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The approach to treatment of severe untreated or recurrent congenital talipes equinovarus deformities is very different in the world where patients are mobile, have access to repeated return visits for follow-up treatment, and where more sophisticated options for gradual correction with external fixation are available. For treatment, talectomy may be the only option to treat certain neglected clubfoot deformities during humanitarian programs and it may still have to be used as a salvage procedure used in modern foot surgery. Our extensive experience with these deformities has been on global humanitarian programs.

As an emerging ambient energy harvesting technology, triboelectric nanogenerators (TENGs) have been proven as robust power sources. Here, we reported a novel functional triboelectric nanogenerator ...

Bei der Pathogenese des Pes planovalgus kommt der medialen Saule des Fuses eine besondere Rolle zu. Die relevanten Strukturen umfassen den tibiokalkaneonavikularen Bandapparat, die navikulokuneiformen Gelenke inklusive der Ossa cuneiformia selbst und auch das erste tarsometatarsale Gelenk. Daher ist eine Kombination knocherner und weichteiliger Korrekturen bei der Korrektur des Pes planovalgus zu berucksichtigen. Die hier vorliegende Arbeit beschreibt stabilisierende und korrigierende Eingriffe an der medialen Saule des Fuses mitsamt der zugrundeliegenden Anatomie und Biomechanik.

To validate and establish targets for the physician-based clinical scale for foot surgery in rheumatoid arthritis (RA) patients based on patient-reported outcomes from a multicenter prospective cohort.We collected data on demographics, values from the RA foot and ankle scale by the Japanese Society for Surgery of the Foot (JSSF-RA), and patient-reported outcomes (PROs) including the Health Assessment Questionnaire Disability Index (HAQ-DI) before (baseline) and 6 and 12 months after joint surgery. Target values for JSSF-RA were determined according to the lower limit of the 95% CI of JSSF-RA in patients with HAQ-DI ≤0.5 after adjusting for age and sex. We used multiple linear regression analysis to examine potential predictors of JSSF-RA target achievement at baseline.Cross-sectional analysis was conducted on data from 417 cases. The JSSF-RA target for foot and ankle surgery was set at 74 according to the JSSF-RA value corresponding to HAQ-DI ≤0.5 (mean 77.6, 95% CI: 74.3-80.9). Longitudinal analysis of patients who underwent foot surgery (A JSSF-RA value of 74 represents an important target for patients with RA who have undergone foot surgery. In order to achieve this target, the timing of the surgery should be considered in the treatment of established RA patients.

Background Chronic pain syndrome (CPS) is a common complication after operative procedures, and only a few studies have focused on the evaluation of CPS in foot-forefoot surgery and specifically on HV percutaneous correction. The objective of this study was to compare postoperative pain levels and incidence of CPS in two groups of patients having undergone femoral-sciatic nerve block or ankle block regional anaesthesia before hallux valgus (HV) percutaneous surgery and the association between postoperative pain levels and risk factors between these patient groups. Methods A consecutive patient series was enrolled and evaluated prospectively at 7 days, 1, 3 and 6 months after surgery. The participants were divided into two groups according to the regional anaesthesia received, femoral-sciatic nerve block or ankle block, and their outcomes were compared. The parameters assessed were postoperative pain at rest and during movement by the numerical rating scale (NRS), patient satisfaction using the Visual Analogue Scale (VAS), quality of life and return to daily activities. Statistical analysis was performed. Results One hundred fifty-five patients were assessed, 127 females and 28 males. Pain at rest (p p p > 0.05), quality of life significantly increased and patients returned to daily activities and work (p p = 0.043) was associated to higher pain during movement; BMI (p = 0.005) and lumbago (p = 0.004) to lower satisfaction. No operative-anaesthetic complications were recorded. Postoperative pain at rest and during movement improved over time independently of the regional block used, with low incidence of CPS at last follow-up. Among risk factors, only a higher ASA was associated to higher pain during movement, while higher BMI and lumbago to lower satisfaction. Conclusions Both ultrasound-guided sciatic-femoral and ankle blocks were safe and effective in reducing postoperative pain with low incidence of CPS at last follow-up. Trial registration Clinical Trial NCT02886221. Registered 1 September 2016.

Background Musculoskeletal dysfunction due to deformities and injuries of the foot is a common orthopedic problem. Objectives To analyze the effect of the COVID-19 pandemic on both elective and emergency foot surgeries. Material and methods This study analyzed the effect of the COVID-19 pandemic on elective and emergency foot surgeries. The comparison included data collected in 2019 (March 15-October 15, when the epidemic did not influence the Polish healthcare system or patient demographics) and in a corresponding period in 2020. This study was conducted in the trauma and orthopedic surgery wards and the emergency departments of 2 regional Polish hospitals. Results The analysis of the data from the orthopedic wards showed a reduction in the total number of admissions in 2020 by 55%. The number of elective and emergency interventions was differently related to the pandemic, with elective interventions declining by 72% and emergency interventions increasing by 27% in 2020 compared to 2019. The total number of elective foot surgeries in children decreased by 59% in 2020. The mean duration of hospital stay was approx. 2.5 days shorter in adults and 1.7 days shorter in children during the 2nd evaluation period. The emergency department data showed a decline of 32% in the number of patients presenting with injuries during the pandemic. Nonetheless, the pandemic did not affect the mean age of patients and the female-to-male ratio. Conclusions The global COVID-19 pandemic affected the epidemiology of foot injuries as well as the prevalence of foot surgeries in children and adults.

Introduction: Sciatic nerve block (SNB) is an established technique of anaesthesia for lower limb and foot surgeries. Although several approaches to SNB have been described not a single one is ideal in all respect. We aimed to compare commonly used two approaches to SNB to fin d out which one is better with regard to efficacy and patient satisfaction. Materials and Methods: Consented 60 diabetic patients of ASA grade II,III posted for foot and /or lower limb surgery were randomly allocated to receive SNB by either anterior (n=30) or posterior (n=30) approach. Blocks were performed utilizing peripheral nerve stimulator (PNS), with 25 ml of local anaesthetic mixture (10 ml of 2% lignocaine with adrenaline and 15 ml of 0.5% bupivacaine). Time taken to perform block with number of attempts required, onset of sensory and motor block, duration of analgesia were record ed and compared. We also had compared comfort level of the patients. Observations and Results: Out of 60 patients, 1of anterior and 2 of posterior approach es had failed block. Time taken to perform anterior approach was significantly less (p approach. Patients were comfortable with anterior approach than that of posterior. Faster onset of sensory and motor block, and more duration of analgesia was observed with the posterior group but the difference was not statistically significant. Conclusion: Our study concluded that though efficacy of both the anterior and posterior approaches to block sciatic nerve was same, anterior approach is easier than posterior approach as it requires lesser time to perform and gives far better patient comfort. Keywords: Anterior sciatic nerve block, Diabetic foot surgery.

