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Fenech M. Sonographic anatomy and technique to image the plantar digital nerves and aid identification of a Morton's neuroma. ULTRASOUND (LEEDS, ENGLAND) 2024; 32:114-126. [PMID: 38694832 PMCID: PMC11060124 DOI: 10.1177/1742271x231215716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 11/05/2023] [Indexed: 05/04/2024]
Abstract
Introduction The anatomy of the forefoot is complex, and the sonographic assessment to image the plantar digital nerves and exclude, diagnose or discriminate between a Morton's neuroma and intermetatarsal bursitis can be challenging. Topic description and discussion A good appreciation of the sonographic anatomy, technique, normal and abnormal appearances is required to undertake a sonographic assessment of the forefoot and its interspaces, particularly the plantar digital nerves. This is unpacked in this paper with associated pictorial aids. Muscles, tendons, and ligaments of the interspaces and the nearby metatarsophalangeal joints and their associated soft-tissue structures are helpful sonographic landmarks to guide imaging and assessment of the common and proper plantar digital nerves and the intermetatarsal bursa. These need to be appreciated from both dorsal and plantar sonographic approaches, in both short- and long-axis imaging planes. Conclusion Improved understanding of the anatomy and sonographic appearances of the interspace structures can enhance the sonographic assessment of the forefoot and improve diagnosis of a Morton's neuroma and/or intermetatarsal bursitis when present to guide patient management.
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Affiliation(s)
- Michelle Fenech
- College of Clinical Sciences, School of Health, Medical and Applied Sciences, Central Queensland University, Brisbane, QLD, Australia; Department of Medical Imaging, Royal Brisbane and Women’s Hospital, Herston, QLD, Australia
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Lopes JG, Rodrigues-Pinho A, Neves MA, Pinto FF, Relvas-Silva M, Vital L, Serdoura F, Nogueira-Sousa A, Madeira MD, Pereira PA. An anatomical approach to the tarsal tunnel syndrome: what can ankle's medial side anatomy reveal to us? J Foot Ankle Res 2023; 16:80. [PMID: 37957735 PMCID: PMC10644421 DOI: 10.1186/s13047-023-00682-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 11/06/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND The heel is a complex anatomical region and is very often the source of pain complaints. The medial heel contains a number of structures, capable of compressing the main nerves of the region and knowing its anatomical topography is mandatory. The purpose of this work is to evaluate if tibial nerve (TN) and its main branches relate to the main anatomical landmarks of the ankle's medial side and if so, do they have a regular path after emerging from TN. METHODS The distal part of the legs, ankles and feet of 12 Thiel embalmed cadavers were dissected. The pattern of the branches of the TN was registered and the measurements were performed according to the Dellon-McKinnon malleolar-calcaneal line (DML) and the Heimkes Triangle (HT). RESULTS The TN divided proximal to DML in 87.5%, on top of the DML in 12,5% and distal in none of the feet. The Baxter's nerve (BN) originated proximally in 50%, on top of the DML in 12,5% and distally in 37.5% of the cases. There was a strong and significant correlation between the length of DML and the distance from the center of the medial malleolus (MM) to the lateral plantar nerve (LPN), medial plantar (MPN) nerve, BN and Medial Calcaneal Nerve (MCN) (ρ: 0.910, 0.866, 0.970 and 0.762 respectively, p < 0.001). CONCLUSIONS In our sample the TN divides distal to DML in none of the cases. We also report a strong association between ankle size and the distribution of the MPN, LPN, BN and MCN. We hypothesize that location of these branches on the medial side of the ankle could be more predictable if we take into consideration the distance between the MM and the medial process of the calcaneal tuberosity.
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Affiliation(s)
- Jorge Gomes Lopes
- Orthopedics and Traumatology Unit; São João University Hospital Center, Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal.
| | - André Rodrigues-Pinho
- Orthopedics and Traumatology Unit; São João University Hospital Center, Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
- Unit of Anatomy, Department of Biomedicine, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Maria Abreu Neves
- Unit of Anatomy, Department of Biomedicine, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Filipe Fonseca Pinto
- Unit of Anatomy, Department of Biomedicine, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Miguel Relvas-Silva
- Orthopedics and Traumatology Unit; São João University Hospital Center, Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Luísa Vital
- Orthopedics and Traumatology Unit; São João University Hospital Center, Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Francisco Serdoura
- Orthopedics and Traumatology Unit; São João University Hospital Center, Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - António Nogueira-Sousa
- Orthopedics and Traumatology Unit; São João University Hospital Center, Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Maria Dulce Madeira
- Unit of Anatomy, Department of Biomedicine, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
- NeuroGen Research Group, Center for Health Technology and Services Research (CINTESIS), Rua Dr. Plácido da Costa, 4200-450, Porto, Portugal
- CINTESIS@RISE, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
| | - Pedro Alberto Pereira
- Unit of Anatomy, Department of Biomedicine, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
- NeuroGen Research Group, Center for Health Technology and Services Research (CINTESIS), Rua Dr. Plácido da Costa, 4200-450, Porto, Portugal
- CINTESIS@RISE, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319, Porto, Portugal
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Development and Effectiveness Testing of a Novel 3D-Printed Multi-Material Orthosis in Nurses with Plantar Foot Pain. PROSTHESIS 2023. [DOI: 10.3390/prosthesis5010006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Plantar foot pain is one of the most common musculoskeletal conditions affecting the foot. It is regularly experienced by the population with occupations that require prolonged standing hours, especially in nurses. The etiology of plantar foot pain remains unclear, but it is likely to be multi-factorial, with many associated risk factors including increased hours of standing. Orthoses and insoles are often recommended to plantar foot pain patients, however with minimal scientific advancements and limited customizations. In this study, a novel 3D-printed multi-material customized foot orthosis was developed, and its effectiveness on plantar foot pain reduction and functional ability improvement was studied in the nursing population. A total of thirty-six subjects were recruited and were randomized into two groups. The experimental group received the novel 3D-printed multi-material customized foot orthosis, whereas the control group received the standard-of-care (or traditional) intervention. Pre-test and the post-test scores of pains, functional ability and plantar pressure were observed using SPSS software. Improvements were observed in both of the groups; however, better improvements were seen in the experimental group. Overall, the novel 3D printing-based customized foot orthosis showed significant efficacy in reducing plantar foot pain and pressure, and also in increasing functional ability in the nursing population as compared to the traditional method.
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Leblebicier MA, Yaman F, Saracoglu I, Ozkaya DB. The effects of tibial nerve mobilization in patients with tarsal tunnel syndrome: A randomized controlled trial. Eur J Integr Med 2022. [DOI: 10.1016/j.eujim.2022.102201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Khodatars D, Gupta A, Welck M, Saifuddin A. An update on imaging of tarsal tunnel syndrome. Skeletal Radiol 2022; 51:2075-2095. [PMID: 35562562 DOI: 10.1007/s00256-022-04072-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 05/02/2022] [Accepted: 05/07/2022] [Indexed: 02/02/2023]
Abstract
Tarsal tunnel syndrome (TTS) is an entrapment neuropathy of the tibial nerve (TN) within the tarsal tunnel (TT) at the level of the tibio-talar and/or talo-calcaneal joints. Making a diagnosis of TTS can be challenging, especially when symptoms overlap with other conditions and electrophysiological studies lack specificity. Imaging, in particular MRI, can help identify causative factors in individuals with suspected TTS and help aid surgical management. In this article, we review the anatomy of the TT, the diagnosis of TTS, aetiological factors implicated in TTS and imaging findings, with an emphasis on MRI.
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Affiliation(s)
- Davoud Khodatars
- Radiology Department, Royal National Orthopaedic Hospital, Stanmore, UK.
| | - Ankur Gupta
- Foot and Ankle Orthopaedic Surgery Department, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Matthew Welck
- Foot and Ankle Orthopaedic Surgery Department, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Asif Saifuddin
- Radiology Department, Royal National Orthopaedic Hospital, Stanmore, UK
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Muacevic A, Adler JR, Lapçin O. Comparison of Isolated Calcaneal Spur Excision and Plantar Fasciotomy in Addition to Spur Excision in Patients With Plantar Heel Pain Accompanied by Calcaneal Spur. Cureus 2022; 14:e31768. [PMID: 36569683 PMCID: PMC9772710 DOI: 10.7759/cureus.31768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION The aim of this study is to clinically compare isolated calcaneal spur excision and plantar fascia release in addition to spur excision in patients with plantar heel pain accompanied by a calcaneal spur. METHOD Patients who did not benefit from conservative treatment and underwent surgical excision of the calcaneal spur and/or plantar fasciotomy were retrospectively evaluated. The patients were divided into two groups according to the surgical procedure performed. The evaluation was done according to the pre- and postoperative foot function index (FFI) using pain and functional evaluation. Pain, disability, and activity restriction were evaluated with FFI. The radiological results and FFI scores of both groups were measured before and after surgery, and the difference between the groups was compared. RESULTS Of the 46 patients in our study group, 30 (65.2%) were female, and 16 (34.8%) were male. The average age was 41.2 years. There was a significant improvement in postoperative FFI scores in both groups. There was no significant difference in postoperative functional results when the groups were compared. CONCLUSION In patients whose plantar heel pain associated with calcaneal spur does not improve despite conservative treatments, both isolated spur excision and plantar fascia release in addition to spur excision may be effective treatment modalities that improve foot functions.
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Ribeiro AP, de Souza BL, João SMA. Effectiveness of mechanical treatment with customized insole and minimalist flexible footwear for women with calcaneal spur: randomized controlled trial. BMC Musculoskelet Disord 2022; 23:773. [PMID: 35964021 PMCID: PMC9375309 DOI: 10.1186/s12891-022-05729-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 08/04/2022] [Indexed: 11/10/2022] Open
Abstract
BACKROUND Calcaneal spurs are described as bony outgrowths arising on medial calcaneal, where inappropriate footwear can promote disease progression. OBJECTIVE Investigate the effectiveness of mechanical treatment with customized insole and minimalist flexible footwear during gait training program in women with calcaneal spur. METHODS Design: A single-blinded, randomized and controlled trial. SETTING Biomechanics laboratory. PARTICIPANTS Forty-three women, 29 with calcaneal spur and 14 control. INTERVENTION Gait training program with use of the minimalist flexible footwear (MFG n = 15, age: 48.9 ± 9.4, height: 1.61 ± 0.1, BMI: 32.1 ± 7.0) and customized insole on footwear (COIG n = 14, age: 50.3 ± 5.8, height: 1.62 ± 0.1, BMI: 32.2 ± 4.3) and control (CG n = 14, age: 47.8 ± 8.6, height: 1.63 ± 0.1, BMI: 27.5 ± 4.5), followed of the evaluations: baseline (T0) and after three (T3) and six (T6) months. Duration of the intervention was of the six months consecutive for at least 42 h per week (six hours a day, seven days a week). Outcome primary were calcaneus pain (visual analogue scale), Foot Function Index (FFI), Foot Health Status Questionnaire (FHSQ-Br) and 6-min walk test (6MWT). Secondary was plantar pressure distribution by a pressure platform system during gait and static index foot posture (FPI). STATISTICAL ANALYSIS analysis of variance for repeated measure and between groups were used to detect treatment-time interactions (α = 5%). Effect size with D Cohen's also was used between T0 and after six (T6) months of intervention. RESULTS The MFG and COIG were effective at reducing pain after six months (MFG: 2.5-4.5 CI, p = 0.001; COIG: 1.5-3.5 CI, p = 0.011). The FFI and FHSQ-Br showed improvements with MFG and COIG after T6 (MFG: 13.7-15.4 CI, p = 0.010; COIG: 11.3-15.0 CI, p = 0.001). The 6MWT increased with MFG (589.3-622.7 CI) and COIG (401.3-644.7 CI) and foot pronation was decreased after T3 and T6 MFG (FPI Right: 4.2-5.4 CI; Left: 3.6-5.4 CI) COIG (FPI Right: 3.4-6.8 CI; Left: 3.3-5.7 CI). The contact area reduced on forefoot and rearfoot with MFG and GOIG and midfoot and rearfoot with MFG. Maximum force was reduced on foot with MFG after T3 and T6. The peak pressure was reduced on the forefoot with MFG and COIG and on midfoot and rearfoot with MFG. CONCLUSIONS The mechanical treatment with customized insole and minimalist flexible footwear during gait training program during six months in women with calcaneal spur reduced the calcaneus pain, increased function and health feet and reduced plantar load on the rearfoot, midfoot and forefoot. However, the footwear alone was more effective than when combined customized insole, given the greater efficacy on clinical and biomechanical aspects. TRIAL REGISTRATION ClinicalTrials.gov NCT03040557 (date of first registration: 02/02/2017).
