Flatfoot in children.

Foot arches are defined by the position of bones and stabilized by active and passive soft tissue structures. The most significant foot arches are longitudinal, medial and lateral. During lifetime they develop and change, while the most significant disorder represents the flatfoot. During the first two years of life, the flatfoot in full weight bearing position is considered a normal physiological condition, while in later age it represents a deformity requiring additional diagnostics and treatment. The flexible flatfoot is caused by ligamentous laxity, it is mostly pain-free and is treated symptomatically (prescription of adequate shoes and kinesitherapy). The rigid foot is most often caused by bone changes (tarsal coalition, vertical congenital talus) occurring idiopathically or within neuromuscular pathological conditions, with mostly present pain problems. In such cases treatment is also initiated by non-surgical methods, however, some type of surgical treatment is most frequently necessary to be used.

Physical treatment of foot deformities in childhood.

During the period of development foot deformities can occur, not only during the growth and development, but also in the later age. The most frequent foot deformity is flatfoot, congenital club foot and hallux valgus. Prior to the decision on surgical treatment of the deformity, whenever possible the patient should be referred for physical therapy that may yield acceptable results in specific treatment phases. The basis of the treatment involves kinesitherapy, application of certain agents (thermotherapy, electrotherapy, ultrasound) and orthosis for maintaining corrections. If such therapy does not yield satisfactory results, the deformity is surgically corrected. After surgical correction, physical procedures can contribute to more rapid recovery and decrease possible complications (pain, edema, complex regional pain syndrome--Mb Sudec), which can follow the surgical correction of the deformity. In addition, the obligatory form of rehabilitation also involves kinesitherapy.

Polyneuropathy in diabetic and nondiabetic patients on CAPD: is there an association with HRQOL?

BACKGROUND: It is well known that patients with uremia, as well as patients with diabetes mellitus, develop polyneuropathy. OBJECTIVES: The signs of polyneuropathy in diabetic and nondiabetic patients on continuous ambulatory peritoneal dialysis (CAPD) and their relation with age, duration of dialysis, biochemical parameters, dialysis adequacy, and health-related quality of life (HRQOL) were analyzed in the present study. PATIENTS AND METHODS: 65 CAPD patients (37 men, age 29-85 years, duration on dialysis 3 months to 14 years) were divided into two groups: group 1 was comprised of 20 diabetic patients (mean age 50.1+/-13.2 years); group 2 was comprised of 45 nondiabetic patients (mean age 62.3+/-9.7 years). Biochemical parameters, dialysis adequacy, and clinical signs were determined. Motor conduction velocity on the peroneal and tibial nerves and sensitive conduction velocity on the sural nerve were measured. The Kidney Disease Quality of Life Short Form (KDQOL-SF) was used to measure the CAPD patients' self-assessment of functioning and well-being using 4 component scores: physical component summary (PCS), mental component summary (MCS), kidney disease target issues, and patient satisfaction. RESULTS: Subjective symptoms were more intense in the diabetic patients and correlated with changes in peroneal and tibial distal motor latency (DML). Diabetic patients were significantly younger, had lower creatinine and higher glucose levels, and all analyzed pathological neurophysiological parameters were higher. Nondiabetic patients had prolonged latency of the F-wave on the peroneal nerve and the tibial nerve and reduced sensitive conduction velocity on the sural nerve. Significant correlations were found between the analyzed neurophysiological parameters and duration of dialysis and diabetes, glucose concentration, and dialysis adequacy in diabetic patients, and between neurophysiological parameters and age and dialysis adequacy in nondiabetic patients. Analysis of the 4 component scores of the KDQOL-SF revealed that diabetic patients had significantly better scores for PCS and MCS, which can be explained by their younger age. Patient satisfaction was worse in diabetic patients and correlated with duration of diabetes. In addition, significant correlations were established between PCS, MCS, and tibial DML (late neuropathic changes) in diabetic patients, and between MCS and tibial F-wave (early neuropathic changes) in nondiabetic patients. CONCLUSION: Polyneuropathy was significantly worse in diabetic than in nondiabetic patients on CAPD. DML on the tibial nerve correlated with glucose concentration, dialysis adequacy, PCS, and MCS in diabetic patients, whereas in nondiabetic patients, dialysis adequacy and azotemia correlated with F-waves on the peroneal nerve and the tibial nerve but MCS only with F-wave on the tibial nerve.