Note: This page contains sample records for the topic chronic plantar heel from
While these samples are representative of the content of,
they are not comprehensive nor are they the most current set.
We encourage you to perform a real-time search of
to obtain the most current and comprehensive results.
Last update: November 12, 2013.

Obesity and pronated foot type may increase the risk of chronic plantar heel pain: a matched case-control study  

Microsoft Academic Search

BACKGROUND: Chronic plantar heel pain (CPHP) is one of the most common musculoskeletal disorders of the foot, yet its aetiology is poorly understood. The purpose of this study was to examine the association between CPHP and a number of commonly hypothesised causative factors. METHODS: Eighty participants with CPHP (33 males, 47 females, mean age 52.3 years, S.D. 11.7) were matched

Damien B Irving; Jill L Cook; Mark A Young; Hylton B Menz



Plantar heel pain and fasciitis  

PubMed Central

Introduction Plantar heel pain causes soreness or tenderness of the sole of the foot under the heel, which sometimes extends into the medial arch. The prevalence and prognosis are unclear, but the symptoms seem to resolve over time in most people. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical question: What are the effects of treatments for plantar heel pain? We searched: Medline, Embase, The Cochrane Library and other important databases up to January 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 15 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: casted orthoses (custom-made insoles), corticosteroid injection (alone, or plus non-steroidal anti-inflammatory drugs), extracorporeal shock wave therapy, heel cups, heel pads (alone or with corticosteroid injection), lasers, local anaesthetic injection (alone or with corticosteroid injection), night splints plus non-steroidal anti-inflammatory drugs, stretching exercises, surgery, taping, and ultrasound.



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

PubMed Central

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

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



The effect of different depths of medial heel skive on plantar pressures  

PubMed Central

Background Foot orthoses are often used to treat lower limb injuries associated with excessive pronation. There are many orthotic modifications available for this purpose, with one being the medial heel skive. However, empirical evidence for the mechanical effects of the medial heel skive modification is limited. This study aimed to evaluate the effect that different depths of medial heel skive have on plantar pressures. Methods Thirty healthy adults (mean age 24 years, range 18–46) with a flat-arched or pronated foot posture and no current foot pain or deformity participated in this study. Using the in-shoe pedar-X® system, plantar pressure data were collected for the rearfoot, midfoot and forefoot while participants walked along an 8 metre walkway wearing a standardised shoe. Experimental conditions included a customised foot orthosis with the following 4 orthotic modifications: (i) no medial heel skive, (ii) a 2 mm medial heel skive, (iii) a 4 mm medial heel skive and (iv) a 6 mm medial heel skive. Results Compared to the foot orthosis with no medial heel skive, statistically significant increases in peak pressure were observed at the medial rearfoot – there was a 15% increase (p?=?0.001) with the 4 mm skive and a 29% increase (p?heel skive. With respect to the midfoot and forefoot, there were no significant differences between the orthoses. Conclusions This study found that a medial heel skive of 4 mm or 6 mm increases peak pressure under the medial rearfoot in asymptomatic adults with a flat-arched or pronated foot posture. Plantar pressures at the midfoot and forefoot were not altered by a medial heel skive of 2, 4 or 6 mm. These findings provide some evidence for the effects of the medial heel skive orthotic modification.



The effectiveness of manual stretching in the treatment of plantar heel pain: a systematic review  

Microsoft Academic Search

Background  Plantar heel pain is a commonly occurring foot complaint. Stretching is frequently utilised as a treatment, yet a systematic\\u000a review focusing only on its effectiveness has not been published. This review aimed to assess the effectiveness of stretching\\u000a on pain and function in people with plantar heel pain.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Medline, EMBASE, CINAHL, AMED, and The Cochrane Library were searched from inception

David Sweeting; Ben Parish; Lee Hooper; Rachel Chester



Effectiveness of dry needling and injections of myofascial trigger points associated with plantar heel pain: a systematic review  

Microsoft Academic Search

BACKGROUND: Plantar heel pain (plantar fasciitis) is one of the most common musculoskeletal pathologies of the foot. Plantar heel pain can be managed with dry needling and\\/or injection of myofascial trigger points (MTrPs) however the evidence for its effectiveness is uncertain. Therefore, we aimed to systematically review the current evidence for the effectiveness of dry needling and\\/or injections of MTrPs

Matthew P Cotchett; Karl B Landorf; Shannon E Munteanu



Biomechanical and histiological considerations for development of plantar fasciitis and evaluation of arch taping as a treatment option to control associated plantar heel pain: a single-subject design  

Microsoft Academic Search

Study design: Alternating single-subject A-B and A-B-A designs. Objective: To discuss biomechanical and histiological issues related to the development of plantar fasciitis and to evaluate the effectiveness of arch taping in controlling heel pain during ambulation. Background: Plantar heel pain as a consequence of plantar fascial strain, a condition frequently diagnosed as plantar fasciitis, can significantly interfere with functional ambulation.

Gary C Hunt; Tom Sneed; Herb Hamann; Sheldon Chisam



Effectiveness of trigger point dry needling for plantar heel pain: study protocol for a randomised controlled trial  

PubMed Central

Background Plantar heel pain (plantar fasciitis) is a common and disabling condition, which has a detrimental impact on health-related quality of life. Despite the high prevalence of plantar heel pain, the optimal treatment for this disorder remains unclear. Consequently, an alternative therapy such as dry needling is increasingly being used as an adjunctive treatment by health practitioners. Only two trials have investigated the effectiveness of dry needling for plantar heel pain, however both trials were of a low methodological quality. This manuscript describes the design of a randomised controlled trial to evaluate the effectiveness of dry needling for plantar heel pain. Methods Eighty community-dwelling men and woman aged over 18 years with plantar heel pain (who satisfy the inclusion and exclusion criteria) will be recruited. Eligible participants with plantar heel pain will be randomised to receive either one of two interventions, (i) real dry needling or (ii) sham dry needling. The protocol (including needling details and treatment regimen) was formulated by general consensus (using the Delphi research method) using 30 experts worldwide that commonly use dry needling for plantar heel pain. Primary outcome measures will be the pain subscale of the Foot Health Status Questionnaire and "first step" pain as measured on a visual analogue scale. The secondary outcome measures will be health related quality of life (assessed using the Short Form-36 questionnaire - Version Two) and depression, anxiety and stress (assessed using the Depression, Anxiety and Stress Scale - short version). Primary outcome measures will be performed at baseline, 2, 4, 6 and 12 weeks and secondary outcome measures will be performed at baseline, 6 and 12 weeks. Data will be analysed using the intention to treat principle. Conclusion This study is the first randomised controlled trial to evaluate the effectiveness of dry needling for plantar heel pain. The trial will be reported in accordance with the Consolidated Standards of Reporting Trials and the Standards for Reporting Interventions in Clinical Trials of Acupuncture guidelines. The findings from this trial will provide evidence for the effectiveness of trigger point dry needling for plantar heel pain. Trial registration Australian New Zealand 'Clinical Trials Registry'. ACTRN12610000611022.



The effectiveness of manual stretching in the treatment of plantar heel pain: a systematic review  

PubMed Central

Background Plantar heel pain is a commonly occurring foot complaint. Stretching is frequently utilised as a treatment, yet a systematic review focusing only on its effectiveness has not been published. This review aimed to assess the effectiveness of stretching on pain and function in people with plantar heel pain. Methods Medline, EMBASE, CINAHL, AMED, and The Cochrane Library were searched from inception to July 2010. Studies fulfilling the inclusion criteria were independently assessed, and their quality evaluated using the modified PEDro scale. Results Six studies including 365 symptomatic participants were included. Two compared stretching with a control, one study compared stretching to an alternative intervention, one study compared stretching to both alternative and control interventions, and two compared different stretching techniques and durations. Quality rating on the modified Pedro scale varied from two to eight out of a maximum of ten points. The methodologies and interventions varied significantly between studies, making meta-analysis inappropriate. Most participants improved over the course of the studies, but when stretching was compared to alternative or control interventions, the changes only reached statistical significance in one study that used a combination of calf muscle stretches and plantar fascia stretches in their stretching programme. Another study comparing different stretching techniques, showed a statistically significant reduction in some aspects of pain in favour of plantar fascia stretching over calf stretches in the short term. Conclusions There were too few studies to assess whether stretching is effective compared to control or other interventions, for either pain or function. However, there is some evidence that plantar fascia stretching may be more effective than Achilles tendon stretching alone in the short-term. Appropriately powered randomised controlled trials, utilizing validated outcome measures, blinded assessors and long-term follow up are needed to assess the efficacy of stretching.



Plantar fasciitis  

PubMed Central

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.

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



An innovative design for reconstruction of plantar heel by split partially overlapping anterolateral thigh flap  

Microsoft Academic Search

Introduction  Reconstruction of the weight bearing, thick and durable heel, in soft tissue injuries of the foot remains a difficult and\\u000a challenging problem. The thick glabrous epidermis and dermis, and the fibrous septae of the subcutaneous layer provide unique\\u000a properties for withstanding pressure and shock associated with gait.\\u000a \\u000a \\u000a \\u000a \\u000a Materials and Methods  Here, the authors put forward an innovative method for a one-stage

Vigneswaran N; H. W. Ng; Y. M. Samuel Ho; S. Y. Michelle Ho; T. C. Marcus Wong; Guan-Ming Feng; Sheng-Fa Yao; Hsing-Kuang Lai; Patel Hasu; Jagdeep Chana; Chandra Bose; Hung-Chi Chen


Diagnosis of heel pain.  


Heel pain is a common presenting symptom in ambulatory clinics. There are many causes, but a mechanical etiology is most common. Location of pain can be a guide to the proper diagnosis. The most common diagnosis is plantar fasciitis, a condition that leads to medial plantar heel pain, especially with the first weight-bearing steps in the morning and after long periods of rest. Other causes of plantar heel pain include calcaneal stress fracture (progressively worsening pain following an increase in activity level or change to a harder walking surface), nerve entrapment (pain accompanied by burning, tingling, or numbness), heel pad syndrome (deep, bruise-like pain in the middle of the heel), neuromas, and plantar warts. Achilles tendinopathy is a common condition that causes posterior heel pain. Other tendinopathies demonstrate pain localized to the insertion site of the affected tendon. Posterior heel pain can also be attributed to a Haglund deformity, a prominence of the calcaneus that may cause bursa inflammation between the calcaneus and Achilles tendon, or to Sever disease, a calcaneal apophysitis in children. Medial midfoot heel pain, particularly with continued weight bearing, may be due to tarsal tunnel syndrome, which is caused by compression of the posterior tibial nerve as it courses through the flexor retinaculum, medial calcaneus, posterior talus, and medial malleolus. Sinus tarsi syndrome occurs in the space between the calcaneus, talus, and talocalcaneonavicular and subtalar joints. The syndrome manifests as lateral midfoot heel pain. Differentiating among causes of heel pain can be accomplished through a patient history and physical examination, with appropriate imaging studies, if indicated. PMID:22010770

Tu, Priscilla; Bytomski, Jeffrey R



Dorsal-plantar loop technique using chronic total occlusion devices via anterior tibial artery.  


The effectiveness of below-the-knee (BTK) percutaneous transluminal angioplasty to obtain successful revascularization in patients with critical limb ischemia has been well established, and many of these patients with chronic lower-extremity disease have been treated by endovascular intervention as the firstline treatment. Dorsal-plantaer loop technique is one of the new BTK interventional techiniques, and includes recanalization of both pedal and plantar arteries and their anatomical anastomoses. This method generally needs two approaches simultaneously, including antegrade and retrograde. In this report, however, we describe a case in which dorsal-plantar loop technique with only one antegrade approach, using chronic total occlusion devices via anterior tibial artery, was used to successfully recanalize BTK arteries. We think that this new technique, which may represent a safe and feasible endovascular option to avoid more invasive, time-consuming, and riskier surgical procedures, especially in end-stage renal disease and diabetes, should be considered whenever the foot is at risk, and results of above-the-ankle percutaneous transluminal angioplasty remain unsatisfactory or insufficient to achieve limb salvage. PMID:23364993

Kim, Seunghwan; Choi, Donghoon; Shin, Sanghoon; Shin, Dong-Ho; Kim, Jung-Sun; Kim, Byeong-Keuk; Ko, Young-Guk; Hong, Myeong-Ki; Jang, Yangsoo



Dorsal-Plantar Loop Technique Using Chronic Total Occlusion Devices via Anterior Tibial Artery  

PubMed Central

The effectiveness of below-the-knee (BTK) percutaneous transluminal angioplasty to obtain successful revascularization in patients with critical limb ischemia has been well established, and many of these patients with chronic lower-extremity disease have been treated by endovascular intervention as the firstline treatment. Dorsal-plantaer loop technique is one of the new BTK interventional techiniques, and includes recanalization of both pedal and plantar arteries and their anatomical anastomoses. This method generally needs two approaches simultaneously, including antegrade and retrograde. In this report, however, we describe a case in which dorsal-plantar loop technique with only one antegrade approach, using chronic total occlusion devices via anterior tibial artery, was used to successfully recanalize BTK arteries. We think that this new technique, which may represent a safe and feasible endovascular option to avoid more invasive, time-consuming, and riskier surgical procedures, especially in end-stage renal disease and diabetes, should be considered whenever the foot is at risk, and results of above-the-ankle percutaneous transluminal angioplasty remain unsatisfactory or insufficient to achieve limb salvage.

Kim, Seunghwan; Shin, Sanghoon; Shin, Dong-Ho; Kim, Jung-Sun; Kim, Byeong-Keuk; Ko, Young-Guk; Hong, Myeong-Ki; Jang, Yangsoo



Heel Pain in Recreational Runners.  

ERIC Educational Resources Information Center

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)

Bazzoli, Allan S.; Pollina, Frank S.



Chronic bilateral heel pain in a child with Sever disease: case report and review of literature  

PubMed Central

We are presenting a case report of a 10-year-old male with a 1 year history of bilateral heel pain. Sever disease is self limiting condition of calcaneal apophysis. It is the most common cause of heel pain in the growing child. There is no documented case of this condition in this region. This case highlights the clinical features of this self limiting disorder as seen in this patient and reviews the current literature.



Heel Pain  


... you may have inflamed the area where the Achilles tendon inserts into the heel bone (retrocalcaneal bursitis). People ... 8" or 1/2" heel insert. Stretch your Achilles tendon by leaning forward against a wall with your ...


Heel Pain  


... pronation may also contribute to injury to the hip, knee, and lower back. Achilles tendinitis: Pain at the back of the heel is associated ... of steps can be taken to avoid heel pain and accompanying afflictions: Wear shoes that fit well—front, back, and sides—and have shock-absorbent soles, ...


Dystrophic calcification following neonatal heel-prick testing.  


A 7-year-old boy presented with a 5-year history of dystrophic calcification manifesting as solitary nodules on the plantar aspect of both heels. Microscopic examination showed hyperkeratosis and psoriasiform hyperplasia overlying an area of dystrophic calcification. Multiple heel-prick tests carried out during the neonatal period to monitor blood glucose levels are the likely causative mechanism. PMID:20695862

Kurzydlo, Ann-Maree; Hannaford, Rodney



Reliability and Validity of the Standing Heel-Rise Test  

ERIC Educational Resources Information Center

|A standardized protocol for a pediatric heel-rise test was developed and reliability and validity are reported. Fifty-seven children developing typically (CDT) and 34 children with plantar flexion weakness performed three tests: unilateral heel rise, vertical jump, and force measurement using handheld dynamometry. Intraclass correlation…

Yocum, Allison; McCoy, Sarah Westcott; Bjornson, Kristie F.; Mullens, Pamela; Burton, Gay Naganuma



Plantar fasciitis  


... uneven surfaces Sudden weight gain or obesity Tight Achilles tendon (the tendon connecting the calf muscles to the ... Making sure your ankle, Achilles tendon, and calf muscles are flexible can help prevent plantar fasciitis.


Long distance running and acute effects on plantar foot sensitivity and plantar foot loading.  


The plantar surface of the foot senses local pressures during stance and locomotion. These foot loading characteristics may be affected by long distance running. Little is known about the physiological effects of sports-related loading on plantar sensitivity and their relationship with plantar foot loading. The purpose of this study was to investigate the acute effects of long distance running on plantar sensitivity to touch and their relationship with foot loading characteristics. It was hypothesized that plantar sensation would decrease after long distance running and may be related to foot loading characteristics. In 15 middle-aged runners, sensory detection thresholds to light touch and plantar pressures were measured before and after a 10 km run. After the run, no significant changes in sensory perception thresholds were observed so that correlations between foot sensitivity and foot loading could not be calculated. A significant decrease of force-time integrals and maximum forces was demonstrated in the whole foot (-6.2%, p=0.003; -3.9%, p=0.001) and the heel (-10.5%, p=0.003; -8.5%, p=0.002). Furthermore, maximum force was significantly reduced in the lateral midfoot (-6.4%, p=0.002). In conclusion, a sub-maximal 10 km running exercise appears to have no significant acute effects on plantar sensitivity, plantar pressure distribution and peak forces. PMID:21871535

Alfuth, Martin; Rosenbaum, Dieter



Ultrasound guided injection of dexamethasone versus placebo for treatment of plantar fasciitis: protocol for a randomised controlled trial  

PubMed Central

Background Plantar fasciitis is the most commonly reported cause of chronic pain beneath the heel. Management of this condition commonly involves the use of corticosteroid injection in cases where less invasive treatments have failed. However, despite widespread use, only two randomised trials have tested the effect of this treatment in comparison to placebo. These trials currently offer the best available evidence by which to guide clinical practice, though both were limited by methodological issues such as insufficient statistical power. Therefore, the aim of this randomised trial is to compare the effect of ultrasound-guided corticosteroid injection versus placebo for treatment of plantar fasciitis. Methods The trial will be conducted at the La Trobe University Podiatry Clinic and will recruit 80 community-dwelling participants. Diagnostic ultrasound will be used to diagnose plantar fasciitis and participants will be required to meet a range of selection criteria. Participants will be randomly allocated to one of two treatment arms: (i) ultrasound-guided injection of the plantar fascia with 1 mL of 4 mg/mL dexamethasone sodium phosphate (experimental group), or (ii) ultrasound-guided injection of the plantar fascia with 1 mL normal saline (control group). Blinding will be applied to participants and the investigator performing procedures, measuring outcomes and analysing data. Primary outcomes will be pain measured by the Foot Health Status Questionnaire and plantar fascia thickness measured by ultrasound at 4, 8 and 12 weeks. All data analyses will be conducted on an intention-to-treat basis. Conclusion This will be a randomised trial investigating the effect of dexamethasone injection on pre-specified treatment outcomes in people with plantar fasciitis. Within the parameters of this protocol, the trial findings will be used to make evidence-based recommendations regarding the use of corticosteroid injection for treatment of this condition. Trial Registration Australian New Zealand Clinical Trials Registry. ACTRN12610000239066.



Endoscopic plantar fascia release: a case series.  


Plantar fasciitis is a common disabling condition that can be recalcitrant to treatment. Endoscopic Plantar Fascia Release (EPFR) has received greater attention in recent years as a viable, and possibly superior, alternative to established open procedures for the treatment of plantar fasciitis. In a series of 17 patients (17 feet) with follow-up over an average of 16 months, we report a two portal endoscopic technique of partial release of the plantar fascia, as a successful, safe and reliable procedure for the treatment of plantar fasciitis in the patient group selected. The surgical results of 17 EPFR's performed by the same surgeon were reviewed. All patients had preoperative symptoms of subcalcaneal heel pain for greater than 12 months, all having undergone nonsurgical measures for at least 12 months. Of 17 feet, all reported marked improvement of preoperative symptoms within two months. Patients' subjective assessment of the procedure was strongly supportive, 100% totally satisfied or satisfied with only minor restrictions. Postoperatively, 82.4% reported mild or no pain, and 100% had improvement in walking distance. Complications all resolved within two to six months; there were no re-operations and no infections. PMID:12627628

Boyle, R A; Slater, G L



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

ERIC Educational Resources Information Center

|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…

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



Pediatric heel pain.  


Heel pain is a common complaint among young children and adolescents. It has many causes, including trauma, overuse injuries, and tumors, and therefore a thorough clinical examination is warranted. This article outlines some common causes of pediatric heel pain. PMID:24075133

Joseph, Alison M; Labib, Irene K



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.  


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

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



Black heel, talon noir or calcaneal petechiae?  


We describe a series of six patients with superficial cutaneous haemorrhages of the feet, including a classical case of black heel (talon noir) and other similar cases with diverse clinical presentations that do not match the typical description of that process. The main differences lay in production mechanism, morphology and location. The causes of these 'atypical' lesions were: burns with hot sand, friction against the rough edge of a swimming pool, wearing new shoes, jogging, or pricking a blister with a needle. Clinically, they consisted of isolated or multiple, small, large or linear, brown or black lesions located in areas that did not include the convex part of the heel, in which talon noir usually appears; on the contrary, the lesions affected the back third of the soles, the toes, periungual fold and plantar arch. As the presence of blood in the horny layer was a common final factor in all these cases, a better name for this process would be 'post-traumatic cutaneous intracorneal blood' to describe black heel and its diverse clinical presentations. PMID:18638222

Urbina, Francisco; León, Lorena; Sudy, Emilio



The effects of total contact casting materials on plantar pressures.  


The plaster-based total contact cast (TCC) is effective at reducing high plantar pressures associated with foot ulceration in the patient with diabetes. However, the weight and the lengthy drying time which require nonweightbearing create an inconvenience for the patient. Fiberglass has been commonly used as a substitute for plaster due to the quicker drying time, although little is known about the effects of fiberglass on plantar pressures. The purpose of the study was to compare a plaster-based TCC (PB-TCC) and an all-fiberglass TCC (AF-TCC) using selected plantar pressure parameters for commonly ulcerated regions of the foot. Using a repeated measures design, 10 healthy subjects consented to walk, for four consecutive trials, along a 25-m corridor while wearing a running shoe, PB-TCC, and AF-TCC. For each of the footwear conditions, parameters of peak pressure, pressure-time integral, and contact time for the forefoot, lateral midfoot, and heel regions were recorded using the Pedar trade mark system of plantar pressure measurement. Both the PB-TCC and AF-TCC produced similar peak plantar pressures that were significantly lower (p =.001) than the running shoe. Pressure-time integrals were similar for all footwear conditions and contact time was not altered with footwear type. In summary, the AF-TCC appears to be an effective alternative to the PB-TCC for plantar pressure reduction in the management of neuropathic foot ulceration. PMID:14992706

Hartsell, Heather D; Brand, Richard A; Frantz, Rita A; Saltzman, Charles L



Plantar Wart (Verruca Plantaris)  


... 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 ...


Treatment of Plantar Fasciitis in Recreational Athletes: Two Different Therapeutic Protocols  

Microsoft Academic Search

Plantar fasciitis (PF) commonly causes inferior heel pain and occurs in up to 10% of the US population. Treatment protocols in most studies include the use of ice therapy, nonsteroidal anti-inflammatory drugs (NSAIDs), and stretching and strengthening protocols. The aim of the current study was to examine the effectiveness of 2 different therapeutic approaches on the treatment of PF in

Panagiotis Karagounis; Maria Tsironi; George Prionas; Georgios Tsiganos; Panagiotis Baltopoulos



Role of plantar fascia in the load bearing capacity of the human foot  

Microsoft Academic Search

Plantar fascia release is an accepted and widely used surgical way to reduce heel pain, however its effect of the load bearing characteristics of the foot is not well studied. A simple biomechanical model is developed here to analyze load bearing mechanism of the foot during the stance phase of the gait cycle. Quasilinearization is used for the system identification,

Wangdo Kim; Arkady S. Voloshin



Chiropractic management of pediatric plantar fasciitis: a case report  

PubMed Central

Objective The purpose of this report is to present the case of a 10-year-old football player with bilateral plantar fasciitis who improved with a multimodal conservative approach using chiropractic treatment. Clinical Features The patient presented with bilateral plantar heel pain at the origin of the plantar fascia with a duration of 3 weeks. Intervention and Outcome Treatment was provided for 6 visits over a 6-week period. Chiropractic care consisted of manipulative therapy, soft tissue therapy, and home rehabilitation exercises. The soft tissue technique (Graston Technique) was performed to the origin of the plantar fascia and the triceps surae bilaterally. High-velocity, low-amplitude manipulation was applied to the restricted ankle mortise joint. After 6 treatments, the patient reported resolution of foot pain bilaterally and improvements in activities of daily livings. Three months later, the patient reported no further complications and the absence of pain. Conclusion This patient with bilateral plantar fasciitis improved after a course of a multimodal treatment approach using chiropractic manipulation and soft tissue therapy in addition to exercise and stretching therapies.

Daniels, Clinton J.; Morrell, Adam P.



Vibration therapy of the plantar fascia improves spasticity of the lower limbs of a patient with fetal-type Minamata disease in the chronic stage.  


The authors present a novel treatment for spasticity using a hand-held vibration massager. A fetal-type Minamata disease patient showing spasticity of lower limbs had direct application of vibratory stimuli to the right plantar fascia and to the left hamstring. After the treatment for 1 year, the Modified Ashworth Scale (MAS) of the lower limbs was improved from three (right > left) to two (right < left). After then, direct application of the same method with the left plantar fascia improved the MAS of the left lower limb to two (right = left). The increased deep tendon reflexes had diminished and markedly positive Babinski's sign had also decreased to slightly positive on both sides. This method is so simple that patients can treat themselves at home. The authors think that direct application of vibratory stimuli to the plantar fascia is valuable to patients with neurologic disorders, particularly those who cannot receive more invasive treatments. PMID:22675016

Usuki, Fusako; Tohyama, Satsuki



Mountaineer’s heel  

Microsoft Academic Search

Mountaineers are at risk of skin lesions caused by constant boot friction. This is the case of a 35 year old mountaineer who presented with large and deeply ulcerated lesions over the medial aspects of both heels after a two and a half day climb using crampons. A number of factors such as the length of the climb in cold

R M Strauss



Comparison of Plantar Pressure Distribution between Different Speed and Incline During Treadmill Jogging  

PubMed Central

The aim of this study was to examine the effect of changes in speed and incline slope on plantar pressure distribution of the foot during treadmill jogging. Plantar pressure parameters were measured with the Pedar-X system in twenty healthy girls (mean age of 20.7 years, mean height of 1.60m, and a mean weight of 53.35kg). Because variations in walking speed or slope can significantly change the magnitude of plantar pressure, comparisons of plantar pressure distribution between the two independent protocols during treadmill jogging were considered in this study. First, the subjects ran at the same speed of 2 m·s-1 with different incline slopes of 0%, 5%, 10%, and 15%. Second, they ran on the same slope of 0% with different speeds of 1.5 m·s-1, 2.0 m·s-1, and 2.5 m·s-1. The peak pressure of the eight plantar surface areas, apart from the medial forefoot and the hallux, significantly increased (p < 0.05) with an increase of 33% of peak pressure from 1.5 m·s-1 to 2.5 m·s-1 (speed) at heel region. In contrast, the peak pressures at the heel, medial fore-foot, toe and hallux decreased significantly (p < 0. 05) with increasing incline slope. At the heel, peak pressure reduced by 27% from 0% to 15% incline, however, pressure at the lateral midfoot region increased as following. Different speeds and incline slopes during jogging were associated with changes in plantar pressures. By systematic investigation of foot kinematics and plantar pressure during jogging with varying incline slope and speed, the results of this study provided further insight into foot biomechanics during jogging. Key points The study aimed to compare the plantar pressure distribution of the foot between different incline and speed during treadmill jogging by using plantar insole measurement system. With the increase of speed, apart from the hallux and medical forefoot, the peak pressure of all regions was raised significantly. As the slope increased, there was reduced peak pressure of the heel, medial forefoot, and hallux and toes.

Ho, I-Ju; Hou, Yi-You; Yang, Chich-Haung; Wu, Wen-Lan; Chen, Sheng-Kai; Guo, Lan-Yuen



Foot kinematics in patients with two patterns of pathological plantar hyperkeratosis  

PubMed Central

Background The Root paradigm of foot function continues to underpin the majority of clinical foot biomechanics practice and foot orthotic therapy. There are great number of assumptions in this popular paradigm, most of which have not been thoroughly tested. One component supposes that patterns of plantar pressure and associated hyperkeratosis lesions should be associated with distinct rearfoot, mid foot, first metatarsal and hallux kinematic patterns. Our aim was to investigate the extent to which this was true. Methods Twenty-seven subjects with planter pathological hyperkeratosis were recruited into one of two groups. Group 1 displayed pathological plantar hyperkeratosis only under metatarsal heads 2, 3 and 4 (n = 14). Group 2 displayed pathological plantar hyperkeratosis only under the 1st and 5th metatarsal heads (n = 13). Foot kinematics were measured using reflective markers on the leg, heel, midfoot, first metatarsal and hallux. Results The kinematic data failed to identify distinct differences between these two groups of subjects, however there were several subtle (generally <3°) differences in kinematic data between these groups. Group 1 displayed a less everted heel, a less abducted heel and a more plantarflexed heel compared to group 2, which is contrary to the Root paradigm. Conclusions There was some evidence of small differences between planter pathological hyperkeratosis groups. Nevertheless, there was too much similarity between the kinematic data displayed in each group to classify them as distinct foot types as the current clinical paradigm proposes.



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

PubMed Central

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.

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



Epidermal thickness and biomechanical properties of plantar tissues in diabetic foot.  


Diabetic foot is a common complication for people with diabetes but it is unclear whether the change is initiated from the skin surface or underneath plantar tissues. This study compared the thickness of epidermis and the thickness and stiffness of the total plantar soft tissue among people with diabetes with or without complications. Seventy-two people with diabetes, including 22 people with neuropathies, 16 foot ulcerations, 34 pure diabetics without complications and 40 healthy controls participated in the study. The thickness of the epidermal layer of the plantar skin was examined using high-frequency ultrasonography; the thickness and stiffness of the total plantar soft tissue were measured by using tissue ultrasound palpation system at the big toe, the first, third and fifth metatarsal heads; and the heel pad. Compared with the control group, the average epidermal thickness of plantar skin was reduced by 15% in people with diabetic foot ulceration and 9% in people with neuropathy, but was increased by 6% in pure diabetics. There was an 8% increase in total thickness of plantar soft tissue in the 3 diabetic groups at all testing sites (all p < 0.05), except the first metatarsal head. The stiffness of plantar soft tissue was increased in all diabetic groups at all testing sites compared with the control (all p < 0.05). The epidermal plantar skin becomes thinner and plantar soft tissues stiffen in people with diabetes, particularly in persons who have neuropathy or ulceration, which increases the risk of tissue breakdown and ulceration formation. PMID:21640473

Chao, Clare Y L; Zheng, Yong-Ping; Cheing, Gladys L Y



Imaging of plantar fascia and Achilles injuries undertaken at the London 2012 Olympics.  


Plantar fascia and distal Achilles injuries are common in elite athletes. Acute athletic injuries of the plantar fascia include acute plantar fasciopathy and partial or complete tears. Underlying most acute injuries is a background of underlying chronic plantar fasciopathy. Injuries may affect the central or less commonly lateral portions of the fascia and acute tears are generally proximal. Athletic Achilles injuries may occur at the mid tendon or the distal insertion, and there may be an underlying chronic tendinopathy. Acute or chronic paratendinopathy may occur as a separate entity or combined with Achilles injury. In this article, the spectrum of athletic injuries of the plantar fascia and Achilles is described, illustrated by imaging findings from the London 2012 Olympic games. PMID:23903598

Elias, David A; Carne, Andrew; Bethapudi, Sarath; Engebretsen, Lars; Budgett, Richard; O'Connor, Philip



Rearward movement of the heel at heel strike.  


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

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



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


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 (?), 9.780 (?) (with an effective Poisson's ratio (?) 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

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



Can the Foot Posture Index or their individual criteria predict dynamic plantar pressures?  


The Foot Posture Index (FPI) quantifies foot posture through the evaluation of six individual criteria. The objective of the present study was then to establish the plantar pressure differences between types of feet, and to study the capacity of the whole FPI value and the six individual criteria to predict the pattern of plantar pressures. In a sample of 400 healthy subjects (201 men and 199 women), the FPI was evaluated and plantar pressures were measured in 10 zones using the Footscan(®) platform. Five plantar pressures measurements were made for each foot, using for the study the mean of these measurements for each subject's left foot. The hallux and the lesser toes had lower pressure indices in highly supinated feet, with the values increasing progressively toward the highly pronated feet (p<0.001 and p=0.019 respectively). The fifth metatarsal head (MTH) values were greater in highly supinated feet, and decreased in the highly pronated feet (p<0.001). The FPI value predicts low variability of plantar pressures, mainly in the heel and midfoot, while the individual criteria predict higher variability in the forefoot. The talonavicular prominence and the calcaneal frontal plane position was the most influential criterion, explaining 8.5% of the hallux pressure and 11.1% of the fifth MTH pressure. Neither talar head palpation nor the supra and infra malleolar curvature predicted any of the plantar pressures variables. The FPI can distinguish three groups of feet--pronated, neutral, and supinated. Its individual criteria predict moderate or low plantar pressures variability, with the talonavicular prominence being the most influential criterion. PMID:22727718

Sánchez-Rodríguez, Raquel; Martínez-Nova, Alfonso; Escamilla-Martínez, Elena; Pedrera-Zamorano, Juan Diego



Ultrasonographic findings of Achilles tendon and plantar fascia in patients with calcium pyrophosphate deposition disease.  


The aims of the study were to detect the frequency of involvement of the Achilles tendon and plantar fascia in patients with calcium pyrophosphate deposition disease (CPPD) by high-frequency gray-scale ultrasonography (US) and power Doppler sonography (PDS) and to correlate these findings with demographic and clinical data. Two groups of patients were enrolled: group I (38 patients with CPPD) and group II (22 patients with knee OA). US/PDS examination of the heels was performed to both groups. In the CPPD group, US/PDS examination of the Achilles tendon revealed: calcification in 57.9%, enthesophytosis in 57.9%, enthesopathy in 23.7%, vascular sign in 21%, bursitis in 13.2%, and cortical bone irregularity in 10.5%. US/PDS examination of plantar fascia in the CPPD group revealed: calcification in 15.8%, cortical bone irregularity in 78.9%, enthesophytosis in 60.5%, and planter fasciitis in 42.1%. In patients with CPPD, age was significantly correlated with enthesophytosis and deep retrocalcaneal bursitis (p = 0.01 and p = 0.04, respectively). Heel tenderness and posterior talalgia were significantly correlated with Achilles tendon enthesopathy, vascular sign, and deep retrocalcaneal bursitis (p = 0.0001 for each). Inferior talalgia was significantly correlated with plantar fasciitis (p = 0.0001). The sensitivity of ultrasonography for detection of calcifications in Achilles tendon and plantar fascia was 57.9% and 15.8%, respectively, and the specificity was 100% for both. To conclude, ultrasonographic Achilles tendon and plantar fascia calcifications are frequent findings in patients with CPPD. These calcifications have a high specificity and can be used as a useful indirect sign of CPPD. PMID:22203095

Ellabban, Abdou S; Kamel, Shereen R; Abo Omar, Hanaa A S; El-Sherif, Ashraf M H; Abdel-Magied, Rasha A



A Randomized Trial of Two Irremovable OffLoading Devices in the Management of Plantar Neuropathic Diabetic Foot Ulcers  

Microsoft Academic Search

OBJECTIVE — The purpose of this study was to compare the effectiveness of a removable cast walker (RCW) rendered irremovable (iTCC) with the total contact cast (TCC) in the treat- ment of diabetic neuropathic plantar foot ulcers. RESEARCH DESIGN AND METHODS — In a prospective, randomized, controlled trial, 41 consecutive diabetic patients with chronic, nonischemic, neuropathic plantar foot ulcers were




Use of pulsed radio frequency energy in the effective treatment of recalcitrant plantar fasciitis: Six case histories.  


Plantar fasciitis (or Heel Pain Syndrome) is a common foot disorder. Whereas most patients with this condition have satisfactory outcomes with conventional treatment, the condition can become recalcitrant. For these patients, the use of Pulsed Radio Frequency Energy (PRFE) appears to be a safe, noninvasive, and effective treatment option. While PRFE has been used to provide pain relief for other clinical conditions, little clinical information is available regarding its effectiveness for the treatment of plantar fasciitis. Reported here are outcomes for six cases of recalcitrant plantar fasciitis (duration 6 months or longer) that were unresponsive to conventional treatment alone, for which complete or near complete pain relief was achieved following adjunctive PRFE therapy. PMID:22265451

Michel, R



Effect of selected exercises on in-shoe plantar pressures in people with diabetes and peripheral neuropathy  

PubMed Central

BACKGROUND In people with diabetes and peripheral neuropathy (DM+PN), injury risk is not clearly known for weight bearing (WB) vs. non-weight bearing (NWB) exercise. In-shoe peak plantar pressures (PPP) often are used as a surrogate indicator of injury to the insensitive foot. OBJECTIVE Compare PPPs in people with DM+PN during selected WB and NWB exercises. METHODS 15 subjects with DM+PN participated. PPPs were recorded for the forefoot, midfoot, and heel during level walking and compared to; WB exercises - treadmill walking, heel and toe raises, sit to stands, stair climbing, single leg standing; and NWB exercises - stationary bicycling, balance ball exercise and plantar flexion exercise. RESULTS Compared to level walking; mean forefoot PPP during treadmill walking was 13% higher, but this difference was eliminated when walking speed was used as a covariate. Mean PPPs were similar or substantially lower for other exercises, except for higher forefoot PPP with heel raise exercises. CONCLUSIONS Slow progression and regular monitoring of insensitive feet are recommended for all exercises, but especially for heel raises, and increases in walking speed. The remaining WB and NWB exercises pose no greater risk to the insensitive foot due to increases in PPP compared to level walking.

Shah, Kshamata M.; Mueller, Michael J.



Identifying and treating plantar warts.  


This article aims to help health practitioners to identify plantar warts, and to provide information on available treatments. The efficacy of various treatments is inconclusive. Topical treatments are recommended instead of other often costly and sometimes unsuccessful treatments such as cryotherapy. Improved education and self-management are encouraged to minimise spread of the virus and to ease discomfort. PMID:16866235

Watkins, P


Plantar Fasciitis: Prescribing Effective Treatments.  

ERIC Educational Resources Information Center

|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…

Shea, Michael; Fields, Karl B.



The compressive mechanical properties of diabetic and non-diabetic plantar soft tissue  

PubMed Central

Diabetic subjects are at an increased risk of developing plantar ulcers. Knowledge of the physiologic compressive properties of the plantar soft tissue is critical to understanding possible mechanisms of ulcer formation and improving treatment options. The purpose of this study was to determine the compressive mechanical properties of the plantar soft tissue in both diabetic and non-diabetic specimens from six relevant locations beneath the foot, namely the hallux (big toe), first, third, and fifth metatarsal heads, lateral midfoot, and calcaneus (heel). Cylindrical specimens (1.905cm diameter) from these locations were excised and separated from the skin and bone from 4 diabetic and 4 non-diabetic age-matched, elderly, fresh-frozen cadaveric feet. Specimens were then subjected to biomechanically realistic strains of ?50% in compression using triangle wave tests conducted at five frequencies ranging from 1 to 10 Hz to determine tissue modulus, energy loss, and strain rate dependence. Diabetic vs. non-diabetic results across all specimens, locations, and testing frequencies demonstrated altered mechanical properties with significantly increased modulus (1146.7 vs. 593.0kPa) but no change in energy loss (68.5 vs. 67.9%). All tissue demonstrated strain rate dependence and tissue beneath the calcaneus was found to have decreased modulus and energy loss compared to other areas. The results of this study could be used to generate material properties for all areas of the plantar soft tissue in diabetic or non-diabetic feet, with implications for foot computational modeling efforts and potentially for pressure alleviating footwear that could reduce plantar ulcer incidence.

Pai, Shruti; Ledoux, William R.



Pulsed radiofrequency electromagnetic field therapy: a potential novel treatment of plantar fasciitis.  


Plantar fasciitis is a common cause of heel pain, and although treatments are usually conservative, they can take up to 2 years to achieve resolution. A double-blind, multicenter, randomized, placebo-controlled study was used to evaluate a small, wearable, extended-use pulsed radiofrequency electromagnetic field (PRFE) device as a treatment of plantar fasciitis. A total of 70 subjects diagnosed with plantar fasciitis were enrolled in the present study. The subjects were randomly assigned a placebo or active PRFE device. The subjects were instructed to wear the PRFE device overnight, record their morning and evening pain using a 0- to 10-point visual analog scale (VAS), and log any medication use. The primary outcome measure for the present study was morning pain, a hallmark of plantar fasciitis. The study group using the active PRFE device showed progressive decline in morning pain. The day 7 AM-VAS score was 40% lower than the day 1 AM-VAS score. The control group, in comparison, showed a 7% decline. A significantly different decline was demonstrated between the 2 groups (p = .03). The PM-VAS scores declined by 30% in the study group and 19% in the control group, although the difference was not significant. Medication use in the study group also showed a trend downward, but the use in the control group remained consistent with the day 1 levels. PRFE therapy worn on a nightly basis appears to offer a simple, drug-free, noninvasive therapy to reduce the pain associated with plantar fasciitis. PMID:22297104

Brook, Joel; Dauphinee, Damien M; Korpinen, Jaryl; Rawe, Ian M



Higher plantar pressure on the medial side in four soccer-related movements  

PubMed Central

Objective To measure the plantar pressure in four soccer?related movements in 15 male soccer players (mean (SD) age 20.9 (1.3)?years, height 173 (4)?cm, weight 61.7 (3.6)?kg). Design To record plantar pressure distribution, the players wore soccer boots with 12 circular studs and with an insole pressure recorder device equipped with 99 sensors. Plantar pressure was recorded in five successful trials in each of the four soccer?related movements: running, sideward cutting, 45° cutting and landing from a vertical jump. Each footprint was divided into 10 recorded areas for analysis. Results Compared with running at 3.3?m/s, maximal speed sideward cutting and 45° cutting induced higher peak pressure (p<0.05) under the second toe, medial forefoot, medial arch and medial heel. The peak pressure of the maximal jump landing was lower under the medial forefoot and lateral forefoot as compared with running (p<0.05). The pressure–time integral showed that sideward cutting and 45° cutting induced higher pressures (p<0.05) than running for all recorded areas, except for the lateral forefoot and the lateral arch. In all the four soccer?related movements, a higher pressure was found on the medial side of the plantar surface as compared with the lateral side. Conclusions These data suggest that the medial side of the plantar surface may be more prone to injuries, and that foot orthosis adoption, improved soccer boot design and specific muscle training could be considered to reduce pressure and the subsequent risk of injury.

Wong, Pui-lam; Chamari, Karim; De Wei Mao; Wisl?ff, Ulrik; Hong, Youlian



The compressive mechanical properties of diabetic and non-diabetic plantar soft tissue.  


Diabetic subjects are at an increased risk of developing plantar ulcers. Knowledge of the physiologic compressive properties of the plantar soft tissue is critical to understanding the possible mechanisms of ulcer formation and improving treatment options. The purpose of this study was to determine the compressive mechanical properties of the plantar soft tissue in both diabetic and non-diabetic specimens from six relevant locations beneath the foot, namely the hallux (big toe), first, third, and fifth metatarsal heads, lateral midfoot, and calcaneus (heel). Cylindrical specimens (1.905 cm diameter) from these locations were excised and separated from the skin and bone from 4 diabetic and 4 non-diabetic age-matched, elderly, fresh-frozen cadaveric feet. Specimens were then subjected to biomechanically realistic strains of approximately 50% in compression using triangle wave tests conducted at five frequencies ranging from 1 to 10 Hz to determine tissue modulus, energy loss, and strain rate dependence. Diabetic vs. non-diabetic results across all specimens, locations, and testing frequencies demonstrated altered mechanical properties with significantly increased modulus (1146.7 vs. 593.0 kPa) but no change in energy loss (68.5 vs. 67.9%). All tissue demonstrated strain rate dependence and tissue beneath the calcaneus was found to have decreased modulus and energy loss compared to other areas. The results of this study could be used to generate material properties for all areas of the plantar soft tissue in diabetic or non-diabetic feet, with implications for foot computational modeling efforts and potentially for pressure alleviating footwear that could reduce plantar ulcer incidence. PMID:20207359

Pai, Shruti; Ledoux, William R



Relationship between plantar pressures, physical activity and sedentariness among preschool children.  


