Dissertations / Theses on the topic 'Podología'

La Podología es una especialidad sanitaria que a lo largo de su desarrollo ha estado sometida a dualidades empíricas y científica, lo que ha originado que su evolución le haya relegado a un nivel supeditado a otras disciplinas médicas hasta mediados del siglo XIX. Se abordan algunos aspectos de esta evolución , así como también aquellas disposiciones legales que han influido en la profesionalización de la Podología. El hecho de describir la evolución de una profesión, no deja de ser equivalente a la descripción de una evolución cultural de la sociedad, historia y legislación. Especial interés, el análisis de las interacciones que configuran la profesionalización y el papel del podólogo en relación a otras profesiones sanitarias. Esta tesis ha pretendido reflejar la existencia y evolución de una actividad antigua que ha originado una profesión sanitaria.

INTRODUCCIÓN: La diabetes es una patología crónica que constituye un problema de salud pública a nivel mundial. Su prevalencia se ha triplicado en los últimos 20 años. En Cataluña desde el año 2010 tenemos referencia de que la tendencia está en constante ascenso. El pie diabético es una de las complicaciones que preocupa y que implican un gasto económico. Es por ello, que se deben incidir sobre sus factores de riesgo y medidas de prevención con el fin de minorizar estas consecuencias. HIPÓTESIS: El análisis de la implementación de la prestación sanitaria complementaria del Programa de atención podológica del pie para diabéticos en Cataluña y el diseño de un Plan de mejora continua del Programa permitirá la evaluación, el ajuste de la efectividad y conocer la demanda respecto al mismo. OBJETIVOS: Evaluar la implementación de la prestación complementaria de pie diabético en el Sistema Nacional de Salud de Cataluña entre 2009 y 2018, describir las variables epidemiológicas y clínicas de los pacientes usuarios, evaluar el conocimiento y la gestión del Programa que realizan los podólogos/as, así como los conocimientos del servicio de medicina y de enfermería del Centro de AP de referencia y diseñar el Plan de mejora continua del Programa sanitario. MÉTODOS: Se ha llevado a cabo en 5 etapas desde el año 2015 al 2021. En la primera etapa se realizó un estudio sobre una muestra de pacientes usuarios en un centro médico privado, en la segunda y tercera etapa se realizaron encuestas a los profesionales podólogos/as y al servicio de enfermería y medicina del CAP de referencia, en la cuarta etapa se diseñó un Plan de mejora continua con propuestas y acciones de mejora. Por último, en la quinta etapa, se analizaron los datos de la demanda (2009 al 2018) y códigos de diagnóstico y tratamiento (2018-2020) del Programa sanitario. RESULTADOS: El número de las visitas, pacientes y de podólogos/as que forman parte del Programa ha aumentado considerablemente en el periodo de estudio. De la muestra de la primera etapa cabría destacar que un 4,1% de los pacientes presentaron úlceras, con un 0,4% de amputaciones, dato estadísticamente significativo entre amputación y úlcera. Si bien en la segunda etapa del estudio se observó que más de la mitad de los podólogos realizaba la exploración vascular y neuropática, el 81,8% consideraba su actuación de carácter preventivo y afirman en el 84% la necesidad de mejoras organizativas. En la tercera etapa, el 76% de AP (medicina) no consideraban que el número de visitas debían aumentarse. El servicio de enfermería era responsable de la derivación en el 95% de los casos. El Plan de mejora continua diseñado colaboró en el sistema de codificación de diagnósticos y tratamientos implantado en junio del año 2018. CONCLUSIONES: La demanda del Programa ha tenido un aumento progresivo y creciente. Los podólogos actúan mayoritariamente en pacientes derivados sin alteración, interviniendo en la detección precoz de enfermedades vasculares y neuropáticas junto con los profesionales de la AP. En consecuencia, es necesario instaurar un Plan de mejora.
INTRODUCTION: Diabetes is a chronic pathology that constitutes a worldwide public health problem. Its prevalence has tripled in the last 20 years. In Catalonia since 2010 we have reference that the trend has been steadily rising. Diabetic foot is one of the complications of concern and involves economic expenditure. For this reason, it is necessary to influence its risk factors and prevention measures in order to reduce these consequences. HYPOTHESIS: The analysis of the implementation of the complementary health service of the podiatric foot care program for diabetics in Catalonia and the design of a continuous improvement plan of the program will allow the evaluation, the adjustment of the effectiveness and to know the demand for it. OBJECTIVES: To evaluate the implementation of the complementary diabetic foot care in the National Health System of Catalonia between 2009 and 2018, to describe the epidemiological and clinical variables of user patients, to evaluate the knowledge and management of the Program performed by podiatrists as well as the knowledge of family physicians and nurses of the reference PC Center and to design the Plan for continuous improvement of the health Program. METHODS: It has been carried out in 5 stages from 2015 to 2021; first stage a study was conducted on a sample of patient users in a private medical center, in the second and the third stage an assessment through surveys to podiatrists professionals, conducting surveys to the nursing and medical service of the reference CAP, in the fourth stage a continuous improvement Plan was designed with the implementation of proposals and actions for improvement. Finally, in the fifth stage, we analyzed the data on the demand of the health program from 2009 to 2018, as well as evaluated the codes implemented during the period 2018-2020. RESULTS: The number of visits, patients and podiatrists who are part of the Program has increased considerably in the study period. From the first stage sample, it should be noted that 4.1% of the patients presented ulcers, with 0.4% of amputations, a statistically significant 0data between amputation and ulcer. Although more than half of the podiatrists performed vascular and neuropathic examination, 81.8% considered their work to be preventive in nature and 84% stated the need for organizational improvements. In the third stage, 76% of primary care professionals not considered that the number of visits should be increased. The nursing service was responsible for referral in 95% of the cases. The continuous improvementplan designed favored the establish, the diagnosis and treatment coding system implementedin June 2018. CONCLUSIONS: The demand for the Program has had a progressive increase. Podiatrists act mostly in patients referred without alteration, intervening in the early detection of vascular and neuropathic diseases together with primary care professionals. Consequently, it is necessary to establish an improvement plan.

