Showing papers on "Heel published in 1992"

The effect of callus removal on dynamic plantar foot pressures in diabetic patients.

Abstract: Clinical observation suggests that neuropathic foot ulceration frequently occurs beneath plantar callosities and in areas of high dynamic shear and vertical stress underneath the foot during walking. Seventeen diabetic patients had dynamic foot pressure measurements made before and after the removal of a total of 43 forefoot plantar callosities. Peak pressures (mean +/- SE) in the treated areas were reduced by 26% from 14.2 +/- 1.0 to 10.3 +/- 0.9 kg cm-2 (p less than 0.001), with reductions at 37 of the 43 sites and in all patients. Mean heel pressures were not significantly different (5.0 +/- 0.6 vs 4.9 +/- 0.6 kg cm-2). These results suggest that callus may act as a foreign body elevating plantar pressures and that a significant reduction in pressure is achieved by local chiropody treatment.

Plantar Fasciotomy for Intractable Plantar Fasciitis: Clinical Results and Biomechanical Evaluation*:

Abstract: Thirteen consecutive patients underwent plantar fasciotomy in 16 feet for intractable plantar fasciitis and had follow-up from 4.5 to 15 years. Plantar fasciotomy was successful (good or excellent results) for 71% of the 14 feet operated on and for which follow-up data were available. However, time to full recovery was prolonged, additional treatment was frequently required, and abnormalities of foot function persisted. Flattening of the longitudinal arch occurred. Dynamic force-plate studies showed differences in peak vertical, fore-aft, and lateral-medial forces between patients and matched controls. More rapid progression of weightbearing along the longitudinal axis of the foot during stance phase in patients indicated avoidance of heel loading.

Treatment of chronic heel pain by surgical release of the first branch of the lateral plantar nerve.

Abstract: Sixty-nine heels (53 patients) with chronic heel pain had a surgical release of the first branch of the lateral plantar nerve. The average duration of heel-pain symptoms was 23 months (range, six months to eight years). No patient had less than six months of conservative treatment before surgery. The average duration of preoperative conservative treatment was 14 months. Forty-four patients (83%) had taken nonsteroidal antiinflammatory agents. Sixty-three heels (91%) had used heel cups and/or orthoses. Fifty-nine heels (86%) had received one or more injections of a steroid preparation. Thirty-four heels had developed pain initially during a sports activity. Postoperatively, 61 heels (89%) had excellent or good results; 57 heels (83%) had complete resolution of pain. The average follow-up period was 49 months. In general, heel pain resolves with conservative treatment. In recalcitrant cases, however, entrapment of the first branch lateral plantar nerve should be suspected. Surgical release of this nerve can be expected to provide excellent relief of pain and facilitate return to normal activity.

A method for measuring foot pressures using a high resolution, computerized insole sensor: the effect of heel wedges on plantar pressure distribution and center of force

Abstract: A new, high resolution, pressure-sensitive insole was tested and found to provide reproducible measurements of static and dynamic plantar pressures inside the shoe of normal test subjects under certain conditions. However, calibration between separate sensors was poor and the sensor pads showed significant wear with use. This system was also used to investigate the effect of heel wedges on plantar foot pressure to determine whether this system was sensitive enough to detect the effect of a gross shoe modification on plantar foot pressure. Medial heel wedges decreased plantar pressures under the first and second metatarsals as well as under the first toe, and shifted the center of force laterally in all portions of the foot. Lateral heel wedges decreased pressures under the third, fourth, and fifth metatarsals, increased pressures under the first and second metatarsals, and shifted the center of force medially in all portions of the foot. Our evaluations indicate that it is possible to measure static and dynamic plantar foot pressures within shoes and to study the possible effect of shoe modifications on plantar pressures in controlled gait trials.

The effects of wearing high heeled shoes on pedal pressure in women.

Abstract: The purpose of this study was to investigate the effects of increased heel height in women's shoes on foot pressure during walking. An increase in heel height increased the maximum peak pressure under the metatarsal heads in the forefoot, decreased the time to maximum peak pressure under the metatarsal heads, and increased the rate of loading to the metatarsals during early support. The higher pressures noted with increased heel height were accompanied by a more uniform distribution of pressure beneath the forefoot. These findings may denote increased stress to the various tissues in the foot when walking in high heeled shoes, which may contribute to deleterious orthopaedic changes. Quantitative studies need to be conducted to determine whether orthopaedic changes occur with prolonged wearing of high heeled shoes.

Partial calcanectomy for the treatment of large ulcerations of the heel and calcaneal osteomyelitis. An amputation of the back of the foot.

