3D Foot Anthropometric Measurements Under Two Weight- Bearing Conditions for Ergonomic Design of Foot-Related Products / Mediciones Antropométricas del Pie en 3D Bajo Dos Condiciones de Soporte de Peso para el Diseño Ergonómico de Productos Relacionados con los Pies

SUMMARY: This study collected 3D models of the left and right feet from 317 Chinese youth (155 females and 162 males) under half weight-bearing and no weight-bearing conditions. Thirteen dimensions and one angle were taken for each sample. By measuring 13 foot dimensions and 1 angle, this study comprehensively investigated the differences in foot shape between genders and the bilateral differences, as well as the foot shape differences under different conditions. The results showed that regardless of the condition, male foot dimensions were significantly larger than those of females. However, female foot shape was not simply a scaled-down version of male foot shape. On the contrary, the average angle of female feet was greater than that of males under both conditions, indicating a higher prevalence of hallux valgus in females. Both males and females exhibited significant correlation in foot dimensions between the left and right feet, with minimal differences. Under the half weight-bearing condition, the average foot length, width, and circumference were significantly larger than the corresponding measurements under the no weight-bearing condition, while the average height and angle were significantly smaller. Therefore, when designing footwear and foot-related medical rehabilitation aids, it is important to consider foot shape and dimensions under different conditions as a reference. The results of this study provide manufacturers of foot- related products with more detailed data support and are of significant value to the field of medical foot morphology research.

Este estudio recolectó modelos 3D de los pies izquierdo y derecho de 317 jóvenes chinos (155 mujeres y 162 hombres) en condiciones de carga media de peso y sin carga de peso. Para cada muestra se tomaron trece dimensiones y un ángulo. Al medir 13 dimensiones del pie y 1 ángulo, se investigó exhaustivamente las diferencias en la forma del pie entre ambos sexos y sus diferencias bilaterales, así como las diferencias en la forma del pie en diferentes condiciones. Los resultados mostraron que, independientemente de la condición, las dimensiones del pie de los hombres, estos eran significativamente más grandes que los de las mujeres. Sin embargo, la forma del pie femenino no era simplemente una versión reducida de la forma del pie masculino. Por el contrario, el ángulo promedio de los pies de las mujeres fue mayor que el de los hombres en ambas condiciones, lo que indica una mayor prevalencia de hallux valgus en las mujeres. Tanto hombres como mujeres exhibieron una correlación significativa en las dimensiones del pie, entre el pie izquierdo y el derecho, con diferencias mínimas. Bajo la condición de medio soporte de peso, la longitud, el ancho y la circunferencia promedio del pie fueron significativamente mayores que las medidas correspondientes bajo la condición sin soporte de peso, mientras que la altura y el ángulo promedio fueron significativamente más pequeños. Por lo tanto, al diseñar calzado y dispositivos médicos de rehabilitación relacionados con los pies, es importante tener en consideración la forma y las dimensiones del pie en diferentes condiciones como referencia. Los resultados de este estudio, brindan a los fabricantes de productos relacionados con los pies un soporte de datos más detallado y son de gran valor para el campo de la investigación médica de la morfología del pie.

Bloqueo del tobillo con lidocaína y bupivacaina para amputación de los radios del pie. Hospital General del Sur "Dr. Pedro Iturbe" / Ankle block with lidocaine and bupivacaine for foot rays amputation. Hospital General del Sur "Dr. Pedro Iturbe"

El objetivo de este trabajo es determinar la utilidad del bloqueo del tobillo con lidocaína y Bupivacaína para amputación de los radios del pie en pacientes atendidos en el Hospital General del Sur Dr. Pedro Iturbe, Maracaibo, Venezuela, desde mayo 2019 hasta mayo 2021. Se realizó un estudio pre-experimental, prospectivo y longitudinal. Se incluyeron pacientes de ambos sexos, entre 18 a 90 años, con amputaciones traumáticas, pie diabético e insuficiencia vascular periférica. Se incluyeron 50 pacientes, con edad promedio de 50,76 ± 25,0 años, 35(70,0%) de sexo masculino. Con antecedente de diabetes 13(26,0%) pacientes, fumadores 4(8,0%), cardiópatas 4(8,0%), hipertensos/diabéticos 6(12,0%), obesidad 5(10,0%), trauma 6(12,0%), nefrópatas 2(4,0%), drogas 1(2,0%) y sin antecedentes 9(18,0%). Diagnóstico preoperatorio predominante: amputación traumática 19 pacientes (38,0%), El promedio de tiempo de inicio del bloqueo fue 5-15min en 21(42,0%) casos. El bloqueo fue satisfactorio en 46(92,0%) pacientes. La duración del bloqueo en 22(44,0%) pacientes fue prolongada. Según la EVA del dolor en 19(38,0%) casos fue leve. No se evidenciaron complicaciones asociadas al procedimiento en 50(100,0%) pacientes. El bloqueo con lidocaína y bupivacaína es una técnica útil en la amputación de los radios del pie, inmediata, ambulatoria, a bajo costo, de duración prolongada y satisfactoria, de bajo dolor postoperatorio, poco requerimiento de analgésicos y con bajas complicaciones(AU)

