Frontal Plane Correction of Hallux Valgus Deformity With a Minimally Invasive Third Generation Tecnique: Short-Term Radiographic Outcomes of a Prospective Case Series.

A number of minimally invasive osteotomies have been described for the repair of hallux abducto valgus (HAV) deformities. However, there are no known published studies that evaluate the effects of minimally invasive surgery techniques on the reduction of frontal plane rotation in patients with HAV. The purpose of this study was to assess correction in the transverse and frontal planes in patients undergoing surgical repair of HAV deformity utilizing a modified percutaneous technique. One hundred and five feet in 105 patients with HAV deformity were treated with a third generation minimally invasive technique using a first metatarsal osteotomy that allowed for frontal plane correction in conjunction with an Akin osteotomy. The minimum follow-up time was 12 months. Preoperative and postoperative anteroposterior weightbearing x-ray images were assessed and four measurements were evaluated: hallux abductus angle (HAA), intermetatarsal angle (IMA), tibial sesamoid position and frontal plane rotation of the first metatarsal. There were statistically significant differences for each of the assessments between the preoperative and postoperative radiographs (p < .001). There was a mean reduction in the HAA of 23.5° ± 9.6°, in the IMA, 7.0° ± 3.5°, in the tibial sesamoid position, 2.6 ± 1.3, and an improvement in the assessment of first metatarsal pronation (1.4 ± 0.9). The overall complication rate was 18.1%, with 5.7% of the feet requiring reoperation. The minimally invasive procedure employed by the authors demonstrated suitable outcomes in reducing deformity in both the transverse and frontal planes.

Evaluating multiproduct chromatography Protein A resin reuse for monoclonal antibodies in biopharmaceutical manufacturing.

In good manufacturing practice (GMP) facilities in the biopharmaceutical industry, chromatography resins are largely underutilized during purification of single drug products during clinical production. Chromatography resins are dedicated to a specific product and disposed of, after only a fraction of their lifetime due to concerns of potential product carryover from one program to another. In this study, we follow a resin lifetime methodology typically used for commercial submissions and apply it to determine the feasibility of purifying different products on a Protein A MabSelect PrismA™ resin. Three distinct monoclonal antibodies were used as model molecules. Column performance was monitored through chromatogram profiles, yield, clearance capability of selected media components, pressure and product quality. A protein carryover study was designed to demonstrate that the column cleaning procedures reduced protein carryover to safe cleanliness levels regardless of multiple product contact cycles and the order in which the mAbs are captured. Data show that up to 90 total cycles (30 cycles per antibody), there was negligible protein carryover and impact on process performance. Product quality was consistent, with the only meaningful trends found for the leached Protein A ligand, without affecting the conclusion of the study. While the study was restricted to three antibodies, the proof of concept for resin reuse was demonstrated.

From forced Working-From-Home to voluntary working-from-anywhere: Two revolutions in telework.

The COVID-19 outbreak has admittedly caused interruptions to production, transportation, and mobility, therefore, having a significant impact on the global supply and demand chain's well-functioning. But what happened to companies developing digital services, such as software? How has the enforced Working-From-Home (WFH) mode impacted their ability to deliver software, if at all? This article shares our findings from monitoring the WFH during 2020 in an international software company with engineers located in Sweden, the USA, and the UK. We analyzed different aspects of productivity, such as developer job satisfaction and well-being, activity, communication and collaboration, efficiency and flow based on the archives of commit data, calendar invites, Slack communication, the internal reports of WFH experiences, and 30 interviews carried out in April/May and September 2020. We add more objective evidence to the existing COVID-19 studies the vast majority of which are based on self-reported productivity from the early months of the pandemic. We find that engineers continue committing code and carrying out their daily duties, as their routines adjust to "the new norm". Our key message is that software engineers can work from home and quickly adjust their tactical approaches to the changes of unprecedented scale. Further, WFH has its benefits, including better work-life balance, improved flow, and improved quality of distributed meetings and events. Yet, WFH is not challenge free: not everybody feels equally productive working from home, work hours for many increased, while physical activity, socialization, pairing and opportunities to connect to unfamiliar colleagues decreased. Information sharing and meeting patterns also changed. Finally, experiences gained during the pandemic will have a lasting impact on the future of the workplace. The results of an internal company-wide survey suggest that only 9% of engineers will return to work in the office full time. Our article concludes with the InterSoft's strategy for work from anywhere (WFX), and a list of useful adjustments for a better WFH.

