Publications by authors named "Emmanuel Navarro-Flores"

35 Publications

Current advances and novel research on minimal invasive techniques for musculoskeletal disorders.

Dis Mon 2021 Jun 4:101210. Epub 2021 Jun 4.

Frailty and Cognitive Impairment Research Group (FROG), University of Valencia, 46010 Valencia, Spain. Electronic address:

The present review summarized the current advances and novel research on minimal invasive techniques for musculoskeletal disorders. Different invasive approaches were proposed in the physical therapy field for the management of musculoskeletal disorders, such as ultrasound-guided percutaneous needle electrolysis, dry needling, acupuncture and other invasive therapy techniques, discussing about their worldwide status, safety and interventional ultrasound imaging. Indeed, dry needling may be one of the most useful and studies invasive physical therapy applications in musculoskeletal disorders of different body regions, such as back, upper limb, shoulder, arm, hand, pelvis, lower limb, neck, head, or temporomandibular joint, and multiple soreness location disorders, such as fibromyalgia. In addition, the assessment and treatment by acupuncture or electro-acupuncture was considered and detailed for different conditions such as plantar fasciitis, osteoarthritis, spasticity, myofascial pain syndrome, osteoporosis and rheumatoid arthritis. As an increasing technique in physical therapy, the use of ultrasound-guided percutaneous needle electrolysis was discussed in injuries of the musculoskeletal system and entrapment neuropathies. Also, ultrasound-guided percutaneous neuromodulation was established as a rising technique combined with ultrasound evaluation of the peripheral nerve system with different clinical applications which need further studies to detail their effectiveness in different musculoskeletal conditions. Thus, invasive physical therapy may be considered as a promising approach with different novel applications in several musculoskeletal disorders and a rising use in the physiotherapy field.
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http://dx.doi.org/10.1016/j.disamonth.2021.101210DOI Listing
June 2021

Ultrasound-Guided Percutaneous Neuromodulation in Patients with Chronic Lateral Epicondylalgia: A Pilot Randomized Clinical Trial.

Int J Environ Res Public Health 2021 May 3;18(9). Epub 2021 May 3.

Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain.

Objective: The aim was to analyze effects of a percutaneous neuromodulation (PNM) treatment on the radial nerve, regarding pain, functionality, electrophysiologic excitability, and morphology, in patients with chronic lateral epicondylalgia (LE).

Methods: Twenty-four patients with chronic unilateral elbow pain were recruited for this preliminary study and were divided into two groups: control (n = 12) and PNM group (n = 12). The subjects in the PNM group received percutaneous peripheral neurostimulation with an acupuncture needle that was located next to the nerve with ultrasound guidance. Pain using a numerical rating scale (NRS), functional ability using patient-rated tennis elbow evaluation (PRTEE), radial nerve cross-sectional area measured by ultrasound, and chronaxie and accommodation index (AI) measured by the strength-duration curve were evaluated.

Results: Both groups showed no differences in the baseline measurements (all = 0.001). However, at the end of the treatment, there were significant differences between groups since only the PNM group significantly improved their values compared to their baseline values: level of pain and cross-sectional area (CSA) values showed a significant decrease while the PRTEE scores showed a significant improvement. Then, regarding AI, the PNM group showed significant improvement for the electrophysiologic nerve excitability pattern, reporting normal function in all radial nerves after treatment ( = 0.001). However, chronaxie values always reported similar values with no differences between groups ( >0.05); Conclusion: Ultrasound-PNM technique may be an interesting therapeutic tool for the treatment of chronic LE due to the improvement in the level of pain, functionality, nerve morphology, and excitability in this population.
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http://dx.doi.org/10.3390/ijerph18094877DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8125558PMC
May 2021

Influence of foot pain on frailty symptoms in an elderly population: a case-control study.

Sao Paulo Med J 2021 May 21. Epub 2021 May 21.

MSc, PhD, DPM. Senior Lecturer and Researcher, Health and Podiatry Group, Department of Health Sciences, School of Nursing and Podiatry, Universidade da Coruña, Ferrol, Spain.

Background: Frailty is a condition that can increase the risk of falls. In addition, foot disorders can negatively influence elderly people, thus affecting their condition of frailty.

Objective: To determine whether foot pain can influence a greater degree of frailty.

Design And Setting: Cross-sectional descriptive study conducted at the University of Valencia, Valencia, Spain.

Methods: A sample older than 60 years (n = 52), including 26 healthy subjects and 26 foot pain patients, was recruited. Frailty disability was measured using the 5-Frailty scale and the Edmonton Frailty scale (EFS).

Results: There were statistically significant differences in the total EFS score and in most of its subscales, according to the Mann-Whitney U test (P < 0.05). In addition, foot pain patients presented worse scores (higher 5-Frailty scores) than did healthy patients, regarding matched-paired subjects (lower EFS scores). With regard to the rest of the measurements, there were no statistically significant differences (P > 0.05). The highest scores (P < 0.001) were for fatigue on the 5-Frailty scale and the EFS, and for the subscale of independence function in EFS.

Conclusions: These elderly patients presented impairment relating to ambulation and total 5-Frailty score, which seemed to be linked to the presence of frailty syndrome and foot disorders.
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http://dx.doi.org/10.1590/1516-3180.2020.0492.R1.0802021DOI Listing
May 2021

Kinesiophobia Levels in Patients with Parkinson's Disease: A Case-Control Investigation.

Int J Environ Res Public Health 2021 04 30;18(9). Epub 2021 Apr 30.

Department of Nursing, Faculty of Nursing and Podiatry, Frailty Research Organized Group, Universidad de Valencia, 46010 Valencia, Spain.

Background: Kinesiophobia can be an obstacle to physical and motor activity in patients with Parkinson's disease (PD). PD affects patients' independence in carrying out daily activities. It also impacts a patient's biopsychosocial well-being. The objective of this study was to analyze the levels and scores of kinesiophobia in PD patients and compare them with healthy volunteers.

Methods: We deployed a case-control study and recruited 124 subjects (mean age 69.18 ± 9.12). PD patients were recruited from a center of excellence for Parkinson's disease (cases n = 62). Control subjects were recruited from the same hospital (control n = 62). Kinesiophobia total scores and categories were self-reported using the Spanish version of the Tampa Scale of Kinesiophobia (TSK-11).

