Showing papers on "Heel published in 1998"

Complications of Plantar Fascia Rupture Associated with Corticosteroid Injection

Abstract: From 1992 to 1995, 765 patients with a clinical diagnosis of plantar fasciitis were evaluated by one of the authors. Fifty-one patients were diagnosed with plantar fascia rupture, and 44 of these ruptures were associated with corticosteroid injection. The authors injected 122 of the 765 patients, resulting in 12 of the 44 plantar fascia ruptures. Subjective and objective evaluations were conducted through chart and radiographic review. Thirty-nine of these patients were evaluated at an average 27-month follow-up. Thirty patients (68%) reported a sudden onset of tearing at the heel, and 14 (32%) had a gradual onset of symptoms. In most cases the original heel pain was relieved by rupture. However, these patients subsequently developed new problems including longitudinal arch strain, lateral and dorsal midfoot strain, lateral plantar nerve dysfunction, stress fracture, hammertoe deformity, swelling, and/or antalgia. All patients exhibited diminished tension of the plantar fascia upon examination by the stretch test. Comparison of calcaneal pitch angles in the affected and uninvolved foot showed a statistically significant difference of 3.7 degrees (P = 0.0001). Treatment included NSAIDs, rest or cross-training, stretching, orthotics, and boot-brace immobilization. At an average 27-month follow-up, 50% had good/excellent scores and 50% had fair/poor scores. Recovery time was varied. Ten feet were asymptomatic by 6 months post rupture, four feet by 12 months post rupture, and 26 feet remained symptomatic 1 year post rupture. Our findings demonstrate that plantar fascia rupture after corticosteroid injection may result in long-term sequelae that are difficult to resolve.

Effective Treatment of Chronic Plantar Fasciitis with Dorsiflexion Night Splints: A Crossover Prospective Randomized Outcome Study

Abstract: Chronic plantar fasciitis frustrates patients and treating physicians. Our hypothesis was that use of a dorsiflexion night splint for 1 month would effectively treat patients with recalcitrant plantar fasciitis. A 6-month randomized crossover study included 37 patients with chronic plantar fasciitis. Patients were treated with dorsiflexion night splints for 1 month. Group A wore splints for the 1st month and group B for the 2nd month. No splints were used in either group for the final 4 months of the study. No other medications, stretching, or strengthening exercises were prescribed. Eighty-eight percent of patients who completed the study improved. Eighty percent of the involved feet improved subjectively. Results of the AOFAS Ankle-Hindfoot Rating System and the Mayo Clinical Scoring System demonstrated significant improvement for both groups during the period of splint wear. Improvements were maintained at study completion. Response to splinting did not correlate with foot type, degree of obesity, or the presence of heel spur on radiographs. We believe dorsiflexion splints provide relief from the symptoms of recalcitrant plantar fasciitis in the majority of patients.

Gait in patients with cerebellar ataxia

Abstract: The gait pattern in 10 patients with cerebellar degenerations was studied and the results were compared with 10 matched normal subjects, seeking the principal patterns in this disorder. Gait at natural speed was studied in a biomechanics laboratory using a video-based kinematic data acquisition system for measuring body movements. Patients showed a reduced step and stride length with a trend to reduced cadence. Heel off time, toe off time, and time of peak flexion of the knee in swing were all delayed. Range of motion of ankle, knee, and hip were all reduced, but only ankle range of motion reached significance. Multijoint coordination was impaired, as indicated by a relatively greater delay of plantar flexion of the ankle compared with flexion of the knee and a relatively late knee flexion compared with hip flexion at the onset of swing. The patients also showed increased variability of almost all measures. Although some of the deviations from normal were simply the result of slowness of walking, the gait pattern of patients with cerebellar degeneration shows incoordination similar to that previously described for their multijoint limb motion.

Do markers of bone resorption add to bone mineral density and ultrasonographic heel measurement for the prediction of hip fracture in elderly women? The EPIDOS prospective study.