Work-from-home is here to stay: Call for flexibility in post-pandemic work policies.

In early 2020, the Covid-19 pandemic forced employees in tech companies worldwide to abruptly transition from working in offices to working from their homes. During two years of predominantly working from home, employees and managers alike formed expectations about what post-pandemic working life should look like. Many companies are experimenting with new work policies that balance employee- and manager expectations regarding where, when and how work should be done in the future. In this article, we gather experiences of the new trend of remote working based on the synthesis of 22 company-internal surveys of employee preferences for WFH, and 26 post-pandemic work policies from 17 companies and their sites, covering 12 countries in total. Our results are threefold. First, through the new work policies, all companies formally give employees more flexibility regarding working time and location. Second, there is a great variation in how much flexibility the companies are willing to yield to the employees. The paper details the different formulations that companies adopted to document the extent of permitted WFH, exceptions, relocation permits and the authorisation procedures. Third, we document a change in the psychological contract between employees and managers, where the option of working from home is converted from an exclusive perk that managers could choose to give to the few, to a core privilege that all employees feel they are entitled to. Finally, there are indications that as the companies learn and solicit feedback regarding the efficiency of the chosen strategies, we will see further developments and changes in the work policies concerning how much flexibility to work whenever and from wherever they grant. Through these findings, the paper contributes to a growing literature about the new trends emerging from the pandemic in tech companies and spells out practical implications onwards.

Tratamiento de pseudoartrosis postquirúrgica en la base del segundo metatarsiano mediante autoinjerto de calcáneo: caso clínico / Treatment of postsurgical pseudoarthrosis in the base of the second metatarsal with calcaneus autograft: a case report

Los procesos de no-unión postquirúrgicos en pie y tobillo no son infrecuentes debido a la gran cantidad de procedimientos quirúrgicos mediante osteotomías o artrodesis que se realizan anualmente. Ocasionalmente, estos procedimientos no tienen una estabilización óptima del foco de fractura y pueden acabar degenerando en un proceso de no-unión. Presentamos el caso de una paciente a la que se le realizaron osteotomías en la base de los metatarsianos menores por cirugía mínimamente invasiva para el tratamiento de metatarsalgia, que derivó en el desarrollo de pseudoartrosis dolorosa en la base del segundo metatarsiano y de no-unión en el 4.º metatarsiano. Se realizó tratamiento quirúrgico consistente en la utilización de autoinjerto corticoesponjoso de calcáneo y estabilización con placa de bloqueo dorsal para 2.º metatarsiano y estabilización con placa dorsal de bloqueo para el 4.º metatarsiano. La radiología mostró integración del injerto a las 8 semanas y los resultados clínicos fueron muy satisfactorios tras 5 años de seguimiento. El autoinjerto de calcáneo con estabilización rígida por medio de placa de bloqueo dorsal puede ser un tratamiento efectivo para el tratamiento de la no unión y pseudoartrosis en la base de los metatarsianos.(AU)

Postsurgical nonunions of the foot and ankle are not uncommon because of the large number of procedures by means of osteotomies and arthrodesis that are performed annually. We present a clinical case of a patient who developed a painful nonunion in the base of the second metatarsal after a minimally invasive surgical procedure for metatarsalgia within a base osteotomy that developed a painful pseudoartrhosis of the 2nd metatarsal and also a nonunion of the 4th metatarsal. The patient was treated with the use of an autograft of corticocancellous bone from ipsilateral calcaneus that was fixated with a dorsal locking plate for the 3rd metatarsal and also with stabilization by means of a dorsal locking plate of the 4th metatarsal. Radiology showed good integration of the graft at 8 weeks and clinical results were excellent after 5 years of followup. Autograft from calcaneus fixed with a locking dorsal plate can be an effective treatment of nonunions in the base of the metatarsals.(AU)

Use of the Snoring, Trouble Breathing, Un-Refreshed questionnaire to predict perioperative respiratory adverse events in children.

