First ray mobility in hallux limitus patients vs. normal patients

Objetivos: El objetivo de este trabajo fue determinar el movimiento del primer radio en el plano sagital en sujetos con hallux limitus y compararlo con el de los sujetos con pies normales mediante el uso de un nuevo instrumento de medida del primer radio. Además, valorar la relación entre la extensión metatarsofalángica y los movimientos del primer radio. Pacientes y métodos: Se valoró la extensión de la primera articulación metatarsofalángica y la movilidad del primer radio en el plano sagital en dos grupos de estudio: sujetos con hallux limitus y un grupo control. Para ello se utilizó un nuevo instrumento de medida del primer radio válido y fiable. Resultados: El movimiento del primer radio para el grupo de hallux limitus en el plano sagital fue de 7.04 ± 0.22 mm de dorsiflexión, 3.51 ± 0.29 mm de plantarflexión y de 10.55 ± 0.33 mm de rango total. Y para el grupo control fue de 5.82 ± 0.21 mm de dorsiflexión, 5.33 ± 0.21 mm de plantarflexión y de 11.15 ± 0.39 mm de rango total. El movimiento total de extensión metatarsofalángica mostró una correlación moderada y directa con la plantarflexión del primer radio (r = 0.63), y débil e inversa con la dorsiflexión del primer radio (r = - 0.36). Conclusión: En los participantes de este estudio se observó que los sujetos con hallux limitus presentaron más movimiento en dorsiflexión y menos movimiento en plantarflexión que los sujetos normales. Sin embargo, el rango de movimiento total fue similar para ambos grupos de estudio.Objectives: The objective of this study was to determine the first ray range of motion (ROM) in the sagittal plane in hallux limitus patients and to compare it with those patients with normal feet by using a new measuring device of first ray mobility. In addition, to assess the relationship between metatarsophalangeal dorsiflexion and first ray mobility. Patients and methods: The dorsiflexion for the first metatarsophalangeal joint and the mobility of the first ray in the sagittal plane were assessed in two study groups: hallux limitus patients and a control group. A new valid and reliable measuring device of the first ray mobility was used. Results: ROM of the first ray for the hallux limitus group in the sagittal plane was 7.04 ± 0.22 mm for dorsiflexion, 3.51 ± 0.29 mm for plantarflexion, and 10.55 ± 0.33 mm of total range. And for the control group it was 5.82 ± 0.21 mm of dorsiflexion, 5.33 ± 0.21 mm of plantarflexion and 11.15 ± 0.39 mm of total range. The total movement of metatarsophalangeal dorsiflexion showed a moderate and direct correlation with the plantarflexion of the first ray (r = 0.63), and weak and inverse with the dorsiflexion of the first ray (r = - 0.36). Conclusion: In the participants of this study, it was observed that the subjects with hallux limitus had more dorsiflexion and less plantarflexion than normal subjects. However the total range of motion was similar in both study groups

Development and Validation of the Overall Foot Health Questionnaire for Patients with Rheumatoid Arthritis: A Cross-Sectional Descriptive Analysis

Background and Objectives: In general, patients with rheumatoid arthritis (RA) are ignorant of the physician’s role and of RA-related feet problems. The aim of our study was to validate a questionnaire on the knowledge of different aspects of overall foot health in patients with RA. Materials and Methods: A cross-sectional descriptive analysis was carried out between March 2017 and April 2017. A questionnaire was designed and validated through the Delphi method to evaluate the knowledge about the illness, the repercussions on feet, medical podiatry care, and the role of the medical podiatrist. Results: After being checked by a panel of experts, all the items obtained a Cronbach’s alpha over 0.70. Conclusions: The content of this questionnaire about the knowledge of different aspects of medical podiatry health in patients with RA has internal consistenc

Bipartite hallucal sesamoid bones: relationship with hallux valgus and metatarsal index

Objective. To relate the incidence of the partition of the hallucal sesamoid bones with the size of the first metatarsal and the hallux valgus deformity. Materials and Methods. In a sample of 474 radiographs, the frequency of appearance of bipartite sesamoids was studied. The length and relative protrusion of the first metatarsal, and the hallux abductus angle, were measured and compared between the feet with and without sesamoid partition. Results. The results showed that 14.6% of the feet studied had at least one partite sesamoid, that the sesamoid most frequently divided was the medial, and that unilateral partition was the most common. No difference was found in the incidence of partite sesamoids between men and women, or between left and right feet. Conclusion. Protrusion and length of the first metatarsal are higher in feet with partite sesamoids than in feet without this condition. A significantly higher incidence of bipartite medial sesamoid was obtained in feet with hallux valgus compared with normal feet

