described as a recessively inherited condition that results in progressive nerve death. GAN usually appears in early childhood and progresses slowly as neuronal injury becomes more severe and leads to death in the second or third decade. There are currently no treatments for any of the forms of CMTs or GAN. We suggest that further clinical studies should analyse electrical impedance myography as an outcome measure for CMT. Further, additional quality of life (QoL assessments for these CMTs are required, and we need to identify GAN biomarkers as well as develop new genetic testing panels for both diseases. We propose that using the Global Registry of Inherited Neuropathy (GRIN could be useful for many of these studies. Patient advocacy groups and professional organizations (such as the Hereditary Neuropathy Foundation (HNF, Hannah's Hope Fund (HHF, The Neuropathy Association (TNA and the American Association of Neuromuscular and Electrodiagnostic Medicine (AANEM can play a central role in educating clinicians and patients. Undertaking these studies will assist in the correct diagnosis of disease recruiting patients for clinical studies, and will ultimately improve the endpoints for clinical trials. By addressing obstacles that prevent industry investment in various forms of inherited neuropathies

  16. Recommendations to enable drug development for inherited neuropathies: Charcot-Marie-Tooth and Giant Axonal Neuropathy [v2; ref status: indexed, http://f1000r.es/3am

    Directory of Open Access Journals (Sweden)

    Lori Sames

    2014-04-01

    Full Text Available Approximately 1 in 2500 Americans suffer from Charcot-Marie-Tooth (CMT disease. The underlying disease mechanisms are unique in most forms of CMT, with many point mutations on various genes causing a toxic accumulation of misfolded proteins. Symptoms of the disease often present within the first two decades of life, with CMT1A patients having reduced compound muscle and sensory action potentials, slow nerve conduction velocities, sensory loss, progressive distal weakness, foot and hand deformities, decreased reflexes, bilateral foot drop and about 5% become wheelchair bound. In contrast, the ultra-rare disease Giant Axonal Neuropathy (GAN is frequently described as a recessively inherited condition that results in progressive nerve death. GAN usually appears in early childhood and progresses slowly as neuronal injury becomes more severe and leads to death in the second or third decade. There are currently no treatments for any of the forms of CMTs or GAN. We suggest that further clinical studies should analyse electrical impedance myography as an outcome measure for CMT. Further, additional quality of life (QoL assessments for these CMTs are required, and we need to identify GAN biomarkers as well as develop new genetic testing panels for both diseases. We propose that using the Global Registry of Inherited Neuropathy (GRIN could be useful for many of these studies. Patient advocacy groups and professional organizations (such as the Hereditary Neuropathy Foundation (HNF, Hannah's Hope Fund (HHF, The Neuropathy Association (TNA and the American Association of Neuromuscular and Electrodiagnostic Medicine (AANEM can play a central role in educating clinicians and patients. Undertaking these studies will assist in the correct diagnosis of disease recruiting patients for clinical studies, and will ultimately improve the endpoints for clinical trials. By addressing obstacles that prevent industry investment in various forms of inherited neuropathies

  17. [Foot equipment of diabetic arteriopathy].

    Science.gov (United States)

    Miault, D; Brun, J P; Dupre, J C; Pill, M; Miault, P; Deschamps, E; Priollet, P; Laurian, C; Fichelle, J M; Cormier, J M

    1993-01-01

    Surgical appliances have a place of choice in the care of the foot with trophic lesions in diabetics, after partial amputation and as a preventive measure when it is free from trophic disorders. The type of appliance will depend on the footwear and the possibility of wearing orthopedic soles, whatever the stage of the affection. For the foot free from trophic disorders the shoes should be wide fitting, in soft leather and of the seamless type. Made to measure shoes should be reserved for badly deformed feet. The soles should be molded in silicone or polyurethane to distribute weight bearing and to avoid it over zones at risk. Appliances for the foot with trophic lesions should allow the resumption of walking. If the lesions are too extensive an orthosis is performed or a specific type of slipper with molded soles is worn to avoid pressure on the wounds. After amputation of toes a silicone orthoplasty is used to fill the interdigital space to avoid deformity of the other toes. If a front of foot has been amputated a corrected silicone molded sole with false extremity is applied. For a back of foot amputation an orthoprosthesis is made, preferentially in silicone introductible in a regular high sided shoe. In order to fulfil its preventive or temporary role, the appliance should evolve with time and be followed up regularly with close collaboration between the diabetic specialist the podologist and the orthotist. PMID:8473812

  18. Climate Reconstructions

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The NOAA Paleoclimatology Program archives reconstructions of past climatic conditions derived from paleoclimate proxies, in addition to the Program's large...

  19. Electrophysiological Evaluation of Chronic Inflammatory Demyelinating Polyneuropathy and Charcot-Marie-Tooth Type 1: Dispersion and Correlation Analysis

    OpenAIRE

    Kang, Ji Hyuk; Kim, Hye Jeong; Lee, Eun Ryeong

    2013-01-01

    [Purpose] The purpose of this study was to analyze and compare electrophysiological characteristics observed in nerve conduction studies (NCS) of chronic inflammatory demyelinating polyneuropathy (CIDP) and Charcot-Marie-Tooth disease type 1 (CMT 1). [Subjects] A differential diagnosis of acquired and congenital demyelinating neuropathies was based on a study of 35 patients with NCS-confirmed CIDP and 30 patients with CMT 1 genetically proven by peripheral myelin protein-22 (PMP-22) gene anal...

  20. Flexor digitorum superficialis opposition tendon transfer improves hand function in children with Charcot-Marie-Tooth disease: Case series

    OpenAIRE

    Estilow, T.; Kozin, S.H.; Glanzman, A. M.; Burns, J; Finkel, R.S.

    2012-01-01

    Charcot-Marie-Tooth disease limits hand function. Tendon transfer has not been reported in pediatric CMT. We report two severely affected children following long finger flexor digitorum superficialis opposition tendon transfer. Improvement was noted in palmar abduction, (30°/40°), opposition, (thumb to all digits), and acquisition of pincer, palmar, and lateral pinch with measureable force (1 lb). Dexterity testing improved on the 9 Hole Peg Test (1.03 s/77 s, 22 s) and Functional Dexterity T...

  1. Molecular analyses of unrelated Charcot-Marie-Tooth (CMT) disease patients suggest a high frequency of the CMTIA duplication.

    OpenAIRE

    Wise, C A; GARCIA, C. A.; Davis, S.N.; Heju, Z; Pentao, L; Patel, P.I.; Lupski, J.R.

    1993-01-01

    Charcot-Marie-Tooth disease (CMT) is the most common inherited peripheral neuropathy. One form of CMT, CMT type 1A, is characterized by uniformly decreased nerve conduction velocities, usually shows autosomal dominant inheritance, and is associated with a large submicroscopic duplication of the p11.2-p12 region of chromosome 17. A cohort of 75 unrelated patients diagnosed clinically with CMT and evaluated by electrophysiological methods were analyzed molecularly for the presence of the CMT1A ...

  2. Laryngopharyngeal reconstruction

    OpenAIRE

    Kazi, Rehan A

    2006-01-01

    There is a high incidence of hypopharyngeal cancer is our country due to the habits of tobacco and alcohol. Moreover these cases are often detected in the late stages thereby making the issue of reconstruction very tedious and unpredictable. There are a number of options for laryngopharyngeal reconstruction available now including the use of microvascular flaps depending upon the patient’s fitness, motivation, technical expertise, size and extent of the defect. This article reviews the differ...

  3. 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;

    2007-01-01

    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 considerabl......). There was no significant association between foot size and FLT values. CONCLUSION: The FLT is a reproducible technique to assess foot posture.......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...... limitations regarding reliability and validity. METHODS: One hundred thirty subjects with mean foot size 44 (41-50 European size) participated. Two examiners, blinded to each other's measurements, measured the right foot of the subjects twice and the left foot once. The position of the most medial aspect...

  4. Foot Comfort for the Fashionable

    Science.gov (United States)

    2002-01-01

    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.

  5. Interpreting radiographs. 1. The foot

    International Nuclear Information System (INIS)

    Radiography of the foot of a conscious standing horse is within the capability of all modern portable X-ray machines; radiographic examination of the feet of horses with long-standing lameness is frequently carried out in practice. With the introduction of modern fast intensifying screens and films there is little excuse for poor results caused by movement or the low output of portable machines. Sadly, although the foot is the most commonly radiographed part of the horse, a high percentage of the films taken are not of diagnostic quality. This is due, first, to over exposure, secondly, to poor developing techniques and thirdly, to poor positioning

  6. Diagnostic radiology of the foot

    International Nuclear Information System (INIS)

    The X-ray radiography continues to be the first and most applied method for diagnostic imaging of the foot and ankle joint. The application of magnetic resonance imaging (MRI) for examination of the foot and ankle joint is on the rise, due to the excellent imaging of soft tissue lesions. A basic requirement of purposeful application, and correct diagnosis, of the various radiological modalities available is a profound knowledge of the anatomy as well as the pathology of the morphological and functional features. (orig./CB)

  7. Modeling and stress analyses of a normal foot-ankle and a prosthetic foot-ankle complex.

    Science.gov (United States)

    Ozen, Mustafa; Sayman, Onur; Havitcioglu, Hasan

    2013-01-01

    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

  8. A rare anomaly of the foot presented as polydactyly

    Directory of Open Access Journals (Sweden)

    Vikram Jeet Singh Dhingra

    2013-01-01

    Full Text Available Presence of one or more digit is called as polydactyly and may manifest singly or with other genetic disorders. The frequency of polydactyly varies widely among populations. It can occur as an isolated condition or as a feature of a congenital condition. Polydactyly is a rare condition, but still rare is in form of triple great toes. We describe a case in a 4-year-old child diagnosed as triphalangism foot with no other obvious visible anomaly. Osteoplasty-combined surgery, which was ideal for anatomical reconstruction. In a 16-month follow-up period child recovered very well.

  9. MDCT classification of osseous ankle and foot injuries

    International Nuclear Information System (INIS)

    Conventional radiography plays an essential role in the primary evaluation of acute ankle and foot trauma. In the case of complex injuries, however, subsequent computed tomography (CT) is nowadays recommended. In this connection, multidetector computed tomography (MDCT) allows better temporal, spatial, and contrast resolution compared with the conventional single-slice spiral CT. Multiplanar reformation and three-dimensional reconstruction of the acquired data sets are also helpful tools for critical assessment of therapeutic intervention. This report reviews the potential of the MDCT technique for accurate fracture classification, precise illustration of displaced components, and postoperative control of arrangement of typical lesions. (orig.)

  10. Diabetic Foot - Multiple Languages: MedlinePlus

    Science.gov (United States)

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

  11. Hand-Foot-and-Mouth Disease

    Science.gov (United States)

    ... clinical tools newsletter | contact Share | Hand-Foot-and-Mouth Disease A parent's guide for infants and babies ... a herpes virus infection. Overview Hand-foot-and-mouth disease is a common illness of infants and ...

  12. Osteoarthritis of the Foot and Ankle

    Science.gov (United States)

    ... joint. Diagnosis In diagnosing osteoarthritis, the foot and ankle surgeon will examine the foot thoroughly, looking for swelling in the joint, limited mobility, and pain with movement. In some cases, deformity ...

  13. American College of Foot and Ankle Surgeons

    Science.gov (United States)

    ... Week @ ACFAS Poll Results Arthroscopy e-Book The Journal of Foot & Ankle Surgery Read some of the latest research from the official peer-reviewed scientific journal of ACFAS, The Journal of Foot & Ankle Surgery ( ...

  14. Tuberculosis of the foot: An osteolytic variety

    OpenAIRE

    Dhillon, Mandeep S; Sameer Aggarwal; Sharad Prabhakar; Vikas Bachhal

    2012-01-01

    Background: Foot involvement in osteoarticular tuberculosis is uncommon and isolated bony involvement of foot bones with an osteolytic defect is even more rare; diagnostic and therapeutic delays can occur, worsening the prognosis. We present a retrospective series of osteolytic variety of foot tuberculosis. Materials and Methods: We present 24 osteolytic variety of foot tuberculosis (Eleven calcaneus, four cuboid, two cunieforms, one talus, three metatarsals, three phalanges) out of 92 fo...

  15. Diabetic foot ulcers. Pathophysiology, assessment, and therapy.

    OpenAIRE

    Bowering, C. K.

    2001-01-01

    OBJECTIVE: To review underlying causes of diabetic foot ulceration, provide a practical assessment of patients at risk, and outline an evidence-based approach to therapy for diabetic patients with foot ulcers. QUALITY OF EVIDENCE: A MEDLINE search was conducted for the period from 1979 to 1999 for articles relating to diabetic foot ulcers. Most studies found were case series or small controlled trials. MAIN MESSAGE: Foot ulcers in diabetic patients are common and frequently lead to lower limb...

  16. 脑瘫尖足内翻畸形的功能重建及A型肉毒毒素配合治疗的临床分析%Clinical research of functional reconstruction with BTA for treatment on equinovarus foot of spasitic cerebral palsy

    Institute of Scientific and Technical Information of China (English)

    李智勇; 王洪刚; 王东; 秦本刚; 易建华; 黎建文; 顾立强; 刘小林; 劳镇国; 朱庆棠; 向剑平; 戚剑

    2011-01-01

    Objective To observe the clinical therapial value of functional reconstruction with Botulinum Toxin A (BTA) on spasitic cerebral palsy. Methods Thirty-two patients were treated by Achilles tendon lengthening and anterior transfer of posterior tibial tendon.According to the spasticity of triceps surae muscle,all cases were arranged by BTA injection 2 months later after operation.Results From Jan.2000 to Jan.2009,thirty-two cases with equinovarus foot of spasticitical cerebral palsy were collected,the muscle strength of ankle dorsal extensor increased from 0-2 grades to 4-5 grades,there was significant difference between preoperational muscle strength and postoperational one.There was also significant improvement to adjust yarus degrees of ankle joint.the musclar tension of triceps muscle of calf decreased from Ⅱ-Ⅳ grades to Ⅰ-Ⅱ grades. Conclusion Anterior transfer of posterior tibial tendon corresponding with Botulinum Toxin A injection not only release muscle spasticity but also improve dorsal extending strength of ankle joint.The clinical effect of these methods was reliable on cerebral palsy.%目的 探讨脑瘫尖足内翻畸形的功能重建及A型肉毒毒素配合治疗的临床疗效.方法 收集2000年1月至2009年1月在我科住院行尖足内翻畸形矫正的痉挛性脑瘫,术后小腿三头肌的肌张力Ⅱ级以上者共32例,给予A型肉毒毒素局部注射治疗,观察手术和药物注射前后的功能改善情况并进行比较.结果 检杳治疗前踝背伸肌力在0~2级,随访时踝背伸的肌力为4~5级,采用配对t检验,术前后比较差异有统计学意义(P<0.05).治疗前足内翻在30°~75°之间,随访时足内翻在0°~25°,采用配对t检验,治疗前后数据的差异有统计学意义(P<0.05).小腿三头肌2个月复查时,肌张力在Ⅱ~Ⅳ级,随访时肌张力在Ⅰ~Ⅱ级.采用配对t检验,术前后比较差异有统计学意义(P<0.05).结论 胫后肌前移配合A型肉毒毒素

  17. Foot-and-mouth disease

    Science.gov (United States)

    Foot-and-mouth disease (FMD) is a highly contagious viral disease of cloven-hoofed animals. An outbreak of FMD can have a significant economic impact because of the restrictions on international trade of susceptible animals and their products with FMD-free countries. In this chapter we discuss vario...

  18. Management of diabetic foot infections

    International Nuclear Information System (INIS)

    Objective: To determine the infecting agent in diabetic food infection with the susceptibility pattern, and to evaluate the effect of wound infection, was culopathy, neuropathy and control of diabetes mellitus on the outcome of the patients. Design: A descriptive and observational study. Place and duration of study: Patients with diabetic foot, admitted in surgical unit 1, B.V. Hospital Bahawalpur, from April 1999 to April 2000, were included in this study. Subject and methods: A total of 60 known diabetic patients were studied, out of these 47 were males and 13 females. They were assessed for angiopathy, neuropathy and extend of foot involvement. Necessary investigations, including x-ray foot, ECG, serum urea and creatinine, pus culture and sensitivity were carried out. Diabetes was controlled on insulin of the basis of serum sugar and urine sugar chart and treated accordingly. Results: The most common age of foot involvement was between 40-70 years. Right side was involved more often than the left (67%: 37%). Most of the infections were due to staphylococcus (50%), pseudomonas (25%) and streptococci (8%). Antibiotic was started based on sensitivity report. Fluoro quinolone plus clindamycin was used in 50%, fluoro quinolone plus metronidazole in 20% and amoxicillin/clavulanate in 23%. Most of the patients (61.7%) were in grade iii or iv of Meggit wagner classification of diabetic foot. Three patients (5%) were treated by below knee amputations while 1.7% patient by above knee amputation. In twenty-four (40%) patients some form of to amputation/ray amputation had to be done,while 32(53.3%) patients had complete healing of would without any amputation. Mortality was 3.33% all the 4 patients (6.7%) who presented late, having uncontrolled diabetes, with angiopathy (absent foot pulses), neuropathy, infection of the foot (grade iii or above) resulted in major amputation sooner or latter. The 32 patients (53.3%) having controlled diabetes mellitus with no angiopathy or

  19. DIABETIC FOOT ULCERS MICROBIOLOGICAL STUDY

    Directory of Open Access Journals (Sweden)

    P. Rajagopal

    2016-08-01

    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

  20. Project Reconstruct.

    Science.gov (United States)

    Helisek, Harriet; Pratt, Donald

    1994-01-01

    Presents a project in which students monitor their use of trash, input and analyze information via a database and computerized graphs, and "reconstruct" extinct or endangered animals from recyclable materials. The activity was done with second-grade students over a period of three to four weeks. (PR)

  1. Vaginal reconstruction

    Energy Technology Data Exchange (ETDEWEB)

    Lesavoy, M.A.

    1985-05-01

    Vaginal reconstruction can be an uncomplicated and straightforward procedure when attention to detail is maintained. The Abbe-McIndoe procedure of lining the neovaginal canal with split-thickness skin grafts has become standard. The use of the inflatable Heyer-Schulte vaginal stent provides comfort to the patient and ease to the surgeon in maintaining approximation of the skin graft. For large vaginal and perineal defects, myocutaneous flaps such as the gracilis island have been extremely useful for correction of radiation-damaged tissue of the perineum or for the reconstruction of large ablative defects. Minimal morbidity and scarring ensue because the donor site can be closed primarily. With all vaginal reconstruction, a compliant patient is a necessity. The patient must wear a vaginal obturator for a minimum of 3 to 6 months postoperatively and is encouraged to use intercourse as an excellent obturator. In general, vaginal reconstruction can be an extremely gratifying procedure for both the functional and emotional well-being of patients.

  2. Vaginal reconstruction

    International Nuclear Information System (INIS)

    Vaginal reconstruction can be an uncomplicated and straightforward procedure when attention to detail is maintained. The Abbe-McIndoe procedure of lining the neovaginal canal with split-thickness skin grafts has become standard. The use of the inflatable Heyer-Schulte vaginal stent provides comfort to the patient and ease to the surgeon in maintaining approximation of the skin graft. For large vaginal and perineal defects, myocutaneous flaps such as the gracilis island have been extremely useful for correction of radiation-damaged tissue of the perineum or for the reconstruction of large ablative defects. Minimal morbidity and scarring ensue because the donor site can be closed primarily. With all vaginal reconstruction, a compliant patient is a necessity. The patient must wear a vaginal obturator for a minimum of 3 to 6 months postoperatively and is encouraged to use intercourse as an excellent obturator. In general, vaginal reconstruction can be an extremely gratifying procedure for both the functional and emotional well-being of patients

  3. Modern Orthopedic Inpatient Care of the Orthopedic Patient With Diabetic Foot Disease.

    Science.gov (United States)

    Bateman, Antony H; Bradford, Sara; Hester, Thomas W; Kubelka, Igor; Tremlett, Jennifer; Morris, Victoria; Pendry, Elizabeth; Kavarthapu, Venu; Edmonds, Michael E

    2015-12-01

    In this article, we describe emergency and elective pathways within our orthopedic multidisciplinary inpatient care of patients with diabetic foot problems. We performed a retrospective cohort review of 19 complex patients requiring orthopedic surgical treatment of infected ulceration or Charcot feet or deformity at our institution. A total of 30 admissions (19 emergency, 11 elective) were included. The pathways were coordinated by a multidisciplinary team and comprised initial assessment and investigation and a series of key events, which consisted of emergency and elective surgery together with the introduction, and change of intravenous antibiotics when indicated. Patients had rigorous microbiological assessment, in the form of deep ulcer swabs, operative tissue specimens, joint aspirates, and blood cultures according to their clinical presentation as well as close clinical and biochemical surveillance, which expedited the prompt institution of key events. Outcomes were assessed using amputation rates and patient satisfaction. In the emergency group, there were 5.6 ± 3.0 (mean ± SD) key events per admission, including 4.2 ± 2.1 antibiotic changes. In the elective group, there were 4.8 ± 1.4 key events per inpatient episode, with 3.7 ± 1.3 antibiotic changes. Overall, there were 3 minor amputations, and no major amputations. The podiatric and surgical tissue specimens showed a wide array of Gram-positive, Gram-negative, aerobic and anaerobic isolates and 15% of blood cultures showed bacteremia. When 9 podiatric specimens were compared with 9 contemporaneous surgical samples, there was concordance in 2 out of 9 pairs. We have described the successful modern care of the orthopedic diabetic foot patient, which involves close clinical, microbiological, and biochemical surveillance by the multidisciplinary team directing patients through emergency and elective pathways. This has enabled successful surgical intervention involving debridement, pressure relief, and

  4. [Phenotypes of Charcot-Marie-Tooth Syndrome and Differential Diagnosis Focused in Inflammatory Neuropathies].

    Science.gov (United States)

    Iijima, Masahiro

    2016-01-01

    Charcot-Marie-Tooth disease (CMT), the most frequent form of inherited neuropathy, is a genetically heterogeneous syndrome of the peripheral nervous system with a rather homologous clinical phenotype (slowly progressive distal weakness and muscle atrophy, skeletal deformities, and areflexia in each limb). CMT1 is the autosomal-dominant demyelinating form, and CMT1A (mostly PMP22 duplication) is the most frequent subtype, followed by CMTX1, HNPP (hereditary neuropathy with liability to pressure palsies), CMT1B, or CMT2. As CMT is characterized by slowly progressive motor and sensory disturbances in each limb, it could be misdiagnosed as chronic inflammatory demyelinating polyneuropathy (CIDP) occasionally. Some points can distinguish demyelinating CMT from CIDP. CMT1 patients do not show the conduction block that is frequent in CIDP. In addition, ultrasonographic findings are useful because CMT1 suggests diffuse enlargement of peripheral nerves, whereas CIDP is characterized by asymmetrical or focal enlargement of peripheral nerves. Some CMT1 cases show favorable responses to immunomodulating therapeutics such as corticosteroids, IVIg, and plasma exchange. Such CIDP-like CMT1 (especially CMT1B or CMT2A) shows moderate to high levels of cerebrospinal fluid protein and infiltrated inflammatory macrophages. PMID:26764297

  5. Resetting translational homeostasis restores myelination in Charcot-Marie-Tooth disease type 1B mice.

    Science.gov (United States)

    D'Antonio, Maurizio; Musner, Nicolò; Scapin, Cristina; Ungaro, Daniela; Del Carro, Ubaldo; Ron, David; Feltri, M Laura; Wrabetz, Lawrence

    2013-04-01

    P0 glycoprotein is an abundant product of terminal differentiation in myelinating Schwann cells. The mutant P0S63del causes Charcot-Marie-Tooth 1B neuropathy in humans, and a very similar demyelinating neuropathy in transgenic mice. P0S63del is retained in the endoplasmic reticulum of Schwann cells, where it promotes unfolded protein stress and elicits an unfolded protein response (UPR) associated with translational attenuation. Ablation of Chop, a UPR mediator, from S63del mice completely rescues their motor deficit and reduces active demyelination by half. Here, we show that Gadd34 is a detrimental effector of CHOP that reactivates translation too aggressively in myelinating Schwann cells. Genetic or pharmacological limitation of Gadd34 function moderates translational reactivation, improves myelination in S63del nerves, and reduces accumulation of P0S63del in the ER. Resetting translational homeostasis may provide a therapeutic strategy in tissues impaired by misfolded proteins that are synthesized during terminal differentiation.

