Tratamiento quirúrgico del pie reumático mediante artrodesis de la primera articulación metatarsofalángica y panresección metatarsal

Introducción: La artritis reumatoide resulta una enfermedad autoinmune, inflamatoria, crónica y progresiva, que afecta al aparato locomotor. Puede provocar deformidad, dolor y disminución de la función del pie. Su tratamiento puede ser conservador o quirúrgico. Objetivo: Demostrar la eficacia de la artrodesis de la primera articulación metatarsofalángica con la panresección metatarsal en el tratamiento quirúrgico del pie reumático. Presentación del caso: Se presentaron diez casos de pacientes con factor reumatoideo positivo, intervenidos mediante artrodesis de la primera articulación metatarsofalángica y panresección metatarsal. Se valoró el seguimiento posquirúrgico inmediato y al año de evolución. Tras la intervención se consiguió una media de satisfacción de la escala Likert de 9,3 y una media de la escala visual analógica de dolor de 2,0. Asimismo, disminuyeron considerablemente los ángulos hallux abductus valgus e intermetatarsal I-II. Conclusiones: La combinación de artrodesis de la primera articulación metatarsofalángica con la panresección metatarsal se aplica en este tipo de pacientes, ya que favorece la funcionabilidad del pie y aminora significativamente la sintomatología dolorosa.

Introduction: Rheumatoid arthritis is an autoimmune, inflammatory, chronic and progressive disease that affects the locomotor system. It can cause deformity, pain, and decreased function of the foot. The treatment can be conservative or surgical. Objective: To demonstrate the efficacy of arthrodesis of the first metatarsophalangeal joint with metatarsal panresection in the surgical treatment of the rheumatoid foot. Methods: Ten cases of patients with positive rheumatoid factor who underwent arthrodesis of the first metatarsophalangeal joint and metatarsal panresection were reported. Immediate post-surgical follow-up and one year of evolution were assessed. Results: After the intervention, a mean Likert scale satisfaction of 9.3 was achieved and a visual analogue pain scale mean of 2.0. Likewise, the hallux abductus valgus and intermetatarsal I-II angles decreased considerably. Conclusions: The combination of arthrodesis of the first metatarsophalangeal joint with metatarsal panresection is used in this type of patients, since it favors the functionality of the foot and significantly reduces painful symptoms.

Foot Pain and Disability in Women with Rheumatoid Arthritis, Ehlers-Danlos Syndrome and Systemic Lupus Erythematosus: Relationship with Quality of Life.

The aim of this work was to investigate the relationship foot pain and foot disability have with HRQoL in groups of women with RA, SLE and EDS, in comparison with a control group. A cross-sectional study was carried out with females with one of these conditions and a control group. The SF-12 questionnaire was used to collect data about quality of life. The type of foot was classified according to the footprint and the foot posture index. A total of 156 patients and 47 controls participated in the study (N = 203). Neither pain nor foot posture were different between groups. The physical and mental components of SF-12 were worse in rheumatoid arthritis and Ehlers-Danlos syndrome patients, and the physical component was worse in systemic lupus erythematosus patients, compared to controls. A significant difference was also observed in the mental component between systemic lupus erythematosus and Ehlers-Danlos syndrome patients, the latter having the lowest values among the groups. We can conclude that women with rheumatoid arthritis, Ehlers-Danlos syndrome, systemic lupus erythematosus and foot pain perceive a worse quality of life. There are no significant changes in foot posture. Pain and health-related quality of life are independent of foot posture.

Effect of a Podiatric Health Education Intervention on the Level of Self-care in Patients with Diabetes Mellitus.

