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Background: Several studies have shown the relationship between poor footwear fit and the risk of feet deformities. The available evidence seems to show that the development of hallux valgus deformity in the feet of schoolchildren may be related to the use of shoes that are poorly fitting in length. The objective of this cross-sectional study was to analyze the relationship between poor footwear fit in length and risk of developing hallux valgus. Methods: Using an instrument that was designed and calibrated for this purpose, maximum foot length was obtained and compared to the inner length of the shoe in 187 schoolchildren. Hallux valgus angle (HVA) was measured on weight-bearing podogram image obtained from the longest foot in 188 schoolchildren. Results: By default, the footwear was poorly fitting in length (too short or close-fitting) in 38.5% of the schoolchildren, with boys having the worst footwear fit, though no significant differences stood out. (p = 0.276). Regarding the HVA, no significant differences were recorded according to age or gender (p = 0.573). A strong correlation was observed between too-short footwear and the increase in HVA in 10-year-old boys (r = 0.817, p = 0.025) and in 9-year-old girls (r = 0.705, p = 0.005). Conclusions: Inadequate footwear fit in length may be a predisposing extrinsic risk factor for the development of hallux valgus in schoolchildren of both sexes. Results of the present study demonstrate the need to adapt the sizes of footwear to the rapid increase in foot-length that occur at puberty to avoid the risk of developing hallux valgus, especially at the ages of onset pubertal foot growth.

Background: In the treatment of Onychocryptosis, chemical matricectomy with 88% phenol solution is one of the most common surgical procedures due to a recurrence rate of less than 5%, but it may produce a delay in healing time. The objective was to compare the healing time between phenol applications of 30 or 60 s. Methods: A comparative, prospective, parallel, randomized, and blinded clinical trial was registered with the European Clinical Trials Database. Twenty-seven patients (54 feet) with 108 affected nail folds were randomized and treated with chemical matricectomy with phenol. Each hallux was randomly assigned to one of two groups (60 vs. 30 s phenolization). Each patient and one investigator were blinded to the phenol application time in each foot. The outcome measurements were healing time, recurrence, pain, post-surgical bleeding, inflammation, and infection rate. Results: The 30 s application presents a shorter healing time (14.93 ± 2.81 days vs. 22.07 ± 3.16 days, p &lt, 0.001) with a similar recurrence rate (p = 0.99). Post-operatory bleeding, pain, inflammation, and the infection rate did not show significant differences (p &gt, 0.05). Conclusions: The 30 s phenol application time offers a shorter healing time than 60 s without affecting the effectiveness of the procedure, showing the same rate of complications.

Background and Objective: This study analyzes the possibility that Stomatognathic and Postural systems are related by muscle chains. Malocclusion may influence the posture, contact between the foot and the ground, center of mass, footprint or vice-versa. This study aimed to verify whether there is a relationship between dental occlusion and podal system.Materials and Methods: A cross-cutting, descriptive study was carried out on 409 children (222 boys and 187 girls) between 8 and 14 years old. Dental occlusion was assessed on the sagittal plane (Angle's classification) the contact between the foot and the ground and the center of mass were evaluated using a stabilometric platform.Results: There was a statistically significant relationship between the plantigrade phase, the contact surface area and center of gravity. There was a prevalence of molar and canine Angle's class II malocclusion. In molar class II, an anterior center of gravity was predominant, in class I it was centered and in class III, it was posterior. There was significant correlation between malocclusions and the FPI (foot posture index) of the left foot and the height of the scaphoid in the right foot (P < 0.001).Conclusions: Some authors agree with our results. There is still much uncertainty in terms of showing a relationship between both systems. In addition, there is scarce scientific evidence on the topic. Some kind of relationship between the two systems has been proven. Studies that evaluate a group of subjects in a longitudinal manner are necessary to enable the changes taking place in both systems to be defined.