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Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)
Objetivou-se avaliar a integridade dos tecidos dérmico e epidérmico do casco colhidos pelo acesso trans-mural dorsal. Oito equinos adultos hígidos foram submetidos a duas biópsias no casco do membro torácico direito, com intervalo de 24 horas. Previamente, como controle de higidez, realizou-se exame radiográfico da porção distal do membro nas posições dorsopalmar e lateromedial. Os animais foram sedados e o tecido podal foi colhido em dois sítios, 2,5 cm distais à borda coronária. A perfuração da parede do casco foi realizada com pedra de esmerilar de óxido de alumínio de 4,8 mm de diâmetro, acoplada à micro retífica. Ao atingir o extrato médio, a perfuração foi mais lenta até detectar-se o amolecimento da parede mediante pressão aplicada com uma pinça hemostática Halsted, deixando-se um milímetro de extrato médio. Obteve-se então uma superfície lisa com aproximadamente um centímetro de diâmetro. Cortes laterais profundos das lâminas até alcançar a falange distal foram realizados com uso de lâmina de bisturi n° 11. Post eriormente, a amostra de tecido laminar foi removida com o auxilio de um esculpidor Frahm. O fragmento de tecido podal obtido apresentava a forma cubóide com a base medindo aproximadamente cinco milímetros e os lados sete milímetros. A técnica de biópsia desenvolvida neste trabalho permitiu a obtenção de amostras de tecidos laminares, os quais permitiram a realização de análises histológicas e de microscopia eletrônica de transmissão, que revelou integridade das estruturas e ultra-estruturas analisadas
The purpose of this study was to evaluate the integrity of dermal and epidermal tissues collected by dorsal trans-mural access. Eight healthy horses were submitted to two biopsies of the right hoof wall within 24 hours interval. To ensure hoof integrity, radiographic evaluation of dorsopalmar and lateromedial positions was performed. After sedation, laminar tissue was collected at five centimeters distal to the coronary band. The hoof wall was perforated using a 4.8 mm diameter aluminum oxide drill connected to a drilling machine. The perforation was performed slowly in the stratum medium, leaving 1 mm of stratum medium remained, as determined by evaluation of movement in response to pressure applied with a Halstead forceps. A 1 cm diameter flat surface was obtained. Laminar deep incisions until reaching the distal phalanx were performed with a scapel blade and the laminar tissue was removed by use of a Frahm scaler. The samples collected by this biopsy technique showed a cuboidal shape with the base measuring approximately five millimeters by seven millimeters. The biopsy technique developed in this work resulted in laminar tissue samples which, due to their quality, allowed the histological analysis and transmission electron microscopy, showing the integrity of the analysed structures and ultra-structures of hoof laminae

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A doença podal é considerada como a terceira mais importante enfermidade nos bovinos leiteiros, após mastite e problemas reprodutivos, levando a uma perda econômica e financeira significativa. Pesquisadores observaram uma correlação negativa de enfermidades podais com produção leiteira e com a eficiência reprodutiva. O propósito deste estudo foi conhecer a ocorrência, tipo e grau de enfermidades falangeanas assintomáticas diagnosticadas pela radiografia, de fêmeas da espécie bovina Bos indicus, da raça Nelore, provenientes do Centro Nacional de Pesquisa do Gado de Corte da EMBRAPA do município de Campo Grande - MS, criadas em sistema extensivo, pastagem de Brachiaria decumbens, com suplementação mineral e controle sanitário e parasitário rigorosos, e correlacionar o grau de alterações ósseas com o peso vivo, circunferência torácica, DMO, proteínas totais, CK, GGT, albumina, globulina, AST, Ca, P, Mg, Mn, Zn, fosfatase alcalina, osteocalcina, leucograma e o pH rumenal. Foram radiografados os cascos dos quatro membros nas posições dorso-palmar, dorso-plantar e látero-medial e o terceiro osso metacarpo na posição dorso-palmar para avaliação densitométrica. Pela avaliação estatística, não ocorreu correlação entre as variáveis obtidas e lesões ósseas podais. Apenas ocorreu correlação entre idade e presença de exostose podal. Ficou comprovada a importância do exame radiográfico como imprescindível meio de diagnostico para a laminite assintomática.
The pedal disease has been as the third most important disease in dairy cattle, after mastitis and reproduction problems, with a significant economical and financial loss. Workers observed a negative correlation of feet diseases with dairy yield and reproductive performance. The purpose of this study was know the occurrence and type and degree of pathological bone chances in phalangies without clinical signs diagnosed through radiographic examine of bovine females species Bos indicus, from Center National of Research of Beef Bovine, EMBRAPA, city Campo Grande - MS, husbandry in extensive system, pasture of Brachiaria decumbens, with mineral supplement and rigorous parasitic and sanitary control; and to correlate the degree osseus changes with weight, toracic circumference, BMD, Protein total serum, CK, GGT, Albumin, Globulin, AST, Ca, P, Mg, Mn, Zn, Alkaline Phosphatase, Osteocalcin, White blood cells and ruminal pH. The claws of fore and hind of cows were radiographed in dorso-palmar, dorso-plantar and latero-medial views, and the bone metacarpus was radiographed in dorso-palmar view to evaluation densitometric. With statistical analysis did not occur correlation between samples obtained and pedal bone lesions. Occur correlation between age and pedal exostosis. It was confirmed the importance of radiographic examine as recourse diagnosis indispensable to subclinic laminitis.

La presente tesis se origina en unas coordenadas interdisciplinares que se proponen integrar intereses epistemológicos relacionados con las ciencias del lenguaje, la antropología y la sociología y, por otra parte, saberes teóricos y aplicados que se vinculan a la práctica de la podología, su enseñanza y su configuración profesional.