It has been speculated that high plantar pressures might cause foot pain and discomfort which, in turn, may discourage children from being physically active and result in them spending more time in sedentary activities. The purpose of this study was to determine whether plantar pressure distributions generated by preschool children were correlated with objectively measured time spent in physical activity and sedentary behaviour. Dynamic plantar pressures were measured for 33 preschool children (age=4.3±0.6 years; height=1.06±0.1 m; mass=18.4±2.9 kg; 17 boys) as they walked across an emed AT-4 pressure platform. Physical activity was objectively assessed using MTI ActiGraph accelerometers. Total physical activity (counts per minute), percentage of time spent in moderate-to-vigorous physical activity (MVPA), light activity and sedentary behaviour were then calculated. Peak pressures across the heel were found to significantly correlate with total physical activity (r=-0.53; p=0.03) and time in MVPA (r=-0.47; p=0.05) in boys. Similarly, the correlation data suggested that girls who generated higher peak pressures in the toe region spent more time in sedentary behaviour (r=0.53; p=0.04). As high plantar pressures appear to be a potential negative correlate of physical activity and sedentary behaviour, it is recommended that further research be conducted to design, test and evaluate the potential of interventions to reduce plantar pressures in inactive children so they can enjoy the benefits associated with participating in a more active lifestyle. PMID:20619735

Mickle, Karen J; Cliff, Dylan P; Munro, Bridget J; Okely, Anthony D; Steele, Julie R



Practice Recommendations for Preventing Heel Pressure Ulcers  

Microsoft Academic Search

Heels are the second most common anatomical location for pressure ulcers. A combination of risk factors, including pressure, may cause ulceration. Heel pressure ulcers are a particular concern for surgical patients. A review of the literature, including poster presentations, shows that controlled clinical studies to assess the effectiveness and cost-effectiveness of available interventions are not available. Case series (with or

Evonne Fowler; Suzy Scott-Williams; James B. McGuire


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


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

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



Imiquimod for plantar and periungual warts.  


Plantar and periungual warts are notoriously difficult to eradicate. Two cases of nongenital warts in teenage girls are presented. Imiquimod was used in combination with cryotherapy for the periungual warts and with occlusion for the plantar warts. Both cases showed complete resolution and that imiquimod may be more effective on thicker keratinized (nongenital) skin when occluded or used in combination with cryotherapy. PMID:11775772

Sparling, J D; Checketts, S R; Chapman, M S



Plantar pressure trigger for reliable nerve stimulus application during dynamic H-reflex measurements.  


In dynamic H-reflex measurements, the standardisation of the nerve stimulation to the gait cycle is crucial to avoid misinterpretation due to altered pre-synaptic inhibition. In this pilot study, a plantar pressure sole was used to trigger the stimulation of the tibialis nerve with respect to the gait cycle. Consequently, the intersession reliability of the soleus muscle H-reflex during treadmill walking was investigated. Seven young participants performed walking trials on a treadmill at 5 km/h. The stimulating electrode was placed on the tibial nerve in the popliteal fossa. An EMG was recorded from the soleus muscle. To synchronize the stimulus to the gait cycle, initial heel strike was detected with a plantar pressure sole. Maximum H-reflex amplitude and M-wave amplitude were obtained and the Hmax/Mmax ratio was calculated. Data reveals excellent reliability, ICC=0.89. Test-retest variability was 13.0% (±11.8). The Bland-Altman analysis showed a systematic error of 2.4%. The plantar pressure sole was capable of triggering the stimulation of the tibialis nerve in a reliable way and offers a simple technique for the evaluation of reflex activity during walking. PMID:23102673

König, Niklas; Reschke, Antje; Wolter, Martin; Müller, Steffen; Mayer, Frank; Baur, Heiner



Novel Surgical Treatment for Refractory Heel Ulcers in Werner's Syndrome  

PubMed Central

Patients with Werner's syndrome frequently develop chronic leg ulcers that heal poorly. We present a patient who suffered from this rare syndrome and developed typical heel ulcers. Treatment of the ulcer is challenging, as flap options are limited over the lower third of the leg and skin grafting is not easy as there is a lack of healthy granulations. We successfully treated the ulcer with osteomyelitis by drilling the bone and applying an ultrathin split thickness skin graft with the thigh skin as the donor site.

Oe, Keisuke; Miwa, Masahiko; Kurosaka, Masahiro



The effect of partial weight bearing in a walking boot on plantar pressure distribution and center of pressure.  


Physicians routinely prescribe partial weight bearing in a walking boot following fractures of the lower limbs in order to produce the needed mechanical environment to facilitate healing. Plantar pressure measurements can provide key information regarding the mechanical environment experienced by lower limb bones. The effect of walking boots on plantar pressure distribution has been well reported, however, the combined effects of partial weight bearing and walking boots on plantar pressure distribution and center of pressure is unknown. Thirteen healthy volunteers with no known gait pathologies were fitted with a multi-pressure sensor insole that recorded their plantar pressure distribution during four walking trials: (i) normal walking, (ii) full weight bearing in a walking boot, (iii) 27 kg partial weight bearing in a walking boot and (iv) 9 kg partial weight bearing in a walking boot. Results demonstrated that changing from trial (i) to (iv) resulted in a posterior shift in weight distribution; the percentage of total weight experienced at the heel increased while the percentage of total weight experienced at the forefoot (both medial and lateral) and the hallux decreased. Center of pressure trajectories also shifted more posteriorly. Additionally, while in a walking boot the gait during full and partial weight bearing resulted in more even foot loading. PMID:22633830

North, Kylee; Potter, Michael Q; Kubiak, Erik N; Bamberg, Stacy J Morris; Hitchcock, Robert W



Plantar warts: a focus on treatment modalities.  


Plantar warts are a common problem frequently seen by dermatologists and other practitioners with an interest in skin disease management. The diagnosis is often straightforward, but the treatment is difficult and lengthy. The available treatment options are reviewed. PMID:17874607

Lichon, Vanessa; Khachemoune, Amor



Foot Plantar Pressure Measurement System: A Review  

PubMed Central

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.

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



Treatment of recalcitrant plantar warts with imiquimod.  


Myrmecia are viral warts that result from the coalescence of plantar or palmar warts into large plaques. Treatment of these warts involves physical or chemical destruction of the verrucae, potent keratolytics or immunotherapy. Imiquimod 5% cream is a novel topical immunomodulator that has been used successfully in the treatment of genital and common warts. We report its successful use in a 35-year-old immunocompetent man who had had resistant plantar warts for 15 years. PMID:12006136

Yesudian, P D; Parslew, R A G



Objective evaluation of plantar hyperhidrosis after sympathectomy  

PubMed Central

OBJECTIVE: The aim of the present study was to prospectively, randomly, blindly, and objectively investigate how surgery affects plantar sudoresis in patients with palmar and plantar hyperhidrosis over a one-year period using a sudorometer (VapoMeter). METHODS: From February 2007 to May 2009, 40 consecutive patients with combined palmar hyperhidrosis and plantar hyperhidrosis underwent video-assisted thoracic sympathectomy at the T3 or T4 ganglion level (15 women and 25 men, with a mean age of 25 years). RESULTS: Immediately after the operation and during the one-year follow-up, all of the patients were free from palmar hyperhidrosis episodes. Compensatory hyperhidrosis of varying degrees was observed in 35 (87.5%) patients after one year. Only two (2.5%) patients suffered from severe compensatory hyperhidrosis. There was a large initial improvement in plantar hyperhidrosis in 46.25% of the cases, followed by a progressive regression of that improvement, such that only 30% continued to show this improvement after one year. The proportion of patients whose condition worsened increased progressively (from 21.25% to 47.50%), and the proportion of stable patients decreased (32.5% to 22.50%). This was not related to resection level; however, a lower intensity of plantar hyperhidrosis prior to sympathectomy correlated with worse evolution. CONCLUSION: Patients with palmar hyperhidrosis and plantar hyperhidrosis who underwent video-assisted thoracic sympathectomy to treat their palmar hyperhidrosis exhibited good initial improvement in plantar hyperhidrosis, which then decreased to lesser degrees of improvement over a one-year period following the surgery. For this reason, video-assisted thoracic sympathectomy should not be performed when only plantar hyperhidrosis is present.

Wolosker, Nelson; Ishy, Augusto; Yazbek, Guilherme; de Campos, Jose Ribas Milanez; Kauffman, Paulo; Puech-Leao, Pedro; Jatene, Fabio Biscegli



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

PubMed Central

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.




Recovery of Plutonium from Electrorefining Anode Heels at Savannah River.  

National Technical Information Service (NTIS)

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 dem...

J. H. Gray L. W. Gray D. G. Karraker



Novel posterior splinting technique to avoid heel ulcers.  


Heel ulcers are a costly and preventable complication of lower-extremity immobilization, but they still occur with some regularity. A technique using a short leg posterior splint that suspends the heel away from the splint is described. This modification completely removes pressure the heel to prevent decubitus ulcer formation. This technique is simple, inexpensive, and effective. PMID:23276331

Hsu, Raymond Y; Lareau, Craig R; Born, Christopher T




PubMed Central

Background: Treatment of plantar warts caused by human papilloma virus (HPV) strain types 1, 2 and 4 is often difficult and a challenging problem. Various therapeutic modalities available for treating this problem have not been uniformly successful. Purpose: The purpose of present study is to evaluate the efficacy of adapalene applied locally with occlusion in plantar warts. Materials and Methods: A total of 10 patient with 118 plantar warts were included in an open study. All were treated by applying adapalene gel 0.1% after paring of warts if needed followed by occlusive dressing with polythene paper in each patient. The effects of the treatment were evaluated every week till the clearance of all warts. Findings: Adapalene was used in 10 patient having 118 plantar warts. All the warts cleared in 39±15.07 days. There was no side effects like scar formation, irritation, erythema or infection with adapalene. Conclusion: Adapalene clears the plantar warts faster compared to other modalities available. Limitation: Need trial with large number of patients.

Gupta, Ramji



Medial plantar flap based distally on the lateral plantar artery to cover a forefoot skin defect.  


The authors report a simple, single-step procedure to promote the distal transfer of the instep island flap for coverage of the submetatarsal weight-bearing zone. First described in 1991 by Martin et aI, this procedure remained unknown. As opposed to the medial plantar flap, this technique proposes an instep island flap based on the lateral plantar artery. The inflow and outflow of blood is assured by the anastomosis between the dorsalis pedis and lateral plantar vessels. This approach allows for the transfer of similar tissue and provides adequate coverage of the weight-bearing zone of the distal forefoot. PMID:11007402

Oberlin, C; Accioli de Vasconcellos, Z; Touam, C



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


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

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



Neglected isolated plantar dislocation of middle cuneiform : a case report  

Microsoft Academic Search

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

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



Analysis of heel pad tissues mechanics at the heel strike in bare and shod conditions.  


A combined experimental and numerical approach is used to investigate the interaction phenomena occurring between foot and footwear during the heel strike phase of the gait. Two force platforms are utilised to evaluate the ground reaction forces of a subject in bare and shod walking. The reaction forces obtained from the experimental tests are assumed as loading conditions for the numerical analyses using three dimensional models of the heel region and of the running shoe. The heel pad region, as fat and skin tissues, is described by visco-hyperelastic and fibre-reinforced hyperelastic formulations respectively and bone region by a linear orthotropic formulation. Different elastomeric foams are considered with regard to the outsole, the midsole and the insole layers. The mechanical properties are described by a hyperfoam formulation. The evaluation of the mechanical behaviour of the heel pad tissues at the heel strike in bare and shod conditions is performed considering different combinations of materials for midsole and insole layers. Results allow for the definition of the influence of different material characteristics on the mechanical response of the heel pad region, in particular showing the compressive stress differentiation in the bare and shod conditions. PMID:22789809

Fontanella, C G; Forestiero, A; Carniel, E L; Natali, A N



A retrospective study of standing gastrocnemius-soleus stretching versus night splinting in the treatment of plantar fasciitis.  


Plantar fasciitis is the most common cause of heel pain, yet the conservative treatment of plantar fasciitis is not standardized. This open retrospective study compared the effects of standing gastrocnemius-soleus stretching to a prefabricated night splint. One hundred and sixty patients with unilateral or bilateral plantar fasciitis were evaluated and treated according to the standard regimen in addition to either night splints or stretching. Seventy-one patients performed standing stretching of the gastrocnemius-soleus complex. Eighty-nine patients utilized the prefabricated night splint without standing stretching. The night splint treatment group had a significantly shorter recovery time (p < .001), fewer follow-up visits to recovery (p < .001), and fewer total additional interventions (p = .034) compared to the stretching group. Absolute body weight, body mass index, and age did not have a statistically significant effect on the time to recovery or additional interventions needed. The duration of pain prior to this treatment was a predictive factor and was associated with increased time to recovery and increased number of treatment interventions. Its was concluded that early treatment in a standardized four-tiered treatment approach, including the night splint without standing stretching of the gastrocnemius-soleus complex, speeds time to recovery. PMID:12194511

Barry, Lance D; Barry, Anna N; Chen, Yinpu


Plantar fasciitis and fascial rupture: MR imaging findings in 26 patients supplemented with anatomic data in cadavers.  


Understanding of the normal anatomy of the plantar aponeurosis (PA) and familiarity with pathologic conditions are required for an accurate evaluation of the patient with subcalcaneal heel pain. In this study, we evaluated the diagnostic capabilities of magnetic resonance (MR) imaging in the assessment of the PA with close anatomic correlation. Herein, we describe the MR imaging features of plantar fasciitis and fascial rupture in 26 patients. High-spatial-resolution MR imaging was performed in four cadaveric feet, and a prescribed imaging plane was used for depiction of the peroneal component of the PA. MR imaging delineated the anatomy of the PA and perifascial soft tissues. The peroneal component was best visualized in prescribed sagittal oblique images. Perifascial edema was the most common finding of plantar fasciitis, and it was remarkable in those cases with acute fascial rupture. MR imaging reliably delineated the anatomy of the PA and may allow precise localization and definition of the extent of involvement in disease processes. PMID:11046170

Theodorou, D J; Theodorou, S J; Kakitsubata, Y; Lektrakul, N; Gold, G E; Roger, B; Resnick, D



Management of Plantar Ulcers in Hansen's Disease  

Microsoft Academic Search

Plantar ulcers occur in patients with Hansen's disease not because of the disease but because of its neuropathic effects on the skin over the feet. This enhances the risk of trauma to patients' feet, leading to the development of ulcers. This short article reviews the current management of leprosy on the basis of World Health Organization guidelines and the complexities

V. S. Chauhan; S. S. Pandey; V. K. Shukla



Flat feet, happy feet? Comparison of the dynamic plantar pressure distribution and static medial foot geometry between Malawian and Dutch adults.  


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

Stolwijk, Niki M; Duysens, Jacques; Louwerens, Jan Willem K; van de Ven, Yvonne Hm; Keijsers, Noël Lw



Effects of Combined Foot/Ankle Electromyostimulation and Resistance Training on the In-Shoe Plantar Pressure Patterns during Sprint in Young Athletes  

PubMed Central

Several studies have already reported that specific foot/ankle muscle reinforcement strategies induced strength and joint position sense performance enhancement. Nevertheless the effects of such protocols on sprint performance and plantar loading distribution have not been addressed yet. The objective of the study is to investigate the influence of a 5-wk foot/ankle strength training program on plantar loading characteristics during sprinting in adolescent males. Sixteen adolescent male athletes of a national training academy were randomly assigned to either a combined foot/ankle electromyostimulation and resistance training (FAST) or a control (C) group. FAST consisted of foot medial arch and extrinsic ankle muscles reinforcement exercises, whereas C maintained their usual training routine. Before and after training, in-shoe loading patterns were measured during 30-m running sprints using pressure sensitive insoles (right foot) and divided into nine regions for analysis. Although sprint times remained unchanged in both groups from pre- to post- training (3.90 ± 0.32 vs. 3.98 ± 0.46 s in FAST and 3.83 ± 0.42 vs. 3.81 ± 0.44 s in C), changes in force and pressure appeared from heel to forefoot between FAST and C. In FAST, mean pressure and force increased in the lateral heel area from pre- to post- training (67.1 ± 44.1 vs. 82.9 ± 28.6 kPa [p = 0.06]; 25.5 ± 17.8 vs. 34.1 ± 14.3 N [p = 0.05]) and did not change in the medial forefoot (151.0 ± 23.2 vs. 146.1 ± 30.0 kPa; 142.1 ± 29.4 vs. 136.0 ± 33.8; NS). Mean area increased in FAST under the lateral heel from pre- to post- (4.5 ± 1.3 vs. 5.7 ± 1.6 cm2 [p < 0.05]) and remained unchanged in C (5.5 ± 2.8 vs. 5.0 ± 3.0 cm2). FAST program induced significant promising lateral and unwanted posterior transfer of the plantar loads without affecting significantly sprinting performance. Key points We have evaluated the effects of a foot/ankle strength training program on sprint performance and on related plantar loading characteristics in teenage athletes, and this have not been examined previously. Our results showed no significant pre- to post- changes in sprint performance. This study revealed initially a lateral transfer and secondly a posterior transfer of the plantar loads after the foot/ankle strength training program.

Fourchet, Francois; Kuitunen, Sami; Girard, Olivier; Beard, Adam J.; Millet, Gregoire P.



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


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

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



The movement of the heel within a running shoe.  


Most running shoe investigations have used the same standard procedure for the evaluation of the shoes: the runners are filmed from behind and a film analysis is carried out digitizing markers at the heel counter of the shoe and on the lower leg. The angular displacement of these markers relative to the horizontal or the vertical is assumed to be an indicator for various sports injuries. The goal of this investigation was to measure the movement of the heel counter as well as the movement of the heel inside the shoe. First, the influence of the size of different heel counter windows was controlled and found negligible for the test conditions of this study. Second, 15 subjects performed the following procedure: running (a) barefoot, (b) with shoes with windows, and (c) without windows. Overall, the heel was found to move similarly but not identically to the heel counter. The maximum change of pronation was (a) 13.7 +/- 3.7 degrees, barefoot; (b) 14.1 +/- 3.8 degrees for the shoe with windows and 12.1 +/- 3.7 degrees for the heel inside these shoes; and 14.9 +/- 4.2 degrees for the shoes with no windows. To achieve a general impression of a shoe in the sense of a qualitative description, the previous method without heel counter windows still seems adequate. However, for a detailed analysis of quantitative nature, it is important to use the method with heel counter windows. PMID:1602942

Stacoff, A; Reinschmidt, C; Stüssi, E



Triaxial plantar pressure sensor: design, calibration and characterization  

Microsoft Academic Search

A novel tri-axial plantar pressure sensor has been developed. This sensor simultaneously measures vertical plantar pressure and anterior-posterior and medial-lateral shear plantar pressures utilizing a central post, four parallel plates, and a commercial miniature pressure transducer. As a subject walks over the sensor, the central post is deflected and the shear pressures are measured utilizing capacitive sensing technology. The miniature

E. J. Heywood; D. C. Jeutter; G. F. Harris



Reduction of digital plantar pressure by debridement and silicone orthosis.  


The lesser digits are frequent sites of elevated plantar pressure and ulceration in the diabetic foot. We sought to determine whether debridement of callus and the wearing of a custom molded digital orthosis could significantly reduce digital plantar pressure. Fourteen patients with distal digital callus were studied. For each patient, the toe with the highest plantar pressure was selected. A computerized pressure mat was used to record the plantar pressure before and after debridement with and without a moldable silicone digital orthosis. Mean peak plantar digital pressures before treatment were 2.80+/-0.7 kg/cm2 for the entire group. The digital orthosis alone reduced plantar pressure to a mean of 1.95+/-0.65 kg/cm2 p < 0.05. Treatment by debridement similarly reduced pressure to 1.99+/-0.76 kg/cm2 p < 0.05. The most effective reduction of pressure for all patients, as well as the most statistically significant, occurred when both treatments were given, with mean peak plantar pressure falling to 1.28+/-0.61 kg/cm2 p < 0.01. Debridement and custom molded digital orthoses alleviate distal digital plantar pressure. Since elevated plantar pressure increases the risk of neuropathic ulceration, these treatments should be considered in the prophylactic care of appropriate patients. PMID:16740335

Slater, R A; Hershkowitz, I; Ramot, Y; Buchs, A; Rapoport, M J



A Biomechanical Evaluation of Standing in High Heeled Shoes  

Microsoft Academic Search

The purpose of this study was to determine the action of the ground reaction force upon the heels of women standing in high-heeled shoes. The study involved a non-invasive determination of the location of the subtalar joint axis, the joint about which the foot bends in and out. It was determined where the ground reaction force acts relative to the

Paula D. Henderson; Penn State; Stephen J. Piazza


Recovery of plutonium from electrorefining anode heels at Savannah River  

SciTech Connect

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.

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




PubMed Central

The purpose of our study was to examine dynamic foot function during gait as it relates to plantar loading in individuals with DM (diabetes mellitus and neuropathy) compared to matched control subjects. Foot mobility during gait was examined using a multi-segment kinematic model, and plantar loading was measured using a pedobarograph in subjects with DM (N=15), control subjects (N=15). Pearson product moment correlation was used to assess the relationship between variables of interest. Statistical significance and equality of correlations were assessed using approximate tests based on Fisher’s Z transformation (?=0.05). In individuals with DM, 1st metatarsal sagittal plane excursion during gait was negatively associated with pressure time integral under the medial forefoot (r = ?0.42 and ?0.06, DM and Ctrl, P= 0.02). Similarly, lateral forefoot sagittal plane excursion during gait was negatively associated with pressure time integral under the lateral forefoot (r = ?0.56 and ?0.11, DM and Ctrl, P = 0.02). Frontal plane excursion of the calcaneus was negatively associated with medial (r= ?0.57 and 0.12, DM and Ctrl, P < 0.01) and lateral (r= ?0.51 and 0.13, DM and Ctrl, P < 0.01) heel and medial forefoot pressure time integral (r= ?0.56 and ?0.02, DM and Ctrl, P < 0.01). The key findings of our study indicate that reductions in segmental foot mobility were accompanied by increases in local loading in subjects with DM. Reduction in frontal plane calcaneal mobility during walking serves as an important functional marker of loss of foot flexibility in subjects with DM.

Rao, Smita; Saltzman, Charles L; Yack, H. John



Isolated plantar dislocation of the middle cuneiform: a case report  

Microsoft Academic Search

Isolated plantar dislocation of the cuneiform was reported in only two cases in the literature. We report a 57-year-old man with plantar dislocation of the cuneiform when the foot was struck by a large concrete block during construction of a building. Tarsometatarsal injuries are frequently overlooked. Therefore, plain computed tomography (CT) and three-dimensional CT are useful for adequate evaluation.

Masaru Fujita; Haruyasu Yamamoto; Kenji Kariyama; Hisahide Yamakawa



Children with ADHD show no deficits in plantar foot sensitivity and static balance compared to healthy controls.  


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 quantified using the length, area and velocity described by the center of pressure (COP) during two-legged as well as one-legged stand (right and left legs). The comparison of vibration thresholds showed no differences between ADHD and healthy children at all anatomical locations of both feet. Whereas COP excursion and area were significantly lower in ADHD subjects compared to the healthy controls during two-legged stand, no differences were found in those variables when balancing on one leg. No differences in COP velocity between ADHD and healthy children were found in any analyzed conditions. The results indicate that the unusual and simple test situation may have increased the perception of vibration stimuli by the ADHD children. Furthermore, ADHD subjects seem to be less variable when performing simple tasks than healthy controls. PMID:22728606

Schlee, Günther; Neubert, Tom; Worenz, Andreas; Milani, Thomas L



[Lower limb stump reconstruction with a functional calcaneo-plantar unit free flap. A series of 16 cases].  


The main objective of surgery, once amputation is inevitable, is to preserve a functional stump. This report describes the immediate reconstruction of 16 leg stumps in children by transfer of a functional calcaneo-plantar unit. Of these, 3 were thigh and 13 were lower leg reconstructions. Amputation was performed for tumor in 4 cases, and was due to accidents in the remaining twelve. The main technical features of flap preparation are preservation of the calcaneum branch and attachment of the heel skin to the greater tuberosity of the calcaneum. One case resulted in failure due to vascular thrombosis. The other 15 cases resulted in bone consolidation after an average of 45 days, sensitive protection by 70 days, and very good trophic and protective results. The provision of good distal pressure area encourages overall development of the child. There was no morbidity at the donor site, and because there is no major muscle mass in the distal fragment, the overall risk is very low compared to that of total proximal leg replantation. The transfer of functional calcaneo-plantar tissue as a single unit is the best strategy for one-step restoration of good distal support area for the stump. All surgeons liable to perform leg amputations should be aware of this technical approach. PMID:10337047

Malikov, S; Dubert, T; Koupatadze, D; Nabokov, V; Polosov, R



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)

MR elastography (MRE) images the intrinsic mechanical properties of soft tissues; e.g., the shear modulus, ?. The ? 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 ? 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 ? along the weight bearing axis and ? 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.

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.



Heel-line hyperpigmentation: a variant of sock-line hyperpigmentation after the use of heel-length socks.  


Two infants developed hyperpigmented curvilinear patches on the posterior heel after wearing heel-length socks. Both of the patient's lesions improved after discontinuing the use of the heel-length socks. Hyperpigmented patches called sock-line or mitten-line hyperpigmentation have been reported at sites of tight elastic bands from socks or mittens in infants on the calves and wrists. Recognizing this clinical entity is important to differentiate it from other causes of linear lesions such as child abuse or amniotic band syndrome. PMID:23432211

Ciliberto, Heather; Berk, David; Salphale, Pankaj; Bayliss, Susan



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


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

Sawacha, Zimi



Changes of Reflex, Non-reflex and Torque Generation Properties of Spastic Ankle Plantar Flexors Induced by Intelligent Stretching.  


Spasticity, contracture, and muscle weakness are major sources of disability in stroke. Changes of torque-generating capacity as well as reflex and non-reflex properties of ankle plantar flexors induced by strenuous stretching in chronic hemiplegia were investigated. Twelve subjects with a unilateral stroke and 10 healthy controls underwent 30 minutes of strenuous intelligent stretching treatment. Reflex and non-reflex components of spastic hypertonia and force-generating capacity of ankle plantar flexors were investigated. Dorsiflexion (DF) range of motion (ROM) was increased (p=0.002) and passive stiffness and passive resistant torque of the spastic muscles were decreased (p=0.004 and 0.007, respectively), while reflex hyper-excitability diminished slightly but with no statistical significance. The maximal voluntary contraction (MVC) torque of the spastic ankle plantar flexors was increased after the forceful stretching treatment (p=0.041). In contrast, the stretching treatment of the healthy plantar flexors did not change any of the variables measured before and after stretching. The stroke subjects who gained more DF ROM or larger decrement of stiffness achieved greater increment of the peak torque generation after the stretching (r=0.597 with p=0.040 and r=-0.746 with p=0.005, respectively). These results suggest that the strenuous dynamic stretching could improve the force-generating capacity of spastic muscles as well as reduce the passive stiffness and increase ROM. PMID:17281024

Chung, S; Bai, Z; Rymer, W Z; Zhang, L Q



Want to Spend Less? Shop in High Heels, Study Says  


... in high heels," study author Jeffrey Larson, a marketing professor at Brigham Young University, said in a ... in the current issue of the Journal of Marketing Research , found people focused on balancing were more ...


Management of subcalcaneal pain and Achilles tendonitis with heel inserts  

PubMed Central

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

Maclellan, G. E.; Vyvyan, Barbara



Changes of Reflex, Non-reflex and Torque Generation Properties of Spastic Ankle Plantar Flexors Induced by Intelligent Stretching  

Microsoft Academic Search

Spasticity, contracture, and muscle weakness are major sources of disability in stroke. Changes of torque-generating capacity as well as reflex and non-reflex properties of ankle plantar flexors induced by strenuous stretching in chronic hemiplegia were investigated. Twelve subjects with a unilateral stroke and 10 healthy controls underwent 30 minutes of strenuous intelligent stretching treatment. Reflex and non-reflex components of spastic

S. G. Chung; Z. Bai; W. Z. Rymer; L. Q. Zhang



Fiber optic plantar pressure/shear sensor  

NASA Astrophysics Data System (ADS)

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.

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



The effect of plantar flexor muscle fatigue on postural control  

Microsoft Academic Search

ObjectivePrevious studies have demonstrated that ankle muscle fatigue alters postural sway. Our aim was to better understand postural control mechanisms during upright stance following plantar flexor fatigue.

Yoav Gimmon; Raziel Riemer; Lars Oddsson; Itshak Melzer



The Accuracy of an Automasking Algorithm in Plantar Pressure Measurements  

Microsoft Academic Search

Masking algorithms provide a way to analyze plantar pressure parameters based on distinct anatomical regions of the foot.\\u000a No study has addressed their accuracy. The purpose of this study was to determine the accuracy of the Novel® ten-region standard\\u000a masking algorithm in both dynamic and static measurements in normal feet. Static and dynamic plantar pressure measurements\\u000a were collected from ten

Scott J. Ellis; Hill Stoecklein; Joseph C. Yu; Grisha Syrkin; Howard Hillstrom; Jonathan T. Deland



Assessment of plantar pressure and balance in patients with diabetes  

PubMed Central

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.

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



Is heel prick as safe as we think?  


Purulent lymphadenitis is rare in newborn and is associated with prematurity and invasive procedure. Neonatal staphylococcal infections due to skin interruption during intramuscular vitamin K administration and national metabolic screening programme (heel prick or Guthrie card test) have been already previously described. This is a report of a premature infant who developed an inguinal adenitis as a result of late complications from heel pricks. The diagnosis was made on clinical grounds and confirmed by ultrasound scans. Staphylococcus aureus was isolated. Bacteremia did not occur and the lymphadenitis had a complete resolution with antimicrobial therapy. The heel prick is a well-established procedure in neonatal practice, nevertheless it is not risk-free. The attention to signs of infections is important to avoid complications such as purulent lymphadenitis, abscess formation and septicemia. Best practice prevention and control in minimising the risk of infections are the most important intervention to prevent this complication. PMID:22675035

Onesimo, Roberta; Fioretti, Maria; Pili, Stefania; Monaco, Serena; Romagnoli, Costantino; Fundarò, Carlo



Farriery for the hoof with low or underrun heels.  


Underrun heels are common and involve hoof capsule distortion in which the horn tubules of the heels undergo bending and lengthening, resulting in decreased strength and functionality. The syndrome varies in clinical presentation, depending on duration, severity of distortion, presence of secondary problems, and presence of lameness. Primary treatment goals are to maintain soundness and functional integrity of the foot and to establish a normal hoof capsule. Resolution of the problem is generally not achieved in horses in a heavy work schedule, and realistic goals in this situation are to maintain function, alleviate lameness, and arrest progression of the distortion. PMID:22981194

Hunt, Robert J



Farriery for the hoof with a sheared heel.  


Sheared heels develop as an adaptation-distortion of the hoof capsule as a result of an abnormal strike and loading pattern of the foot, which is generally a consequence of limb conformation. The growth rate around the circumference of the hoof should be approximately uniform, but regional disturbances in growth rate can occur to either increase or decrease growth. The primary conformational trait that is observed in horses that develop sheared heels is a rotational deformity of the distal limb and a narrow chest. Farriery is directed toward improving the hoof capsule distortion and decreasing the forces on the displaced side of the foot. PMID:22981196

O'Grady, Stephen E



The upright posture improves plantar stepping and alters responses to serotonergic drugs in spinal rats  

PubMed Central

Recent studies on the restoration of locomotion after spinal cord injury have employed robotic means of positioning rats above a treadmill such that the animals are held in an upright posture and engage in bipedal locomotor activity. However, the impact of the upright posture alone, which alters hindlimb loading, an important variable in locomotor control, has not been examined. Here we compared the locomotor capabilities of chronic spinal rats when placed in the horizontal and upright postures. Hindlimb locomotor movements induced by exteroceptive stimulation (tail pinching) were monitored with video and EMG recordings. We found that the upright posture alone significantly improved plantar stepping. Locomotor trials using anaesthesia of the paws and air stepping demonstrated that the cutaneous receptors of the paws are responsible for the improved plantar stepping observed when the animals are placed in the upright posture. We also tested the effectiveness of serotonergic drugs that facilitate locomotor activity in spinal rats in both the horizontal and upright postures. Quipazine and (±)-8-hydroxy-2-(dipropylamino)tetralin hydrobromide (8-OH-DPAT) improved locomotion in the horizontal posture but in the upright posture either interfered with or had no effect on plantar walking. Combined treatment with quipazine and 8-OH-DPAT at lower doses dramatically improved locomotor activity in both postures and mitigated the need to activate the locomotor CPG with exteroceptive stimulation. Our results suggest that afferent input from the paw facilitates the spinal CPG for locomotion. These potent effects of afferent input from the paw should be taken into account when interpreting the results obtained with rats in an upright posture and when designing interventions for restoration of locomotion after spinal cord injury.

Slawinska, Urszula; Majczynski, Henryk; Dai, Yue; Jordan, Larry M



Occurrence, Characterization and Synthesis of Hanford and SRS Tank Heel Materials  

Microsoft Academic Search

The long-range objective of this study was to develop chemically assisted technologies for removing heels from tanks. In FY 01, the first two steps toward this objective were taken: (1) catalogue the occurrence and nature of tank heels and assess which materials are available for study and (2) develop methods for synthesizing non-radioactive surrogate heel materials for use in testing




Functional evaluation of the 10-year outcome after modified Evans repair for chronic ankle instability.  


The Evans tenodesis is an operative treatment for chronic ankle instability with good short-term results. The disadvantage of impaired hind foot kinematics and restricted motion has been described, and only few reports of long-term results can be found. No techniques have been used to assess the outcome objectively. We wanted to determine whether a modified Evans procedure led to a satisfactory clinical and functional outcome. Nineteen patients were available at a 10-year follow-up. The clinical examination included a detailed questionnaire and stress radiographs. Foot function was evaluated with plantar pressure distribution measurements during walking and peroneal reaction time measurements elicited on a rapidly tilting platform (recorded with surface electromyography). High subjective patient satisfaction was contrasted with a high rate of residual instability, pain, and swelling. The radiographs showed an increased number of exostoses. The gait analysis revealed reduced peak pressures under the lateral heel and increased values under the longitudinal arch. The reaction times of the peroneal muscles were shorter on the operated side (significant: peroneus longus). The persistent clinical problems as well as the functional changes indicate that the disturbed ankle joint kinematics permanently alter foot function and may subsequently support the development of arthrosis. Therefore, the Evans procedure should only be applied if anatomical reconstruction of the lateral ankle ligaments is not feasible. PMID:9429877

Rosenbaum, D; Becker, H P; Sterk, J; Gerngross, H; Claes, L



Recurrent plantar ulceration following pan metatarsal head resection.  


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

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


In-shoe plantar pressure measurement and analysis system based on fabric pressure sensing array  

Microsoft Academic Search

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

Lin Shu; Tao Hua; Yangyong Wang; Qiao Li; David Dagan Feng; Xiaoming Tao



Evaluación de la presión plantar en cinta rodante y suelo durante la marcha  

Microsoft Academic Search

The functional evaluation of plantar pressure is performed on the treadmill and on the ground. However, the differences in plantar pressure values between the treadmill versus normal walking on the ground have not been totally clarified. The aim of this study was to detect possible differences on plantar pressure induced by the treadmill with three different walking speeds (slow, mid

P. Salvador; F. García; M. Iranzo; P. Pérez-Soriano; S. Llana



Gender and walking speed effects on plantar pressure distribution for adults aged 20–60 years  

Microsoft Academic Search

This study investigates gender and walking speed (80%, 100%, 120% and 140% of preferred walking speed (PWS)) effects on plantar pressure parameters. In total, 30 healthy males and females, aged between 20 to 60 years, participated in this study. A plantar pressure measurement device was used to measure the peak pressure, peak force and contact area in six plantar zones.

Meng-Jung Chung; Mao-Jiun Wang



Physiological Achilles' heels of Enteropathogenic bacteria in livestock  

Microsoft Academic Search

An elaborate feeding regimen of animals, which takes advantage of the Achilles' heels of enteropathogenic bacteria, can possibly enable prophylaxis in the intestinal tract, attenuate actual disease symptoms, accelerate recovery from a bacterial gastroenteritis or ensure food safety. There is a wide spectrum of conceivable weak spots in bacteria. Some pathogenic bacteria cannot use certain compounds, or use them less

P. M. Becker



Deep peroneal nerve transfer for established plantar sensory loss.  


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

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



Palmar-Plantar Erythrodysesthesia Associated with Chemotherapy and Its Treatment  

PubMed Central

Palmar-plantar erythrodysesthesia (PPE), also called hand-foot syndrome, is a relatively common dermatologic toxic reaction associated with cytotoxic chemotherapy that can limit the use of such drugs. Definitive prevention and treatment strategies for PPE have not yet been established. We present a patient with recurrent ovarian cancer developing severe hand-foot syndrome after treatment with pegylated liposomal doxorubicin. A review of the relevant literature concerning pathophysiology, preventive measures and management of PPE is given. Electronic search was conducted using the Medline database for English-language records. The search terms used were ‘palmar-plantar erythrodysesthesia’, ‘hand-foot syndrome’, ‘pegylated liposomal doxorubicin’ and ‘acral erythema’.

Farr, Katherina Podlekareva; Safwat, Akmal



Skin-to-skin contact (Kangaroo Care) analgesia for preterm infant heel stick.  


The purpose of the study was to compare a heel stick conducted during Kangaroo Care (skin-to-skin contact) with the mother to a heel stick in a warmer in reducing premature infant physiologic and behavioral pain responses. Twenty-four premature infants in a university-based neonatal intensive care unit were recruited and randomized to 2 sequences: sequence A group received 3 hours of Kangaroo Care (with a heel stick in Kangaroo Care) followed by 3 hours in a warmer (with a heel stick in the warmer). Sequence B group had warmer care and a heel stick (in the warmer) before Kangaroo Care and a heel stick (in Kangaroo Care). Heart rate, respiratory rate, oxygen saturation, crying time, and behavioral state were measured before, during, and after heel stick. Repeated measures ANOVA and Mann Whitney U statistics were performed. Heart rate and length of crying in response to pain were significantly reduced during Kangaroo Care and the Kangaroo Care heel stick as compared to when infants were in the warmer and had a heel stick in the warmer. Three infants did not cry at all during the Kangaroo Care heel stick; infants slept more during Kangaroo Care than in the warmer. Kangaroo Care positioning before and during heel stick is a simple and inexpensive analgesic intervention to ameliorate pain in stable premature infants. PMID:16082239

Ludington-Hoe, Susan M; Hosseini, Robert; Torowicz, Deborah L


The influence of heel height on patellofemoral joint kinetics during walking.  


Although wearing high-heeled shoes has long been considered a risk factor for the development for patellofemoral pain (PFP) in women, patellofemoral joint kinetics during high-heeled gait has not been examined. The purpose of this study was to determine if heel height increases patellofemoral joint loading during walking. Eleven healthy women (mean age 25.0±3.1 yrs) participated. Lower extremity kinematics and kinetics were obtained under 3 different shoe conditions: low heel (1.27 cm), medium heel (6.35 cm), and high heel (9.53 cm). Patellofemoral joint stress was estimated using a previously described biomechanical model. Model outputs included patellofemoral joint reaction force, patellofemoral joint stress and utilized contact area as a function of the gait cycle. One-way ANOVAs with repeated measures were used to compare the model outputs and knee joint angles among the 3 shoe conditions. Peak patellofemoral joint stress was found to increase significantly (p=0.002) with increasing heel height (low heel: 1.9±0.7 MPa, medium heel: 2.6±1.2 MPa, and high heel: 3.6±1.5 MPa). The increased patellofemoral joint stress was mainly driven by an increase in joint reaction force owing to higher knee extensor moments and knee flexion angles. Our findings support the premise that wearing high-heeled shoes may be a contributing factor with respect to the development of PFP. PMID:22520457

Ho, Kai-Yu; Blanchette, Mark G; Powers, Christopher M



Dynamic plantar pressure distribution measurements in hemiparetic patients  

Microsoft Academic Search

Objective. A comparison of plantar pressure distribution of hemiparetic patients with a control group was performed to determine quantitative, objective and reproducible criteria for better assessment of hemiparetic gait.Design. This empirical, descriptive study used a clinical sample of 18 hemiparetic patients and compared the data to previously published data from 111 healthy persons.Background. Several biomechanical methods have been used in

S Meyring; RR Diehl; TL Milani; EM Hennig; P Berlit



Nordic Walking Practice Might Improve Plantar Pressure Distribution  

ERIC Educational Resources Information Center

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…

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



Nordic Walking Practice Might Improve Plantar Pressure Distribution  

ERIC Educational Resources Information Center

|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…

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



Heel height affects lower extremity frontal plane joint moments during walking.  


Wearing high heels alters walking kinematics and kinetics and can create potentially adverse effects on the body. Our purpose was to determine how heel height affects frontal plane joint moments at the hip, knee, and ankle, with a specific focus on the knee moment due to its importance in joint loading and knee osteoarthritis. 15 women completed overground walking using three different heel heights (1, 5, and 9 cm) for fixed speed (1.3 ms(-1)) and preferred speed conditions while kinematic and force platform data were collected concurrently. For both fixed and preferred speeds, peak internal knee abduction moment increased systematically as heel height increased (fixed: 0.46, 0.48, 0.55 N m kg(-1); preferred: 0.47, 0.49, 0.53 N m kg(-1)). Heel height effects on net frontal plane moments of the hip and ankle were similar to those for the knee; peak joint moments increased as heel height increased. The higher peak internal knee abduction moment with increasing heel height suggests greater medial loading at the knee. Kinetic changes at the ankle with increasing heel height may also contribute to larger medial loads at the knee. Overall, wearing high heels, particularly those with higher heel heights, may put individuals at greater risk for joint degeneration and developing medial compartment knee osteoarthritis. PMID:22169388

Barkema, Danielle D; Derrick, Timothy R; Martin, Philip E



Differentiation of Heel Pain from Other Hoof Pain in Horses  

Microsoft Academic Search

Sardari, K, Kazemi, H. and Seifi, H. 2005. Differentiation of heel pain from other hoof pain in horses. J. Appl. Amm. Sci., 28: 133–135.Thirty-four horses with forelimb lameness referable to the hoof based on their response to the palmar digital nerves analgesia were divided into 2 groups based on their response to distal interphalangeal joint analgesic injection and hoof tester

K. Sardari; H. Kazemi; H. Seifi



Constitutive formulation and analysis of heel pad tissues mechanics.  


This paper presents a visco-hyperelastic constitutive model developed to describe the biomechanical response of heel pad tissues. The model takes into account the typical features of the mechanical response such as large displacement, strain phenomena, and non-linear elasticity together with time-dependent effects. The constitutive model was formulated, starting from the analysis of the complex structural and micro-structural configuration of the tissues, to evaluate the relationship between tissue histology and mechanical properties. To define the constitutive model, experimental data from mechanical tests were analyzed. To obtain information about the mechanical response of the tissue so that the constitutive parameters could be established, data from both in vitro and in vivo tests were investigated. Specifically, the first evaluation of the constitutive parameters was performed by a coupled deterministic and stochastic optimization method, accounting for data from in vitro tests. The comparison of constitutive model results and experimental data confirmed the model's capability to describe the compression behaviour of the heel pad tissues, regarding both constant strain rate and stress relaxation tests. Based on the data from additional experimental tests, some of the constitutive parameters were modified in order to interpret the in vivo mechanical response of the heel pad tissues. This approach made it possible to interpret the actual mechanical function of the tissues. PMID:20304698

Natali, A N; Fontanella, C G; Carniel, E L



Heel blood sampling in European neonatal intensive care units: compliance with pain management guidelines  

Microsoft Academic Search

ObjectiveTo describe the use of heel blood sampling and non-pharmacological analgesia in a large representative sample of neonatal intensive care units (NICUs) in eight European countries, and compare their self-reported practices with evidence-based recommendations.MethodsInformation on use of heel blood sampling and associated procedures (oral sweet solutions, non-nutritive sucking, swaddling or positioning, topical anaesthetics and heel warming) were collected through a

Valentina Losacco; Marina Cuttini; Gorm Greisen; Dominique Haumont; Carmen R Pallás-Alonso; Veronique Pierrat; Inga Warren; Bert J Smit; Björn Westrup



Minimally invasive surgery for diabetic plantar foot ulcerations  

PubMed Central

Complications of diabetes mellitus constitute the most common indications for hospitalization and non-traumatic amputations in the USA. The most important risk factors for the development of diabetic foot ulcerations include the presence of peripheral neuropathy, vasculopathy, limited joint mobility, and pre-existing foot deformities. In our study, 500 diabetic patients treated for plantar forefoot ulcerations were enrolled in a prospective study from 2000 to 2008 at the Federal University of São Paulo, Brazil. Fifty-two patients in the study met the criteria and underwent surgical treatment consisting of percutaneous Achilles tendon lengthening to treat plantar forefoot ulcerations. The postoperative follow-up demonstrated prevention of recurrent foot ulcerations in 92% of these diabetic patients that maintained an improved foot function. In conclusion, our study supports that identification and treatment of ankle equinus in the diabetic population may potentially lead to decreased patient morbidity, including reduced risk for both reulceration, and potential lower extremity amputation.

