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

Tumor de Köenen: Etiología, diagnóstico diferencial y tratamiento de elección

Los tumores de Köenen son, en muchas ocasiones, el único signo patognomónico de la esclerosis tuberosa. Estas lesiones benignas con frecuencia presentan sintomatología dolorosa, afectando a la capacidad del paciente para caminar o usar calzado, junto con las repercusiones estéticas acompañantes. La exploración clínica irá encaminada a realizar un diagnóstico lo más certero posible, teniendo presente la existencia de otras lesiones con características clínicas similares (verrugas, granuloma piógeno, tumor glómico y fibroqueratoma periungueal adquirido) que pueden desorientarnos a la hora de la confirmación definitiva. En cuanto a la etiología y su diferencia con el fibroqueratoma digital adquirido, podemos decir que ambas presentan como denominador común antecedentes traumáticos. Aunque cabe mencionar que en el caso del tumor de Köenen la mutación de los genes TSC1 y TSC2, juega un papel determinante en el crecimiento tumoral. Desde el punto de vista terapéutico, existen una serie de terapias alternativas a la cirugía convencional tales como la fenolización y el láser de CO2, siendo ambas muy aceptadas debido a la reducción del tiempo de cirugía y los buenos resultados estéticos, aunque por el contrario presenten una alta tasa de recidiva. Por lo tanto, con idea de garantizar una solución definitiva al problema, nos decantamos por la cirugía para la exéresis completa del tumor con la exposición de la matriz, ofreciéndonos las mayores garantías de éxito. El motivo de este trabajo radica en entender una alteración del pie como un principal signo diagnóstico de un trastorno sistémico, siendo aquí cuando el podólogo, es el especialista sanitario que se encuentra en primera línea diagnóstica de dicha patología. Aunque existe un general desconocimiento sobre diversos aspectos relacionados con el tumor de Köenen, queda patente el creciente interés por esta lesión en los últimos años

Clinical protocol of leg length inequality

[Abstract] Objectives: To propose a clinical protocol valid and reliable for the study of the differences in length of lower limb (hereinafter DLMI) scan.Materials and Methods: Literature review in scientific databases, and descriptive study with a total sample of 115 participants: study of different methods of determination and measurement of DLMI.Results: There is no consensus as to the reliability and validity of methods and measurement instruments existing in the literature. It has been proven the reliability of the proposed protocol, according to the results of other authors and the data obtained in our study.Conclusions: The Weber-Barstow maneuver, study with tape measure, PALM® and tablets and pelvic compensation level for clinical determination of DLMI is proposed. The anteroposterior telemetry lower limb load as a complementary test, and the Foot Posture Index (hereinafter FPI) and Navicular Drop Test (hereinafter NDT) for the analysis of the position of the foot[Resumen] Objetivos: Proponer un protocolo clínico de exploración válido y fiable para el estudio de las diferencias de longitud de miembro inferior (en adelante DLMI).Material y método: Revisión bibliográfica en bases de datos científicas, y estudio descriptivo sobre con una muestra total de 115 participantes: estudio de los diferentes métodos de determinación y medición de las DLMI.Resultados: No existe consenso en cuanto a la fiabilidad y validez de los métodos e instrumentos de medida existentes en la bibliografía consultada. Se ha comprobado la fiabilidad del protocolo propuesto, según los resultados de otros autores y por los datos obtenidos en nuestro estudio.Conclusiones: Se propone la maniobra Weber-Barstow, estudio con cinta métrica, PALM® y compensación con tablillas y nivel pélvico para la determinación clínica de las DLMI. La telemetría anteroposterior de miembros inferiores en carga como prueba complementaria, y el Foot Posture Index (en adelante, FPI) y Navicular Drop Test (en adelante, NDT) para el análisis de la posición del pi

Tratamiento quirúrgico del Tumor de Koënen: expresión podológica de la Esclerosis Tuberosa

The Koenen tumors are cutaneous manifestations of tuberous sclerosis, which is of systemic involvement and sometimes with location in the foot. The knowledge of this type of dermatological is very important for proper treatment and for this reason an interdisciplinary approach is essential for the accurate and early diagnosis. In the clinical history is important to make an assessment of family history, perform a scan of the skin and a neurological study. We report a case with symptoms consistent with the presence of tumor Koenen. The differential diagnosis is essential for planning treatment and get a good outcome and speedy recovery.Conclusions. Surgical treatment is proposed as a technique of choice despite the high rate of recurrence presents such treatment. Surgical resection of the lesion allows the pathological diagnosis.Los Tumores de Koënen son manifestaciones cutáneas de la Esclerosis Tuberosa, que es de afectación sistémica y en ocasiones con localización en el pie. El conocimiento de este tipo de afecciones dermatológicas es muy importante para un tratamiento correcto y por este motivo un enfoque interdisciplinario es esencial para que el diagnóstico sea preciso y precoz. En la Historia Clínica es importante realizar una valoración de los antecedentes familiares, realizar una exploración de la piel y un estudio neurológico. Se presenta un caso con clínica compatible con la presencia de Tumor de Koënen. El diagnostico diferencial es esencial para plantear el tratamiento y conseguir un buen pronóstico y pronta curación. Conclusiones. Se plantea el tratamiento quirúrgico como técnica de elección pese a la elevada tasa de recidivas que presenta dicho tratamiento. La resección quirúrgica de la lesión permite el diagnóstico anatomopatologico