Results: Differences between cases and control groups were analyzed using the Mann-Whitney U test. Statistically significant differences ( < 0.05) were shown between groups when comparing kinesiophobia categories (or levels) and total scores, revealing higher kinesiophobia symptoms and levels in PD patients. All of the PD patients reported some degree of kinesiophobia (TSK-11 ≥ 18), while the majority of PD patients (77.3%) had kinesiophobia scores rated as moderate to severe (TSK-11 ≥ 25). On the other hand, ~45.1% of controls reported no or slight kinesiophobia and 53.2% reported moderate kinesiophobia.

Conclusions: Total kinesiophobia scores were significantly higher in PD patients compared with healthy controls, with moderate to severe kinesiophobia levels prevailing in PD patients. Therefore, individuals living with PD should be evaluated and controlled in order to detect initial kinesiophobia symptoms.
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http://dx.doi.org/10.3390/ijerph18094791DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8124702PMC
April 2021

Transcultural adaptation and validation of Italian Selfcare diabetic foot questionnaire.

Int Wound J 2021 May 3. Epub 2021 May 3.

University Center of Plasencia, Universidad de Extremadura, Plasencia, Spain.

The Italian Selfcare diabetic foot questionnaire, (SDFQ-IT) is considered a diabetic foot self-care evaluation tool with 16 questions for assessing diabetic foot health disorders. To date, SDFQ has been validated in different languages, but an Italian version was lacking. Consequently, the purpose of this study was to translate and validate the Italian version of the SDFQ-IT (SDFQ-IT). A suitable method was developed for the translation protocol and cross-cultural validation from Spanish to Italian. Regarding the total marks from each sub-scale, agreement degrees, and confidence were analysed using the Cronbach's α and intraclass correlation coefficient (ICC), respectively. In addition, the mean ± SD differences between pre and post-tests were calculated and completed using the Bland and Altman distribution plots. Excellent agreement between the two versions based on Cronbach's α was demonstrated. Three sub-scales consisting of knowledge of foot hygiene, the appropriate use of footwear and socks, and podiatric self-care were added together to obtain the total score. Excellent retest reliability was shown for the total score. Test/retest reliability was excellent for the self-care domain, and shock and shoe sub-scales. There were no significant differences among any domain (P > .05). There were no statistically significant differences (P = .000) for the mean ± SDs differences between pre-and post-tests (92.9200 ± 12.914) [89.25-96.59] and 92.9200 ± 13.012 [89.22-96.62] points, respectively). Bland and Altman plots or clinically pertinent variations were not statistically significantly different. The SDFQ-IT is considered a strong and valid questionnaire with adequate repeatability in the Italian community.
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http://dx.doi.org/10.1111/iwj.13554DOI Listing
May 2021

Effect of Physiotherapy Treatment in the Autonomic Activation and Pain Perception in Male Patients with Non-Specific Subacute Low Back Pain.

J Clin Med 2021 Apr 20;10(8). Epub 2021 Apr 20.

Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain.

Introduction: Physiotherapy treatment is a common intervention for low back pain (LBP) patients. These interventions have been related to physiological effects in the central nervous system. Thus, the aim of this study was to analyze the effect of physiotherapy treatment in patients with LBP in the autonomic nervous system activation and subjective pain perception of patients.

Methods: A total of 30 male subjects diagnosed with non-specific subacute LBP received a 50 min session consisting of (a) a manual therapy based on joint mobilization and soft tissues techniques in the lumbo-pelvic area, (b) a stretching program, and (c) motor control exercises of the core muscles. The autonomic modification of participants was assessed prior to and after the physiotherapy treatment.

Results: Heart rate variability (HRV) analysis reported a significant increase in average RR ( = 0.001), RMSSD ( = 0.008), LRMSSD ( = 0.001), SDNN ( = 0.005), and PNN50 ( = 0.024) after the session. Frequency-domain measures showed a significant increase in LF ( = 0.030) and HF ( = 0.014), and a decrease in LF/HF ratio ( = 0.046). A significant decrease was found in minimum HR values ( = 0.001) and average HR ( = 0.001). Moreover, maximal HR decreased its value from 116.7 ± 26.1 to 113.7 ± 40.8 after intervention. In addition, subjective pain perception (VAS scores) was significantly lower ( = 0.001) in the post-session assessment.

Conclusions: Physiotherapy treatment produced an increase in parasympathetic nervous system activation and a decrease in subjective pain perception in non-specific subacute LBP patients.
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http://dx.doi.org/10.3390/jcm10081793DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8074333PMC
April 2021

Psychometric evaluation of the Persian version of the diabetic foot self-care questionnaire in Iranian patients with diabetes.

BMC Endocr Disord 2021 Apr 17;21(1):72. Epub 2021 Apr 17.

Spiritual Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran.

Background: Diabetic foot self-care refers to a group of self-management behaviors that can reduce the incidence of foot ulcers and amputations. It is necessary to have a valid and reliable standard tool to measure foot self-care in diabetic patients. This study aimed to evaluate the psychometric properties of the Persian version of the Diabetic Foot Self-Care Questionnaire of the University of Malaga, Spain (DFSQ-UMA) in Iran.

Methods: This cross-sectional study was conducted with 407 diabetic patients who were selected using a convenient sampling method. Construct validity was assessed by exploratory (with 207 patients) and confirmatory (with 200 patients) factor analyses. Internal consistency was calculated using Cronbach's alpha and McDonald's omega coefficients.

Results: In the exploratory factor analysis, three factors with eigenvalues of 3.84, 2.41, and 2.26 were extracted that together explained 56.74% of the total variance of diabetic foot self-care. A Cronbach's alpha of 0.865 was found for the total instrument.

Conclusions: The Persian version of the DFSQ-UMA has good validity and reliability, and given its good psychometric properties, it can be used in future studies.
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http://dx.doi.org/10.1186/s12902-021-00734-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8052781PMC
April 2021

Heart Rate Variability Monitoring during Interferential Current Application in the Lower Back Area: A Cross-Sectional Study.

Int J Environ Res Public Health 2021 03 25;18(7). Epub 2021 Mar 25.

Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain.

