AbstractText: Diabetic footosteomyelitis is a major risk factor for amputation... study was to assess prospectively the remission rate of diabetic footosteomyelitis medically treated using white blood cell (WBC)-single-photon emission ... as a predictive marker of remission AbstractText: Individuals with diabetic footosteomyelitis that was non-surgically treated between April 2014 and December ...
... the undiluted synovial fluid (SF) microenvironment during the acute phase following intra-articular fracture (IAF) of the human ankle AbstractText: Ankle SF from 54 patients with an acute IAF was analyzed for ... 2 days, 3-9 days, and ≥10 days) corresponding to timepoints for clinical anklefracture interventions... Keyword: anklefracture.
Muscular and Skeletal Diseases (2) Osteoarthritis (2), more mentions
Non-fatal tibia and ankleinjuries without proper protection from the restraint system has gotten wide ... coupling their effects, a new evaluation index named CAIEI (Combined AnkleInjury Evaluation Index) is established to evaluate ankleinjury (including tibia fractures in ankle region) risk and severity in robustness.Overall results and analysis ...
One of five chronic lateral ankle instability patients will require surgery, making operative outcomes crucial... operative method influences failure and complication rates in chronic lateral ankle ligament repair surgery AbstractText: We retrospectively reviewed 119 cases (118 patients) of lateral ankle ligament surgery between 2006 and 2016 ... be favourable options to achieve fewer complications in chronic lateral ankle instability repair surgery Keyword: Ankle instability.
Clinical, radiological evaluation and scoring patients' conditions according to the American OrthopaedicFoot & Ankle Society (AOFAS) Ankle-Hindfoot scale was done preoperatively and postoperatively. Percutaneous drilling of the calcaneus combined with mid-sole release of the plantar fascia was done in all cases, and the functional results were evaluated through the follow-up period that extended from 9 to 16 ...
BACKGROUND: This study aimed to determine whether physical findings reflecting triceps surae strength recovery could predict return to activities such as jogging and sports and whether patients' age and sex would influence recovery of triceps surae strength postoperatively.
METHODS: Between 2009 and 2013, 96 consecutive cases of postoperative acute Achilles tendon rupture were reviewed. The postoperative triceps surae strength recovery rate was investigated in all patients by using half body weight 1-time heel rise, full body weight (FBW) 1-time heel rise, FBW 20-time heel rise, jogging, and full return to sports activities. Influence of age and sex on triceps surae strength recovery was also investigated.
RESULTS: FBW 1-time heel rise and jogging were achieved at an average of 14 weeks (range, 6-24 weeks) and 15 weeks (range, 8-25 weeks) postoperatively, respectively. FBW 20-time heel rise and full return to sports activities were achieved at a mean of 21 weeks (range, 12-29 weeks) and 22 weeks (range, 13-29 weeks) postoperatively, respectively. Ability to perform FBW 1-time heel rise was directly related to resilience of jogging capability ( R(2) = 0.317, P < 0.001), and ability to perform FBW 20-time heel rise was related to full return to sports activities ( R(2) = 0.508, P < 0.001). Time to heel rise was not correlated with patient age or sex.
CONCLUSION: Postoperative ability to perform FBW 1-time heel rise in patients postoperatively was directly related to resilience of jogging, and ability to perform FBW 20-time heel rise was directly related to full return to sports activities.
LEVEL OF EVIDENCE: Level IV, case series.
BACKGROUND: The purpose of this study was to compare the functional results of operative and nonoperative treatment of acute Achilles tendon rupture using an identical rehabilitation program of functional bracing.
METHODS: Over a 10-year period, 200 patients (99 operative, 101 nonoperative) aged between 18 and 65 years were treated at our institution's physiotherapy department after acute Achilles tendon rupture. There were 132 patients (62 operative, 70 nonoperative) available for a minimum 2-year follow-up (average 6.5 years; range, 2-13 years). Functional outcome was assessed using the Achilles tendon total rupture score (ATRS).
RESULTS: With the numbers available, no significant difference could be detected in ATRS between operative (mean 84.8, median 90) and nonoperative groups (mean 85.3, median 91; P = 0.55). No significant difference could be detected in ATRS between male and female patients however treated ( P = 0.30) or between patients younger and older than 40 years at time of injury ( P = 0.68). There was no correlation between ATRS score and age at injury in all patients ( ? = -0.0168, P = 0.85). In male patients, there was a weak trend with older patients at follow-up having better scores ( ? = 0.21, P = 0.069). However, among female patients, there was a significant negative correlation between ATRS scores and increasing age ( ? = -0.29, P = 0.03). Logistic regression analysis failed to show any significant effect of age at rupture, gender, or mode of treatment on ATRS.
