Differential diagnosis of Charcot arthropathy and osteomyelitis

Foot problems are common causes of morbidity in patients with diabetes mellitus. Foot ulcers are the leading cause of hospitalization in diabetic patients. Bones may be involved in two different clinical conditions: osteomyelitis and Charcot osteoarthropathy. Osteomyelitis usually develops by spreading from contiguous soft tissue to underlying bone. Charcot foot is deformation of foot as a result of muscle athrophy, bone and joint structure changes in a joint as a secondary complication of neuropathy. To distinguish bone infection from non-infectious bone disorders as in Charcot joint may be difficult, especially if there is no skin ulceration. So, the mere absence of skin ulcers does not exclude the diagnosis of osteomyelitis.     

Action of foot activator on growth and differentiation of cells in hydra

Foot activator is a small peptide found in hydra and specifically activates foot formation. I present a method for the further purification of foot activator by high-pressure liquid chromatography. The morphogenetically active fractions were assayed for their effect at the cellular level. Foot activator acts as a mitogen by pushing epithelial and interstitial cells, which are arrested in G2, into mitosis. In the presence of foot activator, epithelial stem cells are stimulated to differentiate into foot mucus cells, and interstitial nerve precursor cells differentiate into mature nerve cells. The interaction of foot activator with head activator in the development of hydra is discussed.     

Functional foot symmetry and its relation to lower extremity physical performance in older adults: the Framingham Foot Study

BackgroundWhile many studies use gait symmetry as a marker of healthy gait, the evidence that gait symmetry exists is limited. Because gait symmetry is thought to arise through laterality (i.e., limb preference) and affects gait retraining efforts, it is important to understand if symmetry exists during gait in older adults. Therefore, the purpose of this study was to evaluate foot and gait symmetry in the population-based Framingham Foot Study as well as to determine the effects of vertical force symmetry on physical performance measures.MethodsMembers of the Framingham Foot Study were included in this analysis (N=1333). Foot function and force data were collected using the Tekscan Matscan during self-selected gait, with symmetry evaluated using the symmetry index. The short physical performance battery (SPPB) measures of balance, chair stands and gait speed assessed lower extremity physical function. Participants were evaluated using quartiles of gait speed and foot symmetry to determine the effects of symmetry on lower extremity physical function.ResultsIndividuals with faster gait speed displayed greater foot function asymmetry; individuals with ?3.0% to ?9.5% asymmetry in foot function performed better on the short physical performance battery (SPPB). Further, with aging, the degree of asymmetry was reduced.ConclusionsWhile this research suggests that a moderate degree of foot asymmetry is associated with better lower extremity function, the causes of vertical force asymmetry are unknown. Future studies should evaluate the causes of foot asymmetry and should track the changes in symmetry that occur with aging.     

Trackway of a Disabled Seabird

An uncommon trackway of a seabird consisting of impressions of the right foot accompanied at the left side at the supposed position of the foot only by holes was produced by a gull having two legs, but only one foot. Foot size and stride are typical of an adult herring gull. The stride is unequal between right-left and left-right impression by ～15% as the digitigrade producer experienced re-distribution of load due to the missing foot. Tracks of disabled seabirds are underrepresented in reports of both modern settings as well as the fossil record when compared with modern observations. In present time, about 2% of the seabirds have injured feet or legs. Today, however, injuries of seabirds might have increased due to human fishery activities. Actual observations show that fossilisation of such trackways is favoured by microbes preferentially growing in the impressions that are moist for a prolonged period of time.     

Structural and functional predictors of regional peak pressures under the foot during walking

The objective of this study was to identify structural and functional factors which are predictors of peak pressure underneath the human foot during walking. Peak plantar pressure during walking and eight data sets of structural and functional measures were collected on 55 asymptomatic subjects between 20 and 70 yr. A best subset regression approach was used to establish models which predicted peak regional pressure under the foot. Potential predictor variables were chosen from physical characteristics, anthropometric data, passive range of motion (PROM), measurements from standardized weight bearing foot radiographs, mechanical properties of the plantar soft tissue, stride parameters, foot motion in 3D, and EMG during walking. Peak pressure values under the rearfoot, midfoot, MTH1, and hallux were measured. Heel pressure was a function of linear kinematics, longitudinal arch structure, thickness of plantar soft tissue, and age. Midfoot pressure prediction was dominated by arch structure, while MTH1 pressure was a function of radiographic measurements, talo-crural joint motion, and gastrocnemius activity. Hallux pressure was a function of structural measures and MTP1 joint motion. Foot structure and function predicted only approximately 50% of the variance in peak pressure, although the relative contributions in different anatomical regions varied dramatically. Structure was dominant in predicting peak pressure under the midfoot and MTH1, while both structure and function were important at the heel and hallux. The predictive models developed in this study give insight into potential etiological factors associated with elevated plantar pressure. They also provide direction for future studies designed to reduce elevated pressure in "at-risk" patients.     

