"Come and live with my feet and you'll understand" - a qualitative study exploring the experiences of retail footwear in women with rheumatoid arthritis.

BACKGROUND: Foot pain and deformity are common in people with rheumatoid arthritis (RA). Previous research has identified that women with RA seek retail footwear to alleviate their foot problems. The specific footwear features that women with RA require, and what would help them to find shoes that meet these requirements, are unknown. This study aimed to determine the factors that influence the choice of appropriate retail footwear by women with RA. METHOD: An overarching qualitative approach was taken, using reflexive thematic analysis of conversational style interviews. The interviews explored experiences and use of retail footwear in 20 women with RA. The interviews were digitally recorded transcribed verbatim and analysed using a reflexive thematic framework. RESULTS: Women with RA sought retail footwear which had adequate cushioning, width, a flexible sole, lightweight, were made from breathable materials and were easy to put on and take off. However, this choice was driven by the need for comfort, cost and usability, with aesthetics being less of a priority. Despite having opinions on what criteria they felt that they needed, these women did not feel empowered to make good choices about purchasing retail footwear for symptomatic relief. Furthermore, they did not receive the necessary support from podiatrists and shoe shop staff. CONCLUSION: Women with RA have clear ideas about what features a retail shoe should have to achieve comfort. There is a constant compromise between achieving comfort and their feelings about their appearance and how they feel others perceive them. Women with RA describe negative experiences with shoe shop assistants and podiatrists leading to poor footwear choices. Both retail staff and podiatrists need increased understanding about the particular problems that women with RA experience.

Correlation of postoperative midfoot position with outcome following reconstruction of the stage II adult acquired flatfoot deformity.

BACKGROUND: No studies investigating the effect of the midfoot (talonavicular joint) position on clinical outcomes following flatfoot reconstruction have been performed. The purpose of our study was to determine whether a postoperative abducted or adducted forefoot alignment, as determined from anteroposterior (AP) radiographs, was associated with a difference in outcomes using the Foot and Ankle Outcome Score (FAOS). METHODS: Midfoot abduction was defined on postoperative AP radiographs, evaluated at a mean of 1.9 years in 55 patients from the authors' institution who underwent flatfoot reconstruction for a stage II adult acquired flatfoot deformity (AAFD), as a lateral incongruency angle greater than 5 degrees, a talonavicular uncoverage angle greater than 8 degrees, and a talo-first metatarsal angle greater than 8 degrees based on previously reported measurements. Patients with 2 or more measurements in the abduction category were classified as the abduction group (n = 30); those with 1 or fewer measurements in the abduction category were placed in the adduction group (n = 25). The preoperative and postoperative FAOS values with a mean follow-up of 3.1 years were compared using Wilcoxon rank-sum tests. RESULTS: Patients corrected to a position of adduction showed significantly lower improvement in the FAOS daily activities (P = .012) and quality of life subscales (P = .046). The mean improvement in subscale scores for the adducted group was lower for pain (P = .052) and sports activities (P = .085) but did not reach statistical significance. No significant difference in the FAOS symptoms subscale (P = .372) between groups was found. CONCLUSION: Correction of the talonavicular joint to a position of adduction following a stage II AAFD was associated with decreased patient outcomes in daily activities and quality of life compared with an abducted position. These results suggest that overcorrection to a position of midfoot adduction leads to a lesser amount of individual patient improvement in reconstruction of a stage II AAFD.

Femoral bone transport by a monolateral external fixator with or without the use of intramedullary nail: a single-department retrospective study.

BACKGROUNDS: Treatment for bone defect remains a challenge for orthopedists. Bone transport gives an effective alternative, which can be performed with an external fixator alone or combined with an intramedullary nail. Each has its advantages and disadvantages. We present a retrospective study to find out the optimal choice by evaluating the outcomes of treatment for femoral bone defect with two methods. METHODS: Two groups of patients, the monolateral external fixator alone (group A, n = 13) and the monolateral external fixator combined with intramedullary nail (group B, n = 15), were compared. Duration of the external fixator, external fixator index, radiographic consolidation index, complication, and total cost for treatment was also recorded. A modified classification of the Association for the Study and Application of the Method of Ilizarov (ASAMI) was used to assess results in two groups of patients; another SF-36 health survey questionnaire was used to assess the life qualities patients of two groups. RESULTS: Healing was achieved in 13/13 and 13/15 of the two groups, respectively. The rates of complications were significantly higher in the group A. Two patients performed amputations because of persistent deep infections in group B. Statistically significant difference was found when comparing ASAMI scores and categories of the SF-36 health survey. CONCLUSIONS: Bone transport by monolateral external fixator with the use of intramedullary nail reduces the incidence of complication and the duration of external fixator time that give patients a better life quality in both physical and emotional. However, if chronic osteitis exists, bone transport should be treated with monolateral external fixator alone due to a lower rate of amputations.

[Footwear according to the "business dress code", and the health condition of women's feet--computer-assisted holistic evaluation]. / Obuwie zgodne z "business dress code" a kondycja zdrowotna stóp kobiet--komputerowo wspomagana ocena holistyczna.

BACKGROUND: According to the verdict of the Supreme Court in 2005, an employer may dismiss an employee if their conduct (including dress) exposes the employer to losses or threatens his interests. The aim of the study was a holistic assessment of the pleiotropic effects of high-heeled pointed shoes on the health condition of women's feet, wearing them at work, in accordance with the existing rules of the "business dress code". MATERIALS AND METHODS: A holistic multidisciplinary analysis was performed. It takes into account: 1) women employees of banks and other large corporations (82 persons); 2) 2D FEM computer model developed by the authors of foot deformed by pointed high-heeled shoes; 3) web site found after entering the code "business dress code". RESULTS: Over 60% of women in the office wore high-heeled shoes. The following has been found among people walking to work in high heels: 1) reduction in the quality of life in about 70% of cases, through periodic occurrence of pain and reduction of functional capacity of the feet; 2) increase in the pressure on the plantar side of the forefoot at least twice; 3) the continued effects the forces deforming the forefoot. CONCLUSIONS: 1. An evolutionary change of "dress code" shoes is necessary in order to lead to a reduction in non-physiological overload of feet and the consequence of their disability. 2. These changes are particularly urgent in patients with so-called "sensitive foot".