Abstract: Twelve patients who had a large ulceration over the heel were managed with a partial calcanectomy, in lieu of a below-the-knee amputation, after unsuccessful non-operative treatment of the ulcer. Only patients who had an ankle-arm index (the ratio of blood pressure at the ankle to the brachial blood pressure) of more than 0.45, a transcutaneous PO2 of more than twenty-eight millimeters of mercury (3.7 kilopascals), a level of albumin of more than 3.0 grams per deciliter (thirty grams per liter), and a total lymphocyte count of more than 1500 were managed with a partial calcanectomy. The primary diagnosis was diabetes in seven patients, peripheral vascular disease in three, quadriplegia in one, and myelodysplasia in one. The duration of follow-up averaged thirty-three months and ranged from seven to sixty-four months. The wound healed after the partial calcanectomy in ten of the twelve patients. Nine of these ten patients maintained the level of mobility that they had had preoperatively. (One patient was unable to walk because he was quadriplegic before the operation). The wound did not heal in two patients, and those patients ultimately had a below-the-knee amputation and a decrease of one grade on the scale that was used to evaluate walking ability.

The movement of the heel within a running shoe

Abstract: Most running shoe investigations have used the same standard procedure for the evaluation of the shoes: the runners are filmed from behind and a film analysis is carried out digitizing markers at the heel counter of the shoe and on the lower leg. The angular displacement of these markers relative to the horizontal or the vertical is assumed to be an indicator for various sports injuries. The goal of this investigation was to measure the movement of the heel counter as well as the movement of the heel inside the shoe. First, the influence of the size of different heel counter windows was controlled and found negligible for the test conditions of this study. Second, 15 subjects performed the following procedure: running (a) barefoot, (b) with shoes with windows, and (c) without windows. Overall, the heel was found to move similarly but not identically to the heel counter. The maximum change of pronation was (a) 13.7 +/- 3.7 degrees, barefoot; (b) 14.1 +/- 3.8 degrees for the shoe with windows and 12.1 +/- 3.7 degrees for the heel inside these shoes; and 14.9 +/- 4.2 degrees for the shoes with no windows. To achieve a general impression of a shoe in the sense of a qualitative description, the previous method without heel counter windows still seems adequate. However, for a detailed analysis of quantitative nature, it is important to use the method with heel counter windows.

Investigations into the fat pads of the sole of the foot: heel pressure studies.

Abstract: The fat pads of the heel have a structure that is optimized for load bearing In various diseases and aging, the load-carrying ability of the heel pad is clinically impaired The loading pattern was examined in subjects having normal heel pads and those with atrophic heel pads, both with and without clinical symptoms Normal heel pads showed a broad region of high pressure, which accounted for a high percentage of the total load transmission In contrast, the atrophic heels showed a high but narrow peak pressure However, most of the load was transmitted over a large area of low pressure There was no difference between symptomatic and asymptomatic heels The mechanical behavior of the fat pad is discussed with particular reference to the anatomic structure of the pads Pad thickness and septal integrity are both important to the mechanical characteristics of the fat pad The load-bearing patterns observed are discussed in terms of the mechanical components influencing fat pad resilience These results have direct relevance to understanding the pathophysiology of heel pain secondary to degeneration of the fat pad

The medial heel skive technique. Improving pronation control in foot orthoses.

Abstract: A new method of foot orthosis modification that enhances the pronation controlling ability of foot orthoses is presented. The medial heel skive technique involves selectively removing small amounts of the medial portion of the plantar heel of the positive cast of the foot to create a unique varus wedging effect within the heel cup of the foot orthosis. The resulting increase in supination moment across the subtalar joint axis of the foot clinically produces significantly improved pronation control on pediatric flexible flat feet, posterior tibial dysfunction, and other types of excessively pronated feet.

Foot securing device particularly for trekking boots

Abstract: Foot securing device, particularly usable in trekking boots, including a traction element which has a first portion which embraces the upper heel and malleolar region and a second portion which is curved at the foot instep region and defines grip loops for laces. The device furthermore includes a third portion which passes below approximately the median region of the sole of the foot. The device allows, once the boot has been closed, to optimally support the foot while walking, since the foot is secured in the regions overlying the heel and the foot instep.

Anterior dorsal ankle foot orthoses

Abstract: An orthopedic brace for foot drop and similar conditions utilizes an anterior dorsal ankle foot orthoses having an anterior support adapted to be placed against the shin of the leg and strapped to the leg at a point below the knee. The lower end of the orthoses terminates in a yoke at the dorsal portion of the foot, the yoke having lateral side members adapted to be placed on either side of the foot for supporting a foot pad. The foot pad supports the foot from the heel to the ball. The ankle/foot orthoses may be placed in standard footwear, reducing the visibility of the brace to the observer.