The objective to determine the usefulness of the ankle block with lidocaine and Bupivacaine for amputation of the foot rays in patients treated at the Hospital General del Sur Dr. Pedro Iturbe during the period May 2019 to May 2021. A pre-experiment, prospective and longitudinal study was made. Patients of both sexes, between 18 and 90 years old, with traumatic amputations, diabetic foot and peripheral vascular Insufficiency were included. A descriptive statistical analysis was applied. Mean age 50,76±25,0 years, 35(70,0%) male patients. Patients history: Diabetes 13(26,0%), smokers 4(8,0%), heart patients 4(8,0%), hypertensive/diabetics 6(12,0%) patients, obesity 5(10,0%), trauma 6(12,0%), kidney disease 2(4,0%), drugs 1(2,0%), no history 9(18,0%). Predominant preoperative diagnosis: traumatic amputation 19(38,0%) patients, Block onset time: medium (5-15min) 21(42,0%) patients. The blockade was satisfactory in 46 patients (92.0%). Block duration in 22(44,0%) patients was prolonged. Pain scale 19(38,0%) patients mild pain. There were no complications associated with the procedure in 50(100,0%) patients. Conclusions: The blockade with lidocaine and bupivacaine is useful in the amputation of the foot rays since it is performed immediately, on an outpatient basis, at low cost, with a long and satisfactory duration, presenting mild postoperative pain, little need for analgesics and they do not represent a risk for the patient since there were no complications related to the technique(AU)

Análisis de las características demográficas de 94 pacientes con fracturas articulares de calcáneo / Analysis of demographic characteristics in a series of 94 patients with articular calcaneal fractures

Objetivo: Analizar las características demográficas de los pacientes con fracturas articulares de calcáneo en relación con el mecanismo del trauma y los patrones fracturarios según las clasificaciones de Sanders y Essex-Lopresti. materiales y métodos: Se evaluó retrospectivamente a 94 pacientes (111 fracturas articulares de calcáneo). Se analizaron las siguientes variables: edad, sexo, lado fracturado, mecanismo del trauma y lesiones asociadas. Al ingresar, se tomaron radiografías de pie, de frente y perfil, y se realizó una tomografía computarizada con reconstrucción multiplanar. Se analizaron los datos demográficos combinándolos con los tipos de fracturas. Resultados: Se evaluó a 94 pacientes (78 hombres y 16 mujeres) que tenían 105 fracturas intrarticulares de calcáneo (11,7% bilaterales). La edad promedio era de 40.1 ± 12.5 años. El 79,8% de las fracturas se había producido por caída de altura y el 20,1%, por accidente de tránsito. El 9,5% tenía lesiones asociadas. Los pacientes con fracturas bilaterales tenían más lesiones asociadas (p = 0,0123) y el mismo patrón fracturario y tipo de Sanders en ambos pies. No hubo relación entre la clasificación de Sanders y los patrones de Essex-Lopresti con la edad, el sexo y el mecanismo del trauma. Conclusiones: Las fracturas de calcáneo son más frecuentes en hombres y en pacientes jóvenes, y el mecanismo del trauma más común es una caída de altura. Los pacientes con fracturas bilaterales tienen una tasa más alta de lesiones asociadas y el mismo tipo de fractura según la clasificación de Sanders y el patrón fracturario de Essex-Lopresti en ambos pies. Nivel de Evidencia: IV

Objective: To analyze the demographic characteristics of patients with articular calcaneal fractures in connection with trauma mechanisms and fracture patterns, according to the Sanders and Essex-Lopresti classifications. materials and methods: 94 patients and 111 articular calcaneal fractures were evaluated retrospectively, analyzing the following variables: age, gender, fractured side, mechanism of trauma, and associated injuries. The patients were initially evaluated through foot radiographs (anteroposterior and lateral) and axial computerized tomography with multiplanar reconstruction. Demographic data were analyzed combined with the types of fracture. Results: 94 patients (78 men and 16 women) who presented 105 intra-articular calcaneal fractures (11.7% were bilateral) were evaluated. The average age was 40.1±12.5 years. 9.8% of the fractures were caused by high-level falls and 20.1% by traffic accidents. 9.5% had associated injuries. The patients with bilateral fractures presented more associated injuries (p = 0.0123) and the same fracture pattern and Sanders type in both feet. The Sanders classification and Essex Lopresti patterns were unrelated to age, gender, and trauma mechanism. Conclusion: Calcaneal fractures are more frequent in male and young patients, and the most common trauma mechanism is a high-level fall. Patients with bilateral fractures present a higher rate of associated injuries and the same Sanders type fracture and Essex-Lopresti pattern in both feet. Level of Evidence: IV

Síndrome del torniquete capilar en la población pediátrica: reporte de un caso / Hair tourniquet syndrome in the pediatric population. A case report

El síndrome del torniquete es un cuadro poco frecuente que ocurre, por lo general, en la población pediátrica. Consiste en la disminución del aporte sanguíneo por estrangulación circunferencial de algunas partes del cuerpo y suele comprometer dedos de los miembros superiores o inferiores, genitales externos u otros apéndices. En la mayoría de los casos, el agente causal suele ser una hebra de cabello, aunque se han descrito otros elementos, como fibras sintéticas de la indumentaria del paciente. El objetivo de este artículo es presentar el caso de una paciente con síndrome del torniquete y analizar la bibliografía disponible. Se trata de una lactante de 3 meses de edad con síndrome del torniquete por cabello, con compromiso del cuarto dedo del pie derecho, que fue traída al servicio de urgencia por un importante edema de partes blandas. La paciente evolucionó favorablemente luego de la extracción del agente causal (hebra de cabello) de la base del cuarto dígito y la recuperación de la irrigación fue completa. Si bien es un cuadro poco frecuente, es imprescindible tener un alto índice de sospecha y realizar un diagnóstico precoz para indicar un tratamiento oportuno y evitar complicaciones potencialmente graves para el paciente. Nivel de Evidencia: IV

