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Moran C, Tourné Y. Posterior Heel Pain in Cavovarus Foot: How to Approach It. Foot Ankle Clin 2023; 28:775-789. [PMID: 37863534 DOI: 10.1016/j.fcl.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2023]
Abstract
When a patient presents with posterior heel pain on the background of a cavovarus foot, there are many different aspects to take into account. The morphology of the foot and the specific cause of the patient's pain lead the practitioner to alter the treatment appropriately. Some patients should only receive physiotherapy, but the majority should receive more invasive treatments, including calcaneal osteotomies or tendon debridement, depending on their particular presentation and pathology. This review examines the various different facets of posterior heel pain that must be dealt with and the most up-to-date treatments for the same.
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Affiliation(s)
- Conor Moran
- Centre Osteo Articulaires des Cèdres, 5 Rue des Tropiques Echirolles 38130, France
| | - Yves Tourné
- Centre Osteo Articulaires des Cèdres, 5 Rue des Tropiques Echirolles 38130, France.
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2
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Zhou S, Luo W, Wang S, Zhang K. 12 Cases of Haglund's Syndrome Detected through MRI. Curr Med Imaging 2023:CMIR-EPUB-130072. [PMID: 36892125 DOI: 10.2174/1573405619666230309102638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 02/14/2023] [Accepted: 02/16/2023] [Indexed: 03/10/2023]
Abstract
BACKGROUND Haglund's syndrome is a common cause of heel pain but often neglected clinically. Haglund's syndrome refers to a series of symptoms caused by impingement among posterosuperior prominence of the calcaneus, bursa and Achilles tendon. It is difficult to distinguish Haglund's syndrome from other causes of heel pain by clinical diagnosis. Imageology is of great value in the diagnosis of Haglund's syndrome. OBJECTIVE Our study aims to summarize the Magnet resonance (MR) imaging characteristics of Haglund's syndrome and provide some reference to clinical work. METHOD We retrospectively analyzed the MR images of 11 patients (6 males; 5 females; 6 right ankles, 4 left ankles, 1 bimalleolar ankles) who have been clinically and radiologically confirmed Haglund's syndrome. Observation contents: morphological changes of calcaneus and talus, abnormal signal of calcaneus, abnormal Achilles tendon, and soft tissue abnormalities around Achilles tendon. Combined with literature reviews, summarize the MR imaging features of Haglund's syndrome. RESULTS In 12 ankles, all ankles showed posterosuperior prominence of the calcaneus and Achilles tendon degeneration; 7 ankles showed bone marrow edema; 6 Achilles tendons were graded as either type II or type III tendinosis; 5 Achilles tendons showed partial tear; 12 ankles showed retrocalcaneal bursitis, 7 ankles showed retro-Achilles bursitis, 6 ankles showed Kager's fat pad edema. CONCLUSION This study found that MR images of Haglund's syndrome showed bone edema of the calcaneus, degeneration and partial tear of the Achilles tendon, the retrocalcaneal and retro-Achilles bursas, and Kager's fat pad edema.
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Affiliation(s)
- Shuwei Zhou
- Department of Radiology, The First Hospital of Hunan University of Chinese Medicine, 95 Shaoshan Middle Road, Yuhua District, Changsha 410007, P.R. China.,The College of Integrated Traditional Chinese and Western Medicine, Hunan University of Chinese Medicine, 300 Xueshi Road, Yuelu District, Changsha 410208, P.R. China
| | - Wuxing Luo
- Department of Radiology, The First Hospital of Hunan University of Chinese Medicine, 95 Shaoshan Middle Road, Yuhua District, Changsha 410007, P.R. China
| | - Siyu Wang
- Department of Radiology, The First Hospital of Hunan University of Chinese Medicine, 95 Shaoshan Middle Road, Yuhua District, Changsha 410007, P.R. China
| | - Kun Zhang
- Department of Radiology, The First Hospital of Hunan University of Chinese Medicine, 95 Shaoshan Middle Road, Yuhua District, Changsha 410007, P.R. China.,The College of Integrated Traditional Chinese and Western Medicine, Hunan University of Chinese Medicine, 300 Xueshi Road, Yuelu District, Changsha 410208, P.R. China
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3
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Sankey T, Sanchez T, Young S, Varma K, Singh MS, Shah A. Surgical treatment of a hindfoot plantar leiomyoma: A case study. J Clin Orthop Trauma 2023; 37:102090. [PMID: 36691573 PMCID: PMC9860341 DOI: 10.1016/j.jcot.2022.102090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 12/29/2022] [Indexed: 01/01/2023] Open
Abstract
Leiomyomas within the foot are rare and are difficult to diagnose with only the radiographic and clinical picture. They are benign, slow growing, and very rarely cause pain. We present an unusual case of a dermatology referral patient complaining of callus formation on the plantar aspect of the foot as well as shoe discomfort. The mass was believed to be a lipoma or a fibroma but after surgical excision was found to be a leiomyoma. Our case highlights the rarity of this diagnosis and presents a unique surgical technique utilizing a medial approach to the plantar hindfoot for lesion removal.
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Affiliation(s)
- Turner Sankey
- University of Alabama at Birmingham, Department of Orthopaedics, USA
| | - Thomas Sanchez
- University of Alabama at Birmingham, Department of Orthopaedics, USA
| | - Sean Young
- University of Alabama at Birmingham, Department of Orthopaedics, USA
| | - Kavita Varma
- University of Alabama at Birmingham, Department of Pathology, USA
| | | | - Ashish Shah
- University of Alabama at Birmingham, Department of Orthopaedics, USA
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Albano D, Messina C, Gitto S, Serpi F, Basile M, Acquasanta M, Lanza E, Sconfienza LM. Shear-wave elastography of the plantar fascia: a systematic review and meta-analysis. J Ultrasound 2023; 26:59-64. [PMID: 36662404 PMCID: PMC10063692 DOI: 10.1007/s40477-022-00770-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 12/18/2022] [Indexed: 01/21/2023] Open
Abstract
PURPOSE To assess the efficacy of shear-wave elastography (SWE) of the plantar fascia (PF) in identifying plantar fasciitis. METHODS A literature search was conducted on the PubMed and Medline databases for articles published up to August 2022. The Newcastle-Ottawa scale was used to assess the risk of bias. We included original research studies in English dealing with the evaluation of patients with plantar fasciitis by means of SWE and including shear modulus (KPa) and/or shear-wave velocity (m/s). We compared healthy and pathologic PF stiffness using the standardised mean difference (SMD) in a random-effects model (95% CI). RESULTS Five studies were included with a total of 158 pathologic PFs and 134 healthy PFs. No significant publication bias was detected. Studies were highly heterogeneous (p < 0.00001; I2 = 97%). Pathologic PFs showed significantly lower stiffness, with an SMD of - 3.00 m/s (95% confidence interval: - 4.95 to - 1.06, p = 0.002), compared to healthy PF. CONCLUSION Pathologic PFs present significantly lower stiffness than healthy PFs. However, the analysed studies are highly heterogeneous.
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Affiliation(s)
- Domenico Albano
- Unità Operativa di Radiologia Diagnostica e Interventistica, IRCCS Istituto Ortopedico Galeazzi, 20161, Milan, Italy.
| | - Carmelo Messina
- Unità Operativa di Radiologia Diagnostica e Interventistica, IRCCS Istituto Ortopedico Galeazzi, 20161, Milan, Italy.,Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, 20133, Milan, Italy
| | - Salvatore Gitto
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, 20133, Milan, Italy
| | - Francesca Serpi
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, 20133, Milan, Italy
| | - Mariachiara Basile
- Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, 20122, Milan, Italy
| | - Marzia Acquasanta
- Radiologia e Diagnostica per immagini, Ospedale Città di Sesto San Giovanni - ASST Nord Milano, 20099, Sesto San Giovanni, Italy
| | - Ezio Lanza
- Department of Radiology, Humanitas Clinical and Research Center - IRCCS, 20089, Rozzano, Italy
| | - Luca Maria Sconfienza
- Unità Operativa di Radiologia Diagnostica e Interventistica, IRCCS Istituto Ortopedico Galeazzi, 20161, Milan, Italy.,Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, 20133, Milan, Italy
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Chang AH, Rasmussen SZ, Jensen AE, Sørensen T, Rathleff MS. What do we actually know about a common cause of plantar heel pain? A scoping review of heel fat pad syndrome. J Foot Ankle Res 2022; 15:60. [PMID: 35974398 PMCID: PMC9380282 DOI: 10.1186/s13047-022-00568-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 08/09/2022] [Indexed: 12/02/2022] Open
Abstract
Background The heel fat pad is an important structure of the foot as it functions as a cushion to absorb shock and distribute plantar force during ambulation. Clinical practice guidelines or decision support platforms emphasize that heel fat pad syndrome (HFPS) is a distinct pathology contributing to plantar heel pain. We aimed to identify and synthesize the prevalence, etiology and diagnostic criteria, and conservative management of HFPS. Methods A comprehensive search was conducted in May 2021 and updated in April 2022, using MEDLINE, Scopus, Cinahl, EMBASE, Cochrane Library, SPORTDiscus, and PEDro and ClinicalTrials.gov and the World Health Organization's International Clinical Trials Registry Platform (ICTRP) for pertinent registrations. We included all study types and designs describing the prevalence; etiology and diagnostic criteria; and non-pharmacological, non-surgical interventions for HFPS. Results We found a small body of original research for HFPS (n = 7). Many excluded full-text articles were expert-opinion articles or studies of heel fat pad in participants with plantar fasciitis/fasciopathy or unspecified heel pain. HFPS may be the second leading cause of plantar heel pain, based on two studies. A number of differentiating pain characteristics and behaviors may aid in diagnosing HFPS vs. plantar fasciopathy. Thinning heel fat pad confirmed by ultrasonography may provide imaging corroboration. Randomized controlled trials assessing the efficacy of viscoelastic heel cups or arch taping for managing HFPS do not exist. Conclusions The research literature for HFPS is sparse and sometimes lacking scientific rigor. We have identified a substantial knowledge gap for this condition, frequent inattention to distinguishing HFPS from plantar fasciopathy when describing plantar heel pain, and an absence of robust clinical trials to support the commonly recommended conservative management of HFPS.
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Affiliation(s)
- Alison H Chang
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark. .,Department of Physical Therapy and Human Movement Sciences, Northwestern University Feinberg School of Medicine, 645 N. Michigan Ave. #1100, Chicago, IL, 60611, USA.
| | - Steven Zartov Rasmussen
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Asger Emil Jensen
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Thomas Sørensen
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark.,Department of Physio- and Occupational Therapy, Lillebaelt Hospital - University Hospital of Southern Denmark, Vejle, Denmark
| | - Michael Skovdal Rathleff
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark.,Center for General Practice at Aalborg University, Aalborg, Denmark.,Department of Physical and Occupational Therapy, Aalborg University Hospital, Aalborg, Denmark
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6
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Ho M, Nguyen J, Heales L, Stanton R, Kong PW, Kean C. The biomechanical effects of 3D printed and traditionally made foot orthoses in individuals with unilateral plantar fasciopathy and flat feet. Gait Posture 2022; 96:257-264. [PMID: 35709609 DOI: 10.1016/j.gaitpost.2022.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 06/05/2022] [Accepted: 06/09/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Foot orthoses (FOs) are used to manage foot pathologies such as plantar fasciopathy. 3D printed custom-made FOs are increasingly being manufactured. Although these 3D-printed FOs look like traditionally heat-moulded FOs, there are few studies comparing FOs made using these two different manufacturing processes. RESEARCH QUESTION How effective are 3D-printed FOs (3D-Print) compared to traditionally-made (Traditional) or no FOs (Control), in changing biomechanical parameters of flat-footed individuals with unilateral plantar fasciopathy? METHODS Thirteen participants with unilateral plantar fasciopathy walked with shoes under three conditions: Control, 3D-print, and Traditional. 2 × 3 repeated measures analysis of variance (ANOVAs) with Bonferroni post-hoc tests were used to compare discrete kinematic and kinetic variables between limbs and conditions. Waveform analyses were also conducted using statistical parametric mapping (SPM). RESULTS There was a significant condition main effect for arch height drop (p = 0.01; ηp2 =0.54). There was 0.87 mm (95% CI [-1.84, -0.20]) less arch height drop in 3D-print compared to Traditional. The SPM analyses revealed condition main effects on ankle moment (p < 0.001) and ankle power (p < 0.001). There were significant differences between control condition and both 3D-print and Traditional conditions. For ankle moment and power, there were no differences between 3D-print and Traditional conditions. SIGNIFICANCE 3D-printed FOs are more effective in reducing arch height drop, whist both FOs lowered ankle plantarflexion moment and power compared to no FOs. The results support the use of 3D-printed FOs as being equally effective as traditionally-made FOs in changing lower limb biomechanics for a population of flat-footed individuals with unilateral plantar fasciopathy.
