B | Basicmedical Key

Post type	Rationale
Forefoot posts	Post (extrinsic/intrinsic/combination of both) to improve medial-column stability; posting degree/type is dictated by angle between plantar aspects of forefoot and heel, available ranges of motion and level of control sought Extrinsic posts are added to the undersurface of the distal part of the orthotic shell, in effect ‘bringing the ground up to the foot’ and allowing foot to function in its natural orientation to ground and lower limb, whilst accommodating/resolving symptoms of the biomechanical problem Intrinsic posts are added to the cast of the foot to allow the orthosis, made to the adapted cast, to alter the angulation of the medial column in relation to the ground surface. An intrinsically posted orthotic allows the forefoot to come down toward the ground surface during gait and resolves the biomechanical problem by modifying foot function
Bar post	Post (2–5 mm thick) added to the underside of distal part of orthotic to create greater lateral column stability
Rearfoot posts	Extrinsic rearfoot post; post dimension is dictated by the angle between calcaneal bisection and midline of lower leg, and the level of control sought Blake post aligns distal edge of forefoot to parallel with undersurface of extrinsic rearfoot post, imposing considerable rearfoot control

Note: Functional orthoses are made to casts of the foot in subtalar neutral (i.e. point in the gait cycle when the midtarsal area is at its most stable).

baroreceptors stretch-sensitive sensory nerve endings in principal vascular structures which trigger central nervous system reflex pressure-reducing mechanisms, to reduce systolic pressure

barrier preparations topically applied water-repellent creams/ointments (e.g. zinc cream BP, zinc ointment BP, zinc and caster oil ointment BP) used to prevent skin maceration

basal cell carcinoma; BCC; rodent ulcer common skin malignancy caused by long-term exposure to ultraviolet light (sunlight) or irradiation, or from pre-existing naevoid lesions; forms as a pearly nodule that later ulcerates; is locally invasive, but rarely metastatic; treated by excision ± skin graft (see Table N2)

basal cell papilloma see seborrhoeic keratosis

basal closing-wedge osteotomy wedge-shaped excision from the lateral basal area of the first metatarsal to correct severe metatarsus primus varus associated with hallux abductovalgus deformity (i.e. hallux valgus angle >40° and/or the 1/2 intermetatarsal angle >20°)

basal ganglia central nervous system ganglia (i.e. caudate nucleus and putamen [i.e. the striatum], lentiform nucleus and substantia nigra) that control and coordinate fine movement; their output inhibits movement (other than postural reflexes) when at rest, and assists movement initiation by inhibiting postural reflexes

basal ganglia lesions awkward, unintentional or involuntary movements and tremor due to the loss of production of dopamine, causing symptoms of hyperkinetic (e.g. Huntington’s chorea, Sydenham’s chorea or St Vitus’ dance) and hypokinetic (e.g. Parkinson’s disease) dyskinesias

basal membrane zone; BMZ; basement membrane dermal–epidermal junction, made up of types IV and VII collagen, hemidesmosomal proteins, integrins and laminin; BMZ protein deficiencies cause skin fragility and predispose to blistering diseases, e.g. epidermolysis bullosa

basal metabolic rate measure of total cellular activity and energy used in support of basic life functions

base of gait degree of forefoot abduction habitually adopted when standing in relaxed calcaneal stance

base of support area of ground surface (between and beneath the feet) covered by the body silhouette in an erect subject; the wider the base of support, the greater the stability of the erect body; the centre of gravity is more easily maintained within the base of support

basepair nucleotide pair within DNA; formed as a complex of two nucleic acid bases, i.e. one pyrimidine and one purine united by a hydrogen bond

basic life support; BLS maintenance of circulation of oxygenated blood to the brain in a collapsed patient, by external cardiac massage (chest compressions; CCs); CCs are administered at the rate of 100 compressions per minute with the patient’s airway held in the open position (supine patient, head tilted back, neck extended, lower jaw pulled forward); 30 CCs (i.e. at 100/min) may be alternated with two rescue breaths, administered by the rescuer, or an assistant (see respiration); BLS is continued until normal heart function resumes and the patient breathes spontaneously, or until the patient can be passed to the emergency rescue services for ongoing care

basophil a granular white blood cell (leukocyte) that takes up non-acidic stains

basophilia above-normal levels of basophils within circulating blood

Baxter’s nerve first branch of the lateral plantar nerve

Baxter’s neuritis distal tarsal tunnel syndrome; caused by compression of Baxter’s nerve; characterized by insidious infracalcaneal pain and paraesthesia that persists at rest

Bazex syndrome see syndrome, Bazex

b-blockers; B-blockers see beta-blockers

Beau’s lines regular or irregular transverse lines, grooves, furrows or ridges across one or all visible nail plates, each representing temporary interruption of nail matrix activity; showing initially as a ridge at the proximal nail fold that is gradually carried distally with nail plate growth, ultimately to grow out, assuming no repeat cause; as nail plate grows at approximately 1 mm/week, the interval since the causative event can be calculated; Beau’s lines affecting all nails (toes and fingers) indicate a systemic event (e.g. stroke; myocardial infarction); single-digit involvement implies a local cause (e.g. paronychia, local trauma)

becaplermin gel; Regranex topical preparation containing 0.01% recombinant human platelet-derived growth factor; adjunct treatment for chronic full-thickness wounds, e.g. diabetic foot ulcers