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Affiliation(s)
- Ana Paula Ribeiro
- Physical Therapy Department, Post-Graduate Department, School of Medicine, University of São Paulo, R: Cipotânea, 51, Campus Universitário, São Paulo/SP, Brazil. .,School of Medicine, Post-Graduate in Health Science Department, Biomechanics and Musculoskeletal Rehabilitation Laboratory, University Santo Amaro, São Paulo, Brazil.
| | - Brenda Luciano de Souza
- School of Medicine, Post-Graduate in Health Science Department, Biomechanics and Musculoskeletal Rehabilitation Laboratory, University Santo Amaro, São Paulo, Brazil
| | - Silvia Maria Amado João
- Physical Therapy Department, Post-Graduate Department, School of Medicine, University of São Paulo, R: Cipotânea, 51, Campus Universitário, São Paulo/SP, Brazil
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Colberg RE, Kenneth-Nwosa KO, Jurado Vélez JA, Slowik JS, Fleisig GS. Clinical and Imaging Outcomes of Plantar Fasciotomy Using Microdebrider Coblation Wand. FOOT & ANKLE ORTHOPAEDICS 2022; 7:24730114221091797. [PMID: 35479331 PMCID: PMC9036336 DOI: 10.1177/24730114221091797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: A plantar fasciotomy using a microdebrider coblation wand may be an effective treatment for treating chronic plantar fasciitis. The objective of this prospective study was to determine the success rate of performing a plantar fasciotomy using a microdebrider coblation wand to treat plantar fasciitis and determine utility of ultrasonographic imaging to evaluate for recovery after treatment. Methods: Patients with plantar fasciitis treated with a plantar fasciotomy using a microdebrider coblation wand were prospectively followed for 1 year. Outcome measures included numeric rating scale (NRS) for pain, Foot and Ankle Disability Index (FADI), the Foot and Ankle Ability Measure for activities of daily living (FAAMA) and for sports (FAAMS), and plantar fascia thickness evaluated with ultrasonographic imaging. Results: Forty patients were included. Average patient age was 53.4 ± 9.9 years. Average symptom duration prior to the procedure was 20 ± 26 months. Five patients dropped out of the study at various points, most due to the COVID quarantine. The mean preoperative NRS score was 4.7 and at 3 and 6 months postprocedure was ≤2. At 1 year, the outcomes were all improved compared to the preoperative status: NRS 0.7±1.3 (P < .001), FADI 107±16 (P < .001), FAAMA 95%±10% (P < .001), FAAMS 84%±19% (P < .001), and plantar fascia thickness 6.8 ± 1.2 mm (P = .014). Furthermore, 86% of patients had clinically successful outcome in pain, defined as NRS score ≤ 2 (95% CI 0, 2), and 91% of patients had a clinically successful outcome in their function, defined as having an FAAMA score ≥75%. There were no complications at the operative site either during or after the procedure. Conclusion: In this study of 40 patients followed prospectively, we found percutaneous plantar fasciotomy using a microdebrider coblation wand to be an effective treatment for plantar fasciitis, with a low incidence of complications. Ultrasonographic imaging may help evaluate for interval healing. Level of Evidence: Level IV, prospective case series.
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Affiliation(s)
- Ricardo E. Colberg
- Andrew's Sports Medicine and Orthopedic Center, Pelham, AL, USA
- American Sports Medicine Institute, Birmingham, AL, USA
| | - Ken O. Kenneth-Nwosa
- Andrew's Sports Medicine and Orthopedic Center, Pelham, AL, USA
- American Sports Medicine Institute, Birmingham, AL, USA
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Kurtoglu A, Kochai A, Inanmaz ME, Sukur E, Keskin D, Türker M, Sen Z, Daldal I, Avan LY. Effectiveness of radiofrequency ablation for treatment of plantar fasciitis. Medicine (Baltimore) 2022; 101:e29142. [PMID: 35357356 DOI: 10.1097/md.0000000000029142] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 03/03/2022] [Indexed: 11/27/2022] Open
Abstract
Plantar fasciitis is the most common cause of heel pain. Pain can be persistent in some patients and interrupt daily activities and sportive activities. There are a lot of treatment options available for plantar fasciitis. We hypothesized that patients with chronic persistent plantar fasciitis can be successfully treated with radiofrequency nerve ablation (RFNA).Two hundred sixty-one patients with plantar fasciitis (378 feet) treated with RFNA from February 2017 to January 2019 were retrospectively assessed. All the patients had plantar heel pain for at least 6months. Based on their body mass index (BMI), the enrolled patients were divided into obese (BMI ≥ 30kg/m2) and non-obese (BMI < 30kg/m2) groups. The patients were asked to complete a questionnaire just before and after the procedure and during the final follow-up. The BNS Radiofrequency Lesion Generator was used during a single session. The patients' information, including their visual analogue scale (VAS) score and American Orthopaedic Foot and Ankle Society (AOFAS) score, was assessed. During their final follow-up, the patients were asked to rate the success of their treatment by choosing one of the following options: completely successful, very successful, moderately successful, marginally successful, or not successful.The VAS and AOFAS scores of all the patients were evaluated pre-procedure, in the first month after procedure, and during the final follow-up (8-24 months). There was a statistically significant difference between the pre-procedure and postprocedure VAS scores (P < .001), there was no statistically significant difference between the VAS scores in the first month postprocedure and during the final follow-up.There was a statistically significant difference between the pre-procedure and postprocedure AOFAS scores (P < .001), there was no statistically significant difference between the AOFAS scores in the first month postprocedure and during the final follow-up.RFNA can be used as an alternative method to surgical procedures for treating plantar fasciitis because it is safe and effective. The advantages of RFNA are that patients can quickly return to their work and resume weight-bearing activities.
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Affiliation(s)
- Alper Kurtoglu
- Sakarya University Research and Training Hospital, Adapazari, Sakarya, Turkey
| | - Alauddin Kochai
- Sakarya University Research and Training Hospital, Adapazari, Sakarya, Turkey
| | | | - Erhan Sukur
- Sakarya University Research and Training Hospital, Adapazari, Sakarya, Turkey
| | - Dogan Keskin
- Sakarya University Research and Training Hospital, Adapazari, Sakarya, Turkey
| | - Mehmet Türker
- Sakarya University Research and Training Hospital, Adapazari, Sakarya, Turkey
| | - Zafer Sen
- University of Health Sciences, Konya City Hospital Orthopedics and Traumatology, Turkey
| | - Ismail Daldal
- Lokman Hekim Akay Hospital, Department of Orthopaedic and Traumatology, Ankara, Turkey
| | - Laçin Yüksel Avan
- Sakarya University Research and Training Hospital, Adapazari, Sakarya, Turkey
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Samson A, Thakar H, Palekar T. Prevalence for plantar fasciitis of neural origin in community-dwelling adults. MEDICAL JOURNAL OF DR. D.Y. PATIL VIDYAPEETH 2022. [DOI: 10.4103/mjdrdypu.mjdrdypu_501_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Penberthy WT, Vorwaller CE. Utilization of the 1064 nm Wavelength in Photobiomodulation: A Systematic Review and Meta-Analysis. J Lasers Med Sci 2021; 12:e86. [PMID: 35155171 PMCID: PMC8837867 DOI: 10.34172/jlms.2021.86] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 10/18/2021] [Indexed: 07/30/2023]
Abstract
Introduction: Photobiomodulation or low-level laser therapy (LLLT;<0.5 W) has been used as a non-invasive treatment for various medical indications. Short (visible; 635-650 nm) and longer (invisible; 810-850 nm and 915-980 nm) near-infrared wavelengths have been commonly used, but power setting deficiencies or incorrect wavelength settings can cause negative outcomes. The 1064 nm wavelength as the longest wavelength is a relative newcomer in high-powered (>0.5 W) laser photobiomodulation therapy (HPL-PBMT) with unique biophysical characteristics. Methods: A comprehensive search of 2016-2021 PubMed, Google Scholar, and Cochrane databases for "photobiomodulation" restricted to clinical trials for patients with a medical diagnosis was done. "1064 nm" content was identified and restricted to high-powered lasers (>0.5 watt). Cohen's d was calculated for the effect size and the difference was determined as a measure of relative 1064 nm HPL-PBMT efficacy. Results: The 22 independent studies meeting inclusion criteria focused on knee arthropathies, spine, shoulder/elbow, wound, gynecological, or osteoporosis with evaluation of pain, function, quality of life, range of motion (ROM), and anatomy. Pain was reduced with statistical significance (P<0.05) in 90% of study assessments (n=20) and 100% of studies focused on the knee (n=6). Of 18 studies assessing functional outcome measures, 100% demonstrated statistically significant improvements. Follow-up assessments up to 6 months in 5 knee arthritis studies revealed long-term pain reduction after cessation of treatment. Improvements in wound healing, bone mineral density, and knee cartilage thickness were demonstrated. The largest effect sizes observed were pain reduction in knee arthritis (average Cohen's d effect size=2.46). Conclusion: These studies have established that 1064 nm HPL-PBMT can effectively reduce pain, increase ROM, increase functional scores, and increase the quality of life for knee osteoarthritis and spinal disorders, with limitations. More studies are needed for clinical validation of single-trial data detecting changes in musculoskeletal conditions, cartilage thickness and bone density.
