Plantar pressure distribution analysis in normal weight young women and men with normal and claw feet: a cross-sectional study.

We analyzed the plantar support in 72 normal-weight young voluntaries (46 women, 26 men), by a baropodometric platform. We considered subjects with claw foot (CFS) and subjects with normal foot (NFS). We found a significant reduction of total plantar support surface in the CFS (P < 0.0001 for women, P < 0.001 for men), due to the reduction of the forefoot and rear foot areas of both plantar imprints. Indeed, CFS of both sexes exhibited higher values of both plantar pressure and peak pressure, compared to the NFS. Moreover, the load per units of plantar surface increased in CFS compared to the NFS. In conclusion, the reduction of plantar support surfaces in CFS of both sexes was associated to a major load per units of plantar surface in the forefoot and rear foot areas, and this may be a risk factor to lower extremity overuse injuries.

Comparison of ground reaction forces between obese and control young adults during quiet standing on a baropodometric platform.

OBJECTIVE: To determine whether centre of pressure location, plantar surface areas, or plantar pressures differ between obese and control young adults during quiet standing.Design. Cross-sectional study in university setting. BACKGROUND: Given the characteristic distribution of body fat in obesity, it is possible that obesity may systematically alter centre of pressure location, plantar ground contact areas and pressure distributions in males and females. METHODS: Thirty-eight obese subjects (23 women and 15 men) and 34 healthy controls (18 women and 16 men) with a mean age of 23 years were studied. Subjects were asked to stand bipedally on a baropodometric platform while centre of pressure location, plantar ground contact surface areas and pressures were measured over a 5 s interval. Group differences were examined by analyses of variance and Fisher's PLSD test. RESULTS: No significant group differences were found in centre of pressure location by weight or gender. Obesity was associated in both sexes with significantly larger plantar contact areas (+12.2%, P<0.0001 for women and +9.9%, P<0.005 for men) and pressures (mean load: +52.6% for women and +44.7% for men, P<0.0001 in both of sexes; peak pressure: +45.5% for women and +40.5% for men, P<0.0001 in both of sexes). There were significant gender differences in plantar contact areas (P<0.0001), while were no significant differences in mean and peak pressures. CONCLUSIONS: Although centre of pressure location was unaffected by obesity, these young obese individuals showed significantly increased plantar contact areas and pressures. RELEVANCE: The higher plantar pressures associated with obesity may have negative ramifications for foot function over the longer term.

Symmetry of healthy adult feet: role of orthostatic footprint at computerized baropodometry and of digital formula.

Morphological aspects of orthostatic footprints (anterior heel, isthmus, posterior heel), using computerized baropodometry and of the digital formula were studied in 97 subjects (37 males, 60 females; median age: 20.9+/-1.56) at the Medical School of Palermo, Italy. The aim of this study was to contribute to our knowledge of the bilateral symmetry and asymmetry of the human feet in ethnically similar groups. We evaluated the length of the footprints (FL) and the widths of the anterior heel (AHW), isthmus (IW), and the posterior heel (PHW). Values were compared in the left and right feet of each subjects. The general morphology of the footprints was considered to determine bilateral correspondence or divergence. We also evaluated the digital formula to verify any bilateral correspondence. The linear measurements of the footprints did not show any particular bilateral conformity. The general morphology of the footprint showed bilateral correspondence in 76 subjects (78%): in 21 subjects (22%) it did not show any. Typological results of the bilateral orthostatic footprints showed normalfootprints in 54 subjects (55.5%): the isthmus included 1/3 to 2/3 of the AHW. Hollow footprints were found in 20 subjects (20.5%): the isthmus was less than 1/3 of the AHW. At clinical examination, using the digital formula, we found that Egyptian foot (1 degree > 2 degrees) was the most frequent (68%). The standard foot (1 degree = 2 degrees) and the Greek foot (1 degree < 2 degrees) were both present in 16% of the feet examined. Seventy-nine subjects (82%) presented bilaterally correspondent digital formulas: 1 degree > 2 degrees in 59 subjects (62%), 1 degree = 2 degrees in 9 subjects (9%), and 1 degree < 2 degrees in 11 (11%). While comparison of the bilateral linear measurements studied showed that there was primarily no bilateral correspondence, the morphological aspects of the footprints and of the digital formulas showed that bilateral correspondence was prevalent.

