Ultrasound clinical references of the healthy toenail unit

The toenail unit, commonly called the nail, is one of the most frequently examined and treated structures in clinical podiatry. Ultrasound is a standard clinical technique because it is a noninvasive, painless, and rapid diagnostic tool. The main objective of this study was to obtain morphometric data of the healthy toenail unit by ultrasound for clinical application. The nails of 76 participants (152 hallux nails; 38 men, 38 women, average age 26.83 ± 12.20) were examined using a VINNO E35 ultrasound system and an X6-16L linear probe with a frequency of 18 MHz. Five ultrasound measures of the healthy toenail unit were obtained, of which only the distance from the center of the distal phalange to the nail plate varied with age, sex, weight, and foot (p-values ≤ 0.050). The other four parameters were less influenced by the variables analyzed, except sex, which influenced nearly all (p-values ≤ 0.050). In one of these variables, indications of significance were observed (p-values = 0.060), with greater distances in the men than in the women, except for nail plate curvature, which showed a higher value. The other variables studied did not influence the parameters analyzed. High-frequency ultrasound can be used to examine the healthy toenail unit and define anthropometric reference measurements that can be used for more accurate and comparative diagnosis.

Quality of Life, Pedobarographic Parameters, and Foot Disorders in Patients with Extreme Obesity: Preliminary Results on Changes After Bariatric Surgery with Gastric Bypass

PURPOSE

Obesity is a growing health problem that affects a high percentage of the population. In podiatry context, few studies have addressed obesity because most pedobarographic systems are unable to bear the weight of patients with obesity, making it difficult to examine and manage these patients. The objective of this study was analyzed the sociodemographic characteristics, quality of life, foot disorders, and pedobarographic parameters of patients with extreme obesity who are candidates for bariatric surgery and determine the changes after weight loss post-surgery.

MATERIALS AND METHODS

We conducted a foot examination, a pedobarographic study using a Podoprint® pressure platform, and a quality of life questionnaire (EQ-5D) on 23 patients with extreme obesity and analyzed the changes 12-18 months after surgery in 11 of them.

RESULTS

We observed foot disorders, high plantar pressure, greater rearfoot contact, flat footprint, asymmetries, and alterations in toe contact. Almost 73.9% of participants said they had foot pain, 56.5% said they had impaired mobility, and more than 40% said they had limitations in carrying out daily activities and suffered from anxiety. After weight loss, we observed improved quality of life; more foot disorders; changes in total contact area, plantar pressures, barycenter, contact time, and footprint; decreased pain perception, walking problems and anxiety situations. Moreover, medication decreased, but they need to take more vitamins and calcium.

CONCLUSION

Weight loss improved the quality of life of the participating patients but altered their foot disorders. All parameters need regular reassessment to detect changes and modify initially prescribed treatments.

Evaluation of Thermography as a Diagnostic Technique in Asymptomatic or Incipient Onychomycosis

Onychomycosis is usually diagnosed symptomatically due to the very clear signs caused by the fungus on the nail surface and structure, although the growth of the infecting agent must also be verified by culture in an enriched medium. This procedure is normally lengthy (four weeks), and samples can be contaminated, delaying the prescription of appropriate and effective treatment. Only one previous study has addressed the possibility of using thermography as a diagnostic method for onychomycosis in older people (31–70 years). The present study confirms this use but in individuals aged 18–31 years with incipient mycosis and no pathological signs. Using an FLIR E60 BX camera in a study with 214 samples, we found that men had more onychomycosis than women. We observed a relation between the presence of infection and nail temperature, with a higher temperature in yeast infections (+1 °C) and a lower temperature in dermatophyte infections (−2 °C). A higher temperature by almost 1 °C was also observed in older participants. Thermography can be viewed as a new diagnostic method in asymptomatic or incipient onychomycosis, providing the thermographic camera is sufficiently sensitive and the appropriate procedure is followed, although fungal culture is always necessary to confirm recovery after treatment.

Meta-analysis of the antifungal activities of three essential oils as alternative therapies in dermatophytosis infections

Aims

This work examines the available scientific evidence about the efficiency of essential oils (EO) as an alternative therapy to traditional treatment of fungal infections, including onychomycosis, assessing the effect of the three EO most frequently studied for their antifungal activity (thyme, cinnamon and tea tree EO) against three causative agents of fungal diseases in humans: Trichophyton rubrum, Trichophyton mentagrophytes complex and Candida albicans.

Methods and Results

The PRISMA statement protocol was followed to conduct a bibliographical search and 54 articles that met all the inclusion criteria were retrieved. Differences were observed in the MIC and MFC values depending on the micro‐organism strain and the EO used. The lowest MIC were observed with Cinnamomum zeylanicum EO (0.013–1120 μl ml⁻¹) against the three micro‐organisms. For MFC, the lowest value was found for Thymus vulgaris EO (4.2 μl ml⁻¹) against Trichophyton rubrum.

