Feet First

Abstract: Calcaneocuboid fusion with lengthening of the lateral column of the foot has been advocated as a method of treating flatfoot deformity This study was designed to determine how the length of the lateral column chosen or the position of the foot selected when performing this fusion affect hindfoot kinematics in normal cadaver feet An electromagnetic tracking system was used to monitor the positions of the talus, calcaneus, navicular, and cuboid while the intact cadaver feet were moved passively and then under reproducible loads Calcaneocuboid fusion was then performed on these feet first with the feet in neutral position and the lateral column of normal length, then lengthened 10 mm or shortened 5 mm, and then with the lateral column lengthened 10 mm and the feet positioned in plantar flexion and eversion or dorsiflexion and inversion Kinematic measurements were made at each stage using the same loads Fusing the calcaneocuboid joint with lengthening or shortening the lateral column and the feet in neutral position did not affect hindfoot joint motion compared with intact Changing the position of the foot for fusion, however, resulted in significant decreases in motion in the talocalcaneal and talonavicular joints Tibiotalar joint motion was unaffected This study, therefore, demonstrates that when fusing the calcaneocuboid joint, attention should be paid to maintaining a neutral position of the foot

Abstract: A wheel and axle exercising assembly with which the operator is positioned horizontally, either face up or face down and moves the assembly forward and backward either feet first, having the feet at the assembly, by thrusting the legs forward and then retracting them; or hands first, having the hands at the assembly, by thrusting the arms forward and then retracting them. Adjustment means are present to position the foot emplacement assemblies either closer to or farther from the wheel.

Abstract: There is tremendous variation in lower leg amputation attributable to diabetes worldwide and, even more disturbingly, within countries, such as the UK. In the January 2015 issue of Diabetic Medicine, a pilot study was conducted to assess measures to be used in a prospective audit of the management of foot ulcers in people with diabetes [1] and describes the essential first steps required for a national audit. The care of the ‘at risk’ diabetic foot requires the presence of a multidisciplinary team with complementary skills. In 2011 the England National Diabetes Inpatient Audit found that 40.5% of sites participating in the audit did not have access to a multidisciplinary team, consisting of ‘a diabetologist with an expertise in lower limb complications, a surgeon with expertise in managing diabetic foot ulcers, a diabetes specialist nurse, a specialist podiatrist and a tissue viability nurse [2].’ In this issue of Diabetic Medicine we have focused on the diabetic foot with four complementary state-of-the-art reviews and four peer-reviewed original papers. In the first article, we are reminded by Brownrigg et al. (page 738) that half the patients with a diabetic foot ulcer have peripheral arterial disease. This timely review elegantly covers the diagnosis and assessment of peripheral arterial disease in the diabetic foot. The second review by Glaudemans et al. (page 748) highlights the difficulty in diagnosing infection in the foot, and then reviews in detail the challenges to diagnosing infection, starting with history and examination, and progressing to the many tests now available, including stateof-the-art imaging.TheCharcot foot is one of themost difficult complications to treat in a person with diabetes. Bill Jeffcoate (page 760) comprehensively covers the disease definition, pathophysiology, clinical presentation, treatment (off-loading, bisphosphonates, calcitonin, parathyroid hormone, newer agents and surgery) and prevention strategies. The last review in this series by Gandhi and Selvarajah (page 771) provides insights into the understanding and treatment of painful diabetic neuropathy, emphasizing that it is a heterogeneous disorder that requires differing therapeutic approaches.