ZusammenfassungPseudarthrosen können mit Schmerzen und Einschränkungen der Lebensqualität einher gehen. Das Risiko ihr Entstehung kann patientenassoziiert sein und durch Nebenerkrankungen wie Diabetes mellitus, pAVK, Nikotin- oder Alkoholabusus oder fehlende Compliance bedingt sein. Aber auch operationstechnische Komplikationen wie postoperative Infektionen, instabile Osteosynthesen, fehlendes Alignment oder insuffiziente Knochenpräparation bei Arthrodesen sind Faktoren, die zu Pseudarthrosen führen können.Bei instabilen Osteosynthesen, Infektionen oder Knochendefekten sind Revisionseingriffe häufig unvermeidbar. Aber auch im Verlauf kann eine Pseudarthrose persistieren.Mechanische Knochenstimulation mit LIPUS oder fhESWT können eine Konsolidierung erzielen ohne die durch einen operativen Eingriff möglichen Risiken in Kauf nehmen zu müssen. Biologische Knochenstimulation mit osteoinduktiven Effekten werden im Bereich der Fußchirurgie verwendet, haben hier jedoch keine Zulassung.Bei Vorliegen einer Pseudarthrose des Fusses ist die Stabilität des selbigen häufig nicht eingeschränkt wie es bei den langen Röhrenknochen häufig der Fall ist. In straffen Pseudarthrosen ohne entsprechende Symptome ist der Revisionseingriff nicht indiziert und eine orthopädieschuhtechnische Versorgung kann ausreichend sein.

The purpose of the present study is to illustrate the use of a modified subcapital metatarsal osteotomy (MSMO) in the treatment of hallux valgus (HV) recurrence. The article reports the clinical and radiological outcomes of a cohort of 52 consecutive patients presenting with recurrent HV, treated with MSMO. A total of 52 patients (54 feet) underwent operations between May 2010 and November 2015. The mean time of follow-up was 2.5 years (range 5.5-1.0 years), and the mean age was 49 years (range 22-76 years). The patient cohort comprised 46 female and 6 male patients. The results of this research show that MSMO is a reliable technique for the correction of HV recurrence. The postoperative radiographic assessments show a statistically significant postoperative improvement of the HV angle (P < .05) and the intermetatarsal angle (P < .05). The postoperative position of the tibial sesamoid was significantly improved (P < .1). The distal metatarsal articular angle was improved (P < .001), though assessment may be affected by the previous operations performed on the first metatarsophalangeal joint. The statistical analysis shows that the postoperative American Orthopaedic Foot and Ankle Society Hallux Metatarsophalangeal-Interphalangeal Scale parameters were significantly improved (P < 0.001). Results of this study indicate that the minimally invasive MSMO is effective in restoring anatomical alignment and improving patient outcomes in recurrent cases of HV.Levels of Evidence: Level III: Case-control study

Purpose Paediatric foot surgery is often performed to restore anatomical shape or range of movement (ROM). The purpose of this study was to determine how foot morphology and ROM are associated with foot function in children aged five to 16 years of age. Methods Participants included 89 patients with foot disorders and 58 healthy controls. In addition to measuring children's foot alignment and ankle ROM, children and parents completed the Oxford Ankle and Foot Questionnaire (OxAFQ). Results Mean age was 10.3 years for patients and 10.6 years for controls; 53 of 89 patients had clubfoot. All foot measurements and scores on the OxAFQ significantly differed (p < 0.001) between patients and controls. Patients and their parents significantly differed on the physical (p = 0.03) and emotional (p = 0.02) domains of the OxAFQ, with parents’ ratings being lower than their children. Moderate correlations (r = 0.54 to 0.059; p < 0.001) were found between physical domain (reported by parents on the OxAFQ) and dorsiflexion-knee flexed, and foot- arc-of-movement. Moderate correlations were found between physical domain (reported by children on OxAFQ) and foot-arc-of-movement (r = 0.56; p < 0.001). Patients in the surgical group showed moderate correlations (r = 0.57;, p < 0.001) between physical domain (reported by children on OxAFQ) and plantar flexion, and foot arc-of-movement. The control group and the patients in non-surgical subgroup showed no significant correlations. Conclusion Plantar flexion, arc of ankle ROM and hindfoot alignment impact foot function in children with foot deformities. Parents report significantly lower scores on the OxAFQ when judging foot functioning. Level of evidence Level II. Prognostic Studies

Background: In lower extremity surgeries, central neuraxial block or peripheral regional anesthesia technique can be used, mainly in elderly patients. This study investigates the efficiency of spinal anesthesia and sciatic nerve block techniques in lower extremity surgery. Spinal anesthesia may impair hemodynamic stability; peripheral nerve blocks targeting the sciatic nerve may be a useful alternative. Objective: To compare Unilateral Spinal Anesthesia versus Popliteal Block in patients undergoing elective foot surgery to determine the method of better outcome. Patients and Methods: This randomized comparative study was carried out on fifty co-operative patients of both sexes who were scheduled for elective foot surgeries. According to the used method of regional anesthesia, patients were divided into: (S) group unilateral intrathecal block with low-dose (7.5mg) of hyperbaric bupivacaine plus intrathecal fentanyl (25 mcg) and (P) group in which the sciatic nerve at the popliteal fossa was blocked via posterior approach by injecting 20ml 0.5% bupivacaine (100mg). The difficulty of the block performance, level of patient discomfort, block performance time, onset of sensory and motor blocks, time in hours to the first request for supplemental systemic analgesia postoperatively, its total consumption for 24 hours postoperatively and associated side effects were recorded in each group. Results: Statistically, it was found no significant differences between the demographic characteristics as well as the duration of surgery between the groups. The groups did differ significantly in the difficulty of the block performance. However, a longer duration for performing the block was observed in the P group. The level of patient discomfort was significantly lesser in the P group. The onset of complete sensory block was significantly longer in the P group. Hemodynamic profiles of our patients were found to be remarkably stable throughout the intraoperative period. In the P group, the time to first pain medication was significant longer. Moreover, the total dosage of analgesics during the first 24 hours postoperatively in group P was highly significant lesser compared to the other groups. Conclusion: Sciatic nerve block at the popliteal fossa is an ideal alternative where it is preferable to avoid spinal anesthesia for foot surgeries in haemodynamicaly unstable patients. J Bangladesh Coll Phys Surg 2019; 37(4): 181-185