Tourniquet syndrome is a rare condition that usually affects the pediatric population. It consists of a decrease in blood supply due to circumferential strangulation of some parts of the body, mainly fingers or toes, external genitalia or other appendages.In most cases, the causative agent is usually a strand of hair, although other elements have been described, such as synthetic fibers from the patient's clothing. The aim of this study is to report a case of a patient with hair tourniquet syndrome and to review the available literature. The patient is a 3-month-old female with hair tourniquet syndrome, with involvement of the fourth toe of the right foot, who was brought to the emergency department for significant soft tissue edema. The patient evolved favorably after removal of the causative agent (hair strand) from the base of the fourth toe and recovery of irrigation was complete. Although tourniquet syndrome is a rare entity, early diagnosis and treatment is essential to avoid potentially severe complications. Level of Evidence: IV

Bloqueo supramaleolar de tobillo para cirugía de pie y tobillo. Estudio retrospectivo de casos de los últimos cinco años / Supramalleolar ankle block for foot and ankle surgery

Objetivo: Describir la técnica de bloqueo supramaleolar de tobillo y nuestra experiencia con este bloqueo en la cirugía de tobillo y pie. materiales y métodos:Se llevó a cabo un estudio observacional, retrospectivo de los últimos 5 años en pacientes con enfermedad de tobillo y pie, sometidos a un bloqueo supramaleolar de tobillo. Se excluyó a pacientes con cirugía previa, cirugías bilaterales, neuropatía periférica o enfermedad vascular, diabetes, infección activa o tabaquistas. Se realizó el bloqueo supramaleolar de tobillo con lidocaína al 2% y bupivacaína al 0,5%, teniendo en cuenta las referencias anatómicas. Se evaluaron la duración del bloqueo, la escala analógica visual de dolor a las 24 h de la cirugía, el tiempo hasta la toma del primer analgésico y el grado de satisfacción del paciente. Resultados:Se incluyó a 771 pacientes operados, todos tuvieron una analgesia completa por, al menos, 12 h (duración promedio 18 h). El puntaje promedio de la escala para dolor a las 24 h fue de 1,4. El tiempo promedio hasta la toma del primer analgésico fue de 16 h. El grado de satisfacción del paciente con el bloqueo y el dolor percibido en las primeras 24 h fue: muy satisfecho (89%), satisfecho (10%) y poco satisfecho (1%). No hubo casos de secuela neurológica permanente, toxicidad sistémica ni infección. Conclusión:El bloqueo supramaleolar de tobillo es un método simple, eficaz y seguro que puede realizar el traumatólogo para obtener una analgesia posquirúrgica prolongada. Nivel de Evidencia: IV

Background: We present the description of a supramalleolar ankle block technique and our experience using this technique in foot and ankle surgery. Materials and methods: We performed a retrospective observational study of the past 5 years of patients with foot and ankle pathology that had undergone the supramalleolar ankle block. We excluded patients with a history of previous foot surgery, bilateral surgeries, vascular disease, peripheral neuropathy, diabetes, smoking, or active surgical site infection. The supramalleolar ankle block was guided by anatomic landmarks and we used a solution of lidocaine 2% and bupivacaine 0.5%. We evaluated the duration of the ankle block, the visual analog scale (VAS) for pain 24 hrs after surgery, the time until the first analgesic dose, and the level of patient satisfaction. Results:771 patients were included in this study, all of whom had complete analgesia for at least 12 hrs (mean 18 hrs) after surgery. The mean value on the VAS for pain after 24 hrs was 1.4. On average, the first analgesic dose was administered 16 hrs after surgery. The level of satisfaction about the pain perceived in the first 24 hrs after surgery was: very satisfied (89%), satisfied (10%), and dissatisfied (1%). There were no reports of permanent neurological sequelae, systemic toxicity, or surgical site infections. Conclusion: We consider the supramalleolar ankle block a simple, effective, and safe procedure to obtain long-lasting postoperative analgesia. Level of Evidence: IV

Standardization of the Radiographic Study of the Foot Using the Niza Box / Padronização do estudo radiográfico do pé pela caixa Niza

Abstract Objective This study proposes the Niza box, a device created to reduce interpretive errors among professionals and facilitate the correct positioning of structures by standardizing orthopedic radiography of the foot in anteroposterior, loaded, and Saltzman views. Methods Descriptive study based on material collected at an Orthopedics Ambulatory from a tertiary service in a large Brazilian city. The X-ray device was a Lotus X, model HF 500 M, 500 milliamperes and 125 kilovolts capacity, 100 cm focus-film distance, and 24 × 30 cm radiographic chassis. Device controls were set at 100 mA, 5 mA/sec, and 60 kilovolts, depending on the variable size of the foot. The same team of previously trained radiography technicians performed the tests under the authors' supervision. The chassis were positioned in three specific Niza box spaces per the proposed incidence. Data from 50 images from people between 18 and 70 years old were analyzed. Results Radiographs taken using the proposed device usually had a satisfactory quality, allowing correct identification of the anatomical elements of the foot and ankle and angular reconstruction. Small image variations due to foot size were acceptable and expected, allowing radiograph standardization. Conclusion The Niza box is a good method for minimizing interference and avoiding radiographic interpretation errors, providing quality and agility to the examination, and reducing cost and unnecessary repetitions. It is an innovative, low-cost device made of recyclable and biodegradable material.

