David Rodríguez Sanz

Quality of Life Impact Related to Foot Health in a Sample of Older People with Hallux Valgus

Hallux Valgus (HV) is a highly prevalent forefoot deformity in older people associated with progressive subluxation and osteoarthritis of the first metatarsophalangeal (MTP) joint and it is believed to be associated with varying degrees of HV effect on the quality of life related to foot health. The aim of this study is to compare the impact of varying degrees of HV on foot health in a sample of older people. The sample consisted of 115 participants, mean age 76.7 ± 9.1, who attended an outpatient center where self-report data were recorded. The degree of HV deformity was determined in both feet using the Manchester Scale (MS) from stage 1 (mild) to 4 (very severe). Scores obtained on the Foot Health Status Questionnaire (FHSQ) were compared. This has 13 questions that assess 4 health domains of the feet, namely pain, function, general health and footwear. The stage 4 of HV shown lower scores for the footwear domain (11.23 ± 15.6); general foot health (27.62 ± 19.1); foot pain (44.65 ± 24.5); foot function (53.04 ± 27.2); vigour (42.19 ± 16.8); social capacity (44.46 ± 28.1); and general health (41.15 ± 25.5) compared with stage 1 of HV (P<0.05) and there were no differences of physical activity (62.81 ± 24.6). Often, quality of life decreases in the elderly population based in large part on their foot health. There is a progressive reduction in health in general and foot health with increasing severity of hallux valgus deformity which appears to be associated with the presence of greater degree of HV, regardless of gender.

Plantar pressures in children with and without sever's disease.

BACKGROUNDna case-control study was conducted to compare static plantar pressures and distribution of body weight across the two lower limbs, as well as the prevalence of gastrocnemius soleus equinus, in children with and without calcaneal apophysitis (Severs disease).nnnMETHODSnthe participants were 54 boys enrolled in a soccer academy, of which eight were lost to follow-up. Twenty-two boys with unilateral Severs disease comprised the Severs disease group and 24 healthy boys constituted a control group. Plantar pressure data were collected using pedobarography, and gastrocnemius soleus equinus was assessed.nnnRESULTSnpeak pressure and percentage of body weight supported were significantly higher in the symptomatic feet of the Severs disease group than in the asymptomatic feet of the Severs disease group and the control group. Every child in the Severs disease group had bilateral gastrocnemius equinus, while nearly all children in the control group had no equinus.nnnCONCLUSIONSnhigh plantar foot pressures are associated with Severs disease, although it is unclear whether they are a predisposing factor or a result of the condition. Gastrocnemius equinus may be a predisposing factor for Severs disease. Further research is needed to identify other factors involved in the disease and to better understand the factors that contribute to abnormal distribution of body weight in the lower limbs.

Dexamethasone for Parapneumonic Pleural Effusion: A Randomized, Double-Blind, Clinical Trial

Objective To assess whether dexamethasone (DXM) decreases the time to recovery in patients with parapneumonic pleural effusion. Study design This was a multicenter, randomized, double blind, parallel‐group, placebo‐controlled clinical trial of 60 children, ranging in age from 1 month to 14 years, with community‐acquired pneumonia (CAP) and pleural effusion. Patients received either intravenous DXM (0.25 mg/kg/dose) or placebo every 6 hours over a period of 48 hours, along with antibiotics. The primary endpoint was the time to recovery in hours, defined objectively. We also evaluated complications and adverse events. Results Among the 60 randomized patients (mean age, 4.7 years; 58% female), 57 (95%) completed the study. Compared with placebo recipients, the patients receiving DXM had a shorter time to recovery, after adjustment by severity group and stratification by center (hazard ratio, 1.95; 95% CI, 1.10‐3.45; P = .021). The median time to recovery for patients receiving DXM was 68 hours (2.8 days) shorter than patients receiving placebo (109 hours vs 177 hours; P = .037). In exploratory subgroup analysis, the median time to recovery for patients with simple effusion receiving DXM was 76 hours (3.1 days) shorter than for patients with simple effusion receiving placebo (P = .017). The median time to recovery for patients with complicated effusion receiving DXM was 14 hours (0.5 days) shorter than for patients with complicated effusion receiving placebo (P = .66). The difference in the effect of DXM in the 2 severity groups was not statistically significant (P = .138 for interaction). There were no significant differences in complications or adverse events attributable to the study drugs, except for hyperglycemia. Conclusion In this trial, DXM seemed to be a safe and effective adjunctive therapy for parapneumonic pleural effusion. Trial registration ClinicalTrials.gov: NCT01261546.