Heel movement within a court shoe.

Abstract: Lateral movements of the leg and foot were filmed from behind to evaluate court shoes. Inversion/eversion may be an indicator of potential injuries, but estimates of actual inversion/eversion have typically been measured as the angular displacement of marker pairs on the lower leg and on the shoe. The purpose of this study was to measure the shoe movement versus the heel movement inside the shoe in order to determine the appropriateness of using shoe markers to represent the heel position. Two windows were cut into the heel counter of the shoe to show the heel position in addition to shoe position. The subjects were filmed from behind during a lateral side-stepping movement. The difference between the shoe and heel position was [corrected] statistically significant. The average maximum change in heel inversion inside the shoe was 13.3 +/- 3.8 degrees, compared with 30.7 +/- 6.2 degrees for the shoe. In addition, the maximum change in heel inversion in a barefoot movement was 10.1 +/- 3.1 degrees. The results suggest that for a lateral movement shoe markers do not accurately represent the position of the heel, and heel movement inside a shoe is similar to a barefoot movement. Skin markers on the heel as observed through windows in the shoe give a better indication of the actual position of the calcaneus than do markers placed directly on the shoe.

Retrospective analysis of calcaneal spur removal and complete fascial release for the treatment of chronic heel pain.

Abstract: Doctors Gormley and Kuwada investigate the pathology of chronic heel pain secondary to soft tissue and osseous inflammatory conditions. Pertinent literature review regarding success following fascial release as well as bone spur removal is provided. Ninety-four patients are reported having sustained spur removal with fascia resection according to the authors' technique. They report a 95% success rate postoperatively.

Ankle brace with bubble cushioning

Abstract: An ankle brace for protecting and exercising an injured ankle includes a heel portion, inner and outer pivot legs, and padding which lies between the wearer's leg and the brace

Highly resilient EVA shoe insole

Abstract: The present invention pertains to a resilient shoe insole. The shoe insole is comprised of a resilient material having sufficient thickness in the heel and forefoot region to allow the resilient material to act as a spring, thereby absorbing the impact of a foot and then returning at least 70% of absorbed energy to the foot thereon and providing increased lift and response to the foot and reduced O 2 demand in running relative to other insoles for a given activity. In a preferred embodiment, the shoe insole has a heel portion and a forefoot portion, wherein the heel portion is thicker than the forefoot portion. The heel portion is at least 3/8 inch thick and the forefoot portion is at least 1/4 inch thick. In another embodiment, the base is comprised of multiple laminations of the resilient material. In another preferred embodiment, the shoe insole is comprised of a wedge-shaped heel pad comprised of a resilient material which absorbs the maximum impact of the heel of the foot and then returns 70% of absorbed energy to the heel; the heel pad is adapted to fit under a standard sockliner of an athletic shoe and is at least 3/8 inch thick. The heel pad is wedge-shaped with at least an 8° taper such that each step causes the foot to be thrust forward.

Shoe construction having improved backpart fit

Abstract: A device which functions to improve the fit of shoes is described whereby the shoe is urged forward on the foot by means of an elastic member to minimize slippage of the backpart of the shoe relative to the heel of the wearer's foot.

Calcaneal fracture after cortical bone removal.

Abstract: Four patients developed calcaneal fractures while walking, soon after bone removal from the undersurface of the calcaneus. Heel spur or osteomyelitic bone removal can lead to this complication.

Plantar fasciotomy surgical procedure

Abstract: A new surgical technique, the Barrett-Day endoscopic plantar fasciotomy procedure, is used to relieve the symptoms of heel spur syndrome. The positioning of the plantar fascia ligament is determined, and the patient is prepared for surgery. A small, vertical incision is made in the medial side of the foot, and the adipose tissue is spread. A fascial elevator is inserted into the first incision to separate the plantar fascia from the surrounding tissue, creating a channel. A slotted canula and trocar is inserted into the channel, and a second incision is made on the lateral side of the foot, allowing the canula and trocar to substantially pierce the foot. The trocar is removed, and an endoscope is inserted into the canula through the medial portal. A cutting instrument is inserted into the lateral portal of the canula, and is used to release the plantar fascia from the heel bone. Once the plantar fascia has been released from the heel bone, the instruments are removed, and a bandage is placed around heel. The procedure allows the patient to immediately bear weight on the heel after the operation is complete.

