Closed Degloving Injury of the Foot Caused by a High Impact Force: A Case Report

An 18-year-old male subject was referred to our MRI scanning center, by an orthopedic surgeon, for a swelling over the plantar region of the foot. He had been in a motor vehicle accident a few weeks back, with no evidence of fracture at the time of injury. In subsequent weeks, he developed a swelling over his foot. MRI showed the presence of a fluid intensity lesion in the subdermal and dermal layers of his foot. Unguarded motor vehicle accidents often tend to cause severe injuries. Sometimes, they even need operative management since a motor vehicle collision is a high-impact accident. One of the pathologies caused by a high impact force is the Morel-Lavallée lesion or a closed type of degloving injury. A Morel-Lavallee lesion also needs operative intervention if major vascular channels are involved in the degloving. However, if the major vessels supplying the region of degloving are intact, open surgery may not be needed. In such cases, incision and drainage along with serial wound dressing may be attempted. The primary risk in closed degloving is recurrent or subsequent tissue necrosis. Close and watchful monitoring is needed to anticipate and prevent these. Closed degloving injuries or Morel-Lavallée lesions have been commonly described in the thigh and pelvis region. Here, we describe a case that developed in the dermal and fascial layers of the foot and was managed conservatively. The epidermal layer showed regeneration, and the patient did not need subsequent amputation.

The Application of Neoprene Diving Boots in Reduction of Feet Injuries in the Sowing Process Among the Rice Farmers in Thailand

Foot injuries have been a problem among Thai farmers for a long time. The sowing process is one of the high-risk processes because farmers have to walk in the field to spray rice seed without footwear. Literature review showed that cuts from stepping on sharp material or snail shells were major sources of injury. Traditional footwear such as Ninja shoes or cloth socks have raised the questions regarding their ability in protection from such injuries. This study investigates using Neoprene diving boots to protect from foot injuries during the rice sowing process. The sample from this study were farmers from Sena District, Phra Nakhon Si Ayutthaya Province, Thailand. 29 farmer wearing Neoprene diving boots, 7 farmers wearing traditional Ninja shoes, and 19 farmers wearing cloth socks were asked to work in the sowing process and interviewed about any foot injuries that may have occurred. The statistical test showed there were no significant differences in characteristics among each group of farmers, except for work experience. The results show that there were no foot injuries in farmers wearing Neoprene diving boots, whereas 73% of farmers wearing Ninja shoes, and 14% of farmers wearing cloth socks still had foot injuries. Most injuries were alaceration that were caused by the golden apple snail. The satisfaction survey showed that farmers were satisfied and strongly satisfied with all of the aesthetics, utilization, and functionality factors. This study suggested that the Neoprene diving boots can be recommended for farmers to use as safeguarding against foot injuries in the rice sowing process.

The effects of standing foot-transmitted vibration on self-reported discomfort ratings

BACKGROUND

Occupational foot-transmitted vibration (FTV) exposure is common in industries like mining, construction, and agriculture, often leading to acute and chronic injuries. Vibration assessments require technical expertise and equipment which can be costly for employers to perform. Alternatively, researchers have observed that self-reported discomfort can be used as an effective indicator of injury risk.

OBJECTIVE

This study aimed to investigate the effect of standing FTV exposure on self-reported ratings of discomfort, and whether these subjective ratings differed by body area and exposure frequency.

METHODS

Participants (n = 30) were randomly exposed to standing FTV at six frequencies (25, 30, 35, 40, 45, and 50 Hz) for 20-45 seconds. Following each exposure, participants rated discomfort on a scale of 0-9 in four body areas: head and neck (HN), upper body (UB), lower body (LB), and total body.

RESULTS

Results indicated that participants experienced the most discomfort in the LB at higher frequencies (p < 0.001), consistent with the resonance of foot structures. The HN discomfort tended to decrease as the exposure frequency increased, although not statistically significant (p > 0.0167). The UB discomfort remained relatively low across all frequencies.

