Showing papers on "Heel published in 1993"

Intra-articular fractures of the calcaneus. A critical analysis of results and prognostic factors.

Abstract: Forty-four patients who had had fifty-two calcaneal fractures were managed with open reduction and internal fixation. The results were reviewed retrospectively, between four and fourteen years after the operation, with use of an evaluation system for the hindfoot and with plain radiographs. The characteristics of the patients that were associated with an unsatisfactory outcome were an age of more than fifty years, a greater body weight, work involving strenuous labor, and increased time missed from work due to the injury. Other prognostic variables associated with an unsatisfactory result included subtalar incongruity, osteoarthrosis of the talonavicular joint and the ankle, an increased heel width, a decreased fibulocalcaneal space, and a decreased Bohler-angle ratio of the fractured to the normal side. The heel height, fat-pad height, arch angle, talocalcaneal angle, and length of the Achilles-tendon fulcrum were not related to the outcome. Patients who had had a tongue-type fracture had a better result than those who had had a central depression fracture, while those who had had a central depression fracture had a better outcome than those who had had a comminuted fracture. Comminution of tongue and large central-depression fractures was associated with a worse prognosis. The most common most painful area in the patients who had a satisfactory outcome was the lateral aspect of the hindfoot, while in those who had an unsatisfactory result, it was the heel pad.

The correction of complex foot deformities using Ilizarov's distraction osteotomies.

Abstract: Twenty-five very complex foot deformities were treated by Ilizarov distraction osteotomies. The osteotomy types included supramalleolar, U, V, posterior calcaneal, talocalcaneal neck, midfoot, and metatarsal osteotomies. In addition, the leg was lengthened and widened in most cases. The mean treatment time was 6.4 months. There were 20 minor or major complications related to the foot osteotomies in 18 feet, including deep pin-tract infection in three, failure of osteotomy separation in nine, acute postoperative tarsal tunnel syndrome in two, toe contractures in three, wire breakage or cutout in two, and buckle fracture in one. Nineteen secondary procedures were required in 13 patients to treat these complications. The final result was a plantigrade foot in 22 in late follow-up evaluation. The three nonplantigrade feet were attributable to unrecognized heel varus in one, ball and socket ankle joint in one, and partial growth arrest progressive deformity in one. Gait was improved in all cases. Pain was eliminated in all but two patients. Based on these criteria, the results were judged to be satisfactory in 22 and unsatisfactory in three. The Ilizarov method can successfully correct complex foot deformities despite complications.

Use of lateral heel and sole wedges in the treatment of medial osteoarthritis of the knee.

Abstract: The authors discuss the use of lateral heel wedges in the treatment of medial osteoarthritis of the knee in 121 knees in 85 patients. Follow-up was an average of 12 months after the insertion of the wedge. Patients' roentgenograms were graded according to the Ahlback classification, and various improvements were noted. Overall, 38% of patients improved to a Hospital for Special Surgery pain score of 25 or 30, which corresponds to an excellent result from total knee arthroplasty. Fifty percent of patients improved to a pain score of 20 or higher, which corresponds to a good result from total knee arthroplasty. The patients with milder osteoarthritis received greater pain relief. However, even patients with complete loss of joint space and bony erosion showed some improvement. It appears that the use of lateral wedges has a place in the conservative treatment of medial osteoarthritis.

Athletic shoe with rearfoot strike zone

Abstract: An athletic shoe has a sole with a rearfoot strike zone segmented from the remaining heel area by a line of flexion which permits articulation of the strike zone during initial heel strike of a runner. The line of flexion is located to delimit a rearfoot strike zone reflecting the heel to toe running style of the majority of the running population. In addition to allowing articulation of the rearfoot strike zone about the line of flexion, the sole incorporates cushioning elements, including a resilient gas filled bladder, to provide differential cushioning characteristics in different parts of the heel, to attenuate force applications and shock associated with heel strike, without degrading footwear stability during subsequent phases of the running cycle. The line of flexion may be formed by various means including a deep groove, a line of relatively flexible midsole material, and a relatively flexible portion of a segmented fluid bladder.

