Distribution and correlates of plantar hyperkeratotic lesions in older people

<p>Abstract</p> <p>Background</p> <p>Plantar hyperkeratotic lesions are common in older people and are associated with pain, mobility impairment and functional limitations. However, little has been documented in relation to the frequency or distribution of these lesions. The aim of this study was to document the occurrence of plantar hyperkeratotic lesions and the patterns in which they occur in a random sample of older people.</p> <p>Methods</p> <p>A medical history questionnaire was administered to a random sample of 301 people living independently in the community (117 men, 184 women) aged between 70 and 95 years (mean 77.2, SD 4.9), who also underwent a clinical assessment of foot problems, including the documentation of plantar lesion locations, toe deformities and the presence and severity of hallux valgus.</p> <p>Results</p> <p>Of the 301 participants, 180 (60%) had at least one plantar hyperkeratotic lesion. Those with plantar lesions were more likely to be female (χ²= 18.75, <it>p </it>< 0.01; OR = 2.86), have moderate to severe hallux valgus (χ²= 6.15, <it>p </it>< 0.02; OR = 2.95), a larger dorsiflexion range of motion at the ankle (39.4 ± 9.3 <it>vs </it>36.3 ± 8.4°; <it>t </it>= 2.68, <it>df </it>= 286, <it>p </it>< 0.01), and spent more time on their feet at home (5.1 ± 1.0 <it>vs </it>4.8 ± 1.3 hours, <it>t </it>= -2.46, <it>df </it>= 299, <it>p </it>= 0.01). No associations were found between the presence of plantar lesions and body mass index, obesity, foot posture, dominant foot or forefoot pain. A total of 53 different lesions patterns were observed, with the most common lesion pattern being "roll-off" hyperkeratosis on the medial aspect of the 1^stmetatarsophalangeal joint (MPJ), accounting for 12% of all lesion patterns. "Roll-off" lesions under the 1^stMPJ and interphalangeal joint were significantly associated with moderate to severe hallux valgus (<it>p </it>< 0.05), whereas lesions under the central MPJs were significantly associated with deformity of the corresponding lesser toe (<it>p </it>< 0.05). Factor analysis indicated that 62% of lesion patterns could be grouped under three broad categories, relating to medial, central and lateral locations.</p> <p>Conclusion</p> <p>Plantar hyperkeratotic lesions affect 60% of older people and are associated with female gender, hallux valgus, toe deformity, increased ankle flexibility and time spent on feet, but are not associated with obesity, limb dominance, forefoot pain or foot posture. Although there are a wide range of lesion distribution patterns, most can be classified into medial, central or lateral groups. Further research is required to determine whether these patterns are related to the dynamic function of the foot or other factors such as foot pathology or morphology.</p

Clinical recognition of symptomatic midfoot osteoarthritis: findings from the clinical assessment study of the foot

Purpose: Osteoarthritis (OA) is a common yet poorly understood cause of disabling foot pain. In the absence of radiographic confirmation of OA, clinical diagnosis in primary care is inhibited by lack of evidence informing clinical examination. This study aimed to determine whether the presence of symptomatic midfoot OA (SMOA) can be clinically identified in older adults with midfoot pain presenting to primary care.Methods: A diagnostic model using brief clinical assessments was developed using cross-sectional data from 274 adults aged ≥50 years who had self-reported midfoot pain in the last month and attended a research assessment clinic between 2010-2011. All clinical assessment data were collected by trained physiotherapy or podiatry assessors adhering to a standardised, quality-controlled protocol. Presence of radiographic midfoot OA in at least one of four scored joints (1st and 2nd cuneo-metatarsal joint, navicular-first cuneiform joint, and talo-navicular joint) was ascertained by a single reader using a validated atlas and scoring system, and who was blinded to the clinical assessment data. Radiographic OA was defined as a score of ≥2 for osteophytes or joint space narrowing on either weight-bearing dorso-plantar or lateral views. SMOA was defined as co-occuring radiographic OA and midfoot pain. One foot per participant was entered into the analysis. The selection of predictor variables was based on known associations with OA or mechanically-driven putative links to SMOA. Significant predictor variables (p<0.25 from likelihood ratio tests) from univariable analyses were simultaneously entered into a multivariable logistic regression model and backward elimination (p=0.05) was performed. The Hosmer-Lemeshow statistic assessed the calibration of the refitted model and the area under the curve (AUC) evaluated discrimination. Histograms visually summarised discrimination. Internal validation of the model was performed using 1000 bias-corrected bootstrap samples with replacement.Results: 274 participants without inflammatory disease comprised 125 men and 149 women (mean age 65 yrs, SD 9). Of these 155 had midfoot pain and 119 had SMOA. 16 univariable analyses identified 9 significant predictors and no collinearity was observed. In addition to force-entered variables (age, gender, body mass index (BMI)), only two independent predictors of SMOA were retained in the multivariable analysis: (i) reduced ankle dorsiflexion with the knee flexed and (ii) absence of a midfoot exostosis. Based on the strength of univariable association, the Foot Posture Index, subtalar inversion and ankle dorsiflexion with the knee extended appeared too weak to contribute to the final model, whereas the removal of the Arch Index and foot length-corrected navicular height was due to the stronger influence of age explaining these relationships. The final fitted model was well calibrated (p=0.79) but discrimination was poor (AUC, 0.69; 95%CI: 0.62, 0.75). Bootstrapping revealed a small degree of overfitting. The use of categorical predictor variables in continuous form did not identify any other predictors, nor did it improve model performance.Conclusions: Brief clinical assessments offer only marginal improvement to age, gender and BMI for identifying SMOA. Milder severity in a population sample, random and systematic error in the clinical assessment, and variable expression of SMOA disease manifestation may have contributed to poor diagnostic accuracy. A clinically defined SMOA phenotype based on modifiable joint loading characteristics may offer an alternative approach to facilitating the development of more targeted biomechanical interventions

