Diabetic Foot
Foot
Foot Deformities, Acquired
Foot Ulcer
Foot Deformities
Foot Bones
Foot Joints
Differences in costs of treatment for foot problems between podiatrists and orthopedic surgeons. (1/384)
We examined charge data for health insurance claims paid in 1992 for persons under age 65 covered by a large California managed care plan. Charge and utilization comparisons between podiatrists and orthopedic surgeons were made for all foot care and for two specific foot problems, acquired toe deformities and bunions. Podiatrists provided over 59% of foot care services for this commercial population of 576,000 people. Podiatrists charged 12% less per individual service than orthopedists. However, podiatrists performed substantially more procedures per episode of care and treated patients for longer time periods, resulting in 43% higher total charges per episode. Hospitalization was infrequent for all providers, although podiatrists had the lowest rates. In a managed care setting in which all providers must adhere to a preestablished fee schedule, regardless of specialty, the higher utilization by podiatrists should lead to higher overall costs. In some cases, strong utilization controls could offset this effect. We do not know if the utilization difference is due to actual treatment or billing differences. Further, we were unable to determine from the claims data if one specialty had better outcomes than the other. (+info)Plantar fasciitis and other causes of heel pain. (2/384)
The most common cause of heel pain is plantar fasciitis. It is usually caused by a biomechanical imbalance resulting in tension along the plantar fascia. The diagnosis is typically based on the history and the finding of localized tenderness. Treatment consists of medial arch support, anti-inflammatory medications, ice massage and stretching. Corticosteroid injections and casting may also be tried. Surgical fasciotomy should be reserved for use in patients in whom conservative measures have failed despite correction of biomechanical abnormalities. Heel pain may also have a neurologic, traumatic or systemic origin. (+info)Remitting seronegative symmetrical synovitis with pitting oedema (RS3PE) syndrome: a prospective follow up and magnetic resonance imaging study. (3/384)
OBJECTIVE: To determine the clinical characteristics of patients with "pure" remitting seronegative symmetrical synovitis with pitting oedema (RS3PE) syndrome, and to investigate its relation with polymyalgia rheumatica (PMR). Magnetic resonance imaging (MRI) was used to describe the anatomical structures affected by inflammation in pure RS3PE syndrome. METHODS: A prospective follow up study of 23 consecutive patients with pure RS3PE syndrome and 177 consecutive patients with PMR diagnosed over a five year period in two Italian secondary referral centres of rheumatology. Hands or feet MRI, or both, was performed at diagnosis in 7 of 23 patients. RESULTS: At inspection evidence of hand and/or foot tenosynovitis was present in all the 23 patients with pure RS3PE syndrome. Twenty one (12%) patients with PMR associated distal extremity swelling with pitting oedema. No significant differences in the sex, age at onset of disease, acute phase reactant values at diagnosis, frequency of peripheral synovitis and carpal tunnel syndrome and frequency of HLA-B7 antigen were present between patients with pure RS3PE and PMR. In both conditions no patient under 50 was observed, the disease frequency increased significantly with age and the highest frequency was present in the age group 70-79 years. Clinical symptoms for both conditions responded promptly to corticosteroids and no patient developed rheumatoid arthritis during the follow up. However, the patients with pure RS3PE syndrome were characterised by shorter duration of treatment, lower cumulative corticosteroid dose and lower frequency of systemic signs/symptoms and relapse/recurrence. Hands and feet MRI showed evidence of tenosynovitis in five patients and joint synovitis in three patients. CONCLUSION: The similarities of demographic, clinical, and MRI findings between RS3PE syndrome and PMR and the concurrence of the two syndromes suggest that these conditions may be part of the same disease and that the diagnostic labels of PMR and RS3PE syndrome may not indicate a real difference. The presence of distal oedema seems to indicate a better prognosis. (+info)Autosomal dominant burning feet syndrome. (4/384)