OBJECTIVE: To test the effect of a podiatric health education activity on foot self-care and the degree of foot-related disability in a group of people with diabetes mellitus (DM) in the province of Seville. A pretest-posttest quasi-experimental design was used. METHODS: Twenty-nine people with DM participated. The intervention was a podiatric health education activity consisting of a 1-hour informative talk. Foot pain-related disability was measured using the Manchester Foot Pain and Disability Index. The degree of foot self-care was measured with the University of Malaga Foot Self-care questionnaire. RESULTS: One month after the intervention, both parameters had improved significantly. The mean score on the Manchester Foot Pain and Disability Index increased from 59.96 (SD, 8.69) at baseline to 67.39 (SD, 6.99) at 1 month, and the mean score on the University of Malaga Foot Self-care questionnaire improved from 11.65 (SD, 20.07) at baseline to 4.52 (SD, 5.47) after 1 month. CONCLUSIONS: Therapeutic education increases the level of self-care and decreases the degree of foot-related disability in people with DM.

Pilot Study: Effect of Morton's Extension on the Subtalar Joint Forces in Subjects with Excessive Foot Pronation.

This study focuses on the assessment of the mechanical effect produced by Morton's extension as an orthopedic intervention in patients with bilateral foot pronation posture, through a variation in hindfoot and forefoot prone-supinator forces during the stance phase of gait. A quasi-experimental and transversal research was designed comparing three conditions: barefoot (A); wearing footwear with a 3 mm EVA flat insole (B); and wearing a 3 mm EVA flat insole with a 3 mm thick Morton's extension (C), with respect to the force or time relational to the maximum time of supination or pronation of the subtalar joint (STJ) using a Bertec force plate. Morton's extension did not show significant differences in the moment during the gait phase in which the maximum pronation force of the STJ is produced, nor in the magnitude of the force, although it decreased. The maximum force of supination increased significantly and was advanced in time. The use of Morton's extension seems to decrease the maximum force of pronation and increase supination of the subtalar joint. As such, it could be used to improve the biomechanical effects of foot orthoses to control excessive pronation.

Effectiveness of custom-made functional foot orthoses versus flat cushioning insoles on pain in patients with systemic lupus erythematosus.

OBJECTIVE: To determine the effect of foot orthoses on pain, disability and foot functionality in patients with Systemic Lupus Erythematosus. DESIGN: Randomized clinical trial. SETTING: University Podiatric Clinical Area. SUBJECTS: Patients with systemic lupus erythematosus. INTERVENTIONS: Patients were randomly assigned to either group A, which received custom-made functional foot orthoses, or group B, which received flat cushioning insoles, for three months. MAIN MEASURES: The primary outcome was foot pain, measured by 11-point numeric pain rating scale. Foot functionality and foot-related disability were evaluated using the foot function index, the Manchester foot pain and disability, at the beginning and at days 90. RESULTS: Sixty-six participants (age 47.3 ± 11.9 years) suffering from foot pain, received either the custom-made foot orthoses (N = 33) or the flat cushioning insoles (N = 33). For the analysis of the data, only participants who had finished the follow-up period (90 days) were included. None statistically significant difference between groups were found. In group A, all variables showed statistically significant differences when comparing the initial and final measurements. Pain showed 6.8 ± 1.6 and 4.2 ± 2.9 in group A, at baseline and at 90 days, respectively, group B showed 6.5 ± 1.5 and 4.7 ± 3.0 at baseline and at 90 days, respectively. CONCLUSION: Both groups showed a reduction in foot pain. This study suggests that not only controlling the foot function, but providing cushioning to the foot, may have positive effects to manage foot pain in patients with systemic lupus erythematosus.

Morfología y función del pie en pacientes con ciática. Un estudio descriptivo transversal / Morphology and function of the foot in patients with sciatica. A cross-sectional study

