Raquel Sánchez-Rodríguez

Plantar pressures determinants in mild Hallux Valgus

While podobarometric techniques have been applied to the study of pressures in Hallux Valgus (HV), little is known about its clinical and radiological determinants. So, the aim of the present study was to determine the plantar pressure pattern in participants with mild HV, comparing to a control group, and their clinical and anthropometric determinants. Biofoot/IBV(®) in-shoe system was used to evaluate 79 participants with mild HV. Computerized measurements of the 1st intermetatarsal angle (IMA) and the hallux abductus angle (HAA) were made on antero-posterior radiographs. The clinical outcome was assessed using the AOFAS score. The dependent baropodometric variables and the independent clinical and anthropometric variables were subjected to a multiple regression analysis. In both groups, the highest average pressure was in the 2nd metatarsal head (MTH). The mean pressure under the Hallux was significantly higher in HV group (controls, 146.5±92.5kPa; HV, 328.5±113.2kPa; p<0.001). An 18.6% of average pressure under the 1st MTH was accounted for pain, first ray alignment and total AOFAS score. Variations of the HAA explained 26.8% of the mean Hallux pressure. Women with mild HV present with pathologically increased pressure under the Hallux, which is caused by the altered alignment of the first ray. Pain and clinical result were associated with the pressure under the 1st MTH and the remaining variables were only moderate predictors of dynamic plantar pressures.

A New Onychocryptosis Classification and Treatment Plan

Onychocryptosis is a pathologic condition of the nail apparatus in which the toenail damages the nail fold. It is a common condition provoking pain, inflammation, and functional limitation. It principally occurs in the hallux. Onychocryptosis is one of the most frequent complaints regarding the foot and accounts for many clinical consultations. The disorder has been classified in terms of the stages of the pathologic condition. In our practice, we discovered a clinical entity that was not previously classified in the literature. We classify onychocryptosis into stages I, IIa, IIb, III, and the new stage IV. A treatment plan is offered for each stage of this classification, with both general and specific indications given. In onychocryptosis treatment, it is important to select the surgical technique best suited to the patients particular clinical situation.

Can the Foot Posture Index or their individual criteria predict dynamic plantar pressures

The Foot Posture Index (FPI) quantifies foot posture through the evaluation of six individual criteria. The objective of the present study was then to establish the plantar pressure differences between types of feet, and to study the capacity of the whole FPI value and the six individual criteria to predict the pattern of plantar pressures. In a sample of 400 healthy subjects (201 men and 199 women), the FPI was evaluated and plantar pressures were measured in 10 zones using the Footscan(®) platform. Five plantar pressures measurements were made for each foot, using for the study the mean of these measurements for each subjects left foot. The hallux and the lesser toes had lower pressure indices in highly supinated feet, with the values increasing progressively toward the highly pronated feet (p<0.001 and p=0.019 respectively). The fifth metatarsal head (MTH) values were greater in highly supinated feet, and decreased in the highly pronated feet (p<0.001). The FPI value predicts low variability of plantar pressures, mainly in the heel and midfoot, while the individual criteria predict higher variability in the forefoot. The talonavicular prominence and the calcaneal frontal plane position was the most influential criterion, explaining 8.5% of the hallux pressure and 11.1% of the fifth MTH pressure. Neither talar head palpation nor the supra and infra malleolar curvature predicted any of the plantar pressures variables. The FPI can distinguish three groups of feet--pronated, neutral, and supinated. Its individual criteria predict moderate or low plantar pressures variability, with the talonavicular prominence being the most influential criterion.

Cadence, Age, and Weight as Determinants of Forefoot Plantar Pressures Using the Biofoot In-shoe System

BACKGROUND We evaluated normal plantar pressures and studied the effect of weight, cadence, and age on forefoot plantar pressures in healthy subjects by using the Biofoot (Instituto de Biomecánica de Valencia, Valencia, Spain) in-shoe measurement system. METHODS The feet of 45 healthy subjects with no evident foot or lower-limb diseases were measured with the Biofoot in-shoe system. The forefoot was divided into seven areas: the first through fifth metatarsal heads, the hallux, and the second through fifth lesser toes. Three trials of 8 sec each were recorded twice in each subject, and the mean was used to analyze peak and mean plantar pressures. A multiple regression model including weight, age, and cadence was run for each metatarsal head, the hallux, and the lesser toes. Intraclass correlation coefficients and coefficients of variation were also calculated to assess reliability. RESULTS The second metatarsal head had the greatest peak (960 kPa) and mean (585.1 kPa) pressures, followed by the third metatarsal head. Weight and cadence combined explained 18% and 23% of peak plantar pressure at the second and third metatarsal heads, respectively (P < .001). The intraclass correlation coefficient varied from 0.76 to 0.96 for all variables. The coefficient of variation between sessions ranged from 5.8% to 9.0%. CONCLUSION The highest peak and mean plantar pressures were found at the second and third metatarsal heads in healthy subjects. Weight, cadence, and age explained a low variability of this pressure pattern. The Biofoot in-shoe system has good reliability to measure plantar pressures. These data will have implications for the understanding of normal foot biomechanics and its determinants.