Functional anatomy and imaging of the foot.

The foot is constituted from a series of small bones making a segmented structure with multiple joints, likened to a dome, in contact with the ground in three points: posteriorly the calcanear tuberosity; anteriorly and medially the head of 1st metatarsum, and anteriorly and laterally the head of 5th metatarsum. In fact, each foot presents a semi-arch whose base is represented by the lateral border and the summit by the medial border of the foot. The foot has been likened to a half-dome, so that when the medial borders of the two feet are placed together, a complete dome is formed. In the foot are present two longitudinal arches: the medial consists of the calcaneus, the talus, the navicular, the three cuneiform bones and the first three metatarsal bones. It is more arcuated and elastic then the lateral, that consist of the calcaneus, the cuboid and the 4th and 5th metatarsus. This is flattened and in contact with the ground. We can identify two transverse arches between longitudinal arches, extending from the medial to the lateral borders of the foot: the first is a lancet dome, between midfoot and forefoot, at the tarsometatarsal joint level; it consists of the bases of the metatarsal bones and the cuboid and the three cuneiform bones; the second is at flat dome, in correspondence of forefoot, at the metatarsophalangeal joint level; it consists of the bases of the proximal phalanges of the fingers and the head of five metatarsal bones. Longitudinal and transversal arches are supported from: the shape of stones of the structure (foot bones); the long and short plantar ligaments, larger and stronger than the dorsal ligaments, tie together the lower edges of the bones; a beam (the plantar aponeurosis and the plantar muscles and tendons) connecting the ends of the bridge effectively prevents separation of the pillars and consequent sagging of the arch; the maintenance of the arch depends on multiple support (ligaments, tendons of extrinsic muscles of the foot) suspending the arch from a cable above the level of the bridge. In this manner, we obtain a "functional unit" with two important aims: to support the body weight (static foot), and to serve as a lever to propel the bodies forward in walking and running (dinamic foot). Imaging techniques are able to provide further data on functional anatomy of the foot; in particular, these techniques show the bones structures, ligaments, muscles and tendons, taking part to the arch setting. Routine x-ray examinations precise information about the bone-shape and their relationship. The short and long ligaments, the tendons and the suspending the arch from above are instead successfully valuable using ultrasonography, CT and MR.

Clinical and anatomic features of the inguinal canal during hernia.

Seventy-eight patients affected by inguinal hernia, 33 by direct and 45 by indirect external oblique types, were studied. The morphologic and structural aspects of the inguinal canal including its length, the diameter of the deep inguinal ring and the qualitative features of the fascia transversalis and aponeuroses of the external and internal oblique muscles and of the transversus muscle were investigated. In all 78 patients with inguinal hernia, the length of the canal was 4.7 cm. In the 33 patients with direct inguinal hernia the width of the deep inguinal ring varied from 1.5 to 2.5. The aponeurosis of the external oblique muscle was dense in 19 cases (57.58%), rather laddered in 10 (30.30%) and very laddered in 4 (12.12%). The fascia transversalis was discontinued in 28 cases (84.85%) and velamentous in 5 cases (15.15%). In the 45 patients with indirect inguinal hernia the width of the deep inguinal ring varied from 1.5 to 7 cm. The aponeurosis of the external oblique muscle was dense in 14 cases (31.11%), rather laddered in 23 cases (51.11%), very laddered in 8 (17.78%). The fascia transversalis was dense in 15 (33.33%), elastic in 17 (37.78%) and velamentous in 13 cases (28.89%). Based on the results of this study, a series of therapeutic considerations are set forth. The most important of these include early surgical intervention, which is absolutely necessary, and the use of prostheses in the inguinal canal.

Immunohistochemical research on the atrial natriuretic factor (ANF) in rat atrioventricular valves.

