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Sample records for chronic plantar heel

  1. Proximal plantar fibroma as an etiology of recalcitrant plantar heel pain.

    PubMed

    Hafner, Shaun; Han, Nancy; Pressman, Martin M; Wallace, Christopher

    2011-01-01

    Prompted by repeated pathology reports of fibromas at the origin of the plantar fascia after fasciectomy for chronic plantar heel pain, this study examined the incidence of proximal plantar fibroma. A retrospective study of 100 pathology specimens from 97 patients with the preoperative diagnosis of recalcitrant plantar fasciitis was performed. Patients ranged in age from 36 to 82, and included 31 males and 66 females. The specimens consisted of medial and central bands of the fascia obtained from transverse plantar fasciectomies. The fasciectomies were performed by 4 surgeons between July 1994 and March 2008. One quarter of the cases studied had a histological appearance of plantar fibroma. This new finding has not been reported in any literature in connection with recalcitrant heel pain. Histologic findings of the specimens were placed into 3 groups: neoplastic involvement (25%, 21 female and 6 male), inflammation without neoplastic involvement (21%, 13 female and 6 male), and other, which consisted of having no inflammatory or neoplastic response (54%, 32 female and 19 male). All of the patients ailed a 3- to 6-month conservative treatment regimen, which included anti-inflammatory medication, modification of activities, injection of corticosteroids, night splints, custom molded orthotics, and physical therapy. Only 3 patients underwent bilateral plantar fasciectomies. No patient required a revisional procedure. The authors conclude that 25% of recalcitrant heel pain is neoplastic in origin, and that patients presenting with these lesions require excision and not fasciotomy. PMID:21353998

  2. Proximal plantar fibroma as an etiology of recalcitrant plantar heel pain.

    PubMed

    Hafner, Shaun; Han, Nancy; Pressman, Martin M; Wallace, Christopher

    2011-01-01

    Prompted by repeated pathology reports of fibromas at the origin of the plantar fascia after fasciectomy for chronic plantar heel pain, this study examines the incidence of proximal plantar fibroma. A retrospective study of 101 pathology specimens from 97 patients with the preoperative diagnosis of recalcitrant plantar fasciitis was performed. Patients ranged in age from 36 to 82, and included 30 males and 67 females. The specimens consisted of medial and central bands of the fascia obtained from transverse plantar fasciectomies. The fasciectomies were performed between July 1994 and March 2008. One quarter of the cases studied had a histological appearance of plantar fibroma. This new finding has not been reported in any literature in connection with recalcitrant heel pain. Histologic findings of the specimens were placed into 3 groups: neoplastic involvement (25%, 21 female and 6 male), inflammation without neoplastic involvement (21%, 13 female and 6 male), and other, which consisted of having no inflammatory or neoplastic response (54%, 32 female and 19 male). All of the patients failed a 3- to 6-month conservative treatment regimen, which included anti-inflammatory medication, modification of activities, injection of corticosteroids, night splints, custom molded orthotics, and physical therapy. Only 4 patients underwent bilateral plantar fasciectomies. No patient required a revisional procedure. The authors conclude that 25% of recalcitrant heel pain is neoplastic in origin, and that patients presenting with these lesions require excision and not fasciotomy. PMID:21667549

  3. Getting to the heel of the problem: plantar fascia lesions.

    PubMed

    Jeswani, T; Morlese, J; McNally, E G

    2009-09-01

    Heel pain is a frequent disabling symptom. Clinical diagnosis is often difficult with a large range of possible diagnoses. Lesions of the plantar fascia form an important group. We present a review describing the common lesions of the plantar fascia, including plantar fasciitis, plantar fascia rupture, plantar fibromatosis, and plantar xanthoma, and illustrate them with appropriate magnetic resonance imaging (MRI) and ultrasound imaging. We also address foreign-body reactions, enthesopathy, and diabetic fascial disease. PMID:19664484

  4. Comparison between extracorporeal shockwave therapy, placebo ESWT and endoscopic plantar fasciotomy for the treatment of chronic plantar heel pain in the athlete

    PubMed Central

    Saxena, Amol; Fournier, Magali; Gerdesmeyer, Ludger; Gollwitzer, Hans

    2012-01-01

    Summary Plantar fasciitis can be a chronic and debilitating condition affecting athletes of all levels. The aim of this study is to compare treatment outcomes for the treatment of chronic plantar fasciitis in athletes, comparing focused extra corporeal sound wave therapy (ESWT) and the surgical endoscopic plantar fasciotomy (EPF). A total of 37 eligible patients were enrolled in the study between May 2006 and December 2008 at a single institution. Patients were either enrolled in the surgical group, or to the ESWT group which included a placebo controlled, randomized group (P-ESWT). Pre and post Visual Analog Scores (VAS) and Roles and Maudlsey (RM) scores were recorded and compared between the three groups. The patient’s return to activity (RTA) was also documented. The results showed statistical improvement within the EPF and ESWT groups with both VAS & RM scores, with EPF being significantly better than both ESWT and P-ESWT in terms of treatment outcomes. Patients enrolled in the ESWT were able though to continue with their exercise regimen, while the EPF group was able to return to their athletic activity in an average of 2.8 months. In conclusion, EPF and ESWT are both effective forms of treatment for chronic plantar fasciitis; EPF being superior in outcomes yet ESWT treatment could be preferable since the athlete can remain active during treatment. Level of Evidence: II PMID:23738317

  5. Medial plantar artery island flap for heel reconstruction.

    PubMed

    Schwarz, Richard J; Negrini, Jean-Francois

    2006-12-01

    Coverage of soft tissue defects of the heel has been a challenge to reconstructive surgeons in the past. The medial plantar artery flap has facilitated heel coverage since its development in the 1980s. This was a prospective study in 2 centers assessing the complications and durability of this flap primarily in patients with sensory impairment. All patients but 1 had chronic plantar ulceration due to sensory loss, and 5 patients also had developed squamous cell carcinoma. Fifty-one flaps were carried out in 48 patients. One flap underwent necrosis, and delayed healing was seen in 4 cases. Total flap survival was 98%. Minor revision of the flap or its pedicle was required in 3 cases. With a mean follow-up of 14 months, there were recurrences of ulceration in 7 feet (14%). The relevant literature is reviewed. The medial plantar artery flap is a reliable flap for heel coverage in both our centers and others. It is durable and long lasting even in insensate. PMID:17122553

  6. Heel lipoma mimicking plantar fasciitis in a ballroom dancer.

    PubMed

    Taweel, Nicholas R; Raikin, Steven M

    2015-01-01

    The present case illustrates a lipoma as an unusual cause of heel pain. A 64-year-old female ballroom dancer presented with 8 months of pain that was unresponsive to previous treatment of plantar fasciitis. Magnetic resonance imaging revealed a heel lipoma. Her pain was fully resolved after surgical excision. Soft tissue tumors should be included in the differential diagnosis of heel pain, especially when symptoms and treatment response do not follow the typical course of plantar fasciitis. PMID:25624040

  7. Reconstruction of plantar heel defects with free gracilis musculocutaneous flap.

    PubMed

    Tamura, A; Takeuchi, Y; Yamakage, A

    1994-01-01

    Soft tissue defects of heel region are difficult to repair. The flaps taken from the nonweightbearing area of the sole produce good results. However, these flaps are limited in width and cannot always cover the large defects after excision of malignant tumors. The authors experienced two cases of plantar heel reconstruction with free gracilis musculocutaneous flap after wide excision of malignant skin tumors, and successfully covered the defects. The patients have been free of ulcer for 3 and 1.8 years respectively, after flap transfer. Free gracilis musculocutaneous flap should be added to the techniques for plantar heel reconstruction after wide excision of malignant skin tumors. PMID:8081335

  8. Heel pain-plantar fasciitis: revision 2014.

    PubMed

    Martin, Robroy L; Davenport, Todd E; Reischl, Stephen F; McPoil, Thomas G; Matheson, James W; Wukich, Dane K; McDonough, Christine M

    2014-11-01

    The Orthopaedic Section of the American Physical Therapy Association (APTA) has an ongoing effort to create evidence-based practice guidelines for orthopaedic physical therapy management of patients with musculoskeletal impairments described in the World Health Organization's International Classification of Functioning, Disability, and Health (ICF). The purpose of these revised clinical practice guidelines is to review recent peer-reviewed literature and make recommendations related to nonarthritic heel pain. PMID:25361863

  9. Plantar fibromatosis of the heel in children: a report of 14 cases.

    PubMed

    Godette, G A; O'Sullivan, M; Menelaus, M B

    1997-01-01

    Based on a study of 14 patients younger than 16 years, we found that lumps on the plantar aspect of the anteromedial portion of the heel pad can safely be observed. Many remained small and asymptomatic, some disappeared, and two that required repeated excision biopsy did not subsequently recur. The six patients who were subjected to excision biopsy were found to have plantar fibromatosis. This very precise heel site is a characteristic situation for plantar fibromatosis in childhood. PMID:8989694

  10. Regional plantar foot pressure distributions on high-heeled shoes-shank curve effects

    NASA Astrophysics Data System (ADS)

    Cong, Yan; Lee, Winson; Zhang, Ming

    2011-12-01

    Forefoot pain is common in high-heeled shoe wearers due to the high pressure caused by the center of body mass moving forward and the increased arch height with heel elevation. Sufficient arch support could reduce the high pressure over forefoot. However, too much arch support could lead to abnormal foot alignment and pain over midfoot. Little information is reported on the relationship among plantar arch height, shank curve design and plantar pressure. This study aimed at quantifying the plantar arch height changes at different heel heights and investigating the effect of shank curve on plantar pressure distribution. The plantar arch height increased to (7.6±1.3)mm at heel height of 75 mm. The Chinese standard suggests the depth of last should be 8.5mm for heel height of 75 mm. When a shank curve with higher depth of last (11 mm) was used, the peak pressure over forefoot further decreased in midstance phase, which might ease the forefoot problems, while the peak pressure over midfoot increased but not exceeded the discomfort pressure thresholds. To achieve a more ideal pressure distribution in high-heeled shoes, a higher than expected depth of last would be suggested that would not cause discomfort over midfoot.

  11. Clinical Presentation and Self-Reported Patterns of Pain and Function in Patients with Plantar Heel Pain

    PubMed Central

    Klein, Sandra E.; Dale, Ann Marie; Hayes, Marcie Harris; Johnson, Jeffrey E.; McCormick, Jeremy J.; Racette, Brad A.

    2014-01-01

    Background Plantar heel pain is a common disorder of the foot for which patients seek medical treatment. The purpose of this study is to explore the relationship between duration of symptoms in plantar fasciitis patients and demographic factors, the intensity and location of pain, extent of previous treatment and self reported pain and function. Methods The charts of patients presenting with plantar heel pain between June 2008 and October 2010 were reviewed retrospectively and 182 patients with a primary diagnosis of plantar fasciitis were identified. Patients with symptoms less than 6 months were identified as acute and patients with symptoms greater than or equal to six months were defined as having chronic symptoms. Comparisons based on duration of symptoms were performed for age, gender, BMI, comorbidities, pain location and intensity, and a functional score measured by the Foot and Ankle Ability Measure (FAAM). Results The two groups were similar in age, BMI, gender, and comorbidities. Pain severity, as measured by a VAS, was not statistically significant between the two groups (6.6 and 6.2). The acute and chronic groups of patients reported similar levels of function on both the activity of daily living (62 and 65) and sports (47 and 45) subscales of the FAAM. Patients in the chronic group were more likely to have seen more providers and tried more treatment options for this condition. Conclusion As plantar fasciitis symptoms extend beyond 6 months, patients do not experience increasing pain intensity or functional limitation. No specific risk factors have been identified to indicate a risk of developing chronic symptoms. PMID:22995253

  12. Effect of Monophasic Pulsed Current on Heel Pain and Functional Activities caused by Plantar Fasciitis

    PubMed Central

    Alotaibi, Abdullah K.; Petrofsky, Jerrold S.; Daher, Noha S.; Lohman, Everett; Laymon, Michael; Syed, Hasan M.

    2015-01-01

    Background Plantar fasciitis (PF) is a soft tissue disorder considered to be one of the most common causes of inferior heel pain. The aim of this study was to investigate the effect of monophasic pulsed current (MPC) and MPC coupled with plantar fascia-specific stretching exercises (SE) on the treatment of PF. Material/Methods Forty-four participants (22 women and 22 men, with a mean age of 49 years) diagnosed with PF were randomly assigned to receive MPC (n=22) or MPC coupled with plantar fascia-specific SE (n=22). Prior to and after 4 weeks of treatment, participants underwent baseline evaluation; heel pain was evaluated using a visual analogue scale (VAS), heel tenderness threshold was quantified using a handheld pressure algometer (PA), and functional activities level was assessed using the Activities of Daily Living subscale of the Foot and Ankle Ability Measure (ADL/FAAM). Results Heel pain scores showed a significant reduction in both groups compared to baseline VAS scores (P<0.001). Heel tenderness improved significantly in both groups compared with baseline PA scores (P<0.001). Functional activity level improved significantly in both groups compared with baseline (ADL/FAAM) scores (P<0.001). However, no significant differences existed between the 2 treatment groups in all post-intervention outcome measures. Conclusions This trial showed that MPC is useful in treating inferior heel symptoms caused by PF. PMID:25791231

  13. Plantar Fasciitis

    MedlinePlus

    ... version Plantar Fasciitis Overview What is the plantar fascia? The plantar fascia is a band of tissue, much like a ... form the ball of your foot. The plantar fascia works like a rubber band between the heel ...

  14. The nonlinear finite element analysis and plantar pressure measurement for various shoe soles in heel region.

    PubMed

    Shiang, T Y

    1997-10-01

    The most influential factor contributing to foot and shoe comfort is underfoot cushioning. The shock absorbing ability of footwear in the heel area is of particular importance in reducing the impact load during athletic activities and in therapeutic footwear prescribed for heel pain. Furthermore, foot care for foot problem patients is an important part of treatment and educational programs. Therefore, a well-designed sport shoe which can provide comfort and protection is essential. In order to design a functional shoe, biomechanics and other new technologies should be considered, and the design process should be examined in the biomechanics laboratory over and over. The design process requires too much time and effort since the entire experimental and test work can only be done after the prototype is manufactured. Therefore, this study tried to introduce the Finite Element Method (FEM) into the shoe design process by building a three-dimensional FE model with various shoe soles and loading conditions. The material properties of shoe materials were tested using an Instron Testing Machine. An in-shoe pressure insole was used to measure the plantar pressure in different ambulation conditions with various shoe constructions. The subject for this study was a healthy young male without any foot problem. The average plantar pressures obtained from approximately 50 steps in the heel region for each of the various conditions were collected. The results showed that the mean peak plantar pressure of the running situation was significantly higher than that of the walking situation as predicted, and that the insole could provide better cushioning compared to the other shoe constructions. The stress strain relationship for shoe materials was approximated better by a second-order nonlinear curve according to the Instron test. The results of the finite element method suggested that only the second-order nonlinear stress strain curve could correctly describe the shoe material, which also confirmed a potential valuable role for FEM in designing functional shoes. PMID:9369026

  15. Comparison of ankle plantar flexor activity between double-leg heel raise and walking.

    PubMed

    Fujisawa, Hiroyuki; Suzuki, Hiroto; Nishiyama, Toru; Suzuki, Makoto

    2015-05-01

    [Purpose] We aimed to evaluate the difference in the muscle activity between the double-leg heel raise (DHR) and treadmill walking. [Subjects] Thirty healthy males aged 21.5 ± 1.6 years (body mass 63.6 ± 9.3 kg, height 171.0 ± 4.5 cm) participated in the study. [Methods] Electromyograms were simultaneously recorded from both heads of the gastrocnemius and the soleus of the right side during the DHR and treadmill walking. The DHR conditions were maximum plantar flexion (MPF), 3/4 MPF, 2/4 MPF, and 1/4 MPF, and the walking speeds were 20, 40, 60, 80, and 100 m/min. [Results] The muscle activity during the DHR and walking significantly increased with increments in the height of the heel raise and walking speed, respectively. Comparison of the muscle activity at MPF with that at each walking speed revealed that the muscle activity in the soleus and gastrocnemius medial head during walking exceeded that during the DHR in less than 3.3% of cases. [Conclusion] The DHR test is useful for evaluating the ankle plantar flexor activity necessary for walking. PMID:26157255

  16. Anteromedial plantar nodules of the heel in childhood: a variant of the normality?

    PubMed

    García-Mata, Serafín; Hidalgo-Ovejero, Angel

    2010-01-01

    Localized, bilateral, painless, nonpruritic and symmetric papuloid lesions in the posteromedial part of the foot are the clinical features of benign plantar nodules of the heel in children. They are probably congenital; they are asymptomatic and benign. We present 18 children with posteromedial nodules of the heel, 15 bilateral. Mean age was 45.31+/-53.49 months. The reason for the consultation was the lump itself in 10 of the cases. Thirteen were asymptomatic and five presented transient tenderness to pressure. Radiographs were nonspecific in all cases. Sonography showed an accumulation of tissue similar to subcutaneous cell tissue, compatible with fat. MRI was performed in one case, showing an accumulation of fatty tissue similar to subcutaneous cell tissue. Follow-up time was 5.44+/-3.78 years (range 2-16 years). At the end of follow-up, all the patients are asymptomatic with normal functional outcome and with the lump persisting in all but one. In conclusion, a sonographic study is sufficient to diagnose this type of mass, without the need for biopsy and/or surgical exeresis to distinguish fatty tissue from another type of consistency. Subsequent studies should aim at showing piezogenic, hamartomatous or congenital fat herniation aetiology of these typical lumps, probably normal variant of normality. PMID:19741551

  17. Plantar fasciitis

    PubMed Central

    Tahririan, Mohammad Ali; Motififard, Mehdi; Tahmasebi, Mohammad Naghi; Siavashi, Babak

    2012-01-01

    Heel pain, mostly caused by plantar fasciitis (PF), is a common complaint of many patients who requiring professional orthopedic care and are mostly suffering from chronic pain beneath their heels. The present article reviews studies done by preeminent practitioners related to the anatomy of plantar fasciitis and their histo-pathological features, factors associated with PF, clinical features, imaging studies, differential diagnoses, and diverse treatment modalities for treatment of PF, with special emphasis on non-surgical treatment. Anti-inflammatory agents, plantar stretching, and orthosis proved to have highest priority; corticosteroid injection, night splints and extracorporeal shock wave therapy were of next priority, in patients with PF. In patients resistant to the mentioned treatments surgical intervention should be considered. PMID:23798950

  18. Effects of heel support banding using an elastic band on chronic pain at the achilles tendon in a mountaineer.

    PubMed

    Yoo, Won-Gyu

    2016-01-01

    [Purpose] This study developed heel support banding (HSB) using an elastic band for flexible heel support and investigated its effect on chronic Achilles tendon pain of a mountaineer. [Subject] A 40-year-old male mountaineer with chronic Achilles tendon pain [Methods] Ankle dorsiflexion and plantar flexion angles, VISA-A questionnaire, load-induced pain, total pain threshold and tenderness at 3 kg of pressure were measured before and after applying HSB. [Results] After one month of applying HSB, the dorsiflexion and plantar flexion angles increased; the VISA-A questionnaire score increased; the load-induced pain assessment score decreased; the pain threshold increased; and tenderness at 3 kg decreased. [Conclusion] These results indicate that HSB use improves ankle range of motion, decreases pressure and pain, and could provide a new approach for effective intervention and management of chronic Achilles tendon pain. PMID:26957781

  19. Effects of heel support banding using an elastic band on chronic pain at the achilles tendon in a mountaineer

    PubMed Central

    Yoo, Won-Gyu

    2016-01-01

    [Purpose] This study developed heel support banding (HSB) using an elastic band for flexible heel support and investigated its effect on chronic Achilles tendon pain of a mountaineer. [Subject] A 40-year-old male mountaineer with chronic Achilles tendon pain [Methods] Ankle dorsiflexion and plantar flexion angles, VISA-A questionnaire, load-induced pain, total pain threshold and tenderness at 3 kg of pressure were measured before and after applying HSB. [Results] After one month of applying HSB, the dorsiflexion and plantar flexion angles increased; the VISA-A questionnaire score increased; the load-induced pain assessment score decreased; the pain threshold increased; and tenderness at 3 kg decreased. [Conclusion] These results indicate that HSB use improves ankle range of motion, decreases pressure and pain, and could provide a new approach for effective intervention and management of chronic Achilles tendon pain. PMID:26957781

  20. In-shoe plantar pressure measurements for patients with knee osteoarthritis: Reliability and effects of lateral heel wedges.

    PubMed

    Leitch, Kristyn M; Birmingham, Trevor B; Jones, Ian C; Giffin, J Robert; Jenkyn, Thomas R

    2011-07-01

    Although plantar pressure measurement systems are being used increasingly during gait analyses to investigate foot orthotics, there is limited information describing test-retest reliability of such measurements. Objectives of this study were to (1) examine the test-retest reliability of lateral heel pressure (LHP) and centre of pressure (COP) during walking with and without lateral heel wedges, and (2) evaluate the effects of 4° and 8° lateral heel wedges on the magnitude of LHP, the pathway of the COP and the peak external knee adduction moment (KAM) in subjects with and without knee osteoarthritis (OA). Twenty-six subjects, 12 patients with knee OA and 14 healthy subjects, were evaluated during three lateral heel wedge conditions (control, 4° and 8°) with standardized footwear. Three-dimensional analyses of gait with optical motion capture, floor-mounted force plate and in-shoe plantar pressure were completed on two occasions. Intraclass correlation coefficients (ICC(2, 1)) for LHP were excellent (0.79-0.83) while ICCs for COP in the medial-lateral and anterior-posterior directions were more variable (0.66-0.86). Reliability was slightly diminished when using heel wedges. Standard errors of measurement suggested considerable day-to-day variability in an individual's measures. Lateral heel wedges significantly (p<0.001) increased LHP, shifted COP anteriorly and laterally, and decreased the KAM. No significant differences were observed between subjects with and without OA. Although the day-to-day variability appears too large to confidently evaluate changes in individual patients, and decreases in reliability with increases in wedge size indicate caution, these results suggest in-shoe measurement of LHP and COP are appropriate for use in studies evaluating biomechanical effects of foot orthoses for knee OA. PMID:21741243

  1. Influence of in-shoe heel lifts on plantar pressure and center of pressure in the medial-lateral direction during walking.

    PubMed

    Zhang, Xianyi; Li, Bo

    2014-04-01

    The aim of this study was to investigate how the height and material of in-shoe heel lifts affect plantar pressure and center of pressure (COP) trajectory in the medial-lateral direction during walking. Seventeen healthy young male adults were asked to walk along an 8m walkway while wearing a high-cut flat shoe and 5 different heel lifts. Peak pressure (PP), pressure-time integral (PTI) and contact area (CA) were measured by Pedar insole system for three foot regions: forefoot, midfoot and heel. Range and velocity of medial-lateral (ML) COP during forefoot contact phase (FFCP) and foot flat phase (FFP) were collected using Footscan pressure plate. Forefoot pressure and ML-COP parameters increased as the heel was elevated. Statistically significant attenuation of heel peak plantar pressure was provided by all heel lifts except for the hard lift. Post hoc tests suggest that material had a greater influence on the range and velocity of ML-COP during FFCP than heel height, while during FFP, heel height seemed to affect these parameters more. The findings from this study suggest that thick heel lifts should be used with caution, and that a heel lift made of materials with good support and elastic properties might be more appropriate to improve footwear comfort and medial-lateral motion control. PMID:24440428

  2. Effects of heel base size, walking speed, and slope angle on center of pressure trajectory and plantar pressure when wearing high-heeled shoes.

    PubMed

    Luximon, Yan; Cong, Yan; Luximon, Ameersing; Zhang, Ming

    2015-06-01

    High-heeled shoes are associated with instability and a high risk of fall, fracture, and ankle sprain. This study investigated the effects of heel base size (HBS) on walking stability under different walking speeds and slope angles. The trajectory of the center of pressure (COP), maximal peak pressure, pressure time integral, contact area, and perceived stability were analyzed. The results revealed that a small HBS increased the COP deviations, shifting the COP more medially at the beginning of the gait cycle. The slope angle mainly affected the COP in the anteroposterior direction. An increased slope angle shifted the COP posterior and caused greater pressure and a larger contact area in the midfoot and rearfoot regions, which can provide more support. Subjective measures on perceived stability were consistent with objective measures. The results suggested that high-heeled shoes with a small HBS did not provide stable plantar support, particularly on a small slope angle. The changes in the COP and pressure pattern caused by a small HBS might increase joint torque and muscle activity and induce lower limb problems. PMID:25910862

  3. The effectiveness of extra corporeal shock wave therapy for plantar heel pain: a systematic review and meta-analysis

    PubMed Central

    Thomson, Colin E; Crawford, Fay; Murray, Gordon D

    2005-01-01

    Background There is considerable controversy regarding the effectiveness of extracorporeal shock wave therapy in the management of plantar heel pain. Our aim was to conduct a systematic review of randomised controlled trials to investigate the effectiveness of extracorporeal shock wave therapy and to produce a precise estimate of the likely benefits of this therapy. Methods We conducted a systematic review of all randomised controlled trials (RCTs) identified from the Cochrane Controlled trials register, MEDLINE, EMBASE and CINAHL from 1966 until September 2004. We included randomised trials which evaluated extracorporeal shock wave therapy used to treat plantar heel pain. Trials comparing extra corporeal shock wave therapy with placebo or different doses of extra corporeal shock wave therapy were considered for inclusion in the review. We independently applied the inclusion and exclusion criteria to each identified randomised controlled trial, extracted data and assessed the methodological quality of each trial. Results Six RCTs (n = 897) permitted a pooled estimate of effectiveness based on pain scores collected using 10 cm visual analogue scales for morning pain. The estimated weighted mean difference was 0.42 (95% confidence interval 0.02 to 0.83) representing less than 0.5 cm on a visual analogue scale. There was no evidence of heterogeneity and a fixed effects model was used. Conclusion A meta-analysis of data from six randomised-controlled trials that included a total of 897 patients was statistically significant in favour of extracorporeal shock wave therapy for the treatment of plantar heel pain but the effect size was very small. A sensitivity analysis including only high quality trials did not detect a statistically significant effect. PMID:15847689

  4. Effectiveness of calf muscle stretching for the short-term treatment of plantar heel pain: a randomised trial

    PubMed Central

    Radford, Joel A; Landorf, Karl B; Buchbinder, Rachelle; Cook, Catherine

    2007-01-01

    Background Plantar heel pain is one of the most common musculoskeletal disorders of the foot and ankle. Treatment of the condition is usually conservative, however the effectiveness of many treatments frequently used in clinical practice, including stretching, has not been established. We performed a participant-blinded randomised trial to assess the effectiveness of calf muscle stretching, a commonly used short-term treatment for plantar heel pain. Methods Ninety-two participants with plantar heel pain were recruited from the general public between April and June 2005. Participants were randomly allocated to an intervention group that were prescribed calf muscle stretches and sham ultrasound (n = 46) or a control group who received sham ultrasound alone (n = 46). The intervention period was two weeks. No participants were lost to follow-up. Primary outcome measures were 'first-step' pain (measured on a 100 mm Visual Analogue Scale) and the Foot Health Status Questionnaire domains of foot pain, foot function and general foot health. Results Both treatment groups improved over the two week period of follow-up but there were no statistically significant differences in improvement between groups for any of the measured outcomes. For example, the mean improvement for 'first-step' pain (0100 mm) was -19.8 mm in the stretching group and -13.2 mm in the control group (adjusted mean difference between groups -7.9 mm; 95% CI -18.3 to 2.6). For foot function (0100 scale), the stretching group improved 16.2 points and the control group improved 8.3 points (adjusted mean difference between groups 7.3; 95% CI -0.1 to 14.8). Ten participants in the stretching group experienced an adverse event, however most events were mild to moderate and short-lived. Conclusion When used for the short-term treatment of plantar heel pain, a two-week stretching program provides no statistically significant benefit in 'first-step' pain, foot pain, foot function or general foot health compared to not stretching. PMID:17442119

  5. Amniotic Tissues for the Treatment of Chronic Plantar Fasciosis and Achilles Tendinosis

    PubMed Central

    Werber, Bruce

    2015-01-01

    Introduction. Allogeneic amniotic tissue and fluid may be used to treat chronic plantar fasciosis and Achilles tendinosis. This innovative approach involves delivering a unique allograft of live human cells in a nonimmunogenic structural tissue matrix to treat chronic tendon injury. These tissues convey very positive regenerative attributes; procurement is performed with maternal consent during elective caesarian birth. Materials and Methods. In the present investigation all patients were unresponsive to multiple standard therapies for a minimum of 6 months and were treated with one implantation of PalinGen SportFLOW around the plantar fascia and/or around the Achilles paratenon. The patients were given a standard protocol for postimplant active rehabilitation. Results. The analogue pretreatment pain score (VAS) of 8. By the fourth week after treatment, all patients had significantly reduced self-reported pain. Twelve weeks following the procedure the average pain level had reduced to only 2. No adverse reactions were reported in any of the patients. Conclusion. All patients in this study experienced heel or Achilles pain, unresponsive to standard therapy protocols. After treatment all patients noted significant pain reduction, indicating that granulized amniotic membrane and amniotic fluid can be successfully used to treat both chronic plantar fasciosis and Achilles tendinosis. PMID:26491722

  6. Plantar fasciitis.

    PubMed

    Onuba, O; Ireland, J

    1986-12-01

    Thirty patients presenting with the heel pain syndrome, commonly referred to as "plantar fasciitis", were studied prospectively over a two year period. The pain was associated with a calcaneal spur in 21 patients (70%). In a control series of 25 patients without heel symptoms, calcaneal spurs were present in only 4 out of 50 heels (8%). This difference is highly significant (p 0.001). Seven patients (22%) in the plantar fasciitis group complained of ipsilateral sciatica. PMID:3610621

  7. Diagnosis and management of plantar fasciitis.

    PubMed

    Thompson, John V; Saini, Sundeep S; Reb, Christopher W; Daniel, Joseph N

    2014-12-01

    Plantar fasciitis, a chronic degenerative process that causes medial plantar heel pain, is responsible for approximately 1 million physician visits each year. Individuals with plantar fasciitis experience pain that is most intense during their first few steps of the day or after prolonged standing. The authors provide an overview of the diagnosis and management of a common problem encountered in the primary care setting. Routine imaging is not initially recommended for the evaluation of plantar fasciitis but may be required to rule out other pathologic conditions. Overall, plantar fasciitis carries a good prognosis when patients use a combination of several conservative treatment modalities. Occasionally, referral to a specialist may be necessary. PMID:25429080

  8. Endoscopic Plantar Fasciotomy: A Minimally Traumatic Procedure for Chronic Plantar Fasciitis

    PubMed Central

    Hake, Daniel H.

    2000-01-01

    Endoscopic plantar fasciotomy (EPF) is a minimally invasive and minimally traumatic surgical treatment for the common problem of chronic plantar fasciitis. This procedure is indicated only for the release of the proximal medial aspect of the fascia in cases that do not respond to aggressive conservative, nonsurgical treatment. In the literature, an overall 87% success rate has been reported in 1228 procedures, in addition to an 83% success rate reported by Burke at the Northwest Podiatric Foundation Surgical Seminar in January 2000. The author's personal experience with 41 procedures over 5 years is consistent with an overall average success of 90%. EPF complications are reduced in comparison with traditional open procedures and can be avoided in many cases when identified early and treated properly. EPF is recommended as the procedure of choice when conservative treatment measures have been exhausted. PMID:21765689

  9. Evaluation of ultrasound-guided extracorporeal shock wave therapy (ESWT) in the treatment of chronic plantar fasciitis.

    PubMed

    Hyer, Christopher F; Vancourt, Robert; Block, Alan

    2005-01-01

    Thirty patients (39 heels) were evaluated to determine the success of ultrasound-guided ESWT for treatment of recalcitrant plantar fasciitis. All patients had been diagnosed and treated for plantar fasciitis for greater than 6 months and had failed at least 3 conservative treatment modalities. Each patient received 3800 shockwaves into the treated heel using the Dornier Epos Ultra ESWT machine. The average postoperative follow-up was 124 days (range, 33 to 255). Written subjective surveys evaluated pre- and posttreatment pain levels using a visual analog scoring system. The mean pretreatment score was 8.51 (range, 5 to 10), which improved to a mean follow-up score of 3.75 (range, 0 to 10). This represents an improvement in the mean VAS of 4.76, which is statistically significant ( P = .0002). Twenty-five of 30 patients reported some degree of improvement, with 5 experiencing no change. These early results indicate ultrasound-guided ESWT may be a useful tool in the treatment armamentarium for chronic plantar fasciitis. PMID:15768363

  10. Plantar fasciitis

    MedlinePlus

    The plantar fascia is the thick tissue on the bottom of the foot. It connects the heel bone to the toes ... inserts. Use night splints to stretch the injured fascia and allow it to heal. If these treatments ...

  11. Plantar fibromatosis.

    PubMed

    Zgonis, Thomas; Jolly, Gary Peter; Polyzois, Vasilios; Kanuck, David M; Stamatis, Emmanouil D

    2005-01-01

    Plantar fibromatosis is defined as a benign fibrous disorder involving the plantar aponeurosis. Although its incidence is well described on the hands, it is less commonly seen on the feet, and its etiology is unknown. A differential diagnosis for the heel pain along the medial arch could be a benign thickening of the plantar fascia associated with plantar fibromatosis. Its high recurrence after surgical excision and problematic scarring and wound presents a significant challenge to the reconstructive foot and ankle surgeon. This article reviews the history, clinical presentation, pathologic findings, and surgical approaches to the treatment of plantar fibromatosis. PMID:15555840

  12. Orthosis-Shaped Sandals Are as Efficacious as In-Shoe Orthoses and Better than Flat Sandals for Plantar Heel Pain: A Randomized Control Trial

    PubMed Central

    Vicenzino, Bill; McPoil, Thomas G.; Stephenson, Aoife; Paul, Sanjoy K.

    2015-01-01

    Objective To investigate efficacy of a contoured sandal being marketed for plantar heel pain with comparison to a flat flip-flop and contoured in-shoe insert/orthosis. Method 150 volunteers aged 50 (SD: 12) years with plantar heel pain (>4 weeks) were enrolled after responding to advertisements and eligibility determined by telephone and at first visit. Participants were randomly allocated to receive commercially available contoured sandals (n = 49), flat flip-flops (n = 50) or over the counter, pre-fabricated full-length foot orthotics (n = 51). Primary outcomes were a 15-point Global Rating of Change scale (GROC: 1 = a very great deal worse, 15 = a very great deal better), 13 to 15 representing an improvement and the 20-item Lower Extremity Function Scale (LEFS) on which participants rate 20 common weight bearing activities and activities of daily living on a 5-point scale (0 = extreme difficulty, 4 = no difficulty). Secondary outcomes were worst level of heel pain in the preceding week, and the foot and ankle ability measure. Outcomes were collected blind to allocation. Analyses were done on an intention to treat basis with 12 weeks being the primary outcome time of interest. Results The contoured sandal was 68% more likely to report improvement in terms of GROC compared to flat flip-flop. On the LEFS the contoured sandal was 61% more likely than flat flip-flop to report improvement. The secondary outcomes in the main reflected the primary outcomes, and there were no differences between contoured sandal and shoe insert. Conclusions and Relevance Physicians can have confidence in supporting a patient's decision to wear contoured sandals or in-shoe orthoses as one of the first and simple strategies to manage their heel pain. Trial Registration The Australian New Zealand Clinical Trials Registry ACTRN12612000463875 PMID:26669302

  13. Boot-insole effects on comfort and plantar loading at the heel and fifth metatarsal during running and turning in soccer.

    PubMed

    Nunns, Michael P I; Dixon, Sharon J; Clarke, James; Carré, Matt

    2016-04-01

    Plantar loading may influence comfort, performance and injury risk in soccer boots. This study investigated the effect of cleat configuration and insole cushioning levels on perception of comfort and in-shoe plantar pressures at the heel and fifth metatarsal head region. Nine soccer academy players (age 15.7 ± 1.6 years; height 1.80 ± 0.40 m; body mass 71.9 ± 6.1 kg) took part in the study. Two boot models (8 and 6 cleats) and two insoles (Poron and Poron/gel) provided four footwear combinations assessed using pressure insoles during running and 180° turning. Mechanical and comfort perception tests differentiated boot and insole conditions. During biomechanical testing, the Poron insole generally provided lower peak pressures than the Poron/gel insole, particularly during the braking step of the turn. The boot model did not independently influence peak pressures at the fifth metatarsal, and had minimal influence on heel loads. Specific boot-insole combinations performed differently (P < 0.05). The 8-cleat boot and the Poron insole performed best biomechanically and perceptually, but the combined condition did not. Inclusion of kinematic data and improved control of the turning technique are recommended to strengthen future research. The mechanical, perception and biomechanical results highlight the need for a multi-faceted approach in the assessment of footwear. PMID:26197986

  14. Treatment of chronic plantar fasciopathy with extracorporeal shock waves (review).

    PubMed

    Schmitz, Christoph; Császár, Nikolaus B M; Rompe, Jan-Dirk; Chaves, Humberto; Furia, John P

    2013-01-01

    There is an increasing interest by doctors and patients in extracorporeal shock wave therapy (ESWT) for chronic plantar fasciopathy (PF), particularly in second generation radial extracorporeal shock wave therapy (RSWT). The present review aims at serving this interest by providing a comprehensive overview on physical and medical definitions of shock waves and a detailed assessment of the quality and significance of the randomized clinical trials published on ESWT and RSWT as it is used to treat chronic PF. Both ESWT and RSWT are safe, effective, and technically easy treatments for chronic PF. The main advantages of RSWT over ESWT are the lack of need for any anesthesia during the treatment and the demonstrated long-term treatment success (demonstrated at both 6 and 12 months after the first treatment using RSWT, compared to follow-up intervals of no more than 12 weeks after the first treatment using ESWT). In recent years, a greater understanding of the clinical outcomes in ESWT and RSWT for chronic PF has arisen in relationship not only in the design of studies, but also in procedure, energy level, and shock wave propagation. Either procedure should be considered for patients 18 years of age or older with chronic PF prior to surgical intervention. PMID:24004715

  15. Treatment of chronic plantar fasciopathy with extracorporeal shock waves (review)

    PubMed Central

    2013-01-01

    There is an increasing interest by doctors and patients in extracorporeal shock wave therapy (ESWT) for chronic plantar fasciopathy (PF), particularly in second generation radial extracorporeal shock wave therapy (RSWT). The present review aims at serving this interest by providing a comprehensive overview on physical and medical definitions of shock waves and a detailed assessment of the quality and significance of the randomized clinical trials published on ESWT and RSWT as it is used to treat chronic PF. Both ESWT and RSWT are safe, effective, and technically easy treatments for chronic PF. The main advantages of RSWT over ESWT are the lack of need for any anesthesia during the treatment and the demonstrated long-term treatment success (demonstrated at both 6 and 12 months after the first treatment using RSWT, compared to follow-up intervals of no more than 12 weeks after the first treatment using ESWT). In recent years, a greater understanding of the clinical outcomes in ESWT and RSWT for chronic PF has arisen in relationship not only in the design of studies, but also in procedure, energy level, and shock wave propagation. Either procedure should be considered for patients 18 years of age or older with chronic PF prior to surgical intervention. PMID:24004715

  16. Comparison of usual podiatric care and early physical therapy intervention for plantar heel pain: study protocol for a parallel-group randomized clinical trial

    PubMed Central

    2013-01-01

    Background A significant number of individuals suffer from plantar heel pain (PHP) and many go on to have chronic symptoms and continued disability. Persistence of symptoms adds to the economic burden of PHP and cost-effective solutions are needed. Currently, there is a wide variation in treatment, cost, and outcomes of care for PHP with limited information on the cost-effectiveness and comparisons of common treatment approaches. Two practice guidelines and recent evidence of effective physical therapy intervention are available to direct treatment but the timing and influence of physical therapy intervention in the multidisciplinary management of PHP is unclear. The purpose of this investigation is to compare the outcomes and costs associated with early physical therapy intervention (ePT) following initial presentation to podiatry versus usual podiatric care (uPOD) in individuals with PHP. Methods A parallel-group, block-randomized clinical trial will compare ePT and uPOD. Both groups will be seen initially by a podiatrist before allocation to a group that will receive physical therapy intervention consisting primarily of manual therapy, exercise, and modalities, or podiatric care consisting primarily of a stretching handout, medication, injections, and orthotics. Treatment in each group will be directed by practice guidelines and a procedural manual, yet the specific intervention for each participant will be selected by the treating provider. Between-group differences in the Foot and Ankle Ability Measure 6 months following the initial visit will be the primary outcome collected by an independent investigator. In addition, differences in the European Quality of Life – Five Dimensions, Numeric Pain Rating Scale, Global Rating of Change (GROC), health-related costs, and cost-effectiveness at 6 weeks, 6 months, and 1 year will be compared between groups. The association between successful outcomes based on GROC score and participant expectations of recovery generally, and specific to physical therapy and podiatry treatment, will also be analyzed. Discussion This study will be the first pragmatic trial to investigate the clinical outcomes and cost-effectiveness of ePT and uPOD in individuals with PHP. The results will serve to inform clinical practice decisions and management guidelines of multiple disciplines. Trial registration ClinicalTrials.gov: NCT01865734 PMID:24299257

  17. Intervention with Formulated Collagen Gel for Chronic Heel Pressure Ulcers in Older Adults with Diabetes.

    PubMed

    Agosti, Jennifer K; Chandler, Lois A

    2015-11-01

    Chronic pressure ulcers (PrUs), ulcers that fail to progress through the expected phases of wound healing in a timely fashion, are not only a concern for the patients afflicted with them, but are also a significant burden for the long-term-care facilities in which patients reside. The heel is the second most common location for PrUs. Morbidity and mortality rates for heel PrUs, particularly in the diabetic population, are alarming. Therefore, a consistently effective, cost-conscious, and user-friendly topical treatment for heel ulcers would be welcomed by patients and clinicians. This article describes a marked and rapid improvement in wound granulation in 3 older adult patients following weekly treatment for 8 weeks of chronic (≥1-year duration) heel ulcers with an easy-to-use, cost-effective, topical, formulated collagen gel. PMID:26479694

  18. Management of plantar fasciitis in the outpatient setting.

    PubMed

    Lim, Ang Tee; How, Choon How; Tan, Benedict

    2016-04-01

    Plantar fasciitis is a very common cause of inferior heel pain that can be triggered and aggravated by prolonged standing, walking, running and obesity, among other factors. Treatments are largely noninvasive and efficacious. Supportive treatments, including the plantar fascia-specific stretch, calf stretching, appropriate orthotics and night dorsiflexion splinting, can alleviate plantar fascia pain. While local injections of corticosteroids can help with pain relief, the effects are short-lived and must be weighed against the risk of fat pad atrophy and plantar fascia rupture. Ultrasonography-guided focal extracorporeal shock wave therapy is useful for patients with chronic plantar fasciitis and referrals for this treatment can be made in recalcitrant cases. Activity modification to decrease cyclical repetitive loading of the plantar fascia should be advised during the treatment phase regardless of the chosen treatment modality. PMID:27075037

  19. Management of plantar fasciitis in the outpatient setting

    PubMed Central

    Lim, Ang Tee; How, Choon How; Tan, Benedict

    2016-01-01

    Plantar fasciitis is a very common cause of inferior heel pain that can be triggered and aggravated by prolonged standing, walking, running and obesity, among other factors. Treatments are largely noninvasive and efficacious. Supportive treatments, including the plantar fascia-specific stretch, calf stretching, appropriate orthotics and night dorsiflexion splinting, can alleviate plantar fascia pain. While local injections of corticosteroids can help with pain relief, the effects are short-lived and must be weighed against the risk of fat pad atrophy and plantar fascia rupture. Ultrasonography-guided focal extracorporeal shock wave therapy is useful for patients with chronic plantar fasciitis and referrals for this treatment can be made in recalcitrant cases. Activity modification to decrease cyclical repetitive loading of the plantar fascia should be advised during the treatment phase regardless of the chosen treatment modality. PMID:27075037

  20. Diagnosis, treatment, and farriery for horses with chronic heel pain.

    PubMed

    Dabareiner, Robin M; Carter, G Kent

    2003-08-01

    In conclusion, horses with heel or navicular area pain vary, and no one treatment option is suitable for all horses. Each horse must be evaluated individually to determine which structure in the palmar aspect of the foot is injured, severity of disease, horse and hoof conformation, and horse use and level of performance expectation before a treatment plan can be developed. Overall, there are many treatment options to help these horses to perform their intended athletic event. PMID:14575167

  1. How I Manage Heel Spur Syndrome.

    ERIC Educational Resources Information Center

    Seder, Joseph I.

    1987-01-01

    This article discusses plantar fascitis and heel spurs, the two contributing causes of heel spur syndrome. Treatment methods, which include rest, anti-inflammatory medication, shoe padding, and, as a last resort, surgery are described. (Author/MT)

  2. Plantar Fasciitis: A Concise Review

    PubMed Central

    Schwartz, Emily N; Su, John

    2014-01-01

    One challenge in the treatment of plantar fasciitis is that very few high-quality studies exist comparing different treatment modalities to guide evidence-based management. Current literature suggests a change to the way that plantar fasciitis is managed. This article reviews the most current literature on plantar fasciitis and showcases recommended treatment guidelines. This serves to assist physicians in diagnosing and treating heel pain with plantar fasciitis. PMID:24626080

  3. Heel pain

    MedlinePlus

    Pain - heel ... Heel pain is most often the result of overuse. Rarely, it may be caused by an injury. Your heel ... on the heel Conditions that may cause heel pain include: When the tendon that connects the back ...

  4. Plantar fascia: imaging diagnosis and guided treatment.

    PubMed

    McNally, Eugene G; Shetty, Shilpa

    2010-09-01

    Plantar fasciopathy is a common cause of heel pain. This article covers the imaging anatomy of the hindfoot, the imaging findings on ultrasound and magnetic resonance imaging (MRI) of plantar fasciopathy, plantar fibromas, trauma, Achilles tendonopathy, neural compression, stress fractures of the os calcis and other heel pad lesions. Thickening of the plantar fascia insertion more than 5 mm either on ultrasound or MRI is suggestive of plantar fasciopathy. Ultrasound is superior to MRI for diagnosis of plantar fibroma as small low signal lesions on MRI are similar to the normal plantar fascia signal. Ultrasound demonstrates low echogenicity compared with the echogenic plantar fascia. Penetrating injuries can appear bizarre due to associated foreign body impaction and infection. Achilles tendonopathy can cause heel pain and should be considered as a possible diagnosis. Treatment options include physical therapy, ECSWT, corticosteroid injection, and dry needling. Percutaneous US guided treatment methods will be described. PMID:20539958

  5. Relationships between static foot alignment and dynamic plantar loads in runners with acute and chronic stages of plantar fasciitis: a cross-sectional study

    PubMed Central

    Ribeiro, Ana P.; Sacco, Isabel C. N.; Dinato, Roberto C.; João, Silvia M. A.

    2016-01-01

    BACKGROUND: The risk factors for the development of plantar fasciitis (PF) have been associated with the medial longitudinal arch (MLA), rearfoot alignment and calcaneal overload. However, the relationships between the biomechanical variables have yet to be determined. OBJECTIVE: The goal of this study was to investigate the relationships between the MLA, rearfoot alignment, and dynamic plantar loads in runners with unilateral PF in acute and chronic phases. METHOD: Cross-sectional study which thirty-five runners with unilateral PF were evaluated: 20 in the acute phase (with pain) and 15 with previous chronic PF (without pain). The MLA index and rearfoot alignment were calculated using digital images. The contact area, maximum force, peak pressure, and force-time integral over three plantar areas were acquired with Pedar X insoles while running at 12 km/h, and the loading rates were calculated from the vertical forces. RESULTS: The multiple regression analyses indicated that both the force-time integral (R 2=0.15 for acute phase PF; R 2=0.17 for chronic PF) and maximum force (R 2=0.35 for chronic PF) over the forefoot were predicted by an elevated MLA index. The rearfoot valgus alignment predicted the maximum force over the rearfoot in both PF groups: acute (R 2=0.18) and chronic (R 2=0.45). The rearfoot valgus alignment also predicted higher loading rates in the PF groups: acute (R 2=0.19) and chronic (R 2=0.40). CONCLUSION: The MLA index and the rearfoot alignment were good predictors of plantar loads over the forefoot and rearfoot areas in runners with PF. However, rearfoot valgus was demonstrated to be an important clinical measure, since it was able to predict the maximum force and both loading rates over the rearfoot. PMID:26786073

  6. Effects of an auditory biofeedback device on plantar pressure in patients with chronic ankle instability.

    PubMed

    Donovan, Luke; Feger, Mark A; Hart, Joseph M; Saliba, Susan; Park, Joseph; Hertel, Jay

    2016-02-01

    Chronic ankle instability (CAI) patients have been shown to have increased lateral column plantar pressure throughout the stance phase of gait. To date, traditional CAI rehabilitation programs have been unable to alter gait. We developed an auditory biofeedback device that can be worn in shoes that elicits an audible cue when an excessive amount of pressure is applied to a sensor. This study determined whether using this device can decrease lateral plantar pressure in participants with CAI and alter surface electromyography (sEMG) amplitudes (anterior tibialis, peroneus longus, medial gastrocnemius, and gluteus medius). Ten CAI patients completed baseline treadmill walking while in-shoe plantar pressures and sEMG were measured (baseline condition). Next, the device was placed into the shoe and set to a threshold that would elicit an audible cue during each step of the participant's normal gait. Then, participants were instructed to walk in a manner that would not trigger the audible cue, while plantar pressure and sEMG measures were recorded (auditory feedback (AUD FB) condition). Compared to baseline, there was a statistically significant reduction in peak pressure in the lateral midfoot-forefoot and central forefoot during the AUD FB condition. In addition, there were increases in peroneus longus and medial gastrocnemius sEMG amplitudes 200ms post-initial contact during the AUD FB condition. The use of this auditory biofeedback device resulted in decreased plantar pressure in the lateral column of the foot during treadmill walking in CAI patients and may have been caused by the increase in sEMG activation of the peroneus longus. PMID:27004629

  7. [Plantar fibromatosis in infants].

    PubMed

    Pijnenburg, M W; Thomasse, J E; Odink, R J; Hoekstra, H J

    1998-11-28

    In 2 girls aged 5 months swellings were noted shortly after birth, on the plantar surface of the anteromedial parts of both heels and the left heel, respectively. On an expectative management, the swellings grew with the feet, without causing symptoms. The clinical picture and characteristic location led to the diagnosis of plantar fibromatosis. In infants it is a rare disorder which frequently shows spontaneous regression and does not behave aggressively. To avoid unnecessary investigations or even surgery and to reassure the parents, it is important to recognize this condition in infants. PMID:10028366

  8. Treatment of chronic plantar fasciitis with Botulinum toxin A: preliminary clinical results.

    PubMed

    Placzek, Richard; Deuretzbacher, Georg; Meiss, A Ludwig

    2006-02-01

    Based on recent results in chronic lateral epicondylitis we decided to investigate the efficacy of Botulinum toxin A (BTX-A) for treatment of chronic therapy resistant plantar fasciitis. Nine patients with an average duration of symptoms of 14 months and at least two prior conservative treatments received a one injection of 200 units of BTX-A (Dysport) subfascially into the painful area. The patients documented pain at rest and during weight-bearing after 2, 6, 10 and 14 weeks by a visual analogue scale. A significant reduction of pain during weight-bearing to about 50% was seen 6 weeks after injection. The effect was still present at the latest follow-up of 14 weeks. Similarly, the pain at rest was reduced to less than half of the initial value at any follow-up. All patients were satisfied and did not require further treatment. PMID:16428954

  9. Painful heel: MR imaging findings.

    PubMed

    Narváez, J A; Narváez, J; Ortega, R; Aguilera, C; Sánchez, A; Andía, E

    2000-01-01

    Heel pain is a common and frequently disabling clinical complaint that may be caused by a broad spectrum of osseous or soft-tissue disorders. These disorders are classified on the basis of anatomic origin and predominant location of heel pain to foster a better understanding of this complaint. The disorders include plantar fascial lesions (fasciitis, rupture, fibromatosis, xanthoma), tendinous lesions (tendinitis, tenosynovitis), osseous lesions (fractures, bone bruises, osteomyelitis, tumors), bursal lesions (retrocalcaneal bursitis, retroachilleal bursitis), tarsal tunnel syndrome, and heel plantar fat pad abnormalities. With its superior soft-tissue contrast resolution and multiplanar capability, magnetic resonance (MR) imaging can help determine the cause of heel pain and help assess the extent and severity of the disease in ambiguous or clinically equivocal cases. Careful analysis of MR imaging findings and correlation of these findings with patient history and findings at physical examination can suggest a specific diagnosis in most cases. The majority of patients with heel pain can be successfully treated conservatively, but in cases requiring surgery (eg, plantar fascia rupture in competitive athletes, deeply infiltrating plantar fibromatosis, masses causing tarsal tunnel syndrome), MR imaging is especially useful in planning surgical treatment by showing the exact location and extent of the lesion. PMID:10715335

  10. Heel pain: A systematic review.

    PubMed

    Agyekum, Edward Kwame; Ma, Kaiyu

    2015-01-01

    Heel pain is a very common foot disease. Varieties of names such as plantar fasciitis, jogger's heel, tennis heal, policeman's heel are used to describe it. Mechanical factors are the most common etiology of heel pain. Common causes of hell pain includes: Plantar Fasciitis, Heel Spur, Sever's Disease, Heel bump, Achilles Tendinopathy, Heel neuritis, Heel bursitis. The diagnosis is mostly based on clinical examination. Normally, the location of the pain and the absence of associated symptoms indicating a systemic disease strongly suggest the diagnosis. Several therapies exist including rest, physical therapy, stretching, and change in footwear, arch supports, orthotics, night splints, anti-inflammatory agents, and surgery. Almost all patients respond to conservative nonsurgical therapy. Surgery is the last treatment option if all other treatments had failed. Rest, ice, massage, the use of correct exercise and complying with a doctor's advice all play important part in helping to recover from this hell pain condition, but getting good quality, suitable shoes with the appropriate amount of support for the whole foot is the most important. PMID:26643244

  11. Endoscopic Debridement for Treatment of Chronic Plantar Fasciitis: An Innovative Surgical Technique.

    PubMed

    Cottom, James M; Maker, Jared M

    2016-01-01

    Plantar fasciitis is one the most common pathologies seen by foot and ankle surgeons. When nonoperative therapy fails, surgical intervention is warranted. Various surgical procedures are available for the treatment of recalcitrant plantar fasciitis. The most common surgical management typically consists of open versus endoscopic plantar fascia release. The documented comorbidities associated with the release of the plantar fascia include lateral column overload and metatarsalgia. We present a new technique for this painful condition that is minimally invasive, allows visualization of the plantar fascia, and maintains the integrity of this fascia. Our hypothesis was that the use of endoscopic debridement of the plantar fascia would provide a minimally invasive technique with acceptable patient outcomes. PMID:26952313

  12. Heel Pain in Recreational Runners.

    ERIC Educational Resources Information Center

    Bazzoli, Allan S.; Pollina, Frank S.

    1989-01-01

    Provides physicians with the signs, symptoms, and management of heel/sole pain in recreational runners (usually due to plantar fasciitis, Achilles tendinitis, and calcaneal stress fractures). Remedies involve palliative treatment of symptoms, correction of underlying biomechanical problems, and flexibility exercises. (SM)

  13. Spectrum of Ultrasound Pathologies of Achilles Tendon, Plantar Aponeurosis and Flexor Digiti Brevis Tendon Heel Entheses in Patients with Clinically Suspected Enthesitis

    PubMed Central

    Sudoł-Szopińska, Iwona; Zaniewicz-Kaniewska, Katarzyna; Kwiatkowska, Brygida

    2014-01-01

    Summary Background Enthesitis is considered a characteristic presentation of the second most common group of rheumatoid disorders, i.e. spondyloarthropathies (SpAs), particularly peripheral spondyloarthropathies. At the initial stages, enthesitis may be the only symptom of SpA, particularly in patients lacking the HLA-B27 receptor. Material/Methods In light of diagnostic difficulties with detecting enthesitis in clinical examinations and laboratory investigations, many studies point out the high specificity of imaging studies, and particularly ultrasonography. Results A total of 20% Achilles tendon entheses, 45% plantar aponeurosis entheses and 89.5% of flexor digiti brevis tendon entheses were unremarkable. In the remaining cases, the presentation of pathological lesions was not specific to enthesitis and might more likely correspond to degeneration or microinjuries of the entheses, beside the most obvious cases of achillobursitis or Kager’s fat pad inflammation. Conclusions The studies demonstrated that ultrasound scans rarely confirm the clinical diagnosis of enthesitis. PMID:25674194

  14. Orthotics Compared to Conventional Therapy and Other Non-Surgical Treatments for Plantar Fasciitis

    PubMed Central

    Lewis, Rebecca D.; Wright, Paul; McCarthy, Laine H.

    2016-01-01

    Clinical Question In adults with acute plantar fasciitis whose symptoms have not been relieved with the conventional regimen of NSAIDS, stretching and lifestyle modification, do the addition of orthotics (prefabricated or custom fitted) reduce pain and improve function compared with other non-surgical treatments (manipulative chiropractic, physical therapy and/or heel steroid injections)? Answer Yes. Studies have shown that orthotics, both prefabricated and custom fitted, reduce pain and improve function in adults with acute plantar fasciitis with few risks or side effects. Used alone or in addition to conventional therapy (NSAIDs, stretching, lifestyle modification), orthotics are effective and well tolerated by patients for short-term pain relief and improved function. Prefabricated orthotics are less costly and provide similar relief to more expensive custom orthotics. Level of Evidence of the Answer A Search Terms Plantar fasciitis, heel pain, treatment, orthotics, Limits Adult, human, English, Review, Randomized-Control Trials, Systematic Reviews, adults age 18 or more, publication dates 2004 to present. Date Search was Conducted January 16, 2014; updated January 20, 2015 Inclusion Criteria Recent published systematic reviews, randomized controlled, meta-analyses; adults with confirmed acute or recent diagnosis of plantar fasciitis. Exclusion Criteria Studies older than 10 years, children, adolescents less than 18 years of age, chronic or recalcitrant plantar fasciitis. PMID:26855444

  15. Benign anteromedial plantar nodules of childhood: a distinct form of plantar fibromatosis.

    PubMed

    Jacob, C I; Kumm, R C

    2000-01-01

    Plantar fibromatosis is a benign but sometimes locally aggressive proliferation of fibrous tissue that usually arises in adolescence or early adulthood. Pediatric presentation with asymptomatic, bilateral nodules on the anteromedial heel pad may be cause for cosmetic concern, but is otherwise harmless. Awareness and clinical diagnosis of benign anteromedial plantar nodules of childhood will prevent unnecessary and possibly unsuccessful surgery. We present a case of anteromedial plantar nodules and a brief review of the literature. We propose the term "benign anteromedial plantar nodules of childhood" to describe and define this clinically distinctive form of plantar fibromatosis. PMID:11123783

  16. The integration of acetic acid iontophoresis, orthotic therapy and physical rehabilitation for chronic plantar fasciitis: a case study

    PubMed Central

    Costa, Ivano A; Dyson, Anita

    2007-01-01

    A 15-year-old female soccer player presented with chronic plantar fasciitis. She was treated with acetic acid iontophoresis and a combination of rehabilitation protocols, ultrasound, athletic taping, custom orthotics and soft tissue therapies with symptom resolution and return to full activities within a period of 6 weeks. She reported no significant return of symptoms post follow-up at 2 months. Acetic acid iontophoresis has shown promising results and further studies should be considered to determine clinical effectiveness. The combination of acetic acid iontophoresis with conservative treatments may promote recovery within a shorter duration compared to the use of one-method treatment approaches. PMID:17885679

  17. Plantar Cutaneous Sensitivity With and Without Cognitive Loading in People With Chronic Ankle Instability, Copers, and Uninjured Controls.

    PubMed

    Burcal, Christopher J; Wikstrom, Erik A

    2016-04-01

    Study Design Controlled laboratory study. Background Deficits in light touch have recently been identified on the plantar surface of the foot in those with chronic ankle instability (CAI) but not in uninjured controls. It is unknown whether copers display similar deficits. Similarly, cognitive loading has been shown to impact postural control in different populations, but it is unclear how it may impact sensory perception. Objectives To evaluate the difference in cutaneous sensation thresholds at rest and under cognitive loading, using Semmes-Weinstein monofilaments (SWMs), among uninjured controls, copers, and those with CAI. Methods A total of 45 participants (mean ± SD age, 20.2 ± 2.8 years; height, 167.6 ± 9.9 cm; mass, 66.3 ± 14.7 kg) were recruited and categorized to a CAI, coper, or control group, based on Ankle Instability Instrument scores. Participants were assessed with SWMs for cutaneous thresholds using a 4-2-1 stepping algorithm at the head of the first metatarsal, base of the fifth metatarsal, calcaneus, and sinus tarsi. Each participant was then retested while generating random digits to the beat of a metronome in order to simulate cognitive loading. Results Participants with CAI displayed significantly higher SWM thresholds at the head of the first metatarsal, base of the fifth metatarsal, and sinus tarsi than those of the control participants, and significantly higher thresholds at the base of the fifth metatarsal and calcaneus than those of copers (all, P<.05). Copers showed higher thresholds than those of controls at the sinus tarsi only (P<.05). A main effect of cognitive loading was identified at all 4 sites (P<.05). Conclusion People with CAI have deficits in plantar sensation relative to controls and copers. Cognitive loading increases plantar cutaneous sensation thresholds irrespective of CAI status. J Orthop Sports Phys Ther 2016;46(4):270-276. Epub 26 Jan 2016. doi:10.2519/jospt.2016.6351. PMID:26813754

  18. Finite element modelling of radial shock wave therapy for chronic plantar fasciitis.

    PubMed

    Alkhamaali, Zaied K; Crocombe, Andrew D; Solan, Matthew C; Cirovic, Srdjan

    2016-08-01

    Therapeutic use of high-amplitude pressure waves, or shock wave therapy (SWT), is emerging as a popular method for treating musculoskeletal disorders. However, the mechanism(s) through which this technique promotes healing are unclear. Finite element models of a shock wave source and the foot were constructed to gain a better understanding of the mechanical stimuli that SWT produces in the context of plantar fasciitis treatment. The model of the shock wave source was based on the geometry of an actual radial shock wave device, in which pressure waves are generated through the collision of two metallic objects: a projectile and an applicator. The foot model was based on the geometry reconstructed from magnetic resonance images of a volunteer and it comprised bones, cartilage, soft tissue, plantar fascia, and Achilles tendon. Dynamic simulations were conducted of a single and of two successive shock wave pulses administered to the foot. The collision between the projectile and the applicator resulted in a stress wave in the applicator. This wave was transmitted into the soft tissue in the form of compression-rarefaction pressure waves with an amplitude of the order of several MPa. The negative pressure at the plantar fascia reached values of over 1.5 MPa, which could be sufficient to generate cavitation in the tissue. The results also show that multiple shock wave pulses may have a cumulative effect in terms of strain energy accumulation in the foot. PMID:26465270

  19. Ulceroproliferative growth on the heel: epithelioma cuniculatum.

    PubMed

    Rai, Vandana Mehta; Balachandran, C; Kudva, Ranjini

    2006-01-01

    Verrucous papules and plaques on the plantar surfaces should not be assumed to be mere warts, especially if the history is unusual. We present a patient with an ulceroproliferative growth on the heel which was found to represent the epithelioma cuniculatum form of squamous cell carcinoma. PMID:17083863

  20. Mechanical Information of Plantar Fascia during Normal Gait

    NASA Astrophysics Data System (ADS)

    Gu, Yaodong; Li, Zhiyong

    The plantar fascia is an important foot tissue in stabilizing the longitudinal arch of human foot. Direct measurement to monitor the mechanical situation of plantar fascia at human locomotion is difficult. The purpose of this study was to construct a three-dimensional finite element model of the foot to calculate the internal stress/strain value of plantar fascia during different stage of gait. The simulated stress distribution of plantar fascia was the lowest at heel-strike, which concentrated on the medial side of calcaneal tubercle. The peak stress of plantar fascia was appeared at push-off, and the value is more than 5 times of the heel-strike position. Current FE model was able to explore the plantar fascia tension trend at the main sub-phases of foot. More detailed fascia model and intrinsic muscle forces could be developed in the further study.

  1. Narcissistic rage: The Achilles’ heel of the patient with chronic physical illness

    PubMed Central

    Hyphantis, Thomas; Almyroudi, Augustina; Paika, Vassiliki; Goulia, Panagiota; Arvanitakis, Konstantinos

    2009-01-01

    Based on the psychoanalytic reading of Homer’s Iliad whose principal theme is “Achilles’ rage” (the semi-mortal hero invulnerable in all of his body except for his heel, hence “Achilles’ heel” has come to mean a person’s principal weakness), we aimed to assess whether “narcissistic rage” has an impact on several psychosocial variables in patients with severe physical illness across time. In 878 patients with cancer, rheumatological diseases, multiple sclerosis, inflammatory bowel disease, and glaucoma, we assessed psychological distress (SCL-90 and GHQ-28), quality of life (WHOQOL-BREF), interpersonal difficulties (IIP-40), hostility (HDHQ), and defense styles (DSQ). Narcissistic rage comprised DSQ “omnipotence” and HDHQ “extraverted hostility”. Hierarchical multiple regressions analyses were performed. We showed that, in patients with disease duration less than one year, narcissistic rage had a minor impact on psychosocial variables studied, indicating that the rage was rather part of a “normal” mourning process. On the contrary, in patients with longer disease duration, increased rates of narcissistic rage had a great impact on all outcome variables, and the opposite was true for patients with low rates of narcissistic rage, indicating that narcissistic rage constitutes actually an “Achilles’ Heel” for patients with long-term physical illness. These findings may have important clinical implications. PMID:19936167

  2. Baropodometric Evaluations and Sensitivity Alterations in Plantar Ulcer Formation in Leprosy.

    PubMed

    Cordeiro, Thania Loiola; Frade, Marco Andrey Cipriani; Barros, Ana Regina S B; Foss, Norma Tiraboschi

    2014-05-25

    Leprosy is a chronically evolving granulomatous disease caused by the bacillus Mycobacterium leprae, which exhibits tropism for peripheral and motor nerves and slow-growing inflammation that affects the peripheral nervous system, especially the sensory fibers. The aim of this study was to observe the relationship between peak pressure and abnormal sensitivity for the formation of plantar ulcers in patients with multibacillary (MB) and paucibacillary (PB) leprosy. A total of 51 individuals with leprosy were evaluated and classified as either MB or PB and then submitted to the Semmes-Weinstein sensitivity test; 20 normal individuals were examined as a control group and took a baropodometric test. The pressure peaks and sensitivity alterations were noted and compared within groups. Leprosy patients exhibited a greater loss of sensitivity at the heel area that might compromise gait. During dynamic analysis, the MB group with altered sensitivity for right and left feet and PB (left feet) group showed the highest plantar pressure values. Skin damage (calluses or ulcers) did not occur within the areas of high plantar pressure in 80% of MB patients, whereas skin damage was observed in 38% of PB patients in the areas of higher peak pressures. According to these findings, baropodometry and sensitivity tests play an important role in the understanding of ulcer biodynamics. In addition, it could be inferred that the loss of protective sensibility in MB patients is predictive of plantar ulcers, whereas plantar pressure peaks seem to be of greater importance in PB patients. PMID:24861093

  3. Chronic Plantar Fasciitis is Mediated by Local Hemodynamics: Implications for Emerging Therapies

    PubMed Central

    Miller, Larry E.; Latt, Daniel L.

    2015-01-01

    Plantar fasciitis (PF) is a common, disabling condition affecting millions of patients each year. With early diagnosis and timely application of traditional nonsurgical treatments, symptoms generally resolve over time. However, despite adequate treatment, 20% of patients will experience persistent symptoms. In these patients, minimally invasive therapies that augment local hemodynamics to initiate a regenerative tissue-healing cascade have the greatest potential to resolve long-standing symptoms. We performed a narrative review based on a best evidence evaluation of manuscripts published in Medline-indexed journals to determine the mechanisms involved in soft tissue injury and healing. This evaluation also highlights emerging minimally invasive therapies that exploit these mechanisms in recalcitrant PF. PMID:25709971

  4. Calcaneal Plantar Flexion During the Stance Phase of Gait.

    PubMed

    Stamm, Stacy E; Chiu, Loren Z

    2016-04-01

    When the rear- and forefoot are constrained, calcaneal plantar flexion may occur, deforming the longitudinal arch. Previous research has reported calcaneal motion relative to the tibia or forefoot; these joint rotations may not accurately describe rotation of the calcaneus alone. This investigation: (1) characterized the calcaneus and leg segment and ankle joint rotations during stance in gait, and (2) described the range of calcaneal plantar flexion in different structural arch types. Men (n = 14) and women (n = 16) performed gait in a motion analysis laboratory. From heel strike to heel off, the leg rotated forward while the calcaneus plantar flexed. Before foot flat, calcaneal plantar flexion was greater than forward leg rotation, resulting in ankle plantar flexion. After foot flat, forward leg rotation was greater than calcaneal plantar flexion, resulting in ankle dorsiflexion. Structural arch type was classified using the longitudinal arch angle. The range of calcaneal plantar flexion from foot flat to heel off was small in low (-2° to -8°), moderate in high (-3° to -12°), and large in normal (-2° to -20°) structural arches. Calcaneal plantar flexion in gait during midstance may reflect functional arch characteristics, which vary depending on structural arch type. PMID:26398966

  5. [Anteromedial heel pad nodules--a benign condition].

    PubMed

    Marxen, Bent; Bygum, Anette

    2009-08-24

    A 6-month-old girl was referred with plantar tumours noticed a few weeks after birth. The tumours, which were localized on the heels, had grown proportionally with the child. An ultrasonographic examination showed subcutaneous nodules, and she was referred for further dermatologic evaluation. The diagnosis anteromedial heel pad nodules was established clinically. This benign condition has a tendency to spontaneous remission within the first years of life. Knowledge of this benign condition can prevent unnecessary surgical treatment of children. PMID:19732537

  6. Weight-bearing plantar reconstruction using versatile medial plantar sensate flap.

    PubMed

    Oh, Suk Joon; Moon, Mincheol; Cha, Jeongho; Koh, Sung Hoon; Chung, Chul Hoon

    2011-02-01

    The medial plantar flap serves as an ideal tissue reserve for reconstructing the weight-bearing plantar areas as these areas require a sensate and glabrous skin. Furthermore, the flap provides tissue that is structurally similar to the plantar foot as it is also composed of thick glabrous plantar skin, shock-absorbing fibro-fatty subcutaneous tissue and plantar fascia. During the past 25 years, 20 patients (10 men, 10 women) with skin and soft-tissue defects over the weight-bearing plantar foot were treated. They ranged in age from 20 to 70 years (mean, 31.5 years). The causes of the defects were trauma (n=14) and malignant tumour (n=6); the defects were localised at the heel (n=16) and plantar forefoot (n=4). The medial plantar flap was transposed to the defects in three different ways: proximally pedicled sensorial island flaps (n =8), distally pedicled sensate island flaps based on the lateral plantar vessel (n =3) and neurovascular free flaps (n =9). Flap size varied from a width of 4-8cm and a length of 6-12cm. The mean size of the medial plantar flap was 49.5cm(2) (range, 28-96cm(2)). The follow-up period ranged from 6 to 80 months (mean, 19.9 months). Partial flap loss was observed in two proximally pedicled sensorial island flaps and one distally pedicled sensate island flap. Two free flaps restored normal sensation within 5 years of surgery. Minor skin graft loss at the donor site was observed in seven patients. However, no revision or re-grafting was performed. Hyperkeratosis was observed in one case. All patients achieved normal gait within 3 months after surgery and none noticed recurred ulceration. Durable, sensate coverage of the defects was achieved in all patients. We advocate variable sensate medial plantar flaps for the reconstruction of moderate-size defects of the weight-bearing plantar subunits. PMID:20570228

  7. Plantar Fibroma and Plantar Fibromatosis

    MedlinePlus

    ... Contact Us FootCareMD About Us Overview of Foot & Ankle Glossary of Foot & Ankle Terms Adult Foot Health Children's Foot Health The ... During Pregnancy Conditions Currently selected Ailments of the Ankle Ailments of the Midfoot Ailments of the Heel ...

  8. [Controversies over heel pressure ulcers].

    PubMed

    Rueda López, J

    2013-02-01

    Article whose content was exposed in the workshops of the GNEAUPP Congress, held in Seville in November2012, and which refers to ulcers by pressure on the heels as a location exposed to the analysis. A pressure ulcer is a lesion located in skin I underlying tissue usually over a bone prominence, as a result of the pressure, or pressure in combination with the shears. A number of contributing factors or confounding factors are also associated with ulcers by pressure; the importance of these factors still not been elucidated. The heels are next to the sacred area, parts of the body that most frequently presents ulcers by pressure, The importance of the predisposing factors for ulcers in the sacral area as humidity has been studied in recent years, but in heels, remains one of the most important locations in the extremities, which entails adverse outcomes such as amputation in persons with comorbid diseases like Diabetes Mellitus (DM). The incidence of ulcers on heels in patients with DM and without it, is approximately 19-32%. Everything and be a problem associated with elderly people and chronic pathologies, in acute patients are a problem that this underrated, but not devoid of controversy. In hospitals of treble in 2006, the NPUAP encrypted the incidence of UPPin heels in a 43%; in one systematic review conducted by Reddy et al. (2006) puts revealed that 60% of pressure ulcers is produced. The problem of the UPP in heels is present in all the areas of intervention and particularly in paediatric units intensive care, where the first localization it is the occipital area followed by the heels. PMID:23527442

  9. Heel reconstruction with free instep flap: a case report

    PubMed Central

    2014-01-01

    Introduction Reconstruction of weight-bearing heel defects remains a challenge because of the unique characteristics of the plantar skin. Though numerous surgical reconstructive options have been reported, the instep flap represents an ideal option and seems to be more acceptable to patients than others. However, when the heel defect expands to the instep area, the ipsilateral instep is not available for flap elevation. A free instep flap harvested from the contralateral foot can be a good solution, but this method has been scarcely reported. Case presentation A 41-year-old Asian man presented to our institution with a soft-tissue lesion in the weight-bearing heel and instep area. His heel was reconstructed with a free instep flap from the other foot, end-to-side anastomosis of its medial plantar artery to the recipient posterior tibial artery and end-to-side coaptation of the cutaneous sensory fascicles of the flap to the medial plantar nerve. Conclusion The flap survived successfully, and no ulceration occurred in the flap. At the last follow-up appointment at 30 months post-surgery, a very good functional and aesthetic outcome was verified, indicating that the suggested approach may prove to be the treatment of choice in selected cases of weight-bearing heel reconstruction. PMID:25260532

  10. Randomized, Multicenter Trial on the Effect of Radiation Therapy on Plantar Fasciitis (Painful Heel Spur) Comparing a Standard Dose With a Very Low Dose: Mature Results After 12 Months' Follow-Up

    SciTech Connect

    Niewald, Marcus; Micke, Oliver; Graeber, Stefan; Schaefer, Vera; Scheid, Christine; Fleckenstein, Jochen; Licht, Norbert; Ruebe, Christian

    2012-11-15

    Purpose: To conduct a randomized trial of radiation therapy for painful heel spur, comparing a standard dose with a very low dose. Methods and Materials: Sixty-six patients were randomized to receive radiation therapy either with a total dose of 6.0 Gy applied in 6 fractions of 1.0 Gy twice weekly (standard dose) or with a total dose of 0.6 Gy applied in 6 fractions of 0.1 Gy twice weekly (low dose). In all patients lateral opposing 4- to 6-MV photon beams were used. The results were measured using a visual analogue scale, the Calcaneodynia score, and the SF12 health survey. The fundamental phase of the study ended after 3 months, and the follow-up was continued up to 1 year. Patients with insufficient pain relief after 3 months were offered reirradiation with the standard dosage at any time afterward. Results: Of 66 patients, 4 were excluded because of withdrawal of consent or screening failures. After 3 months the results in the standard arm were highly significantly superior compared with those in the low-dose arm (visual analogue scale, P=.001; Calcaneodynia score, P=.027; SF12, P=.045). The accrual of patients was stopped at this point. Further evaluation after 12 months' follow-up showed the following results: (1) highly significant fewer patients were reirradiated in the standard arm compared with the low-dose arm (P<.001); (2) the results of patients in the low-dose arm who were reirradiated were identical to those in the standard arm not reirradiated (reirradiation as a salvage therapy if the lower dose was ineffective); (3) patients experiencing a favorable result after 3 months showed this even after 12 months, and some results even improved further between 3 and 12 months. Conclusions: This study confirms the superior analgesic effect of radiation therapy with 6-Gy doses on painful heel spur even for a longer time period of at least 1 year.

  11. Regional plantar pressure during walking, stair ascent and descent.

    PubMed

    Rao, Smita; Carter, Sylvester

    2012-06-01

    Regional plantar pressures during stair walking may be injurious in at risk populations. However, limited data are available examining the reliability of plantar pressure data collected during stair walking. The aims of this study were three fold; to assess the reliability of the plantar pressure data recorded during stair walking, to assess the effects of level ground and stair walking on plantar loading, and to develop regression equations to predict regional plantar pressures in stair walking from those collected on level ground. Fifteen subjects without conditions affecting their ability to walk on level surfaces or stairs were recruited. Each participant performed at least 10 steps in level ground and stair walking while plantar pressure data were recorded in six foot regions. Reliability was assessed using Intraclass Correlation Coefficient. A repeated measures ANOVA was used to assess the effect of activity on plantar pressure, and a linear regression was used to predict forefoot loading during stair walking. A reliability of 0.9 was achieved within 10 steps in all foot regions, with the forefoot requiring fewer steps. Plantar pressures were influenced by both, foot region and activity, with the heel and forefoot regions generally experiencing lower peak pressures and maximal forces during stair walking than level ground walking. The regression equations predicting peak pressure during stair walking accounted for between 37% and 70% of the variance of the stair walking data. These findings establish the reliability of plantar pressure data collected during stair walking. Future studies should investigate these parameters in clinical populations. PMID:22537610

  12. Bursitis of the heel

    MedlinePlus

    ... by the heel. It is where the large Achilles tendon connects the calf muscles to the heel ... jumping. This condition is very often linked to Achilles tendinitis . Sometimes retrocalcaneal bursitis may be mistaken for ...

