Ricardo Becerro-de-Bengoa-Vallejo

Mechanical stress redistribution in the calcaneus after autologous bone harvesting

The calcaneus is a desirable site for harvesting autologous bone for use in foot surgery. However, fracture of the calcaneus is a serious complication associated with bone harvesting from this site. Currently it is unknown how much bone may be safely harvested from the calcaneus without inducing a fracture. The purpose of this study was to investigate the effect of progressive bone removal from the calcaneus onto the mechanical stress redistribution of the foot, and therefore on the increase in fracture risk. Different loads were applied on the talus to evaluate the calcaneus stress distribution at different situations. Because of the potential increase in mechanical stress in the calcaneus, secondary to contraction of the Achilles tendon, we also evaluated the mechanical behavior properties of the foot with increasing traction force in the Achilles tendon. A three-dimensional (3D) finite element (FE) model developed from CT images obtained from a healthy individual was used to compute displacement, tension and compression stresses in six situations, including intact foot, and five depth of the bone block removed, with a maximum depth of 7.5 mm. The results from these simulations indicated that when the maximum load was applied at the Achilles tendon, the tension stress increased from 42.16 MPa in the intact foot to 86.28 MPa with maximum bone harvesting. Furthermore, as the volume of bone extracted from the calcaneus increases, there is a redistribution of stresses that differs significantly from the intact foot. In fact, although the maximum stress was not significantly affected by increasing the volume of bone harvested-except when increasing the Achilles tendon force-, stresses did increase in areas of the calcaneus is vulnerable to injury, leading to an increase in fracture risk.

Static and Dynamic Plantar Pressures in Children With and Without Sever Disease: A Case-Control Study

Background Calcaneal apophysitis (Sever disease) has been reported to be the most common cause of heel pain in athletic children. Objective The study aim was to compare plantar pressure, plantar surface contact area, distribution of body weight across the lower extremities, and prevalence of gastrocnemius ankle equinus and gastrocnemius-soleus ankle equinus (which can cause decreases in ankle dorsiflexion range of motion) in children with and without Sever disease. Design This was a case-control study. Methods Participants were 56 male students enrolled in a soccer academy. Twenty-eight participants had Sever disease (Sever disease group), and 28 participants were healthy (control group). Dynamic and static peak plantar pressures, plantar surface contact area, and body weight distribution were assessed with pedobarography. A goniometer was used to assess gastrocnemius and gastrocnemius-soleus ankle dorsiflexion range of motion. Results Both maximum and average peak pressures and percentages of body weight supported by each heel were significantly higher in the symptomatic feet of participants in the Sever disease group than in the control group. Twenty-six participants with Sever disease but only 8 participants in the control group exhibited bilateral gastrocnemius ankle equinus. Limitations A limitation of the study is that measurements were obtained from participants who were symptomatic. Conclusions Higher heel plantar pressures under dynamic and static conditions appear to be associated with Sever disease. It is unclear, however, whether these higher pressures are a predisposing factor contributing to the disease or a result of the condition. Gastrocnemius ankle equinus also may be a predisposing factor for Sever disease. Further research is needed to identify other biomechanical factors associated with the disease to enhance prevention and treatment strategies.

Reliability of the OptoGait portable photoelectric cell system for the quantification of spatial-temporal parameters of gait in young adults

Determining progress in gait requires a reliable method. However, achieving standard assessment results in the clinical setting can be challenging. Searching for a reliable tool, we tested OptoGait, a tool that has floor-level, high-density photoelectric cells that can be used to determine patterns of spatial-temporal gait on the basis of 19 variables: step length, stride length, distance, total contact time, step time, walking speed, acceleration, progressive step time, cadence, gait cycle, stance phase, swing phase, heel contact phase, flatfoot phase, takeoff phase, single limb support, double limb support, load response phase, and pre-swing phase. The gait of 126 study participants (41 males, 85 females; 27.37±1.77 years) was assessed twice for each participant during 10 episodes of walking on a 10m walkway each 2 weeks apart. Intra-session and inter-session results were compared using data for each foot alone as well as both feet together. All variables resulted in a high consistency except for acceleration. The intra-session data showed substantial agreement; the intra-class correlation coefficient (ICC) ranged from 0.72-0.78 in the heel contact phase, 0.72-0.76 in the load response phase, and 0.76-0.85 in the pre-swing phase and a low SEM. The inter-session data for each foot alone and both feet together showed substantial agreement (0.77-0.79 in the load response phase) and slight agreement for acceleration (0.06-0.22) with a low SEM. Based on these results, we conclude that the OptoGait system can be used with confidence to evaluate spatial-temporal gait except for acceleration and progressive step time assessment.

