Influence of foot pain on frailty symptoms in an elderly population: a case-control study

ABSTRACT BACKGROUND: Frailty is a condition that can increase the risk of falls. In addition, foot disorders can negatively influence elderly people, thus affecting their condition of frailty. OBJECTIVE: To determine whether foot pain can influence a greater degree of frailty. DESIGN AND SETTING: Cross-sectional descriptive study conducted at the University of Valencia, Valencia, Spain. METHODS: A sample older than 60 years (n = 52), including 26 healthy subjects and 26 foot pain patients, was recruited. Frailty disability was measured using the 5-Frailty scale and the Edmonton Frailty scale (EFS). RESULTS: There were statistically significant differences in the total EFS score and in most of its subscales, according to the Mann-Whitney U test (P < 0.05). In addition, foot pain patients presented worse scores (higher 5-Frailty scores) than did healthy patients, regarding matched-paired subjects (lower EFS scores). With regard to the rest of the measurements, there were no statistically significant differences (P > 0.05). The highest scores (P < 0.001) were for fatigue on the 5-Frailty scale and the EFS, and for the subscale of independence function in EFS. CONCLUSIONS: These elderly patients presented impairment relating to ambulation and total 5-Frailty score, which seemed to be linked to the presence of frailty syndrome and foot disorders.

Diabetic foot and its serial treatment in high-risk patients: focusing on the individual

SUMMARY Objectives: To assess knowledge about diabetic foot, care measures, and the importance attached to serial treatment in a group of high-risk diabetic foot patients. METHODS: This is a cross-sectional study, carried out in a tertiary hospital, with 25 patients undergoing serial treatment for diabetic foot. The tabulation of the data occurred through the use of three methodological figures: core idea, key expressions, and the collective subject discourse. RESULTS: It became evident that even among high-risk patients with diabetic foot, there is no complete knowledge about the definition of the disease. Despite this, all participants reported practicing daily care measures, including frequent inspection of the feet, food care, and attention to footwear. Regarding the importance of serial treatment, there was unanimous recognition of the relevance of this practice, which improves self-care discipline, optimizes the understanding of the disease, and helps to prevent progression. CONCLUSIONS: Authentic speeches in the context of a pathology of considerable prevalence manifested, in an unprecedented way, with conceptions about its definition, care measures, and importance of serial treatment in a high-risk group.

RESUMO OBJETIVOS: Avaliar o conhecimento sobre o pé diabético, medidas de cuidado e importância atribuída ao tratamento seriado em um grupo de alto de risco de portadores de pé diabético. MÉTODOS: Este é um estudo transversal, realizado em um hospital terciário, com 25 pacientes submetidos ao tratamento seriado do pé diabético. A tabulação dos dados ocorreu por meio da utilização de três figuras metodológicas: ideia central, expressões-chave e o discurso sujeito coletivo. RESULTADOS: Evidenciou-se que mesmo entre pacientes de alto risco do pé diabético, não há conhecimento pleno sobre a definição da doença. Apesar disso, todos os participantes relataram praticar medidas diárias de cuidado, incluindo inspeção frequente dos pés, cuidado alimentar e atenção aos calçados. Sobre a importância do tratamento seriado, foi unânime o reconhecimento da relevância dessa prática, a qual melhora a disciplina dos autocuidados, otimiza a compreensão da doença e ajuda a prevenir a progressão. CONCLUSÕES: Discursos autênticos no âmbito de uma patologia de considerável prevalência manifestaram, de forma inédita, as concepções sobre definição, medidas de cuidado e importância do tratamento seriado em um grupo de alto risco.

Weightbearing Forefoot Axial Radiography - Technical Description and Reproducibility Evaluation / Radiografia axial do antepé com carga - Descrição da técnica e avaliação da reprodutibilidade

Abstract Objective The present study aims to describe a new weightbearing radiographic method to visualize the heads of the five metatarsals on the coronal plane, evaluating their accuracy through intraclass correlation coefficients. Methods The subjects were evaluated, with weightbearing, with the ankle at 20 degrees of plantar flexion and the metatarsophalangeal joints at 10 degrees of extension, positioned on a wooden device. Two independent foot and ankle surgeons evaluated the radiography, with one of them doing it twice, at different moments, achieving an inter and intraobserver correlation, with intraclass correlation coefficients. Results We radiographed 63 feet, achieving an interobserver correlation coefficient of the radiographic method for the metatarsal heads heights in the coronal plane of the 1st, 2nd, 3rd, 4th, and 5th metatarsals of, respectively, 0.90, 0.85, 0.86, 0.83, 0.89. The intraobserver correlation coefficient were, respectively, 0.95, 0.93, 0.93, 0.86, 0.92. Conclusion Those correlations demonstrate that the method is accurate and can be used to investigate metatarsal head misalignments in this plane.