CONCLUSIONS

The study suggests a potential connection between resonant frequencies and discomfort, potentially indicating injury risk. Although self-reported discomfort is insufficient for directly assessing injury risk from FTV, it provides a simple method for monitoring potential musculoskeletal risks related to vibration exposure at resonant frequencies. While professional vibration assessment remains necessary, self-reported discomfort may act as an early indicated of vibration-induced injuries, aiding in implementing mitigation strategies.

Use of a non-anatomic mini-fragment fixation system for foot fractures

BACKGROUND

Plating techniques for the fixation of foot fractures can utilize pre-contoured region-specific plates or non-anatomic non-specific mini-fragment plating systems, however there is limited published data describing complication rates.

METHODS

This study reviewed the complication rates and performed a cost analysis of 45 foot fractures that had fixation with the use of mini-fragment non-anatomic implants, comparing them to a series from the same centre fixed using anatomic implants and the published literature.

RESULTS

Complication rates seemed equivalent. Cost analysis demonstrated that non-anatomic implants were more expensive on average.

CONCLUSIONS

Non-anatomic mini-fragment fixation is an appropriate method for use in a variety of foot trauma situations, with comparable complication rates to pre-contoured implants, although the potential for cost savings has not been realized in this patient cohort.

Iselin Disease With a Rare Presentation in an Elderly Patient: A Case Report

We report the case of a 55-year-old female with a rare presentation and different pathophysiology of Iselin's disease. Iselin's disease is a rare condition caused by traction apophysitis of the peroneus brevis tendon at the base of the fifth metatarsal bone. It is usually a case in the adolescent age group due to their repetitive use of the peroneus tendon in daily activities, but not in the elderly group.  This type of apophysitis is rare and easily missed or misdiagnosed as a fracture in the base of the fifth metatarsal bone. However, a simple radiographic image can confirm the diagnosis. In this case, we aim to raise awareness of Iselin's disease for better comprehension of the clinical presentation, differential diagnosis, radiological features, management, and prognosis of Iselin's disease.

Foot, ankle, and leg problems in Australian primary care: consultation patterns, management practices, and costs

OBJECTIVE

To explore consultation patterns, management practices, and costs of foot, ankle, and leg problems in Australian primary care.

STUDY DESIGN

We analyzed data from the Bettering the Evaluation and Care of Health program, April 2000 to March 2016. Foot, ankle, and leg problems were identified using the International Classification of Primary Care, Version 2 PLUS terminology. Data were summarized using descriptive statistics examining general practitioner (GP) and patient characteristics associated with a foot, ankle, or leg problem being managed. Cost to government was estimated by extracting fees for GP consultations, diagnostic imaging, and pathology services from the Medicare Benefits Schedule (MBS) database. Costs for prescription-only medicines were extracted from the Pharmaceutical Benefits Schedule and for nonprescribed medications, large banner discount pharmacy prices were used.

RESULTS

GPs recorded 1,568,100 patient encounters, at which 50,877 foot, ankle, or leg problems were managed at a rate of 3.24 (95% confidence intervals [CIs] 3.21-3.28) per 100 encounters. The management rate of foot, ankle, or leg problems was higher for certain patient characteristics (older, having a health care card, socioeconomically disadvantaged, non-Indigenous, and being English speaking) and GP characteristics (male sex, older age, and Australian graduate). The most frequently used management practice was the use of medications. The average cost (Australian dollars) per encounter was A$52, with the total annual cost estimated at A$256m.

CONCLUSIONS

Foot, ankle, and leg problems are frequently managed by GPs, and the costs associated with their management represent a substantial economic impact in Australian primary care.

An Updated Epidemiology of Foot and Ankle Fractures in the United States: Complications, Mechanisms, and Risk Factors

Foot and ankle fractures are prevalent emergent injuries, about which there remains a lack of in-depth epidemiological information. This analysis of the epidemiology of foot and ankle injuries in the United States updates a previously conducted study. Data from the National Trauma Data Bank (2012-2017) were used for analysis. Demographic variables, mechanism of injuries, and comorbidities were analyzed to determine risk factors for complications after foot and ankle injuries. Young adults aged 21 to 30 years had the highest injury rates; however, in general, older individuals were more at risk for complications. Black individuals were more at risk for certain complications, while Asians were at lower risk, when compared to White individuals. The comorbidities of bleeding disorders, diabetes, smoking, hypertension, and chronic obstructive pulmonary disease all increased risk of at least 1 complication. In terms of mechanism, traffic incidents were found to be the most strongly associated with complications.