Static range of motion of the first metatarsal in the sagittal and frontal planes

The first metatarsal and medial cuneiform form an important functional unit in the foot, called “first ray”. The first ray normal range of motion (ROM) is difficult to quantify due to the number of joints that are involved. Several methods have previously been proposed. Controversy exists related to normal movement of the first ray frontal plane accompanying that in the sagittal plane. The objective of this study was to investigate the ROM of the first ray in the sagittal and frontal planes in normal feet. Anterior-posterior radiographs were done of the feet of 40 healthy participants with the first ray in a neutral position, maximally dorsiflexed and maximally plantarflexed. They were digitalized and the distance between the tibial malleolus and the intersesamoid crest in the three positions mentioned was measured. The rotation of the first ray in these three positions was measured. A polynomic function that fits a curve describing the movement observed in the first ray was obtained using the least squares method. ROM of the first ray in the sagittal plane was 6.47 (SD 2.59) mm of dorsiflexion and 6.12 (SD 2.55) mm of plantarflexion. ROM in the frontal plane was 2.69 (SD 4.03) degrees of inversion during the dorsiflexion and 2.97 (SD 2.72) degrees during the plantarflexion. A second-degree equation was obtained, which represents the movement of the first ray. Passive dorsiflexion and plantarflexion of the first ray were accompanied by movements in the frontal plane: 0.45 degrees of movement were produced in the frontal plane for each millimeter of displacement in the sagittal plane. These findings might be useful for the future design of instruments for clinically quantifying first ray mobility

Medial deviation of the first metatarsal in incipient hallux valgus deformity

The intermetatarsal angle between metatarsals I and II (IMA 1-2) has been radiographicaly studied in 49 normal feet and in 49 feet with a mild hallux valgus (HV) deformity. The aim of the study is to know whether an excessive medial deviation of the first metatarsal with respect to II (IMA 1-2 over normal values reported by some authors) is present in the initial phase of HV. The results demonstrate that the difference in the mean intermetatarsal angle between the two groups is statistically significant (8.76º in normal feet; 9.98º in affected feet). However, the authors think it is not clinically significant. Other authors, comparing the IMA 1-2 in patients with more advanced HV and without HV, report greater differences than those obtained in this study,. The authors conclude that the excessive medial deviation of the first metatarsal is not a causal factor, but a consequence, in the HV deformity

Strain/counterstrain on internal pterygoid muscles. Short-term effects on mandibular dynamics

Objetivo: evaluar la amplitud articular y la fuerza de mordida tras aplicar los métodos de inhibición de tensión/contratensión (TCT) sobre los puntos gatillo miofasciales latentes (PGMs) del músculo pterigoideo interno. Intervención: cuarenta y nueve sujetos, 25 varones y 24 mujeres, fueron aleatoriamente distribuidos en dos grupos; el grupo experimental (25 sujetos) recibió tratamiento de TCT, y el grupo control (24 sujetos) recibió un tratamiento placebo. Las variables de resultado fueron la máxima apertura oral (MAO) y la máxima fuerza de la mordida (MFM). Resultados: los resultados mostraron una mejora significativa en la MAO [Control: (–0,02) mm ± 0,76; Experimental: 1,48 mm ± 1,3; p 0,05). Conclusión: los procedimientos de inhibición muscular mediante TCT se podrían emplear en el tratamiento de los PGMs del músculo pterigoideo interno para mejorar la MAO y la MFM, con independencia del sexo.Objetive: to assess the short-term effects on mandibular dynamics (in terms of jaw opening and bite force) of the application strain/counterstrain (SCS) on latent myofascial trigger points (MTrPs) of the internal pterygoid muscles. Intervention: forty nine subjects, 25 males and 24 females, were randomly allocated to one of two groups: experimental (25 subjects), who received SCS therapy, and control (24 subjects), who received a placebo treatment. As outcome variables, we considered maximum active jaw opening and maximum bite force. Results: the results showed a significant improvement with respect to active jaw opening [controls: (–0,02) mm ± 0,76; experimental subjects: 1,48 mm ± 1,3; p< 0,01] and maximum bite force [controls: (–0,06) N ± 1,21; experimental subjects: 32,43 N ± 16,81; p< 0,001] after treatment of MTrPs with SCS. Conclusions: our results suggest that muscular inhibition methods through the application of strain/counterstrain (SCS) could be used in the treatment of the MTrPs of the internal pterygoid muscles in order to improve maximum jaw opening and maximum bite force. Key words: strain/counterstrain, myofascial pain syndrome, mouth, bite force, muscle hypertonia, temporomandibula