Resumo Objetivo Este estudo tem como objetivo descrever um novo método radiográfico com carga fisiológica para visualizar as cabeças dos cinco metatarsos no plano coronal. Métodos Os indivíduos foram radiograficamente avaliados com carga, com o tornozelo a 20º de flexão plantar e as articulações metatarsofalângicas a 10º de extensão, posicionadas em um dispositivo de madeira. As medidas foram aferidas por dois avaliadores independentes, sendo que um deles mediu em dois momentos distintos, obtendo a correlação inter e intraobservador, com o coeficiente de correlação intraclasses. Resultados Examinamos 63 pés, obtendo um coeficiente de correlação interobservador do método radiográfico para as alturas das cabeças dos metatarsos no plano coronal do 1º, 2º, 3º, 4º e 5º metatarsos de, respectivamente, 0,90, 0,85, 0,86, 0,83, 0,89. O coeficiente de correlação intraobservador foi, respectivamente, 0,95, 0,93, 0,93, 0,86, 0,92. Conclusão Essas correlações demonstram que o método é preciso e pode ser usado para investigar os desalinhamentos de cabeça dos metatarsos nesse plano.

Plasmatic adipocyte biomarkers and foot pain associated with flatfoot in schoolchildren with obesity

SUMMARY OBJECTIVE The aim of this study was to determine the potential association of foot pain and plasmatic adipocytes as physiological biomarkers of childhood obesity with the incidence of flatfoot in a cohort of Egyptian school children aged 6 -12 years. METHODS A total of 550 Egyptian schoolchildren (220 boys and 330 girls) aged 6-12 years were randomly invited to participate in this descriptive survey analysis. For all children, we assessed the diagnosis and severity of flatfoot as well as plasma adipocytes, as well as adiponectin, leptin, resistin, IL-6, and TNF-α, using the Dennis method and immunoassay techniques respectively. Foot pain was assessed by using a standard VAS of 100 mm and Faces Pain Scale, respectively. RESULTS Flat foot was predicted in 30.4% of school-age children, most of them showed a higher frequency of overweight (33.3%) and obesity (62.5%). Boys showed higher ranges of flat foot than girls. Foot pain significantly correlated with flat foot and obesity among the studied populations. In overweight-obese children, plasmatic adipocyte variables, as well as adiponectin, leptin, resistin, IL-6, TNF-α.; showed significant correlations with foot stance, especially in boys. Also, the studied adipocyte variables along with BMI, age, gender explained about~65% of the variance of flatfoot with pain among our school-age students. CONCLUSION Foot pain showed an association with flat foot and childhood obesity in 30.4% of school-age students (6-12 years). Foot pain was shown to correlate positively with the incidence of flat foot and changes in adiposity markers, as well as adiponectin, leptin, resistin, Il-6, TNF-α

RESUMO OBJETIVO O objetivo deste estudo foi determinar a potencial associação de dor no pé e adipócitos plasmáticos como biomarcadores fisiológicos da obesidade infantil com incidência de pé plano em uma coorte de escolares egípcios de 6 a 12 anos. MÉTODOS Um total de 550 escolares egípcios (220 meninos e 330 meninas) com idades entre 6 e 12 anos foram convidados aleatoriamente para participar desta análise descritiva. Para todas as crianças, diagnóstico e gravidade do flatfoot, bem como adipócitos plasmáticos; adiponectina, leptina, resistina, IL-6 e TNF-α; foram avaliados pelo método de Dennis e técnicas de imunoensaio, respectivamente. A dor no pé foi avaliada usando uma EVA padrão de 100 mm e a Faces Pain Scale, respectivamente. RESULTADOS O pé plano foi predito em 30,4% das crianças em idade escolar; a maioria apresentou maior frequência de sobrepeso (33,3%) e obesidade (62,5%). Os meninos apresentaram maiores faixas de pé plano do que as meninas. A dor no pé correlacionou-se significativamente com pé plano e obesidade entre as populações estudadas. Em crianças obesas com sobrepeso, variáveis adipocitárias plasmáticas; adiponectina, leptina, resistina, IL-6 e TNF-α; apresentaram correlação significativa com a postura do pé, em meninos e meninas. Além disso, as variáveis estudadas dos adipócitos, juntamente com o IMC, idade e sexo, explicaram cerca de 65% da variância do pé plano com a dor entre os nossos alunos em idade escolar. CONCLUSÃO A dor no pé mostrou associação com pé plano e obesidade infantil em 30,4% dos estudantes em idade escolar (6-12 anos). A dor no pé se correlacionou positivamente com a incidência de pé plano e a mudança nos marcadores de adiposidade; adiponectina, leptina, resistina, IL-6, TNF-α.

Effects of Strengthening and Stretching Exercises on the Temporospatial Gait Parameters in Patients With Plantar Fasciitis: A Randomized Controlled Trial

OBJECTIVE: To investigate the effects of physical therapy interventions using strengthening and stretching exercise programs on pain and temporospatial gait parameters in patients with plantar fasciitis (PF).METHODS: Eighty-four patients with PF participated in the study and were randomly assigned to the strengthening or stretching exercise groups. All patients received 8 physical therapy interventions two times per week in the first 4 weeks and performed daily strengthening or stretching exercises three times per day. After 4 weeks, they continued the assigned exercise programs every day for 8 weeks. Pain visual analogue scale (VAS) scores at the worst and in the morning and temporospatial gait parameters were evaluated at the baseline, intermediate of the intervention, end of the intervention, and the first and second month follow-up.RESULTS: There were significant effects of the time on the worst pain, morning pain, cadence, stride time, stride length, total double support, and gait speed, but there was no effect on step width. In addition, the main effect of the group and the interaction effects of the time and the group were not found in any parameters. For intra-group comparisons, there were significant differences in worst pain, morning pain, cadence, and stride time among the assessment times in both groups. For inter-group comparisons, there were no significant differences in all parameters.CONCLUSION: Both strengthening and stretching exercise programs significantly reduced pain and improved gait in patients with PF.

