The Foot
Elevated plantar pressure, a major risk factor for diabetic foot ulceration was investigated during uphill and downhill walking. The aim was to evaluate potential changes of pressure distribution with a view to improving the design of insoles. Peak pressure and contact time were analysed in 25 patients with non-insulin dependent diabetes. Fifteen with and 10 without peripheral neuropathy, and in 10...
Orthopaedic management of the patient with neuroarthropathy can be problematic, from both diagnostic and treatment standpoints. Accurate diagnosis depends on incorporation of a high index of suspicion for patients at risk. Once the diagnosis is made, management (surgical or non-surgical) can proceed in a logical fashion based on the patient's clinical and radiographic presentation. The treatment goal...
The Central Institute of Technology in Wellington, New Zealand is the only centre for podiatric training in New Zealand. In 1992, the New Zealand Qualification Authority gave approval for the National Diploma in Podiatry to be upgraded to Bachelor of Health Science (Podiatry). The new problem based curriculum was developed around a core of professional competencies identified from an industrial needs...
A. M. Freiberg described a condition in which a collapse of the juvenile second metatarsal head gave rise to localized pain and swelling. 1 This eponymous disease is traditionally classed as one of the osteochondroses: a group of disparate lesions which typically manifest as destruction of an immature epiphysis. A medieval second metatarsal is presented, which by osteological and radiological...
Diabetes has now replaced syphilis and leprosy as the commonest cause of Charcot joint disease. The exact mechanism for the development of Charcot neuroarthropathy remains debatable and still continues to generate much controversy. In the past neurovascular and neurotraumatic theories had been proposed. More recently, research has yielded a new understanding of the Charcot process by establishing...
We report the 6-year results of salvage procedures following total ankle failure. Of 10 patients (11 ankles), eight (nine ankles) had rheumatoid arthritis and two osteoarthritis. Operations were performed on average 3.5 years (range 0.6-8.7 years) after a Bath and Wessex ankle replacement(BAR). Four revisions to a further BAR, five arthrodeses and two excision arthroplasties were performed.At 6.1...
The concept of the 'at-risk' diabetic foot is well developed in hospital-based practice but much care of the elderly non-insulin dependent diabetic patient, particularly prone to foot ulceration, occurs in the community. Therefore, a community survey of 570 diabetic patients was undertaken to establish the prevalence of foot ulceration, presence of established risk factors and frequency of chiropody...
In patients with diabetes, foot ulceration is a major cause of morbidity and hospitalization. Ulceration is a result of a peripheral neuropathy that produces abnormal weightbearing and decreased sensation. Proper foot care will decrease the risk of ulceration. In the absence of infection and dysvascularity, most foot ulcers heal with non-operative care involving total contact casting. Surgical intervention...
Thirty-one patients (thirty-two feet) had excision of the interdigital nerve as treatment of their Morton's metatarsalgia. A longitudinal dorsal incision was used in all cases. Out of 32 cases, 25 had a macroscopically visible neuroma and only two had no evidence of a neuroma on histological examination.All thirty-two patients were available for follow-up at an average of 44.7 months (range 14-71...
A study was undertaken to demonstrate whether there was a significant difference in shock attenuating effect between different sock types and barefoot walking over a period of 72 h. Five different sock types were tested: cotton socks, wool cushion sole sports socks, acrylic cushion sole hiking socks, double layer cotton socks and towelling cushion sole sports socks. A treadmill and shockmeter were...