STUDY OBJECTIVES: The Snoring, Trouble Breathing, Un-Refreshed (STBUR) screening questionnaire has been validated in identifying pediatric surgical patients with symptoms of sleep-disordered breathing who may be at risk of perioperative respiratory adverse events. We sought to assess the performance of the STBUR questionnaire when adjusting for potential confounders such as patient comorbidities or surgical service. METHODS: This was a retrospective cohort study of children aged 2-18 years undergoing elective procedures under general anesthesia over a 3-month period. Procedure specialties included general surgery, urology, orthopedic surgery, neurosurgery, plastic surgery, otolaryngology, dentistry, and gastroenterology. Preoperative STBUR questionnaire responses and perioperative respiratory adverse events were documented prospectively. Multivariate logistic regression was used to quantify associations between preoperative questionnaire responses, other potential risk factors (including age, sex, surgical specialty, comorbidities), and risk of perioperative respiratory adverse events. RESULTS: Of 555 children, 17% had a positive STBUR screen. The prevalence of perioperative respiratory adverse events with a positive questionnaire screen was significantly greater than with a negative screen (29% vs 9%, respectively; P < .001). A positive questionnaire screen was associated with a significantly increased risk of a perioperative respiratory adverse event (adjusted odds ratio 3.47 [95% confidence interval 1.53-7.84], P = .003). CONCLUSIONS: A positive screen on the STBUR questionnaire was associated with a 3.5-fold increased risk of perioperative respiratory adverse events in pediatric surgical patients. The STBUR questionnaire should be considered as a routine preoperative screening tool in children undergoing elective procedures. CITATION: Huerta J, Taleu H, Norton R, Gries H, Yun P, Lam D. Use of the Snoring, Trouble Breathing, Un-Refreshed questionnaire to predict perioperative respiratory adverse events in children. J Clin Sleep Med. 2022;18(3):695-701.

Variability of the Dynamic Stiffness of Foot Joints: Effect of Gait Speed.

BACKGROUND: Comparison of dynamic stiffness of foot joints was previously proposed to investigate pathologic situations with changes in the properties of muscle and passive structures. Samples must be controlled to reduce the variability within groups being compared, which may arise from different sources, such as gait speed or Foot Posture Index (FPI). METHODS: Variability in the measurement of the dynamic stiffness of ankle, midtarsal, and metatarsophalangeal joints was studied in a controlled sample of healthy men with normal FPI, and the effect of gait speed was analyzed. In experiment 1, dynamic stiffnesses were obtained in three sessions, five trials per session, for each participant, taking the mean value across trials as representative of each session. In experiment 2, five trials were considered at slow, comfortable, and fast velocities. RESULTS: Similar intersession and intrasession errors and intraparticipant errors within sessions were found, indicating the goodness of using five trials per session for averaging. The intraparticipant and interparticipant variability data provided can be used to select the sample size in future comparative analyses. Significant differences with gait speed were observed in most dynamic stiffnesses considered, with a general rise when gait speed increased, especially at the midtarsal joint, this being attributed to an active modulation produced by the central nervous system. CONCLUSIONS: Differences with gait speed were higher than intrasession and intersession repeatability errors for the propulsion phases at the ankle and midtarsal joints; comparative analyses at these phases need more exhaustive control of gait speed to reduce the required sample size.

Dynamic Flexion Stiffness of Foot Joints During Walking.

