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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Health Behavior, Chronic Disease and Health Promotion".

Deadline for manuscript submissions: closed (31 December 2023) | Viewed by 41119

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Dr. Sung Hun Won

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Department of Orthopaedic Surgery, Soonchunhyang University Hospital Seoul, 59, Daesagwan-ro, Yongsan-gu, Seoul 04401, Republic of Korea
Interests: orthopaedics; lower extremity disease; foot pathologies; ankle disease, trauma; diabetic foot; epidemiology; gross anatomy; foot orthoses

Special Issue Information

Dear Colleagues,

Despite existing lower extremity problems, this anatomical region has not received special attention in the past. Currently, knowledge in this field is still rapidly expanding, based on anatomy-based research, mediation and interdisciplinary research in diabetic foot and clinical research related to lower extremity pathologies, as well as trauma. In addition, research about public health such as epidemiology of diseases and injuries in this field is expanding. This means that multidisciplinary approaches to lower extremity problems are still being improved by developing entirely new treatments as well as optimizing existing treatments. Interestingly, this progress can be seen in both conservative and surgical treatments and public health aspects such as prevention. We are pleased to announce the launch of a new Special Issue entitled “Lower extremity diseases, injuries and public health”. This Special Issue will focus on all emerging research papers related to lower extremity disorders or injuries, clinical studies, and epidemiological and preventive medicine related to public health. We look forward to invite authors to submit reviews or original research that fit this scope.

Dr. Sung Hun Won
Guest Editor

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Keywords

disease in lower extremity
conservative treatment
surgical treatment
novel ideas and techniques
injury in lower extremity
diabetic foot
wound healing
epidemiology
prevention
systemic review and meta-analysis
case report

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Published Papers (10 papers)

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9 pages, 502 KiB

Open AccessArticle

Diabetic Foot Complications: A Retrospective Cohort Study

by Bogdan Stancu, Tamás Ilyés, Marius Farcas, Horațiu Flaviu Coman, Bogdan Augustin Chiș and Octavian Aurel Andercou

Int. J. Environ. Res. Public Health 2023, 20(1), 187; https://doi.org/10.3390/ijerph20010187 - 23 Dec 2022

Cited by 11 | Viewed by 4090

Abstract

Diabetes mellitus is a highly prevalent disease globally and contributes to significant morbidity and mortality. As a consequence of multiple pathophysiologic changes which are associated with diabetes, these patients frequently suffer from foot-related disorders: infections, ulcerations, and gangrene. Approximately half of all amputations occur in diabetic individuals, usually as a complication of diabetic foot ulcers. In this retrospective study, we analyzed and characterized a cohort of 69 patients and their diabetes-related foot complications. The main characteristics of our cohort were as follows: older age at diagnosis (mean age 66); higher incidence of diabetes in males; predominantly urban patient population. The most frequent complications of the lower extremity were ulcerations and gangrene. Moreover, in our study, 35% of patients required surgical reintervention, and 27% suffered from complications, while 13% required ICU admission. However, diabetic foot lesions are preventable via simple interventions which pointedly reduce foot amputations. Early identification and the appropriate medical and surgical treatment of the complications associated with diabetic foot disease are important because they still remain common, complex and costly. Full article

(This article belongs to the Special Issue Lower Extremity Diseases, Injuries and Public Health)

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11 pages, 855 KiB

Open AccessArticle

Lower Extremity Muscle Performance and Foot Pressure in Patients Who Have Plantar Fasciitis with and without Flat Foot Posture

by Jin Hyuck Lee, Ki Hun Shin, Taek Sung Jung and Woo Young Jang

Int. J. Environ. Res. Public Health 2023, 20(1), 87; https://doi.org/10.3390/ijerph20010087 - 21 Dec 2022