  13. Plantar Pressure Distribution Patterns of Individuals with Prediabetes in Comparison with Healthy Individuals and Individuals with Diabetes

    PubMed Central

    Robinson, Caroline Cabral; Balbinot, Luciane Fachin; Silva, Marcelo Faria; Achaval, Matilde; Zaro, Milton Antônio

    2013-01-01

    Background Since elevated mechanical stress along with loss of plantar protective sensation are considered relevant factors in skin breakdown resulting in diabetic foot ulcerations, the assessment of plantar pressure is important for the prevention of diabetic foot complications. Prediabetes subjects are at risk of chronic hyperglycemia complications, among them neuropathy, but information about plantar loading in this population is not available. We aimed to compare baropodometric parameters of individuals with prediabetes versus healthy persons and persons with diabetes mellitus (DM). Methods Baropodometric data from 73 subjects (15 with prediabetes (pre-DM), 28 with type 2 DM, 30 healthy) aged between 29 and 69 years of both genders were registered through a pressure platform with self-selected gait speed and first-step protocol. Peak plantar pressure, stance time, percentage of contact time, percentage of contact area and pressure-time integral were assessed in five plantar foot regions: heel, midfoot, metatarsals, hallux, and toes 2 to 5. Groups were compared by one-way analysis of variance with Scheffé post hoc (α = 0.05). Results Age, body mass index, gender, and arch height index did not differ between groups. Pre-DM and DM subjects presented increased peak pressure and pressure-time integral in metatarsals (p = .010; p > .001), as well as increased percentage of contact time in midfoot (p = .006) and metatarsals (p = .004) regions when compared with healthy subjects. Stance time was significantly higher (p = .017) in DM subjects. Conclusions Pre-DM subjects seem to exhibit an altered plantar pressure distribution pattern similar to that often found in DM subjects. PMID:24124936

  14. The effects of fatigue on plantar pressure distribution in walking.

    PubMed

    Bisiaux, M; Moretto, P

    2008-11-01

    The purpose of this study was to assess plantar pressure deviations due to fatigue. Plantar pressure was assessed using a portable system while eleven healthy subjects performed three walking tests, one before, one immediately after and another 30-min after intensive running. Pressure peak, intra-subject coefficient of variation and relative impulse were recorded. Significant decrease in pressure peak and the relative impulse under the heel and the midfoot along with significant increase in pressure peak and relative impulse under the forefoot were observed 30 min after the run. After a 30-min rest, the heel and forefoot loading remained significantly affected compared to the pre-test conditions while variability, step length and frequency remained unchanged. The study demonstrates short- and long-term plantar pressure deviations due to fatigue induced by an intensive 30-min run, while previous studies showed negligible deviation of the ground reaction force. PMID:18586495

  15. Biomechanical evaluation of heel elevation on load transfer — experimental measurement and finite element analysis

    NASA Astrophysics Data System (ADS)

    Luximon, Yan; Luximon, Ameersing; Yu, Jia; Zhang, Ming

    2012-02-01

    In spite of ill-effects of high heel shoes, they are widely used for women. Hence, it is essential to understand the load transfer biomechanics in order to design better fit and comfortable shoes. In this study, both experimental measurement and finite element analysis were used to evaluate the biomechanical effects of heel height on foot load transfer. A controlled experiment was conducted using custom-designed platforms. Under different weight-bearing conditions, peak plantar pressure, contact area and center of pressure were analyzed. A three-dimensional finite element foot model was used to simulate the high-heel support and to predict the internal stress distributions and deformations for different heel heights. Results from both experiment and model indicated that heel elevations had significant effects on all variables. When heel elevation increased, the center of pressure shifted from the midfoot region to the forefoot region, the contact area was reduced by 26% from 0 to 10.2 cm heel and the internal stress of foot bones increased. Prediction results also showed that the strain and total tension force of plantar fascia was minimum at 5.1 cm heel condition. This study helps to better understand the biomechanical behavior of foot, and to provide better suggestions for design parameters of high heeled shoes.

  16. Children with ADHD Show No Deficits in Plantar Foot Sensitivity and Static Balance Compared to Healthy Controls

    ERIC Educational Resources Information Center

    Schlee, Gunther; Neubert, Tom; Worenz, Andreas; Milani, Thomas L.

    2012-01-01

    The goal of this study was to investigate plantar foot sensitivity and balance control of ADHD (n = 21) impaired children compared to age-matched healthy controls (n = 25). Thresholds were measured at 200 Hz at three anatomical locations of the plantar foot area of both feet (hallux, first metatarsal head (METI) and heel). Body balance was…

  17. Explicit finite element modelling of heel pad mechanics in running: inclusion of body dynamics and application of physiological impact loads.

    PubMed

    Chen, Wen-Ming; Lee, Peter Vee-Sin

    2015-01-01

    Many heel pathologies including plantar heel pain may result from micro tears/trauma in the subcutaneous tissues, in which internal tissue deformation/stresses within the heel pad play an important role. Previously, many finite element models have been proposed to evaluate stresses inside the heel pad, but the majority of these models only focus on static loading boundary conditions. This study explored a dynamics modelling approach to the heel pad subjected to realistic impact loads during running. In this model, the inertial property and action of the body are described by a lumped parameter model, while the heel/shoe interactions are modelled using a viscoelastic heel pad model with contact properties. The impact force pattern, dynamic heel pad deformation and stress states predicted by the model were compared with published experimental data. Further parametrical studies revealed the model responses, in terms of internal stresses in the skin and fatty tissue, change nonlinearly when body dynamics changes. A reduction in foot's touchdown velocity resulted in a less severe impact landing and stress relief inside the heel pad, for example peak von-Mises stress in fatty tissue, was reduced by 11.3%. Applications of the model may be extendable to perform iterative analyses to further understand the complex relationships between body dynamics and stress distributions in the soft tissue of heel pad during running. This may open new opportunities to study the mechanical aetiology of plantar heel pain in runners. PMID:24980181

  18. Identification of Foot Pathologies Based on Plantar Pressure Asymmetry

    PubMed Central

    Wafai, Linah; Zayegh, Aladin; Woulfe, John; Aziz, Syed Mahfuzul; Begg, Rezaul

    2015-01-01

    Foot pathologies can negatively influence foot function, consequently impairing gait during daily activity, and severely impacting an individual’s quality of life. These pathologies are often painful and correspond with high or abnormal plantar pressure, which can result in asymmetry in the pressure distribution between the two feet. There is currently no general consensus on the presence of asymmetry in able-bodied gait, and plantar pressure analysis during gait is in dire need of a standardized method to quantify asymmetry. This paper investigates the use of plantar pressure asymmetry for pathological gait diagnosis. The results of this study involving plantar pressure analysis in fifty one participants (31 healthy and 20 with foot pathologies) support the presence of plantar pressure asymmetry in normal gait. A higher level of asymmetry was detected at the majority of the regions in the feet of the pathological population, including statistically significant differences in the plantar pressure asymmetry in two regions of the foot, metatarsophalangeal joint 3 (MPJ3) and the lateral heel. Quantification of plantar pressure asymmetry may prove to be useful for the identification and diagnosis of various foot pathologies. PMID:26295239

  19. Examining the degree of pain reduction using a multielement exercise model with a conventional training shoe versus an ultraflexible training shoe for treating plantar fasciitis.

    PubMed

    Ryan, Michael; Fraser, Scott; McDonald, Kymberly; Taunton, Jack

    2009-12-01

    Plantar fasciitis is a common injury to the plantar aponeurosis, manifesting as pain surrounding its proximal insertion at the medial calcaneal tubercle. Pain is typically worse in the morning when getting out of bed, and may subside after the tissue is sufficiently warmed up. For running-based athletes and individuals who spend prolonged periods of time on their feet at work, plantar fasciitis may become recalcitrant to conservative treatments such as ice, rest, and anti-inflammatory medication. Exercise-based therapies have received only limited attention in the literature for this common problem, yet they are becoming increasingly validated for pain relief and positive tissue remodeling at other sites of similar soft-tissue overuse injury. This study reports on pain outcomes in individuals experiencing chronic plantar fasciitis while wearing a shoe with an ultraflexible midsole (Nike Free 5.0) (FREE) versus a conventional training (CON) shoe in a 12-week multielement exercise regimen, and after a 6-month follow-up. Adults with >or= 6-month history of painful heel pain were recruited and randomly assigned to wear 1 of the 2 shoes. All subjects completed the same exercise protocol. A visual analogue scale item tracked peak pain in the preceding 24 hours taken at baseline, 6- and 12-week points, and at the 6-month follow-up. Twenty-one subjects completed the program (9 FREE; 12 CON). Both groups reported significant improvements in pain by the 6-month follow-up, and the FREE group reported an overall reduced level of pain throughout the study as a result of lower mean pain scores at the midpoint and post-test compared with the CON group. The exercise regimen employed in this study appears to reduce pain associated with chronic plantar fasciitis, and in doing so, the Nike 5.0 shoe may result in reductions in pain earlier than conventional running shoes. PMID:20048543

  20. Effect of Field Size and Length of Plantar Spur on Treatment Outcome in Radiation Therapy of Plantar Fasciitis: The Bigger the Better?

    SciTech Connect

    Hermann, Robert Michael; Meyer, Andreas; Reible, Michael; Carl, Ulrich Martin; Nitsche, Mirko

    2013-12-01

    Purpose: Radiation therapy is well established in the treatment of painful plantar fasciitis or heel spur. A retrospective analysis was conducted to investigate the effect of field definition on treatment outcome and to determine the impact of factors potentially involved. Methods and Materials: A review of treatment data of 250 patients (285 heels) with a mean follow-up time of 11 months showed that complete symptom remission occurred in 38%, partial remission in 32%, and no change in 19% (11% were lost to follow-up). Variables such as radiologic evidence of plantar spurs, their length, radiation dose, field size, age, sex, and onset of pain before administration of radiation therapy were investigated in univariate and multivariate regression analyses. Results: Treatment response depended upon age >53 years, length of heel spur ≤6.5 mm (or no radiologic evidence of a heel spur), and onset of pain <12 months before radiation therapy. Patients with these clinical prerequisites stood a 93% chance of clinical response. Without these prerequisites, only 49% showed any impact. No influence of field size on treatment outcome became evident. Conclusion: Patients with short plantar heel spurs benefit from radiation therapy equally well as patients without any radiologic evidence. Moreover, smaller field sizes have the same positive effect as commonly used large field definitions covering the entire calcaneal bone. This leads to a recommendation of a considerable reduction of field size in future clinical practice.

  1. Slip-Related Changes in Plantar Pressure Distribution, and Parameters for Early Detection of Slip Events

    PubMed Central

    Choi, Seungyoung; Cho, Hyungpil; Kang, Boram; Lee, Dong Hun; Kim, Mi Jung

    2015-01-01

    Objective To investigate differences in plantar pressure distribution between a normal gait and unpredictable slip events to predict the initiation of the slipping process. Methods Eleven male participants were enrolled. Subjects walked onto a wooden tile, and two layers of oily vinyl sheet were placed on the expected spot of the 4th step to induce a slip. An insole pressure-measuring system was used to monitor plantar pressure distribution. This system measured plantar pressure in four regions (the toes, metatarsal head, arch, and heel) for three events: the step during normal gait; the recovered step, when the subject recovered from a slip; and the uncorrected, harmful slipped step. Four variables were analyzed: peak pressure (PP), contact time (CT), the pressure-time integral (PTI), and the instant of peak pressure (IPP). Results The plantar pressure pattern in the heel was unique, as compared with other parts of the sole. In the heel, PP, CT, and PTI values were high in slipped and recovered steps compared with normal steps. The IPP differed markedly among the three steps. The IPPs in the heel for the three events were, in descending order (from latest to earliest), slipped, recovered, and normal steps, whereas in the other regions the order was normal, recovered, and slipped steps. Finally, the metatarsal head-to-heel IPP ratios for the normal, recovered, and slipped steps were 6.1±2.9, 3.1±3.0, and 2.2±2.5, respectively. Conclusion A distinctive plantar pressure pattern in the heel might be useful for early detection of a slip event to prevent slip-related injuries. PMID:26798603

  2. Distally Based Abductor Hallucis Adipomuscular Flap for Forefoot Plantar Reconstruction.

    PubMed

    Lee, Sanglim; Kim, Min Bom; Lee, Young Ho; Baek, Jeong Kook; Baek, Goo Hyun

    2015-09-01

    Soft tissue and bone defects of the lower leg, ankle, and heel region often require coverage by local or distant flaps. The authors successfully used the distally based adipomuscular abductor hallucis flap for the treatment of 7 patients with soft tissue defect on the plantar forefoot after diabetic ulcer (n = 2), excision of melanoma at the medial forefoot (n = 3), and posttraumatic defects of the plantar forefoot (n = 2). The size of the defects ranged from 6 to 36 cm. All defects were covered successfully without major complications. The distally based adipomuscular flap from the abductor hallucis muscle provides a reliable coverage for small and moderate defects of the plantar and medial forefoot. This flap is often preferable to the use of free flaps because the surgery is rapidly performed and does not require microsurgical expertise. PMID:25565013

  3. Plantar Wart (Verruca Plantaris)

    MedlinePlus

    ... Wart (Verruca Plantaris) Text Size Print Bookmark Plantar Wart (Verruca Plantaris) What is a Plantar Wart? A wart is a small growth on the skin that ... when the skin is infected by a virus. Warts can develop anywhere on the foot, but typically ...

  4. Plantar fascia (image)

    MedlinePlus

    The plantar fascia is a very thick band of tissue that covers the bones on the bottom of the foot. It ... band of tissue causes a high arch. This fascia can become inflamed and painful in some people, ...

  5. Heel Injuries and Disorders

    MedlinePlus

    ... bone and the tissues that surround it. That stress can come from Injuries Bruises that you get walking, running or jumping ... tissues that surround your heel. Over time the stress can cause bone spurs and ... exercises, taping, and special shoes. Surgery is rarely needed.

  6. Diabetic foot ulcer incidence in relation to plantar pressure magnitude and measurement location☆,☆☆,★

    PubMed Central

    Ledoux, William R.; Shofer, Jane B.; Cowley, Matthew S.; Ahroni, Jessie H.; Cohen, Victoria; Boyko, Edward J.

    2014-01-01

    Aims We prospectively examined the relationship between site-specific peak plantar pressure (PPP) and ulcer risk. Researchers have previously reported associations between diabetic foot ulcer and elevated plantar foot pressure, but the effect of location-specific pressures has not been studied. Methods Diabetic subjects (n = 591) were enrolled from a single VA hospital. Five measurements of in-shoe plantar pressure were collected using F-Scan. Pressures were measured at 8 areas: heel, lateral midfoot, medial midfoot, first metatarsal, second through fourth metatarsal, fifth metatarsal, hallux, and other toes. The relationship between incident plantar foot ulcer and PPP or pressure–time integral (PTI) was assessed using Cox regression. Results During follow-up (2.4 years), 47 subjects developed plantar ulcers (10 heel, 12 metatarsal, 19 hallux, 6 other). Overall mean PPP was higher for ulcer subjects (219 vs. 194 kPa), but the relationship differed by site (the metatarsals with ulcers had higher pressure, while the opposite was true for the hallux and heel). A statistical analysis was not performed on the means, but hazard ratios from a Cox survival analysis were nonsignificant for PPP across all sites and when adjusted for location. However, when the metatarsals were considered separately, higher baseline PPP was significantly associated with greater ulcer risk; at other sites, this relationship was nonsignificant. Hazard ratios for all PTI data were nonsignificant. Conclusions Location must be considered when assessing the relationship between PPP and plantar ulceration. PMID:24012295

  7. Orthotic Heel Wedges Do Not Alter Hindfoot Kinematics and Achilles Tendon Force During Level and Inclined Walking in Healthy Individuals.

    PubMed

    Weinert-Aplin, Robert A; Bull, Anthony M; McGregor, Alison H

    2016-04-01

    Conservative treatments such as in-shoe orthotic heel wedges to treat musculoskeletal injuries are not new. However, weak evidence supporting their use in the management of Achilles tendonitis suggests the mechanism by which these heel wedges works remains poorly understood. It was the aim of this study to test the underlying hypothesis that heel wedges can reduce Achilles tendon load. A musculoskeletal modeling approach was used to quantify changes in lower limb mechanics when walking due to the introduction of 12-mm orthotic heel wedges. Nineteen healthy volunteers walked on an inclinable walkway while optical motion, force plate, and plantar pressure data were recorded. Walking with heel wedges increased ankle dorsiflexion moments and reduced plantar flexion moments; this resulted in increased peak ankle dorsiflexor muscle forces during early stance and reduced tibialis posterior and toe flexor muscle forces during late stance. Heel wedges did not reduce overall Achilles tendon force during any walking condition, but did redistribute load from the medial to lateral triceps surae during inclined walking. These results add to the body of clinical evidence confirming that heel wedges do not reduce Achilles tendon load and our findings provide an explanation as to why this may be the case. PMID:26502456

  8. [Plantar fibromatosis (Ledderhose's disease)].

    PubMed

    Koudela, K; Koudela, K; Kunešová, M; Koudelová, J

    2010-08-01

    The authors describe the concomitant presence of plantar fibromatosis and Dupuytren's disease in a 33-year-old man. A lesion located under the sesamoid bones of the first metatarsophalangeal joint on the right showed an aggressive tendency (rapid growth, pain, impossibility to put weight on the medial side of the foot). Another lesion located proximal to the first one was smaller and painless. Neither plain radiography nor computed tomography showed any structural changes of the skeleton. Contrast-enhancement on magnetic resonance imaging revealed two lesions on the sole of the foot. Since a concurrence of plantar fibromatosis and malignant tumour could not be ruled out, an excision of both lesions and the adjacent plantar aponeurosis was made for biopsy examination. The operative procedure was carried out from two incisions.The intra-operative findings included proliferative growth and bleeding in the lesion located under the first metatarsophalangeal joint, and delimited growth without noticeable bleeding in the other lesion. Based on histological examination, the diagnosis of plantar fibromatosis was made for both lesions.The differential diagnosis and therapy of plantar fibromatosis is discussed. PMID:21059334

  9. Plantar pressures in individuals with normal and pronated feet according to static squat depths

    PubMed Central

    Koh, Da Hyun; Lee, Jong Dae; Kim, Kyoung

    2015-01-01

    [Purpose] The purpose of the present study was to investigate differences in plantar pressure between individuals with normal and pronated feet according to 3 static squat depths. [Subjects and Methods] Study subjects were 10 young adults with normal and pronated feet. Plantar pressures were measured in the standing position and static squat positions at 45° (semi-squat) and 90° (half-squat) knee flexion using the F-Mat. Subjects’ plantar pressures were analyzed by dividing the foot into 4 areas: forefoot medial, forefoot lateral, midfoot, and heel. [Results] In the half-squat position, the pronated foot group showed a higher foot pressure in the forefoot medial than was seen in the normal group, whereas the normal group exhibited a higher foot pressure in the heel than was seen in the pronated foot group. [Conclusion] An increase in squat depth led to the transfer of plantar pressure to the heel in normal feet and to the forefoot medial in pronated feet. PMID:26504304

  10. Talalgia: plantar fasciitis☆

    PubMed Central

    Cardenuto Ferreira, Ricardo

    2014-01-01

    Plantar fasciitis is a very common painful syndrome, but its exact etiology still remains obscure. The diagnosis is essentially clinical, based on history-taking and physical examination. Complementary laboratory tests and imaging examinations may be useful for differential diagnoses. The treatment is essentially conservative, with a high success rate (around 90%). The essence of the conservative treatment is the home-based program of exercises to stretch the plantar fascia. Indications for surgical treatment are only made when the symptoms persist without significant improvement, after at least six months of conservative treatment supervised directly by the doctor. PMID:26229803

  11. Plantar Hyperhidrosis: An Overview.

    PubMed

    Vlahovic, Tracey C

    2016-07-01

    Plantar hyperhidrosis, excessive sweating on the soles of feet, can have a significant impact on patients' quality of life and emotional well-being. Hyperhidrosis is divided into primary and secondary categories, depending on the cause of the sweating, with plantar hyperhidrosis typically being primary and idiopathic. There is an overall increased risk of cutaneous infection in the presence of hyperhidrosis, including fungal, bacterial, and viral infections. This article discusses a range of treatment options including topical aluminum chloride, iontophoresis, injectable botulinum toxin A, glycopyrrolate, oxybutynin, laser, and endoscopic lumbar sympathectomy. Lifestyle changes regarding hygiene, shoe gear, insoles, and socks are also discussed. PMID:27215162

  12. Objective assessment of corticosteroid effect in plantar fasciitis: additional utility of ultrasound

    PubMed Central

    Moustafa, Asmaa Mahmoud Ali; Hassanein, Eshrak; Foti, Calogero

    2015-01-01

    Summary Background although plantar fascia thickening is well documented as a sonographic criterion for the diagnosis of plantar fasciitis (PF), however it was less evaluated as an objective measure of response to treatment. It is unknown to what extent if any different responses to different treatments are related to the ultrasound (US) morphology changes. We aimed to evaluate changes in US findings in correlation to pain reported. Methods this prospective observational trial included 21 plantar fasciitis patients (26 feet), resistant to conservative treatment for at least 2 months. Plantar fascia thickness and echogenicity were evaluated, compared to asymptomatic feet and correlated with visual analogue scale (VAS) and Heel Tenderness Index (HTI), before and after dexam-ethasone (DXM) iontophoresis in group I, and DXM injection in group II. Results increased thickness and reduced echogenicity were constant in symptomatic feet, with high statistical significant difference compared to asymptomatic side. Correlation between plantar fascia thickness with VAS and HTI before and after treatment showed statistically significant positive correlation (p<0.05). ROC curve test showed that reduction of plantar fascia thickness by US in response to DXM had 100% sensitivity, 65.2% specificity and 69% accuracy, with higher specificity and accuracy than VAS. Conclusion US changes showed concurrent validity correlated with self-reported clinical improvement. Accordingly, ultrasound can be considered an objective useful tool for monitoring response to corticosteroid in patients with plantar fasciitis. PMID:26958538

  13. Heel Pain in the Athlete

    PubMed Central

    Hunt, Kenneth John; Anderson, Robert B.

    2009-01-01

    Context: Heel pain, a relatively common problem in the athlete, can present a diagnostic and therapeutic dilemma. The purpose of this article is to review treatment techniques for common causes of heel pain in the athlete. Evidence Acquisition: Articles in the English literature through August 2008 were selected and reviewed in the context of the management of heel pain in the athlete. Clinical and surgical photographs are presented as an illustration of preferred techniques and pertinent pathologic findings. Results: Although nonoperative treatment remains the mainstay for most painful heel pathologies, a number of surgical interventions have shown encouraging results in carefully selected patients. Conclusions: The management of heel pain in the athlete requires diagnostic skill, appropriate imaging evaluation, and a careful, initially conservative approach to treatment. Surgical treatment can be successful in carefully selected patients. PMID:23015903

  14. Rearward movement of the heel at heel strike.

    PubMed

    McGorry, Raymond W; Chang, Chien-Chi; DiDomenico, Angela

    2008-11-01

    This paper describes the observation of rearward movement (RM) of the heel following heel strike occurring during normal gait. Thirty-one participants recruited as part of a larger study on slip kinematics walked the length of an 8-m runway at a speed of 1.5 m/s. Several floor surfaces, presented dry and with contaminant, were used for the purpose of eliciting a wide range of small slip distances. The normal force applied to a forceplate mounted in the runway was used to identify heel strike, as well as to calculate the utilized coefficient of friction during early stance phase. A motion analysis system tracked the displacement of two heel-mounted markers, and the data were used to derive kinematic variables related to the heel strike event. Results showed that RMs occurred in 18.1% of 494 trials, with a mean rearward displacement of 5.02 (+/-3.68) mm. When present, RMs occurred in close temporal proximity to heel strike, typically completing RM within 40 ms of the heel strike event. When divided into groups by age, older participants (>40 years) were more than twice as likely to have RMs as younger participants. When grouped by height or weight, differences in the proportion of trials with RMs were small. In trials where RMs were observed, forward slip distances were significantly less than for trials with no RMs, 2.17 (+/-3.87) mm vs. 12.58 (+/-10.71) mm, respectively. The time until the heel stopped moving during the post-heel strike period was not significantly different between RM and non-RM trials. Further investigation of this gait feature may improve understanding of normal gait patterns and may have implications for future slipmeter development. PMID:18280459

  15. Long-term complications of reconstruction of the heel using a digitorum brevis muscle flap.

    PubMed

    Furukawa, M; Nakagawa, K; Hamada, T

    1993-04-01

    Seven patients who had surgery for malignant skin tumors of the heel were followed up for several years. The reconstructive procedure performed was repair of the large skin defect after excision of a tumor, by using a flexor digitorum brevis muscle flap and an overlying free graft. Although this procedure is a good method without any serious complications, no long-term follow-up data supporting this opinion have been reported. In this study, plantar flexion of the toes and flattening of the plantar arch appeared 3 months after surgery and developed for 1 year, and the patients complained of easy fatigability in walking and difficulty in going up stairs. These sequelae were probably due to sacrifice of the flexor digitorum brevis muscle. We feel that this procedure should be replaced by another procedure that does not sacrifice any muscle, for example, that using a medial plantar flap. PMID:8512293

  16. Comparison of custom and prefabricated orthoses in the initial treatment of proximal plantar fasciitis.

    PubMed

    Pfeffer, G; Bacchetti, P; Deland, J; Lewis, A; Anderson, R; Davis, W; Alvarez, R; Brodsky, J; Cooper, P; Frey, C; Herrick, R; Myerson, M; Sammarco, J; Janecki, C; Ross, S; Bowman, M; Smith, R

    1999-04-01

    Fifteen centers for orthopaedic treatment of the foot and ankle participated in a prospective randomized trial to compare several nonoperative treatments for proximal plantar fasciitis (heel pain syndrome). Included were 236 patients (160 women and 76 men) who were 16 years of age or older. Most reported duration of symptoms of 6 months or less. Patients with systemic disease, significant musculoskeletal complaints, sciatica, or local nerve entrapment were excluded. We randomized patients prospectively into five different treatment groups. All groups performed Achilles tendon- and plantar fascia-stretching in a similar manner. One group was treated with stretching only. The other four groups stretched and used one of four different shoe inserts, including a silicone heel pad, a felt pad, a rubber heel cup, or a custom-made polypropylene orthotic device. Patients were reevaluated after 8 weeks of treatment. The percentages improved in each group were: (1) silicone insert, 95%; (2) rubber insert, 88%; (3) felt insert, 81%; (4)stretching only, 72%; and (5) custom orthosis, 68%. Combining all the patients who used a prefabricated insert, we found that their improvement rates were higher than those assigned to stretching only (P = 0.022) and those who stretched and used a custom orthosis (P = 0.0074). We conclude that, when used in conjunction with a stretching program, a prefabricated shoe insert is more likely to produce improvement in symptoms as part of the initial treatment of proximal plantar fasciitis than a custom polypropylene orthotic device. PMID:10229276

  17. A three-dimensional inverse finite element analysis of the heel pad.

    PubMed

    Chokhandre, Snehal; Halloran, Jason P; van den Bogert, Antonie J; Erdemir, Ahmet

    2012-03-01

    Quantification of plantar tissue behavior of the heel pad is essential in developing computational models for predictive analysis of preventive treatment options such as footwear for patients with diabetes. Simulation based studies in the past have generally adopted heel pad properties from the literature, in return using heel-specific geometry with material properties of a different heel. In exceptional cases, patient-specific material characterization was performed with simplified two-dimensional models, without further evaluation of a heel-specific response under different loading conditions. The aim of this study was to conduct an inverse finite element analysis of the heel in order to calculate heel-specific material properties in situ. Multidimensional experimental data available from a previous cadaver study by Erdemir et al. ("An Elaborate Data Set Characterizing the Mechanical Response of the Foot," ASME J. Biomech. Eng., 131(9), pp. 094502) was used for model development, optimization, and evaluation of material properties. A specimen-specific three-dimensional finite element representation was developed. Heel pad material properties were determined using inverse finite element analysis by fitting the model behavior to the experimental data. Compression dominant loading, applied using a spherical indenter, was used for optimization of the material properties. The optimized material properties were evaluated through simulations representative of a combined loading scenario (compression and anterior-posterior shear) with a spherical indenter and also of a compression dominant loading applied using an elevated platform. Optimized heel pad material coefficients were 0.001084 MPa (μ), 9.780 (α) (with an effective Poisson's ratio (ν) of 0.475), for a first-order nearly incompressible Ogden material model. The model predicted structural response of the heel pad was in good agreement for both the optimization (<1.05% maximum tool force, 0.9% maximum tool displacement) and validation cases (6.5% maximum tool force, 15% maximum tool displacement). The inverse analysis successfully predicted the material properties for the given specimen-specific heel pad using the experimental data for the specimen. The modeling framework and results can be used for accurate predictions of the three-dimensional interaction of the heel pad with its surroundings. PMID:22482682

  18. Extracorporeal shock wave therapy of gastroc-soleus trigger points in patients with plantar fasciitis: A randomized, placebo-controlled trial

    PubMed Central

    Moghtaderi, Alireza; Khosrawi, Saeid; Dehghan, Farnaz

    2014-01-01

    Background: Plantar fasciitis is the most common cause of heel pain. Extracorporeal shock wave therapy (ESWT) is an alternative treatment for refractory cases of plantar fasciitis. Studies also demonstrated that ESWT may be an appropriate treatment for myofascial trigger points. This study was designed to evaluate its effectiveness by comparing the ESWT of Gastrocnemius/Soleus (gastroc-soleus) trigger points and heel region with the ESWT of the heel region alone. Materials and Methods: The study was carried out among 40 patients with a clinical diagnosis of plantar fasciitis, divided randomly to case (n = 20) and control (n = 20) groups. The case group received ESWT for the heel region and for the gastroc-soleus trigger points. The control group received ESWT just for the heel region. The protocol was the same in both groups and they were treated for three sessions every week. The pain score (100 mm visual analog score [VAS]) and the modified Roles and Maudsley score was evaluated before the first session and eight weeks after the last session. Results: Eight weeks after the last session, although the mean VAS had decreased significantly in both groups, this decrement was more significant in the case group. (P = 0.04). According to the modified Roles and Maudsley score, there was a significant improvement in both the case (P < 0.001) and control (P = 0.01) groups, eight weeks after treatment, but there were significantly better results in the case group. Conclusion: The combination of ESWT for both plantar fasciitis and gastroc-soleus trigger points in treating patients with plantar fasciitis is more effective than utilizing it solely for plantar fasciitis. PMID:24800188

  19. Plantar fibromatosis of the foot.

    PubMed

    Wu, K K

    1994-01-01

    Plantar fibromatosis may be symptomatic or asymptomatic. The stage of the lesion determines its physical appearance. Differential diagnoses among several other soft tissue lesions is important and presented by the author. He further illustrates and discusses plantar fibromatosis according to its clinical and perioperative characteristics. PMID:8162002

  20. High Heels Increase Women's Attractiveness.

    PubMed

    Guéguen, Nicolas

    2015-11-01

    Research has found that the appearance of women's apparel helps increase their attractiveness as rated by men and that men care more about physical features in potential opposite-sex mates. However, the effect of sartorial appearance has received little interest from scientists. In a series of studies, the length of women's shoe heels was examined. A woman confederate wearing black shoes with 0, 5, or 9 cm heels asked men for help in various circumstances. In Study 1, she asked men to respond to a short survey on gender equality. In Study 2, the confederate asked men and women to participate in a survey on local food habit consumption. In Study 3, men and women in the street were observed while walking in back of the female confederate who dropped a glove apparently unaware of her loss. It was found that men's helping behavior increased as soon as heel length increased. However, heel length had no effect on women's helping behavior. It was also found that men spontaneously approached women more quickly when they wore high-heeled shoes (Study 4). Change in gait, foot-size judgment, and misattribution of sexiness and sexual intent were used as possible explanations. PMID:25408499

  1. Acupuncture Treatment for Plantar Fasciitis: A Randomized Controlled Trial with Six Months Follow-Up

    PubMed Central

    Zhang, Shi Ping; Yip, Tsui-Pik; Li, Qiu-Shi

    2011-01-01

    Plantar fasciitis is a common cause of heel pain. It has been suggested that some acupoints have a specific effect on heel pain. The aim of this study was to determine the efficacy and specificity of acupuncture treatment for plantar fasciitis. Subjects were randomly assigned to the treatment group (n = 28) or control group (n = 25). The treatment group received needling at the acupoint PC 7, which is purported to have a specific effect for heel pain. The control group received needling at the acupoint Hegu (LI 4), which has analgesic properties. Treatment was administered five times a week for 2 weeks, with an identical method of manual needling applied to the two acupoints. The primary outcome measure was morning pain on a 100-point visual analog scale (VAS) at one month post-treatment. Secondary outcome measures included a VAS for activity pain, overall pain rating as well as pressure pain threshold using algometry. Significant differences in reduction in pain scores, favoring the treatment group, were seen at one month for morning pain (22.6 ± 4.0 versus 12.0 ± 3.0, mean ± SEM), overall pain (20.3 ± 3.7 versus 9.5 ± 3.6) and pressure pain threshold (145.5 ± 32.9 versus −15.5 ± 39.4). No serious adverse event was observed in either group. The results indicate that acupuncture can provide pain relief to patient with plantar fasciitis, and that PC 7 is a relatively specific acupoint for heel pain. PMID:19933769

  2. On muscle, tendon and high heels.

    PubMed

    Csapo, R; Maganaris, C N; Seynnes, O R; Narici, M V

    2010-08-01

    Wearing high heels (HH) places the calf muscle-tendon unit (MTU) in a shortened position. As muscles and tendons are highly malleable tissues, chronic use of HH might induce structural and functional changes in the calf MTU. To test this hypothesis, 11 women regularly wearing HH and a control group of 9 women were recruited. Gastrocnemius medialis (GM) fascicle length, pennation angle and physiological cross-sectional area (PCSA), the Achilles' tendon (AT) length, cross-sectional area (CSA) and mechanical properties, and the plantarflexion torque-angle and torque-velocity relationships were assessed in both groups. Shorter GM fascicle lengths were observed in the HH group (49.6+/-5.7 mm vs 56.0+/-7.7 mm), resulting in greater tendon-to-fascicle length ratios. Also, because of greater AT CSA, AT stiffness was higher in the HH group (136.2+/-26.5 N mm(-1) vs 111.3+/-20.2 N mm(-1)). However, no differences in the GM PCSA to AT CSA ratio, torque-angle and torque-velocity relationships were found. We conclude that long-term use of high-heeled shoes induces shortening of the GM muscle fascicles and increases AT stiffness, reducing the ankle's active range of motion. Functionally, these two phenomena seem to counteract each other since no significant differences in static or dynamic torques were observed. PMID:20639419

  3. Spatial relationships between shearing stresses and pressure on the plantar skin surface during gait

    PubMed Central

    Stucke, Samantha; McFarland, Daniel; Goss, Larry; Fonov, Sergey; McMillan, Grant R.; Tucker, Amy; Berme, Necip; Guler, Hasan Cenk; Bigelow, Chris; Davis, Brian L.

    2011-01-01

    Based on the hypothesis that diabetic foot lesions have a mechanical etiology, extensive efforts have sought to establish a relationship between ulcer occurrence and plantar pressure distribution. However, these factors are still not fully understood. The purpose of this study was to simultaneously record shear and pressure distributions in the heel and forefoot and to answer whether: (i) peak pressure and peak shear for anterior-posterior (AP) and medio-lateral (ML) occur at different locations, and if (ii) peak pressure is always centrally located between sites of maximum AP and ML shear stresses. A custom built system was used to collect shear and pressure data simultaneously on 11 subjects using the 2-step method. The peak pressure was found to be 362 kPa ±106 in the heel and 527 kPa ± 123 in the forefoot. In addition, the average peak shear values were higher in the forefoot than in the heel. The greatest shear on the plantar surface of the forefoot occurred in the anterior direction (mean and std dev: 37.7 ±7.6 kPa), whereas for the heel, peak shear on the foot was in the posterior direction (21.2 ±5 kPa). The results of this study suggest that the interactions of the shear forces caused greater “spreading” in the forefoot and greater tissue “dragging” in the heel. The results also showed that peak shear stresses do not occur at the same site or time as peak pressure. This may be an important factor in locating where skin breakdown occurs in patients at high-risk for ulceration. PMID:22169152

  4. Changes in plantar load distribution and gait pattern following foot drop correction in leprosy affected patients.

    PubMed

    Karmakar, Mrinmoy; Joshua, Jerry; Mahato, Nidhu

    2015-09-01

    This study was done to compare the changes in plantar load (weight distribution) and gait patterns before and after tibialis posterior transfer surgery in people affected by leprosy. Changes in gait patterns were observed and proportionate changes in plantar load were quantified using data captured by a baropodometer. All the eight patients who underwent tibialis posterior transfer surgery in 2013 in our hospital were included in the study. In addition to the regular pre-operative and post-operative assessments, the patients also underwent baropodometric evaluation. There was a significant change in plantar load at the heel, lateral border and forefoot. Using the foot pressure scan, it was noted that the progression of the centre of mass (displayed graphically as 'the gait line') was also affected by the altered pattern of weight distribution. This study reiterates the importance of tibialis posterior transfer because: it restores the normal gait pattern of 1, 2, 3 (where 1 is heel strike, 2 is mid foot contact and 3 is forefoot contact) and provides a more uniform distribution of planter load. PMID:26665356

  5. Computer Modeling Studies to Assess Whether a Prophylactic Dressing Reduces the Risk for Deep Tissue Injury in the Heels of Supine Patients with Diabetes.

    PubMed

    Levy, Ayelet; Gefen, Amit

    2016-04-01

    Heels are susceptible to pressure ulcer (PU) development. Some evidence suggests dressings may provide mechanical cushioning, reduce friction with support, and lower localized internal tissue loading, which together may minimize the risk for heel ulcers (HUs). To examine the effect of dressing application on pressure ulcer prevention, 20 computer simulations were performed. Volumetric exposure of soft tissues to effective and shear strains and stresses, with and without a multilayered foam dressing, were assessed, with the extent of tissue exposure considered as measures of the theoretical risk for PUs. The simulations, conducted using the finite element method, provided the mechanical strain and stress magnitudes and distributions in the weight-bearing tissues of the heel, which were visualized and analyzed post-hoc for comparing diabetic to healthy tissue loads with/without prophylactic dressings and at different foot (plantar flexion) postures. The volumetric exposure of the soft tissues of the heel to elevated strains and stresses was considerably reduced by the presence of the dressing, whether diabetic or nondiabetic tissue conditions existed, and for the entire range of the simulated plantar flexion positions. Further, greater plantar flexion, which occurs with elevation of the head of the bed, reduced the volumetric exposure of subcutaneous fat to increased effective strains and stresses, again, particularly when the dressing was on. Specifically, peak (maximum of raw data) effective strains in the soft tissues of the heel decreased by 14.8% and 13.5% with the use of the dressing for healthy persons and persons with diabetes, respectively. Additionally, volumetric exposures of the soft tissues to large effective strains, defined as exposures to >50% strain, decreased substantially, by at least a factor of 2, with the angle of plantar flexion and with respect to a neutral foot posture. Volumetric exposures to midrange (less than 50%) strains were more mildly affected by the foot posture (ie, less than 10% difference was noted across plantar flexion angles). The differences in tissue exposures to strains and stresses between the dressing and nondressing models suggest this dressing provides an important biomechanical protective effect, specifically when diabetic tissue conditions exist. In addition, the data suggest alleviating shear by repositioning the heels after elevating the head of the bed may be critical in order to limit the increase in tissue stress and subsequent PU risk. Randomized, controlled clinical studies to examine the efficacy of dressings for the prevention of heel PUs are warranted. PMID:27065218

  6. Plantar soft tissue thickness during ground contact in walking

    NASA Technical Reports Server (NTRS)

    Cavanagh, P. R.

    1999-01-01

    A technique is introduced for the measurement of plantar soft tissue thickness during barefoot walking. Subjects stepped into an adjustable Plexiglas frame which ensured that the required bony landmarks were appropriately positioned relative to a linear ultrasound probe connected to a conventional 7.5 MHz ultrasound scanner. Clear images of the metatarsal condyles or other foot bones were obtained throughout ground contact. Subsequent analysis of the video taped images using a motion analysis system allowed the tissue displacement to be calculated as a function of time. The tissue underneath the second metatarsal head was shown to undergo an average maximum compression of 45.7% during the late stages of ground contact during first step gait in a group of five normal subjects with a mean unloaded tissue thickness of 15.2 mm. The technique has a number of applications, including use in the validation of deformation predicted by finite element models of the soft tissue of the foot, and the study of alterations in the cushioning properties of the heel by devices which constrain the displacement of the heel pad.

  7. A heel cup improves the function of the heel pad in Sever's injury: effects on heel pad thickness, peak pressure and pain.

    PubMed

    Perhamre, S; Lundin, F; Klässbo, M; Norlin, R

    2012-08-01

    Sever's injury (apophysitis calcanei) is considered to be the dominant cause of heel pain among children between 8 and 15 years. Treating Sever's injury with insoles is often proposed as a part of a traditional mix of recommendations. Using a custom-molded rigid heel cup with a brim enclosing the heel pad resulted in effective pain relief without reducing the physical activity level in our previous two studies. The purpose of this study was to assess the effect of the heel cup on heel pad thickness and heel peak pressure (n=50). The difference in heel pad thickness and in heel peak pressure using a sports shoe without and with a heel cup was compared. With the heel cup the heel pad thickness improved significantly and the heel peak pressure was significantly reduced. These effects correlated with a significant reduction in pain when using the heel cup in a sports shoe, compared with using a sports shoe without the heel cup. A heel cup, providing an effective heel pad support in the sports shoe, improved the heel pad thickness and reduced heel peak pressure in Sever's injury with corresponding pain relief. PMID:21410537

  8. Effects of indoor slippers on plantar pressure and lower limb EMG activity in older women.

    PubMed

    Yick, K L; Tse, L T; Lo, W T; Ng, S P; Yip, J

    2016-09-01

    Open-toe mule slippers are popular footwear worn at home especially by older women. However, their biomechanical effects are still poorly understood. The objective of this study is to therefore evaluate the physical properties of two typical types of open-toe mule slippers and the changes in plantar pressure and lower limb muscle activity of older women when wearing these slippers. Five walking trials have been carried out by ten healthy women. The results indicate that compared to barefoot, wearing slippers results in significant increases in the contact area of the mid-foot regions which lead to plantar pressure redistribution from metatarsal heads 2-3 and the lateral heel to the midfoot regions. However, there is no significant difference in the selected muscle activity across all conditions. The findings enhance our understanding of slipper features associated with changes in biomechanical measures thereby providing the basis of slipper designs for better foot protection and comfort. PMID:27184323

  9. Effects of changes in heel fat pad thickness and elasticity on heel pain.

    PubMed

    Ozdemir, Hakan; Söyüncü, Yetkin; Ozgörgen, Mete; Dabak, Kürşat

    2004-01-01

    The heel fat pad has a unique structure that is important for its shock-absorbing function. Loss of elasticity and changes in the thickness of the heel pad have been suggested as causes of heel pain. The present study of a population with heel pain shows the relationship between the thickness and elasticity of the heel fat pad and age, sex, obesity, duration of symptoms, subcalcaneal spurs, and noninvasive conservative treatment. Of 182 patients with heel pain who visited an outpatient clinic during a 3-year period, 50 (67 heels) fulfilling specific criteria were treated with a combination of nonsteroidal anti-inflammatory drugs, contrast baths, stretching exercises, and change of footwear habits. Patients were followed up for 1 year. Delayed healing, increased thickness, and decreased elasticity of the heel fat pad were found in patients who were older than 40 years, who had symptoms for longer than 12 months before treatment, and who had a large subcalcaneal spur. An increase in heel fat pad thickness with aging and increased body weight reduce the elasticity of the heel fat pad. In addition, subcalcaneal spurs diminish the elasticity of the heel fat pad and play a role in the formation of heel pain. PMID:14729991

  10. Plantar Fasciitis: Prescribing Effective Treatments.

    ERIC Educational Resources Information Center

    Shea, Michael; Fields, Karl B.

    2002-01-01

    Plantar fasciitis is an extremely common, painful injury seen among people in running and jumping sports. While prognosis for recovery with conservative care is excellent, prolonged duration of symptoms affects sports participation. Studies on treatment options show mixed results, so finding effective treatments can be challenging. A logical…

  11. How to classify plantar plate injuries: parameters from history and physical examination☆

    PubMed Central

    Nery, Caio; Coughlin, Michael; Baumfeld, Daniel; Raduan, Fernando; Mann, Tania Szejnfeld; Catena, Fernanda

    2015-01-01

    Objective To find the best clinical parameters for defining and classifying the degree of plantar plate injuries. Method Sixty-eight patients (100 metatarsophalangeal joints) were classified in accordance with the Arthroscopic Anatomical Classification for plantar plate injuries and were divided into five groups (0 to IV). Their medical files were reviewed and the incidence of each parameter for the respective group was correlated. These parameters were: use of high heels, sports, acute pain, local edema, Mulder's sign, widening of the interdigital space, pain in the head of the corresponding metatarsal, touching the ground, “drawer test”, toe grip and toe deformities (in the sagittal, coronal and transversal planes). Results There were no statistically significant associations between the degree of injury and use of high-heel shoes, sports trauma, pain at the head of the metatarsal, Mulder's sign, deformity in pronation or displacement in the transversal and sagittal planes (although their combination, i.e. “cross toe”, showed a statistically significant correlation). Positive correlations with the severity of the injuries were found in relation to initial acute pain, progressive widening of the interdigital space, loss of “touching the ground”, positive results from the “drawer test” on the metatarsophalangeal joint, diminished grip strength and toe deformity in supination. Conclusions The “drawer test” was seen to be the more reliable and precise tool for classifying the degree of plantar plate injury, followed by “touching the ground” and rotational deformities. It is possible to improve the precision of the diagnosis and the predictions of the anatomical classification for plantar plate injuries through combining the clinical history and data from the physical examination.

  12. The role of bone scintigraphy in determining the etiology of heel pain.

    PubMed

    Ozdemir, Hakan; Ozdemir, Aysun; Söyücü, Yetkin; Urgüden, Mustafa

    2002-09-01

    In this study we aimed to determine the role of bone scintigraphy as an objective diagnostic method in patients with heel pain. 67 heels of 50 of 182 patients with defined features who attended the orthopedics outpatient clinic with heel pain over a 3-year period, were treated with combined methods such as nonsteroidal anti-inflammatory drugs (NSAID) and contrast baths, stretching exercises and changing of footwear habits. A one year follow-up was established. The criteria identified by Wolgin et al. were used in assessing the results of the treatment. Subcalcaneal spur was demonstrated by radiography in 44 of the 67 heels. There were two different imaging patterns observed on three phase bone scintigraphy. Type I imaging pattern: Focal increased activity in the heel region or normal activity on dynamic and the blood pool phases and focal increased activity at the inferior calcaneal surface in the late static phase. Type II imaging pattern: Diffuse increased activity along the plantar fascia in the dynamic and the blood pool phase, and focal increased activity at the inferior calcaneal surface in the late static phase. There were 34 (50.7%) type I and 18 (26.8%) type II imaging patterns on the scans. Type I and type II imaging patterns were described as osseous and fascial respectively. At the final examination, the results for pattern type I were good in 16 patients (66.7%), fair in 6 patients (25%) and poor in 2 patients (8.3%), whereas in pattern type II results were good in 12 patients (80%) and fair in 3 patients (20%). The recurrence frequency was 4.1% and 6.6%, respectively. Subcalcaneal spur was determined in 70.5% of the patients with osseous pathology and 55.5% of the patients with fascial pathology. Based on this result, it can be ascertained that calcaneal spurs develop during the pathological process causing heel pain. Other findings supporting this claim were the differences in symptom periods of the patients with type I and type II imaging patterns and scintigraphies were normaly in 10 of 44 heels indicating subcalcaneal spurs on radiographies. These findings suggested that metabolic changes contributing to subcalcaneal spur were complete. Three phase bone scintigraphy is an objective method which can be used to diagnose heel pain, especially when determining the etiological factors and prognosis. PMID:12416578

  13. The potential influence of the heel counter on internal stress during static standing: a combined finite element and positional MRI investigation.

    PubMed

    Spears, I R; Miller-Young, J E; Sharma, J; Ker, R F; Smith, F W

    2007-01-01

    Confinement of the heel due to the counter of the shoe is believed to influence heel pad biomechanics. Using a two-dimensional finite element model of the heel pad and shoe during a simulation of static standing, the aim of this study was to quantify the potential effect of confinement on internal heel pad stress. Non-weightbearing MRI and weightbearing MRI with plantar pressure and ground reaction force data were recorded for a single subject. The non-weightbearing MRI was used to create two FE models of the heel pad, using either homogeneous or composite material properties. The composite model included a distinction in material properties between fat pad and skin. Vertical and medial-lateral forces, as measured on the subject's heel, were applied to the models and vertical compressive strains for both models were comparable with those observed by weightbearing MRI. However, only for the composite model was the predicted plantar pressure distribution comparable with measured data. The composite model was therefore used in further analyses. In this composite model, the internal stresses were located mainly in the skin and were predominantly tensile in nature, whereas the stress state in the fat pad approached hydrostatic conditions. A representation of a running shoe, including an insole, midsole and heel counter was then added to the composite heel pad to form the shod model. In order to investigate the counter effect, the load was applied to the shod model with and without the heel counter. The effect of the counter on peak stress was to elevate compression (0-50%), reduce tension (22-34%) and reduce shear (22-28%) in the skin. In addition, the counter reduced both compressive (20-40%) and shear (58-80%) stress in the fat pad and tension in the fat pad remained negligible. Taken together the results indicate that a well-fitted counter works in sympathy with the internal structure of the heel pad and could be an effective reducer of heel pad stress. However, further research needs to be undertaken to assess the long-term effects on the soft-tissues, practicalities of achieving good fit and behavior under dynamic events. PMID:17362970

  14. On high heels and short muscles: A multiscale model for sarcomere loss in the gastrocnemius muscle

    PubMed Central

    Zöllner, Alexander M.; Pok, Jacquelynn M.; McWalter, Emily J.; Gold, Garry E.; Kuhl, Ellen

    2014-01-01

    High heels are a major source of chronic lower limb pain. Yet, more than one third of all women compromise health for looks and wear high heels on a daily basis. Changing from flat footwear to high heels induces chronic muscle shortening associated with discomfort, fatigue, reduced shock absorption, and increased injury risk. However, the long-term effects of high-heeled footwear on the musculoskeletal kinematics of the lower extremities remain poorly understood. Here we create a multiscale computational model for chronic muscle adaptation to characterize the acute and chronic effects of global muscle shortening on local sarcomere lengths. We perform a case study of a healthy female subject and show that raising the heel by 13 cm shortens the gastrocnemius muscle by 5% while the Achilles tendon remains virtually unaffected. Our computational simulation indicates that muscle shortening displays significant regional variations with extreme values of 22% in the central gastrocnemius. Our model suggests that the muscle gradually adjusts to its new functional length by a chronic loss of sarcomeres in series. Sarcomere loss varies significantly across the muscle with an average loss of 9%, virtually no loss at the proximal and distal ends, and a maximum loss of 39% in the central region. These changes reposition the remaining sarcomeres back into their optimal operating regime. Computational modeling of chronic muscle shortening provides a valuable tool to shape our understanding of the underlying mechanisms of muscle adaptation. Our study could open new avenues in orthopedic surgery and enhance treatment for patients with muscle contracture caused by other conditions than high heel wear such as paralysis, muscular atrophy, and muscular dystrophy. PMID:25451524

  15. On high heels and short muscles: a multiscale model for sarcomere loss in the gastrocnemius muscle.

    PubMed

    Zöllner, Alexander M; Pok, Jacquelynn M; McWalter, Emily J; Gold, Garry E; Kuhl, Ellen

    2015-01-21

    High heels are a major source of chronic lower limb pain. Yet, more than one third of all women compromise health for looks and wear high heels on a daily basis. Changing from flat footwear to high heels induces chronic muscle shortening associated with discomfort, fatigue, reduced shock absorption, and increased injury risk. However, the long-term effects of high-heeled footwear on the musculoskeletal kinematics of the lower extremities remain poorly understood. Here we create a multiscale computational model for chronic muscle adaptation to characterize the acute and chronic effects of global muscle shortening on local sarcomere lengths. We perform a case study of a healthy female subject and show that raising the heel by 13cm shortens the gastrocnemius muscle by 5% while the Achilles tendon remains virtually unaffected. Our computational simulation indicates that muscle shortening displays significant regional variations with extreme values of 22% in the central gastrocnemius. Our model suggests that the muscle gradually adjusts to its new functional length by a chronic loss of sarcomeres in series. Sarcomere loss varies significantly across the muscle with an average loss of 9%, virtually no loss at the proximal and distal ends, and a maximum loss of 39% in the central region. These changes reposition the remaining sarcomeres back into their optimal operating regime. Computational modeling of chronic muscle shortening provides a valuable tool to shape our understanding of the underlying mechanisms of muscle adaptation. Our study could open new avenues in orthopedic surgery and enhance treatment for patients with muscle contracture caused by other conditions than high heel wear such as paralysis, muscular atrophy, and muscular dystrophy. PMID:25451524

  16. Effects of the height of shoe heels on muscle activation of cervical and lumbar spine in healthy women

    PubMed Central

    Park, Kisu; Kim, Young; Chung, Yijung; Hwang, Sujin

    2016-01-01

    [Purpose] The purpose of this study was to investigate the effects of different height of high heels on muscle activation of the paraspinalis cervicis and erector spinae in healthy young women. [Subjects and Methods] Thirteen healthy women were recruited in this study. To examine the effects of different heights of heels on muscle activation, the paraspinalis cervicis (cervical spine) and erector spinae (lumbar spine) were measured at the time of heel strike and toe off during gait on three different conditions (barefoot, 4 cm high heels, and 10 cm high heels). There are no previous trials or reports that have evaluated this approach in patients with chronic neck pain. [Results] A significant increase in muscle activation of the paraspinalis cervicis and erector spinae at heel strike and toe off (except that of the paraspinalis cervicis at toe off in healthy subjects) was observed in the under 10 cm high heel condition as, compared to that with barefoot condition, in all the subjects. [Conclusion] The height of the high heels affects to the activation demand of the paraspinalis cervicis and erector spinae in patients with neck pain. PMID:27134392

  17. Plantar fibromatosis--topical review.

    PubMed

    Veith, Nils T; Tschernig, Thomas; Histing, Tina; Madry, Henning

    2013-12-01

    Morbus Ledderhose is a rare hyperproliferative disease of the plantar fascia, leading to the formation of nodules. Its origin is unknown. No causal therapy is available, and treatment remains symptomatic. Various therapeutic strategies to alleviate symptoms are available and are adapted to the severity of the disease. In early stages, conservative therapy including nonpharmacological, physical, and pharmacological treatments is applied. If the disease progresses, irradiation of the plantar surface, injections of steroids, shock wave therapy, and partial or complete fasciectomy as an ultimate therapy may be indicated. Novel experimental treatment options including application of fibrinolytic agents are currently being tested, but no controlled, randomized long-term studies are available. This review aims to provide a systematic overview of current established procedures and outlines novel experimental strategies for the treatment of morbus Ledderhose, including future avenues to treat this rare disease. PMID:24043350

  18. Investigating the Effects of Knee Flexion during the Eccentric Heel-Drop Exercise

    PubMed Central

    Weinert-Aplin, Robert A.; Bull, Anthony M.J.; McGregor, Alison H.

    2015-01-01

    This study aimed to characterise the biomechanics of the widely practiced eccentric heel-drop exercises used in the management of Achilles tendinosis. Specifically, the aim was to quantify changes in lower limb kinematics, muscle lengths and Achilles tendon force, when performing the exercise with a flexed knee instead of an extended knee. A musculoskeletal modelling approach was used to quantify any differences between these versions of the eccentric heel drop exercises used to treat Achilles tendinosis. 19 healthy volunteers provided a group from which optical motion, forceplate and plantar pressure data were recorded while performing both the extended and flexed knee eccentric heel-drop exercises over a wooden step when barefoot or wearing running shoes. This data was used as inputs into a scaled musculoskeletal model of the lower limb. Range of ankle motion was unaffected by knee flexion. However, knee flexion was found to significantly affect lower limb kinematics, inter-segmental loads and triceps muscle lengths. Peak Achilles load was not influenced despite significantly reduced peak ankle plantarflexion moments (p < 0.001). The combination of reduced triceps lengths and greater ankle dorsiflexion, coupled with reduced ankle plantarflexion moments were used to provide a basis for previously unexplained observations regarding the effect of knee flexion on the relative loading of the triceps muscles during the eccentric heel drop exercises. This finding questions the role of the flexed knee heel drop exercise when specifically treating Achilles tendinosis. Key points A more dorsiflexed ankle and a flexing knee are characteristics of performing the flexed knee heel-drop eccentric exercise. Peak ankle plantarflexion moments were reduced with knee flexion, but did not reduce peak Achilles tendon force. Kinematic changes at the knee and ankle affected the triceps muscle length and resulted in a reduction in the amount of Achilles tendon work performed. A version of the heel-drop exercise which reduces the muscle length change will also reduce the amount of tendon stretch, reducing the clinical efficacy of the exercise. PMID:25983597

  19. Complex heel reconstruction with a sural fasciomyocutaneous perforator flap.

    PubMed

    Lu, Shengdi; Chai, Yimin; Wang, Chunyang; Wen, Gen

    2014-02-01

    Reconstruction of weight-bearing surfaces at the foot and ankle is controversial. Free tissue transfer and local fasciocutaneous perforator flaps are preferred for plantar reconstruction, but high rates of flap breakdown and ulceration have caused unsatisfactory functional outcomes. We present a modified "sural fasciomyocutaneous perforator flap" and its functional outcome. Between January 2007 and September 2010, 19 patients were treated for soft-tissue defects in the weight-bearing area with sural fasciomyocutaneous perforator flaps. The gastrocnemius, preserved in the base of the flap, was applied as padding under the calcaneus. In follow-up from 9 to 25 months (mean 13.8 months), each patient's pain score, defect size, ulcer formation, protective sensation recovery, and normal footwear were analyzed. The majority of the flaps survived with satisfactory aesthetic and functional results. One case of partial flap loss and one case of delayed ulceration were noted. With partial weight bearing at 4 weeks, satisfactory gait recovery was obtained at 5 to 8 months (in conjunction with protective sensation recovery). Sural fasciomyocutaneous perforator flap is a reliable modality in heel construction, showing advantages of low ulceration rate, durability, and good protective sensation recovery compared with conventional free tissue transfer and local fasciocutaneous perforator flap. PMID:24163225

  20. Integrated kinematics-kinetics-plantar pressure data analysis: a useful tool for characterizing diabetic foot biomechanics.

    PubMed

    Sawacha, Zimi; Guarneri, Gabriella; Cristoferi, Giuseppe; Guiotto, Annamaria; Avogaro, Angelo; Cobelli, Claudio

    2012-05-01

    The fundamental cause of lower-extremity complications in diabetes is chronic hyperglycemia leading to diabetic foot ulcer pathology. While the relationship between abnormal plantar pressure distribution and plantar ulcers has been widely investigated, little is known about the role of shear stress. Moreover, the mutual relationship among plantar pressure, shear stress, and abnormal kinematics in the etiology of diabetic foot has not been established. This lack of knowledge is determined by the lack of commercially available instruments which allow such a complex analysis. This study aims to develop a method for the simultaneous assessment of kinematics, kinetics, and plantar pressure on foot subareas of diabetic subjects by means of combining three commercial systems. Data were collected during gait on 24 patients (12 controls and 12 diabetic neuropathics) with a motion capture system synchronized with two force plates and two baropodometric systems. A four segment three-dimensional foot kinematics model was adopted for the subsegment angles estimation together with a three segment model for the plantar sub-area definition during gait. The neuropathic group exhibited significantly excessive plantar pressure, ground reaction forces on each direction, and a reduced loading surface on the midfoot subsegment (p<0.04). Furthermore the same subsegment displayed excessive dorsiflexion, external rotation, and eversion (p<0.05). Initial results showed that this methodology may enable a more appropriate characterization of patients at risk of foot ulcerations, and help planning prevention programs. PMID:22464271

  1. The effect of customised and sham foot orthoses on plantar pressures

    PubMed Central

    2013-01-01

    Background The effectiveness of foot orthoses has been evaluated in many clinical trials with sham foot orthoses used as the control intervention in at least 10 clinical trials. However, the mechanical effects and credibility of sham orthoses has been rarely quantified. This study aimed to: (i) compare the effects on plantar pressures of three sham foot orthoses to a customised foot orthosis, and (ii) establish the perceived credibility and the expected benefit of each orthotic condition. Methods Thirty adults aged between 18 and 51 participated in this study. At 0 and 4 weeks, plantar pressure data were collected for the heel, midfoot and forefoot using the pedar®-X in-shoe system for the following five randomly assigned conditions: (i) shoe alone, (ii) customised foot orthosis, (iii) contoured polyethylene sham foot orthosis, (iv) contoured EVA sham foot orthosis, and (v) flat EVA sham foot orthosis. At the initial data collection session, each participant completed a Credibility/Expectancy Questionnaire (CEQ) to determine the credibility and expected benefit of each orthotic condition. Results Compared to the shoe alone at week 0, the contoured polyethylene sham orthosis was the only condition to not significantly effect peak pressure at any region of the foot. In contrast, the contoured EVA sham orthosis, the flat EVA sham orthosis and the customised orthosis significantly reduced peak pressure at the heel. At the medial midfoot, all sham orthoses provided the same effect as the shoe alone, which corresponded to effects that were significantly different to the customised orthosis. There were no differences in peak pressure between conditions at the other mask regions, the lateral midfoot and forefoot. When the conditions were compared at week 4, the differences between the conditions were generally similar to the findings observed at week 0. With respect to credibility and expected benefit, all orthotic conditions were considered the same with the exception of the contoured polyethylene sham orthosis, which was perceived as being less credible and less likely to provide benefits. Conclusion The findings of this study indicate that all of the sham orthoses tested provided the same effect on plantar pressures at the midfoot and forefoot as a shoe alone. However, the contoured EVA sham orthosis and the flat EVA sham orthosis significantly reduced peak pressure under the heel, which was similar to the customised orthosis. In contrast, the contoured polyethylene sham orthosis had no significant effect on plantar pressure and was comparable to the shoe alone at all regions of the foot. Hence, lower plantar pressures were found under the heel with some sham orthoses, but not with others. Importantly, participants perceived the polyethylene sham orthosis – the sham that had no effect on plantar pressure – to be the least credible orthosis and the least likely to provide benefits. This may be critical for the design of future clinical trials as it may introduce confounding effects that produce inaccurate results. These findings provide some evidence for the mechanical effects, treatment credibility and expected benefit of sham foot orthoses, which should be considered when they are used as a control intervention in a clinical trial. PMID:23680496

  2. Report on a clinical evaluation of the KerraPro Heel silicone heel pad.

    PubMed

    Knowles, A; Young, S; Collins, F; Hampton, S

    2013-11-01

    Heels are at increased risk of injury due to the posterior prominence and lack of padding over the calcaneus. Pressure injuries, once established, are extremely costly, both in terms of the detrimental effect on psychosocial wellbeing and threat to life, as well as financially due to length of hospital stay and resources used to heal the wounds. A new and inexpensive silicone heel pad has been designed to simplify the necessary decisions and to address the problems associated with pressure injuries to the heels. This article will describe an observational evaluation of the product. KerraPro Heel pads were evaluated in two separate cohorts of 17 participants over a 4-week period with the primary aim to evaluate the efficacy of the product in preventing and alleviating pressure injuries on the heels. All participants had been reported as 'at risk' or 'at high risk' of pressure injury to the heels and had a history of developing such lesions. The KerraPro heel pads were compared with the participant's standard protocol. The outcome of the evaluation demonstrated the effectiveness of the KerraPro Heel pads in the prevention and treatment of heel pressure injuries. PMID:24225600

  3. Biomechanical behavior of plantar fat pad in healthy and degenerative foot conditions.

    PubMed

    Fontanella, Chiara Giulia; Nalesso, Federica; Carniel, Emanuele Luigi; Natali, Arturo N

    2016-04-01

    The plantar fat pad of the human foot is a specific tissue made up of adipose chambers enveloped by fibrous septa. Aging, pathology or trauma may affect its histo-morphological configuration and mechanical response. The correlation between histo-morphological configuration and mechanical properties is analyzed by a computational approach, aiming to identify the influence of degenerative phenomena on plantar fat pad mechanics. Finite element meso-models, as numerical model of an intermediate-length scale, are developed for healthy and degenerative conditions, considering the different properties that degenerative phenomena may affect, such as the adipose chambers dimension, the fibrous septa thickness, the fibers orientation and the sub-components mechanical behavior. Histo-morphometric data are analyzed to identify average configurations of the fat chambers and fibrous septa, while specific constitutive formulations are provided to define their mechanical response. Numerical analyses are performed to identify the stress-strain behavior of the plantar fat pad considering healthy and degenerative configurations. The results from meso-models are applied to identify the parameters of a phenomenological constitutive formulation that interprets the overall human fat pad tissue mechanics. The constitutive formulation is implemented within a 3D finite element model of the heel region that is applied to evaluate the influence of degenerative phenomena on the overall mechanical functionality of the foot. PMID:26272439

  4. The effectiveness of corticosteroid injection in the treatment of plantar fasciitis

    PubMed Central

    Ang, Teck Wee Andrew

    2015-01-01

    Plantar fasciitis is a common cause of heel pain in adults. Although it is usually a self-limiting condition, the pain may become prolonged and severe enough to cause significant distress and disruption to the patient’s daily activities and work. PubMed and Cochrane Central Register of Controlled Trials databases were searched for randomised controlled trials (RCTs) and a total of ten RCTs were selected for evaluation. These RCTs involved the use of either palpation- or ultrasonography-guided corticosteroid injections in patients diagnosed with plantar fasciitis. All placebo-controlled RCTs showed a significant reduction in pain with the use of corticosteroid injections. Some studies also showed that corticosteroid injections yielded better results than other treatment modalities. However, it is evident from these studies that the effects of corticosteroid injections are usually short-term, lasting 4–12 weeks in duration. Complications such as plantar fascia rupture are uncommon, but physicians need to weigh the treatment benefits against such risks. PMID:26311907

  5. Histomorphological Evaluation of Diabetic and Non-Diabetic Plantar Soft Tissue

    PubMed Central

    Wang, Yak-Nam; Lee, Kara; Ledoux, William R.

    2014-01-01

    Background Diabetic foot ulceration has a complex and multi-factorial etiology and can involve changes in the pathophysiology of the plantar soft tissue. In the current study, histomorphological analyses of diabetic and non-diabetic plantar tissue were performed. It was hypothesized that the diabetic tissue would have thicker skin (epidermis and dermis), less interdigitation between the dermis and epidermis, thicker elastic septa and decreased adipose cell size. Materials and Methods Two locations of the foot (the heel and the first metatarsal) were examined, both of which have been reported to be locations with a high incidence of ulceration. Stereological methods and quantitative morphological techniques were used to evaluate the skin thickness, interdigitation index, elastic septae thickness and adipocyte cell size. Results The diabetic donors had a greater body mass index (BMI) than the non-diabetic donors. The diabetic tissue had significantly thicker elastic septae and dermis. However, no significant difference was observed in the interdigitation index or adipocyte size. Conclusion These findings demonstrate that morphological changes can be evaluated histologically to give a better understanding of the pathological changes in the plantar soft tissue with diabetes. These evaluations can then be associated with biomechanical changes that occur in diabetes to provide new insight into how microstructural changes can alter macroscopic properties. Clinical Relevance An understanding of the histomorphological changes in the soft tissue in relationship to the location on the foot could help to explain the biomechanical changes that occur in diabetes and the subsequent increase in susceptibility to breakdown. PMID:22049867

  6. Prediction of plantar soft tissue stiffness based on sex, age, bodyweight, height and body mass index.

    PubMed

    Teoh, Jee Chin; Lee, Taeyong

    2016-02-01

    15% of Diabetes Mellitus (DM) patients suffer high risk of ulceration and 85% of the amputation involving DM population is caused by non-healing ulcers. These findings elucidate the fact that foot ulcer can result in major amputation especially to the DM and elderly population. Therefore, early diagnosis of abnormally stiffened plantar soft tissue is needed to prevent the catastrophic tissue damage. In order to differentiate between normal and pathological tissues, a threshold reference value that defines healthy tissue is required. The objective of this study is to perform a multivariate analysis to estimate the healthy plantar tissue stiffness values based on the individuals physical attributes such as bodyweight (BW), height and body mass index (BMI) as well as their age and sex. 100 healthy subjects were recruited. Indentation was performed on 2nd metatarsal head pad at 3 different dorsiflexion angles of 0°, 20°, 40° and the hallux and heel at 0°. The results showed the important influences of BW, height and BMI in determining the plantar tissue stiffness. On the other hand, age and sex only play minimal roles. The study can be further extended to increase the reliability and accuracy of the proposed predictive model by evaluating several other related parameters such as body fat content, footwear usage, frequency of sports participation, etc. PMID:26474035

  7. An optoelectric plantar "shear" sensing transducer: design, validation, and preliminary subject tests.

    PubMed

    Lebar, A M; Harris, G F; Wertsch, J J; Zhu, H

    1996-12-01

    A prototype miniature plantar shear sensing transducer was developed, characterized, and tested in this study. Electro-optical components were chosen for the design because of the fast response time, low cost, small size, low power requirements, and adaptability to this application. The optoelectric circuit employed a 660 nm wavelength light source and photodiode solar cell. Signal amplification and sensitivity were adjusted to provide an output voltage proportional to light power. The sensor shell was designed to encapsulate the electro-optical sensing components while providing mechanical resistance to shear through a spring mechanism. A naval bronze was chosen for the shell due to its strength and nonreflective characteristics (alloy of copper and tin). Static and dynamic characteristics of the shear sensor were determined through a series of calibration tests. Mechanical crosstalk sensitivity ranged from 14.34 to 30.51 mV/N. This represented 1% full-scale/Newton sensitivity. Nonlinearity averaged 5.6% in the forward direction and 7.6% in the reverse direction. Overall sensor output hysteresis was 1.1 +/- 3.1% while the natural frequency of the sensor to an input shear transient was approximately 5 Hz. Temperature sensitivity was -7.0 mV/degree C or 3.5% full-scale/degree C. Testing of five adult subjects revealed peak anterior-posterior shear ranging from 6.7 kPa (posterior heel) to 51.4 kPa (great toe) and medial-lateral shear ranging from 5.4 kPa (great toe) to 43.5 kPa (first metatarsal head). Stress-time integral values ranged from 0.78 kPa-sec (posterior shear at the posterior heel) to 37.3 kPa-sec (medial shear at the posterior heel). Contact durations ranged from 0.28 sec (posterior shear at the posterior heel) to 1.25 sec (medial shear at the posterior heel). Further application of the sensor for plantar shear characterization in able-bodied subjects and those with pathology is suggested. PMID:8973957

  8. Neoplastic transformation of chronic ulcers in leprosy patients--a retrospective study of 23 consecutive cases.

    PubMed

    Kumaravel, S

    1998-01-01

    A retrospective analysis of chronic ulcers among leprosy patients seen over the last 20 years yielded 23 cases of neoplastic transformation. It showed a peak at the sixth decade, an incidence of 3.66/100 among hospitalised ulcer cases and male/female ratio of 1.6:1. Borderline tuberculoid was the most common type of leprosy involved (40%). Squamous cell carcinoma was the most common neoplasia. Its usual site was plantar ulcers. Heel ulcers showed relatively greater predeliction for malignancy (38.5%). Histopathological proof of malignancy is desirable and that may require multiple biopsies. Metastasis is rare but potentially fatal. The surgical treatment must provide a functional, trouble-free limb. Forefoot or Lisfranc's amputation for distal third ulcers and below-knee amputation for large midfoot and ulcers are procedures of choice. Wide excision may be used in select cases. PMID:9724853

  9. [Plantar fibromatosis with marked cutaneous involvement].

    PubMed

    de Almeida, H L; Wolter, M; Neugebauer, M G; Neugebauer, S

    2001-03-01

    Cutaneous involvement in plantar fibromatosis is very rare. The classical finding are nodules in the plantar arch, which can be detected only with palpation. A 55 year-old man presented with a 3 year history of painful plantar nodules and an ulceration. Histopathology showed a fibroblastic proliferation with a pseudosarcomatous configuration. The immunohistochemistry was positive for vimentin, alpha-actin and desmin, a pattern which characterizes a myofibroblast. Intralesional therapy with corticosteroids did not reduce the lesions. After surgical treatment, the lesions recurred. PMID:11284070

  10. Plantar pressure of clipless and toe-clipped pedals in cyclists - A pilot study

    PubMed Central

    Davis, Andrea; Pemberton, Troy; Ghosh, Subhajit; Maffulli, Nicola; Padhiar, Nat

    2011-01-01

    Summary To determine the effect of clipless and toe-clipped pedals on plantar foot pressure while cycling. Seven bikers and 11 healthy volunteers were tested on a Giant ATX Team mountain bike, Tekscan Clinical 5.24 F-scan® system with an inner sole pressure sensor, a Tacx Cycle force One Turbo Trainer and a Cateye Mity 8 computerized speedometer were used. The subjects wore Shimano M037 shoes and used a standard clipless and toe-clipped pedal. The seat height was set at 100% of subject’s trochanteric height. Plantar pressures were recorded over 12 consecutive crank cycles at a constant speed for each of the power outputs. The videos were analysed to record the pressure exerted at 12 positions on the foot for each variable. Whether there is any dominance of any of the metatarsals, and any difference in plantar pressures between clipped and clipless pedal. There was a significant difference in the pressure at many positions of the foot, but the sites were different for each individual. General regression analysis indicated that pedal type had a statistically significant effect on plantar pressure at the sites of 1st metatarsal (p=0.042), 3rd metatarsal (p<0.001), 5th metatarsal (<0.001), 2nd (p=0.018) and 5th toe (p<0.001), lateral midfoot (p<0.001) and central heel (p<0.001) areas. Clipless pedals produce higher pressures which are more spread across the foot than toe-clipped pedals. This may have implications for their use in the prevention and/or management of overuse injuries in the knee and foot. PMID:23738240

  11. Foot Plantar Pressure Measurement System: A Review

    PubMed Central

    Razak, Abdul Hadi Abdul; Zayegh, Aladin; Begg, Rezaul K.; Wahab, Yufridin

    2012-01-01

    Foot plantar pressure is the pressure field that acts between the foot and the support surface during everyday locomotor activities. Information derived from such pressure measures is important in gait and posture research for diagnosing lower limb problems, footwear design, sport biomechanics, injury prevention and other applications. This paper reviews foot plantar sensors characteristics as reported in the literature in addition to foot plantar pressure measurement systems applied to a variety of research problems. Strengths and limitations of current systems are discussed and a wireless foot plantar pressure system is proposed suitable for measuring high pressure distributions under the foot with high accuracy and reliability. The novel system is based on highly linear pressure sensors with no hysteresis. PMID:23012576

  12. Effect of heel pressure pad attached to ankle-foot orthosis on the energy conversion efficiency in post-stroke hemiplegic gait

    PubMed Central

    Kon, Keisuke; Hayakawa, Yasuyuki; Shimizu, Shingo; Tsuruga, Takeshi; Murahara, Shin; Haruna, Hirokazu; Ino, Takumi; Inagaki, Jun; Yamamoto, Sumiko

    2015-01-01

    [Purpose] This study aimed to analyze the effect of heel pads in ankle-foot orthoses on dynamic motion aspects of gait in stroke patients from the viewpoint of energy conversion efficiency. [Subjects] Fourteen chronic stroke patients who were ambulatory and had lower extremity motor function categorized as Brunnstrom stage IV participated in the study. [Methods] A three-dimensional motion analysis system was used to assess the effect of heel pad intervention on dynamic motion gait parameters using a single-system A-B-A design. [Results] The results showed that a heel pad attached to the ankle-foot orthosis caused significant retention of the center-of-pressure at the heel during the heel rocker function and significant increase in the dorsiflexion moment and the height of the center of gravity. [Conclusion] The present study showed that a heel pad attached to the calcaneal region of an ankle-foot orthosis caused slight retention of the center-of-pressure at the heel during the heel rocker function along with center of gravity elevation in the stance phase and improved the energy conversion efficiency, especially on the non-paretic side. PMID:26157215

  13. Role of the calcaneal heel pad and polymeric shock absorbers in attenuation of heel strike impact.

    PubMed

    Noe, D A; Voto, S J; Hoffmann, M S; Askew, M J; Gradisar, I A

    1993-01-01

    The capacity of the calcaneal heel pad, with and without augmentation by a polymeric shock absorbing material (Sorbothane 0050), to attenuate heel strike impulses has been studied using five fresh human cadaveric lower leg specimens. The specimens, instrumented with an accelerometer, were suspended and impacted with a hammer; a steel rod was similarly suspended and impacted. The calcaneal heel pad attenuated the peak accelerations by 80%. Attenuations of up to 93% were achieved by the shock absorbing material when tested against the steel rod; however, when tested in series with the calcaneal heel pad, the reduction in peak acceleration due to the shock absorbing material dropped to 18%. Any evaluation of the effectiveness of shock absorbing shoe materials must take into account their mechanical interaction with the body. PMID:8419676

  14. Improved method for determining tank heel volumes

    SciTech Connect

    Holt, S.H.; Livingston, R.R.; Nave, S.E.

    1994-07-01

    As part of the tank calibration process, the instrument heel is that part of the tank that cannot be measured by the liquid level instrumentation. if the tank being calibrated is not a bottom drain tank, some volume of fluid will be present in the bottom of the tank after draining as much as possible. The amount of fluid remaining in the tank at the start of each run can be estimated by measuring a concentration change of an added spiking material. With the great improvement of liquid level measuring instruments, the total error associated with the instrument heel determination can be greatly affected by the laboratory method used to measure the concentration difference. At the Savannah River Site, the laboratory method used has historically been Direct Current Plasma Emission Spectroscopy, which yielded very marginal results at best. In the most recent tank calibrations, the laboratory method was changed to Absorption Spectrophotometry, which reduces the total error on the instrument heel measurement by a factor of 2.5 times. This paper describes the method used to determine tank instrument heels and the improvements made to this process.