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Rodríguez-Merchán EC, Moracia-Ochagavía I. Tarsal tunnel syndrome: current rationale, indications and results. EFORT Open Rev 2021; 6:1140-1147. [PMID: 35839088 PMCID: PMC8693231 DOI: 10.1302/2058-5241.6.210031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Tarsal tunnel syndrome (TTS) is a neuropathy due to compression of the posterior tibial nerve and its branches. It is usually underdiagnosed and its aetiology is very diverse. In 20% of cases it is idiopathic. There is no test that diagnoses it with certainty. The diagnosis is usually made by correlating clinical history, imaging tests, nerve conduction studies (NCSs) and electromyography (EMG). A differential diagnosis should be made with plantar fasciitis, lumbosacral radiculopathy (especially S1 radiculopathy), rheumatologic diseases, metatarsal stress fractures and Morton’s neuroma. Conservative management usually gives good results. It includes activity modification, administration of pain relief drugs, physical and rehabilitation medicine, and corticosteroid injections into the tarsal tunnel (to reduce oedema). Abnormally slow nerve conduction through the posterior tibial nerve usually predicts failure of conservative treatment. Indications for surgical treatment are failure of conservative treatment and clear identification of the cause of the entrapment. In these circumstances, the results are usually satisfactory. Surgical success rates vary from 44% to 96%. Surgical treatment involves releasing the flexor retinaculum from its proximal attachment near the medial malleolus down to the sustentaculum tali. Ultrasound-guided tarsal tunnel release is possible. A positive Tinel’s sign before surgery is a strong predictor of surgical relief after decompression. Surgical treatment achieves the best results in young patients, those with a clear aetiology, a positive Tinel’s sign prior to surgery, a short history of symptoms, an early diagnosis and no previous ankle pathology. Cite this article: EFORT Open Rev 2021;6:1140-1147. DOI: 10.1302/2058-5241.6.210031
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Affiliation(s)
- E. Carlos Rodríguez-Merchán
- Department of Orthopaedic Surgery, La Paz University Hospital, Madrid, Spain
- Osteoarticular Surgery Research, Hospital La Paz Institute for Health Research – IdiPAZ (La Paz University Hospital – Autonomous University of Madrid), Madrid, Spain
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Kim YH, Chai JW, Kim DH, Kim HJ, Seo J. A problem-based approach in musculoskeletal ultrasonography: heel pain in adults. Ultrasonography 2021; 41:34-52. [PMID: 34674456 PMCID: PMC8696136 DOI: 10.14366/usg.21069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 06/29/2021] [Indexed: 11/24/2022] Open
Abstract
Musculoskeletal ultrasonography (US) has unique advantages, such as excellent spatial resolution for superficial structures, the capability for dynamic imaging, and the ability for direct correlation and provocation of symptoms. For these reasons, US is increasingly used to evaluate problems in small joints, such as the foot and ankle. However, it is almost impossible to evaluate every anatomic structure within a limited time. Therefore, US examinations can be faster and more efficient if radiologists know where to look and image patients with typical symptoms. In this review, common etiologies of heel pain are discussed in a problem-based manner. Knowing the common pain sources and being familiar with their US findings will help radiologists to perform accurate and effective US examinations.
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Affiliation(s)
- Yong Hee Kim
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul, Korea
| | - Jee Won Chai
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Dong Hyun Kim
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Hyo Jin Kim
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Jiwoon Seo
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
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14
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López-de-Celis C, Caudevilla Polo S, González-Rueda V, Bueno-Gracia E, Pérez-Bellmunt A, Simon M, Estébanez-de-Miguel E. Dimensional Changes of the Tarsal Tunnel During Foot and Ankle Positions: Anatomical Study. J Foot Ankle Surg 2021; 59:763-767. [PMID: 32253152 DOI: 10.1053/j.jfas.2020.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 02/13/2020] [Indexed: 02/03/2023]
Abstract
The tarsal tunnel is a fibrous osseous conduit for the tibial nerve and associated tendons. It is mechanically dynamic, and foot and ankle movements appear to move and change tunnel shape. However, the effect of foot and ankle movements is not clear. The aim of this study was to measure tarsal tunnel dimensions in anatomical position of the foot and ankle and quantify its changes at different positions in cadavers. A cross-sectional study with a total of 16 cryopreserved lower extremities from cadaveric specimens were used. The foot was cut using an anatomical saw at the level of the tarsal tunnel. Measurements of the cross-sectional area (CSA), transverse diameter (TD), longitudinal diameter (LD) were taken in anatomical position and during foot and ankle movements. All the tarsal tunnel measurements were significantly modified by ankle plantar flexion (p < .05). The CSA increased by 68.97 mm2 (p < .001), the TD increased by 1.40 mm (p < .002) and the LD increased by 2.55 mm (p < .007). The TD was also significantly modified by the inversion position of the ankle, showing an increase of 0.84 mm (p < .004). The rest of the ankle positions did not produce significant changes in tarsal tunnel measurements. Foot and ankle plantar flexion position produce and increase in the CSA and the TD of the tarsal tunnel at its distal end in cadavers. This could suggest a reduction in tarsal tunnel pressure during plantar flexion.
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Affiliation(s)
- Carlos López-de-Celis
- Professor, Faculty of Medicine and Health Sciences, Universitat Intenacional de Catalunya, Barcelona, Spain
| | | | - Vanessa González-Rueda
- Professor, Faculty of Medicine and Health Sciences, Universitat Intenacional de Catalunya, Barcelona, Spain
| | - Elena Bueno-Gracia
- Professor, Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain.
| | - Albert Pérez-Bellmunt
- Professor, Faculty of Medicine and Health Sciences, Universitat Intenacional de Catalunya, Barcelona, Spain
| | - Mathias Simon
- Professor, Faculty of Medicine and Health Sciences, Universitat Intenacional de Catalunya, Barcelona, Spain
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15
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Alshami AM, Alshammari TK, AlMuhaish MI, Hegazi TM, Tamal M, Abdulla FA. Sciatic nerve excursion during neural mobilization with ankle movement using dynamic ultrasound imaging: a cross-sectional study. J Ultrasound 2021; 25:241-249. [PMID: 34036554 DOI: 10.1007/s40477-021-00595-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 05/19/2021] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Ankle movement is used as a sensitizing maneuver for sciatica during neurodynamic techniques. In vivo studies on the sciatic nerve biomechanics associated with ankle movement during different positions of neighboring joints are scarce. The aim of this study was to investigate sciatic nerve excursion during ankle dorsiflexion in different positions in a healthy population. METHODS This is a cross-sectional study. High-resolution dynamic ultrasound imaging was used to measure longitudinal excursion of the sciatic nerve in the posterior thigh of 27 healthy participants during ankle dorsiflexion in six positions of the neck, hip, and knee. Both the long and short distance of the nerve excursion were measured. Wilcoxon signed-rank tests were used for data analysis, and Eta squared (r) was used to quantify the effect size. RESULTS Ankle dorsiflexion resulted in distal sciatic nerve excursion that was significantly higher in positions in which the knee was extended (median 0.7-1.6 mm) than in positions in which the knee was flexed (median 0.5-1.4 mm) (P ≤ 0.049, r ≥ 0.379). There were no significant differences in nerve excursion between positions where the neck was neutral compared with positions where the neck was flexed (P ≥ 0.710, r ≤ 0.072) or between positions where the hip was neutral compared with positions where the hip was flexed (P ≥ 0.456, r ≤ 0.143). CONCLUSION The positions of adjacent joints, particularly the knee, had an impact on the excursion of the sciatic nerve in the thigh during ankle movement.
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Affiliation(s)
- Ali M Alshami
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, P.O. Box 2435, Dammam, 31441, Saudi Arabia.
| | - Tadhi K Alshammari
- Physical Therapy Department, Prince Sultan Military Medical City, Riyadh, 11564, Saudi Arabia
| | - Mona I AlMuhaish
- Department of Radiology, Imam Abdulrahman Bin Faisal University, PO BOX 1982, Dammam, 31441, Saudi Arabia
| | - Tarek M Hegazi
- Department of Radiology, Imam Abdulrahman Bin Faisal University, PO BOX 1982, Dammam, 31441, Saudi Arabia
| | - Mahbubunnabi Tamal
- Department of Biomedical Engineering, College of Engineering, Imam Abdulrahman Bin Faisal University, PO Box 1982, Dammam, 31441, Saudi Arabia
| | - Fuad A Abdulla
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, P.O. Box 2435, Dammam, 31441, Saudi Arabia
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16
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Campillo-Recio D, Ibañez M, Martin-Dominguez LA, Comas-Aguilar M, Fernandez-Morales M, Alberti-Fito G. Local Percutaneous Radiofrequency for Chronic Plantar Fasciitis. Arthrosc Tech 2021; 10:e1315-e1320. [PMID: 34141547 PMCID: PMC8185811 DOI: 10.1016/j.eats.2021.01.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 01/29/2021] [Indexed: 02/03/2023] Open
Abstract
Plantar fasciitis is the most common cause of heel pain. It accounts for 80% of the cases and has an estimated prevalence rate of up to 7% in the general population, with bilateral involvement in 20% to 30% of those patients. This condition affects people of working age, thereby limiting and diminishing their quality of life. There are a wide range of treatment options for the management of plantar fasciitis that include both conservative and surgical treatments. Although surgical treatment based on partial or total plantar fascia release has success rates of some 70% to 90%, it is not free of complications. These complications, soft-tissue healing problems, superficial infection, or longitudinal arch collapse in cases of a greater than 40% release of the fascia. Bipolar radiofrequency appears to be a safe procedure for refractory plantar fasciitis that can provide outcomes equivalent to open plantar fascia release with less morbidity. The purpose of this article is to describe the local percutaneous radiofrequency technique for patients with chronic, recalcitrant plantar fasciitis.
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Affiliation(s)
- David Campillo-Recio
- Institut Català de Traumatologia i Medicina de l'Esport, Hospital Universitari Dexeus, Barcelona, Spain
| | - Maximiliano Ibañez
- Institut Català de Traumatologia i Medicina de l'Esport, Hospital Universitari Dexeus, Barcelona, Spain,Address correspondence to Maximiliano Ibañez, M.D., Department of Orthopedic Surgery and Traumatology, ICATME, Hospital Universitari Dexeus, Carrer de Sabino Arana, 5-19, 08028. Barcelona, Spain.
| | | | - Marta Comas-Aguilar
- Institut Català de Traumatologia i Medicina de l'Esport, Hospital Universitari Dexeus, Barcelona, Spain
| | - Marisol Fernandez-Morales
- Department of Anesthesiology, Resuscitation and Pain Treatment, Hospital Universitari Dexeus, Barcelona, Spain
| | - Gloria Alberti-Fito
- Institut Català de Traumatologia i Medicina de l'Esport, Hospital Universitari Dexeus, Barcelona, Spain
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17
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Iborra Marcos A, Villanueva Martinez M, Sanz-Ruiz P, Barrett SL, Zislis G. Ultrasound-Guided Proximal and Distal Tarsal Decompression: An Analysis of Pressures in the Tarsal, Medial Plantar, and Lateral Plantar Tunnels. Foot Ankle Spec 2021; 14:133-139. [PMID: 32088990 DOI: 10.1177/1938640020905423] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives. To analyze the reliability of measurements of tarsal tunnel and medial and lateral plantar tunnel pressures before and after ultrasound-guided release. Measurements taken were guided by ultrasound to improve reliability. This novel approach may help surgeons make surgical decisions. The second objective was to confirm that decompression using ultrasound-guided surgery as previously described by the authors is technically effective, reducing pressure to the tarsal and medial and lateral plantar tunnels. Methods. The study included 23 patients with symptoms compatible with idiopathic tarsal tunnel syndrome (TTS). The first step was to measure intracompartmental pressure of the tarsal tunnel, medial plantar tunnel, and lateral plantar tunnel preoperatively. The second step was ultrasound-guided decompression of the tibial nerve and its branches. Subsequently, pressure was measured again immediately after decompression in the 3 tunnels. Results. After surgery, the mean values significantly dropped to normal values. This represents a validation of effective decompression of the tibial nerve and its branches in TTS with ultra-minimally invasive surgery. Conclusions. The ultrasound-guided surgical technique to release the tibial nerve and its branches is effective, significantly reducing pressure in the tunnels and, thereby, decompressing the nerves.Level of evidence: Level IV.
