1/27. Aggressive epithelioid hemangioendothelioma of the lower extremity: a case report and review of the literature.A case of epithelioid hemangioendothelioma (EHE) of the left lower extremity in a 50-year-old male is discussed. The neoplasm presented as a tan-purple, painful mass involving the fourth digit of the left foot. Following an excisional biopsy and partial amputation of the fourth digit, the lesion recurred with a multifocal distribution. A physical exam following the recurrence demonstrated multiple palpable lymph nodes in the left inguinal region. A complete amputation of the fourth digit was performed in conjunction with local excisions of the remaining lesions. Additionally, an inguinal lymphadenectomy was performed for staging purposes. Histologically, the tumor was predominantly composed of epithelioid endothelial cells forming nests, cords, and sheets and occasionally forming irregular, primitive vascular structures. Less commonly, nests of tumor cells assumed a spindled morphology. Patches of necrosis and hemorrhage were apparent throughout the neoplasm. There was minimal atypia and mitoses were not identified. Immunohistochemical stains for CD34, CD31, and ulex europaeus antigens were positive in tumor cells. This case illustrates the potential aggressive behavior of this rare neoplasm and argues against the designation "tumor of low-grade malignancy" with which it is commonly attributed.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/27. Management of foot pain associated with accessory bones of the foot: two clinical case reports.STUDY DESIGN: Case study. OBJECTIVES: To discuss the differential diagnosis, the nonsurgical and postoperative management of common accessory bones of the foot. BACKGROUND: Accessory bones of the foot that are formed during abnormal ossification are commonly found in asymptomatic feet. Two of the most common accessory bones are the accessory navicular and the os peroneum. Their painful presence must be considered in the differential diagnosis of any acute or chronic foot pain. The optimal treatment for the conservative and postoperative management of painful os peroneum and accessory navicular bones remains undefined. methods AND MEASURES: Therapeutic management of the fractured os peroneum included bracing, taping, and foot orthotics to allow healing of involved tissues, and stretching. The focus of the postoperative management of the accessory navicular was joint mobilization and progressive strengthening. Dependent variables included level of pain with provocation and alleviation tests of joint and soft tissue; girth and sensory tests of the foot and ankle; goniometric measures of foot and ankle; strength of ankle and hip muscles; functional tests; and patient's self-reported pain status. RESULTS: The patient with the fractured os peroneum was treated in 13 visits for 10 weeks. At discharge from physical therapy, the patient had the following outcomes relative to the noninvolved side: 100% return of normal sensation tested by light touch and vibration; pain decreased from 6/10 to 1/10; 100% reduction of swelling with ankle girth to normal; 100% range of motion of ankle and subtalar joints. Strength in plantar flexion and eversion remained 20% impaired (80% return to normal) secondary to pain. Upon discharge, he still reported mild pain when walking but was able to return to previous leisure activities. The second patient with the accessory navicular was treated in 18 visits over 9 weeks. Relative to the uninvolved side, she was discharged with the following: 70% return of range of motion in the foot and ankle, 100% of strength in hip and ankle, and 100% return of balance. She could squat and jump without pain and she returned to full premorbid activity level. CONCLUSIONS: Rehabilitative management of both cases addressed specific impairments and was successful in improving the patients' activity limitation. Clinicians should be aware that these accessory bones are possible sources of disability, secondary to foot pain.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/27. Pedal interdigital condylomata lata: a rare sign of secondary syphilis.BACKGROUND: Condylomata lata of the toe webs are uncommon manifestations of secondary syphilis. Considering the recent decline in the incidence of syphilis in the united states, such lesions are likely to present infrequently. In some cases, this phenomenon may be the only physical sign of syphilis; therefore, it is important that a high index of suspicion is maintained when evaluating toe web lesions in patients at epidemiologic risk for syphilis. goals: A case of secondary syphilis presenting solely with interdigital condyloma lata in the toe web spaces is reported, and similar cases reported in the literature are reviewed. STUDY DESIGN: This article documents the diagnosis of secondary syphilis based on a positive serology in conjunction with the development of interdigital condyloma lata as the only physical finding suggestive of lues. RESULTS: The latter lesions resolved after appropriate, adequate antibiotic therapy. CONCLUSIONS: A case of condylomata lata of the toe webs without other pertinent physical findings is presented. Analogous to lesions typically seen in the anogenital region, moist exophytic toe web plaques may represent condyloma lata and thereby be a sign of secondary syphilis. The differential diagnosis includes tinea pedis, erythrasma, macerated corns, verrucae, and several tropical mycoses (chromomycosis, mycetoma).- - - - - - - - - - ranking = 3keywords = physical (Clic here for more details about this article) |
4/27. Verrucous carcinoma of the foot associated with human papillomavirus type 16.BACKGROUND: We present 2 patients with verrucous carcinoma (VC) of the foot, a malignancy of unknown origin. OBJECTIVE: Molecular studies from the VCs were undertaken to determine the presence, type, and physical state of human papillomavirus (HPV) as well as the expression levels of certain oncogenes and antioncogenes. methods: Synthetic consensus and type-specific primers were used to determine the HPV type from both VCs via polymerase chain reaction (PCR). Verification of fragments was accomplished by means of specific isotope-labeled oligonucleotide probes. The physical state of HPV dna was determined by two-dimensional gel electrophoresis. Quantitative oncogene and antioncogene expression studies were performed with the use of reverse transcriptase PCR. RESULTS: HPV type 16 was identified in episomal and integrated forms in both tumors. Expression studies revealed increased messenger rna levels of c-Ki-ras oncogene and the p53 antioncogene and decreased messenger rna levels of the Rb antioncogene in both VCs. CONCLUSION: Episomal and integrated forms of HPV-16 dna were found in VCs of the foot, along with alterations of c-Ki-ras, p53, and Rb genes.- - - - - - - - - - ranking = 2keywords = physical (Clic here for more details about this article) |
