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Diabetes Mellitus, Obesity, Lipoprotein Disorders and other Metabolic Diseases
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
This is an unusual complication of neuropathic feet presenting as a red, hot, swollen foot with or without pain. Blood flow to the foot is increased due to autonomic neuropathy. Peripheral neuropathy may contribute to unnoticed trauma. An excessive local inflammatory response results in focal osteolysis and osteoporosis. Sustained mechanical stress deforms the foot with fracture-dislocations of forefoot bones and mid-foot collapse. Once foot deformity has occurred, the risk of foot ulceration is high and with it the risk of soft tissue and bone infection. Charcot arthropathy is often misdiagnosed as cellulitis but, if not recognized, serious complications are likely. Plain radiographs are initially normal, but later show fracture, osteolysis, new bone formation and disorganization of the joint by subluxation.MRI scans may show bone marrow oedema in the mid-foot region, but may be difficult to differentiate from osteomyelitis (Figure 11.10).
Management of diabetic foot
Published in Maneesh Bhatia, Essentials of Foot and Ankle Surgery, 2021
Venu Kavarthapu, Raju Ahluwalia
As the acute and uncontrolled inflammation settles, the CN affected foot progresses to the inactive phase, where the involved bones show a healing response. This results in foot deformity with or without instability. Chronic CN may present to the foot clinic with sequelae due to deformity, such as ulceration/osteomyelitis at the site of deformity or seeking reconstructive surgery for profound deformities such as ‘rocker foot’ from a midfoot collapse or varus hindfoot from ankle bones involvement. In such late presentations, usually months to years after the acute episode, one needs to remain vigilant for coexistent PAD.
Neurology
Published in Stephan Strobel, Lewis Spitz, Stephen D. Marks, Great Ormond Street Handbook of Paediatrics, 2019
Fenella Kirkham, Adnan Manzur, Stephanie Robb
Often none is needed, but includes careful foot care, physiotherapy and orthotic review, occupational therapy assessment for fine motor problems, e.g. handwriting difficulty, with access to keyboard and extra time in exams if necessary. Orthopaedic surveillance and intervention may be needed for progressive foot deformity.
The prevalence and risk factors for foot pressure ulcers in ambulatory pediatric patients with spina bifida
Published in Disability and Rehabilitation, 2021
Susan Rethlefsen, Nicole Mueske, Tishya Wren, Rajan Murgai, Melissa Bent
As is true of all retrospective analyses, the current study had limitations. The sample size may have limited our ability to determine risk factors for foot pressure ulcers. We relied on medical record review for data collection, and though the majority of subjects had all their care at our facility, records may have been incomplete for patients who did not. Age and length of follow up varied among subjects. Some variables were assessed at a single time-point (foot deformity type and flexibility), and were assumed to persist throughout the length of follow-up. Since our focus was prevalence and risk factors, and because the information was not always included in the electronic medical record, we could not record wound severity or staging. However, only open wounds were included as pressure ulcers in the analysis. Because the patients were all under the age of 18 and ambulatory, the study results may not be generalizable to adults with spina bifida or those who are non-ambulatory. Since the study included only subjects who had gait analysis testing performed, and all were seen at the same hospital, there may have been selection bias in the study sample that we were unable to control for. Finally, though gait analysis and pedobarograph data were obtained in all subjects, we did not attempt to correlate pressure ulcers with gait variables or foot pressure patterns. This is an area for future investigation.
Arthroscopic triple arthrodesis for the patient with rheumatoid arthritis; a case report
Published in Modern Rheumatology Case Reports, 2021
Tomoyuki Nakasa, Yasunari Ikuta, Munekazu Kanemitsu, Nobuo Adachi
Arthroscopic triple arthrodesis has its own inherent risk factors related to fragile soft tissues, nerve injury, limited ability to correct severe deformity, secondary incisions for screw placement. On the other hand, open triple arthrodesis has the ability of correction for even if severe flat foot deformity. In addition, open procedure provides good visualisation to avoid nerve injury, and it takes relatively short operation time compared with arthroscopic triple arthrodesis. Surgical procedures should be considered for risks and benefits associated with open versus arthroscopic surgery. Appropriate indication of arthroscopic triple arthrodesis is flexible flat foot with remaining of the joint space of the subtalar joint on the plain radiogram or CT. It would be possible for arthroscopic arthrodesis at the other 2 joints even if the joint spaces disappeared because these joints are close to the skin and the joint spaces could be widened by adjusting the foot position. Severe flat foot deformity may not be indicated for arthroscopic triple arthrodesis because of the large amount of bone resection for the correction and the need for large bone grafting with plate fixation. However, in some cases, it may be better to perform arthroscopic arthrodesis for one or two joints to reduce the skin trouble and postoperative pain, rather than arthroscopic triple arthrodesis.
Effects of forefoot arthroplasty on plantar pressure, pain, gait and disability in rheumatoid arthritis
Published in Modern Rheumatology, 2020
Hayato Shimoda, Yuichi Mochida, Hideyuki Oritsu, Yoshitaka Shimizu, Yoshiki Takahashi, Hidetaka Wakabayashi, Naoko Watanabe
Rheumatoid arthritis (RA) is a systemic inflammatory disease. Articular destruction is sometimes progressive, depending on disease control. Early in the disease course, foot deformity tends to occur, especially at the forefoot [1]. Forefoot deformities such as hallux valgus, metatarsophalangeal (MTP) dislocation, and claw toe are major causes of complaints for patients with RA because of pain during walking, which in turn leads to walking disability [2,3]. Higher plantar pressure underneath the MTP joint is sometimes observed from the early phase of RA [4], with a positive correlation between plantar pressure and arthritis of the MTP joint [5]. Increased pressure under the foot has been reported as one of the gait characteristics [6], which causes pain in RA [7]. Therefore, it is clinically important to treat abnormal high plantar pressure in patients with RA.