Resumo Objetivo Este estudo propõe a utilização da Caixa Niza, dispositivo criado com a finalidade de diminuir os erros interpretativos entre profissionais e facilitar o correto posicionamento das estruturas radiografadas ao padronizar as incidências radiográficas ortopédicas do pé anteroposterior, perfil com carga e Saltzman. Métodos Pesquisa descritiva, material coletado em Ambulatório de Ortopedia em serviço terciário de cidade brasileira de grande porte. Utilizado aparelho de radiografia marca Lotus X, modelo HF 500M, capacidade de 500 miliamperes e 125 quilovolts, distância foco-filme de 100cm, chassi radiográfico 24×30 cm e os comandos do aparelho ajustados para 100 mA, 5mA/seg e 60 quilovolts dependendo do tamanho variável dos pés. Exames realizados pela mesma equipe de técnicos em radiografia previamente treinados com supervisão dos autores. O chassi é posicionado em três espaços específicos da Caixa conforme a incidência proposta. Foram analisados dados de 50 imagens de pessoas entre 18 e 70 anos. Resultados A avaliação das radiografias após utilização do dispositivo proposto ocorreu de modo geral com qualidade satisfatória, permitindo correta identificação dos elementos anatômicos do pé e tornozelo e reconstrução angular. Pequenas variações nas imagens devido ao tamanho dos pés são aceitáveis e esperadas, sendo possível perceber padronização das radiografias. Conclusão A Caixa proposta se mostra um bom método de minimizar as interferências e evitar erros de interpretação radiográfica, proporcionando qualidade e agilidade ao exame, diminuindo custo e repetições desnecessárias. É inovador, um dispositivo de baixo custo, de material reciclável e biodegradável.

Discussion on the relationship between yuan-source points of yang meridians and diseases of fu- organs / 中国针灸

Huangdi Neijing (Yellow Emperor 's Canon of Medicine) establishes the theory that yuan-source points are indicated in zangfu diseases. However, compared with the yuan-source points of yin meridians for the treatment of zang-organ diseases, there is less attention to the indication of yuan-source points of yang meridians for fu-organ diseases, and this statement is even questioned. Collating the early literature and associating with the researches of medical experts, it is found that Nanjing (Classic of Difficult Questions) should be the theoretic origin that yuan-source points of yang meridians are indicated in fu-organ diseases. Regarding the reasons why this theory has not received clinical attention, the three aspects are involved, i.e. the theoretic completion of "he-sea points of three-foot-yang meridians for the diseases of six fu-organs", the limitation of the theory itself, and the lack of literature materials. It is proposed that the exploration on this theory should be deepened in views of the essence of yuan-source points relevant with the characteristic of the wrist-ankle pulse palpation region, acupoint combination, modern technology, etc.

Application of meridian and acupoint diagnosis of three yin meridians of foot in the treatment for gynecological diseases with acupuncture and moxibustion / 中国针灸

With three representative types of gynecological diseases (dysmenorrhea, pelvic inflammation, polycystic ovary syndrome) as examples, the application methods of meridian and acupoint diagnosis for gynecological diseases treated with acupuncture and moxibustion are discussed. During clinical diagnosis and treatment, it is recommended to examine the patient's leg segment along the three yin meridians of foot, aiming to explore the positive reactions of the meridians and acupoints (color, shape, skin temperature, sensory abnormalities, etc.). Acupuncture and moxibustion treatment at this positive reaction place can improve the clinical efficacy. Meridian and acupoint diagnosis could provide basis for meridian syndrome differentiation, thus guiding the selection of acupoint prescriptions; it is also helpful to clarify the deficiency, excess, cold and heat of the disease nature, thus guiding the selection of acupuncture and moxibustion methods. In addition, it is an auxiliary method to estimate the prognosis and outcome of the disease.

A gait signal acquisition and parameter characterization method based on foot pressure detection combined with Azure Kinect system / 生物医学工程学杂志

The gait acquisition system can be used for gait analysis. The traditional wearable gait acquisition system will lead to large errors in gait parameters due to different wearing positions of sensors. The gait acquisition system based on marker method is expensive and needs to be used by combining with the force measurement system under the guidance of rehabilitation doctors. Due to the complex operation, it is inconvenient for clinical application. In this paper, a gait signal acquisition system that combines foot pressure detection and Azure Kinect system is designed. Fifteen subjects are organized to participate in gait test, and relevant data are collected. The calculation method of gait spatiotemporal parameters and joint angle parameters is proposed, and the consistency analysis and error analysis of the gait parameters of proposed system and camera marking method are carried out. The results show that the parameters obtained by the two systems have good consistency (Pearson correlation coefficient r ≥ 0.9, P < 0.05) and have small error (root mean square error of gait parameters is less than 0.1, root mean square error of joint angle parameters is less than 6). In conclusion, the gait acquisition system and its parameter extraction method proposed in this paper can provide reliable data acquisition results as a theoretical basis for gait feature analysis in clinical medicine.