CONCLUSIONS: This study showed no significant difference detectable in ATRS between operative and nonoperative patients in the treatment of acute Achilles tendon ruptures using an identical rehabilitation program with functional bracing.
LEVEL OF EVIDENCE: Level II, prospective comparative study.
INTRODUCTION: Coronal deformity is considered a relative contraindication for arthroscopic ankle fusion. This study assessed whether preoperative coronal ankle joint deformity influenced the outcome of arthroscopic ankle fusion.
METHODS: Ninety-seven patients had 62 arthroscopic and 35 open ankle fusions between 2005 and 2012. Clinical outcomes were prospectively recorded with use of the Ankle Osteoarthritis Scale (AOS) and Ankle Arthritis Scale (AAS) preoperatively and at 6, 12, and 24 months and final follow-up. Radiological alignment was measured using the tibiotalar angle, the tibial plafond angle, the lateral talar station, and the lateral tibiotalar angle. Both groups had the same demographics.
RESULTS: Preoperative deformity was the same regarding sagittal alignment and overall coronal alignment, but the arthroscopic group had less tibial deformity (tibial plafond angle range 0-19 degrees vs 0-43 degrees). At final follow-up, the mean AOS was 34.2 for arthroscopic (95% confidence interval [CI], 23.3-45.2) vs 33.9 for open (95% CI, 17.8-49.9). The AAS at final follow-up was 26.0 for arthroscopic (95% CI, 21.0-31.0) vs 27.5 for open (95% CI, 19.7-35.2). Both groups had the same tibiotalar angle, lateral talar station, and lateral tibiotalar angle at follow-up. Regression analyses revealed no influence of type of surgery, preoperative deformity, postoperative radiological alignment, age, sex, body mass index, smoking status, etiology of the arthritis, and need for bone grafting on outcome scores (all P > .05).
CONCLUSION: Arthroscopic and open ankle fusion yielded equivalent results for both patient-reported outcome measure and radiographic alignment in patients with coronal and sagittal joint deformity. Patients with higher tibial plafond angles more often underwent open fusion.
LEVEL OF EVIDENCE: III, comparative series.
Muscular and Skeletal Diseases (4), Anti-Obesity and Weight Loss (1) Arthritis (3), Osteoarthritis (1), more mentions
BACKGROUND: Extracorporeal shockwave therapy (ESWT) seems to be an effective treatment for plantar fasciitis (PF) and is assumed to be safe. No systematic reviews have been published that specifically studied the complications and side effects of ESWT in treating PF. Aim of this systematic review is therefore to evaluate the complications and side effects of ESWT in order to determine whether ESWT is a safe treatment for PF.
METHODS: For this systematic review the databases PubMed, MEDLINE, Cochrane and Embase were used to search for relevant literature between 1 January 2005 and 1 January 2017. PRISMA guidelines were followed.
RESULTS: Thirty-nine studies were included for this review, representing 2493 patients (2697 heels) who received between 6424 and 6497 ESWT treatment sessions, with an energy flux density between 0.01 mJ/mm(2) and 0.64 mJ/mm(2) and a frequency of 1000-3800 SWs. Average follow-up was 14.7 months (range: 24 h - 6 years). Two complications occurred: precordial pain and a superficial skin infection after regional anaesthesia. Accordingly, 225 patients reported pain during treatment and 247 reported transient red skin after treatment. Transient pain after treatment, dysesthesia, swelling, ecchymosis and/or petechiae, severe headache, bruising and a throbbing sensation were also reported.
CONCLUSION: ESWT is likely a safe treatment for PF. No complications are expected at one-year follow-up. However, according to the current literature long-term complications are unknown. Better descriptions of treatment protocols, patient characteristics and registration of complications and side effects, especially pain during treatment, are recommended.