Ultrasound evaluation of intrinsic plantar muscles and fascia in hallux valgus: A case-control study.

AbstractA cross-sectional area (CSA) and thickness reduction of the abductor hallucis (AbH) is shown in subjects with hallux valgus (HV). To date, other soft-tissue structures have not been researched in relation with HV. The aim of this study was to compare the CSA and thickness of the intrinsic plantar muscles and fascia (PF) between feet with and without HV. Therefore, a cross-sectional and case-control study was performed using B-mode with an iU22 Philips ultrasound system and a 5 to 17-MHz transducer. The CSA and thickness were measured for the AbH, flexor digitorum brevis (FDB) and flexor hallucis brevis (FHB), and also the thickness for the anterior, middle, and posterior PF portions. A convenience sample of 40 feet, 20 with HV and 20 without HV, was recruited from a clinical and research center. A multivariate regression analysis using linear regression was performed to evaluate the ultrasound imaging measurements (&agr;u200a=u200a0.05). Consequently, statistically significant differences were observed between the groups (Pu200a<u200a0.05) for the AbH and FHB thickness, and CSA reduction, and also the plantar fascia thickness increase in favor of the HV group. On the contrary, the FDB thickness and CSA did not show statistically significant differences (Pu200a≥u200a0.05). In conclusion, the CSA and thickness of the AbH and FHB intrinsic plantar muscles are reduced, whereas the thickness of the anterior, middle, and posterior PF portions are increased, in subjects with HV compared with those without HV.

Interrater Reliability in the Clinical Evaluation of Myofascial Trigger Points in Three Ankle Muscles

OBJECTIVEnThe purpose of this study was to evaluate interrater reliability in the diagnosis of myofascial trigger points (MTrPs) in the tibialis anterior, peroneus brevis, and extensor digitorum longus muscles.nnnMETHODSnA reliability research study was performed. Three physical therapists with clinical experience in myofascial pain functioned as raters and randomly and bilaterally evaluated the ankles of 40 subjects in the Madrid public health care system. The absence or presence of MTrPs, nodules in taut bands, patterns of referred pain, local twitch response (LTR), and jump-sign were evaluated.nnnRESULTSnWe calculated the pairwise interrater agreement and κ-value concordance of the presence or absence of trigger points (55%-85%; κ = 0.12-0.60), palpable nodules in taut bands (63%-90%; κ = 0.24-0.60), referred pain (63%-85%; κ = 0.20-0.54), and jump sign (62%-89%; κ = 0.15-0.72) in the 3 studied muscles. The LTR could only be evaluated in the tibialis anterior (43%-70%; κ = 0.05-0.21), and evaluation was not possible for the other muscles.nnnCONCLUSIONSnThree blinded raters were able to reach acceptable pairwise interrater agreement (percentage of agreement value ≥70%) for the presence or absence of MTrPs and LTR in the tibialis anterior, as well as for nodules in taut bands, referred pain, and the jump sign for the extensor digitorum longus. The peroneus brevis showed a wide percentage of agreement value, ranging from 31% to 82%. The results of this study showed that expert raters can agree, with slight-to-moderate concordance, with regard to the clinical testing of muscle trigger points by direct palpation of the 3 muscles studied: the tibialis anterior, the extensor digitorum longus, and the peroneus brevis. Interrater reliability seems to be muscle dependent, especially with regard to the depth of the muscle.