The imaging properties of the Gas Pixel Detector as a focal plane polarimeter

X-rays are particularly suited to probe the physics of extreme objects. However, despite the enormous improvements of X-ray Astronomy in imaging, spectroscopy and timing, polarimetry remains largely unexplored. We propose the photoelectric polarimeter Gas Pixel Detector (GPD) as an instrument candidate to fill the gap of more than thirty years of lack of measurements. The GPD, in the focus of a telescope, will increase the sensitivity of orders of magnitude. Moreover, since it can measure the energy, the position, the arrival time and the polarization angle of every single photon, allows to perform polarimetry of subsets of data singled out from the spectrum, the light curve or the image of source. The GPD has an intrinsic very fine imaging capability and in this work we report on the calibration campaign carried out in 2012 at the PANTER X-ray test facility of the Max-Planck-Institut f\"ur extraterrestrische Physik of Garching (Germany) in which, for the first time, we coupled it to a JET-X optics module with a focal length of 3.5 m and an angular resolution of 18 arcsec at 4.5 keV. This configuration was proposed in 2012 aboard the X-ray Imaging Polarimetry Explorer (XIPE) in response to the ESA call for a small mission. We derived the imaging and polarimetric performance for extended sources like Pulsar Wind Nebulae and Supernova Remnants as case studies for the XIPE configuration, discussing also possible improvements by coupling the detector with advanced optics, having finer angular resolution and larger effective area, to study with more details extended objects.Comment: Accepted for publication in The Astrophysical Journal Supplemen

Transference Principles for Log-Sobolev and Spectral-Gap with Applications to Conservative Spin Systems

We obtain new principles for transferring log-Sobolev and Spectral-Gap inequalities from a source metric-measure space to a target one, when the curvature of the target space is bounded from below. As our main application, we obtain explicit estimates for the log-Sobolev and Spectral-Gap constants of various conservative spin system models, consisting of non-interacting and weakly-interacting particles, constrained to conserve the mean-spin. When the self-interaction is a perturbation of a strongly convex potential, this partially recovers and partially extends previous results of Caputo, Chafa\"{\i}, Grunewald, Landim, Lu, Menz, Otto, Panizo, Villani, Westdickenberg and Yau. When the self-interaction is only assumed to be (non-strongly) convex, as in the case of the two-sided exponential measure, we obtain sharp estimates on the system's spectral-gap as a function of the mean-spin, independently of the size of the system.Comment: 57 page

Reliability of the TekScan MatScan® system for the measurement of plantar forces and pressures during barefoot level walking in healthy adults

<p>Abstract</p> <p>Background</p> <p>Plantar pressure systems are increasingly being used to evaluate foot function in both research settings and in clinical practice. The purpose of this study was to investigate the reliability of the TekScan MatScan^®system in assessing plantar forces and pressures during barefoot level walking.</p> <p>Methods</p> <p>Thirty participants were assessed for the reliability of measurements taken one week apart for the variables maximum force, peak pressure and average pressure. The following seven regions of the foot were investigated; heel, midfoot, 3^rd-5^thmetatarsophalangeal joint, 2^ndmetatarsophalangeal joint, 1^stmetatarsophalangeal joint, hallux and the lesser toes.</p> <p>Results</p> <p>Reliability was assessed using both the mean and the median values of three repeated trials. The system displayed moderate to good reliability of mean and median calculations for the three analysed variables across all seven regions, as indicated by intra-class correlation coefficients ranging from 0.44 to 0.95 for the mean and 0.54 to 0.97 for the median, and coefficients of variation ranging from 5 to 20% for the mean and 3 to 23% for the median. Selecting the median value of three repeated trials yielded slightly more reliable results than the mean.</p> <p>Conclusions</p> <p>These findings indicate that the TekScan MatScan^®system demonstrates generally moderate to good reliability.</p

The clinical assessment study of the foot (CASF): study protocol for a prospective observational study of foot pain and foot osteoarthritis in the general population.

BACKGROUND: Symptomatic osteoarthritis (OA) affects approximately 10% of adults aged over 60 years. The foot joint complex is commonly affected by OA, yet there is relatively little research into OA of the foot, compared with other frequently affected sites such as the knee and hand. Existing epidemiological studies of foot OA have focussed predominantly on the first metatarsophalangeal joint at the expense of other joints. This three-year prospective population-based observational cohort study will describe the prevalence of symptomatic radiographic foot OA, relate its occurrence to symptoms, examination findings and life-style-factors, describe the natural history of foot OA, and examine how it presents to, and is diagnosed and managed in primary care. METHODS: All adults aged 50 years and over registered with four general practices in North Staffordshire, UK, will be invited to participate in a postal Health Survey questionnaire. Respondents to the questionnaire who indicate that they have experienced foot pain in the preceding twelve months will be invited to attend a research clinic for a detailed clinical assessment. This assessment will consist of: clinical interview; physical examination; digital photography of both feet and ankles; plain x-rays of both feet, ankles and hands; ultrasound examination of the plantar fascia; anthropometric measurement; and a further self-complete questionnaire. Follow-up will be undertaken in consenting participants by postal questionnaire at 18 months (clinic attenders only) and three years (clinic attenders and survey participants), and also by review of medical records. DISCUSSION: This three-year prospective epidemiological study will combine survey data, comprehensive clinical, x-ray and ultrasound assessment, and review of primary care records to identify radiographic phenotypes of foot OA in a population of community-dwelling older adults, and describe their impact on symptoms, function and clinical examination findings, and their presentation, diagnosis and management in primary care