Foot drop is the inability to lift the front part of the foot. It can be caused by injuries or conditions that damage the common peroneal nerve. Symptoms include difficulty lifting the foot and dragging the toes. Treatment depends on the underlying cause but may include bracing, nerve stimulation, tendon transfers, or joint fusions. The goal is to improve mobility and gait.
Hoffa's Fracture: Diagnosis, management & New Classification System by BAGARI...Vaibhav Bagaria
Hoffa's Fracture - coronal split fracture of distal femur, its diagnosis, management strategy, a new classification and tips and tricks of management. First described Hoffa, a new classification system by Bagaria et al helps plan the surgery for these tricky fracture. The most crucial step is not to miss these fractures in ER.
As part of a class presentation, we attempted to make this to briefly explain what Torticollis meas, the Types of presentation of Torticollis, and Management strategies for a Physiotherapist for Congenital Torticollis especially.
I hope this helps. :)
The pictures and information had been taken from internet, complied to make a brief presentation for the purpose of class presentation.
I do not own any content.
Hoffa's Fracture: Diagnosis, management & New Classification System by BAGARI...Vaibhav Bagaria
Hoffa's Fracture - coronal split fracture of distal femur, its diagnosis, management strategy, a new classification and tips and tricks of management. First described Hoffa, a new classification system by Bagaria et al helps plan the surgery for these tricky fracture. The most crucial step is not to miss these fractures in ER.
As part of a class presentation, we attempted to make this to briefly explain what Torticollis meas, the Types of presentation of Torticollis, and Management strategies for a Physiotherapist for Congenital Torticollis especially.
I hope this helps. :)
The pictures and information had been taken from internet, complied to make a brief presentation for the purpose of class presentation.
I do not own any content.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
Contact us if you are interested:
Email / Skype : kefaya1771@gmail.com
Threema: PXHY5PDH
New BATCH Ku !!! MUCH IN DEMAND FAST SALE EVERY BATCH HAPPY GOOD EFFECT BIG BATCH !
Contact me on Threema or skype to start big business!!
Hot-sale products:
NEW HOT EUTYLONE WHITE CRYSTAL!!
5cl-adba precursor (semi finished )
5cl-adba raw materials
ADBB precursor (semi finished )
ADBB raw materials
APVP powder
5fadb/4f-adb
Jwh018 / Jwh210
Eutylone crystal
Protonitazene (hydrochloride) CAS: 119276-01-6
Flubrotizolam CAS: 57801-95-3
Metonitazene CAS: 14680-51-4
Payment terms: Western Union,MoneyGram,Bitcoin or USDT.
Deliver Time: Usually 7-15days
Shipping method: FedEx, TNT, DHL,UPS etc.Our deliveries are 100% safe, fast, reliable and discreet.
Samples will be sent for your evaluation!If you are interested in, please contact me, let's talk details.
We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
4. I. Traumatic:
• Tendon injuries to dorsiflexors of foot
• Neurogenic
A)At or below the level of common peroneal nerve
Direct injuries: incised and penetrating injuries
Fracture and dislocations:
Fracture of lateral condyle of tibia
Fracture/ dislocation of head/neck of fibula
Dislocation of knee
compound fracture of upper 1/3rd of tibia
4
Causes of Foot Drop
5. Iatrogenic :
High tibial skeletal traction
Tight plaster around knee
High tibial osteotomy
Total knee replacement
B) Above the level of common peroneal nerve
Fracture of shaft of femur
Posterior dislocation of hip
Deep intra muscular injection
PIVD
Spina bifida
If any cerebral tumors and space occupying lesions of
CNS
5
6. II. infective
• leprosy
• Poliomyelitis
Guillain-Barré Syndrome
• Syphilis
III. Metabolic:
• Diabetes mellitus
• Beri beri
• Alcoholic neuritis
IV. Exogenous toxin:
• Lead
• Arsenic
• Mercury
6
10. • Fasiculi of the peroneal nerve - larger and have
less connective tissue
• Fewer autonomic fibers, so in any injury, motor
and sensory fibers bear the brunt of the trauma.
• More superficial course, especially at the fibular
neck
• Adheres closely to the periosteum of the
proximal fibula
Vulnerability of Peroneal Nerve
11. • Cutaneous sensation is impaired over the lateral aspect
of the lower leg and ankle and dorsum of the foot.
• Reduced dorsiflexion and eversion of the foot and of
toe extension
– The patients will compensate by having a steppage gait.
• N.B Inversion and plantar flexion are normal.
