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Sample records for charcot foot reconstruction

  1. Surgical reconstruction of charcot foot neuroarthropathy, a case based review.

    Science.gov (United States)

    Kučera, Tomáš; Šponer, Pavel; Šrot, Jaromír

    2014-01-01

    Our case-based review focuses on limb salvage through operative management of Charcot neuroarthropathy of the diabetic foot. We describe a case, when a below-knee amputation was considered in a patient with chronic Charcot foot with a rocker-bottom deformity and chronic plantar ulceration. Conservative treatment failed. Targeted antibiotic therapy and operative management (Tendo-Achilles lengthening, resectional arthrodesis of Lisfranc and midtarsal joints, fixation with large-diameter axial screws, and plaster cast) were performed. On the basis of this case, we discuss options and drawbacks of surgical management. Our approach led to healing of the ulcer and correction of the deformity. Two years after surgery, we observed a significant improvement in patient's quality of life. Advanced diagnostic and imaging techniques, a better understanding of the biomechanics and biology of Charcot neuroarthropathy, and suitable osteosynthetic material enables diabetic limb salvage.

  2. Beaming the columns for Charcot diabetic foot reconstruction: a retrospective analysis.

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    Grant, William P; Garcia-Lavin, Silvia; Sabo, Roy

    2011-01-01

    This study explored the concept of "beaming" the medial and lateral longitudinal columns as a variation of the current technique for hindfoot and Lisfranc Charcot reconstruction. We reviewed radiographic changes and outcomes for patients who underwent Charcot foot reconstruction at our facility over the 14-year period from January 1994 to January 2008. Beaming was performed on 71 Charcot foot deformities in 70 patients, 22 (31%) of which displayed an isolated hindfoot deformity, 20 (28%) an isolated Lisfranc deformity, and 29 (41%) with a combination of hindfoot and Lisfranc deformities. The average radiographic follow up was 31.00 ± 22.97 months. Group 1 consisted of reconstructions that involved only medial and lateral column beams and showed significant improvements in radiographic alignment between the preoperative and postoperative measurements, including Meary's angle (P Charcot reconstruction. Complications included pin tract infections, broken pin, osteomyelitis, transfer lesions, and ulcerations.

  3. Charcot foot reconstruction with combined internal and external fixation: case report

    Directory of Open Access Journals (Sweden)

    Zgonis Thomas

    2010-02-01

    Full Text Available Abstract Charcot neuroarthropathy is a destructive and often-limb threatening process that can affect patients with peripheral neuropathy of any etiology. Early recognition and appropriate management is crucial to prevention of catastrophic outcomes. Delayed diagnosis and subsequent pedal collapse often preclude successful conservative management of these deformities and necessitate surgical intervention for limb salvage. We review the current literature on surgical reconstruction of Charcot neuroarthropathy and present a case report of foot reconstruction with combined internal and external fixation methods.

  4. A two-stage percutaneous approach to charcot diabetic foot reconstruction.

    Science.gov (United States)

    Lamm, Bradley M; Gottlieb, H David; Paley, Dror

    2010-01-01

    The goals of Charcot deformity correction are to restore osseous alignment, regain pedal stability, and prevent ulceration. Traditional reconstructive surgical approaches involve large, open incisions to remove bone and the use of internal fixation to attempt to fuse dislocated joints. Such operations can result in shortening of the foot and/or incomplete deformity correction, fixation failure, incision healing problems, infection, and the longterm use of casts or braces. We recommend a minimally invasive surgical technique for the treatment of Charcot deformity, which we performed on 11 feet in 8 patients. Osseous realignment was achieved through gradual distraction of the joints with external fixation, after which minimally invasive arthrodesis was performed with rigid internal fixation. Feet were operated on at various stages of Charcot deformity: Eichenholtz stage I (1 foot), Eichenholtz stage II (6 feet), and Eichenholtz stage III (4 feet). When comparing the average change in preoperative and postoperative radiographic angles, the transverse plane talar-first metatarsal angle (P = .02), sagittal plane talar-first metatarsal angle (P = .008), and calcaneal pitch angle (P = .001) were all found to be statistically significant. Complications included 3 operative adjustments of external or internal fixation, 4 broken wires or half-pins, 2 broken rings, and 11 pin tract infections. Most notably, no deep infection, no screw failure, and no recurrent ulcerations occurred and no amputations were necessary during an average follow-up of 22 months. Gradual Charcot foot correction with the Taylor spatial frame plus minimally invasive arthrodesis is an effective treatment.

  5. Ostectomy and Medial Plantar Artery Flap Reconstruction for Charcot Foot Ulceration Involving the Midfoot.

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    Sato, Tomoya; Ichioka, Shigeru

    2016-01-01

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

  6. 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.

  7. Surgical treatment of the Charcot foot.

    Science.gov (United States)

    Pinzur, Michael S

    2016-01-01

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

  8. The Charcot foot in diabetes.

    Science.gov (United States)

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

    2011-09-01

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

  9. 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 ...

  10. Charcot foot and ankle with osteomyelitis

    OpenAIRE

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

    2013-01-01

    This paper presents a review of the current literature discussing topics of Charcot osteoarthropathy, osteomyelitis, diagnosing osteomyelitis, antibiotic management of osteomyelitis, and treatment strategies for management of Charcot osteoarthropathy with concurrent osteomyelitis.Keywords: Charcot foot; osteomyelitis; diabetes mellitus; infection; neuropathy(Published: 1 October 2013)Citation: Diabetic Foot & Ankle 2013, 4: 21361 - http://dx.doi.org/10.3402/dfa.v4i0.21361

  11. An overview of the Charcot foot pathophysiology.

    Science.gov (United States)

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

    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 in-depth investigations of its enigmatic nature to establish useful guidelines. Yet, this goal seems to be beyond reach, without a holistic view of the immense literature concerning the pathophysiology of the disorder. The primary objective of this article is to put together and review the recent advancements about the etiology and intrinsic mechanisms of diabetic Charcot foot.

  12. An overview of the Charcot foot pathophysiology

    Directory of Open Access Journals (Sweden)

    Gökhan Kaynak

    2013-08-01

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

  13. Intramedullary foot fixation for midfoot Charcot neuroarthropathy.

    Science.gov (United States)

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

    2012-01-01

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

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

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

    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.)

  15. Circular External Fixation as a Primary or Adjunctive Therapy for the Podoplastic Approach of the Diabetic Charcot Foot.

    Science.gov (United States)

    Short, Daniel J; Zgonis, Thomas

    2017-01-01

    Numerous techniques have been described for surgical management of the diabetic Charcot foot. External fixation has become a main surgical tool for the reconstructive foot and ankle surgeon when dealing with the ulcerated diabetic Charcot foot. In the presence of an open wound and/or osteomyelitis, staged reconstruction with circular external fixation becomes ideal for salvage of the diabetic lower extremity. Also, circular external fixation can provide simultaneous compression and stabilization, correct the underlying osseous or soft tissue deformities, and surgically offload the diabetic Charcot foot. This article describes a variety of circular external fixation applications for the diabetic Charcot foot.

  16. A novel combination of printed 3-dimensional anatomic templates and computer-assisted surgical simulation for virtual preoperative planning in Charcot foot reconstruction.

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    Giovinco, Nicholas A; Dunn, S Patrick; Dowling, Leslie; Smith, Clifford; Trowell, Larry; Ruch, John A; Armstrong, David G

    2012-01-01

    Charcot foot syndrome (Charcot neuroarthropathy affecting the foot), particularly in its latter stages, may pose a significant technical challenge to the surgeon. Because of the lack of anatomic consistency, preoperative planning with virtual and physical models of the foot could improve the chances of achieving a predictable intraoperative result. In this report, we describe the use of a novel, inexpensive, 3-dimensional template printing technique that can provide, with just a normal printer, multiple "copies" of the foot to be repaired. Although we depict this method as it pertains to repair of the Charcot foot, it could also be used to plan and practice, or revise, 3-dimensional surgical manipulations of other complex foot deformities.

  17. Osteotomies for the Management of Charcot Neuroarthropathy of the Foot and Ankle.

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    Scott, Ryan T; DeCarbo, William T; Hyer, Christopher F

    2015-07-01

    Patients with diabetic neuropathy that develop unstable Charcot neuroarthropathy not only have an autoimmune disease that prolongs the healing process, they also often have an inability to maintain a non-weight bearing status. Charcot neuroarthopathy is often devastating to the structure and stability of the foot and ankle. This disease may require permanent bracing, reconstructive surgical stabilization, and in some cases lower leg amputation. Successful management of Charcot neuroarthopathy requires diligence and surveillance by physician and patient alike.

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

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    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.

  19. Clinical management of acute diabetic Charcot foot in Denmark

    DEFF Research Database (Denmark)

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

    2016-01-01

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

  20. Abductor hallucis muscle flap with circular external fixation for Charcot foot osteomyelitis: a case report

    Directory of Open Access Journals (Sweden)

    Crystal L. Ramanujam

    2011-05-01

    Full Text Available Complicated soft tissue defects of the diabetic foot often call for alternative methods to traditional primary closure. Despite the popularity of microvascular free flaps, local muscle flaps can offer reliable reconstruction for these challenging wounds with shorter surgical times and reduced complication rates. In this article, the authors describe the successful use of the abductor hallucis muscle flap and external fixation for soft tissue reconstruction of a chronic Charcot foot wound and osteomyelitis in a diabetic patient.

  1. Abductor hallucis muscle flap with circular external fixation for Charcot foot osteomyelitis: a case report

    OpenAIRE

    Zgonis, Thomas; Ramanujam, Crystal L.; Facaros, Zacharia

    2011-01-01

    Complicated soft tissue defects of the diabetic foot often call for alternative methods to traditional primary closure. Despite the popularity of microvascular free flaps, local muscle flaps can offer reliable reconstruction for these challenging wounds with shorter surgical times and reduced complication rates. In this article, the authors describe the successful use of the abductor hallucis muscle flap and external fixation for soft tissue reconstruction of a chronic Charcot foot wound and ...

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

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    Nikolaos Papanas

    2013-05-01

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

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

    Science.gov (United States)

    Papanas, Nikolaos; Maltezos, Efstratios

    2013-01-01

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

  4. Charcot foot and ankle with osteomyelitis

    Directory of Open Access Journals (Sweden)

    Ryan Donegan

    2013-10-01

    Full Text Available This paper presents a review of the current literature discussing topics of Charcot osteoarthropathy, osteomyelitis, diagnosing osteomyelitis, antibiotic management of osteomyelitis, and treatment strategies for management of Charcot osteoarthropathy with concurrent osteomyelitis.

  5. Current concepts of Charcot foot in diabetic patients.

    Science.gov (United States)

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

    2016-03-01

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

  6. Diabetic charcot neuroarthropathy of the foot and ankle with osteomyelitis.

    Science.gov (United States)

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

    2014-10-01

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

  7. Mortality Risk of Charcot Arthropathy Compared With That of Diabetic Foot Ulcer and Diabetes Alone

    OpenAIRE

    Sohn, Min-Woong; Lee, Todd A.; Stuck, Rodney M; Frykberg, Robert G.; Budiman-Mak,Elly

    2009-01-01

    OBJECTIVE The purpose of this study was to compare mortality risks of patients with Charcot arthropathy with those of patients with diabetic foot ulcer and those of patients with diabetes alone (no ulcer or Charcot arthropathy). RESEARCH DESIGN AND METHODS A retrospective cohort of 1,050 patients with incident Charcot arthropathy in 2003 in a large health care system was compared with patients with foot ulcer and those with diabetes alone. Mortality was determined during a 5-year follow-up pe...

  8. Comparison of Complications for Internal and External Fixation for Charcot Reconstruction: A Systematic Review.

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    Dayton, Paul; Feilmeier, Mindi; Thompson, Mitchell; Whitehouse, Paul; Reimer, Rachel A

    2015-01-01

    The surgical reconstruction of Charcot deformity can be a challenge for foot and ankle surgeons. Consensus is lacking among surgeons regarding the best method of surgical fixation to be used in reconstruction, and clear strong evidence is also lacking in published studies. We undertook a systematic review of electronic databases and other relevant sources in an attempt to better understand the complications and outcomes associated with internal and external fixation for Charcot foot and ankle reconstruction. A total of 23 level 4 studies with 616 procedures were identified. Of these, 12 studies with 275 procedures used internal fixation, and 11 studies with 341 procedures used external fixation. The odds of a successful outcome with internal fixation was 6.86. The odds of a successful outcome with external fixation was 13.20 (odds ratio 0.52, 95% confidence interval 0.30 to 0.90). The odds of success for internal fixation was 0.52 times as likely as the odds of success with external fixation. Because the odds ratio did not include 1, this difference was statistically significant at the p foot and ankle surgeons when making decisions regarding fixation for Charcot reconstruction.

  9. Doppler spectrum analysis: a potentially useful diagnostic tool for planning the treatment of patients with Charcot arthropathy of the foot?

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    Wu, T; Chen, P-Y; Chen, C-H; Wang, C-L

    2012-03-01

    It is difficult to determine the safe timing of weight-bearing or reconstructive surgery in patients with Charcot arthropathy of the foot and ankle. In this study the Doppler spectrum of the first dorsal metatarsal artery was used to monitor the activity of the disease activity and served as a guideline for management. A total of 15 patients (seven men and eight women) with acute diabetic Charcot arthropathy of the foot and ankle were immobilised in a non-weight-bearing cast. They were followed at two-week intervals and bilateral Doppler spectra of the first dorsal metatarsal arteries were obtained using a 10 MHz linear ultrasound probe. The patients were allowed to start weight-bearing or undergo surgery after the Doppler spectrum had returned to normal pattern. The Doppler spectra in the unaffected limbs were triphasic in pattern, whereas those in limbs with active Charcot arthropathy showed monophasic forward flow. They returned to normal after a mean of 13.6 weeks (6 to 20) of immobilisation. Three patients underwent pan-talar arthrodesis to correct gross instability and deformity. Doppler spectrum analysis of the foot may reflect the activity of the disease in patients with Charcot arthropathy, and may be used as a guide to begin weight-bearing or undergo reconstructive surgery.

  10. Charcot neuroarthropathy of the foot and ankle: a review.

    Science.gov (United States)

    Varma, Ajit Kumar

    2013-01-01

    Charcot neuroarthropathy is a limb-threatening, destructive process that occurs in patients with neuropathy associated with medical diseases such as diabetes mellitus. Clinicians' treating diabetic patients should be vigilant in recognizing the early signs of acute Charcot neuroarthropathy, such as pain, warmth, edema, or pathologic fracture in a neuropathic foot. Early detection and prompt treatment can prevent joint and bone destruction, which, if untreated, can lead to morbidity and high-level amputation. A high degree of suspicion is necessary. Once the early signs have been detected, prompt immobilization and offloading are important. Treatment should be determined on an individual basis, and it must be determined whether a patient can be treated conservatively or will require surgical intervention when entering the chronic phase. If diagnosed early, medical and conservative measures only will be required. Surgery is indicated for patients with severe or unstable deformities that, if untreated, will result in major amputations. A team approach that includes a foot and ankle surgeon, a diabetologist, a physiotherapist, a medical social councilor, and, most importantly, the patient and immediate family members is vital for successful management of this serious condition.

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

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    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.

  12. An overview of conservative treatment options for diabetic Charcot foot neuroarthropathy

    Directory of Open Access Journals (Sweden)

    Crystal L. Ramanujam

    2011-05-01

    Full Text Available Conservative management of Charcot foot neuroarthropathy remains efficacious for certain clinical scenarios. Treatment of the patient should take into account the stage of the Charcot neuroarthopathy, site(s of involvement, presence or absence of ulceration, presence or absence of infection, overall medical status, and level of compliance. The authors present an overview of evidence-based non-operative treatment for diabetic Charcot neuroarthropathy with an emphasis on the most recent developments in therapy.

  13. 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

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

    OpenAIRE

    Tomas Kucera; Haroun Hassan Shaikh; Pavel Sponer

    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.

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

    Directory of Open Access Journals (Sweden)

    Tomas Kucera

    2016-01-01

    Full Text Available 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.

  16. Surgical Correction of the Achilles Tendon for Diabetic Foot Ulcerations and Charcot Neuroarthropathy.

    Science.gov (United States)

    Ramanujam, Crystal L; Zgonis, Thomas

    2017-04-01

    Achilles tendon pathologic conditions are implicated in contributing to the development of many diabetic foot complications including diabetic foot ulceration and Charcot neuroarthropathy. Surgical correction of the diabetic equinus deformity has been studied as an isolated or adjunctive treatment when dealing with difficult-to-close diabetic foot ulcerations or when surgically addressing the diabetic Charcot neuroarthropathy foot or ankle. This article reviews the most common indications, complications, and surgical procedures for equinus correction by either a tendo-Achilles lengthening or gastrocnemius recession for the management of diabetic foot conditions.

  17. The effectiveness of non-surgical interventions in the treatment of Charcot foot.

    Science.gov (United States)

    Smith, Caroline; Kumar, Saravana; Causby, Ryan

    2007-12-01

    Background  Charcot neuropathic osteoarthropathy is commonly known as 'Charcot foot'. It is a serious foot complication of diabetes mellitus that can frequently lead to foot ulceration, gangrene, hospital admission and foot amputation. A multidisciplinary approach to the management of Charcot foot is taken involving medical and allied health professionals. The management approach may also differ between different countries. To date, there is no systematic review of the literature undertaken to identify the clinical effectiveness of non-operative interventions in the treatment of acute Charcot foot. Objective  The objective of this review was to identify the effectiveness of non-surgical interventions with reducing lesions, ulceration, the rate of surgical intervention, reducing hospital admissions and improve the quality of life of subjects with Charcot foot. Search strategy  A comprehensive search strategy was undertaken on databases available from University of South Australia from their inception to November 2006. Selection criteria  Randomised controlled trials or clinical controlled trials were primarily sought. Critical appraisal of study quality and data extraction was undertaken using Joanna Briggs Institute instruments. Review Manager software was used to calculate comparative statistics. Results  This review identified 11 trials and five trials were included in the review. Three trials involved the use of bisphosphonate, a pharmacological agent. Two experimental treatments were also included, evaluating palliative radiology and magnetic fields. No trials were found using immobilisation and off-loading interventions for acute Charcot foot. The overall methodological quality score of the five studies was moderate. Owing to heterogeneous data, meta-analysis could not be performed. The trials did not report on reducing lesions, ulceration, rate of surgical intervention, hospital admissions and the quality of life of subjects with Charcot foot. The

  18. 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.

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

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    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.

  20. Osteomyelitis or Charcot neuro-osteoarthropathy? Differentiating these disorders in diabetic patients with a foot problem

    OpenAIRE

    Bulent M. Ertugrul; Lipsky, Benjamin A.; Savk, Oner

    2013-01-01

    Both osteomyelitis and Charcot neuro-osteoarthropathy (CN) are potentially limb-threatening complications of diabetic neuropathy, but they require quite different treatments. Almost all bone infections in the diabetic foot originate from an infected foot ulcer while diabetic osteoarthropathy is a non-infectious process in which peripheral neuropathy plays the critical role. Differentiating between diabetic foot osteomyelitis and CN requires careful evaluation of the patient, including the med...

  1. Confronting a dramatic situation: the charcot foot complicated by osteomyelitis.

    Science.gov (United States)

    Dalla Paola, Luca

    2014-12-01

    Charcot osteoarthropathy is a serious complication of diabetic neuropathy. Its prevalence in the diabetic population varies in the literature in relation to certain variables, such as the method of assessment, clinical or instrumental; the population studied; and the scope of the selection. This article is intended as a review of the recent literature concerning Charcot osteoarthropathy in its evolution and complications characterized by the development of ulceration and subsequent bone infection. Diagnosis and treatment strategies--either medical or surgical--are discussed both for Charcot arthropathy and osteomyelitis.

  2. Negative-pressure wound therapy in the management of diabetic Charcot foot and ankle wounds.

    Science.gov (United States)

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

    2013-09-23

    As the prevalence of diabetes mellitus continues to rise, innovative medical and surgical treatment options have increased dramatically to address diabetic-related foot and ankle complications. Among the most challenging clinical case scenarios is Charcot neuroarthropathy associated with soft tissue loss and/or osteomyelitis. In this review article, the authors present a review of the most common utilizations of negative-pressure wound therapy as an adjunctive therapy or combined with plastic surgery as it relates to the surgical management of diabetic Charcot foot and ankle wounds.

  3. Negative-pressure wound therapy in the management of diabetic Charcot foot and ankle wounds

    Directory of Open Access Journals (Sweden)

    Crystal L. Ramanujam

    2013-09-01

    Full Text Available As the prevalence of diabetes mellitus continues to rise, innovative medical and surgical treatment options have increased dramatically to address diabetic-related foot and ankle complications. Among the most challenging clinical case scenarios is Charcot neuroarthropathy associated with soft tissue loss and/or osteomyelitis. In this review article, the authors present a review of the most common utilizations of negative-pressure wound therapy as an adjunctive therapy or combined with plastic surgery as it relates to the surgical management of diabetic Charcot foot and ankle wounds.

  4. Risk factors of diabetic foot Charcot arthropathy: a case-control study at a Malaysian tertiary care centre

    Science.gov (United States)

    Fauzi, Aishah Ahmad; Chung, Tze Yang; Latif, Lydia Abdul

    2016-01-01

    INTRODUCTION This study aimed to determine the risk factors of diabetic Charcot arthropathy of the foot among diabetic patients with and without foot problems. METHODS This was a case-control study involving diabetic patients attending the Diabetic Foot Care and Wound Management Clinic at University Malaya Medical Centre, Kuala Lumpur, Malaysia, from June 2010 to June 2011. Data on sociodemographic profiles, foot factors and diabetes characteristics was collected and analysed. RESULTS A total of 48 diabetic patients with Charcot arthropathy of the foot were identified. Data from these 48 patients was compared with those of 52 diabetic patients without foot problems. Up to 83.3% of patients with diabetic Charcot arthropathy presented with unilateral Charcot foot, most commonly located at the midfoot (45.8%). Patients with a history of foot problems, including foot ulcer, amputation, surgery or a combination of problems, had the highest (26-time) likelihood of developing Charcot arthropathy (odds ratio 26.4; 95% confidence interval 6.4–109.6). Other significant risk factors included age below 60 years, more than ten years’ duration of diabetes mellitus and the presence of nephropathy. CONCLUSION A history of prior diabetic foot problems is the greatest risk factor for developing diabetic Charcot arthropathy, compared with other risk factors such as diabetes characteristics and sociodemographic profiles. Preventive management of diabetic foot problems in the primary care setting and multidisciplinary care are of paramount importance, especially among chronic diabetic patients. PMID:27075668

  5. Data mining for identifying novel associations and temporal relationships with Charcot foot.

    Science.gov (United States)

    Munson, Michael E; Wrobel, James S; Holmes, Crystal M; Hanauer, David A

    2014-01-01

    INTRODUCTION. Charcot foot is a rare and devastating complication of diabetes. While some risk factors are known, debate continues regarding etiology. Elucidating other associated disorders and their temporal occurrence could lead to a better understanding of its pathogenesis. We applied a large data mining approach to Charcot foot for elucidating novel associations. METHODS. We conducted an association analysis using ICD-9 diagnosis codes for every patient in our health system (n = 1.6 million with 41.2 million time-stamped ICD-9 codes). For the current analysis, we focused on the 388 patients with Charcot foot (ICD-9 713.5). RESULTS. We found 710 associations, 676 (95.2%) of which had a P value for the association less than 1.0 × 10⁻⁵ and 603 (84.9%) of which had an odds ratio > 5.0. There were 111 (15.6%) associations with a significant temporal relationship (P Charcot foot in the context of pathogenesis models that include neurotrophic, neurovascular, and microtraumatic factors mediated through inflammatory cytokines. Future work should focus on confirmatory analyses. These novel areas of investigation could lead to prevention or earlier diagnosis.

  6. Data Mining for Identifying Novel Associations and Temporal Relationships with Charcot Foot

    Directory of Open Access Journals (Sweden)

    Michael E. Munson

    2014-01-01

    Full Text Available Introduction. Charcot foot is a rare and devastating complication of diabetes. While some risk factors are known, debate continues regarding etiology. Elucidating other associated disorders and their temporal occurrence could lead to a better understanding of its pathogenesis. We applied a large data mining approach to Charcot foot for elucidating novel associations. Methods. We conducted an association analysis using ICD-9 diagnosis codes for every patient in our health system (n=1.6 million with 41.2 million time-stamped ICD-9 codes. For the current analysis, we focused on the 388 patients with Charcot foot (ICD-9 713.5. Results. We found 710 associations, 676 (95.2% of which had a P value for the association less than 1.0×10−5 and 603 (84.9% of which had an odds ratio > 5.0. There were 111 (15.6% associations with a significant temporal relationship P<1.0×10−3. The three novel associations with the strongest temporal component were cardiac dysrhythmia, pulmonary eosinophilia, and volume depletion disorder. Conclusion. We identified novel associations with Charcot foot in the context of pathogenesis models that include neurotrophic, neurovascular, and microtraumatic factors mediated through inflammatory cytokines. Future work should focus on confirmatory analyses. These novel areas of investigation could lead to prevention or earlier diagnosis.