  15. In the clinic. Plantar fasciitis.

    PubMed

    Young, Craig

    2012-01-01

    This issue provides a clinical overview of plantar fasciitis focusing on prevention, diagnosis, treatment, practice improvement, and patient information. Readers can complete the accompanying CME quiz for 1.5 credits. Only ACP members and individual subscribers can access the electronic features of In the Clinic. Non-subscribers who wish to access this issue of In the Clinic can elect "Pay for View." Subscribers can receive 1.5 category 1 CME credits by completing the CME quiz that accompanies this issue of In the Clinic. The content of In the Clinic is drawn from the clinical information and education resources of the American College of Physicians (ACP), including PIER (Physicians' Information and Education Resource) and MKSAP (Medical Knowledge and Self Assessment Program). Annals of Internal Medicine editors develop In the Clinic from these primary sources in collaboration with the ACP's Medical Education and Publishing division and with assistance of science writers and physician writers. Editorial consultants from PIER and MKSAP provide expert review of the content. Readers who are interested in these primary resources for more detail can consult www.acponline.org, http://pier.acponline.org, and other resources referenced within each issue of In the Clinic. PMID:22213510

  16. A 4-week instructed minimalist running transition and gait-retraining changes plantar pressure and force.

    PubMed

    Warne, J P; Kilduff, S M; Gregan, B C; Nevill, A M; Moran, K A; Warrington, G D

    2014-12-01

    The purpose of this study is to compare changes in plantar pressure and force using conventional running shoes (CRS) and minimalist footwear (MFW) pre and post a 4-week MFW familiarization period. Ten female runners (age: 21 ± 2 years; stature: 165.8 ± 4.5 cm; mass: 55.9 ± 3.2 kg) completed two 11 km/h treadmill runs, 24 hours apart, in both CRS and MFW (pretest). Plantar data were measured using sensory insoles for foot strike patterns, stride frequency, mean maximum force ( M ⁢ F ¯ ), mean maximum pressure ( M ⁢ P ¯ ) and eight mean maximum regional pressures. Subjects then completed a 4-week familiarization period consisting of running in MFW and simple gait-retraining, before repeating the tests (posttest). During the pretests, 30% of subjects adopted a forefoot strike in MFW, following familiarization this increased to 80%; no change occurred in CRS. A significant decrease in M ⁢ F ¯ in both MFW and CRS (P = 0.024) was observed from pre-post, and a significant decrease in heel pressures in MFW. M ⁢ P ¯ was higher in MFW throughout testing (P < 0.001).A 4-week familiarization to MFW resulted in a significant reduction in M ⁢ F ¯ in both the CRS and MFW conditions, as well as a reduction in heel pressures. Higher M ⁢ P ¯ was observed throughout testing in the MFW condition. PMID:24004458

  17. Effect of overground vs treadmill running on plantar pressure: influence of fatigue.

    PubMed

    García-Pérez, José A; Pérez-Soriano, Pedro; Llana, Salvador; Martínez-Nova, Alfonso; Sánchez-Zuriaga, Daniel

    2013-09-01

    The differences produced when running on a treadmill vs overground may call into question the use and validity of the treadmill as a piece of equipment commonly used in research, training, and rehabilitation. The aim of the present study was to analyze under pre/post fatigue conditions the effect of treadmill vs overground on plantar pressures. Twenty-seven recreational runners (17 men and 10 women) ran on a treadmill and overground at two speeds: S1=3.33 m/s and S2=4.00 m/s, before and after a fatigue protocol consisting of a 30-min run at 85% of their individual maximal aerobic speed (MAS). Contact time (CT in seconds), peak pressure (PP in kPa), and relative load (RL in %) were analyzed under nine foot zones of the left foot using an in-shoe plantar pressure device. A two-way repeated measures ANOVA showed that running on a treadmill increases CT (7.70% S1 and 9.91% S2), modifies the pressure distribution and reduces PP (25.98% S1 and 31.76% S2), especially under the heel, medial metatarsals, and hallux, compared to running overground. Moreover, on both surfaces, fatigue (S2) led to a reduced stride frequency (2.78%) and reduced PP on the lateral heel and hallux (15.96% and 16.35%, respectively), and (S1) increased relative load on the medial arch (9.53%). There was no significant interaction between the two factors analyzed (surface and fatigue). Therefore, the aforementioned surface effect, which occurs independently of the fatigue state, should be taken into account when interpreting the results of studies that use the treadmill in their experimental protocols, and when prescribing physical exercise on a treadmill. PMID:23746487

  18. The effect of a long-distance run on plantar pressure distribution during running.

    PubMed

    Willems, Tine Marieke; De Ridder, Roel; Roosen, Philip

    2012-03-01

    The purpose of this study was to assess plantar pressure alterations after long-distance running. Prior to and after a 20 km run, force distribution underneath the feet of 52 participants was registered using Footscan(®) pressure plates while the participants ran shod at a constant self-selected pace. Peak force, mean force and impulse were registered underneath different zones of the foot. In addition, temporal data as total foot contact time, time of contact and end of contact were derived for these zones. Furthermore, a medio-lateral pressure distribution ratio was calculated in different phases of the roll-off. After the run, increases in the loading of the forefoot, midfoot and medial heel were noted and decreases in loading of the lateral toes. In the forefoot push off phase a more lateral pressure distribution was observed. The results of this study demonstrated plantar pressure deviations after long-distance running which could give additional information related to several running injuries. PMID:22153665

  19. Effect of rocker shoes on plantar pressure pattern in healthy female runners.

    PubMed

    Sobhani, Sobhan; van den Heuvel, Edwin; Bredeweg, Steef; Kluitenberg, Bas; Postema, Klaas; Hijmans, Juha M; Dekker, Rienk

    2014-03-01

    Rocker profile shoes (rocker shoes) are one of the treatment options of metatarsalgia and forefoot stress fractures. The efficacy of rocker shoes in unloading the forefoot pressure has been shown in walking. In running, however, the effect of rocker shoes on forefoot pressure is unknown. Eighteen healthy female runners participated in this study. In-shoe plantar pressures were recorded during running with the standard running shoes and rocker shoes. Shoe comfort was assessed after each shoe measurement. Peak pressure (PP), maximum mean pressure (MMP) and force-time integral (FTI) were determined for seven foot areas. The effects of shoes on the different outcome variables were statistically analyzed using a linear mixed model. Running with the rocker shoes caused a significant reduction (p<0.001) in all pressure parameters in the central and lateral forefoot. FTI and MMP were also reduced by 11% and 12% in the medial forefoot while running with rocker shoes. Running with rocker shoes resulted in a significant increase in all pressure parameters at the heel region (p<0.001). Running with rocker shoes received a significant (p<0.01) lower comfort rate than running with standard running shoes. Rocker shoes might be beneficial for runners who are recovering from metatarsalgia or stress fractures of the forefoot region, as it reduces plantar pressure in the forefoot region. PMID:24370440

  20. Plantar fibromatosis masquerading as metastatic melanoma.

    PubMed

    Kroeker, Teresa R; Fisher, Sarah B; Lisle, Allison; Dale, Paul S

    2009-01-01

    We present the evaluation and treatment of a 59-year-old male with a medical history significant for multiple recurrences of malignant melanoma. The patient was found to have increased focal uptake of his right foot on fluorodeoxyglucose positron emission tomography. Given the patient's clinical history, the increased uptake was suspected to be recurrence of his disease. The nodule was surgically excised and was later pathologically diagnosed as benign plantar fibromatosis. To our knowledge, only one other case report of plantar fibromatosis demonstrating increased fluorodeoxyglucose positron emission tomography uptake exists. Given the distinct prognostic differences between plantar fibromatosis and recurrent malignant melanoma, clinicians should be aware of the possibility of such false-positives with fluorodeoxyglucose positron emission tomography during oncologic surveillance. PMID:19605932

  1. [Plantar fibromatosis: therapy by total plantarfasciectomy].

    PubMed

    Beckmann, J; Kalteis, T; Baer, W; Grifka, J; Lerch, K

    2004-01-01

    Morbus Ledderhose is a rare fibromatous disease of the plantar fascia. Clinical features include palpable solitary or multiple nodules and cords, mainly affecting the medial part of the plantar fascia. When clinical symptoms occur, conservative options include stretching, orthotics, nonsteroidal antirheumatic drugs, local cortisone-injections and physiotherapy. Operative treatment is indicated in case of persistent pain or if conservative measures fail. The standard procedure includes a partial fasciectomy of the plantar aponeurosis. There is a high recurrence rate with an increased risk of complications and more aggressive ingrowth into anatomical structures after partial resection. Therefore we recommend a complete fasciectomy not only in recurrent disease, but also as the primary procedure of choice. PMID:15011113

  2. Plantar fibromatosis: an immunohistochemical and ultrastructural study.

    PubMed

    de Palma, L; Santucci, A; Gigante, A; Di Giulio, A; Carloni, S

    1999-04-01

    The analogies between plantar fibromatosis and Dupuytren's disease (palmar fibromatosis) are well known. The latter is clinically more frequent and has been the object of extensive immunohistochemical and ultrastructural studies, with a view to investigating its pathogenesis. By contrast, such data on plantar fibromatosis are quite scarce. A histochemical, immunohistochemical, and ultrastructural study was performed on nodule tissue from six patients who were subjected to total fasciectomy for plantar fibromatosis. The study of myofibroblasts revealed features suggestive of their fibroblastic origin and evidenced a cytoskeleton and an extracellular filamentous system that could enable myofibroblasts to generate and exert the intracellular forces that contribute to the contraction of the aponeurosis. These aspects are similar to those observed in Dupuytren's disease and seem to lend support to the theory that the two diseases are expressions of the same disorder. PMID:10229282

  3. Influence of activity on plantar force distribution.

    PubMed

    Reinschmidt, C; Nigg, B M; Hamilton, G R

    1994-03-01

    The purpose of the study was to quantify the influence of physical activity on force distribution on the plantar surface of the foot. Eleven healthy subjects each performed 10 walking trials over a force distribution platform: five trials before and five trials after a 30-min run. For the analysis the foot was divided into three different regions (rearfoot, midfoot, forefoot), and maximal and average forces were determined for each region. The only statistically significant difference was found in the maximal force in the forefoot, but the difference was relatively small (<3%). The results suggested that the half-hour run did not have a large effect on the plantar force distribution. Differences between subjects were significant for all variables, indicating that relevant information on individual foot structure and/or gait may be obtained from the plantar force distribution. PMID:23916132

  4. Plantar Foot Surface Temperatures with Use of Insoles

    PubMed Central

    Hall, Michelle; Shurr, Donald G; Zimmerman, M Bridget; Saltzman, Charles L

    2004-01-01

    Purpose- Patients with diabetes are often prescribed foot orthoses to help prevent foot ulcer formation. Orthotics are used to redistribute normal and shear stress. Shear stresses are not easily measurable and considered to be responsible for skin breakdown. Local elevation of skin temperature has been implicated as an early sign of impending ulceration especially in regions of high shear stress. The purpose of this study was to measure the effects of commonly prescribed insole materials on local changes in plantar foot temperature during normal gait. Methods- Six commonly used foot orthosis materials were tested using the Thermo Trace™ infrared thermometer to measure foot temperature. Ten healthy adult volunteers without any history of diabetes or abnormal sensation participated in the study. During each trial the subject walked on a treadmill with the test material in the dominant foot's shoe, for six minutes at a speed of four miles per hour and rested for six minutes between trials. Four locations on the foot (hallux, first and fifth metatarsal heads, and heel) and the contralateral bicep temperatures were measured at 0, 1, 3, 5 minutes during the rest period. The order of material and skin location testing was randomized. Results- Significant differences were found between baseline temperatures and foot temperatures for all materials. However, no differences were found between materials for any location on the foot. Conclusion- Previous studies have attempted to characterize materials based on laboratory and clinical testing, while other studies have attempted to characterize the effect of pressure on skin temperature. However, no study has previously attempted to characterize foot orthosis materials based on foot temperatures. This study compared foot temperatures of healthy adults based on the material tested. Although this study was unable to distinguish between materials based on foot temperatures, it was able to show a rise in foot temperature with any material used. This study demonstrates a need to a larger study on a population with diabetes. PMID:15296210

  5. Osseous metaplasia in plantar fibromatosis: a case report.

    PubMed

    DeBrule, Michael B; Mott, Richard C; Funk, Christopher; Nixon, Brent P; Armstrong, David G

    2004-01-01

    A case report about extensive osseous metaplasia of a plantar fibromatosis is presented. The authors are unaware of previous reports in the literature describing osseous metaplasia within plantar fibromatosis in this manner. This case shows that plantar fibromatosis may undergo osseous metaplasia in a fashion similar to fibromatous lesions elsewhere. PMID:15605059

  6. Plantar Pressure Changes and Correlating Risk Factors in Chinese Patients with Type 2 Diabetes: Preliminary 2-year Results of a Prospective Study

    PubMed Central

    Qiu, Xuan; Tian, De-Hu; Han, Chang-Ling; Chen, Wei; Wang, Zhan-Jian; Mu, Zhen-Yun; Liu, Kuan-Zhi

    2015-01-01

    Background: Plantar pressure serves as a key factor for predicting ulceration in the feet of diabetes patients. We designed this study to analyze plantar pressure changes and correlating risk factors in Chinese patients with type 2 diabetes. Methods: We recruited 65 patients with type 2 diabetes. They were invited to participate in the second wave 2 years later. The patients completed identical examinations at the baseline point and 2 years later. We obtained maximum force, maximum pressure, impulse, pressure-time integral, and loading rate values from 10 foot regions. We collected data on six history-based variables, six anthropometric variables, and four metabolic variables of the patients. Results: Over the course of the study, significant plantar pressure increases in some forefoot portions were identified (P < 0.05), especially in the second to forth metatarsal heads. Decreases in heel impulse and pressure-time integral levels were also found (P < 0.05). Plantar pressure parameters increased with body mass index (BMI) levels. Hemoglobin A1c (HbA1c) changes were positively correlated with maximum force (β = 0.364, P = 0.001) and maximum pressure (β = 0.366, P = 0.002) changes in the first metatarsal head. Cholesterol changes were positively correlated with impulse changes in the lateral portion of the heel (β = 0.179, P = 0.072) and pressure-time integral changes in the second metatarsal head (β = 0.236, P = 0.020). Ankle-brachial index (ABI) changes were positively correlated with maximum force changes in the first metatarsal head (β = 0.137, P = 0.048). Neuropathy symptom score (NSS) and common peroneal nerve sensory nerve conduction velocity (SCV) changes were positively correlated with some plantar pressure changes. In addition, plantar pressure changes had a correlation with the appearance of infections, blisters (β = 0.244, P = 0.014), and calluses over the course of the study. Conclusions: We should pay attention to the BMI, HbA1c, cholesterol, ABI, SCV, and NSS changes in the process of preventing high plantar pressure and ulceration. Some associated precautions may be taken with the appearance of infections, blisters, and calluses. PMID:26668141

  7. Neglected isolated plantar dislocation of middle cuneiform : a case report

    PubMed Central

    Verma, Ashu; Sharma, Vinod Kumar; Batra, Sumit; Rohria, Mahender Singh

    2007-01-01

    Background Four cases of plantar dislocation of middle cuneiform have been reported in the english literature. All of them were fresh cases and treated with open reduction. We are reporting a case of neglected plantar dislocation of middle cuneiform which was treated with excision. Case presentation A farmer presented with a painful plantar dislocation of middle cuneiform bone after 9 months of injury. The bone was deformed and was excised by a plantar incision. It resulted in painless foot with no disability. Conclusion The neglected plantar dislocated middle cuneiform bone becomes deformed due to repeated weight bearing. The gap gets filled with Fibrous tissue. Excision of the cuneiform gives good results. PMID:17229316

  8. Flat Feet, Happy Feet? Comparison of the Dynamic Plantar Pressure Distribution and Static Medial Foot Geometry between Malawian and Dutch Adults

    PubMed Central

    Stolwijk, Niki M.; Duysens, Jacques; Louwerens, Jan Willem K.; van de Ven, Yvonne HM.; Keijsers, Noël LW.

    2013-01-01

    In contrast to western countries, foot complaints are rare in Africa. This is remarkable, as many African adults walk many hours each day, often barefoot or with worn-out shoes. The reason why Africans can withstand such loading without developing foot complaints might be related to the way the foot is loaded. Therefore, static foot geometry and dynamic plantar pressure distribution of 77 adults from Malawi were compared to 77 adults from the Netherlands. None of the subjects had a history of foot complaints. The plantar pressure pattern as well as the Arch Index (AI) and the trajectory of the center of pressure during the stance phase were calculated and compared between both groups. Standardized pictures were taken from the feet to assess the height of the Medial Longitudinal Arch (MLA). We found that Malawian adults: (1) loaded the midfoot for a longer and the forefoot for a shorter period during roll off, (2) had significantly lower plantar pressures under the heel and a part of the forefoot, and (3) had a larger AI and a lower MLA compared to the Dutch. These findings demonstrate that differences in static foot geometry, foot loading, and roll off technique exist between the two groups. The advantage of the foot loading pattern as shown by the Malawian group is that the plantar pressure is distributed more equally over the foot. This might prevent foot complaints. PMID:23468936

  9. Squamous cell carcinoma of the heel with free latissimus dorsi myocutaneous flap reconstruction: case report and technical note.

    PubMed

    Al Maksoud, Ahmed Mahmoud; Barsoum, Adel K; Moneer, Mohammed

    2016-01-01

    Squamous cell carcinoma (SCC) is the second most common skin cancer; however, it is relatively rare on the foot. Wide excision of SCC is the recommended surgical treatment. The extent of the excision may involve resection of muscles and bone in cases of deep lesions. The functional and anatomic properties and lack of sufficient locally available tissues make the reconstruction of post-oncosurgical defects of the foot a challenging process. Heel reconstruction poses the biggest challenge due to the unique weight-bearing requirements. We present a case of a Marjolin's ulcer on the heel in a 62-year-old woman complicating a chronic non-healing wound. The heel defect was reconstructed with a free latissimus dorsi myocutaneous flap with delayed secondary closure. The outcome was successful both functionally and cosmetically. No further procedures were needed. PMID:27161144

  10. PLANTAR THROMBOPHLEBITIS: MAGNETIC RESONANCE IMAGING FINDINGS

    PubMed Central

    Miranda, Frederico Celestino; Carneiro, Renato Duarte; Longo, Carlos Henrique; Fernandes, Túlio Diniz; Rosemberg, Laércio Alberto; de Gusmão Funari, Marcelo Buarque

    2015-01-01

    Objective: Demonstrate the magnetic resonance imaging (MRI) findings in plantar thrombophlebitis. Methods: Retrospective review of twenty patients with pain in the plantar region of the foot, in which the MRI findings indicated plantar thrombophlebitis. Results: A total of fourteen men and six women, mean age 46.7 years were evaluated. Eight of these patients also underwent Doppler ultrasonography, which confirmed the thrombophlebitis. The magnetic resonance images were evaluated in consensus by two radiologists with experience in musculoskeletal radiology (more than 10 years each), showing perivascular edema in all twenty patients (100%) and muscle edema in nineteen of the twenty patients (95%). All twenty patients had intraluminal intermediate signal intensity on T2-weighted (100%) and venous ectasia was present in seventeen of the twenty cases (85%). Collateral veins were visualized in one of the twenty patients (5%). All fourteen cases (100%), in which intravenous contrast was administered, showed perivenular tissues enhancement and intraluminal filling defect. Venous ectasia, loss of compressibility and no flow on Doppler ultrasound were also observed in all eight cases examined by the method. Conclusion: MRI is a sensitive in the evaluation of plant thrombophlebitis in patients with plantar foot pain.

  11. Plantar fascia coronal length: a new parameter for plantar fascia assessment.

    PubMed

    Sari, Ahmet Sinan; Demircay, Emre; Cakmak, Gokhan; Sahin, M Sukru; Tuncay, I Cengiz; Altun, Suleyman

    2015-01-01

    The effects of gender and various anthropometric variables were previously reported as significant predictors of plantar fascia thickness. Although a strong correlation between either the body weight or body mass index (BMI) and plantar fascia thickness were not demonstrated, a moderate relation was stated. We retrospectively investigated the role of gender, height, weight, and body mass index on plantar fascia thickness at the calcaneal origin (PFCO) and 1 cm distal from the calcaneal origin (PF1cm) and the coronal length of the plantar fascia at the calcaneal origin (CLPF) in healthy subjects. The PFCO, PF1cm, and CLPF were retrospectively measured from magnetic resonance images of 100 healthy subjects. The gender, height, weight, and body mass index of the participants were also noted. Gender was a predictive factor for the length of the CLPF. The subjects with a BMI >25 kg/m(2) had a significantly greater PFCO, PF1cm, and CLPF. Height was mildly and BMI and weight were moderately related to the PFCO. However the CLPF showed a better correlation with height, BMI, and weight than that of plantar fascia thickness. CLPF better reflected the role of weight, BMI, and height than its thickness. It is a new parameter that could be valuable in the evaluation of plantar fascia disorders. PMID:25488598

  12. Structural analysis of the Heel Jet secondary catch mechanism

    SciTech Connect

    Coverdell, B.L.

    1995-04-17

    Studies of the Heel Jet Pump lifting bail weld indicate that the weld process and/or weld material used may be incompatible with the base metal. For this reason, a backup design for hoist of the Heel Jet Pump is necessary. By using a 0.0508 m (2 in.) and 0.0762 m (3 in.) jumper connector in conjunction with the existing lifting bail the Heel Jet Pump can be safely hoisted.

  13. Dose-response effects of customised foot orthoses on lower limb muscle activity and plantar pressures in pronated foot type.

    PubMed

    Telfer, Scott; Abbott, Mandy; Steultjens, Martijn; Rafferty, Daniel; Woodburn, James

    2013-07-01

    Customised foot orthoses (FOs) featuring extrinsic rearfoot posting are commonly prescribed for individuals with a symptomatic pronated foot type. By altering the angle of the posting it is purported that a controlled dose-response effect during the stance phase of gait can be achieved, however these biomechanical changes have yet to be characterised. Customised FOs were administered to participant groups with symptomatic pronated foot types and asymptomatic normal foot types. The electromyographic (EMG) and plantar pressure effects of varying the dose were measured. Dose was varied by changing the angle of posting from 6° lateral to 10° medial in 2° steps on customised devices produced using computer aided orthoses design software. No effects due to posting level were found for EMG variables. Significant group effects were seen with customised FOs reducing above knee muscle activity in pronated foot types compared to normal foot types (biceps femoris p=0.022; vastus lateralis p<0.001; vastus medialis p=0.001). Interaction effects were seen for gastrocnemius medialis and soleus. Significant linear effects of posting level were seen for plantar pressure at the lateral rearfoot (p=0.001), midfoot (p<0.001) and lateral forefoot (p=0.002). A group effect was also seen for plantar pressure at the medial heel (p=0.009). This study provides evidence that a customised FOs can provide a dose response effect for selected plantar pressure variables, but no such effect could be identified for muscle activity. Foot type may play an important role in the effect of customised orthoses on activity of muscles above the knee. PMID:23391752

  14. Waste Tank Heel Chemical Cleaning Summary

    SciTech Connect

    Barnes, M.J.

    2003-12-02

    At the Savannah River Site in Aiken, South Carolina, there are approximately 40 million gallons of legacy High Level Waste stored in large capacity sub-surface tanks. Twelve of these tanks are single-containment, non-conforming tanks with leaks. These tanks were built in the 1950s. Some of these tanks contain sludge heels and are being considered for near-term removal efforts and vitrification. Currently, only mechanical methods (i.e., pumps) are used to remove the sludge waste with varying degrees of success. To provide for additional levels of removal, chemically-aided techniques are being considered. The objective of the was to collect and evaluate information available on chemical-based methods for removing residual solids from the Site's waste tanks. As part of this study, the team was requested to develop recommendations for chemical treatments to remove residual heels (primarily sludge). Ideally, one agent alone would be efficient at dissolving all residual tank heels and yet satisfy all safety and process concerns. No such chemical cleaning agent was found. The cleaning agents identified from the literature, included oxalic acid, a mixture of oxalic acid and citric acid, a combination of oxalic acid with hydrogen peroxide, nitric acid, formic acid, and organics. A criteria matrix for evaluating the various cleaning agents was developed. The results of the evaluation conclusively support oxalic acid as the cleaning agent of choice for the immediate future. Oxalic acid scored nearly double the next closest cleaning agent. Nitric acid, formic acid, and oxalic acid with hydrogen peroxide were all closely grouped for the next best choice. The mixture of oxalic acid and citric acid rated poorly. Organics rated even more poorly due to large uncertainties in performance and downstream impacts.

  15. Efficacy of EZStep in the management of plantar fasciitis: a prospective, randomized study.

    PubMed

    Al-Bluwi, Mohammed T; Sadat-Ali, Mir; Al-Habdan, Ibrahim M; Azam, Mohammed Q

    2011-08-01

    Plantar fasciitis is one of the most common causes of heel pain. Despite extensive efforts foot surgeons continue to debate the best modality of treatment. Analgesics, shoe inserts, stretching exercises, steroid injection, night splints, and extracorporeal shock wave therapy have proved effective in one group but fail in others. This study evaluated the efficacy of EZStep, a new foot brace for the management of plantar fasciitis. A total of 198 patients were randomized in 2 groups; group 1 (study group) received nonsteroidal anti-inflammatory drugs (NSAIDs; 4-6 weeks) and EZStep whereas group 2 (control group) received either NSAID and physiotherapy alone (2A) or NSAID, physiotherapy, and local steroid injection (2B). None of the patients received over-the-counter insoles or strapping of plantar arch to avoid any bias in randomization. Evaluations included measurement of weight and height, visual analog scale (VAS) for pain, and Short-Form McGill Pain Questionnaire (SFMPQ). After 8 weeks, patients were reevaluated, and assessment for the VAS and SFMPQ with treatment outcome was performed. Patients with VAS scores ?3 were considered as excellent, ?4 as good, and ?7 as poor. The posttreatment evaluation showed that VAS scores were in the range from 2.97 1.06 to 7.64 2.9 (2A), P = .001, 95% confidence interval (CI) <-4.104; for 2B P = .001, CI <-2.44, and SFMPQ was 21.7 4.5 and 69.2 5.8 (group 2A; P = .001, 95% CI <-46.44). Compared with group 2B the SFMPQ was 66.5 4.3 (P = .001, 95% CI <-30.720). In group 1 as per VAS, 86 (73.5%) were evaluated as excellent, 15 (12.8%) as good, and 16 (13.6%) as poor. Our study shows that the regular use of EZStep with short course of NSAIDs (4-6 weeks) was effective in ameliorating symptoms in more than 85% of patients suffering from plantar fasciitis. PMID:21868794

  16. Prominent hyperkeratotic plantar and palmar warts.

    PubMed

    Matsumoto, Y; Adachi, A; Banno, S; Hayashi, Y; Ogiyama, Y; Ohashi, M

    1999-02-01

    We report the case of a 28-year-old man who had prominent hyperkeratotic plantar and palmar warts, and flat warts on his face and chest. By DNA hybridization, human papillomavirus 1 and/or 2, and 3 DNA were detected from the tissues of these skin lesions. Results of laboratory investigations revealed leukopenia, eosinophilia, anti-HBs antigen and anti-hepatitis C virus antibody, and decrease in the OKT4/OKT8 ratio. He had no abnormality in cellular immunity. He was treated with multiple modalities, but was successfully treated with electrocautery to the plantar and palmar warts, and cryotherapy with liquid nitrogen to the flat warts. Nine years after the initial treatment, almost no recurrence was recognized. PMID:10071737

  17. Recovery of plutonium from electrorefining anode heels at Savannah River

    SciTech Connect

    Gray, J H; Gray, L W; Karraker, D G

    1987-03-01

    In a joint effort, the Savannah River Laboratory (SRL), Savannah River Plant (SRP), and the Rocky Flats Plant (RFP) have developed two processes to recover plutonium from electrorefining anode heel residues. Aqueous dissolution of anode heel metal was demonstrated at SRL on a laboratory scale and on a larger pilot scale using either sulfamic acid or nitric acid-hydrazine-fluoride solutions. This direct anode heel metal dissolution requires the use of a geometrically favorable dissolver. The second process developed involves first diluting the plutonium in the anode heel residues by alloying with aluminum. The alloyed anode heel plutonium can then be dissolved using a nitric acid-fluoride-mercury(II) solution in large non-geometrically favorable equipment where nuclear safety is ensured by concentration control.

  18. Classification and treatment of plantar fibromatosis.

    PubMed

    Sammarco, G J; Mangone, P G

    2000-07-01

    A retrospective study of 18 patients (23 feet) with plantar fibromatosis who required surgical excision between January, 1991, and June, 1998, was performed. Subtotal plantar fasciectomy was performed to remove the tumor with a wide disease-free margin. 16 patients (21 feet) were interviewed and 14 patients (19 feet) were examined with an average followup of 36 months. Two patients (2 feet) with less than 12 months followup were excluded. Both subjective and objective evaluations and pre- and postoperative x-rays were reviewed to assess the alignment of the bony arch. There were nine males and nine females, age 49 years, average, at the time of diagnosis. Sixty-seven percent of patients had bilateral disease, and 28% had associated Dupuytren's contracture. There were 18 primary and five recurrent tumors. An operative staging system, I to IV, for plantar fibromatosis is presented which incorporates the extent of plantar fascia involvement, the presence of skin adherence, and the depth of tumor extension. The stage of the tumor correlated well with postoperative wound healing, skin necrosis, and recurrence. In fifteen of 21 feet, the patients were satisfied without reservations, and in three of 21 feet, they were satisfied with reservations. In 18/21 (86%) feet, the patient reported he/she would have surgery done again. There were two recurrent tumors. One was reoperated and the patient was disease free twelve months postoperatively. The other recurrence was asymptomatic 40 months postoperatively and required no treatment. One patient required an excision of a postoperative cutaneous neuroma. Eleven of 21 feet (52%) experienced delayed healing and of which four required a split thickness skin graft. Ten of the eleven feet with delayed wound healing and all four cases requiring a skin graft had a stage ill or IV tumor. Pre- and postoperative weightbearing radiographs revealed a slight decrease in the calcaneal pitch angle, navicular height, and medial cuneiform height indicating a decrease in the height of the medial longitudinal arch. PMID:10919621

  19. Foot Kinematics During a Bilateral Heel Rise Test in Participants With Stage II Posterior Tibial Tendon Dysfunction

    PubMed Central

    HOUCK, JEFF; NEVILLE, CHRISTOPHER; TOME, JOSHUA; FLEMISTER, ADOLPH

    2010-01-01

    STUDY DESIGN Experimental laboratory study using a cross-sectional design. OBJECTIVES To compare foot kinematics, using 3-dimensional tracking methods, during a bilateral heel rise between participants with posterior tibial tendon dysfunction (PTTD) and participants with a normal medial longitudinal arch (MLA). BACKGROUND The bilateral heel rise test is commonly used to assess patients with PTTD; however, information about foot kinematics during the test is lacking. METHODS Forty-five individuals volunteered to participate, including 30 patients diagnosed with unilateral stage II PTTD (mean ± SD age, 59.8 ± 11.1 years; body mass index, 29.9 ± 4.8 kg/m2) and 15 controls (mean ± SD age, 56.5 ± 7.7 years; body mass index, 30.6 ± 3.6 kg/m2). Foot kinematic data were collected during a bilateral heel rise task from the calcaneus (hindfoot), first metatarsal, and hallux, using an Optotrak motion analysis system and Motion Monitor software. A 2-way mixed-effects analysis of variance model, with normalized heel height as a covariate, was used to test for significant differences between the normal MLA and PTTD groups. RESULTS The patients in the PTTD group exhibited significantly greater ankle plantar flexion (mean difference between groups, 7.3°; 95% confidence interval [CI]: 5.1° to 9.5°), greater first metatarsal dorsiflexion (mean difference between groups, 9.0°; 95% CI: 3.7° to 14.4°), and less hallux dorsiflexion (mean difference, 6.7°; 95% CI: 1.7° to 11.8°) compared to controls. At peak heel rise, hindfoot inversion was similar (P = .130) between the PTTD and control groups. CONCLUSION Except for hindfoot eversion/inversion, the differences in foot kinematics in participants with stage II PTTD, when compared to the control group, mainly occur as an offset, not an alteration in shape, of the kinematic patterns. PMID:19648723

  20. Screening Method Based on Walking Plantar Impulse for Detecting Musculoskeletal Senescence and Injury

    PubMed Central

    Fan, Yifang; Fan, Yubo; Li, Zhiyu; Newman, Tony; Lv, Changsheng; Zhou, Yi

    2013-01-01

    No consensus has been reached on how musculoskeletal system injuries or aging can be explained by a walking plantar impulse. We standardize the plantar impulse by defining a principal axis of plantar impulse. Based upon this standardized plantar impulse, two indexes are presented: plantar pressure record time series and plantar-impulse distribution along the principal axis of plantar impulse. These indexes are applied to analyze the plantar impulse collected by plantar pressure plates from three sources: Achilles tendon ruptures; elderly people (ages 62–71); and young people (ages 19–23). Our findings reveal that plantar impulse distribution curves for Achilles tendon ruptures change irregularly with subjects’ walking speed changes. When comparing distribution curves of the young, we see a significant difference in the elderly subjects’ phalanges plantar pressure record time series. This verifies our hypothesis that a plantar impulse can function as a means to assess and evaluate musculoskeletal system injuries and aging. PMID:24386288

  1. Double-Shell Tank Retrieval Allowable Heel Trade Analysis

    SciTech Connect

    Grams, W.H.

    1995-09-27

    This Double-Shell Tank Retrieval Allowable Heel Trade Analysis evaluates the effects a remaining heel has on subsequent waste storage requirements after initial retrieval. The information contained in this analysis will be used as a basis to identify crucial double-shell tank (DST) retrieval system design and performance requirements for continued storage of waste in DSTs. The information presented in this analysis is summarized by the DST initial retrieval and reuse strategy. The strategy is based on the waste compatibility and consolidation requirements that are governed by the remaining heel after initial retrieval

  2. A dynamic model of the windlass mechanism of the foot: evidence for early stance phase preloading of the plantar aponeurosis.

    PubMed

    Caravaggi, Paolo; Pataky, Todd; Goulermas, John Y; Savage, Russel; Crompton, Robin

    2009-08-01

    In the present study we have estimated the temporal elongation of the plantar aponeurosis (PA) during normal walking using a subject-specific multi-segment rigid-body model of the foot. As previous studies have suggested that muscular forces at the ankle can pre-load the PA prior to heel-strike, the main purpose of the current study was to test, through modelling, whether there is any tension present in the PA during early stance phase. Reflective markers were attached to bony landmarks to track the kinematics of the calcaneus, metatarsus and toes during barefoot walking. Ultrasonography measurements were performed on three subjects to determine both the location of the origin of the PA on the plantar aspect of the calcaneus, and the radii of the metatarsal heads. Starting with the foot in a neutral, unloaded position, inverse kinematics allowed calculation of the tension in the five slips of the PA during the whole duration of the stance phase. The results show that the PA experienced tension significantly above rest during early stance phase in all subjects (P<0.01), thus providing support for the PA-preloading hypothesis. The amount of preloading and the maximum elongation of the slips of the PA decreased from medial to lateral. The mean maximum tension exerted by the PA was 1.5 BW (body weight) over the three subjects. PMID:19617443

  3. [Research on Adaptive Balance Reaction for Gait Slippery Instability Events on Level Walk Based on Plantar Pressure and Gait Parameter Analysis].

    PubMed

    Li, Yang; Zhang, Junxia; Si, Ying

    2015-12-01

    Nowadays, for gait instability phenomenon, many researches have been carried out at home and abroad. However, the relationship between plantar pressure and gait parameters in the process of balance adjustment is still unclear. This study describes the human body adaptive balance reaction during slip events on slippery level walk by plantar pressure and gait analysis. Ten healthy male subjects walked on a level path wearing shoes with two contrastive contaminants (dry, oil). The study collected and analyzed the change rule of spatiotemporal parameters, plantar pressure parameters, vertical ground reaction force (VGRF), etc. The results showed that the human body adaptive balance reaction during slip events on slippery level walk mainly included lighter touch at the heel strikes, tighter grip at the toe offs, a lower velocity, a shorter stride length and longer support time. These changes are used to maintain or recover body balance. These results would be able to explore new ideas and provide reference value for slip injury prevention, walking rehabilitation training design, research and development of walking assistive equipments, etc. PMID:27079090

  4. Ultrasound-Assisted Endoscopic Partial Plantar Fascia Release

    PubMed Central

    Ohuchi, Hiroshi; Ichikawa, Ken; Shinga, Kotaro; Hattori, Soichi; Yamada, Shin; Takahashi, Kazuhisa

    2013-01-01

    Various surgical treatment procedures for plantar fasciitis, such as open surgery, percutaneous release, and endoscopic surgery, exist. Skin trouble, nerve disturbance, infection, and persistent pain associated with prolonged recovery time are complications of open surgery. Endoscopic partial plantar fascia release offers the surgeon clear visualization of the anatomy at the surgical site. However, the primary medial portal and portal tract used for this technique have been shown to be in close proximity to the posterior tibial nerves and their branches, and there is always the risk of nerve damage by introducing the endoscope deep to the plantar fascia. By performing endoscopic partial plantar fascia release under ultrasound assistance, we could dynamically visualize the direction of the endoscope and instrument introduction, thus preventing nerve damage from inadvertent insertion deep to the fascia. Full-thickness release of the plantar fascia at the ideal position could also be confirmed under ultrasound imaging. We discuss the technique for this new procedure. PMID:24265989

  5. An evaluation of a silicone adhesive shaped heel dressing.

    PubMed

    Hampton, Sylvie

    Tissue breakdown is complex and involves many factors. Pressure ulcer development in the heels is subject to extrinsic factors such as pressure, shear, friction and moisture. The heels are the most common sites for friction and shear damage, which can lead to blistering, skin erosion and tissue breakdown (Grey et al, 2006). To address the issues of wounds that are painful on dressing removal and friable skin, Smith & Nephew has introduced a soft silicone adhesive dressing to its Allevyn dressing range. Silicone does not adhere to wounded areas and can be removed gently without trauma to the periwound area. This paper discusses the findings of a 20-patient multi-site evaluation examining the performance and acceptability of Allevyn Gentle Border Heel dressing in the management of heel wounds. PMID:20335927

  6. MR elastographic methods for the evaluation of plantar fat pads: preliminary comparison of the shear modulus for shearing deformation and compressive deformation in normal subjects

    NASA Astrophysics Data System (ADS)

    Weaver, John B.; Miller, Timothy B.; Perrinez, Philip R.; Doyley, Marvin M.; Wang, Huifang; Cheung, Yvonne Y.; Wrobel, James S.; Comi, Richard J.; Kennedy, Francis E.; Paulsen, Keith D.

    2006-03-01

    MR elastography (MRE) images the intrinsic mechanical properties of soft tissues; e.g., the shear modulus, μ. The μ of the plantar soft tissues is important in understanding the mechanisms whereby the forces induced during normal motion produce ulcers that lead to amputation in diabetic feet. We compared the compliance of the heel fat pad to compressive forces and to shearing forces. The design of prosthetics to protect the foot depends on the proper understanding of the mechanisms inducing damage. In the heel fat pads of six normal subjects, between 25 and 65 years of age, the μ for deformation perpendicular to the direction of weight bearing is similar but not identical to that determined for deformation along the weight bearing axis. The average difference between μ along the weight bearing axis and μ perpendicular to the weight bearing axis, is well correlated with age (Correlation Coefficient = 0.789). The p-value for the data being random was 0.0347 indicating that the observed difference is not likely to be random. The p-value for control points is 0.8989, indicating a random process. The results are suggestive that the high compressive forces imposed during walking damage the heel fat pads over time resulting in softening to compression preferentially over shearing. It is important to validate the observed effect with larger numbers of subjects, and better controls including measures of activity, and to understand if diseases like diabetes increase the observed damage.

  7. Dynamic Patterns of Forces and Loading Rate in Runners with Unilateral Plantar Fasciitis: A Cross-Sectional Study

    PubMed Central

    Ribeiro, Ana Paula; João, Silvia Maria Amado; Dinato, Roberto Casanova; Tessutti, Vitor Daniel; Sacco, Isabel Camargo Neves

    2015-01-01

    Aim/Hypothesis The etiology of plantar fasciitis (PF) has been related to several risk factors, but the magnitude of the plantar load is the most commonly described factor. Although PF is the third most-common injury in runners, only two studies have investigated this factor in runners, and their results are still inconclusive regarding the injury stage. Objective Analyze and compare the plantar loads and vertical loading rate during running of runners in the acute stage of PF to those in the chronic stage of the injury in relation to healthy runners. Methods Forty-five runners with unilateral PF (30 acute and 15 chronic) and 30 healthy control runners were evaluated while running at 12 km/h for 40 meters wearing standardized running shoes and Pedar-X insoles. The contact area and time, maximum force, and force-time integral over the rearfoot, midfoot, and forefoot were recorded and the loading rate (20–80% of the first vertical peak) was calculated. Groups were compared by ANOVAs (p<0.05). Results Maximum force and force-time integral over the rearfoot and the loading rate was higher in runners with PF (acute and chronic) compared with controls (p<0.01). Runners with PF in the acute stage showed lower loading rate and maximum force over the rearfoot compared to runners in the chronic stage (p<0.01). Conclusion Runners with PF showed different dynamic patterns of plantar loads during running over the rearfoot area depending on the injury stage (acute or chronic). In the acute stage of PF, runners presented lower loading rate and forces over the rearfoot, possibly due to dynamic mechanisms related to pain protection of the calcaneal area. PMID:26375815

  8. Investigation of spectral content from discrete plantar areas during adult gait: an expansion of rehabilitation technology.

    PubMed

    Harris, G F; Acharya, K R; Bachschmidt, R A

    1996-12-01

    Evaluation of foot contact frequency components with the use of a standard force plate has been reported to be helpful in the clinical assessment of degenerative joint disease. Spectral analysis has also been used as a tool for the evaluation of prosthetic and orthotic designs. In this paper, we examine and employ a new method for determining spectral characteristics of discrete plantar foot surface areas. This method is used to characterize spectral frequency content of foot strike at discrete plantar locations in ten normal controls. Spectral data obtained from a standard force plate are also presented and compared to reports in the literature. Measurements at six discrete points under the foot were made with a custom-manufactured strain gage-based force dosimeter. In addition, measurements of ground reaction forces in the sagittal, coronal, and transverse planes were made using a high resonant frequency force plate during barefoot and shod walks for ten adult male control subjects. Spectral frequency components of all forces measured were determined through Fourier analysis. The hypothesis of the study was that discrete plantar frequencies would be essentially similar to those reported in earlier studies of foot contact with a ground reaction force plate. While Fourier transform of time domain force plate data revealed frequency contents that were contained primarily below 10 Hz, as has been previously reported, higher frequency components associated with impulsive loading at heel strike were also observed (75 Hz for barefoot walk and 60 Hz for shod). The anterior-posterior (AP) frequency spectrum of barefoot walking contained higher amplitude components than did shod walking, though both signals contained dominant frequencies of about 1 Hz. Medial-lateral (ML) frequency analyses were similar for both walking conditions with dominant components of about 4 Hz noted. Broader frequency spectrums were seen in the discrete force dosimeter data. Components were contained mostly below 12 Hz with some higher frequency content also noted. Discrete foot force dosimeter and force plate AP and ML spectral data during ambulation have not been previously reported. PMID:8973962

  9. Variation in the location of the shoe sole flexion point influences plantar loading patterns during gait

    PubMed Central

    2014-01-01

    Background Several footwear design characteristics are known to have detrimental effects on the foot. However, one characteristic that has received relatively little attention is the point where the sole flexes in the sagittal plane. Several footwear assessment forms assume that this should ideally be located directly under the metarsophalangeal joints (MTPJs), but this has not been directly evaluated. The aim of this study was therefore to assess the influence on plantar loading of different locations of the shoe sole flexion point. Method Twenty-one asymptomatic females with normal foot posture participated. Standardised shoes were incised directly underneath the metatarsophalangeal joints, proximal to the MTPJs or underneath the midfoot. The participants walked in a randomised sequence of the three shoes whilst plantar loading patterns were obtained using the Pedar® in-shoe pressure measurement system. The foot was divided into nine anatomically important masks, and peak pressure (PP), contact time (CT) and pressure time integral (PTI) were determined. A ratio of PP and PTI between MTPJ2-3/MTPJ1 was also calculated. Results Wearing the shoe with the sole flexion point located proximal to the MTPJs resulted in increased PP under MTPJ 4–5 (6.2%) and decreased PP under the medial midfoot compared to the sub-MTPJ flexion point (−8.4%). Wearing the shoe with the sole flexion point located under the midfoot resulted in decreased PP, CT and PTI in the medial and lateral hindfoot (PP: −4.2% and −5.1%, CT: −3.4% and −6.6%, PTI: −6.9% and −5.7%) and medial midfoot (PP: −5.9% CT: −2.9% PTI: −12.2%) compared to the other two shoes. Conclusion The findings of this study indicate that the location of the sole flexion point of the shoe influences plantar loading patterns during gait. Specifically, shoes with a sole flexion point located under the midfoot significantly decrease the magnitude and duration of loading under the midfoot and hindfoot, which may be indicative of an earlier heel lift. PMID:24642291

  10. Management of subcalcaneal pain and Achilles tendonitis with heel inserts

    PubMed Central

    Maclellan, G. E.; Vyvyan, Barbara

    1981-01-01

    Soft tissue symptoms in the leg due to sporting activity are commonly associated with the force of heel strike. Conventional training shoes compromise between comfort and performance; few models are suitably designed for both considerations. Using a visco-elastic polymer insert the symptoms of heel pain and Achilles tendonitis have been largely or completely abolished in a preliminary study. Imagesp117-ap117-bp117-cp118-a PMID:7272653

  11. Plantar fascia anatomy and its relationship with Achilles tendon and paratenon.

    PubMed

    Stecco, Carla; Corradin, Marco; Macchi, Veronica; Morra, Aldo; Porzionato, Andrea; Biz, Carlo; De Caro, Raffaele

    2013-12-01

    Although the plantar fascia (PF) has been studied quite well from a biomechanical viewpoint, its microscopic properties have been overlooked: nothing is known about its content of elastic fibers, the features of the extracellular matrix or the extent of innervation. From a functional and clinical standpoint, the PF is often correlated with the triceps surae muscle, but the anatomical grounds for this link are not clear. The aim of this work was to focus on the PF macroscopic and microscopic properties and study how Achilles tendon diseases might affect it. Twelve feet from unembalmed human cadavers were dissected to isolate the PF. Specimens from each PF were tested with various histological and immunohistochemical stains. In a second stage, 52 magnetic resonance images (MRI) obtained from patients complaining of aspecific ankle or foot pain were analyzed, dividing the cases into two groups based on the presence or absence of signs of degeneration and/or inflammation of the Achilles tendon. The thickness of PF and paratenon was assessed in the two groups and statistical analyses were conducted. The PF is a tissue firmly joined to plantar muscles and skin. Analyzing its possible connections to the sural structures showed that this fascia is more closely connected to the paratenon of Achilles tendon than to the Achilles tendon, through the periosteum of the heel. The PF extended medially and laterally, continuing into the deep fasciae enveloping the abductor hallucis and abductor digiti minimi muscles, respectively. The PF was rich in hyaluronan, probably produced by fibroblastic-like cells described as 'fasciacytes'. Nerve endings and Pacini and Ruffini corpuscles were present, particularly in the medial and lateral portions, and on the surface of the muscles, suggesting a role for the PF in the proprioception of foot. In the radiological study, 27 of the 52 MRI showed signs of Achilles tendon inflammation and/or degeneration, and the PF was 3.43 ± 0.48 mm thick (99%CI and SD = 0.95), as opposed to 2.09 ± 0.24 mm (99%CI, SD = 0.47) in the patients in which the MRI revealed no Achilles tendon diseases; this difference in thickness of 1.29 ± 0.57 mm (99%CI) was statistically significant (P < 0.001). In the group of 27/52 patients with tendinopathies, the PF was more than 4.5 mm thick in 5, i.e. they exceeded the threshold for a diagnosis of plantar fasciitis. None of the other 25/52 paitents had a PF more than 4 mm thick. There was a statistically significant correlation between the thicknesses of the PF and the paratenon. These findings suggest that the plantar fascia has a role not only in supporting the longitudinal arch of the foot, but also in its proprioception and peripheral motor coordination. Its relationship with the paratenon of the Achilles tendon is consistent with the idea of triceps surae structures being involved in the PF pathology, so their rehabilitation can be considered appropriate. Finally, the high concentration of hyaluronan in the PF points to the feasibility of using hyaluronan injections in the fascia to treat plantar fasciitis. PMID:24028383

  12. Plantar fascia anatomy and its relationship with Achilles tendon and paratenon

    PubMed Central

    Stecco, Carla; Corradin, Marco; Macchi, Veronica; Morra, Aldo; Porzionato, Andrea; Biz, Carlo; De Caro, Raffaele

    2013-01-01

    Although the plantar fascia (PF) has been studied quite well from a biomechanical viewpoint, its microscopic properties have been overlooked: nothing is known about its content of elastic fibers, the features of the extracellular matrix or the extent of innervation. From a functional and clinical standpoint, the PF is often correlated with the triceps surae muscle, but the anatomical grounds for this link are not clear. The aim of this work was to focus on the PF macroscopic and microscopic properties and study how Achilles tendon diseases might affect it. Twelve feet from unembalmed human cadavers were dissected to isolate the PF. Specimens from each PF were tested with various histological and immunohistochemical stains. In a second stage, 52 magnetic resonance images (MRI) obtained from patients complaining of aspecific ankle or foot pain were analyzed, dividing the cases into two groups based on the presence or absence of signs of degeneration and/or inflammation of the Achilles tendon. The thickness of PF and paratenon was assessed in the two groups and statistical analyses were conducted. The PF is a tissue firmly joined to plantar muscles and skin. Analyzing its possible connections to the sural structures showed that this fascia is more closely connected to the paratenon of Achilles tendon than to the Achilles tendon, through the periosteum of the heel. The PF extended medially and laterally, continuing into the deep fasciae enveloping the abductor hallucis and abductor digiti minimi muscles, respectively. The PF was rich in hyaluronan, probably produced by fibroblastic-like cells described as ‘fasciacytes’. Nerve endings and Pacini and Ruffini corpuscles were present, particularly in the medial and lateral portions, and on the surface of the muscles, suggesting a role for the PF in the proprioception of foot. In the radiological study, 27 of the 52 MRI showed signs of Achilles tendon inflammation and/or degeneration, and the PF was 3.43 ± 0.48 mm thick (99%CI and SD = 0.95), as opposed to 2.09 ± 0.24 mm (99%CI, SD = 0.47) in the patients in which the MRI revealed no Achilles tendon diseases; this difference in thickness of 1.29 ± 0.57 mm (99%CI) was statistically significant (P < 0.001). In the group of 27/52 patients with tendinopathies, the PF was more than 4.5 mm thick in 5, i.e. they exceeded the threshold for a diagnosis of plantar fasciitis. None of the other 25/52 paitents had a PF more than 4 mm thick. There was a statistically significant correlation between the thicknesses of the PF and the paratenon. These findings suggest that the plantar fascia has a role not only in supporting the longitudinal arch of the foot, but also in its proprioception and peripheral motor coordination. Its relationship with the paratenon of the Achilles tendon is consistent with the idea of triceps surae structures being involved in the PF pathology, so their rehabilitation can be considered appropriate. Finally, the high concentration of hyaluronan in the PF points to the feasibility of using hyaluronan injections in the fascia to treat plantar fasciitis. PMID:24028383

  13. Effects of high heeled shoes wearing experience and heel height on human standing balance and functional mobility.

    PubMed

    Hapsari, Vaniessa Dewi; Xiong, Shuping

    2016-02-01

    This study aimed to examine the effects of high heeled shoes (HHS) wearing experience and heel height on human standing balance and functional mobility. Thirty young and healthy females (ten experienced and twenty inexperienced HHS wearers) participated in a series of balance tests when they wore shoes of four different heel heights: 1 cm (flat), 4 cm (low), 7 cm (medium) and 10 cm (high). Experimental results show that regardless of the wearing experience, the heel elevation induces more effort from lower limb muscles (particularly calf muscles) and results in worse functional mobility starting at 7 cm heel height. While the heel height increased to 10 cm, the standing balance also becomes worse. Experienced HHS wearers do not show significantly better overall performance on standing balance and functional mobility than inexperienced controls, even though they have better directional control (76.8% vs. 74.4%) and larger maximum excursion (93.3% vs. 89.7%). To maintain standing balance, experienced wearers exert less effort on tibialis anterior, vastus lateralis and erector spinae muscles at the cost of more intensive effort from gastrocnemius medialis muscle. PMID:26155823

  14. Validation of plantar pressure measurements for a novel in-shoe plantar sensory replacement unit.

    PubMed

    Sawacha, Zimi

    2013-09-01

    An article by Ferber and coauthors in Journal of Diabetes Science and Technology reported on the ability of a novel in-shoe plantar sensory replacement unit (PSRU) to provide alert-based feedback derived from analyzing plantar pressure (PP) threshold measurements in real time. The study aimed at comparing the PSRU device to a gold standard pressure-sensing device (GS-PSD) to determine the correlation between concurrent measures of PP during walking. Data were collected simultaneously from 10 participants who walked overground with both devices. The variable of interest was the number of recorded data points greater than 32 mmHg for each of the PSRU sensors and corresponding average recordings from the GS-PSD. Authors concluded that the PSRU provides analogous data to the GS-PSD. However, several aspects of the study should be considered when interpreting their clinical relevance. PMID:24124943

  15. [Effect of body weight on plantar peak pressure in diabetic patients].

    PubMed

    Drerup, B; Beckmann, C; Wetz, H H

    2003-03-01

    The goal was a better understanding of the correlation between body mass and plantar peak pressure in patients with diabetic neuropathy. A further aim was to obtain insight into the practicability of simulated weight increase and weight release and to delineate more clearly the indications for reducing body weight in order to lower the risk of ulcerations. Simulated change of body weight: (1) +20 kg by a waistcoat and (2)-20 kg by a movable overhead suspension. While normal forces and thus mean normal pressures depend directly on body mass, this does not necessarily apply to peak normal pressures. As shown in a transversal study by Cavanagh with pressure measurements in the bare foot, there is only a poor correlation between body mass and peak pressure. Therefore, peak pressure in heavy persons cannot be expected to be higher than in lighter weight persons. However, from these results it cannot be concluded that peak pressure is likely to remain unchanged irrespective of a change in body weight in a specific subject. Ten subjects were investigated: five controls and five patients suffering from diabetes without neuropathy or preceding ulcerations. All subjects wore the same kind of ready made shoes with ready made standard fitting insoles of cork. Each subject was measured in three modes of weight simulation: normal weight,20 kg weight increase (waistcoat with weight pieces), and 20 kg weight release. Weight release was effected by a modified rescue harness attached to an overhead suspension rail with 6m free walking distance. Individual alignment of the waistcoat and the suspension was checked by a force platform. In-shoe pressure measurement was done with the PEDAR in-shoe system (by Novel, Munich,Germany). For data analysis with the PEDAR standard software only peak pressures were considered. The foot was divided into six regions, particularly metatarsal region and heel. No significant difference between diabetics and controls was found. In the regions at highest risk (metatarsals and heel),peak pressure increased and decreased with weight. In the combined group (n=10), a simulated weight loss of 20 kg decreased metatarsal peak pressure by 5.4+/-1.9 N/cm(2), a 20 kg weight gain increased it by 7.4+/-5.1 N/cm(2). Therefore, without a significant deviation from linearity, peak pressure was found to be a linear function of weight. The results of this study show that weight increase or weight loss in the individual patient has an effect on the plantar peak pressure. The effect is significant in the metatarsal and heel regions. The linearity allows for a simple method of predicting the effect of weight loss by inverting the effect of simulated weight gain. PMID:12647040

  16. Fiber optic plantar pressure/shear sensor

    NASA Astrophysics Data System (ADS)

    Soetanto, William; Nguyen, Ngoc T.; Wang, Wei-Chih

    2011-04-01

    A full-scale foot pressure/shear sensor that has been developed to help diagnose the cause of ulcer formation in diabetic patients is presented. The design involves a tactile sensor array using intersecting optical fibers embedded in soft elastomer. The basic configuration incorporates a mesh that is comprised of two sets of parallel optical fiber plane; the planes are configured so the parallel rows of fiber of the top and bottom planes are perpendicular to each other. Threedimensional information is determined by measuring the loss of light from each of the waveguide to map the overall pressure distribution and the shifting of the layers relative to each other. In this paper we will present the latest development on the fiber optic plantar pressure/shear sensor which can measure normal force up from 19.09 kPa to 1000 kPa.

  17. [Chronic arthritis in palmo-plantar pustulosis. Bacterid of Andrews].

    PubMed

    Benhamou, C L; Bardet, M; Luthier, F; Caplan, F; Brigant, S

    1985-01-01

    Report of a 30 years old man story pustulosis palmaris et plantaris, spondylodiscitis L5-S1, right sterno-clavicular arthritis, right sacro-iliitis, and pubic symphysitis. Multiple bacteriologic investigations did not discover any infectious articular process. Histologic articular findings were inflammatory pattern, non steroid anti-inflammatory drugs corrected the arthritis. Anterior thoracic arthropathies are quasi-constant. Inflammatory spondylodiscitis are frequent, while sacro-iliac involvement is infrequent, this pattern distinguishing pustular arthro-osteitis from classic pelvispondylitis. Radiologic lesions are peculiar by predominance on one articular side at each site. Nosology is discussed. Slow infection by non virulent germs has been suspected , but seems improbable. This affection seems close seronegative spondylo-arthropathies and reactive arthritis, like acne conglobata arthritis for instance. Usual absence of HLA-B27 antigen must be noted. PMID:4081595

  18. Medial and Lateral Plantar Artery Angiosome Rotational Flaps for Transmetatarsal and Lisfranc Amputation in Patients With Compromised Plantar Tissue.

    PubMed

    Boffeli, Troy J; Waverly, Brett J

    2016-01-01

    Traditional incision techniques for midfoot amputation might not provide immediate soft tissue coverage of the underlying metatarsal and tarsal bones in the presence of a large plantar soft tissue defect. Patients undergoing transmetatarsal and Lisfranc amputation frequently have compromised plantar tissue in association with neuropathic ulcers, forefoot gangrene, and infection, necessitating wide resection as a part of the amputation procedure. Open amputation will routinely be performed under these circumstances, although secondary healing could be compromised owing to residual bone exposure. Alternatively, the surgeon might elect to perform a more proximal lower extremity amputation, which will allow better soft tissue coverage but compromises function of the lower extremity. A third option for this challenging situation is to modify the plantar flap incision design to incorporate a medial or lateral plantar artery angiosome-based rotational flap, which will provide immediate coverage of the forefoot and midfoot soft tissue defects without excessive shortening of the bone structure. A plantar medial soft tissue defect is treated with the lateral plantar artery angiosome flap, and a plantar lateral defect is treated with the medial plantar artery angiosome flap. Medial and lateral flaps can be combined to cover a central plantar wound defect. Incorporating large rotational flaps requires knowledge of the applicable angiosome anatomy and specific modifications to incision planning and dissection techniques to ensure adequate soft tissue coverage and preservation of the blood supply to the flap. A series of 4 cases with an average follow-up duration of 5.75 years is presented to demonstrate our patient selection criteria, flap design principles, dissection pearls, and surgical staging protocol. PMID:25681945

  19. High-Intensity Running and Plantar-Flexor Fatigability and Plantar-Pressure Distribution in Adolescent Runners

    PubMed Central

    Fourchet, François; Kelly, Luke; Horobeanu, Cosmin; Loepelt, Heiko; Taiar, Redha; Millet, Grégoire

    2015-01-01

    Context: Fatigue-induced alterations in foot mechanics may lead to structural overload and injury. Objectives: To investigate how a high-intensity running exercise to exhaustion modifies ankle plantar-flexor and dorsiflexor strength and fatigability, as well as plantar-pressure distribution in adolescent runners. Design: Controlled laboratory study. Setting: Academy research laboratory. Patients or Other Participants: Eleven male adolescent distance runners (age = 16.9 ± 2.0 years, height = 170.6 ± 10.9 cm, mass = 54.6 ± 8.6 kg) were tested. Intervention(s): All participants performed an exhausting run on a treadmill. An isokinetic plantar-flexor and dorsiflexor maximal-strength test and a fatigue test were performed before and after the exhausting run. Plantar-pressure distribution was assessed at the beginning and end of the exhausting run. Main Outcome Measure(s): We recorded plantar-flexor and dorsiflexor peak torques and calculated the fatigue index. Plantar-pressure measurements were recorded 1 minute after the start of the run and before exhaustion. Plantar variables (ie, mean area, contact time, mean pressure, relative load) were determined for 9 selected regions. Results: Isokinetic peak torques were similar before and after the run in both muscle groups, whereas the fatigue index increased in plantar flexion (28.1%; P = .01) but not in dorsiflexion. For the whole foot, mean pressure decreased from 1 minute to the end (−3.4%; P = .003); however, mean area (9.5%; P = .005) and relative load (7.2%; P = .009) increased under the medial midfoot, and contact time increased under the central forefoot (8.3%; P = .01) and the lesser toes (8.9%; P = .008). Conclusions: Fatigue resistance in the plantar flexors declined after a high-intensity running bout performed by adolescent male distance runners. This phenomenon was associated with increased loading under the medial arch in the fatigued state but without any excessive pronation. PMID:25531143

  20. Foot Modeling and Smart Plantar Pressure Reconstruction from Three Sensors

    PubMed Central

    Ghaida, Hussein Abou; Mottet, Serge; Goujon, Jean-Marc

    2014-01-01

    In order to monitor pressure under feet, this study presents a biomechanical model of the human foot. The main elements of the foot that induce the plantar pressure distribution are described. Then the link between the forces applied at the ankle and the distribution of the plantar pressure is established. Assumptions are made by defining the concepts of a 3D internal foot shape, which can be extracted from the plantar pressure measurements, and a uniform elastic medium, which describes the soft tissues behaviour. In a second part, we show that just 3 discrete pressure sensors per foot are enough to generate real time plantar pressure cartographies in the standing position or during walking. Finally, the generated cartographies are compared with pressure cartographies issued from the F-SCAN system. The results show 0.01 daN (2% of full scale) average error, in the standing position. PMID:25400713

  1. Muscle activation of paraspinal muscles in different types of high heels during standing

    PubMed Central

    Han, Dongwook

    2015-01-01

    [Purpose] This study researched the effects of different types of high heels on the muscles surrounding the cervical spine, the thoracic spine, and the lumbar spine by analyzing muscle activation of the paraspinal muscles during standing while wearing high heels. The high heels were all of the same height: 8 cm. [Subjects and Methods] The 28 subjects in this experiment were females in their 20s with a foot size of 225–230 mm and a normal gait pattern. To measure the muscle activation of the paraspinal muscles, EMG electrodes were attached on the paraspinal muscles around C6, T7, and L5. The muscle activation during standing while wearing 8-cm-high wedge heels, setback heels, and French heels was then measured. The measurements were performed 3 times each, and the mean value was used for analysis. [Results] The levels of muscle activation of the paraspinal muscles induced by standing on wedge heels, setback heels, and French heels in the cervical and lumbar areas were significantly higher than those induced by standing on bare feet. But there was no significant difference according to the heel types. [Conclusion] The height of the heels presented a greater variable than the width of the heels on the muscle activation of paraspinal muscles. Therefore, wearing high heels is not recommended for those who have pain or functional problems in the cervical and/or lumbar spine. PMID:25642040

  2. Assessment of plantar pressure and balance in patients with diabetes

    PubMed Central

    Anjos, Daniela M.C.; Gomes, Luciana P.O.; Sampaio, Luciana M.M.; Correa, João C.F.

    2010-01-01

    Introduction Patients with diabetes for more than 10 years may have an increase in peak plantar pressure, considerable postural oscillation, balance deficit, alterations in gait pattern and an increased risk of falls. The aim of the present study was to assess the correlation between plantar pressure distribution and balance in patients with diabetes using a pressure platform (Footwork). Material and methods The study was carried out at the Human Movement Clinic of the Centro Universitário de Belo Horizonte (Brazil). The sample was made up of 18 right-handed individuals with type 2 diabetes – 14 females and 4 males – with an average age of 58.72 ±9.54 and an average of 18.56 ±6.61 years since diagnosis. Result Data analysis revealed that greater peak plantar pressure on the right hindfoot led to greater radial displacement (Rd) (r = 0.2022) and greater displacement velocity (r = 0.2240). Greater peak plantar pressure on the left hindfoot also led to greater displacement velocity (P) (r = 0.5728) and radial displacement (RD) (r = 0.1972). A positive correlation was found between time elapsed since diagnosis and peak midfoot pressure (r = 0.3752) on the right and left side as well as between BMI and plantar pressure on all regions of the foot. Conclusions The data reveal a correlation between postural oscillation and peak plantar pressure on the hindfoot. PMID:22371719

  3. [Experimental research of gaits based on young plantar pressure test].

    PubMed

    Meng, Qingyun; Tan, Shili; Yu, Hongliu; Shen, Lixing; Zhuang, Jianhai; Wang, Jinwu

    2014-10-01

    The present paper is to study the center line of the plantar pressure of normal young people, and to find the relation between center line of the plantar pressure and gait stability and balance. The paper gives the testing principle and calculating methods for geometric center of plantar pressure distribution and the center of pressure due to the techniques of footprint frame. The calculating formulas in both x direction and y direction are also deduced in the paper. In the experiments carried out in our laboratory, the gait parameters of 131 young subjects walking as usual speed were acquired, and 14 young subjects of the total were specially analyzed. We then provided reference data for the walking gait database of young people, including time parameters, space parameters and plantar pressure parameters. We also obtained the line of geometry center and pressure center under the foot. We found that the differences existed in normal people's geometric center line and the pressure center line. The center of pressure trajectory revealed foot movement stability. The length and lateral changes of the center line of the plantar pressure could be applied to analysis of the plantar pressure of all kinds of people. The results in this paper are useful in clinical foot disease diagnosis and evaluation of surgical effect. PMID:25764708

  4. The effects of the application of low-dye taping on paretic side plantar pressure among patients with plantar fasciitis

    PubMed Central

    Park, Chan; Lee, Sangyong; Kim, Shingyun; Hwangbo, Gak

    2015-01-01

    [Purpose] This study aimed to examine the effects of low-dye taping on paretic side plantar pressure in patients with plantar fasciitis. [Subjects] The 30 patients in this study were randomly allocated to a low-dye taping group (n = 15) or a conservative treatment group (n =15). [Methods] Both groups received treatment thrice a week for six weeks. BioRescue was used to measure the weight distribution of the patients’ paretic side. [Results] Within-group comparison showed that the posterior weight distribution significantly increased among patients in both groups. However, comparison between the two groups showed that the low-dye taping group’s posterior weight distribution was significantly higher than that of the conservative treatment group. [Conclusion] These findings show that the application of low-dye taping is an effective intervention for paretic-side plantar pressure among patients with plantar fasciitis. PMID:26696737

  5. The effects of the application of low-dye taping on paretic side plantar pressure among patients with plantar fasciitis.

    PubMed

    Park, Chan; Lee, Sangyong; Kim, Shingyun; Hwangbo, Gak

    2015-11-01

    [Purpose] This study aimed to examine the effects of low-dye taping on paretic side plantar pressure in patients with plantar fasciitis. [Subjects] The 30 patients in this study were randomly allocated to a low-dye taping group (n = 15) or a conservative treatment group (n =15). [Methods] Both groups received treatment thrice a week for six weeks. BioRescue was used to measure the weight distribution of the patients' paretic side. [Results] Within-group comparison showed that the posterior weight distribution significantly increased among patients in both groups. However, comparison between the two groups showed that the low-dye taping group's posterior weight distribution was significantly higher than that of the conservative treatment group. [Conclusion] These findings show that the application of low-dye taping is an effective intervention for paretic-side plantar pressure among patients with plantar fasciitis. PMID:26696737

  6. Effect of revised high-heeled shoes on foot pressure and static balance during standing.

    PubMed

    Bae, Young-Hyeon; Ko, Mansoo; Park, Young-Soul; Lee, Suk-Min

    2015-04-01

    [Purpose] The purpose of this study was to investigate the effects of revised high-heeled shoes on the foot pressure ratio and static balance during standing. [Subjects and Methods] A single-subject design was used, 15 healthy women wearing revised high-heeled shoes and general high-heeled shoes in a random order. The foot pressure ratio and static balance scores during standing were measured using a SpaceBalance 3D system. [Results] Forefoot and rearfoot pressures were significantly different between the 2 types of high-heeled shoes. Under the 3 conditions tested, the static balance score was higher for the revised high-heeled shoes than for the general high-heeled shoes, but this difference was not statistically significant. [Conclusion] Revised high-heeled shoes are preferable to general high-heeled shoes, as they result in normalization of normalized foot pressure and a positive effect on static balance. PMID:25995572

  7. Effect of revised high-heeled shoes on foot pressure and static balance during standing

    PubMed Central

    Bae, Young-Hyeon; Ko, Mansoo; Park, Young-Soul; Lee, Suk-Min

    2015-01-01

    [Purpose] The purpose of this study was to investigate the effects of revised high-heeled shoes on the foot pressure ratio and static balance during standing. [Subjects and Methods] A single-subject design was used, 15 healthy women wearing revised high-heeled shoes and general high-heeled shoes in a random order. The foot pressure ratio and static balance scores during standing were measured using a SpaceBalance 3D system. [Results] Forefoot and rearfoot pressures were significantly different between the 2 types of high-heeled shoes. Under the 3 conditions tested, the static balance score was higher for the revised high-heeled shoes than for the general high-heeled shoes, but this difference was not statistically significant. [Conclusion] Revised high-heeled shoes are preferable to general high-heeled shoes, as they result in normalization of normalized foot pressure and a positive effect on static balance. PMID:25995572

  8. Validation of Plantar Pressure Measurements for a Novel In-Shoe Plantar Sensory Replacement Unit

    PubMed Central

    Ferber, Reed; Webber, Talia; Kin, B; Everett, Breanne; Groenland, Marcel

    2013-01-01

    Background Research concerning prevention of diabetic foot complications is critical. A novel in-shoe plantar sensory replacement unit (PSRU) has been developed that provides alert-based feedback derived from analyzing plantar pressure threshold measurements in real time. The purpose of this study was to compare the PSRU device to a gold standard pressure-sensing device (GS-PSD) to determine the correlation between concurrent measures of plantar pressure during walking. Methods The PSRU had an array of eight sensors with a range of 10–75 mm Hg and collected data at 4 Hz, whereas the GS-PSD had 99 sensors with a range of 1–112 mm Hg and collected data at 100 Hz. Based on an a priori power analysis, data were collected from 10 participants (3 female, 7 male) while walking over ground in both devices. The primary variable of interest was the number of data points recorded that were greater than 32 mm Hg (capillary arterial pressure—the minimum pressure reported to cause pressure ulcers) for each of the eight PSRU sensors and corresponding average recordings from the GS-PSD sensor clusters. Intraclass correlation coefficient (2,1) was used to compare data between the two devices. Results Compared with the GS-PSD, we found good-to-very-good correlations (r-value range 0.67–0.86; p-value range 0.01–0.05) for six of the PSRU’s eight sensors and poor correlation for only two sensors (r = 0.41, p = .15; r = 0.38, p = .18) when measuring the number of data points recorded that were greater than 32 mm Hg. Conclusions Based on the results of the present study, we conclude the PSRU provides analogous data when compared with a GS-PSD. PMID:24124942

  9. Managing heel ulcers in the community.

    PubMed

    Beldon, Pauline

    2013-10-01

    As the size of the older population increases, the incidence of falls and injuries, in addition to chronic wounds, is likely to increase concurrently. This article highlights the risk of both pressure ulceration and diabetic foot ulceration and gives an overview of appropriate treatment and management. PMID:24471214

  10. Multinucleated giant cells in plantar fibromatosis.

    PubMed

    Evans, Harry L

    2002-02-01

    Specimens from 13 patients with plantar fibromatosis were reviewed with particular attention to the presence and number of multinucleated giant cells in the lesions. These were found in all specimens but one and ranged from very few to many. The nuclei of the giant cells were uniform, rounded to somewhat elongated, and arranged in circles, semicircles, ovals, clusters, chains, and V's. Aside from the giant cells, the lesions were composed of the usual uniform fibroblastic spindle cells. The growth pattern was almost always multinodular, with nodules having moderate to high cellularity. Maximal mitotic rate varied up to more than 10 mitotic figures per 10 high-power fields but was most often between 1 and 4 mitotic figures per 10 high-power fields. The patients were from 10 to 66 years of age; nine were male and four were female. Two had bilateral involvement. Five patients had recurrence, including three with multiple recurrences, and all but one of the remainder had only short follow-up. Judging from the available data, recurrence did not appear to be related to any specific clinical or pathologic feature. PMID:11812947

  11. Heart rate detection from plantar bioimpedance measurements.

    PubMed

    Gonzalez-Landaeta, Rafael; Casas, Oscar; Pallàs-Areny, Ramon

    2008-03-01

    In this paper, a novel technique for heart rate measurement on a standing subject is proposed that relies on electrical impedance variations detected by a plantar interface with booth feet, such as those in some bathroom weighting scales for body composition analysis. Heart-related impedance variations in the legs come from arterial blood circulation and are below 500 mOmega. To detect them, we have implemented a system with a gain in excess of 600, and whose fully differential AC input amplifier has a gain of 4.5 and a common-mode rejection ratio (CMRR) higher than 90 dB at 10 kHz. Differential coherent demodulation based on synchronous sampling yields a signal-to-noise ratio (SNR) of about 54 dB . The system sensitivity is 610 mV/Omega. The technique has been demonstrated on 18 volunteers, whose bioimpedance signal and ECG were simultaneously recorded. A Bland-Altman plot shows a mean bias of -0.2 ms between the RR time intervals obtained from these two signals, which is negligible. The technique is simple and user friendly and does not require any additional sensors or electrodes attached to the body, hence no conductive gel or skin preparation. PMID:18334409

  12. Changes in Achilles tendon mechanical properties following eccentric heel drop exercise are specific to the free tendon.

    PubMed

    Obst, S J; Newsham-West, R; Barrett, R S

    2016-04-01

    Mechanical loading of the Achilles tendon during isolated eccentric contractions could induce immediate and region-dependent changes in mechanical properties. Three-dimensional ultrasound was used to examine the immediate effect of isolated eccentric exercise on the mechanical properties of the distal (free tendon) and proximal (gastrocnemii) regions of the Achilles tendon. Participants (n = 14) underwent two testing sessions in which tendon measurements were made at rest and during a 30% and 70% isometric plantar flexion contractions immediately before and after either: (a) 3 × 15 eccentric heel drops or (b) 10-min rest. There was a significant time-by-session interaction for free tendon length and strain for all loading conditions (P < 0.05). Pairwise comparisons revealed a significant increase in free tendon length and strain at all contraction intensities after eccentric exercise (P < 0.05). There was no significant time-by-session interaction for the gastrocnemii (medial or lateral) aponeurosis or tendon for any of the measured parameters. Immediate changes in Achilles tendon mechanical properties were specific to the free tendon and consistent with changes due to mechanical creep. These findings suggest that the mechanical properties of the free tendon may be more vulnerable to change with exercise compared with the gastrocnemii aponeurosis or tendon. PMID:25919320

  13. Role of the plantar fascia in digital stabilization. A case report.

    PubMed

    Pontious, J; Flanigan, K P; Hillstrom, H J

    1996-01-01

    The plantar aponeurosis is a ligamentous structure that extends from the calcaneus to the proximal phalanges. Under tension, it functions to support the longitudinal arch, supinate the rearfoot, and stabilize the digits against the ground. The anatomy and biomechanics of the plantar fascia and plantar aponeurosis, particularly their role in digital stabilization, are reviewed. A case is presented showing a patient who developed hammer toes as a postoperative complication after having a portion of the plantar aponeurosis removed. PMID:8808324

  14. A Case of Recalcitrant Plantar Warts Associated with Statin Use

    PubMed Central

    Wernham, Aaron G.; Velangi, Shireen S.