Vasovagal reactions may occur occasionally during electrical stimulation using interferential current (IFC). The purpose of this study was to examine variations in autonomic activity during the application of IFC in asymptomatic participants by analysis of their heart rate variability (HRV). Seventy-three male volunteers were randomly assigned to a placebo group ( = 36; HRV was documented for 10 min, both at rest and during a placebo intervention) and an intervention group ( = 37; HRV was documented for 10 min in two conditions labelled as (1) rest and (2) application of IFC technique on the lumbar segment). The diameters of the Poincaré plot (SD1, SD2), stress score (SS), and the ratio between sympathetic and parasympathetic activity (S/PS) were measured. After interventions, differences amongst the placebo group and the IFC group were found in SD2 ( < 0.001), SS ( = 0.01) and S/PS ratio ( = 0.003). The IFC technique was associated with increased parasympathetic modulation, which could induce a vasovagal reaction. Monitorization of adverse reactions should be implemented during the application of IFC technique. HRV indicators might have a part in prevention of vasovagal reactions. Further studies in patients with lumbar pain are needed to explore possible differences in HRV responses due to the presence of chronic pain.
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http://dx.doi.org/10.3390/ijerph18073394DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8036980PMC
March 2021

The Impact of Depression Symptoms in Patients with Parkinson's Disease: A Novel Case-Control Investigation.

Int J Environ Res Public Health 2021 03 1;18(5). Epub 2021 Mar 1.

Frailty Research Organized Group, Department of Nursing, Faculty of Nursing and Podiatry, Universidad de Valencia, 46010 Valencia, Spain.

Parkinson's disease is a common neurodegenerative disease and it is known to cause motor disturbances associated with musculoskeletal problems of the locomotor apparatus, and non-motor symptoms, that are believed to have a harmful effect on health, social functioning and mobility. The aim of this study was to evaluate depression in patients with Parkinson's Disease (PD) compared to subjects who do not have it. The sample consisted of 124 participants (mean age 69.18 ± 9.12). Patients with PD were recruited from a center of excellence for Parkinson's disease (cases = 62) and healthy subjects without PD from their relatives and caregivers (control = 62). The Spanish version of Beck's Depression Inventory (BDI) scores and categories were collected. A clear statistically significant difference ( < 0.05) was evident in the BDI scores between both groups. Parkinson's patients presented worse results on the BDI = 15.48 ± 7.24 points compared to healthy subjects with BDI = 7.03 ± 6.99 points. Regarding BDI categories, there were statistically significant differences ( < 0.001) for the greater BDI categories in the Parkinson's group compared with healthy subjects. The depression represents an important potential risk for increased symptoms and negative impact among patients with PD compared with healthy subjects.
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http://dx.doi.org/10.3390/ijerph18052369DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7967746PMC
March 2021

Changes in Salivary Amylase and Glucose in Diabetes: A Scoping Review.

Diagnostics (Basel) 2021 Mar 6;11(3). Epub 2021 Mar 6.

Frailty and Cognitive Impairment Research Group (FROG), University of Valencia, 46010 Valencia, Spain.

Background And Objective: Diabetes mellitus (DM) is a common long-term disease which can be related with salivary amylase levels. DM has recently been associated with salivary amylase diagnostics that could further impair diagnoses in the diabetic population, as well as being an interesting alternative to traditional methods of determine glucose levels. The main advantage of this method is related to the fact that it is a fast diagnostic method. The DM population experiences changes to their metabolism which affects their salivary parameters, making this an alternative procedure for diagnosis and follow-up of the illness due to the non-invasive nature of salivary analyzes. The objective of this review is to summarize the evidence regarding the changes in salivary amylase and glucose levels, and their relationship with blood markers of glycemic control used in clinical settings such as blood glucose and glycated hemoglobin. The differences in salivary amylase levels depending on the method of saliva collection under fasting or non-fasting conditions. The changes in salivary amylase depends on the type of diabetes, the type of insulin treatment or the quality of glycemic control.

Conclusions: Salivary amylase concentration is increased in diabetic patients in most of the studies and salivary glucose concentration in all studies in both fasting and non-fasting (post-prandial) conditions. Salivary amylase and glucose concentration represent potential non-invasive biomarkers to evaluate glycemic control and clinical management of diabetic patients, although it is necessary to evaluate the influence of potential modulating factors such as age, duration diseases, sex and the effects of pharmacological treatments in these outcomes which remained to be elucidated.
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http://dx.doi.org/10.3390/diagnostics11030453DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8001770PMC
March 2021

Ultrasound Imaging Evaluation of Textural Features in Athletes with Soleus Pathology-A Novel Case-Control Study.

Int J Environ Res Public Health 2021 02 18;18(4). Epub 2021 Feb 18.

Faculty of Sport Sciences, Universidad Europea, Villaviciosa de Odón, 28670 Madrid, Spain.

Background: the aim of this study was to compare the echotexture of patients with soleus muscle injury and age matched controls.

Methods: a sample of 62 athletes was recruited at the private clinic and was divided in two group: a healthy group (n = 31) and a soleus pathology group whose athletes had soleus muscle injury, located in the central tendon (n = 31). The muscle thickness (MTh), echointensity (EI) and echovariation (EV) were analyzed. An intra-rater reliability test (Intraclass Correlation Coefficient-ICC) was performed in order to analyze the reliability of the values of the measurements.

Results: Sociodemographic variables did not show statistically significant differences ( > 0.05). Ultrasound imaging measurements who reported statistically significant differences were EI ( = 0.001) and standard deviation (SD) ( = 0.001). MTh and EV variables did not show statistically significant differences ( = 0.381 and = 0.364, respectively). Moreover, reliability values for the MTh (ICC = 0.911), EI (ICC = 0.982), SD (ICC = 0.955) and EV (ICC = 0.963). Based on these results the intra-rater reliability was considered excellent.

Conclusion: Athletes with a central tendon injury of soleus muscle showed a lower EI when they were compared to healthy athletes. The echogenicity showed by the quantitative ultrasound imaging measurement may be a more objective parameter for the diagnosis and follow-up the soleus muscle injuries.
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http://dx.doi.org/10.3390/ijerph18041983DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7922228PMC
February 2021

The reliability, validity, and sensitivity of the Edmonton Frail Scale (EFS) in older adults with foot disorders.

Aging (Albany NY) 2020 12 21;12(24):24623-24632. Epub 2020 Dec 21.

Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain.

The Edmonton Frail Scale (EFS) is an index employed to measure alterations related to frailty. The main objective in this research was to develop the EFS short-form (EFS-SF) and to evaluate its validity, reliability, and sensitivity to predict frailty disability outcomes in elderly patients with foot disabilities.

