RESUMO

INTRODUCTION: metatarsophalangeal resection arthroplasty is considered a salvage surgical procedure able to improve the quality of life of patients with major forefoot deformities. MATERIAL AND METHODS: a retrospective observational study of 31 patients (36 feet) with major forefoot deformities operated at our institution was performed. Thirty two feet required additional surgery involving the first ray, most of them (72.2%) through MTP joint fusion. The mean follow-up period was 10.3 ± 4.6 years. Most patients were women (87.1%), the mean age was 74.2 ± 11.5 years. RESULTS: at the final follow-up, mean AOFAS score was 77.9 ± 10.2 points and mean MOxFQ score was 18.3 ± 8.3 points. Visual analog scale (VAS) for pain improved significantly from 7.5 ± 1.2 points to 3.4 ± 2.1 points on average. Good clinical results were also reported on ability to put on shoes comfortably. The mean resection arthroplasty spaces at the end of the study were 1.3, 1.8, 2.5 and 4.4 mm, for second to fifth rays, respectively. The mean sizes of remodeling osteophytes at the end of the study were 1.6, 1.4, 1.1 and 0.7 mm, respectively. Significant improvement was also achieved in the hallux valgus angle (HVA) and intermetatarsal angle (IMA) at the end of the study. CONCLUSION: in our experience, metatarsophalangeal resection arthroplasty continues to be a valid choice in patients with major forefoot deformities, with satisfactory long-term clinical and radiographic results.

INTRODUCCIÓN: la artroplastía de resección metatarsofalángica se considera un procedimiento quirúrgico de salvamento capaz de mejorar la calidad de vida de pacientes con deformidades importantes en el antepié. MATERIAL Y MÉTODOS: se realizó un estudio observacional retrospectivo de 31 pacientes (36 pies) con deformidades importantes en el antepié operados en nuestra institución. Treinta y dos pies requirieron cirugía adicional que involucró el primer metatarsiano, la mayoría de ellos (72.2%) a través de la fusión de la articulación metatarsofalángica. El período de seguimiento promedio fue 10.3 ± 4.6 años. La mayoría de los pacientes fueron mujeres (87.1%), con una edad promedio de 74.2 ± 11.5 años. RESULTADOS: en la última visita de seguimiento, la puntuación AOFAS promedio fue de 77.9 ± 10.2 puntos y la puntuación MOxFQ promedio fue de 18.3 ± 8.3 puntos. La escala visual analógica (EVA) para el dolor mejoró significativamente, pasando de 7.5 ± 1.2 puntos a 3.4 ± 2.1 puntos de media. También se constataron buenos resultados clínicos en cuanto a la capacidad de calzarse con comodidad. Los espacios de resección promedio al final del estudio fueron 1.3, 1.8, 2.5 y 4.4 mm para el segundo al quinto radio, respectivamente. Los tamaños promedio de los osteofitos por remodelación al final del estudio fueron de 1.6, 1.4, 1.1 y 0.7 mm, respectivamente. También se logró una mejora significativa en el ángulo de hallux valgus (AHV) y en el ángulo intermetatarsiano (IMA) al final del estudio. CONCLUSIÓN: en nuestra experiencia, la artroplastía de resección metatarsofalángica sigue siendo una opción válida en pacientes con deformidades graves del antepié, con resultados clínicos y radiográficos satisfactorios a largo plazo.

Assuntos

RESUMO

This study describes a corrective procedure for a metatarsal angular malformation using wedge ostectomy in a 41-day-old Thoroughbred filly. A 41.6 °angular malformation of the metatarsus was corrected with wedge ostectomy of the left hindlimb in association with a type II external fixator and methyl methacrylate resin. The animal was subjected to the surgical procedure under general anesthesia. The filly was placed in dorsal recumbency with the left hind limb free for manipulation. A bone saw was used for the wedge ostectomy, while the bars for external fixation were placed using a drill. A Kirschner pin and acrylic resin were then applied. Radiographic images obtained immediately after surgery confirmed a total malformation reduction of 32.6 (from 41.6° to 9°). With medication and a Robert Jones bandage, intensive postoperative care was instituted to ensure that the animal adapted properly to the linear external fixator without overloading the pins and connection bars. No postoperative complications were observed. On the day after surgery, the filly was standing and walking with no signs of pain. After 180 days, total osseous calcification was achieved, and the implants were removed during the second surgery. The filly demonstrated adequate locomotion, performed all the movements, and ran without any difficulty in the paddock. The remaining discrete angular deviations were partially corrected using hoof trimming.