    2015-01-01

    Background. Plantar warts are a common presenting skin complaint caused by the human papillomavirus. 1st line therapies include cryotherapy and topical salicylic acid. Where there is resistance to these treatments, consideration is made for 2nd line therapies, including intralesional bleomycin, imiquimod, 5-fluorouracil, and photodynamic therapy. We present a case of bilateral persistent plantar warts, resistant to treatment with repeated cryotherapy and topical salicylic acid over a 6-year period. Following a patient initiated decision to discontinue their statin medication, we observed rapid clearance of plantar warts without change to standard therapy or their environment. This case correlates with emerging literature demonstrating a link between statin medication and proliferation of HPV through increased levels of FOXP3+ regulatory T cells. PMID:25789179

  15. Recurrent plantar ulceration following pan metatarsal head resection.

    PubMed

    Petrov, O; Pfeifer, M; Flood, M; Chagares, W; Daniele, C

    1996-01-01

    Although the pan metatarsal head resection, since it was originally described and performed by Hoffman in 1911, has proven to be an effective and viable procedure in treating many forefoot deformities, it is not without its own complications. The authors provide an historical perspective of the pan metatarsal head resection, a discussion on the complication of recurrent plantar ulceration after the pan metatarsal head resection, and a review of their own experience with this procedure. A retrospective review was performed of all patients having undergone pan metatarsal resections between August 1980 and April 1993. Twenty procedures were performed on 12 patients with diabetic neuropathy, and 21 procedures were performed on 15 patients with rheumatoid arthritis. The incidence of recurrent plantar ulceration after surgical correction was 25% and 28%, respectively. All 27 patients underwent primary healing. The authors, therefore, conclude that the complication of recurrent plantar ulceration after this procedure is a very likely and distinct possibility. PMID:8986897

  16. A case of recalcitrant plantar warts associated with statin use.

    PubMed

    Wernham, Aaron G; Velangi, Shireen S

    2015-01-01

    Background. Plantar warts are a common presenting skin complaint caused by the human papillomavirus. 1st line therapies include cryotherapy and topical salicylic acid. Where there is resistance to these treatments, consideration is made for 2nd line therapies, including intralesional bleomycin, imiquimod, 5-fluorouracil, and photodynamic therapy. We present a case of bilateral persistent plantar warts, resistant to treatment with repeated cryotherapy and topical salicylic acid over a 6-year period. Following a patient initiated decision to discontinue their statin medication, we observed rapid clearance of plantar warts without change to standard therapy or their environment. This case correlates with emerging literature demonstrating a link between statin medication and proliferation of HPV through increased levels of FOXP3+ regulatory T cells. PMID:25789179

  17. Plantar loading reflects ulceration risks of diabetic foot with toe deformation.

    PubMed

    Lu, Y C; Mei, Q C; Gu, Y D

    2015-01-01

    Diabetes has been one of the most common chronic diseases all over the world. The purpose of this study was to quantitatively assess the foot loading characteristics of diabetic patients with fifth-toe deformity through a comparative analysis with diabetic patients with healthy and normal feet. Six neuropathic diabetic female subjects with the fifth-toe deformation and six age-matched neuropathic diabetic controls without any feet deformities participated in the walking test. Dynamic barefoot plantar pressure was measured with Novel EMED force plate. Peak pressure and pressure-time integral for all 7 foot regions (rearfoot, midfoot, lateral forefoot, central forefoot, medial forefoot, great toe, and other toes) were collected. Peak pressure was significantly higher in the patients with toe deformity in rearfoot, central forefoot, and great toe regions compared with the control group. Meanwhile, loading sustaining period extended longer in great toe region of deformed group than in that of the control group, and the center of pressure was nearly in the big toe region during toe offstage. Diabetic patients with fifth-toe deformity could have plantar contact area reduction in the other toes part and increased loading to the great toe part. The result showed that fifth-toe deformity was associated with potential ulceration risk especially in hallux region. PMID:25861622

  18. Abnormal attachments between a plantar aponeurosis and calcaneus

    PubMed Central

    KALNIEV, MANOL ANASTASOV; KRASTEV, DIMO; KRASTEV, NIKOLAY; VIDINOV, KALIN; VELTCHEV, LUDMIL; MILEVA, MILKA

    2013-01-01

    Background and aims The plantar aponeurosis or fascia is a thick fascial seal located on the lower surface of the sole. It consists of three parts central, lateral, and medial. The central portion is the thickest. It is narrow behind and wider in front. The central portion has two strong vertical intermuscular septa which are directed upward into the foot. The lateral and medial portions are thinner. The medial portion is thinnest. The lateral portion is thin in front and thick behind. The main function of the plantar fascia is to support the longitudinal arch of the foot. In May 2013 during a routine dissection in the section hall of the Department of Anatomy and Histology in Medical University – Sofia, Bulgaria we came across a very interesting variation of the plantar aponeurosis. Materials and methods For the present morphological study tissues from a human corpse material were used. This unusual anatomical variation was photographed using a Nikon Coolpix 995 camera with a 3.34 Megapixels. Results We found some fibrous strands which started from the proximal portion of the plantar aponeurosis on the left foot. The fibrous strands resembled the tentacles of an octopus and started from the proximal portion of the aponeurosis. Two of fibrous strands were directed laterally to adipose tissue and one was directed medially and backward. The first lateral fibrous strand was divided into several fascicles. We found very few data in literature about the varieties of the plantar fascia. Conclusion It is very important to consider the occurrence of above mentioned variations in the plantar aponeurosis when surgical procedures are performed on the sole. PMID:26527947

  19. Abductor Hallucis: Anatomical Variation and Its Clinical Implications in the Reconstruction of Chronic Nonhealing Ulcers and Defects of Foot

    PubMed Central

    Chittoria, Ravi Kumar; Pratap, Harsha; Yekappa, Suma Hottigoudar

    2015-01-01

    Abductor hallucis (AH) is an intrinsic muscle of sole of the foot. It is commonly used in the coverage of ankle and heel defects and chronic nonhealing ulcers of the foot; its use is reported to have a favorable long-term outcome. The muscle's apt bulk and size, its simple surgical isolation, absence of donor-site defect, unvaried anatomy, and long neurovascular pedicle are some of the advantages that make it a promising muscle flap. During routine cadaver dissection in the Department of Anatomy of Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India, we identified an anatomical variation in AH in both feet of a 45-year-old embalmed male Indian cadaver. The variant muscle had innumerable proximal attachments, a majority of them arising atypically in the form of tough tendinous slips from the medial intermuscular septum at the junction of central and tibial components of plantar aponeurosis, the medial surface of first metatarsal and the intermuscular septum separating AH from the flexor hallucis brevis. The tendon: muscle ratio was 1.76, higher than the normal reported ratio of 0.560.07. This article highlights the variation noted and its implication for clinicians. On Internet search, we did not come across the variations described in our article. Findings of the anatomical variation reported in this article could benefit surgeons who decide to use AH flaps in the future. PMID:26634184

  20. Deep peroneal nerve transfer for established plantar sensory loss.

    PubMed

    Koshima, Isao; Nanba, Yuzaburo; Tsutsui, Tetsuya; Takahashi, Yoshio

    2003-10-01

    Patients with established or irreversible plantar sensory loss often have normal sensation on the dorsal aspect of the foot, due to an intact deep peroneal nerve. A new method of deep peroneal nerve transfer is proposed for repair of plantar sensory loss caused by extensive nerve gaps or high-level lesions of the posterior tibial nerve. Two cases in which this technique was used are described. The surgical technique is relatively easy, with a short operating time, rapid nerve regeneration after surgery, accurate sensory recovery, and minimal donor-site morbidity with sensory loss only on the first web space of the foot. PMID:14634907

  1. Intravascular Myopericytoma in the Heel: Case Report and Literature Review

    PubMed Central

    Valero, José; Salcini, José L.; Gordillo, Luis; Gallart, José; González, David; Deus, Javier; Lahoz, Manuel

    2015-01-01

    Abstract Intravascular myopericytoma (IVMP), regarded as a variant of myopericytoma, is a rare tumor. Very few cases have been described, none in the foot. The first case of IVMP located in the heel of the foot is described in this article. A literature review is reported of all cases of IVMP published in the English literature. A 48-year-old man possessed an IVMP on the heel of the right foot. The physical examination and histopathological and ultrasound studies are described. The literature review yielded 5 cases of IVMP, 2 of which were in the thigh and 1 each in the oral mucosa, the periorbital region, and the leg. The possibility that these lesions may be malignant suggests that the histopathological study of vascular tumors should include immunohistochemical tests. PMID:25789958

  2. Heel and toe driving on fuel cell vehicle

    DOEpatents

    Choi, Tayoung; Chen, Dongmei

    2012-12-11

    A system and method for providing nearly instantaneous power in a fuel cell vehicle. The method includes monitoring the brake pedal angle and the accelerator pedal angle of the vehicle, and if the vehicle driver is pressing both the brake pedal and the accelerator pedal at the same time and the vehicle is in a drive gear, activating a heel and toe mode. When the heel and toe mode is activated, the speed of a cathode compressor is increased to a predetermined speed set-point, which is higher than the normal compressor speed for the pedal position. Thus, when the vehicle brake is removed, the compressor speed is high enough to provide enough air to the cathode, so that the stack can generate nearly immediate power.

  3. Effects of high heel wear and increased weight on the knee during walking.

    PubMed

    Titchenal, Matthew R; Asay, Jessica L; Favre, Julien; Andriacchi, Thomas P; Chu, Constance R

    2015-03-01

    Knee osteoarthritis (OA), a leading cause of disability, is more prevalent in women than men. Wearing high heeled shoes has been implicated as a potential contributing factor for the higher lifetime risk of osteoarthritis in women. This study tests the hypotheses that changes to knee kinematics and kinetics observed during high heeled walking increase in magnitude with increasing heel height and are accentuated by a 20% increase in weight. Fourteen healthy females were tested using marker-based gait analysis in combinations of footwear (flat athletic shoe, 3.8 cm and 8.3 cm heeled shoes) and weight (with and without 20% bodyweight vest). At preferred walking speed, knee flexion angle at heel-strike and midstance increased with increasing heel height and weight. Maximum knee extension moment during loading response decreased with added weight; maximum knee extension moment during terminal stance decreased with heel height; maximum adduction moments increased with heel height. Many of the changes observed with increasing heel height and weight were similar to those seen with aging and OA progression. This suggests that high heel use, especially in combination with additional weight, may contribute to increased OA risk in women. PMID:25532875

  4. The mechanical properties of the heel pad in elderly adults.

    PubMed

    Kinoshita, H; Francis, P R; Murase, T; Kawai, S; Ogawa, T

    1996-01-01

    The shock absorbing characteristics of the heel pad in vivo were examined in two groups of active elderly individuals whose ages ranged between 60 and 67 years (n = 10) and between 71 and 86 years (n = 10). For comparative purposes, young adults (n = 10) aged between 17 and 30 years were also examined. A free-fall impact testing device which consisted of an instrumented shaft (mass 5 kg), accelerometer and position detection transducer was used to obtain deceleration and deformation of the heel during impact. The data were obtained from impact velocities of 0.57 m.s-1 (slow) and 0.94 m.s-1 (fast). Peak values of the deceleration and deformation, as well as the time to these peaks from onset of impact, and energy absorption were evaluated. At the slow impact velocity, no age effect was found for the parameters examined except for the energy absorption. At the fast impact velocity, there was higher peak deceleration and smaller deformation for the elderly than for the younger adults. The energy absorbed was less for the elderly than for the younger adults. It was concluded that the capacity for shock absorbency of the heel pad declines with age. PMID:8803499

  5. Cement mantle stress under retroversion torque at heel-strike.

    PubMed

    Afsharpoya, B; Barton, D C; Fisher, J; Purbach, B; Wroblewski, M; Stewart, T D

    2009-12-01

    The paper presents a theory of fixation failure and loosening in cemented total hip prostheses and proceeds to investigate this using an experimentally validated finite element model and two prosthesis types, namely the Charnley and the C-Stem. The study investigates the effects of retroversion torque occurring at heel-strike in combination with a loss of proximal cement/bone support and distal implant/cement support with a good distal cement/bone interface. A 3D finite element model was validated by comparison of femoral surface strains with those measured in an in vitro experimental simulation using an implanted Sawbone femur loaded in the heel-strike position and including a simplified representation of muscle forces. Results showed that the heel-strike position applies a high retroversion torque to the femoral stem that when combined with proximal debonding of the cement/bone interface and distal debonding of the implant/cement interface increases the strain transfer to the cement that may ultimately lead to the breakdown of the cement mantle leading on to osteolysis and loosening of the prostheses. Experimental fatigue testing of the implanted Charnley stem in a Sawbone femur produced cracks within the cement mantle that were located in positions of maximum stress supporting the finite element analysis results and theory of failure. PMID:19879794

  6. Nordic Walking Practice Might Improve Plantar Pressure Distribution

    ERIC Educational Resources Information Center

    Perez-Soriano, Pedro; Llana-Belloch, Salvador; Martinez-Nova, Alfonso; Morey-Klapsing, G.; Encarnacion-Martinez, Alberto

    2011-01-01

    Nordic walking (NW), characterized by the use of two walking poles, is becoming increasingly popular (Morgulec-Adamowicz, Marszalek, & Jagustyn, 2011). We studied walking pressure patterns of 20 experienced and 30 beginner Nordic walkers. Plantar pressures from nine foot zones were measured during trials performed at two walking speeds (preferred…

  7. Nordic Walking Practice Might Improve Plantar Pressure Distribution

    ERIC Educational Resources Information Center

    Perez-Soriano, Pedro; Llana-Belloch, Salvador; Martinez-Nova, Alfonso; Morey-Klapsing, G.; Encarnacion-Martinez, Alberto

    2011-01-01

    Nordic walking (NW), characterized by the use of two walking poles, is becoming increasingly popular (Morgulec-Adamowicz, Marszalek, & Jagustyn, 2011). We studied walking pressure patterns of 20 experienced and 30 beginner Nordic walkers. Plantar pressures from nine foot zones were measured during trials performed at two walking speeds (preferred

  8. Modification of high-heeled shoes to decrease pronation during gait.

    PubMed

    Phillips, R D; Reczek, D M; Fountain, D; Renner, J; Park, D B

    1991-04-01

    One of the reasons that high heels may contribute to the formation of halux valgus is that the wearers pronate during propulsion. This pilot study was performed to determine whether relocation of the heel under the counter of a fashion high-heeled pump could change the degree of pronation of the foot during the gait cycle. The authors report that more foot stability was experienced by the subjects when the center of the heel was offset between 2 and 4 mm medial to the center of the heel counter. This study is designed to promote further research into whether the shoe industry should change the design parameters of high-heeled fashion shoes in order to improve foot function. PMID:1875295

  9. The relationship between plantar pressure and footprint shape.

    PubMed

    Hatala, Kevin G; Dingwall, Heather L; Wunderlich, Roshna E; Richmond, Brian G

    2013-07-01

    Fossil footprints preserve the only direct evidence of the external foot morphologies and gaits of extinct hominin taxa. However, their interpretation requires an understanding of the complex interaction among foot anatomy, foot function, and soft sediment mechanics. We applied an experimental approach aimed at understanding how one measure of foot function, the distribution of plantar pressure, influences footprint topography. Thirty-eight habitually unshod and minimally shod Daasanach individuals (19 male, 19 female) walked across a pressure pad and produced footprints in sediment directly excavated from the geological layer that preserves 1.5 Ma fossil footprints at Ileret, Kenya. Calibrated pressure data were collected and three-dimensional models of all footprints were produced using photogrammetry. We found significant correlations (Spearman's rank, p < 0.0001) between measurements of plantar pressure distribution and relative footprint depths at ten anatomical regions across the foot. Furthermore, plantar pressure distributions followed a pattern similar to footprint topography, with areas of higher pressure tending to leave deeper impressions. This differs from the results of experimental studies performed in different types of sediment, supporting the hypothesis that sediment type influences the relationship between plantar pressure and footprint topography. Our results also lend support to previous interpretations that the shapes of the Ileret footprints preserve evidence of a medial transfer of plantar pressure during late stance phase, as seen in modern humans. However, the weakness of the correlations indicates that much of the variation in relative depths within footprints is not explained by pressure distributions under the foot when walking on firm ground, using the methods applied here. This warrants caution when interpreting the unique foot anatomies and foot functions of extinct hominins evidenced by their footprint structures. Further research is necessary to clarify how anatomical, functional, and sedimentary variables influence footprint formation and how each can be inferred from footprint morphology. PMID:23725794

  10. Heel raises versus prefabricated orthoses in the treatment of posterior heel pain associated with calcaneal apophysitis (Sever's Disease): study protocol for a randomised controlled trial

    PubMed Central

    2010-01-01

    Background Posterior Heel pain can present in children of 8 to 14 years, associated with or clinically diagnosed as Sever's disease, or calcaneal apophysitis. Presently, there are no comparative randomised studies evaluating treatment options for posterior heel pain in children with the clinical diagnosis of calcaneal apophysitis or Sever's disease. This study seeks to compare the clinical efficacy of some currently employed treatment options for the relief of disability and pain associated with posterior heel pain in children. Method Design: Factorial 2 × 2 randomised controlled trial with monthly follow-up for 3 months. Participants: Children with clinically diagnosed posterior heel pain possibly associated with calcaneal apophysitis/Sever's disease (n = 124). Interventions: Treatment factor 1 will be two types of shoe orthoses: a heel raise or prefabricated orthoses. Both of these interventions are widely available, mutually exclusive treatment approaches that are relatively low in cost. Treatment factor 2 will be a footwear prescription/replacement intervention involving a shoe with a firm heel counter, dual density EVA midsole and rear foot control. The alternate condition in this factor is no footwear prescription/replacement, with the participant wearing their current footwear. Outcomes: Oxford Foot and Ankle Questionnaire and the Faces pain scale. Discussion This will be a randomised trial to compare the efficacy of various treatment options for posterior heel pain in children that may be associated with calcaneal apophysitis also known as Sever's disease. Trial Registration Trial Number: ACTRN12609000696291 Ethics Approval Southern Health: HREC Ref: 09271B PMID:20196866

  11. Presence of growth factors in palmar and plantar fibromatoses.

    PubMed

    Zamora, R L; Heights, R; Kraemer, B A; Erlich, H P; Groner, J P

    1994-05-01

    Palmar and plantar fibromatoses are disease processes in which the presence of certain growth factors has not been defined. Monoclonal antibodies against transforming growth factor-beta, epidermal growth factor, procollagen type 1, fibronectin, phosphotyrosine residues, and CD41 platelet antigen were used in standard immunoperoxidase staining to study 36 nodules and 24 cords obtained from patients with fibromatoses. The specimens were studied via light microscopy, and staining intensity was quantitated using a computer-enhanced video system. Transforming growth factor-beta staining paralleled procollagen I, fibronectin, and phosphotyrosine staining within the nodule (early stages) but not the cord (late stages) tissue. These factors showed significant increased staining in the early stage of fibromatosis when compared to the late stage. This study is a preliminary demonstration of the presence of transforming growth factor-beta in palmar and plantar fibromatoses. PMID:7520050

  12. Continuous phenobarbital treatment leads to recurrent plantar fibromatosis.

    PubMed

    Strzelczyk, Adam; Vogt, Heinrich; Hamer, Hajo M; Krämer, Günter

    2008-11-01

    Despite contrary recommendations by expert opinion and international guidelines phenobarbital remains the most widely prescribed anticonvulsant worldwide. Although associated connective tissue disorders were described in a timely way after its introduction, the association between plantar fibromatosis--also called Ledderhose syndrome--and phenobarbital seems not to be well known in general. Our case series uniquely demonstrates that continuous phenobarbital treatment leads to recurrent plantar fibromatosis and may result in long-term disability and numerous unnecessary operations. In general, the association between connective tissue disorders and phenobarbital most prominently appears in adult patients of northern European descent. However, our case series and data from the literature suggest that patient groups less susceptible to connective tissue disorders may as well develop Ledderhose syndrome or other associated syndromes as Dupuytren's contractures, frozen shoulder, Peyronie's disease or complex regional pain syndrome in the course of phenobarbital treatment. PMID:18513351

  13. Plantar fibromatosis: use of magnetic resonance imaging in diagnosis.

    PubMed

    Watson-Ramirez, L; Rasmussen, S E; Warschaw, K E; Mulloy, J P; Elston, D M

    2001-09-01

    For patients presenting with classic features of plantar fibromatosis, a presumptive diagnosis may be made on clinical grounds alone. In less clear cases, a biopsy may allow confirmation of the diagnosis; however, a biopsy exposes the patient to operative complications. Magnetic resonance imaging (MRI) offers a noninvasive method for confirmation of the clinical diagnosis that may obviate the need for a biopsy. We describe a case that demonstrates the potential of this technique. PMID:11579789

  14. Innovations in plantar pressure and foot temperature measurements in diabetes.

    PubMed

    Bus, S A

    2016-01-01

    Plantar pressure and temperature measurements in the diabetic foot primarily contribute to identifying abnormal values that increase risk for foot ulceration, and they are becoming increasingly more integrated in clinical practice and daily life of the patient. While plantar pressure measurements have long been present, only recently evidence shows their importance in ulcer prevention, as a data-driven approach to therapeutic footwear provision. The long-term monitoring of plantar pressures with the option to provide feedback, when alarming pressure levels occur, is a promising development in this area, although more technical and clinical validation is required. Shear is considered important in ulcer aetiology but is technically difficult to measure. Innovative research is underway to assess if foot temperature can act as a useful surrogate for shear. Because the skin heats up before it breaks down, frequent monitoring of foot temperature can identify these warning signals. This approach has shown to be effective in preventing foot ulcers. Innovation in diagnostic methods for foot temperature monitoring and evidence on cost effectiveness will likely facilitate implementation. Finally, monitoring of adherence to offloading treatment using temperature-based sensors has proven to be a feasible and relevant method with a wide range of possible research and patient care applications. These innovations in plantar pressure and temperature measurements illustrate an important transfer in diabetic foot care from subjective to objective evaluation of the high-risk patient. They demonstrate clinical value and a large potential in helping to reduce the patient and economic burden of diabetic foot disease. Copyright © 2016 John Wiley & Sons, Ltd. PMID:26467347

  15. Endoscopic Achilles tenodesis: a surgical alternative for chronic insertional tendinopathy.

    PubMed

    Maquirriain, Javier

    2007-07-01

    This report describes an endoscopic approach for visualization and repair of heel structures potentially involved in patients presenting chronic calcaneal tendon insertion pain. Tendon-bone junction separation allows enthesis debridement. Tenodesis with a knotless absorbable anchor completes this minimally invasive surgical procedure for chronic insertional Achilles tendinopathy. PMID:17053930

  16. Plantar fibromatosis: a review of primary and recurrent surgical treatment.

    PubMed

    Wapner, K L; Ververeli, P A; Moore, J H; Hecht, P J; Becker, C E; Lackman, R D

    1995-09-01

    Plantar fibromatosis can be quite disabling to the patient, as well as a technical challenge to the surgeon. Patients who undergo previous local excisions and in whom aggressive recurrences develop are difficult to manage successfully. We present a consecutive series of five primary procedures on patients with painful plantar fibroma and seven revision operations on patients with recurrent plantar fibroma. The average follow-up was 47 months (range, 22-66 months) in the primary group and 40 months (range, 21-78 months) in the revision group. The overall results were satisfactory in four of the five primary operations, with only one recurrence. In the revision group, five of seven results were satisfactory with no recurrences. The major complication that led to unsatisfactory results was the development of a postoperative neuroma. In this article, we outline our present surgical techniques of wide primary excision and a staged revision procedure with delayed split-thickness skin graft closure. These techniques can be used successfully to manage this disabling, progressive disease. PMID:8563922

  17. A knowledge-based modeling for plantar pressure image reconstruction.

    PubMed

    Ostadabbas, Sarah; Nourani, Mehrdad; Saeed, Adnan; Yousefi, Rasoul; Pompeo, Matthew

    2014-10-01

    It is known that prolonged pressure on the plantar area is one of the main factors in developing foot ulcers. With current technology, electronic pressure monitoring systems can be placed as an insole into regular shoes to continuously monitor the plantar area and provide evidence on ulcer formation process as well as insight for proper orthotic footwear design. The reliability of these systems heavily depends on the spatial resolution of their sensor platforms. However, due to the cost and energy constraints, practical wireless in-shoe pressure monitoring systems have a limited number of sensors, i.e., typically K < 10. In this paper, we present a knowledge-based regression model (SCPM) to reconstruct a spatially continuous plantar pressure image from a small number of pressure sensors. This model makes use of high-resolution pressure data collected clinically to train a per-subject regression function. SCPM is shown to outperform all other tested interpolation methods for K < 60 sensors, with less than one-third of the error for K = 10 sensors. SCPM bridges the gap between the technological capability and medical need and can play an important role in the adoption of sensing insole for a wide range of medical applications. PMID:24833414

  18. Dynamometer for rat plantar flexor muscles in vivo.

    PubMed

    Cutlip, R G; Stauber, W T; Willison, R H; McIntosh, T A; Means, K H

    1997-09-01

    A dynamometer is designed and fabricated to measure the force output during static and dynamic muscle actions of the plantar flexor muscles of anaesthetised rats in vivo. The design is based on a computer-controlled DC servomotor capable of angular velocities in excess of 17.5 rad s-1. The system controls the range of motion, angular velocity and electrical stimulation of the muscles, while monitoring the force output at the plantar surface of the foot. The force output is measured by a piezo-electric load cell that is rated at 5 kg capacity. Angular velocity and position are measured by a DC tachometer and potentiometer, respectively. All measurement devices are linear (r2 = 0.9998). The design minimises inertial loading during high-speed angular motions, with a variation in force output of less than 0.2%. The dynamometer proves to be an accurate and reliable system for quantifying static and dynamic forces of rat plantar flexor muscles in vivo. PMID:9374061

  19. Reliability of the Kinetic Measures under Different Heel Conditions during Normal Walking

    ERIC Educational Resources Information Center

    Liu, Yuanlong; Wang, Yong Tai

    2004-01-01

    The purpose of this study was to determine and compare the reliability of 3 dimension reaction forces and impulses in walking with 3 different heel shoe conditions. These results suggest that changing the height of the heels affects mainly the reliability of the ground reaction force and impulse measures on the medial and lateral dimension and not…

  20. Heel Removal Analysis for Mixing Pumps of Tank 8

    SciTech Connect

    Lee, S.Y.

    2003-05-21

    Computational fluid dynamics methods were used to recommend a slurry pump operational strategy for sludge heel removal in Tank 8. Flow patterns calculated by the model were used to evaluate the performance of various combinations of operating pumps and their orientation. The models focused on removal of the sludge heel located at the east side of Tank 8 using the four existing slurry pumps. The models and calculations were based on prototypic tank geometry and expected normal operating conditions as defined by Waste Removal Closure (WRC) Engineering. The calculated results demonstrated that for pump speeds higher than 1800 rpm and at a 130 inch liquid level, a recommended orientation of the slurry pumps could be provided, based on a minimum sludge suspension velocity of 2.27 ft per sec. Further results showed that the time to reach a steady-state flow pattern was affected by both the tank level and the pump speed. Sensitivity studies showed that for a given pump speed, a higher tank level and a lower pump nozzle elevation would result in better performance in suspending and removing the sludge. The results also showed that the presence of flow obstructions were advantageous for certain pump orientations.

  1. Preventing Heel Pressure Ulcers: Sustained Quality Improvement Initiative in a Canadian Acute Care Facility.

    PubMed

    Hanna-Bull, Debbie

    2016-01-01

    The setting for this quality improvement initiative designed to reduce the prevalence of facility-acquired heel pressure ulcers was a regional, acute-care, 490-bed facility in Ontario, Canada, responsible for dialysis, vascular, and orthopedic surgery. An interdisciplinary skin and wound care team designed an evidence-based quality improvement initiative based on a systematic literature review and standardization of heel offloading methods. The prevalence of heel pressure ulcers was measured at baseline (immediately prior to implementation of initiative) and at 1 and 4 years following implementation. The prevalence of facility-acquired heel pressure ulcers was 5.8% when measured before project implementation. It was 4.2% at 1 year following implementation and 1.6% when measured at the end of the 4-year initiative. Outcomes demonstrate that the initiative resulted in a continuous and sustained reduction in facility-acquired heel pressure ulcer incidence over a 4-year period. PMID:26473635

  2. Fibromatosis of the plantar fascia: diagnosis and indications for surgical treatment.

    PubMed

    Dürr, H R; Krödel, A; Trouillier, H; Lienemann, A; Refior, H J

    1999-01-01

    Plantar fibromatosis is a rare, benign lesion involving the plantar aponeurosis. Eleven patients (13 feet) underwent 24 operations, including local excision, wide excision, or complete plantar fasciectomy. Clinical results were evaluated retrospectively. There were no differences among the subgroups in postoperative complications. Two primary fasciectomies did not recur. Three of six revised fasciectomies, seven of nine wide excisions, and six of seven local excisions recurred. Our results indicate that recurrence of plantar fibromatosis after surgical resection can be reduced by aggressive initial surgical resection. PMID:9921766

  3. The Human Papillomavirus and Its Role in Plantar Warts: A Comprehensive Review of Diagnosis and Management.

    PubMed

    Vlahovic, Tracey C; Khan, M Tariq

    2016-07-01

    Viral warts or verruca pedis (plantar warts) are common skin conditions seen in both children and adults. Human papilloma virus (HPV), a DNA virus, is responsible for plantar verrucae. It needs an epidermal abrasion and a transiently impaired immune system to inoculate a keratinocyte. These entities are a therapeutic conundrum for many practitioners. This article discusses HPV infiltration and its subtypes involved in plantar warts; the evaluation of patients with plantar warts; and subsequent treatment options, such as laser, Candida albicans immunotherapy, topical therapy such as phytotherapy, and surgical excision. PMID:27215155

  4. Technique using interference fixation repair for plantar plate ligament disruption of lesser metatarsophalangeal joints.

    PubMed

    Sung, Wenjay

    2015-01-01

    Lesser metatarsophalangeal joint instability is a challenging disorder for the foot and ankle surgeon to repair. We believe that disruption of the plantar plate is common, and its repair should be carefully considered. However, we believe that most current techniques inadequately address repair of the complete plantar plate ligament tear, and, thus, instability and pain commonly persist after disruption of the plantar plate. In the present report, we present a technique we have found useful for repair of a complete plantar plate ligament rupture. The method we have described uses interference screw fixation through a dorsal incision to stabilize the lesser metatarsophalangeal joint. PMID:24973038

  5. The influence of heel height on utilized coefficient of friction during walking.

    PubMed

    Blanchette, Mark G; Brault, John R; Powers, Christopher M

    2011-05-01

    Wearing high heel shoes has been associated with an increased potential for slips and falls. The association between wearing high heels and the increased potential for slipping suggests that the friction demand while wearing high heels may be greater when compared to wearing low heel shoes. The purpose of this study was to determine if heel height affects utilized friction (uCOF) during walking. A secondary purpose of this study was to compare kinematics at the ankle, knee, and hip that may explain uCOF differences among shoes with varied heel heights. Fifteen healthy women (mean age 24.5±2.5yrs) participated. Subjects walked at self-selected velocity under 3 different shoe conditions that varied in heel height (low: 1.27cm, medium: 6.35cm, and high: 9.53cm). Ground reaction forces (GRFs) were recorded using a force platform (1560Hz). Kinematic data were obtained using an 8 camera motion analysis system (120Hz). Utilized friction was calculated as the ratio of resultant shear force to vertical force. One-way repeated measures ANOVAs were performed to test for differences in peak uCOF, GRFs at peak uCOF and lower extremity joint angles at peak uCOF. On average, peak uCOF was found to increase with heel height. The increased uCOF observed in high heel shoes was related to an increase in the resultant shear force and decrease in the vertical force. Our results signify the need for proper public education and increased footwear industry awareness of how high heel shoes affect slip risk. PMID:21536444

  6. Reproducibility test on a children's insole for measuring the dynamic plantar pressure distribution.

    PubMed

    Hayes, A; Seitz, P

    1997-04-01

    INTRODUCTION:: This study aimed to establish the reproducibility of a insole measuring system specifically designed for use inside children's shoes. It is important to carry out such an investigation before any measurements are taken in order to ensure that any errors associated with the system are known and quantified. The children's insole had 84 pressure sensors, compared to the adult insoles, with 99 pressure sensors. The sensor technology was essentially the same as used in the adult Pedar system, and incorporated capacitance-based pressure transducers. MATERIALS AND METHOD:: An eight year old boy, height 123 cm, weight 29 kg, was used in the study. Dynamic tests were carried out with the Pedar insole measuring system. The subject walked on a treadmill, at a speed comfortable for him (3 km/h), with the insoles placed between the foot and the shoe. No fixation of the insole to the shoe was used. Seven runs were completed, each with four tests recorded of more than twenty steps. In between each run the insoles were completely removed from the shoe and then replaced. A zero measurement was also taken before the continuation of the next run. Before analysis of the data, twenty steps were selected. The first two steps in each sequence were ignored and the following twenty steps were used in the analysis, ten each for the left and the right foot. Any additional steps recorded were also ignored. The average force for the test data file was initially noted, together with the local pressure for each of the forefoot, midfoot, heel and toe regions, for both the left and the right foot, separately. RESULTS:: The within test data and in-between test data when walking on a treadmill at constant speed was found to be reproducible (F(0.01)) for 6 out of 7 tests for the left and the right foot. The standard deviation of the average force for the left and the right foot was 3%. The 95% confidence intervals for the mean of the peak pressure in the total object was within 6% for the treadmill and free walking data. There was no significant difference between these data. The 95% confidence intervals for the mean of the peak pressure under the big toe was 9% for the treadmill data and 16% for the free walking data. CONCLUSIONS:: These results, together with other published data (McPoil et al. 1995) show that the pedar children's insole system provides accurate and reproducible measurements of the dynamic plantar pressure distribution. The clinician can therefore use this system with confidence as a therapeutic or rehabilitative tool. PMID:11415700

  7. Foot deformities, function in the lower extremities, and plantar pressure in patients with diabetes at high risk to develop foot ulcers

    PubMed Central

    Tang, Ulla Hellstrand; Zügner, Roland; Lisovskaja, Vera; Karlsson, Jon; Hagberg, Kerstin; Tranberg, Roy

    2015-01-01

    Objective Foot deformities, neuropathy, and dysfunction in the lower extremities are known risk factors that increase plantar peak pressure (PP) and, as a result, the risk of developing foot ulcers in patients with diabetes. However, knowledge about the prevalence of these factors is still limited. The aim of the present study was to describe the prevalence of risk factors observed in patients with diabetes without foot ulcers and to explore possible connections between the risk factors and high plantar pressure. Patients and methods Patients diagnosed with type 1 (n=27) or type 2 (n=47) diabetes (mean age 60.0±15.0 years) were included in this cross-sectional study. Assessments included the registration of foot deformities; test of gross function at the hip, knee, and ankle joints; a stratification of the risk of developing foot ulcers according to the Swedish National Diabetes Register; a walking test; and self-reported questionnaires including the SF-36 health survey. In-shoe PP was measured in seven regions of interests on the sole of the foot using F-Scan®. An exploratory analysis of the association of risk factors with PP was performed. Results Neuropathy was present in 28 (38%), and 39 (53%) had callosities in the heel region. Low forefoot arch was present in 57 (77%). Gait-related parameters, such as the ability to walk on the forefoot or heel, were normal in all patients. Eighty percent had normal function at the hip and ankle joints. Gait velocity was 1.2±0.2 m/s. All patients were stratified to risk group 3. Hallux valgus and hallux rigidus were associated with an increase in the PP in the medial forefoot. A higher body mass index (BMI) was found to increase the PP at metatarsal heads 4 and 5. Pes planus was associated with a decrease in PP at metatarsal head 1. Neuropathy did not have a high association with PP. Conclusions This study identified several potential risk factors for the onset of diabetic foot ulcers (DFU). Hallux valgus and hallux rigidus appeared to increase the PP under the medial forefoot and a high BMI appeared to increase the PP under the lateral forefoot. There is a need to construct a simple, valid, and reliable assessment routine to detect potential risk factors for the onset of DFU. PMID:26087865

  8. [Extracorporeal shockwave therapy in symptomatic heel spurs. An overview].

    PubMed

    Buch, M; Knorr, U; Fleming, L; Theodore, G; Amendola, A; Bachmann, C; Zingas, C; Siebert, W E

    2002-07-01

    Extracorporeal shock wave application (ESWA) has been successfully used for years in routine clinical management of plantar fasciitis. So far no clinical trails have shown the efficiency in placebo-controlled protocols. This paper presents an overview of conservative and operative treatment modalities with respect to their efficacy. Results of a prospective randomized placebo-controlled double-blind multicenter trial to show efficiency and safety of ESWT are presented. In patients treated conservatively without success, a single shock wave application can improve the condition significantly compared with placebo treatment (p = 0.0149). The Roles and Maudsley score also showed a significant improvement between the groups, with 61.6% good or excellent results in the verum group and 39.7% in the placebo group (p = 0.0128). Therapy-related side effects (local swelling, petechia) are rare. The data presented in this study led to FDA approval in January 2002 of the shock wave device used. PMID:12219661

  9. Radiation levels on empty cylinders containing heel material

    SciTech Connect

    Shockley, C.W.

    1991-12-31

    Empty UF{sub 6} cylinders containing heel material were found to emit radiation levels in excess of 200 mr/hr, the maximum amount stated in ORO-651. The radiation levels were as high as 335 mr/hr for thick wall (48X and 48Y) cylinders and 1050 mr/hr for thin wall (48G and 48H) cylinders. The high readings were found only on the bottom of the cylinders. These radiation levels exceeded the maximum levels established in DOT 49 CFR, Part 173.441 for shipment of cylinders. Holding periods of four weeks for thick-wall cylinders and ten weeks for thin-wall cylinders were established to allow the radiation levels to decay prior to shipment.

  10. Analysis of Heel Raise Exercise with Three Foot Positions

    PubMed Central

    ARNSDORFF, KIMBERLY; LIMBAUGH, KEN; RIEMANN, BRYAN L.

    2011-01-01

    Prior research revealed activation differences between the medial (MG) and lateral (LG) gastrocnemius when performing heel raise exercise with neutral (N), internally-rotated (IR) and externally-rotated (ER) foot positions. Studying underlying biomechanics may help explain activation differences. The purpose was to compare ankle (AN), knee (KN), and hip (HI) contributions (initial joint angles) to attaining each initial foot position, ankle flexion-extension range of motion, ankle mechanical energy expenditure, repetition time, and percent cycle concentric-eccentric transition between N, IR, and ER foot positions. Twenty healthy subjects (11 male, 9 female) with resistance training experience performed twelve repetitions of free-weight (135% body mass) heel raise exercise using N, IR and ER foot positions in a counterbalanced order. Forefeet were elevated .05m onto separate forceplates. Electromagnetic sensors secured along dominant lower limb recorded kinematic data. Dependent variables were averaged across five selected repetitions. No significant differences existed for repetition time (P=.209), percent cycle concentric-eccentric transition (P=.668), ankle mechanical energy expenditure (P=.590), and ankle flexion-extension range of motion (P=.129) between foot positions. Post hoc comparison of a significant joint by foot position interaction (P<.001) demonstrated IR>N>ER for the initial HI and KN angles, whereas for AN, ER>IR and N. Between joints: AN

  11. Quantitative heel ultrasound variables in powerlifters and controls

    PubMed Central

    Jawed, S; Horton, B; Masud, T

    2001-01-01

    Objective—To compare by cross sectional study the quantitative heel ultrasound (QUS) variables broadband ultrasound attenuation (BUA) and velocity of sound (VOS) in male powerlifters and controls. Methods—Twenty four powerlifters and 21 sedentary male controls were recruited to the study. All the powerlifters were members of the British Drug Free Powerlifting Association and actively competing at the time of the study. A questionnaire was completed by all those entered into the study. This included a history of smoking and an estimation of daily intake of alcohol and calcium. For the powerlifters, the number of years spent training and time spent training each week was also recorded. The QUS variables of all powerlifters and controls were measured using a Cubaclinical II (McCue) ultrasound scanner. Results—The powerlifters had been training for a mean (SEM) of 10.6 (1.6) years and they trained for 6.5 (0.4) hours a week. The powerlifters were non-significantly older and had a significantly higher body mass index (BMI) than the controls. Calcium intake and consumption of alcohol and tobacco were similar in the two groups. The mean BUA in the powerlifters was a significant 9.5% (95% confidence interval 0.7 to 18.3%) higher than the controls (105 v 96 dB/MHZ) and 15.6% (95% confidence interval 6.8 to 24.4%) higher after adjustment using analysis of covariance for age, BMI, and alcohol and tobacco consumption (108 v 93 dB/MHZ). The mean VOS was similar in the two groups, but after adjustment it was significantly higher in the powerlifters (1671 v 1651 m/s, p<0.01). Conclusions—The study shows the ability of heel ultrasound to discriminate between QUS variables in powerlifters and controls. The results indicate that the QUS variables BUA and VOS are significantly higher for powerlifters than for controls. PMID:11477028

  12. The Changes of COP and Foot Pressure after One Hour's Walking Wearing High-heeled and Flat Shoes

    PubMed Central

    Ko, Dong Yeol; Lee, Han Suk

    2013-01-01

    [Purpose] This study aimed to determine the most appropriate height for shoe heels by measuring the displacement of the COP (center of pressure) and changes in the distribution of foot pressure after walking in flat (0.5 cm), middle-heeled (4 cm), and high-heeled (9 cm) shoes for 1 hour. [Methods] A single-subject design was used, with 15 healthy women wearing shoes with heels of each height in a random order. The foot pressure and displacement of COP before and after walking in an ordinary environment for 1 hour were measured using an FDM-S (zebris Medical GmbH, Germany). [Results] The distribution of foot pressure did not change significantly after walking in middle-heeled (4 cm) shoes but did change significantly after walking in either flat (0.5 cm) or high-heeled (9 cm) shoes. Similarly, the COP was not significantly displaced after walking in middle-heeled (4 cm) shoes but was significantly displaced after walking in either flat (0.5 cm) or high-heeled (9 cm) shoes. [Conclusion] Both flat and high-heeled shoes had adverse effects on the body. Middle-heeled (4 cm) shoes are preferable to both flat (0.5 cm) and high-heeled (9 cm) shoes for the health and comfort of the feet. PMID:24259782

  13. Effects of shoe inserts and heel height on foot pressure, impact force, and perceived comfort during walking.

    PubMed

    Yung-Hui, Lee; Wei-Hsien, Hong

    2005-05-01

    Studying the impact of high-heeled shoes on kinetic changes and perceived discomfort provides a basis to advance the design and minimize the adverse effects on the human musculoskeletal system. Previous studies demonstrated the effects of inserts on kinetics and perceived comfort in flat or running shoes. No study attempted to investigate the effectiveness of inserts in high heel shoes. The purpose of this study was to determine whether increasing heel height and the use of shoe inserts change foot pressure distribution, impact force, and perceived comfort during walking. Ten healthy females volunteered for the study. The heel heights were 1.0cm (flat), 5.1cm (low), and 7.6cm (high). The heel height effects were examined across five shoe-insert conditions of shoe only; heel cup, arch support, metatarsal pad, and total contact insert (TCI). The results indicated that increasing heel height increases impact force (p<0.01), medial forefoot pressure (p<0.01), and perceived discomfort (p<0.01) during walking. A heel cup insert for high-heeled shoes effectively reduced the heel pressure and impact force (p<0.01), an arch support insert reduced the medial forefoot pressure, and both improved footwear comfort (p<0.01). In particular, a TCI reduced heel pressure by 25% and medial forefoot pressure by 24%, attenuate the impact force by 33.2%, and offered higher perceived comfort when compared to the non-insert condition. PMID:15854579

  14. Severe palmo-plantar hyperkeratosis in Koebner epidermolysis bullosa simplex.

    PubMed

    Shirakata, Yuji; Tamai, Katsuto; Nakaoka, Hiroki; Tokumaru, Sho; Sayama, Koji; Murakami, Shinji; Hashimoto, Koji

    2003-02-01

    A 22-year-old Japanese woman with Koebner epidermolysis bullosa simplex presented with severe palmo-plantar hyperkeratosis. Skin biopsy specimens from the palm revealed hyperkeratosis and acanthosis with blistering in the basal cell layer. An electron microscopic study showed cytolysis of basal cells and clumping of tonofilaments forming thick bundles and perinuclear electron-dense bodies. Hand contractures were released and covered with full thickness autografts or split thickness autografts. The donor site was successfully treated with cultured epidermal autografts. PMID:12692381

  15. Sensory conduction in medial and lateral plantar nerves.

    PubMed Central

    Ponsford, S N

    1988-01-01

    A simple and reliable method of recording medial and lateral plantar nerve sensory action potentials is described. Potentials are recorded with surface electrodes at the ankle using surface electrodes stimulating orthodromically at the sole. The normal values obtained are higher in amplitude than those obtained by the method described by Guiloff and Sherratt and are detectable in older subjects aged over 80 years. The procedure is valuable in the diagnosis of early peripheral neuropathy, mononeuritis multiplex, tarsal tunnel syndrome and in differentiation between pre and post ganglionic L5 S1 lesions. PMID:2831304

  16. Resistance exercise prevents plantar flexor deconditioning during bed rest

    NASA Technical Reports Server (NTRS)

    Bamman, M. M.; Hunter, G. R.; Stevens, B. R.; Guilliams, M. E.; Greenisen, M. C.

    1997-01-01

    Because resistance exercise (REX) and unloading induce opposing neuromuscular adaptations, we tested the efficacy of REX against the effects of 14 d of bed rest unloading (BRU) on the plantar flexor muscle group. Sixteen men were randomly assigned to no exercise (NOE, N = 8) or REX (N = 8). REX performed 5 sets x 6-10 repetitions to failure of constant resistance concentric/eccentric plantar flexion every other day during BRU. One-repetition maximum (1RM) strength was tested on the training device. The angle-specific torque-velocity relationship across 5 velocities (0, 0.52, 1.05, 1.75, and 2.97 rad.s-1) and the full range-of-motion power-velocity relationship were assessed on a dynamometer. Torque-position analyses identified strength changes at shortened, neutral, and stretched muscle lengths. Concentric and eccentric contractile work were measured across ten repetitions at 1.05 rad.s-1. Maximal neural activation was measured by surface electromyography (EMG). 1RM decreased 9% in NOE and improved 11% in REX (P < 0.05). Concentric (0.52 and 1.05 rad.s-1), eccentric (0.52 and 2.97 rad.s-1), and isometric angle-specific torques decreased (P < 0.05) in NOE, averaging 18%, 17%, and 13%, respectively. Power dropped (P < 0.05) in NOE at three eccentric (21%) and two concentric (14%) velocities. REX protected angle-specific torque and average power at all velocities. Concentric and eccentric strength decreased at stretched (16%) and neutral (17%) muscle lengths (P < 0.05) in NOE while REX maintained or improved strength at all joint positions. Concentric (15%) and eccentric (11%) contractile work fell in NOE (P < 0.05) but not in REX. Maximal plantar flexor EMG did not change in either group. In summary, constant resistance concentric/eccentric REX completely prevented plantar flexor performance deconditioning induced by BRU. The reported benefits of REX should prove useful in prescribing exercise for astronauts in microgravity and for patients susceptible to functional decline during bed- or chair-bound hospital stays.

  17. Resistance exercise prevents plantar flexor deconditioning during bed rest.

    PubMed

    Bamman, M M; Hunter, G R; Stevens, B R; Guilliams, M E; Greenisen, M C

    1997-11-01

    Because resistance exercise (REX) and unloading induce opposing neuromuscular adaptations, we tested the efficacy of REX against the effects of 14 d of bed rest unloading (BRU) on the plantar flexor muscle group. Sixteen men were randomly assigned to no exercise (NOE, N = 8) or REX (N = 8). REX performed 5 sets x 6-10 repetitions to failure of constant resistance concentric/eccentric plantar flexion every other day during BRU. One-repetition maximum (1RM) strength was tested on the training device. The angle-specific torque-velocity relationship across 5 velocities (0, 0.52, 1.05, 1.75, and 2.97 rad.s-1) and the full range-of-motion power-velocity relationship were assessed on a dynamometer. Torque-position analyses identified strength changes at shortened, neutral, and stretched muscle lengths. Concentric and eccentric contractile work were measured across ten repetitions at 1.05 rad.s-1. Maximal neural activation was measured by surface electromyography (EMG). 1RM decreased 9% in NOE and improved 11% in REX (P < 0.05). Concentric (0.52 and 1.05 rad.s-1), eccentric (0.52 and 2.97 rad.s-1), and isometric angle-specific torques decreased (P < 0.05) in NOE, averaging 18%, 17%, and 13%, respectively. Power dropped (P < 0.05) in NOE at three eccentric (21%) and two concentric (14%) velocities. REX protected angle-specific torque and average power at all velocities. Concentric and eccentric strength decreased at stretched (16%) and neutral (17%) muscle lengths (P < 0.05) in NOE while REX maintained or improved strength at all joint positions. Concentric (15%) and eccentric (11%) contractile work fell in NOE (P < 0.05) but not in REX. Maximal plantar flexor EMG did not change in either group. In summary, constant resistance concentric/eccentric REX completely prevented plantar flexor performance deconditioning induced by BRU. The reported benefits of REX should prove useful in prescribing exercise for astronauts in microgravity and for patients susceptible to functional decline during bed- or chair-bound hospital stays. PMID:9372483

  18. Symptomatic plantar fibroma with a unique sonographic appearance.

    PubMed

    Haun, Daniel W; Cho, John C S; Kettner, Norman W

    2012-02-01

    We present a case of a solitary plantar fibroma with unique sonographic features with MRI and pathologic correlation. A 25-year-old woman presented with a left foot mass that interfered with her gait. Sonography demonstrated a well-circumscribed, 32 mm × 27 mm × 14 mm subcutaneous mass with heterogeneous echogenicity. Unique sonographic characteristics included posterior acoustic enhancement, cystic components, and mild intratumoral hypervascularity. MRI confirmed the sonographic findings. Surgical excision was performed without complication. A pathologic diagnosis of fibroma with myxoid degeneration and cyst formation was made. PMID:21656782

  19. Use of primary corticosteroid injection in the management of plantar fasciopathy: is it time to challenge existing practice?

    PubMed

    Kirkland, Paul; Beeson, Paul

    2013-01-01

    Plantar fasciopathy (PF) is characterized by degeneration of the fascia at the calcaneal enthesis. It is a common cause of foot pain, accounting for 90% of clinical presentations of heel pathology. In 2009-2010, 9.3 million working days were lost in England due to musculoskeletal disorders, with 2.4 million of those attributable to lower-limb disorders, averaging 16.3 lost working days per case. Numerous studies have attempted to establish the short- and long-term clinical efficacy of corticosteroid injections in the management of PF. Earlier studies have not informed clinical practice. As the research base has developed, evidence has emerged supporting clinical efficacy. With diverse opinions surrounding the etiology and efficacy debate, there does not seem to be a consensus of opinion on a common treatment pathway. For example, in England, the National Institute for Clinical Health and Excellence does not publish strategic guidance for clinical practice. Herein, we review and evaluate core literature that examines the clinical efficacy of corticosteroid injection as a treatment for PF. Outcome measures were wide ranging but largely yielded results supportive of the short- and long-term benefits of this modality. The analysis also looked to establish, where possible, "proof of concept." This article provides evidence supporting the clinical efficacy of corticosteroid injections, in particular those guided by imaging technology. The evidence challenges existing orthodoxy, which marginalizes this treatment as a secondary option. This challenge is supported by recently revised guidelines published by the American College of Foot and Ankle Surgeons advocating corticosteroid injection as a primary treatment option. PMID:24072372

  20. Design and Test of a Soft Plantar Force Measurement System for Gait Detection

    PubMed Central

    Zhang, Xuefeng; Zhao, Yulong; Duan, Zhengyong; Liu, Yan

    2012-01-01

    This work describes a plantar force measurement system. The MEMS pressure sensor, as the key sensing element, is designed, fabricated and embedded into a flexible silicon oil-filled bladder made of silicon rubber to constitute a single sensing unit. A conditioning circuit is designed for signal processing and data acquisition. The characteristics of the plantar force sensing unit are investigated by both static and dynamic tests. A comparison of characteristics between the proposed plantar force sensing unit and a commercial flexible force sensor is presented. A practical experiment of plantar force measurement has been carried out to validate the system. The results demonstrate that the proposed measurement system has a potential for success in the application of plantar force measurement during normal gait. PMID:23208558

  1. Metatarsophalangeal joint instability of the lesser toes and plantar plate deficiency.

    PubMed

    Doty, Jesse F; Coughlin, Michael J

    2014-04-01

    Our understanding of lesser toe metatarsophalangeal joint instability has increased substantially over the past few decades. Some recent articles on the subject have provided detailed anatomic descriptions that help to characterize the primary stabilizing structures of the joint. Some surgeons now advocate the incorporation of a primary repair of the plantar plate into the surgical plan for correction of metatarsophalangeal joint deviation in the sagittal and transverse planes. New surgical techniques have been developed to expose, inspect, and reliably repair the plantar plate, if necessary. Dorsal and plantar approaches have both been used successfully to repair the plantar plate. Tears of the plantar plate can be repaired primarily or advanced on the base of the proximal phalanx through bone tunnels. Outcomes of these procedures are promising, with improvements in pain and function reported along with sustained deformity correction. PMID:24668353

  2. Design and test of a soft plantar force measurement system for gait detection.

    PubMed

    Zhang, Xuefeng; Zhao, Yulong; Duan, Zhengyong; Liu, Yan

    2012-01-01

    This work describes a plantar force measurement system. The MEMS pressure sensor, as the key sensing element, is designed, fabricated and embedded into a flexible silicon oil-filled bladder made of silicon rubber to constitute a single sensing unit. A conditioning circuit is designed for signal processing and data acquisition. The characteristics of the plantar force sensing unit are investigated by both static and dynamic tests. A comparison of characteristics between the proposed plantar force sensing unit and a commercial flexible force sensor is presented. A practical experiment of plantar force measurement has been carried out to validate the system. The results demonstrate that the proposed measurement system has a potential for success in the application of plantar force measurement during normal gait. PMID:23208558

  3. How Plantar Exteroceptive Efficiency Modulates Postural and Oculomotor Control: Inter-Individual Variability

    PubMed Central

    Foisy, Arnaud; Kapoula, Zoï

    2016-01-01

    In a previous experiment, we showed that among young and healthy subjects, thin plantar inserts improve postural control and modify vergence amplitudes. In this experiment, however, significant inter-individual variability was observed. We hypothesize that its origin could be attributed to a different reliance upon feet cutaneous afferents. In order to test this hypothesis, we re-analyzed the data relative to 31 young (age 25.7 ± 3.8) and healthy subjects who participated in the first experiment after having classified them into two groups depending on their Plantar Quotient (PQ = Surface area of CoPfoam/Surface area of CoPfirm ground × 100). Foam decreases the information arising from the feet, normally resulting in a PQ > 100. Hence, the PQ provides information on the weight of plantar cutaneous afferents used in postural control. Twelve people were Plantar-Independent Subjects, as indicated by a PQ < 100. These individuals did not behave like the Normal Plantar Quotient Subjects: they were almost insensitive to the plantar stimulations in terms of postural control and totally insensitive in terms of oculomotor control. We conclude that the inter-individual variability observed in our first experiment is explained by the subjects' degree of plantar reliance. We propose that plantar independence is a dysfunctional situation revealing inefficiency in plantar cutaneous afferents. The latter could be due to a latent somatosensory dysfunction generating a noise which prevents the CNS from correctly processing and using feet somatosensory afferents both for balance and vergence control: Plantar Irritating Stimulus. Considering the non-noxious nature and prevalence of this phenomenon, these results can be of great interest to researchers and clinicians who attempt to trigger postural or oculomotor responses through mechanical stimulation of the foot sole.

  4. Analysis of Factors Affecting Stress Solution at Concrete Gravity Dam Heel

    NASA Astrophysics Data System (ADS)

    Hung, Vu Hoang; Quoc Cong, Trinh; Tongchun, Li

    2010-05-01

    Along with Vietnam's development, various hydraulic constructions including concrete gravity dams have been being built. In some of these dams, the fractures occurred at the heel of the dams are even in small and media dams. There are various reasons cause the factures at dam heel but the main reason is the stress states at dam heel are not determined correctly while designing dam. In this paper, several factors affecting stress solution at concrete gravity dam heel such as element mesh size, crack joints of upstream foundation, execution process are investigated by using finite element model of Banve concrete gravity dam. This work is very significant when the more high concrete gravity dams will be constructed in Vietnam year after year.

  5. Optimum sail design for small heel and weak wind shear conditions

    NASA Astrophysics Data System (ADS)

    Sugimoto, Takeshi

    1995-02-01

    Aerodynamics of sails in weakly sheared wind has been studied based on vortex mechanics. Assumptions of small disturbance simplify the basic equations, which show that the effective application of the rudder and coupled heeling and yawing motions give directional stability to sailing craft close to wind. Analysis has also revealed how heel-yaw motion and sheared wind affect the optimization of the thrust with constraints. The result has been compared with the present author's previous work that disregards the heel and the wind shear. While the optimum circulation is independent of the wind shear and the heel-yaw motion, the optimum geometry of sails is little affected by the wind shear. Closed-form solutions are given to represent the optimum design.

  6. Study on lumbar kinematics and the risk of low back disorder in female university students by using shoes of different heel heights.

    PubMed

    Iqbal, Rauf; De, Amitabha; Mishra, Wricha; Maulik, Shreya; Chandra, A M

    2012-01-01

    The study was taken up to investigate the effects of heel heights on lumbar kinematics and the risk of Low Back Disorder (LBD) in females. Nineteen female university students (24.5 3.36 yrs) volunteered in the study. Lumbar kinematics was measured by using Industrial Lumbar Motion Monitor (iLMM). The volunteers were asked to walk for a distance of 50 meters in 3 different given conditions i.e bare foot (Heel 0), with flat heels (Heel 1) and with high heels (Heel 2). Heights of Heel 1 and Heel 2 were 1.5 0.84 cm and 5.5 1.70 cm respectively. The Lumbar kinematic parameters studied were- Average Twisting Velocity (ATV), Maximum Sagital Flexion (MSF) and Maximum Lateral Velocity (MLV). It was observed that all the above mentioned Lumbar kinematics - ATV, MSF and MLV increases with increase of heel heights, which in turn increases the risk of LBD. As a result of increase in Lumbar kinematic values with increase in heel heights, LBD risk has also increased. Mean and SD of the LBD risk with Heel 0, Heel 1 and Heel 2 were 16.79 6.04%, 19.00 7.38% and 22.11 6.98% respectively. Lower stature with high heels showed higher risk of LBD than the higher stature with high heels. PMID:22317099

  7. Sludge Heel Removal Analysis for Slurry Pumps of Tank 11

    SciTech Connect

    Lee, S.Y.

    2003-09-30

    Computational fluid dynamics methods were used to develop and recommend a slurry pump operational strategy for sludge heel removal in Tank 11. Flow patterns calculated by the model were used to evaluate the performance of various combinations of operating pumps and their orientation. The models focused on removal of the sludge heel located at the edge of Tank 11 using the four existing slurry pumps. The models and calculations were based on prototypic tank geometry and expected normal operating conditions as defined by Tank Closure Project (TCP) Engineering. Computational fluid dynamics models of Tank 11 with different operating conditions were developed using the FLUENT(tm) code. The modeling results were used to assess the efficiency of sludge suspension and removal operations in the 75-ft tank. The models employed a three-dimensional approach, a two-equation turbulence model, and an approximate representation of flow obstructions. The calculated local velocity was used as a measure of sludge removal and mixing capability. For the simulations, a series of the modeling calculations was performed with indexed pump orientations until an efficient flow pattern near the potential location of the sludge mound was established for sludge removal. The calculated results demonstrated that the existing slurry pumps running at 1600 rpm could remove the sludge mound from the tank with a 103 in. liquid level, based on a minimum sludge suspension velocity of 2.27 ft/sec. In this case, the only exception is the region within about 2 ft. from the tank wall. Further results showed that the capabilities of sludge removal were affected by the indexed pump orientation, the number of operating pumps, and the pump speed. A recommended operational strategy for an efficient flow pattern was developed to remove the sludge mound assuming that local fluid velocity can be used as a measure of sludge suspension and removal. Sensitivity results showed that for a given pump speed, a higher tank level and a lower pump nozzle elevation would result in better performance in suspending and removing the sludge. The results also showed that the presence of flow obstructions such as valve housing structure were advantageous for certain pump orientations.

  8. Thinking while walking: experienced high-heel walkers flexibly adjust their gait.

    PubMed

    Schaefer, Sabine; Lindenberger, Ulman

    2013-01-01

    Theories of motor-skill acquisition postulate that attentional demands of motor execution decrease with practice. Hence, motor experts should experience less attentional resource conflict when performing a motor task in their domain of expertise concurrently with a demanding cognitive task. We assessed cognitive and motor performance in high-heel experts and novices who were performing a working memory task while walking in gym shoes or high heels on a treadmill. Surprisingly, neither group showed lower working memory performance when walking than when sitting, irrespective of shoe type. However, high-heel experts adapted walking regularity more flexibly to shoe type and cognitive load than novices, by reducing the variability of time spent in the single-support phase of the gait cycle in high heels when cognitively challenged. We conclude that high-heel expertise is associated with more flexible adjustments of movement patterns. Future research should investigate whether a more demanding walking task (e.g., wearing high heels on uneven surfaces and during gait perturbations) results in expertise-related differences in the simultaneous execution of a cognitive task. PMID:23760158

  9. Interference of high-heeled shoes in static balance among young women.

    PubMed

    Gerber, Susana Bacelete; Costa, Rafael Vital; Grecco, Luanda André Collange; Pasini, Hugo; Marconi, Nádia Fernanda; Oliveira, Claudia Santos

    2012-10-01

    The aim of the present study was to assess the effect of the use of high-heeled shoes on static balance in young adult women. Fifty-three women between 18 and 30 years of age and accustomed to wearing high-heeled shoes participated in the study. None of the participants had any orthopedic or neurologic alterations. Static balance was assessed using a force plate. Oscillations from the center of pressure in the mediolateral and anteroposterior directions were measured both when barefoot and when wearing high-heeled shoes [7 centimeters (cm) in height and 1cm in diameter] under the conditions of eyes open and eyes closed. Two-way analysis of variance was employed for the statistical analysis, with the level of significance set at 5% (p<.05). The results revealed statistically significant differences between tests when barefoot and when wearing high-heeled shoes as well as with eyes open and eyes closed (p<.01). With the use of high-heeled shoes, there was a significant increase in mediolateral oscillation with eyes closed (p<.01). The present study demonstrates that the use of seven-cm high heels altered static balance in the healthy young women analyzed, increasing the oscillation of the center of pressure, regardless of visual restriction. PMID:22742722

  10. Thinking While Walking: Experienced High-Heel Walkers Flexibly Adjust Their Gait

    PubMed Central

    Schaefer, Sabine; Lindenberger, Ulman

    2013-01-01

    Theories of motor-skill acquisition postulate that attentional demands of motor execution decrease with practice. Hence, motor experts should experience less attentional resource conflict when performing a motor task in their domain of expertise concurrently with a demanding cognitive task. We assessed cognitive and motor performance in high-heel experts and novices who were performing a working memory task while walking in gym shoes or high heels on a treadmill. Surprisingly, neither group showed lower working memory performance when walking than when sitting, irrespective of shoe type. However, high-heel experts adapted walking regularity more flexibly to shoe type and cognitive load than novices, by reducing the variability of time spent in the single-support phase of the gait cycle in high heels when cognitively challenged. We conclude that high-heel expertise is associated with more flexible adjustments of movement patterns. Future research should investigate whether a more demanding walking task (e.g., wearing high heels on uneven surfaces and during gait perturbations) results in expertise-related differences in the simultaneous execution of a cognitive task. PMID:23760158

  11. Gait-related strategies for the prevention of plantar ulcer development in the high risk foot.

    PubMed

    Bowling, Frank L; Reeves, Neil D; Boulton, Andrew J

    2011-05-01

    High plantar pressures lead to ulceration in the diabetic foot, particularly in the forefoot region around the metatarsal heads. High plantar pressures persist during gait due to factors such as peripheral neuropathy, foot deformities, limited ankle dorsi flexion range of motion and reduced plantar tissue thickness. Strategies impinging upon gait such as the use of appropriate therapeutic footwear, custom-moulded insoles and injectable silicone can help to reduce plantar pressures and attenuate the risk for ulceration. Shoes adapted with external rocker profiles facilitate plantar flexion and restrict sagittal plane motion of the metatarsophalangeal joint, reducing pressures in the region of the metatarsal heads. Insoles custom-moulded to patient's feet help to reduce plantar pressures and minimise the risk of ulceration in the forefoot region. The loss of subcutaneous fat tissue in the diabetic foot enhances bony prominences and predisposes the foot to high-pressure areas. Silicone is a biocompatible material that can be safely injected into plantar soft tissue to augment tissue thickness and prevent the development of ulceration. This enhancement to the subcutaneous layer is remarkably well retained and is a generally well-adopted procedure in the clinical setting. PMID:21521160

  12. Mechanical power of ankle plantar flexion and subjective pain by monophasic electrical stimulation.

    PubMed

    Suzuki, Tatsuto; Watanabe, Takashi; Saura, Ryuichi; Uchiyama, Hironobu

    2011-01-01

    The aim of this study was to investigate the mechanical power of the ankle plantar flexion. The investigated power of the ankle plantar flexion would help to improve effectively the FES walking system using the ankle plantar flexion for patients and aged people in slow walking. The subjective pain by electrical stimulation sometimes becomes the burden to use the FES system. We also investigated the relationship between the mechanical power in ankle plantar flexion by electrical stimulation and the subjective pain. We developed the device to measure the ankle movement by electrical stimulation against load resistance torque. The device consisted of pads to support a single lower leg, a rotational footplate with a large pulley and a vertical weight to generate the load resistance torque, and a monophasic electrical stimulator via surface electrodes. Our results showed the proportional relationship between the mechanical power of the ankle plantar flexion and the subjective pain by electrical stimulation. To generate the same level in the ankle plantar flexor power 2.75 W under the maximum voluntary exertion, the subjective pain by electrical stimulation exceeded 70, which means the feeling of crying at the Face Pain Scale. This result would help the better design of the FES walking system using the ankle plantar flexion for patients and aged people. PMID:22256008

  13. High-energy focussed extracorporeal shockwave therapy reduces pain in plantar fibromatosis (Ledderhose’s disease)

    PubMed Central

    2012-01-01

    Background Plantar fibromatosis is a benign disease creating nodules on the medial plantar side of affected patients. While surgical removal is regarded as the therapeutic mainstay, recurrence rates and impairment of daily activities remains substantial. High-energy focussed extracorporeal shockwave therapy has been suggested to be potentially effective in plantar fibromatosis in terms of pain reduction. Hypothesis High-energy focussed extracorporeal shockwave therapy reduces pain in plantar fibromatosis. Findings A total number of six patients (5 males, 58±4 years) were included with plantar fibromatosis (Ledderhose’s disease) associated with pain. Three patients were operated on previously, one had concomitant Dupuytren’s contracture. High-energy focussed ESWT was applied using a Storz Duolith SD1 (2000 impulses, 3 Hz, 1.24 mJ/mm2) in two sessions with 7 days between. Pain was 6±2 at baseline, 2±1 after 14 days and 1±1 after 3 months. Softening of the nodules was noted by all patients. No adverse effects were noted. Conclusions High-energy focussed extracorporeal shockwave energy reduces pain in painful plantar fibromatosis (Morbus Ledderhose). Further large-scale prospective trials are warranted to elucidate the value of high-energy focussed extracorporeal shockwave therapy (ESWT) in plantar fibromatosis in terms of recurrence and efficacy. PMID:23031080

  14. Relative sensitivity of depth discrimination for ankle inversion and plantar flexion movements.

    PubMed

    Black, Georgia; Waddington, Gordon; Adams, Roger

    2014-02-01

    25 participants (20 women, 5 men) were tested for sensitivity in discrimination between sets of six movements centered on 8 degrees, 11 degrees, and 14 degrees, and separated by 0.3 degrees. Both inversion and plantar flexion movements were tested. Discrimination of the extent of inversion movement was observed to decline linearly with increasing depth; however, for plantar flexion, the discrimination function for movement extent was found to be non-linear. The relatively better discrimination of plantar flexion movements than inversion movements at around 11 degrees from horizontal is interpreted as an effect arising from differential amounts of practice through use, because this position is associated with the plantar flexion movement made in normal walking. The fact that plantar flexion movements are discriminated better than inversion at one region but not others argues against accounts of superior proprioceptive sensitivity for plantar flexion compared to inversion that are based on general properties of plantar flexion such as the number of muscle fibres on stretch. PMID:24724517

  15. The relationship of the position of the metatarsal heads and peak plantar pressure.

    PubMed

    Weijers, René E; Walenkamp, Geert H I M; van Mameren, Henk; Kessels, Alphons G H

    2003-04-01

    We test the premise that peak plantar pressure is located directly under the bony prominences in the forefoot region. The right foot of standing volunteers was examined in three different postures by a CT-scanner. The plantar pressure distribution was simultaneously recorded. The position of the metatarsal heads and the sesamoids could be related to the corresponding local peak plantar pressures. The metatarsal heads 1, 4, and 5 had a significantly different position than the local peak plantar pressures. The average difference in distance between the position of the metatarsal heads and the peak plantar pressure showed a significant correlation: on the medial side the head was located more distally to the local peak plantar pressure, on the lateral side more proximally. The findings suggest that normal plantar soft tissue is able to deflect a load. The observations might improve insight into the function of the normal forefoot and might direct further research on the pathological forefoot and on the design of footwear. PMID:12735379

  16. Ostectomy and Medial Plantar Artery Flap Reconstruction for Charcot Foot Ulceration Involving the Midfoot.

    PubMed

    Sato, Tomoya; Ichioka, Shigeru

    2016-01-01

    Charcot foot is a serious complication of diabetes, characterized by deformity and overlying ulceration. The condition most commonly affects the midfoot. However, little information is available on the use of a medial plantar artery flap to treat diabetic midfoot ulceration. The purpose of the present study was to evaluate the versatility of ostectomy and medial plantar flap reconstruction for midfoot plantar ulceration associated with rocker-bottom deformity secondary to Charcot foot. Four patients underwent ostectomy and medial plantar flap reconstruction. Before flap reconstruction, the devitalized soft tissues and bone were radically resected. After the infection had been controlled, the ulcerated portion was minimally excised, and the bony prominence underlying the ulcer was removed. A medial plantar artery flap was applied to the ulcer. The donor site was covered with a split-thickness skin graft or artificial dermis. In all patients, the ulcers healed and independent ambulation was achieved. However, 1 patient experienced ulcer recurrence, and subsequent infection necessitated a major amputation. Limb salvage is challenging in the setting of deformity and intractable plantar ulceration. The advantages of medial plantar artery flap reconstruction are that tissues with a rich blood supply are used to cover the exposed bone, and the flap can withstand the pressure and shear stress of the patient's body weight. However, a dominant artery in the foot is sacrificed. Therefore, the patency of the dorsalis pedis artery must be confirmed in every patient. The results of the present study have demonstrated that a medial plantar artery can be an effective alternative for diabetic patients with a plantar ulcer secondary to Charcot foot. PMID:26190780

  17. COX-2 in cancer: Gordian knot or Achilles heel?

    PubMed Central

    Stasinopoulos, Ioannis; Shah, Tariq; Penet, Marie-France; Krishnamachary, Balaji; Bhujwalla, Zaver M.

    2013-01-01

    The networks of blood and lymphatic vessels and of the extracellular matrix and their cellular and structural components, that are collectively termed the tumor microenvironment, are frequently co-opted and shaped by cancer cells to survive, invade, and form distant metastasis. With an enviable capacity to adapt to continually changing environments, cancer represents the epitome of functional chaos, a stark contrast to the hierarchical and organized differentiation processes that dictate the development and life of biological organisms. The consequences of changing landscapes such as hypoxia and acidic extracellular pH in and around tumors create a cascade of changes in multiple pathways and networks that become apparent only several years later as recurrence and metastasis. These molecular and phenotypic changes, several of which are mediated by COX-2, approach the complexities of a Gordian Knot. We review evidence from our studies and from literature suggesting that cyclooxygenase-2 (COX-2) biology presents a nodal point in cancer biology and an Achilles heel of COX-2-dependent tumors. PMID:23579438

  18. The Artificial Gravity Bed Rest Pilot Project: Effects on Knee Extensor and Plantar Flexor Muscle Groups

    NASA Technical Reports Server (NTRS)

    Caiozzo, V. J.; Haddad, F.; Lee, S.; Baker, M.; Baldwin, K. M.

    2007-01-01

    The goal of this project was to examine the effects of artificial gravity (2.5 g) on skeletal muscle strength and key anabolic/catabolic markers known to regulate muscle mass. Two groups of subjects were selected for study: 1) a 21 day-bed rest (BR) control (C) group (N=7); and 2) an AG group (N=8), which was exposed to 21 days of bed-rest plus daily 1 hr exposures to AG (2.5 g). This particular experiment was part of an integrated AG Pilot Project sponsored by NASA/Johnson Space Center. The in vivo torque-velocity relationships of the knee extensors and plantar flexors of the ankle were determined pre and post treatment. Also, pre- and post treatment biopsy samples were obtained from both the vastus lateralis and soleus muscles and were used, in part, for a series of analyses on gene expression (mRNA abundance) of key factors implicated in the anabolic versus catabolic state of the muscle. Post/Pre toque-velocity determinations revealed greater decrements in knee extensor performance in the C versus AG group (P less than 0.04). The plantar flexor muscle group of the AG subjects actually demonstrated a net gain in torque-velocity relationship; whereas, in the C group the overall post/pre responses declined (AG vs C; P less than 0.001). Measurements of muscle fiber cross-sectional area (for both muscles) demonstrated a loss of approx. 20% in the C group while no losses were evident in the AG group. RT-PCR analyses of muscle biopsy specimens demonstrated that markers of growth and cytoskeletal integrity (IGF-1, IGF-1 BP4, mechano growth factor, total RNA, and pro-collagen 3a) were higher in the AG group, whereas catabolic markers (myostatin and atrogen) were elevated in the C group. Importantly, these patterns were seen in both muscles. Based on these observations we conclude that paradigms of AG have the potential to maintain the functional, biochemical, and structural homeostasis of skeletal muscle in the face of chronic unloading states. These findings also warrant further studies since it is likely that other robust paradigms of AG that employ various exercise strategies may be more effective in counteracting long duration unloading states as anticipated on the platforms of the Moon and Mars.

  19. Differential impact of visual feedback on plantar- and dorsi-flexion maximal torque output.

    PubMed

    Toumi, Anis; Jakobi, Jennifer M; Simoneau-Buessinger, Emilie

    2016-05-01

    The effect of visual feedback on enhancing isometric maximal voluntary contractions (MVC) was evaluated. Twelve adults performed plantar-flexion and dorsi-flexion MVCs in 3 conditions (no visual feedback, visual feedback, and visual feedback with target). There was no significant effect of visual conditions on dorsi-flexion MVC but there was an effect on plantar-flexion. Irrespective of whether a target was evident, visual feedback increased plantar-flexion MVC by ∼15%. This study highlights the importance of optimal feedback to enhance MVC. PMID:27031663

  20. Heel effect adaptive flat field correction of digital x-ray detectors

    SciTech Connect

    Yu, Yongjian; Wang, Jue

    2013-08-15

    Purpose: Anode heel effect renders large-scale background nonuniformities in digital radiographs. Conventional offset/gain calibration is performed at mono source-to-image distance (SID), and disregards the SID-dependent characteristic of heel effect. It results in a residual nonuniform background in the corrected radiographs when the SID settings for calibration and correction differ. In this work, the authors develop a robust and efficient computational method for digital x-ray detector gain correction adapted to SID-variant heel effect, without resorting to physical filters, phantoms, complicated heel effect models, or multiple-SID calibration and interpolation.Methods: The authors present the Duo-SID projection correction method. In our approach, conventional offset/gain calibrations are performed only twice, at the minimum and maximum SIDs of the system in typical clinical use. A fast iterative separation algorithm is devised to extract the detector gain and basis heel patterns from the min/max SID calibrations. The resultant detector gain is independent of SID, while the basis heel patterns are parameterized by the min- and max-SID. The heel pattern at any SID is obtained from the min-SID basis heel pattern via projection imaging principles. The system gain desired at a specific acquisition SID is then constructed using the projected heel pattern and detector gain map.Results: The method was evaluated for flat field and anatomical phantom image corrections. It demonstrated promising improvements over interpolation and conventional gain calibration/correction methods, lowering their correction errors by approximately 70% and 80%, respectively. The separation algorithm was able to extract the detector gain and heel patterns with less than 2% error, and the Duo-SID corrected images showed perceptually appealing uniform background across the detector.Conclusions: The Duo-SID correction method has substantially improved on conventional offset/gain corrections for digital x-ray imaging in an SID-variant environment. The technique is relatively simple, and can be easily incorporated into multiple-point gain calibration/correction techniques. It offers a potentially valuable tool for preprocessing digital x-ray images to boost image quality of mammography, chest and cardiac radiography, as well as automated computer aided diagnostic radiology.

  1. Liquid Silicone to Mitigate Plantar Pedal Pressure: A Literature Review

    PubMed Central

    Bowling, Frank L.; Metcalfe, Stuart A.; Wu, Stephanie; Boulton, Andrew J. M.; Armstrong, David G.

    2010-01-01

    Disruption of the body’s plantar fat pad can occur as a result of one of three mechanisms: simple fat pad atrophy associated with age-related degeneration, steroid use, or collagen vascular disease. Actual or relative displacement in to the underlying osseous prominences may be seen in association with structural deformity of the foot. Disease states such as diabetes may alter the normal structural integrity of soft tissues through nonenzymatic glycation leading to increased stiffness and thus reduced attenuating capacity. Fat pad atrophy, regardless of the cause, is often associated with substantial emotional, physical, productivity, and financial losses. In situations where the patient is sensate, the resultant skin on bone situation is extremely painful, especially when walking. PMID:20663447

  2. Microsurgical Reconstruction of Plantar Ulcers of the Insensate Foot.

    PubMed

    Kadam, Dinesh

    2016-06-01

    Background Plantar, neuropathic, or trophic ulcers are often found in patients with decreased sensation in the foot. These ulcers can be complicated by infection, deformity, and increased patient morbidity. Excision results in wider defects and local tissues are often insufficient for reconstruction Methods Total 26 free flaps were used in 25 patients to reconstruct plantar ulcers between years 2007 and 2013. The etiology included diabetic neuropathy (n = 13), leprosy (n = 3), spinal/peripheral nerve injury (n = 7), spina bifida (n = 1), and peripheral neuropathy (n = 1). The duration of the ulcer ranged from 1 to 18 years. Fifteen patients had associated systemic comorbidities and six had previous attempts. Free flaps used in reconstruction were the anterolateral thigh flap (n = 18), radial artery forearm flap (n = 4), and the gracilis muscle flap (n = 4). Recipient vessels were the posterior tibial artery (end to side) in 19 and the dorsalis pedis artery in 7. Results The average age at presentation was 44.6 years with mean duration of ulcer of 5.8 years predominantly located over weight-bearing areas. Mean size of ulcer was 59.45 cm(2) and mean follow-up period was 48 months. All flaps survived except a partial loss. Average time to resume ambulation was 6 weeks. Three patients had recurrence with mean follow-up of 48 months. Secondary flap reduction and bony resection was done in four. Conclusion Microvascular reconstruction of the sole has advantages of vascularity, adequate tissue, and leaving rest of the foot undisturbed for offloading. Three significant local conditions influencing selection and transfer of the flap include (1) distally located forefoot ulcers, (2) extensive subcutaneous fibrosis secondary to frequent inflammation, and (3) Charcot arthropathy. In our series, the anterolateral thigh flap is our first choice for reconstruction of these defects. PMID:26910652

  3. Pathological anatomy and dynamic effect of the displaced plantar plate and the importance of the integrity of the plantar plate-deep transverse metatarsal ligament tie-bar.

    PubMed Central

    Stainsby, G. D.

    1997-01-01

    Normal and deformed forefeet have been investigated by cadaver anatomical dissections and experiments, by radiographs, CT and MRI scanning, and by clinical studies. Evidence is presented to show that the skeleton of the foot rests on and is controlled by a multi-segmental ligamentous and fascial tie-bar system. Transversely across the plantar aspect of the forefoot, the plantar plates and the deep transverse metatarsal ligaments form a strong ligamentous structure which prevents undue splaying of the forefoot. Longitudinally, the five digital processes of the deeper layer of the plantar fascia are inserted into the plantar plates and control the longitudinal arch of the foot. It is suggested that many forefoot deformities result from the failure of parts of the tie-bar system and the dynamic effect of displacement of the plantar plates. Understanding this allows a more logical approach to their treatment. Images Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Figure 9 Figure 10 Figure 11 Figure 12 PMID:9038498

  4. Benign dermoscopic parallel ridge pattern in plantar hyperpigmentation due to capecitabine.

    PubMed

    Tognetti, Linda; Fimiani, Michele; Rubegni, Pietro

    2015-04-01

    We report the case of a 37-year-old woman (phototype II) who presented at our outpatient clinic with a two-month history of hyperpigmented plantar macules. Medical history revealed that the patient had taken capecitabine in the past three months as adjuvant chemotherapy for recurrent breast cancer. Dermoscopic examination of the plantar macules showed parallel ridge pattern with pigmentation in the furrows without obliteration of eccrine gland apertures. Besides in acral melanoma, parallel ridge pattern can also be observed in benign plantar lesions, such as congenital or acquired acral nevi, subcorneal hemorrhage, dye-related pigmentation and drug-induced hyperpigmentation, especially in patients with phototypes III-VI. The few reported cases of capecitabine-induced hyperpigmentation have been associated with hand and foot syndrome in patients with phototypes IV-V and palmar as well as plantar involvement. PMID:26114058

  5. Atypical presentation of plantar fasciitis secondary to soft-tissue mass infiltration.

    PubMed

    Ng, A; Beegle, T; Rockett, A K

    2001-02-01

    This article describes a patient with plantar fascial pain who presented to the office of one of the authors. Physical examination and the patient's description of the history of symptoms revealed classic signs and symptoms of plantar fasciitis. The patient was treated with numerous conservative modalities, including ultrasound, nonsteroidal anti-inflammatory medications, trigger-point injections, over-the-counter orthoses, and stretching exercises. When the pain was not relieved by these conservative measures, magnetic resonance imaging of the area was performed. Visualization of the insertional area of the plantar fascia revealed a mass inferior to, as well as infiltrated into, the plantar fascia. Surgical excision of the lesion resulted in complete elimination of the patient's pain. PMID:11266484

  6. [The use of magnetic resonance imaging in the diagnosis of plantar fibromatosis: a case report].

