Impact of 90 minutes running exercise on plantar loading of the forefoot: a prospective study on symptom-free athletes

Many studies have demonstrated that individuals who engage in running exercises appear to develop musculo-skeletal injuries more frequently [1]. Considering the foot, the most common injuries include stress fractures of the metatarsals, plantar fasciitis, tibialis posterior lesions and ankle sprains. Studies have been conducted who analysed the loading characteristics of the foot in repeated measurement designs – before and after exercise – in order to find a pathomechanical pathway for metatarsal stress fractures [2-4]. The published studies evaluated the in-shoe plantar pressure during treadmill running [2,3] or barefoot after a marathon [4]. To date, no investigation have been conducted who evaluated the impact of a regular training session onto the forefoot loading characteristics. The objective of this investigation was therefore to identify changes in loading characteristics of the foot after a 90 minute running exercise

Diabetic foot: The orthopedic surgery angle

AbstractAs diabetes takes on pandemic proportions, it is crucial for the orthopedic surgeon to be aware of the issues involved in diabetic foot. Ulceration is related to neuropathy and to arterial disease, a vital prognostic factor for healing; infection plays an aggravating role, increasing the risk of amputation. At-risk feet need to be screened for. Ulcer classification is essential, to set treatment strategy and determine prognosis. Before any treatment is decided on, neuropathy, vascular insufficiency and infection should individually be assessed by clinical examination and appropriate additional work-up. Despite the International Consensus on the Diabetic Foot recommendations, management of diabetic foot in Europe still varies greatly from country to country, very few of which have established reference centers. Management of diabetic foot remains multidisciplinary; but it has been shown that the orthopedic surgeon should play a central role, providing a biomechanical perspective so as to avoid complications recurrence. Strategy notably includes prevention of at-risk foot, revascularization surgery (which should systematically precede orthopedic surgery in case of critical vascular insufficiency), and treatment of ulcers, whether these latter are associated with osteitis or not. Indications for “minor” amputation should be adequate, and meticulously implemented. “Acute foot” is a medical emergency, entailing massive empirically selected I.V. antibiotics to “cool” the lesion. Prophylactic surgery to limit further risks of ulceration is to be indicated with caution and only when clearly justified. France urgently requires accredited specialized multidisciplinary centers to manage severe lesions: deep and infected ulceration, advanced arteriopathy, and Charcot foot arthropathy

Évaluation clinique des arthrodèses de l’arrière-pied associées à deux types de greffes : « allogreffe– demineralized bone matrix (DBM)–ponction de moelle » versus « autogreffe-DBM ». Revue de 115 arthrodèses

La pseudarthrose est une complication fréquente (15 %) des arthrodèses de l’arrière-pied et de la cheville. L’utilisation d’autogreffe permet d’améliorer la fusion grâce à ses propriétés d’ostéoconduction, d’ostéo-induction et d’ostéogénicité. Cependant, le prélèvement des autogreffes est source de morbidité. Une alternative est le traitement combiné allogreffe–demineralized bone matrix (DBM)–ponction de moelle iliaque. Par cette association, cette greffe se rapproche des propriétés biologiques de l’os sain. Employée seule, l’allogreffe présente des propriétés ostéoconductrices et parfois structurales. L’ajout de DBM permet d’apporter des propriétés d’ostéo-induction et d’améliorer l’ostéoconductivité. La ponction de moelle y amène la cellularité et donc des propriétés d’ostéogénicité