O objetivo desse estudo é descrever o procedimento de correção da malformação de desvio angular metatársico, utilizando ostectomia em cunha, em uma potra puro-sangue de 41 dias de idade. Uma malformação metatársica angular de 41.6º foi corrigida com a técnica de ostectomia em cunha, em associação com fixador externo tipo II e resina de metilmetacrilato, no membro pélvico esquerdo. O animal foi submetido à cirurgia sob protocolo de anestesia geral. A potra foi posicionada em decúbito dorsal, com o membro pélvico esquerdo livre para manipulação. Para a realização da ostectomia em cunha, foi utilizada uma serra óssea. Para a instalação das barras do fixador externo, uma furadeira foi utilizada e, para fixá-los, pinos de Kirschner e resina acrílica foram aplicados. Logo após a cirurgia, imagens radiográficas foram obtidas para confirmar a redução total de 32,6º (de 41,6º para 9º) de angulação. Para garantir que o animal se adaptasse ao fixador externo linear e não sobrecarregasse os pinos e barras, foram instituídos cuidados pós-operatórios intensos, com medicações e bandagem de Robert Jones. Não houve complicações no pós-operatório. No dia seguinte à cirurgia, a potra estava em pé, caminhando e sem sinais de dor. Após 180 dias, alcançou total calcificação óssea e os implantes puderam ser removidos em um segundo tempo cirúrgico. A potra demonstrou locomoção adequada, realizando todos os movimentos normais e pôde correr pelo pasto sem dificuldades. Um discreto desvio angular remanescente foi parcialmente corrigido por casqueamento.

Assuntos

Assuntos

RESUMO

SUMMARY: The weight of the body is transmitted to the foot through the subtalar joint and talus. Considering the important location of the talus and calcaneus, the morphological structures of these bones may affect the biomechanics of the subtalar joint. At the same time, the morphological structure of these bones is important in some common foot deformities. We aimed to investigate whether the various measurements of the talus and calcaneus are associated with different foot deformities in this study. In this study, radiography images of 158 (72 male and 86 female) patients within the mean age of 44 years were retrospectively examined. Eleven different measurements of the talus and calcaneus were obtained from the lateral and antero-posterior radiographs of the patients. A total of 158 patient's routine clinic radiographs were retrospectively assessed, which have calcaneal spur (n=63), hallux valgus (n=32) and control group (n=63). We determined that the body height of the calcaneus, maximum width of the head of the talus, minimum anterior width of the calcaneus were significantly different between calcaneal spur group and control group. Maximum length fibular malleolar facet of the talus was significantly different between age groups. And we determined that the calcaneal index was significantly different between hallux valgus group and control groups. Also all measurements were significantly different between males and females. As a result, some measurements that significantly determine the morphology of the talus and calcaneus were found to be significant between deformity groups and control groups. We think that our study will contribute to the literature as it is the first study in which the measurements obtained from the radiographic images of the talus and calcaneus are associated with foot deformities.

El peso del cuerpo se transmite al pie a través de la articulación subtalar y el talo. Teniendo en cuenta la importante ubicación del talo y el calcáneo, las estructuras morfológicas de estos huesos pueden afectar la biomecánica de la articulación subtalar. Al mismo tiempo, la estructura morfológica de estos huesos es importante en algunas deformidades comunes del pie. Nuestro objetivo fue investigar si las diversas medidas del talo y el calcáneo están asociadas con diferentes deformidades del pie en este estudio. Se examinaron retrospectivamente imágenes radiográficas de 158 pacientes (72 hombres y 86 mujeres) con una edad promedio de 44 años. Se obtuvieron once medidas diferentes del talo y el calcáneo a partir de las radiografías lateral y anteroposterior de los pacientes. Se evaluaron retrospectivamente un total de 158 radiografías clínicas de rutina de los pacientes, los cuales tenían espolón de calcáneo (n=63), hallux valgus (n=32) y grupo control (n=63). Determinamos que la altura del cuerpo del calcáneo, el ancho máximo de la cabeza del talo, el ancho anterior mínimo del calcáneo fueron significativamente diferentes entre el grupo con espolón calcáneo y el grupo control. La longitud máxima de la faceta maleolar fíbular del talo era significativamente diferente entre los grupos de edad. También determinamos que el índice calcáneo fue significativamente diferente entre el grupo de hallux valgus y los grupos controles. Además, todas las medidas fueron significativamente diferentes entre hombres y mujeres. Como resultado, algunas medidas que determinan la morfología del talo y el calcáneo resultaron significativas entre los grupos de deformidad y los grupos controles. Estimamos que nuestro estudio contribuirá a la literatura debido a que es el primer reporte en el que las medidas obtenidas de las imágenes radiográficas del talo y el calcáneo se asocian con deformidades del pie.