Immunohistochemical research on atrioventricular valves in normotensive rats revealed that valvular myocardiocytes are the seat of synthesis of the atrial natriuretic factor (ANF). The endocardial cells that border the atrial and ventricular surfaces also had granules which were positive for ANF. The ANF which is also synthesized in the valvular myocardiocytes moved towards the cardiac cavity and crossed the endocardial cells in the more distal areas of the valvular edge. At the same time, the ANF was routed into the blood vessels in the areas close to implantation.

Changes in the lumbosacral segment of the spine due to overweight in adults. Preliminary remarks.

The Authors studied postural changes in the lumbosacral segment of the spine due to severe obesity in 28 young adults of both sexes. In particular, the preliminary degree of pelvic rotation caused by overweight was evaluated by studying the lumbosacral angle (LSA) amplitude, changes in normal static equilibrium of the spine and lumbar hyperlordosis in relation to the lordotic angle (LA) amplitude. Body Build Index (BBI), the lumbosacral angle and the lordotic angle were compared to determine if any correlations existed among the three. Even though the patient number was limited, pathologic values for both the LSA and the LA were found in all 28 subjects. The Authors found no correlation between LSA and LA increase regarding BBI; on the contrary, a correlation was evident between LSA increase and LA. A decrease in the LSA and LA values took place after reduction in body weight, after therapeutic intervention. The Authors believe that a one year follow-up is necessary to evaluate any long term decrease in the values of the above mentioned angles.

A contribution to knowledge of the compartments and the fascial and septal formations of the popliteal fossa in the human fetus and the adult.

A contribution to knowledge of the compartments and the fascial and septal formations of the popliteal fossa in the human fetus and the adult. A study was made in human fetuses from the 3rd month onwards, newborn and the adult of the fascial and septal formations and the compartments of the popliteal fossa. Observations of serial sections of the knee of human fetuses, of macroscopic preparations of the knee of newborns and of ultrasound images of the popliteal fossa in adults showed that: the fascial formation covering the popliteal fossa consists of the popliteal fascia and the superficial fascia. The bud of the popliteal fascia is observable in the 3-month fetus as a layer of thin fibrillar connective tissue which is thicker in the tracts between the muscle buds. At birth the popliteal fascia is clearly a separate anatomical entity of continuous laminar structure which is thicker in the tracts between the muscles and thinner where it covers them. The superficial fascia becomes evident in fetuses at a later stage (6th month) in the form of a thin lamina in the frontal plane which at birth is well defined and observable as a thin continuous line deep below the subcutaneous layer. The septal formation consists of four septa: two in the sagittal plane (lateral and medial) and two in the frontal plane (lateral and medial). The bud of these septa appears in 4-month fetuses after the appearance of the popliteal fascia. They branch off from the thicker connective areas between the muscles buds as connective prolongations which later assume a laminar aspect and eventually become compact and form septa. In at-term fetuses and newborns these septal formations are clearly recognizable as antomical entities, which branch off from the deep surface of the thicker tracts of the popliteal fascia and are inserted into the femur. The relationships and connections with the muscular groups are also clearly visible. The organization and demarcation of the compartments, which is already delineated in the 6-month fetus, seems to be completed at birth, considering the presence of the superficial fascia, the popliteal fascia and the septa. It is possible to distinguish a superficial compartment between the popliteal and the superficial fascia an a deep compartment between the frontal septa, the skeletal plane and the popliteal fascia. This deep compartment is clearly subdivided by the two sagittal septa into three sectors (medial, intermediate and lateral). The medial and lateral sectors contain muscles, while the intermediate compartment contains the vasculonervous bundle and the popliteal adipose body.

[Ultrastructural observations on B cells in the human synovial membrane]. / Osservazioni ultrastrutturali sulle cellule B della membrana sinoviale umana.

Two cellular type, A and B cells, are evident in the intimal layer of the human synovial membrane. The Authors studied the B-cells that show in their cytoplasm some secretory granules that are still unknown. In the normal synovial membrane of human knee, with transmission electron microscopic techniques, the relationship between the B-cells and the blood capillary vessels and some morphological features of the secretory granules, are studied. The blood capillary vessels have a continuous cellular wall, surrounded by a basal membrane. Typical features of the B-cells are the marked development of the rough endoplasmic reticulum, the Golgi apparatus and dense secretory vesicles. The B-cells appear to constitute some specific secretory cells, but its function has yet to be determined.

