Residual foreign body in the foot causing chronic osteomyelitis mimicking a pseudotumor: A case report.

Osteomyelitis from a retained foreign body should be included in the differential diagnosis of any osteolytic lesion of the foot. We report here a case of a 59-year-old man who presented with swelling over the dorsolateral aspect of the right foot. Plain x-ray showed an osteolytic lesion that mimicked a pseudotumor. Magnetic resonance imaging (MRI) showed multilocular fluid collection over the right cuboid with a hypointense lesion over the plantar fascia. The patient underwent surgery and a rubber fragment (1 cm × 0.8 cm) was removed from his foot that had been present for two years following a stabbing injury. The patient fully recovered without complication or disability.

Molecular factors involved in the development of diabetic foot syndrome.

Diabetes is one of the major challenges of modern medicine, as it is considered a global epidemic of the XXI century. The disease often leads to the development of serious, health threatening complications. Diabetic foot syndrome is a characteristic set of anatomical and molecular changes. At the macroscopic level, major symptoms are neuropathy, ischemia and chronic ulceration of the lower limb. In every third patient, the neuropathy develops into Charcot neuroarthropathy characterized by bone and joints deformation. Interestingly, all these complications are a result of impaired healing processes and are characteristic for diabetes. The specificity of these symptoms comes from impaired molecular mechanisms observed in type 1 and type 2 diabetes. Decreased wound and fracture healing reflect gene expression, cellular response, cell functioning and general metabolism. Here we present a comprehensive literature update on the molecular factors contributing to diabetic foot syndrome.

Los pies en las diferentes culturas: los pies en la India / Feet in different cultures: the feet in India

En este artículo se presentan diferentes temas relacionados con los pies y la podología, todo ello inmerso en el contexto cultural de la India. Se hace un repaso de los diferentes calzados habituales y tradicionales del país. Se muestran diferentes actividades relacionadas con los pies y finalmente se adjuntan algunas de las extremidades inferiores de los animales más frecuentes en este entorno (AU)

In this article issues related to the foot and podiatry within the Indian cultural context are presented. Different types of frequently used, traditional footwear and foot related activities are reviewed. Finally, the lower extremities of animals common to this cultural context are discussed (AU)

Estudio epidemiológico 2003-2008 diabetes y podología en España / 2003-2008 epidemiological study on diabetes and podiatry Spain

La importancia que tiene la diabetes mellitus (DB) es bien conocida. La diabetes mellitus provoca una serie de afectaciones en todo el cuerpo del paciente y los pies es uno de los órganos diana de esta patología. Debido a que el podólogo, es el único profesional sanitario con una formación específica en el tratamiento del pie, con los conocimientos necesarios para evitar todos los problemas del pie, y que una de las complicaciones más graves a los que puede llegar una úlcera o una afección en un diabético puede ser la amputación, sería interesante ver la relación y la prevención que podría haber entre un podólogo y pacientes diabéticos como estudio epidemiológico e indicador de salud y calidad de vida (AU)

The importance of diabetes mellitus (DB) is well known. Diabetes mellitus causes a serious affectations throughout the patient´s body and feet is one of the target organs of this disease. Because the podiatrist is the only health professional with specific training in treating the foot, with the knowledge needed to prevent all foot problems, and that one of the most serious complications that can get an ulcer or in a diabetic condition may be the amputation, it would be interesting to see the relationship and prevention could be between diabetic and podiatrist and epidemiological study and an indicator of health and quality of life (AU)

Spinal levels of nonprotein thiols are related to nociception in mice.

UNLABELLED: Oxidative stress markers are thought to be related to nociception. Because thiolic compounds are important antioxidants, we investigated the relationship between thiols, endogenous or exogenous, and nociception. Systemic or spinal, but not peripheral, administration of the exogenous thiolic compound N-acetyl-L-cysteine (NAC) reduced nociception induced by intraplantar capsaicin injection. Moreover, we detected an increase in lipid peroxidation and 3-nitrotyrosine and a decrease in nonprotein thiolic levels in the lumbar spinal cord of capsaicin-injected animals. All these effects were prevented by NAC treatment (i.p. and i.t.). Our findings confirm a role for the spinal cord in NAC actions because systemic NAC administration also reduced the nociception trigged by intrathecal injection of capsaicin. Moreover, adjuvant-induced arthritis, but not paw incision, also -decreases nonprotein thiol levels in the spinal cord. Similarly, NAC produced antinociception in adjuvant-treated animals, but not in paw-incised animals. Finally, we investigated the role of endogenous thiol compounds in the nociceptive process administrating buthionine-suphoxamine (BSO), an inhibitor of glutathione-synthesis. Intrathecal BSO treatment decreased nonprotein thiol levels in the spinal cord, as well as induced mechanical allodynia and chemical and thermal hyperalgesia. In conclusion, our results indicate a critical role for nonprotein thiols in nociception at the level of the spinal cord. PERSPECTIVE: The results presented here indicate that the loss of nonprotein thiols in the spinal cord is involved in pain development. Therefore, the administration of thiolic compounds or other strategies allow thiol levels to be maintained and could be a beneficial action in the therapy of painful conditions.