The Effect of Foot Orthotics and Gait Velocity on Lower Limb Kinematics and Temporal Events of stance

Abstract: Research on foot orthotics is primarily restricted to their effect on the lower limb during running. Research is limited, however, on the potential of foot orthotics to control the mechanics of the foot during walking. The purpose of this study was to examine the interactive effect of foot orthotics and two walking speeds on the angular changes at the rearfoot, ankle, and knee, and temporal events during stance. Ten subjects demonstrating a minimum of 3 degrees of calcaneal eversion in relaxed standing participated in the project. All subjects routinely wore functional orthotics that were used during testing in conjunction with personal athletic shoes. Individuals were tested with and without the orthotics while walking on a treadmill at 2 and 3 mph. A four-camera motion analysis system was used to capture three-dimensional motion at 60 frames per second. Angle plots illustrated changes in joint motion at the knee, ankle, and rearfoot. Temporal data for heel strike, heel rise, and toe off of the foot during the stance were calculated. A two-factor repeated analysis of variance was used to determine the main and interactive effects of the orthotic and speed on the dependent variables. When walking with the orthotic, there was a significant reduction in the degree of pronation throughout stance as well as an increase in the duration of stance time as measured from heel strike to heel rise. The orthotic did not significantly reduce the velocity of pronation during the first 20% of stance. There was a speed effect for peak dorsiflexion and knee flexion.(ABSTRACT TRUNCATED AT 250 WORDS)

Endoscopic plantar fasciotomy versus traditional heel spur surgery: a prospective study

Abstract: A comparative study of endoscopic plantar fasciotomy versus traditional type heel spur surgery has been performed involving 76 patients and 92 procedures. Sixty-six of those procedures consisted of endoscopic fasciotomy, whereas 26 involved traditional type surgery. Those patients in which the endoscopic fasciotomy was performed had significantly less postoperative pain, returned to regular activities 4 weeks earlier, and had fewer complications postoperatively than those patients involving traditional heel spur surgery. An overview of the surgical technique involving endoscopic fasciotomies is presented, as well as factors influencing the postoperative outcome, such as duration of preoperative symptoms, extent of conservative care, and obesity.

Ultrasound diagnosis of plantar fasciitis.

Abstract: There is currently no objective reliable diagnostic test for plantar fasciitis inasmuch as diagnosis cannot be made on the basis of finding a heel spur on radiography (x-ray). In this single-blind observational study, ultrasonography was used to measure plantar fascia thickness in subjects with clinically suspected plantar fasciitis and in control subjects. It was concluded that the population mean plantar fascia thickness is greater for people with plantar fasciitis than for people without heel pain (P < .0005) and that the difference is clinically significant. The ultrasonic appearance of the plantar fascia in plantar fasciitis indicated inflammatory changes.

Deformation characteristics of the heel region of the shod foot during a simulated heel strike: The effect of varying midsole hardness

Abstract: Impact tests using a pendulum were performed on the shod heel region of nine subjects. Both soft- and hard-soled shoes were used. The deformations involved were calculated from the registered decelerations during impact. Thus, load-deformation cycles were recorded for various impact velocities. In contrast to in vivo force-platform recordings, peak loadings for the soft- and hard-soled conditions differed significantly (614 +/- 29 N vs 864 +/- 49 N, respectively), thus challenging the evidence for compensation at the level of the heel pad. Moreover, computation of the compression of the heel pad in the shoe showed an unexpected inverse relationship between shoe midsole hardness and degree of heel pad compression: the harder the midsole, the smaller the compression (soft shoe 7.6 +/- 0.9 mm; hard shoe 6.7 +/- 0.9 mm). This can be explained by assuming a loading rate dependent stiffness of the heel pad in the shod condition (stiffness in N.m-1 = 51.25x (loading rate in N.s-1)0.76; R2 = 0.90), determined by the visco-elastic nature of the heel pad and the spatial confinement of the heel counter of the shoe.

Heel pain syndrome: electrodiagnostic support for nerve entrapment.

Abstract: A local entrapment neuropathy has been proposed as one of the etiologies of heel pain, but it has never been documented by electrodiagnostic studies. Primary symptoms in patients suspected of having a neurologic basis for their heel pain include neuritic medial heel pain and radiation either proximally or distally. On physical examination, all patients in our series had reproduction of their symptomatology with palpation over the proximal aspect of the abductor hallucis and/or the origin of the plantar fascia from the medial tubercle of the calcaneus. Twenty-seven patients (20 women and seven men; average age 49) with these clinical characteristics were examined by electromyography and motor/sensory/mixed nerve conduction studies. Bilateral heel signs and symptoms were present in 11 patients. Ten of the patients had a significant history of back pain with referral to the legs. In 23 of the 38 symptomatic heels, abnormalities were identified in the lateral and/or the medial plantar nerves. The number of abnormal values per heel ranged from one to four, with a mean of 2.1. The most common finding was involvement of the medial nerve (57%). Thirty percent of the heels had isolated findings in the lateral plantar nerve and 13% had abnormalities in both plantar nerves. Two patients had electrophysiologic evidence of active S1 radiculopathy, with ipsilateral evidence of plantar nerve entrapment suggesting a "double crush" syndrome. The results of this study support the presence of abnormalities of plantar nerve function in a selected group of patients with neuritic heel pain.