BACKGROUND: Dynamic stiffness can be used for studying foot pathologic abnormalities and for developing prostheses and orthoses. Although previous works have studied the role of ankle joint stiffness during gait, other foot joints have not yet been analyzed. We sought to characterize the dynamic stiffness of the ankle, midtarsal, and metatarsophalangeal joints during normal walking. METHODS: Kinematics and contact data from four healthy individuals during walking were registered with a three-dimensional motion analysis system and a pressure platform. Stance phases with flexion moment-angle linear relationships were identified, and dynamic stiffnesses were calculated from the slope of their linear regressions. Intraparticipant repeatability was analyzed using analyses of variance, and interparticipant variability was checked through the SD of averaged participant stiffnesses. RESULTS: Flexion moment-angle linear relationships were identified (R(2) > 0.98) during the early and late midstance phases and the propulsion phase at the ankle (2.76, 5.23, and 3.42 N·m/kg/rad, respectively) and midtarsal (15.88, 3.90, and 4.64 N·m/kg/rad, respectively) joints. At the metatarsophalangeal joint, a linear relationship (R(2) > 0.96) occurred only during the propulsion phase (0.11 N·m/kg/rad). High dynamic stiffness variability was observed during the late and early midstance phases at the ankle and midtarsal joints, respectively. CONCLUSIONS: These results may serve as a basis for future studies aimed at investigating the role of dynamic stiffness identified herein in different foot disorders. The importance of properly controlling the samples in such studies is highlighted. Study of the dynamic stiffnesses identified might be used in the design of prostheses, orthoses, and other assistive devices.

The effect of the gastrocnemius on the plantar fascia.

Although anatomic and functional relationship has been established between the gastrocnemius muscle, via the Achilles tendon, and the plantar fascia, the exact role of gastrocnemius tightness in foot and plantar fascia problems is not completely understood. This article summarizes past and current literature linking these 2 structures and gives a mechanical explanation based on functional models of the relationship between gastrocnemius tightness and plantar fascia. The effect of gastrocnemius tightness on the sagittal behavior of the foot is also discussed.

A proposed subungual exostosis clinical classification and treatment plan.

Subungual exostosis is a slow-growing, benign outgrowth of normal bone under the nail that affects the nail unit. The most common location in the foot is the dorsal surface of the distal phalanx of the big toe. Clinically, it can appear in combination with a variety of nail disorders, masking the underlying bone condition, which is frequently unrecognized or misdiagnosed. A new classification system for these lesions is proposed on the basis of the clinical signs and symptoms present during examination and the associated disorders of the nail plate. Also, a therapeutic algorithm that describes surgical approaches to the different presentations of this disorder is presented.

Effect of 7-degree rearfoot varus and valgus wedging on rearfoot kinematics and kinetics during the stance phase of walking.

BACKGROUND: The scientific evidence behind the mechanical function of foot orthoses is still controversial. Research studies that have investigated the kinematic effect of foot orthoses on the lower extremity have shown variable results, with orthoses causing either no significant change or a small significant change in foot kinematics. METHODS: The right limbs of 12 healthy asymptomatic individuals were studied in three walking conditions: barefoot, with a 7 degrees rearfoot varus wedge, and with a 7 degrees rearfoot valgus wedge. Kinematic and kinetic variables measured were the foot progression angle, the peak internal tibial rotation angle, and net ankle inversion moments during the stance phase in the three conditions. RESULTS: There were statistically significant differences in the foot progression angle between the barefoot and varus wedge conditions and between the varus and valgus wedge conditions. There were no significant changes in peak internal tibial rotation among the three conditions tested. However, rearfoot varus wedges significantly reduced net ankle inversion moments compared with barefoot and rearfoot valgus wedges. CONCLUSIONS: These results support the idea that foot orthoses work by methods other than by changing kinematic parameters. The present study supports the concept that foot orthoses work primarily by altering kinetics, with their effects on kinematics being secondary.

Plantar epidermoid inclusion cyst as a possible cause of intractable plantar keratosis lesions.