Si queremos definir de una manera sistemática y sintética el planteamiento de esta tesis, diremos que se parte de la siguiente hipótesis inicial: El análisis del discurso puede actuar como eje vertebrador de las aproximaciones interdisciplinares al tema de la construcción de la profesión podológica y contribuir a explicar mecanismos relevantes de ese proceso.

Los objetivos básicos del trabajo son: a) la contextualización social e histórica de ese proceso de construcción de la profesión; b) la descripción y análisis del corpus seleccionado, que es representativo de la actividad discursiva escrita de la comunidad profesional; c) la explicación de la relevancia de los recursos discursivos para incrementar la solidaridad entre los miembros de la comunidad profesional y potenciar su prestigio social.

Finalmente, la metodología escogida corresponde a la aplicación del instrumental teórico y procedimental elaborado por el análisis del discurso, no solo en los aspectos lingüísticos estrictos, sino también en su vertiente de interaccionismo social con un enfoque constructivista y crítico.

Los objetivos citados se cumplen a lo largo de diez capítulos que recorren los aspectos siguientes: Bases para un análisis del discurso de la podología (capítulo 1); Datos para la contextualización de la profesión podológica en el Estado Español (cap.2); La construcción de las profesiones sanitarias a través de las revistas especializadas (cap.3); Corpus de análisis (cap.4); Discurso podológico y semántica léxica: títulos, palabras clave y abstracts (cap.5); Editoriales (cap.6); Artículos culturalistas relacionados con el pie y su representación (cap.7); Función de la imagen gráfica (cap.8); La publicidad en las revistas especializadas (cap.9); Los casos clínicos (cap.10). En el apartado de conclusiones se confirma la operatividad del análisis del discurso para la realización de estos objetivos, tal como se postulaba en la hipótesis inicial. En efecto, las prácticas discursivas examinadas, en particular el corpus extraído de tres revistas profesionales (Revista Española de Podología, El peu, revistapodologia.com), muestran así su relevancia como instrumento en la forja y consolidación de la profesión podológica.

Dissertação de Mestrado Integrado em Medicina Veterinária
Este trabalho procurou testar o efeito de três tratamentos podiátricos sobre o aparelho músculo-esquelético de cavalos ao longo do tempo. Foram selecionados 15 animais, machos, divididos em dois grupos jovens (J) e adultos (A), jovens calçados com ferro (JF) ou deixados descalços (JD), adultos calçados com alumínio (AA) ou calçados com ferro (AF), durante 5 meses. A resposta foi avaliada de modo não invasivo com recurso à ultrassonografia quantitativa (QUS), com três acessos aos terceiros metacarpianos esquerdo e direito: dorsal, lateral e medial. Os valores médios obtidos para cada variável foram: dorsal esquerdo = 3908±142, dorsal direito = 3898±148, lateral esquerdo = 4317±95, lateral direito = 4314±110, medial esquerdo = 4128±208 e medial direito = 4110±166. Para valores de significância de P<0.05, concluiu-se que nenhum dos tratamentos realizados teve efeito, quer positivo quer negativo, sobre a amostra estudada ainda que diversos fatores possam ter influenciado os resultados obtidos. Os testes deveriam ser continuados e mais animais incorporados à amostra para tentar obter conclusões mais representativas.
ABSTRACT - ASSESSMENT OF THE IMPACT OF DIFFERENT TYPES OF SHOEING MATERIALS ON THE BONE QUALITY IN ADULT HORSES STUDIED IN THE III METACARPUS - The purpose of this study was to test the effect of three different podiatric treatments on the musculoskeletal system of horses trough time. A total of 15 animals were selected, all males, divided in two groups young (J) and adults (A), young shoed with iron (JF) or left barefooted (JD), adults shoed with aluminium (AA) or iron (AF), during 5 months. The response was evaluated using a non-invasive technique of quantitative ultrasonography (QUS), in three aspects of the third metacarpal bones left and right: dorsal, lateral and medial. The average values obtained for each variant were: left dorsal = 3908±142, right dorsal = 3898±148, left lateral = 4317±95, right lateral = 4314±110, left medial = 4128±208 and right medial = 4110±166. With significance values of P<0.05, it was concluded that none of the performed treatments had an effect, either positive or negative, on the studied sample although several factors may have influenced the obtained values. The tests should be continued and more animals should be added to the sample to gather more representative conclusions.
N/A

L'etude de cinq taillis de chataignier de rejets d'age varies (2, 5, 9, 13 et 25 ans) et installes sur des stations peu fertiles, met en evidence des differences dans le fonctionnement du cycle biologique des elements nutritifs (n, p, k, ca, et mg). Les facteurs edaphiques ainsi que l'age des rejets jouent un role important dans la circulation de ces elements. La coupe du taillis favorise la degradation et la demineralisation de la matiere organique. Les elements ainsi liberes, principalement le calcium, servent a recharger le complexe adsorbant des horizons de surface. Lorsque les rejets vieillissent et s'accroissent, les prelevements des elements nutritifs par les racines ainsi que leur stockage dans le bois augmentent. Ces faits contribuent a l'appauvrissement des horizons humiferes en bases echangeables que ne peut compenser le cycle biochimique des sols de nature ocre podzolique des taillis de 13 et 25 ans

