The document summarizes a novel approach to offloading the distal digits of patients with diabetes using an extrinsic modification to custom molded insoles. It presents 4 case studies where the modification was used to successfully treat pre-ulcerative lesions, recurrent ulcerations, and blisters on the toes. The modification involves adding layers of cork and polypropylene to the insole to redistribute pressure away from contracted toes. This simple, reproducible approach helps reduce plantar pressures and supports healing in a less invasive way than surgery.
1) Diabetic foot ulcers are a major complication of diabetes and a leading cause of lower limb amputations. Physiotherapists play an important role in preventing and treating diabetic foot ulcers.
2) Proper foot care education, regular foot screening, management of deformities, prescription of appropriate footwear and orthoses, and therapeutic exercises are important physiotherapy interventions to prevent foot ulcers and support wound healing.
3) Splinting techniques like total contact casting are used to offload wounds and promote healing, while electrical stimulation and other modalities can help reduce pain and enhance healing. Regular assessment and individualized treatment are needed to manage the biomechanical and neurological factors underlying diabetic foot complications.
The human foot is a complex structure with 29 joints, 26 bones, and 42 muscles that has evolved to allow for bipedal locomotion. It acts as a mechanical lever and shock absorber to support the body's weight during walking and running. The foot contains longitudinal and transverse arches that help distribute pressure and protect soft tissues. As pressure is applied during walking, the heel, metatarsal heads, and ball of the big toe bear most of the body weight. Damage to the foot's arches from diabetic neuropathy can collapse the foot structure and lead to ulceration by disrupting this pressure distribution.
This document discusses foot biomechanics and pressures in diabetes patients. It explains that excessive mechanical pressure combined with loss of protective sensation is a major factor in diabetic foot ulcers. Abnormally high pressures typically occur under the metatarsal heads, which often correlates with ulcer sites. Additional factors that can increase pressure include limited joint mobility, foot deformities, and improper footwear. Direct measurement of plantar pressures is important for assessing risk of foot ulcers in diabetes patients.
ueda2012 predictors of diabetic foot ulcer-d.walaaueda2015
This document summarizes a study examining predictors of outcome for diabetic foot ulcers at Assiut University Hospital in Egypt. The study prospectively followed 100 patients with diabetic foot ulcers for up to one year to determine factors associated with complete healing within that time period. So far, data has been collected on 50 patients. Preliminary results found that 68% of patients were female, with a mean age of 50.76 years. Factors examined included demographics, medical history, foot examination findings, ulcer characteristics, and lab results. The aim is to identify baseline characteristics that can predict poorer outcomes like non-healing of the ulcer.
Osteoarthritis is a common degenerative joint disease that affects weight-bearing joints like the hips and knees. It is characterized by the breakdown of cartilage and formation of bone spurs. Risk factors include obesity, joint injury, genetics, and age. Patients experience pain, stiffness, and reduced mobility. Diagnosis is made clinically and via x-ray imaging. Treatment involves weight loss, exercise, medications like NSAIDs, and surgery for advanced cases. The goal of treatment is to reduce pain and improve joint function.
Dr EG Penserga discusses developments in hand osteoarthritis - from disease mechanisms to treatment propositions. Presented during the Joint RA OA SIG Symposium held at the F1 Hotel last 28 Nov 2014.
Musculoskeletal disorders
includes the following disorders:
Bone infections: Osteomyelitis, and Septic arthritis; Disorders of foot:
Hallux valgus (bunions), Morton’s neuroma (plantar neuroma), and
Hammer toe; Muscular disorders:
Muscular dystrophy, and Rhabdomyolysis
Predictors of the outcome of diabetic foot ulcer at Assiut university hospitalmhrsrs2011
This study aimed to identify predictors of poor outcome (non-healing) of diabetic foot ulcers at Assiut University Hospital. 100 patients with diabetic foot ulcers were prospectively followed for 1 year. Male sex, diabetes duration over 10 years, severe peripheral neuropathy, ulcer duration over 3 months, Wagner grade 3 ulcers, Texas grade 2D/3D ulcers, and ABI under 0.8 were found to independently predict non-healing of ulcers based on multivariate regression analysis. Baseline characteristics, foot examination findings, ulcer characteristics, and laboratory values of patients with healed versus unhealed ulcers after 1 year were also compared.
1) Diabetic foot ulcers are a major complication of diabetes and a leading cause of lower limb amputations. Physiotherapists play an important role in preventing and treating diabetic foot ulcers.
2) Proper foot care education, regular foot screening, management of deformities, prescription of appropriate footwear and orthoses, and therapeutic exercises are important physiotherapy interventions to prevent foot ulcers and support wound healing.
3) Splinting techniques like total contact casting are used to offload wounds and promote healing, while electrical stimulation and other modalities can help reduce pain and enhance healing. Regular assessment and individualized treatment are needed to manage the biomechanical and neurological factors underlying diabetic foot complications.
The human foot is a complex structure with 29 joints, 26 bones, and 42 muscles that has evolved to allow for bipedal locomotion. It acts as a mechanical lever and shock absorber to support the body's weight during walking and running. The foot contains longitudinal and transverse arches that help distribute pressure and protect soft tissues. As pressure is applied during walking, the heel, metatarsal heads, and ball of the big toe bear most of the body weight. Damage to the foot's arches from diabetic neuropathy can collapse the foot structure and lead to ulceration by disrupting this pressure distribution.
This document discusses foot biomechanics and pressures in diabetes patients. It explains that excessive mechanical pressure combined with loss of protective sensation is a major factor in diabetic foot ulcers. Abnormally high pressures typically occur under the metatarsal heads, which often correlates with ulcer sites. Additional factors that can increase pressure include limited joint mobility, foot deformities, and improper footwear. Direct measurement of plantar pressures is important for assessing risk of foot ulcers in diabetes patients.
ueda2012 predictors of diabetic foot ulcer-d.walaaueda2015
This document summarizes a study examining predictors of outcome for diabetic foot ulcers at Assiut University Hospital in Egypt. The study prospectively followed 100 patients with diabetic foot ulcers for up to one year to determine factors associated with complete healing within that time period. So far, data has been collected on 50 patients. Preliminary results found that 68% of patients were female, with a mean age of 50.76 years. Factors examined included demographics, medical history, foot examination findings, ulcer characteristics, and lab results. The aim is to identify baseline characteristics that can predict poorer outcomes like non-healing of the ulcer.