Objetivos: El objetivo de este trabajo es comparar las características articulares de los pies de pacientes con ciática, con las de los pies de personas sin esta patología. Pacientes y métodos: Se trata de un estudio descriptivo transversal. Se incluyeron 20 pacientes con ciática y 20 pacientes sin esta patología emparejados por edad y sexo. Se cuantificó el dolor del pie mediante la Numeric Pain Rating Scale 11 y se midió la movilidad de las articulaciones del tobillo, subastragalina, antepié, primer radio y primer dedo. Se clasificó el tipo de pie mediante el Foot Posture Index, y se cuantificó la discapacidad relacionada con el dolor del pie mediante el cuestionario Manchester Foot Pain and Disability Index. Se compararon estas variables entre los dos grupos de participantes (con ciática y sin ciática). Resultados: Se observó un menor rango de movimiento de pronación subastragalina, así como mayor dolor en el pie y mayor discapacidad relacionada con el dolor en el pie, en los participantes con ciática en comparación con los del grupo control. La extensión del hallux también fue significativamente menor en los sujetos con ciática, aunque solo en el pie izquierdo. Además, la fuerza muscular en estos pacientes fue menor que en los que no tenían ciática. Los participantes de ambos grupos presentaron valores de flexión dorsal del tobillo por debajo de la normalidad. Conclusiones: Los participantes con ciática presentaron ciertas diferencias articulares y musculares con respecto al grupo control, aunque no se puede establecer una relación causa-efecto debido al diseño del estudio (AU)

Objectives: The objective of this work is to compare the joint characteristics of the feet of patients with sciatica, with those of people without this pathology. Patients and methods: This is a cross-sectional descriptive study. Twenty patients with sciatica and 20 patients without this pathology were included. Foot pain was quantified using the Numeric Pain Rating Scale 11, and mobility of the ankle, subtalar, forefoot, first ray, and hallux joints were measured. Foot type was classified using the Foot Posture Index, and disability related to foot pain was quantified using the Manchester Foot Pain and Disability Index questionnaire. These variables were compared between the two groups (participants with and without sciatica). Results: Less subtalar pronation range of motion, as well as greater foot pain and greater foot pain-related disability, were observed in participants with sciatica compared with those in the control group. Hallux dorsalflexion was also significantly less in subjects with sciatica, although only in the left foot. Muscle strength in these patients was lower than in those without sciatica. Participants in both groups presented values of ankle dorsiflexion below normal.Conclusions: The participants with sciatica presented certain joint and muscle differences with respect to the control group, although a cause-effect relationship cannot be established due to the study design (AU)

Influence of Health Education on Podiatric Knowledge, Self-care, and Conditions in Adults With Diabetes Mellitus: A Systematic Review.

OBJECTIVE: To determine if health education has an influence on podiatric knowledge, self-care, and conditions in adults with diabetes mellitus. DATA SOURCES: The authors conducted a literature search for Spanish-, English-, and Portuguese-language publications using PubMed, Scopus, Dialnet, and CUIDEN. STUDY SELECTION: Selected keywords related to diabetes, health education, (diabetic) foot, and self-care were searched, and the titles, abstracts, and relevant full-text articles were screened. Thirteen studies were selected with a total of 1,296 participants. Four were randomized controlled trials, and nine were quasi-experimental studies. DATA EXTRACTION: Data pertaining to preventive intervention and study outcomes were extracted. DATA SYNTHESIS: The preventive interventions used varied from traditional educational workshops and one-on-one patient education to new technological strategies. Three different outcomes were evaluated in each study: podiatric knowledge (n = 4), foot self-care (n = 13), and foot problems (n = 2). CONCLUSIONS: Health education interventions increase podiatric self-care in adults with diabetes mellitus. These interventions appear to contribute positively to foot health and podiatric knowledge.

Cutaneous Manifestations of COVID-19 in the Lower Limbs: A Narrative Review.

In 2020, the World Health Organization declared the COVID-19 pandemic. This infectious pathology can be associated with different manifestations in different body systems, among which are dermatological lesions. The purpose of this work is to determine the most frequent dermatological signs, in the lower limbs, produced by SARS-CoV-2. To carry this out, a bibliographic search was performed in the following databases: PubMed, SciELO, ScienceDirect, Cochrane Database of Systematic Reviews, and the Google Scholar literature. The inclusion criteria were articles that included confirmed subjects or those with a clinical suspicion of COVID-19, written in the Spanish or English languages, and the results presented clinical manifestations in the lower extremities. Initially, 128 scientific documents were identified and, after reading the title and abstract, 18 articles were selected. The most frequent skin lesions on the lower limbs are acral lesions such as pernio erythema or ischemic lesions, maculopapular rash, petechiae, and erythematous plaques.

