OBJECTIVE: To analyze radiological characteristics of Muller-Weiss disease, evaluate the clinical value of the imaging examination in diagnosis of Muller-Weiss disease. METHODS: The imaging data of 26 patients with Muller-Weiss disease were collected from September 2015 to August 2020, including 7 males and 19 females, aged 43 to 68 years old with an average of (52.7±4.6) years old. In the X-ray examination observed the shape and position of the navicular bone. The talar-first metatarsal angle(TFM) was measured on the weight-bearing anteroposterior radiograph. The arch angle and angle between mid-axis of talus and mid-axis of the first metatarsal(Meary angle) were measured on the weight-bearing lateral radiographs. The morphology, density, adjacent joint space and position of the navicular bone were evaluated by computed tomography(CT), and magnetic resonance imaging(MRI) was used to observe the shape, signal, cartilage and surrounding soft tissue changes of the navicular bone. RESULTS: Among 26 patients, 21 cases were unilateral and 5 cases were bilateral;X-ray examination showed that the lateral part of navicular bone of foot was compressed and flattened, showing"comma like"or"drop like", navicular moved to the medial side, partial fragmentation of bone, peripheral articular hyperplasia, uneven density and narrowing of relationship gap. According to Meary angle and deformity degree of the affected foot on the lateral X-ray of the load-bearing foot, Maceira staging was performed. There were 0 cases in stageⅠ, 2 cases in stage Ⅱ, 11 cases in stage Ⅲ, 9 cases in stage Ⅳand 4 cases in stage Ⅴ. CT examination showed bone fragmentation, medial displacement of navicular bone and formation of the talocalcaneal joint. MRI examination showed the irregular shape and uneven signal of navicular bone, narrowing of joint space, talocalcaneal joint surface hyperplasia and cartilage destruction, tarsal joint effusion and swelling of surrounding soft tissue. CONCLUSION Muller-Weiss disease has specific imaging manifestation, and an accurate diagnosis can be made based on the patient's age, gender, and clinincal history. Preoperative imaging examination can stage the disease, help clinicians to formulate better surgical plans, and postoperative imaging examination can better evaluate the surgical effect.
Adult ; Aged ; Bone Diseases/diagnostic imaging* ; Cartilage Diseases ; Female ; Foot Diseases/diagnostic imaging* ; Humans ; Hyperplasia/pathology* ; Male ; Middle Aged ; Talus/pathology* ; Tarsal Bones/surgery* ; Tarsal Joints

BACKGROUND AND PURPOSE: GNE myopathy is a rare progressive myopathy caused by biallelic mutations in the GNE gene, and frequently accompanied by rimmed vacuoles in muscle pathology. The initial symptom of foot drop or hip-girdle weakness eventually spreads to all limbs over a period of decades. Recent advances in pathophysiologic research have facilitated therapeutic trials aimed at resolving the core biochemical defect. However, there remains unsettled heterogeneity in its natural course, which confounds the analysis of therapeutic outcomes. We performed the first large-scale study of Korean patients with GNE myopathy. METHODS: We gathered the genetic and clinical profiles of 44 Korean patients with genetically confirmed GNE myopathy. The clinical progression was estimated retrospectively based on a patient-reported questionnaire on the status of the functional joint sets and daily activities. RESULTS: The wrist and neck were the last joints to lose antigravity functionality irrespective of whether the weakness started from the ankle or hip. Two-thirds of the patients could walk either independently or with an aid. The order of losing daily activities could be sorted from standing to eating. Patients with limb-girdle phenotype showed an earlier age at onset than those with foot-drop onset. Patients with biallelic kinase domain mutations tended to progress more rapidly than those with epimerase and kinase domain mutations. CONCLUSIONS: The reported data can guide the clinical management of GNE myopathy, as well as provide perspective to help the development of clinical trials.
Age of Onset ; Ankle ; Disease Progression ; Eating ; Extremities ; Foot ; Hip ; Humans ; Joints ; Muscular Diseases ; Muscular Dystrophies, Limb-Girdle ; Neck ; Pathology ; Phenotype ; Phosphotransferases ; Population Characteristics ; Retrospective Studies ; Surveys and Questionnaires ; Vacuoles ; Wrist

This study describes five bilateral anatomical variations in the feet of a 97-year-old male cadaver. Following routine dissection, all variants were measured and documented. Three accessory tendons and two accessory ossicles were identified. Bilateral accessory tendons were present from the tibialis anterior (type II), peroneus tertius (type III), and peroneus brevis muscles. Accessory tendon length was 36–104 mm and width was 1–3 mm each inserting more distally then the main tendon. Accessory ossicles were identified as an accessory navicular and os peroneum, respectively. Individually, each variation has varying prevalence rates in the literature, but to date, no known studies have been published describing the combined presence of all five bilateral variations. The acknowledgement of multi-variant cases such as this one may be helpful in the clinical setting, particularly for patients with pathology or for those undergoing foot and ankle surgery.
Ankle ; Cadaver ; Foot ; Humans ; Male ; Muscles ; Pathology ; Prevalence ; Tendons