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Affiliation(s)
- Alvaro Iborra Marcos
- Institute Avanfi, Madrid, Spain (AIM, MVM, PS-R).,US Neuropathy Centers, Atlanta, Georgia (SLB, GZ)
| | | | - Pablo Sanz-Ruiz
- Institute Avanfi, Madrid, Spain (AIM, MVM, PS-R).,US Neuropathy Centers, Atlanta, Georgia (SLB, GZ)
| | - Stephen L Barrett
- Institute Avanfi, Madrid, Spain (AIM, MVM, PS-R).,US Neuropathy Centers, Atlanta, Georgia (SLB, GZ)
| | - George Zislis
- Institute Avanfi, Madrid, Spain (AIM, MVM, PS-R).,US Neuropathy Centers, Atlanta, Georgia (SLB, GZ)
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18
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Kim I, Nam KE, Kang M, Ahn MY, Lee JI, Nam YS. Novel, user-friendly landmarks for localizing Baxter's nerve: A cadaveric study. Clin Anat 2021; 34:1022-1027. [PMID: 33617076 DOI: 10.1002/ca.23707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 11/23/2020] [Accepted: 11/26/2020] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Identification of Baxter's nerve (BN) has proven challenging for less experienced practitioners using ultrasonography due to a lack of adequate landmarks. This study aimed to establish novel, user-friendly anatomical landmarks and to describe useful structures to localize BN. MATERIALS AND METHODS We examined 10 fresh cadaveric feet and identified the interobserver agreement of measuring three surface landmarks: the most medially protruded point on the medial malleolus (P), the navicular tuberosity (Q), and the center of the calcaneus (B). Next, 24 fresh cadaveric feet were used to identify the point of BN entry into the quadratus plantae (QP) muscle, which corresponds to the proximal BN impingement site. The rectangular coordinate system consisted of the origin (point P), X-axis, extension line P-Q, and Y-axis (the perpendicular line to the X-axis). To consider various foot sizes, the X and Y values were divided by the P-Q length and were designated as the ratios X and Y. RESULTS Points P and Q showed smaller interobserver differences than that of point B. Ratios X and Y were 61.25 and 99.80%, respectively, for the QP. BN arose from the lateral plantar nerve in 20 of 24 specimens. The adjacent vessel was <3 mm from the entrapment site of BN in 20 of 24 specimens. CONCLUSION New landmarks will improve the precision of localizing the entrapment site of BN and will provide advanced guidelines for podiatric patients.
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Affiliation(s)
- Inah Kim
- Department of Rehabilitation Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kyung Eun Nam
- Department of Rehabilitation Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Minsuk Kang
- Department of Rehabilitation Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Min Young Ahn
- Department of Biomedical Art, The Incheon Catholic University Graduate School, Incheon, Republic of Korea
| | - Jong In Lee
- Department of Rehabilitation Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Yong Seok Nam
- Department of Anatomy, Catholic Institute for Applied Anatomy, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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19
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Sahoo RK, Peng PWH, Sharma SK. Ultrasound-Guided Hydrodissection for Baxter's Neuropathy Secondary to Plantar Fasciitis: A Case Report. A A Pract 2020; 14:e01339. [PMID: 33185409 DOI: 10.1213/xaa.0000000000001339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Plantar heel pain is a common pain condition encountered in clinical practice. The common etiologies include plantar fasciitis, calcaneal spur, calcaneus stress fracture, systemic causes, and trauma. Neurogenic causes, including entrapment at the tarsal tunnel or Baxter's nerve entrapment, can contribute to the heel pain and should not be overlooked. In this case report, we describe a patient with severe heel pain, presenting with overlapping features of plantar fasciitis and neuropathic pain. Magnetic resonance imaging suggested Baxter's nerve entrapment, and a subsequent ultrasound-guided hydrodissection of Baxter's nerve provided long-lasting pain relief.
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Affiliation(s)
- Rajendra Kumar Sahoo
- From the Department of Anesthesiology and Pain Management, Health World Hospitals, Durgapur, West Bengal, India
| | - Philip W H Peng
- Department of Anesthesiology and Pain Management, University Health Network, Sinai Health Network, Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Santosh Kumar Sharma
- Department of Anesthesiology, Baba Raghav Das Medical College, Gorakhpur, Uttar Pradesh, India
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20
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Sun X, Zhou Q, Shi C, Lan Y, Jia Y, Qiu Z, Shen Y, Li S. Acupotomy for patients with tarsal tunnel syndrome: A protocol for systematic review and meta analysis. Medicine (Baltimore) 2020; 99:e22369. [PMID: 32991456 PMCID: PMC7523778 DOI: 10.1097/md.0000000000022369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 08/26/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Tarsal tunnel syndrome (TTS) is a painful condition of the ankle that affects patients' quality of life and ability to work. Multiple clinical studies of nerve decompression by acupotomy have been published in China, and the results are encouraging. However, the efficacy and security of this treatment have not been evaluated scientifically and systematically. The purpose of this systematic review protocol is to evaluate the efficacy and security of acupotomy treatment in patients with TTS, which will be helpful to clinical acupotomy doctors. METHODS Relevant randomized controlled trials will be identified by searching 9 databases (PubMed, Embase, Cochrane Library, Chinese literature databases, the Chinese Biomedical Literature Database, China National Knowledge Infrastructure, SinoMed, Technology Journal and the Wanfang Database. Randomized controlled trials examining the use of acupotomy for TTS patients will be identified independently by 2 reviewers by searching the databases from inception to March 2020. Clinical effects will be evaluated as the primary outcome. Visual analog scale scores will be assessed as a secondary outcome. Review Manager 5.3 will be used to perform a fixed effects meta-analysis, and the evidence level will be evaluated by using the Grading of Recommendations Assessment, Development, and Evaluation framework. Continuous outcomes will be presented as mean differences or standard mean differences, while dichotomous data will be expressed as relative risks. RESULTS This study will evaluate the effectiveness and safety of acupotomy in the treatment of TTS in randomized controlled trials with high-quality visual analog scale and Roles and Maudsley score. CONCLUSION This systematic review will provide evidence to determine whether acupotomy is an effective intervention for patients with TTS. REGISTRATION NUMBER DOI 10.17605/OSF. IO/9PYC2 (https://osf.io/9pyc2/).
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Affiliation(s)
- Xiaojie Sun
- Beijing University of Chinese Medicine
- Department of Acupuncture-Moxibustion, China-Japan Friendship hospital, Beijing
| | - Qiaoyin Zhou
- Fujian University of Traditional Chinese Medicine
- Key Laboratory of Orthopedics & Traumatology of Traditional Chinese Medicine and Rehabilitation (Fujian university of TCM), Ministry of Education, Fuzhou, Fujian
| | - Chong Shi
- Beijing University of Chinese Medicine
- Department of Acupuncture-Moxibustion, China-Japan Friendship hospital, Beijing
| | - Yangjing Lan
- Beijing University of Chinese Medicine
- Department of Acupuncture-Moxibustion, China-Japan Friendship hospital, Beijing
| | - Yan Jia
- Beijing University of Chinese Medicine
- Department of Acupuncture-Moxibustion, China-Japan Friendship hospital, Beijing
| | - Zuyun Qiu
- Beijing University of Chinese Medicine
- Department of Acupuncture-Moxibustion, China-Japan Friendship hospital, Beijing
| | - Yifeng Shen
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province, P. R. China
| | - Shiliang Li
- Department of Acupuncture-Moxibustion, China-Japan Friendship hospital, Beijing
- Fujian University of Traditional Chinese Medicine
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21
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Advanced Ankle and Foot Sonoanatomy: Imaging Beyond the Basics. Diagnostics (Basel) 2020; 10:diagnostics10030160. [PMID: 32183398 PMCID: PMC7151198 DOI: 10.3390/diagnostics10030160] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 03/12/2020] [Accepted: 03/12/2020] [Indexed: 12/16/2022] Open
Abstract
Ankle/foot pain is a common complaint encountered in clinical practice. Currently, due to the complex anatomy, the diagnosis and management of the underlying musculoskeletal disorders are extremely challenging. Nowadays, high-resolution ultrasound has emerged as the first-line tool to evaluate musculoskeletal disorders. There have been several existing protocols describing the fundamental sonoanatomy of ankle/foot joints. However, there are certain anatomic structures (e.g., Lisfranc ligament complex or Baxter nerve) which are also clinically important. As they are rarely elaborated in the available literature, a comprehensive review is necessary. In this regard, the present article aims to brief the regional anatomy, illustrate the scanning techniques, and emphasize the clinical relevance of the ankle/foot region.
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22
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Colberg RE, Ketchum M, Javer A, Drogosz M, Gomez M, Fleisig GS. Clinical Outcomes of Percutaneous Plantar Fasciotomy Using Microdebrider Coblation Wand. Foot Ankle Int 2020; 41:187-192. [PMID: 31595806 DOI: 10.1177/1071100719883266] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Plantar fasciitis is the most common cause of heel pain in adults. Multiple conservative treatment plans exist; however, some cases do not obtain significant clinical improvement with conservative treatment and require further intervention. This retrospective case study evaluated the success rate of percutaneous plantar fasciotomy and confounding comorbidities that negatively affect outcomes. METHODS A series of 41 patients treated with percutaneous plantar fasciotomy using the Topaz EZ microdebrider coblation wand were invited to participate in this retrospective follow-up study, and 88% (N = 36) participated. A limited chart review was completed and the patients answered a survey with the visual analog scale (VAS) for pain and the Foot and Ankle Ability Measure (FAAM) questionnaire. Average outcomes were calculated and 45 variables were analyzed to determine if they were statistically significant confounders. Patients had symptoms for an average of 3 years before the procedure and were contacted for follow-up at an average of 14 months after the procedure. RESULTS The average VAS for pain score was 1.3 ± 1.8 and the average FAAM score was 92 ± 15. Eighty-nine percent of patients had a successful outcome, defined as FAAM greater than 75. In addition, patients at 18 months postprocedure reported complete or near-complete resolution of symptoms with an FAAM score greater than 97. Concurrent foot pathologies (eg, tarsal tunnel syndrome), oral steroid treatment prior to the procedure, and immobilization with a boot prior to the procedure were statistically significant negative confounders (P < .05). Being an athlete was a positive confounder (P = .02). CONCLUSION Percutaneous plantar fasciotomy using a microdebrider coblation was an effective treatment for plantar fasciitis, particularly without concurrent foot pathology, with a low risk of complications. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
| | - Monte Ketchum
- American Sports Medicine Institute, Birmingham, AL, USA
| | - Avani Javer
- Andrews Sports Medicine and Orthopaedic Center, Birmingham, AL, USA
| | | | - Melissa Gomez
- St Vincent's East Family Medicine, Birmingham, AL, USA
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23
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Iborra A, Villanueva M, Sanz-Ruiz P. Results of ultrasound-guided release of tarsal tunnel syndrome: a review of 81 cases with a minimum follow-up of 18 months. J Orthop Surg Res 2020; 15:30. [PMID: 31992296 PMCID: PMC6988231 DOI: 10.1186/s13018-020-1559-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 01/14/2020] [Indexed: 12/03/2022] Open
Abstract
Background This study aims to analyse the clinical results of ultrasound-guided surgery for the decompression of the tibial nerve, including its distal medial and lateral branches, to treat tarsal tunnel syndrome. These structures are the complete flexor retinaculum and the deep fascia of the abductor hallucis muscle, including individualised release of the medial and lateral plantar nerve tunnels. Method This is a retrospective review of 81 patients (36 men and 45 women) with an average age of 41 years old (32–62) and an average clinical course of 31 months (8–96) compatible with idiopathic tarsal tunnel syndrome, who underwent ultrasound-guided decompression of the proximal and distal tarsal tunnel between February 2015 and November 2017 (both months included), with a minimum follow-up of 18 months. Results Based on the Takakura et al. scale for the 81 patients, 76.54% obtained excellent results, 13.58% good results, and 9.87% poor results. The patients with the longest course of symptoms displayed the worst results. Conclusion Although 9% of patients did not improve, ultrasound-guided tarsal tunnel release might be a viable alternative to conventional open approaches.