  6. Charcot-Marie-Tooth type 1A disease from patient to laboratory.

    Science.gov (United States)

    Perveen, Shazia; Mannan, Shazia; Hussain, Abrar; Kanwal, Sumaira

    2015-02-01

    Charcot-Marie-Tooth (CMT) disease is a well-known neural or spinal type of muscular atrophy. It is the most familiar disease within a group of conditions called Hereditary Motor and Sensory Neuropathies (HMSN). The disease was discovered by three scientists several years ago. Several genes are involved as the causative agents for the disease. Hundreds of causative mutations have been found and research work for the identification of a novel locus and for the treatment of CMT1A is going on. This review article was planned to gather information on CMT disease and updates on its treatment.National Center for Biotechnology Information (NCBI) and PubMed were searched for data retrieval. Molgen database, which is the exclusive site for CMT mutation, was the other source of articles. Different aspects of the CMT disease were compared.Advancements in the finding of the causative gene, discovery of the novel Loci are the current issues in this regard.CMT disease is incurable, but researchers are trying to get some benefits from different natural compounds and several therapeutic agents.Various groups are working on the treatment projects of CMT1A. Major step forward in CMT research was taken in 2004 when ascorbic acid was used for transgenic mice treatment. Gene therapy for constant neurotrophin-3 (NT- 3) delivery by secretion by muscle cells for the CMT1A is also one of the possible treatments under trial.

  7. Mutational studies in X-linked Charcot-Marie-Tooth disease (CMTX)

    Energy Technology Data Exchange (ETDEWEB)

    Cherryson, A.K.; Yeung, L.; Kennerson, M.L.; Nicholson, G.A. [Univ. of Syndey, Concord (Australia)

    1994-09-01

    Charcot-Marie-Tooth disease, also known as hereditary motor and sensory neuropathy (HMSN), is a heterogeneous group of slowly progressive disorders of the peripheral nerve. X-linked CMT (CMTX) is characterized by slow motor nerve conduction velocities in affected males and the presence of mildly affected or normal carrier females with intermediate or normal nerve conduction velocities. CMTX, which has an incidence of 3.1 per 100,000 and accounts for approximately 10% of CMT cases, has been mapped to Xq13. One of the genes lying in this region, connexin 32, has been found to contain alterations in individuals affected with X-linked CMT. We have identified our X-linked families from dominant type 1 CMT families using the clinical criteria given above. These families were screened for point mutations in connexin 32. We have identified three missense mutations, a G{r_arrow}A transition at amino acid 35 (valine to methionine), a C{r_arrow}G transition at amino acid 158 (proline to alanine) and a T{r_arrow}A transition at amino acid 182 (serine to threonine). Another family showed a 18 bp deletion, which removed the amino acid 111 to 116 inclusive (histidine, glycine, aspartic acid, proline, leucine, histidine).

  8. Myelin protein zero gene mutated in Charcot-Marie-Tooth type 1B patients

    Energy Technology Data Exchange (ETDEWEB)

    Su, Ying; Li, Lanying; Lepercq, J.; Lebo, R.V. (Univ. of California, San Francisco, CA (United States)); Brooks, D.G.; Ravetch, J.V. (Sloan-Kettering Institute, New York, NY (United States)); Trofatter, J.A. (Massachusetts General Hospital, Boston, MA (United States))

    1993-11-15

    The autosomal dominant of Charcot-Marie-Tooth disease (CMT), whose gene is type 1B (CMT1B), has slow nerve conduction with demyelinated Schwann cells. In this study the abundant peripheral myelin protein zero (MPZ) gene, MPZ, was mapped 130 kb centromeric to the Fc receptor immunoglobulin gene cluster in band 1q22, and a major MPZ point mutation was found to cosegregate with CMT1B in one large CMT1B family. The MPZ point mutation in 18 of 18 related CMT1B pedigree 1 patients converts a positively charged lysine in codon 96 to a negatively charged glutamate. The same MPZ locus cosegregates with the CMT1B disease gene in a second CMT1B family [total multipoint logarithm of odds (lod) = 11.4 at [theta] = 0.00] with a splice junction mutation. Both mutations occur in MPZ protein regions otherwise conserved identically in human, rat, and cow since these species diverged 100 million years ago. MPZ protein, expressed exclusively in myelinated peripheral nerve Schwann cells, constitutes >50% of myelin protein. These mutations are anticipated to disrupt homophilic MPZ binding and result in CMT1B peripheral nerve demyelination.

  9. Linkage localization of X-linked Charcot-Marie-Tooth disease

    Energy Technology Data Exchange (ETDEWEB)

    Bergoffen, J. (Children' s Hospital, Philadelphia, PA (United States) Univ. of Pennsylvania, Philadelphia (United States)); Trofatter, J.; Haines, J.L. (Massachusetts General Hospital, Boston (United States)); Pericak-Vance, M.A. (Duke Univ., Durham, NC (United States)); Chance, P.F. (Univ. of Utah, Salt Lake City (United States)); Fischbeck, K.H. (Univ. of Pennsylvania, Philadelphia (United States))

    1993-02-01

    Charcot-Marie-Tooth disease (CMT), also known as hereditary motor and sensory neuropathy, is a heterogeneous group of slowly progressive, degenerative disorders of peripheral nerve. X-linked CMT (CMTX) (McKusick 302800), a subdivision of type I, or demyelinating, CMT is an X-linked dominant condition with variable penetrance. Previous linkage analysis using RFLPs demonstrated linkage to markers on the proximal long and short arms of the X chromosome, with the more likely localization on the proximal long arm of the X chromosome. Available variable simple-sequence repeats (VSSRs) broaden the possibilities for linkage analysis. This paper presents new linkage data and recombination analysis derived from work with four VSSR markers - AR, PGKP1, DXS453, and DXYS1X - in addition to analysis using RFLP markers described elsewhere. These studies localize the CMTX gene to the proximal Xq segment between PGKP1 (Xq11.2-12) and DXS72 (Xq21.1), with a combined maximum multipoint lod score of 15.3 at DXS453 ([theta] = 0). 32 refs., 3 figs., 2 tabs.

  10. Clinical and genetic spectra in a series of Chinese patients with Charcot-Marie-Tooth disease.

    Science.gov (United States)

    Wang, Rui; He, Jin; Li, Jin-Jing; Ni, Wang; Wu, Zhi-Ying; Chen, Wan-Jin; Wang, Yi

    2015-12-01

    The aim of this study was to determine the clinical features and frequencies of genetic subtypes in a series of patients with Charcot-Marie-Tooth (CMT) disease from Eastern China. Patients were divided into three subtypes, CMT1, CMT2 and hereditary neuropathy with liability to pressure palsy (HNPP), according to their electrophysiological manifestations. Multiplex ligation-dependent probe analysis (MLPA) was performed to detect duplications/deletions in the PMP22 gene. The coding regions and splice sites of the GJB1, MPZ, MFN2 and GDAP-1 genes were determined by direct sequencing. Among the 148 patients in the study, 37.2% of the cases had mutations in genes assessed. The mutation detection rate was higher in patients with family histories than in spontaneous cases. PMP22 duplication (13.5%) was predominant in this group of patients, followed by PMP22 deletion (11.5%), and point mutations in GJB1 (8.8%), MPZ (2.0%) and MFN2 (0.7%). Three novel mutations (c.151T>C and c.310 A>G in GJB1 and c.1516 C>G in MFN2) were detected. A small deletion in PMP22 exon 4 was detected in a patient with severe CMT1. Genetic tests have great value in CMT patients with family histories. The frequency of PMP22 duplications was lower in Asian patients than in others. We suggest that genetic testing strategies in CMT patients should be primarily based on electromyography data.

  11. Exacerbation of Charcot-Marie-Tooth type 2E neuropathy following traumatic nerve injury.

    Science.gov (United States)

    Villalón, Eric; Dale, Jeffrey M; Jones, Maria; Shen, Hailian; Garcia, Michael L

    2015-11-19

    Charcot-Marie-Tooth disease (CMT) is the most commonly inherited peripheral neuropathy. CMT disease signs include distal limb neuropathy, abnormal gait, sensory defects, and deafness. We generated a novel line of CMT2E mice expressing hNF-L(E397K), which displayed muscle atrophy of the lower limbs without denervation, proximal reduction in large caliber axons, and decreased nerve conduction velocity. In this study, we challenged wild type, hNF-L and hNF-L(E397K) mice with crush injury to the sciatic nerve. We analyzed functional recovery by measuring toe spread and analyzed gait using the Catwalk system. hNF-L(E397K) mice demonstrated reduced recovery from nerve injury consistent with increased susceptibility to neuropathy observed in CMT patients. In addition, hNF-L(E397K) developed a permanent reduction in their ability to weight bear, increased mechanical allodynia, and premature gait shift in the injured limb, which led to increasingly disrupted interlimb coordination in hNF-L(E397K). Exacerbation of neuropathy after injury and identification of gait alterations in combination with previously described pathology suggests that hNF-L(E397K) mice recapitulate many of clinical signs associated with CMT2. Therefore, hNF-L(E397K) mice provide a model for determining the efficacy of novel therapies.

  12. Mutation in PNKP presenting initially as axonal Charcot-Marie-Tooth disease.

    Science.gov (United States)

    Pedroso, José Luiz; Rocha, Clarissa R R; Macedo-Souza, Lucia I; De Mario, Vitor; Marques, Wilson; Barsottini, Orlando G P; Bulle Oliveira, Acary S; Menck, Carlos F M; Kok, Fernando

    2015-12-01

    PNKP (polynucleotide kinase 3'-phosphatase, OMIM #605610) product is involved in the repair of strand breaks and base damage in the DNA molecule mainly caused by radical oxygen species. Deleterious variants affecting this gene have been previously associated with microcephaly, epilepsy, and developmental delay.(1) According to a previous report, homozygous loss-of-function substitution in PNKP was associated with cerebellar atrophy, neuropathy, microcephaly, epilepsy, and intellectual disability.(2) Recently, whole-exome sequencing (WES) performed in a cohort of Portuguese families with ataxia with oculomotor apraxia (AOA) disclosed pathogenic variants in PNKP in 11 individuals. Other clinical features in that study included neuropathy, dystonia, cognitive impairment, decreased vibration sense, pyramidal signs, mild elevation in α-fetoprotein, and low levels of albumin. This condition was named AOA type 4 (OMIM #616267), as the phenotype of AOA has been previously associated with 3 other genes: APTX, SETX, and PIK3R5.(3) Altogether, these reports demonstrate the great phenotypic diversity associated with PNKP mutations. In this article, we further enlarge this variability by demonstrating that early-onset axonal sensory-motor neuropathy (or axonal Charcot-Marie-Tooth (CMT) disease) followed years later by ataxia without oculomotor apraxia can be caused by deleterious variants in PNKP. Full consent was obtained from the patient and his parents for this publication. This study was approved by institutional ethics committees. PMID:27066567

  13. Vestibular impairment in Charcot-Marie-Tooth disease type 4C.

    Science.gov (United States)

    Pérez-Garrigues, Herminio; Sivera, Rafael; Vílchez, Juan Jesús; Espinós, Carmen; Palau, Francesc; Sevilla, Teresa

    2014-07-01

    Charcot-Marie-Tooth disease type 4C (CMT4C) is a hereditary neuropathy with prominent unsteadiness. The objective of the current study is to determine whether the imbalance in CMT4C is caused only by reduced proprioceptive input or if vestibular nerve involvement is an additional factor. We selected 10 CMT4C patients and 10 age-matched and sex-matched controls. We performed a comprehensive evaluation of the vestibular system, including video Head Impulse Test, bithermal caloric test, galvanic stimulation test and skull vibration-induced nystagmus test. None of the patients experienced dizziness, spontaneous or gaze-evoked nystagmus, but all had significant vestibular impairment when tested when compared to controls. Seven had completely unexcitable vestibular systems and abnormal vestibuloocular reflex. There was no correlation between the degree of vestibulopathy and age or clinical severity. Significant vestibular impairment is a consistent finding in CMT4C and is present early in disease evolution. The profound imbalance that is so disabling in these patients may result from a combination of proprioceptive loss and vestibular neuropathy, and this would modify the recommended rehabilitation strategies. PMID:24614092

  14. Behavioural profiling of a murine Charcot-Marie-Tooth disease type 1A model.

    Science.gov (United States)

    Norreel, J C; Jamon, M; Riviere, G; Passage, E; Fontes, M; Clarac, F

    2001-04-01

    Different features of motor behaviour were studied on a transgenic mouse model of Charcot-Marie-Tooth's disease (CMT). Mutants with 4 or 7 copies of the human PMP22 gene leading to a phenotype significantly close to CMT's disease type 1A were compared with control animals. The aim of the study was to validate this transgenic model and to characterise the impairments occurring in the various lines. Three main types of analysis were performed in 2-month-old mice without any peculiar visible deficit: (i) a study of standardised clinical tests (SHIRPA protocol) demonstrated that only a few motor deficits were expressed; (ii) a measurement of general spontaneous activity by means of a commercial video-tracking system was performed and revealed that the main spontaneous activities were identical in the three lines with, however, some slight localised modifications; and, (iii) by contrast, the three lines respond very differently to the footprints, grip strength, splay test and rotarod test. Even in lines with a significantly limited copy number of the transgene, we observed and quantified impairments. In conclusion, mutants of CMT1A seem to be a very pertinent model of this human pathology and will certainly be useful for therapeutic procedures and for theoretical studies on this disease. PMID:11328356

  15. Oral Health, Temporomandibular Disorder, and Masticatory Performance in Patients with Charcot-Marie-Tooth Type 2

    Directory of Open Access Journals (Sweden)

    Rejane L. S. Rezende

    2013-01-01

    Full Text Available Background. The aim of this study was to evaluate the oral health status of temporomandibular disorders (TMD and bruxism, as well as to measure masticatory performance of subjects with Charcot-Marie-Tooth type 2 (CMT2. Methods and Results. The average number of decayed, missing, and filled teeth (DMFT for both groups, control (CG and CMT2, was considered low (CG = 2.46; CMT2 = 1.85, P=0.227. The OHIP-14 score was considered low (CG = 2.86, CMT2 = 5.83, P=0.899. The prevalence of self-reported TMD was 33.3% and 38.9% (P=0.718 in CG and CMT2 respectively and for self-reported bruxism was 4.8% (CG and 22.2% (CMT2, without significant difference between groups (P=0.162. The most common clinical sign of TMD was masseter (CG = 38.1%; CMT2 = 66.7% and temporalis (CG = 19.0%; GCMT2 = 33.3% muscle pain. The geometric mean diameter (GMD was not significantly different between groups (CG = 4369; CMT2 = 4627, P=0.157. Conclusion. We conclude that the CMT2 disease did not negatively have influence either on oral health status in the presence and severity of TMD and bruxism or on masticatory performance.

  16. Charcot-Marie-Tooth Disease and Related Hereditary Neuropathies: From Gene Function to Associated Phenotypes.

    Science.gov (United States)

    Pareyson, D; Saveri, P; Piscosquito, G

    2014-10-10

    Charcot-Marie-Tooth disease (CMT) and related neuropathies are a genetically highly heterogeneous group of neurodegenerative disorders. CMT affects both the sensory and motor nerves, distal Hereditary Motor Neuropathies (dHMN) are phenotypically similar disorders involving only motor nerves, while Hereditary Sensory and Autonomic Neuropathies (HSAN) are rare distinct disorders affecting sensory and sometimes autonomic nerves. Almost 70 genes have been identified as responsible for these disorders. It is astonishing to learn how diverse are the cellular sublocalisation and the functional roles of the encoded proteins of CMT-associated genes which all lead to similar disorders of the peripheral nervous system. Myelin formation and maintenance, mitochondrial dynamics, cytoskeleton organization, axonal transport, and vesicular trafficking are the most frequently involved pathways. However, dysfunction of several activities from the nucleus to the neuromuscular junction forms the basis for these hereditary neuropathies, making it challenging predicting the functions of newly identified mutated genes. In this review we will discuss the function and related phenotypes of all the genes thus far associated with CMT, dHMN, and HSAN.

  17. Hereditary motor and sensory neuropathies or Charcot-Marie-Tooth diseases: an update.

    Science.gov (United States)

    Tazir, Meriem; Hamadouche, Tarik; Nouioua, Sonia; Mathis, Stephane; Vallat, Jean-Michel

    2014-12-15

    Hereditary motor and sensory neuropathies (HMSN) or Charcot-Marie-Tooth (CMT) diseases are the most common degenerative disorders of the peripheral nervous system. However, the frequency of the different subtypes varies within distinct populations. Although more than seventy clinical and genetic forms are known to date, more than 80% of CMT patients in Western countries have genetic abnormalities associated with PMP22, MPZ, MFN2 and GJB1. Given the considerable genetic heterogeneity of CMT, we emphasize the interest of both clinical and pathological specific features such that focused genetic testing could be performed. In this regard, peripheral nerve lesions in GDAP1 mutations (AR CMT1A), such as mitochondrial abnormalities, have been newly demonstrated. Otherwise, while demyelinating autosomal recessive CMT used to be classified as CMT4 (A, B, C …), we propose a simplified classification such as AR CMT1 (A, B, C …), and AR CMT2 for axonal forms. Also, we stress that next generation sequencing techniques, now considered to be the most efficient methods of genetic testing in CMT, will be helpful in molecular diagnosis and research of new genes involved. Finally, while no effective therapy is known to date, ongoing new therapeutic trials such as PXT3003 (a low dose combination of the three already approved drugs baclofen, naltrexone, and D-sorbitol) give hopes for potential curative treatment.

  18. X inactivation in females with X-linked Charcot-Marie-Tooth disease.

    LENUS (Irish Health Repository)

    Murphy, Sinéad M

    2012-07-01

    X-linked Charcot-Marie-Tooth disease (CMT1X) is the second most common inherited neuropathy, caused by mutations in gap junction beta-1 (GJB1). Males have a uniformly moderately severe phenotype while females have a variable phenotype, suggested to be due to X inactivation. We aimed to assess X inactivation pattern in females with CMT1X and correlate this with phenotype using the CMT examination score to determine whether the X inactivation pattern accounted for the variable phenotype in females with CMT1X. We determined X inactivation pattern in 67 females with CMT1X and 24 controls using the androgen receptor assay. We were able to determine which X chromosome carried the GJB1 mutation in 30 females. There was no difference in X inactivation pattern between patients and controls. In addition, there was no correlation between X inactivation pattern in blood and phenotype. A possible explanation for these findings is that the X inactivation pattern in Schwann cells rather than in blood may explain the variable phenotype in females with CMT1X.

  19. Obese older adults suffer foot pain and foot-related functional limitation.

    Science.gov (United States)

    Mickle, Karen J; Steele, Julie R

    2015-10-01

    There is evidence to suggest being overweight or obese places adults at greater risk of developing foot complications such as osteoarthritis, tendonitis and plantar fasciitis. However, no research has comprehensively examined the effects of overweight or obesity on the feet of individuals older than 60 years of age. Therefore we investigated whether foot pain, foot structure, and/or foot function is affected by obesity in older adults. Three hundred and twelve Australian men and women, aged over 60 years, completed validated questionnaires to establish the presence of foot pain and health related quality of life. Foot structure (anthropometrics and soft tissue thickness) and foot function (ankle dorsiflexion strength and flexibility, toe flexor strength, plantar pressures and spatiotemporal gait parameters) were also measured. Obese participants (BMI >30) were compared to those who were overweight (BMI=25-30) and not overweight (BMI <25). Obese participants were found to have a significantly higher prevalence of foot pain and scored significantly lower on the SF-36. Obesity was also associated with foot-related functional limitation whereby ankle dorsiflexion strength, hallux and lesser toe strength, stride/step length and walking speed were significantly reduced in obese participants compared to their leaner counterparts. Therefore, disabling foot pain and altered foot structure and foot function are consequences of obesity for older adults, and impact upon their quality of life. Interventions designed to reduce excess fat mass may relieve loading of the foot structures and, in turn, improve foot pain and quality of life for older obese individuals. PMID:26260010

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2013-03-05

    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.

  1. Charcot-Marie-Tooth disease and dilated cardiomyopathy. A rare combination. Enfermedad de Charcot-Marie-Tooth y miocardiopatía dilatada. Una rara asociación.

    Directory of Open Access Journals (Sweden)

    Rafael Pila Pérez

    2011-07-01

    Full Text Available

    Se presenta el caso de un paciente de 50 años de edad, con 14 años de evolución de manifestaciones clínicas, destacándose las alteraciones musculoesqueléticas de los cuatro miembros con atrofia de las prominencias tenar e hipotenar y de la musculatura de ambas piernas. Se destacó la presencia de alteraciones sensitivas en miembros inferiores con distribución en calcetín, atrofia, atonía, arreflexia y marcha equina. Desde el punto de vista cardiaco, el paciente presentaba un fibriloaleteo. La radiografía de tórax mostró un aumento marcado del área cardiaca y la ecocardiografía puso de manifiesto una miocardiopatía dilatada. El estudio histopatológico confirmó la presencia de la enfermedad de Charcot-Marie-Tooth asociada a miocardiopatía dilatada. El diagnóstico se basó en las características clínicas, la velocidad de conducción motora, y el estudio histopatológico, que demostró desmielinización con lesiones en “cebolla”, si bien faltaron los estudios genéticos. La enfermedad de Charcot-Marie-Tooth es una enfermedad rara; aproximadamente un 60 % de los pacientes que la padecen, son portadores de una duplicación del cromosoma 17. Por ello, se consideró oportuno transmitir la experiencia de este caso.

    The case of a 50 years old male patient is presented. Along 14 years of clinical evolution, four limbs musculoskeletal disorders with atrophy of the thenar and hypothenar prominences and muscles of both legs had been emphasized. The presence of sensory impairment in lower limbs with stocking distribution, atrophy, weakness, areflexia and equine gait were very peculiar in this case. From the cardiac point of view, the patient presented a fibrillation/flutter. Chest radiography showed a marked increase in the cardiac area and echocardiography revealed dilated cardiomyopathy. Histopathological examination confirmed the presence of Charcot-Marie-Tooth disease associated with dilated cardiomyopathy. While genetic

  2. Charcot-Marie-Tooth病1X型的临床与分子遗传学研究进展%Advance in Clinical and Molecular Genetics Study of Charcot-Marie-Tooth Disease 1X Type (review)

    Institute of Scientific and Technical Information of China (English)

    乔晓会; 李越星

    2009-01-01

    Charcot-Marie-Tooth病(CMT)中,1X型发病率居于第2位,它由GJB1基因突变致Connexin32蛋白结构或功能异常,引起细胞间通道缺陷导致发病.文章综述了CMT1X的典型临床特征和分子遗传学进展,总结了CMT发病机制的研究.

  3. Radio Reconstructions

    OpenAIRE

    Bulley, James; Jones, Daniel

    2013-01-01

    Radio Reconstructions is a sound installation which use indeterminate radio broadcasts as its raw material. Each piece is structured by a notated score, which controls its rhythm, dynamics and melodic contour over time. The audio elements used to enact this score are selected in real-time from unknown radio transmissions, by an autonomous software system which is continuously scanning the radio waves in search of similar fragments of audio. Using a technique known as audio mosaicing, hund...

  4. Copy number variations are a rare cause of non-CMT1A Charcot-Marie-Tooth disease

    OpenAIRE

    Huang, Jia; Wu, Xingyao; Montenegro, Gladys; Price, Justin; Wang, GaoFeng; Vance, Jeffery M.; Shy, Michael E.; Züchner, Stephan

    2009-01-01

    Hereditary peripheral neuropathies present a group of clinically and genetically heterogeneous entities. All known forms, including the various forms of Charcot-Marie-Tooth disease (CMT) are characterized as Mendelian traits and over 35 genes have been identified thus far. The mutational mechanism of the most common CMT type, CMT1A, is a 1.5 Mb chromosomal duplication at 17p12 that contains the gene PMP22. Only recently it has been realized that such copy number variants (CNV) are a widesprea...

  5. Genética de la enfermedad de Charcot-Marie-Tooth autosómica recesiva

    OpenAIRE

    Claramunt Alonso, Reyes

    2008-01-01

    RESUMEN El objetivo de esta tesis doctoral es profundizar en el conocimiento de las bases genéticas y moleculares de la enfermedad de Charcot-Marie-Tooth, especialmente de las formas con herencia autosómica recesiva. En este sentido, se incluyen los resultados obtenidos del análisis genético y molecular del gen GDAP1 en una serie de 118 familias de origen español, cuyas mutaciones son las causantes de la forma autosómica recesiva axonal tipo 4A (CMT4A), así como también, el estudio genétic...

