Showing papers on "Heel published in 1987"

Gait patterns in spastic hemiplegia in children and young adults.

Abstract: Four homogeneous patterns of gait were defined in forty-six patients who had spastic hemiplegia secondary to cerebral palsy or other neurological disorders by analyzing kinematic data in the sagittal plane and electromyographic data. In Group I (twenty patients) the primary abnormality was a drop foot in the swing phase. The thirteen patients in Group II had a tight heel cord in the stance phase as well as a drop foot in the swing phase. The five patients in Group III also had more proximal involvement (that is, restricted motion of the knee) as well as an equinus deformity of the ankle. In Group IV, the eight patients had, in addition, restricted motion of the hip.

Pressure Distribution under Symptom-Free Feet during Barefoot Standing

Abstract: The plantar pressure distributions for a large heterogeneous sample of feet (N = 107) were collected during barefoot standing using a capacitance mat. From these data, the function of the foot during standing was characterized. Peak pressures under the heel (139 kPa) were, on average, 2.6 times greater than forefoot pressures (53 kPa). Forefoot peak pressures were usually located under the second or third metatarsal heads. No significant relationship was found between body weight and the magnitude of peak pressure. The concepts of a transverse arch at the level of the metatarsal heads and a "tripod" theory of load distribution were not substantiated by this study. Load distribution analysis showed that the heel carried 60%, the midfoot 8%, and the forefoot 28% of the weightbearing load. The toes were only minimally involved in the weightbearing process. Examples of unusual distributions are shown; finally, a checklist is provided to aid the clinician in evaluating plantar pressure findings.

Prevention and management of calcaneal apophysitis in children: an overuse syndrome

Abstract: Calcaneal apophysitis (Sever disease) is a common cause of heel pain, particularly in the athletically active child. Eighty-five children (137 heels) with calcaneal apophysitis were reviewed. Both heels were affected in 52 (61%) patients. The most common associated foot condition was pronation, occurring in 16 patients. Sixty-eight patients complained that pain was made worse by a specific sport, with soccer leading the list. All patients were treated with a physical therapy program of lower extremity stretching, especially of the heel cords, and ankle dorsiflexion strengthening. Soft Plastizote orthotics or heel cups were used in 98% of patients. Proper athletic shoewear was advised. All patients improved and were able to return to their sport of choice 2 months after the diagnosis. There were two recurrences.

The influence of lateral heel flare of running shoes on pronation and impact forces.

Abstract: The purpose of this investigation was to study the influence of the flare at the lateral side of the heel of running shoes on: initial and total pronation; impact forces in heel-toe running; and to explain the results with a mechanical model. The experimental part of the study was performed by using 14 male runners. Their running movement (4 m/s) was quantified by using a force platform and high-speed film (100 frames X s-1). Three shoes were used, identical except in their lateral heel flare, one shoe with a conventional flare of 16 degrees, a second shoe with no flare, and a third shoe with a rounded heel (negative flare). The experimental results indicate that (for the used set of shoes); increasing heel flare increases the amount of initial pronation; changes in heel flare do not affect the magnitude of the total pronation; and changes in heel flare do not alter the magnitude of the impact force peaks. Since shoes with rounded lateral heels do reduce initial pronation, it is speculated that this construction could be used to prevent anterior medial compartment syndrome at the tibia of runners. It was concluded that more research is needed to specify whether the reported result is representative for various shoe types or is shoe specific.

Abnormal biomechanics of the foot and ankle.

Abstract: The biomechanics of the foot and ankle is important to the normal function of the lower extremity. The foot is the terminal joint in the lower kinetic chain that opposes external resistance. Proper arthrokinematic movement within the foot and ankle influences the ability of the lower limb to attenuate the forces of weightbearing. It is important for the lower extremity to distribute and dissipate compressive, tensile, shearing, and rotatory forces during the stance phase of gait. Inadequate distribution of these forces could lead to abnormal stress and eventual breakdown of connective tissue and muscle. Pathologies such as heel spurs, hallux valgus, neuromas, hallux limitus, shin splints, and nonspecific knee pain result from abnormal mechanics of the foot and ankle. The use of orthotics to re-establish the normal biomechanics of the foot and ankle have profound clinical applications. The combined effect of muscle, bone, ligaments, and normal biomechanics will result in the most efficient force attenuatio...