Ultrasonography Comparison of Peroneus Muscle Cross-sectional Area in Subjects With or Without Lateral Ankle Sprains

OBJECTIVEnThe purpose of this study was to quantify the cross-sectional area (CSA) of the peroneus brevis, the peroneus longus, and connective tissue; to compare these measures in participants with and without lateral ankle sprains (LAS); and to determine the intraexaminer reliability of the protocol used to acquire these measures.nnnMETHODSnA cross-sectional case-control study was undertaken. B-mode ultrasound imaging was performed to measure the resting CSA and circular perimeter of the muscles and connective tissue and the total area and ratio between the CSA of the peroneus longus and the peroneus brevis. The imaging was performed for 56 feet, 28 with LAS and 28 without LAS (the mean numbers ± SD of total LAS, grade-I LAS and grade-II LAS were 4.1 ± 3.6, 2.71 ± 3.2, and 1.39 ± 0.9, respectively). A univariate correlation analysis using Pearson (r) and the Kendall tau_b (τB) coefficients was performed to evaluate the ultrasound imaging measurements (α = 0.05).nnnRESULTSnStatistically significant differences (P < .05) were observed between the 2 groups, with a moderate negative correlation for the circular perimeter of the peroneus longus (P = .001; r = -0.444) and a weak association for the CSA of the peroneus longus (P = .002; τB = - 0.349), the ratio between the CSA of the peroneus longus and the peroneus brevis (P = .008; τB = -0.293), and the circular perimeter of connective tissue (P = .013; τB = -0.277).nnnCONCLUSIONSnThe peroneus longus CSA is reduced in participants with LAS compared with that in participants without LAS. The intraexaminer reliability of the ultrasonography protocol was excellent when quantifying the peroneus brevis and the peroneus longus muscle tissues and acceptable when quantifying connective tissue.

The concurrent validity and reliability of the Leg Motion system for measuring ankle dorsiflexion range of motion in older adults

Background New reliable devices for range of motion (ROM) measures in older adults are necessary to improve knowledge about the functional capability in this population. Dorsiflexion ROM limitation is associated with ankle injuries, foot pain, lower limb disorders, loss of balance, gait control disorders and fall risk in older adults. The aim of the present study was to assess the validity and reliability of the Leg Motion device for measuring ankle dorsiflexion ROM in older adults. Methods Adescriptive repeated-measures study was designed to test the reliability of Leg Motion in thirty-three healthy elderly patients older than 65 years. The subjects had to meet the following inclusion and exclusion criteria in their medical records: older than 65 years; no lower extremity injury for at least one year prior to evaluation (meniscopathy, or fractures) and any chronic injuries (e.g., osteoarthritis); no previous hip, knee or ankle surgery; no neuropathic alterations and no cognitive conditions (e.g., Alzheimer’s disease or dementia). Participants were recruited through the person responsible for the physiotherapist area from a nursing center. The subjects were evaluated in two different sessions at the same time of day, and there was a break of two weeks between sessions. To test the validity of the Leg Motion system, the participants were measured in a weight-bearing lunge position using a classic goniometer with 1° increments, a smartphone with an inclinometer standard app (iPhone 5S®) with 1° increments and a measuring tape that could measure 0.1 cm. All testing was performed while the patients were barefoot. The researcher had ten years of experience as a physiotherapist using goniometer, tape measure and inclinometer devices. Results Mean values and standard deviations were as follows: Leg Motion (right 5.15 ± 3.08; left 5.19 ± 2.98), tape measure (right 5.12 ± 3.08; left 5.12 ± 2.80), goniometer (right 45.87° ± 4.98; left 44.50° ± 5.54) and inclinometer app (right 46.53° ± 4.79; left 45.27° ± 5.19). The paired t-test showed no significant differences between the limbs or between the test and re-test values. The test re-test reliability results for Leg Motion were as follows: the standard error of the measurement ranged from 0.29 to 0.43 cm, the minimal detectable difference ranged from 0.79 to 1.19 cm, and the intraclass correlation coefficients (ICC) values ranged from 0.97 to 0.98. Conclusions The results of the present study indicated that the Leg Motion device is a valid, reliable, accessible and portable tool as an alternative to the classic weight-bearing lunge test for measuring ankle dorsiflexion ROM in older adults.