  6. Diabetic foot ulcer: assessment and management.

    Science.gov (United States)

    Saraogi, Ravi Kant

    2008-02-01

    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.

  7. Foot kinematics and kinetics during adolescent gait.

    Science.gov (United States)

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

    2003-06-01

    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.

  8. Foot Plantar Pressure Measurement System: A Review

    Directory of Open Access Journals (Sweden)

    Yufridin Wahab

    2012-07-01

    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.

  9. Foot Deformities in Patients with Cerebral Palsy

    OpenAIRE

    E Ameri; A. Yeganeh

    2007-01-01

    Introduction & Objective: In patients with cerebral palsy (CP) the most common presentation is lower extremity deformity specially foot deformity. Inability to ambulation is the one of the most important disabilities, that dependent to the variety of factors such as severity of disease, kind of CP, etc. This study was aimed to assess prevalence of kinds of foot deformity in CP and communication between kind of CP and foot deformity and another hand inability to ambulation.Materials & Methods...

  10. Hyperspectral Imaging in Diabetic Foot Wound Care

    OpenAIRE

    Yudovsky, Dmitry; Nouvong, Aksone; Pilon, Laurent

    2010-01-01

    Diabetic foot ulceration is a major complication of diabetes and afflicts as many as 15 to 25% of type 1 and 2 diabetes patients during their lifetime. If untreated, diabetic foot ulcers may become infected and require total or partial amputation of the affected limb. Early identification of tissue at risk of ulcerating could enable proper preventive care, thereby reducing the incidence of foot ulceration. Furthermore, noninvasive assessment of tissue viability around already formed ulcers co...

  11. Afghanistan Reconstruction

    Institute of Scientific and Technical Information of China (English)

    Fu Xiaoqiang

    2006-01-01

    @@ The Karzai regime has made some progress over the past four years and a half in the post-war reconstruction.However, Taliban's destruction and drug economy are still having serious impacts on the security and stability of Afghanistan.Hence the settlement of the two problems has become a crux of affecting the country' s future.Moreover, the Karzai regime is yet to handle a series of hot potatoes in the fields of central government' s authority, military and police building-up and foreign relations as well.

  12. Innovative quantitative testing of hand function in Charcot-Marie-Tooth neuropathy.

    Science.gov (United States)

    Alberti, Maria A; Mori, Laura; Francini, Luca; Poggi, Ilaria; Monti Bragadin, Margherita; Bellone, Emilia; Grandis, Marina; Maggi, Giovanni; Reni, Lizia; Sormani, Maria P; Tacchino, Andrea; Padua, Luca; Prada, Valeria; Bove, Marco; Schenone, Angelo

    2015-12-01

    To describe a new test to quantitatively evaluate hand function in patients affected by Charcot-Marie-Tooth neuropathy (CMT). The sensor-engineered glove test (SEGT) was applied to CMT patients (N: 26) and compared with a cohort of healthy controls (HC, N: 26). CMT patients were further divided into subjects with clinically normal (group 1) or impaired hand (group 2) function. The SEGT parameters evaluated were touch duration, inter-tapping interval, and movement rate parameters of two different sequences: finger tapping (FT) and index-medium-ring-little (IMRL) performed at self-paced mode (SPM) and maximum velocity (MV). Hand function and strength were assessed by the 9-hole peg test (9HPT) and dynamometry. Disability of patients was measured by the CMT neuropathy score. CMT patients had significantly worst performances at SEGT than controls regarding the rate of execution of both FT (at MV) and IMRL sequences (at SPM and MV). The rate parameter at MV in IMRL sequence showed a significant trend of decreasing in its average between HC (n: 26, rate = 3.08 ± 0.52 Hz), group 1 (n: 9, rate = 2.64 ± 0.66 Hz) and group 2 (n: 17, rate = 2.19 ± 0.45 Hz) (p for trend CMT neuropathy score. The SEGT test is sensitive to show hand dysfunction in CMT patients, with and without clinically impaired hands. PMID:26456943

  13. Myelin protein zero gene sequencing diagnoses Charcot-Marie-Tooth Type 1B disease

    Energy Technology Data Exchange (ETDEWEB)

    Su, Y.; Zhang, H.; Madrid, R. [Univ. of California, San Francisco, CA (United States)] [and others

    1994-09-01

    Charcot-Marie-Tooth disease (CMT), the most common genetic neuropathy, affects about 1 in 2600 people in Norway and is found worldwide. CMT Type 1 (CMT1) has slow nerve conduction with demyelinated Schwann cells. Autosomal dominant CMT Type 1B (CMT1B) results from mutations in the myelin protein zero gene which directs the synthesis of more than half of all Schwann cell protein. This gene was mapped to the chromosome 1q22-1q23.1 borderline by fluorescence in situ hybridization. The first 7 of 7 reported CMT1B mutations are unique. Thus the most effective means to identify CMT1B mutations in at-risk family members and fetuses is to sequence the entire coding sequence in dominant or sporadic CMT patients without the CMT1A duplication. Of the 19 primers used in 16 pars to uniquely amplify the entire MPZ coding sequence, 6 primer pairs were used to amplify and sequence the 6 exons. The DyeDeoxy Terminator cycle sequencing method used with four different color fluorescent lables was superior to manual sequencing because it sequences more bases unambiguously from extracted genomic DNA samples within 24 hours. This protocol was used to test 28 CMT and Dejerine-Sottas patients without CMT1A gene duplication. Sequencing MPZ gene-specific amplified fragments identified 9 polymorphic sites within the 6 exons that encode the 248 amino acid MPZ protein. The large number of major CMT1B mutations identified by single strand sequencing are being verified by reverse strand sequencing and when possible, by restriction enzyme analysis. This protocol can be used to distringuish CMT1B patients from othre CMT phenotypes and to determine the CMT1B status of relatives both presymptomatically and prenatally.

  14. Junctophilin-1 is a modifier gene of GDAP1-related Charcot-Marie-Tooth disease.

    Science.gov (United States)

    Pla-Martín, David; Calpena, Eduardo; Lupo, Vincenzo; Márquez, Celedonio; Rivas, Eloy; Sivera, Rafael; Sevilla, Teresa; Palau, Francesc; Espinós, Carmen

    2015-01-01

    Mutations in the GDAP1 gene cause different forms of Charcot-Marie-Tooth (CMT) disease, and the primary clinical expression of this disease is markedly variable in the dominant inheritance form (CMT type 2K; CMT2K), in which carriers of the GDAP1 p.R120W mutation can display a wide range of clinical severity. We investigated the JPH1 gene as a genetic modifier of clinical expression variability because junctophilin-1 (JPH1) is a good positional and functional candidate. We demonstrated that the JPH1-GDAP1 cluster forms a paralogon and is conserved in vertebrates. Moreover, both proteins play a role in Ca(2+) homeostasis, and we demonstrated that JPH1 is able to restore the store-operated Ca(2+) entry (SOCE) activity in GDAP1-silenced cells. After the mutational screening of JPH1 in a series of 24 CMT2K subjects who harbour the GDAP1 p.R120W mutation, we characterized the JPH1 p.R213P mutation in one patient with a more severe clinical picture. JPH1(p.R213P) cannot rescue the SOCE response in GDAP1-silenced cells. We observed that JPH1 colocalizes with STIM1, which is the activator of SOCE, in endoplasmic reticulum-plasma membrane puncta structures during Ca(2+) release in a GDAP1-dependent manner. However, when GDAP1(p.R120W) is expressed, JPH1 seems to be retained in mitochondria. We also established that the combination of GDAP1(p.R120W) and JPH1(p.R213P) dramatically reduces SOCE activity, mimicking the effect observed in GDAP1 knock-down cells. In summary, we conclude that JPH1 and GDAP1 share a common pathway and depend on each other; therefore, JPH1 can contribute to the phenotypical consequences of GDAP1 mutations.

  15. Priorities in offloading the diabetic foot.

    Science.gov (United States)

    Bus, Sicco A

    2012-02-01

    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.

  16. Duration of off-loading and recurrence rate in Charcot osteo-arthropathy treated with less restrictive regimen with removable walker

    DEFF Research Database (Denmark)

    Christensen, Tomas M; Gade-Rasmussen, Birthe; Pedersen, Lis W;

    2013-01-01

    Recent literature on acute diabetic Charcot osteoarthropathy (CA) reports unusually long periods of off-loading. Data suggest that this might increase the re-currence rate. Subsequently we evaluated the influence of duration of off-loading on the risk of required re-casting....

  17. Rapid genetic screening of Charcot-Marie-Tooth disease type 1A and hereditary neuropathy with liability to pressure palsies patients

    Institute of Scientific and Technical Information of China (English)

    Xiaobo Li; Kun Xia; Beisha Tang; Ruxu Zhang; Xiaohong Zi; Lin Li; Yajing Zhan; Shunxiang Huang; Jin Li; Xuning Li; Xigui Li; Zhengmao Hu

    2012-01-01

    We used the allele-specific PCR-double digestion method on peripheral myelin protein 22 (PMP22) to determine duplication and deletion mutations in the proband and family members of one family with Charcot-Marie-Tooth disease type 1 and one family with hereditary neuropathy with liability to pressure palsies. The proband and one subclinical family member from the Charcot-Marie-Tooth disease type 1 family had a PMP22 gene duplication; one patient from the hereditary neuropathy with liability to pressure palsies family had a PMP22 gene deletion. Electron microscopic analysis of ultrathin sections of the superficial peroneal nerve from the two probands demonstrated demyelination and myelin sheath hyperplasia, as well as an ‘onion-like’ structure in the Charcot-Marie-Tooth disease type 1A patient. We observed an irregular thickened myelin sheath and ‘mouse-nibbled’-like changes in the patient with hereditary neuropathy with liability to pressure palsies. In the Charcot-Marie-Tooth disease type 1A patient, nerve electrophysiological examination revealed moderate-to-severe reductions in the motor and sensory conduction velocities of the bilateral median nerve, ulnar nerve, tibial nerve, and sural nerve. Moreover, the compound muscle action potential amplitude was decreased. In the patient with hereditary neuropathy with liability to pressure palsies, the nerve conduction velocity of the bilateral tibial nerve and sural nerve was moderately reduced, and the nerve conduction velocity of the median nerve and ulnar nerve of both upper extremities was slightly reduced.

  18. The diabetic foot: a review.

    Science.gov (United States)

    Ricco, J B; Thanh Phong, L; Schneider, F; Illuminati, G; Belmonte, R; Valagier, A; Régnault De La Mothe, G

    2013-12-01

    Diabetic foot ulceration (DFU) is among the most frequent complications of diabetes. Neuropathy and ischaemia are the initiating factors and infection is mostly a consequence. We have shown in this review that any DFU should be considered to have vascular impairment. DFU will generally heal if the toe pressure is >55 mmHg and a transcutaneous oxygen pressure (TcPO2) <30 mmHg has been considered to predict that a diabetic ulcer may not heal. The decision to intervene is complex and made according to the symptoms and clinical findings. If both an endovascular and a bypass procedure are possible with an equal outcome to be expected, endovascular treatments should be preferred. Primary and secondary mid-term patency rates are better after bypass, but there is no difference in limb salvage. Bedridden patients with poor life expectancy and a non-revascularisable leg are indications for performing a major amputation. A deep infection is the immediate cause of amputation in 25% to 50% of diabetic patients. Patients with uncontrolled abscess, bone or joint involvement, gangrene, or necrotising fasciitis have a "foot-at risk" and need prompt surgical intervention with debridement and revascularisation. As demonstrated in this review, foot ulcer in diabetic is associated with high mortality and morbidity. Early referral, non-invasive vascular testing, imaging and intervention are crucial to improve DFU healing and to prevent amputation. Diabetics are eight to twenty-four times more likely than non-diabetics to have a lower limb amputation and it has been suggested that a large part of those amputations could be avoided by an early diagnosis and a multidisciplinary approach. PMID:24126512

  19. Tracheal reconstructions.

    Science.gov (United States)

    Srikrishna, S V; Shekar, P S; Shetty, N

    1998-12-01

    Surgical reconstruction of the trachea is a relatively complex procedure. We had 20 cases of tracheal stenosis. We have a modest experience of 16 tracheal reconstructions for acquired tracheal stenosis. Two patients underwent laser treatment while another two died before any intervention. The majority of these cases were a result of prolonged ventilation (14 cases), following organophosphorous poisoning (11 cases), Guillain-Barré syndrome, bullet injury, fat embolism and surprisingly only one tumor, a case of mucoepidermoid carcinoma, who had a very unusual presentation. There were 12 males and 4 females in this series, age ranging from 12-35 years. The duration of ventilation ranged from 1-21 days and the interval from decannulation to development of stridor was between 5-34 days. Six of them were approached by the cervical route, 5 by thoracotomy and cervical approach, 2 via median sternotomy and 3 by thoracotomy alone. Five of them required an additional laryngeal drop and 1 required pericardiotomy and release of pulmonary veins to gain additional length. The excised segments of trachea measured 3 to 5 cms in length. All were end to end anastomosis with interrupted Vicryl sutures. We have had no experience with stents or prosthetic tubes. Three patients developed anastomotic leaks which were controlled conservatively. Almost all of them required postoperative tracheo-bronchial suctioning with fibreoptic bronchoscope. We had one death in this series due to sepsis. PMID:9914459

  20. Site-directed mutagenesis of the foot-and-mouth disease virus RNA-polymerase gene

    International Nuclear Information System (INIS)

    The foot-and-mouth disease virus RNA-polymerase gene was mutagenised in its active site. Pst I digestion of the polymerase gene (cDNA) generated a 790 bp fragment containing the critical sequence. This fragment was subcloned in M13mp8 for mutagenesis method. The polymerase gene was then reconstructed and subcloned in pUC19. These mutants will be used to study the enzyme structure and activity and to develop intracellular immunization assays in eukaryotic cells. (author)

  1. A review of becaplermin gel in the treatment of diabetic neuropathic foot ulcers

    Directory of Open Access Journals (Sweden)

    Robert C Fang

    2008-03-01

    Full Text Available Robert C Fang, Robert D GalianoDivision of Plastic and Reconstructive Surgery and Wound Healing Research Laboratory, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USAAbstract: Diabetic neuropathic foot ulcers represent a serious health care burden to patients and to society. While the management of chronic diabetic foot ulcers has improved in recent years, it remains a frustrating problem for a variety of clinicians. This review examines the scientific underpinnings supporting the use of becaplermin (Regranex®; Ortho-McNeil Pharmaceutical, Raritan, NJ, or recombinant human platelet-derived growth factor (rhPDGF-BB, in diabetic forefoot wounds. An emphasis is placed upon proper medical and surgical care of diabetic foot wounds, as multiple studies have demonstrated that the success of this growth factor in accelerating healing is ultimately dependent on proper ulcer care. A focus on the cost-effectiveness of this form of therapy in the treatment of diabetic foot ulcers is also outlined.Keywords: becaplermin, diabetes, foot ulcer, growth factor

  2. On Sound Footing: The Health of Your Feet

    Science.gov (United States)

    ... link, please review our exit disclaimer . Subscribe On Sound Footing The Health of Your Feet Your feet ... search Features A Bang to the Brain On Sound Footing Wise Choices Links Foot Health Tips Use ...

  3. Classification of diabetic foot ulcers.

    Science.gov (United States)

    Game, Frances

    2016-01-01

    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.

  4. Functional reconstruction of ischemic contracture in the

    Directory of Open Access Journals (Sweden)

    TANG Hao

    2011-04-01

    Full Text Available 【Abstract】Objective: To discuss the method of functional reconstruction of ischemic contracture in the lower limb and propose a classification protocol for ischemic contracture in the lower limb based on its severity and prognosis. Methods: A total of 42 patients with ischemic contracture in the lower limb were included in this study. According to different types of disturbance and degrees of severity, surgical reconstructions consisting of nerve decompression, tendon lengthening or transfer, intrinsic foot muscle release and sural-tibial nerve anastomosis were performed in every patient. Results: Postoperatively, all patients were able to walk on flat ground. Drop foot was corrected in 10 patients, and 5 patients still felt some difficulty during stair activity. Split Achilles tendon transfer to flexor hallucis longus tendon was performed in 12 patients, and their walking stability was improved. Seven patients accepted ipsilateral suraltibial nerve anastomosis, and sensitivity recovery reached to S2 in 2 patients and S3 in 5 patients. Conclusions: Ischemic contracture in the lower limb is a devastating complication after lower limb trauma. The prevention of contracture is much more important than the treatment of an established contracture. Split Achilles tendon transfer to flexor hallucis longus tendon and sural-tibial nerve anastomosis, which was initially implemented by us, could improve the functional recovery of ischemic contracture in lower limbs, and thus provides a new alternative for functional reconstruction of ischemic contracture in the lower limb. Key words: Ischemic contracture; Classification; Recovery of function

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

    Science.gov (United States)

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

    2015-01-01

    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. PMID:26703622

  6. Temperature, salinity, nutrients, oxygen, chlorophyll and other measurements found in dataset SISMER taken from the VAUBAN, JEAN CHARCOT (FNOY) and other platforms in the South Pacific, Coastal North Atlantic and other locations from 1983 to 2007 (NODC Accession 0046621)

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Temperature, salinity, nutrients, oxygen, chlorophyll and other measurements found in CTD and OSD datasets taken from the VAUBAN, JEAN CHARCOT (FNOY) and other...

  7. [The "diabetic foot" syndrome. An overview].

    Science.gov (United States)

    Chantelau, E

    1999-01-01

    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.

  8. Chronic lateral instability of the foot

    NARCIS (Netherlands)

    J.W.K. Louwerens

    1996-01-01

    textabstractInjmy to the ligaments on the lateral side of the ankle and foot, caused by a sudden excessive inversion andlor torsion of the foot in relation to the leg, is probably the most common everyday injury of the locomotory system. Most of these injuries are sustained during sport, but with in

  9. Cosmetic Foot Surgery: Fashion's Pandora's Box

    Science.gov (United States)

    ... Fashion’s Pandora’s Box? A A A | Print | Share Cosmetic Foot Surgery: Fashion’s Pandora’s Box? Foot and ankle ... extreme and imprudent as it may sound, the cosmetic surgery craze isn't just for faces anymore- ...

  10. A comparison of haemolytic responses in fore-foot and rear-foot distance runners.

    Science.gov (United States)

    Caulfield, Stuart; McDonald, Kirsty A; Dawson, Brian; Stearne, Sarah M; Green, Ben A; Rubenson, Jonas; Clemons, Tristan D; Peeling, Peter

    2016-08-01

    This study examined the haemolytic effects of an interval-based running task in fore-foot and rear-foot striking runners. Nineteen male distance runners (10 fore-foot, 9 rear-foot) completed 8 × 3 min repeats at 90% vVO2peak on a motorised treadmill. Pre- and post-exercise venous blood samples were analysed for serum haptoglobin to quantify the haemolytic response to running. Vertical ground reaction forces were also captured via a force plate beneath the treadmill belt. Haptoglobin levels were significantly decreased following exercise (P = 0.001) in both groups (but not between groups), suggesting that the running task created a haemolytic stress. The ground reaction force data showed strong effect sizes for a greater peak force (d = 1.20) and impulse (d = 1.37) in fore-foot runners, and a greater rate of force development (d = 2.74) in rear-foot runners. The lack of difference in haptoglobin response between groups may be explained by the trend for fore-foot runners to experience greater peak force and impulse during the stance phase of their running gait, potentially negating any impact of the greater rate of force development occurring from the rear-foot runners' heel strike. Neither type of runner (fore-foot or rear-foot) appears more susceptible to technique-related foot-strike haemolysis. PMID:26618486

  11. Isolation of a substance activating foot formation in hydra

    DEFF Research Database (Denmark)

    Grimmelikhuijzen, C J; Schaller, H C

    1977-01-01

    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......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...

  12. Selected items from the Charcot-Marie-Tooth (CMT) Neuropathy Score and secondary clinical outcome measures serve as sensitive clinical markers of disease severity in CMT1A patients.

    OpenAIRE

    Mannil, M.; Solari, A.; Leha, A.; Pelayo-Negro, A. L.; Berciano, J; Schlotter-Weigel, B.; Walter, M.C.; Rautenstrauss, B.; Schnizer, T. J.; Schenone, A.; Seeman, P; Kadian, C.; Schreiber, O.; Angarita, N. G.; Fabrizi, G.M.

    2014-01-01

    This study evaluates primary and secondary clinical outcome measures in Charcot-Marie-Tooth disease type 1A (CMT1A) with regard to their contribution towards discrimination of disease severity. The nine components of the composite Charcot-Marie-Tooth disease Neuropathy Score and six additional secondary clinical outcome measures were assessed in 479 adult patients with genetically proven CMT1A and 126 healthy controls. Using hierarchical clustering, we identified four significant clusters of ...

  13. Reconstructive Urology

    Directory of Open Access Journals (Sweden)

    Fikret Fatih Önol

    2014-11-01

    Full Text Available In the treatment of urethral stricture, Buccal Mucosa Graft (BMG and reconstruction is applied with different patch techniques. Recently often prefered, this approach is, in bulber urethra strictures of BMG’s; by “ventral onley”, in pendulous urethra because of thinner spingiosis body, which provides support and nutrition of graft; by means of “dorsal inley” being anastomosis. In the research that Cordon et al. did, they compared conventional BMJ “onley” urethroplast and “pseudo-spongioplasty” which base on periurethral vascular tissues to be nourished by closing onto graft. In repairment of front urethras that spongiosis supportive tissue is insufficient, this method is defined as peripheral dartos [çevre dartos?] and buck’s fascia being mobilized and being combined on BMG patch. Between the years 2007 and 2012, assessment of 56 patients with conventional “ventral onley” BMG urethroplast and 46 patients with “pseudo-spongioplasty” were reported to have similar success rates (80% to 84% in 3.5 year follow-up on average. While 74% of the patients that were applied pseudo-spongioplasty had disease present at distal urethra (pendulous, bulbopendulous, 82% of the patients which were applied conventional onley urethroplast had stricture at proximal (bulber urethra yet. Also lenght of the stricture at the pseudo-spongioplasty group was longer in a statistically significant way (5.8 cm to 4.7 cm on average, p=0.028. This study which Cordon et al. did, shows that conditions in which conventional sponjiyoplasti is not possible, periurethral vascular tissues are adequate to nourish BMG. Even it is an important technique in terms of bringing a new point of view to today’s practice, data especially about complications that may show up after pseudo-spongioplasty usage on long distal strictures (e.g. appearance of urethral diverticulum is not reported. Along with this we think that, providing an oppurtinity to patch directly

  14. Reconstruction of Traumatic Composite Tissue Defect of Medial Longitudinal Arch With Free Osteocutaneous Fibular Graft.

    Science.gov (United States)

    Unal, Mehmet Bekir; Seker, Ali; Demiralp, Bahtiyar; Sahin, Mustafa; Cift, Hakan Turan; Oltulu, Ismail

    2016-01-01

    A 34-year-old male sustained a crush injury resulting in bone and soft tissue loss along the medial longitudinal arch of his left foot. Specifically, the injury resulted in loss of first metatarsal without injury to the medial cuneiform or proximal phalanx, fracture of the third metatarsal, and a 5-cm × 9-cm soft tissue defect overlying the dorsomedial aspect of the right foot. After debridement and daily wound care, the defect was subsequently reconstructed using a free osteocutaneous fibular graft. Approximately 6 months after reconstructive surgery, the patient returned to his job without pain, and his pedogram showed almost equal weightbearing distribution on both feet. PMID:25459091

  15. Charcot-Marie-Tooth syndrome and neurofibromatosis type 1 with multiple neurofibromas of the entire spinal nerve roots.

    Science.gov (United States)

    Onu, David O; Hunn, Andrew W; Peters-Willke, Jens

    2013-01-01

    The coexistence of polyneuropathy which has the definite clinical and electromyographical findings consistent with Charcot-Marie-Tooth (CMT) syndrome and neurofibromatosis type 1 (NF1) has infrequently been reported. We describe a patient with both CMT and NF1, who had multiple neurofibromas involving the entire spinal neural axis. In addition, he had multiple neurofibromas distributed within the ileopsoas and gluteus muscles and subcutaneous tissues. These lesions were detected readily by MRI and the patient underwent successful surgical resection of the largest tumours compressing bilateral C2 nerve roots. To our knowledge, this is the first reported case of CMT syndrome coexisting with NF1 in which multiple neurofibromas involved the entire spinal nerve roots. We discuss the diagnostic and therapeutic challenges, emphasising the role of MRI and electrophysiology in such cases and provide a literature review.