Abstract: We have previously shown that hip bone mineral density (BMD), heel broadband ultrasound attenuation (BUA) and bone resorption markers are independent predictors of hip fracture in elderly women. We investigated whether a combination of these three parameters could improve the predictive value of a single test in a nested case-control analysis (75 hip fractures and 228 age-matched controls) of the EPIDOS prospective study comprising 7598 healthy women 75 years of age and older followed prospectively for a mean 22 months. At baseline, prior fracture, femoral neck BMD by dual-energy X-ray absorptiometry (DXA), heel BUA and urinary type I collagen C-telopeptide breakdown products (CTX) were assessed. The area under the receiver operating characteristic curve was significant for the three diagnostic tests, heel BUA being the best single predictor. The added value of urinary CTX to either BMD or BUA depends on the cutoff point chosen to define patients at risk and on the therapeutic strategy that is considered. Defining patients at risk as those with low BMD (or low BUA) or high CTX resulted in a significant increase in the sensitivity compared with BMD or BUA alone--a strategy that could be applied when a broad treatment is considered. However, this increased sensitivity was also obtained simply by increasing the BMD and BUA cutoffs, suggesting that a combination of CTX with BMD/BUA is not useful for that type of treatment strategy. Conversely, defining patients at risk as those with both low BMD and high CTX increases the specificity (88% vs 78%) with a similar number of hip fracture patients being identified (30% vs 32%)--a combination that could be useful when the strategy is to target treatment to a subset of high-risk patients. This strategy appears to be more cost-effective than bone mass measurement alone as indicated by the 37% fewer patients who need to be treated to avoid one fracture per year. If DXA or ultrasound is not available, the combination of a bone resorption marker with a history of any type of fracture after the age of 50 years gave a predictive value similar to that obtained with femoral neck BMD or heel BUA alone, for both types of treatment strategy. We conclude that the combination of urinary CTX with hip BMD could be useful for the identification of elderly women at high risk for hip fracture, resulting in higher specificity for a given sensitivity threshold than BMD measurement alone. If DXA is not available, the combination of history of fracture and urinary CTX performs as well as hip BMD to assess hip fracture risk in elderly women.

Haglund's syndrome

Abstract: Haglund's syndrome is a painful condition of the heel caused by mechanically induced inflammation of the retrocalcaneal bursa, supracalcaneal bursa, and Achilles tendon. Surgical management has included calcaneal osteotomy, but results have been unpredictable because of the inability to measure accurately bone removal. A method was devised in this study to accurately determine radiographically the amount of bone removal necessary. Sixteen heels in 13 patients underwent surgery after failing 21 months of conservative treatment. The desired osteotomy angle (preop x-rays) was compared to the actual angle obtained at surgery. A patient questionnaire, developed by the Outcome Study Committee of the AOFAS, was used to assess results. There were 13 good results and 3 failures. The average actual angle of the good results was 49° and that of the poor results was 61°. These results were statistically significant to a p = .0012. The average score obtained by the good results was 87 points, while that of the failures was 25 points. Follow-up was 42 months. The authors recommend that the osteotomy be made in such a way as to remove not only the superolateral deformity, but also to decompress the retrocalcaneal bursa and to remove the calcaneal step. In order to do so, an osteotomy angle of 49 degrees should be achieved.

Venipuncture is more effective and less painful than heel lancing for blood tests in neonates