An ultrastructural and biochemical study of foot structure in "catch" smooth muscle cells of a clam

The foot structure of molluscan (clam) catch muscle cells was studied from the structural and biochemical standpoints. In vertebrate cross striated muscle cells, foot structures are situated in the interspaces between T-tubules and sarcoplasmic reticula (SRs). By contrast, T-tubules were not observed in clam catch muscle cells, but foot structures were ultrastructurally identified in the interspaces between the SRs and cell membranes. We isolated the SR fraction from muscle cells which contained vesicles with SRs and cell membranes. Foot structures were also observed in the SR fraction by thin sectioning. The size and shape of the foot structure in both intact muscle cells and the SR fractions appeared to be slightly smaller than those of vertebrates. However, the molecular weight of the foot structures (foot proteins) as determined by SDS-PAGE (450 kD) was similar to ryanodine receptors (RyRs) which were reported previously in cross striated muscle cells from pecten and vertebrates. The protein showing the 450 kD band reacted to an anti-ryanodine receptor by Western blotting. These findings are discussed in comparison with previous studies of foot structures and RyRs of vertebrates and invertebrates.     

A case study of Chinese bound feet: application of footprint analysis

Foot print patterns of the bound feet of a 90-year-old Chinese female were made to obtain insight into the ergonomic consequences of a Chinese custom that caused significant disabilities for many women throughout history. Pressure patterns were evaluated using the techniques applied to standard thumb print analsyis. A digital summary of the pressure patterns were compared to the patterns obtained from a normal subject. The outcomes indicated that the bound foot produced greater plantar tissue pressures than the non-bound foot. These observations help explain the discomfort, gait abnormalities, and disabilities exhibited by many older women with bound feet living in China today. Although foot-binding is no longer practiced, this study offers an ergonomic perspective on a custom practiced in China for centuries.     

Relative size of the foot of two species of Littorina on a rocky shore in Wales

Populations of the gastropods Littorina rudis and L. arcana on the rocky shore at Westdale, Pembroke, South Wales, have been investigated. Foot area has been related to shell length. It is shown that there are differences in the areas of the expanded foot of different groups of snails: those from more exposed sites have a relatively larger foot. Littorina arcana achieves the greatest foot area of all, and it extends on to the most exposed rocks investigated, where L. rudis is absent. It is suggested that this may be important in ecological separation of the two species. It is noted that there is still uncertainty over the taxonomic identity of what is referred to here as 'Littorina rudis' , and further work is in progress.     

LEG CRAMPS

Foot and leg cramps are among the most frequent complaints presented by patients of both sexes, especially older persons. Similar cramping may occur in the thighs or in other skeletal muscles of the extremities and trunk. Foot and leg cramps usually occur after unusual exertion or during sleep. “Nocturnal leg cramps” may be of sufficient intensity to prevent sleep. “Pregnancy cramps” are particularly distressing.Effective treatment of foot and leg cramps requires an understanding of the etiology, pathophysiology and diagnostic techniques. Weight reduction and improved diet are essential. Among the useful supplementary medications are calcium lactate or gluconate, vitamin-mineral supplements, sympathetic blocking agents, vasodilators, ataraxics, muscle relaxants, quinine, hydrochloride, antihistamines, and nonmercurial diuretics.Improved foot care and correction of foot imbalance is usually required. Edema and venous insufficiency are improved by elastic support, by repeated foot elevation for massages, by manipulations and exercises and by the use of diuretics. There may be need for operations on the veins and for sclerotherapy. Patients with arterial insufficiency are often benefited by lumbar sympathetic blocks with long-acting anesthetics and intra-arterial injections with relaxants, vasodilators, thrombolytic enzymes and anticoagulants. Sympathectomy, angiography and reconstructive arterial operations are indicated in only a small proportion of patients with foot and leg cramps.     

Variation in foot size and shape in some British land snails and its functional significance

Live weight, and the length, breadth and surface area of the extended foot sole were measured in 24 species of British terrestrial snails. Allometric relationships between these variables are described, concentrating on the relationship between foot surface area and weight. Intraspecific foot area/weight relationships deviate from isometric expectation for several species; this may be attributed to density changes, foot-shape variation or the physical constraint imposed by shell aperture size.
The rate of increase of foot sole area with live weight among species is greater than expected under isometry, indicating that larger species partially compensate for the increase in foot loading (weight per unit foot area). The rate of whorl expansion of the shell is related to the deviations from the interspecific foot area/weight relationship, reinforcing the possibility that shell aperture area may limit foot size in some species. Foot ratio (foot length:foot width) is negatively related to live weight and foot loading.
The findings are discussed in relation to the known behaviour and microdistribution patterns of the species.     