Conception et évaluation d’un modèle biomécanique, éléments finis, patient-spécifique, du pied humainApplications en podologie, orthopédie et diabétologieLe pied est une des structures les plus complexes du corps humain. Avec 28 os, 33 articulations et une centaine de structures ligamentaires, cette entité poly articulée est le résultat d’une hyperspécialisation ayant contribué à faire de l’homme l’unique primate totalement bipède. Quelque soit le relief, quelque soit le mouvement en cours, le pied transmet au tibia le bon vecteur force afin de finaliser le geste de la manière la plus précise et économe en énergie possible dans l’objectif de préparer l’action des segments sus jacents. Ainsi, en cas de lésion d’une des structures, l’ensemble du complexe pied doit pouvoir s’adapter, si ce n’est pas le cas, les tissus mous, les articulations ou les os seront fragilisés et verront leur fonction propre au sein de ce complexe altérée.Prédire l’adaptation du pied à une modification structurelle, tissulaire, neurologique ou fonctionnelle est un enjeu important dans l’estimation du risque lésionnel.Afin d’initier une réponse à ces problématiques, nous avons décidé au cours de cette thèse de modéliser le pied humain avec des outils mathématiques de simulation biomécanique. Dans un premier temps, un modèle tridimensionnel musculo-squelettique du pied a été reconstruit à partir d’imagerie scanner. Le pied polyarticulé en multicorps rigides obtenu possède des articulations uniquement contraintes par les ligaments et contacts osseux. Les muscles ont été implémentés afin de piloter le modèle en dynamique directe. Enfin, les tissus mous comme les volumes musculaires, le gras et la peau ont été maillés en éléments finis. L’utilisation d’un environnement de programmation multi-physique open source (Artisynth) a permis de coupler la modélisation musculo-squelettique et éléments finis.• L’adaptation du pied au sol en orthostatisme a été évaluée par comparaison des cartographies de pression d’une mise en charge simulée avec la mise en charge réelle du sujet.• Le contrôle moteur du pied en chaine ouverte par l’activation des muscles extrinsèques a été évalué en comparant la cinématique du modèle biomécanique pilotée par électromyographie avec la cinématique capturée en laboratoire sur un mouvement d’abduction – adduction.• Nous avons ensuite cherché à comprendre comment une arthrodèse de cheville modifie la cinématique du pied à la contraction musculaire, l’objectif étant d’aider au réglage chirurgical du geste.• Enfin nous avons utilisé les dernières avancées sur la physiologie de la plaie de pression afin de prédire le risque d’ulcération sur un pied neuroarthropatique diabétique par simulation numérique.Le modèle ainsi que les routines de simulations mis en place nous permettent d’avoir un des modèles les plus aboutis du pied humain utilisant aussi bien des données physiques externes comme les données baropodométriques, les données d’analyse quantifiée du mouvement ou encore les données électromyographiques. Ce modèle permettra par l’intermédiaire d’outils de mesh-matching d’obtenir des modèles patients spécifiques. Les domaines d’applications porteront sur l’aide au geste chirurgical, la prévention des risques d’ulcération, l’analyse avancée des relations entre le pied et le membre inférieur, mais aussi l’aide à la conception de prothèse en orthopédie classique et en mécatronique
Biomechanical modeling of the human foot. Application to the healthy and pathological subject.The foot is one of the more complex structures of the human body. With 28 bones, 33 joints and a hundred ligamentous structures, this articulated entity is the result of a hyper specialization that makes humans the only obligate bipedal primates. Whatever the terrain, whatever the current movement, the foot transmits to the tibia the right force vector to finalize the gesture in the most precise and efficient manner and prepares the action of the lower limb. Thus, in case of injury to one of the structures, the whole foot complex must adapt if it is not the case, soft tissues, joints or bones are fragile and will have their own function within this complex altered .Predicting the foot’s adaptation of a structural, tissue, neurological or functional modification is an important issue in estimating the risk lesion on locomotion, in the design of therapeutic footwear and orthotics of the degenerative foot, but also in the future of this complex in situations where the boundary conditions change like working in microgravity or foot exoskeleton coupling.To initiate a response to these problems, we decided during this thesis to model the human foot with mathematical tools for biomechanical simulation. Initially, a musculoskeletal three-dimensional model of the foot was reconstructed from computed tomography. The multi-articulated foot joints constraints obtained by ligaments and bone contact. The muscles have been implemented to control the model in direct dynamic. Finally, the soft tissues such as muscle volume, fat and skin were meshed into finite elements. Using a multi-physics open source programming environment (Artisynth) allowed to couple musculoskeletal modeling and finite elements.• Adapting the foot on the ground in upright posture was evaluated by comparing the pressure maps at a simulated load setting with the actual loading pressure map of the subject.• The motor control of foot in opened chain by activation of the extrinsic muscles was assessed by comparing the kinematics of the biomechanical model piloted by electromyography with kinematics captured in the laboratory on a movement of abduction - adduction.• We then sought to understand how an ankle arthrodesis alter the kinematics of the foot muscle contraction, with the aim of helping the surgical setting gesture.• Finally, we used the latest advances in the physiology of a pressure ulcer to predict the risk of ulceration on diabetic foot with Charcot neuro arthropathy by numerical simulation.The model and simulation routines in place allow us to have one of the most successful models of the human foot using both external physical data like pedobarographic data, motion analysis data or electromyography data. This model will allow through mesh-matching tool to obtain specific patient models. The fields of applications will focus on assisted surgery, prevention of ulceration, advanced analysis of relations between the foot and the leg, but also will help the prosthesis design in orthopedic and mechatronics