Comparison of hand grip strength and upper limb pressure pain threshold between older adults with or without non-specific shoulder pain

Background There is a high prevalence of non-specific shoulder pain associated with upper limb functional limitations in older adults. The purpose of this study was to determine the minimal clinically important differences (MCID) of grip strength and pressure pain threshold (PPT) in the upper limb between older adults with or without non-specific shoulder pain. Methods A case-control study was carried out following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) criteria. A sample of 132 shoulders (mean ± SD years) with (n = 66; 76.04 ± 7.58) and without (n = 66; 75.05 ± 6.26) non-specific pain were recruited. The grip strength and PPT of the anterior deltoid and extensor carpi radialis brevis (ECRB) muscles were assessed. Results There were statistically significant differences (mean ± SD; P-value) for anterior deltoid PPT (2.51 ± 0.69 vs 3.68 ± 0.65, kg/cm2; P < .001), ECRB PPT (2.20 ± 0.60 vs 3.35 ± 0.38 kg/cm2; P < .001) and grip strength (20.78 ± 10.94 vs 24.63 ± 9.38 kg; P = .032) between shoulders with and without non-specific pain, respectively. Discussion The MCID of 1.17 kg/cm2, 1.15 kg/cm2 and 3.84 kg were proposed for anterior deltoid PPT, ECRB PPT and grip strength, respectively, to assess the upper limb of older adults with non-specific shoulder pain after treatment. In addition, univariate and multivariate (linear regression and regression trees) analyses may be used to consider age distribution, sex, pain intensity, grip strength and PPT in older adults including clinical and epidemiological studies with non-specific shoulder pain.

Tendinopatía aquilea y ejercicio excéntrico, una revisión narrativa

Objectives: The main objective of this bibliographical review is to know the most effective application according to the science of eccentric exercise (EE) when it comes to managing Aquilles Tendinopathy (AT). The secondary objectives are to know the differences between the sexes when receiving the treatment of eccentric exercise in the AT and to know the mechanism of action of EE in the AT. Methods: A literature search was made in the PubMed database. The following terms were used: “Tendinopathy”, “Tendinopathy treatment”, “Tendinopathy eccentric” “Tendinopathy eccentric exercise”, “Achilles tendinopathy”, “Achilles tendinopathy treatment”, “Achilles tendinopathy rehabilitation”, “Achilles tendinopathy physical therapy”, “Achilles tendinopathy exersice”, “Achilles tendinopathy eccentric”. We selected articles that provided methodological quality, scientific relevance, or a novel vision. Results: We found articles that support the application of EE as a treatment for AT and the recommended dosage. We found several articles that theorize about the effects of EE on AT. An article was found that differentiates the effects of EE in men and women in AT. Conclusions: EE is the treatment of choice in AT. The Alfedson protocol has the most scientific support. In the future it will be necessary to carry out studies of higher methodological quality on different exercise options. It is not clear what are the mechanisms of EE action in the TA. It is shown that the effects of EE in women are limited compared to men.

Impact of Hallux Valgus related of quality of life in Women

The purpose of this study is to analyse and compare the impact of hallux valgus (HV) in a sample of adult women with varying degrees of HV scores obtained with regard to foot health and health in general. A total 100 female patients of mean age 43·04u2009±u200916·84u2009years who attended a podiatric clinic were asked to answer a questionnaire. The degree of deformity, HV, was determined on both feet of the patients using the Manchester Scale tool and the scores from the Foot Health Status Questionnaire were compared. Participants with varying degrees of HV recorded lower scores in Section 1 for the footwear and general foot health and higher scores for foot pain and foot function. In Section 2, they obtained lower scores in physical activity and social capacity and higher scores in vigour and general health. Differences between the four groups were evaluated by means of a t‐test for independent samples, showing statistical significance (Pu2009<u20090·001). This study has detected measurable differences of association between varying degrees of HV with impaired quality of life related to foot health in women.