Clínica del pie valgo

Genericamente reconocemos al pie valgo, por las características siguientes: - desviación de la linea de Helbing ( retropié) - aplanamiento de la bóveda longitudinal interna - pronación de antepié. - aspecto de pié plano. Pero no podemos contentarnos con estas cuatro reglas,y por lo tanto hemos de pormenorizar y clasificar en función de los diferentes elementos que intervienen en la morfogenética de pié. Con lo cual también tendremos una visión mas amplia a la hora de poder aplicar un tratamiento mas o menos agresivo ( y con ello me refiero siempre a tratamientos paliativos )., pudiendo emplear plantillas ortopodológicas mas correctivas o bien el empleo de cuñas compensatorias de la simetría del plano de apoyo. Se clasifican y se tratan de analizar cada circunstancia que influyen directa o indirectamente en la creación de un retropié valgo.

Aplicación de las férulas funcionales en las marchas neurológicas

Se expone la metodología de aplicación de la férula funcional Jousto (J.F.F.), así como diferentes casos clínicos a los cuales se aplicó la citada férula.

Pie plano astrágalo vertical asociado a sinovitis. Fases de tratamiento

El pie plano astrágalo vertical congénito es una deformidad poco frecuente que se puede encontrar de forma aislada, dentro de un cuadro polimalformativo o en relación con afectaciones neurológicas. Se caracteriza por una luxación del escafoides por encima del astrágalo,lo que provoca un pie rígido o de dificil manipulación. En este artículo los autores describen un caso clínico de un paciente que acude a consulta por presentar una inflamación dolorosa en la zona de la cabeza del astrágalo del pie derecho. Una vez realizado todo el protocolo exploratorio, se plantea la resolución mediante un plan de tratamiento en dos fases: una primera fase consistente en la realización de paracentesis evacuadora o terapéutica-curativa; y una segunda fase en la que se diseña tratamiento ortopodológlco de descarga.

Dynamic Deflections to Determine Roadway Support Ratings, HR-245, 1983

The Benkelman Beam structural test of flexible pavements was replaced in 1976 by dynamic deflection testing with a model 400 Road Rater. The Road Rater is used to determine structural ratings of flexible pavements. New pavement construction in Iowa has decreased with a corresponding increase of restoration and rehabilitation. A method to determine structural ratings of layered systems and rigid pavements is needed to properly design overlay thickness. The objective of this research was to evaluate the feasibility of using the Road Rater to determine support values of layered systems and rigid pavements. This evaluation was accomplished by correlating the Road Rater with the Federal Highway Administration (FHWA) Thumper, a dynamic deflection testing device. Data were obtained with the Road Rater and Thumper at 411 individual test locations on 39 different structural sections ranging from 10" of PCC pavement and 25" of asphalt pavement to a newly graveled unpaved roadway. A high correlation between a 9000 pound Thumper deflection and the 1185 pound Road Rater deflection was obtained. A Road Rater modification has been completed to provide 2000 pound load inputs. The basin, defined by four sensors spaced at 1 foot intervals, resulting from the 2000 pound loading is being used to develop a graph for determining relative subgrade strengths. Road Rater deflections on rigid pavements are sufficient to support the potential for this technique.

Iowa Motorcycle Ride Meter, HR-1019, 1980

The Iowa Department of Transportation (Iowa DOT) through the Highway Division is responsible for the design, construction and maintenance of roadways that will provide a high level of serviceability to the motorist. First, the motorist expects to be able to get where he wants to go, but now he also demands a minimum level of comfort. In the construction of new roadways, the public is quick to express dissatisfaction with rough pavements. The Highway Division of the Iowa DOT (formerly Iowa State Highway Commission) has a specification which requires a "smooth-riding surface". For over 40 years, new portland cement concrete (pcc) pavement has been checked with a 10-foot rolling straightedge. The contractor is required to grind, saw or mill off all high spots that deviate more than 1/8" from the 10-foot straight line. Unfortunately, there are instances where a roadway that will meet the above criteria does not provide a "smooth-riding surface". The roadway may have monger undulations (swales) that result in an undesirable ride. The objective of this project was to develop a repeatable, reliable time stable, lightweight test unit to measure the riding quality of pcc pavement at normal highway speed the day after construction.

Avulsion fracture of peroneus longus tendon at the first metatarsal insertion: a case report : P16

Introduction: Isolated avulsion fracture at the plantar lateral base of the first metatarsal (M1) is very rare. Case report: A 35 year old overweight woman sustained an eversion strain of her right foot. Despite pain along M1 she was able to continue walking for three days before presenting to her family doctor. Swelling on the plantar aspect of the foot was noticed, there was also pain at eversion of the foot and extension of the ankle. Plain X-ray showed no abnormalities. A MRI showed minimal bone bruise at the basis of M1 and a partial rupture of the peroneus longus tendon at its insertion. The patient was allowed to walk with partial weight bearing with a soft ankle brace. After 6 months she presented at our hospital because of persistent pain. There was still a painful insertion of the peroneus longus but active plantarflexion of M1 was possible. Plain X-rays were poorly contributive except for a discrete flattening of the longitunal arch. CT-scan showed a non displaced fracture at the M1-basis. A protocol with partial weight-bearing in a short-leg cast and partial weight-bearing orthosis each for 6 weeks was unsuccessfully attempted. Therefore, an excision of the non healed bone fragment at the basis of M1 and a first tarsometatarsal joint arthrodesis were performed. Postoperatively the patient wore a partial weight-bearing short leg cast for 6 weeks followed by a weight-bearing short leg cast for 6 weeks with favourable outcome. Discussion: Initial internal fixation has been reported to lead to good results [1, 2]. In our case the conservative treatment failed and leaded to non union. At that time we considered as too risky (overweight) to excise the fragment and reattach the peroneus longus tendon. Therefore, we excised the fragment and fused the first tarsometatarsal joint. This procedure allowed, at least partially, to compensate for the function of the peroneus longus tendon. 1 Murakami T, et al. Avulsion fracture of the peroneus longus at the first metatarsal insertion: a case report. Br J Sports Med. 2004. 2 Kwak HY, and Bae SW. Isolated avulsion fracture at the plantar lateral base of the first metatarsal: a case report. Foot Ankle Int 2000.

