1/25. Distal plantar area reconstruction using a flexor digitorum brevis muscle flap with reverse-flow lateral plantar artery.It is difficult to resurface skin defects of the sole because of its unique anatomy, which is resistant to mechanical stimuli. Though various methods have been reported, few are functionally satisfactory, and it is especially difficult to repair the distal plantar area. We report a reconstruction of the distal plantar area using a flexor digitorum brevis muscle flap based on a reverse-flow lateral plantar artery pedicle in a patient with a malignant melanoma on the right lateral metatarsal head of the fifth toe. The muscle flap was sufficient to cover the exposed fifth metatarsal and was covered with a full-thickness skin graft. The result was favourable and the patient has a normal gait and no pressure sores.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/25. Neuropathic pain and dysesthesia of the feet after Himalayan expeditions.High altitude peripheral nerve disease secondary to frostbite or trauma is a well-recognized medical problem during mountaineering expeditions. However, in our experience as medical professionals on 19 expeditions to the Himalayas in the years 1977 to 2000, an unusual syndrome of neuropathic pain and/or dysesthesia in both feet apparently unrelated to frostbite or trench foot was observed in 8 (4.8%) of 165 European mountaineers. Mountaineers complained of persistent and continuous pain, which was consistently described as a "corky" sensation in their feet, associated with severe lancinating exacerbations. pain improved with cold and worsened with heat and gentle pressure. Symptoms were incapacitating in a third of the cases. Treatment with carbamazepine was effective, and the disorder evolved to total resolution in 4 to 8 weeks. We present the case of a patient who had this syndrome and in whom complete work-up studies done on his arrival home, 14 days after its presentation, were unrevealing. The paucity of information regarding this particular variety of neuropathic pain of the feet may be due to lack of clinical suspicion in the field, favorable outcome, and difficulties for further study and evaluation.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
3/25. Purple toes syndrome associated with warfarin therapy in a patient with antiphospholipid syndrome.Purple toes syndrome is an extremely uncommon, nonhemorrhagic, cutaneous complication associated with warfarin therapy. It is characterized by the sudden appearance of bilateral, painful, purple lesions on the toes and sides of the feet that blanch with pressure. The syndrome usually develops 3-8 weeks after the start of warfarin therapy. A 47-year-old man with a history of purple toes syndrome that resolved after discontinuing warfarin--prescribed for a deep vein thrombosis (DVT) in his right lower leg--experienced an acute, proximal DVT in his other leg. warfarin again was prescribed; 1 week later, purple toes syndrome developed in that extremity. warfarin therapy again was discontinued, and intravenous unfractionated heparin was started; the patient's clinical picture indicated a possible pulmonary embolism, and laboratory analysis suggested antiphospholipid syndrome. The patient's toe pain resolved, but the purple discoloration persisted. Follow-up laboratory analysis confirmed antiphospholipid syndrome, and warfarin was restarted with close monitoring. No further complications occurred with long-term therapy. Although a rare complication of therapy, clinicians should monitor for the development of purple toes syndrome in patients taking warfarin.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
4/25. The cytological and biochemical implications of periungual fibroma.Periungual fibromas may be acquired lesions or they may be associated with tuberous sclerosis or von Recklinghausen's disease. Such tumors are comparatively rare benign dermatological entities. Periungual fibromas associated with the posterior nail fold have a potential for inducing deforming nail deformity. pain resulting from the growth is due to concentration of pressures which may be placed on the nail matrix and contiguous soft tissue structures. This is further complicated by compression developed within the toe box of the shoe. The preferred treatment in symptomatic cases is that of complete surgical excision of the entire lesion. The present study presents such a case, together with histopathological features of this type of growth, with special emphasis on the subcellular features of the neoplasm.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
5/25. Juxtamalleolar lipoma with intermediate dorsal cutaneous nerve entrapment.From a review of the literature, it would appear that lipomas of the foot are relatively rare and that, when they do exist, they are of little clinical significance other than cosmetic appearance. The authors presented a case in which the size, location, and character of the mass predisposed the patient to entrapment syndrome of the intermediate dorsal cutaneous nerve. It is important to emphasize, however, that in these cases symptoms are related to a pressure phenomenon and are not a direct result of tumor physiology.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
6/25. Athlete's nodules. Treatment by surgical excision.Athlete's nodules are connective tissue nevi of the collagen type (collagenomas) which appear as thick dermal masses at sites of chronic trauma. They have been described as occurring on the dorsum of the feet, knees, and knuckles of surfers, boxers and marble players. Recurrent minor blunt trauma and pressure are aetiological factors in this condition. We report a 54-year-old man with dermal nodules on the dorsal surface of his feet. These lesions initially appeared during his participation as a player on a high school football team. They were attributed to the chronic pressure of his high-laced athletic sneakers and frequent minor injuries to the involved areas. We describe the successful treatment of our patient's lesions by surgical excision. We also discuss the differential diagnosis and other therapeutic options for athlete's nodules.- - - - - - - - - - ranking = 2keywords = pressure (Clic here for more details about this article) |
7/25. Piezogenic pedal papules extending into the arch. Case report and discussion.A unique presentation of a painful piezogenic papule in the medial longitudinal arch has been presented. This lesion puts pressure on nearby structures, causing pain. walking without pain is achieved through orthopedic padding. It is essential that these papules be differentiated from similar-appearing lesions of a systemic etiology, so that appropriate treatment can be rendered.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
8/25. The neuropathic foot--a management scheme: a case report.The purpose of this case report is to present a management approach that was effective in the healing and long-term care of a neuropathic plantar ulcer in a patient with diabetes mellitus. The report demonstrates that a successful management program must go beyond the stage of healing and include patient education and techniques for reducing plantar pressures to prevent the recurrence of plantar ulcers.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
9/25. Hereditary perforating ulcers of the foot: "hereditary sensory radicular neuropathy".In 4 cases of hereditary sensory radicular neuropathy the loss of pain and thermal sensibility resulting in perforating ulcers starts distally in lower extremities and progresses proximally. It has a sporadic and familial form as well as the hereditary type. In siblings inheritance appeared to be autosomal dominant. By early recognition of the disease and removing pressure from the involved areas, or spreading pressure equally over the foot with proper footwear ulcers are preventable.- - - - - - - - - - ranking = 2keywords = pressure (Clic here for more details about this article) |
10/25. Biomechanical treatment approach to diabetic plantar ulcers. A case report.The purpose of this case report is to describe a physical therapy approach designed to reduce the mechanical pressure at the site of a diabetic plantar ulcer. The patient was a 69-year-old man with diabetes mellitus for 24 years, insensitive feet, and a right plantar ulcer at the first metatarsal head for 21 months. He had a fixed equinus and rear-foot varus deformity, which seemed to place increased pressure on his forefoot. The patient was treated with total contact casting and showed progressive healing until he refused additional casting. One week later, the ulcer was considerably larger. He consented to resume casting, and the ulcer was completely healed in 85 days from the initial treatment. We provided the patient with extra-depth shoes with rigid rocker-bottom soles and a polyethylene-lined ankle-foot orthosis. The ulcer remained healed at one-week and six-month follow-up visits. The primary cause of diabetic plantar ulcers is often excessive pressure on an insensitive foot, and physical therapists should utilize biomechanical principles to reduce these excessive plantar pressures.- - - - - - - - - - ranking = 4keywords = pressure (Clic here for more details about this article) |
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