Results: Exploratory factor analysis (EFA) of the EFS-SF revealed the presence of three components, as in the original EFA. There were significant differences ( < 0.05) in the study population for several of the EFS and 5-item FRAIL scale indicators. The highest correlation (Pearson = 0.871; < 0.001) was found for the first component of the EFS-SF. Finally, the Cronbach alpha was 0.864 which indicated a high level of internal consistency.

Conclusion: The EFS-SF is a reliable and valid instrument to measure frailty in patients with and without foot disabilities.

Method: A cross sectional descriptive study was carried out. The study population was aged over 60 years ( = 66) and comprised 29 men and 37 women. Frailty disorders were registered by using the EFS, 5-item FRAIL scale, and the Geriatricians' Clinical Impression of Frailty (GCIF) scale. EFA was employed to locate potential constituents of the EFS, with scores ranging from 0.596 to 0.946 for each of the sub scales: (1) cognitive and general health status; (2) medication and nutrition status; and (3) functional and physiological status, thus revealing that the EFS-SF comprised three components, a reduction compared to the nine in the original EFS.
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http://dx.doi.org/10.18632/aging.202140DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7803512PMC
December 2020

M-Mode Ultrasound Examination of Soleus Muscle in Healthy Subjects: Intra- and Inter-Rater Reliability Study.

Healthcare (Basel) 2020 Dec 11;8(4). Epub 2020 Dec 11.

Deparment of Physiotherapy, University of Seville, Avicena Street, 41009 Seville, Spain.

Objective: M-mode ultrasound imaging (US) reflects the motion of connective tissue within muscles. The objectives of this study were to evaluate inter-rater and intra-rater reliability of soleus muscle measurements between examiners with different levels of US experience in asymptomatic subjects and to investigate the level of soleus muscle isometric activity in two positions (knee extended and knee flexed at 30°).

Methods: Thirty volunteers without a history of ankle pain were evaluated with US examinations of the soleus muscle. Each muscle was scanned independently by two evaluators. Muscle at rest thickness, maximal isometric contraction thickness, time and velocity measures were detailed and blinded to the other examiner.

Results: Intra- and inter-rater reliability at rest, in maximal isometric contraction thickness, contraction time and contraction velocity measures for both positions (extended and flexed knee) were reported from good to excellent for all outcome measurements. The position with the knee extended reported a statistically significant increase in thickness after motion showing 1.33 ± 0.27 mm for measurements at rest thickness with knee extended versus 1.50 ± 0.29 mm for measurements at end thickness with the knee in flexed position ( = 0.001), as well as 1.31 ± 0.23 mm for rest thickness with the knee in flexed position measurements with respect to 1.34 ± 0.24 mm for maximal isometric contraction thickness with extended knee measurements ( = 0.058).

Conclusions: This study found that intra- and inter-examiner reliability of M-mode ultrasound imaging of the soleus muscle was excellent in asymptomatic subjects and the soleus muscle activity was different between the position with the knee extended and the position with the knee flexed.
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http://dx.doi.org/10.3390/healthcare8040555DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7763654PMC
December 2020

Foot health-related quality of life in hemophiliacs: A case-control study.

Int J Med Sci 2020 29;17(15):2396-2401. Epub 2020 Aug 29.

University Center of Plasencia. Universidad de Extremadura, Spain.

Haemophilia is considered as a chronic genetic disease related with alteration in coagulation mechanism which affects to health related quality of life (HQoL). The goal compared marks of HQoL, in haemophiliacs with respect non haemophilic subjects. A population of 74 subjects, were recruited from association of haemophilic illness separated in haemophilic subjects (n = 37) and no haemophilic (n = 37). For subjects who suffered haemophilia were enlisted from the association of haemophilic illness after a seminar of 45 minutes to them and to their relatives about foot health. Control subjects, were recruited from their relatives who live with the patient. The marks of the Foot Health Status Questionnaire Spanish S_FHSQ sub-scales were recompiled. Results: All S_FHSQ domains as foot pain, foot function, tootwear, general foot health, general health, physical activity and social capacity showed lower scores in the haemophilic than non-haemophilic group ( <0.01) except for vigour ( = 0.173). Regarding the rest sub-scale marks of S_FHSQ, showed no significant difference <0.01. Subjects with a haemophilia showed significant worse foot QoL in all S_FHSQ domains except vigour domain compared with non-haemophilic subjects.
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http://dx.doi.org/10.7150/ijms.48705DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7484635PMC
August 2020

Sex Differences in Frail Older Adults with Foot Pain in a Spanish Population: An Observational Study.

Int J Environ Res Public Health 2020 08 24;17(17). Epub 2020 Aug 24.

Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, 28040 Madrid, Spain.

Frailty is a condition that can increase the risk of falls. In addition, foot pain can influence older adults and affect their frail condition. The main objective was to measure the frailty degree in older adults in a Spanish population with foot pain from moderate to severe.

Method: This is a cross-sectional descriptive study. A sample of people older than 60 years ( = 52), including 26 males and 26 females, were recruited, and frailty disability was measured using the 5-Frailty scale and the Edmonton Frailty scale (EFS).

Results: Spearman's correlation coefficients were categorized as weak (rs ≤ 0.40), moderate (0.41 ≤ rs ≥ 0.69), or strong (0.70 ≤ rs ≥ 1.00). There was a statistically significant correlation for the total score ( < 0.001) and most of the subscales of the 5-Frailty scale compared with the EFS, except for Mood ( > 0.05). In addition, females and males showed similar 5-Frailty and Edmonton Frail scales scores with no difference ( > 0.05).

Conclusion: Foot pain above 5 points, i.e., from moderate to severe, does not affect the fragility more in one sex than another.
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http://dx.doi.org/10.3390/ijerph17176141DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7504268PMC
August 2020

Women's Foot Health-Related Quality of Life in Ballet Dancers and Nondancers.

Sports Health 2020 Jul/Aug;12(4):347-351. Epub 2020 Jun 8.

School of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, Madrid, Spain.

Background: Prevalence and severity of symptoms related to muscle and joint pain seem to be high in most dancers.

Hypothesis: There will be a worse quality of life related to foot health for ballet dancers compared with nondancers.

Study Design: Case-control study.

Level Of Evidence: Level 4.

Methods: A sample of 156 women was recruited from a clinic of podiatric medicine and surgery. Self-reported data were measured by the Foot Health Status Questionnaire (FHSQ), which has 33 questions that assess 8 health domains of the feet and general health, namely, foot pain, foot function, general foot health, footwear, general health, physical activity, social capacity, and vigor.