Inclusion cysts are benign lesions that appear as a consequence of traumatic inclusion of epidermal cells into the dermis. They can be painful if they appear under pressure areas, especially the metatarsal heads. We report a case of a 36-year-old woman with an intractable plantar keratosis lesion under the third metatarsal head of 3 years' duration. Ultrasonography revealed the presence of a subcutaneous mass with a growing epidermoid. It was surgically excised, and pathology confirmed the diagnosis of a plantar epidermoid cyst. All symptoms disappeared after the excision of the lesion. This case should alert the clinician about the existence of keratotic lesions in the metatarsal heads commonly diagnosed and treated as intractable plantar keratosis, although they are not directly derived from metatarsal overload. Some of the lesions could be directly derived from skin problems aggravated by pressure from the metatarsal head. This should be taken into consideration when addressing the management of these lesions.

Static response of maximally pronated and nonmaximally pronated feet to frontal plane wedging of foot orthoses.

BACKGROUND: Research on foot orthoses has shown that their effect on the kinematics of the rearfoot is variable, with no consistent patterns of changes being demonstrated. It has also been hypothesized that the mechanical effect of foot orthoses could be subject specific. The purpose of our study was to determine if maximally pronated feet have a different response to frontal plane wedging of foot orthoses than do nonmaximally pronated feet during static stance. METHODS: One hundred six feet of 53 healthy asymptomatic subjects were divided into two groups (maximally pronated and nonmaximally pronated) on the basis of their subtalar joint rotational position during relaxed bipedal stance. Functional foot orthoses were constructed for each subject and the relaxed calcaneal stance position was measured while standing on five separate frontal plane orthosis wedging conditions, 10 degrees valgus, 5 degrees valgus, no wedging, 5 degrees varus, and 10 degrees varus, to assess changes in calcaneal position. RESULTS: Relative to the no-wedging condition, there were statistically significant differences (P < .05) in calcaneal position between the maximally pronated and the nonmaximally pronated feet with the 10 degrees valgus and the 10 degrees varus wedging conditions. No significant differences in calcaneal position were found with the 5 degrees varus and the 5 degrees valgus wedging conditions. CONCLUSIONS: Our study shows that the response to foot orthoses is variable between individuals. Maximally pronated subjects do not exhibit the same response to frontal plane wedging of foot orthoses as do nonmaximally pronated with 10 degrees wedging. Intrinsic biomechanical factors such as subtalar joint position may influence the response to foot orthoses.

Relationship of body mass index, ankle dorsiflexion, and foot pronation on plantar fascia thickness in healthy, asymptomatic subjects.

BACKGROUND: We sought to investigate the thickness of plantar fascia, measured by means of ultrasonographic evaluation in healthy, asymptomatic subjects, and its relationship to body mass index, ankle joint dorsiflexion range of motion, and foot pronation in static stance. METHODS: One hundred two feet of 51 healthy volunteers were examined. Sonographic evaluation with a 10-MHz linear array transducer was performed 1 and 2 cm distal to its insertion. Physical examination was also performed to assess body mass index, ankle joint dorsiflexion, and degree of foot pronation in static stance. Both examinations were performed in a blinded manner. RESULTS: Body mass index showed moderate correlation with plantar fascia thickness at the 1- and 2-cm locations. Ankle dorsiflexion range of motion showed no correlation at either location. Foot pronation showed an inverse correlation with plantar fascia thickness at the 2-cm location and no correlation at the 1-cm location. CONCLUSION: Body mass index and foot supination at the subtalar joint are related to increased thickness at the plantar fascia in healthy, asymptomatic subjects. Although the changes in thickness were small compared with those in patients with symptomatic plantar fasciitis, they could play a role in the mechanical properties of plantar fascia and in the development of plantar fasciitis.

Analysis of gastrocnemius recession and medial column procedures as adjuncts in arthroereisis for the correction of pediatric pes planovalgus: a radiographic retrospective study.