Puntajes VI / Scores VI

El Comité Editorial quiere brindar a sus lectores una actualización de las escalas de uso corriente. El empleo de tablas y escalas es una práctica muy extendida en la Ortopedia y Traumatología. La medición y la cuantificación de los aspectos clínicos, funcionales y radiográficos se convirtieron en una herramienta imprescindible para la toma de decisiones en diferentes aspectos de la actividad asistencial. Llevamos a cabo una revisión de las escalas más utilizadas, definiendo su uso e incluyendo bibliografía original y actualizada. Nivel de Evidencia: V

The Editorial Committee wants to provide its readers with an update on the commonly used scales. The use of tables and scales is a widespread practice in Orthopedics and Traumatology. The measurement and quantification of clinical, functional, and radiographic aspects has become an essential tool for decision-making in different aspects of healthcare activity. We carry out a review of the most used scales, defining their use and including original and updated literature. Level of Evidence: V

Entrenamiento de la musculatura intrínseca del pie para la prevención de caídas en personas mayores / Effect of a program of intrinsic musculature exercises of the foot in the prevention of risk of fall on the elderly

OBJETIVO Las personas mayores y particularmente las mujeres, son propensas a sufrir traumatismo por caídas. El objetivo de esta investigación fue mejorar la estabilidad y funcionalidad de la pisada en personas mayores, implementando un programa de entrenamiento de musculatura intrínseca del pie, y determinar sus efectos en el riesgo de caída como método de prevención. MATERIALES Y METODOS Participaron 33 personas mayores, de género femenino y autovalentes. En las participantes se evaluó el equilibrio y la velocidad de la marcha con la prueba Time up and Go (TUG), y el equilibrio dinámico se evaluó con la Escala de Tinetti (ET). La intervención constó de enteramiento de tipo short-foot de forma diaria, durante 4 semanas. RESULTADOS los tiempos del TUG disminuyeron de manera progresiva al final de la intervención, lo que indica una optimización en la velocidad de la marcha, por lo que, el entrenamiento tuvo resultados beneficios para la transferencia de carga corporal de una posición sedente a bípedo y de bípedo a marcha. En cambio, para el equilibrio y marcha según ET no se detectó una diferencia significativa. CONCLUSIONES Este entrenamiento presenta una mejoría en el ámbito funcional de cambio de posición, pero no reemplaza el ajuste postural de base de sustentación para mantener el centro de masa en su posición central.

OBJETIVE Seniors, particularly women, are at risk for suffering traumatisms from falls. The objective of this study was to improve the balance and walking functionality of seniors by implementing a program to training the intrinsic muscles of the foot. The impacts of this training on preventing fall risk were assessed. MATERIALS AND METHODS A total of 33 self sufficient, female seniors participated. Balance and the speed of walking were measured using the Timed Up and Go (TUG) test, while balance and gait were measured using the Tinetti Balance and Gait Assessment Tool (TT). Intervention consisted in four weeks of daily short foot exercises. RESULTS The TUG test times decreases progressively from the start to the end of the intervention period, indicating an optimization in walking speed. This translates into beneficial results for the transfer of body load from a sedentary to standing to walking position. In contrast, balance and gait evidenced no significant changes per the TT. CONCLUSIONS The implemented training program improved the functional sphere of position change, but this did not replace the postural adjustments needed in the base of support (i.e. the feet) to maintain a well-positioned center of mass

Arthroscopic Treatment of Freiberg Disease - Case Report / Tratamento artroscópico da doença de Freiberg - Relato de caso

Abstract Freiberg disease is a rare condition whose diagnosis requires a high clinical suspicion. Avascular necrosis of the metatarsal head progresses with articular collapse, leading to forefoot pain and limitation of the daily activities. Several surgical techniques have been described to address the disease, and since it is usually diagnosed in later-stages, most of them include joint-destructive procedures. The use of arthroscopy on the small joint of the foot has arisen in the last few years, but its application in Freiberg disease is still scant. Joint-preserving procedures have been advocated for cases of early-stage disease, aiming to relieve symptoms while preventing the progression of the disease. In the present report, we describe a successful treatment of a 12-year-old patient with early-stage Freiberg disease using core decompression and bone marrow graft through a minimally-invasive approach assisted by arthroscopy.

Resumo A doença de Freiberg é rara, e seu diagnóstico requer alto grau de suspeita clínica. A necrose avascular da cabeça do metatarso progride com colapso articular, e causa dor no antepé e limitação da atividade. Há diversas técnicas cirúrgicas para o tratamento da doença; como o diagnóstico geralmente é feito em estágios posteriores, a maioria dessas técnicas inclui procedimentos de destruição articular. A artroscopia tem sido utilizada nas pequenas articulações do pé nos últimos anos, mas sua aplicação na doença de Freiberg ainda é escassa. Procedimentos de preservação articular têm sido preconizados na doença em estágio inicial, com o objetivo de aliviar os sintomas e impedir a progressão. Neste relato, descrevemos o tratamento bem-sucedido de uma paciente de 12 anos de idade com doença de Freiberg em estágio inicial por meio de descompressão central e enxerto de medula óssea, por meio de abordagem minimamente invasiva assistida por artroscopia.