Abstract: Objective. Heel lancing has hitherto been the method of choice for screening tests of inborn errors of metabolism in neonates. Eutectic mixture of local anesthetic has little, if any, analgesic effect when applied to the heel of pre- and full-term infants. Today there seems to be no practical method that effectively alleviates the pain caused by heel lancing. The aim of this study was to investigate whether other methods, such as venipuncture of the dorsal side of the hand, are less painful and more efficient than heel lancing in neonates. Methods. One hundred twenty healthy, full-term infants who underwent testing for phenylketonuria (PKU) were included in the study. They were randomized into three groups: a venipuncture group (VP) (n = 50), a heel-lance group with a small lancet (SL) (n = 50), or a large lancet (LL) (n = 20). Pain reactions were assessed by the Neonatal Facial Coding System (NFCS). The latency and duration of the first cry as well as the total screaming time was analyzed. The efficacy of the method was assessed by the time taken to complete the PKU test and number of times the skin had to be punctured. Results. Nociceptive response. The NFCS scores after the first skin puncture were: VP, 247; SL, 333; and LL, 460. The NFCS scores were significantly lower in the VP than in the groups subjected to heel lancing. During the first 60 seconds after skin puncture, 44% of the infants cried in the VP group, compared with 72% and 85% in the SL and LL groups, respectively. Efficacy. A successful PKU test with only one skin puncture was performed in 86% of the VP group, but in only 19% in the SL group and 40% in the LL group. The total time needed to obtain the PKU blood sample was 191 seconds (median) in the VP group, 419 seconds in the SL group, and 279 seconds in the LL group. Conclusion. Venipuncture is more effective and less painful than heel lancing for blood tests in neonates.

Randomised controlled trial of paracetamol for heel prick pain in neonates

Abstract: Aim—To evaluate the eVectiveness of paracetamol in decreasing the pain from heel prick. Methods—A prospective randomised double blind placebo controlled trial was conducted of 75 term neonates undergoing heel prick. Sixty to 90 minutes before the procedure neonates received paracetamol orally in a dose of 20 mg/kg (group 1) or an equal volume of placebo (group 2). Heel prick was performed in a standardised manner. Pain assessments were made using per cent facial action (brow bulge, eye squeeze, and nasolabial fold (range 0‐300%) and per cent of time spent crying (range 0‐100%). Results—Thirty eight neonates were enrolled in group 1 and 37 neonates in group 2. There were no significant diVerences in the demographic characteristics between groups. Mean gestational age was 39 (SD 1.4) vs 39.4 (SD 1.2) weeks, p=0.86, mean birthweight 3.45 (SD 0.45) vs 3.44 (SD 0.42) kg; p=0.31 for groups 1 and 2, respectively. Facial action pain scores did not diVer between groups (143.5 (SD 54.2)% vs 131.1 (SD 59.6)%; p=0.38). Cry scores also did not diVer (29.4 (SD 19.9)% vs 26.8 (SD 20.2)%; p=0.60). No adverse eVects were observed. Conclusion—Paracetamol is ineVective for decreasing the pain from heel prick in term neonates. (Arch Dis Child Fetal Neonatal Ed 1998;79:F209‐F211)

Biomechanical Consequences of Sequential Plantar Fascia Release

Abstract: Plantar fascia release has long been a mainstay in the surgical treatment of persistent heel pain, although its effects on the biomechanics of the foot are not well understood. With the use of cadaver specimens and digitized computer programs, the changes in the medial and lateral columns of the foot and in the transverse arch were evaluated after sequential sectioning of the plantar fascia. Complete release of the plantar fascia caused a severe drop in the medial and lateral columns of the foot, compared with release of only the medial third. Equinus rotation of the calcaneus and a drop in the cuboid indicate that strain of the plantar calcaneocuboid joint capsule and ligament is a likely cause of lateral midfoot pain after complete plantar fascia release.

Symptomatic talocalcaneal coalition resection: indications and results.

Abstract: We report our results of talocalcaneal coalition (TCC) resection in 25 feet after failed nonoperative treatment. Preoperative computed tomography (CT) scans were used to quantify the amount of heel valgus and the size of the coalition relative to the posterior facet. The ratio of mean TCC cross-sectional area to the surface area of the posterior facet was 53.4%. Mean hindfoot valgus was 17.8 degrees. The mean AOFAS (American Orthopaedic Foot and Ankle Society) hindfoot score was 81.9, at an average of 2.5 years after surgery. Statistical analysis determined a significant association between TCC > 50% the size of the posterior facet and poor outcome (p = 0.014). Similarly, heel valgus > 21 degrees was associated with poor outcome (p = 0.014). However, there were good postoperative results in feet with heel valgus > 21 degrees and in those whose TCC was > 50% of the posterior facet. Therefore we advocate using these CT-scan criteria for preoperative discussions with patients and families and not for determination of the index operative procedure (resection vs. arthrodesis). Hindfoot arthrodesis should only be used as a salvage procedure. We recommend those feet with heel valgus > 21 degrees use an orthosis postoperatively to stabilize the hindfoot or a secondary calcaneal procedure should nonoperative management fail.