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Affiliation(s)
- Malia Ho
- Department of Podiatry, School of Health, Medical and Applied Sciences, CQUniversity Australia, Building 34, Bruce Highway, North Rockhampton, QLD 4701, Australia.
| | - Julie Nguyen
- Department of Podiatry, School of Health, Medical and Applied Sciences, CQUniversity Australia, Building 34, Bruce Highway, North Rockhampton, QLD 4701, Australia.
| | - Luke Heales
- Department of Physiotherapy, School of Health, Medical and Applied Sciences, CQUniversity Australia, Building 34, Bruce Highway, North Rockhampton, QLD 4701, Australia.
| | - Robert Stanton
- Department of Exercise and Sports Science, School of Health, Medical and Applied Sciences, CQUniversity Australia, Bruce Highway, North Rockhampton, QLD 4701, Australia.
| | - Pui W Kong
- Physical Education and Sports Science Academic Group, National Institute of Education, Nanyang Technological University, 1 Nanyang Walk, Singapore 637616, Singapore.
| | - Crystal Kean
- Department of Exercise and Sports Science, School of Health, Medical and Applied Sciences, CQUniversity Australia, Bruce Highway, North Rockhampton, QLD 4701, Australia.
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Saijilafu, Li SY, Yu X, Li ZQ, Yang G, Lv JH, Chen GX, Xu RJ. Heel pain caused by os subcalcis: A case report. World J Clin Cases 2022; 10:5373-5379. [PMID: 35812669 PMCID: PMC9210887 DOI: 10.12998/wjcc.v10.i16.5373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 10/11/2021] [Accepted: 04/04/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The accessory bones are common bone variations around the feet and ankles, which usually originate from nonunion of the secondary ossification center adjacent to the main bone mass, and most of them remain asymptomatic. Os subcalcis is an accessory bone at the plantar aspect of the calcaneus, which is located just posterior to the insertion of the plantar fascia. Focal bone formation at the calcaneal plantar pole with heel pain has rarely been reported.
CASE SUMMARY A 55-year-old man presented to our clinic with left plantar heel pain and a progressive swelling for 8 years. X-ray, computer tomography and magnetic resonance imaging showed a large os subcalcison the plantar side of the calcaneus, located at the insertion of the plantar fascia. He underwent surgical excision of the lesion. Microscopically the bony trabeculae were intermingled with fat and covered with cartilage.
CONCLUSION This is a rare case with accessory os subcalcis leading to heel pain. It highlights the awareness of os subcalcis and helps avoid future misdiagnosis of heel pain.
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Affiliation(s)
- Saijilafu
- Department of Orthopaedics, Soochow University, Suzhou 215007, Jiangsu Province, China
| | - Suo-Yuan Li
- Department of Orthopaedics, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou 215000, Jiangsu Province, China
| | - Xiao Yu
- Department of Orthopaedics, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou 215000, Jiangsu Province, China
| | - Zhi-Qiang Li
- Department of Orthopaedics, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou 215000, Jiangsu Province, China
| | - Guang Yang
- Department of pathology, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou 215000, Jiangsu Province, China
| | - Jing-Huan Lv
- Department of pathology, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou 215000, Jiangsu Province, China
| | - Guang-Xiang Chen
- Department of Orthopaedics, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou 215000, Jiangsu Province, China
| | - Ren-Jie Xu
- Department of Orthopaedics, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou 215000, Jiangsu Province, China
- Department of Orthopaedics, the First Affiliated Hospital, Orthopaedic Institute, Soochow University, Suzhou 215000, Jiangsu Province, China
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8
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Caicedo Gutiérrez L, Moreno Martínez D. Case report: Baxter's nerve radiofrequency in patient with plantar fasciitis nonresponsive to conventional treatment. Rev Esp Anestesiol Reanim (Engl Ed) 2022; 69:306-309. [PMID: 35577703 DOI: 10.1016/j.redare.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 02/04/2021] [Indexed: 06/15/2023]
Abstract
Plantar fasciitis is recognized as the leading cause of talalgia worldwide. In the vast majority of cases it can be controlled with the use of appropriate footwear, stretching exercises and changes in the sport activity, while a few cases require infiltrations or surgical interventions. The latter puts the patient at greater risk, and is reserved for the most severe cases. We propose using pulsed radiofrequency ablation of Baxter's nerve to treat this painful symptom in patients who do not respond adequately to conventional treatment. We present the case of a patient with refractory plantar fasciitis in whom surgery had been ruled out. The patient underwent pulsed radiofrequency treatment with satisfactory results in the short and medium term.
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Affiliation(s)
| | - D Moreno Martínez
- Dolor y Cuidado Paliativo, Hospital Universitario San Ignacio, Bogotá DC, Colombia; Departamento de Anestesiología, Pontificia Universidad Javeriana, Bogotá DC, Colombia
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Çatal B, Genç E, Çaçan MA, Güleryüz Y, Erdil ME. Is there a relation between plantar fasciitis and total cholesterol levels? Foot Ankle Surg 2022; 28:390-393. [PMID: 34020883 DOI: 10.1016/j.fas.2021.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 04/04/2021] [Accepted: 05/12/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND The main objective of this study is to investigate the relationship between hypercholesterolemia and Plantar Fasciitis (PF). METHODS The study includes patients who presented to the orthopedics outpatient clinic with heel pain and were diagnosed with PF. The control group was composed of patients who came to the orthopedics outpatient clinic, with complaints other than heel pain. The two groups were compared in terms of epidemiological data, total cholesterol (TC) levels, and hypercholesterolemia prevalence. We also performed an in-group analysis of PF patients in terms of age, sex, body mass index, and duration of symptoms. RESULTS There were 238 patients (mean age, 46.7) in the PF group and 240 patients (mean age, 47.9) in the control group. There was a significant difference between the PF group and the control group in TC levels (207.6 ± 47.5 versus 195.1 ± 30.1, p = 0.001). Hypercholesterolemia (TC level > 240 mg/dL) was found in 22.7% (n = 54) of the patients in the PF group whereas in the control group this rate was 10.8% (n = 26) (p < 0.001). It was seen that the TC levels were significantly higher in patients over the age of 45 in the PF group (p = 0.038). We also found that TC levels were higher in PF patients with symptoms for longer than a year (p = 0.026). CONCLUSION Significantly higher TC levels were found in PF patients in comparison with other orthopedic outpatients. Besides, being over the age of 45 and having a duration of symptoms longer than a year is associated with higher cholesterol levels for PF patients. LEVEL OF CLINICAL EVIDENCE 4.
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Affiliation(s)
- Bilgehan Çatal
- Medipol University Medical School Department of Orthopedic Surgery, İstanbul Turkey.
| | - Erdinç Genç
- University of Health Sciences Bagcilar Training and Research Hospital, Istanbul, Turkey.
| | - Mehmet Akif Çaçan
- Medipol University Medical School Department of Orthopedic Surgery, İstanbul Turkey.
| | - Yiğit Güleryüz
- University of Health Sciences Bagcilar Training and Research Hospital, Istanbul, Turkey.
| | - Mehmet Emin Erdil
- Acıbadem University Medical School Department of Orthopedic Surgery, İstanbul, Turkey.
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Belikan P, Färber LC, Abel F, Nowak TE, Drees P, Mattyasovszky SG. Incidence of calcaneal apophysitis (Sever's disease) and return-to-play in adolescent athletes of a German youth soccer academy: a retrospective study of 10 years. J Orthop Surg Res 2022; 17:83. [PMID: 35139872 PMCID: PMC8827183 DOI: 10.1186/s13018-022-02979-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 01/26/2022] [Indexed: 11/15/2022] Open
Abstract
Background Calcaneal apophysitis, or Sever's disease, is the most common cause of heel pain in childhood and adolescence. It is regarded as an overuse syndrome. Studies on the incidence of calcaneal apophysitis in young athletes and their associated return-to-play time are lacking in the current literature. The aim of our current study was to identify the incidence of calcaneal apophysitis in professional youth soccer, the associated time to return-to-play, predisposing factors and their impact on time to return-to-play.
Methods Retrospective evaluation of injury data gathered from a German youth soccer academy in the years 2009–2018. In total, 4326 injury cases in 612 players were included in the study. The diagnosis and the follow-up visits were carried out in a weekly consultation hour at the youth academy. Results During the observation period of 10 years, 22 cases of calcaneal apophysitis were detected. The incidence of calcaneal apophysitis per 100 athletes per year was found to be 0.36. The mean age of the affected athletes at the time of diagnosis was 11.8 ± 2.1 years (MW ± SD). The complaints were unilateral in 20 and bilateral in two cases. Three of the 22 detected cases of calcaneal apophysitis (13.6%) were recurrent injuries. The mean time to return-to-play of the affected athletes was 60.7 ± 64.9 days (MW ± SD). Athletes with recurrent complaints showed longer recovery time and time to return-to-play when compared to players with primary diagnosed disease. Our results could show that neither age nor body mass index at the time of diagnosis had an impact on time to return-to-play. Conclusions This is the first study investigating the incidence of calcaneal apophysitis and the associated time to return-to-play in youth elite soccer. Calcaneal apophysitis results in substantial time loss for the athletes. Further prospective clinical studies are required to fully understand the etiology and risk factors for calcaneal apophysitis and therefore develop preventive strategies.
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Affiliation(s)
- Patrick Belikan
- Department of Orthopaedics and Traumatology, University Medical Centre of the Johannes Gutenberg-University of Mainz, Langenbeckstraße 1, 55131, Mainz, Germany.
| | - Lars-Christopher Färber
- Department of Orthopaedics and Traumatology, University Medical Centre of the Johannes Gutenberg-University of Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Frédéric Abel
- Department of Orthopaedics and Traumatology, University Medical Centre of the Johannes Gutenberg-University of Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Tobias E Nowak
- Department of Orthopaedics and Traumatology, University Medical Centre of the Johannes Gutenberg-University of Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Philipp Drees
- Department of Orthopaedics and Traumatology, University Medical Centre of the Johannes Gutenberg-University of Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Stefan G Mattyasovszky
- Department of Orthopaedics and Traumatology, University Medical Centre of the Johannes Gutenberg-University of Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
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11
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Caner ÖC, Güneş S, Gökmen D, Ataman Ş, Kutlay Ş. The efficacy and safety of extracorporeal shock wave therapy on plantar fasciitis in patients with axial spondyloarthritis: a double-blind, randomized controlled trial. Rheumatol Int 2022; 42:581-589. [PMID: 35122485 DOI: 10.1007/s00296-022-05098-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 01/21/2022] [Indexed: 01/17/2023]
Abstract
The efficacy and safety of extracorporeal shock wave therapy (ESWT) on chronic plantar fasciitis (PF) in patients with axial spondyloarthritis (axSpA) remain unclear. To investigate the efficacy and tolerability of ESWT in patients with PF in axSpA. In this double-blind, randomized controlled trial, 22 axSpA patients with PF who had heel pain above 5 according to visual analog scale (VAS) over 3 months were randomly divided into 2 groups: ESWT and sham-ESWT. Both groups received a total of three treatments at 1-week intervals. All patients were assessed by the VAS, heel pressure algometry, Foot Function Index (FFI), and plantar fascia ultrasonography (thickness and morphology) at baseline, 1 week after each session, 4th and 8th week after the last therapy. The mean ± SD ages of the ESWT and sham-ESWT groups were 43.8 ± 8.2 and 48.5 ± 7.6 years, respectively. Significant time effects between the time points were observed in both groups in terms of VAS, pressure algometry, and FFI. There was a statistically significant decrease in pain, an increase in perceived pressure algometry values, and an improvement in activity restriction in the ESWT group compared to the sham-ESWT group. There was not a change in the plantar fascia thickness before and after the intervention in both groups. No side effects were observed during the treatment and follow-up. ESWT appears to be a safe and well-tolerated physical therapy modality for improving chronic refractory heel pain due to PF in patients with axSPA. This trial was registered to The Australian New Zealand clinical trial with the registration number ACTRN12618001954213. The enrollment began in 15/12/2018 and data collection stopped in 29/05/2020.