Plantar Fasciitis (3), Ecchymosis (1), Petechiae (1), more mentions
BACKGROUND: Malalignment of the ankle joint has been found after trauma, by neurological disorders, genetic predisposition and other unidentified factors, and results in asymmetrical joint loading. For a medial open wedge supramalleolar osteotomy(SMO), there are some debates as to whether concurrent fibular osteotomy should be performed. We assessed the changes in motion of ankle joint and plantar pressure after supramalleolar osteotomy without fibular osteotomy.
METHODS: Ten lower leg specimens below the knee were prepared from fresh-frozen human cadavers. They were harvested from five males (10 ankles)whose average age was 70 years. We assessed the motion of ankle joint as well as plantar pressure for SS(supra-syndesmotic) SMO and IS(intra-syndesmotic) SMO. After the osteotomy, each specimen was subjected to axial compression from 20 N preload to 350 N representing half-body weight. For the measurement of the motion of ankle joint, the changes in gap and point, angles in ankle joint were measured. The plantar pressure were also recorded using TekScan sensors.
RESULTS: The changes in the various gap, point, and angles movements on SS-SMO and IS-SMO showed no statistically significant differences between the two groups. Regarding the shift of plantar center of force (COF) were noted in the anterolateral direction, but not statistically significant.
CONCLUSIONS: SS-SMO and IS-SMO with intact fibula showed similar biomechanical effect on the ankle joint. We propose that IS-SMO should be considered carefully for the treatment of osteoarthrosis when fibular osteotomy is not performed because lateral cortex fracture was less likely using the intrasyndesmosis plane because of soft tissue support.
Muscular and Skeletal Diseases (1) Osteoarthritis (2), Nervous System Diseases (1), more mentions
BACKGROUND: Ankle-brachial index (ABI) at rest, Post-exercise ABI and Toe-Brachial Index (TBI) are essential diagnostic tools recommended for peripheral artery disease (PAD) diagnosis. Our study investigates the level of knowledge on these three tests among vascular medicine residents from four French medical schools in France.
PATIENTS AND METHODS: We included nineteen vascular medicine residents in a cross-sectional study. During an annual obligatory seminar, all residents accepted to fill three questionnaires concerning knowledge about these three tests.
RESULTS: All residents accepted to fill three questionnaires. None of the residents correctly knows how to perform all pressure measurements (ABI, Post-exercise ABI, and TBI). Two residents had the knowledge to perform the whole ABI at rest procedure whereas no resident had the knowledge to perform neither the Post-exercise ABI (p=0.48), nor the TBI (p=0.48). Twelve residents correctly completed the question regarding the interpretation of ABI at rest, while two correctly completed the Post-exercise ABI question (p=0.001) and four the TBI question (p = 0.02). The number of residents who have performed more than twenty measurements is higher regarding ABI at rest than Post-exercise ABI and TBI (84%, 5%, 37% respectively; p<0.001 and p= 0.006 respectively) and significantly less often in Post-exercise ABI than TBI (5% versus 37%; p=0.04).
CONCLUSION: This study shows for the first time that residents 'knowledge of pressure measurements (resting ABI, Post-exercise ABI and TBI) of four French medical school, are insufficient even though the importance of pressure measurement has been strongly highlighted by the new released PAD guidelines (2016) for PAD diagnosis.
OBJECTIVE: To assess the clinical benefits of joint mobilisation on ankle sprains.
DATA SOURCES: MEDLINE, MEDLINE In Process, Embase, AMED, PsycINFO, CINAHL, Cochrane library, PEDro, Scopus, SPORTDiscus and Dissertations and Thesis were searched from inception to June, 2017.
STUDY SELECTION: Studies investigating humans with a grade I or II lateral or medial sprains of the ankle in any pathological state from acute to chronic, who had been treated with joint mobilisation were considered for inclusion. Any conservative intervention was considered as a comparator. Commonly reported clinical outcomes were considered such as ankle range of movement, pain, and function. After screening of 1530 abstracts, 56 studies were selected for full text screening, and 23 were eligible for inclusion. Eleven studies on chronic sprains reported sufficient data for meta-analysis.
DATA EXTRACTION: Data were extracted using the participants, interventions, comparison, outcomes and study design approach. Clinically relevant outcomes (dorsiflexion range, proprioception, balance, function, pain threshold, pain intensity) were assessed at immediate, short term and long term follow-up points.
