Showing papers on "Heel published in 1991"

Plantar fasciitis. Etiology, treatment, surgical results, and review of the literature.

Abstract: Plantar fasciitis is a common orthopedic syndrome among athletes and nonathletes. The etiology of the pain is multifactorial but usually involves inflammation and degeneration of the plantar fascia origin. The majority of patients will respond to conservative measures. Surgical treatment is reserved for those patients who do not respond. A complete plantar fascia release is performed through a medial longitudinal incision. Prominent heel spurs and degenerated areas in the plantar fascia are resected. Of 27 surgically treated cases followed from one to three years, satisfactory results were obtained in 24 cases. Histologically, localized fibrosis or granulomatous changes or both were noted in several cases.

Plantar fasciitis: MR imaging.

Abstract: The clinical presentation of plantar fasciitis may be mimicked by a number of other painful heel conditions. Thus, magnetic resonance (MR) imaging was used to develop objective morphologic criteria to establish a diagnosis of plantar fasciitis in eight patients. Sagittal T1-weighted and coronal intermediate and T2-weighted images of symptomatic and asymptomatic feet were obtained; additional sequences were used for symptomatic feet. Maximum thickness of the plantar fascia was significantly increased (P less than .0001) in patients with plantar fasciitis (sagittal, 7.40 mm +/- 1.17, and coronal, 7.56 mm +/- 1.01) compared with age- and sex-matched volunteers (sagittal, 3.22 mm +/- 0.44, and coronal, 3.44 mm +/- 0.53) and young male controls (sagittal, 3.00 mm +/- 0.8, and coronal, 3.00 mm +/- 0.0). Furthermore, nine of 10 feet with plantar fasciitis had areas of moderately increased signal intensity in the substance of the fascia. MR imaging may provide an objective assessment of the morphologic changes associated with plantar fasciitis, as well as assist in excluding other causes of heel pain.

Stiff-legged gait in spastic paresis. A study of quadriceps and hamstrings muscle activity.

Abstract: Stiff-legged gait, ascribed to limited knee flexion during swing in spastic paresis, has previously received little detailed investigation In this study, data from 23 patients referred for dynamic electromyographic evaluation of spastic stiff-legged gait were analyzed to identify timing of the activity of eight muscles during the gait cycle Stride characteristics and foot switch data were also analyzed Inappropriate activity in at least one of the quadriceps muscles during the preswing and/or initial swing phases was found in all 23 patients Nine patients (39%) had hamstring activity during preswing This group of 9, compared with the other 14 patients, had a significant reduction in average gait velocity and stride length (P less than 005) suggesting that preswing hamstring activity in stiff-legged gait may be counterproductive No relation was found between biceps femoris (short head) activity and the amount of peak knee flexion attained in swing indicating that other factors are more important in attaining knee flexion Delayed heel rise was observed in 21 patients (91%), which could imply insufficient calf muscle strength Further, patients with markedly delayed heel rise achieved less peak knee flexion in swing than patients with normal or only moderately delayed heel rise (P less than 005) This may support the notion that adequate calf muscle strength is important in initiating knee flexion in the terminal stance/preswing phase Results from this study provide preliminary quantitative information about stiff-legged gait that may prove useful in guiding management techniques

The use of night splints for treatment of recalcitrant plantar fasciitis.

Abstract: This study reports the results of the use of molded ankle foot orthosis night splints for the treatment of recalcitrant plantar fasciitis on 14 patients with a total of 18 symptomatic feet. All patients had symptoms for greater than 1 year and had previously undergone treatment with non-steroidal anti-inflammatory medicines, cortisone injections, shoe modifications, and physical therapy without resolution. All patients were provided with custom-molded polypropylene ankle foot orthoses in 5 degrees of dorsiflexion to be used as a night splint. With continued use of nonsteroidal anti-inflammatory medication, Tuli heel cups, Spenco liners, and general stretching exercises, successful resolution occurred in 11 patients in less than 4 months. There were three failures. It is felt that the use of night splints provides a useful, cost-effective adjunct to current therapeutic regimens of plantar fasciitis.

Footwear and posture. Compensatory strategies for heel height.