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Affiliation(s)
- Özgür Can Caner
- Department of Physical Medicine and Rehabilitation, Akşehir Parkhayat Hastanesi, Konya, Turkey
| | - Seçilay Güneş
- Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Ankara University, Ankara, Turkey.
| | - Derya Gökmen
- Department of Biostatistics, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Şebnem Ataman
- Division of Rheumatology, Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Şehim Kutlay
- Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Ankara University, Ankara, Turkey
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Eke I, Akcal MA, Sayrac AV, Iyetin Y. Effects of intralesional pulsed radiofrequency treatment on pain in patients with calcaneal spur: results of 460 patients. BMC Musculoskelet Disord 2021; 22:1033. [PMID: 34893055 DOI: 10.1186/s12891-021-04926-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 11/23/2021] [Indexed: 11/10/2022] Open
Abstract
Background This study aimed to investigate the efficacy of intralesional pulsed radiofrequency (RF) in the treatment of calcaneal spur and the results of patients who underwent single and double sessions of RF treatment. Methods The population of this retrospective study consisted of 460 patients who were diagnosed with calcaneal spur with clinical examination and direct radiography. The Wong-Baker Faces Pain Rating Scale and The American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score were used to determine the pain status and functional capacities of the patients. Posttreatment evaluation was carried out on average in the 6th week. Results The study involved 460 patients, 76.9% of whom were female, with the average age of 50.8 ± 10.9 years in total. Of the patients 43% was given RF therapy in a single session, and 57% of them in double sessions. After the RF procedure, the number of patients whose pain decreased according to both AOFAS and Wong-Baker pain scoring systems increased statistically significantly (p < 0.001). There was a statistically significant increase in the AOFAS-pain scores and the total AOFAS scores and a significant decrease in the Wong Baker-pain scale after treatment. However, there was no significant change in treatment success with respect to the number of RF sessions. Although not statistically significant, the differences in the AOFAS-pain scores and in the total AOFAS scores were found to be higher in patients who underwent single session RF, while the difference in the Wong Baker-pain ranking was higher in patients who received double sessions RF. Conclusion Intralesional pulsed RF procedure can be preferred as a relatively less invasive method that does not have any serious complications in patients with persistent calcaneal spurs who do not respond to the use of oral anti-inflammatory drugs and shoe insoles, nor corticosteroid injection to the lesion area.
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Alfaro-Santafé JV, Alfaro-Santafé J, Lanuza-Cerzócimo C, Gómez-Bernal A, Pérez-Morcillo A, Almenar-Arasanz AJ, Mena-Tobar A, Laclériga-Giménez AF. Locally linear embedding and plantar pressure-time graph selection in heel pain classification: An observational, case-control study. J Biomech 2021; 128:110784. [PMID: 34628198 DOI: 10.1016/j.jbiomech.2021.110784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 09/16/2021] [Accepted: 09/27/2021] [Indexed: 11/19/2022]
Abstract
Plantar heel pain mainly manifests during the gait cycle when the whole foot is in contact with the floor, which corresponds to the second rocker of the gait. This moment can be studied through the analysis of pressure-time graphs obtained using plantar pressure plate systems. However, these graphs are complex, and a dimensionality reduction method, such as locally linear embedding (LLE), greatly assists in their comprehension. This observational, case-control pilot study included 45 subjects divided into case (n = 21) and control (n = 24) groups, depending on the presence/absence of plantar heel pain. The second rocker pressure-time graphs of the 45 subjects were obtained using the Footwork Pro® plantar pressure plate system. These graphs were analyzed and defined as the dynamic simultaneity surfaces (DSSs). This complex structure was composed of four dimensions: the dynamic simultaneity time (DST), slope upward grade (α), slope downward grade (β), and height (h), and were reduced into one dimension and classified into pathological and non-pathological subjects using the LLE method. All 45 DSSs were successfully reduced and classified to distinguish between the case (plantar heel pain) and control (non-plantar heel pain) subjects. This study is the first to use the LLE method for gait analysis. This method serves as a novel and promising tool for the study and classification of pathological and non-pathological gait cycles. This method opens the door for future research and analysis, with significant potential to assess diagnosis, treatment follow-up, and injury prevention in physical medicine consultations.
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Affiliation(s)
- José-Víctor Alfaro-Santafé
- R & D Department, Biomechanical Unit, Podoactiva Headquarters, Huesca, Spain; Faculty of Health and Sports Sciences, San Jorge University, Villanueva de Gállego, Spain.
| | - Javier Alfaro-Santafé
- R & D Department, Biomechanical Unit, Podoactiva Headquarters, Huesca, Spain; Faculty of Health and Sports Sciences, San Jorge University, Villanueva de Gállego, Spain.
| | - Carla Lanuza-Cerzócimo
- R & D Department, Biomechanical Unit, Podoactiva Headquarters, Huesca, Spain; Faculty of Health and Sports Sciences, San Jorge University, Villanueva de Gállego, Spain.
| | - Antonio Gómez-Bernal
- R & D Department, Biomechanical Unit, Podoactiva Headquarters, Huesca, Spain; Faculty of Health and Sports Sciences, San Jorge University, Villanueva de Gállego, Spain.
| | | | - Alejandro-Jesús Almenar-Arasanz
- R & D Department, Biomechanical Unit, Podoactiva Headquarters, Huesca, Spain; Faculty of Health and Sports Sciences, San Jorge University, Villanueva de Gállego, Spain.
| | | | - Antonio-Francisco Laclériga-Giménez
- Faculty of Health and Sports Sciences, San Jorge University, Villanueva de Gállego, Spain; Service of Orthopaedic Surgery and Traumathology, Miguel Servet Universitary Hospital, Zaragoza, Spain.
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Rio Coles I, Lima Vieira C, Barroco Gouveia I, Rebelo T, Agualusa L. Ultrasound block of first branch of the lateral plantar nerve (baxter nerve): case report of a promising and effective treatment for heel chronic pain. Braz J Anesthesiol 2021; 71:664-6. [PMID: 34715997 DOI: 10.1016/j.bjane.2020.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 11/04/2020] [Accepted: 11/14/2020] [Indexed: 11/23/2022] Open
Abstract
Chronic heel pain is a challenging diagnosis and although it is a common and disabling condition frequently mistreated. Baxter Nerve (BN) entrapment is responsible for 20% of heel pain and can be managed by an ultrasound guide nerve block, a simple, safe, and durable technique. A 67-year-old woman complained of paraesthesia on the left heel and a “stepping on glass” feeling. Various techniques were performed to manage her symptoms without any results. An ultrasound BN block was finally performed with an instant relief and satisfactory pain control for the follow-up period of six months. This clinical report highlights the success of the ultrasound BN block as an effective and lasting solution for chronic heel pain.
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Caicedo Gutiérrez L, Moreno Martínez D. Case report: Baxteŕs nerve radiofrequency in patient with plantar fasciitis nonresponsive to conventional treatment. Rev Esp Anestesiol Reanim (Engl Ed) 2021; 69:S0034-9356(21)00100-6. [PMID: 34289957 DOI: 10.1016/j.redar.2021.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 11/07/2020] [Accepted: 02/04/2021] [Indexed: 11/19/2022]
Abstract
Plantar fasciitis is recognized as the leading cause of talalgia worldwide. In the vast majority of cases it can be controlled with the use of appropriate footwear, stretching exercises and changes in the sport activity, while a few cases require infiltrations or surgical interventions. The latter puts the patient at greater risk, and is reserved for the most severe cases. We propose using pulsed radiofrequency ablation of Baxter's nerve to treat this painful symptom in patients who do not respond adequately to conventional treatment. We present the case of a patient with refractory plantar fasciitis in whom surgery had been ruled out. The patient underwent pulsed radiofrequency treatment with satisfactory results in the short and medium term.
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Affiliation(s)
| | - D Moreno Martínez
- Dolor y Cuidado Paliativo, Hospital Universitario San Ignacio, Bogotá DC, Colombia; Departamento de Anestesiología, Pontificia Universidad Javeriana, Bogotá DC, Colombia
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16
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Sussman WI, Park DJ, Rucci PM, Chen YH. Subluxing fractured plantar fat pad: a case series and description of novel sonographic findings. Skeletal Radiol 2021; 50:1241-1247. [PMID: 33135090 DOI: 10.1007/s00256-020-03639-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/28/2020] [Accepted: 09/30/2020] [Indexed: 02/02/2023]
Abstract
Plantar fat pad syndrome has received little attention in the literature. A variety of structural changes of the plantar fat pad have been described in the literature, including atrophy, contusion, and fractured fat pad. This case series presents 4 patients (5 heels) with subluxation of a fractured plantar fat pad on dynamic ultrasound. Patients with subluxing fractured fat pad typically present with heel pain and a "snapping" or "popping" sensation when weight-bearing. Other causes of heel pain were excluded, and all patients in this series had an MRI that initially did not report any findings in the fat pad. Retrospective review of the MRI showed evidence of diffuse low T1 and T2 infiltration. To the authors' knowledge, subluxation of the plantar fat pad and the respective correlation to MRI findings have not been described in the literature. Here we describe the sonographic findings of this novel condition.
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Affiliation(s)
- Walter I Sussman
- Department of Physical Medicine & Rehabilitation, Tufts University School of Medicine, 800 Washington St, Box 400, Boston, MA, 02111, USA. .,Private Practice N, Easton, MA, USA.
| | - David J Park
- Physical Medicine & Rehabilitation Resident, Tufts Medical Center, Boston, MA, USA
| | | | - Yung H Chen
- Department of Radiology, Tufts University, Boston, MA, USA
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Iborra A, Villanueva M, Sanz-Ruiz P, Martin A, Noriega C. A novel closed technique for ultrasound-guided plantar fascia release with a needle: review of 107 cases with a minimum follow-up of 24 months. J Orthop Surg Res 2021; 16:153. [PMID: 33627158 PMCID: PMC7903032 DOI: 10.1186/s13018-021-02302-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 02/14/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND This study aims to analyze the clinical outcome of a new ultrasound-guided surgery for partial plantar fasciotomy performed with a needle for treatment of plantar fasciitis. METHODS We performed a retrospective review of 107 patients diagnosed with plantar fasciitis who underwent ultrasound-guided release of the plantar fascia. The series included 62 males (57.9%) and 45 females (42.1%) treated between April 2014 and February 2018, with a mean follow-up of 21.05 ± 10.96 months (7-66) and a minimum follow-up of 24 months. The mean age was 48.10 ± 10.27 years (27-72). Clinical assessments and ultrasound examination were carried out before treatment, after 1 week, and then after 1, 3, 12, and 24 months. The clinical assessment was based on a visual analog scale and the Foot and Ankle Disability Index. RESULTS Heel pain improved in 92.5% (99) of patients, but not in 7.4% (8 patients). In the group of patients whose heel pain improved, 9 experienced overload on the lateral column and dorsum of the foot, which improved with the use of plantar orthoses and a rehabilitation program. We recorded no nerve complications (e.g., paresthesia), vascular injuries, or wound-related problems. CONCLUSION Ultrasound-guided partial plantar fasciotomy with a needle is safe, since structures are under direct visualization of the surgeon and the risk of damage is minimal. Stitches are not necessary, and recovery is fast. Consequently, costs are low, and the patient can return to work quickly. This technique may represent a valid option for treatment of plantar fasciitis.
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Affiliation(s)
- A. Iborra
- School of Health Sciences, Department of Podiatry, University of La Salle, Institute Avanfi, 28020 Madrid, Spain
| | | | - P. Sanz-Ruiz
- Institute Avanfi, 28020 Madrid, Spain
- Orthopaedic and Trauma Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Antonio Martin
- Institute Avanfi, 28020 Madrid, Spain
- Orthopaedic and Trauma Department, Hospital General Universitario Donostia, Madrid, Spain
| | - Concepción Noriega
- University of Alcalá, Madrid. School of Medicine and Health Sciences, Department of Nursery and Physiotherapy, University of Alcalá, Alcalá de Henares, Spain
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Yin M, Yan Y, Tong Z, Xu C, Qiao J, Zhou X, Ye J, Mo W. Development and Validation of a Novel Scoring System for Severity of Plantar Fasciitis. Orthop Surg 2020; 12:1882-1889. [PMID: 33112035 PMCID: PMC7767669 DOI: 10.1111/os.12827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 09/07/2020] [Accepted: 09/16/2020] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVES Plantar fasciitis (PF) is the most common cause of heel pain. Though PF is self-limited, it can develop into chronic pain and thus treatment is needed. Early and accurate prognostic assessment of patients with PF is critically important for selecting the optimal treatment pathway. Nevertheless, there is no scoring system to determine the severity of PF and no prognostic model in choosing between conservative or surgical treatment. The study aimed to develop a novel scoring system to evaluate the severity of plantar fasciitis and predict the prognosis of conservative treatment. METHODS Data of consecutive patients treated from 2014 to 2018 were retrospectively collected. One hundred and eighty patients were eligible for the study. The demographics and clinical characteristics served as independent variables. The least follow-up time was 6 months. A minimal reduction of 60% in the visual analog scale (VAS) score from baseline was considered as minimal clinically important difference (MCID). Those factors significantly associated with achieving MCID in univariate analyses were further analyzed by multivariate logistic regression. A novel scoring system was developed using the best available literature and expert-opinion consensus. Inter-observer reliability and intra-observer reproducibility were evaluated. The appropriate cut-off points for the novel score system were obtained using receiver operating characteristic (ROC) curves. RESULTS The system score = VAS (0-3 point = 1; 3.1-7 point = 3; 7.1-10 point = 5) + duration of symptoms (<6 months = 1; ≥1 6 months = 2) + ability to walk without pain (>1 h = 1; ≤1 h = 4) + heel spur in X-ray (No = 0; Yes = 2) + high intensity zone (HIZ) in MRI (No = 0; Yes = 2). The total score was divided in four categories of severity: mild (2-4 points), moderate (5-8 points), severe (9-12 points), and critical (13-15 points). Inter-observer agreement with a value of 0.84 was considered as perfect reliability. Intra-observer reproducibility with a value of 0.92 was considered as perfect reproducibility. The optimum cut-off value was 10 points. The sensitivity of predictive factors was 86.37%, 84.21%, 91.22%, 84.12%, and 89.32%, respectively; the specificity was 64.21%, 53.27%, 67.76%, 62.37%, and 79.58%, respectively; the area under curve was 0.75, 0.71, 0.72, 0.87, and 0.77, respectively. The Hosmer-Lemeshow test showed a good fitting of the score system with an overall accuracy of 90.6%. CONCLUSIONS Based on prognostic factors, the present study establishes a novel scoring system which is highly comprehensible, reliable, and reproducible. This score system can be used to identify the severity of plantar fasciitis and predict the prognosis of conservative treatment accurately. The application of this scoring system in clinical settings can significantly improve the decision-making process.