Reconstructive osteotomy of the calcaneus with subtalar arthrodesis for malunited calcaneal fractures : Calcaneal fractures

Abstract: A technique of dealing with the late complications of malunited calcaneal fractures is based on the philosophy of reversing the deformity associated with late complications. The primary fracture is a shearing fracture that runs obliquely down the length of the calcaneus from superolateral to inferomedial and anterolateral to posteromedial. This permits the tuberosity of the calcaneus to translate laterally and proximally, and often splits the posterior facet. The complications of malunion are loss of height of the heel with concomitant dorsiflexion of the talus, widening of the heel, lateral impingement of the peroneal tendons and the distal fibula, and subtalar posttraumatic arthritis

Reconstructive osteotomy of the calcaneus with subtalar arthrodesis for malunited calcaneal fractures

Abstract: A technique of dealing with the late complications of malunited calcaneal fractures is based on the philosophy of reversing the deformity associated with late complications. The primary fracture is a shearing fracture that runs obliquely down the length of the calcaneus from superolateral to inferomedial and anterolateral to posteromedial. This permits the tuberosity of the calcaneus to translate laterally and proximally, and often splits the posterior facet. The complications of malunion are loss of height of the heel with concomitant dorsiflexion of the talus, widening of the heel, lateral impingement of the peroneal tendons and the distal fibula, and subtalar posttraumatic arthritis. The primary fracture deformity contributes directly to the late complications. The reconstructive osteotomy recreates the primary fracture. This permits repositioning of the tuberosity that narrows the heel, alleviates impingement, and returns height to the heel. The subtalar arthrodesis alleviates the symptoms of posttraumatic arthritis. The reconstruction is not dependent on cortical bone grafts for stability. The clinical series involved ten feet with an average follow-up period of 14 months. Two were revisions of previous triple arthrodeses. Results were satisfactory in nine feet.

Pressure distribution beneath the human foot

Abstract: A descriptive study was undertaken to establish the 95 percentile limits (proposed normal reference range) for pressure beneath the hallux, metatarsal heads, and heel in a group of healthy adult subjects. A new force plate device capable of accurately measuring discrete areas of pressure beneath the human foot with high temporal and spatial resolution was used. The system is capable of accurately measuring plantar foot pressure during dynamic and static foot function. The results of this research are in close agreement with other published studies of plantar foot pressure measurement with comparable systems.

Shoe heel spring and stabilizer

Abstract: A thin, heel-sized plate formed of a composite sandwich of thermoplastic resin and carbon-glass fiber cloth has a pair of upwardly-flanged lateral edges, front and rear ends, and an integral, rearwardly-extending, upwardly-inclined, vertically-acting spring member appending from it. The device is encapsulated within the resilient material of the heel portion of the midsole of an athletic shoe such that the spring member is disposed below the calcaneus of the wearer's foot. The midsole is relieved in an area below the spring member to permit it to bend downward freely in response to heel-imparted forces. A "snubber" or stopper bushing can be molded into the outsole of the shoe to limit the maximum deflection of the spring member.

Coil spring prosthetic foot.

Abstract: A prosthetic foot (101) formed by one continuous coil spring which has a foot center coil section (117), a heel extension section (115), and a forefoot extension section (116). Lateral, medial and torsional movements are accommodated. Energy is absorbed and stored by the prosthetic foot during heel strike in the gait cycle, energy is transferred to the forefoot extension section during foot roll-forward to toe-off in the gait cycle, and energy is released to provide a propelling force on the prosthetic foot at toe-off in the gait cycle. An apparatus allowing the wearer of the prosthetic foot to feel by physical sensation forces being applied to the prosthetic foot is included in one embodiment.