  16. [Current Status of Genetic Diagnosis of Charcot-Marie-Tooth Disease: Variety of the Disease-causing Genes].

    Science.gov (United States)

    Hashiguchi, Akihiro; Higuchi, Yujiro; Takashima, Hiroshi

    2016-01-01

    At least 40 genes have been associated with Charcot-Marie-Tooth disease (CMT) and the related inherited neuropathies. Genetic studies have revealed the following factors as causes of inherited neuropathies: myelin components, transcription factors for myelination, myelin maintenance systems, differentiation factors of the peripheral nerve, neurofilaments, protein transfer systems, mitochondrial proteins, DNA repair, RNA/protein synthesis, ion channels, and aminoacyl-tRNA synthetases. Since 2007, we have tried to screen for mutations in CMT patients using microarrays or next generation sequencers. As a result, the detection rate of gene mutations has improved to about 25%. In this study, we applied target resequencing to 72 genes. From the negative examples, we identified the cases based on clinical course, family history, and electrophysiological findings, and then performed exome analysis. We then tried to identify novel causative genes by analyzing the enormous data obtained from our exome analysis.

  17. A novel mitofusin 2 gene mutation causing Charcot-Marie-Tooth type 2A disease in a Chinese family

    Institute of Scientific and Technical Information of China (English)

    CHEING Chor Kwan; LAU Kwok Kwong; YU Kwok Wai; CHAN Yan Wo Albert; MAK Miu Chloe

    2010-01-01

    @@ Charcot-Marie-Tooth disease (CMT), also known as hereditary motor and sensory neuropathies, comprises a genetically heterogeneous group of inherited peripheral neuropathies. Clinically it is characterized by progressive distal weakness, muscle atrophy, distal sensory loss and loss of deep tendon reflexes. Following electrophysiological criteria, CMT is divided into two main forms: the primarily demyelinating neuropathy CMT1 with severely decreased nerve conduction velocity (NCV) (38 m/s) but decreased amplitudes.1 CMT2A, an autosomal dominant disease caused by mitofusin 2 gene (MFN2) mutations, is the most common type of CMT2, accounting for up to 33% of familial CMT2 cases.2 We reported a patient with clinical diagnosis of CMT2 caused by a novel MFN2 mutation. To our knowledge, this is a relatively early report of genetically confirmed CMT2A in Chinese.

  18. Coexistent Charcot-Marie-Tooth type 1A and type 2 diabetes mellitus neuropathies in a Chinese family

    Directory of Open Access Journals (Sweden)

    A-ping Sun

    2015-01-01

    Full Text Available Charcot-Marie-Tooth disease type 1A (CMT1A is caused by duplication of the peripheral myelin protein 22 (PMP22 gene on chromosome 17. It is the most common inherited demyelinating neuropathy. Type 2 diabetes mellitus is a common metabolic disorder that frequently causes predominantly sensory neuropathy. In this study, we report the occurrence of CMT1A in a Chinese family affected by type 2 diabetes mellitus. In this family, seven individuals had duplication of the PMP22 gene, although only four had clinical features of polyneuropathy. All CMT1A patients with a clinical phenotype also presented with type 2 diabetes mellitus. The other three individuals had no signs of CMT1A or type 2 diabetes mellitus. We believe that there may be a genetic link between these two diseases.

  19. Clinical anatomy of the ankle and foot.

    Science.gov (United States)

    Hernández-Díaz, Cristina; Saavedra, Miguel Ángel; Navarro-Zarza, José Eduardo; Canoso, Juan J; Villaseñor-Ovies, Pablo; Vargas, Angélica; Kalish, Robert A

    This paper emphasizes the anatomical substrate of several foot conditions that are seldom discussed in this context. These include the insertional and non-insertional Achilles tendinopathies, plantar fasciopathy, inferior and posterior heel spurs, foot compartment syndromes, intermetatarsal bursitis and Morton's neuroma. It is a rather superficial anatomical review of an organ that remains largely neglected by rheumatologists. It is our hope that the cases discussed and the cross examination by instructors and participants will stimulate study of the foot and the attention it deserves. PMID:23228530

  20. 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.

    1998-01-01

    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

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

    NARCIS (Netherlands)

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

    2000-01-01

    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. [Diabetic, neuropathic, arteriopathic foot and dressing choice].

    Science.gov (United States)

    Lowe, S; Kayoumi, M

    2012-11-14

    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.

  3. Diabetic foot ulcer management: the podiatrist's perspective.

    Science.gov (United States)

    Turns, Martin

    2013-12-01

    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.

  4. Diabetic foot resulting in amputation: our experience

    Directory of Open Access Journals (Sweden)

    K. G. Patel

    2014-02-01

    Conclusions: Foot ulceration in diabetic patients is a resource consuming, disabling morbidity that often is the first step towards lower extremity amputation. Prevention is the best treatment. [Int J Res Med Sci 2014; 2(1.000: 210-214

  5. Radiographic examination of the equine foot

    International Nuclear Information System (INIS)

    A complete radiographic examination of the equine foot consists of properly exposed, processed, and positioned radiographs. For radiographic interpretation, in addition to knowing radiographic signs of disease, a knowledge of normal radiographic anatomy and possible insignificant anatomic variations is necessary

  6. Postoperative infection in the foot and ankle.

    LENUS (Irish Health Repository)

    Chan, Victoria O

    2012-07-01

    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.

  7. A Case of Hot Foot Syndrome

    OpenAIRE

    Mutlu Çayırlı; Sinem Budak

    2012-01-01

    Hot foot syndrome (HFS) is a benign, self-limited disorder, which is apparently caused by Pseudomonas aeruginosa infection. The disease is characterized by the acute onset in children with painful plantar nodules which generally does not require antibiotic therapy. Particularly, the mechanically stressed areas of the foot are affected after contact with contaminated water from saunas, swimming pools or hot tubs. HFS is a potentially important public health hazard that may causes outbreaks. In...

  8. The management of the infected diabetic foot.

    Science.gov (United States)

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

    2013-01-01

    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.

  9. THE MADURA FOOT - A CASE REPORT

    Directory of Open Access Journals (Sweden)

    Nazimuddin Mohammad

    2011-04-01

    Full Text Available Madura foot or mycetoma is a chronic granulomatous disease characterized by localized infection of subcutaneous tissues by actinomycetes or fungi. The inflammatory response can extend to the underlying bone. Mycetoma was described first in the mid 1800s and was initially called Madura foot. The infection can be caused by true fungi (eumycetoma in 40%, or filamentous bacteria (actinomycetoma in 60%.Actinomycetoma may be due to Actinomadura madurae, Actinomadura pelletieri, Streptomyces somaliensis, Nocardia species. The infection, which may remain latent for a time, forms small, subcutaneous swellings that enlarge, soften with pus, and break through the skin surface, with concurrent invasion of deeper tissues. Sulfonamide, iodide, and antibiotic therapy have been used against actinomycotic infections, but the fungi are more resistant to treatment. We reported a patient of madura foot from International Medical College Hospital, Tongi, Gazipur. A 82-years old male was admitted to the International medical college hospital with a 16 months history of swelling with multiple discharging sinuses filled with granules localized in his right foot. Pus was examined by gram staining and periodic acid Schiff (PAS staining. Moderate number of filamentous branching gram positive bacilli were found . The organism was recognized as a member of the actinomyces genus. PAS staining did not reveal any other organism. The aggressive course and progression of the disease affected the short bones of the involved foot. The patient was diagnosed as a case of Madura foot and was treated in the same hospital.

  10. Hand, foot and mouth disease

    Directory of Open Access Journals (Sweden)

    Radhika Muppa

    2011-01-01

    Full Text Available Hand, foot and mouth disease (HFMD is an acute viral illness with a distinct clinical presentation of oral and characteristic distal extremity lesions. Knowledge of this is important for the dentists as the oral lesions are the first clinical signs and sometimes may be the only sign because the condition occasionally may regress even before the lesions appear on the extremities. This case describes a 5-year-old boy in whom low-grade fever of 38.7°C and oral lesions were the initial manifestations. Proper diagnosis was established later based on the typical location of the initial intraoral ulcers on the soft palate followed by cutaneous lesions on the hands and feet with vesicle formation surrounded by an erythematous halo. The recognition of HFMD is important for both pediatricians and pedodontists as oral manifestations are the first signs and may mimic many other conditions like acute herpetic gingivostomstomatitis, apthous stomatitis, chickenpox, erythema multiformae and misdiagnosis may involve an inappropriate prescription of medication.

  11. Diagnostic laboratory testing for Charcot Marie Tooth disease (CMT): the spectrum of gene defects in Norwegian patients with CMT and its implications for future genetic test strategies

    OpenAIRE

    Østern, Rune André Helland; Fagerheim, Toril; Hjellnes, Helene; Nygård, Bjørn; Mellgren, Svein Ivar; Nilssen, Øivind

    2013-01-01

    Background Current genetic test algorithms for Charcot Marie Tooth (CMT) disease are based on family details and comprehensive clinical and neurophysiological data gathered under ideal conditions for clinical assessment. However, in a diagnostic laboratory setting relying on external test requisitions and patient samples, such conditions are not always met. Our objective was therefore to perform a retrospective evaluation of the data given in laboratory request forms and to assess their quali...

  12. Crime, hysteria and belle époque hypnotism: the path traced by Jean-Martin Charcot and Georges Gilles de la Tourette.

    Science.gov (United States)

    Bogousslavsky, Julien; Walusinski, Olivier; Veyrunes, Denis

    2009-01-01

    Hysteria and hypnotism became a favorite topic of studies in the fin de siècle neurology that emerged from the school organized at La Salpêtrière by Jean-Martin Charcot, where he had arrived in 1861. Georges Gilles de la Tourette started working with Charcot in 1884 and probably remained his most faithful student, even after his mentor's death in 1893. This collaboration was particularly intense on 'criminal hypnotism', an issue on which Hippolyte Bernheim and his colleagues from the Nancy School challenged the positions taken by the Salpêtrière School. Bernheim claimed that hypnotism was not a diagnostic feature of hysteria and that there were real-life examples of murders suggested under hypnosis, while hypnosis susceptibility was identified with hysteria by Charcot and Gilles de la Tourette, who saw rape as the only crime associated with hypnotism. The quarrel was particularly virulent during a series of famous criminal cases which took place between 1888 and 1890. At the time, it was considered that La Salpêtrière had succeeded over Nancy, since the role of hypnotism was discarded during these famous trials. However, the theories of Charcot and Gilles de la Tourette were also damaged by the fight, which probably triggered the conceptual evolution leading to Joseph Babinski's revision of hysteria in 1901. Gilles de la Tourette's strong and public interest in hypnotism nearly cost him his life, when a young woman who claimed to have been hypnotized against her will shot him in the head at his own home in 1893. It was subsequently shown that hypnotism had nothing to do with it. The delusional woman was interned at Sainte-Anne for mental disturbance, thus escaping trial. Ironically, Gilles de la Tourette may have been partly responsible, since he had been one of the strongest proponents of placing mentally-ill criminals in asylums instead of prisons.

  13. Amiotrofia neuro-medular de Charcot-Marie-Tooth associada a artrogripose multipla congenita: registro de um caso e revisão da literatura

    Directory of Open Access Journals (Sweden)

    James Pitagoras de Mattos

    1982-09-01

    Full Text Available Os autores registram a associação da amiotrofia neuro-medular de Charcot-Marie-Tooth com artrogripose múltipla congênita. Mostram as associações com as duas condições em apreço na literatura, assim como acrescentam outras alterações observadas nos diversos exames radiológicos realizados.

  14. Assessment of Targeted Next-Generation Sequencing as a Tool for the Diagnosis of Charcot-Marie-Tooth Disease and Hereditary Motor Neuropathy.

    Science.gov (United States)

    Lupo, Vincenzo; García-García, Francisco; Sancho, Paula; Tello, Cristina; García-Romero, Mar; Villarreal, Liliana; Alberti, Antonia; Sivera, Rafael; Dopazo, Joaquín; Pascual-Pascual, Samuel I; Márquez-Infante, Celedonio; Casasnovas, Carlos; Sevilla, Teresa; Espinós, Carmen

    2016-03-01

    Charcot-Marie-Tooth disease is characterized by broad genetic heterogeneity with >50 known disease-associated genes. Mutations in some of these genes can cause a pure motor form of hereditary motor neuropathy, the genetics of which are poorly characterized. We designed a panel comprising 56 genes associated with Charcot-Marie-Tooth disease/hereditary motor neuropathy. We validated this diagnostic tool by first testing 11 patients with pathological mutations. A cohort of 33 affected subjects was selected for this study. The DNAJB2 c.352+1G>A mutation was detected in two cases; novel changes and/or variants with low frequency (A mutation was also detected in three additional families. On haplotype analysis, all of the patients from these five families shared the same haplotype; therefore, the DNAJB2 c.352+1G>A mutation may be a founder event. Our gene panel allowed us to perform a very rapid and cost-effective screening of genes involved in Charcot-Marie-Tooth disease/hereditary motor neuropathy. Our diagnostic strategy was robust in terms of both coverage and read depth for all of the genes and patient samples. These findings demonstrate the difficulty in achieving a definitive molecular diagnosis because of the complexity of interpreting new variants and the genetic heterogeneity that is associated with these neuropathies.

  15. The central nervous system phenotype of X-linked Charcot-Marie-Tooth disease: a transient disorder of children and young adults.

    Science.gov (United States)

    Al-Mateen, Majeed; Craig, Alexa Kanwit; Chance, Phillip F

    2014-03-01

    We describe 2 patients with X-linked Charcot-Marie-Tooth disease, type 1 (CMTX1) disease and central nervous system manifestations and review 19 cases from the literature. Our first case had not been previously diagnosed with Charcot-Marie-Tooth disease, and the second case, although known to have Charcot-Marie-Tooth disease, was suspected of having CMTX1 after presentation with central nervous system manifestations. The most common central nervous system manifestations were transient and included dysarthria, ataxia, hemiparesis, and tetraparesis resembling periodic paralysis. Of the 21 patients, 19 presented at 21 years of age or younger, implicating CMTX1 with transient central nervous system manifestations as a disorder that predominantly affects children and adolescents. CMTX1 should be included in the differential diagnosis of patients who present with transient central nervous system phenomena, including stroke-like episodes, tetraparesis suggestive of periodic paralysis, dysarthria, ataxia, or combinations of these deficits. Reversible, bilateral, nonenhancing white matter lesions and restricted diffusion on magnetic resonance imaging are characteristic features of the central nervous system phenotype of CMTX1.

  16. Electronic artificial hand controlled by reconstructed digit

    Institute of Scientific and Technical Information of China (English)

    2000-01-01

    Objecive: To treat the loss of part of the forearm with a multi-dimension-freedom electronic artificial hand,which is controlled by a reconstructed finger transplanted from the second toe to the forearm stump.Methods: The female patient was 19 years old, whose right hand and wrist were crushed into pieces by machine at work and her forearm was amputated at the level of 8 cm proximal to the wrist. The second toe of her left foot was transplanted to reconstruct the digit onto the stump of her forearm. Two months after the transplantation, the patient was transferred to the rehabilitation center for further rehabilitation training, which consisted of: training for adaptation to weight bearing, testing and training of sensibility to weight. testing and training for stability of the hand, and testing and training for the controlling function of the reconstructed digit. Results: The transplanted toe survived well. After rehabilitation the reconstructed digit functioned well. In testing the performance under control mandate, the accuracy rate of the electronic artificial hand was 100%.Conclusions: A 100% accuracy rate of the electronic artificial hand can be achieved by transplantation of the toe onto the stump of the forearm. It provides a useful pathway and an example for improvement of control accuracy of a multiple-freedom electronic artificial hand and reduction of false action.

  17. Neuromagnetic source reconstruction

    Energy Technology Data Exchange (ETDEWEB)

    Lewis, P.S.; Mosher, J.C. [Los Alamos National Lab., NM (United States); Leahy, R.M. [University of Southern California, Los Angeles, CA (United States)

    1994-12-31

    In neuromagnetic source reconstruction, a functional map of neural activity is constructed from noninvasive magnetoencephalographic (MEG) measurements. The overall reconstruction problem is under-determined, so some form of source modeling must be applied. We review the two main classes of reconstruction techniques-parametric current dipole models and nonparametric distributed source reconstructions. Current dipole reconstructions use a physically plausible source model, but are limited to cases in which the neural currents are expected to be highly sparse and localized. Distributed source reconstructions can be applied to a wider variety of cases, but must incorporate an implicit source, model in order to arrive at a single reconstruction. We examine distributed source reconstruction in a Bayesian framework to highlight the implicit nonphysical Gaussian assumptions of minimum norm based reconstruction algorithms. We conclude with a brief discussion of alternative non-Gaussian approachs.

  18. COMPARISON OF GAIT USING A MULTIFLEX FOOT VERSUS A QUANTUM FOOT IN KNEE DISARTICULATION AMPUTEES

    NARCIS (Netherlands)

    BOONSTRA, AM; FIDLER, [No Value; SPITS, GMA; HOF, AL; Tuil, P.

    1993-01-01

    The subjective responses and gait patterns of unilateral knee disarticulation amputees wearing prostheses fitted first with the Multiflex foot and then with the Quantum foot were studied. Nine amputees were included in the trial. A questionnaire asked the amputees about their preference for one of t

  19. 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.

    2014-01-01

    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

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

    LENUS (Irish Health Repository)

    Groarke, P J

    2014-04-27

    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.

  1. Long distance running and acute effects on plantar foot sensitivity and plantar foot loading.

    Science.gov (United States)

    Alfuth, Martin; Rosenbaum, Dieter

    2011-09-26

    The plantar surface of the foot senses local pressures during stance and locomotion. These foot loading characteristics may be affected by long distance running. Little is known about the physiological effects of sports-related loading on plantar sensitivity and their relationship with plantar foot loading. The purpose of this study was to investigate the acute effects of long distance running on plantar sensitivity to touch and their relationship with foot loading characteristics. It was hypothesized that plantar sensation would decrease after long distance running and may be related to foot loading characteristics. In 15 middle-aged runners, sensory detection thresholds to light touch and plantar pressures were measured before and after a 10 km run. After the run, no significant changes in sensory perception thresholds were observed so that correlations between foot sensitivity and foot loading could not be calculated. A significant decrease of force-time integrals and maximum forces was demonstrated in the whole foot (-6.2%, p=0.003; -3.9%, p=0.001) and the heel (-10.5%, p=0.003; -8.5%, p=0.002). Furthermore, maximum force was significantly reduced in the lateral midfoot (-6.4%, p=0.002). In conclusion, a sub-maximal 10 km running exercise appears to have no significant acute effects on plantar sensitivity, plantar pressure distribution and peak forces. PMID:21871535

  2. Diagnostics and treatment of the diabetic foot.

    Science.gov (United States)

    Apelqvist, Jan

    2012-06-01

    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.

  3. Nineteen-Foot Diameter Explosively Driven Blast Simulator; TOPICAL

    International Nuclear Information System (INIS)

    This report describes the 19-foot diameter blast tunnel at Sandia National Laboratories. The blast tunnel configuration consists of a 6 foot diameter by 200 foot long shock tube, a 6 foot diameter to 19 foot diameter conical expansion section that is 40 feet long, and a 19 foot diameter test section that is 65 feet long. Therefore, the total blast tunnel length is 305 feet. The development of this 19-foot diameter blast tunnel is presented. The small scale research test results using 4 inch by 8 inch diameter and 2 foot by 6 foot diameter shock tube facilities are included. Analytically predicted parameters are compared to experimentally measured blast tunnel parameters in this report. The blast tunnel parameters include distance, time, static, overpressure, stagnation pressure, dynamic pressure, reflected pressure, shock Mach number, flow Mach number, shock velocity, flow velocity, impulse, flow duration, etc. Shadowgraphs of the shock wave are included for the three different size blast tunnels

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

    Directory of Open Access Journals (Sweden)

    Mourad Benoussaad

    2015-12-01

    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.

  5. MRI对脊髓空洞症合并夏科氏关节病的诊断价值%MRI diagnosis of Charcot arthropathy caused by syringomyelia

    Institute of Scientific and Technical Information of China (English)

    邵硕; 齐先龙; 郑宁; 孟强

    2016-01-01

    Objective To explore the clinical value of MRI diagnosis of Charcot arthropathy caused by syringomyelia , in order to improve the recognition of the disease .Methods 5 patients with Charcot arthropathy caused by syringomyelia were included in this study.All patients underwent MRI examination .Results Three cases of shoulder and two cases of elbow Charcot arthropathy were included.Three cases showed bone absorption mixed with hyperplasia , one case showed absorption , and one case showed hyperplasia .MRI showed bone absorption , bone hyperplasia , free bone fragment , deformation of the joint , and joint dislocation , and can also show the joint capsule relaxation , uneven hypertrophy and surrounding soft tissue swelling , joint effusion , the tendon and ligament damage by joint instability .In addition, cervical spine MRI can accurately diagnose syringomyelia , which provide good diagnostic basis for Charcot arthropathy .Conclusion MRI could be used as an optimal modality for evaluating Charcot ar-thropathy caused by syringomyelia .%目的:探讨MRI在脊髓空洞症合并夏科氏关节病诊断中的价值,提高对该病的认识。方法回顾性分析经临床确诊的5例脊髓空洞症继发夏科氏关节病的MRI影像表现。结果5例夏科氏关节累及肩关节3例,肘关节2例。其中3例为吸收与增生混合型,1例为吸收型,1例为增生型。 MRI不仅显示受累关节骨端骨质吸收、增生硬化、游离骨块、关节变形及关节脱位,还可以清晰显示关节囊松弛、不均匀肥厚、周围软组织肿胀,关节腔积液,关节不稳造成肌腱、韧带的损伤。此外,颈椎MRI能准确诊断脊髓空洞,为夏科氏关节病提供良好的诊断依据。结论 MRI可以作为诊断脊髓空洞症继发夏科氏关节病的首选检查方法。

  6. A shift in priority in diabetic foot care and research: 75% of foot ulcers are preventable.

    Science.gov (United States)

    Bus, Sicco A; van Netten, Jaap J

    2016-01-01

    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%.

  7. Breast reconstruction after mastectomy

    Directory of Open Access Journals (Sweden)

    Daniel eSchmauss

    2016-01-01

    Full Text Available Breast cancer is the leading cause of cancer death in women worldwide. Its surgical approach has become less and less mutilating in the last decades. However, the overall number of breast reconstructions has significantly increased lately. Nowadays breast reconstruction should be individualized at its best, first of all taking into consideration oncological aspects of the tumor, neo-/adjuvant treatment and genetic predisposition, but also its timing (immediate versus delayed breast reconstruction, as well as the patient’s condition and wish. This article gives an overview over the various possibilities of breast reconstruction, including implant- and expander-based reconstruction, flap-based reconstruction (vascularized autologous tissue, the combination of implant and flap, reconstruction using non-vascularized autologous fat, as well as refinement surgery after breast reconstruction.

  8. Breast Reconstruction After Mastectomy

    Science.gov (United States)

    ... reconstruction with or without radiotherapy. Current Opinion in Obstetrics and Gynecology 2011;23(1):44–50. [PubMed Abstract] Barry M, Kell MR. Radiotherapy and breast reconstruction: a meta-analysis. Breast ...

  9. Effect of Custom-Molded Foot Orthoses on Foot Pain and Balance in Children With Symptomatic Flexible Flat Feet

    Science.gov (United States)

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

    2015-01-01

    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

  10. Reoperative midface reconstruction.

    Science.gov (United States)

    Acero, Julio; García, Eloy

    2011-02-01

    Reoperative reconstruction of the midface is a challenging issue because of the complexity of this region and the severity of the aesthetic and functional sequela related to the absence or failure of a primary reconstruction. The different situations that can lead to the indication of a reoperative reconstructive procedure after previous oncologic ablative procedures in the midface are reviewed. Surgical techniques, anatomic problems, and limitations affecting the reoperative reconstruction in this region of the head and neck are discussed.