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Affiliation(s)
- A Iborra
- Department of Podiatry, Faculty of Health Sciences, University of La Salle, Institute Avanfi, 28020, Madrid, Spain. .,Avanfi Institute and Unit for Ultrasound-guided Surgery, Hospital Beata María Ana, Calle Orense 32, 1, 28020, Madrid, Spain.
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24
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An Anatomical Basis for the Myofascial Trigger Points of the Abductor Hallucis Muscle. BIOMED RESEARCH INTERNATIONAL 2020; 2020:9240581. [PMID: 32076620 PMCID: PMC6998759 DOI: 10.1155/2020/9240581] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 12/07/2019] [Accepted: 12/27/2019] [Indexed: 11/21/2022]
Abstract
Myofascial pain syndrome is characterized by pain and a limited range of joint motion caused by muscle contracture related to motor-end-plate dysfunction and the presence of myofascial trigger points (MTrPs). It is the most frequent cause of musculoskeletal pain, with a worldwide prevalence varying between 13.7% and 47%. Of the patients with myofascial pain syndrome, approximately 17% have pain in the medial hindfoot area. The abductor hallucis muscle is located in the medial, posterior region of the foot and is related to painful plantar syndromes. The objective of this study was to describe the distribution of the medial plantar nerve and their anatomical relationship with MTrPs found in the literature. Thirty abductor hallucis muscles were dissected from 15 human cadavers (8 males and 7 females). The muscles were measured, and the distribution data of the medial plantar nerve branches in each quadrant were recorded. For statistical analysis, we used generalized estimation equations with a Poisson distribution and a log logarithm function followed by Bonferroni multiple comparisons of the means. The data are expressed as the mean ± standard deviation. The level of significance was adjusted to 5% (p < 0.05). A high concentration of nerve branches was observed in the first quadrant (Q1) of the abductor hallucis muscle, which is the same area in which the MTrPs are described. The topography of the entry points of the branches of the medial plantar nerve to the abductor hallucis muscle correlates with the topography of the muscular trigger points. The anatomical structure of the MTrPs may be useful for a better understanding of the pathophysiology of myofascial disorders and provide a basis for surgical and clinical treatments.
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25
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The evalaution of the foot core system in individuals with plantar heel pain. Phys Ther Sport 2020; 42:75-81. [PMID: 31951848 DOI: 10.1016/j.ptsp.2019.11.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 11/27/2019] [Accepted: 11/28/2019] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To compare foot posture, plantar sensation, plantar fascia thickness, intrinsic foot muscle performance, and abductor hallucis morphology in individuals with and without plantar heel pain (PHP). DESIGN Cross-Sectional. SETTING Laboratory. PARTICIPANTS Sixteen individuals with PHP and sixteen matched healthy participants. MAIN OUTCOME MEASURES Static foot posture, plantar sensation, plantar fascia thickness, intrinsic foot muscle performance and abductor hallucis morphology were evaluated. Foot posture was assessed with the Foot Posture Index-6. Abductor hallucis morphology and plantar fascia thickness were measured utilizing diagnostic ultrasound. Plantar foot sensation was assessed at the head of the first metatarsal and medial longitudinal arch using Semmes-Weinstein Monofilaments. Intrinsic foot muscle performance was assessed using the intrinsic foot muscle test (IFMT). Mann-Whitney U and independent t-tests were used to examine between group differences. RESULTS Individuals with PHP exhibited a more pronated foot posture and greater plantar fascia thickness at the proximal insertion compared to healthy controls. Plantar sensation thresholds were higher in the PHP compared to healthy controls at the head of the first metatarsal. There were no group differences in abductor hallucis morphology or IFMT performance. CONCLUSIONS Individuals with PHP exhibited a more pronated foot posture, thicker plantar fascia, and diminished plantar tactile sensation.
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26
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Gariani K, Waibel FWA, Viehöfer AF, Uçkay I. Plantar Fasciitis in Diabetic Foot Patients: Risk Factors, Pathophysiology, Diagnosis, and Management. Diabetes Metab Syndr Obes 2020; 13:1271-1279. [PMID: 32368120 PMCID: PMC7183784 DOI: 10.2147/dmso.s184259] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 04/07/2020] [Indexed: 12/19/2022] Open
Abstract
Plantar fasciitis (PF) is a common degenerative disorder and a frequent cause of heel pain, mostly affecting patients in their fourth and fifth decades. Diabetic patients are particularly at risk due to the presence of common risks and co-morbidities such as obesity or a sedentary lifestyle. The diagnosis of PF is mainly clinical. Imaging is not recommended for the initial approach. The initial management is conservative and should include physiotherapy, off-loading, stretching exercises, and nonsteroidal anti-inflammatory drugs. Glucocorticoid injections or surgery is an option at a later stage in recalcitrant cases. The overall management of PF does not differ between patients with diabetic foot problems and non-diabetic patients, although the details can differ. This narrative review summarizes the state of the art in terms of the risk factors, pathophysiology, diagnosis, assessment, and management of PF in diabetic patients.
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Affiliation(s)
- Karim Gariani
- Service of Endocrinology, Diabetes, Hypertension and Nutrition, Geneva University Hospitals, Geneva, Switzerland
- Correspondence: Karim Gariani Endocrinology, Diabetes, Hypertension and Nutrition, Geneva University Hospitals, Geneva, Switzerland Email
| | - Felix W A Waibel
- Foot and Ankle Service, Department of Orthopedic Surgery, Balgrist University Hospital, Zurich, Switzerland
| | - Arnd F Viehöfer
- Foot and Ankle Service, Department of Orthopedic Surgery, Balgrist University Hospital, Zurich, Switzerland
| | - Ilker Uçkay
- Unit for Clinical and Applied Research, Balgrist University Hospital, Zurich, Switzerland
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McClinton SM, Heiderscheit BC, McPoil TG, Flynn TW. Effectiveness of physical therapy treatment in addition to usual podiatry management of plantar heel pain: a randomized clinical trial. BMC Musculoskelet Disord 2019; 20:630. [PMID: 31883516 PMCID: PMC6935140 DOI: 10.1186/s12891-019-3009-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 12/17/2019] [Indexed: 12/19/2022] Open
Abstract
Background Many patients will seek care from a podiatrist for plantar heel pain (PHP), while few of these patients will also be seen by a physical therapist. Physical therapists can provide treatment that is not a part of routine podiatric care for PHP and may provide additional improvement. Therefore, the purpose of this study was to examine the effects of interdisciplinary care for PHP that incorporated physical therapy treatment after initiating podiatric treatment. Methods Eligible individuals with PHP that presented to a podiatrist were randomized to receive usual podiatric care (uPOD) or usual podiatric care plus physical therapy treatment (uPOD+PT). The primary outcome was change in foot and ankle ability measure (FAAM) at 6-months. Secondary outcomes included change in numeric pain rating scale (NPRS), patient-reported success, and 6-week and 1-year endpoints. Patient-reported success was defined as the top two global rating of change scale rankings. Primary analysis was intention-to-treat (ITT) using analysis by covariance adjusted to baseline scores, and a secondary per-protocol (PP) analysis was performed analyzing only those who completed treatment. Results Ninety-five individuals participated and were included in the ITT analysis, and 79 were included in the PP analysis. For the primary outcome of FAAM change from baseline to 6-months, both groups improved significantly (uPOD+PT: 26.8 [95% CI 21.6, 31.9]; uPOD: (20 [15.6, 24.4]), but there was no between-group difference (4.3 [− 1, 9.6]). For secondary outcomes, the uPOD+PT group demonstrated greater improvement in NPRS at 6 weeks (0.9 [0.3, 1.4]) and 1 year (1.5 [0.6, 2.5]) in the ITT analysis. In the PP analysis, the uPOD+PT group demonstrated greater improvement in FAAM at 6 months (7.7 [2.1, 13.3]) and 1 year (5.5 [0.1, 10.8]), NPRS at 6 weeks (0.9 [0.2, 1.6]), 6 months (1.3 [0.6, 2.1]) and 1 year (1.3 [0.6, 2.1]), and in patient-reported success (relative risk [95% CI]) at 6 weeks (2.8 [1.1, 7.1]), 6 months (1.5 [1.1, 2.1]), and 1 year (1.5 [1.1, 1.9]). Conclusions There was no significant benefit of uPOD+PT in the primary outcome of FAAM change at 6 months. Secondary outcomes and PP analysis indicated additional benefit of uPOD+PT, mostly observed in individuals who completed treatment. Trial registration Prospectively registered May 24, 2013 at www.clinicaltrials.gov (NCT01865734).
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Affiliation(s)
- Shane M McClinton
- Doctor of Physical Therapy Program, Des Moines University, 3200 Grand Avenue, Des Moines, IA, USA.
| | - Bryan C Heiderscheit
- Departments of Orthopedics & Rehabilitation and Biomedical Engineering, and Doctor of Physical Therapy Program, University of Wisconsin-Madison, 1636 Highland Ave, Madison, WI, USA
| | - Thomas G McPoil
- School of Physical Therapy, Regis University, Denver, CO, USA
| | - Timothy W Flynn
- School of Physical Therapy, South College, Knoxville, TN, USA
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Bueno-Gracia E, Salcedo-Gadea J, López-de-Celis C, Salcedo-Gadea E, Pérez-Bellmunt A, Estébanez-de-Miguel E. Dimensional Changes of the Tibial Nerve and Tarsal Tunnel in Different Ankle Joint Positions in Asymptomatic Subjects. J Foot Ankle Surg 2019; 58:1129-1133. [PMID: 31679666 DOI: 10.1053/j.jfas.2019.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 12/19/2018] [Accepted: 03/12/2019] [Indexed: 02/03/2023]
Abstract
The tarsal tunnel is a clinically important fibrous osseous conduit for the tibial nerve and associated tendons. It is mechanically dynamic, and normal ankle movements appear to change the tunnel shape, potentially having an impact on the tibial nerve. The objective of this study was to measure changes in the tibial nerve and tarsal tunnel dimensions in plantarflexion and dorsiflexion of the ankle joint in healthy subjects. A cross-sectional study with 13 volunteer subjects and a total of 18 records was designed. The cross-sectional area, anterior-posterior distance, transverse distance, and flattening ratio of the tibial nerve were measured by using ultrasound in plantarflexion and dorsiflexion of the ankle joint. The anterior-posterior distance of the tarsal tunnel was also measured. The tunnel anterior-posterior distance significantly increased during plantarflexion (p < .001) and decreased during dorsiflexion (p = .027) of the ankle. From plantarflexion to dorsiflexion of the ankle, the tibial nerve cross-sectional area significantly decreased (p = .035). The anterior-posterior distance also decreased significantly (p < .001), whereas the transverse distance increased (p < .001), thus decreasing the flattening ratio of the tibial nerve (p < .001). Ankle joint position determined significant changes in the shape and dimensions of the tibial nerve at the tarsal tunnel.