Signs
12. • Progressive weakness of the peronei and
tibialis anterior muscles which result in foot
drop.
peroneus longus , tibialis anterior and the
extensor digitorum wasting
• N.B The paresis results in ankle weakness and
predispose to ankle sprains
13. • Difficulty in lifting the foot.
• Dragging the foot on the floor as one walks.
• Slapping the foot down with each step.
• Raising thigh while walking(stepping gait)
• Pain , weakness or numbness in the foot.
SYMPTOMS
14. Types of foot drop
• Type I – High
above the level of fibular head
deep peroneal nerve
• Type II- Low
below the level of fibular head
superficial peroneal nerve
15.
16. • High lesion : total foot drop
• Unable to dorsiflex and invert foot
• Able to do eversion
• Wasting of ant group of muscles
• Loss of sensation over the 1st web space
16
Clinical features of Type 1 foot drop
17. • Low lesion : incomplete foot drop
• Unable to do eversion
• Able to do dorsiflexion and inversion of the
foot
• Wasting of outer half of leg
• Sensation lost over outer leg and foot
17
Clinical features of type 2 foot drop
18. • Gait of foot drop gait is high stepping gait
• The patients lift the knee high and slaps the
foot to the ground on advancing to the
involved side
18
Gait of Foot Drop
19.
20.
21. X-Ray
Post-Traumatic - tibia/injuryfibula and ankle
- any bony.
Anatomic dysfunction (eg. Charcot joint)
• Ultrasonography
If bleeding is suspected in a patient with a
hip or knee prosthesis
• Magnetic Resonance Neurography
Tumor or a compressive mass lesion to
the peroneal nerve
DIAGNOSIS
22. – This study can confirm the type of neuropathy, establish
the site of the lesion, estimate extent of injury, and
provide a prognosis.
– Sequential studies are useful to monitor recovery of acute
lesions.
Electromyelogram
23. • Depends on the underlying cause.
• If cause is successfully treated foot drop
may improve or even disappear.
• Medical treatment - painful paresthesia
amitriptyline
nortriptyline
pregabalin
TREATMENT
24. • Assistive and adaptive devices and equipment.
– Canes, crutches, or walkers may be used to help
prevent falling, normalize gait patterns, or unload
a painful weight-bearing limb.
• Electrical Stimulation.
– Transcutaneous electrical nerve stimulation
(TENS) for the reduction or obliteration of pain.
25. • Positioning.
– Correct positioning of limb
• Protective Devices and Equipment eg splints,
orthoses
• Cryotherapy, massage
26. • Conservative treatment : shows high incidence
of recovery
• Splintage – splint knee in 20° of flexion and
ankle in 90° for night time
• In day time, walking is allowed by using ‘foot-
drop appliance’
• Varieties of foot drop appliances:
i) dynamic-spring shoe
ii) static- back stop shoe
26
Treatment
27. • Ankle foot orthotics (AFO)
-support the foot with light-weight leg braces
and shoe inserts
• Exercises
-strengthen the muscle, help to maintain
range of motion (ROM) and improve gait
• Electrical Functional Stimulations
-electrically stimulate the peroneal nerve
27
28.
29. Stimulating the nerve (peroneal nerve)
improves foot drop especially if it caused by a
stroke.
Nerve Stimulation
31. • Surgery – done if conservative management
fails
• Repairs or decompression of a damaged
nerve, fusion of the foot and ankle joint or
transfers tendons from stronger leg muscles
31
32.
33. SURGICAL MANAGEMENT
Points to be considered
age
i. Mobility of joints
ii. Availability of muscles and tendons for transfer
A. Soft tissue and muscle contractures
B. Bony changes
34. TENDON TRANSFER SURGERIES
• Objectives:
• Provide active motor power – paralysed
muscle
• Eliminate deforming effect of muscle-
antagonist paralysed
• Improve stability- muscle balance
35. PRINCIPLES
• Muscle
• transferred-strong—good/better
• Nerve and blood supply-not impaired
• Free end of tendon-
• close to insertion of paralysed muscle
• Retained in its own sheath/ another tendon
• Routed direct in line bet muscle origin and new insertion
• Contractures near the joint on which muscle acts- released
• Agonists> antagonists
• Tendon =range of excursion=one reinforcing /replacing
36. BARR’S TECHNIQUE
(anterior transfer of tibialis posterior)
• Classic- 2/3 cuniform; 2/3 metatarsal
• modified - cuboid
• ( tendon passed through ant interossois membrane)
• cast:
• long leg calcaneovalgus-foot
• >3weeks- B/K-
• foot-N ;ankle- DF
• >6WEEKS- remove cast-
• Rehabilitation
• 6 months- Double bar
• foot drop brace with an
• outside T STRAP
37. OBER’S TECHNIQUE
• ( tendon passed through ant comparment of leg)
• Classic- 2nd metatarsal
• HATTS modified obers- medial cuneiform
• Post op = barrs
38.