Australian children's foot, ankle and leg problems in primary care: a secondary analysis of the Bettering the Evaluation and Care of Health (BEACH) data

OBJECTIVES

To explore children's foot, ankle and leg consultation patterns and management practices in Australian primary care.

DESIGN

Cross-sectional, retrospective study.

SETTING

Australia Bettering the Evaluation and Care of Health program dataset.

PARTICIPANTS

Data were extracted for general practitioners (GPs) and patients <18 years from April 2000 to March 2016 inclusive.

MAIN OUTCOME MEASURES

Demographic characteristics: sex, GP age groups (ie, <45, 45-54, 55+ years), GP country of training, patient age grouping (0-4, 5-9, 10-14, 15-18 years), postcode, concession card status, indigenous status, up to three patient encounter reasons, up to four encounter problems/diagnoses and the clinical management actioned by the GP.

RESULTS

Children's foot, ankle or leg problems were managed at a rate of 2.05 (95% CI 1.99 to 2.11) per 100 encounters during 229 137 GP encounters with children. There was a significant increase in the rate of foot, ankle and leg problems managed per 100 children in the population, from 6.1 (95% CI 5.3 to 6.8) in 2005-2006 to 9.0 (95% CI 7.9 to 10.1) in 2015-2016. Management of children's foot, ankle and leg problems were independently associated with male patients (30% more than female), older children (15-18 years were 7.1 times more than <1 years), male GPs (13% more) and younger GPs (<45 years of age 13% more than 55+). The top four most frequently managed problems were injuries (755.9 per 100 000 encounters), infections (458.2), dermatological conditions (299.4) and unspecified pain (176.3). The most frequently managed problems differed according to age grouping.

CONCLUSIONS

Children commonly present to GPs for foot, ankle and leg problems. Presentation frequencies varied according to age. Unexpectedly, conditions presenting commonly in adults, but rarely in children, were also frequently recorded. This data highlights the importance of initiatives supporting contemporary primary care knowledge of diagnoses and management of paediatric lower limb problems to minimise childhood burden of disease.

FOOT INJURIES IN MICHIGAN, USA, GRAY WOLVES (CANIS LUPUS), 1992-2014

The range of gray wolves (Canis lupus) in the contiguous United States is expanding. Research and monitoring to support population recovery and management often involves capture via foothold traps. A population-level epidemiologic assessment of the effect of trap injuries on wolf survival remains needed to inform management. We describe the baseline rate, type, and severity of foot injuries of wolves born 1992-2013 in Michigan's Upper Peninsula, evaluate the reliability of field-scoring trap-related injuries, and the effect of injuries on wolf survival. We assessed foot injuries by physical and radiographic exam at postmortem and/or time of capture for 351 wolves using the International Organization for Standardization 10990-5 standard and the effects of injuries, sex, age, previous capture and body condition on survival using proportional hazards regression. We used ordinal regression to evaluate epidemiologic associations between sex, age, previous capture, body condition, cause of death and injury severity. Most wolves (53%) experienced no physically or radiographically discernable foot injuries over their lifetimes. Among those wolves that did experience injuries, 33% scored as mild. Foot injuries had little epidemiologically discernable effect on survival rates. Wolves with higher foot trauma scores did experience an increased risk of dying, but the magnitude of the increase was modest. Most limb injuries occurred below the carpus or tarsus, and scoring upper-limb injuries added little predictive information to population-level epidemiologic measures of survival and injury severity. There was little association between injury severity and cause of death. Based on necropsy exams, previous trap injuries likely contributed to death in only four wolves (1.1%). Our results suggest that injuries resulting from foothold traps are unlikely to be a limiting factor in recovery and ongoing survival of the Michigan gray wolf population.

Bare Foot and In-shoe Plantar Pressure in Diabetic Males and Females - Is There Difference?

Purpose

High plantar pressure is one of the factors associated with foot ulceration in diabetic patients. High-risk limbs could eventually be identified through this approach. The study was conducted to evaluate the difference in the barefoot and in-shoe plantar pressure among diabetic males and females.