Batista, Fabio; Magalhaes, Antonio Augusto; Nery, Caio; Baumfeld, Daniel; Monteiro, Augusto Cesar; Batista, Fabiola



Nordic walking practice might improve plantar pressure distribution.  


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 and 20% faster), and under two walking conditions (NW vs. normal walking). In comparison to normal walking, NW experience led to a significant (p < .05) pressure reduction of about 50% on the central metatarsals. No significant increases were detected in other foot regions. The differences between experienced and beginners during normal walking including a 40% pressure reduction on the metatarsal area, suggests that regular NW practice might also have a beneficial effect on plantar pressure when walking without poles. PMID:22276400

Pérez-Soriano, Pedro; Llana-Belloch, Salvador; Martínez-Nova, Alfonso; Morey-Klapsing, G; Encarnación-Martínez, Alberto



The Accuracy of an Automasking Algorithm in Plantar Pressure Measurements  

PubMed Central

Masking algorithms provide a way to analyze plantar pressure parameters based on distinct anatomical regions of the foot. No study has addressed their accuracy. The purpose of this study was to determine the accuracy of the Novel® ten-region standard masking algorithm in both dynamic and static measurements in normal feet. Static and dynamic plantar pressure measurements were collected from ten normal subjects (20 ft) with and without 10-mm radiopaque markers placed under the first through fifth metatarsal heads, fifth metatarsal base, and first proximal phalanx. The automask was then applied to subdivide the foot into distinct anatomical areas. Weight-bearing AP radiographs were obtained with and without markers. Plantar pressures and radiographs were overlaid. The percent accuracy of each marker within its appropriate mask region was calculated. The average accuracies of the automasking algorithm regions for dynamic and static measurements, respectively, were 98.8% and 90.4% (1MH), 89.9% and 80.6% (2MH), 98.6% and 81.4% (3MH), 96.8% and 82.3% (4MH), 93.1% and 80.8% (5MH), 97.3% and 92.5% (5MB), and 91.2% and 64.2% (1PPH). Marker presence did not alter foot structure or function as determined by intermetatarsal angles (range, p?=?0.361 to p?=?0.649) and the center of pressure excursion index (p?=?0.727), respectively. The automasking algorithm accurately identifies most foot regions in normal feet, particularly in gait. Such accuracy may be reduced in the setting of foot deformity. Understanding the accuracy of masking algorithms may help guide the interpretation of plantar pressure measurements and ultimately both conservative and operative treatment decisions.

Stoecklein, Hill; Yu, Joseph C.; Syrkin, Grisha; Hillstrom, Howard; Deland, Jonathan T.



Hammertoe surgery: arthroplasty, arthrodesis or plantar plate repair?  


In cases of painful complex hammertoe deformity, there is no single approach that can be used in all circumstances. If conservative care fails, surgical management may include interphalangeal joint arthroplasty, arthrodesis, and/or plantar plate repair. The best and most pragmatic surgical plan must be patient-centered, taking the age, activity level, expectations of the patient, and precise etiology of the hammertoe deformity into account. PMID:22727377

Kernbach, Klaus J



Characteristic Plantar Pressure Distribution Patterns During Soccer-Specific Movements  

Microsoft Academic Search

Purpose: To characterize in-shoe pressure measurements during different soccer-specific maneuvers on two playing surfaces to identify the main loading areas of the foot.Methods: Twenty-one experienced male soccer players participated in the study (25.5 ± 1.8 years, 78.7 ± 5.4 kg, and 182.9 ± 5.7 cm). The Pedar Mobile system was used to collect plantar pressure information inside the soccer shoe.

Eric Eils; Markus Streyl; Stefan Linnenbecker; Lothar Thorwesten; Klaus Völker; Dieter Rosenbaum



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

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



Hybrid toe and heel joints for biped\\/humanoid robots for natural gait  

Microsoft Academic Search

A biped\\/humanoid robot with toe and heel joints is capable of more natural locomotion due to the additional degrees of freedom available. Though passive spring loaded joints can help to some extent, they introduce constraints between the joint torque and the joint angular displacement. In this paper, we propose to use hybrid active\\/passive toe and heel joints in order to

R Prasanth KumarI; Nandha Handharu; Jungwon Yoon; Gap-soon Kim



Comparison of sucrose, expressed breast milk, and breast-feeding on the neonatal response to heel prick  

Microsoft Academic Search

Newborns endure many heel pricks and other uncomfortable procedures during their first hospital stay. The aim of this study was to investigate the effectiveness of breast-feeding in reducing pain in newborns undergoing heel prick tests. One hundred thirty healthy term infants requiring a heel prick blood sampling for the Guthrie test were studied. Infants were randomly allocated to 1 of

Hülya Bilgen; Eren Özek; Dil?at Cebeci; Rahmi Örs



Influence of Different Designs of High-Heeled Shoes on Kinematics, Kinetics, and Muscle EMG of Female Gait  

Microsoft Academic Search

Many studies have investigated the differences in gait patterns with increasing heel height. The purpose of this investigation is to study the differences in gait patterns when wearing stiletto and wedge type high-heeled shoes with different heel designs versus barefoot walking. A Vicon 512 Motion Analysis system and four Kistler force plates were used to record changes in lower-extremity joint

Deger Ozkaramanli



Effect of high-heeled shoes on the parameters of body posture.  


Study Design: The study group consisted of 90 young, healthy women, aged 20 - 25 years. Three types of measurements were conducted for each woman: without shoes, with 4 cm heels, and with 10 cm heels.Objective: The aim of this study was to assess the impact of high-heeled shoes on chosen parameters characterizing body posture.Summary of Background Data: For a long time, high-heeled shoes have been an attribute of femininity. Currently, there is an increasing amount of research being published investigating the effect of high-heeled shoes on selected biomechanical parameters.Methods: The study employed a photogrammetric method, based on the chamber projection and Moiré phenomenon. The study was performed using pre-designated points of anthropometric measures. We used 19 photogrammetric parameters characterizing body posture.Results: Results of the measurements showed no significant differences using the significance level p < 0.05 between the measurements taken with no shoes, with 4 cm high-heeled shoes, and with 10 cm high-heeled shoes. Statistically significant results were obtained only for the ATB (angle of trunk bend) parameter. The value of the p coefficient in the Kruskal-Wallis ANOVA test for the ATB parameter was p = 0.0140. Analysis based on the multiple comparison test indicated differences between the group wearing no shoes, and those wearing 4 cm heels (p = 0.0226), and between the group wearing no shoes and the group wearing 10 cm heels (p = 0.0459).Conclusion: High-heeled shoes increased the forward inclination of the trunk. This paper shows that there are only certain trends for some parameters that require further scientific investigation. PMID:24042722

Drza?-Grabiec, Justyna; Snela, S?awomir



Restoration of the plantar fat pad with autolipotransplantation.  


Atrophied fat pads may be replaced or supplemented with autolipotransplantation. The author reviews the history, theory, uses, and techniques for the adaptation of a cosmetic procedure to a therapeutic procedure for the foot. The first 50 patients are reviewed subjectively in this paper. All 50 patients were asymptomatic after the surgery. Forty-eight patients had a subjective feeling of an increased fat pad on the plantar surface of their foot. One patient had initial improvement but required additional transfers 6 months after surgery. PMID:7951190

Chairman, E L


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

ERIC Educational Resources Information Center

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

Vidmar, Gaj; Novak, Primoz



Epidermal Thickness and Biomechanical Properties of Plantar Tissues in Diabetic Foot  

Microsoft Academic Search

Diabetic foot is a common complication for people with diabetes but it is unclear whether the change is initiated from the skin surface or underneath plantar tissues. This study compared the thickness of epidermis and the thickness and stiffness of the total plantar soft tissue among people with diabetes with or without complications. Seventy-two people with diabetes, including 22 people

Clare Y. L. Chao; Yong-Ping Zheng; Gladys L. Y. Cheing



The reduction and redistribution of plantar pressures using foot orthoses in diabetic patients  

Microsoft Academic Search

High pressures on the soles of the feet of diabetic patients cause plantar ulcerations, and reduction of this pressure is important in the treatment and prevention of such ulcers. The effects of foot orthoses on the distribution of plantar pressures were investigated using a pressure-sensitive insole containing 960 sensor elements in seven diabetic patients (13 feet) with diabetic ulcers or

H. Kato; T. Takada; T. Kawamura; N. Hotta; S. Torii



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

ERIC Educational Resources Information Center

|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

Vidmar, Gaj; Novak, Primoz



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


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

Kirkland, Paul; Beeson, Paul


Assessment of the diabetic foot using spiral computed tomography imaging and plantar pressure measurements: A technical report  

Microsoft Academic Search

Persons with diabetes mellitus (DM) and peripheral neuropathy are at high risk forskinbreakdown due to unnoticed excessive pressures to the plantar foot during walking . We developed methods that combined spiral x-ray computed tomography (SXCT) imaging and plantar pressure analysis to quantify internal foot structure and external pressure during plantar loading . Methods were tested using a subject with DM

Kirk E. Smith; Paul K. Commean; Michael J. Mueller; Douglas D. Robertson; Thomas Pilgram; Jeffrey Johnson


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


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

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



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

PubMed Central

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.

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



Trypanosome resistance to human innate immunity: targeting Achilles' heel.  


Trypanosome lytic factors (TLFs) are powerful, naturally occurring toxins in humans that provide sterile protection against infection by several African trypanosomes. These trypanocidal complexes predominantly enter the parasite by binding to the trypanosome haptoglobin/hemoglobin receptor (HpHbR), trafficking to the lysosome, causing membrane damage and, ultimately, cell lysis. Despite TLF-mediated immunity, the parasites that cause human African Trypanosomiasis (HAT), Trypanosoma brucei rhodesiense and Trypanosoma brucei gambiense, have developed independent mechanisms of resistance to TLF killing. In this review we describe the parasite defenses that allow trypanosome infections of humans and discuss how targeting these apparent strengths of the parasite may reveal their Achilles' heel, leading to new approaches in the treatment of HAT. PMID:23059119

Stephens, Natalie A; Kieft, Rudo; Macleod, Annette; Hajduk, Stephen L



Treatment of a heel blister caused by pressure and friction.  


The treatment of heel blisters caused by pressure, friction, and shear is a complex subject. Issues such as whether to aspirate the blister, how to protect it from further pressure, friction, and shear, and which dressing to choose, need to be considered. As nurses are increasingly aware of the emphasis that has been placed on the importance of ensuring that clinical practice is based on evidence, this article attempts to shed some light on these areas of debate. It is important to highlight that during the literature search very little research was found to exist on blister care and it became clear that further research into the nursing care of a blister caused by pressure would be useful to aid nursing care and patient comfort. PMID:12170479

Read, S


Internal strain estimation for quantification of human heel pad elastic modulus: A phantom study.  


Shock absorption is the most important function of the human heel pad. However, changes in heel pad elasticity, as seen in e.g. long-distance runners, diabetes patients, and victims of Falanga torture are affecting this function, often in a painful manner. Assessment of heel pad elasticity is usually based on one or a few strain measurements obtained by an external load-deformation system. The aim of this study was to develop a technique for quantitative measurements of heel pad elastic modulus based on several internal strain measures from within the heel pad by use of ultrasound images. Nine heel phantoms were manufactured featuring a combination of three heel pad stiffnesses and three heel pad thicknesses to model the normal human variation. Each phantom was tested in an indentation system comprising a 7MHz linear array ultrasound transducer, working as the indentor, and a connected load cell. Load-compression data and ultrasound B-mode images were simultaneously acquired in 19 compression steps of 0.1mm each. The internal tissue displacement was for each step calculated by a phase-based cross-correlation technique and internal strain maps were derived from these displacement maps. Elastic moduli were found from the resulting stress-strain curves. The elastic moduli made it possible to distinguish eight of nine phantoms from each other according to the manufactured stiffness and showed very little dependence of the thickness. Mean elastic moduli for the three soft, the three medium, and the three hard phantoms were 89kPa, 153kPa, and 168kPa, respectively. The combination of ultrasound images and force measurements provided an effective way of assessing the elastic properties of the heel pad due to the internal strain estimation. PMID:23079052

Holst, Karen; Liebgott, Hervé; Wilhjelm, Jens E; Nikolov, Svetoslav; Torp-Pedersen, Søren T; Delachartre, Philippe; Jensen, Jørgen A



Heel pain due to psoriatic arthritis in a 50 year old recreational male athlete: case report  

PubMed Central

Heel pain is a common presentation in a sports injury practice, with a list of common differentials including achilles tendinopathy and retrocalcaneal bursitis. However, seronegative arthritis can also cause enthesopathies that produce heel pain and should be considered in a differential diagnosis list. In this case, a 50 year old recreationally active male presented with non-traumatic insidious heel pain and without history of any skin conditions or any other symptoms of seronegative spondyloarthritis. Clinical suspicion led to laboratory testing and radiographs/bone scan which yielded the diagnosis of psoriatic arthritis.

Yedon, Dominique Forand; Howitt, Scott



Medial patellar taping changes the peak plantar force location and timing of female basketball players.  


Subtle changes in patellofemoral joint biomechanics may influence lower extremity function. The McConnell method of patellar taping has become an increasingly popular method of managing patients with various patellofemoral joint disorders. The purpose of this order effect controlled study was to assess medial patellar taping (McConnell Method) for changes in peak plantar force location and timing while running and dribbling a basketball prior to the performance of a basketball lay-up. Sixteen non-impaired, right hand dominant members of a female junior varsity basketball team (age=14.6 +/- 2 years) participated in this study. Subject bodyweight and height were 607.8 +/- 99 N and 1.67 +/- 0.10 m, respectively. All data were collected from the preferred stance limb. A series of two way analysis of variance (ANOVA) (condition, trial) were used to determine statistical significance (P < or = 0.05). During medial patellar taping, subjects displayed a more forefoot directed peak plantar force location 89.9 +/- 18 versus 81.3 +/- 21 mm and delayed peak plantar force onset 141 +/ - 23 versus 130 +/- 29 ms following initial ground contact. Medial-lateral peak plantar force location and peak plantar force magnitude did not differ between conditions, however, medial-lateral peak plantar force location displayed significant trial sequence influences with the latter trials displaying more lateral center of plantar force locations (30.4 +/- 2 vs. 32.5 +/- 3 mm). The results of this study suggest that medial patellar taping influences distal lower extremity function by shifting peak plantar force location toward the forefoot, and delaying its onset. These changes with consideration for known synergistic ankle plantar flexor-subtalar joint invertor and knee extensor function during weight bearing suggest the presence of increased muscular stiffness acting through a more rigid foot to improve the impact force attenuating capability of the lower extremity. PMID:11869908

Nyland, J A; Ullery, L R; Caborn, David N M



Lateral plantar artery bypass grafting: defining the limits of foot revascularization.  


We placed 20 bypass grafts to the lateral plantar artery in 18 extremities to salvage feet with wet (12) or dry (six) gangrene; 15 grafts were implanted in men (75%), and five were implanted in women (25%). The median age was 65 years. All except two patients had diabetes; eight were treated with insulin. One patient had Buerger's disease, and another had vasculitis with chronic lymphocytic leukemia. History of smoking (65%), hypertension (53%), heart disease (71%), and osteomyelitis in the foot (35%), were noted. Cultures were positive in 15 gangrenous feet, 11 with gram-negative bacilli. Four long femoroplantar bypasses were placed. Ten short grafts were placed from the popliteal artery, and six jump grafts were placed distal to a femoropopliteal or tibial bypass. Hospital stay ranged from 8 to 38 days (median 16 days), and there were two in-hospital deaths. Transmetatarsal or button toe amputations were performed in nine feet. There were two below-knee amputations, one with a patent graft, for a foot salvage rate of 89% at 2 months. In four instances the gangrenous ulcers took longer than 6 months to heal; all other wounds healed within 6 months. The primary and secondary patency rates were 85% at 1 month, and 73% at 3 months and thereafter. Four of five graft failures occurred in the two legs with repeat bypass graftings. All patients with successful revascularization are able to walk, and seven returned to work full time. PMID:2810537

Andros, G; Harris, R W; Salles-Cunha, S X; Dulawa, L B; Oblath, R W



Heel lance in newborn during breastfeeding: an evaluation of analgesic effect of this procedure  

Microsoft Academic Search

OBJECTIVES: The reduction of pain due to routine invasive procedures (capillary heel stick blood sampling for neonatal metabolic screening) in the newborn is an important objective for the so-called \\

Elena Uga; Manuela Candriella; Antonella Perino; Viviana Alloni; Giuseppina Angilella; Michela Trada; Anna Maria Ziliotto; Maura Barbara Rossi; Danila Tozzini; Clelia Tripaldi; Michela Vaglio; Luigina Grossi; Michaela Allen; Sandro Provera



[Palmar and plantar keloid in a black African male].  


The keloid scar is a fibrous skin tumor, intradermal, and exuberant. It is commonly found on the glabrous skin. The keloid of the palms and soles are rare. Small series are reported in English literature. The authors report a case of large keloids located on both palms and soles, within a context of keloid disease, in a man of 37 years. On the left hand, the keloid scar caused a partial syndactyly IV-V. Large keloid tumors occupied the inner edge and, weight-bearing areas of both feet. These tumors rendered wearing of shoes impossible and interfered with walking. The treatment consisted of total excision of palmar and plantar keloid tumors. The residual defects were covered by a total skin graft taken from the suprapubic region. The results were satisfactory aesthetically, functionally and psychosocially. PMID:22980992

Kossoko, H; Allah, K C; Assi Djè Bi Djè, V; Yéo, S; Koffi, K E; Richard Kadio, M



Liquid Silicone to Mitigate Plantar Pedal Pressure: A Literature Review  

PubMed Central

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.

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



Extracorporal shock wave therapy in patients with tennis elbow and painful heel  

Microsoft Academic Search

The aim of this study was to evaluate the effect of extracorporal shock wave therapy (ESWT) in tennis elbow and painful heel.\\u000a Nineteen patients with tennis elbow and 44 patients with painful heel in which conservative treatment had failed underwent\\u000a ESWT. Both groups received 3000 shock waves of 0.12 mJ\\/mm2 three times at weekly intervals. After a follow-up of 5

Dietrich S. Hammer; Stefan Rupp; Stefan Ensslin; Dieter Kohn; Romain Seil



Knee Stretch Walking Method for Biped Robot: Using Toe and Heel Joints to Increase Walking Strides  

NASA Astrophysics Data System (ADS)

This paper proposes a knee stretch walking method for biped robots; the method involves the use of the toes and heel joints to increase walking strides. A knee can be stretched by switching control variables. By a knee stretch walking with heel contacts to the ground and toe takeoffs from the ground, biped robots can increase their walking stride and speed. The validity of the proposed method is confirmed by simulation and experimental results.

Sato, Takahiko; Shimmyo, Shuhei; Nakazato, Miki; Mikami, Kei; Sato, Tomoya; Sakaino, Sho; Ohnishi, Kouhei


Off-the-shelf in-shoe heel inserts: does cost matter?  

Microsoft Academic Search

Objective:A growing exercise culture has lead to an increase in the use of off-the-shelf heel inserts. While there are a variety of designs in a spectrum of cost ranges, probably the ease of availability and cost would mainly determine the choice of purchase. This study was designed to determine whether expensive designs provide better pressure attenuation under the heel than

A K Ramanathan; M C John; G P Arnold; L A Cochrane; R J Abboud



Heel pain due to retrocalcaneal bursitis-radiographic diagnosis (with an historical footnote on Sever's disease)  

Microsoft Academic Search

Retrocalcaneal bursitis is a distinct condition causing posterior heel pain in active, healthy children. It appears to result\\u000a from post-traumatic inflammation of the soft tissues of the posterior heel, and is unrelated to avascular necrosis of the\\u000a calcaneal apophysis. The diagnosis may be confirmed radiographically by the loss of the lucent retrocalcaneal recess, with\\u000a a normal Achilles tendon and superficial

M. A. Heneghan; T. Wallace



Foot-Ankle RollOver Characteristics in Different Heel Heights during Walking  

Microsoft Academic Search

In this study, a feasibility study was performed for biomechanical applications of foot-ankle roll-over characteristics in different heel height shoes during walking. Five nondisabled female volunteers were participated in gait experiments, wearing four pairs of shoes with different heel heights. Roll-over shapes of the foot-ankle systems were obtained using trajectories of ankle, knee and the center of pressure between initial

H. S. Choi; H. L. Park; Y. H. Kim



Influence of Plantar Insensitive for Human Gait in Regular and Irregular Terrain  

Microsoft Academic Search

\\u000a The aim of this study was to investigate an influence of the plantar tactile sensibility during walking on regular and irregular\\u000a terrain. Subjects were 8 healthy men (21.9 ±0.8 years old). In addition, we adopted an ice immersion to make plantar insensitive,\\u000a and compared with normal (not iced) condition. In these experiments, the subjects soaked their soles to the ice

Shinichiro Suzuki; Akira Chaki; Kentaro Sekiguchi; Hiroshi Takemura; Hiroshi Mizoguchi


Plantar pressure distribution in normal, hallux valgus and hallux limitus feet  

Microsoft Academic Search

Selected dynamic plantar pressure measurements of 30 control, 30 hallux valgus and 30 hallux limitus subjects, using an EMED-SF system and a two-step method of data collection, were analysed for significant differences, with a one-way analysis of variance being performed with P<0.05. In comparison to normal control subjects, those with hallux valgus feet demonstrated significant medial plantar peak and mean

A. Bryant; P. Tinley; K. Singer



The real risks of steroid injection for plantar fasciitis, with a review of conservative therapies  

Microsoft Academic Search

This article presents a review of conservative therapies for plantar fasciitis pain reduction with a discussion of steroid\\u000a therapy risks. The therapies reviewed include orthoses, stretching, extracorporeal shockwave, BTX-A, and corticosteroid injection\\/iontophoresis.\\u000a These modes were included based on the availability of double blinded randomized controlled trials. We noted the following\\u000a findings. Orthoses, regardless of type, can improve pain levels. Plantar

Yusuf Ziya Tatli; Sameer Kapasi



Ankle Bracing, Plantar-Flexion Angle, and Ankle Muscle Latencies During Inversion Stress in Healthy Participants  

PubMed Central

Context: Ankle braces may enhance ankle joint proprioception, which in turn may affect reflexive ankle muscle activity during a perturbation. Despite the common occurrence of plantar-flexion inversion ankle injuries, authors of previous studies of ankle muscle latencies have focused on inversion stresses only. Objective: To examine the latency of the peroneus longus (PL), peroneus brevis (PB), and tibialis anterior (TA) muscles in response to various degrees of combined plantar-flexion and inversion stresses in braced and unbraced asymptomatic ankles. Design: Repeated measures. Setting: University biomechanics laboratory. Patients or Other Participants: Twenty-eight healthy females and 12 healthy males (n = 40: mean age = 23.63 years, range = 19 to 30 years; height = 172.75 ± 7.96 cm; mass = 65.53 ± 12.0 kg). Intervention(s): Participants were tested under 2 conditions: wearing and not wearing an Active Ankle T1 brace while dropping from a custom-made platform into 10°, 20°, and 30° of plantar flexion and 30° of inversion. Main Outcome Measure(s): The time between platform drop and the onset of PL, PB, and TA electromyographic activity was measured to determine latencies. We calculated a series of 2-way analyses of variance to determine if latencies were different between the conditions (braced and unbraced) and among the plantar-flexion angles (? = .05). Results: No interaction was found between condition and plantar-flexion angle. No significant main effects were found for condition or plantar-flexion angle. Overall means for braced and unbraced conditions were not significantly different for each muscle tested. Overall means for angle for the PL, PB, and TA were not significantly different. Conclusions: Reflexive activity of the PL, PB, or TA was unaffected by the amount of plantar flexion or by wearing an Active Ankle T1 brace during an unanticipated plantar-flexion inversion perturbation.

Kernozek, Thomas; Durall, Christopher J; Friske, Allison; Mussallem, Matthew



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

PubMed Central

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.

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



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

NASA Astrophysics Data System (ADS)

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.

Sneyd, A. D.; Sugimoto, T.



The effects of orthotic heel lifts on Achilles tendon force and strain during running.  


This study assessed the effects of orthotic heel lifts on Achilles tendon (AT) force and strain during running. Ten females ran barefoot over a force plate in three conditions: no heel lifts (NHL), with 12 mm heel lifts (12HL) and with 18 mm heel lifts (18HL). Kinematics for the right lower limb were collected (200 Hz). AT force was calculated from inverse dynamics. AT strain was determined from kinematics and ultrasound images of medial gastrocnemius (50 Hz). Peak AT strain was less for 18HL (5.5 ± 4.4%) than for NHL (7.4 ± 4.2%) (p = .029, effect size [ES] = 0.44) but not for 12HL (5.8 ± 4.8%) versus NHL (ES = 0.35). Peak AT force was significantly (p = .024, ES = 0.42) less for 18HL (2382 ± 717 N) than for NHL (2710 ± 830 N) but not for 12HL (2538 ± 823 N, ES = 0.21). The 18HL reduced ankle dorsiflexion but not flexion-extension ankle moments and increased the AT moment arm compared with NHL. Thus, 18HL reduced force and strain on the AT during running via a reduction in dorsiflexion, which lengthened the AT moment arm. Therefore, heel lifts could be used to reduce AT loading and strain during the rehabilitation of AT injuries. PMID:22695168

Farris, Dominic James; Buckeridge, Erica; Trewartha, Grant; McGuigan, Miranda Polly



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

PubMed Central

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.

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



Plantar fasciitis - to jab or to support? A systematic review of the current best evidence  

PubMed Central

Background: Plantar fasciitis is a common condition routinely managed by podiatrists in the community and is widely treated conservatively. Two commonly used treatments for plantar fasciitis are customized functional foot orthoses and corticosteroid injections. While common to clinical practice, the evidence base underpinning these treatment strategies is unknown. Therefore, the aim of this systematic review was to assess the effectiveness and safety of customized functional foot orthoses and corticosteroid injections in the treatment of plantar fasciitis. Methods: A systematic literature search was conducted. Experimental studies, in English, from 1998 to 2010 were accepted for inclusion in this review. The PEDro quality assessment tool and the National Health and Medical Research Council’s hierarchy of evidence were used to assess the quality of the included studies. Results: Six randomized controlled trials which met the selection criteria were included in this review. Four reported on customized functional foot orthoses and 2 on corticosteroid injections. Current best available evidence highlights that both customized functional foot orthoses and corticosteroid injections can lead to a decrease in pain associated with plantar fasciitis. Additionally, customized functional foot orthoses may also provide an additional benefit in terms of increased functional ability in patients with plantar fasciitis. Corticosteroid injections may have side effects, especially pain (from the injection). Conclusion: Both customized functional foot orthoses and corticosteroid injections can lead to reduction in pain associated with plantar fasciitis. While customized functional foot orthoses may increase the functional outcomes in patients with plantar fasciitis, corticosteroid injections may have side effects (especially pain as a result of the injection), which may limit its acceptability.

Uden, Hayley; Boesch, Eva; Kumar, Saravana



The effect of heel height on gait and posture: a review of the literature.  


This article explores relevant full-text literature to reveal the effects of heel height on gait and posture and the kinetics and kinematics of the foot, ankle, knee, hip, and spine. Furthermore, special attention will be given to the implications of increased heel height for clinicians treating locomotor disorders and provide information to aid clinical decision making. Full-text articles accessed from databases including AMED, ASSIA, Blackwell Synergy, BNI, Voyager, CINAHL, ScienceDirect, and Taylor Francis inform the review. PMID:19917737

Cowley, Emma E; Chevalier, Thierry L; Chockalingam, Nachiappan


Modification of the syme amputation to prevent postoperative heel pad migration.  


The Syme amputation (ankle disarticulation level amputation) can be a valuable procedure for properly selected patients but might be underused owing to the problem of postoperative migration of the heel pad cushion. The present report presents a modification of the Syme amputation technique to prevent postoperative heel pad migration. The technique was performed in 12 patients, most of whom were male patients with diabetic foot infections. At an average follow-up of 7 years, the soft tissue cushion remained in a stable position, without ulceration. Also, patient satisfaction was high with the Syme level of amputation using the modified technique. PMID:24021266

Bibbo, Christopher



Kinematics and kinetics of the lower extremities of young and elder women during stairs ascent while wearing low and high-heeled shoes  

Microsoft Academic Search

The effect of the heel height on the temporal, kinematic and kinetic parameters was investigated in 16 young and 11 elderly females. Kinematic and kinetic data were collected when the subjects ascended stairs with their preferred speed in two conditions: wearing low-heeled shoes (LHS), and high-heeled shoes (HHS). The younger adults showed more adjustments in forces and moments at the

Bih-Jen Hsue; Fong-Chin Su



Calcaneal osteomyelitis following steroid injection for plantar fasciitis: a case report.  


This study reports a case of a 57-year-old woman diabetic patient who presented to the authors' institution with signs and symptoms typical of plantar fasciitis. Her condition did not resolve with nonsteroidal anti-inflammatory drug therapy, podiatry, and physiotherapy input and she was given a steroid injection for treatment of plantar fasciitis. She was admitted to the hospital 17 days following injection with signs of acute infection. Diagnostic workup revealed an acute calcaneal osteomyelitis. Infection did not respond to conservative treatment and the patient required a partial calcanectomy. This case highlights the significant risk of steroid injection in plantar fasciitis, especially in diabetic patient. The authors urge surgeons to consider this when obtaining consent for injection and they advise very close follow-up of such patients. PMID:22732240

Wronka, Konrad Sebastian; Sinha, Amit



Plantar warts treated with an immune response modifier: a report of two cases.  


Viral warts are the most common disease of the skin and are caused by human papillomavirus (HPV). Plantar warts, a manifestation of infection by HPV-1, -2 and -4, tend to be smoother and flatter than common warts and can also be painful when pressure is applied. A variety of local treatments, including topical salicyclic acid, cryotherapy, topical 5-fluorouracil, intralesional interferons and photodynamic therapy, are available to treat plantar warts. Here we report two cases of plantar warts, which had been previously treated without success. Total clearance of the warts was observed in both cases after treatment with imiquimod 5% cream over a period of 12 weeks. No evidence of local skin reactions was observed in either case during the treatment period. Recurrent lesions were not evident in the follow-up period for each patient. PMID:14616815

Zamiri, M; Gupta, G



The distribution of plantar pressures in American Indians with diabetes mellitus.  


The primary purpose of this study was to determine the magnitude and duration of plantar pressures acting on the feet of American Indians with diabetes mellitus. A secondary purpose was to determine whether differences in the range of motion of the ankle and first metatarsophalangeal joints existed between American Indians with and without diabetes. Three groups of American Indian subjects were tested: a control group (n = 20); a group with diabetes but no peripheral neuropathy (n = 24); and a group with diabetes and peripheral neuropathy (n = 21). A floor-mounted pressure sensor platform was used to collect plantar pressure data while subjects walked barefoot. The results indicated that American Indians with diabetes have 1) a pattern of peak plantar pressure similar to patterns previously reported for non-American Indians with diabetes and 2) a reduction in ankle and first metatarsophalangeal joint range of motion in comparison with nondiabetic American Indians. PMID:11420345

McPoil, T G; Yamada, W; Smith, W; Cornwall, M



Effects of fatiguing isometric exercise upon achilles tendon reflex and plantar flexion reaction time components in man  

Microsoft Academic Search

Effects of three different fatiguing local muscular exercises upon plantar flexion reaction time and achilles tendon reflex time have been studied in 24 normal males. The Exercise Conditions, each involving a series of 30 maximal voluntary isometric contractions (MVC) of the plantar flexors, differed by allowing either 5, 10 or 20 sec rest interval between each MVC. Decrements in strength

Keith C. Hayes



Testing the proficiency to distinguish locations with elevated plantar pressure within and between professional groups of foot therapists  

Microsoft Academic Search

BACKGROUND: Identification of locations with elevated plantar pressures is important in daily foot care for patients with rheumatoid arthritis, metatarsalgia and diabetes. The purpose of the present study was to evaluate the proficiency of podiatrists, pedorthists and orthotists, to distinguish locations with elevated plantar pressure in patients with metatarsalgia. METHODS: Ten podiatrists, ten pedorthists and ten orthotists working in The

Nick A Guldemond; Pieter Leffers; Fred HM Nieman; Antal P Sanders; Nicolaas C Schaper; Geert HIM Walenkamp



Fatiguing handgrip exercise alters maximal force-generating capacity of plantar-flexors.  


Exercise-induced fatigue causes changes within the central nervous system that decrease force production capacity in fatigued muscles. The impact on unrelated, non-exercised muscle performance is still unclear. The primary aim of this study was to examine the impact of a bilateral forearm muscle contraction on the motor function of the distal and unrelated ankle plantar-flexor muscles. The secondary aim was to compare the impact of maximal and submaximal forearm contractions on the non-fatigued ankle plantar-flexor muscles. Maximal voluntary contractions (MVC) of the forearm and ankle plantar-flexor muscles as well as voluntary activation (VA) and twitch torque of the ankle plantar-flexor muscles were assessed pre-fatigue and throughout a 10-min recovery period. Maximal (100 % MVC) and submaximal (30 % MVC) sustained isometric handgrip contractions caused a decreased handgrip MVC (to 49.3 ± 15.4 and 45.4 ± 11.4 % of the initial MVC for maximal and submaximal contraction, respectively) that remained throughout the 10-min recovery period. The fatigue protocols also caused a decreased ankle plantar-flexor MVC (to 77 ± 8.3 and 92.4 ± 6.2 % of pre-fatigue MVC for maximal and submaximal contraction, respectively) and VA (to 84.3 ± 15.7 and 97.7 ± 16.1 % of pre-fatigue VA for maximal and submaximal contraction, respectively). These results suggest central fatigue created by the fatiguing handgrip contraction translated to the performance of the non-exercised ankle muscles. Our results also show that the maximal fatigue protocol affected ankle plantar-flexor MVC and VA more severely than the submaximal protocol, highlighting the task-specificity of neuromuscular fatigue. PMID:22833010

Kennedy, Ashleigh; Hug, François; Sveistrup, Heidi; Guével, Arnaud



Plantar pressure and radiographic changes to the forefoot after the Austin bunionectomy.  


We describe the effects of the Austin bunionectomy on plantar pressure distribution and radiographic measurements in the forefoot in 31 subjects (44 feet) with mild-to-moderate hallux valgus deformity and 36 control subjects (36 feet). Plantar pressure measurements before and 24 months after surgery showed peak pressure beneath the hallux reduced to normal values. Peak pressure measurements beneath the first, second, and third metatarsal heads in hallux valgus feet were relatively unchanged after surgery and remained higher than normal values. The operation produced significant decreases in mean preoperative radiographic measurements of hallux abductus, metatarsus primus varus, and first metatarsal protrusion distance in these patients to below-normal values. PMID:16037551

Bryant, Alan R; Tinley, Paul; Cole, Joan H


Does obesity influence foot structure and plantar pressure patterns in prepubescent children?  

Microsoft Academic Search

OBJECTIVE: This study examined the effects of obesity on plantar pressure distributions in prepubescent children.DESIGN: Field-based, experimental data on BMI (body mass index), foot structure and plantar pressures were collected for 13 consenting obese children and 13 non-obese controls.SUBJECTS: Thirteen obese (age 8.1±1.2 y; BMI 25.5±2.9 kg\\/m2) and 13 non-obese (age 8.4±0.9 y; BMI 16.9±1.2 kg\\/m2) prepubescent children, matched to

AM Dowling; JR Steele; LA Baur



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


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

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



Microsoft Academic Search

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

M Poirier; D David Herman; F Fernando Fondeur; J John Pareizs; M Michael Hay; B Bruce Wiersma; K Kim Crapse; T Thomas Peters; S Samuel Fink; D Donald Thaxton



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

Code of Federal Regulations, 2010 CFR

...whereâ (1) H=wind heeling moment for...foot-pounds (kilogram-meters); (2) k=0... ); (3) v=wind velocity ofâ (i) 70 knots (36 meters per second) for...distance in feet (meters) from the the center of wind pressure on...



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

Code of Federal Regulations, 2010 CFR

...whereâ (1) H=wind heeling moment for...foot-pounds (kilogram-meters); (2) k=0... ); (3) v=wind velocity ofâ (i) 70 knots (36 meters per second) for...distance in feet (meters) from the the center of wind pressure on...



The influence of whole body vibration on the plantarflexors during heel raise exercise.  


Whole body vibration (WBV) during exercise offers potential to augment the effects of basic exercises. However, to date there is limited information on the basic physiological and biomechanical effects of WBV on skeletal muscles. The aim of this study was to determine the effects of WBV (40Hz, 1.9mm synchronous vertical displacement) on the myoelectrical activity of selected plantarflexors during heel raise exercise. 3D motion capture of the ankle, synchronised with sEMG of the lateral gastrocnemius and soleus, was obtained during repetitive heel raises carried out at 0.5Hz on 10 healthy male subjects (age 27±5 years, height 1.78±0.04m, weight 75.75±11.9kg). During both vibration and non vibration the soleus activation peaked earlier than that of the lateral gastrocnemius. The results indicate that WBV has no effect on the timing of exercise completion or the amplitude of the lateral gastrocnemius activity, however significant increases in amplitudes of the soleus muscle activity (77.5-90.4% MVC P<0.05). WBV had no significant effect on median frequencies of either muscle. The results indicate that the greatest effect of WBV during heel raise activity is in the soleus muscles during the early phases of heel raise. PMID:23261083

Robbins, D; Goss-Sampson, M



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

ERIC Educational Resources Information Center

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…

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



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

Code of Federal Regulations, 2012 CFR

...Hm) of a unit in a given normal operating condition or severe storm condition is the sum of the individual wind heeling moments... (ii) 100 knots (51.5 meters per second) for severe storm conditions. (iii) 50 knots (25.8 meters per...



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

Code of Federal Regulations, 2011 CFR

...Hm) of a unit in a given normal operating condition or severe storm condition is the sum of the individual wind heeling moments... (ii) 100 knots (51.5 meters per second) for severe storm conditions. (iii) 50 knots (25.8 meters per...



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

ERIC Educational Resources Information Center

|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…

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



Changes in temporal gait characteristics and pressure distribution for bare feet versus various heel heights  

Microsoft Academic Search

The purpose of this study was to identify changes in temporal gait characteristics and pressure generation across the sole of the foot due to various heel heights in women's dress pumps. Thirty female subjects, aged 18-30 years, volunteered to participate. Subjects were required to have normal gait and to wear comfortably either size 7 or size 9 shoes. Subjects were

Joanne R. Eisenhardt; Deneen Cook; Ingrid Pregler; Henry C. Foehl



Effects of the heel-to-toe rocker sole on walking in able-bodied persons.  


Background and aim:The most commonly prescribed external shoe modification is the use of rocker soles. The aim of this study was to evaluate the effect of a heel-to-toe rocker sole profile on specific temporal-spatial parameters and the kinematics of walking when added to footwear.Method:Seventeen healthy adult volunteers participated in this study. For each subject, gait analysis was performed under two conditions that were tested in a random order: walking with either a baseline shoe with a flat sole or a modified shoe adapted with a heel-to-toe rocker sole.Results:Significant differences were observed between rocker sole conditions during initial double-limb support and second double-limb support during stance phase. In frontal plane movement, significant differences were observed between the rocker sole conditions but only during second double-limb support phase.Conclusions:This heel-to-toe rocker sole may be useful for patients with conditions such as ankle arthrodesis or for use with ankle-foot orthoses where limited ankle motion is required.Clinical relevanceThe heel-to-toe rocker sole may be useful for conditions including ankle arthrodesis and for use with solid ankle-foot orthoses but may not be suitable for patients with reduced balance or an unstable posture. PMID:23401295

Arazpour, Mokhtar; Hutchins, Stephen W; Ghomshe, Farhad T; Shaky, Fahimeh; Karami, Masome V; Aksenov, Andrey Y



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

Microsoft Academic Search

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 \\




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

SciTech Connect

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.

McDaniel, L.B.



Biomechanical implications of the negative heel rocker sole shoe: Gait kinematics and kinetics  

Microsoft Academic Search

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.

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



Neuropeptide Y is analgesic in rats after plantar incision.  


Previous work has demonstrated that neuropeptide tyrosine (NPY), Y(1) receptor and Y(2) receptor are critical in modulation of pain after nerve injury. We hypothesized that NPY was important for nociception after surgical incision. As a model of postoperative pain, rats underwent a plantar incision in one hindpaw. Western blots were used to quantify changes in protein expression of NPY, Y(1) receptor and Y(2) receptor after incision in skin, muscle, and dorsal root ganglion (DRG). Pain-related behaviors were tested after incision in rats treated with intrathecal NPY, Y(1) receptor antagonist (BIBO3304--Chemical Name: N-[(1R)-1-[[[[4-[[(Aminocarbonyl)amino]methyl]phenyl]methyl]amino]carbonyl]-4-[(aminoiminomethyl)amino]butyl]-?-phenyl-benzeneacetamide ditrifluoroacetate), Y(2) receptor antagonist (BIIE0246--Chemical Name: N-[(1S)-4-[(Aminoiminomethyl)amino]-1-[[[2-(3,5-dioxo-1,2-diphenyl-1,2,4-triazolidin-4-yl)ethyl]amino]carbonyl]butyl]-1-[2-[4-(6,11-dihydro-6-oxo-5H-dibenz[b,e]azepin-11-yl)-1-piperazinyl]-2-oxoethyl]-cyclopentaneacetamide), combined NPY+antagonists, morphine, or vehicle. Pain behaviors were tested after incision in rats treated with locally applied intraplantar injections of NPY, Y(1) receptor and Y(2) receptor antagonists or vehicle. NPY protein expression was significantly downregulated in muscle for two days after incision. In contrast, Y(1) receptor and Y(2) receptor protein expression was upregulated in both skin and muscle. A single intrathecal injection of NPY reduced cumulative guarding pain scores, as did morphine. The intrathecal administration of Y(2) receptor antagonist also reduced pain scores; findings that were not observed when drugs were administered locally. Intrathecal Y(2) receptor antagonists and NPY improved mechanical threshold and heat withdrawal latency 2h after incision. Intrathecal administration of NPY and/or central blockade of Y(2) receptor attenuated pain behaviors early after incision (postoperative day (POD) 1-2). Y(1) receptor antagonist administration blocked the anti-hyperalgesic effect of NPY. Together these data suggest a role for spinal NPY in postoperative pain. PMID:23123350

Yalamuri, Suraj M; Brennan, Timothy J; Spofford, Christina M



Long-term use of high-heeled shoes alters the neuromechanics of human walking.  


Human movement requires an ongoing, finely tuned interaction between muscular and tendinous tissues, so changes in the properties of either tissue could have important functional consequences. One condition that alters the functional demands placed on lower limb muscle-tendon units is the use of high-heeled shoes (HH), which force the foot into a plantarflexed position. Long-term HH use has been found to shorten medial gastrocnemius muscle fascicles and increase Achilles tendon stiffness, but the consequences of these changes for locomotor muscle-tendon function are unknown. This study examined the effects of habitual HH use on the neuromechanical behavior of triceps surae muscles during walking. The study population consisted of 9 habitual high heel wearers who had worn shoes with a minimum heel height of 5 cm at least 40 h/wk for a minimum of 2 yr, and 10 control participants who habitually wore heels for less than 10 h/wk. Participants walked at a self-selected speed over level ground while ground reaction forces, ankle and knee joint kinematics, lower limb muscle activity, and gastrocnemius fascicle length data were acquired. In long-term HH wearers, walking in HH resulted in substantial increases in muscle fascicle strains and muscle activation during the stance phase compared with barefoot walking. The results suggest that long-term high heel use may compromise muscle efficiency in walking and are consistent with reports that HH wearers often experience discomfort and muscle fatigue. Long-term HH use may also increase the risk of strain injuries. PMID:22241055

Cronin, Neil J; Barrett, Rod S; Carty, Christopher P



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


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

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



Dissolution of Plutonium Scrub Alloy and Anode Heel Materials in H-Canyon  

SciTech Connect

H-Canyon has a ''gap'' in dissolver operations during the last three months of FY03. One group of material to be processed during the gap is pre-existing scrub alloy material. There are 14 cans of material containing approximately 3.8 kilograms of plutonium. Of the 14 cans, it was anticipated that four cans contain salts, two cans contain anode heel materials, and eight cans contain scrub alloy buttons. H-Canyon desires to process the materials using a flowsheet similar to the SS and C (sand, slag and crucible) dissolution flowsheet used in F-Canyon. The materials will be loaded into carbon steel cans and then placed into aluminum metal charging bundles. Samples were sent to Savannah River Technology Center (SRTC) for characterization and flowsheet testing -- four MSE salts, two anode heels, and seven scrub alloy buttons. SRTC dissolved and characterized each of the samples. Two of them, originally thought to be MSE salts, were found to be graphite mold materials and were unsuitable for processing in H-Canyon. Characterization studies confirmed that the identification of the remaining items as MSE salts, scrub alloy buttons, and anode heel materials was correct. The MSE salts and anode heels solids are comprised primarily of plutonium, potassium, sodium and chloride. Both the MSE salts and anode heels left behind small amounts of residual solids. The scrub alloy buttons are comprised primarily of plutonium and aluminum. The solids dissolve readily with light, effervescent gas generation at the material surface and only trace amounts of NOx generation. Of the seven button samples, four dissolved completely. Two button samples contained small amounts of tantalum that did not dissolve. The last of the seven scrub alloy samples left a trace amount of residual plutonium solids. It is anticipated that the presence of undissolved fissile material is a function of where the sample was located relative to the button surface.