Comparison of health-related quality of life between patients with different metatarsalgia types and matched healthy controls: a cross-sectional analysis

ABSTRACT BACKGROUND: Metatarsalgia can be considered to be a common complaint in clinical practice. The aim of this study was to compare quality of life (QoL) between participants with different metatarsalgia types and matched-paired healthy controls. DESIGN AND SETTING: A cross-sectional analysis on a sample of 124 participants of median age ± interquartile range of 55 ± 22 years was carried out in the University Clinic of Podiatric Medicine and Surgery, Ferrol, Spain. They presented primary (n = 31), secondary (n = 31) or iatrogenic (n = 31) metatarsalgia, or were matched-paired healthy controls (n = 31). METHODS: Self-reported domain scores were obtained using the Foot Health Status Questionnaire (FHSQ) and were compared between the participants with metatarsalgia and between these and the healthy controls. RESULTS: Statistically significant differences were shown in all FHSQ domains (P ≤ 0.001). Post-hoc analyses showed statistically significant differences (P < 0.05) between the metatarsalgia types in relation to the matched healthy control group, such that the participants with metatarsalgia presented impaired foot-specific and general health-related QoL (lower FHSQ scores). CONCLUSION: This study demonstrated that presence of metatarsalgia had a negative impact on foot health-related QoL. Foot-specific health and general health were poorer among patients with metatarsalgia, especially among those with secondary and iatrogenic metatarsalgia, in comparison with matched healthy controls.

Effect of generalized ligamentous hyperlaxity related of quality of life in the foot: a case controlled study

SUMMARY Generalized ligamentous hyperlaxity (GLH) has been shown to predispose an individual to a number of orthopaedic conditions. Little is known about how GLH affects people' foot health-related quality of life. This study analyses a sample of people with GLH and people without GLH with normalised reference values of the scores collected with regard to using the Foot Health Status Questionnaire (FSHQ). A total of 100 respondents with mean age of 22.69 ± 3.78 years old, who attended a health centre were classified as GLH (n = 50) or non-GLH (n = 50). The GLH was determined of the patients with and without GLH using assessment with Beighton tool and the scores on the FHSQ were compared. The control group recorded higher scores in the First Section for foot pain, foot function and general foot health, and lower scores in footwear. In the Second Section, they obtained higher scores in social capacity and lower scores in physical activity, vigour and general health. Differences between the two groups were evaluated through a t-test for independent samples, showing statistical significance (P<0.001). This study has detected measurable differences of association between GLH (Beighton score ≥4) with impaired quality of life related to foot health.

RESUMO A hiperlaxia ligamentosa generalizada (HLG) demonstrou predispor um indivíduo a várias condições ortopédicas. Pouco se sabe sobre como a HLG afeta a qualidade de vida relacionada à saúde do pé das pessoas. Este estudo analisa uma amostra de pessoas com HLG e pessoas sem HLG com valores de referência normalizados das pontuações coletadas no que diz respeito ao Foot Health Status Questionnaire (FSHQ). Um total de 100 informantes com média de idade de 22,69 ± 3,78 anos que eram atendidos em um centro de saúde foi classificado como HLG (n = 50) ou não HLG (n = 50). A HLG foi determinada com os pacientes com e sem HLG usando a ferramenta Beighton e os escores na FHSQ foram comparados. O grupo de controle registrou pontuações mais altas na primeira seção para a dor no pé, função do pé e saúde geral do pé, e menores pontuações no calçado. Na segunda seção obtiveram maiores escores em capacidade social e menores escores em atividade física, vigor e saúde geral. As diferenças entre os dois grupos foram avaliadas por meio de um teste t para amostras independentes, mostrando significância estatística (P<0,001). Este estudo detectou diferenças mensuráveis de associação entre HLG (pontuação de Beighton≥4) com deterioração da qualidade de vida relacionada à saúde dos pés.

Doenças podais em ovinos no estado da Bahia / Foot diseases in sheep in the state of Bahia, Brazil

As doenças dos cascos são as principais causas de claudicação em pequenos ruminantes, causando grande impacto no bem-estar dos animais e provocando sérias perdas econômicas com depreciação e abate de animais afetados. O objetivo do presente estudo foi determinar a ocorrência e caracterizar as doenças podais encontradas em oito rebanhos de ovinos com histórico de doenças podais pertencentes a oito municípios do estado da Bahia. Em cada visita, foram realizadas inspeções do rebanho, aplicação de um questionário de pesquisa e caracterização das doenças. No total, 600 ovinos foram inspecionados, realizando exame do casco em animais doentes para caracterizar as lesões, registrar a quantidade de doenças presentes por animal, o casco afetado e a quantidade de membros afetados. A ocorrência de doença de casco foi de 23,3% (140/600) variando de 12,8 a 55,5% por fazenda. Duzentos e vinte casos envolvendo nove doenças foram registrados. A pododermatite infecciosa foi a doença mais comum com 51,3% dos casos (113/220), 70% correspondente aos estágios avançados e terminais. A dermatite interdigital representou 27,7% dos casos; crescimento excessivo dos cascos 8,6%; doença da linha branca 3,2%; sola dupla 3,2%; granuloma do dígito 2,3%; hiperplasia interdigital 2,3%; úlcera de sola 0,9% e 0,4% de abcesso de pé. Os principais fatores predisponentes envolvidos na ocorrência das doenças foram a alta precipitação pluviométrica, condições de umidade do solo, currais e pastagens, manejo sanitário deficiente e falta de medidas preventivas (pedilúvio, quarentena, isolamento e vacinação), falhas de tratamento e baixa infra-estrutura da maioria das propriedades.(AU)