Evaluación radiológica pre y posoperatoria de la osteotomía de Austin y uso de AutoCAD® / Preoperative and Postoperative Radiological Evaluation of Austin Osteotomy and Use of Autocad®

Introducción: Se han descrito más de 300 técnicas quirúrgicas para la corrección del hallux valgus. Una de ellas es la técnica de Austin, la cual constituye una osteotomía capital en V con una angulación de 60º utilizada en el tratamiento quirúrgico del hallux valgus leve-moderado. Objetivos: Analizar el grado de corrección que tiene la osteotomía de Austin sobre diferentes parámetros radiológicos y describir la frecuencia con la que se utilizan técnicas complementarias sobre la falange proximal. Métodos: Se realizó un estudio descriptivo, transversal, observacional y retrospectivo. Se seleccionó una muestra de 29 pies intervenidos mediante la técnica de Austin, a los que se les realizaron varias mediciones sobre sus radiografías pre y posoperatorias con AutoCAD®. Resultados: Se obtuvieron diferencias estadísticamente significativas en todos los parámetros evaluados. Conclusiones: Esta técnica corrige significativamente todos los parámetros analizados. Se demuestra que el uso de técnicas quirúrgicas complementarias sobre la falange proximal es bastante frecuente al realizar esta osteotomía(AU)

Introduction: More than 300 surgical techniques have been described for the correction of hallux valgus. One of them is the Austin technique, which constitutes a capital V osteotomy with an angulation of 60º used in the surgical treatment of mild-moderate hallux valgus. Objectives: To analyze the degree of correction that Austin osteotomy has on different radiological parameters and to describe the frequency with which complementary techniques are used on the proximal phalanx. Methods: A descriptive, cross-sectional, observational and retrospective study was carried out in a sample of 29 feet operated on using the Austin technique. Several measurements were made on their pre- and postoperative radiographs with AutoCAD®. Results: Statistically significant differences were obtained in all the parameters evaluated. Conclusions: This technique significantly corrects all the parameters analyzed. It is shown that the use of complementary surgical techniques on the proximal phalanx is quite frequent when performing this osteotomy(AU)

Transferencia tendinosa del tibial posterior en pie caído por lesión del nervio peroneo común / Tendon transfer of the posterior tibial in fallen foot due to lesion of the common peroneal nerve i:en

Se describe el caso clínico de un paciente de 34 años de edad, con antecedente de salud, atendido en la consulta intermunicipal de II Frente, provincia de Santiago de Cuba, por presentar, desde hacía 8 meses, una lesión en el nervio peroneo común, en la cara lateral del tercio superior de la pierna derecha, a causa de una mordida de cerdo, la cual no fue diagnosticada inicialmente, sino que se trató como una herida sin lesión neurológica. Se realizó proceder quirúrgico, consistente en una transposición tendinosa del músculo tibial posterior. Se inmovilizó el pie con una férula de yeso por 15 días, se le retiró la sutura a las 6 semanas y se indicó rehabilitación. A las 12 semanas comenzó a caminar sin dificultad y logró reincorporarse a sus actividades cotidianas.

The case report of a 34 years patient with health history is described. He was assisted in the intermunicipal visit of II Frente, province of Santiago de Cuba, due to a lesion in the common peroneal nerve during 8 months, in the lateral face of the superior third of the right leg, because of a pig bite, which was not diagnosed initially, but instead it was treated as a wound without neurological lesion. A surgical procedure was carried out, with a tendon transposition of the posterior tibial muscle. The foot was immobilized with a plaster splint for 15 days, the suture was removed 6 weeks later and rehabilitation was indicated. Twelve weeks later he began to walk without difficulty and he was able to return to his daily activities.

Mediciones de imágenes fotográficas del pie como una metodología no invasiva y válida en la exploración clínica / Measurements of the Foot Photo Images as a Non-Invasive and Valid Methodology in Clinical Examination

Introducción: La evaluación anatómica músculo esquelética por imagen en la exploración clínica del pie diabético es la fotografía digital que evalúa la morfología superficial. Objetivos: Validar la obtención de las imágenes fotográficas del pie, calcular las mediciones longitudinales, angulares y el índice del arco plantar, de las imágenes fotográficas del pie por fotogrametría, y basados en estas, categorizar la normalidad de la forma en sujetos sanos. Métodos: Estudio exploratorio en 30 individuos sanos evaluados en la Unidad clínica de pie diabético en la ciudad de Trujillo, mediante un prototipo de cámaras alrededor de un podoscopio y un software de análisis de imágenes. La imagen fotográfica fue evaluada por mediciones longitudinales, angulares y el índice del arco plantar. Resultados: Los pacientes evaluados tenían una edad media de 25,06+/-11,95 años, y predominaron las mujeres. La longitud total del pie y anchura del metatarso en el lado derecho fue de 226,55 ± 36,49 mm y 98,99 ± 22,71 mm respectivamente; y en el lado izquierdo fue de 229,81 ± 42,25 mm y 104,49 ± 16,84 mm respectivamente. El ángulo intermetatarsal del 1-2 rayo, ángulo intermetatarsal del 4-5 rayo y ángulo del retropié para el lado derecho fueron 14 ± 4º, 11 ± 3º y 2 ± 2º respectivamente; para el lado izquierdo 14 ± 3º, 9 ± 3º y 2 ± 2º respectivamente, y el índice plantar del arco derecho e izquierdo fueron 0,23 ± 0,2 y 0,22 ± 0,1 respectivamente. La variabilidad solo se presentó en el antepie en el 20 percent de los casos. Conclusiones: La obtención de las imágenes fotográficas del pie fueron válidas, las mediciones fueron menores o similares a otros estudios. La variabilidad de la normalidad solo se presentó en el antepie(AU)