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Affiliation(s)
- Elena Bueno-Gracia
- Physiotherapist, Faculty of Health Sciences, University of Zaragoza, Zaragoza, Spain
| | | | - Carlos López-de-Celis
- Physiotherapist, Faculty of Medicine and Health Sciences, International University of Catalonia, Barcelona, Spain
| | | | - Albert Pérez-Bellmunt
- Physiotherapist, Faculty of Medicine and Health Sciences, International University of Catalonia, Barcelona, Spain
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AlKhadhrawi N, Alshami A. Effects of myofascial trigger point dry cupping on pain and function in patients with plantar heel pain: A randomized controlled trial. J Bodyw Mov Ther 2019; 23:532-538. [PMID: 31563366 DOI: 10.1016/j.jbmt.2019.05.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Accepted: 05/18/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate the effects of dry cupping on calf muscle myofascial trigger points (MTrPs) on pain and function in patients with plantar heel pain. METHODS Seventy-one patients were randomly divided into an intervention group or control group. Both groups performed stretching exercises for the calf muscle and plantar fascia and ankle dorsiflexion exercises. The intervention group also received dry cupping. The primary outcome measures were visual analogue scale (VAS), pressure pain threshold (PPT), and patient-specific functional scale (PSFS). The secondary outcomes were ankle dorsiflexion range of motion (ROM) and ankle plantar flexor strength. These measurements were performed at baseline, immediately after intervention, and after 2 days. RESULTS Current VAS significantly decreased immediately in the intervention group (p = 0.002), but not in the control group (p ≥ 0.220). Morning VAS decreased significantly in both groups (p < 0.001) after 2 days, but decreased more in the intervention group (p = 0.006). Trigger point PPT significantly improved immediately in the intervention group (p = 0.003), but not in the control group (p = 0.112). Both groups improved significantly in PSFS (p < 0.001) and ankle dorsiflexion ROM (p < 0.001). Plantar flexor strength significantly increased immediately in the intervention group (p < 0.001), but not in the control group (p = 0.556). CONCLUSION Adding dry cupping on calf MTrPs to self-stretching and ankle dorsiflexion exercises for patients with plantar heel pain was superior to only self-stretching and active ankle dorsiflexion exercises in pain, ankle dorsiflexion ROM, and plantar flexor strength.
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Affiliation(s)
- Nazar AlKhadhrawi
- Department of Physical Therapy, Qatif Central Hospital, P.O.Box: 3718 Qudaih, Unit No. 1, Qatif, 32661, Saudi Arabia.
| | - Ali Alshami
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Saudi Arabia.
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Fernández-Gibello A, Moroni S, Camuñas G, Montes R, Zwierzina M, Tasch C, Starke V, Sañudo J, Vazquez T, Konschake M. Ultrasound-guided decompression surgery of the tarsal tunnel: a novel technique for the proximal tarsal tunnel syndrome-Part II. Surg Radiol Anat 2018; 41:43-51. [PMID: 30382330 PMCID: PMC6513797 DOI: 10.1007/s00276-018-2127-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 10/24/2018] [Indexed: 11/27/2022]
Abstract
Background The aim of this study is to provide a safe ultrasound-guided minimally invasive surgical approach for a proximal tarsal tunnel release concerning nerve entrapments. Methods and results The study was carried out on ten fresh-frozen feet. All of them were examined by high resolution ultrasound at the medial ankle region. The surgical approach was marked throughout the course of the flexor retinaculum (laciniate ligament). Once the previous steps were done, the flexor retinaculum release technique was carried out with a 2-mm entry only. As a result, an effective and safe release of the flexor retinaculum was obtained in all fresh-frozen feet. Conclusion The results of our anatomic study indicate that our novel ultrasound-guided minimally invasive surgical approach for the release of the flexor retinaculum might be an effective, safe and quick decompression technique treating selected patients with a proximal tarsal tunnel syndrome.
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Affiliation(s)
- Alejandro Fernández-Gibello
- Faculty of Health Sciences, Department of Podiatry, University of La Salle, Clinic Vitruvio Biomecánica, Madrid, Spain
| | - Simone Moroni
- Faculty of Health Sciences at Manresa, Department of Podiatry, Universitat de Vic-Universitat Central de Catalunya (UVic-Ucc), Clinic Vitruvio Biomecánica, Barcelona, Madrid, Spain
| | - Gabriel Camuñas
- Faculty of Health Sciences, Department of Podiatry, University of La Salle, Clinic Vitruvio Biomecánica, Madrid, Spain
| | - Rubén Montes
- Faculty of Health Sciences, Department of Podiatry, University of La Salle, Clinic Vitruvio Biomecánica, Madrid, Spain
| | - Marit Zwierzina
- Department of Plastic, Reconstructive and Aesthetic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Christoph Tasch
- Department of Plastic, Reconstructive and Aesthetic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Vasco Starke
- Department of Anatomy, Histology and Embryology, Division of Clinical and Functional Anatomy, Medical University of Innsbruck (MUI), Müllerstr. 59, 6020, Innsbruck, Austria
| | - José Sañudo
- Anatomy and Embryology Department, School of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Teresa Vazquez
- Anatomy and Embryology Department, School of Medicine, Complutense University of Madrid, Madrid, Spain
| | - Marko Konschake
- Department of Anatomy, Histology and Embryology, Division of Clinical and Functional Anatomy, Medical University of Innsbruck (MUI), Müllerstr. 59, 6020, Innsbruck, Austria.
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Clinical-anatomic mapping of the tarsal tunnel with regard to Baxter's neuropathy in recalcitrant heel pain syndrome: part I. Surg Radiol Anat 2018; 41:29-41. [PMID: 30368565 PMCID: PMC6514163 DOI: 10.1007/s00276-018-2124-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 10/21/2018] [Indexed: 02/03/2023]
Abstract
Purpose Neuropathy of the Baxter nerve (BN) seems to be the first cause of the heel pain syndrome (HPS) of neurological origin. Methods 41 alcohol–glycerol embalmed feet were dissected. We documented the pattern of the branches of the tibial nerve (TN) and describe all relevant osteofibrous structures. Measurements for the TN branches were related to the Dellon–McKinnon malleolar-calcaneal line also called DM line (DML) for the proximal TT and the Heimkes Triangle for the distal TT. Additionally, we performed an ultrasound-guided injection procedure of the BN and provide an algorithm for clinical usage. Results The division of the TN was 16.4 mm proximal to the DML. The BN branches off 20 mm above the DML center or 30 mm distally to it. In most of the cases, the medial calcaneal branch (MCB) originated from the TN proximal to the bifurcation. Possible entrapment spots for the medial and lateral plantar nerve (MPN, LPN), the BN and the MCB are found within a circle of 5 mm radius with a probability of 80%, 83%, and 84%, respectively. In ten out of ten feet, the US-guided injection was precisely allocated around the BN. Conclusions Our detailed mapping of the TN branches and their osteofibrous tubes at the TT might be of importance for foot and ankle surgeons during minimally invasive procedures in HPS such as ultrasound-guided ankle and foot decompression surgery (UGAFDS).
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Plaza-Manzano G, Ríos-León M, Martín-Casas P, Arendt-Nielsen L, Fernández-de-Las-Peñas C, Ortega-Santiago R. Widespread Pressure Pain Hypersensitivity in Musculoskeletal and Nerve Trunk Areas as a Sign of Altered Nociceptive Processing in Unilateral Plantar Heel Pain. THE JOURNAL OF PAIN 2018; 20:60-67. [PMID: 30121357 DOI: 10.1016/j.jpain.2018.08.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 07/28/2018] [Accepted: 08/12/2018] [Indexed: 02/03/2023]
Abstract
Our aim was to investigate the differences in pressure sensitivity over musculoskeletal and nerve symptomatic and distant areas between individuals with plantar heel pain and healthy subjects and to determine the relationship between sensitivity to pressure pain, foot pain, and fascia thickness. Thirty-five patients with unilateral chronic plantar heel pain and 35 matched healthy controls participated. Pressure pain thresholds (PPTs) were assessed bilaterally over several nerve trunks (median, radial, ulnar, common peroneal, tibial, and sural nerve trunks) and musculoskeletal structures (calcaneus, medial gastrocnemius, tibialis anterior, and second metacarpal) by an assessor blinded to the subject's condition. Pain was assessed with a numerical pain rating scale (0-10), impact of foot pain was assessed with the Foot Function Index, and plantar fascia thickness was measured via ultrasound imaging. Analysis of covariance revealed lower widespread and bilateral PPTs over both nerve trunks and musculoskeletal structures in individuals with plantar heel pain (P < .001). Female patients showed lower PPT than male patients in almost all points (P < .001). PPT over the peripheral nerve trunks of the lower extremity were significantly associated with the intensity of pain at first step in the morning and with the foot function disability scale of the Foot Function Index (P < .05). This study found widespread pressure pain hypersensitivity over both nerve trunks and musculoskeletal structures in individuals with unilateral chronic plantar heel pain, suggesting the presence of a central altered central nociceptive pain processing. Pressure hypersensitivity over nerve trunks on the lower extremity was associated with higher pain intensity and related disability. PERSPECTIVES: This study found widespread pressure hypersensitivity over both nerve trunks and musculoskeletal structures in individuals with unilateral chronic plantar heel pain, as a manifestation of a centrally altered central nociceptive pain processing.
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Affiliation(s)
- Gustavo Plaza-Manzano
- Department of Radiology, Rehabilitation and Physiotherapy, Universidad Complutense de Madrid, Madrid, Spain; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain
| | - Marta Ríos-León
- Alumna de Doctorado, Escuela Internacional de Doctorado Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - Patricia Martín-Casas
- Department of Radiology, Rehabilitation and Physiotherapy, Universidad Complutense de Madrid, Madrid, Spain; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos, Madrid, Spain
| | - Lars Arendt-Nielsen
- Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, School of Medicine, Aalborg University, Aalborg, Denmark
| | - César Fernández-de-Las-Peñas
- Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, School of Medicine, Aalborg University, Aalborg, Denmark; Cátedra de Investigación y Docencia en Fisioterapia: Terapia Manual y Punción Seca, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain; Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain.
| | - Ricardo Ortega-Santiago
- Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, School of Medicine, Aalborg University, Aalborg, Denmark; Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
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Bishop C, Thewlis D, Hillier S. Custom foot orthoses improve first-step pain in individuals with unilateral plantar fasciopathy: a pragmatic randomised controlled trial. BMC Musculoskelet Disord 2018; 19:222. [PMID: 30021556 PMCID: PMC6052580 DOI: 10.1186/s12891-018-2131-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 06/14/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Foot orthoses are routinely used to treat plantar fasciopathy in clinical practice. However, minimal evidence exists as to the effect of both truly custom designed foot orthoses, as well as that of the shoe the foot orthoses are placed into. This study investigated the effect of wearing custom foot orthoses and new athletic footwear on first-step pain, average 24-h pain and plantar fascia thickness in people with unilateral plantar fasciopathy over 12 weeks. METHODS A parallel, three-arm randomised controlled trial with blinding of participants and assessors. 60 participants diagnosed with unilateral plantar fasciopathy were randomised to either custom foot orthoses and new shoes (orthoses group), a sham insole with a new shoes (shoe group) or a sham insole placed in the participant's regular shoes (control group). Primary outcome was first-step pain. Secondary outcomes were average 24-h pain and plantar fascia thickness measured on ultrasound. Outcomes were assessed at baseline, 4 week and 12 week trial time-points. RESULTS At 4 weeks, the orthoses group reported less first-step pain (p = 0.002) compared to the control group. At 12 weeks, the orthoses group reported less first-step pain compared to both the shoe (p = < 0.001) and sham (p = 0.01) groups. Both the orthoses (p = < 0.001) and shoe (p = 0.006) groups reported less average 24-h pain compared to the control group at 4 and 12 weeks. The orthoses group demonstrated reduced plantar fascia thickness on ultrasound compared to both the shoe (p = 0.032) and control groups (p = 0.011). CONCLUSIONS Custom foot orthoses in new shoes improve first-step pain and reduce plantar fascia thickness over a period of 12 weeks compared to new shoes alone or a sham intervention. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ( ACTRN 12613000446763 ). Submitted on the 10th of April 2013 and registered on the 18th of April 2013.