  7. Charcot neuroarthropathy: realignment of diabetic foot by means of osteosynthesis using intramedullary screws – case report,

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    Alexandre Leme Godoy dos Santos

    2014-10-01

    Full Text Available Diabetes mellitus is a serious disease that affects a large portion of the population. Charcot neuroarthropathy is one of its major complications and can lead to osteoarticular deformities, functional incapacity, ulcers and ankle and foot infections. Realignment of the foot by means of arthrodesis presents a high rate of implant failure due to weight-bearing on an insensitive foot. The aim of this report was to describe successful use of intramedullary osteosynthesis with compression screws to stabilize the deformed foot, in a diabetic patient with neuroarthropathy.

  8. Osteomyelitis or Charcot neuro-osteoarthropathy? Differentiating these disorders in diabetic patients with a foot problem.

    Science.gov (United States)

    Ertugrul, Bulent M; Lipsky, Benjamin A; Savk, Oner

    2013-11-05

    Both osteomyelitis and Charcot neuro-osteoarthropathy (CN) are potentially limb-threatening complications of diabetic neuropathy, but they require quite different treatments. Almost all bone infections in the diabetic foot originate from an infected foot ulcer while diabetic osteoarthropathy is a non-infectious process in which peripheral neuropathy plays the critical role. Differentiating between diabetic foot osteomyelitis and CN requires careful evaluation of the patient, including the medical history, physical examination, selected laboratory findings, and imaging studies. Based on available studies, we review the approaches to the diagnostic differentiation of osteomyelitis from CN of the foot in diabetic patients.

  9. Osteomyelitis or Charcot neuro-osteoarthropathy? Differentiating these disorders in diabetic patients with a foot problem

    Directory of Open Access Journals (Sweden)

    Bulent M. Ertugrul

    2013-11-01

    Full Text Available Both osteomyelitis and Charcot neuro-osteoarthropathy (CN are potentially limb-threatening complications of diabetic neuropathy, but they require quite different treatments. Almost all bone infections in the diabetic foot originate from an infected foot ulcer while diabetic osteoarthropathy is a non-infectious process in which peripheral neuropathy plays the critical role. Differentiating between diabetic foot osteomyelitis and CN requires careful evaluation of the patient, including the medical history, physical examination, selected laboratory findings, and imaging studies. Based on available studies, we review the approaches to the diagnostic differentiation of osteomyelitis from CN of the foot in diabetic patients.

  10. Charcot neuroarthropathy: realignment of diabetic foot by means of osteosynthesis using intramedullary screws - case report.

    Science.gov (United States)

    Dos Santos, Alexandre Leme Godoy; Albino, Rômulo Ballarin; Ortiz, Rafael Trevisan; Sakaki, Marcos Hideyo; de Andrade Corsato, Marcos; Fernandes, Tulio Diniz

    2014-01-01

    Diabetes mellitus is a serious disease that affects a large portion of the population. Charcot neuroarthropathy is one of its major complications and can lead to osteoarticular deformities, functional incapacity, ulcers and ankle and foot infections. Realignment of the foot by means of arthrodesis presents a high rate of implant failure due to weight-bearing on an insensitive foot. The aim of this report was to describe successful use of intramedullary osteosynthesis with compression screws to stabilize the deformed foot, in a diabetic patient with neuroarthropathy.

  11. Marked loss of sympathetic nerve fibers in chronic Charcot foot of diabetic origin compared to ankle joint osteoarthritis.

    Science.gov (United States)

    Koeck, Franz-Xaver; Bobrik, Verena; Fassold, Alexander; Grifka, Joachim; Kessler, Sigurd; Straub, Rainer H

    2009-06-01

    The pathogenesis of Charcot foot is based on three disputed factors: (1) loss of neurotrophic influence, (2) microtraumatic lesions, and (3) neurovascular disturbances. These etiological causes were uncovered by clinicophysiological tests. However, no results of quantitative nerve density studies of sympathetic and sensory substance P-positive (SP+) nerve fibers are available. We studied the density of sympathetic and SP+ nerve fibers in three distinct areas of the tarsus. Fifteen patients with ankle osteoarthritis (OA) and 15 patients with diabetic Charcot foot were included. Patients with OA did not differ from those with Charcot foot in SP+ sensory nerve fiber density. However, at all three areas, the density of sympathetic nerve fibers was significantly lower in patients with Charcot foot compared to OA (p = 0.006). In addition, we found that the sympathetic nerve repellent factor semaphorin 3C was highly expressed in inflamed tissue in Charcot patients. In Charcot foot of diabetic origin a severe loss of sympathetic nerve fibers was observed. These findings in chronically inflamed Charcot foot lend support to the neurovascular theory in the late chronic phase, which probably depends on the inflammatory upregulation of nerve repellent factors.

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

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    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.

  13. Conservative and surgical treatment of the chronic Charcot foot and ankle

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    Mehmet Fatih Güven

    2013-08-01

    Full Text Available Charcot neuroarthropathy (CN is a severe joint disease in the foot and ankle that can result in fracture, permanent deformity, and limb loss. It is a serious and potentially limb-threatening lower-extremity late complication of diabetes mellitus. The aim of this manuscript was to evaluate modern concepts of chronic CN through a review of the available literature and to integrate a perspective of management from the authors’ extensive experience.

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

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    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.

  15. 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).

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

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    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.

  17. Charcot foot in diabetes and an update on imaging

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    Fatma Bilge Ergen

    2013-11-01

    Full Text Available Charcot neuroarthropathy (CN is a serious complication of diabetes mellitus that can cause major morbidity including limb amputation. Since it was first described in 1883, and attributed to diabetes mellitus in 1936, the diagnosis of CN has been very challenging even for the experienced practitioners. Imaging plays a central role in the early and accurate diagnosis of CN, and in distinction of CN from osteomyelitis. Conventional radiography, computed tomography, nuclear medicine scintigraphy, magnetic resonance imaging, and positron emission tomography are the imaging techniques currently in use for the evaluation of CN but modalities other than magnetic resonance imaging appeared to be complementary. This study focuses on imaging findings of acute and chronic neuropathic osteoarthropathy in diabetes and discrimination of infected vs. non-infected neuropathic osteoarthropathy.

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

    Science.gov (United States)

    Schade, Valerie L; Andersen, Charles A

    2015-01-01

    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.

  19. 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.

  20. Charcot neuroarthropathy of the foot and ankle: diagnosis and management strategies.

    Science.gov (United States)

    Blume, Peter A; Sumpio, Bauer; Schmidt, Brian; Donegan, Ryan

    2014-01-01

    This article reviews current literature discussing the etiology, pathophysiology, diagnosis and imaging, and conservative and surgical treatment of Charcot osteoarthropathy. The treatment of Charcot osteoarthropathy with concurrent osteomyelitis is also discussed.

  1. 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)....

  2. 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.

  3. Factors associated with foot and ankle strength in healthy preschool-age children and age-matched cases of Charcot-Marie-Tooth disease type 1A.

    Science.gov (United States)

    Rose, Kristy J; Burns, Joshua; North, Kathryn N

    2010-04-01

    Charcot-Marie-Tooth disease affects foot and ankle strength from the earliest stages of the disease; however, little is known about factors influencing normal strength development or the pathogenesis of foot weakness and deformity in Charcot-Marie-Tooth disease. The authors investigated factors associated with foot and ankle strength in healthy preschool-age children and compared to age-matched cases of Charcot-Marie-Tooth disease type 1A. In healthy children, ankle dorsiflexion range of motion was one of the strongest independent correlates of foot and ankle strength. Compared with healthy children, those with Charcot-Marie-Tooth disease type 1A had significantly less dorsiflexion strength and range as well as imbalance in inversion-to-eversion and plantarflexion-to-dorsiflexion strength ratios. Given the association between ankle dorsiflexion strength and range in the healthy children, and the abnormality of these parameters in Charcot-Marie-Tooth disease, investigation of the cause-effect relationship is warranted to identify more targeted therapy and further understand the pathogenesis of foot deformity in Charcot-Marie-Tooth disease.

  4. Misunderstanding of foot drop in a patient with charcot-marie-tooth disease and lumbar disk herniation.

    Science.gov (United States)

    Han, Youngmin; Kim, Kyoung-Tae; Cho, Dae-Chul; Sung, Joo-Kyung

    2015-04-01

    We report the case of 57-year-old woman diagnosed with Charcot-Marie-Tooth (CMT) disease and lumbar disk herniation (LDH). She had left leg weakness and foot numbness, foot deformity (muscle atrophy, high arch, and clawed toes). The lumbar spine MRI showed LDH at L4-5. Additionally, electrophysiology results were consistent with chronic peripheral motor-sensory polyneuropathy (axonopathy). In genetic testing, 17p11.2-p12 duplication/deletions characteristic of CMT disease were observed. We confirmed the patient's diagnosis as CMT disease and used conservative treatment.

  5. 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.

  6. 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.

  7. The management of Charcot joint disease affecting the ankle and foot by arthrodesis controlled by an Ilizarov frame: early results.

    Science.gov (United States)

    El-Gafary, K A M; Mostafa, K M; Al-Adly, W Y

    2009-10-01

    Charcot osteoarthropathy of the foot is a chronic and progressive disease of bone and joint associated with a risk of amputation. The main problems encountered in this process are osteopenia, fragmentation of the bones of the foot and ankle, joint subluxation or even dislocation, ulceration of the skin and the development of deep sepsis. We report our experience of a series of 20 patients with Charcot osteoarthropathy of the foot and ankle treated with an Ilizarov external fixator. The mean age of the group was 30 years (21 to 50). Diabetes mellitus was the underlying cause in 18 patients. Five had chronic ulcers involving the foot and ankle. Each patient had an open lengthening of the tendo Achillis with excision of all necrotic and loose bone from the ankle, subtalar and midtarsal joints when needed. The resulting defect was packed with corticocancellous bone graft harvested from the iliac crest and an Ilizarov external fixator was applied. Arthrodesis was achieved after a mean of 18 weeks (15 to 20), with healing of the skin ulcers. Pin track infection was not uncommon, but no frame had to be removed before the arthrodesis was sound. Every patient was able to resume wearing regular shoes after a mean of 26.5 weeks (20 to 45).

  8. 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.)

  9. Dynamic pedobarography and radiographic evaluation of surgically treated cavovarus foot deformity in children with Charcot-Marie-Tooth disease.

    Science.gov (United States)

    Erickson, Steven; Hosseinzadeh, Pooya; Iwinski, Henry J; Muchow, Ryan C; Talwalkar, Vishwas R; Walker, Janet L; Milbrandt, Todd A

    2015-07-01

    Pedobarography is a common tool for the evaluation of foot deformity. We describe our radiographic and pedobarographic outcomes of surgical treatment of cavovarus foot deformity in children with Charcot-Marie-Tooth disease. Nineteen patients for a total of 30 feet were included. Preoperative and postoperative dynamic pedobarographic measurements were made and analyzed using the five-mask technique. Pedobarographic measures showed statistical significance for increased contact area and decreased peak forces in most mask areas after surgical treatment. Peak pressure and redistribution of varus pressure patterns trended toward improvement. We found pedobarographic studies helpful; however, pedobarographic data are somewhat difficult to interpret and should be used in addition to clinical and radiographic examination.

  10. 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.

  11. Who was first to diagnose and report neuropathic arthropathy of the foot and ankle: Jean-Martin Charcot or Herbert William Page?

    Science.gov (United States)

    Sanders, Lee J; Edmonds, Michael E; Jeffcoate, William J

    2013-09-01

    In November 1883, Jean-Martin Charcot and Charles Féré reported on bone and joint disease of the foot in cases of tabes dorsalis, and referred to the condition as 'pied tabétique'--a disabling neuropathic osteoarthropathy that we usually now refer to as the Charcot foot. Charcot had originally described neuropathic osteoarthropathy in more proximal joints in 1868, and in his 1883 paper with Féré stated that involvement of the short bones and small joints of the foot had not yet been described. They emphasised in the paper that one of their cases was the first ever observed, two years earlier, in 1881. It is relevant, however, that it was in this same year that involvement of the foot by tabetic arthropathy was presented to the International Medical Congress in London by an English surgeon, Herbert William Page. We believe that Page was the first to diagnose and to report a case of tabetic neuropathic osteoarthropathy in which the bones of the foot and ankle were involved. He was also the first to propose a link between the tabetic foot and disease of the peripheral nerves, as opposed to the central nervous system.

  12. 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...

  13. Proximal tibia reconstruction with a porous tantalum cone in a patient with Charcot arthropathy.

    Science.gov (United States)

    Troyer, Joshua; Levine, Brett R

    2009-05-01

    Neuropathic arthritis, or Charcot arthropathy, is a rapidly destructive process associated with nerve damage and periarticular insensitivity. Most commonly it is associated with diabetes mellitus, tabes dorsalis, syringomyelia, or other peripheral nerve disorders. Clinical manifestations of this disorder classically include gross deformity, crepitus, lack of proprioception, joint effusion, calor, and decreased awareness of pain in the affected joint. Often the clinical picture is difficult to distinguish from septic arthritis. Radiographic findings are typically worse than portrayed during clinical examination. Rapid destruction of the articular surface with bony fragmentation is commonly found. The incidence of neuropathic arthritis among all diabetic patients is relatively small, ranging between 0.15% and 0.4%. Historically, there have been conflicting reports as to the efficacy of total knee arthroplasty (TKA) in patients with neuropathic arthritis. However, recent literature on the use of modern implants has been more optimistic as to the success of TKA. Difficulties associated with severe bone loss, poor bone quality, and ligamentous laxity may necessitate the use of structural allografts/augments, as well as stemmed and/or constrained TKA components. This article presents a case of a patient with Charcot arthropathy of the knee secondary to diabetes mellitus (type 2) treated successfully with a minimally constrained TKA and a porous tantalum cone (Zimmer, Warsaw, Indiana) as an "internal plate," for reconstruction of a combined segmental/cavitary defect of the proximal tibia. At 2-year follow-up, radiographs revealed stable TKA components with reconstitution of the fragmented proximal tibia around an osseointegrated porous cone.

  14. MODERN APPROACHES TO SURGICAL TREATMENT OF CHARCOT NEUROARTHROPATHY (review

    Directory of Open Access Journals (Sweden)

    S. V. Pavlyuchenko

    2016-01-01

    Full Text Available The present review addresses a pressing orthopaedic issue of surgical treatment for patients with severe foot deformities occurring as consequence to Charcot neuroarthropathy. Described pathology is a severe threatening condition causing high risk of infections and potential limb loss. The paper describes main foot reconstructive procedures employed depending on pathology stage and localization as well as identifies ways to improve surgical treatment of affected patients.

  15. 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

  16. 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.

  17. Reconstructive foot and ankle surgeries in diabetic patients

    Directory of Open Access Journals (Sweden)

    Ajit Kumar Varma

    2011-01-01

    Full Text Available Diabetic foot and ankle deformities are secondary to long-standing diabetes and neglected foot care. The concept of surgical correction for these deformities is quite recent. The primary objective of reconstructive foot and ankle surgery is the reduction of increased plantar pressures, reduction of pain and the restoration of function, stability and proper appearance. Foot and ankle deformities can result in significant disability, loss of life style, employment and even the loss of the lower limb. Therefore, restoration of normal, problem free foot function and activities will have a significant impact on peoples′ lives. Reconstructive surgical procedures are complex and during reconstruction, internal and external fixation devices, including pins, compression screws, staples, and wires, may be used for repair and stabilization. The surgeries performed depend on the type and severity of the condition. Surgery can involve any part of the foot and ankle, and may involve tendon, bone, joint, tissue or skin repair. Corrective surgeries can at times be performed on an outpatient basis with minimally invasive techniques. Recovery time depends on the type of condition being treated.

  18. Clinical Characteristics of Charcot Foot in Patients with Diabetes:A Report of Eleven Cases%糖尿病夏科足临床特点分析

    Institute of Scientific and Technical Information of China (English)

    姜鹏; 费军; 姜玉峰; 兰颖; 王玉珍; 许樟荣

    2012-01-01

    Objective To summarize the clinical features of Charcot foot in diabetes and to improve the understanding of Charcot's Foot in physicians. Methods Clinical features of 11 type 2 diabetes patients with Charcot foot were retrospectively analyzed. Results Of the 11 patients, 7 were male and 4 were female with an average age of (60 ± 11) and average diabetes his-tory of 16 years. All the patients were accompanied with neuropathy but without lower extremity microangiopathy. 10 patients had unilateral foot lesion and 1 case had bilateral feet lesion. 3 cases had definite history of trauma before onset. Imaging showed that 7 cases had bone destruction , 6 cases had narrowed joint space , 3 cases had swollen soft tissues , 2 cases had subluxation , 2 cases had joint fusion, and 1 case had broken bone. The activities of the 11 patients were restricted by following the doctor's ad-vice. Foot ulcer was given positive debridement and the ulcer 's dressings were also changed. Antibiotics were selected according to the results of bacteria culture and drug sensitive test. Of the 10 patients accompanied with foot ulcer , 1 case healed after toe am-putation, 3 cases healed, 5 cases were improved and 1 case was lost to following up. 3 cases relapsed into foot ulcer after dis-charge from hospital. Conclusion Early diagnosis and immobilization are beneficial for the healing of foot ulcer and can inhibit the development of Charcot foot.%目的 总结糖尿病夏科足的临床特点,提高临床医师对于本病的认识.方法 回顾性分析11例2型糖尿病夏科足患者的临床特点.结果 11例患者中,男7例,女4例;平均年龄(60±11)岁;平均糖尿病病程16年;全部合并神经病变而无下肢血管病变;单侧足病变10例,双足病变1例;3例发病前有明确的外伤史.影像学表现为足部骨质破坏7例,关节间隙变窄6例,软组织肿胀3例,关节半脱位2例,关节融合2例,碎骨1例.11例患者一入院均遵医嘱限制活动.对足溃

  19. 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.

  20. 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...

  1. 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.

  2. [Charcot-arthropathy in diabetes mellitus

    NARCIS (Netherlands)

    Schoonbeek, A.; Ottens, R.L.J.M.; Lutterman, J.A.

    2002-01-01

    Charcot's arthropathy is a relative uncommon complication of diabetic neuropathy. The aetiology remains poorly understood. According to the neurotraumatic theory, the foot, which has become insensitive through neuropathy, is subjected to extensive (micro)trauma through continuation of use. Ultimatel

  3. A comparative study of zoledronic acid and once weekly Alendronate in the management of acute Charcot arthropathy of foot in patients with diabetes mellitus

    Directory of Open Access Journals (Sweden)

    R Bharath

    2013-01-01

    Full Text Available Aim: The aim of this study was to assess and compare the response to two forms of treatment-immobilization with zoledronic acid injection and immobilization with oral weekly Alendronate, in patients with diabetes mellitus and acute Charcot arthropathy (CA of foot in terms of clinical and radiological parameters. Material and Methods: Patients attending the endocrinology and podiatry clinic with history of diabetes mellitus and Acute CA were taken for study. The patients were randomized into two treatment groups. Group Z-zoledronic acid injection along with total contact cast (TCC. Group A-Tab. Alendronate 70 mg. once a week till the complete clinical resolution of acute CA along with TCC. Forty-five patients were randomized and 40 of them completed the study. The primary end point was complete clinical resolution of acute CA-defined as temperature difference between normal and affected foot <1oF. Results: Among the 40 patients, 30 (75% had complete clinical resolution. The mean number of days taken for complete clinical resolution since the initiation of treatment (either Zoledronic acid or Alendronate was approximately 122 days. There was no significant difference in a number of days required for complete clinical resolution, between the two forms of therapy. There was more than 50% reduction in the visual score between the baseline and the final scan. The target to non-target ratio in the skeletal phase also showed an average of 40% reduction from the baseline to the final skeletal scintigraphy. Conclusion: Both Intravenous Zoledronic acid and oral alendronate had comparable efficacy with respect to the time taken for attaining complete clinical resolution of acute CA of foot. However, Alendronate therapy was cost effective among the two. 99m Tc MDP bone scan can be used as an adjuvant to the clinical parameters in assessing the response to therapy.

  4. 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

  5. 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.

  6. Identification of high-risk groups of charcot foot in the people with diabetic foot neuropathic ulcerations%糖尿病足神经性溃疡进展为Charcot足的高危因素分析

    Institute of Scientific and Technical Information of China (English)

    王璐宁; 关小宏; 田慧

    2016-01-01

    Objective To identify high⁃risk groups of Charcot foot( CN) in the people with diabetic foot neuropathic ulcerations( NU) . Methods Twenty cases patients with CN who were diagnosed in General Hospital of the Chinese People Air Force from June 2008 to June 2013 and 58 patients with diabetic neuropathic ulcer who were hospitalized from January 2010 to December 2011 and followed up until June 2014 without foot deform⁃ity were retrospectively analyzed. All patient's general condition, examination and laboratory results, diabetic chronic complications,complication,diabetes distribution of foot ulcers,and plain features. Results There were no statistically significant differences in terms of patients' average age, sex ratio, proportion of smokers, BMI, HbA1c,blood lipid,dorsalis pedis artery diameter and diabetic nephropathy (Ⅲ⁃Ⅳperiod) ,chronic kidney dis⁃ease stage 3 above,proliferation diabetic retinal pathological changes,the prevalence of coronary heart disease between the two groups(P>0. 05). Compared with NU group,patients with single high proportion(40. 00%(8/20) vs. 10. 34%(6/58)),Short duration of diabetes((12. 37±5. 64) years vs. (14. 27±8. 04) years),Feet long numbness(6(5,9) years vs. 4(2,20) years),low rate of hardening of the arteries narrow(ABI<0. 9)( 0 ( 0/20) vs. 39. 66%( 13/58) ) ,high recurrent diabetic foot ulcer prevalence( 70. 00%( 14/20) vs. 25. 86%( 15/58)),more patients with diabetes mellitus autonomic neuropathy(75. 00%(15/20) vs. 39. 66%(23/58)),less combined with hypertension ( 25. 00%( 5/20 ) vs. 58. 62%( 34/58 ) ) , the differences were significant ( t orχ2=6. 981,2. 259,4. 068,3. 887,12. 405,7. 436,6. 724;P<0. 05) . Diabetic foot wound distribution on mesopodi⁃um of CN group and NU group was 36. 84%(7/19),6. 90%(4/58) respectively,the difference was significant (χ2=11. 443,P=0. 003) . Diabetic foot amputation rate( Wanger 4,5 grade) of CN group and NU group was 44. 44%(4/9),6. 90%(2/29) respectively,the difference was

  7. 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

  8. 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......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...

  9. 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.

  10. Late Corrective Arthrodesis in Nonplantigrade Diabetic Charcot Midfoot Disease Is Associated with High Complication and Reoperation Rates

    Directory of Open Access Journals (Sweden)

    Anica Eschler

    2015-01-01

    Full Text Available Introduction. Charcot arthropathy may lead to a loss of osteoligamentous foot architecture and consequently loss of the plantigrade alignment. In this series of patients a technique of internal corrective arthrodesis with maximum fixation strength was provided in order to lower complication rates. Materials/Methods. 21 feet with severe nonplantigrade diabetic Charcot deformity Eichenholtz stages II/III (Sanders/Frykberg II/III/IV and reconstructive arthrodesis with medial and additional lateral column support were retrospectively enrolled. Follow-up averaged 4.0 years and included a clinical (AOFAS score/PSS, radiological, and complication analysis. Results. A mean of 2.4 complications/foot occurred, of which 1.5/foot had to be solved surgically. 76% of feet suffered from soft tissue complications; 43% suffered hardware-associated complications. Feet with only 2 out of 5 high risk criteria according to Pinzur showed significantly lower complication counts. Radiographs revealed a correct restoration of all foot axes postoperatively with superior fixation strength medially. Conclusion. Late corrective arthrodesis with medial and lateral column stabilization in the nonplantigrade stages of neuroosteoarthropathy can provide reasonable reconstruction of the foot alignment. Nonetheless, overall complication/reoperation rates were high. With separation into low/high risk criteria a helpful guide in treatment choice is provided. This trial is registered with German Clinical Trials Register (DRKS under number DRKS00007537.

  11. 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.

  12. 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.

  13. 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.