Background:The purpose of this article was to review the basic science pertaining to the harmful effects of cigarette smoke, summarize recent clinical outcome studies, and examine the benefits of smoking cessation and the efficacy of current smoking cessation strategies.Methods:The literature concerning basic science, clinical outcomes, and smoking cessation was reviewed; over half (56%) of the 52 articles reviewed were published in the last 5 years.Results:Smoking is associated with low bone mineral density, delayed fracture union, peri-implant bone loss, and implant failure. Orthopedic surgical patients who smoke have increased pain and lower overall patient satisfaction, along with significantly increased rates of wound healing complications.Discussion/Conclusion:Active smoking is a significant modifiable risk factor and should be discontinued before foot and ankle surgery whenever possible. Orthopedic surgeons play an important role in educating patients on the effects of smoking and facilitating access to smoking cessation resources.Level of Evidence:Level V, expert opinion.

Background: For many patients, returning to driving after right foot and ankle surgery is a concern, and it is not uncommon for patients to ask if driving may be performed with their left foot. A paucity of literature exists to guide physician recommendations for return to driving. The purpose of this study was to describe the driving habits of patients after right-sided foot surgery and assess the safety of left-footed driving using a driving simulator. Methods: Patients who underwent right foot or ankle operations between January 2015 and December 2015 were retrospectively identified. A survey assessing driving habits prior to surgery and during the recovery period was administered via a REDCap database through email or telephone. Additionally, simulated driving scenarios were conducted using a driving simulator in 20 volunteer subjects to compare characteristics of left- versus right-footed driving. Results: Thirty-six of 96 (37%) patients who responded to the survey reported driving with the left foot postoperatively. No trends were found associating left-footed driving prevalence and socioeconomic status. In driving simulations, patients exceeded the speed limit significantly more ( P < .001) and hit other vehicles more ( P < .026) when driving with the right foot than the left. The time to fully brake and fully release the throttle in response to vehicular hazards was significantly prolonged in left-footed driving compared with right ( P = .019 and P = .034, respectively). Conclusion: A significant proportion of right foot ankle surgery patients engaged in left-footed driving during postoperative recovery. Driving with both the right and left foot presents a risk of compromised safety. This study provides novel objective data regarding the potential risks of unipedal left-footed driving using a standard right-footed console, which indicates that driving with the left foot may prolong brake and throttle release times. Further studies are warranted for physicians to be able to appropriately advise patients about driving after foot and ankle surgery. Level of Evidence: Level IV, case series.

Background: Partial foot amputations (PFAs) are often indicated for the treatment of severe infection, osteomyelitis, and critical limb ischemia, which consequently leads to irreversible necrosis. Many patients who undergo PFAs have concomitant comorbidities and generally present with a severe acute manifestation of the condition, such as gangrenous changes, systemic infection, or debilitating pain, which would then require emergency amputation on an inpatient basis. Methods: The purpose of this study was to track the recent prevalence of PFAs and to investigate the current demographic trends of the physicians managing and performing PFAs, specifically regarding medical degree and specialty. Doctors of podiatric medicine are striving to achieve parity with their allopathic and osteopathic surgical counterparts and become a more prominent part of the multidisciplinary approach to limb salvage and emergency surgical treatment. This study evaluated 4 years (2009–2012) of PFA data from the Pennsylvania state inpatient database in the two most populated areas of Pennsylvania: Philadelphia and Allegheny counties. Statistics on medical schools were obtained directly from the accrediting bodies of allopathic, osteopathic, and podiatric medical schools. The goal of this study was to evaluate the general trends of patients undergoing a PFA and to quantify the upswing of podiatric surgeons intervening in the surgical care of these patients. Results: The number of partial foot amputations in the United States rose from 2006 to 2012. Podiatric surgeons performed 46% of theses procedures for residents of Philadelphia County from 2009 to 2012. In Allegheny County podiatric physicians performed 42% of these procedures during the same time frame. Conclusions: Partial foot amputations are increasing over time. Podiatric Surgeons perform a significant share of these operations. This share is increasing in the most populated areas of Pennsylvania.

No consensus exists regarding which cleansing technique, solution, and concentration should be used in orthopedic surgery. The aim of this randomized, controlled trial was to compare the effect of chlorhexidine 0.5%/70% alcohol with iodine 1%/70% alcohol on lowering positive cultures before elective foot surgery and to study any wound complications, infections and allergic reactions. Consecutive patients ≥18 years of age scheduled for a hallux valgus correction or arthrodesis of the first metatarsophalangeal joint were included. Swabs were taken from 2 sites before and twice after preparing the skin and were quantitatively and qualitatively analyzed. The study group consisted of 49 patients with a mean age of 52.3 ± 14.4 (range 22 to 75) years of whom 42 (86%) were female. No significant differences were observed for positive cultures between the chlorhexidine (73%, 2%, and 12%) and iodine (68%, 7%, and 9%) group at any time point. Coagulase-negative staphylococci were the most commonly isolated micro-organisms found after skin preparation. Occasionally, Bacillus spp and Corynebacterium spp were cultured. The complication rate 2 weeks postoperatively was 0% in the chlorhexidine group versus 8.7% (n = 2) in the iodine group (delayed wound healing; p = .215). The complication rate at 6 weeks postoperatively was, respectively, 3.8% (n = 1) versus 4.3% (n = 1; both showed swelling and redness; p > .999). There was no significant difference in postoperative wound problems or infection rates between the 2 skin preparation solutions. Chlorhexidine 0.5%/70% alcohol and iodine 1%/70% alcohol both decreased the amount of positive cultures in elective foot surgery.

The aging of the population, the increase in the number of overweight people, and the increase of knee accidents by practicing sports mean that the number of prostheses increases. Recently, there has been an influx of people undergoing surgery for knee or hip replacements. In the first stage of post-surgery, which usually lasts around 2–3 weeks, the patient is exposed to relapse if the doctor's instructions are not followed, including the appropriate amount of pressure placed on the foot. Therefore, many patients struggle as they become unwilling to walk due to the fear of putting too much pressure on the foot and avoid. In order to avoid being re-operated, we propose our T. S.F System, an intelligent embedded system that responds in real-time to the patient and the doctor's requests and easy to use. It uses a control unit, sensors, actuators, and GUI on the smartphone. This allows a correct and successful therapeutic follow-up and facilitates patient rehabilitation.