Adult ; Asian Continental Ancestry Group ; Biopsy, Needle ; Disease Progression ; Erythema ; complications ; physiopathology ; Female ; Foot Dermatoses ; complications ; diagnosis ; pathology ; Hand Dermatoses ; complications ; diagnosis ; pathology ; Humans ; Immunohistochemistry ; Pemphigus ; diagnosis ; pathology ; Prognosis ; Pruritus ; complications ; physiopathology ; Rare Diseases ; Singapore ; Syndrome

Gout occurs mainly in monoarthritis and is found in more than 50% of cases in hallux of the foot. In addition, symptoms sometimes begin in the hand, wrist, and elbow, but they are rarely observed in the spine. The patient was referred for tuberculous polyarthritis due to antituberculosis drug failure. Inflammatory findings were observed in the lumbar, elbow, wrist, hand and foot areas. Surgery was performed on the foot area and a pathology diagnosis revealed gouty arthritis. We report this case with a review of the relevant literature.
Arthritis* ; Arthritis, Gouty* ; Diagnosis ; Elbow ; Foot ; Gout ; Hallux ; Hand ; Humans ; Pathology ; Spine ; Wrist

BACKGROUND: The use of three-dimensional multi-segment foot models (3D MFMs) is increasing since they have superior ability to illustrate the effect of foot and ankle pathologies on intersegmental motion of the foot compared to single-segment foot model gait analysis. However, validation of the repeatability of the 3D MFMs is important for their clinical use. Although many MFMs have been validated in normal adults, research on MFM repeatability in children is lacking. The purpose of this study is to validate the intrasession, intersession, and interrater repeatability of an MFM with a 15-marker set (DuPont foot model) in healthy children. METHODS: The study included 20 feet of 20 healthy children (10 boys and 10 girls). We divided the participants into two groups of 10 each. One group was tested by the same operator in each test (intersession analysis), while the other group was tested by a different operator in each test (interrater analysis). The multiple correlation coefficient (CMC) and intraclass correlation coefficient (ICC) were calculated to assess repeatability. The difference between the two sessions of each group was assessed at each time point of gait cycle. RESULTS: The intrasession CMC and ICC values of all parameters showed excellent or very good repeatability. The intersession CMC of many parameters showed good or better repeatability. Interrater CMC and ICC values were generally lower for all parameters than intrasession and intersession. The mean gaps of all parameters were generally similar to those of the previous study. CONCLUSIONS: We demonstrated that 3D MFM using a 15-marker set had high intrasession, intersession, and interrater repeatability in the assessment of foot motion in healthy children but recommend some caution in interpreting the hindfoot parameters.
Adult ; Ankle ; Child* ; Foot* ; Gait ; Humans ; Pathology

OBJECTIVETo investigate the myocardial protective effect of L-carnitine in children with hand, foot and mouth disease (HFMD) caused by Coxsackie A16 virus and possible mechanisms.

METHODSA total of 60 HFMD children with abnormal myocardial enzyme after Coxsackie A16 virus infection were enrolled and randomly divided into L-carnitine group and fructose-1,6-diphosphate group (fructose group), with 30 children in each group. The two groups were given L-carnitine or fructose diphosphate in addition to antiviral and heat clearance treatment. Another 30 healthy children who underwent physical examination were enrolled as control group. The changes in myocardial zymogram, malondialdehyde (MDA), superoxide dismutase (SOD), and apoptosis factors sFas and sFasL after treatment were compared between groups.

RESULTSThere was no significant difference in treatment response between the L-carnitine group and the fructose group (P>0.05). One child in the fructose group progressed to critical HFMD, which was not observed in the L-carnitine group. Before treatment, the L-carnitine group and the fructose group had significantly higher indices of myocardial zymogram and levels of MDA, sFas, and sFasL and a significantly lower level of SOD than the control group (P<0.05), while there were no significant differences in these indices between the L-carnitine group and the fructose group (P>0.05). After treatment, the L-carnitine group and the fructose group had significant reductions in the indices of myocardial zymogram and levels of MDA, sFas, and sFasL and a significant increase in the level of SOD (P<0.05); the fructose group had a significantly higher level of creatine kinase (CK) than the control group and the L-carnitine group, and there were no significant differences in other myocardial enzyme indices, MDA, sFas, and sFasL between the L-carnitine group and the fructose group, as well as between the L-carnitine and fructose groups and the control group (P>0.05). SOD level was negatively correlated with aspartate aminotransferase, lactate dehydrogenase (LDH), CK, and creatine kinase-MB (CK-MB) (r=-0.437, -0.364, -0.397, and -0.519 respectively; P<0.05), and MDA level was positively correlated with LDH and CK-MB (r=0.382 and 0.411 respectively; P<0.05).