[Metatarsophalangeal arthrodesis of the hallux and arthroplastic resection of the second to fifth metatarsal heads in the rheumatic foot]. / Artrodesis metatarsofalángica del primer dedo y resección artroplástica de la cabeza del segundo al quinto metatarsiano en pie reumático.

UNLABELLED: The objective of this study is to assess the clinical and radiologic results of patients with rheumatic forefoot who underwent metatarsophalangeal arthrodesis of the first ray and arthroplastic resection of the second to fifth metatarsal heads at the National Rehabilitation Institute. MATERIAL AND METHODS: This is a prospective comparative study of the clinical and radiological status before and after the surgical procedure; it is a descriptive, observational single-group study. From April 2006 to December 2011, 31 surgical procedures were performed in 29 female and two male patients. The SPSS 17.0 software was used for the statistical analysis. Efficacy and quality of life indicators were compared using mean comparison tests (Student t test), the indicator of patient safety by means of frequency analysis, and the comparative analysis of the occurrence of complications throughout time. RESULTS: The mean preoperative visual analog scale score was 6.2 +/- 1.3, with an average of 1.6 +/- 2.5, with statistical significance, with p < 0.0001 and t = 7.97. Radiographic measurements of the hallux valgus angle showed a remarkable improvement. CONCLUSIONS: The surgical procedure described is reliable and efficacious, as patients had an important improvement in quality of life, with pain relief and adaptation to their activities of daily living after surgery.

Does cortical reorganisation explain the enduring popularity of foot-binding in medieval China?

In the past, it used to be taught that neural connections were essentially fixed and unchangeable from birth. However, in recent years it has become clear that, in fact, the brain possesses a tremendous degree of latent plasticity, and significant reorganisation can occur in response to changes in the body. This is clearly demonstrated by the phenomenon of phantom limbs--the vivid sensation of a limb still being present despite its amputation. After removal of a limb, the region of the somatosensory cortex that is deafferented is "taken over" by afferents that normally innervate the adjacent areas of cortex. This cross-activation between the different areas of the somatosensory cortex plays a large role in creating these phantom sensations. The same is also true of the motor cortex. After amputation of a limb, the deprived area of motor cortex does not remain nonfunctional but instead becomes active in the control of adjacent non-amputated muscle groups. It is notable that the genital area of the somatosensory cortex and the pelvic floor muscle area of the motor cortex are dislocated and in both cases lie adjacent to the foot area. Foot-binding of Chinese girls started around the 10th Century AD and for the next millennium was an extremely prevalent and popular custom. Mothers would tightly wrap their daughters' feet from about the age of six years, thus preventing the feet from maturing normally. The aim of the process was to create as small feet as possible, since this would greatly enhance a girl's matrimonial prospects. Historians of the period have noted that Chinese men viewed foot-binding as conducive to better sexual intercourse because they believed that women with bound feet had vaginas that were more highly muscled and sensitive. We hypothesise that since foot-binding kept a girl's feet small and atrophic, this resulted in underutilisation of the foot areas of her somatosensory and motor cortices. This resulted in cross-activation between the redundant foot cortex and the adjacent genital areas in her brain. Hence women with bound feet devoted a disproportionately large area of the sensory and motor cortices of their brains to their genitalia and pelvic floor musculature, which made them more sensitive and pleasurable lovers. This caused Chinese men to prefer their sexual partners to have bound feet, which resulted in the enduring popularity of foot-binding in China over the last millennium.

Reaçöes emocionais dos hansenianos portadores de deformidade física / Emotional reactions of leprous with physical deformity

O presente trabalho objetivou levantar as reaçöes emocionais dos hansenianos portadores de uma deformidade física, em tratamento num Centro de Saúde de Ribeiräo Preto. Foram entrevistados 22 pacientes, independentemente do sexo, idade, tempo de tratamento e forma clínica da doença, utilizando como instrumento a análise qualitativa dos depoimentos registrados mediante a questäo: "Como você vê a sua deformidade física?" A análise dos discursos demonstrou alteraçöes emocionais refletindo uma gama de reaçöes geralmente manifestadas por medo, vergonha, repulsa, solidäo, angústia, agressividade, raiva, rejeiçäo familiar e social, preocupaçöes com o futuro, sentimentos de inferioridade, etc. Tais reaçöes devem ser identificadas e compreendidas por toda equipe de saúde, para dar apoio ao paciente, esclarecendo-o quanto à situaçäo vivencial, procurando eliminar falsos conceitos e tabus que ainda persistem com relaçäo à doença

Rehabilitacion del enfermo com lepra

En el presente trabajo, después de una breve introduccion sobre la rehabilitacion del enfermo con lepra, se hace referencia a generalidades de la enfermedad, como: origen de la enfermedad en México, número de enfermos en la Republica Mexicana (se consideran de 50 a 60,000), clasificacion, y dos grupos: indeterminado y dimorfo. Se estudiam las incapacidades físicas y psicosociales que la enfermedad produce a las personas afectadas; las físicas de localizacion en las manos, pies y cara, principalmente y las incapacidades psicosociales desde el punto de vista de como afectam a la persona y sus familiares en los diferentes aspectos: psiquico, economico y social