[Abstract] Lapidus arthrodesis is an established standard procedure to correct various footsurgery problems and hallux limitus, hypermobility of the first ray, halluxabductus valgus, and symptomatic lesser metatarsal. After decades, many fixa-tion methods in the orthopaedic surgery industry have been developed fordecreasing complications and improving this technique. The aim of this PRI-SMA compliant systematic review is to analyse the effectiveness of several lapi-dus plate systems in foot surgery. We have carried out the first systematicreview of the relevant published literature so as to systematically evaluate thescientific knowledge available now on this association, assigning predefined eli-gibility criteria. Fourteen studies were selected which had an overall of 738cases. The first tarsal metatarsal joint and hallux valgus were treated by theapplication of different types of Lapidus plate system. The optimal level of thefixation in these procedures is related with the type and system insertion placeof the plate with or without screw in each specific foot disease. There is an insuf-ficient number of studies about the effectiveness of the different types of Lapidusplate system in foot surgery, and there is a need to increase outcomes knowledgeon the level of the fixation, sort of the system, and insert place in foot surgery. This research was funded by Spanish Ministry of Science and Innovation through the project PID2019-108009RB-I00

In order to address issues related to the prevention and care of postoperative vascular crisis in patients with multifinger detachment reimplantation, and to improve the success rate and postoperative nursing efficiency of replantation operation, the paper comes up with a novel prevention and nursing method of vascular crisis based on big data. In this paper, 248 patients with multifinger detachment injuries admitted to the Department of Hand and Foot Surgery from January 2017 to December 2019 were used and divided into a control group and an observation group. The control group adopts the traditional conventional nursing care, while the observation group adopts the total quality control concept of nursing care, which takes patients' needs and satisfaction as the ultimate goal, respects patients' personal habits, and satisfies patients' psychological and physiological needs through management and quality control from beginning to end. The experimental results show that at the p less than 0.05 level for the incidence of vascular crisis in the observation group was lower than in the control group, the success rate of finger amputation and reimplantation in the observation group was higher than in the control group, the quality of nursing care was completed better in the observation group than in the control group, and the satisfaction of patients with nurses was higher in the observation group than in the control group.

From February 2017 to December 2018, 20 patients (a total of 20 feet) had undergone the proposed modified Wilson-SERI osteotomy technique, for moderate hallux valgus. The mean age of patients was 58,25 years (range 19 to 78). The hallux valgus angle (HVA), the intermetatarsal angle between first and second metatarsal bone (IMA) and the distal metatarsal articular angle (D.M.A.A) were measured. The feet were assessed based on the scoring system used by Broughton and Winson and by the American Orthopedic Foot and Ankle Society (AOFAS) hallux-metatarsophalangeal-interphalangeal scale. All twenty one patients were followed up postoperatively for a minimum of 12 months. No patient was lost at follow-up. The mean HVA angle decreased significantly from 31,1° before surgery (range 22.9°-40°SD 5.0) at 11,2° (range 2.5° to 22.0°SD 5.3) at twelve months follow up. The mean IMA angle decreased significantly from 12,5° (range 8.0°-18.6°SD 3.8) before surgery at 7,4° (range 3.4°-14.0°SD 2.5) at twelve months follow up. The mean DMMA angle decreased significantly from 15.1° (range 5.3° to 20.0°SD 4.4) before surgery at 7,4 °(1.5° - 10.7°SD 2.5) at twelve months follow up. The mean score according to the AOFAS forefoot was increased from 22,1 (range 13-30 SD 5.0) to 88,2 (Range 77-96 SD 5.2) (p

Background Amputation of the abnormal segment seems to be the reference standard treatment for the surgical management of macrodactyly of the foot in children. Our objectives here were to detail the surgical strategies according to the cause, anatomical characteristics, and static or progressive nature of the macrodactyly and to evaluate the long-term clinical outcomes. Hypothesis Conservative treatment can be an option in the management of static macrodactyly of the foot in children. Material and methods We retrospectively included 24 feet in 19 patients seen consecutively. There were 12 primary and 12 secondary types. The macrodactyly was static in 9 cases and progressive in 15 cases. The treatment consisted in either conservative procedures or amputation of the segment. All patients completed the Oxford Ankle Foot Questionnaire for Children (OxAFQ-C) to evaluate their quality of life, shoe wear issues, and satisfaction with their treatment. Results Mean age at first surgery was 5.8 years (range, 0.5–11.5) and the mean interval between two procedures was 2.3 years (range, 0.3–5.5). Mean number of procedures per foot was 2.2 par pied (range, 0–7). All 9 static forms were managed conservatively. Amputation was performed in 11 of the 15 progressive forms. The mean number of procedures was significantly higher in the progressive forms (4.1 vs. 1.5/pied; p = 0.006). Two patients died during follow-up. The remaining 17 patients, with 22 affected feet (primary and secondary in 11 cases; progressive in 14 cases and static in 8 cases) were re-evaluated. Mean follow-up was 9.4 years (range, 2.7–20.6). The final OxAFQ-C score was 46/60 (range, 18–58). Of the 17 patients, 86% would be willing to repeat the same surgical procedures and 77% were satisfied with their treatment at last follow-up. We found no differences between the groups managed with amputation and with conservative treatment regarding quality of life, satisfaction, or shoe size difference. Conclusions Conservative treatment deserves a place in the treatment of static macrodactyly of the foot in children. Regarding amputation of the segment in progressive forms, it is important to reassure the patients and parents about the expected results but also to inform them about the risk of requiring repeat surgical procedures. Level of evidence IV, retrospective study.

Background: Surgery for degenerative foot and ankle conditions often results in a lengthy recovery. Current outcome measures do not accurately assess postoperative mobility, especially in older patients. The Life-Space Assessment (LSA), a questionnaire quantifying patients’ mobility after a medical event, was used in this study to assess perioperative mobility in total hip arthroplasty (THA) and foot and ankle surgery patients. We hypothesized that patients undergoing elective foot and ankle surgery would have greater postoperative mobility limitation than THA patients. Methods: Preoperative, 3-month, and 6-month postoperative LSA data were collected from THA and foot and ankle cohorts. Twelve-month postoperative data were obtained for the foot and ankle group as well. Patient demographics were recorded, and data were analyzed using a Mann-Whitney U test. Results: Twenty-eight degenerative foot and ankle operative patients and 38 THA patients met inclusion criteria. Only patients aged ≥60 years were included in this study. The mean preoperative LSA score was lower in the foot and ankle group (68.8) compared with THA (74.0), although the difference was not statistically significant ( P = .602). THA patients showed a significant increase in LSA score from preoperative (74) to 6 months postoperation (95.9) ( P = .003); however, foot and ankle patients showed no significant difference between preoperative (68.8) and 6-month (61.2) scores ( P = .468). Twelve months postoperatively, foot and ankle patients showed improvement in LSA score (88.3) compared with preoperation ( P = .065). Conclusion: Compared with THA, recovery of mobility after foot and ankle surgery was slower. THA patients exhibited improved mobility as early as 3 months after surgery, whereas foot and ankle patients did not show full improvement until 12 months. This work will assist the foot and ankle specialist in educating patients about challenges in mobility during their recovery from surgery. Level of Evidence: Level II, prospective cohort study.