Foot diseases are the main causes of lameness in small ruminants, causing great impact on animal welfare and important economic losses due to depreciation and culling of affected animals. The aim of the present study was to characterize foot diseases found in eight flocks of sheep with a history of the ailment, that belonged to eight municipalities in the state of Bahia. At each visit, inspection of the flock, survey questionnaire, and characterization of diseases were performed. Altogether 600 sheep were inspected through foot examination in sick animals to characterize the injuries and record the diseases present per animal, as affected hooves and the number of affected limbs. The occurrence of foot disease was 23.3% (140/600) ranging from 12.8 to 55.5% per farm. Two hundred and twenty cases involving nine diseases were recorded. Foot rot was the most common disease with 51.3% of cases (113/220), 70% corresponding to advanced and terminal stages. Interdigital dermatitis represented 27.7% of the cases, excessive hoof growth 8.6%, white line disease 3.2%, double soles 3.2%, toe granuloma 2.3%, interdigital hyperplasia 2.3%, sole ulcers 0.9% and 0.4% foot abscess. The main predisposing factors involved in the genesis of diseases were the high rainfall precipitation, soil moisture conditions, pens and pastures, poor sanitary management and lack of preventive measures (footbath, quarantine, isolation and vaccination), treatment failures and low infrastructure of most properties.(AU)

Hindfoot aneurysmal bone cyst: report of two cases / Cisto ósseo aneurismático do retropé: relato de dois casos

ABSTRACT Osseous tumors of the hindfoot are not usual in the literature, the diagnosis in these cases is difficult and can often go unnoticed. Besides that, surgery and reconstruction are complicated due to the complexity of the local anatomy, which makes these lesions even more challenging for the orthopedic oncological professionals. On the following article two cases of aneurysmal bone cyst of the hindfoot are reported, as well as the alternatives and peculiarities in conducting these cases according to the oncological principles. When the subject are hindfoot tumor lesions, the early diagnosis is extremely important, as well as the proper staging and the management of the case by the orthopedic oncological professional according to oncological principles.

RESUMO Os tumores do retropé são raros na literatura, o diagnóstico é difícil e muitas vezes é feito pelo profissional menos experiente. Acrescente-se a isso o fato de o tratamento cirúrgico e a reconstrução serem complicados pela intrincada anatomia local. Essas lesões são desafiadoras para o ortopedista oncológico. Relatamos dois casos de cisto ósseo aneurismático do retropé e nossas opções e particularidades na condução deles de acordo com os princípios oncológicos. Nas lesões tumorais do retropé é importante a suspeita diagnóstica precoce, bem como o estadiamento adequado e a condução do caso de acordo com os princípios oncológicos, preferencialmente pelo ortopedista oncológico.

The influence of heel height related on quality of life on the foot in a sample of women

SUMMARY Many women have worn high-heel shoes (HHS) at some point in their lives and many wear them on a daily basis, with higher prevalence between 39% and 78% observed in institutional and clinical settings. The purpose of this study was to describe and compare the scores obtained with regard to foot health and health in general in a sample of women that use HHS as opposed to a sample of women without HHS with normalized reference values. A sample of 120 participants with a mean age of 41.94 ± 13.912 came to a health center where self-reported data were registered. The subjects with and without HHS were determined and the scores obtained were compared in the Foot Health Status Questionnaire (FHSQ). This questionnaire is made of 13 questions that assess 4 health domains of the feet, namely pain, function, general health and footwear. The women in the HHS group showed a worse quality of life related to health in general and to foot health specifically. Differences between the two groups were evaluated by means of a t-test for independent samples, showing statistical significance (P<0.01). Women with HHS present a negative impact on the quality of life related to foot health.

RESUMO Muitas mulheres usaram sapatos de salto alto (SSA) em algum momento de suas vidas e muitas usam diariamente, com maior prevalência entre 39% e 78%, observadas em contextos institucionais e clínicos. O objetivo deste estudo foi descrever e comparar os escores obtidos em relação à saúde dos pés e à saúde em geral em uma amostra de mulheres que utilizam SSA em oposição a uma amostra de mulheres sem SSA com valores de referência normalizados. Uma amostra de 120 participantes com idade média de 41,94 ± 13,912 chegou a um centro de saúde onde os dados autorrelatados foram registrados, os informantes com e sem SSA foram determinados e os escores obtidos foram comparados no Foot Health Status Questionnaire (FHSQ). Esse documento tem 13 questões que avaliam quatro domínios de saúde dos pés, nomeadamente dor, função, saúde geral e calçado. As mulheres do grupo SSA apresentaram pior qualidade de vida relacionada à saúde em geral e à saúde dos pés, especificamente. As diferenças entre os dois grupos foram avaliadas por meio de um teste t para amostras independentes, mostrando significância estatística (P <0,01). As mulheres com SSA apresentam um impacto negativo na qualidade de vida relacionada à saúde dos pés.