Introduction: The musculoskeletal anatomical evaluation by imaging in the clinical examination of the diabetic foot is digital photography that assesses the superficial morphology. Objectives: To validate the obtaining of photographic images of the foot, to calculate the longitudinal and angular measurements and the index of the plantar arch, from the photographic images of the foot by photogrammetry, and to categorize the normality of the shape in healthy subjects, based on these photographic images. Methods: This an exploratory study in 30 healthy individuals evaluated at the Diabetic Foot Clinical Unit in Trujillo city, using a prototype of cameras around a podoscope and image analysis software. The photographic image was evaluated by longitudinal and angular measurements and the plantar arch index. Results: The patients evaluated had a mean age of 25.06+/-11.95 years, and women predominated. Total foot length and metatarsal width on the right side were 226.55 ± 36.49 mm and 98.99 ± 22.71 mm, respectively; and on the left side it was 229.81 ± 42.25 mm and 104.49 ± 16.84 mm, respectively. The 1st-2nd ray intermetatarsal angle, 4th-5th ray intermetatarsal angle and hindfoot angle for the right side were 14 ± 4º, 11 ± 3º and 2 ± 2º respectively; for the left side 14 ± 3º, 9 ± 3º and 2 ± 2º respectively, and the plantar index of the right and left arch were 0.23 ± 0.2 and 0.22 ± 0.1 respectively. Variability only occurred in the forefoot in 20 percent of cases. Conclusions: Obtaining of the photographic images of the foot was valid, measurements were smaller or similar to other studies. The variability of normality only appeared in the forefoot(AU)

Anatomical variations of the dorsalis pedis artery in a Thai population / Variaciones anatómicas de la arteria dorsal del pie en una población tailandesa

SUMMARY: The dorsalis pedis artery (DPA) is a vital artery that supplies the foot and ankle area which is clinically important for palpating when taking the pulse. This research was performed on fresh cadaveric dissection of 40 legs by injecting paint into popliteal artery for tracking the dorsalis pedis artery and its branches. The present research revealed that the Thai population has an anatomical variation and different location of the DPA and exact location of DPA for estimating the location of the DPA and may have clinical implications. The statistically descriptive analysis elucidated the distances of the DPA to the lateral malleolus and medial malleolus which were 51.48 ± 7.27 mm and 42.62 ± 11.40 mm, respectively. The distance of the extensor hallucis longus (EHL) to the DPA was 14.29 ± 4.11 mm. The length of the dorsalis pedis artery which measured from artery on intermalleolar line to its dipping in 1st intermetatarsal space to be 122.03 ± 21.07 mm. The arcuate loop which is anastomosis U-loop of lateral tarsal arteries of the DPA was found 55 % in Thais population. There were no statistically significant differences of all parameters between the side and sex in DPA consideration. An understanding of the variations of the anatomical vasculature of DPA is essential for precise clinical assessment because exact anatomical knowledge and location can contribute to the pulse taking and be applied in surgical procedure.

RESUMEN: La arteria dorsal del pie (ADP) es una arteria vital que irriga eldorso del pie y el tobillo, y es clínicamente importante para la toma del pulso. Esta investigación se realizó en disección cadavérica de 40 piernas inyectando látex coloreado en la arteria poplítea para rastrear la ADP y sus ramas. La presente investigación reveló que en la población tailandesa la ADP tiene una variación anatómica y una ubicación diferente. Por tanto, determinar la ubicación exacta del ADP será útil para las implicaciones clínicas. El análisis estadísticamente descriptivo determinó que las distancias del ADP al maléolo lateral y al maléolo medial eran 51,48 ± 7,27 mm y 42,62 ± 11,40 mm, respectivamente. La distancia del tendón del músculo extensor largo del halux (ELH) al ADP era de 14,29 ± 4,11 mm. La longitud de la ADP, desde la línea intermaleolar hasta su entrada al primer espacio intermetatarsiano, era de 122,03 ± 21,07 mm. El asa arqueada, que es una anastomosis U-loop de las arterias tarsales laterales de la ADP, se encontró en un 55 % de la población tailandesa. No hubo diferencias estadísticamente significativas en todos los parámetros de la ADP entre el lado y el sexo. La comprensión de las variaciones de la variaciones anatómicas de la ADP es esencial para una evaluación clínica precisa. El conocimiento anatómico exacto y la ubicación pueden contribuir a la toma del pulso y ser útil en el procedimiento quirúrgico.