Cited by 7 | Viewed by 3975

Abstract

Abnormal foot posture and poor muscle performance are potential causes of plantar fasciitis (PF). However, no study has compared the differences between lower extremity muscle performance and foot pressure in patients who have PF with and without abnormal foot postures. This study aimed to compare the differences in lower extremity muscle performance, such as in the hip, quadriceps, hamstring, and plantar flexor, and foot pressure in patients who have PF with and without flat foot postures. Seventy patients with plantar heel pain were enrolled (37 flat feet and 33 without flat feet). The hip muscle strength was measured using a handheld digital dynamometer. The strength and reaction time of the quadriceps, hamstring, and plantar flexor muscles were evaluated using an isokinetic device. Foot pressure parameters were assessed using pedobarography. The strength of the plantar flexor muscles was significantly lower (p = 0.008), while the reaction time of the plantar flexor muscles was significantly faster (p = 0.007) for the involved feet of PF patients with flat feet than in those without flat feet. This study confirmed the differences in muscle performance between patients who have PF with different foot postures. Therefore, clinicians and therapists should plan treatment considering the differences in these characteristics for the management of these patients. Full article

(This article belongs to the Special Issue Lower Extremity Diseases, Injuries and Public Health)

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16 pages, 1841 KiB

Open AccessArticle

Risk Factors for, and Prediction of, Shoulder Pain in Young Badminton Players: A Prospective Cohort Study

by Antonio Cejudo

Int. J. Environ. Res. Public Health 2022, 19(20), 13095; https://doi.org/10.3390/ijerph192013095 - 12 Oct 2022

Cited by 2 | Viewed by 2538

Abstract

Background: Shoulder pain (SP) caused by hitting the shuttlecock is common in young badminton players. The objectives of the present study were to predict the risk factors for SP in young badminton players, and to determine the optimal risk factor cut-off that best discriminates those players who are at higher risk of suffering from SP. Methods: A prospective cohort study was conducted with 45 under-17 badminton players who participated in the Spanish Championship. Data were collected on anthropometric age, sports history, sagittal spinal curves, range of motion (ROM) and maximum isometric strength of shoulder. After 12 months, players completed a SP history questionnaire. Bayesian Student’s t-analysis, binary logistic regression analysis and ROC analysis were performed. Results: Overall, 18 (47.4%) players reported at least one episode of SP. The shoulder internal rotation (SIR) ROM showed the strongest association (OR = 1.122; p = 0.035) with SP. The SIR ROM has an excellent ability to discriminate players at increased risk for SP (p = 0.001). The optimal cut-off for SIR ROM, which predicts players with an 81% probability of developing SP, was set at 55° (sensitivity = 75.0%, specificity = 83.3%). Conclusions: The young badminton players who had a shoulder internal rotation ROM of 55° or less have a higher risk of SP one year later. Full article

(This article belongs to the Special Issue Lower Extremity Diseases, Injuries and Public Health)

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7 pages, 1959 KiB

Open AccessArticle

Contribution Ratio of Metatarsal Osteotomy and First Tarsometatarsal Joint Reduction in Moderate to Severe Hallux Valgus Correction

by Dong-Kyo Seo, Hasung Park, Myeong Geun Song, Youngjoo Jung and Young-Rak Choi

Int. J. Environ. Res. Public Health 2022, 19(14), 8243; https://doi.org/10.3390/ijerph19148243 - 6 Jul 2022

Viewed by 2005

Abstract

Hallux valgus is a common foot and ankle disease, for which numerous surgical procedures were introduced. So, understanding the mechanism of deformity reduction is important to select the proper method. Intermetatarsal angle (IMA) determines the severity of hallux valgus, which is influenced by the translated metatarsal head and the reduction of the first tarsometatarsal joint. We hypothesized that both of the mechanisms simultaneously contribute to the correction of IMA. Hallux valgus (70 feet) operated with a Scarf osteotomy with the Akin procedure were reviewed. Hallux valgus angle (HVA), IMA (mechanical and anatomical), hallux valgus interphalangeal angle (HVIP), distal metatarsal articular angle (DMAA), and sesamoid position were checked. The ratio of contributions to the IMA changes were calculated and compared. When the individual contributions by metatarsal head translation and first tarsometatarsal joint reduction were compared, metatarsal head translation contributed by 82%, whereas first tarsometatarsal joint reduction contributed by 18%. Both were responsible for mechanical IMA correction. However, IMA change by metatarsal head translation was a major correction mechanism compared to anatomical IMA change by first tarsometatarsal joint reduction. Full article

