Supplementing rehabilitation training with botulinum neurotoxin improves outcomes for Parkinson′s disease patients with striatal foot deformity / 中华物理医学与康复杂志

Objective:To observe any therapeutic effect of combining botulinum toxin type A (BTX-A) with rehabilitation training in treating Parkinson′s disease (PD) patients with striatal foot deformity (SFD).Methods:A total of 68 PD patients with SFD were randomly divided into a control group and a treatment group. Both groups were given routine medication with pramipexole and dopamine receptor agonists and received lower limb rehabilitation training, including passive activity training, strength training and walking training. The treatment group was additionally injected with BTX-A. Sciatic pain was quantified using a visual analogue scale. The Unified Parkinson′s Disease Rating Scale-lower limb motor lower limb motor function (UPDRS-LLM) scale, the Berg balance scale and the modified Barthel index were applied to test all of the participants before the experiment and on the 7th, 14th and 30th day of the treatment.Results:The average scores of the control group on all of measures at were significantly better than those of the control group at the same time points, and by the 14th and 30th day had improved significantly compared with those before treatment.Conclusion:Supplementing rehabilitation training with BTX-A can significantly improve foot deformity and relieve the muscle tension and spastic pain of PD patients with SFD, promoting the motor functioning of their lower limbs, their balance and their performance in the activities of daily living.

Outcomes of Corrective Surgery in Children with Foot Deformities Using Quantitative Gait Analysis

@#OBJECTIVE: This study aimed to quantitatively define outcomes of corrective surgery in children with various foot deformities. METHODS: We used a retrospective, nonrandomized design. All pediatric patients who underwent pre and post-operative gait analysis and corrective surgery were included. Outcome measures included quantitative gait analysis with temporospatial and kinematic parameters, the Gait Deviation Index, Gillette FAQ, and Hoffer’s criteria. RESULTS:. Five patients with neurogenic and idiopathic deformities underwent corrective surgery at the Philippine General Hospital from 2015 to 2017. Comparison of gait pre and postoperatively show promising outcomes, with improvement in GDI and FAQ levels, despite some of the patients’ need for braces. CONCLUSIONS: Quantitative gait analysis is a suitable method for evaluating surgical outcomes for foot deformity correction. It can be used in combination with functional outcome measures and clinical examination to give an overall picture of a patient’s walking ability.

Tibio-talar coalition - a case report and review of the literature

Background: A tarsal coalition is a bridging of two or more of the bones in the hindfoot. Multiple coalitions aredescribed in the literature. However, the presence of a tibio-talar coalition has not previously been reported.Results : Here, we describe the first reported case of tibio-talar and fibulo-talar coalition in the literature in a 31-year-old male. The patient had a 5-year history of bilateral hindfoot and ankle pain, with an established rightsided talo-calaneal coalition. Investigations and subsequent open chilectomy and debridement surgery confirmeda tibio-talar and fibulo-talar coalition. The patient was discharged at one-year following surgery as he was painfree and returned to work.Conclusions: We report the first case of failure of mesenchymal segmentation leading to tibio-talar fibrouscoalition and fibulo-talar coalition. In this case surgical debridement provided resolution of symptoms. Level ofClinical Evidence: 4

Amalgamating osteotomy: A novel surgical technique for the reconstruction of bilateral preaxial polydactyly of the foot

INTRODUCTION@#Polydactyly of the foot is not uncommon, with the preaxial type or hallux duplication comprising 15% of cases.2 Metatarsal type preaxial polydactyly (MTPP) accounts for an estimated third of all reported preaxial polydactyly cases. Traditional surgical procedures for this condition frequently have drawbacks that include varying degrees of hallux varus and a bigger forefoot.1 Due to these disadvantages, developed a simple and effective technique for the reconstruction of MTPP.@*CASE REPORT@#Amalgamating osteotomy procedures were done for bilateral MTPP in an 18-month old girl who had been experiencing shoe ware difficulty. An excellent and pain-free functional outcome was achieved with good cosmetic appearance and an improved ability to wear various kinds of footwear.@*CONCLUSION@#Amalgamating osteotomy could be the procedure of choice for the reconstruction of metatarsal type preaxial polydactyly. Case series and long-term follow-ups should be done to compare outcomes with other surgical techniques.