Osteoarthritis is a common degenerative joint disease that affects weight-bearing joints like the hips and knees. It is characterized by the breakdown of cartilage and formation of bone spurs. Risk factors include obesity, joint injury, genetics, and age. Patients experience pain, stiffness, and reduced mobility. Diagnosis is made clinically and via x-ray imaging. Treatment involves weight loss, exercise, medications like NSAIDs, and surgery for advanced cases. The goal of treatment is to reduce pain and improve joint function.
Dr EG Penserga discusses developments in hand osteoarthritis - from disease mechanisms to treatment propositions. Presented during the Joint RA OA SIG Symposium held at the F1 Hotel last 28 Nov 2014.
Musculoskeletal disorders
includes the following disorders:
Bone infections: Osteomyelitis, and Septic arthritis; Disorders of foot:
Hallux valgus (bunions), Morton’s neuroma (plantar neuroma), and
Hammer toe; Muscular disorders:
Muscular dystrophy, and Rhabdomyolysis
Predictors of the outcome of diabetic foot ulcer at Assiut university hospitalmhrsrs2011
This study aimed to identify predictors of poor outcome (non-healing) of diabetic foot ulcers at Assiut University Hospital. 100 patients with diabetic foot ulcers were prospectively followed for 1 year. Male sex, diabetes duration over 10 years, severe peripheral neuropathy, ulcer duration over 3 months, Wagner grade 3 ulcers, Texas grade 2D/3D ulcers, and ABI under 0.8 were found to independently predict non-healing of ulcers based on multivariate regression analysis. Baseline characteristics, foot examination findings, ulcer characteristics, and laboratory values of patients with healed versus unhealed ulcers after 1 year were also compared.
In the presentation, I discussed new concepts in OA pathogenesis and identified possible targets of treatment. This was followed by a review of new treatment options for osteoarthritis. Presented during the Joint RA OA SIG Symposium at the F1 Hotel last 28 November 2014.
La hernie du sportif : diagnostic et traitement, technique mini-ainvasive -Dr...VitamineB
La hernie du sportif : diagnostic et traitement, technique mini-invasive
Par le Docteur Ulrike MUSCHAWECK
Lors de la 1ère Journée Européenne de la pubalgie
Clinique du Sport Bordeaux Mérignac
This document discusses rheumatoid arthritis, including its clinical features, pathophysiology, assessment, diagnostic criteria, deformities, risk factors, goals of treatment, and physiotherapy management. Rheumatoid arthritis is an autoimmune disease characterized by joint inflammation and destruction, commonly affecting the small joints of the hands and wrists. Physiotherapy treatment includes heat/cold applications, TENS, massage, splinting and exercises to reduce pain, improve function and prevent further joint damage.
This document discusses the pathophysiology of the diabetic foot. It describes how sensory neuropathy, motor neuropathy, autonomic neuropathy, peripheral vascular disease, and infection can each contribute to the development of diabetic foot ulcers and complications. Specifically, it explains how loss of sensation, deformities, dry skin, reduced blood flow, repetitive stress or trauma to the feet, and poor wound healing in diabetes can lead to skin breakdown and ulcer formation over time if not properly managed.
A 13-year-old footballer presented with pain in both knees. Based on the history and physical examination findings, the patient likely has Osgood-Schlatter disease, a common knee condition in young athletes. This disease involves inflammation of the tibial tuberosity, a bony protrusion below the kneecap where the patellar tendon attaches. Conservative treatment including rest, ice, compression, elevation and medications is usually effective in relieving symptoms within 6-18 months. Surgery is rarely required.
This document describes a case report of a rare congenital anomaly called ulnar dimelia in a 1.5 year old male patient. Ulnar dimelia is characterized by double ulnae in the forearm, polydactyly, absence of the radius and thumb. The patient presented with restricted elbow and wrist movement and an unacceptable cosmetic appearance. Management would require multiple staged surgeries but the parents neglected further treatment after the initial visit. Ulnar dimelia results from imbalanced signals during embryonic development leading to abnormalities in the forearm, hand and digits. Surgical management aims to improve function and cosmesis but often requires several procedures and long-term follow up.
- Osteoarthritis can be diagnosed based on risk factors, symptoms, and physical exam findings.
- In deciding which drugs to use for osteoarthritis, factors like the joints involved, disease features, and comorbid conditions should be considered.
- Standard doses of NSAIDs provide comparable levels of analgesia for osteoarthritis, but safety must be the top priority given the potential cardiovascular and gastrointestinal risks.
This document discusses Osgood-Schlatter syndrome, which causes pain and swelling in the knee. It is caused by micro-tears in the growth plate of the shin where the patellar tendon attaches, due to excessive force from activities like running and jumping during periods of rapid bone growth in childhood. Symptoms include pain in the knee that is aggravated by activities like kneeling or jumping. Treatment focuses on rest, ice, stretching, and braces. Most cases resolve on their own within a year as the growth plate fuses.
Camptodactyly-arthropathy-coxa vara-pericarditis (CACP) syndrome is a genetic disorder caused by
mutation in the Proteoglyacn PRG4 gene on chromosome 1. The syndrome is characterized by congenital or early onset camptodactyly and childhood-onset of non-inflammatory arthropathy, coxa vara deformity,or other dysplasia associated with progressive hip disease and non-inflammatory pericardial effusion. It has an autosomal recessive mode of inheritance and the causative gene is located on chromosome band 1q25-31.
A 46-year-old man presented with severe pain in his right foot after playing basketball. Examination found tenderness over the base of the 5th metatarsal with decreased range of motion. X-ray revealed a non-displaced fracture of the 5th metatarsal tuberosity. The patient was diagnosed with a pseudo-Jones fracture and prescribed ice, analgesics, elevation, and follow up with orthopedics.