  14. Foot and ankle reconstruction: an experience on the use of 14 different flaps in 226 cases.

    Science.gov (United States)

    Zhu, Yue-Liang; Wang, Yi; He, Xiao-Qing; Zhu, Min; Li, Fu-Bin; Xu, Yong-Qing

    2013-11-01

    The aim of this report was to present our experience on the use of different flaps for soft tissue reconstruction of the foot and ankle. From 2007 to 2012, the soft tissue defects of traumatic injuries of the foot and ankle were reconstructed using 14 different flaps in 226 cases (162 male and 64 female). There were 62 pedicled flaps and 164 free flaps used in reconstruction. The pedicled flaps included sural flap, saphenous flap, dorsal pedal neurocutaneous flap, pedicled peroneal artery perforator flap, pedicled tibial artery perforator flap, and medial plantar flap. The free flaps were latissimus musculocutaneous flap, anterolateral thigh musculocutaneous flap, groin flap, lateral arm flap, anterolateral thigh perforator flap, peroneal artery perforator flap, thoracdorsal artery perforator flap, medial arm perforator flap. The sensory nerve coaptation was not performed for all of flaps. One hundred and ninety-four cases were combined with open fractures. One hundred and sixty-two cases had tendon. Among 164 free flaps, 8 flaps were completely lost, in which the defects were managed by the secondary procedures. Among the 57 flaps for plantar foot coverage (25 pedicled flaps and 32 free flaps), ulcers were developed in 5 pedicled flaps and 6 free flaps after weight bearing, and infection was found in 14 flaps. The donor site complications were seen in 3 cases with the free anterolateral thigh perforator flap transfer. All of limbs were preserved and the patients regained walking and daily activities. All of patients except for one regained protective sensation from 3 to 12 months postoperatively. Our experience showed that the sural flap and saphenous flap could be good options for the coverage of the defects at malleolus, dorsal hindfoot and midfoot. Plantar foot, forefoot and large size defects could be reconstructed with free anterolateral thigh perforator flap. For the infected wounds with dead spce, the free latissimus dorsi musculocutaneous flap remained to

  15. Charcot in contemporary literature.

    Science.gov (United States)

    Goetz, Christopher G

    2006-03-01

    Charcot and his medical observations remain an enduring topic of scientific study in neurology, but he is also the topic of modern literary works. This essay examines the depiction of Jean-Martin Charcot (1825-1893) as a character in late-twentieth-century literature as an index of the contemporary nonmedical literary public's interest in neurology and Charcot. It focuses on three contemporary works that involve Charcot as a central figure with comparison between primary source documents and the rendered context, character development, and plot lines of these literary works. The two French novels [Slumbers of Indiscretion and Dr. Charcot of the Salpêtrière] and one American play [Augustine (Big Hysteria)] approach Charcot and neurology with differing levels of historical accuracy. All create a figure of authority, each with a different coloration of the balance between power and its abuse. Two focus almost exclusively on his work with hysteria and inaccurately amplify Charcot's concern with symbolic sexual conflict as the origin of hysteria and fictionalize more extensive interactions with Freud than historical documents support. The three works demonstrate that Charcot retains an enduring fascination with an enigmatic personality, a controversial career, and a pivotal role in the development of studies involving the brain and behavior. Neurologists should not look to these works as replacements for more seriously composed historical studies, but as enrichments anchored in the imaginative possibilities of Charcot and his fin de siècle era.

  16. Reverse peroneal artery flap for large defects of ankle and foot: A reliable reconstructive technique

    Directory of Open Access Journals (Sweden)

    Jose Tharayil

    2012-01-01

    Full Text Available Background: Large soft tissue defects around the lower third of the leg, ankle and foot always have been challenging to reconstruct. Reverse sural flaps have been used for this problem with variable success. Free tissue transfer has revolutionised management of these problem wounds in selected cases. Materials and Methods: Twenty-two patients with large defects around the lower third of the leg, ankle and foot underwent reconstruction with reverse peroneal artery flap (RPAF over a period of 7 years. The mean age of these patients was 41.2 years. Results: Of the 22 flaps, 21 showed complete survival without even marginal necrosis. One flap failed, where atherosclerotic occlusion of peroneal artery was evident on the table. Few patients had minor donor site problems that settled with conservative management. Conclusions: RPAF is a very reliable flap for the coverage of large soft tissue defects of the heel, sole and dorsum of foot. This flap adds versatility in planning and execution of this extended reverse sural flap.

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

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    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.

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

    DEFF Research Database (Denmark)

    Fosbol, M.; Reving, S.; Petersen, E. H.

    2017-01-01

    neuropathic osteoarthropathy (CNO) of the foot. METHOD: A retrospective cohort study of TPBS performed on 148 patients with suspected acute CNO referred from a single specialized diabetes care centre. The quantitative blood flow distribution was calculated based on the method described by Deutsch et al. All...

  19. 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...... was the patients with acute Charcot foot (n=17) or chronic Charcot foot (n=7). The inclusion criterion for an acute Charcot foot was a temperature difference of more than 2° between the two feet, oedema of the affected foot, typical hotspots in a bone scintigram and a typical clinical course. In addition, patients...... with first toe amputation (n=5), a high-risk group for development of CA, and two control groups consisting of diabetes patients with (n=9) or without somatic neuropathy (n=11) were investigated. Regional blood flow in the feet was measured by venous occlusion plethysmography. Quantitation of somatic...

  20. Reconstruction of soft tissue defects at the foot and ankle after oncological resection

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    Andrej eRing

    2016-03-01

    Full Text Available Introduction: Solid malignancies at the foot and ankle region are rare and include mainly soft tissue sarcomas, bone sarcomas and skin malignancies. Complete surgical resection with clear margins still remains the mainstay of therapy in these malignancies. However, attainment of negative surgical margins in patients with locally advanced tumors of the foot and ankle region may require extensive surgery and could result in loss of extremity function. In these circumstances, plastic surgical techniques can frequently reduce functional impairment and cover soft tissue defects, particularly in cases of large tumor size or localization adjacent to critical anatomic structures, thereby improving the quality of life for these patients. The aim of this article is to illustrate the various treatment options of plastic surgery in the multimodal therapy of patients with malignant tumors of the foot and ankle region.Material und methods: This article is based on the review of the current literature and the evaluation of the author’s own patient database.Results: The local treatment of malignant extremity tumors has undergone major changes over the last few decades. Primary amputations have been increasingly replaced by limb-sparing techniques, preserving extremity function as much as possible. Although defect coverage at the foot and ankle region is demanding due to complex anatomical features and functional requirements, several plastic surgical treatment options can be implemented in the curative treatment of patients with malignant solid tumors in this area. Soft tissue defects after tumor resection can be covered by a variety of local flaps. If local flaps are not applicable, free flap transfers, such as the anterolateral thigh (ALT flap, parascapular flap or latissimus dorsi flap, can be utilized to cover nearly all kinds of defects in the foot and ankle region. Conclusion: Soft tissue reconstruction in the foot and ankle region is a vital component

  1. 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.

  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. [Charcot and hysteria].

    Science.gov (United States)

    Widlöcher, D; Dantchev, N

    1994-01-01

    Charcot's work on hysteria has always been controversial. All his attitudes, whether on the theory of the ovary, the hysteroepileptic seizure or the use of hypnosis, have always been charicatured, misunderstood and separated from the wider context of his overall approach. Rereading Charcot's works shows that he developed his approach progressively over a period of more than 20 years before coming to his psychological model of hysteria. This model explains the formation of the symptom and the hysterical conversion via a mechanism of being ignorant of the motor representation. This concept has never been disproven and remains the only theory explaining the formation of the hysteria symptom. Based on Charcot's fundamental contribution, Freud and Janet further developed their work on the psychopathology of hysteria.

  4. [Jean-martin charcot].

    Science.gov (United States)

    Sakuta, Manabu

    2014-11-01

    Charcot created a system for the classification and diagnosis of neurological patients in the 1850s. His methodology consisted of listening to a patient's family history and present history, observing the patient scrupulously, and confirming lesions by autopsy once the patient was dead. He compared two different diseases in order to make their differences clear. Once he understood the fundamental form of a disease, he proceeded to study less perfect forms that had a single symptom. By this process, Charcot developed many new symptomatologies in Neurology.

  5. [Reconstructive surgery of sequelae of compartment syndrome of the lower leg and/or foot. Presentation of a new classification].

    Science.gov (United States)

    Zwipp, H

    2008-10-01

    The sequelae of an undiagnosed insufficiently treated or unpreventable (by crush injury) compartment or postischemic syndrome, most often after lower leg fracture or popliteal artery injury, are caused by necrosis and contracture of the extrinsic foot muscles. Therefore claw toes, pes equinus or other forms, such as a severe pes equino varus related to the compartment involved will decide the kind of foot deformity. In cases of a combined compartment syndrome of the lower leg and foot, not only the extrinsic but also the intrinsic muscles especially the short flexors are involved, leading to extensive claw toeing of the hallux and the lesser toes as well. In the case of an isolated compartment syndrome of the foot one will see contracted hammer toes most often after open or third degree closed calcaneal fractures. A new classification of all the different deformities of the foot and ankle as sequelae of a compartment and/or postischemic syndrome, is introduced distinguishing 5 degrees of deformity. Between 1994 and 2006, a total of 66 patients with sequelae of a compartment and/or postischemic syndrome were treated at the Department of Trauma and Reconstructive Surgery of the University Hospital"Carl Gustav Carus" of the Technical University of Dresden. Patients with contract hammer toes after calcaneal fractures were seen most often (n=26). Another large group of 24 patients suffered from the sequelae of a compartment and/or postischemic syndrome of the extrinsic muscles of the superficial and deeper compartment of the flexor tendons, producing a severe pes equino varus. Less common (n=16) were the deformities caused by an isolated compartment syndrome, such as necrosis of the anterior tibialis, long extensor muscles, peroneal muscles or a combined compartment syndrome of the lower leg and foot.

  6. 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.

  7. Charcot and vascular Parkinsonism

    Directory of Open Access Journals (Sweden)

    Hélio A. G. Teive

    Full Text Available ABSTRACT Jean-Martin Charcot (1825-1893, recognized as the founder of Neurology and the first formal teacher of nervous system diseases, died on August 16, 1893, from acute pulmonary edema secondary to myocardial infarction. In his last years, there were several descriptions of his gait and posture disorders, suggesting the diagnosis of “lower-half parkinsonism” due to cerebrovascular disease.

  8. 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.

  9. Charcot arthropathy in ultrasound examination – a case report

    Directory of Open Access Journals (Sweden)

    Mateusz Płaza

    2016-06-01

    Full Text Available 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.

  10. Charcot arthropathy in ultrasound examination – a case report

    Science.gov (United States)

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

    2016-01-01

    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. PMID:27446605

  11. A vascularized osteocutaneous fibular free flap for reconstruction of a complex injury of the foot.

    Science.gov (United States)

    Chung, Y K; Hong, J P; Kang, S Y; Kim, S W; Tark, K C

    2000-11-01

    The foot plays a vital role in standing and gait. Its function results from harmonious interaction of bones, joints, and soft tissue. An imbalance or a defect in these structures can result in problems. The cuneiform bone of the foot consists of three bones: medial, intermediate, and lateral. Its structure plays an important role in maintaining the skeletal arch and it supports the body's weight. A defect or dislocation can disrupt the distribution of the weight-bearing complex of the foot and can lead to difficult gait.

  12. Free Medial Plantar Flap Connection with a Posterior Tibial Artery Flap in Reconstruction of Fore–Mid Foot Skin Defect

    Science.gov (United States)

    Wu, Hao; Sheng, Jia-Gen

    2016-01-01

    Background: Although there are many surgical treatments for covering the skin defect of the fore–mid foot, how to reconstruct the weight-bearing region remains a challenge. The weight-bearing region of the sole needs to withstand the pressure and shearing stresses of walking, so the plantar skin is anatomically different from other skins in the areas of texture, thickness, subcutaneous tissue, etc. Medial plantar flaps that are harvested from the instep region are regarded as the first choice for weight-bearing region reconstruction because of their excellent functional and aesthetic long-term result. However, when facing an extensive skin defect on a weight-bearing area such as a fore–mid foot avulsion, the application of this flap is limited because if we put the flap in a weight-bearing area of the forefoot, the set of vessels will be exposed to outside. Methods: We suggest 2 connected free flaps (posterior tibial artery flap and medial plantar flap) pedicled with 1 set of vessels. The medial plantar flap was used to cover the skin defect of the weight-bearing area in the forefoot. The dorsal skin defect of the injured foot was covered with a posterior tibial artery flap and supplied the medial plantar flap with the posterior tibial vessel. The midfoot skin defect was repaired by a full-skin grafting. Results: Long-term follow-up results showed that the shape and function of the injured limbs recovered almost entirely. Conclusion: This method of connected flaps is suitable for repairing large skin defects of the fore–mid foot. PMID:27975013

  13. Plantar Temperature Response to Walking in Diabetes with and without Acute Charcot: The Charcot Activity Response Test

    Directory of Open Access Journals (Sweden)

    Bijan Najafi

    2012-01-01

    Full Text Available Objective. Asymmetric plantar temperature differences secondary to inflammation is a hallmark for the diagnosis and treatment response of Charcot foot syndrome. However, little attention has been given to temperature response to activity. We examined dynamic changes in plantar temperature (PT as a function of graduated walking activity to quantify thermal responses during the first 200 steps. Methods. Fifteen individuals with Acute Charcot neuroarthropathy (CN and 17 non-CN participants with type 2 diabetes and peripheral neuropathy were recruited. All participants walked for two predefined paths of 50 and 150 steps. A thermal image was acquired at baseline after acclimatization and immediately after each walking trial. The PT response as a function of number of steps was examined using a validated wearable sensor technology. The hot spot temperature was identified by the 95th percentile of measured temperature at each anatomical region (hind/mid/forefoot. Results. During initial activity, the PT was reduced in all participants, but the temperature drop for the nonaffected foot was 1.9 times greater than the affected side in CN group (P=0.04. Interestingly, the PT in CN was sharply increased after 50 steps for both feet, while no difference was observed in non-CN between 50 and 200 steps. Conclusions. The variability in thermal response to the graduated walking activity between Charcot and non-Charcot feet warrants future investigation to provide further insight into the correlation between thermal response and ulcer/Charcot development. This stress test may be helpful to differentiate CN and its response to treatment earlier in its course.

  14. Diagnosis of Charcot-Marie-Tooth Disease

    Directory of Open Access Journals (Sweden)

    Isabel Banchs

    2009-01-01

    Full Text Available Charcot-Marie-Tooth (CMT disease or hereditary motor and sensory neuropathy (HMSN is a genetically heterogeneous group of conditions that affect the peripheral nervous system. The disease is characterized by degeneration or abnormal development of peripheral nerves and exhibits a range of patterns of genetic transmission. In the majority of cases, CMT first appears in infancy, and its manifestations include clumsiness of gait, predominantly distal muscular atrophy of the limbs, and deformity of the feet in the form of foot drop. It can be classified according to the pattern of transmission (autosomal dominant, autosomal recessive, or X linked, according to electrophysiological findings (demyelinating or axonal, or according to the causative mutant gene. The classification of CMT is complex and undergoes constant revision as new genes and mutations are discovered. In this paper, we review the most efficient diagnostic algorithms for the molecular diagnosis of CMT, which are based on clinical and electrophysiological data.

  15. 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

  16. 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.

  17. 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.)

  18. Charcot joints as chronic complications of diabetes mellitus

    Directory of Open Access Journals (Sweden)

    Peter Andrea

    2002-01-01

    Full Text Available Introduction Charcot joints are considered to be chronic complications of diabetes mellitus. Although it is not a common disease, due to its progressive character, it can lead to permanent immobility and reduces quality of life in these patients. It is known that evolution of Charcot joints has three stages and the best results of therapy can only be achieved in the first stage. Later, only surgical treatment can be considered with very poor results. Case report This is a case report of a young patient with a very severe form of diabetic arthropathy and other complications of diabetes. This 27-year old woman suffered from diabetes for 10 years and her family history showed that her grandfather and uncle had diabetes too. During physical examination severe deformities of the foot and malleolus were detected. Detection of chronic complications required evaluation of the level of neuropathy. Discussion Chronic complications of diabetes are very frequent. A severe form of complications are Charcot joints that can lead to permanent immobility. That is why it is important to recognize the early signs and symptoms of these changes in order to treat them in the early phase when best results are expected.

  19. 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.).

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

    Science.gov (United States)

    Teive, Hélio A G; Munhoz, Renato P; Simões, Jefferson C

    2012-04-01

    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.

  1. Outpatient assessment and management of the diabetic foot.

    Science.gov (United States)

    DiPreta, John A

    2014-03-01

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

  2. 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.

  3. 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.

  4. Current Approaches to Diagnosis and Classification Features of Neuroosteoarthropathy Charcot (literature review

    Directory of Open Access Journals (Sweden)

    Balatiuk Irina

    2016-12-01

    Full Text Available The article provides the analysis of the publications of domestic and foreign authors on such complication of diabetes as diabetic Charcot osteoarthropathy. It formulates modern domestic classification of diabetic foot syndrome. It has been stated that diabetic foot syndrome is a serious medical and social problem, due to the high level of disability of patients, it causes significant social and economic losses to society. Pathogenetic basis for the development of diabetic osteoarthropathy is a combination of uncontrolled bone resorption and the lack of sensitivity of the defense, which leads to the destruction of joints. The gold standard for diagnosis of Charcot osteoarthropathy is X-ray densitometry that allows you to objectively assess the state of bone mineral density.

  5. 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.

  6. [Charcot, Freud and the unconscious].

    Science.gov (United States)

    Lellouch, Alain

    2004-01-01

    The aim of this work is to assess, on an historical and critical point of view, the new psychological perspective, introduced by Charcot (1825-1893), during the ten last years (1882-1892) of his life to explain hysteria symptomas. From clinical examples (hypnosis and hypnotherapy, "hystero-traumatism", "psychological theory of hysteria", "faith healing"), the paper shows how psychological dimension went back into the Parisian Hospital Medicine. This occurred on the late XIXth century, just one century after Mesmer, when Freud was Charcot's intern, at La Salpêtrière hospital, during years 1885-1886. The return of a non-rational thought into hospital medicine upset the organicist concepts of the Parisian "Ecole anatomo-clinique".

  7. 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.

  8. 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.

  9. Pes Cavus and Charcot Marie Tooth Disease: A Case Report and Brief Review of the Literature

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    Levent Ediz

    2011-09-01

    Full Text Available Charcot-Marie-Tooth (CMT is a disease that is highly heterogeneous, both clinically and genetically. Clinical and electrophysiological data are essential for diagnosis. Children with CMT experience acquired foot weakness, contracture and deformity (pes cavus and hammer toes from an early age. Early intervention targeting the foot and ankle may prevent long-term disability in CMT. Here we present a CMT patient with acquired pes cavus and hammer toes and review the literature briefly for diagnosis, treatment, and rehabilitation of CMT. As a result we conclude that CMT should also come into mind in the differential diagnosis of acquired pes cavus and hammer toes.

  10. 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.

  11. 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.

  12. Charcot neuroarthropathy in simultaneous kidney–pancreas transplantation: report of two cases

    Directory of Open Access Journals (Sweden)

    Jorge Javier del Vecchio

    2013-08-01

    Full Text Available Charcot neuroarthropathy (CN is considered a major complication in diabetes mellitus (DM, and it is estimated that 1% of diabetic patients may develop this complication. Simultaneous kidney–pancreas transplantation (SKPT is one of the most effective therapies for patients with type 1 DM and end-stage diabetic nephropathy. Some cases with a Charcot-modified clinical presentation during the postoperative convalescence period after SKPT have been described. The clinical presentation may condition severe destructive lesions, and good practices include systematic follow-up. Based on the cases described, SKPT is one more entity that might lead to CN ‘foot-at-risk’. The aim of this article is to describe two cases of neuropathic arthropathy with rapid progression in the short term after SKPT.

  13. 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.

  14. Hysteria after Charcot: back to the future.

    Science.gov (United States)

    Bogousslavsky, Julien

    2011-01-01

    The studies on hysteria and hypnotism probably constitute the most important long-term work of Jean-Martin Charcot and his school, starting around 1870 until Charcot's death in 1893. Désiré Bourneville, Charcot's sixth interne at La Salpêtrière, was probably instrumental in stimulating his mentor's interest in hysteria, while Charles Richet's 1875 article on somnambulism was the trigger for Charcot to introduce hypnotism into the management of hysterics. Albert Pitres, Paul Richer, Georges Gilles de la Tourette, Paul Sollier, Joseph Babinski, Sigmund Freud and Pierre Janet became the most famous of Charcot's collaborators on hysteria, either as 'guardians of the temple' (Richer, Gilles de la Tourette, who defended their mentor's concepts against Hippolyte Bernheim and the Nancy school in the dispute during the 1880-1890s), or in renewing the field in psychology (Janet and Freud, in the 1890s) or clinical neurology (Babinski in the 1900s). In 1908, a 'quarrel of hysteria' led several of Charcot's pupils into opposition with each other, from which Babinski was considered victorious against Charcot's successor Fulgence Raymond, despite the weaknesses of his theory on 'pithiatism'. During World War I, there was a new surge of interest in hysteria associated with war psycho-neuroses, and several students of Charcot became actively involved in medical military care (Sollier, Babinski, Gilbert Ballet, Achille Souques). Babinski's pupil Clovis Vincent developed a treatment called torpillage (torpedoing) against war hysteria, associating painful galvanic current discharges with 'persuasion', but this was dismissed after the soldiers, considering it as torture, rebelled. After World War I, the neurological and psychiatric interest in hysteria again faded away, and this condition largely went back to the no-man's land, where it had been before Charcot initiated his studies. A comprehensive look at the evolution of ideas on hysteria in the followers of Charcot shows that

  15. 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.

  16. 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.

  17. Diabetic Charcot foot%糖尿病Charcot足

    Institute of Scientific and Technical Information of China (English)

    邓浩萍; 薛现中; 李光伟

    2007-01-01

    糖尿病Charcot足是发生在病程较长的糖尿病患者足部的一种骨关节的慢性进展性疾病.目前其发病机制有神经创伤理论和神经血管理论等多种学说.由于尚无统一的临床和放射学诊断标准,许多病例被延误诊断,导致严重的关节破坏、畸形及溃疡,甚至截肢.近年来,随着骨扫描及核磁共振成像等技术的应用,糖尿病Charcot足得到了早期的诊断和治疗.

  18. Jean-Martin Charcot and his legacy.

    Science.gov (United States)

    Bogousslavsky, Julien

    2014-01-01

    Jean-Martin Charcot (1825-1893) rightly is considered the father of both modern neurology and psychiatry in France and much beyond. While he never was interested in mental disease and what was called 'alienism' at the time, his career at La Salpêtrière Hospital over 30 years was mainly marked by the development of a huge group of students which focused on the study and management of hysteria. When Charcot took office at the beginning of 1862, hysteria was a 'no-man's land', medically speaking, since neither the alienists nor the internists had much interest in this condition. At La Salpêtrière, these chronic patients were largely left to themselves before Désiré Bourneville, one of Charcot's first students, convinced his chief to care for them. Subsequently, the studies of Charcot with Paul Richer, Joseph Babinski, Georges Gilles de la Tourette, Paul Sollier, Pierre Janet, and many others allowed the condition to be addressed in detail. During his stay with Charcot in 1885-1866, Sigmund Freud, a young neuropathologist at the time, became fascinated by hysteria, an interest which probably was the main start of his interest in psychology. Charcot emphasized the concept of mental factors in hysteria, along with that of a 'dynamic' lesion, which accounted for the lack of neuropathological findings in the patients. While his ideas on hysteria and hypnotism were criticized after his death even by former pupils, such as Babinski, recent findings from functional studies using magnetic resonance imaging show how accurate and often visionary Charcot's thinking was in this field.

  19. [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.

  20. Abductor Hallucis: Anatomical Variation and Its Clinical Implications in the Reconstruction of Chronic Nonhealing Ulcers and Defects of Foot

    Science.gov (United States)

    Chittoria, Ravi Kumar; Pratap, Harsha; Yekappa, Suma Hottigoudar

    2015-01-01

    Abductor hallucis (AH) is an intrinsic muscle of sole of the foot. It is commonly used in the coverage of ankle and heel defects and chronic nonhealing ulcers of the foot; its use is reported to have a favorable long-term outcome. The muscle's apt bulk and size, its simple surgical isolation, absence of donor-site defect, unvaried anatomy, and long neurovascular pedicle are some of the advantages that make it a promising muscle flap. During routine cadaver dissection in the Department of Anatomy of Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India, we identified an anatomical variation in AH in both feet of a 45-year-old embalmed male Indian cadaver. The variant muscle had innumerable proximal attachments, a majority of them arising atypically in the form of tough tendinous slips from the medial intermuscular septum at the junction of central and tibial components of plantar aponeurosis, the medial surface of first metatarsal and the intermuscular septum separating AH from the flexor hallucis brevis. The tendon: muscle ratio was 1.76, higher than the normal reported ratio of 0.56±0.07. This article highlights the variation noted and its implication for clinicians. On Internet search, we did not come across the variations described in our article. Findings of the anatomical variation reported in this article could benefit surgeons who decide to use AH flaps in the future. PMID:26634184

  1. 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.

  2. 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.

  3. Syringomyelia with Chiari I Malformation Presenting as Hip Charcot Arthropathy: A Case Report and Literature Review

    Directory of Open Access Journals (Sweden)

    Roya Memarpour

    2015-01-01

    Full Text Available Neuroarthropathy (neuropathic osteoarthropathy, also known as Charcot joint, is a condition characterized by a progressive articular surface destruction in the setting of impaired nociceptive and proprioceptive innervation of the involved joint. It is seen most commonly in the foot and ankle secondary to peripheral neuropathy associated with diabetes mellitus. Cases of hip (Charcot neuroarthropathy are rare and almost exclusively reported in patients with neurosyphilis (tabes dorsalis. We report a case of a 36-year-old man who presented to the emergency department complaining of right hip pain. On physical examination, pain and thermal sensory deficits were noted in the upper torso with a cape-like distribution, as well as signs of an upper motor neuron lesion in the left upper and lower extremities. A magnetic resonance imaging study (MRI of the right hip showed evidence of early articular surface destruction and periarticular edema consistent with hip Charcot arthropathy. An MRI of the spine revealed an Arnold-Chiari type I malformation with extensive syringohydromyelia of the cervical and thoracic spine.