Assuntos

RESUMO

BACKGROUND: Prefabricated and customized insoles are used in clinical practice to reduce foot pronation. Although data exist on the effects at key points within the stance phase, exploring the impact of different insoles using time series analysis may reveal more detail about their efficacy. RESEARCH QUESTION: What are the effects revealed by a time series analysis of arch-supported prefabricated insoles (PREFABRICATED) versus arch-supported prefabricated insoles customized with a 6º medial wedge (CUSTOMIZED) on the lower limb biomechanics during walking, stepping up and down tasks in individuals with pronated feet? METHODS: Nineteen individuals with excessive foot pronation performed walking, stepping up and down tasks using three insoles: CONTROL (flat insole), CUSTOMIZED, and PREFABRICATED. Angles and moments of ankle and knee coronal and hip transverse planes were compared between conditions using statistical parametric mapping (SPM). RESULTS: For walking, CUSTOMIZED reduced ankle eversion moment compared to CONTROL during midstance and PREFABRICATED during propulsion. CUSTOMIZED decreased KAM during midstance and propulsion compared to PREFABRICATED. Compared to CONTROL, CUSTOMIZED and PREFABRICATED reduced hip internal rotation during propulsion and loading response, respectively. CUSTOMIZED decreased eversion movement during midstance and propulsion for the stepping up task. PREFABRICATED reduced eversion movement during midstance in comparison to CONTROL. For the stepping down task, CUSTOMIZED increased eversion movement during propulsion compared to PREFABRICATED. CUSTOMIZED reduced hip internal rotation angle for stepping up task during propulsion, decreased medial rotation movement during midstance compared to CONTROL, and reduced medial rotation during midstance compared to PREFABRICATED. CUSTOMIZED increased KAM for stepping up and down tasks during propulsion. SIGNIFICANCE: These findings suggest that both CUSTOMIZED and PREFABRICATED reduce foot pronation. However, non-local effects, such as changes in KAM and hip internal rotation, were seen only in the CUSTOMIZED. Therefore, CUSTOMIZED may be preferable if the objective is to modify the knee and hip mechanics.

Assuntos

RESUMO

Antecedentes: La diabetes mellitus causa complica- ciones importantes, entre estas el pie diabético que se asocia a mayor riesgo de morbilidad y mortalidad. Objetivo: Describir las características y resultados del manejo de úlceras en pacientes con pie diabético de una institución terciaria. Métodos: Estudio retrospectivo descriptivo, llevado a cabo en Hospital de Especia- lidades, Instituto Hondureño de Seguridad Social, abril 2018-abril 2020. Se revisaron expedientes clínicos de pacientes con diag- nóstico de pie diabético. Resultados: La edad promedio de los pacientes fue 62.9 años, con una desviación estándar (DE) (+/- 10.8); de predominio masculino 77.5% (55/71). Un 79.0% (56/71) tenía antecedentes de más de 10 años de diagnóstico de diabe- tes mellitus tipo II. Según clasificación de Wagner fue Grado 3 en 50.7% (36/71). El 69.0% (49/71) presentaron una úlcera en región plantar pie izquierdo. El manejo fue con apósitos impregnados con solución de factor de crecimiento epidérmico y aceite ozonizado en 43.7% (31/71); los antibióticos administrados fueron clindamicina 71.8% (51/71) y ceftriaxone 55.7% (41/71). El número de desbrida- mientos fue entre 1-2 en 49.3% (35/71) y el número de curaciones realizadas entre 6-10 en 38.0% (27/71). El resultado terapéutico fue cierre total de la úlcera en 33.8% (24/71) y las complicaciones (amputación/infección) se presentaron en 16.9% (12/71). No se reportó mortalidad. Discusión: El paciente con diagnóstico de pie diabético es manejado en la institución con desbridamientos, cu- raciones y antibioticoterapia, logrando cierre total de la ulceración en un tercio de los casos, algunos casos se complican y finalizan en amputación, similares resultados reportado por otros autores...(AU)

Assuntos

RESUMO

Introducción: La evaluación anatómica músculo esquelética por imagen en la exploración clínica del pie diabético es la fotografía digital que evalúa la morfología superficial. Objetivos: Validar la obtención de las imágenes fotográficas del pie, calcular las mediciones longitudinales, angulares y el índice del arco plantar, de las imágenes fotográficas del pie por fotogrametría, y basados en estas, categorizar la normalidad de la forma en sujetos sanos. Métodos: Estudio exploratorio en 30 individuos sanos evaluados en la Unidad clínica de pie diabético en la ciudad de Trujillo, mediante un prototipo de cámaras alrededor de un podoscopio y un software de análisis de imágenes. La imagen fotográfica fue evaluada por mediciones longitudinales, angulares y el índice del arco plantar. Resultados: Los pacientes evaluados tenían una edad media de 25,06+/-11,95 años, y predominaron las mujeres. La longitud total del pie y anchura del metatarso en el lado derecho fue de 226,55 ± 36,49 mm y 98,99 ± 22,71 mm respectivamente; y en el lado izquierdo fue de 229,81 ± 42,25 mm y 104,49 ± 16,84 mm respectivamente. El ángulo intermetatarsal del 1-2 rayo, ángulo intermetatarsal del 4-5 rayo y ángulo del retropié para el lado derecho fueron 14 ± 4º, 11 ± 3º y 2 ± 2º respectivamente; para el lado izquierdo 14 ± 3º, 9 ± 3º y 2 ± 2º respectivamente, y el índice plantar del arco derecho e izquierdo fueron 0,23 ± 0,2 y 0,22 ± 0,1 respectivamente. La variabilidad solo se presentó en el antepie en el 20 percent de los casos. Conclusiones: La obtención de las imágenes fotográficas del pie fueron válidas, las mediciones fueron menores o similares a otros estudios. La variabilidad de la normalidad solo se presentó en el antepie(AU)