This document discusses various methods for quantitatively assessing peripheral neuropathy in patients with diabetes. It describes testing vibration perception thresholds using a vibratory instrument, as well as testing heat and cold perception thresholds using a device that applies controlled temperatures. Electrodiagnostic testing such as electromyography and nerve conduction studies are also mentioned as valuable but not always available or affordable methods. The importance of standardized, quantitative testing is discussed for accurately determining neuropathy severity and a patient's risk level.
This document provides an overview of rheumatoid arthritis including its clinical features, pathophysiology, diagnostic criteria, risk factors, goals of treatment, and physiotherapy management. Rheumatoid arthritis is an autoimmune disease characterized by inflammation of the joints causing cartilage destruction and bone erosion over time. It most commonly affects small joints in the hands and feet. Physiotherapy management focuses on reducing pain and inflammation, improving joint mobility and muscle strength, preventing deformities, and educating patients on home exercises. Treatment approaches include heat/cold therapy, TENS, range of motion exercises, splinting, and aquatic therapy.
Osteoarthritis is the most common form of articular disorder, affecting peripheral joints like the fingers, toes, hips and knees. It results from a complex interaction of mechanical, biological and biochemical factors that cause deterioration of hyaline cartilage and changes in subchondral bone. Symptoms include pain worsened by exercise and improved by rest, along with stiffness and reduced joint motion. Treatment focuses on reducing pain, improving function, and includes weight loss, exercise, medications, and sometimes surgery.
Physiotherapy management for rheumatoid arthritissenphysio
Rheumatoid arthritis is an autoimmune disease that causes chronic inflammation of the joints. It most commonly affects women and can lead to joint damage, deformity, and disability over time. Physiotherapy plays an important role in managing rheumatoid arthritis by providing pain relief, preventing deformities, improving flexibility and strength, and maintaining functional ability. Treatment involves heat/cold therapy, exercises, joint protection techniques, and alternative therapies to help reduce inflammation and preserve joint function. The goals of physiotherapy are to protect joints, relieve pain, and prevent disability through regular exercise and mobility work.
This document contains details about a 67-year-old male patient presenting with left knee pain for 8 years. His history, examinations, investigations and x-ray findings are consistent with primary osteoarthritis of the left knee. He is currently admitted for a planned left total knee replacement surgery to relieve his disabling knee pain. Osteoarthritis is a chronic joint condition involving cartilage breakdown and bone changes. Treatment involves non-pharmacological and pharmacological options, with surgery considered for severe cases not relieved by other measures.
2016: Osteoarthritis and Total Joint Replacement-MeyerSDGWEP
Osteoarthritis is a common chronic disease affecting over 27 million Americans that causes pain and limits mobility. While there is no cure, total joint replacement has become a highly successful treatment when conservative measures like exercise, weight loss, and medications fail to provide relief from severe osteoarthritis. Total joint replacements last many years for most patients, dramatically improving their quality of life. However, complications like infection can be devastating and revisions due to implant failure or dislocation are more difficult with poorer outcomes. Careful patient selection and preparation are important to achieve optimal results from total joint arthroplasty.
A 70-year-old female presented with bilateral knee pain diagnosed as osteoarthritis. She received four weeks of physical therapy involving exercises to increase strength and flexibility in the knees and hips. The therapy resulted in decreased pain, improved range of motion and strength. While progress was made, the patient required additional therapy to further improve functional strength.
The document presents a produced water treatment system with the main objective of removing oil from water. It includes produced water skim tanks to reduce oil content from 1000 ppm to 100 ppm, a skimmed oil vessel to collect removed oil, water injection tanks and pumps to inject treated water, and waste water ponds and equipment to handle excess produced water. Challenges mentioned include effective oil-water separation performance, operating within design limits, and preventing environmental pollution.
In the presentation, I discussed new concepts in OA pathogenesis and identified possible targets of treatment. This was followed by a review of new treatment options for osteoarthritis. Presented during the Joint RA OA SIG Symposium at the F1 Hotel last 28 November 2014.
La hernie du sportif : diagnostic et traitement, technique mini-ainvasive -Dr...VitamineB
La hernie du sportif : diagnostic et traitement, technique mini-invasive
Par le Docteur Ulrike MUSCHAWECK
Lors de la 1ère Journée Européenne de la pubalgie
Clinique du Sport Bordeaux Mérignac
This document discusses rheumatoid arthritis, including its clinical features, pathophysiology, assessment, diagnostic criteria, deformities, risk factors, goals of treatment, and physiotherapy management. Rheumatoid arthritis is an autoimmune disease characterized by joint inflammation and destruction, commonly affecting the small joints of the hands and wrists. Physiotherapy treatment includes heat/cold applications, TENS, massage, splinting and exercises to reduce pain, improve function and prevent further joint damage.
This document discusses the pathophysiology of the diabetic foot. It describes how sensory neuropathy, motor neuropathy, autonomic neuropathy, peripheral vascular disease, and infection can each contribute to the development of diabetic foot ulcers and complications. Specifically, it explains how loss of sensation, deformities, dry skin, reduced blood flow, repetitive stress or trauma to the feet, and poor wound healing in diabetes can lead to skin breakdown and ulcer formation over time if not properly managed.
A 13-year-old footballer presented with pain in both knees. Based on the history and physical examination findings, the patient likely has Osgood-Schlatter disease, a common knee condition in young athletes. This disease involves inflammation of the tibial tuberosity, a bony protrusion below the kneecap where the patellar tendon attaches. Conservative treatment including rest, ice, compression, elevation and medications is usually effective in relieving symptoms within 6-18 months. Surgery is rarely required.
This document describes a case report of a rare congenital anomaly called ulnar dimelia in a 1.5 year old male patient. Ulnar dimelia is characterized by double ulnae in the forearm, polydactyly, absence of the radius and thumb. The patient presented with restricted elbow and wrist movement and an unacceptable cosmetic appearance. Management would require multiple staged surgeries but the parents neglected further treatment after the initial visit. Ulnar dimelia results from imbalanced signals during embryonic development leading to abnormalities in the forearm, hand and digits. Surgical management aims to improve function and cosmesis but often requires several procedures and long-term follow up.