Footwear used by older people and a history of hyperkeratotic lesions on the foot: A prospective observational study

Abstract Inadequate footwear, painful and hyperkeratotic lesions (HL) are an extremely common problems amongst older people. Such problems increase the risk of falls, hamper mobility, reduction of quality of life, dignity, and ability to remain independent. The etiology of painful and feet conditions is poorly understood. To discover footwear preferences of older people, pain tolerance may favor presence of HL for the use of inadequate footwear in old age. A sample of 100 participants with a mean age of 74.90 ± 7.01 years attended an outpatient clinic where self-reported demographic data, frequency with which they checked their feet were recorded and measurements were taken of foot sensitivity. Additionally, all participants’ shoes were allocated into optimal, adequate, and dangerous categories based on design, structural and safety features, and materials. Only 12% of the sample population checked their feet every day, 37% revealed symptoms of neuropathy, 14% used optimal shoes, and 61% presented HL. In a bivariate analysis, no significant differences were observed. HL are associated with inadequate footwear, loss of sensitivity, and low frequency of foot health checks.Inadequate footwear, painful and hyperkeratotic lesions (HL) are an extremely common problems amongst older people. Such problems increase the risk of falls, hamper mobility, reduction of quality of life, dignity, and ability to remain independent. The etiology of painful and feet conditions is poorly understood. Todiscover footwearpreferencesof olderpeople,pain tolerancemay favorpresenceofHL for theuseof inadequate footwear inoldage. A sample of 100 participants with amean age of 74.90±7.01 years attended an outpatient clinic where self-reported demographic data, frequency with which they checked their feet were recorded and measurements were taken of foot sensitivity. Additionally, all participants’ shoes were allocated into optimal, adequate, and dangerous categories based on design, structural and safety features, and materials. Only 12% of the sample population checked their feet every day, 37% revealed symptoms of neuropathy, 14% used optimal shoes, and 61% presented HL. In a bivariate analysis, no significant differences were observed. HL are associated with inadequate footwear, loss of sensitivity, and low frequency of foot health checks. Abbreviations: BMI = body mass index, HL = hyperqueratosis lesions, SD = standard deviation.

Relationship of depression in participants with nonspecific acute or subacute low back pain and no-pain by age distribution

Background and purpose Nonspecific low back pain (LBP) is the most prevalent musculoskeletal condition in various age ranges and is associated with depression. The aim of this study was to determine the Beck Depression Inventory (BDI) scores in participants with nonspecific LBP and no-pain by age distribution. Methods A case–control study was carried out following the Strengthening the Reporting of Observational Studies in Epidemiology criteria. A sample of 332 participants, divided into the following age categories: 19–24 (n=11), 25–39 (n=66), 40–64 (n=90), 65–79 (n=124), and ≥80 (n=41) years was recruited from domiciliary visits and an outpatient clinic. The BDI scores were self-reported in participants with nonspecific acute or subacute (≤3 months) LBP (n=166) and no-pain (n=166). Results The BDI scores, mean ± standard deviation, showed statistically significant differences (p<0.001) between participants with nonspecific acute or subacute LBP (9.590±6.370) and no-pain (5.825±5.113). Significantly higher BDI scores were obtained from participants with nonspecific acute and subacute LBP in those aged 40–64 years (p<0.001; 9.140±6.074 vs 4.700±3.777) and 65–79 years (p<0.001; 10.672±6.126 vs 6.210±5.052). Differences were not significant in younger patients aged 19–24 (p=0.494; 5.000±2.646 vs 8.250±7.498), 25–39 (p=0.138; 5.440±5.245 vs 3.634±4.397), and in those aged ≥80 years (p=0.094; 13.625±6.1331 vs 10.440±5.591). Conclusion Participants with nonspecific acute and subacute LBP present higher BDI depression scores, influenced by age distribution. Specifically, patients in the age range from 40 to 80 years with LBP could require more psychological care in addition to any medical or physical therapy. Nevertheless, physical factors, different outcomes, and larger sample size should be considered in future studies.