Dynamic plantar pressure analysis and midterm outcomes in percutaneous correction for mild hallux valgus.

Mild hallux valgus (HV), which can lead to alteration of the plantar pressure pattern with an overpressure under the hallux, can be repaired percutaneously. Our goals were to determine whether the percutaneous distal soft tissue release (DSTR)‐Akin procedure restores the loading pattern and to evaluate which are the determinants of the measures of post‐operative outcome. Seventy‐nine percutaneous DSTR‐Akin procedures were performed in the same number of patients. The plantar pressure patterns were evaluated using the BioFoot/IBV® in‐shoe system and compared with measurements from 98 controls. The clinical and radiological outcome parameters measured were the pre‐ and post‐operative AOFAS scores, and the first intermetatarsal, hallux abductus, and first metatarsal–hallux declination angles (FIMA, HAA, FMHDA) in weight‐bearing radiographs. The mean follow‐up was 28.1 (range 24–33) months. The plantar pressure analysis showed a significant decrease (328–152 kPa, p = 0.001) in the mean pressure under the hallux. Significant improvements occurred in the AOFAS scores, and angular deviations were reduced. The post‐operative HAA correlated with the mean pressure under the 1st toe (r2 = 0.132, p < 0.001). The DSTR‐Akin percutaneous technique in mild HV restores physiological patterns of pressure on the hallux and achieves significant correction of radiographic angles and commensurate improvement in clinical status. © 2011 Orthopaedic Research Society Published by Wiley Periodicals, Inc. J Orthop Res 29:1700–1706, 2011

The Effect of Moderate Running on Foot Posture Index and Plantar Pressure Distribution in Male Recreational Runners

BACKGROUND Fatigue due to running has been shown to contribute to changes in plantar pressure distribution. However, little is known about changes in foot posture after running. We sought to compare the foot posture index before and after moderate exercise and to relate any changes to plantar pressure patterns. METHODS A baropodometric evaluation was made, using the FootScan platform (RSscan International, Olen, Belgium), of 30 men who were regular runners and their foot posture was examined using the Foot Posture Index before and after a 60-min continuous run at a moderate pace (3.3 m/sec). RESULTS Foot posture showed a tendency toward pronation after the 60-min run, gaining 2 points in the foot posture index. The total support and medial heel contact areas increased, as did pressures under the second metatarsal head and medial heel. CONCLUSIONS Continuous running at a moderate speed (3.3 m/sec) induced changes in heel strike related to enhanced pronation posture, indicative of greater stress on that zone after physical activity. This observation may help us understand the functioning of the foot, prevent injuries, and design effective plantar orthoses in sport.

Estudio del patrón de presiones plantares en pies con hallux valgus mediante un sistema de plantillas instrumentadas

Introduccion Las presiones que soporta el antepie en una patologia como el hallux valgus ha sido un tema discutido, con resultados dispares. Este articulo pretende comparar las presiones soportadas por el antepie en un grupo de pies normales y en un grupo de pies con hallux valgus leves o moderados. Material y metodos Se realiza un estudio en 60 sujetos (30 con hallux valgus y 30 con pies sanos), que son analizados con el sistema Biofoot/IBV de plantillas instrumentadas. El sistema emplea unas finas plantillas (0,7 mm de grosor) con 64 sensores piezoelectricos. Se analiza la presion maxima en siete regiones, las cinco cabezas metatarsales, el hallux y los dedos menores. Resultados Los picos maximos de presion en el grupo control se localizaron significativamente en segunda y tercera cabeza metatarsal (p = 0,001). El grupo de pies con hallux valgus registraron picos en la primera cabeza y en el hallux (p = 0,001). La localizacion de los picos de presion en el primer radio sugiere la pronacion como factor desencadenante del hallux valgus. Conclusiones Los sistemas de plantillas instrumentadas son excelentes para analizar las presiones normales y patologicas. Son necesarios estudios mas amplios para llegar a conclusiones mas precisas. Se abren diferentes vias de investigacion, como el estudio de las presiones a cadencias y velocidades determinadas y con diferentes calzados.