Results: Statistically significant differences ( < 0.05) were shown for foot pain, foot function, foot health, and general health, which together revealed a worse foot health-related quality of life (lower FHSQ scores) but a better general health (higher FHSQ scores) for ballet dancers compared with nondancers. The remaining domains did not show statistically significant differences ( > 0.05). According to multivariate linear regression models ( < 0.05), the practice of ballet dance (group) was the only independent variable that predicted the dependent variables, such as foot pain ( = 0.052;β = +8.349), foot function ( = 0.108; β = +11.699), foot health ( = 0.039; β = +10.769), and general health ( = 0.019; β = -6.795).

Conclusion: Ballet dancers showed a negative impact on quality of life related to foot health but better overall quality of life (general health) compared with nondancers.

Clinical Relevance: Paying attention to a dancer's foot health could provide important benefits for the dancer's foot health and physical practice of dance.
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http://dx.doi.org/10.1177/1941738120922962DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7787562PMC
July 2020

Cross-cultural adaptation, translation, and validation of the Spanish Foot and Ankle Outcome Score questionnaire.

Int Wound J 2020 Oct 27;17(5):1384-1390. Epub 2020 May 27.

School of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, Spain.

The Spanish Foot and Ankle Outcome Score questionnaire (FAOS-S) may be considered a health evaluation tool with 42 questions for assessing foot health disorders. To date, FAOS has been validated in different languages, but a Spanish version was lacking. Consequently, the purpose of this study was to translate and validate the Spanish version of the FAOS (FAOS es). A suitable method was developed for the translation protocol and cross-cultural validation from Swedish to Spanish. Regarding the total marks from each domain, agreement degrees and confidence were analysed using the Cronbach's α and intraclass correlation coefficient, respectively. In addition, the mean ± SD differences between pretest and posttests were calculated and completed using of the Bland and Altman distribution plots. Excellent agreement between the two versions based on Cronbach's α was demonstrated. Five domains consisting of pain, symptoms of foot disorders, activities of daily living, sports and recreation, and foot and ankle quality of life were added together to obtain the total score. Excellent retest reliability was shown for the total score. Test/retest reliability was excellent for the pain, stiffness, other foot disorder-related symptoms, and quality of life domains. There were no significant differences among any domain (P > .05). There were no statistically significant differences (P = .000) for the mean ± SD differences between pretest and posttests (56.2524 ± 19.064 [51.98-60.52] and 57.45 ± 21.02 [52.74-62.16] points, respectively). Bland and Altman plots or clinically pertinent variations were not statistically significantly different. The FAOS is considered a strong and valid questionnaire with adequate repeatability in the Spanish community.
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http://dx.doi.org/10.1111/iwj.13400DOI Listing
October 2020

Stiffness degree of ankle range of motion in diabetic patients with atypical amputation.

Rev Assoc Med Bras (1992) 2020 May;66(2):216-221

. DP Research Group FROG: Cognitive Deterioration and Frailty, Nursing Department, Faculty of Nursing and Podiatry, University of Valencia, 46001 - Valencia, Spain.

Objective: In diabetics, foot deformities are risk factors that increase the risk of amputation as a result of developing ulcers. However, knowledge of the influence of plantar stiffness is still limited. The main objective was to describe connections between the degree of stiffness of the ankle, atypical amputation, and the Foot Posture Index (FPI).

Methods: 62 diabetic patients, 58 with type 2 and 4 with type 1 (average age 63.35 years) were included. Records of foot deformities were included; A range of motion test of the ankle joint was used to determine the degree of stiffness. An exploratory analysis of the association of foot position and the degree of rigidity was performed.

Results: The dorsal flexion range of the ankle was 9.6 ± 5.1 0, 13.8 ± 5.9 0 and 17.2 ± 6.5 0 and 20.5 ± 6.8 0 to 45, 67, 89 and 111 N respectively in the amputated feet., And 14 patients (22.58%) had a high level of pronation of IPF with an average value of 3.7 ± 2.629, CI (3.032.-4.367) in amputated feet compared to non-amputees. We use the device "Iowa ankle range of motion" (IAROM) to determine the differences in ankle stiffness. Proper IPF was associated with the presence of amputation and an increase in stiffness.

Conclusions: There was an increase in the degree of limitation of movement of the ankle, as a greater force was applied. Comparing FPI between the groups, there was a higher frequency of prone feet in the group of amputees.
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http://dx.doi.org/10.1590/1806-9282.66.2.216DOI Listing
May 2020

Does Function Determine the Structure? Changes in Flexor Hallucis Longus Muscle and the Associated Performance Related to Dance Modality: A Cross-Sectional Study.

Medicina (Kaunas) 2020 Apr 16;56(4). Epub 2020 Apr 16.

Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain.

: Flexor hallucis longus pathology is one of the most common conditions of the ankle and foot in dancers, due to the high demand of dance movements performed in an extreme plantar flexion and dorsiflexion range of motion. The objectives of this study were to determine the bilateral differences between the thickness and cross-sectional area of the flexor hallucis longus muscle in dancers, to establish possible differences between dance modalities, and to analyze whether there is a correlation between ultrasonographic parameters or performance variables and the dance modality. : A sample of 50 (29 classical and 21 contemporary) full-time pre-professional female dancers were included in the study. The thickness and cross-sectional area of the flexor hallucis longus muscle were evaluated for both limbs using ultrasound imaging. The range of movement of the first metatarsophalangeal joint was measured using functional extension with maximal ankle plantarflexion, balance was measured in a unilateral stance with the heel raised, endurance was evaluated through a modified heel rise fatigue test, and a counter movement jump to assess the vertical jump performance was measured bilaterally. : There were no significant differences recorded between the dominant and non-dominant limbs for each variable, within both groups. Contemporary dancers showed a greater thickness and cross-sectional area of the flexor hallucis longus muscle than classical dancers. However, classical dancers showed an increase of balance, endurance, range of movement of the first metatarsophalangeal joint, and counter movement jump with respect to contemporary dancers. : Bilateral symmetry was identified in all variables for both groups. The size and performance of the flexor hallucis longus muscle may be influenced by the specific nature of dance modality.
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http://dx.doi.org/10.3390/medicina56040186DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7230629PMC
April 2020

Surgical Treatment on Subungual Osteochondromas in Paediatric Feet: A Case Series Study.