Dissertação (mestrado)—Universidade de Brasília, Faculdade de Agronomia e Medicina Veterinária Programa de Pós-Graduação em Saúde Animal, 2017.
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Devido à característica e ao envolvimento vascular da pododermatite asséptica, a compreensão das ocorrências vasculares dentro do casco passou a ser o foco dos trabalhos científicos. A venografia começou a ser utilizada para este fim. É um método de diagnóstico por imagem minimamente invasivo, prático e essencial para acessar a circulação digital. Auxilia, portanto, médicos veterinários e ferradores na escolha da terapêutica apropriada para a restauração da circulação do digito; possuindo acurado valor prognóstico. No presente trabalho, para o estudo venográfico dos cascos de membros torácicos, foram utilizados 19 equinos com idade média de 9,5 ± 4,4 anos, 12 machos e 07 fêmeas, sendo 11 animais com ausência de sinais clínicos de claudicação e 08 apresentando grau de claudicação de apoio, variando de 1 a 4/5, de acordo com método proposto pela AAEP. O objetivo do trabalho foi avaliar venogramas dos dígitos de animais claudicantes e não claudicantes, a partir da criação de escala semi-quantitativa de preenchimento por contraste radiográfico, nas seguintes regiões: arco terminal, vasos laminares dorsais a falange distal, plexo coronário, vasos circunflexos e bulbo do talão. Os dados obtidos foram submetidos à análise estatística ANOVA, complementados por TUKEY, com nível de significância p < 0,05 para comparação entre todos os grupos (membro torácico esquerdo de animais não claudicantes, membro torácico direito de animais não claudicantes, membro torácico esquerdo de animais claudicantes e membro torácico direito de animais claudicantes). Obteve-se diferença estatística entre os venogramas dos animais claudicantes e não claudicantes, não importando o membro torácico utilizado para a análise. Isso significa dizer que o animal com deficiência de apoio apresenta menor perfusão do dígito. Quanto as regiões observadas, a diminuição de irrigação se fez presente com maior frequência no arco terminal, nos vasos circunflexos e nos vasos laminares dorsais.
Due to the characteristic and vascular involvement of aseptic pododermatitis, the understanding of vascular occurrences within the foot became the focus of scientific work. The venography began to be used for this purpose. It is a minimally invasive, practical and essential diagnostic imaging method to access the digital circulation. It assists, therefore, veterinarians and farriers in the choice of the appropriate therapy for the restoration of the circulation of the digit, having an accurate prognostic value. In the present research, 19 horses with a mean age of 9.5 ± 4.4 years,12 males and 07 females, were used for the venography study of the foot of the forelimbs, of wich 11 without clinical signs of lameness and 08 presented a degree of claudication of support, varying from 1 to 4/5, according to the method proposed by the AAEP.The purpose of this study was to evaluate the venograms of the digits of both, claudicating and nonclaudicating animals, from the creation of a semi-quantitative scale flilled by radiographic contrast data, of the following regions: terminal arch, dorsal laminar vessels to the distal phalanx, coronary plexus, circumflex vessels and heel perfusion. The gathered data were submitted to ANOVA statistical analysis, complemented by TUKEY, with significance level p <0.05 for comparison between all groups (left thoracic limb of non-claudicating animals, right thoracic limb of non-claudicating animals, left thoracic limb of claudicating animals and right thoracic limb of claudicating animals). There was a statistical difference among the venograms of the claudicating and non-claudicating animals, regardless of the thoracic limb used for the analysis. This means that the animal with a support deficiency has lower perfusion of the digit. Regarding the regions observed, the decrease of irrigation was more frequently present in the terminal arch, circumflex vessels and dorsal laminar vessels.

La cirugía podológica es una cirugía ambulatoria con unas características propias que implica un papel activo del paciente durante el periodo postquirúrgico. El paciente debe ser capaz de realizarse pequeñas curas, detectar signos y síntomas de alerta y tomar la medicación farmacológica pautada. Se ha sugerido que, en las cirugías ambulatorias, al transferir estas responsabilidades del hospital al paciente, puede aumentar la ansiedad del paciente durante el periodo postquirúrgico. La ansiedad desde el momento que finaliza la cirugía hasta el momento del alta quirúrgica ha recibido una atención insuficiente en la literatura médica y en la práctica clínica habitual. Se detectó, en las 116 cirugías podológicas estudiadas, un nivel de ansiedad moderado que decrecía progresivamente durante el periodo postquirúrgico temprano. La relación de esta ansiedad con el dolor resulto ser especialmente importante a los 10 días postquirúrgicos, mientas que no se encontró relación entre la ansiedad y el consumo de analgésicos. Destaca, que la mayoría de los pacientes sometidos a cirugía podológica en este estudio se muestran satisfechos. Existe una sólida evidencia que demuestra que la percepción de control y las preocupaciones influyen en la ansiedad por lo que también se estudió la relación de la ansiedad durante el periodo postquirúrgico temprano con estos aspectos, viéndose que la percepción de control y las preocupaciones influyen en la ansiedad. Conocer la ansiedad durante el proceso postquirúrgico nos ayuda a mejorar la experiencia quirúrgica del paciente y conseguir el mejor resultado quirúrgico posible.
Podiatric surgery is an outpatient surgery with its own characteristics that implies an active role of the patient during the post-surgical period. The patient should be able to perform small cures, detect signs and symptoms of alertness and take prescribed pharmacological medication. It has been suggested that in outpatient surgeries, transferring these responsibilities from the hospital to the patient may increase the patient's anxiety during the postoperative period. Anxiety from the time the surgery ends to the time of discharge is under-reported in the medical literature and in routine clinical practice. In the 116 podiatric surgeries studied, a moderate level of anxiety gradually decreased during the early postoperative period. The relationship of this anxiety with pain turned out to be especially important at 10 postoperative days, while no relationship was found between anxiety and analgesic use. It should be noted that the majority of patients undergoing podiatric surgery in this study are satisfied. There is strong evidence that perception of control and levels of concern- influence anxiety and so the relationship of anxiety during the early postoperative period with these aspects was also studied, and it was found that perceived control and levels concerns influence anxiety. Knowing the anxiety during the post-surgical process helps us improve the patient's surgical experience and achieve the best surgical result possible.