Relationships between bone mass measurements and lifetime physical activity in a Swedish population.

Abstract: Lifetime occupational and leisure time activities were assessed by a questionnaire in order to evaluate their relationship to bone mass measurements and biochemical markers of bone metabolism in a population of 61 women and 61 men, randomly selected from a Swedish population register, to represent ages between 22 and 85 years. We also considered possible confounders by using questions about smoking habits, milk consumption, hormone replacement therapy (HRT), and menopausal age. Bone mineral density (BMD) and bone mineral content (bone mass, BMC) of the total body, lumbar spine, and proximal femur (neck, trochanter, Ward's triangle) were measured by dual energy X-ray absorptiometry (DXA), and BMD of the forearm with single energy X-ray absorptiometry (SXA). In addition, both DXA and SXA provided information on bone area. Quantitative ultrasound measurements (QUS) at the heel were performed to assess the speed of sound (SOS) and broadband ultrasound attenuation (BUA). Fasting blood samples were analyzed for biochemical markers of bone metabolism as well as parathyroid hormone (PTH) and total serum calcium. After adjustment for confounding factors, neither BMD nor QUS measurements were consistently related to lifetime leisure time or occupational activities; nor were there any consistent patterns relating biochemical markers of bone metabolism to bone mass measurements. However, physical activity seemed to influence bone mass, area, and width more than density. In men, high levels of leisure time activity were associated with raised values for lumbar spine area (6.2%) and width (3.3%) as well as for femoral neck area (5.5%) compared with their low activity counterpart. Men exposed to high levels of occupational activity demonstrated lower lumbar spine BMD (10.9%) and area (5.3%) than men with low activity levels. Within an unselected Swedish population, estimation of lifetime occupational and sport activities as well as bedrest, using a questionnaire, demonstrated no major effects on bone density. However, the association between high levels of lifetime activity and raised values for bone mass, area, and width indicate that geometrical changes in bone may provide better estimations of mechanically induced bone strength than bone density, at least in men.

Flexible sole with cushioned ball and/or heel regions

Abstract: A shoe sole has cushioning in ball and heel regions of the sole. The sole includes an insole which has openings in the ball and heel regions which increase the flexibility of the insole. The insole openings are filled in by a soft insole pad so that the insole does not form a barrier to cushioning the ball and heel of the foot. The outsole also has openings in ball and heel regions which are closed by clear covers. The openings provide for good flexibility of the outsole. A soft cushion is held in the cover for further cushioning of the ball and heel of the foot.

The effect of increased weight on peak pressures: implications for obesity and diabetic foot pathology.

Abstract: The purpose of this study was to determine if increased weight contributes to increased mean peak plantar foot pressures when foot function, deformity, and structure are controlled. Ten male and nine female volunteers without sensory neuropathy or other systemic disease were evaluated in the study. Using a repeated measures design, peak plantar foot pressures were compared using the Novel Pedar in-shoe pressure measurement system under three conditions. Baseline measurements were made while volunteers wore the standard test footwear, a thin-soled rubber oxford sneaker. The second and third test conditions involved pressure measurements with an additional 9.1 kg (20 lb) and 18.2 kg (401b), respectively, of weight evenly distributed in pockets on the front and back of a workout vest. There was a significant increase in mean peak plantar foot pressures under the metatarsal heads, heel, and midfoot for each incremental increase of weight (baseline vs. 9.1 kg, p

The distally based sural artery flap.