J Clin Med 2020 Apr 14;9(4). Epub 2020 Apr 14.

Department of Pediatric Surgery, Hospital Clínico Universitario de Santiago, 15706 Santiago de Compostela, Spain.

Subungual osteochondroma (SO) is an infrequent and non-malignant bone tumour of the distal phalanx, especially prominent in paediatric populations. The aim of this research was to describe a case series of paediatric feet with SO which received surgical treatments. The secondary purpose was to compare these descriptive data by sex distribution.

Methods: Twenty-three paediatric feet with SO confirmed by clinical or radiological features received surgical treatment. Socio-demographic (age, sex, height, weight and BMI) and clinical features (side, location, tumour or pain presence, and nail lift before surgery, as well as recurrence and adverse effects at one month after intervention) were reported.

Results: Regarding clinical features before intervention, the most frequent locations of SO were the first toe (86.8%) and the right lower limb (56.5%). In addition, the presence of the tumour, pain and nail lift showed a prevalence of 91.3%, 69.5% and 47% of the study sample, respectively. Considering clinical features at one month after intervention, the most frequent adverse effect was the pain presence (69.5%). In addition, one case (4.4%) presented ulceration. Only one patient (4.4%) suffered from recurrence with a new tumour. There were not statistically significant differences by sex distribution ( > 0.05).

Conclusions: This novel study showed that surgery treatment for SO in paediatric populations presented a very low recurrence degree with minor adverse effects and without differences by sex distribution. Thus, further randomized clinical trials should be carried out in order to determine the effectiveness of this intervention in this special population.
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http://dx.doi.org/10.3390/jcm9041122DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7230394PMC
April 2020

Footprint Curvature in Spanish Women: Implications for Footwear Fit.

Int J Environ Res Public Health 2020 03 13;17(6). Epub 2020 Mar 13.

Instituto Centro de Investigación Operativa, Universidad Miguel Hernández de Elche. Crta. N 332 Km 8 s/n., 03550 Sant Joan d'Alacant (Alicante), Spain.

The incorrect adjustment of footwear produces alterations in the foot that affect quality of life. The usual measurements for shoe design are lengths, widths and girths, but these measures are insufficient. The foot presents an angle between the forefoot and the rearfoot in the transverse plane, which is associated with foot pronation, hallux valgus and metatarsus adductus. Here, we aimed at identifying the groups formed by the angulations between the forefoot and rearfoot using a sample of footprints from 102 Spanish women. The angle between the forefoot and rearfoot was measured according to the method described by Bunch. A cluster analysis was performed using the K-means algorithm. Footprints were grouped into three types: curved, semi-curved and straight, according to the degrees of angulation between the forefoot and rearfoot. There is great variability in the morphology of the foot. Based on our findings, to achieve a better footwear fit, we propose the manufacture of three types of lasts with different curvatures.
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http://dx.doi.org/10.3390/ijerph17061876DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7142565PMC
March 2020

Comparison of Lateral Abdominal Musculature Activation during Expiration with an Expiratory Flow Control Device Versus the Abdominal Drawing-in Maneuver in Healthy Women: A Cross-Sectional Observational Pilot Study.

Medicina (Kaunas) 2020 Feb 19;56(2). Epub 2020 Feb 19.

Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain.

The purpose of the present study was to quantify and compare lateral abdominal musculature thickness, including the transverse abdominis (TrA), internal oblique (IO), and external oblique (EO) muscles, via rehabilitative ultrasound imaging (RUSI) during the use of the expiratory flow control device (EFCD) versus the classic abdominal drawing-in maneuver (ADIM). A cross-sectional observational pilot study. Twenty-one women were recruited and assessed the thickness of each muscle (TrA, IO, and EO) by ultrasound imaging at rest, during the ADIM, and during expiration with the EFCD. Waist circumference was also measured under the same circumstances. Statistically significant differences were observed between ADIM, EFCD, and at rest condition for the thickness of the TrA ( = 0.001) and IO ( = 0.039). Moreover, statistically significant differences for TrAb at rest compared with the ADIM ( = 0.001, Cohen's = 2.183) and at rest and with the EFCD ( = 0.001, Cohen's = 2.843). In addition, between ADIM and EFCD were not statistically significant, although a moderate effect size was found ( = 0.055, Cohen's = 0.694). For the IO muscle thickness, significant differences were reported between the EFCD and at rest ( = 0.038), Cohen's = 0.081). Significant differences in the increase of the thickness of the TrA and IO muscles during the use of the EFCD and the ADIM with respect to rest. In addition, for the TrA, statistically significant differences were found during expiration with the EFCD with respect to the ADIM. Expiration with EFCD can be a useful method for the activation of the TrA.
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http://dx.doi.org/10.3390/medicina56020084DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7074045PMC
February 2020

Cross-Cultural Adaptation and Test-Retest Reliability of the Spanish ROWAN Foot Pain Assessment Questionnaire (ROFPAQ-S).

Pain Physician 2020 01;23(1):E1-E6

School of Nursing, Physiotherapy and Podiatry, Universidad Complutense de Madrid, Madrid, Spain.

Background: The ROWAN Foot Pain Assessment Questionnaire (ROFPAQ) may be considered as a self-reported health questionnaire with 45 items to measure foot health problems such as foot pain. To date, the ROFPAQ has only been validated into an English-language version.

Objectives: Therefore this study aim was to perform the cross-cultural adaptation and test-retest reliability of the Spanish ROFPAQ version (ROFPAQ-S).

Study Design: A cross-sectional descriptive study.

Settings: Podiatry and physiotherapy clinical centers.

Methods: The recommended forward/backward translation protocol was applied for the procedure of translation and cross-cultural adaptation from United Kingdom to Spain.

Results: An adequate internal consistency (Cronbach alpha) was shown for the 3 domains about cognitive (alpha = 0.763-0.792), affective (alpha = 0.751-0.801), and sensory (alpha = 0.741-0.733) subscales, as well as for the total score (alpha= 0.822-0.813). Good test-retest reliability by intraclass correlation coefficients (ICC [95% confidence interval]) was shown for the total score (ICC = 0.909 [0.850-0.944]), and each domain such as cognitive (ICC = 0.785 [0.648- 0.869]), affective (ICC = 0.995 [0.991-0.997]), and sensory (ICC = 0.662 [0.447-0.794]) subscales. The Spearman correlations (rs) were adequate for the cognitive (rs = 0.81-0.83), affective (rs = 0.73-0.72), and sensory (rs = 0.67-0.63) subscales.