First evidence on foot preference during locomotion in Old World monkeys: a study of quadrupedal and bipedal actions in Sichuan snub-nosed monkeys (Rhinopithecus roxellana)

This is the first report of foot preference during locomotion in Old World monkeys. Foot preferences during the quadrupedal walking action and the bipedal shifting action of a naturalistic group of Sichuan snub-nosed monkeys (Rhinopithecus roxellana) in Zhouzhi National Nature Reserve in the Qinling Mountains of China were investigated. Twelve of 21 individuals tested on quadrupedal action and all 21 individuals tested on bipedal action exhibited a significant foot preference. Both significant right- and left-footed preferences were observed; sex affected neither direction nor strength of foot preference in both actions. The finding that 61.90% of focal R. roxellana showed a right-foot preference, both in quadrupedal action based on the footed index and in bipedal action based on the z-score, is in partial agreement with the postural origin hypothesis on footedness. Foot preference was significantly stronger in bipedal action than in quadrupedal action, supporting the view that posture could be a crucial factor influencing foot preference as well as hand preference in this species.     

Adaptive design of locomotion and foot form in prosobranch gastropods

A comparison of the locomotor types, speed, tenacity, and foot form of nearly 300 species in 52 families of marine prosobranchs has revealed that foot size and shape and even subtle variations of locomotion affect the speed and strength of adhesion to the substratum.Gastropods inhabiting soft substrata move primarily by pedal cilia or by discontinuous locomotion in which shell and foot move alternately. Both types of movement are accompanied by low tenacity. A specialized type of discontinuous locomotion, namely, leaping, surpasses all other methods of movement in speed. Species with ciliary locomotion have a very large foot while those with discontinuous movement have an exceedingly small foot relative to shell size.The majority of prosobranchs inhabit hard substrata, move by continuous pedal muscular gliding, and have moderately high tenacity during movement. Arhythmic pedal locomotion yields lower maximum speeds and tenacities than do rhythmic pedal waves. Foot size and shape relative to shell length in species with arhythmic locomotion vary from very short and broad to long and narrow. Studies of transects at several temperate and tropical marine littoral stations showed that these species are confined to low littoral or sublittoral habitats that are sheltered from heavy wave action. High speed and tenacity are simultaneously attained only by species with rhythmic pedal waves.Speed and tenacity do not represent competing selective pressures on the size and shape of the foot. Speed increases among species as the foot approaches or exceeds shell length and is highest if the foot is also broad; the greatest tenacities are attained by species with a long, broad foot whose dimensions do not exceed that of the shell. The optimal shape for both high tenacity and speed is a broad foot somewhat shorter than the shell; neither speed nor tenacity are much compromised by this form. In general, only species with rhythmic pedal waves whose foot size and shape approximate the optimal form for high tenacity and speed are found in habitats exposed to much wave action. Long rhythmic waves, moving a large proportion of foot area at once, are in theory energetically more economical than small, very rapid waves resulting in the same overall speed, but experiments showed that tenacity is significantly reduced in gastropods which increase speed by enlarging the waves. The optimal wave pattern of a species should be a balance between the demand for speed with the least expenditure of energy, favored by a pattern of many large waves at once, and the demand for tenacity, favored by a pattern of few and small waves.Retrograde ditaxic waves of elongation are the most common pattern encountered among prosobranchs, and are associated with a large range of foot sizes and shapes. Such waves are at least one third as long as the foot, while direct waves and other waves of compression are frequently much smaller. The range of foot forms of species with waves of compression is restricted, tending to be optimal for high tenacity or to be long and narrow. Waves of compression appear to be a specialization with the potential for maintaining high tenacity even at high speeds since the waves can be very small, and for giving superior speed since they can travel very rapidly.     

Ankle and midfoot kinetics during normal gait: a multi-segment approach

Multi-segment foot models are increasingly being used to evaluate intra and inter-segment foot kinematics such as the motion between the hindfoot/tibia (ankle) and the forefoot/hindfoot (midfoot) during walking. However, kinetic analysis have been mainly restricted to one-segment foot models and could be improved by considering a multi-segment approach. Therefore, the aims of this study were to (1) implement a kinetic analysis of the ankle and theoretical midfoot joints using the existing Oxford Foot Model (OFM) through a standard inverse dynamics approach using only marker, force plate and anthropometric data and (2) to compare OFM ankle joint kinetics to those output by the one-segment foot plugin-gait model (PIG). 10 healthy adolescents fitted with both the OFM and PIG markers performed barefoot comfortable speed walking trials over an instrumented walkway. The maximum ankle power generation was significantly reduced by approximately 40% through OFM calculations compared to PIG estimates (p<0.001). This result was not caused by a decrease in OFM computed joint moments, but by a reduction in the angular velocity between the tibia/hindfoot (OFM) compared to the tibia/foot (PIG) (p<0.001). Additionally, analysis revealed considerable midfoot loading. One-segment foot models overestimate ankle power, and may also overestimate the contribution of the triceps surae. A multi-segment approach may help quantify the important contribution of the midfoot ligaments and musculature to power generation. We therefore recommend the use of multi-segment foot models to estimate ankle and midfoot kinetics, especially when surgical decision-making is based on the results of three-dimensional gait analysis.     