(This article belongs to the Special Issue Lower Extremity Diseases, Injuries and Public Health)

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8 pages, 2269 KiB

Open AccessArticle

Early Return to Daily Life through Immediate Weight-Bearing after Lateral Malleolar Fracture Surgery

by Sang-June Lee, Youngrak Choi, Seongju Choi and Hoseong Lee

Int. J. Environ. Res. Public Health 2022, 19(10), 6052; https://doi.org/10.3390/ijerph19106052 - 16 May 2022

Cited by 2 | Viewed by 3407

Abstract

Lateral malleolus fracture is one of the most common fractures. However, there is controversy regarding the rehabilitation protocols used after surgery. In particular, the initiation point for weight-bearing has not been standardized. In the present study, we investigated the prognostic difference between immediate and delayed weight-bearing on lateral malleolus fractures. The medical records of matched patients in the immediate and delayed weight-bearing groups (50 and 50, respectively) were reviewed retrospectively. All patients were treated with open reduction and internal fixation using an anatomical locking compression plate with a lag screw. In the immediate weight-bearing group (IWB), tolerable weight-bearing (i.e., what can be endured immediately after surgery with crutches) was permitted. In the delayed weight-bearing group (DWB), weight-bearing was completely restricted for 4 weeks after surgery. Ankle motion exercise was permitted in both groups, starting from the day after surgery. Radiographic assessment data and clinical outcomes were reviewed between the two groups. No significant differences in radiographic assessments and complications were found between the two groups. Significant differences in terms of a shortened length of hospital stay and time to return to work with the IWB rehabilitation protocol compared with DWB were confirmed (6.0 vs. 9.2 days, p = 0.02 and 6.1 vs. 8.3 weeks, p = 0.02, respectively). A significant difference in sport factor was observed in the Foot and Ankle Outcome Score at 3 months postoperatively (72.3 vs. 67.4, p = 0.02). We found no significant differences between the two groups concerning postoperative radiological outcomes and complications. The benefits of shortening the time to return to work and length of hospital stay associated with the IWB rehabilitation protocol were confirmed. In conclusion, immediate weight-bearing is recommended in patients with lateral malleolus fracture after anatomical reduction and firm fixation by surgery. Full article

(This article belongs to the Special Issue Lower Extremity Diseases, Injuries and Public Health)

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7 pages, 1128 KiB

Open AccessArticle

Preliminary Evidence of the Efficacy of Nitric Acid Treatment in Onychomycosis

by Félix Marcos-Tejedor, Natividad Santos-Carnicero and Raquel Mayordomo

Int. J. Environ. Res. Public Health 2021, 18(24), 13371; https://doi.org/10.3390/ijerph182413371 - 19 Dec 2021

Cited by 2 | Viewed by 3213

Abstract

Onychomycosis is the main cause of toenail disorders and is produced by a fungal infection. It is becoming more prevalent because of new lifestyles and immunosuppression statuses. The therapeutic approach to onychomycosis is under considerable study because of the lengthy treatments that require strong patient commitment, the limited efficacy of treatments, the inclusion of active substances that can be hepatotoxic and cause pharmacological interactions, and/or the questionable efficacy of treatments due to a lack of clinical trials. This study responds to the demand for rapid treatment with minimal pharmacological interactions. Methods: The efficacy of nitric acid 60% treatment in patients with onychomycosis was monitored and studied. The antifungal efficacy of nitric acid was measured by microbiological culture before and after treatment and the clinical evolution of nail dystrophy was quantitatively measured by monitoring with the Onychomycosis Severity Index (OSI). Results: The results show that, with the protocol used, nitric acid 60% painlessly cured 40% (microbiologic cure) of the cases treated, and in all cases, clinical improvement was observed (p = 0.011). Conclusions: The treatment with nitric acid 60% is as efficient as conventional treatments, requires less patient compliance of the treatment and produces no pharmacological interactions, providing alternative treatment in the case of hepatotoxicity. Full article

(This article belongs to the Special Issue Lower Extremity Diseases, Injuries and Public Health)