- Osteoarthritis can be diagnosed based on risk factors, symptoms, and physical exam findings.
- In deciding which drugs to use for osteoarthritis, factors like the joints involved, disease features, and comorbid conditions should be considered.
- Standard doses of NSAIDs provide comparable levels of analgesia for osteoarthritis, but safety must be the top priority given the potential cardiovascular and gastrointestinal risks.
This document discusses Osgood-Schlatter syndrome, which causes pain and swelling in the knee. It is caused by micro-tears in the growth plate of the shin where the patellar tendon attaches, due to excessive force from activities like running and jumping during periods of rapid bone growth in childhood. Symptoms include pain in the knee that is aggravated by activities like kneeling or jumping. Treatment focuses on rest, ice, stretching, and braces. Most cases resolve on their own within a year as the growth plate fuses.
Camptodactyly-arthropathy-coxa vara-pericarditis (CACP) syndrome is a genetic disorder caused by
mutation in the Proteoglyacn PRG4 gene on chromosome 1. The syndrome is characterized by congenital or early onset camptodactyly and childhood-onset of non-inflammatory arthropathy, coxa vara deformity,or other dysplasia associated with progressive hip disease and non-inflammatory pericardial effusion. It has an autosomal recessive mode of inheritance and the causative gene is located on chromosome band 1q25-31.
A 46-year-old man presented with severe pain in his right foot after playing basketball. Examination found tenderness over the base of the 5th metatarsal with decreased range of motion. X-ray revealed a non-displaced fracture of the 5th metatarsal tuberosity. The patient was diagnosed with a pseudo-Jones fracture and prescribed ice, analgesics, elevation, and follow up with orthopedics.
This document discusses various methods for quantitatively assessing peripheral neuropathy in patients with diabetes. It describes testing vibration perception thresholds using a vibratory instrument, as well as testing heat and cold perception thresholds using a device that applies controlled temperatures. Electrodiagnostic testing such as electromyography and nerve conduction studies are also mentioned as valuable but not always available or affordable methods. The importance of standardized, quantitative testing is discussed for accurately determining neuropathy severity and a patient's risk level.
This document provides an overview of rheumatoid arthritis including its clinical features, pathophysiology, diagnostic criteria, risk factors, goals of treatment, and physiotherapy management. Rheumatoid arthritis is an autoimmune disease characterized by inflammation of the joints causing cartilage destruction and bone erosion over time. It most commonly affects small joints in the hands and feet. Physiotherapy management focuses on reducing pain and inflammation, improving joint mobility and muscle strength, preventing deformities, and educating patients on home exercises. Treatment approaches include heat/cold therapy, TENS, range of motion exercises, splinting, and aquatic therapy.
Osteoarthritis is the most common form of articular disorder, affecting peripheral joints like the fingers, toes, hips and knees. It results from a complex interaction of mechanical, biological and biochemical factors that cause deterioration of hyaline cartilage and changes in subchondral bone. Symptoms include pain worsened by exercise and improved by rest, along with stiffness and reduced joint motion. Treatment focuses on reducing pain, improving function, and includes weight loss, exercise, medications, and sometimes surgery.
Physiotherapy management for rheumatoid arthritissenphysio
Rheumatoid arthritis is an autoimmune disease that causes chronic inflammation of the joints. It most commonly affects women and can lead to joint damage, deformity, and disability over time. Physiotherapy plays an important role in managing rheumatoid arthritis by providing pain relief, preventing deformities, improving flexibility and strength, and maintaining functional ability. Treatment involves heat/cold therapy, exercises, joint protection techniques, and alternative therapies to help reduce inflammation and preserve joint function. The goals of physiotherapy are to protect joints, relieve pain, and prevent disability through regular exercise and mobility work.
This document contains details about a 67-year-old male patient presenting with left knee pain for 8 years. His history, examinations, investigations and x-ray findings are consistent with primary osteoarthritis of the left knee. He is currently admitted for a planned left total knee replacement surgery to relieve his disabling knee pain. Osteoarthritis is a chronic joint condition involving cartilage breakdown and bone changes. Treatment involves non-pharmacological and pharmacological options, with surgery considered for severe cases not relieved by other measures.
2016: Osteoarthritis and Total Joint Replacement-MeyerSDGWEP
Osteoarthritis is a common chronic disease affecting over 27 million Americans that causes pain and limits mobility. While there is no cure, total joint replacement has become a highly successful treatment when conservative measures like exercise, weight loss, and medications fail to provide relief from severe osteoarthritis. Total joint replacements last many years for most patients, dramatically improving their quality of life. However, complications like infection can be devastating and revisions due to implant failure or dislocation are more difficult with poorer outcomes. Careful patient selection and preparation are important to achieve optimal results from total joint arthroplasty.
A 70-year-old female presented with bilateral knee pain diagnosed as osteoarthritis. She received four weeks of physical therapy involving exercises to increase strength and flexibility in the knees and hips. The therapy resulted in decreased pain, improved range of motion and strength. While progress was made, the patient required additional therapy to further improve functional strength.
The document presents a produced water treatment system with the main objective of removing oil from water. It includes produced water skim tanks to reduce oil content from 1000 ppm to 100 ppm, a skimmed oil vessel to collect removed oil, water injection tanks and pumps to inject treated water, and waste water ponds and equipment to handle excess produced water. Challenges mentioned include effective oil-water separation performance, operating within design limits, and preventing environmental pollution.
This document describes the process for fabricating a silicon integrated circuit. It begins with an overview of the basic steps, which include cleaning silicon wafers, oxidation, photolithography, etching, diffusion, thin film deposition, and testing. It then focuses on the specific process for fabricating a P-N junction diode, outlining 10 steps: cleaning, oxidation, photolithography, etching, diffusion, metal deposition, photolithography, etching, contact formation, and testing. Diagrams and descriptions are provided for each step in the P-N diode fabrication process.
