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Chronic Painless, Multiple Papulo-Nodular Skin Lesion at Foot Resembles Mycetoma Infection (Madura Foot): A Case Report

Bahar Moni AS, Hoque MM

Int J Low Extrem Wounds, 2023 Sep;22(3):616-619.
PMID: 34223771 DOI: 10.1177/15347346211030753

Madura foot is a chronic, progressively destructive bacterial or fungal infection of the subcutaneous tissues, which may affect skin, muscle, and bone. It is endemic in tropical and subtropical areas known as the "Mycetoma belt" between latitude 30°N and 15°S. Mycetoma is prevalent in the poor population living in remote areas of developing countries that lack proper reporting system and management. The World Health Organization recognized mycetoma as a neglected tropical disease back in 2016. Though the diagnosis is challenging, early detection and proper treatment can reduce morbidity and provide a promising outcome. We report a case of chronic painless, multiple papulo-nodular skin lesions at the foot that resembles mycetoma infection which was detected early and recovered with a satisfactory outcome with proper treatment.

Matched MeSH terms: Foot
Fulltext The physiological, biochemical and quality of life changes in chronic diabetic foot ulcer after hyperbaric oxygen therapy

Mohd Yazid, B., Ayesyah, A., Mohd Rohaizat, H., Nurhanani, A. B.

Medicine & Health, 2017;12(2):210-219.
MyJurnal

Hyperbaric oxygen therapy (HBOT) was established to increase oxygenation and antimicrobial effect that potentially improve the healing of chronic ulcer. Present study aim to assess the effects of HBOT in chronic diabetic foot ulcer (DFU). A total of sixty patients classified according to Wagner 1, 2 or 3 chronic diabetic foot ulcers, were recruited and subsequently divided randomly into two groups; HBOT and control group. All patients underwent the standard treatment for DFU, but for the HBOT group, underwent 20 HBOT sessions, each lasted 80 – 90 mins at 2.5 atmospheres absolute (ATA). White cell count (WCC) and C-reactive protein (CRP) levels were taken during inclusion, at second and fourth week of treatment. Wound sizes were documented at each follow up until six months follow up. SF-36 at one-month post hyperbaric oxygen therapy was used to measure the health-related quality of life. Reduction of WCC and CRP in HBOT group were significant throughout the treatment (p=0.046 and p=0.039, respectively). A total of 26 patients (86.7%) from the HBOT group achieved complete ulcer healing at six months’ follow-up, while 18 patients (60%) in the control group’s ulcer healed completely. Patients treated with HBOT had significantly better mental and physical health constituent of quality of life. It must be emphasised that HBOT is an adjunctive therapy to the standard management of chronic DFU in accelerating wound healing for a better quality of life.
Keywords: oxygenation, quality of life, wound healing

Matched MeSH terms: Foot Ulcer*; Diabetic Foot*
Feet in Malaya

Monro JK

Journal of the Malaya Branch of the British Medical Association, 1941;5:1-8.

Matched MeSH terms: Clubfoot; Flatfoot; Foot; Foot Deformities; Foot Diseases
Fulltext The psychological impact of diabetic limb problems

Bahari R

International Medical Journal Malaysia, 2015;14(2):3-8.
MyJurnal

Limb problem is a common complication for patients with diabetes. While the impact of diabetic limb problems
on physical health is well known, the psychological impact of the condition is still largely unknown. People with
diabetes with or without foot ulcers frequently suffer from major depressive disorder, and this is made worse
by the presence of limb complications. Furthermore, depression itself can have negative consequences on the
person’s diabetes. Hence, in caring for people with diabetic foot problem, the psychological sequelae must not
be overlooked but managed accordingly

Matched MeSH terms: Foot; Foot Ulcer; Diabetic Foot
Bilateral pedal gangrene of unknown aetiology

SAID M

Med J Malaya, 1954 Mar;8(3):263-6.
PMID: 13164697
Matched MeSH terms: Foot*
Fulltext Clinical Factors affecting Minor Amputation in Diabetic Foot Disease at Tengku Ampuan Afzan Hospital, Kuantan

Zakaria Z, Afifi M, Sharifudin MA

Malays J Med Sci, 2015 Mar-Apr;22(2):41-7.
PMID: 26023294 MyJurnal

Diabetic foot disease poses a substantial problem in Malaysian diabetic population. We evaluate the clinical factors affecting minor amputation in diabetic foot disease.