    PubMed

    Halefoğlu, Ahmet Mesrur

    2005-01-01

    Plantar fibromatosis is a benign but infiltrative neoplasm, presenting as a slow-growing nodular thickening most often within the central band of the plantar aponeurosis. In this case report, we presented a 43-year-old male patient who had a tender nodule in the sole of the right foot for two years. On magnetic resonance images, the location and signal intensity characteristics of the lesion were suggestive of plantar fibromatosis, which was histologically confirmed following an incisional biopsy. Magnetic resonance imaging is a noninvasive method for confirmation of the clinical diagnosis of plantar fibromatosis and also has an important role in planning surgical treatment by delineating the extent of the lesion. PMID:15925942

  7. Benign dermoscopic parallel ridge pattern in plantar hyperpigmentation due to capecitabine

    PubMed Central

    Tognetti, Linda; Fimiani, Michele; Rubegni, Pietro

    2015-01-01

    We report the case of a 37-year-old woman (phototype II) who presented at our outpatient clinic with a two-month history of hyperpigmented plantar macules. Medical history revealed that the patient had taken capecitabine in the past three months as adjuvant chemotherapy for recurrent breast cancer. Dermoscopic examination of the plantar macules showed parallel ridge pattern with pigmentation in the furrows without obliteration of eccrine gland apertures. Besides in acral melanoma, parallel ridge pattern can also be observed in benign plantar lesions, such as congenital or acquired acral nevi, subcorneal hemorrhage, dye-related pigmentation and drug-induced hyperpigmentation, especially in patients with phototypes III–VI. The few reported cases of capecitabine-induced hyperpigmentation have been associated with hand and foot syndrome in patients with phototypes IV–V and palmar as well as plantar involvement. PMID:26114058

  8. The biomechanical relationship between the tendoachilles, plantar fascia and metatarsophalangeal joint dorsiflexion angle.

    PubMed

    Carlson, R E; Fleming, L L; Hutton, W C

    2000-01-01

    We carried out an experiment to measure the relationship between tensile force in the tendoachilles and plantar fascia strain, and how this relationship is affected by the metatarsophalangeal joint dorsiflexion angle. Eight cadaver lower extremity specimens underwent biomechanical testing. Using a servo-hydraulic testing machine, a tensile force up to 500 N was applied to the tendoachilles while the strain on the plantar fascia was measured using an extensometer. The experiment was repeated at four different metatarsophalangeal joint dorsiflexion angles (0 degrees, 5 degrees, 30 degrees, and 45 degrees). Measurements and calculations showed that dorsiflexion of the toes tightens the plantar fascia (the windlass effect) and increases the effect that a tensile force in the tendoachilles has on the tensile strain and tensile force in the plantar fascia. PMID:10710257

  9. Anode heel affect in thoracic radiology: a visual grading analysis

    NASA Astrophysics Data System (ADS)

    Mearon, T.; Brennan, P. C.

    2006-03-01

    For decades, the antero-posterior (AP) projection of the thoracic spine has represented a substantial challenge. Patient thickness varies substantially along the cranio-caudal axis resulting in images that are too dark for the upper vertebrae and too light, or with excessive quantum mottle, towards the 9th to 12th thoracic vertebra. The anode heel affect is a well known phenomenon, however there is a paucity of reports demonstrating its exploitation in clinical departments for optimising images. The current work, using an adult, tissue-equivalent anthropomorphic phantom, explores if appropriate positioning ofthe anode can improve image quality for thoracic spine radiology. At each of 5 kVps (70, 81, 90, 102, 109) thirty AP thoracic spine images were produced, 15 with the anode end of the tube towards the cranial part of the phantom and 15 with the anode end of the tube facing caudally. Visual grading analysis of the resultant images demonstrated significant improvements in overall image quality and visualisation of specific anatomical features for the cranially facing anode compared with the alternative position, which were most pronounced for the 1st to 4th and 9th to 12th vertebrae. These improvements were evident at 70, 81 and 90 kVp, but not for the higher beam energies. The results demonstrate that correct positioning of the X-ray tube can improve image quality for thoracic radiology at specific tube potentials. Further work is ongoing to investigate whether this easy to implement and cost-free technique can be employed for other examinations.

  10. A clonal reciprocal t(2;7)(p13;p13) in plantar fibromatosis.

    PubMed

    Sawyer, Jeffrey R; Sammartino, Gael; Gokden, Neriman; Nicholas, Richard W

    2005-04-01

    Cytogenetic reports of plantar fibromatosis are rare, and to our knowledge no clonal reciprocal translocations have been reported in these lesions. Reciprocal chromosome translocations have been identified in a number of solid tumors and in some cases have helped identify genes involved in their pathogenesis. We report a case of plantar fibromatosis with the novel finding of a t(2;7)(p13;p13) balanced reciprocal translocation as the sole cytogenetic abnormality. PMID:15771907

  11. The tilt-up osteotomy for correction of intractable plantar keratoses.

    PubMed

    Berkun, R N; DeVincentis, A; Goller, W L

    1984-01-01

    The purpose of this paper is to describe and follow-up a new surgical technique used for the correction of intractable plantar keratoses. Twenty-five osteotomies were studied from 8 to 20 months postoperatively. The results showed a 60% success rate, but a patient satisfaction rate of 92%. The tilt-up osteotomy is a promising new procedure for the correction of intractable plantar keratoses. PMID:6699361

  12. The influence of a yacht's heeling stability on optimum sail design

    NASA Astrophysics Data System (ADS)

    Sneyd, A. D.; Sugimoto, T.

    1997-01-01

    This paper presents fundamental results concerning the optimum design of yacht sails and masts. The aerodynamics of a high aspect ratio sail in uniform flow is analysed using lifting line theory to maximise thrust for a given sail area. The novel feature of this work is that thrust is optimised subject to the constraint that the aerodynamic heeling moment generated by the sail is balanced by the righting moment due to hull buoyancy (and the weight of the keel). Initially, the heel angle is therefore unknown, and determined as part of the solution process. Under the assumption of small heel angle, the problem reduces to minimising a quadratic form in the Fourier coefficients for the circulation distribution along the mast, and a simple analytic solution can be derived. It is found that if the mast is too high, the upper section is unused, and as a consequence there is a theoretically ideal mast height for a yacht of given heeling stability. Under the constraints of given sail area and heeling equilibrium it is found that no advantage is to be gained by allowing reverse circulation near the top of the mast. Various implications for yacht performance are discussed.

  13. Quantification of tritium ``heels`` and isotope exchange mechanisms in La-Ni-Al tritides

    SciTech Connect

    Wermer, J.R.

    1992-07-27

    Formation of tritium heels in LANA (LaNi{sub 5-x}Al{sub x}) 0.30 (x=0.30) and 0.75 tritides was quantified; size of the heel is dependent on storage and processing conditions. Absorption-desorption cycling of the tritide beds mitigates formation of the tritium heel and can reduce its size. The higher pressure material LANA 0.30 showed slower heel formation than LANA 0.75; this allows more tritium to be removed at the maximum processing temperature. In plant application, LANA 0.30 beds are used as compressors; except during compressor operation, their aging will be very slow. Tritium heel removal by D exchange was demonstrated. Absorption-desorption cycling during an exchange cycle does not improve the exchange efficiency. Residual tritium can be removed to very low levels. For a tritide bed scheduled for removal from the process, a final tritium level can be estimated based on the number of D exchange cycles. 13 refs, 8 figs, 6 tabs.

  14. Oral sucrose for heel lance enhances adenosine triphosphate use in preterm neonates with respiratory distress

    PubMed Central

    Angeles, Danilyn M; Asmerom, Yayesh; Boskovic, Danilo S; Slater, Laurel; Bacot-Carter, Sharon; Bahjri, Khaled; Mukasa, Joseph; Holden, Megan; Fayard, Elba

    2015-01-01

    Objective: To examine the effects of oral sucrose on procedural pain, and on biochemical markers of adenosine triphosphate utilization and oxidative stress in preterm neonates with mild to moderate respiratory distress. Study design: Preterm neonates with a clinically required heel lance that met study criteria (n = 49) were randomized into three groups: (1) control (n = 24), (2) heel lance treated with placebo and non-nutritive sucking (n = 15) and (3) heel lance treated with sucrose and non-nutritive sucking (n = 10). Plasma markers of adenosine triphosphate degradation (hypoxanthine, xanthine and uric acid) and oxidative stress (allantoin) were measured before and after the heel lance. Pain was measured using the Premature Infant Pain Profile. Data were analyzed using repeated measures analysis of variance, chi-square and one-way analysis of variance. Results: We found that in preterm neonates who were intubated and/or were receiving ⩾30% FiO2, a single dose of oral sucrose given before a heel lance significantly increased markers of adenosine triphosphate use. Conclusion: We found that oral sucrose enhanced adenosine triphosphate use in neonates who were intubated and/or were receiving ⩾30% FiO2. Although oral sucrose decreased pain scores, our data suggest that it also increased energy use as evidenced by increased plasma markers of adenosine triphosphate utilization. These effects of sucrose, specifically the fructose component, on adenosine triphosphate metabolism warrant further investigation. PMID:26770807

  15. The effects of extracorporeal shock wave therapy on stroke patients with plantar fasciitis

    PubMed Central

    Kim, Tae Gon; Bae, Sea Hyun; Kim, Gye Yeop; Kim, Kyung Yoon

    2015-01-01

    [Purpose] The purpose of this research was to analyze the efficacy of extracorporeal shock wave therapy for the treatment of stroke patients with plantar fasciitis. [Subjects and Methods] This study included 10 stroke patients diagnosed with plantar fasciitis who were administered 3 sessions of extracorporeal shock wave therapy per week. After the last session, they performed stretching exercises for their Achilles tendon and plantar fascia for 30 min/day, 5 times a week for 6 months. The following parameters were measured and compared prior to therapy, 6 weeks after therapy, and 6 months after therapy: thickness of the plantar fascia, using an ultrasonic imaging system; degree of spasticity, using a muscle tension measuring instrument; degree of pain, using the visual analogue scale; and gait ability, using the Functional Gait Assessment. [Results] Decreased plantar fascia thickness, spasticity, and pain and increased gait ability were noted after therapy. These changes were significantly greater at 6 months after therapy than at 6 weeks after therapy. [Conclusion] These results indicated that extracorporeal shock wave therapy reduced tension in the plantar fascia, relieving pain and improving gait ability in stroke patients. PMID:25729207

  16. Reconstruction of Ankle and Heel Defects with Peroneal Artery Perforator-Based Pedicled Flaps

    PubMed Central

    Ahn, Deok Ki; Lew, Dae Hyun; Roh, Tai Suk

    2015-01-01

    Background The reconstruction of ankle and heel defects remains a significant problem for plastic surgeons. The following options exist for reconstructing such defects: local random flaps, reverse flow island flaps, and free flaps. However, each of these methods has certain drawbacks. Peroneal artery perforators have many advantages; in particular, they are predictable and reliable for ankle and heel reconstructions. In this study, we report our clinical experience with peroneal artery perforator-based pedicled flaps in ankle and heel reconstructions. Methods From July 2005 to October 2012, 12 patients underwent the reconstruction of soft tissue defects in the ankle and heel using a peroneal artery perforator-based pedicled flap. These 12 cases were classified according to the anatomical area involved. The cause of the wound, comorbidities, flap size, operative results, and complications were analyzed through retrospective chart review. Results The mean age of the patients was 52.4 years. The size of the flaps ranged from 5×4 to 20×8 cm2. The defects were classified into two groups based on whether they occurred in the Achilles tendon (n=9) or heel pad (n=3). In all 12 patients, complete flap survival was achieved without significant complications; however, two patients experienced minor wound dehiscence. Nevertheless, these wounds healed in response to subsequent debridement and conservative management. No patient had any functional deficits of the lower extremities. Conclusions Peroneal artery perforator-based pedicled flaps were found to be a useful option for the reconstruction of soft tissue defects of the ankle and heel. PMID:26430635

  17. EFFECT OF SECOND TOE-TO-HAND TRANSFER ON THE PLANTAR PRESSURE DISTRIBUTION OF THE DONOR FOOT

    PubMed Central

    Li, Bing; Chen, Da-wei; Yang, Yun-feng; Yu, Guang-rong

    2016-01-01

    ABSTRACT Objective: To investigate the effect of second toe-to-hand transfer on the plantar pressure distribution of the donor foot. Methods: Twelve normal fresh-frozen cadaveric foot specimens were subjected to an axial load of 600 N. An F-Scan plantar pressure analysis system was used to measure the forefoot plantar pressure. The testing was performed under the conditions of intact second toe, second toe removal with the second metatarsal head reserved, and second toe removal in combination with the distal one-third of the second metatarsal, respectively. Results: The peak pressure of the second metatarsal head was greater than other four forefoot plantar regions. There was no statistically significant change in the forefoot plantar pressure distribution after the second toe was removed (p > 0.05). When the second toe and the distal one-third of the second metatarsal were removed, the forefoot plantar pressure distribution changed significantly (p < 0.05). Conclusions: An intact second metatarsal is essential for the normal distribution of plantar pressure. Removal of the second toe with the second metatarsal head reserved had little influence on the plantar pressure distribution of the donor foot. Removal of the second toe and distal one-third of the second metatarsal resulted in abnormal plantar pressure distribution. Level of Evidence II, Experimental Study. PMID:26997913

  18. Anatomic Reconstruction Technique for a Plantar Calcaneonavicular (Spring) Ligament Tear.

    PubMed

    Palmanovich, Ezequiel; Shabat, Shay; Brin, Yaron S; Feldman, Viktor; Kish, Benny; Nyska, Meir

    2015-01-01

    Acquired flatfoot deformity in adults is usually due to partial or complete tearing of the posterior tibial tendon, with secondary failure of other structures such as the plantar calcaneonavicular (spring) ligament (SL), which maintain the medial longitudinal arch. In flexible cases, the tibialis posterior can be replaced with the flexor digitorum longus. It is common practice to suture the SL directly in the case of a tear; however, if the tear is complete, suturing directly to the ligament alone will not be possible. Reconstruction of the ligament is needed; however, no validated methods are available to reconstruct this ligament. The operative technique of SL reconstruction described in this report as a part of acquired flatfoot deformity reconstruction consists of augmenting remnants of the spring from the navicularis to the sustentaculum tali and suspending it to the medial malleolus using 2-mm-wide, long-chain polyethylene suture tape. This technique results in the firm anatomic reconstruction of the SL, in addition to "classic" medial arch reconstruction. We recommend SL reconstruction for medial arch reconstruction when the SL is torn. PMID:26253476

  19. The Role of Arch Compression and Metatarsophalangeal Joint Dynamics in Modulating Plantar Fascia Strain in Running.

    PubMed

    McDonald, Kirsty A; Stearne, Sarah M; Alderson, Jacqueline A; North, Ian; Pires, Neville J; Rubenson, Jonas

    2016-01-01

    Elastic energy returned from passive-elastic structures of the lower limb is fundamental in lowering the mechanical demand on muscles during running. The purpose of this study was to investigate the two length-modulating mechanisms of the plantar fascia, namely medial longitudinal arch compression and metatarsophalangeal joint (MPJ) excursion, and to determine how these mechanisms modulate strain, and thus elastic energy storage/return of the plantar fascia during running. Eighteen runners (9 forefoot and 9 rearfoot strike) performed three treadmill running trials; unrestricted shod, shod with restricted arch compression (via an orthotic-style insert), and barefoot. Three-dimensional motion capture and ground reaction force data were used to calculate lower limb kinematics and kinetics including MPJ angles, moments, powers and work. Estimates of plantar fascia strain due to arch compression and MPJ excursion were derived using a geometric model of the arch and a subject-specific musculoskeletal model of the plantar fascia, respectively. The plantar fascia exhibited a typical elastic stretch-shortening cycle with the majority of strain generated via arch compression. This strategy was similar in fore- and rear-foot strike runners. Restricting arch compression, and hence the elastic-spring function of the arch, was not compensated for by an increase in MPJ-derived strain. In the second half of stance the plantar fascia was found to transfer energy between the MPJ (energy absorption) and the arch (energy production during recoil). This previously unreported energy transfer mechanism reduces the strain required by the plantar fascia in generating useful positive mechanical work at the arch during running. PMID:27054319

  20. The Role of Arch Compression and Metatarsophalangeal Joint Dynamics in Modulating Plantar Fascia Strain in Running

    PubMed Central

    McDonald, Kirsty A.; Stearne, Sarah M.; Alderson, Jacqueline A.; North, Ian; Pires, Neville J.; Rubenson, Jonas

    2016-01-01

    Elastic energy returned from passive-elastic structures of the lower limb is fundamental in lowering the mechanical demand on muscles during running. The purpose of this study was to investigate the two length-modulating mechanisms of the plantar fascia, namely medial longitudinal arch compression and metatarsophalangeal joint (MPJ) excursion, and to determine how these mechanisms modulate strain, and thus elastic energy storage/return of the plantar fascia during running. Eighteen runners (9 forefoot and 9 rearfoot strike) performed three treadmill running trials; unrestricted shod, shod with restricted arch compression (via an orthotic-style insert), and barefoot. Three-dimensional motion capture and ground reaction force data were used to calculate lower limb kinematics and kinetics including MPJ angles, moments, powers and work. Estimates of plantar fascia strain due to arch compression and MPJ excursion were derived using a geometric model of the arch and a subject-specific musculoskeletal model of the plantar fascia, respectively. The plantar fascia exhibited a typical elastic stretch-shortening cycle with the majority of strain generated via arch compression. This strategy was similar in fore- and rear-foot strike runners. Restricting arch compression, and hence the elastic-spring function of the arch, was not compensated for by an increase in MPJ-derived strain. In the second half of stance the plantar fascia was found to transfer energy between the MPJ (energy absorption) and the arch (energy production during recoil). This previously unreported energy transfer mechanism reduces the strain required by the plantar fascia in generating useful positive mechanical work at the arch during running. PMID:27054319

  1. Effects of mat characteristics on plantar pressure patterns and perceived mat properties during landing in gymnastics.

    PubMed

    Pérez-Soriano, Pedro; Llana-Belloch, Salvador; Morey-Klapsing, Gaspar; Perez-Turpin, Jose Antonio; Cortell-Tormo, Juan Manuel; van den Tillaar, Roland

    2010-11-01

    Shock absorption and stability during landings is provided by both, gymnast ability and mat properties. The aims of this study were to determine the influence of different mat constructions on their energy absorption and stability capabilities, and to analyse how these properties affect gymnast's plantar pressures as well as subjective mat perception during landing. Six mats were tested using a standard mechanical drop test. In addition, plantar pressures and subjective perception during landing were obtained from 15 expert gymnasts. The different mats influenced plantar pressures and gymnasts' subjective perception during landing of gymnasts. Significant correlations between plantar pressures at the medial metatarsal and lateral metatarsal zones of the gymnasts' feet with the different shock absorption characteristics of the mats were found. However, subjective perception tests were not able to discriminate mat functionality between the six mats as no significant correlations between the mechanical mat properties with the subjective perception of these properties were found. This study demonstrated that plantar pressures are a useful tool for discriminating different landing mats. Using similar approaches, ideally including kinematics as well, could help us in our understanding about the influences of different mats upon gymnast-mat interaction. PMID:21309299

  2. Activation of spinal NF-КB mediates pain behavior induced by plantar incision

    PubMed Central

    Yang, Tao; Yang, Pei; Jiang, Liu-Ming; Zhou, Ri-Yong

    2015-01-01

    A growing body of evidence indicates that the activation of nuclear factor kappa B (NF-κB) pathway was involved in neuropathic and inflammatory pain, however, the role of NF-κB in incisional pain is still unclear. Therefore, in this study, we investigated whether the activation of NF-κB in the spinal cord is involved in pain hypersensitivity after a plantar incision in the rat hind paw. After rats received a plantar incision surgery, mechanical allodynia and thermal hyperalgesia were determined by von Frey filaments and radiant heat, respectively. Western blot was used to determineNF-κB activation at different time points after incision. The NF-κB inhibitor pyrrolidinedithiocarbamate (PDTC) was administered intrathecally 30 min before hind paw plantar incision to determine the role of NF-κB in incision-induced pain. Our results showed that the expression level of NF-κB was significantly increased in spinal cord dorsal horn from 30 min to 3 days after the incision. Intrathecal pretreatment of PDTC attenuated incision-induced mechanical allodynia and thermal hyperalgesia. Furthermore, PDTC significantly reduced the expression level of c-Fos in the dorsal horn after plantar incision. Taken together, plantar incision-induced pain behaviors can be prevented by the NF-κB inhibitor. Our results suggest that the blockage of the NF-КB signaling pathway might represent a valuable alternative for treating postoperative pain. PMID:26309571

  3. Osteogenic relationship between the lateral plantar process and the peroneal tubercle in the human calcaneus

    PubMed Central

    Gill, Corey M; Taneja, Atul K; Bredella, Miriam A; Torriani, Martin; DeSilva, Jeremy M

    2014-01-01

    The osteogenic relationship between the lateral plantar process and the peroneal tubercle has been an uncertainty for researchers over several decades. While some argue there to be no developmental relationship between these two calcaneal structures, others have suggested that there is an inverse relationship, the lateral plantar process forming from a part of the peroneal tubercle. However, no previous studies have offered quantitative measurements to test these hypotheses. In this study, we measured the size of the peroneal tubercle, retrotrochlear eminence, and the size and area of the lateral plantar process in 73 subjects using magnetic resonance imaging (MRI). Navicular height was measured using weight-bearing radiographs as a measurement of longitudinal arch in 35 of these subjects. Age, body mass, and body mass index (BMI) were also recorded for all subjects. We determined that there was a significant positive correlation between the lateral plantar process and size of the peroneal tubercle, body mass, and BMI. Thus, assertions that there is an inverse relationship between the size of the lateral plantar process and the peroneal tubercle are here unfounded. We also determined there to be a positive correlation between the peroneal tubercle and both the size of the retrotrochlear eminence and the height of the navicular. In conclusion, we relate these novel findings to hominin fossil calcanei and discuss the evolutionary and biomechanical implications. PMID:24188397

  4. Squamous cell carcinoma of the heel developing at site of previous frostbite.

    PubMed

    Rossis, C G; Yiacoumettis, A M; Elemenoglou, J

    1982-09-01

    Ten cases of squamous cell carcinoma of the heel previously affected by frostbite are reported. They had a similar natural history, location and histological appearance. All were treated by excision, and follow up over periods of 2-5 years has not revealed metastases. PMID:7120256

  5. Bilateral heel pain in a patient with Diamond-Blackfan anaemia.

    PubMed

    Charles, Loren T R; Mehdi, Adil M S; Baker, Dennis; Edwards, Max R

    2015-06-01

    A rare case of bilateral calcaneal stress fractures in a patient with Diamond-Blackfan anaemia is described. This has not been previously reported in the literature. A calcaneal stress fracture is an important differential diagnosis in a patient presenting with heel pain. Bilaterality of symptoms should not exclude this diagnosis and clinicians should be especially vigilant with predisposed patients. PMID:26004126

  6. Classification of gait quality for biofeedback to improve heel-to-toe gait.

    PubMed

    Vadnerkar, Abhishek; Figueiredo, Sabrina; Mayo, Nancy E; Kearney, Robert E

    2014-01-01

    A feature of healthy gait is a clearly defined heel strike upon initial contact of the foot with the ground. However, a common consequence of ageing is deterioration of the heel first nature of gait towards a shuffling gait (flat foot at contact). Physiotherapy can be effective in correcting this but is costly and labour intensive. Gait rehabilitation could be accelerated with home exercise, guided by a biofeedback device that distinguishes between heel first and shuffling gait. This paper describes an algorithm that distinguishes between heel-to-toe gait and shuffling gait on the basis of angular velocity of the foot, using an inertial measurement unit. Measurements were made of normal and abnormal gait and used to develop an algorithm that distinguishes between good and bad steps. Results demonstrate very good algorithm performance, with a classification accuracy at the accuracy-optimal threshold of 92.7% when compared with physiotherapist labels. The sensitivity and specificity at this threshold are 84.4% and 97.5% respectively. These performance metrics suggest that this algorithm is usable in a biofeedback device. PMID:25570776

  7. Feasibility of Quantitative Ultrasound Measurement of the Heel Bone in People with Intellectual Disabilities

    ERIC Educational Resources Information Center

    Mergler, S.; Lobker, B.; Evenhuis, H. M.; Penning, C.

    2010-01-01

    Low bone mineral density (BMD) and fractures are common in people with intellectual disabilities (ID). Reduced mobility in case of motor impairment and the use of anti-epileptic drugs contribute to the development of low BMD. Quantitative ultrasound (QUS) measurement of the heel bone is a non-invasive and radiation-free method for measuring bone…

  8. 46 CFR 174.055 - Calculation of wind heeling moment (Hm).

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... a result of heel must be included; (3) The projected area of a cluster of deck houses may be used instead of the projected area of each individual deck house in the cluster; and (4) The projected area of... Shape Cs. Cylindrical shapes 0.5 Hull (surface type) 1.0 Deckhouse 1.0 Cluster of deckhouses...

  9. 46 CFR 174.055 - Calculation of wind heeling moment (Hm).

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... a result of heel must be included; (3) The projected area of a cluster of deck houses may be used instead of the projected area of each individual deck house in the cluster; and (4) The projected area of... Shape Cs. Cylindrical shapes 0.5 Hull (surface type) 1.0 Deckhouse 1.0 Cluster of deckhouses...

  10. Feasibility of Quantitative Ultrasound Measurement of the Heel Bone in People with Intellectual Disabilities

    ERIC Educational Resources Information Center

    Mergler, S.; Lobker, B.; Evenhuis, H. M.; Penning, C.

    2010-01-01

    Low bone mineral density (BMD) and fractures are common in people with intellectual disabilities (ID). Reduced mobility in case of motor impairment and the use of anti-epileptic drugs contribute to the development of low BMD. Quantitative ultrasound (QUS) measurement of the heel bone is a non-invasive and radiation-free method for measuring bone

  11. Implementation guide for Hanford Tanks Initiative C-106 heel retrieval contract management HNF-2511

    SciTech Connect

    McDaniel, L.B.

    1998-04-17

    This report is an Implementation Guide for Hanford Tanks Initiative C-106 heel retrieval contract management HNF-2511 to provide a set of uniform instructions for managing the two contractors selected. The primary objective is to produce the necessary deliverables and services for the HTI project within schedule and budget.

  12. Bronchiolitis Obliterans Syndrome: The Achilles’ Heel of Lung Transplantation

    PubMed Central

    Weigt, S. Samuel; DerHovanessian, Ariss; Wallace, W. Dean; Lynch, Joseph P.; Belperio, John A.

    2016-01-01

    Lung transplantation is a therapeutic option for patients with end-stage pulmonary disorders. Unfortunately, chronic lung allograft dysfunction (CLAD), most commonly manifest as bronchiolitis obliterans syndrome (BOS), continues to be highly prevalent and is the major limitation to long-term survival. The pathogenesis of BOS is complex and involves alloimmune and nonalloimmune pathways. Clinically, BOS manifests as airway obstruction and dyspnea that are classically progressive and ultimately fatal; however, the course is highly variable, and distinguishable phenotypes may exist. There are few controlled studies assessing treatment efficacy, but only a minority of patients respond to current treatment modalities. Ultimately, preventive strategies may prove more effective at prolonging survival after lung transplantation, but their remains considerable debate and little data regarding the best strategies to prevent BOS. A better understanding of the risk factors and their relationship to the pathological mechanisms of chronic lung allograft rejection should lead to better pharmacological targets to prevent or treat this syndrome. PMID:23821508

  13. Biomechanical implications of the negative heel rocker sole shoe: gait kinematics and kinetics.

    PubMed

    Myers, K A; Long, J T; Klein, J P; Wertsch, J J; Janisse, D; Harris, G F

    2006-11-01

    Rocker sole shoes are commonly prescribed to diabetic patients with insensate feet. Recent passage of the therapeutic shoe bill has drawn an increased focus to prescription rehabilitative footwear. The purpose of this work is to investigate the dynamics of lower extremity joints (hip, knee and ankle) with the application of a negative heel rocker sole shoe under controlled lab conditions. Forty normal adults volunteered for gait evaluations using controlled baseline and prescription negative heel rocker sole shoes. Three-dimensional motion analysis techniques were used to acquire kinematic and kinetic data using a six-camera Vicon 370 motion system and two AMTI force plates. No significant change in walking speed or stride length was seen with the negative heel rocker shoe, although cadence was increased. The most significant kinematic changes with the application of the negative heel shoe occurred at the ankle in the sagittal plane with increased plantarflexion at terminal stance. Significant hip and knee changes were also noted with increased mid-stance hip extension and knee flexion. The most significant kinetic effects were seen in the transverse plane followed by changes in the sagittal and coronal planes. Changes in power were mostly noted in the sagittal plane. Other statistically significant changes in gait kinematics and kinetics were observed, although the magnitudes and durations were limited and as a result were not considered clinically significant. The study results indicated the negative heel rocker shoe significantly altered proximal joint metrics (hip and knee). The most significant distal joint alterations were seen in sagittal plane ankle kinetics. These kinematic and kinetic changes, along with previously studied effects of pressure relief at the metatarsal heads, should aid medical professionals in prescribing prophylactic footwear. PMID:16300949

  14. The influence of revised high-heeled shoes on foot pressure and center of pressure during standing in young women

    PubMed Central

    Bae, Young-Hyeon; Ko, Mansoo; Lee, Suk Min

    2015-01-01

    [Purpose] Revised high-heeled shoes were developed to minimize foot deformities by reducing excessive load on the forefoot during walking or standing in adult females, who frequently wear standard high-heeled shoes. Specifically, this study aimed to investigate the effects of revised high-heeled shoes on foot pressure distribution and center of pressure distance during standing in adult females. [Subjects and Methods] Twelve healthy adult females were recruited to participate in this study. Foot pressures were obtained under 3 conditions: barefoot, in revised high-heeled shoes, and in standard 7-cm high-heeled shoes. Foot pressure was measured using the Tekscan HR mat scan system. One-way repeated analysis of variance was used to compare the foot pressure distribution and center of pressure distance under these 3 conditions. [Results] The center of pressure distance between the two lower limbs and the fore-rear distribution of foot pressure were significantly different for the 3 conditions. [Conclusion] Our findings support the premise that wearing revised high-heeled shoes seems to provide enhanced physiologic standing posture compared to wearing standard high-heeled shoes. PMID:26834343

  15. Dislocation of the lateral cuneiform. Report of two cases: one with dorsal and one with plantar displacement.

    PubMed

    Papanikolaou, Athanassios; Maris, John; Arealis, George; Papadimitriou, George; Charalambidis, Charalambos

    2010-12-01

    We present two cases of lateral cuneiform dislocation, one dorsal and one plantar. Both were the result of high-energy trauma, accompanied by other injuries and were missed at initial examination. Open reduction and fixation with Steinmann pins were necessary. The midterm results were satisfactory, although the cuneiform that dislocated plantarly ended up in developed avascular necrosis. PMID:21047599

  16. THE RELATIONSHIP BETWEEN ISOTONIC PLANTAR FLEXOR ENDURANCE, NAVICULAR DROP, AND EXERCISE-RELATED LEG PAIN IN A COHORT OF COLLEGIATE CROSS-COUNTRY RUNNERS

    PubMed Central

    Reinking, Mark F.; Rauh, Mitchell J.

    2012-01-01

    Purpose: The purpose of this study was to examine the relationships between isotonic ankle plantar flexor endurance (PFE), foot pronation as measured by navicular drop, and exercise-related leg pain (ERLP). Background: Exercise-related leg pain is a common occurrence in competitive and recreational runners. The identification of factors contributing to the development of ERLP may help guide methods for the prevention and management of overuse injuries. Methods: Seventy-seven (44 males, 33 females) competitive runners from five collegiate cross-country (XC) teams consented to participate in the study. Isotonic ankle PFE and foot pronation were measured using the standing heel-rise and navicular drop (ND) tests, respectively. Demographic information, anthropometric measurements, and ERLP history were also recorded. Subjects were then prospectively tracked for occurrence of ERLP during the 2009 intercollegiate cross-country season. Multivariate logistic regression analysis was used to examine the relationships between isotonic ankle joint PFE and ND and the occurrence of ERLP. Results: While no significant differences were identified for isotonic ankle PFE between groups of collegiate XC runners with and without ERLP, runners with a ND >10 mm were almost 7 times (OR=6.6, 95% CI=1.2–38.0) more likely to incur medial ERLP than runners with ND <10 mm. Runners with a history of ERLP in the month previous to the start of the XC season were 12 times (OR=12.3, 95% CI=3.1–48.9) more likely to develop an in-season occurrence of ERLP. Conclusion: While PFE did not appear to be a risk factor in the development of ERLP in this group of collegiate XC runners, those with a ND greater than 10 mm may be at greater odds of incurring medial ERLP. Level of Evidence: 2b. PMID:22666641

  17. Changes in angular kinematics of the paretic lower limb at different orthotic angles of plantar flexion limitation of an ankle-foot-orthosis for stroke patients.

    PubMed

    Lee, Hye Young; Lee, Jeon Hyeong; Kim, Kyoung

    2015-03-01

    [Purpose] An ankle-foot-orthosis (AFO) is an assistive brace that allows stroke patients to achieve an independent gait. Therefore, we examined whether or not the orthotic angle for plantar flexion limitation affects the kinematic parameters of the hip and knee joints on the affected side of patients with stroke. [Subjects and Methods] Fifteen patients with chronic hemiplegia were recruited for this study. Kinematic three-dimensional data was acquired, while patients walked along a walkway wearing AFOs under five different conditions of 0°, 5°, 10°, 15°, and 20° of plantar stop limitation angle in the orthotic joint. Peak angles of the hip and knee joints on the affected side were analyzed. [Results] At the peak angle of the knee joint, statistically significant differences were found only at mid-stance in the sagittal plane and the horizontal plane. However, no significant differences were observed among any of the orthotic limitation angles in the frontal plane. [Conclusion] According to the results, an orthotic limitation angle of more than 10° elicits changes in the knee joint angle at mid-stance in the sagittal and horizontal planes. This study provided basic data on postural changes of patients with stroke. PMID:25931739

  18. Plantar cooling does not affect standing balance: A systematic review and meta-analysis.

    PubMed

    Hoch, Matthew C; Russell, Daniel M

    2016-01-01

    The purpose of this systematic review with meta-analysis was to critically appraise and synthesize the literature to determine if cooling the plantar surface of the foot is an effective method of inducing postural control alterations in healthy individuals. Specific variables that were evaluated within the meta-analysis included (1) the duration of the plantar cooling intervention, (2) the stance type during postural control assessment, and (3) the role of visual input. A computerized search of four electronic databases from inception to March 2015 was performed to identify studies which examined the effects of plantar cooling on postural control in healthy individuals. A critical appraisal of the methodological quality of the included studies was performed using an appraisal criteria instrument previously used for assessing biomechanics studies. The literature search yielded 88 references of which 7 were deemed relevant and included in the systematic review and meta-analysis. A single, overall random-effects model meta-analysis of all study variables were performed; as well as, separate meta-analyses for each study variable. Across the 7 studies, the overall effect was 0.028 (95% CI=-0.177, 0.234; p=0.78) indicating that cooling the plantar surface had a very small effect on postural control. Similar results were obtained when data were examined based on study quality, plantar cooling intervention duration, stance type during postural control assessment, and the presence of visual input. Therefore, cooling the plantar surface of the foot had a very weak, non-significant effect on standing balance despite the anesthetic effects identified in each study. PMID:26669944

  19. Plantar shear stress distributions in diabetic patients with and without neuropathy

    PubMed Central

    Yavuz, Metin

    2014-01-01

    Background The exact pathology of diabetic foot ulcers remains to be resolved. Evidence suggests that plantar shear forces play a major role in diabetic ulceration. Unfortunately, only a few manuscripts exist on the clinical implications of plantar shear. The purpose of this study was to compare global and regional peak plantar stress values in three groups; diabetic patients with neuropathy, diabetic patients without neuropathy and healthy control subjects. Methods Fourteen diabetic neuropathic patients, 14 non-neuropathic diabetic control and 11 non-diabetic control subjects were recruited. Subjects walked on a custom-built stress plate that quantified plantar pressures and shear. Four stress variables were analyzed; peak pressure, peak shear, peak pressure-time and shear-time integral. Findings Global peak values of peak shear (p=0.039), shear-time integral (p=0.002) and pressure-time integral (p=0.003) were significantly higher in the diabetic neuropathic group. Local peak shear stress and shear-time integral were also significantly higher in diabetic neuropathic patients compared to both control groups, in particular, at the hallux and central forefoot. Local peak pressure and pressure-time integral were significantly different between the three groups at the medial and lateral forefoot. Interpretation Plantar shear and shear-time integral magnitudes were elevated in diabetic patients with peripheral neuropathy, which indicates the potential clinical significance of these factors in ulceration. It is thought that further investigation of plantar shear would lead to a better understanding of ulceration pathomechanics, which in turn will assist researchers in developing more effective preventive devices and strategies. PMID:24332719

  20. Plantar plate tears: a review of the modified flexor tendon transfer repair for stabilization.

    PubMed

    Baravarian, Bob; Thompson, Jonathan; Nazarian, Doron

    2011-01-01

    Forefoot pain is one of the most common presenting problems in a foot and ankle practice. One of the most common presenting problems, yet most commonly missed problems, is a plantar plate tear. Often the problem is considered to be potential neuroma, fat pad atrophy, or a generalized diagnosis of metatarsalgia or metatarsal head overload. Unfortunately, not enough attention is placed on the plantar and medial/lateral ligamentous structures of the metatarsal-phalangeal joints. This lack of attention results in poor diagnosis, lack of care, treatment for the wrong condition, and ultimate frustration for the patients and doctor. PMID:21276518

  1. Plantar plate tear diagnosis using dual-energy computed tomography collagen material decomposition application.

    PubMed

    Stevens, Christopher J; Murphy, Darra T; Korzan, Jeffrey R; Nicolaou, Savvas; Munk, Peter L; Ouellette, Hugue

    2013-01-01

    Computed tomography (CT) scans of the feet are often obtained in the context of trauma or suspected stress fracture mainly for assessment of osseous pathology. However, compared with magnetic resonance imaging (MRI), soft-tissue assessment on CT is typically limited. Plantar plate injury is a common cause of metatarsalgia and, along with other soft-tissue injuries, is typically diagnosed with MRI. We present a case of plantar plate tear detected on dual-energy CT scan using a collagen material decomposition algorithm confirmed on subsequent MRI. PMID:23674026

  2. [Mobile phone platform for wireless monitoring of human dynamic plantar pressure].

    PubMed

    Wang, Hao; Han, Meng; Liu, Jing

    2010-11-01

    This paper constructed a plantar pressure sensing system based on Bluetooth communication of mobile phone with embedded Windows Mobile system. With the MCU (Microprocessor Control Unit) and Bluetooth module, the pressure sensor and the data acquisition circuit was designed and integrated, with software developed under Visual Studio 2008 environment. The real-time monitoring of human dynamic plantar pressure signal, and transferring, displaying and storing the recorded data on a mobile phone were achieved. This method offers an important measure to acquire human gait information via a pervasive and low cost way. PMID:21360974

  3. EM-31 RETRIEVAL KNOWLEDGE CENTER MEETING REPORT: MOBILIZE AND DISLODGE TANK WASTE HEELS

    SciTech Connect

    Fellinger, A.

    2010-02-16

    The Retrieval Knowledge Center sponsored a meeting in June 2009 to review challenges and gaps to retrieval of tank waste heels. The facilitated meeting was held at the Savannah River Research Campus with personnel broadly representing tank waste retrieval knowledge at Hanford, Savannah River, Idaho, and Oak Ridge. This document captures the results of this meeting. In summary, it was agreed that the challenges to retrieval of tank waste heels fell into two broad categories: (1) mechanical heel waste retrieval methodologies and equipment and (2) understanding and manipulating the heel waste (physical, radiological, and chemical characteristics) to support retrieval options and subsequent processing. Recent successes and lessons from deployments of the Sand and Salt Mantis vehicles as well as retrieval of C-Area tanks at Hanford were reviewed. Suggestions to address existing retrieval approaches that utilize a limited set of tools and techniques are included in this report. The meeting found that there had been very little effort to improve or integrate the multiple proven or new techniques and tools available into a menu of available methods for rapid insertion into baselines. It is recommended that focused developmental efforts continue in the two areas underway (low-level mixing evaluation and pumping slurries with large solid materials) and that projects to demonstrate new/improved tools be launched to outfit tank farm operators with the needed tools to complete tank heel retrievals effectively and efficiently. This document describes the results of a meeting held on June 3, 2009 at the Savannah River Site in South Carolina to identify technology gaps and potential technology solutions to retrieving high-level waste (HLW) heels from waste tanks within the complex of sites run by the U. S. Department of Energy (DOE). The meeting brought together personnel with extensive tank waste retrieval knowledge from DOE's four major waste sites - Hanford, Savannah River, Idaho, and Oak Ridge. The meeting was arranged by the Retrieval Knowledge Center (RKC), which is a technology development project sponsored by the Office of Technology Innovation & Development - formerly the Office of Engineering and Technology - within the DOE Office of Environmental Management (EM).

  4. High-heeled shoes and musculoskeletal injuries: a narrative systematic review

    PubMed Central

    Barnish, Maxwell S; Barnish, Jean

    2016-01-01

    Objectives To conduct the first systematic review from an epidemiological perspective regarding the association between high-heeled shoe wear and hallux valgus, musculoskeletal pain, osteoarthritis (OA) and both first-party and second-party injury in human participants without prior musculoskeletal conditions. Setting A systematic review of international peer-reviewed scientific literature across seven major languages. Data sources Searches were conducted on seven major bibliographic databases in July 2015 to initially identify all scholarly articles on high-heeled shoes. Supplementary manual searches were conducted. Titles, abstracts and full-text articles were sequentially screened to identify all articles assessing epidemiological evidence regarding the association between high-heeled shoe wear and hallux valgus, musculoskeletal pain, OA and both first-party and second-party injury in human participants without prior musculoskeletal conditions. Standardised data extraction and quality assessment (Threats to Validity tool) were conducted. Primary and secondary outcome measures Musculoskeletal pain or OA as assessed by clinical diagnosis or clinical assessment tool. First-party or second-party injury. Results 644 unique records were identified, 56 full-text articles were screened and 18 studies included in the review. Four studies assessed the relationship with hallux valgus and three found a significant association. Two studies assessed the association with OA and neither found a significant association. Five studies assessed the association with musculoskeletal pain and three found a significant association. Eight studies assessed first-party injury and seven found evidence of a significant injury toll associated with high-heeled shoes. One study provided data on second-party injury and the injury toll was low. Conclusions High-heeled shoes were shown to be associated with hallux valgus, musculoskeletal pain and first-party injury. No conclusive evidence regarding OA and second-party injury was found. Societal and clinical relevance of these findings is discussed. Concern is expressed about the expectation to wear high-heeled shoes in some work and social situations and access by children. PMID:26769789

  5. The Effects of Wearing High Heels while Pressing a Car Accelerator Pedal on Lower Extremity Muscle Activation.

    PubMed

    Jung, Jaemin; Lee, Sang-Yeol

    2014-11-01

    [Purpose] The purpose of this study was to determine the effects of wearing high heels while driving on lower extremity muscle activation. [Subjects] The subjects of this experimental study were 14 healthy women in their 20s who normally wear shoes with high heels. [Methods] The subjects were asked to place their shoes on an accelerator pedal with the heel touching the floor and then asked to press the pedal with as much pressure as possible for 3 seconds before removing their feet from the pedal. A total of 3 measurements were taken for each heel height (flat, 5 cm, 7 cm), and the heel height was randomly selected. [Results] The levels of muscle activity, indicated as the percentage of reference voluntary contraction, for gastrocnemius muscle in the flat, 5 cm, and 7 cm shoes were 180.8±61.8%, 285.4±122.3%, and 366.2±193.7%, respectively, and there were significant differences between groups. Those for the soleus muscle were 477.3±209.2%, 718.8±380.5%, and 882.4±509.9%, and there were significant differences between groups. [Conclusion] To summarize the results of this study, it was found that female drivers require greater lower extremity muscle activation when wearing high heels than when wearing low heels. Furthermore, instability and muscle fatigue of the ankle joint, which results from wearing high heels on a daily basis, could also occur while driving. PMID:25435684

  6. The Effects of Wearing High Heels while Pressing a Car Accelerator Pedal on Lower Extremity Muscle Activation

    PubMed Central

    Jung, Jaemin; Lee, Sang-yeol

    2014-01-01

    [Purpose] The purpose of this study was to determine the effects of wearing high heels while driving on lower extremity muscle activation. [Subjects] The subjects of this experimental study were 14 healthy women in their 20s who normally wear shoes with high heels. [Methods] The subjects were asked to place their shoes on an accelerator pedal with the heel touching the floor and then asked to press the pedal with as much pressure as possible for 3 seconds before removing their feet from the pedal. A total of 3 measurements were taken for each heel height (flat, 5 cm, 7 cm), and the heel height was randomly selected. [Results] The levels of muscle activity, indicated as the percentage of reference voluntary contraction, for gastrocnemius muscle in the flat, 5 cm, and 7 cm shoes were 180.8±61.8%, 285.4±122.3%, and 366.2±193.7%, respectively, and there were significant differences between groups. Those for the soleus muscle were 477.3±209.2%, 718.8±380.5%, and 882.4±509.9%, and there were significant differences between groups. [Conclusion] To summarize the results of this study, it was found that female drivers require greater lower extremity muscle activation when wearing high heels than when wearing low heels. Furthermore, instability and muscle fatigue of the ankle joint, which results from wearing high heels on a daily basis, could also occur while driving. PMID:25435684

  7. The Effect of an In-shoe Orthotic Heel Lift on Loading of the Achilles Tendon During Shod Walking.

    PubMed

    Wulf, Mathias; Wearing, Scott C; Hooper, Sue L; Bartold, Simon; Reed, Lloyd; Brauner, Torsten

    2016-02-01

    Study Design Controlled laboratory study. Background Orthotic heel lifts are thought to lower tension in the Achilles tendon, but evidence for this effect is equivocal. Objective To investigate the effect of a 12-mm, in-shoe orthotic heel lift on Achilles tendon loading during shod walking using transmission-mode ultrasonography. Methods The propagation speed of ultrasound, which is governed by the elastic modulus and density of tendon and proportional to the tensile load to which it is exposed, was measured in the right Achilles tendon of 12 recreationally active men during shod treadmill walking at matched speeds (3.4 ± 0.7 km/h), with and without addition of a heel lift. Vertical ground reaction force and spatiotemporal gait parameters were simultaneously recorded. Data were acquired at 100 Hz during 10 seconds of steady-state walking. Statistical comparisons were made using paired t tests (α = .05). Results Ultrasound transmission speed in the Achilles tendon was characterized by 2 maxima (P1, P2) and minima (M1, M2) during walking. Addition of a heel lift to footwear resulted in a 2% increase and 2% decrease in the first vertical ground reaction force peak and the local minimum, respectively (P<.05). Ultrasonic velocity in the Achilles tendon (P1, P2, M2) was significantly lower with the addition of an orthotic heel lift (P<.05). Conclusion Peak ultrasound transmission speed in the Achilles tendon was lower with the addition of a 12-mm orthotic heel lift, indicating that the heel lift reduced tensile load in the Achilles tendon, thereby counteracting the effect of footwear observed in previous studies. These findings support the addition of orthotic heel lifts to footwear in the rehabilitation of Achilles tendon disorders where management aims to lower tension within the tendon. J Orthop Sports Phys Ther 2016;46(2):79-86. Epub 11 Jan 2016. doi:10.2519/jospt.2016.6030. PMID:26755409

  8. Effects of shoe sole hardness on plantar pressure and comfort in older people with forefoot pain.

    PubMed

    Lane, Tamara J; Landorf, Karl B; Bonanno, Daniel R; Raspovic, Anita; Menz, Hylton B

    2014-01-01

    Plantar forefoot pain is common in older people and is related to increased peak pressures under the foot during gait. Variations in the hardness of the shoe sole may therefore influence both the magnitude of loading under the foot and the perceived comfort of the shoe in this population. The aim of this investigation was to determine the effect of varying shoe sole hardness on plantar pressures and comfort in older people with forefoot pain. In-shoe plantar pressures under the forefoot, midfoot and rearfoot were recorded from 35 older people (mean age 73.2, SD 4.5 years) with current or previous forefoot pain using the pedar-X(®) system. Participants walked at their normal comfortable speed along an 8m walkway in shoes with three different levels of sole hardness: soft (Shore A25), medium (Shore A40) and hard (Shore A58). Shoe comfort was measured on a 100mm visual analogue scale. There were statistically significant differences in peak pressure of between 5% and 23% across the forefoot, midfoot and rearfoot (p<0.01). The hard-soled shoe registered the highest peak pressures and the soft-soled shoe the lowest peak pressures. However, no differences in comfort scores across the three shoe conditions were observed. These findings demonstrate that as shoe sole hardness increases, plantar pressure increases, however this does not appear to have a significant effect on shoe comfort. PMID:23968972

  9. Plantar flexor neuromuscular adjustments following match-play football in hot and cool conditions.

    PubMed

    Girard, O; Nybo, L; Mohr, M; Racinais, S

    2015-06-01

    We assessed neuromuscular fatigue and recovery of the plantar flexors after playing football with or without severe heat stress. Neuromuscular characteristics of the plantar flexors were assessed in 17 male players at baseline and ∼30 min, 24, and 48 h after two 90-min football matches in temperate (∼20 °C and 55% rH) and hot (∼43 °C and 20% rH) environments. Measurements included maximal voluntary strength, muscle activation, twitch contractile properties, and rate of torque development and soleus EMG (i.e., root mean square activity) rise from 0 to 30, -50, -100, and -200 ms during maximal isometric contractions for plantar flexors. Voluntary activation and peak twitch torque were equally reduced (-1.5% and -16.5%, respectively; P < 0.05) post-matches relative to baseline in both conditions, the latter persisting for at least 48 h, whereas strength losses (∼5%) were not significant. Absolute explosive force production declined (P < 0.05) 30 ms after contraction onset independently of condition, with no change at any other epochs. Globally, normalized rate of force development and soleus EMG activity rise values remained unchanged. In football, match-induced alterations in maximal and rapid torque production capacities of the plantar flexors are moderate and do not differ after competing in temperate and hot environments. PMID:25943666

  10. Reliability of in-Shoe Plantar Pressure Measurements in Rheumatoid Arthritis Patients

    ERIC Educational Resources Information Center

    Vidmar, Gaj; Novak, Primoz

    2009-01-01

    Plantar pressures measurement is a frequently used method in rehabilitation and related research. Metric characteristics of the F-Scan system have been assessed from different standpoints and in different patients, but not its reliability in rheumatoid arthritis patients. Therefore, our objective was to assess reliability of the F-Scan plantar…

  11. Palmar-plantar erythrodysesthesia associated with capecitabine chemotherapy: a case report

    PubMed Central

    Kigen, Gabriel; Busakhala, Naftali; Njiru, Evangeline; Chite, Fredrick; Loehrer, Patrick

    2015-01-01

    We report a case of a 62 year-old patient who developed Palmar-plantar erythrodysesthesia upon receiving four cycles of capacitabine-based chemotherapy. She was on post surgical adjuvant treatment for invasive well differentiated adenocarcinoma of the colon. The clinical and therapeutic aspects of this chemotherapeutic adverse effect are discussed. PMID:26523170

  12. Correlation of Foot Posture Index With Plantar Pressure and Radiographic Measurements in Pediatric Flatfoot

    PubMed Central

    Lee, Jung Su; Jeong, Jin Ook; Kwon, Na Yeon; Jeong, Sang Mi

    2015-01-01

    Objective To investigate the correlation between the Foot Posture Index (FPI) (including talar head palpation, curvature at the lateral malleoli, inversion/eversion of the calcaneus, talonavicular bulging, congruence of the medical longitudinal arch, and abduction/adduction of the forefoot on the rare foot), plantar pressure distribution, and pediatric flatfoot radiographic findings. Methods Nineteen children with flatfoot (age, 9.32±2.67 years) were included as the study group. Eight segments of plantar pressure were measured with the GaitView platform pressure pad and the FPI was measured in children. The four angles were measured on foot radiographs. We analyzed the correlation between the FPI, plantar pressure characteristics, and the radiographic angles in children with flatfoot. Results The ratio of hallux segment pressure and the second through fifth toe segment pressure was correlated with the FPI (r=0.385, p=0.017). The FPI was correlated with the lateral talo-first metatarsal angle (r=0.422, p=0.008) and calcaneal pitch (r=-0.411, p=0.01). Conclusion Our results show a correlation between the FPI and plantar pressure. The FPI and pediatric flatfoot radiography are useful tools to evaluate pediatric flatfoot. PMID:25750866

  13. In-Shoe Plantar Pressures and Ground Reaction Forces during Overweight Adults' Overground Walking

    ERIC Educational Resources Information Center

    de Castro, Marcelo P.; Abreu, Sofia C.; Sousa, Helena; Machado, Leandro; Santos, Rubim; Vilas-Boas, João Paulo

    2014-01-01

    Purpose: Because walking is highly recommended for prevention and treatment of obesity and some of its biomechanical aspects are not clearly understood for overweight people, we compared the absolute and normalized ground reaction forces (GRF), plantar pressures, and temporal parameters of normal-weight and overweight participants during…

  14. In-Shoe Plantar Pressures and Ground Reaction Forces during Overweight Adults' Overground Walking

    ERIC Educational Resources Information Center

    de Castro, Marcelo P.; Abreu, Sofia C.; Sousa, Helena; Machado, Leandro; Santos, Rubim; Vilas-Boas, Joo Paulo

    2014-01-01

    Purpose: Because walking is highly recommended for prevention and treatment of obesity and some of its biomechanical aspects are not clearly understood for overweight people, we compared the absolute and normalized ground reaction forces (GRF), plantar pressures, and temporal parameters of normal-weight and overweight participants during

  15. An overview of heel Marjolin's ulcers in the Orthopedic Department of Urmia University of Medical Sciences.

    PubMed

    Shahla, Ahmad

    2009-07-01

    Marjolin's ulcer is defined as a malignant, ulcerating neoplasm occurring in cicatricial tissues. The cancer is usually a well-differentiated squamous cell carcinoma. Wide resection is complicated with a recurrence rate of 20% to 50% and a metastasis rate of 54%. Therefore, we chose amputation as the modality of treatment for heel Marjolin's ulcers in Urmia and presented their results in this study.During the last 10 years in Urmia, nineteen cases of heel Marjolin's ulcers has been detected. About 47% were due to childhood burn. Malignancy was mainly squamous cell carcinoma. The mean latent period of malignant transformation was 11 years. All cases were treated with amputation, without any recurrence or metastasis in an average four-year follow-up period.The squamous cell carcinoma of Marjolin's ulcer has the worst prognosis in comparison with other squamous cell carcinomas and it requires an aggressive treatment. PMID:19566359

  16. The effects of isolation on the mechanics of the human heel pad.

    PubMed Central

    Aerts, P; Ker, R F; de Clercq, D; Ilsley, D W

    1996-01-01

    In previous studies on the mechanical properties of the human heel pad (Bennett & Ker, 1990; Aerts et al. 1995) the fat pad and part of the calcaneus was removed from amputated test specimens. The present study tested whether this procedure influences the mechanical behaviour of the sample. Intact amputated feet were therefore mounted on steel rods driven through the calcaneus and placed in a mechanical test situation (pendulum or servohydraulic material tester). The mechanical properties of the pad were determined for a series of experiments in which the pad was gradually freed from the foot in the way done by Bennett & Ker (1990) and Aerts et al. (1995). The results showed no observable differences in the mechanics of the pad by isolating it from the rest of the foot. Thus, in relation to human locomotion, the load-deformation relation of heel pads as described by Aerts et al. (1995) is the most appropriate to date. PMID:8621341

  17. Accelerations due to impact at heel strike using below-knee prosthesis.

    PubMed

    Van Jaarsveld, H W; Grootenboer, H J; De Vries, J

    1990-08-01

    The acceleration in the sagittal plane of the prosthetic tube at heel strike in normal walking was measured in five healthy amputees with their definitive below-knee prosthesis, every subject using six different prosthetic feet, wearing sport shoes as well as leather shoes. The experiments were carried out in the rehabilitation centre "Het Roessingh", Enschede, The Netherlands. Maximum accelerations were extracted from the acceleration-time-signal. Mean acceleration maxima of all subjects were calculated for each foot-shoe combination to eliminate the individual influence of the subjects. In the axial direction the maximal accelerations demonstrate a clear difference among the prosthetic feet and the shoes, while in dorsoventral (tangential) direction the inter-individual variation in the acceleration extremes dominates the difference between the types of footwear. In comparison with non-amputees the magnitude of the maximal axial acceleration at heel strike does not differ significantly. PMID:2235301

  18. Relationship between navicular drop and measuring position of maximal plantar flexion torque of the first and second-fifth metatarsophalangeal joints

    PubMed Central

    Saeki, Junya; Tojima, Michio; Torii, Suguru

    2015-01-01

    [Purpose] The purpose of this study was to determine the relationship between navicular drop and plantar flexion torque of the first and second-fifth metatarsophalangeal joints. [Subjects] Ten healthy young men participated in this study. [Methods] The Pearson product-moment correlation coefficient was calculated to determine the relationship between navicular drop and plantar flexion torque of the first and second-fifth metatarsophalangeal joints. [Results] Significant negative correlations were observed between navicular drop and plantar flexion torques in the lengthened position of the intrinsic toe plantar flexion muscles, but no correlations were found between navicular drop and plantar flexion torques in the neutral position of the ankle and metatarsophalangeal joints. Moreover, the intrinsic toe plantar flexion muscles were found to contribute to the formation of the medial longitudinal arch. [Conclusion] Navicular drop correlates with metatarsophalangeal joint muscle strength in plantar flexion where the intrinsic toe muscles are capable of exerting force. PMID:26180323

  19. Plantar Pressure Distribution Patterns During Gait in Diabetic Neuropathy Patients with a History of Foot Ulcers

    PubMed Central

    Bacarin, Tatiana Almeida; Sacco, Isabel C. N.; Hennig, Ewald M.

    2009-01-01

    OBJECTIVE: To investigate and compare the influence of a previous history of foot ulcers on plantar pressure variables during gait of patients with diabetic neuropathy. INTRODUCTION: Foot ulcers may be an indicator of worsening diabetic neuropathy. However, the behavior of plantar pressure patterns over time and during the progression of neuropathy, especially in patients who have a clinical history of foot ulcers, is still unclear. METHODS: Subjects were divided into the following groups: control group, 20 subjects; diabetic neuropathy patients without foot ulcers, 17 subjects; and diabetic neuropathy patients with at least one healed foot ulcer within the last year, 10 subjects. Plantar pressure distribution was recorded during barefoot gait using the Pedar-X system. RESULTS: Neuropathic subjects from both the diabetic neuropathy and DNU groups showed higher plantar pressure than control subjects. At midfoot, the peak pressure was significantly different among all groups: control group (139.4±76.4 kPa), diabetic neuropathy (205.3±118.6 kPa) and DNU (290.7±151.5 kPa) (p=0.008). The pressure-time integral was significantly higher in the ulcerated neuropathic groups at midfoot (CG: 37.3±11.4 kPa.s; DN: 43.3±9.1 kPa.s; DNU: 68.7±36.5 kPa.s; p=0.002) and rearfoot (CG: 83.3±21.2 kPa.s; DN: 94.9±29.4 kPa.s; DNU: 102.5±37.9 kPa.s; p=0.048). CONCLUSION: A history of foot ulcers in the clinical history of diabetic neuropathy subjects influenced plantar pressure distribution, resulting in an increased load under the midfoot and rearfoot and an increase in the variability of plantar pressure during barefoot gait. The progression of diabetic neuropathy was not found to influence plantar pressure distribution. PMID:19219316

  20. Force distribution across the heel of the hand during simulated manual chest compression.

    PubMed

    Baubin, M; Kollmitzer, J; Pomaroli, A; Kraincuk, P; Kranzl, A; Sumann, G; Wiesinger, G F; Gilly, H

    1997-11-01

    According to most published guidelines of cardiopulmonary resuscitation chest compression is performed on the lower half of the sternum by compressing the sternum with the heel of one hand and the other hand on top of the first. In all guidelines and during CPR training great importance is attributed to exact localisation of the so-called compression point. In a laboratory investigation we assessed the force distribution across the heel of the hand and defined the total breadth in contact with the sternum. In order to find out whether there is any difference in the force pattern with the right or the left hand in direct contact with the sternum we determined the resultant maximal force of that part of the heel of the hand exerting the maximal force. A total of 12 anaesthetists performed simulated chest compressions onto a flat surface covered with an integrated force sensor mat. The distance between the most ulnar part and the most radial part of the hand was determined to be 9.2 cm. Similar mean total forces were measured (right hand in contact: 644 N; left hand in contact: 621 N). In all except one anaesthetist the hypothenar part of the heel exerted a significantly higher force compared to the thenar part, independent of whether the right hand or the left hand was in contact. The distance between points of maximal force when the right hand or when the left hand in contact was 2.2 cm corresponding to the breadth of one and a half fingers. To reduce the potential risk of sternal fractures by chest compressions applied too far in a cephalad direction, we recommend use of the right hand in contact if the rescuer kneels at the right side of the patient and vice versa. PMID:10203407

  1. Project W-320 Heel Jet Secondary Catch Mechanism lateral load test

    SciTech Connect

    Bellomy, J.R.

    1994-09-01

    This test procedure establishes the requirements for performing a lateral load test of the Heel Jet Secondary Catch Mechanism (SCM). Successful performance of this test will demonstrate that the SCM is capable of performing as designed when subjected to a force applied normal to the longitudinal axis of the mechanism. This test procedure is prepared following the recommended format and content guidelines for test procedures as prescribed in WHC-IP-1026, Engineering Practice Guidelines, Appendix K, Test Plans, Specifications, Procedures and Reports.

  2. A Retrospective Quality Improvement Study Comparing Use Versus Nonuse of a Padded Heel Dressing to Offload Heel Ulcers of Different Etiologies.

    PubMed

    Campbell, Noreen A; Campbell, Donna L; Turner, Andrea

    2015-11-01

    Offloading heel ulcers is a challenging task because strategies deemed to be most optimal from a medical perspective may be unacceptable to patients. Observed adverse dressing events and problems with offloading devices led to a pilot study and subsequent change in practice at the authors' Foot and Leg Ulcer Clinic. Starting in 2004, patients requiring offloading received a nonremovable padded heel dressing (PHD) that was changed twice a week by the visiting nurse. A retrospective quality improvement review was conducted to compare outcomes, nursing visits, and nursing visit costs for 40 consecutive patients with heel ulcers treated at this clinic with a nonremovable PHD (n = 20) or without a PHD (n = 20) between January 20, 2001 and December 31, 2006. Patient demographic data, relevant comorbidities, wound depth, weeks of care, adverse events, and treatment-related narrative comments were abstracted from patient records. Relevant comorbidities were similar in both groups. The PHD group was younger (average age of 74.6 [range 35-91] years) compared to PHD nonuse group (average age 79.5 [range 25-95] years; P less than 0.04). The PHD group required fewer total weeks of care compared to the nonuse group (368 versus 527 weeks, respectively; P less than 0.001), and average duration of clinic treatment in the PHD group was 18.40 (range 5-51) weeks versus 40.54 (range 6-88) weeks in the nonuse group. The PHD group had fewer total nursing visits (736 versus 1,581, P less than 0.001); the average number of nursing visits for the PHD was 36.80 (range 10-102) compared to 121.61 (range 18-264) for the nonuse group. Nursing visit costs were lower for PHD users ($114,080 versus $245,055, P less than 0.001), and the cost-efficiency ratio was less than one third (1:3.3) of PHD nonuse for the average heel ulcer. All 20 patients in the PHD use group had wound closure compared with the PHD nonuse group, in which 13 out of 20 wounds closed, 3 amputations were performed, and 4 patients were lost to review (P less than 0.000). No adverse events were reported in the records of the PHD use group; the PHD nonuse group reported periwound maceration, skin stripping, pressure injury, and sensitivity. Patient and nurse feedback identified pain relief, improved mobility, easy technique, low cost, and reduced workload as benefits of PHD. The results of this quality improvement review warrant a prospective clinical study to examine the efficacy, effectiveness, and cost-effectiveness of PHD for the care of patients with heel ulcers. PMID:26544017

  3. Influence of shoes and heel strike on the loading of the hip joint.

    PubMed

    Bergmann, G; Kniggendorf, H; Graichen, F; Rohlmann, A

    1995-07-01

    The forces and moments acting at the hip joint influence the long-term stability of the fixation of endoprostheses and the course of coxarthrosis. These loads may depend on the kind of footwear and the walking or running style. These factors were investigated in a patient with instrumented hip implants. He wore different sports shoes, normal leather shoes, hiking boots and clogs and walked barefoot with soft, normal and hard heel strikes. The loads were lowest while walking and jogging without shoes. All shoes increased the joint force and the bending moment at the implant slightly but the torsional moment rose by up to 50%. No relation was found between the different type of shoes and the load increase, only shoes with very hard soles were clearly disadvantageous. Soft heels, soles or insoles did not offer advantages. Gait stability seems to play the most important role in increasing the joint loading and should be the criterion for the choice of footwear. Smooth gait patterns with soft heel strikes are the only means to reduce joint loading during slow jogging. PMID:7657680

  4. Plantar shear stress distributions: Comparing actual and predicted frictional forces at the foot-ground interface

    PubMed Central

    Yavuz, Metin; Botek, Georgeanne; Davis, Brian L.

    2007-01-01

    Plantar shear stresses are believed to play a major role in diabetic ulceration. Due to the lack of commercial devices that can measure plantar shear distribution, a number of mathematical models have been developed to predict plantar frictional forces. This study assessed the accuracy of these models using a custom built platform capable of measuring plantar stresses simultaneously. A total of 48 (38 healthy and 10 diabetic) human subjects (75 ± 20kg, 41 ± 20 yrs, 32 male, 16 female) were recruited in the study. Plantar force data were collected for 2 seconds at 50Hz. Two models (M1 and M2) reported in the literature by different groups were used to predict local shear stresses. Root mean squared errors (RMSE) were calculated to compare model data with the actual data, focusing on three parameters: location, magnitude and timing of peak shear components. RMSE values of estimated peak AP and ML shear locations were 3.1 cm and 2.2 cm for M1 and 3.1 cm and 2.1 cm for M2, respectively. Magnitude RMS error values for M1 were found to be 86.6 kPa in AP shear and 38.5 kPa in ML shear, whereas these values were determined to be 97.8 kPa and 63.5 kPa respectively by M2. Time to peak shear RMSE values averaged 17.2% in terms of the gait duration. In conclusion, shear models that were evaluated in this study performed variously depending on the shear parameter. PMID:17449038

  5. Debridement of painful forefoot plantar callosities in rheumatoid arthritis: the CARROT randomised controlled trial.

    PubMed

    Siddle, Heidi J; Redmond, Anthony C; Waxman, Robin; Dagg, Abigail R; Alcacer-Pitarch, Begonya; Wilkins, Richard A; Helliwell, Philip S

    2013-05-01

    The objective of this study was to evaluate the long-term benefits of sharp scalpel debridement of painful forefoot plantar callosities in rheumatoid arthritis (RA). The null hypothesis: sharp scalpel debridement would offer no additional long-term advantage in terms of pain and function. Sixty-five people with RA were randomised to receive regular sharp scalpel debridement of painful forefoot plantar callosities in conjunction with a combined therapeutic approach or a combined therapeutic approach alone. The primary outcome measure was change at 18 months in participant-reported forefoot plantar pain measured by a 100-mm visual analogue scale (VAS). Secondary outcome measures were recorded at baseline and study exit and included revised Foot Function Index, Health Assessment Questionnaire, Foot Impact Scale and gait parameters. At 18 months, there were no differences between groups for the primary outcome VAS-measured forefoot plantar pain (left foot (F = 0.23, p = 0.635), right foot (F = 2.14, p = 0.148)). Within-group changes were highly significant (treatment arm, difference = 16.9 (95 % confidence interval (CI) 9.4, 24.4), t = 4.6, p < 0.0001; control arm, difference = 17.5 (95 % CI 9.4, 25.5), t = 4.4, p < 0.0001). There was little change in scores of overall function and foot impact in either group and there were no significant changes in gait parameters noted. The long-term effects of sharp scalpel debridement of painful forefoot plantar callosities in people with RA, when used in conjunction with a combined therapeutic approach, produced no additional benefit over the combined therapeutic approach alone. Trial registration http://www.controlled-trials.com/ISRCTN05190231. PMID:23247552

  6. Methods for heel retrieval for tanks C-101, C-102, and C-111 at the Hanford Site

    SciTech Connect

    Sams, Terry L.; Kirch, N. W.; Reynolds, Jacob G.

    2013-01-11

    The purpose of this paper is to evaluate the prospects of using bulk waste characteristics to determine the most appropriate heel retrieval technology. If the properties of hard to remove heels can be determined before bulk retrieval, then a heel retrieval technology can be selected before bulk retrieval is complete. This would save substantially on sampling costs and would allow the deployment of the heel retrieval technology immediately after bulk retrieval. The latter would also accelerate the heel removal schedule. A number of C-farm retrievals have been fully or partially completed at the time of this writing. Thus, there is already substantial information on the success of different technologies and the composition of the heels. There is also substantial information on the waste types in each tank based on historical records. Therefore, this study will correlate the performance of technologies used so far and compare them to the known waste types in the tanks. This will be used to estimate the performance of future C Farm heel retrievals. An initial decision tree is developed and employed on tanks C-101, C-102, and C 111. An assumption of this study is that no additional characterization information would be available, before or after retrieval. Note that collecting additional information would substantially increase the probability of success. Deploying some in-situ testing technologies, such as a water lance or an in-situ Raman probe, might substantially increase the probability of successfully selecting the process conditions without having to take samples from the tanks for laboratory analysis.

  7. Methods for Heel Retrieval for Tanks C-101, C-102, and C-111 at the Hanford Site - 13064

    SciTech Connect

    Sams, T.L.; Kirch, N.W.; Reynolds, J.H.

    2013-07-01

    The purpose of this paper is to evaluate the prospects of using bulk waste characteristics to determine the most appropriate heel retrieval technology. If the properties of hard to remove heels can be determined before bulk retrieval, then a heel retrieval technology can be selected before bulk retrieval is complete. This would save substantially on sampling costs and would allow the deployment of the heel retrieval technology immediately after bulk retrieval. The latter would also accelerate the heel removal schedule. A number of C-farm retrievals have been fully or partially completed at the time of this writing. Thus, there is already substantial information on the success of different technologies and the composition of the heels. There is also substantial information on the waste types in each tank based on historical records. Therefore, this study will correlate the performance of technologies used so far and compare them to the known waste types in the tanks. This will be used to estimate the performance of future C Farm heel retrievals. An initial decision tree is developed and employed on tanks C-101, C-102, and C 111. An assumption of this study is that no additional characterization information would be available, before or after retrieval. Note that collecting additional information would substantially increase the probability of success. Deploying some in-situ testing technologies, such as a water lance or an in-situ Raman probe, might substantially increase the probability of successfully selecting the process conditions without having to take samples from the tanks for laboratory analysis. (authors)

  8. Relationship between hamstring activation rate and heel contact velocity: Factors influencing age-related slip-induced falls

    PubMed Central

    Lockhart, Thurmon E.; Kim, Sukwon

    2010-01-01

    The purpose of this research was to determine whether a decreased hamstring activation rate among the elderly is responsible for a higher horizontal heel contact velocity and increased likelihood of slip-induced falls compared to their younger counterparts. Twenty-eight subjects from two age groups (14 young and 14 old) walked across a linear walking track with embedded force platforms while wearing a fall arresting harness attached to an overhead arresting rig for safety. In order to obtain realistic unexpected slip-induced fall data, a soapy vinyl floor surface was hidden from the subjects and unexpectedly introduced. Synchronized kinematics, kinetic and electromyography (EMG) analyses during the heel contact phase of the gait cycle while walking over slippery and non-slippery floor surfaces were examined in the study. Normalized EMG data were examined in terms of hamstring activation rate and evaluated with heel contact velocity and friction demand characteristic (as measured by peak required coefficient of friction (RCOF)) on the dry vinyl floor surface. Furthermore, slip parameters (i.e. slip distances and slipping velocity) were assessed on the soapy vinyl floor surface. The results indicated that younger adults’ hamstring activation rate was higher than older adults, whereas younger adults’ heel contact velocity was not different from older adults. These results suggested that heel contact velocity in younger adults was sufficiently reduced before the heel contact phase of the gait cycle. This could be due to the outcome of higher hamstring activation rate in younger adults in comparison to older adults. However, lower friction demand (peak RCOF), shorter slip distances, slower peak sliding heel velocity and more falls among older adults suggested that the slip initiation characteristics were not the only factors contributing to slip-induced falls among the elderly. PMID:16112575

  9. Plantar opening-wedge osteotomy of cuneiform bones combined with selective plantar release and dwyer osteotomy for pes cavovarus in children.

    PubMed

    Wicart, Philippe; Seringe, Raphael

    2006-01-01

    Neurological pes cavovarus is a challenging deformity to treat during childhood. Based on physiopathology, we propose the following original surgical procedure. Plantar-opening wedge osteotomy of the three cuneiform bones, preceded by selective plantar release, corrects forefoot pronation which is the primum movens of the deformity, and corrects the cavus at its apex. A calcaneal valgisation closing wedge osteotomy, is indicated if pre-operative planning revealed subtalar joint stiffness, incompatible with secondary hind foot realignment in valgus. The follow-up had to be at least 5 years or to reach skeletal maturity. Twenty-six children (36 feet) satisfied these criteria. Mean age at surgery was 10.3 years old. All the children had a neurological disease which was progressive for 65% of them (75% of the feet). Mean follow-up was 6.9 years. This treatment was effective, with a mean percentage of cavus correction of 74%, reaching 100% for 31% of the feet. Complete or partial cavus correction was still observed at last follow-up for 75% of the feet. At last follow-up, global result was satisfactory in 63.9% and non satisfactory in 36.1% of feet. Flat-foot was observed, of minor type, in only 2 cases. Apart from triple arthrodesis, iterative surgery relative to residual deformity (foot adduction, plantar sticking of the first metatarsal head) was indicated for 4 feet (11%). A triple arthrodesis was required in 12 cases (33%). In conclusion, this treatment provides mid-term satisfactory correction of the cavus and may allow avoiding triple arthrodesis at skeletal maturity. PMID:16439912

  10. Chronic pancreatitis

    MedlinePlus

    Chronic pancreatitis - chronic; Pancreatitis - chronic - discharge; Pancreatic insufficiency - chronic; Acute pancreatitis - chronic ... abuse over many years. Repeated episodes of acute pancreatitis can lead to chronic pancreatitis. Genetics may be ...

  11. The damping properties of the venous plexus of the heel region of the foot during simulated heelstrike.

    PubMed

    Weijers, René E; Kessels, Alphons G H; Kemerink, Gerrit J

    2005-12-01

    The damping mechanisms that are operational in the heel pad during the impact phase of locomotion have the important function to protect the musculo-skeletal system from injuries. How this is achieved is still not fully understood, as is for instance illustrated by the 'heel pad paradox', the observation that in vivo and in vitro experiments yielded widely different results. This paradox could so far only partially be explained. In the light of this paradox, and a previous study by our group, we conjectured that the venous plexus might contribute as a hydraulic shock absorber to the damping properties of the heel pad. To investigate this hypothesis in vivo, heel pads of 11 volunteers were subjected to pendulum impact tests, using velocities of 0.2, 0.4, and 0.6 m/s, and three physiologically different, consecutive conditions: (i) a relatively empty venous plexus, (ii) a congested venous plexus, and (iii) a decongested venous plexus. At congestion, the maximum impact force decreased slightly but significantly by 2.6% at 0.2 m/s and 1.8% at 0.4 m/s. This effect was no longer found at 0.6 m/s. Although these effects are rather small, they confirm the fundamental hypothesis that the venous plexus contributes to the damping properties of the heel pad during walking. It is likely that some underestimation of the effect has occurred. PMID:16214490

  12. Microsurgical medial plantar flap banking: a method of choice for digital tip injury?

    PubMed

    Nagase, T; Ohmori, K

    1998-11-01

    A tip injury of the left thumb was repaired via microsurgical medial plantar flap banking. The medial plantar flap was transferred temporarily to the lower abdominal wall and was anastomosed microsurgically to the deep inferior epigastric artery and vein as a banked flap. It was later grafted to the thumb in a manner similar to a pedicled flap. The flap was transferred successfully, and the tissue texture and bulk was sufficient, with considerable sensory recovery and minimal donor site deformity. This method may be worthwhile to consider as one of the options of digital tip reconstruction, and the concept of microsurgical flap banking may be promising in the field of reconstructive microsurgery. PMID:9827959

  13. Autogenous free dermal fat grafts in the surgical approach to plantar fibromatosis.

    PubMed

    Lauf, E; Freedman, B M; Steinberg, J S

    1998-01-01

    Plantar fibromatosis is a benign disorder of the foot in which there is fibrous tissue infiltration of the plantar aponeurosis and in some cases the overlying skin. Treatment is indicated for pain and functional gait disturbance. Even with wide fascial resection, recurrence with spreading, scarring, and continued discomfort can be a frustrating and difficult problem. Various techniques to lessen recurrence have included split-thickness skin grafting and Marlex mesh placement. However, these procedures have documented problems, including recurrence, foreign-body reaction, scarring, and inadequate soft-tissue coverage. The authors introduce dermal fat grafting following primary excision as a means to minimize recurrence while maintaining the anatomic architecture of the foot and preserving a soft, supple weightbearing surface with minimal scar tissue formation. PMID:9638549

  14. Surgical Treatment of a Case of Ledderhose's Disease: A Safe Plantar Approach to Subtotal Fasciectomy

    PubMed Central

    Souza, Bruno Gonçalves Schröder e; de Souza Júnior, Gilberto Zaquine; Rodrigues, Raíssa Mansilla Cabrera; Dias, Diogo Stelito Rezende; de Oliveira, Valdeci Manoel

    2015-01-01

    Plantar fibromatosis, Ledderhose's disease, or Morbus Ledderhose is an uncommon benign nodular hyperplasia of the plantar aponeurosis. The aim of this paper was to report the case of a 47-year-old male patient who had concomitant Dupuytren's disease and failed all conservative measures. He was treated surgically with prompt and complete relief of symptoms postoperatively, and he has had no recurrence at the 2-year follow-up. In this richly documented case, we discuss details of the surgical technique and anatomy, which was important for a successful outcome and preventing complications. The technique for subtotal fasciectomy is reviewed and the relevance of the adequate choice of skin incision to prevent painful scarring, skin necrosis, and difficulties with shoe wearing is highlighted. PMID:26783478

  15. Plantar Loading During Cutting While Wearing a Rigid Carbon Fiber Insert

    PubMed Central

    Queen, Robin M.; Abbey, Alicia N.; Verma, Ravi; Butler, Robert J.; Nunley, James A.

    2014-01-01

    Context Stress fractures are one of the most common injuries in sports, accounting for approximately 10% of all overuse injuries. Treatment of fifth metatarsal stress fractures involves both surgical and nonsurgical interventions. Fifth metatarsal stress fractures are difficult to treat because of the risks of delayed union, nonunion, and recurrent injuries. Most of these injuries occur during agility tasks, such as those performed in soccer, basketball, and lacrosse. Objective: To examine the effect of a rigid carbon graphite footplate on plantar loading during 2 agility tasks. Design:  Crossover study. Setting: Laboratory. Patients or Other Participants: A total of 19 recreational male athletes with no history of lower extremity injury in the past 6 months and no previous metatarsal stress fractures were tested. Main Outcome Measure(s):  Seven 45° side-cut and crossover-cut tasks were completed in a shoe with or without a full-length rigid carbon plate. Testing order between the shoe conditions and the 2 cutting tasks was randomized. Plantar-loading data were recorded using instrumented insoles. Peak pressure, maximum force, force-time integral, and contact area beneath the total foot, the medial and lateral midfoot, and the medial, middle, and lateral forefoot were analyzed. A series of paired t tests was used to examine differences between the footwear conditions (carbon graphite footplate, shod) for both cutting tasks independently (α = .05). Results: During the side-cut task, the footplate increased total foot and lateral midfoot peak pressures while decreasing contact area and lateral midfoot force-time integral. During the crossover-cut task, the footplate increased total foot and lateral midfoot peak pressure and lateral forefoot force-time integral while decreasing total and lateral forefoot contact area. Conclusions: Although a rigid carbon graphite footplate altered some aspects of the plantar-pressure profile during cutting in uninjured participants, it was ineffective in reducing plantar loading beneath the fifth metatarsal. PMID:24955620

  16. [Realization of a compact mobile phone based wireless plantar pressure monitoring system and application].