  11. Foot CT perfusion in patients with peripheral arterial occlusive disease (PAOD): A feasibility study

    Energy Technology Data Exchange (ETDEWEB)

    Iezzi, R., E-mail: roberto.iezzi@rm.unicatt.it [Department of Bioimaging and Radiological Sciences, Institute of Radiology, “A. Gemelli” Hospital – Catholic University, L.go A Gemelli 8, 00168 Rome (Italy); Santoro, M., E-mail: dott.santoromarco@gmail.com [Department of Bioimaging and Radiological Sciences, Institute of Radiology, “A. Gemelli” Hospital – Catholic University, L.go A Gemelli 8, 00168 Rome (Italy); Dattesi, R., E-mail: robertadattesi@gmail.com [Department of Bioimaging and Radiological Sciences, Institute of Radiology, “A. Gemelli” Hospital – Catholic University, L.go A Gemelli 8, 00168 Rome (Italy); La Torre, M.F. [Department of Bioimaging and Radiological Sciences, Institute of Radiology, “A. Gemelli” Hospital – Catholic University, L.go A Gemelli 8, 00168 Rome (Italy); Tinelli, G., E-mail: tinelli@rm.unicatt.it [Department of Vascular Surgery, “A. Gemelli” Hospital – Catholic University, L.go A Gemelli 8, 00168 Rome (Italy); Snider, F., E-mail: fsnider@rm.unicatt.it [Department of Vascular Surgery, “A. Gemelli” Hospital – Catholic University, L.go A Gemelli 8, 00168 Rome (Italy); Bonomo, L., E-mail: lbonomo@rm.unicatt.it [Department of Bioimaging and Radiological Sciences, Institute of Radiology, “A. Gemelli” Hospital – Catholic University, L.go A Gemelli 8, 00168 Rome (Italy)

    2013-09-15

    Purpose: To prospectively assess the technical feasibility and reproducibility of quantitative foot perfusion multidetector-row computed tomography (MDCT) in patients with peripheral occlusive artery disease (PAOD) and to evaluate perfusion parameters changes after endovascular treatment. Materials and methods: Institutional review board approval and informed patient consent were obtained. 10 patients older than 65 years (mean 74.1 years, range 66–95 years) with PAOD and who were referred to our department for single-limb endovascular treatment were enrolled prospectively. All patients underwent foot CT perfusion examinations before and within 72 h after endovascular treatment. A 64-row CT lightspeed VCT scanner (GE Medical Systems) was used with acquisition of eight contiguous 5-mm reconstructed sections (60-s acquisition time; 40 mL Iomeprol 400 mgI/mL, @4 mL/s). Data were analyzed by two blinded readers using commercially available software to calculate perfusion parameters. Inter-observer and intra-observer agreement of perfusion CT analysis was assessed using Bland–Altman analyses and intra-class correlation coefficient (ICC). Changes in perfusion parameters after endovascular treatment were assessed using Wilcoxon's test. Results: Good inter-observer and intra-observer agreement was obtained in all patients. Good agreement was obtained for perfusion parameters for the untreated foot and in repeated studies. By comparing perfusion parameters in the treated foot, a significantly shorter mean transit time (MTT) was obtained. Conclusions: Foot CT perfusion is a feasible and reproducible technique. A significant decrease of MTT between pre- and post-revascularization suggests improved flow in the below-the-knee arteries.

  12. Foot CT perfusion in patients with peripheral arterial occlusive disease (PAOD): A feasibility study

    International Nuclear Information System (INIS)

    Purpose: To prospectively assess the technical feasibility and reproducibility of quantitative foot perfusion multidetector-row computed tomography (MDCT) in patients with peripheral occlusive artery disease (PAOD) and to evaluate perfusion parameters changes after endovascular treatment. Materials and methods: Institutional review board approval and informed patient consent were obtained. 10 patients older than 65 years (mean 74.1 years, range 66–95 years) with PAOD and who were referred to our department for single-limb endovascular treatment were enrolled prospectively. All patients underwent foot CT perfusion examinations before and within 72 h after endovascular treatment. A 64-row CT lightspeed VCT scanner (GE Medical Systems) was used with acquisition of eight contiguous 5-mm reconstructed sections (60-s acquisition time; 40 mL Iomeprol 400 mgI/mL, @4 mL/s). Data were analyzed by two blinded readers using commercially available software to calculate perfusion parameters. Inter-observer and intra-observer agreement of perfusion CT analysis was assessed using Bland–Altman analyses and intra-class correlation coefficient (ICC). Changes in perfusion parameters after endovascular treatment were assessed using Wilcoxon's test. Results: Good inter-observer and intra-observer agreement was obtained in all patients. Good agreement was obtained for perfusion parameters for the untreated foot and in repeated studies. By comparing perfusion parameters in the treated foot, a significantly shorter mean transit time (MTT) was obtained. Conclusions: Foot CT perfusion is a feasible and reproducible technique. A significant decrease of MTT between pre- and post-revascularization suggests improved flow in the below-the-knee arteries

  13. Three-Dimensional Rotational Angiography of the Foot in Critical Limb Ischemia: A New Dimension in Revascularization Strategy

    International Nuclear Information System (INIS)

    Purpose. To evaluate the additional value of three-dimensional rotational angiography (3DRA) of the foot compared with digital subtraction angiography (DSA) in patients with critical limb ischemia (CLI). Technique. For 3DRA, the C-arm was placed in the propeller position with the foot in an isocentric position. The patient’s unaffected foot was positioned in a footrest outside the field of view. For correct timing of 3DRA, the delay from contrast injection in the popliteal artery at the level of knee joint to complete pedal arterial enhancement was assessed using DSA. With this delay, 3DRA was started after injection of 15 ml contrast. Imaging of the 3DRA could directly be reconstructed and visualized.Materials and MethodsPatients undergoing 3DRA of the foot were prospectively registered. DSA and 3DRA images were scored separately for arterial patency and presence of collaterals. Treatment strategies were proposed based on DSA with and without the availability of 3DRA. Results. Eleven patients underwent 3DRA of the foot. One 3DRA was not included because the acquisition was focused on the heel instead of the entire foot. Diagnostic quality of 3DRA was good in all ten patients. 3DRA compared with DSA showed additional patent arteries in six patients, patent plantar arch in three patients, and collaterals between the pedal arteries in five patients. Additional information from 3DRA resulted in a change of treatment strategy in six patients. Conclusion, 3DRA of the foot contains valuable additional real-time information to better guide peripheral vascular interventions in patients with CLI and nonhealing tissue lesions.

  14. Macrodystrophia lipomatosa of foot involving great toe.

    Science.gov (United States)

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

    2014-06-01

    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.

  15. Compartments of the foot: topographic anatomy.

    Science.gov (United States)

    Faymonville, C; Andermahr, J; Seidel, U; Müller, L P; Skouras, E; Eysel, P; Stein, G

    2012-12-01

    Recent publications have renewed the debate regarding the number of foot compartments. There is also no consensus regarding allocation of individual muscles and communication between compartments. The current study examines the anatomic topography of the foot compartments anew using 32 injections of epoxy-resin and subsequent sheet plastination in 12 cadaveric foot specimens. Six compartments were identified: dorsal, medial, lateral, superficial central, deep forefoot, and deep hindfoot compartments. Communication was evident between the deep hindfoot compartment and the superficial central and deep central forefoot compartments. In the hindfoot, the neurovascular bundles were located in separate tissue sheaths between the central hindfoot compartment and the medial compartment. In the forefoot, the medial and lateral bundles entered the deep central forefoot compartment. The deep central hindfoot compartment housed the quadratus plantae muscle, and after calcaneus fracture could develop an isolated compartment syndrome. PMID:22638720

  16. Macrodystrophia lipomatosa of foot involving great toe.

    Science.gov (United States)

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

    2014-06-01

    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. PMID:24703060

  17. A Case of Hot Foot Syndrome

    Directory of Open Access Journals (Sweden)

    Mutlu Çayırlı

    2012-09-01

    Full Text Available Hot foot syndrome (HFS is a benign, self-limited disorder, which is apparently caused by Pseudomonas aeruginosa infection. The disease is characterized by the acute onset in children with painful plantar nodules which generally does not require antibiotic therapy. Particularly, the mechanically stressed areas of the foot are affected after contact with contaminated water from saunas, swimming pools or hot tubs. HFS is a potentially important public health hazard that may causes outbreaks. In search of literature we detected three published reports to date of outbreaks of pseudomonas hot foot syndrome associated with the use of community whirlpools. Here we present a four-year old girl presented with painful plantar erythematous nodules localized in heels that developed one day after contacting with contaminated water from bath tub. According to data of literature we able to reach, our case is the first HFS case presented in Turkey. (Turk J Dermatol 2012; 6: 111-3

  18. 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

    2014-01-01

    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.

  19. 有TIA样表现的Charcot-Marie-Tooth病:病例报告及文献复习%Case report about Charcot-Marie-Tooth disease with manifestation of TIA and literature review

    Institute of Scientific and Technical Information of China (English)

    俞羚; 李建萍; 李焰生

    2007-01-01

    @@ 腓骨肌萎缩症又称为Charcot-Marie-Tooth病(CMT),是人类最常见的遗传性周围神经病,其发病率在美国约为1/2500,国内亦有不少报道.其主要表现为足内侧肌、腓骨肌和大腿肌远端进行性无力和萎缩,典型者呈弓形足和"鹤腿",也可累及手或前臂肌肉,形成爪形手;腱反射(特别是踝反射)减弱或消失;可伴有轻到中度感觉减退,主要累及深感觉.目前将CMT分为CMT1、CMT2、CMT3、CMT4和CMTX等5型.CMTX占其中10%~15%,并不少见,但有类似短暂性缺血发作(TIA)样表现的极少,容易漏诊或误诊.现报道一例初诊为有TIA样表现的CMTX.

  20. Distal amputations for the diabetic foot

    Directory of Open Access Journals (Sweden)

    Aziz Nather

    2013-07-01

    Full Text Available Minor amputations in diabetic patients with foot complications have been well studied in the literature but controversy still remains as to what constitutes successful or non-successful limb salvage. In addition, there is a lack of consensus on the definition of a minor or distal amputation and a major or proximal amputation for the diabetic population. In this article, the authors review the existing literature to evaluate the efficacy of minor amputations in this selected group of patients in terms of diabetic limb salvage and also propose several definitions regarding diabetic foot amputations.

  1. Pathology-designed custom molded foot orthoses.

    Science.gov (United States)

    Rosenbloom, Kevin B

    2011-01-01

    Treating patients with custom foot orthoses for common pathologies is a rewarding experience when the proper steps are taken during foot casting and custom-orthosis prescription writing. This article describes successful methods for orthoses casting and prescription writing for custom-molded orthoses for Achilles tendonitis, pes planus, hallux limitus, plantar fasciitis/heel spurs, lateral ankle instability, metatarsalgia, and pes cavus. In addition, a summary of orthotic laboratory instructions for each pathology-designed custom orthosis is provided, which should be considered by orthotic laboratories. PMID:21276525

  2. Foot Pedals for Spacecraft Manual Control

    Science.gov (United States)

    Love, Stanley G.; Morin, Lee M.; McCabe, Mary

    2010-01-01

    Fifty years ago, NASA decided that the cockpit controls in spacecraft should be like the ones in airplanes. But controls based on the stick and rudder may not be best way to manually control a vehicle in space. A different method is based on submersible vehicles controlled with foot pedals. A new pilot can learn the sub's control scheme in minutes and drive it hands-free. We are building a pair of foot pedals for spacecraft control, and will test them in a spacecraft flight simulator.

  3. A control model for zygodactyl bird's foot

    OpenAIRE

    Lai, Anna Chiara; Loreti, Paola

    2014-01-01

    In this paper we are interested to the zygodactyly phenomenon in birds, and in particolar in parrots. This arrangement, common in species living on trees, is a distribution of the foot with two toes facing forward and two back. We give a model for the foot, and thanks to the methods of iterated function system we are able to describe the reachability set. Moreover we give a necessary and sufficient condition for the grasping problem. Finally we introduce a hybrid dynamical system modeling owl...

  4. Foot and Ankle Injuries in Runners.

    Science.gov (United States)

    Tenforde, Adam S; Yin, Amy; Hunt, Kenneth J

    2016-02-01

    Foot and ankle injuries account for nearly one-third of running injuries. Achilles tendinopathy, plantar fasciopathy, and ankle sprains are 3 of the most common types of injuries sustained during training. Other common injuries include other tendinopathies of the foot and ankle, bone stress injuries, nerve conditions including neuromas, and joint disease including osteoarthritis. This review provides an evidence-based framework for the evaluation and optimal management of these conditions to ensure safe return to running participation and reduce risk for future injury. PMID:26616180

  5. Foot preferences during resting in wildfowl and waders.

    Science.gov (United States)

    Randler, Christoph

    2007-03-01

    Footedness in birds has been reported, e.g., in parrots and chickens, but the direction of footedness remained unclear. Is a bird left-footed because it uses its left foot for holding and handling food, or is it right-footed because it uses the right foot for stabilisation and balancing while perching? In 2004 and 2006 I examined footedness in wildfowl and waders while the birds were performing a single task: roosting on the ground on one foot. Avocet (Recurvirostra avosetta), northern shoveller (Anas clypeata), oystercatcher (Haematopus ostralegus), and Eurasian curlew (Numenius arquata) were right-footed. Another 21 species did not show any significant foot preferences. This study provides some evidence that asymmetries in preferential foot use in birds may be triggered by a preference during postural control. PMID:17365634

  6. Diabetic foot ulcers: Part I. Pathophysiology and prevention.

    Science.gov (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

    2014-01-01

    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.

  7. Back to School Foot Pain (Flip-Flops)

    Science.gov (United States)

    ... foot and ankle surgeons see an increase in ankle injuries among young athletes. Football, soccer and basketball are ... to School Soccer Season Prime time for foot, ankle injuries. Parents and coaches should think twice before coaxing ...

  8. Recognizing the radiographic features of some common bovine foot problems

    International Nuclear Information System (INIS)

    Radiographs of an injured or infected bovine foot can be tricky to interpret - the anatomy is complex, and the signs may be subtle. This guide leads you through the classic radiographic features of several common foot conditions

  9. Parents: Avoid Kids Foot Problems with the Right Shoes

    Science.gov (United States)

    ... Print | Share Avoid Kids Foot Problems with the Right Shoes Before you head to the store to ... College of Foot and Ankle Surgeons (ACFAS), All Rights Reserved. Privacy Statement | Disclaimer | Terms and Conditions | Site ...

  10. Comorbidities associated with Egyptian diabetic foot disease subtypes

    Directory of Open Access Journals (Sweden)

    Mary N. Rizk

    2013-01-01

    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.

  11. OPTIMUM PAD FOOTING DESIGN BY USING GENETIC ALGORITHM

    Directory of Open Access Journals (Sweden)

    Paki TURGUT

    2008-02-01

    Full Text Available In this study, a Genetic Algorithm (GA has been developed in order to find the optimum geometrical sizes in pad footing design. In the solutions of pad footing sizes found by manually or/and software, there is a required assumption of pad footing sizes held by an experienced designer at the beginning. After the assumption of the initial pad footing sizes, the exact sizes have been determined by a time consuming trial and error process. In the developed GA software without the requirement in the assumption of initial pad footing sizes, the most suitable pad footing sizes has been determined within a short period by minimizing the pad footing volume. In contrast to classical methods, developed GA has simultaneously and relationally calculated the pad footing base sizes and its height.

  12. MDCT assessment of CAD in type-2 diabetic subjects with diabetic neuropathy: the role of Charcot neuro-arthropathy

    International Nuclear Information System (INIS)

    To compare the CACS and CAD severity assessed by MDCT in neuropathic type-2 diabetic patients with and without Charcot-neuroarthropathy (CN). Thirty-four CN asymptomatic-patients and 36 asymptomatic-patients with diabetic-neuropathy (DN) without CN underwent MDCT to assess CACS and severity of CAD. Patients were classified as positive for significant CAD in presence of at least one stenosis >50 % on MDCT-coronary-angiography (MDCT-CA). Groups were matched for age, sex and traditional CAD risk-factors. The coronary-angiography (CA) was performed in all patients with at least a significant stenosis detected by MDCT-CA, both as reference and eventually as treatment. CN patients showed higher rates of significant CAD in comparison with DN subjects [p < 0.001], while non-significant differences were observed in CACS (p = 0.980). No significant differences were also observed in CACS distribution in all subjects for stenosis ≥/<50 % (p = 0.814), as well as in both groups (p = 0.661 and 0.559, respectively). The MDCT-CA showed an overall diagnostic-accuracy for significant CAD of 87 %. These preliminary data suggest that CN-patients have a higher prevalence of severe CAD in comparison with DN-patients, while coronary plaques do not exhibit an increased amount of calcium. MDCT may be helpful to assess the CV risk in such asymptomatic type-2-diabetic patients with autonomic-neuropathy. (orig.)

  13. Clinical classification and gene mutation of Chinese probands with Charcot-Marie-Tooth disease Analysis of 57 cases

    Institute of Scientific and Technical Information of China (English)

    Ruxu Zhang; Xiaobo Li; Xiaohong Zi; Shunxiang Huang; Fufeng Zhang; Kun Xia; Qian Pan; Beisha Tang

    2011-01-01

    Charcot-Mafie-Tooth (CMT) disease is the most common inherited peripheral neuropathic disorder.CMT is clinically and genetically heterogeneous. To date, 27 genes associated with the disease have been cloned. The present study carried out clinical classification according to clinical,electrophysiological and pathological features, conducted inheritance classification according to inheritance patterns, and performed mutation analysis of 13 CMT disease genes (PMP22, CX32,HSPB1, MNF2, MPZ, HSPB8, GDAP1, NFL, EGR2, SIMPLE, RAB7, LMNA, MTMR2) in 57 Chinese probands with CMT. Five cases of AD-CMT1 and 13 cases of sporadic CMT1 were diagnosed as CMT1A; five cases of X-CMT1, one case of X-CMT2 and one case of sporadic CMT1 were diagnosed as CMTX1; four cases of AD-CMT2 were diagnosed as CMT2F; one case of AD-CMT2 and one case of sporadic CMT2 were diagnosed as CMT2A2; one case of AD-CMT2 was diagnosed as CMT2L; one case of AD-CMT2 was diagnosed as CMT2J; one case of AR-CMT1 was diagnosed as CMT4A. Among the 57 CMT probands, seven genotypes were determined among 34 patients, with a detection rate of 59.6%. The results indicated that the clinical classification and inheritance classification are indispensable for selecting potential disease genes for mutation detection, and for efficient molecular diagnosis.

  14. MDCT assessment of CAD in type-2 diabetic subjects with diabetic neuropathy: the role of Charcot neuro-arthropathy

    Energy Technology Data Exchange (ETDEWEB)

    Marano, Riccardo; Savino, Giancarlo; Merlino, Biagio; Pirro, Federica; Rutigliano, Claudia; Santangelo, Carolina; Minoiu, Aurelian Costin; Natale, Luigi; Bonomo, Lorenzo [Catholic University of Rome, ' ' A. Gemelli' ' University Hospital, Department of Radiological Sciences - Institute of Radiology, Rome (Italy); Pitocco, Dario [Catholic University of Rome, ' ' A. Gemelli' ' University Hospital, Department of Internal Medicine, Rome (Italy); Di Stasio, Enrico [Catholic University of Rome, ' ' A. Gemelli' ' University Hospital, Department of Clinical Biochemistry, Rome (Italy); Trani, Carlo [Catholic University of Rome, ' ' A. Gemelli' ' University Hospital, Department of Cardiovascular Medicine - Institute of Cardiology, Rome (Italy)

    2016-03-15

    To compare the CACS and CAD severity assessed by MDCT in neuropathic type-2 diabetic patients with and without Charcot-neuroarthropathy (CN). Thirty-four CN asymptomatic-patients and 36 asymptomatic-patients with diabetic-neuropathy (DN) without CN underwent MDCT to assess CACS and severity of CAD. Patients were classified as positive for significant CAD in presence of at least one stenosis >50 % on MDCT-coronary-angiography (MDCT-CA). Groups were matched for age, sex and traditional CAD risk-factors. The coronary-angiography (CA) was performed in all patients with at least a significant stenosis detected by MDCT-CA, both as reference and eventually as treatment. CN patients showed higher rates of significant CAD in comparison with DN subjects [p < 0.001], while non-significant differences were observed in CACS (p = 0.980). No significant differences were also observed in CACS distribution in all subjects for stenosis ≥/<50 % (p = 0.814), as well as in both groups (p = 0.661 and 0.559, respectively). The MDCT-CA showed an overall diagnostic-accuracy for significant CAD of 87 %. These preliminary data suggest that CN-patients have a higher prevalence of severe CAD in comparison with DN-patients, while coronary plaques do not exhibit an increased amount of calcium. MDCT may be helpful to assess the CV risk in such asymptomatic type-2-diabetic patients with autonomic-neuropathy. (orig.)

  15. Absence of Dystrophin Related Protein-2 disrupts Cajal bands in a patient with Charcot-Marie-Tooth disease.

    Science.gov (United States)

    Brennan, Kathryn M; Bai, Yunhong; Pisciotta, Chiara; Wang, Suola; Feely, Shawna M E; Hoegger, Mark; Gutmann, Laurie; Moore, Steven A; Gonzalez, Michael; Sherman, Diane L; Brophy, Peter J; Züchner, Stephan; Shy, Michael E

    2015-10-01

    Using exome sequencing in an individual with Charcot-Marie-Tooth disease (CMT) we have identified a mutation in the X-linked dystrophin-related protein 2 (DRP2) gene. A 60-year-old gentleman presented to our clinic and underwent clinical, electrophysiological and skin biopsy studies. The patient had clinical features of a length dependent sensorimotor neuropathy with an age of onset of 50 years. Neurophysiology revealed prolonged latencies with intermediate conduction velocities but no conduction block or temporal dispersion. A panel of 23 disease causing genes was sequenced and ultimately was uninformative. Whole exome sequencing revealed a stop mutation in DRP2, c.805C>T (Q269*). DRP2 interacts with periaxin and dystroglycan to form the periaxin-DRP2-dystroglycan complex which plays a role in the maintenance of the well-characterized Cajal bands of myelinating Schwann cells. Skin biopsies from our patient revealed a lack of DRP2 in myelinated dermal nerves by immunofluorescence. Furthermore electron microscopy failed to identify Cajal bands in the patient's dermal myelinated axons in keeping with ultrastructural pathology seen in the Drp2 knockout mouse. Both the electrophysiologic and dermal nerve twig pathology support the interpretation that this patient's DRP2 mutation causes characteristic morphological abnormalities recapitulating the Drp2 knockout model and potentially represents a novel genetic cause of CMT.

  16. Multicolor in situ hybridization and linkage analysis order Charcot-Marie-Tooth type I (CMTIA) gene-region markers

    Energy Technology Data Exchange (ETDEWEB)

    Lebo, R.V.; Lynch, E.D.; Golbus, M.S. (Univ. of California, San Francisco (United States)); Bird, T.D. (Univ. of Washington, Seattle (United States)); Barker, D.F.; O' Connell, P.; Chance, P.F. (Univ. of Utah, Salt Lake City (United States))

    1992-01-01

    This study demonstrates a clear and current role for multicolor in situ hybridization in expediting positional cloning studies of unknown disease genes. Nine polymorphic DNA cosmids have been mapped to eight ordered locations spanning the Charcot-Marie-Tooth type 1 (CMT1A) disease gene region in distal band 17p11.2, by multicolor in situ hybridization. When used with linkage analysis, these methods have generated a fine physical map and have firmly assigned the CMT1A gene to distal band 17p11.2. Linkage analysis with four CMT1A pedigrees mapped the CMT1A gene with respect to two flanking markers. Additional loci were physically mapped and ordered by in situ hybridization and analysis of phase-known recombinants in CMT1A pedigrees. These data demonstrate the ability of in situ hybridization to resolve loci within 0.5 Mb on early-metaphase chromosomes. Multicolor in situ hybridization also excluded the possibility of pericentric inversions in two unrelated patients with CMT1 and neurofibromatosis type 1. When used with pulsed-field gel electrophoresis, multicolor in situ hybridization can establish physical location, order, and distance in closely spaced chromosome loci.