Abstract: The belief that wearing high-heeled shoes increases lumbar lordosis is firmly ingrained in clinical folklore. Proponents of negative heel footwear argue that because high positive heels increase the lumbar lordosis, negative heels will decrease the lumbar lordosis. Quantitative documentation of the assumption regarding high heels is not to be found in the literature, although sporadic attempts to prove this assumption have been made throughout the 20th Century. Although other effects, such as decreased gait speed and step length, and increased knee flexion at heel strike have been found in more than one study, no increase in lumbar lordosis has been found. Where an actual decrease in lordosis has been found, authors tend to explain it away as inconsistent with what every clinician feels that he or she has observed. We felt it appropriate, then, to conduct both a static and a dynamic study to assess the effects of heel height on lumbar spine and lower limb joint kinematics in the sagittal plane, as well as other strategies to compensate for heel height. The results indicate that the greatest compensation is at the ankle and knee. Where a significant effect occurred in the lumbar spine (males, dynamic study), high heels decreased the lumbar lordosis, i.e., resulted in less swayback rather than more.

Propulsion plate hydrodynamic footwear

Abstract: An athletic shoe having a hydrodynamic heel insert pad in the midsole to above a specially configurated spring plate which extends beneath the medial but not the lateral portion of the heel, through the arch region, to and beneath the metatarsal head region and toe region, serving to eliminate the force spike at heel impact in combination with foot control as the foot proceeds via complex movements through the gait cycle, and efficient toe off.

Treatment of osteoarthritis of the knee with heel wedges.

Abstract: Sixty-two patients with early medial compartment osteoarthritis of the knee were treated with lateral heel wedges and followed for from 7 years and 5 months to 12 years. Those who were treated with heel wedges and analgesics showed a significantly greater improvement in pain score than those treated with analgesics only, but not in the walking ability score at the second follow up. The lateral heel wedge had no effect on the progress of the radiographic changes. The lateral heel wedge is useful for patients with early medical compartment osteoarthritis provided it is used with an understanding of the indications and its limitations.

Endoscopic plantar fasciotomy for chronic plantar fasciitis/heel spur syndrome: surgical technique--early clinical results.

Abstract: A new, minimally traumatic endoscopic approach to plantar fasciotomy has been developed by the authors. This technique can be performed comfortably under a local anesthetic. Patients are immediately weightbearing and all returned to regular type shoes on the 3rd postoperative day. An earlier return to regular activity and work, with less pain and patient discomfort was found, as compared with traditional heel spur surgery techniques.

Torsional spring insole and method

Abstract: A torsional spring insole for use in footwear having an elevated heel section for supporting the heel of a foot and an inner sole in communication with the elevated heel section for providing a torsional spring capability to the insole. A step-down region is provided for connecting the elevated heel section to the inner sole for flexing the inner sole in response to a pressure imbalance applied to the elevated heel section. The inner sole subsequently reflexes with the movement of the foot to position the elevated heel section to eliminate the pressure imbalance and to counteract pronation and supination in the foot. The elevated heel section of the insole employs the heel counter structure of the shoe in which the insole is inserted to assist in counteracting pressure imbalances associated with pronation and supination. In an alternative embodiment, the elevated heel section of the insole includes a vertical heel counter for counteracting pressure imbalances due to pronation and supination.

Evaluation of plantar fasciitis by three-phase bone scintigraphy.

Abstract: Fifteen patients complaining of chronic heel pain underwent three-phase Tc-99m MDP bone scintigraphy. Ten patients demonstrated abnormal scan findings consistent with plantar fasciitis (PF) and had responded to conventional therapy. Two patients were found to have calcaneal stress fractures, and one patient demonstrated a calcaneal spur that required no treatment. The remaining two patients had normal scans and did not appear clinically to have PF. The three-phase bone scan is therefore very useful in diagnosing PF and in distinguishing it from other etiologies of the painful heel syndrome.

Replaceable high heel

Abstract: For use with a shoe having an upper and a sole and with a block downwardly extending from the lower portion of the sole adjacent to the heel and with a magnetic plate facing downwardly from the block, an improved replaceable heel having an upper surface with an upwardly facing recess therein and a magnetically responsive plate face upwardly on the lower surface of the recess.

Heel spur syndrome. Pathomechanics and nonsurgical treatment. Biomechanics Graduate Research Group for 1988.

Abstract: In this study, the authors review the multitude of suspected etiologies of heel spur syndrome, propose a new pathomechanical theory, and apply a treatment plan to 84 patients with 133 painful heels. The study investigates whether there is a common foot type to the syndrome and whether factors such as sex, age, occupation, and weight influence incidence or treatment. A subgroup is established, consisting of subjects who only received mechanical treatment, to determine if a change in foot position can relieve symptoms.