Patients and Methods

A cross-sectional study was conducted and purposive sampling was employed for the recruitment of subjects in King Abdullah walking center. The dynamic plantar pressure generated by each subject was recorded using “novel footprint software” and up to five successful trials were collected for each subject of right and left foot.

Results

The mean age of female and male patients was 50.6 ± 13.4 and 46.07 ± 11.17, respectively. The mean difference between the weights was higher in males. The barefoot peak plantar pressure between gender in left limb was found significant. Moreover, the mean difference in plantar pressure at maximum concentration and maximum force of right and left limb between males and females was found statistically significant. The mean difference in in-shoe plantar pressure at maximum force of left limb between males and females was found statistically significant.

Conclusion

As the prevalence of diabetes is increasing, the risk of plantar pressure also increasing simultaneously. The difference in plantar pressure among diabetic males and females is critically important as our study indicated that the bare foot and in-shoe plantar pressure was found higher in males than females as males had higher weight than females. Further longitudinal studies are required to be conducted in this context.

Plantar Injuries in Runners: Is There an Association With Weekly Running Volume?

Running is an athletic activity that is increasingly gaining popularity. Despite its benefits, there are many suspected risk factors for running-related overuse injuries. The objective of this study is to describe injuries and clinical symptoms observed on the sole of the foot in runners, giving special attention to the weekly running volume. The literature presented in this narrative review is based on a non-systematic search of the Medline, Google Scholar, and ResearchGate databases and focuses on foot injuries (the full spectrum of the foot pathology from bones to tendons and plantar fascia, nerve, and joint disorders) in runners, which represents an important topic for both professional and recreational runners. The weekly running distance appeared to be one of the strongest predictors for future overuse injuries. Marathon training and average weekly running of over 20 km are possible predictive factors in the development of plantar foot injuries. The plantar medial aspect of the foot is the anatomic area of the foot that most frequently experiences pain, with numerous pathologic conditions. As a result, diagnosis is always a challenging task. The ability to obtain an accurate medical history and carefully perform a physical examination, together with good knowledge of the foot anatomy and kinesiology, are also proven to be key players in ensuring proper diagnosis.

Temporoparietal Fascial Flap for Soft Tissue Reconstruction of Pediatric and Young Adult Foot Defects: A Case Series

Soft tissue defects of the foot due to trauma, infection, or malignancy are common and present a reconstructive challenge, as the foot requires specialized tissue that is thin, supple, yet durable enough to support the high demand of its function. The temporoparietal fascial flap, based on the superficial temporal artery and vein, is a reliable and versatile flap that possesses all these advantages. We present a case series detailing our experience with this flap for reconstruction of post-traumatic soft tissue defects of the foot in 4 patients (3 children and 1 young adult) with 5-year follow-up data. All patients were able to use the foot normally again to full capacity and wear normal footwear. They were also satisfied with the aesthetic outcome of the reconstruction and well-concealed donor site. This series highlights the success of this flap in providing excellent functional and aesthetic coverage for soft tissue foot defects in children and young adults, with minimal donor site morbidity.

Influences of high-heeled shoe parameters on gait cycle, center of pressure trajectory, and plantar pressure in young females during treadmill walking

PURPOSE

This study aimed to investigate the influences of high-heeled shoe (HHS) parameters on gait cycle, center of pressure (COP) trajectory, and plantar pressure in young females.

METHODS

Twenty healthy adult females were recruited to participate in this study. Subjects walked on a treadmill at a fixed speed (1 m/s). Overall, six pairs of HHSs were evaluated, presenting two heel types (thin and thick) and three different heel heights (low: 3 cm, medium: 6 cm, and high: 8.2 cm). Subjects also wore flat shoes (heel height: 0.2 cm) as the control group.

RESULTS

The gait cycle, COP parameters, peak pressure (PP), maximum force, contact area (CA), and force-time integral (impulse) were measured. The comparison between these parameters when the volunteers wore thick heel and flat shoes at different walking conditions indicated that thin heels caused a significant increase in the pre-swing parameter, CA, and PP of the first toe and first metatarsus. Increased heel heights yielded smaller gait line lengths, single support lines, and smaller hindfoot areas. By contrast, increased anterior-posterior positions and plantar pressure parameter values were noted for the forefoot.