  17. Mapping of the chromosome 1p36 region surrounding the Charcot-Marie-Tooth disease type 2A locus

    Energy Technology Data Exchange (ETDEWEB)

    Denton, P.; Gere, S.; Wolpert, C. [Duke Univ., Durham, NC (United States)] [and others

    1994-09-01

    Charcot-Marie-Tooth (CMT) disease is the most common inherited peripheral neuropathy. Although CMT2 is clinically indistinguishable from CMT1, the two forms can be differentiated by pathological and neurophysiological methods. We have established one locus, CMT2A on chromosome 1p36, and have established genetic heterogeneity. This locus maps to the region of the deletions associated with neuroblastoma. We have now identified an additional 11 CMT2 families. Three families are linked to chromosome 1p36 while six families are excluded from this region. Another six families are currently under analysis and collection. To date the CMT2A families represent one third of those CMT2 families examined. We have established a microdissection library of the 1p36 region which is currently being characterized for microsatellite repeats and STSs using standard hybridization techniques and a modified degenerate primer method. In addition, new markers (D1S253, D1S450, D1S489, D1S503, GATA27E04, and GATA4H04) placed in this region are being mapped using critical recombinants in the CEPH reference pedigrees. Fluorescent in situ hybridization (FISH) has been used to confirm mapping. A YAC contig is being assembled from the CEPH megabase library using STSs to isolate key YACs which are extended by vectorette end clone and Alu-PCR. These findings suggest that the CMT2 phenotype is secondary to at least two different genes and demonstrates further heterogeneity in the CMT phenotype.

  18. Occurrence of Optic Neuritis and Cervical Cord Schwannoma with Charcot-Marie-Tooth Type 4B1 Disease.

    Science.gov (United States)

    Scott, Patrick; Bruwer, Zandre; Al-Kharusi, Khalsa; Meftah, Douja; Al-Murshedi, Fathiya

    2016-05-01

    Charcot-Marie-Tooth neuropathy type 4B1 (CMT4B1) disease is a rare subtype of CMT4 with reported association of facial weakness, vocal cord paresis, chest deformities, and claw hands. We report the unusual occurrence of optic neuritis and cervical cord schwannoma in a male individual with confirmed CMT4B1 disease. Sequencing of the MTMR2 gene revealed a novel nonsense homozygous mutation c.1768C>T (p.Gln590*). The mutation was identified in affected relatives of the proband and a second, apparently unrelated, family. The rare association of optic neuritis or schwannoma with genetically confirmed CMT1A has been individually observed, but never with recessive CMT. To the best of our knowledge, the occurrence of optic neuritis and cervical cord schwannoma in the same patient has never been reported with any form of CMT including CMT4B1. In similar cases, we recommend immediate medical attention to rule out the possibility of schwannomas in patients with all demyelinating CMT subtypes in case of the development of focal neurological signs or acute worsening of clinical status.

  19. Bicyclic-Capped Histone Deacetylase 6 Inhibitors with Improved Activity in a Model of Axonal Charcot-Marie-Tooth Disease.

    Science.gov (United States)

    Shen, Sida; Benoy, Veronick; Bergman, Joel A; Kalin, Jay H; Frojuello, Mariana; Vistoli, Giulio; Haeck, Wanda; Van Den Bosch, Ludo; Kozikowski, Alan P

    2016-02-17

    Charcot-Marie-Tooth (CMT) disease is a disorder of the peripheral nervous system where progressive degeneration of motor and sensory nerves leads to motor problems and sensory loss and for which no pharmacological treatment is available. Recently, it has been shown in a model for the axonal form of CMT that histone deacetylase 6 (HDAC6) can serve as a target for the development of a pharmacological therapy. Therefore, we aimed at developing new selective and activity-specific HDAC6 inhibitors with improved biochemical properties. By utilizing a bicyclic cap as the structural scaffold from which to build upon, we developed several analogues that showed improved potency compared to tubastatin A while maintaining excellent selectivity compared to HDAC1. Further screening in N2a cells examining both the acetylation of α-tubulin and histones narrowed down the library of compounds to three potent and selective HDAC6 inhibitors. In mutant HSPB1-expressing DRG neurons, serving as an in vitro model for CMT2, these inhibitors were able to restore the mitochondrial axonal transport deficits. Combining structure-based development of HDAC6 inhibitors, screening in N2a cells and in a neuronal model for CMT2F, and preliminary ADMET and pharmacokinetic profiles, resulted in the selection of compound 23d that possesses improved biochemical, functional, and druglike properties compared to tubastatin A.

  20. DGAT2 Mutation in a Family with Autosomal-Dominant Early-Onset Axonal Charcot-Marie-Tooth Disease.

    Science.gov (United States)

    Hong, Young Bin; Kang, Junghee; Kim, Ji Hyun; Lee, Jinho; Kwak, Geon; Hyun, Young Se; Nam, Soo Hyun; Hong, Hyun Dae; Choi, Yu-Ri; Jung, Sung-Chul; Koo, Heasoo; Lee, Ji Eun; Choi, Byung-Ok; Chung, Ki Wha

    2016-05-01

    Charcot-Marie-Tooth disease (CMT) is the most common inherited peripheral neuropathy and is a genetically and clinically heterogeneous disorder. We examined a Korean family in which two individuals had an autosomal-dominant axonal CMT with early-onset, sensory ataxia, tremor, and slow disease progression. Pedigree analysis and exome sequencing identified a de novo missense mutation (p.Y223H) in the diacylglycerol O-acyltransferase 2 (DGAT2) gene. DGAT2 encodes an endoplasmic reticulum-mitochondrial-associated membrane protein, acyl-CoA:diacylglycerol acyltransferase, which catalyzes the final step of the triglyceride (TG) biosynthesis pathway. The patient showed consistently decreased serum TG levels, and overexpression of the mutant DGAT2 significantly inhibited the proliferation of mouse motor neuron cells. Moreover, the variant form of human DGAT2 inhibited the axonal branching in the peripheral nervous system of zebrafish. We suggest that mutation of DGAT2 is the novel underlying cause of an autosomal-dominant axonal CMT2 neuropathy. This study will help provide a better understanding of the pathophysiology of axonal CMT and contribute to the molecular diagnostics of peripheral neuropathies.

  1. A cohort study of MFN2 mutations and phenotypic spectrums in Charcot-Marie-Tooth disease 2A patients.

    Science.gov (United States)

    Choi, B-O; Nakhro, K; Park, H J; Hyun, Y S; Lee, J H; Kanwal, S; Jung, S-C; Chung, K W

    2015-06-01

    Charcot-Marie-Tooth disease 2A (CMT2A) is the most common axonal form of peripheral neuropathy caused by a defect in the mitofusin 2 (MFN2) gene, which encodes an outer mitochondrial membrane GTPase. MFN2 mutations result in a large range of phenotypes. This study analyzed the prevalence of MFN2 mutation in Korean families with their assorted phenotypes (607 CMT families and 160 CMT2 families). Direct sequencing of the MFN2 coding exons or whole-exome sequencing has been applied to identify causative mutations. A total of 21 mutations were found in 36 CMT2 families. Comparative genotype-phenotype correlations impacting severity, onset age, and specific symptoms were assessed. Most mutations were seen in the GTPase domain (∼86%). A deletion mutation found in the transmembrane helices is reported for the first time, as well as five novel mutations at other domains. MFN2 mutations made up 5.9% of total CMT families, whereas 22.9% in CMT2 families, of which 27.8% occurred de novo. Interestingly, patient phenotypes ranged from mild to severe even for the same mutation, suggesting other factors influenced phenotype and penetrance. This CMT2A cohort study will be useful for molecular diagnosis and treatment of axonal neuropathy.

  2. Charcot-Marie-Tooth Disease Type 4H Resulting from Compound Heterozygous Mutations in FGD4 from Nonconsanguineous Korean Families.

    Science.gov (United States)

    Hyun, Young Se; Lee, Jinho; Kim, Hye Jin; Hong, Young Bin; Koo, Heasoo; Smith, Alec S T; Kim, Deok-Ho; Choi, Byung-Ok; Chung, Ki Wha

    2015-11-01

    Charcot-Marie-Tooth disease type 4H (CMT4H) is an autosomal recessive demyelinating subtype of peripheral enuropathies caused by mutations in the FGD4 gene. Most CMT4H patients are in consanguineous Mediterranean families characterized by early onset and slow progression. We identified two CMT4H patients from a Korean CMT cohort, and performed a detailed genetic and clinical analysis in both cases. Both patients from nonconsanguineous families showed characteristic clinical manifestations of CMT4H including early onset, scoliosis, areflexia, and slow disease progression. Exome sequencing revealed novel compound heterozygous mutations in FGD4 as the underlying cause in both families (p.Arg468Gln and c.1512-2A>C in FC73, p.Met345Thr and c.2043+1G>A (p.Trp663Trpfs*30) in FC646). The missense mutations were located in highly conserved RhoGEF and PH domains which were predicted to be pathogenic in nature by in silico modeling. The CMT4H occurrence frequency was calculated to 0.7% in the Korean demyelinating CMT patients. This study is the first report of CMT4H in Korea. FGD4 assay could be considered as a means of molecular diagnosis for sporadic cases of demyelinating CMT with slow progression.

  3. Autosomal recessive MFN2-related Charcot-Marie-Tooth disease with diaphragmatic weakness: Case report and literature review.

    Science.gov (United States)

    Tan, Christopher A; Rabideau, Marina; Blevins, Amy; Westbrook, Marjorie Jody; Ekstein, Tali; Nykamp, Keith; Deucher, Anne; Harper, Amy; Demmer, Laurie

    2016-06-01

    Pathogenic variants in the mitofusin 2 gene (MFN2) are the most common cause of autosomal dominant Charcot-Marie-Tooth (CMT2) disease, which is typically characterized by axonal sensorimotor neuropathy. We report on a 7-month-old white female with hypotonia, motor delay, distal weakness, and motor/sensory axonal neuropathy in which next-generation sequencing analysis identified compound heterozygous pathogenic variants (c.2054_2069_1170del and c.392A>G) in MFN2. A review of the literature reveals that sporadic and familial cases of compound heterozygous or homozygous pathogenic MFN2 variants have been infrequently described, which indicates that MFN2 can also be inherited in a recessive manner. This case highlights several clinical findings not typically associated with MFN2 pathogenic variants, including young age of onset and rapidly progressing diaphragmatic paresis that necessitated tracheostomy and mechanical ventilation, and adds to the growing list of features identified in autosomal recessive MFN2-related CMT2. Our patient with MFN2-related CMT2 expands the clinical and mutational spectrum of individuals with autosomal recessive CMT2 and identifies a new clinical feature that warrants further observation. © 2016 Wiley Periodicals, Inc.

  4. Improving molecular diagnosis of Chinese patients with Charcot-Marie-Tooth by targeted next-generation sequencing and functional analysis

    Science.gov (United States)

    Liu, Zhi-Jun; Ni, Wang; Li, Hong-Fu; Xiao, Bao-Guo; Wu, Zhi-Ying

    2016-01-01

    Charcot-Marie-Tooth (CMT) disease is the most common hereditary peripheral neuropathy. More than 50 causative genes have been identified. The lack of genotype-phenotype correlations in many CMT patients make it difficult to decide which genes are affected. Recently, targeted next-generation sequencing (NGS) has been introduced as an alternative approach for diagnosis of genetic disorders. Here, we applied targeted NGS in combination with PMP22 duplication/deletion analysis to screen causative genes in 22 Chinese CMT families. The novel variants detected by targeted NGS were then further studied in cultured cells. Of the 22 unrelated patients, 8 had PMP22 duplication. The targeted NGS revealed 10 possible pathogenic variants in 11 patients, including 7 previously reported variants and 3 novel heterozygous variants (GJB1: p.Y157H; MFN2: p.G127S; YARS: p.V293M). Further classification of the novel variants according to American College of Medical Genetics and Genomics (ACMG) standards and guidelines and functional analysis in cultured cells indicated that p.Y157H in GJB1 was pathogenic, p.G127S in MFN2 was likely pathogenic, while p.V293M in YARS was likely benign. Our results suggest the potential for targeted NGS to make a more rapid and precise diagnosis in CMT patients. Moreover, the functional analysis is required when the novel variants are indistinct. PMID:27027447

  5. Non-sagittal plane foot movement during late swing

    OpenAIRE

    VAN ZWIETEN, Koos Jaap; Biesmans, Steven; REYSKENS, Ann; ROBEYNS, Inge; VANDERSTEEN, Marjan; Schmidt, Klaus; LIPPENS, Peter; NARAIN, Faridi; MAHABIER, Roberto; Lamur, K. S.

    2009-01-01

    Introduction: Foot dorsiflexor m.tibialis anterior causes foot inversion too. Foot inversion turns the footsole inwards; eversion turns it outwards. Backgrounds: Quadrupedalism in primates and precursors is characterized by moving forward in a parasagittal plane, while the forefoot keeps clinging to the substratum. This imposes external rotation on the lower leg, tranferred to foot inversion by cardan-like functions of the ankle-joint. Such rotational movements include calcaneo-cuboid pivot i...

  6. 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

    2012-11-01

    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.

  7. Diabetic foot complications: diagnosis and management.

    Science.gov (United States)

    Giurini, John M; Lyons, Thomas E

    2005-09-01

    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.

  8. Hand Foot Skin Reaction Associated with Sunitinib

    Directory of Open Access Journals (Sweden)

    Bengü Çevirgen Cemil

    2015-06-01

    Full Text Available Sunitinib is a multi-targeted kinase inhibitor showing benefits in patients with renal cell carcinoma, and gastrointestinal stromal tumor. Sunitinib may cause various cutaneous toxicities. The most characteristic and common cutaneous toxicity is hand-foot skin reaction. Lesions are characterized by yellow painful callus like hyperkeratosis surrounded by a rim of erythema, they are well-demarcated and localized especially over pressure areas. A 54-year-old male patient with a history of renal cell carcinoma developed painful eruption twenty days after oral sunitinib had been started on 50 mg daily. Dermatological examination showed multiple, yellow, hyperkeratotic plaques with erythematous halos on palms, and soles. The patient was diagnosed as hand-foot skin reaction due to sunitinib due to descriptive clinical findings. Hand-foot skin reaction can greatly affect patients’ quality of life and treatment dosages. Early diagnosis and timely treatment of hand-foot skin reaction will be vital to ensure maximum potential of these drugs.

  9. Patient education for preventing diabetic foot ulceration

    NARCIS (Netherlands)

    Dorresteijn, J.A.; Kriegsman, D.M.; Assendelft, W.J.; Valk, G.D.

    2014-01-01

    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: We

  10. 33 CFR 142.33 - Foot protection.

    Science.gov (United States)

    2010-07-01

    ... 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...

  11. American Orthopaedic Foot and Ankle Society

    Science.gov (United States)

    ... QUALIFIED The Orthopaedic Distinction ​​​​​​​​​​​​​​​​​​ ​ The American Orthopaedic Foot & Ankle Society (AOFAS) is an organization of more than 2,200 orthopaedic surgeons from the US and abroad who specialize in the medical and ...

  12. Animal health: foot-and-mouth disease

    Science.gov (United States)

    Foot-and-mouth disease (FMD) is one of the most contagious viral diseases that can affect cloven-hoofed livestock and wild animals. Outbreaks of FMD have caused devastating economic losses and the slaughter of millions of animals in many regions of the world affecting the food chain and global devel...

  13. Foot-and-mouth disease virus vaccines

    Science.gov (United States)

    Foot and mouth disease (FMD) is a highly infectious and economically devastating disease of livestock. Although vaccines, available since the early 1900s, have been instrumental in eradicating FMD from parts of the world, the disease still affects millions of animals around the globe and remains the...

  14. Influence of footings stiffness on punching resistance

    Directory of Open Access Journals (Sweden)

    Ĺudovít Fillo

    2016-03-01

    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.

  15. ATA gas propagation - 1 foot tank experiment

    International Nuclear Information System (INIS)

    The first gas propagation experiment on ATA is planned to be conducted in a 1-foot diameter tank of up to 10 m length. The primary objectives are to measure beam parameters at injection to determine whether the desired beam conditioning is achieved, and to observe how such conditioned beams propagate in air and neon

  16. On-the-Job Foot Health

    Science.gov (United States)

    ... of protective footwear or complain about it. Safety footwear can be comfort- able, flexible, stylish, and still provide protection from injury. The foot is a most valuable part of your body subjected to injury in industry. Because of the many potential work hazards, it ...

  17. 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.

    2009-01-01

    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

  18. Nonlinear MHD Waves in a Prominence Foot

    Science.gov (United States)

    Ofman, L.; Knizhnik, K.; Kucera, T.; Schmieder, B.

    2015-11-01

    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 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.

  19. Ron Rash: One Foot in Eden

    DEFF Research Database (Denmark)

    Bjerre, Thomas Ærvold

    2010-01-01

    An analysis of Ron Rash's novel One Foot in Eden, focusing on his attachment to place and his depiction of the internal conflicts between farmers and townspeople in a small Appalachian community. Rash depicts the contemporary Southerner’s struggle to maintain his or her roots in a time of rapid...

  20. Complex interventions for preventing diabetic foot ulceration

    NARCIS (Netherlands)

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

    2015-01-01

    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.

  1. Trisomy 18 syndrome with cleft foot.

    OpenAIRE

    Castle, D; Bernstein, R.

    1988-01-01

    Ectrodactyly of the feet has been reported only twice in association with trisomy 18 syndrome. A severe form of this anomaly, the first with published illustrative x rays, is described in a male infant with trisomy 18 syndrome. It is suggested that this may represent an extreme expression of the foot anomalies more commonly associated with this syndrome.

  2. ESTIMATION OF STATURE BASED ON FOOT LENGTH

    Directory of Open Access Journals (Sweden)

    Vidyullatha Shetty

    2015-01-01

    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

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

    OpenAIRE

    Amin, Noha; Doupis, John

    2016-01-01

    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...

  4. The relation between foot arch stability, and mechanical and physiological properties of the foot

    OpenAIRE

    Sakalauskaitė, Raminta

    2013-01-01

    The foot keeps body balance and stability during walking, running and performing various physical activities. It has been determined that mechanical properties of musculoskeletal system influence motion control, body balance maintenance (Richardson et al., 2005; Biewener, Daley, 2007; Nishikawa, 2007). However, it is yet unclear whether there is a relation between body stability and foot arch stability. The relation is yet unknown between the mechanical and physiological properties of the foo...

  5. Tuberculosis of the foot: An osteolytic variety

    Directory of Open Access Journals (Sweden)

    Mandeep S Dhillon

    2012-01-01

    Full Text Available Background: Foot involvement in osteoarticular tuberculosis is uncommon and isolated bony involvement of foot bones with an osteolytic defect is even more rare; diagnostic and therapeutic delays can occur, worsening the prognosis. We present a retrospective series of osteolytic variety of foot tuberculosis. Materials and Methods: We present 24 osteolytic variety of foot tuberculosis (Eleven calcaneus, four cuboid, two cunieforms, one talus, three metatarsals, three phalanges out of 92 foot TB cases collected over last 20 years. There were 16 adults and eight children. Tissue diagnosis was established in 23 of 24 cases based on PCR AFB staining, culture, and histopathology. Surgical intervention was reserved for patients with either a juxtaarticular focus threatening to involve a joint or an impending collapse of a midfoot bone with cystic destruction. Results: Fifteen cases had an osteolytic lesion on the radiographs resembling a space-occupying lesion, five had patchy osteolysis, while four showed coke like sequestra; one patient had a lesion in two bones. Antitubercular chemotherapy after biopsy was sufficient to heal the lesion in 19 cases, while in five cases surgical debridement needed to be done. The lesions healed eventually. At an average followup of 8.3 years, (range 2-15 years there were no recurrences and all patients were free from pain, with no restriction of movements. Six patients complained of occasional pain during walking on uneven ground. Conclusion: When tuberculous pathology is limited to the bone, the prognosis is better than in articular disease, as there is less deformity, and hence, less residual pain and disability.

  6. Normative values for the Foot Posture Index

    Directory of Open Access Journals (Sweden)

    Redmond Anthony C

    2008-07-01

    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.

  7. The Relationship with Balance, Foot Posture, and Foot Size in School of Physical Education and Sports Students

    Science.gov (United States)

    Irez, Gonul Babayigit

    2014-01-01

    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…

  8. 进行性腓肌萎缩症的神经电生理学研究%Study of electroneurophysiology on Charcot-Marie-Tooth disease

    Institute of Scientific and Technical Information of China (English)

    陈菁华; 林丽丽; 魏丽玲

    2007-01-01

    Objective To explore the diagnostic value of electroneurophisology in patients with charcot-Ma-rie-Tooth disease(CMT).Methods Electromyogram(EMG),Motor nerve conduction velocity(MCV),Sensory nenre conduction velocity(SCV) and F wave were measured in 31 cases with Charcot-Marie-Tooth disease(CMT).Resuits The abnormality rate of EMG was 90%,MCV was 100%,SCV was 90%,and F wave was 34%.Conclu-sion The electroneurophysiology is very practical and valuable in diagnosing Charcot-Marie-Tooth disease.%目的 研究进行性腓肌萎缩症患者的肌电图、周围神经传导速度及F反应特点,探讨神经电生理检查对诊断该病的价值.方法 对31例进行性腓肌萎缩症患者的肌电图(EMG)、运动神经传导速度(MCV)、感觉神经传导速度(SCV)及F波进行检测.结果 肌电图异常率90%,运动神经传导速度异常率100%,感觉神经传导速度异常率90%,F波检测异常率34%.结论 神经电生理检查是诊断进行性腓肌萎缩症的可靠方法.

  9. Analysis of X-ray Diagnosis of Charcot Joint Disease%夏科氏关节病的X线诊断分析

    Institute of Scientific and Technical Information of China (English)

    李华明

    2014-01-01

    Objective To analyze the X-ray diagnostic methods and clinical value Charcot arthropathy. Methods March 2010 ~2014 in March in our hospital received 10 patients with Charcot arthropathy, summative analysis methods and clinical value of its X-ray diagnosis. Results 10 patients were single joint disease, including one case of right elbow, two cases left knee, right shoulder four cases, three cases of left elbow; five cases of X-ray showed dysplasia type, 5 cases patients with X-ray absorption-type, the results were statistical y significant ( <0.05). Conclusion X-ray examination of the application in the clinical diagnosis of Charcot's great value in joint disease, should be combined with clinical history of patients, improve the diagnosis rate.%目的:分析夏科氏关节病的X线诊断方法及临床价值。方法搜集2010年3月~2014年3月我院接收的夏科氏关节病10例患者,对其X线诊断的方法和临床价值进行总结性分析。结果本组10例患者均是单关节发病,其中1例右肘关节,2例左膝关节,4例右肩关节,3例左肘关节;5例X线表现为典型增生型,5例患者X线表现为吸收型,结果有统计学意义(P<0.05)。结论 X线检查在夏科氏关节病的临床诊断中应用价值较大,应结合患者临床病史,提高诊断率。

  10. Cosmic Tidal Reconstruction

    CERN Document Server

    Zhu, Hong-Ming; Yu, Yu; Er, Xinzhong; Chen, Xuelei

    2015-01-01

    The gravitational coupling of a long wavelength tidal field with small scale density fluctuations leads to anisotropic distortions of the locally measured small scale matter correlation function. Since the local correlation function is statistically isotropic in the absence of such tidal interactions, the tidal distortions can be used to reconstruct the long wavelength tidal field and large scale density field in analogy with the cosmic microwave background lensing reconstruction. In this paper we present in detail a formalism for the cosmic tidal reconstruction and test the reconstruction in numerical simulations. We find that the density field on large scales can be reconstructed with good accuracy and the cross correlation coefficient between the reconstructed density field and the original density field is greater than 0.9 on large scales ($k\\lesssim0.1h/\\mathrm{Mpc}$). This is useful in the 21cm intensity mapping survey, where the long wavelength radial modes are lost due to foreground subtraction proces...

  11. Conduction block and tonic pupils in Charcot-Marie-Tooth disease caused by a myelin protein zero p.Ile112Thr mutation.

    LENUS (Irish Health Repository)

    Murphy, Sinéad M

    2011-03-01

    We report a patient with Charcot-Marie-Tooth disease (CMT) due to the p.Ile112Thr mutation in myelin protein zero (MPZ) who presented with a patchy neuropathy with conduction block and tonic pupils. Conduction block is unusual in inherited neuropathies, while pupil abnormalities are recognised to occur in CMT especially due to MPZ mutations. This case highlights that patchy demyelinating neuropathy with conduction block may occur in p.Ile112Thr MPZ mutations. Involvement of the pupils, as in this case, may be a pointer towards a genetic rather than inflammatory cause of neuropathy.

  12. Fisiopatología celular del déficit de GDAP1, relacionado con la enfermedad de Charcot-Marie-Tooth

    OpenAIRE

    Pla Martín, David

    2012-01-01

    La enfermedad de Charcot-Marie-Tooth es uno de los trastornos neurológicos hereditarios más comunes que afecta aproximadamente a uno de casa 2.500 – 5.000 habitantes. La enfermedad CMT se clasifica en neuropatías desmielinizantes (CMT1) y neuropatías axonales (CMT2). Para ambas entidades se han descrito diversos patrones de herencia. Actualmente se conocen más de 40 genes implicados en la enfermedad siendo GDAP1 uno de los más variables en cuanto al fenotipo. Mutaciones en el gen GDAP1 se han...