Abstract: The sural artery flap is a distally based fasciocutaneous flap. It is based on a reverse flow through anastomoses between the peroneal artery and the communicating vascular network of the medial sural nerve. In the difficult area of defects in the lower leg and the ankle and heel region, it has a wide variety of indications, even in vascularly compromised patients. It has the largest arc of rotation of all flaps that have been described in this region. The most important advantage is that it does not compromise a major artery. Furthermore, it is simple to dissect and has a low donor morbidity. A series of 15 patients is described in which we covered defects in the lower leg, malleolar, and heel regions. Seven patients were vascularly compromised seriously. Twelve flaps survived completely, two survived partially, and one flap failed.

Ultrasound guided injection of recalcitrant plantar fasciitis

Abstract: OBJECTIVE To determine the effect of ultrasound guided injection in recalcitrant idiopathic plantar fasciitis. METHODS Four patients with a clinical diagnosis of idiopathic plantar fasciitis, who were unresponsive to palpation guided injection with triamcinolone acetonide and local anaesthetic, underwent ultrasonographic examination of the heel. RESULTS The following ultrasonographic features were noted:- (a) increased thickness of plantar fascia in symptomatic heels compared with asymptomatic heels, (b) loss of distinction of the distal plantar fascia borders, (c) reduced echogenicity of the plantar fascia. Ultrasound guided injection of the enlarged, hypoechoic plantar fascia resulted in complete relief in four of five heels(mean duration of follow up=24 months) in three cases. One patient developed a recurrence of symptoms after six months. CONCLUSION Ultrasound allows for confirmation of the clinical diagnosis and ultrasound guided injection produces a good clinical response when unguided injection is unsuccessful. The technique is quick, inexpensive, and entails no radiation exposure.

Early Active Motion and Weightbearing After Cross-Stitch Achilles Tendon Repair

Abstract: Twenty-two closed Achilles tendon ruptures caused by sports injuries in 22 patients (average age, 37.6 years) were repaired with Kirschmayer core suture and cross-stitch epitenon suture, and early active ankle motion with weightbearing was implemented after surgery. This study was undertaken to evaluate the effectiveness of the repair technique and rehabilitation protocol by assessing clinical results and magnetic resonance imaging findings. The follow-up period averaged 24.6 months. Twenty of the tendons (91%) healed without rerupture, and two tendons (9%) suffered a partial rerupture at 23 and 56 days, respectively. Active ankle extension reached from the minus range to 0 degree in an average of 9.7 days, and ankle motion recovered to normal in an average of 6.0 weeks. Full weightbearing without heel raising became possible in an average of 16.4 days, and heel raising with both legs became possible in an average of 7.3 weeks. The patients returned to full sports activity in 13.1 weeks. The interval until the area of high-intensity signal at the tendon repair site on T2-weighted magnetic resonance imaging scans became intermediate-intensity signal averaged 6.9 weeks, and the tendon repair site became low-intensity signal in an average of 12.6 weeks, demonstrating excellent tendon healing. Treatment employing Kirschmayer core suture and cross-stitch epitenon suture may help athletes return to sports activity in a shorter period than that allowed by previous methods of repair for Achilles tendon ruptures.

Reversibility of Joint Thickening in Acromegalic Patients: An Ultrasonography Study

Abstract: Axial and peripheral arthropathy affects the majority of patients with acromegaly, being a leading cause of morbidity and functional disability. Treatment with octreotide (OCT) improves symptoms and signs of acromegalic arthropathy, but objective detection of structural changes in bone and cartilage has not been reported to date. This open prospective study was designed to evaluate the effect of a long term treatment with OCT on acromegalic arthropathy assessed by ultrasonography examination. Articular cartilage thicknesses of shoulder, wrist, and knee as well as sizes of heel tendons were measured in 30 acromegalic patients (18 with active and 12 with inactive disease) and 18 sex-, age-, and body mass index-matched healthy subjects. The thicknesses of shoulder, wrists and knees articular cartilages and that of heel tendons were significantly increased in patients with active acromegaly compared to those in healthy subjects (P < 0.01). With the exception of shoulder cartilage, significant increases in wrist and knee cartilages (P < 0.01) and right and left heel tendon sizes (P < 0.05) were found in patients with active compared to those with inactive disease. After 6 months of OCT treatment, a significant decrease in shoulder, wrist, and left knee articular cartilage was found (P < 0.001). No significant change was recorded in right knee cartilage or heel tendon size. The decrease in thickness of shoulder and wrist cartilages was more pronounced than that measured at the level of left knee (26.3 +/- 3.3% and 27.2 +/- 4.2% vs. 14.2 +/- 4.2%, respectively; P < 0.05). Ultrasonography is able to reveal articular involvement in acromegalic patients and may be useful to monitor the effect of treatment.