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Affiliation(s)
- Chris Bishop
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, East Campus, North Terrace, SA 5000 Australia
| | - Dominic Thewlis
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia, Adelaide, East Campus, North Terrace, SA 5000 Australia
- Centre for Orthopaedic and Trauma Research, University of Adelaide, Adelaide, Australia
| | - Susan Hillier
- Sansom Institute for Health Research, University of South Australia, Adelaide, Australia
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McClinton S, Heiderscheit B, McPoil TG, Flynn TW. Physical therapist decision-making in managing plantar heel pain: cases from a pragmatic randomized clinical trial. Physiother Theory Pract 2018; 36:638-662. [PMID: 29979912 DOI: 10.1080/09593985.2018.1490941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Plantar heel pain (PHP) is a common condition managed by physical therapists that can, at times, be difficult to treat. Management of PHP is complicated by a variety of pathoanatomic features associated with PHP in addition to several treatment approaches with varying efficacy. Although clinical guidelines and clinical trial data support a general approach to management, the current literature is limited in case-specific descriptions of PHP management that addresses unique combinations of pathoanatomical, physical, and psychosocial factors that are associated with PHP. Purpose: The purpose of this case series is to describe physical therapist decision-making of individualized multimodal treatment for PHP cases presenting with varied clinical presentations. Treatment incorporated clinical guidelines and recent evidence including a combination of manual therapy, patient education, stretching, resistance training, and neurodynamic interventions. A common clinical decision-making framework was used to progress individualized treatment from a focus on symptom modulation initially to increased load tolerance of involved tissues and graded activity. In each case, patients met their individual goals and demonstrated clinically meaningful improvements in pain, function, and global rating of change that were maintained at the 1-2-year follow-up. Implications: This case series provides details of physical therapist management of a variety of PHP clinical presentations that can be used to complement clinical practice guidelines in the management of PHP.
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Affiliation(s)
- Shane McClinton
- Doctor of Physical Therapy Program, Des Moines University , Des Moines, IA, USA
| | - Bryan Heiderscheit
- Departments of Orthopedics & Rehabilitation and Biomedical Engineering, and Doctor of Physical Therapy Program, University of Wisconsin-Madison , Madison, WI, USA
| | - Thomas G McPoil
- School of Physical Therapy, Regis University , Denver, CO, USA
| | - Timothy W Flynn
- School of Physical Therapy, South College , Knoxville, TN, USA
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Abstract
INTRODUCTION There is an increasing trend to investigate plantar heel pain with magnetic resonance imaging (MRI) scan though plantar fasciitis is the most common cause. The purpose of our study was to evaluate the role of MRI in patients presenting with plantar heel pain. METHODS Case notes and MRI scans of 141 patients with a clinical diagnosis of plantar fasciitis were reviewed retrospectively. There were 98 females and 43 males patients. Fourteen patients had bilateral symptoms. Average age for male patients was 51 years (range = 26-78 years), and for female patients the average age was 52 years (range = 29-76 years). RESULTS A total of 121 feet had MRI features suggestive of plantar fasciitis. MRI was normal in 32 feet. There was one case of stress fracture of calcaneus and another of a heel fibroma diagnosed on MRI scan. CONCLUSIONS In our study, MRI scan was normal in 20.7% of the cases; 1.3% had a diagnosis other than plantar fasciitis but no sinister pathology. We therefore conclude that MRI scan is not routinely indicated and key is careful clinical assessment. LEVELS OF EVIDENCE Therapeutic, Level IV: Retrospective, Case series.
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Affiliation(s)
- Muhammad Ali Fazal
- Barnet & Chase Farm Hospitals, Royal Free Hospitals NHS Foundation Trust, Enfield, London, UK
| | - Demetris Tsekes
- Barnet & Chase Farm Hospitals, Royal Free Hospitals NHS Foundation Trust, Enfield, London, UK
| | - Irshad Baloch
- Barnet & Chase Farm Hospitals, Royal Free Hospitals NHS Foundation Trust, Enfield, London, UK
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McClinton S, Weber CF, Heiderscheit B. Low back pain and disability in individuals with plantar heel pain. Foot (Edinb) 2018; 34:18-22. [PMID: 29202429 DOI: 10.1016/j.foot.2017.09.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 09/06/2017] [Accepted: 09/23/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Lack of response to plantar heel pain (PHP) treatment may be related to unmanaged low back pain (LBP) and low back dysfunction, but a relationship between LBP and PHP has not been established. The purpose of this investigation was to compare the prevalence of LBP among individuals with and without PHP and to assess the association between low back disability and foot/ankle function. METHODS A cross-sectional study compared the prevalence and likelihood of LBP in individuals with (n=27) and without (n=27) PHP matched to age, sex, BMI, foot posture, and foot mobility. In individuals with PHP, correlations were examined between foot/ankle function using the foot and ankle ability measure (FAAM), low back disability using the Oswestry low back disability questionnaire (OSW), duration of PHP symptoms, body mass index (BMI), and age. RESULTS A greater percentage of individuals with PHP had LBP (74% versus 37% of controls, odds ratio=5.2, P=0.009) and higher levels of low back disability (17% higher OSW score than controls, P<0.001). In individuals with PHP, FAAM scores were correlated with OSW scores (ρ=-0.463, P=0.015), but not with duration of PHP symptoms, BMI, or age (P>0.150). CONCLUSIONS Individuals with PHP had a greater prevalence of LBP and higher low back disability that was correlated to reduced foot and ankle function. Treatment to address both local and proximal impairments, including impairments related to LBP, may be warranted to improve the management of PHP.
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Affiliation(s)
- Shane McClinton
- Doctor of Physical Therapy Program, Des Moines University, 3200 Grand Avenue, Des Moines, IA 50312, USA.
| | - Carolyn F Weber
- Doctor of Physical Therapy Program, Des Moines University, 3200 Grand Avenue, Des Moines, IA 50312, USA.
| | - Bryan Heiderscheit
- Departments of Orthopedics & Rehabilitation and Biomedical Engineering, and Doctor of Physical Therapy Program, University of Wisconsin-Madison, 1300 University Ave, Madison, WI 53706, USA.
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Wibowo DB, Harahap R, Widodo A, Haryadi GD, Ariyanto M. The effectiveness of raising the heel height of shoes to reduce heel pain in patients with calcaneal spurs. J Phys Ther Sci 2017; 29:2068-2074. [PMID: 29643574 PMCID: PMC5890200 DOI: 10.1589/jpts.29.2068] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 09/04/2017] [Indexed: 11/24/2022] Open
Abstract
[Purpose] To investigate the effect of heel height on the distribution of plantar foot force and heel pain in patients with a heel spur. [Subjects and Methods] Plantar force was measured using 8 force sensors in 16 patients (3 men, 13 women), with symptomatic heel spur for 4 heel heights (0-4 cm). Sensors were located at the hallux (T1); medial to lateral metatarsals (M1 through M3), mid-foot (MF); and at the central, lateral, and medial heel (CH, LH, and MH). Pain was evaluated using the minimum compression force that caused pain and was measured using an algometer. [Results] Load bearing shifted from the heel (CH) to the mid-foot (MF) and hallux (T1) with increasing heel height. Raising the heel from 2 to 3 cm reduced the magnitude of load bearing, relative to the minimum compression force for pain, by 3.70% at the LH and 2.35% at the MH. Excellent clinical outcomes, defined by a 70-100% decrease in pain, were achieved in 10/16 participants with the use of a 2-cm and 3-cm heel height in men and women, respectively. [Conclusion] Increasing heel height effectively decreases the plantar force on the heel during weight-bearing activities.
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Affiliation(s)
- Dwi Basuki Wibowo
- Center for Biomechanics, Central Laboratory of Research and Services, Diponegoro University: Prof. Soedharto Street, Tembalang Semarang, Indonesia
| | | | - Achmad Widodo
- Center for Biomechanics, Central Laboratory of Research and Services, Diponegoro University: Prof. Soedharto Street, Tembalang Semarang, Indonesia
| | - Gunawan Dwi Haryadi
- Center for Biomechatronics, Central Laboratory of Research and Services, Diponegoro University, Indonesia
| | - Mochammad Ariyanto
- Center for Biomechatronics, Central Laboratory of Research and Services, Diponegoro University, Indonesia
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Aziz Saba EK, El-Tawab SS, Sultan HAM. Medial calcaneal neuropathy: a missed etiology of chronic plantar heel pain. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2017. [DOI: 10.4103/err.err_16_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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The Effectiveness of Neural Mobilization for Neuromusculoskeletal Conditions: A Systematic Review and Meta-analysis. J Orthop Sports Phys Ther 2017; 47:593-615. [PMID: 28704626 DOI: 10.2519/jospt.2017.7117] [Citation(s) in RCA: 99] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Study Design Systematic review with meta-analysis. Objectives To determine the efficacy of neural mobilization (NM) for musculoskeletal conditions with a neuropathic component. Background Neural mobilization, or neurodynamics, is a movement-based intervention aimed at restoring the homeostasis in and around the nervous system. The current level of evidence for NM is largely unknown. Methods A database search for randomized trials investigating the effect of NM on neuromusculoskeletal conditions was conducted, using standard methods for article identification, selection, and quality appraisal. Where possible, studies were pooled for meta-analysis, with pain, disability, and function as the primary outcomes. Results Forty studies were included in this review, of which 17 had a low risk of bias. Meta-analyses could only be performed on self-reported outcomes. For chronic low back pain, disability (Oswestry Disability Questionnaire [0-50]: mean difference, -9.26; 95% confidence interval [CI]: -14.50, -4.01; P<.001) and pain (intensity [0-10]: mean difference, -1.78; 95% CI: -2.55, -1.01; P<.001) improved following NM. For chronic neck-arm pain, pain improved (intensity: mean difference, -1.89; 95% CI: -3.14, -0.64; P<.001) following NM. For most of the clinical outcomes in individuals with carpal tunnel syndrome, NM was not effective (P>.11) but showed some positive neurophysiological effects (eg, reduced intraneural edema). Due to a scarcity of studies or conflicting results, the effect of NM remains uncertain for various conditions, such as postoperative low back pain, cubital tunnel syndrome, and lateral epicondylalgia. Conclusion This review reveals benefits of NM for back and neck pain, but the effect of NM on other conditions remains unclear. Due to the limited evidence and varying methodological quality, conclusions may change over time. Level of Evidence Therapy, level 1a. J Orthop Sports Phys Ther 2017;47(9):593-615. Epub 13 Jul 2017. doi:10.2519/jospt.2017.7117.
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Doneddu PE, Coraci D, Loreti C, Piccinini G, Padua L. Tarsal tunnel syndrome: still more opinions than evidence. Status of the art. Neurol Sci 2017; 38:1735-1739. [DOI: 10.1007/s10072-017-3039-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 06/17/2017] [Indexed: 11/28/2022]
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Investigation of the optimum heel pad stiffness: a modeling study. AUSTRALASIAN PHYSICAL & ENGINEERING SCIENCES IN MEDICINE 2017; 40:585-593. [DOI: 10.1007/s13246-017-0565-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 06/12/2017] [Indexed: 10/19/2022]
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Wu YT, Chang CY, Chou YC, Yeh CC, Li TY, Chu HY, Chen LC. Ultrasound-Guided Pulsed Radiofrequency Stimulation of Posterior Tibial Nerve: A Potential Novel Intervention for Recalcitrant Plantar Fasciitis. Arch Phys Med Rehabil 2017; 98:964-970. [DOI: 10.1016/j.apmr.2017.01.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 01/10/2017] [Accepted: 01/11/2017] [Indexed: 11/25/2022]
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Kirkpatrick J, Yassaie O, Mirjalili SA. The plantar calcaneal spur: a review of anatomy, histology, etiology and key associations. J Anat 2017; 230:743-751. [PMID: 28369929 DOI: 10.1111/joa.12607] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2017] [Indexed: 12/15/2022] Open
Abstract
The plantar calcaneal spur (PCS) is a bony outgrowth from the calcaneal tuberosity and has been studied using various methods including cadavers, radiography, histology and surgery. However, there are currently a number of discrepancies in the literature regarding the anatomical relations, histological descriptions and clinical associations of PCS. Historically, authors have described the intrinsic muscles of the foot and/or the plantar fascia as attaching to the PCS. In this article we review the relationship between the PCS and surrounding soft tissues as well as examining the histology of the PCS. We identify a number of key associations with PCS, including age, weight, gender, arthritides, plantar fasciitis and foot position; these factors may function as risk factors in PCS formation. The etiology of these spurs is a contentious issue and it has been explained through a number of theories including the degenerative, inflammatory, traction, repetitive trauma, bone-formers and vertical compression theories. We review these and finish by looking clinically at the evidence that PCS causes heel pain.