  4. Jean-Baptiste Charcot and Brazil.

    Science.gov (United States)

    Teive, Hélio Afonso Ghizoni; Lima, Carlos Frederico Leite de Souza; Lima, Plínio Marcos Garcia de; Germiniani, Francisco Manoel Branco; Munhoz, Renato Puppi

    2014-08-01

    Jean-Baptiste Charcot, a neurologist from the famous Salpêtrière school and a renowned maritime explorer, visited Brazil twice. The first visit was in 1903, when the first French Antarctic expedition, traveling aboard the ship Français, made a very short stopover in Recife, in the state of Pernambuco. The second took place in 1908, during the famous voyage of the Pourquoi Pas? to the Antarctic, when Charcot and his crew stayed in the city of Rio de Janeiro for eight days.

  5. Jean-Baptiste Charcot and Brazil

    Directory of Open Access Journals (Sweden)

    Hélio Afonso Ghizoni Teive

    2014-06-01

    Full Text Available Jean-Baptiste Charcot, a neurologist from the famous Salpêtrière school and a renowned maritime explorer, visited Brazil twice. The first visit was in 1903, when the first French Antarctic expedition, traveling aboard the ship Français, made a very short stopover in Recife, in the state of Pernambuco. The second took place in 1908, during the famous voyage of the Pourquoi Pas? to the Antarctic, when Charcot and his crew stayed in the city of Rio de Janeiro for eight days.

  6. Tibiocalcaneal Fusion for Charcot Ankle With Severe Talar Body Loss: Case Report and a Review of the Surgical Literature.

    Science.gov (United States)

    Aikawa, Takao; Watanabe, Koji; Matsubara, Hidenori; Nomura, Issei; Tsuchiya, Hiroyuki

    2016-01-01

    Severe bone loss resulting from talar body necrosis in the Charcot ankle can be challenging to treat. In particular, the Charcot ankle will demonstrate progressive instability and deformity, causing protrusion of the medial or lateral malleolus, which will mostly lead to skin ulcers or osteomyelitis and, in some cases, will ultimately require transtibial amputation. Problems such as bone fragility, poor compliance with load-bearing restrictions, susceptibility to infection, and circulatory disorders cause difficulties in the surgical treatment of the Charcot ankle. We believe that tibiocalcaneal fusion is a reliable method to obtain satisfactory outcomes in these difficult cases. However, no study has reported on the use of a locking plate for tibiocalcaneal fusion. Therefore, we report on tibiocalcaneal fusion using a locking plate in 3 patients with Charcot ankle and severe talar body loss. All patients achieved bony union with a plantigrade foot and without any skin complications. We have concluded that a locking plate provides rigid fixation and easier insertion of additional screws, when necessary.

  7. 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

  8. Early Onset Charcot-Marie-Tooth Disease

    Directory of Open Access Journals (Sweden)

    J Gordon Millichap

    2005-06-01

    Full Text Available The clinical signs and genetic analysis of early-onset Charcot-Marie-Tooth disease (CMT in a 2-year-old boy and members of his family are reported from the Academic Medical Center, Amsterdam, and Sophia Children’s Hospital, Rotterdam, the Netherlands.

  9. The pathogenesis of Charcot neuroarthropathy: current concepts

    Directory of Open Access Journals (Sweden)

    Shelly A. M. Larson

    2012-01-01

    Full Text Available The pathogenesis of Charcot neuroarthropathy (CN has been poorly understood by clinicians and scientists alike. Current researchers have made progress toward understanding the cause of CN and possible treatment options. The authors review the current literature on the pathogenesis of this debilitating disorder and attempt to explain the roles of inflammation, bone metabolism, and advanced glycation end products.

  10. 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.

  11. Jean-Martin Charcot Pathologist, Neurologist, Psychiatrist and Physician

    Directory of Open Access Journals (Sweden)

    Sanjay Pandey

    2012-01-01

    Full Text Available Jean-Martin Charcot is known as father of modern neurology. Before him, neurology was only limited to select disorders like chorea. His contributions were not limited to neurology only, as he was instrumental in many new developments in the field of pathology, psychiatry, and internal medicine. Even after 100 years, Charcot`s clinical methods remain the pillar of modern neurology.

  12. 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.

  13. Ilizarov External Fixator Versus Retrograde Intramedullary Nailing for Ankle Joint Arthrodesis in Diabetic Charcot Neuroarthropathy.

    Science.gov (United States)

    ElAlfy, Barakat; Ali, Ayman M; Fawzy, Sallam I

    Charcot neuroarthropathy of the ankle joint is a destructive process that leads to instability and significant morbidity that can end with amputation. Surgical arthrodesis in Charcot neuroarthropathy has a high failure rate. The aim of the present prospective study was to compare the outcomes of an Ilizarov external fixator and retrograde intramedullary nailing (IMN) for tibiotalar arthrodesis in Charcot neuroarthropathy. From February 2010 to October 2013, 27 patients (16 males and 11 females) with Charcot neuropathy of the ankle joint were treated in our department. Their ages ranged from 32 to 75 (average 54) years. Of the 27 patients, 14 received an Ilizarov external fixator and 13 underwent IMN. A preoperative clinical and radiologic assessment of all patients was performed. The outcomes were measured for bone union, development of complications, and clinical follow-up. The mean score of modified American Orthopaedic Foot and Ankle Society ankle hindfoot scale was 80 ± 2.7 points in the Ilizarov group and 75 ± 1.9 points in the IMN group. In the Ilizarov group, 12 of 14 patients achieved union, and in the IMN group, 10 of 13 patients achieved union. The complication rate was significantly greater in the external fixator group than in the IMN group. The complications in the Ilizarov group included nonunion in 2 patients (14%), pin tract infection in 8 (57%), pin tract loosening in 3 (21%), surgical wound infection in 3 (21%), and wound breakdown in 1 patient (7%). In the IMN group, nonunion occurred in 3 patients (23.1%), back-out of a distal locking bolt in 2 (15.4 %), and a superficial wound infection that resolved with antibiotics in 1 patient (7.7%). In conclusion, retrograde IMN and the Ilizarov external fixator both yielded better union for tibiotalar arthrodesis in Charcot neuroarthropathy. The Ilizarov external fixator resulted in a greater union rate than IMN but the complications with external fixation were significantly greater than those

  14. Rosalie: the brazilian female monkey of Charcot Rosalie: a pequenina macaca brasileira de Charcot

    Directory of Open Access Journals (Sweden)

    Hélio A.G. Teive

    2005-09-01

    Full Text Available Jean-Martin Charcot, the father of Neurology, a very austere and reserved man that did not express affection freely for human being, had a profound affection to animals, particularly to a small female monkey, called "Rosalie", which came from Brazil and was a gift of Dom Pedro II to Charcot.Jean-Martin Charcot, considerado o pai da Neurologia, foi um homem de aspecto austero e reservado, que tinha dificuldades de expressar os seus sentimentos para outros seres humanos. Contudo ele tinha profunda afeição por animais, particularmente por uma pequena macaca, chamada de "Rosalie", oriunda do Brasil e que foi um presente dado a ele por Dom Pedro II.

  15. Charcot-Marie-Tooth disease and posterior scleritis: a case report Doença de Charcot-Marie-Tooth e esclerite posterior: relato de caso

    Directory of Open Access Journals (Sweden)

    Elisabeth N. Martins

    2000-10-01

    Full Text Available Purpose: To describe the unusual association of Charcot-Marie-Tooth disease (CMTD and posterior scleritis. Methods: Case report of a 16-year-old female with decreased visual acuity and pain in both eyes. Results: Ophthalmologic examination showed a posterior scleritis, confirmed by ultrasound and angiofluoresceinography. Foot deformities and sensory dysfunction were identified in the patient and some of her relatives. The diagnosis of CMTD in this patient was confirmed by eletrophysiologic studies. Conclusions: The association of posterior scleritis in a patient with CMTD has never been reported. This is also the first description of an inflammatory ocular disease in these patients.Objetivo: Descrever a associação entre doença de Charcot-Marie-Tooth (DCMT e esclerite posterior. Metodologia: Relato de caso de uma paciente do sexo feminino, 16 anos de idade, com baixa de acuidade visual e dor em ambos os olhos. Resultados: O exame oftalmológico revelou esclerite posterior, observada também por ultra-som e angiofluoresceinografia. Deformidades de pernas e pés foram identificadas na paciente e em seus familiares. O diagnóstico de DCMT na paciente estudada foi confirmado por estudos eletrofisiológicos. Conclusões: A presença de esclerite posterior em paciente com DCMT não é descrita na literatura, não se encontrando também relatos de outras doenças oculares inflamatórias, nestes pacientes.

  16. [Charcot and his legacy to medicine].

    Science.gov (United States)

    Camacho Aguilera, José Francisco

    2012-01-01

    Jean-Martin Charcot (1825-1893) was a French physician whose professional life is divided into two phases: the first dedicated to neurology, and the second dedicated to the psychiatry area. Charcot is considered the father of modern neurology. In the Hospice de la Salpêtrière he began his research on neurological diseases, founded a laboratory of pathology (including microscopy and photography), and gave hospital classes based on pathological anatomy related to clinical manifestations based in the field of neurology. His research led to the description and study of different neurological diseases, such as multiple sclerosis, lateral amyotrophic sclerosis, hereditary motor and sensory neuropathy, motor ataxia, Parkinson`s disease, Gilles de la Tourette syndrome, epilepsy, visual aphasia and agnosia, to name a few. Some signs and diseases took their name as an eponym, and some are still mentioned in the current medicine, while others are left in oblivion.

  17. Reconstruction

    Directory of Open Access Journals (Sweden)

    Stefano Zurrida

    2011-01-01

    Full Text Available Breast cancer is the most common cancer in women. Primary treatment is surgery, with mastectomy as the main treatment for most of the twentieth century. However, over that time, the extent of the procedure varied, and less extensive mastectomies are employed today compared to those used in the past, as excessively mutilating procedures did not improve survival. Today, many women receive breast-conserving surgery, usually with radiotherapy to the residual breast, instead of mastectomy, as it has been shown to be as effective as mastectomy in early disease. The relatively new skin-sparing mastectomy, often with immediate breast reconstruction, improves aesthetic outcomes and is oncologically safe. Nipple-sparing mastectomy is newer and used increasingly, with better acceptance by patients, and again appears to be oncologically safe. Breast reconstruction is an important adjunct to mastectomy, as it has a positive psychological impact on the patient, contributing to improved quality of life.

  18. 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 ...

  19. 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.

  20. 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.

  1. Complication assessment and prevention strategies using midfoot fusion bolt for medial column stabilization in Charcot's osteoarthropathy

    DEFF Research Database (Denmark)

    Mehlhorn, Alexander T; Walther, Markus; Iblher, Niklas

    2016-01-01

    -up was 21.4±14.6 (mean±SDM) months, 64% of patients suffered from diabetes with a preoperative Hba1c of 8.5±2.4. The mean number of revisions per foot was 3.6±4.1. Bolt dislocation was seen in 57% of the patients following 11.3±8.5 months; in 75% of these patients bony healing occurred before dislocation......In Charcot's osteoarthropathy stabilization of the medial column of the foot was introduced in order to establish a stable foot and reduce the risk for amputation. This study was performed to analyze postoperative complications, define risk factors for those and develop strategies for prevention....... Since bolt dislocation takes place frequently, it was aimed to predict an appropriate time point for bolt removal under the condition that osseous healing has occurred. Fourteen consecutive patients with neuroosteoarthropathy of the foot and arch collapse were treated with open reduction...

  2. A case report of Charcot's joint%Charcot's关节病一例报道

    Institute of Scientific and Technical Information of China (English)

    李灿; 孙娟娟; 王朝夫

    2015-01-01

    Objective To investigate the clinicopathologic features and main points of diagnosis and differential diagnosis of Charcot's joint.Methods A case of Charcot's joint was studied and the related literatures were reviewed.Its clinical manifestations and pathomorphological characteristics were analyzed.Results A 41-year-old male was admitted to the hospital due to loss of range of motion ( ROM ) of the left shoulder joint progressively and painlessly.The X-ray showed the humeral head was partially missing.The CT represent ed irregular soft tissue mass es in high density with an indistinct edge,and discontiguous left scapulabone.The MRI showed changes of syringomyelia was presented in the glenoid cavity of the left shoulder joint,humeral head,proximal humerus and spinal cord of thoracic segments.According to the histological ifndings,free bone detritus accumulationswere microscopicallyseen in the lesions and adjacent soft tissues at an early stage,andthe secondary changes due to the reactions of osteoclast-likemultinucleated giant cells and inlfammatory cells and proliferation of ifbrous tissues.The formation of pannusacted as an important basisfor distinguishing Charcot's joint and other kinds of arthritis.Conclusions Charcot's joint is a kind of neuropathic arthropathy which lacks distinctive histopathologic features.So it is necessary to combine clinical features,pathological manifestations with radiographic examination results in clarifying the diagnosis.Only based on typical clinical symptoms,clear imaging features and mixed pathological changes of injury and repair,can a deifnitediagnosis be made.

  3. 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.

  4. 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.

  5. Did Jean-Martin Charcot contribute to stroke?

    Science.gov (United States)

    Bogousslavsky, Julien; Paciaroni, Maurizio

    2010-01-01

    Stroke was never identified as a significant, autonomous field of activity of the emerging school of neurology at La Salpêtrière, which developed after the appointment of Jean-Martin Charcot (1825-1893) during the last days of 1861. However, stroke was already present in Charcot's first paper (1851), which dealt with a case of multiple organ cardiac embolism, including middle cerebral artery infarction, at a time when the studies of Rudolf Virchow on thromboembolism were unknown in France. A few years later, Charcot made a still up-to-date description of vascular intermittent claudication, which had only been reported in the horse. In the 1860s, Charcot and his pupils presented several major works dealing with cerebrovascular disease, including famous studies on miliary aneurysms in cerebral hemorrhage. This work was done with Charles Bouchard, at the time Charcot's 'interne', but who would become one of his 'political' opponents 2 decades later, when in 1892, as president of the 'agrégation' jury, he rejected the professorship application of 4 protégés of Charcot, including Joseph Babinski and Georges Gilles de la Tourette. Further work on cerebrovascular disease by Charcot included histological studies of brain 'softening', paraneoplastic cerebral arterial occlusion and consequences of stroke (e.g. arthropathies, vegetative changes, contractures and abnormal movements). Brain localization, one of Charcot's major neurological topics, was also largely based on stroke case studies. Charcot's work on stroke remains poorly recognized, but it demonstrates his unique skills in stimulating scientific work in younger colleagues, many of whom subsequently became major figures of neurology and psychiatry.

  6. 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.

  7. 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.

  8. [The diabetic foot--state of the art from the orthopedic point of view].

    Science.gov (United States)

    Schaefer, D

    1999-07-08

    A 15-30% rate of amputation of diabetic feet suggests that efforts have to be directed towards improvement of preventive measure including instruction of patients and relatives concerning foot wear. So called foot rules have been established. If surgery is indicated, an angiological and neurological assessment should be performed preoperatively. An ulcer should undergo debridement, plantar pressure release with a full contact cast and antibiotic therapy, if infected. The goal of treatment of Charcot's disease is prevention of deformity. Usually orthoses are sufficient, in irreducible deformities an arthrodesis should be considered. There is no doubt that the interdisciplinary approach improves the treatment of the diabetic foot.

  9. 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.

  10. 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.

  11. Arthrodesis with external fixation in the unstable or misaligned Charcot ankle in patients with diabetes mellitus.

    Science.gov (United States)

    Fabrin, Jesper; Larsen, Kirsten; Holstein, Per E

    2007-06-01

    The unstable or misaligned Charcot ankle with or without chronic foot ulceration is a major clinical challenge. When it cannot be accommodated with an ankle foot orthosis, surgical treatment is indicated in order to avoid leg amputation. This requires extensive soft tissue release and bony resection to realign the foot and arthrodesis with internal or external fixation. The guidance in the literature favors internal fixation. This article reports results with external fixation in 11 patients (12 feet) over a period of 12 years. External fixation was chosen as the surgical option because of the presence of foot ulcers with the attendent risk of infection. There were 7 tibio-talar and 5 tibio-calcaneal fusions. Compression was applied for 6 weeks with an external frame according to Charnley, followed by 6 weeks with total-contact cast. Weight bearing with a rigid leather brace was allowed after 12 weeks. In one case, transtibial amputation was required due to loosening of the distal pins from osteopenic disintegrating bone. In 11 cases (92%), the foot was successfully realigned and independent walking with a brace retained during the follow-up of median 48 months (10-102 months). Bony union took place in 5 out of 7 cases with tibio-talar fusion and in 1 out of 5 with tibio-calcaneal fusion. The functional result in cases with fibrous union was, however, satisfactory. Although meaningful comparisons of series are difficult to conduct and interpret from, the limb salvage rate was similar to results with internal fixation. The authors consider the results to be encouraging and to be used to develop a higher level of evidence.

  12. Jean-Martin Charcot: neurologist by avocation, nephrologist by yearning.

    Science.gov (United States)

    Eknoyan, Garabed

    2011-01-01

    In an age of medical advances and specialization, Jean-Martin Charcot (1825-1893) helped found the discipline of neurology and in 1882 was appointed the first Professor of Diseases of the Nervous System in France. As an investigator with broad interests and vast knowledge, Charcot contributed to several other disciplines. An early mentor and dominant figure in Charcot's formative years was Pierre Rayer (1793-1867), famous for his seminal contributions to the study of the kidney, who gifted to Charcot his passion for clinical pathological correlations and likely a yearning for the study of kidney diseases. Famous for the clarity and incisiveness of his formal teaching presentations, Charcot lectured on the kidney at the Faculty of Medicine in Paris in 1877. Translated into English and published as a book titled Lectures on Bright's Disease, those lectures became widely accessible and quoted in the literature through the 1940s. In addition, at a time when he was already concentrating on the study of neurological disorders, Charcot maintained his life-long interest in the kidney and published original studies on the pathological changes of the kidney in gout and experimental lead poisoning, as well as supporting a study of hysterical ischuria by his students.

  13. [The diabetic foot].

    Science.gov (United States)

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

    1998-10-01

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

  14. Athlete's Foot

    Science.gov (United States)

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

  15. Jean-Martin Charcot's Role in the 19th Century Study of Music Aphasia

    Science.gov (United States)

    Johnson, Julene K.; Lorch, Marjorie; Nicolas, Serge; Graziano, Amy

    2013-01-01

    Jean-Martin Charcot (1825-93) was a well-known French neurologist. Although he is widely recognized for his discovery of several neurological disorders and his research into aphasia, Charcot's ideas about how the brain processes music are less well known. Charcot discussed the music abilities of several patients in the context of his "Friday…

  16. Diabetic foot ulcers: practical treatment recommendations.

    Science.gov (United States)

    Edmonds, Michael

    2006-01-01

    neuroischaemic foot ulcers may need vascular intervention (vascular control). In stage 4, microbiological control is crucial and severe infections need intravenous antibacterial therapy, and urgent assessment of the need for surgical drainage and debridement. Without urgent treatment, severe infections will progress to necrosis. In stage 5, necrosis can be divided into wet and dry necrosis. Wet necrosis in neuropathic feet requires intravenous antibacterials and surgical debridement, and wet necrosis in neuroischaemic feet also needs vascular reconstruction. Aggressive management of diabetic foot ulceration will reduce the number of feet proceeding to infection and necrosis, and thus reduce the number of major amputations in diabetic patients.

  17. 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).

  18. 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.

  19. High osteoprotegerin is associated with development of foot ulcer in type 1 diabetes

    DEFF Research Database (Denmark)

    Zobel, Emilie H; von Scholten, Bernt J; Lajer, Maria

    2016-01-01

    BACKGROUND AND AIM: The bone-related peptide osteoprotegerin has been linked to vascular calcification and peripheral vascular disease. We investigated the association between osteoprotegerin and development of foot complications in persons with type 1 diabetes. MATERIALS AND METHODS: Prospective...... observational study of 573 persons with type 1 diabetes, 225 women; age [mean±SD] 42.3±10.3years. Plasma osteoprotegerin was measured by ELISA. RESULTS: Median (IQR) osteoprotegerin was 2.80(2.35-3.63)μg/L and follow-up time (median (range)) was 12.7(0.1-15.6)years. Endpoints included: new foot ulceration (n......=153), Charcot foot (n=14), vascular surgery/amputation (n=53), loss of foot pulse (n=57), and peripheral neuropathy (n=99). In unadjusted analyses, higher osteoprotegerin was associated with development of all endpoints (p≤0.026). Higher osteoprotegerin remained associated with development of foot...

  20. Cavus Foot Surgery

    Science.gov (United States)

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

  1. 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 t...

  2. 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

  3. 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.)

  4. 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.

  5. [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.

  6. 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.

  7. 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.

  8. 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.

  9. 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.

  10. [Operative treatment of diabetic foot].

    Science.gov (United States)

    Hintermann, B

    1999-07-08

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

  11. The top 10 things foot and ankle specialists wish every primary care physician knew.

    Science.gov (United States)

    Paige, Neil M; Nouvong, Aksone

    2006-06-01

    Foot and ankle problems are common complaints of patients presenting to primary care physicians. These problems range from minor disorders, such as ankle sprains, plantar fasciitis, bunions, and iIngrown toenails, to more serious conditions such as Charcot arthropathy and Achilles tendon rupture. Early recognition and treatment of foot and ankle problems are imperative to avoid associated morbidities. Primary care physicians can address many of these complaints successfully but should be cognizant of which patients should be referred to a foot and ankle specialist to prevent common short-term and long-term complications. This article provides evidence-based pearls to assist primary care physicians in providing optimal care for their patients with foot and ankle complaints.

  12. Reconstruction of foot flexion-extension function after replantation of amputated leg%小腿中段离断再植后重建足跖屈背伸功能

    Institute of Scientific and Technical Information of China (English)

    陈秋生; 余斌; 杨建成; 江浩; 陈霞; 竺筠雯

    2001-01-01

    Objective To investigate the foot function reconstruction after replantation of amputated leg. Methods The n erveless injury muscle in the amputated limbs was cut off, a section tensor fascia lata was resected off to replace the injured muscle. Meanwhile, transfer biceps femoris muscle and sartoriu s muscle to strengthen extensive muscles, and transfer semimembranosus muscle an d gracilis muscle to strengthen flexion muscles. Postoperation functional exer cises of the ankle was carried out. Results 2 patients were tre ated with this t echnique, followed up for more than 2 years. The extension and flexion muscle st rength reached MRC4 with satisfactory ankle function, the range of motion of ank le was restored nearly to normal. Conclusion The technique is e ffective to reconstruct most functions of the normal muscles and restore foot function.%目的 探讨小腿中段离断再植后足跖屈背伸功能重建的方法 。方法 常规断肢再植,术中将离断肢远段失神经支配的肌组织切除,只 保留肌腱及肌腱膜,切取髂胫束条桥接远端背伸肌腱和近端肌腹,同时和前移缝匠肌、股二 头肌长头缝接,加强足背伸肌力;桥接远端跖屈肌腱和近端肌腹,同时和游离的半腱肌、股 薄肌缝接,加强足跖屈肌力。结果 治疗2例,分别随访2年8个月及2年5个 月,足背伸、跖屈肌力达Ⅳ~Ⅳ+,踝关节活动度近正常。结论 应用髂 胫束条桥接远断端的肌腱和近断端的正常肌组织,同时利用缝匠肌、股二头肌、半腱肌、股 薄肌加强足的背伸、跖屈肌力,是一种有效的功能重建方法。

  13. 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.

  14. 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...... hyperthyroidism. Charcots arthropathy is not a recognized cause of hypoparathyroid hypercalcaemia, but the mechanism might be increased boneresorption. We recommend that Charcots arthropathy is considered a cause of hypoparathyroid hypercalcaemia in patients with diabetic neuropathy....

  15. Reconstructing the origin and transmission dynamics of the 1967-68 foot-and-mouth disease epidemic in the United Kingdom.

    Science.gov (United States)

    Wright, Caroline F; Knowles, Nick J; Di Nardo, Antonello; Paton, David J; Haydon, Daniel T; King, Donald P

    2013-12-01

    A large epidemic of foot-and-mouth disease (FMD) occurred in the United Kingdom (UK) over a seven month period in Northwest England from late 1967 to the summer of 1968. This was preceded by a number of smaller FMD outbreaks in the country, two in 1967, in Hampshire and Warwickshire and one in Northumberland during 1966. The causative agent of all four events was identified as FMD virus (FMDV) serotype O and the source of the large epidemic was attributed to infected bone marrow in lamb products imported from Argentina. However, the diagnostic tools available at the time were unable to entirely rule out connections with the earlier UK FMD outbreaks, as well as other potential sources from Europe. The aim of this study was to apply molecular sequencing to investigate the likely source of this epidemic using VP1 region and full genome (FG) sequences determined directly from clinical epithelium samples (n=13) or cell culture isolates (n=6), from this and contemporary outbreaks in the UK, Europe and South America. Analysis of the VP1 sequences provided evidence for at least three separate incursions of FMDV into the UK including one independent introduction that was responsible for the main 1967/68 epidemic. Analysis of FG sequences from the main 1967/68 outbreak (n=10) revealed nucleotide substitutions at 94 genomic sites providing evidence for the linear accumulation of nucleotide substitutions (rate=2.42 × 10(-)(5)nt substitutions/site/day). However, there were five samples where this linear relationship was absent, indicating evolutional dormancy of the virus, presumably outside a host. These results help define the evolutionary dynamics of FMDV during an epidemic and contribute to the knowledge and understanding from which to base future outbreak control strategies.