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Affiliation(s)
- Meng‐chen Yin
- Department of Orthopaedics, Longhua HospitalShanghai University of Traditional Chinese MedicineShanghaiChina
| | - Yin‐jie Yan
- Department of Orthopaedics, Longhua HospitalShanghai University of Traditional Chinese MedicineShanghaiChina
| | - Zheng‐yi Tong
- Department of Orthopaedics, Longhua HospitalShanghai University of Traditional Chinese MedicineShanghaiChina
| | - Chong‐qin Xu
- Department of Orthopaedics, Longhua HospitalShanghai University of Traditional Chinese MedicineShanghaiChina
| | - Jiao‐jiao Qiao
- Department of Orthopaedics, Longhua HospitalShanghai University of Traditional Chinese MedicineShanghaiChina
| | - Xiao‐ning Zhou
- Department of Orthopaedics, Longhua HospitalShanghai University of Traditional Chinese MedicineShanghaiChina
| | - Jie Ye
- Department of Orthopaedics, Longhua HospitalShanghai University of Traditional Chinese MedicineShanghaiChina
| | - Wen Mo
- Department of Orthopaedics, Longhua HospitalShanghai University of Traditional Chinese MedicineShanghaiChina
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Radovic P. Treatment of "plantar fasciitis"/Plantar Heel Pain Syndrome with botulinum toxin - A novel injection paradigm pilot study. Foot (Edinb) 2020; 45:101711. [PMID: 33038660 DOI: 10.1016/j.foot.2020.101711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 05/26/2020] [Accepted: 07/03/2020] [Indexed: 02/04/2023]
Abstract
Randomized controlled trials over the last two decades, although promising with favorable results, have shown varied efficacy in treatment of "plantar fasciitis" with botulinum toxin injection1. One reason may be due to conflating the variabilities of plantar heel conditions solely as plantar fasciitis. Plantar Heel Pain Syndrome can be of one or more etiologies and symptoms which refutes the mistaken tendency to categorize all plantar heel pain singularly as either plantar fasciitis or fasciosis. Recognizing that there is likely an interplay of inflammatory, degenerative, and neuropathic etiologic conditions of this often-difficult malady to treat, a novel injection paradigm of botulinum toxin is explored in the treatment of 4 distinct presentations of Plantar Heel Pain Syndrome with encouraging results. Botulinum toxin injection into two intrinsic foot muscles; Abductor Hallucis and Quadratus Plantae at their origins with electrical stimulation is presented as novel method to treat four distinct etiologies of Plantar Heel Pain Syndrome. This method of botulinum toxin injection resulted in significant prolonged improvement of patient function and pain reduction in four variations of Plantar Heel Pain Syndrome. A precise injection paradigm facilitated with direct intrinsic muscle stimulation of the Abductor Hallucis and Quadratus Plantae at their origins may prove to be effective in reducing the disabilities of Plantar Heel Pain Syndrome and its associated pain.
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Debus F, Eschbach D, Ruchholtz S, Peterlein CD. Rupture of plantar fascia: Current standard of therapy: A systematic literature review. Foot Ankle Surg 2020; 26:358-362. [PMID: 31176530 DOI: 10.1016/j.fas.2019.05.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 04/27/2019] [Accepted: 05/07/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND The aim of the present systematic literature review is to give an overview of ruptures of the plantar fascia. For this purpose, a detailed description of the patient collective is provided. However, the focus of this analysis is based on the current therapy concepts. Based on the results the authors propose a standardized therapy concept. MATERIAL AND METHODS A systematic literature review was performed using the PubMed database using the terms: ("rupture plantar fascia" OR "plantar fascia tear" OR "rupture plantar aponeurosis"). All articles published in the PubMed database until 07.11.2018 were included. The articles were evaluated with regard to three research question: (1) Which patients are affected by a rupture of the plantar fascia? (2) Which therapy concept was used to treat rupture of the plantar fascia? And (3) which result was achieved and how was this measured? RESULTS A total of 78 studies were identified, of which the full text of 17 were analysed. 12 publications were cases reports, 5 studies were retrospective analyses. Data from 124 patients could be included. The average age of patients was 39.6 years. In 63.2% (n = 12) of the studies, patients with a high level of athletic activity or even professional athletes were analyzed. 94.4% of all patients were treated conservatively. The average duration of immobilization in a rigid walker was 2.6 weeks. In the majority of cases, pain-adapted weight-bearing was allowed in the rigid walker. CONCLUSION There are few available studies concerning the rupture of plantar fascia. The quality of data is poor. The maximum duration of immobilization of 3 weeks in a rigid walker with pain-adapted weight-bearing appears to be the most applied therapy concept. Further studies are needed to evaluate the efficacy of the therapy and to optimize the therapy concept.
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Affiliation(s)
| | - Daphne Eschbach
- University of Giessen and Marburg, Department of Orthopeadics and Traumatology, Marburg, Germany
| | - Steffen Ruchholtz
- University of Giessen and Marburg, Department of Orthopeadics and Traumatology, Marburg, Germany
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Sun MY, Jeon A, Seo CM, Kim YG, Wu YN, Kim DW, Lee JH. The injection site in the tarsal tunnel to minimize neurovascular injury for heel pain: an anatomical study. Surg Radiol Anat 2020; 42:681-4. [PMID: 31938852 DOI: 10.1007/s00276-019-02411-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 12/26/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION The aim of this study was to investigate the location and distribution patterns of neurovascular structures and determine the effective injection point in the tarsal tunnel for heel pain. METHODS Fifteen adult non-embalmed cadavers with a mean age of 71.5 years were studied. The most inferior point of the medial malleolus of the tibia (MM) and the tuberosity of the calcaneus (TC) were identified before dissection. A line connecting the MM and TC was used as a reference line. The reference point was expressed in absolute distance along the reference line using the MM as the starting point. For measurements using MRI, the depth from the skin was measured to inferior at an interval of 1 cm from the MM. RESULTS The posterior tibial artery, lateral plantar nerve, and medial plantar nerve were located from 29.0 to 37.3% of the reference line from the MM. The distribution frequencies of the medial calcaneal nerve on the reference line from the MM were 0%, 8.60%, 37.15%, 37.15%, and 17.10%, respectively. The mean depth of the neurovascular structures was 0.3 cm. DISCUSSION This study recommended an effective injection site from 45.0 to 80.0% of the reference line.
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Belhan O, Kaya M, Gurger M. The thickness of heel fat-pad in patients with plantar fasciitis. Acta Orthop Traumatol Turc 2019; 53:463-467. [PMID: 31444011 PMCID: PMC6939011 DOI: 10.1016/j.aott.2019.07.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 03/10/2019] [Accepted: 07/26/2019] [Indexed: 11/25/2022]
Abstract
Objective The aim of this study was to investigate the thickness of heel fat pad (THP) and to detect the relationship between the plantar fasciitis (PF) and age, occupation, BMI, longitudinal arch, the thickness of heel fat-pad in the patients with PF. Methods A total of 50 patients (29 women and 21 men; mean age: 46.5 years (range: 22–70)) that were diagnosed with PF were included to this study. Patients' affected side were compared with the healthy opposite side with the angle of medial arch (AMA) and first metatarsophalangeal angle (FMTPA) on the foot radiograms, and THP and thickness of first metatarsal fat pad (TFMFP) using ultrasonography (USG) of both feet. Results The mean AMAs of feet with pain and without pain were 122.56° and 120.60°, respectively. The mean FMTPAs of feet with pain and without pain were 14.72° and 14.40°, respectively. The mean THPs of feet with pain at the point of the medial calcaneal tubercle and the mean TFMFPs of the feet with pain at the point of the first metatarsal head were 19.45 mm and 6.75 mm, respectively. The mean THPs of feet without pain at the point of the medial calcaneal tubercle and the mean TFMFPs of the feet without pain at the point of the first metatarsal head were 19.94 mm and 6.75 mm, respectively. It was observed that the mean AMA in the heels with pain was significantly higher than that of the heel without pain (p < 0.05) and the mean THP in the heels with pain was significantly thinner than that of the heel without pain (p < 0.05). Conclusion The results indicate that USG is an accurate and reliable imaging technique for the measurement of THP in the diagnosis of plantar fasciitis and the heel pad was thinner in the painful heels of patients with plantar fasciitis. Level of evidence Level III, Diagnostic Study.
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Ho LF, Guo Y, Ching JYL, Chan KL, Tsang PH, Wong MH, Chen L, Ng BFL, Lin ZX. Efficacy and safety of electroacupuncture plus warm needling therapy for heel pain: study protocol for a randomized controlled trial. Trials 2019; 20:480. [PMID: 31391104 PMCID: PMC6686470 DOI: 10.1186/s13063-019-3572-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 07/11/2019] [Indexed: 01/10/2023] Open
Abstract
Background Heel pain is a common foot disorder that causes pain and functional limitations. The prevalence of disabling foot pain will increase as the population ages. Previous studies have reported the positive therapeutic effects of electroacupuncture, warm needling, or the combination of both for heel pain but with limitations in the study methodologies. The current study is a rigorously designed randomized controlled trial that aims to evaluate the clinical efficacy and safety of electroacupuncture plus warm needling therapy in patients with heel pain. Methods/design The study protocol describes a prospective, open-label, parallel-group, randomized controlled trial to be conducted in Hong Kong. Eighty patients aged 50–80 years who have reported heel pain and first-step pain equal to or exceeding 50 mm on the 100-mm visual analog scale (VAS) will be recruited. They will be randomly assigned (1:1 ratio) to the electroacupuncture plus warm needling therapy (i.e., treatment) group or the waitlist (i.e., control) group. The treatment group will undergo six treatment sessions in 4 weeks. The control group will receive no treatment during the study period. The primary outcome measure is a mean change in the first-step pain VAS score from the baseline to week 4. Secondary outcome measures include a mean change in first-step pain VAS score from the baseline to week 2, a mean change in Foot Function Index (FFI) subscale scores and the total score from the baseline to week 2 and week 4, and patients’ self-reported level of improvement at week 4. Additional week 8 follow-up assessments with first-step pain VAS and FFI measurements will be arranged for the treatment group. Any adverse events will be recorded throughout the study to evaluate safety. An intention-to-treat approach will be used to analyze the study results. Discussion This study will provide evidence on the efficacy and safety of electroacupuncture plus warm needling therapy as an alternative treatment method for heel pain. The findings will determine whether the treatment protocol is efficacious in relieving pain and improving foot function among older adults with heel pain. The study will also provide information for subsequent large-scale randomized controlled trials in the future. Trial registration Chinese Clinical Trial Registry, ChiCTR1800014906. Registered on 12 February 2018. Electronic supplementary material The online version of this article (10.1186/s13063-019-3572-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lai Fun Ho
- Chinese Medicine Services, Pok Oi Hospital, Hong Kong SAR, China
| | - Yuanqi Guo
- Chinese Medicine Services, Pok Oi Hospital, Hong Kong SAR, China.,School of Chinese Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Jessica Yuet-Ling Ching
- School of Chinese Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.,Hong Kong Institute of Integrative Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Kam Leung Chan
- School of Chinese Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.,Hong Kong Institute of Integrative Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ping Him Tsang
- Chinese Medicine Services, Pok Oi Hospital, Hong Kong SAR, China
| | - Man Hin Wong
- Chinese Medicine Services, Pok Oi Hospital, Hong Kong SAR, China
| | - Liyi Chen
- Chinese Medicine Services, Pok Oi Hospital, Hong Kong SAR, China.,School of Chinese Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | | | - Zhi-Xiu Lin
- School of Chinese Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China. .,Hong Kong Institute of Integrative Medicine, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.