Effect of heel height on forefoot loading

Abstract: Sixty feet of 30 normal subjects were investigated to determine the effect of changing the heel height on forefoot loading. Subjects walked across footplates barefoot and with rigid polyurethane heels attached to the foot with a tubular bandage. The total load on the forefoot remained unchanged at all of the heel heights, but the distribution of the load changed as the heel was raised. The area of forefoot contact with the footplates decreased and there was a deviation of load toward the medial side of the forefoot with a resultant increase in pressure. These effects could contribute to overload of the distal forefoot and especially of the first ray.

Low-profile symes foot prosthesis

Abstract: A prosthetic foot is characterized by a low-profile, elongated forefoot portion incorporating an attachment section, an arch section and a toe section, said forefoot portion being configured so that the foot may be worn by Symes-type amputees. The foot further preferably includes a heel portion secured to the forefoot portion. A preferably demountable connection of the heel portion to the forefoot portion permits interchangeability of those components to match the weight, stride and activity schedule of the wearer utilizing the prosthetic foot. Adjustment means is provided to permit adjustment and alignment of the foot with respect to the wearer's stump.

Endoscopic plantar fasciotomy: two portal endoscopic surgical techniques--clinical results of 65 procedures.

Abstract: The authors have developed two endoscopic techniques that, in their opinion, are minimally traumatic and achieve superior clinical results when compared with traditional types of heel spur surgery. From the original development of the one-portal system for endoscopic plantar fasciotomy, a two-portal system has been developed (patent pending) that provides significant advantages over the one-portal system. Postoperative morbidity was decreased with both endoscopic techniques when compared with traditional types of open heel spur surgery. Both groups of patients returned to normal activity sooner than would patients who have had their heel spur syndrome/plantar fasciitis treated with open, traditional surgery.

Soreness in lower extremities and back is reduced by use of shock absorbing heel inserts

Abstract: Soccer referees participating in large soccer tournaments may develop overuse injuries. In this study the effect of shock absorbing heel inserts in the incidence of soreness was investigated. Forty-eight referees were randomly selected to wear shock absorbing heel inserts (SAH) in the 5 day-tournament, while 43 referees were the control group. A daily questionnaire inquiring about complaints from the locomotive system was completed for each referee and in case of any soreness they were examined by doctors to document and classify the anatomical site. Calf, thigh, back, achilles tendon and knee were the most common localizations of overuse symptoms. The incidence of soreness in achilles tendon, calf and back were significantly reduced by the use of (SAH) inserts.

Open reduction and circular external fixation of intraarticular calcaneal fractures.

Abstract: Open reduction and internal fixation techniques do not allow early weight bearing. In an effort to develop a better method to obtain calcaneal fracture reduction and maintain it in the face of early weight bearing, a circular external fixator was applied to seven patients in combination with a limited lateral approach and open reduction and internal fixation of the depressed subtalar joint fragments. The operative technique uses the Ilizarov circular external fixator to obtain a ligamentotaxis reduction, following which the depressed subtalar joint fragments are elevated open; then, the fixator is used to reduce the lateral translation. All displacements of the fracture fragments are corrected. This method proved successful in six patients, all of whom achieved a satisfactory result with anatomic restoration of the subtalar joint and heel. One patient went on to late partial collapse of the posterior facet. Subtalar motion was greater than 50% in four of seven patients. None of the patients complained of heel pad pain, which was attributed to the desensitization of the heel by early weight bearing. This technique has produced encouraging preliminary results in two- to four-year follow-up evaluation.

Prosthetic food and three-way ankle joint

Abstract: A lightweight foot prosthesis is claimed, having a heel, a toe, and a raised instep, the instep including an upper surface and a lower surface, an ankle joint connected to the foot and capable of motion around each of three perpendicular axes, a pair of compression mounts for limiting rotation of the ankle joint, and a connector for connecting the ankle joint to a leg.

Adjustable foot prosthesis

Abstract: A foot prosthesis has a support part and a foot element which cooperates with the support part. The foot element includes a forefoot part which is displaceable axially along the support part. The foot element further includes a heel part which is fixed on the lower end of the support part. A setting arrangement sets the position of the forefoot part along the support part in relation to the heel part.