Pé torto congênito: considerações dos pais sobre a doença e seu tratamento / Clubfoot: parents considerations about the pathology and its treatment

INTRODUÇÃO: Diante do nascimento de uma criança portadora de malformação congênita, os pais são tomados por grande choque emocional, negação do defeito, raiva, tristeza, ansiedade, angústia por não saber cuidar adequadamente do bebê e culpa, que pode ser dirigida a eles mesmos ou à equipe médica. OBJETIVOS: Conhecer quais as impressões dos pais em relação ao diagnóstico do pé torto congênito e seu tratamento. MÉTODOS: Estudo qualitativo, descritivo, realizado no Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, com 10 pais cujos filhos são portadores de pé torto congênito. A tabulação dos dados ocorreu por meio da utilização de três figuras metodológicas: ideia central, expressões chave e o discurso sujeito coletivo. RESULTADOS: Quando indagados sobre a impressão gerada quando o filho foi diagnosticado com pé torto congênito, 70% referiram sentimentos de tristeza, susto e preocupação, sendo que apenas 30% demonstraram uma aceitação tranquila do diagnóstico, desprovida de medo e preocupação. Quando indagados em relação ao tratamento que estava sendo feito, 100% dos pais demonstraram otimismo e satisfação com os resultados apresentados; ainda, 40% opinaram em relação ao nível de conforto trazido pelos métodos terapêuticos, e 20% citaram a importância do envolvimento de toda a equipe da saúde na abordagem terapêutica. CONCLUSÃO: Medo e preocupação foram sentimentos frequentemente apresentados, que melhoravam com a melhor elucidação por parte da equipe de saúde em relação a doença. Em relação a terapêutica, a grande satisfação por parte dos pais foi unânime. (AU)

Introduction: In the face of the birth of a child with congenital malformation, the parents are taken by great emotional shock, denial of the defect, anger, sadness, anxiety, anguish for not knowing how to properly take care of the baby and guilt, which can be directed at themselves or to medical staff. Objective: To know the parents' impressions about the diagnosis of congenital foot and its treatment. Methods: A qualitative, descriptive study carried out at the Hospital das Clínicas of the Federal University of Minas Gerais, Belo Horizonte, Brazil, with 10 parents whose children are carriers of congenitall clubfoot. The tabulation of the data occurred through the use of three methodological figures: central idea, key expressions and collective subject discourse. Results: When asked about the impression generated when the child was diagnosed with congenital clubfoot, 70% reported feelings of sadness, fright and worry, and only 30% showed a calm acceptance of the diagnosis, without fear and concern. When asked about the treatment being done, 100% of the parents showed optimism and satisfaction with the presented results; still, 40% opined regarding the comfort level brought by the therapeutic methods, and 20% mentioned the importance of the involvement of all the health team in the therapeutic approach. Conclusion: Fear and concern were frequently presented feelings, which improved with the elucidation by the health team regarding the disease. Regarding therapy, the great satisfaction of the parents was unanimous. (AU)

Estudo epidemiológico e clínico de afecções podais em bovinos de corte manejados extensivamente no sudeste do Pará / Epidemiological and clinical study of foot diseases in beef cattle extensive management in southeastern Pará, Brazil

Foram avaliados os fatores epidemiológicos e as afecções podais de bovinos de corte no estado do Pará em 12 propriedades. Em todas foi realizado o estudo epidemiológico e em nove o estudo epidemiológico e o exame clínico dos animais. Nos centros de manejo foram observados fatores favoráveis a traumatismos nos dígitos dos bovinos, como piso das seringas calçado com pedras, troncos com exposição de ferragens e rampas dos embarcadores com pisos de pedras pontiagudas, além da falta de manutenção e erros estruturais. Em todas as fazendas observou-se um manejo inadequado dos animais. Em 91,7% das fazendas (11/12) havia piquetes com presença de troncos de árvores e 66,7% (8/12) apresentavam áreas de relevo inclinado com presença de pedras. Em 16,7% (2/12) das fazendas havia áreas de brejo com áreas alagadas. A sodomia foi relatada em todas as propriedades. Nenhuma fazenda adotava medidas profiláticas relacionadas às afecções podais. Foram examinados 498 bovinos entre fêmeas e machos. Os membros pélvicos foram mais acometidos, tanto nas fêmeas quanto nos machos. Foram diagnosticadas 629 lesões nas fêmeas, sendo as mais frequentes pododermatite séptica, deformações ungulares, pododermatite da sobreunha e dermatite digital. Nos machos diagnosticou-se 285 lesões e as mais frequentes foram pododermatite séptica, deformações ungulares e abrasão de talão. Conclui-se que erros de manejo associados às condições inadequadas das instalações foram fatores que contribuíram para a ocorrência de enfermidades podais em bovinos de corte nas fazendas estudadas; as características ambientais favoreceram o desenvolvimento das lesões; as associações de lesões foram mais prevalentes do que as simples, sendo diagnosticadas em animais em todas as fazendas estudadas; o diagnóstico precoce a campo não era realizado, o que contribuiu para aumentar a gravidade e a diversificação das afecções podais diagnosticadas.(AU)