5/27. Chigger mite infestation.This article reports on a 45-year-old woman who presented with pruritus and was diagnosed as having chigger mite infestation, a rare condition. The chigger mite larvae were encountered while the patient was traveling in south america. A small erythematous area with a well-circumscribed papule in the sulcus of the second digit of the right foot was incised and drained. Follow-up examination showed relief of all symptoms, including pain and pruritus. This unusual case presentation underscores the need for all podiatric physicians to obtain a comprehensive history, including history of travel, along with performing a thorough physical examination.- - - - - - - - - - ranking = 3.2787895957037keywords = physical examination, physical (Clic here for more details about this article) |
6/27. Palmoplantar eccrine hidradenitis: seven new cases.Palmoplantar eccrine hidradenitis is a self-limited disease characterized by painful erythematous papules and nodules of abrupt onset on the soles, and less frequently on the palms, of young individuals in good health. We describe seven children, four girls and three boys, between 4 and 12 years of age, with characteristic cutaneous and histopathologic findings of palmoplantar eccrine hidradenitis. All patients had complete resolution of their lesions within 2-4 weeks without treatment, however, one child experienced recurrences. All skin biopsy specimens showed a deep dermal mixed infiltrate with abundant neutrophils surrounding eccrine sweat glands, the histologic hallmark of the disease. Palmoplantar eccrine hidradenitis is a distinct clinical entity in which physical activity, excessive sweating, and prolonged wetness are possible triggering factors. The regression of the lesions is usually rapid, with complete clearance after 1 month, although there may be recurrent episodes.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
7/27. Physiotherapy management of patients with hiv-associated Kaposi's sarcoma.BACKGROUND: Kaposi's sarcoma is the most common form of cancer in patients with human immunodeficiency virus (hiv) infection. Although Kaposi sarcoma lesions may contribute to significant physical impairments, there is a lack of scientific literature detailing the role of physiotherapy in the treatment of hiv-associated Kaposi's sarcoma. The present Case Report includes two males, aged 36 and 39 years, seropositive for hiv with invasive Kaposi's sarcoma. METHOD AND RESULTS: Patient A was evaluated for bilateral foot pain caused by plantar surface Kaposi s sarcoma lesions that rendered him unable to walk. He progressed to walking 400feet after a treatment regimen of gait training with the use of custom plastazote sandals. Patient B was evaluated for right lower extremity lymphoedema secondary to invasive Kaposi's sarcoma. He experienced an 18% reduction in limb volume, a 38% reduction in pain and a 20 degrees increase in terminal knee flexion after therapeutic exercise and the use of compressive bandaging and garments. CONCLUSIONS: This Case Report suggests that physiotherapy interventions may be valuable in the conservative management of patients with hiv-associated Kaposi s sarcoma.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
8/27. tarsal tunnel syndrome secondary to neurilemmoma.neurilemmoma is an uncommon cause of tarsal tunnel syndrome, and no other cases of this disorder secondary to a lesion at the bifurcation of the medial and lateral plantar nerves have been described. In this case, a 2 x 0.5 x 1-cm mass was palpable on physical examination, and, after failed conservative treatment, surgical excision brought prompt relief of symptoms.- - - - - - - - - - ranking = 3.2787895957037keywords = physical examination, physical (Clic here for more details about this article) |
9/27. adult-onset primary focal foot dystonia.Although primary focal hand dystonia has been well characterized, primary focal foot dystonia in adults has rarely been reported. Our objective was to describe the clinical phenotype and treatment outcomes in patients with primary, adult-onset focal foot dystonia. To this end we conducted a retrospective study of four consecutive patients (59.5 /-13.5 years, range 44-67) diagnosed over a period of 6 years and followed-up for at least 5 years. Focal foot dystonia resulted in variable physical impairment. Anti-dystonic agents were mildly effective whereas botulinum toxin injections provided substantial benefit when used. Focal primary focal foot dystonia seems to be a rare form of focal dystonia with distinct clinical features that may benefit from treatment with botulinum toxin.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
10/27. ketoprofen gel as an adjunct to physical therapist management of a child with Sever disease.BACKGROUND AND PURPOSE: Sever disease is the most common cause of heel pain in athletic children. The purpose of this case report is to describe the addition of ketoprofen gel to the physical therapy intervention of a child with Sever disease. CASE DESCRIPTION: The patient was an 8-year-old girl diagnosed with Sever disease. Physical therapy intervention consisted of 6 visits over a 3-week period with traditional interventions (including rest, discontinuation of activities that aggravate the condition, hot and cold packs, heel lifts, calf stretching, and strengthening) and the addition of ketoprofen gel to reduce local inflammation and relieve pain. OUTCOMES: The patient demonstrated improvement in all outcome measures: pain rating, the lower extremity Functional Scale, strength, and range of motion. DISCUSSION: The child had relief of pain and returned to activities after 18 days of intervention, which was 30 days less than reports of intervention in the literature that did not include the use of ketoprofen gel.- - - - - - - - - - ranking = 5keywords = physical (Clic here for more details about this article) |
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