Modular composite prosthetic foot and leg

Abstract: A prosthesis fabricated from filamentary laminates including a pylon having an upper extremity, a shin portion, an ankle portion and a forwardly extending foot portion, all integral with one another. A separate heel portion is secured directly to the foot portion and is provided in different modules of stiffness which serve, when secured to the foot portion, to greatly enhance the life-like movement of the foot and the entire prosthesis. The pylon is provided in different modules to match the weight and activity levels of a wide spectrum of individuals.

Imaging study of the painful heel syndrome.

Abstract: A total of 45 patients with the painful heel syndrome without evidence of an associated inflammatory arthritis, seven of whom had pain in both heels, were studied using technetium-99 isotope bone scans and lateral and 45 degrees medial oblique radiographs of both feet. Of the 52 painful heels 31 (59.6%) showed increased uptake of tracer at the calcaneum. Patients with scans showing increased uptake tended to have more severe heel pain and responded more frequently to a local hydrocortisone injection. On plain x-ray, 39 of 52 painful heels (75%) and 24 of the 38 opposite nonpainful heels (63%) showed plantar spurs, compared with five of 63 (7.9%) heels in 59 age- and sex-matched controls. No evidence of stress fractures was seen.

The painful heel syndrome: an entrapment neuropathy.

Abstract: The author describes the role of the nerve to the abductor digiti quinti muscle and presents a preliminary report of a direct surgical approach for decompression.

Heel shoe construction

Abstract: A deflectable heel insert for use in the heel portion of a footwear. The heel insert includes at least one load-bearing plate which is deflectable under loads exerted by the heel of a shoe wearer. The plate is supported above a plate support surface as part of the heel or a base plate forming part of the laminate heel construction.

Painful Plantar Heel, Plantar Fasciitis, and Calcaneal spur: Etiology and Treatment.

Abstract: Painful plantar heel is a relatively common clinical entity encountered by the health care professional who treats patients with foot complaints. Plantar fasciitis and calcaneal spurs are frequently associated with this condition. The most common etiology involves abnormal pronation with resultant increased tension forces developed in the structures attaching in the region of the calcaneal tuberosity. This article reviews the relevant anatomy, pathomechanics, pathophysiology, and clinical presentation of the painful plantar heel patient. A course of treatment is suggested.

Cushioned heel inset for post-operative shoe

Abstract: A cushioned heel inset for an orthopedic, postoperative shoe The shoe has a lightweight, rigid orthopedic sole with a skid proof outer sole and a cushioned inner sole, the heel of the rigid sole having a recess for inset of a cushioning pad which interfaces the inner sole

Sport sandal for active wear

Abstract: A sandal with an elongated sole configured to the profile of a human footprint with a toe end and a heel end, employs a toe strap connected at two anchor points to grip the forward part of user's foot and a heel strap connected at two anchor points to grip the ankle of a user's foot with a lateral strap connected between the toe strap and the heel strap which is located on the outside of the sole and parallel to its surface so it is operable to stabilize the other straps and to maintain essentially constant tension in the individual straps as the sole flexes, with the toe and heel straps being infinitely adjustable so the wearer can cinch the sandal to his foot by adjusting said straps in a manner that it will not be dislodged during rigorous activity.

Posterior tibial-tendon transfer in patients with cerebral palsy.

Abstract: The results of fifty-seven posterior tibial-tendon transfers through the interosseous membrane to the dorsum of the foot that were performed in fifty-one patients who had cerebral palsy, and who were followed for a mean of 9.3 years (range, five to twenty-six years), were evaluated in terms of pattern of gait, alignment of the foot, formation of callus on the sole of the foot, and requirements for bracing. A good or excellent result was achieved in twenty-seven of thirty feet in the hemiplegic patients, twelve of sixteen feet in the paraplegic patients, and two of eleven feet in the quadriplegic patients. We found that in order for the tendon transfer to be successful the foot had to be passively correctable to at least a neutral position and that the tendon had to be passed superficial to the extensor retinaculum and inserted into the lateral cuneiform bone. The heel cord should be lengthened before the tendon transfer.

Anatomic location of acute diabetic foot infection. Its influence on the outcome of treatment.

Abstract: One hundred ten diabetic foot infections were studied in 76 patients with reference to the effect of the anatomic location of the infection on the treatment outcome. Distal infections were located in the toes or metatarsal-phalangeal joints; proximal infections were located along metatarsals, at the heel, or above the ankle. Overall limb salvage was significantly lower in the proximal group (47.8%) than in the distal group (96.6%). A revascularization for healing was required in 12 per cent of hospitalizations. Mortality was significantly higher in the proximal group, but the healing times for open wounds and overall morbidity were not different between the groups. Diabetic foot infections must receive careful and timely treatment by concerned surgeons. The outcome of proximal infections is poor, with major risk of limb loss and mortality, but not hopeless. The treatment of distal infections derives greater limb salvage with nevertheless similar morbidity and healing time.