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Abstract
INTRODUCTION Heel pain is one of the common reasons why patients consult orthopaedic surgeons in an outpatient setting. The dorsal heel pain is often caused by a Haglund's deformity which is an exostosis of the posterior superior calcaneus. It often leads to Haglund's syndrome with calcaneal bursitis and Achilles tendinosis. This study aims to investigate the roll of MRI in diagnosis of Haglund's syndrome and its influence on therapy. MATERIALS AND METHODS We retrospectively analysed data of 45 patients which clinically and radiologically confirmed Haglund's deformity. Patients were divided into two groups that either did not receive MRI (MRI_0) or received MRI (MRI_1). To evaluate the significance, Fisher´s test was used. A statistical significance was assumed at p < 0.05. RESULTS The average age was 57.0 years. There was no significant difference in therapy comparing the groups MRI_0 and MRI_1. Haglund's syndrome was detected in 86.7% of all patients with Haglund's deformity. CONCLUSION MRI does not influence the therapy of patients with Haglund's deformity. Therefore, the resources of this cost-intensive and limited type of investigation should be used elsewhere. In cases of atypical heel pain, the MRI might be useful.
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Affiliation(s)
- Florian Debus
- Gemeinschaftspraxis DREO, Habermehlstraße 8, 75172, Pforzheim, Germany.
| | | | - Manuel Olivieri
- Gemeinschaftspraxis DREO, Habermehlstraße 8, 75172, Pforzheim, Germany
| | - Christian Dominik Peterlein
- Zentrum für Orthopädie und Unfallchirurgie, Universitätsklinikum Marburg, Baldinger Straße, 35043, Marburg, Germany
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25
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Jiménez-Pérez AE, Gonzalez-Arabio D, Diaz AS, Maderuelo JA, Ramos-Pascua LR. Clinical and imaging effects of corticosteroids and platelet-rich plasma for the treatment of chronic plantar fasciitis: A comparative non randomized prospective study. Foot Ankle Surg 2019; 25:354-360. [PMID: 30321976 DOI: 10.1016/j.fas.2018.01.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 01/10/2018] [Accepted: 01/30/2018] [Indexed: 02/04/2023]
Abstract
The purpose is to compare the effectiveness and imaging changes (US and MRI) between PRP and corticoids injections for the treatment of chronic plantar fasciitis, using clinical results evaluated by the visual analogue scale (VAS), the AOFAS clinical rating system and the modified Roles and Maudsley score, and using imaging results (US and MRI). Our hypothesis is that PRP infiltrations are a more effective therapeutic method than infiltrations with corticosteroids. A single-centre, non randomized, prospective study of 40 consecutive patients (40 feet) with plantar fasciitis who had not responded to conservative treatment for at least 6 months was undertaken. The first 20 consecutive patients (group A) were treated with two local injections of 4ml of a PRP concentrate. The second group of 20 patients (group B) were injected with 4ml of 40mg methylprednisolone. Clinical results were evaluated using a visual analogue scale (VAS), the AOFAS clinical rating system and the modified Roles and Maudsley score, with a mean follow-up of 33 months. Imaging results were evaluated by plantar US after 3 and 6 months, and MRI after 6 months. There were no complications arising from the treatment. In group A (PRP), the VAS changed from 8.25 to 1.85 and the AOFAS from 47.05 to 92.10. In group B (methylprednisolone), the VAS changed from 7.7 to 5.30 points and from 50.85 to 49.75 on the AOFAS. In the imaging tests, the thickness of the fascia in group A changed from 7.90mm to 4.82mm over 3 months following the injection, maintaining this thickness in the biannual controls. In group B the change was from 8.05mm to 6.13mm over 3 months, increasing to 6.9mm after 6 months. The other inflammatory signs improved in all cases, especially in group A. The treatment of chronic plantar fasciitis by two injections of PRP is a safe, more efficient and long-lasting method than corticoid injections.
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Affiliation(s)
- Adriana E Jiménez-Pérez
- Radiology Department Complejo, Asistencial Universitario de León, Gerencia Regional de Salud de Castilla y León (SACYL), Spain.
| | - Daniel Gonzalez-Arabio
- Orthopedic surgery and traumatology service, Complejo Asistencial Universitario de León, Gerencia Regional de Salud de Castilla y León (SACYL), Spain.
| | - Andrés Saldaña Diaz
- Orthopedic surgery and traumatology service, Complejo Asistencial Universitario de León, Gerencia Regional de Salud de Castilla y León (SACYL), Spain.
| | - Jose A Maderuelo
- Orthopedic surgery and traumatology service, Complejo Asistencial Universitario de León, Gerencia Regional de Salud de Castilla y León (SACYL), Spain
| | - Luis R Ramos-Pascua
- Orthopedic surgery and traumatology service, Complejo Asistencial Universitario de León, Gerencia Regional de Salud de Castilla y León (SACYL), Spain.
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Johannsen F, Konradsen L, Herzog R, Rindom Krogsgaard M. Plantar fasciitis treated with endoscopic partial plantar fasciotomy-One-year clinical and ultrasonographic follow-up. Foot (Edinb) 2019; 39:50-54. [PMID: 30974340 DOI: 10.1016/j.foot.2019.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 02/04/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Endoscopic operations for plantar fasciitis generally have good clinical outcome. The aim of this study was to record the effect of endoscopic partial fasciotomy and heel spur removal and evaluate by ultrasonography whether the fascia regenerates and the heel spur reforms. METHODS Eleven consecutive patients were evaluated before and 3, 6 and 12 months after surgery. Operations were performed endoscopically using a deep fascial approach with a medial and a lateral portal. Bony spurs were removed and the medial half of the plantar fascia was transected. All patients followed a standardized rehabilitation program. RESULTS Median Foot Function Index values decreased from 119 pre-surgery to 69 and 12 (p=0.004), at 3 months and 1year post-operatively respectively. Median VAS-score for first step pain was likewise reduced from median 71mm to 29mm and 7mm (p=0.004), respectively. Median fascial thickness at the medial insertion was 6.0mm (range 4.6-6.8mm) pre-operatively. A heel spur was present in 9 cases. One year postoperatively a well-defined fascia in the area of resection was demonstrated in 8 cases. In the rest of the cases scar tissue made it impossible to clearly outline the fascia. Nine of the feet showed good medial fascial tensioning. There was no evidence of recurrence of the bony spur. CONCLUSIONS Endoscopic partial plantar fascia resection reduced pain symptoms and increased function significantly 3 months after operation, with additional effect achieved 12 months after surgery. Based on ultrasonography the resected fascia regenerated/healed, and a calcaneal spur did not recur.
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Affiliation(s)
- Finn Johannsen
- Institute of Sports Medicine, Bispebjerg-Frederiksberg Hospital, Copenhagen, Denmark
| | - Lars Konradsen
- Section for Sports Traumatology M51, Department of Orthopedic Surgery, Bispebjerg-Frederiksberg Hospital, Copenhagen, Denmark.
| | - Robert Herzog
- Department of Physiotherapy, Bispebjerg-Frederiksberg Hospital, Copenhagen, Denmark
| | - Michael Rindom Krogsgaard
- Section for Sports Traumatology M51, Department of Orthopedic Surgery, Bispebjerg-Frederiksberg Hospital, Copenhagen, Denmark
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Abstract
A high longitudinal plantar arch, varus position of the heel, forefoot equinus, and pronation of the first ray are characteristic of a cavovarus deformity. Forefoot-driven and hindfoot-driven deformities are distinguished based on pathomechanics. In first ray strong plantarflexion, the forefoot touches the ground first. This leads to compensatory varus heel, lock of the midfoot, reduction of the flexible phase, and decrease in shock absorption. In hindfoot-driven cavovarus deformity, the subtalar joint may compensate for varus deformities above the ankle joint. Overload of the lateral soft tissue structures and degenerative changes may occur in longstanding cavovarus deformity.
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McSweeney S, Reed LF, Wearing SC. Vertical ground reaction forces during gait in children with and without calcaneal apophysitis. Gait Posture 2019; 71:126-30. [PMID: 31054494 DOI: 10.1016/j.gaitpost.2019.04.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 04/16/2019] [Accepted: 04/24/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Heightened vertical load beneath the foot has been anecdotally implicated in the development of activity-related heel pain of the calcaneal apophysis in children but is supported by limited evidence. RESEARCH QUESTION This study investigated whether vertical loading patterns during walking and running differed in children with and without calcaneal apophysitis. METHODS Vertical ground reaction force, peak plantar pressure (forefoot, midfoot, heel) and temporospatial gait parameters (cadence, step length, stride, stance and swing phase durations) were determined in children with (n = 14) and without (n = 14) calcaneal apophysitis. Measures were acquired during barefoot walking and running at matched and self-selected speed using an instrumented treadmill, sampling at 120 Hz. Statistical comparisons between groups were made using repeated measure ANOVAs. RESULTS There were no significant between group differences in vertical ground reaction force peaks or regional peak plantar pressures. However, when normalised to stature, cadence was significantly higher (≈ 5%) and step length shorter (≈ 5%) in children with calcaneal apophysitis than those without, but only during running (P <.05). Maximum pressure beneath the rearfoot during running was significantly correlated with self-reported pain in children with calcaneal apophysitis. SIGNIFICANCE Peak vertical force and plantar pressures did not differ significantly in children with and without calcaneal apophysitis during walking or running. However, children with calcaneal apophysitis adopted a higher cadence than children without heel pain during running. While the findings suggest that children with calcaneal apophysitis may alter their cadence to lower pressure beneath the heel and, hence pain, they also highlight the benefit of evaluating running rather than walking gait in children with calcaneal apophysitis.
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Sahli H, Bachali A, Tekaya R, Mahmoud I, Sedki Y, Saidane O, Abdelmoula L. Involvement of foot in patients with spondyloarthritis: Prevalence and clinical features. Foot Ankle Surg 2019; 25:226-230. [PMID: 29409278 DOI: 10.1016/j.fas.2017.10.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 10/27/2017] [Accepted: 10/27/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND The purpose of this study was to evaluate the foot involvement in a group of patients with spondyloarthritis in regard to symptoms, type and frequency of deformities, location and radiological changes. METHODS We conducted a cross sectional study including 60 patients with spondyloarthritis over a period of six months. Anamnesis, clinical examination, podoscopic examination, biological tests and X-rays of feet were done for each patient. RESULTS Foot involvement was found in 31 patients (52%). It was symptomatic in 35% of cases and inaugural in 42% of cases. The most frequent site was the hindfoot (22 patients/31). Radiological findings were: erosion (17%), reconstruction (33%), erosion and reconstruction (50%). Forefoot involvement was found in 18/31 patients. Forefoot deformities were found in 9 patients. Two patients had sausage toe and feet skin abnormalities were observed in 12 patients. At podoscopic examination, 23 patients had abnormal footprints. Foot involvement was more frequent in peripheral spondyloarthritis (p=0.008). Patients with foot involvement had an advanced age of disease onset (p=0.05), a shorter disease duration (p=0.038) and more comorbidities (p=0.039). Foot involvement was correlated with C Reactive protein (p=0.043). CONCLUSION In our study, foot involvement and foot symptoms were seen frequently in spondyloarthritis and it is associated with late onset of the disease and with higher inflammation in blood tests.
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Affiliation(s)
- Hana Sahli
- Department of Rheumatology, Charles Nicolle Hospital, 1006 Tunis, Tunisia; Université de Tunis El Manar, Faculté de Médecine de Tunis, 1007 Tunis, Tunisia
| | - Asma Bachali
- Department of Clinical Biology, Mohamed Taher Maamouri Hospital, Nabeul, Tunisia; Université de Tunis El Manar, Faculté de Médecine de Tunis, 1007 Tunis, Tunisia.
| | - Raoudha Tekaya
- Department of Rheumatology, Charles Nicolle Hospital, 1006 Tunis, Tunisia; Université de Tunis El Manar, Faculté de Médecine de Tunis, 1007 Tunis, Tunisia
| | - Ines Mahmoud
- Department of Rheumatology, Charles Nicolle Hospital, 1006 Tunis, Tunisia; Université de Tunis El Manar, Faculté de Médecine de Tunis, 1007 Tunis, Tunisia
| | - Yassine Sedki
- Department of Rheumatology, Charles Nicolle Hospital, 1006 Tunis, Tunisia; Université de Tunis El Manar, Faculté de Médecine de Tunis, 1007 Tunis, Tunisia
| | - Olfa Saidane
- Department of Rheumatology, Charles Nicolle Hospital, 1006 Tunis, Tunisia; Université de Tunis El Manar, Faculté de Médecine de Tunis, 1007 Tunis, Tunisia
| | - Leila Abdelmoula
- Department of Rheumatology, Charles Nicolle Hospital, 1006 Tunis, Tunisia; Université de Tunis El Manar, Faculté de Médecine de Tunis, 1007 Tunis, Tunisia
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Harutaichun P, Pensri P, Boonyong S. Physical and psychological predictors on pain intensity in conscripts with plantar fasciitis. Braz J Phys Ther 2019; 24:249-255. [PMID: 30876701 DOI: 10.1016/j.bjpt.2019.02.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 02/12/2019] [Accepted: 02/25/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Plantar fasciitis is commonly found among the physically active population, including conscripts. Some studies have reported that being overweight and having psychological symptoms contribute to pain from plantar fasciitis. However, there is a lack of information regarding the physical predictors, and more research is needed to determine the relationship between such predictors and pain intensity from plantar fasciitis in conscripts. OBJECTIVE To determine which physical and psychological variables act as predictors of pain intensity among Thai novice conscripts with plantar fasciitis. METHODS Two hundred and seventy Thai novice conscripts without musculoskeletal pain completed the Depression, Anxiety and Stress Scale short version and then received baseline assessment of ankle dorsiflexion angle, ankle plantarflexor strength, and quality of lower extremity movement from a physical therapist. After 10 weeks of military training, 71 of these Thai conscripts developed pain from plantar fasciitis. Multiple linear regression analysis with the forward stepwise method was used to explore the predictors of pain intensity due to plantar fasciitis. RESULTS Using a forward regression analysis, anxiety (B=0.13; 95% CI, 0.06-0.20; p<0.01) and quality of movement score (B=0.87; 95% CI, 0.28-1.47; p=0.01) were significant predictors of pain intensity. The regression model with these predictors explained 25% of the variability in pain intensity from plantar fasciitis. CONCLUSION Higher scores of anxiety and movement quality on the lateral step-down task were associated with pain intensity from plantar fasciitis after the completion of a 10-week military program. However, lower ankle dorsiflexion angle and ankle plantarflexor strength did not predict pain intensity.
