2007 June « Podiatry Internet Communications

A one-year follow up of Pilon fractures of Tibia treated with Ilizarov External Fixator without image intensifier guidance
Journal of Orthopaedics

ORIGINAL ARTICLE: Distal Tibial fractures involving the Plafond have been treated in the past in various ways resulting in an array of complications with each. There has been a recent trend to treat them with external fixators. Circular fixators have a special appeal in Pilon Fractures. The study design included retrospective, Observational, nonrandomized, without control group. Seventeen cases of closed or Gustilo Type I/II open fractures which had been treated with Illizarov Fixators with or without the use of a U ring attachment or fibular plate fixation. All had been allowed to bear full weight on the limb in the early postoperative period. A follow up review was done at the completion of one year. All cases healed with minimal displacement, a low complication rate and high patient satisfaction rates regardless of radiological misalignment of the bones. The time of fracture healing was short and a good range of motion was achieved in most at the end of one year. They conclude that Ilizarov fixators can be used with safety and confidence in the treatment of Pilon fractures with low morbidity of the procedure and satisfactory outcome where facilities of image intensifier are not available.

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Advances in the Treatment of Tinea Pedis
Podiatry Management

ORIGINAL ARTICLE: by Mark Kosinski, DPM, Warren S. Joseph, DPM, and Bryan Markinson, DPM. CME series for June 2007. It is estimated that over 70% of the world’s population will develop tinea pedis at some point point during their lifetimes. Tinea pedis is discussed including its causes and treatment. The review includes environmental factors, sock materials, the affects of tinea pedis and diabetes, tinea pedis and xerosis. An in-depth discussion of topical antifungals are reviewed. The review concludes with topics that include off-lable antifungals and long term prevention tips.

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Neuronal mechanism for neuropathic pain
Molecular Pain

ORIGINAL ARTICLE: Among different forms of persistent pain, neuropathic pain presents as a most difficult task for basic researchers and clinicians. Despite recent rapid development of neuroscience and modern techniques related to drug discovery, effective drugs based on clear basic mechanisms are still lacking. Here, I will review the basic neuronal mechanisms that maybe involved in neuropathic pain. I will present the problem of neuropathic pain as a rather difficult task for neuroscientists, and we may have to wait for a long time before we fully understand how brain encode, store, and retrieve painful information after the injury. I propose that neuropathic pain as a major brain disease, rather being a clinic problem due to peripheral injury.

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Obesity and pronated foot type may increase the risk of chronic plantar heel pain: a matched case-control study
BMC Musculoskeletal Disorders

ORIGINAL ARTICLE: Chronic plantar heel pain (CPHP) is one of the most common musculoskeletal disorders of the foot, yet its aetiology is poorly understood. The purpose of this study was to examine the association between CPHP and a number of commonly hypothesised causative factors. Eighty participants with CPHP (33 males, 47 females, mean age 52.3 years, S.D. 11.7) were matched by age (+/- 2 years) and sex to 80 control participants (33 males, 47 females, mean age 51.9 years, S.D. 11.8). The two groups were then compared on body mass index (BMI), foot posture as measured by the Foot Posture Index (FPI), ankle dorsiflexion range of motion (ROM) as measured by the Dorsiflexion Lunge Test, occupational lower limb stress using the Occupational Rating Scale and calf endurance using the Standing Heel Rise Test. Obesity and pronated foot posture are associated with CPHP and may be risk factors for the development of the condition. Decreased ankle dorsiflexion, calf endurance and occupational lower limb stress do not appear to play a role in CPHP.

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Living with muscular dystrophy: health related quality of life consequences for children and adults
Health and Quality of Life Outcomes

Original article: Original article: Muscular dystrophies are chronic diseases manifesting with progressive muscle weakness leading to decreasing activities and participation. To understand the impact on daily life, it is important to determine patients quality of life. Objective: To investigate Health Related Quality of Life (HRQoL) of children and adults with muscular dystrophy (MD), and to study the influence of type and severity of MD on HRQoL in adult patients. Age-related HRQoL questionnaires were administered to 40 children (8-17 years), and 67 adult patients with muscular dystrophies. The results revealed significant differences in HRQoL were found in children and adults with MD compared to healthy controls. Patients with Becker muscular dystrophy reported a better HRQoL on the several scales compared to patients with other MDs. Severity was associated with worse fine motor functioning and social functioning in adult patients. In conclusion, this is one of the first studies describing HRQoL of patients with MD using validated instruments in different age groups. The results indicate that having MD negatively influences the HRQoL on several domains.

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Heelys and Street Gliders Injuries: A New Type of Pediatric Injury
Pediatrics

Original article: Our goals were to highlight an increasing trend in orthopedic injuries in children as a result of “heeling” or “street gliding,” to describe injuries sustained by children using Heelys (HSL, Carrollton, TX) and Street Gliders (Glowgadgets Ltd, Bristol, United Kingdom), and to increase public awareness and prevent such injuries. We prospectively recorded the data of all roller shoes injuries referred to our department during the summer school holiday. Using a data-collection sheet, we recorded demographic data, type of injury, mechanism and place of injury, heeling or street- gliding experience, use of safety equipment, methods of treatment, and intention to continue heeling or street gliding after recovery from injury. In results, over a 10-week period, 67 children suffered orthopedic injuries while using Heelys or Street Gliders. There were 56 girls and 11 boys with a mean age of 9.6 years. Upper limbs were the most common location of injury. Distal radius fractures were the most prevalent, followed by supracondylar fractures, elbow dislocations, and hand fractures. The majority of children suffered the injury while heeling or street gliding outdoors. Interestingly, 20% of the injuries happened while trying Heelys or Street Gliders for the first time, and 36% of the injuries occurred while learning (using 1-5 times) how to use them. None of the children used any sort of protective gear at the time of the injury. The majority of the injured children expressed their intention to continue heeling or street gliding after complete recovery from their injury. In conclusion, our study shows that the majority of children with injuries from heeling or street gliding are girls. We recommend close supervision of children using Heelys or Street Gliders during the steep learning curve and usage of protective gear at all times. These new types of injuries have a serious impact on child health and constitute a burden for the pediatric orthopedic service.

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Podiatry Today ENews
Podiatry Today-Volume 5, Issue 18

Study Links Depression With Diabetes Development
By Brian McCurdy, Senior Editor
Can depression spur the development of diabetes? A recent study in the Archives of Internal Medicine concludes that older patients who are depressed have a higher risk of developing type 2 diabetes.Pertinent Pointers On Equinus Procedures
By Mary Crawford, DPM, FACFAS
Given the various ways people compensate for equinus as well as the many conditions associated with equinus, this author provides an anatomical primer, addresses biomechanical influences and offers pearls on surgical treatment.How To Overcome Obstacles With Custom Orthoses
By Guest Clinical Editor: David Levine, DPM, CPed
Despite the success rate one may have with orthotic devices, sometimes patients may not tolerate the devices. These expert panelists discuss treating patients who do not tolerate orthoses, when orthoses need to be replaced, which orthotic materials may lead to success and how shoes affect orthotic function.