The Influence of the Shoe over the Medial Foot Arch and the Lower Limbs Kinematics in Toddlers / A influência de calçados no arco longitudinal medial do pé e na cinemática dos membros inferiores de crianças no início da fase de aquisição de marcha

Abstract Objective To evaluate the biomechanical behavior of the medial longitudinal arch (MLA) of the foot and the kinematic parameters of the lower limbs with biomimetic footwear (BF) and non-biomimetic (NB1, NB2, NB3 and NB4) footwear in children at the beginning of the gait acquisition phase. Methods Four toddlers were evaluated at the beginning of the gait acquisition phase under the following conditions: walking barefoot, ambulation with BF and NB1, NB2, NB3 and NB4 footwear in hard floor. BF is described as biomimetic because of its property of emulating natural and irregular floors through a dynamic internal insole. The MLA and kinematics of the hip, knee, and ankle during gait were evaluated by three-dimensional motion analysis system. The similarity between the kinematic curves of barefoot and footwear conditions was analyzed by root mean square error (RMSE). Results The use of BF presented the highest magnitude of MLA and the greatest difference in relation to barefoot condition (higher RMSE). The BF showed less difference in the kinematics of the knee and ankle joints during gait when compared to barefoot condition (lower RMSE). NB2 footwear presented hip kinematics more similar to barefoot condition (lower RMSE). Conclusion Biomimetics footwear and NB2 shoes (both with wider forefoot region) generated smaller differences in lower limbs compared to barefoot. In addition, the MLA was higher in the BF, probably because different design from other shoes.

Resumo Objetivo Avaliar o comportamento do arco longitudinal medial do pé (ALM) e os parâmetros cinemáticos dos membros inferiores durante a deambulação com calçados biomiméticos (CBs) e não biomiméticos (NB1, NB2, NB3 e NB4) em crianças no início da fase de aquisição da marcha. Métodos Foram avaliadas quatro crianças no início da fase de aquisição da marcha nas seguintes condições: andar descalço, andar com CBs e calçados NB1, NB2, NB3 e NB4 em solo plano. O calçado biomimético é descrito como biomimético por emular pisos naturais e irregulares por meio de uma palmilha interna dinâmica. O ALM e a cinemática do quadril, joelho e tornozelo durante a marcha foram avaliados por meio de sistema de análise do movimento tridimensional. A similaridade entre as curvas cinemáticas das condições descalça e com calçado foi analisada por meio do cálculo de root mean square error (RMSE). Resultados O CB foi o que apresentou maior magnitude do ALM e maior diferença do ALM em relação à condição descalça (maior RMSE). O CB apresentou ainda menor diferença na cinemática das articulações do joelho e tornozelo durante a marcha quando comparado à condição descalça (menor RMSE). O calçado NB2 apresentou a cinemática do quadril mais semelhante à condição descalça (menor RMSE). Conclusão Os calçados CB e NB2 que apresentam a região do antepé mais larga geraram menores diferenças na cinemática dos membros inferiores. Além disso, o ALM foi maior no CB provavelmente devido a seu design ser diferente daquele dos demais calçados.

Caracterización del equilibrio dinámico y la tipología de pie en futbolistas juveniles / Characterization of dynamic balance and standing typology in youth soccer players

Resumen Introducción: El equilibrio dinámico (ED) es la base para todas las actividades motoras deportivas. Algunas variables como el tipo de pie y el mecanismo de Windlass (MW) están asociadas a dicho equilibrio y al riesgo de lesión en la extremidad inferior. Se hace necesario el reconocimiento de estos elementos en la población con el fin de identificar potenciales factores de riesgo y promover las respectivas medidas preventivas. Objetivo: Caracterizar el equilibrio dinámico, algunas variables sociodemográficas, antropométricas y anatómico-funcionales del pie en jóvenes futbolistas del Club Deportivo Cañasgordas Latinos. Materiales y métodos: Estudio cuantitativo, observacional y de corte transversal. Se incluyeron 10 futbolistas. Se evaluó ED por medio del Y-Balance Test. Se evaluó el MW por medio del Test de Jack. Para determinar la tipología del pie se utilizó el método HERZCO. Resultados: Se identificaron aspectos susceptibles en el equipo y posibles factores de riesgo de lesión como la prevalencia de pies cavos y la inactivación del mecanismo de Windlass en el 70% de la muestra. Ningún deportista presento riesgo de lesión asociado a asimetrías en el equilibrio dinámico. Conclusiones: Se sugiere complementar la evaluación del ED con factores anatómico-funcionales en futuros estudios para determinar el riesgo de lesión.

Abstract Introduction: Dynamic balance (ED) is at the base of all sports motor activity. Some variables such as the type of foot and the Windlass Mechanism (WM) are associated with this balance and the risk of injury on the lower limb. The recognition of these elements in the population is necessary to identify potential risk factors and promote the respective preventive measures. Objective: To characterize the dynamic balance sociodemographic, anthropometric and some anatomical-functional variables of the foot in young soccer players from the Canasgordas Latinos club. Materials and methods: Quantitative, observational, and cross-sectional study. A total of 10 soccer players were included. The ED was evaluated using the Y-Balance Test. MW was evaluated through the Jack's Test. The HERZCO method was used to determine the type of the foot. Results: Susceptible aspects of the equipment and possible risk factors for injury, such as the prevalence of pes cavus and the inactivation of the Windlass Mechanism in 70% of the sample were identified. Any athlete presented an injury risk associated with asymmetries in dynamic balance. Conclusions: It is suggested to complement the evaluation of ED with anatomical-functional factors in athletes to determine the risk of injury.