An analysis of the results of a modified one-stage posteromedial release (Turco operation) for the treatment of clubfoot.

Abstract: Between 1971 and 1977, posteromedial release was performed on 47 feet of 30 children 9 months to 4 years of age. At review, full correction of equinus was achieved in 98%, heel varus in 91%, and cavus in 85%, but in only 50% of feet with forefoot adduction. Between 1978 and 1982, surgery was performed on 22 feet of 18 children 3-10 months of age. Recessions of the abductor hallucis and short plantar muscles and fascia were also performed at operation. Correction of equinus, heel varus, and cavus demonstrated results similar to those of the earlier group, but forefoot adduction was also satisfactorily corrected in 91% of feet.

Heel counter for athletic shoe and footwear incorporating same

Abstract: Footwear having a heel counter comprised of a stiff resilient material, especially an athletic shoe for medium and long distance running, is improved so that a better pressure distribution is assured on the outersole, and also on a possibly existing middle sole, in the area of the heel counter. This is achieved by the fact that the surface area which is enclosed by the sidewalls of the heel counter is provided with a pressure distribution membrane which is connected to a thicker reinforced lower arcuate edge of the sidewalls of the counter, and the pressure distribution membrane is suitably contoured to facilitate the improved distribution of heel pressure to the midsole and outer sole. Downward arching of the distribution membrane under heel pressure applied by the foot of a wearer causes an upper edge area of the sidewalls to be drawn inwardly to hold the heel with greater force.

Foot testing method

Abstract: This invention relates to a foot testing method to analyze the functional biomechanic type of the foot of a person such as an athlete to determine the appropriate insole to be fitted in the person's shoe as well as to a measuring device and insole used to implement this method. This method comprises the following steps: (1) placing the foot in a neutral (unloaded) position; (2) identifying the center line of the heel bone; (3) identifying the center line of the tendo Achillis; (4) placing the person tested in a standing position and preferably identifying the type of arch; (5) measuring the angle between the heel bone center line and the tendo Achillis center line preferably with his/her knees bent at approximately 45°.

Female gait patterns: the influence of footwear.

Abstract: The two horizontal orthogonal ground reaction forces, mediolateral (Fx) and antero-posterior (Fy), together with limb segment displacements, were recorded simultaneously during gait from 24 female subjects aged 18–29 years Recordings were made for each subject barefoot and when wearing each of four different pairs of shoes: soft-soled, rigid-soled, medium- and high-heeled The results showed a trend for increasing lateral stability with increasing heel height and decreasing ground contact area Thiswas reflected in decreasing mean values for defined ground reaction force peaks in the medio-lateral direction at heel strike and at toe off Limb segments displacements tended to increase with decreasing heel height and increasing shoe-ground contact area, being greatest when subjects were wearing pumps, ie flexible-soled, no-heeled shoes

Current concepts of instep island flap.

Abstract: The durability of the instep island flap and the sequelae of the flap donor site were assessed. The average follow-up period for 13 patients was 3 years and 8 months. Flaps provided permanent durable reconstruction of the heel, if there was no scar in the flap preoperatively. Flaps with scar or free skin graft showed hyperkeratosis or fissure of the flap after transfer to the heel. Accordingly, conservative treatment, special shoes, or other surgical procedures should be considered for these patients. All flaps that were transferred as sensory flaps preserved light-touch cutaneous sensitivity and static 2-point discrimination within a measurable range. The sequelae due to the flap elevation were tenderness in the bifurcation of superficial branches from the common digital nerves and sensory disturbance of the forefoot. Indications and surgical techniques are discussed.

Amputation salvage with microvascular free flap from the amputated extremity.

Abstract: Microvascular surgery has allowed creative primary reconstruction using undamaged parts of amputated limbs as donor sites. We present a case of lower extremity below-knee amputation salvage with a free flap of heel, calcaneus, and soft tissues from the amputated lower leg, ankle, and foot supplied by the posterior tibial neurovascular bundle.

Reconstruction of soft-tissue defect of the posterior heel with a lateral calcaneal artery island flap.

Abstract: We obtained most favorable results in 11 patients with a lateral calcaneal artery island flap. It is a simple, stable, sensate, and yet safe and versatile flap to repair defects around the ankle and heel. We have also used this flap to cover defects around the medial malleolus without any delay (extended lateral calcaneal artery island flap).