Prosthetic foot with ankle joint and toe member

Abstract: A prosthetic foot includes an ankle member, a heel member and a toe member coupled to each other for relative pivotable movement with the pivotable movement resisted by elastomeric pads. The heel and ankle member are connected through a joint allowing for translational and pivotable torsional motion of the ankle with respect to the heel and provided with limit stops in the axle and the side walls of the heel member to limit the torsional and translation motion of the ankle joint. The toe member is formed symmetrically to be used for left and right feet with symmetrically positioned and mirror imaged fore sections.

Artificial limb including a shin, ankle and foot

Abstract: The invented artificial limb includes a shin, ankle and foot. The shin includes a first mount, a second mount positioned below the first mount, and a plurality of rods extending between the first and second mounts, where at least one rod is a load bearing rod. The foot includes an elongate member having a toe section and a heel section. In many applications, the elongate member is arched. The shin is coupled to the foot by an ankle. The ankle allows the shin to rotate around an axis substantially perpendicular to a line between the toe and heel sections of the foot. A rotation controlling element such as an elastic band or a compression spring is connected to both the ankle and to the elongate member to restrict rotation of the shin toward the heel section of the foot. The ankle may also allow the shin to move around a second axis to simulate lateral rotation of the ankle. In the preferred embodiment, the rods of the shin and the elongate member of the foot are flexible to provide a more comfortable and responsive artificial limb.

Reduction of lumbar scoliosis by use of a heel lift to level the sacral base.

Abstract: The relationship between unlevelness of the sacral base and scoliosis is unclear. A method for reducing mild lateral bend of the lumbar spine by use of a heel lift to level the sacral base was tested in adults. Special methods were used to demonstrate the weight-bearing plane of the sacral base and the angle of lateral bend radiographically. The procedure significantly decreased the unlevelness of the sacral base and significantly reduced the angle of lateral bend. The results suggest that an unlevel sacral base contributes to lumbar scoliosis and that use of a heel lift to level the sacral base in mild cases of lumbar scoliosis can be beneficial.

Conservative treatment of genu valgus and varum with medial/lateral heel wedges.

Abstract: Symptomatic bowlegs and knock-knees are common in the aging person and aging athlete secondary to knee trauma. Diagnosis is made by observation and in mild degrees by a standing alignment x-ray that shows narrowing of the joint surface on the appropriate side. The patients complained of pain on the convexity side of the deformity. Treatment consisted of a simple exercise program, non-steroidal anti-inflammatory drugs and appropriate 1/8-inch wedges on the lateral side of the heel for bowlegs or on the medial side of the heel for knock-knees. The effect of a simple heel wedge formed the basis for conservative treatment of symptomatic knee deformities.

Ultrasonic bone analysis device and method

Abstract: An instrument for measuring the strength and integrity of bone in vivo by ultrasound pulse taking its data by measurement of the os calcis or heel bone. The measured data is processed so that the instrument is capable of presenting its output in units of estimated spinal bone density, a value of recognized clinical value and acceptance. It has been determined that, using both the changes in the speed of ultrasound in the patient's heel and the broadband ultrasonic attenuation of the ultrasonic pulse as it transmits through the patient, that a value for estimated spinal bone mineral density can be calculated which correlates very well with actual measured values of spine mineral density.

Dynamic stabilizing inner sole system

Abstract: An orthotic device for preventing hyperpronation of a human foot has a deep heel seat to cup the calcaneous and maintain it in approximately 5 degrees of varus, and high medial and lateral flanges which prevent lateral transverse drift of the first and fifth metatarsals.

An electrodynographic study of foot function in shoes of varying heel heights.

Abstract: Forty-three female test subjects had electrodynographic gait analysis performed in barefoot, low-heel shoe, and high-heel shoe conditions. Comparisons of segmental foot function, actual pressures, and pressure durations were determined. The findings suggest that an increased duration of forefoot loading, rather than an increased actual pressure, is responsible for pedal pathology secondary to wearing high-heel shoes. Contrary to previous reports in the literature, evidence of abnormal pronation in high heels was not found in this study.

Hematogenous calcaneal osteomyelitis in children.