The Validity and Reliability of a New Simple Instrument for the Measurement of First Ray Mobility

Several methods have been described to quantify the first ray mobility. They all have certain disadvantages (great size, sophistication, or lack of validation). The objective of this work was to study the validity and reliability of a new instrument for the measurement of first ray mobility. Anterior-posterior radiographs were obtained from 25 normal feet and 24 hallux valgus feet, with the first ray in a neutral position, maximally dorsiflexed and maximally plantarflexed. The first ray mobility was radiographicaly measured in both groups, and was also manually examined with the new device. A cluster analysis determined whether normal and hallux valgus feet were correctly classified, and a graphic analysis of Bland-Altman was performed to compare the radiographic and manual measurement techniques. Based on the radiographs, the first ray mobility only showed significant differences in dorsiflexion between both groups (P = 0.015). First ray dorsiflexion, plantarflexion and total range of motion measured with the new device were different between both groups (P = 0.040, P = 0.011 and P = 0.006, respectively). The silhouette measure of the cohesion and separation coefficients from the cluster analysis was greater than 0.50 for the dorsiflexion, plantarflexion and total range of motion obtained from the radiographs and from the new device. The Bland-Altman graph suggested that 96% of the data presented agreement between both measurement methods. These results suggested that the new instrument was valid and reliable

Podiatric Community Health Programs. Literature review

Objetivo: Realizar una revisión bibliográfica para identificar los Programas de salud de Podología basados en el cuidado de la salud de los pies en otros países y los programas o actividades similares desarrolladas en España. Método: Revisión bibliográfica en diferentes bases de datos (Pubmed, Scopus, CINAHL, SportDiscus y Goggle Académico), con diferentes descriptores MESH relacionados con el tema. Se incluyen artículos que tienen una relación directa con el desarrollo de Programas de Salud Podológica en diferentes países. Como primera línea se han seleccionado artículos que trataban específicamente de la implantación de guías, protocolos o programas de salud dirigidos específicamente por Podología; incluyéndose artículos sin limitar fecha de publicación en algunas bases de datos específicas, para elaborar un recorrido histórico por el campo de actuación de la Podología en diferentes épocas. Se excluyeron los artículos que no se relacionaban con el pie o con el miembro inferior; se incluyeron los artículos que tienen una relación directa con el desarrollo de Programas de Salud Podológica en diferentes países. Resultados: Se identificaron un total de 128 referencias. Se seleccionaron 74 y finalmente 19 estudios fueron los incluidos en el estudio, 16 internacionales y 9 nacionales. Conclusión: Existen escasez de investigaciones sobre Podología y Promoción de la Salud, hecho que nos llama la atención, pues la implementación de Programas de Salud Podológica tiene un impacto positivo en la salud de los pies de las personas y contribuyen a la prevención de alteraciones podológicas y ayudan a reducir la incidencia de complicaciones.Objective: Conduct a literature review to identify health programs based podiatry care foot health in other countries and programs or similar activities in Spain. Method: Literature review in different databases (Pubmed, Scopus, CINAHL, Academic SportDiscus and Goggle), with different descriptors related to the subject MESH. Items that have a direct relationship with the development of Podiatric Health Programs in different countries are included. As the first line have been selected articles dealing specifically with the implementation of guidelines, protocols or health programs specifically targeted by podiatry; without limiting being included articles published in some specific databases, to develop a historical overview of the field of action of podiatry at different times. Items that were not related to the foot or lower limb were excluded; items that have a direct relationship with the development of Podiatric Health Programs in different countries were included. Results: A total of 128 references were identified. 74 were selected and finally 19 studies were included in the study, 16 international and 9 national. Conclusion: There dearth of research on podiatry and health promotion. This fact calls our attention, because implementation of Podiatric Health Programs has a positive impact on the health of the feet of people and contribute to the prevention of podiatric disorders and help reduce the incidence of complications