Matched MeSH terms: Foot Diseases; Diabetic Foot
Fulltext Compartment syndrome of the foot in a child

Sharma AK, Sharaf I, Ajay S

Med J Malaysia, 2001 Jun;56 Suppl C:70-2.
PMID: 11814254

We report a case of a 12-year-old boy with acute compartment syndrome of the foot following a road-traffic accident. Due to the rarity of the injury, there was a delay in diagnosing the injury. An emergency fasciotomy was performed 19 hours after the injury. The foot healed with a mild extension contracture of the second toe.

Matched MeSH terms: Foot Diseases/pathology*; Foot Diseases/radiography*; Foot Diseases/surgery
Fulltext Are diabetic foot lesions precipitated by accidental trauma?

Doshi HK, Moissinac K, Harwant S

Med J Malaysia, 2001 Dec;56 Suppl D:29-33.
PMID: 14569763

Diabetic foot lesions may arise from frictional trauma due to tight or inappropriate footwear, repetitive stresses on parts of the foot, overlying bony prominence generated by walking and accidental trauma to the neuropathic foot. Many diabetics have been found to be unaware of their foot lesion, or know what the precipitating cause was. Based on the assumption that accidental trauma would affect the foot in a random fashion and result in lesions distributed evenly throughout the foot, a study was performed to determine whether foot lesions were distributed evenly or concentrated to certain areas of predilection. It was found that foot lesions were not evenly distributed but concentrated to certain areas of predilection. Even though relatively high proportion of the study population walked about in open slippers and barefeet, the study showed that accidental trauma was not a predominant precipitant of diabetic foot lesions. Diabetic foot lesions tend to occur as a result of cumulative, repetitive trauma to areas of prediliection rather than accidental trauma.

Matched MeSH terms: Diabetic Foot/etiology*; Foot Injuries/complications*
Fulltext Innovative intelligent insole system reduces diabetic foot ulcer recurrence at plantar sites: a prospective, randomised, proof-of-concept study

Abbott CA, Chatwin KE, Foden P, Hasan AN, Sange C, Rajbhandari SM, et al.

Lancet Digit Health, 2019 10;1(6):e308-e318.
PMID: 33323253 DOI: 10.1016/S2589-7500(19)30128-1

BACKGROUND: Prevention of diabetic foot ulcer recurrence in high risk patients, using current standard of care methods, remains a challenge. We hypothesised that an innovative intelligent insole system would be effective in reducing diabetic foot ulcer recurrence in such patients.
METHODS: In this prospective, randomised, proof-of-concept study, patients with diabetes, and with peripheral neuropathy and a recent history of plantar foot ulceration were recruited from two multidisciplinary outpatient diabetic foot clinics in the UK, and were randomly assigned to either intervention or control. All patients received an insole system, which measured plantar pressure continuously during daily life. The intervention group received audiovisual alerts via a smartwatch linked to the insole system and offloading instructions when aberrant pressures were detected; the control group did not receive any alerts. The primary outcome was plantar foot ulcer occurrence within 18 months. This trial is registered with ISRCTN, ISRCTN05585501, and is closed to accrual and complete.
FINDINGS: Between March 18, 2014, and Dec 20, 2016, 90 patients were recruited and consented to the study, and 58 completed the study. At follow-up, ten ulcers from 8638 person-days were recorded in the control group and four ulcers from 11 835 person-days in the intervention group: a 71% reduction in ulcer incidence in the intervention group compared with the control group (incidence rate ratio 0·29, 95% CI, 0·09-0·93; p=0·037). The number of patients who ulcerated was similar between groups (six of 26 [control group] vs four of 32 [intervention group]; p=0·29); however, individual plantar sites ulcerated more often in the control group (ten of 416) than in the intervention group (four of 512; p=0·047). In an exploratory analysis of good compliers (n=40), ulcer incidence was reduced by 86% in the intervention group versus control group (incidence rate ratio 0·14, 95% CI 0·03-0·63; p=0·011). In the exploratory analysis, plantar callus severity (change from baseline to 6 months) was greater in re-ulcerating patients (6·5, IQR 4·0-8·3) than non-re-ulcerating patients (2·0, 0·0-4·8; p=0·040).
INTERPRETATION: To our knowledge, this study is the first to show that continuous plantar pressure monitoring and dynamic offloading guidance, provided by an innovative intelligent insole system, can lead to a reduction in diabetic foot ulcer site recurrence.
FUNDING: Diabetes UK and Orpyx Medical Technologies.

Matched MeSH terms: Diabetic Foot/prevention & control*; Foot Orthoses*
Fulltext Splinter Removal with the Aid of Ultrasonography:A Case Report

Lee, C.K., Sara Ahmad, T., Abdullah, B.J.J.