  13. First reported case of Charcot Marie Tooth disease type 4C in a child from India with SH3TC2 mutation but absent spinal deformities

    Directory of Open Access Journals (Sweden)

    Umesh Dinkar Kalane

    2015-01-01

    Full Text Available Charcot Marie Tooth (CMT disease is a group of hereditary motor sensory neuropathies with significant genetic heterogeneity. This disorder has been scarcely reported in the Indian literature. Here, we report a case of the rare but relatively more severe autosomal recessive CMT type 4C disease with a few features that are distinct from its regular presentation. Our patient was proven to have one of the common mutations in the SH3TC2 gene, which has so far not been described in Indian patients.

  14. Efeitos do uso de órteses na Doença de Charcot-Marie-Tooth: atualização da literatura Orthoses effects in Charcot-Marie-Tooth Disease: update

    Directory of Open Access Journals (Sweden)

    Rouse Barbosa Pereira

    2012-12-01

    Full Text Available A Doença de Charcot-Marie-Tooth (DCMT é a neuropatia periférica hereditária mais comum em seres humanos, apresentando incidência de 1:2.500 pessoas. A fraqueza distal crural na DCMT provoca inúmeras alterações na marcha, como, por exemplo, na velocidade, no comprimento, na largura e cadência dos passos. Vários recursos em reabilitação têm sido propostos para gerenciar os problemas de deambulação, dentre eles, destaca-se a utilização de órteses. O objetivo deste estudo é apresentar e discutir os resultados de estudos sobre os efeitos da utilização de órteses nos padrões de marcha na DCMT. Neste estudo foi utilizada atualização da literatura através das principais bases de dados nacionais/internacionais (SciELO, LILACS e MEDLINE, publicados entre os anos de 2006-2012. O tratamento da DCMT consiste em fisioterapia e utilização de equipamentos de assistência, visto que ainda não há fármacos ou terapia gênica capaz de atenuar os danos clínicos e funcionais. Tal associação busca maximizar a função e melhorar a qualidade de vida desses pacientes, na tentativa de evitar agravos adicionais relativos à incapacidade física. A partir de atualização de literatura é possível concluir que existe consenso sobre a utilização de órteses nos membros inferiores para promover a estabilização das articulações do tornozelo e um padrão de deambulação mais funcional, evitando sinergias inadequadas de movimento e atenuando o risco de quedas.Charcot-Marie-Tooth (CMT disease is the most common hereditary peripheral neuropathy in humans, presenting incidence of 1:2.500 people. The distal crural weakness of the CMT causes numerous gait impairment changes, for example, velocity, length, width and cadence of the steps. Several rehabilitation resources have been proposed to manage the walking problems, among them, the use of orthoses is highlighted. The objective of this study was to present and discuss the results of

  15. PET scanning in plastic and reconstructive surgery

    International Nuclear Information System (INIS)

    In this report we highlight the use of position emission tomography (PET) scan in plastic and reconstructive surgery. PET scanning is a very important tool in plastic surgery oncology (melanoma, soft-tissue sarcomas and bone sarcomas, head and neck cancer, peripheral nerve sheath tumors of the extremities and breast cancer after breast esthetic surgery), as diagnosis, staging, treatment planning and follow-up of cancer patients is based on imaging. PET scanning seems also to be useful as a flap monitoring system as well as an infection's imaging tool, for example in the management of diabetic foot ulcer. PET also contributes to the understanding of pathophysiology of keloids which remain a therapeutic challenge. (author)

  16. Re-construction

    OpenAIRE

    Bernadette Marie Devilat

    2013-01-01

    Re-construct: to build again. The necessary reconstruction process after an earthquake can be seen as an opportunity to improve previous conditions. All damaged buildings undergo a renovation process in which every piece is carefully returned to its original place. The photograph shows roof reconstruction work in San Pedro de Alcántara, a heritage area in the central valley of Chile, which was particularly affected by the 2010 earthquake. 

  17. Temperature reconstruction analysis

    CERN Document Server

    Scafetta, N; Grigolini, P; Roberts, J; Scafetta, Nicola; Imholt, Tim; Grigolini, Paolo; Roberts, Jim

    2002-01-01

    This paper presents a wavelet multiresolution analysis of a time series dataset to study the correlation between the real temperature data and three temperature model reconstructions at different scales. We show that the Mann et.al. model reconstructs the temperature better at all temporal resolutions. We show and discuss the wavelet multiresolution analysis of the Mann's temperature reconstruction for the period from 1400 to 2000 A.D.E.

  18. Molecular genetic analysis of a Chinese family with Charcot-Marie-Tooth disease%一个Charcot-Marie-Tooth病家系的分子遗传学分析

    Institute of Scientific and Technical Information of China (English)

    杨莹韵; 从杨; 孙之星; 田原; 刘辰; 杨威

    2010-01-01

    目的 鉴定一个Charcot-Marie-Tooth病(CMT)家系的致病突变.方法 根据家族史、临床表现和肌电图检查结果判断家系CMT分型.采集16名家系成员外周血,提取基因组DNA.针对CMT1的6个亚型,选择微卫星标记进行连锁分析.针对PMP22基因重复突变,采用实时定量PCR检测家系成员.结果 本家系疾病呈常染色体显性遗传.患者均有青少年发病、缓慢进展的下肢无力症状.部分患者经查体发现下肢腱反射减弱、痛触觉减弱,下肢神经传导速度均小于30 m/s,提示为CMT1型.通过连锁分析排除了CMT1A、CMT1E以外的其他4个亚型,证实患者基因组内PMP22基因存在重复突变.结论 此家系患者表型为CMT1A,其致病突变为染色体17p11.2区域内PMP22基因的重复.

  19. Flexor pulley reconstruction.

    Science.gov (United States)

    Dy, Christopher J; Daluiski, Aaron

    2013-05-01

    Flexor pulley reconstruction is a challenging surgery. Injuries often occur after traumatic lacerations or forceful extension applied to an acutely flexed finger. Surgical treatment is reserved for patients with multiple closed pulley ruptures, persistent pain, or dysfunction after attempted nonoperative management of a single pulley rupture, or during concurrent or staged flexor tendon repair or reconstruction. If the pulley cannot be repaired primarily, pulley reconstruction can be performed using graft woven into remnant pulley rim or looping graft around the phalanx. Regardless of the reconstructive technique, the surgeon should emulate the length, tension, and glide of the native pulley. PMID:23660059

  20. How To Prevent Foot Ulcers In Diabetic Patients

    Directory of Open Access Journals (Sweden)

    Ghada Morshed

    2012-03-01

    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.

  1. Successful delayed reconstruction of common peroneal neuroma-in-continuity using sural nerve graft.

    Science.gov (United States)

    Reichl, Heike; Ensat, Florian; Dellon, A Lee; Wechselberger, Gottfried

    2013-02-01

    Injuries of the common peroneal nerve (CPN) are frequent and associated with poor motor outcomes. So far, the opinion is held, that nerve reconstruction is reasonable and indicated up to 6 months after injury. We describe successful sural nerve interposition grafting in a patient with neuroma-in-continuity formation of the CPN, presenting with foot drop, 13 months after injury. Due to this positive result, we think nerve grafting in neuroma-in-continuity lesions of the CPN should be contemplated in patients with foot drop even more than one year after injury. PMID:23180561

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

    LENUS (Irish Health Repository)

    Hurley, L

    2013-09-25

    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. Enfermedad de Charcot Marie Tooth (CMT4A por mutacion en el gen GDAP1: reporte de una familia colombiana

    Directory of Open Access Journals (Sweden)

    Angela Milena Martin

    2015-12-01

    Full Text Available Antecedentes:Las mutaciones del gen GDAP1 son causantes de la enfermedad de Charcot Marie Tooth tanto autosómica dominante como recesiva, y se han reportado más de 40 mutaciones distintas. La mutación recesiva Q163X ha sido descrita en pacientes de ascendencia española y se ha demostrado una mutación fundadora originaria de España en pacientes de origen suramericano. Describimos las características físicas e histológicas y el impacto molecular de la mutación Q163X en una familia colombiana.Objetivo:Se describe el impacto de la mutación Q163X en las características físicas, histológicas y moleculares en una familia colombiana.Métodos:Se describe dos pacientes de sexo femenino, hijas de padres consanguíneos, quienes presentaron inicio de síntomas en los dos primeros años de vida, mostrando deterioro funcional severo, sin evidencia de dismorfía, disfonía o parálisis diafragmática. Los estudios de electrofisiología mostraron una neuropatía sensitiva y motora con patrón axonal. Se solicitó la secuenciación del gen GDAP1, y el estudio identificó una mutación homocigota puntual (c. 487 C>T en el exón 4, causando un codón de parada prematuro (p. Q163X. Este resultado confirma el diagnóstico de Enfermedad de Charcot Marie Tooth, tipo 4A (recesiva, tipo axonal.Resultados:Las pacientes fueron remitidas al servicio de Fisiatría para evaluación de métodos de asistencia para deambulación. Ellas reciben seguimiento por el servicio de Neumología, quienes vigilan la función pulmonar y el desarrollo de parálisis diafragmática. Se brindó asesoramiento genético. La genealogía del paciente, las características fenotípicas y los hallazgos en los estudios electrofisiológicos son herramientas valiosas en el enfoque clínico del paciente con CMT, de forma que se pueda plantear una posible mutación causal. Se debe considerar la presencia de mutaciones en el gen GDAP1 en pacientes de origen suramericano, en especial la

  4. Strategy of Surgical Management of Peripheral Neuropathy Form of Diabetic Foot Syndrome in Ghana

    Directory of Open Access Journals (Sweden)

    W. M. Rdeini

    2014-01-01

    Full Text Available Introduction. Foot disorders such as ulceration, infection, and gangrene which are often due to diabetes mellitus are some major causes of morbidity and high amputation. Aim. This study aims to use a group of methods for the management of diabetic foot ulcers (DFU in order to salvage the lower limb so as to reduce the rate of high amputations of the lower extremity. Materials and Methods. A group of different advanced methods for the management of DFU such as sharp debridement of ulcers, application of vacuum therapy, and other forms of reconstructive plastic surgical procedures were used. Data collection was done at 3 different hospitals where the treatments were given. Results. Fifty-four patients with type 2 diabetes mellitus were enrolled in the current study: females n=37 (68.51% and males n=17 (31.49% with different stages of PEDIS classification. They underwent different methods of surgical management: debridement, vacuum therapy (some constructed from locally used materials, and skin grafting giving good and fast results. Only 4 had below knee amputations. Conclusion. Using advanced surgical wound management including reconstructive plastic surgical procedures, it was possible to reduce the rate of high amputations of the lower limb.

  5. Efficacy of focal mechanic vibration treatment on balance in Charcot-Marie-Tooth 1A disease: a pilot study.

    Science.gov (United States)

    Pazzaglia, Costanza; Camerota, F; Germanotta, M; Di Sipio, E; Celletti, C; Padua, L

    2016-07-01

    Patients affected by Charcot-Marie-Tooth (CMT) disease experience an impaired balance. Although the causes of the postural instability are not fully understood, somatosensory system seems to play a key role. Mechanical vibration seems to act on the somatosensory system and to improve its function. The aim of our study was to evaluate the effects of focal mechanical vibration (fMV) on the balance of CMT 1A patients. We enrolled 14 genetically confirmed CMT 1A patients (8 female and 6 male, mean age 492 years, range 32-74, mean duration of disease: 13 years, range 1-30). Patients underwent a 3-day fMV treatment on quadriceps and triceps surae and were evaluated before the treatment as well as 1 week and 1 month after the end of the treatment. The primary outcome measure was the Berg Balance Scale (BBS) and the secondary were the Dynamic Gait Index (DGI), the 6 Min Walking Test (6MWT), the muscular strength of lower limbs, the Quality of Life (QoL) questionnaire and the stabilometric variables. The statistical analysis showed a significant modification of the BBS due to the effect of treatment (p CMT 1A patients determined an improvement of balance as detected by the BBS. The concurrent improvement of stabilometric variables in the eyes closed condition only suggests that fMV acts mostly on somatosensory afferences. Further studies are needed to confirm these data on a larger sample of CMT patients. PMID:27177999

  6. Novel mutations in the connexin 32 gene associated with X-linked Charcot-Marie-Tooth disease

    Energy Technology Data Exchange (ETDEWEB)

    Tan, C.; Ainsworth, P. [Victoria Hospital, Ontario (Canada)]|[Childrens Hospital of Western Ontario (Canada)

    1994-09-01

    Charcot-Marie-Tooth disease is a pathologically and genetically hetergenous group of disorders that cause a progressive neuropathy, defined pathologically by degeneration of the myelin (CMT 1) of the axon (CMT 2) of the peripheral nerves. An X-linked type of the demyelinating form of this disorder (CMT X) has recently been linked to mutations in the connexin 32 (Cx32) gene, which codes for a 284 amino acid gap junction protein found in myelinated peripheral nerve. To date some 7 different mutations in this gene have been identified as being responsible for CMT X. The majority of these predict nonconservative amino acid substitutions, while one is a frameshift mutation which predicts a premature stop at codon 21. We report the results of molecular studies on three further local CMT X kindreds. The Cx32 gene was amplified by PCR in three overlapping fragments 300-450 bp in length using leukocyte-derived DNA as template. These were either sequenced directly using a deaza dGTP sequencing protocol, or were cloned and sequenced using a TA vector. In two of the kindreds the affected members carried a point mutation which was predicted to effect a non-conservative amino acid change within the first transmembrane domain. Both of these mutations caused a restriction site alteration (the loss of an Nla III and the creation of a Pvu II, respectively), and the former mutation was observed to segregate with the clinicial phenotype in affected family members. Affected members of the third kindred, which was a very large multigenerational family that had been extensively studied previously, were shown to carry a point mutation predicted to cause a premature truncation of the Cx32 gene product in the intracellular carboxy terminus. This mutation obliterated an Rsa I site which allowed a rapid screen of several other family members.

  7. Efficacy of focal mechanic vibration treatment on balance in Charcot-Marie-Tooth 1A disease: a pilot study.

    Science.gov (United States)

    Pazzaglia, Costanza; Camerota, F; Germanotta, M; Di Sipio, E; Celletti, C; Padua, L

    2016-07-01

    Patients affected by Charcot-Marie-Tooth (CMT) disease experience an impaired balance. Although the causes of the postural instability are not fully understood, somatosensory system seems to play a key role. Mechanical vibration seems to act on the somatosensory system and to improve its function. The aim of our study was to evaluate the effects of focal mechanical vibration (fMV) on the balance of CMT 1A patients. We enrolled 14 genetically confirmed CMT 1A patients (8 female and 6 male, mean age 492 years, range 32-74, mean duration of disease: 13 years, range 1-30). Patients underwent a 3-day fMV treatment on quadriceps and triceps surae and were evaluated before the treatment as well as 1 week and 1 month after the end of the treatment. The primary outcome measure was the Berg Balance Scale (BBS) and the secondary were the Dynamic Gait Index (DGI), the 6 Min Walking Test (6MWT), the muscular strength of lower limbs, the Quality of Life (QoL) questionnaire and the stabilometric variables. The statistical analysis showed a significant modification of the BBS due to the effect of treatment (p < 0.05). A significant modification was also found in the DGI (p < 0.05). Concerning the stabilometric variables we found significant changes only for the eyes closed condition; in particular, a significant decrease was found in VelocityML (p < 0.05) and Sway path length (p < 0.05). The fMV treatment applied on lower limbs of CMT 1A patients determined an improvement of balance as detected by the BBS. The concurrent improvement of stabilometric variables in the eyes closed condition only suggests that fMV acts mostly on somatosensory afferences. Further studies are needed to confirm these data on a larger sample of CMT patients.

  8. Mutational analysis of the myelin protein zero (MPZ) gene associated with Charcot-Marie-Tooth neuropathy type 1B

    Energy Technology Data Exchange (ETDEWEB)

    Roa, B.B.; Warner, L.E.; Lupski, J.R. [Baylor College of Medicine, Houston, TX (United States)] [and others

    1994-09-01

    The MPZ gene that maps to chromosome 1q22q23 encodes myelin protein zero, which is the most abundant peripheral nerve myelin protein that functions as a homophilic adhesion molecule in myelin compaction. Association of the MPZ gene with the dysmyelinating peripheral neuropathies Charcot-Marie-Tooth disease type 1B (CMT1B) and the more severe Dejerine-Sottas syndrome (DSS) was previously demonstrated by MPZ mutations identified in CMT1B and in rare DSS patients. In this study, the coding region of the MPZ gene was screened for mutations in a cohort of 74 unrelated patients with either CMT type 1 or DSS who do not carry the most common CMT1-associated molecular lesion of a 1.5 Mb DNA duplication on 17p11.2-p12. Heteroduplex analysis detected base mismatches in ten patients that were distributed over three exons of MPZ. Direct sequencing of PCR-amplified genomic DNA identified a de novo MPZ mutation associated with CMT1B that predicts an Ile(135)Thr substitution. This finding further confirms the role of MPZ in the CMT1B disease process. In addition, two polymorphisms were identified within the Gly(200) and Ser(228) codons that do not alter the respective amino acid residues. A fourth base mismatch in MPZ exon 3 detected by heteroduplex analysis is currently being characterized by direct sequence determination. Previously, four unrelated patients in this same cohort were found to have unique point mutations in the coding region of the PMP22 gene. The collective findings on CMT1 point mutations could suggest that regulatory region mutations, and possibly mutations in CMT gene(s) apart from the MPZ, PMP22 and Cx32 genes identified thus far, may prove to be significant for a number of CMT1 cases that do not involve DNA duplication.

  9. PMP22 related neuropathies: Charcot-Marie-Tooth disease type 1A and Hereditary Neuropathy with liability to Pressure Palsies.

    Science.gov (United States)

    van Paassen, Barbara W; van der Kooi, Anneke J; van Spaendonck-Zwarts, Karin Y; Verhamme, Camiel; Baas, Frank; de Visser, Marianne

    2014-03-19

    PMP22 related neuropathies comprise (1) PMP22 duplications leading to Charcot-Marie-Tooth disease type 1A (CMT1A), (2) PMP22 deletions, leading to Hereditary Neuropathy with liability to Pressure Palsies (HNPP), and (3) PMP22 point mutations, causing both phenotypes. Overall prevalence of CMT is usually reported as 1:2,500, epidemiological studies show that 20-64% of CMT patients carry the PMP22 duplication. The prevalence of HNPP is not well known. CMT1A usually presents in the first two decades with difficulty walking or running. Distal symmetrical muscle weakness and wasting and sensory loss is present, legs more frequently and more severely affected than arms. HNPP typically leads to episodic, painless, recurrent, focal motor and sensory peripheral neuropathy, preceded by minor compression on the affected nerve. Electrophysiological evaluation is needed to determine whether the polyneuropathy is demyelinating. Sonography of the nerves can be useful. Diagnosis is confirmed by finding respectively a PMP22 duplication, deletion or point mutation. Differential diagnosis includes other inherited neuropathies, and acquired polyneuropathies. The mode of inheritance is autosomal dominant and de novo mutations occur. Offspring of patients have a chance of 50% to inherit the mutation from their affected parent. Prenatal testing is possible; requests for prenatal testing are not common. Treatment is currently symptomatic and may include management by a rehabilitation physician, physiotherapist, occupational therapist and orthopaedic surgeon. Adult CMT1A patients show slow clinical progression of disease, which seems to reflect a process of normal ageing. Life expectancy is normal.

  10. Functional reconstruction of ischemic contracture in the lower limb

    Institute of Scientific and Technical Information of China (English)

    TANG Hao; ZHANG Shao-cheng; TAN Zhang-yong; ZHU Hong-wei; ZHANG Qiu-lin; LI Ming

    2011-01-01

    Objective: To discuss the method of functional reconstruction of ischemic contracture in the lower limb and propose a classification protocol for ischemic contracture in the lower limb based on its severity and prognosis.Methods: Atotal of 42 patients with ischemic contracture in the lower limb were included in this study. According to different types of disturbance and degrees of severity,surgical reconstructions consisting of nerve decompression,tendon lengthening or transfer, intrinsic foot muscle release and sural-tibial nerve anastomosis were performed in every patient.Results: Postoperatively, all patients were able to walk on flat ground. Drop foot was corrected in 10 patients,and 5 patients still felt some difficulty during stair activity.Split Achilles tendon transfer to flexor hallucis longus tendon was performed in 12 patients, and their walking stability was improved. Seven patients accepted ipsilateral suraltibial nerve anastomosis, and sensitivity recovery reached to S2 in 2 patients and S3 in 5 patients.Conclusions: Ischemic contracture in the lower limb is a devastating complication after lower limb trauma. The prevention of contracture is much more important than the treatment of an established contracture. Split Achilles tendon transfer to flexor hallucis longus tendon and sural-tibial nerve anastomosis, which was initially implemented by us, could improve the functional recovery of ischemic contracture in lower limbs, and thus provides a new alternative for functional reconstruction of ischemic contracture in the lower limb.

  11. Foot mounted inertial system for pedestrian navigation

    International Nuclear Information System (INIS)

    This paper discusses algorithmic concepts, design and testing of a system based on a low-cost MEMS-based inertial measurement unit (IMU) and high-sensitivity global positioning system (HSGPS) receivers for seamless personal navigation in a GPS signal degraded environment. The system developed here is mounted on a pedestrian shoe/foot and uses measurements based on the dynamics experienced by the inertial sensors on the user's foot. The IMU measurements are processed through a conventional inertial navigation system (INS) algorithm and are then integrated with HSGPS receiver measurements and dynamics derived constraint measurements using a tightly coupled integration strategy. The ability of INS to bridge the navigation solution is evaluated through field tests conducted indoors and in severely signal degraded forest environments. The specific focus is on evaluating system performance under challenging GPS conditions

  12. [Subintimal angioplasty and diabetic foot revascularisation].

    Science.gov (United States)

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

    2011-01-01

    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.

  13. A study of dermatoglyphics in club foot

    Directory of Open Access Journals (Sweden)

    Sadakat Ali

    2014-04-01

    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

  14. Minor amputations for diabetic foot salvage

    Directory of Open Access Journals (Sweden)

    Salah Y. Habel

    2015-10-01

    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.

  15. Image Reconstruction. Chapter 13

    International Nuclear Information System (INIS)

    This chapter discusses how 2‑D or 3‑D images of tracer distribution can be reconstructed from a series of so-called projection images acquired with a gamma camera or a positron emission tomography (PET) system [13.1]. This is often called an ‘inverse problem’. The reconstruction is the inverse of the acquisition. The reconstruction is called an inverse problem because making software to compute the true tracer distribution from the acquired data turns out to be more difficult than the ‘forward’ direction, i.e. making software to simulate the acquisition. There are basically two approaches to image reconstruction: analytical reconstruction and iterative reconstruction. The analytical approach is based on mathematical inversion, yielding efficient, non-iterative reconstruction algorithms. In the iterative approach, the reconstruction problem is reduced to computing a finite number of image values from a finite number of measurements. That simplification enables the use of iterative instead of mathematical inversion. Iterative inversion tends to require more computer power, but it can cope with more complex (and hopefully more accurate) models of the acquisition process

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

    Science.gov (United States)

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

    2015-06-01

    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. Nodular Foot Myxedema Masquerading as Lymphedema

    OpenAIRE

    Couto, Javier A.; Schmidt, Birgitta A. R.; Greene, Arin K.

    2015-01-01

    Summary: Lymphedema results from abnormal development or injury to the lymphatic system. One-fourth of patients with lower extremity enlargement are erroneously labeled with “lymphedema.” We describe a patient with hypothyroidism who developed soft-tissue overgrowth of her foot. She was referred to our Lymphedema Program for management of “lymphedema” and overgrown toes. The patient’s lymphoscintigram showed normal lymphatic function in her extremities, and she was diagnosed with myxedema by ...

  18. Nuclear medicine applications for the diabetic foot

    Energy Technology Data Exchange (ETDEWEB)

    Hartshorne, M.F.; Peters, V.

    1987-04-01

    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.

  19. Nonlinear MHD Waves in a Prominence Foot

    Science.gov (United States)

    Ofman, L.; Knizhnik, K.; Kucera, T.; Schmieder, B.

    2015-11-01

    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-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.