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Affiliation(s)
- Joshua Kirkpatrick
- Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand
| | - Omid Yassaie
- Department of Orthopedic Surgery, Wellington Hospital, Wellington, New Zealand
| | - Seyed Ali Mirjalili
- Department of Anatomy and Medical Imaging, University of Auckland, Auckland, New Zealand
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Thompson JV, Saini SS, Reb CW, Daniel JN. Diagnosis and management of plantar fasciitis. J Osteopath Med 2016; 114:900-6. [PMID: 25429080 DOI: 10.7556/jaoa.2014.177] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Plantar fasciitis, a chronic degenerative process that causes medial plantar heel pain, is responsible for approximately 1 million physician visits each year. Individuals with plantar fasciitis experience pain that is most intense during their first few steps of the day or after prolonged standing. The authors provide an overview of the diagnosis and management of a common problem encountered in the primary care setting. Routine imaging is not initially recommended for the evaluation of plantar fasciitis but may be required to rule out other pathologic conditions. Overall, plantar fasciitis carries a good prognosis when patients use a combination of several conservative treatment modalities. Occasionally, referral to a specialist may be necessary.
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Affiliation(s)
- John V Thompson
- From the Department of Orthopaedic Surgery at Memorial Hospital in York, Pennsylvania (Dr Thompson); the Rowan University School of Osteopathic Medicine (RowanSOM) in Stratford, New Jersey (Student Doctor Saini); the Department of Orthopedics at RowanSOM in Stratford, New Jersey (Dr Reb); and the Department of Surgery at Jefferson Medical College in Philadelphia, Pennsylvania (Dr Daniel). Dr Thompson is in his second year of residency training, and Dr Reb is in his fifth year of residency training
| | - Sundeep S Saini
- From the Department of Orthopaedic Surgery at Memorial Hospital in York, Pennsylvania (Dr Thompson); the Rowan University School of Osteopathic Medicine (RowanSOM) in Stratford, New Jersey (Student Doctor Saini); the Department of Orthopedics at RowanSOM in Stratford, New Jersey (Dr Reb); and the Department of Surgery at Jefferson Medical College in Philadelphia, Pennsylvania (Dr Daniel). Dr Thompson is in his second year of residency training, and Dr Reb is in his fifth year of residency training
| | - Christopher W Reb
- From the Department of Orthopaedic Surgery at Memorial Hospital in York, Pennsylvania (Dr Thompson); the Rowan University School of Osteopathic Medicine (RowanSOM) in Stratford, New Jersey (Student Doctor Saini); the Department of Orthopedics at RowanSOM in Stratford, New Jersey (Dr Reb); and the Department of Surgery at Jefferson Medical College in Philadelphia, Pennsylvania (Dr Daniel). Dr Thompson is in his second year of residency training, and Dr Reb is in his fifth year of residency training
| | - Joseph N Daniel
- From the Department of Orthopaedic Surgery at Memorial Hospital in York, Pennsylvania (Dr Thompson); the Rowan University School of Osteopathic Medicine (RowanSOM) in Stratford, New Jersey (Student Doctor Saini); the Department of Orthopedics at RowanSOM in Stratford, New Jersey (Dr Reb); and the Department of Surgery at Jefferson Medical College in Philadelphia, Pennsylvania (Dr Daniel). Dr Thompson is in his second year of residency training, and Dr Reb is in his fifth year of residency training
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Abstract
BACKGROUND Pressure pain threshold (PPT) is a useful tool for evaluating mechanical sensitivity in patients suffering from various musculoskeletal disorders. However, no previous study has investigated PPT in the heel of patients experiencing plantar heel pain syndrome (PHPS). The aim of this study was to compare PPT levels and topographic presentation of sensitivity in the heel of patients with PHPS and in healthy controls. METHODS The reliability of PPT testing in patients with PHPS was assessed for intra- and interrater recordings. The PPT levels of 40 feet in each group were then assessed on 5 predetermined sites in the heel using a standardized measurement protocol. Patient functional status (FS) as measured by the Foot & Ankle Computerized Adaptive Test was employed as an external reference. RESULTS Multivariate analysis of covariance revealed no group differences for PPTs at all sites (P = .406). Age (P = .099) or BMI (P = .510) did not affect PPT values, although there was an effect on gender (P = .006). The analysis revealed significant differences between sites (P < .001) demonstrating a diverse topographic distribution. In the PHPS group, PPT levels at the anterior/medial, posterior/medial and central sites were significantly lower than at the posterior/lateral and anterior/lateral sites (P < .05). For the control group, PPT levels at the anterior/medial site were significantly lower than all other sites (P < .001). CONCLUSION No significant differences were found between PPT of the PHPS patients and controls, therefore, PPT cannot be recommended as an assessment tool for these patients. The topographic distribution indicated low PPT levels at the anterior/medial area of the heel in patients with PHPS and controls. LEVEL OF EVIDENCE Level II, comparative study.
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Affiliation(s)
- Bernice Saban
- Spinal Research Laboratory, Department of Physical Therapy, the Stanley Steyer School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Israel Physical Therapy Service, Maccabi Healthcare Services, Shpeigel 3, Petach Tikva, Petach Tikva, Israel
| | - Youssef Masharawi
- Spinal Research Laboratory, Department of Physical Therapy, the Stanley Steyer School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Israel
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Clattenburg E, Herring A, Hahn C, Johnson B, Nagdev A. ED ultrasound-guided posterior tibial nerve blocks for calcaneal fracture analagesia. Am J Emerg Med 2016; 34:1183.e1-3. [DOI: 10.1016/j.ajem.2015.11.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 11/01/2015] [Indexed: 12/23/2022] Open
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Arslan A, Koca TT, Utkan A, Sevimli R, Akel İ. Treatment of Chronic Plantar Heel Pain With Radiofrequency Neural Ablation of the First Branch of the Lateral Plantar Nerve and Medial Calcaneal Nerve Branches. J Foot Ankle Surg 2016; 55:767-71. [PMID: 27073185 DOI: 10.1053/j.jfas.2016.03.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Indexed: 02/03/2023]
Abstract
From March 2012 to February 2013, 37 patients experiencing plantar heel pain for ≥6 months despite treatment with physical therapy and other conservative treatment modalities were followed up. If neurogenic heel pain originating from the first branch of the lateral plantar nerve was present, with or without the medial calcaneal nerve, diagnostic nerve blocks to these nerves were performed for confirmation. If the pain was determined to be of neurogenic origin, radiofrequency neural ablation (RFNA) was applied to the corresponding sensory nerve endings. Pain was evaluated using the visual analog scale, and patients were followed for at least one year. A total of 41 feet from 37 patients (30 [81.1%] females, 7 [18.9%] males; mean age, 50.7 ± 1.6 years; mean body mass index, 30.6 ± 0.7 kg/m(2)) were included. The mean visual analog scale scores improved significantly from 1 to 6 to 12 months after the procedure relative to before the procedure, with 88% of all patients rating the treatment as either very successful or successful at 12 months postoperatively. RFNA applied to both the first branch of the lateral plantar nerve and the medial calcaneal nerve sensory branches (16 [39%] feet) and only the first branch of the lateral plantar nerve sensory branches (25 [61%] feet) showed similarly high levels of success. Of the 41 feet, 28 [68.3%] had received extracorporeal shockwave therapy, 35 [85.4%] had received steroid injections, and 22 [53.7%] had received both extracorporeal shockwave therapy and steroid injections before RFNA as an index procedure. All were unresponsive to these previous treatments. In contrast, almost all (88%) were treated successfully with RFNA. Despite a high incidence of neurologic variations, with a precise diagnosis and good application of the technique using the painful points, chronic plantar heel pain can be treated successfully with RFNA.
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Affiliation(s)
- Aydın Arslan
- Orthopaedic Surgeon, Department of Orthopaedics, State Hospital, Malatya, Turkey.
| | - Tuba Tulay Koca
- Physical Therapy and Rehabilitation Specialist, Department of Physical Therapy and Rehabilitation, State Hospital, Malatya, Turkey
| | - Ali Utkan
- Orthopaedic Surgeon, Department of Orthopaedics, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Resit Sevimli
- Orthopaedic Surgeon and Assistant Professor, Department of Orthopaedics, Inonu University, Turgut Ozal Medical Center, Malatya, Turkey
| | - İbrahim Akel
- Orthopaedic Surgeon and Associate Professor, Department of Orthopaedics, Kent Hospital, İzmir, Turkey
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Saba EKA, El-Sherif SM. Ultrasound-guided versus palpation-guided local corticosteroid injection therapy for treatment of plantar fasciitis. THE EGYPTIAN RHEUMATOLOGIST 2016. [DOI: 10.1016/j.ejr.2015.06.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Rodrigues RN, Lopes AA, Torres JM, Mundim MF, Silva LLG, Silva BRDCE. Compressive neuropathy of the first branch of the lateral plantar nerve: a study by magnetic resonance imaging. Radiol Bras 2016; 48:368-72. [PMID: 26811554 PMCID: PMC4725398 DOI: 10.1590/0100-3984.2013.0028] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To assess the prevalence of isolated findings of abnormalities leading to entrapment of the lateral plantar nerve and respective branches in patients complaining of chronic heel pain, whose magnetic resonance imaging exams have showed complete selective fatty atrophy of the abductor digiti quinti muscle. MATERIALS AND METHODS Retrospective, analytical, and cross-sectional study. The authors selected magnetic resonance imaging of hindfoot of 90 patients with grade IV abductor digiti quinti muscle atrophy according to Goutallier and Bernageau classification. Patients presenting with minor degrees of fatty muscle degeneration (below grade IV) and those who had been operated on for nerve decompression were excluded. RESULTS A female prevalence (78.8%) was observed, and a strong correlation was found between fatty muscle atrophy and plantar fasciitis in 21.2%, and ankle varices, in 16.8% of the patients. CONCLUSION Fatty atrophy of the abductor digiti quinti muscle is strongly associated with neuropathic alterations of the first branch of the lateral plantar nerve. The present study showed a significant association between plantar fasciitis and ankle varices with grade IV atrophy of the abductor digiti quinti muscle.
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Affiliation(s)
| | - Alexia Abuhid Lopes
- MDs, Musculoskeletal Radiologists, Axial Medicina Diagnóstica, Belo Horizonte, MG, Brazil
| | - Jardélio Mendes Torres
- MD, Orthopedist, Head of the Foot Surgery Group at Santa Casa de Belo Horizonte, Professor at Faculdade de Ciências Médicas de Minas Gerais (FCMMG), Belo Horizonte, MG, Brazil
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