CONCLUSIONS

Data analyses showed significant differences in the plantar pressure distribution associated with heel height and heel type at increased pressure in the first metatarsal and central forefoot region and decreased pressure in the midfoot and heel sections, thus increasing anterior shift. The results presented herein may allow for the design of HHSs with reduced adverse health effects on the wearer.

Surgical Realignment of a Dorsiflexed Metatarsal Fracture

Metatarsal fractures are common injuries that routinely present to outpatient clinics. Whilst usually amenable to conservative care, there is controversy regarding treatment when the fracture results in significant misalignment. In this case report, a 54-year-old female recreational basketball player who sustained a second metatarsal fracture that had healed in a dorsiflexed position in relation to the adjacent metatarsals was referred for a surgical opinion. She had experienced worsening overload pain to her third metatarsophalangeal joint (MTPJ). Open reduction with internal fixation (ORIF) via a 6-hole locking plate was employed to reduce the fracture misalignment and re-establish the metatarsal parabola. She enjoyed an uneventful recovery with a full return to her sporting activities. ORIF with locking plate may be an acceptable technique for reducing displaced metatarsal fractures and re-establishing the metatarsal parabola.

Gunshot-Related Injuries to the Foot & Ankle: Review Article

Gunshot-related injuries remain a significant and important cause of global morbidity and cost. The foot and ankle has certain anatomic and functional considerations that make gunshot-related injuries challenging to manage. While the scientific literature regarding gunshot-related injuries is extensive, little of the existing literature focuses on the foot and ankle. While principles of management can be somewhat extrapolated from the current literature, an understanding of the body of work specific to the foot and ankle is valuable. Therefore, this review provides an overview of ballistic injuries to the foot and ankle as well as specific guidelines to aid surgeons in treating these difficult injuries. Level of Evidence: Level V, expert opinion.

Standing MRI lesions of the distal interphalangeal joint and podotrochlear apparatus occur with a high frequency in warmblood horses

Foot pain is a common presenting complaint in Warmblood horses. The aim of this retrospective, cross-sectional study was to determine the spectrum of foot lesions detected by magnetic resonance imaging (MRI) in Warmblood horses used for dressage, jumping, and eventing. The medical records of 550 Warmblood horses with foot pain that were scanned using standing MRI were reviewed and the following data were recorded: signalment, occupation, lameness, diagnostic analgesia, imaging results, treatments, and follow-up assessments. Associations between standing MRI lesions and chronic lameness following treatment were tested. Abnormalities of the navicular bone (409 horses, 74%), distal interphalangeal joint (362 horses, 65%), and deep digital flexor (DDF) tendon (260 horses, 47%) occurred with the highest frequency. The following abnormalities were significantly associated (P < .05) with chronic lameness following conservative therapy: moderate to severe MRI lesions in the trabecular bone of the navicular bone, mild or severe erosions of the flexor surface of the navicular bone, moderate sagittal/parasagittal DDF tendinopathies, and moderate collateral sesamoidean desmopathies. Also, identification of concurrent lesions of the DDF tendon, navicular bone, navicular bursa, and distal sesamoidean impar ligament was associated with chronic lameness after conservative therapy. Development of effective treatment options for foot lesions that respond poorly to conservative therapy is necessary.

Quality of life related to foot health status in women with fibromyalgia: a case-control study

INTRODUCTION

To date, the Foot Health Status Questionnaire (FHSQ) has not been applied to women who suffer from fibromyalgia. The main purpose of this study was to compare both foot and general health-related quality of life between women with fibromyalgia and healthy matched women. We hypothesized that women with fibromyalgia may present an impaired quality of life related to foot and general health.

MATERIAL AND METHODS

A sample of 208 women, mean age of 55.00 ±8.25 years, was recruited from an outpatient clinic and divided into 2 groups, 104 women with fibromyalgia (for the case group) and 104 healthy matched women (for the control group). Demographic data and the domains of the FHSQ scores were registered.