Impact of Hallux Valgus related of quality of life in Women: Hallux valgus related to 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 43·04 ± 16·84 years 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 (P < 0·001). This study has detected measurable differences of association between varying degrees of HV with impaired quality of life related to foot health in women.

Reliability and concurrent validity of a peripheral pulse oximeter and health–app system for the quantification of heart rate in healthy adults

There are downloadable applications (Apps) for cell phones that can measure heart rate in a simple and painless manner. The aim of this study was to assess the reliability of this type of App for a Smartphone using an Android system, compared to the radial pulse and a portable pulse oximeter. We performed a pilot observational study of diagnostic accuracy, randomized in 46 healthy volunteers. The patients’ demographic data and cardiac pulse were collected. Radial pulse was measured by palpation of the radial artery with three fingers at the wrist over the radius; a low-cost portable, liquid crystal display finger pulse oximeter; and a Heart Rate Plus for Samsung Galaxy Note®. This study demonstrated high reliability and consistency between systems with respect to the heart rate parameter of healthy adults using three systems. For all parameters, ICC was > 0.93, indicating excellent reliability. Moreover, CVME values for all parameters were between 1.66−4.06 %. We found significant correlation coefficients and no systematic differences between radial pulse palpation and pulse oximeter and a high precision. Low-cost pulse oximeter and App systems can serve as valid instruments for the assessment of heart rate in healthy adults.

Foot health-related quality of life among elderly with and without lesser toe deformities: a case–control study

Purpose The aim of this study was to compare the health-related quality of life impact related to foot health and health in general in older adults with lesser toe deformities (LTD) and without any foot conditions. Methods A case–control observational study was carried out following the Strengthening the Reporting of Observational Studies in Epidemiology criteria. A total of 100 older adults with a mean age of 74.39±6.02 years were recruited at an outpatient clinic; 50 of these subjects had LTD (case group) and 50 subjects were without any foot conditions (control group). Presence of LTD was determined in both feet using the Kelikian push-up test, and the Foot Health Status Questionnaire scores were self-reported. Results The case group showed lower scores in quality of life in relation to health in general and to foot health specifically. Statistically significant differences (p<0.05) between case and control groups were shown by means of the Wicoxon test. Conclusion A negative impact in quality of life in relation to foot health should be considered in older adults with LTD, regardless of gender.

Electromyography comparison of the effects of various footwear in the activity patterns of the peroneus longus and brevis muscles

BACKGROUND Peroneus longus and brevis (PLB) disorders are commonly in people with lateral ligamentous instability, ankle pain, lateral hindfoot pain and structures of the proximal compartment of the lower legs and their muscle activity is believed to be influenced by different footwear types. The proposal of this research is to evaluate the effects of five types of footwear with respect to the barefoot condition and analyze the activity patterns of PLB muscles in healthy subjects during the gait cycle. METHODS Thirty healthy subjects were recruited in a laboratory in this cross-sectional research design. While walking, electromyography (EMG) activity was measured from PLB via surface electrodes in six experimental conditions: 1) barefoot, 2) minimalist, 3) pronated control, 4) air chamber, 5) ethyl-vinyl-acetate (EVA) and 6) boost. These data were obtained and compared. RESULTS The peroneus brevis showed significant reductions in the peak amplitude of the five footwear types (minimalist, pronation control, air chamber, EVA and boost) with respect to the barefoot condition in the propulsion phase of the gait cycle during walking (P = 0.034; P < 0.001; P < 0.001; P < 0.001; P = 0.006) and running (P = 0.004; P < 0.001; P = 0.001; P < 0.001; P = 0.001), respectively. Furthermore, peroneus longus showed significant reductions in the peak amplitude of these five footwear types with respect to the barefoot condition in the propulsion phase of the gait cycle during running (P = 0.005; P = 0.038; P = 0.019; P = 0.025; P = 0.021). CONCLUSION The EMG activity patterns of the PLB muscles may depend on the use of different types of sport shoes such as minimalist, pronation control, air chamber, EVA and boost footwear with respect the barefoot condition in different phases of the gait cycle during walking and running.

Impact of the mechanical hyperkeratotic lesions and its association with quality of life: An observational case–control study

Mechanical hyperkeratotic lesions (MHL) are common condition amongst population of all ages. Such problems may be associated with pain, reduction in mobility, changes of gait and risk of falls and is believed to affect the quality of life (QoL), general health and optimal foot health.