    PubMed

    Liu, Lin; Liu, Jing

    2012-05-01

    An improved compact mobile phone based wireless plantar pressure monitoring system and software are proposed based on former progress, which can collect pressure data by sensors and circuit board, transmit data through Bluetooth wirelessly, and display and calculate the data on the mobile terminal. Conceptual experiments carried out demonstrate the feasibility and accuracy of the new system The system is expected to be widely used in the future owing to its portability, ease of use, and cost-effectiveness PMID:22916468

  17. Recalibration of somesthetic plantar information in the control of undisturbed upright stance maintenance.

    PubMed

    Bernard-Demanze, L; Burdet, C; Berger, L; Rougier, P

    2004-12-01

    To assess the effects of changes in somesthetic plantar information on upright quiet stance, a rotary plantar massage was applied under the feet of healthy subjects for ten minutes. The controlling variable, the centre of pressure (CP) displacements, were recorded, before and after massage, through a force platform and decomposed into two elementary motions: the vertical projection of the centre of gravity (CG(v)) and the difference between the latter and the CP (CP-CG(v)) along medio-lateral ML and antero-posterior AP directions. These motions were processed through frequency analysis and modelled as fractional Brownian motion. For CP-CG(v) motions, the frequency analysis shows that massage under the plantar soles induces a decrease of the amplitudes along the ML direction suggesting reduced overall muscular activity (abductor-adductor muscles of the hip according to Winter et al.). A general trend is that the CG(v) amplitudes are also diminished after massage especially in the ML direction, indicating a better distribution of the body weight on the two supports. On the other hand, the effects tend to vanish after about 8 minutes. Conversely, when the massage was given under the toes, no particular effect on any elementary motion was observed, suggesting that the plantar mechanoreceptors under the toes necessitate stronger stimulation to respond significantly and/or that the greater sensitivity obtained was not used by the CNS. Overall, this data emphasises the fact that a recalibration of somesthetic cues may occur when enhanced afferent information is fed to the postural system. PMID:15657978

  18. Plantar fibromatosis: treatment of primary and recurrent lesions and factors associated with recurrence.

    PubMed

    Aluisio, F V; Mair, S D; Hall, R L

    1996-11-01

    Plantar fibromatosis is a benign but often problematic foot disorder which, when surgically treated, is difficult to eradicate. The purpose of this investigation was to identify epidemiologic factors associated with disease recurrence and to determine which method of treatment most successfully eliminated recurrence. A retrospective review of surgical pathology reports and clinical histories from 1979 to 1993 was performed to identify all patients who underwent surgery for plantar fibromatosis at our institution during that time. Thirty-three feet of 30 patients were identified with a minimum 2-year follow-up. Seventeen feet underwent surgery for primary lesions, and 4 of 10 that had local excision, 1 of 3 that had wide excision, and 2 of 4 that had subtotal fasciectomy (with or without skin grafting) had recurrence. All 16 feet in patients presenting with recurrent lesions had undergone prior local excision at other institutions. When combined with patients from our institution who underwent a second procedure, 21 feet had surgery for recurrent plantar fibromatosis. Of these, three of four had further recurrence when treated with local or wide excision. In feet with recurrences treated with subtotal fasciectomy, only 4 of 17 had recurrence after the first attempt at such treatment. Average follow-up for all patients was 7.7 years, and all patients with postoperative recurrences showed evidence of disease within 14 months after surgery (mean, 6.9 months). Factors identified with an increased risk for recurrence were multiple nodules, bilateral lesions, and positive family history. In treating recurrent disease, subtotal fasciectomy was more effective than local or wide excision. This study identified factors associated with a significant likelihood of postoperative recurrence in treating plantar fibromatosis and found subtotal fasciectomy to provide the most successful treatment in eradicating disease in recurrent cases. PMID:8946181

  19. Controlling Posture and Vergence Eye Movements in Quiet Stance: Effects of Thin Plantar Inserts

    PubMed Central

    Foisy, A.; Gaertner, C.; Matheron, E.; Kapoula, Z.

    2015-01-01

    The purpose of this study was to assess properties of vergence and saccade eye movements as well as posture in quiet stance, and the effects of thin plantar inserts upon postural and oculomotor control. The performances of 36 young healthy subjects were recorded by a force platform and an eye tracker in three testing conditions: without plantar stimulation, with a 3 millimetre-thick plantar insert, either a Medial or a Lateral Arch Support (MAS / LAS). The results showed a decrease of the Surface and Variance of Speed and a more posterior position of the CoP with either stimulation compared with the control condition. The fractal analysis showed a decrease with MAS. Wavelet analysis in the time-frequency domain revealed an increase in the Cancelling Time of the low frequency band with MAS. These results suggest a better stability for a lower energy cost. Concerning eye movements, the inserts influenced only vergence (not saccades): MAS caused an increase of the phasic amplitude of divergence, and conversely a decrease of the tonic amplitude. In contrast, LAS caused an increase of the tonic amplitude of convergence. Thus, MAS renders divergence less visually driven, while LAS renders convergence more visually driven. We conclude that the CNS uses the podal signal for both postural and vergence control via specific mechanisms. Plantar inserts have an influence upon posture and vergence movements in a different way according to the part of the foot sole being stimulated. These results can be useful to clinicians interested in foot or eye. PMID:26637132

  20. Morphological Pattern Classification System for Plantar Thermography of Patients with Diabetes

    PubMed Central

    Mori, Taketoshi; Nagase, Takashi; Takehara, Kimie; Oe, Makoto; Ohashi, Yumiko; Amemiya, Ayumi; Noguchi, Hiroshi; Ueki, Kohjiro; Kadowaki, Takashi; Sanada, Hiromi

    2013-01-01

    Background A plantar temperature distribution can be obtained by thermography; however, the advantage has not been effectively utilized in the past. We previously proposed a classification method based on the angiosome concept, but the method was insufficient because it was too subjective and complicated for clinicians. In this study, we propose a new classification system of plantar forepart thermographic patterns using an image segmentation technique. Methods A cross-sectional observational study was conducted including 32 healthy volunteers and 129 patients with diabetes mellitus (DM). Individual thermographic variations and trends were evaluated. A comparison was conducted between the patterns obtained by our previous angiosome-based research and the patterns found by the new classification system. Results The system objectively found wider variations of the plantar forepart thermographic patterns in the patients with DM compared with those in the control subjects. In patients with DM, the system showed that the whole-high pattern was most frequent (46%), followed by the butterfly pattern (12%). In the control group, the butterfly pattern was most frequent (44%), followed by the whole-high pattern (19%). Both ankle and toe brachial indices were higher in feet with high temperature area in the inner side of the plantar. Conclusions Thermographic patterns found by the new computer-based system were similar to those obtained in our previous subjective work. The classification system found forefoot-low pattern and tiptoe-low pattern objectively. The system based on infrared thermography will be a screening tool to assess circulatory status in daily foot care of patients with DM. PMID:24124935

  1. Multi-plug insole design to reduce peak plantar pressure on the diabetic foot during walking

    PubMed Central

    Actis, Ricardo L.; Ventura, Liliana B.; Lott, Donovan J.; Smith, Kirk E.; Commean, Paul K.; Hastings, Mary K.; Mueller, Michael J.

    2009-01-01

    There is evidence that appropriate footwear is an important factor in the prevention of foot pain in otherwise healthy people or foot ulcers in people with diabetes and peripheral neuropathy. A standard care for reducing forefoot plantar pressure is the utilization of orthotic devices such as total contact inserts (TCI) with therapeutic footwear. Most neuropathic ulcers occur under the metatarsal heads, and foot deformity combined with high localized plantar pressure, appear to be the most significant factors contributing to these ulcers. In this study, patient-specific finite element models of the second ray of the foot were developed to study the influence of TCI design on peak plantar pressure (PPP) under the metatarsal heads. A typical full contact insert was modified based on the results of finite element analyses, by inserting 4 mm diameter cylindrical plugs of softer material in the regions of high pressure. Validation of the numerical model was addressed by comparing the numerical results obtained by the finite element method with measured pressure distribution in the region of the metatarsal heads for a shoe and TCI condition. Two subjects, one with a history of forefoot pain and one with diabetes and peripheral neuropathy, were tested in the laboratory while wearing therapeutic shoes and customized inserts. The study showed that customized inserts with softer plugs distributed throughout the regions of high plantar pressure reduced the PPP over that of the TCI alone. This supports the outcome as predicted by the numerical model, without causing edge effects as reported by other investigators using different plug designs, and provides a greater degree of flexibility for customizing orthotic devices than current practice allows. PMID:18266017

  2. Characteristics of Plantar Loads in Maximum Forward Lunge Tasks in Badminton

    PubMed Central

    Hu, Xiaoyue; Li, Jing Xian; Hong, Youlian; Wang, Lin

    2015-01-01

    Background Badminton players often perform powerful and long-distance lunges during such competitive matches. The objective of this study is to compare the plantar loads of three one-step maximum forward lunges in badminton. Methods Fifteen right-handed male badminton players participated in the study. Each participant performed five successful maximum lunges at three directions. For each direction, the participant wore three different shoe brands. Plantar loading, including peak pressure, maximum force, and contact area, was measured by using an insole pressure measurement system. Two-way ANOVA with repeated measures was employed to determine the effects of the different lunge directions and different shoes, as well as the interaction of these two variables, on the measurements. Results The maximum force (MF) on the lateral midfoot was lower when performing left-forward lunges than when performing front-forward lunges (p = 0.006, 95% CI = −2.88 to −0.04%BW). The MF and peak pressures (PP) on the great toe region were lower for the front-forward lunge than for the right-forward lunge (MF, p = 0.047, 95% CI = −3.62 to −0.02%BW; PP, p = 0.048, 95% CI = −37.63 to −0.16 KPa) and left-forward lunge (MF, p = 0.015, 95% CI = −4.39 to −0.38%BW; PP, p = 0.008, 95% CI = −47.76 to −5.91 KPa). Conclusions These findings indicate that compared with the front-forward lunge, left and right maximum forward lunges induce greater plantar loads on the great toe region of the dominant leg of badminton players. The differences in the plantar loads of the different lunge directions may be potential risks for injuries to the lower extremities of badminton players. PMID:26367741

  3. Effectiveness of scalpel debridement for painful plantar calluses in older people: a randomized trial

    PubMed Central

    2013-01-01

    Background Plantar calluses are a common cause of foot pain, which can have a detrimental impact on the mobility and independence of older people. Scalpel debridement is often the first treatment used for this condition. Our aim was to evaluate the effectiveness of scalpel debridement of painful plantar calluses in older people. Methods This study was a parallel-group, participant- and assessor-blinded randomized trial. Eighty participants aged 65 years and older with painful forefoot plantar calluses were recruited. Participants were randomly allocated to one of two groups: either real or sham scalpel debridement. Participants were followed for six weeks after their initial intervention appointment. The primary outcomes measured were the difference between groups in pain (measured on a 100-mm visual analogue scale) immediately post-intervention, and at one, three and six weeks post-intervention. Results Both the real debridement and sham debridement groups experienced a reduction in pain when compared with baseline. Small, systematic between-group differences in pain scores were found at each time point (between 2 and 7 mm favoring real scalpel debridement); however, none of these were statistically significant and none reached a level that could be considered clinically worthwhile. Scalpel debridement caused no adverse events. Conclusions The benefits of real scalpel debridement for reducing pain associated with forefoot plantar calluses in older people are small and not statistically significant compared with sham scalpel debridement. When used alone, scalpel debridement has a limited effect in the short term, although it is relatively inexpensive and causes few complications. However, these findings do not preclude the possibility of cumulative benefits over a longer time period or additive effects when combined with other interventions. Trial registration Australian Clinical Trials Registry (ACTRN012606000176561). PMID:23915078

  4. Low heel ultrasound parameters predict mortality in men: results from the European Male Ageing Study (EMAS)

    PubMed Central

    Pye, Stephen R.; Vanderschueren, Dirk; Boonen, Steven; Gielen, Evelien; Adams, Judith E.; Ward, Kate A.; Lee, David M.; Bartfai, György; Casanueva, Felipe F.; Finn, Joseph D.; Forti, Gianni; Giwercman, Aleksander; Han, Thang S.; Huhtaniemi, Ilpo T.; Kula, Krzysztof; Lean, Michael E.; Pendleton, Neil; Punab, Margus; Wu, Frederick C.; O'Neill, Terence W.

    2015-01-01

    Background: low bone mineral density measured by dual-energy x-ray absorptiometry is associated with increased mortality. The relationship between other skeletal phenotypes and mortality is unclear. The aim of this study was to determine the relationship between quantitative heel ultrasound parameters and mortality in a cohort of European men. Methods: men aged 40–79 years were recruited for participation in a prospective study of male ageing: the European Male Ageing Study (EMAS). At baseline, subjects attended for quantitative ultrasound (QUS) of the heel (Hologic—SAHARA) and completed questionnaires on lifestyle factors and co-morbidities. Height and weight were measured. After a median of 4.3 years, subjects were invited to attend a follow-up assessment, and reasons for non-participation, including death, were recorded. The relationship between QUS parameters (broadband ultrasound attenuation [BUA] and speed of sound [SOS]) and mortality was assessed using Cox proportional hazards model. Results: from a total of 3,244 men (mean age 59.8, standard deviation [SD] 10.8 years), 185 (5.7%) died during the follow-up period. After adjusting for age, centre, body mass index, physical activity, current smoking, number of co-morbidities and general health, each SD decrease in BUA was associated with a 20% higher risk of mortality (hazard ratio [HR] per SD = 1.2; 95% confidence interval [CI] = 1.0–1.4). Compared with those in higher quintiles (2nd–5th), those in the lowest quintile of BUA and SOS had a greater mortality risk (BUA: HR = 1.6; 95% CI = 1.1–2.3 and SOS: HR = 1.6; 95% CI = 1.2–2.2). Conclusion: lower heel ultrasound parameters are associated with increased mortality in European men. PMID:26162912

  5. SLUDGE HEEL REMOVAL BY ALUMINUM DISSOLUTION AT SAVANNAH RIVER SITE 12390

    SciTech Connect

    Keefer, M.

    2012-01-12

    High Level Waste (HLW) at the Savannah River Site (SRS) is currently stored in aging underground storage tanks. This waste is a complex mixture of insoluble solids, referred to as sludge, and soluble salts. Continued long-term storage of these radioactive wastes poses an environmental risk. Operations are underway to remove and disposition the waste, clean the tanks and fill with grout for permanent closure. Heel removal is the intermediate phase of the waste retrieval and tank cleaning process at SRS, which is intended to reduce the volume of waste prior to treatment with oxalic acid. The goal of heel removal is to reduce the residual amount of radioactive sludge wastes to less than 37,900 liters (10,000 gallons) of wet solids. Reducing the quantity of residual waste solids in the tank prior to acid cleaning reduces the amount of acid required and reduces the amount of excess acid that could impact ongoing waste management processes. Mechanical heel removal campaigns in Tank 12 have relied solely on the use of mixing pumps that have not been effective at reducing the volume of remaining solids. The remaining waste in Tank 12 is known to have a high aluminum concentration. Aluminum dissolution by caustic leaching was identified as a treatment step to reduce the volume of remaining solids and prepare the tank for acid cleaning. Dissolution was performed in Tank 12 over a two month period in July and August, 2011. Sample results indicated that 16,440 kg of aluminum oxide (boehmite) had been dissolved representing 60% of the starting inventory. The evolution resulted in reducing the sludge solids volume by 22,300 liters (5900 gallons), preparing the tank for chemical cleaning with oxalic acid.

  6. [Ulceration of the heel in a woman from Djibouti: squamous cell carcinoma with carcinomatous lymphangitis].

    PubMed

    Bertani, A; Massoure, P L; Menguy, P; Lamblin, G; Eve, O; Morand, J J

    2011-02-01

    The purpose of this report is to describe a case in which a heel ulcer with atypical features, i.e., large size and rapid progression, led to diagnosis of squamous cell carcinoma. Patient management was based on specialist advice obtained by "tele-dermatology" based on pictures and comments transmitted over the Internet. However, due to the risk of spreading and impossibility of providing other medical treatment (radiotherapy-chemotherapy), the lower limb was amputated at the top of the thigh. PMID:21585103

  7. Results of Characterization and Retrieval Testing on Tank 241-C-109 Heel Solids

    SciTech Connect

    Callaway, William S.

    2013-09-26

    Eight samples of heel solids from tank 241-C-109 were delivered to the 222-S Laboratory for characterization and dissolution testing. After being drained thoroughly, one-half to two-thirds of the solids were off-white to tan solids that, visually, were fairly evenly graded in size from coarse silt (30-60 μm) to medium pebbles (8-16 mm). The remaining solids were mostly strongly cemented aggregates ranging from coarse pebbles (16-32 mm) to fine cobbles (6-15 cm) in size. Solid phase characterization and chemical analysis indicated that the air-dry heel solids contained ≈58 wt% gibbsite [Al(OH){sub 3}] and ≈37 wt% natrophosphate [Na{sub 7}F(PO{sub 4}){sub 2}�19H{sub 2}O]. The strongly cemented aggregates were mostly fine-grained gibbsite cemented with additional gibbsite. Dissolution testing was performed on two test samples. One set of tests was performed on large pieces of aggregate solids removed from the heel solids samples. The other set of dissolution tests was performed on a composite sample prepared from well-drained, air-dry heel solids that were crushed to pass a �-in. sieve. The bulk density of the composite sample was 2.04 g/mL. The dissolution tests included water dissolution followed by caustic dissolution testing. In each step of the three-step water dissolution tests, a volume of water approximately equal to 3 times the initial volume of the test solids was added. In each step, the test samples were gently but thoroughly mixed for approximately 2 days at an average ambient temperature of 25 �C. The caustic dissolution tests began with the addition of sufficient 49.6 wt% NaOH to the water dissolution residues to provide ≈3.1 moles of OH for each mole of Al estimated to have been present in the starting composite sample and ≈2.6 moles of OH for each mole of Al potentially present in the starting aggregate sample. Metathesis of gibbsite to sodium aluminate was then allowed to proceed over 10 days of gentle mixing of the test samples at temperatures ranging from 26-30 �C. The metathesized sodium aluminate was then dissolved by addition of volumes of water approximately equal to 1.3 times the volumes of caustic added to the test slurries. Aluminate dissolution was allowed to proceed for 2 days at ambient temperatures of ≈29 �C. Overall, the sequential water and caustic dissolution tests dissolved and removed 80.0 wt% of the tank 241-C-109 crushed heel solids composite test sample. The 20 wt% of solids remaining after the dissolution tests were 85-88 wt% gibbsite. If the density of the residual solids was approximately equal to that of gibbsite, they represented ≈17 vol% of the initial crushed solids composite test sample. In the water dissolution tests, addition of a volume of water ≈6.9 times the initial volume of the crushed solids composite was sufficient to dissolve and recover essentially all of the natrophosphate present. The ratio of the weight of water required to dissolve the natrophosphate solids to the estimated weight of natrophosphate present was 8.51. The Environmental Simulation Program (OLI Systems, Inc., Morris Plains, New Jersey) predicts that an 8.36 w/w ratio would be required to dissolve the estimated weight of natrophosphate present in the absence of other components of the heel solids. Only minor amounts of Al-bearing solids were removed from the composite solids in the water dissolution tests. The caustic metathesis/aluminate dissolution test sequence, executed at temperatures ranging from 27-30 �C, dissolved and recovered ≈69 wt% of the gibbsite estimated to have been present in the initial crushed heel solids composite. This level of gibbsite recovery is consistent with that measured in previous scoping tests on the dissolution of gibbsite in strong caustic solutions. Overall, the sequential water and caustic dissolution tests dissolved and removed 80.3 wt% of the tank 241-C-109 aggregate solids test sample. The residual solids were 92-95 wt% gibbsite. Only a minor portion (≈4.5 wt%) of the aggregate solids was dissolved and recovered in the water dissolution test. Other than some smoothing caused by continuous mixing, the aggregates were essentially unaffected by the water dissolution tests. During the caustic metathesis/aluminate dissolution test sequence, ≈81 wt% of the gibbsite estimated to have been present in the aggregate solids was dissolved and recovered. The pieces of aggregate were significantly reduced in size but persisted as distinct pieces of solids. The increased level of gibbsite recovery, as compared to that for the crushed heel solids composite, suggests that the way the gibbsite solids and caustic solution are mixed is a key determinant of the overall efficiency of gibbsite dissolution and recovery. The liquids recovered after the caustic dissolution tests on the crushed solids composite and the aggregate solids were observed for 170 days. No precipitation of gibbsite was observed. The distribution of particle sizes in the residual solids recovered following the dissolution tests on the crushed heel solids composite was characterized. Wet sieving indicated that 21.4 wt% of the residual solids were >710 μm in size, and laser light scattering indicated that the median equivalent spherical diameter in the <710-μm solids was 35 μm. The settling behavior of the residual solids following the large-scale dissolution tests was also studied. When dispersed at a concentration of ≈1 vol% in water, ≈24 wt% of the residual solids settled at a rate >0.43 in./s; ≈68 wt% settled at rates between 0.02 and 0.43 in./s; and ≈7 wt% settled slower than 0.02 in./s.

  8. Results of Characterization and Retrieval Testing on Tank 241-C-110 Heel Solids

    SciTech Connect

    Callaway, William S.

    2013-09-30

    Nine samples of heel solids from tank 241-C-110 were delivered to the 222-S Laboratory for characterization and dissolution testing. After being drained thoroughly, the sample solids were primarily white to light-brown with minor dark-colored inclusions. The maximum dimension of the majority of the solids was <2 mm; however, numerous pieces of aggregate, microcrystalline, and crystalline solids with maximum dimensions ranging from 5-70 mm were observed. In general, the larger pieces of aggregate solids were strongly cemented. Natrophosphate [Na{sub 7}F(PO{sub 4}){sub 2}�19H{sub 2}O] was the dominant solid phase identified in the heel solids. Results of chemical analyses suggested that 85-87 wt% of the heel solids were the fluoridephosphate double salt. The average bulk density measured for the heel solids was 1.689 g/mL; the reference density of natrophosphate is 1.71 g/mL. Dissolution tests on composite samples indicate that 94 to 97 wt% of the tank 241-C-110 heel solids can be retrieved by dissolution in water. Dissolution and recovery of the soluble components in 1 kg (0.59 L) of the heel solids required the addition of ≈9.5 kg (9.5 L) of water at 15 �C and ≈4.4 kg (4.45 L) of water at 45 �C. Calculations performed using the Environmental Simulation Program indicate that dissolution of the ≈0.86 kg of natrophosphate in each kilogram of the tank 241-C-110 heel solids would require ≈9.45 kg of water at 15 �C and ≈4.25 kg of water at 45 �C. The slightly larger quantities of water determined to be required to retrieve the soluble components in 1 kg of the heel solids are consistent with that required for the dissolution of solids composed mainly of natrophosphate with a major portion of the balance consisting of highly soluble sodium salts. At least 98% of the structural water, soluble phosphate, sodium, fluoride, nitrate, carbonate, nitrite, sulfate, oxalate, and chloride in the test composites was dissolved and recovered in the dissolution tests. Most of the {sup 99}Tc and {sup 137}Cs present in the initial heel solids composites was removed in the water dissolution tests. The estimated activities/weights of {sup 129}I, {sup 234}U, {sup 235}U, {sup 236}U, and {sup 238}U in the dry residual solids were <25% of the weights/activities in the initial composite solids. Gibbsite and nordstrandite [both Al(OH){sub 3}] were the major solid phases identified in the solids remaining after completion of the dissolution tests. Chemical analysis indicated that the residual solids may have contained up to 62 wt% Al(OH){sub 3}. Significant quantities of unidentified phosphate-, iron-, bismuth-, silicon-, and strontium- bearing species were also present in the residual solids. The reference density of gibbsite (and nordstrandite) is 2.42 g/mL. The measured density of the residual solids, 2.65 g/mL, would be a reasonable value for solids containing gibbsite as the major component with minor quantities of other, higher density solids. Sieve analysis indicated that 22.2 wt% of the residual solids were discrete particles >710 μm in size, and 77.8 wt% were particulates <710 μm in size. Light-scattering measurements suggested that nearly all of the <710-μm particulates with diameters >12 μm were weakly bound aggregates of particles with diameters <2 μm. The <710-μm residual solids settled very slowly when dispersed in reagent water. The physical appearance of a suspension containing ≈0.4 vol% of the solids in pure water changed very little over a period of 46.5 hours. It should be noted that the distribution of particle sizes in the residual solids and the observed settling behavior were both strongly influenced by the procedures followed in the dissolution tests.

  9. Dose-Related Effect of Extracorporeal Shock Wave Therapy for Plantar Fasciitis

    PubMed Central

    Lee, Su-Jin; Kang, Jung-Ho; Kim, Ja-Young; Kim, Jin-Hong; Jung, Kwang-Ik

    2013-01-01

    Objective To examine the dose-related effect of extracorporeal shock wave therapy (ESWT) for plantar fasciitis. Methods Sixty patients with plantar fasciitis despite conservative treatment were enrolled. The patients were divided into a low-energy group (group L: n=30, 1,000 shocks/session, energy flux density [EFD] per shock 0.08 mJ/mm2) and a medium-energy group (group M: n=30, 1,000 shocks/session, EFD 0.16 mJ/mm2). The main outcome measures were visual analogue scale (VAS), Roles and Maudsley (RM) score, and thickness of plantar fascia (PF). To compare the effects between each group, follow-up was carried out 1 week after 3 and 6 sessions, and 1 and 3 months after ESWT. Results Significant VAS and RM score improvement, and PF thickness reduction were observed in both groups (p<0.01). After 3 sessions of ESWT, group M showed significant improvement in the VAS and RM score than group L, whereas after 3 additional sessions applied in group L, the main outcomes were no longer significantly different in both groups (p>0.05). Conclusion Therapeutic effect might disclose a dose-related relationship; therefore, EFD and the times of the session are considerable factors when treating with ESWT. PMID:23869336

  10. In-shoe plantar pressure measurement and analysis system based on fabric pressure sensing array.

    PubMed

    Shu, Lin; Hua, Tao; Wang, Yangyong; Qiao Li, Qiao; Feng, David Dagan; Tao, Xiaoming

    2010-05-01

    Spatial and temporal plantar pressure distributions are important and useful measures in footwear evaluation, athletic training, clinical gait analysis, and pathology foot diagnosis. However, present plantar pressure measurement and analysis systems are more or less uncomfortable to wear and expensive. This paper presents an in-shoe plantar pressure measurement and analysis system based on a textile fabric sensor array, which is soft, light, and has a high-pressure sensitivity and a long service life. The sensors are connected with a soft polymeric board through conductive yarns and integrated into an insole. A stable data acquisition system interfaces with the insole, wirelessly transmits the acquired data to remote receiver through Bluetooth path. Three configuration modes are incorporated to gain connection with desktop, laptop, or smart phone, which can be configured to comfortably work in research laboratories, clinics, sport ground, and other outdoor environments. A real-time display and analysis software is presented to calculate parameters such as mean pressure, peak pressure, center of pressure (COP), and shift speed of COP. Experimental results show that this system has stable performance in both static and dynamic measurements. PMID:20071266

  11. Isokinetic plantar flexion endurance. Reliability and validity of output/excitation measurements.

    PubMed

    Fugl-Meyer, A R; Gerdle, B; Eriksson, B E; Jonsson, B

    1985-01-01

    The reliability and validity of isokinetic measurement of plantar flexion endurance has been studied by a method previously described by us which utilizes simultaneous measurements of mechanical contractional work (CW) and integrated electromyogram (iEMG). The reliability was gauged by test/re-test with a two year's interval; while validity was assessed by myoelectric power spectrum analyses. The output/input balance (CW/iEMG) remained unchanged for the group as well as inter-individually. Changes in myoelectric power spectrum as function of number of contractions were clearly indicative of fatigue. Under the present conditions fatigue of fast twitch motor units may explain the rapid decreases in output and excitation followed by nearly steady state levels of all registered parameters. As is the case for non-fatigued isokinetic plantar flexions, the motor unit recruitment order appears quite stereotyped during plantar flexion fatigue. The findings of significantly lower mean power spectrum during the first part of each contraction than during the second part may support the size-principle described by Henneman. PMID:4023659

  12. Age changes in the tibial and plantar nerves of the rat.

    PubMed Central

    Sharma, A K; Bajada, S; Thomas, P K

    1980-01-01

    Observations have been made on the changes in the myelinated fibres of the rat tibial and plantar nerves between 2 and 24 months of age. There is an initial rapid increase in fibre diameter followed by a later more gradual increase, which ceases after approximately 9 months of age in the tibial nerve but which continues for longer in the medial plantar nerve. The fibre size distribution remains substantially unimodal throughout. In both nerves maximal and average fibre diameter become reduced by 24 months. Total fibre number shows considerable variability between animals, but no definite systematic alteration with age is detectable. Teased fibre preparations demonstrate a low level of abnormality in the tibial nerve until after 18 months of age, but by 24 months approximately 30% of fibres display abnormalities. Although both paranodal and segmental demyelination and remyelination, and axonal degeneration and regeneration occur, the latter type of change predominates. By contrast, in the lateral plantar nerve paranodal and segmental demyelination become detectable to a significant extent from 6 months of age. Axonal degeneration and regeneration also become evident after 15 months, and by 24 months of age 55% of fibres show abnormalities. The possible explanation of these changes is discussed, as is their relevance to the frequent use of the tibial nerve for studies on experimental neuropathies. PMID:7400044

  13. Double cancer of plantar malignant melanoma and vulvar extramammary Paget's disease.

    PubMed

    Tsuji, Masataka; Nakai, Noriaki; Ueda, Eiichiro; Takenaka, Hideya; Katoh, Norito; Kishimoto, Saburo

    2010-05-01

    A 75-year-old woman presented with a 2-year history of a pigmented nodular lesion on her left sole and a 9-year history of a red infiltrative plaque on the vulva. The plantar lesion was a 15-mm ulcerated nodule located at the center of a 25-mm atypical pigmentation region; the nodule was clinically suspected to be a malignant melanoma. Histopathological analysis of the vulvar lesion biopsy sample indicated extramammary Paget's disease (EMPD). There was no evidence of metastasis in the computed tomography (CT) and (18)F-fluorodeoxyglucose positron emission tomography scans. We simultaneously performed a wide excision of both lesions and a left inguinal sentinel lymph node biopsy. Melanoma cells were identified in the sentinel lymph nodes, and left radical lymph node dissection was performed after a course of neoadjuvant chemotherapy. All the lymph nodes that were resected during the second operation tested negative for melanomas, and the plantar lesion was diagnosed as a stage IIIB malignant melanoma (pT4b, Na2, M0). Thereafter, we administrated four courses of chemotherapy, and 8 months after the operation, there was no evidence of recurrence or metastatic lesions. We present a case report of double cancer: a plantar malignant melanoma and vulvar EMPD, and also discuss the possible genetic mutations responsible for these two tumors. PMID:20536656

  14. Antigenic relationships between polypeptides derived from plantar and hand wart viruses.

    PubMed

    Staquet, M J; Viac, J; Thivolet, J

    1979-06-01

    Guinea pigs immunized with polypeptides derived from plantar and hand wart viruses developed both humoral and cell mediated immunity. The specificity of the antiserum was determined by indirect immunofluorescence (IF) tests and cellular immunity by intradermal tests. While whole plantar and hand wart virus particles (PV and HV) appeared to be immunologically analogous, they had different polypeptide patterns as shown by analysis on acrylamide slab gels. In particular, the P2 polypeptide (major virus protein) with different mol. wt. for PV (56750) and HV (54500) induced the production of high antibody titres in the animals and the immune sera specifically labelled wart substrates as shown in thie IF test, demonstrating that no cross humoral reaction occurs between these two polypeptides. Furthermore, a delayed hypersensitivity reaction was observed in P2 polypeptide-inoculated guinea pigs when whole particles were introduced in skin tests, but a total cross reactivity between PV and HV was noticed at the cellular level. However, the study of the virus isolated from the lesions of a patient (Ri) bearing extensive common hand warts has shown that the virus particles possessed all the biochemical and immunological characteristics of PV, in particular with regard to the P2 polypeptide. Such a case may represent plantar-like warts located on the hands. PMID:90120

  15. Fiber composition of the lateral plantar and superficial peroneal nerves in the rat foot.

    PubMed

    Povlsen, B; Stankovic, N; Danielsson, P; Hildebrand, C

    1994-05-01

    This study examines the fiber composition of two nerves projecting to the rat hindpaw: the lateral plantar nerve (LPN), which innervates plantar glabrous skin and some plantar muscles, and the foot branch of the superficial peroneal nerve (fSPN), which projects to dorsal hairy skin. The LPN contains 872 (33%) myelinated axons with a size range of 1-7 microns and a peak at 4 microns. Some 200 of the myelinated axons are muscle efferents. There are 1,969 (67%) C-fibers. After neonatal capsaicin treatment, the number of C-fibers in the LPN is 61% below the normal level, but it is not significantly different from control levels after chemical sympathectomy with guanethidine. The fSPN is composed of 470 (20%) myelinated axons with a size range similar to that in the LPN. Virtually all myelinated fibers are sensory. There are 1,791 (80%) C-fibers. In neonatally capsaicin-treated animals, the occurrence of C-fibers is 65% below control levels. In chemically sympathectomized animals, the number of C-fibers in the fSPN is normal. This description of the fiber composition of the LPN and the fSPN in the rat provides a basis for future experimental studies. PMID:8092492

  16. Sonoelastography of Plantar Fascia: Reproducibility and Pattern Description in Healthy Subjects and Symptomatic Subjects.

    PubMed

    Ríos-Díaz, José; Martínez-Payá, Jacinto J; del Baño-Aledo, María Elena; de Groot-Ferrando, Ana; Botía-Castillo, Paloma; Fernández-Rodríguez, David

    2015-10-01

    The purpose of the work reported here was to describe the sonoelastographic appearance of the plantar fascia of healthy volunteers and patients with fasciitis. Twenty-three healthy subjects and 21 patients with plantar fasciitis were examined using B-mode and real-time sonoelastography (RTSR) scanning. B-Mode examination included fascia thickness and echotexture. Echogenicity and echovariation of the color histogram were analyzed. Fasciae were classified into type 1, blue (more elastic); type 2, blue/green (intermediate); or type 3, green (less elastic). RTSE revealed 72.7% of fasciae as type 2, with no significant association with fasciitis (χ(2) = 3.6, df = 2, p = 0.17). Quantitative analysis of the color histogram revealed a significantly greater intensity of green (mean = 77.8, 95% confidence interval [CI] = 71.9-83.6) and blue (mean = 74.2, 95% CI = 69.7-78.8) in healthy subjects. Echovariation of the color red was 33.4% higher in the fasciitis group than in the healthy group (95% CI = 16.7-50.1). Sonoelastography with quantitative analysis of echovariation can be a useful tool for evaluation of plantar fascia pathology. PMID:26164287

  17. Relationship between lumbar changes and modifications in the plantar arch in women with low back pain

    PubMed Central

    Borges, Cláudia dos Santos; Fernandes, Luciane Fernanda Rodrigues Martinho; Bertoncello, Dernival

    2013-01-01

    OBJECTIVE : Evaluate the probable relationship among plantar arch, lumbar curvature, and low back pain. METHODS : Fifteen healthy women were assessed taking in account personal data and anthropometric measurements, photopodoscopic evaluation of the plantar arch, and biophotogrammetric postural analysis of the patient (both using the SAPO software), as well as evaluation of lumbar pain using a Visual Analog Scale (VAS). The average age of the participants was 30.45 (±6.25) years. RESULTS : Of the feet evaluated, there were six individuals with flat feet, five with high arch, and four with normal feet. All reported algic syndrome in the lumbar spine, with the highest VAS values for the volunteers with high arch. Correlation was observed between the plantar arch and the angle of the lumbar spine (r = -0.71, p = 0.004) Conclusion: High arch was correlated with more intense algic syndrome, while there was moderate positive correlation between flat foot and increased lumbar curvature, and between high arch and lumbar correction. Level of Evidence IV. Case Series. PMID:24453656

  18. Integrated pressure-force-kinematics measuring system for the characterisation of plantar foot loading during locomotion.

    PubMed

    Giacomozzi, C; Macellari, V; Leardini, A; Benedetti, M G

    2000-03-01

    Plantar pressure, ground reaction force and body-segment kinematics measurements are largely used in gait analysis to characterise normal and abnormal function of the human foot. The combination of all these data together provides a more exhaustive, detailed and accurate view of foot loading during activities than traditional measurement systems alone do. A prototype system is presented that integrates a pressure platform, a force platform and a 3D anatomical tracking system to acquire combined information about foot function and loading. A stereophotogrammetric system and an anatomically based protocol for foot segment kinematics is included in a previously devised piezo-dynamometric system that combines pressure and force measurements. Experimental validation tests are carried out to check for both spatial and time synchronisation. Misalignment of the three systems is found to be within 6.0, 5.0 and 1.5 mm for the stereophotogrammetric system, force platform and pressure platform, respectively. The combination of position and pressure data allows for a more accurate selection of plantar foot subareas on the footprint. Measurements are also taken on five healthy volunteers during level walking to verify the feasibility of the overall experimental protocol. Four main subareas are defined and identified, and the relevant vertical and shear force data are computed. The integrated system is effective when there is a need for loading measurements in specific plantar foot subareas. This is attractive both in clinical assessment and in biomechanics research. PMID:10829407

  19. One-year treatment follow-up of plantar fasciitis: radial shockwaves vs. conventional physiotherapy

    PubMed Central

    Grecco, Marcus Vinicius; Brech, Guilherme Carlos; Greve, Júlia Maria D'Andrea

    2013-01-01

    OBJECTIVE: To compare radial shockwave treatment with conventional physiotherapy for plantar fasciitis after 12 months of follow-up. METHOD: This was a randomized, prospective, comparative clinical study. Forty patients with a diagnosis of plantar fasciitis were divided randomly into two treatment groups: group 1, with 20 patients who underwent ten physiotherapy sessions comprising ultrasound, kinesiotherapy and guidance for home-based stretching; and group 2, with 20 patients who underwent three applications of radial shockwaves, once a week, and guidance for home-based stretching. All patients were assessed regarding pain and functional abilities before treatment, immediately after and 12 months after treatment. The mean age was 49.6±11.8 years (range: 25-68 years), 85% were female, 88% were overweight, 63% were affected bilaterally, and 83% used analgesics regularly. RESULTS: At the 12-month follow-up, both treatments were effective for improving pain and functional ability among the patients with plantar fasciitis. The improvement with shockwaves was faster. CONCLUSION: Shockwave treatment was not more effective than conventional physiotherapy treatment 12 months after the end of the treatment. PMID:24037003

  20. Constitutive Modeling of Time-Dependent Response of Human Plantar Aponeurosis

    PubMed Central

    Pavan, P. G.; Pachera, P.; Stecco, C.; Natali, A. N.

    2014-01-01

    The attention is focused on the viscoelastic behavior of human plantar aponeurosis tissue. At this purpose, stress relaxation tests were developed on samples taken from the plantar aponeurosis of frozen adult donors with age ranging from 67 to 78 years, imposing three levels of strain in the physiological range (4%, 6%, and 8%) and observing stress decay for 240 s. A viscohyperelastic fiber-reinforced constitutive model with transverse isotropy was assumed to describe the time-dependent behavior of the aponeurotic tissue. This model is consistent with the structural conformation of the tissue where collagen fibers are mainly aligned with the proximal-distal direction. Constitutive model fitting to experimental data was made by implementing a stochastic-deterministic procedure. The stress relaxation was found close to 40%, independently of the level of strain applied. The agreement between experimental data and numerical results confirms the suitability of the constitutive model to describe the viscoelastic behaviour of the plantar aponeurosis. PMID:24701249

  1. The Effect of Landing Surface on the Plantar Kinetics of Chinese Paratroopers Using Half-Squat Landing

    PubMed Central

    Li, Yi; Wu, Ji; Zheng, Chao; Huang, Rong Rong; Na, Yuhong; Yang, Fan; Wang, Zengshun; Wu, Di

    2013-01-01

    The objective of the study was to determine the effect of landing surface on plantar kinetics during a half-squat landing. Twenty male elite paratroopers with formal parachute landing training and over 2 years of parachute jumping experience were recruited. The subjects wore parachuting boots in which pressure sensing insoles were placed. Each subject was instructed to jump off a platform with a height of 60 cm, and land on either a hard or soft surface in a half-squat posture. Outcome measures were maximal plantar pressure, time to maximal plantar pressure (T-MPP), and pressure-time integral (PTI) upon landing on 10 plantar regions. Compared to a soft surface, hard surface produced higher maximal plantar pressure in the 1st to 4th metatarsal and mid-foot regions, but lower maximal plantar pressure in the 5th metatarsal region. Shorter T- MPP was found during hard surface landing in the 1st and 2nd metatarsal and medial rear foot. Landing on a hard surface landing resulted in a lower PTI than a soft surface in the 1stphalangeal region. For Chinese paratroopers, specific foot prosthesis should be designed to protect the1st to 4thmetatarsal region for hard surface landing, and the 1stphalangeal and 5thmetatarsal region for soft surface landing. Key Points Understanding plantar kinetics during the half-squat landing used by Chinese paratroopers can assist in the design of protective footwear. Compared to landing on a soft surface, a hard surface produced higher maximal plantar pressure in the 1st to 4th metatarsal and mid-foot regions, but lower maximal plantar pressure in the 5th metatarsal region. A shorter time to maximal plantar pressure was found during a hard surface landing in the 1st and 2nd metatarsals and medial rear foot. Landing on a hard surface resulted in a lower pressure-time integral than landing on a soft surface in the 1st phalangeal region. For Chinese paratroopers, specific foot prosthesis should be designed to protect the 1st to 4th metatarsal region for a hard surface landing, and the 1st phalangeal and 5th metatarsal region for a soft surface landing. PMID:24149145

  2. The effect of landing surface on the plantar kinetics of chinese paratroopers using half-squat landing.

    PubMed

    Li, Yi; Wu, Ji; Zheng, Chao; Huang, Rong Rong; Na, Yuhong; Yang, Fan; Wang, Zengshun; Wu, Di

    2013-01-01

    The objective of the study was to determine the effect of landing surface on plantar kinetics during a half-squat landing. Twenty male elite paratroopers with formal parachute landing training and over 2 years of parachute jumping experience were recruited. The subjects wore parachuting boots in which pressure sensing insoles were placed. Each subject was instructed to jump off a platform with a height of 60 cm, and land on either a hard or soft surface in a half-squat posture. Outcome measures were maximal plantar pressure, time to maximal plantar pressure (T-MPP), and pressure-time integral (PTI) upon landing on 10 plantar regions. Compared to a soft surface, hard surface produced higher maximal plantar pressure in the 1(st) to 4(th) metatarsal and mid-foot regions, but lower maximal plantar pressure in the 5(th) metatarsal region. Shorter T- MPP was found during hard surface landing in the 1(st) and 2(nd) metatarsal and medial rear foot. Landing on a hard surface landing resulted in a lower PTI than a soft surface in the 1(st)phalangeal region. For Chinese paratroopers, specific foot prosthesis should be designed to protect the1(st) to 4(th)metatarsal region for hard surface landing, and the 1(st)phalangeal and 5(th)metatarsal region for soft surface landing. Key PointsUnderstanding plantar kinetics during the half-squat landing used by Chinese paratroopers can assist in the design of protective footwear.Compared to landing on a soft surface, a hard surface produced higher maximal plantar pressure in the 1(st) to 4(th) metatarsal and mid-foot regions, but lower maximal plantar pressure in the 5(th) metatarsal region.A shorter time to maximal plantar pressure was found during a hard surface landing in the 1(st) and 2(nd) metatarsals and medial rear foot.Landing on a hard surface resulted in a lower pressure-time integral than landing on a soft surface in the 1(st) phalangeal region.For Chinese paratroopers, specific foot prosthesis should be designed to protect the 1(st) to 4(th) metatarsal region for a hard surface landing, and the 1(st) phalangeal and 5(th) metatarsal region for a soft surface landing. PMID:24149145

  3. A Rare Case of Plantar Epithelioma Cuniculatum Arising from a Wart.

    PubMed

    Ray, Rahul; Bhagat, Aditi; Vasudevan, Biju; Sridhar, Jandhyala; Madan, Renu; Ray, Manjusha

    2015-01-01

    A 68-year-old man, a known case of hypertension, coronary artery disease and old cardiovascular accident with right-sided hemiplegia, came with the chief complaints of a large cauliflower like growth with pus discharge on the left heel since 15 years. The patient had sustained a penetrating injury by a thorn on the left heel region few days before the lesion appeared. Dermatological examination revealed a single verrucous lesion measuring 7 7 cm on the left heel region associated with discharge of foul smelling cheesy material. There was also a enlarged right inguinal lymph node which was non-tender, firm, measuring 2 cm in diameter with normal overlying skin. X-ray left ankle was done which showed some soft tissue swelling. A skin biopsy showed hyperkeratosis, acanthosis and parakeratosis. Elongated rete ridges with keratinocyte hyperplasia, forming a large mass pressing on the underlying dermis were seen. There was formation of multiple large keratin filled invaginations and crypts. No atypical cells were seen. Based on history, clinical examination and investigations, a diagnosis of epithelium cuniculatum type of verrucous squamous cell carcinoma was made. A wide excision with a flap cover was performed in consultation with the oncosurgeon and the excision sample was sent for histopathological re-examination, which confirmed the diagnosis of epithelioma cuniculatum. PMID:26538697

  4. A Rare Case of Plantar Epithelioma Cuniculatum Arising from a Wart

    PubMed Central

    Ray, Rahul; Bhagat, Aditi; Vasudevan, Biju; Sridhar, Jandhyala; Madan, Renu; Ray, Manjusha

    2015-01-01

    A 68-year-old man, a known case of hypertension, coronary artery disease and old cardiovascular accident with right-sided hemiplegia, came with the chief complaints of a large cauliflower like growth with pus discharge on the left heel since 15 years. The patient had sustained a penetrating injury by a thorn on the left heel region few days before the lesion appeared. Dermatological examination revealed a single verrucous lesion measuring 7 7 cm on the left heel region associated with discharge of foul smelling cheesy material. There was also a enlarged right inguinal lymph node which was non-tender, firm, measuring 2 cm in diameter with normal overlying skin. X-ray left ankle was done which showed some soft tissue swelling. A skin biopsy showed hyperkeratosis, acanthosis and parakeratosis. Elongated rete ridges with keratinocyte hyperplasia, forming a large mass pressing on the underlying dermis were seen. There was formation of multiple large keratin filled invaginations and crypts. No atypical cells were seen. Based on history, clinical examination and investigations, a diagnosis of epithelium cuniculatum type of verrucous squamous cell carcinoma was made. A wide excision with a flap cover was performed in consultation with the oncosurgeon and the excision sample was sent for histopathological re-examination, which confirmed the diagnosis of epithelioma cuniculatum. PMID:26538697

  5. Biochemical response to chronic shortening in unloaded soleus muscles

    NASA Technical Reports Server (NTRS)

    Jaspers, S. R.; Fagan, J. M.; Tischler, M. E.

    1985-01-01

    One leg of tail-casted suspended rats was immobilized in a plantar-flexed position to test whether chronic shortening of posterior leg muscles affected the metabolic response to unloading. The immobilized plantaris and gastrocnemius muscles of these animals showed approximately 20 percent loss of muscle mass in contrast to simply a slower growth rate with unloading. Loss of mass of the soleus muscle during suspension was not accentuated by chronic shortening. Although protein degradation in the isolated soleus muscle of the plantar-flexed limb was slightly faster than in the contralateral free limb, this difference was offset by faster synthesis of the myofibrillar protein fraction of the chronically shortened muscle. Total adenine nucleotides were 17 percent lower (P less than 0.005) in the chronically shortened soleus muscle following incubation. Glutamate, glutamine, and alanine metabolism showed little response to chronic shortening. These results suggest that, in the soleus muscle, chronic shortening did not alter significantly the metabolic responses to unloading and reduced activity.

  6. Evidence for reduced efficacy of the Ia-pathway during shortening plantar flexions with increasing effort.

    PubMed

    Oya, T; Cresswell, A G

    2008-03-01

    To determine whether the soleus (SOL) H-reflex is modulated during shortening contractions in a manner that has been observed for isometric contractions, SOL H-reflexes and M-waves were elicited via percutaneous electrical stimulation to the tibial nerve at an intensity that evoked an H-reflex at 50% of its maximum in 11 healthy subjects. Paired electrical stimuli were delivered as the ankle angle passed through 90 degrees at an interval of 400 ms while the subject performed shortening contractions at levels of plantar flexion torque ranging between 2 and 30% of that during a maximal voluntary contraction (MVC). H-reflexes were also recorded during the performance of isomeric contractions of plantar flexors at similar levels of plantar flexion torque and at the same joint angle (muscle length) in an additional five healthy subjects. Correlations were examined between the peak-to-peak amplitude of the first H-reflexes, M-waves and plantar flexion torques in both protocols. It was revealed that no significant correlation was found between the SOL H-reflex and increasing plantar flexion torque during shortening contractions (rho = -0.07, P = 0.15), while a strong positive correlation was observed for the isometric conditions (rho = 0.99, P < 0.01). No significant change was observed in the SOL M-wave for either contraction type. Furthermore, the H-reflexes elicited via paired stimuli with the same background activity in voluntary shortening contractions showed almost identical amplitudes, suggesting that the level of homosynaptic post-activation depression did not change in response to the varying levels of activation in voluntary shortening contractions. Therefore, the lack of increase in the H-reflex during shortening contractions at increasing intensities is possibly due to a centrally regulated increase in presynaptic inhibition. Such a downward modulation of the reflex suggests that Ia-excitatory input onto the SOL motoneurone pool needs to be reduced during the performance of shortening contractions. PMID:17989963

  7. CHEMICAL SLUDGE HEEL REMOVAL AT THE SAVANNAH RIVER SITE F TANK FARM CLOSURE PROJECT 8183

    SciTech Connect

    Thaxton, D; Timothy Baughman, T

    2008-01-16

    Chemical Sludge Removal (CSR) is the final waste removal activity planned for some of the oldest nuclear waste tanks located at the Savannah River Site (SRS) in Aiken, SC. In 2008, CSR will be used to empty two of these waste tanks in preparation for final closure. The two waste tanks chosen to undergo this process have previously leaked small amounts of nuclear waste from the primary tank into an underground secondary containment pan. CSR involves adding aqueous oxalic acid to the waste tank in order to dissolve the remaining sludge heel. The resultant acidic waste solution is then pumped to another waste tank where it will be neutralized and then stored awaiting further processing. The waste tanks to be cleaned have a storage capacity of 2.84E+06 liters (750,000 gallons) and a target sludge heel volume of 1.89E+04 liters (5,000 gallons) or less for the initiation of CSR. The purpose of this paper is to describe the CSR process and to discuss the most significant technical issues associated with the development of CSR.

  8. Chronic Diarrhea

    MedlinePlus

    ... infections that cause chronic diarrhea be prevented? Chronic Diarrhea What is chronic diarrhea? Diarrhea that lasts for more than 2-4 ... represent a life-threatening illness. What causes chronic diarrhea? Chronic diarrhea has many different causes; these causes ...

  9. Heel Pain

    MedlinePlus

    ... outside of the foot, then moves toward the big toe. The arch rises, the foot generally rolls ... including gout, which usually manifests itself in the big toe joint; an inflamed bursa (bursitis), a small, ...

  10. Control of the motion of the body's center of mass in relation to the center of pressure during high-heeled gait.

    PubMed

    Chien, Hui-Lien; Lu, Tung-Wu; Liu, Ming-Wei

    2013-07-01

    High-heeled shoes are associated with instability and falling, leading to injuries such as fracture and ankle sprain. Knowledge of the motion of the body's center of mass (COM) with respect to the center of pressure (COP) during high-heeled gait may offer insights into the balance control strategies and provide a basis for approaches that minimize the risk of falling and associated adverse effects. The study aimed to investigate the influence of the base and height of the heels on the COM motion in terms of COM-COP inclination angles (IA) and the rate of change of IA (RCIA). Fifteen females who regularly wear high heels walked barefoot and with narrow-heeled shoes with three heel heights (3.9cm, 6.3cm and 7.3cm) while kinematic and ground reaction force data were measured and used to calculate the COM and COP, as well as the temporal-distance parameters. The reduced base of the heels was found to be the primary factor for the reduced normalized walking speed and the reduced frontal IA throughout the gait cycle. This was achieved mainly through the control of the RCIA during double-leg stance (DLS). The heel heights affected mainly the peak RCIA during DLS, which were not big enough to affect the IA. These results suggest young adults adopt a conservative strategy for balance control during narrow-heeled gait. The results will serve as baseline data for future evaluation of patients and/or older adults during narrow-heeled gait with the aim of reducing the risk of falling. PMID:23337731

  11. A Vibrotactile and Plantar Force Measurement-Based Biofeedback System: Paving the Way towards Wearable Balance-Improving Devices.

    PubMed

    Ma, Christina Zong-Hao; Wan, Anson Hong-Ping; Wong, Duo Wai-Chi; Zheng, Yong-Ping; Lee, Winson Chiu-Chun

    2015-01-01

    Although biofeedback systems have been used to improve balance with success, they were confined to hospital training applications. Little attempt has been made to investigate the use of in-shoe plantar force measurement and wireless technology to turn hospital training biofeedback systems into wearable devices. This research developed a wearable biofeedback system which detects body sway by analyzing the plantar force and provides users with the corresponding haptic cues. The effects of this system were evaluated in thirty young and elderly subjects with simulated reduced foot sensation. Subjects performed a Romberg test under three conditions: (1) no socks, system turned-off; (2) wearing five layers of socks, system turned-off; (3) wearing five layers of socks, and system turned-on. Degree of body sway was investigated by computing the center of pressure (COP) movement measured by a floor-mounted force platform. Plantar tactile sensation was evaluated using a monofilament test. Wearing multiple socks significantly decreased the plantar tactile sensory input (p < 0.05), and increased the COP parameters (p < 0.017), indicating increased postural sway. After turning on the biofeedback system, the COP parameters decreased significantly (p < 0.017). The positive results of this study should inspire future development of wearable plantar force-based biofeedback systems for improving balance in people with sensory deficits. PMID:26694399

  12. A Vibrotactile and Plantar Force Measurement-Based Biofeedback System: Paving the Way towards Wearable Balance-Improving Devices

    PubMed Central

    Ma, Christina Zong-Hao; Wan, Anson Hong-Ping; Wong, Duo Wai-Chi; Zheng, Yong-Ping; Lee, Winson Chiu-Chun

    2015-01-01

    Although biofeedback systems have been used to improve balance with success, they were confined to hospital training applications. Little attempt has been made to investigate the use of in-shoe plantar force measurement and wireless technology to turn hospital training biofeedback systems into wearable devices. This research developed a wearable biofeedback system which detects body sway by analyzing the plantar force and provides users with the corresponding haptic cues. The effects of this system were evaluated in thirty young and elderly subjects with simulated reduced foot sensation. Subjects performed a Romberg test under three conditions: (1) no socks, system turned-off; (2) wearing five layers of socks, system turned-off; (3) wearing five layers of socks, and system turned-on. Degree of body sway was investigated by computing the center of pressure (COP) movement measured by a floor-mounted force platform. Plantar tactile sensation was evaluated using a monofilament test. Wearing multiple socks significantly decreased the plantar tactile sensory input (p < 0.05), and increased the COP parameters (p < 0.017), indicating increased postural sway. After turning on the biofeedback system, the COP parameters decreased significantly (p < 0.017). The positive results of this study should inspire future development of wearable plantar force-based biofeedback systems for improving balance in people with sensory deficits. PMID:26694399

  13. Inhibition of cyclooxygenase attenuates the blood pressure response to plantar flexion exercise in peripheral arterial disease.

    PubMed

    Muller, Matthew D; Drew, Rachel C; Ross, Amanda J; Blaha, Cheryl A; Cauffman, Aimee E; Kaufman, Marc P; Sinoway, Lawrence I

    2015-08-01

    Prostanoids are produced during skeletal muscle contraction and subsequently stimulate muscle afferent nerves, thereby contributing to the exercise pressor reflex. Humans with peripheral arterial disease (PAD) have an augmented exercise pressor reflex, but the metabolite(s) responsible for this augmented response is not known. We tested the hypothesis that intravenous injection of ketorolac, which blocks the activity of cyclooxygenase, would attenuate the rise in mean arterial blood pressure (MAP) and heart rate (HR) evoked by plantar flexion exercise. Seven PAD patients underwent 4 min of single-leg dynamic plantar flexion (30 contractions/min) in the supine posture (workload: 0.5-2.0 kg). MAP and HR were measured on a beat-by-beat basis; changes from baseline in response to exercise were determined. Ketorolac did not affect MAP or HR at rest. During the first 20 s of exercise with the most symptomatic leg, ΔMAP was significantly attenuated by ketorolac (2 ± 2 mmHg) compared with control (8 ± 2 mmHg, P = 0.005), but ΔHR was similar (6 ± 2 vs. 5 ± 1 beats/min). Importantly, patients rated the exercise bout as "very light" to "fairly light," and average pain ratings were 1 of 10. Ketorolac had no effect on perceived exertion or pain ratings. Ketorolac also had no effect on MAP or HR in seven age- and sex-matched healthy subjects who performed a similar but longer plantar flexion protocol (workload: 0.5-7.0 kg). These data suggest that prostanoids contribute to the augmented exercise pressor reflex in patients with PAD. PMID:26055794

  14. Range of motion, neuromechanical, and architectural adaptations to plantar flexor stretch training in humans.

    PubMed

    Blazevich, A J; Cannavan, D; Waugh, C M; Miller, S C; Thorlund, J B; Aagaard, P; Kay, A D

    2014-09-01

    The neuromuscular adaptations in response to muscle stretch training have not been clearly described. In the present study, changes in muscle (at fascicular and whole muscle levels) and tendon mechanics, muscle activity, and spinal motoneuron excitability were examined during standardized plantar flexor stretches after 3 wk of twice daily stretch training (4 × 30 s). No changes were observed in a nonexercising control group (n = 9), however stretch training elicited a 19.9% increase in dorsiflexion range of motion (ROM) and a 28% increase in passive joint moment at end ROM (n = 12). Only a trend toward a decrease in passive plantar flexor moment during stretch (-9.9%; P = 0.15) was observed, and no changes in electromyographic amplitudes during ROM or at end ROM were detected. Decreases in H(max):M(max) (tibial nerve stimulation) were observed at plantar flexed (gastrocnemius medialis and soleus) and neutral (soleus only) joint angles, but not with the ankle dorsiflexed. Muscle and fascicle strain increased (12 vs. 23%) along with a decrease in muscle stiffness (-18%) during stretch to a constant target joint angle. Muscle length at end ROM increased (13%) without a change in fascicle length, fascicle rotation, tendon elongation, or tendon stiffness following training. A lack of change in maximum voluntary contraction moment and rate of force development at any joint angle was taken to indicate a lack of change in series compliance of the muscle-tendon unit. Thus, increases in end ROM were underpinned by increases in maximum tolerable passive joint moment (stretch tolerance) and both muscle and fascicle elongation rather than changes in volitional muscle activation or motoneuron pool excitability. PMID:24947023

  15. Neuromuscular function and fatigue resistance of the plantar flexors following short-term cycling endurance training

    PubMed Central

    Behrens, Martin; Weippert, Matthias; Wassermann, Franziska; Bader, Rainer; Bruhn, Sven; Mau-Moeller, Anett

    2015-01-01

    Previously published studies on the effect of short-term endurance training on neuromuscular function of the plantar flexors have shown that the H-reflex elicited at rest and during weak voluntary contractions was increased following the training regime. However, these studies did not test H-reflex modulation during isometric maximum voluntary contraction (iMVC) and did not incorporate a control group in their study design to compare the results of the endurance training group to individuals without the endurance training stimulus. Therefore, this randomized controlled study was directed to investigate the neuromuscular function of the plantar flexors at rest and during iMVC before and after 8 weeks of cycling endurance training. Twenty-two young adults were randomly assigned to an intervention group and a control group. During neuromuscular testing, rate of torque development, isometric maximum voluntary torque and muscle activation were measured. Triceps surae muscle activation and tibialis anterior muscle co-activation were assessed by normalized root mean square of the EMG signal during the initial phase of contraction (0–100, 100–200 ms) and iMVC of the plantar flexors. Furthermore, evoked spinal reflex responses of the soleus muscle (H-reflex evoked at rest and during iMVC, V-wave), peak twitch torques induced by electrical stimulation of the posterior tibial nerve at rest and fatigue resistance were evaluated. The results indicate that cycling endurance training did not lead to a significant change in any variable of interest. Data of the present study conflict with the outcome of previously published studies that have found an increase in H-reflex excitability after endurance training. However, these studies had not included a control group in their study design as was the case here. It is concluded that short-term cycling endurance training does not necessarily enhance H-reflex responses and fatigue resistance. PMID:26029114

  16. Plantar thermography is useful in the early diagnosis of diabetic neuropathy

    PubMed Central

    Balbinot, Luciane Fachin; Canani, Luis Henrique; Robinson, Caroline Cabral; Achaval, Matilde; Zaro, Milton Antônio

    2012-01-01

    OBJECTIVES: This study evaluated plantar thermography sensitivity and specificity in diagnosing diabetic polyneuropathy using cardiac tests (heart rate variability) as a reference standard because autonomic small fibers are affected first by this disease. METHODS: Seventy-nine individuals between the ages of 19 and 79 years old (28 males) were evaluated and divided into three groups: control (n = 37), pre-diabetics (n = 13) and type 2 diabetics (n = 29). The plantar images were recorded at baseline and then minutes after a provocative maneuver (Cold Stress Test) using an infrared camera that is appropriate for clinical use. Two thermographic variables were studied: the thermal recovery index and the interdigital anisothermal technique. Heart rate variability was measured in a seven-test battery that included three spectral indexes (in the frequency domain) and four Ewing tests (the Valsalva maneuver, the orthostatic test, a deep breathing test, and the orthostatic hypotension test). Other classically recommended tests were applied, including electromyography (EMG), Michigan inventory, and a clinical interview that included a neurological physical examination. RESULTS: Among the diabetic patients, the interdigital anisothermal technique alone performed better than the thermal recovery index alone, with a better sensitivity (81.3%) and specificity (46.2%). For the pre-diabetic patients, the three tests performed equally well. None of the control subjects displayed abnormal interdigital anisothermal readouts or thermal recovery indices, which precluded the sensitivity estimation in this sample of subjects. However, the specificity (70.6%) was higher in this group. CONCLUSION: In this study, plantar thermography, which predominately considers the small and autonomic fibers that are commonly associated with a sub-clinical condition, proved useful in diagnosing diabetic neuropathy early. The interdigital anisothermal test, when used alone, performed best. PMID:23295596

  17. Neuromuscular function and fatigue resistance of the plantar flexors following short-term cycling endurance training.

    PubMed

    Behrens, Martin; Weippert, Matthias; Wassermann, Franziska; Bader, Rainer; Bruhn, Sven; Mau-Moeller, Anett

    2015-01-01

    Previously published studies on the effect of short-term endurance training on neuromuscular function of the plantar flexors have shown that the H-reflex elicited at rest and during weak voluntary contractions was increased following the training regime. However, these studies did not test H-reflex modulation during isometric maximum voluntary contraction (iMVC) and did not incorporate a control group in their study design to compare the results of the endurance training group to individuals without the endurance training stimulus. Therefore, this randomized controlled study was directed to investigate the neuromuscular function of the plantar flexors at rest and during iMVC before and after 8 weeks of cycling endurance training. Twenty-two young adults were randomly assigned to an intervention group and a control group. During neuromuscular testing, rate of torque development, isometric maximum voluntary torque and muscle activation were measured. Triceps surae muscle activation and tibialis anterior muscle co-activation were assessed by normalized root mean square of the EMG signal during the initial phase of contraction (0-100, 100-200 ms) and iMVC of the plantar flexors. Furthermore, evoked spinal reflex responses of the soleus muscle (H-reflex evoked at rest and during iMVC, V-wave), peak twitch torques induced by electrical stimulation of the posterior tibial nerve at rest and fatigue resistance were evaluated. The results indicate that cycling endurance training did not lead to a significant change in any variable of interest. Data of the present study conflict with the outcome of previously published studies that have found an increase in H-reflex excitability after endurance training. However, these studies had not included a control group in their study design as was the case here. It is concluded that short-term cycling endurance training does not necessarily enhance H-reflex responses and fatigue resistance. PMID:26029114

  18. Repeatability of Infrared Plantar Thermography in Diabetes Patients: A Pilot Study

    PubMed Central

    Balbinot, Luciane Fachin; Robinson, Caroline Cabral; Achaval, Matilde; Zaro, Milton Antônio; Brioschi, Marcos Leal

    2013-01-01

    Objective Infrared (IR) thermography has been used as a complementary diagnostic method in several pathologies, including distal diabetic neuropathy, by tests that induce thermoregulatory responses, but nothing is known about the repeatability of these tests. This study aimed to assess the repeatability of the rewarming index in subjects with type 2 diabetes mellitus (T2DM) and nondiabetic control subjects. Methods Using an IR camera, plantar IR images were collected at baseline (pre-) and 10 min after (post-) cold stress testing on two different days with 7 days interval. Plantar absolute average temperatures pre- and post-cold stress testing, the difference between them (ΔT), and the rewarming index were obtained and compared between days. Repeatability of the rewarming index after the cold stress test was assessed by Bland–Altman plot limits of agreement. Results Ten T2DM subjects and ten nondiabetic subjects had both feet analyzed. Mean age did not differ between groups (p = .080). Absolute average temperatures of plantar region pre- (p = .033) and post-cold stress test (p = .019) differed between days in nondiabetic subjects, whereas they did not differ in T2DM subjects (pretest, p = .329; post-test, p = .540). ΔT and rewarming index did not differ between days for both groups, and the rewarming index presented a 100% agreement of day-to-day measurements from T2DM subjects and 95% with nondiabetic subjects. Conclusions The rewarming index after cold stress testing presented good repeatability between two days a week in both groups. Despite T2DM subjects presenting no differences on absolute temperature values between days, ΔT or rewarming index after cold stress testing remain recommended beside absolute temperature values for clinical use. PMID:24124938

  19. Plantar pressure analysis of accommodative insole in older people with metatarsalgia.

    PubMed

    Chang, Bao-Chi; Liu, Ding-Hao; Chang, Jeffrey Liao; Lee, Si-Huei; Wang, Jia-Yi

    2014-01-01

    Foot pain frequently reduces physical activity and increases the risk of falls in older people. In current orthotic management of forefoot pain, metatarsal padding is the main strategy to reduce metatarsal pressure. However, pressure reductions are usually diverse and limited. The multi-step accommodative insole is fabricated by sequential foam padding on Plastazote under dynamic accommodation in daily walking. The aims of this study were to investigate the effectiveness and mechanisms of accommodative insole on plantar pressure redistribution in older people with metatarsalgia. The study was conducted on 21 old outpatients with moderate to severe metatarsalgia, using the ethylene vinyl acetate control, 9-mm flat Plastazote, and accommodative insoles with and without metatarsal and arch support. Outcome measures included pressure-related variables measured by a Pedar-X system, and pain scores assessed with a 0-10 Visual Analog Scale. The accommodative insole significantly decreased peak pressure under the metatarsal heads by 47.2% (p<0.001) and the pain scores from 8.2 to 1.1 (p<0.001). Plantar pressure analyses indicated that the effects of dynamic metatarsal contouring and cushioning on reducing peak pressure were greater than those of metatarsal padding. The temporo-spatial relationships between the toe and metatarsal head can assist in explaining an elevated metatarsal pressure and higher risk of falls in older people with toe deformities. The multi-step insole is simple in orthotic fabrication and ensures an even distribution of plantar pressure loading in walking. It can effectively relieve metatarsalgia and help to preserve regular walking activity for older people with metatarsalgia. PMID:24119776

  20. Laryngeal squamous cell carcinoma with knee and heel skin metastases: a case report.

    PubMed

    Kavgaci, Halil; Yildiz, Bulent; Cobanoglu, Umit; Fidan, Evren; Ozdemir, Feyyaz; Aydin, Fazil

    2010-01-01

    Distant metastases from laryngeal carcinoma are frequently seen in the lung, bone and liver, while skin metastases are rarely observed. In these cases presented as case reports in the literature, the supradiaphragmatic region is usually involved. Skin metastasis in lower extremity has only been reported in a few cases. While being an indicator of poor prognosis, skin metastasis is also considered as a messenger of distant organ metastasis. Survival is very short after development of skin metastasis. In our case, nodular skin metastasis was found both in the superior-lateral margin of the left patella and in the right heel. This is the first case reported in the literature on laryngeal carcinoma metastasizing to these localizations. PMID:20361886

  1. Preventing healthcare-associated transmission of the Middle East Respiratory Syndrome (MERS): Our Achilles heel.

    PubMed

    Balkhy, Hanan H; Perl, Trish M; Arabi, Yaseen M

    2016-01-01

    Middle East Respiratory Syndrome (MERS) coronavirus is the most recent among the Coronaviridae family to jump species and infect humans. Major healthcare associated MERS outbreaks have occurred in the Middle East and Korea that affected both patients and healthcare workers. These outbreaks were characterized by intra and inter-hospital spread and were exacerbated specifically by overcrowding, delayed diagnosis and appropriate use of personal protective equipment. Recent experience with this virus emphasizes the importance of compliance with infection control practices and with other interventions addressing patient triage, placement and flow within and between healthcare facilities. Our Achilles heel remains compliance with the best infection prevention practices and their harmonization with patient flow. Both infection prevention compliance and maintenance of patient flow are critical in preventing healthcare-associated transmission of many of these emerging infectious diseases, including MERS. PMID:27158023

  2. Plantar-Plate Disruptions: “The Severe Turf-Toe Injury.” Three Cases in Contact Athletes

    PubMed Central

    Drakos, Mark C.; Fiore, Russell; Murphy, Conor; DiGiovanni, Christopher W.

    2015-01-01

    Objective: To present 3 cases of plantar-plate rupture and turf-toe injury in contact athletes at 1 university and to discuss appropriate diagnosis and treatment algorithms for each case. Background: Turf toe is a common injury in athletes participating in outdoor cutting sports. However, it has been used as an umbrella term to describe many different injuries of the great toe. In some cases, the injury can be so severe that the plantar plate and sesamoid apparatus may be ruptured. These patients may be better managed with surgery than with traditional nonoperative interventions. Differential Diagnosis: Turf toe, plantar-plate disruption, sesamoid fracture. Treatment: For stable injuries in which the plantar plate is not completely disrupted, nonoperative treatment with casting or a stiff-soled shoe, gradual weight bearing, and rehabilitation is the best practice. Unstable injuries require surgical intervention and plantar-plate repair. Uniqueness: Turf toe and injury to the first metatarsophalangeal joint are relatively common injuries in athletes, but few researchers have detailed the operative and nonoperative treatments of plantar-plate disruption in these patients. We examine 3 cases that occurred over 4 seasons on a collegiate football team. Conclusions: Turf toe represents a wide array of pathologic conditions involving the first metatarsophalangeal joint. Stress and instability testing are key components to assess in determining whether surgical intervention is warranted to restore optimal function. Stiffer-soled shoes or shoes with steel-plate insertions may help to prevent these injuries and are useful tools for protection during the rehabilitation period. PMID:25695855

  3. Heel bone strength is related to lifestyle factors in Okinawan men with type 2 diabetes mellitus

    PubMed Central

    Gushiken, Michiko; Komiya, Ichiro; Ueda, Shinichiro; Kobayashi, Jun

    2015-01-01

    Aims/Introduction Although male diabetic patients have an increased risk of fracture, there is little information about this in the literature. The association between heel bone stiffness and the lifestyle of male patients with diabetes was evaluated. Materials and Methods The study included 108 participants with type 2 diabetes mellitus patients and 168 age-adjusted, healthy male volunteers. None of the participants had a history of osteoporosis or other severe diseases. Heel bone stiffness was examined by quantitative ultrasound, and each participant completed a health interview survey questionnaire. Bone stiffness was taken as an indicator of bone strength. Stepwise regression analysis was used to investigate associations between bone stiffness and lifestyle-related factors, such as sunlight exposure, intake of milk or small fish, regular exercise, cigarette smoking, consumption of alcohol, and number of remaining teeth. Results Bone stiffness showed a significant negative association with cigarette smoking [standardized coefficient (SC) = −0.297, F-value (F) = 10.059] and age (SC = −0.207, F = 7.565) in diabetic patients. Bone stiffness showed a significant negative association with age (SC = −0.371, F = 12.076) and height (SC = −0.193, F = 7.898), as well as a significant positive association with sunlight exposure (SC = 0.182, F = 9.589) and intake of small fish (SC = 0.170, F = 7.393) in controls. Conclusions These findings suggest that cigarette smoking and age are negatively associated with bone stiffness in Okinawan male patients with type 2 diabetes mellitus. PMID:25802722

  4. Plantar pressure patterns in women affected by Ehlers-Danlos syndrome while standing and walking.

    PubMed

    Pau, Massimiliano; Galli, Manuela; Celletti, Claudia; Morico, Gianfranco; Leban, Bruno; Albertini, Giorgio; Camerota, Filippo

    2013-11-01

    This study aims to quantitatively characterize plantar pressure distribution in women affected by Ehlers-Danlos syndrome of the hypermobile type (EDS-HT) to verify the existence of peculiar patterns possibly related to postural anomalies or physical and functional lower limb impairments typical of this disease. A sample of 26 women affected by EDS-HT (mean age 36.8, SD 12.0) was tested using a pressure platform in two conditions, namely static standing and walking. Raw data were processed to assess contact area and mean and peak pressure distribution in rearfoot, midfoot and forefoot. Collected data were then compared with those obtained from an equally numbered control group of unaffected women matched for age and anthropometric features. The results show that, in both tested conditions, women with EDS-HT exhibited significantly smaller forefoot contact areas and higher peak and mean pressure than the control group. No differences in the analyzed parameters were found between right and left limb. The findings of the present study suggest that individuals with EDS-HT are characterized by specific plantar pressure patterns that are likely to be caused by the morphologic and functional foot modification associated with the syndrome. The use of electronic pedobarography may provide physicians and rehabilitation therapists with information useful in monitoring the disease's progression and the effectiveness of orthotic treatments. PMID:24021390

  5. Effects of surface characteristics on the plantar shape of feet and subjects' perceived sensations.

    PubMed

    Witana, Channa P; Goonetilleke, Ravindra S; Xiong, Shuping; Au, Emily Y L

    2009-03-01

    Orthotics and other types of shoe inserts are primarily designed to reduce injury and improve comfort. The interaction between the plantar surface of the foot and the load-bearing surface contributes to foot and surface deformations and hence to perceived comfort, discomfort or pain. The plantar shapes of 16 participants' feet were captured when standing on three support surfaces that had different cushioning properties in the mid-foot region. Foot shape deformations were quantified using 3D laser scans. A questionnaire was used to evaluate the participant's perceptions of perceived shape and perceived feeling. The results showed that the structure in the mid-foot could change shape, independent of the rear-foot and forefoot regions. Participants were capable of identifying the shape changes with distinct preferences towards certain shapes. The cushioning properties of the mid-foot materials also have a direct influence on perceived feelings. This research has strong implications for the design and material selection of orthotics, insoles and footwear. PMID:18513701

  6. The plantar fat pad and the diabetic foot--a review.

    PubMed

    Dalal, Sunit; Widgerow, Alan D; Evans, Gregory R D

    2015-12-01

    There has been much debate concerning the pathologic consequences of diabetes on the plantar fat pad and its subsequent association with the development of a foot ulcer. This review article documents two theories regarding pathophysiology in diabetic foot ulcer formation as they are related to the plantar fat pad and discusses current treatment options for this pathophysiological phenomenon. Traditionally, fat pad atrophy in diabetic patients was thought to result as an irregular arrangement of collagen fibrils within the septal walls as a result of glycation as well as diminishing adipocyte size due to thickened septal walls. Contrary to this traditional theory, a model depicting distal fat pad migration from under the metatarsal heads has been described in the diabetic patient. Such pad migration renders the metatarsal heads vulnerable to increased pressure, which, in turn, predisposes to foot ulceration. This migratory fat pad theory plays a significant role in approaches to the prevention of diabetic foot ulceration and subsequent amputation. Various methods of fat pad supplementation and claw toe management are impacted by the pathophysiological changes described and new avenues of therapy may be based on these changes. PMID:24131727

  7. Increased plantar force and impulse in American football players with high arch compared to normal arch

    PubMed Central

    Carson, Daniel W.; Myer, Gregory D.; Hewett, Timothy E.; Heidt, Robert S.; Ford, Kevin R.