Hypertrophic scar formation following carbon dioxide laser ablation of plantar warts in cyclosporin-treated patients.  


We present four renal transplant patients who developed hypertrophic scars following carbon dioxide laser ablation of recalcitrant plantar warts. All of the patients were on long-term treatment with cyclosporin, which we believe to be responsible. We discuss several possible mechanisms by which cyclosporin may influence wound healing and scarring. PMID:11899123

Ozluer, S M; Chuen, B Y; Barlow, R J; Markey, A C



Plantar warts in twins after successful bone marrow transplantation for severe combined immunodeficiency.  


Nine-year-old twin sisters presented with long-standing severe plantar warts following bone marrow transplantation for severe combined immunodeficiency (SCID). Combination therapy with keratolysis, cidofovir and water-filtered infrared coagulation (WIRA) led to complete clearance after 8 months of therapy. This dermatologic problem and the treatment of SCID including gene therapy are discussed. PMID:16686610

Marini, Alessandra; Niehues, Tim; Stege, Helger; Ruzicka, Thomas; Hengge, Ulrich R



The Influence of Dynamic Trans-tibial Prosthetic Alignment on Standing Plantar Foot Pressure  

Microsoft Academic Search

In order to study quantitative effect of dynamic prosthetic alignment on standing biomechanical property for trans-tibial amputees, plantar foot pressure of one subject during natural standing were recorded by using the Pedar in-shoe pressure measurement system with different alignment angles in the sagittal and frontal planes. The results showed that angular alignment had significant effects on the foot pressure distribution

Jia Xiaohong; Li Xiaobing; Dou Peng; Zhang Ming



The duration and plantar pressure distribution during one-leg stance in Tai Chi exercise  

Microsoft Academic Search

BackgroundTai Chi exercise improved the balance control and muscle strength of the lower extremities. The aim of this study is to quantify the one-leg stance duration and plantar pressure distribution during the one-leg stance in Tai Chi and to try to elaborate on its probable effects on the ability to balance on one leg.

D. W. Mao; J. X. Li; Y. Hong



Development of a Mechatronical Device to Measure Plantar Pressure for Medical Prevention of Gait Issues  

Microsoft Academic Search

A medically helpful mechatronical device for natural gait analysis is proposed. This consists of an instrumented shoe equipped with eight force sensors. The instantaneous plantar pressures are recorded by a personal digital assistant (PDA) belted on the patient hips. This article describes this original concept and the first results of its use

Fany Chedevergne; Arnaud Faivre; Marc Dahan



Are stance ankle plantar flexor muscles necessary to generate propulsive force during human gait initiation?  

Microsoft Academic Search

The study examined whether the generation of the forward propulsive force (PF) during gait initiation resulted mainly from the electromyogram activity of stance ankle plantar flexor muscles (APF) which ‘push’ on the ground as is generally claimed in the literature. Six unilateral above-knee amputees performed a specific gait initiation protocol, i.e. they were asked to walk as fast as possible

V. Michel



An in-shoe device to measure plantar pressure during daily human activity  

Microsoft Academic Search

In this work, we report the development of a novel device, integrated into a shoe, to monitor plantar pressure under real-life conditions by reducing the spatial and temporal resolution. The device consists of a shoe insole with seven pressure-sensitive conductive rubber sensors and a wireless data transmission unit incorporated into a smaller measurement unit. One advantage of this approach is

M. Saito; K. Nakajima; C. Takano; Y. Ohta; C. Sugimoto; R. Ezoe; K. Sasaki; H. Hosaka; T. Ifukube; S. Ino; K. Yamashita



Acute effects of two massage techniques on ankle joint flexibility and power of the plantar flexors  

Microsoft Academic Search

The purpose of this study was to determine if three minutes of petrissage and tapotement forms of massage would influence plantar flexors' flexibility, and muscle power. Nineteen partici- pants were randomly subjected to three conditions (control and two massages) before performing two power tests. Prior to the intervention, subjects completed ankle joint flexibility assess- ments. The conditions were; (1) control,

Grant J. B. McKechnie; Warren B. Young; David G. Behm


Palmar-plantar erythrodysesthesia secondary to docetaxel chemotherapy: a case report  

PubMed Central

Introduction Docetaxel is a chemotherapeutic agent used alone or in combination for the management of many neoplastic conditions. Numerous side effects are well described as a consequence. Palmar-plantar erythrodysesthesia, although a relatively common side effect of some types of chemotherapy, occurs infrequently with docetaxel and is often attributed to other drug agents. Case Presentation We report the case of a 66-year-old Caucasian woman who received adjuvant docetaxel monotherapy for invasive breast cancer. She developed palmar-plantar erythrodysesthesia following her first cycle of treatment, which necessitated a change in management. Conclusion Palmar-plantar erythrodysesthesia is a relatively common side effect of cytotoxic chemotherapy, particularly with drugs such as 5-fluorouracil, capecitabine and liposomal doxorubicin. Docetaxel is commonly used both alone and in combination with a number of these agents for the management of various malignant conditions. We would like to highlight the occurrence of palmar-plantar erythrodysesthesia as a result of docetaxel monotherapy so that it can be considered as a potential cause in patients receiving combination treatment with chemotherapeutic agents better known to cause this toxicity.



The reduction and redistribution of plantar pressures using foot orthoses in diabetic patients.  


High pressures on the soles of the feet of diabetic patients cause plantar ulcerations, and reduction of this pressure is important in the treatment and prevention of such ulcers. The effects of foot orthoses on the distribution of plantar pressures were investigated using a pressure-sensitive insole containing 960 sensor elements in seven diabetic patients (13 feet) with diabetic ulcers or past histories of diabetic ulcers. Plantar pressures at the foot-insole interface and their distribution were measured in a stable standing position wearing the patients' own shoes, with and without foot orthoses. The preorthotic peak pressure was 130.6 +/- 41.9 kPA (mean +/- S.D.), while the postorthotic peak pressure was reduced to 52.6 +/- 17.9 kPa (P < 0.001 vs. preorthotic). The mean reduction of pressure was 56.3%. The preorthotic contact area was 330.2 +/- 48.4 pressure-sensitive elements and the postorthotic contact area was increased to 517.2 +/- 105.5 elements (P < 0.001), with a mean increase of 62.7%. The marked reduction in plantar pressures at the foot-insole interface by pressure redistribution indicates that this new pressure measurement system is very useful for the design of such orthoses. PMID:8792110

Kato, H; Takada, T; Kawamura, T; Hotta, N; Torii, S



Plantar pressures in diabetic patients with foot ulcers which have remained healed  

Microsoft Academic Search

Aims The recurrence of foot ulcers is a significant problem in people with diabetic neuropathy. The purpose of this study was to measure in-shoe plantar pressures and other characteristics in a group of neuropathic patients with diabetes who had prior foot ulcers which had remained healed. Methods This was an epidemiological cohort study of patients from diabetes clinics of two

T. M. Owings; J. Apelqvist; A. Stenstrom; M. Becker; S. A. Bus; A. Kalpen; J. S. Ulbrecht; P. R. Cavanagh



Dynamic Plantar Loading Index: Understanding the benefit of Custom Foot Orthoses for Painful Pes Cavus  

PubMed Central

The purpose of this study was to evaluate a new method showing how custom foot orthoses (CFO) improve dynamics of plantar loading. The method is based on the probability distribution of peak pressure time series and is quantified using the Regression Factor (RF). RF is a least square regression slope between the experimentally observed plantar pressure magnitude probability distribution and a modeled Gaussian shape. Plantar pressure data from a randomized controlled trial of 154 participants with painful Pes Cavus were retrospectively re-analyzed. The participants were randomized to an active treatment group given CFO or a control group given sham orthoses. The location of 2nd Peak pressure as a percentage of stance time (PLoc2) and its magnitude (PM2) was also calculated. In addition, plantar pressure data were collected on 23 healthy volunteers with normal foot alignment and no foot pain. Results demonstrated Pes Cavus had a significantly lower RF than healthy participants (0.30 v. 0.51; p<10?7). PM2 was reduced in both active and control groups. However, RF and the PLoc2 were only changed in the active group (p<0.005) without any significant change in the control group (p>0.5). This study suggests that painful Pes Cavus alters the shape of probability distribution of plantar loading during walking and CFO are an effective therapeutic solution that can significantly improve it. Further use of the RF index and 2nd peak pressure location as an outcome measure for treatment of foot and ankle deformities is suggested.

Najafi, Bijan; Barnica, Elizabeth; Wrobel, James S.; Burns, Joshua



Engineering and Economic Feasibility Study of Roll Stabilization and Heel Inducing Systems for New Coast Guard Polar Icebreakers. Volume I.  

National Technical Information Service (NTIS)

This report summarizes studies of various roll stabilization and heeling systems for a new polar icebreaker design. Though the functions to these two systems are distinct they may be studied as one larger system because there exist many technical similari...

J. F. Dalzell H. Nowacki



Impact of heel effect and ROI size on the determination of contrast-to-noise ratio for digital mammography systems  

NASA Astrophysics Data System (ADS)

The European Guidelines for quality control in digital mammography specify a procedure for measuring contrast-to-noise ratio (CNR) using a 0.2mm thickness of aluminium with different thicknesses of Plexiglas. The relationship between ROI size and heel effect and how this affects CNR measurement is investigated in this work for DR and CR systems. The measured relative noise for the CR images was found to be strongly dependant on the ROI size due to the heel effect. After applying heel effect correction there was very little dependence on ROI size. The relative noise in the images from the DR system showed very little dependence on ROI size. The heel effect also distorted the CNR measurement on CR images when larger ROI is used. However the use of multiple small ROIs led to a result that was essentially the same as if a heel effect correction had been applied. The appropriate ROI size which should be used for CNR measurement was found to be 0.25 × 0.25 cm. Using this size the heel effect had an insignificant impact on the measurement of relative noise and CNR. This approach has the advantage that only a single image is required for each measurement. The application of heel effect correction with CR systems requires two images and complex image processing. The current suggestion in the European guidelines to use a 2 × 2cm ROI is inappropriate for CR systems and leads to an error of 8% to 18% in CNR determination due to the heel effect.

Alsager, Abdulaziz; Young, Kenneth C.; Oduko, Jennifer M.



Ability to perform a single heel-rise is significantly related to patient-reported outcome after Achilles tendon rupture.  


This study evaluated the short-term recovery of function after an acute Achilles tendon rupture, measured by a single-legged heel-rise test, with main emphasis on the relation to the patient-reported outcomes and fear of physical activity and movement (kinesiophobia). Eighty-one patients treated surgically or non-surgically with early active rehabilitation after Achilles tendon rupture were included in the study. Patient's ability to perform a single-legged heel-rise, physical activity level, patient-reported symptoms, general health, and kinesiophobia was evaluated 12 weeks after the injury. The heel-rise test showed that 40 out of 81 (49%) patients were unable to perform a single heel-rise 12 weeks after the injury. We found that patients who were able to perform a heel-rise were significantly younger, more often of male gender, reported a lesser degree of symptoms, and also had a higher degree of physical activity at 12 weeks. There was also a significant negative correlation between kinesiophobia and all the patient-reported outcomes and the physical activity level. The heel-rise ability appears to be an important early achievement and reflects the general level of healing, which influences patient-reported outcome and physical activity. Future treatment protocols focusing on regaining strength early after the injury therefore seem to be of great importance. Kinesiophobia needs to be addressed early during the rehabilitation process. PMID:22716232

Olsson, N; Karlsson, J; Eriksson, B I; Brorsson, A; Lundberg, M; Silbernagel, K G



Antiviral activity of Engystol® and Gripp-Heel®: an in-vitro assessment  

PubMed Central

Background Infections with respiratory viruses can activate the innate immune response - an important host defence mechanism in the early stage of viral infection. Interferon (IFN) release, triggered by virus infection, is an important factor in establishing an antiviral state, where IFN activation occurs prior to the onset of the adaptive immune response. The two ultra-low-dose combination medications, Engystol® and Gripp-Heel®, have documented efficacy for the treatment of the respiratory infections. However, the underlying antiviral mechanisms remain elusive. Methods It was the goal to investigate whether Engystol® and Gripp-Heel® display antiviral activity in a prophylactic treatment protocol (2, 24 and 48 h pre-incubation) using a plaque reduction assay and whether the medications affect the release of type 1 IFN in virus-susceptible cell lines and human peripheral blood mononuclear cells (PBMCs). Results Both medications demonstrate prophylactic effect against viral respiratory virus replication. However, when the incubation was continued for up to 5 days, both medications exhibited a pronounced antiviral effect which was dependent on the pre-incubation time. Moreover, in co-stimulated HeLa cells as well as in activated PBMCs Gripp-Heel® and Engystol® demonstrated an increased type 1 IFN production. Conclusions Engystol® and Gripp-Heel® inhibited the replication of a variety of respiratory viruses. Additionally, we showed that pre-incubation affects the magnitude of the inhibitory effect differently for the various tested viruses. Both medications stimulate type 1 IFN release in different cell systems which suggests that their antiviral activity may be mediated possibly via modulation of the antiviral type 1 IFN host response.



The Effects of 10 Weeks Military Training on Heel Ultrasound and Bone Turnover  

Microsoft Academic Search

.   To measure the physiological changes in bone in response to strenuous exercise we performed a prospective study of male army\\u000a recruits over 10 weeks of basic training. Measurements performed at the start and completion of training consisted of ultrasound\\u000a (US) measurements of the heel: velocity of sound (VOS in m\\/seconds) and broadband ultrasound attenuation (BUA in dB\\/MHz) and\\u000a bone

J. Etherington; J. Keeling; R. Bramley; R. Swaminathan; I. McCurdie; T. D. Spector



Kangaroo mother care diminishes pain from heel lance in very preterm neonates: A crossover trial  

Microsoft Academic Search

BACKGROUND: Skin-to-skin contact, or kangaroo mother care (KMC) has been shown to be efficacious in diminishing pain response to heel lance in full term and moderately preterm neonates. The purpose of this study was to determine if KMC would also be efficacious in very preterm neonates. METHODS: Preterm neonates (n = 61) between 28 0\\/7 and 31 6\\/7 weeks gestational

C Celeste Johnston; Francoise Filion; Marsha Campbell-Yeo; Celine Goulet; Linda Bell; Kathryn McNaughton; Jasmine Byron; Marilyn Aita; G Allen Finley; Claire-Dominique Walker



The influence of a small insert, in the footbed of a shoe, upon plantar pressure distribution.  


INTRODUCTION:: A recent development in plantar pressure distribution research, has been the study of the effects of sensory input on pressure distribution. It has been suggested that proprioceptive and exteroceptive information received from the plantar surface of the foot plays an important role in adapting to high pressures in shoes. Robbins and Gouw (1991) suggested that surface irregularities should be added to the insoles of running shoes to gain correct sensory input. Hayda et al. (1994) found that placing a pad proximal to the metatarsal heads produced significant reductions in forefoot plantar pressures around the first and second metatarsal heads. A development by Villeneuve (1993), 'La Posteropodle', utilized a small insert to maintain postural equilibrium, by stimulating the mechanoreceptors in the plantar surface of the foot. The aim of this study was to measure changes in plantar pressure distribution using a small circular insert. METHODS:: Ten non-pathological male subjects were tested whilst walking, after one day of wearing a pair of oxfords (hard) and running shoes (soft), containing an insert of 4 mm in height placed on a 0.8 mm EVA insole. The foot was split into five sections: (1) midfoot, (2) first metatarsal head, (3) 2nd and 3rd metatarsal heads, (4) 4th and 5th metatarsal heads, (5) the phalanges. A PEDAR system (Novel GmbH) was used to collect in-shoe plantar pressure data, with data collections at the beginning and end of a working day. Subjects were tested under two conditions: (1) the insert 5 mm proximal to the metatarsal heads, between the 2nd and 3rd heads, (2) a control, with no insert. RESULTS:: Preliminary results indicate that whilst wearing a hard shoe the insert had the effect of shifting peak pressures from the first metatarsal head, to the area of the second and third metatarsal heads. Peak pressures were found to be lower with the insert present. This has not yet been tested for significance. With the running shoe there appeared to be no significant differences between conditions with and without the insert. There were also no differences between the beginning and end of the day, for both shoe types. DISCUSSION:: From the results it appears that the insert is successful in both shifting peak pressures from the medial to the lateral forefoot, whilst reducing peak pressures simultaneously. This was only evident in the hard shoe condition however, suggesting that the footbed of the running shoe was perhaps too soft to allow the insert to influence sensory input sufficiently. These findings indicate that there may be implications for the use of small orthotics. Further study is required, however, to fully substantiate this hypothesis. PMID:11415702

Burgess, S; Jordan, C; Bartlett, RM



Gating of SEPs by contraction of the contralateral homologous muscle during the preparatory period of self-initiated plantar flexion  

Microsoft Academic Search

To investigate the centrifugal change in somatosensory information processing caused by contraction of the contralateral homologous muscle, we recorded the somatosensory-evoked potentials (SEPs) during the preparatory period of a self-initiated plantar flexion. The SEPs following stimulation of the right tibial nerve at the popliteal fossa were recorded in nine healthy subjects. Self-initiated plantar flexion of the left ankle was performed

Toshiaki Wasaka; Hiroki Nakata; Tetsuo Kida; Ryusuke Kakigi



Effects of plantar-flexor muscle fatigue on the magnitude and regularity of center-of-pressure fluctuations  

Microsoft Academic Search

Control of bipedal posture is highly automatized but requires attentional investment, the amount of which varies between participants\\u000a and with postural constraints, such as plantar-flexor muscle fatigue. Elevated attentional demands for standing with fatigued\\u000a plantar flexors have been demonstrated using a stimulus–response reaction-time paradigm. Recently, a direct relation between\\u000a the regularity of center-of-pressure (COP) fluctuations and the amount of attention

Melvyn Roerdink; Petra Hlavackova; Nicolas Vuillerme



Difference in plantar pressure between the preferred and non-preferred feet in four soccer-related movements  

Microsoft Academic Search

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

Pui-lam Wong; Karim Chamari; Anis Chaouachi; De Wei Mao; Ulrik Wisløff; Youlian Hong



The most temperature-adapted corals have an Achilles' Heel.  


The corals of the Persian/Arabian Gulf are better adapted to temperature fluctuations than elsewhere in the Indo-Pacific. The Gulf is an extreme marine environment displaying the highest known summer water temperatures for any reef area. The small and shallow sea can be considered a good analogue to future conditions for the rest of the world's oceans under global warming. The fact that corals can persist in such a demanding environment indicates that they have been able to acclimatize and selectively adapt to elevated temperature. The implication being that colonies elsewhere may be able to follow suit. This in turn provides hope that corals may, given sufficient time, similarly adapt to survive even in an impoverished form, under conditions of acidification-driven lowering of CaCO? saturation state, a further consequence of raised atmospheric CO?. This paper demonstrates, however, that the uniquely adapted corals of the Gulf may, within the next three centuries, be threatened by a chronic habitat shortage brought about by the dissolution of the lithified seabed on which they rely for colonisation. This will occur due to modifications in the chemical composition of the Gulf waters due to climate change. PMID:21094502

Purkis, S J; Renegar, D A; Riegl, B M



PTEN, the Achilles' heel of myocardial ischaemia/reperfusion injury?  


Myocardial ischaemia/reperfusion injury leading to myocardial infarction is one of the most frequent causes of debilitation and death in man. Considerable research has been undertaken to investigate the possibility of reducing myocardial infarction and increasing cell survival by activating certain endogenous prosurvival signaling pathways. Thus, it has been established that the activation of the PI3K (Phosphoinositide-3 kinase)/Akt (Protein kinase B, PKB) signaling pathway is essential for protection against ischaemia/reperfusion injury. This pathway has been shown to be activated by mechanical procedures (e.g. pre and post conditioning) as well as by a number of pharmacological agents. Although the activation of this prosurvival signaling pathway induces the phosphorylation of a large number of substrates implicated in increased cell survival, when activated over a prolonged period this pathway can have detrimental consequences by facilitating unwanted growth and malignancies. Importantly PTEN (phosphatase and tensin homolog deleted on chromosome ten), is the main phosphatase which negatively regulates the PI3K/Akt pathway. In this review we discuss: a) the significance and the limitations of inhibiting PTEN in myocardial ischaemia/reperfusion injury; b) PTEN and its relationship to ischaemic preconditioning, c) the role of PTEN in the development of tolerance to chronic administration of drugs known to limit infarction by activating PI3K/Akt pathway when given acutely, and d) the possible role of PTEN in the ischaemic/reperfused diabetic heart. The experimental evidence discussed in this review illustrates the importance of PTEN inhibition in the protection of the heart against ischaemia/reperfusion injury. PMID:17293884

Mocanu, M M; Yellon, D M



Multi-plug insole design to reduce peak plantar pressure on the diabetic foot during walking.  


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

Actis, Ricardo L; Ventura, Liliana B; Lott, Donovan J; Smith, Kirk E; Commean, Paul K; Hastings, Mary K; Mueller, Michael J



Efficacy of Intralesional Bleomycin in Palmo-plantar and Periungual Warts  

PubMed Central

Background/Aim: Intralesional bleomycin gained increasing popularity in the recent past for treatment of warts particularly in palmo-plantar and periungual regions as other modalities are not very effective. Hence we evaluated the role of intralesional bleomycin in periungual and palmo-plantar warts to know its efficacy in Indian patients. Settings and Design: This was a placebo-controlled study. Materials and Methods: Fifty patients of multiple palmo-plantar and periungual warts were included in this study and categorized in groups A and B of 25 each. Alternate patients were included in groups A and B and treated respectively with intralesional bleomycin (1 mg/mL solution) and normal saline as placebo, fortnightly for maximum up to two injections. Patients were followed up weekly for 1 month, fortnightly up to 12 weeks, and then quarterly for 1 year. If warts persisted after 12 weeks of starting treatment, it was considered a failure. Statistical analysis was done by the chi-square test using M-stat software. Results: Group A and B patients were having 85 warts and 72 warts, respectively. The cure rate in group A and B patients was 96.47% (82/85 warts) and 11.11% (8/72 warts), respectively, after one or two injections within 12 weeks. The difference in the cure rate between two groups was statistically highly significant (<0.0001). In group A patients, a haemorrhagic eschar was formed which gradually healed in 8-12 weeks without atrophy or pigmentation; this phenomenon was not seen in group B. Only moderate pain was observed by most of the patients during injection in both groups. Conclusion: The intralesional injection of bleomycin is highly effective, safe, and non-toxic in periungual and palmo-plantar warts.

Soni, Prasoon; Khandelwal, Kanika; Aara, Naushin; Ghiya, Bhikam C; Mehta, Rajesh D; Bumb, Ram A



Injury reduction effectiveness of selecting running shoes based on plantar shape.  


Popular running magazines and running shoe companies suggest that imprints of the bottom of the feet (plantar shape) can be used as an indication of the height of the medial longitudinal foot arch and that this can be used to select individually appropriate types of running shoes. This study examined whether or not this selection technique influenced injury risk during United States Army Basic Combat Training (BCT). After foot examinations, BCT recruits in an experimental group (E: n = 1,079 men and 451 women) selected motion control, stability, or cushioned shoes for plantar shapes judged to represent low, medium, or high foot arches, respectively. A control group (C: n = 1,068 men and 464 women) received a stability shoe regardless of plantar shape. Injuries during BCT were determined from outpatient medical records. Other previously known injury risk factors (e.g., age, fitness, and smoking) were obtained from a questionnaire and existing databases. Multivariate Cox regression controlling for other injury risk factors showed little difference in injury risk between the E and C groups among men (risk ratio (E/C) = 1.01; 95% confidence interval = 0.88-1.16; p = 0.87) or women (risk ratio (E/C) = 1.07; 95% confidence interval = 0.91-1.25; p = 0.44). In practical application, this prospective study demonstrated that selecting shoes based on plantar shape had little influence on injury risk in BCT. Thus, if the goal is injury prevention, this selection technique is not necessary in BCT. PMID:19387413

Knapik, Joseph J; Swedler, David I; Grier, Tyson L; Hauret, Keith G; Bullock, Steven H; Williams, Kelly W; Darakjy, Salima S; Lester, Mark E; Tobler, Steven K; Jones, Bruce H



Enhanced spatio-temporal alignment of plantar pressure image sequences using B-splines.  


This article presents an enhanced methodology to align plantar pressure image sequences simultaneously in time and space. The temporal alignment of the sequences is accomplished using B-splines in the time modeling, and the spatial alignment can be attained using several geometric transformation models. The methodology was tested on a dataset of 156 real plantar pressure image sequences (3 sequences for each foot of the 26 subjects) that was acquired using a common commercial plate during barefoot walking. In the alignment of image sequences that were synthetically deformed both in time and space, an outstanding accuracy was achieved with the cubic B-splines. This accuracy was significantly better (p < 0.001) than the one obtained using the best solution proposed in our previous work. When applied to align real image sequences with unknown transformation involved, the alignment based on cubic B-splines also achieved superior results than our previous methodology (p < 0.001). The consequences of the temporal alignment on the dynamic center of pressure (COP) displacement was also assessed by computing the intraclass correlation coefficients (ICC) before and after the temporal alignment of the three image sequence trials of each foot of the associated subject at six time instants. The results showed that, generally, the ICCs related to the medio-lateral COP displacement were greater when the sequences were temporally aligned than the ICCs of the original sequences. Based on the experimental findings, one can conclude that the cubic B-splines are a remarkable solution for the temporal alignment of plantar pressure image sequences. These findings also show that the temporal alignment can increase the consistency of the COP displacement on related acquired plantar pressure image sequences. PMID:23135784

Oliveira, Francisco P M; Tavares, João Manuel R S



Long-term efficacy of radiofrequency ablation in treatment of common and palmo-plantar warts.  


Current treatments for warts induce significant local tissue damage and do not prevent recurrence. We evaluated the efficacy of localised radiofrequency heat (RFH) therapy in inducing the long-term resolution of common and palmo-plantar warts in a placebo-controlled randomised single blind trial. Our data show that RFH therapy is a safe, cosmetically acceptable and long-term effective treatment for warts. PMID:23127158

Khandelwal, Kanika; Bumb, Ram A; Mehta, Rajesh D; Ghiya, Bhikam C; Satoskar, Abhay R



Gender Differences in Human Muscle and Joint Mechanical Properties During Plantar Flexion in Old Age  

Microsoft Academic Search

Muscle and joint mechanical properties during plantar flexion were investigated in 13 elderly women (EW) (age range 73-83 years) and 15 elderly men (EM) (age range 74-81 years). Maximal torque, at several angular velocities, was measured to construct torque-velocity relationship. This led to the calculation of an index of maximal shortening velocity (VImax )a t 10% of maximal isometric torque.

Julien Ochala; Denis Valour; Michel Pousson; Daniel Lambertz; Jacques Van Hoecke



A walking monitoring shoe system for simultaneous plantar-force measurement and gait-phase detection  

Microsoft Academic Search

This paper presents a walking-monitoring-shoe (WMS) system capable of simultaneous performing accurate plantar-force measurement and reliable gait-phase detection for continuous monitoring of human walking on treadmill. Based on anatomical information, the WMS employs four strain-gauges embedded in a homemade sole to accurately measure the contact force of the human foot exerted on the shoe-pad, and an efficient classification algorithm to

Hui Yu; Dong-hai Wang; Can-Jun Yang; Kok-Meng Lee



Location specificity of plantar cutaneous reflexes involving lower limb muscles in humans  

Microsoft Academic Search

It is known that cutaneous reflexes in human hand muscles show strong location-specificity dependent on the digit stimulated. We hypothesized that in lower leg muscles the cutaneous reflex following tactile sensation of the plantar surface of the foot is also organized in a location-specific manner. The purpose of the present study was to test this hypothesis. Middle latency reflexes (?70–110 ms,

Tsuyoshi Nakajima; Masanori Sakamoto; Toshiki Tazoe; Takashi Endoh; Tomoyoshi Komiyama



Topical DMSO treatment for pegylated liposomal doxorubicin-induced palmar-plantar erythrodysesthesia  

Microsoft Academic Search

Purpose: Chemotherapeutic regimens that utilize fluorouracil, cytarabine, and doxorubicin have been shown to cause a dermatologic\\u000a syndrome known as hand-foot syndrome, or palmar-plantar erythrodysesthesia syndrome (PPES). Pegylated liposomal doxorubicin\\u000a has proven effective in the treatment of AIDS-related Kaposi's sarcoma, ovarian cancer refractory to platinum and paclitaxel\\u000a therapies, and metastatic breast cancer. In a study of the treatment of refractory epithelial

A. M. Lopez; L. Wallace; R. T. Dorr; M. Koff; E. M. Hersh; D. S. Alberts



In-shoe plantar pressure measurement and analysis system based on fabric pressure sensing array.  


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

Shu, Lin; Hua, Tao; Wang, Yangyong; Qiao Li, Qiao; Feng, David Dagan; Tao, Xiaoming



Status of oxidative stress on lesional skin surface of plantar warts.  


Background? Warts are abnormal skin growths caused by human papilloma virus (HPV) infections within the skin of the patients. Sometimes the disease is difficult to treatment, and also, the relationship between HPV and some forms of skin cancers is important. The cutaneous oxidative stress status of warts is absent in the literature. Objectives? To evaluate the role of oxidative stress in affected skin areas in a group of patients with plantar warts. Methods? Thirty-six consecutive patients with a diagnosis of plantar warts were enrolled. The samples were obtained by scraping the skin surface. Superoxide dismutase (SOD) and catalase (CAT) activities and malondialdehyde (MDA) levels were measured spectrophotometrically at samples. Results? The SOD activity was significantly lower, and the MDA level was significantly higher on the lesional area than on the non-lesional area (P?plantar warts may play a role in pathogenesis of the disease. The addition of topical drugs with antioxidative effects may be valuable in the treatment of warts. PMID:22221210

Arican, O; Ozturk, P; Kurutas, E B; Unsal, V



Photodynamic therapy with topical delta-aminolaevulinic acid for the treatment of plantar warts.  


Treatments currently employed for plantar warts are often painful (electrosurgery, cryotherapy) and not always effective (keratolytic agents). In this paper we investigate the effect of photodynamic therapy (PDT) with topical delta-aminolaevulinic acid (ALA) on plantar warts. In order to remove the superficial hyperkeratotic layer of the warts an ointment containing 10% urea and 10% salicylic acid was applied for 7 days. After gentle curettage, a cream containing 20% ALA was applied under an occlusive dressing for 5 h on 64 warts, while 57 warts (controls) received only the vehicle. Both the ALA-treated warts and the controls were irradiated using a visible light lamp (with a range of 400-700 nm, peaking at 630 nm). The light dose was 50 J/cm(2). Patients were followed-up for 22 months. Two months after the last irradiation session 48 (75.0%) out of 64 ALA-PDT treated warts had resolved. By contrast only 13 (22.8%) of the 57 control warts had done so. During the treatment a few patients complained of a mild burning sensation. The absorption of ALA by the verrucous tissue was demonstrated by in vivo fluorescence spectroscopy. This study shows that topical ALA-PDT can be an alternative treatment for plantar warts. Further studies will be necessary in order to optimize the concentration of ALA and duration of treatment. PMID:11485845

Fabbrocini, G; Di Costanzo, M P; Riccardo, A M; Quarto, M; Colasanti, A; Roberti, G; Monfrecola, G



The Quasi-Linear Viscoelastic Properties of Diabetic and Non-Diabetic Plantar Soft Tissue  

PubMed Central

The purpose of this study was to characterize the viscoelastic behavior of diabetic and non-diabetic plantar soft tissue at six ulcer-prone/load-bearing locations beneath the foot to determine any changes that may play a role in diabetic ulcer formation and subsequent amputation in this predisposed population. Four older diabetic and four control fresh frozen cadaveric feet were each dissected to isolate plantar tissue specimens from the hallux, first, third, and fifth metatarsals, lateral midfoot, and calcaneus. Stress relaxation experiments were used to quantify the viscoelastic tissue properties by fitting the data to the quasi-linear viscoelastic (QLV) theory using two methods, a traditional frequency-insensitive approach and an indirect frequency-sensitive approach, and by measuring several additional parameters from the raw data including the rate and amount of overall relaxation. The stress relaxation response of both diabetic and non-diabetic specimens was unexpectedly similar and accordingly few of the QLV parameters for either fit approach and none of raw data parameters differed. Likewise, no differences were found between plantar locations. The accuracy of both fit methods was comparable, however, neither approach predicted the ramp behavior. Further, fit coefficients varied considerably from one method to the other, making it hard to discern meaningful trends. Future testing using alternate loading modes and intact feet may provide more insight into the role that time-dependent properties play in diabetic foot ulceration.

Pai, Shruti; Ledoux, William R.



Effects of Wearing Different Personal Equipment on Force Distribution at the Plantar Surface of the Foot  

PubMed Central

Background. The wearing of personal equipment can cause specific changes in muscle activity and posture. In the present study, we investigated the influence of differences in equipment related weight loading and load distribution on plantar pressure. In addition, we studied functional effects of wearing different equipment with a particular focus on relevant changes in foot shape. Methods. Static and dynamic pedobarography were performed on 31 male soldiers carrying increasing weights consisting of different items of equipment. Results. The pressure acting on the plantar surface of the foot increased with higher loading, both under static and dynamic conditions (p < 0.05). We observed an increase in the contact area (p < 0.05) and an influence of load distribution through different ways to carry the rifle. Conclusions. The wearing of heavier weights leads to an increase in plantar pressure and contact area. This may be caused by flattening of the transverse and longitudinal arches. The effects are more evident in subjects with flat feet deformities which seem to flatten at an earlier load condition with a greater amount compared to subjects with normal arches. Improving load distribution should be a main goal in the development of military equipment in order to prevent injuries or functional disorders of the lower extremity.

Woitge, Sandra; Finze, Susanne; Mittelmeier, Wolfram



The effects of dynamic stretching on plantar flexor muscle-tendon tissue properties.  


Dynamic stretching is commonly used in warm-up routines for athletic activities. Even though several positive effects of dynamic stretching on athletic performance have been reported, the effects on the muscle-tendon unit (MTU) itself are still unclear. The objective of this study is to determine the effects of dynamic stretching on the ankle plantar flexor muscle-tendon properties by use of ultrasonography. Twenty healthy male subjects participated in the present study. The subjects were asked to engage in dynamic stretching of plantar flexors for 30 s and to repeat for 5 sets. Ankle dorsiflexion ROM was measured before and after the dynamic stretching. Changes in the displacement of the myotendinous junction (MTJ), pennation angle, and fascicle length were also determined by using ultrasonography. Ankle dorsiflexion ROM increased significantly after the dynamic stretching (p < 0.0001). A significant distal displacement of the MTJ was observed until the second stretching set (p < 0.001) with no significant changes thereafter. Pennation angle, and fascicle length were unaffected by the dynamic stretching. Dynamic stretching was shown to be effective in increasing ankle joint flexibility. Outcomes that could have indicated changes in muscle tissue (such as the pennation angle and fascicle length) were unaltered. However, a significant displacement of the MTJ was found, indicating some change in the tendon tissues. Therefore, dynamic stretching of the plantar flexors was considered an effective means of lengthening the tendon tissues. PMID:21813313

Samukawa, Mina; Hattori, Masaki; Sugama, Naoko; Takeda, Naoki



Does skin stimulation compensate impairments in postural control after ankle plantar flexors fatigue?  


It has been suggested that skin stimulation using tape glued to the skin over the Achilles tendon helps to improve postural control. It was recently shown that these effects might emerge only after muscle fatigue and not during non-fatigue standing. Here we tested the influence of skin stimulation on postural control before and after fatigue of ankle plantar flexors. Eighteen subjects stood quietly on a force plate while the center of pressure was monitored before and after fatigue of ankle plantar flexors muscles, with and without medical tape glued to the skin over the Achilles tendon. Our results suggested main effects of tape stimulation before fatigue (P<.05) and significant effect of tape stimulation after fatigue only for amplitude of center of pressure in the anteroposterior direction. The novelty of our study is that most of the center of pressure variables are improved by skin stimulation when the ankle plantar flexors are not fatigued. Therefore the benefits of tape stimulation during fatigue condition are questionable. PMID:23117097

Kunzler, Marcos R; Lopes, Liane M; Ueda, Letícia S; de Britto, Morgana A; Carpes, Felipe P



Effectiveness of local tenoxicam versus corticosteroid injection for plantar fasciitis treatment.  


Plantar fasciitis is one of the most common causes of foot pain in adults. In this prospective study, the outcomes of local tenoxicam injection and corticosteroid therapy for the treatment of plantar fasciitis were compared. Patients were randomly assigned to either the tenoxicam or corticosteroid group. The tenoxicam group (n=31) was treated using a local injection of 1 mL of tenoxicam (20 mg/2 mL) and 1 mL of 2% lidocaine, whereas the steroid group (n=30) was treated with a local 1-mL injection containing 40 mg of methylprednisolone acetate and 1 mL of 2% lidocaine. Clinical evaluations, which were performed before the injection and 6 and 12 months after the injection, consisted of patient-assessed pain using a visual analog scale. In addition, patient satisfaction was measured using the Roles and Maudsley score. Comparison of pre- and posttreatment visual analog scale scores demonstrated a statistically significant difference in both groups (P<.05). Furthermore, no significant difference was found between the steroid and tenoxicam groups in terms of visual analog scale scores measured 12 months after injection (P>.05). The tenoxicam injection was not significantly more effective than the corticosteroid injection. However, both methods were effective and successful in treating patients with plantar fasciitis. Tenoxicam therapy appears to provide pain relief, but its effectiveness in the long term should be explored in additional studies. PMID:24093711

Guner, Savas; Onder, Haci; Guner, Sukriye Ilkay; Ceylan, Mehmet Fethi; Gökalp, Mehmet Ata; Keskin, Siddik



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

PubMed Central

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.

Lockhart, Thurmon E.; Kim, Sukwon



The Effect of Landing Surface on the Plantar Kinetics of Chinese Paratroopers Using Half-Squat Landing  

PubMed Central

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.

Li, Yi; Wu, Ji; Zheng, Chao; Huang, Rong Rong; Na, Yuhong; Yang, Fan; Wang, Zengshun; Wu, Di



Artificial gravity as a countermeasure to microgravity: a pilot study examining the effects on knee extensor and plantar flexor muscle groups  

PubMed Central

The goal of this project was to examine the effects of artificial gravity (AG) 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) group (n = 7) and 2) an AG group (n = 8), which was subjected to 21 days of 6° head-down tilt bed rest plus daily 1-h exposures to AG (2.5 G at the feet). Centrifugation was produced using a short-arm centrifuge with the foot plate ?220 cm from the center of rotation. The torque-velocity relationships of the knee extensors and plantar flexors of the ankle were determined pre- and posttreatment. Muscle biopsy samples obtained from the vastus lateralis and soleus muscles were used for a series of gene expression analyses (mRNA abundance) of key factors implicated in the anabolic vs. catabolic state of the muscle. Post/pre torque-velocity determinations revealed greater decrements in knee extensor performance in the BR vs. AG group (P < 0.04). The plantar flexors of the AG subjects actually demonstrated a net gain in the torque-velocity relationship, whereas in the BR group, the responses declined (AG vs. BR, P < 0.001). Muscle fiber cross-sectional area decreased by ?20% in the BR group, whereas no losses were evident in the AG group. RT-PCR analyses of muscle biopsy specimens demonstrated that markers of growth and cytoskeletal integrity were higher in the AG group, whereas catabolic markers were elevated in the BR group. Importantly, these patterns were seen in both muscles. 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.

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



Botulinum toxin effects on gasatrocnemius strength and plantar pressure in diabetics with peripheral neuropathy and forefoot ulceration  

PubMed Central

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.

Hastings, Mary K.; Mueller, Michael J.; Sinacore, David R.; Strube, Michael J.; Crowner, Beth; Johnson, Jeffrey E.; Racette, Brad A.



Chronic cuff electrode recordings from walking Göttingen mini-pigs.  


We present data from cuff electrode recordings from a mixed sensory-/motor nerve as expressed during walking in chronically implanted Göttingen mini-pigs. Our results show that it is possible to filter out residual electromyographic interference and that the energy content of the resulting electroneurographic (ENG) signals modulate clearly with gait. The approach may be used to detect heel strike from cuff electrode measurements to control the timing of stimulation in implantable foot drop correction systems. PMID:22254796

Andersen, Mads P; Munch, Majken; Jensen, Winnie; Sørensen, Preben; Eder, Clemens F



Chronic arsenic poisoning.  


Symptomatic arsenic poisoning is not often seen in occupational exposure settings. Attempted homicide and deliberate long-term poisoning have resulted in chronic toxicity. Skin pigmentation changes, palmar and plantar hyperkeratoses, gastrointestinal symptoms, anemia, and liver disease are common. Noncirrhotic portal hypertension with bleeding esophageal varices, splenomegaly, and hypersplenism may occur. A metallic taste, gastrointestinal disturbances, and Mee's lines may be seen. Bone marrow depression is common. 'Blackfoot disease' has been associated with arsenic-contaminated drinking water in Taiwan; Raynaud's phenomenon and acrocyanosis also may occur. Large numbers of persons in areas of India, Pakistan, and several other countries have been chronically poisoned from naturally occurring arsenic in ground water. Toxic delirium and encephalopathy can be present. CCA-treated wood (chromated copper arsenate) is not a health risk unless burned in fireplaces or woodstoves. Peripheral neuropathy may also occur. Workplace exposure or chronic ingestion of arsenic-contaminated water or arsenical medications is associated with development of skin, lung, and other cancers. Treatment may incklude the use of chelating agents such as dimercaprol (BAL), dimercaptosuccinic acid (DMSA), and dimercaptopanesulfonic acid (DMPS). PMID:11869818

Hall, Alan H



Incidental findings of massive heel spurs in a veteran with a variant of psoriatic arthritis.  


A middle-aged man presented for left foot diabetic ulcer care. Pedal radiographs were negative for signs of osteomyelitis. However, asymptomatic incidental osseous findings demonstrated significant plantar and posterior calcaneal spurring possibly consistent with diffuse idiopathic skeletal hyperostosis (DISH). A differential of DISH, psoriatic arthritis, Reiter's, and ankylosing spondylitis was developed. Subsequent spinal imaging and laboratory work-up did not satisfy the diagnostic criteria for DISH. This case illustrates radiographic changes characteristic of multiple seronegative arthropathies. On initial presentation a diagnosis of DISH was most likely, but with further imaging studies a diagnosis of a variant of psoriatic arthritis may be more correct. PMID:23001738

Lowell, Danae L; Osher, Lawrence S; Grady, Angela F



SciTech Connect

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.

Keefer, M.



Solitary erythematous, tender plaque of the heel in a young infant.  


Calcinosis cutis is a rare disorder resulting from the precipitation and deposition of insoluble calcium and phosphate salts (hydroxyapatite crystals) in the dermis and subcutaneous tissue. It is generally divided into four main groups on the basis of etiology and pathogenesis. Clinical presentation of cutaneous calcinosis cutis varies according to the diagnosis and the underlying process. We report a case of calcinosis cutis of the heel in which both the extravasation of a calcium gluconate infusion and renal failure could have promoted the development of calcinosis cutis. PMID:24050291

Vaccari, Sabina; Ismaili, Alma; Barisani, Alessia; Neri, Iria; Patrizi, Annalisa



[Ulceration of the heel in a woman from Djibouti: squamous cell carcinoma with carcinomatous lymphangitis].  