Introduction: The musculoskeletal anatomical evaluation by imaging in the clinical examination of the diabetic foot is digital photography that assesses the superficial morphology. Objectives: To validate the obtaining of photographic images of the foot, to calculate the longitudinal and angular measurements and the index of the plantar arch, from the photographic images of the foot by photogrammetry, and to categorize the normality of the shape in healthy subjects, based on these photographic images. Methods: This an exploratory study in 30 healthy individuals evaluated at the Diabetic Foot Clinical Unit in Trujillo city, using a prototype of cameras around a podoscope and image analysis software. The photographic image was evaluated by longitudinal and angular measurements and the plantar arch index. Results: The patients evaluated had a mean age of 25.06+/-11.95 years, and women predominated. Total foot length and metatarsal width on the right side were 226.55 ± 36.49 mm and 98.99 ± 22.71 mm, respectively; and on the left side it was 229.81 ± 42.25 mm and 104.49 ± 16.84 mm, respectively. The 1st-2nd ray intermetatarsal angle, 4th-5th ray intermetatarsal angle and hindfoot angle for the right side were 14 ± 4º, 11 ± 3º and 2 ± 2º respectively; for the left side 14 ± 3º, 9 ± 3º and 2 ± 2º respectively, and the plantar index of the right and left arch were 0.23 ± 0.2 and 0.22 ± 0.1 respectively. Variability only occurred in the forefoot in 20 percent of cases. Conclusions: Obtaining of the photographic images of the foot was valid, measurements were smaller or similar to other studies. The variability of normality only appeared in the forefoot(AU)

Assuntos

RESUMO

Abstract Objective To describe the profile of the patients and the results obtained with the use of an external fixator for metatarsal lengthening in brachymetatarsia. Methods A retrospective analysis of the medical records of patients with brachymetatarsia treated between January 2018 and April 2020 was performed. During this period, eight feet of six patients were operated on. Frequencies were estimated according to demographic and surgical aspects. Results All patients (100%; n= 6) were female, with a mean age of 28 years old, ranging from 15 to 48 years old, and were motivated to seek the orthopedic service due to aesthetic deformity. The deformity was bilateral in two patients and unilateral in four patients. The average lengthening time was 22 days ( ± 7.15, 95% confidence interval [CI]: 19.04-26.81). The lengthening speed was 0.5 mm/day, and the average total length of the lengthening was 11.46 mm ( ± 3.57; 95%CI: 9.52-13.40). Half of the patients (50%; n= 3) had local infection of the pins and were treated with antibiotics, and the others did not report any postsurgical complications. All patients denied pain or calluses after the surgical procedure and reported satisfaction with the results. Conclusion All patients were female and sought surgery for brachymetatarsia for aesthetic reasons. Osteogenic distraction at a rate of 0.5 mm/day resulted in successful lengthening of the metatarsal, with a low frequency of complications, good clinical outcomes, and high patient satisfaction.

Resumo Objetivo Descrever o perfil dos pacientes e os resultados obtidos com o uso de fixador externo para alongamento de metatarso em braquimetatarsia. Métodos Foi realizada uma análise retrospectiva dos prontuários de pacientes com braquimetatarsia tratados entre janeiro de 2018 e abril de 2020. Durante este período, foram operados oito pés de seis pacientes. Foram coletadas e estimadas as frequências em relação a aspectos demográficos e cirúrgicos. Resultados Todas as pacientes (100%; n= 6) eram do sexo feminino, com média de idade de 28 anos, variando de 15 a 48 anos, e motivadas a buscar o serviço de ortopedia em função da deformidade estética. O acometimento era bilateral em duas pacientes e unilateral em quatro pacientes. O tempo médio de alongamento foi de 22 dias ( ± 7,15; intervalo de confiança [IC] 95%: 19,04-26,81). A velocidade de alongamento foi de 0,5 mm/dia e o comprimento médio total do alongamento foi de 11,46 mm ( ± 3,57; IC95%: 9,52-13,40). Metade das pacientes (50%; n= 3) teve infecção local dos pinos e foi tratada com antibióticos; as demais não relataram nenhuma complicação pós-cirúrgica. As pacientes negaram dor ou calosidade após o procedimento cirúrgico e relataram satisfação com os resultados. Conclusão Todas as pacientes eram do sexo feminino e buscaram a cirurgia para braquimetatarsia por motivos estéticos. A distração osteogênica a uma taxa de 0,5 mm/dia resultou em alongamento bem-sucedido do metatarso, com uma baixa frequência de complicações, bons resultados clínicos e alta satisfação das pacientes.

Assuntos

RESUMO

The term progressive collapsing foot deformity (PCFD) is currently recommended as the replacement to adult-acquired flatfoot deformity and posterior tibial tendon dysfunction to better reflect its pathology, which consists of a complex three-dimensional deformity involving the foot and ankle. The new consensus has also provided a new classification that requires clinical and radiographic findings for patient stratification into each class. However, conventional radiographs are susceptible to errors resulting from the inadequate positioning of patients, incorrect angulation of the X-ray tube, and overlapping of bone structures. Weightbearing cone beam computed tomography (WBCBCT), which has greater diagnostic accuracy than conventional radiograph, is useful for evaluating progressive collapsing foot deformity to determine medial arch collapse, hindfoot alignment, peritalar subluxation, posterior subtalar joint valgus, intrinsic talus valgus, and lateral extra-articular bone impingement. The present review aimed to discuss the new recommendations for nomenclature, classification, and imaging evaluation of PCFD, with an illustrative and quantitative focus on the measurements used in conventional radiography and WBCBCT. The measurements presented here are important criteria for decision-making.