  16. An Analysis of the Symptomatic Domains Most Relevant to Charcot Marie Tooth Neuropathy (CMT) Patients

    Science.gov (United States)

    2015-04-28

    Charcot Marie Tooth Disease (CMT); Hereditary Sensory and Motor Neuropathy; Nerve Compression Syndromes; Tooth Diseases; Congenital Abnormalities; Genetic Diseases, Inborn; Heredodegenerative Disorders, Nervous System

  17. 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.

  18. 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

  19. [Charcot and Babinski: beyond a simple teacher-student relationship].

    Science.gov (United States)

    Massie, Rami

    2004-08-01

    Jean-Martin Charcot (1825-1893) is now considered to be the father of clinical neurology in France. He trained a generation of eminent neurologists, among them Joseph Babinski, with whom he had a special relationship. Babinski was undoubtedly Charcot's favorite pupil and they enjoyed an excellent collaboration at la Salpétrière. Even though both men felt tremendous respect for each other, it is sad that this relationship may, in one instance, have been detrimental to Babinski. This is probably the reason why Bouchard denied him full professorship, a decision with eventual consequences for both men. In spite of this, the neurologist of Polish origin held his master in tremendous admiration, even as he pursued Charcot's research on hysteria after his death. Even though Babinski eventually contradicted his master on many fundamental issues, it did not affect his devotion to him. The relationship between the two men can be considered as more than a simple relationship between a teacher and his pupil and may be compared to a father-son relationship, which is a reminder of the original model of Hippocratic teaching.

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

    Science.gov (United States)

    Teive, Hélio A G; Munhoz, Renato P; Lima, Plínio G de; Germiniani, Francisco M B

    2015-09-01

    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.

  1. 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

  2. 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

  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.

  4. 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.

  5. Minimally invasive surgery of diabetic foot – review of current techniques

    Science.gov (United States)

    I, Botezatu; D, Laptoiu

    2016-01-01

    The term diabetic foot is usually used to indicate advanced foot pathology (complex clinical situations correlating diabetic foot ulcers, diabetic foot infections, Charcot foot, and critical limb ischemia). The early recognition of the etiology of these foot lesions is essential for the therapeutic decision in order to achieve a good functional result. Several surgical procedures involving the foot have been developed in order to promote healing and avoid complications. Traditionally, surgery has been performed in an open way. The literature regarding the performance and efficacy of classical osteotomies and arthrodesis is inconsistent. This can be attributed to several variables, such as differences in patient clinical aspects and the panel of surgical techniques utilized. As with other surgical specialties, fluoroscopic imaging and minimally invasive tools are now being incorporated in these procedures. The use of high speed burrs associated with specialized osteosynthesis implants, offers several advantages over classical techniques. The ability to associate these gestures to complex protocols is beginning to be currently developed. The respect for the soft tissues is considered one of the first advantages. Despite the limited time since they were introduced in clinical practice, functional results seemed to be consistent, supporting the use of this technology. PMID:27974928

  6. Adult Foot Health

    Science.gov (United States)

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

  7. [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.

  8. Prevention of foot blisters.

    Science.gov (United States)

    Knapik, Joseph J

    2014-01-01

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

  9. Charcot-Marie-Tooth病的特殊类型

    Institute of Scientific and Technical Information of China (English)

    马永才; 李太伟

    2003-01-01

    @@ Charcot-Marie-Tooth病(CMT)又名腓骨肌萎缩症或遗传性运动、感觉神经病(HMSN)是一组影响周围神经系统临床、亚临床的遗传多型性疾病.以首先出现腓骨肌萎缩,继以远端肌萎缩为特征,伴感觉障碍、脊柱及足畸形、植物神经功能紊乱等.

  10. 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.

  11. 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.

  12. 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...... with CMT type 1, using four different techniques, and identified a de novo duplication in a sporadic case. Analysis of the fully informative pVAW409R3a alleles in this family showed the duplication to be of paternal origin....

  13. Vibration therapy for Parkinson's disease: Charcot's studies revisited.

    Science.gov (United States)

    Kapur, Sachin S; Stebbins, Glenn T; Goetz, Christopher G

    2012-01-01

    The 19th century neurologist, J-M Charcot, used a vibration chair for treating Parkinson's disease (PD). He documented improvement, but few subsequent studies examined vibration treatment. Using a specialized lounge chair, we conducted a rater blinded, randomized trial of body vibration vs. no vibration in 23 PD patients. The primary outcome measure was change from baseline in the motor section of the MDS-UPDRS. Both vibration and no vibration groups significantly improved after one month of daily treatments. However, there was no significant difference between the two treatment groups, suggesting that non-specific or placebo factors had an effect on PD motor function.

  14. Sarcopenia and body composition in diabetic Charcot osteoarthropathy

    DEFF Research Database (Denmark)

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

    2015-01-01

    : Cross-sectional case-control study of people with diabetes with acute or chronic Charcot osteoarthropathy, matched with otherwise healthy people with diabetes. A total of 49 subjects (distribution ~1:1) had a total body DXA-scanning, measuring appendicular lean mass, android/gynoid and truncal...... (24.5-31.9%), whereas there were no significant differences found between the groups (P=0.065). Neither truncal/total fat percent nor android/gynoid fat percent ratios showed differences between the groups. CONCLUSION: To our knowledge, this is the first published dataset investigating body...

  15. Chapter 15: Jean-Martin Charcot and the anatomo-clinical method of neurology.

    Science.gov (United States)

    Goetz, Christopher G

    2010-01-01

    Jean-Martin Charcot (1825-1893) was the premier clinical neurologist of the 19th century. Charcot's research was anchored in the anatomo-clinical method, a two-part methodology that linked clinical signs with anatomical lesions. The first step of this method involved the careful documentation of clinical signs with longitudinal observation. At the time of death, the second step involved autopsy examination of the brain and spinal cord. With combined clinical and anatomical data, Charcot was able to suggest concrete clinical-anatomical correlations. This method helped to define the tracts and nuclei responsible for normal and abnormal neurological signs and was pivotal to a new classification of neurological diseases based on anatomy. The best-developed example of this method was Charcot's work with motor system degenerative disorders, specifically amyotrophic lateral sclerosis. These studies led to the international designation of amyotrophic lateral sclerosis as Charcot's disease. Other examples of the fruits of the anatomo-clinical method included several stroke syndromes and the linkage of specific signs to specific lesions in multiple sclerosis. The discipline fostered cortical localization theory, which moved neurologists away from the concept of the brain as a homogenous organ in preference to the concept that brain regions controlled specific motor, sensory and language functions. Charcot's attempts to apply his anatomo-clinical method to the knotty neurological diagnosis of hysteria led him to experiments and conclusions that drew criticism and even scorn from colleagues. These events tarnished Charcot's reputation at the close of his career. In the context of Charcot's extensive discoveries and lasting contributions, the anatomo-clinical method remains the anchor of modern neurological diagnosis and is Charcot's most important contribution to clinical neurology.

  16. 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.

  17. 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.

  18. 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.

  19. 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.

  20. 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.

  1. 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.

  2. 跖侧钢板重建糖尿病性夏科氏足跖跗关节脱位的临床观察%Clinical observation on plate on the metatarsal side to reconstruction of tarsometatarsal joint dislocations secondary to diabetic charcot foot

    Institute of Scientific and Technical Information of China (English)

    周海波; 张超; 刘彩龙; 陈雷

    2016-01-01

    目的:探讨采用跖侧钢板重建糖尿病性夏科氏足跖跗关节脱位的临床疗效.方法:自2012年4月至2014年12月,采用放置钢板于内侧跖跗关节跖侧重建7例(9足)糖尿病性夏科氏足的跖跗关节脱位患者,均为男性,其中单侧5例,双侧2例;年龄45~52岁,平均48岁;发现糖尿病病史6~15年.术后采用X线片和CT检查评估骨愈合情况,并采用美国足踝外科协会(AOFAS)中足评分标准进行功能评估.结果:所有患者获得随访,时间12~24个月,平均19个月.术后所有患者创口Ⅰ期愈合.术后无感染、内固定无松动或断裂及骨不愈合等并发症发生.术后X线片及CT复查显示骨愈合时间10~20周,平均16周.按照AOFAS评分,优6足,良2足,可1足.结论:采用跖侧钢板重建糖尿病性夏科氏足的跖跗关节,可使跖跗关节获得坚强的支撑,并取得满意的早期临床疗效.

  3. 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.

  4. 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.

  5. 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.

  6. 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.

  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. 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 (pCharcot 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

  9. Charcot, la salpêtrière, and hysteria as represented in European literature.

    Science.gov (United States)

    Koehler, Peter J

    2013-01-01

    In this chapter, I describe the influence of Jean-Martin Charcot (1825-1893), his neurological school at the Salpêtrière (Paris), and his teaching of hysteria on European literature. Many references to Charcot and descriptions of hysterical attacks are found not only in French naturalistic literature but also subsequently in naturalistic novels from other European countries (the Netherlands, Russia, Scandinavian countries, Spain, Italy, and Germany) and furthermore in novels written in new literary movements that followed naturalism. At first, objective descriptions were presented, but in the periods that followed, in particular during the past decades, criticism, rather than objective descriptions, became the motivation for continuing to use Charcot and his teaching of hysteria as inspiration for novels and plays, although Charcot as an admired founder of neurology did not quite disappear, even in recent novels. It is quite impressive to observe how Charcot and his demonstrations of hysterical attacks still resound throughout European literature, even after more than a century.

  10. On the early history of male hysteria and psychic trauma. Charcot's influence on Freudian thought.

    Science.gov (United States)

    Libbrecht, K; Quackelbeen, J

    1995-10-01

    This paper discusses the influence of Jean-Martin Charcot's views on Sigmund Freud's early theory of hysteria and the notion of psychical trauma. We consider the early history of both psychical trauma and male hysteria, for in Charcot's view traumatic hysteria and male hysteria are identical. Freud's two 1886 lectures on male hysteria, delivered after his return from Paris, are crucial to the subject because they present Freud's first impressions of Charcot and his teaching. Some of the ideas presented in the two lectures foreshadow Freud's later generalization of the etiological role of trauma and his theory of the role of psychical trauma in the genesis of hysteria; that is, each hysterical symptom is due to a psychical trauma reviving an earlier traumatic event--the so-called principle of deferred action (Nachträglichkeit). Several arguments substantiate the thesis that Freud's notion of psychical (sexual) trauma was developed in reference to Charcot's notion of traumatic hysteria, and that the early psychoanalytic theory of psychical trauma is clearly indebted to Freud's encounter with Charcot's male traumatic hysterical patients. The discussed Freudian development points out the major role of (physical) traumata in eliciting psychopathological pictures and in this way is of definite historical relevance for the present-day discussion on the traumatic nature of the so-called multiple personality syndrome and other dissociative disorders, and post-traumatic stress disorders.

  11. Dynamic Foot Morphology

    OpenAIRE

    Barisch-Fritz, Bettina

    2014-01-01

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

  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病一家族分析

    Institute of Scientific and Technical Information of China (English)

    孙明周

    2014-01-01

    目的 通过对1家族Charcot-Marie-Tooth病(cMT)系谱分析,探讨其遗传特点、临床表现及预后,为遗传咨询提供依据.方法 分析家族中患者的性别分布规律,临床表现特点进行分析.结果 家族中男女均可发病,男性患病率明显高于女性.男性患者症状典型,典型症状表现为慢性进展性四肢远端肌肉无力和消瘦肌萎缩呈典型的“鹤腿”,双足骨骼畸形呈“弓形足”;家族中女性患者少见,除Ⅱ8症状表现典型外,其余女性无受累;感觉主诉不显著,无中枢神经受累表现.结论 本例家族CMT呈常染色体显性遗传,男性受累多且症状典型,女性受累少.由于患者症状特征显著,遗传模式明确,预后良好,对于遗传咨询具有指导意义.

  14. 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.

  15. 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.

  16. On the centenary of Charcot: hysteria, suggestibility and hypnosis.

    Science.gov (United States)

    Chertok, L

    1984-06-01

    In studying hysteria by means of hypnosis, Charcot placed emphasis on the psychological aetiology of the neuroses. Among his pupils, Freud alone grasped this epistemological turning-point, from which he made his great discoveries. But hysteria and hypnosis still remain today largely unknown. We have not yet elucidated the 'mysterious leap' between the psychological and the somatic for the former, and between the relational and the instrumental for the latter. While psychoanalysts have constantly concerned themselves with hysteria, they have shown a lack of interest in hypnosis after Freud abandoned its practice. According to Freud, thanks to transference, affect would be controlled by cognition, a viewpoint eminently suited to satisfy his rationalistic outlook. Affect, however, remains an unknown realm. The affective relationship has, at all events, acquired an ever-increasing importance in psychoanalysis during the last few years, with the emphasis on the early mother-child relationship. The 'affective locus' remains the basic, as well as the most obscure, element in the hypno-suggestive relationship. The behaviourist approach, which quantifies the 'vertical' dimension in depth, is a limited one. The study of the 'horizontal' dimension of subjective experience represents a new line of research, which may make it possible to distinguish different forms of hypnosis. The understanding of hypno-suggestion may throw light on psychoanalysis, psychotherapy, and the human sciences in general.

  17. 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.

  18. 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.

  19. Mouse model for Charcot Marie-Tooth as a tool to better understand the disease

    OpenAIRE

    Barneo Muñoz, Manuela

    2016-01-01

    Introducción La enfermedad de Charcot-Marie-Tooth (CMT) es uno de los trastornos neurológicos hereditarios más comunes que afecta a 17-40 de cada 100.000 personas según poblaciones; concretamente esta cifra se sitúa en 28 personas de cada 100.000 en España. La enfermedad recibe el nombre de los tres médicos que la identificaron por primera vez en 1886; Jean-Marie Charcot y Pierre Marie en París, Francia y Howard Henry Tooth en Cambridge, Inglaterra. La enfermedad de CMT, también conocida c...

  20. 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.

  1. Charcot-Marie-Tooth Disease Type 2B

    Directory of Open Access Journals (Sweden)

    Şenay Durdu

    2009-06-01

    Full Text Available Chatcot-Marie-Tooth (CMT is also known as peroneal muscular atrophy and hereditary motor-sensory neuropathy (HMSN. It is the most commonly encountered inherited peripheral neuropathy. Actually, CMT is not a single disease, but is a group of disorders with similar symptoms. CMT type 2 is the second most common form after CMT type1. Symptoms usually begin in childhood or early adulthood. Mostly the peripheral nerves of the lower extremities and occasionaly upper extremities may be affected. Motor nerve involvoment induces distal muscle weakness and atrophy in the lower extremities that may result in foot deformities known as foot drop, pes cavus, pes planus, hammer toe etc. As a result of sensorial nevre degeneration, callus, recurrent foot ulcers, osteonecrosis, osteolysis and spontaneous amputation may accompany the disease. The speed of nerve conduction is not changed in the EMG, but axonal type sensorymotor semptoms that lead to a decrease of amplitude. We report here a 55 year old man with recurrent foot ulcers for 33 years and self amputations, whose EMG findings suggest acsonal neuropathy and who also has a 20 year - old son with similar complaints.

  2. Jean-Martin Charcot and art: relationship of the "founder of neurology" with various aspects of art.

    Science.gov (United States)

    Bogousslavsky, Julien; Boller, François

    2013-01-01

    Jean-Martin Charcot (1825-1893), the "father of neurology" in France and much beyond, was also the man who established academic psychiatry in Paris, differentiating it from clinical alienism. In his teaching, he used artistic representations from previous centuries to illustrate the historical developments of hysteria, mainly with the help of his pupil Paul Richer. Charcot liked to draw portraits (in particular, sketches of colleagues during boring faculty meetings and students' examinations), caricatures of himself and others, church sculptures, landscapes, soldiers, etc. He also used this skill in his clinical and scientific work; he drew histological or anatomic specimens, as well as patients' features and demeanor. His most daring artistic experiments were drawing under the influence of hashish. Charcot's tastes in art were conservative; he displayed no affinity for the avant-gardes of his time, including impressionism, or for contemporary musicians, such as César Franck or Hector Berlioz. Léon Daudet, son of Charcot's former friend and famous writer Alphonse Daudet, described Charcot's home as a pseudo-gothic kitsch accumulation of heteroclite pieces of furniture and materials. However, as Henry Meige wrote a few years after his mentor's death, Charcot the artist remains "inseparable from Charcot the physician."

  3. A Rasch Analysis of the Charcot-Marie-Tooth Neuropathy Score (CMTNS) in a Cohort of Charcot-Marie-Tooth Type 1A Patients

    Science.gov (United States)

    Guedj, Mickaël; Bertrand, Viviane; Foucquier, Julie; Jouve, Elisabeth; Commenges, Daniel; Proust-Lima, Cécile; Murphy, Niall P.; Blin, Olivier; Magy, Laurent; Cohen, Daniel; Attarian, Shahram

    2017-01-01

    The Charcot-Marie-Tooth Neuropathy Score (CMTNS) was developed as a main efficacy endpoint for application in clinical trials of Charcot-Marie-Tooth disease type 1A (CMT1A). However, the sensitivity of the CMTNS for measuring disease severity and progression in CMT1A patients has been questioned. Here, we applied a Rasch analysis in a French cohort of patients to evaluate the psychometrical properties of the CMTNS. Overall, our analysis supports the validity of the CMTNS for application to CMT1A patients though with some limitations such as certain items of the CMTNS being more suitable for moderate to severe forms of the disease, and some items being disordered. We suggest that additional items and/or categories be considered to better assess mild-to-moderate patients. PMID:28095456

  4. 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.

  5. 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…

  6. 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.

  7. 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。

  8. 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.

  9. 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

  10. Connexin32 gene mutations in X-linked dominant Charcot-Marie-Tooth disease (CMTX1)

    NARCIS (Netherlands)

    Janssen, EAM; Kemp, S; Hensels, GW; Sie, OG; deDieSmulders, CEM; Hoogendijk, JE; deVisser, M; Bolhuis, PA

    1997-01-01

    Single-strand conformational polymorphisms (SSCP) of the connexin32 gene were analyzed in 121 patients possibly affected by Charcot-Marie-Tooth (CMT) disease. The 121 patients were selected from 443 possible CMT/HNPP (hereditary neuropathy with liability to pressure palsies) patients based on geneti

  11. 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.

  12. Charcot, Mitchell and Lees: neurology free thinkers and their experiences of psychoactive drugs

    Directory of Open Access Journals (Sweden)

    Hélio A. G. Teive

    Full Text Available ABSTRACT Three world-famous neurologists, Charcot and Mitchell, in the 19th century, and Lees, in this century, all of whom had great scientific curiosity, experimented with the psychoactive drugs hashish, mescal and yagé, respectively, in an attempt to increase their knowledge of neurological diseases and how the brain works.

  13. 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…

  14. 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…

  15. Effective cauda equina decompression in two siblings with Charcot-Marie-Tooth disease type 1B

    NARCIS (Netherlands)

    van Doormaal, Tristan P C; van Ruissen, Fred; Miller, Kai J; Hoogendijk, Jessica E

    2016-01-01

    Two siblings with Charcot-Marie-Tooth (CMT) 1B due to a c.517G>C (p.Gly173Arg) mutation in the MPZ gene both developed an acute cauda syndrome with unbearable back pain radiating to both legs, progressive muscle weakness of the legs, and saddle hypesthesia with fecal and urinary incontinence. MRI sh

  16. Charcot-Marie-Tooth disease: The development of a diagnostic platform using next generation sequencing

    DEFF Research Database (Denmark)

    Christensen, Rikke; Væth, Signe; Thorsen, Kasper;

    Background: Charcot-Marie-Tooth Disease (CMT) is one of the most common inherited neurological diseases. Today, more than 70 CMT related genes are known to cause inherited neuropathy. The diagnostic strategy in most laboratories is based on Sanger-sequencing of few genes. In our patient cohort...

  17. [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.

  18. Charcot arthropathy of the elbow joint as a presenting feature of Chiari malformation with syringomyelia.

    Science.gov (United States)

    Sahoo, Sushanta K; Salunke, Pravin

    2014-12-01

    Charcot arthropathy of the elbow joint is occasionally seen with Chiari malformation with syringomyelia, but rarely as a presenting feature as in the reported case. The treatment is directed toward its underlying cause to halt its progression. Thus, it is important to diagnose the cause as early as possible.

  19. Increased spasticity from a fracture in the baclofen catheter caused by Charcot spine: case report.

    Science.gov (United States)

    Ravindra, Vijay M; Ray, Wilson Z; Sayama, Christina M; Dailey, Andrew T

    2015-04-01

    In patients with Charcot spine, a loss of normal feedback response from the insensate spine results in spinal neuropathy. Increasing deformity, which can manifest as sitting imbalance, crepitus, or increased back pain, can result. We present the case of a patient with a high-thoracic spinal cord injury (SCI) who subsequently developed a Charcot joint at the T10-11 level that resulted in a dramatic increase in previously controlled spasticity after fracture of an existing baclofen catheter. The 68-year-old man with T4 paraplegia presented with increasing baclofen requirements and radiographic evidence of fracture of the intrathecal baclofen catheter with an associated Charcot joint with extensive bony destruction. The neuropathic spinal arthropathy caused mechanical baclofen catheter malfunction and resulting increased spasticity. The patient was found to have transected both his spinal cord and the baclofen catheter. Treatment consisted of removal of the catheter and stabilization with long-segment instrumentation and fusion from T6 to L2. Follow-up radiographs obtained a year and a half after surgery showed no evidence of hardware failure or significant malalignment. The patient has experienced resolution of symptoms and does not require oral or intrathecal baclofen. This is the only reported case of a Charcot spine causing intrathecal catheter fracture, leading to increased spasticity. This noteworthy case suggests that late spinal instability should be considered in the setting of SCI and increased spasticity.

  20. Diabetic foot infections: a team-oriented review of medical and surgical management

    Directory of Open Access Journals (Sweden)

    Claire M Capobianco

    2010-09-01

    Full Text Available As the domestic and international incidence of diabetes and metabolic syndrome continues to rise, health care providers need to continue improving management of the long-term complications of the disease. Emergency department visits and hospital admissions for diabetic foot infections are increasingly commonplace, and a like-minded multidisciplinary team approach is needed to optimize patient care. Early recognition of severe infections, medical stabilization, appropriate antibiotic selection, early surgical intervention, and strategic plans for delayed reconstruction are crucial components of managing diabetic foot infections. The authors review initial medical and surgical management and staged surgical reconstruction of diabetic foot infections in the inpatient setting.

  1. Foot Push-Up Test

    Science.gov (United States)

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

  2. 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? ...

  3. 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

  4. Osteomyelitis in the diabetic foot

    OpenAIRE

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

    2014-01-01

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

  5. Adult cavovarus foot.

    Science.gov (United States)

    Younger, Alastair S E; Hansen, Sigvard T

    2005-09-01

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

  6. X-Ray Exam: Foot

    Science.gov (United States)

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

  7. Neuropathy and Diabetic Foot Syndrome.

    Science.gov (United States)

    Volmer-Thole, Maren; Lobmann, Ralf

    2016-06-10

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

  8. 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

  9. Diabetic foot infection treatment and care.

    Science.gov (United States)

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

    2016-04-01

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

  10. The athlete's foot.

    Science.gov (United States)

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

    1977-09-01

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

  11. 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.

  12. 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.

  13. 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.

  14. 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.

  15. [A case of Charcot-Marie-Tooth disease 1 B with Val 146Phe mutation of myelin protein zero showing a severe clinical phenotype].

    Science.gov (United States)

    Ohnishi, A; Aoki, A; Yamamoto, T; Tsuji, S

    2000-03-01

    A 15-year-old boy had complaints of progressive gait disturbance and foot deformity. He started to walk at the age of 18 months. Since two years of age, he had noticed unstable gait. He showed evident scoliosis and enlarged great auricular nerves. Moderate to slight degrees of muscular atrophy and weakness of distal upper, and proximal and distal lower limbs were observed. Pes equinovarus deformity of both feet was obvious. Muscle stretch reflexes were absent in both limbs except decreased triceps brachii reflex. Vibratory sensation was decreased severely in the toes and mildly in the fingers. In cerebrospinal fluid, protein was mildly elevated. Median nerve motor conduction velocity was 5.0 m/sec. On sural nerve biopsy, both demyelinated and remyelinated axons and onion-bulbs without hypomyelination were observed. Therefore, the diagnosis of Charcot-Marie-Tooth disease 1 was made. The direct sequencing of the genomic DNA encoding the Po gene revealed a mutant allele, a guanine to thymine substitution of nucleotide position 436, which caused a substitution of phenylalanine for valine at amino acid position 146. This type of Po mutation is different from any type of Po mutation reported in the literature.

  16. ACL reconstruction

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/article/007208.htm ACL reconstruction To use the sharing features on this page, please enable JavaScript. ACL reconstruction is surgery to reconstruct the ligament in ...