Apache Drill: Building Highly Flexible, High Performance Query Engines by M.C...The Hive
SQL is one of the most widely used languages to access, analyze, and manipulate structured data. As Hadoop gains traction within enterprise data architectures across industries, the need for SQL for both structured and loosely-structured data on Hadoop is growing rapidly Apache Drill started off with the audacious goal of delivering consistent, millisecond ANSI SQL query capability across wide range of data formats. At a high level, this translates to two key requirements – Schema Flexibility and Performance. This session will delve into the architectural details in delivering these two requirements and will share with the audience the nuances and pitfalls we ran into while developing Apache Drill.
Industrial internet big data usa market studySari Ojala
The document discusses the industrial internet market validation study. It defines key terms like industrial internet, internet of things, big data, and internet of everything. The industrial internet involves integrating physical machinery with sensors and software to ingest and analyze machine data in real-time. There are several challenges to the industrial internet's adoption, including skills shortages, security concerns, and limited data analysis capabilities. However, the market size is immense, estimated at $29.8 trillion in global output affected. The outlook for Finnish companies in data analytics and visualization is positive given their expertise.
To learn more about the user experience design process, and how to evaluate a web design, you'll want to watch Matt Schleyer's presentation. During the session you'll learn: 1) Best practices in web design
2) Common mistakes in web design
3) The right questions to ask about an existing design, or a proposed design
4) The role evolving technology can --and should-- play on your site
Modern Art in Europe and the Americas 1900-1945smolinskiel
This document provides an overview of major art movements in Europe and the Americas from 1900-1945. It discusses Fauvism, Expressionism, Cubism, Futurism, Dada, De Stijl, Surrealism, and Art Deco. Key aspects covered include the optimism of the time period despite political and social upheaval, influential artists and patrons, and characteristics of each movement such as their use of color, form, and abstraction. Major works are cited from artists like Matisse, Picasso, Kandinsky, and others to illustrate styles and techniques.
Sensors, Wearables and the Internet of Things: A Revolution in the MakingMatt Turck
This document discusses the emerging field of sensors, wearables, and the Internet of Things. It describes how physical devices are increasingly being connected to networks and being able to both sense data and communicate. This represents a transition to the "Internet of Things" where not just computers and people but physical objects are part of the network. The document outlines several industries that will be impacted and technologies enabling this transition like mobile connectivity, open source platforms, and new applications across various verticals. It poses questions about what challenges may emerge as more of the physical world becomes networked and quantifiable.
The 5 most persuasive words in the English language are You, Free, Because, Instantly, and New. Using these power words in your digital marketing and social media updates can unlock huge potential.
And the list doesn't stop there. We found a huge selection of words that convert - 189 in total - to help you reach your audience with exclusivity, security, and impact.
Fractures and fracture dislocations of the tarsometatarsal jointMurugesh M Kurani
Here I have discussed an article from Journal of Bone and Joint Surgery. The presentation includes classification, treatment, results and complications. Lets share and learn.
This document discusses diabetic foot reconstruction. It begins by defining diabetic foot as a complex of diseases involving the skin, muscles or bones of the foot resulting from nerve damage, poor circulation or infection related to diabetes. Classification systems are discussed to facilitate treatment and monitoring of foot ulcers. Epidemiology data on diabetes and foot complications in Egypt is provided. Various surgical reconstruction techniques are described including revascularization procedures, wound debridement, negative pressure therapy, flap reconstruction using local, regional and free flaps, and microvascular surgery. Postoperative care and prevention strategies to reduce amputations through early detection and education are also summarized.
The document discusses the development and philosophy behind twin block therapy. It was developed in 1977 by Dr. William Clark to treat a patient with a class II malocclusion. The twin block uses occlusal inclined planes and proprioceptive stimulus to encourage mandibular growth. Details are provided on case selection, diagnosis, treatment planning, and bite registration techniques for twin block.
This study analyzed 15 cases of lower limb amputations performed at Kenyatta National Hospital in Kenya over a six-week period. The most common indication for amputation was diabetic foot gangrene, accounting for over half of cases. Elderly patients over 60 years old made up more than 30% of amputees due to diabetic gangrene of the foot. The study recommends increased patient education and counseling, as well as establishment of rehabilitation programs, to address the psychological and economic impact of amputations.
This study analyzed 252 knee replacement surgeries performed between 2008-2013 to determine surgical site infection rates. 10 patients (4%) developed superficial infections treated with antibiotics or debridement. 4 patients (1.6%) developed deep infections, with 1 acute infection treated with debridement and antibiotics. 3 patients developed delayed deep infections between 4 weeks to 2 years post-op, with 2 requiring revision surgery. Increased body mass index was the only risk factor significantly associated with higher superficial infection rates. Overall infection rates were comparable to literature reports for primary knee replacements.
Charcot case study and review questionsPodiatry Town
This 22-year old female with a history of type 1 diabetes and other conditions presented with swelling, redness, and warmth in her left foot and ankle over 3 days without pain or trauma. Physical exam found erythema and swelling in the right foot and ankle with diminished sensation. X-ray revealed acute charcot arthropathy. She was diagnosed with acute charcot arthropathy and treated with splinting, casting, and eventually a ankle foot orthosis to allow full weight bearing over several months.
Journal Club on Autologous blood injection for the treatment of recurrent tmj...Dr Bhavik Miyani
The document summarizes a journal club presentation on a study evaluating the effectiveness of autologous blood injection for the treatment of recurrent mandibular dislocation. The study included 11 patients with recurrent dislocation who underwent injection of their own blood into the temporomandibular joint. After a follow up period ranging from 24 to 35 months, 8 of the 11 patients (72.7%) did not experience further dislocation episodes. Autologous blood injection was found to be a simple, minimally invasive procedure for treating recurrent mandibular dislocation. However, more research with larger sample sizes and longer follow up periods is still needed.