Abstract: Heel pain is a frequent complaint in children due to intensive school and leisure-time sports. Heel pain accompanied by inflammatory signs has to be considered as osteomyelitis until the opposite is proven. From 1980 to 1989, twenty children were treated for acute or subacute osteomyelitis of the calcaneus (OMC) at the Department of Pediatric Surgery of the Children's Hospital of Lucerne. The schema of investigation comprising laboratory work-up, x-rays, scintiscanning and aspiration of the focus makes quick and accurate diagnosis possible. Exogenous osteitis of the newborn and calcaneal apophysitis in children must be differentiated; this is a prime consideration. Treatment includes surgical interventions (curettage, drainage) and long-term antibiotics. The course of the disease can be shortened, complications become avoidable and the rate of recurrence is diminished.

Calcaneus deformity in the ambulant patient with myelomeningocele

Abstract: We reviewed our experience of tibialis anterior transfer and anterior release for calcaneus deformity in 46 feet of 26 ambulant patients with myelomeningocele. At an average follow-up of 8.4 years (2 to 17.6) there were 89% who had satisfactory results; 64% of the patients having tibialis anterior transfers were able to stand on their toes. Hip abductor power was a good predictor of a functional transfer. Pre-operative trophic ulceration of the heel increased from 3.2% to 33% if surgery was delayed. Secondary deformities, two-thirds of them into valgus, developed in 76% of feet.

Medio-lateral control enhancing, cantilever-spring type prosthetic foot

Abstract: An improved prosthetic foot keel is proposed, based on the capability of the flexible keel to maintain the amputee's stability by means of medio-lateral forces and impulsions, while initially storing energy at heel strike and mid-stance, for restoring same at toe-off, in all planes. The keel is of the cantilever spring type, as generally disclosed in U.S. Pat. No. 4,645,509 to Poggi et al.. The improvement is directed: firstly, to a medially-oriented heel curvature which, at heel strike, provides medio-lateral stability during the weight transfer from the contra-lateral limb to the prosthetic limb; and secondly, to an inward medio-lateral forefront portion extension thereof which, by extending the lever arm of the deformable keel, produces a medio-lateral propulsion capability at foot push off. Hence, this keel medio-lateral heel curvature and inward extension facilitates lateral back and forth swinging motion of the amputee's body center of gravity, typical of a normal gait.

Auditory feedback for walking difficulties in a case of unilateral neglect: A pilot study

Abstract: A 29-year-old woman with left sensory neglect, visual neglect, and frontal lobe difficulties presented problems in physiotherapy because she walked with her left foot heel-up in a highly unstable plantarflex position. She completely failed to learn to lower her heel on walking, which as a result could have led to an eversion injury, despite the fact that she could lower her heel to the floor on command. A pressure-sensitive switch attached to a buzzer on her belt was inserted under her left heel, and a walking programme instituted, with time of heel contact during a 4-m walking test being gradually increased through a process of charting progress and setting goals. Improvements in her walking were charted and appeared to generalise to everyday life.

The efficacy of six heel pressure reducing devices.

Abstract: Twenty to 90 percent of pressure ulcers are located on the heel. The purpose of this study was to evaluate the pressure exerted on the heel when the foot in both the supine and the 30 degree elevated position was placed in various heel pressure reducing devices. Interface pressures of six heel devices were measured to determine their performance. Other factors, such as body weight, height shoe size, shoe width, as well as whether the device provided leg support were examined.

Shoe construction with self seating removable heel

Abstract: A high heel shoe (10) with a self seating removable heel portion (20) includes a shoe body having a sole portion (13) with a toe area (14) and a heel area (16), the heel area (16) being elevated substantially above the toe area (14) so that the shoe sole (13) is inclined between the toe and the heel and at the heel area. The heel portion (18) of the shoe sole (13) has a socket (25) with a forwardly facing open end (26) and a closed rear end (28), the socket (25) having a sidewall forming a continuous dove-tail joint portion. The high heel (20) has an enlarged upper end portion with an inclined upper surface and a dove-tail locking member extends upwardly from the high heel upper end portion inclined surface, the locking member including a pedestal (30) with a dove-tail sidewall (32) that corresponds to and registers with the socket (25) so that the heel (20) can be attached to the socket (25) by moving the heel pedestal (30) into the socket into a fore to aft direction, and wherein the heel (20) is constantly loaded rearwardly during use insuring a seating of the heel (20) upon the socket (25) during use.