Background A new approach is described to blocking the sciatic and saphenous nerves in the proximal thigh (level of the lesser trochanter or immediately below) using a single-penetration technique. The popliteal-sciatic approach necessitates repositioning of the leg exposing the popliteal fossa and an extra injection for the saphenous nerve (SAN) block at the midthigh level. Aim of the Study The aim of this work is to compare between the new single-penetration block technique for block of the SCN and SAN at proximal thigh and the traditional popliteal sciatic nerve block at popliteal fossa with saphenous nerve block at adductor canal technique for leg and foot surgery. Subjects and Methods This prospective single blinded randomized parallel group study was conducted to compare between the ultrasound guided single penetration block technique for sciatic and saphenous nerve at proximal thigh to the traditional popliteal sciatic nerve block at popliteal fossa and saphenous block at adductor canal. Results Performance time was significantly faster with the single penetration technique median time 6.33 minutes (range, 3-10 minutes) versus 12.57 minutes (range from 8-20 minutes) (P Conclusions The single penetration block resulted in significantly faster performance time and reduced positioning time with statistically equal efficacy in relation to pain assessment, nausea, meperdin demand, dermatomal anesthesia, and motor blockade. The single penetration block is statistically an equally effective alternative to the traditional popliteal-sciatic/saphenous block combination for leg and foot surgery, but it is faster, requires only 1 skin penetration, and does not require repositioning of the leg.

Ganglion cysts have been recorded in many areas throughout the body. Intratendinous ganglion cysts in the foot are very rare. We present the case of 51-year-old woman with a recurrent right foot ganglion cyst. Surgical excision revealed a ganglion cyst in the tendon sheath of the extensor digitorum longus. It is important to be aware of potential tendon involvement for ganglion cysts, as surgeons must be prepared to perform tendon repairs in addition to mass excisions if the tendon is compromised.

Guillain-Barré syndrome (GBS) represents an acute inflammatory immune-mediated demyelinating polyradiculoneuropathy with an incidence of 0.6 per 100 000 people. In this article, we report the case of a 19-year-old girl affected by GBS since the age of 2 who presented at our clinic complaining for a chronic plantar hindfoot–infected ulceration. Serology showed increase of inflammatory markers and leukocytosis, and magnetic resonance imaging revealed osteomyelitis of calcaneum and soft tissue alterations with air bubbles. The patient was treated in our clinic by an integrated multidisciplinary approach consisting of immediate admission, soft tissue and bone debridement, and administration of antibiotics under the close control of infectious disease specialist. After the control of acute condition, the patient underwent negative pressure therapy associated with instillation of antiseptic solution until the restoration of bone and soft tissue loss of substance and, eventually, to the application of bioactive glass substitute until the achievement of complete wound healing.

espanolIntroduccion: El estado emocional del paciente antes de una cirugia del pie no esta incluido en la valoracion prequirurgica rutinaria en Podologia. La ansiedad preoperatoria ha sido estudiada en diferentes disciplinas medicas, pero se desconoce en procedimientos quirurgicos del pie. El objetivo principal fue determinar la prevalencia de ansiedad preoperatoria en cirugia del pie, asi como evaluar la demanda de informacion quirurgica de los pacientes. Pacientes y metodos: Se empleo la escala validada de ansiedad e informacion de Amsterdam (APAIS) para evaluar la ansiedad preoperatoria y la necesidad de informacion en 93 pacientes sometidos a diferentes cirugias del antepie (osteoarticular, ungueal y partes blandas). Tambien se utilizo un cuestionario para la recogida de otras variables de interes antes de la cirugia como la edad, sexo y nivel educativo. Resultados: La ansiedad preoperatoria se presento en el 23.7 % de los pacientes y el 49.5 % demando mas informacion. Ademas, existio relacion entre ambas variables (p Conclusion: En este estudio existio ansiedad y desinformacion en cirugia podologica. Por tanto, existe la necesidad de instaurar la valoracion psicologica prequirurgica e informar al paciente adecuadamente. EnglishIntroduction: The emotional state of the patient before a foot surgery is not included in the routine presurgical assessment in Podiatry. The assessment of preoperative anxiety has been studied in different medical disciplines, but it is unknown in surgical procedures of the foot. The main objective was to determine the prevalence of preoperative anxiety in foot surgery, as well as to assess the demand for surgical information from patients. Patients and methods: The validated Amsterdam anxiety and information scale (APAIS) was used to assess preoperative anxiety and the need for information in 93 patients undergoing different forefoot surgery (osteoarticular, nail and soft tissue). A questionnaire was also used to collect other variables before surgery such as age, sex and educational level. Results: Preoperative anxiety occurred in 23.7 % of the patients and 49.5 % demanded more information. In addition, there was a relationship between both variables (p Conclusion: In this study there was high anxiety and misinformation in podiatric surgery. Therefore, there is a need to establish the pre-surgical psychological assessment and inform the patient properly.

There has been growing interest in minimally invasive foot surgery due to the benefits it delivers in post-operative outcomes in comparison to conventional open methods of surgery. One of the major factors determining the protocol in minimally invasive surgery is to prevent iatrogenic thermal osteonecrosis. The aim of the study is to look at various drilling parameters in a minimally invasive surgery setting that would reduce the risk of iatrogenic thermal osteonecrosis.Sixteen fresh-frozen tarsal bones and two metatarsal bones were retrieved from three individuals and drilled using various settings. The parameters considered were drilling speed, drill diameter, and inter-individual cortical variability. Temperature measurements of heat generated at the drilling site were collected using two methods; thermocouple probe and infrared thermography. The data obtained were quantitatively analysed.There was a significant difference in the temperatures generated with different drilling speeds (p0.05). However, there was no significant difference in temperatures recorded between the bones of different individuals and in bones drilled using different drill diameters. Thermocouple showed significantly more sensitive tool in measuring temperature compared to infrared thermography.Drilling at an optimal speed significantly reduced the risk of iatrogenic thermal osteonecrosis by maintaining temperature below the threshold level. Although different drilling diameters did not produce significant differences in temperature generation, there is a need for further study on the mechanical impact of using different drill diameters.