Familial burning feet syndrome inherited as an autosomal dominant trait has been described in only one family. Due to an associated sensory neuropathy the autosomal dominant burning feet syndrome was suggested to represent a variant form of hereditary sensory and autonomic neuropathy type I (HSAN I). Clinical, histopathological, and molecular genetic studies were performed in a large German kindred with autosomal dominant burning feet syndrome. The autosomal dominant burning feet syndrome was associated with a neuropathy predominantly affecting small unmyelinated nerve fibres. Linkage to the HSAN I locus on chromosome 9q22 and to the Charcot-Marie-Tooth disease type 2B (CMT 2B) locus on chromosome 3q13-q22 was excluded. The autosomal dominant burning feet syndrome is neither allelic to HSAN I nor to CMT 2B and thus represents a distinct genetic entity. (+info)Hyperthermic isolated limb perfusion with tumor necrosis factor-alpha and melphalan in patients with locally advanced soft tissue sarcomas: treatment response and clinical outcome related to changes in proliferation and apoptosis. (5/384)
Hyperthermic isolated limb perfusion with tumor necrosis factor-alpha and melphalan (HILP-TM) with or without IFN-gamma is a promising local treatment in patients with locally advanced extremity soft tissue sarcomas (STSs), with response rates of up to 84%. The mechanisms of the treatment response are poorly understood. Here, we determined the HILP-TM-induced changes in mitotic activity, proliferation, and apoptosis in 37 STSs; the additional effect of IFN-gamma; and the association of HILP-TM with treatment response and clinical outcome. On archival material, obtained before and 6-8 weeks after HILP-TM with (n = 15) or without (n = 22) IFN-gamma, the number of mitoses was counted, and the proliferation fraction was determined by immunohistological staining for the proliferation associated Ki-67 antigen (MIB1). Apoptosis was visualized by enzymatic detection of DNA fragmentation (terminal deoxynucleotidyl transferase-mediated nick end labeling method). Clinical and histological response, follow-up status, and survival were recorded. The number of mitoses dropped 57% and proliferation rate decreased with 40% after HILP-TM, whereas the amount of apoptosis after HILP-TM more than doubled as before HILP-TM. The addition of IFN-gamma to HILP-TM did not influence the changes in tumor parameters and did not affect treatment response. A better clinical response to HILP-TM was correlated with high mitotic activity and low amount of apoptosis in tumor samples before HILP-TM. Patients with highly proliferative STS before and after HILP-TM had a relatively poor prognosis. Furthermore, patients who developed distant metastases after HILP-TM had a relatively high number of dividing cells in the tumor remnants after treatment. (+info)Heterotopic endochondrial ossification with mixed tumor formation in C3(1)/Tag transgenic mice is associated with elevated TGF-beta1 and BMP-2 expression. (6/384)
Transgenic mice which express the simian virus 40 large T-antigen (Tag) under the regulatory control of the hormone responsive rat C3(1) gene develop unusual lesions of heterotopic bone growth associated with mixed tumor formation arising from eccrine sweat glands found only in the foot pads of mice, ischiocavernosus muscle adjacent to bulbourethral glands and occasionally the salivary and mammary glands. These lesions are very similar to mixed tumors arising in several types of human cancers. Based upon electron microscopic examination and immunocytochemical analyses of cellular differentiation markers, the mixed proliferative lesions in this transgenic mouse model begin with the Tag-induced proliferation of epithelial and myoepithelial cells. The proliferation of these two types of cells results in hyperplasia and adenomatous transformation of the epithelial component, whereas the proliferating myoepithelial cells undergo metaplasia to form chondrocytes which deposit extracellular matrix, including collagen fibers. Cartilage develops focally between areas of epithelial proliferation and subsequently ossifies through a process of endochondrial bone formation. The metaplasia of myoepithelial cells to chondrocytes appears to require the inductive interaction of factors produced by the closely associated proliferating epithelial cells, including members of the TGF-beta superfamily. We demonstrate that TGF-beta1 protein accumulates in the extracellular matrix of the lesions, whereas RNA in situ hybridization reveals that BMP-2, another strong inducer of heterotopic bone formation, is overexpressed by the proliferating epithelial cells during the development of ectopic bone. The formation of sarcomatous tumors within the mixed tumors appears to be androgen-dependent and more frequent in mice lacking a normal allele of p53. This process of cartilage and bone induction may mimic epithelial-mesenchymal interactions which occur during embryonic bone formation. These transgenic mice may provide new insights into the processes of ectopic endochondrial bone formation associated with mixed tumor formation and serve as a useful model for human heterotopic bone disease. (+info)A systematic review of treatments for the painful heel. (7/384)