La sole plantaire, véritable interface entre le corps et le sol, joue un rôle primordial dans le contrôle de la posture bipédique. Diverses pathologies peuvent affecter le capteur podal. Elles se situent le plus souvent au niveau de la face plantaire, et sont généralement accompagnées de phénomènes algiques voir hyperalgiques. Un quart de la population présente ou présentera une pathologie au niveau des pieds. Les douleurs associées à ces pathologies podales sont souvent décrites comme invalidantes, par les patients, réduisant le périmètre de marche et associées à une cohorte de gênes fonctionnelles (démarche antalgique, douleurs sus-jacentes, anxiété, état dépressif…). La prise en charge de podologie raisonnée de ces podalgies, notamment chez la personne âgée, représente aujourd'hui un enjeu de santé publique majeur. Pour y répondre, il est tout d’abord nécessaire de mener une recherche fondamentale sur les mécanismes mis en jeu dans le contrôle de la posture bipédique, afin de proposer une prise en charge adaptée et raisonnée (« evidence based practice ») des troubles de la posture chez des personnes souffrant de douleurs plantaires.Ce préalable important et nécessaire constitue le cœur et la justification de ce travail doctoral. L’objectif était d’évaluer les effets d’une douleur plantaire induite mécaniquement sur le contrôle de la posture bipédique.Pour répondre à cet objectif général, trois études complémentaires ont été successivement conduites. La première étude visait, dans un premier temps, à évaluer les effets d’une stimulation douloureuse des soles plantaires sur le contrôle de la posture bipédique. Les deuxième et troisième études visaient à évaluer, si et dans quelle mesure, ces effets étaient modifiés en fonction des informations visuelles et sensorielles issues du segment tête-cou pour l’étude 2 et des informations sensorielles issues du segment pied-cheville pour l’étude 3.Dans leur ensemble, les conclusions de ce travail doctoral mettent en évidence l’importance des afférences nociceptives plantaires dans le contrôle de la posture bipédique. En effet, une stimulation douloureuse mécanique des soles plantaires dégrade les capacités de contrôle de la posture bipédique. Une stimulation douloureuse mécanique des soles plantaires induit également une modification de la contribution des différentes informations sensorielles (informations visuelles, informations sensorielles issues du segment tête-cou et du segment pied-cheville) mise en jeu pour contrôler la posture bipédique, soulignant ainsi les mécanismes de repondération sensorielle.Les travaux de cette thèse de doctorat constituent un préambule fondamental indispensable à l’optimisation de la prise en charge par le podologue des douleurs plantaires, et, plus largement, à l’amélioration de l’autonomie et de la qualité de vie des personnes souffrant de douleurs plantaires. Dans ce sens, diverses études cliniques visant à évaluer les effets des orthèses plantaires, sur la prise en charge des douleurs plantaires et par voie de conséquence l’amélioration et/ou le recouvrement des capacités de contrôle de la posture bipédique, sont en cours
The plantar sole, first point of contact between the body and the ground, plays a real key role in bipedal postural control. A lot of painful pathologies can affect the feet, particularly on the plantar face. Approximately one quarter of the population suffers or will suffer from foot injuries. The pain associated with these pathologies podal are often described as disabling for patients, reducing the walking distance and associated with a cohort of functional perturbations (limp, lowback pain, anxiety, depression ...). Care of foot pain, notably in elderly people, is a very important issue in public health. In order to achieve such care, it is necessary to conduct some fundamental research about the mechanisms that are in action concerning bipedal postural control, to propose some adapted treatments (evidence based practice) to improve the posture of the patients who have foot pain.This important and necessary prerequisite is the heart and justification of this doctoral work. The aim was to evaluate the effects of experimentally induced plantar pain on the bipedal postural control.Three experiments were successively conducted. The aim of the first experiment was to evaluate the effects of experimentally induced plantar pain on the bipedal postural control. The second and third experiments were aimed to assess if these effects were modified in function of the somatosensory information from the vision, the vestibular system and the neck (Study 2) and the somatosensory information from the ankle (Study 3).The results show that an experimentally induced plantar pain degrades the capacity to maintain postural control, and modifies the contributions of the other senses (visual, vestibular, neck and ankle muscle proprioception), showing the mechanisms of somatosensory reweighting in postural control when a pain was applied.This research constitutes a fundamental and indispensable starting point to optimize the care of foot injuries by podiatrists and, more broadly, to improve the autonomy and quality of life of persons suffering from foot pain.Clinical experiments aim to address these issues

La thèse présentée a pour objectif d’analyser les modifications cinématiques et affectives générées par les orthèses plantaires (OP) lors de la locomotion chez les sujets présentant une inégalité de la longueur des membres inférieurs (ILMI). L’ILMI est une affection courante due soit à des déformations anatomiques, soit à une déformation fonctionnelle. L’ILMI a été associée à plusieurs pathologies et douleurs au niveau des membres inférieurs et du bassin, et est souvent traitée par OP dans le domaine de la podologie. Cependant, il n’existe pas encore de réel consensus quant aux effets des OP sur la cinématique de la marche chez les sujets présentant une ILMI légère (≤ 3,0 cm). L’objectif général de cette thèse est de savoir si les OP peuvent être un traitement adapté pour les sujets présentant une légère ILMI. Une première étude nous a permis de mettre en avant une diminution significative des lombalgies chez les sujets présentant une ILMI légère sans effet significatif sur la symétrie articulaire après 3 semaines d’utilisation de semelles orthopédiques (SO). Ensuite, une revue systématique de la littérature a confirmé l’effet positif des OP sur les douleurs lombaires. Toutefois, les OP semblaient diminuer les déséquilibres cinématiques des sujets présentant une ILMI, seulement lorsque l’ILMI était modérée à sévère. Notre dernière étude révèle un effet immédiat des SO sur la cinématique et la douleur chez des sujets présentant une légère ILMI. Les SO semblent pouvoir améliorer la symétrie articulaire au niveau du bassin dans le plan frontal et de la cheville dans le plan sagittal, ainsi que la douleur des sujets présentant une légère ILMI. Ces trouvailles suggèrent que l’analyse cinématique peut être utile dans le domaine de la podologie
The aim of this doctoral thesis is to analyze the kinematic and affective modifications generated by foot orthoses (FO) during locomotion in subjects with limb length discrepancy (LLD). LLD is a common condition due to either anatomical or functional deformities. LLD has been associated with several pathologies and pain in the lower limbs and pelvis, and is often treated by FO in the field of podiatrist. However, there is not yet consensus regarding the effects of FO on gait kinematics in subjects with mild LLD (≤ 3.0 cm). The main aim of this doctoral thesis is to determine whether FO can be an appropriate treatment for subjects with mild LLD. A first study highlights a significant decrease in low back pain in subjects with mild LLD without significant effect on joint symmetry after 3 weeks of use of orthotics insoles (OI). Then, a systematic review of the literature confirms the positive effect of FO on low back pain. However, the FO appear to decrease kinematic imbalances in subjects with LLD, only when LLD is moderate to severe. Our latest study shows an immediate effect of OI on kinematics and pain in subjects with mild LLD. OI seem likely to improve joint symmetry in the pelvis in the frontal plane and the ankle in the sagittal plane, as well as pain in subjects with mild LLD. These findings suggest that kinematic analysis can be useful in the field of podiatry