Malays Orthop J, 2008;2(2):47-49.
MyJurnal

Splinter or foreign body removal from the hand and foot is a common occurrence. Usually only the deep seated, broken or missed splinters are referred to the surgeon for removal. Unless the object is radio-opaque, plain radiograph will not give any useful information, hence removal can sometimes be very difficult and traumatic. We are reporting a case where a radiolucent splinter was removed with the aid of ultrasonography. This modality can help to localize a splinter at the pre and intra-operative period, minimizing amount of exploration and time of operation.

Matched MeSH terms: Foot
Fulltext A Pictorial Review of Diabetic foot Manifestations

Yang C, Tandon A

Med J Malaysia, 2013 Jun;68(3):279-89.
PMID: 23749027

The diabetic foot with its many associated complications and presentations can provide a challenge in diagnosis and subsequent treatment. MRI, being increasingly available commonly, is now the main investigative modality. In particular, it is helpful in differentiating between neuroarthropathy and osteomyelitis and in cases where the latter is superimposed on the former. By being well versed in the interpretation of the images, the radiologist can make crucial contribution to the care and management of these patients.

Matched MeSH terms: Diabetic Foot*
Absence of the peroneus tertius muscle: cadaveric study with clinical considerations

Das S, Haji Suhaimi F, Abd Latiff A, Pa Pa Hlaing K, Abd Ghafar N, Othman F

Rom J Morphol Embryol, 2009;50(3):509-11.
PMID: 19690784

Peroneus tertius (PT) is a muscle of the anterior compartment of the leg. The PT muscle originates from the anterior surface of the fibula and the interosseous membrane and inserts into the medial side of the dorsal region of the fifth metatarsal bone. During routine dissection, we observed the absence of PT on the left lower limb of a cadaver. Usually, the PT is involved in dorsiflexion and eversion of the foot. In many cases, the absence of PT maybe asymptomatic and it may be incidentally detected during cadaveric dissections or autopsies. The existence of PT may help in the swing phase of bipedal walking. The PT may be used for tendon graft surgeries. The pull of the PT may be responsible for causing stress on the fifth metacarpal and account for all stress fractures in any individual. The absence of the PT may puzzle any transplant and foot surgeons performing graft operations. We as anatomists discuss the clinical implications of the absence of PT.

Matched MeSH terms: Foot/pathology
Fulltext Clinical presentation and microorganisms sensitivity profile for diabetic foot ulcers: a pilot study

Nur Hilda Hanina AW, Intan NS, Syafinaz AN, Zalinah A, Lailatul Akmar MN, Devnani AS

Med J Malaysia, 2015 Jun;70(3):182-7.
PMID: 26248782 MyJurnal

INTRODUCTION: Patients suffering from diabetes mellitus (DM) frequently present with infected diabetic foot ulcers (DFU). This study was done to record the anatomical site and the grade of ulcers according to Wagner's classification and to culture the microorganisms from the ulcers and determine their antibiotic sensitivity.
MATERIALS AND METHODS: Prospective study was conducted on 77 diabetic patients who were admitted with DFU from June until December 2011. Patients with end stage renal failure, those who had previous vascular surgery on the involved limb, or hyperbaric oxygen or maggot therapy for the ulcers, or had unrelated skin diseases around the involved foot were excluded from the study. Specimens for culture were obtained by a sterile swab stick or tissue sample was taken from the wound with sterile surgical instruments.
RESULTS: Wagner's grade III and IV ulcers were most common. Majority of the ulcers involved toes (48%). Gram negative microorganisms were predominantly isolated (71.1%). Gram positive microorganisms were less frequently cultured (27.7%). Fungus was cultured from one sample (1.2%). Gram negative microorganisms were sensitive to aminoglycosides, cephalosporins or β-lactamase inhibitors. More than 40% were resistant to ampicillin. Gram positive microorganisms were sensitive to cloxacillin. MRSA were sensitive to vancomycin.
CONCLUSION: Empirical use of antibiotics should be curtailed to prevent development of drug resistant strains of microorganisms and MRSA. We suggest use of antiseptic solutions to clean the ulcers until antibiotic sensitivity report is available. Results of our altered treatment regimen we plan to publish in a later study.