Gender and foot orthotic device effect on frontal plane hip motion during landing from a vertical jump

Excessive hip motion has been linked to lower extremity pathology. Foot orthoses are commonly used to control motion within lower extremity joints when lower extremity pathology and dysfunction are present. Few studies have investigated the effect of foot orthoses on hip angular kinematics during functional activities. Eighteen females and 18 males performed a vertical jump with and without a prefabricated foot orthoses to determine the biomechanical effect of foot orthoses on hip kinematics when landing from a jump. Data collection included three-dimensional motion analysis of the lower extremity. Paired t tests were performed to determine if differences existed within genders with and without foot orthoses. At the hip joint, there was significantly less hip adduction motion in the foot orthoses condition as compared with the no foot orthoses condition in females (p < .05). There were no differences between foot orthoses conditions in males. Females appear to have a different proximal response to foot orthoses when landing from a forward jump than males.     

Extremity heat loss in water in humans and macaques

Human hands and feet lose about the same amount of heat per unit time in cold water. This is somewhat strange since they are grossly different in size (volume). When corrected for size, the human hand loses far more heat per unit volume than the foot. This study attempted to see if macaques showed comparable hand-foot differences by repeating the human test situation as closely as possible on 20 macaques. The monkeys lose less total heat in cold water because their hands and feet are so much smaller, but on a volume basis they exceeded human heat losses. Even more important, the macaque hand and foot show very similar heat losses when the size difference is removed. The human hand and the macaque hand and foot are reasonably close in heat loss per unit volume; the human foot appears unique. Another sample of human subjects in which both extremity volumes and surface areas were measured showed closer heat loss correspondence between hands and feet on the basis of surface area, but the human foot still was lower. Pedal heat loss in man is apparently conditioned by a combination of the foot's special morphology and vascularity.     

A Phase-Dependent Hypothesis for Locomotor Functions of Human Foot Complex

The human foot is a very complex structure comprising numerous bones, muscles, ligaments and synovial joints. As the only component in contact with the ground, the foot complex delivers a variety of biomechanical functions during human locomotion, e.g. body support and propulsion, stability maintenance and impact absorption. These need the human foot to be rigid and damped to transmit ground reaction forces to the upper body and maintain body stability, and also to be compliant and resilient to moderate risky impacts and save energy. How does the human foot achieve these apparent conflicting functions？ In this study, we propose a phase-dependent hypothesis for the overall locomotor functions of the human foot complex based on in-vivo measurements of human natural gait and simulation results of a mathematical foot model. We propse that foot functions are highly dependent on gait phase, which is a major characteristics of human locomotion. In early stance just after heel strike, the foot mainly works as a shock absorber by moderating high impacts using the viscouselastic heel pad in both vertical and horizontal directions. In mid-stance phase （-80% of stance phase）, the foot complex can be considered as a springy rocker, reserving external mechanical work using the foot arch whilst moving ground contact point forward along a curved path to maintain body stability. In late stance after heel off, the foot complex mainly serves as a force modulator like a gear box, modulating effective mechanical advantages of ankle plantiflexor muscles using metatarsal-phalangeal joints. A sound under- standing of how diverse functions are implemented in a simple foot segment during human locomotion might be useful to gain insight into the overall foot locomotor functions and hence to facilitate clinical diagnosis, rehabilitation product design and humanoid robot development.     

A machine-learning method for classifying and analyzing foot placement: Application to manual material handling

Foot placement strategy is an essential aspect in the study of movement involving full body displacement. To get beyond a qualitative analysis, this paper provides a foot placement classification and analysis method that can be used in sports, rehabilitation or ergonomics. The method is based on machine learning using a weighted k-nearest neighbors algorithm. The learning phase is performed by an observer who classifies a set of trials. The algorithm then automatically reproduces this classification on subsequent sets. The method also provides detailed analysis of foot placement strategy, such as estimating the average foot placements for each class or visualizing the variability of strategies. An example of applying the method to a manual material handling task demonstrates its usefulness. During the lifting phase, the foot placements were classified into four groups: front, contralateral foot behind, ipsilateral foot behind, and parallel. The accuracy of the classification, assessed with a holdout method, is about 97%. In this example, the classification method makes it possible to observe and analyze the handler’s foot placement strategies with regards to the performed task.