    2014-01-01

    Background Risk of overuse injury among athletes is high due in part to repeated loading of the lower extremities. Compared to individuals with normal arch (NA) structure, those with high (HA) or low arch (LA) may be at increased risk of specific overuse injuries, including stress fractures. A high medial longitudinal arch may result in decreased shock absorbing properties due to increased rigidity in foot mechanics. While the effect of arch structure on dynamic function has been examined in straight line walking and running, the relationship between the two during multi-directional movements remains unstudied. Objective The purpose of this study was to determine if differences in plantar loading in football players occur during both walking and pivoting movements. Method Plantar loading was examined in 9 regions of the foot for 26 participants (16 NA, 10 HA). Results High arch athletes demonstrated increased maximum force in the lateral rear foot and medial forefoot, and force time integral in the medial forefoot while walking. HA athletes also demonstrated increased maximum force in the medial rear foot and medial and central forefoot during rapid pivoting. Conclusions The current findings demonstrate that loading patterns differ between football players with high and normal arch structure, which could possibly influence injury risk in this population. PMID:23141809

  8. Reliability of Various Measurement Stations for Determining Plantar Fascia Thickness and Echogenicity.

    PubMed

    Bisi-Balogun, Adebisi; Cassel, Michael; Mayer, Frank

    2016-01-01

    This study aimed to determine the relative and absolute reliability of ultrasound (US) measurements of the thickness and echogenicity of the plantar fascia (PF) at different measurement stations along its length using a standardized protocol. Twelve healthy subjects (24 feet) were enrolled. The PF was imaged in the longitudinal plane. Subjects were assessed twice to evaluate the intra-rater reliability. A quantitative evaluation of the thickness and echogenicity of the plantar fascia was performed using Image J, a digital image analysis and viewer software. A sonography evaluation of the thickness and echogenicity of the PF showed a high relative reliability with an Intra class correlation coefficient of ≥0.88 at all measurement stations. However, the measurement stations for both the PF thickness and echogenicity which showed the highest intraclass correlation coefficient (ICCs) did not have the highest absolute reliability. Compared to other measurement stations, measuring the PF thickness at 3 cm distal and the echogenicity at a region of interest 1 cm to 2 cm distal from its insertion at the medial calcaneal tubercle showed the highest absolute reliability with the least systematic bias and random error. Also, the reliability was higher using a mean of three measurements compared to one measurement. To reduce discrepancies in the interpretation of the thickness and echogenicity measurements of the PF, the absolute reliability of the different measurement stations should be considered in clinical practice and research rather than the relative reliability with the ICC. PMID:27089369

  9. Decreased foot inversion force and increased plantar surface after maximal incremental running exercise.

    PubMed

    Vie, Bruno; Brerro-Saby, Christelle; Weber, Jean Paul; Jammes, Yves

    2013-06-01

    Formulating the hypothesis that a maximal running exercise could induce fatigue of some foot muscles, we searched for electromyographic (EMG) signs of fatigue in the tibialis anterior (TA), peroneus longus (PL), and gastrocnemius medialis (GM) muscles. We also searched for post-exercise alterations of the stationary upright standing in normal-arched feet subjects. Healthy subjects performed a maximal running exercise. Surface EMGs of the TA, PL, and GM muscles were analysed during maximal dynamic efforts. Before and after the running bout, we measured the evoked compound muscle potential (M-wave) in TA, the maximal force into inversion (MIF), and the repartition of the plantar and barycentre surfaces with a computerised stationary platform. During maximal running exercise, the median frequency of the EMG spectra declined in TA while it remained stable in the PL and GM muscles. After the exercise, MIF decreased, and both the rearfoot plantar surface and the barycentre surface increased. We concluded that a maximal running bout elicits EMG signs of fatigue, though only in the TA muscle. It also elicits post-exercise changes in the foot position during stationary upright standing which indicates a foot eversion. These data solely concern a maximal running test and they can not be extrapolated to walking or running at a low speed. PMID:23313412

  10. [Dynamic plantar pressure distribution after percutaneous hallux valgus correction using the Reverdin-Isham osteotomy].

    PubMed

    Rodrguez-Reyes, Gerardo; Lpez-Gavito, Eduardo; Prez-Sanpablo, Alberto Isaac; Galvn Duque-Gastlum, Carlos; Alvarez-Camacho, Micheln; Mendoza-Cruz, Felipe; Parra-Tllez, Patricia; Vzquez-Escamilla, Jess; Quiones-Uristegui, Ivett

    2014-07-01

    Percutaneous surgical techniques are suitable for the correction of the hallux valgus deformity. Satisfactory aesthetic and functional results obtained with the Reverdin- Isham osteotomy have been reported. The aim of this study was to describe dynamic plantar pressure redistribution after the correction of the deformity using this technique. A sample of 20 feet with mild or moderate hallux valgus was conformed and surgically treated using the Reverdin-Isham osteotomy. Clinical, radiological, surface and pressure assessments were performed pre and postoperatively. Postoperative mean ( SD) values of the American Orthopaedic Foot and Ankle Society (AOFAS) score, metatarsophalangeal, first intermetatarsal and proximal articular sect angles were 95.7 (3.3), 15.5 (5.4), 9.5 (1.5) y 5.3 (3.0), respectively. A significant decrease was observed in surface values of both lateral (P = 0.003) and medial (P = 0.001) masks of the forefoot. Mean pressure values of the lateral forefoot region denoted a significant increase (P < 0.001) while the medial forefoot region showed no change (P = 0.137). There is evidence that this particular surgical technique promotes a new plantar pressure pattern in the foot that might significantly favour the increase of the pressure observed under the lesser metatarsal heads and might not induce meaningful changes in the mean pressure registered under the first metatarsal head and hallux. PMID:25264801

  11. Evidence of Preserved Oxidative Capacity and Oxygen Delivery in the Plantar Flexor Muscles With Age.

    PubMed

    Hart, Corey R; Layec, Gwenael; Trinity, Joel D; Liu, Xin; Kim, Seong-Eun; Groot, H Jonathan; Le Fur, Yann; Sorensen, Jacob R; Jeong, Eun-Kee; Richardson, Russell S

    2015-09-01

    Studies examining the effect of aging on skeletal muscle oxidative capacity have yielded equivocal results; however, these investigations may have been confounded by differences in oxygen (O(2)) delivery, physical activity, and small numbers of participants. Therefore, we evaluated skeletal muscle oxidative capacity and O(2) delivery in a relatively large group (N = 40) of young (22 2 years) and old (73 7 years) participants matched for physical activity. After submaximal dynamic plantar flexion exercise, phosphocreatine (PCr) resynthesis ((31)P magnetic resonance spectroscopy), muscle reoxygenation (near-infrared spectroscopy), and popliteal artery blood flow (Doppler ultrasound) were measured. The phosphocreatine recovery time constant (Tau) (young: 33 16; old: 30 11 seconds), maximal rate of adenosine triphosphate (ATP) synthesis (young: 25 9; old: 27 8 mM/min), and muscle reoxygenation rates determined by the deoxyhemoglobin/myoglobin recovery Tau (young: 48 5; old: 47 9 seconds) were similar between groups. Similarly, although tending to be higher in the old, there were no significant age-related differences in postexercise popliteal blood flow (area under the curve: young: 1,665 227 vs old: 2,404 357 mL, p = .06) and convective O(2) delivery (young: 293 146 vs old: 404 191 mL, p = .07). In conclusion, when physical activity and O(2) delivery are similar, oxidative capacity in the plantar flexors is not affected by aging. These findings reveal that diminished skeletal muscle oxidative capacity is not an obligatory accompaniment to the aging process. PMID:25165028

  12. The relationship between trans-femoral prosthesis alignment and the center trajectory of plantar pressure in the frontal plane.

    PubMed

    Nomura, Tomohiro; Watanabe, Kota; Nosaka, Toshiya; Matsubara, Hiroyuki; Akiyama, Masaharu; Inui, Kimiharu

    2016-01-01

    [Purpose] It is difficult to identify by visual observation whether alignment abnormalities in trans-femoral prostheses in the frontal plane are attributable to the adduction angle or the abnormal alignment of the positions of the medial and lateral sides of the socket in relation to the foot. Therefore, we focused on the trajectory of the center of plantar pressure during walking, and we proposed a method for differentiating these two alignment abnormalities. [Subjects and Methods] We recruited 4 trans-femoral unilateral amputees. Bench alignment was achieved initially. We compared the amplitude of the trajectory of the center of plantar pressure when walking under 2 conditions: 1) when changing the adduction angle and 2) when changing the positional relationship between the socket and the foot. [Results] It was not possible to distinguish between the 2 types of malalignment on the prosthesis side. There was a significant difference when changing the positional relationship on the contralateral side. Thereby, the plantar pressure of the contralateral side could be used to distinguish between the 2 types of malalignment. [Conclusion] The results of this study suggested that trans-femoral prosthesis malalignment could be evaluated through the plantar pressure of the contralateral side in amputees. PMID:27065546

  13. The relationship between trans-femoral prosthesis alignment and the center trajectory of plantar pressure in the frontal plane

    PubMed Central

    Nomura, Tomohiro; Watanabe, Kota; Nosaka, Toshiya; Matsubara, Hiroyuki; Akiyama, Masaharu; Inui, Kimiharu

    2016-01-01

    [Purpose] It is difficult to identify by visual observation whether alignment abnormalities in trans-femoral prostheses in the frontal plane are attributable to the adduction angle or the abnormal alignment of the positions of the medial and lateral sides of the socket in relation to the foot. Therefore, we focused on the trajectory of the center of plantar pressure during walking, and we proposed a method for differentiating these two alignment abnormalities. [Subjects and Methods] We recruited 4 trans-femoral unilateral amputees. Bench alignment was achieved initially. We compared the amplitude of the trajectory of the center of plantar pressure when walking under 2 conditions: 1) when changing the adduction angle and 2) when changing the positional relationship between the socket and the foot. [Results] It was not possible to distinguish between the 2 types of malalignment on the prosthesis side. There was a significant difference when changing the positional relationship on the contralateral side. Thereby, the plantar pressure of the contralateral side could be used to distinguish between the 2 types of malalignment. [Conclusion] The results of this study suggested that trans-femoral prosthesis malalignment could be evaluated through the plantar pressure of the contralateral side in amputees. PMID:27065546

  14. Activation of spinal phosphatidylinositol 3-kinase/protein kinase B mediates pain behavior induced by plantar incision in mice.

    PubMed

    Xu, Bing; Guan, Xue-Hai; Yu, Jun-Xiong; Lv, Jing; Zhang, Hong-Xing; Fu, Qiao-Chu; Xiang, Hong-Bing; Bu, Hui-Lian; Shi, Dai; Shu, Bin; Qin, Li-Sheng; Manyande, Anne; Tian, Yu-Ke

    2014-05-01

    The etiology of postoperative pain may be different from antigen-induced inflammatory pain and neuropathic pain. However, central neural plasticity plays a key role in incision pain. It is also known that phosphatidylinositol 3-kinase (PI3K) and protein kinase B/Akt (PKB/Akt) are widely expressed in laminae I-IV of the spinal horn and play a critical role in spinal central sensitization. In the present study, we explored the role of PI3K and Akt in incision pain behaviors. Plantar incision induced a time-dependent activation of spinal PI3K-p110γ and Akt, while activated Akt and PI3K-p110γ were localized in spinal neurons or microglias, but not in astrocytes. Pre-treatment with PI3K inhibitors, wortmannin or LY294002 prevented the activation of Akt brought on by plantar incision in a dose-dependent manner. In addition, inhibition of spinal PI3K signaling pathway prevented pain behaviors (dose-dependent) and spinal Fos protein expression caused by plantar incision. These data demonstrated that PI3K signaling mediated pain behaviors caused by plantar incision in mice. PMID:24594219

  15. Effects of the application of Low-Dye taping on the pain and stability of patients with plantar fasciitis

    PubMed Central

    Park, Chan; Lee, Sangyong; Lim, Dong-young; Yi, Char-Woo; Kim, Jang Hwan; Jeon, Chunbae

    2015-01-01

    [Purpose] This study examined how the application of Low-Dye (LD) taping affected the pain and stability of patients with plantar fasciitis. [Subjects] The subjects were 30 patients with plantar fasciitis who were divided into two groups: a Low-Dye taping group (LTG, n=15) and a conservative treatment group (CTG, n=15). [Methods] The treatments were performed three times a week for six weeks in both groups. A visual analog scale (VAS) was used to evaluate the pain and stability of patients with plantar fasciitis, and the transfer area of the center of gravity (TAOCOG) was measured to evaluate stability using a BioRescue device. [Results] In the within-group comparison of the VAS, the LTG and CTG values significantly decreased. In the post-test between-group comparison, the VAS pain decreased more significantly in LTG than in CTG. In the within-group comparison of the TAOCOG, the LTG value significantly increased. In the post-test between-group comparison, the TAOCOG value increased more significantly than in LTG than in CTG. [Conclusion] Utilizing Low-Dye taping for patients with plantar fasciitis appears to be an effective intervention method for reducing pain and enhancing stability. PMID:26355306

  16. Ankle dorsi- and plantar-flexion torques measured by dynamometry in healthy subjects from 5 to 80 years

    PubMed Central

    2013-01-01

    Background Ankle strength is often impaired in some of the most common neuromuscular disorders. Consequently, strength generated around this joint is important to assess, because it has a great impact on balance and gait. The objectives of this study were to establish normative data and predictive equations for both ankle dorsi- and plantar-flexion strength from a population of healthy subjects (children and adults), to assess the reliability of the measurements and to study the feasibility of using a novel dynamometer on a group of patients with a neuromuscular disorder. Methods Measurements of maximal isometric torque for dorsi- and plantar-flexion were performed on 345 healthy subjects from 5 to 80 years of age. The feasibility of the method was tested on nine patients diagnosed with type 2A limb girdle muscular dystrophy. Results The results documented normal strength values depending on gender and age on ankle dorsi- and plantar-flexion. The reliability of the technique was good with no evaluator effect and a small learning effect. The dynamometer was found suitable in the group of patients, even very weak. Conclusions The device developed was both reliable and accurate in assessing both ankle dorsi-flexion and plantar-flexion torque measurements from weak patients and children to strong healthy adults. Norms and predictive equations are provided for these two muscle functions. PMID:23522186

  17. Three Case Reports of Successful Vibration Therapy of the Plantar Fascia for Spasticity Due to Cerebral Palsy-Like Syndrome, Fetal-Type Minamata Disease.

    PubMed

    Usuki, Fusako; Tohyama, Satsuki

    2016-04-01

    Fetal-type Minamata disease is caused by the exposure to high concentrations of methylmercury in the fetal period and shows cerebral palsy-like clinical features. Relief of spasticity is a major task of rehabilitation to improve their activities of daily living.Here we report the effect of long-term vibration therapy on bilateral lower-limb spasticity in 3 patients with fetal-type Minamata disease. We used a simple, inexpensive, and noninvasive approach with hand-held vibration massagers, which were applied to the plantar fascia at 90 Hz for 15 minutes.The effect was observed soon after the first treatment and resulted in better performance of the repetitive facilitation. Vibration therapy for 1 year improved Modified Ashworth Scale for the ankle flexors in 2 cases. The labored gait improved and gait speed increased in another case. Continued vibration therapy for another 1 year further improved Modified Ashworth Scale score and range of motion of ankle dorsiflexion in 1 case. This case showed the decreased amplitude of soleus H-reflex after the 15-minute vibration therapy, suggesting that α-motor neuron excitability was suppressed.Vibration therapy using a hand-held vibration massager may offer safe and effective treatment for lower-limb spasticity in patients with chronic neurological disorders. PMID:27082608

  18. Botulinum toxin effects on gasatrocnemius strength and plantar pressure in diabetics with peripheral neuropathy and forefoot ulceration

    PubMed Central

    Hastings, Mary K.; Mueller, Michael J.; Sinacore, David R.; Strube, Michael J.; Crowner, Beth; Johnson, Jeffrey E.; Racette, Brad A.

    2013-01-01

    Background High forefoot plantar pressure is associated with plantar ulcers in people with diabetes and peripheral neuropathy. The purpose of this pilot study is to determine safety and efficacy of botulinum toxin A injected into the gastrocnemius-soleus muscles to reduce muscle strength and plantar pressure. Materials and Methods This double blind, randomized clinical trial studied 17 people with diabetes mellitus, peripheral neuropathy and forefoot plantar ulcer. Subjects were randomized into one of three groups receiving gastrocnemius-soleus muscle injections on the involved side with; 1) Saline (n=5, weight = 99 ± 21 kg), 2) 200 units of Botox® (n=7, weight = 101 ± 5 kg), or 3) 300 units of Botox® (n=5, weight=129 ± 22 kg). Botox® dose was converted to units/kg, the majority received between 1.9 and 2.4 units/kg (n=11) and one 3.2 units/kg. Plantarflexor peak torque and forefoot peak plantar pressure were quantified prior and two weeks post injection. Results There were no complications from the injections. Plantarflexor peak torque on the involved side increased in the placebo and 300 groups (3 ± 4 Nm and 6 ± 10 Nm respectively) and decreased −8 ± 11 Nm in the 200 group. There was no relationship between units/kg of Botox® for each subject and change in plantarflexor peak torque. Forefoot peak plantar pressure did not change in the placebo and 300 groups (0 ± 11 and 0 ± 5 N/cm2 respectively) and decreased −4 ± 16 N/cm2 (4%) for the 200 group. Conclusions There were no adverse events associated with the Botox® injections. This study was unable to determine the dose to consistently reduce plantarflexor strength and forefoot plantar pressure. Additional research is needed to investigate diabetes mellitus specific physiological changes and their impact of BoNT-A effectiveness in order to guide appropriate dosing. PMID:22735277

  19. REMOVING SLUDGE HEELS FROM SAVANNAH RIVER SITE WASTE TANKS BY OXALIC ACID DISSOLUTION

    SciTech Connect

    Poirier, M; David Herman, D; Fernando Fondeur, F; John Pareizs, J; Michael Hay, M; Bruce Wiersma, B; Kim Crapse, K; Thomas Peters, T; Samuel Fink, S; Donald Thaxton, D

    2009-03-01

    The Savannah River Site (SRS) will remove sludge as part of waste tank closure operations. Typically the bulk sludge is removed by mixing it with supernate to produce a slurry, and transporting the slurry to a downstream tank for processing. Experience shows that a residual heel may remain in the tank that cannot be removed by this conventional technique. In the past, SRS used oxalic acid solutions to disperse or dissolve the sludge heel to complete the waste removal. To better understand the actual conditions of oxalic acid cleaning of waste from carbon steel tanks, the authors developed and conducted an experimental program to determine its effectiveness in dissolving sludge, the hydrogen generation rate, the generation rate of other gases, the carbon steel corrosion rate, the impact of mixing on chemical cleaning, the impact of temperature, and the types of precipitates formed during the neutralization process. The test samples included actual SRS sludge and simulated SRS sludge. The authors performed the simulated waste tests at 25, 50, and 75 C by adding 8 wt % oxalic acid to the sludge over seven days. They conducted the actual waste tests at 50 and 75 C by adding 8 wt % oxalic acid to the sludge as a single batch. Following the testing, SRS conducted chemical cleaning with oxalic acid in two waste tanks. In Tank 5F, the oxalic acid (8 wt %) addition occurred over seven days, followed by inhibited water to ensure the tank contained enough liquid to operate the mixer pumps. The tank temperature during oxalic acid addition and dissolution was approximately 45 C. The authors analyzed samples from the chemical cleaning process and compared it with test data. The conclusions from the work are: (1) Oxalic acid addition proved effective in dissolving sludge heels in the simulant demonstration, the actual waste demonstration, and in SRS Tank 5F. (2) The oxalic acid dissolved {approx} 100% of the uranium, {approx} 100% of the iron, and {approx} 40% of the manganese during a single contact in the simulant demonstration. (The iron dissolution may be high due to corrosion of carbon steel coupons.) (3) The oxalic acid dissolved {approx} 80% of the uranium, {approx} 70% of the iron, {approx} 50% of the manganese, and {approx} 90% of the aluminum in the actual waste demonstration for a single contact. (4) The oxalic acid dissolved {approx} 100% of the uranium, {approx} 15% of the iron, {approx} 40% of the manganese, and {approx} 80% of the aluminum in Tank 5F during the first contact cycle. Except for the iron, these results agree well with the demonstrations. The data suggest that a much larger fraction of the iron in the sludge dissolved, but it re-precipitated with the oxalate added to Tank 5F. (5) The demonstrations produced large volumes (i.e., 2-14 gallons of gas/gallon of oxalic acid) of gas (primarily carbon dioxide) by the reaction of oxalic acid with sludge and carbon steel. (6) The reaction of oxalic acid with carbon steel produced hydrogen in the simulant and actual waste demonstrations. The volume produced varied from 0.00002-0.00100 ft{sup 3} hydrogen/ft{sup 2} carbon steel. The hydrogen production proved higher in unmixed tanks than in mixed tanks.

  20. Plantar Wart

    MedlinePlus

    ... counter wart removers have a high percentage of salicylic acid and work by dissolving away the layer of ... if it touches unaffected skin around it; 40% salicylic acid self-stick pads appear to be one of ...

  1. Relationship between self-reported high-heeled shoe use and bone mineral density using quantitative ultrasound at a community health fair.

    PubMed

    Glassy, Crystal M; Glassy, Matthew S; Guggenheim, Carla

    2013-01-01

    This is the first known study to examine the relationship between high-heel use and bone mineral density (BMD). Because women are disproportionately affected by osteoporosis, it is important to identify possible modifiable behaviors of women that may adversely affect bone health. Many studies have shown changes in body mechanics when wearing high-heeled shoes in comparison to normal gait. Because the composition of bone changes according to mechanical load and muscle activity, this study investigates whether wearing high heels may alter BMD. Two hundred and twenty-one participants at a community health fair in Lansing, Michigan, were surveyed on high-heel use and bone health risk (gender, thin/small frame, fair skin, family history of fracture, smoking history, walking, dairy consumption, and early menopause or oopherectomy at <45 years old). Quantitative ultrasound (QUS) of the heel by Hologic's Sahara Sonometer was used to measure BMD. The mean age was 45.2 (SD 13.7) years, and the majority of participants were female (208, 94 %). A significant difference between mean BMD and high-heel use was not found. Independent correlations existed between fair skinned/sunburn easily and BMD, r(212) = -0.14, p = 0.038, as well as history of smoking and BMD, r(212) = -0.14, p = 0.042. Bone health risk score was strongly correlated with heel use binary variable "yes/no," r(210) = 0.21, p = 0.003. Our study suggests that wearing high-heeled shoes does not lead to appreciable differences in BMD among community health fair participants as assessed by QUS. PMID:22983265

  2. Skeletal transients during heel and toe strike running and the effectiveness of some materials in their attenuation.

    PubMed

    Oakley, T; Pratt, D J

    1988-08-01

    Because of the increased popularity of running, interest has focussed on ways of reducing injurious skeletal shocks. This paper examines heel and toe strike running styles and the effect of shock attenuating materials in reducing foot/floor contact forces and skeletal shocks. Using a force plate and an accelerometer, 18volunteers (10 men, 8 women) were studied and the following observations made. Firstly, toe striking reduced the skeletal transients and the rate of rise of foot loading. Secondly, the three materials studied (PPT, Viscolas and Cleron) all reduced the rate of foot loading in heel strike, but only one (PPT) affected the skeletal transient peak height during toe strike. No other significant results were obtained. PMID:23915893

  3. Cyclic impacts on heel strike: a possible biomechanical factor in the etiology of degenerative disease of the human locomotor system.

    PubMed

    Folman, Y; Wosk, J; Voloshin, A; Liberty, S

    1986-01-01

    The cyclic impacts induced by heel strike when walking were studied using both a high-resonance-frequency force plate and a low-mass skin-mounted accelerometer. The data were computer analyzed. The results showed that during normal human walking, the locomotor system is subjected to repetitive impact loads at heel strike, lasting about 5 ms and consisting of frequency spectra up to and above 100 Hz. The natural shock-absorbing structures in the musculoskeletal system have viscoelastic time-dependent mechanical behavior, which is relatively ineffective in withstanding sudden impulsive loads. Degenerative joint diseases may thus be seen as a late clinical result of fatigue failure of the natural shock absorbers, submitted to deleterious impacts over a period of time. PMID:3964043

  4. Intermediate-term results of partial plantar fascia release with microtenotomy using bipolar radiofrequency microtenotomy.

    PubMed

    Lucas, Douglas E; Ekroth, Scott R; Hyer, Christopher F

    2015-01-01

    Plantar fasciitis is a common condition, with most patients treated successfully with nonoperative management. Recalcitrant disease has been managed with surgical procedures that vary in design and associated morbidity. The present study sought to determine the intermediate-term results of percutaneous bipolar radiofrequency microtenotomy in recalcitrant plantar fasciitis. The patient medical records were reviewed, and data were gathered for all the patients who met the inclusion criteria. The foot function index and visual analog scale (VAS) pain scale questionnaires were mailed to the 111 patients. Of the 111 patients, 61 (55.0%) returned their questionnaires and were ultimately included in the present analysis. Of the 61 patients, 44 (72.1%) were female and 17 were (27.9%) male, with an average reported follow-up of 33.3 ± 8.6 (range 16.1 to 46.6) months. The median postoperative VAS score was 0.0 (range 0.0 to 10.0), and the median foot function index score was 3.1 (range 0.0 to 97.1). The patients were subdivided into success and failure groups according to their satisfaction. Of the 61 patients, 51 (83.6%) were satisfied and would recommend the procedure to a friend. The median VAS score in the success group was 0.0 (range 0.0 to 5.0), and the median VAS score in the failure group was 6.0 (range 0.0 to 10.0), a significant difference (p < .001). A significant difference was also seen in the foot function index score between the success (median 2.4, range 0.0 to 25.7) and failure (median 37.4, range 0.0 to 97.1) groups (p < .001). Bipolar radiofrequency microtenotomy appears to be a safe procedure that can provide outcomes equivalent to those with open surgery, with less morbidity, for recalcitrant plantar fasciitis. PMID:25617155

  5. Difference in plantar pressure between the preferred and non‐preferred feet in four soccer‐related movements

    PubMed Central

    Wong, Pui‐lam; Chamari, Karim; Chaouachi, Anis; De Wei Mao; Wisløff, Ulrik; Hong, Youlian

    2007-01-01

    Objective and participants The present study measured the difference in plantar pressure between the preferred and non‐preferred foot in four soccer‐related movements in 15 male university soccer players (mean (SD) age 20.9 (1.3) years, mean (SD) height 173 (4) cm and mean (SD) weight 61.7 (3.6) kg). Design To record plantar pressure distribution, players randomly wore three types of soccer shoes (classical 6‐stud and 12‐stud, and specially designed 12‐stud) embedded with an insole pressure recorder device with 99 sensors, divided into 10 areas for analysis. Plantar pressure was recorded in five successful trials in each of the four soccer‐related movements: running (at 3.3 m/s), sideward cutting, 45° cutting and landing from a vertical jump. Results Plantar pressures of the preferred and non‐preferred foot were different in 115 of 120 comparisons. The overall plantar pressure of the preferred foot was higher than that of the non‐preferred foot. Specifically, in each of the four movements, higher pressure was found in the preferred foot during the take‐off phase, whereas this was found in the non‐preferred foot during the landing phase. This would suggest a tendency of the preferred foot for higher motion force and of the non‐preferred foot for a greater role in body stabilisation. Conclusions The data indicate that the preferred and non‐preferred foot should be treated independently with regard to strength/power training to avoid unnecessary injuries. Different shoes/insoles and different muscular strengthening programmes are thus suggested for each of the soccer player's feet. PMID:17138639

  6. Sensory Re-Weighting in Human Bipedal Postural Control: The Effects of Experimentally-Induced Plantar Pain

    PubMed Central

    Pradels, Antoine; Pradon, Didier; Hlavačková, Petra; Diot, Bruno; Vuillerme, Nicolas

    2013-01-01

    The present study was designed to assess the effects of experimentally-induced plantar pain on the displacement of centre of foot pressure during unperturbed upright stance in different sensory conditions of availability and/or reliability of visual input and somatosensory input from the vestibular system and neck. To achieve this goal, fourteen young healthy adults were asked to stand as still as possible in three sensory conditions: (1) No-vision, (2) Vision, and (3) No-vision – Head tilted backward, during two experimental conditions: (1) a No-pain condition, and (2) a condition when a painful stimulation was applied to the plantar surfaces of both feet (Plantar-pain condition). Centre of foot pressure (CoP) displacements were recorded using a force platform. Results showed that (1) experimentally-induced plantar pain increased CoP displacements in the absence of vision (No-vision condition), (2) this deleterious effect was more accentuated when somatosensory information from the vestibular and neck was altered (No-vision – Head tilted backward condition) and (3) this deleterious effect was suppressed when visual information was available (Vision condition). From a fundamental point of view, these results lend support to the sensory re-weighting hypothesis whereby the central nervous system dynamically and selectively adjusts the relative contributions of sensory inputs (i.e. the sensory weightings) in order to maintain balance when one or more sensory channels are altered by the task (novel or challenging), environmental or individual conditions. From a clinical point of view, the present findings further suggest that prevention and treatment of plantar pain may be relevant for the preservation or improvement of balance control, particularly in situations (or individuals) in which information provided by the visual, neck proprioceptive and vestibular systems is unavailable or disrupted. PMID:23840337

  7. Evaluation and Optimization of Therapeutic Footwear for Neuropathic Diabetic Foot Patients Using In-Shoe Plantar Pressure Analysis

    PubMed Central

    Bus, Sicco A.; Haspels, Rob; Busch-Westbroek, Tessa E.

    2011-01-01

    OBJECTIVE Therapeutic footwear for diabetic foot patients aims to reduce the risk of ulceration by relieving mechanical pressure on the foot. However, footwear efficacy is generally not assessed in clinical practice. The purpose of this study was to assess the value of in-shoe plantar pressure analysis to evaluate and optimize the pressure-reducing effects of diabetic therapeutic footwear. RESEARCH DESIGN AND METHODS Dynamic in-shoe plantar pressure distribution was measured in 23 neuropathic diabetic foot patients wearing fully customized footwear. Regions of interest (with peak pressure >200 kPa) were selected and targeted for pressure optimization by modifying the shoe or insole. After each of a maximum of three rounds of modifications, the effect on in-shoe plantar pressure was measured. Successful optimization was achieved with a peak pressure reduction of >25% (criterion A) or below an absolute level of 200 kPa (criterion B). RESULTS In 35 defined regions, mean peak pressure was significantly reduced from 303 (SD 77) to 208 (46) kPa after an average 1.6 rounds of footwear modifications (P < 0.001). This result constitutes a 30.2% pressure relief (range 18–50% across regions). All regions were successfully optimized: 16 according to criterion A, 7 to criterion B, and 12 to criterion A and B. Footwear optimization lasted on average 53 min. CONCLUSIONS These findings suggest that in-shoe plantar pressure analysis is an effective and efficient tool to evaluate and guide footwear modifications that significantly reduce pressure in the neuropathic diabetic foot. This result provides an objective approach to instantly improve footwear quality, which should reduce the risk for pressure-related plantar foot ulcers. PMID:21610125

  8. A comparison of the effectiveness of extracorporeal shock wave and ultrasound therapy in the management of heel pain

    NASA Astrophysics Data System (ADS)

    Cheing, G. L. Y.; Chang, H.; Lo, S. K.

    2007-11-01

    The aim of this study was to compare the effectiveness of extracorporeal shock wave therapy (ESWT) and ultrasound therapy (US) for managing heel pain. Thirty-seven subjects received either: ESWT (once a week), US (three times a week), or CONTROL (no treatment) for 3 consecutive weeks and were followed-up for 3 more weeks. A visual analogue scale (VAS), the maximum tolerable duration for prolonged walking or standing, and the Mayo clinical scoring system (MCSS) were evaluated. Mixed models treating baseline measures as covariates were adopted for statistical analysis. By week 3, intensity of heel pain on palpation was reduced by 37% (VAS score from 7.5 to 4.6) in the ESWT group, 24% (from 5.3 to 4.2) in the US group, and increased by 3% (5.6-5.7) in the control group; this difference was significant after adjusting for baseline VAS scores ( p = 0.022). The improvements in the maximum tolerable duration of prolonged walking or standing was only significant in the ESWT group (157% increase, p = 0.043) but not the other two groups. Both active treatment groups maintained the treatment effect at the three-week follow-up. We conclude that ESWT is potentially more effective in reducing heel pain than ultrasound therapy but additional evidence is needed due to the various limitations of the study.

  9. [Experimental gait study based on the plantar pressure test for the young people].

    PubMed

    Fang, Zheng; Zhang, Xingliang; Wang, Chao; Gu, Xin; Ma, Shenglin; Wang, Lei; Chen, Siyuan

    2014-12-01

    Based on force sensing resistor (FSR) sensor, we designed insoles for pressure measurement, which were stable and reliable with a simple structure, and easy to wear and to do outdoor experiments with. So the insoles could be used for gait detection system. The hardware includes plantar pressure sensor array, signal conditioning unit and main circuit unit. The software has the function of data acquisition, signal processing, feature extraction and classification function. We collected 27 groups of gait data of a healthy person based on this system to analyze the data and study pressure distribution under various gait features, i.e., walking on the flat ground, uphill, downhill, up the stairs, and down the stairs. These five gait patterns for pattern recognition and classification by K-nearest neighbors (KNN) recognition algorithm reached up to 90% accuracy. This preliminarily verified the usefulness of the system. PMID:25868244

  10. Plantar Pressure as a Risk Assessment Tool for Diabetic Foot Ulceration in Egyptian Patients with Diabetes

    PubMed Central

    Fawzy, Olfat A; Arafa, Asmaa I; El Wakeel, Mervat A; Abdul Kareem, Shaimaa H

    2014-01-01

    BACKGROUND Diabetic foot ulceration is a preventable long-term complication of diabetes. In the present study, peak plantar pressures (PPP) and other characteristics were assessed in a group of 100 Egyptian patients with diabetes with or without neuropathy and foot ulcers. The aim was to study the relationship between plantar pressure (PP) and neuropathy with or without ulceration and trying to clarify the utility of pedobarography as an ulceration risk assessment tool in patients with diabetes. SUBJECTS AND METHODS A total of 100 patients having diabetes were selected. All patients had a comprehensive foot evaluation, including assessment for neuropathy using modified neuropathy disability score (MNDS), for peripheral vascular disease using ankle brachial index, and for dynamic foot pressures using the MAT system (Tekscan). The studied patients were grouped into: (1) diabetic control group (DC), which included 37 patients who had diabetes without neuropathy or ulceration and MNDS ≤2; (2) diabetic neuropathy group (DN), which included 33 patients who had diabetes with neuropathy and MNDS >2, without current or a history of ulceration; and (3) diabetic ulcer group (DU), which included 30 patients who had diabetes and current ulceration, seven of those patients also gave a history of ulceration. RESULTS PP parameters were significantly different between the studied groups, namely, forefoot peak plantar pressure (FFPPP), rearfoot peak plantar pressure (RFPPP), forefoot/rearfoot ratio (F/R), forefoot peak pressure gradient (FFPPG) rearfoot peak pressure gradient (RFPPG), and forefoot peak pressure gradient/rearfoot peak pressure gradient (FFPPG/RFPPG) (P < 0.05). FFPPP and F/R were significantly higher in the DU group compared to the DN and DC groups (P < 0.05), with no significant difference between DN and DC. FFPPG was significantly higher in the DU and DN groups compared to the DC group (P < 0.05). RFPPP and FFPPG/RFPPG were significantly higher in the DU and DN groups compared to the DC group (P < 0.05) with no significant difference between the DN and DU groups (P > 0.05). FFPPP, F/R ratio, FFPPG, and FFPPG/RFPPG correlated significantly with the severity of neuropathy according to MNDS (P < 0.05). These same variables as well as MNDS were also significantly higher in patients with foot deformity compared to those without deformity (P < 0.05). Using the receiver operating characteristic analysis, the optimal cut-point of PPP for ulceration risk, as determined by a balance of sensitivity, specificity, and accuracy was 335 kPa and was found at the forefoot. Multivariate logistical regression analysis for ulceration risk was statistically significant for duration of diabetes (odds ratio [OR] = 0.8), smoking (OR = 9.7), foot deformity (OR = 8.7), MNDS (OR = 1.5), 2-h postprandial plasma glucose (2 h-PPG) (OR = 0.9), glycated hemoglobin (HbA1c) (OR = 2.1), FFPPP (OR = 1.0), and FFPPG (OR = 1.0). CONCLUSION In conclusion, persons with diabetes having neuropathy and/or ulcers have elevated PPP. Risk of ulceration was highly associated with duration of diabetes, smoking, severity of neuropathy, glycemic control, and high PP variables especially the FFPPP, F/R, and FFPPG. We suggest a cut-point of 355 kPa for FFPPP to denote high risk for ulceration that would be more valid when used in conjunction with other contributory risk factors, namely, duration of diabetes, smoking, glycemic load, foot deformity, and severity of neuropathy. PMID:25520564

  11. An update on the evaluation and management of plantar puncture wounds and Pseudomonas osteomyelitis.

    PubMed

    Inaba, A S; Zukin, D D; Perro, M

    1992-02-01

    The management of children who present to the ED with plantar puncture wounds is dependent upon the nature of the injury, the examination of the puncture site, and the potential risk of a retained foreign body. Not all patients will require wound enlargement and a search for a retained foreign body. Close follow-up of all children who are being treated as outpatients is of vital importance in detecting an early development of an infectious complication. Pseudomonas osteomyelitis should be suspected in all patients who present with foot pain, swelling, and a decreased ability to bear weight after sustaining a nail puncture through a sneaker. The current consensus favors open surgical débridement followed by a course of intravenous antibiotics. The exact duration of the postoperative antibiotic course is still being debated. PMID:1603689

  12. Plantar fibromatosis may adopt the brain gyriform pattern of a low-grade fibromyxoid sarcoma.

    PubMed

    Touraine, Sébastien; Bousson, Valérie; Kaci, Rachid; Parlier-Cuau, Caroline; Haddad, Samuel; Laouisset, Liess; Petrover, David; Laredo, Jean-Denis

    2013-01-01

    We report the case of a 42-year-old man with histologically proven plantar fibromatosis (Ledderhose disease) demonstrating an uncommon brain gyriform pattern at MRI, so far exclusively described in the low-grade fibromyxoid sarcoma (LGFMS). An acoustic posterior enhancement at ultrasound, a high intensity on T2w and post-contrast T1wMR images were unusual and related to a high tumor cellularity at histology with no myxoid tissue. The juxtaposition of areas of high and low cellularity (with more fibrous material) in a multilobulated mass built a brain gyriform pattern at MR, similar to what was so far described exclusively in LGFMS. This case demonstrates that the brain gyriform pattern may also be observed in other soft tissue fibrous tumors with no myxoid material but with high cellularity areas alternating with fibrous zones of low cellularity. PMID:23415764

  13. Dendritic cells as Achilles' heel and Trojan horse during varicella zoster virus infection.

    PubMed

    Schönrich, Günther; Raftery, Martin J

    2015-01-01

    Varicella zoster virus (VZV), a human alphaherpesvirus, causes varicella and subsequently establishes latency within sensory nerve ganglia. Later in life VZV can reactivate to cause herpes zoster. A reduced frequency of VZV-specific T cells is strongly associated with herpes zoster illustrating that these immune cells are central to control latency. Dendritic cells (DCs) are required for the generation of VZV-specific T cells. However, DCs can also be infected in vitro and in vivo allowing VZV to evade the antiviral immune response. Thus, DCs represent the immune systems' Achilles heel. Uniquely among the human herpesviruses, VZV infects both DCs and T cells, and exploits both as Trojan horses. During primary infection VZV-infected DCs traffic to the draining lymph nodes and tonsils, where the virus is transferred to T cells. VZV-infected T cells subsequently spread infection throughout the body to give the typical varicella skin rash. The delicate interplay between VZV and DCs and its consequences for viral immune evasion and viral dissemination will be discussed in this article. PMID:26005438

  14. EM-21 ALTERNATIVE ENHANCED CHEMICAL CLEANING PROGRAM FOR SLUDGE HEEL REMOVAL

    SciTech Connect

    Hay, M.; King, W.; Martino, C.

    2009-12-18

    Preliminary studies in the EM-21 Alternative Chemical Cleaning Program have focused on understanding the dissolution of Hematite (a primary sludge heel phase) in oxalic acid, with a focus on minimizing oxalic acid usage. Literature reviews, thermodynamic modeling, and experimental results have all confirmed that pH control, preferably using a supplemental proton source, is critical to oxalate minimization. With pH control, iron concentrations as high as 0.103 M have been obtained in 0.11 M oxalic acid. This is consistent with the formation of a 1:1 (iron:oxalate) complex. The solubility of Hematite in oxalic acid has been confirmed to increase by a factor of 3 when the final solution pH decreases from 5 to below 1. This is consistent with literature predictions of a shift in speciation from a 1:3 to 1:1 as the pH is lowered. Above a solution pH of 6, little Hematite dissolves. These results emphasize the importance of pH control in optimizing Hematite dissolution in oxalic acid.

  15. EM-31 ALTERNATIVE AND ENHANCED CHEMICAL CLEANING PROGRAM FOR SLUDGE HEEL REMOVAL - 11220

    SciTech Connect

    King, W.; Hay, M.; Wiersma, B.; Pennebaker, F.

    2010-12-10

    Mixtures of oxalic acid with nitric acid have been shown to be superior to oxalic acid alone for the dissolution of iron-rich High Level Waste sludge heels. Optimized conditions resulting in minimal oxalate usage and stoichiometric iron dissolution (based on added oxalate ion) have been determined for hematite (a primary sludge iron phase) in oxalic/nitric acid mixtures. The acid mixtures performed better than expected based on the solubility of hematite in the individual acids through a synergistic effect in which the preferred 1:1 Fe:oxalate complex is formed. This allows for the minimization of oxalate additions to the waste stream. Carbon steel corrosion rates were measured in oxalic/nitric acid mixtures to evaluate the impacts of chemical cleaning with these solutions on waste tank integrity. Manageable corrosion rates were observed in the concentration ranges of interest for an acid contact timescale of 1 month. Kinetics tests involving hematite and gibbsite (a primary sludge aluminum phase) have confirmed that {ge}90% solids dissolution occurs within 3 weeks. Based on these results, the chemical cleaning conditions recommended to promote minimal oxalate usage and manageable corrosion include: 0.5 wt. % oxalic acid/0.175 M nitric acid mixture, 50 C, 2-3 week contact time with agitation.

  16. The effect of three different toe props on plantar pressure and patient comfort

    PubMed Central

    2012-01-01

    Background Arthritic toe pathologies frequently lead to the development of painful apical pressure skin lesions that can compromise gait and affect quality of life. Historically conservative treatments involve the use of a toe prop with the intended aim of reducing plantar pressure from the apex of the digit. However, the effect of toe prop treatment on plantar digital pressure has not been investigated. Method Twenty two subjects were recruited with lesser digital deformities and associated apical skin lesions. Individual pressure sensors were placed on the apices of the lesser toes and pressure was recorded under three toe prop conditions (leather, gel and silicone mould). A modified comfort index was utilised to assess the comfort of each condition. Results Significant difference (p < 0.05) in mean peak pressure was observed at the apex of the 2nd toe when using the gel (p < 0.001) and silicone (p < 0.001) toe prop compared to no toe prop. There was also a significant difference in the mean pressure time integral at the apex of the 2nd toe when using gel (p < 0.001) and silicone (p < 0.004) toe props. There was no significant correlation between comfort and the recorded peak pressures. However, there was an indication that the silicone toe prop was more comfortable. Conclusion As compared to the leather and silicone mould toe props, gel toe props were found to be the most effective for reducing peak pressure and pressure time integral on the apex of the second digit in patients with claw or hammer toe deformity. PMID:22932230

  17. Residual force enhancement after lengthening is present during submaximal plantar flexion and dorsiflexion actions in humans.

    PubMed

    Pinniger, Gavin J; Cresswell, Andrew G

    2007-01-01

    Stretch of an activated muscle causes a transient increase in force during the stretch and a sustained, residual force enhancement (RFE) after the stretch. The purpose of this study was to determine whether RFE is present in human muscles under physiologically relevant conditions (i.e., when stretches were applied within the working range of large postural leg muscles and under submaximal voluntary activation). Submaximal voluntary plantar flexion (PF(v)) and dorsiflexion (DF(v)) activation was maintained by providing direct visual feedback of the EMG from soleus or tibialis anterior, respectively. RFE was also examined during electrical stimulation of the plantar flexion muscles (PF(s)). Constant-velocity stretches (15 degrees /s) were applied through a range of motion of 15 degrees using a custom-built ankle torque motor. The muscles remained active throughout the stretch and for at least 10 s after the stretch. In all three activation conditions, the stable joint torque measured 9-10 s after the stretch was greater than the isometric joint torque at the final joint angle. When expressed as a percentage of the isometric torque, RFE values were 7, 13, and 12% for PF(v), PF(s), DF(v), respectively. These findings indicate that RFE is a characteristic of human skeletal muscle and can be observed during submaximal (25%) voluntary activation when stretches are applied on the ascending limb of the force-length curve. Although the underlying mechanisms are unclear, it appears that sarcomere popping and passive force enhancement are insufficient to explain the presence of RFE in these experiments. PMID:16946022

  18. Alteration in neuromuscular function of the plantar flexors following caffeine ingestion.

    PubMed

    Behrens, Martin; Mau-Moeller, Anett; Heise, Sandra; Skripitz, Ralf; Bader, Rainer; Bruhn, Sven

    2015-02-01

    The aim of this study was to compare the neuromuscular function of the plantar flexors following caffeine or placebo administration. Thirteen subjects (25 ± 3 years) ingested caffeine or placebo in a randomized, controlled, counterbalanced, double-blind crossover design. Neuromuscular tests were performed before and 1 h after caffeine or placebo intake. During neuromuscular testing, rate of torque development, isometric maximum voluntary torque, and neural drive to the muscles were measured. Triceps surae muscle activation was assessed by normalized root mean square of the EMG signal during the initial phase of contraction (0-100 ms, 100-200 ms) and maximal voluntary contraction (MVC). Furthermore, evoked spinal reflex responses of the soleus muscle (H-reflex evoked at rest and during MVC, V-wave) and peak twitch torques were evaluated. The isometric maximum voluntary torque and evoked potentials were not different. However, we found a significant difference between groups for rate of torque development in the time intervals 0-100 ms [41.1 N · m/s (95% CI: 8.3-73.9 N · m/s, P = 0.016)] and 100-200 ms [32.8 N · m/s (95% CI: 2.8-62.8 N · m/s, P = 0.034)]. These changes were accompanied by enhanced neural drive to the plantar flexors. Data suggest that caffeine solely increased explosive voluntary strength of the triceps surae because of enhanced neural activation at the onset of contraction whereas MVC strength was not affected. PMID:24798789

  19. Use of locally made off-loading techniques for diabetic plantar foot ulcer in Karachi, Pakistan.

    PubMed

    Miyan, Zahid; Ahmed, Jameel; Zaidi, Syed I; Ahmedani, Muhammad Y; Fawwad, Asher; Basit, Abdul

    2014-12-01

    The aim of this study was to evaluate the effectiveness of applying locally made pressure off-loading techniques on plantar foot ulcer in individuals with diabetes. This prospective study of 70 diabetic patients was conducted at the foot clinic of Baqai Institute of Diabetology & Endocrinology. Plantar foot ulcer, stages 1A and 2A according to the University of Texas classification, was treated by using three off-loading techniques: modified foot wear (sandal), modified plaster of Paris cast with plywood platform and Scotchcast boot. The outcome was assessed at either complete wound healing (defined as complete epithelialisation) or at 12 weeks, whichever came first. Of the 70 patients, 24 were in modified foot wear group, 23 in modified plaster of Paris cast and 23 in Scotchcast boot group. There was almost equal proportion of patients healed within 12 weeks period treated with these three off-loading techniques, i.e. 22 (95·7%) for modified foot wear group, 19 (95%) for modified plaster cast and 18 (94·7%) for Scotchcast boot group. No significant difference was observed in median healing time and cumulative wound survival at 12 weeks in the three off-loading techniques. Modified foot wear group was the most cost effective ($7) amongst the three off-loading techniques. It is concluded that in this cohort, no significant difference in healing time was observed in the three off-loading techniques, although modified foot wear (sandal) was found to be a more cost-effective treatment modality. PMID:23369009

  20. Ambulatory assessment of 3D ground reaction force using plantar pressure distribution.

    PubMed

    Rouhani, H; Favre, J; Crevoisier, X; Aminian, K

    2010-07-01

    This study aimed to use the plantar pressure insole for estimating the three-dimensional ground reaction force (GRF) as well as the frictional torque (T(F)) during walking. Eleven subjects, six healthy and five patients with ankle disease participated in the study while wearing pressure insoles during several walking trials on a force-plate. The plantar pressure distribution was analyzed and 10 principal components of 24 regional pressure values with the stance time percentage (STP) were considered for GRF and T(F) estimation. Both linear and non-linear approximators were used for estimating the GRF and T(F) based on two learning strategies using intra-subject and inter-subjects data. The RMS error and the correlation coefficient between the approximators and the actual patterns obtained from force-plate were calculated. Our results showed better performance for non-linear approximation especially when the STP was considered as input. The least errors were observed for vertical force (4%) and anterior-posterior force (7.3%), while the medial-lateral force (11.3%) and frictional torque (14.7%) had higher errors. The result obtained for the patients showed higher error; nevertheless, when the data of the same patient were used for learning, the results were improved and in general slight differences with healthy subjects were observed. In conclusion, this study showed that ambulatory pressure insole with data normalization, an optimal choice of inputs and a well-trained nonlinear mapping function can estimate efficiently the three-dimensional ground reaction force and frictional torque in consecutive gait cycle without requiring a force-plate. PMID:20576436

  1. Determination of the augmentation effects of hyaluronic acid on different heel structures in amputated lower limbs of diabetic patients using ultrasound elastography.

    PubMed

    Hsu, Chih-Chin; Chen, Carl Pai-Chu; Lin, Shih-Cherng; Tsai, Wen-Chung; Liu, Hsien-Tao; Lin, Yi-Chia; Lee, Hsin-Jung; Chen, Weng-Pin

    2012-06-01

    This study measured tissue properties of different anatomies of heels in amputated lower limbs of diabetic patients before and after hyaluronic acid (HA) or normal saline (NS) injections. Seven amputated lower limbs from six diabetic patients constituted the experimental group and one amputated lower limb from a diabetic patient served as the control. The limbs were placed in a fixation platform. A 5-12 MHz linear-array ultrasound transducer controlled by a stepping motor was used to load and unload tested heels. The loading-unloading velocity was 6 mm/s and the maximum loading stress was 178 kPa. Loading-unloading tests were performed before and after 1 mL HA injections into heels in the experimental group. The control limb underwent the same test before and after 1 mL NS injection. The unloaded thickness and Young's modulus of the macrochambers, microchambers and heel pads were determined before and after the interventions. The unloaded thickness of the macrochambers and the heel pad increased significantly (p = 0.012) after HA injection. The Young's modulus of the macrochambers decreased nonsignificantly after HA injections. Similar thickness and tissue stiffness changes were observed in the control limb. The baseline heel-pad energy dissipation ratio (EDR(hp)) was 81.3 1.3% and decreased significantly (p = 0.012) to 73.1 1.7% after HA injections. The EDR(hp) in the control increased after NS injection. Histologic examinations revealed localized HA accumulation in the macrochambers with an extension into the adjacent fibrous septa. Injection of HA can increase tissue thickness and enhance heel-pad tissue resilience. PMID:22502884

  2. Clarification of functional differences between the hallux and lesser toes during the single leg stance: immediate effects of conditioning contraction of the toe plantar flexion muscles

    PubMed Central

    Saeki, Junya; Tojima, Michio; Torii, Suguru

    2015-01-01

    [Purpose] The purpose of this study was to determine the functional differences of the plantar flexion muscles of the hallux and lesser toes during the single leg stance by comparing postural sway in different conditioning contraction interventions. [Subjects] Thirty-four healthy, young males and females participated in this study. [Methods] The front-back and right-left direction components of maximal displacement and postural sway velocity during the single leg stance were measured in various conditioning contraction interventions for the plantar flexion muscles of the hallux or lessor toes. [Results] The main findings of this study were as follows: 1) the front-back direction component of maximal displacement was reduced by conditioning contraction of the plantar flexion muscles of the hallux, and 2) the front-back direction component of the postural sway velocity was reduced by conditioning contraction of the plantar flexion muscles of the lesser toes during the single leg stance. [Conclusion] The plantar flexion muscles of the lesser toes control the postural sway velocity. Furthermore, the plantar flexion muscles of the hallux appear to control the amplitude of postural sway. PMID:26504272

  3. On Heels and Toes: How Ants Climb with Adhesive Pads and Tarsal Friction Hair Arrays.

    PubMed

    Endlein, Thomas; Federle, Walter

    2015-01-01

    Ants are able to climb effortlessly on vertical and inverted smooth surfaces. When climbing, their feet touch the substrate not only with their pretarsal adhesive pads but also with dense arrays of fine hairs on the ventral side of the 3rd and 4th tarsal segments. To understand what role these different attachment structures play during locomotion, we analysed leg kinematics and recorded single-leg ground reaction forces in Weaver ants (Oecophylla smaragdina) climbing vertically on a smooth glass substrate. We found that the ants engaged different attachment structures depending on whether their feet were above or below their Centre of Mass (CoM). Legs above the CoM pulled and engaged the arolia ('toes'), whereas legs below the CoM pushed with the 3rd and 4th tarsomeres ('heels') in surface contact. Legs above the CoM carried a significantly larger proportion of the body weight than legs below the CoM. Force measurements on individual ant tarsi showed that friction increased with normal load as a result of the bending and increasing side contact of the tarsal hairs. On a rough sandpaper substrate, the tarsal hairs generated higher friction forces in the pushing than in the pulling direction, whereas the reverse effect was found on the smooth substrate. When the tarsal hairs were pushed, buckling was observed for forces exceeding the shear forces found in climbing ants. Adhesion forces were small but not negligible, and higher on the smooth substrate. Our results indicate that the dense tarsal hair arrays produce friction forces when pressed against the substrate, and help the ants to push outwards during horizontal and vertical walking. PMID:26559941

  4. Increased F-18 FDG uptake on positron emission tomography/computed tomography imaging caused by plantar fibromatosis.

    PubMed

    Scheler, Jennifer; Rehani, Bhavya; Percy, Thomas; Pelstring, Richard; Bharija, Ankur; Ames, Donald; Mantil, Joseph

    2008-04-01

    We detail the history and evaluation of a 68-year-old man who had head-to-toe PET/CT scanning that showed a focal area of increased FDG uptake in the left medial foot. This was thought to be recurrence of his melanoma. The patient was asymptomatic. He had a history of malignant melanoma of the right ear, which was removed in 2001. On biopsy, the foot lesion was diagnosed as plantar fibromatosis. Plantar fibromatosis is a benign fibroblastic condition, which can be indistinguishable from malignancy in head-to-toe PET/CT scans. Awareness of their potential appearance on PET and PET/CT will aid in the appropriate staging of oncology patients. PMID:18356670

  5. Pulsed dye laser versus Nd:YAG laser in the treatment of plantar warts: a comparative study.

    PubMed

    El-Mohamady, Abd El-Shakor; Mearag, Ibrahim; El-Khalawany, Mohamed; Elshahed, Ahmed; Shokeir, Hisham; Mahmoud, Anas

    2014-05-01

    Plantar warts are common viral infection that are usually challenging in treatment. Conventional treatment methods are usually invasive, have low efficacy, and need long recovery periods. In this study, we compared pulsed dye laser (PDL) and neodymium yttrium aluminum garnet (Nd:YAG) lasers in the treatment of recalcitrant plantar warts. The study included 46 patients with multiple plantar warts. In each patient, lesions were divided into two groups: one treated with Nd:YAG (spot size, 7 mm; energy, 100 J/cm(2); and pulse duration, 20 ms) and the other with PDL (spot size, 7 mm; energy, 8 J/cm(2); and pulse duration, 0.5 ms). Laser sessions were applied every 2 weeks with maximum of six sessions. The study included 63% males and 37% females with a mean age of 29.6 ± 7.34 years. The cure rate was 73.9% with PDL with no significant difference (p = 0.87) from Nd:YAG (78.3%). The number of sessions required was more in PDL (mean, 5.05 ± 0.2) compared with Nd:YAG (mean, 4.65 ± 0.5) but without significant difference. Complications were significantly higher with Nd:YAG (43.5%) compared with PDL (8.7%). Hematoma was the most common complication recorded by Nd:YAG (28.3 %), and it was significantly higher (p = 0.002) than PDL (2.2%). Relapse was recorded in 8.7% with Nd:YAG compared with 13% in PDL with no significant difference (p = 0.74). Our results suggested that PDL and Nd:YAG lasers are effective in the treatment of resistant plantar warts. PDL is safer and less painful but needs more sessions, while Nd:YAG is more painful and shows more complications. PMID:24218179

  6. Assessment of Diabetic Polyneuropathy and Plantar Pressure in Patients with Diabetes Mellitus in Prevention of Diabetic Foot

    PubMed Central

    Skopljak, Amira; Sukalo, Aziz; Batic-Mujanovic, Olivera; Muftic, Mirsad; Tiric-Campara, Merita; Zunic, Lejla

    2014-01-01

    Introduction: Risk assessment for development foot ulcer in diabetics is a key aspect in any plan and program for prevention of non-traumatic amputation of lower extremities. Material and methods: In the prospective research to assessed diabetic neuropathy in diabetic patients, to determined the dynamic function of the foot (plantar pressure), by using pedobarography (Group I), and after the use of orthopedic insoles with help of pedobarography, to determined the connection between the risk factors: deformity of the foot, limited joint movements, diabetic polyneuropathy, plantar pressure in effort preventing changes in the diabetic foot. Results: Out of 1806 patients, who are registered in one Team of family medicine examined 100 patients with diabetes mellitus Type 2. The average age of subjects was 59.4, SD11.38. The average HbA1c was 7.78% SD1.58. Combining monofilament and tuning fork tests, the diagnosis of polyneuropathy have 65% of patients. Comparing Test Symptom Score individual parameters between the first and second measurement, using pedobarography, in Group I, statistically significant difference was found for all of the assessed parameters: pain, burning sensation, paresthesia and insensitivity (p<0,05). The measurements of peak pressure, both first and the second measurement, for all of the subjects in Group I(45) show values above 200kPa. That’s a level of pressure that needs to be corrected. The study finds correlation between the foot deformation, diabetic polyneuropathy and plantar pressure (p>0,05). Conclusion: A detail clinical exam of diabetic food in a family doctor office equipped with pedobarography (plantar pressure measurements), use of orthopedic insoles, significantly reduces clinical symptoms of diabetic polyneuropathy in patients with diabetes. PMID:25650237

  7. Why person affected by leprosy did not look after their plantar ulcer? Experience from Pakokku zone, Myanmar.

    PubMed

    Win, Le Le; Shwe, San; Maw, Win; Ishida, Yutaka; Myint, Kyaw; Mar, Kyi Kyi; Min, Thandar; Oo, Phyo Min; Khine, Aye Win

    2010-09-01

    A cross-sectional study was carried out to identify methods of caring plantar ulcers in leprosy patients and the underlying causes of poor plantar ulcer care during January and February 2008. This was conducted in Pakokku zone as it was one of the "9 selected townships of the Disabilities survey, i.e., Basic Health Staff project 2003/4", which was funded by Japan International Cooperation Agency. After getting consent, all available leprosy cases, i.e., 101 cases with foot disability grade 2 were interviewed with the pre-tested questionnaire. Among 101 cases, 13 cases who took care of their ulcer poorly and 20 who did none of the recommended measures were recruited for in-depth interview (IDI). The subjects were largely old people, males and people with no marriage partner. The majority had earned money by doing sedentary job. Prolongation of ulcers was observed in 78 cases. Most had been suffering from ulcers for years. When asking face-to-face interview, all the recommended care measures were not reported. Among these recommended measures, a large number of respondents reported about soaking measure. However, these reported measures were contradicted to the preventive methods which they disclosed in IDI. Plantar ulcer care seemed to be an individualised practice. The individual ways of performing were related to their view of ulcer, the environment, and occupation, and custom, communication with family and health staff. The findings identified the actual practice of plantar ulcer care in study areas. It is suggested that the current performance of planar ulcer care is inadequate and more attention should be given to achieve the target set by the programme as a recommendation. PMID:20857653

  8. Pedal bone density, strength, orientation, and plantar loads preceding incipient metatarsal fracture after Charcot neuroarthropathy: 2 case reports

    PubMed Central

    Gutekunst, David J.; Sinacore, David R.

    2014-01-01

    Study Design Case reports Background Charcot neuroarthropathy (CN) is a progressive, non-infective, inflammatory destruction of bones and joints leading to foot deformities and plantar ulceration. Though individuals with CN typically have low areal bone mineral density (aBMD), little is known regarding changes in volumetric bone mineral density (vBMD), bone geometry, joint mal-alignment, and biomechanical loads preceding fracture. Case Description Two females, aged 45 and 54 years at the onset of an acute non-fracture CN event, received regular physical therapy with wound care and total contact casting. Both enrolled in a larger research study that included plantar pressure assessment and quantitative computed tomography (QCT) at enrollment and 3, 6, and 12 months later. The women sustained mid-diaphyseal fifth metatarsal fracture 10–11 months after enrollment. QCT image analysis techniques were used to measure vBMD; bone geometric indices reflecting strength in compression, bending, and cortical buckling; and 3-dimensional bone-to-bone orientation angles reflecting foot deformity. Outcomes Fifth metatarsal mid-diaphyseal vBMD decreased during off-loading treatment from 0 to 3 months, then increased to above baseline levels by 6 months. All geometric strength indices improved from baseline through 6 months. Plantar loading in the lateral midfoot increased preceding fracture, concomitant with alterations in bone orientation angles which suggest progressive development of metatarsus adductus and equinovarus foot deformity. Discussion Fractures may occur when bone strength decreases or when biomechanical loading increases. Incipient fracture was preceded by increased loading in the lateral midfoot, but not by reductions in vBMD or geometric strength indices, suggesting that loading played a greater role in fracture. Moreover, the progression of foot deformities may be causally linked to the increased plantar loading. Level of evidence Therapy, level 4 PMID:24256173

  9. Unilateral plantar flexors static-stretching effects on ipsilateral and contralateral jump measures.

    PubMed

    da Silva, Josinaldo Jarbas; Behm, David George; Gomes, Willy Andrade; Silva, Fernando Henrique Domingues de Oliveira; Soares, Enrico Gori; Serpa, Érica Paes; Vilela Junior, Guanis de Barros; Lopes, Charles Ricardo; Marchetti, Paulo Henrique

    2015-06-01

    The aim of this study was to evaluate the acute effects of unilateral ankle plantar flexors static-stretching (SS) on the passive range of movement (ROM) of the stretched limb, surface electromyography (sEMG) and single-leg bounce drop jump (SBDJ) performance measures of the ipsilateral stretched and contralateral non-stretched lower limbs. Seventeen young men (24 ± 5 years) performed SBDJ before and after (stretched limb: immediately post-stretch, 10 and 20 minutes and non-stretched limb: immediately post-stretch) unilateral ankle plantar flexor SS (6 sets of 45s/15s, 70-90% point of discomfort). SBDJ performance measures included jump height, impulse, time to reach peak force, contact time as well as the sEMG integral (IEMG) and pre-activation (IEMGpre-activation) of the gastrocnemius lateralis. Ankle dorsiflexion passive ROM increased in the stretched limb after the SS (pre-test: 21 ± 4° and post-test: 26.5 ± 5°, p < 0.001). Post-stretching decreases were observed with peak force (p = 0.029), IEMG (P<0.001), and IEMGpre-activation (p = 0.015) in the stretched limb; as well as impulse (p = 0.03), and jump height (p = 0.032) in the non-stretched limb. In conclusion, SS effectively increased passive ankle ROM of the stretched limb, and transiently (less than 10 minutes) decreased muscle peak force and pre-activation. The decrease of jump height and impulse for the non-stretched limb suggests a SS-induced central nervous system inhibitory effect. Key pointsWhen considering whether or not to SS prior to athletic activities, one must consider the potential positive effects of increased ankle dorsiflexion motion with the potential deleterious effects of power and muscle activity during a simple jumping task or as part of the rehabilitation process.Since decreased jump performance measures can persist for 10 minutes in the stretched leg, the timing of SS prior to performance must be taken into consideration.Athletes, fitness enthusiasts and therapists should also keep in mind that SS one limb has generalized effects upon contralateral limbs as well. PMID:25983580

  10. Changes in Plantar Loading Based on Shoe Type and Sex During a Jump-Landing Task

    PubMed Central

    DeBiasio, Justin C.; Russell, Mary E.; Butler, Robert J.; Nunley, James A.; Queen, Robin M.

    2013-01-01

    Context: Metatarsal stress fractures are common in cleated-sport athletes. Previous authors have shown that plantar loading varies with footwear, sex, and the athletic task. Objective: To examine the effects of shoe type and sex on plantar loading in the medial midfoot (MMF), lateral midfoot (LMF), medial forefoot (MFF), middle forefoot (MidFF), and lateral forefoot (LFF) during a jump-landing task. Design: Crossover study. Setting: Laboratory. Patients or Other Participants: Twenty-seven recreational athletes (14 men, 13 women) with no history of lower extremity injury in the last 6 months and no history of foot or ankle surgery. Main Outcome Measure(s): The athletes completed 7 jumping trials while wearing bladed-cleat, turf-cleat, and running shoes. Maximum force, contact area, contact time, and the force-time integral were analyzed in each foot region. We calculated 2 × 3 analyses of variance (α = .05) to identify shoe-condition and sex differences. Results: We found no shoe × sex interactions, but the MMF, LMF, MFF, and LFF force-time integrals were greater in men (P < .03). The MMF maximum force was less with the bladed-cleat shoes (P = .02). Total foot and MidFF maximum force was less with the running shoes (P < .01). The MFF and LFF maximum forces were different among all shoe conditions (P < .01). Total foot contact area was less in the bladed-cleat shoes (P = .01). The MMF contact area was greatest in the running shoes (P < .01). The LFF contact area was less in the running shoes (P = .03). The MFF and LFF force-time integrals were greater with the bladed-cleat shoes (P < .01). The MidFF force-time integral was less in the running shoes (P < .01). Conclusions: Independent of shoe, men and women loaded the foot differently during a jump landing. The bladed cleat increased forefoot loading, which may increase the risk for forefoot injury. The type of shoe should be considered when choosing footwear for athletes returning to activity after metatarsal stress fractures. PMID:24067149

  11. Pads and flexion creases on the plantar surface of hammertoe mutant mouse (Hm).

    PubMed

    Kimura, S; Terashima, T; Schaumann, B A; Shimada, M; Shiota, K

    2000-09-01

    The purpose of the present work was to determine the effects of the hereditary malformation of Hammertoe mutant mice (gene symbol Hm) on the surrounding morphological structures and, specifically, on the volar pads, i.e., the sites of the epidermal ridge patterns (dermatoglyphics). The hindlimbs of the wild-type (+/+) Hammertoe mice show no anomalies and their major pad and flexion crease configurations correspond to those of normal mice. The heterozygous (Hm/+) and homozygous (Hm/Hm) mice display a fusion of the interdigital tissues involving all digits with the exception of digit I. In Hm/Hm mice, this webbing extends to the distal phalanx and the markedly flexed digits form a shape resembling a hammer. In Hm/+ mice, the interdigital webbing does not extend as far and the digits show moderate flexion compared to those of Hm/Hm mice. Both Hm/Hm and Hm/+ have a rudimentary extra digit in the postaxial area of the hindlimbs. The ventral volar skin of the flexed digits is incompletely developed. The more posterior digits show the more severe camptodactyly. These aberrant configurations are related to the abnormal occurrence of the programmed cell death (PCD) in the interdigital zones II-IV and the proximal part of the postaxial margin during hindlimb development. They are limited to the pads on the plantar surface of the postaxial area; the preaxial area is not affected. As a result of a severe camptodactyly of digit V, its volar skin is shifted into the distal portion of the hypothenar area. This shifting affects the number, size, and location of the pads, especially of the hypothenar pad, resulting in varying pad configurations, such as a displacement of the distal and proximal components of the hypothenar pad, or a fusion of the two components of the hypothenar pad, leading to a reduced final pad number. These pad modifications are induced by the postaxial plantar surface shifting proximally and are not affected by the presence of an extra rudimentary digit. The pad modifications in Hammertoe mice with webbed digits and postaxial polydactyly resemble closely those of the previously studied mice with genetic preaxial polydactyly. PMID:10967533

  12. Unilateral Plantar Flexors Static-Stretching Effects on Ipsilateral and Contralateral Jump Measures

    PubMed Central

    da Silva, Josinaldo Jarbas; Behm, David George; Gomes, Willy Andrade; Silva, Fernando Henrique Domingues de Oliveira; Soares, Enrico Gori; Serpa, Érica Paes; Vilela Junior, Guanis de Barros; Lopes, Charles Ricardo; Marchetti, Paulo Henrique

    2015-01-01

    The aim of this study was to evaluate the acute effects of unilateral ankle plantar flexors static-stretching (SS) on the passive range of movement (ROM) of the stretched limb, surface electromyography (sEMG) and single-leg bounce drop jump (SBDJ) performance measures of the ipsilateral stretched and contralateral non-stretched lower limbs. Seventeen young men (24 ± 5 years) performed SBDJ before and after (stretched limb: immediately post-stretch, 10 and 20 minutes and non-stretched limb: immediately post-stretch) unilateral ankle plantar flexor SS (6 sets of 45s/15s, 70-90% point of discomfort). SBDJ performance measures included jump height, impulse, time to reach peak force, contact time as well as the sEMG integral (IEMG) and pre-activation (IEMGpre-activation) of the gastrocnemius lateralis. Ankle dorsiflexion passive ROM increased in the stretched limb after the SS (pre-test: 21 ± 4° and post-test: 26.5 ± 5°, p < 0.001). Post-stretching decreases were observed with peak force (p = 0.029), IEMG (P<0.001), and IEMGpre-activation (p = 0.015) in the stretched limb; as well as impulse (p = 0.03), and jump height (p = 0.032) in the non-stretched limb. In conclusion, SS effectively increased passive ankle ROM of the stretched limb, and transiently (less than 10 minutes) decreased muscle peak force and pre-activation. The decrease of jump height and impulse for the non-stretched limb suggests a SS-induced central nervous system inhibitory effect. Key points When considering whether or not to SS prior to athletic activities, one must consider the potential positive effects of increased ankle dorsiflexion motion with the potential deleterious effects of power and muscle activity during a simple jumping task or as part of the rehabilitation process. Since decreased jump performance measures can persist for 10 minutes in the stretched leg, the timing of SS prior to performance must be taken into consideration. Athletes, fitness enthusiasts and therapists should also keep in mind that SS one limb has generalized effects upon contralateral limbs as well. PMID:25983580

  13. An avulsion fracture of the calcaneal tuberosity: delay of treatment causes the 'Achilles heel' of optimal recovery.

    PubMed

    Bosman, Willem-Maarten; Leijnen, Michiel; van den Bremer, Jephta; Ritchie, Ewan D

    2016-01-01

    A 72-year-old woman was diagnosed with an avulsion fracture of the tuberosity of the calcaneus. The fracture was planned for elective fixation 12 days after the accident. The planned open reduction and internal fixation was not possible due to a decubital wound on the Achilles heel as a result of pressure on the skin of the fractured tuberosity. Closed reduction and internal fixation was performed, leading to an acceptable outcome. Avulsion fractures of the tuberosity of the calcaneus are rare injuries, and delay in treatment should be avoided as it may lead to preventable complications. PMID:26759395

  14. Excision of a Dermatobia hominis larva from the heel of a South American traveler: a case report.

    PubMed

    Adams, Donald W; Cooney, Ryan T

    2004-01-01

    Although foot and ankle specialists are well versed in treating insect bites and foreign bodies, many physicians in the United States are unfamiliar with parasitic organisms that are common in other parts of the world. This article presents a case of a patient inoculated in the posterior heel with the larva of a Dermatobia hominis, or human bot fly. Excision of the larva provided a complete resolution of the patient's symptoms. Although the initial clinical presentation suggested a simple foreign body, the patient's recent travel history to Brazil shows that a thorough history is essential to establishing a complete list of differential diagnoses. PMID:15284816

  15. Hybrid diffuse optical techniques for continuous hemodynamic measurement in gastrocnemius during plantar flexion exercise

    NASA Astrophysics Data System (ADS)

    Henry, Brad; Zhao, Mingjun; Shang, Yu; Uhl, Timothy; Thomas, D. Travis; Xenos, Eleftherios S.; Saha, Sibu P.; Yu, Guoqiang

    2015-12-01

    Occlusion calibrations and gating techniques have been recently applied by our laboratory for continuous and absolute diffuse optical measurements of forearm muscle hemodynamics during handgrip exercises. The translation of these techniques from the forearm to the lower limb is the goal of this study as various diseases preferentially affect muscles in the lower extremity. This study adapted a hybrid near-infrared spectroscopy and diffuse correlation spectroscopy system with a gating algorithm to continuously quantify hemodynamic responses of medial gastrocnemius during plantar flexion exercises in 10 healthy subjects. The outcomes from optical measurement include oxy-, deoxy-, and total hemoglobin concentrations, blood oxygen saturation, and relative changes in blood flow (rBF) and oxygen consumption rate (rV˙O2). We calibrated rBF and rV˙O2 profiles with absolute baseline values of BF and V˙O2 obtained by venous and arterial occlusions, respectively. Results from this investigation were comparable to values from similar studies. Additionally, significant correlation was observed between resting local muscle BF measured by the optical technique and whole limb BF measured concurrently by a strain gauge venous plethysmography. The extensive hemodynamic and metabolic profiles during exercise will allow for future comparison studies to investigate the diagnostic value of hybrid technologies in muscles affected by disease.

  16. Effect of pinpoint plantar long-wavelength infrared light irradiation on subcutaneous temperature and stress markers

    PubMed Central

    Ryotokuji, Kenji; Ishimaru, Keisou; Kihara, Kazuhiko; Namiki, Yoshihisa; Hozumi, Nobumichi

    2013-01-01

    Background and aims: The current investigation was aimed at the development of a novel non-invasive treatment system, pinpoint plantar long-wavelength infrared light irradiation (PP-LILI), which may be able to relieve mental stress and reduce stress-related hormones. Materials (Subjects) and methods: We compared the subcutaneous temperature, blood pressure, the degree of secretion of stress hormones before and after pinpoint irradiations (wavelength: 811 ?m; output: 30mW). The study enrolled 15 subjects (Japanese healthy adults; 8 males, 7 females; average age 47.8 14.6 years). Two parts of the planter region were irradiated for 15 min respectively. The stress markers such as ACTH, salivary amylase and cortisol were measured. As well, core body temperature and blood pressure were analyzed before and after the irradiation. Results: A series of experiments revealed increased body temperature, decreased levels of blood pressure and stress markers described above after the irradiation. Conclusions: These results clearly suggest that the PP-LILI system will be quite useful for relieving stress and improvement of homeostatic functions in the body. PMID:24155554

  17. Recalcitrant caustic burn wound and definitive treatment with medial plantar flap.

    PubMed

    Öksüz, Sinan; Eren, Fikret; Sever, Celalettin; Karagöz, Hüseyin; Ülkür, Ersin

    2015-09-01

    Caustic chemicals cause destruction in tissues even long after the initial exposure. This study reported a case of recurrent graft lysis encountered throughout the treatment of a sodium hydroxide burn. A caustic burn on the ankle of a patient was reconstructed with split thickness skin grafts thrice in a period of four months. The burn site healed uneventfully after each skin grafting. However, weeks after each successful graft take, even though the patient did not experience any trauma at his operated ankle, an eczematous blistering at the skin graft site was observed. Thereafter, skin grafts almost totally sloughed over time even after each successful graft take. Six months after the initial burn and recurrent skin graft lysis, the defect site was reconstructed with medial plantar flap. At the postoperative ninth month follow-up, there was no sign of the blistering or skin loss at the burn area after definitive flap surgery. Recurrent graft lysis, in a few weeks after total skin graft take is an unusual complication for most of the burn cases. Caustic burns may have a deceptively superficial appearance concealing the chemical reactions that further damage the tissue. Therefore, early surgical interventions such as deep debridement and graft surgery should be kept in mind as primary treatment options. PMID:26388279

  18. ["Epidemic" of plantar dermatitis during military maneuvers in the rain forest of Guyana].

    PubMed

    Dampierre, H

    2003-01-01

    The purpose of this report is to describe an "epidemic" outbreak of plantar dermatitis that occurred in 30 soldiers on mission in the rain forest of Guyana. The contingent was forced to stop twice and operational readiness was seriously reduced. The first episode affecting 43% (13/30) of the contingent occurred after 4 days of march. In the second episode 70% (21/30) of the contingent was affected. Manifestations were characterized by the appearance of distinct, dry, nonpruriginus, erythematous papules followed a few hours later by quasi-exfoliating, noncoalescing, nonoozing, nonmalodorous lesions measuring several centimeters in diameter. Symptoms regressed quickly within 48 to 72 hours with only symptomatic treatment. A combination of microtrauma and maceration is the most likely mechanism. However identification of an offending microbial, viral or fungal agent or of a cause in the environment, clothing or products could not be made. A tempting hypothesis involves an inflammatory reaction caused by an organism in ground water or the soil. A prospective study could be undertaken at the Rain Forest Training Camp in Regina where similar clinical manifestation have been observed. PMID:12910659

  19. Effect of plantar intrinsic muscle training on medial longitudinal arch morphology and dynamic function.

    PubMed

    Mulligan, Edward P; Cook, Patrick G

    2013-10-01

    A specific training program emphasizing the neuromuscular recruitment of the plantar intrinsic foot muscles, colloquially referred to as "short foot" exercise (SFE) training, has been suggested as a means to dynamically support the medial longitudinal arch (MLA) during functional tasks. A single-group repeated measures pre- and post-intervention study design was utilized to determine if a 4-week intrinsic foot muscle training program would impact the amount of navicular drop (ND), increase the arch height index (AHI), improve performance during a unilateral functional reaching maneuver, or the qualitative assessment of the ability to hold the arch position in single limb stance position in an asymptomatic cohort. 21 asymptomatic subjects (42 feet) completed the 4-week SFE training program. Subject ND decreased by a mean of 1.8 mm at 4 weeks and 2.2 mm at 8 weeks (p < 0.05). AHI increased from 28 to 29% (p < 0.05). Intrinsic foot muscle performance during a static unilateral balancing activity improved from a grade of fair to good (p < 0.001) and subjects experienced a significant improvement during a functional balance and reach task in all directions with the exception of an anterior reach (p < 0.05). This study offers preliminary evidence to suggest that SFE training may have value in statically and dynamically supporting the MLA. Further research regarding the value of this exercise intervention in foot posture type or pathology specific patient populations is warranted. PMID:23632367

  20. Quantitative estimation of temperature variations in plantar angiosomes: a study case for diabetic foot.

    PubMed

    Peregrina-Barreto, H; Morales-Hernandez, L A; Rangel-Magdaleno, J J; Avina-Cervantes, J G; Ramirez-Cortes, J M; Morales-Caporal, R

    2014-01-01

    Thermography is a useful tool since it provides information that may help in the diagnostic of several diseases in a noninvasive and fast way. Particularly, thermography has been applied in the study of the diabetic foot. However, most of these studies report only qualitative information making it difficult to measure significant parameters such as temperature variations. These variations are important in the analysis of the diabetic foot since they could bring knowledge, for instance, regarding ulceration risks. The early detection of ulceration risks is considered an important research topic in the medicine field, as its objective is to avoid major complications that might lead to a limb amputation. The absence of symptoms in the early phase of the ulceration is conceived as the main disadvantage to provide an opportune diagnostic in subjects with neuropathy. Since the relation between temperature and ulceration risks is well established in the literature, a methodology that obtains quantitative temperature differences in the plantar area of the diabetic foot to detect ulceration risks is proposed in this work. Such methodology is based on the angiosome concept and image processing. PMID:24688595

  1. Correlation between maximum in-shoe plantar pressures and clubhead speed in amateur golfers.

    PubMed

    Pataky, Todd Colin

    2015-01-01

    Disagreements exist in the literature regarding the manner in which weight should be dynamically shared during the golf swing, both within-feet and between the back- and target-foot, to generate maximal clubhead speed. The purpose of this study was to determine whether preferential foot-loading locations underlie weight sharing by examining the correlation between clubhead speed and maximum plantar pressure (PP) distributions. Thirty-two amateur golfers with handicap indexes ranging from 2.7 to 25 performed 10 driver swings on artificial turf following a warm-up. PP distributions were recorded at 100 Hz, and clubhead speed was recorded using a ball-tracking Doppler radar system. Maximum PPs were extracted from a 2-s window approximately centred on ball contact and were regressed against clubhead speed. Significance was assessed over the entire foot surface using statistical parametric mapping (SPM), a spatially continuous technique. SPM revealed, at relatively high anatomical resolution, significant positive correlations between clubhead speed and PPs in the lateral target-foot (P < 0.05). This suggests that not only weight transfer but also weight-transfer location may be an important determinant of clubhead speed in amateur golfers. PMID:25010946

  2. Quantitative Estimation of Temperature Variations in Plantar Angiosomes: A Study Case for Diabetic Foot

    PubMed Central

    Peregrina-Barreto, H.; Morales-Hernandez, L. A.; Rangel-Magdaleno, J. J.; Avina-Cervantes, J. G.; Ramirez-Cortes, J. M.; Morales-Caporal, R.