Conclusions

The antifungal effects of EO could be a very promising solution to overcome the therapeutic shortcomings of antimycotic medication. More experiments are needed to examine the properties of these oils to devise effective and nonaggressive therapies for treatment of dermatophytosis.

Significance and Impact of Study

The results indicate that EO remain good candidates for future treatments and could provide a solution for failed medications and/or adverse reactions to current pharmacological treatments.

Toe Support Pattern as a New Predictive Factor Associated with Falls in Older People with Psychiatric Disorders

BACKGROUND

Maintaining autonomy is one of the principal objectives for seniors and people with psychiatric disorders. Podiatric medical care can help them maintain autonomy. This work aimed to characterize and quantify the support of the toes in a psychiatric population by analyzing the influence of psychotropic medications and toe and foot support parameters on the prevalence of falls.

METHODS

We conducted a cross-sectional descriptive study in 67 participants (31 people with psychiatric disorders and 36 without diagnosed disorders [control population]). Toe support pattern was analyzed with a pressure platform. Variables were measured in static and dynamic loading and related to falls and psychotropic medication use.

RESULTS

The psychiatric population fell more than the control population and presented less toe-ground contact in static measurements, although it has more foot-ground contact time. Maximum toe pressure during toe-off is also less intensive in the psychiatric population and is related to people who take psychotropic medications.

CONCLUSIONS

Toe support pattern could be used as a predictive factor for falls and to improve stability in these populations.

Importance of Sock Type in the Development of Foot Lesions on Low-Difficulty, Short Hikes

Background and objectives: Foot lesions can be developed during hiking because of external factors. This makes it important to study the effect of hiking equipment on lesion development. Materials and Methods: Technical and non-technical socks were given to 109 hikers to wear during a short hike. Participants were examined at three stages of the hike to determine the development of dermal, muscle and nail lesions, temperature and perimeter in various areas of each foot. Results: The percentage of hikers without injuries was significantly higher among those wearing technical socks (p-value < 0.001). Differences were also observed in mean foot temperature, which was higher in participants wearing technical socks (p-value < 0.001). Conclusion: The results indicate that even on a low-difficulty, short-term sport activity, it is advisable to wear technical socks to prevent lesion development and keep the foot temperature more stable. Sock type was identified as an external conditioning factor in lesion development.

Importance of Preexisting Physical Factors in the Development of Dermatological and Muscular Lesions During Hiking

Hiking has become very popular due to the physical and mental health benefits it provides. Skin lesions may occur with hiking and various factors contribute to their development. Although some lesions may appear to have little importance, something as simple as chaffing can cause serious ulcers in people with at-risk feet. Few studies have analyzed preexisting physical characteristics in hiking and addressed the development of lesions in hikers. This observational and longitudinal study examines the development of foot lesions during hiking, taking into account the influence of existing skin disorders, nail disorders, and/or toe deformities and other intrinsic factors of participants. The feet of 109 hikers doing a 29.6-km hike were analyzed, considering the intrinsic factors of participants and the possible influence of these factors in the development of foot lesions during the walk. The results show that some preexisting physical factors of participants such as gender, existing systemic disease, preexisting keratosis, dermatosis, nontraumatic and traumatic onychopathies, and toe deformities significantly predispose to the development of skin lesions. These factors also predispose to muscle lesions except for nontraumatic and traumatic onychopathies and toe deformities. Due to the influence of preexisting physical factors, such as preexisting keratosis, dermatosis, and toe deformities, in the development of foot lesions in hikers, it is worthwhile and advisable to check these factors before a hike to reduce the incidence of foot disorders. Ensuring adequate podiatry treatment a few days before the walk and warmup of muscles properly before starting are recommended.

Using a polymerase chain reaction as a complementary test to improve the detection of dermatophyte fungus in nails

BACKGROUND

Dermatomycoses are a group of pathologic abnormalities frequently seen in clinical practice, and their prevalence has increased in recent decades. Diagnostic confirmation of mycotic infection in nails is essential because there are several pathologic conditions with similar clinical manifestations. The classical method for confirming the presence of fungus in nail is microbiological culture and the identification of morphological structures by microscopy.

METHODS

We devised a nested polymerase chain reaction (PCR) that amplifies specific DNA sequences of dermatophyte fungus that is notably faster than the 3 to 4 weeks that the traditional procedure takes. We compared this new technique and the conventional plate culture method in 225 nail samples. The results were subjected to statistical analysis.

RESULTS

We found concordance in 78.2% of the samples analyzed by the two methods and increased sensitivity when simultaneously using the two methods to analyze clinical samples. Now we can confirm the presence of dermatophyte fungus in most of the positive samples in just 24 hours, and we have to wait for the result of culture only in negative PCR cases.

CONCLUSIONS

Although this PCR cannot, at present, substitute for the traditional culture method in the detection of dermatophyte infection of the nails, it can be used as a complementary technique because its main advantage lies in the significant reduction of time used for diagnosis, in addition to higher sensitivity.