The document discusses amputation, which is the surgical removal of a limb or extremity. It defines amputation and describes the various types including those for the legs and arms. It outlines the causes of amputation such as circulatory disorders, trauma, infection, tumors and congenital deformities. The document also discusses the surgical procedure for amputation, complications, nursing management both pre-and post-operatively, and the use of prosthetics to replace amputated limbs.
DIABETIC FOOT ULCER- / SURGICAL WOUNDS
#surgicaleducator #diabeticfootulcer #surgicaltutor #babysurgeon #usmle
• Dear Viewers,
• Greetings from “Surgical Educator”
• Today in this episode I have discussed Diabetic Foot Ulcer- DFU
• It is a complication of Type 2 Diabetes
• I have discussed about the overview, epidemiology, etiopathogenesis, clinical features, assessment, investigations, grading and treatment of Diabetic Foot Ulcer- DFU
• I hope this video is interesting and also useful to all of you
• You can watch the video in the following links:
• surgicaleducator.blogspot.com youtube.com/c/surgicaleducator
Neglected Tendo-Achilles Rupture Repair by Fhl Augmentation Using Bio-Screw a...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
This case report describes the orthodontic treatment of a 13-year-old female patient presenting with an open bite. After initial records and splint therapy, a new mounting revealed an open bite from the second molars bilaterally. The treatment plan involved four first bicuspid extractions, closure of extraction spaces, and intrusion of the upper molars using temporary anchorage devices. Over the course of 2 years, the open bite was corrected through space closure mechanics, intrusion of posterior teeth, and autorotation of the mandible. Careful case analysis and use of segmented models, extractions, and vertical control techniques resulted in a successful correction of the open bite.
This document provides guidance on clinical assessment of the diabetic foot. It outlines the importance of conducting a thorough historical review, physical examination, and footwear examination at every patient follow up visit. The physical examination should assess neurological symptoms, skin condition, deformities, nails, joints, and vascular status. Notable deformities include clawed toes, hammer toes, and pes cavus. Nail and skin conditions provide clues to neuropathy and vascular involvement. Joint flexibility is important to assess as well to prevent ulcer formation. A systematic examination incorporating historical review and physical assessment is necessary to fully evaluate the foot risk and guide preventative intervention.
This document provides information about frozen shoulder (adhesive capsulitis), including its causes, symptoms, diagnosis, treatment, and rehabilitation. It describes frozen shoulder as a condition causing stiffness and tightness in the shoulder joint capsule. There are typically three stages: freezing, frozen, and thawing. Risk factors include age over 40, female gender, diabetes, injury or trauma, and recent surgery. Symptoms are pain, stiffness, and difficulty moving the shoulder. Treatment involves hot/cold packs, TENS, gentle mobilization exercises, and physical therapy focused on maintaining range of motion. The pathology involves inflammation and fibrosis of the joint capsule and synovium. Diagnosis is made based on signs, symptoms, and imaging like x
Management of compound fracture tibia in children with titanium elastic nailsApollo Hospitals
Tibia fractures in the skeletally immature patient can usually be treated without surgery. The purpose of this study was to assess the use of flexible titanium nails in the open fracture tibia that requires operative stabilization.
This document describes a case of a patient with microstomia (reduced oral aperture) due to extensive post-surgical facial scarring. Standard impression techniques could not be used due to the small mouth opening. The dentists innovatively used impression compound on an articulator bite fork to create a preliminary impression, allowing for complete denture construction. The patient was ultimately satisfied with the functional and aesthetic outcome, though she continues to experience recurring skin cancers. The technique of using a bite fork with compound is recommended for similar microstomia cases where small stock trays do not fit.
Lipogranuloma of Hand Due to High Pressure Diesel Injurysemualkaira
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Similar to The Murphy Modification to Offload Ulceration Secondary to Digital Deformity (20)
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This document provides an overview of wound healing, its functions, stages, mechanisms, factors affecting it, and complications.
A wound is a break in the integrity of the skin or tissues, which may be associated with disruption of the structure and function.
Healing is the body’s response to injury in an attempt to restore normal structure and functions.
Healing can occur in two ways: Regeneration and Repair
There are 4 phases of wound healing: hemostasis, inflammation, proliferation, and remodeling. This document also describes the mechanism of wound healing. Factors that affect healing include infection, uncontrolled diabetes, poor nutrition, age, anemia, the presence of foreign bodies, etc.
Complications of wound healing like infection, hyperpigmentation of scar, contractures, and keloid formation.
2. Introduction
✤ Lifetime ulcer incidence: 25%
✤ Mortality post amputation: 13 to
40% at 1 year
✤ Quality of Life
✤ Economic Implications
✤ 1 in 10 health care dollars
The lifetime incidence of ulceration may be as high as 25%
Indeed, and the mortality rate post amputation at one year is between 13 to 40% and only increases
This can and does place a strain upon the quality of life; not only the physical health, but also mental health. How one perceives oneself. Social, family—can be a burden, economic.
American Diabetes association has a calculator, called the Diabetes Cost Calculator, which is readily available on its site. This calculator can estimate state by state the exact economic burden diabetes plays.
The statistics are from 2006, but still relevant.
2006 is estimated at $5,926,000,000 (FIVE BILLION, NINE HUNDRED AND TWENTY-SIX MILLION) DOLLARS IN THE STATE OF OHIO
MEDICAL COSTS OF $3,857,000,000 (THREE BILLION EIGHT HUNDRED AND FIFTY-SEVEN MILLION) DOLLARS
Lost productivity valued at $2,069,000,000 (TWO BILLION AND SIXTY-NINE MILLION) DOLLARS
Combined 10th, 11th, and 13th congressional districts: 1,163,600,000 (ONE BILLION ONE HUNDRED AND SIXTY-THREE MILLION SIX HUNDRED THOUSAND DOLLARS)
3. Objectives
✤ Elevated plantar pressures in the presence of diabetic peripheral
neuropathy increases ulceration risk
✤ Numerous conservative modalities have been employed to minimize
the risk
✤ Retrospective case series of 4 patients
✤ A novel approach to offload the distal digit with an extrinsic addition
to a custom molded insole (CMI)
Ulcerations in the diabetic foot are caused by a number of contributing factors, most significant being
peripheral neuropathy.