Effect of Foot Orthoses and Shoes in Parkinson's Disease Patients: A PRISMA Systematic Review.

Reduced plantar foot sensation, postural instability, and gait difficulties are characteristic of Parkinson´s disease patients. A systematic review was carried out to determine the effect of the different types of insoles and shoes in these patients. Several databases were used to search for relevant articles reporting Parkinson´s disease patients undergoing treatment with any type of insole and footwear. All titles and abstracts were reviewed independently by two reviewers and the available data were extracted. The study eligibility criteria were any type of experimental study that included Parkinson's disease patients treated with any type of insole or footwear. Eight studies were selected. Interventions used were textured insoles, footwear modifications, and habitual footwear. Three different outcomes were evaluated in each study: gait parameters, balance, and plantar sensation. According to the data available from this systematic review, the most important conclusion is that more controlled studies are needed in this research field. There are indications to suggest that textured insoles have positive effects on gait parameters, balance, and plantar sensation in Parkinson's disease patients.

Relationship of Body Mass Index and Footprint Morphology to the Actual Height of the Medial Longitudinal Arch of the Foot.

The medial longitudinal arch height of the foot is linked to individual characteristics such as sex and body mass index, and these characteristics have been shown to be associated with conditions such as flat feet. In this cross-sectional descriptive study, we examined the medial longitudinal arch morphology in an adult population to determine if there are differences related to sex and body mass index, and values were obtained for the foot posture index. Normalized anthropometric measurements and arch indices were calculated from footprints. Groups, defined by sex and body mass index, were compared, and the correlations between body mass index and the variables were determined. In the population studied (266 women and 177 men), significant differences between men and women for the foot posture index and normalized arch measurements were found. Analysis of the variables related to body mass index indicated there were significant differences in arch indices. Significant differences and positive correlations were also found between the arch index and body mass index for the left and right feet among the men and women studied. The results obtained allow us to reflect on and analyze whether the medial longitudinal arch morphology classification methods used in the clinical and research setting are adequate or whether the influence of factors such as body mass index can generate confusion.

Foot Pain and Morphofunctional Foot Disorders in Patients with Rheumatoid Arthritis: A Multicenter Cross-Sectional Study.

Foot problems are highly prevalent in people with rheumatoid arthritis. This study aims to explore the foot morphology, pain and function in rheumatoid arthritis patients and the relation with the time of disease debut. A cross-sectional study was designed. Footprint, the Foot Posture Index, the hallux valgus prevalence, foot pain and function in 66 rheumatoid arthritis patients and the association with time since diagnosis, were recorded. The Foot Function Index, the Manchester Foot Pain and Disability Index, the Visual Analogic Scale, and the Manchester Scale for hallux valgus were administered and analyzed in two groups, with less and more than 10 years of diagnosis of the disease. A high prevalence of pronated (right 36.8% and left 38.6%) and highly pronated (right 15.8% and left 15.8%) feet was observed, as well as an elevated percentage of low arched footprints (right 68.4 and left 66.7%) and hallux valgus (right 59.6% and left 54.4%). Hallux valgus prevalence, toe deformities and Foot Function Index (Functional limitation) factors were significantly associated with the time since RA diagnosed adjusted for the other factors. The adjusted odds ratio of Hallux valgus prevalence was 4.9 (1.2-19.7). In addition, the foot function was diminished, and foot pain was present in most participants. In conclusion, rheumatoid arthritis patients' feet showed altered morphology and function, and with longer rheumatoid arthritis history, metatarsophalangical stability and foot function, but not pain and global foot posture, were likely to deteriorate.

Study of the Distortion of the Indirect Angular Measurements of the Calcaneus Due to Perspective: In Vitro Testing.

