Regional and national responses
The advisory panel for the government of Ontario, Canada has recommended against the use of heparin for management of thrombosis after vaccination until more is known.In response to the concerns over the adverse effects relating to rare blood clotting types Germany has suspended use of the AZD1222 in those under 60 years of age; in contrast to a period previously having suspended use of AZD1222 to over–65s due to limited data of the efficacy of the vaccine to this age group at that time.Following a few days of suspended use of AZD1222, the Ministry of Health, Welfare and Sport of the Netherlands decided to continue administering the vaccine only to persons above the age of 60.On 8 April 2021, the Australian Technical Advisory Group on Immunisation (ATAGI) advised the Australian Government that the Pfizer COVID‑19 vaccine is recommended over AZD1222 for adults aged under 50 years. The advice is "based on the increasing risk of severe outcomes from COVID‑19 in older adults (and hence a higher benefit from vaccination) and a potentially increased risk of thrombosis with thrombocytopenia following AstraZeneca vaccination in those under 50 years." AZD1222 is still recommended by ATAGI for people over 50, and those under 50 who have already had their first dose with no ill effects. In the state of Victoria, there were reports of some, aged under 50, being turned away from vaccination centres, despite having confirmed appointments.
Brachymetatarsia is a condition in which there is one or more abnormally short or overlapping toe bones (metatarsals). This condition may result due to a congenital defect or it may be an acquired condition. It most frequently involves the fourth metatarsal. If it involves the first metatarsal, the condition is known as Mortons syndrome. Treatment is via a number of differing surgical procedures. Diagnosis
Differential diagnosis
Congenital causes include: Aarskog syndrome, Turner syndrome, Albrights hereditary osteodystrophy, maternal ingestion of thalidomide during pregnancy and Apert syndrome. Can be caused by a trauma, although the exact mechanism is not known. Treatment
Symptoms may be treated by wearing wider shoes to relieve pressure, or patient can wear padding around the toes. Surgery is also an option, if the pain and discomfort cannot be treated, or for cosmetic reasons. In this procedure, the short metatarsal is typically cut and a piece of bone is grafted between the two ends. In some cases an external fixator may be attached to the metatarsal with pins. Within the external fixator is an adjustable screw that must be turned (per doctors orders) to lengthen the gap between bone segments, so the bone will regrow to the appropriate shape.Following surgery, crutches or a knee scooter should be used to keep all weight off the surgically repaired foot for 3 months. After this period, orthopedic shoes or boots may be used. Epidemiology
Brachymetatarsia is found to occur more frequently in women than men.