Assuntos

RESUMO

Deformities of the midfoot are often treated with midfoot osteotomies. The goal of the midfoot osteotomy is to create a plantigrade forefoot to hindfoot relationship. Many different techniques are described for performing midfoot osteotomies. Our goal is to present an objective pre-operative planning method and an intra-operative technique for accurate multiplanar realignment and discuss our short-term results. We retrospectively reviewed 18 patients, 10 female (56%) and 8 male (44%), that underwent realignment midfoot osteotomies. The mean follow-up was 25 months (range, 4-120). The mean age at the time of surgery was 53 years (range, 21-76). Statistically significant improvement in radiographic alignment was found in the anteroposterior talo-first metatarsal angle (p = .002) and the mechanical axis deviation of the foot (p = .02). This study proved that our pre-operative and intra-operative planning technique provides accurate multiplanar radiographic realignment with good clinical results.

Assuntos

RESUMO

El conjunto de patologías bajo el nombre de síndromes dolorosos de pie y tobillo engloban diferentes tendinopatías asociadas entre varios factores clínicos a la presencia de huesos accesorios tarsianos. La correcta identificación y diferenciación radiológica de estas variantes anatómicas en virtud de su capacidad de influir en la dinámica normal del tarso motivan el estudio de su incidencia. Nuestro objetivo es determinar la presencia de distintos huesos accesorios tarsianos en una muestra poblacional. Se expone el resultado de un estudio observacional retrospectivo en 240 pacientes entre 15 y 85 años de edad atendidos en un centro privado de la ciudad de Las Piedras, Canelones, con radiografías de pie y tobillo preexistentes en la base de datos institucional. Se determinó presencia de huesos accesorios tarsianos en 23 pacientes (9,58%), identificando hallazgos de Os Trigonum (1,66%), Proceso de Stieda (3.33%), Os Peroneum (2,93%) y Os Navicular (1,66%). Se presenta en tablas el análisis de frecuencia correspondiente y estudio de contingencia entre variantes encontradas, edad y sexo del paciente. El resultado de la investigación busca aportar al conocimiento de variantes anatómicas normales correlativas a procesos patológicos infradiagnosticados, desde el rol de la anatomía radiológica.

The group of pathologies under the name of foot and ankle pain syndromes encompass different tendinopathies associated among various clinical factors with the presence of accessory tarsal bones. The correct identification and radiological differentiation of these anatomical variants, by virtue of their ability to influence the normal dynamics of the tarsus, motivated the study of their incidence. Our objective is to determine the presence of different tarsal accessory bones in a population sample. Here we present the results of a retrospective observational study in 240 patients between 15 and 85 years of age, treated in a private health center in the city of Las Piedras, Canelones, with pre-existing ankle and foot x-rays in the institutional database. The presence of tarsal accessory bones was determined in 23 patients (9.58%), identifying findings of Os Trigonum (1.66%), Stieda Process (3.33%), Os Peroneum (2.93%) and Os Navicular (1, 66%). The corresponding frequency analysis and contingency study between the variants found, age and sex of the patient are exposed in tables. The result of the research seeks to contribute to the knowledge of normal anatomical variants correlative to under diagnosed pathological processes, from the role of radiological anatomy.

O grupo de patologias com a denominação de síndromes dolorosas no pé e tornozelo engloba diferentes tendinopatias associadas entre diversos fatores clínicos à presença de ossos acessórios do tarso. A correta identificação e diferenciação radiológica dessas variantes anatômicas em virtude de sua capacidade de influenciar a dinâmica normal do tarso motiva o estudo de sua incidência. Nosso objetivo é determinar a presença de diferentes ossos acessórios do tarso em uma amostra populacional. É apresentado o resultado de um estudo observacional retrospectivo em 240 pacientes entre 15 e 85 anos de idade atendidos em um centro privado na cidade de Las Piedras, Canelones, com radiografias de pé e tornozelo pré-existentes no banco de dados institucional. A presença de ossos acessórios do tarso foi determinada em 23 pacientes (9,58%), identificando achados de Os Trigonum (1,66%), Processo de Stieda (3,33%), Os Peroneum (2,93%) e Os Navicular (1,66%). A correspondente análise de frequência e estudo de contingência entre as variantes encontradas, idade e sexo do paciente são apresentados em tabelas. O resultado da pesquisa busca contribuir para o conhecimento das variantes anatômicas normais correlativas aos processos patológicos subdiagnosticados, a partir do papel da anatomia radiológica.