Recycling of Portland Cement Concrete Roads in Iowa, MLR-77-6, 1977

We are depleting the once seemingly endless supply of aggregate available for concrete paving in Iowa. At the present time, some parts of our state do not have locally available aggregates of acceptable quality for portland cement concrete paving. This necessitates lengthy truck and rail hauls which frequently more than doubles the price of aggregate. In some parts of the state, the only coarse aggregates available locally are "d-cracking" in nature. Iowa's recycling projects were devised to alleviate the shortage of aggregates wherever they were found to have an economic advantage. We completed our first recycling project in 1976 on a 1.4 project in Lyon county. The data collected in this project was used to schedule two additional projects in 1977. The larger of these two projects is located in Page and Taylor county on Highway #2 and is approximately 15 miles in length. This material is to be crushed and re-used in the concrete paving, it is to be reconstructed on approximately the same alignment. The second project is part of the construction of Interstate I-680 north of council Bluffs where an existing 24 foot portland cement concrete roadway is to be recycled and used as the aggregate in the slip form econocrete subbase and the portland cement concrete shoulders.

Importance of polyethylene thickness in total shoulder arthroplasty: a finite element analysis.

BACKGROUND: Articular surfaces reconstruction is essential in total shoulder arthroplasty. Because of the limited glenoid bone support, thin glenoid component could improve anatomical reconstruction, but adverse mechanical effects might appear. METHODS: With a numerical musculoskeletal shoulder model, we analysed and compared three values of thickness of a typical all-polyethylene glenoid component: 2, 4 (reference) and 6mm. A loaded movement of abduction in the scapular plane was simulated. We evaluated the humeral head translation, the muscle moment arms, the joint force, the articular contact pattern, and the polyethylene and cement stress. Findings Decreasing polyethylene thickness from 6 to 2mm slightly increased humeral head translation and muscle moment arms. This induced a small decreased of the joint reaction force, but important increase of stress within the polyethylene and the cement mantel. Interpretation The reference thickness of 4mm seems a good compromise to avoid stress concentration and joint stuffing.

Nonlinear Finite Element Study of Piles in Integral Abutment Bridges, HR-227, Part 2, 1982

The highway departments of the states which use integral abutments in bridge design were contacted in order to study the extent of integral abutment use in skewed bridges and to survey the different guidelines used for analysis and design of integral abutments in skewed bridges. The variation in design assumptions and pile orientations among the various states in their approach to the use of integral abutments on skewed bridges is discussed. The problems associated with the treatment of the approach slab, backfill, and pile cap, and the reason for using different pile orientations are summarized in the report. An algorithm based on a state-of-the-art nonlinear finite element procedure previously developed by the authors was modified and used to study the influence of different factors on behavior of piles in integral abutment bridges. An idealized integral abutment was introduced by assuming that the pile is rigidly cast into the pile cap and that the approach slab offers no resistance to lateral thermal expansion. Passive soil and shear resistance of the cap are neglected in design. A 40-foot H pile (HP 10 X 42) in six typical Iowa soils was analyzed for fully restrained pile head and pinned pile head. According to numerical results, the maximum safe length for fully restrained pile head is one-half the maximum safe length for pinned pile head. If the pile head is partially restrained, the maximum safe length will lie between the two limits. The numerical results from an investigation of the effect of predrilled oversized holes indicate that if the length of the predrilled oversized hole is at least 4 feet below the ground, the vertical load-carrying capacity of the H pile is only reduced by 10 percent for 4 inches of lateral displacement in very stiff clay. With no predrilled oversized hole, the pile failed before the 4-inch lateral displacement was reached. Thus, the maximum safe lengths for integral abutment bridges may be increased by predrilling. Four different typical Iowa layered soils were selected and used in this investigation. In certain situations, compacted soil (> 50 blow count in standard penetration tests) is used as fill on top of natural soil. The numerical results showed that the critical conditions will depend on the length of the compacted soil. If the length of the compacted soil exceeds 4 feet, the failure mechanism for the pile is similar to one in a layer of very stiff clay. That is, the vertical load-carrying capacity of the H pile will be greatly reduced as the specified lateral displacement increases.

Pavement Profiling by Milling, Addendum to HR-283, 1988

Iowa DOT research in 1986, demonstrated that carbide tooth milling can produce an acceptable surface texture. Based upon that research, specifications were developed for "Pavement Surface Repair (Milling)". This specification was applied to reprofile a nine-mile section of badly faulted portland cement concrete (pcc) pavement on route 163 just east of Des Moines. The Profile Index (measured with a 25-foot California Profilograph) was improved from an average of 55.2 inches per mile prior to milling to 10.6 inches per mile after milling. The bid price was $0.75 per square yard for pcc containing limestone coarse aggregate and $1.21 for pcc containing gravel coarse aggregate. Carbide tooth milling should be considered as an acceptable alternate method of reprofiling even though there is some spalling of joints.