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

Bertani, A; Massoure, P L; Menguy, P; Lamblin, G; Eve, O; Morand, J J



Ultrasound imaging for diagnosis of plantar plate ruptures of the lesser metatarsophalangeal joints: a retrospective case series.  


Tears of the plantar plate can be a source of significant forefoot pain, leading to alterations of foot function and gait. The objective of the present retrospective study was to further determine the value of ultrasound imaging in diagnosing plantar plate tears after clinical evaluation through a comparison of the ultrasound and intraoperative examination findings. Eight patients were identified who had undergone surgical intervention for a painful lesser metatarsophalangeal joint after ultrasound examination to diagnose a plantar plate pathologic entity. The intraoperative examination findings were used to calculate the sensitivity, specificity, and positive and negative predictive values of ultrasound in the diagnosis of plantar plate tears. The sensitivity and specificity of the ultrasound examination was 1 and 0.6, respectively. The positive and negative predictive value was 0.6 and 1, respectively. An ultrasound examination in the diagnosis of lesser metatarsophalangeal joint plantar plate tears displayed comparable sensitivity in identifying the pathologic features when compared with magnetic resonance imaging, with considerably less financial cost for the examination. PMID:23870658

Carlson, Russell M; Dux, Katherine; Stuck, Rodney M



Variations of plantar thermographic patterns in normal controls and non-ulcer diabetic patients: novel classification using angiosome concept.  


Thermometry of the plantar skin temperature has been one of the important parameters for assessing ulceration risks in diabetic patients. Recent progress of infrared thermographic technology allows us to obtain imaging of temperature distribution of the whole plantar skin. However, it has not been fully elucidated to what extent the individual variation of the plantar thermographic patterns shows different trends between normal controls and diabetics. In this study, we made a novel framework of conceptual classification with 20 different categories of plantar thermographic patterns according to the foot angiosome concept. The thermographic images from 32 normal volunteers and 129 non-ulcer diabetic patients, recruited from Diabetes Foot Outpatient Clinic of the University of Tokyo Hospital, were allocated to the above-mentioned framework categories. In the normal group, thermographic patterns of more than 65% of feet were allocated to the two typical categories, including the 'butterfly pattern' among the 20 categories, whereas 225 feet (87.2%) of the diabetic groups were variously allocated to 18 out of the 20 categories. This is the first study, which describes detailed plantar thermographic patterns, showing wider variations in the diabetic patients than in the normal subjects. Thermography will be one of the screening options to assess circulatory status in both daily foot care and surgical intervention. PMID:21257357

Nagase, Takashi; Sanada, Hiromi; Takehara, Kimie; Oe, Makoto; Iizaka, Shinji; Ohashi, Yumiko; Oba, Miho; Kadowaki, Takashi; Nakagami, Gojiro



Control of bipedal posture following localised muscle fatigue of the plantar-flexors and finger-flexors.  


The present experiment investigated the control of bipedal posture following localised muscle fatigue of the plantar-flexors and finger-flexors. Twelve young healthy adults voluntarily participated in this study. They were asked to stand upright as still as possible with their eyes closed in two randomly ordered experimental sessions. Each session consisted of pre- and post-fatigue bipedal static postural control measurements immediately before and after a designated fatiguing protocol for plantar-flexor and finger-flexor muscles. Centre of foot pressure (CoP) displacements were recorded using a force platform. The results showed that the postural effects of localised muscle fatigue differed between the muscles targeted by the fatiguing procedures. Indeed, localised muscle fatigue of the plantar-flexors yielded increased CoP displacements, whereas localised muscle fatigue of the finger-flexors had no significant effect on the CoP displacements. In other words, fatigue localised to muscles which are involved in the performance of the postural task (plantar-flexors) degraded postural control, whereas fatigue localised to muscles which are not involved in the performance of the postural task did not. Taken together, the present findings support the recent conclusions that the effects of localised muscle fatigue on upright postural control is joint- and/or muscle-specific, and suggest that localised muscles fatigue of the plantar-flexors could mainly affect bipedal postural control via sensorimotor rather than cognitive processes. PMID:21626040

Hlavackova, Petra; Pradon, Didier; Vuillerme, Nicolas



Effects of plantar-flexor muscle fatigue on the magnitude and regularity of center-of-pressure fluctuations.  


Control of bipedal posture is highly automatized but requires attentional investment, the amount of which varies between participants and with postural constraints, such as plantar-flexor muscle fatigue. Elevated attentional demands for standing with fatigued plantar flexors have been demonstrated using a stimulus-response reaction-time paradigm. Recently, a direct relation between the regularity of center-of-pressure (COP) fluctuations and the amount of attention invested in posture was proposed, according to which more regular COP fluctuations are expected with muscle fatigue than without. To study this prediction, we registered anterior-posterior COP fluctuations for bipedal stance with eyes closed prior to and after a plantar-flexor muscle fatiguing exercise protocol in 16 healthy young adults. We quantified the magnitude of COP fluctuations with conventional posturography and its regularity with sample entropy. The magnitude of COP fluctuations increased significantly with fatigued plantar flexors. In addition, more regular COP fluctuations were observed with fatigued plantar flexors, as evidenced by significantly lower sample entropy values. These findings corroborated our hypotheses. Moreover, COP regularity assisted in qualifying the change in sway magnitude with fatigue. Whereas increased sway is customary taken to reflect impaired postural control, we interpret it as a functional, but attention-demanding adaptation to the alteration of important posture-specific information. PMID:21656214

Roerdink, Melvyn; Hlavackova, Petra; Vuillerme, Nicolas




SciTech Connect

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.

Thaxton, D; Timothy Baughman, T



[A case of aseptic osteomyelitis with heel ulcer improved by steroid application].  


A 43-year-old male patient was admitted to our hospital because of left heel pain and fever. He had had swelling of the left ankle joint and pain 4 years prior to this, and 4 years later, he was admitted to another hospital when left heel ulcer and fever developed. The ulcer was diagnosed and treated as a diabetic ulcer because of hyperglycemia. In spite of good control of blood sugar, the ulcer became enlarged and the pain deteriorated, so he was transferred to orthopedics. Antibiotics produced no response, and culture from a specimen of the ulcer was negative. However, severe inflammatory response was seen in blood examination. MRI and scintigram of his left foot showed disseminated low intensity areas and accumulation in the tarsal bone area, so osteomyelitis was suspected. A biopsy of the ulcer showed infiltration of inflammatory cells into the dermis. We considered amputation of the left lower leg at first. However the biopsy result suggested an autoimmune mechanism, so prednisolone was administered. As a result, the ulcer and pain both diminished. This case was similar to pyoderma gangenosum, however this diagnosis cannot explain osteomyelitis or all its symptoms. We expect that there must be other case report with the same symptoms. PMID:10917019

Idogawa, M; Takahashi, H; Soma, T; Mihara, M; Mizukoshi, T; Murakami, R; Sugaya, T; Makiguchi, Y; Imai, K



Lapidus bunionectomy: Early evaluation of crossed lag screws versus locking plate with plantar lag screw.  


We compared outcomes of the Lapidus bunionectomy fixated with crossed lag screws versus a locking plate with a plantar lag screw. Forty patients who underwent Lapidus bunionectomy between August 2001 and May 2006 were evaluated in a combined retrospective and prospective fashion. Crossed lag screws were used in 19 of the patients, and a locking plate with a plantar lag screw was used in 21 of the patients. Other than fixation, the only interventional difference pertained to postoperative weight bearing, where those receiving the plate initiated full weight bearing on the operated foot at 4 weeks postoperative, as compared to 6 weeks for those receiving crossed screws. Overall, the mean preoperative AOFAS hallux score was 41.75 +/- 2.52, and the postoperative score was 90.48 +/- 8.41 (P < .0001). The overall mean preoperative first intermetatarsal angle was 15.3 degrees +/- 2.32 degrees , and long term the angle was 5.03 degrees +/- 2.86 degrees (P < .0001). When comparisons were made based on the method of fixation, use of an adjunct Akin osteotomy and surgery performed before 2003 were statistically significantly associated with crossed screw fixation, and the preoperative AOFAS score was statistically significantly higher in the locking plate fixation group. There were no statistically significant differences related to postoperative complications between the 2 fixation groups. In conclusion, the Lapidus bunionectomy fixated with a locking plate and a plantar lag screw allows earlier weight bearing in comparison with crossed lag screws, without a difference in complications. Level of Clinical Evidence: 2. PMID:19232969

Saxena, Amol; Nguyen, Aidan; Nelsen, Elise


Effects of reduced plantar cutaneous afferent feedback on locomotor adjustments in dynamic stability during perturbed walking.  


This study examined the effects of reduced plantar cutaneous afferent feedback on predictive and feedback adaptive locomotor adjustments in dynamic stability during perturbed walking. Twenty-two matched participants divided between an experimental-group and a control-group performed a gait protocol, which included surface alterations to one covered exchangeable gangway-element (hard/soft). In the experimental-group, cutaneous sensation in both foot soles was reduced to the level of sensory peripheral neuropathy by means of intradermal injections of an anaesthetic solution, without affecting foot proprioception or muscles. The gait protocol consisted of baseline trials on a uniformly hard surface and an adaptation phase consisting of nineteen trials incorporating a soft gangway-element, interspersed with three trials using the hard surface-element (2nd, 8th and 19th). Dynamic stability was assessed by quantifying the margin of stability (MS), which was calculated as the difference between the base of support (BS) and the extrapolated centre of mass (CM). The horizontal velocity of the CM and its vertical projection in the anterior-posterior direction and the eigenfrequency of an inverted pendulum determine the extrapolated-CM. Both groups increased the BS at the recovery step in response to the first unexpected perturbation. These feedback corrections were used more extensively in the experimental-group, which led to a higher MS compared to the control-group, i.e. a more stable body-position. In the adaptation phase the MS returned to baseline similarly in both groups. In the trial on the hard surface directly after the first perturbation, both groups increased the MS at touchdown of the disturbed leg compared to baseline trials, indicating rapid predictive adjustments irrespective of plantar cutaneous input. Our findings demonstrate that the locomotor adaptational potential does not decrease due to the loss of plantar sensation. PMID:21726865

Höhne, Angela; Stark, Christian; Brüggemann, Gert-Peter; Arampatzis, Adamantios



Effect of Orthotics on Postural Sway After Fatigue of the Plantar Flexors and Dorsiflexors  

PubMed Central

Objective: To examine the effects of orthotic intervention on unilateral postural sway after fatigue of the plantar flexor and dorsiflexor muscle groups. Design and Setting: Subjects were assigned to both orthotic and nonorthotic testing conditions in a counterbalanced order, then assessed for postural sway before and after isokinetic fatiguing contractions of the plantar flexors and dorsiflexors. Postural stability was measured on the motor-dominant extremity. (Motor dominance was assessed as the foot the subject used to kick a ball.) Subjects: Eleven active, healthy male subjects (mean age = 24 ± 2.0 years, wt = 74.5 ± 8.8 kg, ht = 180.3 ± 8.4 cm) volunteered to participate in the study. Measurements: Center-of-pressure postural sway was assessed via the force platforms of a Chattecx Dynamic Balance System and transformed via 4 transducers as values indicative of sway in the anterior-posterior and medial-lateral directions. The dependent measure was postural sway in centimeters. Fatigue was induced by consecutive concentric plantar flexiondorsiflexion contractions on a Kin-Com II isokinetic dynamometer. Results: A repeated-measures analysis of variance revealed a significant orthotic-by-test interaction. Post hoc analysis with the Tukey honestly significant difference method revealed that postural sway values of the postfatigue nonorthotic condition were significantly greater when compared with the prefatigue orthotic, prefatigue nonorthotic, and postfatigue orthotic conditions. Conclusions: Our results suggest that molded orthotics may be an effective means of decreasing postural sway after an isokinetic fatigue protocol. Further research is needed to determine the exact mechanism of this improvement and whether orthotics are an effective means of preventing ankle injury.

Ochsendorf, David T.; Mattacola, Carl G.; Arnold, Brent L.



Fixation of the Lapidus arthrodesis with a plantar interfragmentary screw and medial low profile locking plate.  


The Lapidus arthrodesis can be used to correct pathology within the forefoot or midfoot, and severe hallux valgus deformities as well as hypermobility of the medial column may be amenable to correction with this procedure. Many different skeletal fixation methods have been described for this procedure, and one form that appears to provide enough construct stability to allow patients to bear weight early in the postoperative period is described herein. This construct consists of an interfragmental compression screw oriented from the plantar aspect of the first metatarsal to the superior aspect of the medial cuneiform, with medial locking plate augmentation. PMID:22632842

Cottom, James M



Forefoot plantar multilobular noninfiltrating angiolipoma: a case report and review of the literature  

PubMed Central

Background Soft tissue tumors of the feet are uncommon and there have been very few reports of large series in the literature. These tumors continue to present the clinician with one of the most difficult problems in medicine. Case presentation We present a case of a large multilobular noninfiltrating angiolipoma at the plantar surface of the forefoot. Only three cases occurring at the foot have been previously described. We report this new case due to unusual location of the tumor, the long duration (25 years) of its existence and the unique surgical approach for the tumor excision. Conclusion Surgical excision is the treatment of choice and adjuvant radiotherapy is indicated in select cases.

Grivas, Theodoros B; Savvidou, Olga D; Psarakis, Spyridon A; Liapi, Georgia; Triantafyllopoulos, George; Kovanis, Ioannis; Alexandropoulos, Panagiotis; Katsiva, Vasiliki



Topical 5% 5-fluorouracil cream in the treatment of plantar warts: a prospective, randomized, and controlled clinical study.  


Topical 5-fluorouracil (5-FU) is an antineoplastic antimetabolite that inhibits DNA and RNA synthesis, thereby preventing cell replication and proliferation. This mechanism of action may allow topical 5-FU to be utilized in the treatment of human papilloma virus (HPV). We conducted a study comparing 5% 5-FU cream under tape occlusion versus tape occlusion alone in 40 patients presenting with plantar warts. Nineteen out of 20 patients (95%) randomized to 5% 5-FU with tape occlusion had complete eradication of all plantar warts within 12 weeks of treatment. The average time to cure occurred at 9 weeks of treatment. Three patients (15%) had a recurrence at the 6-month follow-up visit; accordingly, an 85% sustained cure rate was observed. It is concluded that use of topical 5% 5-fluorouracil cream for plantar warts is safe, efficacious, and accepted by the patient. PMID:16703777

Salk, Robert S; Grogan, Kirk A; Chang, Thomas J



Movement Behavior of High-Heeled Walking: How Does the Nervous System Control the Ankle Joint during an Unstable Walking Condition?  

PubMed Central

The human locomotor system is flexible and enables humans to move without falling even under less than optimal conditions. Walking with high-heeled shoes constitutes an unstable condition and here we ask how the nervous system controls the ankle joint in this situation? We investigated the movement behavior of high-heeled and barefooted walking in eleven female subjects. The movement variability was quantified by calculation of approximate entropy (ApEn) in the ankle joint angle and the standard deviation (SD) of the stride time intervals. Electromyography (EMG) of the soleus (SO) and tibialis anterior (TA) muscles and the soleus Hoffmann (H-) reflex were measured at 4.0 km/h on a motor driven treadmill to reveal the underlying motor strategies in each walking condition. The ApEn of the ankle joint angle was significantly higher (p<0.01) during high-heeled (0.38±0.08) than during barefooted walking (0.28±0.07). During high-heeled walking, coactivation between the SO and TA muscles increased towards heel strike and the H-reflex was significantly increased in terminal swing by 40% (p<0.01). These observations show that high-heeled walking is characterized by a more complex and less predictable pattern than barefooted walking. Increased coactivation about the ankle joint together with increased excitability of the SO H-reflex in terminal swing phase indicates that the motor strategy was changed during high-heeled walking. Although, the participants were young, healthy and accustomed to high-heeled walking the results demonstrate that that walking on high-heels needs to be controlled differently from barefooted walking. We suggest that the higher variability reflects an adjusted neural strategy of the nervous system to control the ankle joint during high-heeled walking.

Alkjaer, Tine; Raffalt, Peter; Petersen, Nicolas C.; Simonsen, Erik B.



The impact of the Spartathlon ultramarathon race on athletes' plantar pressure patterns.  


More than 90% of injuries in runners are recorded in the lower extremity, equally affecting the regions of the knee, shank, and foot. Stress fractures are responsible for numerous running-related injuries. In the current study, the plantar pressure patterns of prerace, immediately postrace, and 24 hours after long-distance running in the Spartathlon were analyzed to compare foot loading in the respective conditions. Forty-six male participants of the Spartathlon ultramarathon were examined before, immediately after completion of the race, and 24 hours later with plantar pressure measurements during barefoot walking on a capacitive platform. The results revealed a significant increase in the peak pressure and impulse values in the forefoot areas and a decrease under the toes before and immediately after the race. On the contrary, no significant differences were found between the prerace and the 24-hour postrace values. The present findings indicate that the Spartathlon race leads to significant variations in foot-loading characteristics, especially in the peak pressure and impulse values under the forefoot and toe regions. Twenty-four-hour postrace data measurements reveal insignificant differences from the prerace statement, probably because of the restoration of local muscular activity. PMID:19825771

Karagounis, Panagiotis; Prionas, Giorgos; Armenis, Elias; Tsiganos, Georgios; Baltopoulos, Panagiotis



Vascularized plantar myocutaneous free flap transfer for amputee stump preparation: a proof of concept cadaver study.  


Lower extremity amputee stump ulceration, irritation, and pain have been a deterrent to consistent long-term or continuous use of lower extremity prosthetics. This study is the first in a series that hypothesizes that these complications can be minimized through the insetting of a vascularized plantar free flap (VPFF) on the amputee stump. Using three hip disarticulated cadaver specimens, a VPFF was designed, dissected, and implanted on one transfemoral and two transtibial stumps. Using accepted vascular anastomosis techniques, the posterior tibial artery was anastomosed to the distal femoral or popliteal artery with corresponding anastomoses for venous drainage. In addition, the possibility of a limited to partial sensate flap may be created with a neurorrhaphy of the associated nerves. This potentially sensate area would provide plantar skin that aids the existing local sensate flap used to close the defect. It is hypothesized that this procedure offers significant rehabilitative and long-term benefits to battlefield or other acute causes for lower extremity amputation. The procedure can be accomplished in battlefield surgical setting as an immediate or delayed inset for some but not all traumatic amputations. Salvaging a partial or complete VPFF from a traumatized foot will obviously be predicated on the degree of trauma to the donor tissue. PMID:23495470

Smith, Larry N; Richards, Winston T; Mozingo, David W; Lottenberg, Lawrence



Optimal control of the heel-off to lift-off phase of two maximum height jumps  

Microsoft Academic Search

A Mathematical model is first developed for the following two tasks. Jump as high as possible starting from a deep crouch with your feet flat on the floor. Jump as high as possible starting from a deep crouch with your weight balanced on your toes (heels off the ground throughout). Then, the mathematical model, which takes the form of an

W. Levine; F. Zajac; Y. Cho; M. Zomlefer


Small Molecule Inhibitors Targeting the 'Achilles' Heel of Androgen Receptor Activity  

PubMed Central

Androgen ablation therapy remains the gold standard for the treatment of advanced prostate cancer, but unfortunately, it is not curative and eventually the disease will return as lethal castration-resistant prostate cancer (CRPC). There is mounting evidence supporting the concept that development of CRPC is causally related to continued transactivation of androgen receptor (AR). All current therapies that target the AR are dependent on the presence of its C-terminal ligand-binding domain (LBD). However, it is the N-terminal domain (NTD) of the AR that is the “Achilles Heel” of AR activity, with AF-1 being essential for AR activity regardless of androgen. Recent efforts to develop drugs to the AR NTD have yielded EPI-001 a small molecule, sintokamide peptides, and decoys to the AR NTD with EPI-001 the best characterized and most promising for clinical development based upon specificity, low toxicity, and cytoreductive antitumor activity.

Sadar, Marianne D.



Detection of swing heel-off event in gait initiation using force-plate data.  


This study investigated the accuracy and reliability of four methods using force-plate data for detecting the swing heel-off (HO) time in gait initiation. Results of these methods were compared to those obtained by means of a reference method using a footswitch. Ten young healthy adults performed 18 forward gait initiation trials at self-selected speed and at maximal speed. Results showed that the method based on vertical impulse was the most accurate and reliable in determining HO in both speed conditions. The mean error obtained with this method was -8±10ms in the self-selected speed condition (-7±10ms in the maximal speed condition), with no significant effect of gait speed (P>0.05). These findings suggest that this method based on force-plate data is valid and reliable for detecting HO in forward gait initiation in the absence of additional hardware. PMID:22980912

Caderby, T; Yiou, E; Peyrot, N; Bonazzi, B; Dalleau, G



Wet litter as a cause of plantar pododermatitis, leading to foot ulceration and lameness in fattening turkeys  

Microsoft Academic Search

Spraying water to produce wet litter increased the severity and incidence of plantar pododermatitis in two commercial strains of fattening turkeys. A clinical syndrome resembling “shaky leg” was also produced. In one experiment breast blisters, scabby hocks and a depression of final body weight were seen.

M. F. Martland



The use of felt deflective padding in the management of plantar hallux and forefoot ulcers in patients with diabetes  

Microsoft Academic Search

BackgroundFoot ulceration in diabetes is precipitated and perpetuated by many factors, chiefly peripheral neuropathy and biomechanical abnormalities. Offloading of plantar pressure is a key element in the management of diabetic neuropathic foot ulcers with different techniques available to achieve this. Felt deflective padding (or accommodative padding) with an aperture over the ulcer site has been shown to reduce pressure.

Vanessa L. Nubé; Lynda Molyneaux; Thyra Bolton; Tazmin Clingan; Eva Palmer; Dennis K. Yue



Acute passive stretching alters the mechanical properties of human plantar flexors and the optimal angle for maximal voluntary contraction  

Microsoft Academic Search

The purpose of this study was to investigate whether acute passive stretching (APS) reduced maximal isometric voluntary contraction (MVC) of the plantar flexors (PF) and if so, by what mechanisms. The PF in 15 female volunteers were stretched for 10 min (5×120 s) by a torque motor to within 2° of maximum dorsiflexion (D) range of motion (ROM). MVC with twitch interpolation,

Derek E. Weir; Jill Tingley; Geoffrey C. B. Elder



Differences in plantar loading between training shoes and racing flats at a self-selected running speed  

Microsoft Academic Search

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

Johannes I. Wiegerinck; Jennifer Boyd; Jordan C. Yoder; Alicia N. Abbey; James A. Nunley; Robin M. Queen



Differential postural effects of plantar-flexor muscles fatigue under normal, altered and improved vestibular and neck somatosensory conditions  

Microsoft Academic Search

The aim of the present study was to assess the effects of plantar-flexor muscles fatigue on postural control during quiet standing under normal, altered and improved vestibular and neck somatosensory conditions. To address this objective, young male university students were asked to stand upright as still as possible with their eyes closed in two conditions of No Fatigue and Fatigue

Nicolas Pinsault; Nicolas Vuillerme



Comparison of foot orthoses made by podiatrists, pedorthists and orthotists regarding plantar pressure reduction in The Netherlands  

Microsoft Academic Search

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

Nick A Guldemond; Pieter Leffers; Nicolaas C Schaper; Antal P Sanders; Fred HM Nieman; Geert HIM Walenkamp



Foot claudication with plantar flexion as a result of dorsalis pedis artery impingement in an Irish dancer.  


Dorsalis pedis artery impingement is an extremely rare cause of foot claudication, with a single case reported in the literature. In this report, we describe the case of a 17-year-old female Irish dancer who presented with intermittent bilateral foot pain and discoloration during active plantar flexion. PMID:23352357

Smith, Brigitte K; Engelbert, Travis; Turnipseed, William D



Effect of plantar local anesthetic injection on dorsal horn neuron activity and pain behaviors caused by incision  

Microsoft Academic Search

Hypersensitivity after tissue injury is an expression of neuronal plasticity in the central nervous system. This has been explored most extensively using in vitro preparations and animal models of inflammatory pain and chemical irritation. For pain after surgery, a similar process has been proposed. In the present study, we examined dorsal horn neuron (DHN) sensitization using the plantar incision model

Esther M Pogatzki; Erik P Vandermeulen; Timothy J Brennan



Plantar Wart  


... respond in 1–2 months. Over-the-counter freezing medications are available but have not been found ... try one or more of the following treatments: Freezing with liquid nitrogen (cryosurgery) Burning with an electric ...


Plantar Warts  


... apply liquid nitrogen with a spray canister or cotton-tipped applicator to freeze and destroy your wart. ... the wart with a cider-soaked piece of cotton ball, and cover the cotton ball with an ...


Knee extensor and plantar flexor muscle size and function following 90 days of bed rest with or without resistance exercise.  


Skeletal muscle atrophy and strength loss induced by short-term simulated spaceflight are offset or attenuated by resistance exercise (RE). This study compared the effects of plantar flexor and knee extensor RE on muscle size and function in 17 healthy men (aged 26-41years) subjected to 90 days 6 degrees head-down-tilt bed rest with (BRE; n = 8) or without (BR; n = 9) RE. The RE program consisted of coupled maximal concentric and eccentric actions in the supine squat (4 sets of 7 repetitions) and calf press (4 x 14) every third day employing a gravity-independent flywheel ergometer (FW). Prior to, and following bed rest, muscle volume was assessed using magnetic resonance imaging. Similarly, muscle strength and power and surface electromyographic (EMG) activity were determined during maximal actions using FW or isokinetic dynamometry. In BR, knee extensor and plantar flexor muscle volume decreased (P < 0.05) 18% and 29%, respectively. Torque or force and power decreased (P < 0.05) 31 60% (knee extension) and 37-56% (plantar flexion) while knee extensor and plantar flexor EMG activity decreased 31-38% and 28-35%, respectively following BR. Muscle atrophy in BRE was prevented (P > 0.05; knee extensors) or attenuated (-15%; plantar flexors). BRE maintained task-specific force, power and EMG activity. The decrease in non-task-specific torque was less (P < 0.05) than in BR. The present data imply that the triceps surae and quadriceps muscles show different responsiveness to long-term bed rest with or without resistance exercise. The results also suggest that designing in-flight resistance exercise protocols for space travellers is complex and must extend beyond preserving muscle only. PMID:15338217

Alkner, Björn A; Tesch, Per A



Evaluation and Optimization of Therapeutic Footwear for Neuropathic Diabetic Foot Patients Using In-Shoe Plantar Pressure Analysis  

PubMed Central

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.

Bus, Sicco A.; Haspels, Rob; Busch-Westbroek, Tessa E.



Difference in plantar pressure between the preferred and non-preferred feet in four soccer-related movements  

PubMed Central

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.

Wong, Pui-lam; Chamari, Karim; Chaouachi, Anis; De Wei Mao; Wisl?ff, Ulrik; Hong, Youlian



Plantar fibromatosis may adopt the brain gyriform pattern of a low-grade fibromyxoid sarcoma.  


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

Touraine, Sébastien; Bousson, Valérie; Kaci, Rachid; Parlier-Cuau, Caroline; Haddad, Samuel; Laouisset, Liess; Petrover, David; Laredo, Jean-Denis



A Hybrid Soft-computing Method for Image Analysis of Digital Plantar Scanners  

PubMed Central

Digital foot scanners have been developed in recent years to yield anthropometrists digital image of insole with pressure distribution and anthropometric information. In this paper, a hybrid algorithm containing gray level spatial correlation (GLSC) histogram and Shanbag entropy is presented for analysis of scanned foot images. An evolutionary algorithm is also employed to find the optimum parameters of GLSC and transform function of the membership values. Resulting binary images as the thresholded images are undergone anthropometric measurements taking in to account the scale factor of pixel size to metric scale. The proposed method is finally applied to plantar images obtained through scanning feet of randomly selected subjects by a foot scanner system as our experimental setup described in the paper. Running computation time and the effects of GLSC parameters are investigated in the simulation results.

Razjouyan, Javad; Khayat, Omid; Siahi, Mehdi; Mansouri, Ali Alizadeh



The effect of three different toe props on plantar pressure and patient comfort  

PubMed Central

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?



Separate groups of dorsal horn neurons transmit spontaneous activity and mechanosensitivity one day after plantar incision.  


Dorsal horn neuron (DHN) sensitization can be induced and maintained by nociceptor activation. In previous studies, only a small increase in ongoing DHN activity was present immediately after plantar incision; yet, powerful activation of nociceptors was prominent 1 day after incision. In the present study, rats underwent plantar incision or sham surgery as control. One day later pain behaviors were measured; then DHN activity and response properties to mechanical stimulation were recorded in vivo. In some neurons with spontaneous activity, the incision was anesthetised using bupivacaine. Spontaneous activity was identified in 9 of 27 neurons in the control group and in 16 of 26 neurons (P<0.05) in the incision group; the spontaneous activity in incised animals (19.1+/-8.5 imp/s) was also greater than in controls (10.6+/-6.1 imp/s, P<0.05). For neurons without spontaneous activity, the responses to mechanical stimuli of the incision group were greater (P<0.01); for neurons with spontaneous activity, there was no such difference. After bupivacaine injection, no difference was present in the amount of spontaneous activity between the two groups. This study demonstrates that 1 day after incision, DHN sensitization manifests in markedly increased spontaneous activities, enhanced responses to mechanical stimuli and expanded receptive fields (RFs). Separate groups of neurons appear to transmit spontaneous activity and enhanced responses to mechanical stimuli. Inhibition of spontaneous activity by blockade of afferent input indicates that the prolonged spinal hyperactivity remains largely dependent on the ongoing primary afferent activity. PMID:19081275

Xu, Jun; Richebe, Philippe; Brennan, Timothy J



Relationship between self-reported high-heeled shoe use and bone mineral density using quantitative ultrasound at a community health fair.  


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

Glassy, Crystal M; Glassy, Matthew S; Guggenheim, Carla



Quantitative ultrasound variables of the heel in Finnish men aged 18–20 yr: predictors, relationship to bone mineral content, and changes during military service  

Microsoft Academic Search

Introduction  Determinants of BUA and SOS and their changes during military service-associated physical training were studied in 196 army recruits and 50 control men, aged 18–20 years.Methods  Heel ultrasound measurement, DXA, muscle strength test, Cooper’s running test and genetic analyses were performed. Lifestyle factors were recorded. Sex steroids and bone turnover markers were determined. Heel ultrasound was repeated after six months.Results  Exercise was the most

V.-V. Välimäki; E. Löyttyniemi; M. J. Välimäki



Compensatory adjustments in lower extremity kinematics in response to a reduced cushioning of the impact interface in heel–toe running  

Microsoft Academic Search

The response of heel-toe runners to changes in cushioning of the impact interface was investigated. Ground reaction force\\u000a and sagittal plane kinematic data were collected for six heel-toe runners performing barefoot running trials on a conventional\\u000a asphalt surface and an asphalt surface with additional cushioning. Statistical analysis indicated that similar peak impact\\u000a force values were maintained when running on the

S. J. Dixon; A. C. Collop; M. E. Batt



Chronic ankle instability.  


Chronic instability of the ankle and anterolateral impingement syndrome are abnormalities that present as a result of inversion and forced plantar-flexion traumas of the foot, despite strict conservative management in the ER and in rehabilitation. A conservative approach is always the first choice of treatment, including anti-inflammatory medications, rehabilitation and proprioception, infiltration with steroids in impingement cases, and use of orthotics, whose true effectiveness is the subject of multiple studies and much debate. Good to excellent results can be obtained surgically with a minimally invasive approach, such as the arthroscopic technique presented herein. Such an approach is useful in managing a combination of conditions such as anterolateral impingement, synovitis, and osteochondral lesions of the talus. The method is easily reproducible, its learning curve is rapid, and it has the advantage of not preventing the use other arthroscopic methods, or open anatomic or nonanatomic methods (tendon transfers), in the case of failure. No nerve lesion was recorded, probably owing to the use of the security zone, and neither was there any arthrofibrosis, possibly related to the use of nonsteroidal anti-inflammatory medications in the immediate postsurgical period coupled with aggressive rehabilitation from the fourth week. The success of the technique is due to multidisciplinary team work leading to the ultimate achievement of patient satisfaction. This technique is not indicated for patients with a high sports demand or for sport professionals, until further biomechanical studies on its use and success are completed. PMID:22938637

Gerstner Garces, Juan Bernardo



Low-energy extracorporeal shock wave therapy for painful heel: a prospective controlled single-blind study  

Microsoft Academic Search

The aim of this prospective single-blind pilot study was to explore the pain-alleviating effect of low-energy extracorporeal shock wave therapy (ESWT) in painful heel associated with inferior calcaneal spurs. Thirty patients who suffered from persistent symptoms for more than 12 months qualified for low-energy ESWT and were assigned at random to two groups, real or simulated ESWT. Before beginning the

J. D. Rompe; C. Hopf; B. Nafe; R. Bürger



Early mobilization after sliding and Z-lengthening of heel cord: a preliminary experimental study in rabbits  

Microsoft Academic Search

Sliding lengthening and Z-lengthening techniques are widely used in heel cord lengthening. Even though most surgeons performing\\u000a these procedures apply a short leg cast after surgery, their postoperative immobilization intervals vary from 3 to 7 weeks.\\u000a Nather et al. showed that there was no need for immobilization after the musculotendinous lengthening of long, deep flexor\\u000a tendons. In the present study,

Seref Aktas; Selcuk Ercan; Latife Candan; Ulker Moralar; Erol Akata



The oscillatory behavior of the CoM facilitates mechanical energy balance between push-off and heel strike  

Microsoft Academic Search

Humans use equal push-off and heel strike work during the double support phase to minimize the mechanical work done on the center of mass (CoM) during the gait. Recently, a step-to-step transition was reported to occur over a period of time greater than that of the double support phase, which brings into question whether the energetic optimality is sensitive to

Seyoung Kim


The relation between bone mineral density in the heel and pixel intensity in the mandibular jaw bone among elderly women  

PubMed Central

Objectives The purpose of this study was to investigate the correlation between pixel intensity (PI) in digital radiographs of the lower jaw and bone mineral density (BMD) in the heels of post-menopausal women (as measured with DXL, a combination of dual energy X-ray absorptiometry and lasers). Methods Two intraoral periapical digital radiographs were taken in the right and left mandible premolar region, and the digital images were analysed by a computer program (Dimaxis) regarding PI. As the radiographs were taken, the BMD of the patient's left heel was measured via a portable Calscan device. The patient answered a questionnaire concerning risk factors. The correlation between variables was analysed using statistical tests. Results A significant correlation was found between the PI in the left (P = 0.001) and right (P = 0.004) mandible and the BMD of the left heel for the whole group. A pronounced correlation was found to exist for women > 70 years old. Based on a cut-off value of the PI, to differentiate between healthy individuals and those who required further analysis for osteoporosis, the following values were obtained: sensitivity 0.74, specificity 0.50, positive predictive value 0.77 and negative predictive value 0.46. Conclusion A positive correlation was found between PI in digital radiographs of the mandible and the BMD of the heel. The low predictive value does not allow any definite conclusions to be drawn from the present study. A reasonable recommendation could be for future studies to employ a larger study population to explore the effect on this value.

Hedstrom, L; Baigi, A; Bergh, H



The oscillatory behavior of the CoM facilitates mechanical energy balance between push-off and heel strike.  


Humans use equal push-off and heel strike work during the double support phase to minimize the mechanical work done on the center of mass (CoM) during the gait. Recently, a step-to-step transition was reported to occur over a period of time greater than that of the double support phase, which brings into question whether the energetic optimality is sensitive to the definition of the step-to-step transition. To answer this question, the ground reaction forces (GRFs) of seven normal human subjects walking at four different speeds (1.1-2.4 m/s) were measured, and the push-off and heel strike work for three differently defined step-to-step transitions were computed based on the force, work, and velocity. To examine the optimality of the work and the impulse data, a hybrid theoretical-empirical analysis is presented using a dynamic walking model that allows finite time for step-to-step transitions and incorporates the effects of gravity within this period. The changes in the work and impulse were examined parametrically across a range of speeds. The results showed that the push-off work on the CoM was well balanced by the heel strike work for all three definitions of the step-to-step transition. The impulse data were well matched by the optimal impulse predictions (R(2)>0.7) that minimized the mechanical work done on the CoM during the gait. The results suggest that the balance of push-off and heel strike energy is a consistent property arising from the overall gait dynamics, which implies an inherited oscillatory behavior of the CoM, possibly by spring-like leg mechanics. PMID:22035641

Kim, Seyoung; Park, Sukyung



Effects of 17?days bedrest on the maximal voluntary isometric torque and neuromuscular activation of the plantar and dorsal flexors of the ankle  

Microsoft Academic Search

Maximal voluntary isometric torque values of the ankle plantar (T\\u000a im,PF) and dorsal flexors (T\\u000a im,DF) were assessed in eight healthy adult males at 5° and 15° of dorsal flexion (DF) and at 5°, 15° and 25° of plantar flexion\\u000a (PF) with the knee at right angles, before (two times), during (three times) and after (three times) 17?days of 6°

S. Milesi; C. Capelli; J. Denoth; T. Hutchinson; E. Stüssi



Plantar-flexor Static Stretch Training Effect on Eccentric and Concentric Peak Torque - A comparative Study of Trained versus Untrained Subjects  

PubMed Central

The aim of this study was to examine the long-term effects of static stretching of the plantar-flexor muscles on eccentric and concentric torque and ankle dorsiflexion range of motion in healthy subjects. Seventy five healthy male volunteers, with no previous history of trauma to the calf that required surgery, absence of knee flexion contracture and no history of neurologic dysfunction or disease, systemic disease affecting the lower extremities were selected for this study. The participants were divided into three equal groups. The control group did not stretch the plantar-flexor muscles. Two Experimental groups (trained and untrained) were instructed to perform static stretching exercise of 30 second duration and 5 repetitions twice daily. The stretching sessions were carried out 5 days a week for 6 weeks. The dorsiflexion range of motion was measured in all subjects. Also measured was the eccentric and concentric torque of plantar-flexors at angular velocities of 30 and 120°/s pre and post stretching. Analysis of variance showed a significant increase in plantar-flexor eccentric and concentric torque (p < 0.05) of trained and untrained groups, and an increase in dorsiflexion range of motion (p < 0.05) at both angular velocities for the untrained group only. The static stretching program of plantar-flexors was effective in increasing the concentric and eccentric plantarflexion torque at angular velocities of 30 and 120°/s. Increases in plantar-flexors flexibility were observed in untrained subjects.

Abdel-aziem, Amr Almaz; Mohammad, Walaa Sayed



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

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.



Plantar-flexor Static Stretch Training Effect on Eccentric and Concentric Peak Torque - A comparative Study of Trained versus Untrained Subjects.  


The aim of this study was to examine the long-term effects of static stretching of the plantar-flexor muscles on eccentric and concentric torque and ankle dorsiflexion range of motion in healthy subjects. Seventy five healthy male volunteers, with no previous history of trauma to the calf that required surgery, absence of knee flexion contracture and no history of neurologic dysfunction or disease, systemic disease affecting the lower extremities were selected for this study. The participants were divided into three equal groups. The control group did not stretch the plantar-flexor muscles. Two Experimental groups (trained and untrained) were instructed to perform static stretching exercise of 30 second duration and 5 repetitions twice daily. The stretching sessions were carried out 5 days a week for 6 weeks. The dorsiflexion range of motion was measured in all subjects. Also measured was the eccentric and concentric torque of plantar-flexors at angular velocities of 30 and 120°/s pre and post stretching. Analysis of variance showed a significant increase in plantar-flexor eccentric and concentric torque (p < 0.05) of trained and untrained groups, and an increase in dorsiflexion range of motion (p < 0.05) at both angular velocities for the untrained group only. The static stretching program of plantar-flexors was effective in increasing the concentric and eccentric plantarflexion torque at angular velocities of 30 and 120°/s. Increases in plantar-flexors flexibility were observed in untrained subjects. PMID:23486840

Abdel-Aziem, Amr Almaz; Mohammad, Walaa Sayed




SciTech Connect

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.

Hay, M.; King, W.; Martino, C.



Variability of neural activation during walking in humans: short heels and big calves.  


People come in different shapes and sizes. In particular, calf muscle size in humans varies considerably. One possible cause for the different shapes of calf muscles is the inherent difference in neural signals sent to these muscles during walking. In sedentary adults, the variability in neural control of the calf muscles was examined with muscle size, walking kinematics and limb morphometrics. Half the subjects walked while activating their medial gastrocnemius (MG) muscles more strongly than their lateral gastrocnemius (LG) muscles during most walking speeds ('MG-biased'). The other subjects walked while activating their MG and LG muscles nearly equally ('unbiased'). Those who walked with an MG-biased recruitment pattern also had thicker MG muscles and shorter heel lengths, or MG muscle moment arms, than unbiased walkers, but were similar in height, weight, lower limb length, foot length, and exhibited similar walking kinematics. The relatively less plastic skeletal system may drive calf muscle size and motor recruitment patterns of walking in humans. PMID:21288939

Ahn, A N; Kang, J K; Quitt, M A; Davidson, B C; Nguyen, C T



Unsupervised segmentation of heel-strike IMU data using rapid cluster estimation of wavelet features.  


When undertaking gait-analysis, one of the most important factors to consider is heel-strike (HS). Signals from a waist worn Inertial Measurement Unit (IMU) provides sufficient accelerometric and gyroscopic information for estimating gait parameter and identifying HS events. In this paper we propose a novel adaptive, unsupervised, and parameter-free identification method for detection of HS events during gait episodes. Our proposed method allows the device to learn and adapt to the profile of the user without the need of supervision. The algorithm is completely parameter-free and requires no prior fine tuning. Autocorrelation features (ACF) of both antero-posterior acceleration (aAP) and medio-lateral acceleration (aML) are used to determine cadence episodes. The Discrete Wavelet Transform (DWT) features of signal peaks during cadence are extracted and clustered using Swarm Rapid Centroid Estimation (Swarm RCE). Left HS (LHS), Right HS (RHS), and movement artifacts are clustered based on intra-cluster correlation. Initial pilot testing of the system on 8 subjects show promising results up to 84.3%±9.2% and 86.7%±6.9% average accuracy with 86.8%±9.2% and 88.9%±7.1% average precision for the segmentation of LHS and RHS respectively. PMID:24109847

Yuwono, Mitchell; Su, Steven W; Moulton, Bruce D; Nguyen, Hung T




SciTech Connect

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.

King, W.; Hay, M.; Wiersma, B.; Pennebaker, F.



How a plantar pressure-based, tongue-placed tactile biofeedback modifies postural control mechanisms during quiet standing  

Microsoft Academic Search

The purpose of the present study was to determine the effects of a plantar pressure-based, tongue-placed tactile biofeedback\\u000a on postural control mechanisms during quiet standing. To this aim, 16 young healthy adults were asked to stand as immobile\\u000a as possible with their eyes closed in two conditions of No-biofeedback and Biofeedback. Centre of foot pressure (CoP) displacements,\\u000a recorded using a

Nicolas Vuillerme; Nicolas Pinsault; Olivier Chenu; Matthieu Boisgontier; Jacques Demongeot; Yohan Payan



Quantifying a relationship between tactile and vibration sensitivity of the human foot with plantar pressure distributions during gait  

Microsoft Academic Search

Objective. To quantify the relationship between the tactile and vibration sensitivity thresholds of the sole of the human foot with plantar pressure distribution while walking and running.Design. Cross-sectional study performed in a laboratory setting.Background. Results of previous studies of human locomotion have identified potentially dangerous variations in locomotion patterns. A common approach to manage these variations is with the use

Matthew A Nurse; Benno M Nigg



Control of bipedal posture following localised muscle fatigue of the plantar-flexors and finger-flexors  

Microsoft Academic Search

The present experiment investigated the control of bipedal posture following localised muscle fatigue of the plantar-flexors\\u000a and finger-flexors. Twelve young healthy adults voluntarily participated in this study. They were asked to stand upright as\\u000a still as possible with their eyes closed in two randomly ordered experimental sessions. Each session consisted of pre- and\\u000a post-fatigue bipedal static postural control measurements immediately

Petra Hlavackova; Didier Pradon; Nicolas Vuillerme


Differential postural effects of plantar–flexor muscle fatigue under normal, altered and improved vestibular and neck somatosensory conditions  

Microsoft Academic Search

The aim of the present study was to assess the effects of plantar–flexor muscle fatigue on postural control during quiet standing\\u000a under normal, altered and improved vestibular and neck somatosensory conditions. To address this objective, young male university\\u000a students were asked to stand upright as still as possible with their eyes closed in two conditions of No Fatigue and Fatigue

Nicolas Pinsault; Nicolas Vuillerme



The effect of low-dye taping on rearfoot motion and plantar pressure during the stance phase of gait  

PubMed Central

Background Low-dye (LD) taping is commonly used to reduce rearfoot pronation. No studies have previously investigated the effectiveness of LD taping using both plantar pressure distribution (F-Scan) and 3-D (CODA) analysis of rearfoot motion. Methods 20 healthy subjects with a navicular drop test exceeding 10 mm participated in the study. T tests were used to determine whether significant (p < 0.05) differences in plantar pressure and rearfoot motion occurred with LD taping. Results LD taping resulted in statistically significant increases in peak plantar pressure in the lateral midfoot (p = 0.000), along with significant decreases in pressure in the medial forefoot (p = 0.014), and the medial (p = 0.000) and lateral hindfoot (p = 0.007). No significant changes occurred in the medial midfoot (p = 0.794) or lateral forefoot (p = 0.654). When assessed using motion analysis, taping resulted in a statistically significant decrease in rearfoot pronation (p = 0.006), supination (p = 0.025) and total rearfoot range of motion (p = 0.000). The mean rearfoot position during stance was not significantly different however (p = 0.188). Conclusion LD taping is associated with alterations in peak plantar pressure in the midfoot and forefoot that indicate reduced pronation with LD taping. However, LD taping appears to reduce both pronation and supination in the rearfoot, rather than simply reducing pronation, when assessed using 3D motion analysis. Therefore, it would appear that LD taping does indeed reduce pronation, by restricting rearfoot motion in general, rather than pronation specifically. The degree of change observed with LD taping was however very small, and further research is needed to clarify the clinical significance of these initial findings.