Function disability evaluation in hereditary motor and sensory neuropathy pediatric patients / 中华实用儿科临床杂志

Hereditary motor and sensory neuropathy is the most common peripheral neuropathy.It is slowly progressive,proximal limb weakness and muscular dystrophy and severe foot deformity can cause function disability.For most patients were diagnosed in early children,so function disability evaluation and effective treatment from children is significant to their prognosis.

Analysis of the Deformities of the Foot after Tibial Fracture and Outcome of the Surgical Treatment / 대한족부족관절학회지

PURPOSE: We wanted to evaluate the relating factors for deformities of the foot after tibial fracture and the outcome of respective surgical treatment. MATERIALS AND METHODS: We studied thirty-two patients (thirty-five feet) who had foot deformities after tibia fracture. The age, gender, shape, location, concurrent soft tissue injury and operative treatment of tibial fracture were analysed and outcome of the surgical treatment was investigated. RESULTS: Deformities of the foot mostly occurred in open fractures of Gustilo type 3 or closed fracture with severe soft tissue injury. Variable surgical treatments such as simple release, lengthening, Z-plasty and osteotomy were performed. The AOFAS ankle-hind foot scale was improved from average of 37.3 points preoperatively to an average of 77.2 points at the last follow up. The Maryland foot score was from 42.9 to 90.2 and AOFAS Lesser Toe Metatarso-phalangeal interphalangeal scale was from 42.9 to 90.5. Radiological correction was also improved from 21.9 degrees to 7.9 degrees (Meary angle), from 112.2 to 138.5 (Hibb's angle) and from 33.8 to 25.9 (Calcaneal pitch). CONCLUSION: We proposed that great care should be taken of treatment for the tibial fracture and early detection and proper management of the foot deformities are crucial.

The Effect of Foot Orthosis on Spinal Curvature by Correction of Foot Pronation and Limb Length Discrepancy

OBJECTIVE: To investigate the effect of foot orthosis on spinal curvature, by correction of foot pronation and limb length discrepancy METHOD: 38 cases of foot-pronated children were investigated for changes in Cobb's angle before and after applying foot orthosis, and followed up after 6 months. RESULTS: There were 25 males and 13 females, and the average age was 10.28+/-0.45 years. There were no significant correlation among Cobb's angle, limb length discrepancy, and difference of pronation. Cobb's angles were improved in 26 cases after applying foot orthosis, by mean 5.84+/-2.47 degree. 16 cases were followed up after 6 months, and Cobb's angle were maintained or improved in 11 cases. Mean correctability was 47.93+/-26.47%. CONCLUSION: This study showed that foot orthosis could be one of the effective method to improve spinal curvature.

Treatment of congenital vertical talus in infants by minimally invasive release operation / 中国矫形外科杂志

[Objective]To evaluate the application value of minimally invasive release operation about congenital vertical talus(CVT).[Method]All operation were operated with single method by author.Firstly,Achilles tendon,capsulotomy of the ankle and subtalar joint were released through a small straight posterior inside of Achilles tendon end point.Secondly,astragaloscaphoid and subtalar front joint were released bluntly through a straight posterior incision.Thirdly,based on circs subtalar joint were released through calcaneocuboid articulation outside foot.Then one K-wire were passed through the body of talus from its axis,and passed through instep after reposition of astragaloscaphoid joint.Two K-wires was passed through calcaneus to talus from planta.[Result]Eight cases were available for follow-up from 17 to 36 months(mean,28 months),follow-up results was evaluated by using a version of Adelaar and Kodros score,there were excellent result in 1 foot,good in 5,fair in 2.The presence of hindfoot valgus and forefoot abduce were noted in one foot,forefoot pronation was appeared in one foot.Two parameters-talar and calcaneus axis-first metalarsal base angles,calcaneus talus angles of eutopic and lateral radiograph were basally normal.[Conclusion]Operative reduction has been advocated as the only effective treatment for CVT,it is the best choice to use minimally invasive release operation for infant.