The study of the foot is relevant in kinematic analyses of gait. Images captured through a lens can be subjected to various aberrations or distortions that affect the measurements. An in vitro study was performed with a rearfoot simulator to compare the apparent degrees (photographed) with the real ones (placed in the simulator) in the plane of the rearfoot's orientation, according to variations in the capture angle in other planes of space (the sagittal plane and transverse plane-the latter determined by the foot progression angle). The following regression formula was calculated to correct the distortion of the image: real frontal plane = 0.045 + (1.014 × apparent frontal plane) - (0.018 × sagittal plane × foot progression angle). Considering the results of this study, and already knowing its angle in the transverse and sagittal planes, it is possible to determine the angle of a simulated calcaneus with respect to the ground in the frontal plane, in spite of distortions caused by perspective and the lack of perpendicularity, by applying the above regression formula. The results show that the angular measurements of a body segment made on frames can produce erroneous data due to the variation in the perspective from which the image is taken. This distortion must be considered when determining the real values of the measurements.

Effectiveness of custom-made foot orthoses in patients with systemic lupus erythaematosus: protocol for a randomised controlled trial.

INTRODUCTION: Systemic lupus erythaematosus (SLE) is a chronic autoimmune disease of heterogeneous involvement. The disease may affect feet with a high prevalence of symptoms such as, for example, pain, forefoot and rearfoot deformities, and biomechanics dysfunctions. Custom-made foot orthoses (CMFO) have been previously reported to be effective in patients with other rheumatic diseases. However, as far as the authors know, there exist no studies about their effectiveness in SLE. This study aims at determining the effect of CMFO versus placebo flat cushioning insoles on pain, foot functionality, fatigue and quality of life in patients with SLE. METHODS AND ANALYSIS: A randomised controlled trial would compare the effects of (1) CMFO and group B, which received a placebo, flat cushioning insoles, for 3 months. The main outcome measures are foot pain, foot functionality and foot-related disability. The secondary outcome measures are fatigue and quality of life. ETHICS AND DISSEMINATION: The study has been approved by the Portal de Ética de la Investigación Biomédica de Andalucía ethical committee 1494-N-19. The results will be disseminated regardless of the magnitude or direction of effect. TRIAL REGISTARTION NUMBER: Clinicaltrials.gov identifier NCT04098055.

Validity of clinical methods in the detection of leg-length discrepancies.

INTRODUCTION: Lower limb-length discrepancy is highly prevalent in the general population. Numerous methods and measurement instruments for its diagnosis appear in the literature, but there has not been an agreement about their validity. The aim of this work is to determine the validity of the Weber-Barstow manoeuvre (WB) of the pelvic measuring device (PMD) and the block method (BM), in comparison with standing anteroposterior telemetry of the lower limbs in subjects with leg-length discrepancy (LLD). METHODS: 71 subjects took part in the study. First, the WB was carried out in the supine position. the LLD was then quantified standing with the PMD and with the BM. Lastly, standing anteroposterior telemetry of the lower limbs was obtained. This was measured with Autocad 2013, using the highest part of the head of the femur and the most distal edge of the bisection of the femur as points of reference. RESULTS: The Kappa index was calculated to check the agreement between the WB manoeuvre and the telemetry. This was 0.52. The relation of the PMD, BM and telemetry difference variables was calculated. A direct relation between the BM and telemetry was shown, with p > 0.05 (0.48 cm and 0.51 cm, respectively). CONCLUSIONS: The WB manoeuvre got acceptable validity results. The PMD was not valid according to the results obtained in this work. The BM achieved a good validity result for the diagnosis of LLD.

Analysis and Assessment through Mechanical Static Compression Tests of Damping Capacity in a Series of Orthosis Plantar Materials Used as Supports.