Becker’s naevus patchy pigmented naevus, of leg or shoulder skin, developing during second to third decades; characterized by palpable defined outline, and gradual size increase up to approximately 20 cm diameter

bed rest rest, with the leg supported along its length, with the heel higher than the buttocks

bed sore; pressure sore; decubitus ulcer chronic pressure ulceration developing at sacral or heel areas in debilitated patients on prolonged bed rest

Behçet’s syndrome see syndrome, Behçet’s

Beighton score; Beighton–Carter–Wilson (BCW) score scoring system to delineate joint hypermobility; each positive result is awarded one point; BCW score is expressed as x/9 (Table B2)

Table B2 The Beighton score of joint hypermobility

One point is awarded for each positive result in each test and aggregated, giving a score of x/9

Test	Score awarded for positive result
Metacarpophalangeal joint hyperextension to 90°/>90°	+ 1 right + 1 left
Hyperflexion of wrist (i.e. ability to touch medial (ulnar) forearm with thumb)	+ 1 right + 1 left
Elbow hyperextension >10°	+ 1 right + 1 left
Knee joint hyperextension >10°	+ 1 right + 1 left
Hyperflexion of hips (i.e. ability to touch toes and place palms flat on floor with knee joints fully extended)	+1
Maximum score	9

below-knee cast; B-K cast rigid plaster of Paris or resin bandage cast extending from the metatarsophalangeal joints to just proximal to the knee applied to impose rest, and immobilize skeletal-muscle tissue (see bi-valve cast; weight-bearing cast)

bending deforming force, which imposes tension on the outer curve and compression on the inner curve of a cylindrical body

bendroflumethiazide see diuretics

benign non-malignant, non-invasive and non-threatening

benign familial joint hypermobility syndrome; BFJHS see syndrome, benign familial joint hypermobility, (Table B3)

Table B3 The major and minor diagnostic criteria of benign familial joint hypermobility syndrome (BFJHS)

Major criteria

Current/historic Brighton score of 4/9

Arthralgia for >3/12 in four or more joints

Minor criteria

Current/historic Brighton score of 1, 2 or 3/9 (0, 1, 2, 3/9 if >50 years old)

Arthralgia for minimum of 3 months in 1–3 joints, or back pain for minimum of 3 months, or spondylosis/spondylolysis/spondylolisthesis

Dislocation/subluxation of > one joint, or one episode of simultaneous dislocation/subluxation of more than one joint

Three or more lesions of soft-tissue rheumatism (e.g. spondylitis, tenosynovitis, bursitis)

Marfanoid habitus (i.e. tall, slim physique, span:height ratio >1.3, upper:lower segment ratio <0.89, arachnodactyly [+Steinberg/wrist signs])

Abnormal skin: striae, hyperextensibility, thin skin, papyraceous scarring

Eye signs: drooping eyelids, myopia, antimongoloid slant

Varicose veins or hernia or uterine/rectal prolapse

Note: BFJHS is diagnosed in the presence of two major criteria, or one major and two minor criteria, or four minor criteria (adapted from Grahame R, Bird HA, Child A, Dolan AL, Fowler-Edwards A, Ferrell W, Gurley-Green S, Keer R, Mansi E, Murray K, Smith E. The British Society Special Interest Group on Heritable Disorders of Connective Tissue Criteria for the Benign Joint Hypermobility Syndrome. “The Revised (Brighton 1998) Criteria for the Diagnosis of the BJHS”. Journal of Rheumatology 2000; 27:1777-1779).

benign juvenile melanoma see Spitz naevus

benzocaine a weak topical anaesthetic (see Table A14)

benzodiazepine parent compound of several psychoactive drugs (e.g. nitrazepam, temazepam and diazepam) used as anxiolytics, sedatives and hypnotics; they do not specifically contraindicate local anaesthetics, but as they can cause drowsiness, ataxia, dysarthria and impaired consciousness, their concomitant use could mask early signs of toxic effects of local anaesthetics

benzoic acid ointment; compound benzoic acid ointment see Whitfield’s ointment

benzoin see friars’ balsam

benzyl benzoate topical agent used to treat scabies infections in adults (but not in children)

benzyl peroxide 10% with 0.5% potassium hydroxyquinoline sulphate in an astringent vanishing cream base topical agent used in the treatment of tinea pedis

beriberi polyneuritis (distal sensory neuropathy of feet, and later hands) due to chronic dietary thiamine (vitamin B₁) deficiency

bespoke footwear shoes or boots constructed on a last made to the patient’s foot (contrast with semibespoke footwear)

bespoke last see last, bespoke

beta-blockers; beta-adrenoceptor-blocking drugs; β-blockers agents that block beta- adrenoceptors of heart, peripheral vasculature, bronchi, pancreas and liver; often administered in conjunction with thiazide diruetics; cardiovascular effects: slow heart rate, reduce blood pressure; relieve symptoms of glaucoma; exacerbate Raynaud’s; bronchial effects: exacerbate asthma; pancreatic effects: tend to impaired glucose tolerance and mask early symptoms of hypoglycaemia; hepatic effects: additive toxic effect with local anaesthetic (see also Table A2)

Betadine see iodine