The inability to sense and to adjust to noxious stimuli can lead to tissue strain and eventual skin
breakdown over areas of high localized stress.
We present a retrospective case series of 4 patients with DM with digital plantar ulcerations in the presence
of mallet toe deformity
These patients underwent and extrinsic modification to a custom molded insole without surgical correction
4. Methods
Consists of two layers of 1/8” cork and 1/8” PPT glued together
The extrinsic offloading device consists of two layers of 1/8” cork and 1/8” PPT glued together
The materials used depended on the severity of the callus or ulceration--the more severe, the more memory material
required.
Steps in making this modification:
First, the callus or ulceration was traced upon the under-base of the insole
Next, with the 1/8” PPT, a U-shape was created around the affected toe with the material extended proximally to the
metatarsal head.
The length and width should be tapered, as not to affect the other toes or metatarsal heads
The 1/8” cork was added inferior to the PPT in the same manner.
5. Case 1
✤ 76yo NIDDM male
✤ June 2009
✤ Pre-ulcerative lesion
✤ February 2010
✤ Extrinsic modification
to CMI
In June of 2009, a 76yo NIDDM male presented for preventative foot care. The patient’s past medical history included a HgbA1c of 8, tobacco history of 1ppd for 40 years, peripheral neuropathy, venous
insufficiency, and previous non-healing ulceration with chronic osteomyelitis to the first metatarsophalangeal joint of the right foot.
His past surgical history included a recent partial first ray resection and vascular intervention to the right lower extremity.
Upon physical exam, the patient presented with the pre-ulcerative lesion to the distal tip of the right 2nd toe, secondary to a rigid mallet toe. The hyperkeratotic tissue was debrided and revealed an area of
underlying central hemorrhage. The patient was fitted with a silicone digital cap and reappointed for one month.
Again, on physical exam the pre-ulcerative lesion with central hemorrhaging was observed and the hyperkeratotic tissue was debrided.
Once again, the patient was fitted with a silicone digital cap and a crest pad was applied to the toe.
Over the course of sixth months, the patient returned for debridement of the pre-ulcerative lesion to the right second toe.
In February of 2010, offloading of the distal aspect of the right second toe was performed through the use of an extrinsic modification to the CMI.
After the modification was made to the plantar aspect of the right CMI, the patient was reappointed for one month.
6. Case 1
✤ At one month post-modification
✤ Decrease in hyperkeratotic
tissue
✤ At six months post-modification
✤ Area of pre-ulceration
remained healed
At one month, when this photograph was taken, a decrease in the amount
of hyperkeratotic tissue was observed with minimal debridement
necessary.
At two months post-modification, no hyperkeratotic tissue was detected.
At six months post-modification, the area of the pre-ulceration remained
healed and no new ulcerations upon physical examination.
7. Case 2
✤ 66yo IDDM male
✤ August 2010
✤ Recurrent ulceration
✤ Extra-depth shoes, CMIs, local
wound care
✤ Extrinsic modification
In early August of 2010, a 66 year-old IDDM male presented for follow up of a recurrent ulceration to the distal tip
of the left 3rd toe. The patient’s past medical history included a HgbA1C of 8.8, PAD, CAD, CHF, and morbid
obesity. Past pedal surgical history included a partial fifth ray resection of the right foot, partial first and second ray
resection of the left foot.
Over the previous year, treatment consisted of extra depth shoes, CMIs and local wound care that included
debridement.
Upon physical exam, a full-thickness ulceration was documented to the plantar left 3rd toe secondary to a rigid
mallet toe deformity. At this time, the wound was debrided of all hyperkeratotic tissue and the extrinsic modification
was made to offload the third digit.
8. Case 2
✤ One month post-modification
✤ Decreased in size and
thickness
9. Case 3
✤ 57yo IDDM male
✤ August 2010
✤ Blisters to 2nd and 3rd toes
✤ CMI extrinsic modification
In mid August 2010, a 57year-old IDDM male presented to the office with the complaint of
blisters to the distal 2nd and 3rd digits, right foot.
Pertinent past medical history included peripheral neuropathy, cataract, and four years prior, a
previously resolved ulceration to the right second digit.
Upon examination of the right foot, DIPJ contractures were noted as well as non-infected
superficial ulcerations to the distal 2nd and 3rd toes. Dry sterile dressings were applied and the
patient’s CMIs were modified to offload the contracted DIPJ of the 2nd and 3rd toes.
The patient was reappointed for three weeks, and upon examination, the superficial ulcerations
were fully healed.
11. Case 4
✤ 63yo NIDDM female
✤ October 2010
✤ Ulcer to 2nd toe
✤ CMI modification
In early October 2010, a 63 year old NIDDM female presented to the office with the complaint of
a wound to the distal toe after she trimmed her own toe nails.
Pertinent past medical history included peripheral neuropathy, hypertension, hyperlipidemia,
and previous amputation of the 3rd toe of the right foot.
Upon examination of the right foot, DIPJ contractures were noted as well as non-infected
superficial ulceration to the distal 2nd toes. Dry sterile dressings were applied and the patient’s
CMIs were modified to offload the contracted DIPJ of the 2nd toe.
12. Case 4
✤ Three weeks post-modification
✤ Fully healed
The patient was reappointed for three weeks, and upon examination, the
superficial ulcerations were fully healed.
14. Discussion
✤ Excessive plantar pressure
leads to tissue strain and
ulceration
✤ Limited joint mobility
✤ Changes shock absorption
and load of the foot
✤ Structural deformities
✤ Callus acts as noxious stimulus
Excessive plantar pressures can lead to tissue strain in the neuropathic foot and can lead to ulceration.
Although no set threshold of plantar pressures that would lead to ulceration, it has been suggested that as peak plantar pressures increase, the likelihood of ulceration increases as well.