39. KAUFER’S PROCEDURE
( split transfer of tibialis post tendon)
• Incision-
• 1st- curvilinear- navicular tuberosity
• Extend-inf and post to medial malleolus
• Proximal- post midline over tendocalcaneus
• Tibialis Post –split longitudinally-plantar and dorsal
• Tendocalneus lengthening
• 2nd- tip of lateral malleolus-base of 5th metatarsal
• Peronius brevis- pass tendon carrier –proximally –just post to
lat malleolus- t.post tendon- foot in corrected position-
• t.post sutured to brevis under tension.
• Post op:
• long leg cast- 2months
• short leg cast – 2 months
40.
41. SRINIVASAN TECHNIQUE
( two tailed transfer of tibialis post)
• Position- supine –
• passive dorsiflexion of ankle- knee extension
• 1st-Short transverse incision- navicular-tibialis post endon
exposed
• Flexar retinaculum split
• 2nd-Medial aspect of L/3rd of leg-incision-FDL retracted-
tibialis post hooked up-split
• 3rd& 4th -2 curvilinear – dorsum of foot-
• medial- tendon of EHL-LOWER SLIP(anderson tunneler)
• Lateral- tendon of EDL- UPPER SLIP- laced up
42.
43. • Post op:
• B/K- foot in 70 deg dorsiflexion
• >3weeks- non-weight bearing reeducative exercises
• Bivalve POP cast- crutches
• 7th post op week- weight bearing
44. TENDO ACHILLIS LENGTHENING
WHITES TECHNIQUE: (open)
Posteromedial incision- expose tendocalcaneus
Long cast- knee extension ;ankle-dorsiflexion
1ST post op- weight bearing
Knee extension – 3weeks
Short leg- 3 weeks
AFO- ankle in neutral dorsiflexion
45.
46. • HAUSER TECHNIQUE:
• Posteromedial incision- expose tendocalcaneus
• Plantaris tendon- incised-beneficial
• Cast- mid thigh to toe
knee-full flexion; ankle-neutral dorsiflexion
skin blanching- little equinus (1st cast change-N)
>6WEEKS- AFO
47. PERCUTANEOUS LENGTHENING OF
TENDOCALCANEUS
• Position: prone
knee-E; ankle- DF
3 partial tenotomies
Heel-varus-2 incisions medially
valgus- 2 incisions laterally
After suregery Mx = White technique
48.
49. Semiopen sliding tenotomy of
tendocalcaneus
• Position-prone
• 2 long incision 2cm along the tendocalcaneus
• Plantaris tendon- tenotomy
• Post op-=Hauser technique
52. LAMBRINUDI ARTHRODESIS
• Indiactions:Isolated fixed equinus deformity
> 10 years
• CI: flail foot
hip& knee instability requiring brace
Lateral x-ray- ant subluxation of talus- 2 stage
plantar arthodesis
Complications-1. ankle instability
2.residual varus/valgus due to muscle imbalance
3.Pseudoarthrosis of talonavicular joint
53.
54. • S/R – 10-14 days
• Short leg cast- x –ray satisfactory
• Weight bearing- > 6weeks
• Short leg walking cast- fusion complete(3mon)
55. TRIPLE ARTHODESIS
• Most effective ; age > 12 years
• Subtalar-calcaneocuboid-talonavicular joints
• Indications: weakness and deformity of subtalar
& mid tarsal joints
stable& static realignment
remove deforming forces
arrest progression of deformity
Eliminate pain
eliminate use of short leg brace/ provide sufficient correction for
fitting long leg brace
obtain near normal correction of foot
After Rx: walk with crutches / walker
56.
57.
58.
59. CAMPBELLS post bone block
• Permits lengthening of tendocalcaneus & ankylosing both ankle and
subtalar joints
• Incision: medial and parallel to TA
• FHL retracted to capsule of ankle joint is exposed
• Post part of talus and articular surfaces of ankle and subtalar joints-
excised
• Ilium- large bony bridge across the ankle and subtalar joints
• post op:
ankle- plaster cast- A/K- foot at right angle
>4 weeks- boot cast ( snugly fitting)
full weight bearing delayed > 8-12 weeks
cast immobilisation- until fusion
walking on irregular surfaces difficult
60.
61. ANKLE ARTHODESIS
• BARR & BONE
• Severe paralytic equinus deformity in adults
• Subcutaneous plantar fasciotomy- lenthening
of TA – ankle arthodesis