In this study, we investigated the responsiveness of the Self-Administered Foot Evaluation Questionnaire (SAFE-Q) for patient's assessment before and after hallux valgus surgery.
Patient-reported ...answers on the SAFE-Q and Short Form-36 (SF-36) before and at a mean of 3-4 and 9-12 months after hallux valgus surgery were analyzed. Data of 100 patients (92 women, eight men) from 36 institutions throughout Japan were used for analysis.
In all subscales of the SAFE-Q, the trend of increased scores after surgery was statistically significant (P < 0.001). Among the patients with available scores both before and at 9-12 months after surgery (n = 66), the largest effect sizes (ESs) were observed for shoe-related (1.60), pain and pain-related (1.05), and general health and well-being (0.84) scales. In the SF-36 (n = 64), the largest ES was observed for the bodily pain scale (0.86). Less notable changes were observed for the remaining SF-36 domains.
The SAFE-Q is the first patient-reported outcome measure which includes a quality of life assessment of shoes. In our cohort, the most remarkable responsiveness was observed for the shoe-related subscale. Based on its responsiveness, the SAFE-Q appears to be sufficient for evaluation of foot-related quality of life before and after surgery.
Category:
Bunion
Introduction/Purpose:
Total arthroplasty or arthrodesis is often used as a surgical procedure for severe case of hallux rigidus. However, because these procedures involve problems ...such as loss of joint function, age, and postoperative motion restriction, joint-preserving surgery is desirable for achieving a better quality of life. To resolve these problems, we have performed dorsiflexion osteotomy of the first metatarsal head since 2000, yielding favorable outcomes. We report about middle to long-term follow-up for our clinical results and radiographic findings.
Methods:
The study involved 31 feet of 30 patients (20 male,11 female) with Grade 2 (joint space narrowed to about 1/2 or less) or Grade 3 according to the Hattrup and Johnson classification. The mean age at surgery was 61.6 years (range: 53-77). Surgical techniques: We have used dorsal approach and conducted closed wedge osteotomy of the first metatarsal bone neck. Then, the bone head was flexed dorsally to form an articular surface and fixation. PWB was permitted 3 weeks after surgery. Mean postoperative follow-up period was 4 years and 2 months (range: 3-13 years). Clinical outcomes, range of motion (ROM), and radiographic findings were investigated.
Results:
Clinical outcomes were rated as excellent in 24 feet, good in 7, and fair/poor in none. All patients returned to normal daily life. Stiffness while walking was noted in 10 feet. As for ROM, most patients had a 1/2 to 2/3 of the normal range. No complications such as infection, nonunion, or transfer metatarsalgia were seen in any case. An X-ray film showed joint space narrowing in about half of all cases. None of the patients experienced pain relapse requiring arthrodesis again.
Conclusion:
The mechanism of pain relief is Dorsiflexion osteotomy is by bone shortening, make a decreasing joint pressure and regaining of normal articular to the dorsal side so that it faces the articular surface of the proximal phalanx. The postoperative restriction of ROM may be attributable to changes in the bone alignment and in the tension of soft tissue around the joint as compared to the healthy condition. None of the patients experienced pain relapse. Our procedure appears to be useful as joint- preserving surgery for severe cases with hallux rigidus.