Total calcanectomy for the treatment of chronic calcaneal osteomyelitis.

Abstract: The purpose of this study is to present the surgical and functional results of a total calcanectomy procedure as a foot salvage alternative in patients with extensive chronic osteomyelitis of the calcaneus. A retrospective review identified eight patients treated with a total calcanectomy for a chronic nonhealing plantar ulcer of the heel and osteomyelitis of the calcaneus. The primary diagnosis was insulin-dependent diabetes mellitus (six patients), pneumococcal septicemia (one patient), and an open calcaneal fracture (one patient). The average age of the patients was 52 years. Prior procedures included irrigation and debridement of the heel ulcer (seven patients), partial calcanectomy (three patients), and split thickness skin grafting (two patients). The vascular status of each limb was assessed preoperatively. Distal extremity bypass surgery was performed on two patients before calcanectomy. Osteomyelitis of the calcaneus was diagnosed by magnetic resonance imaging alone in three patients, and by technetium/indium scans and magnetic resonance imaging in five patients. The average follow-up duration was 27.3 months (range, 6-57 months). Infection at the plantar heel was controlled in all patients. In all eight cases the incisions were closed primarily. During a prolonged time of total contact casting to facilitate wound healing, one patient developed an anterior tibial ulcer that progressed to osteomyelitis and underwent below-knee amputation. Talonavicular subluxation occurred as a late complication in one patient. This was treated with a talonavicular arthrodesis and subsequent bracing for a nonunion. An assessment of functional ambulation was performed on all eight patients. Four patients maintained the same ambulation level postoperatively in a modified heel-containment orthosis. Two patients decreased one functional ambulation level, and one patient decreased two levels. One patient underwent below-knee amputation and is currently ambulatory with a prothesis. Assessment of ankle strength and range of motion of the surgical limb demonstrated decreased dorsiflexion and plantarflexion strength and a variable range of motion compared to the contralateral limb. Total calcanectomy is an alternative procedure to transtibial amputation in patients with chronic osteomyelitis of the calcaneus. Eradication of infection and preservation of the functional ambulation is achieved.

Percutaneous plantar fasciotomy : A minimally invasive procedure for recalcitrant plantar fasciitis

Abstract: A retrospective study was done to evaluate patient pain level and satisfaction after a percutaneous plantar fasciotomy. Between 1990 and 1996, 51 patients underwent percutaneous plantar fasciotomy for chronic plantar fasciitis associated with heel pain syndrome. All patients had undergone at least 6 months of conservative therapy. A questionnaire incorporating a visual analog pain scale was used to determine the effectiveness and patient satisfaction of the procedure. Of 35 patients who responded to the questionnaire, 27 were female and eight were male, ranging in age from 31 to 76 years with an average age of 47 years. Follow-up time after surgery ranged from 12 to 57 months, with an average of 34 months. Utilizing a visual analog pain scale, results showed a preoperative pain level of 8.7 (±1.2) with a range of 6–10. Pain level at follow-up was 2.1 (±2.7) with a range of 0–10. Eighty-three percent of the patients stated that the procedure met or exceeded their expectations. Percutaneous plantar fasciotomy is a simple and cost-effective method for surgical intervention of chronic heel pain syndrome. Complications are rare and the results compare favorably with other reported more invasive and costly techniques.