The epidemiological study was conducted in 12 farms with the history of foot disease occurrence. Clinical examination of the affected cattle for the diagnosis of foot disease was performed only on nine of these farms. Multiple risk factors were found for digit injuries, as syringes floors paved with rocks, working chutes with iron fittings exposure, loading ramps covered with sharp stones and the lack of maintenance and structural errors. On each farm there was an inappropriate handling of cattle. On 91.7% of them (11/12) existed pickets with trunks of trees and 66.7% (8/12) had areas of sloping relief with stones. Moreover, 16.7% (2/12) of the farms were in marsh areas and wetlands. Sodomy was reported for all farms. None of them adopted preventive measures related to foot problems. A total of 498 cattle, males and females, were examined. The hind limbs were the most affected in both, females and in males. In females 629 lesions were diagnosed. The septic pododermatitis was the most common, followed by claw deformities, pododermatitis in the paradigits and digital dermatitis. In males 285 injuries were diagnosed; the most common were septic pododermatitis, claw deformities and heel erosion. It was concluded that management errors associated with inadequate facilities were factors that contributed to the occurrence of foot diseases in beef cattle of the farms studied. The environmental characteristics favored the development of lesions; combined injuries were more prevalent than the simple ones diagnosed in cattle of all farms. Early diagnosis was not carried out in the field, what helped to increase the severity and the diversification of the foot problems.(AU)

Translation, cultural adaptation and validation of the foot function index - revised (ffi-r) / Tradução, adaptação cultural e validação do índice de função do pé revisado (ffi-r)

ABSTRACT Objective: The aim of this study was to translate, culturally adapt, and validate the "Foot Function Index - Revised" (FFI-R) for use in Brazilian Portuguese. Methods: The scale was translated and administered (as recommended by Guillemin, 2000) to 52 patients in the postoperative period after foot and ankle surgery. Seven days after the initial assessment, the scale was readministered by a different interviewer. The data were entered into an Excel spreadsheet and analyzed using SPSS version 23.0 software for Mac. Reproducibility was assessed using intraclass correlation analysis. Results were considered statistically significant at a type I error rate of 5%. Results: The following random-effects intraclass correlation coefficients (ICC) were obtained for each score on the FFI-R: 0.625 for pain, 0.558 for stiffness, 0.757 for difficulty, 0.718 for activity restrictions, 0.854 for personal concerns, and 0.753 for the total score. Conclusion: The FFI-R was successfully translated to Portuguese and culturally adapted for use in Brazilian patients, demonstrating satisfactory validity and reliability. Level of Evidence I, Testing of Previously Developed Diagnostic Criteria on Consecutive Patients (with universally applied reference "golg" standard).

RESUMO Objetivo: O objetivo deste estudo traduzir, fazer a adaptação cultural e a validação do "Foot Function Index - Revised" (FFI-R) para o idioma português. Métodos: A escala foi traduzida e aplicada (segundo recomendado por Guillemin, 2000) a 52 pacientes depois de cirurgia do pé e tornozelo. Sete dias depois da avaliação inicial, a escala foi novamente aplicada por outro entrevistador. Os dados foram inseridos em uma planilha do Excel e a análise estatística foi realizada no software SPSS 23.0 para Mac. A análise de correlação intraclasse foi realizada para avaliar a reprodutibilidade. Os resultados foram considerados estatisticamente significantes em erro do tipo I de até 5%. Resultados: Foram obtidos os seguintes coeficientes de correlação intraclasse (CCI) de efeitos aleatórios para cada pontuação no FFI-R: 0,625 para dor, 0,558 para rigidez, 0,757 para dificuldade, 0,718 para restrição de atividades, 0,854 para preocupações pessoais e 0,753 para o escore total. Conclusão: O FFI-R foi traduzido com sucesso para o português e adaptado culturalmente para aplicação em pacientes brasileiros, demonstrando validade e confiabilidade satisfatórias. Nível de Evidência I, Teste de Critérios Diagnósticos Desenvolvidos Anteriormente em Pacientes Consecutivos (com padrão de referência "ouro" aplicado).

A Study on the Foot and Ankle Disease of Shelter-based Homeless People / 대한족부족관절학회지

PURPOSE: Foot and ankle disease (FAD) is a frequent cause of morbidity among the homeless population. Various conditions, exacerbated by malnutrition, poor lifestyle habits, psychiatric disorders, physical injuries, poor hygiene, and limited access to healthcare, have been described in this population. The purpose of this study was to investigate the cognition and management status of FAD in shelter-based homeless people. MATERIALS AND METHODS: Fifty-two male and twenty-five female volunteer homeless individuals were recruited from two homeless shelters. Each person completed a questionnaire assessing any presence of pain, pain management, as well as foot and ankle care status. A foot and ankle surgeon examined the physical status of the individual's foot and ankle, including tenderness and instability. A radiologic evaluation was done for 18 male and 11 female homeless people who agreed to participate in this test for the existence osteophyte or joint space narrowing representing osteoarthritis and some reference angles for hallux valgus, flatfoot and cavus foot. RESULTS: Homeless people had higher prevalence of body mass index, diabetes, and smoking than the general population. The most prevalent infectious disease was fungal infection (male 78%, female 68%), with a low compliance of management for FAD. CONCLUSION: Although most of shelter-based homeless people showed an acceptable foot and ankle management status, the potential risk for FAD development and exacerbation of mild FAD was high.