DATA SYNTHESIS: Methodological quality was assessed independently by two reviewers and most studies were found to be of moderate quality, with no studies rated as poor. Meta-analysis revealed significant immediate benefits of joint mobilisation compared to comparators on improving postero-medial dynamic balance (p=0.0004), but not for improving dorsiflexion range (p= 0.16), static balance (p = 0.96) or pain intensity (p= 0.45). Joint mobilisation was beneficial in the short term for improving weight-bearing dorsiflexion range (p= 0.003) compared to a control.
CONCLUSION: Joint mobilisation appears to be beneficial for improving dynamic balance immediately after application and dorsiflexion range in the short term. Long term benefits have not been adequately investigated.
OBJECTIVES: The aim of this study is to summarize the risk factors of severe Hand, foot and mouth disease (HFMD) and explore the clinical characteristics of pulmonary edema (PE) and non-PE in the expired patients with HFMD.
METHODS: We identified 89 HFMD deaths which were separated into the PE group or non-PE group. Next, patients were divided based on their initial admission to hospitals as stage 1, 2, 3, or 4; at this point, their clinical manifestations were compared.
RESULTS: There were 87 cases in the PE group, and 2 cases in the non-PE group. In the PE group, the difference in median time for patients at different stages from onset to symptoms, showed no significant difference (p>0.05). The etiology was detected as the positive rate for enterovirus 71 (EV71) was 89.19%, which showed more severe course than other etiologies. The white blood cell (WBC) counts, lymphocyte (LYM) counts and creatine kinase MB (CK-MB) counts of patients admitted in different stages increased significantly with severity (p<0.05).
CONCLUSIONS: There may be two clinical subtypes, mostly PE and rarely non-PE, in the expired patients with HMFD. EV71 and risk factors such as an increased WBC count are associated with a severe course of HMFD.
Pulmonary Edema (3), Hand, Foot and Mouth Disease (2), Mouth Diseases (1), more mentions
The Neanderthal remains from Shanidar Cave, excavated between 1951 and 1960, have played a central role in debates concerning diverse aspects of Neanderthal morphology and behavior. In 2015 and 2016, renewed excavations at the site uncovered hominin remains from the immediate area where the partial skeleton of Shanidar 5 was found in 1960. Shanidar 5 was a robust adult male estimated to have been aged over 40 years at the time of death. Comparisons of photographs from the previous and recent excavations indicate that the old and new remains were directly adjacent to one another, while the disturbed arrangement and partial crushing of the new fossils is consistent with descriptions and photographs of the older discoveries. The newly discovered bones include fragments of several vertebrae, a left hamate, part of the proximal left femur, a heavily crushed partial pelvis, and the distal half of the right tibia and fibula and associated talus and navicular. All these elements were previously missing from Shanidar 5, and morphological and metric data are consistent with the new elements belonging to this individual. A newly discovered partial left pubic symphysis indicates an age at death of 40-50 years, also consistent with the age of Shanidar 5 estimated previously. Thus, the combined evidence strongly suggests that the new finds can be attributed to Shanidar 5. Ongoing analyses of associated samples, including for sediment morphology, palynology, and dating, will therefore offer new evidence as to how this individual was deposited in the cave and permit new analyses of the skeleton itself and broader discussion of Neanderthal morphology and variation.
BACKGROUND AND OBJECTIVE: Performing limb salvage with safe margins and preserving meaningful function is very difficult in the setting of primary malignant bone and soft tissue tumors due to the complex and constrained anatomy of the foot and ankle. The study aims to evaluate the efficacy of limb salvage procedures in terms of functional and oncological outcomes.
METHODS: Clinical data of 48 patients, who underwent surgical treatment between 1992 and 2015 in our institution, were retrospectively analyzed. Twenty-one (43.7%) patients had unplanned resections elsewhere previously. Limb salvage surgery (LSS) was the index surgery in 43 (89.6%) patients. In the LSS group, 28 (65.1%) received preoperative radiotherapy and 13 (30.2%) underwent complex reconstruction. The functional outcomes were assessed with Musculoskeletal Tumor Society (MSTS) scores. Limb survival and oncological outcomes were evaluated according to Kaplan-Meier curves.
RESULTS: The mean follow-up time was 32.7 (3-115) months. Mild deformities and wound healing problems were the most common problems. While the functional scores were significantly higher in the LSS group, no significant difference was detected between amputation and LSS patients in terms of survival rates.
CONCLUSION: LSS performed in specialized centers is an effective treatment method for malignant tumors of the foot and ankle.