Objective: To determine the clinical results of custom-made foot orthoses versus placebo flat cushioning insoles combined with an extracorporeal shock wave therapy on pain and foot functionality in patients with plantar fasciitis. Design and setting: A randomised controlled clinical trial with follow-up at six months. Faculty of Podiatry and Centre Clinical private of Physiotherapy, Seville, Spain. Subjects and interventions: Patients with plantar fasciitis were randomly assigned to either group A ( n = 42), which received custom-made foot orthoses, or group B ( n = 41), which received placebo insoles. All the participants received active extracorporeal shock wave therapy including stretching exercises. Recruitment period was from Mach 2019 to July 2020. Main measurements: The main outcome was foot pain, measured by visual analogue scale and the secondary outcome measures were recorded by Roles and Maudsley scores respectively, at the beginning and at one week, one month and six months. Results: Eighty-eight patients were assessed for eligibility. Eighty-three patients were recruited and randomised. This study showed significant differences between both groups according to the visual analogue scale. In control group, the difference was at baseline ( P 0.01) and, in the experimental group was at the one- and six-month follow-up ( P 0.001). The mean (SD) visual analogue scale at baseline were Control group 6.31 (1.69) and Experimental group 5.27 (1.64); and at six months were 7.52 (3.40) and 3.29 (4.26), respectively. The custom-made foot orthosis was perceived as ‘good’ (85%) and ‘excellent’ (97.5%) at medium-long term. Conclusion: Wearing a custom-made foot orthosis leads to a improvement in patients with plantar fasciitis; it reduced foot pain and improved foot functionality.

Background Chevron osteotomy for the treatment of mild and moderate hallux valgus obtain good effects. The procedure is suitable for a variety of cases, thereby allowing for a significant degree of correction. This study aimed to investigate Chevron osteotomy procedures for the correction of hallux valgus in the medium-term (2010-2016) by podiatrists surgeons. It takes into account clinical and radiological findings as well as patient perspectives and level of satisfaction. Methods All patients were assessed preoperatively, postoperatively and at a final follow-up. Fifty feet (forty five patients). The mean age was 59.43 (range 32 to 80) years. All of the participants signed an informed consent form to take part in the study. The protocols include: chart review, clinical and radiological. Anterior-posterior weight-bearing radiographs were analyzed preoperatively and at final follow-up. All radiological data were assessed by two observers blinded. Clinical and functional measurements as well as evaluation of the satisfaction survey at the final visit were carried out by another researcher blinded to the study. All patients were analyzed with VAS and AOFAS score. It was applied to evaluate clinical effects. Results Inter and intra-observer reliability was evaluated (ICC- 95%). The average value of the hallux valge angle (HVA) decreased at final follow-up (25.30o {plus minus} 7.21 VS 17.98o{plus minus} 8.18; p=0.041). There was no significant reduction in the average value of the intermetatarsal angle (IMA) at final follow-up (13.13o {plus minus} 3.03 VS 11.3o {plus minus}3.18; p= 0.78). Final AOFAS scale was 83. This study show the relevance of magnet therapy, nail surgery and others additional procedures. No patient was dissatisfied with the aesthetic scarring. Conclusions The results showed that radiological results at final follow-up weren´t compatible with relapse of the deformity. The definitive clinical results, and the degree of patient satisfaction achieved with this technique were favorable from the patients' point of view.

The number of studies that investigate the correlations between the temporomandibular system and body posture, postural control, or the distribution of plantar pressure has recently been increasing. However, most of the existing information is not conclusive. Therefore, the study objective was to evaluate if the features of dental malocclusion are correlated with body posture alterations at the lower limb level. This is a multicentre cross-sectional study with 289 children (8–14 years). Angle’s molar relation was analysed at the dental level. The postural control and the plantar pressure distribution were recorded via a force platform. Correlation and inferential analysis between the Angle class and the foot’s biomechanics were tested. The centre of gravity is anteriorised in Angle’s Class II in both the molar class (p ≤ 0.001) and the canine class (p ≤ 0.001). Likewise, a relationship was observed between the contact surface and Angle’s classes, being higher in class III than in II (p ≤ 0.001). The plantigrade phase is shortened in Angle’s Class III. A relationship was found between Angle’s Class II and a forward movement of the centre of gravity. No relationship was found between the Foot Posture Index and the truncated scaphoid height and the dental classification. An evident relationship between the gait typology and dental malocclusion was not found.