A method of dynamic foot-pressure measurement for the evaluation of pediatric orthopaedic foot deformities.

Abstract: Dynamic foot-pressure measurements are time-sensitive measurements of the pressures under the foot while walking. Historically, many methods are used to measure these pressures; however, current medical literature does not contain a method suitable for the evaluation of pediatric orthopaedic foot deformities. A method for the measurement of dynamic foot pressure for the treatment of pediatric orthopaedic foot deformities was defined in this study. We established the dynamic foot-pressure pattern of a normal population using this method. Dynamic foot-pressure measurements were collected from 54 normal subjects (108 feet). These measurements were divided into the following five segments: the heel, the lateral midfoot, the medial midfoot, the lateral forefoot, and the medial forefoot. Standard tables and graphs were created describing the normal progression of pressure across each segment of the foot while walking. These standard tables and graphs can be used as a reference with which clinical measurements can be compared. This method may be useful as a diagnostic measure of foot deformities and may increase the clinician's ability to measure changes in foot deformity resulting from treatment intervention.

Prosthetic foot assembly having improved resilient cushions and components

Abstract: A prosthetic foot assembly (20) includes an ankle member (22), a heel member (24) pivotally connected to the ankle member, an elongate metatarsal toe member (26) pivotally connected to the heel member, having a rear portion underlying a forward portion of the heel member, and projecting forwardly from the heel member. A first compressible element (32) is engaged between a portion of the ankle member, and a portion of the heel member. A second compressible element (34, 120) having first, and second substantially circular bearing surfaces (122, 124), is engaged between the heel member, and the metatarsal toe member to resist upward pivotal movement of a forward end of the metatarsal toe member relative to the heel member. A portion (126) of the compressible element spaced apart from one of the bearing surfaces has a smaller diameter than the diameter of at least one of the bearing surfaces. Noise abatement features include surface treatments, and modified compressible elements.

Late results of subtalar distraction fusion.

Abstract: Between 1990 and 1994, 15 subtalar distraction fusions were performed on 14 patients for sequelae of calcaneus fractures Twelve patients (13 feet) were available for a minimum 2-year follow-up and constituted the composition of this study All patients complained of lateral ankle pain and had CT evidence of calcaneofibular abutment and radiographic evidence of loss of heel height preoperatively The average age at time of surgery was 56 years (range, 23–81 years), and the average follow-up was 47 months (range, 25–75 months) The only change in surgical technique from that previously described was the use of a bone spreader rather than a femoral distractor for distraction of the subtalar joint The average preoperative talocalcaneal angle improved from 27° (range, 19–37°) to 33° (range, 23–45°) postoperatively (P < 0003) The mean talar declination angle improved from 11° (range, 6–18°) to 16° (range, 7–27°) postoperatively (P < 0003) The mean heel height increased from 71 mm (range, 60–83 mm) to 76 m

Plantar Fasciitis/Calcaneal Spur among Security Forces Personnel

Abstract: A prospective single survey was conducted among Security Forces personnel at the Mobile Hospital, Ministry of Interior, Makkah Al-Mukarramah, Saudi Arabia. One hundred three patients presented to the orthopedic clinic with painful heel. A control group of patients from the other clinics without painful heel was also screened. The average age was 38.81 years and 38.1 years in the patient and the control group, respectively. The mean Quetelet index of body mass in the patient group was 30.36 kg/m2 and in the control group it was 26.71 kg/m2. There was a statistically significant difference of p < 0.05 between the two groups for Quetelet index of body mass. The right side was affected in 37 patients, the left side was involved in 45 patients, and 21 patients had pain bilaterally. Seventy-one patients had spur on the calcaneum. The prevalence of painful heel attributable to plantar fasciitis/calcaneum spur was 1.18%. This study suggests that obesity is a cause and initiator of heel pain and plantar fasciitis/calcaneal spur and that improper footwear aggravates the condition.