Matched MeSH terms: Diabetic Foot*
Pseudopseudohypoparathyroidism: a case report

Khong CC

Med J Malaysia, 1975 Jun;29(4):302-8.
PMID: 1196179
Matched MeSH terms: Foot/radiography
Maduramycosis in a Chinese in West Malaysia

Kutty MK, Bau K

Med J Malaya, 1969 Dec;24(2):151-3.
PMID: 4244142
Matched MeSH terms: Foot Diseases*
A triple compound pendulum model to analyse the effect of an ankle-foot orthosis on swing phase kinematics

Marconi G, Gopalai AA, Chauhan S

Med Eng Phys, 2023 Feb;112:103951.
PMID: 36842774 DOI: 10.1016/j.medengphy.2023.103951

Powered ankle-foot orthoses can be utilised to overcome gait abnormalities such as foot drop; however, normal gait is rarely restored with compensatory gait patterns arising and prevalence of gait asymmetry. Therefore, this study aims to determine the effect of orthosis mass and mass distribution on the swing phase of gait, to understand residual gait asymmetry with orthosis use. Using a triple compound pendulum model, which accounts for mass distribution of the limb and orthosis, the swing phase of gait is simulated in terms of natural dynamics and the effect of an orthosis on kinematic parameters is quantitatively determined. It was found that additional mass causes faster and shorter steps on the affected side due to rapid knee extension and reduced hip flexion, with particular actuator positions and natural cadence causing varying severity of these effects. Our study suggests that this model could be used as a preliminary design tool to identify subject specific optimum orthosis mass distribution of a powered ankle-foot orthosis, without the need for motion data or experimental trials. This optimisation intends to more accurately mimic natural swing phase kinematics, consequently allowing for the reduction in severity of gait asymmetry and the potential to improve rehabilitative outcomes.

Matched MeSH terms: Foot Orthoses*
Fulltext Efficacy of Topical Wound Oxygen Therapy in Healing Chronic Diabetic Foot Ulcers: Systematic Review and Meta-Analysis

Carter MJ, Frykberg RG, Oropallo A, Sen CK, Armstrong DG, Nair HKR, et al.

Adv Wound Care (New Rochelle), 2023 Apr;12(4):177-186.
PMID: 35593010 DOI: 10.1089/wound.2022.0041

Objective: To conduct a systematic review and meta-analysis of recently published randomized controlled trials (RCTs) that employed the use of topical oxygen therapy (TOT) as an adjunct therapy in the treatment of Wagner 1 and 2 diabetic foot ulcers. Approach: Following a literature search of eligible studies from 2010 onward, four RCTs were included. Studies were analyzed for patient and wound characteristics, outcomes, risk of bias, and quality of the evidence assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. A random-effects meta-analysis for complete wound healing was carried out due to statistical heterogeneity of included studies. Results: Risk of bias judgment (RoB2 analysis) resulted in one low-risk trial and three trials with some risk. One study was determined to be the origin of the statistical heterogeneity. Pooled results showed statistical significance with a risk ratio (RR) of 1.59 (95% confidence interval [CI]: 1.07-2.37; p = 0.021). Sensitivity analysis, based on imputed values for missing outcomes, demonstrated that both the RR and 95% CIs changed little. The GRADE ratings for each domain were as follows: (a) risk of bias: moderate (3); (b) imprecision: moderate (2), high (1); (c) inconsistency: low (2), high (1); (d) indirectness: moderate (2), high (1); and (e) publication bias: moderate (1), high (2). Overall, the evidence was moderate. Innovation: Our study shows that TOT is a viable diabetic foot ulcer therapy. Conclusions: These data support the use of TOT for the treatment of chronic Wagner 1 or 2 diabetic foot ulcers in the absence of infection and ischemia.

Matched MeSH terms: Foot Ulcer*
Stepease™ diabetic socks: An answer to efficacious indoor foot pressure relief- A prospective study

Soh EZF, Htwe O, Naicker AS, Nasirabadi AR, Ghazali MJ, Mohd Mustafah N, et al.