Background: In onychocryptosis surgery, incisional and non-incisional matricectomy is indicated according to the stage. The chemical matricectomy with 88% phenol solution is the gold standard and a wedge resection is indicated for more advanced stages. The aesthetic reconstruction has the advantages of the incisional procedure without eponychium incisions and an effectiveness similar to the chemical matricectomy with phenol. Objective: To compare the recurrence and the healing time between the chemical matricectomy with phenol and the aesthetic reconstruction. Methods: A comparative, prospective, parallel, randomized, and one-blinded clinical trial was registered with the European Clinical Trials Database (EudraCT) with identification number 2019-001294-80. Thrity-four patients (56 feet) with 112 onychocryptosis were randomized in two groups. Thirty-six were treated with chemical matricectomy with phenol and 76 with aesthetic reconstruction. Each patient was blind to the surgical procedure assigned by the investigator. The primary outcome measurements were healing time and recurrence. The secondary outcome measurements were post-surgical bleeding, pain, inflammation, and infection rate. Results: The aesthetic reconstruction procedure presents a shorter healing time (8.2 &plusmn, 1.4 days vs. 21.3 &plusmn, 3.1 days, p &lt, 0.001) with a similar recurrence rate (p = 0.98). Post-operatory bleeding, pain, inflammation, and the infection rate did not show significant differences (p &gt, 0.05). Conclusions: The aesthetic reconstruction presents a shorter healing time, favoring the patients&rsquo, recuperation, with a recurrence similar to the chemical matricectomy with 88% phenol solution.

Aims The aims of this study are to assess the variability in the prevalence of diabetic peripheral neuropathy (DPN), according to the diagnostic and clinical guidelines used. Methods A cross-sectional observational study was conducted of 111 patients with diabetes mellitus. The presence/absence of DPN was determined according to 12 different criteria stipulated in various clinical guidelines (ADA 2018, IWGDF 2016, IDF 2012 and CONUEI 2018). The Cohen’s kappa coefficient (κ) was performed to determine the degree of agreement for DPN diagnosis among the different criteria. Results The recorded prevalence of DPN ranged from 13.1% (criterion ADA 2018) to 68.5% (criterion IDF 2012). The sensory parameter that was most commonly affected was the non-perception of vibration (68.5%) and the absence of Achilles reflexes (59.4%). IWGDF, based on the use of a monofilament, cotton wisp and tuning fork, was the test with more agreements, presenting good agreement with 2 criteria from ADA 2018 (k = 0.845), 1b2 (k = 0.817), 2 criteria from IWGDF 2016 (k = 0.933), (k = 0.817), 1 criteria from IDF 2012 (k = 0.845) and 1 criteria from CONUEI 2018 (k = 0.860), all p Conclusion The IWGDF criterion based on the use of a monofilament, cotton wisp and tuning fork for the diagnosis presented the highest level of concordance with the other criteria (>0.8).

Objetivos: El objetivo principal es revisar en la bibliografía descrita, si en el pie plano adquirido del adulto la insuficiencia del ligamento calcaneonavicular plantar es factor primario o, por el contrario, consecuencia de la insuficiencia tendinosa del tibial posterior.Material y métodos: En la bibliografía consultada se analizan diversos atlas de anatomía y manuales de biomecánica del pie. Además, se han seleccionado 46 publicaciones científicas de interés en distintas bases de datos, estableciendo una serie de criterios de inclusión y de exclusión.Resultados: Se trata de un ligamento que puede lesionarse de manera aislada o asociada a la disfunción del tendón tibial posterior. Como consecuencia, se desestabiliza la bóveda plantar, lo cual desencadena la flexión plantar del astrágalo y la alineación en eversión del calcáneo. El resultado clínico es la deformidad de pie plano adquirido en el adulto.Discusión: Múltiples teorías se debaten sobre si la deformidad de pie plano adquirido procede o no de la insuficiencia del tendón tibial posterior, o bien es secundaria a la lesión de estructuras ligamentosas.Conclusiones: El ligamento calcaneonavicular plantar o ligamento Spring es la principal estructura pasiva que mantiene la estabilidad estática del arco longitudinal medial del pie, la cual contribuye al sostén de la cabeza del astrágalo y proporciona equilibrio en la articulación talocalcaneonavicular. Si la lesión ligamentosa no se trata va a evolucionar hacia un pie plano adquirido en el adulto.