Impact of shoe size in a sample of elderly individuals / Impacto do tamanho do calçado em uma amostra de idosos

Summary Introduction: The use of an improper shoe size is common in older people and is believed to have a detrimental effect on the quality of life related to foot health. The objective is to describe and compare, in a sample of participants, the impact of shoes that fit properly or improperly, as well as analyze the scores related to foot health and health overall. Method: A sample of 64 participants, with a mean age of 75.3±7.9 years, attended an outpatient center where self-report data was recorded, the measurements of the size of the feet and footwear were determined and the scores compared between the group that wears the correct size of shoes and another group of individuals who do not wear the correct size of shoes, using the Spanish version of the Foot Health Status Questionnaire. Results: The group wearing an improper shoe size showed poorer quality of life regarding overall health and specifically foot health. Differences between groups were evaluated using a t-test for independent samples resulting statistically significant (p<0.05) for the dimension of pain, function, footwear, overall foot health, and social function. Conclusion: Inadequate shoe size has a significant negative impact on quality of life related to foot health. The degree of negative impact seems to be associated with age, sex, and body mass index (BMI).

Resumo Introdução: o uso de sapatos com tamanhos inadequados é comum em pessoas idosas e acredita-se resultar em efeito negativo sobre a qualidade de vida relacionada à saúde do pé. O objetivo é descrever e comparar o impacto de uma amostra de participantes usando calçados de tamanho adequado e indivíduos com calçados de tamanho inadequado, e as pontuações relacionadas com a saúde do pé e geral. Método: de uma amostra de 64 participantes, com idade média de 75,3±7,9, de um centro ambulatorial, dados de autorrelato foram registrados e medidas do tamanho dos pés e dos calçados foram determinadas. Os escores foram comparados pelo Foot Health Status Questionnaire, na versão em espanhol, entre os grupos que usavam sapatos de tamanhos corretos e incorretos. Resultados: o grupo que utilizava sapatos inadequados mostrou pior qualidade de vida relacionada à saúde geral e no pé. Diferenças entre os grupos foram avaliadas utilizando o teste t para amostras independentes, sendo estatisticamente significativas (p<0,05) para dimensão da dor, função, calçados, saúde geral, do pé e função social. Conclusão: o uso de calçado inadequado tem um impacto negativo significativo sobre a qualidade de vida relacionada à saúde do pé. O grau de impacto negativo parece estar associado com idade, sexo e índice de massa corpórea (IMC).

Clinical Factors affecting Minor Amputation in Diabetic Foot Disease at Tengku Ampuan Afzan Hospital, Kuantan

Background: Diabetic foot disease poses a substantial problem in Malaysian diabetic population. We evaluate the clinical factors affecting minor amputation in diabetic foot disease. Methods: A cross-sectional study enrolling patients admitted to orthopaedic wards of a single tertiary hospital for diabetic foot disease was conducted. Patients who had undergone major amputation or with medical condition above the ankle joint were not included. Clinical data were collected by measurement of ankle brachial systolic index and Semmes-Weinstein 5.07 gauge monofilament test with foot clinical evaluation using King’s classification respectively. Results: The total number of patients included was 138, with mean age of 59.7 years (range 29 to 94 years old). Fifty patients (36.2%) had minor amputations. Poor compliance to diabetic treatment, King’s classification stage 5, low measures of ankle brachial systolic index, sensory neuropathy, high serum C-Reactive protein and high serum creatinine are significant predictive factors for minor amputation (P < 0.05). Conclusion: Identifying these risk factors may help in prevention of minor amputation and subsequently reduce limb loss in diabetic foot.

Pé doloroso do idoso associado à incapacidade funcional / Foot pain in the elderly associated to functional incapacity

JUSTIFICATIVA E OBJETIVOS: O pé doloroso no idoso pode interferir no equilíbrio e no ciclo da marcha podendo ser um fator contribuinte para a incapacidade funcional na população geriátrica. O objetivo deste estudo foi avaliar a frequência de incapacidade funcional associada ao pé doloroso no idoso. MÉTODO: Cem participantes, com idade > 60 anos, dor no pé de intensidade > 30 mm pela escala analógica visual (EAV) de dor. Foram analisados os tipos de pés e suas lesões, tipos de calçados, ocorrência de queda, sua circunstância e consequência. Aplicado o Índice Manchester de Incapacidade Associada ao Pé Doloroso no Idoso (MFPDI) e a EAV ao repouso e movimento, Índice de Marcha Dinâmica (DGI), e Escala de Atividade Instrumental de Vida Diária (AIVD). Análise estatística com os testes de Spermann e regressão múltipla, com nível de significância em 5% (p < 0,05). RESULTADOS: Foi observada prevalência de incapacidade funcional associada ao pé doloroso maior que 50%. Na análise univariada houve correlações significantes da incapacidade funcional associada ao pé doloroso com intensidade de dor no pé ao movimento (p < 0,002), o nível de independência funcional para as AIVD (p < 0,001), e a funcionalidade de marcha, equilíbrio e risco de queda (p < 0,003), em relação a esta última variável, a associação foi importante. Na análise multivariada, as mesmas correlações mantiveram-se significantes (p < 0,05). CONCLUSÃO: A incapacidade funcional associada ao pé doloroso foi muito prevalente no idoso, e correlacionou-se significativamente com a intensidade da dor no pé em movimento, o nível de independência funcional para as AIVD, e a funcionalidade da marcha/equilíbrio e risco de queda.