Ultrastructural comparisons of human synovial membrane in joints exposed to varying stresses.

The writers used the electron transmission microscope to study the ultrastructure of the synovial membrane in joints or synovial areas that varied in their exposure to weight bearing or other mechanical stresses. They used fragments of synovial membrane obtained surgically from the knee and from the elbow joints. In the joints or synovial areas little exposed to weight bearing or traction, the three strata of which the synovial membrane is composed were well differentiated from the fibrous capsule. The intima contained abundant cells with a trophic function (chiefly A cells); the subintima was intensely vascularised and had numerous fat cells but few fibres; the subsynovia was predominantly fibrous. On the other hand, in joints or synovial areas notably exposed to weight bearing or traction stresses, the synovial membrane was thinner, with few cellular elements (mostly resembling fibroblasts) and few blood vessels, while the fibrillar component was particularly marked. These differences in the ultrastructure confirm Franceschini's hypothesis that the synovial fluid is produced in those areas of the synovia that are less exposed to mechanical stress.

Ultrastructural appearance of human synovial membrane in the reabsorption phase of acute haemarthrosis.

Using the electron transmission microscope, the writers studied the ultrastructural appearances of the synovial membrane obtained during acute haemarthrosis, with the aim of elucidating the morphological basis of he mechanism of reabsorption of the various components of the blood. It was observed that all the elements of the synovial intima showed substantial modifications of the cytoplasm and of the plasmalemma. The cytoplasm showed: (a) marked abundance of lysosomes and lysophagosomes; (b) the presence of conspicuous cavities crammed with erythrocytic fragments; (c) marked reduction of normal cytoplasmic organelles. The plasmalemma, on the surface bordering the joint cavity, showed numerous philopods and lamellipods. These modifications, which affected all the cellular elements of the intimal stratum, demonstrate that they are macrophagically differentiated.

[Practical use of the Möhr and Johnson formula for calculation of ideal weight. Preliminary observations on deviations from ideal weight in a group of 1,000 Sicilian adults]. / Sull'applicazione pratica della formula di Möhr e Johnsen per il calcolo del peso ideale. Osservazioni preliminari sulle deviazioni dal peso ideale in un gruppo di 1000 soggetti adulti siciliani.

Simplification of the operations required for the calculation of ideal weight in adults in accordance with the formula of Möhr & Johnsen is suggested. Preliminary notes on a group of 500 male and 500 female Sicilians aged 18-24 following determination of the Strömgren metrical index and somatotype, ideal weight, and a variation index of differences between the real weight and the ideal weight are presented. Leptomorphs were clearly predominant, particularly among the males. Assessment of the variation index values for each subject within the different somatotypes was followed by analysis of the frequency distribution of under-, normal, and over-weight subjects. Percent frequency was noticeably asymmetrical, with marked differences between somatotypes and the sexes, though there was a clear ratio between deviation and somatotype features. The overall percent frequencies without reference to somatotype were slightly more symmetrical and lay on a leptokurtic curve.

[Frequency distribution of excess weight and comparative results of somatotype aspects over a period of 8 years. Studies made in young Sicilian subjects]. / Distribuzione di frequenza dell'eccedenza ponderale e risultati comparativi degli aspetti del somatotipo nell'arco di otto anni.

Weight excess frequency distribution with respect to ideal weight was studied in a sample of 2000 men and 2000 women from Sicily aged between 19 and 24. The following findings were made: greater representation of subjects with excess weight in the female sample (18.75%) than in the males (11.80%); about twice the percentage of females in classes with greater overweight incidence (+20 +29%; +30% and over); a slight distributional discrepancy of weight excess in relation to province of origin of the subjects under examination. The standards of thirteen somatic measurements obtained in the samples were compared with those obtained personally in 1967 in a sample of Sicilian men and women with similar characteristics, for the purpose of assessing any modifications in somatotype aspects between 1967 and 1975. No statural growth was found in either men or women while both showed fair weight decrease (about 3 kg) together with a reduction in almost all trunk diameters and extremity perimeters. Thus the somatic aspect of the 1975 sample compared with the 1967 sample would seem to be slimmer and more agile.