In vivo examination of the dynamic properties of the human heel pad

Abstract: The shock-absorbing characteristics of the heel pad in vivo were examined in adults (N = 16) and 7-year-old children (N = 5) using a drop-impact tester (wt = 5 kg). Impact velocities were 0.72 m/s and 0.93 m/s. It was found that in adults the average peak deceleration was 11.6 G at an impact velocity of 0.93 m/s. The maximum deformation of the heel pad was 11.3 mm, and the computed energy absorption during impact amounted to 79% (range = 75%-89%). These mechanical characteristics remained nearly the same even after 6 min of repeated impacts by the impact tester and even after a 10 km run. The children had larger values of peak deceleration and maximum deformation and smaller energy loss than the adults. It was concluded that the heel pad was a fairly effective shock attenuator and high energy absorber, and that these characteristics remain nearly unchanged even after a relatively long period of repeated impacts. It was also concluded that the mechanical properties of the children's heel pads were different from those of the adults.

Applications of the posterior thigh flap.

Abstract: As our population ages and spinal cord injuries continue at their present rate due to motor vehicle accidents and handgun injuries, the development of pressure sores will most likely increase in frequency. The three major populations at risk to develop pressure sores include the elderly, long-term hospital patients, and neurologically impaired patients. the posterior thigh flap evolved during our experience with the lower extremity muscle flaps. We have used 22 posterior thigh flaps in 21 patients. We have found that it is a reliable flap with a dependable blood supply that can be used in the soft tissue coverage of trochanteric, ischial, and some sacral wounds. In addition, the posterior thigh flap can be used as a pedicled flap in the management of heel and foot wounds. In this review, the anatomy and application of the posterior thigh flap are elaborated.

Reduction of plantar pressure with the rigid relief orthosis.

Abstract: The rigid relief orthosis was developed to protect vulnerable sites on the plantar surface of the insensitive foot against reulceration by providing both a nonyielding relief under the healed lesion site and a total contact fit. Clinically, the rigid relief orthosis has been effective in protecting the foot against the trauma induced by the repetitive mechanical stress of walking. This study used both the Hercules and F-Scan pressure transducer systems to measure pressure at the first metatarsal head in three orthotic treatments. Both measurement systems recorded significant reductions in pressure at the first metatarsal head with the rigid relief orthosis, establishing a quantitative rationale explaining its clinical effectiveness. Significant pressure differences were also recorded at the secondary sites of the heel, midfoot, and third metatarsal head.

Therapeutic foot orthosis

Abstract: A therapeutic device for attachment to the foot and leg of a user for alleviating and correcting foot deformities, and for maintaining the foot in a fixed, stable, yet comfortable position following surgery or other medical procedure performed on the foot. The device comprises a leg engaging portion, a foot supporting portion and a heel portion which interconnects and advantageously is integral with the leg and foot portions. The heel portion has an inner and an outer surface and a curvature such that the inner surface of the heel portion can be positioned in sufficient spaced relation to the heel of a user to prevent contact between the inner surface of the heel portion and the heel of the user thereby to eliminate any chafing, or abrasive contact, or decubitus or pain-inducing pressure between the heel of the user and the inner surface of the heel portion. The side margins of the heel portion are adapted to receive releasable fastening members for engaging the foot of a user whereby the inner surface of the heel portion will be maintained in a stable, fixed position in spaced relation to the heel of a user. A one-piece liner is secured to the inside of the device which acts to provide both optimum comfort to the user and to aid in maintaining the foot of a user in the stable, fixed position established by the releasable fastenings carried on the side margins of the heel portion.

Sandal having adjustable straps

Abstract: A sandal includes a pair of heel posts on a sole, a heel strap between the heel posts, a toe post on the sole, an adjustable toe strap, and an adjustable cinch strap attached to the toe post. The cinch strap has a longitudinal portion which extends longitudinally through a heel cinch on one of the heel posts, and a transverse instep portion which thereupon extends transversely through a heel cinch on another heel post. The adjustable toe and cinch straps ensures a secure, custom fit.

High-heeled shoe orthotic device

Abstract: An orthotic device for insertion into a high-heeled shoe is provided, which orthotic device virtually eliminates the problems associated with the wearing of high-heeled shoes, particularly pronation effects, general foot discomfort, posture problems, toe pain, and arch pain The orthotic device comprises a rigid or semi-rigid shell (28) for positioning beneath the heel (30) of the foot (40) and extending forwardly towards the toes (34) of the foot (40) The shell (28) terminates behind the five metatarsal heads (32) of the foot (40), and is shaped whereby to permit the first metatarsal head freely to evert and plantarflex under load, and is shaped such that the heel (30) of the foot (40) is carried substantially parallel to or slightly backwardly inclined relative to the ground plane