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19 pages, 18788 KiB

Open AccessProtocol

Description of ROM-SPORT I Battery: Keys to Assess Lower Limb Flexibility

by Antonio Cejudo

Int. J. Environ. Res. Public Health 2022, 19(17), 10747; https://doi.org/10.3390/ijerph191710747 - 29 Aug 2022

Cited by 8 | Viewed by 4918

Abstract

Limited range of motion (ROM) is considered one of the most important intrinsic and modifiable risk factors for the most common sports-related injuries. In addition, controlling and monitoring an athlete’s ROM is a strategy to achieve optimal ROM and improve athletic performance in sports, especially those that require high ROM in the major joints. Therefore, assessing ROM (pre-participation, during a rehabilitation process, on return to play, etc.) is important not only as a method to prevent sports injuries, but also as a quantitative determinant of the potential of athletic performance. However, despite the variety of different ROM assessment methods described in the literature, there is no consensus on which methods are best suited for this goal. Recently, the ROM-SPORT I battery has been shown to have advantages over other ROM assessment methods. This tool has not yet been fully described in detail for researchers, sports professionals, and clinicians to learn. The main objective of this study is to describe the ROM-SPORT I battery tests in detail using the following criteria: test description, simplicity of the test procedure, low need for human and material resources, predictive validity, and reliability. Full article

(This article belongs to the Special Issue Lower Extremity Diseases, Injuries and Public Health)

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11 pages, 2108 KiB

Open AccessBrief Report

Trend and Seasonality of Diabetic Foot Amputation in South Korea: A Population-Based Nationwide Study

by Hyung-Jin Chung, Dong-Il Chun, Eun Myeong Kang, Keonwoo Kim, Jinyoung Lee, Ye Jin Jeon, Jaeho Cho, Sungho Won and Young Yi

Int. J. Environ. Res. Public Health 2022, 19(7), 4111; https://doi.org/10.3390/ijerph19074111 - 30 Mar 2022

Cited by 4 | Viewed by 2285

Abstract

The number of lower extremity amputations in diabetic foot patients in Korea is increasing annually. In this nationwide population-based retrospective study, we investigated the data of 420,096 diabetes mellitus patients aged ≥18 years using the Korean Health Insurance Review and Assessment Service claim database. We aimed to study the seasonal and monthly trends in diabetic foot amputations in Korea. After applying the inclusion criteria, 8156 amputation cases were included. The analysis showed an increasing trend in monthly amputation cases. In terms of seasonality, the monthly frequency of amputation was commonly observed to be lower in February and September every year. Diabetic foot amputations frequently occurred in March, July, and November. There was no difference between the amputation frequency and mean temperature/humidity. This study is meaningful as it is the first nationwide study in Korea to analyze the seasonal and monthly trends in diabetic foot amputation in relation to climatic factors. In conclusion, we recognize an increased frequency of amputation in March, July, and November and recommend intensive educational program on foot care for all diabetes patients and their caregivers. This could improve wound management and amputation prevention guidelines for diabetic foot patients in the Far East with information on dealing with various seasonal changes. Full article

(This article belongs to the Special Issue Lower Extremity Diseases, Injuries and Public Health)

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9 pages, 5611 KiB

Open AccessCase Report

Staged Joint Arthrodesis in the Treatment of Severe Septic Ankle Arthritis Sequelae: A Case Report

by Yong-Cheol Hong, Ki-Jin Jung, Hee-Jun Chang, Eui-Dong Yeo, Hong-Seop Lee, Sung-Hun Won, Jae-Young Ji, Dhong-Won Lee, Ik-Dong Yoo, Sung-Joon Yoon and Woo-Jong Kim

Int. J. Environ. Res. Public Health 2021, 18(23), 12473; https://doi.org/10.3390/ijerph182312473 - 26 Nov 2021

