Introduction: Many studies have demonstrated that individuals who engage in running exercises appear to develop musculo-skeletal injuries more frequently (1). Considering the foot, the most common injuries include stress fractures of the metatarsals, plantar fasciitis, tibialis posterior lesions and ankle sprains. Studies have been conducted who analysed the loading characteristics of the foot in repeated measurement designs –before and after exercise- in order to find a pathomechanical pathway for metatarsal stress fractures (2,3,4). The published studies evaluated the in-shoe plantar pressure during treadmill running (2,3) or barefoot after a marathon (4). To date, no investigation have been conducted who evaluated the impact of a regular training session onto the forefoot loading characteristics.

The objective of this investigation was therefore to identify changes in loading characteristics of the foot after a 90 minute running exercise.

Methods: Thirty-two volunteer athletes (4 women, 28 men) were recruited to participate in this study and gave their informed consent. During the pre-training session, participants were asked to run barefoot at a self-selected speed across a plantar pressure platform (RSscan International, 0,5m × 0,4m, 4 sensors/cm², 300Hz) that was embedded in a 16 meter walkway (EVA foam, shore 60). The post-training measurements were performed in the same location and according to the same method. Three left and three right steps were captured for each session and each participant. One observer localised 6 anatomical regions on the footprints using the multi-mask function of the software (Scientific version 7.0). For these regions (the five metatarsal heads and the hallux) the following dependent variables were analyzed: Peak Pressure, Impulse, Time to Peak, Start Time and End Time.

Intra-individual differences between both conditions were tested for significance with the paired student T-test.

Results: The contact time of the whole foot was not significantly different between the pre-and post training sessions, which indicates repeatable gait.

Also, no significant differences were found between the various parameters of the two sessions, and this for all the 6 regions under investigation.

However, in some participants a clear different Peak Pressure pattern, was found in the pre-and post exercise situation.

Conclusion: The results of this study show no significant changes in the loading characteristics as reported by other publications.

Background: Simultaneous pancreas-kidney transplantation is performed in type 1 diabetic patients with long standing diabetes and end stage renal disease. Morbidity and mortality rates early after transplantation are high, with lower limb amputations being an important event. However, no data are available on the exact rate of Charcot foot presentation after simultaneous pancreas-kidney transplantation. The aim of the present study was to examine the prevalence of Charcot foot in the population of simultaneous pancreas-kidney transplanted patients at our institution

Methods: We retrospectively examined the medical files and radiographic documents of 66 consecutive patients transplanted in our institution. Demographic and historical data collected included gender, date of diagnosis of DM and nephropathy, mean HbA1c and mean C-peptide, retinopathy and data on renal replacement therapy. Data on immunosuppressive therapy and transplant outcome were also collected.

Results: None of the patients was found to have Charcot foot before transplantation. 8 patients (12%) developed a Charcot foot afterwards (mean 1.8 ± 1.9 years post-transplantation) and four of them developed bilateral involvement in time (6%). No new Charcot foot attacks in the previously affected foot were recorded. Considering the pre-transplant demographic characteristics, all 66 patients were at high risk to develop Charcot foot. Comparing patients who developed Charcot foot to those who did not, a significant difference was only found for pre-transplant glycemic control (mean HbA1c 9.2 ± 1.0 vs. 8.0 ± 1.4, p = 0.01). In patients developing Charcot foot, acute rejection, graft failure and mortality show a trend to be more frequent (HR = 3.57, p = 0.164, HR = 4.56, p = 0.165 and HR = 2.46, p = 0.236, respectively).

Conclusions: Charcot foot proves to be a frequent complication early after simultaneous pancreas-kidney transplantation. Considering the important morbidity and mortality of this complication, awareness of all healthcare providers treating transplanted patients is mandatory to detect a presentation early after onset. Prompt referral to a multidisciplinary diabetic foot clinic for further diagnosis and specialised treatment must always be considered.

Objective: to investigate the long-term clinical and radiological outcome of talar avascular necrosis after treatment by a patellar-tendon bearing brace (PTB), and if parameters predictive for a positive or negative outcome could be identified.

Patients and methods: 21 patients were reviewed retrospectively, 10 had a non-traumatic origin and 11 a traumatic one (groups comparable to gender and age). Mean follow-up was 5,5 and 6,3 years, respectively; mean use of the PTB was 17,2 and 14,8 months. Clinical outcome was assessed by the Mazur scale and the Kitaoka score for function, and a VAS for pain and subjective satisfaction; radiological outcome by the Ficat & Arlet classification and by the Kellgren scale. Clinical parameters were analysed for their positive or negative predictive value on outcome.

Results: A very early pain control was achieved in both groups (2.1 versus 1.9 weeks). On both the Mazur scale and the Kitaoka score the non-traumatic group scored lower as the posttraumatic group (66,3 versus 77,6 and 76.1 versus 78.1). Both VAS were similar in both groups: 3,1 and 3,6 for pain and 6,8 and 7,1 for satisfaction. The need for analgesic medication was slightly higher in the non-traumatic group: 4 versus 3 patients. Radiologically both groups showed a similar outcome with both evaluation systems. Older age, delay in treatment, corticosteroids, alcohol, hyperlipidaemia and female gender were identified as negative predictive parameters.

Conclusions: A PTB is an efficient treatment for talar avascular necrosis of both non-traumatic and traumatic origin. Clinical outcome is better in the posttraumatic group, although radiological outcome is comparable. Only negative predictive parameters could be identified.