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Podiatry - Disease Topic Overview

Podiatry is the medical science detailing the study, prevention, diagnosis and appropriate management of diseases of the foot and ankle.

The foot plays an essential role in standing and locomotion.¹ It supports the body's weight during standing, levers it forward during walking, and absorbs shock during running and jumping.¹ The foot is exposed to forces between two and four times a person's bodyweight during running, and jumping.² This intense and repeated exposure makes the foot the site of many problems.²

The foot can be affected by a variety of congenital, inflammatory, infectious, degenerative, and neoplastic disorders.¹ Foot pain is a highly prevalent condition reported by at least one in five people in the general population.³ The prevalence of foot pain increases with age, and is more prevalent in women and the obese.³ It can be quite disabling as it can interfere with the ability to work, perform daily tasks, and participate in recreational activities.² Many patients with common chronic diseases like osteoporosis, diabetes and obesity, have foot problems that limit their ability to treat their disease with physical exercises.²
Disease of the foot represents a major health problem in patients with diabetes, and is the source of enormous cost to healthcare services.⁴ Healing is delayed and uncertain, and the incidence of amputation has been reported to be as high as 27%, even in expert centres.⁴ Since the options for specific therapy are limited, greater emphasis is placed on prevention, and on foot care education in particular.⁴
1. Bianchi S. et al. Ultrasound of the musculoskeletal system. Medical Radiology. Edition Springer. 2007 ; 2-3 : 835-888.
2. Shahady E. Primary care of musculoskeletal problems in the outpatient setting. Edition Springer. 2006 ; 15 : 310.
3. Menz H.B. et al. Predictors of podiatry utilisation in Australia: the North West Adelaide Health Study. Journal of Foot and Ankle Research. August 2008 ; 1 : 8.
4. Lincoln N.B. et al. Education for secondary prevention of foot ulcers in people with diabetes: a randomised controlled trial. Diabetologia. August 2008 ; 51 : 1954-1961

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An Animation Explaining Claw Toe

Podiatry Drug Data - A-Z English

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Have you ever responded to "is there a doctor in the house/on the plane?"
on doc2doc

... Grand Canion. As we were traveling through the high dessert (about 7,000 feet), there was a call for a doctor. My mother-in-law who is a nurse and I ...

Telephone translation lines
on doc2doc

... patient who had almost no English vocabulary that she had broken her ankle (snapping action) and that she would have to have it put into a below knee ...

Caring with patients with multimorbidity in systems classically built for single diseases...
on doc2doc

... treatment of physical and emotional disabilities. As a specialist in diabetes I come across people whose ability to apply complex self-care behaviors ...

Latest Clinical Trials

Blood Markers for Inflammation and Coronary Artery Vasoreactivity Testing in Patients With Chest Pain and Normal Coronary Arteries (ACOVA)

The investigators are hoping to discover the cause of chest pain in patients with a normal coronary arteriogram. For patients with chest pain coronary angiography is the standard method by which the blood vessels of the heart can be visualized and any narrowing can be assessed. In some cases the investigators find totally normal coronary blood vessels or only minor disease. Such a finding is associated with an excellent long term prognosis. However, as a large proportion of patients with normal coronary arteries or mild coronary narrowings often continue to experience recurrent chest pains the investigators are interested in understanding the mechanisms responsible for this. The investigators hypothesise that in many cases, coronary artery spasms are responsible for the recurrent chest pains. These spasms usually respond to treatment with drugs known as vasodilators. The acetylcholine test (ACH-test) has been recommended by the European Society of Cardiology and the American College of Cardiology as a diagnostic test. This test can reveal whether the coronary blood vessels have a tendency to go into spasm. The investigators plan in this study to carry out the test in patients who have chest pains suggestive of coronary narrowings but are found to have normal or only mildly narrowed coronary arteries on angiography. A positive test -indicating a tendency for spasm- may help guiding therapy with vasodilators, which are often very effective to prevent coronary spasms. The investigators would also like to take blood samples during the test (before and after) from every patient to measure blood markers and see if there is a relation between these markers and the result of the ACH-test.

Observatory of Screening Aneurysms of the Abdominal Aorta During Echocardiography. National Epidemiological Survey (E2T3A)

Study of the prevalence of Abdominal Aortic Aneurysms (AAA) (> 3 cm) in patients with echocardiography (transthoracic or) during a specific day, with cardiologists in France. This is a cross-sectional epidemiological investigation, assembling evidence from a routine ultrasound screening for AAA at the waning of echocardiograms performed during a specific day. The study will be offered a list of centers selected by the Scientific Committee in the complete list of locations being in France, the subsidiary of echocardiography Echocardiography of French Society of Cardiology. These centers will be 500 in number representative of the French centers, geographically and by type of centers.