Cited by 3 | Viewed by 4665

Abstract

Septic ankle arthritis is a devastating clinical entity with high risks of morbidity and mortality. Prompt treatment is necessary because delayed or inadequate treatment can lead to irreversible damage that may occur on the articular surface, resulting in cartilage erosion, infective synovitis, osteomyelitis, joint deformity, and pain and joint dysfunction. An aggressive surgical approach is required when a joint infection causes severe limb-threatening arthritis. A 58-year-old woman visited our clinic with increasing pain in the right ankle, which had been present for the previous 2 months. She complained of discomfort in daily life due to deformity of the ankle; limping; and severe pain in the ankle even after walking a little. The patient reported a history of right-ankle injury while exiting a bus in her early 20s. Plain radiographs of the right ankle joint revealed that the medial malleolus was nearly absent in the right ankle joint on the anteroposterior view, and severe varus deformity was observed with osteoarthritic changes because of joint space destruction. Magnetic resonance imaging revealed diffuse synovial thickening of the destroyed tibiotalar joint with joint effusion. Hybrid 99mTc white blood cell single-photon emission computed tomography/computed tomography showed increased uptake along the soft tissue around the ankle joint; uptake was generally low in the talocrural and subtalar joints. A two-stage operation was performed to remove the infected lesions and correct the deformity, thus enabling limb salvage. The patient was nearly asymptomatic at the 6-month follow-up, with no discomfort in her daily life and nearly normal ability to carry out full functional activities. She had no complications or recurrent symptoms at the 1-year follow-up. We have described a rare case of a staged limb salvage procedure in a patient with chronic septic arthritis sequelae. For patients with severe joint deformity because of septic ankle sequelae, staged arthrodesis is a reliable method to remove infected lesions, solve soft tissue problems, correct deformities, and maintain leg length. Full article

(This article belongs to the Special Issue Lower Extremity Diseases, Injuries and Public Health)

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8 pages, 3185 KiB

Open AccessCase Report

Reconstruction of a Neglected, Extensor Hallucis Longus Tendon Rupture Using Interposed Scar Tissue: A Case Report and Literature Review

by Woo-Jong Kim, Ki-Jin Jung, Hyein Ahn, Eui-Dong Yeo, Hong-Seop Lee, Sung-Hun Won, Dhong-Won Lee, Jae-Young Ji, Sung-Joon Yoon and Yong-Cheol Hong

Int. J. Environ. Res. Public Health 2021, 18(22), 12157; https://doi.org/10.3390/ijerph182212157 - 19 Nov 2021

Cited by 7 | Viewed by 9035

Abstract

Injury of the extensor hallucis longus (EHL) tendon is relatively rare, but surgical repair is necessary to prevent deformity and gait disturbance. Primary suturing is possible if the condition is acute, but not when it is chronic. The scar tissue between the ruptured ends is a proliferative tissue composed of fibroblasts and collagen fibers. Given the histological similarity to normal tendons, several studies have reported tendon reconstruction using scar tissue. Here, we report a reconstruction of a neglected EHL rupture using interposed scar tissue. A 54-year-old female visited our clinic with a weak extension of a big toe. She had dropped a knife on her foot a month prior, but did not go to hospital. The wound had healed, but she noted dysfunctional extension of the toe and increasing pain. Magnetic resonance imaging (MRI) revealed that EHL continuity was lost and that the proximal tendon stump was displaced toward the midfoot. Scar tissue running in the direction of the original ligament was observed between the ruptured ends. In the surgical field, the scar tissue formed a shape similar to the extensor tendon. Therefore, we performed tendon reconstruction using the interposed scar tissue. For the first 2 postoperative weeks, the ankle and foot were immobilized to protect the repair. Six weeks after surgery, the patient commenced full weight-bearing. At the 3-month follow-up, active extension of the hallux was possible, with a full range of motion. The patient did not feel any discomfort during daily life. Postoperative MRI performed at 1 year revealed that the reconstructed EHL exhibited homogeneously low signal intensity, and was continuous. The AOFAS Hallux Metatarsophalangeal-Interphalangeal scale improved from 57 to 90 points and the FAAM scores improved from 74% to 95% (the Activities of Daily Living subscale) and from 64% to 94% (the Sports subscale). Scar tissue reconstruction is as effective as tendon autografting or allografting, eliminates the risk of donor site morbidity and infection, and requires only a small incision and a short operative time. Full article

(This article belongs to the Special Issue Lower Extremity Diseases, Injuries and Public Health)

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