High plantar pressure is the cause of multiple types of foot injuries and one of the main reasons for patient visits in podiatry and traumatology. Therefore, there is a need to acquire specific tools to address such injuries. The aim of this study was to determine the absorption capacity of selected materials applied as plantar supports and their response to pressure. The study had a cross-sectional design. A total of 21 materials were chosen and different material families were assessed, including ethylene-vinyl acetate, polyurethane foams, and polyethylene foams. Static compression tests were performed to analyze each material. The system is ideally suited for lower-force applications, small components, biomedical applications, and lower-strength materials. Damping was determined using mathematical calculations performed on the study data. It was found that materials with a low Shore A, or soft materials, exhibited worse absorption capacity than harder materials. Ethyl-vinyl acetates had good absorption capacity, polyurethane foams had a poor absorption capacity, and soft materials provided better adaption to impact. The results suggested that damping is not determined by the hardness of the material, and materials within the same family exhibit different damping capabilities.

Polyethylene Nail Brace for Ingrown Toenails Treatment: A Randomized Clinical Trial.

Background: Onychocryptosis is one of the most prevailing onychopathies and one of the usual reasons for visiting podiatry clinics. In this research, we aim to evaluate the effectiveness of a procedure of nail reeducation technique via a strip of polyethylene in subjects with stage I or IIa onychocryptosis, in which pathological toenail curves are present. Methods: This research was a randomized clinical trial (ACTRN12615000834550). The sample was made up of 94 cases of stage I or IIa onychocryptosis, according to the Mozena classification. Briefly, 46 cases were treated with the combination of a spicule technique and nail brace with a polyethylene plastic strip, and 48 were only treated with the spicule technique. Results: The combination of the spicule technique and the nail brace technique with a strip of polyethylene had a significantly lower recurrence rate compared to that achieved with just the spicule technique, twelve months after the beginning of the study (N.S. = 0.000 for α = 0.05). The change in the nail width achieved with the nail brace technique, twelve months after the beginning of the study, was statistically significant (N.S. = 0.000 for α = 0.05). Conclusions: The recurrence rate of the spicule technique alone was significantly higher than the combined technique of spicule with nail brace. A nail brace with a strip of polyethylene reduces the recurrence rate of onychocryptosis.

Psychosocial Influence of Ehlers-Danlos Syndrome in Daily Life of Patients: A Qualitative Study.

(1) Background: Ehlers-Danlos syndrome is a heterogeneous group of connective tissue disorders causing pain, fatigue, and disabilities; it has several implications for patients who suffer from this disease. The major clinical manifestations of EDS include joint hypermobility, skin hyperextensibility, and generalized connective tissue fragility. This research aims to explore their perceptions and experiences about the phycological and social spheres. (2) Methods: Semistructured interviews were carried out. Participants were encouraged to talk about issues related to their disease by asking open-ended questions in one to one interview. The interview guide included questions to identify the syndrome's influence on the social and psychological life of patients All interviews were audio recorded, fully transcribed, and analyzed using the phenomenological theoretical framework. The method of analysis was the thematic interpreting of perspectives and approaches. (3) Results: 31 individuals were proposed to participate in this study. Five patients refused to participate, so a total of 26 interviews were performed. Six themes ((1) Pain and its consequences on a daily basis; (2) The need to name the problem: the diagnosis; (3) Restructuring leisure and social relationships; (4) Limitations due to economic conditions; (5) Psychological impact of the disease situation; (6) Professional limitations) and four subthemes ((1) The value of partner support; (2) The weather influence on social plans; (3) Physical exercise and illness; (4) Support groups) emerged from the data. (4) Conclusions: This study revealed the impact of the syndrome on the social and daily life of patients, and not only in a physical level, but also in a psychological and social approach. These findings allow healthcare providers to know more about this disease in order to support and give advice to patients about the changes they will have to make.

Methicillin-Resistant Staphylococcus aureus Diabetic Foot Crossed Infection: A Case Report.