RESULTS

Statistically significant differences (p < 0.001) between case and control groups were found for both all specific foot domains (pain, foot function, foot health and footwear) and all general wellbeing domains (general health, physical activity, social capacity and vigor), showing a worse foot and general health-related quality of life (with lower scores for all FHSQ domains) in the women with fibromyalgia compared to healthy matched women.

CONCLUSIONS

Impaired foot and general health-related quality of life was observed in women who suffered from fibromyalgia compared to healthy matched women.

Evaluation of podiatric disorders in a sample of children with intellectual disabilities: an analytical cross-sectional study

BACKGROUND

Intellectual disabilities (IDs) usually derive from neurodevelopmental disabilities. They limit intellectual functioning and cause adaptive behaviors and orthopedic problems. These disabilities have harmful effects on health, everyday practical skills and social functioning, and they diminish quality of life. The goal of our research was to perform podiatric evaluations on schoolchildren with and without ID and ascertain their records of foot disorders.

DESIGN AND SETTING

Analytical cross-sectional study conducted at a podiatric clinic in the city of Piedras Blancas, province of Asturias, Spain.

METHODS

An analytical cross-sectional study on 82 schoolchildren affected by ID, compared with 117 healthy schoolchildren, was conducted at a podiatric clinic. Demographic data, clinical characteristics and measurements relating to podiatric examinations were recorded among the participants who completed all phases of the tool that was used in the study process.

RESULTS

Almost 90% of the schoolchildren with and without ID presented foot disorders relating to smaller toes, nail disorders, flat feet or lower-limb alterations.

CONCLUSIONS

The participants showed elevated prevalence of foot disorders. Podiatric evaluations are a significant means for preventing the appearance of medical conditions and/or foot problems, and they also improve general health.

Welfare of layers housed in small furnished cages on Danish commercial farms: the condition of keel bone, feet, plumage and skin

1. An on-farm assessment of keel bone, feet, plumage and skin damage was conducted in layers in small furnished cages to evaluate welfare implications. 2. Thirteen farms participated, all housing Lohmann LSL layers in systems allowing 8 or 10 hens per cage. 3. Each flock was visited at three different ages: 32, 62 and 77 weeks. During each visit, 100 hens were examined for keel bone fractures and deviations, plumage damage, body wounds, foot pad lesions, bumble feet, missing toes and toe wounds. 4. A deterioration with age of the condition of the plumage and keel bone was found (P < 0.001). At 77 weeks of age, 16% of the birds had poor plumage, and 43% of the birds had keel bone damage. In contrast, foot pad lesions were most prevalent at 32 weeks of age (13%), whereas the other foot injuries and body wounds remained at a relatively low level throughout the three ages examined. 5. Prevention of damage to the keel bone, plumage and foot pads should therefore be considered when aiming to improve welfare of laying hens housed in small furnished cages.

Anatomical Basis of the Intermediate Dorsal Pedal Neurocutaneous Perforator Pedicled Propeller Flap: A Cadaveric Dissection

Soft tissue defects of the forefoot represent a challenging surgical modality to reconstructive microsurgeons. This study describes the anatomical basis and design of the perforator-based intermediate dorsal pedal neurocutaneous vascular flap. Thirty fresh human lower limb specimens were injected with red latex and used for dissection of the dorsal vascular and neural anatomy of the foot. The direction and distribution of the intermediate dorsal cutaneous nerve and the vascular anatomy of the third dorsal artery of the plantar arch, along with the intermediate dorsal neurocutaneous nutrient vessels, were mapped. A simulated flap elevation procedure was performed on one fresh cadaver specimen. A clinical series of five cases is presented to demonstrate the feasibility of using the perforator-based intermediate dorsal pedal neurocutaneous vascular flap to reconstruct soft-tissue defects of the forefoot. The intermediate dorsal cutaneous nerve usually originates from the lateral branch of the superficial peroneal nerve. Crossing the surface of the cruciate ligament, it descends distally to the proximal part of the fourth intermetatarsal space and divides into the third and fourth dorsal metatarsal branches. The intermediate dorsal cutaneous neural nutrient vessels, which are multi-segmental and polyphyletic, offer innervation to the skin paddle of the flap elevated on the basis of the third dorsal perforator of the plantar arch. This perforator occupies a relatively constant position in the proximal part of the intermetatarsal space. It sends multiple tiny branches toward the intermediate dorsal cutaneous neural or paraneural nutrient vessel chain. In terms of clinical application, all flaps survived completely; one patient had partial loss of the skin graft. The design and anatomical basis of the intermediate dorsal pedal neurocutaneous vascular flap based on the third dorsal perforator of the plantar arch is a reliable reconstructive option for reconstructing small soft tissue defects in the forefoot. Clin. Anat. 31:1077-1084, 2018. © 2018 Wiley Periodicals, Inc.