Limitations: The original ROFPAQ was developed from a podiatry department of the health care national service.

Conclusions: The ROFPAQ-S was shown as a valid and reliable tool with an acceptable use in the Spanish population.

Key Words: Foot, quality of life, chronic pain, health impact assessment, validation studies.
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January 2020

Beneficial Effect of Foot Plantar Stimulation in Gait Parameters in Individuals with Parkinson's Disease.

Brain Sci 2020 Jan 27;10(2). Epub 2020 Jan 27.

Frailty and cognitive impairment organized group (FROG), University of Valencia, Valencia 46010, Spain.

New treatments based on peripheral stimulation of the sensory-motor system have shown to be promising in rehabilitation strategies for patients with neurological disorders, including Parkinson's disease (PD), especially in regards to reducing gait impairment, and hence, the incidence of falls. The aim of this study was to evaluate the change in several gait parameters measured by sensor inertial measurement in PD patients after acute plantar stimulation, under the distal phalanx of the big toe, and underneath the head of the first metatarsal joint of both feet, using a 3D printing insole. In order to assess whether the effects are selective for PD patients, we compared the effect of the treatment in a control group (age-matched) consisting of patients with other neurological disorders which also displayed gait and balance impairment, and a similar cognitive function, depressive symptoms, body mass index, and comorbidity burden observed in the PD group. Plantar foot stimulation in PD patients eliminated the significant ( < 0.05) alterations existing in stride asymmetry and in stride variability. When comparing the effects of post-plantar stimulation with the respective basal level, considered as 100% in both groups, we observed a significant ( = 0.019, Mann-Whitney test) increase in stride length compared to basal in the PD group and control group. No significant effects of foot plantar stimulation were observed in any of the gait parameters in the control group. Plantar foot stimulation has a positive effect on the step and stride length, and has a positive effect on walking stability, measured by the increase in stride length. No significant effect was observed on bradykinesia because it did not improve walking velocity. These findings indicate that foot plantar stimulation using a 3D printing insole seems to generate a more stable walking pattern in PD patients, with an interesting applicability, and a low-cost, for reducing gait impairment in PD patients.
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http://dx.doi.org/10.3390/brainsci10020069DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7071420PMC
January 2020

Quality of Life in Individuals with Diabetic Foot Syndrome.

Endocr Metab Immune Disord Drug Targets 2020 ;20(9):1365-1372

Department of Nursing, University of Valencia, Valencia, Spain

Background And Objective: Diabetic foot syndrome (DFS) is a common long-term complication of diabetes mellitus. DFS has recently been associated with adverse effects that could further impair the quality of life of diabetic patients, and increase the social and economic burden, morbidity, and premature mortality of the disease. The main physio-pathological basis of DFS is due to diabetesinduced neuropathy and angiopathy in the lower limbs and feet. Patients diagnosed with DFS must significantly modify their daily habits in order to cope with signs and symptoms of DFS and this can alter their quality of life. The objective of this review is to summarize the evidence regarding the economic, physical and social limitations which can affect the quality of life (QoL) in patients with DFS, the effects of ulcers and amputations on QoL outcomes.

Results: Different aspects related to DFS such as physical alterations, psychological complaints and even disorders, socio-economic difficulties can affect the quality of life of these patients. However, the QoL related to low socio-economic factors gave mixed results and physical activity, education and type of footwear can influence the outcomes. There is a general gender-dependent higher prevalence of DFS in men, although it depends on the geographical area. DFS often co-occurs with other diabetes-induced complications (retinopathy, nephropathy and cardiovascular disorders) and comorbid obesity generally worsens it.

Conclusion: Accessibility to health services aimed at reducing inequalities and constant health education and promotion and care regarding psychological and socio-economic issues should be continuously undertaken for individuals with DFS in order to improve their QoL.
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http://dx.doi.org/10.2174/1871530320666200128154036DOI Listing
January 2020

Reliability Study of Diagnostic Tests for Functional Hallux Limitus.

Foot Ankle Int 2020 04 29;41(4):457-462. Epub 2020 Jan 29.

Research, Health and Podiatry Group, Department of Health Sciences, Faculty of Nursing and Podiatry, Universidade da Coruña, Ferrol, Spain.

Background: Functional hallux limitus (FHL) refers to dorsiflexion hallux mobility limitation when the first metatarsal head is under loading conditions but not in the unloaded state. The goal of the study was to evaluate 3 common manual tests (Buell, Dananberg, and Jack tests) for assessing first metatarsophalangeal joint (MPJ) mobility and determining the normal values needed to detect FHL, and clarify the signs and symptoms associated with this pathology.

Methods: Forty-four subjects were included in this reliability study. Subjects were divided into healthy control (non-FHL) and FHL groups according to the Buell first MPJ limitation values in addition to signs and symptoms derived from the literature. In both groups, we measured the mobility in the Buell, Dananberg, and Jack tests using a goniometer; their intraclass correlation coefficients (ICCs), sensitivities, and specificity indexes were also calculated.

Results: All techniques showed high reliability across measurement trials with ICCs ranging from 0.928 to 0.999. The optimal mobility grades for predicting FHL were 68.6 ± 3.7 degrees, 21 ± 5.9 degrees, and 25.5 ± 6.5 degrees (mean±SD) ( < .05) for the Buell, Dananberg, and Jack tests, respectively.

Conclusion: Normal and limited mobility values were established for assessing FHL using each technique. The sensitivity and specificity data were perfect for the Dananberg and Jack tests, thus identifying these tests as specific and valid tools for use in FHL diagnosis. Pinch callus was the sign most associated with FHL.

Level Of Evidence: Level II, comparative series.
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http://dx.doi.org/10.1177/1071100719901116DOI Listing
April 2020

Predictive model to identify the risk of losing protective sensibility of the foot in patients with diabetes mellitus.

Int Wound J 2020 Feb 5;17(1):220-227. Epub 2019 Nov 5.

Department of Nursing, Faculty of Nursing and Podiatry, Frailty Research Organized Group, Universidad de Valencia, Valencia, Spain.