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Affiliation(s)
- Pavinee Harutaichun
- Department of Physical Therapy, Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok, Thailand.
| | - Praneet Pensri
- Department of Physical Therapy, Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok, Thailand.
| | - Sujitra Boonyong
- Department of Physical Therapy, Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok, Thailand.
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31
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Moroni S, Gibello AF, Zwierzina M, Nieves GC, Montes R, Sañudo J, Vazquez T, Konschake M. Ultrasound-guided decompression surgery of the distal tarsal tunnel: a novel technique for the distal tarsal tunnel syndrome-part III. Surg Radiol Anat 2019; 41:313-321. [PMID: 30798383 PMCID: PMC6420489 DOI: 10.1007/s00276-019-02196-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Accepted: 01/20/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND The aim of this study was to provide a safe ultrasound-guided minimally invasive surgical approach for a distal tarsal tunnel release concerning nerve entrapments. METHODS AND RESULTS The study was carried out on ten fresh-frozen feet. All of them have been examined by high-resolution ultrasound at the distal tarsal tunnel. The surgical approach has been marked throughout the course of the medial intermuscular septum (MIS, the lateral fascia of the abductor hallucis muscle). After the previous steps, nerve decompression was carried out through a MIS release through a 2.5 mm (± 0.5 mm) surgical portal. As a result, an effective release of the MIS has been obtained in all fresh-frozen feet. CONCLUSION The results of our anatomic study indicate that this novel ultrasound-guided minimally invasive surgical approach for the release of the MIS might be an effective, safe and quick decompression technique treating selected patients with a distal tarsal tunnel syndrome.
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Affiliation(s)
- Simone Moroni
- Department of Podiatry, Faculty of Health Sciences at Manresa, Universitat de Vic-Universitat Central de Catalunya (UVic-Ucc), Barcelona, Spain.,Clinic Vitruvio Biomecánica, Madrid, Spain
| | - Alejandro Fernández Gibello
- Clinic Vitruvio Biomecánica, Madrid, Spain.,Department of Podiatry, Faculty of Health Sciences, University of La Salle, Madrid, Spain
| | - Marit Zwierzina
- Department of Plastic, Reconstructive and Aesthetic Surgery, Center of Operative Medicine, Medical University of Innsbruck, Innsbruck, Austria
| | - Gabriel Camunas Nieves
- Clinic Vitruvio Biomecánica, Madrid, Spain.,Department of Podiatry, Faculty of Health Sciences, University of La Salle, Madrid, Spain
| | - Rubén Montes
- Clinic Vitruvio Biomecánica, Madrid, Spain.,Department of Podiatry, Faculty of Health Sciences, University of La Salle, Madrid, Spain
| | - 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
- Division of Clinical and Functional Anatomy, Department of Anatomy, Histology and Embryology, Medical University of Innsbruck (MUI), Müllerstr. 59, 6020, Innsbruck, Austria.
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S SS, Thygarajan U, Raj DG, Susruthan M. Ledderhose Disease: Pathophysiology Diagnosis and Management. J Orthop Case Rep 2019; 9:84-86. [PMID: 31534943 PMCID: PMC6727448 DOI: 10.13107/jocr.2250-0685.1384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Ledderhose's disease, also known asplantar fibromatosis, is a rare benign nodular hyperplasia of the plantar aponeurosis. The disease is locally aggressive and can be managed very well conservatively. In patients who present with severe pain on weight-bearing might require surgical excision. CASE REPORT We would like to report about a case of 40-year-old female with bilateral Ledderhose's disease. She was treated conservatively to no avail. On surgical excision of the fibrosis tissue, the patient gives complete relief of symptoms. In this paper, we would to discuss both the conservative and surgical methods adopted to prevent post-operative complications. CONCLUSION Ledderhose disease is a rare benign aggressive disease which presents as nodules over the sole of the foot. The disease is usually manageable conservatively. Wide margin surgical excision of the nodule in severe cases will provide pain-free mobilization and prevent recurrence.
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Affiliation(s)
- Santhosh Srinivasan S
- Department of Orthopedics, Sri Ramachandra Medical College, Chennai, TamilNadu, India,Address of Correspondence: Dr. Santhosh Srinivasan, Department of Orthopedics, Sri Ramachandra Medical College, Porur, Chennai, Tamil Nadu, India. E-mail:
| | - U Thygarajan
- Department of Orthopedics, Sri Ramachandra Medical College, Chennai, TamilNadu, India
| | - D Gokul Raj
- Department of Orthopedics, Sri Ramachandra Medical College, Chennai, TamilNadu, India
| | - M. Susruthan
- Department of Orthopedics, Sri Ramachandra Medical College, Chennai, TamilNadu, India
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Abstract
Background Calcaneal apophysitis is a common clinical entity affecting children and adolescents. It is also known as Sever’s disease. Heel pain without a recent trauma is the primary manifestation. There are limited studies on the incidence of this disease. In this study, we aimed to report the regional incidence in Istanbul. Methods This retrospective audit of health records of all paediatric patients aged 6–17 years between January 1, 2014, and December 15, 2017 was undertaken. During this period, data were extracted from health records that recorded calcaneal apophysitis as the primary diagnosis. Results The 4-year incidence of calcaneal apophysitis was found to be 0.35% (74 of 20,967 paediatric patients). It commonly affected males, and bilateral cases were more common than unilateral cases. There were more admissions during the spring season, which may indicate a possible association with physical activity. Conclusion Although calcaneal apophysitis is a relatively common paediatric foot problem, due to its benign course and spontaneous healing capacity, most physicians are not interested in this topic. However, increased awareness of this diagnosis is important for reducing the rates of unnecessary radiological examinations and orthopaedic referrals. With increased knowledge, most cases may be diagnosed at the family physician level, which may decrease the economic burden on the health system. Incidence reports from various countries and regions may be published in the future.
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Affiliation(s)
- H H Ceylan
- Lutfiye Nuri Burat Devlet Hastanesi, 50.Yil Mah., 2107 Sok, 34256, Sultangazi, Istanbul, Turkey.
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Abstract
INTRODUCTION A calcaneal spur, also known as enthesophyte, is an abnormal bone outgrowth at the inferior part of the calcaneus, which is the most common site of bony spur occurrence. Although there is consensus that a calcaneal spur is a common cause of heel pain, approximately 20% of calcaneal spurs are asymptomatic and its pathology remains not fully understood. PRESENTATION OF CASE In this report, we present a rare case of a very large and bizarre calcaneal spur in a young adult man. The calcaneal spur was painful, which affected his foot function and was associated with plantar fasciitis. The spur length was measured in the radiograph and exhibited the longest calcaneal spur reported in the literature. The patient was treated conservatively, and he fully recovered his foot function. DISCUSSION This case was unique because although the patient presented with an extremely large unilateral calcaneal spur, he was young and did not have any chronic disease; hence, he was treated conservatively. The pain subsided and he regained full function of his foot. This case questions the association between calcaneal spur length and plantar fasciitis symptoms. CONCLUSION This case confirms that the length of calcaneal spurs, even extremely long ones, is not associated with the pathology of plantar fasciitis and that surgical treatment is not necessary.
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Affiliation(s)
- Raheef Alatassi
- Security Forces Hospital, Department of Orthopedic Surgery, Riyadh, Saudi Arabia.
| | - Ahmad Alajlan
- Security Forces Hospital, Department of Orthopedic Surgery, Riyadh, Saudi Arabia
| | - Talal Almalki
- Security Forces Hospital, Department of Orthopedic Surgery, Riyadh, Saudi Arabia
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Li L, Yang L, Yu F, Shi J, Zhu L, Yang X, Teng H, Wang X, Jiang Q. 3D printing individualized heel cup for improving the self-reported pain of plantar fasciitis. J Transl Med 2018; 16:167. [PMID: 29914501 PMCID: PMC6007068 DOI: 10.1186/s12967-018-1547-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Accepted: 06/12/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND To explore the therapeutic effect and the biomechanical mechanism of 3D printing individualized heel cup in treating of plantar heel pain. METHODS The clinical effect was evaluated by plantar pressure analysis and pain assessment in participants. Its biomechanical mechanism of protecting the plantar heel was explored using finite element simulation. RESULTS The individualized heel cup could support and protect the osseous structure and soft tissue of plantar heel while walking and jogging, as well as significantly reduce the self-reported pain after being worn for 4 weeks. The nylon heel cup could alter the load concentration of the heel as well as decrease the load affected on plantar fascia and calcaneus bone. It also provided an obvious support for heel pad. CONCLUSION To summarize, the 3D printed individualized heel cup can be used as an effective method for the treatment of plantar heel pain.
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Affiliation(s)
- Lan Li
- School of Mechanical Engineering, Southeast University, No. 2 Southeast University Road, Nanjing, China
- Department of Sports Medicine and Adult Reconstructive Surgery, Drum Tower Hospital Affiliated to Medical School of Nanjing University, Nanjing, China
- Institute of Medical 3D Printing, Nanjing University, Nanjing, China
| | - Longfei Yang
- School of Mechanical Engineering, Southeast University, No. 2 Southeast University Road, Nanjing, China
| | - Fei Yu
- Drum Tower of Clinical Medicine, Nanjing Medical University, Nanjing, China
| | - Jianping Shi
- School of Mechanical Engineering, Southeast University, No. 2 Southeast University Road, Nanjing, China
| | - Liya Zhu
- School of Electrical and Automation Engineering, Nanjing Normal University, Nanjing, China
| | - Xianfeng Yang
- Department of Sports Medicine and Adult Reconstructive Surgery, Drum Tower Hospital Affiliated to Medical School of Nanjing University, Nanjing, China
| | - Huajian Teng
- School of Electrical and Automation Engineering, Nanjing Normal University, Nanjing, China
- Model Animal Research Center, Nanjing University, Nanjing, China
| | - Xingsong Wang
- School of Mechanical Engineering, Southeast University, No. 2 Southeast University Road, Nanjing, China
| | - Qing Jiang
- Department of Sports Medicine and Adult Reconstructive Surgery, Drum Tower Hospital Affiliated to Medical School of Nanjing University, Nanjing, China
- Model Animal Research Center, Nanjing University, Nanjing, China
- Institute of Medical 3D Printing, Nanjing University, Nanjing, China
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Murphy M, Travers M, Gibson W. Is heavy eccentric calf training superior to wait-and-see, sham rehabilitation, traditional physiotherapy and other exercise interventions for pain and function in mid-portion Achilles tendinopathy? Syst Rev 2018; 7:58. [PMID: 29653591 PMCID: PMC5899347 DOI: 10.1186/s13643-018-0725-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Accepted: 04/05/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mid-portion Achilles tendinopathy (AT) is prevalent amongst athletic and non-athletic populations with pain, stiffness and impaired function typically reported. While different management options exist, loading protocols remain the best available intervention and have been shown to be effective in the management of AT. Trials investigating loading in AT have used a variety of different protocols, and recent narrative reviews suggest that no protocol is superior to another when comparing outcomes in pain and function. However, there has been no systematic review or meta-analysis completed to determine this. Furthermore, the narrative review did not consider wait-and-see or sham interventions, thus a systematic review and met-analysis which includes wait-and-see or sham interventions is warranted. METHODS A systematic review and meta-analyses will be conducted as per the PRISMA guidelines. The databases PUBMED, CINAHL (Ovid) and CINAHL (EBSCO) will be searched for articles published from inception to 31 December 2017. Our search focuses on studies examining the improvement of pain and function when completing a loading program for mid-portion AT. Only randomised/ quasi-randomised trials will be included while case reports and case series will be excluded. The primary outcome assessing pain and function will be the Victorian Institute Sports Assessment - Achilles (VISA-A). Two reviewers will screen articles, extract data and assess the risk of bias independently with a third reviewer resolving any disagreements between the two reviewers. A meta-analysis will then be performed on the data (if appropriate) to determine if the traditional heavy load calf training protocol described by Alfredson is superior to wait-and-see, sham intervention, traditional physiotherapy, and other forms of exercise rehabilitation. DISCUSSION This systematic review and meta-analysis will allow us to investigate if there are difference in pain and function when comparing wait-and-see, sham interventions, traditional physiotherapy and different exercise interventions to the traditional heavy eccentric calf training protocol for mid-portion Achilles tendon pain. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration number CRD42018084493 .