This work presents a protocol to prevent the transmission of multidrug-resistant infections. We focus on the Diabetic Foot Unit Podiatry Clinic Area attached to the University of Seville in particular. The most common complication for patients with diabetes is leg ulcers. Together with neuropathy, vasculopathy, and immunological response disorder, these individuals have a high predisposition to developing infections. Staphylococcus aureus is a highly prevalent microorganism in humans which, at times, may act as a pathogen. Due mainly to indiscriminate abuse of antibiotics, the methicillin-resistant strain known by its initials as MRSA is the most extended nosocomial infection globally and is a severe community and hospital healthcare problem. This paper describes compliance with new general recommendations on cleaning, hygiene, and decontamination, in addition to implementation of this specific protocol, after detection of cross infection (healthcare-related infection) in the studied unit in two patients with MRSA-infected ulcers. After an in-depth bibliographical review, strict hand hygiene measures and use of non-sterile gloves were used when treating all patients with a diabetic foot. Finally, we reflect on the need to educate healthcare personnel to guarantee correct prescription of selected antibiotics. The role of the podiatrist in the multidisciplinary team is highlighted not only in terms of management and treatment of lesions in diabetic patients, but also as a healthcare agent for the detection and prevention of MRSA together with other multidrug-resistant infections.

Cross-cultural adaptation, translation, and validation of the Spanish Foot and Ankle Outcome Score questionnaire.

The Spanish Foot and Ankle Outcome Score questionnaire (FAOS-S) may be considered a health evaluation tool with 42 questions for assessing foot health disorders. To date, FAOS has been validated in different languages, but a Spanish version was lacking. Consequently, the purpose of this study was to translate and validate the Spanish version of the FAOS (FAOS es). A suitable method was developed for the translation protocol and cross-cultural validation from Swedish to Spanish. Regarding the total marks from each domain, agreement degrees and confidence were analysed using the Cronbach's α and intraclass correlation coefficient, respectively. In addition, the mean ± SD differences between pretest and posttests were calculated and completed using of the Bland and Altman distribution plots. Excellent agreement between the two versions based on Cronbach's α was demonstrated. Five domains consisting of pain, symptoms of foot disorders, activities of daily living, sports and recreation, and foot and ankle quality of life were added together to obtain the total score. Excellent retest reliability was shown for the total score. Test/retest reliability was excellent for the pain, stiffness, other foot disorder-related symptoms, and quality of life domains. There were no significant differences among any domain (P > .05). There were no statistically significant differences (P = .000) for the mean ± SD differences between pretest and posttests (56.2524 ± 19.064 [51.98-60.52] and 57.45 ± 21.02 [52.74-62.16] points, respectively). Bland and Altman plots or clinically pertinent variations were not statistically significantly different. The FAOS is considered a strong and valid questionnaire with adequate repeatability in the Spanish community.

Custom-Made Foot Orthoses Reduce Pain and Fatigue in Patients with Ehlers-Danlos Syndrome. A Pilot Study.

BACKGROUND: Pain and fatigue are major clinical manifestations in patients with Ehlers-Danlos Syndrome (EDS). The aim of this study is to measure change of the effects of custom-made foot orthotics on some manifestations related to EDS, such as foot pain, foot functionality, fatigue, and quality of life. METHODS: Thirty-six patients with EDS wore foot orthoses for three months. Foot pain, foot-related disability, foot functionality, fatigue, and quality of life were measured using the 11-point Numeric Rating Scale, the Manchester Foot Pain and Disability Index, the Foot Function Index, the Fatigue Severity Score, and the 12-Item Short Form Health Survey questionnaires, respectively, at the beginning and after 3 months. RESULTS: Participants demonstrated significantly improved foot pain (p = 0.002), disability related to foot pain (p < 0.001), foot functionality (p = 0.001), fatigue (p < 0.007), and mental health-related quality of life (p = 0.016). The physical health-related quality of life did not show significant changes. CONCLUSIONS: The use of custom-made foot orthoses help in the management of the symptoms by participants. This study could contribute to the foot specialists being considered as an additional member in multidisciplinary teams that are trying to develop an approach for patients with EDS.