Polyethylene Nail Brace for Ingrown Toenails Treatment: A Randomized Clinical Trial

[Abstract] Background: Onychocryptosis is one of the most prevailing onychopathies and one of the usual reasons for visiting podiatry clinics. In this research, we aim to evaluate the e ectiveness of a procedure of nail reeducation technique via a strip of polyethylene in subjects with stage I or IIa onychocryptosis, in which pathological toenail curves are present. Methods: This research was a randomized clinical trial (ACTRN12615000834550). The sample was made up of 94 cases of stage I or IIa onychocryptosis, according to the Mozena classification. Briefly, 46 cases were treated with the combination of a spicule technique and nail brace with a polyethylene plastic strip, and 48 were only treated with the spicule technique. Results: The combination of the spicule technique and the nail brace technique with a strip of polyethylene had a significantly lower recurrence rate compared to that achieved with just the spicule technique, twelve months after the beginning of the study (N.S. = 0.000 for = 0.05). The change in the nail width achieved with the nail brace technique, twelve months after the beginning of the study, was statistically significant (N.S. = 0.000 for = 0.05). Conclusions: The recurrence rate of the spicule technique alone was significantly higher than the combined technique of spicule with nail brace. A nail brace with a strip of polyethylene reduces the recurrence rate of onychocryptosis

Foot Pain and Morphofunctional Foot Disorders in Patients with Rheumatoid Arthritis: A Multicenter Cross-Sectional Study

[Abstract] Foot problems are highly prevalent in people with rheumatoid arthritis. This study aims to explore the foot morphology, pain and function in rheumatoid arthritis patients and the relation with the time of disease debut. A cross-sectional study was designed. Footprint, the Foot Posture Index, the hallux valgus prevalence, foot pain and function in 66 rheumatoid arthritis patients and the association with time since diagnosis, were recorded. The Foot Function Index, the Manchester Foot Pain and Disability Index, the Visual Analogic Scale, and the Manchester Scale for hallux valgus were administered and analyzed in two groups, with less and more than 10 years of diagnosis of the disease. A high prevalence of pronated (right 36.8% and left 38.6%) and highly pronated (right 15.8% and left 15.8%) feet was observed, as well as an elevated percentage of low arched footprints (right 68.4 and left 66.7%) and hallux valgus (right 59.6% and left 54.4%). Hallux valgus prevalence, toe deformities and Foot Function Index (Functional limitation) factors were significantly associated with the time since RA diagnosed adjusted for the other factors. The adjusted odds ratio of Hallux valgus prevalence was 4.9 (1.2–19.7). In addition, the foot function was diminished, and foot pain was present in most participants. In conclusion, rheumatoid arthritis patients’ feet showed altered morphology and function, and with longer rheumatoid arthritis history, metatarsophalangical stability and foot function, but not pain and global foot posture, were likely to deteriorat

Estudio descriptivo de los pacientes asistidos en el servicio de Pie de Riesgo del Área Clínica de Podología de la Universidad de Sevilla

El Área Clínica de Podología de la Universidad de Sevilla cuenta entre sus servicios con la Unidad de Pie de Riesgo. Donde se presta atención podológica integral a pacientes con lesiones podológicas o riesgo de padecerlas por enfermedades sistémicas que comprometen especialmente las funciones neurológicas y vasculares del pie, en especial la Diabetes. En el año 2012 se atendieron en este servicio un total de 117 pacientes. Se realiza un estudio descriptivo longitudinal retrospectivo de los principales datos registrados en las Historias clínicas de estos pacientes. Hay muchas variables que no están registradas en las Historias clínicas. Se propone la utilización de un registro especíi co para este servicio para intentar mejorar el grado de implementación de la Historia clínica.The Podiatry Clinic at the University of Seville among its services with risk foot unit. Where comprehensive podiatric care is provided to patients with podiatric injury or risk of suffering from systemic diseases especially involving neurological and vascular functions of the foot, especially diabetes. In 2012 this service was attended by a total of 117 patients. We performed a descriptive longitudinal retrospective study of the main data recorded in the medical records of these patients. There are many variables that are not recorded in medical records. We propose the use of a specii c register for this service to try to improve the level of implementation of the clinical history

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

Custom-made foot orthoses reduce pain and fatigue in patients with Ehlers-Danlos Syndrome. A pilot study

Background: Pain and fatigue are major clinical manifestations in patients with Ehlers-Danlos Syndrome (EDS). The aim of this study is to measure change of the effects of custom-made foot orthotics on some manifestations related to EDS, such as foot pain, foot functionality, fatigue, and quality of life. Methods: Thirty-six patients with EDS wore foot orthoses for three months. Foot pain, foot-related disability, foot functionality, fatigue, and quality of life were measured using the 11-point Numeric Rating Scale, the Manchester Foot Pain and Disability Index, the Foot Function Index, the Fatigue Severity Score, and the 12-Item Short Form Health Survey questionnaires, respectively, at the beginning and after 3 months. Results: Participants demonstrated significantly improved foot pain (p = 0.002), disability related to foot pain (p < 0.001), foot functionality (p = 0.001), fatigue (p < 0.007), and mental health-related quality of life (p = 0.016). The physical health-related quality of life did not show significant changes. Conclusions: The use of custom-made foot orthoses help in the management of the symptoms by participants. This study could contribute to the foot specialists being considered as an additional member in multidisciplinary teams that are trying to develop an approach for patients with EDS