Assuntos

RESUMO

Abstract Congenital clubfoot is one of the most common deformities at birth. The inadequacy or absence of treatment causes serious limitations for people with this condition. The initial treatment using the Ponseti method ensures functional results superior to other treatment modalities previously proposed. However, recurrences and neglected feet are still a challenge today. An understanding of the pathophysiology of the disease, as well as of the anatomy and local biomechanics and a thorough clinical and radiological evaluation of patients are essential to understanding the limits of the method and choosing the best treatment.

Resumo O pé torto congênito é uma das deformidades mais comuns ao nascimento. A inadequação ou ausência do tratamento provoca sérias limitações aos portadores desta condição. O tratamento inicial pelo método Ponseti garante resultados funcionais superiores a outras modalidades de tratamento propostas anteriormente, porém as recidivas e os pés negligenciados ainda são um desafio na atualidade. O entendimento da fisiopatologia da doença, da anatomia e biomecânica local e uma minuciosa avaliação clínica e radiológica dos pacientes são imprescindíveis para entendermos o limite do método e escolhermos o melhor tratamento.

Assuntos

RESUMO

BACKGROUND: Foot deformities are highly prevalent in older adults and negatively impact their mobility and quality of life. However, the association between foot problems and physical function is still unclear. OBJECTIVE: To investigate whether structural foot deformities and plantar tactile sensitivity are associated with lower extremity physical function impairment in community-dwelling older adults. METHODS: We included 200 men and women aged 60 years and older from a community-based program. The foot assessment included toe deformities and calluses inspection and evaluation of plantar tactile sensitivity using monofilaments. The Short Physical Performance Battery (SPPB) was used to assess lower extremity physical function. We conducted a multivariate logistic regression analysis to investigate the association between foot problems and lower extremity physical function. RESULTS: Hallux valgus was the most prevalent deformity among older adults. Those participants with reduced plantar tactile sensitivity (OR= 2.77; 95% CI: 1.38, 5.55) and a hallux valgus (OR= 2.23; 95% CI: 1.10, 4.52) were more likely to present poor lower extremity physical function. CONCLUSION: Hallux valgus and impaired plantar sensitivity were associated with reduced lower extremity physical function in older adults. Further studies are necessary to identify this causality and to what extent management of these foot problems can improve general mobility and quality of life of older adults.

Assuntos

RESUMO

Las alteraciones en los pies son una consulta frecuente en ortopedia pediátrica. La gran mayoría corresponde a condiciones que no constituyen patología y habitualmente no necesitan tratamiento, como el pie plano flexible. Por otro lado, existen deformidades patológicas que necesitarán un adecuado estudio y tratamiento. Según su morfología podemos clasificarlas en cavo-varo, plano-valgo y misceláneas. Su origen puede ser congénito o adquirido y de diversas etiologías, destacando el pie bot, metatarso varo, hallux valgus juvenil y aquellas secundarias a enfermedades neuromusculares, entre otras. Conocer la historia natural de cada deformidad nos permite decidir el momento más adecuado para cada tratamiento. Los antecedentes mórbidos y perinatales del paciente son muy importantes, así como el nivel de actividad física y/o deportiva. El examen físico debe incluir observar la marcha, extremidades inferiores, tobillo y pie. En el pie se debe analizar cada segmento por separado (antepié, mediopié y retropié) y las articulaciones respectivas. Es muy importante distinguir entre deformidades rígidas y flexibles. El tratamiento incluye la observación (condiciones benignas y autolimitadas), calzado adecuado, insertos plantares, órtesis, yesos correctores, cirugía de partes blandas y cirugía ósea; todo complementado por un adecuado programa de rehabilitación funcional y deportivo.

Foot disorders are a frequent cause of consultation in pediatric orthopaedics. The vast majority correspond to conditions that don't constitute pathology and usually don ́t need treatment, such as flexible flat foot. On the other hand, there are pathological deformities that will require a proper study and treatment. According to their morphology we can classify them in cavo-varus, plano-valgus and miscellaneous. Its origin can be congenital or acquired and due to various etiologies, highlighting clubfoot, metatarsus adductus, juvenile hallux valgus and those secondary to neuromuscular diseases, among others. Knowing the natural history of each deformity allows us to decide the most appropriate time for each treatment. Patient's morbility and perinatal history is very important, as well as their level of physical and/or sports activity. Physical exam should include gait obsevation, lower limbs, ankles and feet. In the foot, each segment should be analyzed separately (forefoot, midfoot and hindfoot) and their joints. It ́s very important to distinguish between rigid and flexible deformities. Treatments include observation (benign and self-limited conditions), adequate footwear, insoles, orthosis, corrective casting, soft tissue surgery and bone surgery; all complemented by an adequate functional and sports rehabilitation programs

Assuntos

RESUMO

BACKGROUND: Valgus hindfoot is a very common postural deviation, and the associated foot pronation can be a triggering factor for diseases such as tarsal tunnel syndrome. RESEARCH QUESTION: This work compares two techniques for hindfoot valgus correction: GPR (Global Postural Reeducation) and PIMT (Postural Integration by Manual Therapy). METHODS: Sixty young adult subjects from the Brazilian Army with unilateral hindfoot valgus were selected and divided into two groups of 30 subjects, one treated with GPR and the other treated with PIMT. Differences between normal and valgus hindfeet (plantar surface and body weight load) for each subject were measured and analysed, using a baropodometer with subjects in static standing position for 5s. Measurements were performed before and after each treatment session (4 weeks, once a week), and 4 weeks after the end of treatment. RESULTS: Data shows that both treatments were equally effective for improving symmetry in body weight load between feet and plantar surface. After 4 weeks from the end of treatment, both treatments were equally effective for body weight load symmetry, but plantar surface symmetry was better in PIMT treated subjects. SIGNIFICANCE: This study shows that PIMT technique can be validated as a physical therapy procedure, at least for valgus hindfoot.