UNLABELLED: The radiographic outcomes of 28 feet in 20 pediatric patients with pes planovalgus treated with subtalar arthroereisis, arthroereisis combined with gastrocnemius recession, or arthroereisis combined with gastrocnemius recession and medial column reconstruction were retrospectively analyzed. Preoperative and postoperative radiographic angles for talar declination, calcaneal inclination, and first metatarsal declination in the lateral view, and the angle formed between the longitudinal axis of the talus and the longitudinal axis of the lesser tarsus in the anteroposterior view were compared. Overall, analyses revealed statistically significant differences in the preoperative and postoperative radiographic angles for the 4 measured angles. Analysis by treatment group revealed statistically significant differences in correction of the angle measured in the anteroposterior view. Arthroereisis with gastrocnemius recession showed the greatest correction of this angle (median 19 degrees, range 11 degrees to 34 degrees) compared with the other treatment groups. There were no statistically significant differences in the degree of correction of the calcaneal inclination or talar declination angles, whereas a statistically significant difference in the correction of first metatarsal declination was observed. The greatest degree of angular change was achieved with medial column reconstruction (median 7 degrees, range 0 degrees to 9 degrees). Gastrocnemius recession displayed a notable effect on the correction of transverse plane deformity when used as an adjunct to arthroereisis. However, medial column reconstruction has a negative impact on the degree of correction in the transverse plane when it is used as an adjunct to arthroereisis and gastrocnemius recession. LEVEL OF CLINICAL EVIDENCE: 4.

Cadence, age, and weight as determinants of forefoot plantar pressures using the Biofoot in-shoe system.

BACKGROUND: We evaluated normal plantar pressures and studied the effect of weight, cadence, and age on forefoot plantar pressures in healthy subjects by using the Biofoot (Instituto de Biomecánica de Valencia, Valencia, Spain) in-shoe measurement system. METHODS: The feet of 45 healthy subjects with no evident foot or lower-limb diseases were measured with the Biofoot in-shoe system. The forefoot was divided into seven areas: the first through fifth metatarsal heads, the hallux, and the second through fifth lesser toes. Three trials of 8 sec each were recorded twice in each subject, and the mean was used to analyze peak and mean plantar pressures. A multiple regression model including weight, age, and cadence was run for each metatarsal head, the hallux, and the lesser toes. Intraclass correlation coefficients and coefficients of variation were also calculated to assess reliability. RESULTS: The second metatarsal head had the greatest peak (960 kPa) and mean (585.1 kPa) pressures, followed by the third metatarsal head. Weight and cadence combined explained 18% and 23% of peak plantar pressure at the second and third metatarsal heads, respectively (P < .001). The intraclass correlation coefficient varied from 0.76 to 0.96 for all variables. The coefficient of variation between sessions ranged from 5.8% to 9.0%. CONCLUSION: The highest peak and mean plantar pressures were found at the second and third metatarsal heads in healthy subjects. Weight, cadence, and age explained a low variability of this pressure pattern. The Biofoot in-shoe system has good reliability to measure plantar pressures. These data will have implications for the understanding of normal foot biomechanics and its determinants.

Effect of gender, age and anthropometric variables on plantar fascia thickness at different locations in asymptomatic subjects.

PURPOSE: The study was aimed to investigate plantar fascia thickness at different locations in healthy asymptomatic subjects and its relationship to the following variables: weight, height, sex and age. MATERIAL AND METHODS: The study evaluates 96 feet of healthy asymptomatic volunteers. The plantar fascia thickness was measured at four different locations: 1cm proximal to the insertion of the plantar fascia, at the insertion of the plantar fascia on the calcaneus and separate out 1 cm + 2 cm distal to the insertion. A 10 MHz linear-array transducer was used. RESULTS: There were statistically significant differences in plantar fascia thickness at the four different locations (p<0.001) although no differences in PF thickness were found between the two distal from insertion locations (1 and 2 cm). Multiple regression analysis showed sex as independent predictor of plantar fascia thickness at 1cm proximal to the insertion. At origin and 1cm distal to insertion weight was an independent predictor of plantar fascia thickness. CONCLUSIONS: There are differences of thickness at different locations of plantar fascia measured by ultrasonography. Thickness at 1cm proximal to the insertion is influenced by sex and thickness at origin and at 1cm distal to the insertion has a direct relationship with body weight. This could be attributed to the overloading effect that weight has on plantar fascia in healthy symptomatic subjects at these two locations. Height and age did not seem to influence as independent variables in plantar fascia thickness among non-painful subjects.