•Foot deformities are frequently observed in Charcot-Marie-Tooth disease patients.•Surgical management is variable among centres.•During the workshop current surgical approaches were reviewed.•Recommendations for foot surgery in CMT patients were agreed by the participants.

Objective: The aim of this study was to retrospectively measure the outcomes of foot-sparing surgery at one year follow-up for patients with diabetic foot ulcers (DFUs). We assessed wound healing and the need for further surgery in relation to the variables that influence healing. Method: Data were retrospectively collected by reviewing the electronic files of patients attending the Wound Expert Clinic (WEC). Outcomes of surgical debridement, toe, ray and transmetatarsal amputations were assessed. Results: A total of 129 cases in 121 patients were identified for inclusion. The results demonstrated that complete wound healing was reached in 52% (61/117) of the patients within 12 months. The need for additional surgery or for major amputation was 56% (n=72/129) and 30% (n=39/129) respectively. The need for an additional procedure was particularly high after surgical debridement (75%, 33/44) and transmetatarsal amputation (64%, 7/11). Risk factors for non-healing or for a major amputation were: infection (p=0.01), ischaemia (p=0.01), a history of peripheral arterial occlusive disease (pConclusion: The results of the study reveal some areas for improvement including timely revascularisation and performance of multiple debridement procedures if needed in order to save a limb

This is a retrospective review of 80 intra-articular calcaneal fractures treated with open reduction and internal fixation by a specialist team under supervision of a single surgeon in a tertiary centre between 2005 and 2014. The fractures were evaluated with plain radiography and computed tomography, and graded using the Eastwood–Atkins classification. A lateral approach was used and all fractures were fixed with calcaneal plates. All patients had clinical and radiological follow-up. Clinical assessment included foot and ankle disability index, SF-36® and Kerr–Atkins scores. The mean follow-up duration was 72 months (range: 12–130 months). The mean age of patients was 49 years (range: 17–73 years). There were three open fractures and eight patients had other injuries. The mean Bohler’s angle improved from 6° preoperatively to 26° postoperatively. The mean foot and ankle disability index score was 78.62, the mean SF-36® scores were 45.5 (physical component) and 52.6 (mental component), and the mean Kerr–Atkins score was 72 (range: 36–100). Early complications included one case of screw protrusion in the subtalar joint (which warranted a repeat procedure), one sural nerve injury and one wound breakdown, which healed with non-operative measures. Twelve patients had symptomatic subtalar joint osteoarthritis. Four of these had subtalar fusion. We believe that our strict protocols of patient selection, intraoperative and postoperative management produced long-term results comparable with those in the peer reviewed literature.

Ultrasound-guided regional anesthesia is a growing modality within the pediatric emergency department. Here we present a case where a posterior tibial nerve block was used for anesthesia during foreign body removal from the plantar foot. We further review the technique and literature regarding this straightforward and highly effective procedure.

Background: Precision in minimal-incision surgery allows surgeons to achieve accurate osteotomies and patients to avoid risks. Herein, a surgical guide for the foot is designed and validated in vitro using resin foot models for hallux abducto valgus surgery. Methods: Three individuals with different experience levels (an undergraduate student, a master's student, and an experienced podiatric physician) performed an Akin osteotomy, a Reverdin osteotomy, and a basal osteotomy of the first metatarsal. Results: The average measurements of each osteotomy and the angle of the basal osteotomy do not reveal significant differences among the three surgeons. A shorter deviation from the planned measurements has been observed in variables corresponding to the Akin osteotomy (the maximum deviation in the measurement of the distance from the proximal medial end of the Akin osteotomy to the first metatarsophalangeal joint interline was 1.67 mm, and the maximum deviation from the proximal lateral end of the Akin osteotomy to the first metatarsophalangeal joint interline was 1.00 mm). As for the Reverdin osteotomies, the maximum deviations in the measurement of the distance from the proximal medial end of the osteotomy to the first metatarsophalangeal joint interline were 3.60 and 3.53 mm in the expert and undergraduate surgeons, respectively. All of the osteotomies were precise among the groups, reducing the learning curve to the maximum. Conclusions: The three-dimensional–printed prototype has been proven effective in guiding surgeons to perform different types of osteotomies. Minimal deviations from the predefined osteotomies were found among the three surgeons.

Background Complications following orthopedic surgeries are undesirable and costly. A potential method to reduce these costs is to perform traditionally inpatient surgical procedures in the outpatient setting. The purpose of this study is to compare outcomes between inpatient and outpatient settings for elective foot and ankle surgeries using the National Surgical Quality Improvement Program (NSQIP) database. Methods Patients with Current Procedural Terminology (CPT) codes specific to orthopedic foot and ankle surgery were identified from the 2011-2015 American College of Surgeons NSQIP database. Demographics, comorbidities, and complications were compared between patients undergoing inpatient and outpatient procedures. Results Patients receiving inpatient surgery were significantly older and more frequently male. Black patients were significantly more likely to undergo inpatient surgery than outpatient surgery while white patients were significantly more likely to undergo outpatient surgery. Outpatients had a significantly higher mean body mass index (BMI) than inpatients. Smokers were at a significantly greater risk of undergoing inpatient surgery than outpatient surgery. Outpatients had significantly longer operative times, were more likely to receive general anesthesia, had a lower American Society of Anesthesiologists (ASA) class, were more likely to be functionally independent, and were less likely to expire postoperatively. Patients who received surgery as an inpatient were significantly more likely to have comorbidities as compared to outpatients. The overall risk of surgical complications was significant between groups with 8.6% in the inpatient group and 2.0% in the outpatient group. The overall risk of medical complications was 16.9% in the inpatient group and 1.7% in the outpatient group. Similar to the surgical complications, inpatients were significantly more likely to sustain each of the individual medical complications except for stroke/CVA and venous thromboembolism. Conclusions Outpatient management is associated with decreased postoperative complications in select patients. Performing more operations in the outpatient setting in select patients may be beneficial for cost reduction and patient satisfaction.

Resume L’objet de cette mise au point pratique consiste a detailler l’organisation d’un circuit court ambulatoire ou « fast-track », en prenant comme exemple le parcours d’un patient opere en ambulatoire d’une chirurgie du pied sous anesthesie locoregionale, en reprenant en detail une communication video diffusee lors du congres VIDEOCAA en 2016.