Latest Journal Publications

Journal of Electromyography and Kinesiology

Mechanical oscillation (vibration) is an osteogenic stimulus for bone in animal models and may hold promise as an anti-osteoporosis measure in humans with spinal cord injury (SCI). However, the level of reflex induced muscle contractions associated with various loads (g force) during limb segment oscillation is uncertain. The purpose of this study was to determine whether certain gravitational loads (g forces) at a fixed oscillation frequency (30 Hz) increases muscle reflex activity in individuals with and without SCI. Nine healthy subjects and two individuals with SCI sat with their hip and knee joints at 90° and the foot secured on an oscillation platform. Vertical mechanical oscillations were introduced at 0.3, 0.6, 1.2, 3 and 5g force for 20 s at 30 Hz. Non-SCI subjects received the oscillation with and without a 5% MVC background contraction. Peak soleus and tibialis anterior (TA) EMG were normalized to M-max. Soleus and TA EMG were <2.5% of M-max in both SCI and non-SCI subjects. The greatest EMG occurred at the highest acceleration (5g). Low magnitude mechanical oscillation, shown to enhance bone anabolism in animal models, did not elicit high levels of reflex muscle activity in individuals with and without SCI. These findings support the g force modulated background muscle activity during fixed frequency vibration. The magnitude of muscle activity was low and likely does not influence the load during fixed frequency oscillation of the tibia.

Annuals of Rheumatic Diseases

Objectives: To evaluate the effectiveness of a single intra-articular injection of hylan G-F 20 (Synvisc) for symptomatic first metatarsophalangeal joint (MTPJ) osteoarthritis (OA). Methods: Participants (n = 151) with symptomatic first MTPJ OA were randomly allocated to receive up to 1 ml intra-articular injection of either hylan G-F 20 or placebo (saline). Participants and assessors were blinded. Outcomes were evaluated at 1, 3 and 6 months after injection. The primary outcome measurement was the foot pain domain of the Foot Health Status Questionnaire (FHSQ) at 3 months. Secondary outcome measurements were foot function assessed via the FHSQ, first MTPJ pain and stiffness, magnitude of symptom change, global satisfaction, health-related quality of life (assessed using the Short-Form-36 version two), first MTPJ dorsiflexion range of motion, hallux plantar flexion strength, use of pain-relieving medication or co-interventions and changes in plantar pressures. Results: No statistically significant differences in foot pain were found between the groups at 3 months. There were few statistically significant differences in the secondary outcome measures. Overall, the incidence of adverse effects was not significantly different between groups. Conclusions: An intra-articular injection of hylan G-F 20 is no more effective than a placebo in reducing symptoms in people with symptomatic first MTPJ OA.

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23^rd February 2012

NX 1207 (Recordati/Nymox) starts Phase III trial for BPH Men's Health, Andrology and Urology Page

Recordati and Nymox Pharmaceutical Corporation announced the start of activities aimed to the preparation of a European Phase III clinical trial for NX-1207, following the successful completion of a Scientific Advice meeting with the European Medicines Agency. NX-1207, is a Phase III investigational drug from Nymox and is currently in clinical development in the United States for the treatment of Benign Prostatic Hyperplasia (BPH). The pivotal controlled clinical trial will assess the efficacy and safety of a single TRUS-guided intraprostatic injection of NX-1207 in patients with lower urinary tract symptoms (LUTS) associated with BPH not adequately controlled by medical therapy.The drug is injected by a urologist in an office setting directly into the zone of the prostate where the enlargement occurs and involves little or no pain or discomfort. NX-1207 has successfully completed a series of blinded controlled multi-center U.S. clinical trials where a single dose of NX-1207 has been found to improve the signs and symptoms of BPH, with improvements about double those reported for currently approved BPH drugs, and without the side effects associated with those drugs, which can include sexual problems and blood pressure changes. Follow-up studies have shown evidence of long lasting benefit with a significant proportion of men reporting maintained improvement in BPH symptoms without other treatments for up to 7½ years.

Zelboraf (Daiichi Sankyo/Roche) is EU approved for BRAFV600 mutation Metastatic Melanoma Page

Plexxikon Inc., a member of Daiichi Sankyo Group,has announced that the European Commission has approved Zelboraf (vemurafenib) for the monotherapy treatment of adult patients with BRAFV600 mutation-positive unresectable or Metastatic Melanoma. The cobas 4800 BRAF V600 Mutation Test, a companion diagnostic used to identify patients with the BRAF mutation, is CE marked and commercially available in Europe. Zelboraf is designed to selectively inhibit the BRAF mutation that occurs in about half of all cases of melanoma. Zelboraf and its companion diagnostic have already been approved in the United States, Switzerland, Israel, Brazil, New Zealand and Canada. In the United States, Zelboraf is being co-promoted by Daiichi Sankyo, Inc. and Genentech, a member of the Roche Group. Roche promotes Zelboraf outside of the United States.

CHMP recommends Pixuvri (CTI Life Sciences) for Non Hodgkin's B-cell Lymphoma Oncology Page

The CHMP has given a conditional recommendation for the approval of Pixuvri (pixantrone dimaleate) from CTI Life Sciences for relapsed or refractory aggressive non-Hodgkin’s B-cell Lymphoma. The drug application at the FDA was withdrawn as additional information was requested. The drug is now scheduled to be considered at the FDA Advisory Comitteee meeting in April 2012.