CONCLUSIONSL-carnitine exerts a good myocardial protective effect in children with HFMD caused by Coxsackie A16 virus, possibly by clearing oxygen radicals and inhibiting cardiomyocyte apoptosis.

Carnitine ; therapeutic use ; Child, Preschool ; Coxsackievirus Infections ; complications ; Female ; Hand, Foot and Mouth Disease ; drug therapy ; etiology ; metabolism ; Heart ; drug effects ; Humans ; Infant ; Male ; Malondialdehyde ; analysis ; Myocardium ; metabolism ; pathology ; Superoxide Dismutase ; metabolism

Orthostatic or postural proteinuria is the most common cause of asymptomatic proteinuria in children. As orthostatic proteinuria (OP) is a benign disease with relatively good prognosis, it has no specific management, and patients only need to be observed. However, if OP shows a persistently high level of proteinuria, in theory, glomerular changes can occur. An 11-year-old girl was referred to the hospital due to asymptomatic proteinuria and was diagnosed as having OP based on the results of clinical and laboratory examinations, urinalysis, and protein/creatinine (TP/Cr) ratio at both supine and erect positions. During follow-up observation, the 24-hour TP/Cr ratio was persistently higher than 1.5 mg/mg for 2 years. We performed renal biopsy, which showed mesangial proliferative glomerular lesions with focal effacement of the podocyte foot processes, but without immune depositions. OP can be accompanied by glomerular lesions if moderate to severe proteinuria persists.
Biopsy ; Child ; Female ; Follow-Up Studies ; Foot ; Glomerulonephritis ; Humans ; Pathology* ; Podocytes ; Prognosis ; Proteinuria* ; Urinalysis

Orthostatic or postural proteinuria is the most common cause of asymptomatic proteinuria in children. As orthostatic proteinuria (OP) is a benign disease with relatively good prognosis, it has no specific management, and patients only need to be observed. However, if OP shows a persistently high level of proteinuria, in theory, glomerular changes can occur. An 11-year-old girl was referred to the hospital due to asymptomatic proteinuria and was diagnosed as having OP based on the results of clinical and laboratory examinations, urinalysis, and protein/creatinine (TP/Cr) ratio at both supine and erect positions. During follow-up observation, the 24-hour TP/Cr ratio was persistently higher than 1.5 mg/mg for 2 years. We performed renal biopsy, which showed mesangial proliferative glomerular lesions with focal effacement of the podocyte foot processes, but without immune depositions. OP can be accompanied by glomerular lesions if moderate to severe proteinuria persists.
Biopsy ; Child ; Female ; Follow-Up Studies ; Foot ; Glomerulonephritis ; Humans ; Pathology* ; Podocytes ; Prognosis ; Proteinuria* ; Urinalysis

This study aimed to investigate factors affecting length of hospital stay and mortality of a specific group of patients with infected diabetic foot ulcer who underwent surgical drainage without major amputation, which is frequently encountered by orthopedic surgeons. Data on length of hospital stay, mortality, demographics, and other medical information were collected for 79 consecutive patients (60 men, 19 women; mean age, 66.1 [SD, 12.3] yr) with infected diabetic foot ulcer who underwent surgical drainage while retaining the heel between October 2003 and May 2013. Multiple linear regression analysis was performed to determine factors affecting length of hospital stay, while multiple Cox regression analysis was conducted to assess factors contributing to mortality. Erythrocyte sedimentation rate (ESR, P=0.034), glycated hemoglobin (HbA1c) level (P=0.021), body mass index (BMI, P=0.001), and major vascular disease (cerebrovascular accident or coronary artery disease, P=0.004) were significant factors affecting length of hospital stay, whereas age (P=0.005) and serum blood urea nitrogen (BUN) level (P=0.024) were significant factors contributing to mortality. In conclusion, as prognostic factors, the length of hospital stay was affected by the severity of inflammation, the recent control of blood glucose level, BMI, and major vascular disease, whereas patient mortality was affected by age and renal function in patients with infected diabetic foot ulcer undergoing surgical drainage and antibiotic treatment.
Aged ; Amputation ; Blood Sedimentation ; Blood Urea Nitrogen ; Body Mass Index ; Diabetic Foot/mortality/*pathology/*surgery ; Drainage ; Female ; Hemoglobin A, Glycosylated/analysis ; Humans ; Length of Stay ; Male ; Middle Aged ; Proportional Hazards Models ; Retrospective Studies ; Risk Factors ; Severity of Illness Index ; Survival Rate ; Vascular Diseases/complications