Neuropathic ulcers develop at areas on the sole of the foot exposed to moderate to high repetitive stress. Over an extended period of time, this repetitive injury leads to inflammation, local ischemia, necrosis, and ulceration. Simply, when any
material, be it steel, bone, or skin, when placed under increased stress it will fatigue and fail.
Bus, Lott, and Boulton demonstrated that limited joint mobility and foot deformity are factors that contribute to heightened pressure and risk for ulceration. This was further reinforced by Mueller and Zimny’s respective papers, that a decrease in
joint mobility changes the dynamics in shock absorption and load placed upon the foot. Indeed, ankle and first MPJ mobility are reduced in the patient with diabetic neuropathy, which can lead to increased mechanical pressure on the forefoot
escalating the risk of ulceration.
Furthermore, deformities such as claw toes or mallet toes, predispose the foot to callus formation and transfer of load in the forefoot.
The deformity in combination with limited joint mobility amplifies the likelihood of callus formation and subsequent ulceration. Indeed, ulcerations to the neuropathicfoot often occur in areas of high stress and excessive callus formation. In works
by Bus, Pitei, and Young, the calluses, themselves, may act as a repetitive, noxious foreign stimulus and require routine debridement.
In this respect, our modification offloads those areas of increased mechanical stress and lessen; the callus buildup.
15. Conclusion
✤ CMI can reduce plantar pressures
✤ Footwear + CMIs = minimize pressure to the soft tissue structures
✤ Ashry et al. J Foot Ankle Surg, 1997:
✤ 5 to 15% reduction in peak plantar pressures of lesser toes
✤ Demonstrated a simple, novel and reproducible modification
Indeed, custom molded insoles can reduce plantar pressure and can result in ulcer healing; although, the literature in regards to
effectiveness is insufficient at best. The purpose of a CMI is to redistribute plantar pressure and weightbearing forces along the insole.
In combination with footwear, CMIs can minimize pressure to the soft tissue structures
Ashry and colleagues demonstrated a reduction in peak plantar pressures of the lesser toes by 5 to 15% in those treated with an insole
compared to only those treated with accommodative footwear.
Presented today, is a simple, novel and reproducible modification for diabetic insoles to offload pressure from the distal phalanges and
offer a limb preserving treatment option that is less invasive than surgical correction.
16. References
✤ Armstrong DG, Peters EJG, Athanasiou KA, Lavery LA. Is there a critical level of plantar foot pressure to identify patients at risk for neuropathic foot
ulceration? J Foot Ankle Surg. 1998;37(4):303-07.
✤ Ashry HR, Lavery LA, Murdoch DP, Frolich M, Lavery DC. Effectiveness of diabetic insoles to reduce foot pressures. J Foot Ankle Surg. 1997;36(4):
268-71.
✤ Burns J, Wegener C, Begg L, Vicaretti M, Fletcher J. Randomized trial of custom orthoses and footwear on foot pain and plantar pressure in diabetic
peripheralarterial disease. Diabet Med. 2009;26(9):893-9.
✤ Bus SA, Maas M, de Lange A, Michels RP, Levi M. Elevated plantar pressures in neuropathic diabetic patients with claw/hammer toe deformity. J
Biomech. 2005;38(9)1918-25.
✤ Bus SA. Foot structure and footwear prescription in diabetes mellitus. Diabetes Metab Res Rev. 2008; 24 (Suppl 1):S90-95.
✤ Bus SA, Valk GD, van Deursen RW, Armstrong DG, Caravaggi C, Hlavácek P, Bakker K, Cavanagh PR. The effectiveness of footwear and offloading
interventions to prevent and heal foot ulcers and reduce plantar pressure in diabetes: a systematic review. Diabetes Metab Res Rev. 2008;24 (Suppl
1):S162-80.
✤ Boulton AJ, Hardisty CA, Betts RP, Franks CI, Worth RC, Ward JD, Duckworth T. Dynamic foot pressure and other studies as diagnostic and
management aids in diabetic neuropathy. Diabetes Care. 1983;6(1):26-33.
✤ Ghanassia E, Boegner C, Villon L, Avignon A, Thuan dit Dieudonné JF, Sultan A. Long-term outcome and disability of diabetic patients hospitalized
for diabetic foot ulcers: a 6.5-year follow up study. Diabetes Care. 2008;31(7):1288-92.
17. References
✤ Frykberg RG, Lavery LA, Pham H, Harvey C, Harkless L, Veves A. Role of neuropathy and high foot pressures in diabetic foot ulceration. Diabetes
Care. 1998;21(10):1714-9.
✤ Lott DJ, Hastings MK, Commean PK, Smith KE, Mueller MJ. Effect of footwear and orthotic devices on stress reduction and soft tissue strain of the
neuropathic foot. Clin Biomech. 2007;22(3):352-9.
✤ Mueller MJ, Diamond JE, Delitto A, Sinacore DR. Insensitivity, limited joint mobility, and plantar ulcers in patients with diabetes mellitus. Phys Ther.
1989;9:453-62.
✤ Murray HJ, Young MJ, Hollis S, Boulton AJ. The association between callus formation, high pressures and neuropathy in diabetic foot ulceration.
Diabet Med. 1996;13)11):979-82.
✤ Pitei DL, Foster A, Edmonds M. The effect of regular callus removal on foot pressures. J Foot Ankle Surg. 1999;38(4):251-5.
✤ Singh N, Armstrong DG, Lipsky BA. Preventing foot ulcers in patients with diabetes. JAMA. 2005;293(2):217-28.
✤ Stockl K, Tafesse E, Vanderplas A, Chang E. Costs of lower-extremity ulcers among patients with diabetes. Diabetes Care. 2004;27(9):2129-34.
✤ Young MJ, Cavanagh PR, Thomas G, Johnson MM, Murray H, Boulton AJ. The effect of callus removal on dynamic plantar foot pressures in diabetic
patients. Diabet Med.1992;9(1):55-7.
✤ Zimny S, Schatz H, Pfohl M. The role of limited joint mobility in diabetic patients with an at-risk foot. Diabetes Care. 2004;27:942-46.