Introduction Posterior ankle pain is a common but serious problem in ballet dancers. Certain kinds of pathological conditions have been reported, such as os trigonum (OT) syndrome, fracture of the ...Stieda process, flexor hallucis longus (FHL) tendinosis and/or tenosynovitis, soft tissue impingement, and so on. They are considered as a pathological unit of posterior ankle impingement syndrome (PAIS). The purpose of this study is to elucidate the pathologies of PAIS and to clarify how to approach and treat these conditions. Methods Between September 2007 and August 2010, 35 feet of 32 patients, including only one foot of a male patient, underwent hindfoot endoscopic surgery due to PAIS. Average age was 19.6 years (range, 12-40) at the time of surgery. The pathological conditions were retrospectively analyzed mainly with operative findings, also referring with X-ray, MRI, and histological findings. Surgical technique presented by van Dijk was applied to all feet. Results Synchondrosis injury (SCI) was detected in 14 feet, synovitis associated with one or more movable os trigonum (mOT) in 12, a fracture (or microfracture) in os trigonum or posterior process of the talus in four, DJD beneath the OT in two. Injury to the FHL tendon matrix was observed in 23 feet, distal insertion of FHL muscle fibers in 12, and anomalous muscle (FDAL) in two. Intermalleolar ligament (IML), which is also called a tibial slip, a part of transverse tibiofibular ligament, or a pseudomeniscoid were found in 21 feet (60%), ranging from 1 to 5 mm in width. Among them, five were adherent to the FHL tendon sheath, and three had behavior linked with the FHL motion, which seemed to undergo posterior ankle impingement. Osteochondral lesion of the medial talar trochlea were observed in two feet, nodular fibrosis in posterior talocalcaneal ligament and marked synovitis in ankle and posterior subtalar joint in one, respectively. A great majority of feet were affected with two or more pathologic conditions, except four feet. 22 feet (62.9%) had combined bony impingement (SCI, mOT, fracture) with FHL tendon injury. Conclusion Bony impingement was the major pathological process, related in more than 90 percent of the patients; special attention, however, should be paid to some other conditions that concomitantly existed. The hindfoot arthroscopic approach has great diagnostic potentials to posterior aspect of ankle and posterior subtalar joint. And also enables to treat bony impingement, IML lesions, and tenolysis of the FHL and/or FDAL tendon. But when repair of the severely injured FHL tendonor extirpation of ganglions on the tendon sheath is necessary, the other approach should be considered.
Category:
Bunion
Introduction/Purpose:
X-ray measurement for hallux valgus has been conducted with various results in the evaluation. However, it was not quite clarified yet and it still remains ...questionable why a mild case shifts to a severe case during the course. We report about the difference between the severity and the foot shape.
Methods:
The study subjects were 206 feet of 138 patients.
Mild case: 80 feet, mean age 53 y.o (A)
Moderate case: 61 feet, 62 y.o (B)
Severe case: 65 feet, 67 y.o (C)
For the examination items, HVA, M1-2 angle, and M1-5 angle were measured with the x-ray frontal radiograph for loading position, and First, Second, Fifth intermetatarsal angle (M1Y/M2Y/M5Y) on sagittal plane were also measured. We also evaluated the foot arch ratio with Yokokura Method, then compared/examined those results after dividing the cases into the mild, moderate, and severe group with age bracket.
Results:
The age of Group C were older than Group A, B.
M1-2 angle: In younger generation, three is significant difference between Group A and B.
M1-5 angle: Significant in 60 s between A and B. In 70 s, significant: all group.
Navicular height: all group is low arch with aging. Significant between A and C
It is becoming low arch at Lisfranc level with aging in all group.
There is significantly low height at M5 with aging in all group.
On sagittal plane, bone axis of M1 and M2 is lowered at 40 s in Group A and B and 70 s in Group C.
Conclusion:
In hallux valgus, the foot shape was changed in coronal and sagittal plane.
It means the collapse of bone structure at foot and ankle.
It may possibly be shifting to a severe case with aging.
However, we could not find any result definitely suggesting such condition.
Category:
Trauma
Introduction/Purpose:
Treatment of talus fracture is difficult. Because talus fracture often cause the avascular necrosis, and necessitate a prolonged non-weight-bearing period or ...arthrodesis in these cases. Identification of the fracture type that results in necrosis before a surgery may help in the determination of the planning of treatment and the prognosis. However, necrosis cannot be identified directly by a conventional fracture classification. We investigated the sites in which fracture lines of the talus are visible by using CT to determine the association between fracture of the talus and the occurrence of necrosis.
Methods:
Twenty-five patients (25 feet; 18 men and 7 women; mean age at the first visit, 48.4 years range, 15–80 years) treated through 2003 to 2013 were included in this study.