Radiographic study of the mobility of the first ray in the sagittal and frontal planes

Objetivos: El objetivo de este trabajo fue estudiar el rango de movimiento del primer radio en el plano sagital y frontal en pies normales. Pacientes y métodos: Se realizaron radiografías anteroposteriores de tobillo que cogían todo el pie en 60 participantes sanos, con el primer radio en posición neutra, en máxima dorsiflexión y en máxima plantarflexión. Se digitalizaron las radiografías y se midió la distancia entre el maléolo tibial y la cresta intersesamoidea en las tres posiciones mencionadas. Mediante un ángulo trazado entre la cabeza del primer metatarsiano y una línea horizontal, se midió la rotación del primer radio en el plano frontal en esas tres posiciones. Resultados: El movimiento del primer radio para toda la muestra en el plano sagital fue de 5.91 ± 0.33 mm de dorsiflexión, y 4.92 ± 0.36 mm de plantarflexión. El movimiento en el plano frontal fue de 2.67 ± 0.52 grados de inversión durante la dorsiflexión, y de 2.97 ± 0.36 grados de eversión durante la plantarflexión. Conclusión: En los participantes de este estudio se observó que al realizar la dorsiflexión en el plano sagital, la cabeza del primer metatarsiano se invirtió, y al realizar la plantarflexión, el primer radio se evertió, por lo que se produjeron movimientos tanto en el plano sagital como en el frontal. En los participantes de este estudio se produjeron 0,52 grados de movimiento en el plano frontal por cada milímetro de desplazamiento en el plano sagital.Objectives: The objective of this study was to investigate the first ray normal range of motion (ROM) in the sagittal and frontal planes in normal feet. Patients and methods: Anterior-posterior radiographs were done of the ankle showing the whole foot of 60 healthy participants with the first ray in a neutral position, maximally dorsiflexed and maximally plantarflexed. They were digitalized and the distance between the tibial malleolus and the intersesamoid crest in the three positions mentioned was measured. The rotation of the first ray in these three positions was measured. Results: ROM of the first ray in the sagittal plane was de 5.91 ± 0.33 mm of dorsiflexion and 4.92 ± 0.36 mm of plantarflexion. ROM in the frontal plane was 2.67 ± 0.52 degrees of inversion during the dorsiflexion and 2.97 ± 0.36 degrees of eversion during the plantarflexion. Conclusion: In the participants of this study it was observed that when performing dorsiflexion in the sagittal plane, the head of the first metatarsal inverted, and when performing plantarflexion the first ray everted, thus producing movements in both the sagittal and frontal planes. 0.52 degrees of movement in the frontal plane took place in the participants of this study for each millimeter of displacement in the sagittal plane

Psychosocial Influence of Ehlers–Danlos Syndrome in Daily Life of Patients: A Qualitative Study

Ehlers–Danlos syndrome is a heterogeneous group of connective tissue disorders causing pain, fatigue, and disabilities; it has several implications for patients who suffer from this disease. The major clinical manifestations of EDS include joint hypermobility, skin hyperextensibility, and generalized conjunctive tissue fragility. This research aims to explore their perceptions and experiences about the phycological and social spheres. (2) Methods: Semistructured interviews were carried out. Participants were encouraged to talk about issues related to their disease by asking open-ended questions in one to one interview. The interview guide included questions to identify the syndrome’s influence on the social and psychological life of patients All interviews were audio recorded, fully transcribed, and analyzed using the phenomenological theoretical framework. The method of analysis was the thematic interpreting of perspectives and approaches. (3) Results: 31 individuals were proposed to participate in this study. Five patients refused to participate, so a total of 26 interviews were performed. Six themes ((1) Pain and its consequences on a daily basis; (2) The need to name the problem: the diagnosis; (3) Restructuring leisure and social relationships; (4) Limitations due to economic conditions; (5) Psychological impact of the disease situation; (6) Professional limitations) and four subthemes ((1) The value of partner support; (2) The weather influence on social plans; (3) Physical exercise and illness; (4) Support groups) emerged from the data. (4) Conclusions: This study revealed the impact of the syndrome on the social and daily life of patients, and not only in a physical level, but also in a psychological and social approach. These findings allow healthcare providers to know more about this disease in order to support and give advice to patients about the changes they will have to make.University of Seville “VI PLAN PROPIO DE INVESTIGACIÓN Y TRANSFERENCIA—US 2018