OBJECTIVE: To establish the efficacy for treatments of pain on the plantar aspect of the heel. METHODS: Systematic review of the published and unpublished literature. Electronic search of Medline, BIDS and the Cochrane database of clinical trials. An assessment of the quality of the reporting was made of studies included in the review. MAIN OUTCOME MEASURE: patients' pain scores. STUDY SELECTION: randomized controlled trials, published or unpublished, that evaluated treatments used for plantar heel pain. Foreign language papers were excluded. RESULTS: Eleven randomized controlled trials were included in the review. These evaluated some of the most frequently described treatments (steroid injections and orthoses) and some experimental therapies (extracorporeal shock wave therapy and directed electrons). The methodological assessment scores of the published trials were low; small sample sizes and failure to conceal the treatment allocation from study participants prevents more definitive statements about the efficacy of treatments. In 10 of the included trials, patients in both the intervention and control arms reported improved pain scores at the final outcome measure. CONCLUSIONS: Although much has been written about the treatment of plantar heel pain, the few randomized controlled trials involve small populations of patients and do not provide robust scientific evidence of treatment efficacy. (+info)Steroid injection for heel pain: evidence of short-term effectiveness. A randomized controlled trial. (8/384)
OBJECTIVES: To compare the effectiveness of a steroid injection (25 mg/ml prednisolone acetate) with a local anaesthetic control in the treatment of heel pain and to determine any advantage for patients' comfort of using a posterior tibial nerve block to anesthetize the heel prior to infiltration. METHODS: A double-blind randomized controlled trial using a 2 x 2 design in a hospital-based rheumatology clinic. Subjects comprised 106 patients with heel pain referred by general practitioners and other rheumatologists working in Camden and Islington Health Authority. MAIN OUTCOME MEASURES: heel pain reduction at 1, 3 and 6 months, and patient comfort at the time of injection. All outcomes were measured using a 10 cm visual analogue scale. RESULTS: A statistically significant reduction in pain was detected at 1 month (P=0.02) in favour of steroid injection, but thereafter no differences could be detected. Patient comfort was not significantly affected by anaesthesia of the heel (P=0.5). CONCLUSIONS: A steroid injection can provide relief from heel pain in the short term. There appears to be no increase in patient comfort from anaesthetizing the heel prior to infiltration. (+info)Foot diseases refer to various medical conditions that affect the foot, including its structures such as the bones, joints, muscles, tendons, ligaments, blood vessels, and nerves. These conditions can cause symptoms like pain, swelling, numbness, difficulty walking, and skin changes. Examples of foot diseases include:
1. Plantar fasciitis: inflammation of the band of tissue that connects the heel bone to the toes.
2. Bunions: a bony bump that forms on the joint at the base of the big toe.
3. Hammertoe: a deformity in which the toe is bent at the middle joint, resembling a hammer.
4. Diabetic foot: a group of conditions that can occur in people with diabetes, including nerve damage, poor circulation, and increased risk of infection.
5. Athlete's foot: a fungal infection that affects the skin between the toes and on the soles of the feet.
6. Ingrown toenails: a condition where the corner or side of a toenail grows into the flesh of the toe.
7. Gout: a type of arthritis that causes sudden, severe attacks of pain, swelling, redness, and tenderness in the joints, often starting with the big toe.
8. Foot ulcers: open sores or wounds that can occur on the feet, especially in people with diabetes or poor circulation.
9. Morton's neuroma: a thickening of the tissue around a nerve between the toes, causing pain and numbness.
10. Osteoarthritis: wear and tear of the joints, leading to pain, stiffness, and reduced mobility.
Foot diseases can affect people of all ages and backgrounds, and some may be prevented or managed with proper foot care, hygiene, and appropriate medical treatment.
The term "diabetic foot" refers to a condition that affects the feet of people with diabetes, particularly when the disease is not well-controlled. It is characterized by a combination of nerve damage (neuropathy) and poor circulation (peripheral artery disease) in the feet and lower legs.
Neuropathy can cause numbness, tingling, or pain in the feet, making it difficult for people with diabetes to feel injuries, cuts, blisters, or other foot problems. Poor circulation makes it harder for wounds to heal and increases the risk of infection.