  20. Tendon transfers for the drop foot.

    Science.gov (United States)

    Schweitzer, Karl M; Jones, Carroll P

    2014-03-01

    The paralytic drop foot represents a challenging problem for even the most experienced orthopedic surgeon. Careful patient selection, thorough preoperative examination and planning, and application of tendon transfer biomechanical and physiologic principles outlined in this article can lead to successful results, either through a posterior tibialis tendon transfer, Bridle transfer, or variations on these procedures. Achilles lengthening or gastrocnemius recession may also be needed at the time of tendon transfer. PMID:24548510

  1. Radiology of the ankle and foot

    International Nuclear Information System (INIS)

    The purpose of this paper is to provide a systematic approach to the diagnosis of common foot conditions, including traumatic conditions, arthritis, and tumors. The differential diagnosis of monarticular arthritis and pain in the big toe is discussed. The characteristic features of rheumatoid arthritis are compared with those of degenerative and metabolic deposition disease. Trauma, including common athletic injuries, is reviewed. Selected tumors that frequently cause confusion, such as synovial chondromatosis, PVNS, and tendon sheath xanthoma, are shown

  2. Diagnostic dilemmas in foot and ankle injuries

    International Nuclear Information System (INIS)

    Differential diagnosis of foot and ankle injuries should include (1) stress fractures of the great toe sesamoids, the shaft of the fifth metatarsal, and the tarsal navicular bone; (2) transchondral talar-dome fractures; (3) fractures of the os trigonum; and (4) dislocating peroneal tendons. Diagnosis of these injuries is challenging because the initial roentgenograms often are normal, and special clinical tests and ancillary studies are required

  3. Bacteriological study of diabetic foot infections.

    Directory of Open Access Journals (Sweden)

    Khairul Azmi ABD KADIR

    2012-02-01

    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.

  4. NONLINEAR MHD WAVES IN A PROMINENCE FOOT

    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)

    2015-11-10

    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.

  5. Multiscale Phenomena Related to Diabetic Foot

    OpenAIRE

    Agić, Ante; Nikolić, Tatjana; Mijović, Budimir

    2011-01-01

    Diabetes is a group of metabolic diseases causing a system disorder, i.e.; it cannot be explained or understood by phenomena on single material scale. The diabetic foot is studied as flexible multibody structure by nonlinear finite element method. The physical and geometrical multiscale heterogeneity is solved by multilevel finite element approach. The diabetic tissue is described by internal coordinate’s formalism, as complex multiscale process in tissue. The accompanying problem...

  6. Effects of hallux limitus on plantar foot pressure and foot kinematics during walking.

    Science.gov (United States)

    Van Gheluwe, Bart; Dananberg, Howard J; Hagman, Friso; Vanstaen, Kerstin

    2006-01-01

    The effects of hallux limitus on plantar foot pressure and foot kinematics have received limited attention in the literature. Therefore, a study was conducted to assess the effects of limited first metatarsophalangeal joint mobility on plantar foot pressure. It was equally important to identify detection criteria based on plantar pressures and metatarsophalangeal joint kinematics, enabling differentiation between subjects affected by hallux limitus and people with normal hallux function. To further our understanding of the relation between midtarsal collapse and hallux limitus, kinematic variables relating to midtarsal pronation were also included in the study. Two populations of 19 subjects each, one with hallux limitus and the other free of functional abnormalities, were asked to walk at their preferred speed while plantar foot pressures were recorded along with three-dimensional foot kinematics. The presence of hallux limitus, structural or functional, caused peak plantar pressure under the hallux to build up significantly more and at a faster rate than under the first metatarsal head. Additional discriminators for hallux limitus were peak dorsiflexion of the first metatarsophalangeal joint, time to this peak value, peak pressure ratios of the first metatarsal head and the more lateral metatarsal heads, and time to maximal pressure under the fourth and fifth metatarsal heads. Finally, in approximately 20% of the subjects, with and without hallux limitus, midtarsal pronation occurred after heel lift, validating the claim that retrograde midtarsal pronation does occur. PMID:16988174

  7. Diabetes Foot Ulcers: A novel Treatment Strategy

    Directory of Open Access Journals (Sweden)

    Golnaz Namazi

    2008-05-01

    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.

  8. Risk factors for developing diabetic foot

    Directory of Open Access Journals (Sweden)

    Julia Estela Willrich Boell

    2014-06-01

    Full Text Available The goal of the present study is to identify the risk factors for developing diabetic foot. A cross-sectional study, with a convenience sample, developed with 70 individuals with diabetes mellitus (DM, registered in three basic health units in the municipality of Florianópolis/SC, Brazil, in the period from November 2010 to May 2011. Biometric data was collected regarding their sociodemographic, health and illness conditions. An assessment of the feet was also carried out. The average participant age was 66.17 years and time with diagnosed disease was under ten years (61.42%. The following risk factors were identified: advanced age; time of DM diagnosis; few years of schooling; overweight/obesity; inadequate diet; physical inactivity; inadequate metabolic control; lack of proper and specific foot care; and arterial hypertension. We conclude that the majority of the population presented one or more risk factors that favor the appearance of foot-related complications. doi: 10.5216/ree.v16i2.20460.

  9. Computed tomographic anatomy of the equine foot.

    Science.gov (United States)

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

    2014-10-01

    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.

  10. Compressive Sensing of Foot Gait Signals and Its Application for the Estimation of Clinically Relevant Time Series.

    Science.gov (United States)

    Pant, Jeevan K; Krishnan, Sridhar

    2016-07-01

    A new signal reconstruction algorithm for compressive sensing based on the minimization of a pseudonorm which promotes block-sparse structure on the first-order difference of the signal is proposed. Involved optimization is carried out by using a sequential version of Fletcher-Reeves' conjugate-gradient algorithm, and the line search is based on Banach's fixed-point theorem. The algorithm is suitable for the reconstruction of foot gait signals which admit block-sparse structure on the first-order difference. An additional algorithm for the estimation of stride-interval, swing-interval, and stance-interval time series from the reconstructed foot gait signals is also proposed. This algorithm is based on finding zero crossing indices of the foot gait signal and using the resulting indices for the computation of time series. Extensive simulation results demonstrate that the proposed signal reconstruction algorithm yields improved signal-to-noise ratio and requires significantly reduced computational effort relative to several competing algorithms over a wide range of compression ratio. For a compression ratio in the range from 88% to 94%, the proposed algorithm is found to offer improved accuracy for the estimation of clinically relevant time-series parameters, namely, the mean value, variance, and spectral index of stride-interval, stance-interval, and swing-interval time series, relative to its nearest competitor algorithm. The improvement in performance for compression ratio as high as 94% indicates that the proposed algorithms would be useful for designing compressive sensing-based systems for long-term telemonitoring of human gait signals.

  11. Compressive Sensing of Foot Gait Signals and Its Application for the Estimation of Clinically Relevant Time Series.

    Science.gov (United States)

    Pant, Jeevan K; Krishnan, Sridhar

    2016-07-01

    A new signal reconstruction algorithm for compressive sensing based on the minimization of a pseudonorm which promotes block-sparse structure on the first-order difference of the signal is proposed. Involved optimization is carried out by using a sequential version of Fletcher-Reeves' conjugate-gradient algorithm, and the line search is based on Banach's fixed-point theorem. The algorithm is suitable for the reconstruction of foot gait signals which admit block-sparse structure on the first-order difference. An additional algorithm for the estimation of stride-interval, swing-interval, and stance-interval time series from the reconstructed foot gait signals is also proposed. This algorithm is based on finding zero crossing indices of the foot gait signal and using the resulting indices for the computation of time series. Extensive simulation results demonstrate that the proposed signal reconstruction algorithm yields improved signal-to-noise ratio and requires significantly reduced computational effort relative to several competing algorithms over a wide range of compression ratio. For a compression ratio in the range from 88% to 94%, the proposed algorithm is found to offer improved accuracy for the estimation of clinically relevant time-series parameters, namely, the mean value, variance, and spectral index of stride-interval, stance-interval, and swing-interval time series, relative to its nearest competitor algorithm. The improvement in performance for compression ratio as high as 94% indicates that the proposed algorithms would be useful for designing compressive sensing-based systems for long-term telemonitoring of human gait signals. PMID:25675451

  12. Lower extremity muscles activity in standing and sitting position with use of sEMG in patients suffering from Charcot-Marie-Tooth syndrome.

    Science.gov (United States)

    Kuciel, Natalia Maria; Konieczny, Grzegorz Krzysztof; Oleksy, Łukasz; Wrzosek, Zdzisława

    2016-01-01

    There is very limited, evidenced data about movement possibilities in patients with high level of lower limb muscles atrophy and fatigue in patients suffering from Charcot-Marie-Tooth syndrome. Patient (age 46) suffering from Charcot-Marie-Tooth disease for 30 years with multiple movement restrictions and muscles atrophy above knees took part into the study. Tests were performed for 8 muscles of the lower limb and pelvis. Muscles electrical activity was tested in sitting and standing position (for knees extended and hyperextended). In the right leg rectus femoris, vastus lateralis obliquus, gluteus medius and semitendinosus muscles activated at first and were working the longest time. The highest activity was observed in standing position with knees extended. In the left leg rectus femoris and biceps femoris muscles activated at first and biceps femoris was working the longest time. Activity level in left lower limb is much lower than in the right one. Muscles weakness is asymmetric. Left leg is much weaker and engages antagonists and synergists muscles to compensate weaker rectus femoris, vastus medialis obliquus and vastus lateralis obliquus.

  13. A novel mutation in GJB1 (c.212T>G) in a Chinese family with X-linked Charcot-Marie-Tooth disease.

    Science.gov (United States)

    Xiao, Fei; Tan, Jia-ze; Zhang, Xu; Wang, Xue-Feng

    2015-03-01

    Gap junction protein beta 1 (GJB1) gene mutations lead to X-linked Charcot-Marie-Tooth (CMTX) disease. We investigated a Chinese family with CMTX and identified a novel GJB1 point mutation. Clinical and electrophysiological features of the pedigree were examined, and sequence alterations of the coding region of GJB1 that encode connexin32 were determined by direct sequencing. Sequence alignment of the mutation site was performed using Clustal W. Mutation effects were analysed using PolyPhen-2, SIFT and Mutation Taster software. The three-dimensional structures of the mutant and wild-type proteins were predicted by modeling with SWISS MODEL online software. The affected family members displayed typical Charcot-Marie-Tooth phenotypes, but phenotypic heterogeneity was observed. Nerve conduction velocities of all affected patients were slow. Sequencing of GJB1 revealed a heterozygous T>G missense mutation at nucleotide 212 in the proband, the proband's mother and the proband's daughter. The affected male sibling of the proband displayed a hemizygous missense mutation with T>G transition at the identical position on the GJB1 gene. This mutation resulted in an amino acid change from isoleucine to serine that was predicted to lead to tertiary structural alterations that would disrupt the function of the GJB1 protein. A novel point mutation in GJB1 was detected, expanding the spectrum of GJB1 mutations known to be associated with CMTX.

  14. Are diabetic foot lesions precipitated by accidental trauma?

    Science.gov (United States)

    Doshi, H K; Moissinac, K; Harwant, S

    2001-12-01

    Diabetic foot lesions may arise from frictional trauma due to tight or inappropriate footwear, repetitive stresses on parts of the foot, overlying bony prominence generated by walking and accidental trauma to the neuropathic foot. Many diabetics have been found to be unaware of their foot lesion, or know what the precipitating cause was. Based on the assumption that accidental trauma would affect the foot in a random fashion and result in lesions distributed evenly throughout the foot, a study was performed to determine whether foot lesions were distributed evenly or concentrated to certain areas of predilection. It was found that foot lesions were not evenly distributed but concentrated to certain areas of predilection. Even though relatively high proportion of the study population walked about in open slippers and barefeet, the study showed that accidental trauma was not a predominant precipitant of diabetic foot lesions. Diabetic foot lesions tend to occur as a result of cumulative, repetitive trauma to areas of prediliection rather than accidental trauma. PMID:14569763

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

    Science.gov (United States)

    Amin, Noha; Doupis, John

    2016-01-01

    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

  16. Diabetic foot disease: From the evaluation of the "foot at risk" to the novel diabetic ulcer treatment modalities.

    Science.gov (United States)

    Amin, Noha; Doupis, John

    2016-04-10

    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.

  17. Care of Patients with Diabetic Foot Disease in Oman.

    Science.gov (United States)

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

    2016-08-01

    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

  18. Pathogenesis of foot ulcers and the need for offloading.

    Science.gov (United States)

    Rathur, H M; Boulton, A J

    2005-04-01

    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.

  19. Care of Patients with Diabetic Foot Disease in Oman

    Science.gov (United States)

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

    2016-01-01

    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

  20. Acromioclavicular Joint Reconstruction.

    Science.gov (United States)

    Scillia, Anthony J; Cain, E Lyle

    2015-12-01

    Our technique for acromioclavicular joint reconstruction provides a variation on coracoclavicular ligament reconstruction to also include acromioclavicular ligament reconstruction. An oblique acromial tunnel is drilled, and the medial limb of the gracilis graft, after being crossed and passed beneath the coracoid and through the clavicle, is passed through this acromial tunnel and sutured to the trapezoid graft limb after appropriate tensioning. Tenodesis screws are not placed in the bone tunnels to avoid graft fraying, and initial forces on the graft are offloaded with braided absorbable sutures passed around the clavicle. PMID:27284528

  1. Reconstructing Step by Step

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    On May 22,10 days after the Wenchuan earthquake in Sichuan Province,the State Council formed the Post-earthquake Reconstruction Planning Group,deciding to work out a general recon- struction plan within a period of three months. Sichuan was the worst-hit area of China,so reconstruction work there will have a direct influence on how plans proceed in other areas.On July 18,Beijing Review reporter Feng Jianhua interviewed Wang Guangsi,Vice Director of the Sichuan Development and Reform Commission,about Sichuan’s reconstruction plan.

  2. Use of Pressure Offloading Devices in Diabetic Foot Ulcers

    OpenAIRE

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

    2008-01-01

    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...

  3. Interdigital foot infections: Corynebacterium minutissimum and agents of superficial mycoses

    OpenAIRE

    Fatma Mutlu Sariguzel; A. Nedret Koc; Gülhan Yagmur; Elife Berk

    2014-01-01

    Interdigital foot infections are mostly caused initially by dermatophytes, yeasts and less frequently by bacteria. Erythrasma caused by Corynebacterium minutissimum can be confused with superficial mycoses. The aim of the study was to determine the prevalence of the etiologic agents of superficial mycoses and the frequency of Corynebacterium minutissimum in interdigital foot infections. All the samples obtained from the 121 patients with interdigital foot infections were examined directly wit...

  4. Hand, foot and mouth disease - a short case report

    OpenAIRE

    Kashyap, Roopashri Rajesh; Kashyap, Rajesh Shanker

    2015-01-01

    Hand, foot and mouth disease, that was once considered a disease of cattle, has been emerging as a common human childhood disease in the last few years. It is a viral disease characterized by a brief febrile illness and typical vesicular rashes. In rare cases, patients may also develop neurological complications. This report describes a case of hand, foot and mouth disease, presented with typical clinical features in the South Indian region. Key words:Hand, foot and mouth disease, viral lesio...

  5. 6-Axis Force/Moment Sensor In Humanoid Robot Foot

    Science.gov (United States)

    Ai-Faifi, Badrih; Al-Shammary, Maryam; Al-Shehry, Zinab

    2014-07-01

    The foot is the most Important part of the humanoid .Thought the sensor of the robot can understand the environment In which they live, it is important to developed an intelligent foot. In order to walk on uneven terrain safely this poster describes an intelligent foot with 6- axis force/moment sensors for humanoid robot that is one of the solution that can help the robot to walk in uneven terrain safely.

  6. FootPrinter3: phylogenetic footprinting in partially alignable sequences

    OpenAIRE

    Fang, Fei; Blanchette, Mathieu

    2006-01-01

    FootPrinter3 is a web server for predicting transcription factor binding sites by using phylogenetic footprinting. Until now, phylogenetic footprinting approaches have been based either on multiple alignment analysis (e.g. PhyloVista, PhastCons), or on motif-discovery algorithms (e.g. FootPrinter2). FootPrinter3 integrates these two approaches, making use of local multiple sequence alignment blocks when those are available and reliable, but also allowing finding motifs in unalignable regions....

  7. Tibialis posterior tendon transfer for drop foot deformity

    OpenAIRE

    Bekler, Halil; Beyzadeoglu, Tahsin; Gokce, Alper

    2004-01-01

    Objectives: We evaluated tibialis posterior tendon (TPT) transfers in patients with drop foot deformity. Methods: Eight patients with drop foot deformity (2 females, 6 males; mean age 40 years; range 15 to 75 years) underwent TPT transfer to the dorsum of the foot. The deformity was on the left in three patients and on the right in five patients. Etiology was traumatic peroneal nerve injuries in six patients, and upper-level nerve injuries after hip and lumbar surgery in two patients. For ...

  8. Costs of Deep Foot Infections in Patients with Diabetes Mellitus

    OpenAIRE

    Gunnel Ragnarson Tennvall; Jan Apelqvist; Magnus Eneroth

    2000-01-01

    Objective: To calculate costs for the management of deep foot infections and to identify the most important factors related to treatment costs. Design: Costs for in-hospital care, surgery, investigations, antibacterials, visits to the foot-care team, orthopaedic appliances and topical treatment were calculated retrospectively from diagnosis until healing or death. Multiple regression analysis was used to identify factors that independently affect costs. Setting: A multidisciplinary foot-care ...

  9. Foot structure and footwear prescription in diabetes mellitus.

    Science.gov (United States)

    Bus, Sicco A

    2008-01-01

    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.

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

    Directory of Open Access Journals (Sweden)

    Yadagiri Surender Rao

    2015-01-01

    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.

  11. Benign and malignant tumors of the foot and ankle

    International Nuclear Information System (INIS)

    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.)

  12. Clinical workflow for personalized foot pressure ulcer prevention.

    Science.gov (United States)

    Bucki, M; Luboz, V; Perrier, A; Champion, E; Diot, B; Vuillerme, N; Payan, Y

    2016-09-01

    Foot pressure ulcers are a common complication of diabetes because of patient's lack of sensitivity due to neuropathy. Deep pressure ulcers appear internally when pressures applied on the foot create high internal strains nearby bony structures. Monitoring tissue strains in persons with diabetes is therefore important for an efficient prevention. We propose to use personalized biomechanical foot models to assess strains within the foot and to determine the risk of ulcer formation. Our workflow generates a foot model adapted to a patient's morphology by deforming an atlas model to conform it to the contours of segmented medical images of the patient's foot. Our biomechanical model is composed of rigid bodies for the bones, joined by ligaments and muscles, and a finite element mesh representing the soft tissues. Using our registration algorithm to conform three datasets, three new patient models were created. After applying a pressure load below these foot models, the Von Mises equivalent strains and "cluster volumes" (i.e. volumes of contiguous elements with strains above a given threshold) were measured within eight functionally meaningful foot regions. The results show the variability of both location and strain values among the three considered patients. This study also confirms that the anatomy of the foot has an influence on the risk of pressure ulcer. PMID:27212210

  13. Role of industries in the care of diabetic foot.

    Science.gov (United States)

    Ramachandran, A; Lakshmi, S; Arun, Nanditha; Samith Shetty, A; Snehalatha, C

    2010-09-01

    Diabetic foot disease is a dreaded complication causing severe economic and social burden, mental and physical agony, and severe morbidity and mortality. This complication is largely preventable if the risk factors such as peripheral neuropathy and peripheral arterial disease are detected early and appropriate measures are taken to control glycemia, foot pressure, and chances of foot injury. In the case of ulceration, proper microbial control, pressure offloading by debridement, and use of appropriate footwear are mandatory to save the foot. This article focuses on the need for preventive care for diabetic complications demonstrating potentially helpful roles for industry in India. PMID:20705621

  14. 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)

    2016-03-15

    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.)

  15. Prairie Reconstruction Initiative

    Data.gov (United States)

    US Fish and Wildlife Service, Department of the Interior — The purpose of the Prairie Reconstruction Initiative Advisory Team (PRIAT) is to identify and take steps to resolve uncertainties in the process of prairie...

  16. Overview of Image Reconstruction

    Energy Technology Data Exchange (ETDEWEB)

    Marr, R. B.

    1980-04-01

    Image reconstruction (or computerized tomography, etc.) is any process whereby a function, f, on Rn is estimated from empirical data pertaining to its integrals, ∫f(x) dx, for some collection of hyperplanes of dimension k < n. The paper begins with background information on how image reconstruction problems have arisen in practice, and describes some of the application areas of past or current interest; these include radioastronomy, optics, radiology and nuclear medicine, electron microscopy, acoustical imaging, geophysical tomography, nondestructive testing, and NMR zeugmatography. Then the various reconstruction algorithms are discussed in five classes: summation, or simple back-projection; convolution, or filtered back-projection; Fourier and other functional transforms; orthogonal function series expansion; and iterative methods. Certain more technical mathematical aspects of image reconstruction are considered from the standpoint of uniqueness, consistency, and stability of solution. The paper concludes by presenting certain open problems. 73 references. (RWR)

  17. The evolving breast reconstruction

    DEFF Research Database (Denmark)

    Thomsen, Jørn Bo; Gunnarsson, Gudjon Leifur

    2014-01-01

    The aim of this editorial is to give an update on the use of the propeller thoracodorsal artery perforator flap (TAP/TDAP-flap) within the field of breast reconstruction. The TAP-flap can be dissected by a combined use of a monopolar cautery and a scalpel. Microsurgical instruments are generally...... not needed. The propeller TAP-flap can be designed in different ways, three of these have been published: (I) an oblique upwards design; (II) a horizontal design; (III) an oblique downward design. The latissimus dorsi-flap is a good and reliable option for breast reconstruction, but has been criticized...... for oncoplastic and reconstructive breast surgery and will certainly become an invaluable addition to breast reconstructive methods....

  18. Delayed breast implant reconstruction

    DEFF Research Database (Denmark)

    Hvilsom, Gitte B.; Hölmich, Lisbet R.; Steding-Jessen, Marianne;

    2011-01-01

    Studies of complications following reconstructive surgery with implants among women with breast cancer are needed. As the, to our knowledge, first prospective long-term study we evaluated the occurrence of complications following delayed breast reconstruction separately for one- and two......-stage procedures. From the Danish Registry for Plastic Surgery of the Breast, which has prospectively registered data for women undergoing breast implantations since 1999, we identified 559 women without a history of radiation therapy undergoing 592 delayed breast reconstructions following breast cancer during...... of reoperation was significantly higher following the one-stage procedure. For both procedures, the majority of reoperations were due to asymmetry or displacement of the implant. In conclusion, non-radiated one- and two-stage delayed breast implant reconstructions are associated with substantial risks...

  19. On TPC cluster reconstruction

    CERN Document Server

    Dydak, F; Nefedov, Y; Wotschack, J; Zhemchugov, A

    2004-01-01

    For a bias-free momentum measurement of TPC tracks, the correct determination of cluster positions is mandatory. We argue in particular that (i) the reconstruction of the entire longitudinal signal shape in view of longitudinal diffusion, electronic pulse shaping, and track inclination is important both for the polar angle reconstruction and for optimum r phi resolution; and that (ii) self-crosstalk of pad signals calls for special measures for the reconstruction of the z coordinate. The problem of 'shadow clusters' is resolved. Algorithms are presented for accepting clusters as 'good' clusters, and for the reconstruction of the r phi and z cluster coordinates, including provisions for 'bad' pads and pads next to sector boundaries, respectively.

  20. Permutationally invariant state reconstruction

    CERN Document Server

    Moroder, Tobias; Toth, Geza; Schwemmer, Christian; Niggebaum, Alexander; Gaile, Stefanie; Gühne, Otfried; Weinfurter, Harald

    2012-01-01

    Feasible tomography schemes for large particle numbers must possess, besides an appropriate data acquisition protocol, also an efficient way to reconstruct the density operator from the observed finite data set. Since state reconstruction typically requires the solution of a non-linear large-scale optimization problem, this is a major challenge in the design of scalable tomography schemes. Here we present an efficient state reconstruction scheme for permutationally invariant quantum state tomography. It works for all common state-of-the-art reconstruction principles, including, in particular, maximum likelihood and least squares methods, which are the preferred choices in today's experiments. This high efficiency is achieved by greatly reducing the dimensionality of the problem employing a particular representation of permutationally invariant states known from spin coupling combined with convex optimization, which has clear advantages regarding speed, control and accuracy in comparison to commonly employed n...