O'Sullivan, Kieran; Kennedy, Norelee; O'Neill, Emer; Ni Mhainin, Una



Investigation into the relationship between the passive flexibility and active stiffness of the ankle plantar-flexor muscles  

Microsoft Academic Search

Objective. The purpose of the study was to investigate the relationship between measurements of passive flexibility and active stiffness of the ankle plantar-flexor muscles.Design. The study was a correlation design.Background. Flexibility has passive and active components. Little information is available regarding the relationship of these measurements in terms of the information that they yield on the state of the muscle–tendon

D. Glenn Hunter; Jonathon Spriggs



Plantar foot pressure responses to changes during dynamic trans-tibial prosthetic alignment in a clinical setting.  


Alignment of a lower limb prosthesis refers to the spatial orientation of the prosthetic components and socket with respect to one another. During the process of dynamic alignment, a prosthetist repeatedly modifies this spatial orientation and observes the amputee's resulting walking pattern, eventually arriving at an alignment that is judged to be optimal. Quantification of the effect of each alignment modification and correlation of the magnitude of modification with the changes in gait could improve understanding of the process and promote an evidential base for practice. This investigation quantified bilateral plantar foot pressures in six trans-tibial amputee subjects during the process of dynamic alignment at prosthetists' clinics during regularly scheduled appointments. Outcomes of changes in prosthetic alignment during the clinical dynamic alignment process were determined to be quantifiable via plantar pedobarography. Changes in the angle between the pylon and the socket in the frontal plane produced predictable shifts in foot pressure between medial and lateral foot regions under the prosthesis, and typically shifted pressure to the lateral region of the contralateral foot, regardless of the direction of the modification. Temporal parameters revealed that subjects initially adopt a conservative locomotor pattern after an alignment change but within a few steps begin to refine their gait and approach more symmetrical single limb support times. Plantar pedobarography provides the clinician with potentially useful information to augment dynamic alignment and provides a tangible record of the results of the process. PMID:15382804

Geil, M D; Lay, A



Changes in plantar loading based on shoe type and sex during a jump-landing task.  


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 (? = .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

Debiasio, Justin C; Russell, Mary E; Butler, Robert J; Nunley, James A; Queen, Robin M



Pads and flexion creases on the plantar surface of hammertoe mutant mouse (Hm).  


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

Kimura, S; Terashima, T; Schaumann, B A; Shimada, M; Shiota, K



Differential involvement of alpha1-adrenoceptors in vasoconstrictor responses to cooling in mouse plantar arteries in vitro and in vivo.  


Cooling-induced reduction of skin blood flow results from a reflex increase in sympathetic output and an enhanced vasoconstrictor activity of skin vessels. The latter has been proposed to be mediated by increased reactivity of alpha(2C)-adrenoceptors during cooling in studies with isolated cutaneous vessels in vitro. We have previously shown in studies with tetrodotoxin-treated mice in vivo that reduction of plantar skin blood flow (PSBF) induced by local cooling results primarily from increased reactivity of alpha(2C)-adrenoceptors. In addition, we showed that part of the cooling-induced response was also mediated by alpha(1)-adrenoceptors. However, the mechanisms involved in the cooling-induced responses mediated by alpha(1)-adrenoceptors have not been elucidated. The present study is an investigation seeking to clarify the mechanisms involving alpha(1)-adrenoceptors. Medial plantar arteries were isolated from male ddY mice and changes in vessel diameter were measured in vitro using pressurized arteriography. In vivo measurements of PSBF were performed on artificially ventilated tetrodotoxin treated mice, anaesthetized with pentobarbital sodium, using laser Doppler flowmetry, with the probe positioned above the medial plantar artery. In the in vitro studies with isolated plantar arteries, cooling from 37 to 28 degrees C did not affect the constrictor potency of phenylephrine, an alpha(1)-adrenoceptor agonist, and the threshold concentration to evoke constriction was rather higher at 28 degrees C than it was at 37 degrees C. The cooling also suppressed the constrictor efficacy of UK14,304, an alpha(2)-adrenoceptor agonist. In contrast, cooling the air temperature around the foot from 25 to 10 degrees C in vivo decreased PSBF, which was significantly inhibited by phentolamine, an alpha-adrenoceptor antagonist, although MK-912, an alpha(2C)-adrenoceptor antagonist, had no effect on it. These results suggest that although alpha(1)-adrenoceptors are involved in cooling-induced reduction of PSBF in mice, the response is unlikely to result from an enhancement of alpha(1)-adrenoceptor-mediated vasoconstriction of plantar arteries during cooling. PMID:19602853

Kashihara, Toshihide; Goto, Kazunori; Sahara, Yoshiki; Nakayama, Koichi; Ishikawa, Tomohisa



Age-related decreases in motor unit discharge rate and force control during isometric plantar flexion.  


Aging is related to multiple changes in muscle physiology and function. Previous findings concerning the effects of aging on motor unit discharge rate (DR) and fluctuations in DR and force are somewhat contradictory. Eight YOUNG and nine OLD physically active males performed isometric ramp (RECR) and isotonic (ISO) plantar flexions at 10 and 20% of surface EMG at MVC. Motor unit (MU) action potentials were recorded with intramuscular fine-wire electrodes and decomposed with custom build software "Daisy". DR was lower in OLD in RECR-10% (17.9%, p < 0.001), RECR-20% (15.8%, p < 0.05), ISO-10% (17.7%, p < 0.01) and ISO-20% (14%, n.s.). In YOUNG force fluctuations were smaller at ISO-10% (72.1%, p < 0.001) and ISO-20% (55.2%, p < 0.05) which were accompanied with a slight increase in DR variation (n.s.). The observed lower DR in OLD is in line with earlier findings in small distal muscles. Also the larger force fluctuation in OLD was in line with previous studies with smaller hand muscles. These findings suggest that the age-related changes in MU control do exist also in large leg extensors that play an important role in human locomotion and balance control. PMID:22749379

Kallio, J; Søgaard, K; Avela, J; Komi, P; Selänne, H; Linnamo, V



Pretreatment of plantar warts with azone enhances the effect of 5-aminolevulinic acid photodynamic therapy.  


5-Aminolevulinic acid (5-ALA) is a well characterized precursor in the synthesis of various endogenous porphyrins used in photodynamic therapy (PDT). It is most often administered topically into a tumor which is then irradiated with visible light at established wavelength to sensitize porphyrins accumulated therein. Our main aim in the present study was to increase the penetration of 5-ALA through the altered skin by application of 3% azone (1-dodecyl-azepan-2-one) before the application of 20% 5-ALA in patients with plantar warts: mosaic warts (MW) and myrmecia (MY). We also used 20% 5-ALA only to treat warts in other patients. We compared the therapeutic and cosmetic effects of the two treatment modalities. The lesions treated with modification of 5-ALA-PDT by pretreatment with azone responded with better effectiveness. In 18 patients subjected to 5-ALA-PDT plus 3% azone, we observed 66.7% complete response of MW and 100% of MY following PDT repeated two or three times; whereas in other 18 patients treated with 5-ALA-PDT alone, we observed only 37.5% complete response of MW and 70% of MY. These results provide evidence that the pretreatment with azone should be considered as the step that enhances 5-ALA penetration in tissues and thus increases the effectiveness of applied PDT. PMID:16566731

Ziolkowski, Piotr; Osiecka, Beata J; Siewinski, Maciej; Bronowicz, Andrzej; Ziolkowska, Jolanta; Gerber-Leszczyszyn, Hanna



A stereologic study of the plantar fat pad in young and aged rats.  


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

Molligan, Jeremy; Schon, Lew; Zhang, Zijun



The effects of different shoes on plantar forces in Irish dance.  


The purpose of this study was to compare the effects of different footwear on plantar loading in Irish dance. Participants were 12 open class dancers (the highest level) who were actively engaged in Irish dance competition. Subjects had a mean of 9.2 ± 2.1 years of experience in Irish dance. All dancers completed one bar of a set phrase in each of three shoes: Irish dance soft shoe, hard shoe, and a dance trainer. The order in which the shoes were tested was counterbalanced with a Latin square design. The variables compared were maximum force, maximum pressure, and impulse. Data were collected at 100 Hz using a Pedar insole pressure sensor system. Values were analyzed for the whole foot, forefoot, and rearfoot. Significant differences between shoe types were observed in impulse (p < 0.01) and maximum pressure (p < 0.01), with the trainer exhibiting lower values than the other shoes. Differences were also found between shoes in loading on regions of the foot (p < 0.01), with forefoot values highest in the soft shoe. The footwear choice had a significant effect on the measured kinetics of the dancers. The trainer displayed significantly lower values for kinetics than did the soft shoe. Thus, it may be a safer (less injurious) choice for daily training. PMID:23498356

Trégouët, Paul; Merland, François



Neuromuscular fatigue induced by alternating isometric contractions of the ankle plantar and dorsiflexors.  


Ankle muscle activity is important in regulating postural control as well as more complex movement tasks. Fatigue of these muscles clearly influences postural stability; however, the mechanisms responsible for this change have not been well characterized. In this study the fatigue produced in the plantar (PF) and dorsiflexors (DF) during intermittent, isometric contractions was examined and the recovery process was monitored for ten minutes post-fatigue. Fifteen healthy participants alternated between isometric PF and DF contractions until the torque was reduced to >50% of the pre-fatigue maximal voluntary contraction level in both directions. Peripheral fatigue was identified by measuring the change in the twitch torque and M-wave amplitude pre and post-fatigue. Central fatigue was determined by comparing the level of voluntary activation in the PF and DF between pre and post-fatigue. The fatigue protocol decreased the torque production in PF and DF to similar levels; however, the characteristics and recovery of the fatigue were different for the two muscle groups. This study demonstrates that although the torque produced by two antagonist muscles can be reduced to the same level, the mechanisms responsible for this change may not be similar and therefore may not impact motor tasks in the same way. PMID:21376628

Kennedy, Ashleigh; Hug, François; Bilodeau, Martin; Sveistrup, Heidi; Guével, Arnaud



Giant keratoacanthoma of the plantar foot: a report of two cases.  


KA develops from a rapidly growing, firm, smooth nodule into a mature dome-shaped lesion with a central core filled with keratin that usually degenerates into an involuting keratinous mass. KAs must be differentiated from squamous cell carcinoma. Classically, KA is a benign tumor that is self-limiting. However, there is controversy concerning the aggressiveness of the tumor. Some authors believe there is no way to determine the aggressiveness of the tumors and they should be classified as low grade squamous cell carcinomas (3). Others feel that the risk of malignant transformation is not a serious consideration but misdiagnosis is, due to the histopathologic similarities (31, 33). Overall, the literature shows that solitary and giant lesions should be excised. Excisional biopsy yields a more cosmetic scar and increases the chance for an accurate biopsy diagnosis. Multiple and multinodular lesions should be excised if they have the potential for causing a mutilating deformity but are otherwise treated systematically. If a solitary or multiple lesion which is left to spontaneously resolve shows signs of aggressiveness, even with a biopsy indicating that it is a KA, it should be immediately excised. Solitary and giant KA are usually not considered to be located on the palms and soles. However, with the cases presented here, there are now a total of 4 cases in the literature. Therefore, KA should be included in the differential diagnosis when dealing with rapidly growing tumors on the plantar aspect of the foot. PMID:8318965

Hale, D S; Dockery, G L


Center of pressure progression characteristics under the plantar region for elderly adults.  


This investigation identifies the center of pressure (COP) progression characteristics under the plantar region for elderly adults during barefoot walking. A total of 60 healthy adults (30 young and 30 old) were recruited. The young and elderly participants had average ages of 23.6 (SD=2.7) and 70.8 (SD=4.1) years old, respectively. All subjects had normal foot arch and no relevant musculoskeletal disease in the lower extremities. The foot pressure measurement system (RS-scan(®) system) was used to measure the center of pressure coordinates (COP), progression angle and COP velocity. Four sub-phases of the stance phase were calculated. The initial contact (ICP) and forefoot contact phase (FFCP) corresponded to the loading response. The foot flat phase (FFP) coincided with the mid-stance. The forefoot push-off phase (FFPOP) corresponded to the terminal stance and pre-swing phases. The analytical results revealed that age effects were found in the relative time percentages for the initial contact, foot flat and forefoot push-off phases during foot movement. The elderly subjects exhibited significant medial COP curve and faster COP velocity during the initial contact phase and more pronated mid-foot posture and slower COP velocity during the mid-stance. The older adults tended to have a more pronated foot and displayed a significant medial COP curve compared to young adults. These COP progression characteristics can provide further insight into relevant foot function and gait performance evaluations for older adults. PMID:23018027

Chiu, Min-Chi; Wu, Hsin-Chieh; Chang, Li-Yu; Wu, Min-Huan



An Achilles' heel in an amyloidogenic protein and its repair: insulin fibrillation and therapeutic design.  


Insulin fibrillation provides a model for a broad class of amyloidogenic diseases. Conformational distortion of the native monomer leads to aggregation-coupled misfolding. Whereas beta-cells are protected from proteotoxicity by hexamer assembly, fibrillation limits the storage and use of insulin at elevated temperatures. Here, we have investigated conformational distortions of an engineered insulin monomer in relation to the structure of an insulin fibril. Anomalous (13)C NMR chemical shifts and rapid (15)N-detected (1)H-(2)H amide-proton exchange were observed in one of the three classical alpha-helices (residues A1-A8) of the hormone, suggesting a conformational equilibrium between locally folded and unfolded A-chain segments. Whereas hexamer assembly resolves these anomalies in accordance with its protective role, solid-state (13)C NMR studies suggest that the A-chain segment participates in a fibril-specific beta-sheet. Accordingly, we investigated whether helicogenic substitutions in the A1-A8 segment might delay fibrillation. Simultaneous substitution of three beta-branched residues (Ile(A2) --> Leu, Val(A3) --> Leu, and Thr(A8) --> His) yielded an analog with reduced thermodynamic stability but marked resistance to fibrillation. Whereas amide-proton exchange in the A1-A8 segment remained rapid, (13)Calpha chemical shifts exhibited a more helical pattern. This analog is essentially without activity, however, as Ile(A2) and Val(A3) define conserved receptor contacts. To obtain active analogs, substitutions were restricted to A8. These analogs exhibit high receptor-binding affinity; representative potency in a rodent model of diabetes mellitus was similar to wild-type insulin. Although (13)Calpha chemical shifts remain anomalous, significant protection from fibrillation is retained. Together, our studies define an "Achilles' heel" in a globular protein whose repair may enhance the stability of pharmaceutical formulations and broaden their therapeutic deployment in the developing world. PMID:20106984

Yang, Yanwu; Petkova, Aneta; Huang, Kun; Xu, Bin; Hua, Qing-Xin; Ye, I-Ju; Chu, Ying-Chi; Hu, Shi-Quan; Phillips, Nelson B; Whittaker, Jonathan; Ismail-Beigi, Faramarz; Mackin, Robert B; Katsoyannis, Panayotis G; Tycko, Robert; Weiss, Michael A



The human foot and heel-sole-toe walking strategy: a mechanism enabling an inverted pendular gait with low isometric muscle force?  


Mechanically, the most economical gait for slow bipedal locomotion requires walking as an 'inverted pendulum', with: I, an impulsive, energy-dissipating leg compression at the beginning of stance; II, a stiff-limbed vault; and III, an impulsive, powering push-off at the end of stance. The characteristic 'M'-shaped vertical ground reaction forces of walking in humans reflect this impulse-vault-impulse strategy. Humans achieve this gait by dissipating energy during the heel-to-sole transition in early stance, approximately stiff-limbed, flat-footed vaulting over midstance and ankle plantarflexion (powering the toes down) in late stance. Here, we show that the 'M'-shaped walking ground reaction force profile does not require the plantigrade human foot or heel-sole-toe stance; it is maintained in tip-toe and high-heel walking as well as in ostriches. However, the unusual, stiff, human foot structure--with ground-contacting heel behind ankle and toes in front--enables both mechanically economical inverted pendular walking and physiologically economical muscle loading, by producing extreme changes in mechanical advantage between muscles and ground reaction forces. With a human foot, and heel-sole-toe strategy during stance, the shin muscles that dissipate energy, or calf muscles that power the push-off, need not be loaded at all--largely avoiding the 'cost of muscle force'--during the passive vaulting phase. PMID:22572024

Usherwood, J R; Channon, A J; Myatt, J P; Rankin, J W; Hubel, T Y



The human foot and heel-sole-toe walking strategy: a mechanism enabling an inverted pendular gait with low isometric muscle force?  

PubMed Central

Mechanically, the most economical gait for slow bipedal locomotion requires walking as an ‘inverted pendulum’, with: I, an impulsive, energy-dissipating leg compression at the beginning of stance; II, a stiff-limbed vault; and III, an impulsive, powering push-off at the end of stance. The characteristic ‘M’-shaped vertical ground reaction forces of walking in humans reflect this impulse–vault–impulse strategy. Humans achieve this gait by dissipating energy during the heel-to-sole transition in early stance, approximately stiff-limbed, flat-footed vaulting over midstance and ankle plantarflexion (powering the toes down) in late stance. Here, we show that the ‘M’-shaped walking ground reaction force profile does not require the plantigrade human foot or heel–sole–toe stance; it is maintained in tip–toe and high-heel walking as well as in ostriches. However, the unusual, stiff, human foot structure—with ground-contacting heel behind ankle and toes in front—enables both mechanically economical inverted pendular walking and physiologically economical muscle loading, by producing extreme changes in mechanical advantage between muscles and ground reaction forces. With a human foot, and heel–sole–toe strategy during stance, the shin muscles that dissipate energy, or calf muscles that power the push-off, need not be loaded at all—largely avoiding the ‘cost of muscle force’—during the passive vaulting phase.

Usherwood, J. R.; Channon, A. J.; Myatt, J. P.; Rankin, J. W.; Hubel, T. Y.



Prediction of absolute risk of non-spinal fractures using clinical risk factors and heel quantitative ultrasound  

Microsoft Academic Search

Summary  The relationship between osteoporosis risk factors, bone quantitative ultrasound (QUS) and non-spinal fracture risk was estimated\\u000a in a cohort of 5,201 postmenopausal women from Spain who were prospectively evaluated during three years. Several clinical\\u000a risk factors and low heel QUS values were independently associated with non-spinal fracture risk.\\u000a \\u000a \\u000a \\u000a Introduction  Low-trauma, non-spinal fractures are a growing source of morbidity and mortality in

A. Díez-Pérez; J. González-Macías; F. Marín; M. Abizanda; R. Alvarez; A. Gimeno; E. Pegenaute; J. Vila



Heritability estimates of tarsocrural osteochondrosis and palmar/plantar first phalanx osteochondral fragments in Standardbred trotters.  


REASONS FOR PERFORMING STUDY: The pathogenesis of osteochondrosis (OC) and palmar/plantar first phalanx osteochondral fragments (POFs) is multifactorial, but specific knowledge of heritability is limited. OBJECTIVES: To improve the precision of heritability estimates and to estimate the genetic correlation between tarsocrural OC and POFs in Standardbred trotters. Further aims were to examine whether the prevalence of OC/POFs was different in the American and French lineages that have contributed to the Norwegian population, and if the prevalence was affected by heterozygosity. STUDY DESIGN: Retrospective cohort study. METHODS: Categorical data on tarsocrural OC and POFs from 2 radiographic studies performed in 1989 and 2007/2008 (n = 1217) were analysed with sire threshold models that included 230 sires. RESULTS: Heritability of OC at the distal intermediate ridge of the tibia and/or the lateral trochlear ridge of the talus was estimated at 0.29 ± 0.15. For OC at the distal intermediate ridge of the tibia only, the estimate was 0.40 ± 0.17. Heritability of POFs in all 4 limbs was estimated at 0.23 ± 0.13; for metatarsophalangeal POFs this was 0.26 ± 0.13 and for medial metatarsophalangeal POFs 0.32 ± 0.14. Estimates of genetic correlation between OC and POFs ranged from 0.68 ± 0.27 to 0.73 ± 0.28 but were not significantly different from a zero-genetic correlation. Effects of lineages or heterozygosity were not observed. CONCLUSIONS AND POTENTIAL RELEVANCE: This study confirmed a moderate to high heritability of tarsocrural OC and POF, providing further evidence of the heritable nature of these diseases. Examination of specific lesions yielded the highest heritability; therefore, breeding programmes and future genome-analysis studies should focus on predilection sites rather than the entire disease complex. PMID:23448227

Lykkjen, S; Olsen, H F; Dolvik, N I; Grøndahl, A M; Røed, K H; Klemetsdal, G



Neuromuscular factors influencing the maximum stretch limit of the human plantar flexors.  


Maximum joint range of motion is an important parameter influencing functional performance and musculoskeletal injury risk. Nonetheless, a complete description of the muscle architectural and tendon changes that occur during stretch and the factors influencing maximum range of motion is lacking. We measured muscle-tendon elongation and fascicle lengthening and rotation sonographically during maximal plantar flexor stretches in 21 healthy men. Electromyogram (EMG) recordings were obtained synchronously with ultrasound and joint moment data, and H-reflex measurements were made with the ankle at neutral (0°) and dorsiflexed (50% maximal passive joint moment) positions; the maximum H amplitude (normalized to maximum M-wave amplitude; M(max)) and H-amplitude elicited at a stimulation intensity that evoked 10% M(max) were obtained. Maximal stretch was accomplished through significant muscle (14.9%; 30 mm) and tendon lengthening (8.4%; 22 mm). There were similar relative changes in fascicle length and angle, but planimetric modeling indicated that the contribution of fascicle rotation to muscle lengthening was small (<4 mm). Subjects with a greater range of motion showed less resistance to stretch and a greater passive joint moment at stretch termination than less flexible subjects (i.e., greater stretch tolerance). Also, greater fascicle rotation accompanied muscle elongation (9.7 vs. 5.9%) and there was a greater tendon length at stretch termination in more flexible subjects. Finally, a moderate correlation between the angle of EMG onset and maximum range of motion was obtained (r = 0.60, P < 0.05), despite there being no difference in H-reflex magnitudes between the groups. Thus clear differences in the neuromuscular responses to stretch were observed between "flexible" and "inflexible" subjects. PMID:22923509

Blazevich, A J; Cannavan, D; Waugh, C M; Fath, F; Miller, S C; Kay, A D



Changes in mechanical properties of human plantar flexor muscles in ageing.  


Changes in contractile and elastic properties of human plantar flexor muscles in ageing, were investigated in 12 young (19-24 years, YG) and 11 old (61-74 year, OG) men. Maximal isometric and concentric voluntary torques, at several angular velocities, were measured to construct torque-angular velocity relationship. This led to the calculation of an index of maximal shorting velocity (VImax) at low torque. Two methods were then used to calculate musculotendinous (MT, quick-release movements) and musculoarticular (MA, sinusoidal perturbations) stiffness. In both cases, stiffness was linearly related to torque, leading to the calculation of a stiffness index (SI) as the slope of the stiffness-torque relationship: SI(MT) and SI(MA), respectively. MA stiffness under passive conditions (Kp) was also determined. Surface electromyograms were useful to control agonist and antagonist myoelectrical activities. As expected, maximal isometric (P<0.005) and concentric torques (P<0.05) as well as VImax(p<0.05) were lower in OG compared to YG. SI(MT) values were higher for OG compared to YG (P<0.05) leading to a mean difference of 55%, whereas SI(MA) and Kp were not significantly different between the two groups. Thus, older men were weaker and exhibited higher SI(MT) values. These impairments seem to be principally due to muscular atrophy and modifications in both muscle fibre-type distribution and fibre composition, in ageing. Invariance of SI(MA) and Kp would suggest an adaptive mechanism in articular structures to avoid the continuous integration of the ankle joint stiffness by the central nervous system, what may simplify most daily motor tasks. PMID:15036394

Ochala, Julien; Lambertz, Daniel; Pousson, Michel; Goubel, Francis; Hoecke, Jacques Van



Reliability of footprint geometric and plantar loading measurements in children using the Emed(®) M system.  


This study investigated the between-day reliability of footprint geometric and plantar loading measurements on children utilising the Emed(®) M pressure measurement device. Bilateral footprints (static and dynamic) and foot loading measurements using the two-step gait method were collected on 21 children two days apart (age = 9.9 ± 1.8 years; mass = 34.6 ± 8.9 kg; height = 1.38 ± 0.12 m). Static and dynamic footprint geometric (lengths, widths and angles) and dynamic loading (pressures, forces, contact areas and contact time) parameters were compared. Intraclass correlation coefficients of static geometric parameters were varied (0.19-0.96), while superior results were achieved with dynamic geometric (0.66-0.98) and loading variables (0.52-0.94), with the exception of left contact time (0.37). Standard error of measurement recorded small absolute disparity for all geometric (length = 0.1-0.3 cm; arch index = 0.00-0.01; subarch angle = 0.6-6.2°; left/right foot progression angle = 0.5°/0.7°) and loading (peak pressure = 2.3-16.2 kPa; maximum force = 0.3-3.0%; total contact area = 0.28-0.49 cm(2); % contact area = 0.1-0.6%; contact time = 32-79 ms) variables. Coefficient of variation displayed widest spread for static geometry (1.1-27.6%) followed by dynamic geometry (0.8-22.5%) and smallest spread for loading (1.3-16.8%) parameters. Limits of agreement (95%) were narrower in dynamic than static geometric parameters. Overall, the reliability of most dynamic geometric and loading parameters was good and excellent. Static electronic footprint measurements on children are not recommended due to their light body mass which results in incomplete footprints. PMID:23266249

Tong, Jasper W K; Kong, Pui W



Lung carcinoma with congenital plantar keratoderma as a variant of Clarke-Howel-Evans syndrome.  


A 32-year-old man was admitted to the Magdeburg University Hospital with icterus and for further diagnosis of suspected hepatitis. He also complained of generalized pruritus, abdominal pain, nausea, and diarrhea. The patient's history revealed the excision of a lymph node metastasis of the left groin showing pleomorphic macrocellular infiltrates, 2 months previously. The patient presented to our department with prominent hyperkeratosis of both feet, which had been present since early youth. The family history was negative. Both soles showed very thick, white and blackish hyperkeratosis with predominance of the heels and the forefeet (Fig. 1). The naturally occurring wrinkles of the skin of the toes were flattened. The palms were not affected, and neither was the oral mucosa. Further investigations revealed icterus of the sclera and multiple, firm tumors, which were located in the deep subcutaneous tissue, on the left hip, thigh, and buttock. From thorough clinical, laboratory and staging investigations, a non-small-cell bronchogenic carcinoma, with metastases of the liver, kidneys, adrenal glands, and several skin sites, was diagnosed. A skin biopsy specimen of the foot showed substantial acanthosis of the epidermis with hypergranulosis and excessive orthohyperkeratosis. The corneocytes were enlarged and arranged in a tile-like pattern (Fig. 2). The dermis was free of inflammatory infiltrates and human papillomavirus infection was ruled out by immunohistochemistry. Polychemotherapy was immediately started with 5-fluorouracil, mitomycin, and cisplatin, which was well tolerated. When the patient was admitted for the second cycle, however, his general health had worsened markedly. He complained of abdominal pain, severe weight loss, and nausea. Generalized metastases showed substantial progression. Chemotherapy could not be continued because of a Karnowsky index below 20%. The patient died 2 weeks later. PMID:12786874

Grundmann, Jens-Uwe; Weisshaar, Elke; Franke, Ingolf; Bonnekoh, Bernd; Gollnick, Harald




SciTech Connect

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.




Plantar pressure and daily cumulative stress in persons affected by leprosy with current, previous and no previous foot ulceration.  


Not only plantar pressure but also weight-bearing activity affects accumulated mechanical stress to the foot and may be related to foot ulceration. To date, activity has not been accounted for in leprosy. The purpose was to compare barefoot pressure, in-shoe pressure and daily cumulative stress between persons affected by leprosy with and without previous or current foot ulceration. Nine persons with current plantar ulceration were compared to 15 with previous and 15 without previous ulceration. Barefoot peak pressure (EMED-X), in-shoe peak pressure (Pedar-X) and daily cumulative stress (in-shoe forefoot pressure time integral×mean daily strides (Stepwatch™ Activity Monitor)) were measured. Barefoot peak pressure was increased in persons with current and previous compared to no previous foot ulceration (mean±SD=888±222 and 763±335 vs 465±262kPa, p<0.05). In-shoe peak pressure was only increased in persons with current compared to without previous ulceration (mean±SD=412±145 vs 269±70kPa, p<0.05). Daily cumulative stress was not different between groups, although persons with current and previous foot ulceration were less active. Although barefoot peak pressure was increased in people with current and previous plantar ulceration, it did not discriminate between these groups. While in-shoe peak pressure was increased in persons with current ulceration, they were less active, resulting in no difference in daily cumulative stress. Increased in-shoe peak pressure suggests insufficient pressure reducing footwear in persons with current ulceration, highlighting the importance of pressure reducing qualities of footwear. PMID:22947998

van Schie, Carine H M; Slim, Frederik J; Keukenkamp, Renske; Faber, William R; Nollet, Frans



Gait improvement of hemiplegic patients using an ankle-foot orthosis with assistance of heel rocker function.  


The ankle-foot orthosis (AFO) with oil damper, GaitSolution (GS), was previously developed to make heel rocker function possible during the gait of hemiplegic patients. To clarify the characteristics of patients who show adaptation to GS use, a questionnaire was completed by the clinicians responsible for 99 patients with hemiplegia who participated in this study. Clinicians completed items concerning gait data of patients without AFO use and with GS use, adaptation to the use of GS, and patient opinion of GS use. Approximately 60% of patients achieved heel rocker function during the loading response of the paretic limb and improved gait when using GS. A comparison of the patients whose gaits were improved by GS more than by other AFOs revealed the use of GS was well suited to the gait of patients with a relatively higher Brunnstrom stage and a slightly flexed knee joint during the stance phase. Approximately 60% of patients reported feeling comfortable using GS, although patient comfort did not necessarily coincide with the results of gait assessment by clinicians. Patient comfort mainly depended on trunk posture and hip joint outward rotation; hip joint outward rotation could be improved using GS in the recovery phase but not in the maintenance phase. This result implies the importance of gait training in the early stage of rehabilitation. PMID:19961292

Yamamoto, Sumiko; Hagiwara, Akiyoshi; Mizobe, Tomofumi; Yokoyama, Osamu; Yasui, Tadashi



Equine developmental orthopaedic diseases - a genome-wide association study of first phalanx plantar osteochondral fragments in Standardbred trotters.  


Palmar/plantar osteochondral fragments (POF) in fetlock joints commonly affect and influence the athletic performance of horses. In this study, we used the Equine SNP50 BeadChip(®) to perform a genome-wide association study of metatarsophalangeal POF in 176 Norwegian Standardbred trotter yearlings. Putative quantitative trait loci (QTL) for medial and/or lateral POF, and medial POF only were identified on ECA1, 2, 7, 9 and 31, whereas for lateral POF, only on ECA7, 11, 27 and X. The moderate number of QTL evidences a complex inheritance and suggests various genes controlling POF development in medial and lateral locations. PMID:23742657

Lykkjen, S; Dolvik, N I; McCue, M E; Rendahl, A K; Mickelson, J R; Røed, K H



The effect of shoe toe box shape and volume on forefoot interdigital and plantar pressures in healthy females  

PubMed Central

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.



Observations and hypothesis on an individual patient topically treated for capecitabine-induced Palmar-Plantar syndrome  

PubMed Central

Palmar-Plantar syndrome (PPS) is a common side effect of oral capecitabine—a chemotherapeutic agent used as an adjuvant treatment for colorectal cancer. A 66-year-old man suffering from grade II PPS described how Germolene New Skin, a topical healing agent, provided relief from the pain associated with this syndrome and a return to normal function. The patient's observations form the basis for some interesting hypotheses regarding the natural progression of PPS and the potential of New Skin to alleviate pain. Caution must be exercised at this stage as these are single case observations; however, they may be worthy of further exploration in a randomised controlled clinical trial.

Gafson, Arie R; Goodkin, Olivia; Begent, Richard



Dynamic force distribution during level walking under the feet of patients with chronic ankle instability  

PubMed Central

Objectives: To examine changes in the pattern of force transfer between the foot and the floor associated with chronically sprained ankles by measuring the peak forces and their timing under several regions of the feet during level walking. Methods: Twelve young male subjects (mean (SD) age 21 (2) years) with recurrent ankle sprains were studied. Seven of them had unilateral and bilateral chronic instability and laxity, and five had bilateral instability. Twelve healthy men (without orthopaedic or medical disease) served as a control group. Subjects walked at their own pace along a 7 m walkway, which included a Mini-EMED pressure distribution measuring system. The variables measured were relative peak force (fraction of body weight) and relative timing (fraction of stance time). These variables were measured under six regions of interest in each foot print: heel, midfoot, medial, central, and lateral forefoot, and toes. Results: (a) A significant delay to the time of peak force under the central and lateral forefoot and toes in subjects with chronic ankle instability. (b) A significant decrease in the relative forces under the heel and toes and an increase in the relative forces under the midfoot and lateral forefoot in subjects with chronic ankle instability. (c) In the patients with unilateral instability, there were no significant differences in any of the variables between the injured and non-injured foot. Conclusions: In patients with chronic ankle instability, there is a slowing down of weight transfer from heel strike to toe off, a reduced impact at the beginning and end of the stance phase, and a lateral shift of body weight.

Nyska, M; Shabat, S; Simkin, A; Neeb, M; Matan, Y; Mann, G



Extracorporeal shock wave therapy in patients with plantar fasciitis. A randomized, placebo-controlled trial with ultrasonographic and subjective outcome assessments  

PubMed Central

Background and Aim: Results of previous studies have been conflicting on the efficacy of extracorporeal shock wave therapy (ESWT) in the treatment of plantar fasciitis. We evaluated the effects of ESWT on plantar fasciitis in terms of ultrasonographic and subjective evaluations. Materials and Methods: In this randomized placebo-controlled trial, patients with plantar fasciitis were assigned to receive ESWT (4000 shock waves/session of 0.2 mJ/mm2) in 3 sessions at weekly intervals) or sham therapy (n = 20 in each group). Outcomes were documented by the ultrasonographic appearance of the aponeurosis and by patients’ pain scores, performed at baseline and 12 weeks after completion of the therapy. Results: The two groups were similar in baseline characteristics. Over the study period, plantar fascia thickness significantly reduced in the ESWT group (4.1 ± 1.3 to 3.6 ± 1.2 mm, P < 0.001), but slightly increased in the sham group (4.1 ± 0.8 to 4.5 ± 0.9 mm, P = 0.03). Both groups showed significant pain improvement over the course of the study (P < 0.001), though pain scores were significantly more reduced in the ESWT than the sham group (-4.2 ± 2.9 vs. -2.7 ± 1.8, P = 0.049). Conclusions: Extracorporeal shock wave therapy contributes to healing and pain reduction in plantar fasciitis and ultrasound imaging is able to depict the morphologic changes related to plantar fasciitis as a result of this therapy.

Vahdatpour, Babak; Sajadieh, Sepideh; Bateni, Vahid; Karami, Mehdi; Sajjadieh, Hamidreza



Plantar pressure distribution in a hyperpronated foot before and after intervention with an extraosseous talotarsal stabilization device-a retrospective study.  


Plantar pressure measurements have long been used by clinicians to provide information regarding potential impairments and disorders of the foot and ankle. Elevations in peak plantar pressures or a poor distribution of these pressures can be an indication of pathomechanics in the foot. Lower extremity deficits such as sensory impairment, foot deformities, limited joint mobility, and reduced plantar tissue thickness have been associated with high plantar pressures. The total pressures, pressure distribution, and peak pressures provide useful information to evaluate the abnormal functioning of the talotarsal joint. Instability of the talotarsal joint can result in excessive forces exerted on the joints and surrounding tissues in the foot that can then lead to dysfunction of the proximal musculoskeletal kinetic chain. In the present study, we performed a retrograde analysis of the pre- and postoperative measurements of the peak plantar pressures, peak forces, and area of contact between the foot and the ground during each phase of the gait cycle for 6 patients (12 feet) who had undergone a bilateral extraosseous talotarsal stabilization procedure using a type II extraosseous talotarsal stabilization device. After the procedure, a significant reduction was seen in the peak pressures (42%) over the entire foot and a significant increase in the contact area (19.7%) between the foot and the floor. This could imply that the extraosseous talotarsal stabilization procedure was effective in stabilizing the talotarsal joint complex, thus eliminating abnormal hindfoot motion and restoring the normal biomechanics of the foot and ankle complex, as indicated by a reduction and realignment of the peak plantar pressures and forces. PMID:23632067

Fitzgerald, Ryan H; Vedpathak, Anuja



Differences in plantar loading between training shoes and racing flats at a self-selected running speed.  


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

Wiegerinck, Johannes I; Boyd, Jennifer; Yoder, Jordan C; Abbey, Alicia N; Nunley, James A; Queen, Robin M



Size and separability of the calcaneal and the medial and lateral plantar nerves in the distal tibial nerve.  


The tibial nerve (TN) has three main terminal branches: the medial and lateral plantar nerves and the calcaneal branch (CB), which innervates the foot sole. The design and implantation of nerve cuff electrodes with separate channels for each of these three terminal branches would provide significant sensory information, which can be used in functional electrical stimulation systems to assist standing or to correct foot drop. Detailed quantitative anatomical data about fascicular size and separability of the terminal branches of TN are needed for the design and implantation of such cuff electrodes. Therefore, the branching pattern, the fascicular separability and the fascicular size of the TN posterior to the medial malleolar-calcaneal axis were examined in this study, using ten human TN specimens. The TN branching patterns were highly dispersed. For the CBs, multiple branches were identified in five (50%) of the specimens. For the TN, the bifurcation point was located within the tarsal tunnel in eight (80%) of the cases. The distance proximal to the medial malleolar-calcaneal axis for which the TN could be split ranged form 0 to 41 mm. Quantitative and qualitative data were obtained for the fascicular size and separability of the TN. Only the CB of the TN proved separable for a sufficient length for nerve cuff electrode implantation. The results suggest the use of a two-channel cuff with one common channel for the lateral and medial plantar nerves, having multiple electrodes for selective recording, and one channel for the CB. PMID:19449089

Andreasen Struijk, Lotte N S; Birn, Henrik; Teglbjaerg, Peter S; Haase, Jens; Struijk, Johannes J



Quantitative ultrasound of the heel and serum and urinary cortisol values in assesment of long-term corticotherapy side effects in female bronchial asthma patients  

Microsoft Academic Search

Female asthma patients (26) with and without corticotherapy were studied. The control group included 19 healthy women. Skeletal status was assessed by ultrasound measurement of the heel (Achilles, Lunar, Madison, WI, USA) and serum and urinary corisol expressed adrenal function. Ultrasound and hormonal values were significantly lower in patients treated with glucocorticosteroids (GC) than in controls. In patients without GC,

Beata Kos-Kud?a; Wojciech Pluskiewicz



Familial hypophosphatemia: an unusual presentation with low back ache, heel pain, and a limp in a young man, and literature review.  


A case of young man with low back ache and heel pains who was examined in a rheumatology outpatient and diagnosed as familial hypophosphatemia (FH), probably X-linked (XL), is presented. FH is most commonly transmitted as XL. The role of PHEX gene and fibroblast growth factor 23 is also described. PMID:21042824

Arthur, Sharon; Chopra, Arvind



Automated method to distinguish toe walking strides from normal strides in the gait of idiopathic toe walking children from heel accelerometry data.  


Toe walking mainly occurs in children due to medical condition or physical injury. When there are no obvious signs of any medical condition or physical injury, a diagnosis of Idiopathic Toe Walking (ITW) is made. ITW children habitually walk on their toes, however can modify their gait and walk with a heel-toe gait if they want to. Correct gait assessment in ITW children therefore becomes difficult. To solve this problem, we have developed an automated way to assess the gait in ITW children using a dual axis accelerometer. Heel acceleration data was recorded from the gait of ITW children using boots embedded with the sensor in the heel and interfaced to a handheld oscilloscope. An innovative signal processing algorithm was developed in IgorPro to distinguish toe walking stride from normal stride using the acceleration data. The algorithm had an accuracy of 98.5%. Based on the statistical analysis of the heel accelerometer data, it can be concluded that the foot angle during mid stance in ITW children tested, varied from 36° to 11.5° while as in normal children the foot stance angle is approximately zero. This algorithm was later implemented in a system (embedded in the heel) which was used remotely to differentiate toe walking stride from normal stride. Although the algorithm classifies toe walking stride from normal stride in ITW children, it can be generalized for other applications such as toe walking in Cerebral Palsy or Acquired Brain Injury subjects. The system can also be used to assess the gait for other applications such as Parkinson's disease by modifying the algorithm. PMID:22300731

Pendharkar, Gita; Percival, Paul; Morgan, David; Lai, Daniel



Platelet-rich plasma application in the management of chronic tendinopathies.  


Platelet-rich plasma (PRP) may represent a new therapeutic option for chronic tendinopathies. Platelets release various cytokines and growth factors which promote angiogenesis, tissue remodeling, and wound healing. We made an extended literature review of the use of PRP in chronic tendinopathies: epicondylitis, rotator cuff, patellar and calcaneal tendinopathies, and plantar fasciitis. Medline, Embase and Google Scholar were used (until July 31, 2012). Clinical studies on PRP and tendinopathies published in English and French language peer-reviewed journals were included. Articles with a high level of evidence were given special consideration. Despite the proven efficacy of PRP on tissue regeneration in experimental studies, there is currently scanty tangible clinical evidence with respect to its efficacy in chronic tendon disorders. The few studies that have been performed appear unlikely to be comparable. Randomized controlled studies with appropriate placebo groups are needed to determine the real effectiveness of PRP for treating chronic musculoskeletal injuries. PMID:23547508

Kaux, Jean-François; Crielaard, Jean-Michel



Low-dye taping versus medial arch support in managing pain and pain-related disability in patients with plantar fasciitis.  