Diabetic foot ulcers are a common complication of diabetic neuropathy and can lead to serious infections, hospitalization, and even amputation if not treated promptly and effectively. Preventive care, including regular foot exams, proper footwear, and good blood glucose control, is essential for people with diabetes to prevent or manage diabetic foot problems.
In medical terms, the foot is the part of the lower limb that is distal to the leg and below the ankle, extending from the tarsus to the toes. It is primarily responsible for supporting body weight and facilitating movement through push-off during walking or running. The foot is a complex structure made up of 26 bones, 33 joints, and numerous muscles, tendons, ligaments, and nerves that work together to provide stability, balance, and flexibility. It can be divided into three main parts: the hindfoot, which contains the talus and calcaneus (heel) bones; the midfoot, which includes the navicular, cuboid, and cuneiform bones; and the forefoot, which consists of the metatarsals and phalanges that form the toes.
Acquired foot deformities refer to structural abnormalities of the foot that develop after birth, as opposed to congenital foot deformities which are present at birth. These deformities can result from various factors such as trauma, injury, infection, neurological conditions, or complications from a medical condition like diabetes or arthritis.
Examples of acquired foot deformities include:
1. Hammertoe - A deformity where the toe bends downward at the middle joint, resembling a hammer.
2. Claw toe - A more severe form of hammertoe where the toe also curls under, forming a claw-like shape.
3. Mallet toe - A condition where the end joint of a toe is bent downward, causing it to resemble a mallet.
4. Bunions - A bony bump that forms on the inside of the foot at the big toe joint, often causing pain and difficulty wearing shoes.
5. Tailor's bunion (bunionette) - A similar condition to a bunion, but it occurs on the outside of the foot near the little toe joint.
6. Charcot foot - A severe deformity that can occur in people with diabetes or other neurological conditions, characterized by the collapse and dislocation of joints in the foot.
7. Cavus foot - A condition where the arch of the foot is excessively high, causing instability and increasing the risk of ankle injuries.
8. Flatfoot (pes planus) - A deformity where the arch of the foot collapses, leading to pain and difficulty walking.
9. Pronation deformities - Abnormal rotation or tilting of the foot, often causing instability and increasing the risk of injury.
Treatment for acquired foot deformities varies depending on the severity and underlying cause but may include orthotics, physical therapy, medication, or surgery.
A foot ulcer is a wound or sore on the foot that occurs most commonly in people with diabetes, but can also affect other individuals with poor circulation or nerve damage. These ulcers can be challenging to heal and are prone to infection, making it essential for individuals with foot ulcers to seek medical attention promptly.
Foot ulcers typically develop due to prolonged pressure on bony prominences of the foot, leading to breakdown of the skin and underlying tissues. The development of foot ulcers can be attributed to several factors, including:
1. Neuropathy (nerve damage): This condition causes a loss of sensation in the feet, making it difficult for individuals to feel pain or discomfort associated with pressure points, leading to the formation of ulcers.
2. Peripheral artery disease (PAD): Reduced blood flow to the lower extremities can impair wound healing and make the body more susceptible to infection.
3. Deformities: Structural foot abnormalities, such as bunions or hammertoes, can cause increased pressure on specific areas of the foot, increasing the risk of ulcer formation.
4. Poorly fitting shoes: Shoes that are too tight, narrow, or ill-fitting can create friction and pressure points, contributing to the development of foot ulcers.
5. Trauma: Injuries or trauma to the feet can lead to the formation of ulcers, particularly in individuals with neuropathy who may not feel the initial pain associated with the injury.
6. Foot care neglect: Failure to inspect and care for the feet regularly can result in undetected wounds or sores that progress into ulcers.
Foot ulcers are classified based on their depth, severity, and extent of tissue involvement. Proper assessment, treatment, and prevention strategies are crucial in managing foot ulcers and minimizing the risk of complications such as infection, gangrene, and amputation.
Foot injuries refer to any damage or trauma caused to the various structures of the foot, including the bones, muscles, tendons, ligaments, blood vessels, and nerves. These injuries can result from various causes such as accidents, sports activities, falls, or repetitive stress. Common types of foot injuries include fractures, sprains, strains, contusions, dislocations, and overuse injuries like plantar fasciitis or Achilles tendonitis. Symptoms may vary depending on the type and severity of the injury but often include pain, swelling, bruising, difficulty walking, and reduced range of motion. Proper diagnosis and treatment are crucial to ensure optimal healing and prevent long-term complications.