Hindfoot and midfoot fusions can be performed with percutaneous techniques. Preliminary results of these procedures are encouraging because they provide similar results than those obtained with open techniques with less morbidity and quick recovery. The best indications are probably fusions for mild-to-moderate reducible hindfoot and midfoot deformities in fragile patients with general or local bad conditions. The main limit is linked to the surgeon's experience in percutaneous foot surgery because a learning curve with the specific tools is necessary before doing these procedures.

ResumenHistóricamente la fusión de la primera articulación metatarsofalángica ha sido una técnica quirúrgica usada para tratar pacientes con un grado de artrosis avanzada de la articulación o como un procedimiento de salvamento en deformidades iatrogénicas. El autor del presente trabajo ha utilizado este procedimiento durante los últimos 20 años en pacientes ancianos con deformidad en hallux valgus y se ha mostrado como un procedimiento seguro y fiable. El artículo describe el razonamiento para el uso de la fusión articular como primera opción en el tratamiento del hallux valgus en esta población de pacientes en vez de usar otro tipo de procedimientos. Se describe también la técnica quirúrgica, la fijación y los cuidados postoperatorios.AbstractHistorically first metatarsophalangeal joint fusion has been used to treat patients with joint arthritis or as a salvage procedure for iatrogenic deformities. For the past 20 years the author has used this procedure in older patients with hallux valgus deformity, and it has proven to be a safe and reliable technique. The paper describes the rationale for use of joint fusion as a primary option for hallux valgus repair in this patient population as opposed to other procedures. The surgical technique, fixation, and aftercare are also described.

ResumenIntroducciónLa osteotomía de Weil es actualmente una de las osteotomías más utilizadas para el tratamiento de la metatarsalgia en las articulaciones metatarsofalángicas menores. Sin embargo, este procedimiento no está exento de complicaciones posquirúrgicas. El presente estudio analizó de forma retrospectiva las complicaciones asociadas a esta técnica en una serie de casos de pacientesPacientes y métodosSe analizaron de forma retrospectiva las historias clínicas de pacientes operados con la osteotomía de Weil (simple o triple) de forma consecutiva entre enero del 2012 y mayo del 2015. Se anotaron las complicaciones posquirúrgicas descritas en las historias que incluían la recidiva del dolor y/o metatarsalgia de transferencia, presencia de dedos flotantes, presencia de unión retrasada o no unión, infecciones o cualquier otro tipo de complicación aparecida en el postoperatorio.ResultadosSe incluyeron un total de 25 casos operados en 21 pies. La osteotomía de Weil simple se realizó en 8 casos (32,0%) y la osteotomía de Weil triple se realizó en 17 pies (68,0%). Tres casos presentaron dolor metatarsal postoperatorio; 22 casos (88%) presentaron dedos flotantes entre los 3-6 meses del postoperatorio. No hubo diferencias en la presencia de dedos flotantes entre la osteotomía de Weil simple y triple. Hubo7 casos con dolor dorsal en el mediopié durante el postoperatorio tardío que fueron diagnosticados de síndrome de compresión interóseo intertarsal dorsal.DiscusiónEl presente estudio aporta datos sobre cuáles son las complicaciones más comunes que podrían estar asociadas a la realización de la osteotomía de Weil.AbstractIntroductionWeil osteotomy is one of the most common surgical techniques used for lesser metatarsophalangeal joints. However, this procedure is not absent of complications. The present study analyzed retrospectively surgical complications associated with Weil osteotomy in a case series of patients.Patients and methodsSurgical records were retrospectively reviewed for patients consecutively operated with a Weil osteotomy (simple or three step modification) from January 2012 and May 2015. Surgical complications such us transfer metatarsalgia, recurrence of metatarsal pain, floating toes, delayed unions or non unions as well as any complication noted in the record.ResultsIt was included a total of 25 feet operated in 21 patients. Simple Weil osteotomy was performed in 8 feet (32,0%) and three step modification of Weil osteotomy was performed in 17 feet (68,0%). Three cases had transfer metatarsalgia. Twenty-two cases (88%) had floating toes at 3 months postoperative. There were no differences in floating toes between the simple and the tree step modification of Weil osteotomy. There were 7 casesof dorsal pain in the late postoperative period that were diagnosed as dorsal interosseous intertarsal compression syndrome.DiscussionThe present study shows valid information about the most common complications associated with the Weil osteotomy.

Category: Ankle; Basic Sciences/Biologics; Hindfoot; Midfoot/Forefoot; Trauma; Other Introduction/Purpose: The management of postoperative soft tissue healing is fundamental for the success of elective foot and ankle surgery. As postoperative edema is more relevant in such surgery due to its localization, soft tissue healing can take longer and pain can restrict function. There is no universal approach to surgery aftercare among foot and ankle surgeons. Although infections following foot and ankle surgery are rare, soft tissue healing can be jeopardized after extensive and multiple approaches. Postoperative edema, however, is common and contributes to unfavorable conditions for wound healing. Our study addresses the results of avoiding postoperative edema with the use of the Jones dressing cast. Methods: We defined a precise fixation technique of the foot and ankle in the immediate post-operative phase using what we call ‘the Jones dressing cast’. This technique is a modification of the Jones dressing bandage. In a previous study we compared two groups of patients (N = 20/23) who underwent similar reconstructive surgery with the application of the described cast for one week and without. At the twomonth follow-up we observed that the group treated with the cast required less pain relief, spent less time in hospital and achieved faster autonomy using crutches (Gottlieb and Klaue, 2013). In this study we considered a group of 45 patients who underwent similar reconstructive procedures to those in the first study and who were treated with the cast for two weeks post-operatively. There was no visual check of the soft tissues before removal of the cast. Results: Although patients in Group 2 had more complex surgery, mobility was achieved earlier and hospitalization time was shorter. The incidence of infection was lower in the group wearing the cast for 2 weeks. The patients treated with the cast for 2 weeks regained autonomous mobility significantly earlier than those in Group 1 (cast 1 week or less). Conclusion: The Jones dressing cast is a useful tool that can help minimize postoperative complication rates. Wearing the cast for two weeks is preferable. Our study suggests its effectiveness in reducing soft tissue complications and facilitating independent mobility.