  17. Foot and ankle reconstruction:an experience on the use of 14 different flaps in 226 cases%足踝软组织重建的皮瓣选择策略:14种皮瓣226例分析

    Institute of Scientific and Technical Information of China (English)

    朱跃良; 梅良斌; 吕乾; 王毅; 范新宇; 李福兵; 吴一鹏; 徐永清

    2014-01-01

    目的 总结大样本足踝软组织重建病例使用不同皮瓣的经验,提出皮瓣的选择策略.方法 从2007年3月至2012年10月,使用14种不同皮瓣对226例足踝软组织缺损进行重建.男162例,女64例.带蒂皮瓣62例,游离皮瓣164例.带蒂皮瓣包括腓肠神经营养血管皮瓣、隐神经营养血管皮瓣、足背皮神经营养血管皮瓣、带蒂腓动脉穿支皮瓣、带蒂胫后动脉穿支皮瓣、足内侧皮瓣;游离皮瓣包括背阔肌皮瓣、股前外侧肌皮瓣、腹股沟皮瓣、臂前外侧皮瓣、股前外穿支皮瓣、腓动脉穿支皮瓣、胸背动脉穿支皮瓣、臂内侧穿支皮瓣.所有皮瓣未进行感觉神经重建.226例中194例合并足踝部骨折,162例合并肌腱断裂.结果 带蒂皮瓣62例中有11例发生远端部分坏死.164例游离皮瓣中8例全部坏死,局部坏死5例,创面二期处理后愈合.覆盖足底的57例皮瓣(带蒂25例,游离32例)在负重后,11例(带蒂5例,游离6例)出现了足底溃疡,14例出现了感染.56例恢复了足底的保护性感觉,恢复时间为3~12个月.所有术后随访4~ 48个月,平均16.7个月,均保肢成功并恢复了日常行走功能.结论 目前临床常用的皮瓣中,腓肠神经营养血管皮瓣、隐神经营养血管皮瓣是覆盖内外踝、后足背、中足背的良好选择;足底、前足、大面积的缺损应首选游离股前外侧穿支皮瓣;对于伴有感染、死腔的创面,游离背阔肌皮瓣为最佳选择.%Objective To present the experience on the use and choice of different flaps for soft tissue reconstruction of the foot and ankle.Methods From March 2007 to October 2012,the soft tissue defects of traumatic injuries on foot and ankle were reconstructed by using 14 different flaps in 226 cases (162 males and 64 females).There were 62 pedicled flaps and 164 free flaps used in reconstruction.The pedicled flaps included sural flap,saphenous flap,dorsal pedal neurocutaneous flap

  18. 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.

  19. 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.

  20. 自拟柴胡四金汤治疗夏科(Charcot)综合征

    Institute of Scientific and Technical Information of China (English)

    韩美荣

    2002-01-01

    @@ 笔者在2001年临床中遇到2例夏科(Charcot)综合征患者,2例均表现为典型的上腹痛、发热、黄疸,B超检查均提示胆总管呈泥沙样结石伴有胆管炎.笔者自拟柴胡四金汤治疗,疗效显著,兹介绍如下.

  1. Birth of modern psychiatry and the death of alienism: the legacy of Jean-Martin Charcot.

    Science.gov (United States)

    Bogousslavsky, Julien; Moulin, Thierry

    2011-01-01

    At the time of Jean-Martin Charcot, Paris--the main center for studies on the nervous system and its disorders--was home to critical exchanges between the developing discipline of neurology and psychiatry. Contrary to the commonly held view, and in spite of an established tradition concerning mental diseases, emerging neurology had a much stronger influence on psychiatry ('alienism') than the reverse. This was largely due to the school built up by Jean-Martin Charcot himself, which was organized around the study and management of hysteria. Although Charcot always claimed to be uninterested in mental medicine, he stimulated the development of an original scientific approach to nervous system conditions, based on Claude Bernard's method, along with structured academic teaching. Conversely, alienism paradoxically remained stuck in organicism, after Antoine Bayle's report in 1822 of 'arachnitis' as the substratum of general paresis of the insane. Contrary to alienism, the young neurological school was capable of self-criticism, and progressively highlighted mental factors in hysteria. This led to the paradox that neurologists were active in a disease with no organic cerebral lesion, while alienists were postulating brain lesions in all mental disorders. Pushed by Charcot, the academic evolution led to the launch of a faculty chair of mental and brain diseases in 1875, which was taken over for nearly half a century by his direct pupils Benjamin Ball, Alix Joffroy and Gilbert Ballet, who held the position until 1916, supporting the development of modern psychiatry in general hospitals, while alienism progressively disappeared at the turn of the century.

  2. 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.

  3. 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.

  4. Bilateral Charcot arthropathy of shoulder secondary to syringomyelia: An unusual case report

    Directory of Open Access Journals (Sweden)

    Ashok Panagariya

    2012-01-01

    Full Text Available Neuropathic arthropathy of the shoulder is a relatively rare disorder characterized by destruction of joint secondary to loss of sensory innervation. Bilateral Charcot arthropathy is an even rarer disorder, with very few cases reported in the English literature. We herein present a case of bilateral shoulder arthropathy secondary to syringomyelia with classical clinical and radiological findings. Radiological finding on one side was of resorptive type and resorptive mixed with productive on the other side.

  5. 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.

  6. 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.

  7. Central Nervous System Demyelination in a Charcot-Marie-Tooth Type 1A Patient

    OpenAIRE

    Christos Koros; Maria-Eleftheria Evangelopoulos; Costas Kilidireas; Elisabeth Andreadou

    2013-01-01

    Introduction. Central nervous system involvement, either clinical or subclinical, has been reported mainly in X-linked Charcot-Marie-Tooth (CMT-X) patients. Case Presentation. We present the case of a 31-year-old man with a genetically confirmed history of CMT1A who developed CNS involvement mimicking multiple sclerosis (MS). Clinical, imaging, and laboratory findings suggested an autoimmune CNS demyelination. Discussion. Although the simultaneous existence of CMT1A and MS could be coincident...

  8. Novel use of a Dektak 150 surface profiler unmasks differences in resorption pit profiles between control and Charcot patient osteoclasts.

    Science.gov (United States)

    Petrova, Nina L; Petrov, Peter K; Edmonds, Michael E; Shanahan, Catherine M

    2014-04-01

    We hypothesized that newly formed osteoclasts from patients with acute Charcot osteoarthropathy can resorb surfaces of bone more extensively compared with controls. Peripheral blood monocytes, isolated from eight Charcot patients and nine controls, were cultured in vitro on 24-well plates and bovine bone discs in duplicate with macrophage colony-stimulating factor (M-CSF) and receptor activator of nuclear factor κβ ligand (RANKL). Osteoclast formation was assessed by tartrate-resistant acid phosphatase staining (TRAcP) at day 17. Resorption was measured at day 21 after toluidine blue staining by two methods: (1) area of resorption at the surface by image analysis (%) and (2) area of resorption under the surface (μm(2)) measured by a Dektak 150 Surface Profiler. Ten 1,000 μm-long scans were performed per disc. Pits were classified as unidented, bidented, and multidented according to their shape. Although the number of newly formed TRAcP positive multinucleated cells (>3 nuclei) was similar in M-CSF + RANKL-treated cultures between controls and Charcot patients, the latter exhibited increased resorbing activity. The area of resorption on the surface by image analysis was significantly greater in Charcot patients compared with controls (21.1 % [14.5-26.2] vs. 40.8 % [35.4-46.0], median [25-75th percentile], p Charcot patients pits were deeper and wider and more frequently presented as multidented pits. This application of the Dektak 150 Surface Profiler revealed novel differences in resorption pit profile from osteoclasts derived from Charcot patients compared with controls. Resorption in Charcot patients was mediated by highly aggressive newly formed osteoclasts from monocytes eroding large and deep areas of bone.

  9. 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.

  10. Inhibition of TNF-α Reverses the Pathological Resorption Pit Profile of Osteoclasts from Patients with Acute Charcot Osteoarthropathy

    Directory of Open Access Journals (Sweden)

    Nina L. Petrova

    2015-01-01

    Full Text Available We hypothesised that tumour necrosis factor-α (TNF-α may enhance receptor activator of nuclear factor-κβ ligand- (RANKL- mediated osteoclastogenesis in acute Charcot osteoarthropathy. Peripheral blood monocytes were isolated from 10 acute Charcot patients, 8 diabetic patients, and 9 healthy control subjects and cultured in vitro on plastic and bone discs. Osteoclast formation and resorption were assessed after treatment with (1 macrophage-colony stimulating factor (M-CSF and RANKL and (2 M-CSF, RANKL, and neutralising antibody to TNF-α (anti-TNF-α. Resorption was measured on the surface of bone discs by image analysis and under the surface using surface profilometry. Although osteoclast formation was similar in M-CSF + RANKL-treated cultures between the groups (p>0.05, there was a significant increase in the area of resorption on the surface (p<0.01 and under the surface (p<0.01 in Charcot patients compared with diabetic patients and control subjects. The addition of anti-TNF-α resulted in a significant reduction in the area of resorption on the surface (p<0.05 and under the surface (p<0.05 only in Charcot patients as well as a normalisation of the aberrant erosion profile. We conclude that TNF-α modulates RANKL-mediated osteoclastic resorption in vitro in patients with acute Charcot osteoarthropathy.

  11. Distally based sural perforator propeller flap for foot and ankle reconstruction: technical pedicle evolufion%小腿远端蒂穿支皮瓣修复足踝创面的蒂部改进

    Institute of Scientific and Technical Information of China (English)

    张世民; 王欣; 陶友伦; 张英琪; 黄轶刚

    2012-01-01

    patients,with 180 degrees rotation to cover foot and ankle defects.Postoperatively,flap swelling,survival and functional recovery were evaluated. Results There were 7 posterior tibial artery perforator flaps from the posteromedial and 5 peroneal artery perforator flaps from the posterolateral sural region. The proximal fasciocutaneous flap measured 4 cm × 8 cm-6 cm × 18 cm, and the distal cutaneous flaps measured 2 cm × 2cm-4 cm × 4 cm.Flap swelling was noted under grade 2 in 9 cases,grade 3 in 2 cases,and grade 4 in 1case with some distal superficial skin necrosis,which occurred in the largest flap in our series.All flaps survived eventfully.After average 13 months follow up,the wound were cured successfully,and all patients recovered walking and shoe wearing function. Conclusion Pedicle evolution by keeping some adipofascial tissue around the pivot perforator, can preserve more venous return routes and relieve flap swelling. This technique should be recommended in perforator pedicled propeller flaps,as it enhances flap safety,and without increasing the difficulty of 180 degrees rotation.

  12. [Pyo-necrotic injuries in case of the neuro-ischemic form of diabetic foot syndrome].

    Science.gov (United States)

    Mitish, V A; Pakhalova, Iu S; Eroshkin, I A; Galstian, G R; Blatun, L A

    2014-01-01

    It was analyzed the results of examination and treatment of 217 patients with neuro-ischemic form of the diabetic foot syndrome. Diabetic macroangiopathy with critical limb ischemia (TASC II) was diagnosed in all patients. Tissue foot damage of grade 3 (Wagner) was observed in 100 (46.1%) patients, grade 4 - in 117 (53.9%) patients. The developed strategy of surgical treatment includes the revascularization of an affected limb, surgical management of a pyo-necrotic focus and the plastic reconstruction of the foot after rapid relief of ischemia symptoms. An application of such treatment strategy led to preserve a foot or a stump of the foot in 205 (94.5%) patients.

  13. Malignant Melanoma of the Foot

    Science.gov (United States)

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

  14. 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...

  15. Sesamoid Injuries in the Foot

    Science.gov (United States)

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

  16. 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.

  17. 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.

  18. 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

  19. 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.

  20. 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.

  1. 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

  2. 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.

  3. 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.

  4. 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.

  5. 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.

  6. 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.

  7. An Unusual Presentation of Charcot Arthropathy Caused by Syringomyelia Mimicking a Soft Tissue Tumor

    Directory of Open Access Journals (Sweden)

    Cuneyd Gunay

    2014-01-01

    Full Text Available Charcot arthropathy is a chronic, degenerative condition and is associated with decreased sensorial innervation. Numerous causes of this arthropathy have been described. Here we report a case of neuropathic arthropathy secondary to syringomyelia which was misdiagnosed as a soft tissue tumor and treated surgically and additionally with radiotherapy at another institution. The patient had clinical and radiological signs of syringomyelia, associated with a limited range of motion, swelling, and pain in the affected joint. Neuropathic arthropathy, although less common, should be considered in cases of unexplained joint swelling, pain, and limited range of motion of the affected joint.

  8. Clinical Efficacy and Safety of a New Method for Pressure Off-load for Patients with Diabetic Foot Syndrome: Ankle-foot Pneumoorthosis with TM Orlett

    Directory of Open Access Journals (Sweden)

    Galina Yurevna Strakhova

    2014-09-01

    Full Text Available AimThe purpose of this study was to assess the clinical efficacy, safety and consumer properties of ankle-foot pneumoorthosis with a HAS-337 TM Orlett compared with non-removable total contact cast (TCC immobilization.Materials and methodsOur study included 40 patients with diabetes mellitus type 1 (DM1 and type 2 (DM2 with neuropathic diabetic foot syndrome and chronic uninfected wounds of the plantar surface of the forefoot, with wound duration of at least 3 weeks, wound areas not less than 1 cm2 and wound depths not more than stage II based on Wagner’s classification. We excluded patients with infected wounds, osteomyelitis, Charcot osteoarthropathy or peripheral vascular disease. Our test group included 20 patients who received pressure off-load using ankle-foot pneumoorthosis with a HAS-337 TM Orlett. For a control group (n = 20, pressure off-load was achieved using TCC immobilization. Both groups were comparable with regard to age, gender, duration and degree of diabetes compensation and by original wound defect sizes (p >0.05. The study duration was 6 months. Plantar pressure was measured inside the orthosis or TCC and was compared with test shoe measurements. Our major criteria for pressure relief were reduced pressures in the wound area and the whole foot and the rate of wound healing.ResultsAt the end of the 6-month period, complete healing of all ulcers was achieved. The average healing time was 46.1±19.0 days for the test group and was 48.3±20.5 days for the control group (p >0.05. Two patients who wore pneumoorthosis with HAS-337 were discontinued upon patient request.With pneumoorthosis, the maximum peak pressure on the foot and wound defect areas was reduced by 26% and 57%, respectively. The pressure/time integral decreased on average by 41% (p >0.05. Furthermore, in the midfoot area with pneumoorthosis, the maximum pressure increased by 48% and the pressure/time integral increased by 47%.ConclusionsUsing pneumoorthosis with

  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. 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.)

  11. Radiographic and functional results in the treatment of early stages of Charcot neuroarthropathy with a walker boot and immediate weight bearing

    Directory of Open Access Journals (Sweden)

    Maria Candida Ribeiro Parisi

    2013-10-01

    Full Text Available Background: One of the most common gold standards for the treatment of Charcot neuroarthropathy (CN in the early Eichenholtz stages I and II is immobilization with the total contact casting and lower limb offloading. However, the total amount of offloading is still debatable. Objectives: This study evaluates the clinical and radiographic findings in the treatment of early stages of CN (Eichenholtz stages I and II with a walker boot and immediate total weight-bearing status. Methods: Twenty-two patients with type 2 diabetes mellitus (DM and CN of Eichenholtz stages I and II were selected for non-operative treatment. All patients were educated about their condition, and full weight bearing was allowed as tolerated. Patients were monitored on a fortnightly basis in the earlier stages, with clinical examination, temperature measurement, and standardized weight-bearing radiographs. Their American Orthopedic Foot and Ankle Society (AOFAS scores were determined before and after the treatment protocol. Results: No cutaneous ulcerations or infections were observed in the evaluated cases. The mean measured angles at the beginning and end of the study, although showing relative increase, did not present a statistically significant difference (p > 0.05. Mean AOFAS scores showed a statistically significant improvement by the end of the study (p < 0.005. Conclusion: The treatment of early stages of CN (Eichenholtz stages I and II with emphasis on walker boot and immediate weight bearing has shown a good functional outcome, non-progressive deformity on radiographic assessment, and promising results as a safe treatment option.

  12. A family with Charcot-Marie-Tooth disease (type 1: evaluating diagnostic role of nerve conduction studies

    Directory of Open Access Journals (Sweden)

    Sangeeta Gupta

    2014-06-01

    Full Text Available We aimed to report a case history of a family with Charcot-Marie-Tooth disease and to assess the role of nerve conduction studies in the diagnosis. A 10-year-old girl presented with difficulty in walking with a history of delayed motor milestones and slowly progressive weakness in distal muscles of both the lower limbs, with similar group of complaints in her father and a younger brother. Clinical examination of the patients was done and nerve conduction studies were performed. Clinical features and nerve conduction studies suggested the diagnosis as Charcot-Marie-Tooth disease with characteristic electro-diagnostic findings of Charcot-Marie-Tooth disease type-1. Charcot-Marie-Tooth disease is a rare disorder found in India. Although genetic tests form the basis of accurate diagnosis, yet nerve conduction studies, to a great extent, prove to be remarkable in approaching the diagnosis and distinguishing the common subtypes of this rare condition. [Int J Res Med Sci 2014; 2(3.000: 1147-1150

  13. Postural instability in Charcot-Marie-Tooth type 1A patients is strongly associated with reduced somatosensation.

    NARCIS (Netherlands)

    Linden, M.H. van der; Linden, S.C. van der; Hendricks, H.T.; Engelen, B.G.M. van; Geurts, A.C.H.

    2010-01-01

    In order to determine the influence of somatosensory impairments, due to the loss of large myelinated fibres, on the postural stability of Charcot-Marie-Tooth 1A (CMT) patients, a cross-sectional balance assessment was done. Nine CMT patients were compared with eight patients with a distal type of S

  14. Spine deformities in Charcot-Marie-Tooth 4C caused by SH3TC2 gene mutations.

    NARCIS (Netherlands)

    Azzedine, H.; Ravise, N.; Verny, C.; Gabreëls-Festen, A.A.W.M.; Lammens, M.M.Y.; Grid, D.; Vallat, J.M.; Durosier, G.; Senderek, J.; Nouioua, S.; Hamadouche, T.; Bouhouche, A.; Guilbot, A.; Stendel, C.; Ruberg, M.; Brice, A.; Birouk, N.; Dubourg, O.; Tazir, M.; LeGuern, E.

    2006-01-01

    BACKGROUND: Charcot-Marie-Tooth (CMT) disease is a heterogeneous group of inherited peripheral motor and sensory neuropathies with several modes of inheritance: autosomal dominant, X-linked, and autosomal recessive (AR) CMT. A locus responsible for the demyelinating form of ARCMT was assigned to the

  15. 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.

  16. 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

  17. Jean-Martin Charcot's house officers at La Salpêtrière Hospital.

    Science.gov (United States)

    Walusinski, Olivier

    2011-01-01

    From the time he became chef de service at La Salpêtrière Hospital in 1866 until his death in 1893, Jean-Martin Charcot oversaw 32 house officers. Some of them became famous, such as D.M. Bourneville, E. Brissaud, P. Marie and G. Gilles de la Tourette. Others are less well known. The fact remains that Charcot knew how to surround himself with fine students and leverage their talents in order to make the neurological discoveries by which he would become famous throughout the world. Here, we present the biographies of H. Soulier (1862), J. Cotard (1865), R. Lépine (1867), A. Gombault (1872), A. Pierret (1874), A. Pitres (1876), P. Oulmont (1877), G. Guinon (1885), P. Blocq(1887), E. Huet (1888), E. Parmentier (1890) and A. Souques(1893). Each of these men with their unique paths and interests helped lay the foundations for the birth of neurology at the end of the 19th century in Paris. As Emile Littré said: 'La science de la Médecine, si elle ne veut pas être rabaissée au rang de métier, doit s'occuper de son histoire et soigner les vieux monuments que les temps passés lui ont légués', which could be translated as 'to avoid being reduced to a trade, the science of medicine must attend to its history and take care of the old monuments handed down by time'.

  18. 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.

  19. The memory of two great mental calculators: Charcot and Binet's neglected 1893 experiments.

    Science.gov (United States)

    Nicolas, Serge; Gounden, Yannick; Levine, Zachary

    2011-01-01

    French neurologist Jean Martin Charcot (1825-1893) and French psychologist Alfred Binet (1857-1911) are almost unknown as investigators who conducted original and fascinating studies in the area of memory. In a series of 1893 experiments, they compared the performance of two expert mental calculators, Jacques Inaudi and Périclès Diamandi, in tasks that consisted of recalling digits. Inspired by Ribot's psychological work (1881), they believed in the existence of not one type of memory but several partial, special, and local memories, each devoted to a particular domain. In all arithmetical prodigies, memory for digits is abnormally developed compared with other memories. Inaudi was considered to be an auditory memory-based mental calculator; when memorizing digits, he did not rely onthe appearance of the items or create visual imagery of any kind. Rather, he remembered digits principally by their sounds. Inaudi's methods of calculation and memorization were original and different from those used by Diamandi, who was a typical visual memory-based mental calculator. The experiments presented in the 1893 article were among the first scientific demonstrations of the importance to psychology of studying different types of memory. The present work gives a translation of this pioneering experimental article on expert calculators by Charcot and Binet, instructive for the comprehension of normal memory.

  20. Copy Number Variations in a Population-Based Study of Charcot-Marie-Tooth Disease

    Directory of Open Access Journals (Sweden)

    Helle Høyer

    2015-01-01

    Full Text Available Copy number variations (CNVs are important in relation to diversity and evolution but can sometimes cause disease. The most common genetic cause of the inherited peripheral neuropathy Charcot-Marie-Tooth disease is the PMP22 duplication; otherwise, CNVs have been considered rare. We investigated CNVs in a population-based sample of Charcot-Marie-Tooth (CMT families. The 81 CMT families had previously been screened for the PMP22 duplication and point mutations in 51 peripheral neuropathy genes, and a genetic cause was identified in 37 CMT families (46%. Index patients from the 44 CMT families with an unknown genetic diagnosis were analysed by whole-genome array comparative genomic hybridization to investigate the entire genome for larger CNVs and multiplex ligation-dependent probe amplification to detect smaller intragenomic CNVs in MFN2 and MPZ. One patient had the pathogenic PMP22 duplication not detected by previous methods. Three patients had potentially pathogenic CNVs in the CNTNAP2, LAMA2, or SEMA5A, that is, genes related to neuromuscular or neurodevelopmental disease. Genotype and phenotype correlation indicated likely pathogenicity for the LAMA2 CNV, whereas the CNTNAP2 and SEMA5A CNVs remained potentially pathogenic. Except the PMP22 duplication, disease causing CNVs are rare but may cause CMT in about 1% (95% CI 0–7% of the Norwegian CMT families.

  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. 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

  3. Bacteriology of diabetic foot lesions.

    Science.gov (United States)

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

    2006-02-01

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

  4. 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

  5. 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.

  6. 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.

  7. Design and Analysis of New Prosthetic Foot.

    Directory of Open Access Journals (Sweden)

    Kadhim K.Al-Kinani,MSc

    2007-01-01

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

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

    Science.gov (United States)

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

  9. American Orthopaedic Foot and Ankle Society

    Science.gov (United States)

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

  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. 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

  12. Ligament reconstruction.

    Science.gov (United States)

    Glickel, Steven Z; Gupta, Salil

    2006-05-01

    Volar ligament reconstruction is an effective technique for treating symptomatic laxity of the CMC joint of the thumb. The laxity may bea manifestation of generalized ligament laxity,post-traumatic, or metabolic (Ehler-Danlos). There construction reduces the shear forces on the joint that contribute to the development and persistence of inflammation. Although there have been only a few reports of the results of volar ligament reconstruction, the use of the procedure to treat Stage I and Stage II disease gives good to excellent results consistently. More advanced stages of disease are best treated by trapeziectomy, with or without ligament reconstruction.

  13. 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.

  14. 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.

  15. 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.

  16. 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.

  17. 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.

  18. 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.

  19. 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

  20. [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.

  1. 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.

  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. 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.

  4. 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).

  5. Foot Health Facts for Athletes

    Science.gov (United States)

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

  6. 24 CFR 3285.312 - Footings.

    Science.gov (United States)

    2010-04-01

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

  7. 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.

  8. 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 holdings...

  9. Breast Reconstruction

    Science.gov (United States)

    ... senos Preguntas Para el Médico Datos Para la Vida Komen El cuidado de sus senos:Consejos útiles ... that can help . Federal law requires most insurance plans cover the cost of breast reconstruction. Learn more ...

  10. 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

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

    Directory of Open Access Journals (Sweden)

    Harshanand Popalwar

    2016-03-01

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

  12. 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 considerable......). There was no significant association between foot size and FLT values. CONCLUSION: The FLT is a reproducible technique to assess foot posture....

  13. 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

  14. 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

  15. 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

  16. 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.

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

    Science.gov (United States)

    Mota Gomes, Marleide da; Engelhardt, Eliasz

    2014-12-01

    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 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.

  18. Charcot-Marie-Tooth type 4F disease caused by S399fsx410 mutation in the PRX gene.

    Science.gov (United States)

    Kabzinska, D; Drac, H; Sherman, D L; Kostera-Pruszczyk, A; Brophy, P J; Kochanski, A; Hausmanowa-Petrusewicz, I

    2006-03-14

    Charcot-Marie-Tooth type 4F disease (CMT4F) is an autosomal recessive neuropathy caused by mutations in the PRX gene. To date, only seven mutations have been identified in the PRX gene. In this study, the authors report a novel S399fsX410 mutation in the PRX gene and its effects at the protein level, which was identified in an 8-year-old patient with early-onset CMT disease.