Background Many risk factors have been identified to be associated with ingrown toenail. Internal pressure by the distal phalanx of the hallux and the second toe and external compression from the shoes has been proposed as a reason for the pathology. The main objective of the study was to analyze the existence of a correlation between the presence of pathological hallux interphalangeal angle (HIA) and risk of ingrown hallux nail. Methods One hundred and sixty-five subjects (312 ft) were enrolled in a cross-sectional, analytical and observational case–control study. A radiographic computerized system was used to measure HIA in both groups. The angle was considered as the sum of three angles, obliquity, asymmetry and joint deviation. Results The mean HIA in case group subjects (patients with hallux ingrown nail) was significantly higher than that obtained in control group subjects (17.39 ± 6.0° versus 13.47 ± 4.6°, p = .036). A total of 73.71 and 46.79 % of feet presented an angle equal or greater than 13.47° in the onychocryptosis and control group, respectively. Conclusions The results show a correlation between the variables analysed. The presence of an HIA greater or equal than 14.5° may be a predisposing factor for developing onychocryptosis of the hallux. Clinicians treating individuals with pathology in hallux might use a baseline cutoff of HIA equal than 13.5°.

Background The Surgical Safety Checklist (SSC) is a tool developed by the World Health Alliance for Patient Safety, to assist health professionals in improving patient safety during surgery. Numerous specialties have incorporated this into their clinical practice. The purpose of this study is to adapt and implement this tool within the field of podiatric surgery and to evaluate its impact upon safety standards and post-surgical complications. Methods An analytical, observational, longitudinal study has been performed retrospectively. The implementation of the Surgical Safety Checklist in podiatric surgery took place over a 10-month period. The sample is made up from the medical histories of patients who were operated on (n = 134) in the University of Seville’s podiatric clinic. The sample was divided into three groups: those prior to the implementation process (65 subjects), those after the implementation process: without the SSC (35 subjects) and those with the SSC (34 subjects). The safety standards included in the tool were analysed in conjunction with the results and post-operative complications. Results An improvement was seen in compliance with the Prophylaxis Protocol and the correct completion of the Informed Consent (p = 0.00), as well as a statistically significant relationship between the correct use of antibiotic prophylaxis and the use of the Surgical Safety Checklist (p = 0.049). The results demonstrate a reduction in the number of post-operative days (p = 0.012). No cases of surgery being performed in the wrong place were found in this study. Conclusions The Surgical Safety Checklist allows us to improve compliance with the safety protocols recommended by the scientific community, and consequently to reduce the incidence of complications related to surgery and to improve patient safety during elective podiatric surgery.

The Koenen tumors are cutaneous manifestations of tuberous sclerosis, which is of systemic involvement and sometimes with location in the foot. The knowledge of this type of dermatological is very important for proper treatment and for this reason an interdisciplinary approach is essential for the accurate and early diagnosis. In the clinical history is important to make an assessment of family history, perform a scan of the skin and a neurological study. We report a case with symptoms consistent with the presence of tumor Koenen. The differential diagnosis is essential for planning treatment and get a good outcome and speedy recovery. Conclusions. Surgical treatment is proposed as a technique of choice despite the high rate of recurrence presents such treatment. Surgical resection of the lesion allows the pathological diagnosis.

The authors propose a surgical security check-list adapted to the podiatric surgery. This check-list is based on the Surgical Security Checklist proposed by the World Health Organization. The proposed document contains 18 items divided into two groups: those which are checked before the surgery and those which must be verified after it, before the patient leaves the operating room. The checklist is characterized as being an easy-to- use tool, it requires a short time and permits to systematically increase the patient safety. The authors think that the result is a checklist that is easy to fill and that improves the patient safety in the podiatric surgery.