Background: Pain following surgery in children cause discomfort, restlessness and agitation in the postoperative period which may result in an increased incidence of nausea, vomiting and maladaptive behavioural changes. Regional anaesthesia is commonly used as an adjunct to general anaesthesia for perioperative analgesia in children as part of a multimodal approach of pain relief. This study is to compare between caudal epidural block and popliteal nerve block for postoperative analgesia in children undergoing foot surgery.Methods: A prospective randomized single blind study was carried out on 30 children aged 1-12 years of either sex undergoing foot surgery. Patients were randomly assigned into caudal epidural block group and Popliteal nerve block group, 15 children each. Both groups receive 1 ml/kg of 0.25% bupivacaine. Foot surgery was carried out under general anesthesia along with regional block for all children. After completion of surgery, children were shifted to PACU and HR, BP, SPO2 were monitored. Patient was discharged from PACU after CHEOPS (1-5 years) or VAS (6-12 years)

Minimally invasive foot surgery is performed through the smallest possible incisions by using specialised instruments to reduce the risk of iatrogenic damage. Physiological bleeding should not be stopped during this particular surgery but rather helped, in order to prevent hypothermia induced by high-speed burrs, also used in dental surgery, which reach 10,000 rpm.

Background: The tibialis anterior tendon has its insertion sites on both the medial and plantar surfaces of the medial cuneiform and the base of the first metatarsal. Operative procedures near those areas, especially at the first metatarsocuneiform joint, may disturb tendon insertions and cause irritation or functional impairment of the tendon. Methods: Tibialis anterior tendons and their insertion sites were dissected and examined from 46 cadaveric feet (19 female and 27 male cadavers, aged between 33 and 86 years, with a mean of 68.5 ± 14.3 years). The greatest lengths and widths of the tendon attachments on the bony surface of the medial cuneiform and base of the first metatarsal, on both the medial and plantar surfaces, were measured and analyzed. The measurement reliability was evaluated by using the intraclass correlation coefficient. Results: Most of the tibialis anterior tendon insertions were found to be longer at the medial cuneiform than at the base of the first metatarsal (mean, 8.3 and 5.4 mm; P < .001), but the widths were almost similar (mean, 11.0 and 10.4 mm; P = .079). When focusing on each bone, the widths of the tendon attachments on the medial and plantar surfaces of the medial cuneiform were equivalent (mean, 5.4 and 5.6 mm; P = .584). At the base of the first metatarsal, the tendon attachment on the plantar surface was found to be wider than on the medial surface (mean, 7.0 and 3.4 mm; P < .001). Conclusion: The widths of the tibialis anterior tendon insertions on the medial and plantar surfaces of the medial cuneiform were equal, as were the total widths of insertions on the medial cuneiform and on the base of the first metatarsal. However, the width of insertions on the medial surface of the first metatarsal was significantly smaller than on the plantar surface, and the total length of insertions at the medial cuneiform was longer than at the first metatarsal. Clinical Relevance: This study provides information about characteristics of the tibialis anterior tendon insertions, particularly details of the dimensions on each surface of the bones. This knowledge enables surgeons to minimize the risk of irritation or tendon injuries during operations near the base of the first metatarsal and medial cuneiform area.

[Resumen] El Angioedema Hereditario (AEH), es una enfermedad poco frecuente, pero de gran importancia para la calidad de vida de la persona que la padece, debido a la recurrencia de los síntomas y al riesgo vital en ciertas circunstancias. Se trata de una enfermedad de origen genético, transmitida con un patrón autosómico dominante. Su característica principal son los episodios recurrentes de angioedema no pruriginoso que puede afectar a cualquier parte del cuerpo, principalmente a las extremidades inferiores y superiores, aparato digestivo, cara y vía respiratoria. Entre los factores que se han identificado como desencadenantes de los síntomas se incluyen: el trauma físico, procedimientos quirúrgicos, médicos y dentales, intubación, presión, bipedestación prolongada, infecciones, estrés emocional y algunos fármacos; situaciones por tanto, que deben evitarse o minimizarse. Este proyecto de investigación pretende aportar los conocimientos necesarios para conocer la presentación clínica de esta enfermedad y la actuación que se debe adoptar en podología, ya sea ante un proceso quirúrgico en el pie, tratamiento quiropodológico o aplicación de terapia farmacológica en pacientes con AEH. La finalidad es por tanto, la identificación del AEH y la actitud podológica que se debe adoptar ante procesos que puedan exponer al paciente a episodios de angioedema y, de esta forma, prevenirlos o minimizarlos. [Resumo] O Angioedema Hereditario (AEH), é unha enfermidade rara, pero de gran importancia para a calidade de vida da persoa que o padece, debido á recurrencia de síntomas e de vida en determinadas circunstancias. É unha enfermidade de orixe xenética, transmitida cun patrón autosómico dominante. A súa característica principal son os episodios recorrentes de angioedema non prurítico que 4 Angioedema Hereditario. Proyecto de Investigación: Clínica y actitud podológica. poden afectar calquera parte do corpo, principalmente as extremidades inferiores e superiores, sistema dixestivo, cara e vía aérea. Entre os factores que se identificaron como activadores de síntomas inclúense: trauma físico, procedementos cirúrxicos, médicos e odontológicos, intubación, presión de pé prolongada, infeccións, estrés emocional e algúns medicamentos; Por conseguinte, as situacións deben evitarse ou minimizarse. Este proxecto de investigación ten como obxectivo proporcionar os coñecementos necesarios para coñecer a presentación clínica desta enfermidade ea acción que se debe tomar en podoloxía, xa sexa antes dun proceso cirúrxico no pé, tratamento quiromodolóxico ou aplicación da terapia farmacolóxica en pacientes con AEH. O obxectivo é, polo tanto, a identificación de AEH ea actitude podológica que debe ser adoptada antes de procesos que poidan expoñer ao paciente a episodios de angioedema e, deste xeito, impedir ou minimizar os seus efectos. [Abstract] Hereditary Angioedema (AEH), is a rare disease, but of great importance for the quality of life of the person who suffers it, due to the recurrence of symptoms and life-threatening in certain circumstances. It is a disease of genetic origin, transmitted with an autosomal dominant pattern. Its main characteristic are the recurrent episodes of non-pruritic angioedema that can affect any part of the body, mainly the lower and upper extremities, digestive system, face and airway. Among the factors that have been identified as triggers of symptoms include: physical trauma, surgical, medical and dental procedures, intubation, prolonged standing pressure, infections, emotional stress and some drugs; situations therefore, that should be avoided or minimized. This research project aims to provide the knowledge necessary to know the clinical presentation of this disease and the action to be taken in podiatry, either before a surgical process in the foot, chiropodological treatment or application of pharmacological therapy in patients with AEH. The purpose is, therefore, the identification of AEH and the podiatric attitude that should be adopted before processes that may expose the patient to episodes of angioedema and, in this way, prevent or minimize them. Traballo fin de grao (UDC.FEP). Podoloxía. Curso 2017/2018