Resumo: Objetivou-se avaliar a integridade dos tecidos dérmico e epidérmico do casco colhidos pelo acesso trans-mural dorsal. Oito equinos adultos hígidos foram submetidos a duas biópsias no casco do membro torácico direito, com intervalo de 24 horas. Previamente, como controle de higidez, realizou-se exame radiográfico da porção distal do membro nas posições dorsopalmar e lateromedial. Os animais foram sedados e o tecido podal foi colhido em dois sítios, 2,5 cm distais à borda coronária. A perfuração da parede do casco foi realizada com pedra de esmerilar de óxido de alumínio de 4,8 mm de diâmetro, acoplada à micro retífica. Ao atingir o extrato médio, a perfuração foi mais lenta até detectar-se o amolecimento da parede mediante pressão aplicada com uma pinça hemostática Halsted, deixando-se um milímetro de extrato médio. Obteve-se então uma superfície lisa com aproximadamente um centímetro de diâmetro. Cortes laterais profundos das lâminas até alcançar a falange distal foram realizados com uso de lâmina de bisturi n° 11. Post eriormente, a amostra de tecido laminar foi removida com o auxilio de um esculpidor Frahm. O fragmento de tecido podal obtido apresentava a forma cubóide com a base medindo aproximadamente cinco milímetros e os lados sete milímetros. A técnica de biópsia desenvolvida neste trabalho permitiu a obtenção de amostras de tecidos laminares, os quais permitiram a realização de análises histológicas e de microscopia eletrônica de transmissão, que revelou integridade das estruturas e ultra-estruturas analisadas
Abstract: The purpose of this study was to evaluate the integrity of dermal and epidermal tissues collected by dorsal trans-mural access. Eight healthy horses were submitted to two biopsies of the right hoof wall within 24 hours interval. To ensure hoof integrity, radiographic evaluation of dorsopalmar and lateromedial positions was performed. After sedation, laminar tissue was collected at five centimeters distal to the coronary band. The hoof wall was perforated using a 4.8 mm diameter aluminum oxide drill connected to a drilling machine. The perforation was performed slowly in the stratum medium, leaving 1 mm of stratum medium remained, as determined by evaluation of movement in response to pressure applied with a Halstead forceps. A 1 cm diameter flat surface was obtained. Laminar deep incisions until reaching the distal phalanx were performed with a scapel blade and the laminar tissue was removed by use of a Frahm scaler. The samples collected by this biopsy technique showed a cuboidal shape with the base measuring approximately five millimeters by seven millimeters. The biopsy technique developed in this work resulted in laminar tissue samples which, due to their quality, allowed the histological analysis and transmission electron microscopy, showing the integrity of the analysed structures and ultra-structures of hoof laminae
Orientador: José Corrêa de Lacerda Neto
Coorientadora: Rita de Cássia de Lima Sampaio
Banca: Rosimeri de Oliveira Vasconcelos
Banca: Juliana Regina Peiro
Mestre

Resumo: A doença podal é considerada como a terceira mais importante enfermidade nos bovinos leiteiros, após mastite e problemas reprodutivos, levando a uma perda econômica e financeira significativa. Pesquisadores observaram uma correlação negativa de enfermidades podais com produção leiteira e com a eficiência reprodutiva. O propósito deste estudo foi conhecer a ocorrência, tipo e grau de enfermidades falangeanas assintomáticas diagnosticadas pela radiografia, de fêmeas da espécie bovina Bos indicus, da raça Nelore, provenientes do Centro Nacional de Pesquisa do Gado de Corte da EMBRAPA do município de Campo Grande - MS, criadas em sistema extensivo, pastagem de Brachiaria decumbens, com suplementação mineral e controle sanitário e parasitário rigorosos, e correlacionar o grau de alterações ósseas com o peso vivo, circunferência torácica, DMO, proteínas totais, CK, GGT, albumina, globulina, AST, Ca, P, Mg, Mn, Zn, fosfatase alcalina, osteocalcina, leucograma e o pH rumenal. Foram radiografados os cascos dos quatro membros nas posições dorso-palmar, dorso-plantar e látero-medial e o terceiro osso metacarpo na posição dorso-palmar para avaliação densitométrica. Pela avaliação estatística, não ocorreu correlação entre as variáveis obtidas e lesões ósseas podais. Apenas ocorreu correlação entre idade e presença de exostose podal. Ficou comprovada a importância do exame radiográfico como imprescindível meio de diagnostico para a laminite assintomática.
Abstract: The pedal disease has been as the third most important disease in dairy cattle, after mastitis and reproduction problems, with a significant economical and financial loss. Workers observed a negative correlation of feet diseases with dairy yield and reproductive performance. The purpose of this study was know the occurrence and type and degree of pathological bone chances in phalangies without clinical signs diagnosed through radiographic examine of bovine females species Bos indicus, from Center National of Research of Beef Bovine, EMBRAPA, city Campo Grande - MS, husbandry in extensive system, pasture of Brachiaria decumbens, with mineral supplement and rigorous parasitic and sanitary control; and to correlate the degree osseus changes with weight, toracic circumference, BMD, Protein total serum, CK, GGT, Albumin, Globulin, AST, Ca, P, Mg, Mn, Zn, Alkaline Phosphatase, Osteocalcin, White blood cells and ruminal pH. The claws of fore and hind of cows were radiographed in dorso-palmar, dorso-plantar and latero-medial views, and the bone metacarpus was radiographed in dorso-palmar view to evaluation densitometric. With statistical analysis did not occur correlation between samples obtained and pedal bone lesions. Occur correlation between age and pedal exostosis. It was confirmed the importance of radiographic examine as recourse diagnosis indispensable to subclinic laminitis.
Orientador: Lucy Marie Ribeiro Muniz
Coorientador: Pedro Paulo Pires
Doutor