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Affiliation(s)
- Myles Murphy
- School of Physiotherapy, The University of Notre Dame Australia, 19 Mouat Street, PO Box 1225, Fremantle, Western Australia 6959 Australia
- SportsMed Subiaco, St John of God Health Care, Subiaco, Australia
- Sports Science Sports Medicine Department, Western Australian Cricket Association, East Perth, Australia
| | - Mervyn Travers
- School of Physiotherapy, The University of Notre Dame Australia, 19 Mouat Street, PO Box 1225, Fremantle, Western Australia 6959 Australia
- School of Physiotherapy and Exercise Science, Curtin University, Bentley, Australia
| | - William Gibson
- School of Physiotherapy, The University of Notre Dame Australia, 19 Mouat Street, PO Box 1225, Fremantle, Western Australia 6959 Australia
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Kumai T, Samoto N, Hasegawa A, Noguchi H, Shiranita A, Shiraishi M, Ikeda S, Sugimoto K, Tanaka Y, Takakura Y. Short-term efficacy and safety of hyaluronic acid injection for plantar fasciopathy. Knee Surg Sports Traumatol Arthrosc 2018; 26:903-911. [PMID: 28255655 DOI: 10.1007/s00167-017-4467-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 02/06/2017] [Indexed: 11/25/2022]
Abstract
PURPOSE Plantar fasciopathy is the most common cause of plantar heel pain and is considered to be a type of enthesopathy. The short-term efficacy, safety, and dose-response relationship of high-molecular-weight hyaluronic acid (HA) was investigated in patients with plantar fasciopathy. METHODS In this multicenter, prospective, randomized, double-blind, placebo-controlled trial, 168 patients with persistent pain from plantar fasciopathy for more than 12 weeks were randomly assigned to receive 2.5 mL of 1% HA (H-HA), 0.8 mL of 1% HA (L-HA), or 2.5 mL of 0.01% HA (control group) once a week for 5 weeks. The primary endpoint was improvement in visual analogue scale (VAS) score for pain from baseline to week 5. RESULTS The VAS scores (least squares mean ± standard error) in each group decreased gradually after the start of treatment, a change of -3.3 ± 0.3 cm for the H-HA group, -2.6 ± 0.3 cm for the L-HA group, and -2.4 ± 0.3 cm for the control group, with the H-HA group improving significantly more than the control group (P = 0.029). No serious adverse events were reported. There was no difference between the groups in the incidence rates of adverse drug reactions. CONCLUSION The administration of five injections of high-molecular-weight HA is an effective treatment with no serious adverse drug reactions and is a conservative treatment option for plantar fasciopathy. This treatment contributed to alleviation of pain in patients with plantar fasciopathy and improvement in their activities of daily living. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Tsukasa Kumai
- Department of Orthopaedic Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan.
| | - Norihiro Samoto
- Department of Orthopaedic Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan
| | - Atsushi Hasegawa
- Agatsuma Higashi Orthopaedic Clinic, 756-1, Isemachi, Nakanojo-machi Agatsuma-gun, Gumma, 377-0423, Japan
| | - Hideo Noguchi
- Ishii Orthopaedic and Rehabilitation Clinic, 1089-1, Shimo-Oshi, Gyoda-shi, Saitama, 361-0037, Japan
| | - Atsushi Shiranita
- Shiranita Orthopaedic Clinic, 1-6-13, Shiragane, Kokurakita-ku Kitakyushu-shi, Fukuoka, 802-0074, Japan
| | - Masaharu Shiraishi
- Shiraishi Orthopaedic Pain Clinic, 5-41-16, Nakakasai, Edogawa-ku, Tokyo, 134-0083, Japan
| | - Satoshi Ikeda
- Department of Orthopaedic Surgery, Ken-Ai Memorial Hospital, 1191, Kimori, Onga-cho, Onga-gun, Fukuoka, 811-4313, Japan
| | - Kazuya Sugimoto
- Department of Orthopaedic Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan
| | - Yasuhito Tanaka
- Department of Orthopaedic Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan
| | - Yoshinori Takakura
- Department of Orthopaedic Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8521, Japan
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Sodani A, Dube M, Jain R. Value of Motor Nerve Conduction Studies in the Diagnosis of Idiopathic Tarsal Tunnel Syndrome: A Single-center Prospective Observational Study from India. Ann Indian Acad Neurol 2018; 21:35-41. [PMID: 29720796 PMCID: PMC5909144 DOI: 10.4103/aian.aian_320_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Nerve conduction studies are considered to be the gold standard for diagnosing secondary tarsal tunnel syndrome (s TTS), but their utility in the diagnosis of idiopathic tarsal tunnel syndrome (i TTS) is largely unknown. OBJECTIVE We sought to investigate the value of motor nerve conductions studies (MNCS) in the diagnosis of clinically suspected iTTS. MATERIALS AND METHODS Twenty-six (52 limbs) adult patients of clinically suspected iTTS were subjected to motor nerve conductions of posterior tibial nerve, and its branches and motor conduction parameters were compared with those of 45 healthy controls. RESULTS Symptoms were bilateral in 70% (P = 0.02), with heel pain in 95% of symptomatic limbs. MNCS was abnormal in 32 (80%) of symptomatic limbs and 8 (66.6%) of asymptomatic limbs (P = 0.004). Out of electrophysiologically abnormal nerves (n = 67), the pathological process could be identified in all the nerves with abnormal MNCS (P = 0.02). Probable demyelination was seen in 58.2% of the electrophysiologically abnormal nerves. DISCUSSION The present study shows that iTTS are gender and Body Mass Index neutral with bilateral symptoms being common. Tinel's sign was inconsistent. Heel pain did not correlate with abnormal inferior calcaneal nerve conductions. Motor nerve conduction study was abnormal in a significant number of symptomatic limbs. "Probable demyelination" was more frequent in symptomatic limbs. CONCLUSION MNCS is significantly abnormal in symptomatic limbs of subjects with iTTS. Demyelination is slightly more common than axonopathy in iTTS. With a sensitivity of 80% and specificity of 33.3%, MNCS seems to be useful as a screening tool in clinically suspected iTTS. This study is Level II: Lesser quality randomized controlled trial or prospective comparative study.
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Affiliation(s)
- Ajoy Sodani
- Department of Neurology, Sri Aurobindo Medical College and Postgraduate Institute, Indore, Madhya Pradesh, India,Address for correspondence: Prof. Ajoy Sodani, Department of Neurology, 4th Floor, Sri Aurobindo Medical College and Postgraduate Institute, Sanwer Road, Indore - 453 555, Madhya Pradesh, India. E-mail:
| | - Mukesh Dube
- Department of Neurology, Sri Aurobindo Medical College and Postgraduate Institute, Indore, Madhya Pradesh, India
| | - Rahul Jain
- Department of Neurology, Sri Aurobindo Medical College and Postgraduate Institute, Indore, Madhya Pradesh, India
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Andrade Fernandes de Mello R, Garcia Rondina R, Valim V, Santos Belisario S, Burgomeister Lourenço R, Francisco Batista E, Horst Duque R. Isolated atrophy of the abductor digiti quinti in patients with rheumatoid arthritis. Skeletal Radiol 2017; 46:1715-1720. [PMID: 28799033 DOI: 10.1007/s00256-017-2741-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 07/11/2017] [Accepted: 07/24/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE We aim to discuss the association of isolated atrophy of the abductor digiti quinti muscle in patients with rheumatoid arthritis as well as review the anatomy and imaging findings of this condition on MRI. MATERIALS AND METHODS A consecutive series of 55 patients diagnosed with rheumatoid arthritis according to the 2010 ACR/EULAR classification criteria were recruited. MRI of the clinically dominant feet was performed using a 1.5-T scanner. RESULTS The study population was predominantly female (94.5%), and the age range was 31-79 years (mean 57.5 ± 11). A total of 55 ankles were examined by MRI, and 20 patients (36.3%), all females, showed abductor digiti quinti denervation signs. Seven patients demonstrated severe fatty atrophy of the abductor digiti quinti, corresponding to Goutallier grade 4, 2 patients showed moderate fatty atrophy (Goutallier grade 3), and the remaining 11 patients showed less than 50% fatty atrophy, corresponding to a Goutallier grade 2. Substantial agreement was found for both intra- and interobserver agreement regarding the Goutallier grading system. CONCLUSION Prevalence of signs of abductor digiti quinti denervation on MRI was high in the studied population, suggesting that rheumatoid arthritis may be associated with inferior calcaneal nerve compression.
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Affiliation(s)
| | - Ronaldo Garcia Rondina
- Department of Internal Medicine, Universidade Federal do Espírito Santo, Av. Marechal Campos 1468, Vitória, ES, Brazil
| | - Valéria Valim
- Department of Internal Medicine, Universidade Federal do Espírito Santo, Av. Marechal Campos 1468, Vitória, ES, Brazil
| | - Stéphano Santos Belisario
- Department of Internal Medicine, Universidade Federal do Espírito Santo, Av. Marechal Campos 1468, Vitória, ES, Brazil
| | | | - Elton Francisco Batista
- Department of Internal Medicine, Universidade Federal do Espírito Santo, Av. Marechal Campos 1468, Vitória, ES, Brazil
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Mischke JJ, Jayaseelan DJ, Sault JD, Emerson Kavchak AJ. The symptomatic and functional effects of manual physical therapy on plantar heel pain: a systematic review. J Man Manip Ther 2017; 25:3-10. [PMID: 28855787 DOI: 10.1080/10669817.2015.1106818] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES Plantar heel pain is common and can be severely disabling. Unfortunately, a gap in the literature exists regarding the optimal intervention for this painful condition. Consequently, a systematic review of the current literature regarding manual therapy for the treatment of plantar heel pain was performed. METHODS A computer-assisted literature search for randomized controlled trials in MEDLINE, EMBASE, Cochrane, CINAHL, and Rehabilitation & Sports Medicine Source, was concluded on 7 January 2014. After identification of titles, three independent reviewers selected abstracts and then full-text articles for review. RESULTS Eight articles were selected for the final review and underwent PEDro scale assessment for quality. Heterogeneity of the articles did not allow for quantitative analysis. Only two studies scored ≥7/10 on the PEDro scale and included joint, soft tissue, and neural mobilization techniques. These two studies showed statistically greater symptomatic and functional outcomes in the manual therapy group. DISCUSSION This review suggests that manual therapy is effective in the treatment of plantar heel pain; however, further research is needed to validate these findings given the preponderance of low quality studies.
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Affiliation(s)
- John J Mischke
- Department of Physical Therapy, University of Montana, Missoula, MT, USA
| | - Dhinu J Jayaseelan
- Department of Physical Therapy and Health Care Sciences, The George Washington University, Washington, DC, USA
| | - Josiah D Sault
- Department of Physical Therapy, University of Illinois at Chicago, Chicago IL, USA
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Raposio E, Calderazzi F. Fat grafting for chronic heel pain following surgery for adult flatfoot deformity: Pilot study. Foot (Edinb) 2017; 31:56-60. [PMID: 28549282 DOI: 10.1016/j.foot.2017.02.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 02/17/2017] [Accepted: 02/18/2017] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Autologous fat grafting is now a highly popular technique in plastic and reconstructive surgery, with broad applicability for various surgical procedures. Fat grafting can impart contours and augmentation, nourish tissue, modulate scar tissue, and produce regeneration at the recipient site. In this pilot study, the authors suggest that fat grafting may be useful therapeutic adjunct for cases of chronic heel pain following surgery for adult flatfoot deformity. MATERIALS AND METHODS Eight patients with chronic heel pain following surgery for adult flatfoot deformity underwent autologous subcutaneous heel fat grafting and recorded their levels of pain relief for 6 months postoperatively. RESULTS The authors recorded a statistically significant difference (p<0.001) between pain scale values recorded before (t0) and six months postoperatively (t6). From t0 to t6, mean pain scale values changed from 8.125 to 2.413. CONCLUSIONS Volumetric enhancement of the subcutaneous heel fat pad significantly ameliorated weight-bearing pain in these patients.
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Affiliation(s)
- Edoardo Raposio
- Department of Surgical Sciences, Plastic Surgery Chair, University of Parma, Via Gramsci 14, 43126 Parma, Italy.
