The latest medical research on Podiatrist

After an ankle sprain, the ligament and joint capsule are damaged, and as a result, proprioceptive sense is damaged, causing a feeling of giving away in the ankle and resulting in recurrent sprains. Given the relevant studies, it has been seen that people with chronic ankle instability (CAI) commonly have deficits in joint position sense and reinjury risks. Joint position sense plays an important role in ankle control, thereby reducing the risk of injury. Therefore, this study aims to compare the effects of balance and strength training on ankle proprioception in people with CAI.

This single-blind randomized controlled study included 29 volunteer participants (21 women and eight men) aged 18 to 30 years. Participants with a Cumberland ankle instability scale score less than or equal to 24 were randomly divided into two treatment groups: strength training (n = 14) and balance training (n = 15). Y balance test, joint position, and vibration sense were evaluated at the beginning and end of the treatment. "Hop to stabilization" exercises were applied to the balance group and resistive bands exercises to the strength group, which were performed for 6 weeks, 35 minutes per day, two times per week.

There was no significant difference between the two groups in the anterior, posterolateral, and posteromedial directions of the Y balance test (P = .89, P = .50, and P = .34, respectively), but the strength training group showed significant improvement in ankle proprioception (140°) and vibration sense (fifth finger) (P < .001), and the post hoc Cohen's d effect size values were medium (.52) and small (.25), respectively.

The findings of this study show that strengthening and balance exercises have similar effects on dynamic balance, but strengthening exercises are more effective in improving joint position and vibration sense. Given the positive effects of both exercise programs, it is recommended to implement the two interventions separately or together for CAI rehabilitation.

Diabetes foot infection is a very important public health problem that causes serious health problems, mortality, and high health expenditures, and is one of the most important complications of diabetes mellitus. There are concerns that approaches such as limited personal visits to doctors, avoidance of hospitals, and restrictions on nonemergency surgical procedures during the coronavirus disease of 2019 pandemic pose a threat to those with diabetic foot problems, including diabetic foot ulcers (DFUs), ischemia, and infection, resulting in increased limb loss and mortality.

This multicenter, retrospective, cross-sectional study was conducted in 14 tertiary care hospitals from various regions of Turkey. A total of 1,394 patient records were evaluated, 794 of which were between January 1, 2019, and January 30, 2020 (prepandemic [Pre-P]), and 605 of which were between February 1, 2020, and February 28, 2021 (pandemic period [PP]).

During the PP, diabetic foot patient follow-up decreased by 23.8%. In addition, the number of hospitalizations attributable to DFU has decreased significantly during the PP (P = .035). There was no difference between the groups regarding patient demographics, medical history, DFU severity, biochemical and radiologic findings, or comorbidities, but the mean duration of diabetes mellitus years was longer in patients in the Pre-P than in those in the PP (15.1 years versus 13.7 years). There was no difference between the two groups in terms of major complications such as limb loss and mortality, but infection recurrence was higher in the PP than in the Pre-P (12.9% versus 11.4%; P < .05). The prevalence of nonfermentative gram-negative bacteria as causative agents in DFU infections increased during the PP. In particular, the prevalence of carbapenem-resistant Pseudomonas spp. increased statistically during the PP.

The rapid adaptation to the pandemic with the measures and changes developed by the multidisciplinary diabetic foot care committees may be the reasons why there was no increase in complications because of DFU during the pandemic in Turkey.

Management of tibial pilon fracture in elderly patients with psychiatric illness remains challenging for orthopedic doctors because of patients' poor bone quality and inability for self-care. This study aimed to ascertain the viability and reliability of primary arthrodesis by using retrograde hindfoot nail for these difficult cases.

We retrospectively reviewed eight elderly consecutive patients (age older than 65 years) with tibial pilon fractures and psychiatric illness from January of 2012 to December of 2019 in our institute. Primary tibiotalocalcaneal arthrodesis with retrograde hindfoot nail was used as a definitive procedure. The bone union time, wound complication rate, ankle alignment, necessity for narcotic agents, and ambulation status were evaluated.

The average length of follow-up was 22.25 months (range, 15-36 months). Additional bone grafting surgery was performed for one patient because of fusion-site nonunion 6 months postoperatively. Another patient required debridement and removal of posterior calcaneal screw because of implant prominence and local infection. Osseous union with angular deformity less than 10° was achieved in all patients finally. The average bone union time was 6.6 months (range, 4-12 months). In terms of walking ability, six patients were capable of outdoor ambulation (classes 2 and 3). Two patients required oral pain medication at the final visit.

The current study involved only a small number of patients, and two of the eight cases encountered undesired complications (one local infection and one bone nonunion); however, we believe that our method may serve as a valuable alternative for the treatment of tibial pilon fractures in elderly patients with psychiatric illness, considering the specificity of this fragile population.