    2014-01-01

    Thermography is a useful tool since it provides information that may help in the diagnostic of several diseases in a noninvasive and fast way. Particularly, thermography has been applied in the study of the diabetic foot. However, most of these studies report only qualitative information making it difficult to measure significant parameters such as temperature variations. These variations are important in the analysis of the diabetic foot since they could bring knowledge, for instance, regarding ulceration risks. The early detection of ulceration risks is considered an important research topic in the medicine field, as its objective is to avoid major complications that might lead to a limb amputation. The absence of symptoms in the early phase of the ulceration is conceived as the main disadvantage to provide an opportune diagnostic in subjects with neuropathy. Since the relation between temperature and ulceration risks is well established in the literature, a methodology that obtains quantitative temperature differences in the plantar area of the diabetic foot to detect ulceration risks is proposed in this work. Such methodology is based on the angiosome concept and image processing. PMID:24688595

  3. A stereologic study of the plantar fat pad in young and aged rats

    PubMed Central

    Molligan, Jeremy; Schon, Lew; Zhang, Zijun

    2013-01-01

    Plantar fat pad (PFP) is a tissue structure that absorbs the initial impact of walking and running and ultimately bears body weight at standing. This study was designed to quantify the histomorphological changes of the PFP in aged rats. The most medial PFP was dissected from the hind feet of young rats (4 months old, n = 6) and aged rats (24 months old, n = 6). Histological structure and cellular senescence of PFP were analyzed stereologically and histomorphometrically. Immunohistochemistry of matrix metalloproteinase 9 (MMP9) was also performed on PFP tissue sections. Compared with young rats, the thickness of epidermis, dermis and septa of the PFP were significantly reduced in the aged rats. The total volume of adipose tissue in the PFP of aged rats was only about 65% of that in the young rats. The microvascular density and the number of fat pad units (FPU), a cluster of adipocytes enclosed by elastin septa, in the PFP were unchanged in the aged rats. In the aged rats, the number of adipocytes per FPU was reduced but the number of simple adipocyte clusters, without surrounding septa, was increased. The shift of the types of adipocyte clusters in the aged PFP was accompanied by degradation of elastin fibers and increased expression of MMP9. In conclusion, the PFP, particularly the elastic septa, degenerates significantly in aged rats and this may contribute to the pathology of PFP-related diseases. PMID:24033117

  4. Manipulation in the Treatment of Plantar Digital Neuralgia: A Retrospective Study of 38 Cases

    PubMed Central

    Cashley, David G.; Cochrane, Lynda

    2015-01-01

    Objective The purpose of this retrospective case series is to describe treatment outcomes for patients with plantar digital neuralgia (PDN) (Morton’s neuroma) who were treated using foot manipulation. Methods Charts were reviewed retrospectively for patients with a diagnosis of PDN and who received a minimum of 6 treatments consisting of manipulation alone. Visual analogue pain scales (VAS) and pressure threshold meter readings (PTM) were extracted as outcome measures. Results Thirty-eight cases met inclusion criteria. Mean pretreatment duration of pain was 28 months. Mean pretreatment VAS was 69.5/100 mm. Mean pretreatment PTM was 2.54 Kp. By the sixth treatment, 30 (79%) of the 38 patients scored a VAS of 0 mm and a further 4 (10%) were below 10 mm. Contralateral limb PTM showed a mean pre-treatment score of 5.5 Kp, which rose slightly to 5.85 Kp. This compared to a pre-treatment score of 2.54 Kp rising to 5.86 Kp in the affected limb. This represents a 126% increase in the affected side compared to 6.5% in the unaffected limb. Statistical analysis demonstrated a significant linear trend between decreasing VAS and manipulation (P < .001). Conclusion The patients with PDN who were included in this case series improved with conservative care that included only foot manipulation. PMID:26257593

  5. A two-phase model of plantar tissue: a step toward prediction of diabetic foot ulceration.

    PubMed

    Sciumè, G; Boso, D P; Gray, W G; Cobelli, C; Schrefler, B A

    2014-11-01

    A new computational model, based on the thermodynamically constrained averaging theory, has been recently proposed to predict tumor initiation and proliferation. A similar mathematical approach is proposed here as an aid in diabetic ulcer prevention. The common aspects at the continuum level are the macroscopic balance equations governing the flow of the fluid phase, diffusion of chemical species, tissue mechanics, and some of the constitutive equations. The soft plantar tissue is modeled as a two-phase system: a solid phase consisting of the tissue cells and their extracellular matrix, and a fluid one (interstitial fluid and dissolved chemical species). The solid phase may become necrotic depending on the stress level and on the oxygen availability in the tissue. Actually, in diabetic patients, peripheral vascular disease impacts tissue necrosis; this is considered in the model via the introduction of an effective diffusion coefficient that governs transport of nutrients within the microvasculature. The governing equations of the mathematical model are discretized in space by the finite element method and in time domain using the θ-Wilson Method. While the full mathematical model is developed in this paper, the example is limited to the simulation of several gait cycles of a healthy foot. PMID:24841993

  6. Prevention of Recurrent Foot Ulcers With Plantar Pressure–Based In-Shoe Orthoses: The CareFUL Prevention Multicenter Randomized Controlled Trial

    PubMed Central

    Ulbrecht, Jan S.; Hurley, Timothy; Mauger, David T.

    2014-01-01

    OBJECTIVE To assess the efficacy of in-shoe orthoses that were designed based on shape and barefoot plantar pressure in reducing the incidence of submetatarsal head plantar ulcers in people with diabetes, peripheral neuropathy, and a history of similar prior ulceration. RESEARCH DESIGN AND METHODS Single-blinded multicenter randomized controlled trial with subjects randomized to wear shape- and pressure-based orthoses (experimental, n = 66) or standard-of-care A5513 orthoses (control, n = 64). Patients were followed for 15 months, until a study end point (forefoot plantar ulcer or nonulcerative plantar forefoot lesion) or to study termination. Proportional hazards regression was used for analysis. RESULTS There was a trend in the composite primary end point (both ulcers and nonulcerative lesions) across the full follow-up period (P = 0.13) in favor of the experimental orthoses. This trend was due to a marked difference in ulcer occurrence (P = 0.007) but no difference in the rate of nonulcerative lesions (P = 0.76). At 180 days, the ulcer prevention effect of the experimental orthoses was already significant (P = 0.003) when compared with control, and the benefit of the experimental orthoses with respect to the composite end point was also significant (P = 0.042). The hazard ratio was 3.4 (95% CI 1.3–8.7) for the occurrence of a submetatarsal head plantar ulcer in the control compared with experimental arm over the duration of the study. CONCLUSIONS We conclude that shape- and barefoot plantar pressure–based orthoses were more effective in reducing submetatarsal head plantar ulcer recurrence than current standard-of-care orthoses, but they did not significantly reduce nonulcerative lesions. PMID:24760263

  7. Experience with extracorporeal shock wave therapy (ESWT) in the United States

    NASA Astrophysics Data System (ADS)

    Furia, John P.

    2005-04-01

    The purpose of this presentation is to summarize the literature and to report on single treatment, high-energy ESWT for the treatment of chronic plantar fasciitis and lateral epicondylitis. Fifty-three patients (60 heels) were treated with 3800 shock waves. Sixteen patients (19 heels) were active, 21 (22 heels), were moderately active, and 16 (19 heels) were sedentary. Twelve weeks post treatment, mean visual analog scores (VAS) for the entire group improved from 9.2 to 2.4 (p<0.05), RAND-Physical Functioning score improved from 40.4 to 91.5 (p<0.05), and RAND-Pain score improved from 33.3 to 90 (p<0.05). Fifty heels (83.3%) were assigned an excellent or good result. Thirty-six patients with chronic lateral epicondylitis were treated with 3200 shock waves. There were 9 workers compensation and 27 non-workers compensation patients. Twelve weeks post treatment, the mean VAS for the entire group improved from 8.0 to 2.5 (p<0.05), and the mean RAND-Physical Functioning score improved from 65.6 to 88.0 (p<0.05). Twenty-eight elbows (77.8%) were assigned an excellent or good result. In both trials, outcome was similar for each subgroup. There were no significant complications in either trial. Using the therapeutic parameters applied, ESWT is a safe and effective treatment for chronic plantar fasciitis and lateral epicondylitis.

  8. SOLID PHASE CHARACTERIZATION OF HEEL SAMPLES FROM TANK 241-C-110

    SciTech Connect

    PAGE JS; COOKE GA; PESTOVICH JA; HUBER HJ

    2011-12-01

    During sluicing operations of tank 241-C-110, a significant amount of solids were unable to be retrieved. These solids (often referred to as the tank 'heel') were sampled in 2010 and chemically and mineralogically analyzed in the 222-S Laboratory. Additionally, dissolution tests were performed to identify the amount of undissolvable material after using multiple water contacts. This report covers the solid phase characterization of six samples from these tests using scanning electron microscopy, polarized light microscopy, and X-ray diffraction. The chemical analyses, particle size distribution analysis, and dissolution test results are reported separately. Two of the samples were from composites created from as-received material - Composite A and Composite B. The main phase in these samples was sodium-fluoride-phosphate hydrate (natrophosphate) - in the X-ray diffraction spectra, this phase was the only phase identifiable. Polarized light microscopy showed the presence of minor amounts of gibbsite and other phases. These phases were identified by scanning electron microscopy - energy dispersive X-ray spectroscopy as sodium aluminosilicates, sodium diuranate, and sodium strontium phosphate hydrate (nastrophite) crystals. The natrophosphate crystals in the scanning electron microscopy analysis showed a variety of erosive and dissolution features from perfectly shaped octahedral to well-rounded appearance. Two samples were from water-washed Composites A and B, with no change in mineralogy compared to the as-received samples. This is not surprising, since the water wash had only a short period of water contact with the material as opposed to the water dissolution tests. The last two samples were residual solids from the water dissolution tests. These tests included multiple additions of water at 15 C and 45 C. The samples were sieved to separate a coarser fraction of > 710 {mu}m and a finer fraction of < 710 {mu}m. These two fractions were analyzed separately. The coarser fraction contained mostly gibbsite with minor amounts of sodium aluminosilicates (cancrinite) and bismuth aluminum-rich phases. The finer fraction was mostly composed of gibbsite, the sodium alumino silicate phase, cancrinite, and a poorly crystalline to non-crystalline phase containing varying amounts of iron, bismuth, aluminum, and phosphorus.

  9. Chronic Bronchitis

    MedlinePlus

    Bronchitis is an inflammation of the bronchial tubes, the airways that carry air to your lungs. It ... chest tightness. There are two main types of bronchitis: acute and chronic. Chronic bronchitis is one type ...

  10. Chronic Bronchitis

    MedlinePlus

    ... Calendar Read the News View Daily Pollen Count COPD Program This program offers comprehensive, individualized care for people with chronic obstructive pulmonary disease (COPD) including emphysema and chronic bronchitis. Learn more. Doctors ...

  11. Chronic Hiccups

    MedlinePlus

    ... Rare Disease Day More Search for News on Rare Diseases Search Go Advanced News Search About GARD About ... GARD Home Diseases Chronic hiccups Diseases Genetic and Rare Diseases Information Center (GARD) Print friendly version Chronic hiccups ...

  12. Prediction of the strength of the elderly proximal femur by bone mineral density and quantitative ultrasound measurements of the heel and tibia.

    PubMed

    Bouxsein, M L; Coan, B S; Lee, S C

    1999-07-01

    Quantitative ultrasound (QUS) of the heel and tibia have recently been approved in the United States for diagnostic evaluation of low bone mass. The goal of this study was to use human cadaveric specimens to compare correlations among: a) strength of the proximal femur; b) bone mineral density of the femur, tibia, and heel; and c) QUS of the tibia and heel. We obtained 26 proximal femurs and intact lower limbs from 16 female and 10 male cadavers, with a mean age of 81+/-12 years. Bone mineral density (BMD, g/cm2) of the proximal femur and tibia were assessed using dual-energy x-ray absorptiometry, and BMD (g/cm) of the heel was measured using single-energy x-ray absorptiometry. Ultrasound velocity at the mid-tibia was determined using a contact, gel-coupled ultrasound device. Broadband ultrasound attenuation (BUA) and speed of sound (SOS) of the heel were determined using a transmission ultrasound device with water-based coupling. The femurs were tested to failure in a configuration designed to simulate a fall to the side with impact to the greater trochanter. As in previous studies, the strength of the proximal femur was very strongly correlated with femoral BMD and heel BMD (r2 = 0.78-0.92, p < .0001 for all). BUA and SOS of the heel were also strongly correlated to femoral strength (r2 = 0.70 and 0.67, respectively, p < 0.0001 for both), whereas tibia SOS was only weakly correlated (r2 = 0.19, p = 0.03). The average coefficient of variation for triplicate tibial SOS measurements was 0.50%. This study indicates that, although tibial SOS measurements are precise, they are not strongly correlated with femoral BMD or strength. In contrast, heel QUS measurements are strongly correlated with the strength of the proximal femur. These findings imply that tibial SOS may be of limited use for assessing hip fracture risk. Prospective fracture risk data are needed to define further the clinical utility of tibia ultrasound measurements. PMID:10423021

  13. Chronic Pain

    MedlinePlus

    ... Enhancing Diversity Find People About NINDS NINDS Chronic Pain Information Page Synonym(s): Pain - Chronic Condensed from Pain: ... Español Additional resources from MedlinePlus What is Chronic Pain? While acute pain is a normal sensation triggered ...

  14. Three-dimensional morphology and strain of the human Achilles free tendon immediately following eccentric heel drop exercise.

    PubMed

    Obst, Steven J; Newsham-West, Richard; Barrett, Rod S

    2015-12-01

    Our understanding of the immediate effects of exercise on Achilles free tendon transverse morphology is limited to single site measurements acquired at rest using 2D ultrasound. The purpose of this study was to provide a detailed 3D description of changes in Achilles free tendon morphology immediately following a single clinical bout of exercise. Freehand 3D ultrasound was used to measure Achilles free tendon length, and regional cross-sectional area (CSA), medio-lateral (ML) diameter and antero-posterior (AP) diameter in healthy young adults (N=14) at rest and during isometric muscle contraction, immediately before and after 3×15 eccentric heel drops. Post-exercise reductions in transverse strain were limited to CSA and AP diameter in the mid-proximal region of the Achilles free tendon during muscle contraction. The change in CSA strain during muscle contraction was significantly correlated to the change in longitudinal strain (r=-0.72) and the change in AP diameter strain (r=0.64). Overall findings suggest the Achilles free tendon experiences a complex change in 3D morphology following eccentric heel drop exercise that manifests under contractile but not rest conditions, is most pronounced in the mid-proximal tendon and is primarily driven by changes in AP diameter strain and not ML diameter strain. PMID:26519510

  15. Effect of footwear on minimum foot clearance, heel slippage and spatiotemporal measures of gait in older women.

    PubMed

    Davis, Annette M; Galna, Brook; Murphy, Anna T; Williams, Cylie M; Haines, Terry P

    2016-02-01

    Footwear has been implicated as a factor in falls, which is a major issue affecting the health of older adults. This study investigated the effect of footwear with dorsal fixation, slippers and bare feet on minimum foot clearance, heel slippage and spatiotemporal variables of gait in community dwelling older women. Thirty women participated (mean age (SD) 69.1 (5.1) years) in a gait assessment using the GaitRITE and Vicon 612 motion analysis system. Conditions included footwear with dorsal fixation, slippers or bare feet. Footwear with dorsal fixation resulted in improved minimum foot clearance compared to the slippers and bare feet conditions and less heel slippage than slippers and an increase in double support. These features lend weight to the argument that older women should be supported to make footwear choices with optimal fitting features including dorsal fixation. Recommendations of particular styles and features of footwear may assist during falls prevention education to reduce the incidence of foot trips and falls. PMID:27004631

  16. A pilot study of a plantar sensory evaluation system for early screening of diabetic neuropathy in a weight-bearing position.

    PubMed

    Ino, Shuichi; Chikai, Manabu; Takahashi, Noriyo; Ohnishi, Tadasuke; Doi, Kohki; Nunokawa, Kiyohiko

    2014-01-01

    The purpose of this study is to develop smart equipment to quantify plantar tactile sensibility for the early diagnosis and tracking of peripheral neuropathy caused by diabetes mellitus. In this paper, we offer a new testing system that is composed of a plantar tactile stimulation platform with a small moving contactor to stretch the skin tangentially, a response switch for each tactile stimulus, a motor control box, and a personal computer (PC) for psychophysical data processing. This quantitative sensory testing system has detailed measurements available and is easy to use compared with the conventional testing devices, such as von Frey monofilaments, pin-prick testing devices, and current perception threshold testers. When using our testing system in a weight-bearing position, we observed that the plantar tactile thresholds for the tangential stretching stimulus on the plantar surface of the foot ranged from approximately 10 um to 30 um for healthy subjects. However, the threshold for a subject with diabetes was nearly three times higher than that for healthy subjects. The significant difference between these values suggests that the plantar sensory evaluation system using the lateral skin stretch stimulation can be used for early diagnosis, for the accurate staging of diabetic neuropathy, and for evaluating its progression noninvasively in a clinic and at home. PMID:25570747

  17. Monochloroacetic acid application is an effective alternative to cryotherapy for common and plantar warts in primary care: a randomized controlled trial.

    PubMed

    Bruggink, Sjoerd C; Gussekloo, Jacobijn; Egberts, Paulette F; Bavinck, Jan Nico Bouwes; de Waal, Margot W M; Assendelft, Willem J J; Eekhof, Just A H

    2015-05-01

    Cryotherapy and salicylic acid (SA) often fail as treatments for skin warts. We examined the effectiveness of monochloroacetic acid (MCA) for patients with common or plantar warts. Consecutive patients aged 4 years and older with one or more newly diagnosed common or plantar warts were recruited in 53 Dutch general practices. We randomly allocated eligible patients to 13-week treatment protocols of office-applied MCA versus liquid nitrogen cryotherapy every 2 weeks for patients with common warts (n=188), and MCA versus cryotherapy combined with daily SA self-application for patients with plantar warts (n=227). The primary outcome was the proportion of patients whose warts were all cured at 13 weeks. In the common wart group, cure rates were 40/92 (43%, 95% confidence interval 34-54) for MCA and 50/93 (54%, 44-64) for cryotherapy (risk difference (RD) -10%, -25-4.0, P=0.16). In the plantar wart group, cure rates were 49/106 (46%, 37-56) for MCA and 45/115 (39%, 31-48) for cryotherapy combined with SA (RD 7.1, 5.9-20, P=0.29). For common warts, MCA is an effective alternative to cryotherapy to avoid pain during the treatment, although pain after the treatment is similar. For plantar warts, office-applied MCA may be preferred over cryotherapy combined with SA, on the basis of comparable effectiveness, less treatment pain, and less treatment burden. PMID:25584800

  18. In vivo maximal fascicle-shortening velocity during plantar flexion in humans.

    PubMed

    Hauraix, Hugo; Nordez, Antoine; Guilhem, Gaël; Rabita, Giuseppe; Dorel, Sylvain

    2015-12-01

    Interindividual variability in performance of fast movements is commonly explained by a difference in maximal muscle-shortening velocity due to differences in the proportion of fast-twitch fibers. To provide a better understanding of the capacity to generate fast motion, this study aimed to 1) measure for the first time in vivo the maximal fascicle-shortening velocity of human muscle; 2) evaluate the relationship between angular velocity and fascicle-shortening velocity from low to maximal angular velocities; and 3) investigate the influence of musculo-articular features (moment arm, tendinous tissues stiffness, and muscle architecture) on maximal angular velocity. Ultrafast ultrasound images of the gastrocnemius medialis were obtained from 31 participants during maximal isokinetic and light-loaded plantar flexions. A strong linear relationship between fascicle-shortening velocity and angular velocity was reported for all subjects (mean R(2) = 0.97). The maximal shortening velocity (V(Fmax)) obtained during the no-load condition (NLc) ranged between 18.8 and 43.3 cm/s. V(Fmax) values were very close to those of the maximal shortening velocity (V(max)), which was extrapolated from the F-V curve (the Hill model). Angular velocity reached during the NLc was significantly correlated with this V(Fmax) (r = 0.57; P < 0.001). This finding was in agreement with assumptions about the role of muscle fiber type, whereas interindividual comparisons clearly support the fact that other parameters may also contribute to performance during fast movements. Nevertheless, none of the biomechanical features considered in the present study were found to be directly related to the highest angular velocity, highlighting the complexity of the upstream mechanics that lead to maximal-velocity muscle contraction. PMID:26429868

  19. Gene Expression in Skin, Muscle, and Dorsal Root Ganglion after Plantar Incision in the Rat

    PubMed Central

    Spofford, Christina M.; Brennan, Timothy J.

    2012-01-01

    Background Treating postoperative pain remains a significant challenge for perioperative medicine. Recent studies have shown that nerve growth factor is upregulated and contributes to incisional pain. To date, few studies have examined expression of other neurotrophin-related mediators that may contribute to the development and/or maintenance of incisional pain. Methods Male, Sprague-Dawley rats underwent a plantar incision and pain behaviors were examined (n = 6). In a separate group of rats, expression of neurotrophic factors were studied. At various times after incision (n = 4) or sham surgery (n = 4), the skin, muscle and dorsal root ganglia were harvested and total RNA isolated. Real-time reverse transcription polymerase chain reaction was performed and the fold change in gene expression was analyzed using significance analysis of microarrays. Results Several genes were changed (p < 0.05) as early as one hour after incision. Expression of artemin and nerve growth factor were increased in both incised skin and muscle. Brain-derived neurotrophic factor, neurotrophin-3, and neurotrophin-5 were all downregulated in the skin but upregulated in the muscle 48 h after incision. Few genes changed in the dorsal root ganglion. Most changes in expression occurred in the first 48 h after incision, a timeframe when pain behavior was the greatest. Conclusion Surgical incision is associated with pain-related gene expression changes in skin, muscle, and to a lesser extent, dorsal root ganglion. The gene expression profile provides clues as to mediators that are involved in peripheral sensitization and pain transmission after surgical incision and also suggest mechanisms for resolution of postoperative pain when more persistent pain syndromes like neuropathic pain continue. PMID:22617252

  20. Spinal plasticity in stroke patients after botulinum neurotoxin A injection in ankle plantar flexors

    PubMed Central

    Aymard, Claire; Giboin, Louis-Solal; Lackmy-Vallée, Alexandra; Marchand-Pauvert, Véronique

    2013-01-01

    The effect of botulinum neurotoxin A (BoNT-A) in stroke patients' upper limbs has been attributed to its peripheral action only. However, BoNT-A depressed recurrent inhibition of lumbar motoneurons, likely due to its retrograde transportation along motor axons affecting synapses to Renshaw cells. Because Renshaw cells control group Ia interneurons mediating reciprocal inhibition between antagonists, we tested whether this inhibition, particularly affected after stroke, could recover after BoNT-A. The effect of posterior tibial nerve (PTN) stimulation on tibialis anterior (TA) electromyogram (EMG) was investigated in 13 stroke patients during treadmill walking before and 1 month after BoNT-A injection in ankle plantar flexors. Before BoNT-A, PTN stimuli enhanced TA EMG all during the swing phase. After BoNT-A, the PTN-induced reciprocal facilitation in TA motoneurons was depressed at the beginning of swing and reversed into inhibition in midswing, but at the end of swing, the reciprocal facilitation was enhanced. This suggests that BoNT-A induced spinal plasticity leading to the recovery of reciprocal inhibition likely due to the withdrawal of inhibitory control from Renshaw cells directly blocked by the toxin. At the end of swing, the enhanced reciprocal facilitation might be due to BoNT-induced modification of peripheral afferent inputs. Therefore, both central and peripheral actions of BoNT-A can modify muscle synergies during walking: (1) limiting ankle muscle co-contraction in the transition phase from stance to swing, to assist dorsiflexion, and (2) favoring it from swing to stance, which blocks the ankle joint and thus assists the balance during the single support phase on the paretic limb. PMID:24400171

  1. Plantar tactile perturbations enhance transfer of split-belt locomotor adaptation.

    PubMed

    Mukherjee, Mukul; Eikema, Diderik Jan A; Chien, Jung Hung; Myers, Sara A; Scott-Pandorf, Melissa; Bloomberg, Jacob J; Stergiou, Nicholas

    2015-10-01

    Patterns of human locomotion are highly adaptive and flexible and depend on the environmental context. Locomotor adaptation requires the use of multisensory information to perceive altered environmental dynamics and generate an appropriate movement pattern. In this study, we investigated the use of multisensory information during locomotor learning. Proprioceptive perturbations were induced by vibrating tactors, placed bilaterally over the plantar surfaces. Under these altered sensory conditions, participants were asked to perform a split-belt locomotor task representative of motor learning. Twenty healthy young participants were separated into two groups: no-tactors (NT) and tactors (TC). All participants performed an overground walking trial, followed by treadmill walking including 18 min of split-belt adaptation and an overground trial to determine transfer effects. Interlimb coordination was quantified by symmetry indices and analyzed using mixed repeated-measures ANOVAs. Both groups adapted to the locomotor task, indicated by significant reductions in gait symmetry during the split-belt task. No significant group differences in spatiotemporal and kinetic parameters were observed on the treadmill. However, significant group differences were observed overground. Step and swing time asymmetries learned on the split-belt treadmill were retained and decayed more slowly overground in the TC group whereas in NT, asymmetries were rapidly lost. These results suggest that tactile stimulation contributed to increased lower limb proprioceptive gain. High proprioceptive gain allows for more persistent overground after effects, at the cost of reduced adaptability. Such persistence may be utilized in populations displaying pathologic asymmetric gait by retraining a more symmetric pattern. PMID:26169104

  2. Impact of age on exercise-induced ATP supply during supramaximal plantar flexion in humans.

    PubMed

    Layec, Gwenael; Trinity, Joel D; Hart, Corey R; Kim, Seong-Eun; Groot, H Jonathan; Le Fur, Yann; Sorensen, Jacob R; Jeong, Eun-Kee; Richardson, Russell S

    2015-08-15

    Currently, the physiological factors responsible for exercise intolerance and bioenergetic alterations with age are poorly understood due, at least in art, to the confounding effect of reduced physical activity in the elderly. Thus, in 40 healthy young (22 ± 2 yr) and old (74 ± 8 yr) activity-matched subjects, we assessed the impact of age on: 1) the relative contribution of the three major pathways of ATP synthesis (oxidative ATP synthesis, glycolysis, and the creatine kinase reaction) and 2) the ATP cost of contraction during high-intensity exercise. Specifically, during supramaximal plantar flexion (120% of maximal aerobic power), to stress the functional limits of the skeletal muscle energy systems, we used (31)P-labeled magnetic resonance spectroscopy to assess metabolism. Although glycolytic activation was delayed in the old, ATP synthesis from the main energy pathways was not significantly different between groups. Similarly, the inferred peak rate of mitochondrial ATP synthesis was not significantly different between the young (25 ± 8 mM/min) and old (24 ± 6 mM/min). In contrast, the ATP cost of contraction was significantly elevated in the old compared with the young (5.1 ± 2.0 and 3.7 ± 1.7 mM·min(-1)·W(-1), respectively; P < 0.05). Overall, these findings suggest that, when young and old subjects are activity matched, there is no evidence of age-related mitochondrial and glycolytic dysfunction. However, this study does confirm an abnormal elevation in exercise-induced skeletal muscle metabolic demand in the old that may contribute to the decline in exercise capacity with advancing age. PMID:26041112

  3. Plantar Pressure Distribution During Robotic-Assisted Gait in Post-stroke Hemiplegic Patients

    PubMed Central

    Yang, Jin Kyu; Ahn, Na El; Kim, Dae Hyun

    2014-01-01

    Objective To assess the plantar pressure distribution during the robotic-assisted walking, guided through normal symmetrical hip and knee physiological kinematic trajectories, with unassisted walking in post-stroke hemiplegic patients. Methods Fifteen hemiplegic stroke patients, who were able to walk a minimum of ten meters independently but with asymmetric gait patterns, were enrolled in this study. All the patients performed both the robotic-assisted walking (Lokomat) and the unassisted walking on the treadmill with the same body support in random order. The contact area, contact pressure, trajectory length of center of pressure (COP), temporal data on both limbs and asymmetric index of both limbs were obtained during both walking conditions, using the F-Scan in-shoe pressure measurement system. Results The contact area of midfoot and total foot on the affected side were significantly increased in robotic-assisted walking as compared to unassisted walking (p<0.01). The contact pressure of midfoot and total foot on affected limbs were also significantly increased in robotic-assisted walking (p<0.05). The anteroposterior and mediolateral trajectory length of COP were not significantly different between the two walking conditions, but their trajectory variability of COP was significantly improved (p<0.05). The asymmetric index of area, stance time, and swing time during robotic-assisted walking were statistically improved as compared with unassisted walking (p<0.05). Conclusion The robotic-assisted walking may be helpful in improving the gait stability and symmetry, but not the physiologic ankle rocker function. PMID:24855607

  4. Simplified versus geometrically accurate models of forefoot anatomy to predict plantar pressures: A finite element study.

    PubMed

    Telfer, Scott; Erdemir, Ahmet; Woodburn, James; Cavanagh, Peter R

    2016-01-25

    Integration of patient-specific biomechanical measurements into the design of therapeutic footwear has been shown to improve clinical outcomes in patients with diabetic foot disease. The addition of numerical simulations intended to optimise intervention design may help to build on these advances, however at present the time and labour required to generate and run personalised models of foot anatomy restrict their routine clinical utility. In this study we developed second-generation personalised simple finite element (FE) models of the forefoot with varying geometric fidelities. Plantar pressure predictions from barefoot, shod, and shod with insole simulations using simplified models were compared to those obtained from CT-based FE models incorporating more detailed representations of bone and tissue geometry. A simplified model including representations of metatarsals based on simple geometric shapes, embedded within a contoured soft tissue block with outer geometry acquired from a 3D surface scan was found to provide pressure predictions closest to the more complex model, with mean differences of 13.3kPa (SD 13.4), 12.52kPa (SD 11.9) and 9.6kPa (SD 9.3) for barefoot, shod, and insole conditions respectively. The simplified model design could be produced in <1h compared to >3h in the case of the more detailed model, and solved on average 24% faster. FE models of the forefoot based on simplified geometric representations of the metatarsal bones and soft tissue surface geometry from 3D surface scans may potentially provide a simulation approach with improved clinical utility, however further validity testing around a range of therapeutic footwear types is required. PMID:26708965

  5. Foot-type analysis and plantar pressure differences between obese and nonobese adolescents during upright standing.

    PubMed

    Cimolin, Veronica; Capodaglio, Paolo; Cau, Nicola; Galli, Manuela; Pau, Massimiliano; Patrizi, Alessandra; Tringali, Gabriella; Sartorio, Alessandro

    2016-03-01

    This study aimed to characterize the effect of obesity on foot-type and plantar pressure distribution in adolescents. Ten obese adolescents (obese group; BMI: 35.45±4.73 kg/m) and eight normal-weighted adolescents (control group; BMI: 18.67±2.46 kg/m) were recruited. Both groups were evaluated while standing using the Pedar-X in-shoe system. Foot-ground contact was characterized using contact area, peak of force and pressure calculated for the subareas of the foot. The analysis showed that obese participants had significantly higher area of contact in forefoot and midfoot (only in medial area) regions in comparison with the control group, whereas no statistically significant differences were observed for the rearfoot region. As far as the maximum pressure and force was concerned, similar results were obtained for both groups. Obese participants showed higher values for all the regions, with the exception of medial rearfoot area, for which the values were similar between the two groups. The analysis of foot-type distribution displayed that in the obese group high percentage of participants presented flat foot (70%) respect to cavus foot (20%) and normal foot (10%); on the contrary, in the control group, foot-types were markedly different, with 25% of participants with flat foot, 25% with cavus foot and 50% with normal foot. These results are important from a clinical perspective to develop and enhance the rehabilitative options in these patients and to avoid a worsening of their foot abnormalities. Untreated flat foot can in fact be disabling and over time can result in significant difficulties for the patient. PMID:26632774

  6. Prospective Randomized Comparison of the Effectiveness of Radiation Therapy and Local Steroid Injection for the Treatment of Plantar Fasciitis

    SciTech Connect

    Canyilmaz, Emine; Canyilmaz, Fatih; Aynaci, Ozlem; Colak, Fatma; Serdar, Lasif; Uslu, Gonca Hanedan; Aynaci, Osman; Yoney, Adnan

    2015-07-01

    Purpose: The purpose of this study was to conduct a randomized trial of radiation therapy for plantar fasciitis and to compare radiation therapy with local steroid injections. Methods and Materials: Between March 2013 and April 2014, 128 patients with plantar fasciitis were randomized to receive radiation therapy (total dose of 6.0 Gy applied in 6 fractions of 1.0 Gy three times a week) or local corticosteroid injections a 1 ml injection of 40 mg methylprednisolone and 0.5 ml 1% lidocaine under the guidance of palpation. The results were measured using a visual analog scale, a modified von Pannewitz scale, and a 5-level function score. The fundamental phase of the study was 3 months, with a follow-up period of up to 6 months. Results: The median follow-up period for all patients was 12.5 months (range, 6.5-18.6 months). For the radiation therapy patients, the median follow-up period was 13 months (range, 6.5-18.5 months), whereas in the palpation-guided (PG) steroid injection arm, it was 12.1 months (range, 6.5-18.6 months). After 3 months, results in the radiation therapy arm were significantly superior to those in the PG steroid injection arm (visual analog scale, P<.001; modified von Pannewitz scale, P<.001; 5-level function score, P<.001). Requirements for a second treatment did not significantly differ between the 2 groups, but the time interval for the second treatment was significantly shorter in the PG steroid injection group (P=.045). Conclusion: This study confirms the superior analgesic effect of radiation therapy compared to mean PG steroid injection on plantar fasciitis for at least 6 months after treatment.

  7. Plantar pressure relief under the metatarsal heads: therapeutic insole design using three-dimensional finite element model of the foot.

    PubMed

    Chen, Wen-Ming; Lee, Sung-Jae; Lee, Peter Vee Sin

    2015-02-26

    Therapeutic footwear with specially-made insoles is often used in people with diabetes and rheumatoid arthritis to relieve ulcer risks and pain due to high pressures from areas beneath bony prominences of the foot, in particular to the metatarsal heads (MTHs). In a three-dimensional finite element study of the foot and footwear with sensitivity analysis, effects of geometrical variations of a therapeutic insole, in terms of insole thicknesses and metatarsal pad (MP) placements, on local peak plantar pressure under MTHs and stress/strain states within various forefoot tissues, were determined. A validated musculoskeletal finite element model of the human foot was employed. Analyses were performed in a simulated muscle-demanding instant in gait. For many design combinations, increasing insole thicknesses consistently reduce peak pressures and internal tissue strain under MTHs, but the effects reach a plateau when insole becomes very thick (e.g., a value of 12.7mm or greater). Altering MP placements, however, showed a proximally- and a distally-placed MP could result in reverse effects on MTH pressure-relief. The unsuccessful outcome due to a distally-placed MP may attribute to the way it interacts with plantar tissue (e.g., plantar fascia) adjacent to the MTH. A uniform pattern of tissue compression under metatarsal shaft is necessary for a most favorable pressure-relief under MTHs. The designated functions of an insole design can best be achieved when the insole is very thick, and when the MP can achieve a uniform tissue compression pattern adjacent to the MTH. PMID:25620685

  8. Comparison of foot orthoses made by podiatrists, pedorthists and orthotists regarding plantar pressure reduction in The Netherlands

    PubMed Central

    Guldemond, Nick A; Leffers, Pieter; Schaper, Nicolaas C; Sanders, Antal P; Nieman, Fred HM; Walenkamp, Geert HIM

    2005-01-01

    Background There is a need for evidence of clinical effectiveness of foot orthosis therapy. This study evaluated the effect of foot orthoses made by ten podiatrists, ten pedorthists and eleven orthotists on plantar pressure and walking convenience for three patients with metatarsalgia. Aims were to assess differences and variability between and within the disciplines. The relationship between the importance of pressure reduction and the effect on peak pressure was also evaluated. Methods Each therapist examined all three patients and was asked to rate the 'importance of pressure reduction' through a visual analogue scale. The orthoses were evaluated twice in two sessions while the patient walked on a treadmill. Plantar pressures were recorded with an in-sole measuring system. Patients scored walking convenience per orthosis. The effects of the orthoses on peak pressure reduction were calculated for the whole plantar surface of the forefoot and six regions: big toe and metatarsal one to five. Results Within each discipline there was an extensive variation in construction of the orthoses and achieved peak pressure reductions. Pedorthists and orthotists achieved greater maximal peak pressure reductions calculated over the whole forefoot than podiatrists: 960, 1020 and 750 kPa, respectively (p < .001). This was also true for the effect in the regions with the highest baseline peak pressures and walking convenience rated by patients A and B. There was a weak relationship between the 'importance of pressure reduction' and the achieved pressure reduction for orthotists, but no relationship for podiatrists and pedorthotists. Conclusion The large variation for various aspects of foot orthoses therapy raises questions about a consistent use of concepts for pressures management within the professional groups. PMID:16368005

  9. A Novel and Alternative Treatment Method for Diabetic Heel Ulceration Exposing the Calcaneus Which Is Not Suitable for Flap Surgery: Vacuum Assisted Sandwich Dermal Matrix

    PubMed Central

    Bingol, Ugur A.; Cinar, Can; Arslan, Hakan; Altındas, Muzaffer

    2015-01-01

    Background. Currently, free flaps and pedicled flaps are the first treatment choices for large heel ulcer reconstruction. However, flap reconstruction of heel ulcerations cannot be performed in all diabetics especially with concurrent severe peripheral vascular disease because of higher flap failure rate. In recent years, the use of acellular dermal matrix (ADM) has emerged as an alternative treatment option for extremity ulcers. Methods. We present 13 diabetic patients with a large heel ulceration exposing the calcaneus, who were not eligible for flap surgery due to the presence of only one patent artery of trifurcation. These cases were treated with the vacuum assisted sandwich dermal matrix (VASDEM) method. Results. None of the patients required amputation. Skin grafting was successful in ten patients. Although partial losses were observed in three patients, they were healed spontaneously without surgical interventions. During the follow-up period none of the patients developed ulceration on the treatment area. All patients maintained their preoperative ambulatory ability. Conclusion. VASDEM is a novel method offering opportunity for treatment before proceeding to amputation in diabetic heel ulceration exposing the calcaneus which is not suitable for flap surgery. It also has the potential to close wounds of all sizes independent of the vessel status and wound size in selected diabetic patients. PMID:26516626

  10. Large heel soft tissue defects managed successfully with reverse medial crural fasciocutaneous flap: a 7-year single-center experience with 21 consecutive cases.

    PubMed

    Jing-Chun, Zhao; Kai, Shi; Jia-Ao, Yu; Chun-Jing, Xian; Lai-Jin, Lu; Chun-Hui, Xie

    2015-01-01

    The medial crural fasciocutaneous flap is a reliable cutaneous flap that can be used for soft tissue reconstruction in the extremities. The purpose of this article is to evaluate the application and clinical significance of this surgical technique in the reconstruction of heel soft tissue defects. Twenty-one cases of heel soft tissue defect between March 2005 and March 2012 were included in this study. Wound sizes varied from 5.0 × 5.5 to 7.5 × 10.0 cm. All cases were managed with a reverse medial crural fasciocutaneous flap. Patient demographics and case information were analyzed and are reported. The sizes of the reverse medial crural fasciocutaneous flap varied from 6.5 × 10.0 to 9.0 × 15.0 cm; the average size was 7.7 × 13.8 cm. Out of the 21 consecutive cases, 20 flaps survived intact and one flap underwent partial necrosis. Follow-up observations were conducted for 6-36 months. The cosmetic results were satisfactory, without apparent bulkiness; the weight-bearing outcomes were satisfactory. The donor site can be closed primarily or by skin graft. Reverse medial crural fasciocutaneous flap transfer is appropriate for the reconstruction of heel soft tissue defects. The method is safe and can cover large heel defects. PMID:25448373

  11. A pedestrian dead-reckoning system that considers the heel-strike and toe-off phases when using a foot-mounted IMU

    NASA Astrophysics Data System (ADS)

    Ju, Hojin; Lee, Min Su; Park, So Young; Song, Jin Woo; Park, Chan Gook

    2016-01-01

    In this paper, we propose an advanced pedestrian dead-reckoning (PDR) algorithm that considers the heel-strike and toe-off phases. Generally, PDR systems that use a foot-mounted inertial measurement unit are based on an inertial navigation system with an extended Kalman filter (EKF). To reduce the influence of the bias and white noises in the gyroscope and accelerometer signals, a zero-velocity update is often adopted at the stance phase. However, transient and large acceleration, which cannot be measured by the accelerometer used in pedestrian navigation, occur momentarily in the heel-strike phase. The velocity information from integration of the acceleration is not reliable because the acceleration is not measured in the heel-strike phase. Therefore, the designed EKF does not correctly reflect the actual environment, because conventional algorithms do not take the non-measurable acceleration into consideration. In order to reflect the actual environment, we propose a PDR system that considers the non-measurable acceleration from the heel-strike impact. To improve the PDR system’s performance, the proposed algorithm uses a new velocity measurement obtained using the constraint between the surface and the foot during the toe-off phase. The experimental results show improved filter performance after comparison of the proposed algorithm and a conventional algorithm.

  12. Photoletter to the editor: Exogenous pigmentation after Diplopoda exposure leading to a dermatoscopic parallel ridge pattern on the plantar region.

    PubMed

    Fracaroli, Tainá Scalfoni; Miranda, Ludmilla Queirós; Maceira, Juan Piñeiro; Barcaui, Carlos Baptista

    2015-09-30

    The millipedes (also known as "gongolos") are arthropods characterized by a cylindrical body consisting of rings. When threatened, they release chemicals that can cause erythema and hyperpigmentation. We report the case of a patient who developed a darkened macule on the plantar region after stepping on a millipede. Dermatoscopic examination showed a parallel-ridge pattern, which is considered typical for acral melanoma. A detailed history was essential for the diagnosis, as the clinical and dermatoscopic features suggested a malignant melanocytic lesion. PMID:26512306

  13. Hereditary neuropathy with liability to pressure palsy combined with schwannomas of the median and medial plantar nerves.

    PubMed

    Heckmann, Josef G; Dütsch, Matthias; Buslei, Ralf

    2007-01-01

    A 42-year-old woman was surgically treated for carpal tunnel syndrome, revealing schwannoma of the median nerve. A year later, she developed a tarsal tunnel syndrome. At time of this diagnosis, hereditary neuropathy with liability to pressure palsies (HNPP) was diagnosed genetically and a schwannoma of the medial plantar nerve was treated surgically. The occurrence of HNPP and schwannomas in the same patient might be purely coincidental, but it is tempting to speculate that they share a common genetic basis. PMID:16969831

  14. The effect of shoe toe box shape and volume on forefoot interdigital and plantar pressures in healthy females

    PubMed Central

    2013-01-01

    Background Ill-fitting footwear can be detrimental to foot health with the forefoot being an area for most discomfort. Studies on footwear have primarily examined sports or orthopaedic prescription shoes and little is known about the effects that everyday flat shoes have on the forefoot. The aim of this study was to investigate the effect of toe box shape in a popular slip-on pump on dorsal and plantar pressures with particular interest around the forefoot in a healthy female population. Method A convenience sample of 27 female participants with no known foot pathologies was recruited. After assessment of foot size, plantar foot pressure and interdigital pressures were recorded for each of the 3 different toe box styles; round, square and pointed. Participants walked at a self-selected speed over a 10 m walkway whilst wearing each of the 3 styles of shoe and also whilst barefoot. Processed and analysed data extracted included peak pressure, time to peak pressure, contact time and pressure time integral. ANOVA and Freidman analysis was used to test for statistical significance. Results Shoes with a round toe showed least pressure around the medial aspect of the toes whilst the pointed shoe had least pressure on the lateral toes. Contact times for the plantar regions were not altered in any shoe condition yet contact around the medial aspect of the toes was highest in the pointed shoe. Conclusion This study highlights that the shape of the toe box in footwear can significantly influence the amount of pressure applied to the forefoot. Furthermore, the contours of the shoe also have an impact on the contact time and pressure time integral around the forefoot and also the peak plantar pressure in the toe region. The changes observed could be significant in the development of pathology in certain footwear toe box shapes. Consideration should be given to footwear design around the toe box to improve fit and reduce pressure. Further work is required to investigate the effect of toe box shape and volume on a pathological population with pressure related lesions. PMID:23886242

  15. A novel approach to mapping load transfer from the plantar surface of the foot to the walls of the total contact cast: a proof of concept study

    PubMed Central

    2012-01-01

    Background Total contact casting is regarded as the gold standard treatment for plantar foot ulcers. Load transfer from the plantar surface of the foot to the walls of the total contact cast has previously been assessed indirectly. The aim of this proof of concept study was to determine the feasibility of a new method to directly measure the load between the cast wall and the lower leg interface using capacitance sensors. Methods Plantar load was measured with pedar® sensor insoles and cast wall load with pliance® sensor strips as participants (n=2) walked along a 9 m walkway at 0.4±0.04 m/sec. The relative force (%) on the cast wall was calculated by dividing the mean cast wall force (N) per step by the mean plantar force (N) per step in the shoe-cast condition. Results The combined average measured load per step upon the walls of the TCC equated to 23-34% of the average plantar load on the opposite foot. The highest areas of load on the lower leg were located at the posterior margin of the lateral malleolus and at the anterior ankle/extensor retinaculum. Conclusions These direct measurements of cast wall load are similar to previous indirect assessment of load transfer (30-36%) to the cast walls. This new methodology may provide a more comprehensive understanding of the mechanism of load transfer from the plantar surface of the foot to the cast walls of the total contact cast. PMID:23237261

  16. Citral: a monoterpene with prophylactic and therapeutic anti-nociceptive effects in experimental models of acute and chronic pain.

    PubMed

    Nishijima, Catarine M; Ganev, Ellen G; Mazzardo-Martins, Leidiane; Martins, Daniel F; Rocha, Lúcia R M; Santos, Adair R S; Hiruma-Lima, Clelia A

    2014-08-01

    Citral (3,7-dimethyl-2,6-octadienal) is an open-chain monoterpenoid present in the essential oils of several medicinal plants. The aim of this work was to evaluate the effects of orally administered citral in experimental models of acute and chronic nociception, inflammation, and gastric ulcers caused by non-steroidal anti-inflammatory drugs (NSAIDs). Oral treatment with citral significantly inhibited the neurogenic and inflammatory pain responses induced by intra-plantar injection of formalin. Citral also had prophylactic and therapeutic anti-nociceptive effects against mechanical hyperalgesia in plantar incision surgery, chronic regional pain syndrome, and partial ligation of sciatic nerve models, without producing any significant motor dysfunction. In addition, citral markedly attenuated the pain response induced by intra-plantar injection of glutamate and phorbol 12-myristate 13-acetate (PMA, a protein kinase C activator), as well as by intrathecal (i.t.) injection of ionotropic and metabotropic glutamate receptor agonists (N-methyl-D-aspartic acid [NMDA] and 1-amino-1,3-dicarboxycyclopentane [trans-ACPD], respectively), substance P, and cytokine tumour necrosis factor-α. However, citral potentiated behaviours indicative of pain caused by i.t., but not intra-plantar, injection of a transient receptor potential vanilloid receptor type 1 (TRPV1) agonist. Finally, the anti-nociceptive action of citral was found to involve significant activation of the 5-HT2A serotonin receptor. The effect of citral was accompanied by a gastro-protective effect against NSAID-induced ulcers. Together, these results show the potential of citral as a new drug for the treatment of pain. PMID:24792822

  17. [IMMUNOLOGICAL REACTIVITY AND CORRECTION OF IMMUNOLOGICAL DISORDERS BY BIOLOGICAL MEDICINES IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE EXACERBATIONS].

    PubMed

    Il'nyts'kyĭ, R I

    2014-01-01

    The results of systemic immunological reactivity research were presented in 97 patients with chronic obstructive pulmonary disease (COPD) exacerbations. The patients were randomized on two groups. 67 patients, which additionally to standard anti-inflammatory therapy were prescribed different combinations of homotoxicological medicines, entered in a clinical group. The homotoxicological medicines such as Lymphomyosot, Galium-Heel®, Traumeel S, Echinacea compositum S, Bronchalis-Heel®, Mucosa compositum were prescribed according to the value of immune-regulatory index and type of T-cells immune disorders. 30 patients, which got standard anti-inflammatory therapy, entered in the group. of comparison. For the patients of clinical group immunological values were improved after the conducted treatment, unlike the patients of group of comparison in which an immunodeficiency was deepened. PMID:26118077

  18. Chronic migraine.

    PubMed

    Schwedt, Todd J

    2014-01-01

    Chronic migraine is a disabling neurologic condition that affects 2% of the general population. Patients with chronic migraine have headaches on at least 15 days a month, with at least eight days a month on which their headaches and associated symptoms meet diagnostic criteria for migraine. Chronic migraine places an enormous burden on patients owing to frequent headaches; hypersensitivity to visual, auditory, and olfactory stimuli; nausea; and vomiting. It also affects society through direct and indirect medical costs. Chronic migraine typically develops after a slow increase in headache frequency over months to years. Several factors are associated with an increased risk of transforming to chronic migraine. The diagnosis requires a carefully performed patient interview and neurologic examination, sometimes combined with additional diagnostic tests, to differentiate chronic migraine from secondary headache disorders and other primary chronic headaches of long duration. Treatment takes a multifaceted approach that may include risk factor modification, avoidance of migraine triggers, drug and non-drug based prophylaxis, and abortive migraine treatment, the frequency of which is limited to avoid drug overuse. This article provides an overview of current knowledge regarding chronic migraine, including epidemiology, risk factors for its development, pathophysiology, diagnosis, management, and guidelines. The future of chronic migraine treatment and research is also discussed. PMID:24662044

  19. Plantar Pressure in Diabetic Peripheral Neuropathy Patients with Active Foot Ulceration, Previous Ulceration and No History of Ulceration: A Meta-Analysis of Observational Studies

    PubMed Central

    Fernando, Malindu Eranga; Crowther, Robert George; Pappas, Elise; Lazzarini, Peter Anthony; Cunningham, Margaret; Sangla, Kunwarjit Singh; Buttner, Petra; Golledge, Jonathan

    2014-01-01

    Aims Elevated dynamic plantar pressures are a consistent finding in diabetes patients with peripheral neuropathy with implications for plantar foot ulceration. This meta-analysis aimed to compare the plantar pressures of diabetes patients that had peripheral neuropathy and those with neuropathy with active or previous foot ulcers. Methods Published articles were identified from Medline via OVID, CINAHL, SCOPUS, INFORMIT, Cochrane Central EMBASE via OVID and Web of Science via ISI Web of Knowledge bibliographic databases. Observational studies reporting barefoot dynamic plantar pressure in adults with diabetic peripheral neuropathy, where at least one group had a history of plantar foot ulcers were included. Interventional studies, shod plantar pressure studies and studies not published in English were excluded. Overall mean peak plantar pressure (MPP) and pressure time integral (PTI) were primary outcomes. The six secondary outcomes were MPP and PTI at the rear foot, mid foot and fore foot. The protocol of the meta-analysis was published with PROPSERO, (registration number CRD42013004310). Results Eight observational studies were included. Overall MPP and PTI were greater in diabetic peripheral neuropathy patients with foot ulceration compared to those without ulceration (standardised mean difference 0.551, 95% CI 0.290–0.811, p<0.001; and 0.762, 95% CI 0.303–1.221, p = 0.001, respectively). Sub-group analyses demonstrated no significant difference in MPP for those with neuropathy with active ulceration compared to those without ulcers. A significant difference in MPP was found for those with neuropathy with a past history of ulceration compared to those without ulcers; (0.467, 95% CI 0.181– 0.753, p = 0.001). Statistical heterogeneity between studies was moderate. Conclusions Plantar pressures appear to be significantly higher in patients with diabetic peripheral neuropathy with a history of foot ulceration compared to those with diabetic neuropathy without a history of ulceration. More homogenous data is needed to confirm these findings. PMID:24915443

  20. A Cross-Sectional Study of the Association of VDR Gene, Calcium Intake, and Heel Ultrasound Measures in Early Adulthood.

    PubMed

    Correa-Rodríguez, María; Schmidt Rio-Valle, Jacqueline; González-Jiménez, Emilio; Rueda-Medina, Blanca

    2016-03-01

    The acquisition of a high adult peak bone mass (PBM) is considered an important determinant of osteoporotic risk later in life. Genetic and environmental factors determine optimal PBM acquisition in early adulthood. The aim of this study was to test the association of vitamin D receptor (VDR) gene polymorphisms and dietary calcium intake with the bone mass of young adults. The study population comprised a total of 305 individuals (mean age 20.41; SD 2.36) whose bone mass was assessed through heel ultrasound [quantitative ultrasound measurements (QUS)] measurements (BUA, dB/MHz). The FokI G/A, rs9729 G/T, and TaqI G/A polymorphisms were selected as genetic markers of VDR. A significant difference in BUA values was observed according to gender (females 82.96; SD 15.89 vs. males 97.72; SD 16.50; p < 0.00001). The mean dietary calcium intake of the study group (827.84 mg/day; SD 347.04) was lower than the dietary reference intake for young adults (1000 mg/day) and had no association with BUA. None of the three VDR polymorphisms tested showed an association with BUA. Similarly, the analysis of VDR 3' haplotypes, estimated using rs9729 and Taq1 as tag SNPs, did not reveal any significant association with QUS traits. Our results confirm the existence of different heel QUS for women and men, as well as a tendency towards low calcium consumption by young adults, and they also suggest that the VDR gene does not play a major role in the genetic determination of QUS parameter in early adulthood. PMID:26590811

  1. Effectiveness of a heel cup with an arch support insole on the standing balance of the elderly

    PubMed Central

    Chen, Tzu-Hsuan; Chou, Li-Wei; Tsai, Mei-Wun; Lo, Ming-Jor; Kao, Mu-Jung

    2014-01-01

    Background The use of insoles may enhance postural stability and prevent falls. The aim of this study was to design a new insole and to explore the effectiveness of the insole on the standing balance of the healthy elderly. Methods The study was conducted at a community hospital. Patients older than 65 years at an outpatient clinic without abnormal gait patterns, lower limb deformities, or foot pain were enrolled. The participants were assigned to good- and poor-stability groups on the basis of the stability index (SI), using the Biodex® Balance System. A heel cup with an arch support insole was provided. Participants wore the insole for 8 weeks for a minimum of 4 hours/day. A static balance test for SI was performed at the initial meeting and 8 weeks after the assigned insoles were worn for each participant. Results Five participants (10.0%) of 50 total did not finish the study. There were 25 patients in the good-stability group and 20 in the poor-stability group. The SI, before and after intervention, was significantly different for all 45 participants (3.244±0.688 versus 3.064±0.671; P<0.001). The differences in SI before and after the intervention both in the good-stability group (2.764±0.546 versus 2.592±0.538) and the poor-stability group (3.845±0.188 versus 3.655±0.128) were statistically significant (P<0.001). No statistically significant difference on changes of SI were seen between the two groups. Conclusion The results suggest a heel cup with arch support insole is effective in enhancing the standing balance of the elderly. This may be of benefit in preventing falls. PMID:24600215

  2. Differences in plantar loading between training shoes and racing flats at a self-selected running speed.

    PubMed

    Wiegerinck, Johannes I; Boyd, Jennifer; Yoder, Jordan C; Abbey, Alicia N; Nunley, James A; Queen, Robin M

    2009-04-01

    The purpose of this study was to examine the difference in plantar loading between two different running shoe types. We hypothesized that a higher maximum force, peak pressure, and contact area would exist beneath the entire foot while running in a racing flat when compared to a training shoe. 37 athletes (17 male and 20 female) were recruited for this study. Subjects had no history of lower extremity injuries in the past six months, no history of foot or ankle surgery within the past 3 years, and no history of metatarsal stress fractures. Subjects had to be physically active and run at least 10 miles per week. Each subject ran on a 10m runway 7 times wearing two different running shoe types, the Nike Air Pegasus (training shoe) and the Nike Air Zoom Katana IV (racing flat). A Pedar-X in-shoe pressure measurement system sampling at 50Hz was used to collect plantar pressure data. Peak pressure, maximum force, and contact area beneath eight different anatomical regions of the foot as well as beneath the total foot were obtained. The results of this study demonstrated a significant difference between training shoes and racing flats in terms of peak pressure, maximum force, and contact area. The significant differences measured between the two shoes can be of importance when examining the influence of shoe type on the occurrence of stress fractures in runners. PMID:19147359

  3. Treatment of the Secondary Defect on the First Metatarsophalangeal Joint Using the Medial Plantar Hallucal Artery Dorsal Perforator Flap.

    PubMed

    Zhang, Xu; Bai, Guangqi; Zhang, Zhihong; Chen, Chao; Yu, Yadong; Shao, Xinzhong

    2016-05-01

    Injuries or burns to the dorsum of the first metatarsophalangeal (MTP) joint may develop scar formation, resulting in hyperextension contracture. Surgical correction of the deformity often produces a secondary defect. The purpose of this study is to report on the use of the medial plantar hallucal artery dorsal perforator flap for the treatment of such defect. From February 2010 to June 2011, 16 patients were treated. The mean preoperative hyperextension of the first MTP joint was 48 degrees. The mean size of the defects was 3.6 × 6 cm. The mean flap size was 4 × 6.5 cm. The mean pedicle length was 4 cm. All flaps survived completely. Patient follow-up lasted a mean of 14 months. At the final follow-up, the mean hyperextension of the first MTP joint was 9 degrees. After surgery, the mean Foot Function Index improved from 62 to 7. Almost all patients were satisfied with the results. Transferring the medial plantar hallucal artery dorsal perforator flap is a useful and reliable technique for the reconstruction of the secondary defect on the first MTP joint. PMID:25275474

  4. Correlation between Plantar Foot Temperature and Diabetic Neuropathy: A Case Study by Using an Infrared Thermal Imaging Technique

    PubMed Central

    Bagavathiappan, Subramnaiam; Philip, John; Jayakumar, Tammana; Raj, Baldev; Rao, Pallela Narayana Someshwar; Varalakshmi, Muthukrishnan; Mohan, Viswanathan

    2010-01-01

    Background Diabetic neuropathy consists of multiple clinical manifestations of which loss of sensation is most prominent. High temperatures under the foot coupled with reduced or complete loss of sensation can predispose the patient to foot ulceration. The aim of this study was to look at the correlation between plantar foot temperature and diabetic neuropathy using a noninvasive infrared thermal imaging technique. Methods Infrared thermal imaging, a remote and noncontact experimental tool, was used to study the plantar foot temperatures of 112 subjects with type 2 diabetes selected from a tertiary diabetes centre in South India. Results Patients with diabetic neuropathy (defined as vibration perception threshold (VPT) values on biothesiometry greater than 20 V) had a higher foot temperature (32–35 °C) compared to patients without neuropathy (27–30 °C). Diabetic subjects with neuropathy also had higher mean foot temperature (MFT) (p = .001) compared to non-neuropathic subjects. MFT also showed a positive correlation with right great toe (r = 0.301, p = .001) and left great toe VPT values (r = 0.292, p = .002). However, there was no correlation between glycated hemoglobin and MFT. Conclusion Infrared thermal imaging may be used as an additional tool for evaluation of high risk diabetic feet. PMID:21129334

  5. Classification of Forefoot Plantar Pressure Distribution in Persons with Diabetes: A Novel Perspective for the Mechanical Management of Diabetic Foot?

    PubMed Central

    Deschamps, Kevin; Matricali, Giovanni Arnoldo; Roosen, Philip; Desloovere, Kaat; Bruyninckx, Herman; Spaepen, Pieter; Nobels, Frank; Tits, Jos; Flour, Mieke; Staes, Filip

    2013-01-01

    Background The aim of this study was to identify groups of subjects with similar patterns of forefoot loading and verify if specific groups of patients with diabetes could be isolated from non-diabetics. Methodology/Principal Findings Ninety-seven patients with diabetes and 33 control participants between 45 and 70 years were prospectively recruited in two Belgian Diabetic Foot Clinics. Barefoot plantar pressure measurements were recorded and subsequently analysed using a semi-automatic total mapping technique. Kmeans cluster analysis was applied on relative regional impulses of six forefoot segments in order to pursue a classification for the control group separately, the diabetic group separately and both groups together. Cluster analysis led to identification of three distinct groups when considering only the control group. For the diabetic group, and the computation considering both groups together, four distinct groups were isolated. Compared to the cluster analysis of the control group an additional forefoot loading pattern was identified. This group comprised diabetic feet only. The relevance of the reported clusters was supported by ANOVA statistics indicating significant differences between different regions of interest and different clusters. Conclusion/s Significance There seems to emerge a new era in diabetic foot medicine which embraces the classification of diabetic patients according to their biomechanical profile. Classification of the plantar pressure distribution has the potential to provide a means to determine mechanical interventions for the prevention and/or treatment of the diabetic foot. PMID:24278219

  6. Genetic heterogeneity in families with non-epidermolytic palmar plantar keratosis

    SciTech Connect

    Spurr, N.K.; Kelshell, D.P.; Stevens, H.

    1994-09-01

    Following reports of linkage close to the keratin gene cluster in families with tylosis and the detection of mutations in the keratin 9 gene cosegregating in families with epidermolytic palmar plantar keratoderma (EPPK, and EPPK associated with breast and ovarian cancer), we have identified families with three phenotypically distinct forms of non-epidermolytic keratosis with either punctate, diffuse or focal keratoderma, one with diffuse lesions and one with punctate and malignancies. Initially we typed these families with 17q markers close to the keratin gene cluster; this included a dinucleotide repeat marker within the keratin 9 gene. Two point linkage analysis of the focal keratoderma family showed a positive lod score of 3.2 at a theta of 0 from the marker D17S855. The lod score for the diffuse family was -6.0 at a theta of 0.05 from the marker D17S776. The second focal keratoderma family showed a haplotype consistent with linkage to 17q close to the keratin gene cluster. A second keratin gene cluster has been mapped in humans on 12q, and we decided to test the unlinked diffuse and punctate keratoderma families with markers in that region. We used the markers: D12S87-D12S85-D12S368-D12S96-D12S90. Linkage analysis of the diffuse family gave a lod score of 3.1 at a theta of 0 from the marker D12S368. Currently studies are underway to look for mutations in specific keratin genes in the clusters on 17q and 12q that segregate with the observed phenotypes. The punctate keratoderma family gave lod scores of -3.9 at a theta of 0.55 with D17S855 and -6.0 at a theta of 0.05 with D12S90/D12S83. This would lead us to the conclusion that a separate susceptibility locus must exist for the punctate family associated with malignancy. Investigations of candidate regions are in progress.

  7. Genetic determinants of heel bone properties: genome-wide association meta-analysis and replication in the GEFOS/GENOMOS consortium.

    PubMed

    Moayyeri, Alireza; Hsu, Yi-Hsiang; Karasik, David; Estrada, Karol; Xiao, Su-Mei; Nielson, Carrie; Srikanth, Priya; Giroux, Sylvie; Wilson, Scott G; Zheng, Hou-Feng; Smith, Albert V; Pye, Stephen R; Leo, Paul J; Teumer, Alexander; Hwang, Joo-Yeon; Ohlsson, Claes; McGuigan, Fiona; Minster, Ryan L; Hayward, Caroline; Olmos, José M; Lyytikäinen, Leo-Pekka; Lewis, Joshua R; Swart, Karin M A; Masi, Laura; Oldmeadow, Chris; Holliday, Elizabeth G; Cheng, Sulin; van Schoor, Natasja M; Harvey, Nicholas C; Kruk, Marcin; del Greco M, Fabiola; Igl, Wilmar; Trummer, Olivia; Grigoriou, Efi; Luben, Robert; Liu, Ching-Ti; Zhou, Yanhua; Oei, Ling; Medina-Gomez, Carolina; Zmuda, Joseph; Tranah, Greg; Brown, Suzanne J; Williams, Frances M; Soranzo, Nicole; Jakobsdottir, Johanna; Siggeirsdottir, Kristin; Holliday, Kate L; Hannemann, Anke; Go, Min Jin; Garcia, Melissa; Polasek, Ozren; Laaksonen, Marika; Zhu, Kun; Enneman, Anke W; McEvoy, Mark; Peel, Roseanne; Sham, Pak Chung; Jaworski, Maciej; Johansson, Åsa; Hicks, Andrew A; Pludowski, Pawel; Scott, Rodney; Dhonukshe-Rutten, Rosalie A M; van der Velde, Nathalie; Kähönen, Mika; Viikari, Jorma S; Sievänen, Harri; Raitakari, Olli T; González-Macías, Jesús; Hernández, Jose L; Mellström, Dan; Ljunggren, Osten; Cho, Yoon Shin; Völker, Uwe; Nauck, Matthias; Homuth, Georg; Völzke, Henry; Haring, Robin; Brown, Matthew A; McCloskey, Eugene; Nicholson, Geoffrey C; Eastell, Richard; Eisman, John A; Jones, Graeme; Reid, Ian R; Dennison, Elaine M; Wark, John; Boonen, Steven; Vanderschueren, Dirk; Wu, Frederick C W; Aspelund, Thor; Richards, J Brent; Bauer, Doug; Hofman, Albert; Khaw, Kay-Tee; Dedoussis, George; Obermayer-Pietsch, Barbara; Gyllensten, Ulf; Pramstaller, Peter P; Lorenc, Roman S; Cooper, Cyrus; Kung, Annie Wai Chee; Lips, Paul; Alen, Markku; Attia, John; Brandi, Maria Luisa; de Groot, Lisette C P G M; Lehtimäki, Terho; Riancho, José A; Campbell, Harry; Liu, Yongmei; Harris, Tamara B; Akesson, Kristina; Karlsson, Magnus; Lee, Jong-Young; Wallaschofski, Henri; Duncan, Emma L; O'Neill, Terence W; Gudnason, Vilmundur; Spector, Timothy D; Rousseau, François; Orwoll, Eric; Cummings, Steven R; Wareham, Nick J; Rivadeneira, Fernando; Uitterlinden, Andre G; Prince, Richard L; Kiel, Douglas P; Reeve, Jonathan; Kaptoge, Stephen K

    2014-06-01

    Quantitative ultrasound of the heel captures heel bone properties that independently predict fracture risk and, with bone mineral density (BMD) assessed by X-ray (DXA), may be convenient alternatives for evaluating osteoporosis and fracture risk. We performed a meta-analysis of genome-wide association (GWA) studies to assess the genetic determinants of heel broadband ultrasound attenuation (BUA; n = 14 260), velocity of sound (VOS; n = 15 514) and BMD (n = 4566) in 13 discovery cohorts. Independent replication involved seven cohorts with GWA data (in silico n = 11 452) and new genotyping in 15 cohorts (de novo n = 24 902). In combined random effects, meta-analysis of the discovery and replication cohorts, nine single nucleotide polymorphisms (SNPs) had genome-wide significant (P < 5 × 10(-8)) associations with heel bone properties. Alongside SNPs within or near previously identified osteoporosis susceptibility genes including ESR1 (6q25.1: rs4869739, rs3020331, rs2982552), SPTBN1 (2p16.2: rs11898505), RSPO3 (6q22.33: rs7741021), WNT16 (7q31.31: rs2908007), DKK1 (10q21.1: rs7902708) and GPATCH1 (19q13.11: rs10416265), we identified a new locus on chromosome 11q14.2 (rs597319 close to TMEM135, a gene recently linked to osteoblastogenesis and longevity) significantly associated with both BUA and VOS (P < 8.23 × 10(-14)). In meta-analyses involving 25 cohorts with up to 14 985 fracture cases, six of 10 SNPs associated with heel bone properties at P < 5 × 10(-6) also had the expected direction of association with any fracture (P < 0.05), including three SNPs with P < 0.005: 6q22.33 (rs7741021), 7q31.31 (rs2908007) and 10q21.1 (rs7902708). In conclusion, this GWA study reveals the effect of several genes common to central DXA-derived BMD and heel ultrasound/DXA measures and points to a new genetic locus with potential implications for better understanding of osteoporosis pathophysiology. PMID:24430505

  8. Genetic determinants of heel bone properties: genome-wide association meta-analysis and replication in the GEFOS/GENOMOS consortium

    PubMed Central

    Moayyeri, Alireza; Hsu, Yi-Hsiang; Karasik, David; Estrada, Karol; Xiao, Su-Mei; Nielson, Carrie; Srikanth, Priya; Giroux, Sylvie; Wilson, Scott G.; Zheng, Hou-Feng; Smith, Albert V.; Pye, Stephen R.; Leo, Paul J.; Teumer, Alexander; Hwang, Joo-Yeon; Ohlsson, Claes; McGuigan, Fiona; Minster, Ryan L.; Hayward, Caroline; Olmos, José M.; Lyytikäinen, Leo-Pekka; Lewis, Joshua R.; Swart, Karin M.A.; Masi, Laura; Oldmeadow, Chris; Holliday, Elizabeth G.; Cheng, Sulin; van Schoor, Natasja M.; Harvey, Nicholas C.; Kruk, Marcin; del Greco M, Fabiola; Igl, Wilmar; Trummer, Olivia; Grigoriou, Efi; Luben, Robert; Liu, Ching-Ti; Zhou, Yanhua; Oei, Ling; Medina-Gomez, Carolina; Zmuda, Joseph; Tranah, Greg; Brown, Suzanne J.; Williams, Frances M.; Soranzo, Nicole; Jakobsdottir, Johanna; Siggeirsdottir, Kristin; Holliday, Kate L.; Hannemann, Anke; Go, Min Jin; Garcia, Melissa; Polasek, Ozren; Laaksonen, Marika; Zhu, Kun; Enneman, Anke W.; McEvoy, Mark; Peel, Roseanne; Sham, Pak Chung; Jaworski, Maciej; Johansson, Åsa; Hicks, Andrew A.; Pludowski, Pawel; Scott, Rodney; Dhonukshe-Rutten, Rosalie A.M.; van der Velde, Nathalie; Kähönen, Mika; Viikari, Jorma S.; Sievänen, Harri; Raitakari, Olli T.; González-Macías, Jesús; Hernández, Jose L.; Mellström, Dan; Ljunggren, Östen; Cho, Yoon Shin; Völker, Uwe; Nauck, Matthias; Homuth, Georg; Völzke, Henry; Haring, Robin; Brown, Matthew A.; McCloskey, Eugene; Nicholson, Geoffrey C.; Eastell, Richard; Eisman, John A.; Jones, Graeme; Reid, Ian R.; Dennison, Elaine M.; Wark, John; Boonen, Steven; Vanderschueren, Dirk; Wu, Frederick C.W.; Aspelund, Thor; Richards, J. Brent; Bauer, Doug; Hofman, Albert; Khaw, Kay-Tee; Dedoussis, George; Obermayer-Pietsch, Barbara; Gyllensten, Ulf; Pramstaller, Peter P.; Lorenc, Roman S.; Cooper, Cyrus; Kung, Annie Wai Chee; Lips, Paul; Alen, Markku; Attia, John; Brandi, Maria Luisa; de Groot, Lisette C.P.G.M.; Lehtimäki, Terho; Riancho, José A.; Campbell, Harry; Liu, Yongmei; Harris, Tamara B.; Akesson, Kristina; Karlsson, Magnus; Lee, Jong-Young; Wallaschofski, Henri; Duncan, Emma L.; O'Neill, Terence W.; Gudnason, Vilmundur; Spector, Timothy D.; Rousseau, François; Orwoll, Eric; Cummings, Steven R.; Wareham, Nick J.; Rivadeneira, Fernando; Uitterlinden, Andre G.; Prince, Richard L.; Kiel, Douglas P.; Reeve, Jonathan; Kaptoge, Stephen K.

    2014-01-01

    Quantitative ultrasound of the heel captures heel bone properties that independently predict fracture risk and, with bone mineral density (BMD) assessed by X-ray (DXA), may be convenient alternatives for evaluating osteoporosis and fracture risk. We performed a meta-analysis of genome-wide association (GWA) studies to assess the genetic determinants of heel broadband ultrasound attenuation (BUA; n = 14 260), velocity of sound (VOS; n = 15 514) and BMD (n = 4566) in 13 discovery cohorts. Independent replication involved seven cohorts with GWA data (in silico n = 11 452) and new genotyping in 15 cohorts (de novo n = 24 902). In combined random effects, meta-analysis of the discovery and replication cohorts, nine single nucleotide polymorphisms (SNPs) had genome-wide significant (P < 5 × 10−8) associations with heel bone properties. Alongside SNPs within or near previously identified osteoporosis susceptibility genes including ESR1 (6q25.1: rs4869739, rs3020331, rs2982552), SPTBN1 (2p16.2: rs11898505), RSPO3 (6q22.33: rs7741021), WNT16 (7q31.31: rs2908007), DKK1 (10q21.1: rs7902708) and GPATCH1 (19q13.11: rs10416265), we identified a new locus on chromosome 11q14.2 (rs597319 close to TMEM135, a gene recently linked to osteoblastogenesis and longevity) significantly associated with both BUA and VOS (P < 8.23 × 10−14). In meta-analyses involving 25 cohorts with up to 14 985 fracture cases, six of 10 SNPs associated with heel bone properties at P < 5 × 10−6 also had the expected direction of association with any fracture (P < 0.05), including three SNPs with P < 0.005: 6q22.33 (rs7741021), 7q31.31 (rs2908007) and 10q21.1 (rs7902708). In conclusion, this GWA study reveals the effect of several genes common to central DXA-derived BMD and heel ultrasound/DXA measures and points to a new genetic locus with potential implications for better understanding of osteoporosis pathophysiology. PMID:24430505

  9. A comparative study evoking a sensory action potential from the medial and lateral plantar nerves using the probe and ring method of stimulation.

    PubMed

    Adam, Jamila K; Bechoo, Reneal; Rmaih, Wafaa S

    2010-01-01

    Nerve conduction studies (NCS) aid in the detection of foot nerve pathologies. However, there has been a debate on method of plantar nerves stimulation that is more effective; the ring method of stimulation or probe method of stimulation. This study aims at determining the one method that is more effective among the two methods of stimulating for eliciting proper responses. Thirty healthy adults, aged 19 to 55 years, free of any neurological disease were the subjects of the study. Values considered for determining the effectiveness of the stimulating technique were mean amplitudes of the evoked responses from medial and lateral plantar nerves. A significant increase in amplitude difference was noted in favor of the probe stimulation method. The amplitude difference noted in favor of the probe method of stimulation was double the values elicited by the ring method of stimulation in both the medial and lateral plantar nerves. Results suggest that the direct probe method of stimulation may be a more effective method of stimulating for the medial and lateral plantar nerves studies. PMID:20508349

  10. Chronic Meningitis

    MedlinePlus

    ... not infections can cause chronic meningitis. They include sarcoidosis and certain disorders that cause inflammation, such as ... For disorders that are not infections, such as sarcoidosis and Behçet syndrome: Corticosteroids or other drugs that ...

  11. The design and validation of a magnetic resonance imaging-compatible device for obtaining mechanical properties of plantar soft tissue via gated acquisition.

    PubMed

    Williams, Evan D; Stebbins, Michael J; Cavanagh, Peter R; Haynor, David R; Chu, Baocheng; Fassbind, Michael J; Isvilanonda, Vara; Ledoux, William R

    2015-10-01

    Changes in the mechanical properties of the plantar soft tissue in people with diabetes may contribute to the formation of plantar ulcers. Such ulcers have been shown to be in the causal pathway for lower extremity amputation. The hydraulic plantar soft tissue reducer (HyPSTER) was designed to measure in vivo, rate-dependent plantar soft tissue compressive force and three-dimensional deformations to help understand, predict, and prevent ulcer formation. These patient-specific values can then be used in an inverse finite element analysis to determine tissue moduli, and subsequently used in a foot model to show regions of high stress under a wide variety of loading conditions. The HyPSTER uses an actuator to drive a magnetic resonance imaging-compatible hydraulic loading platform. Pressure and actuator position were synchronized with gated magnetic resonance imaging acquisition. Achievable loading rates were slower than those found in normal walking because of a water-hammer effect (pressure wave ringing) in the hydraulic system when the actuator direction was changed rapidly. The subsequent verification tests were, therefore, performed at 0.2 Hz. The unloaded displacement accuracy of the system was within 0.31%. Compliance, presumably in the system's plastic components, caused a displacement loss of 5.7 mm during a 20-mm actuator test at 1354 N. This was accounted for with a target to actual calibration curve. The positional accuracy of the HyPSTER during loaded displacement verification tests from 3 to 9 mm against a silicone backstop was 95.9% with a precision of 98.7%. The HyPSTER generated minimal artifact in the magnetic resonance imaging scanner. Careful analysis of the synchronization of the HyPSTER and the magnetic resonance imaging scanner was performed. With some limitations, the HyPSTER provided key functionality in measuring dynamic, patient-specific plantar soft tissue mechanical properties. PMID:26405098

  12. Chronic prostatitis

    PubMed Central

    2008-01-01

    Introduction Chronic prostatitis can cause pain and urinary symptoms, and usually occurs without positive bacterial cultures from prostatic secretions (known as chronic abacterial prostatitis or chronic pelvic pain syndrome, CP/CPPS). Bacterial infection can result from urinary tract instrumentation, but the cause and natural history of CP/CPPS are unknown. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of treatments for chronic bacterial prostatitis? What are the effects of treatments for chronic abacterial prostatitis/chronic pelvic pain syndrome? We searched: Medline, Embase, The Cochrane Library and other important databases up to August 2007 (BMJ Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found 30 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review we present information relating to the effectiveness and safety of the following interventions: 5 alpha-reductase inhibitors, allopurinol, alpha-blockers, biofeedback, local injections of antimicrobial drugs, mepartricin, non-steroidal anti-inflammatory drugs, oral antimicrobial drugs, pentosan polysulfate, prostatic massage, quercetin, radical prostatectomy, sitz baths, transurethral microwave thermotherapy, and transurethral resection. PMID:19450305

  13. Chronic prostatitis

    PubMed Central

    2011-01-01

    Introduction Chronic prostatitis can cause pain and urinary symptoms, and usually occurs without positive bacterial cultures from prostatic secretions (known as chronic abacterial prostatitis or chronic pelvic pain syndrome [CP/CPPS]). Bacterial infection can result from urinary tract instrumentation, but the cause and natural history of CP/CPPS are unknown. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of treatments for chronic bacterial prostatitis? What are the effects of treatments for chronic abacterial prostatitis/