Foot deformities refer to abnormal changes in the structure and/or alignment of the bones, joints, muscles, ligaments, or tendons in the foot, leading to a deviation from the normal shape and function of the foot. These deformities can occur in various parts of the foot, such as the toes, arch, heel, or ankle, and can result in pain, difficulty walking, and reduced mobility. Some common examples of foot deformities include:
1. Hammertoes: A deformity where the toe bends downward at the middle joint, resembling a hammer.
2. Mallet toes: A condition where the end joint of the toe is bent downward, creating a mallet-like shape.
3. Claw toes: A combination of both hammertoes and mallet toes, causing all three joints in the toe to bend abnormally.
4. Bunions: A bony bump that forms on the inside of the foot at the base of the big toe, caused by the misalignment of the big toe joint.
5. Tailor's bunion (bunionette): A similar condition to a bunion but occurring on the outside of the foot, at the base of the little toe.
6. Flat feet (pes planus): A condition where the arch of the foot collapses, causing the entire sole of the foot to come into contact with the ground when standing or walking.
7. High arches (pes cavus): An excessively high arch that doesn't provide enough shock absorption and can lead to pain and instability.
8. Cavus foot: A condition characterized by a very high arch and tight heel cord, often leading to an imbalance in the foot structure and increased risk of ankle injuries.
9. Haglund's deformity: A bony enlargement on the back of the heel, which can cause pain and irritation when wearing shoes.
10. Charcot foot: A severe deformity that occurs due to nerve damage in the foot, leading to weakened bones, joint dislocations, and foot collapse.
Foot deformities can be congenital (present at birth) or acquired (develop later in life) due to various factors such as injury, illness, poor footwear, or abnormal biomechanics. Proper diagnosis, treatment, and management are essential for maintaining foot health and preventing further complications.
'Foot bones,' also known as the tarsal and metatarsal bones, are the 26 bones that make up the foot in humans. The foot is divided into three parts: the hindfoot, midfoot, and forefoot.
The hindfoot contains two bones: the talus, which connects to the leg bone (tibia), and the calcaneus (heel bone). These bones form the ankle joint and heel.
The midfoot is made up of five irregularly shaped bones called the navicular, cuboid, and three cuneiform bones. These bones help form the arch of the foot and connect the hindfoot to the forefoot.
The forefoot contains the metatarsals (five long bones) and the phalanges (14 small bones). The metatarsals connect the midfoot to the toes, while the phalanges make up the toes themselves.
These bones work together to provide stability, support, and movement for the foot, allowing us to walk, run, and jump.
"Foot joints" is a general term that refers to the various articulations or connections between the bones in the foot. There are several joints in the foot, including:
1. The ankle joint (tibiotalar joint): This is the joint between the tibia and fibula bones of the lower leg and the talus bone of the foot.
2. The subtalar joint (talocalcaneal joint): This is the joint between the talus bone and the calcaneus (heel) bone.
3. The calcaneocuboid joint: This is the joint between the calcaneus bone and the cuboid bone, which is one of the bones in the midfoot.
4. The tarsometatarsal joints (Lisfranc joint): These are the joints that connect the tarsal bones in the midfoot to the metatarsal bones in the forefoot.
5. The metatarsophalangeal joints: These are the joints between the metatarsal bones and the phalanges (toes) in the forefoot.
6. The interphalangeal joints: These are the joints between the phalanges within each toe.
Each of these foot joints plays a specific role in supporting the foot, absorbing shock, and allowing for movement and flexibility during walking and other activities.
Congenital foot deformities refer to abnormal structural changes in the foot that are present at birth. These deformities can vary from mild to severe and may affect the shape, position, or function of one or both feet. Common examples include clubfoot (talipes equinovarus), congenital vertical talus, and cavus foot. Congenital foot deformities can be caused by genetic factors, environmental influences during fetal development, or a combination of both. Treatment options may include stretching, casting, surgery, or a combination of these approaches, depending on the severity and type of the deformity.