Pivoting ski boot

Abstract: A ski boot minimizes torsional rotation of the foot while permitting bending movement about the ball of the foot. The ski boot includes a toe portion connected to a heel portion by a hinge structure that prohibits torsional movement therebetween. A heel bracket is connected to and pivots with respect to the toe portion independently of the heel portion. The toe portion has a forward tip that may engage a front ski binding, and the heel bracket has a heel member that may engage a rear ski binding. The heel portion may be releasably fastened to the heel bracket for alpine skiing and walking or released for nordic skiing. Hyperextension and hyperflexion limit stops are provided. Extension linkage may be implemented to space the toe and heel portions.

The painful heel.

Abstract: The painful heel syndrome is a common complaint of the middle-aged and elderly. Most patients have no associated disease, except obesity, but young men should be carefully evaluated for ankylosing spondylitis or reactive arthritis. The majority of cases respond to appropriate heel padding, corticosteroid injection or a specially designed insole.

Heel reconstruction with the deep circumflex iliac artery osteocutaneous flap

Abstract: A patient with extensive loss of bone and soft tissue from the right heel is presented. The defect was reconstructed using an osteocutaneous flap based on the deep circumflex iliac vessels. Indications for this procedure include extensive loss of bone and soft tissue precluding the use of local flaps. A 30-month period has elapsed since her reconstruction. A single ulcer developed 13 months postoperatively that healed after flap revision. We feel that tailoring the flap to minimize redundancy at the initial operation, subsequent tissue excision if necessary, and reinnervation augment durability of the flap.

Measurement of leg length by computerised tomographic scanography: brief report.

Abstract: We describe a technique for the accurate measurement of total leg length, including heel height. Computerised tomography (CT) can be used to measure the length of each tibia and femur (Helms and McCarthy 1984) but this technique cannot measure discrepancy of leg length distal to the ankle. The heel height may be a significant component of total discrepancy. Our technique allows this to be measured accurately with the foot in the same relationship to the tibia as in the standing position. It is a quick method with 50 to 100 times less radiation than orthoroentgenography (Green, Wyatt and Anderson 1946).

Calcaneal Pain: A Review of Various Disorders

Abstract: The heel is a common site of foot pain. However, determining the etiology of the pain requires performing a careful history, and a specific biomechanical and musculoskeletal examination supplemented with appropriate radiological and laboratory tests. The etiology of calcaneal pain is commonly related to enthesopathy, arthritic conditions, entrapment of foot nerves, dysfunction of soft tissues, and bony stress syndromes. Treatment of calcaneal pain is directed at establishing appropriate balance of the musculoskeletal system in the lower leg, developing an activity or training program that controls mechanical stresses, providing an environment where the pericalcaneal tissue can heal, and (when appropriate) altering plantar contact or biomechanical function of the foot with foot orthotic devices.

The relationship between oblique fractures of the medial malleolus and concomitant fractures of the anterolateral aspect of the tibial plafond.

Abstract: The cavovarus foot is challenging to treat. The deformity is typically progressive with an unpredictable natural history. There are concurrent deformities in the fore-, mid-, and hindfoot: the medial arch is elevated, the first ray is plantarflexed, and the heel is in varus. Muscle imbalance and joint contractures are common. Successful correction requires confirmation of the underlying diagnosis and the application of principles to select the appropriate surgical procedures.

Conservative management of metatarsal and heel pain in the adult foot.

Abstract: The Louisiana State University (LSU) Affiliated Hospitals foot clinic has had good success in the treatment of metatarsal and heel pain using the following five modalities. Muscle strengthening and muscle stretching of the intrinsic muscles and the muscles about the ankle joint, especially the gastrocnemius-soleus complex. Contrast baths in the acute condition to decrease the edema and inflammatory process. Nonsteroidal agents with the acute condition to decrease the inflammatory response. Shoe modifications. Orthotic devices. Orthotic devices seem to be the most useful in the treatment of both conditions. It has been found necessary to prescribe orthotics in almost all cases of chronic problems to institute permanent relief. Opposition remains to multiple steroid injections into either area, although there is no great objection to one or possibly two injections into a particular area to decrease the inflammatory process. It has been observed that a general worsening of the condition occurs from multiple injections. After repeated steroid injections one sets the stage for increased atrophy of the fat pad, which results in a more prominent bony surface and increased pain. Cases have been documented on many occasions showing indented areas over the heel or metatarsals or complete loss of the metatarsal fat pad of patients who have received multiple injections of steroids.