  19. 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

  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. Nonlinear Reconstruction

    CERN Document Server

    Zhu, Hong-Ming; Pen, Ue-Li; Chen, Xuelei; Yu, Hao-Ran

    2016-01-01

    We present a direct approach to non-parametrically reconstruct the linear density field from an observed non-linear map. We solve for the unique displacement potential consistent with the non-linear density and positive definite coordinate transformation using a multigrid algorithm. We show that we recover the linear initial conditions up to $k\\sim 1\\ h/\\mathrm{Mpc}$ with minimal computational cost. This reconstruction approach generalizes the linear displacement theory to fully non-linear fields, potentially substantially expanding the BAO and RSD information content of dense large scale structure surveys, including for example SDSS main sample and 21cm intensity mapping.

  2. Alfred Vulpian and Jean-Martin Charcot in each other's shadow? From Castor and Pollux at La Salpêtrière to neurology forever.

    Science.gov (United States)

    Bogousslavsky, Julien; Walusinski, Olivier; Moulin, Thierry

    2011-01-01

    While Alfred Vulpian (1826-1887) is not completely forgotten, he cannot match the uninterrupted celebrity which Jean-Martin Charcot (1825-1893) still enjoys today. After becoming interne (residents) at the same institute in 1848, both were involved in shaping the cradle of what would become modern neurology. Both started work as chiefs at a La Salpêtrière service on January 1, 1862, making common rounds and studies, with several common publications. While their friendship remained 'for life', as stated by Charcot at Vulpian's funeral, their career paths differed. Vulpian progressed quicker and higher, being appointed full professor and elected at the Académie Nationale de Médecine and the Académie des Sciences several years before Charcot, as well as becoming dean of the Paris Faculty of Medicine. These positions also enabled him to support his friend Charcot in getting appointed full clinical professor and becoming the first holder of the chair of Clinique des Maladies du Système Nerveux in 1882. Before studying medicine, Vulpian had worked in physiology with Pierre Flourens, and his career always remained balanced between physiology and neurology, with remarkable papers. He introduced Charcot to optic microscopy during their La Salpêtrière years, indirectly helping him to become his successor to the chair of pathological anatomy in 1872. While Vulpian succeeded so well in local medical affairs, Charcot spent his time building up a huge clinical service and a teaching 'school' at La Salpêtrière, which he never left for over 31 years until his death. This 'school' progressively became synonymous with clinical neurology itself and perpetuated the master's memory for decades. Vulpian never had such support, although Jules Déjerine was his pupil and Joseph Babinski was his interne before becoming Charcot's chef de clinique (chief of staff) in 1885. This unusual switch in Parisian medicine contributed to Charcot's unaltered celebrity over more than a century

  3. ACL reconstruction - discharge

    Science.gov (United States)

    Anterior cruciate ligament reconstruction - discharge; ACL reconstruction - discharge ... had surgery to reconstruct your anterior cruciate ligament (ACL). The surgeon drilled holes in the bones of ...

  4. 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.

  5. Narrative review: Diabetic foot and infrared thermography

    Science.gov (United States)

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

    2016-09-01

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

  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. Prevention and treatment of diabetic foot ulcers.

    Science.gov (United States)

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

    2017-03-01

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

  9. 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.

  10. Breast Reconstruction Alternatives

    Science.gov (United States)

    ... Breast Reconstruction Surgery Breast Cancer Breast Reconstruction Surgery Breast Reconstruction Alternatives Some women who have had a ... chest. What if I choose not to get breast reconstruction? Some women decide not to have any ...

  11. Smooth Reconstruction

    Institute of Scientific and Technical Information of China (English)

    2009-01-01

    Eighty percent of the reconstruction projects in Sichuan Province will be completed by the end of the year Despite ruins still seen everywhere in the earthquake-hit areas in Sichuan (Province, new buildings have been completed, and many people have moved into new houses. Through cameras of the media, the faces, once painful and melancholy after last year’s earthquake, now look confident and firm, gratifying people all over the

  12. Sural artery perforator flap with posterior tibial neurovascular decompression for recurrent foot ulcer in leprosy patients

    Directory of Open Access Journals (Sweden)

    Ismail, Hossam El-din Ali

    2017-01-01

    Full Text Available Introduction: The sensory loss and alteration of the shape of the foot make the foot liable to trauma and pressure, and subsequently cause more callus formation, blisters, and ulcers. Foot ulcers usually are liable to secondary infection as cellulitis or osteomyelitis, and may result in amputations. Foot ulcers are a major problem and a major cause of handicaps in leprosy patients. The current study is to present our clinical experience and evaluate the use of sural flap with posterior tibial neurovascular decompression (PTND in recurrent foot ulcers in leprosy patients.Patient and methods: A total number of 9 patients were suffering from chronic sequelae of leprosy as recurrent foot ulcers. All the patients were reconstructed with the reverse sural artery fasciocutaneous flap with posterior tibial neurovascular decompression from September 2012 to August 2015. Six patients were male and three were female with a mean age of 39.8 years (range, 30–50 years. All the soft tissue defects were in the weight-bearing area of the inside of the foot. The flap sizes ranged from 15/4 to 18/6 cm. Mean follow-up period was 21.2 months (range, 35–2 months.Results: All the flaps healed uneventfully. There was no major complication as total flap necrosis. Only minor complications occurred which were treated without surgical intervention except in two patients who developed superficial necrosis of the skin paddle. Surgical debridement was done one week later. The flap was completely viable after surgery, and the contour of the foot was restored. We found that an improvement of sensation occurred in those patients in whom the anesthesia started one year ago or less and no sensory recovery in patient in whom the anesthesia had lasted for more than two years.Conclusion: The reverse sural artery flap with posterior tibial neurovascular decompression provides a reliable method for recurrent foot soft tissue reconstruction in leprosy patients with encouraging

  13. Sural artery perforator flap with posterior tibial neurovascular decompression for recurrent foot ulcer in leprosy patients

    Science.gov (United States)

    Ismail, Hossam El-din Ali; El Fahar, Mohamed Hassan

    2017-01-01

    Introduction: The sensory loss and alteration of the shape of the foot make the foot liable to trauma and pressure, and subsequently cause more callus formation, blisters, and ulcers. Foot ulcers usually are liable to secondary infection as cellulitis or osteomyelitis, and may result in amputations. Foot ulcers are a major problem and a major cause of handicaps in leprosy patients. The current study is to present our clinical experience and evaluate the use of sural flap with posterior tibial neurovascular decompression (PTND) in recurrent foot ulcers in leprosy patients. Patient and methods: A total number of 9 patients were suffering from chronic sequelae of leprosy as recurrent foot ulcers. All the patients were reconstructed with the reverse sural artery fasciocutaneous flap with posterior tibial neurovascular decompression from September 2012 to August 2015. Six patients were male and three were female with a mean age of 39.8 years (range, 30–50 years). All the soft tissue defects were in the weight-bearing area of the inside of the foot. The flap sizes ranged from 15/4 to 18/6 cm. Mean follow-up period was 21.2 months (range, 35–2 months). Results: All the flaps healed uneventfully. There was no major complication as total flap necrosis. Only minor complications occurred which were treated without surgical intervention except in two patients who developed superficial necrosis of the skin paddle. Surgical debridement was done one week later. The flap was completely viable after surgery, and the contour of the foot was restored. We found that an improvement of sensation occurred in those patients in whom the anesthesia started one year ago or less and no sensory recovery in patient in whom the anesthesia had lasted for more than two years. Conclusion: The reverse sural artery flap with posterior tibial neurovascular decompression provides a reliable method for recurrent foot soft tissue reconstruction in leprosy patients with encouraging function and

  14. Charcot-Marine-Tooth CMT-2 Polyneuropathy Syndrome A Case Study.

    Directory of Open Access Journals (Sweden)

    Arbind Kumar Choudhary

    2015-06-01

    Full Text Available Abstract Charcot-Marie-Tooth disease CMT refers to the inherited peripheral neuropathies affect approximately one in 2500 people they are among the most common inherited neurological disorders. The majority of CMT patients have autosomal dominant inheritance although X-linked dominant and autosomal recessive forms also exist. The majority of cases are demyelinating although up to one third appear to be primary axonal or neuronal disorders. A patient of 9-year-old girl visited our hospital because of began to suffer from an insidious onset of progressive distal weakness and numbness and muscle twitching in both in her upper and lower limbs. Nerve conduction studies showed sensory nerve conduction SNCV of bilateral median and ulnar nerve was reduced in upper limb and bilateral sural nerve was reduced in lower limb While in case of motor nerve conduction MNCV bilateral median and ulnar nerve was reduced in upper limb and common peroneal nerve CPN as well as posterior tibial nerve was decreased leg. F response latencies were markedly prolonged in patient. Family history along with electrophysiological studied showed It was typical case of autosomal dominant CMT 2 axonal neuropathy. CMT is currently an untreatable disorder and at the moment the treatment of CMT is only supportive as there are no drugs available that would halt the disease symptoms. The care of a CMT patient is challenging for the health care team.

  15. Ultrastructural localization of Charcot-Leyden crystal protein in human eosinophils and basophils.

    Science.gov (United States)

    Calafat, J; Janssen, H; Knol, E F; Weller, P F; Egesten, A

    1997-01-01

    The Charcot-Leyden crystal (CLC) protein with lysophospholipase activity and carbohydrate-binding properties is a characteristic constituent of eosinophils and basophils. We investigated its subcellular distribution using immunoelectron microscopy. Eosinophil progenitors, mature eosinophils and basophils all contained CLC protein in their cytosol and in the euchromatin of the nucleus. A minor population of granules in eosinophils, increasing in number with maturation, and a more abundant granule-population in basophils, were found to contain CLC protein. Double-labeling experiments showed, in eosinophils, that CLC protein-containing granules contain also eosinophil peroxidase, a characteristic specific granule protein. This suggests a relationship between the CLC protein-containing organelle and the specific granule. In basophils both the CLC protein positive and the negative granules showed the same characteristic particulate-like structure of the granular matrix and both share the same membrane marker CD63. In nasal polyps, macrophages were observed phagocytosing necrotic eosinophils. In these macrophages CLC protein-containing vesicles were observed, probably representing late endosomes. The dual (cytosolic/nuclear and granular) localization of CLC protein suggests that this protein enters both a secretory and a nonsecretory pathway during its biosynthesis, indicating functional roles for this protein both within the cell and extracellularly.

  16. 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.

  17. 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.

  18. Quality of life in patients with Charcot-Marie-Tooth disease type 1A

    Directory of Open Access Journals (Sweden)

    Juliana B. Taniguchi

    2013-06-01

    Full Text Available We assessed the functional impairment in Charcot-Marie-Tooth resulting from 17p11.2-p12 duplication (CMT1A patients using the Short-Form Health Survey (SF-36, which is a quality of life questionnaire. Twenty-five patients of both genders aged ≥10 years with a positive molecular diagnosis of CMT1A were selected. Age- and gender-matched Control Group (without family history of neuropathy, and the sociodemographic and professional conditions similar to the patients' group were selected to compare the SF-36 results between them. The results showed that the majority quality of life impairments in CMT1A patients occurred in the social and emotional domains. Functional capacity also tended to be significantly affected; other indicators of physical impairment were preserved. In conclusion, social and emotional aspects are mostly neglected in the assistance provided to CMT1A Brazilian patients, and they should be better understood in order to offer global health assistance with adequate quality of life as a result.

  19. 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).

  20. Mild phenotype of Charcot-Marie-Tooth disease type 4B1.

    Science.gov (United States)

    Murakami, Tatsufumi; Kutoku, Yumiko; Nishimura, Hirotake; Hayashi, Makiko; Abe, Akiko; Hayasaka, Kiyoshi; Sunada, Yoshihide

    2013-11-15

    Charcot-Marie-Tooth type 4B1 (CMT4B1) is a rare autosomal recessive demyelinating neuropathy caused by mutation of the myotubularin-related 2 (MTMR2) gene. It is characterized by a severe early-onset motor and sensory neuropathy, and myelin outfoldings on nerve biopsy. We describe a mild phenotype of CMT4B1 in a Japanese patient. She noticed difficulty in walking as an initial symptom at age 13. Her symptoms progressed slowly, and she could still walk at age 34. There was no cranial neuropathy. A nerve conduction study demonstrated demyelinating neuropathy. Sural nerve biopsy revealed a moderate-to-severe loss of myelinated fibers, and many focally folded myelin sheaths. Electron micrographs showed myelin outfoldings and infoldings. DNA tests for CMT showed that she is a homozygote for the MTMR2 p.R628PfsX18 mutation. The mild phenotype in our patient is probably due to the C-terminal position of the frame-shift mutation in MTMR2.

  1. 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.

  2. GDAP1 mutations in Italian axonal Charcot-Marie-Tooth patients: Phenotypic features and clinical course.

    Science.gov (United States)

    Pezzini, I; Geroldi, A; Capponi, S; Gulli, R; Schenone, A; Grandis, M; Doria-Lamba, L; La Piana, C; Cremonte, M; Pisciotta, C; Nolano, M; Manganelli, F; Santoro, L; Mandich, P; Bellone, E

    2016-01-01

    Mutations in the ganglioside-induced differentiation associated-protein 1 (GDAP1) gene have been associated with both autosomal recessive (AR) and dominant (AD) Charcot-Marie-Tooth (CMT) axonal neuropathy. The relative frequency of heterozygous, dominant mutations in Italian CMT is unknown. We investigated the frequency of dominant mutations in GDAP1 in a cohort of 109 axonal Italian patients by sequencing genomic DNA and search for copy number variations. We also explored correlations with clinical features. All cases had already been tested for variants in common axonal AD genes. Eight patients (7.3%) harbored five already reported heterozygous mutations in GDAP1 (p.Arg120Gly, p.Arg120Trp, p.His123Arg, p.Gln218Glu, p.Arg226Ser). Mutations had different penetrances in the families; the onset of symptoms is in the first decade and progression is slower than usually seen in GDAP1-related AR-CMT. We show that the relative frequency of mutations in GDAP was slightly higher than those observed in MFN2 and MPZ (7.3% vs 6.3% and 5.0%). The relatively milder clinical features and the quite indolent course observed are relevant for prognostic assessment. On the basis of our experience and the data reported here, we suggest GDAP1 as the first gene that should be analysed in Italian patients affected by CMT2.

  3. 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.

  4. Perk Ablation Ameliorates Myelination in S63del-Charcot-Marie-Tooth 1B Neuropathy.

    Science.gov (United States)

    Musner, Nicolò; Sidoli, Mariapaola; Zambroni, Desireè; Del Carro, Ubaldo; Ungaro, Daniela; D'Antonio, Maurizio; Feltri, Maria L; Wrabetz, Lawrence

    2016-01-01

    In peripheral nerves, P0 glycoprotein accounts for more than 20% of myelin protein content. P0 is synthesized by Schwann cells, processed in the endoplasmic reticulum (ER) and enters the secretory pathway. However, the mutant P0 with S63 deleted (P0S63del) accumulates in the ER lumen and induces a demyelinating neuropathy in Charcot-Marie-Tooth disease type 1B (CMT1B)-S63del mice. Accumulation of P0S63del in the ER triggers a persistent unfolded protein response. Protein kinase RNA-like endoplasmic reticulum kinase (PERK) is an ER stress sensor that phosphorylates eukaryotic initiation factor 2 alpha (eIF2alpha) in order to attenuate protein synthesis. We have shown that increasing phosphophorylated-eIF2alpha (P-eIF2alpha) is a potent therapeutic strategy, improving myelination and motor function in S63del mice. Here, we explore the converse experiment:Perkhaploinsufficiency reduces P-eIF2alpha in S63del nerves as expected, but surprisingly, ameliorates, rather than worsens S63del neuropathy. Motor performance and myelin abnormalities improved in S63del//Perk+/- compared with S63del mice. These data suggest that mechanisms other than protein translation might be involved in CMT1B/S63del neuropathy. In addition,Perkdeficiency in other cells may contribute to demyelination in a non-Schwann-cell autonomous manner.

  5. 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.

  6. 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.

  7. 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.

  8. Postural stabilization and balance assessment in Charcot-Marie-Tooth 1A subjects.

    Science.gov (United States)

    Lencioni, T; Rabuffetti, M; Piscosquito, G; Pareyson, D; Aiello, A; Di Sipio, E; Padua, L; Stra, F; Ferrarin, M

    2014-09-01

    The aim of the present study was to assess postural stabilization skill in adult subjects affected by Charcot-Marie-Tooth disease (CMT) type 1A. For this purpose ground reaction force (GRF) was measured by means of a piezoelectric force platform during the sit-to-stand (STS) movement, until a steady state erect posture was achieved. Specific indexes to quantify Centre of Mass acceleration, both during postural stabilization and during quiet standing, were computed using a mathematical model. Forty-seven CMT1A subjects were recruited for the study, and the control group was formed by forty-one age- and sex-matched healthy subjects. The results show that CMT1A subjects are less stable than controls during the quiet stance. Greater difficulty (high values of Yinf, the final instability rate) to maintain erect posture appears to be mainly associated with plantar-flexor muscle weakness, rather than to damage of the proprioceptive system. The worst performances shown by CMT1A subjects in the stabilization phase (high values of I, the global index of postural stabilization performance) seem to be associated with reduced muscle strength and the loss of large sensory nerve fibres. Distal muscle weakness appears to affect both postural stabilization and quiet erect posture. The presented protocol and the analysis of postural stabilization parameters provide useful information on CMT1A balance disorders.

  9. 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.

  10. Characterization of gait parameters in patients with Charcot-Marie-Tooth disease.

    Directory of Open Access Journals (Sweden)

    Kuruvilla A

    2000-01-01

    Full Text Available The gait of five patients with Charcot-Marie-Tooth(CMT disease was analyzed using light-emitting diodes and a force plate. The flexion-extension motions of the hips, knees, and ankles, as well as their moments (vector sums of forces acting at the joints in the flexion-extension and abduction-adduction planes, were quantified. The gait of the CMT patients showed abnormalities consistent with both distal weakness (ankle dorsi- and plantar-flexors and weakness of the hip abductor muscles. The latter weakness appeared to produce asymmetric hip moments and truncal instability in the mediolateral plane during ambulation. However, the extent to which the gait was abnormal appeared not to be exclusively related to the severity of the sensorimotor conduction deficits in the peripheral nerves. In the four patients for whom nerve conduction velocity studies were available, decrease in the lower-extremity distal conduction velocities and evoked motor amplitude potentials did not correlate with the severity and extent of the gait abnormalities.

  11. 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.

  12. 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.

  13. Maxillary reconstruction

    Directory of Open Access Journals (Sweden)

    Brown James

    2007-12-01

    Full Text Available This article aims to discuss the various defects that occur with maxillectomy with a full review of the literature and discussion of the advantages and disadvantages of the various techniques described. Reconstruction of the maxilla can be relatively simple for the standard low maxillectomy that does not involve the orbital floor (Class 2. In this situation the structure of the face is less damaged and the there are multiple reconstructive options for the restoration of the maxilla and dental alveolus. If the maxillectomy includes the orbit (Class 4 then problems involving the eye (enopthalmos, orbital dystopia, ectropion and diplopia are avoided which simplifies the reconstruction. Most controversy is associated with the maxillectomy that involves the orbital floor and dental alveolus (Class 3. A case is made for the use of the iliac crest with internal oblique as an ideal option but there are other methods, which may provide a similar result. A multidisciplinary approach to these patients is emphasised which should include a prosthodontist with a special expertise for these defects.

  14. 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.......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....

  15. 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.

  16. 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

  17. The madura foot: looking deep.

    Science.gov (United States)

    Venkatswami, Sandhya; Sankarasubramanian, Anandan; Subramanyam, Shobana

    2012-03-01

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

  18. 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.

  19. Diabetic Foot and Risk: How to Prevent Losing Your Leg

    Science.gov (United States)

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

  20. 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

  1. 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

    2015-12-23

    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.

  2. [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.

  3. Louisiana farm discussion: 8 foot row spacing

    Science.gov (United States)

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

  4. The role of foot morphology on foot function in diabetic subjects with or without neuropathy.

    Science.gov (United States)

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

    2013-04-01

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

  5. Moléstia de Charcot-Marie-Tooth: conceito clínico-patológico atual

    Directory of Open Access Journals (Sweden)

    José Antonio Levy

    1962-06-01

    Full Text Available Após considerações sobre o quadro anátomo-patológico da moléstia de Charcot-Marie-Tooth, o autor relata 4 casos, chegando à conclusão de que esta moléstia pode ser considerada como uma neuromiopatia em virtude de algumas alterações histopatológicas musculares serem primárias, ao passo que outras são secundárias à lesão do neurônio motor periférico.

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

    OpenAIRE

    A-ping Sun; Lu Tang; Qin Liao; Hui Zhang; Ying-shuang Zhang; Jun Zhang(UT Austin)

    2015-01-01

    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 ...

  7. 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.

  8. Toe-to-hand transfer from a cross-foot replantation in a traumatic four-extremity amputation.

    Science.gov (United States)

    Yildirim, Serkan; Akan, Mithat; Aköz, Tayfun

    2005-10-01

    Treatment of mutilating hand injuries often requires multiple innovative procedures. This report describes a case of multi-limbed amputations from a train injury and the extraordinary microsurgical approaches for a two-hand reconstruction. The first stage of the procedure was a cross replantation of the left foot to the right leg. The second stage was a combined second and third toe transfer from the cross replantation of the left foot to the right hand, and a sensate fibular osteocutaneous flap transfer for left hand reconstruction. Satisfactory function was restored, including good protective sensation. These kinds of extraordinary microsurgical approaches are useful salvage procedures for hand reconstruction, when presented with a case of multi-limb amputation.

  9. Clinical, neurophysiological and morphological study of dominant intermediate Charcot-Marie-Tooth type C neuropathy.

    Science.gov (United States)

    Thomas, Florian P; Guergueltcheva, Velina; Gondim, Francisco A A; Tournev, Ivailo; Rao, Chitharanjan V; Ishpekova, Boryana; Kinsella, Laurence J; Pan, Yi; Geller, Thomas J; Litvinenko, Ivan; De Jonghe, Peter; Scherer, Steven S; Jordanova, Albena

    2016-03-01

    Dominant intermediate Charcot-Marie-Tooth neuropathy subtype C (DI-CMTC) was associated with mutations in the YARS gene, encoding tyrosyl-tRNA synthetase, in two large unrelated Bulgarian and US pedigrees and one sporadic case. Here for the first time we describe the clinical, neurophysiological and histopathological features, and phenotypic differences between these two DI-CMTC families. Twenty-one affected individuals from the US family and 27 from the Bulgarian family were evaluated. The mean age of onset in US subjects was 10.7 years in men and 7.3 years in women, while in the Bulgarian participants it was 18.2 years in men and 33.7 years in women. The course was slowly progressive. Extensor digitorum brevis atrophy was uniform. Atrophy and/or weakness of upper and lower limb muscles were found in over 50 % of the subjects. Nerve conduction studies (NCS) were abnormal in all US adults and five of six children and all Bulgarian patients except one asymptomatic 25-year-old man. Median motor NCS were in the range of 29.5-45.6 m/s in the US family and 24.7-57.8 m/s in the Bulgarian family. Sural sensory nerve action potentials were absent in 14/21 and 4/12 NCS from adult US and Bulgarian participants, respectively. Analysis of sural nerve biopsies from US patients revealed age-dependent morphological changes of axonal degeneration, absence of onion bulbs, and <10 % fibers with segmental remyelination. Our findings provide further insights into the diagnosis and pathology of intermediate CMT. They also extend the phenotypic spectrum of peripheral neuropathies associated with aminoacyl-tRNA synthetase mutations.

  10. 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.

  11. [Molecular diagnosis of axonal forms of Charcot-Marie-Tooth disease].

    Science.gov (United States)

    Latour, P; Vial, C

    2009-12-01

    Charcot-Marie-Tooth (CMT) disease is the most common cause of inherited peripheral neuropathies with a frequency estimated at 1/2500. Electroneuromyographic examination distinguishes a myelinic form (CMT1) and an axonal form of the disease (CMT2). Significant genetic heterogeneity is found in CMT, with 15 genes or loci for CMT2. To date, a molecular diagnosis has not been established for most CMT2 patients and the distribution of identified mutations is wide spreading over nearly all genes. Simple guidelines for daily practice are difficult to establish from compilation of mutation reports or consultation of databases; little simplification can be expected from future findings. We present our results of molecular diagnosis for 251 CMT2 index cases characterized by their mode of inheritance (217 dominant and 34 recessive cases), and a motor conduction velocity in median nerve equal to or above to 38m/s. For each case, at least one of the genes known to date for CMT2 (MFN2, RAB7, GARS, NF-L, HSPB1, GDAP1, MPZ, HSPB8, GJB1, DNM2, YARS, LMNA, and MED25) was studied. Around 22% of diagnoses were established and efficiency was comparable for dominant or recessive cases. For dominant cases, the first objective was to search for mutations of proteins connexin32, mitofusin2 and P0. For recessive cases, GDAP1 provided the key to molecular diagnosis; lamin A/C mutations were only found for patients with an ethnic background from North Africa. Heat shock proteins HSPB1 and HSPB8 were implicated in a significant proportion of "spinal" (or pure motor) CMT2. NF-L or RAB7 mutations were rare. We did not identify any deleterious mutations in GARS, DNM2, YARS orMED2. We propose a simple decision tree for molecular diagnosis of CMT2.

  12. 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.

  13. 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.

  14. Tripod pinch strength and thumb opposition are the major determinants of manual dexterity in Charcot-Marie-Tooth disease type 1A

    NARCIS (Netherlands)

    Videler, A.J.; Beelen, A.; van Schaik, I.N.; Verhamme, C.; van den Berg, L.H.; Visser, M.; Nollet, F.