Plantar fasciitis is thought to develop because of repeated mechanical stresses. This study aimed to compare 2 means of foot arches support-low-Dye tape (LDT) and medial arch support (MAS)-in patients with plantar fasciitis. Thirty patients with unilateral plantar fasciitis (23 men and 7 women) were randomly assigned to the LDT or MAS groups. Both groups were assessed before and after experiment for pain and foot function. Both groups received 9 sessions over 3 weeks consisting of ultrasound and calf muscles stretching. They were instructed to maintain supportive intervention (LDT or MAS) throughout this period. Pre-post comparison showed reduced pain and improved function in both groups. Between-groups analysis showed non-significant difference in pre-VAS and pre-FPDS. Post-VAS and post-FPDS showed significant improvement in patients in MAS group. Results indicate that MAS is more convenient for short-term management of pain and disability in patients with plantar fasciitis than LDT. PMID:21123667

Abd El Salam, Mohammed Shawki; Abd Elhafz, Yehia Nassef



The effect of removing plugs and adding arch support to foam based insoles on plantar pressures in people with diabetic peripheral neuropathy  

PubMed Central

Background Removable plug insoles appear to be beneficial for patients with diabetic neuropathic feet to offload local plantar pressure. However, quantitative evidence of pressure reduction by means of plug removal is limited. The value of additional insole accessories, such as arch additions, has not been tested. The purpose of this study was to evaluate the effect of removing plugs from foam based insoles, and subsequently adding extra arch support, on plantar pressures. Methods In-shoe plantar pressure measurements were performed on 26 patients with diabetic neuropathic feet at a baseline condition, in order to identify the forefoot region with the highest mean peak pressure (MPP). This was defined as the region of interest (ROI) for plug removal.The primary outcome was measurement of MPP using the pedar® system in the baseline and another three insole conditions (pre-plug removal, post-plug removal, and post-plug removal plus arch support). Results Among the 26 ROIs, a significant reduction in MPP (32.3%, P<0.001) was found after removing the insole plugs. With an arch support added, the pressure was further reduced (9.5%, P<0.001). There were no significant differences in MPP at non-ROIs between pre- and post-plug removal conditions. Conclusions These findings suggest that forefoot plantar pressure can be reduced by removing plugs and adding arch support to foam-based insoles. This style of insole may therefore be clinically useful in managing patients with diabetic peripheral neuropathy.



In Vitro Antifungal Activity of KP103, a Novel Triazole Derivative, and Its Therapeutic Efficacy against Experimental Plantar Tinea Pedis and Cutaneous Candidiasis in Guinea Pigs  

Microsoft Academic Search

The in vitro activity of KP-103, a novel triazole derivative, against pathogenic fungi that cause dermatomy- coses and its therapeutic efficacy against plantar tinea pedis and cutaneous candidiasis in guinea pigs were investigated. MICs were determined by a broth microdilution method with morpholinepropanesulfonic acid- buffered RPMI 1640 medium for Candida species and with Sabouraud dextrose broth for dermatophytes and by




Low-pressure, single-point grout injection for tank heel sludge mixing and in-situ immobilization  

SciTech Connect

This report describes tests conducted in an approximately 9-ft diameter test tank situated outside the 336 building in Hanford`s 300 area. The tests were performed to measure the ability of jets of grout slurry to mobilize and mix simulated tank sludge. The technique is intended for in situ immobilization of tank waste heels. The current approach uses a single, rotated, larger-diameter nozzle driven at lower pressure. Due to the larger diameter, the potential for plugging is reduced and the effective radius around an injection point over which the jet is effective in mobilizing sludge from the tank bottom can be made larger. A total of three grout injection tests were conducted in a 9-ft diameter tank. In each case, a 2-in. layer of kaolin clay paste was placed on a dry tank floor to simulate a sludge heel. The clay was covered with 4 inches of water. The grout slurry, consisting of Portland cement, class F fly ash, and eater, was prepared and delivered by an offsite vendor. In the third test, the sludge in half of the tank was replaced by a layer of 20x50 mesh zeolite, and bentonite clay was added to the grout formulation. After injection, the grout was allowed to set and then the entire grout monolith was manually broken up and excavated using a jack hammer. Intact pieces of clay were visually apparent due to a sharp color contrast between the grout and clay. Remaining clay deposits were collected and weighed and suspended clay pieces within the monolith were photographed. The mobilization performance of the grout jets exceeded expectations.

Whyatt, G.A.; Hymas, C.R.



Chronic Pain  


... cause. Problems that cause chronic pain include Headache Low back strain Cancer Arthritis Pain from nerve damage Chronic pain usually cannot be cured. But treatments can help. They include medicines, acupuncture, electrical stimulation and surgery. Other treatments include psychotherapy, ...


Changes in the relative contribution of each leg to the control of quiet two-legged stance following unilateral plantar-flexor muscles fatigue.  


We used unilateral plantar-flexor muscles fatigue to assess the capacity of the central nervous system to adapt quiet two-legged stance control to a unilateral ankle neuromuscular perturbation. Eighteen young healthy adults stood barefoot with their eyes closed and were asked to sway as little as possible. The Experimental group (n = 9) executed this postural task in two conditions, before (pre-test) and following the completion of a fatiguing exercise designed to induce a muscular fatigue in the plantar-flexor muscles of their dominant leg (post-test). For the Control group (n = 9), this fatiguing exercise was replaced with a standing rest period corresponding to the fatiguing exercise. Results of the Experimental group showed no significant difference between the weightbearing index measured in the pre-test condition and that observed in the post-test condition. Results further revealed that unilateral plantar-flexor muscles fatigue yielded different effects on the centre of foot pressure (CoP) displacements under the non-fatigued leg and under the fatigued leg: a wider surface area of the CoP displacements was observed under the non-fatigued than under the fatigued leg, and a higher mean speed of the CoP displacements was observed under the non-fatigued leg only in the post-test relative to the pre-test condition. These findings evidenced that the contribution of each leg to the control of quiet two-legged stance is modified as a result of muscle fatigue of unilateral plantar-flexor muscles. The greater contribution of the non-fatigued leg could be viewed as a fatigue-induced adaptive change in the control of quiet two-legged stance in response to an alteration of the unilateral ankle neuromuscular function induced by unilateral plantar-flexor muscles fatigue. PMID:20390292

Vuillerme, Nicolas; Boisgontier, Matthieu



In-shoe plantar pressure distribution during running on natural grass and asphalt in recreational runners  

Microsoft Academic Search

The type of surface used for running can influence the load that the locomotor apparatus will absorb and the load distribution could be related to the incidence of chronic injuries. As there is no consensus on how the locomotor apparatus adapts to loads originating from running surfaces with different compliance, the objective of this study was to investigate how loads

Vitor Tessutti; Francis Trombini-Souza; Ana Paula Ribeiro; Ana Luiza Nunes; Isabel de Camargo Neves Sacco



Assessment of the efficacy of a new formulation for plantar wart mummification: new experimental design and human papillomavirus identification.  


Cutaneous warts are caused by infection of the epidermis with human papillomavirus (HPV). Cryotherapy using liquid nitrogen is one of the most common local treatments. In this study, we used a novel ex vivo approach to compare the efficacy of a new product with conventional liquid-nitrogen cryotherapy by studying epidermal histology and assessing the presence of HPV types 1 and 2 DNA in plantar warts. The studied formulation, which acts by tissues mummification, is a combination of nitric acid, organic acids and metallic salts. We found that, similar to liquid nitrogen, the studied product induced alterations in the wart structure. In addition, unlike liquid nitrogen, this product also reduced the amount of HPV DNA. The results suggest that there is a poor correlation between the histological response and the antiviral efficacy of standard wart treatment. PMID:23252755

Viennet, C; Gheit, T; Muret, P; Aubin, F; Cabou, J; Marchal, A; Tommasino, M; Humbert, P



Fixation of lapidus arthrodesis with a plantar interfragmentary screw and medial locking plate: a report of 88 cases.  


Lapidus arthrodesis is a powerful procedure that can be used to correct pathologic features within the forefoot or midfoot. Many different methods of fixation for this procedure have been reported. The use of plating constructs has been shown to provide increased stability compared with screw-only constructs. The technique we have described consists of a plantar to dorsal retrograde lag screw across the arthrodesis site, coupled with a low-profile medial locking plate. A total of 88 consecutive patients were treated with this modification of the Lapidus procedure by 2 surgeons and were retrospectively evaluated. All patients followed an early postoperative weightbearing protocol. Patient age, gender, follow-up duration, interval to weightbearing and radiographic fusion, preoperative and postoperative intermetatarsal angle, hardware removal, preoperative and postoperative American Orthopaedic Foot and Ankle Society midfoot scores, and adjunct procedures were analyzed. The mean follow-up period was 16.76 ± 5.9 (range 12 to 36) months, and all healed fusions demonstrated radiographic union at a mean of 51 ± 19.1 (range 40 to 89) days. The patients were treated with weightbearing starting a mean of 10.90 ± 4.1 (range 5 to 28) days postoperatively. Complications included 15 patients (17%) requiring hardware removal, 2 cases (2%) of hallux varus, 6 cases (7%) of radiographic recurrent hallux valgus, and 2 patients (2%) with first metatarsocuneiform nonunion. The results of the present study have demonstrated that plantar lag screw fixation with medial locking plate augmentation for Lapidus arthrodesis allows for early weightbearing with satisfactory outcomes, improved clinical and radiographic alignment, and improved American Orthopaedic Foot and Ankle Society scores. PMID:23540755

Cottom, James M; Vora, Anand M



Heel-strike in walking: assessment of potential sources of intra- and inter-subject variability in the activation patterns of muscles stabilizing the knee joint.  


The electromyographic (EMG) signal is known to show large intra-subject and inter-subject variability. Adaptation to, and preparation for, the heel-strike event have been hypothesized to be major sources of EMG variability in walking. The aim of this study was to assess these hypotheses using a principal component analysis (PCA). Two waveform shapes with distinct characteristic features were proposed based on conceptual considerations of how the neuro-muscular system might prepare for, or adapt to, the heel-strike event. PCA waveforms obtained from knee muscle EMG signals were then compared with the predicted characteristic features of the two proposed waveforms. Surface EMG signals were recorded for ten healthy adult female subjects during level walking at a self-selected speed, for the following muscles; rectus femoris, vastus medialis, vastus lateralis, semitendinosus, and biceps femoris. For a period of 200 ms before and after heel-strike, EMG power was extracted using a wavelet transformation (19-395 Hz). The resultant EMG waveforms (18 per subject) were submitted to intra-subject and inter-subject PCA. In all analyzed muscles, the shapes of the first and second principal component (PC-) vectors agreed well with the predicted waveforms. These two PC-vectors accounted for 50-60% of the overall variability, in both inter-subject and intra-subject analyses. It was also found that the shape of the first PC-vector was consistent between subjects, while higher-order PC-vectors differed between subjects. These results support the hypothesis that adaptation to, and preparation for, a variable heel-strike event are both major sources of EMG variability in walking. PMID:23518206

Huber, Cora; Federolf, Peter; Nüesch, Corina; Cattin, Philippe C; Friederich, Niklaus F; Tscharner, Vinzenz von



Effect of continuing or stopping smoking during pregnancy on infant birth weight, crown-heel length, head circumference, ponderal index, and brain:body weight ratio.  


The objective of this study was to determine whether stopping smoking between the first prenatal care visit and the 32nd week of pregnancy affects the smoking-associated changes in five infant anthropometric indices. The study population consisted of 15,185 births in the Swedish Medical Birth Register from 1991 and 1992. The associations between birth weight, crown-heel length, head circumference, ponderal index, brain:body weight ratio, maternal smoking status at the first prenatal care visit and at 32 weeks' gestation, and other maternal and infant characteristics were assessed using multivariate linear regression. The infants of 946 women who stopped smoking before week 32 of pregnancy were statistically indistinguishable from the 9,802 infants of nondaily smokers in terms of birth weight, head circumference, and brain:body weight ratio, but they retained a significant deficit in crown-heel length of 0.23 cm (standard error, 0.08) and a significant elevation in ponderal index of 0.027 (standard error, 0.009). In this study, stopping smoking between the first prenatal care visit and week 32 of pregnancy prevented smoking-associated deficits in infant birth weight, head circumference, and brain:body weight ratio, but did not completely prevent deficits in crown-heel length in comparison with nonsmokers' infants of the same age, and did not prevent elevation of ponderal index in comparison with nonsmokers' infants of the same weight and age. PMID:10933268

Lindley, A A; Becker, S; Gray, R H; Herman, A A



Medialis Pedis Flap in the Reconstruction of Palmar Skin Defects of the Digits: Clarifying the Anatomy of the Medial Plantar Artery.  


Because of its outstanding texture, bulkiness, pliability and sensory recovery, the medialis pedis is an excellent alternative in the reconstruction of complex volar skin defects of the digits in selected patients. However, the surgical flap anatomy related with the medial plantar artery is still somewhat confusing to the point that the different journal articles and anatomy textbooks and atlases use different terminology and are, to some extent, misleading and/or incomplete. The authors report a clinical series of 15 medialis pedis free flaps in the reconstruction of skin defects of the fingers and evaluate their indications in free flap reconstruction of the skin defects of the digits. A review is made of the most relevant journal articles, anatomy textbooks, and atlases that describe the anatomy of the medial plantar artery with a special emphasis on the cutaneous branches that nourish the medialis pedis flap. PMID:23486116

Rodriguez-Vegas, Manuel



The effect of lateral heel studs on the kinematics of the equine digit while cantering on grass.  


This study aimed to assess the effect of lateral heel studs on foot-ground interaction in the horse by quantifying foot slip during stance whilst cantering on a grass surface. It was hypothesised that using studs would decrease foot slip distance on the ground conditions tested. Nine horses were ridden with and without a stud placed laterally in the shoe of each of the 4 feet. High speed video-analysis was used to track hoof markers and to provide data quantifying foot slip distance, slip duration and stance duration. Using studs resulted in a significant decrease in foot slip distance in all four limbs (all P values<0.004). The magnitude of the difference in slip distance with and without studs was greatest in the trailing limbs. The results supported the hypothesis that using studs will decrease foot slip distance in horses cantering on a grass surface, and additionally, highlights that stud efficacy may vary between limbs. The decrease in slip distance with studs demonstrated increased traction and a more stable foot-ground interaction, although this may cause a concomitant increase in the required energy dissipation, either within the limb or via surface deformation. The effect of repetitive usage of studs in the aetiology of musculoskeletal conditions should therefore be investigated further. PMID:21752677

Harvey, Alison M; Williams, Sarah B; Singer, Ellen R



The heel and toe of the cell's foot: A multifaceted approach for understanding the structure and dynamics of focal adhesions  

PubMed Central

Focal adhesions (FAs) are large clusters of transmembrane receptors of the integrin family and a multitude of associated cytoplasmic “plaque” proteins, which connect the extracellular matrix-bound receptors with the actin cytoskeleton. The formation of nearly stationary focal adhesions defines a boundary between dense and highly dynamic actin network in lamellipodium and the sparser and more diverse cytoskeletal organization in the lamella proper, creating a template for the organization of entire actin network. The major “mechanical” and “sensory” functions of FAs, namely, the nucleation and regulation of the contractile, myosin-II-containing, stress fibers and the mechanosensing of external surfaces depend, to a major extent, on the dynamics of molecular components within FAs. A central element in FA regulation concerns the positive feedback loop, based on the most intriguing feature of FAs, namely, their dependence on mechanical tension developing by the growing stress fibers. FAs grow in response to such tension, and rapidly disassemble upon its relaxation. In this article we address the mechanistic relationships between the process of FA development, maturation and dissociation and the dynamic molecular events, which take place in different regions of the FA, primarily in the distal end of this structure (the “toe”) and the proximal “heel”, and discuss the central role of local mechanical forces in orchestrating the complex interplay between FAs and the actin system.

Wolfenson, Haguy; Henis, Yoav I.; Geiger, Benjamin; Bershadsky, Alexander D.



A systemic review of Toxic Death in clinical oncology trials: an Achilles' heel in safety reporting revisited  

PubMed Central

Background: Toxic death is defined as study treatment-related mortality and as such is considered as an iatrogenic death. This belongs to unnatural death where an autopsy is advised. Until now, conventional autopsy is the gold standard to discriminate between pre- and post-mortem discrepancies. Methods: The consequences of lack of systematically performing an autopsy will be explored in the setting of oncological clinical trials. Results: During more than one decade, 6428 Serious Adverse Events have been registered in the EORTC Safety database on a total of 34?734 subjects. The number of deaths were 764 (mortality rate of 2.2%) whereof 255 (rate of 0.7%) toxic deaths. In 89.8% of these toxic deaths, no autopsy has been done; in 25.1% (64 cases) an inconsistent cause of death was found based on studying of the medical narrative. The autopsy rate was only 10.2% (26 out of 255) and, in 46.2% of the performed autopsies, there was a clinical pathological discrepancy. conclusion: When no autopsy is performed, there is a high risk for a wrong diagnosis in case of suspected toxic death. The high discrepancy rate, possibly due to a low autopsy rate, shows that toxic death is an Achilles' heel in iatrogenic mortality.

Penninckx, B; Van de Voorde, W M; Casado, A; Reed, N; Moulin, C; Karrasch, M



Thermal-hydraulic analysis of an annular fuel element: The Achilles' heel of the particle bed reactor  

NASA Astrophysics Data System (ADS)

The low pressure nuclear thermal propulsion (LPNTP) concept offers significant improvements in rocket engine specific impulse over rockets employment chemical propulsion. This study investigated a parametric thermal-hydraulic analysis of an annular fueld element, also referred to as a fuel pipe, using the computer code ATHENA (Advanced Thermal Hydraulic Energy Network Analyzer). The fuelpipe is an annular particle bed fuel element of the reactor with radially inward flow of hydrogen through the element. In this study, the outlet temperature of the hydrogen is parametrically related to key effects, including the reactor power at two different pressure drops, the effect of power coupling for in-core testing, and the effect of hydrogen flow rates. Results show that the temperature is linearly related to the reactor power, but not to pressure drop, and that cross flow inside the fuelpipe occurs at approximately 0.3 percent of the radial flow rates. More importantly, because of limited properties data for hydrogen and the probable yet uncharacterized dynamic distribution of packed fuel particles in the fuel pin during reactor operations, results from any thermal-hydraulic code, including ATHENA, do not give designs of satisfactory fidelity. This lack of design confidence is the Achilles' heel for current LPNTP reactors.

Dibben, Mark J.; Tuttle, Ronald F.



Frequent alternate muscle activity of plantar flexor synergists and muscle endurance during low-level static contractions as a function of ankle position  

Microsoft Academic Search

We have investigated the appropriate joint angle for detecting frequent alternating activity in synergistic muscles and the\\u000a relationship between muscle activation patterns and endurance during static low-level contractions. Eleven healthy men performed\\u000a prolonged static plantar flexion of the ankle at 10% of the maximal voluntary contraction, with the ankle flexed at 100°,\\u000a 110°, or 120°, while seated with the right

Hiroyuki Tamaki; Hikari Kirimoto; Kengo Yotani; Hiroaki Takekura


Postural destabilization induced by trunk extensor muscles fatigue is suppressed by use of a plantar pressure-based electro-tactile biofeedback  

Microsoft Academic Search

Separate studies have reported that postural control during quiet standing could be (1) impaired with muscle fatigue localized\\u000a at the lower back, and (2) improved through the use of plantar pressure-based electro-tactile biofeedback, under normal neuromuscular\\u000a state. The aim of this experiment was to investigate whether this biofeedback could reduce postural destabilization induced\\u000a by trunk extensor muscles. Ten healthy adults

Nicolas Vuillerme; Nicolas Pinsault; Olivier Chenu; Anthony Fleury; Yohan Payan; Jacques Demongeot



Evaluation of skin surface hydration state and barrier function of stratum corneum of dorsa of hands and heels treated with PROTECT X2 skin protective cream.  


Skin roughness is a term commonly used in Japan to describe a poor skin condition related to a rough and dry skin surface that develops as a result of various damaging effects from the environment or skin inflammation. Recovery from skin roughness requires skin care for a long period, thus it is important to prevent development of such skin changes. PROTECT X2 contains agents used for a protective covering of the skin from frequent hand washing or use of alcohol-based disinfectants. These unique components are also thought to be effective to treat skin roughness of the dorsa of the hands and heels. In the present study, we evaluated the effectiveness of PROTECT X2 to increase skin surface hydration state, as well as enhance the barrier function of the stratum corneum of the dorsa of the hands and heels in elderly individuals. A total of 8 elderly subjects and their caretakers without any skin diseases participated in the study. They applied PROTECT X2 by themselves to the dorsum area of 1 hand and heel 3 to 5 times daily for 1 month, while the opposite sides were left untreated. We measured stratum corneum (SC) hydration and transepidermal water loss (TEWL) before beginning treatment, then 1 week and 1 month after the start of treatment to compare between the treated and untreated skin. SC hydration state after applications of PROTECT X2 was 1.5- to 3.0-fold higher than that of the untreated skin in the dorsa of both hands and heels, indicating that the moisturizing ingredients accompanied by water were replenished in those areas where the cream was applied. Also, TEWL in the dorsum of the hands was 17.0-27.9% lower on the treated side, indicating improvement in SC barrier function. On the basis of these findings, we concluded that PROTECT X2 enhances water-holding in the SC and aids the barrier function of the skin in the dorsum of the hands. In addition, we consider that this formulation is useful for not only protecting the hands from the effects of such agents as detergents and alcohol-based disinfectants, but also for protecting heel skin covered by a thick SC from dry and cold conditions such as those encountered in winter. However, since the SC in that area is much thicker than that of the hands, the barrier function was not significantly improved within 1 month of daily treatments. PMID:22890206

Kubota, Takahiro



Gait functional assessment: Spatio-temporal analysis and classification of barefoot plantar pressure in a group of 11-12-year-old children.  


Analysis of pedobarographical data requires geometric identification of specific anatomical areas extracted from recorded plantar pressures. This approach has led to ambiguity in measurements that may underlie the inconsistency of conclusions reported in pedobarographical studies. The goal of this study was to design a new analysis method less susceptible to the projection accuracy of anthropometric points and distance estimation, based on rarely used spatio-temporal indices. Six pedobarographic records per person (three per foot) from a group of 60 children aged 11-12 years were obtained and analyzed. The basis of the analysis was a mutual relationship between two spatio-temporal indices created by excursion of the peak pressure point and the center-of-pressure point on the dynamic pedobarogram. Classification of weight-shift patterns was elaborated and performed, and their frequencies of occurrence were assessed. This new method allows an assessment of body weight shift through the plantar pressure surface based on distribution analysis of spatio-temporal indices not affected by the shape of this surface. Analysis of the distribution of the created index confirmed the existence of typical ways of weight shifting through the plantar surface of the foot during gait, as well as large variability of the intrasubject occurrence. This method may serve as the basis for interpretation of foot functional features and may extend the clinical usefulness of pedobarography. PMID:21782441

Latour, Ewa; Latour, Marek; Arlet, Jaros?aw; Adach, Zdzis?aw; Bohatyrewicz, Andrzej



Cost-effectiveness of cryotherapy versus salicylic acid for the treatment of plantar warts: economic evaluation alongside a randomised controlled trial (EVerT trial)  

PubMed Central

Abstract Background Plantar warts (verrucae) are extremely common. Although many will spontaneously disappear without treatment, treatment may be sought for a variety of reasons such as discomfort. There are a number of different treatments for cutaneous warts, with salicylic acid and cryotherapy using liquid nitrogen being two of the most common forms of treatment. To date, no full economic evaluation of either salicylic acid or cryotherapy has been conducted based on the use of primary data in a pragmatic setting. This paper describes the cost-effectiveness analysis which was conducted alongside a pragmatic multicentre, randomised trial evaluating the clinical effectiveness of cryotherapy versus 50% salicylic acid of the treatment of plantar warts. Methods A cost-effectiveness analysis was undertaken alongside a pragmatic multicentre, randomised controlled trial assessing the clinical effectiveness of 50% salicylic acid and cryotherapy using liquid nitrogen at 12 weeks after randomisation of patients. Cost-effectiveness outcomes were expressed as the additional cost required to completely cure the plantar warts of one additional patient. A NHS perspective was taken for the analysis. Results Cryotherapy costs on average £101.17 (bias corrected and accelerated (BCA) 95% CI: 85.09-117.26) more per participant over the 12 week time-frame, while there is no additional benefit, in terms of proportion of patients healed compared with salicylic acid. Conclusions Cryotherapy is more costly and no more effective than salicylic acid. Trial registration Current Controlled Trials ISRCTN18994246 [] and National Research Register N0484189151.



Biomechanical properties of the plantar flexor muscle-tendon complex 6 months post-rupture of the Achilles tendon.  


We compared the effects of a non-weight bearing protocol (NWB) and a weight bearing (WB) protocol on energy stored, stiffness, and shock absorption in the plantar flexor muscle-tendon unit of patients managed non-operatively following an Achilles tendon rupture. Thirty-eight subjects were randomized to a WB cast fitted with a Bohler iron or a traditional non-weight-bearing cast. At a 6-month follow-up, a biomechanical assessment utilizing an isokinetic dynamometer allowed measurement of peak passive torque, energy stored, shock absorption, and stiffness. The WB group had greater peak passive torque (? 20%). Irrespective of group, peak passive torque in unaffected legs was greater (? 26%) than affected legs. Across the groups, energy stored in the NWB group was 74% of the WB group. The energy stored in affected legs was 80% of that in unaffected legs. Shock absorption was not significantly different across legs or groups. Irrespective of group, affected legs had significantly less stiffness (20-40%). While the augmentation of plaster with a Bohler iron to allow increased weight bearing had positive effects, deficits in affected compared to unaffected legs irrespective of group were notable, and should be addressed prior to participation in vigorous physical activities. PMID:23649780

McNair, Peter; Nordez, Antoine; Olds, Margie; Young, Simon W; Cornu, Christophe



Chronic Illness  


... giving up cherished activities, adapting to new physical limitations and special needs, and paying for what can ... as long as eight years after diagnosis. Physical limitations imposed by heart disease and other chronic illnesses ...


Chronic Pericarditis  


... unknown. However, it may be caused by cancer, tuberculosis, or an underactive thyroid gland (hypothyroidism). Usually, the ... injury, heart surgery, or a bacterial infection. Previously, tuberculosis was the most common cause of chronic pericarditis ...


Native American lithic procurement along the international border in the boot heel region of southwestern New Mexico  

NASA Astrophysics Data System (ADS)

Multidisciplinary field projects can be very useful to a more fundamental understanding of the world around us, though these projects are not as common as they should be. In particular, the combination of archeology and geology combines our understanding of human behavior and human use of the landscape with an intimate knowledge of geologic processes and the materials available for human use in order to gain a broader understanding of human-Earth interaction. Here we present data from a cross-disciplinary project that uses a common dataset, archeological artifacts, to explore the anthropological and geologic implications of useage patterns. Archeological excavations and surveys conducted by the Office of Contract Archeology in 2007 along the route of the proposed international border fence reveal patterns of use of geologic materials by Archaic, Formative and Protohistoric Native Americans in the Boot Heel of southwestern New Mexico. Thousands of artifacts were recorded in multiple sites from Guadalupe Pass in the southern Peloncillo Mountains to the Carrizalillo Hills west of Columbus. We identified the lithologies of artifacts, ranging from projectile points to groundstones, and then constructed material movement maps based on either known procurement sites ("quarries") or outcrops identified as the closest source to a given site for each lithology. Not unexpectedly, the majority of the rock types utilized by native peoples are local siliceous volcanic materials. However, several artifacts constructed from obsidian were transported into the region from northern Mexico and eastern Arizona, indicating long-distance travel and/or trade routes. We also examine useage pattern difference between Archaic, Formative and Protohistoric sites. Additionally, a dramatic change in distribution of sources for geologic materials occurs between one pre-Spanish site and one post-Spanish site that are adjacent to one another.

Zeigler, K. E.; Hughes, C.; Kurota, A.; Hogan, P.



Native American lithic procurement along the international border in the boot heel region of southwestern New Mexico  

NASA Astrophysics Data System (ADS)

Multidisciplinary field projects can be very useful to a more fundamental understanding of the world around us, though these projects are not as common as they should be. In particular, the combination of archeology and geology combines our understanding of human behavior and human use of the landscape with an intimate knowledge of geologic processes and the materials available for human use in order to gain a broader understanding of human-Earth interaction. Here we present data from a cross-disciplinary project that uses a common dataset, archeological artifacts, to explore the anthropological and geologic implications of useage patterns. Archeological excavations and surveys conducted by the Office of Contract Archeology in 2007 along the route of the proposed international border fence reveal patterns of use of geologic materials by Archaic, Formative and Protohistoric Native Americans in the Boot Heel of southwestern New Mexico. Thousands of artifacts were recorded in multiple sites from Guadalupe Pass in the southern Peloncillo Mountains to the Carrizalillo Hills west of Columbus. We identified the lithologies of artifacts, ranging from projectile points to groundstones, and then constructed material movement maps based on either known procurement sites ("quarries") or outcrops identified as the closest source to a given site for each lithology. Not unexpectedly, the majority of the rock types utilized by native peoples are local siliceous volcanic materials. However, several artifacts constructed from obsidian were transported into the region from northern Mexico and eastern Arizona, indicating long-distance travel and/or trade routes. We also examine useage pattern difference between Archaic, Formative and Protohistoric sites. Additionally, a dramatic change in distribution of sources for geologic materials occurs between one pre-Spanish site and one post-Spanish site that are adjacent to one another.

Zeigler, K. E.; Hogan, P.; Hughes, C.; Kurota, A.



Utilization of the MPI Process for in-tank solidification of heel material in large-diameter cylindrical tanks  

SciTech Connect

A major problem faced by the US Department of Energy is remediation of sludge and supernatant waste in underground storage tanks. Exhumation of the waste is currently the preferred remediation method. However, exhumation cannot completely remove all of the contaminated materials from the tanks. For large-diameter tanks, amounts of highly contaminated ``heel'' material approaching 20,000 gal can remain. Often sludge containing zeolite particles leaves ``sand bars'' of locally contaminated material across the floor of the tank. The best management practices for in-tank treatment (stabilization and immobilization) of wastes require an integrated approach to develop appropriate treatment agents that can be safely delivered and mixed uniformly with sludge. Ground Environmental Services has developed and demonstrated a remotely controlled, high-velocity jet delivery system termed, Multi-Point-Injection (MPI). This robust jet delivery system has been field-deployed to create homogeneous monoliths containing shallow buried miscellaneous waste in trenches [fiscal year (FY) 1995] and surrogate sludge in cylindrical (FY 1998) and long, horizontal tanks (FY 1999). During the FY 1998 demonstration, the MPI process successfully formed a 32-ton uniform monolith of grout and waste surrogates in about 8 min. Analytical data indicated that 10 tons of zeolite-type physical surrogate were uniformly mixed within a 40-in.-thick monolith without lifting the MPI jetting tools off the tank floor. Over 1,000 lb of cohesive surrogates, with consistencies similar to Gunite and Associated Tank (GAAT) TH-4 and Hanford tank sludges, were easily intermixed into the monolith without exceeding a core temperature of 100 F during curing.

Kauschinger, J.L.; Lewis, B.E.



Ear infection - chronic  


Middle ear infection - chronic; Otitis media - chronic; Chronic otitis media; Chronic ear infection ... Chole RA, Sudhoff HH. Chronic otitis media, mastoiditis, and ... eds. Otolaryngology: Head & Neck Surgery . 5th ed. Philadelphia, ...


Unique Hippocampal Changes and Allodynia in a Model of Chronic Stress  

PubMed Central

Sustained stress can have numerous pathologic effects. There have been several animal models for chronic stress. We tried to identify the changes of pain threshold and hippocampus in a model of chronic stress. Male Sprague-Dawley rats were kept in a cage filled with 23? water to a height of 2.2 cm for 7 days. Nociceptive thresholds, expressed in grams, were measured with a Dynamic Plantar Aesthesiometer. Golgi staining was used to identify hippocampal changes. To demonstrate how long allodynia was lasting, behavioral test was repeated daily on another experiment. Compared to control group, chronic stress group showed bilateral mechanical hyper-responsiveness on days 5 (P = 0.047) and 7 (P = 0.032). In general, dendrite atrophic changes within hippocampus of chronic stress model were much more prominent in comparison with control. Compared to control, decreased spine number (P < 0.001) and spine length (P < 0.001) on Golgi staining were seen in the hippocampus of animals with chronic stress. Bilateral mechanical hyperresponsiveness was recovered on day 19 in animals with chronic stress. Chronic stress may bring about central sensitization and hippocampal changes in rats.

Moon, Il Soo; Park, In-Sick



Patterns of physical activity and ultrasound attenuation by heel bone among Norfolk cohort of European Prospective Investigation of Cancer (EPIC Norfolk): population based study  

PubMed Central

Objectives To study associations between patterns of physical activity and ultrasound attenuation by the heel bone in men and women. Design Cross sectional, population based study. Setting Norfolk. Participants 2296 men and 2914 women aged 45-74 registered with general practices participating in European Prospective Investigation into Cancer (EPIC Norfolk). Results Self reported time spent in high impact physical activity was strongly and positively associated with ultrasound attenuation by the heel bone, independently of age, weight, and other confounding factors. Men who reported participating in ?2 hours/week of high impact activity had 8.44 dB/MHz (95% confidence interval 4.49 to 12.40) or 9.5%, higher ultrasound attenuation than men who reported no activity of this type. In women, the difference in ultrasound attenuation between those reporting any high impact activity and those reporting none was 2.41 dB/MHz (0.45 to 4.37) or 3.4% higher. In women this effect was similar in size to that of an age difference of four years. Moderate impact activity had no effect. However, climbing stairs was strongly independently associated with ultrasound attenuation in women (0.64 dB/MHz (0.19 to 1.09) for each additional five flights of stairs). There was a significant negative association in women between time spent watching television or video and heel bone ultrasound attenuation, which decreased by 0.08 dB/MHz (0.02 to 0.14) for each additional hour of viewing a week. Conclusions High impact physical activity is independently associated with ultrasound attenuation by the heel bone in men and women. As low ultrasound attenuation has been shown to predict increased risk of hip fracture, interventions to promote participation in high impact activities may help preserve bone density and reduce the risk of fracture. However, in older people such interventions may be inappropriate as they could increase the likelihood of falls.

Jakes, Rupert W; Khaw, Kay-Tee; Day, Nicholas E; Bingham, Sheila; Welch, Ailsa; Oakes, Suzy; Luben, Robert; Dalzell, Nicola; Reeve, Jonathan; Wareham, Nicholas J



Plantar Fascia Thickness is Longitudinally Associated with Retinopathy and Renal Dysfunction: A Prospective Study from Adolescence to Adulthood  

PubMed Central

Aim The aim was to study the longitudinal relationship between plantar fascia thickness (PFT) as a measure of tissue glycation and microvascular (MV) complications in young persons with type 1 diabetes (T1DM). Methods We conducted a prospective longitudinal cohort study of 152 (69 male) adolescents with T1DM who underwent repeated MV complications assessments and ultrasound measurements of PFT from baseline (1997–2002) until 2008. Retinopathy was assessed by 7-field stereoscopic fundal photography and nephropathy by albumin excretion rate (AER) from three timed overnight urine specimens. Longitudinal analysis was performed using generalized estimating equations (GEE). Results Median (interquartile range) age at baseline was 15.1 (13.4–16.8) years, and median follow-up was 8.3 (7.0–9.5) years, with 4 (3–6) visits per patient. Glycemic control improved from baseline to final visit [glycated hemoglobin (HbA1c) 8.5% to 8.0%, respectively; p = .004]. Prevalence of retinopathy increased from 20% to 51% (p < .001) and early elevation of AER (>7.5 µg/min) increased from 26% to 29% (p = .2). A greater increase in PFT (mm/year) was associated with retinopathy at the final assessment (?PFT 1st vs. 2nd–4th quartiles, ?2 = 9.87, p = .02). In multivariate GEE, greater PFT was longitudinally associated with retinopathy [odds ratio (OR) 4.6, 95% confidence interval (CI) 2.0–10.3] and early renal dysfunction (OR 3.2, CI 1.3–8.0) after adjusting for gender, blood pressure standard deviation scores, HbA1c, and total cholesterol. Conclusions In young people with T1DM, PFT was longitudinally associated with retinopathy and early renal dysfunction, highlighting the importance of early glycemic control and supporting the role of metabolic memory in MV complications. Measurement of PFT by ultrasound offers a noninvasive estimate of glycemic burden and tissue glycation.

Benitez-Aguirre, Paul Z.; Craig, Maria E.; Jenkins, Alicia J.; Gallego, Patricia H.; Cusumano, Janine; Duffin, Anthony C.; Hing, Stephen; Donaghue, Kim C.



Pattern description and reliability parameters of six force-time related indices measured with plantar pressure measurements.  


BACKGROUND: Functional interpretation of plantar pressure measurements is commonly done through the use of ratios and indices which are preceded by the strategic combination of a subsampling method and selection of physical quantities. However, errors which may arise throughout the determination of these temporal indices/ratio calculations (T-IRC) have not been quantified. The purpose of the current study was therefore to estimate the reliability of T-IRC following semi-automatic total mapping (SATM). METHODS: Using a repeated-measures design, two experienced therapists performed three subsampling sessions on three left and right pedobarographic footprints of ten healthy participants. Following the subsampling, six T-IRC were calculated: Rearfoot-Forefoot_fti, Rearfoot-Midfoot_fti, Forefoot medial/lateral_fti, First ray_fti, Metatarsal 1-Metatarsal 5_fti, Foot medial-lateral_fti. FINDINGS: Patterns of the T-IRC were found to be consistent and in good agreement with corresponding knowledge from the literature. The inter-session errors of both therapists were similar in pattern and magnitude. The lowest peak inter-therapist error was found in the First ray_fti (6.5a.u.) whereas the highest peak inter-therapist error was observed in the Forefoot medial/lateral_fti (27.0a.u.) The magnitude of the inter-session and inter-therapist error varied over time, precluding the calculation of a simple numerical value for the error. The difference between both error parameters of all T-IRC was negligible which underscores the repeatability of the SATM protocol. CONCLUSION: The current study reports consistent patterns for six T-IRC and similar inter-session and inter-therapist error. The proposed SATM protocol and the T-IRC may therefore serve as basis for functional interpretation of footprint data. PMID:23665063

Deschamps, Kevin; Roosen, Philip; Bruyninckx, Herman; Desloovere, Kaat; Deleu, Paul-Andre; Matricali, Giovanni A; Peeraer, Louis; Staes, Filip



Adjuvant role of a new emollient cream in patients with palmar and/or plantar psoriasis: a pilot randomized open-label study.  


Emollients are considered important adjunctive tools for the therapeutic management of psoriasis patients. In spite of the widespread use, the actual impact of emollients on psoriasis is far to be completely elucidated. The objective of this study was to evaluate the effect of a new emollient cream containing milk proteins and Glycyrrhiza glabra extracts in patients with palmar and/or plantar psoriasis treated with topical corticotherapy. This pilot open parallel-group trial was carried out in 40 patients with palmar and/or plantar psoriasis. Patients were randomized to receive monotherapy with mometasone furoate ointment, applied once daily to the palmoplantar lesions until remission and for a maximum of 4 weeks (N=20), or the same topical corticotherapy in combination with the emollient cream (N=20). The emollient was applied twice a day for 4 weeks. Clinical assessments were performed at baseline and 2 and 4 weeks after the start of treatment. All patients completed the study and showed a progressive improvement of their palmo-plantar psoriasis over the treatment period, achieving at week 4 a statistical significant reduction in the severity of all clinical signs (erythema, desquamation and infiltration) and in the surface area affected. The comparison between the two groups showed no differences in the mean average duration of corticosteroid therapy, whereas a significantly greater improvement of desquamation, surface area affected, and subjective symptoms was observed at week 4 in the group treated with the corticotherapy combined with the emollient as compared to patients who received the corticotherapy alone. This pilot experience suggests the importance of the adjuvant role of particular emollients in the management of psoriasis. PMID:21139557

Cassano, N; Mantegazza, R; Battaglini, S; Apruzzi, D; Loconsole, F; Vena, G A



The validity and reliability of a portable slip meter for determining floor slipperiness during simulated heel strike.  


A previously developed test rig was used as starting point for designing a portable slip meter with two new features. First, an inflatable pneumatic test wheel, consisting of six slider units, was introduced as the impacting contact element relative to floor surface. Second, an inductive trigger was built into the system to facilitate a precise timing of the slider-floor contact during the test. This new test rig was designed to measure transitional friction properties of contaminated floor surfaces during simulated heel strike, which is considered the most critical phase of gait from the slip and fall point of view. Another objective was to quantify the validity and reliability of this test method in the laboratory, but not yet in the field. The measurement process was evaluated on eight wet and oily floor surfaces (vinyl and ceramic tile floorings) using two slider materials (plain, profiled), two normal loads (100, 200 N), and two sliding velocities (0.15, 0.30 m/s) as independent variables. The outputs of the portable slip meter, in terms of transitional friction coefficients, were compared to force platform-based friction values and to slip resistance values obtained with a slip simulator apparatus for laboratory testing of shoes and floor surfaces. The outputs were also evaluated against slipperiness ratings made by three male subjects in paired comparison trials, in which the subjects walked over eight wet floor surfaces wearing shoes with the plain soling material. The results showed that test option 200 N and 0.15m/s led to optimum validity despite its tendency to promote frictional vibrations (stick-slip) in the contact surface. Compared to the lower sliding speed, the higher speed reduced both stick-slip and measurement bias. Test option 200 N and 0.30 m/s was the most reliable one in this experiment. It yielded lower friction coefficients than any other test option and reduced the likelihood of underestimating slip and fall hazards. The results implied that the minimum friction coefficient was 0.25 for preventing a fall on wet floor surfaces, whereas the limit for preventing a slip was in the range 0.30-0.35. Transitional friction measurement was found to be a valid and reliable indicator for slip resistance. A more accurate control of the normal force during testing is needed for actual field use of the test method. PMID:12504142

Grönqvist, Raoul; Hirvonen, Mikko; Rajamäki, Erkki; Matz, Simon



Local hyperthermia at 44 degrees C for the treatment of plantar warts: a randomized, patient-blinded, placebo-controlled trial.  


There have been anecdotal reports that local hyperthermia was effective in the treatment of viral warts. We conducted a randomized, patient-blinded, placebo-controlled trial to test the effect of local hyperthermia (44 degrees C for 30 min a day for 3 consecutive days plus 2 additional days 2 weeks later) on plantar warts. By the end of 3 months, 53.57% of patients (15/28) in the treatment group and 11.54% of patients (3/26) in the control group were cured (P < .01). The effect was not influenced by patient age, duration of disease, or number or size of lesions. PMID:20199243

Huo, Wei; Gao, Xing-Hua; Sun, Xiu-Ping; Qi, Rui-Qun; Hong, Yuxiao; Mchepange, Uwesu Omari; Li, Xiao-Dong; Xiao, Bi-Huan; Lin, Jun-Ping; Jiang, Yi; Zhang, Li; Li, Yuan-Hong; Xiao, Ting; Chen, John Z S; Chen, Hong-Duo



Papillon-Lefevre syndrome-like presentation in chronic arsenicosis: A rare mimicry  

PubMed Central

Chronic arsenicosis is a major health and occupational problem in rural parts of West Bengal such as in parts of the Gangetic plain of India. Chronic arsenicosis occurs due to accidental ingestion of repeated amounts of small doses by those working with metal or by taking food or drink in which there are traces of arsenic. Chronic exposure may result accumulation in the hair, nail, and skin. Arsenic can also cross the placenta. Papillon-Lefèvre syndrome is a rare disease characterized by skin lesions caused by palmar-plantar hyperkeratosis and severe periodontal destruction involving both the primary and permanent dentitions. Until date, more than 200 cases have been reported worldwide. Palmoplantar hyperkeratosis is a major manifestation in both chronic arsenicosis and Papillon-Lefèvre syndrome. We report herein a rare case of chronic arsenicosis in a patient from rural Bengal, whose all features mimic Papillon-Lefèvre syndrome. It is probably the first case of Papillon-Lefevre syndrome-like presentation in chronic arsenicosis from India.

Das, Somak K.; Nath, Tanusree; Ghosal, Anirban; Jana, Chanchal K.



Hypertrophy of chronically unloaded muscle subjected to resistance exercise.  


In an effort to simulate the compromised function and atrophy of lower limb muscles experienced by astronauts after spaceflight, 21 men and women age 30-56 yr were subjected to unilateral lower limb unloading for 5 wk. Whereas 10 of these subjects performed unilateral knee extensor resistance exercise (ULRE) two or three times weekly, 11 subjects (UL) refrained from training. The exercise regimen consisted of four sets of seven maximal actions, using an apparatus that offers concentric and eccentric resistance by utilizing the inertia of rotating flywheel(s). Knee extensor muscle strength was measured before and after UL and ULRE, and knee extensor and ankle plantar flexor muscle volumes were determined by means of magnetic resonance imaging. Surface electromyographic activity measured after UL inferred increased muscle use to perform a given motor task. UL induced an 8.8% decrease (P < 0.05) in knee extensor muscle volume. After ULRE and as a result of only approximately 16 min of maximal contractile activity over the 5-wk course, muscle volume increased 7.7% (P < 0.05). Muscle strength decreased 24-32% (P < 0.05) in response to UL. Group ULRE showed maintained (P > 0.05) strength. Ankle plantar flexor muscle volume of the unloaded limb decreased (P < 0.05) in both groups (UL 10.5%; ULRE 11.1%). In neither group did the right weight-bearing limb show any change (P > 0.05) in muscle volume or strength. The results of this study provide evidence that resistance exercise not only may offset muscle atrophy but is in fact capable of promoting marked hypertrophy of chronically unloaded muscle. PMID:14660503

Tesch, P A; Trieschmann, J T; Ekberg, A



Calcaneus (Heel Bone) Fractures  


... They are held together with special screws or metal plates and screws. Percutaneous screw fixation. Sometimes, if the ... bone fragments and holding them in place with metal plates and screws. Top of page Recovery Bones have ...