BACKGROUND AND OBJECTIVES: Foot pain in elderly people may interfere with gait balance and cycle and may contribute for functional incapacity in the geriatric population. This study aimed at evaluating the frequency of functional incapacity associated to foot pain in elderly people. METHOD: Participated in this study 100 elderly people aged 60 years, with foot pain intensity of 30 mm by the pain visual analog scale (VAS). Types of feet and their injuries, types of shoes, falls, their circumstances and consequences were evaluated. Manchester Foot Pain Disability Index (MFPDI) and VAS at rest and movement, dynamic gait index and instrumental activity of daily life scale (IADL) were applied. Sperman and multiple regression tests were used for statistical analysis with significance level of 5% (p < 0.05). RESULTS: There has been prevalence of functional incapacity associated to foot pain above 50%. Univariate analysis has shown significant correlations of functional incapacity associated to foot pain and foot pain intensity at movement (p < 0.002), with the level of functional independence for IADL (p < 0.001), and with gait functionality, balance and risk for falls (p < 0.003), with significant association with the latter. The same correlations were significant in the multivariate analysis (p < 0.005). CONCLUSION: Functional incapacity associated to foot pain was highly prevalent in the elderly and was significantly correlated to foot pain intensity at movement, to the level of functional independence for IADL and to gait / balance functionality and risk for falls.

Espondilo artritis anquilosante: presentación de un caso atípico / Ankylosing spondyloarthritis: an atypical case report

La espondiloartritis anquilosante es una enfermedad que tiene muy baja prevalencia en Cuba, y es muy rara en Pinar del Río, y más en la juventud. Se presenta un caso de un joven adolescente de 16 años, estudiante, blanco, que debuta con dolor plantar y espolones calcáneos. Es ingresado y estudiado y se le diagnóstica espondiloartritis anquilosante. Se expone el cuadro clínico, los complementarios y la terapéutica utilizada. Se revisa la literatura al respecto.

Ankylosing spondyloarthritis (AS) is an uncommon disease in Cuba, and very rare in Pinar del Río Province, and much more uncommon in teenagers. A white 16- year-old adolescent student begins with plantar pain and calcaneous spikes. He is admitted to be studied and Ankylosing Spondyloarthritis is diagnosed. Clinical chart, complementary exams and the therapeutics to be used are discussed. Medical Literature is reviewed.

Afecções podais em vacas da bacia leiteira de Rondon do Pará / Foot disorders in cows from basin milk of Rondon do Pará

As doenças digitais estão entre as principais causas de performance reduzida de rebanhos leiteiros. Com o objetivo de determinar a prevalência, classificar clinicamente e estabelecer os fatores epidemiológicos das enfermidades podais em vacas da bacia leiteira de Rondon do Pará, foram avaliadas 1.236 vacas, das quais 275 apresentaram pelo menos um tipo de lesão podal. Identificou-se 655 lesões, o que resultou em uma prevalência de 22,25 por cento. As enfermidades mais frequentes foram hiperplasia interdigital (80,92 por cento), necrobacilose interdigital (6,11 por cento) e cascos com crescimento excessivo (6,42 por cento). Os membros pélvicos foram os mais acometidos (61,83 por cento) e o espaço interdigital, tanto nos membros torácicos (36,34 por cento), quanto nos pélvicos (48,09 por cento), a região digital acometida com maior frequência. O estudo epidemiológico mostrou que características ambientais tais como relevo montanhoso, pastagem em formação com presença de troncos e galhos de árvores, irregularidades nos pisos dos currais, presença de piçarra e lama podem favorecer o aparecimento das lesões podais. Constatou-se a ausência de medidas de controle e profilaxia de afecções que acometem os cascos em 95,5 por cento das propriedades estudadas. O exame clínico específico do casco foi eficiente no diagnóstico das enfermidades.

Foot diseases are some of the main causes of low performance in dairy cows. In order to determine the prevalence, clinical classification and to establish the epidemio-logical factors of foot diseases in cows from basin milk of Rondon do Pará, 1,236 cows were evaluated and 275 had at least one type of foot injury. A total of 655 lesions was showed which a prevalence of 22.25 percent. Most frequent lesions were interdigital hyperplasia (80.92 percent), claw overgrowth (6.42 percent), and interdigital necrobacillosis (6.11 percent). Hind limbs were most frequently affected (61.83 percent), and lesions affecting the interdigital space were the most common in both the thoracic (36.34 percent) and hind limbs (48.09 percent). Epidemiological study showed that the environmental characteristics such as mountainous areas, newly formed grassland (with trunks and branches of trees), irregular ground, and mud and gravel in the floor of the pens may promote the development of foot lesions. In 95.5 percent of the farms, no measures had been taken for the control and prophylaxis of foot diseases. The specific clinical examination of the feet was efficient for the diagnosis.