Entrapment Neuropathy: The Etiology of Intractable Chronic Heel Pain Syndrome

Abstract: Chronic heel pain syndrome (CHPS) is a common clinical entity. The etiology of CHPS has never been completely defined and there are no clear treatment regimens in the literature. Most authors agree that nonoperative treatment is effective in most patients. However, in 5%-10% of patients, operative intervention is required. Outcomes for these patients have been inconsistent. A series of 51 patients with intractable CHPS who were diagnosed with an entrapment of the posterior tibial nerve and its terminal branches is presented. Descriptive statistics were obtained for the demographic data and pre and postsurgical start-up and standing pain visual analog scale (VAS) scoring. Statistical testing of the VAS mean scores was performed using a paired t-test at the 0.01 level of significance. Pre- and postsurgical start-up and pre- and postsurgical standing pain VAS means were significantly different from each other (t = 19.6, p = .001 and t = 19.4, p = .001, respectively). Based on subjective and objective criteria, 96% of the patients experienced significant improvement and 90% reported completed resolution of heel pain. The presence of tarsal tunnel syndrome in all 51 patients strongly suggests entrapment neuropathy as the etiology of intractable CHPS.

Standup exercise apparatus with pedal articulation

Abstract: A standup exercise apparatus simulates walking and jogging with arm exercise. Foot pedals move with heel and toe curves inclined in opposing directions. The pedals incline with the toe above the heel during the latter portion of forward movement of the foot while the heel inclines above the toe during the latter portion of rearward movement of the foot. Foot pedals move with smooth elliptical motion resulting from a linkage mechanism guiding one foot support member pivot and a rocker link to support the other foot support member pivot. The pedal is is pivoted to one end of the foot support member and articulates the pedal angle separately from the foot support member. Leg joint impact is controlled to be very low as to allow extended exercise without joint soreness. Arm exercise is coordinated with motion of the feet.

Rearfoot-Forefoot Orientation and Traumatic Risk for Runners

Abstract: Factors making runners more susceptible to injuries were identified with a comparative study between a healthy control group (216) and runners (66) suffering from overuse pathology On static and dynamic footprint, the angles α0 (static) and α1 (dynamic) between heel and forefoot have been measured Analysis showed that the injured subjects have a more pronated foot than control group subjects These results suggest that the pronating foot configuration would be an injury risk factor

Instructional Course Lectures, The American Academy of Orthopaedic Surgeons - Disorders of the Insertion of the Achilles Tendon and Achilles Tendinitis*†

Abstract: Because of its size and unique functional anatomy, the Achilles tendon is susceptible to both acute and chronic injury. This paper addresses some of these injuries, including the various forms of tendinitis as well as the various pain syndromes of the retrocalcaneal space, such as retrocalcaneal bursitis and Haglund deformity. The Achilles tendon is the continuation of the triceps surae, which originates from the medial and lateral femoral condyles as the two heads of the gastrocnemius and continues as the gastrocnemius blends with the soleus distally. The Achilles tendon inserts onto the middle third of the posterior tuberosity of the calcaneus. At the bone-tendon junction, the enthesis is composed of calcified and noncalcified cartilage. Paratenon surrounds the tendon and is able to stretch two to three centimeters with movement of the tendon, thereby allowing the Achilles tendon to glide smoothly. The tendon is vascularized by anterior muscular branches as well as osseous and periosteal vessels near the site of insertion. Although there is both a proximal and a distal intratendinous vascular supply, there are considerably fewer vessels four centimeters proximal to the calcaneus than anywhere else in the tendon5,27,44. Thus, the region of the tendon three to five centimeters proximal to the insertion is a relatively avascular zone and is the area most prone to various pathological problems, including chronic tendinitis and rupture. It is assumed that this hypovascularity is one of the causes of rupture. The anatomical structures that make up the posterior aspect of the heel are the Achilles tendon, the posterior aspect of the calcaneus, the retrocalcaneal bursa, and the pretendinous bursa. The retrocalcaneal bursa lies anterior to the posterosuperior calcaneal tuberosity and lubricates the anterior aspect of the tendon as well as the superior aspect of the calcaneus14. …