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Saban B, Masharawi Y. Three single leg standing tests for clinical assessment of chronic plantar heel pain syndrome: static stance, half-squat and heel rise. Physiotherapy 2016; 103:237-244. [PMID: 27908459 DOI: 10.1016/j.physio.2016.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To assess reliability and validity of three single leg standing clinical tests in patients with plantar heel pain syndrome (PHPS). DESIGN Cross-sectional reliability study. PARTICIPANTS Forty patients diagnosed with PHPS. MAIN OUTCOME MEASURES Patients stood on their affected foot in a static stance for up to 30seconds, a half squat for up to 10 repetitions, and a heel rise for up to 10 repetitions. The first sensation of pain (p1) determined the termination of each test, and established a positive test result. The level of p1 was measured using a visual analogue scale (VAS); time or repetitions for each test were recorded. Prior to performing the tests, all patients completed the Foot & Ankle Computerized Adaptive Test to measure functional status (FS). RESULTS Detection of p1 in each test showed good reliability for inter- and intrarater assessment (Kappa=0.60 to 0.78 and 0.56 to 0.77, respectively). The intraclass correlation coefficient for the VAS measures was 0.85 to 0.95 for inter-rater assessment and 0.78 to 0.92 for intrarater assessment. However, the Bland and Altman limits of agreement were wide, indicating that these measures were less reliable than the correlation coefficients suggested. Thirty-five patients (88%) experienced a positive pain response to at least one test. Significant correlations were found between the VAS measures in each test and FS (r=0.63 to 0.72). CONCLUSIONS The static stance, half squat and heel rise tests were easily implemented, and found to be reliable and valid according to one analysis, yet less reliable with another, for pain provocation and VAS levels in patients with PHPS. All three VAS levels correlated well with FS.
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Affiliation(s)
- B Saban
- Spinal Research Laboratory, Department of Physical Therapy, The Stanley Steyer School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Physical Therapy Service, Maccabi Healthcare Services, Petach Tikva, Israel.
| | - Y Masharawi
- Spinal Research Laboratory, Department of Physical Therapy, The Stanley Steyer School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Abstract
When conservative therapy fails for chronic plantar fasciitis, surgical intervention may be an option. Surgical techniques that maintain the integrity of the plantar fascia will have less risk of destabilizing the foot and will retain foot function. Endoscopic debridement of the plantar fascia can be performed reproducibly to reduce pain and maintain function of the foot.
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Srivastava P, Aggarwal A. Ultrasound-guided retro-calcaneal bursa corticosteroid injection for refractory Achilles tendinitis in patients with seronegative spondyloarthropathy: efficacy and follow-up study. Rheumatol Int 2016; 36:875-80. [PMID: 26894910 DOI: 10.1007/s00296-016-3440-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 02/08/2016] [Indexed: 12/19/2022]
Abstract
Ultrasound (US)-guided corticosteroid injection has been shown to be safe and effective for varied causes of plantar fasciitis; however, its use for Achilles tendinitis is controversial. We studied the efficacy and changes in US findings at Achilles enthesitis after corticosteroid injection in patients with spondyloarthropathy (SpA). Patients with SpA with symptomatic Achilles enthesitis, refractory to 6 weeks of full-dose NSAIDs, were offered US-guided local corticosteroid injection. Injected entheses were examined by US (both B mode and power Doppler) at baseline and 6 weeks after injection. Standard OMERACT definitions were used to define enthesitis. Achilles tendon thickness >5.29 mm, 2 cm proximal to insertion in long axis, was considered thickened. Twenty-seven symptomatic Achilles tendons (in 18 patients) were injected with 20 mg methylprednisolone under US guidance baseline, and 6-week follow-up US features were compared. All patients reported improvement in pain (VAS) in the affected tendon after injection (p < 0.0001). Simultaneously, improvement in local inflammatory changes were noted, in the form of significant reduction in tendon thickness (p < 0.0001), vascularity (p < 0.0001), peritendinous oedema (p = 0.001), bursitis and bursal vascularity (p < 0.001 and < 0.0001, respectively). There was no change in bone erosions and enthesophyte. None of the patients had tendon rupture or other injection-related complications at 6 weeks of follow-up. US-guided local corticosteroid injection is an effective and safe modality for refractory Achilles enthesitis in patients with SpA and leads to reversion of acute changes at entheseal site.
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Affiliation(s)
- Puja Srivastava
- Department of Clinical Immunology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, 226 014, India
| | - Amita Aggarwal
- Department of Clinical Immunology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, 226 014, India.
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Mizuno D, Naito M, Hayashi S, Ohmichi Y, Ohmichi M, Nakano T. Sex differences in the branching position of the nerve to the abductor digiti minimi muscle: an anatomical study of cadavers. J Foot Ankle Res 2015; 8:22. [PMID: 26075026 PMCID: PMC4465320 DOI: 10.1186/s13047-015-0077-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2015] [Accepted: 05/06/2015] [Indexed: 11/30/2022] Open
Abstract
Background The nerve to the abductor digiti minimi muscle (ADMM nerve) is the first branch of the lateral plantar nerve or originates directly from the posterior tibial nerve. Damage to the ADMM nerve is a cause of heel pain and eventually results in ADMM atrophy. It is known that ADMM atrophy occurs more often in females than in males, and the reason remains unclear. This study aimed to explore sex differences in the branching pattern, position, and angle of the ADMM nerve. Methods Forty-two cadavers (20 males, 22 females) were dissected at Aichi Medical University between 2011 and 2015. Cases of foot deformity or atrophy were excluded and 67 ft (30 male, 37 female) were examined to assess the branching pattern, position, and angle of the ADMM nerve. Results The branching positions of the ADMM nerve were superior to the malleolar–calcaneal axis (MCA) in 37 ft (55 %), on the MCA in 10 ft (15 %), and inferior to the MCA in 20 ft (30 %). There was no case among male feet in which the ADMM nerve branched inferior to the MCA, whereas this pattern was observed in 19 of 37 female feet (51 %). The branching position of the ADMM nerve was significantly closer to the MCA in female feet than in male feet. There were no significant sex differences in the branching pattern and angle of the ADMM nerve. Conclusions The ADMM nerve sometimes branches off inferior to the MCA in females, but not in males. This difference may be the reason for the more frequent occurrence of ADMM atrophy in females than in males.
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Affiliation(s)
- Daisuke Mizuno
- Department of Anatomy, Aichi Medical University School of Medicine, Nagakute, Aichi 480-1195 Japan
| | - Munekazu Naito
- Department of Anatomy, Aichi Medical University School of Medicine, Nagakute, Aichi 480-1195 Japan
| | - Shogo Hayashi
- Department of Anatomy, Tokyo Medical University School of Medicine, Shinjuku-ku, Tokyo Japan
| | - Yusuke Ohmichi
- Department of Anatomy, Aichi Medical University School of Medicine, Nagakute, Aichi 480-1195 Japan
| | - Mika Ohmichi
- Department of Anatomy, Aichi Medical University School of Medicine, Nagakute, Aichi 480-1195 Japan
| | - Takashi Nakano
- Department of Anatomy, Aichi Medical University School of Medicine, Nagakute, Aichi 480-1195 Japan
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Abstract
Plantar fasciitis (PF) is a common, disabling condition affecting millions of patients each year. With early diagnosis and timely application of traditional nonsurgical treatments, symptoms generally resolve over time. However, despite adequate treatment, 20% of patients will experience persistent symptoms. In these patients, minimally invasive therapies that augment local hemodynamics to initiate a regenerative tissue-healing cascade have the greatest potential to resolve long-standing symptoms. We performed a narrative review based on a best evidence evaluation of manuscripts published in Medline-indexed journals to determine the mechanisms involved in soft tissue injury and healing. This evaluation also highlights emerging minimally invasive therapies that exploit these mechanisms in recalcitrant PF.
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Affiliation(s)
- Larry E Miller
- Miller Scientific Consulting, Inc., Asheville, North Carolina, United States
| | - Daniel L Latt
- Department of Orthopaedic Surgery, University of Arizona, Tucson, Arizona, United States
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Abstract
Pain and reduced function caused by disorders of either the plantar fascia or the Achilles tendon are common. Although heel pain is not a major public health problem it affects millions of people each year. For most patients, time and first-line treatments allow symptoms to resolve. A proportion of patients have resistant symptoms. Managing these recalcitrant cases is a challenge. Gastrocnemius contracture produces increased strain in both the Achilles tendon and the plantar fascia. This biomechanical feature must be properly assessed otherwise treatment is compromised.
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Affiliation(s)
- Matthew C Solan
- Department of Trauma and Orthopaedic Surgery, Royal Surrey County Hospital, Egerton Road, Guildford, Surrey GU2 5XX, UK; University of Surrey, Guildford, UK; Surrey Foot and Ankle Clinic, Guildford, UK; London Foot and Ankle Centre, London, UK.
| | - Andrew Carne
- Department of Trauma and Orthopaedic Surgery, Royal Surrey County Hospital, Egerton Road, Guildford, Surrey GU2 5XX, UK
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Paoloni M, Tavernese E, Ioppolo F, Fini M, Santilli V. Complete remission of plantar fasciitis with a gluten-free diet: relationship or just coincidence? Foot (Edinb) 2014; 24:140-2. [PMID: 25063015 DOI: 10.1016/j.foot.2014.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 06/18/2014] [Indexed: 02/04/2023]
Abstract
We report the case of a 46-year-old woman with no known history for gluten sensitivity who presented severe heel pain, and was successfully managed with a gluten-free diet. Previously she had been unsuccessfully treated with several conservative remedies. The presence of musculoskeletal problems in patients with gluten sensitivity is not rare. To the best of our knowledge, however, this is the first case report mentioning the successful management of plantar fasciitis with a gluten-free diet. The case report highlights the importance of considering gluten sensitivity among other possible differential diagnosis for musculoskeletal pain insensitive to traditional therapies.
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Affiliation(s)
- Marco Paoloni
- Board of Physical Medicine and Rehabilitation, Department of Anatomy, Histology, Forensic Medicine and Orthopedics, "Sapienza" University, Rome, Italy.
| | - Emanuela Tavernese
- Pediatric Neuro-Rehabilitation Division, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Francesco Ioppolo
- Physical Medicine and Rehabilitation Unit, Azienda Policlinico Umberto I, Rome, Italy
| | | | - Valter Santilli
- Board of Physical Medicine and Rehabilitation, Department of Anatomy, Histology, Forensic Medicine and Orthopedics, "Sapienza" University, Rome, Italy; Physical Medicine and Rehabilitation Unit, Azienda Policlinico Umberto I, Rome, Italy
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Abstract
Foot pain is a common orthopedic condition that can have an impact on health-related quality of life. The evaluation of plantar hindfoot pain begins with history and physical examination. Imaging modalities, standard radiographs, sonography, MR, CT are often utilized to clarify the diagnosis. The article is a detailed description of the sonographic evaluation of the plantar fascia and its disorders as well as the common etiologies in the differential diagnosis of plantar fasciopathy.
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Lohrer H, Nauck T. Retrocalcaneal bursitis but not Achilles tendinopathy is characterized by increased pressure in the retrocalcaneal bursa. Clin Biomech (Bristol, Avon) 2014; 29:283-8. [PMID: 24370462 DOI: 10.1016/j.clinbiomech.2013.12.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Revised: 12/01/2013] [Accepted: 12/03/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND We questioned whether different forms of Achilles tendon overuse injuries can be differentiated by retrocalcaneal bursa pressure measurement. METHODS Retrocalcaneal bursa pressure was determined by using invasive pressure measurement in patients suffering from retrocalcaneal bursitis (n=13) or Achilles tendinopathy (n=15), respectively. Standardized measurements were taken with the subject lying prone. Initially, the foot and ankle was in a spontaneous, unsupported position. Then passive dorsiflexion was induced by an increasing pressure which was applied in five defined steps against the plantar forefoot. FINDINGS Mean pressures found in unloaded position were 30.5 (SD 28.9) mmHg in retrocalcaneal bursitis and -9.9 (SD 17.2) mmHg in Achilles tendinopathy (p<0.001). A stepwise increase in passive ankle dorsiflexion was associated with increasing pressure values in both groups. The differences were p=0.009 to 0.035 when dorsiflexion was initiated with 10, 20, 30, and 40N, respectively. Dorsiflexion induced by 50N load resulted in a mean pressure of 113.7 (SD 124.9) mmHg for retrocalcaneal bursitis and 32.5 (SD 48.9) mmHg for Achilles tendinopathy (p=0,051). INTERPRETATION Higher retrocalcaneal bursa pressure values were found in patients suffering from chronic retrocalcaneal bursitis. This result supports the hypothesis that retrocalcaneal bursa hypertension leads to an impingement lesion of the corresponding anterior Achilles tendon.
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Affiliation(s)
- Heinz Lohrer
- Institute for Sports Medicine, Otto-Fleck-Schneise 10, D-60528 Frankfurt am Main, Germany; Institute for Sports and Sports Science, Albert-Ludwigs-University Freiburg i.Brsg., Schwarzwaldstraße 175, D-79117 Freiburg, Germany.
| | - Tanja Nauck
- Institute for Sports Medicine, Otto-Fleck-Schneise 10, D-60528 Frankfurt am Main, Germany
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