Biomechanical comparison of a locking plate with intraplate compression screw versus locking plate with plantar interfragmentary screw for Lapidus arthrodesis: a cadaveric study.  


Lapidus arthrodesis (first metatarsal cuneiform arthrodesis) has become an accepted procedure for hallux abducto valgus. Several variations of fixation have been described. Earlier weightbearing postoperatively has been one reported benefit of using locking plates for fixation. Additionally, studies have demonstrated that fixation placed on the plantar or tension side of the arthrodesis increases the biomechanical advantage. We performed a biomechanical cadaveric study of the Lapidus procedure, comparing a previously reported technique using a low profile locking plate with an intraplate compression screw versus the same locking plate with a plantar interfragmentary screw (PIFS) placed on the tension side of the arthrodesis in 10 fresh, paired, cadaver limbs. The mean ultimate load of the plate with a PIFS was 383.2 ± 211.5 N, and the mean ultimate load of the plate with an intraplate compression screw was 205.5 ± 97.2 N. The mean ultimate load of the LPS Lapidus plate with a PIFS was statistically greater (p = .027) than that with the plate intraplate compression screw. Our results indicated that changing the orientation of the compression screw to a PIFS significantly increased the stability of the Lapidus arthrodesis fixation construct. The modified construct with the PIFS might decrease the incidence of nonunion and, ultimately, allow patients to bear weight faster postoperatively. PMID:23621977

Cottom, James M; Rigby, Ryan B


Chronic Rhinosinusitis  

Microsoft Academic Search

\\u000a Rhinosinusitis describes a group of inflammatory conditions of the nasal mucosa and paranasal sinuses that affect 31 million\\u000a people in the USA each year. When the term chronic rhinosinusitis (CRS) is used, it implies that the condition has persisted\\u000a for more than 12 weeks despite medical therapy. The diagnosis of CRS requires the presence of at least two of the

Philip Wexler; Helen Hollingsworth


[Chronic pneumonia?].  


The differential diagnosis of persistent radiologic pulmonary shadow is broad and is illustrated and discussed with the help of four patients histories. The term chronic pneumonia is a misnomer. Particularly, slowly growing types of lung cancer should be considered as a potential etiology. They are potentially curable by surgical resection. Other diseases can be treated as soon as they are specified with appropriate diagnostic methods. PMID:23188777

Russi, E



Chronic Diseases  

Microsoft Academic Search

Although diabetes mellitus, cardiovascular disease, and human immunodeficiency virus infection are three separate entities,\\u000a each has causal and non-causal risk factors that are common in the stage 5 chronic kidney disease population. The medical\\u000a nutrition therapies are similar, which emphasize adequate protein and energy intakes, fluid control, and possibly carbohydrate\\u000a and fat modifications. Each patient requires an individualized evaluation, taking

Sharon R. Schatz


Life-Course Predictors of Ultrasonic Heel Measurement in a Cross-sectional Study of Immigrant Women from Southeast Asia  

Microsoft Academic Search

Few studies address chronic disease risk for Southeast Asians in the United States. In 1999, the authors conducted a cross-sectional study of bone mineral density (BMD) estimated from ultrasonic calcaneal measurements in women born in Southeast Asia who then lived in Chicago, Illinois. The study addressed three questions: Do Southeast-Asian women have relatively low BMD? What factors before and after

Diane S. Lauderdale; Talya Salant; Katherine L. Han; Phuong L. Tran


Use of a pressure plate to analyse the toe-heel load redistribution underneath a normal shoe and a shoe with a wide toe in sound warmblood horses at the walk and trot.  


The objective of this study was to use a pressure plate to quantify the toe-heel load redistribution in the forelimbs of sound warmblood horses with normal shoes and shoes with a wide toe and narrow branches, used empirically in the treatment of superficial digital flexor tendon or suspensory ligament injuries. In a crossover-design study, six horses, randomly shod with normal shoes and shoes with a wide toe, were led over a dynamically calibrated pressure plate to record data from both forelimbs. There were no significant differences between both shoes in the toe-heel index of stance time, peak vertical force and vertical impulse. For the adapted shoe, the peak vertical pressure was slightly lower and was exerted slightly earlier in the stance phase, albeit not significantly. However, the significantly larger toe contact area of the adapted shoe resulted in a significantly lower total vertical pressure in the toe region. Hence, the pressure plate adequately visualised the individual loading of the toe and heel region, and clearly demonstrated the altered pressure distribution underneath the shoe with a wide toe. Although further research on a deformable surface is needed to confirm this hypothesis, the pressure redistribution from the toe to the heels could promote sinking of the heels in arena footing, thereby mimicking the biomechanical effects of a toe wedge and providing a rationale for its application in the treatment of SDFT or SL injuries. The pressure measuring equipment used in this study can offer to the clinician a diagnostic tool for the evaluation of the load distribution underneath the equine hoof and for the fine-tuning of corrective shoeing. PMID:22342126

Oomen, A M; Oosterlinck, M; Pille, F; Sonneveld, D C; Gasthuys, F; Back, W



Chronic urticaria.  


Chronic urticaria is defined as case of spontaneous wheals and/or angioedema persisting for a period of at least six weeks. The disease has an average duration of three to five years and is strongly associated with a decrease of quality of life and performance. Current international guidelines recommend the use of non-sedating antihistamines as the first choice in therapy and up-dosing these up to fourfold in cases of non-response. Alternative treatments for the afflicted who do not respond to antihistamine-treatment are also available but are not approved for use on urticaria. PMID:22638841

Zuberbier, Torsten



The use of specific binding of peptide-nucleic acid to DNA in the {open_quotes}Achilles heel{close_quotes} method  

SciTech Connect

The `Achilles heel` method (AHM) is used in the design of random-cleavage restriction endonucleases. These promising compounds can be widely used in practice, particularly for genomic DNA mapping. DNA is complexed with a site-specific DNA-binding reagent (protein or oligonucleotide) and then treated with methylase. The methylation sites overlapping with or adjacent to the DNA-binding sites of the reagent are protected from methylation. Thereafter, methylase is inactivated, the DNA-binding reagent is removed, and DNA is cleaved by the restriction endonuclease corresponding to the methylase used. As a result, DNA is cleaved only at those restriction sites that were protected by the DNA-binding reagent from methylation. Until now, proteins or oligonucleotides were used as site-specific DNA-binding reagents. Here, we report on the use of a peptide-nucleic acid (PNA) in AHM. 7 refs., 4 figs.

Krasil`nikova, M.M.; Izvol`skii, K.I.; Krupnik, O.V.; Lazurkin, Yu.S. [Institute of Molecular Genetics, Moscow (Russian Federation)



Genetic variation in sex hormone genes influences heel ultrasound parameters in middle-aged and elderly men: results from the European Male Aging Study (EMAS).  


Genes involved in sex hormone pathways are candidates for influencing bone strength. Polymorphisms in these genes were tested for association with heel quantitative ultrasound (QUS) parameters in middle-aged and elderly European men. Men 40-79 yr of age were recruited from population registers in eight European centers for the European Male Aging Study (EMAS). Polymorphisms were genotyped in AR, ESR1, ESR2, CYP19A1, CYP17A1, SHBG, SRD5A2, LHB, and LHCGR. QUS parameters broadband ultrasound attenuation (BUA) and speed of sound (SOS) were measured in the heel and used to derive BMD. The relationships between QUS parameters and polymorphisms were assessed using linear regression adjusting for age and center. A total of 2693 men, with a mean age of 60.1 +/- 11.1 (SD) yr were included in the analysis. Their mean BUA was 80.0 +/- 18.9 dB/Mhz, SOS was 1550.2 +/- 34.1 m/s, and BMD was 0.542 +/- 0.141 g/cm(2). Significant associations were observed between multiple SNPs in a linkage disequilibrium (LD) block within CYP19A1, peaking at the TCT indel with the deletion allele associating with reduced ultrasound BMD in heterozygotes (beta =-0.016, p = -0.005) and homozygotes (beta = -0.029, p = 0.001). The results for BUA and SOS were similar. Significant associations with QUS parameters were also observed for the CAG repeat in AR and SNPs in CYP17A1, LHCGR, and ESR1. Our data confirm evidence of association between bone QUS parameters and polymorphisms in CYP19A1, as well as modest associations with polymorphisms in CYP17A1, ESR1, LHCGR, and AR in a population sample of European men; this supports a role for genetically determined sex hormone actions in influencing male bone health. PMID:18767927

Limer, Kate L; Pye, Stephen R; Thomson, Wendy; Boonen, Steven; Borghs, Herman; Vanderschueren, Dirk; Huhtaniemi, Ilpo T; Adams, Judith E; Ward, Kate A; Platt, Hazel; Payne, Debbie; John, Sally L; Bartfai, Gyorgy; Casanueva, Felipe; Finn, Joseph D; Forti, Gianni; Giwercman, Aleksander; Han, Thang S; Kula, Krzysztof; Lean, Michael E; Pendleton, Neil; Punab, Margus; Silman, Alan J; Wu, Frederick C; O'Neill, Terence W



Radical resection of a venous malformation in middle finger and immediate reconstruction using medial plantar artery perforator flap: a case report.  


Reconstruction of complex defects resulting from radical resection of venous malformation occurring in other digits except the thumb is challenging because a thin and durable flap is required to achieve optimal reconstruction without functional impairment. Here, we describe an alternative reconstruction technique in a young patient. A 15-year-old female patient with venous malformation of the left 3rd finger was treated by radical excision of the tumor including involved skin, distal phalanx, and nail bed followed by reconstruction with free medial plantar artery perforator flap and split thickness nail bed graft from the great toe. Twenty-nine months after surgery, the reconstructed finger showed a acceptable aesthetic result without tumor recurrence and excellent restoration of motor function. This method can be considered as an useful alternative option for management of the digital venous malformation in other digits except the thumb. Indications and technical aspects of this method are discussed in this report. PMID:22389901

Gu, Ja Hea; Jeong, Seong-Ho



[Chronic constipation].  


Complaints of chronic constipation may substantially impair the quality of life of a patient. The disease feeling is shaped not only by objective parameters but also by subjective perceptions. This is along-considered into the so-called Rome-III-criteria. In the majority of the patients no distinct pathology can be found. A smaller group of patients however exhibit isolated or in combination a slow colonic transit or a pelvic floor dysfunction. Secondary extraintestinal causes are to be looked for particularly during a first clinical evaluation. Apart from general clinical investigations if necessary combined with a colonscopy, specific function tests (transit measurements, defecography) may be applied. Different laxative agents are the primary cornerstone of treatment. In selected cases biofeedback training or even surgical intervention can be successfully adopted. PMID:17663207

Degen, L



Chronic Sinusitis  

PubMed Central

Paranasal sinuses, which communicate with the nasal passages through the sinus ostia, are essentially sterile structures, sterility being maintained by a healthy epithelium with normal actively beating cilia. Irritants, including viruses and bacteria, are trapped in mucus and cilia to allow the clearance of sinuses through the natural ostia into the nasal cavity. Interference with this normal physiological function results in inflammation and infection within the sinus cavities. All of the sinuses are subjected to the same environmental as well as physiological stimuli; thus it is uncommon for a single sinus to be infected and for the others to remain entirely normal. Allergic and non-allergic vasomotor rhinitis should be differentiated from chronic bacterial rhinosinusitis. The understanding of these diseases cannot be separated from the physiological function of the sinus mucosa.

Steinberg, Johannes; Modi, Pradip



In vitro antifungal activity of KP-103, a novel triazole derivative, and its therapeutic efficacy against experimental plantar tinea pedis and cutaneous candidiasis in guinea pigs.  


The in vitro activity of KP-103, a novel triazole derivative, against pathogenic fungi that cause dermatomycoses and its therapeutic efficacy against plantar tinea pedis and cutaneous candidiasis in guinea pigs were investigated. MICs were determined by a broth microdilution method with morpholinepropanesulfonic acid-buffered RPMI 1640 medium for Candida species and with Sabouraud dextrose broth for dermatophytes and by an agar dilution method with medium C for Malassezia furfur. KP-103 was the most active of all the drugs tested against Candida albicans (geometric mean [GM] MIC, 0.002 microg/ml), other Candida species including Candida parapsilosis and Candida glabrata (GM MICs, 0.0039 to 0.0442 microg/ml), and M. furfur (GM MIC, 0.025 microg/ml). KP-103 (1% solution) was highly effective as a treatment for guinea pigs with cutaneous candidiasis and achieved mycological eradication in 8 of the 10 infected animals, whereas none of the imidazoles tested (1% solutions) was effective in even reducing the levels of the infecting fungi. KP-103 was as active as clotrimazole and neticonazole but was less active than lanoconazole and butenafine against Trichophyton rubrum (MIC at which 80% of isolates are inhibited [MIC(80)], 0.125 microg/ml) and Trichophyton mentagrophytes (MIC(80), 0.25 microg/ml). However, KP-103 (1% solution) exerted therapeutic efficacy superior to that of neticonazole and comparable to those of lanoconazole and butenafine, yielding negative cultures for all samples from guinea pigs with plantar tinea pedis tested. This suggests that KP-103 has better pharmacokinetic properties in skin tissue than the reference drugs. Because the in vitro activity of KP-103, unlike those of the reference drugs, against T. mentagrophytes was not affected by hair as a keratinic substance, its excellent therapeutic efficacy seems to be attributable to good retention of its antifungal activity in skin tissue, in addition to its potency. PMID:11302816

Tatsumi, Y; Yokoo, M; Arika, T; Yamaguchi, H



Ipsi- and contralateral H-reflexes and V-waves after unilateral chronic Achilles tendon vibration.  


Chronic Achilles tendon vibration has previously shown its effectiveness in improving plantar flexor's strength and activation capacities. The present study investigated the related neural mechanisms by analyzing H-reflexes and V-waves of the soleus (SOL) and gastrocnemii (GM gastrocnemius medialis; GL gastrocnemius lateralis) muscles under maximal isometric plantar flexion. Moreover, recordings were conducted bilaterally to address potential crossed effects. 11 subjects were engaged in this study. Maximal voluntary contraction and superimposed H-reflexes and V-waves were quantified in both legs at baseline (PRE) and 2 weeks later to verify repeatability of data (CON). Then, subjects were retested after 14 days of daily unilateral Achilles tendon vibration (VIB; 1 h per day; frequency: 50 Hz). No changes were reported between PRE and CON data. In the VIB condition, there was an increase in MVC for both the vibrated (+9.1 %; p = 0.016) and non-vibrated (+10.2 %; p = 0.009) legs. The H-reflex increased by a mean 25 % in the vibrated SOL (p < 0.001), while it remained unchanged for the contralateral side (p = 0.531). The SOL V-wave also increased in the vibrated limb (+43.3 %; p < 0.001), as well as in the non-vibrated one (+41.9 %; p = 0.006). Furthermore, the GM V-wave increased by 37.8 % (p = 0.081) in the vibrated side and by 39.4 % (p = 0.03) in the non-vibrated side. However, no changes were reported for the GL muscles. While the present study confirmed the strength gains induced by chronic Achilles tendon vibration, the results indicated a cross-education phenomenon with differences in neural adaptations between the vibrated leg and non-vibrated leg. PMID:23652708

Lapole, Thomas; Canon, Francis; Pérot, Chantal




PubMed Central

Chronic urticaria (CU) is a disturbing allergic condition of the skin. Although frequently benign, it may sometimes be a red flag sign of a serious internal disease. A multitude of etiologies have been implicated in the causation of CU, including physical, infective, vasculitic, psychological and idiopathic. An autoimmune basis of most of the ‘idiopathic’ forms is now hypothesized. Histamine released from mast cells is the major effector in pathogenesis and it is clinically characterized by wheals that have a tendency to recur. Laboratory investigations aimed at a specific etiology are not always conclusive, though may be suggestive of an underlying condition. A clinical search for associated systemic disease is strongly advocated under appropriate circumstances. The mainstay of treatment remains H1 antihistaminics. These may be combined with complementary pharmacopeia in the form of H2 blockers, doxepin, nifedipine and leukotriene inhibitors. More radical therapy in the form of immunoglobulins, plasmapheresis and cyclophosphamide may be required for recalcitrant cases. Autologous transfusion and alternative remedies like acupuncture have prospects for future. A stepwise management results in favorable outcomes. An update on CU based on our experience with patients at a tertiary care centre is presented.

Sachdeva, Sandeep; Gupta, Vibhanshu; Amin, Syed Suhail; Tahseen, Mohd



Chronic insomnia.  


Insomnia is a prevalent complaint in clinical practice that can present independently or comorbidly with another medical or psychiatric disorder. In either case, it might need treatment of its own. Of the different therapeutic options available, benzodiazepine-receptor agonists (BzRAs) and cognitive-behavioural therapy (CBT) are supported by the best empirical evidence. BzRAs are readily available and effective in the short-term management of insomnia, but evidence of long-term efficacy is scarce and most hypnotic drugs are associated with potential adverse effects. CBT is an effective alternative for chronic insomnia. Although more time consuming than drug management, CBT produces sleep improvements that are sustained over time, and this therapy is accepted by patients. Although CBT is not readily available in most clinical settings, access and delivery can be made easier through use of innovative methods such as telephone consultations, group therapy, and self-help approaches. Combined CBT and drug treatment can optimise outcomes, although evidence to guide clinical practice on the best way to integrate these approaches is scarce. PMID:22265700

Morin, Charles M; Benca, Ruth



Life-course predictors of ultrasonic heel measurement in a cross-sectional study of immigrant women from Southeast Asia.  


Few studies address chronic disease risk for Southeast Asians in the United States. In 1999, the authors conducted a cross-sectional study of bone mineral density (BMD) estimated from ultrasonic calcaneal measurements in women born in Southeast Asia who then lived in Chicago, Illinois. The study addressed three questions: Do Southeast-Asian women have relatively low BMD? What factors before and after immigration are associated with BMD? Are factors that reflect the childhood/adolescent environment equally associated with BMD for postmenopausal and premenopausal women? An interviewer-administered bilingual questionnaire collected immigration, reproductive, and lifestyle data from 213 women (aged 20--80 years) born in Vietnam, Cambodia, or Laos. The authors found that the estimated mean BMD of postmenopausal Southeast-Asian women was lower than the reference values for White women. Four summary indicators of childhood/adolescent environment were predictive of higher BMD: more years of education, earlier age at menarche, lower height, and coastal birth; these indicators were more strongly associated with BMD for premenopausal (multiple-partial R(2) = 0.21) than postmenopausal (R(2) = 0.06) women. Young-adult exposures (e.g., early first pregnancy and age at immigration) and proximal lifestyle factors (e.g., smoking, physical inactivity, vegetarian diet, and betel nut use) were also assessed as potential predictors of BMD. PMID:11257066

Lauderdale, D S; Salant, T; Han, K L; Tran, P L



Environmental pollution and chronic arsenicosis in south Calcutta.  

PubMed Central

Careless handling of industrial wastes often creates problems for human health and the environment. Chronic arsenic toxicity, resulting from household use of arsenic-contaminated water occurred in 53 out of 79 members (67%) of 17 families residing in South Calcutta close to a factory that manufactured Paris-green (copper acetoarsenite). Clinical investigation of 20 of these affected persons showed typical skin pigmentation as well as palmar and plantar keratosis in all of them, while gastrointestinal symptoms, anaemia and signs of liver disease and peripheral neuropathy were seen in many. The water used by the affected families for drinking and cooking had been taken from shallow tubewells and had arsenic levels from 5.0 to 58 mg/l (WHO permissible limit, 0.05 mg/l). Other residents in the same area whose drinking-water came from deep tubewells or from tap water supplied by the Calcutta Municipal Corporation (arsenic levels, less than 0.05 mg/l) were not affected. The study confirms that arsenic in the shallow tubewells was due to the waste discharged by the factory producing Paris-green.

Mazumder, D. N.; Das Gupta, J.; Chakraborty, A. K.; Chatterjee, A.; Das, D.; Chakraborti, D.



Management of Chronic Pressure Ulcers  

PubMed Central

Executive Summary In April 2008, the Medical Advisory Secretariat began an evidence-based review of the literature concerning pressure ulcers. Please visit the Medical Advisory Secretariat Web site, to review these titles that are currently available within the Pressure Ulcers series. Pressure ulcer prevention: an evidence based analysis The cost-effectiveness of prevention strategies for pressure ulcers in long-term care homes in Ontario: projections of the Ontario Pressure Ulcer Model (field evaluation) Management of chronic pressure ulcers: an evidence-based analysis Objective The Medical Advisory Secretariat (MAS) conducted a systematic review on interventions used to treat pressure ulcers in order to answer the following questions: Do currently available interventions for the treatment of pressure ulcers increase the healing rate of pressure ulcers compared with standard care, a placebo, or other similar interventions? Within each category of intervention, which one is most effective in promoting the healing of existing pressure ulcers? Background A pressure ulcer is a localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in conjunction with shear and/or friction. Many areas of the body, especially the sacrum and the heel, are prone to the development of pressure ulcers. People with impaired mobility (e.g., stroke or spinal cord injury patients) are most vulnerable to pressure ulcers. Other factors that predispose people to pressure ulcer formation are poor nutrition, poor sensation, urinary and fecal incontinence, and poor overall physical and mental health. The prevalence of pressure ulcers in Ontario has been estimated to range from a median of 22.1% in community settings to a median of 29.9% in nonacute care facilities. Pressure ulcers have been shown to increase the risk of mortality among geriatric patients by as much as 400%, to increase the frequency and duration of hospitalization, and to decrease the quality of life of affected patients. The cost of treating pressure ulcers has been estimated at approximately $9,000 (Cdn) per patient per month in the community setting. Considering the high prevalence of pressure ulcers in the Ontario health care system, the total cost of treating pressure ulcers is substantial. Technology Wounds normally heal in 3 phases (inflammatory phase, a proliferative phase of new tissue and matrix formation, and a remodelling phase). However, pressure ulcers often fail to progress past the inflammatory stage. Current practice for treating pressure ulcers includes treating the underlying causes, debridement to remove necrotic tissues and contaminated tissues, dressings to provide a moist wound environment and to manage exudates, devices and frequent turning of patients to provide pressure relief, topical applications of biologic agents, and nutritional support to correct nutritional deficiencies. A variety of adjunctive physical therapies are also in use. Method Health technology assessment databases and medical databases were searched from 1996 (Medline), 1980 (EMBASE), and 1982 (CINAHL) systematically up to March 2008 to identify randomized controlled trials (RCTs) on the following treatments of pressure ulcers: cleansing, debridement, dressings, biological therapies, pressure-relieving devices, physical therapies, nutritional therapies, and multidisciplinary wound care teams. Full literature search strategies are reported in appendix 1. English-language studies in previous systematic reviews and studies published since the last systematic review were included if they had more than 10 subjects, were randomized, and provided objective outcome measures on the healing of pressure ulcers. In the absence of RCTs, studies of the highest level of evidence available were included. Studies on wounds other than pressure ulcers and on surgical treatment of pressure ulcers were excluded. A total of 18 systematic reviews, 104 RCTs, and 4 observational



Resveratrol engages AMPK to attenuate ERK and mTOR signaling in sensory neurons and inhibits incision-induced acute and chronic pain  

PubMed Central

Background Despite advances in our understanding of basic mechanisms driving post-surgical pain, treating incision-induced pain remains a major clinical challenge. Moreover, surgery has been implicated as a major cause of chronic pain conditions. Hence, more efficacious treatments are needed to inhibit incision-induced pain and prevent the transition to chronic pain following surgery. We reasoned that activators of AMP-activated protein kinase (AMPK) may represent a novel treatment avenue for the local treatment of incision-induced pain because AMPK activators inhibit ERK and mTOR signaling, two important pathways involved in the sensitization of peripheral nociceptors. Results To test this hypothesis we used a potent and efficacious activator of AMPK, resveratrol. Our results demonstrate that resveratrol profoundly inhibits ERK and mTOR signaling in sensory neurons in a time- and concentration-dependent fashion and that these effects are mediated by AMPK activation and independent of sirtuin activity. Interleukin-6 (IL-6) is thought to play an important role in incision-induced pain and resveratrol potently inhibited IL-6-mediated signaling to ERK in sensory neurons and blocked IL-6-mediated allodynia in vivo through a local mechanism of action. Using a model of incision-induced allodynia in mice, we further demonstrate that local injection of resveratrol around the surgical wound strongly attenuates incision-induced allodynia. Intraplantar IL-6 injection and plantar incision induces persistent nociceptive sensitization to PGE2 injection into the affected paw after the resolution of allodynia to the initial stimulus. We further show that resveratrol treatment at the time of IL-6 injection or plantar incision completely blocks the development of persistent nociceptive sensitization consistent with the blockade of a transition to a chronic pain state by resveratrol treatment. Conclusions These results highlight the importance of signaling to translation control in peripheral sensitization of nociceptors and provide further evidence for activation of AMPK as a novel treatment avenue for acute and chronic pain states.



Assessment of the Medial Dorsal Cutaneous, Dorsal Sural, and Medial Plantar Nerves in Impaired Glucose Tolerance and Diabetic Patients With Normal Sural and Superficial Peroneal Nerve Responses  

PubMed Central

OBJECTIVE This study evaluated the nerve conduction study (NCS) parameters of the most distal sensory nerves of the lower extremities—namely, the medial dorsal cutaneous (MDC), dorsal sural (DS), and medial plantar (MP) nerves—in diabetic (DM) and impaired glucose tolerance (IGT) patients who displayed normal findings on their routine NCSs. RESEARCH DESIGN AND METHODS Standard NCSs were performed on healthy control (HC), DM, and IGT groups (N = 147). The bilateral NCS parameters of the MDC, DS, and MP nerves were investigated. The Toronto Clinical Scoring System (TCSS) was assessed for the DM and IGT groups. RESULTS The mean TCSS scores of the IGT and DM groups were 2.5 ± 2.3 and 2.8 ± 2.2, respectively. No significant differences between the two groups were observed. After adjustment of age and BMI, the DM group showed significant NCS differences in DS and MDC nerves compared with the HC group (P < 0.05). These differences were also exhibited in the left DS of the IGT group (P = 0.0003). More advanced NCS findings were observed in the DM group. Bilateral abnormal NCS responses in these distal sensory nerves were found in 40 and 16% of DM and IGT patients, respectively. CONCLUSIONS These results showed that the simultaneous assessment of the most distal sensory nerves allowed the detection of early NCS changes in the IGT and DM groups, even when the routine NCS showed normal findings.

Im, Sun; Kim, Sung-Rae; Park, Joo Hyun; Kim, Yang Soo; Park, Geun-Young



Sleep and chronic pain  

Microsoft Academic Search

Objective: The ?-EEG sleep anomaly has been associated with chronic benign pain syndromes. Although controversial, the anomaly is believed by some to be an important biologic correlate of certain otherwise poorly explained painful conditions (e.g., fibromyalgia and chronic fatigue syndrome). To shed further light on this phenomenon, this study compared the sleep and psychological characteristics of chronic pain patients who

Jeanetta C Rains; Donald B Penzien



Task failure during standing heel raises is associated with increased power from 13 to 50 Hz in the activation of triceps surae  

PubMed Central

The goal of this paper was to investigate the amplitude and sub-100 Hz frequency content of surface electromyography (EMG) signals obtained from agonist, antagonist and synergist muscles during a heel-raise task sustained to failure. Twenty-two healthy adults, 14 men and 8 women participated in the study. Surface EMG data from the raising and lowering phases of the movement were studied in the time (EMG amplitude) and frequency (wavelet transform) domains. For the raising phase, we found a significant increase in the EMG amplitude of all muscles studied throughout the task (P < 0.02); however, for the lowering phase, we found a decrease in overall muscle activation for the medial gastrocnemius and tibialis anterior. Additionally, we found higher 13–30 and 30–50 Hz normalized power during the raising phase for the triceps surae prior to task failure and at task failure compared with the beginning and midway of the task (P < 0.05); during the lowering phase, however, we found higher normalized power from 30 to 50 Hz for the triceps surae (P < 0.01) and higher 13–30 Hz normalized power for the tibialis anterior (P < 0.01) at task failure compared with the beginning and midway of the task. Finally, we showed that a dynamic task performed until failure can induce different activation strategies for agonist, antagonist and synergist muscles, and that the frequency content below 100 Hz contains useful information about the neural activation of these muscles in relation to task failure that is not evident from the EMG amplitude.

Pereira, Rafael; Schettino, Ludmila; Machado, Marco; Victor da Silva, Pierre Augusto; Neto, Osmar Pinto



The association between body mass index and musculoskeletal foot disorders: a systematic review.  


The primary aim of this systematic review was to investigate the relationship between body mass index (BMI) and foot disorders. The secondary aim was to investigate whether weight loss is effective for reducing foot pain. Five electronic databases (Ovid MEDLINE, Ovid EMBASE, Ovid AMED, CINAHL and The Cochrane Library) and reference lists from relevant papers were searched in April 2011. Twenty-five papers that reported on the association between BMI and musculoskeletal foot disorders met our inclusion criteria and were reviewed. The evidence indicates: (i) a strong association between increased BMI and non-specific foot pain; and (ii) a strong association between increased BMI and chronic plantar heel pain in a non-athletic population. The evidence is inconclusive regarding the relationship between BMI and the following specific disorders of the foot; hallux valgus, tendonitis, osteoarthritis and flat foot. With respect to our second aim, there were only two prospective cohort studies that reported a reduction in foot symptoms following weight loss surgery. In summary, increased BMI is strongly associated with non-specific foot pain in the general population and chronic plantar heel pain in a non-athletic population. However, there is currently limited evidence to support weight loss to reduce foot pain. PMID:22498495

Butterworth, P A; Landorf, K B; Smith, S E; Menz, H B



A novel plantar stimulation technology for improving protective sensation and postural control in patients with diabetic peripheral neuropathy: a double-blinded, randomized study.  


Background: Many diabetes-related peripheral neuropathy (DPN) patients also experience postural instability. Objective: This study examined the effect of electrical stimulation therapy on DPN patients' postural control as well as recovery of plantar sensation. Methods: 54 patients with mild to moderate DPN were enrolled into this study evaluating treatment of DPN with electrical stimulation provided via aqueous solution. The subjects were randomized into either sham or active stimulation. Treatments were administered 5 times per week for 6 weeks. Changes in neuropathy severity were assessed via Semmes-Weinstein monofilament tests and vibration perception threshold (VPT) tests. The potential benefit in postural control was assessed in a subsample of 13 subjects by measuring the area of center of mass (COM) sway. Results: The active group saw a significant (p < 0.05) improvement in VPT at treatment week 6 in comparison to the sham group. The difference did not remain significant at follow-up visits. There were no significant differences between groups for the Semmes-Weinstein monofilament test. However, time was a significant main effect, with both groups improving over the course of the study. The area of COM sway was significantly reduced on average by 36% at treatment week 2 compared to the baseline. Although at treatment week 6 an additional 7% reduction in COM sway was observed compared to treatment week 2, the improvement from treatment week 2 to treatment week 6 was not significant (p > 0.6). Interestingly, no significant difference was observed in the sham group during the study (p > 0.7). Conclusion: This randomized pilot study provides preliminary data on the potential of electrical stimulation via aqueous solution to improve protective sensation and postural stability in DPN patients. © 2013 S. Karger AG, Basel. PMID:23860103

Najafi, Bijan; Crews, Ryan T; Wrobel, James S



Phytotherapy in chronic prostatitis  

Microsoft Academic Search

Chronic prostatitis\\/chronic pelvic pain syndrome continues to pose a treatment challenge for urologists. Chronic prostatitis\\u000a is a very common and poorly understood condition with significant impact on quality of life. In recent literature, studies\\u000a have been conducted with various treatment modalities that include antibiotics, ?-blockers, anti-inflammatory agents, and\\u000a cognitive behavioral interventions such as biofeedback and psychotherapy. Patients have shown interest

Maximilien C. Goris; Thierry Roumeguere; Sanjai K. Addla; Claude C. Schulman; Bob Djavan



Chronic Idiopathic Diarrhea  

Microsoft Academic Search

\\u000a Chronic diarrhea is defined as passage of loose stools for more than 4 weeks. In most instances the cause of chronic diarrhea\\u000a can be discovered and treated effectively. A few less common causes also play a role: laxative abuse, small bowel bacterial\\u000a overgrowth, and even bile acid malabsorption. Rarer syndromes account for a much smaller percentage of chronic diarrheas but

Lawrence R. Schiller


Chronic Conditions and School  


... setting possible. Last Updated 7/31/2013 Source Students With Chronic Health Conditions: Guidance for Families, Schools, and Students (Copyright © 2004 American Academy of Pediatrics) The information ...


Chronic Critical Illness  

PubMed Central

Although advances in intensive care have enabled more patients to survive an acute critical illness, they also have created a large and growing population of chronically critically ill patients with prolonged dependence on mechanical ventilation and other intensive care therapies. Chronic critical illness is a devastating condition: mortality exceeds that for most malignancies, and functional dependence persists for most survivors. Costs of treating the chronically critically ill in the United States already exceed $20 billion and are increasing. In this article, we describe the constellation of clinical features that characterize chronic critical illness. We discuss the outcomes of this condition including ventilator liberation, mortality, and physical and cognitive function, noting that comparisons among cohorts are complicated by variation in defining criteria and care settings. We also address burdens for families of the chronically critically ill and the difficulties they face in decision-making about continuation of intensive therapies. Epidemiology and resource utilization issues are reviewed to highlight the impact of chronic critical illness on our health care system. Finally, we summarize the best available evidence for managing chronic critical illness, including ventilator weaning, nutritional support, rehabilitation, and palliative care, and emphasize the importance of efforts to prevent the transition from acute to chronic critical illness. As steps forward for the field, we suggest a specific definition of chronic critical illness, advocate for the creation of a research network encompassing a broad range of venues for care, and highlight areas for future study of the comparative effectiveness of different treatment venues and approaches.

Nelson, Judith E.; Cox, Christopher E.; Hope, Aluko A.; Carson, Shannon S.



A randomised controlled trial of the effectiveness of soft silicone multi-layered foam dressings in the prevention of sacral and heel pressure ulcers in trauma and critically ill patients: the border trial.  


The prevention of hospital acquired pressure ulcers in critically ill patients remains a significant clinical challenge. The aim of this trial was to investigate the effectiveness of multi-layered soft silicone foam dressings in preventing intensive care unit (ICU) pressure ulcers when applied in the emergency department to 440 trauma and critically ill patients. Intervention group patients (n?=?219) had Mepilex® Border Sacrum and Mepilex® Heel dressings applied in the emergency department and maintained throughout their ICU stay. Results revealed that there were significantly fewer patients with pressure ulcers in the intervention group compared to the control group (5 versus 20, P?=?0·001). This represented a 10% difference in incidence between the groups (3·1% versus 13·1%) and a number needed to treat of ten patients to prevent one pressure ulcer. Overall there were fewer sacral (2 versus 8, P?=?0·05) and heel pressure ulcers (5 versus 19, P?=?0·002) and pressure injuries overall (7 versus 27, P?=?0·002) in interventions than in controls. The time to injury survival analysis indicated that intervention group patients had a hazard ratio of 0·19 (P?=?0·002) compared to control group patients. We conclude that multi-layered soft silicone foam dressings are effective in preventing pressure ulcers in critically ill patients when applied in the emergency department prior to ICU transfer. PMID:23711244

Santamaria, Nick; Gerdtz, Marie; Sage, Sarah; McCann, Jane; Freeman, Amy; Vassiliou, Theresa; De Vincentis, Stephanie; Ng, Ai Wei; Manias, Elizabeth; Liu, Wei; Knott, Jonathan



Quantitative heel ultrasound (QUS), 25-hydroxyvitamin D (25-OHD), and urine N-terminal cross linking telopeptide of type I collagen (NTX) in patients with a recent hip fracture  

PubMed Central

Objective This study examined heel ultrasonography, levels of 25-OHD, and levels of urinary NTX-I in patients with a recent osteoporotic hip fracture to see if they were clinically useful. Methods T scores of stiffness index(SI) obtained from quantitative heel ultrasound(QUS), levels of serum 25-hydroxyvitamin D(25-OHD) and levels of urine N-terminal cross linking telopeptide of type I collagen(NTX-I) were obtained in 53 female and 32 male hip fracture patients. Sixty five female patients and five male patients attending our geriatric clinic were used for comparison. Results The T scores of SI of the hip fracture patients were less than those of the geriatric clinic patients. The difference was signficant in females(p = 0.0001), but not in males (p = 0.1). Serum levels of 25-OHD were less than 28 ng/ml in 50 out of 59 patients, and less than 5 ng/ml in two patients. Levels of urinary NTX-I were variable, and were not correlated with other parameters. Conclusions Patients who have sustained a hip fracture have a low SI determined by QUS; this is easy to perform and it provides a baseline T score from which to assess treatment effects. The majority of these patients are vitamin D deficient and measurement of the level of 25-OHD would enable physicians to prescribe an appropriate dose of vitamin D. Urine NTX-I measured shortly after a hip fracture is not clinically helpful.

Colt, Edward; Gorich, George; Quinnan, Stephen; Raj, Ramona; Thornton, John; Matti, Brenda; Pierson, Richard; Quinlan, Eileen



Net Neutrality's Unpublicized Achilles' Heel  

Microsoft Academic Search

Recent comments from telecommunications executives medicating that the might start charging bandwidth-intensive service providers to transport their content have raised objections from those companies, and from law makers. Even in peering situations, the peers have to pay for the capacity to interconnect themselves to various peers at various access points, public or private. There is a cost to achieving full

Greg Goth



Chronic tension empyema.  


A 60-year-old man who had suffered from chronic left tuberculous empyema for 25 years, was diagnosed with chronic tension empyema based on enlargement of the empyema cavity. To prevent compression of the heart and left lung, we removed the empyema capsule. This procedure relieved the compression of the left lung, and the patient's lung function improved. PMID:23430433

Sano, Atsushi; Murakawa, Tomohiro; Nakajima, Jun



Neurobiology of chronic migraine  

Microsoft Academic Search

Chronic daily headache (CDH) is an important problem for clinicians. It is frequent in tertiary care structures, although at present there is no clear consensus about definitions and operational criteria. In fact, CDH is a group of headache disorders that includes chronic migraine (CM). CDH usually evolves from an episodic headache form, which was migraine in most cases. Several psychopathological

F. Moschiano; D. D'Amico; F. Schieroni; G. Bussone



Symptoms in chronic constipation  

Microsoft Academic Search

OBJECTIVES: This study was designed to evaluate whether detailed symptom analysis would help to identify pathophysiologic subgroups in chronic constipation. METHODS: In 190 patients with chronic constipation (age, 53 (range, 18–88) years; 85 percent of whom were women), symptom evaluation, transit time measurement (radiopaque markers), and functional rectoanal evaluation (proctoscopy, anorectal manometry, defecography) were performed. Patients were classified on the

Alexander Koch; Winfried A. Voderholzer; Andreas G. Klauser; Stefan Müller-Lissner



Chronic Disease Indicators  

NSDL National Science Digital Library

The Chronic Disease Indicators (CDI) is a cross-cutting set of 97 indicators that were developed by consensus and that allows states and territories and large metropolitan areas to uniformly define, collect, and report chronic disease data that are important to public health practice and available for states, territories and large metropolitan areas. 

Control, Center F.


Chronic fatigue syndrome  

Microsoft Academic Search

Chronic fatigue and chronic fatigue syndrome (CFS) have become increasingly recognized as a common clinical problem, yet one that physicians often find difficult to manage. In this review we suggest a practical, pragmatic, evidence-based approach to the assessment and initial management of the patient whose presentation suggests this diagnosis. The basic principles are simple and for each aspect of management

M. Sharpe; T. Chalder; I. Palmer; Simon Wessely



Chronic mucocutaneous candidiasis  

Microsoft Academic Search

Chronic mucocutaneous candidiasis can be defined as a group of syndromes that have as a common feature infections of the skin, nails and mucous membranes withCandida albicans. A variety of disorders including endocrine dysfunctions, alopecia, vitiligo, malabsorption syndromes, neoplasms and other infections may also occur in patients with chronic mucocutaneous candidiasis, but these vary considerably from patient to patient. In

C. H. Kirkpatrick



Chronic Illness and Disability  

Microsoft Academic Search

In this paper we describe some of the unique personal, medical, social, and religious challenges facing people living with chronic illness and disability. Our specific focus involves the connections between suffering, healing, and disability in two religious traditions: Buddhism and Christianity. Two core questions focus our inquiry. First, why are chronic illness and disability often associated with merited suffering in

Darla Y. Schumm; Michael Stoltzfus



Chronic Postoperative Roseomonas Endophthalmitis?  

PubMed Central

We report one case with chronic postoperative endophthalmitis caused by Roseomonas species. Roseomonas spp. induced chronic endophthalmitis, which might result in misdiagnosis and delayed treatment and causes ocular damage and severe visual loss. This report is the first one related to a case with postoperative endophthalmitis secondary to Roseomonas infection.

Chen, Kuan-Jen; Lai, Chi-Chun; Kuo, Ya-Hui; Wu, Wei-Chi; Chen, Tun-Lu



Sex di¡erences in spinal excitability during observation of bipedal locomotion  

Microsoft Academic Search

This study investigated whether there are sex di¡erences in the spinal excitability of the human mirror^ neuron system. We mea- sured the modulation of spinal excitability, elicited by Ho¡mann re£ex in the left plantar £exor muscle (soleus), when women and men participants observed videos of bipedal heel-stepping (plantar dorsi£exion), standing still, and bipedal toe-stepping (plantar £exion). Men and women were

Zheng Zhou


Microglial Activation & Chronic Neurodegeneration  

PubMed Central

Microglia, the resident innate immune cells in the brain, have long been implicated in the pathology of neurodegenerative diseases. Accumulating evidence points to activated microglia as a chronic source of multiple neurotoxic factors, including TNF?, NO, IL1-?, and reactive oxygen species (ROS), driving progressive neuron damage. Microglia can become chronically activated by either a single stimulus (ex. LPS or neuron damage) or multiple stimuli exposures to result in cumulative neuronal loss over time. While the mechanisms driving these phenomena are just beginning to be understood, reactive microgliosis (the microglial response to neuron damage) and ROS have been implicated as key mechanisms of chronic and neurotoxic microglial activation, particularly in the case of Parkinson’s Disease. Here, we review the mechanisms of neurotoxicity associated with chronic microglial activation and discuss the role of neuronal death and microglial ROS driving the chronic and toxic microglial phenotype.

Lull, Melinda E.; Block, Michelle L.



[Chronic constipation in adults].  


Chronic constipation is a very common condition, which is responsible for a major socioeconomic burden. Primary management must rule out secondary constipation before recognizing chronic idiopathic constipation, which is the most common diagnosis. Initial treatment frequently associates simple lifestyle modifications, whose efficacy is limited, with osmotic laxatives or bulking agents. If those measures do not relieve symptoms, a switch of laxatives or a combination must be proposed. Pharmacological treatments of constipation represent a new alternative approach in case of failure of previously mentioned measures. In case of chronic constipation reluctant to all conservative therapies, specific tests are required before considering biofeedback intervention or exceptionally a surgical option. PMID:23453994

Zeitoun, Jean-David; de Parades, Vincent



Chronic Urticaria (Hives)  


... with substances that could have caused an allergic reaction. Some questions will be about your activities. About 15 to 20 percent of chronic causes are physical, triggered by cold, heat, light or exercise. If the medical history does not ...


Chronic subdural hematoma  


... the dura and surface of the brain (bridging veins) tear and leak blood. This is usually the result of a ... the brain. In a chronic subdural collection, blood leaks from the veins slowly over time, or a fast hemorrhage is ...


American Chronic Pain Association  


... in Cart : 0 Resource Guide to Chronic Pain Medications & Treatments The Art of Pain Management What We Have Learned Going to the ER Communication Tools Pain Management Programs Videos Resources Glossary FAQs ...


What Is Chronic Pain?  

MedlinePLUS Videos and Cool Tools

... Learned Going to the ER Communication Tools Pain Management Programs Videos Resources Glossary FAQs Surveys September is ... for Understanding Pain Pain Awareness Toolkits Home Pain Management Tools Videos What Is Chronic Pain? Featured Tool ...