Efficacy of foot orthoses for the treatment of plantar heel pain: a systematic review and meta-analysis

BACKGROUND

Plantar heel pain (PHP) is common. Foot orthoses are often applied as treatment for PHP, even though there is little evidence to support this.

OBJECTIVE

To investigate the effects of different orthoses on pain, function and self-reported recovery in patients with PHP and compare them with other conservative interventions.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

A systematic literature search was conducted in MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Web of Science, CINAHL and Google Scholar up to January 2017.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Randomised controlled trials comparing foot orthoses with a control (defined as no intervention, sham or other type of conservative treatment) reporting on pain, function or self-reported recovery in patients with PHP.

RESULTS

Twenty studies investigating eight different types of foot orthoses were included in the review. Most studies were of high quality. Pooled data from six studies showed no difference between prefabricated orthoses and sham orthoses for pain at short term (mean difference (MD) of 0.26 (95% CI -0.09 to 0.60)). No difference was found between sham orthoses and custom orthoses for pain at short term (MD 0.22 (95% CI -0.05 to 0.50)), nor was there a difference between prefabricated orthoses and custom orthoses for pain at short term (MD 0.03 (95% CI -0.15 to 0.22)). For the majority of other interventions, no significant differences were found.

CONCLUSIONS

Foot orthoses are not superior for improving pain and function compared with sham or other conservative treatment in patients with PHP.

PROSPERO REGISTRATION NUMBER

CRD42015029659.

Review article: Best practice management of common ankle and foot injuries in the emergency department (part 2 of the musculoskeletal injuries rapid review series)

Ankle and foot injuries are the most common musculoskeletal injuries presenting to Australian EDs and are associated with a large societal and economic impact. The quality of ED care provided to patients with ankle and foot fractures or soft tissue injuries is critical to ensure the best possible outcomes for the patient. This rapid review investigated best practice for the assessment and management of common ankle and foot injuries in the ED. Databases including PubMed, CINAHL, EMBASE, TRIP and the grey literature, including relevant organisational websites, were searched in 2017. Primary studies, systematic reviews and guidelines were considered for inclusion. English language articles published in the last 12 years that addressed the acute assessment, management or prognosis in the ED were included. Data extraction of included articles was conducted, followed by quality appraisal to rate the level of evidence where possible. The search revealed 1242 articles, of which 71 were included in the review (n = 22 primary articles, n = 35 systematic reviews and n = 14 guidelines). This rapid review provides clinicians managing fractures and soft tissue injuries of the ankle and foot in the ED a summary of the best available evidence to enhance the quality of care for optimal patient outcomes. Following a thorough history and physical examination, including the application of the Ottawa ankle rules, ED clinicians should not only provide a diagnosis, but rate the severity of soft tissue injuries, or stability of fractures and dislocations, which are the pivotal decision points in guiding ED treatment, specialist referral and the follow-up plan.

Effectiveness of foot orthoses for the prevention of lower limb overuse injuries in naval recruits: a randomised controlled trial

OBJECTIVES

To evaluate the effectiveness of prefabricated foot orthoses for the prevention of lower limb overuse injuries in naval recruits.

METHODS

This study was a participant-blinded and assessor-blinded, parallel-group randomised controlled trial. Three-hundred and six participants aged 17-50 years who undertook 11 weeks of initial defence training at the Royal Australian Navy Recruit School (Cerberus, Australia) were randomised to a control group (flat insoles, n=153) or an intervention group (contoured, prefabricated foot orthoses, n=153). The combined incidence of medial tibial stress syndrome, patellofemoral pain, Achilles tendinopathy and plantar fasciitis/plantar heel pain during the 11-week training period were compared using incidence rate ratios (IRR). Data were analysed using the intention-to-treat principle.