BACKGROUND: Arterial stiffness is one of the earliest indicators of changes in vascular wall structure and function and may be assessed using various indicators, such as pulse-wave velocity (PWV), the cardio-ankle vascular index (CAVI), the ankle-brachial index (ABI), pulse pressure (PP), the augmentation index (AI), flow-mediated dilation (FMD), carotid intima media thickness (IMT) and arterial stiffness index-β. Arterial stiffness is generally considered an independent predictor of cardiovascular and cerebrovascular diseases. To date, a significant number of studies have focused on the relationship between arterial stiffness and cognitive impairment.
OBJECTIVES AND METHODS: To investigate the relationships between specific arterial stiffness parameters and cognitive impairment, elucidate the pathophysiological mechanisms underlying the relationship between arterial stiffness and cognitive impairment and determine how to interfere with arterial stiffness to prevent cognitive impairment, we searched PUBMED for studies regarding the relationship between arterial stiffness and cognitive impairment that were published from 2000 to 2017. We used the following key words in our search: "arterial stiffness and cognitive impairment" and "arterial stiffness and cognitive impairment mechanism". Studies involving human subjects older than 30years were included in the review, while irrelevant studies (i.e., studies involving subjects with comorbid kidney disease, diabetes and cardiac disease) were excluded from the review.
RESULTS: We determined that arterial stiffness severity was positively correlated with cognitive impairment. Of the markers used to assess arterial stiffness, a higher PWV, CAVI, AI, IMT and index-β and a lower ABI and FMD were related to cognitive impairment. However, the relationship between PP and cognitive impairment remained controversial. The potential mechanisms linking arterial stiffness and cognitive impairment may be associated with arterial pulsatility, as greater arterial pulsatility damages the cerebral microcirculation, which causes various phenomena associated with cerebral small vessel diseases (CSVDs), such as white matter hyperintensities (WMHs), cerebral microbleeds (CMBs), and lacunar infarctions (LIs). The mechanisms underlying the relationship between arterial stiffness and cognitive impairment may also be associated with reductions in white matter and gray matter integrity, medial temporal lobe atrophy and Aβ protein deposition. Engaging in more frequent physical exercise; increasing flavonoid and long-chain n-3 polyunsaturated fatty acid consumption; increasing tea, nitrite, dietary calcium and vitamin D intake; losing weight and taking medications intended to improve insulin sensitivity; quitting smoking; and using antihypertensive drugs and statins are early interventions and lifestyle changes that may be effective in preventing arterial stiffness and thus preventing cognitive impairment.
CONCLUSION: Arterial stiffness is a sensitive predictor of cognitive impairment, and arterial stiffness severity has the potential to serve as an indicator used to facilitate treatments designed to prevent or delay the onset and progression of dementia in elderly individuals. Early treatment of arterial stiffness is beneficial and recommended.
Neuroscience (1), Kidney Disease (1), Cardiovascular Diseases (1) Atrophy (1), Heart Diseases (1), Cerebral Small Vessel Diseases (1), more mentions
Spasticity is common in stroke and multiple sclerosis. To treat spasticity we have a wide range of interventions, whose application may depend not only on the severity of spasticity but also on its etiology. Consequently, a better understanding of muscle spasticity in different neurological diseases may inform clinicians as to the more appropriate therapeutic approach. Our aim was to compare the clinical and ultrasonographic features of spastic equinus in patients with chronic stroke and multiple sclerosis. Thirty-eight patients with secondary progressive multiple sclerosis and 38 chronic stroke patients with spastic equinus were evaluated at the affected ankle according to the following outcomes: modified Ashworth scale, Tardieu scale, passive range of motion, spastic gastrocnemius muscle echo intensity and thickness. Affected calf muscles tone was significantly greater in patients with chronic stroke (modified Ashworth scale P=0.008; Tardieu scale angle P=0.004) as well as spastic gastrocnemius muscle echo intensity (P<0.001). Affected ankle range of motion was significantly greater in patients with multiple sclerosis (P<0.001) as well as spastic gastrocnemius muscle thickness (medialis: P=0.003; lateralis: P=0.004). Our findings evidenced that the same pattern of spasticity (equinus foot) has some different features according to its etiology. This may help the management of spasticity.
Cardiovascular Diseases (5), Immune System Diseases (5) Multiple Sclerosis (4), Muscle Spasticity (2), Equinus Deformity (1), more mentions