Fracture lines were assessed using radiography and CT. According to the conventional classification, 12 neck fractures and 13 body fractures were found. The Inokuchi–Ogawa classification was used to assess the fracture line on the subtalar joint surfaces. A fracture line was defined as the line connecting 1 with the other point as follows: (a) the sulcus tali ; (b) the sinus tarsi; (c) between the lateral process and the lateral tubercle; and (d) the medial tubercle. MRI was used for the assessment of necrosis. The subjects were divided into the non-necrosis group (group A) and the necrosis group (group B), and relationship between fracture lines and appearance of necrosis was examined.
Results:
With the exclusion of 2 unclassifiable cases, group A consisted of 15 feet, whereas group B consisted of 8 feet. At the Inokuchi–Ogawa classification, 1fracture line was found in 8 feet,2:5, and and 3:1 in group A. In group B, all cases showed multiple fracture lines. Among the lines connecting a-b, a-c, and b-d, fracture was observed in more than 2 lines in the all cases .
Conclusion:
The most important factor for determining the prognosis of talus fracture is the presence or absence of necrosis. The results of this study indicate that fracture lines connecting a-b, a-c, and b-d interrupt major blood routes, and talus fracture more than 2 fracture lines were highly likely to develop avascular necrosis. Thus, fracture lines may predict the occurrence of necrosis and possible sites of its occurrence.
Background:
Second metatarsophalangeal (MTP) joint dislocation is associated with hallux valgus, and the treatment of complete dislocation can be difficult. The purpose of this study was to ...radiographically clarify the characteristic foot shape in the presence of second MTP joint dislocation.
Methods:
Weight-bearing foot radiographs of the 268 patients (358 feet) with hallux valgus were examined. They were divided into 2 groups: those with second MTP joint dislocation (study group = 179 feet) and those without dislocation (control group = 179 feet). Parameters measured included the hallux valgus angle (HVA), first-second intermetatarsal angle (IMA), second MTP joint angle, hallux interphalangeal angle (IPA), second metatarsal protrusion distance (MPD), metatarsus adductus angle (MAA), and the second metatarsal declination angle (2MDA). Furthermore, the dislocation group was divided into 3 subgroups according to second toe deviation direction: group M (medial type), group N (neutral type), and group L (lateral type).
Results:
The IPA and the 2MDA were significantly greater in the study group than in the control group. By multiple comparison analysis, the IMA was greatest in group M and smallest in group L. The IPA was smaller and 2MDA greater in group N than in group L. The HVA and MAA in group L were greatest, and MPD in group L was smallest.
Conclusions:
The patients with second MTP joint dislocation associated with hallux valgus had greater hallux interphalangeal joint varus and a second metatarsal more inclined than with hallux valgus alone. The second toe deviated in a different direction according to the foot shape.
Level of Evidence:
Level III, retrospective comparative study.
Urinary free-glycans are promising markers of disease. In this study, we attempted to identify novel tumor markers by focusing on neutral free-glycans in urine. Free-glycans extracted from the urine ...of normal subjects and cancer patients with gastric, colorectal, pancreatic and bile duct were fluorescently labeled with 2-aminopyridine. Profiles of these neutral free-glycans constructed using multidimensional high performance liquid chromatography separation were compared between normal controls and cancer patients. The analysis identified one glycan in the urine of cancer patients with a unique structure, which included a pentose residue. To reveal the glycan structure, the linkage fashion, monosaccharide species and enantiomer of the pentose were analyzed by high performance liquid chromatography and mass spectrometry combined with several chemical treatments. The backbone of the glycan was a monoantennary complex-type free-N-glycan containing β1,4-branch. The pentose residue was attached to the antennal GlcNAc and released by α1,3/4-L-fucosidase. Intriguingly, the pentose residue was consistent with D-arabinose. Collectively, this glycan structure was determined to be Galβ1-4(D-Araβ1-3)GlcNAcβ1-4Manα1-3Manβ1-4GlcNAc-PA. Elevation of D-arabinose-containing free-glycans in the urine of cancer patients was confirmed by selected reaction monitoring. This is the first study to unequivocally show the occurrence of a D-arabinose-containing oligosaccharide in human together with its detailed structure.