    2010-01-01

    BACKGROUND: Clinical features of Charcot-Marie-Tooth disease type 1A (CMT1A) include slowly progressive distal muscle weakness, atrophy and sensory loss. Upper-limb involvement results in reduced manual dexterity interfering with the execution of daily activities. OBJECTIVE: To identify which hand f

  15. Tripod pinch strength and thumb opposition are the major determinants of manual dexterity in CharcoteMarieeTooth disease type 1A

    NARCIS (Netherlands)

    Videler, Annemieke J.; Beelen, Anita; van Schaik, Ivo N.; Verhamme, Camiel; van den Berg, Leonard H.; de Visser, Marianne; Nollet, Frans

    2010-01-01

    Background Clinical features of Charcot-Marie-Tooth disease type 1A (CMT1A) include slowly progressive distal muscle weakness, atrophy and sensory loss. Upper-limb involvement results in reduced manual dexterity interfering with the execution of daily activities. Objective To identify which hand fun

  16. Foot roll-over evaluation based on 3D dynamic foot scan.

    Science.gov (United States)

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

    2014-01-01

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

  17. Novel mutations in the PRX and the MTMR2 genes are responsible for unusual Charcot-Marie-Tooth disease phenotypes.

    Science.gov (United States)

    Nouioua, Sonia; Hamadouche, Tarik; Funalot, Benoit; Bernard, Rafaëlle; Bellatache, Nora; Bouderba, Radia; Grid, Djamel; Assami, Salima; Benhassine, Traki; Levy, Nicolas; Vallat, Jean-Michel; Tazir, Meriem

    2011-08-01

    Autosomal recessive Charcot-Marie-Tooth diseases, relatively common in Algeria due to high prevalence of consanguineous marriages, are clinically and genetically heterogeneous. We report on two consanguineous families with demyelinating autosomal recessive Charcot-Marie-Tooth disease (CMT4) associated with novel homozygous mutations in the MTMR2 gene, c.331dupA (p.Arg111LysfsX24) and PRX gene, c.1090C>T (p.Arg364X) respectively, and peculiar clinical phenotypes. The three patients with MTMR2 mutations (CMT4B1 family) had a typical phenotype of severe early onset motor and sensory neuropathy with typical focally folded myelin on nerve biopsy. Associated clinical features included vocal cord paresis, prominent chest deformities and claw hands. Contrasting with the classical presentation of CMT4F (early-onset Dejerine-Sottas phenotype), the four patients with PRX mutations (CMT4F family) had essentially a late age of onset and a protracted and relatively benign evolution, although they presented marked spine deformities. These observations broaden the spectrum of clinical phenotypes associated with these two CMT4 forms.

  18. Complex Technique of Large Sural Flap: An Alternative Option for Free Flap in Large Defect of the Traumatized Foot

    Directory of Open Access Journals (Sweden)

    Naser Mohammadkhah

    2011-04-01

    Full Text Available The distally based sural fasciocutaneous flap has become a main part of the reconstruction of the lower leg, heel and foot. However, perfusion problems and venous congestion have been reported. Over the past decade, several flap modifications have been reported to improve flap viability and to solve a myriad of reconstructive needs. The purpose of this paper is to describe our experience in harvesting the reversed large sural flap from the proximal and middle third of the leg for large defects on the foot. We applied the extended reversed sural flap from the proximal third of the leg in traumatized patients which had large defects on their foot. The technique was done in 3 parts: 1- the flaps were designed in the proximal third of the leg five centimeter lipofascial tissue was protected around the pedicle in distal part; 3- The pivot point was located in seven to eight cm proximal the lateral malleolus before the first fasciocutaneous perforators arising from the peroneal artery. Sural flaps from the proximal and middle third of the leg were designed in13 patients who had large defects on their foot. No flap necrosis or split thickness skin graft loss occurred. The flaps healed by the 3rd week excluding two patients. This study supports the application of our technique as a safe, easy and useable method in large defects of the foot. The results showed low rates of ischemia, venous congestion, dehiscence, infection and flap necrosis. Proximal extended and large distally based sural flap is an alternative to free tissue transfer for large defect reconstruction of the foot.

  19. 5-foot Vertical Wind Tunnel

    Science.gov (United States)

    1932-01-01

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

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

    NARCIS (Netherlands)

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

    2016-01-01

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

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

    NARCIS (Netherlands)

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

    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. 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

  3. 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...

  4. 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

  5. Glossary of Foot and Ankle Terms

    Science.gov (United States)

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

  6. On-the-Job Foot Health

    Science.gov (United States)

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

  7. American College of Foot and Ankle Surgeons

    Science.gov (United States)

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

  8. Growth factors for treating diabetic foot ulcers

    DEFF Research Database (Denmark)

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

    2015-01-01

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

  9. [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.

  10. 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.

  11. The landmine foot: its description and management.

    Science.gov (United States)

    Jacobs, L G

    1991-11-01

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

  12. 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.

  13. 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.

  14. Outcomes of a Nurse-Managed Diabetes Foot Clinic

    Science.gov (United States)

    2016-06-07

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

  15. Painless foot ulcer of Charcot foot lead to amputation: A case report%糖尿病夏科足无痛性足底溃疡致截肢一例报告

    Institute of Scientific and Technical Information of China (English)

    章燕; 姜杉; 甘华侠; 杨治芳; 刘建英

    2016-01-01

    糖尿病夏科关节病又称糖尿病神经关节病,是一种相对少见的糖尿病慢性并发症,夏科足特指发生在糖尿病患者足部的夏科关节病,好发于DPN的患者,因其临床表现隐匿常被临床医师漏诊或误诊,易导致不良的临床结局.本文报道一例长期被漏诊的糖尿病夏科足患者,足部多个关节骨折移位、畸形,引发足底无痛性溃疡,最终并发严重感染而导致截肢.通过总结该病例的诊治过程旨在复习夏科足的规范化诊疗原则,提高临床对夏科足的诊断率.

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

    OpenAIRE

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

    2014-01-01

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

  17. Doença de Charcot-Marie-Tooth: estudo da biópsia do nervo sural em 41 pacientes Charcot-Marie-Tooth disease: sural nerve biopsy findings in 41 patients

    OpenAIRE

    Freitas,Marcos R. G.; Osvaldo J. M. Nascimento; Leila Chimelli; Freitas,Gabriel R. de

    1995-01-01

    São apresentados os resultados da biópsia do nervo sural à microscopia óptica e eletrônica (ME) em 41 pacientes com doença de Charcot-Marie-Tooth (CMT) Por estudos de neurocondução prévios nove eram do tipo I e 32 do tipo II. No tipo I, todos tinham grande diminuição do número de fibras, sendo os histogramas do tipo unimodal. Encontramos imagens de desmielinização, remielinização, formação de bulbos de cebola e de regeneração. Um paciente apresentava espessamento da bainha de mielina (atrofia...

  18. A totally laparoscopic peritoneal free flap for reconstruction of hand

    Institute of Scientific and Technical Information of China (English)

    En-Qi Guo; Qing-Ping Xie

    2016-01-01

    Management of defects on the hand and foot with exposed tendons remains a major challenge for plastic surgeons.Here,we present a case of hand reconstruction with a totally laparoscopic peritoneal flap.The anterior rectus sheath was preserved in situ.The peritoneal free flap supplied by peritoneal branches of the deep inferior epigastric artery was retrieved by laparoscopy to cover the soft tissue defect of the hand.The defect of the dorsal hand was 17 cm × 12 cm.The peritoneal flap measuring 22 cm × 15 cm survived completely without any complications.A following split-thickness skin graft offered the successful wound closure.Motor and sensory function improved gradually within the first year follow-up.The totally laparoscopic peritoneal free flap is a good choice for reconstruction of the soft tissue defects accompanied by exposed tendons on the hand and foot.

  19. 半限制性假体治疗 Charcot 膝关节病的疗效分析%An effect analysis of semi-restrictive prosthesis in Charcot arthropathy of the knee

    Institute of Scientific and Technical Information of China (English)

    邓立庆; 康鹏德; 裴福兴; 沈彬; 杨静; 周宗科; 谭振; 谢小伟

    2015-01-01

    Objective To evaluate the application and clinical results of semi-restrictive prosthesis in total knee arthroplasty ( TKA ) for Charcot arthropathy of the knee.Methods Twelve patients ( 5 males and 7 females, 12 knees ) with Charcot arthropathy of the knee in our hospital from July 2003 to June 2013 were performed TKA and clinical results were reviewed and analyzed. The mean age was 48 years ( range: 30-70 years ). Semi-restrictive prostheses were used in all knees, including 7 knees with extension rod. Patients were followed up postoperatively at 1 month, 3 months, 6 months, 12 months, and annually thereafter. The mean follow-up period was 6.5 years ( range: 14 months-11 years ). Anteroposterior and lateral X-ray was taken in each follow-up. Hospital for Special Surgery ( HSS ), American Knee Society Score ( KSS ), knee range of motion ( ROM ), stability, and prosthesis location were evaluated.Results One deep infection had developed with acute hematogenous pattern at 2 years and was successfully treated with 2-stage revision. X-ray iflm showed good recovery positions of the prostheses and lower limb force lines in other patients. Postoperatively, pain completely disappeared, knee joint deformity was corrected, stability and functions were good, no prosthetic loosening or deep venous thrombosis ( DVT ) was developed. The mean Hospital for Special Surgery ( HSS ) knee score increased from 51.5 points ( range: 32-72 points ) before surgery to 87.7 points ( range: 82-96 points ) at the ifnal follow-up with statistical signiifcance (P<0.01 ). The mean clinical Knee Society Score ( KSS ) was 87.5 points ( range: 80-95 points ) postoperatively and 57.9 points ( range: 35-70 points ) preoperatively withstatistical significance (P<0.01 ). The mean functional Knee Society Score ( KSS ) was 86.9 points ( range: 80-95 points ) postoperatively and 56.8 points ( range: 30-70 points ) preoperatively with statistical signiifcance (P<0.01 ). The preoperative range of motion

  20. 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

  1. 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.

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

    DEFF Research Database (Denmark)

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

    2017-01-01

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

  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. Charcot-Marie-Tooth病Ⅰ型的免疫学机制研究进展(综述)

    Institute of Scientific and Technical Information of China (English)

    笪宇威; 贾建平

    2005-01-01

    Charcot-Marie-Tooth病(CMT)即进行性腓骨肌萎缩症,是神经系统常见的遗传病之一,目前已报道11个致病基因与Ⅰ型相关.近来研究发现,CMT1(脱髓鞘型)动物模型中髓鞘损害伴随T淋巴细胞和巨噬细胞增加,部分CMT患者周围血中活化的T细胞增加,MHC-Ⅱ分子在腓肠神经中表达增高以及一些病例对激素治疗效果好,均提示该病可能与免疫因素有关.

  6. Correlation between connexin 32 gene mutations and clinical phenotype in X-linked dominant Charcot-Marie-Tooth neuropathy

    Energy Technology Data Exchange (ETDEWEB)

    Ionasescu, V.; Ionasescu, R.; Searby, C. [Univ. of Iowa Hospitals and Clinics, Iowa City, IA (United States)

    1996-06-14

    We studied the relationship between the genotype and clinical phenotype in 27 families with dominant X-linked Charcot-Marie-Tooth (CMTX1) neuropathy. Twenty-two families showed mutations in the coding region of the connexin32 (cx32) gene. The mutations include four nonsense mutations, eight missense mutations, two medium size deletions, and one insertion. Most missense mutations showed a mild clinical phenotype (five out of eight), whereas all nonsense mutations, the larger of the two deletions, and the insertion that produced frameshifts showed severe phenotypes. Five CMTX1 families with mild clinical phenotype showed no point mutations of the cx32 gene coding region. Three of these families showed positive genetic linkage with the markers of the Xq13.1 region. The genetic linkage of the remaining two families could not be evaluated because of their small size. 25 refs., 1 fig., 1 tab.

  7. 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.

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

    Science.gov (United States)

    Gomes, Marleide da Mota; Engelhardt, Eliasz

    2013-10-01

    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 barn for diseased people--Salpetrière Hospital, were the basis of his achievements, which are still discussed 120 years after his death.

  9. 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.

  10. [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.

  11. Analysis of the benefits of vitamin cocktails in treating Charcot-Marie-Tooth disease type 1A.

    Science.gov (United States)

    Kaya, Ferdinand; Belin, Sophie; Micallef, Joelle; Blin, Olivier; Fontés, Michel

    2008-08-01

    We recently proposed that the use of high doses of ascorbic acid (AA) could constitute the first potential treatment for Charcot-Marie-Tooth disease type 1A (CMT1A).4 We investigated the potential benefits of using cocktails of vitamins for CMT1A therapy. We used transient transfection of Schwann cells with a construction placing the expression of a reporter gene under the control of the Schwann cell-specific promoter of PMP22. Transfected cells were cultured with or without addition of ascorbic acid, vitamin A, vitamin E, or a cocktail of these vitamins. Adding vitamin A or E counteracts the effect of ascorbic acid in inhibiting PMP22 expression. We thus recommend that vitamins A and E should not be included in combination with AA in clinical trials.

  12. [Case of Charcot-Marie-Tooth disease type 1A with increased cerebrospinal fluid proteins and nerve root hypertrophy].

    Science.gov (United States)

    Ishigami, Noriko; Kondo, Masaki; Nakagawa, Masanori

    2008-06-01

    We report herein a 54-year-old man who first noticed muscle weakness of the hands and legs and hypesthesia of the legs at 20-years-old. Symptoms gradually worsened. Charcot-Marie-Tooth disease type 1A (CMT 1A) was diagnosed on the basis of a nerve conduction study and PMP22 gene duplication. Increased levels of cerebrospinal fluid proteins were identified and cervical and lumbosacral nerve root hypertrophy was evident on magnetic resonance imaging (MRI). CMT 1A with increased CSF proteins and nerve root hypertrophy was carefully evaluated clinically and electrophysiologically to rule out other motor sensory neuropathies such as CIDP. Increased levels of CSF proteins in this case might have resulted from circulatory disturbance of CSF in hypertrophic nerve roots.

  13. Clinical and neurophysiological investigation of a large family with dominant Charcot-Marie-Tooth type 2 disease with pyramidal signs

    Directory of Open Access Journals (Sweden)

    Eduardo Luis de Aquino Neves

    2011-06-01

    Full Text Available Charcot-Marie-Tooth (CMT disease is a hereditary neuropathy of motor and sensory impairment with distal predominance. Atrophy and weakness of lower limbs are the first signs of the disease. It can be classified, with the aid of electromyography and nerve conduction studies, as demyelinating (CMT1 or axonal (CMT2. OBJECTIVE: Clinical and neurophysiological investigation of a large multigenerational family with CMT2 with autosomal dominant mode of transmission. METHOD: Fifty individuals were evaluated and neurophysiological studies performed in 22 patients. RESULTS: Thirty individuals had clinical signs of motor-sensory neuropathy. Babinski sign was present in 14 individuals. Neurophysiological study showed motor-sensory axonal polyneuropathy. CONCLUSION: The clinical and neurophysiological characteristics of this family does not differ from those observed with other forms of CMT, except for the high prevalence of Babinski sign.

  14. 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

    2013-07-13

    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.

  15. 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%.

  16. Nursing care of the aging foot.

    Science.gov (United States)

    Mitty, Ethel

    2009-01-01

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

  17. 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

  18. 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.

  19. Compressive sensing of foot-gait signals by enhancing group block-sparse structure on the first-order difference.

    Science.gov (United States)

    Pant, Jeevan K; Krishnan, Sridhar

    2016-08-01

    A new technique for improving the signal reconstruction performance for compressive sensing of gait signals is proposed. The algorithm is based on the minimization of a pseudo-norm which promotes group-block-sparse structure on the first-order difference of the signal. Signal blocks in foot gait signals occur as groups, and the locations of the group are estimated based on the regularization promoting block-sparse structure. The group locations are used for minimizing the pseudonorm for promoting group-block-sparse structure. Simulation results demonstrate that the proposed technique yields upto 0.76dB improvement in the reconstruction performance for foot-gait signals relative to the algorithms promoting block-sparse structure.

  20. [Mycetoma of the foot: a case report].

    Science.gov (United States)

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

    2015-04-01

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

  1. 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.

  2. 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.

  3. 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.

  4. 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.

  5. 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.

  6. Stratigraphy and sedimentology of a basement-onlapping shallow marine sandstone succession, the Charcot Bugt Formation, Middle-Upper Jurassic, East Greenland

    Energy Technology Data Exchange (ETDEWEB)

    Larsen, M.; Piasecki, S. [Geological Survey of Denmark and Greenland, Copenhagen (Denmark)]. Geocenter; Surlyk, F. [Univ. of Copenhagen, Copenhagen (Denmark)]. Geological Inst.

    2003-07-01

    A rocky shore developed in early Middle Jurassic times by transgression of the crystalline basement in Milne'Land at the western margin of the East Greenland rift basin. The basement is onlapped by shallow marine sandstones of the Charcot Bugt Formation, locally with a thin fluvial unit at the base. The topography of the onlap surface suggests that a relative sea-level rise of at least 300 m took place in Early Bathonian - Middle Oxfordian times. The sea-level rise was punctuated by relative stillstands and falls during which progradation of the shoreline took place. Palynological data tied to the Boreal ammonite stratigraphy have greatly improved time resolution within the Charcot Bugt Formation, and the Jurassic succession in Milne Land can now be understood in terms of genetically-related depositional systems with a proximal to distal decrease in grain size. The sequence stratigraphic interpretation suggests that translation of the depositional systems governed by relative sea-level changes resulted in stacking of sandstone-dominated falling stage deposits in the Bastern, basinwards parts of Milne Land, whereas thick, remarkably coarsegrained transgressive systems tract deposits formed along the western basin margin. The bulk of the Charcot Bugt Formation consists of stacked sandstone-dominated shoreface units that prograded during highstands. The overall aggradational to backstepping stacking pattem recognised in the Charcot Bugt Formation is comparable to that in the contemporaneous Pelion Formation of the Jameson Land Basin and in correlative units of the mid-Norway shelf and the Northern North Sea. We suggest that the long-term evolution of the depositional systems may have been controlled by long-term eustatic rise acting in concert with relative sea-level changes reflecting regionally contemporaneous phases of rift initiation, dimax and gradual cessation of rifting. (au)

  7. 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.

  8. Three-dimensional finite element analysis of the foot during standing--a material sensitivity study.

    Science.gov (United States)

    Cheung, Jason Tak-Man; Zhang, Ming; Leung, Aaron Kam-Lun; Fan, Yu-Bo

    2005-05-01

    Information on the internal stresses/strains in the human foot and the pressure distribution at the plantar support interface under loading is useful in enhancing knowledge on the biomechanics of the ankle-foot complex. While techniques for plantar pressure measurements are well established, direct measurement of the internal stresses/strains is difficult. A three-dimensional (3D) finite element model of the human foot and ankle was developed using the actual geometry of the foot skeleton and soft tissues, which were obtained from 3D reconstruction of MR images. Except the phalanges that were fused, the interaction among the metatarsals, cuneiforms, cuboid, navicular, talus, calcaneus, tibia and fibula were defined as contact surfaces, which allow relative articulating movement. The plantar fascia and 72 major ligaments were simulated using tension-only truss elements by connecting the corresponding attachment points on the bone surfaces. The bony and ligamentous structures were embedded in a volume of soft tissues. The encapsulated soft tissue was defined as hyperelastic, while the bony and ligamentous structures were assumed to be linearly elastic. The effects of soft tissue stiffening on the stress distribution of the plantar surface and bony structures during balanced standing were investigated. Increases of soft tissue stiffness from 2 and up to 5 times the normal values were used to approximate the pathologically stiffened tissue behaviour with increasing stages of diabetic neuropathy. The results showed that a five-fold increase in soft tissue stiffness led to about 35% and 33% increase in the peak plantar pressure at the forefoot and rearfoot regions, respectively. This corresponded to about 47% decrease in the total contact area between the plantar foot and the horizontal support surface. Peak bone stress was found at the third metatarsal in all calculated cases with a minimal increase of about 7% with soft tissue stiffening.

  9. Foot and ankle injuries in theatrical dancers.

    Science.gov (United States)

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

    1985-10-01

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

  10. Diabetic foot ulcers: Part II. Management.

    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

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

  11. 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.

  12. 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.

  13. Shortening and Angulation for Soft-Tissue Reconstruction of Extremity Wounds in a Combat Support Hospital

    Science.gov (United States)

    2009-08-01

    until future definitive reconstructive procedures can be performed. In the setting of an amputation without the aid of a prosthesis . little improve...142 8. tl Ncudcck I . Klac’ W. Continuou’ skm expanS~nn for cmcnng ;.olt ’’"lu: dclcch of the foot ’ole. Unfallchirurg 1995: 9H( I): 40 -1 ~4

  14. 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.

  15. 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.

  16. 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.

  17. 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.

  18. 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

  19. Malignant melanoma of the foot and ankle.

    Science.gov (United States)

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

    2000-04-01

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

  20. Do foot pad scores measure Turkey welfare

    NARCIS (Netherlands)

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

    2017-01-01

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

  1. 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.

  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. 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...

  4. Osteoarthritis of the Foot and Ankle

    Science.gov (United States)

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

  5. 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.

  6. Assessment of acute foot and ankle sprains.

    Science.gov (United States)

    Lynam, Louise

    2006-07-01

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

  7. Foot deformation during walking: differences between static and dynamic 3D foot morphology in developing feet.

    Science.gov (United States)

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

    2014-01-01

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

  8. The Athletic Foot and Its Import to Performance during Running.

    Science.gov (United States)

    Bogdan, Richard

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

  9. Quick foot placement adjustments during gait: direction matters

    NARCIS (Netherlands)

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

    2015-01-01

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

  10. 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.

  11. 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.

  12. 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。

  13. Surfaces, Digitisations and Reconstructions

    DEFF Research Database (Denmark)

    2015-01-01

    We present a new digital reconstruction of r-regular sets in three-dimensional Euclidean space. We introduce a vector field and analyse the relation between the topologies of the boundaries of the r-regular set and its reconstruction. This reconstruction can be carried out faster than prior models...

  14. 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...

  15. 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.

  16. 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…

  17. Should I Have Breast Reconstruction?

    Science.gov (United States)

    ... Reconstruction Surgery Breast Cancer Breast Reconstruction Surgery Should I Get Breast Reconstruction Surgery? Women who have surgery ... It usually responds well to treatment. What if I choose not to have breast reconstruction? Many women ...

  18. Neuroelectrophysiological and pathological features of Charcot-Marie-Tooth disease ( report of 2 cases)%腓骨肌萎缩症的神经电生理及病理学特点(附2例报告)

    Institute of Scientific and Technical Information of China (English)

    刘艳; 黄辉; 王超; 赵玉红

    2012-01-01

    目的 探讨腓骨肌萎缩症(CMT)的神经电生理及病理学特点.方法 回顾性分析2例腓骨肌萎缩症患者的神经电生理及病理学资料.结果 本组患者主要表现为慢性进行性双下肢远端肌无力和肌萎缩,弓形足,伴有双上肢受累,腱反射消失,四肢感觉障碍.神经电生理检查显示神经传导速度减慢,神经源性损害;神经活检显示节段性脱髓鞘,部分区域“洋葱球样”改变;电镜显示有髓神经密度中度减少,髓鞘破坏;肌活检显示肌纤维萎缩呈角形.结论 CMT的神经电生理特点为神经源性损害;病理学特点为周围神经节段性脱髓鞘和神经源性肌萎缩.%Objective To explore the features of neuroelectrophysiological and pathological of Charcot-Marie-Tooth disease (CMT). Methods The neuroelectrophysiological and pathological datas of 2 CMT patients were analyzed retrospectively. Results The clinical manifestations of the 2 cases were chronic progressive of lower limbs distal muscle weakness and muscle atrophy, bow foot, and with double upper limbs involved, the tendon reflexes were disappeared and sensory disturbance in limbs. Electrophysiological examination showed nerve conduction velocity decreased and neurogenic damages. Nerve biopsy showed that there were segmental demyelination and "onion ball" structure in some lesion. Electron microscope showed that the density of myelinated nerve fibers was moderate reduced and myelin damage. Muscle biopsy showed the muscle fibers atrophy with angle type. Conclusions The neuroelectrophysiology feature of CMT is neurogenic damages. The pathological features are segmental demyelination of peripheral nerve and neural atrophy.

  19. Free temporal fascia flap to cover soft tissue defects of the foot: a case report

    Directory of Open Access Journals (Sweden)

    Schreiber, Martin

    2015-01-01

    Full Text Available Severe soft tissue defects as a result of lye contamination remain a huge challenge in the interdisciplinary approach of trauma surgeons and plastic surgeons. Free tissue transfer is a suitable surgical option for successful reconstruction of form and function of defects in the distal parts of the lower extremities. We report the successful two-stage reconstruction of a full thickness lye contamination at the dorsum of the foot with a free temporoparietal fascia flap covered with a split-thickness skin graft from the thigh. The described method is a suitable operative alternative to anterolateral thigh flaps or other thin fascia flaps regarding flap harvest and donor site morbidity and should be considered in the portfolio of the plastic surgeon.

  20. Visual guidance of the human foot during a step

    OpenAIRE

    Reynolds, R. F.; Day, B L

    2005-01-01

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