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Nerve growth factor expression after plantar incision in the rat.

BACKGROUND: Postoperative pain control remains a significant problem. Advances will proceed if we can further reveal the underlying mechanisms of incisional pain and its mediators. Previous studies have demonstrated that nerve growth factor (NGF) is released in incised tissue and contributes to hyperalgesia in incisional pain. The purpose of this study is to examine the expression of NGF in skin after planter incision. METHODS: Adult Sprague-Dawley rats underwent incision at the plantar aspect of hind paw. The NGF messenger RNA (mRNA) was measured at various times after incision by polymerase chain reaction. NGF protein expression was detected by Western blot and immunohistochemistry in incisions. RESULTS: NGF mRNA increased from 2 to 4 h after incision and was the same as control by postoperative day 1. A large-molecular-weight form of NGF, approximately 75 kd, was found in normal skin. The large-molecular-weight NGF protein increased 4 h after incision and returned to baseline on postoperative day 7. The skin immediately adjacent to the incision had the greatest NGF expression. Immunohistochemical staining for NGF was present adjacent to the incision and localized in Schwann cells and axons. CONCLUSION: NGF mRNA is increased and a large-molecular-weight form of NGF protein is expressed in the region adjacent to the incision. NGF immunoreactivity is present in nerve bundles; both Schwann cells and axons are labeled. Immunoreactive NGF in axons is likely taken up into cut axons. This study suggests some common mechanisms for neuropathic and incisional pain.

The effects of pretreatment with lidocaine or bupivacaine on the spatial and temporal expression of c-Fos protein in the spinal cord caused by plantar incision in the rat.

UNLABELLED: We investigated the spatial and temporal patterns of c-Fos protein (Fos) expression in the dorsal horn of the spinal cord caused by plantar incision in the rat and the effects of pretreatment with local anesthetics. Bupivacaine (0.5%), lidocaine (2%), or saline for control was injected for nerve block and local infiltration before the plantar incision was made under anesthesia. Pain behavior and Fos expression in the L4-L5 segments of the spinal cord were assessed at 1, 3, 6, 24, 48, 72, and 120 h after the incision. The withdrawal threshold to mechanical stimulation decreased significantly at 1 h until 120 h (1-72 h, P < 0.01;120 h, P < 0.05), and pretreatment with local anesthetics increased the threshold significantly at 1 h (both groups: P < 0.01), 3 h (both groups: P < 0.01), and 6 h (bupivacaine, P < 0.01; lidocaine, P < 0.05) in comparison with that in the saline group. In the saline group, Fos expression was detected predominantly in laminae I-II and V-VI, and the total Fos expression was maximal at 1 h and then decreased gradually. Pretreatment with local anesthetics suppressed Fos expression significantly in all layers, and this suppression continued for several days. This study provides evidence of spatial and temporal changes in Fos expression induced by plantar incision. Our results indicate that although pretreatment with local anesthetics suppresses Fos expression for several days in the postoperative period, the analgesic effect is observed only for the expected duration of the local anesthetic used. IMPLICATIONS: Prevention of early pain by pretreatment with local anesthetics provides little benefit for postoperative pain relief in the plantar incision model, although c-Fos expression is suppressed. The number of c-Fos-expressing neurons is not necessarily correlated with pain behavior.

A critical appraisal of pinhole scintigraphy of the ankle and foot.

BACKGROUND: Scintigraphy is an established imaging technique for injuries of the ankle and foot that are not apparent on plain radiographs. The scintigraphic technique has varied, with planar and pinhole images being used. MATERIALS AND METHODS: The incremental value of pinhole scintigraphy over planar imaging was studied in 16 patients with established diagnoses. Inter-reporter reproducibility was also measured. RESULTS: Pinhole scintigraphy improved the diagnostic specificity in nearly one half of the patients (48%). It did not contribute substantial information in 46% and led to confusion in the diagnosis of one patient. Inter-reporter agreement was good, with a kappa value of 0.78. Diagnoses varied from fractures of the talar dome to avulsion fractures of the malleoli and impingement syndromes. CONCLUSIONS: Pinhole images add a significant incremental value to planar scintigraphy of the foot and ankle. Although this had been perceived intuitively in the past, it has not been critically evaluated. The technique has good inter-reporter agreement.