RESULTS

Sixty-seven injuries (21.9%) were recorded. The control and intervention group sustained 40 (26.1%) and 27 (17.6%) injuries, respectively (IRR 0.66, 95% CI 0.39 to 1.11, p=0.098). This corresponds to a 34% reduction in risk of developing medial tibial stress syndrome, patellofemoral pain, Achilles tendinopathy or plantar fasciitis/plantar heel for the intervention group compared with the control group. Participants in the prefabricated orthoses group were more likely to report at least one adverse event (20.3% vs 12.4%; relative risk (RR) 1.63, 95% CI 0.96 to 2.76; p=0.068; number needed to harm 13, 95% CI 6 to 253). The most common adverse events were foot blisters (n=20, 6.6%), arch pain (n=10, 3.3%) and shin pain (n=8, 2.6%).

CONCLUSION

Prefabricated foot orthoses may be beneficial for reducing the incidence of lower limb injury in naval recruits undertaking defence training.

TRIAL REGISTRATION NUMBER

Australian New Zealand Clinical Trials Registry: ACTRN12615000024549.

Epidemiology of High-Heel Shoe Injuries in U.S. Women: 2002 to 2012

The purpose of the present study was to investigate the epidemiology of high-heel-related injuries among a nationally representative population of women in the United States and to analyze the demographic differences within this group. The data used in the present study were collected from the Consumer Product Safety Commission's National Electronic Injury Surveillance System. A total of 3294 injuries, representing an estimated 123,355 high-heel-related injuries, were treated in emergency departments within the United States from 2002 to 2012. The overall rate of high-heel-related injuries for the study was 7.32 per 100,000 females (95% confidence interval 7.08 to 7.56). The injury rate was greatest for young adult females, with the greatest rates observed for those aged 20 to 29 years (18.38 per 100,000 females) and those aged 30 to 39 years (11.07 per 100,000 females). The results from the present study suggest that high-heel-related injuries have nearly doubled during the 11-year period from 2002 to 2012. Injuries from high heels are differential by body region, with most injuries occurring as sprains and strains to the foot and ankle. Although high heels might be stylish, from a health standpoint, it could be worthwhile for females and those interested in wearing high heels to understand the risks of wearing high-heeled shoes and the potential harm that precarious activities in high-heeled shoes can cause. The results of the present study can be used in the development of a prospective cohort study to investigate the risk of injury from high-heeled shoes, accounting for the exposure time and studying differences in demographics (e.g., age and race).

The use of locking plates in complex midfoot fractures

INTRODUCTION

Complex fracture dislocations of the midfoot are uncommon. Improved outcomes have been demonstrated where it has been possible to restore and maintain the length and alignment of the medial column as well as the congruity of the articular surfaces. We present our experience with the use of angle-stable locking plates in the stabilisation of complex midfoot fracture dislocations.

METHODS

Twelve patients were identified on a prospective trauma database between 2003 and 2009. All fractures involved the medial column with four associated fracture subluxations of the lateral column also. Patients underwent open reduction internal fixation (ORIF) with restoration of the medial column axis, reduction of the articular surface congruity and stabilisation with angle-stable locking plates.

RESULTS

There were no post-operative infections or neurological injuries. Ten of the twelve patients required metalwork removal. There were no implant failures prior to removal of the metalwork. At a mean follow-up of 12.4 months (range: 4-32 months), 11 patients had minimal symptoms of swelling, discomfort or stiffness in the midfoot. This did not restrict their daily activities. One patient developed post-traumatic arthritis and collapse of the medial longitudinal arch. Two patients declined removal of the metalwork.

CONCLUSIONS

Angle-stable locking plates provide satisfactory stabilisation following ORIF of complex midfoot fracture dislocations. Most patients will require removal of the metalwork. Following removal of metalwork, the majority of patients will maintain the length, alignment and stability of the midfoot.