Shoe and Insole Modification for Hallux Valgus and Its Associated Foot Deformities

OBJECTIVE: To evaluate outcomes of treatment of hallux valgus and its associated foot deformities with shoe and insole modification. METHOD: We present the short-term follow-up of 32 symptomatic hallux valgus deformities in 20 patients. The patients were all female and 32 to 77 years in age at the time of modification of shoe and insole. Twenty patients were evaluated on an average of 4 weeks following their shoe and insole modification. Hallux valgus angles and first-second intermetatarsal angle were evaluated as well as the range of motion of the first metatarsophalangeal joint and patient's satisfaction. Outcome was measured using changes in visual analogue scale (VAS) on twenty occasions during 4 weeks. RESULTS: Hallux valgus was commonly associated with the lesser (2nd~5th) toe deformity (21 cases, 65.5%), pes planus (12 cases, 37.5%), Achilles tightness (12 cases, 37.5%) and great toe pronation (10 cases, 31.5%). The result obtained was highly significant (p<0.002), suggesting that the shoe and insole modification were as effective in reducing the level of pain due to hallux valgus and its associated foot deformities. CONCLUSION: The shoe and insole modification can be an effective treatment of reducing pain of hallux valgus and its associated deformities.

A Study On The Foot In Patients With Rheumatoid Arthritis / 대한류마티스학회지

OBJECTIVES: Aims were to evaluate foot deformity in patients with rheumatoid arthritis for its types, prevalence, and relation with duration of the disease. METHODS: Inspection, measuring of hallux valgus and calcaneal angle and footprint were done on 256 feet of 128 patients with rheumatoid arthritis. Transverse (metatarsal) arch and longitudinal arch were evaluated by foot printings. RESULTS: 1) The most common type of foot deformities was hallux valgus in 175 of 256 feet(68.4%). Depressed transverse arches were in 169(66.0%), toe deformities including claw toe, hammer toe, curl toe and mallet toe in 125(48.9%), calcaneal valgus in 87(34.0%), callus in 67(26.2%), pes planus in 37(14.5%), and bunion in 25 (9.8%) of 256 feet. 2) Foot involvements as the initial manifestation were seen in 41 (32.0%) of 128 patients with rheumatoid arthritis. A duration of rheumatoid arthritis over 10 years were seen in 37 of 128 patients. In this patients mean number of involved toes per foot was 2.78 which was not statistically significant increase compared to that of all patients, 2.23 (p-value>0.05). Even with absence of foot symptoms in 28 of 128 patient with rheumatoid arthritis, toe deformities were seen in 1.55 toes per foot. And prevalence of hallux valgus, pes planus, depressed transverse arch and calcaneal valgus were 58.9%, 10.7%, 51.8% and 39.3% respectively. CONCLUSIONS: Foot deformities in patients with rheumatoid arthritis were usually inevitable complication. Even in the patients who had no foot symptom, there were foot deformities. So, we think that physicians should pay attention to the foot in all rheumatoid arthritis.

Surgical Treatment of Foot Deformities in Myelodysplasia / 대한정형외과학회잡지

We reviewed 43 feet in 23 patients who had myelodysplasia and underwent surgical treatment for foot deformities at the Seoul National University Children's Hospital from 1986 to 1991. There were 12 boys, and 11 girls. Eleven patients had myelomeningocele, whereas 11 patients had lipomyelomeningocele and 1 patient had occult spinal dysraphism. The mean age at operation was 7 years 1 month(range, 2 month-14 years). The affected neurological levels were below L1 or L2-2 patients, below L3 in 2 patients, below L4 in 12 patients, below L5 in 5 patients, and sacral in 2 patients. The average length of follow-up was 3 years(range, lyear-7years and 1 month). There was significant correlation between the types of foot deformity and the neurosegmental level as follows : 4(100%) feet of varus deformity in below L3, 13(61%) feet of varus deformity in below L4, 4(40%) feet of cavus deformity and 5(50%) feet of calcaneal deformity in below L5, and 4(100%) feet of cavus deformity in below sacral level. Equinovaurs, however, was observed irrespective of the neurosegmental level. Various kind of bony surgery (41 feet), soft tissue release(40 feet), and tendon transfer(36 feet) were performed to obtain the plantigrade foot. Satisfactory results were obtained in 30 of 43(70%) feet. Unsatisfactory results were due to recurrence(8 feet), overcorrection(3 feet), and incomplete correction(2 feet) of the foot deformity. Lipomeningocele, preoperative ankle valgus deformity and retethering of the nerve roots were high risk factors which were closely related to the recurrence of the foot deformity. To reduce the recurrence of foot deformity, we suggest that complete correction of the deformity, the maintenance of correction, and early detection of neurologic change due to retethering are mandatory.