Morton’s Neuroma;Surgical Exploration Is an Option in Symptomatic Patients with Normal Investigation

Morton neuroma is well described problem to metatarsophalangeal Joint (MTPJ) Etiology of Morton’s Neuroma which has wide range of problems from trauma, and nerve hypertrophy etc. Clinical evaluation is very important for diagnosis and sometimes investigations like ultrasound or MRI scan are helpful for conformation of diagnosis. Management varies from orthotics, shoe modification, injections or surgical excision. We are reporting a case which showed importance of surgical exploration when investigation is normal and difficulty in making diagnosis clinically.

Assessment of orthotic needs in Iranian veterans with ankle and foot disorders

Background: War-related traumas can lead to orthopedic and neurological disorders in victims. However, the scope of such disorders may expand months or even years after the trauma. Orthotic treatment as a rehabilitation process aims to enable people with disabilities to reach and maintain their optimal physical, sensory, intellectual, psychological, and social functional levels. This study aimed to investigate the rate of using orthoses among Iranian veterans with neuromuscular and skeletal disorders of the ankle and foot. Furthermore, the priorities of orthotic treatment in those veterans were explored.Methods: This qualitative study was a national health needs assessment conducted in 11 provinces of Iran during 2011–2016. A stakeholder research group was established to survey the veterans in respect to their demographic variables, activities of daily living, current health conditions, and rate of using orthoses.Results: Overall, 907 of the 1124 veteran participants completed the survey(response rate: 80.7%). Most of the veterans were men(97.7%), and their age and disability rate were 52.07±8.13 years and 31.92%±14.93%, respectively. Nearly 42% of the veterans had experience in using orthoses on a daily and weekly basis. As physical ambulation was the main problematic activity in veterans, most of them were using medical shoes and foot orthoses. Nearly 37% of veterans were in need of some type of lower limb orthoses on the contralateral side to compensate for their hip inequality. In sequential order, the most in need orthoses for veterans were foot orthoses(n=538), medical shoes(n=447), lower limb orthoses on the contralateral side(n=320), spinal orthoses(n=273), and upper limb orthoses(n=86).Conclusion: In spite of the high demands for orthoses among Iranian veterans with ankle and foot disorders, the use of orthoses is insufficient. Hence, there is a discrepancy between the current rate of orthoses use and its ideal situation, and more resources should be provided for service providers to be able to serve veterans. Moreover, veterans should be educated regarding orthoses, their use, and their impacts on the user's health status. The findings of a needs assessment of orthoses can be used in strategic planning and decision making to improve health care services for Iranian veterans.

The Role of Orthotic Service in Modern Rehabilitation of Patients with Charcot-Marie-Tooth Disease

Charcot-Marie-Tooth (CMT) disease, which encompasses several hereditary motor and sensory neuropathies, is one of the most common neuro-muscular disorders. 80% of patients having CMT disease are diagnosed with per cavus deformity. Orthosis is widespread and varies widely in forms. The paper arises the necessity of habilitation at the earliest possible stage as only a few patients use it. The meta-analysis of 412 scientific papers concerning this problem demonstrates the getting better gate, balance and the stopping CMT progression which is scientifically proven. It is also shown that patients with CMT use low prevalence of orthotics, and demonstrate low compliance of patients (for various reasons), high expectations from this habilitation technique.

Traumatic soft tissue defects:a perspective review on reconstruction and communication priorities from the orthopaedic trauma surgeon as a partner in care

Communication and coordination between orthopedic and plastic surgeons improve outcomes in severe extremity trauma.The“orthoplastics”approach to limb salvage incorporates priorities and skillsets from both fields.Prevention of infection,coordinated skeletal and soft tissue reconstruction,and communication during recovery and rehabilitation are key priorities.The purpose of this review is to describe the orthopedic trauma surgeon’s perspectives on lower extremity reconstruction,including initial management,techniques and timing for provisional and definitive skeletal reconstruction,and considerations for rehabilitation and orthotic use to optimize functional outcomes.

Clinical Observation of 3D Printing Technology in Insoles for Flexible Flatfoot Patients

Flatfoot is defined as the flattening of the medial arch of the foot,and it is classified into flexible flatfoot and rigid flatfoot based on whether the flattening of the medial arch of the foot can be reset when standing on toes.The insole is the most basic and common treatment,which is relatively cheaper and easier to adopt.Three-dimensional(3D)printing,an emerging technology characterized by high machining accuracy and use of various materials,can be utilised in personalised insoles,which have good application prospects.Further research on the clinical effects of 3D-printed insoles is still needed.In this study,64 cases of 3D-printed insoles were clinically observed.The results showed that 3D-printed insoles had statistically positive effects in treating flatfoot(P=0.00017),and with adjustment and adaptation,their comfort and clinical effect can be improved.This study provides an empirical reference for further large-scale clinical control research.