Tungiasis--traveler's ectoparasitosis of the foot: a case report.

Tungiasis is a temporary human ectoparasitosis caused by the burrowing flea, Tunga penetrans. Its temporary nature occurs since one evolutionary form of the parasite’s life cycle participates in the process causing the lesion.2 This ectoparasitosis is mainly found in many parts of sub-Saharan Africa, and Brazil and other Latin American countries.5 The flea is also known as nigua (Argentina, Venezuela, and the Caribbean), kuti, suthipique (Bolivia), ogri-eye (Surinam), bicho de pé, bicho de porco (Brazil), chica (Colombia and Venezuela), sikka (Guyana), pique (Argentina, Chile, Uruguay, and Paraguay), piqui (Quechua), and tii (Tupi-Guarani).15 As well as humans, several domestic and peridomestic animals are affected.9 Where humans live in close contact with these animals, the risk of infection is high.12,21 Dogs are considered to be the most important source of such infestations.4 In endemic zones, Tunga penetrans has an apparent preference for sandy, poorly illuminated, soils. Significant control measures include paving public streets and laying cement on the floors of dwellings.10 Tunga penetrans is also found in the sand of beaches, which is the most common location of infestation for tourists. In the life cycle of Tunga penetrans the eggs are laid on the ground, and hatch in 3 or 4 days. After 2 weeks, the larva spins a cocoon. After 1 or 2 weeks, the adult female fleas penetrate the skin of the host. It creates a groove or ‘fibrous sac’ with its head within the dermis in contact with

Estudio baropodométrico de los valores de presión plantar en pies no patológicos

Resumen Introduccion El objetivo de este estudio fue evaluar las presiones plantares normales en sujetos sanos mediante baropodometria electronica. Material y metodos Cuarenta y seis sujetos sanos fueron analizados con el sistema Biofoot ® de plantillas instrumentadas. El sistema emplea unas plantillas con 64 sensores piezoelectricos. Se midieron las presiones en el talon, mediopie y antepie en 6 segundos de grabacion para cada sujeto. El pico de presion maxima y la presion media fue calculado y analizado. Resultados La media del tiempo de contacto fue de 0,81 segundos (desviacion estandar [DE] 0,08) en el pie derecho, y 0,82 segundos (DE 0,09) en el izquierdo. La cadencia fue de 105,6 (± 8,4) pasos por minuto. El pico maximo de presion y presion media en el retropie fue de 750 y 253 kPa, respectivamente. En el mediopie el pico de presion fue de 400 kPa y la presion media de 65 kPa. En el antepie los valores encontrados fueron de 1.240 kPa para el pico de presion y de 220 kPa para la presion media. Discusion Los picos de presion mas elevados se encontraron en el antepie, seguidos del retropie y por ultimo en el mediopie. En relacion a la presion media, el porcentaje de apoyo del talon es del 46,4 %, el del mediopie de un 12 % y el del antepie de un 41,6 %. Con el numero de pacientes analizados no se encontro correlacion entre cadencia y presiones, aunque el peso presentaba una correlacion significativa y positiva con los valores de presion en todas las zonas.

Normal values of the Foot Posture Index in a young adult Spanish population: a cross-sectional study.

BACKGROUND Although the appearance of foot or lower-limb pathologies is etiologically multifactorial, foot postures in pronation or supination have been related to certain diseases such as patellofemoral syndrome and plantar fasciitis. The objective of the present study was to determine the normal values of foot posture in a healthy young adult Spanish sample, and to identify individuals at risk of developing some foot pathology. METHODS The Foot Posture Index (FPI) was determined in a sample of 635 (304 men, 331 women) healthy young adults (ages 18-30 years). The FPI raw score was transformed into a logit score, and a new classification was obtained with the mean ± 2 SD to identify the 5% of the sample with potentially pathologic feet. RESULTS The normal range of the FPI was -1 to +6, and FPI values from +10 to +12 and -6 to -12 could be classified as indicating potentially pathologic feet. The womens logit FPI (0.50 ± 1.4, raw FPI +3) was higher than the mens (0.25 ± 1.6, raw FPI +2), with the difference being significant (P = 0.038). No statistically significant differences were found between body mass index groups (P = 0.141). CONCLUSIONS The normal FPI range goes from just one point of supination to a certain degree of pronation (+6). The identification of 35 individuals with potentially pathologic feet may help in the implementation of a preventive plan to avoid the appearance of foot disorders.