Prosthesis with a monobloc framework for leg amputation and method for producing this prosthesis

Abstract: The invention relates to a prosthesis for a leg amputee, comprising a thermoformed framework made of a thermoplastic material or of a laminated substance, covered with a coating material and comprising a socket (1), a leg part (2) and a prosthetic foot (3), one adjoining the other According to the invention, the framework of the leg part (2) and the prosthetic foot (3) constitutes a monobloc assembly, produced in a single casting operation, and in that the prosthetic foot comprises, at the level of the sole, a cut having served for the extraction of the molding core and, at the level of the heel, above the sole, a cut (9) of wedge formation lending itself to a flexion of the rear of the sole relative to the leg part

Custom foot beds for footwear

Abstract: Custom molded foot beds position the feet in balanced positions A balanced foot position represents a referenced neutral foot position compensated for an individual's particular lower body anatomy The foot beds and the apparatus and method for making the foot beds produce a balanced position by applying forces to the foot First forces move the foot toward the referenced neutral position by a first foam block located under the forefoot lateral column A composite foam block produces a rolling force in the rear foot to move the subtalar joint toward alignment Other forces provide anatomical compensation including forces that elevate the heel and cup fatty tissue around the heel Other forces support the remainder of the foot in this balanced position

Operative treatment of plantar fasciitis.

Abstract: Ten patients undergoing 12 fasciotomy by stripping the plantar fascia and superficial plantar muscles from the calcaneus have been reviewed for an average of 24.9 months after the operation. All patients failed to respond to conservative treatment by anti-inflammatory medication, heel pads and local steroid injections for a duration of 6 months to 3 years (average 15 months). There were 7 females and 3 males. Their work was of a light nature and none of them were professional athletes. The results indicated 91.6 per cent excellent, 8.4 per cent good and no failure. Complete pain relief at rest and walking was obtained in 11 of 12 for an average of 11.75 months (from 8 months to 18 months) after surgery. There was only 1 of 12 who had mild pain at walking that did not impair activity. All patients could return to their jobs about 4-6 weeks after surgery. Bloodless operation (under tourniquet control) was performed under general anaesthesia.

Articulated ankle joint with inner and outer races for universal movement

Abstract: An artifical ankle joint for use as an ankle between a foot prosthesis and leg prosthesis in an artificial limb. The artificial ankle joint includes a foot plate attached to a foot prosthesis, a leg plate attached to a leg prosthesis, a stem assembly and bearing assembly connected between the plates in which the bearing is a spherical bearing oriented vertically and including an inner race connected to the leg plate about an axis generally horizontal when the ankle joint is in use and an outer race connected with the stem assembly. Resilient structure extends between the plates for providing a degree of resistance to relative movement of the plates and includes a heel spring enclosing the stem assembly and a toe spring spaced from the heel spring with both the toe and heel springs extending between the plates. The stem includes a unitary or two piece unit anchored to the foot plate at one end and including a vertically disposed spherical bearing assembly connected to the leg plate at its other end to enable relative pivotal movement of the foot prosthesis in any angular direction with respect to the leg prosthesis and enabling limited swivelling movement of the foot prosthesis in relation to the leg prosthesis. This enables the articulated ankle to closely simulate all movement capabilities of a natural ankle.

Contoured ankle brace and stabilizer

Abstract: In an orthopedic device as a flexible contoured ankle stabilizer having a generally U-shaped "stirrup" member having a base portion and a pair of removably attachable opposed contoured vertical shells with a compressible medium disposed interiorly of the opposed contoured shells, the improvement wherein each of the opposed contoured shells has a heel bone extension protruding generally along and toward the back of the ankle in the vicinity of the heel; wrapping straps used to hold the contoured shells with heel extensions and attached stirrup base in place on the ankle and heel.

Plantar fasciitis-heel pain in athletes.

Abstract: Plantar fasciitis is the most frequent hind foot problem that affects runners. It occurs when repetitive stress is placed on the heel from a chronic or acute condition. Athletes with biomechanical imbalances are most susceptible to this condition. They exhibit pain in the morning upon weight bearing and, frequently, in the acute stage, have discoloration of the injured area. Management includes preventive and therapeutic exercise, physical therapy, strengthening routines, taping, and the use of orthotics and non-steroidal anti-inflammatory drugs (NSAIDs). Although injections and NSAIDs bring relief, their effects are often only temporary. This condition is best treated with therapeutic exercises and orthotics in order to correct the athlete's biomechanical faults. This article presents principles and techniques that can be used to effectively prevent and treat plantar fasciitis.