Assuntos

RESUMO

Metatarsalgia is a common problem that refers to the tenderness and pain beneath the forefoot. Many metatarsal shortening osteotomies have been described to alleviate metatarsal overload; however, these osteotomies have been associated with a high complication rate of floating toe deformity. We present a case study that describes an innovative technique for the treatment of lesser metatarsalgia that allows for the repositioning of the metatarsal head, using a stable screw fixation designed to minimize the common complication of the floating toe.

Assuntos

RESUMO

Introducción: la enfermedad de Sever es causa frecuente de talalgia en niños. Objetivo: evaluar la utilidad de la Ozonoterapia en el tratamiento de la enfermedad de Sever en niños de 7-18 años atendidos en el Hospital Provincial Pediátrico Docente "Pepe Portilla" de Pinar del Río, de julio 2017 a julio 2018. Métodos: se ha realizado investigación descriptiva longitudinal y prospectiva, a 46 niños, que asistieron a consulta de Medicina Natural y Tradicional con enfermedad de Sever recidivante. Se les aplicó Ozono terapéutico, por la vía rectal, mediante el equipo OZOMED mini. En el procesamiento se utilizaron herramientas descriptivas como tablas de frecuencias y cálculo porcentual. Resultados: el grupo de edad de 7 a 12 años fue el más representado y el sexo masculino sobre el femenino, el calcáneo valgo fue la deformidad podálica que más se presentó. Se encontró actividad física alta en el 73.9 % de los niños y la mitad eran sobrepesos u obesos. Para la cuarta semana total de casos se encontraban aliviados, no hubo recaídas. No se presentaron efectos indeseables durante la aplicación de la Ozonoterapia. Conclusiones: la Ozonoterapia es una modalidad terapéutica útil en el tratamiento de la enfermedad de Sever.

Introduction: Sever's disease is a common cause of thalalgia in children. Objective: to evaluate the effectiveness of the Ozone Therapy in the treatment of Sever's disease in children from 7-18 years old attended at Pepe Portilla Pediatric Provincial Teaching Hospital, Pinar del Rio province, during July 2017 to July 2018. Methods: longitudinal and prospective descriptive research was conducted to 46 children, who attended Natural and Traditional Medicine service with relapsed of Sever's disease. Therapeutic ozone was applied to them through the rectal route, and by means of the OZOMED mini-equipment. Descriptive tools such as frequency tables and percentage calculation were used throughout the process. Results: the age group from 7 to 12 years old was the most represented and male sex prevailed over the female, the calcaneus valgus was the most frequent foot deformity. High physical activity prevailed in the 73.9% of children and half of them were overweight or obese. By the fourth week of treatment, the total of cases were relieved, without relapses. No undesirable effects during the application of ozone therapy were observed. Conclusions: ozone therapy is a useful therapeutic modality in the treatment of Sever's disease.

Assuntos

RESUMO

Objetivo: Evaluar los resultados clínico-radiográficos y las complicaciones en pacientes <18 años con coaliciones calcáneo-escafoideas (CCE) sintomáticas tratados con resección e interposición de grasa autóloga de la región glútea. Materiales y métodos: Se analizó retrospectivamente a los pacientes con CCE sintomáticas operados con dicha técnica, en dos instituciones, y un seguimiento mínimo de 2 años. Se analizaron los datos demográficos y las complicaciones posoperatorias. Los resultados funcionales fueron evaluados con la escala AOFAS y la EAV. Se determinó la presencia de recidiva en la radiografía oblicua más reciente (defecto remanente <50%). Resultados: Entre enero de 2008 y enero de 2018, se operó a 52 pacientes (65 pies) con CCE. Cuarenta (48 pies) cumplían con los criterios de inclusión. La edad promedio al operarse era de 11.9 años. El seguimiento promedio fue de 43 meses. El puntaje AOFAS promedio mejoró significativamente de 58,9 ± 8,2 precirugía a 92,9 ± 7,8 después (p <0,001). El puntaje promedio preoperatorio de la EAV era de 6,9 ± 2,5 y de 0,49 ± 1,1 (p <0,001) en el último seguimiento. El 87,5% no tenía síntomas en el último control y 5 pacientes (6 pies) sufrían molestias ocasionales con la actividad física intensa. Hubo 5 complicaciones posoperatorias: dehiscencia de la herida e infección superficial. Dos pies (4,2%) presentaron recidiva radiográfica de la coalición aunque ningún paciente requirió revisión. Conclusión: La resección de CCE y la interposición de grasa autóloga permiten aliviar el dolor y mejorar la función con una baja tasa de complicaciones en la población pediátrico-adolescente. Nivel de Evidencia: IV