J Tissue Viability, 2020 May;29(2):104-109.
PMID: 32014382 DOI: 10.1016/j.jtv.2020.01.005

BACKGROUND: Diabetic foot ulcer is commonly seen in people with diabetes mellitus. Inadequate plantar pressure offloading has been identified as a contributing factor to development of diabetic foot ulcers. Various pressure off-loading footwear are widely available in the market but poor compliance has been reported especially for indoor usage. StepEase™ diabetic socks have been designed using Ethylene Vinyl Acetate (EVA) microspheres for better redistribution of plantar pressure. The objective of this study was to determine the efficacy of StepEase™ in redistributing the foot plantar pressure and to assess patients' satisfaction on the usage of the socks.
METHODS: This was a prospective non randomized clinical trial conducted on 31 patients with diabetes mellitus with high risk foot (King's classification stage II) over a 12 weeks period. Dynamic foot plantar pressure reading was recorded at day 0, 6 weeks and 12 weeks intervals, both barefoot and with StepEase™, using Novel Pedar-X system (Novel GmbH, Munich, Germany). Patients' satisfaction and usage practice were assessed by a questionnaire.
RESULTS: The mean age of subjects was 57.9 years with mean body mass index (BMI) of 26 kg/m2. The mean duration of diagnosis with diabetes mellitus was 10.2 years. The mean peak plantar pressure was found to be highest at the right forefoot and left heel region, 267.6 kPa (SD113.5 kPa) and 266.3 kPa (SD 94.6 kPa) respectively. There was a statistically significant reduction of mean peak pressure (P foot pressure relieving footwear. It resulted in significant peak plantar pressure reduction by up to 49.2% and the effect was maintained for at least 12 weeks duration.

Matched MeSH terms: Foot/physiopathology; Diabetic Foot/prevention & control*; Diabetic Foot/therapy*
Biomechanical evaluation of two commonly used external fixators in the treatment of open subtalar dislocation--a finite element analysis

Ramlee MH, Kadir MR, Murali MR, Kamarul T

Med Eng Phys, 2014 Oct;36(10):1358-66.
PMID: 25092623 DOI: 10.1016/j.medengphy.2014.07.001

Subtalar dislocation is a rare injury caused by high-energy trauma. Current treatment strategies include leg casts, internal fixation and external fixation. Among these, external fixators are the most commonly used as this method is believed to provide better stabilization. However, the biomechanical stability provided by these fixators has not been demonstrated. This biomechanical study compares two commonly used external fixators, i.e. Mitkovic and Delta. CT imaging data were used to reconstruct three-dimensional models of the tibia, fibula, talus, calcaneus, navicular, cuboid, three cuneiforms and five metatarsal bones. The 3D models of the bones and cartilages were then converted into four-noded linear tetrahedral elements, whilst the ligaments were modelled with linear spring elements. Bones and cartilage were idealized as homogeneous, isotropic and linear. To simulate loading during walking, axial loading (70 N during the swing and 350 N during the stance phase) was applied at the end of diaphyseal tibia. The results demonstrate that the Mitkovic fixator produced greater displacement (peak 3.0mm and 15.6mm) compared to the Delta fixator (peak 0.8mm and 3.9 mm), in both the swing and stance phase, respectively. This study demonstrates that the Delta external fixator provides superior stability over the Mitkovic fixator. The Delta fixator may be more effective in treating subtalar dislocation.

Matched MeSH terms: Foot Joints/injuries*; Foot Joints/physiopathology; Foot Joints/radiography; Foot Joints/surgery
Fulltext Congenital bilateral agenesis of the tibialis anterior muscles: a rare case report

Htwe O, Swarhib M, Pei TS, Naicker AS, Das S

Rom J Morphol Embryol, 2012;53(3):657-9.
PMID: 22990563

Congenital bilateral agenesis of the tibialis anterior muscles is a rare condition. We present a case of congenital absence of bilateral tibialis anterior muscles in a 6-year-old boy who presented with an abnormal gait. He was previously diagnosed to have bilateral congenital talipes equinovarus (CTEV) deformity for which he underwent corrective surgery two times. However, he still had a residual foot problem and claimed to have difficulty in walking. On examination, he walked with a high stepping gait and muscle power of both lower limbs was 5/5 on the medical research council scale (MRCS) except for both ankle dorsiflexors and long toe extensors. The sensation was intact. Magnetic Resonance Imaging (MRI) study of both legs revealed that tibialis anterior muscles were not visualized on both sides suggestive of agenesis of the tibialis anterior muscles. The rest of the muscles appeared mildly atrophied. The electrophysiological study showed normal motor and sensory conduction in both upper and lower limbs. Electromyographic (EMG) study of the vastus medialis was within normal limit and no response could be elicited for EMG of tibialis anterior muscles suggesting possible absence of tibialis anterior muscles, bilaterally. The patient underwent split tibialis posterior tendon transfer to achieve a balanced and functional foot and was well on discharge. The present case describes the normal anatomy and embryology of tibialis anterior muscles as well as possible causes of its agenesis along with its clinical implications.

Matched MeSH terms: Foot Deformities, Congenital/pathology*; Foot Deformities, Congenital/radiography

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