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Coordenação de Aperfeiçoamento de Pessoal de Nível Superior
Considerando a lacuna na bibliografia existente sobre a educação profissional como campo de estudo, esta pesquisa pretende investigar a constituição da profissionalidade e os saberes docentes no eixo tecnológico Ambiente, Saúde e Segurança áreas de Saúde e Bem-estar. Foi realizada uma pesquisa qualitativa com dez docentes, atuantes nos cursos: Técnico em Enfermagem, Técnico em Estética, Técnico em Massoterapia, Técnico em Podologia e Técnico em Segurança do Trabalho, da unidade Jundiaí do Serviço Nacional de Aprendizagem Comercial SENAC (São Paulo), em duas etapas distintas: primeiramente, por meio de entrevistas individuais e, posteriormente, por meio de dois encontros coletivos psicodramáticos, com a presença de seis dos dez participantes, em cada um dos encontros. O quadro teórico está fundamentado nas produções de: Placco e Souza (2006), Imbernón (2011), Tardif (2002), Freire (1983, 2002), Barato (2003, 2004), Shulman (1987) e Moreno (1975, 2008). Os dados nos possibilitam analisar os processos de socialização primária e profissional dos docentes, identificando a constituição da profissionalidade docente como o desenvolvimento do exercício docente, in loco e na relação aluno-docente, de modo processual, gradual e infindável, baseada nas experiências pessoais, escolares e profissionais dos docentes. Outro resultado significativo, na pesquisa, é a relevância da interdependência dos saberes docentes, especialmente os profissionais-experienciais, os pedagógicos, os pessoais e os do profetizar, que se imbricam no desenvolvimento da profissionalidade. Embora não se reconhecendo como profissionais docentes, as falas dos pesquisados nos permitem afirmar que há um desenvolvimento dessa profissionalidade e dos saberes docentes pedagógicos, com o compromisso e a intencionalidade explícitos com a aprendizagem dos alunos e da docência, com o exercício profissional Considering the gap in the literature on vocational education as a field of study, this research aims to investigate the construction of professionality and teaching knowledge in the technical domain of Environment, Health and Safety - fields of Health and Wellness. A qualitative survey was conducted with 10 teachers of the following courses: Nursing Technician, Esthetics Technician, Massage Therapy Technician, Podiatry Technician, and Occupational Safety Technician from the Jundiaí unit of Serviço Nacional de Aprendizagem Comercial (Senac São Paulo), in two distinct stages first, through individual interviews and later, through two group psychodramatic encounters, with six participants per encounter. The theoretical framework is based on the works of: Placco e Souza (2006), Imbernón (2011), Tardif (2002), Freire (1983, 2002), Barato (2003, 2004), Shulman (1987), and Moreno (1975, 2008). The data allowed us to analyze the teachers primary and professional socialization processes and identify the construction of teaching professionality as the development of the teaching practice, both on site and in the student-teacher relation, in a gradual, never-ending process, based on the teachers personal, school, and professional experiences. Another significant result of the research is the relevance of the interdependence of teaching knowledge - especially professional/experiential, educational, personal, and prophetic skills, which interweave in the development of professionality. Although the respondents do not identify themselves as teaching professionals, their reports allow us to state that the educational professionality and teaching knowledge are developed with an explicit commitment and intentionality to the students learning and education, with professional practice and with the enhancement of their educational skills. The perception of the possibility of social change, through education, also strengthens and deepens the respondents educational vision
Considerando a lacuna na bibliografia existente sobre a educação profissional como campo de estudo, esta pesquisa pretende investigar a constituição da profissionalidade e os saberes docentes no eixo tecnológico Ambiente, Saúde e Segurança áreas de Saúde e Bem-estar. Foi realizada uma pesquisa qualitativa com dez docentes, atuantes nos cursos: Técnico em Enfermagem, Técnico em Estética, Técnico em Massoterapia, Técnico em Podologia e Técnico em Segurança do Trabalho, da unidade Jundiaí do Serviço Nacional de Aprendizagem Comercial SENAC (São Paulo), em duas etapas distintas: primeiramente, por meio de entrevistas individuais e, posteriormente, por meio de dois encontros coletivos psicodramáticos, com a presença de seis dos dez participantes, em cada um dos encontros. O quadro teórico está fundamentado nas produções de: Placco e Souza (2006), Imbernón (2011), Tardif (2002), Freire (1983, 2002), Barato (2003, 2004), Shulman (1987) e Moreno (1975, 2008). Os dados nos possibilitam analisar os processos de socialização primária e profissional dos docentes, identificando a constituição da profissionalidade docente como o desenvolvimento do exercício docente, in loco e na relação aluno-docente, de modo processual, gradual e infindável, baseada nas experiências pessoais, escolares e profissionais dos docentes. Outro resultado significativo, na pesquisa, é a relevância da interdependência dos saberes docentes, especialmente os profissionais-experienciais, os pedagógicos, os pessoais e os do profetizar, que se imbricam no desenvolvimento da profissionalidade. Embora não se reconhecendo como profissionais docentes, as falas dos pesquisados nos permitem afirmar que há um desenvolvimento dessa profissionalidade e dos saberes docentes pedagógicos, com o compromisso e a intencionalidade explícitos com a aprendizagem dos alunos e da docência, com o exercício profissional e com o aperfeiçoamento de suas práticas pedagógicas. A percepção de possibilidade de transformação social, por meio da docência, também reforça e aprofunda a visão educacional dos pesquisados