Summary
Stevens‐Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare but life‐threatening severe cutaneous adverse reactions. Recently, strong associations of HLA‐B*1502 with ...carbamazepine‐induced SJS/TEN have been found in Han Chinese patients. These associations have been confirmed in several Asian populations, excluding Japanese. SJS patients carrying HLA‐B*1508, HLA‐B*1511, or HLA‐B*1521, which are members of the HLA‐B75 type along with HLA‐B*1502, were detected in studies in India and Thailand. In the current study, we genotyped the HLA‐B locus from 14 Japanese typical and atypical SJS/TEN patients in whom carbamazepine was considered to be involved in the onset of adverse reactions. Although there were no HLA‐B*1502 carriers, four patients had HLA‐B*1511. Our data suggest that HLA‐B*1511, a member of HLA‐B75, is a risk factor for carbamazepine‐induced SJS/TEN in Japanese.
We recently reported increased levels of urinary free-glycans in some cancer patients. Here, we focused on cancer related alterations in the levels of high molecular weight free-glycans. The ...rationale for this study was that branching, elongation, fucosylation and sialylation, which lead to increases in the molecular weight of glycans, are known to be up-regulated in cancer. Urine samples from patients with gastric cancer, pancreatic cancer, cholangiocarcinoma and colorectal cancer and normal controls were analyzed. The extracted free-glycans were fluorescently labeled with 2-aminopyridine and analyzed by multi-step liquid chromatography. Comparison of the glycan profiles revealed increased levels of glycans in some cancer patients. Structural analysis of the glycans was carried out by performing chromatography and mass spectrometry together with enzymatic or chemical treatments. To compare glycan levels between samples with high sensitivity and selectivity, simultaneous measurements by reversed-phase liquid chromatography-selected ion monitoring of mass spectrometry were also performed. As a result, three lactose-core glycans and 78 free-N-glycans (one phosphorylated oligomannose-type, four sialylated hybrid-type and 73 bi-, tri- and tetra-antennary complex-type structures) were identified. Among them, glycans with α1,3-fucosylation ((+/- sialyl) Lewis X), triply α2,6-sialylated tri-antennary structures and/or a (Man3)GlcNAc1-core displayed elevated levels in cancer patients. However, simple α2,3-sialylation and α1,6-core-fucosylation did not appear to contribute to the observed increase in the level of glycans. Interestingly, one tri-antennary free-N-glycan that showed remarkable elevation in some cancer patients contained a unique Glcβ1-4GlcNAc-core instead of the common GlcNAc2-core at the reducing end. This study provides further insights into free-glycans as potential tumor markers and their processing pathways in cancer.
Although maternal nurturing behavior is extremely important for the preservation of a species, our knowledge of the biological underpinnings of these behaviors is insufficient. Here we show that the ...degree of a mother’s nurturing behavior is regulated by factors present during her own fetal development. We found that Cin85-deficient (Cin85
−/−) mother mice had reduced pituitary hormone prolactin (PRL) secretion as a result of excessive dopamine signaling in the brain. Their offspring matured normally and produced their own pups; however, nurturing behaviors such as pup retrieval and nursing were strongly inhibited. Surprisingly, when WT embryos were transplanted into the fallopian tubes of Cin85
−/− mice, they also exhibited inhibited nurturing behavior as adults. Conversely, when Cin85
−/− embryos were transplanted into the fallopian tubes of WT mice, the resultant pups exhibited normal nurturing behaviors as adults. When PRL was administered to Cin85
−/− mice during late pregnancy, a higher proportion of the resultant pups exhibited nurturing behaviors as adults. This correlates with our findings that neural circuitry associated with nurturing behaviors was less active in pups born to Cin85
−/− mothers, but PRL administration to mothers restored neural activity to normal levels. These results suggest that the prenatal period is extremely important in determining the expression of nurturing behaviors in the subsequent generation, and that maternal PRL is one of the critical factors for expression. In conclusion, perinatally secreted maternal PRL affects the expression of nurturing behaviors not only in a mother, but also in her pups when they have reached adulthood.
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