background: The purpose of the present study was to evaluate clinical/radiographic outcomes, and complications for calcaneonavicular coalition (CNC) excision and fat graft interposition in patients under the age of 18. materials and methods: A retrospective review of all pediatric patients surgically treated with symptomatic CNC at two institutions was performed. Demographic data and postoperative complications were recorded. Functional results were evaluated with AOFAS Ankle-hindfoot Scale and Visual analog scale (VAS). Radiographic assessment of coalition recurrence was performed on the most recent oblique radiograph (resect-ed gap remaining <50%). Results: Between January 2008 and January 2018, 52 patients (65 feet) with CNC were surgically treated. Forty patients (48 feet) met the inclusion criteria and were available for evaluation. The average age at surgery was 11.9 years old (range 9-17 years old). The average follow-up was 43 months. The average AOFAS score improved from 58.9±8 points preoperative to 92.9±7.8 points postoperatively (p<0.001). Preoperative pain scores averaged 6.9 ± 2.5 points. At the last follow-up, the VAS score was 0.49 ±1.1 points (p<0.001). Most patients (87.5%) were painless at the last follow-up and five patients (6 feet) had occasional pain with strenuous activities. Five complications were recorded: wound dehiscence (N=3) and superficial infection (N=2). Two feet (4.2%) had coalition regrowth on the postoperative radiographs without requiring further surgery. Conclusion: Calcaneonavicular coalition excision with fat graft interposition can improve function and relieve pain with a low rate of complications in the pediatric adolescent population. Level of Evidence: IV

Assuntos

RESUMO

El colgajo peroneo posterior es un colgajo fasciocutáneo, que está basado en 4 posibles fuentes como son perforantes fasciocutáneas de la arteria peronea, perforantes fasciocutáneas de la arteria tibial posterior, perforantes venocutáneas de la vena safena menor y perforantes neurocutáneas del nervio sural. El objetivo de este trabajo es describir la técnica quirúrgica y demostrar la versatilidad que tiene el colgajo peroneo posterior para la reconstrucción y cobertura de defectos del tercio distal de la pierna y el tercio proximal del pie, proporcionando el potencial para el cierre simple y eficiente de dichos defectos. Este colgajo proporciona grandes ventajas debido a que es reproducible en cualquier centro quirúrgico y no requiere un entrenamiento específico en microcirugía del cirujano y del resto del equipo quirúrgico. Si bien las complicaciones existen, la mayoría no son graves y en general son de resolución simple. En los últimos años, se ha incrementado el empleo del colgajo fasciocutáneo peroneo posterior para lograr la cobertura de los defectos de partes blandas del tercio distal de la pierna y pie. El éxito de estos colgajos está relacionado con el tipo de paciente y de su lesión: el porcentaje es alto en pacientes jóvenes y sanos en quienes el origen del defecto es traumático.

The posterior peroneal flap is a fasciocutaneous flap, which is based on 4 possible sources such as fasciocutaneous perforations of the peroneal artery, fasciocutaneous perforations of the posterior tibial artery, venocutaneous perforations of the saphenous vein, and neurocutaneous perforators of the sural nerve. The objective of this work is to describe the surgical technique and demonstrate the versatility of the posterior peroneal flap for the reconstruction and coverage of defects in the distal third of the leg and the proximal third of the foot, providing the potential for simple and efficient closure of said defects. It provides great advantages because it is reproducible in any surgical center and does not require specific training in microsurgery of the surgeon and the rest of the surgical team. Although complications do exist, most are not serious and are generally of simple resolution. In recent years, the use of the posterior peroneal flap has been increased to achieve coverage of soft tissue defects of the distal third of the leg and foot. The success of these flaps is related to the type of patient and his injury, the success rate is high in young and healthy patients in whom the origin of the defect is traumatic.

Assuntos

RESUMO

La corrección de deformidades en extremidades inferiores del adulto sigue siendo un capítulo desafiante en ortopedia y traumatología. El conocimiento del alineamiento normal de las extremidades inferiores y su comportamiento son fundamentales para una adecuada planificación quirúrgica y éxito del tratamiento, especialmente en tobillo y retropié. El objetivo de esta revisión, es conocer los principios fundamentales de la corrección de deformidades, orientar en que factores fijarse al momento de corregir y poder dar una guía de cómo planificar la cirugía, particularmente en deformidades de tobillo y retropié. NIVEL DE EVIDENCIA: Nivel V.

Adult lower limb deformity corrections remain a challenging chapter in orthopedic surgery. The knowledge of the normal lower limb alignment and their behavior is essential for a proper surgical planning and treatment success, especially on foot and ankle surgery. The objective of this review is to show the main principles of deformity correction, to guide the factors to consider when correcting and to provide a surgical planning guide, particularly in the ankle and hind foot deformities.

Assuntos