Diabetic neuropathy is defined as the presence of symptoms and signs of peripheral nerve dysfunction in diabetics. The aim of this study is to develop a predictive logistic model to identify the risk of losing protective sensitivity in the foot. This descriptive cross-sectional study included 111 patients diagnosed with diabetes mellitus. Participants completed a questionnaire designed to evaluate neuropathic symptoms, and multivariate analysis was subsequently performed to identify an optimal predictive model. The explanatory capacity was evaluated by calculating the R coefficient of Nagelkerke. Predictive capacity was evaluated by calculating sensitivity, specificity, and estimation of the area under the receiver operational curve. Protective sensitivity loss was detected in 19.1% of participants. Variables associated by multivariate analysis were: educational level (OR: 31.4, 95% CI: 2.5-383.3, P = .007) and two items from the questionnaire: one related to bleeding and wet socks (OR: 28.3, 95% CI: 3.7-215.9, P = .001) and the other related to electrical sensations (OR: 52.9, 95% CI: 4.3-643.9, P = .002), which were both statistically significant. The predictive model included the variables of age, sex, duration of diabetes, and educational level, and it had a sensitivity of 81.3% and a specificity of 95.5%. This model has a high predictive capacity to identify patients at risk of developing sensory neuropathy.
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http://dx.doi.org/10.1111/iwj.13263DOI Listing
February 2020

Neuro-Psychiatric Alterations in Patients with Diabetic Foot Syndrome.

CNS Neurol Disord Drug Targets 2019 ;18(8):598-608

Frailty and cognitive impairment organized group (FROG), University of Valencia, Valencia, Spain.

Diabetic Foot Syndrome (DFS) is a common long-term complication of diabetes mellitus. DFS has recently been associated with adverse effects on brain function which could further impair the quality of life of these patients, as well as increase the social and economic burden, morbidity, and premature mortality of the disease. The current knowledge of neuropsychiatric alterations e.g. cognitive impairment, gait disorder, depression, and quality of life in patients with diabetic foot syndrome is summarized. The cognitive domains altered in DFS are executive function, memory, and psychomotor speed. Compared to diabetic patients without DFS, individuals with DFS present gait alterations caused by changes in several spatio-temporal parameters and lower-limb kinematics. The increased rates of anxiety and depression among patients with DFS were related to several factors, including female sex, a smoking habit, age under 50 years, and foot ulceration exceeding 7 months' duration. The role of infections and the use of preventive antimicrobial treatment need further studies regarding their effect on comorbid neuropsychiatric disorders. The care of these patients should include the prevention, detection and treatment of these neuropsychiatric disorders in order to improve their quality of life.
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http://dx.doi.org/10.2174/1871527318666191002094406DOI Listing
October 2020

Effectiveness of Leukocyte and Platelet-Rich Fibrin versus Nitrofurazone on Nail Post-Surgery Bleeding and Wound Cicatrization Period Reductions: A Randomized Single Blinded Clinical Trial.

J Clin Med 2019 Sep 27;8(10). Epub 2019 Sep 27.

Research, Health and Podiatry Unit, Department of Health Sciences, Faculty of Nursing and Podiatry, Universidade da Coruña, 15403 Ferrol, Spain.

Leukocyte and platelet-rich fibrin (L-PRF) may be considered a co-adjuvant intervention that may play a key role in blood coagulation and tissue repair after nail surgeries. The aim of this study was to determine the effectiveness of L-PRF versus nitrofurazone on the post-surgical bleeding and wound cicatrization period in patients with bilateral onychocryptosis during surgeries of chemical matrixectomies with 88% phenol solution. A randomized single-blind clinical trial was registered with the European Clinical Trials Database (EudraCT) with identification number 2016-002048-18. Twenty healthy participants with bilateral onychocryptosis ( = 40) were recruited and bilaterally received both protocols for both halluces. Patients with a mean age mean of 45.55 ± 12.19 years attended a specialized foot and ankle surgery clinic. Both halluces of each patient were randomized and allocated to receive L-PRF (experimental group; = 20 halluces) or nitrofurazone (control group; = 20 halluces) interventions in conjunction with surgery of chemical matrixectomies with 88% phenol solution for bilateral ingrown of toenail border (medial and lateral). Patients were blinded to their intervention in each hallux. The primary outcome measurement was post-surgical bleeding. The secondary outcome measurements were post-surgical pain intensity, inflammation, infection, analgesic intake, and wound cicatrization period. Statistically significant differences ( < 0.001) were found between both groups showing a reduction for wound cicatrization period and post-surgical bleeding for the L-PRF intervention with respect to nitrofurazone treatment. The rest of the outcome measurements did not show any statistically significant differences ( > 0.05). L-PRF rather than nitrofurazone in conjunction with chemical matrixectomies performed with 88% phenol solution reduced the wound cicatrization period and bleeding after nail surgery. Thus, L-PRF may be considered a first-line co-adjuvant intervention for patients who suffer from nail problems, such as onychocryptosis, that require surgical procedures.
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http://dx.doi.org/10.3390/jcm8101552DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6832351PMC
September 2019

Fibularis tertius muscle in women & men: A surface anatomy cross-sectional study across countries.

PLoS One 2019 9;14(4):e0215118. Epub 2019 Apr 9.

Unidad de Investigación, Salud y Podología, Departamento de Ciencias de la Salud, Facultad de Enfermería y Podología, Universidade da Coruña, A Coruña, Spain.

The fibularis tertius muscle (FTM) is a rare anatomic variation. The prevalence of this exclusively human structure, which is found in the anterior compartment of the leg, is often underestimated, and it is believed that foot and ankle conditions are more difficult to manage in patients with an FTM. The aim of this study was to assess the presence of the FTM palpation and determine whether its presence is associated with an individual's sex, because the exact prevalence in males and females is unclear. An observational cross-sectional study was carried out. The study included 481 people (23.49% men and 76.51% women) with a mean age of 23.51±5.369 years, who were recruited from a Podiatric Medicine and Surgery Clinic (Spain). Data on routine demographic and clinical factors were recorded, and the presence or absence of the FTM was determined based on surface visual or palpated localization of the tendon (using a consistent protocol). The FTM was present in 38.25% (184/481) of the participants. Furthermore, FTM were present in 38.6% (142/481) of females and 37.2% (42/481) of males. The study revealed that the presence of the FTM varies between individuals and does not depend on an individual's sex. Significant differences in the prevalence of the FTM between countries should be carefully evaluated rather than generalizing the results of this Spanish study to other non-Spanish populations. Larger numbers of participants should be enrolled in future studies in order to meet the statistical criteria.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0215118PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6456249PMC
December 2019